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Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged > = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) > = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP < = 90mmHg, B) triage MAP < = 65mmHg or C) serum lactate > = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.
Birth weight and early growth have been associated with later blood pressure. However, not all studies consistently find a significant reduction in blood pressure with an increase in birth weight. In addition, the relative importance of birth weight and of other lifestyle and environmental factors is often overlooked and the association is rarely studied in adolescents. We investigated early life predictors, including birth weight, of adolescent blood pressure in the Gateshead Millennium Study (GMS). The GMS is a cohort of 1029 individuals born in 1999–2000 in Gateshead in Northern England. Throughout infancy and early childhood, detailed information were collected, including birth weight and measures of height and weight. Assessments of 491 returning participants at age 12 years included measures of body mass and blood pressure. Linear regression and path analysis were used to determine predictors and their relative importance on blood pressure. Birth weight was not directly associated with blood pressure at the age of 12. However, after adjustment for contemporaneous body mass index (BMI), an inverse association of standardized birth weight on systolic blood pressure was significant. The relative importance of birth weight on later systolic blood pressure was smaller than other contemporaneous body measures (height and BMI). There was no independent association of birth weight on blood pressure seen in this adolescent population. Contemporaneous body measures have an important role to play. Lifestyle factors that influence body mass or size, such as diet and physical activity, where interventions are directed at early prevention of hypertension should be targeted.
A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.
As a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute’s (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided.
The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online.
This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.
Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited.
To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs.
The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress.
Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men.
Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
The physics and spectral content of cloud cavitation about a sphere are investigated in a variable-pressure water tunnel using dynamic surface pressure measurement and high-speed imaging. Experiments are conducted using a polyvinyl chloride sphere at a Reynolds number of
with cavitation numbers,
, ranging from inception to supercavitation. Three distinct shedding regimes are identified: a uni-modal regime for
and two bi-modal regimes for
. For small cavity lengths (
), Kelvin–Helmholtz instability and transition to turbulence in the overlying separated boundary layer form the basis for cavity breakup and coherent vortex formation. At greater lengths (
), larger-scale shedding ensues, driven by coupled re-entrant jet formation and shockwave propagation. Strong adverse pressure gradients about the sphere lead to accumulation and radial growth of re-entrant flow, initiating breakup, from which, in every case, a condensation shockwave propagates upstream causing cavity collapse. When the shedding is most energetic, shockwave propagation upstream may cause large-scale leading edge extinction. The bi-modal response is due to cavity shedding being either axisymmetric or asymmetric. The two bi-modal regimes correspond to
ranges where the cavity and re-entrant jet either remain attached or become detached from the sphere. There is a distinct frequency offset at transition between regimes in both shedding modes. Despite the greater cavity lengths at lower
values, the second bi-modal regime initially exhibits shorter shedding periods due to increased cavity growth rates. The second regime persists until supercavitation develops for
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
Geological disposal facilities (GDF) are intended to isolate and contain radioactive waste within multiple protective barriers, deep underground, to ensure that no harmful quantities of radioactivity reach the surface environment. The last line of defense in a multi-barrier GDF is the geosphere, where iron is present in the host rock mineralogy as either Fe(II) or Fe(III), and in groundwater as Fe(II) under reducing conditions. The mobility of risk-driving radionuclides, including uranium and technetium, in the environment is affected significantly by their valence state. Due to its low redox potential, Fe(II) can mediate reduction of these radionuclides from their oxidized, highly mobile, soluble state to their reduced, insoluble state, preventing them from reaching the biosphere. Here a study of five types of potential host rocks, two granitoids, an andesite, a mudstone and a clay-rich carbonate, is reported. The bulk rocks and their minerals were analysed for iron content, Fe(II/III) ratio, and for the speciation and fine-grained nature of alteration product minerals that might have important controls on groundwater interaction. Total iron content varies between 0.9% in clays to 5.6% in the andesite. X-ray absorption spectroscopy reveals that Fe in the granitoids and andesite is predominantly Fe(II), and in mudstones, argillaceous limestone and terrestrial sandstone is predominantly Fe(III). The redox reactivity of the potential host rocks both in the presence and absence of Fe(II)-containing 'model' groundwater was investigated using an azo dye as a probe molecule. Reduction rates as determined by reactivity with the azo dye were correlated with the ability of the rocks to uptake Fe(II) from groundwater rather than with initial Fe(II) content. Potential GDF host rocks must be characterized in terms of mineralogy, texture, grain size and bulk geochemistry to assess how they might interact with groundwater. This study highlights the importance of redox reactivity, not just total iron and Fe(II)/(III) ratio, when considering the host rock performance as a barrier material to limit transport of radionuclides from the GDF.
