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Background: Since January 1, 2016 2358 people have died from opioid poisoning in Alberta. Buprenorphine/naloxone (bup/nal) is the recommended first line treatment for opioid use disorder (OUD) and this treatment can be initiated in emergency departments and urgent care centres (EDs). Aim Statement: This project aims to spread a quality improvement intervention to all 107 adult EDs in Alberta by March 31, 2020. The intervention supports clinicians to initiate bup/nal for eligible individuals and provide rapid referrals to OUD treatment clinics. Measures & Design: Local ED teams were identified (administrators, clinical nurse educators, physicians and, where available, pharmacists and social workers). Local teams were supported by a provincial project team (project manager, consultant, and five physician leads) through a multi-faceted implementation process using provincial order sets, clinician education products, and patient-facing information. We used administrative ED and pharmacy data to track the number of visits where bup/nal was given in ED, and whether discharged patients continued to fill any opioid agonist treatment (OAT) prescription 30 days after their index ED visit. OUD clinics reported the number of referrals received from EDs and the number attending their first appointment. Patient safety event reports were tracked to identify any unintended negative impacts. Evaluation/Results: We report data from May 15, 2018 (program start) to September 31, 2019. Forty-nine EDs (46% of 107) implemented the program and 22 (45% of 49) reported evaluation data. There were 5385 opioid-related visits to reporting ED sites after program adoption. Bup/nal was given during 832 ED visits (663 unique patients): 7 visits in the 1st quarter the program operated, 55 in the 2nd, 74 in the 3rd, 143 in the 4th, 294 in the 5th, and 255 in the 6th. Among 505 unique discharged patients with 30 day follow up data available 319 (63%) continued to fill any OAT prescription after receiving bup/nal in ED. 16 (70%) of 23 community clinics provided data. EDs referred patients to these clinics 440 times, and 236 referrals (54%) attended their first follow-up appointment. Available data may under-report program impact. 5 patient safety events have been reported, with no harm or minimal harm to the patient. Discussion/Impact: Results demonstrate effective spread and uptake of a standardized provincial ED based early medical intervention program for patients who live with OUD.
A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Healthʼs (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic–public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic–public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.
We present the first measurement of the evolution of the apparent projected shape of galaxy clusters from 0.2≲ z≲2. We measure the ellipticities (εcl) of homogeneously selected galaxy clusters over this wide redshift range. We confirm the predictions of N-body simulations that clusters are more elongated at higher redshift, finding the mean projected ellipticity changes linearly from 0.36±0.01 to 0.25±0.01 over that range. The fraction of relaxed clusters (defined as having εcl<0.2) is 9+5-3% at z∼1.8, steadily increasing to 42+7-6% by z∼0.3. Because more spherical clusters have a higher degree of virialization, our result shows significant evolution in the degree of cluster virialization over cosmic time.
In taste cells, taste receptors, their coupled G proteins and downstream signalling elements mediate the detection and transduction of sweet, bitter and umami compounds. In some intestinal endocrine cells, taste receptors and gustducin contribute to the release of glucagon-like peptide 1 (GLP-1) and other gut hormones in response to glucose and non-energetic sweeteners. Conversely, taste cells have been found to express multiple hormones typically found in intestinal endocrine cells, e.g. GLP-1, glucagon, somatostatin and ghrelin. In the present study, by immunohistochemistry, multiple subsets of taste cells were found to express GLP-1. The release of GLP-1 from ‘endocrine taste cells’ into the bloodstream was examined. In wild-type mice, even after oesophagectomy and vagotomy, oral stimulation with glucose induced an elevation of GLP-1 levels in the bloodstream within 10 min. Stimulation of taste cell explants from wild-type mice with glucose led to the release of GLP-1 into the medium. Knocking out of the Tas1r3 gene did not eliminate glucose-stimulated GLP-1 release from taste cells in vivo. The present results indicate that a portion of the cephalic-phase rise in circulating GLP-1 levels is mediated by the direct release of GLP-1 from taste cells into the bloodstream.
Thin-film absorber layers for photovoltaics have attracted much attention for their potential for low cost per unit power generation, due both to reduced material consumption and to higher tolerance for defects such as grain boundaries. Cu2ZnGeSe4 (CZGSe) comprises one such material system which has a near-optimal direct band gap of 1.6 eV for absorption of the solar spectrum, and is made primarily from earth-abundant elements.
CZGSe metallic precursor films were sputtered from Cu, Zn, and Ge onto Mo-coated soda lime glass substrates. These were then selenized in a two-zone close-space sublimation furnace using elemental Se as the source, with temperatures in the range of 400 to 500 C, and at a variety of background pressures. Films approximately 1-1.5 µm thick were obtained with the expected stannite crystal structure.
