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Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.
CVD and associated metabolic diseases are linked to chronic inflammation, which can be modified by diet. The objective of the present study was to determine whether there is a difference in inflammatory markers, blood metabolic and lipid panels and lymphocyte gene expression in response to a high-fat dairy food challenge with or without milk fat globule membrane (MFGM). Participants consumed a dairy product-based meal containing whipping cream (WC) high in saturated fat with or without the addition of MFGM, following a 12 h fasting blood draw. Inflammatory markers including IL-6 and C-reactive protein, lipid and metabolic panels and lymphocyte gene expression fold changes were measured using multiplex assays, clinical laboratory services and TaqMan real-time RT-PCR, respectively. Fold changes in gene expression were determined using the Pfaffl method. Response variables were converted into incremental AUC, tested for differences, and corrected for multiple comparisons. The postprandial insulin response was significantly lower following the meal containing MFGM (P < 0·01). The gene encoding soluble epoxide hydrolase (EPHX2) was shown to be more up-regulated in the absence of MFGM (P = 0·009). Secondary analyses showed that participants with higher baseline cholesterol:HDL-cholesterol ratio (Chol:HDL) had a greater reduction in gene expression of cluster of differentiation 14 (CD14) and lymphotoxin β receptor (LTBR) with the WC+MFGM meal. The protein and lipid composition of MFGM is thought to be anti-inflammatory. These exploratory analyses suggest that addition of MFGM to a high-saturated fat meal modifies postprandial insulin response and offers a protective role for those individuals with higher baseline Chol:HDL.
The need for hollow microneedle arrays is important for both drug delivery and wearable sensor applications; however, their fabrication poses many challenges. Hollow metal microneedle arrays residing on a flexible metal foil substrate were created by combining additive manufacturing, micromolding, and electroplating approaches in a process we refer to as electromolding. A solid microneedle with inward facing ledge was fabricated with a two photon polymerization (2PP) system utilizing laser direct write (LDW) and then molded with polydimethylsiloxane. These molds were then coated with a seed layer of Ti/Au and subsequently electroplated with pulsed deposition to create hollow microneedles. An inward facing ledge provided a physical blocking platform to restrict deposition of the metal seed layer for creation of the microneedle bore. Various ledge sizes were tested and showed that the resulting seed layer void could be controlled via the ledge length. Mechanical properties of the PDMS mold was adjusted via the precursor ratio to create a more ductile mold that eliminated tip damage to the microneedles upon removal from the molds. Master structures were capable of being molded numerous times and molds were able to be reused. SEM/EDX analysis showed that trace amounts of the PDMS mold were transferred to the metal microneedle upon removal. The microneedle substrate showed a degree of flexibility that withstood over 100 cycles of bending from side to side without damaging. Microneedles were tested for their fracture strength and were capable of puncturing porcine skin and injecting a dye.
The Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman, Madigan, & Lyons-Ruth, 2009–2014; Bronfman, Parsons, & Lyons-Ruth, 1992–2004) is a widely used and well-validated measure for assessing disrupted forms of caregiver responsiveness within parent–child interactions. However, it requires evaluating approximately 150 behavioral items from videotape and extensive training to code, thus making its use impractical in most clinical contexts. Accordingly, the primary aim of the current study was to identify a reduced set of behavioral indicators most central to the AMBIANCE coding system using latent-trait item response theory (IRT) models. Observed mother–infant interaction data previously coded with the AMBIANCE was pooled from laboratories in both North America and Europe (N = 343). Using 2-parameter logistic IRT models, a reduced set of 45 AMBIANCE items was identified. Preliminary convergent and discriminant validity was evaluated in relation to classifications of maternal disrupted communication assigned using the full set of AMBIANCE indicators, to infant attachment disorganization, and to maternal sensitivity. The results supported the construct validity of the refined item set, opening the way for development of a brief screening measure for disrupted maternal communication. IRT models in clinical scale refinement and their potential for bridging clinical and research objectives in developmental psychopathology are discussed.
