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.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
Background: The surgical risk factors and neuro-imaging characteristics associated with cerebellar mutism (CM) remain unclear and require further investigation. We aimed to examine surgical and MRI findings associated with CM in children following posterior fossa tumor resection. Methods: Using our data registry, we retrospectively collected data from pediatric patients who acquired CM and were matched based on age and pathology type with patients not acquiring CM after posterior fossa surgery. The strength of association between surgical and MRI variables and CM were examined using odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results: A total of 22 patients were included. Medulloblastoma was the most common pathology among CM patients (91%). Tumor attachment to the floor of the fourth ventricle (OR, 6; 95% CI, 0.7-276), calcification/hemosiderin deposition (OR 7; 95% CI 0.9-315.5), and post-operative peri-ventricular ischemia on MRI (OR, 5; 95% CI, 0.5-236.5) were found to have the highest association with CM. Conclusions: Our results may suggest that tumor attachment to the floor of the fourth ventricle, pathological calcification, and post-operative ischemia are relatively more prevalent in patients with CM. Collectively, our work calls for a larger multi-institutional study of CM patients to further investigate the determinants and management of CM to potentially minimize its development and predict onset.
A few studies have examined the association between vitamin D and telomere length, and fewer still have examined the relationship in black or male populations. We investigated the cross-sectional association between the vitamin D metabolite 25-hydroxyvitamin D (25(OH)D) concentration in plasma and relative leucocyte telomere length (LTL) in 1154 US radiologic technologists who were 48–93 years old (373 white females, 278 white males, 338 black females, 165 black males). Plasma 25(OH)D concentration was measured by the chemiluminescence immunoassay, and relative LTL was measured by quantitative PCR. Logistic regression was used to obtain OR and 95 % CI for long v. short (based on median) LTL in relation to continuous 25(OH)D, quartiles of 25(OH)D and 25(OH)D deficiency. We found no significant association between continuous 25(OH)D and long LTL in all participants (Ptrend=0·440), nor in white females (Ptrend=0·845), white males (Ptrend=0·636), black females (Ptrend=0·967) or black males (Ptrend=0·484). Vitamin D deficiency (defined as 25(OH)D<30 nmol/l), however, was significantly associated with short LTL in whites (P=0·024), but not in other groups. In this population, we found little evidence to support associations between 25(OH)D and long LTL over the entire range of 25(OH)D in the overall study population or by sex and race.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.
In the post-closure period of a geological disposal facility for radioactive waste, leaching of cement components is likely to give rise to an alkaline plume which will be in chemical disequilibrium with the host rock (which is clay in some concepts) and other engineered barrier system materials used in the facility, such as bentonite. An industrial analogue for cement-clay interaction can be found at Tournemire, southern France, where boreholes filled with concrete and cement remained in contact with the natural mudstone for 15–20 years. The boreholes have been overcored, extracted and mineralogical characterization has been performed. In this study, a reactive-transport model of the Tournemire system has been set up using the general-purpose modelling tool QPAC. Previous modelling work has been built upon by using the most up-to-date data and modelling techniques, and by adding both ion exchange and surface complexation processes in the mudstone. The main features observed at Tournemire were replicated by the model, including porosity variations and precipitation of carbonates, K-feldspar, ettringite and calcite. It was found that ion exchange needed to be included in order for C-S-H minerals to precipitate in the mudstone, providing a better match with the mineralogical characterization. The additional inclusion of surface complexation, however, led to limited calcite growth at the concrete-mudstone interface unlike samples taken from the Tournemire site that have a visible line of crusty carbonates along the interface.
The international long-term cement studies (LCS) project aims to increase the understanding of the behaviour of cement within a radioactive waste disposal system and how hyper-alkaline leachates may interact with host rock. Such an understanding enables confident, robust and safety-relevant statements to be made concerning future system behaviour, irrespective of host rock, engineered barrier system, or waste type. The LCS project involves laboratory experiments, in situ tests and numerical modelling to address these issues. The agencies participating are Nagra (Switzerland), JAEA (Japan), the Nuclear Decommissioning Authority, Radioactive Waste Mangement Directorate (UK), Posiva (Finland) and SKB (Sweden).
