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Healthcare workers (HCWs) are at risk of acquiring and transmitting respiratory viruses while working in healthcare settings.
To investigate the incidence of and factors associated with HCWs working during an acute respiratory illness (ARI).
HCWs from 9 Canadian hospitals were prospectively enrolled in active surveillance for ARI during the 2010–2011 to 2013–2014 influenza seasons. Daily illness diaries during ARI episodes collected information on symptoms and work attendance.
At least 1 ARI episode was reported by 50.4% of participants each study season. Overall, 94.6% of ill individuals reported working at least 1 day while symptomatic, resulting in an estimated 1.9 days of working while symptomatic and 0.5 days of absence during an ARI per participant season. In multivariable analysis, the adjusted relative risk of working while symptomatic was higher for physicians and lower for nurses relative to other HCWs. Participants were more likely to work if symptoms were less severe and on the illness onset date compared to subsequent days. The most cited reason for working while symptomatic was that symptoms were mild and the HCW felt well enough to work (67%). Participants were more likely to state that they could not afford to stay home if they did not have paid sick leave and were younger.
HCWs worked during most episodes of ARI, most often because their symptoms were mild. Further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
There is community concern about the treatment of farm animals post-farm gate, particularly animal transport and slaughter. Relationships between lamb behavioural and physiological variables on farm, stockperson, dog and lamb behavioural variables pre-slaughter and plasma cortisol, glucose and lactate in lambs post-slaughter were studied in 400 lambs. The lambs were observed in three behavioural tests, novel arena, flight distance to a human and temperament tests, before transport for slaughter. Closed-circuit television video footage was used to record stockperson, dog and lamb behaviour immediately before slaughter. Blood samples for cortisol, glucose and lactate analyses were collected on farm following the three behavioural tests and immediately post-slaughter. The regression models that best predicted plasma cortisol, glucose and lactate concentrations post-slaughter included a mixture of stockperson and dog behavioural variables as well as lamb variables both on-farm and pre-slaughter. These regression models accounted for 33%, 34% and 44% of the variance in plasma cortisol, glucose and lactate concentrations post-slaughter, respectively. Some of the stockperson and dog behaviours pre-slaughter that were predictive of the stress and metabolic variables post-slaughter included the duration of negative stockperson behaviours such as fast locomotion and lifting/pulling lambs, and the duration of dog behaviours such as lunging and barking at the lamb, while some of the predictive lamb behaviour variables included the durations of jumping and fleeing. Some of the physiological and behavioural responses to the behavioural tests on farm were also predictive of the stress and metabolic variables post-slaughter. These relationships support the well-demonstrated effect of handling on fear and stress responses in livestock, and although not direct evidence of causal relationships, highlight the potential benefits of training stockpeople to reduce fear and stress in sheep at abattoirs.
The search for extraterrestrial habitable planets will require long observation times and the intelligent selection of appropriate parent stars and target biosignatures. While life can certainly develop in the absence of photosynthesis, such life forms on earth exhibit metabolic rates several orders of magnitude less than the activity accompanying a photosynthetic-driven ecosystem. The most accessible spectral biosignatures are those accompanying a system driven away from thermodynamic equilibrium by photosynthetic activity. For example, the co-existence in a planetary atmosphere of significant amounts of ozone, oxygen, and methane would be a strong indication of biotic activity. Investigating the issue of the Habitable Zone from the standpoint of the constraints inherent in photosynthesis it appears that the absorption characteristics of photosynthetic microorganisms on this planet make it likely that photosynthetic activity can exist on planets orbiting stars to red-ward of the Sun on the H-R diagram. Such a possibility is encouraging for terrestrial planet finder efforts since stars classified red-ward of our sun (G3 to K7) account for more than 55% of our nearest neighbors.
To evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.
Prospective observational cohort study.
Single transplant center in Canada.
Patients who underwent liver transplantation between February 2011 and August 2014.
Multivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.
We enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02–12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.
Organ-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.
A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.
According to many works on English phonology, word-final alveolar consonants – and only alveolar consonants – assimilate to following word-initial consonants, e.g. ran quickly → ra[ŋ] quickly. Some phonologists explain the readiness of alveolar consonants to assimilate (vs. the resistance of velar and labial articulations) by proposing that they have underspecified place of articulation (e.g. Avery & Rice 1989). Labial or dorsal nasals do not undergo assimilation because their place nodes are specified. There are reports that velar and labial consonants sometimes assimilate in English, but these are anecdotal observations, with no available audio and no statistics on their occurrence. We find evidence of assimilation of labial and velar nasals in the Audio British National Corpus, motivating a new, quantitative phonological framework: a statistical model of underspecification and variation which captures typical as well as less common but systematic patterns seen in non-coronal assimilation.
Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent.
To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980).
Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up.
No variants passed a genome-wide significance threshold (P=5×10–8) in either analysis. Four variants met criteria for suggestive significance (P<5×10–6) in association with response post-treatment, and three variants in the 6-month follow-up analysis.
This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.
Studies were conducted in a stale field production system in 2012 and 2013 to determine the effect of herbicide timing on Palmer amaranth control and ‘Covington’ sweetpotato yield and quality. Treatments consisted of flumioxazin at 72, 90, or 109 g ai ha−1 applied 45 d before transplanting (DBT) or 1 DBT, or sequentially the same rate at 45 DBT followed by (fb) 1 DBT; flumioxazin 109 g ha−1 applied 1 DBT fb S-metolachlor (800 g ai ha−1) at 0, 6 (± 1), or 10 d after treatment (DAT); flumioxazin at 72, 90, or 109 g ha−1 plus clomazone (630 g ai ha−1) applied 45 DBT fb S-metolachlor (800 g ha−1) applied 10 DAT; and fomesafen alone at 280 g ai ha−1 applied 45 DBT. Nontreated weed-free and weedy controls were included for comparison. Flumioxazin application time had a significant effect on Palmer amaranth control and sweetpotato yields, and the effect of flumioxazin rate was not significant. Treatments consisting of sequential application of flumioxazin 45 DBT fb 1 DBT or flumioxazin plus clomazone 45 DBT fb S-metolachlor 10 DAT provided the maximum Palmer amaranth control and sweetpotato yields (jumbo, No. 1, jumbo plus No. 1, marketable) among all treatments. Delayed flumioxazin application timings until 1 DBT allowed Palmer amaranth emergence on stale seedbeds and resulted only in 65, 62, 48, and 17% control at 14, 32, 68, and 109 DAT, respectively. POST transplant S-metolachlor applications following flumioxazin 1 DBT did not improve Palmer amaranth control, because the majority of Palmer amaranth emerged prior to S-metolachlor application. A control program consisting of flumioxazin 109 g ha−1 plus clomazone 630 g ha−1 at 45 DBT fb S-metolachlor 800 g ha−1 at 0 to 10 DAT provides an effective herbicide program for Palmer amaranth control in stale seedbed production systems in North Carolina sweetpotato.
We previously reported an association between 5HTTLPR genotype and
outcome following cognitive–behavioural therapy (CBT) in child anxiety
(Cohort 1). Children homozygous for the low-expression short-allele
showed more positive outcomes. Other similar studies have produced mixed
results, with most reporting no association between genotype and CBT
To replicate the association between 5HTTLPR and CBT outcome in child
anxiety from the Genes for Treatment study (GxT Cohort 2,
n = 829).
Logistic and linear mixed effects models were used to examine the
relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both
cohorts were performed.
There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2.
Mega-analyses identified a significant association between 5HTTLPR and
remission from all anxiety disorders at follow-up (odds ratio 0.45,
P = 0.014), but not primary anxiety disorder
The association between 5HTTLPR genotype and CBT outcome did not
replicate. Short-allele homozygotes showed more positive treatment
outcomes, but with small, non-significant effects. Future studies would
benefit from utilising whole genome approaches and large, homogenous
Measurements of the soft X-ray background intensity show that the intensity is largest in that part of the sky where the columnar atomic hydrogen density is smallest. In the direction bII =-60°, lII = 10° the intensity is found to be 195 ± 20 photons cm−2 sec−1 ster−1 keV−1 near 0.26 keV and 20 ± 3 photons cm−1 sec−1 ster−1 keV−1 near 0.9 keV. The intensity in the galactic plane is unexpectedly large.
Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents. (Disaster Med Public Health Preparedness. 2012;0:1-10)
Bulk ion implantations of AlxGa1-xAs (x = 0.6 or 0.85) were performed at 77 K with 1.5 MeV Kr+, 1 MeV Ar+ or 1.5 MeV++ ions, and the resulting damage state examined by using Rutherford backscattering spectrometry-channeling at 77 K and 293 K and transmission electron microscopy at 300 K. Amorphization of a portion of the A1xGa1-x As layer occurred at 77 K only for the 1.5 MeV Kr+ implantation, although the dose required to cause amorphization was higher for the higher Al content alloy. TRIM calculations[10–11] show that with this implantation the density of high energy density cascades varies as a function of depth through the layer and that these are superimposed on a high, uniform density of defects. Comparison of the ion channeling spectra at 77 K and 293 K shows that recovery occurs over a portion of the layer in the Al0.6Ga0.4As but is not detected in the A10.85Ga0.15As layer. In both alloys, the room temperature microstructure consists of an amorphous and a crystalline region. The amorphous region extends from the deeper AlxGa1-xAs/GaAs interface into the layer, and is separated from the crystalline material by a crystalline region containing planar defects. The difference between the alloys is in the extent of this latter region, which decreases in width with increasing Al content. These results will be used to examine current models for amorphization in the AlxGa1-xAs system.
