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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
In this report, a unique case of a symptomatic vascular ring formed by right aortic arch, aberrant left subclavian artery, and left ligamentum arteriosus in which there is atresia of the proximal left subclavian artery is described. Imaging modalities were non-diagnostic and the patient was sent to surgery based on strong clinical suspicion. Her anatomy was delineated in the operating room and the ring was successfully repaired.
An onboard automated coronal mass ejections (CMEs) detection algorithm has been developed for Visible Emission Line Coronagraph (VELC) onboard ADITYA-L1. The aim of this algorithm is to reduce the load on telemetry by sending the high spatial (~ 2.51 arcsec pixel−1) and temporal (1 s) resolution images of corona from 1.05 R⊙ to 3 R⊙, containing CMEs and rejecting others. It is based on intensity thresholding followed by an area thresholding in successive running difference images which are re-binned to lower resolution to improve signal to noise. Here we present the results of application of the algorithm on synthetic corona images generated for the VELC field of view (FOV).
A new approach is proposed to analyze Bremsstrahlung X-rays that are emitted from laser-produced plasmas (LPP) and are measured by a stack type spectrometer. This new method is based on a spectral tomographic reconstruction concept with the variational principle for optimization, without referring to the electron energy distribution of a plasma. This approach is applied to the analysis of some experimental data obtained at a few major laser facilities to demonstrate the applicability of the method. Slope temperatures of X-rays from LPP are determined with a two-temperature model, showing different spectral characteristics of X-rays depending on laser properties used in the experiments.
Compressive Sensing is an emerging technology for data compression and simultaneous data acquisition. This is an enabling technique for significant reduction in data bandwidth, and transmission power and hence, can greatly benefit space-flight instruments. We apply this process to detect exoplanets via gravitational microlensing. We experiment with various impact parameters that describe microlensing curves to determine the effectiveness and uncertainty caused by Compressive Sensing. Finally, we describe implications for space-flight missions.
Proton beam therapy (PBT) offers compelling advantages in physical dose distribution compared to photon therapy. There are increasing numbers of gantry-based proton facilities worldwide but no such facilities exist in Canada. To access PBT, Canadian patients must travel abroad for treatment at high cost. In the face of limited access, this report seeks to provide recommendations for the selection of patients most likely to benefit from PBT and suggests an out-of-country referral process. METHODS: A systematic literature search for studies between January 1990 and May 2014 evaluating clinical outcomes after PBT. A draft report was developed through review of evidence, externally reviewed, and approved by the Alberta Health Services Cancer Care Proton Therapy Guidelines steering committee. RESULTS: Proton therapy is often used to treat tumours close to radiosensitive tissues, and children at risk of developing significant late effects of radiation therapy (RT). Local control rates with PBT appear similar to or, in some cases, higher than photon RT in uncontrolled and retrospective studies. Randomized trials comparing equivalent doses of PBT and photon RT are not available. SUMMARY: Referral for PBT is recommended for patients being treated with curative intent, with an expectation for long-term survival, and who are able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents occurring in patients with greatest risk of long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head and neck, breast, lung, gastrointestinal tract, and pelvic cancers including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.
“Solar X-ray Spectrometer (SOXS)” mission on-board GSAT-2 Indian spacecraft was launched on 08 May 2003 by GSLV-D2 and deployed in geostationery orbit to study the X-ray emission from solar flares with high spectral and temporal resolution. The SOXS consists of two independent payloads viz. SOXS Low Energy Detector (SLD) payload, and SOXS High Energy Detector (SHD) payload. The SLD consists of two solid state detectors Si PIN and CZT, which cover the energy range from 4-60 keV, while the SHD has NaI(Tl)/CsI(Na) sandwiched phoswich detector that covers energy range from 20 keV to 10 MeV. We present very briefly the science objectives and instrumentation of SLD payload. After the successful In-orbit Tests (IOT), the first light was fed into SLD payload on 08 June 2003 when the solar flare was already in progress. We briefly present the first results from the SLD payload.
India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India.
The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators.
This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.
The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment.
Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18–65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria.
High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS.
In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.
There are several ways planets can survive the giant phase of the host star, hence one can consider the case of Earth-like planets orbiting white dwarfs. As a white dwarf cools from 6000 K to 4000 K, a planet orbiting at 0.01 AU from the star would remain in the continuous habitable zone (CHZ) for about 8 Gyr. Polarisation due to a terrestrial planet in the CHZ of a cool white dwarf (CWD) is 102 (104) times larger than it would be in the habitable zone of a typical M-dwarf (Sun-like star). Polarimetry is thus a powerful tool to detect close-in planets around white dwarfs. Multi-band polarimetry would also allow one to reveal the presence of a planet atmosphere, even providing a first characterisation. With current facilities a super-Earth-sized atmosphereless planet is detectable with polarimetry around the brightest known CWD. Planned future facilities render smaller planets detectable, in particular by increasing the instrumental sensitivity in the blue. Preliminary habitability study show also that photosynthetic processes can be sustained on Earth-like planets orbiting CWDs and that the DNA-weighted UV radiation dose for an Earth-like planet in the CHZ is less than the maxima encountered on Earth, hence white dwarfs are compatible with the persistence of complex life from the perspective of UV irradiation.
Alumina-silicone hybrid nanolaminate films were synthesized by plasma enhanced chemical vapor deposition (PECVD) process. PECVD allows digital control over nanolaminate construction, and may be performed at low temperature for compatibility with flexible substrates. These materials are being considered as dielectrics for application such as capacitors in thin film transistors and memory devices. Temperature dependent electrical and dielectric properties of the nanolaminate dielectric films in metal-insulator-metal structures are taken in the range of 200- 340 K to better asses their potential applications for different devices. It is observed that the frequency dependent dielectric constant (εr) and ac conductivity (σac) increase with the temperature. Both quadratic (α) and linear (β) voltage coefficient of capacitance (VCC) increases as the temperature increases. The temperature co-efficient of capacitance (TCC) decreases from 894 to 374 ppm/K as the Al2O3 composition increases in the alumina/silicone nanolaminates. Activation energy (Ea) for hopping conduction mechanism varies from 0.011 eV to 0.008 eV as the alumina composition increases from 50 to 83.3%.
In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation.
In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation.
Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured.