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.
ABSTRACT IMPACT: Our results reveal a limited amount of breast cancer survivorship print materials as both understandable and actionable, and indicate a need to supplement material with personalized teaching. OBJECTIVES/GOALS: Using educational print material for young women breast cancer survivors (YBCS) is considered a best practice in patient teaching. Little is known about how well YBCS understand or act upon the material. The purpose of this study was to assess the understandability and actionability of commonly distributed breast cancer survivorship print materials. METHODS/STUDY POPULATION: We used an environmental scan approach to obtain breast cancer survivorship print materials available in eight outpatient oncology clinics and one electronic medical record used in a Midwestern state. Print materials were included if they were freely available to patients, were specific to breast cancer, provided detailed information about survivorship, and were directly given to patients by physicians or nurses. Print materials were excluded if topics were related to treatment, diagnosis, or prevention. All brochures, drug advertisements, and advertisements for support services were excluded. The understandability and actionability analyses of the breast cancer survivorship print materials were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). RESULTS/ANTICIPATED RESULTS: The environmental scan resulted in 82 individual print materials. After applying the inclusion and exclusion criteria, eight breast cancer survivorship print materials were included in the final sample. The final sample included two books, two patient education handouts from the electronic medical record, two multi-page booklets, and two pamphlets. The overall mean understandability score of the print materials was 68.9% ? 11.3 with a range of 47% to 80%. Five materials scored above the recommended 70% in understandability. The overall mean actionability score of the print materials was much higher at 81.3% ? 21.6 with a range of 67% to 100%. Five materials scored above 70% in actionability. However, only three of the eight materials scored above the recommended 70% in both understandability and actionability. DISCUSSION/SIGNIFICANCE OF FINDINGS: Limited breast cancer survivorship print materials exist as both understandable and actionable. Personalized instruction provided by oncology team members may be indicated to supplement the material. This additional teaching may help ensure survivors comprehend messages and act upon specific tasks as indicated in survivorship print material.
Toxoplasma gondii infections are common in humans and animals worldwide. Wild and domestic avian species are important in the epidemiology of T. gondii infections because felids prey on them and excrete millions of oocysts in the environment, disseminating the infection. Herbivorous birds are also excellent sentinels of environmental contamination with T. gondii oocysts because they feed on the ground. Toxoplasma gondii infections in birds of prey reflect infections in intermediate hosts. Humans can become infected by consuming undercooked avian tissues. Here, the authors reviewed prevalence, persistence of infection, clinical disease, epidemiology and genetic diversity of T. gondii strains isolated from turkeys, geese, ducks, ratites and avian species (excluding chickens) worldwide 2009–2020. Genetic diversity of 102 T. gondii DNA samples isolated worldwide is discussed. The role of migratory birds in dissemination of T. gondii infection is discussed.
Based on an accurate numerical solution of the kinetic equation using well-resolved spatial and velocity grids, the separation of rarefied gas flow in a microchannel with double rectangular bends is investigated over a wide range of Knudsen and Reynolds numbers. Rarefaction effects are found to play different roles in flow separation (vortex formation) at the concave and convex corners. Flow separations near the concave and convex corners are only observed for a Knudsen number up to
, respectively. With further increase of the Knudsen number, flow separation disappears. Due to the velocity slip at the solid walls, the concave (convex) vortex is suppressed (enhanced), which leads to the late (early) onset of separation of rarefied gas flows with respect to the Reynolds number. The critical Reynolds numbers for the emergence of concave and convex vortices are found to be as low as
, respectively. The slip velocity near the concave (convex) corner is found to increase (decrease) when the Knudsen number increases. An adverse pressure gradient appears near the concave corner for all the examined Knudsen numbers, while for the convex corner it only occurs when the Knudsen number is less than
. Due to the secondary flow and adverse pressure gradient near the rectangular bends, the mass flow rate ratio between the bent and straight channels of the same length is a non-monotonic function of the Knudsen number. Our results clarify the diversified and often contradictory observations reported in the literature about flow rate enhancement and vortex formation in bent microchannels.
