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Introduction: 9-1-1 telecommunicators receive minimal education on agonal breathing, often resulting in unrecognized out-of-hospital cardiac arrest (OHCA). We successfully piloted an educational intervention that significantly improved telecommunicators’ OHCA recognition and bystander CPR rates in Ottawa. We sought to better understand the operations of Canadian 9-1-1 communications centers (CC) in preparation for a multi-centre study of this intervention. Methods: We conducted a National survey of all Canadian CCs. Survey domains included information on organizational structure, dispatch system used, education curriculum, and performance monitoring. It was peer-reviewed, translated in French, pilot-tested, and distributed electronically using a modified Dillman method. We designated respondents in each CC before distribution and used targeted follow-up and small incentives to increase response rate. Respondents also described functioning of neighboring CCs if known. Results: We received information from 51/51 provincial and 1/25 territorial CCs, representing 99.7% of the Canadian population. CCs largely utilize the Medical Dispatch Priority System (MPDS) platform (93%), many are Province/Ministry regulated (50%) and most require a High School diploma as minimum entry level education (78%). Telecommunicators receive initial in-class training (median 1.3 months, IQR 0.3-1.9; range 0.1-2.2), often followed by a preceptorship (84.4%) (median 1.0 months, IQR 0.7-1.7; range 0.4-6.0). Educational curriculum includes information on agonal breathing in 41% of CC, without audio examples in 34%. Among responding CCs, over 39,000 suspected OHCA 9-1-1 calls are received annually. Few CCs maintain local performance statistics on OHCA recognition (25%), bystander CPR rates (25%) or survival rates (50%). Most (97%) expressed interest in future research collaborations. Conclusion: Most Canadian telecommunicators receive no or minimal education in recognizing agonal breathing. Further training and improved OHCA monitoring may assist recognition and enhance outcomes.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
To test the hypothesis that more frequent consumption of sugar-sweetened soft drinks would be associated with increased risk of obesity-related cancers. Associations for artificially sweetened soft drinks were assessed for comparison.
Prospective cohort study with cancers identified by linkage to cancer registries. At baseline, participants completed a 121-item FFQ including separate questions about the number of times in the past year they had consumed sugar-sweetened or artificially sweetened soft drinks. Anthropometric measurements, including waist circumference, were taken and questions about smoking, leisure-time physical activity and intake of alcoholic beverages were completed.
The Melbourne Collaborative Cohort Study (MCCS) is a prospective cohort study which recruited 41 514 men and women aged 40–69 years between 1990 and 1994. A second wave of data collection occurred in 2003–2007.
Data for 35 593 participants who developed 3283 incident obesity-related cancers were included in the main analysis.
Increasing frequency of consumption of both sugar-sweetened and artificially sweetened soft drinks was associated with greater waist circumference at baseline. For sugar-sweetened soft drinks, the hazard ratio (HR) for obesity-related cancers increased as frequency of consumption increased (HR for consumption >1/d v. <1/month=1·18; 95 % CI 0·97, 1·45; P-trend=0·007). For artificially sweetened soft drinks, the HR for obesity-related cancers was not associated with consumption (HR for consumption >1/d v. <1/month=1·00; 95 % CI 0·79, 1·27; P-trend=0·61).
Our results add to the justification to minimise intake of sugar-sweetened soft drinks.
Symmetric, two-sided morphology seems to argue against relativistic effects dominating compact radio emission. This kind of structure has been reported for a number of sources (Phillips and Mutel 1982; Pearson 1983) based on maps made at one frequency. Various arguments, all indirect, can be made for these sources being (1) Twin regions formed at the ends of jets which emerge from an invisible core, or (2) misidentified core-jet sources wherein the core and an unusually bright knot are wrongly taken to be a “double.” A telling test of both hypotheses is to map the sources in question over an octave or so of frequency. Proponents of view (1) would predict that the two double components will show nearly identical spectral indices and that weak central cores with flat or rising spectra might even be revealed. Champions of view (2) would predict that one end or the other will dominate at high frequencies (the core!) or that complex bridges of emission (the jet!) will be revealed between the components at low frequencies. We have followed our initial discovery of 5 symmetric compact doubles by (A) attempting to enlarge the sample of symmetric sources available to study, and (B) by investigating at 5 GHz those doubles for which the best maps exist at 1.7 GHz.
