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.
Surgical site infection (SSI) is a common postprocedure complication that may be prevented by adhering to established recommendations, including administration of preoperative antibiotic prophylaxis. Patients with a β-lactam allergy (BLA) label have an increased risk of SSI. We sought to evaluate the appropriateness of preoperative antibiotic prophylaxis in patients labeled with a BLA compared those without a BLA.
This was a single-center, retrospective, matched cohort study of adult patients who underwent a clean or clean-contaminated knee replacement, abdominal hysterectomy, colorectal surgery, or coronary artery bypass graft (CABG). Patients with a BLA label were matched to patients without a BLA label based on procedure, age, and body mass index (BMI). The primary end point was the rate of appropriate preoperative antibiotic prophylaxis, including antibiotic selection and timing prior to incision.
In total, 260 patients were included. Knee replacement (38%) was the most common procedure, followed by abdominal hysterectomy (25%), colorectal surgery (18%), and CABG (18%). Appropriate preoperative antibiotic prophylaxis was higher among patients without a BLA (76% vs 37%; P < .001). Among patients with a mild-to-moderate reaction or intolerance, 29 (53%) received antibiotics that would have been appropriate only if the patient had had a severe BLA. Patients with a BLA were more likely to have had an antibiotic omitted from the prophylactic regimen (44% vs 4%; P < .001).
Patients with a BLA were more likely to receive inappropriate preoperative antibiotic prophylaxis, attributed to misinterpretation of BLA labels and antibiotic omissions. Optimizing antibiotic prophylaxis among patients with BLAs remains an area of opportunity to prevent SSIs.
Background: Pertussis continues to be an important health issue in Vietnam despite infant vaccination programs. In Vietnam, the incidence rates of pertussis per 100,000 population rose from 0.09 in 2014 to 0.33 in 2015 and to 0.58 in 2017. Macrolides, especially erythromycin, are the treatment of choice. However, erythromycin-resistant cases, caused by transition at A2047G position in 23S rRNA, have been reported in the region. Few data are available on antimicrobial resistance in Bordetella pertussis to guide treatment in Vietnam. We report antimicrobial susceptibility of the circulating strains in southern Vietnam during 2015–2017. Methods: Tracheal aspirates from 263 suspected pertussis cases were subject to multiplex real-time PCR to identify B. pertussis and Bordetella spp. Samples were cultured on Regan Lowe agar with 10% sheep blood containing cephalexin (40 µg/mL) and incubated at 37°C for 10 days. The antimicrobial susceptibilities to erythromycin, azithromycin, clarithromycin, and trimethoprim/sulfamethoxazole were determined using the disc diffusion method (CLSI-2017) on Regan Lowe and Mueller Hinton agar. Erythromycin minimum inhibitory concentrations (MICs) were determined using an E-test. The results were recorded after days 3 and 7 of incubation. Sequencing of the 23S rRNA gene was performed to detect mutations conferring macrolide resistance. Results: Of 263 cases, 119 were positive for B. pertussis (45.2%) by real-time PCR, and 15 of 263 strains (5.7%) were successfully cultured. All 15 isolates were susceptible to macrolides and no heterogeneous phenotype was recorded after 7 days; erythromycin MICs were ≤0.094 µg/mL (Fig. 1). We observed no difference in results generated on Regan Lowe and Mueller Hinton media. However, for testing trimethoprim/sulfamethoxazole, results on were superior, as those on Regan Lowe media were unclear. Sequencing of 23S rRNA identified no mutations known to confer macrolide resistance. Conclusions: None of 15 B. pertussis isolates tested were nonsusceptible to erythromycin and macrolides. Similarly, no mutation at the erythromycin-binding site in the 23S rRNA gene was identified. The low isolation rate of B. pertussis by culture means that few positive specimens were tested for antimicrobial susceptibility. To overcome this limitation, detection of resistance directly from clinical specimens needs to be investigated. Ongoing screening for B. pertussis and antimicrobial susceptibility is recommended to support efforts to control the spread of this respiratory tract infection agent.
