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To identify ways that the built environment may support or disrupt safe doffing of personal protective equipment (PPE) in biocontainment units (BCU).
We observed interactions between healthcare workers (HCWs) and the built environment during 41 simulated PPE donning and doffing exercises.
The BCUs of 4 Ebola treatment facilities and 1 high-fidelity BCU mockup.
A total of 64 HCWs (41 doffing HCWs and 15 trained observers) participated in this study.
In each facility, we observed how the physical environment influences risky behaviors by the HCW. The environmental design impeded communication between trained observers (TOs) and HCWs because of limited window size or visual obstructions with louvers, which allowed unobserved errors. The size and configuration of the doffing area impacted HCW adherence to protocol, and lack of clear demarcation of zones resulted in HCWs inadvertently leaving the doffing area and stepping back into the contaminated areas. Lack of standard location for items resulted in equipment and supplies frequently shifting positions. Finally, different solutions for maintaining balance while removing shoe covers (ie, chair, hand grips, and step stool) had variable success. We identified the 5 key requirements that doffing areas must achieve to support safe doffing of PPE, and we developed a matrix of proposed design strategies that can be implemented to meet those requirements.
Simple, low-cost environmental design interventions can provide structure to support and improve HCW safety in BCUs. These interventions should be implemented in both current and future BCUs.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
Recent developments in U.S-Cuba relations have resulted in a proliferating global interest in Cuba, including its legal regime. This comprehensive Guide aims to fill a noticeable void in the availability of information in English on this enigmatic jurisdiction's legal order, and on how to conduct research related to it. Covered topics include “The Constitution,” “Legislation and Codes,” “The Judiciary,” “Cuba in the International Arena,” and “The Legal Profession.” A detailed section on “Cuban Legal Materials in U.S. and Canadian Libraries” is also featured. Although the Guide emphasizes sources in English and English-language translation, materials in Spanish are likewise included as English-language equivalents are often unavailable. The Guide's 12 authors are members of the Latin American Law Interest Group of the American Association of Law Libraries’ Foreign, Comparative, and International Law Special Interest Section (FCIL-SIS).
The glucocorticoid receptor (GR) is a key receptor involved in inflammatory responses and is influenced by sex steroids. This study measured GR expression on circulating leukocyte subtypes in males and females.
A total of 23 healthy adults (12 female) participated in this study. GR expression was measured in leukocyte subtypes using flow cytometry. Peripheral blood mononuclear cell (PBMC) gene expression of GR (NR3C1), GR β, TGF-β1 and 2, and glucocorticoid-induced leucine zipper (GILZ) were determined by real-time polymerase chain reaction.
Leukocyte GR was lower in females, particularly in granulocytes, natural killer cells, and peripheral blood mononuclear cells (p≤0.01). GR protein expression was different across leukocyte subtypes, with higher expression in eosinophils compared with granulocytes, T lymphocytes, and natural killer cells (p<0.05). There was higher gene expression of GR β in males (p=0.03).
This is the first study to identify sexual dimorphism in GR expression in healthy adults using flow cytometry. These results may begin to explain the sexual dimorphism seen in many diseases and sex differences in glucocorticoid responsiveness.
Nutrition during pregnancy can impact on the susceptibility of the offspring to CVD. Postnatal consumption of trans-fatty acids (TFA), associated with partially hydrogenated vegetable oil (PHVO), increases the risk of atherosclerosis, whereas evidence for those TFA associated with ruminant-derived dairy products and meat remain equivocal. In this study, we investigate the impact of maternal consumption of dietary PHVO (P) and ruminant milk fat (R) on the development of atherosclerosis in their offspring, using the transgenic apoE*3 Leiden mouse. Dams were fed either chow (C) or one of three high-fat diets: a diet reflecting the SFA content of a ‘Western’ diet (W) or one enriched with either P or R. Diets were fed during either pregnancy alone or pregnancy and lactation. Weaned offspring were then transferred to an atherogenic diet for 12 weeks. Atherosclerosis was assessed as lipid staining in cross-sections of the aorta. There was a significant effect of maternal diet during pregnancy on development of atherosclerosis (P=0·013) in the offspring with those born of mothers fed R or P during pregnancy displaying smaller lesions that those fed C or W. This was not associated with changes in total or lipoprotein cholesterol. Continuing to feed P during lactation increased atherosclerosis compared with that seen in offspring of dams fed P only during pregnancy (P<0·001). No such effect was seen in those from mothers fed R (P=0·596) or W (P=901). We conclude that dietary TFA have differing effects on cardiovascular risk at different stages of the lifecycle.