Toxoplasma gondii infections are common in humans and animals worldwide. Domestic free-range chickens (Gallus domesticus) are excellent sentinels of environmental contamination with T. gondii oocysts because they feed on the ground. Chickens can be easily infected with T. gondii; however, clinical toxoplasmosis is rare in these hosts. Chickens are comparatively inexpensive and thus are good sentinel animals for T. gondii infections on the farms. Here, the authors reviewed prevalence, the persistence of infection, clinical disease, epidemiology and genetic diversity of T. gondii strains isolated from chickens worldwide for the past decade. Data on phenotypic and molecular characteristics of 794 viable T. gondii strains from chickens are discussed, including new data on T. gondii isolates from chickens in Brazil. This paper will be of interest to biologists, epidemiologists, veterinarians and parasitologists.
Fluid motion has two well-known fundamental processes: the vector transverse process characterized by vorticity, and the scalar longitudinal process consisting of a sound mode and an entropy mode, characterized by dilatation and thermodynamic variables. The existing theories for the sound mode involve the multi-variable issue and its associated difficulty of source identification. In this paper, we define the source of sound inside the fluid by the objective causality inherent in dynamic equations relevant to a longitudinal process, which naturally favours the material time-rate operator
rather than the local time-rate operator
, and describes the sound mode by inhomogeneous advective wave equations. The sources of sound physical production inside the fluid are then examined at two levels. For the conventional formulation in terms of thermodynamic variables at the first level, we show that the universal kinematic source can be condensed to a scalar invariant of the surface deformation tensor. Further, in the formulation in terms of dilatation at the second level, we find that the sound mode in viscous and heat-conducting flow has sources from rich nonlinear couplings of vorticity, entropy and surface deformation, which cannot be disclosed at the first level. Preliminary numerical demonstration of the theoretical findings is made for two typical compressible flows, i.e. the interaction of two corotating Gaussian vortices and the unsteady type IV shock/shock interaction. The results obtained in this study provide a new theoretical basis for, and physical insight into, understanding various nonlinear longitudinal processes and the interactions therein.
Electroconvulsive therapy (ECT) involves the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp to induce a seizure for therapeutic purposes. In 2001, the American Psychiatric Association (APA) task force on ECT concluded that convincing data exists to support use for major depression, bipolar depression and mania, schizophrenia, and schizoaffective and schizophreniform disorders. However, the National Institute for Clinical Excellence in the UK (NICE 2003) does not recommend that ECT be used as a long-term treatment to prevent recurrence of depressive illness, and that it recommends that ECT should not be used in the general management of schizophrenia.
To review and describe the practice of ECT in the largest psychiatric hospital in Singapore.
This was a retrospective descriptive study performed on all patients who were administered electroconvulsive therapy at the Institute of Mental Health in Singapore during the 2-year study period of 1st July 2005 – 30th June 2007. Data was collected from existing medical records on the demographics, indications, frequency and the complications of the patients given ECT. The frequency of missed fits was also determined as measuring the number of missed-fits provided one way of assessing an ECT clinic's efficiency.
The main indications for electroconvulsive therapy at the Institute of Mental Health in Singapore were patients with Schizophrenia or Schizoaffective Disorders with poor response to medications, followed by patients with mood disorders. The rate of complications of ECT and the frequency of missed-fits were found to be low.
With the widespread of atypical antipsychotics used among children and adolescents, the treatment effectiveness has been of great interest alongside with the efficacy and safety in this population. The study was designed to assess whether second-generation antipsychotics (SGAs) are associated with lower service costs in the real world. Factors associated with service costs were also examined.
The claim data (PIMC) of 1996-2008 from the National Insurance Plan of Taiwan was used. Patients aged less than 20 with an incident use of antipsychotics and last for 12 months during this period were included for analysis. Comparisons were made between 8 SGAs and 2 first-generation antipsychotics (FGAs). Changes in service costs were examined with 95% confidence interval. Multivariate regressions with propensity scores adjustment were performed to explore factors associated with psychiatric service costs.