The surface and bottom topography of the central Greenland ice sheet was determined from airborne ice-radar soundings over a 180 km by 180 km grid centered on the 1974 “Summit” site (lat. 72°18′N., long. 37°55′W.), using the Technical University of Denmark 60 MHz ice radar. Over 6100 km of high-quality radar data were obtained, covering over 99'% of the grid, along lines spaced 12.5 km apart in both north-south and east-west directions. Aircraft location was done with an inertial navigation system (INS) and a pressure altimeter, with control provided by periodically flying over a known point at the center of the grid. The ice radar was used to determine ice thickness; the surface topography was determined independently using height-above-terrain measurements from the aircraft’s radar altimeter. The calculated surface topography is accurate to about ±6 m, with this error arising mostly from radar-altimeter errors. The ice thickness and bottom topography are accurate to about ±50 m, with this error dominated by the horizontal navigation uncertainties due to INS drift; this error increases to about ±125 m in areas of rough bottom relief (about 12% of the grid).
The highest point on Greenland is at lat. 72°34′ N., long. 37°38′W., at an altitude of 3233 ± 6 m a.s.l. The ice surface at this point divides into three sectors, one facing north, one east-south-east, and one west-south-west, with each having a roughly uniform slope. The ice divide between the last two sectors is a well-defined ridge running almost due south. The ice is about 3025 m thick at the summit. Excluding the mountainous north-east corner of the grid, where the ice locally reaches a thickness of about 3470 m and the bed dips to about 370 m below sea-level, the maximum ice thickness, approximately 3375 m, occurs about 97 km south-south-west of the summit. The average bed altitude over the entire grid is 180 m and the average ice thickness is 2975 ± 235 m. The ice in most of the south-west quadrant of the grid is over 3200 m thick, and overlies a relatively smooth, flat basin with altitudes mostly below sea-level. There is no predominant direction to the basal topography over most of the grid; it appears to be undulating, rolling terrain with no obvious ridge/valley structure. The summit of the ice sheet is above the eastern end of a relatively large, smooth, flat plateau, about 10–15 km wide and extending about 50 km to the west. If the basal topography were the sole criterion, then a site somewhere on this plateau or in the south-west basin would be suitable for the drilling of a new deep ice core.
A new short-pulse digital profiling radar system that operates at lower frequencies than most ice radars used in polar regions to date has been designed and built by the U.S. Geological Survey. The transmitter is an avalanche transistor pulser which drives a resistively loaded dipole transmitting antenna. A similar, but separate antenna is connected to the receiver. The receiver has adjustable sensitivity time control (STC) of as much as 60 dB to compensate for attenuation and geometric spreading factors. A fiber-optic cable is used to transmit both control signals and data. The data-acquisition and display system incorporates very high-speed digitizing and signal averaging, real-time profile display, and data storage on standard computer nine-track magnetic tape.
The system was successfully used on Ice Stream B in West Antarctica at centre frequencies of 1, 2, 4, 8, and 12.5 MHz. Bottom-return signal-to-noise ratios of more than 40 dB were obtained at 2 MHz through 800 m of ice. Convoluted internal surfaces not related to present bottom topography were resolved within the ice streams and anomalous strong reflections or “bright spots” were identified near the base of the ice. At present, there is no satisfactory glaciological explanation for either of these observations.
Low-frequency surface-based radar-profiling experiments on Ice Streams Β and C, West Antarctica, have yielded high-resolution images which depict folding of the internal layers that can aid in the interpretation of ice-stream dynamics. Unlike folding seen in most earlier radar studies of ice sheets, the present structures have no relationship to bedrock topography and show tilting of their axial fold planes in the flow direction. Rather than being standing waves created by topography or local variations in basal shear stress, the data show that these folds originate upstream of the region of streaming flow and are advected into the ice streams. The mechanism for producing folds is hypothesized to be changes in the basal boundary conditions as the ice makes the transition from inland ice to ice-stream flow. Migration of this transition zone headward can then cause folds in the internal layering to be propagated down the ice streams.