Background: Whooping cough is a serious respiratory illness in infants caused by Bordetella pertussis. In spite of the vaccination program, the incidence rates of whooping cough per 100,000 population in Vietnam increased from 0.33 in 2015 to 0.58 in 2017. If this represents a pertussis resurgence, contributors may include pathogen adaptation, the spread of specific variants, vaccine failure, and failure to effectively treat cases and contacts. There has been little research in Vietnam on B. pertussis strains. Therefore, we investigated the molecular epidemiology of circulating B. pertussis strains in Southern Vietnam by applying multilocus sequence typing (MLST) for 7 housekeeping genes and 4 antigenic determinant genes as components in the acellular vaccine including prn, ptxP, ptxS1, and fim3. Methods: DNA was extracted from 15 isolates collected from 263 case patients during 2015–2017 and was subject to MLST using primers and cycling conditions from the Bordetella pubMLST website (www.Pubmlst.org/Bordetella/). The products were analyzed using BioEdit version 7.2.5 software and then were aligned and compared to reference sequences of each genotype in the database. The evolutionary relationship among sequence types (STs) from housekeeping genes was performed as a minimum spanning tree via the goeBURST algorithm, whereas the correlation of different variants from 4 antigenic determinant genes was built up and clarified with phylogenetic trees based on the UPGMA method by MEGA 7 program. Results: The 15 isolates were all classified as ST2 (100%) by MLST of housekeeping genes, and they belonged to a common global clonal group (Fig. 1). Sequencing of antigenic determinant genes prn2 – ptxP3 – ptxS1-1 – fim3-1 determined that all were identical to each another and the reference sequences (Fig. 2). Conclusions:B. pertussis isolates circulating in Southern Vietnam appeared to be the same as the common global strain. Few isolates were available for testing; therefore, continued surveillance is important to confirm these findings and to monitor population changes over time.
The ultimate goal of artificial intelligence (AI) is to develop technologies that are best able to serve humanity. This will require advancements that go beyond the basic components of general intelligence. The term “intelligence” does not best represent the technological needs of advancing society, because it is “wisdom”, rather than intelligence, that is associated with greater well-being, happiness, health, and perhaps even longevity of the individual and the society. Thus, the future need in technology is for artificial wisdom (AW).
We examine the constructs of human intelligence and human wisdom in terms of their basic components, neurobiology, and relationship to aging, based on published empirical literature. We review the development of AI as inspired and driven by the model of human intelligence, and consider possible governing principles for AW that would enable humans to develop computers which can operationally utilize wise principles and result in wise acts. We review relevant examples of current efforts to develop such wise technologies.
AW systems will be based on developmental models of the neurobiology of human wisdom. These AW systems need to be able to a) learn from experience and self-correct; b) exhibit compassionate, unbiased, and ethical behaviors; and c) discern human emotions and help the human users to regulate their emotions and make wise decisions.
A close collaboration among computer scientists, neuroscientists, mental health experts, and ethicists is necessary for developing AW technologies, which will emulate the qualities of wise humans and thus serve the greatest benefit to humanity. Just as human intelligence and AI have helped further the understanding and usefulness of each other, human wisdom and AW can aid in promoting each other’s growth
In this paper, we review empirical studies of multidisciplinary collaboration in design and innovation activities. From 200 papers, we selected 17 for a meta-synthesis review. When revisited and compared, they present common themes and dichotomy in findings. This literature review discusses such diversity, offering a methodological critique of unclear areas. Four emerged themes were identified: (1) Knowledge diversity, (2) Trust, (3) Barrier and (4) Jargon and communication, providing perspectives for further research on how online collaboration will influence multidisciplinary team processes.
Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression.
Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study.
Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21–88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9–63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire – Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively.
The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.
This paper focuses on the problem of skin corrosion on the upper wing surfaces of rib-stiffened aircraft. For maritime and military transport aircraft this often results in multiple co-located repairs. The common approach to corrosion damage in operational aircraft is to blend out the corrosion and rivet a mechanical doubler over the region. In particular this paper describes the results of a combined numerical and experimental investigation into the ability of the additive metal technology, Supersonic Particle Deposition (SPD), to restore the load-carrying capacity of rib-stiffened wing planks with simulated skin corrosion. The experimental results reveal that unrepaired skin corrosion can result in failure by yielding. The experimental results also reveal that SPD repairs to skin corrosion can restore the stress field in the structure, and can ensure that the load-carrying capability of the repaired structure is above proof load.
