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Less than half of stool samples from people symptomatic with infectious intestinal disease (IID) will identify a causative organism. A secondary data analysis was undertaken to explore whether symptomology alone could be used to make inferences about causative organisms. Data were utilised from the Second Study of Infectious Intestinal Disease in the Community. A total of 844 cases were analysed. Few symptoms differentiated individual pathogens, but grouping pathogens together showed that viral IID was more likely when symptom onset was in winter (odds ratio (OR) 2.08, 95% confidence interval (CI) 1.16–3.75) or spring (OR 1.92, 95% CI 1.11–3.33), the patient was aged under 5 years (OR 3.63, 95% CI 2.24–6.03) and there was loss of appetite (OR 2.19, 95% CI 1.29–3.72). The odds of bacterial IID were higher with diarrhoea in the absence of vomiting (OR 3.54, 95% CI 2.37–5.32), diarrhoea which persisted for >3 days (OR 2.69, 95% CI 1.82–3.99), bloody diarrhoea (OR 4.17, 95% CI 1.63–11.83) and fever (OR 1.67, 95% CI 1.11–2.53). Symptom profiles could be of value to help guide clinicians and public health professionals in the management of IID, in the absence of microbiological confirmation.
Introduction: The number of seniors presenting to emergency departments after a fall is increasing. Head injury concerns in this population often leads to a head CT scan. The CT rate among physicians is variable and the reasons for this are unknown. This study examined the role of patient characteristics and country of practice in the decision to order a CT. Methods: This study used a case-based survey of physicians across multiple countries. Each survey included 9 cases pertaining to an 82-year old man who falls. Each case varied in one aspect compared to a base case (aspirin, warfarin, or rivaroxaban use, occipital hematoma, amnesia, dementia, and fall with no head trauma). For each case, participants indicated how “likely” they were to order a head CT scan, measured on a 100-point scale. A response of 80 or more was defined a priori as ‘likely to order a CT scan’. The survey was piloted among emergency residents for feedback on design and comprehension, and was published in French and English. Recruitment was through the Canadian Association of Emergency Physicians, Twitter and CanadiEM. For each case we compared the proportion of physicians who were ‘likely to scan’ with relative to the base case. We also compared the proportion of participants who were ‘likely to scan’ each case in the USA, UK and Australia, relative to Canada. Results: Data was collected from 484 respondents (Canada-308, USA-64, UK-67, Australia-27, and 18 from other countries). Social media distribution limited our ability to estimate of the response rate. Physicians were most likely to scan in the anticoagulation cases (90% likely to order a scan compared to 36% for the base case (p = <0.001)). Other features associated with increased scans were occipital hematoma (48%), multiple falls (68%), and amnesia (68%) (all p < 0.005). Compared to Canada, US physicians were more likely to order CT scans for all cases (p = <0.05). Compared to Canada, UK physicians were significantly less likely to order CT for patients in every case except in the patient with amnesia. Finally, Australian physicians differed from Canada only for the occipital hematoma case where they were significantly more likely to order CT scan. Conclusion: Anticoagulation, amnesia and a history of multiple falls appear to drive the ordering a head CT scan in elderly patients who had fallen. We observed variations in practice between countries. Future clinical decision rules will likely have variable impact on head CT scan rates depending on baseline practice variation.
Introduction: Simulation has assumed an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High quality simulation-based research (SBR) is required to ensure the effective and efficient use of this tool. This study sought to establish national SBR priorities and describe the barriers and facilitators of SBR in Emergency Medicine (EM) in Canada. Methods: Simulation leads (SLs) from all fourteen Canadian Departments or Divisions of EM associated with an adult FRCP-EM training program were invited to participate in three surveys and a final consensus meeting. The first survey documented active EM SBR projects. Rounds two and three established and ranked priorities for SBR and identified the perceived barriers and facilitators to SBR at each site. Surveys were completed by SLs at each participating institution, and priority research themes were reviewed by senior faculty for broad input and review. Results: Twenty SLs representing all 14 invited institutions participated in all three rounds of the study. 60 active SBR projects were identified, an average of 4.3 per institution (range 0-17). 49 priorities for SBR in Canada were defined and summarized into seven priority research themes. An additional theme was identified by the senior reviewing faculty. 41 barriers and 34 facilitators of SBR were identified and grouped by theme. Fourteen SLs representing 12 institutions attended the consensus meeting and vetted the final list of eight priority research themes for SBR in Canada: simulation in CBME, simulation for interdisciplinary and inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology. Conclusion: Conclusion: This study has summarized the current SBR activity in EM in Canada, as well as its perceived barriers and facilitators. We also provide a consensus on priority research themes in SBR in EM from the perspective of Canadian simulation leaders. This group of SLs has formed a national simulation-based research group which aims to address these identified priorities with multicenter collaborative studies.
