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Psychiatric disorders are increasingly prevalent and present as a comorbidity in many hospitalized patients. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with worsened inpatient outcomes. Emergency surgical admissions and the impact of CPC on their outcomes has not been studied in Ireland to date. This study aims to provide a comprehensive analyses of the relationship between a wide range of psychiatric comorbidities and surgical presentations.
The Hospital In-Patient Enquiry (HIPE) and prospectively maintained electronic patient records were used to identify all surgical emergency admissions between 31st August 2019 and 1st September 2020 to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), discharge destination, and surgical interventions were recorded. Subgroup analyses were performed examining LoS variation in the type of surgical presentation. Physical comorbidities were scored using the Charlson Comorbidity Index (CCI). Statistical calculations were performed using SPSS.
A total of 995 admissions were recorded. The presence of CPC increased the overall mean LoS by 1.9 days (p = .002). This trend was observed in both operative and conservative management. Significant increase in LoS was noted in patients with a comorbid depression (2.4 days, p = .003), dementia (2.8 days, p = .019), and intellectual disability (6.7 days, p = .007). Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = .019), skin and soft tissue infections (2.5 days, p = .040), bowel obstruction (4.3 days, p = .047), and medical disorders (18.6 days, p = .010). The odds of nursing home or convalescence as a discharge destination was 2.44 (95% CI: 1.37–4.35, p = 0.002) in patients with CPC and the odds of self-discharge against medical advice in this population was 4.89 (95% CI: 1.43–16.70, p = 0.005). No significant difference was observed in mortality and readmission rates.
Psychiatric comorbidities significantly impact length of hospital stay and influence discharge planning in surgical inpatients. Greater vigilance is required in providing care for patients with psychiatric comorbidities, particularly those with depression, dementia and intellectual disability. Better optimisation of facilities and a more personalised approach to patients with CPC are required to improve inpatient outcomes and resource allocation.
Radiative-magnetohydrodynamic (RMHD) equations along with a full set of Maxwell's equations are followed to formulate the charged surface waves at the interface of an incompressible, radiative, magnetized dusty plasma and vacuum, while assuming that the characteristic wave frequency is much smaller than the ion gyrofrequency, having an equilibrium background state. It is found that the separation of charges on the surface is followed by thermal motion, which further leads to a negative pressure gradient normal to the surface, hence the plasma–vacuum interface is under tension due to two different types of oppositely directed pressures. The dusty plasma RMHD set of equations admits a linear dispersion relation of surface Jeans instability of an incompressible dusty plasma, which exhibits a strong coupling between the electron surface charge and dust surface mass densities and we conclude that the surface densities of both electrons and dust as well as the dust inertia play major roles in the gravitational collapse of the surface of astrophysical objects such as stars, galaxies etc. Further, the growth rate of radiative surface waves is found to be function of both the temperature inhomogeneity, appearing due to thermal radiation heat flux, as well as the thermal radiation pressure. The present findings of charged surface waves may seek application at the astroscales.
Risk for emotional and behavioural problems are known to be high among children of depressed mothers, but little is known about the impact of antenatal and postnatal depression on the physical health of the infant. Our one-year prospective follow-up study of 320 mothers and their infants in rural Rawalpindi, Pakistan, shows that infants of antenatally depressed mothers have poorer growth than controls. The relative risk for being underweight (weight-for-age z-score < -2SD) is 4.0 (95%CI 2.1-7.7) at 6 months and 2.6 (95% CI 1.7-4.1) at 12 months, while the risks for stunting (length-for-age z-score < –2SD) is 4.4 (95%CI 1.7-11.4) at 6 months and 2.5 (95% CI 1.6-4.0) at 12 months. Relative risk for ≥5 diarrhoeal episodes per year is 2.4 (95% CI 1.7-3.3). Chronic depression carries a greater risk for poor outcome than episodic depression. The associations remain significant after adjustment for confounders by multivariate analyses. It is concluded that preventive and treatment strategies for maternal depression could benefit not only the mother's well-being but also the infant's physical health and development.
The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.
A systematic review of the literature was performed using standardised methodology.
Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.
Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.
Avian influenza virus (AIV) type A subtype H9N2 usually causes mild asymptomatic infections, and is mostly undetected and is, therefore, under-reported. This has allowed the virus to rapidly evolve via mutations and reassortments in its genome with other avian influenza subtypes especially H1N1, H5N1 and H7N3 thereby introducing new variant strains and producing severe disease. It has been reported that the AIV H9N2 donated its internal genes for the devastating 1997 Hong Kong outbreak and furthermore, it may be the cause of the next influenza pandemic. There are many factors such as its wide host range, ability to cross the species barrier, ecological diversity, antiviral resistance and zoonotic importance that make it an excellent candidate for the next influenza pandemic. These and other factors like ineffective vaccination, negative immunological pressures, lack of surveillance, which contribute to its continuous persistence and evolutionary dynamics are discussed in this paper. It is important to take the necessary measures to control and prevent its unchecked circulation to prevent the future outbreaks.
