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In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P < 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013.
Introduction: When a patient is incapable of making medical decisions for themselves, choices are made according to the patient's previously expressed, wishes, values, and beliefs by a substitute decision maker (SDM). While interventions to engage patients in their own advance care planning exist, little is known about public readiness to act as a SDM on behalf of a loved one. This mixed-methods survey aimed to describe attitudes, enablers and barriers to preparedness to act as a SDM, and support for a population-level curriculum on the role of an SDM in end-of-life and resuscitative care. Methods: From November 2017 to June 2018, a mixed-methods street intercept survey was conducted in Ottawa, Canada. Descriptive statistics and logistic regression analysis were used to assess predictors of preparedness to be a SDM and understand support for a high school curriculum. Responses to open-ended questions were analyzed using inductive thematic analysis. Results: The 430 respondents were mostly female (56.5%) with an average age of 33.9. Although 73.0% of respondents felt prepared to be a SDM, 41.0% of those who reported preparedness never had a meaningful conversation with loved ones about their wishes in critical illness. The only predictors of SDM preparedness were the belief that one would be a future SDM (OR 2.36 95% CI 1.34-4.17), and age 50-64 compared to age 16-17 (OR 7.46 95% CI 1.25-44.51). Thematic enablers of preparedness included an understanding of a patient's wishes, the role of the SDM and strong familial relationships. Barriers included cultural norms, family conflict, and a need for time for high stakes decisions. Most respondents (71.9%) believed that 16 year olds should learn about SDMs. They noted age appropriateness, potential developmental and societal benefit, and improved decision making, while cautioning the need for a nuanced approach respectful of different maturity levels, cultures and individual experiences. Conclusion: This study reveals a concerning gap between perceived preparedness and actions taken in preparation to be an SDM for loved ones suffering critical illness. The results also highlight the potential role for high school education to address this gap. Future studies should further explore the themes identified to inform development of resources and curricula for improved health literacy in resuscitation and end-of-life care.
Background: Patients presenting to the Emergency Department (ED) with unmet palliative care needs are often admitted to hospital and this can be a pivotal point in their subsequent health care journey. Literature from the United States supports the integration of palliative care resources in the ED and to our knowledge, this has yet to be done in a Canadian setting. Aim Statement: To develop, implement, and evaluate a model to support patients presenting to the ED with unmet palliative care needs. Measures & Design: A pilot project was implemented in one campus of the ED at a tertiary care academic center in Ottawa, Ontario. A palliative care nurse specialist was available for consultation with goals to: a) reduce admission to hospital for patients choosing to have a palliative approach to their care; b) increase coordination between ED and community resources; and c) be a resource for ED staff. Referral criteria were developed after systematic review of the literature and in consultation with palliative and emergency medicine experts. Evaluation/Results: Over the course of the study period (9 months), 50 referrals were made. The primary reason for referral was for increased community supports. Patient outcomes: 10 patients were discharged to hospice/palliative care units from the ED, 38 patients were discharged home. Of those discharged home, 66% had no returns to ED within 30 days. Qualitative feedback collected via pre and post survey has been extremely supportive from ED health care practitioners and community palliative care providers. Discussion/Impact: This ongoing project has led to positive, patient centered outcomes and decreased admission to acute care hospital. Ongoing evaluation will include consideration of Ontario Palliative Care Network quality indicators and cost-analysis to determine impact on health care system.
