Please note, due to essential maintenance online transactions will not be possible between 02:30 and 04:00 BST, on Tuesday 17th September 2019 (22:30-00:00 EDT, 17 Sep, 2019). We apologise for any inconvenience.
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.
Our world is becoming more urban. More than fifty percent of the global population now lives in cities, which poses new challenges for sustainable development. This book integrates theory and methods of sustainability assessment with concepts from systems science to provide guidelines for assessing the sustainability of urban systems. It discusses different aspects of urban sustainability, from energy and housing, to mobility and health, covering social, economic and environmental factors, as well as the various stakeholders and actors involved. The book argues for the need to find models and solutions in order to design sustainable cities of the future in light of the complexity of urban social life. Including diverse case studies from the developed and developing world, this book provides a useful reference for researchers and students from a broad range of disciplines working in the field of sustainability, as well as for environmental consultants and policy makers.
The advent of the CRISPR/Cas9 class of genome editing tools is transforming not just science and medicine, but also law. When the genome of germline cells is modified, the modifications could be inherited, with far-reaching effects in time and scale. Legal systems are struggling with keeping up with the CRISPR revolution and both lawyers and scientists are often confused about existing regulations. This book contains an analysis of the national regulatory framework in eighteen selected countries. Written by national legal experts, it includes all major players in bioengineering, plus an analysis of the emerging international standards and a discussion of how international human rights standards should inform national and international regulatory frameworks. The authors propose a set of principles for the regulation of germline engineering, based on international human rights law, that can be the foundation for regulating heritable gene editing both at the level of countries as well as globally.
This study aims to estimate Autism Spectrum Disorders (ASD) prevalence in school-aged children in the province of Pisa (Italy) using the strategy of the ASD in the European Union (ASDEU) project.
A multistage approach was used to identify cases in a community sample (N = 10 138) of 7–9-year-old children attending elementary schools in Pisa – Italy. First, the number of children with a disability certificate was collected from the Local Health Authority and an ASD diagnosis was verified by the ASDEU team. Second, a Teacher Nomination form (TN) to identify children at risk for ASD was filled in by teachers who joined the study and the Social Communication Questionnaire (SCQ) was filled in by the parents of children identified as positive by the TN; a comprehensive assessment, which included the Autism Diagnostic Observation Schedule-Second Edition, was performed for children with positive TN and SCQ⩾9.
A total of 81 children who had a disability certificate also had ASD (prevalence: 0.79%, i.e. 1/126). Specifically, 66 children (57 males and nine females; 62% with intellectual disability –ID-) were certified with ASD, whereas another 15 (11 males and four females; 80% with ID) were recognised as having ASD among those certified with another neurodevelopmental disorder. Considering the population of 4417 (children belonging to schools which agreed to participate in the TN/SCQ procedure) and using only the number of children certified with ASD, the prevalence (38 in 4417) was 0.86%, i.e. one in 116. As far as this population is concerned, the prevalence rises to 1% if we consider the eight new cases (six males and two females; no subject had ID) identified among children with no pre-existing diagnoses and to 1.15%, i.e., one in 87, if probabilistic estimation is used.
This is the first population-based ASD prevalence study conducted in Italy so far and its results indicate a prevalence of ASD in children aged 7–9 years of about one in 87. This finding may help regional, national and international health planners to improve ASD policies for ASD children and their families in the public healthcare system.
We present observations of 50 deg2 of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes l = 300–350° and latitudes |b| ⩽ 0.5°. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s−1spectral resolution, providing an unprecedented view of the molecular clouds and gas of the Southern Galactic Plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O.
We present a series of velocity-integrated maps, spectra, and position-velocity plots that illustrate Galactic arm structures and trace masses on the order of ~106 M⊙ deg−2, and include a preliminary catalogue of C18O clumps located between l = 330–340°. Together with the information about the noise statistics of the survey, these data can be retrieved from the Mopra CO website and the PASA data store.
