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To examine the effectiveness of short-term progressive muscle relaxation therapy in reducing symptoms of depression, anxiety, and aggression/agitation, in patients on an inpatient psychiatric unit. Additionally, to determine the impact of clinical and sociodemographic factors on its effectiveness.
Methods
Psychiatric inpatients at a private, community-based psychiatric hospital were invited to participate in a progressive muscle relaxation activity and filled out pre- and post-activity surveys querying symptoms of depression, anxiety, and aggression/agitation, using a created Likert scale.
Results
The 57 participants in this study showed an average decrease in every symptom domain, including -0.93 in agitation/aggressive symptoms (p<0.001), -2.14 in depressive symptoms (p<0.001), and -1.81 in anxiety symptoms (p<0.001). While diagnosis did not appear to be significantly related to change in score, patients with different primary diagnoses had changes in different symptom domains, with patients with Bipolar Disorder having statistically significant changes in aggression (-1.57, p=0.012) and depression (-2.36, p<0.001), but not in anxiety. Patients with Depression had significant changes in depression (-2.08, p<0.001) and anxiety (-1.96, p<0.001) but not in aggression/agitation, while patients with a Schizophrenia spectrum illness had changes in depression alone (-2.33, p=0.008). Sociodemographic variables had no significant impact.
Conclusions
The findings in this study indicate that a short-term progressive muscle relaxation intervention can lead to statistically and clinically significant changes across various symptom domains and in patients with a variety of psychiatric diagnoses, and support the implementation of this non-invasive and budget-friendly exercise.
Adolescence is a critical period for preventing substance use and mental health concerns, often targeted through separate school-based programs. However, co-occurrence is common and is related to worse outcomes. This study explores prevention effects of leading school-based prevention programs on co-occurring alcohol use and psychological distress.
Methods
Data from two Australian cluster randomized trials involving 8576 students in 97 schools were harmonized for analysis. Students received either health education (control) or one of five prevention programs (e.g. Climate Schools, PreVenture) with assessments at baseline and 6, 12, 24, and 30 or 36 months (from ages ~13–16). Multilevel multinomial regressions were used to predict the relative risk ratios (RRs) of students reporting co-occurring early alcohol use and psychological distress, alcohol use only, distress only, or neither (reference) across programs.
Results
The combined Climate Schools: Alcohol and Cannabis and Climate Schools: Mental Health courses (CSC) as well as the PreVenture program reduced the risk of adolescents reporting co-occurring alcohol use and psychological distress (36 months RRCSC = 0.37; RRPreVenture = 0.22). Other evaluated programs (excluding Climate Schools: Mental Health) only appeared effective for reducing the risk of alcohol use that occurred without distress.
Conclusions
Evidence-based programs exist that reduce the risk of early alcohol use with and without co-occurring psychological distress, though preventing psychological distress alone requires further exploration. Prevention programs appear to have different effects depending on whether alcohol use and distress present on their own or together, thus suggesting the need for tailored prevention strategies.
Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure’s feasibility, validity, and reliability.
Design:
Retrospective observational study
Participants:
10 CAHs
Methods:
From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.
Results:
Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).
Conclusions:
Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity—all cases identified as ASB were considered ASB—but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.
Youth self-harm (SH) is viewed as a public health concern and one of the main reasons for urgent psychiatry assessment. This systematic review sought to establish prevalence of SH among youth in Ireland.
Methods:
A systematic review using pre-defined search terms was conducted (Jan 1980–March 2024).
Results:
From a total of 204 papers identified, 18 were included. Significant variation in rates of SH was found. Limiting data to adolescent years (15–18), best estimates for overall lifetime rates of SH ranged from 1.5% (when rates of SH were reported based on a two-stage study design), to 23% (where SH was limited to non-suicidal SH). SH was typically higher in females, impulsive in nature, and occurred in the home setting. Whilst almost half of youth sought help before (43.7%) or after (49.8%) the SH episode, this was most often to a friend or family member. Overall rates of professional help seeking were low.
