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 email@example.com
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.
To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease.
A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection.
Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment.
New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.
Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.
Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.
Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.
This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
Background: With advancements in technology, the use of video as a pedagogical method in medical education has gained in popularity, and may aid in teaching clinical skills. In the UBC MD program, videos have been used to assist in teaching the -neurological exam for several decades, but the currently available videos are outdated and not of contemporary quality. Methods: Drawing upon the cognitive theory of multimedia learning from Mayer and Moreno (2003) which describes methods to maximize learning by minimizing cognitive load, we developed a tool to systematically assess pedagogical videos. We inventoried twelve existing neurology videos and analyzed their use of methods such as weeding (removing extraneous information), signalling (visually highlighting important information), and chunking (grouping similar information together). Results: Generally, older videos had poor audiovisual quality that introduced extraneous load, while more current videos had higher production value, albeit inconsistent with the depth of their content. We therefore produced a new three-part neurological exam video series. We wrote storyboards, filmed with a focus on visually depicting the exam and findings, and edited to elucidate relevant physiological concepts. Conclusions: The end product has been adopted by the UBC MD program, and can be shared with other programs who may wish to adopt them.
Background: Previously-identified deficiencies in stroke training for emergency and internal medicine trainees led us to develop a competency-based curriculum for a stroke rotation, based upon entrusbable professional activities (EPAs). EPAs are observable and measurable activities that are routine care within a given medical specialty. Methods: We surveyed stroke- and non-stroke neurologists using a modified Delphi process with two iterations. The survey sought input on the number and nature of EPAs considered most important and achievable during a one month stroke rotation. Results: Surveyed neurologists considered 5-10 EPAs as adequate and reasonable to achieve during a one month elective. A list of the most essential EPAs was obtained and will be used as the basis of a curriculum for rotating residents in Internal and Emergency medicine at the Island Medical Program in Victoria, BC. Conclusions: Our work highlights an approach to meeting an identified gap in resident training in an important area of neurology (stroke). A competency based approach to medical education, focusing on EPAs, offers an innovative way of approaching resident education that seeks to ensure residents develop skills that experts in the field have identified as most essential for the work at hand (in this case, the proper management of stroke patients).
The Birmingham Hip Resurfacing procedure (BHR) is metal-on-metal resurfacing procedure for hip arthritis. BHR was associated with low risk of surgical site infection (SSI; 0.6%). In addition to antimicrobials, superficial SSIs were treated with incision and drainage, whereas deep incisional or organ-space SSIs required removal of prosthesis.
This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.
A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.
Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.
These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.
To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).
Prospective cohort study from February 2009 to October 2009.
Eleven teaching hospitals.
One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.
Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%—4.9%) and with all 5 components (31.5%—6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84—55.54]; P = .008) associated with increasing burden of isolation.
As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
Sharp-tail sunfish (Masturus lanceolatus) occurrence in Indian seas is uncommon and its taxonomy is still in controversy. The species was hooked in a sub-surface long-line during an exploratory survey for oceanic tuna and allied fish within the Indian exclusive economic zone in the Lakshadweep Sea along the west coast of India by survey ship MFV ‘Yellow Fin’ attached to the Fishery Survey of India, Mormugoa, Goa, India. It is reported to be the first Masturus species in the Lakshadweep Sea. The sample weighted 100 kg and had a total length of 147 cm. The morphometric and meristic measurements were made and results indicated; the species recorded was the third largest in total length and the heaviest in terms of mass compared to earlier reports in Indian seas.
Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures. To identify specific predictors of CRE, patients with CRE were compared with 3 control groups: (1) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, (2) patients with non-ESBL-containing Enterobacteriaceae, and (3) uninfected controls.
Matched multivariable analyses.
Patients and Setting.
Patients possessing CRE that were isolated at Detroit Medical Center from September 1, 2008, to August 31, 2009.
Patients were matched (1:1 ratio) to the 3 sets of controls. Matching parameters included (1) bacteria type, (2) hospital/ facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Matched multivariable analyses were conducted between uninfected controls and patients with CRE, ESBL, and non-ESBL Enterobacteriaceae. Models were also designed comparing patients with CRE to patients with ESBL, patients with non-ESBL Enterobacteriaceae, and all 3 non-CRE groups combined.
Ninety-one unique patients with CRE were identified, and 6 matched models were constructed. Recent (less than 3 months) exposure to antibiotics was the only parameter that was consistently associated with CRE, regardless of the group to which CRE was compared, and was not independently associated with isolation of ESBL or non-ESBL Enterobacteriaceae.
