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Background: In Alberta in 2016 more people died from an opioid overdose than from motor vehicle crashes. Naloxone is an opioid antagonist - it can reverse an opioid overdose for a period of 30 to 60 minutes. Naloxone kits are available free at emergency departments and community organizations around the province with training provided at the point of pickup. It is possible that training may be refused or may be forgotten and people are often left to rely solely on the instructions included in the kit. Human centred design can improve the way people interact with overdose instructions. Aim Statement: This study will measure the effectiveness and usefulness of prototype community naloxone kit instructions over a six month period of time (2018) in Calgary and Edmonton with the aim to use human centred design principles to improve the way people interpret emergency overdose response directions. Measures & Design: Information design experts engaged people with lived experience to provide a process map outlining the current role that educational materials and instructions for community naloxone kits play in responding to an opioid overdose. Alberta Health Services (AHS) Human Factors, in collaboration with AHS harm reduction developed the protocol and administered pre- and post-questionnaire and specific ‘performance checkpoints’ intended to measure effectiveness and usefulness. A simulated overdose including a mannequin, injection trainer and anatomical paper diagram was designed and a community naloxone kit with instructions setting was provided. Participants were recruited through harm reduction nurses with pre-existing clinical relationships (experienced group), family and friends of people who use opioids and general public (non-experienced) through the University of Alberta Faculty of Art and Design. Evaluation/Results: A total of 30 voluntary participants provided their informed consent and engaged in a simulated overdose scenario using a set of prototype instructions developed by a professional information designer. Through repeated data sampling, the following points were observed and will be integrated in the next iteration of design: It isn't clear to people what opioids are. It isn't clear to people that giving a dose of naloxone will not harm a person, especially if they have not overdosed. Almost none of the participants called 911. People seem to read pictures and text equally in the non-experienced group, but in the experienced group, typically read the pictures. Many participants stated that they knew how to do rescue breaths, but did not perform them correctly. Performing the procedure is a not the same as being asked about how to perform the procedure. Discussion/Impact: Even with new instructional prototypes, many participants identified components that were unclear or confusing. The experienced group made less mistakes than the non-experienced group. They seemed to be more invested or interested in saving a friend's life. These instructions will go through another round of design to incorporate feedback from end users. The final product will be part of a larger provincial emergency medicine initiative that includes participant led design and education around emergency response in opioid overdose settings.
Grommet insertion is a common surgical procedure in children. Long waiting times for grommet insertion are not unusual. This project aimed to streamline the process by introducing a pathway for audiologists to directly schedule children meeting National Institute for Health and Care Excellence Clinical Guideline 60 (‘CG60’) for grommet insertion.
Method and results
A period from June to November 2014 was retrospectively audited. Mean duration between the first audiology appointment and grommet insertion was 294.5 days (median = 310 days). Implementing the direct-listing pathway reduced the duration between first audiology appointment and grommet insertion (mean = 232 days; median = 231 days). There has been a reduction in the time between the first audiology appointment and surgery (mean difference of 62.5 days; p = 0.024), and a reduction in the time between second audiology appointment and surgery (28 days; p = 0.009).
Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.
