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Household surveys are one of the most commonly used tools for generating insight into rural communities. Despite their prevalence, few studies comprehensively evaluate the quality of data derived from farm household surveys. We critically evaluated a series of standard reported values and indicators that are captured in multiple farm household surveys, and then quantified their credibility, consistency and, thus, their reliability. Surprisingly, even variables which might be considered ‘easy to estimate’ had instances of non-credible observations. In addition, measurements of maize yields and land owned were found to be less reliable than other stationary variables. This lack of reliability has implications for monitoring food security status, poverty status and the land productivity of households. Despite this rather bleak picture, our analysis also shows that if the same farm households are followed over time, the sample sizes needed to detect substantial changes are in the order of hundreds of surveys, and not in the thousands. Our research highlights the value of targeted and systematised household surveys and the importance of ongoing efforts to improve data quality. Improvements must be based on the foundations of robust survey design, transparency of experimental design and effective training. The quality and usability of such data can be further enhanced by improving coordination between agencies, incorporating mixed modes of data collection and continuing systematic validation programmes.
Currently, mark-making practices as a form of identification and proof of life are an unrealized resource. Over a three-year period, systematic walkover surveys were conducted on and within fortifications and other structures on the island of Alderney to locate historic and modern marks. The investigations presented in this article demonstrate the importance of non-invasive recording and examination of marks to identify evidence connected to forced and slave labourers, and soldiers present on the island of Alderney during the German occupation in World War II. Names, hand and footwear impressions, slogans, artworks, dates, and counting mechanisms were recorded electronically and investigated by using international databases, archives, and translation services. We discuss the value and challenges of interpreting traces of human life in the contexts of conflict archaeology and missing person investigations and underline the need for greater recognition of marks as evidence of past lives.
Dyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.
A systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.
Data Extraction and Synthesis
The search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).
Our results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.
This article explores where the people fit in to British history and whether there was such a thing as British public opinion in the seventeenth century. It argues that given the nature of the Stuart multiple monarchy, and the way the power structures of that monarchy impinged upon Ireland, Scotland, and England, the Stuarts' political authority was at times publicly negotiated on a Britannic level. People across Britain were engaged with British affairs: there was public opinion about British politics, in other words, albeit not British public opinion, since the people were bitterly divided at this time. However, because the crisis that brought down Charles I had been a three-kingdoms crisis, which in turn had helped spark the growth of a more sophisticated British news culture, the Restoration monarchy became increasingly sensitive to the need to try to keep public opinion across the Britannic archipelago on its side. In response to the challenge of the Whigs during the Exclusion Crisis, Charles II and his Tory allies sought to rally public support across England, Scotland, and Ireland and thus to represent “British public opinion” as being in favor of the hereditary succession. It was a representation, however, that remained contested.
The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling.
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
Pathogenic animal trypanosomes affecting livestock have represented a major constraint to agricultural development in Africa for centuries, and their negative economic impact is increasing in South America and Asia. Chemotherapy and chemoprophylaxis represent the main means of control. However, research into new trypanocides has remained inadequate for decades, leading to a situation where the few compounds available are losing efficacy due to the emergence of drug-resistant parasites. In this review, we provide a comprehensive overview of the current options available for the treatment and prophylaxis of the animal trypanosomiases, with a special focus on the problem of resistance. The key issues surrounding the main economically important animal trypanosome species and the diseases they cause are also presented. As new investment becomes available to develop improved tools to control the animal trypanosomiases, we stress that efforts should be directed towards a better understanding of the biology of the relevant parasite species and strains, to identify new drug targets and interrogate resistance mechanisms.
The runtime for a modern, concurrent, garbage collected language like Java or Haskell is like an operating system: sophisticated, complex, performant, but alas very hard to change. If more of the runtime system were in the high-level language, it would be far more modular and malleable. In this paper, we describe a novel concurrency substrate design for the Glasgow Haskell Compiler that allows multicore schedulers for concurrent and parallel Haskell programs to be safely and modularly described as libraries in Haskell. The approach relies on abstracting the interface to the user-implemented schedulers through scheduler activations, together with the use of Software Transactional Memory to promote safety in a multicore context.