Conclusions:
Robust studies using clear definitions of terms, separately capturing SH with and without suicidal intent, and distinguishing SH in the context of a mental illness, are required to inform service developments. Given the frequent occurrence of SH among youth accompanied by predominance of help seeking via friends and family, it is imperative that psychoeducation is delivered to families and peers. Out of hours community and specialist mental health services are essential to address this important issue.
Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship. We aimed to determine if stewardship including the ID-UTI measure could reduce ASB treatment in CAHs.
Methods:
From October 2022 to July 2023, ten CAHs participated in an Intensive Quality Improvement Cohort (IQIC) program including 3 interventions to reduce ASB treatment: 1) learning labs (ie, didactics with shared learning), 2) mentoring, and 3) data-driven performance reports including hospital peer comparison based on the ID-UTI measure. To assess effectiveness of the IQIC program, change in the ID-UTI measure (ie, percentage of patients treated for a UTI who had ASB) was compared to two non-equivalent control outcomes (antibiotic duration and unjustified fluoroquinolone use).
Results:
Ten CAHs abstracted a total of 608 positive urine culture cases. Over the cohort period, the percentage of patients treated for a UTI who had ASB declined (aOR per month = 0.935, 95% CI: 0.873, 1.001, P = 0.055) from 28.4% (range across hospitals, 0%-63%) in the first to 18.6% (range, 0%-33%) in the final month. In contrast, antibiotic duration and unjustified fluoroquinolone use were unchanged (P = 0.768 and 0.567, respectively).
Conclusions:
The IQIC intervention, including learning labs, mentoring, and performance reports using the ID-UTI measure, was associated with a non-significant decrease in treatment of ASB, while control outcomes (duration and unjustified fluoroquinolone use) did not change.
Milk production declines as dairy cows enter late lactation, resulting in reduced milk quality and negatively impacting milk processability, such as rennet coagulation time (RCT), milk pH and ethanol stability (ES), leading to seasonality issues for milk processors. Multispecies forages, containing grass, legume and herb species, require lower N inputs and are of interest to dairy farmers. However, little is known about the effect of grazing multispecies forages on milk processability characteristics in late lactation dairy cows. Forty-five autumn-calving dairy cows in late lactation were allocated to 1 of 3 grazing forages; perennial ryegrass (PRG; Lolium perenne), perennial ryegrass and white clover (Trifolium pratense) (PRGWC), and a 6 – species multispecies forage (MULTI) containing perennial ryegrass, timothy (Phleum pratense), white clover, red clover (Trifolium repens), chicory (Cichorium intybus) and plantain (Plantago lanceolata). Cows were allocated 12 kg DM grazed forage and supplemented with a grass – silage TMR and concentrate. Forage DMI was significantly lower for cows grazing PRG. Milk yield increased when cows grazed PRGWC (18.07 kg/d) and MULTI (17.84 kg/d) compared to PRG (16.08 kg/d). Milk RCT (mins) and ES (%) were unaffected by treatment. However, offering cows PRGWC and MULTI increased the concentration of C18:2 cis – 9, 12 and C18:3 cis – 9, 12, 15 in milk compared to PRG. Compared to PRG, grazing forages containing clover and herb species improved milk yield and beneficially altered milk fatty acid profile in late lactation dairy cows without negatively impacting milk processability.
Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services.
Aim:
To establish prevalence of MH disorders among youth (under 18) in Ireland.
Method:
A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Empirical studies conducted in Ireland, in youth and focusing on MH disorders were included.
