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The RemoveDEBRIS mission has been the first mission to successfully demonstrate, in-orbit, a series of technologies that can be used for the active removal of space debris. The mission started late in 2014 and was sponsored by a grant from the EC that saw a consortium led by the Surrey Space Centre to develop the mission, from concept to in-orbit demonstrations, that terminated in March 2019. Technologies for the capture of large space debris, like a net and a harpoon, have been successfully tested together with hardware and software to retrieve data on non-cooperative target debris kinematics from observations carried out with on board cameras. The final demonstration consisted of the deployment of a drag-sail to increase the drag of the satellite to accelerate its demise.
Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
The leaf-eating caterpillar, Opisina arenosella Walker, is the most destructive pest of coconut palm in India and Southeast Asia. The management practices employed against O. arenosella so far have been unsuccessful in many instances in India, due to the pest behaviour and coconut palm phenology. The life cycle, incidence and behaviour of O. arenosella are rather interesting and useful for the intervention of pheromone trapping technique for its management. We conducted the present study with the intention of identifying the female sex pheromone of O. arenosella and testing its efficacy under field conditions. Gas chromatography coupled electroantennographic detection (GC–EAD) and gas chromatography–mass spectrometry (GC–MS) analysis of female pheromone glands extract of one-day-old O. arenosella females confirmed the presence of (Z,Z,Z)-3,6,9-tricosatriene (Z3Z6Z9-23Hy) as the dominant sex pheromone component. The male antennal response to female pheromone gland extract and synthetic Z3Z6Z9-23Hy was recorded using GC–EAD, and the results revealed that antennal response was positive to both the treatments at 0.13 mV and 0.14 mV respectively, compared to control (air), which was 0.016 mV. It was also evident from wind-tunnel experiments that the male moth response was high (80%) with the female gland extract, compared to 60% with synthetic pheromone and 0% for control (air). Male moths caught in the traps with and without lure were assessed in two field sites and recorded 69.26% and 54.25% more moth catches in the traps with the lure. We also observed a similar result in the cage experiment in which male moths caught in the traps with and without lure were 64.50% and 12.40%, respectively. The study also confirmed that 93.20% moths caught in the pheromone-baited traps were male. From the study, it is evident that the presence of (Z,Z,Z)-3,6,9-tricosatriene, which is the sex pheromone compound from the female gland extract of O. arenosella, is an effective attractant in pheromone traps for the male moth under field conditions.
Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the emergency department (ED) accounting for significant morbidity, mortality and health care resource usage. In Alberta, a provincial care pathway was recently developed to provide an evidence informed approach to managing patients with an UGIBs in the ED. Pantoprazole infusions are a commonly used treatment despite evidence that suggests they are generally not indicated prior to endoscopy in the ED. The goal of this project was to optimize management of patients with a NVUGIB, in particular reduce pre-endoscopy pantoprazole infusions. Methods: In July 2016, we implemented a multi-faceted intervention to optimize management of ED patients with NVUGIB including 1. de-emphasizing IV pantoprazole infusions in the ED, 2. clinical decision support (CDS) embedded (for endoscopy, disposition and transfusions) within the order set and 3. educating clinicians about the care pathway. We used a pre/post-order set design, analyzing 391 days pre and 189 days post-order set changes. Data was extracted from our fully integrated electronic health records system. The primary outcome was the % of patients receiving IV pantoprazole infusion ordered by an emergency physician (EP) among all patients with NVUGIB. Secondary outcomes included % transfused with hgb >70g/L and whether using the GIB order set impacted management of NVUGIB patients. Results: In the 391 days pre-order set changes, there were 2165 patients included and in the 189 days post-order set changes, there were 901 patients. For baseline characteristics, patients in the post-order set change group were significantly older (64.4 yrs vs 60.9 yrs p-value=0.0016) and had a lower hgb (115 vs 118, p-value=0.049) but otherwise for gender, measures of severity of illness (systolic blood pressure, heart rate, CTAS, % admitted) there were no significantly differences. For the primary outcome, in the pre-order set phase, 47.1% received a pantoprazole infusion ordered by an EP, compared to 31.5% in the post-order phase, for an absolute reduction of 15.6% (p-value= <0.001). For the secondary outcomes, transfusion rates were similar pre/post (22.08% vs 22.75%). Significant inter-site variability exists with respect to the reduction in pantoprazole infusion rates across the four sites (-23.3% to +6.12%). Conclusion: Our interventions resulted in a significant overall reduction in pantoprazole infusions in ED patients with NVUGIB. Reductions in pantoprazole infusions varied significantly across the different sites, future work in our department will explore and address this variability. Keys to the success of this project included engaging clinicians as well as leveraging the SCM order sets as well as the provincial care pathway. Although there were no changes in transfusion rates, it in unclear if this a function of the CDS not being effective or whether these transfusions were clinically indicated.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.