The OGLE survey of the SMC has discovered ~1500 eclipsing binaries thereby providing an excellent platform to study the evolution of close binary systems through case A and case B mass-exchange processes. The complementary spectroscopic radial-velocity studies of these binaries are now in progress and are revealing many interesting systems which challenge current theoretical models of close binary star evolution. These studies also provide excellent direct determinations of distances to these binary stars leading to an improved understanding of the mean distance to the SMC and its 3-D structure. Comparisons between these binary-star distances and other methods of determining the mean distance to the SMC will also be made.
Twin pairs discordant for disease may help elucidate the epigenetic mechanisms and causal environmental factors in disease development and progression. To obtain the numbers of pairs, especially monozygotic (MZ) twin pairs, necessary for in-depth studies while also allowing for replication, twin studies worldwide need to pool their resources. The Discordant Twin (DISCOTWIN) consortium was established for this goal. Here, we describe the DISCOTWIN Consortium and present an analysis of type 2 diabetes (T2D) data in nearly 35,000 twin pairs. Seven twin cohorts from Europe (Denmark, Finland, Norway, the Netherlands, Spain, Sweden, and the United Kingdom) and one from Australia investigated the rate of discordance for T2D in same-sex twin pairs aged 45 years and older. Data were available for 34,166 same-sex twin pairs, of which 13,970 were MZ, with T2D diagnosis based on self-reported diagnosis and medication use, fasting glucose and insulin measures, or medical records. The prevalence of T2D ranged from 2.6% to 12.3% across the cohorts depending on age, body mass index (BMI), and national diabetes prevalence. T2D discordance rate was lower for MZ (5.1%, range 2.9–11.2%) than for same-sex dizygotic (DZ) (8.0%, range 4.9–13.5%) pairs. Across DISCOTWIN, 720 discordant MZ pairs were identified. Except for the oldest of the Danish cohorts (mean age 79), heritability estimates based on contingency tables were moderate to high (0.47–0.77). From a meta-analysis of all data, the heritability was estimated at 72% (95% confidence interval 61–78%). This study demonstrated high T2D prevalence and high heritability for T2D liability across twin cohorts. Therefore, the number of discordant MZ pairs for T2D is limited. By combining national resources, the DISCOTWIN Consortium maximizes the number of discordant MZ pairs needed for in-depth genotyping, multi-omics, and phenotyping studies, which may provide unique insights into the pathways linking genes to the development of many diseases.
We sought to compare two ultrasound simulation interventions used during critical care simulation. The primary outcome was trainee and instructor preference for either intervention. Secondary outcomes included the identification of strengths and weaknesses of each intervention as well as overall merits of ultrasound simulation during high-fidelity, critical care simulation. The populations of interest included emergency medicine trainees and physicians.
This was a randomized crossover study with two ultrasound simulation interventions. 25 trainees and eight emergency physician instructors participated in critical-care simulation sessions. Instructors were involved in session debriefing and feedback. Pre- and post-intervention responses were analyzed for statistically significant differences using t test analyses. Qualitative data underwent thematic analysis and triangulation.
Both trainees and instructors deemed ultrasound simulation valuable by allowing trainees to demonstrate knowledge of indications, correct image interpretation, and clinical integration (p<0.05). Trainees described increased motivation to develop and use ultrasound skills. The edus2 was the preferred intervention, as it enabled functional fidelity and the integration of ultrasound into resuscitation choreography. Instructors preferred the edus2, as it facilitated better assessment of trainees’ skills, thus influencing feedback.
These findings support the use of ultrasound simulation during critical care simulations. The increased functional fidelity associated with edus2 suggests that it is the preferred intervention. Further study of the impact on clinical performance is warranted.