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Introduction: We implemented a pharmacist-led antimicrobial stewardship (AMS) service for patients discharged from the pediatric emergency department (PED). This service, supported by a collaborative practice agreement, allows pharmacists to follow up with patients and independently stop, start, or adjust antimicrobial agents based on culture results. The primary objective of our study was to evaluate the impact of this service on the rate of return visits to the PED within 96 hours. The secondary objective was to evaluate the appropriateness of the prescribed antimicrobial agent at follow up. Methods: This study was completed as a retrospective chart review 6 months pre-implementation (January 1st, 2016 to June 31st, 2016) and 6 months post-implementation (February 1st, 2017 to July 31st, 2017) of a pharmacist-led AMS service. A research assistant extracted data from electronic medical records using a standardized data collection form. All patients discharged from the PED with a suspected infection whose cultures fell within the parameters of the collaborative practice agreement were included in this study. Data were reported descriptively and compared using a two-sided chi-square test. Results: This study included 1070 patient encounters pre-implementation and 1040 patient encounters post-implementation of the AMS service. The most commonly reviewed culture was urine (38% pre-implementation and 41% post-implementation). The rate of return visits to the PED within 96 hours was 12.0% (129/1070) pre-implementation vs 10.0% (100/1049) post-implementation phase (p = 0.07). A significantly higher percentage of inappropriate antimicrobial therapy was identified at the time of follow up in the pre-implementation phase (7.0%, 68/975) compared to the post-implementation phase (5.0%, 46/952), p = 0.047. Conclusion: Although this pharmacist-led AMS service did not affect the rate of return visits within 96 hours, it may have led to more judicious use of antimicrobial agents.
The epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.
The aim of this analysis was to test if changes in insomnia symptoms and global sleep quality are associated with coinciding changes in depressed mood among older adults. We report on results yielded from secondary analysis of longitudinal data from a clinical trial of older adults (N = 49) aged 55 to 80 years who reported at least moderate levels of sleep problems. All measures were collected at baseline and after the trial ten weeks later. We computed change scores for two separate measures of disturbed sleep, the Athens Insomnia Scale (AIS) and the Pittsburgh Sleep Quality Index (PSQI), and tested their association with change in depressed mood (Beck Depression Inventory-II; BDI-II) in two separate linear regression models adjusted for biological covariates related to sleep (sex, age, body mass index, and NF-κB as a biological marker previously correlated with insomnia and depression). Change in AIS scores was associated with change in BDI-II scores (β = 0.38, p < 0.01). Change in PSQI scores was not significantly associated with change in BDI-II scores (β = 0.17, p = 0.26). Our findings suggest that improvements over ten weeks in insomnia symptoms rather than global sleep quality coincide with improvement in depressed mood among older adults.
Body image disturbance (BID) is a core symptom of anorexia nervosa (AN), but as yet distinctive features of BID are unknown. The present study aimed at disentangling perceptual and attitudinal components of BID in AN.
We investigated n = 24 women with AN and n = 24 controls. Based on a three-dimensional (3D) body scan, we created realistic virtual 3D bodies (avatars) for each participant that were varied through a range of ±20% of the participants’ weights. Avatars were presented in a virtual reality mirror scenario. Using different psychophysical tasks, participants identified and adjusted their actual and their desired body weight. To test for general perceptual biases in estimating body weight, a second experiment investigated perception of weight and shape matched avatars with another identity.
Women with AN and controls underestimated their weight, with a trend that women with AN underestimated more. The average desired body of controls had normal weight while the average desired weight of women with AN corresponded to extreme AN (DSM-5). Correlation analyses revealed that desired body weight, but not accuracy of weight estimation, was associated with eating disorder symptoms. In the second experiment, both groups estimated accurately while the most attractive body was similar to Experiment 1.
Our results contradict the widespread assumption that patients with AN overestimate their body weight due to visual distortions. Rather, they illustrate that BID might be driven by distorted attitudes with regard to the desired body. Clinical interventions should aim at helping patients with AN to change their desired weight.
Far-UV photons (FUV, E < 13.6 eV) from hot massive stars regulate, or at least influence, the heating, ionization, and chemistry of most of the neutral interstellar medium (H i and H2 clouds). Investigating the interaction between FUV radiation and interstellar matter (molecules, atoms and grains) thus plays an important role in astrochemistry.
