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Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.
Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.
Core and tidal radii of the Carina dwarf galaxy are determined by fitting King dynamical models to number count radial profiles, derived from COSMOS data. These values are compared with those of the other six known Local Group dwarf spheroidals.
We have observed 3 moderate redshift clusters using a combination of 7 intermediate band filters and 2 CCDs in order to derive photometric information for cluster galaxies from 400 nm to 900 nm. Preliminary results are presented for 2 clusters: Abell 1942 (z=0.224) and Abell 1525 (z=0.259) from 580 nm to 860 nm. The CCD photometry reaches a limit equivalent to RF=21 mag with a precision of better than 0.1 mag. The galaxy colours derived from the intermediate band measurements are generally consistent with those expected at the appropriate redshift. However, in Abell 1525, and to a lesser extent in Abell 1942, a large proportion of cluster members have far red (720–860 nm) colours redder than expected. Many of these galaxies have blue photographic BJ-RF colours. A possible explanation for the anomalous CCD colours is that these galaxies possess a strong emission line component which enters the far red filter at z=0.25.
Grassland silage management is generally ad hoc resulting in soil compaction damage. Literature suggests grass yield reductions of 5 to 74% through compaction (UK mean 13%), while a 2015 study, reported here, comparing grass dry matter (DM) yield between controlled traffic farming (CTF) and normal management (N), found a 13.5% (0.80 t ha−1) increase for CTF. Commercially available grass forage equipment with widths of 3 to 12 m set up for CTF reduced trafficked areas from 80%–90% for N to 40%–13%. Economic analysis based on 13% increase in DM for 2 and 3 cut systems, gave an increased grass value between £38 ha−1 and £98 ha−1. CTF for multi-cut grass silage effectively increases yields by reducing compaction and sward damage.
The Functional Visual Field (FVF) offers explanatory power. To us, it relates to existing literature on the flexibility of attentional focus in visual search and reading (Eriksen & St. James 1986; McConkie & Rayner 1975). The target article promotes reflection on existing findings. Here we consider the FVF as a mechanism in the Prevalence Effect (PE) in visual search.
Introduction: The following adverse outcomes have been described in patients treated in hospital for opioid overdose: pulmonary edema, cardiac dysrhythmias, neurologic injury secondary to hypoxia, prolonged opioid toxicity, recurrent opioid toxicity. In addition, patients who take an overdose of fentanyl may develop fentanyl induced chest rigidity, a life-threatening complication that appears to be uniquely related to fentanyl. The prevalence of adverse outcomes and the clinical course of patients that develop these complications have been described in patients who have taken an overdose of heroin. However, in British Columbia there has been a dramatic increase in the number of patients who overdose on fentanyl and other ultrapotent opioids. The proportion of illicit drug overdose deaths in British Columbia for which fentanyl was detected was only 5% in 2012 but, by 2016, this proportion had increased to 62%. It is very important to know the prevalence of adverse outcomes and the clinical course of patients that develop these adverse outcomes in patients with an overdose of fentanyl or another ultrapotent opioid. Methods: We are completing a retrospective cohort study to evaluate the prevalence of the following adverse outcomes for patients treated in hospital for an opioid overdose: i) pulmonary edema, ii) cardiac dysrhythmias, iii) fentanyl induced chest rigidity, iv) neurologic injury secondary to hypoxia, v) prolonged opioid toxicity, vi) recurrent opioid toxicity. Health records of patients treated for opioid overdose in the emergency departments of six greater Vancouver hospitals from Jan 1, 2014 to Dec 31, 2016 are being reviewed. Results: All Institutional approvals have been obtained. The dataset of 3600 ED visits for opioid overdose has been obtained and 160 health records have now been reviewed as of January 8, 2017. We will describe the type and prevalence (with 95% confidence intervals) of complications sustained by these patients. Conclusion: The results of this study will guide management of opioid overdose in a setting were ultrapotent opioids are commonly ingested. All health records will have been reviewed and the data analysis completed by May 2017.