Mastitis can prove expensive in sheep reared for meat production due to costs associated with treatment methods, poor lamb growth and premature culling of ewes. The most commonly used method to detect mastitis, in dairy systems, is somatic cell counts. However, in many meat-producing sheep flocks ewes are not routinely handled, thus regular milk sampling is not always possible. It is, therefore, worthwhile to investigate alternative phenotypes, such as those associated with udder conformation and methods of evaluating somatic cell counts in the milk, such as the California Mastitis Test. The main objectives of this study were therefore: (a) to estimate genetic parameters of traits relating to mastitis and udder conformation in a meat sheep breed; (b) estimate the level of association between somatic cell counts and the California Mastitis Test and (c) assess the relationships between mastitis and both udder conformation and lamb live weights. Data were collected from Texel ewes based on 29 flocks, throughout the UK, during 2015 and 2016. The ewes were scored twice each year, at mid- and late-lactation. Eight different conformation traits, relating to udder and teat characteristics, and milk samples were recorded. The data set comprised of data available for 2957 ewes. The pedigree file used contained sire and dam information for 31 775 individuals. The animal models used fitted relevant fixed and random effects. Heritability estimates for traits relating to mastitis (somatic cell score and the California Mastitis Test), ranged from 0.08 to 0.11 and 0.07 to 0.11, respectively. High genetic correlations were observed between somatic cell score and the California Mastitis Test (0.76 to 0.98), indicating the California Mastitis Test to be worthwhile for assessing infection levels, particularly at mid-lactation. The strongest correlations observed between the mastitis traits and the udder conformation traits were associated with udder depth (0.61 to 0.75) also at mid-lactation. Negative phenotypic correlations were estimated between mastitis and the weight of lamb reared by the ewe (−0.15 to −0.23), suggesting that lamb weights fell as infection levels rose. Genetic correlations were not significantly different from zero. Reducing mastitis will lead to improvements in flock productivity and the health and welfare of the animals. It will also improve the efficiency of production and the resilience to disease challenge. The economic benefits, therefore, of these results combined could be substantial not only in this breed but also in the overall meat sheep industry.
The presence of footrot in a flock can have serious implications for animal health, welfare and productivity. Associated increases in treatment and prevention costs, as well as losses in performance, have led to a notable interest in using breeding to control footrot in sheep. Current breeding indexes for UK hill sheep such as the Scottish Blackface, include both lamb and maternal traits, and have led to improvements in economic returns. So that breeding for resistance to footrot can be evaluated in the context of multi-trait selection programmes, the genetic relationships with current breeding goal traits must be quantified. The objective of this study was to identify important environmental factors affecting footrot prevalence and to estimate genetic parameters between footrot severity and other traits used in current UK hill sheep breeding indexes.
The primary goal for all involved in the care of women in labor is a healthy mother and baby after delivery. For most pregnancies, which are low risk, delivery by cesarean section appears to pose greater risk of maternal morbidity and mortality than vaginal delivery and can have significant implications for future pregnancies.
To investigate the feasibility of a national audit of epistaxis management led and delivered by a multi-region trainee collaborative using a web-based interface to capture patient data.
Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires.
Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5).
This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.
Green galenia is a South African woody prostrate perennial that was first recorded in Australia in the early 1900s and has since become a serious threat to indigenous temperate grasslands and surrounding agricultural areas. Laboratory and field based experiments were conducted to examine the effect of environmental factors on the germination and viability of green galenia seed. It was shown that green galenia was able to germinate over a broad range of temperatures, but short bursts (5 min) of high temperatures (80 C to 120 C replicating possible exposures to a fire) reduced seed germination. Seed germination was positively favored by light, declined rapidly in darkness, and decreased by > 80% at a depth of only 0.5 cm in soil. Water stress greatly reduced seed germination (45% germination at osmotic potentials below −0.2 MPa). Germination was completely inhibited at water potentials of −0.4 to −1.0 MPa. This species is moderately tolerant to salinity, with over 50% of seeds germinating at low levels of salinity (60 mM NaCl), and moderate germination (49%) occurring at 120 mM NaCl, it can germinate well in both alkaline (pH 10–83%) and acidic (pH 4–80%) conditions. The results of this study have contributed to our understanding of the germination and emergence of green galenia, and this will assist in developing tools and strategies for the long term management of this noxious weed in Victoria and other parts of Australia.
