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Evidence is emerging regarding the influence of meteorological factors on seasonal respiratory syncytial virus outbreaks. Data however, are limited for subtropical regions, especially in the southern hemisphere. We examined whether meteorological data (daily minimum and maximum temperatures, rainfall, relative humidity, dew point, daily global solar exposure) and tourist numbers were associated with the incidence of RSV in children aged <5 years for the Gold Coast region of South-East Queensland, Australia (latitude 28.0°S). RSV cases between 1 July 2007 and 30 June 2016 were identified from the Pathology Queensland Gold Coast Laboratory database. Time-series methods were used to identify seasonal patterns. RSV activity peaked in mid-to-late autumn (April–May), tapering in winter (June–August). While most meteorological variables measured were associated with RSV incidence, rainfall (ρ = 0.40, 95% confidence interval (CI) 0.32–0.48) and humidity (ρ = 0.38, 95% CI 0.29–0.46) 8 weeks earlier had the nearest temporal relationship. Tourist numbers were not correlated with RSV activity. Identifying meteorological conditions associated with seasonal RSV epidemics can improve understanding of virus transmission and assist planning for their impact upon the health sector, including timing of passive RSV immunoprophylaxis for high-risk infants and future public health interventions, such as maternal immunisation with RSV vaccines.
Introduction: In Ottawa, STEMI patients are transported directly to percutaneous coronary intervention (PCI) by advanced care paramedics (ACPs), primary care paramedics (PCPs), or transferred from PCP to ACP crew (ACP-intercept). PCPs have a limited skill set to address complications during transport.The objective of this study was to determine what clinically important events (CIEs) occurred in STEMI patients transported for primary PCI via a PCP crew, and what proportion of such events could only be treated by ACP protocols. Methods: We conducted a health record review of STEMI patients transported for primary PCI from Jan 1, 2011-Dec 21, 2015. Ottawa has a single PCI center and its EMS system employs both PCP and ACP paramedics. We identified consecutive STEMI bypass patients transported by PCP-only and ACP-intercept using the dispatch database. A data extraction form was piloted and used to extract patient demographics, transport times, and primary outcomes: CIEs and interventions performed during transport, and secondary outcomes: hospital diagnosis, and mortality. CIEs were reviewed by two investigators to determine if they would be treated differently by ACP protocols. We present descriptive statistics. Results: We identified 967 STEMI bypass cases among which 214 (118 PCP-only and 96 ACP-intercept) met all inclusion criteria. Characteristics were: mean age 61.4 years, 78% male, 31.8% anterior and 44.4% inferior infarcts, mean response time 6 min, total paramedic contact time 29 min, and in cases of ACP-intercept 7 min of PCP-only contact time.A CIE occurred in 127 (59%) of cases: SBP<90 mmHg 26.2%, HR<60 30.4%, HR>100 20.6%, malignant arrhythmias 7.5%, altered mental status 6.5%, airway intervention 2.3%, 2 patients (0.9%) arrested, both survived. Of the CIE identified, 54 (42.5%) could be addressed differently by ACP vs PCP protocols (25.2% of total cases). The majority related to fluid boluses for hypotension (44 cases; 35% of CIE). ACP intervention for CIEs within the ACP intercept group was 51.6%. There were 6 in-hospital deaths (2.8%) with no difference in transport crew type. Conclusion: CIEs are common in STEMI bypass patients however a smaller proportion of such CIE would be addressed differently by ACP protocols compared to PCP protocols. The vast majority of CIE appeared to be transient and of limited clinical significance.
Introduction/Innovation Concept: In 2014, Eastern Ontario paramedic services, their medical director staff and area community colleges developed an EMS Boot Camp experience to orient Queen’s University and the University of Ottawa emergency medicine residents to the role of paramedics and the challenges they face in the field. Current EMS ride-alongs and didactic classroom sessions were deemed ineffective at adequately preparing residents to provide online medical control. From those early discussions came the creation of a real-world, real-time (RWRT) educational experience. Methods: Specific challenges unique to paramedicine are difficult to communicate to a medical control physician at the other end of a telephone. The goal of this one-day educational experience is for residents to gain insight into the complexity and time sensitive nature of delivering medical care in the field. Residents are immersed as responding paramedics in a day of intense RWRT simulation exercises reflecting the common paramedic logistical challenges to delivering patient care in an uncontrolled and dynamic environment. Curriculum, Tool, or Material: Scenarios, run by paramedic students, are overseen by working paramedics from participating paramedic services. Residents learn proper use of key equipment found on an Ontario ambulance while familiarize themselves with patient care standards and medical directives. Scenarios focus on prehospital-specific clinical care issues; performing dynamic CPR in a moving vehicle, extricating a bariatric patient with limited personnel, large scale multi-casualty triage as well as other time sensitive, high risk procedures requiring online medical control approval (i.e. chest needle thoracostomy). Conclusion: EMS Boot Camp dispels preconceived biases regarding “what it’s really like” to deliver high quality prehospital clinical care. When providing online medical control in the future, the residents will be primed to understand and expect certain challenges that may arise. The educational experience fosters collaboration between prehospital and hospital-based providers. The sessions provide a reproducible, standardized experience for all participants; something that cannot be guaranteed with traditional EMS ride-alongs. Future sessions will evaluate participant satisfaction and self-efficacy with the use of a standard evaluation form including pre/post self-evaluations.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type.
Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York.
Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes.
TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully.
This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.
Most research examining the impact of patients seeking online health information treats internet information homogenously, rather than recognizing that there are multiple types and sources of available information. The present research was conducted to differentiate among sources and types of internet information that patients search for, intend to discuss with their doctors, and recall discussing with their doctors, and to determine how accurate and hopeful patients rate this information.
We surveyed 70 breast cancer patients recruited from the waiting rooms of breast medical oncology and surgery clinics. The main variables in the study were as follows: (1) the sources and types of online information patients have read, intended to discuss, and actually discussed with their doctors, and (2) how accurately and hopefully they rated this information to be.
Patients read information most frequently from the websites of cancer organizations, and most often about side effects. Patients planned to discuss fewer types of information with their doctors than they had read about. They most often intended to discuss information from cancer organization websites or WebMD, and the material was most often about alternative therapies, side effects, and proven or traditional treatments. Some 76.8% of total participants rated the information they had read as very or somewhat accurate, and 61% rated the information they had read as very or somewhat hopeful.
Significance of Results:
Internet information varies widely by source and type. Differentiating among sources and types of information is essential to explore the ways in which online health information impacts patients' experiences.
Acinetobacter is a well-recognized nosocomial pathogen. Previous reports of community-associated Acinetobacter infections have lacked clear case definitions and assessment of healthcare-associated (HCA) risk factors. We identified Acinetobacter bacteraemia cases from blood cultures obtained <3 days after hospitalization in rural Thailand and performed medical record reviews to assess HCA risk factors in the previous year and compare clinical and microbiological characteristics between cases with and without HCA risk factors. Of 72 Acinetobacter cases, 32 (44%) had no HCA risk factors. Compared to HCA infections, non-HCA infections were more often caused by Acinetobacter species other than calcoaceticus–baumannii complex species and by antibiotic-susceptible organisms. Despite similar symptoms, the case-fatality proportion was lower in non-HCA than HCA cases (9% vs. 45%, P < 0·01). Clinicians should be aware of Acinetobacter as a potential cause of community-associated infections in Thailand; prospective studies are needed to improve understanding of associated risk factors and disease burden.
We present Herschel-SPIRE imaging spectroscopy (194-671 μm) of the bright starburst galaxy M82. We use RADEX and a Bayesian Likelihood Analysis to simultaneously model the temperature, density, column density, and filling factor of both the cool and warm components of molecular gas traced by the entire CO ladder up to J=13-12. The high-J lines observed by SPIRE trace much warmer gas (~500 K) than those observable from the ground. The addition of 13CO (and [C I]) is new and indicates that [C I] may be tracing different gas than 12CO. At such a high temperature, cooling is dominated by molecular hydrogen; we conclude with a discussion on the possible excitation processes in this warm component. Photon-dominated region (PDR) models require significantly higher densities than those indicated by our Bayesian likelihood analysis in order to explain the high-J CO line ratios, though cosmic-ray enhanced PDR models can do a better job reproducing the emission at lower densities. Shocks and turbulent heating are likely required to explain the bright high-J emission.
Patients with major depressive disorder (MDD) show deficits in processing of facial emotions that persist beyond recovery and cessation of treatment. Abnormalities in neural areas supporting attentional control and emotion processing in remitted depressed (rMDD) patients suggests that there may be enduring, trait-like abnormalities in key neural circuits at the interface of cognition and emotion, but this issue has not been studied systematically.
Nineteen euthymic, medication-free rMDD patients (mean age 33.6 years; mean duration of illness 34 months) and 20 age- and gender-matched healthy controls (HC; mean age 35.8 years) performed the Emotional Face N-Back (EFNBACK) task, a working memory task with emotional distracter stimuli. We used blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to measure neural activity in the dorsolateral (DLPFC) and ventrolateral prefrontal cortex (VLPFC), orbitofrontal cortex (OFC), ventral striatum and amygdala, using a region of interest (ROI) approach in SPM2.
rMDD patients exhibited significantly greater activity relative to HC in the left DLPFC [Brodmann area (BA) 9/46] in response to negative emotional distracters during high working memory load. By contrast, rMDD patients exhibited significantly lower activity in the right DLPFC and left VLPFC compared to HC in response to positive emotional distracters during high working memory load. These effects occurred during accurate task performance.
