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To describe the pattern of blood culture utilization in an academic university hospital setting.
Retrospective cohort study.
A 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.
We analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.
In total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.
Ordering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.
The authors of this paper met at Harvard University in July, 1955, to discuss the theoretical problems which arise in the study of culture contact situations in archaeology. The subject of contacts between cultures is one in which ethnologists have long been interested, and there is a substantial body of literature, both descriptive and theoretical, on contemporary and recent historic situations of this kind. Archaeological interest in the subject is somewhat more recent, but a few excellent reports on specific examples have appeared which we could use as a basis for our discussions. We believe that this paper is only the second attempt to contribute something to this field by generalization from archaeological data (Willeyl953).
To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus.
A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report.
The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the ‘cookie bite’ out of the superior semicircular canal on computed tomography imaging.
Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging.
Various variables that might influence the rapid and sustained virological response to recombinant PEG-IFN-α-2a were explored in Iraqi HCV-infected patients with haemoglobinopathy. Forty-three patients were evaluated for the relationship between rapid virological response (RVR), IL-28B polymorphism, viral load, liver enzyme levels, blood group, ultrasound findings, or HCV genotype and the sustained virological response (SVR) achievement. The overall RVR was 55·81% while the overall SVR was 53·49%. SVR in patients that achieved RVR was 82·61% (P = 0·0004). A significant association was found between initial alanine transaminase levels and viral load with SVR achievement (P = 0·025) and (P = 0·004), respectively. Thirty-two (74%) out of 43 of our samples were host genotyped at the IL-28B locus as CC, a significant association was found between CC group and SVR achievement (P = 0·04). Of our samples, 23/43 (53%) were typed as HCV genotype 4, 10/43 (23%) as genotype 1, 9/43 (20·9%) as genotype 3 and 1/43 (2·3%) as genotype 2. A significant association was found between genotype 3 and SVR achievement (P = 0·006). Multivariate analysis showed that only RVR achievement independently associated with SVR in the Iraqi population (P = 0·00). These results can be used to classify the patients requiring the more expensive new direct-acting antiviral drugs.
We present the first experimentally determined oscillator strengths for the Pb ii transitions at 1203.6 Å and 1433.9 Å, obtained from lifetime measurements made using beam-foil techniques. We also present new detections of these lines in the interstellar medium from an analysis of archival spectra acquired by the Space Telescope Imaging Spectrograph onboard the Hubble Space Telescope. Our observations of the Pb ii λ1203 line represent the first detection of this transition in interstellar gas. Our experimental f-values for the Pb ii λ1203 and λ1433 transitions are consistent with recent theoretical results, including our own relativistic calculations, but are significantly smaller than previous values based on older calculations. Our new f-value for Pb ii λ1433 (0.321 ± 0.034) yields an increase in the interstellar abundance of Pb of 0.43 dex over estimates based on the f-value listed by Morton. With our revised f-values, and with our new detections of Pb ii λ1203 and λ1433, we find that the depletion of Pb onto interstellar grains is not nearly as severe as previously thought, and is very similar to the depletions seen for elements such as Zn and Sn, which have similar condensation temperatures.
We analyze the interplay between anomalous transport and conversion reaction kinetics in mesoporous materials functionalized with catalytic groups. Of primary interest is functionalized mesoporous silica containing an array of linear pores with diameters tunable from 2-10 nm, although functionalization can produce smaller effective diameters, d. For d < 2 nm, transport and specifically passing of reactant and product species within the pores can be strongly inhibited (single-file diffusion). The distribution of catalytic groups can also vary depending on the synthesis approach. We apply statistical mechanical modeling (utilizing spatially discrete stochastic lattice-gas models) to explore the dependence of reactivity on the extent of inhibition of passing of species within the pore, as well as on the distribution of catalytic sites.
Nitridation is the process in which, during the initial growth of a-SiNx:H layers on Si surfaces, nitrogen (N) is incorporated into Si lattice near its surface. We show that this nitridation process affects the density of interface states (Dit) and fixed charges (Qf) at the interface. These parameters determine the effective surface passivation quality of the layers. The nitridation can be tuned independently of the growth of a-SiNx:H layers by using a plasma treatment prior to actual a-SiNx:H layer deposition. It is shown that the Qf can be varied from 2·1012 to 15·1012 cm-2 without changing the a-SiNx:H deposition process. It is demonstrated that in our case and processing window, Qf is the determining factor in surface passivation quality in the range of 2·1012 to 8·1012 cm-2. For higher values of Qf, Dit has increased significantly and has become dominant thereby reducing the passivation quality. It is shown that the passivation can be controlled independently of the a-SiNx:H deposition process. On completed solar cells this variation in Qf due to nitridation results in a change in open-circuit voltage, Voc, of almost 20mV.
