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Nitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.
After reading this article you will be able to:
•understand the epidemiological and clinical features of nitrous oxide misuse
•understand the mechanisms of action of nitrous oxide
•describe potential treatment options in nitrous oxide misuse.
Harold J. Berman, a Jewish convert to Christianity, was a pioneer in the study of legal history, legal philosophy, and law and religion. He mapped the deep Christian and post-Christian foundations of the Western legal tradition as a whole and of many of its particular legal doctrines. He developed an integrative jurisprudence that transcended many of the dualistic dialectics of the past, and that reconciled natural law theory, legal positivism, and historical jurisprudence with each other on the basis of a holistic theory of God and humanity. He offered creative explorations of the roles of language, speech, and dialogue in the development of local and global legal communities. And he developed an innovative theory of the religious dimensions of law, the legal dimensions of religion, and the need for a healthy interaction of legal ideas, institutions, and methods in a just and orderly society. Despite the tensions that exist in all societies between religious faith and legal order, he argued, law and religion inevitably interact, and neither can maintain its vitality independently of the other. At the highest level, surely the just and the holy are one.
Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.
An exact knowledge of environmental particulate levels at their sources of production, geographic sites of dissemination and/or anatomic sites of deposition after they have been inhaled or ingested by the body is considered a main priority in the environmental health field. One must therefore recognize the need for rapid, accurate and sensitive means of sampling and analyzing these materials, often found in trace amounts, with little alteration from their original physical and chemical structure. A summary of the various theoretical approaches and methodologies investigated in our laboratory towards that goal are discussed with emphasis on X-ray techniques used, correction factors involved, and areas requiring further research.
Many of the scientific programs proposed for implementation at existing and future synchrotron radiation sources involve measurement of the spatial distribution of transmitted or diffracted x-ray beams. The design of a general purpose position-sensitive detector for use in such experiments must address several conflicting requirements. Ideally, such a detector would meet the following criteria: high detection efficiency over a wide energy range, large dynamic range in measured photon intensities and response to a wide range of measurement intervals. Existing detector systems only partially meet these requirements, although much work has gone into improving the current technology.
In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p = 0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR = 2.16, p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean.
To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms.
Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents’ characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms.
Overall, 20.6% of infants were ‘at risk of overweight’. Fathers were present in 52% of households. Fathers’ presence [OR (95% CI) 0.60 (0.37–0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices.
Fathers may be important agents of change in intervention strategies to prevent childhood overweight.
This Research Communication describes an investigation of the nutritional depletion of total mixed rations (TMR) by pest birds. We hypothesized that species-specific bird depredation of TMR can alter the nutritional composition of the ration and that these changes can negatively impact the performance of dairy cows. Blackbirds selected the high energy fraction of the TMR (i.e., flaked corn) and reduced starch, crude fat and total digestible nutrients during controlled feeding experiments. For Holsteins producing 37·1 kg of milk/d, dairy production modeling illustrated that total required net energy intake (NEI) was 35·8 Mcal/d. For the reference TMR unexposed to blackbirds and the blackbird-consumed TMR, NEI supplied was 41·2 and 37·8 Mcal/d, and the resulting energy balance was 5·4 and 2·0 Mcal/d, respectively. Thus, Holsteins fed the reference and blackbird-consumed TMR were estimated to gain one body condition score in 96 and 254 d, and experience daily weight change due to reserves of 1·1 and 0·4 kg/d, respectively. We discuss these results in context of an integrated pest management program for mitigating the depredation caused by pest birds at commercial dairies.
Cryptosporidium is a protozoan parasite that causes the diarrhoeal disease, cryptosporidiosis. Although many species have been identified, the majority of human disease worldwide is caused by two species; Cryptosporidium parvum and Cryptosporidium hominis. In Australia, data from the National Notifiable Diseases Surveillance System (NNDSS) show that cryptosporidiosis outbreaks occur every few years. To better understand the transmission, trends and nature of cryptosporidiosis outbreaks in Western Australia, epidemiological and genomic data from three cryptosporidiosis outbreaks in 2003, 2007 and 2011 were reviewed. The 2007 outbreak was the largest (n = 607) compared with the outbreaks in 2003 (n = 404) and 2011 (n = 355). All three outbreaks appeared to have occurred predominantly in the urban metropolitan area (Perth), which reported the highest number of case notifications; increases in case notifications were also observed in rural and remote areas. Children aged 0–4 years and non-Aboriginal people comprised the majority of notifications in all outbreaks. However, in the 2003 and 2007 outbreaks, a higher proportion of cases from Aboriginal people was observed in the remote areas. Molecular data were only available for the 2007 (n = 126) and 2011 (n = 42) outbreaks, with C. hominis the main species identified in both outbreaks. Subtyping at the glycoprotein 60 (gp60) locus identified subtype IbA10G2 in 46.3% and 89.5% of C. hominis isolates typed, respectively, in the 2007 and 2011 outbreaks, with the IdA15G1 subtype was identified in 33.3% of C. hominis isolates typed in the 2007 outbreak. The clustering of cases with the IdA15G1 subtype in the remote areas suggests the occurrence of a concurrent outbreak in remote areas during the 2007 outbreak, which primarily affected Aboriginal people. Both the C. hominis IbA10G2 and IdA15G1 subtypes have been implicated in cryptosporidiosis outbreaks worldwide; its occurrence indicates that the mode of transmission in both the 2007 and 2011 outbreaks was anthroponotic. To better understand the epidemiology, sources and transmission of cryptosporidiosis in Australia, genotyping data should routinely be incorporated into national surveillance programmes.
