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Alteplase is an effective treatment for ischaemic stroke patients, and it is widely available at all primary stroke centres. The effectiveness of alteplase is highly time-dependent. Large tertiary centres have reported significant improvements in their door-to-needle (DTN) times. However, these same improvements have not been reported at community hospitals.
Red Deer Regional Hospital Centre (RDRHC) is a community hospital of 370 beds that serves approximately 150,000 people in their acute stroke catchment area. The RDRHC participated in a provincial DTN improvement initiative, and implemented a streamlined algorithm for the treatment of stroke patients. During this intervention period, they implemented the following changes: early alert of an incoming acute stroke patient to the neurologist and care team, meeting the patient immediately upon arrival, parallel work processes, keeping the patient on the Emergency Medical Service stretcher to the CT scanner, and administering alteplase in the imaging area. Door-to-needle data were collected from July 2007 to December 2017.
A total of 289 patients were treated from July 2007 to December 2017. In the pre-intervention period, 165 patients received alteplase and the median DTN time was 77 minutes [interquartile range (IQR): 60–103 minutes]; in the post-intervention period, 104 patients received alteplase and the median DTN time was 30 minutes (IQR: 22–42 minutes) (p < 0.001). The annual number of patients that received alteplase increased from 9 to 29 in the pre-intervention period to annual numbers of 41 to 63 patients in the post-intervention period.
Community hospitals staffed with community neurologists can achieve median DTN times of 30 minutes or less.
The morphology of englacial drainage networks and their temporal evolution are poorly characterised, particularly within cold ice masses. At present, direct observations of englacial channels are restricted in both spatial and temporal resolution. Through novel use of a terrestrial laser scanning (TLS) system, the interior geometry of an englacial channel in Austre Brøggerbreen, Svalbard, was reconstructed and mapped. Twenty-eight laser scan surveys were conducted in March 2016, capturing the glacier surface around a moulin entrance and the uppermost 122 m reach of the adjoining conduit. The resulting point clouds provide detailed 3-D visualisation of the channel with point accuracy of 6.54 mm, despite low (<60%) overall laser returns as a result of the physical and optical properties of the clean ice, snow, hoar frost and sediment surfaces forming the conduit interior. These point clouds are used to map the conduit morphology, enabling extraction of millimetre-to-centimetre scale geometric measurements. The conduit meanders at a depth of 48 m, with a sinuosity of 2.7, exhibiting teardrop shaped cross-section morphology. This improvement upon traditional surveying techniques demonstrates the potential of TLS as an investigative tool to elucidate the nature of glacier hydrological networks, through reconstruction of channel geometry and wall composition.
Fe deficiency in early childhood is associated with long-term consequences for cognitive, motor and behavioural development; however explorations in healthy children from low risk, high-resource settings have been limited. We aimed to explore associations between Fe status and neurodevelopmental outcomes in low risk, healthy 2-year-olds. This study was a secondary analysis of a nested case–control subgroup from the prospective, maternal-infant Cork Babies after Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact using Neurological and Nutritional Endpoints (BASELINE) Birth Cohort Study. At 2 years, serum ferritin, Hb and mean corpuscular volume (MCV) were measured and neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development (n 87). Five children had Fe deficiency (ferritin <12 µg/l) and no child had Fe deficiency anaemia (Hb<110 g/l+ferritin<12 µg/l). Children with microcytosis (MCV<74 fl, n 13) had significantly lower mean cognitive composite scores (88·5 (sd 13·3) v. 97·0 (sd 7·8), P=0·04, Cohen’s d effect size=0·8) than those without microcytosis. The ferritin concentration which best predicted microcytosis was calculated as 18·4 µg/l (AUC=0·87 (95% CI 0·75, 0·98), P<0·0001, sensitivity 92 %, specificity 75 %). Using 18·5 µg/l as a threshold, children with concentrations <18·5 µg/l had significantly lower mean cognitive composite scores (92·3 (sd 10·5) v. 97·8 (sd 8·1), P=0·012, Cohen’s d effect size=0·6) compared with those with ferritin ≥18·5 µg/l. All associations were robust after adjustment for potential confounding factors. Despite a low prevalence of Fe deficiency using current diagnostic criteria in this healthy cohort, microcytosis was associated with lower cognitive outcomes at 2 years. This exploratory study emphasises the need for re-evaluation of the diagnostic criteria for Fe deficiency in young children, with further research in adequately powered studies warranted.
