Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

We compared antibiotic prescribing to older people in different settings to inform antibiotic stewardship interventions. We used data linkage to stratify individuals aged 65 years and over in Northern Ireland, 1st January 2012–31st December 2013, by residence: community dwelling, care home dwelling or ‘transitioned’ if admitted to a care home. The odds of being prescribed an antibiotic by residence were analysed using logistic regression, adjusting for patient demographics and selected medication use (proxy for co-morbidities). Trends in monthly antibiotic prescribing were examined in the 6 months pre- and post-admission to the care home. The odds of being prescribed at least one antibiotic were twofold higher in care homes compared with community dwellers (adjusted odds ratio 2.05, 95% CI 1.93–2.17). There was a proportionate increase of 51.5% in the percentage prescribed an antibiotic on admission, with a monthly average of 23% receiving an antibiotic in the 6 months post admission. While clinical need likely accounts for some of the observed antibiotic prescribing in care homes we cannot rule out more liberal prescribing, given the twofold difference between care home residents and their community dwelling peers having accounted for co-morbidities. The appropriateness of antibiotic prescribing in the care home setting should be examined.

Englerophytum and Synsepalum are two closely related genera of trees and shrubs from the African tropics. Previous molecular studies have shown that these genera collectively form a clade within the subfamily Chrysophylloideae (Sapotaceae). However, little is known about the inter-relationships of the taxa within the Englerophytum–Synsepalum clade. In this study, nuclear ribosomal DNA and plastid trnH–psbA sequences were used to estimate the phylogeny within the clade. Results indicate that the clade consists of six major lineages, two composed solely of taxa from the genus Englerophytum and four composed of taxa from the genus Synsepalum. Each lineage can be distinguished by suites of vegetative and floral characters. Leaf venation patterns, calyx fusion, style length and staminodal structure were among the most useful characters for distinguishing clades. Some of the subclades within the Englerophytum–Synsepalum clade were also found to closely fit descriptions of former genera, most of which were described by Aubréville, that have since been placed in synonymy with Englerophytum and Synsepalum. The clade with the type species of Englerophytum also contains the type species of the genera Wildemaniodoxa and Zeyherella, which are confirmed as synonyms.

In the study of X-ray absorption fine structure, one is faced with the task of measuring sample absorbance over an extended wavelength region. For the sake of accuracy, these measurements are often carried out on a fixed-count basis. Manual collection of the data at a hundred or more spectrometer settings is a tedious and time-consuming chore. This paper describes an automated system for accumulating absorption data.

The equipment is used in conjunction with a Philips wide-range goniometer employed as a single-crystal spectrometer. It consists of: (1) a four-position sample changer, (2) a fixed-count selector for each sample position, (3) a five-digit counter and paper tape printer which register and record sample identification and counting times based on a 60-cps clock frequency, and (4) a programmer. The spectrometer advance is accomplished using the Philips step-scan arrangement. An IBM 7094 FORTRAN program for data reduction and computation will be described. The possibility of using X-ray absorption fine-structure measurements as a quantitative method for determining the various absorbing species will be discussed.

In (7), Veblen and Wedclerburn gave an example of a non-Desarguesian projective plane of order 9; we shall show that this plane is self-dual and can be characterized by a collineation group of order 78, somewhat like the planes associated with difference sets. Furthermore, the technique used in (7) will be generalized and we will construct a new non-Desarguesian plane of order p 2n for every positive integer n and every odd prime p.

Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25–49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8–76.1% male), Giardia (53.1–57.6%) and Campylobacter (52.1–53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.

Ice volume during the last ten 100 ka glacial cycles was driven by solar radiation flux in the Northern Hemisphere. Early minima in solar radiation combined with critical levels of atmospheric CO2 drove initial glacier expansion. Glacial cycles between Marine Isotope Stage (MIS) 24 and MIS 13, whilst at 100 ka periodicity, were irregular in amplitude, and the shift to the largest amplitude 100 ka glacial cycles occurred after MIS 16. Mountain glaciers in the mid-latitudes and Asia reached their maximum extents early in glacial cycles, then retreated as global climate became increasingly arid. In contrast, larger ice masses close to maritime moisture sources continued to build up and dominated global glacial maxima reflected in marine isotope and sea-level records. The effect of this pattern of glaciation on the state of the global atmosphere is evident in dust records from Antarctic ice cores, where pronounced double peaks in dust flux occur in all of the last eight glacial cycles. Glacier growth is strongly modulated by variations in solar radiation, especially in glacial inceptions. This external control accounts for ~50–60% of ice volume change through glacial cycles. Internal global glacier–climate dynamics account for the rest of the change, which is controlled by the geographic distributions of glaciers.

