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.
Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE).
In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital. We developed clear and reproducible inclusion criteria and processes, including measures of program efficiency. We conducted seminars and teaching modules to paramedics and hospital-based clinicians including monthly simulator sessions, and performed detailed reviews of each treated case in the form of report cards. In this before-and-after study we compared patients with ECPR attempted prior to, and after, protocol implementation. The primary outcome was TTE, defined as the time of initial professional CPR to establishment of extracorporeal circulation. We compared the median TTE for patients in the two groups using the Wilcoxon signed rank test.
Four patients were identified prior to the protocol and managed in an ad hoc basis; for nine patients the protocol was utilized. Overall favourable neurological outcomes among ECPR-treated patients were 27%. The median TTE was 136 minutes (IQR 98 - 196) in the pre-protocol group, and 60 minutes (IQR 49 - 81) minutes in the protocol group (p=0.0165).
An organized clinical and educational protocol to initiate ECPR for patients with OHCA is feasible and significantly reduces the key benchmark of time-to-ECPR flows.
Hybrid solar receivers utilizing both photovoltaic cells and thermal collectors are capable of collecting the entire solar spectrum for use in energy systems. Such systems provide efficient solar energy conversion using PV in addition to dispatchability through thermal storage by incorporating a thermal collector in conjunction with the PV. Proposed hybrid systems typically invoke spectrum splitting so to redirect photons optimized for PV electric conversion to a cell while non-PV efficient photons are directed to a thermal absorber. This work discusses a hybrid system with a selective solar filter using a suspended nanoparticle fluid to directly absorb non-PV photons. Non-absorbed photons pass through the filter and impact the PV. Choice of nanoparticles in the fluid allow absorption and transmission of specific wavelengths. Nanoparticles were chosen based on optimization simulations for a bandpass filter to a cSi solar cell. The synthesized fluid has been experimentally characterized to show the effects of high temperature on nanoparticle stability and optical properties. Thermodynamic modeling of the system suggests solar to electric efficiency of the total system is 23.2% if all thermal energy is converted to electricity through an organic Rankine cycle (ORC). However, high temperature generation could be used for industrial process heat at a specific temperature by changing parameters such as absorbed energy and flow rates. Furthermore, a prototype is being developed with 14x concentration to demonstrate the technology on-sun with initial testing targeted for the 2nd quarter of 2016. Overall, the hybrid nanoparticle filter concentrating solar collector can be modified to fit a variety of applications through easily changeable parameters in the system.
The discovery of Heusler alloys has revolutionized the research field of intermetallics due to the ease with which one can derive potential candidates for multifunctional applications. During recent years, many half Heusler alloys have been investigated for their thermoelectric properties. The f-electron-based rare-earth ternary half Heusler compound DyPdBi has its f energy levels located close to the Fermi energy level. Other research efforts have emphasized that such materials have good thermoelectric capabilities. We have explored using first principles the electronic band structure of DyPdBi by use of different exchange correlation potentials in the density functional theoretical framework. Transport coefficients that arise in the study of thermoelectric properties of DyPdBi have been calculated and have illustrated its potential as an efficient thermoelectric material. Both the theoretically estimated Seebeck coefficient and the power factor agree well with the available experimental results. Our calculations illustrate that it is essential to include spin–orbit coupling in these models of f-electron half Heusler materials.
The two Pan-STARRS telescopes, located on Haleakala, Maui, Hawaii, are 1.8-meter diameter telescopes equipped with 1.4 Gigapixel cameras that deliver 7 square degree fields-of-view. The first of these telescopes, Pan-STARRS1, is conducting a search for Near Earth Objects, and is currently the leading discoverer of Near Earth Objects. The second telescope, Pan-STARRS2, is nearing the end of its commissioning, and is becoming more productive.
Pan-STARRS has become the leading survey for Near Earth Objects, responsible for approximately half of the NEO discoveries to date in 2015. Pan-STARRS is also the leading discoverer of new comets.
To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization.
Pragmatic cluster-randomized trial.
Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals.
Patients admitted to adult ICUs from July 1, 2009, to September 30, 2011.
After a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms.
During the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1,2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71).
In this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.
Diamond is a unique material that often exhibits extreme properties compared to other materials. Discovered about 30 years ago, the use of hydrogen in plasma-enhanced chemical vapor deposition (CVD) has enabled the growth and coating of diamond in film form on various substrate materials. CVD diamond research has been actively continued subsequently to develop new understanding and approaches for the growth and processing of this fascinating material. Currently, the study and development of diamond films has enabled a wide range of applications based on the combination of unique and extreme properties of diamond and the variety of film properties obtainable through tuning the microstructure, morphology, impurities, and surfaces. This issue of MRS Bulletin introduces the latest research, recent applications, and the challenges ahead for CVD diamond films.
The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery.
To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data.
We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006-September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007-September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates.
We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23-0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74-0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN.
The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation.