Centaurus A (NGC 5128) is a giant early-type galaxy containing the nearest radio-bright AGN. The high-angular resolution Chandra images of Cen A reveal multi-scale X-ray structures with unprecedented detail and clarity. We present results from our study of X-ray structures surrounding the Cen A nuclear region, including the discovery of giant arc-like structures, extending to about 8 kpc in the direction perpendicular to the jet. We compare the X-ray structures with observations in other wavelengths and discuss their implication for a global understanding of the morphology of Cen A.
We describe preliminary results from our study of multi-scale structures in Centaurus A (NGC 5128) obtained using the Chandra X-ray Observatory HRC-I observations. The high-angular resolution Chandra images reveal X-ray multi-scale structures in this object with unprecedented detail and clarity. The region surrounding the Cen A nucleus, believed to be associated with a supermassive black hole, shows structures on arcsecond scales clearly resolved from the central source.
Community-based conservation efforts are designed to foster local stewardship of important ecological resources. However, inequitable distribution of costs and benefits in communities surrounding protected areas can negatively impact livelihoods, increase wealth disparities and create conflict. To examine the potential for conflict between host communities involved in a community-based conservation program and neighbouring (non-host) communities, we explored local residents’ attitudes towards conservation at Tiwai Island Wildlife Sanctuary (TIWS) in Sierra Leone. Intercept surveys (n = 368) were conducted in 18 villages (eight host, ten non-host) within 8 km of TIWS during 2010. Results revealed significant differences between residents of the host and non-host villages with respect to attitudes towards resource use and overall support for site protection. The most substantial discrepancies centred on perceived benefits associated with TIWS, and these drastically different perspectives generated a high potential for conflict. To minimize conflict and foster broader community support for conservation, managers must carefully consider how benefits associated with protected areas are communicated and distributed across protected area-proximate landscapes.
We discuss two themes from Chandra cluster observations. First, we describe the interaction of buoyant, radio emitting plasma bubbles with the hot intracluster gas. Second we summarize the Chandra observations of “cold” fronts (sharp discontinuities in gas density and temperature) separating cool, denser gas clouds from the hotter intracluster medium.
Germany has been an officially bovine tuberculosis (bTB)-free (OTF) country since 1996. Gradually rising numbers of bTB herd incidents due to Mycobacterium bovis and M. caprae in North-Western and Southern Germany during the last few years prompted the competent authorities to conduct a nationwide bTB survey in 2013/2014. This led to the detection of a dairy herd in which as many as 55 cattle reacted positively to consecutive intra vitam testing. Test-positive animals lacked visible lesions indicative of bTB at necropsy. Extensive mycobacterial culturing as well as molecular testing of samples from 11 tissues for members of the M. tuberculosis complex (MTC) yielded negative results throughout. However, caseous lymphadenitis of Ln. mandibularis accessorius was observed during meat inspection of a fattening pig from the same farm at regular slaughter at that time. Respective tissue samples tested MTC positive by polymerase chain reaction, and M. tuberculosis T1 family were identified by spoligotyping. Four human reactors within the farmer's family were also found to be immunoreactive. As exposure of livestock to M. tuberculosis is not generally considered, its impact may result in regulatory and practical difficulties when using protocols designed to detect classical bTB, particularly in OTF countries.
Internally consistent distances to classical cepheids can be derived with considerable accuracy because they satisfy period-luminosity and period-colour relations. Studies of five cepheids that are members of galactic clusters have led to a revised period-colour relation and a new zero point for the period-luminosity relation. Distances have been computed for all cepheids given in recently published photoelectric surveys. The material can be regarded as complete to a distance of about 1500 pc.
Objective: Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature.
Methods: All patients enrolled in an institutional post– cardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4°C (39.2°F) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year.
Results: One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p=0.64), nor was there any improvement in hospital survival (54% v. 50%, p=0.67), good neurologic outcome (49% v. 44%, p=0.61), or 1- year survival (49% v. 42%, p=0.46) between the two groups. Transport times were longer in the prehospital cooled group.
Conclusions: Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption.
In-situ tensile tests have been performed in a dual beam focused ion beam and scanning electron microscope on as-grown and prestrained single-crystal molybdenum-alloy (Mo-alloy) fibers. The fibers had approximately square cross sections with submicron edge lengths and gauge lengths in the range of 9–41 μm. In contrast to previously observed yield strengths near the theoretical strength of 10 GPa in compression tests of ∼1–3-μm long pillars made from similar Mo-alloy single crystals, a wide scatter of yield strengths between 1 and 10 GPa was observed in the as-grown fibers tested in tension. Deformation was dominated by inhomogeneous plastic events, sometimes including the formation of Lüders bands. In contrast, highly prestrained fibers exhibited stable plastic flow, significantly lower yield strengths of ∼1 GPa, and stress–strain behavior very similar to that in compression. A simple, statistical model incorporating the measured dislocation densities is developed to explain why the tension and compression results for the as-grown fibers are different.