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In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
We conducted probabilistic data linkage of three population datasets for the Northern Territory (NT), Australia, to describe the incidence of preterm births, stillbirths, low birthweight and small for gestational age (SGA) per 1000 NT births; and influenza and pertussis hospitalisations per 1 00 000 NT births in infants <7 months of age, in a pre-maternal vaccination era. The Perinatal Trends dataset (1994–2014) formed the cohort of 78 382 births. Aboriginal mother–infant pairs (37%) had disproportionately higher average annual rates (AR) for all adverse birth outcomes compared to their non-Aboriginal counterparts; rate ratios: preterm births 2.2 (AR 142.4 vs. 64.7); stillbirths 2.3 (AR 10.8 vs. 4.6); low birthweight 2.9 (AR 54 vs. 19); and SGA 1.7 (AR 187 vs. 111). Hospitalisation (2000–2015) and Immunisation Register datasets (1994–2015), showed that influenza hospitalisations (n = 53) and rates were 42.3 times higher in Aboriginal infants (AR 254 vs. 6); and that pertussis hospitalisations (n = 37) were 7.1 times higher in Aboriginal infants (AR 142.5 vs. 20.2) compared to non-Aboriginal infants. These baseline data are essential to assess the safety and effectiveness of influenza and pertussis vaccinations in pregnant women from the NT. Remote living Aboriginal women and infants stand to benefit the most from these vaccines.
Pertussis morbidity is highest in infants too young to be fully protected by routine vaccination schedules. Alternate vaccine strategies are required to maximise protection in this age-group. To understand baseline pertussis epidemiology prior to the introduction of the maternal pertussis vaccination program in 2014, we conducted a retrospective case series analyses of 53 901 notifications and temporal trends from 1997 to 2014. Notifications were highest in infants younger than 4 months of age and highest annual notification rates in infants younger than 1 month of age (308/100 000 per year). Amongst Aboriginal and Torres Strait Islander infants aged younger than 1 month, this rate was 576/100 000 per year. Notification rates were 40% higher amongst women 15–44 years, 62·4/100 000 population compared with men (44·5/100 000) and 90% higher in Aboriginal and Torres Strait Islander women of the same age (38·2/100 000) compared with men (19·7/100 000). Six infant deaths were identified, all younger than 2 months of age. Monitoring epidemiology in at-risk groups – infants too young to be vaccinated, women of childbearing age and Aboriginal and Torres Strait Islander peoples – following implementation of the maternal pertussis vaccination program will be important to assess its impact and safety.
Conventionally perennial ryegrass evaluations are conducted under simulated grazing studies to identify varieties with the best phenotypic performance. However, cut-plot environments differ greatly to those experienced on commercial farms as varieties are not exposed to the same stress levels in test environments. It could be argued that plot-based testing regimes provide little direction to plant breeders in the development of advanced varieties. Varietal phenotypic performance needs to be quantified in ‘commercial’ situations. The objective of the current study was to evaluate the phenotypic performance of a range of perennial ryegrass varieties under commercial farm conditions. Monocultures of 11 Irish Recommended List perennial ryegrass varieties were sown on 66 commercial farms throughout Ireland where performance was evaluated over a 3-year period from 2013 to 2015, inclusive. A linear mixed model was used to quantify variety effects on grassland phenotypic performance characteristics. No significant variety effect was estimated for total, seasonal or silage herbage production. Despite the lack of variety effects, pairwise comparisons found significant performance differences between individual varieties. Grazed herbage yield is of primary importance and was shown to be correlated strongly with total production (0.71); Grazed herbage yield differed significantly by variety, with a range of 1927 kg dry matter (DM)/ha between the highest and lowest performing varieties. Sward quality (dry matter digestibility [DMD]) and density were influenced by variety with a range of 44 g/kg DM for DMD and 0.7 ground score units between the highest and lowest performing varieties. Results of the current study show that on-farm evaluation is effective in identifying the most suitable varieties for intensive grazing regimes, and the phenotypic variance identified among varieties performance for many traits should allow for improved genetic gain in areas such as DM production, persistence and grazing efficiency.
