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Newton's Principia is perhaps the second most famous work of mathematics, after Euclid's Elements. Originally published in 1687, it gave the first systematic account of the fundamental concepts of dynamics, as well as three beautiful derivations of Newton's law of gravitation from Kepler's laws of planetary motion. As a book of great insight and ingenuity, it has raised our understanding of the power of mathematics more than any other work. This heavily annotated translation of the third and final edition (1726) of the Principia will enable any reader with a good understanding of elementary mathematics to easily grasp the meaning of the text, either from the translation itself or from the notes, and to appreciate some of its significance. All forward references are given to illuminate the structure and unity of the whole, and to clarify the parts. The mathematical prerequisites for understanding Newton's arguments are given in a brief appendix.
Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya.
Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test.
Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001).
The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
Generalized Algebraic Data Types, or simply GADTs, can encode non-trivial properties in the types of the constructors. Once such properties are encoded in a datatype, however, all code manipulating that datatype must provide proof that it maintains these properties in order to typecheck. In this paper, we take a step toward gradualizing these obligations. We introduce a tool, Ghostbuster, that produces simplified versions of GADTs which elide selected type parameters, thereby weakening the guarantees of the simplified datatype in exchange for reducing the obligations necessary to manipulate it. Like ornaments, these simplified datatypes preserve the recursive structure of the original, but unlike ornaments, we focus on information-preserving bidirectional transformations. Ghostbuster generates type-safe conversion functions between the original and simplified datatypes, which we prove are the identity function when composed. We evaluate a prototype tool for Haskell against thousands of GADTs found on the Hackage package database, generating simpler Haskell'98 datatypes and round-trip conversion functions between the two.
Introduction: The objective of this systematic review was to investigate the psychometric properties and diagnostic performance of instruments used in the emergency department to identify pediatric mental health and substance use problems. Methods: A search of seven electronic databases and the grey literature was conducted. Studies assessing any instrument to identify and or diagnose mental illness, emotional or behavioural problems, or substance use disorders in pediatric patients with presentations for mental health or substance use issues were considered eligible for inclusion. Two independent reviewers judged the relevance and study quality of the studies. A descriptive analysis of the outcomes was reported. Results: From 4832 references, 14 studies were included. Eighteen instruments were evaluated for identifying suicide risk, alcohol use disorders, mood disorders, and ED decision-making. The HEADS-ED has good inter-rater reliability (r=0.785) for identifying general mental health problems and modest evidence for ruling out patients requiring hospital admission (positive likelihood ratio, LR+=6.30). The internal consistency varied for tools to screen for suicide risk (α=0.46-0.97); no tools have both high sensitivity and high specificity. The Ask Suicide-Screening Questionnaire (ASQ) is highly sensitive (98%) and provides strong evidence to rule out risk (negative likelihood ratio, LR−=0.04). Among tools to screen for alcohol use disorders, a two-item tool based on DSM-IV criteria was found to be the most accurate in identifying patients with a disorder (area under the curve: 0.89), and has modest evidence to rule in and rule out risk (LR+=8.80, LR−=0.13). Conclusion: Reliable, valid, and accurate instruments are available for use with pediatric mental health ED visits. Based on available evidence, emergency care clinicians are recommended to use the HEADS-ED to rule in ED admission, ASQ to rule out suicide risk, and DSM-IV two-item tool to rule in/rule out alcohol use disorders.
Introduction: Active substance use and unstable housing are both associated with increased emergency department (ED) utilization. This study examined ED health care costs among a cohort of substance using and/or homeless adults following an index ED visit, relative to a control ED population. Methods: Consecutive patients presenting to an inner-city ED between August 2010 and November 2011 who reported unstable housing and/or who had a chief presenting complaint related to acute or chronic substance use were evaluated. Controls were enrolled in a 1:4 ratio. Participants’ health care utilization was tracked via electronic medical record for six months after the index ED visit. Costing data across all EDs in the region was obtained from Alberta Health Services and calculated to include physician billing and the cost of an ED visit excluding investigations. The cost impact of ED utilization was estimated by multiplying the derived ED cost per visit by the median number of visits with interquartile ranges (IQR) for each group during follow up. Proportions were compared using non-parametric tests. Results: From 4679 patients screened, 209 patients were enrolled (41 controls, 46 substance using, 91 unstably housed, 31 both unstably housed and substance using (UHS)). Median costs (IQR) per group over the six-month period were $0 ($0-$345.42) for control, $345.42 ($0-$1139.89) for substance using, $345.42 ($0-$1381.68) for unstably housed and $1381.68 ($690.84-$4248.67) for unstably housed and substance using patients (p<0.05). Conclusion: The intensity of excess ED costs was greatest in patients who were both unstably housed and presenting with a chief complaint related to substance use. This group had a significantly larger impact on health care expenditure relative to ED users who were not unstably housed or who presented with a substance use related complaint. Further research into how care or connection to community resources in the ED can reduce these costs is warranted.
Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
Epstein Barr virus (EBV) infects 95% of the global population and is associated with up to 2% of cancers globally. Immunoglobulin G (IgG) antibody levels to EBV have been shown to be heritable and associated with developing malignancies. We, therefore, performed a pilot genome-wide association analysis of anti-EBV IgG traits in an African population, using a combined approach including array genotyping, whole-genome sequencing and imputation to a panel with African sequence data. In 1562 Ugandans, we identify a variant in human leukocyte antigen (HLA)-DQA1, rs9272371 (p = 2.6 × 10−17) associated with anti-EBV nuclear antigen-1 responses. Trans-ancestry meta-analysis and fine-mapping with European-ancestry individuals suggest the presence of distinct HLA class II variants driving associations in Uganda. In addition, we identify four putative, novel, very rare African-specific loci with preliminary evidence for association with anti-viral capsid antigen IgG responses which will require replication for validation. These findings reinforce the need for the expansion of such studies in African populations with relevant datasets to capture genetic diversity.
The status and potential of aquaculture is considered as part of a broader food landscape of wild aquatic and terrestrial food sources. The rationale and resource base required for the development of aquaculture are considered in the context of broader societal development, cultural preferences and human needs. Attention is drawn to the uneven development and current importance of aquaculture globally as well as its considerable heterogeneity of form and function compared with established terrestrial livestock production. The recent drivers of growth in demand and production are examined and the persistent linkages between exploitation of wild stocks, full life cycle culture and the various intermediate forms explored. An emergent trend for sourcing aquaculture feeds from alternatives to marine ingredients is described and the implications for the sector with rapidly growing feed needs discussed. The rise of non-conventional and innovative feed ingredients, often shared with terrestrial livestock, are considered, including aquaculture itself becoming a major source of marine ingredients. The implications for the continued expected growth of aquaculture are set in the context of sustainable intensification, with the challenges that conventional intensification and emergent integration within, and between, value chains explored. The review concludes with a consideration of the implications for dependent livelihoods and projections for various futures based on limited resources but growing demand.
The yields of spring barley during a medium-term (7 years) compost and slurry addition experiment and the soil carbon (C) and nitrogen (N) contents, bacterial community structure, soil microbial biomass and soil respiration rates have been determined to assess the effects of repeated, and in some cases very large, organic amendments on soil and crop parameters. For compost, total additions were equivalent to up to 119 t C/ha and 1·7 t N/ha and for slurry they were 25 t C/ha and 0·35 t N/ha over 7 years, which represented very large additions compared to control soil C and N contents (69 t C/ha and 0·3 t N/ha in the 0–30 cm soil depth). There was an initial positive response to compost and slurry addition on barley yield, but over the experiment the yield differential between the amounts of compost addition declined, indicating that repeated addition of compost at a lower rate over several years had the same cumulative effect as a large single compost application. By the end of the experiment it was clear that the addition of compost and slurry increased soil C and N contents, especially towards the top of the soil profile, as well as soil respiration rates. However, the increases in soil C and N contents were not proportional to the amount of C and N added, suggesting either that: (i) a portion of the added C and N was more vulnerable to loss; (ii) that its addition rendered another C or N pool in the soil more susceptible to loss; or (iii) that the C inputs from additional crop productivity did not increase in line with the organic amendments. Soil microbial biomass was depressed at the highest rate of organic amendment, and whilst this may have been due to genuine toxic or inhibitory effects of large amounts of compost, it could also be due to the inaccuracy of the substrate-induced respiration approach used for determining soil biomass when there is a large supply of organic matter. At the highest compost addition, the bacterial community structure was significantly altered, suggesting that the amendments significantly altered soil community dynamics.
Introduction: Substance use and unstable housing are associated with heavy use of the Emergency Department (ED). This study examined the impact of substance use and unstable housing on the probability of future ED use. Methods: Case-control study of patients presenting to an urban ED. Patients were eligible if they were unstably housed for the past 30 days, and/or if their chief complaint was related to substance use. Following written informed consent, patients completed a baseline survey and health care use was tracked via electronic medical records for the next six months. Controls were enrolled in a 1:4 ratio. More than 2 ED visits during the follow-up was pre-specified as a measure of excess ED use. Descriptive analyses included proportions and medians with interquartile ranges (IQR). Binomial logistic regression models were used to estimate the impact of housing status, high-risk alcohol use (AUDIT) and drug use (DUDIT), and combinations of these factors on subsequent acute care system contacts (ED visits + admissions). We controlled for age, gender, comorbidities at baseline, and baseline presenting acuity. Results: 41 controls, 46 substance using, 91 unstably housed, and 31 both unstably housed and substance using patients were enrolled (n = 209). Median ED visits during follow up were 0 (IQR: 0-1.0) for controls, 1.0 (IQR: 0-3.3) for substance using, 1.0 (IQR: 0-4.0) for unstably housed and 4 (IQR: 2-12.3) for unstably housed and substance using patients. The median acute care system contacts over the same period was 1.0 (IQR 0-2.0) for controls, 1.0 (IQR: 0-4.0) for substance using, 1.0 (IQR: 0-5.0) for unstably housed and 4.5 (IQR: 2.8-14.3) for unstably housed and substance using patients. Being unstably housed was the factor most strongly associated with having > 2 ED visits (b=3.288, p<0.005) followed by high-risk alcohol and drug use (b=2.149, p<0.08); high risk alcohol use alone was not significantly associated with ED visits (b=1.939, p<0.1). The number of comorbidities present at baseline was a small but statistically significant additional risk factor (b=0.478, p<0.05). The model correctly predicted 70.1% of patients’ ED utilization status. Conclusion: Unstable housing is a substantial risk factor for ED use; high-risk alcohol and drug use, and comorbidities at baseline increased this risk. The intensity of excess ED use was greatest in patients who were unstably housed and substance using.