This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.
Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d = 1.37), externalizing (d = 0.85), and posttraumatic stress (d = 1.71), and improvements in well-being (d = 0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.
This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.
A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.
This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.
The P300 amplitude and latency were not associated (regression coef. −0.06, 95% CI −0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10–0.28, p < 0.001). There was no evidence of associations between lateral ventricular volume and the other measures (all p > 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.
The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.
Schizophrenia is a highly heritable disorder, linked to several structural abnormalities of the brain. More specifically, previous findings have suggested that increased gyrification in frontal and temporal regions are implicated in the pathogenesis of schizophrenia.
The current study included participants at high familial risk of schizophrenia who remained well (n = 31), who developed sub-diagnostic symptoms (n = 28) and who developed schizophrenia (n = 9) as well as healthy controls (HC) (n = 16). We first tested whether individuals at high familial risk of schizophrenia carried an increased burden of trait-associated alleles using polygenic risk score analysis. We then assessed the extent to which polygenic risk was associated with gyral folding in the frontal and temporal lobes.
We found that individuals at high familial risk of schizophrenia who developed schizophrenia carried a significantly greater burden of risk-conferring variants for the disorder compared to those at high risk (HR) who developed sub-diagnostic symptoms or remained well and HC. Furthermore, within the HR cohort, there was a significant and positive association between schizophrenia polygenic risk score and bilateral frontal gyrification.
These results suggest that polygenic risk for schizophrenia impacts upon early neurodevelopment to confer greater gyral folding in adulthood and an increased risk of developing the disorder.
Introduction: We examined persons transported to hospital after police use of force to determine whether Emergency Department (ED) assessment and/or mode of transport could be predicted. Methods: A multi-site prospective consecutive cohort study of police use of force with data on ED assessment for individuals ≥18 yrs was conducted over 36 months (Jan 2010-Dec 2012) in 4 cities in Canada. Police, EMS and hospital data were linked by study ID. Stepwise logistic regression examined the relationship between the police call for service and subject characteristics on subsequent ED assessment and mode of transport. Results: In 3310 use of force events, 86.7% of subjects were male, median age 29 yrs. ED transport occurred in 26% (n=726). Odds of ED assessment increased by 1.2 (CI 1.1, 1.3) for each force modality >1. Other predictors of ED use: if the nature of police call was for Mental Health Act (MHA) (Odds 14.3, CI 10.6, 19.2), features of excited delirium (ExD) (Odds 2.7, CI 1.9, 3.7), police-assessed emotional distress (EDP) not an MHA (Odds 2.1, CI 1.5, 3.0) and combined drugs, alcohol and EDP (Odds 1.7, CI 1.9, 3.7). Those with alcohol impairment alone were less likely to go to ED from the scene: OR 0.6 (CI 0.5, 0.7). EMS transported 55% of all patients (n=401), although police transported ~100 people who EMS attended at the scene but did not subsequently transport. For patients brought to the ED, 70% had a retrievable chart (512/726) with a discernible primary diagnosis: 25% for physical injury, 32% for psychiatric and 43% for drug and/or alcohol intoxication. For use of force events that began as MHA calls, patient transport was more often by police car than ambulance OR 1.8 (CI 1.2, 2.5), while those with drug intoxication or ≥3 ExD features were more often brought by ambulance: odds of police transport 0.5 (CI 0.3, 0.9) and 0.4 (CI 0.3, 0.7). Violence or aggression did not predict mode of transport in our study. Conclusion: About one quarter of police use of force events lead to ED assessment; 1 in 4 patients transported had a physical injury of some description. Calls including the Mental Health Act or individuals with drug intoxication or excited delirium features are most predictive of ED use following police use of force. In MHA calls with use of force, persons are nearly twice as likely to go to ED by police car than by ambulance.