Project activities have included: the development of conceptual and theoretical models of cement–rock interaction; testing of numerical models against data from laboratory experiments and industrial and natural analogues of cement–rock reaction; and the synthesis and incorporation of performance assessment (PA) relevant data from analogue studies. Key threads running through these studies include an analysis of issues relating to upscaling of processes and data to the greater temporal and spatial scales relevant to PA, and investigations of modelling the changes in physical properties that accompany geochemical reaction. Here we present examples of the results from model test cases, highlighting the important issues that have arisen.
The effects of silanising using the coupling agent γ-glycidoxpropyltrimethoxysilane on microstructural stability and magnetic properties of Sm-Co powder particles have been investigated. The silanisation provides structural stability by improving the oxidation resistance at 400oC for 10 hours. The untreated particles undergo microchemical changes by redistribution of alloying elements which mainly accumulate in parallel black and grey streaks in the interior of the particles. The silanised particles after heat treatment show coercivity of 836 Oe and the untreated particles show a much lower coercivity of 376 Oe. The difference in magnetic properties of uncoated particles is caused by diffusion of oxygen and microstructural instability.
An overview is given of the development of advanced nanoporous carbons as storage ma-terials for natural gas (methane) and molecular hydrogen in on-board fuel tanks for next-generation clean automobiles. The carbons are produced in a multi-step process from corncob, have surface areas of up to 3500 m2/g, porosities of up to 0.8, and reversibly store, by physisorp-tion, record amounts of methane and hydrogen. Current best gravimetric and volumetric storage capacities are: 250 g CH4/kg carbon and 130 g CH4/liter carbon (199 V/V) at 35 bar and 293 K; and 80 g H2/kg carbon and 47 g H2/liter carbon at 47 bar and 77 K. This is the first time the DOE methane storage target of 180 V/V at 35 bar and ambient temperature has been reached and exceeded. The hydrogen values compare favorably with the 2010 DOE gravimetric and volu-metric targets for hydrogen. A prototype adsorbed natural gas (ANG) tank, loaded with carbon monoliths produced accordingly and currently undergoing a road test in Kansas City, is de-scribed. A preliminary analysis of the surface and pore structure is given that may shed light on the mechanisms leading to the extraordinary storage capacities of these materials. The analysis includes pore-size distributions from nitrogen adsorption isotherms; spatial organization of pores across the entire solid from small-angle x-ray scattering (SAXS); pore entrances from scanning electron microscopy (SEM) and transmission electron microscopy (TEM); H2 binding energies from temperature-programmed desorption (TPD); and analysis of surface defects from Raman spectra. For future materials, expected to have higher H2 binding energies via appropriate sur-face functionalization, preliminary projections of H2 storage capacities based on molecular dy-namics simulations of adsorption of H2 on graphite, are reported.
Background. There is evidence that individuals with bipolar disorder exhibit neuropsychological impairments not only during episodes of depression or mania but also when they are euthymic. One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is impairment in episodic memory. Learning and memory depend on individuals' ability to organize information during learning. A recent study by our group showed that verbal episodic memory impairments in euthymic patients with bipolar I disorder (BP-I) are mediated by difficulties in organizing verbal information appropriately during learning. The purpose of the present study was to determine whether memory impairments in euthymic individuals with BP-I extend to non-verbal memory and whether non-verbal memory impairments are mediated by difficulties in organizing non-verbal information during encoding.
Method. Study participants were 25 euthymic, remitted individuals with BP-I and 25 age, gender and education matched control participants. Participants completed the Rey-Osterrieth Complex Figure Test (RCFT), a well-established measure of non-verbal memory that enables assessment of organization during learning.
Results. Compared to control participants, BP-I participants showed impaired performance on the RCFT immediate recall. They also relied less on organizational strategies during encoding. Multiple regression modeling indicated that group differences between control and BP-I participants in long-delayed free recall did not remain statistically significant when effects of lower organization were partialled out.
Conclusions. Non-verbal memory problems in individuals with bipolar disorder, while euthymic, are mediated by poor use of non-verbal organization strategies during encoding, but do not appear to reflect deficits in retention of information.
