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The correlation between ATP concentration and bacterial burden in the patient care environment was assessed. These findings suggest that a correlation exists between ATP concentration and bacterial burden, and they generally support ATP technology manufacturer-recommended cutoff values. Despite relatively modest discriminative ability, this technology may serve as a useful proxy for cleanliness.
Very-long-baseline Interferometry (VLBI) has opened for study a broad new spectrum of geophysical phenomena including: direct observation of the tectonic motions and deformations of the Earth's crustal plates, observations of unprecedented detail of the variations in the rotation of the Earth, and direct measurement of the elastic deformations of the Earth in response to tidal forces. These new measurements have placed significant constraints on models of the interior structure of the Earth; for example, measurements of the variations in the Earth's nutation have been shown to be particularly sensitive to the shape of the core-mantle boundary. The VLBI measurements will allow us to construct a global reference frame accurate at the centimeter level. Such a frame will be essential to studying long-term global changes, especially those changes related to sea-level variations as recorded by tide gauge measurements.
Project IRIS (International Radio Interferometric Surveying) was set up under the IAG and COSPAR to provide an operational system that would employ Very-Long-Baseline Interferometry (VLBI) techniques to monitor variations in the rotation of the Earth. Currently the IRIS-A network, with stations at Westford, MA, Ft. Davis, TX, Richmond, FL, and Wettzell, FRG, conducts 24-hour observing sessions every five days to produce determinations of pole position, UT1, and nutation in addition to other parameters of geophysical and astrometric interest. The resulting Earth orientation parameters (EOP) have been shown to have an accuracy of 1 to 2 milliseconds of arc in pole position, and 0.05 to 0.1 milliseconds of time in UT1. In order to observe the relatively large higher frequency variations in UT1, daily 45-minute observing sessions are conducted using the single baseline between Westford and Wettzell. Intercomparison of the UT1 values from the daily and the 5-day series indicates that the accuracy of the daily values is better than 0.1 millisecond of time.
The longer term objectives of the IRIS project include improving the monitoring of Earth orientation by increasing the sampling rate and accuracy of the observations. In April, 1987, the IRIS-P network, with stations in Kashima, Japan, Fairbanks, AK, Ft, Davis, TX, and Richmond, FL began monthly 24-hour observing sessions, and a second series of daily UT1 observing sessions was begun using the stations in Richmond and Bologna, Italy. The additional networks will provide redundancy that will improve the reliability of the system and allow the accuracy of the EOP values to be estimated.
The IRIS UT1 time series provides, for the first time, sufficient accuracy and temporal resolution to look for the few percent increase in k/C caused by the anelastic response of the mantle. Initial results presented here suggest that improved methods of accounting for the dynamics of the oceans and atmosphere may be required before the intertwined variations in UT1 can be fully separated.
The combined POLARIS-IRIS Earth orientation time series now span nearly a full cycle of the Chandler-annual beat period, beginning in late 1980. Since April 1985 there is also a nearly continuous coverage of UT1 at daily intervals. We have fit a simple model, consisting of circular 14-month and annual components and a linear drift to the polar motion series, then computed the “along-track” and “cross-track” residuals. Both sets of residuals display structure with amplitudes of tens of milliseconds of arc on time scales of months, but Fourier analysis reveals no significant peaks at shorter periods, including the 40-60 day period found in the UT1 time series.
During September, 1986, we introduced a new “quick-look” UT1 time series. The values are typically available within 7 days. The accuracy, which depends strongly on the accuracy of the X and Y pole coordinates used in the computations, ranged from 0.3 to 0.7 milliseconds during the first two weeks, but improved to about 0.1 milliseconds during the latter two weeks of the month. We plan to continue the quick-look UT1 series as a standard product of the IRIS Earth orientation monitoring service.
Research shows that cognitive rehabilitation (CR) has the potential to improve goal performance and enhance well-being for people with early stage Alzheimer’s disease (AD). This single subject, multiple baseline design (MBD) research investigated the clinical efficacy of an 8-week individualised CR intervention for individuals with early stage AD.
