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Background: Preliminary reports and subsequent immediate management decisions of radiological scans are often performed by emergency physicians and on-call radiology residents. Many academic hospitals have resident-only coverage for after-hour shifts. Generally, these preliminary reports are eventually reviewed by a staff radiologist, during which discrepancies may be identified. Depending on the severity of the discrepancy and the time taken to notify the treating physician, there is potential for significant impact on the patient's care. Aim Statement: In an attempt to identify and minimize errors in radiological readings, and to improve the communication of discrepancies, our project aims to retrospectively audit all radiological discrepancies that have occurred at The Ottawa Hospital's emergency departments from April 2018 to May 2019. Measures & Designs: A systematic review of all cases with noted radiological discrepancies was obtained from the Picture Archive and Communication System software and EPIC platform. Analysis of these cases will allow us to define when errors occur, what is the type and severity of the error, how long it took to relay the discrepancy to a treating physician, and what was the subsequent management impact. Evaluation/Results: We discovered 712 cases with radiological reading discrepancies, 168 major, 527 minor, and 17 incidentals. Interestingly, a significant portion of major (severely affecting care/life-threatning) discrepancies were reported from radiology residents, especially on CT images, although emergency physicians had the most discrepancies (mostly minor). Radiology residents were seen to have more discrepant reports during after-hour services while emergency physicians did not show any specific pattern of discrepant reporting. The average time to report a major discrepancy to a treating physician is 8.8 hours, where the maximum time taken was 104 hours and the minimum was 0.2 hours. 56% of reports with major discrepancies made no mention of who was notified. Discussion/Impact: By identifying weak points in radiological reporting, our results will allow us to provide suggestions at an administration and teaching level to minimize discrepancies. It is critical to create a workflow where mistakes are mitigated, and communication is efficient and standardized to prevent patient harm from delayed or incorrect diagnosis.
The Square Kilometre Array (SKA) is a planned large radio interferometer designed to operate over a wide range of frequencies, and with an order of magnitude greater sensitivity and survey speed than any current radio telescope. The SKA will address many important topics in astronomy, ranging from planet formation to distant galaxies. However, in this work, we consider the perspective of the SKA as a facility for studying physics. We review four areas in which the SKA is expected to make major contributions to our understanding of fundamental physics: cosmic dawn and reionisation; gravity and gravitational radiation; cosmology and dark energy; and dark matter and astroparticle physics. These discussions demonstrate that the SKA will be a spectacular physics machine, which will provide many new breakthroughs and novel insights on matter, energy, and spacetime.
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
To identify and synthesise the literature on the cost of mental disorders.
Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980–May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783).
In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ.
This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.
Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.
We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.
Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).
Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
We consider a two-layer fluid of finite depth with a free surface and, in particular, the surface tension at the free surface and the interface. The usual assumptions of a linearized theory are considered. The objective of this work is to analyse the effect of surface tension on trapped modes, when a horizontal circular cylinder is submerged in either of the layers of a two-layer fluid. By setting up boundary value problems for both of the layers, we find the frequencies for which trapped waves exist. Then, we numerically analyse the effect of variation of surface tension parameters on the trapped modes, and conclude that realistic changes in surface tension do not have a significant effect on the frequencies of these.
Tomato leaf curl virus (TLCV) is a major viral disease in tomato that causes quantitative and qualitative losses to the crop. One hundred and fifty three tomato genotypes were screened for three consecutive years (2006–09) under glasshouse and field conditions for TLCV resistance. The incidence of disease was higher during the Rabi season as compared to the Kharif season trials. The reactions of different genotypes were studied by artificial inoculation. Based on the coefficient of infection, nine genotypes (viz. EC-520049 (Solanum chmielewskii), EC-520058, EC-520060 and EC-520061 (S. habrochaites), EC-520070, EC-520071, EC-520077, EC-520079 (S. pimpinellifolium) and H-88-78-1(S. lycopersicum; a derivative of S. habrochaites f. glabratum) were found to be highly resistant in both environments. H-88-78-1 was used for inheritance studies during 2008–10. Using F2 Mendelian segregation, populations showed a 3 (resistant):1 (susceptible) ratio for TLCV disease and were proposed to have both additive and dominant non-allelic gene interactions for various traits.
Faecal specimens of diarrhoea cases (n=2495, collected between November 2007 and October 2009) from Infectious Diseases and Beliaghata General (ID&BG) Hospital, Kolkata, India, were screened by RT–PCR using specific primers targeting region C of the capsid gene of noroviruses (NoVs) to determine the seasonal distribution and clinical characteristics of NoVs associated with diarrhoea. NoV infection was detected in 78 cases, mostly in children aged <2 years. In 22/78 positive cases, the virus was detected as the sole agent; others were as mixed infections with other enteric pathogens. Sequencing of NVGII strains showed clustering with GII.4 NoVs followed by GII.13 and GII.6 NoVs. Clinical characteristics of the diarrhoeic children and adults in Kolkata indicated that NoV infections were detected throughout the year and were associated with a mild degree of dehydration.
Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals.