In taste cells, taste receptors, their coupled G proteins and downstream signalling elements mediate the detection and transduction of sweet, bitter and umami compounds. In some intestinal endocrine cells, taste receptors and gustducin contribute to the release of glucagon-like peptide 1 (GLP-1) and other gut hormones in response to glucose and non-energetic sweeteners. Conversely, taste cells have been found to express multiple hormones typically found in intestinal endocrine cells, e.g. GLP-1, glucagon, somatostatin and ghrelin. In the present study, by immunohistochemistry, multiple subsets of taste cells were found to express GLP-1. The release of GLP-1 from ‘endocrine taste cells’ into the bloodstream was examined. In wild-type mice, even after oesophagectomy and vagotomy, oral stimulation with glucose induced an elevation of GLP-1 levels in the bloodstream within 10 min. Stimulation of taste cell explants from wild-type mice with glucose led to the release of GLP-1 into the medium. Knocking out of the Tas1r3 gene did not eliminate glucose-stimulated GLP-1 release from taste cells in vivo. The present results indicate that a portion of the cephalic-phase rise in circulating GLP-1 levels is mediated by the direct release of GLP-1 from taste cells into the bloodstream.
The use of parasites as biological tags to discriminate among marine fish stocks has become a widely accepted method in fisheries management. Here, we first link this approach to its unstated ecological foundation, the decay in the similarity of the species composition of assemblages as a function of increasing distance between them, a phenomenon almost universal in nature. We explain how distance decay of similarity can influence the use of parasites as biological tags. Then, we perform a meta-analysis of 61 uses of parasites as tags of marine fish populations in multivariate discriminant analyses, obtained from 29 articles. Our main finding is that across all studies, the observed overall probability of correct classification of fish based on parasite data was about 71%. This corresponds to a two-fold improvement over the rate of correct classification expected by chance alone, and the average effect size (Zr = 0·463) computed from the original values was also indicative of a medium-to-large effect. However, none of the moderator variables included in the meta-analysis had a significant effect on the proportion of correct classification; these moderators included the total number of fish sampled, the number of parasite species used in the discriminant analysis, the number of localities from which fish were sampled, the minimum and maximum distance between any pair of sampling localities, etc. Therefore, there are no clear-cut situations in which the use of parasites as tags is more useful than others. Finally, we provide recommendations for the future usage of parasites as tags for stock discrimination, to ensure that future applications of the method achieve statistical rigour and a high discriminatory power.
Ramanujan’s last letter to Hardy concerns the asymptotic properties of modular forms and his ‘mock theta functions’. For the mock theta function
, Ramanujan claims that as
approaches an even-order
root of unity, we have
We prove Ramanujan’s claim as a special case of a more general result. The implied constants in Ramanujan’s claim are not mysterious. They arise in Zagier’s theory of ‘quantum modular forms’. We provide explicit closed expressions for these ‘radial limits’ as values of a ‘quantum’
-hypergeometric function which underlies a new relationship between Dyson’s rank mock theta function and the Andrews–Garvan crank modular form. Along these lines, we show that the Rogers–Fine false
-functions, functions which have not been well understood within the theory of modular forms, specialize to quantum modular forms.
A high-fat diet disturbs the composition and function of the gut microbiota and generates local gut-associated and also systemic responses. Intestinal mast cells, for their part, secrete mediators which play a role in the orchestration of physiological and immunological functions of the intestine. Probiotic bacteria, again, help to maintain the homeostasis of the gut microbiota by protecting the gut epithelium and regulating the local immune system. In the present study, we explored the effects of two probiotic bacteria, Lactobacillus rhamnosus GG (GG) and Propionibacterium freudenreichii spp. shermanii JS (PJS), on high fat-fed ApoE*3Leiden mice by estimating the mast cell numbers and the immunoreactivity of TNF-α and IL-10 in the intestine, as well as plasma levels of several markers of inflammation and parameters of lipid metabolism. We found that mice that received GG and PJS exhibited significantly lower numbers of intestinal mast cells compared with control mice. PJS lowered intestinal immunoreactivity of TNF-α, while GG increased intestinal IL-10. PJS was also observed to lower the plasma levels of markers of inflammation including vascular cell adhesion molecule 1, and also the amount of gonadal adipose tissue. GG lowered alanine aminotransferase, a marker of hepatocellular activation. Collectively, these data demonstrate that probiotic GG and PJS tend to down-regulate both intestinal and systemic pro-inflammatory changes induced by a high-fat diet in this humanised mouse model.
Woodland bird communities are immensely variable in the number and composition of species and the overall density. Some of this variation is essentially biogeographic. For example, the species pool in most taxonomic and ecological avian groups increases from Ireland through to central Europe (Fuller et al., 2007a). At more local scales, variation is driven mainly by environmental attributes that influence the resources available and consequently determine fitness of individual birds within habitat patches (Holmes, 1990; Chapter 2).
The context for this chapter is long-established woodland in landscapes that have been heavily populated and modified by people for hundreds, even thousands, of years. These woods are predominantly broadleaved, often with a recently introduced coniferous element. Mountain and conifer forests lie outside the scope of the chapter, but for a discussion of northern conifer forests see Chapter 19. In western Europe, a long history of human-related disturbance has produced woodland that is far removed from any ‘natural’ state. Historical interactions between socio-economic processes and environmental factors have produced great diversity of woodland types of varying habitat quality for birds. Regional traditions, differences in management systems and markets, spatial variation in grazing pressure, even neglect, all contribute to this heterogeneity. Whilst some heavily wooded landscapes have persisted, much woodland exists merely as fragments in agricultural landscapes and its plant and animal communities are strongly affected by the surroundings (Chapters 4–6).