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Asteroids represent a time capsule, storing information about the composition of and conditions in the solar nebula as well as processes that have affected the Solar System. The asteroid population includes primitive bodies, partially melted material, and the result of full melting and differentiation of planetesimals. Asteroidal minerals, organic molecules, and ices that are relevant to uncovering the history of the Solar System are accessible spectroscopically. Reflection and thermal emission spectroscopy from ground-based telescopes, space telescopes, and spacecraft provide a rich view of asteroid surfaces. Analysis techniques, including taxonomic classification, direct comparisons to meteorites and pure materials, band parameter analysis, and physical models of light scattering, are customized to the specific science question under study. In recent years, spacecraft missions to asteroids have provided ground-truth to more remote spectral analyses, corroborating many inferences from ground-based observations, while enabling new discoveries and a richer, deeper view of asteroid surfaces. These compositional studies provide an important complement to and constraint on dynamical investigations of Solar System evolution. The future of asteroid science is bright, with advances expected in the areas of sample return, additional reconnaissance missions, improved wavelength coverage spectroscopy, and significant increases in the size of the database of asteroid spectra.
An increased incidence of CHD has been noted in twin gestations and in infants conceived using assisted reproductive technologies. However, CHD in these populations remains understudied and the mechanisms underlying these phenomena remain unclear. We present the case of twins conceived via in vitro fertilisation both with Tetralogy of Fallot and additional cardiac and extracardiac malformations.
A central and critical step in the molecular detection of soil-transmitted helminths from environmental sources is the extraction of DNA from the eggs. In this study, we investigated the yield of DNA extracted from known quantities (500, 100, 50, 20, 10 and 5) of Ascaris suum eggs, as well as directly from wastewater and sludge samples containing Ascaris spp. eggs, using six commercial DNA extraction kits. The amount of DNA extracted was quantified with NanoDrop, Qubit and Ct values from quantitative polymerase chain reaction (qPCR) assay using CFX96 Touch™ real-time PCR equipment. The PowerLyzer Ultraclean Microbial DNA isolation kit and PowerSoil DNA isolation kit gave the highest yield of DNA based on the NanoDrop, Qubit and Ct values. However, the qPCR results indicate that in some of the kits, PCR inhibitors may have been carried over to the PCR reaction. DNA extraction kits that incorporate a bead-beating step as well as other mechanical eggshell disruption steps were superior in extracting DNA from Ascaris spp. eggs. Additionally, for the accurate quantification of extracted DNA, the use of Ct values from qPCR and Qubit readings gives better results compared to the NanoDrop readings. For efficient downstream applications, the use of DNA extraction kits with superior inhibitor removal technology is essential, in addition to a high yield of DNA.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Proteomics based clinical diagnostics systems utilize the principle of protein identification as a means of biomarker profiling for disease diagnosis. The current standardized immunoassay techniques such as Enzyme linked Immunosorbent Assays (ELISA) are based on the fluorescent detection of the antibody (Ab)-antigen (Ag) binding event. These techniques are expensive; time consuming requiring a large sample volume. We present here two electrical immunoassay techniques that can potentially used for the rapid, multiplexed diagnosis of proteins for disease identification. The first technique involves the use of nanoporous templates in conjunction with microfabricated platforms with metallic base electrodes resulting In the formation of a “nanowell” assay system that is analogous to the micro titer well plate system. The detection of the formation of binding complex is achieved by capacitive measurement techniques. The dynamic range and the calibration of the device has been performed with respective to the current gold standard in proteomics. The second technique involves the use of microscale carriers to transport ab’s to sensing sites on microfabricated base platforms. The binding of the Ag’s to the Ab’s coupled to the carriers’ results in measurable voltage changes that are recorded in a real time manner. The calibration and the dynamic range of this device has also been determined. Both these techniques demonstrate potential as early diagnostic devices and their performance in detection of clinically relevant proteins is demonstrated.
