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Legionnaires’ disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014–2016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of ⩽30 and ⩽180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of ⩾20, ⩾100 and ⩾365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of ⩾100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.
Effective integrated weed management in agricultural landscapes depends on the ability to identify and manage processes that drive weed dynamics. The current study reports the effects of grazing management and crop rotation strategies on the seedbank and emerged weed flora in an integrated crop-livestock system (ICLS) experiment during a 12-year period under no-tillage in sub-tropical southern Brazil. During winter, Italian ryegrass cover crops were grazed by sheep: grazing management treatments included two stocking methods (continuous and rotational) and two forage allowances (10 and 20 kg of herbage dry matter available per 100 kg animal live weight). During summer, the crop rotation treatments involved either soybean-maize or soybean-soybean in succession with winter-grazed cover crops. The treatments were part of a factorial randomized complete block design. Treatment effects were evaluated on the weed seedbank and emerged weed flora populations during winter-grazed cover crop and summer crop growth as well as during the harvest phase. The current results demonstrate that crop rotation and grazing management exhibited interactive effects on the determination of weed outcomes in an ICLS. However, overall, compared with moderate forage allowance, high forage allowance during the winter-grazed cover crop caused lower emerged weed flora in subsequent crops (20% reduction during crop growth and 90% reduction at crop harvest) and 48% reduction in seedbank size. High forage allowance promoted more residue from winter-grazed cover crop biomass, which remained during the summer crop phases and probably resulted in a physical barrier to weed emergence.
This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.
This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.
Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d = 1.37), externalizing (d = 0.85), and posttraumatic stress (d = 1.71), and improvements in well-being (d = 0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.
This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.
We employed a commercial wireline drill rig to investigate the subglacial conditions of Black Rapids Glacier, a well-studied surge-type glacier in the central Alaska Range. The four main goals were: to assess the capabilities of the commercial drilling industry for sampling subglacial material, to investigate the basal morphology, to determine the subglacial geology and to emplace borehole instruments. The drilling was done in an area where seasonal and secular variations in speed are large, and where seismic studies suggested the presence of a till layer. Four holes were drilled at three locations to a maximum depth of 620 m. Three holes yielded samples of basal ice and till, although recovery of the latter was generally poor. Bedrock was sampled in one or possibly two of the holes. In the area sampled, t he glacier is underlain by a till layer some 4–7 m thick, confirming the seismic interpretation. It consists of a sandy matrix at least 20–30% of which comprises larger clasts. Limited samples of the matrix indicate that near the top of the till the porosity is 40%, and t hat some of the pore water is frozen. Geologic studies suggest that the drilling area lies to the north of the Denali Fault, a major tectonic boundary followed by the glacier, and that most of the till is locally derived with transport distances of <2 km.
Jakobshavns Isbræ is a large, fast-moving ice stream/outlet glacier in West Greenland which ends at a floating, calving front. It drains about 6.5% of the area of the Greenland ice sheet. Studies of its surface morphology are described in this paper. The surface is relatively steep (0.01–0.03) and the thickness is large (up to 2600 m along the center line (Clarke and Echelmeyer, 1989)), indicating very high driving stresses (200–300 kPa). The ice stream is about 6 km wide and 85–90 km long, all of which is in an area of surface melting. The base of the ice stream, and of much of the drainage area, is below sea level. Marginal crevasse zones have a width on the order of the width of the ice stream itself. Unique surficial features are ice blisters and lakes; the latter have a sequence of ogive-like features on their floating ice cover which can be used to determine velocity. There is a pinning point near the terminus which may act as a stabilizing influence, possibly playing a role in halting, at least temporarily, a recent retreat of the terminus. Ice-thickness estimates at the terminus lead to a flux which is less than previously assumed by others (e.g. Bindschadler, 1984; Pelto and others, 1989) when estimating Jakobshavns Isbræ’s drainage basin to be nearly in balance.
The driving stresses on Jakobshavns Isbræ are an order of magnitude higher than those of the ice streams of West Antarctica. Its crevasse patterns are much less localized. Its relatively unconfined terminus is more comparable to that of relatively unbuttressed ice streams such as Pine Island and Thwaites Glaciers than it is to other West Antarctic ice streams which terminate in large, confined ice shelves.
The efficacy of three sources of vitamins A and D supplements was tested in an experiment with fattening pigs involving the following four treatments :
(1) Control—basal meal.
(2) As control, but at one week of age the pigs had been given a single intramuscular injection of a commercial preparation, supplying 500,000 i.u. of vitamin A and 100,000 i.u. of vitamin D3.
(3) Basal meal + 1 % cod-liver oil (containing 500 i.u./g. of vitamin A and 68 i.u./g. of vitamin 3), supplying 2,270 i.u. of vitamin A and 309 i.u. of vitamin D3 per lb. of diet.
(4) Basal meal + synthetic vitamins A and D concentrate (containing 50,000 i.u./g. of vitamin A and 5,000 i.u./g. of vitamin D3), added to supply 2,250 i.u. of vitamin A and 300 i.u. of vitamin D3 per lb. of diet.