The Orion Bar, an interface region between the Orion A molecular cloud and the H ii region around the Trapezium cluster, is a textbook example of a strongly illuminated dense PDR (photodissociation region). The Bar is illuminated by a FUV field of a few 104 times the mean interstellar radiation field. Because of its proximity and nearly edge-on orientation, it provides a very good template to investigate the chemical content, structure, and dynamics of a strongly irradiated molecular cloud edge. We have used ALMA to mosaic a small field of the Bar where the critical transition from atomic to molecular gas takes place. These observations provide an unprecedented sharp view of this transition layer (≲ 1″ resolution or ≲ 414 AU). The resulting images (so far in the rotational emission of CO, HCO+, H13CO+, SO+, SO, and reactive ions SH+ and HOC+) show the small-scale structure in gas density and temperature, and the steep abundance gradients. The images reveal a pattern of high-density substructures, photo-ablative gas flows and instabilities at the edge of the molecular cloud. These first ALMA images thus show a more complex morphology than the classical clump/interclump static model of a PDR.
In order to quantify the chemical content in strongly FUV-irradiated gas, we have also used the IRAM-30 m telescope to carry out a complete line-survey of the illuminated edge of the Bar in the millimeter domain. Our observations reveal the presence of complex organic molecules (and precursors) that were not expected in such a harsh environment. In particular, we have reported the first detection of the unstable cis conformer of formic acid (HCOOH) in the ISM. The energy barrier to internal rotation (the conversion from trans to cis) is approximately 4827 cm−1 (≈7000 K). Hence, this detection is surprising. The low inferred trans-to-cis abundance ratio of 2.8±1.0 supports a photoswitching mechanism: a given conformer absorbs a FUV stellar photon that radiatively excites the molecule to electronic states above the interconversion barrier. Subsequent fluorescent decay leaves the molecule in a different conformer form. This mechanism, which we have specifically studied with ab initio quantum calculations, was not considered so far in astrochemistry although it can affect the structure of a variety of molecules in PDRs.
According to diathesis–stress models, personality traits, such as negative emotionality (NE) and positive emotionality (PE), may moderate the effects of stressors on the development of depression. However, relatively little empirical research has directly examined whether NE and PE act as diatheses in the presence of stressful life events, and no research has examined whether they moderate the effect of disaster exposure on depressive symptoms. Hurricane Sandy, the second costliest hurricane in US history, offers a unique opportunity to address these gaps.
A total of 318 women completed measures of NE and PE 5 years prior to Hurricane Sandy. They were also assessed for lifetime depressive disorders on two occasions, the latter occurring an average of 1 year before the hurricane. Approximately 8 weeks after the disaster (mean = 8.40, s.d. = 1.48 weeks), participants completed a hurricane stress exposure questionnaire and a measure of current depressive symptoms.
Adjusting for lifetime history of depressive disorders, higher levels of stress from Hurricane Sandy predicted elevated levels of depressive symptoms, but only in participants with high levels of NE or low levels of PE.
These findings support the role of personality in the development of depression and suggest that personality traits can be useful in identifying those most vulnerable to major stressors, including natural disasters.
To examine the association between cardiorespiratory fitness and dietary patterns in adolescents.
Food choice was assessed using the validated New Zealand Adolescent FFQ. Principal components analysis was used to determine dietary patterns. Trained research assistants measured participants’ height and body mass. Cardiorespiratory fitness was assessed in a subset of participants using the multistage 20 m shuttle run. The level and stage were recorded, and the corresponding VO2max was calculated. Differences in mean VO2max according to sex and BMI were assessed using t tests, while associations between cardiorespiratory fitness and dietary patterns were examined using linear regression analyses adjusted for age, sex, school attended, socio-economic deprivation and BMI.
Secondary schools in Otago, New Zealand.
Students (n 279) aged 14–18 years who completed an online lifestyle survey during a class period.
Principal components analysis produced three dietary patterns: ‘Treat Foods’, ‘Fruits and Vegetables’ and ‘Basic Foods’. The 279 participants who provided questionnaire data and completed cardiorespiratory fitness testing had a mean age of 15·7 (sd 0·9) years. Mean VO2max was 45·8 (sd 6·9) ml/kg per min. The ‘Fruits and Vegetables’ pattern was positively associated with VO2max in the total sample (β=0·04; 95 %CI 0·02, 0·07), girls (β=0·06; 95 % CI 0·03, 0·10) and boys (β=0·03; 95 % CI 0·01, 0·05).
These results indicate that increase in cardiorespiratory fitness was associated with a healthier dietary pattern, suggesting both should be targeted as part of a global lifestyle approach. Longitudinal studies are needed to confirm this association in relation to health outcomes in New Zealand adolescents.
