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Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED) and are often not used correctly, which leads to unnecessary CT scanning. The YEARS diagnostic algorithm, consisting of three items (clinical signs of deep vein thrombosis, hemoptysis, and whether pulmonary embolism is the most likely diagnosis) and D-dimer, is a novel and simplified way to approach suspected acute PE. The purpose of this study was to 1) evaluate the use of the YEARS algorithm in the ED and 2) to compare the rates of testing for PE if the YEARS algorithm was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 and those without a D-dimer test were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the false negative rate was calculated. Results: There were 1,163 patients that were tested for PE and 1,083 patients were eligible for our analysis. Of the total, 317/1,083 (29.3%; 95%CI 26.6-32.1%) had CT/VQ imaging for PE, and 41/1,083 (3.8%; 95%CI 2.8-5.1%) patients were diagnosed with PE at baseline. Three patients had a missed PE, resulting in a false negative rate of 0.4% (95%CI 0.1-1.2%). If the YEARS algorithm was used, 211/1,083 (19.5%; 95%CI 17.2-22.0%) would have required imaging for PE. Of the patients who would not have required imaging according to the YEARS algorithm, 8/872 (0.9%; 95%CI 0.5-1.8%) would have had a missed PE. Conclusion: If the YEARS algorithm was used in all patients with suspected PE, fewer patients would have required imaging with a small increase in the false negative rate.
Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. The pulmonary embolism rule-out criteria (PERC) can identify patients who can be safely discharged from the ED without further investigation for PE. The purpose of this study is to evaluate the use of the PERC rule in the ED and to compare the rates of testing for PE if the PERC rule was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the negative predictive value was calculated. Results: There were 1,163 patients that were tested for PE and 1,097 patients were eligible for our analysis. Of the total, 330/1,097 (30.1%; 95%CI 27.4-32.3%) had CT/VQ imaging for PE, and 48/1,097 (4.4%; 95%CI 3.3-5.8%) patients were diagnosed with PE. 806/1,097 (73.5%; 95%CI 70.8-76.0%) were PERC positive, and of these, 44 patients had a PE (5.5%; 95%CI 4.1-7.3%). Conversely, 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients were PERC negative, and of these, 4 patients had a PE (1.4%; 95%CI 0.5-3.5%). Of the PERC negative patients, 291/291 (100.0%; 95%CI 98.7-100.0%) had a D-dimer test done, and 33/291 (11.3%; 95%CI 8.2-15.5%) had a CT angiogram. If PERC was used, CT/VQ imaging would have been avoided in 33/1,097 (3%; 95%CI 2.2-4.2%) patients and the D-dimer would have been avoided in 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients. Conclusion: If the PERC rule was used in all patients with suspected PE, fewer patients would have further testing. The false negative rate for the PERC rule was low.
The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.
Prospective survey of rhinology patients.
Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.
Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.
Recent observations on strength and deformation of small metals containing microstructures, including dislocation patterns, grain boundaries, and second-phase precipitates are reviewed. These microstructures impose an internal length scale that may interplay with the extrinsic length scale due to the specimen size to affect strength and deformation in an intricate manner. For micro-crystals containing pre-existing dislocations, Taylor work-hardening may dictate the dependence of strength on specimen size. The presence of grain boundaries in a small specimen may lead to effects far from the conventional Hall–Petch behavior. Precipitate–dislocation interactions in a small specimen may lead to an interesting weakest-size behavior.
We use Monte Carlo techniques to simulate the statistical properties of rotation-powered pulsars in the Gould Belt. The gamma-ray properties of these pulsars are calculated by using a self-consistent outer gap model and other pulsar properties, i.e., initial magnetic field and period, and velocity distribution of the neutrons stars at birth, are obtained from the statistics of radio pulsars. We obtain distributions of the magnetic inclination angle, period, distance and age for these gamma-ray pulsars in the Gould Belt.
Vitamin D plays an important role in skeletal health throughout life. Some studies have hypothesised that vitamin D may reduce the risk of other diseases. Our study aimed to estimate age-specific and sex-specific serum 25-hydroxyvitamin D (25(OH)D) status and to identify the determinants of serum 25(OH)D status in Hong Kong, a subtropical city in southern China. In 2009–2010, households in Hong Kong were followed up to identify acute respiratory illnesses, and sera from 2694 subjects were collected in three to four different study phases to permit measurement of 25(OH)D levels at different times of the year. A questionnaire survey on diet and lifestyle was conducted among children, with simultaneous serum collection in April and May 2010. The mean of serum 25(OH)D levels in age groups ranged from 39 to 63 nmol/l throughout the year with the mean values in all age groups in spring below 50 nmol/l. Children aged 6–17 years, and girls and women had significantly lower serum 25(OH)D levels than adults, and boys and men, respectively (all P< 0·001). We estimated that serum 25(OH)D levels in Hong Kong followed a lagged pattern relative to climatic season by 5 weeks with lowest observed levels in early spring (March). For children aged 6–17 years, reporting a suntan, having at least 1 servings of fish/week and having at least 1 serving of eggs/week were independently associated with higher serum 25(OH)D levels. Adequate sunlight exposure and increased intake of dietary vitamin D could improve vitamin D status, especially for children and females in the winter and spring.