Electropolymerization is a promising approach to produce thin films of active organic conjugated materials on a desired conducting substrate. In this work, an electropolymerization study has been carried out on two diketopyrrolopyrrole (DPP)-based monomers 2,5-bis(2-butyloctyl)-3,6-di(furan-2-yl)pyrrolo[3,4-c]pyrrole-1,4(2H,5H)-dione (BO-DPPF) and 2,5-bis(2-butyloctyl)-3,6-di(thiophen-2-yl)pyrrolo[3,4-c]pyrrole-1,4(2H,5H)-dione (BO-DPPT). These monomers consist of thiophene and furan heterocyclic moieties attached to a DPP core with a common solubilizing alkyl chain (butyl-octyl). The properties of these monomers were analyzed via differential scanning calorimetry, thermogravimetric analysis, UV–Vis spectrometry (UV) and photoluminescence. Cyclic voltammetry (CV) studies indicate the presence of irreversible oxidation and reduction reactions. The electropolymerization of BO-DPPF and BO-DPPT electron-deficient monomers to form polymer films on a glassy carbon electrode is achieved by applying a potential between −2 V and 2 V versus ferrocene for up to 50 cycles. The properties of the polymers were investigated using the cyclic voltammetry (CV) technique.
Collectors of prehistoric antiquities have long regarded the foreshore of long stretches of the Essex Coast between the rivers Stour and Blackwater as a prolific hunting ground, and many notable collections, consisting mainly of flints, have been obtained from this area. It is not the purpose of this paper to record these discoveries in detail, but rather to discuss the circumstances under which the antiquities are found, to summarise the main facts relating to the age of the old land-surface now submerged below the sea at high tide, and in conclusion to relate the facts observed on the Essex Coast to the stratigraphy established for the post-glacial deposits of the Fenland basin.
The object of the excavations described in this preliminary report was to recover evidence of:
(a) the more perishable elements in the material culture of a Maglemosian community,
(b) the fauna on which this community largely subsisted and
(c) the vegetation which formed the ecological setting of man and beast alike.
The best way of appreciating the need for such an investigation and of judging the measure of success attained in this first season is to consider how knowledge of the Maglemosian culture in Britain grew up between the two world wars. There appear to have been two main clues, namely single finds of barbed bone points, commonly, though probably wrongly, referred to in the early literature as ‘harpoons,’ and flint industries of a type associated with analogous points on Maglemosian sites in the Baltic area.
Few regions have yielded so many bronzes as the East Anglian fens, yet accurate records of the circumstances of their discovery exist for a small fraction only of the finds. This is very regretable since this evidence is usually of far more importance been than the objects found. In the case of the Methwold spear-head it has to some extent recovered by the diligence of Major Gordon Fowler, F.S.A., who interviewed the discoverer, Mr. John Harrod of Methwold, and obtained the object for the University Museum of Archaeology and Ethnology at Cambridge. The only completely satisfactory method is an immediate visit to the site of a discovery, and in this the Fenland Research Committee, which is vitally interested in such finds, is always keen to co-operate.
The site of the discovery may be found immediately below the “un” of Queen's Ground, Methwold Fen (Norfolk 6 in. sheet LXXXI, S.E., 1906 edtn.; Long. 0° 28′ 57″, Lat. 52° 30′ 29″). The spear-head itself (fig. 1) has loops at the junction of the socket and wings. Mr. Estyn Evans, F.S.A., to whom a photograph has been submitted, is of the opinion that this type marks the transition from the Middle to the Late Bronze Age in Britain, in which case it would date from approximately 1000 B.C.
It would, perhaps, be more conventional to ascribe the spear-head to the end of the Middle Bronze Age.
