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In this work, a poly-Si0.35Ge0.65 microelectromechanical systems (MEMS)- based actuator was designed and fabricated using a CMOS compatible standard process to specifically strain a bi-layered (2L) MoS2 flake and measure its electrical properties. Experimental results of the MEMS-TMDC device show an increase of conductivity up to three orders of magnitude by means of vertical actuation using the substrate as the body terminal. A force balance model of the MEMS-TMDC was used to determine the amount of strain induced in the MoS2 flake. Strains as high as 3.3% is reported using the model fitted to the experimental data.
Once the domain of a few spacefaring nations, outer space has exploded with new actors, state and private, in recent years. New actors and activities bring new potential threats and concerns for new and existing actors alike. In this complex environment, where mistrust and misunderstanding often prevail, international law can play an important role in bridging gaps and creating predictability, clarity, and consistency. Although new treaty law is unlikely, the ordinary incremental international law processes of state practice, opinio juris, and international jurisprudence will help to resolve critical questions about the content and application of international law in outer space over time.
The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
There is a well-established gender divide among people who do and do not seek professional help from mental health professionals. Females are typically more likely to report, and seek help for, mental health problems. The current paper sought to examine the role of employment context on help-seeking for mental health issues. We hypothesised that men and women in male-dominated occupations would be less likely to seek help than those in non-male-dominated occupations.
Data from the Household, Income and Labour Dynamics in Australia survey were used. Help-seeking, measured in 2013, was defined as whether a person reported attending a mental health professional in the 12 months prior to the survey. The exposure, male- and non-male-dominated occupations (measured in 2012), was defined using census data based on self-reported occupation. Analyses were stratified by gender and controlled for relevant confounders (measured in 2012), including mental health and prior help-seeking. We conducted multivariate logistic and propensity score analyses to improve exchangeability of those exposed and unexposed.
For males, being in a male-dominated occupation was independently associated with reduced likelihood of help-seeking (OR 0.66, 95% CI 0.46–0.95) in the adjusted model, although this result fell just out of significance in the propensity score analysis. There was no independent effect of being in a male-/non-male-dominated occupation for help-seeking among women.
Results suggest that male-dominated occupations may negatively influence help-seeking among males. There is a need for more research to understand this relationship and for workplace-based prevention initiatives.
Up to 70 per cent of the population search online for medical or health-related information. This study aimed to assess the quality of online health resources available to educate patients on a variety of otolaryngological conditions.
Two clinicians independently analysed the quality and content of educational websites (patient.co.uk and wikipedia.org) for common and uncommon diagnoses, with cancerresearchuk.org also used to assess two head and neck cancers.
Cancerresearchuk.org, followed by patient.co.uk, scored most highly in their ability to inform readers on a selection of otolaryngological conditions. Although wikipedia.org was less likely to include all relevant information and was more difficult to read, it still provided mostly accurate information.
Where possible, patients should be advised to access professionally maintained health information websites (patient.co.uk and cancerresearchuk.org). However, wikipedia.org can provide adequate information, although it lacks depth and can be difficult to understand.
