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This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care.
Methods:
A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to “000” that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance.
Results:
Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves.
Conclusion:
Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.
In this article we present the results of two geophysical surveys conducted at Cahokia Mounds State Historic Site. The goal was to reveal neighborhood settlement patterns at two locales located on the periphery of “Downtown” Cahokia—the densely populated administrative core—and to further understand the type and chronological affiliation of these settlements. We compared structure length and width ratios from Rattlesnake West and the Rouch Mound Group with datasets from the Cahokia and East St. Louis precincts as a proxy for chronological affiliation to understand changes to neighborhood density over time. Using noninvasive techniques to illuminate population density and neighborhood configurations, we gained a more detailed understanding of how Cahokia's communities and neighborhoods chose to adopt the building style and infrastructure of Cahokia's Downtown Precinct.
Decisions around psychiatric interventions for children and young people involve balancing respect for the child’s wishes, the need to provide benefit and relevant risk factors. We recommend establishing a framework for assessment of interventions for children with mental disabilities, using a human-rights-based approach that can be applied across jurisdictions, alongside national laws.
In epidemiological investigations, pathogen genomics can provide insights and test epidemiological hypotheses that would not have been possible through traditional epidemiology. Tools to synthesize genomic analysis with other types of data are a key requirement of genomic epidemiology. We propose a new ‘phylepic’ visualization that combines a phylogenomic tree with an epidemic curve. The combination visually links the molecular time represented in the tree to the calendar time in the epidemic curve, a correspondence that is not easily represented by existing tools. Using an example derived from a foodborne bacterial outbreak, we demonstrated that the phylepic chart communicates that what appeared to be a point-source outbreak was in fact composed of cases associated with two genetically distinct clades of bacteria. We provide an R package implementing the chart. We expect that visualizations that place genomic analyses within the epidemiological context will become increasingly important for outbreak investigations and public health surveillance of infectious diseases.
Trauma is a common cause of morbidity and mortality in humans and companion animals. Recent efforts in procedural development, training, quality systems, data collection, and research have positively impacted patient outcomes; however, significant unmet need still exists. Coordinated efforts by collaborative, translational, multidisciplinary teams to advance trauma care and improve outcomes have the potential to benefit both human and veterinary patient populations. Strategic use of veterinary clinical trials informed by expertise along the research spectrum (i.e., benchtop discovery, applied science and engineering, large laboratory animal models, clinical veterinary studies, and human randomized trials) can lead to increased therapeutic options for animals while accelerating and enhancing translation by providing early data to reduce the cost and the risk of failed human clinical trials. Active topics of collaboration across the translational continuum include advancements in resuscitation (including austere environments), acute traumatic coagulopathy, trauma-induced coagulopathy, traumatic brain injury, systems biology, and trauma immunology. Mechanisms to improve funding and support innovative team science approaches to current problems in trauma care can accelerate needed, sustainable, and impactful progress in the field. This review article summarizes our current understanding of veterinary and human trauma, thereby identifying knowledge gaps and opportunities for collaborative, translational research to improve multispecies outcomes. This translational trauma group of MDs, PhDs, and DVMs posit that a common understanding of injury patterns and resulting cellular dysregulation in humans and companion animals has the potential to accelerate translation of research findings into clinical solutions.
Commentaries on the target article offer diverse perspectives on integrative experiment design. Our responses engage three themes: (1) Disputes of our characterization of the problem, (2) skepticism toward our proposed solution, and (3) endorsement of the solution, with accompanying discussions of its implementation in existing work and its potential for other domains. Collectively, the commentaries enhance our confidence in the promise and viability of integrative experiment design, while highlighting important considerations about how it is used.
Alzheimer’s disease (AD) is experienced by > 600,000 Canadians. Disease-modifying therapies (DMTs) for earlier stages of disease are in development. Existing health system capacity constraints and the need for biomarker-driven diagnostics to confirm DMT eligibility are concerning. This study aimed to characterize the capacity gap related to early AD (eAD) treatment with DMTs in Canada.
Methods:
A capacity model was developed to simulate the flow of a patient from screening to treatment for eAD to quantify the gap between available and required healthcare resources and qualify the bottlenecks restricting the patient journey at a provincial and national level. The model inputs (epidemiological, human resource, and clinical) were evidence-based, healthcare professional-, and patient advocate-informed.
Results:
The model estimated that nationally < 2% of patients would have access to the required healthcare resources for treatment with a DMT. Eligibility assessment represented the step with the largest capacity gap across all provinces, with a wait list of about 382,000 Canadians one year following DMT introduction. The top three resource gaps included AD specialist time and positron emission tomography and magnetic resonance imaging exam slots. Sensitivity analysis showed that full reliance on cerebrospinal fluid for eligibility testing increased capacity for assessment by about 47,000 patients.