IR spectroscopy in the range 12–230 μm with the SPace IR telescope for Cosmology and Astrophysics (SPICA) will reveal the physical processes governing the formation and evolution of galaxies and black holes through cosmic time, bridging the gap between the James Webb Space Telescope and the upcoming Extremely Large Telescopes at shorter wavelengths and the Atacama Large Millimeter Array at longer wavelengths. The SPICA, with its 2.5-m telescope actively cooled to below 8 K, will obtain the first spectroscopic determination, in the mid-IR rest-frame, of both the star-formation rate and black hole accretion rate histories of galaxies, reaching lookback times of 12 Gyr, for large statistically significant samples. Densities, temperatures, radiation fields, and gas-phase metallicities will be measured in dust-obscured galaxies and active galactic nuclei, sampling a large range in mass and luminosity, from faint local dwarf galaxies to luminous quasars in the distant Universe. Active galactic nuclei and starburst feedback and feeding mechanisms in distant galaxies will be uncovered through detailed measurements of molecular and atomic line profiles. The SPICA’s large-area deep spectrophotometric surveys will provide mid-IR spectra and continuum fluxes for unbiased samples of tens of thousands of galaxies, out to redshifts of z ~ 6.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Background: Standardized data collection for traumatic brain injury (TBI) (including concussion) using common data elements (CDEs) has strengthened clinical care and research capacity in the United States and Europe. Currently, Ontario healthcare providers do not collect uniform data on adult patients diagnosed with concussion. Objective: The Ontario Concussion Care Strategy (OCCS) is a collaborative network of multidisciplinary healthcare providers, brain injury advocacy groups, patient representatives, and researchers with a shared vision to improve concussion care across the province, starting with the collection of standardized data. Methods: The International Framework of Functioning Disability and Health was selected as the conceptual framework to inform the selection of CDEs. The CDEs recommended by the OCCS were identified using key literature, including the National Institute of Neurological Disorders and Stroke–Zurich Consensus Statements for concussion in sport and the Ontario Neurotrauma Foundation Concussion/mTBI clinical guidelines. Results: The OCCS has recommended and piloted CDEs for Ontario that are readily available at no cost, clinically relevant, patient friendly, easy to interpret, and recognized by the international scientific community. Conclusions: The implementation of CDEs can help to shift Ontario toward internationally recognized standard data collection, and in so doing yield a more comprehensive evidence-based approach to care while also supporting rigorous research.
Mechanical conditions at the base of Trapridge Glacier, Yukon Territory, were investigated using a “ploughmeter”. We describe the physical characteristics and the theory of this new instrument as well as its operation. Observational results reveal variations in ploughmeter response that might be attributed to spatial variability in subglacial processes or spatial variation in sediment granulometry. Quantitative analysis of the interaction of the ploughmeter with the basal layer yields estimates of rheological parameters. If the sediment is assumed to behave as a Newtonian viscous fluid, the estimated effective viscosity is 3.0 × 109 −3.1 × 1010Pas; if it is assumed to behave as an ideal plastic solid, the estimated yield strength is 48–57 kPa. In both cases, the estimated shear resistance of subglacial material is comparable to but somewhat less than that required to balance fully the applied basal shear stress.
The mechanical interaction between a glacier and subglacial sediment can be observed using an instrumented rod that we refer to as the UBC ploughmeter. For clast-rich sediments, the rate of collision between clasts and a rod dragged through these sediments should be related to the glacier sliding rate. By assuming that proglacial measurements of sediment granulometry represent the subglacial granulometry of Trapridge Glacier, Yukon Territory, Canada, we have used ploughmeter results to obtain an estimated sliding rate of ∼45 mm d−1, in good agreement with known rates. In addition, for a subglacial material treated as a solid-liquid dispersion having a linear viscous rheology, the force of collision experienced by the rod should be proportional to the effective sediment viscosity. Our estimate of ∼2.0 × 1010 Pa s agrees well with previously, derived values.
