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This study investigated the incidence and risk to staff groups for sustaining needlestick injuries (NSIs) in the National University Hospital (NUH), Singapore. A retrospective cohort review of incident NSI cases was undertaken to determine the injury rate, causation, and epidemiological profile of such injuries. Analysis of the risk of sustaining recurrent NSI by occupation and location was done using the Cox proportional hazards model. There were 244 NSI cases in 5957 employees in NUH in 2014, giving an incidence rate of 4·1/100 healthcare workers (HCWs) per year. The incidence rate was highest for doctors at 21·3, and 2·7 for nurses; 40·6% of injuries occurred in wards, and 32·8% in operating theatres. There were 27 cases of repeated NSI cases. The estimated cost due to NSIs in NUH ranged from US$ 109 800 to US$ 563 152 in 2014. We conclude that creating a workplace environment where top priority is given to prevention of NSIs in HCWs, is essential to address the high incidence of reported NSIs. The data collected will be of value to inform the design of prevention programmes to reduce further the risk of NSIs in HCWs.
Although playing a key role in the understanding of the supernova phenomenon, the evolution of massive stars still suffers from uncertainties in their structure, even during their “quiet” main sequence phase and later on during their subgiant and helium burning phases. What is the extent of the mixed central region? In the local mixing length theory (LMLT) frame, are there structural differences using Schwarzschild or Ledoux convection criterion? Where are located the convective zone boundaries? Are there intermediate convection zones during MS and post-MS phase, and what is their extent and location? We discuss these points and show how asteroseismology could bring some light on these questions.
A recent photometric survey in the NGC 3766 cluster led to the detection of stars presenting an unexpected variability. They lie in a region of the Hertzsprung-Russell (HR) diagram where no pulsation are theoretically expected, in between the δ Scuti and slowly pulsating B (SPB) star instability domains. Their variability periods, between ~0.1–0.7 d, are outside the expected domains of these well-known pulsators. The NCG 3766 cluster is known to host fast rotating stars. Rotation can significantly affect the pulsation properties of stars and alter their apparent luminosity through gravity darkening. Therefore we inspect if the new variable stars could correspond to fast rotating SPB stars. We carry out instability and visibility analysis of SPB pulsation modes within the frame of the traditional approximation. The effects of gravity darkening on typical SPB models are next studied. We find that at the red border of the SPB instability strip, prograde sectoral (PS) modes are preferentially excited, with periods shifted in the 0.2–0.5 d range due to the Coriolis effect. These modes are best seen when the star is seen equator-on. For such inclinations, low-mass SPB models can appear fainter due to gravity darkening and as if they were located between the δ Scuti and SPB instability strips.
Most individuals with dementia live in the community, receiving care from family or lay carers. Carers’ wellbeing, and the quality of the care they provide, depends on their resilience in the face of the challenges associated with caring for someone with dementia. However, factors associated with carers’ resilience are not yet fully understood. The aim of this review is to present a narrative synthesis of factors, materials and resources associated with carers’ resilience. Electronic and hand searches identified relevant published literature, which was narratively synthesized. A framework consisting of three inter-related domains of factors influencing carers’ resilience emerged, encompassing: social and cultural factors; properties of the care relationship; and carers’ psychological factors. Holistic assessment based on this framework can help practitioners to identify vulnerable carers and to target help on factors that help to make them vulnerable but that are amenable to change.
We investigated an international outbreak of Salmonella Agona with a distinct PFGE pattern associated with an Irish Food company (company X) producing pre-cooked meat products sold in various food outlet chains in Europe. The outbreak was first detected in Ireland. We undertook national and international case-finding, food traceback and microbiological investigation of human, food and environmental samples. We undertook a matched case-control study on Irish cases. In total, 163 cases in seven European countries were laboratory-confirmed. Consumption of food from food outlet chains supplied by company X was significantly associated with being a confirmed case (mOR 18·3, 95% CI 2·2–149·2) in the case-control study. The outbreak strain was isolated from the company's pre-cooked meat products and production premises. Sufficient evidence was gathered to infer the vehicles of infection and sources of the outbreak and to justify the control measures taken, which were plant closure and food recall.
Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently.
Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year.
Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder.
Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.
Transmission electron microscopy (TEM) and spectroscopy have been evolved to a stage such that they can be routinely used to probe the structure and composition of the materials with the resolution of a single atomic column. However, a direct in situ TEM observation of structural evolution of the materials in a lithium ion battery during dynamic operation of the battery has never been reported. In this paper, we report the results of exploring the in situ TEM techniques for observation of interfaces in the lithium ion battery during the operation of the battery. A miniature battery was fabricated using a single nanowire and an ionic liquid electrolyte. The structure and composition of the interface across the anode and the electrolyte was studied using TEM imaging, electron diffraction, and electron energy-loss spectroscopy. In addition, we also explored the possibilities of carrying out in situ TEM studies of lithium ion batteries with a solid state electrolyte.
