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The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
We performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases.
A retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses.
Data were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution.
We used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015.
We estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP).
From 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program.
The NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.
Organic mercury, especially methylmercury, poisoning causes chronic neurological disease predominantly affecting the brain. There have been documented exposures from eating fish from contaminated waters in Japan and in northwestern Ontario and in Iraq from eating bread made from seed wheat treated with methylmercuric fungicide. The neurological disease is called Minamata disease in Japan. Visual field constriction due to involvement of the calcarine cortex, sensory disturbance due to involvement of the somatosensory cortex, and cerebellar ataxia due to involvement of granule cell neurons of the cerebellum are common and characteristic features due to methylmercury poisoning. Other neurological features include dysarthria, postural and action tremor, cognitive impairment, and hearing loss and dysequilibrium. In contrast, peripheral nerve disease is more characteristic of inorganic mercury intoxication. Similarly, psychosis is more typical of exposure to inorganic mercury, which has been documented in the felt hat industry (“mad hatter”). Laboratory tests (e.g., on blood and hair and toenail samples) are of limited value in the assessment of chronic neurological disease due to mercury poisoning because they may not reflect remote neuronal injury due to mercury. Methylmercury also causes injury to fetal brains during development. There is no effective treatment.
We aimed to improve the research consenting process by developing and evaluating simplified consent forms.
Four templates written at the eighth-tenth grade reading level were developed and trialed by a group of experts in clinical research, health literacy, national regulatory requirements, and end users. Researchers from protocols which had received expedited review were surveyed at 2 time points regarding their use and assessment of the templates.
At baseline 18/86 (20.9%) responding researchers had heard of the templates and 5 (5.8%) reported that they had used them; 2 years later, 54.2% (32/59) had heard of the templates and 87.5% (28/32) had used them (p<0.001).
Consent form templates may be one mechanism to improve patient comprehension of research protocols as well as efficiency of the review process, but require considerable time for development and implementation, and one key to their success is involvement and support from the IRB and technical staff.
Metrarabdotos Canu, 1914 and the related genera Escharoides Milne Edwards, 1836b, Adeonellopsis MacGillivray, 1886, and Reptadeonella Busk, 1884 were key taxa in the decline of Bryozoa with erect, arborescent colonies and concomitant increase in numbers of species with encrusting colonies in the late Paleogene and Neogene of tropical America. In particular, the abundance, continuity of occurrence, and diversity of Metrarabdotos before its decline have made this genus, over the past 20 years, a model taxon for detailed morphometric studies of fine-scale evolutionary tempo and mode. During the same period, significant new occurrences of both Metrarabdotos and its near relatives have been documented with detailed collections from tropical American areas not represented in the original studies.
In this paper we present a complete reanalysis of the original morphometric data (Cheetham, 1986a), incorporating the new tropical American material and comparative material of selected Metrarabdotos species from Europe and Africa in order to formalize the taxonomy of the genus, many species of which have been in open nomenclature since 1986, and to explore their possible phylogenetic relationships to each other and to Escharoides, Adeonellopsis, and Reptadeonella. The new analysis, with procedures slightly modified from those used in the original analysis, is based on more than twice the number of specimens and 20% more morphological characters. Although the results include changes in species assignments for 13% of the specimens in the original analysis, the pattern of intraspecific morphological stasis previously identified in the tropical American Neogene species, and thus the concomitant interpretation of evolutionary tempo and mode, are unaltered.
