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We have observed the G23 field of the Galaxy AndMass Assembly (GAMA) survey using the Australian Square Kilometre Array Pathfinder (ASKAP) in its commissioning phase to validate the performance of the telescope and to characterise the detected galaxy populations. This observation covers ~48 deg2 with synthesised beam of 32.7 arcsec by 17.8 arcsec at 936MHz, and ~39 deg2 with synthesised beam of 15.8 arcsec by 12.0 arcsec at 1320MHz. At both frequencies, the root-mean-square (r.m.s.) noise is ~0.1 mJy/beam. We combine these radio observations with the GAMA galaxy data, which includes spectroscopy of galaxies that are i-band selected with a magnitude limit of 19.2. Wide-field Infrared Survey Explorer (WISE) infrared (IR) photometry is used to determine which galaxies host an active galactic nucleus (AGN). In properties including source counts, mass distributions, and IR versus radio luminosity relation, the ASKAP-detected radio sources behave as expected. Radio galaxies have higher stellar mass and luminosity in IR, optical, and UV than other galaxies. We apply optical and IR AGN diagnostics and find that they disagree for ~30% of the galaxies in our sample. We suggest possible causes for the disagreement. Some cases can be explained by optical extinction of the AGN, but for more than half of the cases we do not find a clear explanation. Radio sources aremore likely (~6%) to have an AGN than radio quiet galaxies (~1%), but the majority of AGN are not detected in radio at this sensitivity.
In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
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: Although use of point of care ultrasound (PoCUS) protocols for patients with undifferentiated hypotension in the Emergency Department (ED) is widespread, our previously reported SHoC-ED study showed no clear survival or length of stay benefit for patients assessed with PoCUS. In this analysis, we examine if the use of PoCUS changed fluid administration and rates of other emergency interventions between patients with different shock types. The primary comparison was between cardiogenic and non-cardiogenic shock types. Methods: A post-hoc analysis was completed on the database from an RCT of 273 patients who presented to the ED with undifferentiated hypotension (SBP <100 or shock index > 1) and who had been randomized to receive standard care with or without PoCUS in 6 centres in Canada and South Africa. PoCUS-trained physicians performed scans after initial assessment. Shock categories and diagnoses recorded at 60 minutes after ED presentation, were used to allocate patients into subcategories of shock for analysis of treatment. We analyzed actual care delivered including initial IV fluid bolus volumes (mL), rates of inotrope use and major procedures. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: Although there were expected differences in the mean fluid bolus volume between patients with non-cardiogenic and cardiogenic shock, there was no difference in fluid bolus volume between the control and PoCUS groups (non-cardiogenic control 1878 mL (95% CI 1550 – 2206 mL) vs. non-cardiogenic PoCUS 1687 mL (1458 – 1916 mL); and cardiogenic control 768 mL (194 – 1341 mL) vs. cardiogenic PoCUS 981 mL (341 – 1620 mL). Likewise there were no differences in rates of inotrope administration, or major procedures for any of the subcategories of shock between the control group and PoCUS group patients. The most common subcategory of shock was distributive. Conclusion: Despite differences in care delivered by subcategory of shock, we did not find any significant difference in actual care delivered between patients who were examined using PoCUS and those who were not. This may help to explain the previously reported lack of outcome difference between groups.
Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.
The mammal family Tenrecidae (Afrotheria: Afrosoricida) is endemic to Madagascar. Here we present the conservation priorities for the 31 species of tenrec that were assessed or reassessed in 2015–2016 for the IUCN Red List of Threatened Species. Six species (19.4%) were found to be threatened (4 Vulnerable, 2 Endangered) and one species was categorized as Data Deficient. The primary threat to tenrecs is habitat loss, mostly as a result of slash-and-burn agriculture, but some species are also threatened by hunting and incidental capture in fishing traps. In the longer term, climate change is expected to alter tenrec habitats and ranges. However, the lack of data for most tenrecs on population size, ecology and distribution, together with frequent changes in taxonomy (with many cryptic species being discovered based on genetic analyses) and the poorly understood impact of bushmeat hunting on spiny species (Tenrecinae), hinders conservation planning. Priority conservation actions are presented for Madagascar's tenrecs for the first time since 1990 and focus on conserving forest habitat (especially through improved management of protected areas) and filling essential knowledge gaps. Tenrec research, monitoring and conservation should be integrated into broader sustainable development objectives and programmes targeting higher profile species, such as lemurs, if we are to see an improvement in the conservation status of tenrecs in the near future.
Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs.
Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices.
The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis.
This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.
A laboratory-based X-ray microprobe, composed of a high-brilliance microfocus X-ray tube, coupled with a small glass capillary, has been developed for materials applications. Because of total external reflectance of X rays from the smooth inside bore of the glass capillary, the microprobe has a high sensitivity as well as a high spatial resolution. The use of X rays to excite elemental fluorescence offers the advantages of good peak-to-background, the ability to operate in air, and minimal specimen preparation. In addition, the development of laboratory-based instrumentation has been of Interest recently because of greater accessibility when compared with synchrotron X-ray microprobes.
X-ray diffraction topographs were obtained from large arsenic single crystals. The camera employed copper Kα, radiation from a microfocus tube and an oscillating assembly of Soller slits limited the beam divergence. Reflections of the type (11) and (20) (primitive rhombohedral cell) were used to characterise dislocation Burgers vectors. The technique has been applied to arsenic single crystals grown from the vapour and from the melt. The majority of dislocations were found to belong to Burgers vectors <10>. Comparison has been made between dislocation etch pit patterns on (111) surfaces and X-ray topographs.
X-ray micro fluorescence imaging refers to the use of an x-ray beam as a probe to excite XRF in a specimen and produce a spatially resolved image of the element distribution. The advantages of high sensitivity and low background, together with the nondestructive nature of the measurement, have lead to applications of x-ray microfluorescence analysis in biology, geology, materials science, as well as in the area of nondestructive evaluation. Previous reports have described the development of an x-ray microprobe which uses a conventional source of x-rays to produce a 10-μm beam. This paper describes improvements to the microprobe which have increased the beam power and the solid angle of detection. The data collection and display software have also been enhanced.
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽−2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score −2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3–99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.
The structural relations of solid solutions in the series (Sr1−xBax)Al2O4 were studied using room- and high-temperature X-ray methods, infra-red spectroscopy, and DTA. At room temperature, SrAl2O4 and solid solutions with x up to 0.31 are monoclinic, between x = 0.31 and 0.43 monoclinic and hexagonal forms coexist, and between x = 0.43 and 1.0 only hexagonal forms occur. On heating, a member of the monoclinic series of solid solutions transforms to hexagonal symmetry over a range of temperature within which both monoclinic and hexagonal forms coexist. The proportion of the hexagonal form increases instantaneously as the temperature is raised. The transformation temperature decreases with increasing BaAl2O4 in solid solution and, in addition, the temperature width of the region of coexistence is markedly enlarged. SrAl2O4 transforms over the range 665–705 °C and (Sr0.7Ba0.3)Al2O4 over 170–405 °C. The DTA trace for SrAl2O4 shows a peak at 677 °C. On cooling, the transformations show hysteresis of 15 to 25 °C.
The coexisting monoclinic and hexagonal forms are believed to be isochemical, and discontinuities in cell parameters occur within the region of coexistence both in the compositional series at room temperature and in the elevated temperature transformation experiments. The low-to-high transformation is accompanied by a volume change of −0.2 to −0.3 %, and is believed to be first-order displacive with additional characteristics similar to those of martensitic transformations.
The thermal expansion behaviour of structures in the (Sr,Ba)Al2O4, series indicates that two tilt systems are operative: co-operative rotation of tetrahedra about the c-axis, and tilting of tetrahedra relative to the 0001 plane.
The results for the (Sr,Ba)Al2O4 series are shown to be invaluable in reinterpreting the structural behaviour of members of the nepheline and leucite groups of minerals.
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) represent a disease continuum with common genetic causes and molecular pathology. We recently identified mutations in the T-cell restricted intracellular antigen-1 (TIA1) protein as a cause of ALS +/− FTD. TIA1 is an RNA-binding protein containing a low complexity domain (LCD) that promotes the assembly of membrane-less organelles, such as stress granules (SG). Whole exome sequencing of two family members with fALS/FTD revealed a novel missense mutation in the TIA1 LCD (P362L). Subsequent screening identified five more TIA1 mutations in six additional ALS patients, but none in controls. All mutation carriers presented with weakness, behavioral abnormalities or language impairments and had a final diagnosis of ALS +/− FTD. Autopsy on five TIA1 mutation carriers showed widespread neurodegeneration with TDP-43 pathology. Round eosinophilic inclusions in lower motor neurons were a consistent feature. Cellular assays revealed abnormal SG dynamics in the presence of TIA1 mutations. In summary, missense mutations in the LCD of TIA1 are a newly recognized cause of ALS/FTD with TDP-43 pathology and strengthen the role of RNA metabolism in the pathogenesis in this disease.
