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Background: Automated testing instruments (ATIs) are commonly used by clinical microbiology laboratories to perform antimicrobial susceptibility testing (AST), whereas public health laboratories may use established reference methods such as broth microdilution (BMD). We investigated discrepancies in carbapenem minimum inhibitory concentrations (MICs) among Enterobacteriaceae tested by clinical laboratory ATIs and by reference BMD at the CDC. Methods: During 2016–2018, we conducted laboratory- and population-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE) through the CDC Emerging Infections Program (EIP) sites (10 sites by 2018). We defined an incident case as the first isolation of Enterobacter spp (E. cloacae complex or E. aerogenes), Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem from normally sterile sites or urine identified from a resident of the EIP catchment area in a 30-day period. Cases had isolates that were determined to be carbapenem-resistant by clinical laboratory ATI MICs (MicroScan, BD Phoenix, or VITEK 2) or by other methods, using current Clinical and Laboratory Standards Institute (CLSI) criteria. A convenience sample of these isolates was tested by reference BMD at the CDC according to CLSI guidelines. Results: Overall, 1,787 isolates from 112 clinical laboratories were tested by BMD at the CDC. Of these, clinical laboratory ATI MIC results were available for 1,638 (91.7%); 855 (52.2%) from 71 clinical laboratories did not confirm as CRE at the CDC. Nonconfirming isolates were tested on either a MicroScan (235 of 462; 50.9%), BD Phoenix (249 of 411; 60.6%), or VITEK 2 (371 of 765; 48.5%). Lack of confirmation was most common among E. coli (62.2% of E. coli isolates tested) and Enterobacter spp (61.4% of Enterobacter isolates tested) (Fig. 1A), and among isolates testing resistant to ertapenem by the clinical laboratory ATI (52.1%, Fig. 1B). Of the 1,388 isolates resistant to ertapenem in the clinical laboratory, 1,006 (72.5%) were resistant only to ertapenem. Of the 855 nonconfirming isolates, 638 (74.6%) were resistant only to ertapenem based on clinical laboratory ATI MICs. Conclusions: Nonconfirming isolates were widespread across laboratories and ATIs. Lack of confirmation was most common among E. coli and Enterobacter spp. Among nonconfirming isolates, most were resistant only to ertapenem. These findings may suggest that ATIs overcall resistance to ertapenem or that isolate transport and storage conditions affect ertapenem resistance. Further investigation into this lack of confirmation is needed, and CRE case identification in public health surveillance may need to account for this phenomenon.
Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.
Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).
We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.
We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).
Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.
We develop a dynamic general equilibrium growth model, where households purchase final goods on cash or credit and have different capital and money endowments, to investigate whether inflation affects trends in income and consumption inequality. We show that, under a strong substitutability between cash and credit goods, inflation has a negative relationship with income inequality, but a U-shaped relationship with consumption inequality. The divergence between income and consumption inequality explains several recent empirical observations. This result has important policy implications, as consumption inequality better reflects the welfare distribution whereas income inequality fails to capture consumption disparities resulting from different consumption and asset distributions across households. In the growth model with heterogeneous households, there is a mixed relationship between growth and income inequality, confirming the existence of the Kuznets curve. The inflation-driven asset reallocation might also produce a Mundell–Tobin effect, enhancing growth.
To evaluate efficacy and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, in obese (BMI =30kg/m2) and non-obese (BMI <30kg/m2) patients with schizophrenia.
Data from a 38-week, double-blind, active-controlled, non-inferiority study (NCT00706654); randomisation (2:2:1) to AOM-400mg, oral aripiprazole (10-30mg/day) (ARI), or aripiprazole once-monthly 50mg (AOM-50mg) assessing the efficacy and safety of AOM in patients requiring chronic antipsychotic treatment were used for this post-hoc analysis. We report the overall relapse rates in the 38-week randomized phase. Comparisons of overall relapse rates were analyzed using the Chi-squared test.
662 patients were randomized to: AOM-400mg (n=265); ARI (n=266); or AOM-50mg (n=131). Of these, the following were obese: AOM- 400mg: n=95; ARI: n=95; AOM-50mg: n=43. In the obese patients, the overall relapse rate was significantly (p=0.0012) lower with AOM-400mg (7.4%) than with AOM-50mg (27.9%). The difference between AOM-400mg and ARI (8.4%) was not significantly different. In the non-obese patients, the overall relapse was significantly (p=0.0153) lower with AOM-400mg (8.8%) than with AOM-50mg (19.3%). The difference between AOM-400mg and ARI (7.6%) was not significantly different. For patients treated with AOM-400mg, the most common TEAEs (>10% in any group) are presented in Table 1.