Cladistic analysis resulted in a single most parsimonious tree for the 22 tropical American Metrarabdotos species, arranged in two monophyletic crown groups and a paraphyletic stem group. The stem group, ranging from latest Eocene to late Early or early Middle Miocene in age, includes four species, two of which are new: M. aguilerai from Venezuela and M. hispaniolae from the Dominican Republic and Haiti. Crown group A comprises seven species occurring in deposits of Late Miocene to Recent age, four of which are new: M. arawakorum from Venezuela; M. boldi and M. saundersi from the Dominican Republic; and M. coatesi, which occurs in the Dominican Republic, Costa Rica, and Panama. Crown group B, comprising 11 species, ranges from Early Miocene to Recent and includes five new species: M. cubaguaense from Venezuela; M. vokesorum from the Dominican Republic, Costa Rica, and Panama; and M. tainorum, M. jungi, and M. lopezense from the Dominican Republic. Incorporation of six European and African (eastern Atlantic) species, ranging in age from Early Miocene to Recent, into cladograms with the tropical American species produced more variable results in terms of both numbers of alternative trees and the positions of the tropical American species in them. One of these species, M. thomseni from the Pleistocene of Greece, and possibly a second, M. cf. M. maleckii Cheetham, 1968 from the Miocene of the Czech Republic, are new. With one exception, the eastern Atlantic species were placed in more or less basal positions in one or the other of the crown groups, suggesting that, as hypothesized by Cheetham (1968), the “Old World” and “New World” species of Metrarabdotos represent largely independent radiations. The exception is the living species M. cookae Cheetham, 1968, from West Africa and the Cape Verde Islands, which is placed unequivocally in a terminal position in crown group B. Although the three groups of tropical American species correspond in part to subgenera of Metrarabdotos erected by Cheetham (1968), the paraphyly of the stem group and the unresolved identity of the type species of the subgenus apparently corresponding to crown group A suggest that formalizing the taxonomy of these groups is unwarranted at present.
A further cladistic analysis, incorporating the three groups of Metrarabdotos species and Escharoides, Adeonellopsis, and Reptadeonella, yielded two trees, both of which support Cheetham's (1968) hypothesis that Metrarabdotos is more closely related to Escharoides than to Adeonellopsis and Reptadeonella. Escharoides is represented in tropical American Neogene deposits by two species, one of which, E. guraboensis from the Dominican Republic, is new. Of the six tropical American Neogene species of Adeonellopsis, four are new: A. cribrospiramen and A. guraboensis from the Dominican Republic, A. limonensis from Costa Rica, and A. antilleana from Cuba and Jamaica. Three of the six tropical American Neogene species of Reptadeonella, R. buddae from the Dominican Republic, R. collinsae from the Dominican Republic, Panama, Costa Rica, and the southeastern United States, and R. buricaensis from Panama, are also new.
Objectives: To assess the etiology of cerebrospinal fluid (CSF) pleocytosis in critical care patients with seizure(s) or status epilepticus (SE). Many previous studies, some performed decades ago, concluded that CSF pleocytosis may be entirely attributable to seizure activity. Methods: We undertook a retrospective chart review of adult patients with an admitting or acquired diagnosis of seizure(s) or SE in critical care units at the Winnipeg Health Sciences Centre between 2009 and 2012. Patients were identified through a critical care information database at a tertiary care center. We limited our study to patients who had lumbar punctures at our center within 5 days of seizure(s) or SE. Results: Of 426 patients with seizures in critical care units, 51 met the inclusion criteria. Seizure subtypes included focal seizures (5 or 10%), generalized seizures (14 or 27%), and SE (32 or 63%). Twelve (seven with SE) of the 51 (24%) were found to have CSF pleocytosis. A probable etiological cause for the CSF pleocytosis was identified in all 12 cases. Conclusions: We conclude that seizures do not directly induce a CSF pleocytosis. Instead, the CSF pleocytosis more likely reflects the underlying acute or chronic brain process responsible for the seizure(s). This was not readily apparent in early studies without magnetic resonance imaging (MRI) of the brain and currently available laboratory investigations. An etiological cause of CSF pleocytosis must always be sought when patients present with seizures and it should never be assumed that seizures are the cause.
Background: An increased incidence of hospital admissions coded as acute disseminated encephalomyelitis (ADEM) was noted in Winnipeg, Manitoba, Canada, during the second wave of the influenza pandemic from October 2009 to March 2010. However, it was not clear whether this was due to heightened awareness of potential neurological complications of influenza or influenza vaccination or an actual increase in the number of cases. Methods: We extracted data from the charts of 139 patients hospitalized with an International Classification of Diseases-10 discharge code indicating ADEM (G04.0) or unspecified noninfectious encephalitis or myelitis (G04.8, G04.9) between January 2006 and December 2012. Clinical and laboratory data were reviewed by a neurologist, and diagnoses were determined using the Brighton criteria. Results: Over the entire study period, there were 22 cases of ADEM. During the peak pandemic period (April-December 2009), seven patients were hospitalized with ADEM, corresponding to a rate of 7.8/million/year; 4.7 (95% confidence interval: 1.9-11.4) times higher than the rate before or after the pandemic period. Only one patient with ADEM had received the monovalent A(H1N1)pdm09 vaccine within 12 weeks of hospitalization. Conclusions: We have found an increased incidence of ADEM during the pandemic period that may be related, at least in part, to the increased incidence of influenza during that period. However, there was no temporal relationship with the administration of A(H1N1)pdm09 or seasonal influenza vaccines. Our study provides reassurance that use of these vaccines was not associated with increased risk of ADEM.
