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.
The purpose of the current study was two-fold: 1) to develop a new dual energy X-ray absorptiometry (DXA)-derived body volume (BV) equation with the GE-Lunar prodigy while utilizing underwater weighing (UWW) as a criterion; and 2) cross-validate the novel DXA-derived BV equation (4C-DXANICKERSON), Wilson DXA-derived BV equation (4C-DXAWILSON), and ADP-derived BV (4C-ADP) in Hispanic adults. METHODS: 191 Hispanic adults (18-45yrs) participated in the current study. The development sample consisted of 120 females and males (50% females) whereas the cross-validation sample comprised of 41 females and 30 males (n=71). Criterion body fat percentage (BF%) and fat-free mass (FFM) were determined using a four-compartment (4C) model with UWW as a criterion for BV (4C-UWW). 4C-DXANICKERSON, 4C-DXAWILSON, and 4C-ADP were compared against 4C-UWW in the cross-validation sample. RESULTS: 4C-DXANICKERSON, 4C-DXAWILSON, and 4C-ADP all produced similar validity statistics when compared to 4C-UWW in Hispanic males (all p>0.05). 4C-DXANICKERSON also yielded similar BF% and FFM values as 4C-UWW when evaluating the mean differences (CE) in Hispanic females (CE=-0.79% and 0.38kg; p=0.060 and 0.174, respectively). However, 4C-DXAWILSON produced significantly different BF% and FFM values (CE=3.22% and -2.20kg, respectively; both p<0.001). Additionally, 4C-DXAWILSON yielded significant proportional bias when estimating BF% (p<0.001) whereas 4C-ADP produced significant proportional bias for BF% and FFM (both p<0.05) when evaluated in Hispanic females. CONCLUSIONS: Current study findings demonstrate that 4C-DXANICKERSON is a valid measure of BV in Hispanics and is recommended for use in clinics where DXA is the main body composition assessment technique.
The majority of running geothermal plants worldwide are located in geological settings with convection- or advection-dominant heat transport. In Germany as in most regions in Europe, conduction is the dominating heat transport mechanism, with a resulting average geothermal gradient. The geothermal play type concept is a modern methodology to group geothermal resources according to their geological setting, and characteristic heat transport mechanisms. In particular, the quantity of heat transport is related to fluid flow in natural or engineered geothermal reservoirs. Hence, the permeability structure is a key element for geothermal play typing. Following the existing geothermal play type catalogue, four major geothermal play types can be identified for Germany: intracratonic basins, foreland basins and basement/crystalline rock provinces as conduction-dominated play types, and extensional terrains as the convection-dominated play type. The installed capacity of geothermal facilities sums up to 397.1 MWth by the end of 2018. District heating plants accounted for the largest portion, with about 337.0 MWth. The majority of these installations are located in the play type ‘foreland basin’, namely the Molasse Basin in southern Germany. The stratigraphic unit for geothermal use is the Upper Jurassic, also known as ‘Malm’ formation, a carbonate reservoir with high variability in porosity and permeability. Recently drilled wells in the southernmost Molasse Basin indicate the Upper Jurassic as a tight, fracture-controlled reservoir, not usable for conventional hydrothermal well doublets. Our new data compilation including the recently drilled deep geothermal well Geretsried reveals the relation of porosity and permeability to depth. The results suggest that obviously diagenetic processes control permeability with depth in carbonate rock, diminishing the predictability of reservoir porosity and permeability. The play type concept helps to delineate these property variations in play type levels because it is based on geological constraints, common for exploration geology. Following the general idea of play typing, the results from this play analysis can be transferred to geological analogues as carbonate rock play levels in varying depth.
There is demand for new, effective and scalable treatments for depression, and development of new forms of cognitive bias modification (CBM) of negative emotional processing biases has been suggested as possible interventions to meet this need.
We report two double blind RCTs, in which volunteers with high levels of depressive symptoms (Beck Depression Inventory ii (BDI-ii) > 14) completed a brief course of emotion recognition training (a novel form of CBM using faces) or sham training. In Study 1 (N = 36), participants completed a post-training emotion recognition task whilst undergoing functional magnetic resonance imaging to investigate neural correlates of CBM. In Study 2 (N = 190), measures of mood were assessed post-training, and at 2-week and 6-week follow-up.
