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Lithium-ion capacitors (LICs) and Hybrid LICs (H-LICs) were assembled as three-layered pouch cells in an asymmetric configuration employing Faradaic pre-lithiated hard carbon anodes and non-Faradaic ion adsorption-desorption activated carbon (AC) cathodes for LICs and lithium iron phosphate (LiFePO4-LFP)/AC composite cathodes for H-LICs. The room temperature rate performance was evaluated after the initial LIC and H-LIC cell formation as a function of the electrolyte additives. The capacity retention was measured after charging at high temperature conditions, while the design factor explored was electrolyte additive formulation, with a focus on their stability. The high temperature potential holds simulate electrochemical energy materials under extreme environments and act to accelerate the failure mechanisms associated with cell degradation to determine robust electrolyte/additive combinations.
Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Curcumin has been attributed with antioxidant, anti-inflammatory, antibacterial activities, and has shown highly protective effects against enteropathogenic bacteria and mycotoxins. Ochratoxin A (OTA) is one of the major intestinal pathogenic mycotoxins. The possible effect of curcumin on the alleviation of enterotoxicity induced by OTA is unknown. The effects of dietary curcumin supplementation on OTA-induced oxidative stress, intestinal barrier and mitochondrial dysfunctions were examined in young ducks. A total of 540 mixed-sex 1-day-old White Pekin ducklings with initial BW (43.4±0.1 g) were randomly assigned into controls (fed only the basal diet), a group fed an OTA-contaminated diet (2 mg/kg feed), and a group fed the same OTA-contaminated feed plus 400 mg/kg of curcumin. Each treatment consisted of six replicates, each containing 30 ducklings and treatment lasted for 21 days. There was a significant decrease in average daily gain (ADG) and increased feed : gain caused by OTA (P<0.05); curcumin co-treatment prevented the decrease in BW and ADG compared with the OTA group (P<0.05). Histopathological and ultrastructural examination showed clear signs of enterotoxicity caused by OTA, but these changes were largely prevented by curcumin supplementation. Curcumin decreased the concentrations of interleukin-1β, tumor necrosis factor-α and malondialdehyde, and increased the activity of glutathione peroxidase induced by OTA in the jejunal mucosa of ducks (P<0.05). Additionally, curcumin increased jejunal mucosa occludin and tight junction protein 1 mRNA and protein levels, and decreased those of ρ-associated protein kinase 1 (P<0.05). Notably, curcumin inhibited the increased expression of apoptosis-related genes, and downregulated mitochondrial transcription factors A, B1 and B2 caused by OTA without any effects on RNA polymerase mitochondrial (P<0.05). These results indicated that curcumin could protect ducks from OTA-induced impairment of intestinal barrier function and mitochondrial integrity.
A study was conducted to assess the effects of rapid wilting of grass prior to ensiling on milk composition in lactating dairy cattle across a range of silage harvests. The effects of wilting on the response to bacterial inoculation were also examined. Experiments 1 and 2 were of 2 x 2 factorial design based on the factors wilting (unwilted and wilted treatments) and inoculant (control and inoculant treatments). The inoculants each had Lactobacillus plantarum plus other bacterial species. Experiments 1 and 2 had 3 and 8 harvests respectively and the corresponding feeding experiments were balanced changeover designs with 3 and 8 periods respectively. The feeding periods were of 8 and 3 weeks duration in Experiments 1 and 2 respectively and during each period each silage was fed ad libitum together with a concentrate supplement to 12 cows.
The durations of the wilting periods ranged from 24 to 48 h in each experiment and the mean initial and final dry matter contents of the grass were 200; 317 g/kg and 176; 316 g/kg for Experiments 1 and 2 respectively.
