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To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.
Design:
Pilot prospective multicenter surveillance study.
Setting:
The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.
Methods:
All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.
Results:
In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.
Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).
Conclusions:
Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
Hearing loss affects over 1.3 billion individuals worldwide, with the greatest burden among adults. Little is known regarding the association between adult-onset hearing loss and employment.
Methods
Seven databases (PubMed, Embase, Cochrane Library, ABI/Inform Collection, Business Source Ultimate, Web of Science and Scopus) were searched through to October 2018. The key word terms used related to hearing loss and employment, excluding paediatric or congenital hearing loss and deaf or culturally deaf populations.
Results
The initial search resulted in 13 144 articles. A total of 7494 articles underwent title and abstract screening, and 243 underwent full-text review. Twenty-five articles met the inclusion criteria. Studies were set in 10 predominantly high-income countries. Seven of the 25 studies analysed regionally or nationally representative datasets and controlled for key variables. Six of these seven studies reported associations between hearing loss and employment.
Conclusion
The highest quality studies currently available indicate that adult-onset hearing loss is associated with unemployment. However, considerable heterogeneity exists, and more rigorous studies that include low- and middle-income countries are needed.
Dans le cadre du développement de la classification internationale des maladies (CIM-11), les groupes de travail ont développé des propositions avec pour objectif d’améliorer l’utilité clinique de la classification. Ces propositions sont testées via la plateforme internet « Réseau Mondial de Pratique Clinique (RMPC) » permettant de conduire à des études cliniques électroniques dans les langues officielles de l’OMS, dont le français. Cette étude s’intéresse aux catégories diagnostiques des troubles de l’alimentation et des conduites alimentaires (TCA). Des nouveaux diagnostics ont été proposés tels que le trouble d’hyperphagie et le trouble d’évitement et de restriction de l’apport alimentaire.
Objectifs
– évaluer l’impact des changements spécifiques des TCA entre la CIM-10 et la CIM-11 auprès des membres francophones du RMPC ;
– évaluer la validité, l’utilité clinique des nouvelles propositions et l’accord inter-juges des participants.
Méthode
Étude mixte, internationale, conduite par internet auprès des membres francophones du RMPC.
Population
Membres du RMPC maîtrisant le français (environ 1000 professionnels) et exerçant une activité clinique.
Déroulement
La population cible recevra un email d’invitation. Les participants seront amenés à lire deux vignettes puis à poser des diagnostics et à répondre à des questions complémentaires, en se basant sur la CIM-10 ou la CIM-11 qu’ils auront reçu de façon aléatoire.
Outils
Les vignettes représenteront des cas cliniques réels et reflèteront les changements spécifiques entre la CIM-10 et la CIM-11. Elles seront ainsi présentées par pair (8 pairs possibles).
Analyse
Comparaisons :
– interparticipants portant sur l’utilisation du système diagnostique (10 ou 11) et l’attribution du diagnostic en fonction des changements spécifiques ;
– intra-participant sur l’évaluation des pairs de vignettes.
Résultats attendus
Cette étude doit permettre d’évaluer les nouvelles propositions CIM en français, en tenant compte des spécificités culturelles et linguistiques de la francophonie.
The PAtient SAtisfaction with Psychotropic (PASAP) scale is a self-completed questionnaire measuring satisfaction with psychotropic medication. The aim of the study was to describe its development in French and its psychometric properties.
Materials and methods:
Scale construction was based on an extensive search of the literature. The item reduction process required semi-structured interviews of psychiatric outpatients (n = 30). The final version of the PASAP is a 9-item, 5-point Likert-type scale, covering the scope of effectiveness and adherence. To assess the psychometric properties of the scale, French patients with an acute manic episode (n = 314) from a large European observational cohort completed the PASAP scale 3 months after psychotropic treatment initiation/change. Internal validity and reliability were assessed using principal component analysis (PCA). Concurrent validity was assessed using comparisons to physician-rated satisfaction with life, illness severity, mood relapse, compliance and side effects.
Results:
Participation rate was 68.4%. PCA was in favour of uni-dimensionality. Cronbach's α coefficient was 0.85 (95%CI 0.83–0.88). All five concurrent measures were significantly associated with the PASAP score.
