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In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response.
An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response.
Setting and Participants:
The survey was distributed to site representatives from the 56 originally designated ETCs; 37 (66%) responded.
Data were coded and analyzed using descriptive statistics.
Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols).
Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.
Formation of a low barrier back contact plays a critical role in improving the photoconversion efficiency of the CdTe solar cells. Incorporating a buffer layer to minimize the band bending at the back of the CdTe device can significantly lower the barrier for the hole current, improving open circuit voltage (VOC) and the fill factor. Over the past years, researchers have incorporated the both ZnTe and Te as buffer layers to improve CdTe device performance. Here we compare device performance using these two materials as buffer layers at the back of CdTe devices. We show that using Te in contact to CdTe results in higher performance than using ZnTe in contact to the CdTe. Low temperature current density-voltage measurements show that Te results is a lower barrier with CdTe than ZnTe, indicating that Te has better band alignment, resulting in less downward bending in the CdTe at the back interface, than ZnTe does.
The timing in which supplements are provided in grazing systems can affect dry matter (DM) intake and productive performance. The objective of this study was to evaluate the effect of timing of corn silage supplementation on ingestive behaviour, DM intake, milk yield and composition in grazing dairy cows. In total, 33 Holstein dairy cows in a randomized block design grazed on a second-year mixed grass–legume pasture from 0900 to 1500 h and received 2.7 kg of a commercial supplement at each milking. Paddock sizes were adjusted to provide a daily herbage allowance of 15 kg DM/cow determined at ground level. The three treatments imposed each provided 3.8 kg DM/day of corn silage offered in a single meal at 0800 h (Treatment AM), equally distributed in two meals 0800 and 1700 h (Treatment AM-PM) or a single meal at 1700 h (Treatment PM). The experiment was carried out during the late autumn and early winter period, with 1 week of adaptation and 6 weeks of measurements. There were no differences between treatments in milk yield, but 4% fat-corrected milk yield tended to be greater in AM-PM than in AM cows, which did not differ from PM (23.7, 25.3 and 24.6±0.84 kg/day for AM, AM-PM and PM, respectively). Fat percentage and yield were greater for AM-PM than for AM cows and intermediate for PM cows (3.89 v. 3.66±0.072% and 1.00 v. 0.92±0.035 kg/day, respectively). Offering corn silage in two meals had an effect on herbage DM intake which was greater for AM-PM than AM cows and was intermediate in PM cows (8.5, 11.0 and 10.3±0.68 kg/day for AM, AM-PM and PM, respectively). During the 6-h period at pasture, the overall proportion of observations on which cows were grazing tended to be different between treatments and a clear grazing pattern along the grazing session (1-h observation period) was identified. During the time at pasture, the proportion of observations during which cows ruminated was positively correlated with the DM intake of corn silage immediately before turn out to pasture. The treatment effects on herbage DM intake did not sufficiently explain differences in productive performance. This suggests that the timing of the corn silage supplementation affected rumen kinetics and likewise the appearance of hunger and satiety signals as indicated by observed changes in temporal patterns of grazing and ruminating activities.
Hemihedrite from the Florence Lead-Silver mine in Pinal County, Arizona, USA was first described and assigned the ideal chemical formula Pb10Zn(CrO4)6(SiO4)2F2, based upon a variety of chemical and crystal-structure analyses. The primary methods used to determine the fluorine content for hemihedrite were colorimetry, which resulted in values of F that were too high and inconsistent with the structural data, and infrared (IR) spectroscopic analysis that failed to detect OH or H2O. Our reinvestigation using electron microprobe analysis of the type material, and additional samples from the type locality, the Rat Tail claim, Arizona, and Nevada, reveals the absence of fluorine, while the presence of OH is confirmed by Raman spectroscopy. These findings suggest that the colorimetric determination of fluorine in the original description of hemihedrite probably misidentified F due to the interferences from PO4 and SO4, both found in our chemical analyses. As a consequence of these results, the study presented here proposes a redefinition of the chemical composition of hemihedrite to the ideal chemical formula Pb10Zn(CrO4)6(SiO4)2(OH)2. Hemihedrite is isotypic with iranite with substitution of Zn for Cu, and raygrantite with substitution of Cr for S. Structural data from a sample from the Rat Tail claim, Arizona, indicate that hemihedrite is triclinic in space group P1, a = 9.4891(7), b = 11.4242(8), c = 10.8155(7) Å, α = 120.368(2)°, β = 92.017(3)°, γ = 55.857(2)°, V = 784.88(9) Å3, Z= 1, consistent with previous investigations. The structure was refined from singlecrystal X-ray diffraction data to R1 = 0.022 for 5705 unique observed reflections, and the ideal chemical formula Pb10Zn(CrO4)6(SiO4)2(OH)2 was assumed during the refinement. Electron microprobe analyses of this sample yielded the empirical chemical formula Pb10.05(Zn0.91Mg0.02)∑ = 0.93(Cr5.98S0.01P0.01)∑ = 6.00 Si1.97O34H2.16 based on 34 O atoms and six (Cr + S + P) per unit cell.
To identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.
Retrospective, cross-sectional study.
Large urban academic medical center hospital.
A total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.
An electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.
The best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.
A simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.
Marriage is known to be associated with improved mental health, but little research has examined whether the duration of a cohabiting relationship is associated with mental health.
To examine the associations between relationship duration and mental health problems in a birth cohort of 30-year-olds.
Associations between relationship duration and mental health were examined using a generalised estimating equation approach. Associations were adjusted for covariates, including prior mental health problems.
Longer relationship duration was significantly associated with lower rates of depression, suicidal behaviour and substance abuse/dependence, even after adjustment for covariates. In most cases the associations did not vary with gender. Legal relationship status (legally or de facto married) was not significantly related to mental health once due allowance was made for relationship duration.
Increasing relationship duration, but not legal relationship status, has a protective effect on mental health for men and women.
Psychiatric disorders are common during young adulthood and comorbidity is frequent. Individual psychiatric disorders have been shown to be associated with negative economic and educational outcomes, but few studies have addressed the relationship between the total extent of psychiatric disorder and life outcomes.
To examine whether the extent of common psychiatric disorder between ages 18 and 25 is associated with negative economic and educational outcomes at age 30, before and after controlling for confounding factors.
Participants were 987 individuals from the Christchurch Health and Development Study, a longitudinal study of a birth cohort of individuals born in Christchurch, New Zealand, in 1977 and followed to age 30. Linear and logistic regression models were used to examine the associations between psychiatric disorder from age 18 to 25 and workforce participation, income and living standards, and educational achievement at age 30, before and after adjustment for confounding factors.
There were significant associations between the extent of psychiatric disorder reported between ages 18 and 25 and all of the outcome measures (all P<0.05). After adjustment for confounding factors, the associations between psychiatric disorder and workforce participation, income and living standards remained significant (all P<0.05), but the associations between psychiatric disorder and educational achievement were not significant (all P>0.10).
After due allowance had been made for a range of confounding factors, psychiatric disorder between ages 18 and 25 was associated with reduced workforce participation, lower income and lower economic living standards at age 30.
Self-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.
To examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.
Randomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.
After adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.
The postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.