Based upon its economical perspective, the phenomenon of forced moulting in the poultry industry has become a common practice to increase the productivity and reproductive life span of birds. Different feed supplements, including vitamins, minerals, probiotics and prebiotics have been extensively used by poultry farmers for many years. In the last decade, researchers have reported advantageous effects of these supplements in improving different health biomarkers of post moult poultry birds. Therefore, including with these supplements in post moult feed is believed to exhibit better results than moulting alone. The current review is aimed at highlighting the empirical data available on the importance of various feed supplements that are considered favourable in ameliorating the health status of moulted poultry birds.
The effect of sodium butyrate on various bodily parameters of broilers such as performance, gut microflora, gut morphology, and immunity is reviewed in order to highlight its importance as an alternative to antibiotic growth promoters. Sodium butyrate is used as a source of butyric acid, which is known for its beneficial effects in the gut in monogastrics. Sodium butyrate is available in uncoated and enteric-coated forms protected with fat or fatty acid salts. Varying results in productive performance, gut microbes, and gut morphology have been reported in the literature in response to supplementation of broiler diets with uncoated and fat-coated types of sodium butyrate. However, sodium butyrate has shown pronounced effects on immunity of chickens that are not fully understood yet. Although there are contrasting results of sodium butyrate in chicken, further research is needed using the sodium butyrate coated with the salts of fatty acids.
We quantified the prevalence of vitamin D status in 6–24-month-old underweight and normal-weight children and identified the socio-economic and dietary predictors for status.
Cross-sectional, baseline data from a nutritional intervention study were analysed. Multinomial logistic regression was used to estimate the odds of being vitamin D deficient or insufficient with the reference being vitamin D sufficient.
Urban slum area of Mirpur field site, Dhaka, Bangladesh.
Underweight (weight-for-age Z-score <−2·00) and normal-weight (weight-for-age Z-score ≥−1·00) children aged 6–24 months.
Among 468 underweight children, 23·1 % were sufficient, 42·3 % insufficient, 31·2 % deficient and 3·4 % severely vitamin D deficient. Among 445 normal-weight children, 14·8 % were sufficient, 39·6 % insufficient and 40·0 % deficient and 5·6 % severely deficient. With adjusted multinominal regression analysis, risk factors (OR (95 % CI)) for vitamin D deficiency in underweight children were: older age group (18–24 months old; 2·9 (1·5–5·7)); measurement of vitamin D status during winter (3·0 (1·4–6·4)) and spring (6·9 (3·0–16·1)); and maternal education (≥6 years of institutional education; 2·2 (1·0–4·9)). In normal-weight children, older age group (3·6 (1·2–10·6)) and living in the richest quintile (3·7 (1·1–12·5)) were found to be significantly associated with vitamin D insufficiency.
The study demonstrates a significant burden of vitamin D insufficiency and deficiency in both underweight and normal-weight children <2 years of age from an urban slum of Bangladesh. Identification of risk factors may help in mitigating the important burden in such children.
This study aimed to evaluate the relationship between cholesteatoma formation and the degree of mastoid pneumatisation, and to assess the relationship between the location of cholesteatoma and the degree of mastoid pneumatisation.
Data on all patients undergoing mastoid exploration for cholesteatoma between 1993 and 2011 were collected prospectively. Basic demographics, the degree of mastoid pneumatisation and cholesteatoma site were recorded.
A total of 393 patients (222 males and 171 females) underwent surgery for cholesteatoma. Patients' mean age was 37 years (range, 6–79 years). Pneumatisation of the mastoid was sclerotic in 23 per cent (n = 90), diploic in 16.7 per cent (n = 66) and cellular in 60.3 per cent of cases (n = 237) (p < 0.001). Atticoantral disease was present in 88.9 per cent of sclerotic, 95.4 per cent of diploic and 91.1 per cent of cellular mastoids. Middle-ear cholesteatoma was present in 54.4 per cent of sclerotic, 56 per cent of diploic and 51.9 per cent of cellular mastoids.
The findings demonstrate the presence of cholesteatoma in well-pneumatised mastoids. It is hypothesised that a well-pneumatised mastoid may lead to cholesteatoma formation.
It is generally accepted that with experience clinicians develop the ability to identify patients who present with malignancy prior to a formal diagnosis. This ability cannot be quantified, nor is it a plausible substitute for investigation. This study aimed to evaluate the association between instinct and head and neck cancer diagnosis.