Exposure to antibiotics within 3 months was an independent predictor that characterized patients with CRE isolation. As a result, antimicrobial stewardship efforts need to become a major focus of preventive Interventions. Regulatory focus regarding appropriate antimicrobial use might decrease the detrimental effects of antibiotic misuse and spread of CRE.
Plant-specific transcription factors belonging to the dehydration response element binding (DREB)/C-repeat binding factor (CBF) subfamily of the AP2/EREBP family specifically interact with dehydration-responsive elements (DRE)/C-repeat (CRT) and control the expression of many stress-inducible genes in plants. Two major subgroups of DREB proteins are represented by DREB1 and DREB2, which are induced specifically under cold and drought/salt stress, respectively. A DREB2 transcription factor gene from sorghum, SbDREB2 was identified and cloned in binary vectors, such that it was driven either by a constitutive CaMV35S promoter or a stress-inducible rd29A promoter. These gene constructs were transferred into rice through Agrobacterium tumefaciens-mediated transformation. Expression patterns of the native DREB gene (OsDREB2) and the transgene (SbDREB2) were similar. Both genes showed induction at 1 h exposure to drought, after which expression gradually dropped to basal levels by 24 h. Constitutive expression of SbDREB2 led to pleiotropic effects in rice and these transgenics did not set seed. The rd29A: SbDREB2 rice plants set seed and the grains collected from primary transformants were sown to raise T1 plants. The drought-stressed rd29A: SbDREB2 transgenics showed a significantly higher number of panicles as compared to the wild-type rice plants. Other phenological and agronomic traits were not affected in wild-type and rd29A: SbDREB2 transgenic rice.
The Pele La Group in the Wachi La section in the Black Mountains of central Bhutan represents the easternmost exposure of Cambrian strata known in the Himalaya. The group contains a succession of siliciclastic rocks with minor amounts of carbonate, the uppermost unit of which, the Quartzite Formation, bears age-diagnostic trilobite body fossils that are approximately 493 Ma old. Trilobite species include Kaolishania granulosa, Taipaikia glabra and the new species Lingyuanaspis sangae. A billingsellid brachiopod, Billingsella cf. tonkiniana, is co-occurrent. This fauna is precisely correlated with that of a specific stratigraphic horizon within the upper part of the Kaolishania Zone, Stage 9 of the Cambrian System, Furongian Epoch of the North China block, and thus represents the youngest Cambrian sedimentary rocks yet known from the Himalaya. The faunal similarity suggests proximity between North China and the Himalayan margin at this time. This unit was deposited in a predominantly storm-influenced shelf and shoreface environment. U–Pb geochronological data from detrital zircon grains from the fossil-bearing beds of the Quartzite Formation and strata of the underlying Deshichiling Formation show grain age spectra consistent with those from Cambrian rocks of the Lesser and Tethyan Himalaya in Tibet, India and Pakistan. These data support continuity of the northern Gondwanan margin across the Himalaya. Prominent peaks of approximately 500 Ma zircons in both the Quartzite and Deshichiling formations are consistent with the Furongian (late Cambrian) age assignment for these strata. The presence of these relatively young zircon populations implies rapid post-cooling erosion of igneous bodies and subsequent deposition which may reflect the influence of a widespread Cambro-Ordovician orogenic event evident in the western Himalaya.
We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool.
We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen.
To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.
We have measured the ensemble averaged transverse spin relaxation time T2* (associated with g = 4 resonance) in bulk powders of the organic molecule Alq3, and in samples containing 1-2 molecules confined in nanocavities of dimension ˜ 2 nm. Both T2* times are strongly temperature dependent indicating that they are determined by phonon-mediated spin relaxation. Interestingly, the T2* time in nanocavities is ˜2.5 times longer than in bulk powder over a wide temperature range. The longer T2* in the nanocavity is evidence of weakened electron-phonon interaction. We believe that electron-phonon interaction is suppressed because the cavity confines phonons and discretizes the phonon modes and phonon energies. As a result, the chances of a phonon induced (inelastic) spin relaxation event are reduced owing to the need to conserve energy in the relaxation process. This is a novel “phonon bottleneck effect” that to our knowledge has not been previously reported.
