To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India.
We conducted a population-based cross-sectional survey of intended WIFS programme beneficiaries (in-school adolescent girls and boys and out-of-school adolescent girls).
Birbhum Health and Demographic Surveillance System.
A total of 4448 adolescents 10–19 years of age participated in the study.
The percentage of adolescents who reported taking four WIFS tablets during the last month as intended by the national programme was 9·4 % among in-school girls, 7·1 % for in-school boys and 2·3 % for out-of-school girls. The low effective coverage was due to the combination of large deficits in WIFS provision and poor adherence. A large proportion of adolescents reported they were not provided any WIFS tablets in the last month: 61·7 % of in-school girls, 73·3 % of in-school boys and 97·1 % of out-of-school girls. In terms of adherence, only 41·6 % of in-school girls, 38·1 % of in-school boys and 47·4 % of out-of-school girls reported that they consumed all WIFS tablets they received. Counselling from teachers, administrators and school staff was the primary reason adolescents reported taking WIFS tablets, whereas the major reasons for non-adherence were lack of perceived benefit, peer suggestion not to take WIFS and a reported history of side effects.
The effective coverage of the WIFS programme for in-school adolescents and out-of-school adolescent girls is low in rural Birbhum. Integrated supply- and demand-side strategies appear to be necessary to increase the effective coverage and potential benefits of the WIFS programme.
The widespread evolution of herbicide resistance in weed populations has become an increasing concern for no-tillage (NT) growers in semiarid regions of the U.S. Great Plains. Lack of cost-effective and alternative new herbicide sites of action further exacerbates the problem of herbicide-resistant (HR) weeds and threatens the long-term sustainability of prevailing cropping systems in the region. A recent decline in commodity prices and increasing herbicide costs to manage HR weeds has spurred research efforts to build a strong rationale for developing ecologically based integrated weed management (IWM) strategies in the U.S. Great Plains. Integration of cover crops (CCs) in NT dryland production systems potentially offers several ecosystem services, including weed control, soil health improvement, decline in selective pest pressure, and overall reduction in pest management inputs. This review article aims to document the role of CCs for IWM, with emphasis on exploring emerging weed issues; ecological, economic, and agronomic benefits of growing CCs; and constraints preventing adoption of CCs in NT cropping systems in the semiarid Great Plains. We attempt to focus on changes in weed management practices, their long-term impacts on weed seedbanks, weed shifts, and herbicide-resistance evolution in the most common weed species in the region. We also highlight current knowledge gaps and propose new research priorities based on an improved understanding of CC management strategies that will ultimately aid in achieving sustainable weed management goals and preserving natural resources in water-limited environments.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
The aim of this study was to evaluate contact endoscopy in detecting local treatment failures post-radiotherapy in squamous cell carcinoma of the upper aerodigestive tract.
A total of 135 consecutive patients with suspected residual or recurrent cancer after definitive radiotherapy underwent contact endoscopy before biopsy. Contact endoscopy findings were compared with histopathological examination findings. Contact endoscopy could not be completed in 7 patients (5.9 per cent) and histopathological examination was inconclusive in 5 patients (3.7 per cent). The findings of the remaining 123 patients were compared.
The sensitivity, specificity and accuracy of contact endoscopy were 88.75, 88.72 and 86.99 per cent, respectively, with similar results across various sites of upper aerodigestive tract. Inter-observer kappa value was 0.86 (95 per cent confidence interval: 0.79–0.93). The intra-observer kappa value was 0.93 (95 per cent confidence interval: 0.87–1.00) for the first observer and 0.95 (95 per cent confidence interval: 0.90–1.00) for second and third observers.
Contact endoscopy showed the same high sensitivity and specificity with low inter- and intra-observer variability in detecting post-radiotherapy failures in cancer of the upper aerodigestive tract as has been shown in non-irradiated tissues in earlier studies.
