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Introduction: Opioid side effects are common when treating chronic pain. However, the rate of opioid side effects for acute pain has rarely been examined, particularly in the post emergency department (ED) setting. The objective of this study was to evaluate the short-term incidence of opioid induced side effects (constipation, nausea/vomiting, dizziness, and drowsiness) in patients discharged from the ED with an opioid prescription. Methods: This was a prospective cohort study of patients aged ≥18 years that visited the ED for an acute pain condition (≤ 2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain medication use and side effects. Results: Mean age of the 386 patients included was 55 ± 16 years; 50% were women. During the 2-week follow-up, 80% of patients consumed at least one dose of opioids. Among the patients who used opioids, 38% (95%CI: 33-48) reported constipation, 27% (95%CI:22-32) nausea/vomiting, 30% (95%CI:25-35) dizziness, 51% (95%CI:45-57) drowsiness, and 77% (95%CI:72-82) reported any side effects. Adjusting for age, sex, and pain condition, patients who used opioids were more likely to report any side effect (OR 7.5, 95%CI:4.3-13.3) and constipation (OR 7.5, 95%CI:3.1-17.9). A significant dose response effect was observed for constipation but not for the other side effects. Nausea/vomiting (OR 2.0, 95%CI:1.1-3.6) and dizziness (OR 1.9, 95%CI:1.1-3.4) were associated with oxycodone compared to morphine. Conclusion: Similar to chronic pain, opioid side effects are highly prevalent during short-term treatment for acute pain. Physicians should be aware and inform patients about those side effects.
Characterising the three-dimensional (3D) distribution of hydraulic conductivity and its variability in the shallow subsurface is fundamental to understanding groundwater behaviour and to developing conceptual and numerical groundwater models to manage the subsurface. However, directly measuring in situ hydraulic conductivity can be difficult and expensive and is rarely carried out with sufficient density in urban environments. In this study we model hydraulic conductivity for 603 sites in the unconsolidated Quaternary deposits underlying Glasgow using particle size distribution and density description widely available from geotechnical investigations. Six different models were applied and the MacDonald formula was found to be most applicable in this heterogeneous environment, comparing well with the few available in situ hydraulic conductivity data. The range of the calculated hydraulic conductivity values between the 5th and 95th percentile was 1.56×10–2–4.38mday–1 with a median of 2.26×10–1 mday–1. These modelled hydraulic conductivity data were used to develop a suite of stochastic 3D simulations conditioned to existing 3D representations of lithology. Ten per cent of the input data were excluded from the modelling process for use in a split-sample validation test, which demonstrated the effectiveness of this approach compared with non-spatial or lithologically unconstrained models. Our spatial model reduces the mean squared error between the estimated and observed values at the excluded data locations over those predicted using a simple homogeneous model by 73 %. The resulting 3D hydraulic conductivity model is of a much higher resolution than would have been possible from using only direct measurements, and will improve understanding of groundwater flow in Glasgow and reduce the spatial uncertainty of hydraulic parameters in groundwater process models. The methodology employed could be replicated in other regions where significant volumes of suitable geotechnical and site investigation data are available to predict ground conditions in areas with complex superficial deposits.
We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
The structure of a series of lanthanide iron cobalt perovskite oxides, R(Fe0.5Co0.5)O3 (R = Pr, Nd, Sm, Eu, and Gd), have been investigated. The space group of these compounds was confirmed to be orthorhombic Pnma (No. 62), Z = 4. From Pr to Gd, the lattice parameter a varies from 5.466 35(13) Å to 5.507 10(13) Å, b from 7.7018(2) to 7.561 75(13) Å, c from 5.443 38(10) to 5.292 00(8) Å, and unit-cell volume V from 229.170(9) Å3 to 220.376(9) Å3, respectively. While the trend of V follows the trend of the lanthanide contraction, the lattice parameter “a” increases as the ionic radius r(R3+) decreases. X-ray diffraction (XRD) and transmission electron microscopy confirm that Fe and Co are disordered over the octahedral sites. The structure distortion of these compounds is evidenced in the tilt angles θ, ϕ, and ω, which represent rotations of an octahedron about the pseudocubic perovskite p, p, and p axes. All three tilt angles increase across the lanthanide series (for R = Pr to R = Gd: θ increases from 12.3° to 15.2°, ϕ from 7.5° to 15.8°, and ω from 14.4° to 21.7°), indicating a greater octahedral distortion as r(R3+) decreases. The bond valence sum for the sixfold (Fe/Co) site and the eightfold R site of R(Fe0.5Co0.5)O3 reveal no significant bond strain. Density Functional Theory calculations for Pr(Fe0.5Co0.5)O3 support the disorder of Fe and Co and suggest that this compound to be a narrow band gap semiconductor. XRD patterns of the R(Fe0.5Co0.5)O3 samples were submitted to the Powder Diffraction File.
