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Subglacial hydrological systems require innovative technological solutions to access and observe. Wireless sensor platforms can be used to collect and return data, but their performance in deep and fast-moving ice requires quantification. We report experimental results from Cryoegg: a spherical probe that can be deployed into a borehole or moulin and transit through the subglacial hydrological system. The probe measures temperature, pressure and electrical conductivity in situ and returns all data wirelessly via a radio link. We demonstrate Cryoegg's utility in studying englacial channels and moulins, including in situ salt dilution gauging. Cryoegg uses VHF radio to transmit data to a surface receiving array. We demonstrate transmission through up to 1.3 km of cold ice – a significant improvement on the previous design. The wireless transmission uses Wireless M-Bus on 169 MHz; we present a simple radio link budget model for its performance in cold ice and experimentally confirm its validity. Cryoegg has also been tested successfully in temperate ice. The battery capacity should allow measurements to be made every 2 h for more than a year. Future iterations of the radio system will enable Cryoegg to transmit data through up to 2.5 km of ice.
Background: Automated testing instruments (ATIs) are commonly used by clinical microbiology laboratories to perform antimicrobial susceptibility testing (AST), whereas public health laboratories may use established reference methods such as broth microdilution (BMD). We investigated discrepancies in carbapenem minimum inhibitory concentrations (MICs) among Enterobacteriaceae tested by clinical laboratory ATIs and by reference BMD at the CDC. Methods: During 2016–2018, we conducted laboratory- and population-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE) through the CDC Emerging Infections Program (EIP) sites (10 sites by 2018). We defined an incident case as the first isolation of Enterobacter spp (E. cloacae complex or E. aerogenes), Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem from normally sterile sites or urine identified from a resident of the EIP catchment area in a 30-day period. Cases had isolates that were determined to be carbapenem-resistant by clinical laboratory ATI MICs (MicroScan, BD Phoenix, or VITEK 2) or by other methods, using current Clinical and Laboratory Standards Institute (CLSI) criteria. A convenience sample of these isolates was tested by reference BMD at the CDC according to CLSI guidelines. Results: Overall, 1,787 isolates from 112 clinical laboratories were tested by BMD at the CDC. Of these, clinical laboratory ATI MIC results were available for 1,638 (91.7%); 855 (52.2%) from 71 clinical laboratories did not confirm as CRE at the CDC. Nonconfirming isolates were tested on either a MicroScan (235 of 462; 50.9%), BD Phoenix (249 of 411; 60.6%), or VITEK 2 (371 of 765; 48.5%). Lack of confirmation was most common among E. coli (62.2% of E. coli isolates tested) and Enterobacter spp (61.4% of Enterobacter isolates tested) (Fig. 1A), and among isolates testing resistant to ertapenem by the clinical laboratory ATI (52.1%, Fig. 1B). Of the 1,388 isolates resistant to ertapenem in the clinical laboratory, 1,006 (72.5%) were resistant only to ertapenem. Of the 855 nonconfirming isolates, 638 (74.6%) were resistant only to ertapenem based on clinical laboratory ATI MICs. Conclusions: Nonconfirming isolates were widespread across laboratories and ATIs. Lack of confirmation was most common among E. coli and Enterobacter spp. Among nonconfirming isolates, most were resistant only to ertapenem. These findings may suggest that ATIs overcall resistance to ertapenem or that isolate transport and storage conditions affect ertapenem resistance. Further investigation into this lack of confirmation is needed, and CRE case identification in public health surveillance may need to account for this phenomenon.
The threshold to secondary health care should be similar for all patients independent of the underlying disease. This study compared, using a validated health-related quality of life (HRQoL)-instrument, whether the perceived burden of illness is similar in patients admitted for secondary care treatment into a university hospital because of one of six common conditions.
HRQoL, assessed by the generic 15D instrument before elective treatment, was compared in six groups: operative treatment of cataract (n = 219), operative treatment of cervical or lumbar radicular pain (n = 270), hysterectomy due to benign uterine conditions (n = 337), hip or knee replacement surgery (n = 223), coronary angiography due to suspected coronary artery disease (n = 261), and secondary care treatment of depression (n = 89).