To identify neuropsychological and psychosocial factors predictive of amnestic Mild Cognitive Impairment (aMCI) among a group of 94 nondemented older adults, we employed a novel nonlinear multivariate classification statistical method called Optimal Data Analysis (ODA) in a dataset collected annually for 3 years. Performance on measures of memory and visuomotor processing speed or symptoms of depression in year 1 predicted aMCI status by year 2. Performance on a measure of learning at year 1 predicted aMCI status at year 3. No other measures significantly predicted incidence of aMCI at years 2 and 3. Results support the utility of multiple neuropsychological and psychosocial measures in the diagnosis of aMCI, and the present model may serve as a testable hypothesis for prospective investigations of the development of aMCI. (JINS, 2010, 16, 721–729.)
In reattribution, general practitioners (GPs) request psychosocial information directly and explain medically unexplained symptoms (MUS) using psychosocial information in the consultation. We explored whether reattribution training (RT) increased the communication of psychosocial information and decreased communication about somatic intervention between GPs and their MUS patients.
A cluster randomized controlled trial (RCT) of RT versus usual treatment in GPs from 16 practices and 141 patients with MUS on audio-recorded and transcribed doctor–patient communication in an index consultation. In a secondary data analysis, the Liverpool Clinical Interaction Analysis Scheme (LCIAS) was applied by an experienced rater to each turn of speech in the transcript from the index consultation blind to treatment allocation.
After RT, patients were more likely to disclose and discuss psychosocial problems, and propose psychosocial explanations for symptoms; around 25% of patients discussed psychosocial information extensively. In the RT group, GPs did not seek new psychosocial disclosure but they reduced advocacy for somatic intervention. After RT, GPs suggested, on average, two utterances of psychosocial explanation and six utterances of somatic intervention.
After RT, some patients discussed psychosocial issues extensively but GPs did not probe underlying psychosocial issues. They gave mixed psychosocial and somatic messages about MUS, which may have increased patients' concerns about their health. GPs should actively seek the disclosure of underlying psychosocial problems and give clear, unambiguous messages to MUS patients when they are willing to discuss psychosocial issues.
A point source outbreak of haemorrhagic colitis due to Escherichia coli O 157. H7 producing verocytotoxin (VT), took place following a christening party in Birmingham in June 1987. Twenty-six people were affected, six were admitted to hospital and one developed haemolytic uraemic syndrome: there were no deaths. VT + E. coli O 157. H7 was isolated from 13 (57%) of 23 faecal specimens from affected people and from 3 (9%) of 33 specimens from asymptomatic people. Free VT was detected in the faeces of one further asymptomatic person. Illness was associated with eating turkey-roll sandwiches (P < 0·001) suggesting that cold meats might be an important source of infection.
During a group A streptococcus (GAS) outbreak 21 abattoir workers developed skin infections. The unusual outbreak strain (emm 108.1) was cultured from five workers and four persons in the community with links to the abattoir. The attack rate was 26% in the lamb line. Communal nailbrushes were neither routinely disinfected nor changed, and had high bacterial counts. A cohort study found a higher risk from working in the gutting area and getting cuts on hands more than weekly. Despite high bacterial counts daily nailbrush use had a lower risk, as did always wearing disposable gloves. Working in the gutting area (OR 11·44) and nailbrush use at least once a day (OR 0·04) were significant in the multivariate model. Transmission of infection is likely to have occurred on carcasses. GAS infection among abattoir workers was once common. Simple hygiene measures, such as nailbrush use, may reduce the impact of future outbreaks.
Human factors certification criteria are being developed for large civil aircraft with the objective of reducing the incidence of design-induced error on the flight deck. Many formal error identification techniques currently exist which have been developed in non-aviation contexts but none have been validated for use to this end. This paper describes a new human error identification technique (HET – human error template) designed specifically as a diagnostic tool for the identification of design-induced error on the flight deck. HET is benchmarked against three existing techniques (SHERPA – systematic human error reduction and prediction approach; human error HAZOP – hazard and operability study; and HEIST – human error In systems tool). HET outperforms all three existing techniques in a validation study comparing predicted errors to actual errors reported during an approach and landing task in a modern, highly automated commercial aircraft. It is concluded that HET should provide a useful tool as a adjunct to the proposed human factors certification process.
