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 firstname.lastname@example.org
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.
There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness.
Prospective data from 505 mother–child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models.
Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034).
Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.
Fracture of crystalline silicon (c-Si) solar cells in photovoltaic modules is a big concern to the photovoltaics (PV) industry. Cell cracks cause performance degradation and warranty issues to the manufacturers. The roots of cell fractures lie in the manufacturing and integration process of the cells and modules as they go through a series of elevated temperature and pressure processes, involving bonding of dissimilar materials, causing residual stresses. Evaluation of the exact physical mechanisms leading to these thermomechanical stresses is highly essential to quantify them and optimize the PV modules to address them. We present a novel synchrotron X-ray microdiffraction based techniques to characterize the stress and fracture in the crystalline silicon PV modules. We show the detailed stress state after soldering and lamination process, using the synchrotron X-ray microdiffraction experiments. We also calculate the maximum tolerable microcrack size in the c-Si cells to sustain the residual stress after lamination. We further demonstrate the effect of these residual stresses on the cell fractures using the widely accepted fracture (4-point bending) tests. These test results show that the soldering and lamination induced localized residual stresses indeed reduce the load-carrying capacity of the c-Si cells.
Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a pest species complex that causes widespread damage to cassava, a staple food crop for millions of households in East Africa. Species in the complex cause direct feeding damage to cassava and are the vectors of multiple plant viruses. Whilst significant work has gone into developing virus-resistant cassava cultivars, there has been little research effort aimed at understanding the ecology of these insect vectors. Here we assess critically the knowledge base relating to factors that may lead to high population densities of sub-Saharan African (SSA) B. tabaci species in cassava production landscapes of East Africa. We focus first on empirical studies that have examined biotic or abiotic factors that may lead to high populations. We then identify knowledge gaps that need to be filled to deliver sustainable management solutions. We found that whilst many hypotheses have been put forward to explain the increases in abundance witnessed since the early 1990s, there are little published data and these tend to have been collected in a piecemeal manner. The most critical knowledge gaps identified were: (i) understanding how cassava cultivars and alternative host plants impact population dynamics and natural enemies; (ii) the impact of natural enemies in terms of reducing the frequency of outbreaks and (iii) the use and management of insecticides to delay the development of resistance. In addition, there are several fundamental methodologies that need to be developed and deployed in East Africa to address some of the more challenging knowledge gaps.
An outbreak of gastroenteritis affected 453 attendees (attack rate 28·5%) of six separate events held at a hotel in Singapore. Active case detection, case-control studies, hygiene inspections and microbial analysis of food, environmental and stool samples were conducted to determine the aetiology of the outbreak and the modes of transmission. The only commonality was the food, crockery and cutlery provided and/or handled by the hotel's Chinese banquet kitchen. Stool specimens from 34 cases and 15 food handlers were positive for norovirus genogroup II. The putative index case was one of eight norovirus-positive food handlers who had worked while they were symptomatic. Several food samples and remnants tested positive for Escherichia coli or high faecal coliforms, aerobic plate counts and/or total coliforms, indicating poor food hygiene. This large common-source outbreak of norovirus gastroenteritis was caused by the consumption of contaminated food and/or contact with contaminated crockery or cutlery provided or handled by the hotel's Chinese banquet kitchen.
Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV), Singapore has enhanced its national surveillance system to detect the potential importation of this novel pathogen. Using the guidelines from the Singapore Ministry of Health, a suspect case was defined as a person with clinical signs and symptoms suggestive of pneumonia or severe respiratory infection with breathlessness, and with an epidemiological link to countries where MERS-CoV cases had been reported within the preceding 14 days. This report describes a retrospective review of 851 suspected MERS-CoV cases assessed at the adult tertiary-care hospital in Singapore between September 2012 and December 2015. In total, 262 patients (31%) were hospitalized. All had MERS-CoV infection ruled out by RT–PCR or clinical assessment. Two hundred and thirty (88%) of the hospitalized patients were also investigated for influenza virus by RT–PCR. Of these, 62 (27%) tested positive for seasonal influenza. None of the patients with positive influenza results had been vaccinated in the year prior to hospital admission. Ninety-three (36%) out of the 262 hospitalized patients had clinical and/or radiological evidence of pneumonia. This study demonstrates the potential benefits of pre-travel vaccination against influenza and pneumococcal disease.
