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All anaesthetists need to be skilled in the administration of IV anaesthesia, yet evidence from the 5th National Audit Project (NAP5) of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland documenting cases of accidental awareness during general anaesthesia (AAGA) suggests that this might not be the case. TIVA is used in only 7% of cases, with preponderance for certain surgical operations such as those on the airway where administration of an inhaled anaesthetic is not feasible. Conversely, TIVA has been almost completely avoided in other types of surgery such as Caesarean sections, at least in the UK and Ireland. TIVA is also used for transfer of patients and in remote areas that do not have the equipment required to deliver inhaled anaesthesia. For the purpose of this discussion, it should be clarified from the outset that there are several modes of TIVA delivery. The majority is target-controlled infusion (TCI), carried out with dedicated PK pumps and used in ~5% of all cases or ~81% of TIVA cases. The most basic is manual boluses of propofol using a hand-held syringe: the anaesthetist simply injects the amount they judge necessary to maintain anaesthesia (0.7% of all UK cases, or ~10% of all TIVA cases). The third is non-TCI infusions, which constitute ~0.6% of all cases, or ~9% of TIVA cases. However, there is some international geographic variation in this practice, because in the United States TCI remains unlicensed and therefore seldom used.
Drawing on the new institutional theory and the resources based view of the firm (RBV), this study tries to shed light upon the idea that isomorphic organizational changes seek legitimacy over efficiency. Using data from 102 Spanish companies and employing partial least squares, a variance-based structural equation modeling technique, this study concludes that both objectives are achievable simultaneously when firms implement total quality management (TQM) as an integrative stream of both theories. Furthermore, empirical results reveal that: (i) institutional pressures (IP) condition significantly the implementation of TQM, (ii) TQM exerts a double mediating role in the IP-legitimacy and IP-efficiency relationships, and (iii) both efficiency and legitimacy objectives are achieved by means of TQM. However, we observe a dual phenomenon: (i) while we find a significant positive effect of TQM on overall performance (OP) via efficiency and (ii) we failed to find support for the TQM-OP link via legitimacy.
The precise control of curing reaction parameters allows a better crosslinking polymer. Modelling and optimization of this process require a correct kinetic of curing model. The kinetics of the crosslinking reaction is studied for the ethylene propylene diene monomer (EPDM) synthetic elastomer by mobile die rheometer (MDR). The kinetic parameters of reaction were calculated from Kamal-Ryan, Sestak-Berggren, and the Isayev-Deng methods at different temperatures. An Arrhenius-type function for the order of reaction n is introduced to improve the adjusting. Finally, a graphical and analytical description of the cure kinetics was developed. The order of reaction is predicted to better establishment of processing time. It was noted that for EPDM at higher temperatures, the increase of the rate of reaction occurs in short period of time, which could cause premature curing if the supply system is inadequate.
With the aim to elucidate gonococcal antimicrobial resistance (AMR)–risk factors, we undertook a retrospective analysis of the molecular epidemiology and AMR of 104 Neisseria gonorrhoeae isolates from clinical samples (urethra, rectum, pharynx and cervix) of 94 individuals attending a sexually transmitted infection clinic in Madrid (Spain) from July to October 2016, and explored potential links with socio-demographic, behavioural and clinical factors of patients. Antimicrobial susceptibility was determined by E-tests, and isolates were characterised by N. gonorrhoeae multi-antigen sequence typing. Penicillin resistance was recorded for 15.4% of isolates, and most were susceptible to tetracycline, cefixime and azithromycin; a high incidence of ciprofloxacin resistance (~40%) was found. Isolates were grouped into 51 different sequence types (STs) and 10 genogroups (G), with G2400, ST5441, ST2318, ST12547 and G2992 being the most prevalent. A significant association (P = 0.015) was evident between HIV-positive MSM individuals and having a ciprofloxacin-resistant strain. Likewise, a strong association (P = 0.047) was found between patient age of MSM and carriage of isolates expressing decreased susceptibility to azithromycin. A decrease in the incidence of AMR gonococcal strains and a change in the strain populations previously reported from other parts of Spain were observed. Of note, the prevalent multi-drug resistant genogroup G1407 was represented by only three strains in our study, while the pan-susceptible clones such as ST5441, and ST2318, associated with extragenital body sites were the most prevalent.