During the 1992 summer field season we installed arrays of “plough-meters” and water-pressure transducers beneath Trapridge Glacier. Yukon Territory, Canada, to study hydromechanical coupling at the ice–bed interface. Diurnal signals recorded with two of these ploughmeters appear to correlate with fluctuations in sub-glacial water pressure. These diurnal variations can be explained by changes in basal resistance to sliding as mechanical conditions at the bed vary temporally in response to changes in the subglacial hydrological system. We propose that a lubricating water film, associated with high water pressures, promotes glacier sliding, whereas low pressures cause increased basal drag resulting in “sticky” areas. Using a theoretical model, we analyze the sliding motion of glacier ice over a flat surface having variable basal drag and show that a consistent explanation can be developed. Results from our model calculations provide strong support for the existence of time-varying sticky spots which are associated with fluctuations in subglacial water pressure.
Sliding at the base of Trapridge Glacier, Yukon Territory, Canada, was measured using a “drag spool”. We describe this simple and inexpensive instrument as well as its installation and operation. From 1990 to 1992 seven sites were instrumented with drag spools. At six of the sites basal sliding, during the period of observation, accounted for 50-70% of the total flow observed at the glacier surface. The contribution from ice creep is known to be small, so most of the remaining surface motion must be attributed to subglacial sediment deformation. For the seventh site the observed sliding rate was ~ 90% of the total flow, an indication that the sliding contribution varies spatially across the bed. Diurnal variations in the response of one of our instruments appear to be correlated to subglacial water-pressure fluctuations and are interpreted in terms of changes in sliding velocity rather than the opening and closing of basal cavities.
Measurement of basal sliding is an important component in studying the mechanical and hydrological coupling between a glacier and its bed. During the 1992 summer field season we used a “drag spool” to measure sliding at the ice/bed interface of Trapridge Glacier, a small surge-type glacier in the St Elias Mountains, Yukon Territory, Canada. Measured diurnal variations in sliding appear to be correlated to subglacial water pressure fluctuations. In contrast to other observations where peak subglacial water pressure and glacier motion appear to coincide, our data imply that maximum sliding rates coincide with rises in water pressure. If the growth of water-filled cavities at the glacier bed is associated with these pressure increases, then our observations may correspond to numerical results by Iken (1981) which indicate that the largest sliding velocity occurs during cavity growth and not when the steady-state size of cavitation is attained. However, our data suggest the idea that a localized stick–slip relaxation process is at work. As the water pressure rises, a local strain build-up in the ice is released, resulting in a momentary increase in sliding rate; once the finite relaxation has occurred, further rises in water pressure do not produce additional enhancement of basal sliding, and the stick–slip cycle begins again by accumulation of elastic strain. We have developed a theoretical model for the sliding motion of ice over a surface having a basal drag that varies temporally in response to changes in subglacial water pressure. Our model results support the proposed stick–slip sliding process at the glacier base, whereby accumulated elastic strain in the ice is released as the rising water pressure decouples the ice from the bed.
A new generation of solar instruments provides improved spectral, spatial, and temporal resolution, thus facilitating a better understanding of dynamic processes on the Sun. High-resolution observations often reveal multiple-component spectral line profiles, e.g., in the near-infrared He i 10830 Å triplet, which provides information about the chromospheric velocity and magnetic fine structure. We observed an emerging flux region, including two small pores and an arch filament system, on 2015 April 17 with the ‘very fast spectroscopic mode’ of the GREGOR Infrared Spectrograph (GRIS) situated at the 1.5-meter GREGOR solar telescope at Observatorio del Teide, Tenerife, Spain. We discuss this method of obtaining fast (one per minute) spectral scans of the solar surface and its potential to follow dynamic processes on the Sun. We demonstrate the performance of the ‘very fast spectroscopic mode’ by tracking chromospheric high-velocity features in the arch filament system.
Observed cyclotron spectra of AM Herculis binaries imply a large range of mass flow rates in the accretion spot on the white dwarf. We derive this ṁ–distribution for the case of UZ For. For AM Her stars with different field strength B, such a distribution is shifted in ṁ proportional to B. This fact can account for the observed dominance of bremsstrahlung at low B and of quasi-blackbody emission at high B values.