Conclusion:
This model highlights that the Canadian health system is critically under-resourced to diagnose, assess, and treat patients with eAD with DMT. It underscores an urgent need for national policy and provincial resource allocation to close the gap.
A machine learning model was created to predict the electron spectrum generated by a GeV-class laser wakefield accelerator. The model was constructed from variational convolutional neural networks, which mapped the results of secondary laser and plasma diagnostics to the generated electron spectrum. An ensemble of trained networks was used to predict the electron spectrum and to provide an estimation of the uncertainty of that prediction. It is anticipated that this approach will be useful for inferring the electron spectrum prior to undergoing any process that can alter or destroy the beam. In addition, the model provides insight into the scaling of electron beam properties due to stochastic fluctuations in the laser energy and plasma electron density.
The dominant paradigm of experiments in the social and behavioral sciences views an experiment as a test of a theory, where the theory is assumed to generalize beyond the experiment's specific conditions. According to this view, which Alan Newell once characterized as “playing twenty questions with nature,” theory is advanced one experiment at a time, and the integration of disparate findings is assumed to happen via the scientific publishing process. In this article, we argue that the process of integration is at best inefficient, and at worst it does not, in fact, occur. We further show that the challenge of integration cannot be adequately addressed by recently proposed reforms that focus on the reliability and replicability of individual findings, nor simply by conducting more or larger experiments. Rather, the problem arises from the imprecise nature of social and behavioral theories and, consequently, a lack of commensurability across experiments conducted under different conditions. Therefore, researchers must fundamentally rethink how they design experiments and how the experiments relate to theory. We specifically describe an alternative framework, integrative experiment design, which intrinsically promotes commensurability and continuous integration of knowledge. In this paradigm, researchers explicitly map the design space of possible experiments associated with a given research question, embracing many potentially relevant theories rather than focusing on just one. Researchers then iteratively generate theories and test them with experiments explicitly sampled from the design space, allowing results to be integrated across experiments. Given recent methodological and technological developments, we conclude that this approach is feasible and would generate more-reliable, more-cumulative empirical and theoretical knowledge than the current paradigm – and with far greater efficiency.
To assess the incidence of radiological inflammation within the paranasal sinuses, middle ear and mastoid in patients with confirmed severe acute respiratory syndrome coronavirus-2.
Methods
A retrospective cohort study was conducted to examine consecutive adults (aged over 18 years) with coronavirus disease 2019 (confirmed on polymerase chain reaction within 7 days of imaging) who underwent computed tomography of the head between 1 March 2020 and 24 June 2020. Lund–Mackay and mastoid and middle-ear opacification scores were used to categorise the extent of sinus and mastoid opacification on axial and coronal computed tomography images.
Results
Of 147 patients originally identified, only 83 met the inclusion criteria. Sinus opacification was present in 51.8 per cent of patients (n = 43), and middle-ear or mastoid opacification was observed in 24.1 per cent (n = 20). There was no statistically significant difference in sinus or middle-ear and mastoid opacification between patients after stratification based on 30-day all-cause mortality.
Conclusion
Radiological computed tomography findings suggest mild mucosal disease within the sinuses, middle ear and mastoid. There was no statistical correlation between such opacification and 30-day mortality.
This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness.
Method
This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018.
Results
A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary ‘pre-vestibular function testing balance diagnosis’, which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients.
Conclusion
Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing.
Drawing on examples from published research, the authors offer a perspective on the side effects that are associated with organizational interventions. This perspective is framed in the context of the many hard-won positive influences that industrial and organizational (I-O) psychologists have had on individuals, groups, organizations, and social institutions over the last century. With a few exceptions, we argue that side effects tend to receive less attention from I-O psychology researchers and practitioners than they deserve. A systematic approach to studying, monitoring, and advertising side effects is needed to better understand their causes, consequences, and the contexts in which they are most likely to emerge. The purpose of this piece is to stimulate conversations within the field about the phenomenon of side effects as well as what might be done to improve our science and practice in this domain.
Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques.
Method
A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic.
Results
The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure.
Conclusion
Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.
Implementation of clinically useful research discoveries in the academic environment is challenged by limited funding for early phase proof-of-concept studies and inadequate expertise in product development and commercialization. To address these limitations, the National Institutes of Health (NIH) established the National Centers for Accelerated Innovations (NCAI) program in 2013. Three centers competed successfully for awards through this mechanism. Here, we present the experience of one such center, the Boston Biomedical Innovation Center (B-BIC), and demonstrate its remarkable success at the translation of innovations to clinical application and commercialization, as well as skills development and education.
