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Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.
A retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.
In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.
Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.
Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.
In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.
Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).
Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.
Socioeconomic difficulties affect the cognitive and emotional development of children. However, the focus of prior studies has largely been on poverty and material hardship. This study expands on the existing literature by examining the impact of familial transient financial difficulties during infancy on long-term cognitive and behavioral outcomes.
The National Longitudinal Surveys of Youth (79) were used to assess the association between a transient drop in family income by 50% or more (called transient income decline or TID) during the first 3 years of life and later-life Peabody Individual Achievement Math and Reading scores and behavior problem index (BPI) scores (N = 8272–17 348; median assessment age = 9 years). A subsample of matched siblings (N = 2049–4238) was examined to tease out maternal and intra-familial effects.
Exposure to TID predicted increased total and externalizing BPI scores (std. coefficients of 0.10 and 0.09, respectively, p < 0.01) in the overall sample. Among matched siblings, exposure to TID predicted increased total, externalizing, and internalizing BPI scores (std. coefficients of 0.27, 0.25, and 0.23, respectively, p < 0.01).
Familial transient financial difficulties can have long-lasting behavioral effects for infants. The study identifies an early risk factor and at-risk children, thus providing insight into developing early intervention measures for infants to avoid long-term behavioral problems.
The focused ion beam (FIB) has the necessary precision, spatial resolution and control over ion delivery for potential nano-scale doping of nanostructures such as semiconductor quantum dots (QDs). The ion current density in a FIB is 0.1-10 A/cm2, which is at least three orders of magnitude higher than that in a commercial broad beam ion implanter. Therefore an understanding of FIB implantation damage and recovery is of substantial interest. In this work we employ Raman probes of wavelengths 514 nm and 405 nm for quantifying ion implantation damage—both before and after annealing—in 30 kV Si2+, Ge2+ and Ga+ implants (fluences: 1x1012-5x1015 ions/cm2) into Si(100), for the purpose of understanding the effect of ion species on damage recovery.
An investigation was carried out to quantify and characterize the corrosion behavior of
AZ61A magnesium alloy joints. Extruded 6-mm-thick Mg alloy plates of AZ61A grade were
butt-welded using a solid-state, environmentally cleaner welding process, the friction
stir welding process. The weld specimens underwent immersion, salt spray, pitting and
galvanic corrosion tests in order to quantify and characterize the corrosion rates of the
welds with the influence of different pH values, chloride ion concentrations and the
corrosion time. The corrosion rates, microstructure, scanning electron microscopy and
X-ray diffraction analysis concluded the optimum parameters for the usage of the magnesium
alloy welds for the best service applications.
During a routine survey, the scalloped hammerhead shark, Sphyrna lewini was caught from Nagapattinam coastal waters, south-east coast of India. It is the second time this species has occurred after a long period along the Indian coast, and this substantiates the possibility of its entry from another place.
The properties of turbulent mixing in a Richtmyer–Meshkov (RM) unstable fluid layer are studied under the impact of a single shock followed by a reshock wave using simultaneous velocity–density measurements to provide new insights into the physics of RM mixing. The experiments were conducted on a varicose fluid layer (heavy fluid) interposed in air (light fluid) inside a horizontal shock tube at an incident Mach number of 1.21 and a reflected reshock Mach number of 1.14. The light–heavy–light fluid layer is observed to develop a nonlinear growth pattern, with no transition to turbulence upon impact by a single shock (up to ). However, upon reshock, enhanced mixing between the heavy and light fluids along with a transition to a turbulent state characterized by the generation of significant turbulent velocity fluctuations () is observed. The streamwise and spanwise root-mean-squared velocity fluctuation statistics show similar trends across the fluid layer after reshock, with no observable preference for the direction of the shock wave motion. The measured streamwise mass flux () shows opposing signs on either side of the density peak within the fluid layer, consistent with the turbulent material transport being driven along the direction of the density gradient. Measurements of three of the six independent components of the general Reynolds stress tensor () show that the self-correlation terms and are similar in magnitude across much of the fluid layer, and much larger than the cross-correlation term . Most importantly, the Reynolds stresses () are dominated by the mean density, cross-velocity product term (), with the mass flux product and triple correlation terms being negligibly smaller in comparison. A lack of homogeneous mixing (and, possibly, a long-term imprint of the initial conditions) is observed in the spanwise turbulent mass flux measurements, with important implications for the simulation and modelling of RM mixing flows.
Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear.
To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India.
Patients with a DSM–IV diagnosis of schizophrenia (η = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome.
Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures.
Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.
To evaluate the type of aerobic bacteria commonly isolated from peritonsillar abscesses.
A retrospective study involving 60 patients presenting with peritonsillar abscess treated between 2003 and 2006.
The patients were treated in a tertiary care, teaching hospital. The records of the patients were reviewed and analysed.
Gram-positive organisms were commonly isolated from the abscesses. However, an increasing trend towards Gram-negative bacterial isolates was noted. The antibiogram showed changing patterns of sensitivity, with a resistance to penicillin.
There is an increasing incidence of Gram-negative aerobic bacteria causing peritonsillar abscess. Appropriate antibiotics for Gram-negative bacteria should be included in the regimen if such bacteria are isolated in culture and sensitivity studies.
Empirical antibiotics with Gram-negative cover will be appropriate as adjunctive therapy.
Lack of insight has been observed in people with schizophrenia across
cultures but assessment of insight must take into account prevailing
To determine whether culturally specific and Western biomedical
interpretations of insight and psychosis can be reconciled.
Patients with schizophrenia (n=131) were assessed during
their first contact with psychiatric services in Vellore, South India.