The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11·5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2·2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3·2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11·5 per 100 person-years) and non-diarrhoeal (11·1 per 100 samples). Multiple infections in a family were rare. In 19·4% of the occasions one or more animals were campylobacter positive. However, only in 7·7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive.
The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.
Cyclic GMP (cGMP) is responsible for various cellular functions including signal pathways and it acts as a mediator for nitric oxide (NO). In order to evaluate the anthelmintic efficacy of the plant-derived isoflavones, the crude peel extract of Flemingia vestita and pure genistein were tested with respect to the activity of nitric oxide synthase (NOS), NO efflux and the cGMP concentration in Rallietina echinobothrida, the cestode parasite of domestic fowl. For comparison, the parasites were also treated with genistein (the major isoflavone present in the crude peel extract), sodium nitroprusside (SNP), a known NO donor, and praziquantel (PZQ), the reference drug. At the time of onset of paralysis in the parasite, the activity of NOS showed a significant increase (35–46%) and a 2-fold increase of NO efflux into the incubation medium in the treated worms in comparison to the respective controls. The cGMP concentration in the parasite tissue increased by 46–84% in the treated test worms in comparison to the controls. The results show that the isoflavones, genistein in particular, from the crude peel extract of F. vestita influence the cGMP concentration in the parasite tissue, which plays a major role in the downstream signal pathways.
The plasma parameters for the fast deposition of highly crystallized
microcrystalline silicon (µc-Si) films with low defect density are
presented using a high-density and low-temperature SiH4-H2 mixture
microwave plasma. A very high deposition rate of
65 Å/s was
achieved for a SiH4 concentration of 67% diluted in H2 with a
high Raman crystallinity Ic/Ia > 2.5 and a low defect density of
1−2 × 1016 cm−3 by adjusting the plasma conditions. Contrary
to the case of a conventional rf plasma, the defect density of the µc-Si films strongly depends on substrate temperature, Ts, and
increases with increasing Ts even if Ts is below 300 °C. This
indicates that the real temperature at the growing surface is higher than
the monitored value. A sufficient supply of deposition precursors such as
SiH3 at the growing surface under an appropriate ion bombardment is
effective for the fast deposition of highly crystallized µc-Si films as
well as for the suppression of the amorphous incubation and transition
interface layers at the initial growth stage.
In this study the status of oxidant stress, vitamin A and angiotensin-converting enzyme (ACE) levels were evaluated in cases of laryngeal carcinoma patients from Northern India. In control subjects the levels of malondialdehyde (MDA), vitamin A and ACE were 0.23 ± 0.07 nmole/ml, 2515 ± 84 IU, and 1.4 ± 0.8 U/ml respectively. Thirty laryngeal cancer patients were divided into three groups according to the TNM classification (American Joint Committee on Cancers). In laryngeal cancer patients according to tumour size, MDA and ACE levels increased to 0.32 ± 0.04 nmole/ml and 4.7 ± 0.5 U/ml respectively and the effect was statistically significant (p<0.01). The correlation coefficient between different subgroups was also highly significant (r =0.96, p<0.01). However, serum vitamin A levels decreased to 621 ± 20 IU and the effect was statistically significant (p<0.01). In another two groups of laryngeal cancer patients, a similar pattern of various markers was obtained. Thirty patients with laryngeal carcinoma were divided into four different groups according to nodal involvement and it was observed that in laryngeal cancer patients with no nodal involvement, ACE levels were low 3.6 ± 1.4 U/ml while patients with maximum nodal involvement had the highest levels of ACE 7.1 ± 0.18 U/ml. The correlation coefficient between different groups is highly statistically significant (r = 0.95, p<0.01). In patients with laryngeal cancer the serum MDA and vitamin A levels correlation coefficient between different groups was not significant. It is thus concluded that serum ACE might be a specific test marker for laryngeal cancer disease burden. The use of this marker enzyme for therapeutics is being planned.
This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we employed logistic regression and marginal structural modelling of the data. The relative risk of diarrhoea for ‘always’ vs. ‘never’ drinking boiled water was 0.68 (95% CI 0.45–1.04) and for ‘always’ vs. ‘never’ drinking bottled water was 1.22 (95% CI 0.82–1.82). Drinking filtered water was unrelated to diarrhoea [1.03 (95% CI 0.78, 1.35) for ‘always’ vs. ‘never’ drinking filtered water]. Adjustment for confounding did not have any notable effect on the point estimates (0.61, 1.35 and 0.98 for boiled, bottled, and filtered water respectively, as defined above). The risk of diarrhoea was lower among those consuming boiled water but this finding was not statistically significant. Because of these findings, the importance of diarrhoea in immunocompromised individuals, and the limitations of cross-sectional data further prospective investigations of water consumption and diarrhoea among HIV-positive individuals are needed.
This study traces the evolutionary pathways of the apolipoprotein B gene in the low risk Chinese
and high risk Asian Indians in relation to coronary artery disease (CAD). Haplotypes were
constructed from six apoB polymorphisms sp24/27, Ag(c/g),
Ag(a1/d), XbaI, Ag(h/i) and, Ag(t/z).
