Liquid-immersible electrostatic ultrasonic transducer

A broadband megahertz range electrostatic acoustic transducer for use in a liquid environment is described. A liquid tight enclosure includes a metallic conducting membrane as part of its outside surface and has a means inside the liquid tight enclosure for applying a tension to the membrane and for mounting an electrode such that the flat end of the electrode is aproximately parallel to the membrane. The invention includes structure and a method for ensuring that the membrane and the flat end of the electrode are exactly parallel and a fixed predetermined distance from each other

Effects of service changes affecting distance / time to access urgent and emergency care facilities on patient outcomes : a systematic review

Background Reconfiguration of urgent and emergency care services often increases travel time/distance for patients to reach an appropriate facility. Evidence of the effects of reconfiguration is important for local communities and commissioners and providers of health services. Methods We performed a systematic review of the evidence regarding effects of service reconfigurations that increase the time/distance for some patients to reach an urgent and emergency care (UEC) facility. We searched seven bibliographic databases from 2000 to February 2019 and used citation tracking and reference lists to identify additional studies. We included studies of any design that compared outcomes for people with conditions requiring emergency treatment before and after service reconfiguration with an associated change in travel time/distance to access UEC. Studies had to be conducted in the UK or other developed countries. Data extraction and quality assessment (using the Joanna Briggs Institute checklist for quasi-experimental studies) were undertaken by a single reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies. Overall strength of evidence was assessed using a previously published method that considers volume, quality and consistency. Results We included 12 studies, of which six were conducted in the USA, two in the UK and four in other European countries. The studies used a variety of observational designs, with before–after and cohort designs being most common. Only two studies included an independent control site/sites where no reconfiguration had taken place. The reconfigurations evaluated in these studies reported relatively small effects on average travel times/distance. Discussion For studies of general UEC populations, there was no convincing evidence as to whether reconfiguration affected mortality risk. However, evidence of increased risk was identified from studies of patients with acute myocardial infarction, particularly 1 to 4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. Conclusions We found insufficient evidence to determine whether increased distance to UEC increases mortality risk for the general population of people requiring UEC, although this conclusion may not extend to people with specific conditions

Ultrasonic Characterization of Interfaces in Composite Bonds

The inverse determination of imperfect interfaces from reflection spectra of normal and oblique incident ultrasonic waves in adhesive bonds of multidirectional composites is investigated. The oblique measurements are complicated by the highly dispersed nature of oblique wave spectra at frequencies above 3MHz. Different strategies for bond property reconstruction, including a modulation method, are discussed. The relation of measured interfacial spring density to the physico-chemical model of a composite interface described by polymer molecular bonds to emulate loss of molecular strength on an adhesive composite interface is discussed. This potentially relates the interfacial (adhesion) strength (number of bonds at the adhesive substrate interface) to the spring constant (stiffness) area density (flux), which is an ultrasonically measurable parameter

Synthetic Mudscapes: Human Interventions in Deltaic Land Building

In order to defend infrastructure, economy, and settlement in Southeast Louisiana, we must construct new land to mitigate increasing risk. Links between urban environments and economic drivers have constrained the dynamic delta landscape for generations, now threatening to undermine the ecological fitness of the entire region. Static methods of measuring, controlling, and valuing land fail in an environment that is constantly in flux; change and indeterminacy are denied by traditional inhabitation. Multiple land building practices reintroduce deltaic fluctuation and strategic deposition of fertile material to form the foundations of a multi-layered defence strategy. Manufactured marshlands reduce exposure to storm surge further inland. Virtual monitoring and communication networks inform design decisions and land use becomes determined by its ecological health. Mudscapes at the threshold of land and water place new value on former wastelands. The social, economic, and ecological evolution of the region are defended by an expanded web of growing land

Two 'b's in the Beehive: The Discovery of the First Hot Jupiters in an Open Cluster

We present the discovery of two giant planets orbiting stars in Praesepe (also known as the Beehive Cluster). These are the first known hot Jupiters in an open cluster and the only planets known to orbit Sun-like, main-sequence stars in a cluster. The planets are detected from Doppler shifted radial velocities; line bisector spans and activity indices show no correlation with orbital phase, confirming the variations are caused by planetary companions. Pr0201b orbits a V=10.52 late F dwarf with a period of 4.4264 +/- 0.0070 days and has a minimum mass of 0.540 +/- 0.039 Mjup, and Pr0211b orbits a V=12.06 late G dwarf with a period of 2.1451 +/- 0.0012 days and has a minimum mass of 1.844 +/- 0.064 Mjup. The detection of 2 planets among 53 single members surveyed establishes a lower limit on the hot Jupiter frequency of 3.8 (+5.0)(-2.4) % in this metal-rich open cluster. Given the precisely known age of the cluster, this discovery also demonstrates that, in at least 2 cases, giant planet migration occurred within 600 Myr after formation. As we endeavor to learn more about the frequency and formation history of planets, environments with well-determined properties -- such as open clusters like Praesepe -- may provide essential clues to this end.Comment: 5 pages, 3 tables, 2 figures. Published in ApJ Letter

Digital and online symptom checkers and health assessment/triage services for urgent health problems: systematic review

Objectives In England, the NHS111 service provides assessment and triage by telephone for urgent health problems. A digital version of this service has recently been introduced. We aimed to systematically review the evidence on digital and online symptom checkers and similar services. Design Systematic review. Data sources We searched Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium, Web of Science and ACM Digital Library up to April 2018, supplemented by phrase searches for known symptom checkers and citation searching of key studies. Eligibility criteria Studies of any design that evaluated a digital or online symptom checker or health assessment service for people seeking advice about an urgent health problem. Data extraction and synthesis Data extraction and quality assessment (using the Cochrane Collaboration version of QUADAS for diagnostic accuracy studies and the National Heart, Lung and Blood Institute tool for observational studies) were done by one reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies structured around pre-defined research questions and key outcomes. Results We included 29 publications (27 studies). Evidence on patient safety was weak. Diagnostic accuracy varied between different systems but was generally low. Algorithm-based triage tended to be more risk averse than that of health professionals. There was very limited evidence on patients’ compliance with online triage advice. Study participants generally expressed high levels of satisfaction, although in mainly uncontrolled studies. Younger and more highly educated people were more likely to use these services. Conclusions The English ‘digital 111’ service has been implemented against a background of uncertainty around the likely impact on important outcomes. The health system may need to respond to short-term changes and/or shifts in demand. The popularity of online and digital services with younger and more educated people has implications for health equity. PROSPERO registration number CRD42018093564

Bacteroides fragilis enterotoxin gene sequences in patients with inflammatory bowel disease.

We identified enterotoxigenic Bacteroides fragilis in stool specimens of patients with inflammatory bowel disease and other gastrointestinal disorders. The organism was detected in 11 (13.2%) of 83 patients with inflammatory bowel disease. Of 57 patients with active disease, 19.3% were toxin positive; none of those with inactive disease had specimens positive for enterotoxigenic Bacteroides fragilis gene sequences