We are mapping 29 rotational transitions of 21 chemical and isotopic molecular species in the central Orion molecular ridge with Nyquist sampling using the new 15-element focal plane array receiver QUARRY on the FCRAO 14 m telescope. Our goal is to obtain complete, unbiased data sets for a study of the interrelated physics and chemistry in GMC cores.
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
This study examined the effect of including different dietary proportions of starch, protein and lipid, in diets balanced for digestible energy, on the utilisation efficiencies of dietary energy by barramundi (Lates calcarifer). Each diet was fed at one of three ration levels (satiety, 80 % of initial satiety and 60 % of initial satiety) for a 42-d period. Fish performance measures (weight gain, feed intake and feed conversion ratio) were all affected by dietary energy source. The efficiency of energy utilisation was significantly reduced in fish fed the starch diet relative to the other diets, but there were no significant effects between the other macronutrients. This reduction in efficiency of utilisation was derived from a multifactorial change in both protein and lipid utilisation. The rate of protein utilisation deteriorated as the amount of starch included in the diet increased. Lipid utilisation was most dramatically affected by inclusion levels of lipid in the diet, with diets low in lipid producing component lipid utilisation rates well above 1·3, which indicates substantial lipid synthesis from other energy sources. However, the energetic cost of lipid gain was as low as 0·65 kJ per kJ of lipid deposited, indicating that barramundi very efficiently store energy in the form of lipid, particularly from dietary starch energy. This study defines how the utilisation efficiency of dietary digestible energy by barramundi is influenced by the macronutrient source providing that energy, and that the inclusion of starch causes problems with protein utilisation in this species.
Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v. low intake and stratified intake dose–response analyses. Additional dose–response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95 % CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95 % CI 0·72, 0·93) and stroke (SRRE=0·87; 95 % CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95 % CI 0·60, 0·81). However, there was little evidence for inverse dose–response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose–response patterns.
To describe adherence with infant feeding and complementary feeding guidelines.
Prospective study of infant feeding and complementary feeding practices were collected as part of the Cork BASELINE Birth Cohort Study.
Data are described for the 823 infants for whom a diary was completed.
Breast-feeding was initiated in 81 % of infants, and 34 %, 14 % and 1 % of infants were exclusively breast-fed at hospital discharge, 2 and 6 months, respectively. Stage one infant formula decreased from 71 % at 2 months to 13 % at 12 months. The majority of infants (79 %) were introduced to solids between 17 and 26 weeks and 18 % were given solid foods before 17 weeks. Mothers of infants who commenced complementary feeding prior to 17 weeks were younger (29·8 v. 31·5 years; P<0·001) and more likely to smoke (18 v. 8 %; P=0·004). The first food was usually baby rice (69 %), infant breakfast cereals (14 %) or fruit/vegetables (14 %). Meals were generally home-made (49 %), cereal-based (35 %), manufactured (10 %), dairy (3 %) and dessert-based (3 %). The median gap between the first–second, second–third, third–fourth and fourth–fifth new foods was 4, 2, 2 and 2 d, respectively.
We present the largest prospective cohort study to date on early infant feeding in Ireland. The rate of breast-feeding is low by international norms. Most mothers introduce complementary foods between 4 and 6 months with lengthy gaps between each new food/food product. There is a high prevalence of exposure to infant breakfast cereals, which are composite foods, among the first foods introduced.