Our re-examination of the neutral hydrogen gas in the Small Magellan Cloud has led to four important results. Firstly, we find that Hindman’s (1967) total content HI map is a satisfactory representation of the gas in the line of sight. Secondly, we find that the HI gas in the SMC exists in four distinct large masses separated from one another in radial velocity by 20 to 30 km s−1. Thirdly, having made this division of the gas we show that there is good correlation between the radial velocities of HII regions, supergiant stars and HI. Finally, we believe that our observations reveal that the SMC is associated with an extremely large trailing halo of HI gas which forms the major component of the inter-cloud bridge region.
Two hundred and seventeen HI profiles at positions approximately 1 ° apart in the bridge region between the Small and Large Magellanic Clouds have been observed with a 15’ arc beam. Diagrams of all the profiles, lists of column densities and average radial velocities are given, together with details of the extensive Gaussian analysis needed to account for the components.
It is shown that the bridge region is most complex. (a) Two radial velocity groups, +214 and +238 km s-1, represent the actual HI bridge between the two galaxies, (b) Three other components, at mean radial velocities of +155, +177 and +195 km s-1 are seen to be integral parts of the SMC, stretching east to R. A. ~ 04h. (c) A further three components in groups at mean radial velocities +253, +272 and +293 km s-1 appear to be extensions of HI from the main body of the LMC.
Nine sets of five closely spaced observations in the lower Magellanic Stream and in the bridge region at high sensitivity supply further information about the region.
Observations of 21 cm HI emission-line profiles have been made in 34 directions from l= 172° through 0° to l=97° at high galactic latitudes and in 59 directions towards the LMC (b~ –33°) with the aim of detecting low-intensity halo features which may be compared with other element features of similar radial velocities detected by ultraviolet or optical absorption lines. Data are presented as spectra and tables of the parameters: radial velocities, line temperatures, halfwidths and column densities. Spectra of both low-intensity (halo) and high-intensity components are given for 48 positions in three tracks across the LMC.
Features near radial velocities –48 and +58 km s -1 are found in all the directions examined, whereas significant numbers of features grouped around average radial velocities + 112, +160 and +373 km s-1 (Isr) are found only in the directions of the LMC.
Using the HI column densities as references, we have estimated depletions in the abundances of calcium and sodium in the halo, spiral arms and the LMC disk. In one direction towards the LMC depletions in the halo features of carbon, nitrogen, oxygen, magnesium, aluminium, silicon and iron (from International Ultraviolet Explorer (IUE) satellite data) have also been estimated.
Pulse arrival time measurements allow the determination of accurate pulsar periods, period derivatives and, provided the data span is at least one year, precise pulsar positions. If observations are frequent and reasonably regular, irregularities in the period can also be investigated. To minimize the effect of possible variations in dispersion measure, it is important that these observations be made at a relatively high frequency, preferably above 1 GHz. To eliminate pulse shape variations due to variable ionospheric Faraday
rotation, the pulse total intensity or one of the circular polarizations must be recorded.
In November 1975 workers at the Herzberg Institute for Astrophysics in Canada (Avery et al. 1976) discovered cyanodiacetylene in Sgr B2. This molecule is the heaviest yet detected in interstellar space, having a molecular weight of 75 amu, and is the longest linear molecule known.
Graphics Processing Units (GPUs) offer potential for very high performance; they are also rapidly evolving. Obsidian is an embedded language (in Haskell) for implementing high performance kernels to be run on GPUs. We would like to have our cake and eat it too; we want to raise the level of abstraction beyond CUDA code and still give the programmer control over the details relevant to kernel performance. To that end, Obsidian provides array representations that guarantee elimination of intermediate arrays while also using the type system to model the hierarchy of the GPU. Operations are compiled very differently depending on what level of the GPU they target, and as a result, the user is gently constrained to write code that matches the capabilities of the GPU. Thus, we implement not Nested Data Parallelism, but a more limited form that we call Hierarchical Data Parallelism. We walk through case-studies that demonstrate how to use Obsidian for rapid design exploration or auto-tuning, resulting in performance that compares well to the hand-tuned kernels used in Accelerate and NVIDIA Thrust.
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.