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The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Innovation Concept: Residents bear an enormous burden of responsibility for patient care which can lead to stress and mental exhaustion, especially in the face-paced and acute environment of emergency medicine (EM). In addition to numerous demands faced by EM residents, being a member of a geographically distributive residency program presents many unique challenges from a support and wellness perspective. To address these issues we sought to implement a video conferenced peer support network in hopes to foster wellness in the NOSM Family Medicine/EM program, where learners are commonly separated for training. Methods: Participants completed a pre-pilot questionnaire that strongly showed interest for this type of novel network. Furthermore residents conveyed that they are reluctant to access formal services and commonly rely on co-residents for support. This pilot program intends to decrease barriers that geography and stigma create that negatively hinder seeking support throughout medical training. Keeping the network small, consisting of only co-residents maintains a collegial and confidential environment that enables colleagues to provide relevant help to one another. Offering this outlet allows the opportunity to debrief and share unique experiences, which can lead to improved knowledge and wellbeing. Curriculum, Tool or Material: Informal, co-resident run and easy to access sessions are held twice monthly and average one hour in length. Discussion topics commonly include residency issues, difficult patient encounters and challenging situations. These sessions are conducted via video conferencing making them easily accessible from a distance and also from a comfortable and convenient environment of the participants choosing. Residents have commented that this is a helpful platform to discuss important issues while providing and safe and confidential resource to help cope with residency challenges. Conclusion: Further data analysis is underway as we are in the initial stages of implementing the program. In the final stages (April 2018) a pending post-pilot questionnaire will be interpreted to explore barriers, limitations and to determine the role of the network going forward. If found to be effective it is something that can be implemented and adapted for future residents. Other programs can use this feasible model to increase wellness and foster the same supportive environment among residents, especially those separated geographically from peers who may benefit most.
Background: There is growing concern about emergency physicians overuse of computed tomography (CT). In an attempt to ensure appropriate ordering many hospitals implement strict protocols for ordering of CT scans in the emergency department (ED) that include approval of all scans by a board-certified radiologist, and a reduced access to CT overnight. Aim Statement: The aim of this study is to review the impact of RAD ED – direct access to CT ordering by ED physicians, 24hr CT technologist and third-party reporting on CT scans overnight. Our objectives were to assess the effect on; 1) ED length of stay, 2) number of CT scans ordered and 3) admission rates. Measures & Design: We conducted a prospective pilot before & after study at a single tertiary-care emergency department between February 1st, 2018 and July 31st, 2018. Inclusion criteria were adult patients presenting to the emergency department and undergoing CT for any of the following: face, neck, spine, upper and lower extremities, chest, abdomen and pelvis. Exclusion criteria were those undergoing CT head for stroke or trauma. Evaluation/Results: A total of 924 patients met our criteria, 352 before and 568 after implementation. Comparison of the patient populations demonstrate very similar characteristics in both groups; (49% male, average age 56 years, CTAS 2(40%) and 3(47%). Results demonstrate that an additional 216 scans were performed in post-implementation group. This equates to an increase of 61%. ED length of stay averaged 5.6 hours pre-implementation and 4.7 hours post-implementation. This corresponds to a significant reduction in length of stay of approximately 0.9 hours (p < 0.01). Collection is currently ongoing for factors that we will adjust for a multivariate analysis, including admission rates. Discussion/Impact: RAD ED led to a significant increase in CT ordering and decrease in ED length of stay. We believe that this project provides important information to clinicians and patients with regards to overall CT utilization, ED wait times, follow up visits for CT scanning and admission rates. It is also important for administrators to help decide if these new rules are leading to improved efficiency, and to help estimate their financial impact.
The Paleolithic diet excludes two major sources of fibre, grains and legumes. However, it is not known whether this results in changes to resistant starch (RS) consumption. Serum trimethylamine-N-oxide (TMAO) is produced mainly from colonic fermentation and hepatic conversion of animal protein and is implicated in CVD, but changes in RS intake may alter concentrations. We aimed to determine whether intake of RS and serum concentrations of TMAO varied in response to either the Paleolithic or the Australian Guide to Healthy Eating (AGHE) diets and whether this was related to changes in food group consumption. A total of thirty-nine women (mean age 47 (sd 13) years, BMI 27 (sd 4) kg/m2) were randomised to AGHE (n 17) or Paleolithic diets (n 22) for 4 weeks. Serum TMAO concentrations were measured using liquid chromatography–MS; food groups, fibre and RS intake were estimated from weighed food records. The change in TMAO concentrations between groups (Paleolithic 3·39 μmv. AGHE 1·19 μm, P = 0·654) did not reach significance despite greater red meat and egg consumption in the Paleolithic group (0·65 serves/d; 95 % CI 0·2, 1·1; P <0·01, and 0·22 serves/d; 95 % CI 0·1, 0·4, P <0·05, respectively). RS intake was significantly lower on the Paleolithic diet (P <0·01) and was not associated with TMAO concentrations. However, the limited data for RS and the small sample size may have influenced these findings. While there were no significant changes in TMAO concentrations, increased meat consumption and reduced RS intake warrant further research to examine the markers of gastrointestinal health of Paleolithic diet followers and to update Australian food databases to include additional fibre components.