Dynamic wetting failure in shear-thinning and shear-thickening liquids is examined in this paper. Flow visualization experiments using a curtain-coating geometry suggest that shear thinning postpones the onset of wetting failure and the resulting air entrainment. To advance the fundamental understanding of the underlying physical mechanisms, a hydrodynamic model consisting of liquid displacing air in a rectangular channel in the absence of inertia is developed. Both shear thinning and shear thickening are considered by using Carreau-type models to describe the liquid rheology. Steady-state solutions are calculated using the Galerkin finite-element method and the critical capillary number where wetting failure occurs is identified. Shear thinning is found to postpone the onset of wetting failure whereas shear thickening is found to promote it. The underlying mechanism involves thickening/thinning of the air film as a consequence of shear thinning/thickening of the liquid and the tangential stress balance. The results can be interpreted in terms of an effective viscosity, and demonstrate that similar physical mechanisms govern dynamic wetting failure in Newtonian, shear-thinning and shear-thickening liquids.
In healthy volunteers, light acting through serotonin pathways, decreases the threshold for sweet, but not salt taste; similar to SSRI paroxetine. In depressive disorders, there is deficiency of serotonin throughput, which is remedied by SSRI medications, and results in improvement in symptoms of depression. Thus, we report on taste thresholds before and after SSRI treatment.
To study the variation in thresholds for sweet with SSRI treatment in depressed patients in short- and long-term.
To compare the threshold for sweet (test) and salt (control) after 1 and 4 weeks of SSRI escitalopram therapy in depressed patients.
The project was approved by the institutional ethics committee. Following informed consent, depressed patients were initiated on escitalopram 10 mg/d (increased to 15 or 20 mg, if required after 1 week,). Taste recognition threshold, intensity and pleasantness were measured for sweet and salt. Each tastant was made −1 to −3 (100 mM–1 mM). Regional recognition thresholds were determined at the tip of the tongue using a cotton bud well soaked in the tastant.
Three males and 4 females of mean ages 39.1 years completed the study. There was significant shift to the left for sweet thresholds between days 0 and 7, and 7 and 28 [F(Dfn, Dfd) = 9.242 (4.162) P < 0.0001]. A similar shift to the left was seen for salt but day 7 only [F(Dfn, Dfd) = 6.213 (4.162)].
The increase in serotonin throughput as envisaged through SSRI treatment was paralleled by decrease in sweet thresholds.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Schizophrenia is a severe mental disorder with a relatively high toll on the quality of life of the patient and caregiver. It has a high financial, emotional and psychosocial burden. Surprisingly, optimum academic and educational outcomes in individuals with schizophrenia have been a neglected area of research and service provision.
Development of an interview schedule assessing the helpful and hindering factors affecting the educational attainment in persons with schizophrenia.
Twenty-one participant were recruited (11 patients and 10 caregivers) from August 2014 to 2015 using purposive sampling and interviewed in a semi-structured qualitative fashion. Patients were between 16–25 years of age. Data collection and interpretation continued iteratively till saturation of factors was achieved. The list of factors (hindering/helping) was compiled and sent to a panel of 14 experts. They rated the schedule and the individual factors on a Likert scale. Reliability and validity parameters were tested and the final schedule was formulated.
The final schedule contained 17 hindering and 18 helping factors. Detailed instructions to the interviewer for administration of the schedule are included. The factors have been further subdivided into illness related and illness unrelated. Some of the major hindering factors were symptoms of illness, medication side effects, delay in treatment initiation, perceived conflict in parents, lack of motivation. The major helpful factors were adequate symptom control, withholding inpatient care, spirituality, and peer group acceptance.