Patients' explanatory models, psychopathology and insight were
investigated using a standard schedule translated into Tamil.
Supernatural explanations of symptoms were frequent. Some insight
dimensions were weakly associated (inversely) with severity of symptoms
whereas preserved insight was associated with anxiety, help-seeking and
perception of change. Willingness to attribute symptoms to disease, in
others and in one's self, but not to supernatural forces was strongly
associated with insight.
The relationship between insight, awareness of illness and other clinical
variables is similar in South India to elsewhere. However, the assessment
of insight might have failed to capture locally accepted explanatory
frameworks. An inclusive conceptual model which emphasises help-seeking
In this study, the developmental ability and cellular composition of porcine IVF, parthenote and somatic cell nuclear transfer (SCNT) embryos were evaluated following different in vitro culture systems. Group 1, embryos were cultured in NCSU-23 with 5.55 mM D-glucose (NCSU+) until day 6 on 20% O2 or 5% O2 (Group 2). Group 3, embryos were cultured in D-glucose-free NCSU-23 (NCSU−) with 0.17 mM Na pyruvate/2.73 mM Na lactate for 58 h and subsequently cultured in NCSU+ until day 6 (NCSU −/+) on 20% O2 or 5% O2 (Group 4). IVF blastocysts did not differ significantly with O2 concentrations, but differed significantly with major energy source (glucose and pyruvate/lactate). In Group 3 and 4 IVF blastocysts, the total cell number and apoptosis rates were not significantly different with different O2 concentrations. Blastocyst rate, total cell number and apoptosis rate in Groups 3 and 4 parthenote embryos also were not significantly different. Parthenote and SCNT, under the same culture treatment, exhibited significant differences in blastocyst and apoptosis rates (47.5 ± 16.1 vs. 24.0 ± 4.0 and 4.9 ± 9.0 vs. 22.8 ± 23.3). Apoptosis-generating rate increased in the order parthenote, IVF and then SCNT. In conclusion, in vitro development of porcine embryos was not affected by O2 concentrations but was affected by major energy source. Even so, the concentration of each major energy source and the timing of its inclusion in culture could accomplish relatively high embryonic development, the apoptosis rate stressed that more work still needs to be done in developing a better defined culture system that could support SCNT embryos equivalent to in vivo preimplantation porcine embryos.
Nickel monosilicide (NiSi) is a leading contender to replace the currently used class of silicides for contacts to the source, drain and gate regions in Complimentary Metal-Oxide- Semiconductor (CMOS) circuits. In this work, the effect of substrate hydrogenation by a hydrogen plasma treatment prior to nickel deposition and silicidation was studied. The sheet resistance of the silicide film shows a significant decrease under hydrogenation of the Si substrate prior to Ni evaporation/anneal for projected silicidation temperatures below 600°C. Correspondingly, the Si region near the interface is decorated with defects. At higher silicidation temperatures, the sheet resistance rises along with greater in-diffusion of Ni into the hydrogenated Si samples. Secondary Ion Mass Spectrometry, Transmission Electron Microscopy and Hall effect measurements are used to characterize the samples.
The sidewalls of etched Si lines will be the carrier channel surfaces in FinFET devices. These surfaces must be as smooth as possible for optimal device performance. Thus, the ability to quantitatively measure sidewall roughness is essential to process development. A methodology to quantitatively measure Fin sidewall roughness by AFM is presented. The samples were prepared for measurement by cleaving along the length of the Fins or dense-line test structures and by FIB polishing to bring the edge of the sample close to the sidewall of the etched feature. The cleaved and FIB-polished sample was mounted 17 degrees shy of normal. This exposes the sidewall on the top surface while preventing shadowing of the lower part of the sidewall due to contact between the side of the probe support and the cleaved or polished edge. Quantitative AFM measurements taken by this method show meaningful differences in the sidewall roughness for samples that have seen different sidewall smoothing treatments. The average observed rms roughness values for various surface-smoothing treatments range from 0.8 to 1.8 Å for a 50 nm square area.
In this study, the developmental capacity and cytogenetic composition of different oocyte activation protocols was evaluated following intracytoplasmic sperm injection (ICSI) of in vitro matured bovine oocytes. Motile spermatozoa selected by Percoll density gradient were treated with 5 mM dithiothreitol (DTT) and analysed for ultrastructural changes of the head using transmission electron microscopy (TEM). The alterations in sperm morphology after DTT treatment for different times (15, 30 and 60 min) were 10%, 45-55% and 70-85%, respectively. Further, a partial decondensation of sperm heads was observed after DTT treatment for 30 min. Oocytes were injected with sperm treated with DTT for 30 min. In group 1, sperm injection was performed without any activation stimulus to the oocytes. In group 2, sham injection without sperm was performed without activating the oocytes. Oocytes injected with sperm exposed to 5 μM ionomycin for 5 min (group 3), 5 μM ionomycin + 1.9 mM dimethylaminopurine (DMAP) for 3 h (group 4) and 5 µM ionomycin + 3 h culture in M199 + 1.9 mM DMAP (group 5) were also evaluated for cleavage, development and chromosomal abnormality. Cleavage and development rates in groups 1, 2 and 3 were significantly (p < 0.05) lower than those in groups 4 and 5. The incidence of chromosomal abnormality in the embryos treated directly with DMAP after ionomycin (group 4) was higher than in group 5. We conclude that immediate DMAP treatment after ionomycin exposure of oocytes results in arrest of release of the second polar body, and thus leads to changes in chromosomal pattern. Therefore, the time interval between ionomycin and DMAP plays a crucial role in bovine ICSI.