The objective of the present study was to investigate live weight (LW) gain, urinary nitrogen (UN) excretion and urination behaviour of dairy heifers grazing pasture, chicory and plantain in autumn and spring. The study comprised a 35-day autumn trial (with a 7-day acclimation period) and a 28-days spring trial (with a 7-day acclimation period). For each trial, 56 Friesian × Jersey heifers were blocked into five dietary treatments balanced for their LW and breeding worth (i.e. genetic merit of a cow for production and reproduction): 1·00 perennial ryegrass–white clover pasture (PA); 1·00 chicory (CH); 1·00 plantain (PL); 0·50 pasture + 0·50 chicory (PA + CH); and 0·50 pasture + 0·50 plantain (PA + PL). A fresh allocation of the herbage was offered every 3 days with allowance calculated according to feed requirement for maintenance plus gain of 1·0 kg LW/day. In both trials, LW gain was lower on CH than other treatments. In the spring trial, UN concentration and UN excretion were lower in CH and PL than other treatments. In autumn, a higher urination frequency was observed over the first 6 h after forage allocation in CH and PA + CH than other treatments. Data from the present study indicate that feeding CH alone limited heifer LW gain. However, heifers grazing swards containing chicory (CH and PA + CH) and plantain (PL and PA + PL) had the potential to lower nitrous oxide emissions and nitrate leaching from soil compared with heifers grazing PA, by reducing N loading in urine patches.
Empathy involves being able to understand and respond to others’ emotional experiences. Whilst deficits in empathy have been observed in frontotemporal dementia, the extent to which empathy is disrupted in dementia syndromes with predominant language impairment remains unclear. The current study investigated cognitive and affective empathy in the two non-fluent primary progressive aphasia syndromes: progressive non-fluent aphasia (PNFA) and logopenic progressive aphasia (LPA). Informants of 23 PNFA and 16 LPA patients completed the Interpersonal Reactivity Index (IRI), regarding patients’ capacity for empathy pre- and post-disease onset. Twenty-four healthy control participants completed the self-rated IRI for comparison of post-disease empathy capabilities. Within-group analyses revealed reduced cognitive empathy and increased personal distress in both patient groups. In addition, lowered affective empathy was reported in PNFA, with a similar trend observed in LPA. Interestingly, reduced affective empathy was associated with greater carer burden in LPA. Between-group analyses revealed reduced cognitive empathy in both patient groups relative to controls. The current study is the first to document empathy changes in PNFA and LPA, offering insight into the social cognitive deficits experienced in these syndromes. Future neuroimaging studies are needed to identify the underlying neural correlates and mechanisms driving empathy deficits in PNFA and LPA.
Spatial studies of the emission line regions in planetary nebulae (PN) can provide insight into the physical and chemical environments across the nebulae. In a collaborative effort by the coauthors, a K-band Fabry-Perot etalon has been coupled with an advanced 256 × 256 InSb focal plane array at the Wyoming Infrared Observatory 2.3m telescope. This system permits us to obtain spatially resolved, 0.24″/pixel, moderate spectral resolution (R ≈ 800), flux-density IR emission line images of astronomical sources. We obtained continuum-subtracted images of Br γ, HeI 2.06 μm, the 2-μm UIR features, and the 3.3 μm PAH dust feature in the PN NGC 6572, NGC 7027, and NGC 7662. One objective was to determine the spatial morphology of two unidentified emission lines, UIR1−2.199 μm, and UIR2−2.287 μm (Geballe et al. 1991). These UIR lines appear in the spectra of many PN (Hora et al. 1997) and in the Orion Nebula (Luhman & Rieke 1996). Geballe et al. suggested that the UIR lines are most likely forbidden transitions and showed that the parent ion ionization potential is ≈ 30–40 eV, while the ionization potential for the ions themselves is 40–60 eV. Here we directly compare the distribution of the UIR emitters to that of the gas (H+,He+) and dust (PAHs).
Interplanetary dust particles collected in the form of micrometeorites in the stratosphere and meteor ablation spherules in deep sea sediments are possibly a relatively unbiased sample of the micrometeoroid complex near 1 AU. Detailed laboratory analysis of the particles has provided information on physical properties which may be useful in modeling a variety of aspects of interplanetary dust.
