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Introduction: There is increasing evidence supporting ultrasonography for the determination of optimal chest compression location during cardiac arrest. Radiological studies have demonstrated that in up to 1/3 of patients the aortic root or outflow tract is being compressed during standard CPR. Out-of-hospital-cardiac-arrests (OHCA) could benefit from cardiac localization, undertaken with scaled-down ultrasound equipment by which the largest fluid filled structure in the chest (the heart) is identified to guide optimal compression location. We intend to evaluate 1) where the left ventricle is in supine patients, 2) the accuracy and precision as well as 3) the feasibility and reliability of cardiac localization with a scaled down ultrasound device (bladder scanners). Methods: We are recruiting men and women over the age of 40. The scanning protocol involves using a bladder scanner on a 15-point grid over the subject's left chest and parasternal, midclavicular, and anterior axillary intercostal spaces 3-7. Detected volumes will be recorded, with the presumption that the intercostal space with the largest measured volume is centered over the heart. Echocardiography will then be used to confirm the bladder scanner accuracy and to better describe the patient's internal chest anatomy. Having assessed procedural feasibility on 3 pilot subjects, we are now recruiting 100 participants, with planned interim analysis at 50 participants for sample size reassessment. Maximal volume location frequencies from the echocardiograms will be described and assessed for variation utilizing the goodness-of-fit test. The proportion of agreement across the two modalities regarding the maximal volume location will also be examined. Results: Among the 3 volunteers (pilot study), the scanner identified fluid in 4-8 of 15 intercostal spaces. In each of the three pilot study patients, the maximal volume identified by the bladder scanner was found to be at the parasternal location of the 6th intercostal space. This was also the location of the mid left ventricular diameter on echocardiography. Conclusion: Our literature review and pilot study data support the premise that lay persons and emergency medical personnel may improve compressions (and thus outcomes) during OHCA by using a scaled-down ultrasound to identify the location of optimal compression. We are currently enrolling patients in our study.
Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65–84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060–1122) compared with 522/100 000 (95% CI 501–545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61–22.87) vs. 6.82/100 000 (95% CI 4.56–9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.
During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
Objectives: Although subjective cognitive complaints (SCC) are an integral component of the diagnostic criteria for mild cognitive impairment (MCI), previous findings indicate they may not accurately reflect cognitive ability. Within the Alzheimer’s Disease Neuroimaging Initiative, we investigated longitudinal change in the discrepancy between self- and informant-reported SCC across empirically derived subtypes of MCI and normal control (NC) participants. Methods: Data were obtained for 353 MCI participants and 122 “robust” NC participants. Participants were classified into three subtypes at baseline via cluster analysis: amnestic MCI, mixed MCI, and cluster-derived normal (CDN), a presumptive false-positive group who performed within normal limits on neuropsychological testing. SCC at baseline and two annual follow-up visits were assessed via the Everyday Cognition Questionnaire (ECog), and discrepancy scores between self- and informant-report were calculated. Analysis of change was conducted using analysis of covariance. Results: The amnestic and mixed MCI subtypes demonstrated increasing ECog discrepancy scores over time. This was driven by an increase in informant-reported SCC, which corresponded to participants’ objective cognitive decline, despite stable self-reported SCC. Increasing unawareness was associated with cerebrospinal fluid Alzheimer’s disease biomarker positivity and progression to Alzheimer’s disease. In contrast, CDN and NC groups over-reported cognitive difficulty and demonstrated normal cognition at all time points. Conclusions: MCI participants’ discrepancy scores indicate progressive underappreciation of their evolving cognitive deficits. Consistent over-reporting in the CDN and NC groups despite normal objective cognition suggests that self-reported SCC do not predict impending cognitive decline. Results demonstrate that self-reported SCC become increasingly misleading as objective cognitive impairment becomes more pronounced. (JINS, 2018, 24, 842–853)
Reliable and affordable technology for collecting and managing livestock production process information is being developed. The advances in data measurement, collection and transfer technology enable us to retrieve information from one or more remote sites to be processed and managed centrally. This opens up the opportunity to advance from open loop, prescriptive production to closed loop systems where factors influencing the actual performance of animals are used to modify and improve their production parameters (feed, environment, medication). We strive from producing animals by predicting what is needed using outdated data, to measuring what is actually happening as they grow, processing this information and acting to optimise animal performance by modifying production parameters in real time.