We examine the roles of actuaries in UK life offices, along with trends, challenges to and opportunities for actuaries. We carry out an analysis of senior roles in life offices, a questionnaire survey and interviews with relevant senior personnel. We find that actuaries occupy many important roles in life offices and are regarded as having good industry knowledge and technical skills, especially in financial modelling. There are fewer executive directors and more non-executive directors of life offices who are actuaries compared with the position in 1990. A higher proportion of reserved roles is outsourced to consultants than was the case in 1990. Only a small number of Actuarial Function Holders are directors. Actuaries are more siloed than was the case in the past, although actuaries are well represented in the finance and risk functions of many offices. Although actuarial work in connection with the preparation for Solvency II will decline, there will be important ongoing requirements for actuaries following Solvency II implementation. We also see opportunities for actuaries in four areas: in risk management, in financial analysis and management based on Solvency II and international financial reporting standards, in connection with “big data”, and in product development and the customer proposition. There are implications for the examination syllabus, continuing professional development and research.
the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized.
retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members.
there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS.
the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.
We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore.
A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day.
It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy.
Proton exchange membrane with interconnected H+-transfer channels in submicron scale has been synthesized by means of pore filling polymerization. Polysulfone (PSU) membrane containing densely distributed pores is synthesized using the phase inversion approach. The membrane is then filled up with a designed formula consisting of monomers (e.g. 2-acrylamido-2-methylpropane sulphonic acid and N, N’-Methylenebisacrylamide) and a binary solvent. It is undertaken through solution diffusion of the monomer formula into the pores impregnated with the bore liquid. When the PSU matrix loaded with monomers is subjected to polymerization, a uniform distribution of interconnected H+-transfer channels is realized. This special membrane structure gives rise to a maximum ionic exchange capacity of 2.43 meq/g and the highest proton conductivity of 0.2 S/cm. Compared to the commercial Nafion® membrane, the pore-filled membrane significantly enhances the power output of H2-PEM fuel cell.
Although antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.
Twenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.
T tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.
This study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.
The liquid lining in small human airways can become unstable and form liquid plugs that close off the airways. Direct numerical simulations are carried out on an airway model to study this airway instability and the flow-induced stresses on the airway walls. The equations governing the fluid motion and the interfacial boundary conditions are solved using the finite-volume method coupled with the sharp interface method for the free surface. The dynamics of the closure process is simulated for a viscous Newtonian film with constant surface tension and a passive core gas phase. In addition, a special case is examined that considers the core dynamics so that comparisons can be made with the experiments of Bian et al. (J. Fluid Mech., vol. 647, 2010, p. 391). The computed flow fields and stress distributions are consistent with the experimental findings. Within the short time span of the closure process, there are large fluctuations in the wall shear stress. Furthermore, dramatic velocity changes in the film during closure indicate a steep normal stress gradient on the airway wall. The computational results show that the wall shear stress, normal stress and their gradients during closure can be high enough to injure airway epithelial cells.
The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.
Direct interviews of hospitalized and community-dwelling cognitively intact patients >65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.
Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76–85 vs. 59–75: OR 3.4, p < 0.0543; <85 vs. 59–75: OR 6.3, p < 0.0263).
Significance of results:
This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.