Accurate weed emergence models are valuable tools for scheduling planting, cultivation, and herbicide applications. Multiple models predicting giant ragweed emergence have been developed, but none have been validated in diverse crop rotation and tillage systems, which have the potential to influence weed emergence patterns. This study evaluated the performance of published giant ragweed emergence models across various crop rotations and spring tillage dates in southern Minnesota. Across experiments, the most robust model was a mixed-effects Weibull (flexible sigmoidal function) model predicting emergence in relation to hydrothermal time accumulation with a base temperature of 4.4 C, a base soil matric potential of −2.5 MPa, and two random effects determined by overwinter growing degree days (GDD) (10 C) and precipitation accumulated during seedling recruitment. The deviations in emergence between individual plots and the fixed-effects model were distinguished by the positive association between the lower horizontal asymptote (Drop) and maximum daily soil temperature during seedling recruitment. This finding indicates that crops and management practices that increase soil temperature will have a shorter lag phase at the start of giant ragweed emergence compared with practices promoting cool soil temperatures. Thus, crops with early-season crop canopies such as perennial crops and crops planted in early spring and in narrow rows will likely have a slower progression of giant ragweed emergence. This research provides a valuable assessment of published giant ragweed emergence models and illustrates that accurate emergence models can be used to time field operations and improve giant ragweed control across diverse cropping systems.
On 1983 May 10–11 we undertook simultaneous λ3.6 and λ13 cm Mark III VLBI observations of the quasars 1038+528 A,B. Our experimental conditions (i.e., synthesized band, uv-coverage, etc.) were almost identical to those we used on 1981 March 17–18. Thus, we could make a direct comparison of the results from both epochs.
VLBI observations at 2.3 GHz of SN1987A on 28 February 1987 yielded no fringes, implying, for an optically thin shell, a lower bound on the (outer) diameter of 1.9 mas. From the comparison of the VLBI and optical results, we infer that the radiosphere of SN1987A was either about equal to, or larger than, the photosphere of the supernova five days after the explosion.
An antenna in geostationary orbit was used for VLBI observations at 2.3 GHz, in combination with ground antennas in Australia and Japan. 23 of the 25 observed sources were detected on orbiter-ground baselines, with baseline lengths as large as 2.15 earth diameters. Brightness temperatures between 1012 K and 4 × 1012 K were measured for 10 sources.
On the basis of extensive studies of synthetic perovskite-structured
compounds it is possible to derive a hierarchy of hettotype structures which
are derivatives of the arisotypic cubic perovskite structure
(ABX3), exemplified by SrTiO3 (tausonite) or
KMgF3 (parascandolaite) by: (1) tilting and distortion of the
BX6 octahedra; (2) ordering of A- and
B-site cations; (3) formation of A-,
B- or X-site vacancies. This
hierarchical scheme can be applied to some naturally-occurring oxides,
fluorides,hydroxides, chlorides, arsenides, intermetallic compounds and
silicates which adopt such derivative crystal structures. Application of
this hierarchical scheme to naturally-occurring minerals results in the
recognition of a perovskite supergroup which is divided into stoichiometric
and non-stoichiometricperovskite groups, with both groups further divided
into single ABX3 or double A2BB'X6 perovskites. Subgroups, and potential subgroups, of
stoichiometric perovskites include: (1) silicate single perovskites of the
bridgmanite subgroup;(2) oxide single perovskites of the perovskite subgroup
(tausonite, perovskite, loparite, lueshite, isolueshite, lakargiite,
megawite); (3) oxide single perovskites of the macedonite subgroup which
exhibit second order Jahn-Teller distortions (macedonite, barioperovskite);
(4) fluoride singleperovskites of the neighborite subgroup (neighborite,
parascandolaite); (5) chloride single perovskites of the chlorocalcite
subgroup; (6) B-site cation ordered double fluoride
perovskites of the cryolite subgroup (cryolite, elpasolite, simmonsite); (7)
B-site cation orderedoxide double perovskites of the
vapnikite subgroup [vapnikite, (?) latrappite]. Non-stoichiometric
perovskites include: (1) A-site vacant double hydroxides,
or hydroxide perovskites, belonging to the söhngeite, schoenfliesite and
stottite subgroups; (2) Anion-deficient perovskitesof the brownmillerite
subgroup (srebrodolskite, shulamitite); (3) A-site vacant
quadruple perovskites (skutterudite subgroup); (4) B-site
vacant single perovskites of the oskarssonite subgroup [oskarssonite]; (5)
