Epidemiological studies of the bacterial fish pathogen Yersinia ruckeri

A new mediumi, designated Ribose Ornithine Deoxycholate agar (ROD), was developed and used in field trials at two fish farms where fish were known to have ERM. The medium indicated that Yersinia ruckeri could occur in faeces four to six weeks before appearing in the kidney. Fxurther epidemiological studies dealing with fish condition, performance, disease signs and water isolation are presented. These factors are discussed in relation to husbandry and management practices. The minimum uihibitory concentration (MIC) values for 124 strains of F. ruckeri were detemuned. The effect of oxolinic acid, oxytetracycline and a potentiated sulphonamide, on growth patterns over a 72 h period, was also determined. Results showed the bactericidal or bacteriostatic nature of each antimicrobial agent. It was possible to increase the MIC for oxoUnic acid, oxytetracycline and a potentiated sulphonamide usmg an in vitro technique. Attempts to decrease resistance to oxolinic acid were unsuccessful. However, it was possible to reduce the MIC's for o^etracycline and a potentiated sulphonamide. The recovery of Y. ruckeri, after artificial challenge, was less from the faecal and kidney material of a vaccinated group of fish compared with a non-vaccinated group. An E L I S A technique indicated that although there was no detectable serum antibody there was a local mucosal response i n vaccinated fish. Uptake of F. ruckeri antigen was demonstrated in vaccinated and non-vaccinated fish using an immunoperoxidase technique. However, only vaccinated fish appeared to take up the antigen by an active process. A survey of salmonid farms showed that there was a tendency for those sites where ERM had been diagnosed, irrespective of vaccination, to be larger table farms with production ranging up to over 200 tonnes p:a. Certain environmental and husbandry factors were reported as coinciding with the appearance of F. ruckeri. A slight tendency to consider that vaccines had failed i n some way was also indicated. This and the use of antimicrobial agents are discussed

Mesospheric vertical thermal structure and winds on Venus from HHSMT CO spectral-line observations

We report vertical thermal structure and wind velocities in the Venusian mesosphere retrieved from carbon monoxide (12CO J=2-1 and 13CO J=2-1) spectral line observations obtained with the Heinrich Hertz Submillimeter Telescope (HHSMT). We observed the mesosphere of Venus from two days after the second Messenger flyby of Venus (on June 5 2007 at 23:10 UTC) during five days. Day-to-day and day-to-night temperature variations and short-term fluctuations of the mesospheric zonal flow were evident in our data. The extensive layer of warm air detected recently by SPICAV at 90 - to 100 km altitude is also detected in the temperature profiles reported here. These data were part of a coordinated ground-based Venus observational campaign in support of the ESA Venus Express mission. Furthermore, this study attempts to cross-calibrate space- and ground-based observations, to constrain radiative transfer and retrieval algorithms for planetary atmospheres, and to contribute to a more thorough understanding of the global patterns of circulation of the Venusian atmosphere.Comment: 35 pages, 18 figures. Shortcut URL to this page: http://www.sciencedirect.com/science/journal/0032063

Local u'g'r'i'z' Standard Stars in the Chandra Deep Field-South

Because several observing programs are underway in various spectral regimes to explore the Chandra Deep Field South (CDF-S), the value of local photometric standards is obvious. As part of an NOAO Surveys Program to establish u'g'r'i'z' standard stars in the southern hemisphere, we have observed the central region of the CDF-S to create local standards for use by other investigators using these filters. As a courtesy, we present the CDF-S standards to the public now, although the main program will not finish until mid-2005.Comment: Accepted by AJ (scheduled for October 2003 issue). 26 pages, 5 tables, 5 figures. High resolution version of Figure 7 available at http://home.fnal.gov/~dtucker/Southern_ugriz/index.htm

Development and validation of a pragmatic prehospital tool to identify stroke mimic patients

Aim Stroke mimics (SM) are non-stroke conditions producing stroke-like symptoms. Prehospital stroke identification tools prioritise sensitivity over specificity.1 It is estimated that >25% of prehospital suspected stroke patients are SM.2 Failure to identify SM creates inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool to identify SM amongst suspected prehospital stroke patients. Method The tool was developed using regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to primary hospital diagnoses (derivation dataset, n=1,650, 40% SM).3 It was refined using feedback from paramedics (n=3) and hospital clinicians (n=9), and analysis of an expanded prehospital derivation dataset (n=3,797, 41% SM (original 1650 patients included)). Results The STEAM tool combines six variables: 1 point for Systolic blood pressure 38.5°C with Abstracts A2 BMJ Open 2018;8(Suppl 1):A1–A34 (NHS). Protected by copyright. on 14 August 2019 at Manchester University NHS Foundation Trust http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.6 on 16 April 2018. Downloaded from heart rate >90 bpm; 1 point for seizures or 2 points for seizures with known diagnosis of Epilepsy; 1 point for Age <40 years or 2 points for age <30 years; 1 point for headache with known diagnosis of Migraine; 1 point for FAST-ve. A score of 2 on STEAM predicted SM diagnosis in the derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. External validation (n=1,848, 33% SM) showed 5.5% sensitivity, 99.4% specificity and a PPV of 82.5%. Conclusion STEAM uses common clinical characteristics to identify SM patients with high certainty. The benefits of using STEAM to reduce SM admissions to stroke services need to be weighed up against delayed admissions for stroke patients wrongly identified as SM. https://bmjopen.bmj.com/content/8/Suppl_1/A2.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.

