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.
Pneumonia is a leading cause of death in New York City (NYC). We identified spatial clusters of pneumonia-associated hospitalisation for persons residing in NYC, aged ⩾18 years during 2010–2014. We detected pneumonia-associated hospitalisations using an all-payer inpatient dataset. Using geostatistical semivariogram modelling, local Moran's I cluster analyses and χ2 tests, we characterised differences between ‘hot spots’ and ‘cold spots’ for pneumonia-associated hospitalisations. During 2010–2014, there were 141 730 pneumonia-associated hospitalisations across 188 NYC neighbourhoods, of which 43.5% (N = 61 712) were sub-classified as severe. Hot spots of pneumonia-associated hospitalisation spanned 26 neighbourhoods in the Bronx, Manhattan and Staten Island, whereas cold spots were found in lower Manhattan and northeastern Queens. We identified hot spots of severe pneumonia-associated hospitalisation in the northern Bronx and the northern tip of Staten Island. For severe pneumonia-associated hospitalisations, hot-spot patients were of lower mean age and a greater proportion identified as non-Hispanic Black compared with cold spot patients; additionally, hot-spot patients had a longer hospital stay and a greater proportion experienced in-hospital death compared with cold-spot patients. Pneumonia prevention efforts within NYC should consider examining the reasons for higher rates in hot-spot neighbourhoods, and focus interventions towards the Bronx, northern Manhattan and Staten Island.
To report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004–2013.
Surveillance using US National Healthcare Safety Network’s criteria and definitions, and International Nosocomial Infection Control Consortium methodology.
We collected data from 236,700 ICU patients for 970,713 bed-days
Pooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line–associated bloodstream infections (CLABSIs)/1,000 central line–days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator–days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter–days
In neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line–days and 1.9 VAPs/1,000 mechanical ventilator–days
Extra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAP
Crude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUs
Pooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs.
Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.
Infect. Control Hosp. Epidemiol. 2016;37(2):172–181
This research article investigates the effect of SiO2 flux on Nd:YAG laser welding of 5 mm thick plates of super-austenitic stainless steel, AISI 904L. Microstructure studies revealed multidirectional grain growth comprising columnar and cellular dendrites along with a prominent, fine equiaxed dendritic growth at the centerline of the fusion zone. Tensile studies showcased the fracture at the fusion zone in all the trials. The average tensile strength reported for the flux assisted laser weldments was found to be 587 MPa which was slightly lower than the parent metal. The impoverishment of tensile strength could be attributed to the formation of centerline equiaxed grains. Similarly the impact toughness of the joints was found to be 58 J. The studies demonstrated the possibility of using a 2 kW Nd:YAG laser welding machine to weld 5 mm thick plate with the use of SiO2 flux. A detailed study on the structure–property relationship of flux assisted Nd:YAG laser weldment was carried out using the combined techniques optical microscopy, scanning electron microscopy, and energy dispersive x-ray analysis.
Microwave-assisted oxidation of trichloroethane (TCE) performed at 500-580°C has been found to be significantly more efficient than conventional oxidation methods. Experiments were conducted using a 6 kW, 2.45 GHz power supply and a 6 inch bed of silicon carbide granules in a 1 inch diameter quartz reactor tube which in turn was placed in a microwave cavity. After heating the reactor to a given temperature a TCE-air stream was passed through the silicon carbide bed. TCE was almost completely detoxified (98-99%) in a single pass through the silicon carbide bed at 500-580°C. The oxidation products are HC1, CO2 and CO. By comparison the corresponding single-pass detoxification using conventional thermal methods results in only partial conversion. The principal products being dichloroethylene (C2H2C12) and HCl.
Some metallization systems consisting of barrier metals and Au-Sn (multiple alternating layers) were studied as a bonding schemes of InP-based laser diodes to the first time used, CVD-diamond submounts. The first system to be studied, which was traditionally used in various other applications was Ti(100nm)/Pt(200nm)/Au(500nm)/Au-Sn(2.5 μm). This structure provided a molten Au-Sn layer of eutectic composition (80:20 wt%) on top of the Ti/Pt metals for about 6 sec, while heated at temperatures of 300 to 350°C, and allowed for efficient bonding of the device to the submount. Longer heating durations, however, led to reaction between Pt and Sn to consume significant amounts of Sn from the solder, thus elevating its melting temperature and resolidifying the solder. With optimum bonding conditions, a high quality bond of the InP-based laser diode to the CVD-diamond submount was observed, and a superior electrical performance of the diode was measured compared to diodes that were bonded with the standard In/BeO configurations. In order to maintain the superior performance of the InP laser diode bonded assembly but improve the thermodynamic stability of the metallurgical system and thus extending the bonding processing window, various metals such as W and Cr were studied as a replacement for the Ti/Pt barrier metals in between the CVD-diamond submount and the Au-Sn solder. While applying the W layer, a thin Ti(10nm) layer was introduced in between it and the Au-Sn to improve the solder wettability. The W layer was found to remain intact after heating at 350°C for durations as long as 5 min, and thus, due to the inert nature of the Au-Sn/W interface, the Au-Sn ratio was kept uniform at the eutectic liquid composition through a long heating duration (up to 5 min). Minimum reaction was observed, as well, at the Au-Sn/Cr interface, while executing a Ti(100nm)/Cr(200nm)/Au-Sn(1.5 μm) system, and thus allowed for an excellent bonding of the InP laser diodes to the CVD-diamond submounts.
