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Introduction: Little is known about the variety of roles volunteers play in the emergency department (ED), and the potential impact they have on patient experience. The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in EDs, and determine how these programs impacted patient experiences or outcomes. Methods: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. A grey literature search was also conducted (Web of Science, ProQuest, Canadian Business and Current Affairs Database ProQuest Dissertations and Theses Global). Two reviewers independently screened titles and abstracts, reviewed full text articles, and extracted data. Results: The search strategy yielded 4,589 potentially relevant citations. After eliminating duplicate citations and articles that did not meet eligibility criteria, 87 reports were included in the review. Of the included reports, 18 were peer-reviewed articles, 6 were conference proceedings, 59 were magazine or newspaper articles, and 4 were graduate dissertations or theses. Volunteer activities were categorized as non-clinical tasks (e.g., provision of meals/snacks, comfort items and mobility assistance), navigation, emotional support/communication, and administrative duties. 52 (59.8%) programs had general volunteers in the ED and 35 (40.2%) had volunteers targeting a specific patient population, including pediatrics, geriatrics, patients with mental health and addiction issues and other vulnerable populations. 20 (23.0%) programs included an evaluative component describing how ED volunteers affected patient experiences and outcomes. Patient satisfaction, follow-up and referral rates, ED and hospital costs and length of stay, subsequent ED visits, medical complications, and malnutrition in the hospital were all reported to be positively affected by volunteers in the ED. Conclusion: This scoping review demonstrates the important role volunteers play in enhancing patient and caregiver experience in the ED. Future volunteer engagement programs implemented in the ED should be formally described and evaluated to share their success and experience with others interested in implementing similar programs in the ED.
Giardiasis is one of the most important non-viral causes of human diarrhoea. Yet, little is known about the epidemiology of giardiasis in the context of developed countries such as Australia and there is a limited information about local sources of exposure to inform prevention strategies in New South Wales. This study aimed to (1) describe the epidemiology of giardiasis and (2) identify potential modifiable risk factors associated with giardiasis that are unique to south-western Sydney, Australia. A 1:2 matched case-control study of 190 confirmed giardiasis cases notified to the South-Western Local Health District Public Health Unit from January to December 2016 was employed to investigate the risk factors for giardiasis. Two groups of controls were selected to increase response rate; Pertussis cases and neighbourhood (NBH) controls. A matched analysis was carried out for both control groups separately. Variables with a significant odds ratio (OR) in the univariate analysis were placed into a multivariable regression for each matched group, respectively. In the regression model with the NBH controls, age and sex were controlled as potential confounders. Identified risk factors included being under 5 years of age (aOR = 7.08; 95% confidence intervals (CI) 1.02–49.36), having a household member diagnosed with a gastrointestinal illness (aOR = 15.89; 95% CI 1.53–164.60) and having contact with farm animals, domestic animals or wildlife (aOR = 3.03; 95% CI 1.08–8.54). Cases that travelled overseas were at increased risk of infection (aOR = 19.89; 95% CI 2.00–197.37) when compared with Pertussis cases. This study provides an update on the epidemiology and associated risk factors of a neglected tropical disease, which can inform enhanced surveillance and prevention strategies in the developed metropolitan areas.
Background: Heterozygous loss-of-function mutations in the synaptic scaffolding gene SHANK2 are strongly associated with autism spectrum disorder (ASD). However, their impact on the function of human neurons is unknown. Derivation of induced pluripotent stem cells (iPSC) from affected individuals permits generation of live neurons to answer this question. Methods: We generated iPSCs by reprogramming dermal fibroblasts of neurotypic and ASD-affected donors. To isolate the effect of SHANK2, we used CRISPR/Cas9 to knock out SHANK2 in control iPSCs and correct a heterozygous nonsense mutation in ASD-affected donor iPSCs. We then derived cortical neurons from SOX1+ neural precursor cells differentiated from these iPSCs. Using a novel assay that overcomes line-to-line variability, we compared neuronal morphology, total synapse number, and electrophysiological properties between SHANK2 mutants and controls. Results: Relative to controls, SHANK2 mutant neurons have increased dendrite complexity, dendrite length, total synapse number (1.5-2-fold), and spontaneous excitatory postsynaptic current (sEPSC) frequency (3-7.6-fold). Conclusions: ASD-associated heterozygous loss-of-function mutations in SHANK2 increase synaptic connectivity among human neurons by increasing synapse number and sEPSC frequency. This is partially supported by increased dendrite length and complexity, providing evidence that SHANK2 functions as a suppressor of dendrite branching during neurodevelopment.