Palladium nanoparticles supported by alumina nanofibers have been successfully synthesized by electrospinning using palladium chloride incorporated into a solution of polyvinyl pyrrolidone and aluminum acetate. Palladium agglomerate sizes and the surface morphology of the electrospun nanofibers were determined by transmission electron microscopy. Palladium nanoparticles appeared to be well dispersed within the electrospun nanofiber structure. X-ray diffraction, x-ray photoelectron spectroscopy, and Raman scattering spectroscopy techniques were used to identify the crystalline form and distinguish between oxidized and metallic palladium particles after heating and hydrogenation.
Nanoporous Ti (and TiOx) has been formed by anodization of RF sputtered titanium thin films. A solution of 1M (NH4)2SO4 (ammonium sulphate) electrolytes containing 0.5wt% (NH4)F (ammonium fluoride) was used in the anodization process. Different nano and micro structures were obtained. Voltage in a rage of 2 to 10V was employed in the process. It was observed that the magnitude of applied voltage have a significant impact in the formation of different surface morphologies with various nano/micro structures. The anodized titanium thin films were characterised using scanning electron microscopy and X-ray diffraction techniques.
Precise biostratigraphic constraints on the age of the Tal Group are restricted to (1) a basal level correlative with the Anabarites trisulcatus–Protohertzina anabarica Assemblage Zone of southwest China, (2) a level near the boundary of the lower and upper parts of the Tal Group correlative with the early Tsanglangpuan Stage (Drepanuroides Zone), and (3) an interval low in the upper part of the Tal Group correlative with later in the Tsanglangpuan Stage (Palaeolenus Zone). These correlations are based on small shelly fossil and trilobite taxa. Other chronostratigraphic constraints include the marked negative δ13C isotopic excursion coincident with the transition from the Krol Group to the Tal Group. This excursion is used as a proxy for the Precambrian–Cambrian boundary in several sections worldwide and, if applied to the Lesser Himalaya, indicates that the boundary is at or just above the base of the Tal Group. The upper parts of the Tal Group may be of middle or late Cambrian age and might form proximal equivalents of sections in the Zanskar–Spiti region of the Tethyan Himalaya. Both faunal content and lithological succession are comparable to southwest China, furthering recent arguments for close geographic proximity between the Himalaya and the Yangtze block during late Neoproterozoic and early Cambrian time. Trilobites from the uppermost parts of the Sankholi Formation from the Nigali Dhar syncline are described and referred to three taxa, one of which, Drepanopyge gopeni, is a new species. They are the oldest trilobites yet described from the Himalaya.
We present a novel self-assembly nanowire synthesis technique capable of producing nickelrich oxide nanowires of lengths up to 20μm and diameters as small as 5nm. The method was discovered while examining the oxidation of Alloy 600 (nickel- 15.5a/o Cr, 8a/o Fe) in a pressurized water reactor environment. The nanowires have been grown on substrates of Alloy 600 and other nickel-chromium substrates exposed to oxidizing conditions in 1500psi pressurized water with 2ppm lithium and 1200ppm boron at temperatures ranging from 238°C to 288°C. Oxidizing conditions can be controlled in one of two ways: by controlling the aqueous solution's dissolved oxygen concentration, or by use of a potentiostat. Compositional studies performed via energy dispersive spectroscopy (EDS) using a transmission electron microscope (TEM) indicate the content of the nanowires grown on Alloy 600 to be 49a/o oxygen, 47a/o Ni, and 4a/o Fe. Preliminary TEM analysis has revealed the nanowires to be single crystalline with an aspect ratio up to 1000:1. The nickel-rich oxide nanowires are particularly exciting because of their functional properties. The oxide composition of the nanowires gives them an inherent resistance to electrochemically aggressive environments, such as ones found in the body or many other aqueous solutions, in contrast to simple metal nanowires, which are susceptible to corrosion in such environments. Most importantly, analysis with a superconducting quantum interference device (SQUID) magnetometer indicates that the nickel-rich oxide nanowires are ferromagnetic with a coercivity of approximately 850e and a remnant field of 0.032emu/g at 300K.
We demonstrated a novel approach to fabricate a self-assembled array of energetic nanocomposites which undergo an exothermic reaction at high temperature. The nanocomposites are a mixture of fuel and oxidizer materials where one of the components (fuel or oxidizer) is in the form of an array of nanowires embedded in the other component (oxidizer or fuel) which is in the form of a thin film. Our fabrication approach allows for a very high packing density of the nanocomposites, precise control of oxidizer-fuel sizes at the nanoscale level and intimate mechanical contact between oxidizer and fuel. Such nanocomposites will have important applications in novel energetic devices, for example MEMS-based fuzes, nanoexplosives and in applications requiring light-weight, single-use energy sources.