Glioblastomas (GBMs) account for nearly half of all primary malignant brain tumours, and current therapies are often only marginally effective. Our understanding of the underlying biology of these tumours and the development of new therapies have been complicated in part by widespread inter- and intratumoural heterogeneity. To characterize this heterogeneity, we performed regional subsampling of primary glioblastomas and derived organoids from these tissue samples. We then performed single-cell RNA-sequencing (scRNA-seq) on these primary regional subsamples and 1-3 matched organoids per sample. We have profiled samples from six tumour sets to date and have obtained sequencing data for 21,234 primary tissue cells and 14,742 organoid cells. While the most apparent differences in gene expression appear to be between individual tumours, we were also able to identify similar cellular subpopulations across tissue samples and across organoids. Importantly, organoids derived from the same tissue sample appeared to be composed of similar cellular subpopulations and were highly comparable to each other, indicating that replicate organoids faithfully represent the original tumour tissue. Overall, our scRNA-seq approach will help evaluate the utility of tumour-derived organoids as model systems for GBM and will aid in identifying cellular subpopulations defined by gene expression patterns, both in primary GBM regional subsamples and their associated organoids. These analyses will allow for the characterization of clonal or subclonal populations that are likely to respond to different therapeutic approaches and may also uncover novel therapeutic targets previously unrevealed through bulk analyses.

Introduction: Emergency Department Overcrowding (EDOC) is a multifactorial issue that leads to Access Block for patients needing emergency care. Identified as a national problem, patients presenting to a Canadian Emergency Department (ED) at a time of overcrowding have higher rates of admission to hospital and increased seven-day mortality. Using the well accepted input-throughput-output model to study EDOC, current research has focused on throughput as a measure of patient flow, reported as ED length of stay (LOS). In fact, ED LOS and ED beds occupied by inpatients are two “extremely important indicators of EDOC identified by a 2005 survey of Canadian ED directors. One proposed solution to improve ED throughput is to utilize a physician at triage (PAT) to rapidly assess newly arriving patients. In 2017, a pilot PAT program was trialed at Kelowna General Hospital (KGH), a tertiary care hospital, as part of a PDSA cycle. The aim was to mitigate EDOC by improving ED throughput by the end of 2018, to meet the national targets for ED LOS suggested in the 2013 CAEP position statement. Methods: During the fiscal periods 1-6 (April 1 to September 7, 2017) a PAT shift occurred daily from 1000-2200, over four long weekends. ED LOS, time to inpatient bed, time to physician initial assessment (PIA), number of British Columbia Ambulance Service (BCAS) offload delays, and number of patients who left without being seen (LWBS) were extracted from an administrative database. Results were retrospectively analyzed and compared to data from 1000-2200 of non-PAT trial days during the trial periods. Results: Median ED LOS decreased from 3.8 to 3.4 hours for high-acuity patients (CTAS 1-3), from 2.1 to 1.8 hours for low-acuity patients (CTAS 4-5), and from 9.3 to 8.0 hours for all admitted patients. During PAT trial weekends, there was a decrease in the average time to PIA by 65% (from 73 to 26 minutes for CTAS 2-5), average number of daily BCAS offload delays by 39% (from 2.3 to 1.4 delays per day), and number of patients who LWBS from 2.4% to 1.7%. Conclusion: The implementation of PAT was associated with improvements in all five measures of ED throughput, providing a potential solution for EDOC at KGH. ED LOS was reduced compared to non-PAT control days, successfully meeting the suggested national targets. PAT could improve efficiency, resulting in the ability to see more patients in the ED, and increase the quality and safety of ED practice. Next, we hope to prospectively evaluate PAT, continuing to analyze these process measures, perform a cost-benefit analysis, and formally assess ED staff and patient perceptions of the program.

Schmidt hammer (SH) sampling of 54 10Be-dated granite surfaces from the Pyrenees reveals a clear relationship between exposure and weathering through time (n=52, R 2=0.96, P<0.01) and permits the use of the SH as a numerical dating tool. To test this 10Be-SH calibration curve, 100 surfaces were sampled from five ice-front positions in the Têt catchment, eastern Pyrenees, with results verified against independent 10Be and 14C ages. Gaussian modelling differentiates Holocene (9.4±0.6 ka), Younger Dryas (12.6±0.9 ka), Oldest Dryas (16.1±0.5 ka), last glacial maximum (LGM; 24.8±0.9 ka) and Würmian maximum ice extent stages (MIE; 40.9±1.1 ka). These data confirm comparable glacier lengths during the LGM and MIE (~300 m difference), in contrast to evidence from the western Pyrenees (≥15 km), reflecting the relative influence of Atlantic and Mediterranean climates. Moreover, Pyrenean glaciers advanced significantly during the LGM, with a local maximum at ~25 ka, driven by growth of the Laurentide Ice Sheet, southward advection of the polar front, and a solar radiation minimum in the Northern Hemisphere. This calibration curve is available online (http://shed.earth) to enable wider application of this method throughout the Pyrenees.