In Experiment 1 the butterfat, protein and lactose concentrations (g/kg) from the unwilted and wilted silages were 45.1 and 47.2 (s.e. 0.23, P<0.001), 33.7 and 35.6 (s.e. 0.11, P<0.001) and 48.9 and 48.7 (s.e. 0.08, P<0.05) respectively. In Experiment 2 the corresponding values (g/kg) were 45.2 and 46.4 (s.e. 0.23, P<0.05), 32.3 and 33.2 (s.e. 0.13, P<0.05) and 48.9 and 49.1 (s.e. 0.06, P>0.05) respectively. Inoculation had no significant effects on milk composition with either unwilted or wilted silage except for a reduction in protein content in Experiment 1, with values (g/kg) of 34.8 and 35.4 (s.e. 0.11, P<0.05) for control and inoculant treated silage respectively.
It is concluded that wilting produced statistically significant increases in the concentrations of butterfat and protein in milk and that inoculants had little effect on milk composition in this study.
Whether there are distinct subtypes of schizophrenia is an important issue to advance understanding and treatment of schizophrenia.
To understand and treat individuals with schizophrenia, the aim was to advance understanding of differences between individuals, whether there are discrete subtypes, and how fist-episode patients (FEP) may differ from multiple episode patients (MEP).
These issues were analysed in 687 FEP and 1880 MEP with schizophrenia using the Positive and Negative Syndrome Scale for (PANSS) schizophrenia before and after antipsychotic medication for 6 weeks.
The seven Negative Symptoms were correlated with each other and with P2 (conceptual disorganisation), G13 (disturbance of volition), and G7 (motor retardation). The main difference between individuals was in the cluster of seven negative symptoms, which had a continuous unimodal distribution. Medication decreased the PANSS scores for all the symptoms, which were similar in the FEP and MEP groups.
The negative symptoms are a major source of individual differences, and there are potential implications for treatment.
Breeding programmes for the Holstein-Friesian have historically focused on improved milk production with little emphasis on functional traits such as fertility or disease resistance (Yan et al., 2006). Recently, a major breeding programme has been adopted in Northern Ireland using the cross-breeding technique (Holstein cows x Jersey sires) with the aim of improving fertility and disease resistance of dairy cows whilst maintaining milk production capacity. The objectives of the present study were to evaluate possible breed differences in the efficiency of energy utilisation between Holstein and Jersey-Holstein dairy cows offered mixed diets of grass silage with a low or high level of concentrates.
Heat production of animals is mainly derived from body protein metabolism and energy expenditure per unit protein in internal organs is much higher than skeletal muscle. The accurate estimation of CP mass in internal organs can thus improve rationing systems for farm animals. The objective of the present study was to examine relationships between CP mass in internal organs and empty body weight (EBW) with other live animal variables in lactating dairy cows.
Organic acids, most commonly fumarate and malate, when offered to ruminants have been shown to produce a decrease in methane emissions along with an increase in in vitro DM digestibility in rumen fluid taken from sheep (López et al., 1999). They are classed as ‘preservatives’ in the list of feed additives authorised by EU legislation, and as such are permitted for use in livestock (Castillo et al., 2004). However, the addition of fumaric acid to the diet has been associated with inappetance and problems of reduced rumen pH. Fumaric acid encapsulated in a soya oil capsule enables a slow release of fumaric acid in the rumen, which should overcome these problems. Encapsulated fumaric acid (EFA), when offered to lambs as 10% of the diet, reduced methane emissions by 75% and increased feed conversion efficiency by 20% (Wallace et al., 2006). To date, no in vivo studies have been carried out on dairy cattle. Therefore, the objective of this study was to determine the effect of addition of EFA on animal performance and methane production from grazing dairy cows.
Body condition of lactating dairy cows varies at different stages of lactation. Cows usually mobilise their body reserves to provide energy and protein for milk production in early lactation, and gain weight to deposit energy and protein for pregnancy at a later stage. The objective of the present study was to examine relationships between body condition score (CS) and body concentration of lipid, CP and energy.