In both studies, CBM resulted in an initial change in emotion recognition bias, which (in Study 2) persisted for 6 weeks after the end of training. In Study 1, CBM resulted in increases neural activation to happy faces, with this effect driven by an increase in neural activity in the medial prefrontal cortex and bilateral amygdala. In Study 2, CBM did not lead to a reduction in depressive symptoms on the BDI-ii, or on related measures of mood, motivation and persistence, or depressive interpretation bias at either 2 or 6-week follow-ups.
CBM of emotion recognition has effects on neural activity that are similar in some respects to those induced by Selective Serotonin Reuptake Inhibitors (SSRI) administration (Study 1), but we find no evidence that this had any later effect on self-reported mood in an analogue sample of non-clinical volunteers with low mood (Study 2).
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
We document a positive and strong correlation between speciation and extinction rates in the Paleozoic zooplankton graptoloid clade, between 481 and 419 Ma. This correlation has a magnitude of ~0.35–0.45 and manifests at a temporal resolution of <50 kyr and, for part of our data set, <25 kyr. It cannot be explained as an artifact of the method used to measure rates, sampling bias, bias resulting from construction of the time series, autocorrelation, underestimation of species durations, or undetected phyletic evolution. Correlations are approximately equal during the Ordovician and Silurian, despite the very different speciation and extinction regimes prevailing during these two periods, and correlation is strongest in the shortest-lived cohorts of species.
We infer that this correlation reflects approximately synchronous coupling of speciation and extinction in the graptoloids on timescales of a few tens of thousands of years. Almost half of graptoloid species in our data set have durations of <0.5 Myr, and previous studies have demonstrated that, during times of background extinction, short-lived species were selectively targeted by extinction. These observations may be consistent with the model of ephemeral speciation, whereby new species are inferred to form constantly and at high rate, but most of them disappear rapidly through extinction or reabsorption into the ancestral lineage. Diversity dependence with a lag of ~1 Myr, also documented elsewhere, may reflect a subsequent and relatively slow, competitive dynamic that governed those species that dispersed beyond their originating water mass and escaped the ephemeral species filter.
Hobby metal detecting is a controversial subject. Legal and policy approaches differ widely across national and regional contexts, and the attitudes of archaeologists and heritage professionals towards detectorists are often polarized and based on ethical or emotive arguments. We, the European Public Finds Recording Network (EPFRN), have implemented collaborative approaches towards detectorist communities in our respective contexts (Denmark, England and Wales, Finland, Flanders, and the Netherlands). Although our motivations are affected by our national circumstances, we base our work on an agreed set of goals, practices, and visions. This article presents the EPFRN's vision statement and provides insight into its underlying thoughts. We hope to create a debate on how to develop best practice approaches that acknowledge the inherent challenges of hobby metal detecting while realizing its potential.
Different manufacturers recommend different levels of disinfection for oxygen nipple and nut adaptors, also known as Christmas-tree adaptors (CTAs). We aimed to determine the bacterial contamination rates of CTAs before and after clinical use and whether disinfection wipes effectively eliminate bacteria from CTAs.
CTAs were swabbed for bacteria directly from the shipment box or after use in a medical intensive care unit to determine levels of contamination. CTAs were also inoculated in the laboratory with a variety of bacteria and disinfected with either 0.5% hydrogen peroxide (Oxivir 1) or 0.25% tetra-ammonium chloride with 44.50% isopropyl alcohol (Super Sani-Cloth), and the effectiveness of each wipe was determined by comparing the bacterial recovery before and after disinfection.
CTAs exhibit low levels of bacterial burden before and after clinical use. Both disinfecting wipes were effective at removing bacteria from the CTAs.
Low-level disinfection of CTAs is appropriate prior to redeployment in the clinical setting.