A detailed understanding of the response of mineral phases to the radiation fields experienced in a geological disposal facility (GDF) is currently poorly constrained. Prolongued ion irradiation has the potential to affect both the physical integrity and oxidation state of materials and therefore may alter a structure's ability to react with radionuclides. Radiohalos (spheres of radiation damage in minerals surrounding radioactive (α-emitting) inclusions) provide useful analogues for studying long term α-particle damage accumulation. In this study, silicate minerals adjacent to Th- and U-rich monazite and zircon were probed for redox changes and long/short range disorder using microfocus X-ray absorption spectroscopy (XAS) and high resolution X-ray diffraction (XRD) at Beamline I18, Diamond Light Source. Fe3+ → Fe2+ reduction has been demonstrated in an amphibole sample containing structural OH– groups – a trend not observed in anhydrous phases such as garnet. Coincident with the findings of Pattrick et al. (2013), the radiolytic breakdown of OH– groups is postulated to liberate Fe3+ reducing electrons. Across all samples, high point defect densities and minor lattice aberrations are apparent adjacent to the radioactive inclusion, demonstrated by micro-XRD.
The dynamic model Nitrogen Dynamics in Crop rotations in Ecological Agriculture (NDICEA) was used to assess the nitrogen (N), phosphorus (P) and potassium (K) balance of long-term organic cropping trials and typical organic crop rotations on a range of soil types and rainfall zones in the UK. The measurements of soil N taken at each of the organic trial sites were also used to assess the performance of NDICEA. The modeled outputs compared well to recorded soil N levels, with relatively small error margins. NDICEA therefore seems to be a useful tool for UK organic farmers. The modeling of typical organic rotations has shown that positive N balances can be achieved, although negative N balances can occur under high rainfall conditions and on lighter soil types as a result of leaching. The analysis and modeling also showed that some organic cropping systems rely on imported sources of P and K to maintain an adequate balance and large deficits of both nutrients are apparent in stockless systems. Although the K deficits could be addressed through the buffering capacity of minerals, the amount available for crop uptake will depend on the type and amount of minerals present, current cropping and fertilization practices and the climatic environment. A P deficit represents a more fundamental problem for the maintenance of crop yields and the organic sector currently relies on mined sources of P which represents a fundamental conflict with the International Federation of Organic Agriculture Movements organic principles.
Cavitation occurrence about a jet in crossflow is investigated experimentally in a variable-pressure water tunnel using still and high-speed photography. The 0.012 m diameter jet is injected on the centreplane of a 0.6 m square test section at jet to freestream velocity ratios ranging from 0.2 to 1.6, corresponding to jet-velocity-based Reynolds numbers of
respectively. Measurements were made at a fixed freestream-based Reynolds number, for which the ratio of the undisturbed boundary layer thickness to jet diameter is 1.18. The cavitation number was varied from inception (up to about 10) down to 0.1. Inception is investigated acoustically for bounding cases of high and low susceptibility to phase change. The influence of velocity ratio and cavitation number on cavity topology and geometry are quantified from the photography. High-speed photographic recordings made at 6 kHz provide insight into cavity dynamics, and derived time series of spatially averaged pixel intensities enable frequency analysis of coherent phenomena. Cavitation inception was found to occur in the high-shear regions either side of the exiting jet and to be of an intermittent nature, increasing in occurrence and duration from 0 to 100 % probability with decreasing cavitation number or increasing jet to freestream velocity ratio. The frequency and duration of individual events strongly depends on the cavitation nuclei supply within the approaching boundary layer. Macroscopic cavitation develops downstream of the jet with reduction of the cavitation number beyond inception, the length of which has a power-law dependence on the cavitation number and a linear dependence on the jet to freestream velocity ratio. The cavity closure develops a re-entrant jet with increase in length forming a standing wave within the cavity. For sufficiently low cavitation numbers the projection of the re-entrant jet fluid no longer reaches the cavity leading edge, analogous to supercavitation forming about solid cavitators. Hairpin-shaped vortices are coherently shed from the cavity closure via mechanisms of shear-layer roll-up similar to those shed from protuberances and jets in crossflow in single-phase flows. These vortices are shed at an apparently constant frequency, independent of the jet to freestream velocity ratio but decreasing in frequency with reducing cavitation number and cavity volume growth. Highly coherent cavitating vortices form along the leading part of the cavity due to instability of the jet upstream shear layer for jet to freestream velocity ratios greater than about 0.8. These vortices are cancelled and condense as they approach the trailing edge in the shear layer of opposing vorticity associated with the cavity closure and the hairpin vortex formation. For lower velocity ratios, where there is decreased jet penetration, the jet upstream shear velocity gradient reverses and vortices of the opposite sense form, randomly modulated by boundary layer turbulence.
