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To determine how well machine learning algorithms can classify mild cognitive impairment (MCI) subtypes and Alzheimer’s disease (AD) using features obtained from the digital Clock Drawing Test (dCDT).
dCDT protocols were administered to 163 patients diagnosed with AD(n = 59), amnestic MCI (aMCI; n = 26), combined mixed/dysexecutive MCI (mixed/dys MCI; n = 43), and patients without MCI (non-MCI; n = 35) using standard clock drawing command and copy procedures, that is, draw the face of the clock, put in all of the numbers, and set the hands for “10 after 11.” A digital pen and custom software recorded patient’s drawings. Three hundred and fifty features were evaluated for maximum information/minimum redundancy. The best subset of features was used to train classification models to determine diagnostic accuracy.
Neural network employing information theoretic feature selection approaches achieved the best 2-group classification results with 10-fold cross validation accuracies at or above 83%, that is, AD versus non-MCI = 91.42%; AD versus aMCI = 91.49%; AD versus mixed/dys MCI = 84.05%; aMCI versus mixed/dys MCI = 84.11%; aMCI versus non-MCI = 83.44%; and mixed/dys MCI versus non-MCI = 85.42%. A follow-up two-group non-MCI versus all MCI patients analysis yielded comparable results (83.69%). Two-group classification analyses were achieved with 25–125 dCDT features depending on group classification. Three- and four-group analyses yielded lower but still promising levels of classification accuracy.
Early identification of emergent neurodegenerative illness is criterial for better disease management. Applying machine learning to standard neuropsychological tests promises to be an effective first line screening method for classification of non-MCI and MCI subtypes.
To determine the best nursing home facility characteristics for aggregating antibiotic susceptibility testing results across nursing homes to produce a useful annual antibiogram that nursing homes can use in their antimicrobial stewardship programs.
Derivation cohort study.
Center for Medicare and Medicaid Services (CMS) certified skilled nursing facilities in Georgia (N = 231).
All residents of eligible facilities submitting urine culture specimens for microbiologic testing at a regional referral laboratory.
Crude and adjusted metrics of antibiotic resistance prevalence (percent of isolates testing susceptible) for 5 bacterial species commonly recovered from urine specimens were calculated using mixed linear models to determine which facility characteristics were predictive of testing antibiotic susceptibility.
In a single year, most facilities had an insufficient number of isolates tested to create facility-specific antibiograms: 49% of facilities had sufficient Escherichia coli isolates tested, but only about 1 in 10 had sufficient isolates of Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, or Pseudomonas aeruginosa. After accounting for antibiotic tested and age of the patient, facility characteristics predictive of susceptibility were: E. coli, region, year, average length of stay; K. pneumoniae, region, bed size; P. mirabilis, region; and for E. faecalis or P. aerginosa no facility parameter remained in the model.
Nursing homes often have insufficient data to create facility-specific antibiograms; aggregating data across nursing homes in a region is a statistically sound approach to overcoming data shortages in nursing home stewardship programs.
We evaluated the isolation of postoperative nontuberculous mycobacteria (NTM) associated with heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB) surgery in the Veterans Health Administration from January 1, 2010, to December 31, 2016. In more than 38,000 CPB procedures, NTM was isolated in 111 patients; 1 Mycobacterium chimaera mediastinitis case and 1 respiratory isolate were found.
We present the results of an approximately 6 100 deg2 104–196 MHz radio sky survey performed with the Murchison Widefield Array during instrument commissioning between 2012 September and 2012 December: the MWACS. The data were taken as meridian drift scans with two different 32-antenna sub-arrays that were available during the commissioning period. The survey covers approximately 20.5 h < RA < 8.5 h, − 58° < Dec < −14°over three frequency bands centred on 119, 150 and 180 MHz, with image resolutions of 6–3 arcmin. The catalogue has 3 arcmin angular resolution and a typical noise level of 40 mJy beam− 1, with reduced sensitivity near the field boundaries and bright sources. We describe the data reduction strategy, based upon mosaicked snapshots, flux density calibration, and source-finding method. We present a catalogue of flux density and spectral index measurements for 14 110 sources, extracted from the mosaic, 1 247 of which are sub-components of complexes of sources.
In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.
(Disaster Med Public Health Preparedness. 2012;6:67–71)
The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.