The liquid lining in small human airways can become unstable and form liquid plugs that close off the airways. Bench-top experiments have been performed in a glass capillary tube as a model airway to study the airway instability and the flow-induced stresses on the airway walls. A microscale particle image velocimetry system is used to visualize quantitatively the flow fields during the dynamic process of airway closure. An annular film is formed by injecting low-viscosity Si-oil into the glycerol-filled capillary tube. The viscosity ratio between these two fluids is similar to that between water and air. The thickness of the film varies with the infusion rate of the core fluid, which is controlled by a syringe pump. After a uniform film is formed, the syringe pump is shut off so that the core flow speed is close to zero during closure. Instantaneous velocity fields in the annular film at various stages of airway closure are computed from the images and analysed. The wall shear stress at the instant when a liquid plug forms is found to be approximately one order of magnitude higher than the exponential growth period before closure. Within the short time span of the closure process, there are large wall shear stress fluctuations. Furthermore, dramatic velocity changes in the film flow during closure indicate a steep normal stress gradient on the airway wall. The experimental results show that the wall shear stress during closure can be high enough to injure airway epithelial cells. An airway that experiences closure and reopening cyclically during breathing could be injured from fluid forces during both phases of the cycle (i.e. inspiration and expiration).
With the increasing demand for one-lung ventilation in both thoracic surgery and other procedures, identifying the correct placement becomes increasingly important. Currently, endobronchial intubation is suspected based on a combination of auscultation and physiological findings. We investigated the ability of the visual display of airflow-induced vibrations to detect single-lung ventilation with a double-lumen endotracheal tube.
Double-lumen tubes were placed prior to surgery. Tracheal and endobronchial lumens were alternately clamped to produce unilateral lung ventilation of right and left lung. Vibration response imaging, which detects vibrations transmitted to the surface of the thorax, was performed during both right- and left-lung ventilation. Geographical area of vibration response image as well as amount and distribution of lung sounds were assessed.
During single-lung ventilation, the image and video obtained from the vibration response imaging identifies the ventilated lung with a larger and darker image on the ventilated side. During single-lung ventilation, 87.2 ± 5.7% of the measured vibrations was detected over the ventilated lung and 12.8 ± 5.7% over the non-ventilated lung (P < 0.0001). It was also noted that during single-lung ventilation, the vibration distribution in the non-ventilated lung had a majority of vibration detected by the medial sensors closest to the midline (P < 0.05) as opposed to the midclavicular sensors when the lung is ventilated.
During single-lung ventilation, vibration response imaging clearly showed increased vibration in the lung that is being ventilated. Distribution of residual vibration differed in the non-ventilated lung in a manner that suggests transmission of vibrations across the mediastinum from the ventilated lung. The lung image and video obtained from vibration response imaging may provide useful and immediate information to help one-lung ventilation assessment.
Diffusion tensor imaging (DTI) can be used to investigate cerebral structural connectivity in never-medicated individuals with first-episode schizophrenia.
Subjects with first-episode schizophrenia according to DSM-IV-R who had never been exposed to antipsychotic medication (n=25) and healthy controls (n=26) were recruited. Groups were matched for age, gender, best parental socio-economic status and ethnicity. All subjects underwent DTI and structural magnetic resonance imaging (MRI) scans. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values differed significantly between groups. A confirmatory region-of-interest (ROI) analysis of FA scores was performed in which regions were placed blind to group membership.
In patients, FA values significantly lower than those in healthy controls were located in the left fronto-occipital fasciculus, left inferior longitudinal fasciculus, white matter adjacent to right precuneus, splenium of corpus callosum, right posterior limb of internal capsule, white matter adjacent to right substantia nigra, and left cerebral peduncle. ROI analysis of the corpus callosum confirmed that the patient group had significantly lower mean FA values than the controls in the splenium but not in the genu. The intra-class correlation coefficient (ICC) for independent ROI measurements was 0.90 (genu) and 0.90 (splenium). There were no regions where FA values were significantly higher in the patients than in the healthy controls.
Widespread structural dysconnectivity, including the subcortical region, is already present in neuroleptic-naive patients in their first episode of illness.
