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Infectious diseases, such as Helicobacter pylori, which produce systemic inflammation may be one key factor in the onset of autoimmunity. The association between H. pylori and antinuclear antibodies (ANA), a marker of autoimmunity, has been understudied. Data from the 1999–2000 National Health and Nutrition Examination Survey were used to evaluate the cross-sectional association between H. pylori seroprevalence and ANA positivity in US adults aged ≥20 years. ANA was measured in a 1:80 dilution of sera by indirect immunofluorescence using HEp-2 cells (positive ⩾3). H. pylori immunoglobulin G enzyme-linked immunosorbent assays were used to categorise individuals as seropositive or seronegative. H. pylori seropositivity and ANA positivity were common in the adult US population, with estimated prevalences of 33.3% and 9.9%, respectively. Both were associated with increasing age. H. pylori seropositivity was associated with higher odds of ANA (prevalence odds ratio = 1.89, 95% confidence interval = 1.08–3.33), adjusted for age, sex, race/ethnicity, educational attainment and body mass index. H. pylori infection may be one key factor in the loss of self-tolerance, contributing to immune dysfunction.
Light Detection and Ranging (LiDAR) is a primary sensor for autonomous vehicles to recognize surroundings. It detects near-infrared (NIR) light pulses, typically at 905nm, which is emitted and reflected by surrounding objects. Here, the fact of the matter is that conventional black or dark-tone cars with extremely low NIR reflection are hard to be detected by LiDAR and endanger the future highway. In this work, we propose to use platelet-shaped effect pigments with visible absorption and NIR reflectivity. Copper(Ⅱ) oxide and Silicon dioxide multilayer are theoretically investigated with different numbers of layers and thicknesses. The optimized structures appear various dark-tone colors with high NIR-reflectivity over 90%.
The esophagus is approximately 25 cm in length and begins at the level of the C6 vertebra. The external landmark is the cricoid cartilage. It terminates 2–3 cm below the diaphragmatic hiatus, which corresponds to the T11 vertebra.
The esophagus is divided into three parts: cervical, thoracic, and intra-abdominal. The cervical esophagus begins approximately 15 cm from the upper incisors and is approximately 6 cm long. The thoracic esophagus begins approximately 23 cm from the incisors and is approximately 15 cm in length. The intra-abdominal esophagus begins approximately 38 cm from the incisors at the diaphragmatic hiatus and extends for 2–3 cm distally before becoming the gastric cardia.
The thoracic esophagus rests on the thoracic spine and the longus colli muscles. It passes posterior to the trachea, the tracheal bifurcation, the left main stem bronchus, and the left atrium. It descends to the right of the thoracic aorta and moves anterior to the aorta, just above the diaphragm (Figures 18.1a and 18.1b).
The azygos vein lies in front of the bodies of the lower thoracic vertebrae and to the right of the esophagus. At the level of the bifurcation of the trachea, it arches anteriorly to drain into the superior vena cava, just before it enters the pericardium.
The hemiazygos vein passes from the left side of the spine to the right, after crossing the spine and travelling behind the aorta, esophagus, and thoracic duct, to drain into the azygos vein.
The thoracic duct lies between the esophagus, the aorta, and the azygos vein before crossing over, just below the level of the tracheal bifurcation, to the left hemithorax, where it drains into the left subclavian vein.
The esophagus does not have a serosal layer. This increases the risk of anastomotic leaks.
The arterial and venous blood supply and drainage of the esophagus are segmental. The cervical esophagus is supplied by branches of the inferior thyroid artery. The upper thoracic esophagus is supplied by the inferior thyroid artery and an anterior esophagotracheal branch directly from the aorta. The middle and lower esophagus receives its arterial supply directly from the aorta via a bronchoesophageal branch. The lower esophagus and intra-abdominal esophagus portions are supplied by small branches from the left gastric artery and the left inferior phrenic artery.
The parasympathetic innervation of the esophagus is through the vagal nerves. The right and left recurrent laryngeal nerves ascend in the tracheoesophageal groove, giving off branches to both the trachea and the cervical and upper esophagus. The vagal nerves join with the fibers of the sympathetic chain to form the esophageal plexus. Together with the esophagus, the vagi pass through the diaphragm and continue along the lesser curvature of the stomach.
The sympathetic innervation comes from the cervical and thoracic sympathetic chains.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
On 24 May 1847, Sir John Franklin’s third expedition reported “All well”, but less than a year later, on 22 April 1848, the 129 sailors who had set out from Britain on Erebus and Terror had been reduced to 105 survivors departing their frozen ships in a desperate attempt to escape the Arctic. At least 24 were so unhealthy that they would perish after having travelled little more than 100 km from the ships. By contrast, the small mortality rates on other contemporary Arctic expeditions, some of which stayed in the Arctic considerably longer, were consistent with the mortality rates in the Royal Navy worldwide. This paper explores the question of what difference caused so many of Franklin’s crew to die during their final months on-board the ships and in the initial stages of the escape attempt. From the perspective of cultural ecology, the most significant difference, and the ultimate cause of the catastrophe as it unfolded, was wintering in the ice pack. This distinguished the Franklin expedition from all of the other comparable overwintering expeditions, and precluded the Erebus and Terror crews from hunting or fishing. That in turn led to nutritional deficiencies due to much greater reliance on stored provisions than other expeditions.
