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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Single-molecule manipulation and detection of biomolecules has significantly advanced our understanding of the molecular movement, dynamics, and biological function of proteins. Fluorescence microscopy currently serves as one of the primary noninvasive techniques for the sensitive detection of molecules in solution and on surfaces. However, the performance and sensitivity of this laser-induced fluorescence technique is strongly influenced by the fluorescent labels attached to DNA, proteins or cells. Organic dyes have most commonly been used as fluorescent biolabels; however, they quickly photobleach, limiting the time scale over which molecular events can be followed. Quantum dots show great promise for fluorescence measurements due to their improved photophysical properties, such as size-tunable narrow emissions, large Stokes shifts and minimal photobleaching. However, problems still exist for the use of quantum dots as biolabels, including: photoblinking, toxic synthetic approaches, surface passivation issues and relatively large physical sizes that are comparable to proteins. Here, we report the synthesis of a new class of fluorescent labels, gold nanoclusters, which consist of several gold atoms (<1 nm in size) with strong fluorescence emission. These small fluorescent gold nanoclusters are synthesized at physiological temperature using poly(amidoamine) dendrimer as a template. Small blue emissive gold nanoclusters were produced without the use of a reductant and without concurrent nanoparticle formation. Gold nanoclusters with green and red emissions were synthesized using a mild reductant, also without nanoparticle formation. The studies of pH-dependent stability suggest that these fluorescent nanoclusters are very stable in a pH range of 6 - 8. These new approaches produce gold nanoclusters with a much higher yield and eliminate the toxicity of the previously reported process, resulting in a biologically compliant approach. This work is the first known report of fluorescent gold nanoclusters via a green-chemistry approach and without the formation of gold nanoparticles. This work is funded by Los Alamos Laboratory Directed research and Development program.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Recently, the telecommunication market experiences an explosion in the subscribers of emergent high-debit services which require bandwidth that exceeds the one provided by actual copper based access networks . To cope with these demands and keep competitive, great efforts have been done to develop access networks based on optical technology, such as passive all-optical networks due to their intrinsic low cost . Sol-gel processing is suitable for the development of organic-inorganic hybrid (OIH) materials for the production of functional integrated optic (IO) devices in a cost effective way. Urea cross-linked OIH show acceptable transparency, mechanical flexibility and thermal stability [3-6]. The control over the refractive index is achieved by zirconium (IV) n-propoxide (ZPO) doping stabilized with methacrylic acid (MA) [3-5]. The combination in a single material of urea cross-linked OIH and ZPO allowed the preparation of UV written low losses planar waveguides  and low rugosity diffraction grating [4,5]. It has been demonstrated that MA acts not only as ZPO stabilizer but impacts directly on the photopolimerization properties as it contains a photopolymerizable group making the OIH easily UV patterned without photoinitiator . Moreover, it also impacts on the OHIs local structure as it forms a complex with ZPO, that originate ordered clusters dispersed within the OIH host [4,5]. Besides the potential of this OIH as IO components, the hybrid hosts are room-temperature efficient white light emitters lacking metal activator ions, presenting quantum yields as higher as 20 % . In this work, a series of OIH, so called di-ureasils, formed of a siliceous skeleton to which oligopolyether chains of different lengths are covalently grafted by means of urea bridges and modified by ZPO and MA will be prepared and characterized by X-ray and small angle X-ray diffractions, Raman, infrared, atomic force and photoluminescence spectroscopies. The use of the proposed OIH in the development of IO functionalities such as optical filters will be evaluated based on waveguide numerical simulation methods (beam propagation method). Waveguides will be written and characterized using the OIH aforementioned. The recording of a Bragg grating in the waveguides allow the implementation of a wavelength discrimination device with applications on optical filtering. The relevant properties of the devices, such as spectral rejection and insertion losses will be characterized.  S-J Park et al. Journal of Lightwave Tech. 22, 2004.  D.J. Shin et al., Journal of Lightwave Tech. 23, 2005.  C. Molina et al., J. Mater. Chem. 15, 3937, 2005.  R.A. Sá Ferreira et al., Proceedings of the International Conference on Telecomunications, 2006.  P.S. André et al. Proceedings ICTON, 1, We.C1.6, 223, 2006.  a) L.D. Carlos et al., Adv. Func. Mater. 11, 111, 2001; b) J. Chem. Phys. B. 108, 14924, 2004. Siemens SA and FCT (POCTI/CTM/59075/2004) is gratefully acknowledged.