To investigate the manipulation of electromagnetic properties of two-dimensional materials, this effort characterizes charge transfer behavior of colloidal COF-5 (covalent organic framework) in the presence of various metal ions. A series of metal chloride compounds was introduced to COF-5 in solution and solid film phases and the interaction of the material with electromagnetic radiation was monitored across the visible region using electronic absorption spectroscopy. Notable changes were observed, quantified, and discussed for copper (II) chloride (CuCl2), chromium (III) chloride (CrCl3), and iron (III) chloride (FeCl3) with COF-5. Ligand-to-metal and metal-to-ligand charge transfer are explored as a possible mechanism for the observed electronic behaviors.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
The Vietnam Era Twin Study of Aging (VETSA) is a longitudinal behavioral genetic study with a primary focus on cognitive and brain aging in men, particularly early identification of risk for mild cognitive impairment (MCI) and Alzheimer’s disease (AD). It comprises a subset of over 1600 twins from the Vietnam Era Twin Registry. Twins live all over the USA. Assessments began when participants were in their 50s. Follow-ups were conducted every 5–6 years, and wave 3 has been completed as of this writing. The age range of participants is narrow (about 10 years). An extensive neurocognitive test battery has added precision in assessing differences in middle-aged adults, and predicting progression to MCI. Young adult cognitive test data (at an average age of 20 years) provide a means of disentangling aging effects from longstanding differences. Genome wide genotyping and plasma assays of AD biomarkers from waves 1 and 3 were conducted in wave 3. These features make the VETSA ideal for studying the heterogeneity of within-individual trajectories from midlife to old age, and for early detection of risk factors for cognitive decline.
Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.
Internal waves shoaling on the continental slope can break and form materially coherent vortices called boluses. These boluses are able to trap and transport material up the continental slope, yet the global extent of bolus transport is unknown. Previous studies of bolus formation primarily focused on systems consisting of two layers of uniform density, which do not account for the presence of ocean pycnoclines of finite thickness. We use hyperbolic tangent profiles to model the density stratification in our simulations and demonstrate the impact of the pycnocline on the bolus. A spectral clustering method is used to objectively identify the bolus as a Lagrangian coherent structure that contains the material advected upslope. The bolus size and displacement upslope are examined as a function of the pycnocline thickness, incoming wave energy, density change across the pycnocline and topographic slope. The dependence of bolus transport on the pycnocline thickness demonstrates that boluses in continuous stratifications tend to be larger and transport material further than in corresponding two-layer stratifications.
Non-invasive prenatal testing (NIPT) for the detection of foetal aneuploidy through analysis of cell-free DNA (cfDNA) in maternal blood is offered routinely by many healthcare providers across the developed world. This testing has recently been recommended for evaluative implementation in the UK National Health Service (NHS) foetal anomaly screening pathway as a contingent screen following an increased risk of trisomy 21, 18 or 13. In preparation for delivering a national service, we have implemented cfDNA-based NIPT in our Regional Genetics Laboratory. Here, we describe our validation and verification processes and initial experiences of the technology prior to rollout of a national screening service.
Data are presented from more than 1000 patients (215 retrospective and 840 prospective) from ‘high- and low-risk pregnancies’ with outcome data following birth or confirmatory invasive prenatal sampling. NIPT was by the Illumina Verifi® test.
Our data confirm a high-fidelity service with a failure rate of ~0.24% and a high sensitivity and specificity for the detection of foetal trisomy 13, 18 and 21. Secondly, the data show that a significant proportion of patients continue their pregnancies without prenatal invasive testing or intervention after receiving a high-risk cfDNA-based result. A total of 46.5% of patients referred to date were referred for reasons other than high screen risk. Ten percent (76/840 clinical service referrals) of patients were referred with ultrasonographic finding of a foetal structural anomaly, and data analysis indicates high- and low-risk scan indications for NIPT.
NIPT can be successfully implemented into NHS regional genetics laboratories to provide high-quality services. NHS provision of NIPT in patients with high-risk screen results will allow for a reduction of invasive testing and partially improve equality of access to cfDNA-based NIPT in the pregnant population. Patients at low risk for a classic trisomy or with other clinical indications are likely to continue to access cfDNA-based NIPT as a private test.