The stress in the surface of a thin (0–10 monolayer) film of mercury can be relieved by either changing the substrate and consequently changing adlayer lattice constants or by growing thicker films. An empirical relationship between strain and the valence electronic structure of mercury overlayers can be demonstrated, though we present evidence that this relationship can be altered and destroyed by crystallography changes.
Combustion synthesis of NbAl3-matrix composites with Al2O3 and B additions was studied using the thermal explosion mode. The addition of B to the reaction mixture resulted in the formation of NbB2, small amounts of NbB and unreacted Al. The Al2O3 addition did not affect the NbAl3-matrix reaction completion but the final product density increased with increasing Al2O3 loading. In both NbAl3-matrix composites, the reaction was initiated above the melting point of Al.
Thin films of Bi2VO5.5 (BVO), a vanadium analog of the n = I member of the Aurivillius family, have been prepared by pulsed laser deposition. The BVO films grow along the  direction on LaNiO3(LNO) and YBa2Cu3O7 (YBCO) electrode buffer layers on LaA- IO3(LAO) substrates as obtained from X-ray diffraction studies. The microstructure of the films and of the interfaces within the film and between the film and the substrate were characterized using transmission electron microscopy. The in-plane epitaxial relationship of the rhombohedral LNO on perovskite LAO was  LNO //  LAO and  LNO //  LAO. High resolution lattice images showed a sharp interface between LNO and LAO. However, the LNO film is twinned with a preferred orientation along the growth direction. The BVO layer is single crystalline on both LNO/LAO and YBCO/LAO with the caxis parallel to the growth direction except for a thin layer of about 400 Å at the interface which is polycrystalline.
Based on the analysis of extensive experimental data, we have formulated basic criteria necessary for the synthesis of a variety of oxides in the combustion mode, and defined optimum conditions for the production of high-surface area, well-crystalline nano-powders of desired phase composition and purity. Also, for the first time, detailed chemical mechanisms of interaction for various systems are identified, outlining specific roles of different fuels, oxidizers and thermal conditions
In this paper it is shown that a stationary plasma can be accelerated by a moving neutral gas only if the velocity of the neutral gas exceeds Alfvén's critical velocity. An expression for the terminal velocity of the interaction is given which shows that, in the limit of high incoming neutral gas speeds, the composite plasma is accelerated up to one quarter of the gas speed. We also discuss terminal velocities associated with the inverse problem, namely the deceleration of a magnetized plasma as a result of its motion through, and interaction with, a stationary neutral gas.
Reye's syndrome (RS) is an acute, serious, postinfectious, metabolic encephalopathy and fatty infiltration of the liver. Despite prodromes related to viral illnesses, there is no encephalitis or viral invasion, and brain and liver tissue cultures show no viral growth. It typically affects children, but young and rarely older adults may be involved. Classic RS follows influenza B or chickenpox, but many respiratory and other viruses have been implicated. In the 1970s and early 1980s, it was recognized as a prominent cause of mental changes in children, and many infections, drugs, and toxins were suspected in the etiology. An association with the use of salicylates in children with febrile illnesses was recognized. Avoidance of salicylates has been followed by a dramatic decline in cases since the mid-1980s. Because aspirin is still used in combination in over-the-counter cold and other medicines, inadvertent use can occur. Aspirin is widely used in adults, including those with febrile illnesses; it raises at least a theoretical possibility of RS cases in adults. Salicylates most likely exacerbate an underlying disease in susceptible individuals rather than cause it. It is now suspected that at least some of the patients with RS may have had metabolic diseases or toxic exposures that were not recognized in the 1970s and 1980s. These heterogeneous groups of disorders are often labeled as Reyelike syndromes (RLS).