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
Wild oat is a problematic weed species that requires new management
techniques in the face of herbicide resistance; harvest weed-seed control
(HWSC) may be an option. Wild oat demographic information was collected in
long-term, rotational field studies in Lacombe, AB, Canada, in 2006 and
2007, and a periodic matrix model was parameterized using management
extremes (no IPM, no herbicide to high IPM, and full herbicide). Population
growth rates were calculated for each treatment and year. Prospective
(elasticity) and retrospective (LTRE) analyses were conducted alongside a
rearrangement of the model equation in which population growth rates were
designated and the required proportion of newly shed seed survival that
gives that growth rate was solved for. All populations had λ > 1 or
increasing populations. Elasticity analyses indicated that λ was most-highly
elastic to the overwinter seedbank (Esw = 1), followed by seedling survival, fecundity, and survival of
newly shed seed (0.63 to 0.86 across treatments). The latter may be the
most-accessible vital rate for management of herbicide resistant
populations. LTRE exposed the stochasticity of wild oat population growth
rates between years and their ability to take advantage of lapses in
control. Decreasing the proportion of newly shed seeds
(snew) that survives was the most-effective and available control
strategy until reduced to 0.1 to 0.3 when the summer seedbank becomes more
critical. When averaged across treatments, > 80% of newly shed seed must
be eliminated to stop the population from growing, resulting in a stable
population, but not a decline. Because of preharvest shattering, HWSC will
likely not be effective enough alone to cause wild oat populations to
decline. New management techniques for wild oat control that can be used in
combination with HWSC and integrated weed management strategies are
Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31–17·45], male gender (aOR 1·74, 95% CI 1·06–2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03–0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01–4·09).
National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown.
Children (<18 years) hospitalised with infective endocarditis at 29 centres participating in the Pediatric Health Information Systems Database from 2003 to 2014 were eligible for inclusion. Our primary analysis focussed on infective endocarditis most directly related to the change in guidelines and included community-acquired cases in those >5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations.
A total of 841 cases were identified. The median age was 13 years (interquartile range 9–15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results.
We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children’s hospitals.
Introduction: This study provides an estimate of the number of EMS calls related to police use of force events that involve struggling, intoxicated and/or emotionally distressed patients. We hypothesized there would be under-reporting of EMS risk by paramedic agencies due to lack of standardized reporting of police events by EMS services and lack of a common linked case number between prehospital agencies in Canada. Methods: Data were collected during a multi-site, prospective, consecutive cohort study of police use of force in 4 Canadian cities using standardized data forms. Use of force was defined a priori and the application of handcuffs was not considered a force modality. Inclusion criteria: all subjects ≥ 18 years of age involved in a use of force police-public encounter. We defined risk to EMS as the presence of police- and/or paramedic- assessments of violent or struggling subjects on the scene. Three separate data forms (police-report of use of force, EMS encounter, and Emergency Department (ED) visit) were linked in the study by unique ID. When police-reported EMS was activated, investigators hand searched the EMS service reports at the relevant agencies for matching call sheets. Results: From Jan 2010 to Dec 2012, we studied 3310 consecutive public-police interactions involving use of force above simple joint lock application. Subjects were male (86%) with a mean age of 33 yrs; 85% were assessed by police as emotionally disturbed, intoxicated with drugs and/or alcohol or a combination of those. 45% were violent at the scene. Police-reported EMS attendance in 24% (809/3310) of use of force events, of which only 43% (349/809) of EMS run sheets were available. In events with violent subjects, EMS transported 51% to ED compared to 35% by police transport (chi=79.7, p=0.00). Conclusion: We identified periods of professional and physical risk to paramedics attending police use of force events and found that risk significantly underrepresented in EMS data. Paramedical training would benefit from policy and procedures for response to police calls and the violent patient, the majority of whom are struggling. A common linked case number in prehospital care would enable more specific quantification of the risk for EMS providers involved in police events.
Our knowledge of the universe comes from recording the photon and particle fluxes incident on the Earth from space. We thus require sensitive measurement across the entire energy spectrum, using large telescopes with efficient instrumentation located on superb sites. Technological advances and engineering constraints are nearing the point where we are recording as many photons arriving at a site as is possible. Major advances in the future will come from improving the quality of the site. The ultimate site is, of course, beyond the Earth’s atmosphere, such as on the Moon, but economic limitations prevent our exploiting this avenue to the degree that the scientific community desires. Here we describe an alternative, which offers many of the advantages of space for a fraction of the cost: the Antarctic Plateau.
The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0–∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.