Introduction: Tertiary care emergency departments (EDs) in large urban environments may have a low volume of high acuity pediatric presentations due to their proximity to dedicated childrens hospitals or large community centres. This may lead to discomfort among emergency physicians (EPs) and registered nurses (RNs) in managing these patients and a waning of knowledge and skills for this unique population. Among the EP group at our institution, 68% indicated they managed pediatric patients in less than 25% of their shifts, 68% also indicated they were uncomfortable managing an undifferentiated critically unwell neonate and only 32% indicated they would be comfortable teaching pediatric topics to emergency medicine residents. At our institution, our innovation was to create a useful curriculum for certified EPs and RNs to improve the interdisciplinary teams comfort level, knowledge and skill set when managing pediatric emergencies. Methods: A needs assessment was undertaken of the EPs and RNs working in our centre. This information was used to develop intended learning outcomes in a collaborative manner with the clinical nursing educator and physician curriculum leads. The team further collaborated with the local simulation centre and a pediatric emergency physician from the local childrens hospital. Results: A one-year, three-module curriculum was developed to cover the areas felt to be highest yield by the EP group: febrile illness, respiratory disease and critically ill neonates and infants. Each module contains three components: an in person interactive lecture delivered by an EP who routinely manages pediatric patients, either at a childrens hospital or large community centre; an online component with e-mail blasts of high yield pediatric content; and, culminating in an interdisciplinary interdepartmental simulation held in situ. This latter is particularly important so that all members of the interdisciplinary team can practice finding and using equipment based on its actual location within the ED. Each component of each module is then evaluated by the participants to ensure improvement for subsequent delivery. Conclusion: Well delivered continuing professional development (CPD) will become increasingly important as competence by design becomes the model for maintenance of certification. Maintaining skills for pediatric patients is an important component of CPD for physicians working in general emergency departments that see a low volume of high acuity pediatric presentations. Our curriculum seeks to address this identified need in an innovative manner using a modular and interdisciplinary approach with a diversity of teaching methods to appeal to the learning styles among our health care team.
Probably, the long-term monitoring of the solar atmosphere started in Italy with the first telescopic observations of the Sun made by Galileo Galilei in the early 17th century. His recorded observations and science results, as well as the work carried out by other following outstanding Italian astronomers inspired the start of institutional programs of regular solar observations at the Arcetri, Catania, and Rome Observatories.
These programs have accumulated daily images of the solar photosphere and chromosphere taken at various spectral bands over a time span larger than 80 years. In the last two decades, regular solar observations were continued with digital cameras only at the Catania and Rome Observatories, which are now part of the INAF National Institute for Astrophysics. At the two sites, daily solar images are taken at the photospheric G-band, Blue (λ = 409.4 nm), and Red (λ = 606.9 nm) continua spectral ranges and at the chromospheric Ca II K and Hα lines, with a 2″ spatial resolution.
Solar observation in Italy, which benefits from over 2500 hours of yearly sunshine, currently aims at the operational monitoring of solar activity and long-term variability and at the continuation of the historical series as well. Existing instruments will be soon enriched by the SAMM double channel telescope equipped with magneto-optical filters that will enable the tomography of the solar atmosphere with simultaneous observations at the K I 769.9 nm and Na I D 589.0 nm lines. In this contribution, we present the available observations and outline their scientific relevance.
The purpose of the present study was to reconstruct the phylogeny of dengue virus serotype 4 (DENV-4) that was circulating in Espírito Santo state, Brazil, in 2013 and 2014, and to discuss the epidemiological implications associated with this evolutionary hypothesis. Partial envelope gene of eight DENV-4 samples from Espírito Santo state were sequenced and aligned with 72 worldwide DENV-4 reference sequences from GenBank. A phylogenetic tree was reconstructed through Bayesian Inference and the Time of the Most Recent Common Ancestor was estimated. The study detected the circulation of DENV-4 genotype II in Espírito Santo state, which was closely related to strains from the states of Mato Grosso collected in 2012 and of São Paulo sampled in 2015. This cluster emerged around 2011, approximately 4 years after the entry of the genotype II in Brazil through its northern states, possibly imported from Venezuela and Colombia. This is so far the first phylogenetic study of the DENV-4 circulating in Espírito Santo state and shows the importance of an internal route of dengue viral circulation in Brazil to the introduction of the virus into this state.
