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Asthma is increasing in prevalence in school-aged children. Causes for it include psychological triggers such as anxiety, stress, and depression. Interventions that are derived from education and psychology appear promising for symptom reduction. These treatments include written emotional expression, relaxation and guided imagery, gratitude exercises, mindfulness, and yoga, amongst others. This chapter reviews the myriad causes and treatments for childhood asthma.
Introduction: In 2008 British Columbia created a nurse (RN) staffed telephone triage service, (TTS) to provide timely advice to non-911 callers (811). A perception exists that some callers are inappropriately directed to emergency departments (EDs) thereby worsening crowding. We sought to determine whether supplementary emergency physician (EP) triage would decrease ED visits while preserving caller safety and satisfaction. Methods: TTS RNs use computer algorithms and judgment to triage callers. Potentially sick callers are directed to “seek care now” (red calls). Often this is to an ED depending on acuity and time of day. In the Vancouver Health Region from April-September 2016 between 8:00-24:00 hours, a co-located EP also spoke with “red” callers to provide further guidance. Callers were followed up with 1 week and satisfaction was evaluated on a 5-point Likert scale. The TTS data was linked to the regional ED database to assess ED attendance within 7 days, and the provincial vital statistics database for 30-day mortality. Our primary outcome was the proportion of unique “red” callers who did not attend the ED compared with a historical cohort one year earlier without EP triage in place. Secondary outcomes were the proportion of “red” callers advised not to attend the ED but (a) attended, (b) admitted, or (c) died. Results: In the study period there were 5105 “red” calls of which 3440 were transferred to the EP (67.4%), 2958 of EP assessed callers (86.0%) had a family doctor, but only one-quarter of such patients could contact their family doctor. Overall, 2301/3440 “red” callers did not attend an ED (67.0%) compared to 2508/4770 in the control period (52.6%), for an absolute reduction of 14.4% (95% CI 12.2 to 16.4%, p<0.0001). In callers for those <17 years old there was a 20.3% (95% CI 16.5 to 24.1%) reduction in ED visits compared to the control group: 771/1520 (50.7%) vs 364/1067 (30.4%). 40% of callers attending an ED (458/1139) were advised to try non-ED follow up by the MD and 108 (9.5%) were admitted, with no difference in 30-day mortality between groups. Age and CTAS distribution were similar between the two groups and the non MD-transferred cohort. Mean caller satisfaction was excellent (4.7/5.0). Conclusion: EP supplementation of a RN advice service has the potential to reduce ED visits by almost 15% while providing excellent safety and satisfaction.
Private protected areas (PPAs) are a board category that includes reserves established and managed by non-government entities, including civil society organizations, businesses and private individuals. It was recently suggested that the creation of a system of PPAs in Brazil may act as a useful model for extending protected area systems internationally. While it is clear that RPPNs have an important role to play in the future development of Brazil's protected area system, there are several significant challenges that need to be overcome if they are fulfil their potential: (1) ensuring that RPPNs contribute to coverage and representation; (2) ensuring adequate governance; and (3) increasing the attractiveness of the RPPN model. While it is still too early to determine whether RPPNs constitute a robust PPA model that could (or should) be exported to other countries, they are creating new opportunities for innovation and novel management strategies that might eventually lead to a vibrant and distinctly Brazilian protected area movement.
Bentonite clay is planned to form a part of deep-geological repositories of spent nuclear fuel in several countries. The extremely long operation time of the repository requires an indepth understanding of the structure and properties of used materials. In this work the microstructure of a simplified system of Ca-montmorillonite is investigated using a set of complementary methods: X-ray diffraction, small angle X-ray scattering, nuclear magnetic resonance, transmission electron microscopy and ion exclusion. The paper presents experimental results obtained from compacted, water saturated samples in the dry density range 0.6–1.5 g/cm3. It can be observed that different methods yield similar quantification of water present in the interlamellar space. Combined results support the multiple porosity concept of the bentonite structure.
Routine laboratory testing may not detect non-O157 Shiga toxin-producing Escherichia coli (STEC) reliably. Active clinical, epidemiological, environmental health, and laboratory collaboration probably influence successful detection and study of non-O157 STEC infection. We summarized two outbreak investigations in which such coordinated efforts identified non-O157 STEC disease and led to effective control measures. Outbreak 1 involved illness associated with consuming unpasteurized apple cider from a local orchard. Public health personnel were notified by a local hospital; stool specimens from ill persons contained O111 STEC. Outbreak 2 involved bloody diarrhoea at a correctional facility. Public health personnel were notified by the facility infection control officer; O45 STEC was the implicated agent. These reports highlight the ability of non-O157 STEC to cause outbreaks and demonstrate that a coordinated effort by clinicians, infection-control practitioners, clinical diagnostic laboratorians, and public health personnel can lead to effective identification, investigation, and prevention of non-O157 STEC disease.
The spade, or snow shovel, is an item of equipment required by any community living in the snow, particularly in the accumulation area of an ice sheet, where any object placed on the snow is eventually buried beneath a continually rising surface. Roald Amundsen, Alfred Wegener, R. E. Byrd, A. R. Glen and others have described the hours and sometimes days spent by members of their expeditions moving snow by hand. The Norwegian-British-Swedish Antarctic Expedition, 1949–52 was no exception. Some shovelling is unavoidable, being a consequence of natural accumulation, but much results from the burial of stores and equipment under snowdrifts caused either by the objects themselves or by their neighbours.
Little is known about the association of eating disorder subtypes across multiple categories of substance use in population-based samples. We examined the association between eating disorders and substance use in a large population-based sample.