Three new Miocene-Pliocene species of the cheilostome bryozoan Metrarabdotos from Venezuela are atypical in showing significant evidence that as many as half the colonies originated asexually (clonally) by “regeneration” from previously existing colonies, rather than almost exclusively from ancestrular zooids (products of metamorphosis of sexually produced larvae), as is characteristic of the genus. The extremely low proportion of zooids (less than two percent) recognizably committed to producing larvae (ovicelled) in these Venezuelan species agrees with that reported in a variety of Danian (Paleocene) genera in which clonal propagation has been reported to predominate. However, all but two of 17 other living and fossil species of Metrarabdotos also have fewer than two percent of their zooids ovicelled, even though all but one of more than 250 colony bases examined originated from ancestrulae. The lack of significant correlation in Metrarabdotos between frequencies of ovicelled zooids and of ancestrular colonies suggests that clonal propagation may not have diverted resources from sexual reproduction. This inference is supported by the retention in these species of a level of heritable morphologic variation (estimated by partitioning among-colonies and within-colonies variance in zooid characters) that is commensurate with that estimated for species of Metrarabdotos in which propagation was apparently entirely by sexual means. Thus, sexual reproduction throughout the genus was apparently sufficient to maintain the genetic diversity from which speciation could proceed at normal rates. As estimated by both cladistic and nearest-neighbor morphologic-stratigraphic methods, the three Venezuelan species occupy quite different positions in the inferred phylogeny of Metrarabdotos. Thus, the elevated level of clonal propagation in these species appears to be a response to local conditions, most probably high productivity associated with upwelling, that promoted more rapid vegetative growth while leaving the level of sexual reproduction unchanged.
Diets rich in fruits and vegetables (FV), which contain (poly)phenols, protect against age-related inflammation and chronic diseases. T-lymphocytes contribute to systemic cytokine production and are modulated by FV intake. Little is known about the relative potency of different (poly)phenols in modulating cytokine release by lymphocytes. We compared thirty-one (poly)phenols and six (poly)phenol mixtures for effects on pro-inflammatory cytokine release by Jurkat T-lymphocytes. Test compounds were incubated with Jurkat cells for 48 h at 1 and 30 µm, with or without phorbol ester treatment at 24 h to induce cytokine release. Three test compounds that reduced cytokine release were further incubated with primary lymphocytes at 0·2 and 1 µm for 24 h, with lipopolysaccharide added at 5 h. Cytokine release was measured, and generation of H2O2 by test compounds was determined to assess any potential correlations with cytokine release. A number of (poly)phenols significantly altered cytokine release from Jurkat cells (P<0·05), but H2O2 generation did not correlate with cytokine release. Resveratrol, isorhamnetin, curcumin, vanillic acid and specific (poly)phenol mixtures reduced pro-inflammatory cytokine release from T-lymphocytes, and there was evidence for interaction between (poly)phenols to further modulate cytokine release. The release of interferon-γ induced protein 10 by primary lymphocytes was significantly reduced following treatment with 1 µm isorhamnetin (P<0·05). These results suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and açai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation.
Worldwide, human rabies is prevalent where there is endemic dog rabies, but the disease may present unexpectedly in critical care units when suggestive clinical features have passed. In North America transmission from bats is most common and there is often no history of a bat bite or even contact with bats. Laboratory diagnostic evaluation for rabies includes serology plus skin biopsy, cerebrospinal fluid, and saliva specimens for rabies virus antigen and/or RNA detection. Rare patients have survived rabies, and most received rabies vaccine prior to the onset of illness. Therapeutic coma (midazolam and phenobarbital), ketamine, and antiviral therapies (dubbed the "Milwaukee Protocol") were given to a rabies survivor, but this therapy was likely not directly responsible for the favorable outcome. There have been many subsequent failures of similar therapeutic approaches. There is no scientific rationale for the use of therapeutic coma in human rabies. New approaches to treating human rabies need to be developed.
