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School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
The increase in mortality and total prehospital time (TPT) seen in Qatar appear to be realistic. However, existing reports on the influence of TPT on mortality in trauma patients are conflicting. This study aimed to explore the impact of prehospital time on the in-hospital outcomes.
A retrospective analysis of data on patients transferred alive by Emergency Medical Services (EMS) and admitted to Hamad Trauma Center (HTC) of Hamad General Hospital (HGH; Doha, Qatar) from June 2017 through May 2018 was conducted. This study was centered on the National Trauma Registry database. Patients were categorized based on the trauma triage activation and prehospital intervals, and comparative analysis was performed.
A total of 1,455 patients were included, of which nearly one-quarter of patients required urgent and life-saving care at a trauma center (T1 activations). The overall TPT was 70 minutes and the on-scene time (OST) was 24 minutes. When compared to T2 activations, T1 patients were more likely to have been involved in road traffic injuries (RTIs); experienced head and chest injuries; presented with higher Injury Severity Score (ISS: median = 22); and had prolonged OST (27 minutes) and reduced TPT (65 minutes; P = .001). Prolonged OST was found to be associated with higher mortality in T1 patients, whereas TPT was not associated.
In-hospital mortality was independent of TPT but associated with longer OST in severely injured patients. The survival benefit may extend beyond the golden hour and may depend on the injury characteristics, prehospital, and in-hospital settings.
The aim of the present study was to estimate aetiology and risk factors for psychoactive substances among adolescent students in Assiut Governorate,Egypt
This study was cross sectional community survey conducted during academic year (2010-2011). The sample size was 5476 students from preparatory and secondary schools were subjected to a standardized questionnaire of substance misuse questionnaire of Egypt in an Arabic version and modified Arabic version of socioeconomic scale .
22.9 % of sample stated that they used psychoactive substance. Peak age of onset was among students between 11-15 (61%), followed by 16-19 (31%) and lastly less than 10 (8%). Students raised in Nuclear families reported higher prevalence (83.92%) than those in Extended families (16.08%). Substance use disorder was prevalent in students with first Order of birth (38.85%) and then last (30.90%). Substance use was prevalent in students with moderate socioeconomic status (67.12%),then with low (16.64 %) and with high (16.24 %). According to beliefs of substance users toward substance, 30.18 % believed it makes person euphoric, 23.25% it make person lives in world of dreams, 23.81% it makes person works for long time.
Risk factors for adolescent substance use disorders represent psychosocial continuum begin from representing levels of exposure to anything like a ‘drug atmosphere’
Lymphopenia is common in adults who have had a Fontan operation although its aetiology and clinical implications remain unknown. Previous work suggests an association between lymphopenia and both liver disease and splenomegaly. The objective of this study was to assess the prevalence of lymphopenia in adults with a Fontan circulation and evaluate its associations with risk factors and clinical outcomes. Using a retrospective cohort study design, we studied 73 adult Fontan patients (age 25.0 ± 8.4 years) who had a complete blood count and abdominal imaging performed. Patients with protein-losing enteropathy were excluded. Clinical data were extracted from hospital records. The mean white blood cell count was 6580 ± 220/ml with a mean lymphocyte count of 1223 ± 508/ml. Lymphopenia, defined as lymphocyte count <1000/ml, was present in 23 (32%) patients. Patients with lymphopenia had a lower total white blood cell count (5556 ± 2517 versus 7136 ± 1924/ml, p = 0.009) and a lower platelet count (162 ± 69 versus 208 ± 69 k/ml, p = 0.008). Lymphopenia was also associated with findings of portal hypertension, including splenomegaly (36 versus 14%, p = 0.04), varices (22 versus 6%, p = 0.04), and ascites (39 versus 14%, p = 0.02). Lymphopenia did not correlate with any cardiac imaging, haemodynamic or exercise testing variables. In conclusion, lymphopenia is common in adult Fontan patients and is associated with markers of portal hypertension. Larger studies are needed to better define the relationship between lymphopenia and clinical outcomes.
Foodborne salmonellosis causes approximately 1 million illnesses annually in the United States. In the summer of 2017, we investigated four multistate outbreaks of Salmonella infections associated with Maradol papayas imported from four Mexican farms. PulseNet initially identified a cluster of Salmonella Kiambu infections in June 2017, and early interviews identified papayas as an exposure of interest. Investigators from Maryland, Virginia and Food and Drug Administration (FDA) collected papayas for testing. Several strains of Salmonella were isolated from papayas sourced from Mexican Farm A, including Salmonella Agona, Gaminara, Kiambu, Thompson and Senftenberg. Traceback from two points of service associated with illness sub-clusters in two states identified Farm A as a common source of papayas, and three voluntary recalls of Farm A papayas were issued. FDA sampling isolated four additional Salmonella strains from papayas sourced from Mexican Farms B, C and D. In total, four outbreaks were identified, resulting in 244 cases with illness onset dates from 20 December 2016 to 20 September 2017. The sampling of papayas and the collaborative work of investigative partners were instrumental in identifying the source of these outbreaks and preventing additional illnesses. Evaluating epidemiological, laboratory and traceback evidence together during investigations is critical to solving and stopping outbreaks.