We studied a cross-sectional sample of the population of Kech, a small rural town in Pakistan to determine the prevalence and risk factors for hepatitis C infection. The prevalence of hepatitis C was 110 out of 2000 persons (5·5%, 95% confidence interval 4·5–6·5). Higher rates were identified in males. Independent risk factors identified were age ⩾75 years, being a healthcare worker, and injecting drug use. There was a high prevalence of many potential routes of transmission of bloodborne viruses and most people reported at least one potential risk factor.
Energies for symmetric tilt grain boundaries in pure Al and in Al with substitutional Pb defects at coincident sites along the grain boundaries were calculated using a modified embedded atom method potential and density functional theory. The agreement between the analytic potential, the first principles calculations and experiment is reasonably good for the pure system. For the Al-Pb system both the analytic potential and first principles calculations predict that Pb segregation to the interface is energetically preferred compared to the dilute solution. The application of a disclination structural unit model to calculating grain boundary energies over the entire range of tilt angles is also explained.
The adhesive pressure needed to separate two ocatdecyltrichlorosilane (ODTS) coated surfaces both with and without the addition of tricresyl phosphate (TCP) as a function of separation rate is characterized using molecular dynamics simulation. The simulations predict that when TCP is added between surfaces the adhesive pressure needed for separation is reduced compared to the system containing ODTS only. Both the adhesive pressure and the break up of the TCP layers exhibit a separation rate dependence that appears unrelated to the rate of diffusion of TCP on the ODTS. The ability of the TCP to remain localized to defected areas of the ODTS layer upon normal separation of the contact is also characterized. It is found that the TCP remains localized to defect sites, which effectively coats the damaged area.
1. A group of rats has been fed on a poor human dietary supplemented with milk and green food. A further group has been given the same dietary supplemented with Ca and P as salts, equivalent in amount to that present in the milk and green food. The experiment has been continued over three generations.
2. The diet supplemented with Ca and P salts has been found to be as effective as that containing milk and green food in promoting reproduction, calcification and tooth formation; it has induced growth as effectively in the first generation of rats but is unable to maintain this growth rate as effectively over several generations. It is obvious that Ca and P are of the chief deficiencies in the poor diet. The addition of these elements greatly increases the nutritive value of this diet, but they are inferior in this respect to milk and green food supplements.
3. Under conditions of Ca and P lack, tooth formation is much less adversely affected than is skeletal ossification.
The cross-reaction of HHV6 antibody with that to the other herpesviruses was studied in 96 blood donors whose sera were tested for IgG antibody to human herpesvirus type 6 (HHV6), cytomegalovirus (CMV), Epstein–Barr virus (EBV), varicella zostervirus (VZV) and herpes simplex virus (HSV). No correlation was found between IgG antibody to HHV6 and that to any of the other herpesviruses in these individuals. Antibodies to HHV6 and CMV were measured in patients undergoing documented serological responses to HHV6. Eleven cases of primary HHV6 infection associated with roseola infantum in babies, 1 of whom suffered from gastroenteritis as well as pyrexia and rash, are reported. Three cases of HHV6 reactivation, 1 in a 3-year-old child and 2 in adults, 1 of whom simultaneously underwent a primary CMV infection are also reported. Our results suggest that indirect immunofluorescence is a specific way of measuring HHV6 antibody, that HHV6 IgG and IgM can be detected in the absence of antibody to CMV and that HHV6 IgM is present both in primary HHV6 infections and in reactivations.
This paper describes sentinel laboratory surveillance of hepatitis C antibody testing in England. Demographic and test result data were supplemented by follow-up questionnaires sent to the requesting clinician. Between October 2002 and September 2003 almost 75000 anti-HCV tests were performed in eight sentinel centres. More males were tested than females and over half of those tested were aged 25–44 years. Overall 5·7% (3333/58144, range 2·8–7·7%) individuals tested positive. Follow-up questionnaire data showed that 82% (1043/1277) of the positives had injecting drug use reported as the main risk exposure. The majority of negative individuals were undergoing routine screening as recommended for specific patient groups. Most individuals were asymptomatic. Antibody prevalence was estimated to be 34% in current injecting drug users and 42% in former injectors. Comparing positives to routine national surveillance suggests that only 53% (1782/3333) of diagnosed cases were reported. Sentinel laboratory data can provide valuable supplementary data to national surveillance.
The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.
Viruses continually evolve and adapt, posing new threats to health. This book discusses the ecology of viruses with particular emphasis on the emergence of devastating haemorrhagic disease, and reviews the molecular and cell biological basis of the pathogenesis of several virus diseases. An introduction is given to the mathematical analysis of recurrent epidemic virus disease, such as measles. Neurological and psychological disease is discussed in relation to the pathological mechanisms that may underlie prion disease (such as new variant CJD) and to the possible virus involvement in human psychiatric illness. Virus infections that have come to prominence recently (HIV, bunyaviruses, morbilliviruses and caliciviruses) or that remain a threat (influenza and hepatitis viruses) are discussed. There are also chapters on new and potential niches for virus infections in the immunocompromised, and the problem of the emergence of antiviral drug resistance in viruses for which therapies exist.