Objectives: As the number of adolescents and young adults (AYAs) surviving congenital heart disease (CHD) grows, studies of long-term outcomes are needed. CHD research documents poor executive function (EF) and cerebellum (CB) abnormalities in children. We examined whether AYAs with CHD exhibit reduced EF and CB volumes. We hypothesized a double dissociation such that the posterior CB is related to EF while the anterior CB is related to motor function. We also investigated whether the CB contributes to EF above and beyond processing speed. Methods: Twenty-two AYAs with CHD and 22 matched healthy controls underwent magnetic resonance imaging and assessment of EF, processing speed, and motor function. Volumetric data were calculated using a cerebellar atlas (SUIT) developed for SPM. Group differences were compared with t tests, relationships were tested with Pearson’s correlations and Fisher’s r to z transformation, and hierarchical regression was used to test the CB’s unique contributions to EF. Results: CHD patients had reduced CB total, lobular, and white matter volume (d=.52–.99) and poorer EF (d=.79–1.01) compared to controls. Significant correlations between the posterior CB and EF (r=.29–.48) were identified but there were no relationships between the anterior CB and motor function nor EF. The posterior CB predicted EF above and beyond processing speed (ps<.001). Conclusions: This study identified a relationship between the posterior CB and EF, which appears to be particularly important for inhibitory processes and abstract reasoning. The unique CB contribution to EF above and beyond processing speed alone warrants further study. (JINS, 2018, 24, 939–948)
Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the emergency department (ED) accounting for significant morbidity, mortality and health care resource usage. In Alberta, a provincial care pathway was recently developed to provide an evidence informed approach to managing patients with an UGIBs in the ED. Pantoprazole infusions are a commonly used treatment despite evidence that suggests they are generally not indicated prior to endoscopy in the ED. The goal of this project was to optimize management of patients with a NVUGIB, in particular reduce pre-endoscopy pantoprazole infusions. Methods: In July 2016, we implemented a multi-faceted intervention to optimize management of ED patients with NVUGIB including 1. de-emphasizing IV pantoprazole infusions in the ED, 2. clinical decision support (CDS) embedded (for endoscopy, disposition and transfusions) within the order set and 3. educating clinicians about the care pathway. We used a pre/post-order set design, analyzing 391 days pre and 189 days post-order set changes. Data was extracted from our fully integrated electronic health records system. The primary outcome was the % of patients receiving IV pantoprazole infusion ordered by an emergency physician (EP) among all patients with NVUGIB. Secondary outcomes included % transfused with hgb >70g/L and whether using the GIB order set impacted management of NVUGIB patients. Results: In the 391 days pre-order set changes, there were 2165 patients included and in the 189 days post-order set changes, there were 901 patients. For baseline characteristics, patients in the post-order set change group were significantly older (64.4 yrs vs 60.9 yrs p-value=0.0016) and had a lower hgb (115 vs 118, p-value=0.049) but otherwise for gender, measures of severity of illness (systolic blood pressure, heart rate, CTAS, % admitted) there were no significantly differences. For the primary outcome, in the pre-order set phase, 47.1% received a pantoprazole infusion ordered by an EP, compared to 31.5% in the post-order phase, for an absolute reduction of 15.6% (p-value= <0.001). For the secondary outcomes, transfusion rates were similar pre/post (22.08% vs 22.75%). Significant inter-site variability exists with respect to the reduction in pantoprazole infusion rates across the four sites (-23.3% to +6.12%). Conclusion: Our interventions resulted in a significant overall reduction in pantoprazole infusions in ED patients with NVUGIB. Reductions in pantoprazole infusions varied significantly across the different sites, future work in our department will explore and address this variability. Keys to the success of this project included engaging clinicians as well as leveraging the SCM order sets as well as the provincial care pathway. Although there were no changes in transfusion rates, it in unclear if this a function of the CDS not being effective or whether these transfusions were clinically indicated.
Early postnatal intestinal development involves the preparation of the intestinal epithelium for extrauterine life when maternal secretions provide the sole nutrient source. A further shift in the digestive capability of the epithelium occurs later in development with the introduction of complex solid foods. Ontogenesis involves extensive epithelial cell proliferation and cytodifferentiation including changes in the expression of enzymes, receptors and transport systems and is regulated through the interaction of endogenous and exogenous factors. The mucosal epithelium plays a key rôle in the reception and transmisson of these trophic signals. In particular, the interplay between dietary constituents and microvillar membranes exerts profound influence on intestinal development and adaptation during the postnatal period.
We conducted a seismic and radar survey of the central part of midtre Lovénbreen, a small, polythermal valley glacier in Svalbard. We determined the physical properties of the material beneath the glacier by measuring the reflection coefficient of the bed by comparing the energy of the primary and multiple reflections, and deriving the acoustic impedance. By making reasonable assumptions about the properties of the basal ice, we determined the acoustic impedance of the bed material as (6.78 ± 1.53) × 106 kg m−2 s−1. We interpret the material beneath the glacier to be permafrost with up to 50% ice, and we speculate that the material may be frozen talus similar to a deposit observed directly by others beneath another Svalbard glacier. The implication for midtre Lovénbreen is that the basal material beneath the present glacier is not able to support fast flow. We conclude that midtre Lovénbreen has most likely had limited capability for faster flow in the past, with motion dominated by internal deformation. Midtre Lovénbreen is used as a ‘study glacier’ for the scientific community in Svalbard, and a large number of studies have been based there. Our results show that it cannot be used as an analogue for larger glaciers in Svalbard, having distinct basal boundary conditions.
