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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.
Introduction: Emergency department (ED) staff carry a high risk for the burnout syndrome of increased emotional exhaustion, depersonalization and decreased personal accomplishment. Previous research has shown that task-oriented coping skills were associated with reduced levels of burnout compared to emotion-oriented coping. ED staff at one hospital participated in an intervention to teach task-oriented coping skills. We hypothesized that the intervention would alter staff coping behaviors and ultimately reduce burnout. Methods: ED physicians, nurses and support staff at two regional hospitals were surveyed using the Maslach Burnout Inventory (MBI) and the Coping Inventory for Stressful Situations (CISS). Surveys were performed before and after the implementation of communication and conflict resolution skills training at the intervention facility (I) consisting of a one-day course and a small group refresher 6 to 15 months later. Descriptive statistics and multivariate analysis assessed differences in staff burnout and coping styles compared to the control facility (C) and over time. Results: 85/143 (I) and 42/110 (C) ED staff responded to the initial survey. Post intervention 46 (I) and 23(C) responded. During the two year study period there was no statistically significant difference in CISS or MBI scores between hospitals (CISS: (Pillai's trace = .02, F(3,63) = .47, p = .71, partial η2 = .02); MBI: (Pillai's trace = .01, F(3,63) = .11, p = .95, partial η2 = .01)) or between pre- and post-intervention groups (CISS: (Pillai's trace = .01, F(3,63) = .22, p = .88, partial η2 = .01); MBI: (Pillai's trace = .09, F(3,63) = 2.15, p = .10, partial η2 = .01)). Conclusion: We were not able to measure improvement in staff coping or burnout in ED staff receiving communication skills intervention over a two year period. Burnout is a multifactorial problem and environmental rather than individual factors may be more important to address. Alternatively, to demonstrate a measurable effect on burnout may require more robust or inclusive interventions.
Introduction: In Nova Scotia, under the Paramedics Providing Palliative Care program, paramedics can now manage symptom crises in patients with palliative care goals and often at home without the need to transport to hospital. Growing recognition that non-cancer conditions benefit from a palliative approach is expanding the program. Our team previously found treatment of pain and breathlessness is not optimized, pain scores are underutilized, and paramedics were more comfortable (pre-launch) with a palliative approach in cancer versus non-cancer conditions. Our objective was to compare symptom management in cancer versus non-cancer subgroup. Methods: We conducted a retrospective cohort study. The Electronic Patient Care Record and Special Patient Program were queried for patients with palliative goals from July 1, 2015 to July 1, 2016. Descriptive analysis was conducted and results were compared with a t-test and Bonferroni correction (alpha = p < 0.007). Results: 1909 unique patients; 765/1909 (40.1%) cancer and 1144/1909 (59.9%) non-cancer. Female sex: cancer 357/765 (46.7%), non-cancer 538/1144 (47.0%). Mean age cancer: 73.3 (11.65), non-cancer 77.7 (12.80). Top non-cancer conditions: COPD (495/1144, 43.3%), CHF (322/1144, 28.1%), stroke (172/1144, 15.0%) and dementia (149/1144, 13.0%). Comorbidities for cancer patients (range): 0 to 3; non-cancer 0 to 5. Most common chief complaint (CC) for cancer and non-cancer: respiratory distress, 10.8% vs 21.5%. Overall, no difference in proportion treated cancer vs non-cancer, 11.5% vs 10.1%, p = 0.35. Some difference in individual therapies: morphine 83/765 (10.8%) vs 55/1144 (4.8%), p < 0.001, hydromorphone 9/765 (1.2%) vs 2/1144 (0.2%), p = 0.014, salbutamol 38/765 (5.0%) vs 5/1144 (0.4%), p < 0.001 and ipratropium 27/765 (3.5%) vs 134/1144 (11.7%), p < 0.001, in addition to any support with home medication which is not queriable. Pre-treatment pain scores were documented more often than post-treatment in both groups (58.7% vs 25.6% (p < 0.001), 57.4% vs 26.9% (p < 0.001)). Conclusion: Non-cancer patients represent an important proportion of palliative care calls for paramedics. Cancer and non-cancer patients had very similar CC and received similar treatment, although low proportions, despite pre-launch findings that non-cancer conditions were likely to be undertreated. Pain scores remain underutilized. Further research into the underlying reason(s) is required to improve the support of non-cancer patients by paramedics.