Conclusion:
The PASAP scale showed good psychometric properties in a large bipolar population and thus seems adequate for evaluating treatment satisfaction. Its short length and good acceptability makes it suitable for clinical research.
To examine the associations between overall diet quality and hearing function among middle–older aged adults in the USA.
Design:
Cross-sectional analysis. Diet quality was examined using the Mediterranean Diet Score (MDS), using data from a single 24 h dietary recall. Hearing function was objectively measured by audiometry assessments and hearing loss, including high- and low-frequency hearing loss, was defined as pure-tone averages at specific ranges of hearing frequencies >25 dB. Weighted logistic regression analyses were performed to examine the associations of MDS (scored 0–9, categorized at the median as ≤3 or >3) with hearing loss and high- and low-frequency hearing loss.
Setting:
National Health and Nutrition Examination Surveys 2000–2006 and 2009–2012.
Participants:
Adults aged ≥50 years (n 1639) with valid dietary and audiometry assessments.
Results:
After adjusting for potential confounders, a non-significant trend for a protective association of higher MDS was observed for hearing loss (OR = 0·78; 95 % CI 0·49, 1·23). A significant inverse association was observed for high-frequency hearing loss (OR = 0·64; 95 % CI 0·43, 0·95). No association was found for low-frequency hearing loss among women; however, higher MDS was significantly associated with higher odds of low-frequency hearing loss among men (OR = 2·63; 95 % CI 1·39, 4·95).
Conclusions:
Among middle–older aged adults, adherence to a Mediterranean-style diet was inversely associated with hearing loss, including those at high hearing frequencies, among older adults. However, a detrimental association was observed at low hearing frequencies among men. Future investigations with a longitudinal design are needed to clarify the associations between diet quality and hearing loss.
Spinel lherzolite xenoliths from two localities in the Massif Central are undepleted in Al2O3, CaO, and Na2O. One suite from Tarreyres, is K2O depleted and amphibole-bearing whereas the other, from Monistrol d'Allier some 18 km away, is amphibole-free and has a higher mean K2O content of 0.035 wt.%. We present bulk major and minor element abundances in a harzburgite and a lherzolite from each locality and microprobe analyses of their constituent phases. Amphibole-bearing lherzolite and its pyroxenes are light-rare earth element (LREE) depleted, whereas amphibole-free lherzolite and its pyroxenes are LREE enriched. Both harzburgites and their pyroxenes are LREE enriched and one rock contains LREE enriched glass. The harzburgites are like harzburgite xenoliths from elsewhere but each lherzolite represents a previously unrecognized type of mantle in terms of the mineralogy and REE content. The implication for basalt genesis are briefly discussed.
Characterization of Brazilian agates containing a lower horizontally banded section and an upper chamber with bands parallel to the walls shows that these agates formed much later than the 135 Ma Paraná basalt host rock. Age differentiation between the two types of banding showsthat the horizontal bands formed between 43 to 63 Ma ago with a final infill of wall-lining bands between 7 and 27 Ma later. The horizontal bands have a higher Al3+ concentration and a greater crystallite size than the wall-lining layers; they have a lower mogánite contentand defect-site water content. The formation of these agates appears to be the result of a three-stage process. After the separate formation of horizontally banded and wall-lining agate, a silica infill seals the gap between the agate and the cavity wall. The detection of cristobalite in somespecimens indicates that genesis of both the horizontally banded and wall-lining deposits in the Brazilian samples proceeds along an amorphous silica → opal-CT → opal-C → chalcedony pathway.
The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015–2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015–2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015–2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.
Phytotoxicity of glyphosate (N-(phosphonomethyl) glycine), applied at 0, 0.56, 1.12, 1.68, 2.24 and 4.49 kg ai/ha to uniform, naturally growing quackgrass, [Agropyron repens (L.) Beauv.] plants, was studied with the electron microscope. Visible damage (yellowing of the leaves) to the plants was observed at the 2.24 and 4.49 kg ai/ha dosage rates within 72 hr. Similar damage became evident 120 hr after treatment at the 0.56 to 1.68 dosages. Leaf discs (1 mm in diameter) were harvested at 24, 48, 96, and 192 hr and prepared for electron microscopy by standard techniques. Cellular damage could be detected at all dosage rates as early as 24 hr after treatment. The type of damage observed was partial to complete disruption of the chloroplast envelope, and swelling of the rough endoplasmic reticulum (RER) with a subsequent formation of vesicles. With loss of integrity of the envelope, the chloroplast became completely disrupted with increased time. Other organelles within the cell were also destroyed.
