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The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.
We develop a model of the rapid propagation of water at the contact between elastic glacial ice and a poroelastic subglacial till, motivated by observations of the rapid drainage of supraglacial lakes in Greenland. By treating the ice as an elastic bending beam, the fluid dynamics of contact with the subglacial hydrological network, which is modelled as a saturated poroelastic till, can be examined in detail. The model describes the formation and dynamics of an axisymmetric subglacial cavity, and the spread of pore pressure, in response to injection of fluid. A combination of numerical simulation and asymptotic analysis is used to describe these dynamics for both a rigid and a deformable porous till, and for both laminar and turbulent fluid flow. For constant injection rates and laminar flow, the cavity is isostatic and its spread is controlled by bending of the ice and suction of pore water in the vicinity of the ice–till contact. For a deformable till, this control can be modified: generically, a flexural wave that is initially trapped in advance of the contact point relaxes over time by diffusion of pore pressure ahead of the cavity. While the dynamics are found to be relatively insensitive to the properties of the subglacial till during injection with a constant flux, significant dependence on the till properties is manifest during the subsequent spread of a constant volume. A simple hybrid turbulent–laminar model is presented to account for fast injection rates of water: in this case, self-similar turbulent propagation can initially control the spread of the cavity, but there is a transition to laminar control in the vicinity of the ice–till contact point as the flow slows. Finally, the model results are compared with recent geophysical observations of the rapid drainage of supraglacial lakes in Greenland; the comparison provides qualitative agreement and raises suggestions for future quantitative comparison.
The role of herbivorous livestock in supporting the sustainability of the farming systems in which they are found is complex and sometimes conflicting. In Sub-Saharan Africa (SSA), the integration of livestock into farming systems is important for sustainable agriculture as the recycling of nutrients for crop production through returns of animal manure is a central element of the dominant mixed crop-livestock systems. Sustainable agriculture has been widely advocated as the main practical pathway to address the challenge of meeting the food needs of the rapidly growing population in SSA while safeguarding the needs of future generations. The objective of this paper is to review the state of knowledge of the role of herbivores in sustainable intensification of key farming systems in SSA. The pathways to sustainable agriculture in SSA include intensification of production and livelihood diversification. Sustainable agricultural practices in SSA have focused on intensification practices which aim to increase the output : input ratio through increasing use of inputs, introduction of new inputs or use of existing inputs in a new way. Intensification of livestock production can occur through increased and improved fodder availability, genetic production gains, improved crop residue use and better nutrient recycling of manure. Livestock deliver many ‘goods’ in smallholder farming systems in SSA including improving food and nutrition security, increased recycling of organic matter and nutrients and the associated soil fertility amendments, adding value to crop residues by turning them into nutrient-rich foods, income generation and animal traction. Narratives on livestock ‘bads’ or negative environmental consequences have been largely shaped by the production conditions in the Global North but livestock production in SSA is a different story. In SSA, livestock are an integral component of mixed farming systems and they play key roles in supporting the livelihoods of much of the rural population. None-the-less, the environmental consequences of livestock production on the continent cannot be ignored. To enhance agricultural sustainability in SSA, the challenge is to optimize livestock’s role in the farming systems by maximizing livestock ‘goods’ while minimizing the ‘bads’. This can be through better integration of livestock into the farming systems, efficient nutrient management systems, and provision of necessary policy and institutional support.
Conventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.
Declaration of interest
All authors had financial support from the National Institute for Health Research Health Services and Delivery Research Programme while completing this work. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, the Medical Research Council, Central Commissioning Facility, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, the Health Services and Delivery Research Programme or the Department of Health. S.P.S. is part funded by Collaboration for Leadership in Applied Health Research and Care West Midlands. K.B. is editor of the British Journal of Psychiatry.
Introduction: Early recognition of sepsis can improve patient outcomes yet recognition by paramedics is poor and research evaluating the use of prehospital screening tools is limited. Our objective was to evaluate the predictive validity of the Regional Paramedic Program for Eastern Ontario (RPPEO) prehospital sepsis notification tool to identify patients with sepsis and to describe and compare the characteristics of patients with an emergency department (ED) diagnosis of sepsis that are transported by paramedics. The RPPEO prehospital sepsis notification tool is comprised of 3 criteria: current infection, fever &/or history of fever and 2 or more signs of hypoperfusion (eg. SBP<90, HR 100, RR24, altered LOA). Methods: We performed a review of ambulance call records and in-hospital records over two 5-month periods between November 2014 February 2016. We enrolled a convenience sample of patients, assessed by primary and advanced care paramedics (ACPs), with a documented history of fever &/or documented fever of 38.3°C (101°F) that were transported to hospital. In-hospital management and outcomes were obtained and descriptive, t-tests, and chi-square analyses performed where appropriate. The RPPEO prehospital sepsis notification tool was compared to an ED diagnosis of sepsis. The predictive validity of the RPPEO tool was calculated (sensitivity, specificity, NPV, PPV). Results: 236 adult patients met the inclusion criteria with the following characteristics: mean age 65.2 yrs [range 18-101], male 48.7%, history of sepsis 2.1%, on antibiotics 23.3%, lowest mean systolic BP 125.9, treated by ACP 58.9%, prehospital temperature documented 32.6%. 34 (14.4%) had an ED diagnosis of sepsis. Patients with an ED diagnosis of sepsis, compared to those that did not, had a lower prehospital systolic BP (114.9 vs 127.8, p=0.003) and were more likely to have a prehospital shock index >1 (50.0% vs 21.4%, p=0.001). 44 (18.6%) patients met the RPPEO sepsis notification tool and of these, 27.3% (12/44) had an ED diagnosis of sepsis. We calculated the following predictive values of the RPPEO tool: sensitivity 35.3%, specificity 84.2%, NPV 88.5%, PPV 27.3%. Conclusion: The RPPEO prehospital sepsis notification tool demonstrated modest diagnostic accuracy. Further research is needed to improve accuracy and evaluate the impact on patient outcomes.