Wild sheep and many primitive domesticated breeds have two coats: coarse hairs covering shorter, finer fibres. Both are shed annually. Exploitation of wool for apparel in the Bronze Age encouraged breeding for denser fleeces and continuously growing white fibres. The Merino is regarded as the culmination of this process. Archaeological discoveries, ancient images and parchment records portray this as an evolutionary progression, spanning millennia. However, examination of the fleeces from feral, two-coated and woolled sheep has revealed a ready facility of the follicle population to change from shedding to continuous growth and to revert from domesticated to primitive states. Modifications to coat structure, colour and composition have occurred in timeframes and to sheep population sizes that exclude the likelihood of variations arising from mutations and natural selection. The features are characteristic of the domestication phenotype: an assemblage of developmental, physiological, skeletal and hormonal modifications common to a wide variety of species under human control. The phenotypic similarities appeared to result from an accumulation of cryptic genetic changes early during vertebrate evolution. Because they did not affect fitness in the wild, the mutations were protected from adverse selection, becoming apparent only after exposure to a domestic environment. The neural crest, a transient embryonic cell population unique to vertebrates, has been implicated in the manifestations of the domesticated phenotype. This hypothesis is discussed with reference to the development of the wool follicle population and the particular roles of Notch pathway genes, culminating in the specific cell interactions that typify follicle initiation.
Lebanon has a need for innovative approaches to increase access to mental health care to meet the country's current high demand. E-mental health has been included in its national mental health strategy while in parallel the World Health Organization has produced an online intervention called ‘Step-by-Step’ to treat symptoms of depression that is being tested in Lebanon over the coming years.
Aim.
The primary aim of this study is to conduct bottom-up, community-driven qualitative cognitive interviewing from a multi-stakeholder perspective to inform the cultural adaptation of an Internet-delivered mental health intervention based on behavioural activation in Lebanon.
Methods.
National Mental Health Programme staff conducted a total of 11 key informant interviews with three mental health professionals, six front-line workers in primary health care centres (PHCCs) and two community members. Also, eight focus group discussions, one with seven front-line workers and seven others with a total of 66 community members (Lebanese, Syrians and Palestinians) were conducted in several PHCCs to inform the adaptation of Step-by-Step. Results were transcribed and analysed thematically by the project coordinator and two research assistants.
Results.
Feedback generated from the cognitive interviewing mainly revolved around amending the story, illustrations and the delivery methods to ensure relevance and sensitivity to the local context. The results obtained have informed major edits to the content of Step-by-Step and also to the model of provision. Notably, the intervention was made approximately 30% shorter; it includes additional videos of content alongside the originally proposed comic book-style delivery; there is less emphasis on total inactivity as a symptom of low mood and more focus on enjoyable activities to lift mood; the story and ways to contact participants to provide support were updated in line with local gender norms; and many of the suggested or featured activities have been revised in line with suggestions from community members.
Conclusions.
These findings promote and advocate the use of community-driven adaptation of evidence-based psychological interventions. Some of the phenomena recorded mirror findings from other research about barriers to care seeking in the region and so changes made to the intervention should be useful in improving utility and uptake of ‘Step-by-Step’.
Antibodies at gastrointestinal mucosal membranes play a vital role in immunological protection against a range of pathogens, including helminths. Gastrointestinal health is central to efficient livestock production, and such infections cause significant losses. Fecal samples were taken from 114 cattle, across three beef farms, with matched blood samples taken from 22 of those animals. To achieve fecal antibody detection, a novel fecal supernatant was extracted. Fecal supernatant and serum samples were then analysed, using adapted enzyme-linked immunosorbent assay protocols, for levels of total immunoglobulin (Ig)A, IgG, IgM, and Teladorsagia circumcincta-specific IgA, IgG, IgM and IgE (in the absence of reagents for cattle-specific nematode species). Fecal nematode egg counts were conducted on all fecal samples. Assays performed successfully and showed that IgA was the predominant antibody in fecal samples, whereas IgG was predominant in serum. Total IgA in feces and serum correlated within individuals (0.581, P = 0.005), but other Ig types did not. Results support the hypothesis that the tested protocols are an effective method for the non-invasive assessment of cattle immunology. The method could be used as part of animal health assessments, although further work is required to interpret the relationship between results and levels of infection and immunity.
A new hydrated zinc aluminium phosphate mineral has the composition ZnAl2(PO4)2(OH)2.3H2O. It has been named kleemanite. It occurred rarely both as veinlets 1–2 mm thick, and as thin layers on surfaces of cracks and small cavities in one section of the iron ore deposit at Iron Knob, South Australia. Chemical, X-ray, thermal analysis, and optical data are given.
A new sodium aluminium sulphate phosphate has been named peisleyite. It has the ideal formula Na3Al16(SO4)2(PO4)10(OH)17 · 20H2O. It occurs as fine-grained, compact, brittle, white material on dumps at Tom's Phosphate Quarry, near Kapunda, South Australia. Strongest X-ray diffraction lines are 12.63 Å (100) 010, 7.82(35) 11, 5.41(35) 004, 7.59(30) 111. Unit cell parameters are a 13.31 ± 0.006, b 12.62 ± 0.006, c 23.15 ± 0.01 Å, β 110.0°±0.03°, Z = 2.