Injection site pain
Upper respiriatory tract infection
The efficacy and tolerability of aripiprazole once-monthly 400mg were similar in both the obese and non-obese subgroups.
Supported by Otsuka Pharmaceutical Development & Commercialization, Inc., and H. Lundbeck A/S
Electroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.
Using data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n = 1571) were treated with ECT.
We found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.
ECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.
This study investigated the flow bifurcations of flows driven by a pressure gradient in a rectangular curved tube. When fluid flows within a curved tube, due to the centrifugal effect, secondary vortices can be induced in the cross section of the tube. The secondary flow states are dependent on the magnitude of the pressure gradient (q) and the aspect ratio (γ). In this study, the continuation method was applied to investigate the flow bifurcations in a curved tube with increasing pressure gradient (1 < q < 6000) and aspect ratio (0.9 < γ < 1.4).
The bifurcation diagrams are composed of solution branches, which are linked by limiting points or bifurcation points. The flow states in a solution branch belong to the same group. The ranges of the flow states and the relationship between the states can also be derived from the bifurcation diagrams. In this study, two types of bifurcation were found, one in the range of 0.9 < γ < 1.17, and another in the range of 1.18 < γ < 1.4. The ranges of stable flow solutions and the distributions of limit and bifurcation points in both pressure gradient and aspect ratio are derived in this study.
Prior to integrated circuit (IC) packaging, die performance must be verified using probe cards to screen for defective products. With the decrease in IC line width, the dimensions of the pads used for performance verification and the spacing between adjacent pads have also decreased. However, when the pad pitch is reduced to less than 30 μm, commonly used probe cards will face manufacturing problems in miniaturization. To resolve probe card manufacturing problems caused by the miniaturization of IC components, the use of an anisotropic conductive film (ACF) in probe cards was proposed in this study. Theoretical calculations and experimental testing of this probe structure were conducted to demonstrate the feasibility of this concept.
In theoretical calculations, composite material and buckling theory were utilized to evaluate the buckling behavior of the ACF. In experimental testing, photolithography and electroplating techniques were used to control the line width and spacing intervals of the micron-scale metal wires in the ACF. After the ACF was fabricated, the mechanical properties of the ACF during wafer testing were assessed. Theoretical analyses and experimental testing verified that ACFs can potentially be applied to the performance verification of IC products. In the ACF structure, multiple probes came into contact with each pad. Therefore, ACFs can potentially be applied to the performance verification of IC components with pad diameters of less than 20 μm. The results of this study directly benefit the miniaturization of ICs.
Social networks, particularly those defined by friendships, influence many childhood and adolescent health behaviors such as the use of alcohol, tobacco, and other drugs, as well as diet and physical activity. Few, if any, studies have examined the concordance between friendship networks and sun exposure/safety behaviors. This study examines the friendship networks and sun safety behaviors for a group of fourth and fifth grade students taking part in a larger sun safety intervention, “SunSmart” (n = 128). Intra-class correlation, homophily hypothesis testing, and exponential random graph models were used to test friendship homophily based on sun safety behaviors. Peer Leaders were identified through social network popularity, and sun safety change scores were compared between Peer Leaders and non-leaders. Results show that students cluster based on shared demographic characteristics and some sun safety behaviors, and that there was a trend for Peer Leaders to respond better to the SunSmart intervention than non-leaders. Implications for future sun safety interventions using Peer Leaders as champions for sun safety behavior change are discussed.
Through silicon via (TSV) is the critical structure for three dimensional (3D) integration, which provides vertical interconnection between stacking dies. In TSV structure, large coefficient differences of thermal expansion exist between silicon substrate, dielectric material, and filled metal. Due to the large thermal mismatch, the high thermal stress occurring at the interface of different materials would result in delamination. Therefore, thermal-mechanical reliability is a key issue for 3D integration. In this study, we investigated the thermal-mechanical stress distribution of TSV under the condition of the accelerated thermal cycling loading by finite element analysis based on a 3D model of TSV structure. Due to the thermal expansion, that the TSV structure squeezed the surface area between TSVs at a high temperature resulted in compressive stresses at the surface area between TSVs. Therefore, a proper distance between the stress-sensitive device and the TSV should be kept. The stress analysis shows that the maximum thermal stress occurs in the outside region of TSV interface and in the annular region of TSV at a high temperature and at a low temperature, respectively. This study helps to obtain a clear thermal stress distribution of TSV and possible failure regions can be determined.
Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.
We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.
In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.
Haemangioma of the adult larynx is an uncommon, benign lesion. The optimal surgical method of treating these lesions is controversial because only very limited case series are available. This paper reports the results of transoral robotic resection of a supraglottic haemangioma in an adult and reviews the literature.