(Disaster Med Public Health Preparedness. 2012;6:60–66)
Jökulhlaups in 2007 and 2008 from an ice-dammed lake at the northern margin of Russell Glacier, West Greenland, marked the onset of a renewed jökulhlaup cycle after 20 years of stability. We present a record of successive ice-dammed lake drainage events and associated ice-margin dynamics spanning ∼25 years. Robust calculations of lake volumes and peak discharges are made, based on intensive field surveys and utilizing high-spatial-resolution orthophotographs of the lake basin and ice margin. These data enable identification of controls on the behaviour of the ice-dammed lake and provide the first field-based examination of controls on jökulhlaup magnitude and frequency for this system. We find that Russell Glacier jökulhlaups have a much higher peak discharge than predicted by the Clague–Mathews relationship, which we attribute to an unusually short englacial/subglacial routeway and the presence of a thin ice dam that permits incomplete sealing of jökulhlaup conduits between lake drainage events. Additionally, we demonstrate that the passage of jökulhlaups through an interlinked system of proglacial bedrock basins produces significant attenuation of peak discharge downstream. We highlight that improved understanding of jökulhlaup dynamics requires accurate information about ice-dammed lake volume and ice-proximal jökulhlaup discharge.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
We examined the relationship between whole grain intake and obesity, insulin resistance, inflammation, diabetes and subclinical CVD using baseline data from the Multi-Ethnic Study of Atherosclerosis. Whole grain intake was measured by a 127-item FFQ in 5496 men and women free of CHD and previously known diabetes. Mean whole grain intake was 0·5 (sd 0·5) servings per d; biochemical measures reflect fasting levels. After adjustment for demographic and health behaviour variables, mean differences for the highest quintile of whole grain intake minus the lowest quintile of intake were 0·6 kg/m2 for BMI, 0·36 mg/l for C-reactive protein, 0·82 μmol/l for homocysteine, 0·15 mU/l*mmol/l for homeostasis model assessment (HOMA), 0·48 mU/l for serum insulin, 2·0 mg/dl for glucose and 5·7 % for prevalence of newly diagnosed impaired fasting glucose (glucose ≥ 100 mg/dl or diabetes medication). These differences represent 11–13 % of a standard deviation of BMI, HOMA, glucose and impaired fasting glucose, but 23 %, 52 % and 80 % of a standard deviation of homocysteine, C-reactive protein and insulin, respectively. An inverse association between whole grains and urine albumin excretion was suggested but retained statistical significance after adjustment only in Chinese and Hispanic participants. No associations were observed between whole grain intake and two subclinical disease measures: carotid intima-media thickness and coronary artery calcification. Concordant with previous research, whole grain intake was inversely associated with obesity, insulin resistance, inflammation and elevated fasting glucose or newly diagnosed diabetes. Counter to hypothesis, however, whole grain intake was unrelated to subclinical CVD.
Assisted living facilities (ALFs) pose unique fire risks to the elderly that may be linked to specific fire safety (FS) practices.
To evaluate self-reported FS practices among ALF residents.
All residents of a small ALF were surveyed regarding actual and hypothetical FS behaviors, self-perceived fire risk, and FS preparedness.
Fifty-eight ALF residents completed the survey. Thirty-three 58%) individuals reported one or more disabilities. Seven (12%) residents ignored the fire alarm and 21 (35%) could not hear it clearly. Sixteen (28%) residents would attempt to locate the source of a fire rather than escape from the building. Only 24 (42%) residents were familiar with the building fire plan.Twenty-three (40%) people surveyed believed that they were not at risk of fire in the study facility.
Residents of an ALF may be at increased fire injury risk due to their FS practices and disabilities.
The cell is the fundamental unit of all living organisms, ranging from the unicellular archaea and bacteria (prokaryotes) to higher multicellular plants and animals (eukaryotes). All cells are bounded by a complex and dynamic plasma membrane, which functions principally to maintain cellular and organismal steady state by performing complex energy transformations and regulating the flow of information for the cell. The cell membrane also performs a number of vital housekeeping functions, which include control of the transport of substances between extracellular and intracellular environments, participation in cell signaling cascades by hosting receptors of extracellular ligands, and facilitating critical cell-to-cell communications in multicellular organisms (Karp, 2005).
Considerable research over the last fifty years has significantly increased our understanding of cell membranes and their structural organization. Every membrane is fundamentally comprised of a dynamic lipid bilayer that supports a variety of transmembrane and membraneassociated proteins.
Resources to address the needs of parents of intellectually disabled children in developing countries are limited.
The efficacy of interactive group psychoeducation on measures of parental attitude towards intellectual disability was assessed in southern India.
Fifty-seven parents randomised to 10 weeks of experimental and control therapy were assessed using the Parental Attitude Scale towards the Management of Intellectual Disability. The pre- and post-intervention measurements were done by a single-blinded rater and compared.
The intervention group had a statistically significant increase in the outcome scores and clinical improvement in the total parental attitude score, orientation towards child-rearing, knowledge towards intellectual disability and attitude towards management of intellectual disability, but no change in attitude towards the intellectual disability subscale.
Interactive group psychoeducation is effective for changing the attitude of parents with intellectually disabled children, and is a viable option to be developed in situations where resources are limited.