Field studies were conducted to determine the possible rate and timing of nicosulfuron to suppress annual ryegrass (ARG) seeded as a cover crop at the time of corn planting without affecting corn performance near Ridgetown, ON, Canada, in 2016 and 2017. Nicosulfuron was applied at rates from 0.8 to 50 g ai ha–1 when the ARG was at the two- to three- or four- to five-leaf stages, or approximately 3 or 4 wk after emergence of both corn and ARG. There were no differences between the two application timings in grain yield responses or ARG suppression. As the rate of nicosulfuron increased from 0.8 to 50 g ai ha–1, ARG was suppressed 6% to 76% and 5% to 96%, at 1 and 4 wk after application (WAA), respectively. At 4 WAA, ARG biomass decreased from 29 to 1 g m–2 as the rate of nicosulfuron increased from 0.8 to 50 g ai ha–1, compared to 36 g m–2 in the untreated control. Where nicosulfuron was not applied to ARG, grain corn yield was reduced by 6% compared to the ARG-free control; similar effects on corn yield were observed with nicosulfuron at the lowest rate applied at 0.8 g ai ha–1. Grain corn yield was reduced by 2.5% with the application of nicosulfuron at 25 g ai ha–1 (label rate for corn) compared to no ARG control, but this was not statistically significant. This study identified rates of nicosulfuron that suppressed ARG when emerged approximately the same day as corn, but there was evidence that grain corn yields were lowered because of interference, possibly during the critical weed control period. Based on this study, an ARG cover crop should not be seeded at the same time as corn unless one is willing to accept a risk for corn grain yield losses for the sake of the cover crop.
This paper is based on part of the thesis of one of the authors (5), submitted at the University of Toronto in 1963. In the first part of the paper a result on induced representations (2, 4, 9) is generalized slightly and a number of corollaries are derived. In the rest of the paper a special case of this result is applied to put the representation theory of the alternating group on a par with that of the symmetric group. A knowledge of the representation theory of Sn (7) on the part of the reader is assumed.
The study of the modular representation theory of the symmetric group has been greatly facilitated lately by the introduction of the graph (9, III ), the q-graph (5) and the hook-graph (4) of a Young diagram [λ]. In the present paper we seek to coordinate these ideas and relate them to the r-inducing and restricting processes (9, II ).
The present paper is a sequel to that of J. H. Chung (2) and contains a proof of a conjecture made by him, namely, that the number of ordinary (modular) irreducible representations contained in a given p-block of Sn is independent of the p-core. A summary of the results contained herein appeared in the Proceedings of the National Academy of Sciences (9).
1. Introduction. The problem of the expression of an invariant matrix of an invariant matrix as a direct sum of invariant matrices is intimately associated with the representation theory of the full linear group on the one hand and with the representation theory of the symmetric group on the other. In a previous paper the author gave an explicit formula for this reduction in terms of characters of the symmetric group. Later J. A. Todd derived the same formula using Schur functions, i.e. characters of representations of the full linear group.
If we define the weight b of a Young diagram containing n nodes to be the number of removable p-hooks where n = a + bp, then three fundamental theorems stand out in the modular representation theory of the symmetric group Sn.
1. Introduction. It has been observed (2) that the number of p-regular classes of Sn, i.e. the number of classes of order prime to p, is equal to the number of partitions (λ) of n in which no summand is repeated p or more times. For this relation to hold it is essential that p be prime. It seems natural to call the Young diagram [λ] associated with (λ) p-regular if no p of its rows are of equal length, otherwise p-singular.
