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Introduction: Emergency hospital admissions are a growing concern for patients and health systems, globally. The objective of this study was to systematically review the evidence for diagnostic, medical, and surgical interventions that reduce emergency hospital admissions. Methods: We conducted a systematic review of systematic reviews by searching MEDLINE, PubMED, the Cochrane Database of Systematic Reviews, Google Scholar, and grey literature. Systematic reviews of any diagnostic, surgical, or medical interventions examining the effect on emergency hospital admissions among adults were included. The quality of reviews was assessed using AMSTAR and the quality of evidence was assessed using GRADE. The subsequent analysis was restricted to interventions with moderate or high-quality evidence only. Results: 13 051 titles and abstracts and 1 791 full-text articles were screened from which 42 systematic reviews were included. The reviews included an underlying evidence base of 215 randomized controlled trials with 135 282 patients. Of 20 unique diagnostic, medical, and surgical interventions identified, four had moderate (n = 4) or high (n = 0) quality evidence for significant reductions in hospital admissions in five patient populations. These were: cardiac resynchronization therapy for heart failure and atrial fibrillation, percutaneous aspiration for pneumothorax, early/routine coronary angiography for acute coronary syndrome (alone or comorbid with chronic kidney disease), and natriuretic peptide guided therapy for heart failure. Conclusion: We identified four interventions across five populations that when optimized, may lead to reductions in emergency hospital admissions. These finding can therefore help guide the development of quality indicators, standards, or practice guidelines.
Monolithic integrated thin film tandem solar cells consisting of a high bandgap perovskite top cell and a low bandgap thin film bottom cell are expected to reach higher power conversion efficiencies (PCEs) with lower manufacturing cost and environmental impacts than the market-dominant crystalline silicon photovoltaics. There have been several demonstrations of 4-terminal and 2-terminal perovskite tandem devices with CuInGaSe2 (CIGS) or CuInSe2 (CIS) and, similar to the other tandem structures, the optimization of this device relies on optimal choice for the perovskite bandgap and thickness. Therefore, further advancement will be enabled by tuning the perovskite absorber to maximize the photocurrent limited by the current match condition. Here, we systematically study the optical absorption and transmission of perovskite thin films with varying absorber band gap. Based on these results, we model the photocurrent generations in both perovskite and CIS subcells and estimate the performances of projected tandem devices by considering the ideally functioning perovskite and CIS device. Our results show that for perovskite layers with 500 nm thickness the optimal bandgap is around 1.6 eV. With these configurations, PCEs above 20% could be achieved by monolithically integrated perovskite/CIS tandem solar cells. Also by modelling the absorption at every layer we calculate the quantum efficiency at each subcell in addition to tracking optical losses.
The aim of the present paper is to summarise current and future applications of dietary assessment technologies in nutrition surveys in developed countries. It includes the discussion of key points and highlights of subsequent developments from a panel discussion to address strengths and weaknesses of traditional dietary assessment methods (food records, FFQ, 24 h recalls, diet history with interviewer-assisted data collection) v. new technology-based dietary assessment methods (web-based and mobile device applications). The panel discussion ‘Traditional methods v. new technologies: dilemmas for dietary assessment in population surveys’, was held at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, September 2015. Despite respondent and researcher burden, traditional methods have been most commonly used in nutrition surveys. However, dietary assessment technologies offer potential advantages including faster data processing and better data quality. This is a fast-moving field and there is evidence of increasing demand for the use of new technologies amongst the general public and researchers. There is a need for research and investment to support efforts being made to facilitate the inclusion of new technologies for rapid, accurate and representative data.
Verotoxin-producing Escherichia coli (VTEC) is a significant problem in the under-six population in the Midlands, Ireland. VTEC spreads by person-to-person transmission and children attending childcare facilities are excluded until they achieve two consecutive negative stool samples. This report analyses 10 years data on the number of days children under the age of six take to microbiologically clear VTEC. We identified from our data that the median clearance time for VTEC was 39 days, interquartile range (IQR) 27–56 days, maximum clearance time 283 days. At 70 days from onset of infection, 90% of children had cleared the infection. These findings were slightly more prolonged but consistent with international literature on VTEC clearance times for children. Asymptomatic children cleared VTEC infection significantly faster (median time 25 days IQR 13–43 days) than symptomatic children (median time 43 days IQR 31–58 days). Symptomatic children older than 1 year of age cleared VTEC infection significantly faster (median time 42 days IQR 31–57) than symptomatic children year under 1 year (median time 56 days IQR 35–74 days). This report identifies clear data which can be used to more accurately advise parents on time periods required to achieve microbiological clearance from VTEC.