The increased use of the MATRICS Consensus Cognitive Battery (MCCB) to investigate cognitive dysfunctions in schizophrenia fostered interest in its sensitivity in the context of family studies. As various measures of the same cognitive domains may have different power to distinguish between unaffected relatives of patients and controls, the relative sensitivity of MCCB tests for relative–control differences has to be established. We compared MCCB scores of 852 outpatients with schizophrenia (SCZ) with those of 342 unaffected relatives (REL) and a normative Italian sample of 774 healthy subjects (HCS). We examined familial aggregation of cognitive impairment by investigating within-family prediction of MCCB scores based on probands’ scores.
Multivariate analysis of variance was used to analyze group differences in adjusted MCCB scores. Weighted least-squares analysis was used to investigate whether probands’ MCCB scores predicted REL neurocognitive performance.
SCZ were significantly impaired on all MCCB domains. REL had intermediate scores between SCZ and HCS, showing a similar pattern of impairment, except for social cognition. Proband's scores significantly predicted REL MCCB scores on all domains except for visual learning.
In a large sample of stable patients with schizophrenia, living in the community, and in their unaffected relatives, MCCB demonstrated sensitivity to cognitive deficits in both groups. Our findings of significant within-family prediction of MCCB scores might reflect disease-related genetic or environmental factors.
Litopterna is represented in the Pleistocene of the Brazilian Intertropical Region by a monospecific genus of Macraucheniidae, Xenorhinotherium. Although most of the knowledge about this family is derived from the dentition, some dental features still remain unknown. This study describes the eruption sequence of permanent dentition and classifies the hypsodonty status of X. bahiense. The specimens studied are from Toca dos Ossos, a limestone cave located in Bahia State. We perform qualitative macroscopic analysis to describe the eruption dental sequence. Additionally, we perform quantitative analysis to determine the hypsodonty index. The dental eruption sequence of the juvenile specimen is M1, M2, I1, I2, M3, I3, P1, P2, P3, and P4. In addition, the analysis of tooth wear in adult specimens provides similar results. The hypsodonty index assigns a mesodont tooth crown for X. bahiense. The dental eruption sequence is most similar to a rapid-growth extant mammal. Moreover, our results do not support afrotherian-like delayed dental eruption to Litopterna. The hypsodonty index can be related to data on vegetation of the Brazilian Intertropical Region and the shape of the premaxilla of X. bahiense, both of which suggest a browsing diet for this macraucheniid.
In the event of a disaster, all personnel present in the airport area must modify their own everyday rules to ensure the best response to the emergency situation. For medical aid there are two main objectives: (a) organization of rescue operation; and (b) mustering medical resources. The initiators of the rescue operation must be the control tower staff and each Italian airport is provided with emergency plans which have been carefully studied.
Information systems between the accident site and the centers of available medical resources, however, are less well organized. These can be simplified by the use of a video terminal, connected with a data system elaborator. The Lombardy region plans to install a video-terminal in every Regional Hospital in order to be able to present the airport with the up-to-date situation of vacant beds and of medical staff present in the hospital for emergency tasks.
It is proposed that the alert from the accident site should be in two phases. Initially, a general alert must be given, followed after a short time by a more detailed specific alert. The first phase must be addressed to those departments that, independently of the type of the disaster, will always be involved in any critical situation, e.g., Ambulance Headquarters, ICUs, Blood Centers, Emergency Departments. The second phase will be used to inform hospital departments specializing in treating the pathology prevailing in the particular disaater. In airport disasters, the pathology which prevails will include major and multiple injuries with blood loss and burns.
In serious emergency situations such as the aircraft crash, the medical staff can also be in danger. The risk for the medical and paramedical staff has two sources: (a) factors related to the cause of the accident; and (b) dangers occurring during rescue operations. It is necessary that the emergency staff look to their own security, and avoid exposing themselves to the risks associated with the panicking movements of frightened people (herd effect). The first aid station should be established in a position down-wind, to avoid the toxic smoke from fire. An essential condition is that the medical emergency staff is composed of people physically and psychologically suitable to the sudden effort and the acute stress.