Significant increases in excess all-cause mortality, particularly in the elderly, were observed during the winter of 2014/15 in England. With influenza A(H3N2) the dominant circulating influenza A subtype, this paper determines the contribution of influenza to this excess controlling for weather. A standardised multivariable Poisson regression model was employed with weekly all-cause deaths the dependent variable for the period 2008–2015. Adjusting for extreme temperature, a total of 26 542 (95% CI 25 301–27 804) deaths in 65+ and 1942 (95% CI 1834–2052) in 15–64-year-olds were associated with influenza from week 40, 2014 to week 20, 2015. This is compatible with the circulation of influenza A(H3N2). It is the largest estimated number of influenza-related deaths in England since prior to 2008/09. The findings highlight the potential health impact of influenza and the important role of the annual influenza vaccination programme that is required to protect the population including the elderly, who are vulnerable to a severe outcome.
Pale soft exudative pork (PSE) is a major problem affecting swine industries worldwide that results in significant economic loss because it reduces processing and saleable product yields. The PSE condition results from a rapid rate of muscle glycolysis early postmortem and a rapid drop in muscle pH while the temperature of the carcass is still high. Stress prior to slaughter can increase the rate of glycolysis and postmortem acidification. Blood acid-base has been used as an indicator of stress in pigs. The objective of this experiment was to investigate the relationship between blood acid-base status at slaughter and fresh meat quality in pigs.
At weaning, piglets must adapt to considerable changes in their environmental, immunological, and nutritional status. This period of adaptation is accompanied by a reduction in piglet growth rate that has been associated with the shift from sow’s milk to a solid dry diet. Consequently, feeding management strategies that result in increased feed intake may increase piglet growth rate postweaning. This study evaluated the effects of providing feed as a gruel and feeding on floor mats on piglet performance for three weeks after weaning
When emptying finishing barns, it is common practice on U.S. operations to dispatch pigs over a two- to three-week period with the heaviest animals being selected first. However, there has been little research carried out under commercial conditions on the effect of removing pigs from a pen at slaughter weight on the performance of the remaining animals. This study was carried out to investigate the effect of removing the heaviest 30% of animals from a pen on the subsequent growth performance of the remaining pigs.
Wean-to-finish production, which involves taking pigs from weaning to slaughter in the same building, is becoming widely adopted in the US swine industry. This production system is being advocated largely because of claims of improved animal performance and a decrease in labor needed for animal movement compared to conventional multiple-stage systems. One of the potential disadvantages of this system is the considerable underutilization of floor space during the early growth period if pigs are penned in the group sizes that are appropriate for finishing pigs. However, increasing the stocking rate initially at weaning, with some of these pigs subsequently being moved to another finishing facility, may increase output from the system. Therefore, the objective of this research was to investigate effects of initial stocking rate and of feeder-trough space in commercial wean-to-finish facilities on pig performance from weaning to slaughter.
In-spiraling supermassive black holes should emit gravitational waves, which would produce characteristic distortions in the time of arrival residuals from millisecond pulsars. Multiple national and regional consortia have constructed pulsar timing arrays by precise timing of different sets of millisecond pulsars. An essential aspect of precision timing is the transfer of the times of arrival to a (quasi-)inertial frame, conventionally the solar system barycenter. The barycenter is determined from the knowledge of the planetary masses and orbits, which has been refined over the past 50 years by multiple spacecraft. Within the North American Nanohertz Observatory for Gravitational Waves (NANOGrav), uncertainties on the solar system barycenter are emerging as an important element of the NANOGrav noise budget. We describe what is known about the solar system barycenter, touch upon how uncertainties in it affect gravitational wave studies with pulsar timing arrays, and consider future trends in spacecraft navigation.
A global array of 20 radio observatories was used to measure the three-dimensional position and velocity of the two meteorological balloons that were injected into the equatorial region of the Venus atmosphere by the VEGA spacecraft.