This paper describes commercially available systems that make possible the retrieval, collection, processing and distribution of near real time production information. Various aspects of production management using this technology are discussed, and examples of how it can be applied to monitor water usage, how it relates to pig performance and how energy usage can be influenced, are considered.
This study compared the effect of feeding AmyPlus, a moist feed, as opposed to rolled wheat on the yield and composition of milk from dairy cows consuming grass silage based total mixed ration (TMR). Seventy-two Holstein-Friesian cows were distributed into AmyPlus (Treatment) and Wheat (Control) groups and loose housed on straw in an open shed. Each kg Wheat based concentrate contained 345g rolled wheat, 230g rapeseed meal, 115g sugarbeet pulp, 115g Molaferm 20, 115g soybean meal, 56g barley straw and 24g vitamin-minerals. In contrast, each kg AmyPlus based concentrate contained 501g AmyPlus (480g DM /kg), 105g rapeseed meal, 126g sugarbeet pulp, 126g Molaferm 20, 84g soybean meal, 41g barley straw and 17g vitamin-minerals. Here, AmyPlus was loaded directly into the mixer wagon to prepare fresh AmyPlus based TMR with a silage to concentrate ratio of 68:32. Each TMR was fed once daily to the corresponding group of cows also receiving 2kg of Distillers’ grains per cow in the parlour during milking. Daily milk yield and composition was recorded from November 1999 to February 2000. The overall daily Dry matter intake (DMI) of each TMR per cow remained uniform (20.19 vs 20.15 kg for Treatment and Control group respectively) across both groups. Daily milk yield and total cell counts per cow did not vary significantly (P>0.05) between groups during various months. While, milk fat and protein contents were greater in Treatment than Control group during each month, the differences were significant (P<0.05) only during November and December for fat and in January for protein. On average, the Treatment group tended to show a non-significant increase (P>0.05) in daily milk yield per cow by 0.144 kg than the Control group. The fat (46.2 vs 43.7) and protein (34.5 vs 33.5) contents in g /kg milk were also increased significantly (P<0.001) in Treatment compared with Control group. Total cell counts did not vary significantly (P>0.05) and remained within the acceptable limits. The cows consuming AmyPlus maintained their health as indicated by their intake, production, cell counts and general appearance. It would appear that AmyPlus can replace rolled wheat in TMR. However, it may be necessary to evaluate the storage, economic and environmental implications of using such moist co-products in silage based dairy rations.
Nutritional management of pigs to optimise growth demands pig-specific, time-specific and place-specific determination and provision of nutritional requirement. These elements need to be incorporated into response prediction models that operate in a real-time (not retrospective) closed-loop control environment. This implies appropriate means for the on-line measurement of response to change in nutrient provision, and the simultaneous means for manipulation of feeding level and feed quality. The paper describes how response prediction modelling and response measurement may now be achieved. Optimisation may be pursued with mixed objectives, including those of production efficiency and environmental protection.
A key to long-term sustainable enhancement of viable livestock production is the introduction of genetic traits that ensure that fertility and meat quality characteristics are compatible with farming environments and market needs. For example, the sheep industry could benefit if daughters of hill-breed ewes were of a crossbred genotype that enhances both carcass characteristics and fertility traits. Use of sires that confer better conformation is an option but does not significantly boost prolificacy. Introduction of the ‘Inverdale’ fecundity gene could change this. On a flock basis in the Romney breed, mean ovulation is increased by 1.0 and litter size by 0.6 in adult ewes carrying a single copy of this gene (designated as FecXI because it is on the X chromosome; Davis et al. 1992). Carrier males transmit it to all of their female offspring, these being heterozygous carriers of the gene unless it also is maternally inherited. In the latter instance, young would be infertile the homozygous genotype confers an undesirable ‘streak ovary’ phenotype. Although a number of sheep breeds world-wide exhibit significant ‘single gene’ effects on ovulation and litter size (Montgomery et al. 2001), Scottish hill sheep breeds show no evidence of this. Consequently, all ewe lambs generated by crossing these hill ewes with a ram carrying the Inverdale gene should be heterozygous. To ascertain whether such animals exhibit enhanced fecundity, an on-farm study investigated ovulation incidence in cyclic ewe lambs born to Cheviot or Scottish Blackface ewes that had been bred to Texel rams carrying a single copy of the ‘Inverdale’ gene.