These were genotyped from 474 Chinese (253 healthy, 221 CAD patients) and 248 Asian Indians (164
healthy, 84 CAD patients). The maximum parsimony method was used to construct a cladogram for
each ethnic group. Three haplotypes in the Chinese and one in the Indians were found exclusively
in CAD patients. These haplotypes were sp27ca1X-ht,
sp24ga1X-iz and sp24ca1X+it
in Chinese, and sp24cdX-it in Indians. Those in the Chinese all occurred
as terminal haplotypes and represented the
most recent mutations. Evolutionary pathways for both ethnic groups were similar for majority of
the haplotypes except for the presence of an additional third branch in the Indians arising from the
ancestral haplotype. However, this third branch does not appear to contribute to the susceptibility
of the Indians to CAD.
An approximate analysis, based on the standard perturbation technique, is described in this paper to find the corrections, up to first order to the reflection and transmission coefficients for the scattering of water waves by a submerged slender barrier, of finite length, in deep water. Analytical expressions for these corrections for a submerged nearly vertical plate as well as for a submerged vertically symmetric slender barrier of finite length are also deduced, as special cases, and identified with the known results. It is verified, analytically, that there is no first order correction to the transmitted wave at any frequency for a submerged nearly vertical plate. Computations for the reflection and transmission coefficients up to O(ε), where ε is a small dimensionless quantity, are also performed and presented in the form of both graphs and tables.
The on-farm performance of more than 150 000 pre-basic potato (Solanum tuberosum) minitubers of 1–10 g was monitored over two years in contrasting environments in Nepal. Average minituber productivity (grams of basic seed produced per minituber planted) was 171 g in the southern plains and 116 g in the hills. Although the performance of minitubers varied between environments, minituber sizes and potato varieties, the overall results clearly indicated that minitubers can be successfully multiplied by small-scale farmers. This technology therefore allows for the highly decentralized production of basic seed which, in turn, will reduce farmers' dependence on an unreliable and costly supply of bulky conventional seed.
Silkworm larvae infected transovarially with Nosema bombycis were fed with an aqueous suspension of Bavistin (50% carbendazim w/w) at 2 and 3% concentrations. The treatments increased the survival of worms and reduced the pebrine infection in the lot significantly, although complete elimination of infection was not observed. Significant beneficial effects of the treatments at 2 and 3% were also observed with respect to larval, cocoon and cocoon shell weights and cocoon to shell ratio. However, treatments with Bavistin at 4% concentration produced an adverse effect on cocoon characters.
Observations with the Wide Field Camera on HST were examined, and 27 Cepheids were discovered. Photometry and period analysis have produced unambiguous light curves free of alias. The observed P-L relation has a slope consistent with seminal calibration studies of Galactic and LMC Cepheids. An apparent distance modulus (in V) of 28.47 ± 0.10 to IC 4182 is derived. This implies that Mv(max) for SNIa 1937C is -19.92 ± 0.2 mag, independent of everything except differential absorption between the Cepheids and the supernova. Using this to calibrate Hubble diagrams for SNIa by several authors, and allowing for a 1-σ uncertainty in the absolute magnitude from the calibration of only one SNIa, we obtain H0 = 45 ± 14kms-1Mpc-1.
Results are reported from an investigation of the properties of boron nitride thin films. The BN films were deposited by the method of plasma enhanced chemical vapor deposition (PECVD) from mixtures of ammonia and diborane. The deposition variables were RF power, pressure, ammonia partial pressure, diborane partial pressure, diluent type (nitrogen or argon), and temperature. The films were characterized for their stoichiometry, hydrogen content, stress, refractive index, and especially for their dielectric properties. It was observed that the main parameters affecting the dielectric constant were the ratio of ammonia to diborane flow, and the deposition temperature. The dielectric constant decreased with increasing ammonia to diborane ratio, while it increased with decreasing deposition temperature. The lowest dielectric constant value achieved was 4.0 ·, 0.1. Nitrogen dilution allowed the deposition of boron nitride films with the lowest dielectric constant value at ammonia to diborane ratios smaller than those required under argon dilution, which suggests some incorporation of nitrogen into the boron nitride matrix from the diluent.
1. The vitamin A content of human liver tissue was determined in 363 autopsy samples. The sample comprised a total of 181 subjects dying after accidents and 182 dying from coronary heart disease among Singapore ethnic groups of both sexes.
2. The medium vitamin A reserve was 146 mg/kg in accident victims and 141 mg/kg in those who had died of coronary heart disease. Of all the samples 16% contained less than 40 mg/kg, 45% had 100–300 mg/kg, while 9% contained more than 500 mg/kg liver.
3. Among the accident victims, Indians had the lowest median liver vitamin A reserve (118 mg/kg) compared with that in other ethnic groups (137 mg/kg in Chinese, 191 mg/kg in Malays, 155 mg/kg in Caucasians).
4. The ethnic distribution of vitamin A reserve in coronary deaths was similar to that in accident victims.
5. There was no significant difference between the sexes in hepatic vitamin A reserve.
6. The distribution of vitamin A reserve in all the groups was skewed to the right.