Unusual speleothems, associated with hyperalkaline (pH > 12) groundwaters
have formed within a shallow, abandoned railway tunnel at Peak Dale,
Derbyshire, UK. The hyperalkaline groundwaters are produced by the leaching
of a thin layer (<2 m) of old lime-kiln waste on the soil-bedrock surface
above the tunnel by rainwater. This results in a different reaction and
chemical process to that more commonly associated with the formation of
calcium carbonate speleothems from Ca-HCO3-type groundwaters and
degassing of CO2. Stalagmites within the Peak Daletunnel have
grown rapidly (averaging 33 mm y–1), following the closure of the
tunnel 70 years ago. They have an unusual morphology comprising a central
sub-horizontally-laminated column of micro- to nano-crystalline calcium
carbonate encompassed by an outer sub-vertical assymetricripple-laminated
layer. The stalagmites are composed largely of secondary calcite forming
pseudomorphs (<1 mm) that we believe to be predominantly after the 'cold
climate' calcium carbonate polymorph, ikaite (calcium carbonate hexahydrate:
CaCO3·6H2O), withminor volumes of small (<5 μm)
pseudomorphs after vaterite. The tunnel has a near constant temperature of
8–9°C, which is slightly above the previously published crystallization
temperatures for ikaite (<6°C). Analysis of a stalagmite actively growing
at the time ofsampling, and preserved immediately within a dry nitrogen
cryogenic vessel, indicates that following crystallization of ikaite,
decomposition to calcite occurs rapidly, if not instantaneously. We believe
this is the first occurrence of this calcium carbonate polymorph observed
In autumn 2014, enterovirus D68 (EV-D68) cases presenting with severe respiratory or neurological disease were described in countries worldwide. To describe the epidemiology and virological characteristics of EV-D68 in England, we collected clinical information on laboratory-confirmed EV-D68 cases detected in secondary care (hospitals), between September 2014 and January 2015. In primary care (general practitioners), respiratory swabs collected (September 2013–January 2015) from patients presenting with influenza-like illness were tested for EV-D68. In secondary care 55 EV-D68 cases were detected. Among those, 45 cases had clinical information available and 89% (40/45) presented with severe respiratory symptoms. Detection of EV-D68 among patients in primary care increased from 0.4% (4/1074; 95% CI 0.1–1.0) (September 2013–January 2014) to 0.8% (11/1359; 95% CI 0.4–1.5) (September 2014–January 2015). Characterization of EV-D68 strains circulating in England since 2012 and up to winter 2014/2015 indicated that those strains were genetically similar to those detected in 2014 in USA. We recommend reinforcing enterovirus surveillance through screening respiratory samples of suspected cases.
To investigate the feasibility of a national audit of epistaxis management led and delivered by a multi-region trainee collaborative using a web-based interface to capture patient data.
Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires.
Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5).
This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.
The horse is a non-ruminant herbivore adapted to eating plant-fibre or forage-based diets. Some horses are stabled for most or the majority of the day with limited or no access to fresh pasture and are fed preserved forage typically as hay or haylage and sometimes silage. This raises questions with respect to the quality and suitability of these preserved forages (considering production, nutritional content, digestibility as well as hygiene) and required quantities. Especially for performance horses, forage is often replaced with energy dense feedstuffs which can result in a reduction in the proportion of the diet that is forage based. This may adversely affect the health, welfare, behaviour and even performance of the horse. In the past 20 years a large body of research work has contributed to a better and deeper understanding of equine forage needs and the physiological and behavioural consequences if these are not met. Recent nutrient requirement systems have incorporated some, but not all, of this new knowledge into their recommendations. This review paper amalgamates recommendations based on the latest understanding in forage feeding for horses, defining forage types and preservation methods, hygienic quality, feed intake behaviour, typical nutrient composition, digestion and digestibility as well as health and performance implications. Based on this, consensual applied recommendations for feeding preserved forages are provided.
We discuss HST imaging of eight spectroscopically-confirmed giant arcs, pairs and arclets. Although our HST observations include both pre- and post-refurbishment images, the depth of the exposures guarantees that the majority of the arcs are detected with diffraction-limited resolution. We present the size information on these distant field galaxies in the light of HST studies of lower redshift samples. We suggest that the dominant population of star-forming galaxies at z ∼ 1 is a factor of 1.5–2 times smaller in size than the equivalent population in the local field. This implies either a considerable evolution in the sizes of star-forming galaxies within the last ∼10 Gyrs or a shift in the relative space densities of massive and dwarf star-forming systems over the same time scale.
With HST and WFPC2, galaxies in the Medium Deep Survey can be reliably classified to magnitudes I814 ≲ 22.0 in the F814W band, at a mean redshift . The main result is the relatively high proportion (~40%) of objects which are in some way irregular or anomalous, and which are of relevance in understanding the origin of the familiar excess population of faint galaxies. These diverse objects include compact galaxies, apparently interacting pairs, galaxies with superluminous starforming regions and diffuse low surface brightness galaxies of various forms. The ‘irregulars’ and ‘peculiar’ galaxies contribute most of the excess counts in the I-band at our limiting magnitude, and may explain the ‘faint blue galaxy’ problem.