A detailed survey was undertaken to assess the rate of production and current management practices on Irish sheep farms and quantify their associations with flock size and ewe breed type. A total of 39 questions relating to the farm production system and farm management practices were devised, including: producer age, location, farm size, livestock numbers and type, in addition to flock management data such as flock breeding policy, lamb finishing strategy, flock health, lambing date, winter housing and feeding practices. A total of 717 sheep producers were surveyed across 45 different discussion groups. The surveyed respondents were sub-divided into four groups depending on flock size (very small, small, medium and large) and into three groups depending on ewe breed type (maternal, terminal and hill). The average survey respondent was 48 years old, with a flock size of 150 breeding ewes on a farm size of 58 ha. The average stocking rates were 6·55 and 3·14 ewes/ha and weaning rates were 1·44 and 1·02 lambs per ewe joined to the ram for the lowland and hill flocks, respectively. Relative to very small flocks (<62 ewes), larger flocks (>190 ewes) had higher stocking rates (6·98 v. 5·66 ewes/ha) and ewe to ram ratios (40 v. 30), and tended to lamb later in the year. The rate of technology adoption such as faecal egg sampling and pregnancy scanning was greater on larger flocks compared with smaller flocks. Flocks with maternal ewe breeds had higher scanning and weaning rates, and drafted a greater proportion of lambs off grass compared with flocks with terminal and hill ewe breeds. Flocks with maternal and terminal ewe breed types were more likely to winter house ewes, lamb indoors, test silage quality and have a handling unit compared with flocks with hill-type ewe breeds. Results from the present study provide a bank of knowledge on current Irish sheep industry performance and show that flock size and ewe breed type have a significant impact on key flock performance variables.
A total economic merit index (Pasture Profit Index, PPI) for perennial ryegrass variety selection was developed to rank perennial ryegrass varieties (Lolium perenne L.) based on their economic potential for grass-based ruminant production systems. The key traits of importance identified were: spring, mid-season (April 11–August 10) and autumn dry matter (DM) yield, first and second cut silage DM yield, grass quality April to July (inclusive) and sward persistency. Variety persistency was quantified by determining the ground score (GS) change across years, which was associated with a yield threshold which triggered sward replacement. Each one-unit decline in GS was associated with a 1683 kg loss in DM yield. Data generated in the Irish recommended list trials for value for cultivation and use were analysed to quantify the relative performance of each variety for each of the aforementioned traits. A previously developed methodology to generate economic values was used with updated price assumptions to develop economic values, which were applied to the analysed performance data of individual varieties. These data were used to estimate the total economic merit of each variety. Thirty-nine varieties were ranked on total economic merit with the highest performing variety (Cv111) generating €213 per ha/year compared with Cv201, which was the lowest ranking variety generating −€31 per ha/year. Use of the PPI provides information to end users in relation to the economic merit of one variety over another, facilitating a more informed decision-making process at farm level.
The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
Peer volunteers can be key to delivering effective social cognitive interventions due to increased potential for social modeling. We consulted peer volunteers who had just taken part in an 8-week social and nutritional mealtime intervention with older adults living alone, to seek their evaluation of the intervention.
Semi-structured focus groups were used with a total of 21 volunteers (17 female) and two facilitators. Thematic analysis was used to interrogate the data.
Six themes (16 sub-themes) are discussed. Peer volunteers described the importance of the socializing aspect of the intervention, of pairing considerations and compatibility in peer interventions, of considering the needs of the participant, of benefits to the volunteers, and of the practical considerations of conducting an intervention. Volunteers also discussed considerations for future research and services for older adults living alone.
Volunteers found their involvement in the intervention to be personally beneficial, and revealed some valuable considerations for the researchers to take forward to future research. Results are pertinent to intervention design and could inform future social cognitive and other peer-oriented interventions for older adults living alone.
There are significant costs associated with reproductive inefficiency in pasture-based dairy herds. This study has quantified the economic effect of a number of key variables associated with reproductive inefficiency in a dairy herd and related them to 6-week calving rate for both cows and heifers. These variables include: increased culling costs, the effects of sub optimum calving dates, increased labour costs and increased artificial insemination (AI) and intervention costs. The Moorepark Dairy Systems Model which is a stochastic budgetary simulation model was used to simulate the overall economic effect at farm level. The effect of change in each of the components was simulated in the model and the costs associated with each component was quantified. An analysis of national data across a 4-year period using the Irish Cattle Breeding Federation database was used to quantify the relationship between the 6-week calving rate of a herd with survivability (%), calving interval (days) and the level of AI usage. The costs associated with increased culling (%), calving date slippage (day), increased AI and intervention costs (0.1 additional inseminations), as well as, increased labour costs (10%) were quantified as €13.68, €3.86, €4.56 and €29.6/cow per year. There was a statistically significant association between the 6-week calving rate and survivability, calving interval and AI usage at farm level. A 1% change in 6-week calving rate was associated with €9.26/cow per annum for cows and €3.51/heifer per annum for heifers. This study does not include the indirect costs such as reduced potential for expansion, increased costs associated with failing to maintain a closed herd as well as the unrealised potential within the herd.
