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.
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.
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
To study zooplankton–phytoplankton relationships in the diatom-dominated plankton communities of the northern Adriatic we performed feeding experiments with diatoms and zoea I larvae of the brachyuran Xantho poressa. We found that zoea I of X. poressa feed on diatoms of different forms (centric, pennate, colony forming, single celled, with or without setae) and size classes. In a laboratory setup, we presented the zoeas with a mix of diatom species similar to communities observed during blooms regularly found in the northern Adriatic. We report that the grazing activity resulted in a decrease of the relative abundance of the toxic diatom Pseudo-nitzschia calliantha. For the colonial, bloom-forming diatom Skeletonema marinoi our results show a chain length reduction in the presence of zoea I. Of particular interest is the observation that the presence of larvae also resulted in an increased growth rate and abundance of S. marinoi, which resembles bloom induction by grazer presence.
Two single-nucleotide polymorphisms (SNPs) (rs4281084 and rs12155594) within the neuregulin-1 (NRG1) gene have been associated with psychosis transition. However, the neurobiological changes associated with these SNPs remain unclear. We aimed to determine what relationship these two SNPs have on lateral ventricular volume and white matter integrity, as abnormalities in these brain structures are some of the most consistent in schizophrenia.
Structural (n = 370) and diffusion (n = 465) magnetic resonance imaging data were obtained from affected and unaffected individuals predominantly of European descent. The SNPs rs4281084, rs12155594, and their combined allelic load were examined for their effects on lateral ventricular volume, fractional anisotropy (FA) as well as axial (AD) and radial (RD) diffusivity. Additional exploratory analyses assessed NRG1 effects on gray matter volume, cortical thickness, and surface area throughout the brain.
Individuals with a schizophrenia age of onset ⩽25 and a combined allelic load ⩾3 NRG1 risk alleles had significantly larger right (up to 50%, padj = 0.01) and left (up to 45%, padj = 0.05) lateral ventricle volumes compared with those with allelic loads of less than three. Furthermore, carriers of three or more risk alleles, regardless of age of onset and case status, had significantly reduced FA and elevated RD but stable AD in the frontal cortex compared with those carrying fewer than three risk alleles.
Our findings build on a growing body of research supporting the functional importance of genetic variation within the NRG1 gene and complement previous findings implicating the rs4281084 and rs12155594 SNPs as markers for psychosis transition.
To assess iodine status among pregnant women in rural Zinder, Niger and to compare their status with the iodine status of school-aged children from the same households.
Seventy-three villages in the catchment area of sixteen health centres were randomly selected to participate in the cross-sectional survey.
Salt iodization is mandatory in Niger, requiring 20–60 ppm iodine at the retail level.
A spot urine sample was collected from randomly selected pregnant women (n 662) and one school-aged child from the same household (n 373). Urinary iodine concentration (UIC) was assessed as an indicator of iodine status in both groups. Dried blood spots (DBS) were collected from venous blood samples of pregnant women and thyroglobulin (Tg), thyroid-stimulating hormone and total thyroxine were measured. Iodine content of household salt samples (n 108) was assessed by titration.
Median iodine content of salt samples was 5·5 ppm (range 0–41 ppm), 98 % had an iodine content <20 ppm. Median (interquartile range) UIC of pregnant women and school-aged children was 69·0 (38·1–114·3) and 100·9 (61·2–163·2) µg/l, respectively. Although nearly all pregnant women were euthyroid, their median (interquartile range) DBS-Tg was 34·6 (23·9–49·7) µg/l and 38·4 % had DBS-Tg>40 µg/l.
In this region of Niger, most salt is inadequately iodized. UIC in pregnant women indicated iodine deficiency, whereas UIC of school-aged children indicated marginally adequate iodine status. Thus, estimating population iodine status based solely on monitoring of UIC among school-aged children may underestimate the risk of iodine deficiency in pregnant women.
Magnetic reconnection can occur in current sheets separating magnetic fields sheared by any angle and of arbitrarily different amplitudes. In such asymmetric and non-coplanar systems, it is not yet understood what the orientation of the X-line will be. Studying how this orientation is determined locally by the reconnection process is important to understand systems such as the Earth magnetopause, where reconnection occurs in regions with large differences in upstream plasma and field properties. This study aims at determining what the local X-line orientation is for different upstream magnetic shear angles in an asymmetric set-up relevant to the Earth’s magnetopause. We use two-dimensional hybrid simulations and vary the simulation plane orientation with regard to the fixed magnetic field profile and search for the plane maximizing the reconnection rate. We find that the plane defined by the bisector of upstream fields maximizes the reconnection rate and this appears not to depend on the magnetic shear angle, domain size or upstream plasma and asymmetries.