Each irreducible representation [λ] of the symmetric group Sn may be identified by a partition [λ] of n into non-negative integral parts λ1 ≥ λ2 ≥ … λn ≥ 0, of which the first λ'j parts are ≥j, or by a right (Young) diagram also called [λ], that contains λi nodes in its ith row and λ'j
nodes in its jth column.
The purpose of this paper is to clarify and sharpen the argument in the last two chapters of the author's Representation theory of the symmetric group(3). When these chapters were written the peculiar properties of the case p = 2 were not fully appreciated. No difficulty arises in the definition of the block in terms of the p-core, or in the application of the general modular theory based on the formula
This paper discusses the sustainability of livestock systems, emphasising bidirectional relations with animal health. We review conventional and contrarian thinking on sustainability and argue that in the most common approaches to understanding sustainability, health aspects have been under-examined. Literature review reveals deep concerns over the sustainability of livestock systems; we recognise that interventions are required to shift to more sustainable trajectories, and explore approaches to prioritising in different systems, focusing on interventions that lead to better health. A previously proposed three-tiered categorisation of ‘hot spots’, ‘cold spots’ and ‘worried well’ animal health trajectories provides a mental model that, by taking into consideration the different animal health status, animal health risks, service response needs and key drivers in each system, can help identify and implement interventions. Combining sustainability concepts with animal health trajectories allows for a richer analysis, and we apply this to three case studies drawn from North Africa and the Middle East; Bangladesh; and the Eastern Cape of South Africa. We conclude that the quest for sustainability of livestock production systems from the perspective of human and animal health is elusive and difficult to reconcile with the massive anticipated growth in demand for livestock products, mainly in low- and middle-income countries, as well as the aspirations of poor livestock keepers for better lives. Nevertheless, improving the health of livestock can contribute to health sustainability both through reducing negative health impacts of livestock and increasing efficiency of production. However, the choice of the most appropriate options must be under-pinned by an understanding of agro-ecology, economy and values. We argue that a new pillar of One Health should be added to the three traditional sustainability pillars of economics, society and environment when addressing livestock systems.
Glyphosate-resistant (GR) and multiple herbicide–resistant (groups 2 and 9) Canada fleabane have been confirmed in 30 and 23 counties in Ontario, respectively. The widespread incidence of herbicide-resistant Canada fleabane highlights the importance of developing integrated weed management strategies. One strategy is to suppress Canada fleabane using cover crops. Seventeen different cover crop monocultures or polycultures were seeded after winter wheat harvest in late summer to determine GR Canada fleabane suppression in corn grown the following growing season. All cover crop treatments seeded after wheat harvest suppressed GR Canada fleabane in corn the following year. At 4 wk after cover crop emergence (WAE), estimated cover crop ground cover ranged from 31% to 68%, a density of 124 to 638 plants m–2, and a range of biomass from 29 to 109 g m–2, depending on cover crop species. All of the cover crop treatments suppressed GR Canada fleabane in corn grown the following growing season from May to September compared to the no cover crop control. Among treatments evaluated, annual ryegrass (ARG), crimson clover (CC)/ARG, oilseed radish (OSR)/CC/ARG, and OSR/CC/cereal rye (CR) were the best treatments for the suppression of GR Canada fleabane in corn. ARG alone or in combination with CC provided the most consistent GR Canada fleabane suppression, density reduction, and biomass reduction in corn. Grain corn yields were not affected by the use of the cover crops evaluated for Canada fleabane suppression.
Many novel therapeutic options for depression exist that are either not mentioned in clinical guidelines or recommended only for use in highly specialist services. The challenge faced by clinicians is when it might be appropriate to consider such ‘non-standard’ interventions. This analysis proposes a framework to aid this decision.
