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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
We present a broad study of linear, clustered, noble gas puffs irradiated with the frequency doubled (527 nm) Titan laser at Lawrence Livermore National Laboratory. Pure Ar, Kr, and Xe clustered gas puffs, as well as two mixed-gas puffs consisting of KrAr and XeKrAr gases, make up the targets. Characterization experiments to determine gas-puff density show that varying the experimental parameter gas-delay timing (the delay between gas puff initialization and laser-gas-puff interaction) provides a simple control over the gas-puff density. X-ray emission (>1.4 keV) is studied as a function of gas composition, density, and delay timing. Xe gas puffs produce the strongest peak radiation in the several keV spectral region. The emitted radiation was found to be anisotropic, with smaller X-ray flux observed in the direction perpendicular to both laser beam propagation and polarization directions. The degree of anisotropy is independent of gas target type but increases with photon energy. X-ray spectroscopic measurements estimate plasma parameters and highlight their difference with previous studies. Electron beams with energy in excess of 72 keV are present in the noble gas-puff plasmas and results indicate that Ar plays a key role in their production. A drastic increase in harder X-ray emissions (X-ray flash effect) and multi-MeV electron-beam generation from Xe gas-puff plasma occurred when the laser beam was focused on the front edge of the linear gas puff.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Recently, the telecommunication market experiences an explosion in the subscribers of emergent high-debit services which require bandwidth that exceeds the one provided by actual copper based access networks . To cope with these demands and keep competitive, great efforts have been done to develop access networks based on optical technology, such as passive all-optical networks due to their intrinsic low cost . Sol-gel processing is suitable for the development of organic-inorganic hybrid (OIH) materials for the production of functional integrated optic (IO) devices in a cost effective way. Urea cross-linked OIH show acceptable transparency, mechanical flexibility and thermal stability [3-6]. The control over the refractive index is achieved by zirconium (IV) n-propoxide (ZPO) doping stabilized with methacrylic acid (MA) [3-5]. The combination in a single material of urea cross-linked OIH and ZPO allowed the preparation of UV written low losses planar waveguides  and low rugosity diffraction grating [4,5]. It has been demonstrated that MA acts not only as ZPO stabilizer but impacts directly on the photopolimerization properties as it contains a photopolymerizable group making the OIH easily UV patterned without photoinitiator . Moreover, it also impacts on the OHIs local structure as it forms a complex with ZPO, that originate ordered clusters dispersed within the OIH host [4,5]. Besides the potential of this OIH as IO components, the hybrid hosts are room-temperature efficient white light emitters lacking metal activator ions, presenting quantum yields as higher as 20 % . In this work, a series of OIH, so called di-ureasils, formed of a siliceous skeleton to which oligopolyether chains of different lengths are covalently grafted by means of urea bridges and modified by ZPO and MA will be prepared and characterized by X-ray and small angle X-ray diffractions, Raman, infrared, atomic force and photoluminescence spectroscopies. The use of the proposed OIH in the development of IO functionalities such as optical filters will be evaluated based on waveguide numerical simulation methods (beam propagation method). Waveguides will be written and characterized using the OIH aforementioned. The recording of a Bragg grating in the waveguides allow the implementation of a wavelength discrimination device with applications on optical filtering. The relevant properties of the devices, such as spectral rejection and insertion losses will be characterized.  S-J Park et al. Journal of Lightwave Tech. 22, 2004.  D.J. Shin et al., Journal of Lightwave Tech. 23, 2005.  C. Molina et al., J. Mater. Chem. 15, 3937, 2005.  R.A. Sá Ferreira et al., Proceedings of the International Conference on Telecomunications, 2006.  P.S. André et al. Proceedings ICTON, 1, We.C1.6, 223, 2006.  a) L.D. Carlos et al., Adv. Func. Mater. 11, 111, 2001; b) J. Chem. Phys. B. 108, 14924, 2004. Siemens SA and FCT (POCTI/CTM/59075/2004) is gratefully acknowledged.
Meningococcal carriage dynamics drive patterns of invasive disease. The distribution of carriage by age has been well described in Europe, but not in the African meningitis belt, a region characterised by frequent epidemics of meningitis. We aimed to estimate the age-specific prevalence of meningococcal carriage by season in the African meningitis belt. We searched PubMed, Web of Science, the Cochrane Library and grey literature for papers reporting carriage of Neisseria meningitidis in defined age groups in the African meningitis belt. We used a mixed-effects logistic regression to model meningococcal carriage prevalence as a function of age, adjusting for season, location and year. Carriage prevalence increased from low prevalence in infants (0.595% in the rainy season, 95% CI 0.482–0.852%) to a broad peak at age 10 (1.94%, 95% CI 1.87–2.47%), then decreased in adolescence. The odds of carriage were significantly increased during the dry season (OR 1.5 95% CI 1.4–1.7) and during outbreaks (OR 6.7 95% CI 1.6–29). Meningococcal carriage in the African meningitis belt peaks at a younger age compared to Europe. This is consistent with contact studies in Africa, which show that children 10–14 years have the highest frequency of contacts. Targeting older children in Africa for conjugate vaccination may be effective in reducing meningococcal transmission.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.