The compassion of healthcare workers towards patients is widely recognized, but research suggests a dearth of compassion among co-workers. Indeed, workplace bullying and negative employee outcomes are over-represented in the healthcare sector (including burnout and substantial staff turnover). In this paper, we discuss the cultivation of compassion for healthcare workers, using the lens of positive organizational scholarship. Our concern is not only with the individual level compassion (i.e. between employees), we also consider how compassion can be cultivated systemically across healthcare institutions at the organizational level. More specifically, we present a proposed Noticing, Empathising, Assessing and Responding Mechanisms Model of Organizational Compassion as a tool for consciously cultivating workplace compassion in healthcare organizations.
Background: Post-craniotomy pain can be severe and is often undermanaged. Opioids can interfere with neurological monitoring and are associated with adverse effects. This systematic review aimed to identify measures of opioid-free analgesia and compare their effectiveness with opioid analgesia for post-craniotomy pain in patients with supratentorial tumors. Methods: EMBASE, MEDLINE, and Cochrane databases were searched from their inception to February 14, 2017, for randomized controlled trials (RCTs) evaluating opioid versus non-opioid analgesia post-supratentorial craniotomy. Two reviewers independently carried out study selection and data extraction. Risk of bias assessment was performed using the Cochrane Collaboration’s tool. Outcomes were pain control (changes to pain scores or use of rescue analgesia) and adverse effects. Considering the number of studies and heterogeneity, a narrative synthesis was done without pooling and results were summarized using tables. Non-opioids were assessed for the potential to be equivalent to opioid-based analgesics for pain relief and adverse effects. Results: Of 467 RCTs, 4 met our inclusion criteria (n = 186 patients). Patients with scalp blocks (2 RCTs) had less post-operative nausea and vomiting (PONV), but scalp block was not superior to morphine for analgesia. Acetaminophen (1 RCT) was less likely to induce PONV but provided inadequate pain relief compared to morphine and sufentanil. Dexmedetomidine (1 RCT) was not superior to remifentanil for analgesia although it delayed time to rescue analgesia. Conclusions: Limited evidence suggests that scalp blocks and dexmedetomidine have the potential to eliminate the need for opioid analgesia. Multimodal analgesia should be considered as significant opioid-sparing effects have been shown.
Background: Migraine is a common disorder most typically presenting as headache and often associated with vertigo and motion sickness. It is a genetically complex condition with multiple genes ultimately contributing to the predisposition and development of this episodic neurological disorder. We identified a large American family of 29 individuals of which 17 members suffered from at least one of these disorders, migraine, vertigo, or motion sickness. Many of these individuals suffered from several simultaneously. We hypothesized that vertigo and motion sickness may involve genes that are independent to those directly contributing to migraine susceptibility. Methods: Genome-wide linkage analysis performed using 400 microsatellite repeat markers spaced at 10 cM throughout the genome. The members of this family were phenotyped for each condition, migraine, vertigo, and motion sickness and analyzed separately. Statistical analysis was performed using two-point and multipoint linkage analysis employing a number of models including autosomal recessive or dominant patterns of inheritance with high and low genetic penetrance. Results: We identified a novel locus for migraine, 9q13-q22 (maximum two-point logarithm of odds [LOD] score-2.51). In addition, there are suggestive LOD scores that localize to different chromosomes for each phenotype; vertigo (chromosome 18, LOD score of 1.82) and motion sickness (chromosome 4, LOD score of 2.09). Conclusions: Our analysis supports our hypothesis that the migraine-associated vertigo and motion sickness may involve distinct susceptibility genes.