The aims of this study were to identify Staphylococcus aureus nasal colonization prevalence, behavioural risk factors, and to determine staphylococcal protein A (spa) types in community-based injection drug users (IDUs). Nasal swabs were collected and methicillin susceptibility testing and spa/SCCmec typing were performed on S. aureus isolates. Generalized estimating equations were used to report adjusted odds ratios and 95% confidence intervals. Of the 440 participants, 24·1% were colonized and 5·7% had methicillin-resistant S. aureus (MRSA). Colonization was associated with age, employment/marital status, and the presence of scabs but not with sexually transmitted disease co-infection, HIV status, antibiotic use, hospitalization, or drug treatment programme participation. The USA300 MRSA clone spa types were most common, but 15/49 spa types were new to one of the international databases. Community-based IDUs appear to have different risk factors compared to IDUs from clinical studies. In addition, the number of newly identified spa types indicates a diverse, understudied population.
We examined factors affecting the immunogenicity of trivalent inactivated influenza vaccination (TIV) in children using the antibody titres of children participating in a Hong Kong community-based study. Antibody titres of strains included in the 2009–2010 northern hemisphere TIV [seasonal A(H1N1), seasonal A(H3N2) and B (Victoria lineage)] and those not included in the TIV [2009 pandemic A(H1N1) and B (Yamagata lineage)] were measured by haemagglutination inhibition immediately before and 1 month after vaccination. Multivariate regression models were fitted in a Bayesian framework to characterize the distribution of changes in antibody titres following vaccination. Statistically significant rises in geometric mean antibody titres were observed against all strains, with a wide variety of standard deviations and correlations in rises observed, with the influenza type B antibodies showing more variability than the type A antibodies. The dynamics of antibody titres after vaccination can be used in more complex models of antibody dynamics in populations.
The epidemiology of varicella is believed to differ between temperate and tropical countries. We conducted a varicella seroprevalence study in elementary and college students in the US territory of American Samoa before introduction of a routine varicella vaccination programme. Sera from 515 elementary and 208 college students were tested for the presence of varicella-zoster virus (VZV) IgG antibodies. VZV seroprevalence increased with age from 76·0% in the 4–6 years group to 97·7% in those aged ⩾23 years. Reported history of varicella disease for elementary students was significantly associated with VZV seropositivity. The positive and negative predictive values of varicella disease history were 93·4% and 36·4%, respectively, in elementary students and 97·6% and 3·0%, respectively, in college students. VZV seroprevalence in this Pacific island appears to be similar to that in temperate countries and suggests endemic VZV circulation.
We examined the impact of the neonatal hepatitis B immunization programme, first provided to all neonates born to mothers screened positive for hepatitis B surface antigen (HBsAg) in late 1983, on the age-specific prevalence of HBsAg carriage in teenage mothers managed in 1998–2008. HBsAg carriage was found in 2·5%, 2·7%, 8·8% and 8·0% of mothers aged ⩽16, 17, 18, and 19 years, respectively (P = 0·004), which was also correlated with advancing age (P = 0·011). While neither difference nor correlation with age was found in mothers born before 1984, the prevalence of 1·2%, 1·5%, 7·1% and 8·3%, respectively, was significantly different among (P = 0·008) and correlated with (P = 0·002) age in mothers born 1984 onwards. Regression analysis indicated there was a significantly higher incidence of HBsAg carriage from age 17 onwards (adjusted odds ratio 2·55, 95% confidence interval 1·07–6·10, P = 0·035), suggesting that the protective effect of the vaccine declined in late adolescence.
Fullerene chemistry is booming, but how the chemical reactions affect fullerene's materials properties has seldom been studied. We have investigated optical limiting behavior of a series of fullerene derivatives, polymers, and glasses and have observed the following structure-property relationships for optical limiting in the fullerene materials: (i) The fullerene polymers with aromatic and chlorine moieties, i.e., C60-containing polycarbonate (C60-PC), polystyrene (C60- PS), and poly(vinyl chloride) (C60-PVC), limit the 8-ns pulses of 532-nm laser light more effectively than does the parent C60; (ii) the fullerene polymers with carbonyl groups, i.e., C60- containing CR-39 (C60-CR-39) and poly(methyl methacrylate), (C60-PMMA), do not enhance C60's limiting power; and (iii) the aminated fullerene derivatives, i.e., HxC60 (NHR)x [R = -(CH2CH2O)2H (1), x = 11; -(CH2)6OH (2), x = 7; -cyclo-C6H11 (3), x = 11; -(CH2)3Si(OC2H5)3 (4), x = 4], and their sol-gel glasses, i.e., 1–3/SiO2 (physical blending) and 4-SiO2 (chemical bonding), show complex limiting responses, with 4(-SiO2) performing consistently better than 1-3(/SiO2). The fullerene glasses are optically stable and their optical limiting properties remainunchanged after being subjected to continuous attack by the strong laser pulses for ca. 1 h.