Three participants with early stage AD were recruited to take part in the study. The intervention consisted of eight sessions of 60–90 minutes of CR. Outcomes included goal performance and satisfaction, quality of life, cognitive and everyday functioning, mood, and memory self-efficacy for participants with AD; and carer burden, general mental health, quality of life, and mood of carers.
Visual analysis of MBD data demonstrated a functional relationship between CR and improvements in participants’ goal performance. Subjective ratings of goal performance and satisfaction increased from baseline to post-test for three participants and were maintained at follow-up for two. Baseline to post-test quality of life scores improved for three participants, whereas cognitive function and memory self-efficacy scores improved for two.
Our findings demonstrate that CR can improve goal performance, and is a socially acceptable intervention that can be implemented by practitioners with assistance from carers between sessions. This study represents one of the promising first step towards filling a practice gap in this area. Further research and randomised-controlled trials are required.
Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based guidelines be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. A first step, and our objective, was a cataloguing and appraisal of the current guidelines targeting EMS providers. Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals. Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines were retained for full review. Only three guidelines obtained a score of >90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Only two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a score of <50%. Conclusion: There are few high-quality, evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. Although a lack of randomized controlled trials (RCTs) conducted in the prehospital field continues to limit guideline development, suboptimal methodology is also commonplace within the existing literature.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear.
We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments.
Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72–0.82] and positive predictive value of 0.76 (95% CI 0.70–0.80), the specificity of 0.29 (95% CI 0.20–0.38) and negative predictive value of 0.36 (95% CI 0.22–0.40) were low. Thus, 64% of those who scored below the AQ cut-off were ‘false negatives’ who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may ‘mimic’ ASD and inflate AQ scores, leading to false positives.
The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.
Blazar OJ 287 is one of the best observed extragalactic objects. It's historical light curve goes back to 1890′s. Based on the historical behaviour Sillanpää et al. (1988) showed that OJ 287 displays large periodic outbursts, with a period of 11.7 years. We have monitored OJ 287 intensively for two years, during the OJ-94 project. This project was created for monitoring OJ 287 during its predicted new outburst in 1994. In the data archive we have over 7000 observations on OJ 287, in the radio, infrared and optical bands. This data archive contains the best ever obtained light curves for any extragalactic object. The optical light curve shows continuous variability down to time scales of tens of minutes. The variability observed in OJ 287 can be broken down to (at least) four different categories:
To identify and systematically evaluate user-friendly smartphone snoring apps.
The Apple iTunes app store was searched for snoring apps that allow recording and playback. Snoring apps were downloaded, evaluated and rated independently by four authors. Two patients underwent polysomnography, and the data were compared with simultaneous snoring app recordings, and one patient used the snoring app at home.
Of 126 snoring apps, 13 met the inclusion and exclusion criteria. The most critical app feature was the ability to graphically display the snoring events. The Quit Snoring app received the highest overall rating. When this app's recordings were compared with in-laboratory polysomnography data, app snoring sensitivities ranged from 64 to 96 per cent, and snoring positive predictive values ranged from 93 to 96 per cent. A chronic snorer used the app nightly for one month and tracked medical interventions. Snoring decreased from 200 to 10 snores per hour, and bed partner snoring complaint scores decreased from 9 to 2 (on a 0–10 scale).
Select smartphone apps are user-friendly for recording and playing back snoring sounds. Preliminary comparison of more than 1500 individual snores demonstrates the potential clinical utility of such apps; however, further validation testing is recommended.
Radio interferometric observations of extragalactic radio sources have been made with antennas at the Haystack Observatory in Massachusetts and the Owens Valley Radio Observatory in California during fourteen separate experiments distributed between September 1976 and May 1978. The components of the baseline vector and the coordinates of the sources were estimated from the data from each experiment separately. The root-weighted-mean-square scatter about the weighted mean (“repeatability”) of the estimates of the length of the 3900 km baseline was approximately 7 cm, and of the source coordinates, approximately or less, except for the declinations of low-declination sources. With the source coordinates all held fixed at the best available, a posteriori, values, and the analyses repeated for each experiment, the repeatability obtained for the estimate of baseline length was 4 cm. From analyses of the data from several experiments simultaneously, estimates were obtained of changes in the x component of pole position and in the Earth's rotation (UT1). Comparison with the corresponding results obtained by the Bureau International de l'Heure (BIH) discloses systematic differences. In particular, the trends in the radio interferometric determinations of the changes in pole position agree more closely with those from the International Polar Motion Service (IPMS) and from the Doppler observations of satellites than with those from the BIH.