The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
On May 22, 1989 the Japanese Ginga Team discovered a new X-ray source that was cataloged as GS 2023+338. This source was subsequently identified as coincident in position with a previously known nova cataloged as V404 Cygni. Its last recorded outburst was in 1938 when it rose to about 12th mag. Spectroscopic data were obtained and confirmed the nature of the outburst. Additional ground based data were obtained by us at CTIO and the VLA. The X-ray behavior of this object has been reported to be very unusual and it reached a peak of about 17 crab about one week after discovery. Since then it has varied widely in magnitude at all wavelengths at which it has been studied. We present a brief summary of the observations that have been obtained up to the time of the meeting and shortly thereafter.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
Many astrophysical disks, such as protoplanetary disks, are in a regime where non-ideal, plasma-specific magnetohydrodynamic (MHD) effects can significantly influence the behaviour of the magnetorotational instability (MRI). The possibility of studying these effects in the plasma Couette experiment (PCX) is discussed. An incompressible, dissipative global stability analysis is developed to include plasma-specific two-fluid effects and neutral collisions, which are inherently absent in analyses of Taylor–Couette flows (TCFs) in liquid metal experiments. It is shown that with boundary driven flows, a ion-neutral collision drag body force significantly affects the azimuthal velocity profile, thus limiting the flows to regime where the MRI is not present. Electrically driven flow (EDF) is proposed as an alternative body force flow drive in which the MRI can destabilize at more easily achievable plasma parameters. Scenarios for reaching MRI relevant parameter space and necessary hardware upgrades are described.
Millions of people throughout the tropics consume wild meat. Overhunting reduces food security for people and large predators, yet little is known of the impact of hunting in systems where people and predators target the same prey species. We collate published data on predator diet in Belize with interview data about the consumption of wild and domestic meat by Belizeans, to compare the wild-meat diets of humans, jaguars Panthera onca and pumas Puma concolor and assess the sustainability of the combined offtake by humans and jaguars. Six wild mammal species (nine-banded armadillo Dasypus novemcinctus, paca Cuniculus paca, collared peccary Pecari tajacu, white-lipped peccary Tayassu pecari, red brocket deer Mazama americana and white-tailed deer Odocoileus virginianus) comprised 7% of the animal-protein meals eaten by Belizeans. Overall, 80% of these meals were eaten by 20% of interviewees, suggesting a necessary role of wild meat for the minority. The same species were found in 69 and 86% of jaguar and puma scats, respectively. We estimate a national annual harvest of c. 4,000 tonnes of these six wild mammals by humans and jaguars, of which 78% is hunted by people. Sustainability is difficult to evaluate because prey population data are lacking in Belize. However, simple models suggest that a sustainable harvest at this rate would require higher prey population densities than averages recorded in hunted Neotropical forests. We emphasize the need for robust regional estimates of game species densities, to improve assessments of sustainability and inform hunting regulations. We recommend that the requirements of predators as well as those of people be considered when assessing wild meat harvests.
The excavations of the cemetery groups at Balneaves, Loanleven and Park of Tongland facilitate an examination of many aspects of Bronze Age burial practices in Scotland. They are notable as much for the differences in burial ritual they imply as for the very narrow chronological period in which they were used. The three sites produced a total of seventeen 14C dates, two of which are aberrant, with means of the remaining fifteen falling within a period of 250 years (3370–3610 bp in radiocarbon years). The excavations were sponsored by Historic Scotland (formerly Historic Buildings and Monuments, Scotland).
At Balneaves, a penannular ditch enclosed sixteen features, including a group of seven pits with cremation burials, four of which were associated with a distinctive assemblage of collared urns. The cremated bone was well preserved. At least one large standing stone had been erected on the site, and this was buried in the medieval period.
At Loanleven, only a segment of the enclosing ring-ditch survived, within which were four cists, two containing inhumations and two cremations, one of the latter (Cist 2) associated with a fragment of a food vessel. A decorated slab, in so-called ‘Passage Grave Style’, was recovered from Cist 1, and the same cist produced palynological evidence for grave furnishings in the form of a mat of plant material which probably underlay the body. 14C dates give a terminus ante quem of 3620±50 bp (GU–2543) for the re-use of the decorated slab, and a terminus post quem of 3410±50 bp (GU–2542) for the food vessel grave.
Park of Tongland, regarded as a Four-Poster stone circle, was excavated after the fall of a standing stone. It was shown to be of multi-period construction, consisting of a cairn which overlay seven pits containing fragmentary cremation burials, two associated with collared urns. The standing stones may not all have been erect at the same time. A series of 14C dates fell within the range of 1480–1530 bc.