Infra-red (JHK) photometry of long period variables (LPV) in the Magellanic Clouds has shown that the LPV's can be divided into core helium burning supergiants and asymptotic giant branch (AGB) stars. Application of the pulsation theory allows masses to be derived for the LPV's while stellar evolution theory allows core masses to be derived for the AGB stars. By considering evolution of the LPV's in the (Mbol,P) diagram, estimates of planetary nebula mass and planetary nebula nucleus mass are derived as a function of initial mass. Spectra of the LPV's suggest that many low mass planetary nebulae in the Magellanic Clouds should be carbon rich while the more massive nebulae may be nitrogen enhanced.
We have obtained Hubble Space Telescope (HST) Planetary Camera (PC) images of a number of Magellanic Cloud planetary nebulae. The objects, except for SMP 83 were observed as part of the Cycle I GO program. The observations were made in the [O III] λ5007Å line. The object SMP 83, was observed as part of the GTO program, and in this case observations were also made in the Hα line using the F650N filter. In order to characterise the point spread function, a star was placed at the same point on the chip as the PN. This allowed us to determine the diameters of barely resolved PN in an accurate manner, by convolving the PSF with a function until it matched the appearance of the PN image. The results are given in Table 1.
We present soft X-ray photomosaic images of two supernova remnants, Puppis A and IC 443, constructed from a series of exposures by the Einstein imaging instruments. The complex morphologies displayed in these images reflect the interaction between “middle-aged” supernova remnants and various components of the interstellar medium. Surface brightness variations across Puppis A suggest that inhomogeneities on scales from 0.2 to 30 pc are present in the interstellar medium, while the structure of IC 443 is apparently dominated by the interaction between the remnant and a giant molecular cloud.
The observational material for this study consists of a series of 19 I plates (IVN+RG715) of the southern half of the LMC taken by the UK Schmidt Telescope over a six year period from 1977–1983. A small region of size 28′x56′ centred on α(1950) = 5 28 50.7, δ(1950) = −69 31 56 was scanned on all plates with a PDS microdensitometer and magnitudes were derived for typically 14000 stars per scan area. All magnitudes were converted to a common system by comparison of magnitudes to a standard plate; this comparison showed the individual rms measurement error to be 0.13 mag. No photoelectric standard sequence exists in the region studied but the instrumental magnitudes have been converted to preliminary IK magnitudes by using the IK magnitudes given by Blanco, McCarthy and Blanco (1980) for some of the red stars in the field.
The evolution of planetary nebula (PN) nuclei has been studied at masses of 0.60, 0.70 and 0.76 M⊙, and for the ejection of the PN at various phases of a helium shell flash cycle. The evolution at high luminosities takes longer for nuclei resulting from PN ejection at shell flash peak than it does for those resulting from ejection in the inter-flash phase. Comparison of our calculations with various observational results does not allow us to reach any definite conclusions regarding the phase of the shell flash cycle at which PN ejection occurs.
We present soft x-ray observations made with the Einstein Observatory Imaging Proportional Counter (IPC) of IC443, W44 and W49B (for details of the observatory and instruments see Giacconi et al. 1979). The x-ray emission from IC443 and W44 is clearly concentrated within the interior of the remnant with little or no evidence for a limb-brightened shell. Significant spectral differences are found across the x-ray images in both remnants which are interpreted as being due to a combination of differential absorption by molecular clouds and intrinsic spatial temperature variations. The distant remnant W49B is only just resolved in the IPC observations, but additional observations with the High Resolution Imager (HRI) indicate a similar “infilled” morphology to IC443 and W44.