Results:
From a total of 830 papers identified, 38 papers met inclusion criteria. Significant variation in rates of MH disorders was evident based on study methodology. Screening questionnaires for general psychopathology reported rates of 4.8–17.8% scoring above clinical cut-offs, with higher rates for ADHD (7.3%). Studies examining depression ranged from 4% to 20.8%, while rates for ‘current’ MH disorder, determined by semi-structured interview, were 15.5%, while ‘lifetime’ rates varied from 19.9% to 31.2%. Fewer than half (44%) of those identified as ‘in need’ of specialist MH services were accessing CAMHS
Conclusion:
Data on MH disorders among Irish youth is limited, and studies showed significant variance in rates, making service planning difficult. There is an urgent need for serial epidemiological surveys, with clear operational criteria for clinically impairing MH difficulties. Such studies are essential to understand potential demand and service planning. This is most urgent given the expected increased demand post Covid-19.
One of the principal systematic constraints on the Epoch of Reionisation (EoR) experiment is the accuracy of the foreground calibration model. Recent results have shown that highly accurate models of extended foreground sources, and including models for sources in both the primary beam and its sidelobes, are necessary for reducing foreground power. To improve the accuracy of the source models for the EoR fields observed by the Murchison Widefield Array (MWA), we conducted the MWA Long Baseline Epoch of Reionisation Survey (LoBES). This survey consists of multi-frequency observations of the main MWA EoR fields and their eight neighbouring fields using the MWA Phase II extended array. We present the results of the first half of this survey centred on the MWA EoR0 observing field (centred at RA (J2000) $0^\mathrm{h}$, Dec (J2000) $-27^{\circ}$). This half of the survey covers an area of 3 069 degrees$^2$, with an average rms of 2.1 mJy beam–1. The resulting catalogue contains a total of 80 824 sources, with 16 separate spectral measurements between 100 and 230 MHz, and spectral modelling for 78$\%$ of these sources. Over this region we estimate that the catalogue is 90$\%$ complete at 32 mJy, and 70$\%$ complete at 10.5 mJy. The overall normalised source counts are found to be in good agreement with previous low-frequency surveys at similar sensitivities. Testing the performance of the new source models we measure lower residual rms values for peeled sources, particularly for extended sources, in a set of MWA Phase I data. The 2-dimensional power spectrum of these data residuals also show improvement on small angular scales—consistent with the better angular resolution of the LoBES catalogue. It is clear that the LoBES sky models improve upon the current sky model used by the Australian MWA EoR group for the EoR0 field.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.
To assess whether the implementation of an intensive care unit (ICU) rounding checklist reduces the number of catheter-associated urinary tract infections (CAUTIs).
Design:
Retrospective before-and-after study that took place between March 2013 and February 2017.
Setting:
An academic community hospital 16-bed, mixed surgical, cardiac, medical ICU.
Patients:
Participants were all patients admitted to the adult mixed ICU and had a diagnosis of CAUTI.
Intervention:
Initiation of an ICU rounding checklist that prompts physicians to address any use of urinary catheters with analysis comparing the preintervention period before roll out of the rounding checklist versus the postintervention periods.
Results:
There were 19 CAUTIs and 9,288 urinary catheter days (2.04 CAUTIs per 1,000 catheter days). The catheter utilization ratio increased in the first year after the intervention (0.67 vs 0.60; P = .0079), then decreased in the second year after the intervention (0.53 vs 0.60; P = .0992) and in the third year after the intervention (0.53 vs 0.60; P = .0224). The rate of CAUTI (ie, CAUTI per 1,000 urinary catheter days) decreased from 4.62 before the checklist was implemented to 2.12 in the first year after the intervention (P = .2104). The CAUTI rate was 0.45 in the second year (P = .0275) and 0.96 in the third year (P = .0532).
Conclusions:
Our study suggests that utilization of a daily rounding checklist is associated with a decrease in the rates of CAUTI in ICU patients. Incorporating a rounding checklist is feasible in the ICU.