We studied the spread of influenza in the community between 1993 and 2009 using primary-care surveillance data to investigate if the onset of influenza was age-related. Virus detections [A(H3N2), B, A(H1N1)] and clinical incidence of influenza-like illness (ILI) in 12·3 million person-years in the long-running Royal College of General Practitioners-linked clinical-virological surveillance programme in England & Wales were examined. The number of days between symptom onset and the all-age peak ILI incidence were compared by age group for each influenza type/subtype. We found that virus detection and ILI incidence increase, peak and decrease were in unison. The mean interval between symptom onset to peak ILI incidence in virus detections (all ages) was: A(H3N2) 20·5 [95% confidence interval (CI) 19·7–21·6] days; B, 18·8 (95% CI 15·8·0–21·7) days; and A(H1N1) 17·0 (95% CI 15·6–18·4) days. Differences by age group were examined using the Kruskal–Wallis test. For A(H3N2) and A(H1N1) viruses the interval was similar in each age group. For influenza B there were highly significant differences by age group (P = 0·0001). Clinical incidence rates of ILI reported in the 8 weeks preceding the period of influenza virus activity were used to estimate a baseline incidence and threshold value (upper 95% CI of estimate) which was used as a marker of epidemic progress. Differences between the age groups in the week in which the threshold was reached were small and not localized to any age group. In conclusion we found no evidence to suggest that influenza A(H3N2) and A(H1N1) occurs in the community in one age group before another. For influenza B, virus detection was earlier in children aged 5–14 years than in persons aged ⩾25 years.
We present the first experimentally determined oscillator strengths for the Pb ii transitions at 1203.6 Å and 1433.9 Å, obtained from lifetime measurements made using beam-foil techniques. We also present new detections of these lines in the interstellar medium from an analysis of archival spectra acquired by the Space Telescope Imaging Spectrograph onboard the Hubble Space Telescope. Our observations of the Pb ii λ1203 line represent the first detection of this transition in interstellar gas. Our experimental f-values for the Pb ii λ1203 and λ1433 transitions are consistent with recent theoretical results, including our own relativistic calculations, but are significantly smaller than previous values based on older calculations. Our new f-value for Pb ii λ1433 (0.321 ± 0.034) yields an increase in the interstellar abundance of Pb of 0.43 dex over estimates based on the f-value listed by Morton. With our revised f-values, and with our new detections of Pb ii λ1203 and λ1433, we find that the depletion of Pb onto interstellar grains is not nearly as severe as previously thought, and is very similar to the depletions seen for elements such as Zn and Sn, which have similar condensation temperatures.
Unlike the mammalian retina, the teleost fish retina undergoes persistent neurogenesis from intrinsic stem cells. In marine teleosts, most cone photoreceptor genesis occurs early in the embryonic and larval stages, and rods are added primarily during and after metamorphosis. This study demonstrates a developmental paradigm in elopomorph fishes in which retinas are rod-dominated in larvae, but undergo periods of later cone genesis. Retinal characteristics were compared at different developmental stages among three ecologically distinct elopomorph fishes—ladyfish (Elops saurus), bonefish (Albula vulpes), and speckled worm eel (Myrophis punctatus). The objectives were to improve our understanding of (1) the developmental strategy in the elopomorph retina, (2) the functional architecture of the retina as it relates to ecology, and (3) how the light environment influences photoreceptor genesis. Photoreceptor morphologies, distributions, and spectral absorption were studied at larval, juvenile, and adult stages. Premetamorphic retinas in all three species are rod-dominated, but the retinas of these species undergo dramatic change over the course of development, resulting in juvenile and adult retinal characteristics that correlate closely with ecology. Adult E. saurus has high rod densities, grouped photoreceptors, a reflective tapetum, and longer-wavelength photopigments, supporting vision in turbid, low-light conditions. Adult A. vulpes has high cone densities, low rod densities, and shorter-wavelength photopigments, supporting diurnal vision in shallow, clear water. M. punctatus loses cones during metamorphosis, develops new cones after settlement, and maintains high rod but low cone densities, supporting primarily nocturnal vision. M. punctatus secondary cone genesis occurs rapidly throughout the retina, suggesting a novel mechanism of vertebrate photoreceptor genesis. Finally, in postsettlement M. punctatus, the continuous presence or absence of visible light modulates rod distribution but does not affect secondary cone genesis, suggesting some degree of developmental plasticity influenced by the light environment.
General Practitioner consultation rates for influenza-like illness (ILI) are monitored through several geographically distinct schemes in the UK, providing early warning to government and health services of community circulation and intensity of activity each winter. Following on from the 2009 pandemic, there has been a harmonization initiative to allow comparison across the distinct existing surveillance schemes each season. The moving epidemic method (MEM), proposed by the European Centre for Disease Prevention and Control for standardizing reporting of ILI rates, was piloted in 2011/12 and 2012/13 along with the previously proposed UK method of empirical percentiles. The MEM resulted in thresholds that were lower than traditional thresholds but more appropriate as indicators of the start of influenza virus circulation. The intensity of the influenza season assessed with the MEM was similar to that reported through the percentile approach. The MEM pre-epidemic threshold has now been adopted for reporting by each country of the UK. Further work will continue to assess intensity of activity and apply standardized methods to other influenza-related data sources.