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.
In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.
This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.
The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.
We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.
A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.
The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.
This Review describes the objectives and methodology of the DairyWater project as it aims to aid the Irish dairy processing industry in achieving sustainability as it expands. With the abolition of European milk quotas in March 2015, the Republic of Ireland saw a surge in milk production. The DairyWater project was established in anticipation of this expansion of the Irish dairy sector in order to develop innovative solutions for the efficient management of water consumption, wastewater treatment and the resulting energy use within the country's dairy processing industry. Therefore, the project can be divided into three main thematic areas: dairy wastewater treatment technologies and microbial analysis, water re-use and rainwater harvesting and environmental assessment. In order to ensure the project remains as relevant as possible to the industry, a project advisory board containing key industry stakeholders has been established. To date, a number of large scale studies, using data obtained directly from the Irish dairy industry, have been performed. Additionally, pilot-scale wastewater treatment (intermittently aerated sequencing batch reactor) and tertiary treatment (flow-through pulsed ultraviolet system) technologies have been demonstrated within the project. Further details on selected aspects of the project are discussed in greater detail in the subsequent cluster of research communications.
In this Research Communication we investigate the microbiological profile of 12 dairy wastewater streams from three contrasting Irish dairy processing factories to determine whether faecal indicators/pathogens were present and in turn, whether disinfection may be required for potential water reuse within the factory. Subsequently, the impact of suspended solids on the inactivation efficiency of Escherichia coli via two means of ultravoilet (UV) disinfection; flow-through pulsed UV (PUV) and continuous low pressure UV (LPUV) disinfection was analysed. Faecal indicators total coliforms and E. coli were detected in 10 out of the 12 samples collected at the dairy processing factories while pathogenic bacteria Listeria monocytogenes was detected in all samples collected at 2 out of the 3 factories. Salmonella spp. was undetected in all samples. The results also indicated that organic dairy wastewater solids had an impact on the performance efficiency of the PUV system and, to a lesser extent, the LPUV system. The findings indicate that the targeting of key pathogens would be required to enable wastewater reuse (and indeed effluent discharges if regulation continues to become more stringent) and that LPUV may offer a more robust disinfection method as it appears to be less susceptible to the presence of suspended solids.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Control of cucurbit pests, such as striped cucumber beetle (Acalymma vittatum), spotted cucumber beetle (Diabrotica undecimpunctata howardi) and squash bug (Anasa tristis), in organic systems is difficult due to a lack of effective insecticide options. This has led to the development of many integrated pest management techniques, such as use of row covers, crop rotation and cover crops. This study explored the novel use of strip tillage and row covers to reduce pest pressure in summer squash (Cucurbita pepe) and muskmelon (Cucumis melo) production systems. Results showed that although strip tillage reduced striped cucumber beetle and squash bug numbers, there was a yield reduction in both crops compared with the plasticulture system. Row cover increased marketable yield in both systems, with the highest yield being in the plasticulture system. Unmarketable fruit directly attributed to insect damage was higher in the plasticulture systems, but was not significantly different when compared with the strip tillage system. Although there are many documented positive attributes of strip tillage, results from this study indicate that a combination of plasticulture and row cover may be a superior system for organic cucurbit production.
Although high dose n-3 PUFA supplementation reduces exercise- and hyperpnoea-induced bronchoconstriction (EIB/HIB), there are concurrent issues with cost, compliance and gastrointestinal discomfort. It is thus pertinent to establish the efficacy of lower n-3 PUFA doses. Eight male adults with asthma and HIB and eight controls without asthma were randomly supplemented with two n-3 PUFA doses (6·2 g/d (3·7 g EPA and 2·5 g DHA) and 3·1 g/d (1·8 g EPA and 1·3 g DHA)) and a placebo, each for 21 d followed by 14 d washout. A eucapnic voluntary hyperpnoea (EVH) challenge was performed before and after treatments. Outcome measures remained unchanged in the control group. In the HIB group, the peak fall in forced expiratory volume in 1 s (FEV1) after EVH at day 0 (−1005 (sd 520) ml, −30 (sd 18) %) was unchanged after placebo. The peak fall in FEV1 was similarly reduced from day 0 to day 21 of 6·2 g/d n-3 PUFA (−1000 (sd 460) ml, −29 (sd 17) % v. −690 (sd 460) ml, −20 (sd 15) %) and 3·1 g/d n-3 PUFA (−970 (sd 480) ml, −28 (sd 18) % v. −700 (sd 420) ml, −21 (sd 15) %) (P<0·001). Baseline fraction of exhaled nitric oxide was reduced by 24 % (P=0·020) and 31 % (P=0·018) after 6·2 and 3·1 g/d n-3 PUFA, respectively. Peak increases in 9α, 11β PGF2 after EVH were reduced by 65 % (P=0·009) and 56 % (P=0·041) after 6·2 and 3·1 g/d n-3 PUFA, respectively. In conclusion, 3·1 g/d n-3 PUFA supplementation attenuated HIB and markers of airway inflammation to a similar extent as a higher dose. Lower doses of n-3 PUFA thus represent a potentially beneficial adjunct treatment for adults with asthma and EIB.