The commercially available collar device MooMonitor+ was evaluated with regards to accuracy and application potential for measuring grazing behavior. These automated measurements are crucial as cows feed intake behavior at pasture is an important parameter of animal performance, health and welfare as well as being an indicator of feed availability. Compared to laborious and time-consuming visual observation, the continuous and automated measurement of grazing behavior may support and improve the grazing management of dairy cows on pasture. Therefore, there were two experiments as well as a literature analysis conducted to evaluate the MooMonitor+ under grazing conditions. The first experiment compared the automated measurement of the sensor against visual observation. In a second experiment, the MooMonitor+ was compared to a noseband sensor (RumiWatch), which also allows continuous measurement of grazing behavior. The first experiment on n = 12 cows revealed that the automated sensor MooMonitor+ and visual observation were highly correlated as indicated by the Spearman’s rank correlation coefficient (rs) = 0.94 and concordance correlation coefficient (CCC) = 0.97 for grazing time. An rs-value of 0.97 and CCC = 0.98 was observed for rumination time. In a second experiment with n = 12 cows over 24-h periods, a high correlation between the MooMonitor+ and the RumiWatch was observed for grazing time as indicated by an rs-value of 0.91 and a CCC-value of 0.97. Similarly, a high correlation was observed for rumination time with an rs-value of 0.96 and a CCC-value of 0.99. While a higher level of agreement between the MooMonitor+ and both visual observation and RumiWatch was observed for rumination time compared to grazing time, the overall results showed a high level of accuracy of the collar device in measuring grazing and rumination times. Therefore, the collar device can be applied to monitor cow behavior at pasture on farms. With regards to the application potential of the collar device, it may not only be used on commercial farms but can also be applied to research questions when a data resolution of 15 min is sufficient. Thus, at farm level, the farmer can get an accurate and continuous measurement of grazing behavior of each individual cow and may then use those data for decision-making to optimize the animal management.
Mycobacterium ulcerans is recognised as the third most common mycobacterial infection worldwide. It causes necrotising infections of skin and soft tissue and is classified as a neglected tropical disease by the World Health Organization (WHO). However, despite extensive research, the environmental reservoir of the organism and mode of transmission of the infection to humans remain unknown. This limits the ability to design and implement public health interventions to effectively and consistently prevent the spread and reduce the incidence of this disease. In recent years, the epidemiology of the disease has changed. In most endemic regions of the world, the number of cases reported to the WHO are reducing, with a 64% reduction in cases reported worldwide in the last 9 years. Conversely, in a smaller number of countries including Australia and Nigeria, reported cases are increasing at a rapid rate, new endemic areas continue to appear, and in Australia cases are becoming more severe. The reasons for this changing epidemiology are unknown. We review the epidemiology of M. ulcerans disease worldwide, and document recent changes. We also outline and discuss the current state of knowledge on the ecology of M. ulcerans, possible transmission mechanisms to humans and what may be enabling the spread of M. ulcerans into new endemic areas.
This paper considers the timing and mechanisms of deforestation in the Western Isles of Scotland, focusing in particular on the landscape around the Calanais stone circles, one of the best preserved late Neolithic/early Bronze Age monumental landscapes in north-west Europe. We present new archaeological and palaeoenvironmental evidence from a soil and peat sequence at the site of Aird Calanais, which spans the main period of use of the Calanais circles. We then draw on a new synthesis of archaeobotanical and palynological evidence from across the Western Isles and a review of comparable data from the wider North Atlantic zone, before assessing the role of early farming communities in clearing the wooded landscapes of the region. Pollen and radiocarbon dating at the site of Aird Calanais reveal that a layer of birch branches, dating to the late Neolithic (2912–2881 cal bc), was contemporaneous with a decline in woodland at the site, as well as with the major phase of Neolithic activity at the Calanais stone circle complex. However, our synthesis of the pollen and plant macrofossil evidence from across the Western Isles suggests that the picture across these islands was altogether more complex: woodlands declined both before, as well as during, the Neolithic and deciduous woodlands remained sufficiently abundant for Neolithic fuel procurement. Finally, we consider the implications of the results for understanding the interactions between first farmers and woodlands in the wider North Atlantic region.
