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Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.
We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007–December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011–2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430–437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.
In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03–1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00–1.67).
Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
Diarrhea is a common cause of morbidity and mortality and the incidence of diarrhea in the world has changed little over the past four decades. To assess the prevalence of and healthcare practices for diarrhea, a cross-sectional study was conducted in Pudong, Shanghai, China. In October 2014, a total of 5324 community residents were interviewed. Respondents were asked if they had experienced diarrhea (defined as ⩾3 passages of watery, loose, bloody, or mucoid stools within a 24-h period) in the previous month prior to the interview. The monthly prevalence of diarrhea was 4·1% (95% CI: 3·3–4·8), corresponding to an incidence rate of 0·54 episodes per person-year. The proportion of individuals with diarrhea who sought healthcare was 21·2% (95% CI: 13·4–29·0). Diarrhea continues to impose a considerable burden on the community and healthcare system in Pudong. Young age and travel were identified as predictors of increased diarrhea occurrence.
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted body image and are frequently co-morbid with each other, although their relationship remains little studied. While there is evidence of abnormalities in visual and visuospatial processing in both disorders, no study has directly compared the two. We used two complementary modalities – event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI) – to test for abnormal activity associated with early visual signaling.
We acquired fMRI and ERP data in separate sessions from 15 unmedicated individuals in each of three groups (weight-restored AN, BDD, and healthy controls) while they viewed images of faces and houses of different spatial frequencies. We used joint independent component analyses to compare activity in visual systems.
AN and BDD groups demonstrated similar hypoactivity in early secondary visual processing regions and the dorsal visual stream when viewing low spatial frequency faces, linked to the N170 component, as well as in early secondary visual processing regions when viewing low spatial frequency houses, linked to the P100 component. Additionally, the BDD group exhibited hyperactivity in fusiform cortex when viewing high spatial frequency houses, linked to the N170 component. Greater activity in this component was associated with lower attractiveness ratings of faces.
Results provide preliminary evidence of similar abnormal spatiotemporal activation in AN and BDD for configural/holistic information for appearance- and non-appearance-related stimuli. This suggests a common phenotype of abnormal early visual system functioning, which may contribute to perceptual distortions.
This multicentre surveillance study was conducted to investigate the trends in incidence and aetiology of healthcare-associated bloodstream infections (HCA-BSIs) in Taiwan. From 2000 to 2011 a total of 56 830 HCA-BSIs were recorded at three medical centres, and coagulase-negative staphylococci (CoNS) were the most common pathogens isolated (n = 9465, 16·7%), followed by E. coli (n = 7599, 13·4%). The incidence of all HCA-BSIs in each and all hospitals significantly increased over the study period owing to the increase of aerobic Gram-positive cocci and Enterobacteriaceae by 4·2% and 3·6%, respectively. Non-fermenting Gram-negative bacteria, Bacteroides spp. and Candida spp. also showed an increase but there was a significant decline in the numbers of methicillin-resistant S. aureus. In conclusion, the incidence of HCA-BSIs in Taiwan is significantly increasing, especially for Enterobacteriaceae and aerobic Gram-positive cocci.
Miscible thermals are formed by instantaneously releasing a finite volume of buoyant fluid into stagnant ambient. Their subsequent motion is then driven by the buoyancy convection. The gross characteristics (e.g. overall size and velocity) of a thermal have been well studied and reported to be self-similar. However, there have been few studies concerning the internal structure. Here, turbulent miscible thermals (with initial density excess of 5 % and Reynolds number around 2100) have been investigated experimentally through a large number of realizations. The vorticity and density fields were quantified separately by particle image velocimetry (PIV) and planar laser-induced fluorescence (PLIF) techniques. Ensemble-averaged data of the transient development of the miscible thermals are presented. Major outcomes include: (i) validating Turner’s assumption of constant circulation within a buoyant vortex ring; (ii) measuring the vorticity and density distributions within the miscible thermal; (iii) quantifying the effect of baroclinicity on the generation and destruction of vorticity within the thermal; and (iv) identifying the significantly slower decay rate of the peak density as compared to the mean.