To reduce the risks associated with rescue operations training is essential, conducted under the supervision of experts from the Fire Brigade. A minimum program of training must be arranged between the physician in charge and the airport authorities, so as to reconcile the activities of the two parties and achieve co-ordination. The medical and paramedical staff must be trained to operate with a gas-mask or oxygen auto-respirator, necessary to prevent intoxication with compounds such as tri-o-cresyl phosphate, fire extinguisher compounds such as dibromodil-fluoromethane and bromocloromethane. Metabolites of air contaminants found in airport disasters are not well known. We summarize in the table some toxicologic data of interest.
The use of oxygen in emergency situations outside hospitals is limited by difficulties in supply. Low capacity cylinders (100-120 1) weigh 3-4 kg, and have cumbersome mechanisms for pressure and flow reduction. Disposable cylinders of oxygen from a chemical source create the possibility of the contents running out, and are fragile. Particularly when exposed to high pressures or temperature.
Mouth-to-mouth remains most rational and effective. Problems include aesthetic concern and exhaustion in rescuer. It is possible, however, to adapt a Brooke or a Safar airway for use with oxygen, by attaching a tube with tape near the proximal outlet of the airway. This apparatus has been tried on 4 patients during general anesthesia with thiopentone-succinylcholine-neuroleptics—for appendectomies using controlled ventilation with expired air with oxygen added. Tidal volumes of 350-500 ml of air/oxygen were delivered at a frequency of 6-8 breaths per minute. The nose was closed by a clip. Sellik's maneuver could prevent gastric inflation. The color of blood was normal, arterial pressure and pulse did not change, and skin was dry. No fatigue or other effects were reported by the anesthesiologist-“rescuer”. In outdoor use, where oxygen from a chemical source is used, the problems associated with the exothermic reaction can be limited by cylinder lagging with openings to disperse heat. A flow of O2 6-7 1/min is sufficient to support a critical situation. It allows O2 enrichment for mouth-to-mouth, mouth-to-mask, mouth-to-airway, or bag valve ventilation. Modest cost, and low weight allow large numbers to be stored for airport disasters, when resuscitation is performed on a large scale for many victims.
Mycobacterium avium sp. avium (MAA), M. avium sp. hominissuis (MAH), and M. avium sp. paratuberculosis (MAP) are the main members of the M. avium complex (MAC) causing diseases in several hosts. The aim of this study was to describe the genetic diversity of MAC isolated from different hosts. Twenty-six MAH and 61 MAP isolates were recovered from humans and cattle, respectively. GenoType CM® and IS1311-PCR were used to identify Mycobacterium species. The IS901-PCR was used to differentiate between MAH and MAA, while IS900-PCR was used to identify MAP. Genotyping was performed using a mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) scheme (loci: 292, X3, 25, 47, 3, 7, 10, 32) and patterns (INMV) were assigned according to the MAC-INMV database (http://mac-inmv.tours.inra.fr/). Twenty-two (22/26, 84·6%) MAH isolates were genotyped and 16 were grouped into the following, INMV 92, INMV 121, INMV 97, INMV 103, INMV 50, and INMV 40. The loci X3 and 25 showed the largest diversity (D: 0·5844), and the global discriminatory index (Hunter and Gaston discriminatory index, HGDI) was 0·9300. MAP (100%) isolates were grouped into INMV 1, INMV 2, INMV 11, INMV 8, and INMV 5. The HGDI was 0·6984 and loci 292 and 7 had the largest D (0·6980 and 0·5050). MAH presented a higher D when compared with MAP. The MIRU-VNTR was a useful tool to describe the genetic diversity of both MAH and MAP as well as to identify six new MAH patterns that were conveniently reported to the MAC-INMV database. It was also demonstrated that, in the geographical region studied, human MAC cases were produced by MAH as there was no MAA found among the human clinical samples.
With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children’s Hospital of Philadelphia (CHOP) and University of Michigan (UM).
We included children undergoing benchmark operations of the Society of Thoracic Surgeons. Considerations regarding personnel, patient/parent engagement, funding, regulatory issues, and annual data collection are described, and initial follow-up rates are reported.