Next, Cu2ZnSnSe4 (CZTSe), which has a direct band gap of 1.0 eV, was prepared in a similar manner and combined with CZGSe as either compositionally homogeneous or layered absorbers. The compositional uniformity of selenide absorbers made by selenizing compositionally homogeneous Cu-Zn-Ge-Sn precursor layers was determined and the band gap as a function of composition was investigated in order to demonstrate that the band gap is tuneable for a range of compositions. For layered Cu-Zn-Ge/Cu-Zn-Sn precursor films, the composition profile was measured before and after selenization to assess the stability of the layered structure, and its applicability for forming a band-gap-graded device for improved current collection.
In July 2011, a cluster of Yersinia enterocolitica infections was detected in southwestern Pennsylvania, USA. We investigated the outbreak's source and scope in order to prevent further transmission. Twenty-two persons were diagnosed with yersiniosis; 16 of whom reported consuming pasteurized dairy products from dairy A. Pasteurized milk and food samples were collected from this dairy. Y. enterocolitica was isolated from two products. Isolates from both food samples and available clinical isolates from nine dairy A consumers were indistinguishable by pulsed-field gel electrophoresis. Environmental and microbiological investigations were performed at dairy A and pasteurization deficiencies were noted. Because consumption of pasteurized milk is common and outbreaks have the potential to become large, public health interventions such as consumer advisories or closure of the dairy must be implemented quickly to prevent additional cases if epidemiological or laboratory evidence implicates pasteurized milk as the outbreak source.
Retention of a nanostructure in thermoelectric materials through rapid sintering (e.g., field-assisted sintering) is generally associated with leaving certain amounts of porosity due to short sintering times. In this study, the influence of porosity on the thermoelectric transport properties in Bi2Te3-based alloys was studied by changing the sintering pressure during spark plasma sintering. N-type Bi2Te3 and p-type (Bi0.2Sb0.8)2Te3 were sintered at 673 K using pressures from 50 to 300 MPa to obtain different levels of porosity. Electrical resistivity, thermal conductivity, Seebeck coefficient, carrier concentrations, and Hall mobility were measured and characterized. The results show that increasing sintering pressure is effective in reducing porosity, which lowers electrical resistivity and increases the carrier concentrations. The transport properties were fitted to general effective medium equations and demonstrate that in p-type (Bi0.2Sb0.8)2Te3 sintered at high pressures, decreases in electrical resistivity and lattice thermal conductivity exceeded the Seebeck coefficient reduction, improving the thermoelectric figure of merit.
We use deep nIR imaging of 15 galaxy clusters at z ≃ 1 to study the build-up of the red-sequence in rich clusters since the Universe was half its present age. We measured, for the first time, the luminous-to-faint ratio of red-sequence galaxies at z=1 from a large ensemble of clusters, and found an increase of 100% in the ratio of luminous-to-faint red-sequence galaxies from z=0.45 to 1.0. The measured change in this ratio as function of redshift is well-reproduced by a simple evolutionary model developed in this work, that consists in an early truncation of the star formation for bright cluster galaxies and a delayed truncation for faint cluster galaxies.
Studies have shown that soya consumption has been associated with low incidence of CVD. Because the chemical structures of soya isoflavones are similar to oestrogen, the beneficial outcome may be attributed to the oestrogenicity of these compounds. In this study, effect of the soya isoflavone genistein on the mRNA expression of apoA-1 in the human hepatoma HepG2 cell was investigated. Without oestrogen receptor (ER) α transfection, soya isoflavones in the physiological range had no effect on the apoA-1 transcription. Once ERα was ectopically expressed in these cells, soya isoflavone dramatically increased the apoA-1 mRNA abundance quantified by real-time PCR. ApoA-1-reporter assays with plasmid constructed from the 5′-flanking segment upstream to the coding region revealed that the transactivation of the apoA-1 promoter was induced by the soya isoflavone in HepG2 cells expressing ERα. This induction was reduced by the anti-oestrogen ICI 182780, but not the inhibitors of protein kinase (PK) C, PKA, or mitogen-activated PK. Based on the previously identified response elements on the promoter, a series of truncated promoter reporter plasmids were then constructed. An induction profile of genistein was built and insulin response core element at − 411 to − 404 appeared to be a potential site of interaction. This study illustrated that soya isoflavones at physiological concentrations could up regulate apoA-1 mRNA expression in ERα-transfected HepG2 cells.
We enhance the theoretical precision of cultural intelligence (CQ: capability to function effectively in culturally diverse settings) by developing and testing a model that posits differential relationships between the four CQ, dimensions (metacognitive, cognitive, motivational and behavioural) and three intercultural effectiveness outcomes (cultural judgment and decision making, cultural adaptation and task performance in culturally diverse settings). Before testing the model, we describe development and cross-validation (N = 1,360) of the multidimensional cultural intelligence scale (CQS) across samples, time and country. We then describe three substantive studies (N = 794) in field and educational development settings across two national contexts, the USA and Singapore. The results demonstrate a consistent pattern of relationships where metacognitive CQ and cognitive CQ predicted cultural judgment and decision making; motivational CQ and behavioural CQ predicted cultural adaptation; and metacognitive CQ and behavioural CQ predicted task performance. We discuss theoretical and practical implications of our model and findings.