The basal meal which was the standard fattening diet used at Shinfield consisted of: fine miller’s offal 50, barley meal 30, flaked maize 10, white fish meal 10, all parts by weight. It should be noted that the diet contained a precursor of vitamin A, and it was calculated that this would provide about one-third of the recommended allowance of vitamin A for fattening pigs.
Simultaneous XUV and microwave (μ – ѡ) observations of a solar filament, performed by several instruments onboard SOHO and by the Very Large Array (VLA), are analyzed. The filament appears as a dark structure, very similar in shape to the optical Hα filament, in all images taken in the transition region (TR) lines observed by CDS, in the Ne VIII lines observed by SUMER at λ = 770Å and 780Å and at all radio wavelengths with 1.7 cm ≤ λ ≤ 6 cm. Contrary to that, in six TR lines observed by SUMER at λ > 1300Å no trace of the filament, either in absorption or in emission, is visible. Finally, at λ = 21 cm, as well as in all images taken in coronal lines by CDS and EIT, a dark feature is present at the filament position, although with less defined contours than in the first-mentioned TR images. The constraints imposed by all these observations are discussed and interpreted.
Mood instability is common, and an important feature of several psychiatric
disorders. We discuss the definition and measurement of mood instability,
and review its prevalence, characteristics, neurobiological correlates and
clinical implications. We suggest that mood instability has underappreciated
transdiagnostic potential as an investigational and therapeutic target.
Luminescence dating provides a direct age estimate of the time of last exposure of quartz or feldspar minerals to light or heat and has been successfully applied to deposits, rock surfaces, and fired materials in a number of archaeological and geological settings. Sampling strategies are diverse and can be customized depending on local circumstances, although all sediment samples need to include a light-safe sample and material for dose-rate determination. The accuracy and precision of luminescence dating results are directly related to the type and quality of the material sampled and sample collection methods in the field. Selection of target material for dating should include considerations of adequacy of resetting of the luminescence signal (optical and thermal bleaching), the ability to characterize the radioactive environment surrounding the sample (dose rate), and the lack of evidence for post-depositional mixing (bioturbation in soils and sediment). Sample strategies for collection of samples from sedimentary settings and fired materials are discussed. This paper should be used as a guide for luminescence sampling and is meant to provide essential background information on how to properly collect samples and on the types of materials suitable for luminescence dating.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
Sarcomatoid salivary duct carcinoma of the submandibular gland is extremely rare. This paper highlights the impact of surgery and adjuvant radiation therapy on the outcome of this disease.
A 59-year-old man with human immunodeficiency virus presented with a painless, rapidly growing left neck mass. Biopsy followed by surgical excision of the left submandibular gland revealed sarcomatoid salivary duct carcinoma of the submandibular gland duct with perineural invasion and close margins, for which he underwent adjuvant radiotherapy. Post-operative positron emission tomography and computed tomography revealed no residual or metastatic disease. Pathological analysis of tumour–node–metastasis staging revealed a T2 N0 M0 (stage II) tumour.
The patient tolerated his treatment without serious acute or long-term side effects. There was no evidence of disease on comprehensive examination or on positron emission tomography or computed tomography scans at the 4.6-year follow up.
Surgery followed by adjuvant radiotherapy provided practical locoregional control with acceptable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.
Ceruminous mucoepidermoid carcinoma of the external auditory canal is extremely rare. This paper highlights the impact of concurrent chemoradiotherapy on the outcomes of this disease.
A 47-year-old female presented with a 2-month history of otalgia and a mass in her right ear. Biopsy revealed high grade ceruminous mucoepidermoid carcinoma. She underwent surgical excision of the right external auditory canal and right upper neck dissection. Pathological analysis of tumour–node–metastasis staging revealed a T2 N0 (stage II) tumour. One year later, computed tomography scanning of the temporal bone showed tumour recurrence. Biopsy revealed recurrent ceruminous mucoepidermoid carcinoma. The patient underwent salvage resection. Pathology revealed that the tumour was diffusely invading nearby structures, with perineural invasion, lymphatic spread and extracapsular extension. Pathological analysis of tumour–node–metastasis staging revealed a T3 N1 M0 (recurrent stage IV) tumour.
The patient subsequently received concurrent chemoradiotherapy. There was no evidence of disease at 37 months' follow up.
The trimodality approach, using surgery plus concurrent chemoradiotherapy, provided reasonable loco-regional control with tolerable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.
NASA's NuSTAR observatory is the first focusing hard X-ray telescope. Launched in June 2012, NuSTAR is sensitive in the 3–79 keV range with unprecedented ~17″ FWHM angular resolution above 12 keV, a result of its multilayer-coated optics and 10-m focal length. With its large effective area (900 cm2 at 10 keV), NuSTAR has point-source sensitivity ~100 times better than previous hard X-ray telescopes. Here we describe NuSTAR and its planned work on rotation-powered pulsars and magnetars during its nominal 2-yr baseline mission that has just commenced.