Unicellular flagellates of the family Trypanosomatidae are obligatory parasites of invertebrates, vertebrates and plants. Dixenous species are aetiological agents of a number of diseases in humans, domestic animals and plants. Their monoxenous relatives are restricted to insects. Because of the high biological diversity, adaptability to dramatically different environmental conditions, and omnipresence, these protists have major impact on all biotic communities that still needs to be fully elucidated. In addition, as these organisms represent a highly divergent evolutionary lineage, they are strikingly different from the common ‘model system’ eukaryotes, such as some mammals, plants or fungi. A number of excellent reviews, published over the past decade, were dedicated to specialized topics from the areas of trypanosomatid molecular and cell biology, biochemistry, host–parasite relationships or other aspects of these fascinating organisms. However, there is a need for a more comprehensive review that summarizing recent advances in the studies of trypanosomatids in the last 30 years, a task, which we tried to accomplish with the current paper.
Foodborne non-typhoidal salmonellosis causes approximately 1 million illnesses annually in the USA. In April 2015, we investigated a multistate outbreak of 65 Salmonella Paratyphi B variant L(+) tartrate(+) infections associated with frozen raw tuna imported from Indonesia, which was consumed raw in sushi. Forty-six (92%) of 50 case-patients interviewed ate sushi during the week before illness onset, and 44 (98%) of 45 who specified ate sushi containing raw tuna. Two outbreak strains were isolated from the samples of frozen raw tuna. Traceback identified a single importer as a common source of tuna consumed by case-patients; this importer issued three voluntary recalls of tuna sourced from one Indonesian processor. Four Salmonella Weltevreden infections were also linked to this outbreak. Whole-genome sequencing was useful in establishing a link between Salmonella isolated from ill people and tuna. This outbreak highlights the continuing foodborne illness risk associated with raw seafood consumption, the importance of processing seafood in a manner that minimises contamination with pathogenic microorganisms and the continuing need to ensure imported foods are safe to eat. People at higher risk for foodborne illness should not consume undercooked animal products, such as raw seafood.
We report on the results of coherent X-ray diffraction imaging (CXDI) and ptychography measurements of two individual core-shell-shell GaAs/(In,Ga)As/GaAs nanowires (NWs) grown by molecular beam epitaxy (MBE) on patterned Si(111) substrate. CXDI at the axial GaAs 111 Bragg reflection was applied at different positions along the NW axis in order to characterize the NWs in terms of structural homogeneity along the radial directions. At each positon 3D reciprocal space maps have been recoded and inverted using phase retrieval algorithms. The CXDI were complemented by 2D ptychography measurements at GaAs 111 Bragg reflection probing the same NWs with respect to their structural homogeneity. Both methods provide structural homogeneity for NW1 and NW2 except at the bottom part of the NWs. In case of NW2 CXDI and ptychography show changes in the structure of the top part of the NW indicated by 60° rotation of the indicated three-fold rotational symmetry in the observed diffraction patterns and changes in the strain field reconstructed from ptychography.
Service utilisation by refugee families may be affected by the mismatch between Western individualistic service delivery approaches and the target communities’ more collectivist cultural patterns and practices. In addition to access barriers, utilisation of early childhood services by refugees can also be impacted upon by distrust of services, health and settlement issues, stigma, unfamiliarity with early childhood programmes, and fear of child protection and other legal systems. This low service utilisation sits in conflict with the need for early interventions for very young children, who are in the peak period of brain development. This article explores the implementation of a model to address these issues in early childhood work with refugee families and communities, with the intent to increase service uptake. Some strategies to address potential barriers will be described in the context of a community engagement model that includes consultation, relationship building, collaborative flexible service design and delivery, partnerships in community capacity building and cross-referral. Flexible, culturally appropriate interventions can enhance strengths based, non-pathologising and development-focused approach. A community engagement approach will, nevertheless, present challenges for service providers who must be willing to adapt their practices. Services and funding bodies need to recognise that this process is lengthy and resource intensive, but will ultimately lead to better service delivery and uptake, potentially leading to improvements in health, development and relational outcomes, for children and families from refugee backgrounds.
We report on a wide-range Density Functional Theory (DFT) investigation of the g-C3N4 photocatalysis systems combined with metals/nonmetals, especially those available in plants and involved in the natural photosynthesis process, such as K, Mg, Mn, Mo, Fe, Co, Cr, S and B. It is found that doping increases the range at which light absorption occurs to significantly large regions of the visible spectrum. These findings suggested that the g-C3N4 can be a promising system for the photosynthesis process.
