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Introduction: Emergency care serves as an important health resource for First Nations (FN) persons. Previous reporting shows that FN persons visit emergency departments at almost double the rate of non-FN persons. Working collaboratively with FN partners, academic researchers and health authority staff, the objective of this study is to investigate FN emergency care patient visit statistics in Alberta over a five year period. Methods: Through a population-based retrospective cohort study for the period from April 1, 2012 to March 31, 2017, patient demographics and emergency care visit characteristics for status FN patients in Alberta were analyzed and compared to non-FN statistics. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage Acuity Scale (CTAS)). Means and standard deviations (medians and interquartile ranges (IQR)) describe continuous variables (e.g., distances) as appropriate for the data distribution. These descriptions are repeated for the FN and non-FN populations, separately. Results: The data set contains 11,686,288 emergency facility visits by 3,024,491 unique persons. FN people make up 4.8% of unique patients and 9.4% of emergency care visits. FN persons live further from emergency facilities than their non-FN counterparts (FN median 6 km, IQR 1-24; vs. non-FN median 4 km, IQR 2-8). FN visits arrive more often by ground ambulance (15.3% vs. 10%). FN visits are more commonly triaged as less acute (59% CTAS levels 4 and 5, compared to non-FN 50.4%). More FN visits end in leaving without completing treatment (6.7% vs. 3.6%). FN visits are more often in the evening – 4:01pm to 12:00am (43.6% vs. 38.1%). Conclusion: In a collaborative validation session, FN Elders and health directors contextualized emergency care presentation in evenings and receiving less acute triage scores as related to difficulties accessing primary care. They explained presentation in evenings, arrival by ambulance, and leaving without completing treatment in terms of issues accessing transport to and from emergency facilities. Many factors interact to determine FN patients’ emergency care visit characteristics and outcomes. Further research needs to separate the impact of FN identity from factors such as reasons for visiting emergency facilities, distance traveled to care, and the size of facility where care is provided.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from
$z = 0.35$
to 3; and a deep, high-redshift HI IM survey over 100 deg2 from
$z = 3$
to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to
$z \sim 3$
with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to
$z = 6$
. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
The Square Kilometre Array (SKA) is a planned large radio interferometer designed to operate over a wide range of frequencies, and with an order of magnitude greater sensitivity and survey speed than any current radio telescope. The SKA will address many important topics in astronomy, ranging from planet formation to distant galaxies. However, in this work, we consider the perspective of the SKA as a facility for studying physics. We review four areas in which the SKA is expected to make major contributions to our understanding of fundamental physics: cosmic dawn and reionisation; gravity and gravitational radiation; cosmology and dark energy; and dark matter and astroparticle physics. These discussions demonstrate that the SKA will be a spectacular physics machine, which will provide many new breakthroughs and novel insights on matter, energy, and spacetime.
Tuberculosis (TB) in livestock, caused by Mycobacterium bovis, persists in many countries. In the UK and Ireland, efforts to control TB through culling of badgers (Meles meles), the principal wildlife host, have failed and there is significant interest in vaccination of badgers as an alternative or complementary strategy. Using a simulation model, we show that where TB is self-contained within the badger population and there are no external sources of infection, limited-duration vaccination at a high level of efficacy can reduce or even eradicate TB from the badger population. However, where sources of external infection persist, benefits in TB reduction in badgers can only be achieved by ongoing, annual vaccination. Vaccination is likely to be most effective as part of an integrated disease management strategy incorporating a number of different approaches across the entire host community.
We present a unique case in which closure of a large tracheoesophageal fistula was achieved with planned conservative management.
The literature was reviewed for other documented cases of spontaneous closure of traumatic tracheoesophageal fistula.
Acquired tracheoesophageal fistula may result secondary to a chemical burn from an alkaline disc battery impacted in the oesophagus, particularly when the presentation, and thus diagnosis, are delayed. This condition is rare. The majority of such cases occur in children, and are conventionally managed with surgical repair. We found only three previously reported cases in which conservative management was attempted.
Non-interventional management should be tried initially for the management of paediatric acquired tracheoesophageal fistula, to permit closure by secondary intention.
