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This article examines the history of immigrant business proprietors in England and Wales between 1851 and 1911. The newly available electronic version of the Census (I-CeM) allows all business proprietors in each Census year to be identified, and provides birthplace information that allows entrepreneurs from different countries to be compared to each other and to business proprietors born in the United Kingdom. Immigrant populations had higher rates of business proprietorship than the English and Welsh-born population. This article argues that this was caused by labour market structure and demography rather than cultural differences between English- and foreign-born business proprietors.
This article explores rabbinic traditions that see in the character of Joseph a figure of uncertain sexual orientation. I examine a series of rabbinic and biblical texts in which an unconventional gender dynamic may be present. While it is true that these biblical and rabbinic texts ran contrary to the normative ideational and behaviorally prescriptive traditions concerning sexuality presented by the main body of biblical and rabbinic texts, it is nonetheless true that the texts I examine invite readers to see an alternative dynamic through their stories. I will employ a variety of methodologies, including philological/critical scholarship, close literary reading, and queer theory, through which we might most profitably examine the interpretative traditions I consider.
The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.
Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival.
For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample.
Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
This article describes the creation of a new urban classification based on the 1891 census of England and Wales. It is the first attempt to use the recently available electronic version of the census (I-CeM) to classify all large towns in late Victorian England and Wales on their economic structure. Where previous scholars were restricted by the form of occupation data contained in the published census reports, I-CeM allows manipulation of the data in order to aggregate urban units and examine their occupational structures in great detail. The classification is then used to compare key socio-economic characteristics of different towns.
Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex.
Electronic Records in Ambulances (ERA) is a two-year study which aims to investigate and describe the opportunities and challenges of implementing EHR and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision-making skills.
Our study includes a scoping review of relevant issues and a baseline assessment of progress in all UK ambulance services in implementing EHR. These will inform four in-depth case studies of services at different stages of implementation, assessing current usage, and examining context.
The scoping review identified themes including: there are many perceived potential benefits of EHR, such as improved safety and remote diagnostics, but as yet little evidence of them; technical challenges to implementation may inhibit uptake and lead to increased workload in the short term; staff implementing EHR may do so selectively or devise workarounds; and EHR may be perceived as a tool of staff surveillance.
Our scoping review identified some complex issues around the implementation of EHR and the relevant challenges, opportunities and workforce implications. These will help to inform our fieldwork and subsequent data analysis in the case study sites, to begin early in 2017. Lessons learned from the experience of implementing EHR so far should inform future development of information technology in ambulance services, and help service providers to understand how best to maximize the opportunities offered by EHR to redesign care.
Tomography produces complex volumetric datasets containing the entire internal structure and density of an object in three dimensions (3D). Interpreting volumetric data requires 3D visualization but needs specialized software distinguishable from more familiar tools used in animation for 3D surface data. This tutorial reviews 3D visualization techniques for volumetric data using the open-source tomviz software package. A suite of tools including two-dimensional (2D) slices, surface contours, and full volume rendering provide quantitative and qualitative analysis of volumetric information. The principles outlined here are applicable to a wide range of 3D tomography techniques and can be applied to volumetric datasets beyond materials characterization.
Water cultures were significantly more sensitive than concurrently collected swab cultures (n=2,147 each) in detecting Legionella pneumophila within a Veterans Affairs healthcare system. Sensitivity for water versus swab cultures was 90% versus 30% overall, 83% versus 48% during a nosocomial Legionnaires’ disease outbreak, and 93% versus 22% post outbreak.
An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation.
This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians. A standardized chart review identified demographics, comorbidities, and ED treatments. The primary outcome was the rate of new AC. Secondary outcomes were ED length of stay (LOS), referrals to AFF clinic, ED revisit rates, and 30-day rates of return visits for congestive heart failure (CHF), stroke, major bleeding, and death.
ED AFF patients totalling 301 (129 pre-pathway [PRE]; 172 post-pathway [POST]) were included; baseline demographics were similar between groups. The rates of AC at ED presentation were 18.6% (PRE) and 19.7% (POST). The rates of new AC on ED discharge were 48.6 % PRE (95% confidence interval [CI] 42.1%-55.1%) and 70.2% POST (62.1%-78.3%) (20.6% [p<0.01; 15.1-26.3]). Median ED LOS decreased from 262 to 218 minutes (44 minutes [p<0.03; 36.2-51.8]). Thirty-day rates of ED revisits for CHF decreased from 13.2% to 2.3% (10.9%; p<0.01; 8.1%-13.7%), and rates of other measures were similar.
The evidence-based pathway led to an improvement in the rate of patients with new AC upon discharge, a reduction in ED LOS, and decreased revisit rates for CHF.
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.
Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE).
In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital. We developed clear and reproducible inclusion criteria and processes, including measures of program efficiency. We conducted seminars and teaching modules to paramedics and hospital-based clinicians including monthly simulator sessions, and performed detailed reviews of each treated case in the form of report cards. In this before-and-after study we compared patients with ECPR attempted prior to, and after, protocol implementation. The primary outcome was TTE, defined as the time of initial professional CPR to establishment of extracorporeal circulation. We compared the median TTE for patients in the two groups using the Wilcoxon signed rank test.
