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To better understand hepatitis C virus (HCV) epidemiology in Punjab state, India, we estimated the distribution of HCV antibody positivity (anti-HCV+) using a 2013–2014 HCV household seroprevalence survey. Household anti-HCV+ clustering was investigated (a) by individual-level multivariable logistic regression, and (b) comparing the observed frequency of households with multiple anti-HCV+ persons against the expected, simulated frequency assuming anti-HCV+ persons are randomly distributed. Village/ward-level clustering was investigated similarly. We estimated household-level associations between exposures and the number of anti-HCV+ members in a household (N = 1593 households) using multivariable ordered logistic regression. Anti-HCV+ prevalence was 3.6% (95% confidence interval 3.0–4.2%). Individual-level regression (N = 5543 participants) found an odds ratio of 3.19 (2.25–4.50) for someone being anti-HCV+ if another household member was anti-HCV+. Thirty households surveyed had ⩾2 anti-HCV+ members, whereas 0/1000 (P < 0.001) simulations had ⩾30 such households. Excess village-level clustering was evident: 10 villages had ⩾6 anti-HCV+ members, occurring in 31/1000 simulations (P = 0.031). The household-level model indicated the number of household members, living in southern Punjab, lower socio-economic score, and a higher proportion having ever used opium/bhuki were associated with a household's number of anti-HCV+ members. Anti-HCV+ clusters within households and villages in Punjab, India. These data should be used to inform screening efforts.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350
m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200
m images will also have a factor
30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Many important oxidative reactions, such as CO oxidation, take place on metal surfaces at high temperatures and partial pressures. Understanding the atomic processes involved in these catalyzed reactions are of great importance and may be achievable by observations of the adsorbate-induced surface structure under temperatures and pressures relevant to working catalysts. Many of the prior studies, however, have only considered quenched-in structures with no dynamic interaction between the metal surface and the gas phase. This presentation describes in-situ synchrotron x-ray studies of the Cu (001) surface as a function of pO2, the oxygen partial pressure, and temperature. We utilize a controlled-flow reaction chamber specially constructed to mount onto an eight-circle diffractometer at the Advanced Photon Source. The chamber allows the flow of oxygen, hydrogen, and argon mixtures with pO2 ranging from 760 to 1×10-12 Torr and sample temperatures variable from 25 to 1000 °C. After reaching a critical pO2, oxygen adsorbs onto the initially clean Cu (001) surface, resulting in the rapid nucleation and growth of c(2×2)-O domains. Domain formation is concurrent with a small in-plane surface contraction and a large out-of-plane surface expansion associated with a compressive adsorbate-induced surface stress. The often reported (2√2×√2)R45 reconstruction is observed only below ~ 150 °C. Relationships between the different surface structures, subsurface oxygen, surface stress, and surface reactivity will be discussed.
Introduction: Choosing Wisely Canada guidelines suggest that in the absence of red flags or clinical indicators suggestive of serious underlying conditions, physicians should not order radiological images for patients presenting with non-specific low back pain, and current recommendations do not endorse routine prescribing of opioids for this condition. The objective of this study was to determine how many patients presenting to the ED with non-traumatic low back pain have spinal imaging and how many are discharged home on opioids. Methods: We conducted a retrospective medical record review for adult (>17 years) patients presenting to an academic tertiary care ED with non-traumatic low back pain from April 1st 2014 to March 31st 2015 (pre-guideline) and April 1st 2017 to March 31st 2018 (post-guideline). Patients were excluded if they were >70 years old, were not discharged home, had a traumatic injury, features of cauda equina syndrome, weight loss, history of cancer, fever, night sweats, chronic use of systemic corticosteroids, chronic use of illicit intravenous drugs, first episode of low back pain over 50 years of age, abnormal reflexes, loss of motor strength or loss of sensation in the legs. Results: 1060 (545 pre-guideline, 515 post-guideline) were included. Mean (SD) age was 39.6 (12.3) years and 549 (51.8%) were female. Pre-guideline, 45 (8.3%) patients had spinal imaging, compared to 39 (7.6%) post-guideline (Δ 0.7%; 95% CI: −2.6% to 4.0%). Of the 84 (7.9%) patients who had spinal imaging, 4 (8.9%) had pathologic findings pre-guideline, compared to 10 (25.6%) patients post-guideline. The proportion of patients discharged home with a prescription for opioids was lower after the Choosing Wisely Canada guidelines (40.9% vs. 11.1%; Δ29.8%; 95% CI: 24.8% to 34.7%). Conclusion: Choosing Wisely Canada guidelines did not appear to alter the rate of imaging for patients presenting to the ED with non-traumatic low back pain. Overall the rate of spinal imaging was lower than expected. The proportion of patients who were discharged home with a prescription for opioids was lower after the Choosing Wisely Canada guidelines, however we don't know if this represents an overall trend in the reduction of opioid prescribing, or a specific change in practice related to the ED management of low back pain.
Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Recent advances in techniques to generate static ultra-high pressure (>100 GPa) in the diamond anvil cell have significantly enhanced our understanding of the properties of solids under these extreme conditions. In order to characterize the structure of solids at these pressures, X-ray diffraction using synchrotron radiation has become an invaluable tool. Since the highest pressures are attained at the expense of sample volume (~ 100 μm3) , it is best to use the intense radiation available from a synchrotron to study the very small samples used in ultra-high pressure studies. Even with the intense x-ray beams currently available, it is still often desirable to focus the x-ray beam to increase the available flux. We have developed a focusing system which uses multilayer coated spherical mirrors. With this system, intense x-ray beams with sizes smaller than 10 μm by 10 μm can be achieved at a synchrotron radiation beamline. Previously, we used the focusing system for x-ray microprobe experiments.
The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.
Studies examining productive syntax have used varying elicitation methods and have tended to focus on either young children or adolescents/adults, so we lack an account of syntactic development throughout middle childhood. We describe here the results of an analysis of clause complexity in narratives produced by 354 speakers aged from four years to adulthood using the Expressive, Receptive, and Recall of Narrative Instrument (ERRNI). We show that the number of clauses per utterance increased steadily through this age range. However, the distribution of clause types depended on which of two stories was narrated, even though both stories were designed to have a similar story structure. In addition, clausal complexity was remarkably similar regardless of whether the speaker described a narrative from pictures, or whether the same narrative was recalled from memory. Finally, our findings with the youngest children showed that the task of generating a narrative from pictures may underestimate syntactic competence in those aged below five years.
Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.
Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.
A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.
Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123–127)
Central nervous system infections (CNSI) are a leading cause of death and long-term disability in children. Using ICD-10 data from 2005 to 2015 from three central hospitals in Ho Chi Minh City (HCMC), Vietnam, we exploited generalized additive mixed models (GAMM) to examine the spatial-temporal distribution and spatial and climatic risk factors of paediatric CNSI, excluding tuberculous meningitis, in this setting. From 2005 to 2015, there were 9469 cases of paediatric CNSI; 33% were ⩽1 year old at admission and were mainly diagnosed with presumed bacterial CNSI (BI) (79%), the remainder were >1 year old and mainly diagnosed with presumed non-bacterial CNSI (non-BI) (59%). The urban districts of HCMC in proximity to the hospitals as well as some outer districts had the highest incidences of BI and non-BI; BI incidence was higher in the dry season. Monthly BI incidence exhibited a significant decreasing trend over the study. Both BI and non-BI were significantly associated with lags in monthly average temperature, rainfall, and river water level. Our findings add new insights into this important group of infections in Vietnam, and highlight where resources for the prevention and control of paediatric CNSI should be allocated.
