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Introduction: Email and text messaging holds the potential to not only contact patients after emergency department (ED) care for clinically important communications such as appointment reminders, but also to solicit feedback for quality improvement and/or participation in research. A necessary first step though is the collection of electronic contact information, but little is known about current practice in Ontario EDs. In this study, we sought to characterize current collection, consent and use of patient email and texting to communicate with ED patients at academic and community hospitals across Ontario. Methods: We developed a questionnaire, with a blend of multiple choice and open-ended questions, targeted at ED registration administrators. The questions focused on if and how EDs collect, store and consent for patient emails, how and what they utilize those emails for and if they text patients. The questionnaire was administered both online and by phone. Participants were recruited through snowball sampling, including facilitated dissemination of the questionnaire via an existing listserv of the Patient Registration Network of Ontario (PRNO). Results: Twenty-two respondents (41% response rate) completed the questionnaire. Seven of the 22 institutions were academic health centres (32%). Nine institutions (41%) collected patient email addresses in the ED and none collected or used text message technology. In all 9, registration staff were tasked with asking, consenting, collecting and storing patient details within their hospital admissions, discharge and transfer system (ADT). For sites with email address collection, respondents estimated 40-60% of ED patients shared an email address. Seven of 9 institutions had a verbal consent process, while 2 used implied consent. Only 2 institutions used email to send patients post-discharge feedback questionnaires and four used email to facilitate access to patient portals. Four institutions were looking at using text messages to direct patients at triage, sometime in the future. Conclusion: Engagement in optimized care and feedback requires communication which is quickly shifting to electronic format. Collection of electronic contact information continues to be slow and uneven in Ontario. There is an immediate need for clearer guidance to accelerate collection, storage, consent and use of email and text messaging technology.
Based on hierarchies of filter lengths, the large eddy decomposition and the related subgrid stresses are recognized to represent generalized central moments for the study and modelling of the different modes composing turbulence. In particular, the subgrid stresses and the subgrid dissipation are shown to be alternative observables for quantitatively assessing the scale-dependent properties of momentum flux (subgrid stresses) and the energy exchange between the large and small scales (subgrid dissipation). In this work we present a theoretical framework for the study of the subgrid stress and dissipation. Starting from an alternative decomposition of the turbulent stresses, a new formalism for their approximation and understanding is proposed which is based on a tensorial turbulent viscosity. The derived formalism highlights that every decomposition of the turbulent stresses is naturally approximated by a general form of turbulent viscosity tensor based on velocity increments which is then recognized to be a peculiar property of small-scale stresses in turbulence. The analysis in a turbulent channel shows the rich physics of the small-scale stresses which is unveiled by the tensorial formalism and usually missed in scalar approaches. To further exploit the formalism, we also show how it can be used to derive new modelling approaches. The proposed models are based on the second- and third-order inertial properties of the grid element. The basic idea is that the structure of the integration volume for filtering (either implicit or explicit) impacts the anisotropy and inhomogeneity of the filtered-out motions and, hence, this information could be leveraged to improve the prediction of the main unknown features of small-scale turbulence. The formalism provides also a rigorous definition of characteristic lengths for the turbulent stresses, which can be computed in every type of computational elements, thus overcoming the rather elusive definition of filter length commonly employed in more classical models. A preliminary analysis in a turbulent channel shows reasonable results. In order to solve numerical stability issues, a tensorial dynamic procedure for the evolution of the model constants is also developed. The generality of the procedure is such that it can be employed also in more conventional closures.
The purpose of this study is the verification of intensity modulated radiation therapy (IMRT) head neck treatment planning with one-dimensional and two-dimensional (2D) dosimeters using imaging and radiation oncology core (IROC) Houston head & neck (H&N) phantom.
The image of the H&N phantom was obtained by computed tomography scan which was then transferred to Pinnacle@3 treatment planning system (TPS) for treatment planning. The contouring of the target volumes and critical organ were done manually and dose constraints were set for each organ according to IROC prescription. The plan was optimised by adoptive convolution algorithm to meet the IROC criteria and collapse cone convolution algorithm calculated the delivered doses for treatment. Varian Clinac 2110 was used to deliver the treatment plan to the phantom, the process of irradiation and measurement were repeated three times for reproducibility and reliability. The treatment plan was verified by measuring the doses from thermoluminescent dosimeters (TLDs) and GafChromic external beam therapy 2 films. The agreement between the planned and delivered doses were checked by calculating the percentage dose differences, analysing their isodose line profiles and 2D gamma maps.