Portugal has developed an active Antarctic programme over the past decade. Here, we examine Portuguese Antarctic activity using a variety of bibliometric measures, showing that Portuguese scientific output has grown substantially faster than the field as a whole, with quality remaining broadly constant. Antarctic science made up a growing percentage of overall Portuguese research, up to 0.14% of all papers in 2016—a level comparable to many other nations with well-established research programmes. Alongside this, Portugal has increasingly engaged in policy discussions and produced policy papers for Antarctic Treaty Consultative Meetings, some of which were based on Portuguese environmental science. The Antarctic Treaty reserves decision-making powers to ‘Consultative Parties’—those who have been recognised as demonstrating substantial research activity in the continent. Our data indicates that Portugal is currently the fourth most productive non-Consultative Party, and has similar or greater output than several Parties who have already attained consultative status—its publication record is similar to that of the Czech Republic, which became a Consultative Party in 2014. The rapid growth of Portugal's Antarctic research may make it well placed to consider attaining consultative status to the Antarctic Treaty in the near future.

The catchments of Pine Island Glacier and Thwaites Glacier in the Amundsen Sea Embayment are two of the largest, most rapidly changing, and potentially unstable sectors of the West Antarctic Ice Sheet. They are also neighboring outlets, separated by the topographically unconfined eastern shear margin of Thwaites Glacier and the southwest tributary of Pine Island Glacier. This tributary begins just downstream of the eastern shear margin and flows into the Pine Island ice shelf. As a result, it is a potential locus of interaction between the two glaciers and could result in cross-catchment feedback during the retreat of either. Here, we analyze relative basal reflectivity profiles from three radar sounding survey lines collected using the UTIG HiCARS radar system in 2004 and CReSIS MCoRDS radar system in 2012 and 2014 to investigate the extent and character of ocean access beneath the southwest tributary. These profiles provide evidence of ocean access ~12 km inland of the 1992–2011 InSAR-derived grounding line by 2014, suggesting either retreat since 2011 or the intrusion of ocean water kilometers inland of the grounding line.

Herbicide resistance has increased the need for novel weed control strategies. Fluridone has herbicidal as well as potential germination stimulant activity. The objectives of this study were to evaluate fluridone as a fall-applied germination stimulant for weed control and to assess rotational crop tolerance. Fall-applied fluridone was compared with a nontreated control in areas established with false cleavers, volunteer canola, and wild oat at Lacombe, AB, in 2014–2015 and 2015–2016, and at St Albert, AB, in 2015–2016. In the fall, there was a trend for weed densities to be higher in fluridone treatments than in untreated controls across site-years. The stimulatory effect of fluridone on weed germination was not statistically significant in fall assessments, while the weed control effect was significant in 33% of spring assessments. While fluridone reduced weed biomass for some site-years, it also reduced canola crop emergence and biomass at St Albert in 2015–2016, and caused injury symptoms on wheat and field pea. Risk of carryover to subsequent crops outweighed the benefits of using fluridone in the fall to stimulate weed germination in this study.

As chemical management options for weeds become increasingly limited due to selection for herbicide resistance, investigation of additional nonchemical tools becomes necessary. Harvest weed seed control (HWSC) is a methodology of weed management that targets and destroys weed seeds that are otherwise dispersed by harvesters following threshing. It is not known whether problem weeds in western Canada retain their seeds in sufficient quantities until harvest at a height suitable for collection. A study was conducted at three sites over 2 yr to determine whether retention and height criteria were met by wild oat, false cleavers, and volunteer canola. Wild oat consistently shed seeds early, but seed retention was variable, averaging 56% at the time of wheat swathing, with continued losses until direct harvest of wheat and fababean. The majority of retained seeds were >45 cm above ground level, suitable for collection. Cleavers seed retention was highly variable by site-year, but generally greater than wild oat. The majority of seed was retained >15 cm above ground level and would be considered collectable. Canola seed typically had >95% retention, with the majority of seed retained >15 cm above ground level. The suitability ranking of the species for management with HWSC was canola>cleavers>wild oat. Efficacy of HWSC systems in western Canada will depend on the target species and site- and year-specific environmental conditions.

Rutford Ice Stream and Carlson Inlet are neighbouring glaciers in West Antarctica. Rutford Ice Stream flows at speeds greater than 350 m a−1, whereas Carlson Inlet, which has some similar dimensions and supports a similar driving stress, flows 10–50 times slower. We discuss a range of observations concerning Carlson Inlet, and conclude that there is good indirect evidence that it is a relict ice stream, which ceased streaming more than 240 years BP, but sufficiently recently that its surface morphology, basal water content and basal morphology still retain characteristics produced by streaming. An analysis of expected subglacial drainage pathways indicates that Carlson Inlet is not streaming because it is currently starved of subglacial water, which is currently directed beneath Rutford Ice Stream. This current state of water piracy by Rutford Ice Stream is, however, sensitive to minor thickness changes on the ice streams; a ∼120 m (<4%) thickening of Rutford Ice Stream would divert almost all the subglacial water in the system towards Carlson Inlet and could reactivate its flow. The result highlights the importance of subglacial drainage in controlling ice-stream evolution and the requirement for ice-sheet models to couple ice flow with subglacial drainage.