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Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
Aims and Objectives:
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.
Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).
Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.
Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.
In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.
Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa.
To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care.
Demographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed.
The total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2–9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02–1.08, p=0.001. Follow-up was complete in 151 (78%) patients for more than 7 years.
Despite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.
Silver nanowire-based contacts represent one of the major new directions in transparent contacts for opto-electronic devices with the added advantage that they can have Indium-Tin-Oxide-like properties at substantially reduced processing temperatures and without the use of vacuum-based processing. However, nanowires alone often do not adhere well to the substrate or other film interfaces; even after a relatively high-temperature anneal and unencapsulated nanowires show environmental degradation at high temperature and humidity. Here we report on the development of ZnO/Ag-nanowire composites that have sheet resistance below 10 Ω/sq and >90% transmittance from a solution-based process with process temperatures below 200 °C. These films have significant applications potential in photovoltaics and displays.
Beta-gallium oxide (β-Ga2O3) is of increasing interest to the optoelectronic community for transparent conductor and power electronic applications. Considerable variability exists in the literature on the growth and doping of Ga2O3 films, especially as a function of growth approach, temperature, and oxygen partial pressure. Here pulsed laser deposition (PLD) was used to grow high-quality β-Ga2O3 films on (0001) sapphire and (−201) Ga2O3 single crystals and to explore the growth, stability, and dopability of these films as function of temperature and oxygen partial pressure. There is a strong temperature dependence to the phase formation, morphology, and electronic properties of β-Ga2O3 from 350 to 550 °C.
The biography of Pope Zacharias (741-52) in the Liber Pontificalis gives an account of his building-works and embellishments at the papal Lateran palace. After describing a new dining-room (triclinium) and an oratory and portico of St. Silvester, the account goes on to say:
Fecit autem a fundamentis ante scrinium Lateranensem porticum atque turrem ubi et portas ereas atque cancellos instituit et per figuram Salvatoris ante fores ornavit; et per ascendentes scalas in superioribus super eandem turrem triclinium et cancellos aereos construxit, ubi et orbis terrarum descriptione depinxit atque diversis versiculis ornavit.
(He made from their foundations, in front of the offices of the Lateran, a portico and tower, where he set up bronze doors and railings, and adorned it in front of the doors with a figure of our Saviour. [Reached] by stairs going up, in the upper parts over the same tower he built a triclinium and bronze railings, and here painted a representation of the orb of the world and ornamented it with various verses).
We analyzed the recent (< 25 yr) spread in New Hampshire, USA, of the exotic tree Kalopanax septemlobus, native to Asia. The invasion was likely initiated by a single tree planted ca. 1972. Our objective was to assess the viability of the invasion, especially in light of the small propagule size. We tallied, mapped, aged, and measured the height and growth of K. septemlobus individuals at two sites, the University of New Hampshire campus (UC) and Thompson Farm (TF), both in Durham. We found over 3,800 plants at UC and 270 at TF in < 120 ha (296 ac) total area. Plant age ranged from 0 to 22 yr, and UC plants were as far as 775 m (2,543 ft) from the purported parent tree. Annual height growth was comparable to midtolerant native trees. Plants occurred in both open and forested habitats, and the mean level of photosynthetically active radiation incident on understory plants was 4 to 6% of full sun. The large population size, shade tolerance, rapid height growth, and ability to sprout from damaged stems suggest potential for K. septemlobus to invade and persist in forests, the most common natural ecosystem in the northeastern United States. We further suggest that small propagule size, likely a single tree, has not prevented K. septemlobus from initiating a spatially extensive and vigorous population. Kalopanax septemlobus has been planted as an ornamental in the northeastern United States, and prevention of region-wide invasion might depend on removal of these trees, even when they occur as single individuals.
Alluvial and lacustrine sediments exposed beneath late Pleistocene glaciolacustrine silt and clay at two sites along the Old Crow River, northern Yukon Territory, are rich in fossils and contain tephra beds. Surprise Creek tephra (SZt) occurs in the lower part of the alluvial sequence at CRH47 and Little Timber tephra (LTt) is present near the base of the exposure at CRH94. Surprise Creek tephra has a glass fission-track age of 0.17 ± 0.07 Ma and Little Timber tephra is 1.37 ± 0.12 Ma. All sediments at CRH47 have a normal remanent magnetic polarity and those near LTt at CRH94 have a reversed polarity — in agreement with the geomagnetic time scale. Small mammal remains from sediments near LTt support an Early Pleistocene age but the chronology is not so clear at CRH47 because of the large error associated with the SZt age determination. Tephrochronological and paleomagnetic considerations point to an MIS 7 age for the interglacial beds just below SZt at CRH47 and at Chester Bluffs in east-central Alaska, but mammalian fossils recovered from sediments close to SZt suggest a late Irvingtonian age, therefore older than MIS 7. Further studies are needed to resolve this problem.
The Santa Cruz and Pinturas Formations (SCF and PF) are two partially coeval
formations in the southern part of Santa Cruz Province, Argentina, that were
deposited during the Early to Middle Miocene. The SCF underlies the coastal
plain between 47.0° and 51.6° S and extends from the Atlantic
Coast into the Andean foothills. The PF has a more restricted distribution
centered on eastern tributaries of the Rio Pinturas along the northern perimeter
of the SCF. Both formations have abundant tephra and tuffaceous sediments with
likely sources in volcanoes associated with emplacement of the late Cenozoic
South Patagonian batholith. This study re-evaluates the age of the SCF and the
relationship of the SCF to the PF, adding some radiometric dates to those
previously published and using the methods of tephrochronology. Tephra samples
were collected from 26 localities in the SCF and PF. Glass shards were analyzed
by electron microscopy. Ten tephra samples were analyzed by the
40Ar/39Ar method: nine from the SCF and one from the
PF. Results of these analyses, in conjunction with previous studies, indicate
that there are at least 38 individual tephra layers in the SCF, while there are
likely many more tephra than the six analyzed from the PF. Of the 38 tephra
layers in the SCF, 16 are shared by two or more sections, with one key tephra,
the Toba Blanca, present in eight and possibly nine localities from 51.6°
S northward to 47.0° S, over a distance of ~525 km. Integrating
results of the tephra correlations and radiometric ages indicates that the SCF
spans the interval ~18 Ma to 16 Ma in the Atlantic coastal plain and
~19 to 14 Ma in the Andean foothills, with a chronologic overlap between
the PF and lower part of the SCF. With this tephrochronology in place, studies
of space-time variations such as rates of sediment accumulation, composition of
mammalian faunas, facies changes, and other aspects of the SCF and PF can be
Santa Cruz Province, Argentina, has some of the richest fossil mammal localities
in the world. However, the absolute and relative ages of its fossil localities
have long been a source of confusion and debate. In particular, there has been
longstanding disagreement about the relative ages of the fossils from the
western part of the province in deposits of the Pinturas Formation compared with
those from the numerous localities of the Santa Cruz Formation along the
Atlantic coast. Drawing on recent studies of the tuffaceous sediments in many
classic fossil localities, and studies of fossil representatives of marsupials,
rodents, and primates, we provide a synthesis of the temporal relationship among
fossil localities throughout the province. There is broad agreement between the
results of the tephrochronology and mammalian paleontology. Both tephra
correlations and paleontological comparisons indicate that the lower units of
the Pinturas Formation are older than the sections of the Santa Cruz Formation
preserved at Monte León and Cerro Observatorio, supporting Ameghino's
suggestion that part of the Pinturas Formation represents a distinct faunal
zone. However, the upper unit of the Pinturas Formation seems to correspond in
age with the lower part of the sections at Monte León and Cerro