In this paper, a robust geometric navigation algorithm, designed on the special Euclidean group SE(3), of a quadrotor is proposed. The equations of motion for the quadrotor are obtained using the Newton–Euler formulation. The geometric navigation considers a guidance frame which is designed to perform autonomous flights with a convergence to the contour of the task with small normal velocity. For this purpose, a super twisting algorithm controls the nonlinear rotational and translational dynamics as a cascade structure in order to establish the fast and yet smooth tracking with the typical robustness of sliding modes. In this sense, the controller provides robustness against parameter uncertainty, disturbances, convergence to the sliding manifold in finite time, and asymptotic convergence of the trajectory tracking. The algorithm validation is presented through experimental results showing the feasibility of the proposed approach and illustrating that the tracking errors converge asymptotically to the origin.
Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.
To identify factors associated with suicidal risk in major mood disorders.
We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis.
Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors.
Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.
Declaration of interest
No author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.
Trace minerals have important roles in immune function and oxidative metabolism; however, little is known about the relationships between supplementation level and source with outcomes in dairy cattle. Multiparous Holstein cows (n=48) beginning at 60 to 140 days in milk were utilized to determine the effects of trace mineral amount and source on aspects of oxidative metabolism and responses to intramammary lipopolysaccharide (LPS) challenge. Cows were fed a basal diet meeting National Research Council (NRC) requirements except for no added zinc (Zn), copper (Cu) or manganese (Mn). After a 4-week preliminary period, cows were assigned to one of four topdress treatments in a randomized complete block design with a 2×2 factorial arrangement of treatments: (1) NRC inorganic (NRC levels using inorganic (sulfate-based) trace mineral supplements only); (2) NRC organic (NRC levels using organic trace mineral supplements (metals chelated to 2-hydroxy-4-(methythio)-butanoic acid); (3) commercial inorganic (approximately 2×NRC levels using inorganic trace mineral supplements only; and (4) commercial organic (commercial levels using organic trace mineral supplements only). Cows were fed the respective mineral treatments for 6 weeks. Treatment effects were level, source and their interaction. Activities of super oxide dismutase and glutathione peroxidase in erythrocyte lysate and concentrations of thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) in plasma were measured as indices of oxidative metabolism. Effects of treatment on those indices were not significant when evaluated across the entire experimental period. Plasma immunoglobulin G level was higher in cows supplemented with organic trace minerals over the entire treatment period; responses assessed as differences of before and after Escherichia coli J5 bacterin vaccination at the end of week 2 of treatment period were not significant. Cows were administered an intramammary LPS challenge during week 5; during week 6 cows fed commercial levels of Zn, Cu and Mn tended to have higher plasma TAC and cows fed organic sources had decreased plasma TBARS. After the LPS challenge, the extent and pattern of response of plasma cortisol concentrations and clinical indices (rectal temperature and heart rate) were not affected by trace mineral level and source. Productive performance including dry matter intake and milk yield and composition were not affected by treatment. Overall, results suggest that the varying level and source of dietary trace minerals do not have significant short-term effects on oxidative metabolism indices and clinical responses to intramammary LPS challenge in midlactation cows.
