There has been widespread concern that neonicotinoid pesticides may be adversely impacting wild and managed bees for some years, but recently attention has shifted to examining broader effects they may be having on biodiversity. For example in the Netherlands, declines in insectivorous birds are positively associated with levels of neonicotinoid pollution in surface water. In England, the total abundance of widespread butterfly species declined by 58% on farmed land between 2000 and 2009 despite both a doubling in conservation spending in the UK, and predictions that climate change should benefit most species. Here we build models of the UK population indices from 1985 to 2012 for 17 widespread butterfly species that commonly occur at farmland sites. Of the factors we tested, three correlated significantly with butterfly populations. Summer temperature and the index for a species the previous year are both positively associated with butterfly indices. By contrast, the number of hectares of farmland where neonicotinoid pesticides are used is negatively associated with butterfly indices. Indices for 15 of the 17 species show negative associations with neonicotinoid usage. The declines in butterflies have largely occurred in England, where neonicotinoid usage is at its highest. In Scotland, where neonicotinoid usage is comparatively low, butterfly numbers are stable. Further research is needed urgently to show whether there is a causal link between neonicotinoid usage and the decline of widespread butterflies or whether it simply represents a proxy for other environmental factors associated with intensive agriculture.
In the HPTN 052 study, transmission between HIV-discordant couples was reduced by 96% when the HIV-infected partner received suppressive antiretroviral therapy (ART). We examined two transmission events where the newly infected partner was diagnosed after the HIV-infected partner (index) initiated therapy. We evaluated the sequence complexity of the viral populations and antibody reactivity in the newly infected partner to estimate the dates of transmission to the newly infected partners. In both cases, transmission most likely occurred significantly before HIV-1 diagnosis of the newly infected partner, and either just before the initiation of therapy or before viral replication was adequately suppressed by therapy of the index. This study further strengthens the conclusion about the efficacy of blocking transmission by treating the infected partner of discordant couples. However, this study does not rule out the potential for HIV-1 transmission to occur shortly after initiation of ART, and this should be recognized when antiretroviral therapy is used for HIV-1 prevention.
RapidSCAN is a new portable active crop canopy sensor with three wavebands in red, red-edge, and near infrared spectral regions. The objective of this study was to determine the potential and practical approaches of using this sensor for non-destructive diagnosis of rice nitrogen (N) status. Sixteen plot experiments and ten on-farm experiments were conducted from 2014 to 2016 in Jiansanjiang Experiment Station of the China Agricultural University and Qixing Farm in Northeast China. Two mechanistic and three semi-empirical approaches using the sensor’s default vegetation indices, normalized difference vegetation index and normalized difference red edge, were evaluated in comparison with the top performing vegetation indices selected from 51 tested indices. The results indicated that the most practical and stable method of using the RapidSCAN sensor for rice N status diagnosis is to calculate N sufficiency index with the default vegetation indices and then to estimate N nutrition index non-destructively (R(2) = 0.50-0.59). This semi-empirical approach achieved a diagnosis accuracy rate of 59-76%. The findings of this study will facilitate the application of the RapidSCAN active sensor for rice N status diagnosis across growth stages, cultivars and site-years, and thus contributing to precision N management for sustainable intensification of agriculture.
We are in the midst of an unprecedented outbreak of fungal infections associated with epidural injection of methylprednisolone that was contaminated with environmental molds. The index case, which prompted clinicians at Vanderbilt to call the Tennessee Department of Health and which brought this event to national attention, is now reported by Pettit et al. in the Journal.(1) The persistence and progression of neutrophilic meningitis of unknown cause was the trigger for obtaining the history of a recent epidural injection of methylprednisolone. Then events fell into place. After the alarm was sounded about this association, other physicians throughout the country . . .
Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial
- The British journal of general practice : the journal of the Royal College of General Practitioners
- Published over 2 years ago
Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice.