Silicon on insulator (SOI) substrate is a key materials for nano-scaling IC device and the requirement for its crystal structure and quality is really high. Nanothick silicon thin film can be transferred onto a handle wafer from a donation wafer to form a SOI wafer after this process including hydrogen implantation of donation wafer, wafer bonding, and thermal treatment at moderately high temperatures of 400 to 600 degree centigrade. The expansion of the hydrogen molecular evolving from the implanted hydrogen ions interacting with silicon dangling bonds and trapped inside the microcavities located near the ion projected range resulted in exfoliation of the silicon thin film in the final heating step. The hydrogen molecules inside the microcavities tend to expand along the bonded interface rather than radially to form individual blisters. Finally, the fracture failure of ion implanted area parallel to the bonded interface near the projected ion range is formed by the sideway expansion of the cavities due to the diffusion supply of implanted hydrogen excited by thermal energy. Microwave processing can lower the activity energy to speed the chemical reaction so that it leads the format of microcavities occurring at low temperature by directly exciting the implanted hydrogen ions by microwave energy and also results in decreasing the critical dosage for layer splitting. However, microwave irradiation alone at room temperature causes the formation of lots of nucleus sites of micro-voids filled by hydrogen molecule which is immobility in silicon resulting in the issue of uniformity of transferred layer. In this study, the hydrogen implanted silicon substrate was irradiated by microwave at low temperature (200 degree centigrade) rather than microwave alone to co-activate the implanted hydrogen ions in silicon to increase not only kinetic energy but also mobility to successfully achieve a completely transferred layer in a short time.
Thin SiN films deposited by plasma enhanced chemical vapor deposition (PECVD) have been analyzed by a variety of analytical techniques including Fourier Transform Infrared Spectroscopy (FTIR), X-ray reflectivity (XRR), and Rutherford Backscattering Spectrometry/Hydrogen Forward Scattering (RBS/HFS) to collect data on bonding, density and chemical composition respectively. Both tensile and compressive SiN films have been deposited and analyzed. Mechanisms of stress formation in SiN thin films are discussed. It has been found that amount of bonded hydrogen as detected by FTIR is higher for compressive films compared to tensile SiN films. Amount of bonded hydrogen in a film is correlated well with tensile stress. Effect of deposition temperature and other process parameters on stress have been studied. Exposure of SiN films to elevated temperature after deposition lead to increase in tension and degradation in compressive stress. New approaches to stress generation in thin films like creation of multilayer film structures have been delineated.
Two-dimensional hexagonal photonic crystals of air columns in a wax substrate were fabricated by jet-based methods. By modifying the structure of the photonic crystals (PC), electromagnetic waves can be controlled, enabling the design of novel devices for waveguides, filters, and couplers. The jet-based processing is a solid freeforming method that can fabricate complex 2D or 3D photonic structures quickly and easily as compared to micro-machining and lithographic methods. The resolution of our 3D Systems ThermoJet® solider object printer is 300 × 400 × 600 dpi (XYZ) with the layer thickness of 0.042 mm. The wax used is a thermopolymer build material, similar to production investment casting wax material. The periodicity of the lattice of our 2D PC structures was designed to form bandstop filters in the 0.1–0.3 THz range. Transmission spectra of the structures were measured with a Bruker IFS 66v FT-IR interferometer. Photonic band gaps were observed at 0.17 THz and 0.23 THz along the Γ-M direction for both the TM and TE polarized incident beam for the PC structures with lattice constant of 0.787 mm and 0.586 mm, respectively. The location and width of the bandgaps agree with theoretical calculation based on a block-iterative frequency-domain method for Maxwell's equations in a planewave basis. To the best of our knowledge, this is the first time a jet-based process has been used successfully to fabricate PC structures at these high frequencies. However, the ThermoJet® printer as well as other current available solid freeforming technologies lack the resolution to PC structures operating in the terahertz regime. To extend this technology to terahertz applications, such as terahertz lasers, waveguides, and imaging system, a 10-fold increase in machine resolution is required to produce finer structures. Engineering materials with lower electromagnetic absorption and higher dielectric constants at terahertz frequencies are also critical to developing THz photonic bandgap technology.