We present the results from our first observing runs with the South Pole Imaging Fabry-Perot Inteferometer (SPIFI). SPIFI is a direct detection imaging spectrometer for use in the submillimeter - the first of its kind. SPIFI employs a
5 × 5 element array of bolometers as its focal plane, and uses two Fabry-Perot in series as its resolution achieving devices. To date, SPIFI has had 5 observing runs on the 15 meter James Clerk Maxwell Telescope (JCMT), three of which were entirely weathered out. During the two good runs, we obtained fully sampled maps in the 370 μm [CI] fine structure line and 372 μm CO(7→6) rotational line of the Galactic Center and the nuclei of several infrared bright galaxies. We present the results, and preliminary analysis of the data obtained for several of these sources below.
To date, we have only used SPIFI in the 350 μm telluric window, but SPIFI can also access the 450 and 600 μm windows available to the JCMT, and the far-IR 200 μm window available to the NSF's 1.7 m AST/RO telescope at the South Pole. SPIFI is fully described in [1,2,9].
The fine structure of dislocations in intermetallic compounds can have a profound influence on their macroscopic mechanical properties. The development of appropriate models of deformation requires consideration of dislocation core structure, possible dissociation or decomposition reactions, overall dislocation morphology and relevant dislocation interactions based on detailed transmission electron microscopy study. This empirical information may be rationalized based on both atomistic and continuum-level dislocation modeling. The specific cases of jogged 1/2<110] ordinary dislocations in γ-TiAl and a<101> superdislocations in NiAl are discussed.
Compression tests have been performed on hard-oriented Ni-44A1 single crystals for several temperatures and strain levels. There is a slip transition from a<111> type slip to non-a<111> type slip which corresponds with the observation of yield points. Transmission electron microscopy studies provide evidence for decomposition of a<111> dislocations into a<101> and a<010> dislocations near the “knee” of the yield strength curve. The mechanism of this slip transition and the nature of the dislocation processes both below and above the “knee” are described.
X-ray diffraction has been used to quantify the interface roughness of GaAs/AlxGa1-xAs multilayers. X-ray measurements, both θ-2θ and rocking-curve analyses, quantitatively determine the correlated and random components of the interface roughness as well as the correlation length of the roughness along the interface. The multilayer structures of GaAs/Al0.3Ga0.7As and GaAs/AlAs differ substantially in the amplitude and correlation length of the interface roughness. The change in interfacial roughness is compared to that determined from low temperature photoluminescence (PL) measurements, the conventional measure of interface uniformity.
The microstructure evolution during preparation of thin Si(111) samples for surface sensitive imaging has been studied using ultra-high vacuum (UHV) transmission electron microscopy (TEM). The effects of ion beam sputtering and electron annealing have been investigated. A unique and routine sample preparation method for surface sensitive TEM imaging that combines TEM sample preparations with surface science sample preparation was developed. The microstructure evolution during the sample preparation process was studied in detail.
A series of (NixFeyAlz)0.9983B0.0017 (where x=58-60, y=13-15 and z=26-28, in at%) alloys have been rapidly solidified by - melt spinning. The ribbons have been characterized by HREM, DSC, X-ray diffraction and recoverable strain measurements. The as-cast alloys exhibit excellent bend ductility (in contrast to B2 type alloys conventionally cast) and a wide range of transformation temperatures: Ms=244-466 K, Mf=200-395K, As=236-427K and Af=262-526K. X-ray diffraction shows the presence of β (NiAl), β′ (NiAl), γ (Ni3Al), γ′ (Ni3A1), Ni and other phases such as Fe3Al, FeAl, FeNi and Al5Fe2. It is the β- β′ diffusionless transformation which is responsible for the shape memory effect. The results obtained by transmission electron microscopy (TEM) show two different types of crystalline grains. In one case, the grains have a high density of twins which are the fingerprints of the martensite transformation. However, other areas in the specimen show crystalline grains with very poor image contrast due to the transformation from β′ -β. There are also sections in the specimens with domains of both crystalline sgrains in coexistance. Both crystalline grains have large amounts of precipitates. In the β′ (NiAl) phase the size of the precipitates range fron lnm to lOnm. In the γ (Ni3Al) phase large precipitates (20nm) can be found. Some of them display pentagonal shapes which resemble the image contrast obtained in the TEM for small icosahedral metallic particles. Experimental evidence is also obtained on different habit or twin planes. HREM images from the twinned areas suggest diferent kinds of atomic structures for the parent and martensite crystalline sections. These results give some insights into the nature of the martensite transformation.