Remitted depressed patients may continue to exhibit attentional biases toward negative emotional information, reflected by greater recruitment of prefrontal regions implicated in attentional control in the context of negative emotional information.
Although pneumonia is a leading cause of death from infectious disease worldwide, comprehensive information about its causes and incidence in low- and middle-income countries is lacking. Active surveillance of hospitalized patients with pneumonia is ongoing in Thailand. Consenting patients are tested for seven bacterial and 14 viral respiratory pathogens by PCR and viral culture on nasopharyngeal swab specimens, serology on acute/convalescent sera, sputum smears and antigen detection tests on urine. Between September 2003 and December 2005, there were 1730 episodes of radiographically confirmed pneumonia (34·6% in children aged <5 years); 66 patients (3·8%) died. A recognized pathogen was identified in 42·5% of episodes. Respiratory syncytial virus (RSV) infection was associated with 16·7% of all pneumonias, 41·2% in children. The viral pathogen with the highest incidence in children aged <5 years was RSV (417·1/100 000 per year) and in persons aged ⩾50 years, influenza virus A (38·8/100 000 per year). These data can help guide health policy towards effective prevention strategies.
Angora goats are known to be vulnerable to cold stress, especially after shearing, but their thermoregulatory responses to shearing have not been measured. We recorded activity, and abdominal and subcutaneous temperatures, for 10 days pre-shearing and post-shearing, in 10 Angora goats inhabiting the succulent thicket of the Eastern Cape, South Africa, in both March (late summer) and September (late winter). Within each season, environmental conditions were similar pre-shearing and post-shearing, but September was an average 5°C colder than March. Shearing resulted in a decreased mean (P < 0.0001), minimum (P < 0.0001) and maximum daily abdominal temperature (P < 0.0001). Paradoxically, the decrease in daily mean (P = 0.03) and maximum (P = 0.01) abdominal temperatures, from pre-shearing to post-shearing, was greater in March than in September. Daily amplitude of body temperature rhythm (P < 0.0001) and the maximum rate of abdominal temperature rise (P < 0.0001) increased from pre-shearing to post-shearing, resulting in an earlier diurnal peak in abdominal temperature (P = 0.001) post-shearing. These changes in amplitude, rate of abdominal temperature rise and time of diurnal peak in abdominal temperature suggest that the goats’ thermoregulatory system was more labile after shearing. Mean daily subcutaneous temperatures also decreased post-shearing (P < 0.0001), despite our index goat selecting more stable microclimates after shearing in March (P = 0.03). Following shearing, there was an increased difference between abdominal and subcutaneous temperatures (P < 0.0001) at night, suggesting that the goats used peripheral vasoconstriction to limit heat loss. In addition to these temperature changes, mean daily activity increased nearly two-fold after March shearing, but not September shearing. This increased activity after March shearing was likely the result of an increased foraging time, food intake and metabolic rate, as suggested by the increased water influx (P = 0.0008). Thus, Angora goats entered a heat conservation mode after shearing in both March and September. That the transition from the fleeced to the shorn state had greater thermoregulatory consequences in March than in September may provide a mechanistic explanation for Angora goats’ vulnerability to cold in summer.
The insulin-like growth factor (IGF) system is altered with intra-uterine growth retardation and in adult metabolic disease. The aim of the present study was to observe effects of continued protein restriction on the IGF-I system and body composition in offspring of mothers fed a low-protein (LP) diet. Offspring from Wistar dams fed either a 20 % (CON) or 8 % (LP) protein diet during gestation and lactation were studied at birth, 10 d, weaning and at 12 weeks after maintenance on either the 8 % (lp) or 20 % (con) protein diet from weaning. LP offspring had reduced weaning weights (P < 0·05) and reduced serum insulin (P < 0·005). Serum IGF-I (P < 0·001) and acid-labile subunit (ALS) (P < 0·0001) were reduced at 10 and 21 d. Hepatic expression of IGF-I (P < 0·05) and ALS (P < 0·005) were reduced at 10 and 21 d. IGF binding protein (IGFBP)-1 hepatic expression was elevated at 10 d (P < 0·001) but not at 21 d. Adult LP-con offspring had reduced body weight (P < 0·05), lean (P < 0·0001) and bone (P < 0·0001) but not fat (P = 0·6) mass with no persistent effects on IGF-I, ALS and IGFBP-1.Postnatal lp feeding reduced lean mass (P < 0·0001) and bone mass (P < 0·0001) in CON and LP animals. Percentage fat (LP P = 0·04; CON P = 0·6) and IGFBP-1 (LP P = 0·01; CON P = 0·2) were increased in LP-lp but not CON-lp offspring. This suggests that postnatal nutrition is important in the effects of maternal protein restriction on adult body composition and that IGFBP-1 may be involved.