The 2001/02 austral summer was the warmest summer on record in Taylor Valley, Antarctica, (∼78° S) since continuous records of temperature began in 1985. The highest stream-flows ever recorded in the Onyx River, Wright Valley, were also recorded that year (the record goes back to the 1969/70 austral summer). In early January 2002, a groundwater seep was observed flowing in the southwest portion of Taylor Valley. This flow has been named ‘Wormherder Creek’ (WHC) and represents an unusual event, probably occurring on a decadal time-scale. The physical characteristics of this feature suggest that it may have flowed at other times in the past. Other groundwater seeps, emanating from the north-facing slope of Taylor Valley, were also observed. Little work has been done previously on these very ephemeral seeps, and the source of water is unknown. These features, resembling recently described features on Mars, represent the melting of subsurface ice. The Martian features have been interpreted as groundwater seeps. In this paper we compare the chemistry of the WHC groundwater seep to that of the surrounding streams that flow every austral summer. The total dissolved solids content of WHC was ∼6 times greater than that of some nearby streams. The Na : Cl and SO4 : Cl ratios of the seep waters are higher than those of the streams, but the Mg : Cl and HCO3 : Cl ratios are lower, indicating different sources of solutes to the seeps compared to the streams. The enrichment of Na and SO4 relative to Cl may suggest significant dissolution of mirabilite within the previously unwetted soil. The proposed occurrence of abundant mirabilite in higher-elevation soils of the dry valley region agrees with geochemical models developed, but not tested, in the late 1970s. The geochemical data demonstrate that these seeps could be important in ‘rinsing’ the soils by dissolving and redistributing the long-term accumulation of salts, and perhaps improving habitat suitability for soil biota. The H4SiO4 concentration is 2–3 times greater in WHC than in the surrounding streams, indicating a large silicate-weathering component in the seep waters.
The Square Kilometre Array will be an amazing instrument for pulsar astronomy. While the full SKA will be sensitive enough to detect all pulsars in the Galaxy visible from Earth, already with SKA1, pulsar searches will discover enough pulsars to increase the currently known population by a factor of four, no doubt including a range of amazing unknown sources. Real time processing is needed to deal with the 60 PB of pulsar search data collected per day, using a signal processing pipeline required to perform more than 10 POps. Here we present the suggested design of the pulsar search engine for the SKA and discuss challenges and solutions to the pulsar search venture.
With the global ageing of our societies and the predicted increase of cognitive impairment and dementia, there is increasing interest in the role and scope of memory clinics or memory assessment services in the early assessment, diagnosis and management of all subtypes of dementia. Memory clinics generally attempt to provide a multidisciplinary approach to the diagnosis and treatment of memory impairment and dementia. However, little consensus exists about the profile or complement of staff that would constitute an ideal memory clinic, and services vary widely in terms of their organisation, remit and functioning. The purpose of this article is to highlight the variation amongst the existing complement of memory clinics in Ireland. The 17 models are compared in terms of their core multidisciplinary service and services available on referral. The Irish National Dementia Strategy recommends a well-coordinated service that provides early diagnosis and treatment, and one with good links to local support agencies. However, many of the services in Ireland lack input from relevant allied health professionals. This article also focusses on one privately funded memory clinic in Ireland which aims to bridge the gap between accurate diagnosis, holistic assessment and follow-up through comprehensive multidisciplinary input. The challenges facing this service are discussed, with particular reference to the difficulties encountered when providing community follow-up by a private sector clinic.
Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan–Meier method.
The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.
The concepts of nature, culture and heritage are deeply entwined; their threads run together in some of our finest museums, in accounts of exploration and discovery, in the work of artists, poets andwriters, and in areas that are cherished and protected because of their landscapes and wildlife. The conservation ethic - placing a value on the natural environment - lies at the heart of the notion of "natural heritage", but we need to question how those values originated, were consolidated and ultimately moulded and changed over time. In a contemporary context the connections between nature andculture have sometimes become lost, fragmented, dislocated or misunderstood; where did "natural heritage" begin and how do we engage with the idea of "nature" today? The essays collected here re-evaluate the role of culture in developing the concept of natural heritage, reflecting on the shifts in its interpretation over the last 300 years.
Contributors: Martin Holdgate, Marie Addyman,E. Charles Nelson, Darrell Smith, Andrew Ramsey, Viktor Kouloumpis, Richard Milner, Gina Douglas, Penny Bradshaw, Arthur MacGregor, Chiara Nepi, Hannah Paddon, Stephen Hewitt, Gordon McGregor Reid, Ghillean T Prance, Peter Davis, Christopher Donaldson, Lucy McRobert, Sophie Darlington, Keith Scholey, Paul A. Roncken, Angus Lunn, Juliet Clutton-Brock, Tim Sands, Robert A. Lambert, James Champion,Erwin van Maanen, Heather Prince, Chris Loynes, Julie Taylor, Sarah Elmeligi, Samantha Finn, Owen Nevin, Jared Bowers, Kate Hennessy, Natasha Lyons, Mike Jeffries.