Four patients were identified prior to the protocol and managed in an ad hoc basis; for nine patients the protocol was utilized. Overall favourable neurological outcomes among ECPR-treated patients were 27%. The median TTE was 136 minutes (IQR 98 - 196) in the pre-protocol group, and 60 minutes (IQR 49 - 81) minutes in the protocol group (p=0.0165).
An organized clinical and educational protocol to initiate ECPR for patients with OHCA is feasible and significantly reduces the key benchmark of time-to-ECPR flows.
We summarize B,V imagery results from the CTIO 4-m telescope and two electronic detectors: (1) The SIT vidicon at the R-C focus yielded pixels in the 0.82 or 1.1 arcmin2 frames (Harris, Hesser and Atwood 1983). (2) KPNO's P-F CCD (used by McClure and Hesser) gave 0.6 pixels in 3×5′ fields. (The latter data are being analyzed in cooperation with Stryker and Nemec, who observed some of the same objects.) Zero points for the CCD data are set by observations of E region standards and of giants in Galactic star clusters.
Ramalina europaea Gasparyan, Sipman & Lücking and R. labiosorediata Gasparyan, Sipman & Lücking, two species of the R. pollinaria group, are described here as new to science. Ramalina europaea, widely distributed in Europe, can be distinguished by small, punctiform, often terminal soralia starting out on small, spine-like branchlets, whereas R. labiosorediata from North America differs from R. pollinaria s. str. and R. europaea in the almost exclusively terminal soralia formed on the tips of normal lobes, originating from the underside and becoming irregularly labriform. Morphological characters, chemistry, ecology and geographical distribution are discussed and a key to the species of the Ramalina pollinaria group is provided. The topology of a maximum likelihood tree based on ITS shows the presence of three well-supported clades, corresponding to the morphological differences of the three species. The status of several historical names variously placed in synonymy with or described as infraspecific entities of R. pollinaria is reassessed and a new neotype and an epitype are designated for Lichen pollinarius, a neotype for L. squarrosus, making it a synonym of R. farinacea, and lectotypes for R. pollinaria var. elatior, making it a synonym of R. pollinaria s. str., and for var. humilis, a taxon of yet unknown affinity.
The large volume production of flexible electronics by solution based roll-to-roll (R2R) manufacturing technologies is a promising upscaling strategy for the organic electronics industry. Typical optoelectronic devices like organic light emitting diodes (OLEDs) consist of a complex stack of functional layers. Solution deposition of these structures eliminates the need for expensive vacuum processing. This contribution presents approaches for solution based R2R production methods of functional OLED layers on flexible polymer substrates. The development of a R2R line with two slot-die coating stations is discussed which can deposit two uniform layers consecutively in a single run (“tandem coating”) at web speeds up to 30 m/min. Furthermore, it offers the unique feature that there is no contact between the rollers and the top side of the substrate where the functional coating is deposited. Thereby, an important source of particle contamination and other damage to the device is eliminated. In addition to continuous deposition, stripe and intermittent coating techniques have been developed, allowing the production of patterned layers. Finally, examples will be shown of OLEDs where two functional materials are deposited by R2R processing from solution.
Oral glucose tolerance and insulin sensitivity are common measures, but are determined using various blood sampling methods, employed under many different experimental conditions. This study established whether measures of oral glucose tolerance and oral glucose-derived insulin sensitivity (insulin sensitivity indices; ISI) differ when calculated from venous v. arterialised blood. Critically, we also established whether any differences between sampling methods are consistent across distinct metabolic conditions (after rest v. after exercise). A total of ten healthy men completed two trials in a randomised order, each consisting of a 120-min oral glucose tolerance test (OGTT), either at rest or post-exercise. Blood was sampled simultaneously from a heated hand (arterialised) and an antecubital vein of the contralateral arm (venous). Under both conditions, glucose time-averaged AUC was greater from arterialised compared with venous plasma but importantly, this difference was larger after rest relative to after exercise (0·99 (sd 0·46) v. 0·56 (sd 0·24) mmol/l, respectively; P<0·01). OGTT-derived ISIMatsuda and ISICederholm were lower when calculated from arterialised relative to venous plasma and the arterialised–venous difference was greater after rest v. after exercise (ISIMatsuda: 1·97 (sd 0·81) v. 1·35 (sd 0·57) arbitrary units (au), respectively; ISICederholm : 14·76 (sd 7·83) v. 8·70 (sd 3·95) au, respectively; both P<0·01). Venous blood provides lower postprandial glucose concentrations and higher estimates of insulin sensitivity, compared with arterialised blood. Most importantly, these differences between blood sampling methods are not consistent after rest v. post-exercise, preventing standardised venous-to-arterialised corrections from being readily applied.