Hydrilla is an invasive aquatic plant that has rapidly spread through many inland water bodies across the globe by outcompeting native aquatic plants. The negative impacts of hydrilla invasion have become a concern for water resource management authorities, power companies, and environmental scientists. The early detection of hydrilla infestation is very important to reduce the costs associated with control and removal efforts of this invasive species. Therefore, in this study, we aimed to develop a tool for rapid, frequent, and large-scale monitoring and predicting spatial extent of hydrilla habitat. This was achieved by integrating in situ and Landsat 8 Operational Land Imager satellite data for Lake J. Strom Thurmond, the largest US Army Corps of Engineers lake east of the Mississippi River, located on the border of Georgia and South Carolina border. The predictive model for presence of hydrilla incorporated radiometric and physical measurements, including remote-sensing reflectance, Secchi disk depth (SDD), light-attenuation coefficient (Kd), maximum depth of colonization (Zc), and percentage of light available through the water column (PLW). The model-predicted ideal habitat for hydrilla featured high SDD, Zc, and PLW values, low values of Kd. Monthly analyses based on satellite images showed that hydrilla starts growing in April, reaches peak coverage around October, begins retreating in the following months, and disappears in February. Analysis of physical and meteorological factors (i.e., water temperature, surface runoff, net inflow, precipitation) revealed that these parameters are closely associated with hydrilla extent. Management agencies can use these results not only to plan removal efforts but also to evaluate and adapt their current mitigation efforts.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Solvency II came into force on 1 January 2016 and included a transitional measure on technical provisions (“TMTP”) designed to help smooth in the capital impact of Solvency II over a 16-year period. The working party’s view is that the main intention of the TMTP is to mitigate the impact of the introduction of the risk margin, which significantly increases the technical provisions of firms, relative to their Solvency I Pillar 2 liabilities.
The majority of firms who hold a TMTP have now had at least one recalculation approved by the Prudential Regulation Authority (PRA); or are in the process of applying for a recalculation. Despite this large number of approved recalculations, there remains significant uncertainty in the industry around the approach and triggers for recalculation.
This paper considers aspects of TMTP recalculation for regulated UK life firms, for example practicalities of the calculation, asset and liability considerations, and communications/announcements.
In this paper, we outline the need for pragmatism when considering the approach to recalculation of a measure originally intended to serve as the bridge between two regimes. We call for an allowance for doing what is sensible in a principles-based regime balancing what might be more theoretically correct with what is practical and possible to support effective management of the business.
There are no estimates of the heritability of phenotypic udder traits in suckler sheep, which produce meat lambs, and whether these are associated with resilience to mastitis. Mastitis is a common disease which damages the mammary gland and reduces productivity. The aims of this study were to investigate the feasibility of collecting udder phenotypes, their heritability and their association with mastitis in suckler ewes. Udder and teat conformation, teat lesions, intramammary masses (IMM) and litter size were recorded from 10 Texel flocks in Great Britain between 2012 and 2014; 968 records were collected. Pedigree data were obtained from an online pedigree recording system. Univariate quantitative genetic parameters were estimated using animal and sire models. Linear mixed models were used to analyse continuous traits and generalised linear mixed models were used to analyse binary traits. Continuous traits had higher heritabilities than binary with teat placement and teat length heritability (h2) highest at 0.35 (SD 0.04) and 0.42 (SD 0.04), respectively. Udder width, drop and separation heritabilities were lower and varied with udder volume. The heritabilities of IMM and teat lesions (sire model) were 0.18 (SD 0.12) and 0.17 (SD 0.11), respectively. All heritabilities were sufficiently high to be in a selection programme to increase resilience to mastitis in the population of Texel sheep. Further studies are required to investigate genetic relationships between traits and to determine whether udder traits predict IMM, and the potential benefits from including traits in a selection programme to increase resilience to chronic mastitis.
Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.
We aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response.
Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety.
Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28–3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68–16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response.
Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects.