Knowledge of the effects of burial depth and burial duration on seed viability and, consequently, seedbank persistence of Palmer amaranth (Amaranthus palmeri S. Watson) and waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] ecotypes can be used for the development of efficient weed management programs. This is of particular interest, given the great fecundity of both species and, consequently, their high seedbank replenishment potential. Seeds of both species collected from five different locations across the United States were investigated in seven states (sites) with different soil and climatic conditions. Seeds were placed at two depths (0 and 15 cm) for 3 yr. Each year, seeds were retrieved, and seed damage (shrunken, malformed, or broken) plus losses (deteriorated and futile germination) and viability were evaluated. Greater seed damage plus loss averaged across seed origin, burial depth, and year was recorded for lots tested at Illinois (51.3% and 51.8%) followed by Tennessee (40.5% and 45.1%) and Missouri (39.2% and 42%) for A. palmeri and A. tuberculatus, respectively. The site differences for seed persistence were probably due to higher volumetric water content at these sites. Rates of seed demise were directly proportional to burial depth (α=0.001), whereas the percentage of viable seeds recovered after 36 mo on the soil surface ranged from 4.1% to 4.3% compared with 5% to 5.3% at the 15-cm depth for A. palmeri and A. tuberculatus, respectively. Seed viability loss was greater in the seeds placed on the soil surface compared with the buried seeds. The greatest influences on seed viability were burial conditions and time and site-specific soil conditions, more so than geographical location. Thus, management of these weed species should focus on reducing seed shattering, enhancing seed removal from the soil surface, or adjusting tillage systems.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a thin dielectric, and thin separated metal top-surface structures. The dielectric SiO2 strongly absorbs near 9 µm wavelength and has correspondingly strong long-wave-infrared (LWIR) dispersion for the refractive index. This dispersion results in multiple absorption resonances spanning the LWIR, which can enhance broad-band sensitivity for LWIR bolometers. Similar considerations apply to silicon nitride Si3N4. TiO2 and AlN have comparatively low dispersion and give simple single LWIR resonances. These dispersion-dependent features for infrared MIM devices are demonstrated by experiment, electrodynamic simulation, and an analytic model based on standing waves.
Palmer amaranth (Amaranthus palmeri S. Watson) is a problematic weed encountered in U.S. cotton (Gossypium hirsutum L.) and soybean [Glycine max (L.) Merr.] production, with infestations spreading northward. This research investigated the influence of planting date (early, mid-, and late season) and population (AR, IN, MO, MS, NE, and TN) on A. palmeri growth and reproduction at two locations. All populations planted early or midseason at Throckmorton Purdue Agricultural Center (TPAC) and Arkansas Agriculture Research and Extension Center (AAREC) measured 196 and 141 cm or more, respectively. Amaranthus palmeri height did not exceed 168 and 134 cm when planted late season at TPAC and AAREC, respectively. Early season planted A. palmeri from NE grew to 50% of maximum height 8 to 13 d earlier than all other populations under TPAC conditions. In addition, the NE population planted early, mid-, and late season achieved 50% inflorescence emergence 5, 4, and 6 d earlier than all other populations, respectively. All populations established at TPAC produced fewer than 100,000 seeds plant−1. No population planted at TPAC and AAREC produced more than 740 and 1,520 g plant−1 of biomass at 17 and 19 wk after planting, respectively. Planting date influenced the distribution of male and female plants at TPAC, but not at AAREC. Amaranthus palmeri from IN and MS planted late season had male-to-female plant ratios of 1.3:1 and 1.7:1, respectively. Amaranthus palmeri introduced to TPAC from NE can produce up to 7,500 seeds plant−1 if emergence occurs in mid-July. An NE A. palmeri population exhibited biological characteristics allowing it to be highly competitive if introduced to TPAC due to a similar latitudinal range, but was least competitive when introduced to AAREC. Although A. palmeri originating from different locations can vary biologically, plants exhibited environmental plasticity and could complete their life cycle and contribute to spreading populations.
To examine the potential links between activity spaces, the food retail environment and food shopping behaviours for the population of young, urban adults.
Participants took part in the Canada Food Study, which collected information on demographics, food behaviour, diet and health, as well as an additional smartphone study that included a seven-day period of logging GPS (global positioning system) location and food purchases. Using a time-weighted, continuous representation of participant activity spaces generated from GPS trajectory data, the locations of food purchases and a geocoded food retail data set, negative binomial regression models were used to explore what types of food retailers participants were exposed to and where food purchases were made.