We report on an effort to identify further members of the dwarf carbon class and new members of a putative dwarf S group in the general field through determination of proper motions of catalogued stars. Examination of nearly 1500 C stars and over 300 S stars reveals some interesting false alarms but no new dwarf members of these classes.
To investigate relationships between mortality and circulating 25-hydroxyvitamin D (25(OH)D), 25-hydroxycholecalciferol (25(OH)D3) and 25-hydroxyergocalciferol (25(OH)D2).
Case–cohort study within the Melbourne Collaborative Cohort Study (MCCS). We measured 25(OH)D2 and 25(OH)D3 in archived dried blood spots by LC–MS/MS. Cox regression was used to estimate mortality hazard ratios (HR), with adjustment for confounders.
The MCCS included 29 206 participants, who at recruitment in 1990–1994 were aged 40–69 years, had dried blood spots collected and no history of cancer. For the present study we selected participants who died by 31 December 2007 (n 2410) and a random sample (sub-cohort, n 2996).
The HR per 25 nmol/l increment in concentration of 25(OH)D and 25(OH)D3 were 0·86 (95 % CI 0·78, 0·96; P=0·007) and 0·85 (95 % CI 0·77, 0·95; P=0·003), respectively. Of 5108 participants, sixty-three (1·2 %) had detectable 25(OH)D2; their mean 25(OH)D concentration was 11·9 (95 % CI 7·3, 16·6) nmol/l higher (P<0·001). The HR for detectable 25(OH)D2 was 1·80 (95 % CI 1·09, 2·97; P=0·023); for those with detectable 25(OH)D2, the HR per 25 nmol/l increment in 25(OH)D was 1·06 (95 % CI 0·87, 1·29; P interaction=0·02). HR were similar for participants who reported being in good, very good or excellent health four years after recruitment.
Total 25(OH)D and 25(OH)D3 concentrations were inversely associated with mortality. The finding that the inverse association for 25(OH)D was restricted to those with no detectable 25(OH)D2 requires confirmation in populations with higher exposure to ergocalciferol.
The 2012 West Nile virus (WNV) epidemic was the largest since 2003 and the North Texas region was the most heavily impacted. We conducted a serosurvey of blood donors from four counties in the Dallas–Fort Worth area to characterize the epidemic. Blood donor specimens collected in November 2012 were tested for WNV-specific antibodies. Donors positive for WNV-specific IgG, IgM, and neutralizing antibodies were considered to have been infected in 2012. This number was adjusted using a multi-step process that accounted for timing of IgM seroreversion determined from previous longitudinal studies of WNV-infected donors. Of 4971 donations screened, 139 (2·8%) were confirmed WNV IgG positive, and 69 (1·4%) had IgM indicating infection in 2012. After adjusting for timing of sampling and potential seroreversion, we estimated that 1·8% [95% confidence interval (CI) 1·5–2·2] of the adult population in the Dallas–Fort Worth area were infected during 2012. The resulting overall estimate for the ratio of infections to reported WNV neuroinvasive disease (WNND) cases was 238:1 (95% CI 192–290), with significantly increased risk of WNND in older age groups. These findings were very similar to previous estimates of infections per WNND case, indicating no change in virulence as WNV evolved into an endemic infection in the United States.