The profiles of neuropsychological deficits associated with
Alzheimer's disease (AD) in Young-Old (M age <
70) and Very-Old (M age > 80) patients were compared,
along with possible modifying effects of apolipoprotein E (APOE)
genotype on these profiles. A comprehensive battery of
neuropsychological tests was administered to the two AD patient
groups (Young-Old: n = 33; Very-Old: n = 48)
and their respective age-matched normal control (NC) groups
who remained free of dementia on follow-up examinations over
a 1 to 10 year period (Young-Old: n = 43; Very-Old:
n = 36). AD and NC groups did not differ in education
levels or gender distributions. Young-Old AD and Very-Old AD
groups were comparable in education, gender, dementia severity,
and disease duration. Results showed that both AD groups achieved
comparable raw scores on all the neuropsychological measures.
However, when scores were standardized on the basis of performance
of their respective NC groups (i.e., age-corrected z
scores), Very-Old AD patients significantly outperformed Young-Old
AD patients on tests of executive functions, visuospatial skills,
and delayed memory. Furthermore, the relationship between age
and memory and executive function deficits in AD was modified
by APOE genotype. These data suggest that the profile of
neuropsychological deficits associated with AD in the Very-Old
lacks the disproportionate saliency of episodic memory and
executive function deficits typical of the Young-Old.
(JINS, 2003, 9, 783–795.)
We describe an optical fiber based interferometer
to measure velocity profiles in sheared complex fluids using dynamic light scattering (DLS).
After a review of the theoretical problem of DLS under shear,
a detailed description of the setup is given. We outline the various experimental difficulties
induced by refraction when using a Couette cell.
We also show that homodyne DLS is not well suited
to measure quantitative velocity profiles in narrow-gap Couette geometries.
On the other hand, the heterodyne technique allows us to determine the velocity field
inside the gap of a Couette cell. All the technical features of the setup,
namely its spatial resolution (≈ 50 − 100 µm) and its temporal resolution (≈ 1 s per point, ≈ 1 min per profile)
are discussed, as well as the calibration procedure with a Newtonian fluid.
As briefly shown on oil-in-water emulsions, such a setup permits one to record both velocity
profiles and rheological data simultaneously.
Psychotic symptoms are common in Alzheimer's
disease (AD) and clinicoanatomical and neuropsychological
evidence indicate an association between these symptoms
and frontal lobe dysfunction. Neurobehaviors associated
with frontal dysfunction were assessed in Alzheimer's
disease (AD) patients with (n = 20) and without
psychotic symptoms (n = 21) matched for mean age,
education, gender, and dementia severity. The Frontal Lobe
Personality Scale (FLOPs) was completed by patient caregivers
to measure behaviors typically associated with frontal
dysfunction. Findings indicated that AD patients with psychotic
symptoms exhibited significantly greater neurobehavioral
dysfunction (FLOPs M = 130.69, SD = 24.70)
than AD patients without psychotic symptoms (FLOPs M =
111.10, SD = 25.83). Subscale analyses indicated that
psychotic AD patients were more disinhibited (M = 28.28,
SD = 7.54) than patients without psychotic symptoms
(M = 20.92, SD = 4.9). Findings are consistent
with and contribute to previous neuropsychological and
clinicoanatomical research suggesting increased frontal
dysfunction in AD with psychotic symptoms and lend additional
empirical support to subtyping AD based on the presence
of psychotic symptoms. Furthermore, findings provide preliminary
evidence indicating which specific type of neurobehavioral
abnormalities are related to the presence of distressing psychotic
symptoms. (JINS, 2000, 6, 815–820.)
To determine the occupational significance of tick-borne zoonoses
we sought serological
evidence of Lyme borreliosis, human monocytic ehrlichiosis (HME) and human
ehrlichiosis (HGE) in a representative sample of farmworkers. Although
around 20% reported
ticks on their domestic and companion animals, few (<2% per year) reported
being bitten by
ticks. Seroprevalence of Lyme borreliosis (0·2%), HME (0·2%)
and HGE (1·5%) was low.
Those seropositive for HGE were no more likely to report tick bites nor
more likely to report
ticks on their animals. This study provides evidence that farmworkers in
England are exposed
to tick-borne zoonoses but that they are uncommon. Since the severity of
these diseases is
linked to delays in diagnosis and treatment, clinicians should be aware
of these diagnoses in
patients from rural communities, with or without a self-reported history
of tick bite.
1. The resistance of the hop-mildew (Sphaerotheca Humuli (DC.) Burr.) to polysulphide solutions varies according to its stage of development. The earliest stages after infection and antecedent to the production of conidiophores are the most resistant, requiring approximately a solution of double the concentration lethal for the “powdery” conidial stage. The “powdery” conidial stage occurring on young leaves is more resistant than the same stage on older leaves.
2. Conclusive proof has been obtained that with polysulphide solutions neither the total sulphur content nor the sulphide sulphur content gives an index of their fungicidal value.
3. The percentage of polysulphide sulphur in polysulphide solutions appears to be the factor determining their fungicidal value.
4. The fungicidal value of such solutions does not depend upon the nature of the polysulphides present.