We construct links of arbitrarily many components each component of which is slice and yet are not concordant to any link with even one unknotted component. The only tool we use comes from the Alexander modules.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Introduction: Geriatric patients commonly present to the emergency department (ED) after a fall. Unfortunately, recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric falls guidelines. This study applied a theoretical domains framework (TDF)-driven approach to systematically investigate barriers and enablers in the provision of guideline-based care to older patients presenting to the ED with a fall. Methods: From June to September 2017, semi-structured interviews of staff ED physicians practicing in Ontario, Canada were conducted and analyzed. An interview guide based on the TDF was used to capture 14 domains that may influence provision of guideline-based care. Interview transcripts were analyzed, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs, and evidence of strong beliefs that would influence provision of guideline-based care. Results: Eleven interviews were conducted with practicing ED physicians. Thirty specific belief statements across 13 different TDF domains (all except Optimism) were identified as relevant. Overall, Ontario ED physicians are supportive of providing guideline-based care and believe it would lead to better outcomes for geriatric falls patients. Important barriers include knowledge, skills, time and workload constraints, and inconsistent allied health support. Conclusion: This study identified important barriers and enablers to provision of guideline-based care in geriatric ED falls patients. These results will help guide implementation of guidelines nationally and internationally, with a focus on improved knowledge dissemination, implementation of training interventions, and improvements in allied health coverage and supports.
Cast iron objects recovered primarily in eastern Mongolia, spanning the Xiongnu through the Early Historic periods (ca. 3rd BC–AD 17th century), were examined for their radiocarbon (14C) concentration and microstructure. Most of the samples examined were found to have originated from charcoal-based smelting with a few exceptions that were made using a mineral coal-based technique. A comparison of 14C dates with dates derived from artifact typology allowed the charcoal-smelted objects to be classified into two groups, based on whether the radiometric and typological periodization are in agreement or not. In addition, those with differing 14C and typological dates can be divided into two subgroups with and without evidence for a melt treatment applied after original casting. These conflicting dating results are confusing and would seem to provoke skepticism about the use of 14C measurements for dating iron artifacts. We demonstrate however that 14C analysis, when combined with metallographic examination and other lines of chronological evidence, can clarify the history of a given iron object and its multiple users, often separated in time by more than a millennium.
In June 2012, the Botswana Ministry of Health and Wellness (MOHW; Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system in response to significant morbidity and mortality associated with prehospital emergencies. The MOHW requested external expertise to train its developing workforce. Simulation-based training was planned to equip these health care providers with clinical knowledge, procedural skills, and communication techniques.
The objective of this study was to assess the educational needs of the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook review and EMS provider feedback to guide development of a novel educational curriculum.
Data were abstracted from a representative sample of the Gaborone, Botswana MOHW EMS response log from 2013-2014 and were quantified into the five most common call types for both adults and children. Informal focus groups with health professionals and EMS staff, as well as surveys, were used to rank common response call types and self-perceived educational needs.
Based on 1,506 calls, the most common adult response calls were for obstetric emergencies, altered mental status, gastrointestinal/abdominal pain, trauma, gynecological emergencies, and cardiovascular and respiratory distress-related emergencies. The most common pediatric response calls were for respiratory distress, gastrointestinal complaints/dehydration, trauma and musculoskeletal injuries, newborn delivery, seizures, and toxic ingestion/exposure. The EMS providers identified these same chief complaints as priorities for training using the qualitative approach. A locally relevant, simulation-based curriculum for the Botswana MOHW EMS system was developed and implemented based on these data.
: Trauma, respiratory distress, gastrointestinal complaints, and puerperal/perinatal emergencies were common conditions for all age groups. Other age-specific conditions were also identified as educational needs based on epidemiologic data and provider feedback. This needs assessment may be useful when designing locally relevant EMS curricula in other low-income and middle-income countries.GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM, GalapiC, ParkesPS, KumarS, LabaB.Needs Assessment for Simulation Training for Prehospital Providers in Botswana. Prehosp Disaster Med. 2018;33(6):621–626.
We observed a bright H II complex, Hubble V in NGC 6822, using the high-resolution near-infrared spectrograph IGRINS (R = 45,000) attached on the 2.7 m telescope at the McDonald Observatory. We carried out a spectral mapping over a 15″ × 18″ region in the H and K bands using a slit-scanning technique. The emission lines Brγ and He i from ionized regions as well as molecular hydrogen lines from photo-dissociation regions (PDRs), were detected. We show three-dimensional maps of the emission lines and discuss the possibility of an expanding hot bubble structure within which many ionized components are around the central stellar cluster.
Outpatient parenteral antimicrobial therapy (OPAT) programmes facilitate hospital discharge, but patients remain at risk of complications and consequent healthcare utilisation (HCU). Here we elucidated the incidence of and risk factors associated with HCU in OPAT patients. This was a retrospective, single-centre, case–control study of adult patients discharged on OPAT. Cases (n = 63) and controls (n = 126) were patients that did or did not utilise the healthcare system within 60 days. Characteristics associated with HCU in bivariate analysis (P ≤ 0.2) were included in a multivariable logistic regression model. Variables were retained in the final model if they were independently (P < 0.05) associated with 60-day HCU. Among all study patients, the mean age was 55 ± 16, 65% were men, and wound infection (22%) and cellulitis (14%) were common diagnoses. The cumulative incidence of 60-day unplanned HCU was 27% with a disproportionately higher incidence in the first 30 days (21%). A statin at discharge (adjusted odds ratios (aOR) 0.23, 95% confidence intervals (CIs) 0.09–0.57), number of prior admissions in past 12 months (aOR 1.48, 95% CIs 1.05–2.10), and a sepsis diagnosis (aOR 4.62, 95% CIs 1.23–17.3) were independently associated with HCU. HCU was most commonly due to non-infection related complications (44%) and worsening primary infection (31%). There are multiple risk factors for HCU in OPAT patients, and formal OPAT clinics may help to risk stratify and target the highest risk groups.