Tourists approaching wild animals can potentially cause disturbance as a result of the perceived predation risk. Risk effects arise when prey alter their behaviour in response to predators. This response may carry costs through its impact on fitness-related activities such as foraging. We recorded behavioural responses of whale sharks Rhincodon typus to experimental vessel and swimmer approaches. We simulated the disturbance caused by ecotourism in the foraging site of this planktivorous fish in Bahia de Los Angeles, Gulf of Baja California, Mexico. Stress-related behaviours (vigilance, change of direction, diving and acceleration) were more common directly after both types of disturbance than before, in particular after approach by a swimmer. Individuals were more likely to be vigilant when they were new to the bay, but we did not find evidence of within-season behavioural habituation. Sharks were 24% more likely to forage before human stimuli than after. Our study highlights negative effects of vessel and swimmer approaches on whale shark behaviour, with a short-term increase in stress-related behaviours potentially carrying energetic costs, combined with a decrease in food intake following the disturbance. Our results indicate concerns about the impact of ecotourism on large fish species. An important next step would be to determine whether these short-term behavioural responses to the perception of predation risk negatively affect fitness. Among other guidelines, we recommend preventing swimmers from approaching if whale sharks stop feeding when a vessel approaches.
To assess counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults with or without long-term exposure to cigarette tobacco smoke.
Twenty-two patients with and 22 patients without exposure to cigarette tobacco smoke participated in the study. After endoscopic polypectomy, the fragments of the nasal polyps were analysed by immunohistochemistry.
Compared to patients with no exposure, patients with exposure showed higher counts of α4 and α7 nicotinic acetylcholine receptors (t-test, p < 0.05). However, in patients with no exposure, multivariate analysis showed gender dimorphism, with lower counts in males than in females, and no influence from other variables (analysis of covariance, p > 0.05).
Exposure to cigarette tobacco smoke may induce increased counts of α4 and α7 nicotinic acetylcholine receptors in nasal polyps of adults, with lower counts in males than females without exposure to tobacco smoke.
This paper presents a fully-integrated direct-conversion fundamentally-operated mixer-first quadrature receiver module with a tunable LO in the 219–266 GHz band. It has been implemented in a 0.13-μm SiGe heterojunction bipolar transistor technology. It includes an on-chip LO path driven externally from the printed circuit board (PCB) connector level at 13.6–16.7 GHz. A hybrid coupler generates the quadrature LO signal, which drives a pair of double-balanced fundamentally-operated down-conversion mixers, whose RF ports are connected to a wideband lens-integrated on-chip ring antenna. The chip-on-lens assembly is placed in the recess of a high-speed PCB and wire-bonded. To compensate the inductive behavior of the wire-bond interconnection between the chip and the PCB at the high-speed IF outputs, an on-board 8-section step-impedance low-pass filter has been implemented. The module shows a 47 GHz 3-dB radio frequency/local oscillator operation bandwidth (BW), a peak conversion gain of 7.8 dB, a single-side-band noise figure of 11.3 dB, and a 3-dB IF BW of 13 GHz. The in-phase and quadrature amplitude imbalance stays below 1.58 dB for the 210–280 GHz band. The down-conversion and the baseband stages consume together 75.5 mW, while the LO path 378 mW. The maximum data-rate achieved with this receiver in combination with the transmitter presented in [1–3] is 60 Gbps for quadrature phase shift keying modulation.
While there are effective treatments for psychiatric disorders, many individuals with such disorders do not receive treatment and those that do often take years to get into treatment. Information regarding treatment contact failure and delay in Argentina is needed to guide public health policy and planning. Therefore, this study aimed to provide data on prompt treatment contact, lifetime treatment contact, median duration of treatment delays and socio-demographic predictors of treatment contact after the first onset of a mental disorder.
The Argentinean Study of Mental Health Epidemiology (EAESM) is a multistage probability sample representative of adults (aged 18+) living in large urban areas of Argentina. A total of 2116 participants were evaluated with the World Mental Health Composite International Diagnostic Interview to assess psychiatric diagnosis, treatment contact and delay.