A prospective study of patients requiring urgent diagnostic procedures for suspected cancer between August and December 2010 was performed. Risk factors, symptoms, signs and the clinician's impression were recorded. These were graded and subsequently correlated with histology findings.
Twenty-seven patients, with a mean age of 62.2 years, underwent a diagnostic procedure. Thirty per cent of patients were referred under the two-week pathway and 18.5 per cent had a previous history of head and neck cancer. A diagnosis of cancer was made in 37 per cent of patients. There was a positive correlation between clinical suspicion and cancer diagnosis (Kendall's tau-b = 0.648749).
This study highlights the importance of clinical suspicion in cancer diagnosis. Although clinical suspicion cannot be quantified, it should be regarded as an integral part of patient assessment.
Poultry red mite (Dermanyssus gallinae), the haematophagous pest of egg laying hens, is an important problem in poultry production in many parts of the world. Control has typically relied on synthetic acaricides in spite of advancements in immunological, biotechnological and genetic approaches. However, the repeated long term use of these compounds has resulted in the development of drug resistant populations of poultry mites, therefore, the availability of effective acaricides is diminishing rapidly. Due to this, there is need for the continuous availability of new chemical acaricides to replace the older types, however the development and registration of new acaricides is a long expensive process, therefore, preserving and maintaining the effectiveness of available acaricides is essential.
This review has two parts; the first is to provide the basic understanding of acaricide resistance in D. gallinae while the second part provides more detailed knowledge about the management of resistance to preserve the efficacy of available acaricides.
Pheasants and peafowl have been used as ornamental birds worldwide because of their beauty and use as game birds. They can be hampered by the disease mycoplasmosis in breeding pens, wildlife parks and zoos. This review paper describes the prevalence, diagnostic procedures and different combinations of treatments for mycoplasmosis in these birds. This paper also discusses the association of prevalence with management practices.
The boundary layer flow of an Eyring-Powell fluid over a stretching surface subject to the convective boundary condition is investigated. Nonlinear problem is computed and a comparative study is presented with the existing results in viscous fluid. The constructed differential systems have been solved for homotopic solutions. Convergence of series solutions has been discussed. Special emphasis has been given to the effects of material parameters of fluid (ε), (δ), Biot number (γ) and Prandtl number (Pr) on the velocity and temperature profiles. Tabulated values of Nusselt number and skin friction for different emerging parameters are also illustrated. It is noted that the boundary layer thickness is an increasing function of (ε) and decreasing function of (δ). However the temperature and thermal boundary layer thickness decrease when the values of (ε) and (δ) are increased.
This article describes the boundary layer flow and heat transfer in a second grade fluid over a stretching sheet. Heat transfer analysis is carried out in the presence of a Newtonian heating. The partial differential systems have been transformed into the ordinary differential systems by appropriate relations. Homotopy analysis method (HAM) is used for the solutions. Graphical and tabulated results are presented to see the significance of influential parameters on the velocity and temperature fields. It is seen that temperature profiles and heat transfer rate significantly increase by increasing the conjugate parameter (γ) for Newtonian heating.
Carbon nanotube-spinel lithium titanate (CNT-Li4Ti5O12) nanoparticles have been synthesized by hydrothermal reaction and higher-temperature calcinations with LiOH·H2O and TiO2 precursors in the presence of carbon nanotubes sources. The CNT-Li4Ti5O12 nanoparticles have been characterized by X-ray diffraction (XRD), high angle annular dark field (HAADF) images, and selected area electron diffraction (SAED). The particles exhibited a spinel cubic crystal phase and homogenous size distribution, with sizes around 50-70 nm. HAADF imaging confirmed that carbon content exists on the surface of the CNT-Li4Ti5O12 nanoparticles with graphitic carbon coating of 3-5 nm thickness under 800oC in the Ar gas. The graphitic carbon phase was further confirmed with Raman spectroscopy analysis on powder samples. Electrochemical characteristics were evaluated with galvanostatic discharge/charge tests, which showed that the initial discharge capacity is 172 mA·h/g at 0.1C. The nanoscale carbon layers uniformly coated the particles, and the interconnected carbon nanotube network is responsible for the improved charge rate capability and conductivity.