We undertook a national paediatric seroprevalence survey of measles, mumps and rubella (MMR) in Singapore to assess the impact of the national childhood immunization programme against these three diseases after introduction of the trivalent MMR vaccine in 1990. The survey involved 1200 residual sera of Singapore residents aged 1–17 years collected from two hospitals between 2008 and 2010. The overall prevalence of antibodies against measles, mumps and rubella was 83·1% [95% confidence interval (CI) 80·9–85·1], 71·8% (95% CI 69·1–74·2) and 88·5% (95% CI 86·6–90·2), respectively. For all three diseases, the lowest prevalence was in children aged 1 year (47·8–62·3%). The seroprevalence of the vaccinated children declined over time. The national MMR immunization programme is effective in raising the herd immunity of the childhood population, although certain age groups are more susceptible to infection, in particular, those who are not eligible for vaccination at age <15 months.
We report on a program to delineate magnetic field structure inside molecular clouds by optical and infrared polarization observations. An ordered magnetic field inside a dense cloud may efficiently align the spinning dust grains to cause a detectable level of optical and near-infrared polarization of otherwise unpolarized background starlight due to dichroic extinction. The near-infrared polarization data were taken by SIRPOL mounted on IRSF in SAAO. Here we present the SIRPOL results in RCW 57, for which the magnetic field is oriented along the cloud filaments, and in Carina Nebula, for which no intrinsic polarization is detected in the turbulent environment. We further describe TRIPOL, a compact and efficient polarimer to acquire polarized images simultaneously at g', r', and i' bands, which is recently developed at Nagoya University for adaption to small-aperture telescopes. We show how optical observations probe the translucent outer parts of a cloud, and when combining with infrared observations probing the dense parts, and with millimeter and submillimeter observations to sutdy the central embedded protostar, if there is one, would yield the magnetic field structure on different length scales in the star-formation process.
Coral reef ecosystems have great importance for the countries of the Wider Caribbean Region in terms of both use and non-use values and services. Several of the contributors to this symposium attest to their importance for fisheries and biodiversity (see Ehrhardt et al. in Chapter 11; Appeldoorn in Chapter 10; Appeldoorn et al. in Chapter 12; Horrocks et al. in Chapter 9). Coral reef ecosystems support livelihoods (see McConney and Salas in Chapter 7) and provide critical ecosystem services (Schuhmann et al. in Chapter 8) including for tourism, although this aspect of their value is not developed in detail in Chapter 8. Caribbean coral reef ecosystems have been degraded by many human impacts of both marine and land-based origin (see Sweeney and Corbin in Chapter 4; Gil and Wells in Chapter 5; Yáñez-Arancibia et al. in Chapter 17). They are among the most complex and biologically diverse marine ecosystems, and will require a holistic ecosystem- based approach for their conservation and sustainable use.
This synthesis chapter presents the outputs of a group process aimed at developing a vision and way ahead for ecosystem-based management (EBM) for coral reef ecosystems in the Wider Caribbean, using the methods described earlier (Fanning et al. in Chapter 1). The chapter first describes a vision for coral reef EBM and reports on the priorities assigned to the identified vision elements. It then discusses how the vision might be achieved by taking into account assisting factors (those that facilitate achievement) and resisting factors (those that inhibit achievement). The chapter concludes with guidance on the strategic direction needed to implement the vision, identifying specific actions to be undertaken for each of the vision elements.
The occupational breakdown of members of the Coral Reef Ecosystems Working Group reflected the diversity of affiliations present at the EBM Symposium and included governmental, intergovernmental, academic, non-governmental and private sector (fishers and fishing industry and consulting) representatives. With guidance provided by the facilitator, this diverse group of participants was asked to first address the question of “What do you see in place in 10 years’ time when EBM/EAF has become a reality in the Caribbean?”
Weekly (August 2003–December 2008) numbers of five common paediatric diseases and the incidence of respiratory viruses were obtained from a children's hospital in Singapore and correlated with climate data using multivariate time-series techniques. Upper respiratory tract infections were positively correlated with the incidences of influenza A, B, respiratory syncytial virus (RSV) and parainfluenza viruses (types 1–3 combined). Lower respiratory tract infections were positively correlated with only the incidence of RSV. Both upper and lower respiratory tract infections were negatively correlated with relative humidity. Asthma admissions were negatively correlated with maximum temperature and positively correlated with the incidence of influenza B and increasing hours of sunshine. Although sporadic cases of adenovirus infection were identified, not enough cases were available for a more detailed analysis. Gastroenteritis and urinary tract infections, included as control diseases, were not correlated significantly with any climate parameters. These correlations are compatible with current understanding of respiratory virus survival under certain climate conditions and may assist the prediction of disease burdens and hospital resource planning in such tropical environments.