The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.
A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).
Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
Transient (nuclear) heating experiments were conducted with uranium carbide fuel rods to study the failure characteristics of typical rod designs. Extremely unusual changes in microstructure were observed and the electron microprobe was employed to establish the disposition of materials resulting from the meltdown experiments. The probe results indicated substantial fuel-clad interactions and permitted the resolution of several uncertainties regarding the course of fuel rod failure and material redistribution. The electron microprobe represents a unique capability in the post-test analysis of such meltdown tests.
Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.
We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.
Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.
Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
This study argues that rights discourse influences heterosexual public opinion in Washington State. We tested this through a survey experiment conducted in the 2011 Washington Poll. We broke interviewees into three groups, with each group exposed to a different frame: a pro–lesbian and gay equal rights frame, an anti–lesbian and gay special rights frame, and a control or no frame. Immediately following the treatment, we asked interviewees if they agreed with a pro–lesbian and gay policy: changing state antidiscrimination law to encompass those who identify as lesbian and gay. Overall, this study concludes that a special rights frame dampens support among some while an equal rights frame has no effect. Respondents who indicated that they were against same-sex marriage even more strongly opposed altering antidiscrimination policy to include sexual orientation when confronted with an equal rights frame than when confronted with the special rights frame or no frame at all.
There are no estimates of the heritability of phenotypic udder traits in suckler sheep, which produce meat lambs, and whether these are associated with resilience to mastitis. Mastitis is a common disease which damages the mammary gland and reduces productivity. The aims of this study were to investigate the feasibility of collecting udder phenotypes, their heritability and their association with mastitis in suckler ewes. Udder and teat conformation, teat lesions, intramammary masses (IMM) and litter size were recorded from 10 Texel flocks in Great Britain between 2012 and 2014; 968 records were collected. Pedigree data were obtained from an online pedigree recording system. Univariate quantitative genetic parameters were estimated using animal and sire models. Linear mixed models were used to analyse continuous traits and generalised linear mixed models were used to analyse binary traits. Continuous traits had higher heritabilities than binary with teat placement and teat length heritability (h2) highest at 0.35 (SD 0.04) and 0.42 (SD 0.04), respectively. Udder width, drop and separation heritabilities were lower and varied with udder volume. The heritabilities of IMM and teat lesions (sire model) were 0.18 (SD 0.12) and 0.17 (SD 0.11), respectively. All heritabilities were sufficiently high to be in a selection programme to increase resilience to mastitis in the population of Texel sheep. Further studies are required to investigate genetic relationships between traits and to determine whether udder traits predict IMM, and the potential benefits from including traits in a selection programme to increase resilience to chronic mastitis.
In a previous paper (2), I discussed conditions in order that a holomorphic function f(w) be a Laplace transform of a function F(t) such that, for some a, F(t)e-at ∈ Lp(0, ∞). These conditions involved (a) the behaviour of integral transforms of the values of the function on a vertical line w = const, and (b) conditions involving the order of magnitude of the function at infinity. The present article discusses the corresponding question for Laplace transforms of distributions.
In their focal article, Chernyak-Hai and Rabenu (2018) argue that social exchange theory (SET) needs an update, and in this they are aligned with Cropanzano, Anthony, Daniels, and Hall's (2017) recent critical review of SET. Drawing on Chernyak-Hai and Rabenu's research, we explore two issues in more depth: first, that work relationships are becoming more complex than can be represented by simple dyadic reciprocity; and second, that the context of work is changing rapidly, with implications for workplace relationships. In exploring the ideas put forward by Chernyak-Hai and Rabenu, we draw on Cropanzano et al.’s two-dimensional model of social exchange, with the first dimension being desirable (positive) resources contrasted with undesirable (negative) ones, and the additional dimension being active (exhibit) behavior versus passive (withdraw) behavior. The first valence-oriented dimension fits clearly with the four foci of Chernyak-Hai and Rabenu's research, which cover both positive constructs, namely leader–member exchange (LMX), perceived organizational support and loyalty, and organizational citizenship behaviors (OCB), as well as negative constructs of perceived organizational politics and counterproductive work behaviors (CWB). The second, behavioral dimension proposed by Cropanzano et al. adds useful theoretical specificity that may address Chernyak-Hai and Rabenu's contention that SET needs updating to account for changes in how employees work and how organizations function.
This chapter presents a critical review of the literature on presenteeism. The goal is to summarize and identify the main conceptual and methodological limitations of presenteeism. More specifically, we critically review the presenteeism literature with a view to suggesting future research avenues that take into account the dynamic aspects of this phenomenon. First, some of the most popular and widely used definitions of presenteeism are presented along with their limitations. Then, we consider the various measures of presenteeism and suggest some improvements. Finally, we present methodological limitations based on an overview of research and current thinking in the field. This chapter highlights the methodological importance of considering small and medium-sized enterprises (SMEs) in future research.