Kjeldsen et al. (1995) detected excess power in the GO subgiant η Boo from measurements of Balmer-line equivalent widths. The excess was at the expected level, and these authors were able to extract frequency separations and individual frequencies which agreed well with theoretical models (Christensen-Dalsgaard et al., 1995; Guenther & Demarque, 1996). A more detailed discussion of theoretical models for η Bootis was given by Di Mauro & Christensen-Dalsgaard (2001).
Kjeldsen et al. (1995) estimated the average amplitude of the strongest modes to be 7 times solar, corresponding to 1.6 m/s in velocity. 13 individual oscillation modes were identified consistent with a large frequency separation of 40.3 μHz. We note, however, that a search for velocity oscillations in this star by Brown et al. (1997) failed to detect a signal, setting limits at a level below that expected on the basis of the Kjeldsen et al. result.
In this paper we report further observations made in 1998. We observed this star in Balmer-line equivalent width with the 2.5-m Nordic Optical Telescope and in velocity with the 24-inch Lick CAT.
As part of the activities of the Collaborative Research Centre ‘SFB 350’, measurements of geodetic and geodynamic changes in the area of the Lower Rhine Embayment and the Rhenish Shield are being performed at different scales in space and time. Continuous borehole tilt measurements and repeated microgravimetric surveys yield information on the local stability of the ground and changes in horizontal gravity gradients that are both dominated by seasonal fluctuations. Results of more than seven years of regular GPS campaigns are discussed in terms of vertical and horizontal point motions. The most prominent motions are man-induced effects occurring in or near the browncoal mining areas, where groundwater withdrawal produces subsidence of up to 2.2 cm/y in the area under investigation. Horizontal and vertical motions at other GPS points are smaller by one order of magnitude and in most cases are only marginally detectable. The eastward motion of two points in the Bergisches Land and the westward motion of two points in the Eifel near the Belgian border may be interpreted as a result of the ongoing extension of the Cenozoic rift system in the western part of the Eurasian plate.
While searches for young stellar objects (YSOs) with the Spitzer Space Telescope focused on known molecular clouds, photometry from the Wide-field Infrared Survey Explorer (WISE) can be used to extend the search to the entire sky. As a precursor to more expansive searches, we present results for a 100 deg2 region centered on the Canis Major clouds.
The photometric data returned by WISE, the Wide-field Infrared Survey Explorer, can be used to search the sky for young stellar objects (YSOs) away from the molecular clouds studied in detail by Spitzer and Herschel. We present updated results for a 100 deg2 region centered on Canis Major, including a look at the clustering properties of YSOs in the region.
Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) have recently emerged in livestock and humans. Therefore, this study assessed the carriage of Enterobacteriaceae in the anterior nares and associated antimicrobial resistance in pig-exposed persons. Nasal swabs were enriched in non-selective broth and then plated on MacConkey and ESBL-selective agars. Species was confirmed by matrix-assisted laser-desorption ionization–time-of-flight mass spectrometry (MALDI-ToF MS). Antimicrobial susceptibility testing was performed according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Of 114 pig-exposed persons tested, Enterobacteriaceae were detected in the nares of 76 (66·7%) participants. The predominant species were Proteus mirabilis (n = 17, 14·9%), Pantoea agglomerans (n = 13, 11·4%), Morganella morganii (n = 9, 7·9%), Citrobacter koseri (n = 9, 7·9%), Klebsiella pneumoniae, Escherichia coli and Proteus vulgaris (each n = 8, 7·0%). ESBL-E were not detected. Of all isolates tested, 3·4% were resistant against ciprofloxacin, 2·3% against gentamicin, 23·9% against trimethoprim-sulfamethoxazole and 44·3% against tigecycline. Despite the high prevalence of ESBL-E in livestock, pig-exposed persons did not carry ESBL-E in their nares. This finding is important, because colonization of the nasal reservoir might cause endogenous infections or facilitate transmission of ESBL-E in the general population.
Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.