Neptunium-237 will be present in radioactive wastes over extended time periods due to its long half-life (2.13 × 106 years). Understanding its behaviour under conditions relevant to radioactive waste disposal is therefore of particular importance. Here, microcosm experiments were established using sediments from a legacy lime workings with high-pH conditions as an analogue of cementitious intermediate-level radioactive waste disposal. To probe the influence of Fe biogeochemistry on Np(V) in these systems, additional Fe(III) (as ferrihydrite) was added to select experiments. Biogeochemical changes were tracked in experiments with low levels of Np(V) (20 Bq ml–1; 3.3 μM), whilst parallel higher concentration systems (2.5 KBq ml–1; 414 μM) allowed X-ray absorption spectroscopy. As expected, microbial reduction processes developed in microbially-active systems with an initial pH of 10; however, during microbial incubations the pH dropped from 10 to ∼7, reflecting the high levels of microbial metabolism occurring in these systems. In microbially-active systems without added Fe(III), 90% sorption of Np(V) occurred within one hour with essentially complete removal by one day. In the ferrihydrite-amended systems, complete sorption of Np(V) to ferrihydrite occurred within one hour. For higher-activity sediments, X-ray absorption spectroscopy (XAS) at end points where Fe(II) ingrowth was observed confirmed that complete reductive precipitation of Np(V) to Np(IV) had occurred under similar conditions to low-level Np experiments. Finally, pre-reduced, Fe(III)-reducing sediments, with and without added Fe(III) and held at pH 10, were spiked with Np(V). These alkaline pre-reduced sediments showed significant removal of Np to sediments, and XAS confirmed partial reduction to Np(IV) with the no Fe system, and essentially complete reduction to Np(IV) in the Fe(III)-enriched systems. This suggested an indirect, Fe(II)-mediated pathway for Np(V) reduction under alkaline conditions. Microbial analyses using 16S rRNA gene pyrosequencing suggested a role for alkali-tolerant, Gram-positive Firmicutes in coupled Fe(III) reduction and Np immobilization in these experiments.
Depression and diabetes commonly co-occur; however, the strength of the physiological effects of diabetes as mediating factors towards depression is uncertain.
We analyzed extensive clinical, epidemiological and laboratory data from n = 2081 Mexican Americans aged 35–64 years, recruited from the community as part of the Cameron County Hispanic Cohort (CCHC) divided into three groups: Diagnosed (self-reported) diabetes (DD, n = 335), Undiagnosed diabetes (UD, n = 227) and No diabetes (ND, n = 1519). UD participants denied being diagnosed with diabetes, but on testing met the 2010 American Diabetes Association and World Health Organization definitions of diabetes. Depression was measured using the Center for Epidemiological Studies – Depression (CES-D) scale. Weighted data were analyzed using dimensional and categorical outcomes using univariate and multivariate models.
The DD group had significantly higher CES-D scores than both the ND and UD (p ⩽ 0.001) groups, whereas the ND and UD groups did not significantly differ from each other. The DD subjects were more likely to meet the CES-D cut-off score for depression compared to both the ND and UD groups (p = 0.001), respectively. The UD group was also less likely to meet the cut-off score for depression than the ND group (p = 0.003). Our main findings remained significant in models that controlled for socio-demographic and clinical confounders.
Meeting clinical criteria for diabetes was not sufficient for increased depressive symptoms. Our findings suggest that the ‘knowing that one is ill’ is associated with depressive symptoms in diabetic subjects.
Our aim was to describe the epidemiology and incidence of community-onset invasive S. aureus disease in children presenting to our hospital, and to compare the clonal complexes and virulence genes of S. aureus strains causing invasive and non-invasive disease. The virulence gene repertoire of invasive disease isolates was characterized using DNA microarray and compared with the virulence gene repertoire of non-invasive S. aureus isolates. Over the study period, 163 children had an invasive S. aureus infection. There was no difference in the distribution of clonal complexes or in the prevalence of genes encoding virulence factors between invasive and non-invasive isolates. Future research should include a strong focus on identifying the host and environmental factors that, along with organism virulence factors, are contributing to the patterns of invasive S. aureus disease observed in New Zealand.
We carried out an extensive photometric and spectroscopic investigation of the SPB binary, HD 25558 (see Fig. 1 for the time and geographic distribution of the observations). The ~2000 spectra obtained at 13 observatories during 5 observing seasons, the ground-based multi-colour light curves and the photometric data from the MOST satellite revealed that this object is a double-lined spectroscopic binary with a very long orbital period of about 9 years. We determined the physical parameters of the components, and have found that both lie within the SPB instability strip. Accordingly, both components show line-profile variations consistent with stellar pulsations. Altogether, 11 independent frequencies and one harmonic frequency were identified in the data. The observational data do not allow the inference of a reliable orbital solution, thus, disentangling cannot be performed on the spectra. Since the lines of the two components are never completely separated, the analysis is very complicated. Nevertheless, pixel-by-pixel variability analysis of the cross-correlated line profiles was successful, and we were able to attribute all the frequencies to the primary or secondary component. Spectroscopic and photometric mode-identification was also performed for several of these frequencies of both binary components. The spectroscopic mode-identification results suggest that the inclination and rotation of the two components are rather different. While the primary is a slow rotator with ~6 d rotation period, seen at ~60° inclination, the secondary rotates fast with ~1.2 d rotation period, and is seen at ~20° inclination. Our spectropolarimetric measurements revealed that the secondary component has a magnetic field with at least a few hundred Gauss strength, while no magnetic field was detected in the primary.