To reduce competition with human-edible feed resources, it is of interest to incorporate by-products from the food industry in animal feeds. The current research investigated the effect of including increasing amounts of tofu by-product (TF) in practical pig diets on animal performance, nitrogen balance and ammonia emissions from manure. Two experiments were conducted including a control diet without TF, containing 160 g/kg dietary non-starch polysaccharides (NSPs) and three diets including 122, 246 and 360 g TF/kg DM (TF122, TF246 and TF360, respectively) to reach 220, 280 and 360 g/kg NSP. All diets had the same level of CP and protein digestible in the small intestine which particularly was realized by replacing rice bran with TF. Animal performance was assessed in a first experiment with 40 growing barrows with initial BW of 26.6 ± 1.80 kg (M ± SD) being allocated to the 4 treatments, during 2 growth phases (i.e. until 50 kg BW and from 50 to 80 kg BW). In the growth phase until 50 kg, feed intake and average daily gain (ADG) were linearly reduced by dietary TF inclusion, while this negative impact disappeared during the second growth phase (50 to 80 kg BW). Tofu by-product inclusion even positively affected the feed conversion ratio during this second growth phase (3.4 to 2.7 kg feed/kg ADG for 0 to 360 g/kg dietary TF). Over the entire growth period, performance and feed intake were negatively affected at the highest dietary TF level. Experiment 2 was conducted to assess digestibility, nitrogen balance and ammonia emission from manure. For this purpose, 16 pigs with BW of 62.8 ± 3.6 kg (M ± SD) were assigned to either 1 of the 4 treatments. There was no difference in total tract apparent digestibility of dietary organic matter or CP, while NDF digestibility increased with increasing TF level, suggesting increasing importance of the hindgut fermentation when digesting diets with increasing TF levels. Nevertheless, this was not reflected in increasing levels of faecal volatile fatty acids or purines, nor in reduced manure pH. As a result, ammonia emission from slurry was not reduced through dietary TF inclusion, despite the linear decrease in urinary nitrogen. In conclusion, TF can be included in pigs’ diets up to an inclusion rate of 25% without risk of impaired animal performance; however, this dietary strategy fails to mitigate ammonia emission from slurry.
Thermoelectric (TE) materials, or materials that can generate an electrical energy from temperature gradient, are promising for renewable energy technology. One fundamental aspect in the TE research is the demand to maximize the TE power-factor, PF = S2 σ, by having as large Seebeck coefficient (S) and electrical conductivity (σ) as possible. In the early 90s, Hicks and Dresselhaus proposed the PF enhancement by using low-dimensional materials, in which electrons are confined in certain directions and they move freely in the other directions. This quantum effect is known as the confinement length (L) effect, in which L is the thickness or diameter of the two-dimensional (2D) or one-dimensional materials, respectively. However, a key challenge is to understand the critical value of L, at which the PF can be significantly enhanced. Recently, we reevaluated the confinement theory of the low-dimensional materials to solve this issue. We showed that electrons are fully confined only when L is smaller than an intrinsic length Λ, the so-called thermal de Broglie wavelength, which depends on the materials and can be experimentally measured. Monolayer 2D materials naturally satisfy the condition of L < Λ since their confinement length is ∼ 1 nm, while their thermal de Broglie wavelength is ∼ 5-10 nm. Therefore, they could be a good candidate for TE materials. In this review article, we first review the TE materials with low dimensions. Then, we show the basic concept of the confinement effect and the consequence of such an effect. Finally, based on this effect, we turn our attention to the progress achieved recently in the TE properties of the 2D materials such as monolayer InSe, GaN electron gas, and SrTiO3 superlattices.
Alcohol and cannabis remain the substances most widely used by adolescents. Better understanding of the dynamic relationship between trajectories of substance use in relation to neuropsychological functioning is needed. The aim of this study was to examine the different impacts of within- and between-person changes in alcohol and cannabis use on neuropsychological functioning over multiple time points.
Hierarchical linear modeling examined the effects of alcohol and cannabis use on neuropsychological functioning over the course of 14 years in a sample of 175 adolescents (aged 12–15 years at baseline).
Time-specific fluctuations in alcohol use (within-person effect) predicted worse performance across time on the Wechsler Abbreviated Scale of Intelligence Block Design subtest (B = −.05, SE = .02, p = .01). Greater mean levels of percent days of cannabis use across time (between-person effect) were associated with an increased contrast score between Delis–Kaplan Executive Function System Color Word Inhibition and Color Naming conditions (B = .52, SE = .14, p < .0001) and poorer performance over time on Block Design (B = −.08, SE = .04, p = .03). Neither alcohol and/nor cannabis use over time was associated with performance in the verbal memory and processing speed domains.