Future impacts of climate change on marine fisheries have the potential to negatively influence a wide range of socio-economic factors, including food security, livelihoods and public health, and even to reshape development trajectories and spark transboundary conflict. Yet there is considerable variability in the vulnerability of countries around the world to these effects. We calculate a vulnerability index of 147 countries by drawing on the most recent data related to the impacts of climate change on marine fisheries. Building on the Intergovernmental Panel on Climate Change framework for vulnerability, we first construct aggregate indices for exposure, sensitivity and adaptive capacity using 12 primary variables. Seven out of the ten most vulnerable countries on the resulting index are Small Island Developing States, and the top quartile of the index includes countries located in Africa (17), Asia (7), North America and the Caribbean (4) and Oceania (8). More than 87% of least developed countries are found within the top half of the vulnerability index, while the bottom half includes all but one of the Organization for Economic Co-operation and Development member states. This is primarily due to the tremendous variation in countries' adaptive capacity, as no such trends are evident from the exposure or sensitivity indices. A negative correlation exists between vulnerability and per capita carbon emissions, and the clustering of states at different levels of development across the vulnerability index suggests growing barriers to meeting global commitments to reducing inequality, promoting human well-being and ensuring sustainable cities and communities. The index provides a useful tool for prioritizing the allocation of climate finance, as well as activities aimed at capacity building and the transfer of marine technology.
The MERA monopivot centrifugal pump has been developed for use in open-heart surgery, circulatory support, and bridge-to-decision for up to 4 weeks. The pump has a closed-type, 50-mm diameter impeller with four straight paths. The impeller is supported by a monopivot bearing and is driven by a radial-flux magnet-coupling motor. Because flow visualization experiments have clarified sufficient pivot wash and stagnation at the sharp corner of the pivot support was suggested, sharp corners were removed in the design stage. The index of hemolysis of the pump operating at more than 200 mm Hg was found to be lower than that of a commercial pump. Four-week animal tests were then conducted two times; improvement of thrombus formation was seen in the female pivot through modification of female pivot geometry. Overall antithrombogenicity was also recorded. Finally, to assure mid-term use, an additional 4-week durability test revealed that the rate of the axial pivot wear was as small as 1.1 µm/day. The present in vitro and in vivo studies revealed that the MERA monopivot centrifugal pump has sufficient hemocompatibility and durability for up to 4 weeks.
BACKGROUND: Previous studies have identified four clinical characteristics associated with a favorable response to cardiac resynchronization therapy (CRT): female gender, left bundle branch block (LBBB), QRS duration ≥ 150 msec, and nonischemic etiology of heart failure. The aim of this study was to evaluate the incremental value of baseline inefficient deformation and time delay indices over clinical characteristics for predicting CRT response. METHODS: Speckle-tracking longitudinal strain was analyzed in 119 CRT candidates. Patients were divided into subgroups according to sex (male vs female), QRS morphology (LBBB vs non-LBBB), QRS duration (≥150 vs <150 msec), and heart failure etiology (ischemic vs nonischemic). Inefficient deformation was indexed by the septal systolic stretching that occurred after prematurely terminated shortening (systolic rebound stretch in the septal wall) and the absolute differences between peak strain and end-systolic strain across 16 segments (strain delay index). Time to peak strain was measured to derive the septal-to-lateral delay and the 12-segment standard deviation of time to peak strain. CRT response was defined as 6-month end-systolic volume reduction ≥ 15%. RESULTS: Patients with one of the four favorable characteristics were more likely to exhibit other favorable characteristics and had greater amounts of inefficient deformation than those without. In contrast, time delay indices were not significantly different in any pairwise comparison except for that between patients with and those without LBBB. Of the 43 patients for whom 6-month follow-up data were available, CRT response was found in 26 (60%). Systolic rebound stretch in the septal wall and strain delay index rather than time delay indices provided significant incremental value over clinical characteristics when predicting CRT response. CONCLUSIONS: Combined systolic rebound stretch in the septal wall (or strain delay index) and favorable characteristics may help identify CRT responders.