Increased summer ice velocities on the Greenland ice sheet are driven by meltwater input to the subglacial environment. However, spatial patterns of surface input and partitioning of meltwater between different pathways to the base remain poorly understood. To further our understanding of surface drainage, we apply a supraglacial hydrology model to the Paakitsoq region, West Greenland for three contrasting melt seasons. During an average melt season, crevasses drain ~47% of surface runoff, lake hydrofracture drains ~3% during the hydrofracturing events themselves, while the subsequent surface-to-bed connections drain ~21% and moulins outside of lake basins drain ~15%. Lake hydrofracture forms the primary drainage pathway at higher elevations (above ~850 m) while crevasses drain a significant proportion of meltwater at lower elevations. During the two higher intensity melt seasons, model results show an increase (~5 and ~6% of total surface runoff) in the proportion of runoff drained above ~1300 m relative to the melt season of average intensity. The potential for interannual changes in meltwater partitioning could have implications for how the dynamics of the ice sheet respond to ongoing changes in meltwater production.
Gut microbes have a substantial influence on systemic immune function and allergic sensitisation. Manipulation of the gut microbiome through prebiotics may provide a potential strategy to influence the immunopathology of asthma. This study investigated the effects of prebiotic Bimuno-galactooligosaccharide (B-GOS) supplementation on hyperpnoea-induced bronchoconstriction (HIB), a surrogate for exercise-induced bronchoconstriction, and airway inflammation. A total of ten adults with asthma and HIB and eight controls without asthma were randomised to receive 5·5 g/d of either B-GOS or placebo for 3 weeks separated by a 2-week washout period. The peak fall in forced expiratory volume in 1 s (FEV1) following eucapnic voluntary hyperpnoea (EVH) defined HIB severity. Markers of airway inflammation were measured at baseline and after EVH. Pulmonary function remained unchanged in the control group. In the HIB group, the peak post-EVH fall in FEV1 at day 0 (−880 (sd 480) ml) was unchanged after placebo, but was attenuated by 40 % (−940 (sd 460) v. −570 (sd 310) ml, P=0·004) after B-GOS. In the HIB group, B-GOS reduced baseline chemokine CC ligand 17 (399 (sd 140) v. 323 (sd 144) pg/ml, P=0·005) and TNF-α (2·68 (sd 0·98) v. 2·18 (sd 0·59) pg/ml, P=0·040) and abolished the EVH-induced 29 % increase in TNF-α. Baseline C-reactive protein was reduced following B-GOS in HIB (2·46 (sd 1·14) v. 1·44 (sd 0·41) mg/l, P=0·015) and control (2·16 (sd 1·02) v. 1·47 (sd 0·33) mg/l, P=0·050) groups. Chemokine CC ligand 11 and fraction of exhaled nitric oxide remained unchanged. B-GOS supplementation attenuated airway hyper-responsiveness with concomitant reductions in markers of airway inflammation associated with HIB.
Because horsenettle and tall ironweed are difficult to control in cool-season grass pastures, research was conducted in Tennessee and Kentucky in 2010 and 2011 to examine the efficacy of aminocyclopyrachlor on these weeds. Aminocyclopyrachlor was evaluated at 49 and 98 g ai ha−1 alone and in mixtures with 2,4-D amine at 371 and 742 g ae ha−1. Aminopyralid was also included as a comparison treatment at 88 g ai ha−1. Treatments were applied at three POST timings to horsenettle and two POST timings to tall ironweed. By 1 yr after treatment (YAT) horsenettle was controlled 74% with aminocyclopyrachlor plus 2,4-D applied late POST (LPOST) at 98 + 742 g ha−1. By 1 YAT, tall ironweed was controlled ≥ 93% by aminocyclopyrachlor applied early POST (EPOST) or LPOST, at rates as low as 49 g ha−1. Similar control was achieved with aminopyralid applied LPOST. Both aminocyclopyrachlor and aminopyralid were found to reduce horsenettle and tall ironweed biomass the following year. Moreover, all LPOST applications of aminocyclopyrachlor alone or in mixtures with 2,4-D prevented regrowth of tall ironweed at 1 YAT. Based on these studies, a LPOST herbicide application in August or September when soil moisture is adequate is recommended for control of horsenettle and tall ironweed in cool-season grass pastures.
The histories of chronicles composed in England during the fourteenth and fifteenth centuries and onwards, with a focus on texts belonging to or engaging with the Prose Brut tradition, are thefocus of this volume. The contributors examine the composition, dissemination and reception of historical texts written in Anglo-Norman, Latin and English, including the Prose Brut chronicle (c. 1300 and later), Castleford's Chronicle (c. 1327), and Nicholas Trevet's Les Cronicles (c. 1334), looking at questions of the processes of writing, rewriting, printing and editing history. They cross traditional boundaries of subject and period, taking multi-disciplinary approaches to their studies in order to underscore the (shifting) historical, social and political contexts inwhich medieval English chronicles were used and read from the fourteenth century through to the present day. As such, the volume honours the pioneering work of the late Professor Lister M. Matheson, whose research in this area demonstrated that a full understanding of medieval historical literature demands attention to both the content of the works in question and to the material circumstances of producing those works.
Jaclyn Rajsic is a Lecturer in Medieval Literature in the School of English and Drama at Queen Mary University of London; Erik Kooper taught Old and Middle English at Utrecht University; until his retirement in 2007; Dominique Hoche is an Associate Professor at West Liberty University in West Virginia.
Contributors: Elizabeth J. Bryan, Caroline D. Eckhardt, A.S.G. Edwards, Dan Embree, Alexander L. Kaufman, Edward Donald Kennedy, Erik Kooper, Julia Marvin, William Marx, Krista A. Murchison, Heather Pagan, Jaclyn Rajsic, Christine M. Rose, NeilWeijer