The impact of a deep-water plunging breaker on a finite height two-dimensional structure with a vertical front face is studied experimentally. The structure is located at a fixed horizontal position relative to a wave maker and the structure’s bottom surface is located at a range of vertical positions close to the undisturbed water surface. Measurements of the water surface profile history and the pressure distribution on the front surface of the structure are performed. As the vertical position,
axis is positive up and
is the mean water level), of the structure’s bottom surface is varied from one experimental run to another, the water surface evolution during impact can be categorized into three classes of behaviour. In class I, with
in a range of values near
is the nominal wavelength of the breaker, the behaviour of the water surface is similar to the flip-through phenomena first described in studies with shallow water and a structure mounted on the sea bed. In the present work, it is found that the water surface between the front face of the structure and the wave crest is well fitted by arcs of circles with a decreasing radius and downward moving centre as the impact proceeds. A spatially and temporally localized high-pressure region was found on the impact surface of the structure and existing theory is used to explore the physics of this phenomenon. In class II, with
in a range of values near the mean water level, the bottom of the structure exits and re-enters the water phase at least once during the impact process. These air–water transitions generate large-amplitude ripple packets that propagate to the wave crest and modify its behaviour significantly. At
, all sensors submerged during the impact record a nearly in-phase high-frequency pressure oscillation indicating possible air entrainment. In class III, with
in a range of values near
, the bottom of the structure remains in air before the main crest hits the bottom corner of the structure. The subsequent free surface behaviour is strongly influenced by the instantaneous momentum of the local flow just before impact and the highest wall pressures of all experimental conditions are found.
Sheep in the uplands of the United Kingdom face a series of choices as to where to graze. These choices have been shown to be influenced by the spatial distribution of nutrient supply from herbage (Duncan et al., 1994). Micro-climatic variation may also determine where animals forage, particularly in topographically complex environments found in upland areas. Wind and rain have marked effects on heat loss and hence on lower critical temperature (LCT) in sheep (Blaxter, 1977). Mount and Brown (1982) demonstrated that there were occasions during a year when sheep were below their LCT. This study assumed that data gathered from a standard meteorological station were applicable to conditions actually experienced by grazing animals and took no account of the ability of herbivores to select a more favourable micro-climate under extreme conditions (Mount and Brown, 1982). The experiment reported here was carried out to examine the extent to which microclimate influenced the distribution of grazing by sheep under windy conditions. Micro-climate was manipulated using artificial shelters.
Adaptation of large herbivores to secondary plant compounds found in their food plants may influence their food choice. Plants, which are potentially toxic, may initially be avoided by herbivores but, following sampling and adaptation of detoxification pathways, herbivores may be able to exploit certain toxic plants without detrimental effects. Thus, adaptation of the rumen microbial population can protect the host animal from the toxic effects of plant secondary compounds. Oxalic acid is a plant component found at high concentrations in a range of food plants, such as Beta vulgaris L, and Rumex spp., commonly consumed by ruminants. It is readily degraded in the rumen by Oxalobacter formigenes following a period of adaptation (Allison and Reddy, 1984).
To what extent has the North American Free Trade Agreement contributed to strengthening and deepening international environmental management in the Americas? Should the system be broadened to incorporate other nations? While a complete answer to these queries is currently beyond reach, there should be little doubt that NAFTA has influenced and continues to influence the direction of environmental management in North America and the hemisphere at large. The agreement has spawned a series of new institutions that are already reshaping current practices and that have considerable promise for broadening the range of international commitments to environmental management in the Americas. The most prominent and most relevant of these is the Commission for Environmental Cooperation (CEC).