The detailed analysis and results of this study will be published elsewhere.
In order to help establish the role of Cr in high-dose, high-dose-rate, elevated temperature N implantation of austenitic (fcc) stainless steels, similar implantations into fee Ni80Fe20 and Ni80Cr20 alloys have been made and characterized by Auger depth profiling and X-ray diffraction. For the Ni-Fe alloy a shallow layer fcc(∼ 0.2 μm) containing an ordered fee γ'-(Ni0.8Fe0.4)4N phase is induced. In contrast, for the Ni-Cr alloy a much thicker N-containing layer (∼ 0.2 μm) is produced consisting primarily of a high-N solid solution fee phase. The fractions of the implanted N retained in Ni-Fe and Ni-Cr were approximately 10 and 100%, respectively. The mechanisms by which Cr is promoting the deep migration and high retention of N in solid solution are proposed.
Many industrially important metallurgical processes are accompanied by the emission of light, the analysis of which often supplies useful information concerning the current state of the process while also providing insight into the details of specific process mechanisms. Optical diagnostic techniques are finding an increasingly wide range of application throughout the metallurgical community. This paper discusses the application of emission spectroscopy and imaging techniques to the analysis of such diverse processes as vacuum arc remelting, laser welding, and arc welding. A discussion of these techniques will be presented addressing such subjects as instrumentation, data analysis, the kind of information available and its potential impact on the selection of process parameters. Special attention will be given to discussing the difficulties encountered in applying these diagnostic technologies to “real life” processes in non-laboratory environments.
We have used small-angle X-ray scattering (SAXS) and Doppler-broadening measurements of positron-annihilation radiation to study changes in the microvoid distribution in PECVD a-Si:H films during annealing. From a comparison of data on deuterium diffusion with information obtained from SAXS we conclude that changes, during annealing, in the dispersive character of deuterium diffusion are likely to be caused by void formation through clustering of smaller structural defects.
Small angle x-ray scattering (SAXS), IR spectroscopy, and deuterium secondary ion mass spectrometry (DSIMS) were used to study the microstructure and hydrogen dynamics of undoped and boron-doped if-sputter-deposited (RFS) and electron cyclotron resonance (ECR)-deposited hydrogenated amorphous silicon carbides (a-Si1-xCx:H) with x ≤ 19 at.%. The SAXS measurements indicated residual columnar-like features and roughly spherical nanovoids of total content CnV ≤ 1.0 vol.%. The growth of CnV with annealing was due largely to an increase in the average nanovoid radius. It was noticeably smaller than in RFS a-Si:H films. The IR spectra demonstrated H transfer by annealing from mostly bulk-like Si-H groups to C-bonds. The H diffusion and its temperature dependence in undoped films resembled those of a-Si:H and were consistent with the SAXS and IR data. Suppression of long-range motion of most of the H atoms, consistent with increased CnV was observed in B-doped ECR films. However, a small fraction of the H atoms appeared to undergo fast diffusion, reminiscent of the fast diffusion in doped a-Si:H. The results are consistent with impeded relaxation processes of the Si network, caused by the presence of C atoms, and H trapping at C-H bonds.
A finite element numerical model is used to predict the thermal and mechanical response of mineral-bearing ores irradiated by microwave energy. The model considers a small, spherical, pyrite particle surrounded by a matrix of calcite. Power density data are determined from the dielectric properties of the mineral and host rock materials at typical microwave frequencies and power capabilities. The effects of varying power density and mineral particle diameter are studied. Using power densities within the expected achievable range for pyrite, significant temperature differences are predicted between the mineral particle and host rock. These temperature gradients lead to circumferential tensile stresses in the host rock well in excess of the reported uniaxial tensile strength of common rock materials. It is shown that, for a fixed microwave energy source, both the temperature difference between the mineral and host rock, and the peak tensile stress in the host rock are reduced as the mineral particle size is reduced. Recent experimental efforts to corroborate this numerical study are briefly described.