Feasibility and evaluation of an emergency department‐based general practitioner streaming and treatment service

Rationale Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services. Aims and Objectives To evaluate the acceptability, satisfaction, and potential impacts of a co-located primary care service at an emergency department. Methods This is a prospective feasibility study and service evaluation comprising a narrative summary of activity, satisfaction, well-being, and safety, and comparisons of wait times for ED services by patient category (‘minor’, ‘majors’, ‘paediatric’ or ‘resus’) before and during the service operation. Patients and staff were asked using semistructured interview topic guides about service perception, well-being, representation within 48 h, safety concerns, and/or satisfaction. Wait times for patient categories in usual ED care service were in secondary care electronic records. Pathway changes were captured under primary care electronic records. Results Approximately 96% of general practitioner streaming and treatment (GPST) patients were seen within 1 h. There was a statistically significant reduction in ED patients with minor injuries or illnesses waiting >4 h for admission or discharge ‘breaches’ during the 3 months that GPST was operating compared with the previous 3 months (p ≤ 0.005). Wait times for other ED services did not significantly improve. A total of 769 walk-in patients received GPST consultation and 661 (86%) needed no further ED intervention. Fast discharge was a major determinant of patient satisfaction. No staff expressed dissatisfaction, but some suggested possible improvements in eligibility criteria and built environment design features. Conclusion Provision of GPST correlated with shorter waits for discharge from ED. Patient and staff experiences of GPST were positive

Effect of body composition methodology on heritability estimation of body fatness

Heritability estimates of human body fatness vary widely and the contribution of body composition methodology to this variability is unknown. The effect of body composition methodology on estimations of genetic and environmental contributions to body fatness variation was examined in 78 adult male and female monozygotic twin pairs reared apart or together. Body composition was assessed by six methods - body mass index (BMI), dual energy x-ray absorptiometry (DXA), underwater weighing (UWW), total body water (TBW), bioelectric impedance (BIA), and skinfold thickness. Body fatness was expressed as percent body fat, fat mass, and fat mass/height2 to assess the effect of body fatness expression on heritability estimates. Model-fitting multivariate analyses were used to assess the genetic and environmental components of variance. Mean BMI was 24.5 kg/m2 (range of 17.8-43.4 kg/m2). There was a significant effect of body composition methodology (p<0.001) on heritability estimates, with UWW giving the highest estimate (69%) and BIA giving the lowest estimate (47%) for fat mass/height2. Expression of body fatness as percent body fat resulted in significantly higher heritability estimates (on average 10.3% higher) compared to expression as fat mass/height2 (p=0.015). DXA and TBW methods expressing body fatness as fat mass/height2 gave the least biased heritability assessments, based on the small contribution of specific genetic factors to their genetic variance. A model combining DXA and TBW methods resulted in a relatively low FM/ht2 heritability estimate of 60%, and significant contributions of common and unique environmental factors (22% and 18%, respectively). The body fatness heritability estimate of 60% indicates a smaller contribution of genetic variance to total variance than many previous studies using less powerful research designs have indicated. The results also highlight the importance of environmental factors and possibly genotype by environmental interactions in the etiology of weight gain and the obesity epidemic.R01 AR046124 - NIAMS NIH HHS; R01 MH065322 - NIMH NIH HHS; T32 HL069772 - NHLBI NIH HHS; R21 DK078867 - NIDDK NIH HHS; R37 DA018673 - NIDA NIH HHS; R01 DK076092 - NIDDK NIH HHS; R01 DK079003 - NIDDK NIH HHS; F32 DK009747 - NIDDK NIH HHS; R01 DA018673 - NIDA NIH HH