Projections of cases that will make treatment contact by 50 years taken from a survival curve suggest that the majority of individuals with a mood (100%) or anxiety disorder (72.5%) in Argentina whose disorder persist for a sufficient period of time eventually make treatment contact while fewer with a substance disorder do so (41.6%). Timely treatment in the year of onset is rare (2.6% for a substance disorder, 14.6% for an anxiety disorder and 31.3% of those with a mood disorder) with mean delays between 8 years for mood disorders and 21 years for anxiety disorders. Younger cohorts are more likely to make treatment contact than older cohorts, whereas those with earlier ages of disorder onset are least likely to make treatment contact. Those with anxiety disorders and major depressive disorder are more likely to make treatment contact when they have comorbid disorders, whereas those with substance use disorders are less likely.
Argentina needs to implement strategies to get individuals with substance use disorders into treatment, and to reduce treatment delays for all, but particularly to target early detection and treatment among children and adolescents.
The objective of this study was to demonstrate the safety and feasibility of using the new Cardia Ultrasept II™ device with interposed Goretex patch referring to the perforation of polyvinyl alcohol membrane.
Great advances have been made in the development of devices for closure of atrial septal defect. The Cardia Ultrasept II™ with interposed Goretex patch is the modified last generation of Cardia devices, having the advantage of a super-low profile within the atria and an integral locking delivery-retrieval mechanism that ensures safe deployment. In addition, with the interposition of the Goretex, it has been possible to abolish perforation of Ivalon’s membrane as a complication.
Methods and results
Patients with ostium secundum atrial septal defect with surrounding rims with a minimum length of 5 mm and who underwent atrial septal defect closure with the new Ultrasept II™ with Goretex patch were included from two paediatric cardiac centres. Primary end point was to determine perforation of the Goretex membrane at follow-up; secondary end point included right ventricular diastolic diameter. In total, 30 patients underwent atrial septal defect closure at a median age of 6 (1–29) years. At follow-up for 6 (range, 1–15) months, freedom from perforations was 100%. A continuous decrease in right ventricular diastolic diameter was found with an initial median of 30 (25–49) mm and after catheterisation of 27.5 (18–33) mm, p=0.01, and Z-score of 2.6 (1.7–3.6) versus 1.9 (1–2.9) after procedure, p=0.01.
The new modified generation of the Ultrasept II™ device with interposed Goretex patch is a good alternative to achieve atrial septal defect closure safely and feasibly with no membrane perforation at follow-up.
This study assessed milk productivity, demographic characteristics and workload distribution on a single high-yield dairy ewe farm in Spain (Avila, Spain; continental climate, latitude of 40.90 N, altitude of 900 m) over a 7-year period considering a transition from a herd management system involving five lambings per year (5LY) to a system involving 10 lambings per year (10LY). The 5LY system was practiced on the farm from 2010 to 2012 and the 10LY system from 2014 to 2015, with 2009 and 2013 being considered transition years. During this period, 27 415 lactations were recorded from an average of 3746 Lacaune sheep/year. Several productivity parameters were higher in 2014 to 2015 than in 2010 to 2012: milk yield/lactation (370±156 v. 349±185 l), lactation length (218±75 v. 192±75 days) and dry period length (53.5±38.3 v. 69.1±34.8 days) (all P<0.0001). During 2014 to 2015, investment in new lambing facilities was possible, workload was distributed more uniformly throughout the year, workload per worker was smaller, rate of ewe culling was lower (35.39±0.53% v. 42.51±7.51%), ewe longevity was greater and higher-order lactations were more numerous (P<0.0001). On the other hand, during 2010 to 2012, daily production was higher (1.73±1.66 v. 1.70±0.62 l/day; P=0.038), the interlambing period was shorter (283±50 v. 302±44 days; P<0.0001) and lambings/ewe per year were greater (1.42±0.01 v. 1.30±0.01; P<0.05). These results suggest that a 10LY herd management system can be compatible with profitability, productivity and good animal and worker’s welfare on a high-yield dairy farm, and may even be associated with better outcomes than a 5LY system.