This study updates the status and conservation of the Endangered Asian elephant Elephas maximus in Cat Tien National Park, Vietnam. Line transect indirect surveys, block surveys for elephant signs, village surveys of elephant-human conflict incidents, guard-post surveys for records of sightings, and surveys of elephant food plants were undertaken during the dry and wet seasons of 2001. A minimum of 11 elephants and a maximum of 15-17 elephants was estimated for c. 500 km2 of the Park and its vicinity. The elephants are largely confined to the southern boundary of the Park and make extensive use of the adjoining La Nga State Forest Enterprises. During the dry season the elephants depend on at least 26 species of wild and cultivated plants, chiefly the fruits of cashew. Most of the villages surveyed reported some elephant-human conflict. Two adult male elephants seem to cover a large area to raid crops, whereas the family groups restrict themselves to a few villages; overall, the conflict is not serious. Since 2001 there have been no reports of any deaths or births of elephants in the Park. We make recommendations for habitat protection and management, increasing the viability of the small population, reducing elephant-human conflicts, and improving the chances of survival of the declining elephants of this Park. The Government has now approved an Action Plan for Urgent Conservation Areas in Vietnam that calls for the establishment of three elephant conservation areas in the country, including Cat Tien National Park.
Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002–2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23–125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.
Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.
To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.
Historic prospective study. Standardised assessments of course and outcome.
About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.
A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
Ectopic pregnancy occurs when the conceptus implants outside the normal site within the uterine cavity. The most common site is within the Fallopian tube (98.3%), followed by abdominal (1.4%), ovarian (0.15%) and cervical (0.15%) implantation. Considering tubal ectopic pregnancies, 80% occur at the ampulla and 12% at the isthmus; 6% are fimbrial and 2% are interstitial. Approximately 5% to 5.7% of all clinical pregnancies from assisted reproductive technology (ART) in 1988–92 were ectopic; however, in 1995 the incidence was less at 2.8%. A meta-analysis of risk factors that predispose to ectopic pregnancy is depicted in Table 1. However, this meta-analysis does not control for the interplay of risk factors (multivariate analysis), including the impact of control group data and consequent problems of data collection (e.g. the incidence of pelvic inflammatory disease (PID) in the ectopic group is laparoscopically derived whereas it is derived from the history in the control group).
Nanocrystalline powders of ferroelectric bismuth vanadate, Bi4V2O11 (n-BiV), with crystallite size less than 50 nm, were obtained by mechanical milling of a stoichiometric mixture of bismuth oxide and vanadium pentoxide. The n-BiV powders on sintering yielded high-density, fine-grained ceramics with improved dielectric and polar characteristics. Dielectric studies on samples obtained from milled powders indicated that the ferroelectric-to-paraelectric phase transition temperature is strongly frequency dependent. The Curie–Weiss law is found to be valid only at a temperature away from the transition temperature, confirming the diffused nature of the transition, which is attributed to the presence of compositional inhomogeneity, because of partial reduction of vanadium.
The effect of the additive KCl, on the structural, microstructural, and polar properties of bismuth vanadate (BiV) ceramics is investigated. The scanning electron microscopic (SEM) studies reveal a remarkable modification in the microstructure and the occurrence of high grain-orientation (75%) on KCl addition. The energy dispersive x-ray (EDX) analyses indicate the presence of chemically inhomogeneous distribution of KCl, with core-shell-like grain structure. The KCl-modified BiV samples exhibit a broad and depressed phase transition, with no frequency dispersion, as a result of the increased internal stress and the formation of core-shell-like grain structure. Significant anisotropies are observed in the dielectric, piezoelectric, and pyroelectric responses of these grain-oriented ceramic samples. These samples are characterized by near rectangular ferroelectric hysteresis loops, with a significant anisotropy in the Pr (Pr┴/Pr∥ = 2.43, at 300 K) and Ec (Ec∥/Ec┴= 2.22, at 300 K) values between the directions parallel and perpendicular to the cold-pressing axis.
Time-resolved x-ray diffraction (TRXRD) was performed during Ti5Si3 synthesis by the self-propagating high-temperature synthesis mode for different Ti size fractions. It was determined that the time for product formation (ca. 15 s) was independent of Ti particle size. However, the formation of Ti5Si4 phase occurred when relatively large titanium particles were used. A simultaneous measurement of the temperature and TRXRD allowed us to attribute the shifting of XRD peaks at high temperature to thermal expansion of the Ti5Si3 product. The thermal expansion coefficients differ for different crystal planes, and their numerical values compare well with those reported previously in the literature.
This study explored the relation of level of socio-economic development to the course of non-affective psychosis, by extending the analysis of urban/rural differences in course in Chandigarh, India.
The proportion of ‘best outcome cases between urban (n=110) and rural (n=50) catchment areas were compared at two-year follow-up, separately for CATEGO S+ and non-S+ schizophrenia.
The proportion of subjects with ‘best outcome’ ratings at the urban and rural sites, respectively, was similar for CATEGO S+ schizophrenia (29 v. 29%), but significantly different for non-S+ psychosis (26 v. 47%)
The fact that in rural Chandigarh, psychoses have a more favourable course than in the urban area may be explained in large part by psychoses distinct from ‘nuclear’ schizophrenia.