The National Geodetic Survey (NGS) of the National Ocean Survey (NOS), a component of the National Oceanic and Atmospheric Administration has begun a project to establish and operate a 3-station network of permanent observatories to monitor polar-motion and Earth rotation (UT1) by radio interferometric observations of quasars. The project designation is POLARIS (POLar-motion Analysis by Radio Interferometric Surveying).
The POLARIS observatories will be equipped with a new generation of instrumentation and software, the Mark III data acquisition and processing system currently under development by a multi-organizational team.
Little has been written about the ways in which computers can be used to deal with specifically actuarial problems, as opposed to data processing ones. The development of “higher-level” computer languages has enabled algorithms to be written in the form of programs which are reasonably intelligible, and with the use of one such language, Algol, the paper sets out to show how a variety of actuarial problems can be tackled.
Section 2 describes Algol in sufficient detail for the programs shown in the paper to be understood. Numerical Analysis is discussed in Section 3, which gives algorithms for some problems in Finite Differences, and Section 4 suggests the kind of program subroutines that may be required for statistical work. Part of the present Faculty Part II syllabus is dealt with in Sections 5 and 6 while Section 7 discusses the use that could be made of modern mathematical techniques, with the aid of the computer, in the problem of curve-fitting. Section 8 deals with the question of up-to-date actuarial notation and in Section 9 reference is made to two special column-processing computer languages, specially written for actuarial work, which are in use at the present time.
1.1.1. In October 1980 the Council of the Faculty of Actuaries set up a Working Party with the following brief:—
(1) To investigate the criteria by which the solvency of life assurance companies should be assessed and to determine the amount of the solvency margin which should be required in practice by supervisory authorities. The existing requirements of the E.E.C. Life Establishment Directive should be considered with a view to recommending any desirable alterations thereto to be made when those requirements are reviewed in due course by the E.E.C. Commission. In carrying out its work the Working Party should co-operate with Working Parties or Committees of other actuarial bodies.
(2) To report the result of their investigations to Council.
The paper describes a with-profit group bonus system similiar to a rebate system being operated at the present time. It is suggested that, in view of the present high level of interest rates, the premium rates for such a scheme should be based on an immunization approach, and the paper describes how these rates can be calculated using a computer. It is envisaged that capital profits for with-profit group pension business will be distributed, and a system is outlined for arriving at the distributable surplus, and for distributing it. This system is based on reserves calculated on the premium basis and on a special “market value fund”.
In late February and early March 2002, an archaeological watching brief at Lynford Quarry, Mundford, Norfolk revealed a palaeochannel with a dark organic fill containing in situ mammoth remains and associated Mousterian stone tools and debitage buried under 2–3 m of bedded sands and gravels. Well-preserved in situ Middle Palaeolithic open air sites are very unusal in Europe and exceedingly rare within a British context. As such, the site was identified as being of national and international importance, and was subsequently excavated by the Norfolk Archaeological Unit with funding provided by English Heritage through the Aggregates Levy Sustainability Fund.
This report presents some of the initial results of the excavation. It sets out how the site was excavated, outlines the stratigraphic sequence for the site, and presents some provisional findings of the excavation based on the results of the assessment work carried out by project specialists and Norfolk Archaeological Unit staff.
The partial excavation under rescue conditions in 1961–63 of the ditches and
interior of an enclosure of the earlier neolithic period is described. The
enclosure, covering a total area of approximately 2.4 ha, was defined by
double concentric interrupted ditches, which were for the most part
naturally filled. There were many traces of activity within the interior,
presumed to be contemporary with the ditches, including pits, gullies, post-
and stake-holes, and varying concentrations of struck and burnt flint and
pottery. Human burials were found. There is a little Ebbsfleet pottery in
secondary contexts and there are later prehistoric, Roman and medieval
finds. It is probably not possible to ascribe a single or specific role to
the site, which may have been important as a place where several activities
were concentrated, including occupation, subsistence, exchange, enclosure or
defence, burial and ritual.