B-site vacant inverse single perovskites of the
coheniteand auricupride subgroups; (6) B-site vacant double
perovskites of the diaboleite subgroup; (7) anion-deficient partly-inverse
B-site quadruple perovskites of the hematophanite
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
An extensive program of seismic refraction and reflection shooting was undertaken in the vicinity of Dome C station, East Antarctica (latitude 74°39'S, longitude 124°10'E). Refraction experiments (1978–79, 1979–80) were performed at 37 different shot-point-to-center-of-spread distances along four lines of different azimuth using receiver spacings of 2 to 30 m. The principal result is an extremely well-determined velocity-depth relation for the upper few hundred meters of the ice sheet. Availability of good bore-hole control at Dome C allows us to demonstrate the validity of Kohne's (1972) density-velocity formula, which was developed for warmer ice. Also, after a careful search for azimuthal dependence of variations in the time-distance relationship along different refraction lines, deviations from transverse isotropy in the firn and upper ice are not indicated. Our reflection work (1979–80), conducted along three mutually-centered lines (10.2, 10.2, and 10.7 km in length) oriented at 60° angles to one another, used a series of 16 bore holes, each 30 m in depth, and 18 separate 24-channel recording stations. This extensive coverage combined with common reflection-point shooting geometries (to minimize topographic error) and small charge sizes (to increase resolution) yielded the highest quality set of reflection data yet obtained in East Antarctica. Significant crystalline anisotropy in the lower portion of the ice sheet is indicated. A model with 75% of the ice thickness below the firn (approximately 2 400 m) having c-axes distributed throughout a vertical cone with a semi-apex angle of 20° gives good agreement with the field observations.
We report the direct detection of cyclic diameter variations in the Mira variable χ Cygni. Interferometric observations made between 1997 July and 1998 September, using the Cambridge Optical Aperture Synthesis Telescope (COAST) indicate periodic changes in the apparent angular diameter with amplitude 45 per-cent of the smallest value.
The measurements were made in a 50 nm bandpass centred on 905 nm, which is only moderately contaminated by molecular absorption features. To assess the effects of atmospheric stratification on the apparent diameter measured in this band, we have also measured near-infrared diameters for a sample of five Miras, in both the J-band (1.3 μm) and Wing's (1971) 1.04 μm band, which is expected to isolate essentially pure continuum emission. We present J-band visibility curves which indicate that the intensity profiles of the stars in the sample differ greatly from each other.
Introduction: Atrial fibrillation and flutter (AFF) are the most common arrhythmias presenting to the emergency department. A coordinated ED AFF electronic order-set and management pathway was developed in collaboration with cardiologists at our institution. The primary objective of this study was to compare the ED length of stay pre and post pathway implementation. Secondary objectives included comparison of the following outcomes pre and post-pathway (PRE & POST): AFF Clinic referral rates, ED return rates, and mortality. Methods: This was a retrospective case series of patients presenting to our quarternary care ED with AFF pre and post AFF pathway implementation. Cases were identified using an administrative database covering 120 000 annual ED visits. Trained research assistants and the primary investigator extracted data from the electronic medical record. 20% of all charts were double collected to ensure accuracy (k=0.85). Descriptive variables were described using counts, means, medians and confidence intervals. Chi-square statistics of dependent samples were calculated for the primary outcome. Results: We examined 307 cases of AFF presenting to our ED (n=130 PRE; n=177 POST). Demographic variables were similar PRE and POST: mean age (66.0 [95%CI 63.8-68.3] PRE; 65.0 [63.0-67.0] POST), % male (59.2% PRE; 59.3% POST), presenting rhythm (66.2% A.fib [58.0-74.3] A. flutter 29.2% [21.4-37.0] PRE; 61.0% A.fib [53.8-68.1] A. flutter 17.5% [11.9-23.1] POST), and CHADS2VASC score (2.1 [1.8-2.4] PRE; 1.9 [1.7-2.1] POST). The mean ED LOS decreased by 72.5 minutes (95% CI -22.9 to -122.1; P < 0.001). AFF clinic referral rates increased from 16.9% PRE to 25.4% POST (not significant). ED return rates within 30 days for AFF, CHF, major bleeding and CVA were unchanged. 30 day mortality rates were not statistically different (1.5% PRE vs. 2.8% POST). Conclusion: A coordinated ED AFF pathway was associated with a significant reduction in ED LOS without significant changes in ED return rates or mortality.