To examine the potential associations between diet quality and multiple measures of body composition in a sample of New Zealand adolescents aged 14–18 years.
Cross-sectional survey of eleven high schools in Otago, New Zealand. Each participant completed an online FFQ and a New Zealand Diet Quality Index for Adolescents (NZDQI-A) score was calculated based on variety and adequacy of intake for five major food groups. Besides height and waist circumference measurements, body composition was assessed using segmental bio-impedance analysis. Generalized estimating equations were used to examine associations between diet quality and body composition in models adjusted for sex, age, ethnicity and socio-economic status.
High schools in Otago, New Zealand.
High-school students (n 681, 56 % male, mean age 16·1 (sd 1·5) years) participating in the Otago School Students Lifestyle Survey Two.
Higher NZDQI-A scores were significantly associated with lower body fat percentage (β=−0·19; 95 % CI −0·35, −0·04; P=0·014), fat-to-lean mass ratio (β=−0·26; 95 % CI −0·46, −0·05; P=0·016) and lower fat mass index (β=−0·23; 95 % CI −0·45, −0·004; P=0·046) after multivariate adjustment. No association was found between NZDQI-A and BMI, waist circumference or waist-to-height ratio.
Diet quality, as measured by NZDQI-A, was associated only with measures of body fat, not measures of overall body size. Measures specific to body fat should be used for more accurate ascertainment of body composition in examining the diet–body composition associations in this age group.
We conducted an experiment to determine whether early-life social learning of feeding site selection in lambs was sex-specific. Sixteen ewes and their new born lambs were used in a controlled experiment. Eight ewe–lamb pairs included a male lamb and the remaining eight a female lamb. All pairs were individually exposed to an experimental arena containing a safe and unsafe artificial feeding site (SFS, UFS) each consisting of nine bowls which contained either ground Bermuda grass hay (SFS) or ground alfalfa hay (UFS). The bowls in UFS were surrounded by bright orange traffic cones (visual cues). Half the ewes were trained with controlled electric shock to avoid UFS. Thus, pairs were randomly assigned to: (1) shock aversion training (SAT) to mothers of male lambs (MS); (2) SAT to mothers of female lambs (FS); (3) no aversion training (NAT, control) to mothers of male lambs (MC); and (4) NAT (control) to mothers of female lambs (FC). None of the lambs were subjected to SAT. During training, testing, extinction, and retraining ewe–lamb pairs were exposed to the arena together. Ewes were then removed from the experiment and two additional extinction phases were conducted with weaned lambs alone. Fear conditioning elicited UFS avoidance of both the trained ewes (means±s.e.m. % times observed in UFS during testing phase: FC=95.3±1.70; MC=94.4±4.87; FS=1.6±1.63; MS=0 ±0; P<0.01) and their naïve lambs (FC=83.8±6.07%; MC=76.6±6.56%; FS=30.4±7.90%; MS=33.9±9.23%; P<0.01). UFS avoidance in lambs occurred regardless of sex and tended to persist after weaning (% times observed in UFS during 1st post-weaning extinction phase: FC=92.6±4.50%; MC=89.8±6.09%; FS=45.1±10.57%; MS=43.5±10.42%; P=0.06). Fear conditioning in mothers appeared to alter sex-related differences in mother–infant behavioral synchrony by increasing and decreasing feeding synchrony of male and female lambs, respectively (FC: r=0.52, P<0.01; MC: r=−0.02, P=0.86; FS: r=0.14, P=0.26; MS: r=0.46, P<0.01). During the extinction phase mothers of ram lambs were observed feeding more often (FC=85.0±2.33%; MC=92.7±1.45%; FS=47.3±8.81%; MS=72±5.68%; P=0.02) and standing less often than ewes with daughters (FC=7.3±2.40%; MC=2.7±0.83%; FS=39.3±9.04%; MS=18.0±5.29%; P=0.06). This study suggests that social conditioning at an early age could be a viable tool to induce learning of feeding site avoidance in female and male lambs alike.
A NIST SRM certified to address the issue of crystallite size measurement through a line profile analysis has been under development for several years. In order to prepare the feedstock for the SRM, nano-crystalline zinc oxide was produced from thermal decomposition of zinc oxalate. The thermal processing parameters were chosen to yield particles in two size ranges, one with a distribution centered at approximately 15 nm and another centered at 60 nm. Certification data were collected on a NIST-built diffractometer equipped with a Johansson incident beam monochromator and scintillation detector. Data were analyzed using whole powder pattern modeling to determine microstructural data. The analysis shows domains to be in the form of discs of a fairly small aspect ratio. While both materials exhibit the effects of stacking faults through broadening of specific hkl reflections, their presence in the 60 nm is more difficult to discern. Images of the crystallites obtained with transmission electron microscopy are consistent with the results from the X-ray diffraction analyses.