Mean (±SD) HRQoL score was clearly highest in patients with benign uterine conditions (0.908 ± 0.071) and lowest in patients with depression (0.729 ± 0.120) (P < 0.001 between the groups). Also all the other groups had a significantly (P < 0.001) higher baseline HRQoL score (ranging from 0.802 to 0.824) than patients with depression. Outcome of treatment, in terms of HRQoL improvement, was in depressive patients at least equal, and in some cases even better, than that in the other groups.
Our results imply that, at least concerning perceived burden of illness, patients with depression are worse off when admitted to secondary care treatment than patients with many somatic conditions. That may be a consequence of poor motivation of depressive patients to seek treatment or that, contradictory to guidelines, the health care system does nor give priority to those worst off and sets a higher threshold for specialized care of patients with depression than of those with common somatic disorders.
In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% (‘telephone’) to 84.0% (‘psychotic symptoms’). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% (‘telephone’) and 80.6% (‘food’).
The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs.
In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received.
In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs.
It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.
The mean episode duration of adolescent major depression is 4 – 9 months among clinically referred youths, recovery rates vary between 35% - 90%, and recurrent episodes are common. In naturalistic studies comprising less selected populations than clinical trials, comorbid psychiatric disorders, poor psychosocial functioning and severity of depression at study entry are among the most consistently reported clinical predictors of less favorable prognosis of youthful depression.
The study aimed at studying the one-year course and at investigating the impact of characteristics of the depressive episode and comorbidity on the one-year outcome of adolescent depression.
A sample of 179 consecutive adolescent (13-19 years) psychiatric outpatients and 17 school-derived matched controls, all with unipolar depressive disorders at baseline, were reinterviewed for DSM-IV Axis I and II disorders at 12 months.
The outpatients had equal recovery rate and episode duration, but shorter time to recurrence than the controls. Fifty percent of the outpatients and 65 % of the depressed controls recovered during the follow-up, 13% of the outpatients and 29% of controls had at least one recurrent depressive episode. Among the outpatients, Axis II comorbidity predicted shorter time to recurrence. Longer time to recovery was predicted by earlier lifetime age of onset for depression, poor psychosocial functioning, depressive disorder diagnosis, and longer episode duration by study entry, with an interaction between episode duration and depressive disorder diagnosis.
Characteristics of depression generally predicted the outcome better than comorbidity. Axis II comorbidity has prognostic value in adolescent depression.
Primary health care is in the central position in the general sphere of mental health services. This article deals with, as a part of a joint Nordic project, the occurrence of mental disorders of patients in primary health care as based on the material (n = 1,000) collected in the health centre of Turku. The relation of the occurrence of mental disorders as diagnosed by means of a standardized psychiatric interview method (PSE) to the disorders, recognized by general practitioners (GPs) working in the health centre is also observed. It was found that one fourth of the patients had a clear mental disorder that required treatment, while studies in the general population, using the same method, reveal only 10% as having some kind of mental disorder. Three quarters of the evident mental disorders recognized by GPs were diagnosed as such also by the PSE, but the GPs were capable of recognizing only 43% of the cases identified by the PSE. On the basis of these results, the importance of the mental health issue in the basic and postgraduate training of the general practitioners must be emphasized.
This longitudinal study was performed to characterise frequently readmitted patients in a sample of 64 first-timers of inpatient care. Half of the 12 revolving door patients were psychotic at last discharge. The relative risk for diagnostic change in the Axis I group was nine times higher than in the personality disorder group.
As panic disorder often remains unrecognized in the health care system, some screening methods have been developed to enhance its recognition. The aim of this study was to test and compare the Autonomic Nervous System Questionnaire (ANS) and the Brief Patient Health Questionnaire (BPHQ) in primary care.
Subjects and methods
A total sample of 211 primary care outpatients was studied. The Structured Clinical Interview for DSM-IV was the criterion standard for the presence of panic disorder. Indices of diagnostic utility for both screening methods were calculated and compared.
The AUC (area under the ROC curve) was 0.885 for the ANS and 0.877 for the BPHQ. At the optimal cut-off level, the ANS had the sensitivity of 0.88 and specificity of 0.77; the BPHQ had the sensitivity of 0.79 and the specificity of 0.87. There was not any statistically significant difference between the screens.
Both screening methods can be recommended both for clinical practice and research use. In busy primary care practice, the BPHQ may be more useful, as it can be used together with the depression module of the BPHQ.