In temperate zones, human respiratory syncytial virus (HRSV) outbreaks typically occur in cold weather, i.e. in late autumn and winter. However, recent outbreaks in Japan have tended to start during summer and autumn. This study examined associations of meteorological conditions with the numbers of HRSV cases reported in summer in Japan. Using data from the HRSV national surveillance system and national meteorological data for summer during the period 2007–2014, we utilized negative binomial logistic regression analysis to identify associations between meteorological conditions and reported cases of HRSV. HRSV cases increased when summer temperatures rose and when relative humidity increased. Consideration of the interaction term temperature × relative humidity enabled us to show synergistic effects of high temperature with HRSV occurrence. In particular, HRSV cases synergistically increased when relative humidity increased while the temperature was ⩾28·2 °C. Seasonal-trend decomposition analysis using the HRSV national surveillance data divided by 11 climate divisions showed that summer HRSV cases occurred in South Japan (Okinawa Island), Kyushu, and Nankai climate divisions, which are located in southwest Japan. Higher temperature and higher relative humidity were necessary conditions for HRSV occurrence in summer in Japan. Paediatricians in temperate zones should be mindful of possible HRSV cases in summer, when suitable conditions are present.
This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray.
The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging.
There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray.
These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.
A systematic x-ray diffraction (XRD) study was performed on room-temperature Xe-irradiated and postirradiation annealed CeO2. Large scale XRD did not show any additional irradiation-induced phases upon irradiation. Depth profiling the CeO2 (111) diffraction peak over the 150 nm deep Xe-irradiated layer (400 keV, 1 × 1020 Xe/m2) by grazing incidence XRD indicated a lattice expansion at the irradiated layer. Postirradiation annealing (1 h at 1000 °C) in an oxygen-containing environment removed the observed XRD features. Electron energy loss spectroscopy (EELS) was performed for cross-sectional samples before and after postirradiation annealing. EELS showed that the Ce charge state changed from +4 to +3 at the CeO2 surface indicating the presence of O vacancies in both as-irradiated and annealed samples. EELS also indicated that the amount of O vacancies was reduced at the irradiated region by annealing. The experimental results are discussed based on electronic properties of CeO2, annihilation of oxygen vacancies, and evolution of irradiation damage.
Covalent functionalization of reduced graphene oxide (rGO) with the photosynthetic reaction center (RC) from Rhodobacter sphaeroides R26 via click chemistry reaction has been performed. The hybrid system was characterized by flash photolysis and infrared spectroscopy and the RC was found to retain its photoactivity and structural integrity. The strategy is applicable for the fabrication of hybrid bio-electronic devices capable of absorbing and converting solar energy.
To determine whether a threshold apparent diffusion coefficient value may help to differentiate laryngeal carcinomas from benign lesions.
Fifty-three patients with laryngeal masses were recruited; four of them were excluded because of susceptibility artefacts. In the remaining 49 patients, the pathological results showed 32 laryngeal carcinomas and 17 benign lesions. The diagnostic value of diffusion-weighted magnetic resonance imaging for the identification of malignant lesions was determined. In addition, the agreement between diffusion-weighted magnetic resonance imaging and histopathology was assessed. Moreover, the sensitivity, specificity, and negative and positive predictive values of the apparent diffusion coefficient in detecting benign and malignant lesions were analysed. An apparent diffusion coefficient histogram was also produced.
An apparent diffusion coefficient value of 1.1 × 10−3 mm2/second produced the best result when used as the cut-off point to differentiate malignant from benign masses.
An apparent diffusion coefficient threshold of 1.1 × 10−3 mm2/second is optimal for distinguishing laryngeal carcinomas from benign lesions. Apparent diffusion coefficient values were lower for patients with laryngeal carcinomas than for those with benign lesions.
The early Miocene site of Wadi Moghra, Qattara Depression, Egypt, is important for interpreting anthracothere (Mammalia, Artiodactyla) evolution, because the Moghra sediments preserve a higher diversity of anthracotheres than any other pene-contemporaneous site. New specimens from Moghra are described and form the basis for the systematic revision of Moghra anthracotheres provided here. Among the important discoveries recently made at Moghra is the first complete skull of Sivameryx moneyi. Other new specimens described here include two new species of Afromeryx, and a new genus and species, all of which are unique to Moghra. A review of biogeographic information supports the conclusion that three of the Moghra anthracotheres (Brachyodus depereti, B. mogharensis, and Jaggermeryx naida, n. gen. n. sp.) are members of late surviving lineages with a long history in Africa, while three other species (Afromeryx grex, n. sp., A. palustris, n. sp., and Sivameryx moneyi) represent more recent immigrants from Eurasia.