The European Union Nitrates Directive stipulates mandatory measures that must be included in national action programmes, one of which involves a limit on the amount of livestock manure which may be applied to land each year, set at 170 kg organic nitrogen (manure N) per hectare. This limit will have very significant implications for stocking rates on intensive livestock farms. Consequently, there is increasing interest in developing mitigation strategies to reduce N output in faeces and urine in animal production The objectives of the present study were to evaluate the effects of cross-breeding of Holstein cows with Jersey sires on the efficiency of N utilisation and manure N output.
The accurate prediction of body composition of dairy cows is important for developing appropriate nutritional and management regimes. The objective of the present study was to develop prediction equations for empty body (EB) composition of lactating dairy cows using body weight and other live animal data.
In order to assess the impact of methane (CH4) production from ruminants on the environment, and to measure the effects of various mitigation strategies for methanogenesis, it is necessary to accurately measure CH4 output under different scenarios. Techniques which enable measurement of CH4 output from individual animals can facilitate a meaningful investigation of factors affecting methanogenesis. Indirect open-circuit respiration calorimetry chambers are an efficient way to measure CH4 production from individual animals. However, chamber measurements cannot be used to measure CH4 output from grazing animals. To overcome this, the sulphur hexafluoride (SF6) tracer technique was developed by Johnson et al. (1994), and is widely used to measure CH4 emissions from individual grazing ruminants. Although the SF6 technique has been used quite extensively, relatively few studies have been carried out to validate its accuracy compared to respiration calorimetry studies. Additional validation studies are required to clarify the situation, especially for dairy cows which are major producers of CH4. Consequently, the objective of this experiment was to use indirect open-circuit respiration calorimetry chambers to validate the SF6 technique for measuring CH4 emissions from dairy cows, and to develop a prediction model for actual CH4 production of dairy cows from SF6 estimates.
Empty body (EB) weight (EBW) is used to estimate the energy and protein requirements for maintenance for dairy cattle. It is predicted from live weight (LW), but the prediction can be influenced by a number of factors, e.g., feed and water intake, pregnancy and body condition. The objective of the present study was to develop prediction equations for EBW and carcass weight in lactating dairy cows using LW and other live animal data.
There is little information available in the literature on the validation of the currently adopted energy feeding systems developed from calorimetric data, using data obtained in production studies. The objective of the present study was to use production data from feeding studies to validate some metabolisable energy (ME) systems (AFRC, 1990 and 1993; SCA, 1990) and net energy (NE) systems (Van Es, 1978, INRA, 1989; NRC, 2001).
The energy feeding systems used for dairy cows recommend that the metabolisable energy (ME) concentration of a feed at maintenance feeding level is calculated from its digestible nutrients. The objective of the present study was to develop equations to calculate the ME concentration from digestibility data for grass silages
It is well recognised that the fat and protein concentration in the milk of dairy cows is influenced by volatile fatty acids (VFAs) produced in the rumen. There has however been little information available on models to predict milk composition from rumen VFAs in the literature. The objective of the present study was to develop empirical relationships to predict milk fat and protein concentration using rumen VFA data.
Chowdhury and Ørskov (1994) observed that heat production in sheep was reduced by approximately 10% below that at fasting when the animal was offered one third of the predicted maintenance requirement through intragastric nutrition. These authors also suggested that this indicated a glucose deficient state in the fasted animal, and that as a result the heat production at fasting was artificially raised. In agreement with Ørskov and MacLeod (1990), Chowdhury and Ørskov (1994) further stated that when measuring heat production to estimate basal metabolism animals should have their heat production measured when being offered one third of maintenance rather than fasting, although this was not tested by experiment. Birnie et al., (2000) reported that fasting heat production was influenced by the condition score of the cow. The objectives of this experiment were firstly to investigate the influence of maintenance and sub-maintenance levels of feeding on the observed heat production in nonpregnant, nonlactating dairy cows offered a more normal diet and secondly to further examine the influence of cow condition score on the fasting heat production.