Background: Stroke is a leading cause of perinatal brain injury and cerebral palsy. Term neonatal hemorrhagic stroke (NHS) is a common syndrome with poorly defined epidemiology. We aimed to determine incidence and mechanisms within a large population-based NHS sample. Methods: The Alberta Perinatal Stroke Project (APSP), a provincial registry ascertained NHS cases using exhaustive ICD-9/10 code searching (1992-2012, >2400 chart reviews). Prospective cases were captured through the Calgary Pediatric Stroke Program from 2007-2014 (n=387). All NHS cases underwent structured chart review using a data capture form and blinded review of neuroimaging. Provincial live births were obtained from statistics Canada. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure (PSOM). Results: We identified 74 cases: 49 NHS (26 retrospective, 27 prospective), 4 presumed perinatal HS (PPHS), and 21 hemorrhagic transformation (HT) of ischemic injury. Incidence of NHS was 1:8800 live births (1:5820 for all forms). HT was common (28.4%) including global, arterial venous ischemic lesions. Presumed perinatal hemorrhagic stroke presented with epilepsy. No risk factor was identified in 68% of cases. Outcomes were abnormal (PSOM 1 or more) in 30% and better in the HT group. Conclusion: NHS occurs in 1:8800 live births. Imaging classification is essential to define mechanisms.
The Roman and Byzantine port of Butrint, situated on the SW coast of Albania directly opposite the island of Corfu, has been the focus of a major research project since 1994. The investigation of the site and its hinterland commenced with excavations within the walled town and a survey of sites and monuments in the region (Hodges et al 1997). Despite a brief hiatus caused by civil unrest in Albania in 1997, work continued with excavation and study seasons in 1998 and 1999. The results of the first five years of the project are due to be published shortly (Hodges, Bowden and Lako, forthcoming).
The second phase of the Butrint project, starting in 2000, has encompassed a wide variety of research aims. They have included extensive research on the archives of the Italian mission that conducted large-scale excavations between 1928 and 1942. Among other finds, this resulted in the discovery of the manuscript of L. Ugolini's Albania antica vol. 4, the hitherto unpublished results of the Italian excavation of the Hellenistic and Roman theatre (Gilkes, forthcoming). Other archival research has focussed on the records of the communist-period archaeological investigations, and has resulted in a much better understanding of the aims and results of these projects, which in some cases are almost wholly unpublished. Our project is also concerned with the controlled development of the site for tourism. This has resulted in the expansion of the UNESCO World Heritage site to 2900 ha and the creation of a National Park with the intent of protecting the archaeological and natural landscape around Butrint (Hodges and Martin 2000; Martin 2001). The present report is a synthesis of the first results of the major excavations of 2000 and 2001. While it is possible (and indeed likely) that interpretations may change as excavations continue, it was felt that the material was of sufficient interest to justify an interim statement.
Approximately 25% of people with bulimia nervosa (BN) who undertake therapy are treated in groups. National guidelines do not discriminate between group and individual therapy, yet each has potential advantages and disadvantages and it is unclear how their effects compare. We therefore evaluated how group therapy for BN compares with individual therapy, no treatment, or other therapies, in terms of remission from binges and binge frequency.
We performed a systematic review and meta-analysis of randomized controlled trials of group therapies for BN, following standard guidelines.
A total of 10 studies were included. Studies were generally small with unclear risk of bias. There was low-quality evidence of a clinically relevant advantage for group cognitive behavioural therapy (CBT) over no treatment at therapy end. Remission was more likely with group CBT versus no treatment [relative risk (RR) 0.77, 95% confidence interval (CI) 0.62–0.96]. Mean weekly binges were lower with group CBT versus no treatment (2.9 v. 6.9, standardized mean difference = −0.56, 95% CI −0.96 to −0.15). One study provided low-quality evidence that group CBT was inferior compared with individual CBT to a clinically relevant degree for remission at therapy end (RR 1.24, 95% CI 1.03–1.50); there was insufficient evidence regarding frequency of binges.
Conclusions could only be reached for CBT. Low-quality evidence suggests that group CBT is effective compared with no treatment, but there was insufficient or very limited evidence about how group and individual CBT compared. The risk of bias and imprecise estimates of effect invite further research to refine and increase confidence in these findings.