Coprolites can provide detailed information about the nutritional habits and digestive processes of the animals that produced them and may also yield information about the palaeoenvironment in which the animal existed. To test the utility of the lipid biomarker approach to coprolite analysis, lipids were extracted from a coprolite of the Pleistocene ground sloth Nothrotheriops shastensis. Gas chromatography/mass spectrometry results revealed a dominant spiroketal sapogenin component identified, using nuclear magnetic resonance spectroscopy, as epismilagenin. The dominance of epismilagenin is probably due to ingestion of Yucca spp. and Agave spp., which is consistent with previous studies on the diet of this species.
Infections by Campylobacter spp. are a major cause of gastrointestinal disease in the United Kingdom. Most cases are associated with the consumption of chicken that has become contaminated during production. We investigated the epidemiology of Campylobacter spp. in chickens in a 3-year longitudinal study of flocks reared on 30 farms in the United Kingdom. We used Generalized Linear Mixed Effect Models (GLMM) to investigate putative risk factors associated with incidence and prevalence of flock infection arising from farm and flock management and local environmental conditions during rearing. We used survival analysis to investigate infection events and associated risk factors over the course of the study using two marginal models – the independent increment approach, which assumed that individual infection events were independent; and a conditional approach, which assumed that events were conditional on those preceding. Models of flock prevalence were highly overdispersed suggesting that infection within flocks was aggregated. The key predictors of flock infection identified from the GLMM analyses were mean temperature and mean rainfall in the month of slaughter and also the presence of natural ventilation. Mean temperature in the month of slaughter was also a significant predictor of flock infection, although the analyses suggested that the risk in flocks increased in a unimodal way in relation to temperature, peaking at 12°C. The extent of pad burn was also identified as a predictor in these analyses. We conclude that predicting prevalence within flocks with linear modelling approaches is likely to be difficult, but that it may be possible to predict when flocks are at risk of Campylobacter infection. This is a key first step in managing disease and reducing the risks posed to the human food chain.
The story of Morell Mackenzie and his involvement in the case of Crown Prince Frederick III (the future Emperor of Germany) is as well known as it is controversial. The consequences of the case were profound, both medically and politically. Most documents concerning the case are affected by varying degrees of bias, and as a result our understanding of the true events is incomplete. We present a brief summary of the case, and review an unpublished manuscript which adds to our understanding of the events. This manuscript is supportive of Mackenzie's early management of the Crown Prince's illness and acknowledges the importance of the case in medical history.
Part of a large male woolly mammoth (Mammuthus primigenius) was preserved in permafrost in northern Yakutia. It was radiocarbon dated to ca. 18,50014C yr BP (ca. 22,500 cal yr BP). Dung from the lower intestine was subjected to a multiproxy array of microscopic, chemical, and molecular techniques to reconstruct the diet, the season of death, and the paleoenvironment. Pollen and plant macro-remains showed that grasses and sedges were the main food, with considerable amounts of dwarf willow twigs and a variety of herbs and mosses. Analyses of 110-bp fragments of the plastid rbcL gene amplified from DNA and of organic compounds supplemented the microscopic identifications. Fruit-bodies of dung-inhabiting Ascomycete fungi which develop after at least one week of exposure to air were found inside the intestine. Therefore the mammoth had eaten dung. It was probably mammoth dung as no bile acids were detected among the fecal biomarkers analysed. The plant assemblage and the presence of the first spring vessels of terminal tree-rings of dwarf willows indicated that the animal died in early spring. The mammoth lived in extensive cold treeless grassland vegetation interspersed with wetter, more productive meadows. The study demonstrated the paleoecological potential of several biochemical analytical techniques.
The advent of public reporting of hospital-acquired infection rates has sparked ongoing discussion about the most appropriate surveillance data to present. When we used different numerators to calculate rates of surgical site infection following coronary artery bypass graft surgery, we found that some hospitals' rates and their rankings were notably affected.
Abnormalities of the first branchial cleft are rare. They may present with a cutaneous defect in the neck, parotid region, external auditory meatus or peri-auricular area, or with inflammatory or infective lesions at these sites.
A retrospective case note review of the patients treated by the senior author is presented. This group consisted of 18 patients and represents the largest published UK series to date. Eleven patients (65 per cent) had undergone incomplete surgery prior to referral.
Over half the patients had a clinically apparent lesion in relation to the external auditory meatus. There was a variable relationship between the tract and the facial nerve, which was identified at surgery in 15 cases.