Here we present the installation and successful commissioning of an L'-band Annular Groove Phase Mask (AGPM) coronagraph on VLT/NACO. The AGPM is a vector vortex coronagraph made from diamond subwavelength gratings tuned to the L' band. The vector vortex coronagraph enables high contrast imaging at very small inner working angle (here 0″.09, the diffraction limit of the VLT at L'), potentially being the key to a new parameter space. During technical and science verification runs, we discovered a late-type companion at two beamwidths from an F0V star (Mawet et al. 2013), and imaged the inner regions of β Pictoris down to the previously unexplored projected radius of 1.75 AU. The circumstellar disk was also resolved from ≃ 1″ to 5″ (see J. Milli et al., these proceedings). These results showcase the potential of the NACO L-band AGPM over a wide range of spatial scales.
We studied the prevalence of and association between psychotic symptoms and childhood trauma experiences in primary care patients compared with psychiatric care patients.
Patients and methods
We note 911 primary care and psychiatric care patients over 16 years of age filled in a questionnaire including a list of lifetime psychotic symptoms of the Composite International Diagnostic Interview (CIDI) and the childhood Trauma and Distress Scale (TADS). Prevalence of and correlations between psychotic symptoms and childhood trauma and stressful experiences were calculated. Association between the sum of CIDI symptoms and the TADS sum score was analysed by Anova.
In primary care, more than half of the patients had had at least one psychotic symptom during their lifetime, and nearly 70% of patients had experienced a childhood trauma at some time or more often. In psychiatric care patients, CIDI symptoms were more prevalent and TADS scores were higher than in primary care patients. In the whole sample, CIDI symptoms correlated with TADS scores. The association remained even when the effects of age, service, and patient's functioning were taken into account. There was a dose-response between TADS scores and CIDI symptoms.
Childhood trauma experiences associate with psychotic symptoms. In clinical work, it is important to acknowledge that psychotic symptoms and childhood trauma experiences are common not only in psychiatric care but also in primary care patients, and thus require adequate attention.
Scouring (diarrhoea) is a major concern for sheep producers as the accumulation of faecal material (dags) around the breech pre-disposes sheep to flystrike. Scouring occurs when the consistency of faeces is fluid with a low percentage of dry matter. In temperate areas such as the southern half of Australia, New Zealand and the United Kingdom, scouring is associated with ingestion of parasitic nematode larvae, mainly Teladorsagia circumcincta and Trichostrongylus colubriformis (Larsen et al., 1994). Breeding sheep to be resistant to these nematodes is a sustainable parasite-control strategy due to reduced reliance on chemical treatment. However, in adult sheep, scouring appears equally prevalent in resistant animals and, in some environments, is even more severe than in susceptible sheep (Karlsson et al., 2004). In this experiment, we investigated how faecal dry matter (FDM) in sheep from a flock bred for resistance to parasitic nematodes changed when challenged with infective larvae. We expected that FDM would be lower in challenged sheep compared to unchallenged controls, and FDM would also be lower in sheep with high dag scores compared to sheep with low dag scores.
Boar taint is an off-flavour of pork caused primarily by a microbial breakdown product, skatole and a testicular steroid, androstenone. As skatole is produced in the large intestine from tryptophan, it is possible that some ‘bioactive’ ingredients could modify protein fermentation and, in the process, diminish boar taint. The aim of this study was to examine the effect of inulin-rich chicory roots (Cichorium intybus L.) on boar taint. In the first of three trials individually penned, entire males and females were given an organic concentrate in which 0·25 of the daily energy intake was replaced with crude chicory roots for 9 or 4 weeks prior to slaughter. In the second trial, entire male pigs were given diets that included, either crude chicory roots, dried chicory roots, or inulin (extracted from chicory roots) for 6 weeks pre-slaughter. In the third trial, intact male pigs were given the dried chicory diet for either 2 or 1 week before slaughter. In all trials the chicory diets were offered on a scale at 0·95 of the Danish recommendation for energy intake, and pig performance was compared with a control group given the organic concentrate at 0·95 of recommended energy intake plus silage ad libitum. In trial 1 an additional control group was offered the organic concentrate at a daily energy intake level of 1·0 of Danish recommendations. The pigs in trials 1, 2, and 3 were slaughtered at an average live weight of 118, 124, and 110 kg, respectively, in order to ensure that they had achieved sexual maturity. Overall, skatole concentrations in blood plasma and backfat at slaughter were reduced to almost zero levels by including crude or dried chicory or inulin in the diet. This occurred irrespective of sex and length of feeding period (1 to 9 weeks). In trial 3 a significant effect on blood plasma concentration was observed after 3 days of feeding a diet containing dried chicory. The only significant reduction in plasma androstenone levels was detected in pigs given the crude chicory for a 9 week duration in trial 1. The production and proportion of lean was generally not affected by the addition of either form of chicory to the diets in trials 1 and 2. Therefore, dried chicory may be the most suitable form for commercial use because it: had no initial adverse effects on food intake, consistently reduced skatole without reducing performance, was easy to handle throughout the entire year and is relatively inexpensive.