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.
New noncentrosymmetric compounds having both electron-accepting and electron-donating substituents on a conjugated, aromatic heterocyclic structure were synthesized and their spectroscopic, thermal, and solubility properties were determined. D.C. electric field-induced second harmonic generation (EFISH) experiments were performed to provide values of the second-order nonlinear optical susceptibility/dipole moment product βμ. Long alkyl substituents were required in heterocycle-containing compounds for sufficient solubility to conduct EFISH analysis. 2,4-Dinitro-substitution on these imine-linked materials gave the highest βμ in the series.
Bulk single crystals of GaN were used for epitaxial growth of GaN films by molecular beam epitaxy. Low temperature photoluminescence yields much higher intensity emission in the near bandedge region for epitaxial films with respect to the situation in bulk crystals. Character of this luminescence changes also. Dominant band-to-band transitions in the bulk crystals are exchanged by bound exciton and/or donor-acceptor pair transitions observed in the epitaxial layers. We will compare the obtained results with the available data on the homoepitaxial samples grown by metalorganic chemical vapor deposition method and discuss the importance of establishing the basic information on energetic positions of excitonic transitions in stress free samples.
Capacitors, resistors and inductors are surface mounted components on circuit boards, which occupy up to 70% of the circuit board area. For selected applications, these passives are packaged inside green ceramic tape substrates and sintered at temperatures over 700°C in a co-fired process. These high temperature processes are incompatible with organic substrates, and low temperature processes are needed if passives are to be embedded into organic substrates. A new high permeability dual-phase Nickel Zinc Ferrite (DP NZF) core fabricated using a low temperature sol-gel route was developed for use in embedded inductors in organic substrates. Crystalline NZF powder was added to the sol-gel precursor of NZF. The solution was deposited onto the substrates as thin films and heat-treated at different temperatures. The changes in the microstructures were characterized using XRD and SEM. Results showed that addition of NZF powder induced low temperature transformation of the sol-gel NZF phase to high permeability phase at 250°C, which is approximately 350°C lower than transformation temperature for pure NZF sol gel films. Electrical measurements of DP NZF cored two-layered spiral inductors indicated that the inductance increased by three times compared to inductors without the DP NZF cores. From microstructural observations, the increase is correlated with the changes in microstructural connectivity of the powder phase.
Phase evolution during ball milling of Si in NH3 gas and during subsequent annealing has been studied and compared with nitride formation during ion bombardment of Si. X-ray diffraction, differential thermal analysis, Rutherford backscattering and channeling, combustion analysis and transmission electron microscopy have been used as analytical techniques. Results have shown that an amorphous SixNy(Fe) phase forms during milling which transforms into α-Si3N4 and FeSi2 on annealing. During ion bombardment, slightly N-rich Si3N4 is formed but it is mostly crystalline at temperatures between 150 and 450°C.
This study reports on the use of zirconolite-rich Synroc to demonstrate the safe immobilisation of ‘high-fired’ Pu02. The zirconolite-rich Synroc used in this study was prepared by adding 13 wt% Pu with equimolar amounts of Gd and Hf, relative to Pu, as neutron absorbers. The incorporation of the Pu and neutron absorbers has been studied microstructurally as well as by longer-term leach testing. This work has shown that the sintered ceramic can immobilise 13 wt% of Pu with almost complete incorporation of the Pu (≃ 98%) into the zirconolite phase. Durability studies have shown that under a wide range of leaching conditions there is no major separation of the Pu and neutron absorbers, with the majority of these elements either remaining in the matrix or leaching at low (< 10−4 g m−2 d−1) and comparable rates from the waste form.
The effects of film thickness and passivation on plasticity of thin metal films on substrates have been studied using gold films as a model system. Wafer curvature/thermal cycling measurements were used to study plasticity in films ranging in thickness from 0.2 to 2.5 micrometers. We were able to describe these stress-temperature curves using a simple phenomenological model for linear kinematic hardening. The yield stresses revealed by the modeling were inversely proportional to the film thickness for thicknesses greater than about one micrometer. This relationship is expected from a dislocation model of plasticity. However, the residual stresses in thinner films are substantially lower than this relationship would predict and on unloading, these films show stress-temperature plots not predicted by the model. Stress-temperature curves were also measured after a tungsten passivation was deposited on the gold surface. Films thinner than one micrometer were substantially strengthened by this passivation and could then be described by the linear kinematic model. The observed stresses are only minimally affected for films thicker than about a micrometer. This strengthening effect on thinner films is consistent with the complete blocking of grain boundary diffusion near the free surface of the film.