Greenhouse experiments were conducted to quantify resistance levels to the 4-hydroxyphenyl-pyruvate dioxygenase (HPPD)-inhibiting herbicides mesotrione (MES) and isoxaflutole (IFT) in NEB (Nebraska HPPD- and atrazine-resistant) and SIR (Stanford, IL, HPPD- and atrazine-resistant) waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] populations. These populations differ in their field-use histories and resistance levels to MES. Foliar growth responses were compared with ACR (HPPD sensitive; metabolic atrazine-resistant) and SEN (sensitive to HPPD and photosystem II [PSII] inhibitors). A greenhouse dose–response study was conducted with each herbicide at two POST timings: early (EPOST) (5 cm; 4 to 5 true leaves) and POST (10 cm; 8 to 9 true leaves). At the EPOST timing, SIR was 10-fold resistant to IFT and 32-fold resistant to MES, while NEB was 4-fold resistant to IFT and 7-fold resistant to MES when compared with ACR. At the POST timing, SIR was 17-fold resistant to IFT and 21-fold resistant to MES, while NEB was 3-fold resistant to IFT and 7-fold resistant to MES when compared with ACR. Results overall indicated greater fold-resistance levels to MES relative to IFT at each timing. However, POST treatments to SIR showed contrasting effects on resistance levels relative to EPOST. To investigate potential management strategies for resistant A. tuberculatus populations, a POST interaction study was conducted using combinations of metribuzin and either IFT or MES. A metribuzin rate (191 g ai ha−1) causing an approximately 20% biomass reduction was chosen for interaction studies and combined with varying rates of either IFT or MES. Results indicated 52.5 g ai ha−1 of MES combined with metribuzin displayed a synergistic effect on biomass reduction in SIR. However, other combinations of either MES or IFT and metribuzin resulted in additive effects on biomass reduction in both HPPD-resistant populations. These results provide insights into the joint activity between HPPD and PSII inhibitors for controlling metabolism-based, multiple herbicide–resistant A. tuberculatus.
Amorphous TiO2 and SnO2 electron transport layers (ETLs) were deposited by low-temperature atomic layer deposition (ALD). Surface morphology and x-ray photoelectron spectroscopy (XPS) indicate uniform and pinhole free coverage of these ALD hole blocking layers. Both mesoporous and planar perovskite solar cells were fabricated based on these thin films with aperture areas of 1.04 cm2 for TiO2 and 0.09 cm2 and 0.70 cm2 for SnO2. The resulting cell performance of 18.3 % power conversion efficiency (PCE) using planar SnO2 on 0.09 cm2 and 15.3 % PCE using mesoporous TiO2 on 1.04 cm2 active areas are discussed in conjunction with the significance of growth parameters and ETL composition.
Introduction: Head injury is a common presentation to all emergency departments. Previous research has shown that such injuries may be complicated by delayed intracranial hemorrhage (D-ICH) after the initial scan is negative. Exposure to anticoagulant or anti-platelet medications (ACAP) may be a risk factor for D-ICH. We have conducted a systematic review and meta-analysis to determine the incidence of delayed traumatic intracranial hemorrhage in patients taking anticoagulants, anti-platelets or both. Methods: The literature search was conducted in March 2017 with an update in April 2017. Keyword and MeSH terms were used to search OVID Medline, Embase and the Cochrane database as well as grey literature sources. All cohort and experimental studies were eligible for selection. Inclusion criteria included pre-injury exposure to oral anticoagulant and / or anti-platelet medication and a negative initial CT scan of the brain (CT1). The primary outcome was delayed intracranial hemorrhage present on repeat CT scan (CT2) within 48 hours of the presentation. Only patients who were rescanned or observed minimally were included. Clinically significant D-ICH were those that required neurosurgery, caused death or necessitated a change in management strategy, such as admission. Results: Fifteen primary studies were ultimately identified, comprising a total of 3801 patients. Of this number, 2111 had a control CT scan. 39 cases of D-ICH were identified, with the incidence of D-ICH calculated to be 1.31% (95% CI [0.56, 2.27]). No more than 12 of these patients had a clinically significant D-ICH representing 0.09% (95% CI [0.00, 0.31]). 10 of them were on warfarin and two on aspirin. There were three deaths recorded and three patients needed neurosurgery. Conclusion: The relatively low incidence suggests that repeat CT should not be mandatory for patients without ICH on first CT. This is further supported by the negligibly low rate of clinically significant D-ICH. Evidence-based assessments should be utilised to indicate the appropriate discharge plan, with further research required to guide the balance between clinical observation and repeat CT.