Taiwan Photon Source is a new 3-GeV ring with characteristics of great brightness and small emittance, at present under construction at National Synchrotron Radiation Research Center (NSRRC) site in Taiwan and due to be commissioned in 2013. The positioning of the magnets is highly sensitive to alignment errors, and the entire building will be constructed half underground at depth 12 m relative to Taiwan Light Source (TLS) for stability reasons; for these reasons the survey and alignment work is confined and difficult. To position magnets precisely and quickly, a highly accurate auto-tuning girder system combined with a survey network was designed to accomplish the alignment tasks. The survey network includes a preliminary Global Positioning System (GPS) network and a laser-tracking network. The position data from the survey network define a basis for the system of motorized girders to auto-tune and improve the accuracy. The detailed survey and alignment design, simulation and preliminary data are described in this paper.
A precise laser positioning system had been preliminarily developed for the girder system of the Taiwan Photon Source. This laser positioning system, a part of a girder auto-alignment scheme, will be installed on the girders located at both sides of each straight section of the storage ring. The system is composed of a laser and four sets of a position sensing device (PSD). The laser, held on one girder, propagates 13 m along the girder and plays the role of a reference line of girders of the straight section. Based on the laser linear characteristics, the other girder can be adjusted and aligned by a cam mover according to PSD data. To achieve superior precision, the whole laser positioning system should be constructed stably. After making some improvements to eliminate the unstable terms, the precision of the laser positioning system can achieve 2 µm at 13 m propagating distance every 4 h.
Taiwan Photon Source is now under construction at NSRRC Taiwan. In order to maintain the Taiwan Light Source (TLS) for normal operation, a hydrostatic levelling system and precision inclination sensor (Leica Nivel 220) were installed both in the storage ring and beamlines to monitor ground deformation arising. This paper presents the monitoring system setup and the circumstances of ground deformation including vertical settlement and floor inclination during the ground breaking period to provide a criterion for TLS operation.
Taiwan Photon Source (TPS), a new 3 GeV synchrotron ring, is under construction at National Synchrotron Radiation Research Center (NSRRC). To discover problems of design, manufacture and installation, a mockup of 1/24 section (one cell) of TPS was installed at NSRRC. A modified, precise, six-axis, prototype girder system of this mockup composed of three girders was fabricated. We discuss both the installation of the girder system and its diagnostics, and present the results including measurement of the dimensions of the components of the girder system and the vibration tests.
In contrast to bacteraemic pneumococcal community-acquired pneumonia (CAP), there is a paucity of data on the clinical characteristics and outcomes of non-bacteraemic pneumococcal CAP. This retrospective study compared the outcome of hospitalized patients with bacteraemic and non-bacteraemic pneumococcal CAP treated at a medical centre from 2004 to 2008. Data on clinical outcomes including all-cause mortality, length of hospital stay, need for intensive-care unit admission and extrapulmonary involvement were analysed. In all, 221 patients with pneumococcal pneumonia (87 bacteraemic, 134 non-bacteraemic) were included. Patients with bacteraemic pneumococcal pneumonia (BPP) were older than those with non-BPP (46·2±30·7 years vs. 21·7±30·8 years, P<0·001) and were more likely to have underlying medical diseases (66·7% vs. 33·6%, P<0·001). The overall mortality rates at 7, 14, and 30 days were significantly higher in BPP than non-BPP patients (12·6% vs. 2·2%, 14·9% vs. 3·7%, 19·5% vs. 5·1%, all P<0·01). Multivariate logistic regression analysis showed that pneumococcal bacteraemia was correlated with extrapulmonary involvement (odds ratio 5·46, 95% confidence interval 1·97–15·16, P=0·001). In conclusion, S. pneumoniae bacteraemia increased the risk of mortality and extrapulmonary involvement in patients with pneumococcal CAP.
Four thousand and one hospital staff were screened for hepatitis B virus (HBV) markers in a vaccination programme in Hong Kong. The seropositivity rate for HBsAg, anti-HBs and anti-HBc were significantly higher in the 3160 existing hospital staff than in 841 new recruits. Of the subjects negative for HBV markers, 605 were randomized to receive three doses of either 10 or 20 μg of the Merck Institute vaccine (HB-VAX). Compared with the 20 μg dose, vaccination with the 10 μg dose results in equal immunogenicity and efficacy at the completion of the three injections but induced a slower response rate and lower anti-HBs titres with the first two doses. The commonest side-effect of local soreness was less with the 10 μg dose. We conclude that (1) hospital staff working in high endemic areas should be vaccinated on recruitment and (2) the 10 μg dose of HB-VAX can replace the recommended 20 μg dose for adults, being cheaper and as efficacious.