The perovskite catalysts La0.75Sr0.25Cr0.5X0.5O3±δ (where X= Mn, Fe and Co) were prepared by combustion synthesis and the influence of transition metals B-site substitution on the structural and catalytic properties of the catalysts in steam reforming of both pure and by-product glycerol to produce hydrogen-rich gases for utilization in solid oxide fuel cell was investigated. All the catalyst systems were found very active and selective with the Fe-substituted catalyst slightly more active. Hydrogen yield and coke suppression was better in the Mn-substituted catalyst which was also structurally more stable in fuel environment. Impregnation of Ni into the lattice structure of the pre-reacted both A-site and B-site stoichiometric catalysts from nickel nitrate solution and subsequent redox exsolution of Ni nano particles supported on the oxide surface of the materials has significantly improved the hydrogen yield by enhancing water-gas-shift reaction (WGSR). Thus, extent of the exsolution phenomenon observed in the materials followed the order LSCM > LSCC > LSCF.
The aim of this study was to evaluate potential sampling strategies for detection of infected flocks that could be applied during an outbreak of low pathogenicity notifiable avian influenza (LPNAI) initiated in duck holdings, following initial detection. A simulation model of avian influenza virus transmission and spread within and between holdings, respectively, was used to predict the impact on the size and duration of an outbreak of (i) changing the tracing window within which premises that might be the source of infection or that may have been infected by the index premises were sampled and (ii) changing the number of birds sampled in the flock being tested. It has shown that there is potential benefit in increasing the tracing window in terms of reducing the likelihood of a large outbreak. It has also shown that there is comparatively little benefit from increasing the number of birds sampled per flock.
Early detection of an invading nonindigenous plant species (NIS) may be critical for efficient and effective management. Adaptive survey sampling methods may provide unbiased sampling for best estimates of distribution of rare and spatially clustered populations of plants in the early stages of invasion. However, there are few examples of these methods being used for nonnative plant surveys in which travelling distances away from an initial or source patch, or away from a road or trail, can be time consuming due to the topography and vegetation. Nor is there guidance as to which of the many adaptive methods would be most appropriate as a basis for invasive plant mapping and subsequent management. Here we used an empirical complete census of four invader species in early to middle stages of invasion in a management area to assess the effectiveness and efficiency of three nonadaptive methods, four adaptive cluster methods, and four adaptive web sampling methods that all originated from transects. The adaptive methods generally sampled more NIS-occupied cells and patches than standard transect approaches. Sampling along roads only was time-efficient and effective, but only for species with restricted distribution along the roads. When populations were more patchy and dispersed over the landscape the adaptive cluster starting at the road generally proved to be the most time-efficient and effective NIS detection method.
In order to reduce the growth temperature of (Hg,Cd)Te by MOVPE below 350–400°C, alternative organometallic precursors will be required which either decompose at a lower temperature than existing precursors or which absorb strongly at a suitable wavelength in the ultraviolet. The features required for a programme of assessment of organometallics are discussed. UV absorption spectra for dimethyltelluride, dimethylditelluride, diethyltelluride, di-iso-propyltelluride and diallyltelluride are presented and their usefulness as photolytic MOVPE precursors discussed.
Mechanisms for the low temperature photo-dissociation of alkyl precursors for the epitaxial growth of CdxHg1-xTe (CMT) are discussed. The roles of vapour and surface nucleation are considered in the light of the free radical model which also can provide methods for controlling the vapour phase photochemistry. Higher quality CMT has been grown at 250 °C by using dimethyl mercury as a source of free methyl radicals. Problems encountered in reducing growth temperature for multilayer epitaxy are considered for CdTe and HgTe and conditions established for epitaxial growth at 200°C.The roles of alkyl concentration, substrate temperature, UV intensity and free radical concentration are explored. Results on the first reported growth of CdTe deposition using a cw UV laser source are compared with the arc lamp grown layers.
A preliminary study has been made of the UV photolysis of metal-organic compounds of Hg, Cd and Te which could be used for low-temperature, selective-area deposition of cadmium mercury telluride (CMT). High-resolution UV absorption spectra have been measured for dimethylcadmium (CdMe2), dimethylmercury (HgMe2) and diethyltelluride (TeEt2). Possible modes for photodissociation are discussed in the light of these results. The photodissociation of these alkyls was attempted in a hydrogen stream at atmospheric pressure using a mercury-xenon lamp, deposition being being onto a silica reaction tube. Yields of Cd, Hg and Te were measured under different deposition conditions to determine the dependence on UV intensity, alkyl concentration and flow velocity.