We present a multi-frequency study of the intermediate spiral SAB(r)bc type galaxy NGC 6744, using available data from the Chandra X-Ray telescope, radio continuum data from the Australia Telescope Compact Array and Murchison Widefield Array, and Wide-field Infrared Survey Explorer infrared observations. We identify 117 X-ray sources and 280 radio sources. Of these, we find nine sources in common between the X-ray and radio catalogues, one of which is a faint central black hole with a bolometric radio luminosity similar to the Milky Way’s central black hole. We classify 5 objects as supernova remnant (SNR) candidates, 2 objects as likely SNRs, 17 as H ii regions, 1 source as an AGN; the remaining 255 radio sources are categorised as background objects and one X-ray source is classified as a foreground star. We find the star-formation rate (SFR) of NGC 6744 to be in the range 2.8–4.7 M⊙~yr − 1 signifying the galaxy is still actively forming stars. The specific SFR of NGC 6744 is greater than that of late-type spirals such as the Milky Way, but considerably less that that of a typical starburst galaxy.
Early detection of karyotype abnormalities, including aneuploidy, could aid producers in identifying animals which, for example, would not be suitable candidate parents. Genome-wide genetic marker data in the form of single nucleotide polymorphisms (SNPs) are now being routinely generated on animals. The objective of the present study was to describe the statistics that could be generated from the allele intensity values from such SNP data to diagnose karyotype abnormalities; of particular interest was whether detection of aneuploidy was possible with both commonly used genotyping platforms in agricultural species, namely the Applied BiosystemsTM AxiomTM and the Illumina platform. The hypothesis was tested using a case study of a set of dizygotic X-chromosome monosomy 53,X sheep twins. Genome-wide SNP data were available from the Illumina platform (11 082 autosomal and 191 X-chromosome SNPs) on 1848 male and 8954 female sheep and available from the AxiomTM platform (11 128 autosomal and 68 X-chromosome SNPs) on 383 female sheep. Genotype allele intensity values, either as their original raw values or transformed to logarithm intensity ratio (LRR), were used to accurately diagnose two dizygotic (i.e. fraternal) twin 53,X sheep, both of which received their single X chromosome from their sire. This is the first reported case of 53,X dizygotic twins in any species. Relative to the X-chromosome SNP genotype mean allele intensity values of normal females, the mean allele intensity value of SNP genotypes on the X chromosome of the two females monosomic for the X chromosome was 7.45 to 12.4 standard deviations less, and were easily detectable using either the AxiomTM or Illumina genotype platform; the next lowest mean allele intensity value of a female was 4.71 or 3.3 standard deviations less than the population mean depending on the platform used. Both 53,X females could also be detected based on the genotype LRR although this was more easily detectable when comparing the mean LRR of the X chromosome of each female to the mean LRR of their respective autosomes. On autopsy, the ovaries of the two sheep were small for their age and evidence of prior ovulation was not appreciated. In both sheep, the density of primordial follicles in the ovarian cortex was lower than normally found in ovine ovaries and primary follicle development was not observed. Mammary gland development was very limited. Results substantiate previous studies in other species that aneuploidy can be readily detected using SNP genotype allele intensity values generally already available, and the approach proposed in the present study was agnostic to genotype platform.
We present first results from a coordinated multiwavelength study of the neutron star low-mass X-ray binary EXO 0748 676. Fast UV, X-ray, and optical data were obtained including both spectral and timing information. We discuss how this study allows us to probe the temperature distribution within the binary and hence the geometry and efficiency of X-ray irradiation.
An adolescent male with a recent history of streptococcal pharyngitis presented with severe substernal chest pain, troponin leak, and ST-segment elevation, which are suggestive of acute inferolateral myocardial infarction. The coronary angiogram was normal. The patient was subsequently diagnosed with non-rheumatic streptococcal myocarditis. He was treated with amoxicillin and had excellent recovery. Non-rheumatic streptococcal myocarditis is an important mimic of acute myocardial infarction in young adults.