Service provisions for ensuring optimal educational achievement can be formulated by assessing the felt needs and hindrances of patients and their caregivers.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Deformation twinning is a prevalent plastic deformation mode in hexagonal close-packed (HCP) materials, such as magnesium, titanium, and zirconium, and their alloys. Experimental observations indicate that these twins occur heterogeneously across the polycrystalline microstructure during deformation. Morphological and crystallographic distribution of twins in a deformed microstructure, or the so-called twinning microstructure, significantly controls material deformation behavior, ductility, formability, and failure response. Understanding the development of the twinning microstructure at the grain scale can benefit design efforts to optimize microstructures of HCP materials for specific high-performance structural applications. This article reviews recent research efforts that aim to relate the polycrystalline microstructure with the development of its twinning microstructure through knowledge of local stress fields, specifically local stresses produced by twins and at twin/grain–boundary intersections on the formation and thickening of twins, twin transmission across grain boundaries, twin–twin junction formation, and secondary twinning.
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
Data mining is a process of finding correlations and collecting and analysing a huge amount of data in a database to discover patterns or relationships. Flight delay creates significant problems in the present aviation system. Data mining techniques are desired for analysing the performance in which micro-level causes propagate to make system-level patterns of delay. Analysing flight delays is very difficult – both when looking from a historical view as well as when estimating delays with forecast demand. This paper proposes using Decision Tree (DT), Support Vector Machine (SVM), Naive Bayesian (NB), K-nearest neighbour (KNN) and Artificial Neural Network (ANN) to study and analyse delays among aircrafts. The performance of different data mining methods is found in the different regions of the updated datasets on these classifiers. Finally, the result shows a significant variation in the performance of different data mining methods and feature selection for this problem. This paper aims to deal with how data mining techniques can be used to understand difficult aircraft system delays in aviation. Our aim is to develop a classification model for studying and reducing delay using different data mining methods and, in this manner, to show that DT has a greater classification accuracy. The different feature selectors are used in this study in order to reduce the number of initial attributes. Our results clearly demonstrate the value of DT for analysing and visualising how system-level effects happen from subsystem-level causes.
To compare round window niche visibility as seen endoscopically during cochlear implant surgery with pre-operative high-resolution computed tomography of the temporal bone.
Nineteen patients scheduled for cochlear implantation, aged 2–20 years, were referred for computed tomography from October 2016 to March 2018. Angles were measured between the lines passing through the mid-sagittal plane and cochlear basal turn on the scans. Endoscopic round window niche visibility during posterior tympanotomy was categorised as: type I = 100 per cent, type IIa = more than 50 per cent, type IIb = less than 50 per cent or type III = 0 per cent. Pre-operative computed tomography measurements were used to predict round window niche visibility before surgery and correlated with intra-operative findings.
The mean (range) of pre-operative angles on computed tomography for endoscopic visibility types I, IIa and IIb, were 64.06° (61.16–69.37°), 63.81° (58.61–71.35°) and 56.48° (50.37–59.05°), respectively, a statistically significant finding (one-way analysis of variance test, p = 0.016).
Pre-operative high-resolution temporal bone computed tomography measurements are useful in predicting round window niche visualisation as viewed endoscopically during posterior tympanotomy. The angle was more acute in type IIb compared to type I.
One of the major and widely known small scale problem with the Lambda CDM model of cosmology is the “core-cusp” problem. In this study we investigate whether this problem can be resolved using bar instabilities. We see that all the initial bars are thin (b/a < 0.3) in our simulations and the bar becomes thick ( b /a > 0.3) faster in the high resolution simulations. By increasing the resolution, we mean a larger number of disk particles. The thicker bars in the high resolution simulations transfer less angular momentum to the halo. Hence, we find that in the high resolution simulations it takes around 7 Gyr for the bar to remove inner dark matter cusp which is too long to be meaningful in galaxy evolution timescales. Physically, the reason is that as the resolution increases, the bar buckles faster and becomes thicker much earlier on.
We investigate the minor interactions of two disk galaxies with mass ratio of 10:1 in fly-by encounters that do not lead to the merging of the galaxies. In our N-body simulations, we vary only the pericenter distances to see the effect of the fly-by on the bulge of the major galaxy over the course of the trajectory. At different time steps of the evolution, we did two-dimensional fittings of disk, bulge and bar to trace the variation in the sersic index of the bulge. Our results suggest that galaxy bulges can become boxy/disky through flyby interactions of galaxies.