A total of 343 treatment encounters were included and results showed no difference in psychiatric services costs in the SGAs group as the total service costs were offset to high antipsychotics costs of SGAs, though antiparkinsonian costs were not different between two groups. Factor positively associated with service costs were relapse (RR=4.0, p< 0.0001) and EPS incidence (RR=1.6, p< 0.008), while types of antipsychotics and diagnoses were not significant factors after adjusting for covariates.
Service costs were not different between FGAs and SGAs groups and medication costs were significantly higher in the SGAs group. Relapse and EPS incidence were factors of high costs among children and adolescents psychiatric patients treated with antipsychotics in Taiwan.
To assess the role of white-tailed deer (Odocoileus virginianus, WTD) in the epidemiology of toxoplasmosis, we conducted a national survey of WTD across the USA for Toxoplasma gondii infection. To do this, we combined serology with parasite isolation to evaluate the prevalence and genetic diversity of T. gondii in this game species. From October 2012 to March 2019, serum and tissues were collected from 914 WTD across the USA. Serum samples were screened for antibodies to T. gondii, and then the tissues of seropositive WTD were bioassayed in mice. Antibodies were detected in 329 (36%) of 914 WTD tested by the modified agglutination test (positive reaction at 1:25 or higher). Viable T. gondii was isolated from the heart of 36 WTD from 11 states. Three of the 36 isolates were pathogenic but not highly virulent to outbred Swiss Webster mice and all 36 isolates could be propagated further in cell culture and were genotyped. For genotyping, DNA extracted from cell culture-derived tachyzoites was characterized by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using the genetic markers SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico. Genotyping revealed seven ToxoDB PCR-RFLP genotypes, including 24 isolates for genotype #5 (haplogroup 12), four isolates for #2 (type III, haplogroup 3), three isolates for genotypes #1 (type II, haplogroup 2), two isolates for genotypes #3 (type II, haplogroup 2) and one isolate each for #39, #221 and #224. Genotype #5 was the most frequently isolated, accounting for 66.6% (24 of 36) of the isolates. Combining the 36 isolates from this study with previously reported 69 isolates from WTD, 15 genotypes have been identified. Among these, 50.4% (53/105) isolates belong to genotype #5. Our results indicate moderate genetic diversity of T. gondii in WTD. The results also indicate that undercooked venison should not be consumed by humans or fed to cats.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
The Murchison Widefield Array (MWA) is an open access telescope dedicated to studying the low-frequency (80–300 MHz) southern sky. Since beginning operations in mid-2013, the MWA has opened a new observational window in the southern hemisphere enabling many science areas. The driving science objectives of the original design were to observe 21 cm radiation from the Epoch of Reionisation (EoR), explore the radio time domain, perform Galactic and extragalactic surveys, and monitor solar, heliospheric, and ionospheric phenomena. All together
programs recorded 20 000 h producing 146 papers to date. In 2016, the telescope underwent a major upgrade resulting in alternating compact and extended configurations. Other upgrades, including digital back-ends and a rapid-response triggering system, have been developed since the original array was commissioned. In this paper, we review the major results from the prior operation of the MWA and then discuss the new science paths enabled by the improved capabilities. We group these science opportunities by the four original science themes but also include ideas for directions outside these categories.