We compared phylogenies derived from morphological data for two cheilostome bryozoan genera, Stylopoma and Metrarabdotos, with genetic differences between species (Stylopoma) and the stratigraphic occurrence of fossils (both genera). Correspondence between species of Stylopoma defined by protein electrophoresis and on preservable skeletal morphology is excellent, despite great morphological variability within colonies and the predominance of quantitative over discrete characters. Moreover, agreement between genetic and morphological classifications increased greatly when morphological discrimination was pushed to the limit, despite inability to consistently assign all specimens to species with high confidence. This “splitting” strategy also maximized the correlation between genetic distances and the distances between species in cladistically derived phylogenies.
Fossil and living species of both genera are sufficiently abundant and widespread to provide credible limits for inferred ancestral relationships. Inclusion of fossils in cladistic analyses of Stylopoma increased the consistency of cladistic hypotheses by up to 30% and provided a more effective means of rooting trees than comparison with living species of the most closely related genus (“outgroup”). Moreover, in the case of Metrarabdotos, failure to incorporate stratigraphic information turned the cladogram virtually upside down, so that postulated ancestors first appear in the fossil record 6–16 m.y. after their putative descendants became extinct.
Stratigraphically rooted trees suggest that most well-sampled Metrarabdotos and Stylopoma species originated fully differentiated morphologically and persisted unchanged for > 1 to > 16 m.y., typically alongside their putative ancestors. Moreover, the tight correlation between phenetic, cladistic, and genetic distances among living Stylopoma species suggests that changes in all three variables occurred together during speciation. All of these observations support the punctuated equilibrium model of speciation.
During pregnancy, glycine and serine become more important because they are the primary suppliers of methyl groups for the synthesis of fetal DNA, and more glycine is required for fetal collagen synthesis as pregnancy progresses. In an earlier study, we reported that glycine flux decreased by 39 % from the first to the third trimester in pregnant adolescent girls. As serine is a primary precursor for glycine synthesis, the objective of this study was to measure and compare glycine and serine fluxes and inter-conversions in pregnant adolescent girls and adult women in the first and third trimesters. Measurements were made after an overnight fast by continuous intravenous infusions of 2H2-glycine and 15N-serine in eleven adolescent girls (17·4 (se 0·1) years of age) and in ten adult women (25·8 (se 0·5) years of age) for 4 h. Adolescent girls had significantly slower glycine flux and they made less glycine from serine in the third (P<0·05) than in the first trimester. Baby birth length was significantly shorter of adolescent girls (P=0·04) and was significantly associated with third trimester glycine flux. These findings suggest that the pregnant adolescent cannot maintain glycine flux in late pregnancy compared with early pregnancy because of decreased synthesis from serine. It is possible that the inability to maintain glycine synthesis makes her fetus vulnerable to impaired cartilage synthesis, and thus linear growth.
The Milwaukee protocol has been attributed to survival in rabies encephalitis despite a lack of scientific evidence supporting its therapeutic measures. We have reviewed the literature with reference to specific treatment recommendations made within the protocol. Current literature fails to support an important role for excitotoxicity and cerebral vasospasm in rabies encephalitis. Therapies suggested in the Milwaukee protocol include therapeutic coma, ketamine infusion, amantadine, and the screening/prophylaxis/management of cerebral vasospasm. None of these therapies can be substantiated in rabies or other forms of acute viral encephalitis. Serious concerns over the current protocol recommendations are warranted. The recommendations made by the Milwaukee protocol warrant serious reconsideration before any future use of this failed protocol.
Mitral valve prolapse has been reported to be associated with a variety of neurologic disorders, including cerebral ischemia, transient global amnesia, migraine, autonomic dysfunction, and psychiatric disease. The evidence supporting these associations and possible pathogenetic mechanisms are discussed. Some neurologic disorders may be direct complications of mitral valve prolapse, while others may occur as part of an underlying genetic defect or common link.