The Empire of Aksum was one of Africa's most influential ancient civilisations. Traditionally, most archaeological fieldwork has focused on the capital city of Aksum, but recent research at the site of Beta Samati has investigated a contemporaneous trade and religious centre located between Aksum and the Red Sea. The authors outline the discovery of the site and present important finds from the initial excavations, including an early basilica, inscriptions and a gold intaglio ring. From daily life and ritual praxis to international trade, this work illuminates the role of Beta Samati as an administrative centre and its significance within the wider Aksumite world.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
There is no single ultrasound probe available that allows visualization of all airway structures in children of all ages. In larger children above approximately 8 years of age, the linear medium-to-high frequency (5–14 MHz) transducer is suitable for imaging superficial airway structures (within 0–5 cm beneath the skin surface). The curved low-frequency transducer (~4.0 MHz) is most suitable for obtaining sagittal and parasagittal views of the tongue and structures in the submandibular and supraglottic regions, mainly because of its wider field of view. Linear transducers, which are used for assessment of the upper airways, provide excellent images of superficial structures, such as ribs and the pleura, but deeper structures can be difficult to assess. A micro-convex transducer (~8.0 MHz) is a good all-round transducer for focused ultrasonographic examination of the lungs, since most micro-convex transducers have an acceptable image quality of both superficial (pleura) and deeper structures (e.g., lung consolidation, atelectasis). Furthermore, micro-convex transducers are often small, which makes it easier to access the posterior thoracic wall, when the patient can only be examined in the supine position. An alternative to the micro-convex transducer for examination of the lungs is the curved low-frequency transducer (~4.0 MHz), which also has an acceptable image quality of both superficial and deeper structures. Since visualization of superficial and deep structures is needed, it is important to continuously optimize transducer frequency to obtain the best possible images. The presence or absence of artifacts are an important part of lung ultrasonography; hence, one should be mindful to deactivate any image optimization software that is inherently built into newer ultrasound machines as this would remove or diminish the presence of these useful artifacts when performing lung ultrasonography.
Cover crops provide a number of agronomic benefits, including weed suppression, which is important as cases of herbicide resistance continue to rise. To effectively suppress weeds, high cover crop biomass is needed, which necessitates later termination timing. Cover crop termination is important to mitigate potential planting issues and prevent surviving cover crop competition with cash crops. Field studies were conducted in Virginia to determine the most effective herbicide options alone or combined with glyphosate or paraquat to terminate a range of cover crop species. Results revealed that grass cover crop species were controlled (94% to 98%) by glyphosate alone 4 wk after application (WAA). Overall, legume species varied in response to the single active-ingredient treatments, and control increased with the addition of glyphosate or paraquat. Mixes with glyphosate provided better control of crimson clover and hairy vetch by 7% to 8% compared with mixes containing paraquat 4 WAA. Mix partner did not influence control of Austrian winter pea. No treatment adequately controlled rapeseed in this study, with a maximum of 58% control observed with single active-ingredient treatments and 62% control with mixes. Height reduction for all cover crop species supports visible rating data. Rapeseed should be terminated when smaller, which could negate weed suppressive benefits from this cover crop species. Growers should consider herbicide selection and termination timing in their cover crop plan to ensure effective termination.
Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population.
We performed a retrospective review of all neonates admitted to the 54-bed, level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013, and December 31, 2018. Clinical definitions per NICU team and NHSN site-specific definitions used for source identification were compared using the McNemar χ2 test.
We identified 86 HABSIs with an incidence rate of 0.80 per 1,000 patient days. Only 13% of these were CLABSIs. Both CLABSIs and non–catheter-related bloodstream infections occurred primarily in preterm neonates, but the latter were associated with a significantly higher incidence of comorbidities and the need for respiratory support. The NHSN definitions were less likely to identify a source compared to the clinical definitions agreed upon by our NICU treating team (P < .001). Furthermore, 50% of patients without an identified source of infection by NHSN definitions were bacteremic with a mucosal barrier injury organism, likely from gut translocation.
HABSIs occur primarily in premature infants with comorbidities, and CLABSIs account for a small proportion of these infections. With the increasing focus on HABSI prevention, there is a need for better NHSN site-specific definitions for the NICU population to prevent misclassification and direct prevention efforts.