Nano-structured thin films have a variety of applications from waveguides, gaseous sensors to piezoelectric devices. Grazing Incidence Small Angle x-ray Scattering images enable classification of such materials. One challenge is to determine structure information from scattering patterns alone. This paper highlights the design of multiple Convolutional Neural Networks (CNN) to classify nanoparticle orientation in a thin film by learning scattering patterns. The network was trained on several thin films with a success rate of 94%. We demonstrate CNN robustness under different noises as well as demonstrate the potential of our proposed approach as a strategy to decrease scattering pattern analysis time.
OBJECTIVES/SPECIFIC AIMS: The study aims to identify patient and provider factors associated with delay in diagnostic resolution after an abnormal screening mammogram, with an emphasis on whether patients who spoke Chinese as their primary language sustained longer times to resolution. Primary outcome is to identify what proportion of patients achieve diagnostic resolution after abnormal screening mammogram within 90 days. Secondary outcome is to identify whether Chinese-speaking patients experience longer times to diagnostic resolution. METHODS/STUDY POPULATION: We performed a single-center retrospective cohort study at Tufts Medical Center (TMC), a tertiary care hospital that serves as the primary referral site for the Chinatown neighborhood in Boston. We included patients who underwent screening mammogram between 10/1/2015-9/30/2016 which was resulted as BIRADS-0 (non-diagnostic). Diagnostic resolution was defined as BIRADS-1, 2, or 3 imaging or definitive biopsy. We collected data on patient demographics (age, insurance plan, race/ethnicity, primary language, history of cancer), provider characteristics (referring provider location), and post-referral testing. Insurance was categorized as private-only or subsidized. Poverty was categorized using the American Fact Finder database, with a binary variable of <20% of ≥20% people in poverty for a given zip code. We performed descriptive statistics for all variables. We will perform multivariable Cox regression analyses to determine whether Chinese-speaking patients experience longer time to diagnostic resolution, adjusting for age, referring provider type, insurance status, poverty, and breast cancer history. We will use p<0.05 for our threshold for significance. RESULTS/ANTICIPATED RESULTS: We identified 386 patients who met inclusion criteria. Over half (55.9%) of patients were Caucasian, the mean age of study patients was 59 years, and 22% of patients were classified as poor. English was the most commonly spoken primary language (77.7%), while 15.3% of patients identified a Chinese dialect as their primary language. Most patients solely used private insurance for their medical care (73.1%). Majority of patients (83%) presented after undergoing a routine screening mammography, but a considerable proportion (14.4%) had prior breast cancer or a palpable mass. Most patients were referred for their screening mammogram by a hospital-based provider at TMC (85%), of which 77% of TMC referrals were from primary care. We also noted a limited number of referrals from community health centers, private practices and other PCP’s (Table 1). We will calculate median time to diagnostic resolution after screening mammogram and the proportion of patients who achieve resolution within 90 days. We will also calculate time to initiation of diagnostic workup, and whether this differed among Chinese-speaking patients, subsidized patients, or among those who were referred from outside of TMC. We will complete Cox multivariable analysis to identify if Chinese-speaking patients experience longer time to diagnostic resolution, adjusting for age, insurance status, Primary care provider location, poverty, and prior history of breast cancer. We will a priori test for an interaction between primary care provider within Tufts and Chinese as primary language to identify if a PCP within TMC modifies the relationship between Chinese language and time to resolution. DISCUSSION/SIGNIFICANCE OF IMPACT: The proposed study will identify whether disparities exist in time to achieving diagnostic resolution. Specifically, we will identify if patients who are primarily Chinese-speaking experience longer time to resolution. Our results will potentially provide the foundation for a patient navigation program to attenuate existing disparities by providing additional support for Chinese speaking patients in breast imaging workup.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.