To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events
Retrospective chart review
A convenience sample of 8 acute-care hospitals in Pennsylvania
All patients hospitalized during 2011–2012
Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.
We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.
Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis.
We present preliminary results on a processing protocol by chemical activation that transforms organic waste product such as coconut husk into high surface area activated carbon. Dried raw materials of the coconut husk were carbonized anaerobically into char. The char was impregnated with KOH of different ratios and were activated at 800°C and 900°C. The transmission electron microscope was used to acquire structural and morphological information of the activated carbon, and the surface area and porosity analysis were performed using Micromeritics ASAP 2020 analyzer. The activated carbons show both micropores and mesopores with specific surface area as high as 2900m2/g.
We outfitted six male Hawaiian geese, or nene (Branta sandvicensis), with 45-g solar-powered satellite transmitters and collected four location coordinates d−1 from 2010 to 2012. We used 6193 coordinates to characterize migration corridors, habitat preferences and temporal patterns of displacement for 16 migration events with Brownian bridge utilization distributions (BBUD). We used 1552 coordinates to characterize stopovers from 37 shorter-distance movement events with 25% BBUDs. Two subpopulations used a well-defined common migration corridor spanning a broad gradient of elevation. Use of native-dominated subalpine shrubland was 2.81 times more likely than the availability of this land-cover type. The nene differed from other tropical and temperate-zone migrant birds in that: (1) migration distance and the number of stopovers were unrelated (Mann–Whitney test W = 241, P < 0.006), and; (2) individual movements were not unidirectional suggesting that social interactions may be more important than refuelling en route; but like other species, nene made more direct migrations with fewer stopovers in return to breeding areas (0.58 ± 0.50) than in migration away from breeding areas (1.64 ± 0.48). Our findings, combined with the direction and timing of migration, which is opposite that of most other intratropical migrants, suggest fundamentally different drivers of altitudinal migration.
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
The geologic sequestration of carbon dioxide ( CO2) in structural and stratigraphic traps is a viable option to reduce anthropogenic emissions. While dissolution of the CO2 stored in these traps reduces the long-term leakage risk, the dissolution process remains poorly understood in systems that reflect the appropriate subsurface geometry. Here, we study dissolution in a porous layer that exhibits a feature relevant for CO2 storage in structural and stratigraphic traps: a finite CO2 source along the top boundary that extends only part way into the layer. This feature represents the finite extent of the interface between free-phase CO2 pooled in a trap and the underlying brine. Using theory and simulations, we describe the dissolution mechanisms in this system for a wide range of times and Rayleigh numbers, and classify the behaviour into seven regimes. For each regime, we quantify the dissolution flux numerically and model it analytically, with the goal of providing simple expressions to estimate the dissolution rate in real systems. We find that, at late times, the dissolution flux decreases relative to early times as the flow of unsaturated water to the CO2 source becomes constrained by a lateral exchange flow though the reservoir. Application of the models to several representative reservoirs indicates that dissolution is strongly affected by the reservoir properties; however, we find that reservoirs with high permeabilities (
Darcy) that are tens of metres thick and several kilometres wide could potentially dissolve hundreds of megatons of CO2 in tens of years.
Few fathers will hesitate to chop down a tree if this helps to pay for the education of their children, even though they know that this might hurt them in the long run. Neither is it much of a choice when existing plots of farmland become unproductive, and a farmer can either let his family go hungry, or create a new plot by burning down a patch of forest. Considering these ‘choices’, it is no surprise that the forest and farming practices of the poor forest and mountain communities have been the main causes of forest depletion in the Philippines.
The Philippine forests are home to a large, marginalized sector of society composed of both migrant and indigenous dwellers. They constitute about 20 million or 25% of the total population and are generally considered the poorest of the poor. The relationship between poverty and forest degradation is not always the same and there are some poor forest communities that invest considerable time and resources in sustainable forest management practices while trying to meet their basic needs. In many cases, however, these communities’ dependence on the forests results in the degradation of the resources they need for their livelihood and survival.