The average percent dose difference of 1·8% was obtained between computed doses by TPS and measured doses from TLDs, however these differences were found to be higher for organ at risk. The film dose profile was well in agreement with the planned dose distribution with distance to agreement of 1·5 mm. The gamma analysis of the computed and recorded doses passed the criteria of 3%/3 mm with passing percentages of >96%, which shows successful authentication of delivered doses for IMRT.
IMRT pre-treatment validation can be done with IROC anthropomorphic phantoms, which is essential for the delivery of modulated radiotherapies. It was concluded that films and TLDs can be used as quality assurance tools for IMRT.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
Direct numerical simulations of turbulent suspension flows are carried out with the force-coupling method in plane Couette and pressure-driven channel configurations. Dilute to moderately concentrated suspensions of neutrally buoyant finite-size spherical particles are considered when the Reynolds number is slightly above the laminar–turbulent transition. Tests performed with synthetic streaks, in both turbulent channel and Couette flows, show clearly that particles trigger the instability in channel flow whereas the plane Couette flow becomes laminar. Moreover, we have shown that particles have a pronounced impact on pressure-driven flow through a detailed temporal and spatial analysis whereas they have no significant impact on the plane Couette flow configuration. The substantial difference between the two flow configurations is related to the spatial preferential distribution of particles in the large-scale rolls (inactive motion) in Couette flow, whereas they are accumulated in the ejection (active motion) regions in pressure-driven flow. Through investigation of particle modification in two distinct flow configurations, we were able to show the specific response of turbulent structures and the modulation of the fundamental mechanisms composing the regeneration cycle in the buffer layer of the near-wall turbulence. Especially for pressure-driven flow, the particles enhance the lift-up and let it act continuously whereas the particles do not significantly alter the streak breakdown process. The reinforcement of the streamwise vortices is attributed to the vorticity stretching term by the wavy streaks. The smaller and more numerous wavy streaks enhance the vorticity stretching and consequently strengthen the circulation of large-scale streamwise vortices in suspension flow.
Oligodeoxynucleotides (ODNs) containing cytosine-phosphate-guanosine sequence (CpG) is considered as an immune stimulator when it is fed to animals. These synthetic molecules mount different immune responses in the animals including mice, chickens, ducks, dogs and horses. CpG ODNs induce specific antigenic immunity against co-administered vaccines and are well tolerated in healthy individuals and are capable of stimulating toll-like receptors (TLRs) such as TLR-9 to activate innate immunity. The CpG ODNs can be used as an adjuvant in different vaccines synthesised specifically for poultry diseases caused by viruses and bacteria. In chickens, CpG ODNs stimulate TLRs involved in humoral immunity. CpG ODNs have been used as mucosal vaccine adjuvants against several pathogens, including avian influenza and Newcastle disease. The CpG ODNs function to protect the chickens from Newcastle disease by producing plasma dendric cells (pDCs) which ultimately produce interferons (INFs). The inoculation of CpG ODNs along with the cationic microparticles and DNA vaccine for infectious bursal disease virus result in the influx of T cells and a reduction of antigen load. When CpG ODNs are used against avian leucosis, they result in significantly higher antibody titres. In many other vaccines e.g., infectious laryngotracheitis, infectious bronchitis, herpes, viral enteritis, Marek's disease virus, E. coli and Salmonella spp. including CpG ODNs exhibit immunostimulatory effects. In conclusion, CpG ODNs may be used as effective adjuvants in viral, bacterial and parasitic vaccines in poultry.
Avian influenza virus (AIV) type A subtype H9N2 usually causes mild asymptomatic infections, and is mostly undetected and is, therefore, under-reported. This has allowed the virus to rapidly evolve via mutations and reassortments in its genome with other avian influenza subtypes especially H1N1, H5N1 and H7N3 thereby introducing new variant strains and producing severe disease. It has been reported that the AIV H9N2 donated its internal genes for the devastating 1997 Hong Kong outbreak and furthermore, it may be the cause of the next influenza pandemic. There are many factors such as its wide host range, ability to cross the species barrier, ecological diversity, antiviral resistance and zoonotic importance that make it an excellent candidate for the next influenza pandemic. These and other factors like ineffective vaccination, negative immunological pressures, lack of surveillance, which contribute to its continuous persistence and evolutionary dynamics are discussed in this paper. It is important to take the necessary measures to control and prevent its unchecked circulation to prevent the future outbreaks.
Thirty-eight species of larger foraminifera belonging to Nummulites, Operculina and Assilina are recorded, identified and systematically described from 5 stratigraphic sections of the Thebes Formation in the Red Sea Coast and the Nile Valley, Egypt.