Declaration of interest
In the past 3 years R.H.M.W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, LivaNova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. D.M.B.C. has received fees from LivaNova for attending an advisory board. In the past 3 years A.J.C. has received fees for lecturing from Astra Zeneca and Lundbeck; fees for consulting from LivaNova, Janssen and Allergan; and research grant support from Lundbeck.
In the past 3 years A.C. has received fees for lecturing from pharmaceutical companies namely Lundbeck and Sunovion. In the past 3 years A.L.M. has received support for attending seminars and fees for consultancy work (including advisory board) from Medtronic Inc and LivaNova. R.M. holds joint research grants with a number of digital companies that investigate devices for depression including Alpha-stim, Big White Wall, P1vital, Intel, Johnson and Johnson and Lundbeck through his mindTech and CLAHRC EM roles. M.S. is an associate at Blueriver Consulting providing intelligence to NHS organisations, pharmaceutical and devices companies. He has received honoraria for presentations and advisory boards with Lundbeck, Eli Lilly, URGO, AstraZeneca, Phillips and Sanofi and holds shares in Johnson and Johnson. In the past 3 years P.R.A.S. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending an advisory board) from life sciences companies including Corcept Therapeutics, Indivior and LivaNova. In the past 3 years P.S.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has received funding for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth.
Objectives: This study investigated the relationship between close proximity to detonated blast munitions and cognitive functioning in OEF/OIF/OND Veterans. Methods: A total of 333 participants completed a comprehensive evaluation that included assessment of neuropsychological functions, psychiatric diagnoses and history of military and non-military brain injury. Participants were assigned to a Close-Range Blast Exposure (CBE) or Non-Close-Range Blast Exposure (nonCBE) group based on whether they had reported being exposed to at least one blast within 10 meters. Results: Groups were compared on principal component scores representing the domains of memory, verbal fluency, and complex attention (empirically derived from a battery of standardized cognitive tests), after adjusting for age, education, PTSD diagnosis, sleep quality, substance abuse disorder, and pain. The CBE group showed poorer performance on the memory component. Rates of clinical impairment were significantly higher in the CBE group on select CVLT-II indices. Exploratory analyses examined the effects of concussion and multiple blasts on test performance and revealed that number of lifetime concussions did not contribute to memory performance. However, accumulating blast exposures at distances greater than 10 meters did contribute to poorer performance. Conclusions: Close proximity to detonated blast munitions may impact memory, and Veterans exposed to close-range blast are more likely to demonstrate clinically meaningful deficits. These findings were observed after statistically adjusting for comorbid factors. Results suggest that proximity to blast should be considered when assessing for memory deficits in returning Veterans. Comorbid psychiatric factors may not entirely account for cognitive difficulties. (JINS, 2018, 24, 466–475)
The Foodborne Diseases Active Surveillance Network (FoodNet) conducts population-based surveillance for Campylobacter infection. For 2010 through 2015, we compared patients with Campylobacter jejuni with patients with infections caused by other Campylobacter species. Campylobacter coli patients were more often >40 years of age (OR = 1·4), Asian (OR = 2·3), or Black (OR = 1·7), and more likely to live in an urban area (OR = 1·2), report international travel (OR = 1·5), and have infection in autumn or winter (OR = 1·2). Campylobacter upsaliensis patients were more likely female (OR = 1·6), Hispanic (OR = 1·6), have a blood isolate (OR = 2·8), and have an infection in autumn or winter (OR = 1·7). Campylobacter lari patients were more likely to be >40 years of age (OR = 2·9) and have an infection in autumn or winter (OR = 1·7). Campylobacter fetus patients were more likely male (OR = 3·1), hospitalized (OR = 3·5), and have a blood isolate (OR = 44·1). International travel was associated with antimicrobial-resistant C. jejuni (OR = 12·5) and C. coli (OR = 12) infections. Species-level data are useful in understanding epidemiology, sources, and resistance of infections.