Dietary fatty acid (FA) composition may influence metabolism, possibly affecting weight management. The purpose of this study was to compare the effects of a 5-d diet rich in PUFA v. MUFA. A total of fifteen normal-weight men participated in a randomised cross-over design with two feeding trials (3 d lead-in diet, pre-diet visit, 5-d PUFA- or MUFA-rich diet, post-diet visit). The 5-d diets (50 % fat) were rich in either PUFA (25 % of energy) or MUFA (25 % of energy). At pre- and post-diet visits, subjects consumed breakfast and lunch test meals, rich in the FA for that 5-d diet. Indirect calorimetry was used for 4 h after each meal. There were no treatment differences in fasting metabolism acutely or after the 5-d diet. For acute meal responses before diet, RER was higher for PUFA v. MUFA (0·86 (sem 0·01) v. 0·84 (sem 0·01), P<0·05), whereas diet-induced thermogenesis (DIT) was lower for PUFA v. MUFA (18·91 (SEM 1·46) v. 21·46 (SEM 1·34) kJ, P<0·05). After the 5-d diets, the change in RER was different for PUFA v. MUFA (−0·02 (sem 0·01) v. 0·00 (sem 0·01), P<0·05). Similarly, the change in fat oxidation was greater for PUFA v. MUFA (0·18 (sem 0·07) v. 0·04 (sem 0·06) g, P<0·05). In conclusion, acutely, a MUFA-rich meal results in lower RER and greater DIT. However, after a 5-d high-fat diet, the change in metabolic responses was greater in the PUFA diet, showing the metabolic adaptability of a PUFA-rich diet.
Arachidonic acid (ARA) and DHA, supplied primarily from the mother, are required for early development of the central nervous system. Thus, variations in maternal ARA or DHA status may modify neurocognitive development. We investigated the relationship between maternal ARA and DHA status in early (11·7 weeks) or late (34·5 weeks) pregnancy on neurocognitive function at the age of 4 years or 6–7 years in 724 mother–child pairs from the Southampton Women’s Survey cohort. Plasma phosphatidylcholine fatty acid composition was measured in early and late pregnancy. ARA concentration in early pregnancy predicted 13 % of the variation in ARA concentration in late pregnancy (β=0·36, P<0·001). DHA concentration in early pregnancy predicted 21 % of the variation in DHA concentration in late pregnancy (β=0·46, P<0·001). Children’s cognitive function at the age of 4 years was assessed by the Wechsler Preschool and Primary Scale of Intelligence and at the age of 6–7 years by the Wechsler Abbreviated Scale of Intelligence. Executive function at the age of 6–7 years was assessed using elements of the Cambridge Neuropsychological Test Automated Battery. Neither DHA nor ARA concentrations in early or late pregnancy were associated significantly with neurocognitive function in children at the age of 4 years or the age of 6–7 years. These findings suggest that ARA and DHA status during pregnancy in the range found in this cohort are unlikely to have major influences on neurocognitive function in healthy children.
J. F. Cooper, NASA Goddard Space Flight Center Greenbelt, Maryland, USA,
R. E. Johnson, University of Virginia Charlottesville, Virginia, USA,
P. Kollmann, Johns Hopkins University Applied Physics Laboratory Laurel, Maryland, USA,
E. Roussos, Max Planck Institute for Solar System Studies Göttingen, GERMANY,
E. C. Sittler, NASA Goddard Space Flight Center Greenbelt, Maryland, USA
Ring systems around magnetized planets are expected to have varied interactions with the magnetic fields, hot plasma, and energetic particles of the associated magnetospheres. In our solar system all the giant planets, Jupiter to Neptune, have magnetospheres with embedded rings. Each ring system and its associated moons have strong interactions with their radiation environments (the most intense of which is at Jupiter). Such interactions both erode diffuse rings (such as the E ring of Saturn) and supply plasma and energetic particles to the magnetosphere and its radiation belts. Compositional and structural measurements of rings are enabled by these interactions, such as the information obtained by detection of the secondary neutron and gamma-ray emissions produced by galactic cosmic ray (GCR) interactions with the rings. It is also notable that Earth has both a magnetosphere with radiation belts, and an artificial ring system of satellites and debris, that continuously interact. Konradi (1988) even projected that the high energy trapped protons of the inner Van Allen Belt should now be experiencing significant depletion by this interaction, and we will later discuss the possible evidence for this. Magnetized exoplanets with rings would have similar interactions.