We investigate the dependence of galaxy populations on environment. Our samples are selected from the follow-up of Red-Sequence Cluster Survey (RCS) catalogs using wide-field BVRz' imaging for 60 intermediate redshift (0.3 < z < 0.6) clusters. Galaxy redshifts are estimated using an empirical photometric redshift technique with a training set of 3996 galaxies to z 1.4. To obtain photometric redshift probability density for each galaxy, we bootstrap the training set galaxies to estimate the fitting uncertainties and apply Monte-Carlo method to simulate galaxy magnitudes errors. In order to find galaxy groups using photometric redshift, we develop a modified friends-of-friends algorithm, ‘Probability Friends-of-Friends Algorithm (pFOF)’, where photometric redshift redshift probability densities of individual galaxies are used to determine member galaxies of a group. We calculate the red galaxy fraction to infer the evolutionary status of cluster galaxies and also for galaxies in groups selected in the same redshift space as the clusters.
The molecular mechanisms underlying the involvement of oligodendrocytes in formation of the nodes of Ranvier (NORs) remain poorly understood. Here we show that oligodendrocyte-myelin glycoprotein (OMgp) aggregates specifically at NORs. Nodal location of OMgp does not occur along demyelinated axons of either Shiverer or proteolipid protein (PLP) transgenic mice. Over-expression of OMgp in OLN-93 cells facilitates process outgrowth. In transgenic mice in which expression of OMgp is down-regulated, myelin thickness declines, and lateral oligodendrocyte loops at the node-paranode junction are less compacted and even join together with the opposite loops, which leads to shortened nodal gaps. Notably, each of these structural abnormalities plus modest down-regulation of expression of Na+ channel α subunit result in reduced conduction velocity in the spinal cords of the mutant mice. Thus, OMgp that is derived from glia has distinct roles in regulating nodal formation and function during CNS myelination.
Southeast Asian women have a lower incidence of breast cancer than their counterparts in the West. Epidemiological studies have indicated that soya consumption may be a contributing factor. Carcinogenesis is a process involving multiple stages. The present review attempts to fit the cellular mechanisms attributed to soya isoflavones into these different stages. Many cell-culture studies have reported the growth-inhibitory effect of soya isoflavones; however, with the non-physiological concentrations employed in these studies it would be difficult to explain the protection mechanisms observed in epidemiological studies. Our laboratory has previously found that genistein inhibits cytochrome P450 (CYP)1A1 and CYP1B1. The inhibition implies that soya consumption may have the potential to prevent chemical carcinogenesis. The preferential inhibition of CYP1B1 may also block the oestrogen-initiated carcinogenesis. The antagonism of oestrogen receptor (ER) binding can affect the cell-proliferative phase, which is likely to be important in the promotion stage of breast cancer. Since our laboratory and others have indicated that genistein at physiological concentrations has no effect on the downstream activities of ER binding, the antagonism of ER is not likely to be a contributing factor in the disease prevention. Moreover, soya isoflavones cannot inhibit aromatase (CYP19), which is the enzyme responsible for oestrogen synthesis. In the present review various cellular activities altered by soya isoflavones are discussed
A recent comprehensive photometric survey of 45 low-z X-ray selected Abell clusters (López-Cruz 1997) has measured significant variations in the faint end slope of the luminosity function (LF). This result indicates that dwarf galaxies (dGs) comprise a different fraction of the cluster population as a function cluster environment. Clusters having a central “cD-like” galaxy have a flatter faint end slope than non-cD clusters. Also, cD clusters were found to have a dwarf-to-giant ratio (D/ G) which was smaller than non-cD clusters. López-Cruz et al. (1997) has suggested that the light contained in cD envelopes can be accounted for by assuming that it is produced from stars that originally formed dGs. In this simple model, the D/ G would be expected to increase with radial distance from the cluster centre due to the decrease in the disruptive forces.
We report on the first measurement of the average mass and mass-to-light ratio of galaxy groups by analysing the weak lensing signal induced by these systems. The Canadian Network for Observational Cosmology Field Galaxy Redshift Survey (CNOC2) allows the identification of a large number of groups at intermediate redshifts. For our analysis we use a sample of 50 groups which are selected on the basis of a careful dynamical analysis of group candidates. We detect a signal at the 99% confidence limit. The best fit singular isothermal sphere model yields an Einstein radius rE = 0″.72 ± 0″.29. This corresponds to a velocity dispersion of 〈σ2〉1/2 = 274±+48-59 km/s, which is in good agreement with the dynamical estimate. Under the assumption that the light traces the mass, we find an average mass-to-light ratio of 191 ± 83 h in the restframe B band. Unlike dynamical estimates, this result is insensitive to problems associated with determining group membership. We use the observed mass-to-light ratio to estimate the matter density of the universe, for which we find Ωm = 0.19 ± 0.10 (ΩΛ = 0), in good agreement with other recent estimates. For a closed universe (Ωm + ΩΛ = 1), we obtain Ωm = 0.13 ± 0.07.