This meta-analysis compared the efficacy and safety of desvenlafaxine and venlafaxine at the Australian approved doses.
A systematic literature search was conducted to identify all placebo-controlled studies of desvenlafaxine and venlafaxine in the treatment of major depression. The pivotal outcome measure used to assess comparative efficacy was the mean change in Hamilton Rating Scale for Depression-17 score from baseline. Tolerability and safety were compared by an evaluation of reported adverse events. Standard and Bayesian methods were used to conduct the indirect comparisons.
Using a mixed model repeated measures analysis, the pooled weighted mean difference for the mean change in Hamilton Rating Scale for Depression-17 score from baseline was −2.81 (−3.72, −1.91; p < 0.001) for desvenlafaxine and −2.61 (−3.17, −2.05; p < 0.001) for venlafaxine. An indirect Bayesian analysis adjusted for baseline Hamilton Rating Scale for Depression-17 score showed no significant difference between the two treatments (weighted mean difference −0.27; −1.17, 0.65). A standard indirect comparison of any adverse events showed no significant difference between desvenlafaxine and venlafaxine (relative risk 1.01; 0.96, 1.06; p = 0.70 and risk difference −0.01; −0.05, 0.03; p = 0.59). Standard indirect comparisons of both nausea and drop-outs identified potential differences between treatments, with the risk difference analyses suggesting a trend in favor of desvenlafaxine (nausea: relative risk 0.97; 0.77, 1.22; p = 0.80/RD −0.07; −0.12, −0.01; p = 0.02; and drop-outs due to adverse events: RR 0.86; 0.58, 1.29; p = 0.48/RD −0.04; −0.08, 0.00; p = 0.06).
Based on the results of this meta-analysis, desvenlafaxine was shown to be non-inferior to venlafaxine in terms of efficacy, and has an advantage in terms of less nausea.
Pyrite textures are described and illustrated and stable S-isotope data are presented from the Alton (Gastrioceras listen) marine horizon of the Westphalian Lower Coal Measures, from sections near Penistone in central northern England, with the object of relating the paragenetic sequence of pyrite formation to the conditions of sediment deposition and diagenesis. The earliest diagenetic pyrite is dispersed as framboidal and related textures. It is followed in the marine shale, coal and ganister by more localised but more intense pyrite deposition and replacement in a variety of textures. Most of this is precompactional in age, but some, together with pyrite in veinlets and cleat, is postcompactional. Marcasite is rare and mainly late. δ34S ratios range between −35·31‰ and +20·39‰. There is a definite trend from lighter values (−1·15 ± 6·47‰) in the marine part of the sequence to much heavier values (+12·73 ± 7·66‰) in the sediment below the coal. This allows the relationship of the earliest pyrite deposition in the coal-peat and ganister to the chemistry of their own depositional fresh water to be seen but then relates the main pyrite deposition to the influx of the marine-water sulphate of the Alton horizon, and shows the penetration of this influence downward into the coal-peat and its seat-bed.
To determine whether drinking water contaminated with antimicrobial-resistant E. coli is associated with the carriage of resistant E. coli, selected households sending water samples to Ontario and Alberta laboratories in 2005–2006 were asked to participate in a cross-sectional study. Household members aged ⩾12 years were asked to complete a questionnaire and to submit a rectal swab. In 878 individuals, 41% carried a resistant strain of E. coli and 28% carried a multidrug-resistant strain. The risk of carriage of resistant E. coli was 1·26 times higher for users of water contaminated with resistant E. coli. Other risk factors included international travel [prevalence ratio (PR) 1·33], having a child in nappies (PR 1·33), being male (PR 1·33), and frequent handling of raw red meats (PR 1·10). Protecting private water sources (e.g. by improving systems to test and treat them) may help slow the emergence of antimicrobial resistance in E. coli.
Single walled carbon nanotubes are shown to interact with a conjugated polymer in a periodic manner. Here this interaction is probed using electron microscopy, scanning tunneling microscopy optical and vibrational spectroscopy. The spectroscopic behaviour of the polymer is seen to be dramatically affected, which is attributed to conformational changes due to the effect of the nanotubes.