The present analysis included 1737 eligible patients undergoing surgery at CHOP from January 2007 to December 2014 and 887 UM patients from January 2010 to December 2014. Overall, follow-up data, of any type, were obtained from 90.8% of patients at CHOP (median follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8 years, 92.7% survival), with similar rates across operations and institutions. Most patients lost to follow-up at CHOP had undergone surgery before 2010. Standardised questionnaires assessing burden of disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via phone follow-up. In subsequent pilot testing of an automated e-mail system, 53.4% of eligible patients completed the follow-up questionnaire through this system.
Standardised follow-up data can be obtained on the majority of children undergoing benchmark operations. Ongoing efforts to support automated electronic systems and integration with registry data may reduce resource needs, facilitate expansion across centres, and support multi-centre efforts to understand and improve long-term outcomes in this population.
Dengue presents a wide clinical spectrum of signs and symptoms, with characteristics of the host potentially influencing the disease evolution. Therefore, the purpose of this study was to evaluate the influence of gender and age on dengue clinical outcomes in a recent outbreak situation in Brazil, applying a cross-sectional design and including 6703 dengue cases with laboratory confirmation, occurring in Vitória, Espírito Santo State, Brazil, between 2007 and 2013. Data were obtained from the Information System for Notifiable Diseases. Overall, 11·3% of the sample presented with severe dengue, which affected 13·0% of males, 10·0% of females, 8·8% of children, 12·5% of adolescents, 10·5% of adults and 15·5% of the elderly. Age was higher in the severe dengue group (P = 0·03). Severe dengue was associated with males and the elderly (P < 0·01); however, considering only severe cases, children presented haemorrhage and plasma leakage more frequently than older age groups. The results emphasize the importance of a differentiated protocol for management of dengue cases, taking into consideration host factors like age. These findings also suggest the elderly and children as priority groups for immunization in a future implementation of a vaccine.
We have recently completed a comprehensive analysis of the morphological and kinematical properties of ~ 50 PNe which are known to possess low-ionization (micro)structures (LISs; Gonçalves et al. 2001). This study has shown that density is a crucial parameter for distinguishing among several physical processes responsible for their formation and evolution.
We are at present analysing long-slit, medium-resolution optical spectra of 18 PNe in order to determine the physical parameters of the LISs and their environments. These data were obtained with the 1.5 m Danish (ESO) and the 2.5 m Isaac Newton (ORM) telescopes.
Here we show the first results of this survey, presenting the density variation of NGC 7009 and comparing it with the derived densities of K 4-47 and Wray 17-1.
A simulation model is presented, where temperature, phases and internal stresses can be predicted as a function of time during the heating of large steel ingots for forging. Heating cycle measurements and computer simulations are compared for an A105 steel grade 34-Ton tapered ingot. A study of the heat transfer inside a natural gas-fired furnace was carried out to make an estimation of internal stresses due to thermal expansion and phase transformation from α ferrite and pearlite to γ austenite during heating. The model was validated with a second test of an AISI 4330 steel grade 35.4-Ton ingot. The simulation model described can calculate internal stresses in any ingot in order to optimize its heating cycle without compromising ingot internal quality, reducing energy consumption and increasing productivity of the furnace.
Bilateral retinal detachments are a rare complication of preeclampsia. We present a case report of a patient with an unknown pregnancy who presented with acute bilateral vision loss and elevated blood pressure. Point-of-care ocular ultrasound revealed bilateral retinal detachments. She was diagnosed with severe preeclampsia and taken for an urgent caesarean section with the delivery of a 26-week-old infant.
We have obtained deep g, r, and i-band Subaru and ultra-deep 3.6 μm IRAC images of parts of the multiply-wrapped stellar stream around the nearby edge-on galaxy NGC 5907. We have fitted the surface brightness measurements of the stream with FSPS stellar population synthesis models to derive the metallicity and age of the brightest parts of the stream. The resulting relatively high metallicity ([Fe/H] = −0.3) is consistent with a major merger scenario but a satellite accretion event cannot be ruled out.