Achieving adequate fertility is essential in any dairy unit, but is compromised by genetic selection for increased yield. Selection has altered the somatotrophic axis and resulted in cows which mobilise more body tissue for milk production in early lactation, thus prolonging both the depth and duration of the post partum negative energy balance. Poor energy status is reflected in altered metabolic parameters including raised urea and decreased insulin-like growth factor-I (IGF-I) and insulin concentrations, which adversely affect ovarian cyclicity and early embryo survival. Attempts to optimise the diet in terms of energy and protein content have generally been aimed at increasing milk production further rather than improving fertility. Advances in biosensor technology now provide us with the opportunity to monitor production, fertility and health parameters of each cow. Integration of this information should improve the timing for inseminations and could assist in selecting diets more suited to the needs of the individual cow. Genetic selection may in future be used to produce cows optimised for a particular type of management system. In both cases we need a greater understanding of the rules governing nutrient partitioning at different stages of the cows' life cycle to ensure that diets selected are cost effective and achieve an appropriate balance in promoting production, reproduction and health.
This study compared the effect of feeding AmyPlus, a moist feed, as opposed to rolled wheat on the yield and composition of milk from dairy cows consuming grass silage based total mixed ration (TMR). Seventy-two Holstein-Friesian cows were distributed into AmyPlus (Treatment) and Wheat (Control) groups and loose housed on straw in an open shed. Each kg Wheat based concentrate contained 345g rolled wheat, 230g rapeseed meal, 115g sugarbeet pulp, 115g Molaferm 20, 115g soybean meal, 56g barley straw and 24g vitamin-minerals. In contrast, each kg AmyPlus based concentrate contained 501g AmyPlus (480g DM /kg), 105g rapeseed meal, 126g sugarbeet pulp, 126g Molaferm 20, 84g soybean meal, 41g barley straw and 17g vitamin-minerals. Here, AmyPlus was loaded directly into the mixer wagon to prepare fresh AmyPlus based TMR with a silage to concentrate ratio of 68:32. Each TMR was fed once daily to the corresponding group of cows also receiving 2kg of Distillers’ grains per cow in the parlour during milking. Daily milk yield and composition was recorded from November 1999 to February 2000. The overall daily Dry matter intake (DMI) of each TMR per cow remained uniform (20.19 vs 20.15 kg for Treatment and Control group respectively) across both groups. Daily milk yield and total cell counts per cow did not vary significantly (P>0.05) between groups during various months. While, milk fat and protein contents were greater in Treatment than Control group during each month, the differences were significant (P<0.05) only during November and December for fat and in January for protein. On average, the Treatment group tended to show a non-significant increase (P>0.05) in daily milk yield per cow by 0.144 kg than the Control group. The fat (46.2 vs 43.7) and protein (34.5 vs 33.5) contents in g /kg milk were also increased significantly (P<0.001) in Treatment compared with Control group. Total cell counts did not vary significantly (P>0.05) and remained within the acceptable limits. The cows consuming AmyPlus maintained their health as indicated by their intake, production, cell counts and general appearance. It would appear that AmyPlus can replace rolled wheat in TMR. However, it may be necessary to evaluate the storage, economic and environmental implications of using such moist co-products in silage based dairy rations.
With a high affinity to carbon comparable to titanium and an electrically conductive carbide, zirconium has potential to form ohmic contact on boron doped diamond. In this work, formation of ohmic contacts on boron doped diamond using zirconium is studied in comparison to titanium. Boron doped diamond epitaxial layers have been grown by microwave plasma enhanced chemical vapour deposition with various B/C ratio. Circular Transmission Line Model structures were fabricated using standard micro-fabrication technologies. Specific contact resistance of fabricated contacts was determined for different boron concentrations and for various annealing temperatures. Ohmic contacts using zirconium are formed after annealing at 400 °C. Specific contact resistance steadily decreases with high temperature annealing down to a value of ca. 1 mΩ.cm2 after annealing at 700 °C for highly boron doped diamond. In comparison, titanium contact fabricated on highly doped diamond appears not stable under high temperature annealing.
Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed.
A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up.
Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up.
Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.