In the context of water use for agricultural production, water footprints (WFs) have become an important sustainability indicator. To understand better the water demand for beef and sheep meat produced on pasture-based systems, a WF of individual farms is required. The main objective of this study was to determine the primary contributors to freshwater consumption up to the farm gate expressed as a volumetric WF and associated impacts for the production of 1 kg of beef and 1 kg of sheep meat from a selection of pasture-based farms for 2 consecutive years, 2014 and 2015. The WF included green water, from the consumption of soil moisture due to evapotranspiration, and blue water, from the consumption of ground and surface waters. The impact of freshwater consumption on global water stress from the production of beef and sheep meat in Ireland was also computed. The average WF of the beef farms was 8391 l/kg carcass weight (CW) of which 8222 l/kg CW was green water and 169 l/kg CW was blue water; water for the production of pasture (including silage and grass) contributed 88% to the WF, concentrate production – 10% and on-farm water use – 1%. The average stress-weighted WF of beef was 91 l H2O eq/kg CW, implying that each kg of beef produced in Ireland contributed to freshwater scarcity equivalent to the consumption of 91 l of freshwater by an average world citizen. The average WF of the sheep farms was 7672 l/kg CW of which 7635 l/kg CW was green water and 37 l/kg CW was blue water; water for the production of pasture contributed 87% to the WF, concentrate production – 12% and on-farm water use – 1%. The average stress-weighted WF was 2 l H2O eq/kg CW for sheep. This study also evaluated the sustainability of recent intensification initiatives in Ireland and found that increases in productivity were supported through an increase in green water use and higher grass yields per hectare on both beef and sheep farms.
Accurate genomic analyses are predicated on access to a large quantity of accurately genotyped and phenotyped animals. Because the cost of genotyping is often less than the cost of phenotyping, interest is increasing in generating genotypes for phenotyped animals. In some instances this may imply the requirement to genotype older animals with greater phenotypic information content. Biological material for these older informative animals may, however, no longer exist. The objective of the present study was to quantify the ability to impute 11 129 single nucleotide polymorphism (SNP) genotypes of non-genotyped animals (in this instance sires) from the genotypes of their progeny with or without including the genotypes of the progenys’ dams (i.e. mates of the sire to be imputed). The impact on the accuracy of genotype imputation by including more progeny (and their dams’) genotypes in the imputation reference population was also quantified. When genotypes of the dams were not available, genotypes of 41 sires with at least 15 genotyped progeny were used for the imputation; when genotypes of the dams were available, genotypes of 21 sires with at least 10 genotyped progeny were used for the imputation. Imputation was undertaken exploiting family and population level information. The mean and variability in the proportion of genotypes per individual that could not be imputed reduced as the number of progeny genotypes used per individual increased. Little improvement in the proportion of genotypes that could not be imputed was achieved once genotypes of seven progeny and their dams were used or genotypes of 11 progeny without their respective dam’s genotypes were used. Mean imputation accuracy per individual (depicted by both concordance rates and correlation between true and imputed) increased with increasing progeny group size. Moreover, the range in mean imputation accuracy per individual reduced as more progeny genotypes were used in the imputation. If the genotype of the mate of the sire was also used, high accuracy of imputation (mean genotype concordance rate per individual of 0.988), with little additional benefit thereafter, was achieved with seven genotyped progeny. In the absence of genotypes on the dam, similar imputation accuracy could not be achieved even using genotypes on up to 15 progeny. Results therefore suggest, at least for the SNP density used in the present study, that it is possible to accurately impute the genotypes of a non-genotyped parent from the genotypes of its progeny and there is a benefit of also including the genotype of the sire’s mate (i.e. dam of the progeny).
Anomalous aortic origin of the coronary arteries is associated with exercise-induced ischaemia, leading some physicians to restrict exercise in patients with this condition. We sought to determine whether exercise restriction was associated with increasing body mass index over time. From 1998 to 2015, 440 patients ⩽30 years old were enrolled into an inception cohort. Exercise-restriction status was documented in 143 patients. Using linear mixed model repeated-measures regression, factors associated with increasing body mass index z-score over time, including exercise restriction and surgical intervention as time-varying covariates, were investigated. The 143 patients attended 558 clinic visits for which exercise-restriction status was recorded. The mean number of clinic visits per patient was 4, and the median duration of follow-up was 1.7 years (interquartile range (IQR) 0.5–4.4). The median age at first clinic visit was 10.3 years (IQR 7.1–13.9), and 71% (101/143) were males. All patients were alive at their most recent follow-up. At the first clinic visit, 54% (78/143) were exercise restricted, and restriction status changed in 34% (48/143) during follow-up. The median baseline body mass index z-score was 0.2 (IQR 0.3–0.9). In repeated-measures analysis, neither time-related exercise restriction nor its interaction with time was associated with increasing body mass index z-score. Surgical intervention and its interaction with time were associated with decreasing body mass index z-score. Although exercise restriction was not associated with increasing body mass index over time, surgical intervention was associated with decreasing body mass index z-score over time in patients with anomalous aortic origin of the coronary arteries.