These findings are consistent with those of previously published series. Clinicians should keep this diagnosis in mind when assessing patients with infected lesions in the neck and parotid area. Surgeons should be familiar with parotid surgery, in children where appropriate, and be prepared to expose the facial nerve before embarking on the surgical management of these lesions.
We describe a new technique for inserting grommets which is both easy to master and provides better visualization of the tympanic membrane. This is particularly helpful in patients with narrow ear canals.
Post-mortem examinations of harbour porpoises, Phocoena phocoena, regularly reveal heavy parasitic worm burdens. These same post-mortem records show varying levels of polychlorinated biphenyls (PCBs) accumulating in the blubber of porpoises. Although a number of papers have documented geospatial and temporal changes of PCBs and their detrimental effects on marine mammal health, as yet none have examined their role in determining nematode burdens in wild marine mammal populations. Using a data set consisting of harbour porpoises stranded in the UK between 1989 and 2002, we found a significant, positive association between PCB levels and nematode burdens, although the nature of the relationship was confounded with porpoise sex, age and cause of death. It was also apparent that individuals with the heaviest infestations of nematodes did not have the highest PCB level: while PCBs are important, they are clearly not the sole determinants of nematode burdens in wild populations of the harbour porpoise around the UK.
Micro-Raman spectroscopy is a valuable tool for thermometry of operational polysilicon MEMS devices. By using the temperature-calibrated response of the optical phonon peak of the polysilicon Raman signature and the micron-scale spatial resolution achieved with a 488 nm Ar+ laser Raman probe, we have obtained spatially resolved steady-state thermal profiles of Joule-heated thermal flexure actuators. The measured thermal profiles are further compared to one-dimensional numerical models of the thermal response of the electrically heated devices.
A contender for future generations of CMOS technology is the strained silicon (S-Si) MOSFET. The mobility enhancement in S-Si can be exploited to maintain the performance enhancements demanded by Moore's law with reduced critical dimensions. S-Si is obtained by growth of a thin Si layer over a thick virtual substrate (VS) of relaxed silicon-germanium (SiGe). The mobility of a surface channel MOSFET is dependent on the quality of the silicon-oxide (Si/SiO2) interface. Ge may out diffuse from the virtual substrate to the oxide interface causing an increase in trapping density. As the Ge content in the virtual substrate increases surface roughness also increases. These phenomena both lead to a reduction in mobility.
The study of a matrix of devices having variable Ge composition and S-Si thickness is crucial in deconvolving the contributions of Ge diffusion and wafer cross-hatching roughness on electrical parameters. Increasing VS Ge composition increases the Ge concentration at the SSi/SiO2 interface and cross-hatching amplitude whereas reducing S-Si channel thickness only increases Ge concentration at the S-Si/SiO2 interface and does not increase cross-hatch amplitude. Interface state density, drive current, gate leakage current, transconductance and carrier mobility data are presented for this two-dimensional space of VS composition and S-Si thickness. The relative importance of Ge diffusion and cross-hatching roughness can be seen in this data. The results of this study indicate a lower limit of 7 nm for the S-Si thickness and an upper limit of approximately 20 % Ge in the virtual substrate for the current processing technology. Understanding the performance-limiting mechanisms in S-Si is crucial in the optimisation of VS Ge composition and S-Si thickness for current and future generations of S-Si CMOS.
The use of laser Raman spectroscopy to assess the residual strain in strained silicon/silicon germanium devices is well established. The peak shift associated with the 520cm−1 silicon peak can be used to directly measure the strain in the cap layer provided that the strained silicon peak can be deconvoluted from the more intense Si in SiGe peak which occurs at slightly lower wavenumbers. However, though peak position gives a measure of the macrostrains in the layer it is not useful for the assessment of microstrains associated with point defects which may also influence device performance; such microstrains influence the intensity of the Raman peaks and can, in principle, be monitored by this method. In this study we have undertaken a study of peak shape as a function of processing conditions for strained silicon on SiGe. Changes in peak position may be correlated with macrostrains and macrostrain relaxation around extended defects such as dislocations. Changes in peak width can be correlated with processes which lead to changes in composition (e.g. germanium build-up in the surface after etching) and microstrain. Such changes are not necessarily correlated with changes in macrostrain but indicate that microstrain could also be an important factor influencing device performance.