Breeding Biology of Atlantic Population Canada Geese in Nunavik, Northern Québec

The Atlantic population of Canada Geese (Branta canadensis interior) experienced a sharp decline in numbers in the late 1980s. Management agencies in Canada and the United States responded by implementing several measures, notably closing sport hunting seasons for a number of years in most Atlantic Flyway states and provinces and funding a research project to study the nesting ecology and the factors affecting productivity of this goose population. In this paper we present the nesting phenology and breeding biology of Atlantic population Canada Geese on their tundra nesting grounds in Nunavik, Québec, specifically on a primary study area (32.8 km2) along Hudson Bay (1997–2003) and on several secondary sites (most smaller than 1 km2) distributed along the coastal lowlands of Hudson Bay and Ungava Bay (1996–2005). In the late 1990s the population rebounded, with strong increases in the population of breeding pairs and the density of nests between 1996 and 2001, followed by stabilization of both variables from 2001 to 2005. As a result, there was a near doubling in productivity index (the number of goslings produced per km2) on the primary study area, from 17.9 in 1997 to 32.0 in 2003. Geese start laying eggs soon after snow disappears from their nesting grounds. On the primary study area, for all years pooled, mean clutch initiation date, clutch size, hatching date, and Mayfield nesting success were 27 May, 4.54 eggs, 26 June, and 67.3%, respectively. Among secondary sites along both Hudson Bay and Ungava Bay, we found a correlation between the annual average daily temperature for 4–24 May (the period leading up to egg-laying) and the annual mean clutch initiation date: higher temperatures were correlated with earlier initiation. Similarly, an earlier annual mean clutch initiation date was correlated with large mean clutch size.La population de l’Atlantique de la bernache du Canada (Branta canadensis interior) a subi un déclin prononcé à la fin des années 1980. Les organismes chargés de la gestion de la faune au Canada et aux États-Unis ont réagi en mettant en place plusieurs mesures. Ils ont notamment fermé la saison de chasse sportive dans la plupart des États et provinces de la voie migratoire de la population de l’Atlantique pendant un certain nombre d’années et financé un projet de recherche sur l’écologie de la nidification et sur les facteurs limitant la productivité de cette population. Dans le présent article, nous décrivons la phénologie de la nidification et la biologie de la reproduction de la population de l’Atlantique de la bernache du Canada dans son aire de nidification de la toundra du Nunavik (Québec), plus précisément dans une aire d’étude principale (32,8 km2) établie en bordure de la baie d’Hudson (1997 – 2003) et dans plusieurs sites secondaires de superficie plus modeste (dans la plupart des cas, inférieure à 1 km2) disséminés dans les basses-terres côtières de la baie d’Hudson et de la baie d’Ungava (1996 – 2005). À la fin des années 1990, la population a rebondi, le nombre de couples nicheurs et la densité des nids augmentant fortement entre 1996 et 2001 pour ensuite se stabiliser de 2001 à 2005. Par suite de ce redressement, le nombre d’oisons produits par kilomètre carré a presque doublé (indice de productivité) dans l’aire d’étude principale, passant de 17,9 en 1997 à 32,0 en 2003. La ponte débute peu après la disparition de la neige dans les sites de nidification. Dans l’aire d’étude principale, nous avons enregistré les valeurs moyennes suivantes (années regroupées) : début de la période de ponte : 27 mai; taille des couvées : 4,54 oeufs; premières éclosions : 26 juin; succès de la nidification en mai : 67,3 %. Aux sites secondaires, en bordure de la baie d’Hudson et de la baie d’Ungava, nous avons relevé une corrélation entre la température journalière moyenne annuelle pour la période du 4 au 24 mai (période précédant le début de la période de ponte) et la date annuelle moyenne du début de la ponte: les températures plus élevées donnaient une corrélation avec un début de période de ponte plus hâtif. De même, une date annuelle moyenne plus hâtive du début de la ponte a été corrélée avec une grande taille moyenne des couvées

Safety of trastuzumab (Herceptin®) during pregnancy: two case reports

We report on two cases of women on trastuzumab therapy for breast cancer who became pregnant and delivered healthy live infants. At the time of reporting the children are growing and developing normally (ages 3 and 2)

Professionalism and the Millbank Tendency: The Political Sociology of New Labour's employees

This article analyses party employees, one of the most under-researched subjects in the study of British political parties. We draw on a blend of quantitative and qualitative data in order to shed light on the social and political profiles of Labour Party staff, and on the question of their professionalisation. The latter theme is developed through a model derived from the sociology of professions. While a relatively limited proportion of party employees conform to the pure ideal-type of professionalism, a considerably greater number manifest enough of the core characteristics of specialisation, commitment, mobility, autonomy and self-regulation to be reasonably described as 'professionals in pursuit of political outcomes'

Influence of nonlocal electrodynamics on the anisotropic vortex pinning in YNi2B2CYNi_2B_2C

