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Sediments that accumulate in high-latitude lakes serve as valuable environmental archives of changing conditions in a region currently undergoing rapid change. A previously unexplored sedimentary sequence reaching back 16,000 years from Lakes Peters and Schrader (Neruokpuk Lakes) in the northeastern Brooks Range (69°N), Alaska, shows distinct changes in accumulation rates and biophysical properties including bulk density (BD), organic matter (OM) content, and grain-size distribution at five widely distributed core sites. The oldest sediments contain little OM and accumulated rapidly as glaciers retreated around 15 ka. OM peaked between 12 and 10 ka along with Northern Hemisphere summer insolation. BD increased and OM decreased until around 5 ka, possibly reflecting a decrease in river-transported terrestrial OM. From 5–2 ka, OM consistently increased, suggesting a rise in river discharge, or a rise in summer temperatures, which led to higher productivity, or both. After 2 ka, sediments increased in BD and decreased in OM, suggesting glacier growth. Evidence for glacier expansion late during the Little Ice Age is weak, but increased sedimentation rates may reflect glacier retreat during the last century. This study provides a framework for future paleoenvironmental research of a rare archive in a relatively pristine Arctic setting.
The objectives of this paper are to: (1) identify contextual factors such as policy that impacted the implementation of community-based primary health care (CBPHC) innovations among 12 Canadian research teams and (2) describe strategies used by the teams to address contextual factors influencing implementation of CBPHC innovations. In primary care settings, consideration of contextual factors when implementing change has been recognized as critically important to success. However, contextual factors are rarely recorded, analyzed or considered when implementing change. The lack of consideration of contextual factors has negative implications not only for successfully implementing primary health care (PHC) innovations, but also for their sustainability and scalability. For this evaluation, data collection was conducted using self-administered questionnaires and follow-up telephone interviews with team representatives. We used a combination of directed and conventional content analysis approaches to analyze the questionnaire and interview data. Representatives from all 12 teams completed the questionnaire and 11 teams participated in the interviews; 40 individuals participated in this evaluation. Four themes representing contextual factors that impacted the implementation of CBPHC innovations were identified: (I) diversity of jurisdictions (II) complexity of interactions and collaborations (III) policy, and (IV) the multifaceted nature of PHC. The teams used six strategies to address these contextual factors including: (1) conduct an environmental scan at the beginning (2) maintaining engagement among partners and stakeholders by encouraging open and inclusive communication; (3) contextualizing the innovation for different settings; (4) anticipating and addressing changes, delays, and the need for additional resources; (5) fostering a culture of research and innovation among partners and stakeholders; and (6) ensuring information about the innovation is widely available. Implementing CBPHC innovations across jurisdictions is complex and involves navigating through multiple contextual factors. Awareness of the dynamic nature of context should be considered when implementing innovations.
Background: Motor evoked potentials (MEP’S) measure myelin/axonal integrity of the central nervous system. MEP’s reliability and correlation to conventional clinical measures in multiple sclerosis (MS) patients have yet to be demonstrated. Alemtuzumab is a high efficacy therapy used in patients with MS. Its longitudinal impact on electrophysiological measures has yet to be examined. Methods: This is a single center, observational study. 10 patients with MS who received their first cycle of alemtuzumab within less than 3 months were evaluated with both clinical and MEP’s measures at baseline and every 6 months thereafter for 36 months. MEP’s were repeated two weeks after every time point. We report our preliminary analyses. Results: Patient follow-up ranges from 6 to 36 months. The intraclass correlation coefficient (ICC) between two consecutive time points were good with values of 0.774 for the biceps and 0.867 for the tibialis anterior with p values less than 0.0005 for both. The correlation for the biceps MEP’s to the 9 hole peg test (9HPT) was 0.51 with p less than 0.0005 and for the tibialis anterior MEP’s to the 6 minute walk test (6MWT) was -0.411 with p=0.01. Conclusions: Our preliminary analyses demonstrate that MEP results are reproducible and correlate with clinical measures.
Background: Sotos syndrome is a genetic condition caused by NSD1 alterations, characterized by overgrowth, macrocephaly, dysmorphic features, and learning disability. Approximately half of children with Sotos syndrome develop seizures. We investigated the spectrum of seizure phenotypes in these patients. Methods: Patients were recruited from clinics and referral from support groups. Those withclinical or genetic diagnosis of Sotos syndrome and seizures were included. Phenotyping data was collected via structured clinical interview and medical chart review. Results: 25 patients with typical Sotos syndrome features were included. Of 14 tested patients, 64% (n=9) had NSD1 alterations. Most had developmental impairment (80%, n=20) and neuropsychiatric comorbidities (68%, n=17). Seizure onset was variable (2 months to 12 years). Febrile and absence seizures were the most frequent types (64%, n=16). Afebrile generalized tonicclonic (40%, n=10) and atonic (24%, n=6) seizures followed. Most patients (60%, n=15) had multiple seizure types. The majority (72%, n=18) was controlled on a single antiepileptic, or none; 4% (n=1) remained refractory to antiepileptics. Conclusions: The seizure phenotype in Sotos syndrome most commonly involves febrile convulsions or absence seizures. Afebrile tonic-clonic or atonic seizures may also occur. Seizures are typically well-controlled with antiepileptics. The rate of developmental impairment and neuropsychiatric comorbidities is high.
Surveillance of dialysis-related bloodstream infections (DRBSIs) has been mandatory in Québec since April 2011. The aim of this study was to describe the epidemiology of DRBSIs in Québec.
Cohort study of prevalent patients undergoing chronic dialysis in the 36 facilities that participated without interruption in the provincial surveillance, between April 2011 and March 2017. Two indicators were analyzed: proportion of patient months dialyzed using a fistula (a patient month is a 28-day cycle during which an individual patient received dialysis) and incidence rate of DRBSI. Binomial and Poisson regression with generalized estimating equations were used to describe the evolution of indicators over time and to quantify the association between facilities’ proportion of fistulas and their incidence rate.
Globally, 42.6% of all patient months were dialyzed using a fistula, but there was a statistically significant decrease over time (46.2% in 2011–2012 to 39.3% in 2016–2017). Despite this decline in the use of fistulas, rates of DRBSIs have also decreased, going from 0.38 DRBSIs per 100 patient months in 2011–2012 to 0.23 DRBSIs per 100 patient months in 2016–2017. No association was found between facility use of fistulas and the rate of DRBSI. At the individual level, however, the DRBSI rate was 4.12 times higher for patients using a catheter.
In Québec, the rate of DRBSIs has decreased over a 6-year period despite an increasing proportion of patients dialyzed by catheter.
Quantum theory underpins much of modern physics and its implications draw the attention of industry, academia and public funding agencies. However there are many unsettled conceptual and philosophical problems in the interpretation of quantum mechanics which are a matter of extensive debate. These hotly debated topics include the meaning of the wave function, the nature of the quantum objects, the role of the observer, the non-locality of the quantum world, and the emergence of classicality from the quantum domain. Containing chapters written by eminent researchers from the fields of physics and philosophy, this book provides interdisciplinary, comprehensive and up-to-date perspectives of the problems related to the interpretation of quantum theory. It is ideal for academic researchers in physics and philosophy working on the ontology of quantum mechanics.