Vitamin E and selenium have been reported to improve immune function across a range of species. Ewes lambing on poor-quality dry pasture in autumn in Western Australia are at risk of being deficient in vitamin E and selenium at lambing thus predisposing their lambs to deficiencies and increasing the risk of infection and disease. This study tested the hypotheses that (i) supplementation of autumn-lambing ewes with vitamin E plus selenium in late gestation will increase the concentrations of vitamin E and selenium in plasma in the ewe and lamb and (ii) that the increased concentrations of vitamin E and selenium in plasma in the lambs will improve their innate and adaptive immune responses and thus survival. Pregnant Merino ewes were divided into a control group (n=58) which received no supplementation or a group supplemented with vitamin E plus selenium (n=55). On days 111, 125 and 140 of pregnancy ewes in the vitamin E plus selenium group were given 4 g all-rac-α-tocopherol acetate orally. On day 111 the ewes were also given 60 mg of selenium as barium selenate by subcutaneous injection. The concentrations of α-tocopherol and selenium were measured in ewes and/or lambs from day 111 of pregnancy to 14 weeks of age±10 days (weaning). Immune function of the lamb was assessed by analysing the numbers and phagocytic capacities of monocytes and polymorphonuclear leucocytes and plasma IgG and anti-tetanus toxoid antibody concentrations between birth and 14 weeks of age±10 days. Maternal supplementation with vitamin E plus selenium increased the concentration of α-tocopherol in plasma (1.13 v. 0.67 mg/l; P<0.001) and selenium in whole blood (0.12 v. 0.07 mg/l; P<0.01) of the ewes at lambing compared with controls. Supplementation also increased the concentration of α-tocopherol (0.14 v. 0.08 mg/l; P<0.001) and selenium (0.08 v. 0.05 mg/l; P<0.01) in lambs at birth compared with controls. There was no significant effect of supplementation on immune function or survival in the lambs.
Seasonal temperature variations occur in the glacier layer about 15–20 m below the surface, while at greater depths the glacier temperature depends on the long-term surface conditions. It is generally accepted that for glaciers without surface melting the temperature at 10 m depth (T10) is close to the mean annual air temperature at standard screen level (Ta), i.e. T10 =Ta. We found that this relationship is not valid for Ta above –17˚C and below –55˚C. The goal of our investigation is to find a better temperature transfer function (TTF) between Ta and temperature at the boundary of the active layer in accumulation areas of polar and tropical glaciers. Low-precision T10 temperatures from boreholes, obtained at 41 sites, are compared with air temperatures (Ta) measured in the vicinity of these sites for at least a 1 year period. We determine that when Ta falls into the temperature range –60 to –7˚C, empirical values can be approximated as T10 = 1:2Ta + 6:7. Analysis of these data suggests that high T10 occurs in the areas of the glacier that collect meltwater.
Ortles mountain (3905 m a.s.l.), South Tyrol, Italy, is the highest mountain of the Eastern European Alps, and its upper glacier, Alto dell’Ortles, presents a unique opportunity to obtain the first paleoenvironmental record from an ice core in this area. To study the suitability of this glacier as a drilling site, in 2009 we performed the first preliminary study of its glaciological characteristics at ˜3830 m a.s.l. The maximum thickness is ˜75 m, and lamination of the exposed ice layers is excellent down to bedrock. Firn and ice lenses were observed in a 10 m shallow core, and the firn/ice transition was below ˜24m. The seasonal chemical signal is clearly preserved only within the uppermost 2008 and 2009 snow/firn. A simple mass-balance model, the incipient ‘smoothing’ of the chemical record, and the observed ice lenses provide evidence that melting, infiltration and refreezing cycles occurred within the firn layers formed before 2008. Nevertheless, the mass balance of the upper part of Alto dell’Ortles was positive (˜800mma_1) during the last few years. We suggest that an environmental history is likely to be well preserved only within the ice layers formed before ˜1980, when summer air temperature was ˜2°C colder than today in this area. Clearly the continued warming trend predicted to occur over the next few decades, and the consequent increase in frequency and/or intensity of infiltration processes, will endanger the preservation of the glacial archive conserved in the deep ice layers of Ortles mountain.