Methods and results:
A 58-year-old woman presented having experienced a lump-in-the-throat sensation for 1 year. Investigations on laryngoscopy revealed a lobulated, dark red mass in the region of the supraglottis. This was successfully excised by transoral robotic excision without complications.
Adult supraglottic haemangiomas can be treated successfully with transoral robotic excision; this potentially allows more of the surrounding mucosal tissue to be spared and enables easy control of bleeding.
An uneven neurocognitive profile is a hallmark of autism spectrum disorder (ASD). Studies focusing on the visual memory performance in ASD have shown controversial results. We investigated visual memory and sustained attention in youths with ASD and typically developing (TD) youths.
We recruited 143 pairs of youths with ASD (males 93.7%; mean age 13.1, s.d. 3.5 years) and age- and sex-matched TD youths. The ASD group consisted of 67 youths with autistic disorder (autism) and 76 with Asperger's disorder (AS) based on the DSM-IV criteria. They were assessed using the Cambridge Neuropsychological Test Automated Battery involving the visual memory [spatial recognition memory (SRM), delayed matching to sample (DMS), paired associates learning (PAL)] and sustained attention (rapid visual information processing; RVP).
Youths with ASD performed significantly worse than TD youths on most of the tasks; the significance disappeared in the superior intelligence quotient (IQ) subgroup. The response latency on the tasks did not differ between the ASD and TD groups. Age had significant main effects on SRM, DMS, RVP and part of PAL tasks and had an interaction with diagnosis in DMS and RVP performance. There was no significant difference between autism and AS on visual tasks.
Our findings implied that youths with ASD had a wide range of visual memory and sustained attention impairment that was moderated by age and IQ, which supports temporal and frontal lobe dysfunction in ASD. The lack of difference between autism and AS implies that visual memory and sustained attention cannot distinguish these two ASD subtypes, which supports DSM-5 ASD criteria.
The earliest fossil gray whale (Eschrichtius) from the eastern North Pacific is reported from the Lower Pleistocene Rio Dell Formation of Humboldt County, Northern California. This specimen, a tympanic bulla and posterior process, is identical in morphology to extant Eschrichtius robustus and differs from Pliocene Eschrichtius sp. from the western North Pacific (Japan). Thus, it suggests that the modern bulla morphology of the gray whale had been acquired by the Early Pleistocene. The absence of fossil Eschrichtius in the Pliocene of the eastern North Pacific may indicate that the extant gray whale lineage originated in the western North Pacific during the Pliocene before invading the eastern North Pacific during the Early Pleistocene. Further discoveries of Plio-Pleistocene gray whale fossils will help test this hypothesis and properly interpret the evolutionary history of eschrichtiid clade.
In this study, the properties of surface acoustic wave (SAW) filters, including phase velocity and electromechanical coupling coefficient (K2) are investigated. The effective surface permittivity (ESP) method was employed to estimate the K2 of bulk materials (single layer) and multi-layer (double-layer and trilayer) structures. In the cases of bulk materials, the calculation results agree with the experimental data, and the errors are less than 7% for quartz. In the cases of double-layer materials, the phase velocity and K2 of various materials, such as ZnO/Diamond and LiNbO3/Diamond, were acquired, and the results demonstrate that LiNbO3/diamond is the optimal choice for high-frequency SAW devices. For the cases of trilayer, the structure of ZnO/PZT/diamond has relatively high K2 and phase velocity. Therefore, this structure is the optimal trilayer structure for high-frequency SAW devices. The study demonstrates that ESP method can be successfully used for estimating SAW properties in piezoelectric multi-layer structures even though the structures contain nonpiezoelectric film (diamond). The proposed numerical computation has the potential to shorten the developing time of SAW device.
A continuation method, accompanied with a linear stability analysis, is employed to investigate the bifurcation diagram of the flow solutions, as well as the multiple flow states in a cavity with different aspect ratios for parallel motion of two facing lids. The Reynolds number proportional to the wall velocity is used as the continuation parameter, and the evolution of the bifurcation diagrams in cases with different aspect ratios is illustrated. The induced flow patterns are highly dependent upon both the aspect ratios and the moving velocity of the walls. Three different types of bifurcation diagrams and their corresponding flow states are classified according to the aspect ratios. One stable symmetric flow state and one stable asymmetric flow state are identified. The stable asymmetric flow state is obtained at a high aspect ratio and a low Reynolds number. Meanwhile, the regions of stable and unstable flows are distinguished according to the different aspect ratios.
There is increasing recognition that, in addition to negative psychological consequences of trauma such as post-traumatic stress disorder (PTSD), some individuals may develop post-traumatic growth (PTG) following such experiences. To date, however, data regarding the prevalence, correlates and functional significance of PTG in population-based samples are lacking.