A search has been made for 1612 MHz OH maser emission from OH/IR stars in the Magellanic Clouds. Candidate objects were selected mainly on the basis of their 25μm flux densities and the 25 to 12μm flux ratio as given in the IRAS point source catalog; two known long-period variables and two HII regions (30 Doradus and N159) were also examined. One OH source (IRAS 04553-6825) was detected, this being the first OH/IR star found in the Magellanic Clouds. Upper limits were placed on the flux for 17 other sources. The expansion velocity of the circumstellar material surrounding IRAS 04553-6825, as indicated by the OH peak separation of 11 km s−1, is surprisingly small compared to Galactic sources of similar bolometric and OH luminosity. The OH intensity of IRAS 04553-6825, and the upper flux limits placed on many of the other objects examined, indicate that Magellanic Cloud OH/IR stars do not emit OH as strongly as their Galactic counterparts of similar 25μm/12μm flux ratio. Both the low expansion velocity of IRAS 04553-6825 and the low OH intensity of the Magellanic Cloud infrared sources may be explained by the low metal abundance in the Clouds.
More than 3000 radial velocity observations across the face of the Crab Nebula are used to investigate its 3-dimensional properties. In the standard model it consists of a thick hollow shell with synchrotron emission from within. We show that the thick shell is composed of bright inner and faint outer components
The temperature calibration for cool stars and in particular the Miras continues to be contentious. Lunar occultations have provided radii for many K and M stars and a good temperature calibration has been derived for the hotter non-variable M stars (Ridgway et al. 1980). The situation for the Miras and carbon stars and the metal-rich and metal-poor M stars is, however, not so clear cut. Observations are generally made in some broad-band color such as (R-I), (V-K) or (J-K) and a temperature derived using either the Ridgway et al. (1980) empirical scale or a black-body scale; differences can amount to several hundred degrees. We decided to theoretically explore the effects that extension, metallicity and pulsation could have on colors.
Extinctions have altered island ecosystems throughout the late Quaternary. Here, we review the main historic drivers of extinctions on islands, patterns in extinction chronologies between islands, and the potential for restoring ecosystems through reintroducing extirpated species. While some extinctions have been caused by climatic and environmental change, most have been caused by anthropogenic impacts. We propose a general model to describe patterns in these anthropogenic island extinctions. Hunting, habitat loss and the introduction of invasive predators accompanied prehistoric settlement and caused declines of endemic island species. Later settlement by European colonists brought further land development, a different suite of predators and new drivers, leading to more extinctions. Extinctions alter ecological networks, causing ripple effects for islands through the loss of ecosystem processes, functions and interactions between species. Reintroduction of extirpated species can help restore ecosystem function and processes, and can be guided by palaeoecology. However, reintroduction projects must also consider the cultural, social and economic needs of humans now inhabiting the islands and ensure resilience against future environmental and climate change.
A legionellosis outbreak at an industrial site was investigated to identify and control the source. Cases were identified from disease notifications, workplace illness records, and from clinicians. Cases were interviewed for symptoms and risk factors and tested for legionellosis. Implicated environmental sources were sampled and tested for legionella. We identified six cases with Legionnaires’ disease and seven with Pontiac fever; all had been exposed to aerosols from the cooling towers on the site. Nine cases had evidence of infection with either Legionella pneumophila serogroup (sg) 1 or Legionella longbeachae sg1; these organisms were also isolated from the cooling towers. There was 100% DNA sequence homology between cooling tower and clinical isolates of L. pneumophila sg1 using sequence-based typing analysis; no clinical L. longbeachae isolates were available to compare with environmental isolates. Routine monitoring of the towers prior to the outbreak failed to detect any legionella. Data from this outbreak indicate that L. pneumophila sg1 transmission occurred from the cooling towers; in addition, L. longbeachae transmission was suggested but remains unproven. L. longbeachae detection in cooling towers has not been previously reported in association with legionellosis outbreaks. Waterborne transmission should not be discounted in investigations for the source of L. longbeachae infection.