Female participants (n=13 297) were from the Swedish Twin Registry [Lichtenstein et al., Twin Research and Human Genetics (2006) 9, 875–882]. Substance use was examined in four defined groups – (1) anorexia nervosa (AN); (2) bulimia nervosa (BN); (3) AN and BN (ANBN); and (4) binge eating disorder (BED) as well as a referent group without eating disorder (no ED). Secondary analyses examined differences between restricting AN (RAN) and binge and/or purge AN (ANBP).
In general, eating disorders were associated with greater substance use relative to the referent. The AN group had significantly increased odds for all illicit drugs. Significant differences emerged across the RAN and ANBP groups for alcohol abuse/dependence, diet pills, stimulants, and polysubstance use with greater use in the ANBP group. Across eating disorder groups, (1) the BN and ANBN groups were more likely to report alcohol abuse/dependence relative to the AN group, (2) the ANBN group was more likely to report diet pill use relative to the AN, BN and BED groups, and (3) the BN group was more likely to report diet pill use relative to the no ED, AN and BED groups.
Eating disorders are associated with a range of substance use behaviors. Improved understanding of how they mutually influence risk could enhance understanding of etiology and prevention.
We describe an Escherichia coli O157[ratio ]H7 outbreak
associated with a fresh water lake at a
county park. Campers were surveyed for diarrhoeal illness within 10
days of their visit, and a
case-control study of day visitors was conducted. A confirmed case was a
with a stool culture positive for E. coli O157[ratio ]H7
and a probable case was a person with
bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped
by pulsed field gel
electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers
had a diarrhoeal
illness (relative risk [RR]=12·4; 95% confidence
interval [RR]=1·7–89·7). For the case-control
study, the 12 cases were more likely than controls to have purposefully
ingested lake water
(odds ratio [OR]=6·9, 95% CI=0·9–55·8).
The PFGE patterns of six clinical isolates were
indistinguishable. This report further demonstrates that contaminated
fresh-water lakes can be
the source of community outbreaks of E. coli O157[ratio ]H7.
A requirement exists in the aeronautical industry for measuring temperature non-invasively in critical components, such as the turbine disc in an operating engine. Neutron diffraction, unique among nuclear techniques, offers the possibility of measuring both temperature and strain within an operating engine by virtue of the high penetration of neutrons through industrial materials. Static diffraction experiments on Waspaloy and Ti6A14V showed, by comparison with thermocouples, that both the diffraction peak position and the peak intensity can measure the tempeiaturc to within ±6 K aL 800 K. Measurements on a rotating Waspaloy disc, heated from its rim, showed that temperature gradients could be determined accurately by lattice parameter measurements. The large grain size in Waspaloy prevented accurate peak intensity measurements in this dynamic test. Finally, the structures within a small Pratt & Whitney engine in its equatorial plane were mapped by mounting the engine on an X-Y translator on the diffractometer and moving it through a grid of positions. Possible future directions in the field will be discussed.
Lithium can be intercalated into a variety of materials using aqueous electrochemical methods, provided that certain criteria are met. The materials must be stable in concentrated Li+ aqueous solution and Li intercalation must take priority over hydrogen intercalation. We use X-ray and neutron diffraction, as well as electrochemical methods to investigate if lithium or hydrogen is intercalated into certain hosts. For example, spinel Li2Mn2O4 can be made from spinel LiMn204 by intercalating one Li per mole in an electrochemical cell with 1 M LiOH electrolyte. If the electrochemical reduction is carried out further, beyond one electron per mole, Mn(OH)2 is then formed, as we prove using neutron diffraction. By carefully selecting electrode materials and electrolyte composition it is possible to make rechargeable lithium-ion cells with aqueous electrolytes. For example, LiMn204/γ-Li0.36MnO2 can be selected as an electrode couple, and5 M LiNO3 in water as an electrolyte to make lithium-ion cells with aqueous electrolytes.
Sleeve coldworking (SCW) is a mechanical process used in the aircraft industry to strengthen fastener holes of structural parts. By cold-expanding the holes, compressive residual stresses and a high dislocation density are introduced around the holes, the effect of which is to counteract the initiation and propagation of fatigue cracks and thus increase the fatigue life of the parts. The knowledge of residual stress due to SCW is therefore crucial for assessing the fatigue properties of a treated part. In this study, residual stresses were investigated, by employing neutron and X-ray diffraction methods, in a lug specimen that was sleeve coldworked and fatigued.
The specimen had been used for testing the influence of the SCW process on fatigue life and crack propagation behaviour under constant amplitude or variable amplitude cyclic loading.
The axial and tangential components of residual strain have been measured through the region of an electron beam weld in Zr 2.5 wt.% Nb tube. Marked changes in grain orientation in the tube occur as far away as 10 mm from the weld-centre. In particular a large fraction of the grains which had an  direction aligned tangentially in the original tube were reoriented with this direction aligned axially. These grains showed high (5 x 10-4) tensile strain. Compressive strains (-5 to - 10 x I0-4) were measured in the region 5 - 10 mm from the weld-centre in those grains with  directioný aligned axially. The hoop straint vary from tensile (maximum 5 x 10-4) to compressive (maximum -5 x 10-4) as a function of distance from the weld centre.
Longevity and fecundity data are presented for cohorts of cabbage aphid, Brevicoryne brassicae (L.), reared on different hosts (Barbarea vulgaris, Brassica pekinensis, and two varieties of Brassica oleracea) and under constant and fluctuating environmental conditions. Changes in fecundity and development were the chief causes for the different rates of population increase (r) observed on each host. Alate forms developed only in the cohort reared on B. vulgaris, the most resistant host studied. Host factors, acting during the late prenatal period or during postnatal development, appear to be capable of influencing form determination in this aphid.