From whatever standpoint it may be viewed, the decision of President Johnson to order the Marines into the Dominican Republic on April 28, 1965, was bound to provide a focus for controversy. However, the essentially political nature of that act and its ostensible and concealed motivations have tended to shroud the impact of the Dominican crisis upon the legal mechanisms of the Inter-American System, outlined in the basic documents and developed in the practice of the Organization of American States. This is not to suggest that the problems of Latin America in general and of the Dominion Republic in particular are reducible to a statement of principles of international law. Indeed, it is the present writer’s contention that the Latin American members of the Organization have demonstrated that they are far too servile towards what they deem to be the basic norms of American international law, and that this attitude coupled with the equivocal political manœuvres of the United States has produced a form of institutional schizophrenia which deflects attention from the basic problems of contemporary Latin America and the pressing need for their solution. The main purposes of this comment are to examine the Dominican crisis in the context of fundamental stresses in Latin American society, to evaluate the roles of the United States and the O.A.S. in terms of their reactions to this case, and to make some general comments on how the Inter-American System may be rendered more meaningful in dealing with the political, economic, and social priorities of the region.
In order to assess the extent of genotype by environment interactions (G×E) and environmental sensitivity in sheep farm systems, environmental factors must be identified and quantified, after which the relationship with the traits(s) of interest can be investigated. The objectives of this study were to develop a farm environment (FE) scale, using a canonical correlation analysis, which could then be used in linear reaction norm models. Fine-scale farm survey data, collected from a sample of 39 Texel flocks across the United Kingdom, was combined with information available at the national level. The farm survey data included information on flock size and concentrate feed use. National data included flock performance averages for 21-week-old weight (21WT), ultrasound back-fat (UFD) and muscle (UMD) depths, as well as regional climatic data. The FE scale developed was then combined with 181 555 (21WT), 175 399 (UMD) and 175 279 (UFD) records from lambs born between 1990 and 2011, on 494 different Texel flocks, to predict reaction norms for sires used within the population. A range of sire sensitivities estimated across the FE scale confirmed the presence of genetic variability as both ‘plastic’ and ‘robust’ genotypes were observed. Variations in heritability estimates were also observed indicating that the rate genetic progress was dependent on the environment. Overall, the techniques and approaches used in this study have proven to be useful in defining sheep FEs. The results observed for 21WT, UMD and UFD, using the reaction norm models, indicate that in order to improve genetic gain and flock efficiency, future genetic evaluations would benefit by accounting for the G×E observed.
The Fezzan Project completed its five-year fieldwork cycle in 2001. The geographical research team located numerous additional palaeolake sites within the Edeyen Ubari, using a combination of Remote Sensing technology and field visits. Additional samples were taken for analysis and dating from many lake edge locations, relating to both the large Pleistocene lake and to the numerous smaller Holocene lakes that have been identified by the team. The excavations at Old Germa were taken down through Garamantian occupation levels to the natural subsoil below the earliest cultural horizon. The earliest activity, represented by a few mudbrick walls and hearths built directly on the natural soil, is believed to date to c. 400-300 BC. Traces of several phases of Garamantian buildings were uncovered, along with numerous rubbish pits, which yielded a rich assemblage of finds, including, for the first time, examples of Garamantian figurines, small 3-D sculptures of humans and animals. Work on the various classes of finds (pottery, small finds, lithics and other stone artefacts, metallurgical evidence, etc.) complemented the excavation work. In addition, a small amount of further survey work was carried out on sites in the Wadi al-Ajal, along with a contour survey of Old Germa and standing building survey at a number of other sites.
During the late republic and early principate the Jews who called Rome their home occasionally found themselves in the public gaze. Some of their customs and aspects of their ways of life also attracted occasional comment, often for their apparently strange and foreign manner. At no stage, however, during this period did they feature prominently in the public sphere of life in Rome. The aftermath of the war of 66-70 CE brought about an abrupt change in circumstances for the Jews living in Rome. Apart from the immediate visual celebration of the triumph, there followed a number of substantial monumental and numismatic commemorations of the Roman victory. In this article the purpose and function of those commemorations and the possible consequences for the Jews who lived in Rome are examined. In particular, the impact of the public profiling of the war on Jewish identity and of how the writings of Josephus are to be read in this setting is explored. Rather than regard Josephus as a supporter of the Flavian rulers, writing an account of the war that encouraged fellow Jews to collaborate with Rome, it is argued that he was offering Jews in Rome a counter-narrative to the way the war was being publicly commemorated.