Feral swine are known reservoirs of various pathogens, including Toxoplasma gondii. Here, we report the first national survey of viable T. gondii in feral swine in the USA. We paired serological surveys with parasite isolation and bioassay to evaluate the prevalence and genetic diversity of these parasites. From 2012–2017, sera and tissues from 1517 feral swine across the USA were collected for the isolation of viable T. gondii. Serum samples were initially screened for antibodies to T. gondii, and then the tissues of seropositive feral swine were bioassayed in mice. Antibodies were detected in 27.7% of feral swine tested by the modified agglutination test (1:25 or higher). Antibody positive rates increased significantly with age, with 10.1% of juveniles, 16.0% of sub-adults and 38.4% of adults testing seropositive. Myocardium (50 g) from 232 seropositive feral swine was digested in pepsin and bioassayed in mice. Viable T. gondii was isolated from 78 feral swine from 21 states. Twelve of the 78 isolates were pathogenic to outbred Swiss Webster mice and 76 of the 78 isolates could be propagated further in cell culture and were genotyped. For genotyping, deoxyribonucleic acid extracted from cell culture-derived tachyzoites was characterized by polymerase chain reaction restriction fragment length polymorphism using the genetic markers SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico. Genotyping revealed 15 ToxoDB genotypes, including 43 isolates for genotype #5 (haplogroup 12), 11 isolates for #24, four isolates for #2 (haplogroup 3), two isolates for each of genotypes #3 (haplogroup 2), #4 (haplogroup 12), #216, #221, #289 and #297 and one isolate for each of genotypes #1 (haplogroup 2), #39, #66, #260, #261 and #299. Genotype #5 was the most frequently isolated, accounted for 57% (43/76) of the isolates, followed by #24, accounted for 14% (11/76). Genotypes #260, #289, #297 and #299 are new types. Genotype #289 was highly virulent to mice and originated from feral swine collected in Louisiana on the same day at the same location. Genotype #216 was previously demonstrated to be highly virulent to mice. Our results indicate moderate genetic diversity of T. gondii in feral swine in the USA, with the genotype #5 (haplogroup 12) dominant in the continental USA, whereas genotype #24 (10/14) was dominant in Hawaii, suggesting different population structures of the parasites among the two distinct geographical locations.
Precise bone cut is fundamental in total knee arthroplasty. However, notching of anterior femoral is not uncommon in clinical practice. Reviewing the article, notching and its complication may reach up to 30% and 2.5%, and there is scanty study of notching on the femoral strength. We therefore conduct the finite element analysis to elucidate the effect of notching on femoral mechanical strength. The computerized tomography images were used as the basis to develop the knee model, which was assumed mainly to consist of cortical and cancellous bones. For the implant joint, Zimmer data was considered partly as the basis to develop the model. This study investigated the femoral improper cut effect on the surgery with a static standing condition. The results show that the anterior femoral cut should be undercut 2 mm to overcut 1 mm during the surgery, in order to prevent bone materials from yielding. The exposure of the cancellous bone may cause bone materials to yield when the femur overcut was 2 mm; the cancellous bone may load too much and result in a fracture when the undercut was 3 mm. The effect of undercut, which was rarely discussed, was particularly addressed in our study. Precise femoral cut is crucial for the longevity of total knee arthroplasty.
Thermosonic wire bonding is a common fabrication process for connecting devices in electronic packaging. However, when the free air ball (FAB) is compressed onto the I/O pad of the chip during bonding procedure, chip cracking may occur if the contact pressure is too large. This study proposes an effective simulation technique that can predict the wire ball geometry after bonding in an accurate range. The contact force obtained in the simulation can be used for possible die cracking behavior evaluation. The simulation in this study used the explicit time integration scheme to deal with the time marching problem, and the second-order precision arbitrary Lagrangian-Eulerian (ALE) algorithm was used to deal with the large deformation of the wire ball during the bonding process. In addition, the equilibrium smoothing algorithm in LS-DYNA can make the contact behavior and geometry of the bonding wire almost the same as the experiment, which can also significantly reduce the distortion of the mesh geometry after remeshing.