Background: The Endoscopic endonasal approach (EEA) has been gaining popularity in the past decade as an alternative to traditional transcranial and transorbital approaches. We have performed orbital apex decompression for a variety of pathological entities. Methods: We performed a retrospective chart review on patients who underwent EEA orbital apex decompression between January 1st 2010 and December 1st 2018 at McMaster University. Results: Eight patients underwent endoscopic endonasal orbital decompression at our center, including five male patients and three female patients. The mean age of our patients was 50.1 years. The different pathologies we treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 disease, inverted papilloma, angioleiomyoma, and neuroendocrine paraganglioma. Five patients presented with visual symptoms. Postoperatively, one of these five patients improved to baseline, three had stable vision, another one had progressive visual decline despite surgical intervention. Conclusions: Endoscopic endonasal approach can be used as an alternative to decompress orbital apex pathologies in selected patients.
Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p<0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p<0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p<0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.
Background: Central neurocytoma’s are typically located in the lateral ventricles and are optimally treated with surgical resection. Surgical entry into the ventricles are associated with a number of complications, including subdural hygroma and shunt-dependent hydrocephalus. Methods: We report a patient who developed acute bilateral uncal herniation from progessively enlarging subdural hygromas following intraventricular tumour resection. Results: A 60-year-old female underwent minimally invasive transcortical transventricular resection of an intraventricular CN. The patient’s postoperative course was complicated by repeated presentations to the emergency department due to persistent and intractable nausea and headaches, without focal neurological deficits. Imaging demonstrated small bilateral subdural hygromas. The patient eventually presented with acute deterioration in her level of consciousness with clinical and radiologic evidence of bilateral uncal herniation, requiring urgent insertion of a subdural drain to treat elevated intracranial pressure (ICP). After insertion of a ventriculoperitoneal shunt, the patient was discharged in stable condition and is currently followed by the multi-disciplinary neuro-oncology team. Conclusions: Bilateral subdural hygroma could mask underlying external hydrocephalus post transventricular surgeries. Patients who are symptomatic from bilateral subdural hygromas after transventricular resection of tumors should be carefully monitored for radiographic or clinical progression, in order to avoid acute deterioration caused by elevated ICP.
The developments leading to the global financial crisis and experiences with policy responses have led to an inconclusive but fundamental rethinking on the practice of public policy. We know that the intellectual framework that prevailed before 2008 was not sustainable. We are yet to agree on what the new normal should be, except that money and finance are critical, though one part, and that excess finance is injurious to health. But right sizing finance cannot happen if the attention is confined to finance. We are in search of new balances not only between finance and real economy, but also between state and market, between national and global, and between old global economic order and evolving new one.
It is often argued that the ongoing financial crisis reflects excessive belief in the efficiency and self-correcting mechanisms of markets. It is, therefore, argued that the state should be empowered so that the balance between the state and the market is restored. Consequently, the policy prescriptions are essentially in the nature of creating a strengthened role for state, broadly defined to include intervention in the functioning of markets by the public policy.
It is possible to argue that the recent financial crisis represents the failure of both the market and the state. The apparatus of the state, in particular the independent central banks and regulators, seem to have failed to discharge the duties assigned and deliver the outcomes that they had assured. There are sufficient grounds to believe that the crisis is a result of the capture of the governments by the markets, especially by the financial institutions and financial markets. In other words, it can be argued that the crisis was caused by not a mere failure of regulators but a capture of the regulators and the governments by the financial markets. This plausible explanation of the crisis warrants an entirely different dimension to the traditional debate of state versus market. The debate may have to focus on the relationship between the state and the market in each country, on one hand, and the relationship between the nation states, national financial markets and international financial markets, on the other.
Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.
To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.
The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel
Disaster response programs should ensure:
Collection of data to identify vulnerable populations
Establishment of procedures for monitoring and reporting
Inclusion of female staff at all levels of planning and response
Implementation of holistic services including physical and psychosocial care and legal response
Safety in designing accommodations and distribution centers
Pre-Deployment training should include:
Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence
Familiarity with behaviors and conditions associated with gender-based violence
Non-judgmental, supportive, and validating approach to inquiry and response
Familiarity with risk assessment tools
Mobilization of social supports
Knowledge of resources, including medical and legal services
Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.