β-Glucans have been identified as natural biomolecules with immunomodulatory activity. The first objective of the present study was to compare the effects of purified β-glucans derived from Laminariadigitata, L. hyperborea and Saccharomyces cerevisiae on piglet performance, selected bacterial populations and intestinal volatile fatty acid (VFA) production. The second aim was to compare the gene expression profiles of the markers of pro- and anti-inflammation in both unchallenged and lipopolysaccharide (LPS)-challenged ileal and colonic tissues. β-Glucans were included at 250 mg/kg in the diets. The β-glucans derived from L. hyperborea, L. digitata and S. cerevisiae all reduced the Enterobacteriaceae population (P < 0·05) without influencing the lactobacilli and bifidobacteria populations (P>0·05) in the ileum and colon. There was a significant interaction between gastrointestinal region and β-glucan source in the expression of cytokine markers, IL-1α (P < 0·001), IL-10 (P < 0·05), TNF-α (P < 0·05) and IL-17A (P < 0·001). β-Glucans did not stimulate any pro- or anti-inflammatory cytokine markers in the ileal epithelial cells. In contrast, the expression of a panel of pro- and anti-inflammatory cytokines (IL-1α, IL-10, TNF-α and IL-17A) was down-regulated in the colon following exposure to β-glucans from all the three sources. However, the data suggest that the soluble β-glucans derived from L. digitata may be acting via a different mechanism from the insoluble β-glucans derived from L. hyperborea and S. cerevisiae, as the VFA profile was different in the L. digitata-treated animals. There was an increase in IL-8 gene expression (P < 0·05) in the gastrointestinal tract from the animals exposed to L. digitata following an LPS ex vivo challenge that was not evident in the other two treatment groups. In conclusion, β-glucans from both seaweed and yeast sources reduce Enterobacteriaceae counts and pro-inflammatory markers in the colon, though the mechanisms of action may be different between the soluble and insoluble fibre sources.
The passive film stability of several Fe-based amorphous metal formulations have been found to be comparable to that of high-performance Ni-based alloys, and superior to that of stainless steels, based on electrochemical measurements of the passive film breakdown potential and general corrosion rates. Chromium (Cr), molybdenum (Mo) and tungsten (W) provide corrosion resistance; boron (B) enables glass formation; and rare earths such as yttrium (Y) lower critical cooling rate (CCR). The high boron content of this particular amorphous metal also makes it an effective neutron absorber, and suitable for criticality control applications, as discussed in companion publications. Corrosion data for SAM2X5 (Fe49.7Cr17.7Mn1.9Mo7.4W1.6B15.2C3.8Si2.4) is discussed here.
The present work shows results on elemental distribution analyses in Cu(In,Ga)Se2 thin films for solar cells performed by use of wavelength-dispersive and energy-dispersive X-ray spectrometry (EDX) in a scanning electron microscope, EDX in a transmission electron microscope, X-ray photoelectron, angle-dependent soft X-ray emission, secondary ion-mass (SIMS), time-of-flight SIMS, sputtered neutral mass, glow-discharge optical emission and glow-discharge mass, Auger electron, and Rutherford backscattering spectrometry, by use of scanning Auger electron microscopy, Raman depth profiling, and Raman mapping, as well as by use of elastic recoil detection analysis, grazing-incidence X-ray and electron backscatter diffraction, and grazing-incidence X-ray fluorescence analysis. The Cu(In,Ga)Se2 thin films used for the present comparison were produced during the same identical deposition run and exhibit thicknesses of about 2 μm. The analysis techniques were compared with respect to their spatial and depth resolutions, measuring speeds, availabilities, and detection limits.
A prototype expanded-beam spectroscopic ellipsometer has been developed that uses uncollimated (non-parallel, diffuse) illumination with a detection system consisting of an angle-of-incidence-sensitive pinhole camera for high-speed, large-area imaging/mapping applications. The performance of this novel instrument is being tested for imaging/mapping of mixed-phase hydrogenated silicon films having graded amorphous (a-Si:H) and nanocrystalline (nc-Si:H) components throughout the film depth. The speed of the measurement system makes the instrument suitable for use on production lines. The precision enables detection of subnanometer thicknesses, and refractive index and extinction coefficient changes of 0.01. Angle-of-incidence and mirror calibrations are made via well-known sample structures. Alternative commercial instrumentation for mapping by spectroscopic ellipsometry must translate the sample or ellipsometer in two dimensions. For this instrumentation, even a 15 × 15 cm2 sample with cm2 resolution requires > 200 measurements and at least 15 min. By imaging along one dimension in parallel, the expanded-beam system can measure with similar resolution in < 2 min. The focus of recent instrumentation efforts is on improving the overall system spectral range and its performance.