Data were analysed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 3157 US veterans. Veterans completed a survey containing measures of sociodemographic, military, health and psychosocial characteristics, and the Posttraumatic Growth Inventory-Short Form.
We found that 50.1% of all veterans and 72.0% of veterans who screened positive for PTSD reported at least ‘moderate’ PTG in relation to their worst traumatic event. An inverted U-shaped relationship was found to best explain the relationship between PTSD symptoms and PTG. Among veterans with PTSD, those with PTSD reported better mental functioning and general health than those without PTG. Experiencing a life-threatening illness or injury and re-experiencing symptoms were most strongly associated with PTG. In multivariable analysis, greater social connectedness, intrinsic religiosity and purpose in life were independently associated with greater PTG.
PTG is prevalent among US veterans, particularly among those who screen positive for PTSD. These results suggest that there may be a ‘positive legacy’ of trauma that has functional significance for veterans. They further suggest that interventions geared toward helping trauma-exposed US veterans process their re-experiencing symptoms, and to develop greater social connections, sense of purpose and intrinsic religiosity may help promote PTG in this population.
A novel allergy biosensor is designed and fabricated by using thin film bulk acoustic resonator (TFBAR) devices with shear mode ZnO piezoelectric thin films. To fabricate TFBAR devices, the off-axis RF magnetron sputtering method for the growth of piezoelectric ZnO piezoelectric thin films is adopted. The influences of the relative distance and sputtering parameters are investigated. In this report, the piezoelectric ZnO thin films with tilting angle are set by controlling the deposition parameters. The properties of the shear mode ZnO thin films are investigated by X-ray diffraction and scanning electron microscopy. The frequency response is measured using an HP8720 network analyzer with a CASCADE probe station. The resonance frequency of the shear mode is 796.75 MHz. The sensitivity of the shear mode is calculated to be 462.5 kHz·cm2/ng.
In this study, the fictitious time integration method (FTIM) is applied to investigate wave propagation over an arbitrary bathymetry with measured uncertainty. The FTIM is used to convert the higher-order elliptic mild-slope equation (EMSE) into a FTIM like EMSE (FTIMEMSE). It has the advantage to describe wave transformation from deep water to shallow water region in a large coastal area with numerical efficiency. The validity of the noise resistance for the measured uncertainty of the bathymetry is also studied. In addition, typical examples for waves propagating over an elliptic shoal rest on a horizontal and sloping bottom is presented. It is concluded that the FTIM is robust in the numerical stability and capable of against the noise of the measurement.
This paper is concerned with entire solutions of a class of bistable delayed lattice
differential equations with nonlocal interaction. Here an entire solution is meant by a
solution defined for all (n,t) ∈ ℤ × ℝ. Assuming that the equation has an
increasing traveling wave front with nonzero wave speed and using a comparison argument,
we obtain a two-dimensional manifold of entire solutions. In particular,
it is shown that the traveling wave fronts are on the boundary of the manifold.
Furthermore, uniqueness and stability of such entire solutions are studied.
In clinical practice, cam-out failure at the recess-screwdriver interfaces may occur when tightening or removing a bone screw. For titanium-based periarticular fixation, the literature reports have revealed that cold welding at the plate-screw interfaces makes the screw recess especially prone to cam-out failure during screw removal. In this study, the effects of the four recess shapes (cross, hexagon, star, and crest), three torque value (0.8, 1.0, and 1.2N-m), and the three interfacial misfits (0.00, 0.05, and 0.10mm) on the cam-out failure were numerically evaluated. The free-rotation angle, torque-recess angle, slippage-resisting length, and interfacial stress distribution were defined and chosen as comparison indices for the twelve recess-misfit variations. The results revealed that the interfacial slippage, torque transfer, and stress distribution are highly related to both recess shape and interfacial misfit. The stresses of all recesses and screwdrivers consistently initiate at the contact sites. However, the recess profile significantly affects the stress propagation. The stress patterns of the recess and screwdriver are quite different between the cross-star and hexagon-crest groups. The cross-star group is superior to the hexagon-crest group in terms of the torque-recess angle and slippage-resisting length over. This makes the recess of the cross-star group less stressed than its counterpart. However, the volumes of the cross and the star screwdriver are more highly stressed than the hexagon due to the irregular shape and the thinner flange, respectively. The greater torque and misfit increase the performance difference between the four recess designs. In conclusion, the geometry of the cross and star groups provide the better performance of the screw recess in terms of torque-transferring efficiency and slippage-resisting ability. If the screwdriver material is properly strengthened and the stress-concentrating corners are modified, the cross and star groups would be the optimal designs that protects and extends the lifetime of both recess and reused screwdriver.