The high prevalence of anthelmintic-resistant gastrointestinal nematodes (GINs) throughout the world has led to the need for alternative worm control strategies. One of the possible substitutes to reduce the problems of drug resistance and residue is the evaluation/breeding of small ruminants for greater resistance to the GINs (organically produced), which in turn would be a helpful tool to predict the performance of an animal. At present, the existing diversity in the genetic potential to resist/tolerate GINs infection both within and between breeds has been validated. Successful selection of animals to define the genotype and identified resistance is related to the employed markers. A number of phenotypic traits such as faecal egg count (FEC), worm burden, serum antibodies, peripheral eosinophilia, packed cell volume, live weight, serum protein and albumin concentrations have been used for this purpose both in natural and artificial infections. Relatively resistant/tolerant animals have also been found to have mastocytosis, globule leucocytes, high levels of histamine and immunoglobulin (Ig) A and IgE concentrations. Of these traits, the principal and most practical measurement used to assess resistance status in animals undergoing similar parasite challenges is FEC. FEC has a positive/negative correlation with other biochemical, cellular and immunological parameters; however, the reliability of individual trial is often questioned and valuable information regarding the genetic makeup can be obtained from pooled data of a large number of trials and parameters. This paper covers all the aspects reported in the literature on various parameters considered to evaluate the resistance status of a range of small ruminant breeds.
The objective of the present study was to evaluate the anticoccidial effect of different concentrations of the herbal complex of 4 plants (leaves of Azadirachta indica and Nicotiana tabacum, flowers of Calotropis procera and seeds of Trachyspermum ammi) in broiler chickens in comparison with amprolium anticoccidial. Three concentrations (2 g, 4 g and 6 g) of herbal complex were given to the experimental groups once a day and amprolium (at the dose rate of 125 ppm) was given orally in drinking water from the 14th to the 21st days of age. One group was kept as infected, non-medicated control and one as non-infected, non-medicated control. All groups were inoculated orally with 75 000 sporulated oocysts on the 14th day of age except the non-infected, non-medicated control. Among herbal complex medicated groups, the maximum anticoccidial effect was seen in the group medicated with 6 g herbal complex followed by 4 g and 2 g herbal complex medicated groups. Treatment with 6 g of the herbal complex significantly reduced the negative performance and pathogenic effects associated with Eimeria tenella challenge at a level that was comparable with amprolium when using a largely susceptible recent field isolate. In summary, concentration-dependent anticoccidial activity of the studied herbal complex suggests its use as an alternative anticoccidial agent to chemotherapeutic drugs for Eimeria tenella control.
The development of drug resistance in Eimeria is common because of extensive use of anticoccidial drugs for the control of avian coccidiosis. The significance of chemotherapy is evident from the fact that, in spite of advancement in the field of immunological, biotechnological and genetic methods, prophylactic chemotherapy with anticoccidial drugs is still widely used for the control of coccidiosis. In such situations, new drugs should be available to replace the older ones against which resistance has developed, however it takes a long time to develop any new compounds. It is therefore currently necessary to develop strategies to minimise the emergence of resistance in Eimeria strains and to prolong the effect of available anticoccidial drugs. This paper summarises the resistance status of Eimeria species in different parts of the world and reviews different types of resistance, mechanism of resistance development, factors involved in the development and spread of resistance, management of resistant strains and strategies to preserve the efficacy of the available anticoccidial drugs. Use of vaccines, synthetic and botanical anticoccidials and educating farmers about recommended coccidiosis control practices are discussed in this review, along with the integration of currently available options for the management of drug resistance and, ultimately, the control of coccidiosis.
This paper provides an estimation of the point prevalence of fascioliasis and its economic impact in terms of increased milk yield after chemotherapy of a bovine population from the district of Toba Tek Singh, Punjab, Pakistan. A total of 2400 cattle and buffaloes were examined quantitatively using the McMaster egg-counting technique. Infected cattle and buffaloes (50 of each) were randomly selected and each divided into two groups of 25 animals. Groups A (buffaloes) and C (cattle) were treated with oxyclozanide (orally, 16.6 mg kg− 1 body weight). Groups B and D served as negative controls for buffaloes and cattle, respectively. Pre- and post-treatment milk yield was recorded to determine if there were any changes in milk yield after treatment. Of 2400 faecal samples analysed, 654 (27.25%) were positive for Fasciola spp. with a mean number of eggs per gram (EPG) of 503.2. The point prevalence and worm burden of fascioliasis was significantly higher (OR = 2.13; P < 0.05) in buffaloes (34.58%; 415/1200; mean EPG maximum likelihood = 521.4) as compared to that of cattle (19.92%; 239/1200; mean EPG maximum likelihood = 415.8). Among the parasite species, F. gigantica (19.88%; 477/2400) was predominant (OR = 3.12; P < 0.05) as compared to F. hepatica (7.38%; 177/2400). An average daily increase of 0.67 and 0.87 litres of milk, with 0.41% and 0.37% more fat per animal, was observed in oxyclozanide-treated buffaloes and cattle, respectively. The economic value of reduced production of infected animals was estimated as US$0.33 and 0.32 per animal per day for cattle and buffaloes, respectively.