Among different MEMS wafer level bonding processes glass frit bonding provides reliable vacuum tight seals in volume production. The quality of the seal is a function of both seal glass materials and the processing parameters used in glass frit bonding. Therefore, in this study Taguchi L18 screening Design of Experiment (DOE) was used to study the effect of materials and process variables on the quality of the glass seal in 6” silicon wafers bonded in EVG520IS bonder. Six bonding process variables at three levels and two types of sealing glass pastes were considered. The seals were characterized by Scanning Acoustic Microscopy (SAM), cross sectional Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Analysis (EDAX). The results were quantified into four responses for DOE analysis. Key results are a) peak temperature has the strongest influence on seal properties, b) hot melt paste has significantly lower defects compared to liquid paste, and c) peak firing temperatures can be as low as 400°C under certain conditions.
Heat stress of sheep in feedlot systems and within the live export industry is an animal welfare concern and a financial concern due to loss of life and reduced production (Richards et al. 1989). Early research has been undertaken in short term studies exposing Merino sheep to excessive heat load (Lee 1950; Ames et al. 1971). However, little is known of the physiological changes in animals subject to prolonged periods of excessive heat and humidity as can occur in the live export industry. Knowledge of the physiological responses of Merino sheep to prolonged heat and humidity is needed to correctly manage these sheep during shipment. This experiment investigated the physiological responses of Merino sheep to high heat and humidity similar to that experienced during long haul live export voyages to the Middle-East.
Feedlots are important in both fattening of lambs prior to slaughter and familiarizing sheep with a pellet diet prior to live export. Feedlotting is prominent in Western Australia, with 19% of prime lamb producers identifying feedlotting as their main finishing method (Connell et al. , 2002). Anecdotal reports are that temperatures within a West Australian feedlot during summer can often be in excess of 40˚C. Past research has shown that excessive heat load is a problem with feedlotted cattle (Hahn and Nienaber, 1993) and could be of particular importance when animals are being fed high energy rations; however, the extent of the problem in sheep is unknown. Previous work has shown that high temperatures lead to a decrease in feed intake and therefore productivity of the animal (Baile and Forbes, 1974). The aim of this study was to determine environmental conditions in a Western Australian feedlot during summer and to determine the core temperature of both wethers and ewes within this feedlot. The hypothesis was that sheep exposed to feedlot conditions during summer would have an increased core body temperature above normal.
Low pressure chemical vapor deposition (LPCVD) and plasma enhanced chemical vapor deposition (PECVD) silicon oxide and silicon nitride films were implanted subcutaneously in a rat model to study in vivo behavior of the films. Silicon chips coated with the films of interest were implanted for up to one year, and film thickness was evaluated by spectrophotometry and sectioning. Dissolution rates were estimated to be 0.33 nm/day for LPCVD silicon nitride, 2.0 nm/day for PECVD silicon nitride, and 3.5 nm/day for PECVD silicon oxide. A similar PECVD silicon oxide dissolution rate was observed on a silicon oxide / silicon nitride / silicon oxide stack that was sectioned by focused ion beam etching. These results provide a biostability reference for designing implantable microfabricated devices that feature exposed ceramic films.
Field studies evaluated wild radish control in oat with thifensulfuron plus tribenuron in 1995 and 1997. Thifensulfuron plus tribenuron at 16 or 21 g ai/ha controlled wild radish completely in both years. In tolerance studies conducted in 1995 and 1996, thifensulfuron plus tribenuron reduced vigor of ‘Bay,’ ‘Belle,’ ‘Dane,’ ‘Ensiler,’ ‘Gem,’ ‘Horicon,’ ‘Ogle,’ ‘Porter,’ and ‘Prairie’ oat varieties and Wisconsin test selection oat ‘X6396-1’ up to 25% 7 d after treatment (DAT), but all chlorotic symptoms had disappeared 28 DAT. Thifensulfuron plus tribenuron reduced oat height 13 to 19% in 1995 and 21 to 24% in 1996 7 DAT. Bay, Belle, Dane, Ensiler, Horicon, Prairie, and X6396-1 recovered from height reductions by 28 DAT in 1995; however, in 1996 only Horicon and Porter recovered. Thifensulfuron plus tribenuron did not reduce 1995 grain yields, but 1996 Bay and Porter grain yields were reduced 29 and 15%, respectively. Dane and Prairie seed weights were reduced 7 and 14%, respectively, in 1995, whereas no seed weight reduction occurred in 1996.