Introduction/Innovation Concept: In 2014, Eastern Ontario paramedic services, their medical director staff and area community colleges developed an EMS Boot Camp experience to orient Queen’s University and the University of Ottawa emergency medicine residents to the role of paramedics and the challenges they face in the field. Current EMS ride-alongs and didactic classroom sessions were deemed ineffective at adequately preparing residents to provide online medical control. From those early discussions came the creation of a real-world, real-time (RWRT) educational experience. Methods: Specific challenges unique to paramedicine are difficult to communicate to a medical control physician at the other end of a telephone. The goal of this one-day educational experience is for residents to gain insight into the complexity and time sensitive nature of delivering medical care in the field. Residents are immersed as responding paramedics in a day of intense RWRT simulation exercises reflecting the common paramedic logistical challenges to delivering patient care in an uncontrolled and dynamic environment. Curriculum, Tool, or Material: Scenarios, run by paramedic students, are overseen by working paramedics from participating paramedic services. Residents learn proper use of key equipment found on an Ontario ambulance while familiarize themselves with patient care standards and medical directives. Scenarios focus on prehospital-specific clinical care issues; performing dynamic CPR in a moving vehicle, extricating a bariatric patient with limited personnel, large scale multi-casualty triage as well as other time sensitive, high risk procedures requiring online medical control approval (i.e. chest needle thoracostomy). Conclusion: EMS Boot Camp dispels preconceived biases regarding “what it’s really like” to deliver high quality prehospital clinical care. When providing online medical control in the future, the residents will be primed to understand and expect certain challenges that may arise. The educational experience fosters collaboration between prehospital and hospital-based providers. The sessions provide a reproducible, standardized experience for all participants; something that cannot be guaranteed with traditional EMS ride-alongs. Future sessions will evaluate participant satisfaction and self-efficacy with the use of a standard evaluation form including pre/post self-evaluations.
The development of a parametric-based indirect aircraft structural usage monitoring system using artificial neural networks is described. Flight parametric data, captured during Operational Loads Measurement have been used to predict strains or stresses at key structural locations for several military aircraft types, using mapping relationships determined by artificial neural networks. A framework for the development of a neural network-based structural usage monitor is discussed and the basic architecture of the multilayer perceptron artificial neural network is described. Additionally, results from case studies are presented. It is concluded that this technology could provide the basis for accurate, cost-effective structural usage monitoring systems across the range of military aircraft types and roles.
From necessity, military aircraft often operate in a highly fatigue damaging environment and history has shown in lost lives and aircraft the consequences of failure to appreciate fully the usage environment. The need for robust and cost effective structural usage monitoring of military aircraft to ensure operations are conducted within acceptable levels of risk is paramount. Furthermore, increased economic pressures require ever-inventive methods to be employed to maximise the lives of military fleets; structural usage monitoring will be a key asset in this drive. A highly cost effective indirect structural health and usage neural network (SHAUNN) monitoring system is proposed. A SHAUNN uses regression relationships determined by artificial neural networks to predict stresses, strains, loads, or fatigue damage from flight parameters. Within this paper the development of a SHAUNN monitoring system is described. Flight parametric data, captured during Operational Loads Measurement of the Royal Air Force Dominie TMk1 aircraft have been used to predict stresses at the key structural location in the wing, using mapping relationships determined by artificial neural networks. A framework for the development of the SHAUNN monitoring system is discussed and the basic architecture of the multilayer perceptron artificial neural network is described. It is concluded that this technology could provide the basis for an accurate, cost-effective structural usage monitoring system and further work to investigate the prediction of ground – based stresses in the wing is recommended.
