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Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
This article starts with a brief review of the UK Supreme Court's decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.
•Appreciate that a new test of consent has been established as of a result of the UK Supreme Court's Montgomery ruling
•Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery
•Understand how values-based practice and Montgomery together support shared decision-making in psychiatry
Previous research has shown relatively diminished medial prefrontal cortex activation and heightened psychophysiological responses during the recollection of personal events in post-traumatic stress disorder (PTSD), but the origin of these abnormalities is unknown. Twin studies provide the opportunity to determine whether such abnormalities reflect familial vulnerabilities, result from trauma exposure, or are acquired characteristics of PTSD.
In this case–control twin study, 26 male identical twin pairs (12 PTSD; 14 non-PTSD) discordant for PTSD and combat exposure recalled and imagined trauma-unrelated stressful and neutral life events using a standard script-driven imagery paradigm during functional magnetic resonance imaging and concurrent skin conductance measurement.
Diminished activation in the medial prefrontal cortex during Stressful v. Neutral script-driven imagery was observed in the individuals with PTSD, relative to other groups.
Diminished medial prefrontal cortex activation during Stressful v. Neutral script-driven imagery may be an acquired characteristic of PTSD. If replicated, this finding could be used prospectively to inform diagnosis and the assessment of treatment response.
Observations of the sun and major and minor planets made by transit circle telescopes are used to determine positions of the equinox and the celestial equator and, by repeated observing programs, the motions of these fiducial references. Long series of such absolute observations, when combined into catalogs such as the FK5, yield a fundamental coordinate system which is an observational approximation to an ideal, dynamically defined coordinate system. In such a system the equinox, for example, is defined implicitly by the right ascensions (at mean epoch) and the proper motions of the stars included in the catalog system, together with the adopted constant of precession. It may be noted that independent, highly accurate determinations of the latter quantity thus help to improve the fundamental proper motion system.
Considerable progress has been made over the last few years in ground based optical interferometery. The Mark III optical interferometer at Mount Wilson which at this time is operating with a 12 meter north south baseline is capable of measuring amplitude and phase. Experience gained from this facility will allow for the development of a large optical array. Preliminary plans are described for a facility that will be capable of milliarcsecond imaging of celestial objects at wavelengths from 0.4 to 10 microns. If funded this array will be in operation by 1993.
We present low-frequency spectral energy distributions of 60 known radio pulsars observed with the Murchison Widefield Array telescope. We searched the GaLactic and Extragalactic All-sky Murchison Widefield Array survey images for 200-MHz continuum radio emission at the position of all pulsars in the Australia Telescope National Facility (ATNF) pulsar catalogue. For the 60 confirmed detections, we have measured flux densities in 20 × 8 MHz bands between 72 and 231 MHz. We compare our results to existing measurements and show that the Murchison Widefield Array flux densities are in good agreement.
In 1987 we began a 5-year program to establish a reference system of at least 400 extragalactic sources which are compact and flat spectrum in the radio and which also display optical emission. This reference frame is to be global with about one source per 100 sq deg (Johnston, et al., 1988). The program incorporates some data which had been obtained previously for other purposes. Altogether, in one or another aspect of the program, 489 sources have been considered so far.
The Earth is within the Contemporaneous Solar Maximum (CSM), analogous to the Medieval Solar Maximum (MSM). If this analogy is valid, solar activity will continue to increase well into the 21st century. We have completed 75 single-ring and 10 double-ring measurements from ad 1065 to ad 1150 to obtain information about solar activity during this postulated analog to solar activity during the MSM. δ14C decreases steadily during the period ad 1065 to ad 1150 but with cyclical oscillations around the decreasing trend. These oscillations can be successfully modeled by four cycles. These four frequencies are 1/52 yr-1, 1/22 yr-1, 1/11 yr-1, and 1/5.5 yr, i.e., the 4th harmonic of the Suess cycle, the Hale and Schwabe cycles and the 2nd harmonic of the Schwabe cycle.
Trigonometric parallaxes have been measured by Dahn et al. (2002) for 28 cool dwarfs and brown dwarfs, including 17 L dwarfs and three T dwarfs. Broadband CCD and near-IR photometry (VRIz*JHK) have been obtained for these objects and for 24 additional late-type dwarfs. These data have been supplemented with astrometry and photometry from the literature, including parallaxes for the brighter companions of ten L and two T dwarfs. The absolute magnitudes and colors are reviewed here. The I - J color and the spectral type are both good predictors of absolute magnitude for late-M and L dwarfs. MJ becomes monotonically fainter with I - J color and with spectral type through late-L dwarfs, then brightens for early-T dwarfs. In contrast, the J - K color correlates poorly with absolute magnitude for L dwarfs. Using several other parameters from the literature (Li detection, Hα emission strength, projected rotation velocity, and tangential velocity), we fail to uncover any measurable parameter that correlates with the anomalous J - K color.
We have assembled a new sample of some of the most FIR-luminous galaxies in the Universe and have imaged them in 1.1 mm dust emission and measured their redshifts 1 < z < 4 via CO emission lines using the 32-m Large Millimeter Telescope / Gran Telescopio Milimétrico (LMT/GTM). Our sample of 31 submm galaxies (SMGs), culled from the Planck and Herschel all-sky surveys, includes 14 of the 21 most luminous galaxies known, with LFIR > 1014L⊙ and SFR > 104M⊙/yr. These extreme inferred luminosities – and multiple / extended 1.1 mm images – imply that most or all are strongly gravitationally lensed, with typical magnification μ ~ 10 × . The gravitational lensing provides two significant benefits: (1) it boosts the S/N, and (2) it allows investigation of star formation and gas processes on sub-kpc scales.