[T]he ordinary citizen who detests exploited prostitution has no unbalanced desire for legislation at any price. He or she is prepared to face the inescapable truth that the causes of this evil cannot be touched by law, however perfectly conceived, however perfectly administered. Those who are obsessed by a frenzy for legislative measures achieve contentment and futility. The slow way is the only way of advance here: education, a changed social outlook, a gradual reorganization of economic conditions, these may remove such causes as are within our control. And not the wisest of us can prophesy but that we shall find the primary cause will baffle us at the end. Teresa Billington-Greig
The relationship between criminal law and morality is one which has always evoked strong feelings. Moreover, the question of whether and how to use criminal law sanctions to curb sexual immorality has been particularly susceptible to both outbursts of moral fervour in the community at large and to the pressure exercised by crusaders and propagandists with moral missions.
The objective of this study was to define different terminal sire flock environments, based on a range of environmental factors, and then investigate the presence of genotype by environment interactions (G×E) between the environments identified. Data from 79 different terminal sire flocks (40 Texel, 21 Charollais and 18 Suffolk), were analysed using principal coordinate and non-hierarchical cluster analyses, the results of which identified three distinct environmental cluster groups. The type of grazing, climatic conditions and the use of vitamins and mineral supplements were found to be the most important factors in the clustering of flocks. The presence of G×E was then investigated using data from the Charollais flocks only. Performance data were collected for 12 181 lambs, between 1990 and 2010, sired by 515 different sires. Fifty six of the sires had offspring in at least two of the three different cluster groups and pedigree information was available for a total of 161 431 animals. Traits studied were the 21-week old weight (21WT), ultrasound muscle depth (UMD) and log transformed backfat depth (LogUFD). Heritabilities estimated for each cluster, for each trait, ranged from 0.32 to 0.45. Genetic correlations estimated between Cluster 1 and Cluster 2 were all found to be significantly lower than unity, indicating the presence of G×E. They were 0.31 (±0.17), 0.68 (±0.14) and 0.18 (±0.21) for 21WT, UMD and LogUFD, respectively. Evidence of sires re-ranking across clusters was also observed. Providing a suitable strategy can be identified, there is potential for the optimisation of future breeding programmes, by taking into account the G×E observed. This would enable farmers to identify and select animals with an increased knowledge as to how they will perform in their specific farm environment thus reducing any unexpected differences in performance.
Newell & Shanks (N&S) argue against the idea that any significant role for unconscious influences on decision making has been established by research to date. Inasmuch as this conclusion applies to the idea of an “intelligent cognitive unconscious,” we would agree. Our concern is that the article could lead the unwary to conclude that there are no unconscious influences on decision making – and never could be. We give reasons why this may not be the case.
While the summit of the Antarctic Plateau has long been expected to harbor the best ground-based sites for terahertz (THz) frequency astronomical investigations, it is only recently that direct observations of exceptional THz atmospheric transmission and stability have been obtained. These observations, in combination with recent technological advancements in astronomical instrumentation and autonomous field platforms, make the recognition and realization of terahertz observatories on the high plateau feasible and timely. Here, we will explore the context of terahertz astronomy in the era of Herschel, and the crucial role that observatories on the Antarctic Plateau can play. We explore the important scientific questions to which observations from this unique environment may be most productively applied. We examine the importance and complementarity of Antarctic THz astronomy in the light of contemporary facilities such as ALMA, CCAT, SOFIA and (U)LDB ballooning. Finally, building from the roots of THz facilities in Antarctica to present efforts, we broadly highlight future facilities that will exploit the unique advantages of the Polar Plateau and provide a meaningful, lasting astrophysical legacy.
We argue for an example of “core cognition” based on Diamond and Carey's (1986) work on expertise and recognition, which is not made use of in The Origin of Concepts. This mechanism for perceptual learning seems to have all the necessary characteristics in that it is innate, domain-specific (requires stimulus sets possessing a certain structure), and demonstrably affects categorisation in a way that strongly suggests it will influence concept formation as well.