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Shiga-toxin producing Escherichia coli (STEC) is a pathogen that can cause bloody diarrhoea and severe complications. Cases occur sporadically but outbreaks are also common. Understanding the incubation period distribution and factors influencing it will help in the investigation of exposures and consequent disease control. We extracted individual patient data for STEC cases associated with outbreaks with a known source of exposure in England and Wales. The incubation period was derived and cases were described according to patient and outbreak characteristics. We tested for heterogeneity in reported incubation period between outbreaks and described the pattern of heterogeneity. We employed a multi-level regression model to examine the relationship between patient characteristics such as age, gender and reported symptoms; and outbreak characteristics such as mode of transmission with the incubation period. A total of 205 cases from 41 outbreaks were included in the study, of which 64 cases (31%) were from a single outbreak. The median incubation period was 4 days. Cases reporting bloody diarrhoea reported shorter incubation periods compared with cases without bloody diarrhoea, and likewise, cases aged between 40 and 59 years reported shorter incubation period compared with other age groups. It is recommended that public health officials consider the characteristics of cases involved in an outbreak in order to inform the outbreak investigation and the period of exposure to be investigated.
Intent to commit a crime has in recent times been used as a basis for assigning fault and making appropriate correctional decisions. The author defines attempt to commit a crime as “engaging in conduct with the specific intention to produce forbidden consequences while aware of the possibility that the circumstances that render such consequences criminal may exist.” The author develops and defends the thesis that inchoate crime is more than merely anticipatory guilt. Mens rea in inchoate offenses is not merely a condition of fault-it is a component of the danger of criminal harm that determines the need for forceful intervention.
A long accepted canon of professional ethics forbids a lawyer to appear in a particular matter in the dual role of advocate and witness for his client. As Disciplinary Rule 5-101(B) of the American Bar Association's Code of Professional Responsibility states:
A lawyer shall not accept employment in contemplated or pending litigation if he knows or it is obvious that he or a lawyer in his firm ought to be called as a witness….
Children and adolescents with autism spectrum disorder (ASD) are a highly medicated group. Few studies have examined the neuropsychiatric profile and patterns of psychotropic medication use among adults with ASD.
To describe and compare the neuropsychiatric profile and psychotropic medication use in a cohort of adults with ASD and non-autistic controls.
Baseline data from a survey-based, longitudinal study of adults with ASD in Australia. Participants were 188 adults with ASD and 115 controls aged 25–80 years.
ASD was associated with increased odds of psychotropic medication use even when controlling for the presence of any neurological or psychiatric disorder. There were no corresponding indications for 14.4% of psychotropic medications prescribed to adults with ASD.
This study found substantial psychotropic prescribing for adults with ASD. Patterns of psychotropic medication use may reflect prescribing for behavioural indications despite limited evidence to support this practice.
Occasional cases of classical bovine spongiform encephalopathy (BSE) still continue to occur within the European Union (EU) for animals born after reinforced feed bans (BARBs), which should in theory have eliminated all risk of infection. The study aimed to determine (i) whether a common rate of decline of BSE infection was evident across EU member states, i.e. to determine whether control measures have been equally effective in all member states, (ii) whether there was any evidence of spontaneous occurrence of BSE in the data and (iii) the expected date for the last BSE case in UK. It was found that there was no significant difference in the rate of decline of BSE prevalence between member states, with a common rate of decline of 33·9% per annum (95% CI 30·9–37%) in successive annual birth cohorts. Trend analysis indicated an ultimate decline to 0 prevalence, suggesting that spontaneous occurrence does not explain the majority of cases. Projecting forward the trends from the back-calculation model indicated that there was approximately a 50% probability of further cases in the UK, and should the current rate of decline continue, there remains the possibility of further occasional cases up until 2026.