A lightweight, portable drilling system for coring up to 500 m depths has been developed and field-tested. The drilling system includes four major components: (1) an electromechanical (EM) dry-hole drill; (2) an ethanol thermal electric drill; (3) a drill set-up with a 500 m cable capacity; and (4) a controller unit. The system may be switched quickly from a dry-hole EM drill to an antifreeze thermal electric drill. This lightweight system makes ice-core drilling more cost-efficient, and creates a minimal environmental impact. The new EM drill, which recovers 100 mm diameter, 1 m long pieces of ice core, is 3.2 m long and weighs 35 kg. This drill and the drilling set-up were recently tested at the Raven (former Dye 2) site, southern Greenland, where a core was recovered to 122 m. The thermal drill is 2.9 m long and weighs 25 kg. It produces 100 mm diameter, 2.1 m long pieces of ice core, and was tested to 315 m in Franz Josef Land, Eurasian Arctic. The drilling set-up with a 250 m cable weighs about 100 kg (or 128 kg for 500 m of cable). After minor adjustments this drill system retrieved cores of better quality than those recovered by other drill systems under similar glaciological conditions. After adjustments to optimize its performance, the drill retrieved 5.25 m of core per hour over the depth range 0–21 m.
A total of 11 ice cores to a maximum depth of 460 m have been obtained over the past 3 years from high-altitude glaciers on the saddle of Mount Bona and Mount Churchill in Alaska (designated B–C), and on Quelccaya ice cap and Nevado Coropuna in Peru. Ice coring was conducted using an intermediate-depth drilling system. The system includes an electromechanical drill (EMD) and an ethanol thermal electric drill (ETED). The EMD permitted an average ice-core production rate (ICPR) of 7.0 m h−1 down to 150 m. An average ICPR of 2 m h−1 to 460 m depth was possible with the ETED. The quality of the B–C ice cores is better than that of cores previously drilled with an EMD and ETED system. A new cutter design, drilling with a lubricant/cutting fluid and a new anti-torque assembly were tested in the laboratory and in glacier boreholes. We examine the performance of the drills in cold and temperate ice and in clean and particle-laden ice. The influence of the ethanol drilling fluid on ice-core isotopic, ionic and dust composition is discussed.
Ice coring of temperate and polythermal glaciers demonstrates some limitations of most electromechanical (EM) and thermal electric (TE) drills. Most TE drills are heavy, require a heavy power system, work slowly and cannot operate in boreholes going through the cold–temperate ice transition. Antifreeze thermal electric drills (ATED) are capable of operating in polar ice caps, polythermal and temperate glaciers, in boreholes filled with water and/or hydrophilic fluids. Performance of the ATED drill can be improved by using an open-top core barrel and low-power and narrow-kerf coring head. ATED-type drills can be modified for an open-top core barrel equipped with low-power coring head and include a new scheme for drilling-fluid circulation using two pumps. A small metering pump releases pure ethanol above the top of the drill, and a second pump enables circulation of the borehole fluid, an ethanol–water solution (EWS), above the kerf. Use of a narrow-kerf coring head reduces power requirements and makes it possible to design a lightweight drilling system that includes the EM and TE drills for shallow and intermediate-depth drilling.
This paper describes a new, environmentally friendly drilling technique for making short-and long-term access boreholes in shelf glaciers using lightweight drills. The new drilling technique was successfully developed for installation of small-diameter sensors under the Ross Ice Shelf through ~ 193 m thick ice at Windless Bight, McMurdo Ice Shelf, Antarctica. The two access boreholes were drilled and sensors installed in 110 working hours. The total weight of the drilling equipment including the power system and fuel is <400 kg. Installation of small-diameter sensors was possible for 1.8– 6 hours after penetration through the glacier into the sea water beneath. The new drilling technique does not require drilling fluid and therefore has minimal environmental impact. It should permit access through ice-shelf ice up to 350 m thick, or glaciers on grounded ice or subglacial lakes if there is no water-permeable interface at the base. Modifications, presented in this work, of the drilling equipment and protocol will allow for (1) ~ 21 working hours for penetration through 200 m of ice, (2) installation of sensors up to 120 mm in diameter and (3) drilling long-term open boreholes through 400 m thick ice in 100 working hours.