The positive predictive value of stroke identification by ambulance clinicians in North East England: a retrospective cohort study

Introduction/background Accurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England. Methods This service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy. Results Ambulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine. Discussion In this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity. http://dx.doi.org/10.1136/emermed-2019-208902. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

A survey of UK paramedics’ views about their stroke training, current practice and the identification of stroke mimics

Aims ‐ Paramedics play a crucial role in identifying patients with suspected stroke and transporting them to appropriate acute care. Between 25% and 50% of suspected stroke patients are later diagnosed with a condition other than stroke known as a ‘stroke mimic’. If stroke mimics could be identified in the pre-hospital setting, unnecessary admissions to stroke units could potentially be avoided. This survey describes UK paramedics’ stroke training and practice, their knowledge about stroke mimic conditions and their thoughts about pre-hospital identification of these patients.Methods ‐ An online survey invitation was circulated to members within the UK College of Paramedics and promoted through social media (8 September 2016 and 23 October 2016). Topics included: stroke training; assessment of patients with suspected stroke; local practice; and knowledge about and identification of stroke mimics.Results ‐ There were 271 responses. Blank responses (39) and non-paramedic (1) responses were removed, leaving 231 responses from paramedics which equates to 2% of College of Paramedics membership and 1% of Health and Care Professions Council registered paramedics. The majority of respondents (78%) thought that they would benefit from more training on pre-hospital stroke care. Narrative comments focused on a desire to improve the assessment of suspected stroke patients and increase respondents’ knowledge about atypical stroke presentations and current stroke research. The Face Arm Speech Test was used by 97% of respondents to assess suspected stroke patients, although other tools such as Recognition of Stroke in the Emergency Room (17%) and Miami Emergency Neurological Deficit (11%) were also used. According to those responding, 50% of stroke patients were taken to emergency departments, 35% went straight to a stroke ward and 8% were taken directly to CT scan. Most respondents (65%) were aware of the term ‘stroke mimic’. Two-thirds of respondents (65%) thought a tool that predicted the likelihood of a suspected stroke being a stroke mimic would be useful in pre-hospital care.Conclusion ‐ This study reports a survey of UK paramedics’ views about the stroke care they provide. Conclusions are limited by the low number of responses. Assessment of suspected stroke patients was recognised as an important skill by paramedics and an area where many would like further training. Respondents’ current practice varied in terms of the stroke assessment tools used and whether suspected stroke patients were taken to the emergency department or direct to a stroke ward. A stroke mimic identification tool would be useful if it allowed stroke mimic patients to be directed to appropriate care, but it would need to have a high level of specificity and not adversely impact on time to treatment for true stroke patients

The frequency, characteristics and aetiology of stroke mimic presentations::a narrative review

A significant proportion of patients with acute stroke symptoms have an alternative ‘mimic’ diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1–64%). The prehospital median was 27% (range: 4–43%) and the thrombolysis median 10% (range: 1–25%). Seizures, migraines and psychiatric disorders are the most frequently reported causes of stroke mimics. Several characteristics are consistently associated with stroke mimics; however, they do not fully exclude the possibility of stroke. Nineteen per cent of suspected stroke patients had a mimic condition. Stroke mimics were more common with younger age and female sex. The range of mimic diagnoses, a lack of clear differentiating characteristics and the short treatment window for ischaemic stroke create challenges for early identification

Point-Focus Concentration Compact Telescoping Array: EESP Option 1 Phase Final Report for Public Release

Orbital ATK, in partnership with Mark ONeill LLC (MOLLC) and SolAero Technologies Corp., has developed a novel solar array platform, PFC-CTA, which provides a significant advance in performance and cost reduction compared to all currently available space solar systems. PFC refers to the Point Focus Concentration of light provided by MOLLCs thin, flat Fresnel optics. These lenses focus light to a point of approximately 100 times the intensity of the ambient light, onto a solar cell of approximately 1/25th the size of the lens. CTA stands for Compact Telescoping Array1, which is the solar array blanket structural platform originally devised by NASA and currently being advanced by Orbital ATK and partners under NASA and AFRL funding to a projected TRL 5+ by late-2018. The NASA Game Changing Development Extreme Environment Solar Power (EESP) Option 1 Phase study has enabled Orbital ATK to generate and refine component designs, perform component level and system performance analyses, and test prototype hardware of the key elements of PFC-CTA, and increased the TRL of PFC-specific technology elements to TRL ~5. Key performance metrics currently projected are as follows: Scalability from 300 kW per wing (AM0); Specific Power > 250 W/kg (BoL, AM0); Stowage Efficiency > 60 kW/m3; 5:1 margin on pointing tolerance vs. capability; >50% launched cost savings; Wide range of operability between Venus and Saturn by active and/or passive thermal management

Improved u′g′r′i′z′u'g'r'i'z' to UBVRCICUBVR_CI_C Transformation Equations for Main Sequence Stars

We report improved transformation equations between the $u'g'r'i'z'$ and $UBVR_CI_C$ photometric systems. Although the details of the transformations depend on luminosity class, we find a typical rms scatter on the order of 0.001 magnitude if the sample is limited to main sequence stars. Furthermore, we find an accurate transformation requires complex, multi-color dependencies for the bluer bandpasses. Results for giant stars will be reported in a subsequent paper.Comment: 7 pages, 8 figure