According to these species the age assigned to the Thebes Formation is Lower Eocene (Ypresian).
The Nummulites species are subdivided here into 6 groups based on their evolutionary lineage following Schaub (1981). Moreover, spiral diagrams for the different species showing the relation between the number of whorls and the corresponding radius in median sections are drawn.
We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia.
We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted.
We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively.
We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38–46)
Serpins are a broadly distributed family of proteases found in various organisms that play an important role in regulating the immune response. Here, we identified a serpin-1 gene from Antheraea pernyi that encodes a 279 amino acid protein with a molecular weight of 30.8 kDa. We expressed the recombinant Ap-serpin-1 protein in Escherichia coli and used the purified protein to prepare rabbit anti-Ap-serpin-1 polyclonal antibodies. We calculated the enzyme-linked immunosorbent assay titer of the antibody as 1:128000. Quantitative real-time polymerase chain reaction analysis revealed that Ap-serpin-1 was expressed in all examined tissues, including hemolymph, malpighian tubules, midgut, silk gland, integument and the fat body; the highest Ap-serpin-1 expression levels was detected in the fat body. We next investigated the expression patterns of Ap-serpin-1 in both fat body and hemolymph samples, following treatment with E. coli, Beauveria bassiana, Micrococcus luteus and nuclear polyhedrosis virus (NPV). We reported that NPV and M. luteus significantly enhanced Ap-serpin-1 expression in the fat body. While, in the hemolymph samples, treatment with B. bassiana and M. luteus was shown to upregulate Ap-serpin-1 expression at 24 h induction. Altogether, our results suggest that Ap-serpin-1 is involved in the innate immunity of A. pernyi.
The Jeans instability is examined in quantum dusty magnetoplasmas due to low-frequency magnetosonic perturbations. The fluid model consisting of the momentum balance equation for quantum plasmas, Poisson’s equation for the gravitational potential and Maxwell’s equations for electromagnetic magnetosonic perturbations is solved. The numerical analysis elaborates the significant contribution of magnetic field, electron number density and variable dust mass to the Jeans instability.
The poultry industry is currently facing a serious problem of controlling coccidiosis, owing to the development of drug resistance against commonly available anticoccidials. Furthermore, an increasing demand in the consumers for drug residue free poultry and poultry products has led to the development of alternative strategies for the treatment and control of avian coccidiosis. In response to the invasion of Eimeria species in coccidiosis, oxidative stress is created by host cellular response which imparts pathology to the host tissue besides damaging the parasite. Hence, in order to alleviate the damage caused by oxidative stress during coccidiosis, the use of essential oils (EOs) rich in antioxidant compounds is being considered as an appealing approach. However, results are very divergent and often not as satisfactory as expected. Essential oils, as natural products, obtained from aromatic plants have the potential to serve as an alternate to anticoccidials. The present work aims to review the current state of knowledge, informative collection of results obtained over the years and to attain a critical decision in aspects of the use of EOs as anticoccidials.
We conducted a systematic review of the 2012–2013 multistate fungal meningitis epidemic in the United States from the perspectives of clinical response, outbreak investigation, and epidemiology. Articles focused on clinical response, outbreak investigation, and epidemiology were included, whereas articles focused on compounding pharmacies, legislation and litigation, diagnostics, microbiology, and pathogenesis were excluded. We reviewed 19 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. The source of the fungal meningitis outbreak was traced to the New England Compounding Center in Massachusetts, where injectable methylprednisolone acetate products were contaminated with the predominant pathogen, Exserohilum rostratum. As of October 23, 2013, the final case count stood at 751 patients and 64 deaths, and no additional cases are anticipated. The multisectoral public health response to the fungal meningitis epidemic from the hospitals, clinics, pharmacies, and the public health system at the local, state, and federal levels led to an efficient epidemiological investigation to trace the outbreak source and rapid implementation of multiple response plans. This systematic review reaffirms the effective execution of a multisectoral public health response and efficient delivery of the core functions of public health assessment, policy development, and service assurances to improve population health.(Disaster Med Public Health Preparedness. 2016;10:145–151)
Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.
A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.
A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).
Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.
Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260
There is considerable confusion concerning Sarcocystis species in camels. Five species: Sarcocystis cameli, Sarcocystis ippeni, Sarcocystis camelicanis, Sarcocystis camelocanis and Sarcocystis miescheri were named with inadequate descriptions and no type specimens. Here, we review literature on sarcocystosis in camels worldwide and redescribe structure of S. cameli and S. ippeni sarcocysts by light- and transmission electron microscopy (LM and TEM). Eight sarcocysts from the oesophagi of two camels (Camelus dromedarius) from Egypt were studied. By LM, all sarcocysts were thin-walled with barely visible projections on the cyst walls. By TEM, two structurally distinct sarcocysts were recognized by unique villar protrusions (vp) not found in sarcocysts from any other host. Sarcocysts of S. cameli had vp of type 9j. The sarcocyst wall had upright slender vp, up to 3·0 µm long and 0·5 µm wide; the total thickness of the sarcocyst wall with ground substance (gs) layer was 3·5 µm. On each vp, there were rows of knob-like protrusions that appeared to be interconnected. The vp had microtubules that originated at midpoint of the gs and continued up to the tip; microtubules were smooth, without any granules or dense areas. Bradyzoites were approximately 14–15 × 3–4 µm in size with typical organelles. Sarcocystis ippeni sarcocysts had type 32 sarcocyst wall characterized by conical vp with an electron dense knob. The total thickness of the sarcocyst wall (from the base of gs to vp tip) was 2·3–3·0 µm. The vp were up to 1·2 µm wide at the base and 0·25 µm at the tip. Microtubules in vp originated at midpoint of gs and continued up to tip; microtubules were criss-crossed, smooth and without granules or dense areas. Bradyzoites were 12·0–13·5 × 2·0–3·0 µm in size. Sarcocystis camelicanis, S. camelocanis and S. miescheri are considered invalid.
The addition of a CdMgTe (CMT) layer at the back of a CdTe solar cell should improve its performance by reflecting both photoelectrons and forward-current electrons away from the rear surface. Higher collection of photoelectrons will increase the cell’s current, and reduction of forward current will increase its voltage. To achieve electron reflection, conformal CMT layers were deposited at the back of CdTe cells, and a variety of measurements including performance curves, transmission electron microscopy, x-ray photoelectron spectroscopy, and energy-dispersive x-ray spectroscopy were performed. Oxidation of magnesium in the CMT layer was addressed by adding a CdTe capping layer. MgCl2 passivation was substituted for CdCl2 in some cases, but little difference was seen.
The cadmium chloride annealing treatment is an essential step in the manufacture of efficient thin film CdTe solar cells. In previous work we have shown that the primary effect of the treatment is to remove high densities of stacking faults from the as-deposited material. Use of density functional theory has shown that some of the higher energy stacking faults are hole traps. Removal of these defects dramatically improves cell efficiency. In this study we focus on the effect of the activation treatment on the underlying n-type cadmium sulphide layer. A range of techniques has been used to observe the changes to the microstructure as well as the chemical and crystallographic changes as a function of treatment parameters. Electrical tests that link the device performance with the micro-structural properties of the cells have also been undertaken. Techniques used include High Resolution Transmission Electron Microscopy (HRTEM) for sub-grain analysis, EDX for chemical analysis and XPS and SIMS for composition-depth profiling. By studying the effect of increasing the treatment time and temperature, we will show that the cadmium sulphide layer depletes to the point of complete dissolution into the absorber layer. We will also show that chlorine penetrates and decorates the grain boundaries in the cadmium sulphide. In addition we will show that chlorine builds up at the heterojunction and concentrates in voids at the cadmium telluride/cadmium sulphide interface. A combination of these effects damages the electrical performance of the solar cell.
There has been a recent move in psychiatry towards the use of electronic discharge (e-discharge) summaries in an effort to improve the efficiency of communication between primary and secondary care, but there are little data on how this affects the quality of information exchanged.
To evaluate the quality of psychiatric discharge summaries before and after the introduction of the e-discharge summary system.
A retrospective analysis of 50 dictated discharge summaries from 1 January to 1 July 2010 and of 50 e-discharge summaries from 1 January to 1 July 2012, evaluating for the inclusion of 15 key items of clinical information.
The average total score of the dictated summaries (mean=9.5, s.d.=2.0) was significantly higher (p<0.001) than the e-discharge summaries (mean=6.7, s.d.=1.8). There were statistically significant differences in five of the standards: findings of physical examination (p<0.001), ICD-10 code (p<0.001), forensic history (p<0.001), alcohol history (p<0.001) and drug history (p<0.001).
Our results revealed a decline in the quality of discharge summaries following the introduction of an electronic system. The reasons for this are unclear and require further analysis. Specific suggestions will depend on the local need, but include improvements in software design and layout as well as better education and training.