The Murchison Widefield Array (MWA) is an open access telescope dedicated to studying the low-frequency (80–300 MHz) southern sky. Since beginning operations in mid-2013, the MWA has opened a new observational window in the southern hemisphere enabling many science areas. The driving science objectives of the original design were to observe 21 cm radiation from the Epoch of Reionisation (EoR), explore the radio time domain, perform Galactic and extragalactic surveys, and monitor solar, heliospheric, and ionospheric phenomena. All together $60+$ programs recorded 20 000 h producing 146 papers to date. In 2016, the telescope underwent a major upgrade resulting in alternating compact and extended configurations. Other upgrades, including digital back-ends and a rapid-response triggering system, have been developed since the original array was commissioned. In this paper, we review the major results from the prior operation of the MWA and then discuss the new science paths enabled by the improved capabilities. We group these science opportunities by the four original science themes but also include ideas for directions outside these categories.
The Murchison Widefield Array (MWA) is an electronically steered low-frequency (<300 MHz) radio interferometer, with a ‘slew’ time less than 8 s. Low-frequency (∼100 MHz) radio telescopes are ideally suited for rapid response follow-up of transients due to their large field of view, the inverted spectrum of coherent emission, and the fact that the dispersion delay between a 1 GHz and 100 MHz pulse is on the order of 1–10 min for dispersion measures of 100–2000 pc/cm3. The MWA has previously been used to provide fast follow-up for transient events including gamma-ray bursts (GRBs), fast radio bursts (FRBs), and gravitational waves, using systems that respond to gamma-ray coordinates network packet-based notifications. We describe a system for automatically triggering MWA observations of such events, based on Virtual Observatory Event standard triggers, which is more flexible, capable, and accurate than previous systems. The system can respond to external multi-messenger triggers, which makes it well-suited to searching for prompt coherent radio emission from GRBs, the study of FRBs and gravitational waves, single pulse studies of pulsars, and rapid follow-up of high-energy superflares from flare stars. The new triggering system has the capability to trigger observations in both the regular correlator mode (limited to ≥0.5 s integrations) and using the Voltage Capture System (VCS, 0.1 ms integration) of the MWA and represents a new mode of operation for the MWA. The upgraded standard correlator triggering capability has been in use since MWA observing semester 2018B (July–Dec 2018), and the VCS and buffered mode triggers will become available for observing in a future semester.
The search for life in the Universe is a fundamental problem of astrobiology and modern science. The current progress in the detection of terrestrial-type exoplanets has opened a new avenue in the characterization of exoplanetary atmospheres and in the search for biosignatures of life with the upcoming ground-based and space missions. To specify the conditions favourable for the origin, development and sustainment of life as we know it in other worlds, we need to understand the nature of global (astrospheric), and local (atmospheric and surface) environments of exoplanets in the habitable zones (HZs) around G-K-M dwarf stars including our young Sun. Global environment is formed by propagated disturbances from the planet-hosting stars in the form of stellar flares, coronal mass ejections, energetic particles and winds collectively known as astrospheric space weather. Its characterization will help in understanding how an exoplanetary ecosystem interacts with its host star, as well as in the specification of the physical, chemical and biochemical conditions that can create favourable and/or detrimental conditions for planetary climate and habitability along with evolution of planetary internal dynamics over geological timescales. A key linkage of (astro)physical, chemical and geological processes can only be understood in the framework of interdisciplinary studies with the incorporation of progress in heliophysics, astrophysics, planetary and Earth sciences. The assessment of the impacts of host stars on the climate and habitability of terrestrial (exo)planets will significantly expand the current definition of the HZ to the biogenic zone and provide new observational strategies for searching for signatures of life. The major goal of this paper is to describe and discuss the current status and recent progress in this interdisciplinary field in light of presentations and discussions during the NASA Nexus for Exoplanetary System Science funded workshop ‘Exoplanetary Space Weather, Climate and Habitability’ and to provide a new roadmap for the future development of the emerging field of exoplanetary science and astrobiology.
Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.
Aims
To estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).
Method
We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.
Results
The additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold.
Conclusions
In its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.
Declaration of interest
R.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.
Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.
Aims
To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).
Method
RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.
Results
After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.