Objectives: The International Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) ontology is a knowledge base created from the Thai modification of the World Health Organization International Classification of Diseases and Related Health Problems, 10th Revision. The objectives of this research were to develop the ICD-10-TM ontology as a knowledge base for use in a semi-automated ICD coding system and to test the usability of this system. Methods: ICD concepts and relations were identified from a tabular list and alphabetical indexes. An ICD-10-TM ontology was defined in the resource description framework (RDF), notation-3 (N3) format. All ICD-10-TM contents available as Microsoft Word documents were transformed into N3 format using Python scripts. Final RDF files were validated by ICD experts. The ontology was implemented as a knowledge base by using a novel semi-automated ICD coding system. Evaluation of usability was performed by a survey of forty volunteer users. Results: The ICD-10-TM ontology consists of two main knowledge bases (a tabular list knowledge base and an index knowledge base) containing a total of 309,985 concepts and 162,092 relations. The tabular list knowledge base can be divided into an upper level ontology, which defines hierarchical relationships between 22 ICD chapters, and a lower level ontology which defines relations between chapters, blocks, categories, rubrics and basic elements (include, exclude, synonym etc.) of the ICD tabular list. The index knowledge base describes relations between keywords, modifiers in general format and a table format of the ICD index. In this research, the creation of an ICD index ontology revealed interesting findings on problems with the current ICD index structure. One problem with the current structure is that it defines conditions that complicate pregnancy and perinatal conditions on the same hierarchical level as organ system diseases. This could mislead a coding algorithm into a wrong selection of ICD code. To prevent these coding errors by an algorithm, the ICD-10-TM index structure was modified by raising conditions complicating pregnancy and perinatal conditions into a higher hierarchical level of the index knowledge base. The modified ICD-10-TM ontology was implemented as a knowledge base in semi-automated ICD-10-TM coding software. A survey of users of the software revealed a high percentage of correct results obtained from ontology searches (>95%) and user satisfaction on the usability of the ontology. Conclusion: The ICD-10-TM ontology is the first ICD-10 ontology with a comprehensive description of all concepts and relations in an ICD-10-TM tabular list and alphabetical index. A researcher developing an automated ICD coding system should be aware of The ICD index structure and the complexity of coding processes. These coding systems are not a word matching process. ICD-10 ontology should be used as a knowledge base in The ICD coding software. It can be used to facilitate successful implementation of ICD in developing countries, especially in those countries which do not have an adequate number of competent ICD coders.
Miranda J, Brunet Ll, Roset P, Farré M, Mendieta C. Reliability of two measurement indices for gingival enlargement. J Periodont Res 2012; 47: 776-782. © 2012 John Wiley & Sons A/S Background and Objective: The objective of this study was to analyze the concordance of the vertical gingival overgrowth index (GOi) and the horizontal Miranda & Brunet index (MBi) and to compare their reliability and reproducibility for an early diagnosis of gingival enlargement. A wide range of methods has been employed to determine the severity of drug-induced gingival enlargement (DIGE) that has resulted in uncertainty with regard to the prevalence of this side effect. In recent studies, different indices have been used to grade DIGE. The large variability observed between studies and the differences between vertical and horizontal gingival-enlargement measurements could be the result of the use of nonreliable indices during the measurement process. Some indices involve invasive procedures that require many measurements, or even a data-processing system, while others are less convenient and technically expensive and complex. In previous studies we used two complementary indices - the vertical GOi and the horizontal MBi. The results of these studies found some differences between both indices, with the MBi rendering higher estimates of DIGE prevalence that was attributed to its greater sensitivity for the detection of minimal changes in gingival thickness. To our knowledge, there are no studies comparing different measurement indices for gingival enlargement that are supported by statistical concordance analysis. Material and Methods: Twelve plaster casts from patients who had worn orthodontic brackets, and who had different degrees of chronic inflammatory gingival enlargement, were analyzed. Three previously trained examiners registered twice the degree of buccal overgrowth, using the GOi and MBi, in all cast models with a minimum interval of 7 d between the first and the second evaluation. In total, from each cast, measurements from 16 gingival sites were taken using the GOi, and from nine gingival units (mesial and distal sites measurements) using the MBi. Concordance analysis of the registered measurements (intra-examiner and among examiners) for each index and between indices was assessed using the nonweighted Kappa index with a confidence interval of 95%. Results: We obtained 648 values for the GOi and the MBi. The overall score 0 (indicating absence of enlargement) was 32.7% and 19.8% for GOi and MBi, respectively, score 1 (light/moderate) was 39.7% and 48.1%, and score 2 (severe) was 27.6% and 32.1%. Concordance analysis for each index showed intra-examiner Kappa values of 0.820 for the GOi and 0.830 for the MBi. Interexaminer Kappa values were 0.720 for the GOi and 0.770 for the MBi. Concordance between indices showed Kappa values for the same examiner of 0.600, whereas concordance among different examiners was 0.550. Discrepancies between indices indicated a systematic skew, with 79-82.1% of discrepancy associated with a higher value for the MBi compared with the GOi. Conclusion: Both gingival enlargement indices analyzed are reliable, complementary and applicable for measuring gingival overgrowth. However, the MBi shows, with fewer measurements, a greater sensitivity than the GOi for the detection of the early stages of gingival enlargement, being adequate for the screening of large populations at risk.