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Systematic, national surveillance of outbreaks of intestinal infectious disease has been undertaken by Public Health England (PHE) since 1992. Between 1992 and 2002, there were 19 outbreaks linked to raw drinking milk (RDM) or products made using raw milk, involving 229 people; 36 of these were hospitalised. There followed an eleven-year period (2003–2013) where no outbreaks linked to RDM were reported. However, since 2014 seven outbreaks of Escherichia coli O157:H7 (n = 3) or Campylobacter jejuni (n = 4) caused by contaminated RDM were investigated and reported. Between 2014 and 2017, there were 114 cases, five reported hospitalisations and one death. The data presented within this review indicated that the risk of RDM has increased since 2014. Despite the labelling requirements and recommendations that children should not consume RDM, almost a third of outbreak cases were children. In addition, there has been an increase in consumer popularity and in registered RDM producers in the UK. The Food Standards Agency (FSA) continue to provide advice on RDM to consumers and have recently made additional recommendations to enhance existing controls around registration and hygiene of RDM producers.
To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU.
We performed a single-institution retrospective cohort study (11 January 2013–16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children’s hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model’s discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest.
The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%.
Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
It was not the reputation of a famous leader in the wars which he sought (as it was construed a great while) but only power and greatness to serve his own ends, considering he never loved virtue nor valor in another, but where he thought he should be proprietary and commander of it, as referred to himself.
Francis Bacon on the earl of Essex
Critics have long noted Othello's connection to the miles gloriosus or ‘braggart soldier’ of classical comedy and Italian commedia dell'arte, but on what to make of this connection there is little agreement. Thomas Rymer commented in the late seventeenth century that Othello's ‘love and his jealousy are no part of a soldier's character, unless for comedy’. But Othello is not a comedy or, if it is a comedy, it is not a very funny one. Rymer called the play a ‘bloody farce’ but ‘without salt or savour’, and recent critics have found the lack of salt and savour sufficient reason to question its connections to the braggart soldier tradition. Kenneth Muir suggests the comic echoes are misleading. ‘Far from being a braggart soldier, Othello is modest in his claims’, Muir contends, and ‘his frequent expressions of self-esteem would be regarded by Shakespeare's audience, not as vanity, but as legitimate and proper pride’. Other critics have found the comic echoes to amplify Othello's tragic force. The shadow of the comic braggart creates a ‘strange and contradictory experience’, in Teresa J. Faherty's reading. As Othello's noble facade erodes, the features he shares with the braggart soldier – his bullying and misogyny – become ‘newly disturbing’. Stephen Rogers contends that ‘Othello is not the miles gloriosus. But the music of his utterance and the splendor of his nobility are reduced to the solemn and pathetic counterparts of the comic soldier's vanities.’
The comedic echoes in Othello are less confusing, however, when both the play and the braggart soldier are viewed in the context of the discourses on Elizabethan veterans.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.
It is commonly held that we wrong someone if we punish them without first determining whether they are guilty through the process of a sufficiently fair and reliable procedure. This wrong is best explained by pre-institutional moral procedural rights. Recently, Christopher Heath Wellman has argued for the skeptical conclusion that there are no such rights, challenging a widely held orthodoxy. I propose two novel grounds for pre-institutional moral procedural rights and so answer Wellman's skepticism. First, we have rights not to be subject to punitive systems that do not include specific sorts of reliable procedures because otherwise we are subject to unreasonable risks of undeserved punishment. Second, not only do we have rights that others not harm us or unreasonably risk harming us, we have rights that they control for avoiding wrongfully harming us across relevant close possible worlds.
False generalisations have often been made about the use of hyperbaton in Latin prose. According to Hofmann-Szantyr, for instance, ‘die klass. Prosa geht im Gebrauch des Hyperbatons…kaum über die Praxis des Aldateins hinaus'. The same scholars also imply that even when Cicero and Caesar do separate a substantive from its attribute, the separating word is seldom a verb. Again, E. Fraenkel, while showing that long disjunctions are common in Cicero, has maintained that hyperbaton ‘vielmehr ist… in der Umgangssprache zuhause’.
E. Skard has recendy pointed out the frequency with which Cornelius Nepos uses hyperbaton of the kind which comprises a substantive separated from its attribute by a verb. Since Skard accepts the above assertions of Hofmann-Szantyr, he is led to suggest that Nepos must have been following a Greek master. The favoured candidate is Dionysius of Halicarnassus. Dionysius not only has hyperbaton more often than any earlier Greek prose author; his work περὶ ἐνδόξων ἀνδρῶν may have been a source for some of Nepos' biographies.
It is the purpose of this paper to discuss the history of one type of hyperbaton in Latin prose, that consisting of a verb standing between a substantive and its adjective (henceforth for convenience referred to as ‘verbal hyperbaton’). It will be demonstrated that, however easy disjunction might seem in a synthetic language, our device was artistic rather than natural to ordinary speech. The statements of Hofmann-Szantyr mentioned above will be shown to be inaccurate, and Skard's hypothesis to be unnecessary.