Background: Asymptomatic proximal coronary artery stenosis after arterial switch operation (ASO) is rare, but a potentially life-threatening condition, that is reported to appear in up to 7%. Angiography, although considered the state-of-the-art method of diagnosis, is an invasive method, but has limitations for diagnosing ostial stenosis. We report changes in Doppler flow profile and coronary flow reserve (CFR) in two asymptomatic patients (9- and 10-year old) with left main coronary artery (LMCA) ostial stenosis after ASO. Methods: Coronary flow was assessed by Transthoracic pulsed and colour-flow Doppler echocardiography (TTDE). CFR was measured in one patient using adenosine infusion (140 mcg/kg/min) over 4 minutes. CFR was calculated as the ratio of reactive hyperaemia to basal average peak velocity (APV). Both children were investigated with coronary angiography. They had myocardial Single-photon Emission Computed Tomography (SPECT), and magnetic resonance imaging (MRI) at rest and after reactive hyperaemia with adenosine infusion. Both patients had balloon dilatation and Cypher select (drug eluted) stent. Results: On echocardiogram a flame-like colour-flow diastolic signal was detected at the stenotic coronary ostia. The maximal spectral velocities during baseline conditions over the stenotic ostia were over 1.9 and 2.0 m/s (normal 30 ± 10 cm/s). The post-stenotic CFR was haemodynmically significant with value of 1.3, normal adult range 2.5–4. Coronary angiography showed a significant ostial stenosis 90% in both patients. Myocardial SPECT and MRI at rest/adenosine infusion were consistent with severe myocardial ischemia in the territory of the left coronary artery. Normal coronary angiography and coronary flow studies after stenting. Conclusion: We suggest that coronary artery flow assessment should be an integral part of the TTDE in the follow up of children with ASO. Serious coronary artery stenosis can be detected with TTDE. Assessment of CFR provides information of the physiological significance of the coronary stenosis.
Laying hens are highly cost-effective producers of polyclonal antibodies in comparison with mammals as the antibodies can be purified from egg yolk. The antibodies are called IgY to differentiate them from mammalian IgG antibodies. Avian antibodies represent both a reduction and refinement in animal use. The cost for producing IgY is lower than for mammalian antibodies as chicken housing is cheap and the isolation/separation process is economical, high yielding, uncomplicated and fast.
IgY antibodies do not cross-react with Fc receptors, mammalian immunoglobulins such as RF and HAMA or activate the complement system and thereby reducing the cause of false positive results in immunological assays. These properties have also made them attractive for peroral immunotherapy for a variety of gastrointestinal diseases, such as human rotaviruses, enterotoxigenic Escherichia coli and Salmonella spp. In the future the IgY technology offers great opportunities to be more widely used in immunotherapy, diagnostics and research.
Background. Somatization is a clinical phenomenon characterized by multiple, medically unexplained somatic symptoms. The pathophysiology remains unknown. We aimed to test the hypothesis of a central nervous system dysfunction in the pathophysiology of this disorder.
Methods. We studied 10 female patients diagnosed as having somatization disorder or undifferentiated somatoform disorder with no current Axis I disorders according to DSM-IV. They were compared with 17 healthy female volunteers using brain [18F]-fluorodeoxyglucose-PET with MRI reference.
Results. The patients had lower cerebral metabolism rates of glucose (P<0·05) in both caudate nuclei, left putamen and right precentral gyrus compared with healthy volunteers.
Conclusions. This is the first study to demonstrate changes in brain metabolism in somatizing women. The regional cerebral hypometabolism is probably associated with the pathophysiology of somatization.