The ring systems of Jupiter and Saturn have been explored by multiple spacecraft. The Jovian ring environment was first explored in situ in 1974 by Pioneer 11, which subsequently flew under Saturn's main rings in 1979. After passing through the Saturn ring plane near the G ring in 1981, Voyager 2 encountered Uranus in 1986 and then Neptune in 1989, but in neither case were the rings and arcs of these two ice giant planets traversed. The Galileo Probe passed across the Jovian ring in December 1995 en route to the first direct penetration into Jupiter's atmosphere. The Cassini Orbiter crossed over the Saturn A and B rings in mid-2004 (Figure 14.1) as part of the Saturn Orbital Insertion (SOI). Cassini will again traverse the main rings during its Grand Finale orbit phase many times, crossing the ring plane just inwards of the D ring, prior to final atmospheric entry in 2017. With the exception of the Cassini Plasma Spectrometer (CAPS) instrument, turned off in 2012 due to electrical problems, Cassini will continue to operate through the final observations.
To understand increasing rates of hepatitis C virus (HCV) infection in Tennessee, we conducted testing, risk factor analysis and a nested case–control study among persons who use drugs. During June–October 2016, HCV testing with risk factor assessment was conducted in sexually transmitted disease clinics, family planning clinics and an addiction treatment facility in eastern Tennessee; data were analysed by using multivariable logistic regression. A nested case–control study was conducted to assess drug-using risks and behaviours among persons who reported intranasal or injection drug use (IDU). Of 4753 persons tested, 397 (8.4%) were HCV-antibody positive. HCV infection was significantly associated with a history of both intranasal and IDU (adjusted odds ratio (aOR) 35.4, 95% confidence interval (CI) 24.1–51.9), IDU alone (aOR 52.7, CI 25.3–109.9), intranasal drug use alone (aOR 2.6, CI 1.8–3.9) and incarceration (aOR 2.7, CI 2.0–3.8). By 4 October 2016, 574 persons with a reported history of drug use; 63 (11%) were interviewed further. Of 31 persons who used both intranasal and injection drugs, 26 (84%) reported previous intranasal drug use, occurring 1–18 years (median 5.5 years) before their first IDU. Our findings provide evidence that reported IDU, intranasal drug use and incarceration are independent indicators of risk for past or present HCV infection in the study population.
The effects of high milk yields on the behaviour and welfare of the dairy cow are unclear. A high milk yield increases the need to consume sufficient fodder in an attempt to meet high nutrient demands. The failure to meet the demands may result in persistent hunger in the dairy cow having to modify her behaviour by employing various coping strategies. These modifications may help the cow overcome a state of hunger but at the expense of being unable to express other important behaviours. The objective of this study was therefore to determine whether the behaviour and welfare of the genetically high yielding dairy cow is being compromised by the increased nutritional demands of milk production, and to investigate the possibility that an increased amount of time spent in food-directed behaviours may have a detrimental effect on the time available to perform other important behaviours.
To determine the patterns and predictors of treatment response trajectories for veterans with post-traumatic stress disorder (PTSD).
Conditional latent growth mixture modelling was used to identify classes and predictors of class membership. In total, 2686 veterans treated for PTSD between 2002 and 2015 across 14 hospitals in Australia completed the PTSD Checklist at intake, discharge, and 3 and 9 months follow-up. Predictor variables included co-morbid mental health problems, relationship functioning, employment and compensation status.
Five distinct classes were found: those with the most severe PTSD at intake separated into a relatively large class (32.5%) with small change, and a small class (3%) with a large change. Those with slightly less severe PTSD separated into one class comprising 49.9% of the total sample with large change effects, and a second class comprising 7.9% with extremely large treatment effects. The final class (6.7%) with least severe PTSD at intake also showed a large treatment effect. Of the multiple predictor variables, depression and guilt were the only two found to predict differences in response trajectories.
These findings highlight the importance of assessing guilt and depression prior to treatment for PTSD, and for severe cases with co-morbid guilt and depression, considering an approach to trauma-focused therapy that specifically targets guilt and depression-related cognitions.