Planetary material in the atmospheres of white dwarfs is thought to be scattered inwards from outer planetary systems. Dusty emission in the infrared traces the accretion. As the scattering of many small asteroids is a stochastic process, variability in the infrared emission is predicted. We report a 3 year near-infrared (J, H and K) monitoring campaign of 34 dusty, polluted white dwarfs which aims to search for dust emission variability. We find all white dwarfs have consistent near-infrared fluxes, implying the excess emission is stable. This suggests tidal disruption events which lead to large variabilities are rare and quick (<1 year) and become stable within a few years. For WD 0408–041, the system that shows both increases and decreases in dust emission over 11 years, our K band data suggest a potential colour change associated with the dust emission that needs further confirmation.
Genetic predispositions play an important role in the development of internalizing and externalizing behaviors. Understanding the mechanisms through which genetic risk unfolds to influence these developmental outcomes is critical for developing prevention and intervention efforts, capturing key elements of Irv's research agenda and scientific legacy. In this study, we examined the role of parenting and personality in mediating the effect of genetic risk on adolescents’ major depressive disorder and conduct disorder symptoms. Longitudinal data were drawn from a sample of 709 European American adolescents and their mothers from the Collaborative Studies on Genetics of Alcoholism. Results from multivariate path analysis indicated that adolescents’ depressive symptoms genome-wide polygenic scores (DS_GPS) predicted lower parental knowledge, which in turn was associated with more subsequent major depressive disorder and conduct disorder symptoms. Adolescents’ DS_GPS also had indirect effects on these outcomes via personality, with a mediating effect via agreeableness but not via other dimensions of personality. Findings revealed that the pattern of associations was similar across adolescent gender. Our findings emphasize the important role of evocative gene–environment correlation processes and intermediate phenotypes in the pathways of risk from genetic predispositions to complex adolescent outcomes.
The regular solar observations are operated at Huairou Solar Observing Station (HSOS) since 1987, which make the construction of long-term magnetic field datasets available to understand solar magnetic field and cycles. There exist some inconveniences for solar physicist to use these data, because the data storage medium and format at HSOS experienced some changes. Additionally, the processes of magnetic field calibration are not easy to deal with for who are not familiar with these data. Here shows that the magnetic field of HSOS are further processed toward international standards, in order to explore HSOS observations data for scientific research.
The earlier work on the oscillatory phenomena in sunspot structures have supported in validating the detection of long-period oscillations, which are generated by the photospheric umbral response to the five minute p-mode global oscillations. We report here on the events of 3- min umbral oscillations which are detected within a duration of one hour from a single-polarity sunspot of active region NOAA 12132. The umbral oscillations that appear first around umbral boundaries is speculated to be excited by the wavefronts at the umbral-penumbral boundaries due to sub-photospheric or photospheric granular buffetings. The appearance of the wavefronts in spiral structures suggests that the wave guides are twisted. In addition, the newly formed running penumbral waves (RPWs) appears to be connected with the preceding RPWs.
To characterise multi-level obstruction in terms of prevalence, obstructive sleep apnoea severity and predictive factors, and to collect epidemiological data on upper airway morphology in obstructive sleep apnoea patients.
Retrospective review of 250 obstructive sleep apnoea patients.
On clinical examination, 171 patients (68.4 per cent) had multi-level obstruction, 49 (19.6 per cent) had single-level obstruction and 30 (12 per cent) showed no obstruction. Within each category of obstructive sleep apnoea severity, multi-level obstruction was more prevalent. Multi-level obstruction was associated with severe obstructive sleep apnoea (more than 30 events per hour) (p = 0.001). Obstructive sleep apnoea severity increased with the number of obstruction sites (correlation coefficient = 0.303, p < 0.001). Multi-level obstruction was more likely in younger (p = 0.042), male (p = 0.045) patients, with high body mass index (more than 30 kg/m2) (p < 0.001). Palatal (p = 0.004), tongue (p = 0.026) and lateral pharyngeal wall obstructions (p = 0.006) were associated with severe obstructive sleep apnoea.
Multi-level obstruction is more prevalent in obstructive sleep apnoea and is associated with increased severity. Obstruction at certain anatomical levels contributes more towards obstructive sleep apnoea severity.