Excavations in 1958 for the construction of a dam at Loch Droma, Ross and Cromarty, revealed a deep and extensive section in peat and Late-glacial silts. The section was surveyed, its environs studied, and samples of materials analyzed by the Macaulay Institute, Aberdeen, and the Sub-department of Quaternary Research, University of Cambridge. The watershed location of the site, the early radio-carbon date obtained for the basal silts (12,810 ± 155 B.P.), and the nature of their organic contents, make this a critical site for the elucidation of the deglaciation and vegetational history of the Atlantic seaboard of North-west Scotland. In Part I of this report, W. Kirk describes the site and its setting, and indicates some of the problems it raises for existing glacial chronologies of Northern Scotland, and in Part II, H. Godwin summarizes and comments upon the analyses of organic remains.
Determination of optimum sperm requirement in artificial breeding helps to improve the fertilization efficiency, sperm economy and minimize the sacrificing of males for milt. Quantification of sperm cells was done by spectrophotometer at 420 nm followed by haemocytometer counting. Best correlation (r2 = 0.97) was recorded. The minimum number of sperm required for optimal fertilization success in Heteropneustes fossilis was determined. An average fertilization success of 78–93% was recorded at 8 × 103 to 8 × 107 sperm per egg. The optimum contact duration of gametes was 5 minutes. The highest fertilization rate of 98.18% was recorded at 8 × 107 spermatozoa.egg−1.
The translocation of C and N in a maize-Striga hermonthica association was investigated at three rates of nitrogen application in a glasshouse experiment. The objectives were to measure the transfer of C and N from maize to S. hermonthica and to determine whether the amount of N in the growing medium affected the proportions of C and N transferred. Young plants of maize were labelled in a 13CO2 atmosphere and leaf tips were immersed in (15NH4)2SO4 solution. The Striga×N interaction was not significant for any of the responses measured. Total dry matter for infected maize was significantly smaller than for uninfected maize from 43 to 99 days after planting, but N application increased total dry matter at all sampling times. Infected maize plants partitioned 39–45% of their total dry matter to the roots compared with 28–31% for uninfected maize. Dry matter of S. hermonthica was not affected by the rate of N applied. S. hermonthica derived 100% of its carbon from maize before emergence, decreasing to 22–59% thereafter; the corresponding values for nitrogen were up to 59% pre-emergence and up to 100% after emergence. The relative proportions of nitrogen depleted from the host (up to 10%) were greater than those of carbon (maximum 1.2%) at all times of sampling after emergence of the parasite. The results show that the parasite was more dependent on the host for nitrogen than for carbon.
Global influences have long had an effect on the development of African cities, but the degree of influence was enhanced by the increased frequency of contact with the outside world in the late nineteenth and twentieth centuries. African cities are home to Africans from throughout the continent as well as foreigners who came to the cities at different times and for various reasons. The hybrid nature of the urban environment was determined by immigration, religious factors, and the continuing conflict between “traditional” and “modern” space. Global influences, however, do not imply a lack of African agency. We must recognize the cultural and political synthesis that was undergoing continual transformation. The essays in this section reflect these themes and show that identities were also linked closely to these processes of change.
The early colonial era witnessed an increased flow of people and ideas between African areas and from abroad. Jeremy Rich looks at the connections that tied Libreville, Gabon, to the Atlantic and imperial worlds and attracted Africans from not only the interior but from the coastal regions of West Africa. Senegalese workers, sailors, soldiers, and religious clerics, for example, immigrated to Libreville during the early colonial era and helped shape the physical and social space of the city. Vietnamese laborers, brought into the region by French administrators to do menial labor, also contributed to the diverse character of the port community. Both groups faced difficulties in adapting to their new environment but were instrumental in determining the spatial development of the city. Rich calls for historians to pay greater heed to the level of global influences in the early colonial era and acknowledge their importance in the economic, social, and cultural development of coastal African cities.
For many years, the focus of urban scholarship in Africa was on the changes that rural-urban migrants underwent during their early adaptation to the urban environment. Too often, however, their histories stopped there. Maurice Amutabi looks not only at the problematic legacy of colonialism in Kenya, but also suggests a move away from migrationist histories toward an analysis of what happened to immigrant groups once they had settled in their new cities.