The kinetics of BST thin film grain nucleation and growth caused by rapid thermal annealing have been investigated. A series of Ba0.67Sr0.33Tii0.5O3 films were deposited on Pt electrodes using a metal-organic decomposition process. The effects of anneal time and temperature on BST grain sizes were studied by altering the processing conditions during RTA. A series of films were annealed by RTA at temperatures ranging from 550°C to 950°C for times ranging from 30 to 120 seconds. Crystallographic and microstructural characterization were done using XRD and TEM. The XRD results indicated that BST grain size increased with increasing anneal temperature, but was not affected by anneal time. Plan-view TEM indicated that BST grains were imbedded in an amorphous matrix. The average grain size was on the order of 200 Å.
Ultramicrotomy was successfully implemented for sectioning solder/Cu and composite solder/Cu samples for TEM. Solder/Cu joints, approximately 10 mm by 2 mm by 3 mm, were carbon coated and dipped in cyanoacrylate ester before being embedded into an epoxy mount. The mounted samples were trimmed in a series of steps to obtain a pyramid-shaped, embedded sample with a flat, trapezoidal face of exposed metal for sectioning. Thin sections were sliced directly from the bulk sample using an ultramicrotome and a diamond knife. Once sectioned, the samples were placed on Formvar and carbon coated copper grids for examination by TEM. Solder/Cu joints made with eutectic (63Sn/37Pb) solder and several composite solders, including Cu, Ni, and Cu6Sn5, were examined. For the first time, it was possible to image simultaneously each phase in the material using a single TEM sample. The various phases present in the solder joints, including the Pb-rich and Sn-rich solder phases, the Cu6Sn5 and Cu3Sn intermetallic phases, and Cu were identified using selected area electron diffraction. Artifacts due to sectioning, such as knife marks, intermetallic tearing, and brittle phase extraction, were observed. These artifacts were minimized by controlling the sectioning conditions.
The formation and growth of Cu6Sn5 and Cu3Sn at the interface of Sn-Pb solder/copper substrate are factors which affect the solderability and reliability of electronic solder joints. The addition of particles such as Ni to eutectic Sn-Pb solder drastically affects the activation energies of formation for both intermetallics. This study was performed to understand the mechanisms of intermetallic formation and the effects of Ni on intermetallic growth. Cu/Sn and Cu/Sn/Ni thin films were deposited by evaporation and observed in the TEM in real time using a hot stage. The diffusion of Sn through Cu6Sn5 and Cu3Sn followed by reaction with Cu must occur for intermetallic formation and growth to take place. Ni is an effective diffusion barrier which prevents Sn from diffusing into Cu.
BaTiO3 (BT) thin films deposited using pulsed laser ablation on substrates of (100) Si and (100) Si with 0.3 μm Ge were examined. For one set of samples, approximately 2000 Å of BT was deposited at 70°C at O2 pressures of 0, 1.0 and 10.0 mT. In a second set, O2 pressures of 0 and 1.0 mT were used during deposition of 200 Å of BT at 450°C followed by a 5 minute anneal and deposition of an additional 2000 Å at 750°C. This gave a total sample matrix of 10 samples. Cross-sectional TEM revealed that an interfacial layer formed in the BT on Si samples but not in the BT on Ge samples. HREM analysis of the interfaces showed that the interfacial layer was amorphous. On Ge, the BT films were found to have large areas of epitactic growth along the interface. This was confirmed by diffraction tilt angle experiments which showed a strong preferred orientation of BT on Ge. No preferred orientation was found for BT on Si. Statistical grain size analysis of the films using multiple regression showed that the film microstructures were affected most strongly by the substrate type (Ge or Si) followed by the deposition temperature of the substrate. Only a weak effect of O2 pressure was observed.
Barium strontium titanate films were deposited onto silicon substrates using pulsed laser ablation deposition. The films were characterized using conventional and high resolution cross-sectional TEM. It was found that the grains were columnar with an average width of approximately 23 nm. An amorphous interfacial layer formed between the Si and BST in all cases. The interfacial layer thickness increased as the sample exposure to O2 increased. TiSi2 was also observed in all the films, although its location at the interface was not directly verified. There are no systematic effects of O2 overpressure on either the film thickness or film microstructure. However, the film which was fabricated with the greatest exposure to O2 may contain TixOy, and contains more equiaxed grains than the other samples. An interfacial layer was also observed at the Au-Pd/BST interface in a metal/ferroelectric/silicon capacitor. The significance of the results is the observation that BST may never come in direct contact with either capacitor electrode, which may explain why the fatigue behavior and electrical characteristics of ferroelectric capacitors depend so strongly on the interfaces.
Can an action cease to be required of a moral agent solely because it comes too costly? Can self-sacrifice or risk of self-sacrifice serve as a limit on our moral obligations? Two recent articles in Philosophy, concerned primarily with the possibility of supererogatory action, suggest very different answers to these questions.
A case of spinal subdural hematoma occurring in association with anticoagulant therapy is reported. Seven similar cases from the literature are reviewed with emphasis on the clinical features, investigation, and the results of treatment. The prognosis for recovery is good, only if the condition is diagnosed and the clot evacuated before severe spinal cord compression and subsequent ischemic necrosis has occurred.
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