New Zealand's ageing population and health inequities for Māori (Indigenous peoples) have prompted calls for innovative, culturally based approaches to improving health and wellbeing, and managing transitions in later life. This is particularly important for kaumātua (Māori elders) who, despite cultural strength and resilience, carry a significant burden in health, economic and social inequities. This paper describes the culture-centred development of a ‘tuakana‒teina’ (elder sibling‒younger sibling) peer support education programme designed to help kaumātua support other kaumātua experiencing transitions in later life. Taking a strengths-based approach that highlights ‘kaumātua mana motuhake’ (elder independence and autonomy), the study used kaupapa Māori (Māori approach, knowledge, skills, attitudes and values) and community-based participatory research methodology, to develop and pilot a culture-centred tuakana‒teina/peer education programme. Methods included establishing two advisory groups (one of kaumātua and one of sector experts); holding five focus groups with kaumātua; and running a pilot programme with 21 kaumātua. The findings demonstrate the value in a strengths-based approach that centralises Māori culture and kaumātua potential, capacity and ability, and recognises the continuing value and contribution of kaumātua to society. The study helps shift the focus from dominant stereotypes of ageing populations as a burden on society and shows the value of kaumātua supporting others during transitions in later life.
Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).
Retrospective observational study.
We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.
Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.
Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.
The shear-induced collective diffusivity down a concentration gradient in a viscous emulsion is computed using direct numerical simulation. A layer of randomly packed drops subjected to a shear flow, shows the layer width to increase with the
power of time, consistent with a semi-dilute theory that assumes a diffusivity linear with concentration. This characteristic scaling and the underlying theory are used to compute the collective diffusivity coefficient. This is the first ever computation of this quantity for a system of deformable particles using fully resolved numerical simulation. The results match very well with previous experimental observations. The coefficient of collective diffusivity varies non-monotonically with the capillary number, due to the competing effects of increasing deformation and drop orientation. A phenomenological correlation for the collective diffusivity coefficient as a function of capillary number is presented. We also apply an alternative approach to compute collective diffusivity, developed originally for a statistically homogeneous rigid sphere suspension – computing the dynamic structure factor from the simulated droplet positions and examining its time variation at small wavenumber. We show that the results from this alternative approach qualitatively agree with our computation of collective diffusivity including the prediction of the non-monotonic variation of diffusivity with the capillary number.
A cyclotomic polynomial
is an essential cyclotomic factor of
and every prime divisor of
is less than or equal to the number of terms of
We show that if a monic polynomial with coefficients from
has a cyclotomic factor, then it has an essential cyclotomic factor. We use this result to prove a conjecture posed by Mercer [‘Newman polynomials, reducibility, and roots on the unit circle’, Integers12(4) (2012), 503–519].
We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).
Prospective, observational study.
The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital.
HCWs who cared for patients on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines.
We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69; P = .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76; P = .025).
When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.
To evaluate the feasibility and potential effectiveness of a lifestyle intervention (diet and physical activity) among women with history of gestational diabetes mellitus (GDM), delivered by trained facilitators.
Fifty-six normoglycaemic or prediabetic women with prior GDM were recruited at mean of 17 months postpartum. Socio-demographic, medical and anthropometric data were collected. Six sessions on lifestyle modification were delivered in groups (total four groups, with 12–15 women in each group). Pre and post intervention (6 months) weight, body mass index (BMI), waist circumference, 75 g oral glucose tolerance test, blood pressure (BP) and lipid parameters were compared.
The intervention was feasible, with 80% of women attending four or more sessions. Post-intervention analyses showed a significant mean reduction of 1.8 kg in weight, 0.6 kg/m2 in BMI and 2 cm in waist circumference. There was also a significant drop of 0.3 mmol/L in fasting plasma glucose, 0.9 mmol/L in 2 h post glucose load value of plasma glucose, 3.6 mmHg in systolic BP, and 0.15 mmol/L in triglyceride levels. Changes in total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and diastolic BP were non-significant.
This study showed feasibility of the lifestyle intervention delivered in group sessions to women with prior gestational diabetes.