We have studied the pinning force density Fp of YNi_2B_2C superconductors for various field orientations. We observe anisotropies both between the c-axis and the basal plane and within the plane, that cannot be explained by usual mass anisotropy. For magnetic field $H \parallel c$, the reorientation structural transition in the vortex lattice due to nonlocality, which occurs at a field $H_1 \sim 1kOe$, manifests itself as a kink in Fp(H). When $H \bot c$, Fp is much larger and has a quite different H dependence, indicating that other pinning mechanisms are present. In this case the signature of nonlocal effects is the presence of a fourfold periodicity of Fp within the basal plane.Comment: 4 pages, 3 figure

Practical quantum cryptography for secure free-space communications

Quantum cryptography is an emerging technology in which two parties may simultaneously generate shared, secret cryptographic key material using the transmission of quantum states of light. The security of these transmissions is based on the inviolability of the laws of quantum mechanics and information-theoretically secure post-processing methods. An adversary can neither successfully tap the quantum transmissions, nor evade detection, owing to Heisenberg's uncertainty principle. In this paper we describe the theory of quantum cryptography, and the most recent results from our experimental free-space system with which we have demonstrated for the first time the feasibility of quantum key generation over a point-to-point outdoor atmospheric path in daylight. We achieved a transmission distance of 0.5 km, which was limited only by the length of the test range. Our results provide strong evidence that cryptographic key material could be generated on demand between a ground station and a satellite (or between two satellites), allowing a satellite to be securely re-keyed on orbit. We present a feasibility analysis of surface-to-satellite quantum key generation.Comment: 12 pages, 4 figure

Early development of structural networks and the impact of prematurity on brain connectivity

Preterm infants are at high risk of neurodevelopmental impairment, which may be due to altered development of brain connectivity. We aimed to (i) assess structural brain development from 25 to 45 weeks gestational age (GA) using graph theoretical approaches and (ii) test the hypothesis that preterm birth results in altered white matter network topology. Sixty-five infants underwent MRI between 25(+3) and 45(+6) weeks GA. Structural networks were constructed using constrained spherical deconvolution tractography and were weighted by measures of white matter microstructure (fractional anisotropy, neurite density and orientation dispersion index). We observed regional differences in brain maturation, with connections to and from deep grey matter showing most rapid developmental changes during this period. Intra-frontal, frontal to cingulate, frontal to caudate and inter-hemispheric connections matured more slowly. We demonstrated a core of key connections that was not affected by GA at birth. However, local connectivity involving thalamus, cerebellum, superior frontal lobe, cingulate gyrus and short range cortico-cortical connections was related to the degree of prematurity and contributed to altered global topology of the structural brain network. The relative preservation of core connections at the expense of local connections may support more effective use of impaired white matter reserve following preterm birth

Characterizing spatial and temporal variability of lightning activity associated with wildfire over Tasmania, Australia

Lightning strikes are pervasive, however, their distributions vary both spatially and in time, resulting in a complex pattern of lightning-ignited wildfires. Over the last decades, lightning-ignited wildfires have become an increasing threat in south-east Australia. Lightning in combination with drought conditions preceding the fire season can increase probability of sustained ignitions. In this study, we investigate spatial and seasonal patterns in cloud-to-ground lightning strikes in the island state of Tasmania using data from the Global Position and Tracking System (GPATS) for the period January 2011 to June 2019. The annual number of lightning strikes and the ratio of negative to positive lightning (78:22 overall) were considerably different from one year to the next. There was an average of 80 lightning days per year, however, 50% of lightning strikes were concentrated over just four days. Most lightning strikes were observed in the west and north of the state consistent with topography and wind patterns. We searched the whole population of lightning strikes for those most likely to cause wildfires up to 72 h before fire detection and within 10 km of the ignition point derived from in situ fire ignition records. Only 70% of lightning ignitions were matched up with lightning records. The lightning ignition efficiency per stroke/flash was also estimated, showing an annual average efficiency of 0.24% ignition per lightning stroke with a seasonal maximum during summer. The lightning ignition efficiency as a function of different fuel types also highlighted the role of buttongrass moorland (0.39%) in wildfire incidents across Tasmania. Understanding lightning climatology provides vital information about lightning characteristics that influence the probability that an individual stroke causes ignition over a particular landscape. This research provides fire agencies with valuable information to minimize the potential impacts of lightning-induced wildfires through early detection and effective response