Designing effective control for complex three-dimensional flow fields proves to be non-trivial. Often, intuitive control strategies lead to suboptimal control. To navigate the control space, we use a linear parabolized stability analysis to guide the design of a control scheme for a trailing vortex flow field aft of a NACA0012 half-wing at an angle of attack
and a chord-based Reynolds number
. The stability results show that the unstable mode with the smallest growth rate (fifth wake mode) provides a pathway to excite a vortex instability, whereas the principal unstable mode does not. Inspired by this finding, we perform direct numerical simulations that excite each mode with body forces matching the shape function from the stability analysis. Relative to the uncontrolled case, the controlled flows show increased attenuation of circulation and peak streamwise vorticity, with the fifth-mode-based control set-up outperforming the principal-mode-based set-up. From these results, we conclude that a rudimentary linear stability analysis can provide key insights into the underlying physics and help engineers design effective physics-based flow control strategies.
Ischemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.
This study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).
A retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.
Barriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).
Barriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.
LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care. Prehosp Disaster Med.2018;33(5):501–507.
Repeated measurements of the same countries, people, or groups over time are vital to many fields of political science. These measurements, sometimes called time-series cross-sectional (TSCS) data, allow researchers to estimate a broad set of causal quantities, including contemporaneous effects and direct effects of lagged treatments. Unfortunately, popular methods for TSCS data can only produce valid inferences for lagged effects under some strong assumptions. In this paper, we use potential outcomes to define causal quantities of interest in these settings and clarify how standard models like the autoregressive distributed lag model can produce biased estimates of these quantities due to post-treatment conditioning. We then describe two estimation strategies that avoid these post-treatment biases—inverse probability weighting and structural nested mean models—and show via simulations that they can outperform standard approaches in small sample settings. We illustrate these methods in a study of how welfare spending affects terrorism.
While research on conspiracy theories and those who believe them has recently undergone a renaissance, there still exists a great deal of uncertainty about the measurement of conspiratorial beliefs and orientations, and the consequences of a conspiratorial mindset for expressly political attitudes and behaviors. We first demonstrate, using data from the 2012 American National Election Study, that beliefs in a variety of specific conspiracy theories are simultaneously, but differentially, the product of both a general tendency toward conspiratorial thinking and left/right political orientations. Next, we employ unique data including a general measure of conspiratorial thinking to explore the predictors of specific conspiracy beliefs. We find that partisan and ideological self-identifications are more important than any other variable in predicting ‘birther’ beliefs, while conspiratorial thinking is most important in predicting conspiracy beliefs about the assassination of John F. Kennedy and the 9/11 terrorist attacks.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Survey and laboratory experiments are increasingly common in political science. Investment in experimental data collection comes with costs and benefits, particularly for graduate students and advisers. This article describes a set of institutionalized procedures we have adopted with the goal of capitalizing on the advantages that come with experimental research. This includes requiring planning documents, holding research-group meetings, and centralizing data collection. We conclude by discussing the limitations of our approach, ultimately highlighting the need for more disciplinary conversation about how to best structure research groups to produce quality research and advising.
We analyse unsteady cavity dynamics, cavitation patterns and instability mechanisms governing partial cavitation in the flow past a sharp convergent–divergent wedge. Reproducing a recent reference experiment by numerical simulation, the investigated flow regime is characterised by large-scale cloud cavitation. In agreement with the experiments, we find that cloud shedding is dominated by the periodic occurrence of condensation shocks, propagating through the two-phase medium. The physical model is based on the homogeneous mixture approach, the assumption of thermodynamic equilibrium, and a closed-form barotropic equation of state. Compressibility of water and water vapour is taken into account. We deliberately suppress effects of molecular viscosity, in order to demonstrate that inertial effects dominate the flow evolution. We qualify the flow predictions, and validate the numerical approach by comparison with experiments. In agreement with the experiments, the vapour volume fraction within the partial cavity reaches values
for its spanwise average. Very good agreement is further obtained for the shedding Strouhal number, the cavity growth and collapse velocities, and for typical coherent flow structures. In accordance with the experiments, the simulations reproduce a condensation shock forming at the trailing part of the partial cavity. It is demonstrated that it satisfies locally Rankine–Hugoniot jump relations. Estimation of the shock propagation Mach number shows that the flow is supersonic. With a magnitude of only a few kPa, the pressure rise across the shock is much lower than for typical cavity collapse events. It is thus far too weak to cause cavitation erosion directly. However, by affecting the dynamics of the cavity, the flow aggressiveness can be significantly altered. Our results indicate that, in addition to classically observed re-entrant jets, condensation shocks feed an intrinsic instability mechanism of partial cavitation.