We report on the further development of an ion source for producing intense, continuous beams of large positive and negative cluster ions comprised of high temperature materials. This device, the Smoke-Ion Source, is the result of combining inert gas condensation methods with techniques for injecting electrons directly into expanding jets. We demonstrate the capability of this ion source to generate strong beams of cluster ions comprised of materials including metals, semiconductors, and metal oxide ceramics.
Relationships between mixing conditions, viscoelastic paste properties and flexural strength of hardened matrices have been investigated for an MDF cement. The correlation of paste relaxation times and matrix mechanical properties with mixing intensity suggests the build up and eventual breakdown of a network structure during mixing.
Synchrotron radiation from the Cornell High Energy Synchrotron Source (CHESS) was used to probe the alignment kinetics of a class of thermotropic siloxane-based liquid crystals under the influence of an electric field. The high flux allows for real-time investigation of microstructural changes as a function of frequency and temperature. The packing behavior of a pentamethylcyclosiloxane ring with pendant biphenyl mesogens was thoroughly investigated. The director orientation parameter, Sd, typically increased with decreasing temperature and was not strongly affected by frequency. Electric-field induced changes in the director orientation were also monitored. Upon application of an electric field, the nematic system exhibited a tendency to pack in columns with short-range correlation of the mesogens. Column correlation lengths are examined as a function of temperature for two frequencies. At the low temperature end of the mesophase, a tendency for the mesogens to layer pack was observed.
Research findings have fuelled debate on the construct validity of post-traumatic stress disorder (PTSD). Accompanying these issues are competing suggestions to redefine PTSD's criteria, including a recent proposal by DSM–V committee members. We review various approaches to revising the PTSD diagnosis and conclude that proposed changes should be placed in the appendix that the DSM has used for experimental criteria sets.
Significant issues challenge the diagnosis of post-traumatic stress disorder
(PTSD). Yet, applications of the PTSD ‘model’ have been extended to an
increasing array of events and human reactions across diverse cultures.
These issues have implications for clinical practice and for those who
revise criteria in the DSM-V.
In a particular success for translational research agendas, characterization of the neuronal circuits underlying fear extinction, and basic research in animal extinction paradigms, has led to intervention studies examining the use of D-cycloserine (DCS) to enhance therapeutic learning from exposure-based cognitive-behavioral therapy (CBT). In this article, we review these intervention studies, and discuss DCS augmentation of CBT relative to more traditional combination-treatment strategies in the treatment of anxiety disorders. We offer an accounting, based on evidence for internal context effects, of current limitations in the combination of antidepressant or benzodiazepine medications with CBT and discuss the advantages of isolated-dosing strategies with DCS relative to these limitations. This strategy is contrasted with the chronic-dosing applications of DCS for schizophrenia and Alzheimer's disease, and future directions for isolated-dosing strategies are discussed.
To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).
Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).
Level III NICU in a tertiary care center.
Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.
Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.
Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.
An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.
The objectives of this retrospective study were to (1) examine the predictive value of employer's disability management (DM) perceptions and DM policies in return-to-work outcomes for the injured worker, (2) examine factors that influence employer's DM perceptions, polices and return-to-work outcomes, and (3) examine the relationship between demographic factors of the individual and return-to-work outcomes. Employers from a northern British Columbia, Canada community were randomly selected to participate. The findings of the study supported the hypothesis that company perception towards DM is a significant contributing factor to the presence of DM policies in the workplace and that DM polices are predictive of return-to-work outcomes for injured workers.
Microstructure, microchemistry and mechanical properties of hardened macro-defect-free (MDF) composites processed at various rotor rates in a Banbury mixer were investigated. A quiescently formed calcium aluminate-polyvinyl alcohol composite served as a substitute for an unmixed system. Results from the Banbury studies in conjunction with microchemical analysis of the unmixed composite showed evidence that the polymer-particle interaction is a mechanically induced crosslinking reaction. The rate of the mechano-chemistry increases with mixing speeds. Scanning electron micrographs (SEM) and transmission electron micrographs (TEM) of hardened composites mixed for 15 min at 30, 50, 100, and 200 rpm indicate that much of the mechanical strength of MDF is due to the crosslinked interphase zones that blanket the cement grains. Stresses in the paste due to mixing can destroy the interphase layer, leading to a weaker hardened composite. Microchemical analysis revealed that the mechano-chemistry of the system did not vary with changes in the mixing conditions studied.