Conclusions
The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Introduction: Trampoline injuries are frequent complaints of children presenting to paediatric emergency departments (PED) in Canada. The medical community has recognized the danger of recreational trampoline use, with the Canadian Paediatric Society (CPS) formally recommending against their use. A new type of trampoline recreation has recently emerged in the form of trampoline parks. Trampoline parks are dangerous, with similar rates of injury as backyard trampolines, and an increased likelihood of injuries warranting hospital admission. No current Canadian governmental or industry regulations exist for trampoline parks. This study aimed to determine the public perspective of trampoline park safety in order to provide a basis for addressing the current lack of safety recommendations around trampoline parks. Methods: Parents/caregivers of children seeking care in the PED were approached to participate in a survey regarding trampoline safety. Parents/caregivers of patients with severe injury/illness were excluded. Survey questions included demographics, safety perceptions of both home trampolines and trampoline parks, as well as awareness of the CPS statement regarding trampoline use. The survey was completed in the Research Electronic Data Capture System. Results: To date, 68 participants have completed the survey. 66% of participants (45/68) were aware of the new trampoline parks recently opening in the community. 31/68 (46%) of participants had allowed their child to visit a trampoline park. A comparison of the perception of the relative safety of trampoline parks found that 31% of participants (21/67) considered home trampolines “safe/very safe” while 39% of participants (26/66) considered trampoline parks “safe/very safe.” The median [IQR] age at which participants thought children could safely play at trampoline parks was 10 [3-15]. 43% of participants (29/67) thought the current CPS statement about backyard trampolines should apply to trampoline parks, and 93% of participants (62/67) thought the Ontario government should institute mandatory standards for trampoline parks. Conclusion: Trampoline parks are a significant emerging source of paediatric injury. Trends in preliminary data suggest that participants consider trampoline parks to be safer than backyard trampolines, and perceive that young children can safely participate in trampoline park activities. Should final survey data analysis support these trends, a call for adjustment of CPS guidelines and public policy should proceed.
A two-year (2015 and 2016) grazing study was established to compare ewe and lamb performance when grazed on a perennial ryegrass only sward compared to more diverse sward types. In that study four sward types were investigated: a perennial ryegrass (Lolium perenne) only sward receiving 163 kg nitrogen per hectare per year (N/ha/yr) (PRG); a perennial ryegrass and white clover (Trifolium repens) sward receiving 90 kg N/ha/yr (PRGWC); a six species sward (two grasses (perennial ryegrass and timothy (Phleum pratense)), two legumes (white and red clover (Trifolium pratense)) and two herbs (ribwort plantain (Plantago lanceolata) and chicory (Cichorium intybus)) receiving 90 kg N/ha/yr (6S); and a nine species sward containing cocksfoot (Dactylis glomerata), greater birdsfoot trefoil (Lotus pedunculatus) and yarrow (Achillea millefolium) in addition to the six species listed above, receiving 90 kg N/ha/yr (9S). Each sward type was managed as a separate farmlet and stocked with 30 twin-rearing ewes at a stocking rate of 12.5 ewes/ha under rotational grazing management from turnout post-lambing until housing. Lamb live weight was recorded fortnightly and lambs were drafted for slaughter at 45 kg. Ewe live weight and body condition score (BCS) were recorded on five occasions annually. Lamb faecal egg count (FEC) was recorded fortnightly and lambs were treated with anthelmintics when mean lamb FEC per sward type was above 400 eggs per gram. Ewes grazing the 6S and 9S swards had heavier (P < 0.01) live weights and BCS throughout the study than the ewes grazing the PRG sward. Lambs grazing the 6S sward were heavier than lambs grazing all other sward types of 14 weeks old (P < 0.05). Lambs grazing the PRG sward required more days to reach slaughter weight than lambs grazing all other sward types (P < 0.001). Lambs grazing the 6S and 9S swards required fewer anthelmintic treatments than lambs grazing the PRG or PRGWC swards. In conclusion, grazing multispecies swards improved ewe and lamb performance and reduced the requirement for chemical anthelmintics.