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Skin care practices for radiotherapy patients are complicated by dosimetric concerns. This study measures the effect on skin dose of various topical agents and dressings.
Materials and methods
Superficial doses were measured under 17 topical agents and dressings and three clinical materials for reference. Dose was measured using a MOSFET detector under a 1 mm polymethyl methacrylate slab, with 6 MV photon beams at 100 cm source to surface distance.
Relative skin dose under reference materials was 128% (thermoplastic mask), 158% (5 mm bolus) and 171% (10 mm bolus). Under a realistic application of topical agent (0·5 mm), relative skin doses were 106–111%. All dry dressings yielded relative dose of ≤111%; two wet dressings yielded higher relative doses (133 and 141%).
Under clinically relevant conditions, no cream, gel or dry dressing increased the skin dose beyond that seen with a thermoplastic mask. Dressings soaked with water produced less skin dose than 5 mm bolus. This may be unacceptable if wet dressings are in place for the majority of the treatment course. Our results suggest that skin care practices should not be limited by dosimetric concerns when using a 6 MV photon beam.
In this systematic review, we summarized change in Salmonella prevalence and/or quantity associated with pathogen reduction treatments (washes, sprays, steam) on pork carcasses or skin-on carcass parts in comparative designs (natural or artificial contamination).
In January 2015, CAB Abstracts (1910–2015), SCI and CPCI–Science (1900–2015), Medline® and Medline® In-Process (1946–2015) (OVIDSP), Science.gov, and Safe Pork (1996–2012) were searched with no language or publication type restrictions. Reference lists of 24 review articles were checked. Two independent reviewers screened 4001 titles/abstracts and assessed 122 full-text articles for eligibility. Only English-language records were extracted.
Fourteen studies (5 in commercial abattoirs) were extracted and risk of bias was assessed by two reviewers independently. Risk of bias due to systematic error was moderate; a major source of bias was the potential differential recovery of Salmonella from treated carcasses due to knowledge of the intervention. The most consistently observed association was a positive effect of acid washes on categorical measures of Salmonella; however, this was based on individual results, not a summary effect measure.
There was no strong evidence that any one intervention protocol (acid temperature, acid concentration, water temperature) was clearly superior to others for Salmonella control.
State programs promoting their agricultural products have proliferated in response to increased consumer interest in locally grown foods. Tennessee, for example, currently has two state-funded programs promoting its agricultural products. This study examines the factors associated with participation by Tennessee fruit and vegetable farmers in those programs. The results suggest that farmer participation is associated with farm income, use of extension resources, and fresh produce sales. These results should be of interest to anyone attempting to increase producer participation in such programs.
Patient teaching in radiation therapy may include restrictions on applying skin products owing to concerns that the presence of such materials may increase skin dose. These restrictions may create unnecessarily complicated and conflicting self-care instructions.
To determine what thickness of skin product is necessary to produce a clinically meaningful dose increase to the skin, and provide recommendations for evidence-based patient instructions.
Dosimetric measurements and Monte Carlo simulations were used to calculate skin dose under 0–1·5 mm thicknesses of two common classes of skin product for a variety of treatment geometries. The thickness of product required to produce a clinically significant dose increase to the skin was determined.
The thickness of product required to create a clinically meaningful dose increase was >0·7 mm for 10 × 10 cm2 fields and >1·5 mm for 1 × 1 cm2 fields. A typical application of product would be only 0·3 mm.
It seems unrealistic to anticipate patients using sufficiently large quantities of skin product to be of clinical concern. We therefore recommend that there are no dosimetric reasons to restrict the use of these types of skin products during radiation therapy for common treatment scenarios.
To explore the experiences and attitudes of mental health professionals working in acute elderly care to a new clinical dashboard system. Metrics were identified from the Royal College of Psychiatrists' Accreditation for Inpatient Mental Health Services – Older People (AIMS-OP); these were tracked from baseline to 6 months. A questionnaire was developed and distributed across the three clinical areas involved in the clinical dashboard mental health pilot.
Staff completed the questionnaire 3 months after the initial implementation. At this point the benefits of the introduction of the dashboard were suggested as: improved access to information, increased communication and information-sharing, increased staff awareness, and data quality.
The introduction of the clinical dashboard in older adult mental health services allowed for better data availability and resulted in better data quality.
Using a recently developed multidimensional nanocontact system designed for a quantitative measurement of lateral contact stiffness in the 10–106 N/m stiffness range (or 10–1000 nm contact size), we found a crystallographic-orientation-dependent lateral-stiffness reduction relative to the elastic prediction at contact sizes around 50 nm for polished Ni single crystal surface in air. The slidingless measurement is enabled by a frequency-specific, continuous stiffness measurement technique. Based on an interface microslip model and an anisotropic elastic contact analysis, the resulting friction stress is found to increase monotonically when the tested lateral direction rotates away from the closely packed direction.
We examine the effects of grain-boundaries on the order-parameter and critical-currents in superconductors. We use a geometrical model of the lattice structure of grain-boundaries. We solve the Bogoliubov-de Gennes equation using the Recursion Method to obtain the self-consistent BCS gap function Δ and the local density of states N(E) near the boundary. Imposing a phase difference across the boundary we calculate the supercurrent and hence obtain the critical-current, Ic, of the junction.
To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.
A 439-bed, university-affiliated community hospital.
To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, “non-ICU areas”), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed.
The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P = .03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P = .43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P = .02).
The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.
Antimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This “Reality Check” session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.
It is shown that star disclinations can be a significant source of stress in chemical vapor deposited (CVD) diamond. This purely geometrical origin contrasts with other sources of stress that have been proposed previously. The effectiveness is demonstrated of the use of electron irradiation using a transmission electron microscope (TEM) to displace atoms from their equilibrium sites to investigate intrinsic defects and impurities in CVD diamond. After irradiation, the samples are studied by low temperature photoluminescence microscopy using UV or blue laser illumination. Results are given that are interpreted as arising from isolated <100> split self-interstitials and positively charged single vacancies. Negatively charged single vacancies can also be revealed by this technique. Nitrogen and boron impurities may also be studied similarly. In addition, a newly developed liquid gallium source scanned ion beam mass spectrometry (SIMS) instrument has been used to map out the B distribution in B doped CVD diamond specimens. The results are supported by micro-Raman spectroscopy.
Morphometric studies of allopatric populations of the Cotesia flavipes species complex representing three putative species; C. flavipes Cameron, C. sesamiae (Cameron) and C. chilonis (Matsumura), were conducted. Sixteen characters were measured. Principal component analysis separated the complex into three somewhat overlapping groups that corresponded well with previous concepts of the species. Canonical variate analysis separated the complex into three distinct clusters with populations from Africa together, populations from Asia and the Neotropics forming a second cluster, and material from China and Japan forming a third cluster. The Mahalanobis squared distances between the three clusters were nearly equal. Results support recognition of three species in the C. flavipes complex.
As an experiment, a Balinese gamelan was integrated with a summer music course for the physically handicapped. Two ethnomusicologists were invited to demonstrate playing techniques and to teach pieces of gamelan music which were later performed. This article documents the success of the experiment and describes the very considerable potential of the gamelan in general recreational and educational music therapy. More particularly, the essentially non-Western methods of learning and practising adopted on the course encouraged and engendered a broad range of skills in those with little or no previous musical experience, and significantly extended the abilities of the musically trained. The results of this experiment suggest that both music therapists and music educators may be able to extend the range of their work by drawing on certain non-Western musical traditions.
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