Advances in radiocarbon dating by accelerator mass spectrometry (AMS) have made it possible to date prehistoric cave paintings by sampling the pigment itself instead of relying on dates derived from miscellaneous prehistoric remains recovered in the vicinity of the paintings. The work at the Laboratoire des Sciences du Climat et de l'Environnement (LSCE) concentrated on prehistoric charcoal cave paintings from southern France and northern Spain. In most caves, pigment samples were collected from several paintings, and in some instances the sample size allowed for multiple independent measurements on the same figure, so that the coherence of the calculated dates could be tested. Before being dated, each specimen was subjected to a thermal treatment preceded by an acid and basic treatment of intensity commensurate with the sample size.
Nine bison drawings from three caves in the Cantabrian region of Spain—two from Covaciella, three from Altamira, and four from El Castillo—were sampled and dated. The 27 dates fell between 13,000 and 14,500 BP, allowing us to attribute the drawings to the Magdalenian period. The 24 dates for 13 drawings in the Cosquer cave indicated two distinct periods of painting activity—one around 28,000 BP and the other around 19,000 BP. The Chauvet cave paintings turned out to be the oldest recorded to date, as five dates fell between 32,000 and 31,000 BP. After discussing the sample preparation protocol in more detail, we will discuss the ages obtained and compare them with other chronological data.
In this paper, we explain our routine pretreatment of bone for radiocarbon dating by accelerator mass spectrometry (AMS), based on the specific reaction between amino acids and ninhydrin described by Nelson (1991). The values and uncertainties of the total system background are presented as a function of the carbon sample mass and the reliability of this method is discussed.
An OH/IR star is an intermediate mass AGB star which loses mass and is optically obscured by its envelope. Such stars can be detected in the infrared and by radio maser lines. In particular the OH line (1612 MHz) is bright and has a distinctive profile, that allows us to determine the radial velocity of the central star. OH/IR stars are excellent tracers for the study of Galactic dynamics because they are bright, unaffected by extinction in the OH line – and therefore visible throughout the Galaxy – and because they represent a wide range of stellar masses. The outflow velocity of the circumstellar shell is most likely driven by radiation pressure from the central star on the dust. Therefore outflow velocity increases with stellar luminosity and metallicity, and decreases with age.
The Laboratoire des Sciences du Climat et de l'Environnement (LSCE) research program on prehistoric art conducts chronological studies of parietal representations with their associated archaeological context. This multidisciplinary approach provides chronological arguments about the creation period of parietal representations. This article presents chronological investigations carried out in several decorated caves in France (La Grande Grotte, Labastide, Lascaux, La Tête-du-Lion, Villars) and Spain (La Garma, Nerja, La Pileta, Urdiales). Several types of organic materials, collected from different areas of the caves close to the walls and in connection with parietal art, were dated to determine the periods of human presence in the cave, a presence that may have been related to artistic activities. These new radiocarbon results range from 33,000–29,000 (La Grande Grotte) to 16,000–14,000 cal BP (Urdiales).
Introduced plants threaten biodiversity and ecosystem processes, including carbon (C) and nitrogen (N) cycles, but little is known about the threshold at which such effects occur. We examined the impact of the invasive shrub Amur honeysuckle on soil organic carbon (SOC) and N density at study sites that varied in invasion history. In plots with and without honeysuckle, we measured honeysuckle abundance and size (basal area) and extracted soil cores. SOC and N densities were highest at the site with the longest invasion history and highest invasion intensity (i.e., greatest abundance and basal area of honeysuckle). Basal area of honeysuckle positively affected SOC and N densities likely because of increased litter decomposition and altered microbial communities. Because honeysuckle increases forest net primary productivity (NPP) and SOC, it also may play a role in C sequestration. Our results demonstrate the need to consider the influence of invasion history and intensity when evaluating the potential impact of invasive species.
Magnetic fields are one of the most important drivers of the highly dynamic processes that occur in the lower solar atmosphere. They span a broad range of sizes, from large- and intermediate-scale structures such as sunspots, pores and magnetic knots, down to the smallest magnetic elements observable with current telescopes. On small scales, magnetic flux tubes are often visible as Magnetic Bright Points (MBPs). Apart from simple V/I magnetograms, the most common method to deduce their magnetic properties is the inversion of spectropolarimetric data. Here we employ the SIR code for that purpose. SIR is a well-established tool that can derive not only the magnetic field vector and other atmospheric parameters (e.g., temperature, line-of-sight velocity), but also their stratifications with height, effectively producing 3-dimensional models of the lower solar atmosphere. In order to enhance the runtime performance and the usability of SIR we parallelized the existing code and standardized the input and output formats. This and other improvements make it feasible to invert extensive high-resolution data sets within a reasonable amount of computing time. An evaluation of the speedup of the parallel SIR code shows a substantial improvement in runtime.