In this work, we study the hard-magnetic properties and its influence on the microstructure of MnBi-based glass-coated microwires obtained by Taylor-Ulitovsky process, as well as their magnetic and thermal dependence in the range of 200 K-360 K. We obtained glass-coated microwires pieces trough of the Taylor-Ulitovsky process. Glass-coated microwires exhibited the formation of Low-Temperature Intermetallic Phase (LTIP)-MnBi, as confirmed by scanning electron microscopy (SEM). Energy Dispersive Spectroscopy (EDS) elemental chemical composition analysis showed LTIP regions interspersed within Bi- and Mn-rich areas. Magnetic properties were determined by vibrating sample magnetometry (VSM), for which a considerable intrinsic coercivity field (iHc) up to 6000 Oe at 360 K, together with a saturation magnetization (Ms) of 57.49 emu/cm3. Therefore, this combination of properties renders LTIP is a promising precursor with potential for applications at high temperatures.
This review examines the relative bioefficacy of 2-hydroxy-4-(methylthio) butanoic acid (HMTBA) and DL-methionine (DL-Met) which includes chemical, metabolic, nutritional, and statistical aspects of its bioefficacy. The chemical, enzymatic and biological differences and similarities between these two products are explained and the evidence and reasons for HMTBA relative bioefficacy to DL-Met in monogastric animals are discussed. In addition, appropriate statistical methods for comparing the bioefficacy of these two products for successful use of each product are provided. HMTBA is an organic acid precursor of L-Met. The chemical structure differences between HMTBA and DL-Met leads to differences in how and where the two materials are absorbed, enzymatically converted to L-Met and used by the animal. Because of these differences, when the two compounds are supplemented into animal feeds in graded doses, they do not produce dose response curves of the same form due in part to differences in intake and metabolism at the extremes of the dose response curves. At deficient levels of the response curve, HMTBA fed animals may exhibit lower feed consumption and growth than DL-Met while at requirement levels they may have greater feed consumption and growth. This review provides biological evidence for why these differences in growth response occur and demonstrates that lower growth, whether for DL-Met or HMTBA, does not mean that either product is being converted to methionine inefficiently. Since the two products have different dose response curves, statistically valid methods are provided for unbiased determination of relative bioefficacy across tested dose ranges. Field nutritionists typically feed commercial doses of HMTBA or DL-Met at a total sulphur amino acid dietary level capable of achieving maximum performance. At these commercial levels, and based on the evidence, the full relative bioefficacy of HMTBA relative to DL-Met is discussed.
RR Lyrae variables are old (>10 Gyr) stars and, as such, they are useful probes of the earliest events of star formation in galaxies (Bernard et al. 2008, Martínez-Vázquez et al. 2016) as well as of the galaxy assembly process predicted by ΛCDM simulations of structure formation. In fact, the nature of the building-blocks of galaxies such as the Milky Way, and in particular, those of their stellar haloes, has been a matter of a substantial debate (Venn et al. 2004). Unlike other stellar tracers, RR Lyrae offer a snapshot of the stellar content present at the epoch when most of the merging action is predicted to have taken place, and thus they are ideal witnesses of this process.
The improvement in porcine embryo preservation and non-surgical embryo transfer (ET) procedures achieved in recent years represents essential progress for the practical use of ET in the pig industry. This study aimed to evaluate the effects of parity, weaning-to-estrus interval (WEI) and season on reproductive and embryonic parameters at day 6 after insemination of donor sows superovulated after weaning. The selection of donor sows was based on their reproductive history, body condition and parity. The effects of parity at weaning (2 to 3, 4 to 5 or 6 to 7 litters), season (fall, winter and spring), and WEI (estrus within 3 to 4 days), and their interactions on the number of corpus luteum, cysts in sows with cysts, number and quality of viable and transferable embryos, embryo developmental stage and recovery and fertilization rates were evaluated using linear mixed effects models. The analyses showed a lack of significant effects of parity, season, WEI or their interactions on any of the reproductive and embryonic parameters examined. In conclusion, these results demonstrate that fertilization rates and numbers of viable and transferable embryos collected at day 6 of the cycle from superovulated donor sows are not affected by their parity, regardless of the time of the year (from fall to spring) and WEI (3 or 4 days).