Toronto, Montreal, Vancouver, Edmonton and Halifax, Canada.
Young adults aged 16–30 years (n 496). These participants were a subset of the larger Canada Food Study.
Demographics, household food shopper status and city of residence were significantly associated with different levels of exposure to various types of food retailers. Food shopping behaviours were also statistically significantly associated with demographics, the activity space-based food environment, self-reported health and city of residence.
The study confirms that food behaviours are related to activity space-based food environment measures, which provide a more comprehensive accounting of food retail exposure than home-based measures. In addition, exposure to food retail and food purchasing behaviours of an understudied population are described.
Prolonged periods of stress have been associated with impaired immune function; the experiment reported here investigates a potential link between level of metabolic load and immune function in lactating dairy cattle. A group of 111 Holstein-Friesian dairy cows was used. The cows belonged to one of two genetic lines: a selection line (S) with high genetic merit for fat plus protein yield and an unselected control line (C). The cows were offered one of two silage-based total mixed diets containing either 200 g (LC) or 450 g (HC) of concentrate per kg dry matter. Combination of genetic selection and food gave four groups: S-LC, S-HC, C-LC and C-HC. All cows were inoculated with a live attenuated BHV-1 vaccine soon after parturition and the primary antibody response in whey monitored. The number of BHV-1 antibody positive cows was not significantly different between the four groups; but, the initial antibody response was lower in cows of high genetic merit which were given a low concentrate diet. Statistical analysis demonstrated that the contribution of diet to this effect was highly significant. One year later, again after parturition, the experiment was repeated, this time using serum as the test sample. The average antibody response of the BHV-1 antibody positive cows was not significantly different between the four groups but the number of antibody positive cows was group-dependent. In conclusion, diet type but not genetic merit for high fat plus protein yield made a highly significant contribution to the antibody response of dairy cows to BHV-1 vaccination, both initially and a year later.
The healthcare environment is recognized as a source for healthcare-acquired infection. Because cleaning practices are often erratic and always intermittent, we hypothesize that continuously antimicrobial surfaces offer superior control of surface bioburden.
To evaluate the impact of a photocatalytic antimicrobial coating at near-patient, high-touch sites in a hospital ward.
The study took place in 2 acute-care wards in a large acute-care hospital.
A titanium dioxide-based photocatalytic coating was sprayed onto 6 surfaces in a 4-bed bay in a ward and compared under normal illumination against the same surfaces in an untreated ward: right and left bed rails, bed control, bedside locker, overbed table, and bed footboard. Using standardized methods, the overall microbial burden and presence of an indicator pathogen (Staphylococcus aureus) were assessed biweekly for 12 weeks.
Treated surfaces demonstrated significantly lower microbial burden than control sites, and the difference increased between treated and untreated surfaces during the study. Hygiene failures (>2.5 colony-forming units [CFU]/cm2) increased 2.6% per day for control surfaces (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.009–1.043; P=.003) but declined 2.5% per day for treated surfaces (OR, 0.95; 95% CI, 0.925–0.977; P<.001). We detected no significant difference between coated and control surfaces regarding S. aureus contamination.
Photocatalytic coatings reduced the bioburden of high-risk surfaces in the healthcare environment. Treated surfaces became steadily cleaner, while untreated surfaces accumulated bioburden. This evaluation encourages a larger-scale investigation to ascertain whether the observed environmental amelioration has an effect on healthcare-acquired infection.
We examined risk factors associated with the intestinal acquisition of antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) and development of community-acquired urinary tract infection (UTI) in a case-control study of young women across Canada. A total of 399 women were recruited; 164 women had a UTI caused by E. coli resistant to ⩾1 antimicrobial classes and 98 had a UTI caused by E. coli resistant to ⩾3 antimicrobial classes. After adjustment for age, student health service (region of Canada) and either prior antibiotic use or UTI history, consumption of processed or ground chicken, cooked or raw shellfish, street foods and any organic fruit; as well as, contact with chickens, dogs and pet treats; and travel to Asia, were associated with an increased risk of UTI caused by antimicrobial resistant E. coli. A decreased risk of antimicrobial resistant UTI was associated with consumption of apples, nectarines, peppers, fresh herbs, peanuts and cooked beef. Drug-resistant UTI linked to foodborne and environmental exposures may be a significant public health concern and understanding the risk factors for intestinal acquisition of existing or newly emerging lineages of drug-resistant ExPEC is important for epidemiology, antimicrobial stewardship and prevention efforts.
VLBI observations of SiO masers recover at most 40-50% of the total flux obtained by single dish observations at any spectral channel. Some previous studies seems to indicate that, at least, part of the lost flux is divided up into many weak components rather than in a large resolved emission area. Taking benefit of the high sensitivity and resolution of the HSA, we investigate the problem of the missing flux in VLBI observations of SiO maser emission at 7 mm in the AGB stars and obtain a high dynamic range map of IRC+10011. We conclude that the missing flux is mostly contained in many very weak maser components.