High-resolution surface velocity measurements and passive seismic observations from Rutford Ice Stream, West Antarctica, 40 km upstream from the grounding line are presented. These measurements indicate a complex relationship between the ocean tides and currents, basal conditions and ice-stream flow. Both the mean basal seismicity and the velocity of the ice stream are modulated by the tides. Seismic activity increases twice during each semi-diurnal tidal cycle. The tidal analysis shows the largest velocity variation is at the fortnightly period, with smaller variations superimposed at diurnal and semi-diurnal frequencies. The general pattern of the observed velocity is two velocity peaks during each semi-diurnal tidal cycle, but sometimes three peaks are observed. This pattern of two or three peaks is more regular during spring tides, when the largest-amplitude velocity variations are observed, than during neap tides. This is the first time that velocity and level of seismicity are shown to correlate and respond to tidal forcing as far as 40 km upstream from the grounding line of a large ice stream.
Previous studies have highlighted the role of the brain reward and cognitive control systems in the etiology of anorexia nervosa (AN). In an attempt to disentangle the relative contribution of these systems to the disorder, we used functional magnetic resonance imaging (fMRI) to investigate hemodynamic responses to reward-related stimuli presented both subliminally and supraliminally in acutely underweight AN patients and age-matched healthy controls (HC).
fMRI data were collected from a total of 35 AN patients and 35 HC, while they passively viewed subliminally and supraliminally presented streams of food, positive social, and neutral stimuli. Activation patterns of the group×stimulation condition×stimulus type interaction were interrogated to investigate potential group differences in processing different stimulus types under the two stimulation conditions. Moreover, changes in functional connectivity were investigated using generalized psychophysiological interaction analysis.
AN patients showed a generally increased response to supraliminally presented stimuli in the inferior frontal junction (IFJ), but no alterations within the reward system. Increased activation during supraliminal stimulation with food stimuli was observed in the AN group in visual regions including superior occipital gyrus and the fusiform gyrus/parahippocampal gyrus. No group difference was found with respect to the subliminal stimulation condition and functional connectivity.
Increased IFJ activation in AN during supraliminal stimulation may indicate hyperactive cognitive control, which resonates with clinical presentation of excessive self-control in AN patients. Increased activation to food stimuli in visual regions may be interpreted in light of an attentional food bias in AN.
We performed a spatial-temporal analysis to assess household risk factors for Ebola virus disease (Ebola) in a remote, severely-affected village. We defined a household as a family's shared living space and a case-household as a household with at least one resident who became a suspect, probable, or confirmed Ebola case from 1 August 2014 to 10 October 2014. We used Geographic Information System (GIS) software to calculate inter-household distances, performed space-time cluster analyses, and developed Generalized Estimating Equations (GEE). Village X consisted of 64 households; 42% of households became case-households over the observation period. Two significant space-time clusters occurred among households in the village; temporal effects outweighed spatial effects. GEE demonstrated that the odds of becoming a case-household increased by 4·0% for each additional person per household (P < 0·02) and 2·6% per day (P < 0·07). An increasing number of persons per household, and to a lesser extent, the passage of time after onset of the outbreak were risk factors for household Ebola acquisition, emphasizing the importance of prompt public health interventions that prioritize the most populated households. Using GIS with GEE can reveal complex spatial-temporal risk factors, which can inform prioritization of response activities in future outbreaks.
Lake Ejagham is a small, shallow lake in Cameroon, West Africa, which supports five endemic species of cichlid fishes in two distinct lineages. Genetic evidence suggests a relatively young age for the species flocks, but supporting geologic evidence has thus far been unavailable. Here we present diatom, geochemical, mineralogical, and radiocarbon data from two sediment cores that provide new insights into the age and origin of Lake Ejagham and its endemic fishes. Radiocarbon ages at the base of the longer core indicate that the lake formed approximately 9 ka ago, and the diatom record of the shorter core suggests that hydroclimate variability during the last 3 millennia was similar to that of other lakes in Cameroon and Ghana. These findings establish a maximum age of ca. 9 cal ka BP for the lake and its endemic species and suggest that repeated cichlid speciation in two distinct lineages occurred rapidly within the lake. Local geology and West African paleoclimate records argue against a volcanic, chemical, or climatic origin for Lake Ejagham. Although not conclusive, the morphometry of the lake and possible signs of impact-induced effects on quartz grains are instead more suggestive of a bolide impact.