Here, we report the feasibility and long-term efficacy of a granulomatous slack skin disease (GSSD) treatment with combined high-energy photon and proton beams.
Patient and methods
A GSSD patient with abdominal disease volume 25×15×2–4 cm deep was recommended for treatment at this institution. In addition to photons and electrons, high-energy protons delivered with advanced planning techniques and patient positioning were used. The patient was irradiated to a total dose of 40 Gy by using 20 Gy matched photon and electrons followed by 20 Gy equivalent protons delivered by using innovative range compensation and patient positioning.
The test patient tolerated the treatment well and is now a 10-year survivor of the disease.
Treatment of GSSD with protons is feasible. The range and narrow penumbra properties of the proton beam provided an ideal capability to match fields accurately to cover large volumes while also sparing underlying normal tissues.
In re A was decided by the English courts in 2000. Twin girls, named Jodie and Mary for purposes of the decision, were born joined together at their lower extremities. Jodie's heart and lungs were more or less healthy. But Mary's were insufficiently developed and could not provide her with the flow of blood and oxygen needed to survive. However, the girls shared a single circulatory system so that Jodie's heart pumped blood that flowed through both their bodies. In this manner, Jodie's heart and lungs kept Mary alive. According to the doctors, this situation could continue for a period of three to six months, or a bit longer, at the most. As the girls grew, Jodie would be unable to provide sufficient blood and oxygen to support both Mary and herself. Both would die. The doctors recommended surgical separation of the two girls. Mary would necessarily die “within minutes,” being cut off from her source of sustenance. Jodie would have a good chance of surviving. The legal issue presented was whether the doctors may perform the surgery that would cause Mary's death. At issue were questions concerning the scope of self-defense and necessity. In the course of the Court's opinions, brief reference was made to Jewish law. This article considers the Jewish law sources that bear on these issues.
Objective: To establish whether the use of near-infrared spectroscopy is potentially beneficial in high-risk cardiac infants in United Kingdom paediatric intensive care units. Design: A prospective observational pilot study. Setting: An intensive care unit in North West England. Patients: A total of 10 infants after congenital heart surgery, five with biventricular repairs and five with single-ventricle physiology undergoing palliation. Interventions: Cerebral and somatic near-infrared spectroscopy monitoring for 24 hours post-operatively in the intensive care unit. Measurement and main results: Overall, there was no strong correlation between cerebral near-infrared spectroscopy and mixed venous oxygen saturation (r=0.48). At individual time points, the correlation was only strong (r=0.74) 1 hour after admission. The correlation was stronger for the biventricular patients (r=0.68) than single-ventricle infants (r=0.31). A strong inverse correlation was demonstrated between cerebral near-infrared spectroscopy and serum lactate at 3 of the 5 post-operative time points (1, 4, and 12 hours: r=−0.76, −0.72, and −0.69). The correlation was stronger when the cerebral near-infrared spectroscopy was <60%. For cerebral near-infrared spectroscopy <60%, the inverse correlation with lactate was r=−0.82 compared with those cerebral near-infrared spectroscopy >60%, which was r=−0.50. No correlations could be demonstrated between (average) somatic near-infrared spectroscopy and serum lactate (r=−0.13, n=110) or mixed venous oxygen saturation and serum lactate. There was one infant who suffered a cardiopulmonary arrest, and the cerebral near-infrared spectroscopy showed a consistent 43 minute decline before the event. Conclusions: We found that cerebral near-infrared spectroscopy is potentially beneficial as a non-invasive, continuously displayed value and is feasible to use on cost-constrained (National Health Service) cardiac intensive care units in children following heart surgery.