Abnormalities in the anterior inter-hemispheric connectivity have previously been implicated in major depressive disorder. Disruptions in fractional anisotropy in the callosum and fornix have been reported in schizophrenia and major depressive disorder. Oligodendrocyte density and overall size of the callosum and fornix show no alteration in either illness, suggesting that gross morphology is unchanged but more subtle organizational disruption may exist within these brain regions in mood and affective disorders.
Using high-resolution oil-immersion microscopy we examined the cross-sectional area of the nerve fibre and the axonal myelin sheath, and using standard high-resolution light microscopy we measured the density of myelinated axons. These measurements were made in the genu of the corpus callosum and the medial body of the fornix at its most dorsal point. Measures were taken in the sagittal plane in the callosal genu and in the coronal plane at the most dorsal part of the fornix body.
Cases of major depressive disorder had significantly greater mean myelin cross-sectional area (p = 0.017) and myelin thickness (p = 0.004) per axon in the genu than in control or schizophrenia groups. There was no significant change in the density of myelinated axons, and no changes observed in the fornix.
The results suggest a clear increase of myelin in the axons of the callosal genu in MDD, although this type of neuropathological study is unable to clarify whether this is caused by changes during life or has a developmental origin.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
It has been suggested that in addition to genetic factors, fetal and post-natal growth influence cognition in early adulthood. However, most studies have been in developed populations, so it is unclear if the same findings would be seen in other, less developed, settings, and have used testing tools not applicable to an Australia Aboriginal population. This study investigated the relationships between cognitive function in early adulthood and birth weight and contemporary height. Simple reaction time (SRT), choice reaction time (CRT) and working memory (WM) were assessed using the CogState battery. A significant association was seen between birth weight and SRT in early adulthood, but not with the other two cognitive measures. Urban dwellers had significantly shorter SRT and CRT than their remote counterparts. Contemporary body mass index and maternal age were associated with CRT. Only fetal growth restriction was associated with WM, with greater WM in those with restricted growth. No associations were seen with contemporary height. These results suggest that fetal growth may be more important than the factors influencing post-natal growth in terms of cognition in early adulthood in this population, but that the associations may be inconsistent between cognitive outcomes. Further research is required to identify whether similar associations are seen in other, similar, populations and to assess why differences in cognitive outcome measures are seen.
Heat stress (HS) jeopardizes livestock health and productivity and both may in part be mediated by reduced intestinal integrity. Dietary zinc improves a variety of bowel diseases, which are characterized by increased intestinal permeability. Study objectives were to evaluate the effects of supplemental zinc amino acid complex (ZnAA) on intestinal integrity in heat-stressed growing pigs. Crossbred gilts (43±6 kg BW) were ad libitum fed one of three diets: (1) control (ZnC; 120 ppm Zn as ZnSO4; n=13), (2) control+100 ppm Zn as ZnAA (Zn220; containing a total of 220 ppm Zn; n=14), and (3) control+200 ppm Zn as ZnAA (Zn320; containing a total of 320 ppm Zn; n=16). After 25 days on their respective diets, all pigs were exposed to constant HS conditions (36°C, ∼50% humidity) for either 1 or 7 days. At the end of the environmental exposure, pigs were euthanized and blood and intestinal tissues were harvested immediately after sacrifice. As expected, HS increased rectal temperature (P⩽0.01; 40.23°C v. 38.93°C) and respiratory rate (P⩽0.01; 113 v. 36 bpm). Pigs receiving ZnAA tended to have increased rectal temperature (P=0.07; +0.27°C) compared with ZnC-fed pigs. HS markedly reduced feed intake (FI; P⩽0.01; 59%) and caused BW loss (2.10 kg), but neither variable was affected by dietary treatment. Fresh intestinal segments were assessed ex vivo for intestinal integrity. As HS progressed from days 1 to 7, both ileal and colonic transepithelial electrical resistance (TER) decreased (P⩽0.05; 34% and 22%, respectively). This was mirrored by an increase in ileal and colonic permeability to the macromolecule dextran (P⩽0.01; 13- and 56-fold, respectively), and increased colonic lipopolysaccharide permeability (P⩽0.05; threefold) with time. There was a quadratic response (P⩽0.05) to increasing ZnAA on ileal TER, as it was improved (P⩽0.05; 56%) in Zn220-fed pigs compared with ZnC. This study demonstrates that HS progressively compromises the intestinal barrier and supplementing ZnAA at the appropriate dose can improve aspects of small intestinal integrity during severe HS.