The semi-arid Hindu-Kush-Karakoram-Himalayan region of Pakistan covers 72,000 sq km with a rainfall of 100-400 mm per year5. Limited arable land and water scarcity have made subsistence farming the dominant agro-pastoral farming system. Each household keeps a range of ruminant livestock species such as goats, cattle, sheep, donkeys and yaks their proportion in the herd are 0.53, 0.23, 0.19, 0.03 and 0.02 respectively. In winter, livestock are confined and stall-fed on stored roughages or grazed on marginal lands and fallow agricultural fields close to the villages. The aim of this study was to quantify nutritional inputs in terms of metabolisable energy resources, and to compare these with ME requirements of the animals for maintenance over winter.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Subglacial lakes beneath Antarctica’s fast-moving ice streams are known to undergo ∼1 km3 volume changes on annual timescales. Focusing on the MacAyeal Ice Stream (MacIS) lake system, we create a simple model for the response of subglacial water distribution to lake discharge events through assimilation of lake volume changes estimated from Ice, Cloud and land Elevation Satellite (ICESat) laser altimetry. We construct a steady-state water transport model in which known subglacial lakes are treated as either sinks or sources depending on the ICESat-derived filling or draining rates. The modeled volume change rates of five large subglacial lakes in the downstream portion of MacIS are shown to be consistent with observed filling rates if the dynamics of all upstream lakes are considered. However, the variable filling rate of the northernmost lake suggests the presence of an undetected lake of similar size upstream. Overall, we show that, for this fast-flowing ice stream, most subglacial lakes receive >90% of their water from distant distributed sources throughout the catchment, and we confirm that water is transported from regions of net basal melt to regions of net basal freezing. Our study provides a geophysically based means of validating subglacial water models in Antarctica and is a potential way to parameterize subglacial lake discharge events in large-scale ice-sheet models where adequate data are available.
On an 11 m firn/ice core from Kongsvegen, Svalbard, we have used dielectric profiling (DEP) to measure electrical properties, and digital photography to measure a core optical stratigraphy (COS) profile. We also used a neutron-scattering probe (NP) to measure a density profile in the borehole from which the core was extracted. The NP- and DEP-derived density profiles were similar, showing large-scale (>30 cm) variation in the gravimetric densities of each core section. Fine-scale features (<10 cm) are well characterized by the COS record and are seen at a slightly lower resolution in both the DEP and NP records, which show increasing smoothing. A combination of the density accuracy of NP and the spatial resolution of COS provides a useful method of evaluating the shallow-density profile of a glacier, improving paleoclimate interpretation, mass-balance measurement and interpretation of radar returns.
Extinctions have altered island ecosystems throughout the late Quaternary. Here, we review the main historic drivers of extinctions on islands, patterns in extinction chronologies between islands, and the potential for restoring ecosystems through reintroducing extirpated species. While some extinctions have been caused by climatic and environmental change, most have been caused by anthropogenic impacts. We propose a general model to describe patterns in these anthropogenic island extinctions. Hunting, habitat loss and the introduction of invasive predators accompanied prehistoric settlement and caused declines of endemic island species. Later settlement by European colonists brought further land development, a different suite of predators and new drivers, leading to more extinctions. Extinctions alter ecological networks, causing ripple effects for islands through the loss of ecosystem processes, functions and interactions between species. Reintroduction of extirpated species can help restore ecosystem function and processes, and can be guided by palaeoecology. However, reintroduction projects must also consider the cultural, social and economic needs of humans now inhabiting the islands and ensure resilience against future environmental and climate change.
Integral field unit spectrographs allow the 2D exploration of the kinematics and stellar populations of galaxies, although they are generally restricted to small fields-of-view. Using the large field-of-view of the DEIMOS multislit spectrograph on Keck and our Stellar Kinematics using Multiple Slits technique, we are able to extract sky-subtracted stellar light spectra to large galactocentric radii. Here, we present a new DEIMOS mask design named SuperSKiMS that explores large spatial scales without sacrificing high spatial sampling. We simulate a set of observations with such a mask design on the nearby galaxy NGC 1023, measuring stellar kinematics and metallicities out to where the galaxy surface brightness is orders of magnitude fainter than the sky. With this technique we also reproduce the results from literature integral field spectroscopy in the innermost galaxy regions. In particular, we use the simulated NGC 1023 kinematics to model its total mass distribution to large radii, obtaining comparable results with those from published integral field unit observation. Finally, from new spectra of NGC 1023, we obtain stellar 2D kinematics and metallicity distributions that show good agreement with integral field spectroscopy results in the overlapping regions. In particular, we do not find a significant offset between our Stellar Kinematics using Multiple Slits and the ATLAS3D stellar velocity dispersion at the same spatial locations.
We summarise the first year of operation of the Medium Deep Survey - a key project of the HST. Two fields in the LMC are discussed and some preliminary scientific results presented. We also comment on image deconvolution for the extragalactic fields observed as part of the Medium Deep Survey.
We discuss new observations of the starburst galaxy NGC 7552. From optical and near–infrared colour maps we find a red, dusty circumnuclear ring. High-resolution radio mapping from the ATCA reveals the same ring, and a number of bright blobs (probably SNRs). The ring is probably associated with gas and dust which have lost angular momenta due to torques in the bar potential and settled at the inner Lindblad resonance. These circumnuclear starburst rings may be relatively common (when mapped without the obscuring affects of dust) and may play a role in collimating material of a nuclear outflow.
The 1665 and 1667 MHz OH intensity towards Halley’s comet has been monitored during the period October 1985 to April 1986. The flux density variation during the course of the apparition roughly follows the predictions of Schloerb and Gerard (1985), although we find a systematically lower flux than they predicted. The relative intensities of these lines are approximately in the ratio expected for thermodynamic equilibrium.