Introduction: Atrial fibrillation and flutter (AFF) are the most common arrhythmias presenting to the emergency department. Without anticoagulation, AFF increases stroke risk; individuals with paroxysmal AFF have a similar prognosis. A coordinated ED AFF electronic order-set and management pathway was developed at our institution. The primary objective of this study was to measure rates of appropriate anticoagulation (AAC) on discharge from the ED for patients presenting with AFF not previously on antithrombotic or anticoagulant medications. Secondary objectives included comparison of the following outcomes pre and post-pathway (PRE & POST): AFF Clinic referral rates, ED return rates, and mortality. Methods: This was a retrospective case series of patients presenting to our quarternary care ED with AFF pre and post AFF pathway implementation. Cases were identified using an administrative database covering 120 000 annual ED visits. Trained research assistants and the primary investigator extracted data from the electronic medical record. 20% of all charts were double collected to ensure accuracy (k=0.85). Descriptive variables were described using counts, means, medians and confidence intervals. Chi-square statistics of dependent samples were calculated for the primary outcome. Results: We examined 307 cases of AFF presenting to our ED (n=130 PRE; n=177 POST). Demographic variables were similar PRE and POST: mean age (66.0 [95%CI 63.8-68.3] PRE; 65.0 [63.0-67.0] POST), % male (59.2% PRE; 59.3% POST), presenting rhythm (66.2% A.fib [58.0-74.3] A. flutter 29.2% [21.4-37.0] PRE; 61.0% A.fib [53.8-68.1] A. flutter 17.5% [11.9-23.1] POST), and CHADS2VASC score (2.1 [1.8-2.4] PRE; 1.9 [1.7-2.1] POST). The rate of AAC rose from 39.1% PRE to 77.8% POST (P < 0.01). AFF clinic referral rates increased from 16.9% PRE to 25.4% POST (not significant). ED return rates within 30 days for AFF, CHF, major bleeding and CVA were unchanged. 30 day mortality rates were not statistically different (1.5% PRE vs. 2.8% POST). Conclusion: The implementation of a coordinated ED AFF pathway was associated with significant improvements in the proportion of patients discharged with appropriate anticoagulation who had not previously been on antithrombotic or anticoagulant medications. ED return rates and mortality did not change significantly.
The synthesis telescopes at Fleurs and Molonglo have been used to map 50 supernova remnants. Additional specialized software to process the maps has been developed, and Parkes observations have been used to supply short spacing information missing from the maps.
The Molonglo Observatory synthesis telescope (MOST) of the University of Sydney (Mills 1981) produces maps of the 843 MHz continuum emission from fields of width 23′, 46′ or 70′ arc. The telescope comprises two co-linear east-west cylindrical paraboloids each 2186λ in length and separated by a gap of 43λ. For each paraboloid a phasing network (Durdin et al. 1984) generates a comb of 64 contiguous fan beams. Mapping is accomplished in real time during a 12-h observation by overlaying, in the map plane, the instantaneous cross-correlations of corresponding beams. The synthesized point-source response (beam) produced by this method has a width of 43″ (E-W) by 43″ cosec δ (N-S).
8.4 GHz linear polarization maps, obtained with the Parkes radio telescope, are presented for six southern supernova remnants. These results are compared with published and unpublished polarization maps at 5 GHz to derive the magnetic field direction and Faraday rotation measure distribution.
These results are part of a program to map the magnetic fields in galactic supernova remnants and complement our program to obtain high-resolution maps of galactic SNRs using the Molonglo Observatory Synthesis Telescope; five new Molonglo maps are presented here.
The results of photometric and spectroscopic observations of dwarf novae are presented. The data were obtained during an international program of multiwavelength observations, held in 1986 February at several observatories, of dwarf novae during the first and subsequent days of outburst. During the campaign numerous dwarf novae were monitored in order to catch them in outburst. Preliminary results and analysis of some objects are reported elsewhere. A total of 30 dwarf novae were observed in the northern and southern hemispheres. Among them 37% were caught in outburst, including 10% on the rise to outburst and 17% in decline. Photometric observations were carried out in the UBVRI system and colour indexes were calculated.