Greater cumulative cannabis use over adolescence may be linked to poorer inhibitory control and visuospatial functioning performance, whereas more proximal increases in alcohol consumption during adolescence may drive alcohol-related performance decrements in visuospatial functioning. Results from this prospective study add to the growing body of literature on the impact of alcohol and cannabis use on cognition from adolescent to young adulthood.
The neuro-endoscopy is a surgical technique that allows the neurosurgeon to maintain a visual contact while operating inside the brain of a patient. A special instrument called the neuro-endoscope is inserted in the brain until the neurosurgeon reaches his/her target. Its manipulation requires a high level of training for neurosurgeons. To enforce both quality and safety of neuro-endoscopy, we propose a robotic manipulator based on a Spherical Decoupled Mechanism. This mechanical architecture has been modified from a 5-Bar Spherical Linkages and adapted to this medical application. It is able to generate a Remote Center of Motion of 2 Degrees of Freedom. It merges the advantages of parallel mechanisms with the kinematic and control simplicity of decoupled mechanisms, while having a very simple architecture. Motion capture experiments using a brain simulation model have been performed with a team of neurosurgeons to obtain the kinematic data of the neuro-endoscope during brain exploration. Based on the identified workspace, the mechanism has been optimized using kinematic performance and architectural compactness as criteria. An optimum mechanism has been selected, showing better kinematic performances than the original 5-bar spherical linkage mechanism.
Increasing weed control costs and limited herbicide options threaten vegetable crop profitability. Traditional interrow mechanical cultivation is very effective at removing weeds between crop rows. However, weed control within the crop rows is necessary to establish the crop and prevent yield loss. Currently, many vegetable crops require hand weeding to remove weeds within the row that remain after traditional cultivation and herbicide use. Intelligent cultivators have come into commercial use to remove intrarow weeds and reduce cost of hand weeding. Intelligent cultivators currently on the market such as the Robovator, use pattern recognition to detect the crop row. These cultivators do not differentiate crops and weeds and do not work well among high weed populations. One approach to differentiate weeds is to place a machine-detectable mark or signal on the crop (i.e., the crop has the mark and the weed does not), thereby facilitating weed/crop differentiation. Lettuce and tomato plants were marked with labels and topical markers, then cultivated with an intelligent cultivator programmed to identify the markers. Results from field trials in marked tomato and lettuce found that the intelligent cultivator removed 90% more weeds from tomato and 66% more weeds from lettuce than standard cultivators without reducing yields. Accurate crop and weed differentiation described here resulted in a 45% to 48% reduction in hand-weeding time per hectare.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
The last two decades have witnessed a remarkable reinvention of the role of the neurologist, from an outpatient consultant to a critical presence in the inpatient setting. Spotting a neurologist in an emergency room or intensive care unit is no longer incongruous, rather an expectation of their relatively new roles as acute stroke doctors and neurointensivists. With this shift in patient care setting came a shift in research and many questions that have plagued the neurologic community for decades have resurfaced. The groundbreaking neurophysiologic discoveries of the previous century have armed us with an understanding of how the normal neuron functions. Now, in the inpatient, critically ill population, we once again find ourselves wondering what is happening within the shroud of the skull.
Gac is a dioecious tropical and perennial climber. The fruit is a rich source of carotenoids and is used in traditional cuisine and medicine. Improving propagation methods using simple techniques would increase production and improve conservation in regional areas. This study evaluated temperature requirements for seed germination, the use of rooting hormones to strike female cuttings and the grafting of female scions onto seedling rootstock. Seed germination was optimised between 25 and 35 °C, with a maximum germination percentage of 91% at 30 °C. However, increasing storage time from 6 to 18 months under laboratory conditions (21 ± 1°C and 60% relative humidity) reduced germination and this was associated with seed weight loss, highlighting the need to develop storage guidelines, particularly for the higher temperature and humidity conditions where Gac is grown. Survival of softwood cuttings was improved from 53 to 77% with indole-3-butyric acid (IBA) (3–5 g/L) and semi-hardwood cuttings did not require IBA treatment. Both splice and wedge grafting techniques achieved a survival rate > 53% and with the youngest rootstock (4 and 8 weeks) this increased to > 85%. Further work could investigate the production potential of crops using cuttings and grafted plants.