The Herschel Space Observatory carried out observations at far-infrared wavelengths, which significantly increased our knowledge of the interstellar medium and the star-formation process in the Milky Way and external galaxies, as well as our understanding of astrochemistry.
Absorption features, known, e.g., from observations at millimeter wavelengths, are more commonly observed in the far-infrared, in particular toward strong dust continuum sources. The lowest energy transitions are not only observed at LSR-velocities related to the source, but often also at velocities associated with diffuse molecular clouds along the line of sight toward the background source.
Unbiased spectral line surveys of the massive and very luminous Galactic Center sources Sagittarius B2(M) and (N) were carried out across the entire frequency range of the high-resolution Heterodyne Instrument for Far-Infrared Astronomy (HIFI). An absorption feature was detected toward both sources at about 617.531 GHz, corresponding to 20.599 cm−1, 485.47 μm, or 2.5539 meV. This feature is unique in its appearance at all velocity components associated with diffuse foreground molecular clouds, together with its conspicuous absence at velocities related to the sources themselves. The carriers of at least a substantial part of the DIBs are thought to reside in the diffuse interstellar medium. Therefore, we consider this absorption feature to be a far-infrared DIB analog.
Subsequent dedicated observations confirmed that the line is present only in the foreground clouds on the line of sight toward other massive star-forming regions in the Galactic disk. There is indication that the feature has substructure, possibly of fine or hyperfine nature. Attempts to assign the feature to atomic or molecular species have been unsuccessful so far.
What are the affordances of online gaming environments for second language learning and socialization? To answer this question, this qualitative study examines two college-age Spanish learners’ experiences participating in the Spanish language version of the massively multi-player online game World of Warcraft. Using data culled from participant observation, interviews, logs of in-game chat, and student journal entries, we describe how the design of the game, cultural norms for its use, and participants’ own abilities interact to afford distinct opportunities for language learning for these two students. Discussion focuses on how online games might be used for language teaching and learning in ways that take full advantage of the medium's affordances for both experienced and inexperienced players.
The study of molecules in space, known as astrochemistry or molecular astrophysics, is a rapidly growing field. Molecules exist in a wide range of environments in both gaseous and solid form, from our own solar system to the distant early universe. To astronomers, molecules are indispensable and unique probes of the physical conditions and dynamics of regions in which they are detected, especially the interstellar medium. In particular, the many stages of both low-mass and high-mass star formation are better understood today thanks to the analysis of molecular observations. Molecules can also yield a global picture of the past and present of sources. Moreover, molecules affect their environment by contributing to the heating and cooling processes that occur.
In May 2009, we investigated a hospital outbreak of pandemic H1N1 (pH1N1) infection among healthcare personnel (HCP). Thirteen (65%) of 20 HCP with pH1N1 infection had healthcare-associated cases, which were primarily attributed to transmission among HCP. Eleven (55%) of HCP with pH1N1 infection worked for 1 day or more after the onset of illness. Personnel working with mild illness may have contributed to transmission among HCP.
Organic photovoltaic devices offer a potentially cheap source of electrical power due to the relative ease of processing compared to silicon devices. Over the last decade the efficiency of these devices has improved significantly and the best devices are currently have >6% power conversion efficiency and ~100% quantum efficiency.
A novel blend of ferroelectric nanostructures, poly(3-hexylthiophene) (P3HT) and [6, 6]-phenyl-C61-butyric acid methyl ester (PCBM) has been used to fabricate hybrid organic and inorganic photovoltaic devices. These devices comprise a glass substrate coated with indium tin oxide (ITO) and an layer of PEDOT:PSS to form the first electrode. The active layer was deposited by spin coating and finally metallic top contacts have been added by thermal evaporation. The devices were characterized using standard current-voltage (IV) measurements under illuminated and dark conditions using an AM1.5 solar simulator and a source-voltage device and the results indicate a difference in efficiency compared to similar devices fabricated at the same time without the novel nanostructures. Additional UV-Vis measurements were used to determine the absorption characteristics of the active layers. The initial results suggest an improvement in the absorption of light in the visible region and higher open circuit voltages and short circuit currents compared to P3HT/PCBM alone.