Background: There are no disease modifying agents for the treatment of Alzheimer’s disease (AD). Pathologically, AD is associated with the misfolding of two peptides: beta-amyloid (plaques) and tau (tangles). Methods: Using large-scale computer simulations, we modelled the misfolding of both beta-amyloid and tau, identifying a common conformational motif (CCM; i.e. an abnormal peptide shape), present in both beta-amyloid and tau, that promotes their misfolding. We screened a library of 11.8 million compounds against this in silico model of protein misfolding, identifying three novel molecular classes of putative therapeutics as anti-protein misfolding agents. We synthesized approximately 400 new chemical entity drug-like molecules in each of these three classes (i.e. 1200 potential drug candidates). These were comprehensively screened in a battery of five in vitro protein oligomerization assays. Selected compounds were next evaluated in the APP/PS1 doubly transgenic mouse model of AD. Results: Two new classes of molecules were identified with the ability to block the oligomerization of both beta-amyloid and tau. These compounds are drug-like with good pharmacokinetic properties and are brain-penetrant. They exhibit excellent efficacy in transgenic mouse models. Conclusion: Computer aided drug design has enabled the discovery of novel drug-like molecules able to inhibit both tau and beta-amyloid misfolding.
We analysed a cross-sectional telephone survey of U.S. adults to assess the impact of selected characteristics on healthcare-seeking behaviours and treatment practices of people with influenza-like illness (ILI) from September 2009 to March 2010. Of 216 431 respondents, 8·1% reported ILI. After adjusting for selected characteristics, respondents aged 18–64 years with the following factors were more likely to report ILI: a diagnosis of asthma [adjusted odds ratio (aOR) 1·88, 95% CI 1·67–2·13] or heart disease (aOR 1·41, 95% CI 1·17–1·70), being disabled (aOR 1·75, 95% CI 1·57–1·96), and reporting financial barriers to healthcare access (aOR 1·63, 95% CI 1·45–1·82). Similar associations were seen in respondents aged ⩾65 years. Forty percent of respondents with ILI sought healthcare, and 14% who sought healthcare reported receiving influenza antiviral treatment. Treatment was not more frequent in patients with high-risk conditions, except those aged 18–64 years with heart disease (aOR 1·90, 95% CI 1·03–3·51). Of patients at high risk for influenza complications, self-reported ILI was greater but receipt of antiviral treatment was not, despite guidelines recommending their use in this population.
There is increasing emphasis on the need for effective ways of sharing knowledge to enhance environmental management and sustainability. Knowledge exchange (KE) are processes that generate, share and/or use knowledge through various methods appropriate to the context, purpose, and participants involved. KE includes concepts such as sharing, generation, coproduction, comanagement, and brokerage of knowledge. This paper elicits the expert knowledge of academics involved in research and practice of KE from different disciplines and backgrounds to review research themes, identify gaps and questions, and develop a research agenda for furthering understanding about KE. Results include 80 research questions prefaced by a review of research themes. Key conclusions are: (1) there is a diverse range of questions relating to KE that require attention; (2) there is a particular need for research on understanding the process of KE and how KE can be evaluated; and (3) given the strong interdependency of research questions, an integrated approach to understanding KE is required. To improve understanding of KE, action research methodologies and embedding evaluation as a normal part of KE research and practice need to be encouraged. This will foster more adaptive approaches to learning about KE and enhance effectiveness of environmental management.
At the summit of the Antarctic plateau, Dome A offers an intriguing location for future large scale optical astronomical observatories. The Gattini Dome A project was created to measure the optical sky brightness and large area cloud cover of the winter-time sky above this high altitude Antarctic site. The wide field camera and multi-filter system was installed on the PLATO instrument module as part of the Chinese-led traverse to Dome A in January 2008. This automated wide field camera consists of an Apogee U4000 interline CCD coupled to a Nikon fisheye lens enclosed in a heated container with glass window. The system contains a filter mechanism providing a suite of standard astronomical photometric filters (Bessell B, V, R) and a long-pass red filter for the detection and monitoring of airglow emission. The system operated continuously throughout the 2009, and 2011 winter seasons and part-way through the 2010 season, recording long exposure images sequentially for each filter. We have in hand one complete winter-time dataset (2009) returned via a manned traverse. We present here the first measurements of sky brightness in the photometric V band, cloud cover statistics measured so far and an estimate of the extinction.