To determine whether drinking water contaminated with antimicrobial-resistant E. coli is associated with the carriage of resistant E. coli, selected households sending water samples to Ontario and ...Alberta laboratories in 2005–2006 were asked to participate in a cross-sectional study. Household members aged ⩾12 years were asked to complete a questionnaire and to submit a rectal swab. In 878 individuals, 41% carried a resistant strain of E. coli and 28% carried a multidrug-resistant strain. The risk of carriage of resistant E. coli was 1·26 times higher for users of water contaminated with resistant E. coli. Other risk factors included international travel prevalence ratio (PR) 1·33, having a child in nappies (PR 1·33), being male (PR 1·33), and frequent handling of raw red meats (PR 1·10). Protecting private water sources (e.g. by improving systems to test and treat them) may help slow the emergence of antimicrobial resistance in E. coli.
Aim
To investigate the interdependence between risk factors associated with long‐term intellectual development in individuals with tuberous sclerosis complex (TSC).
Method
The Tuberous Sclerosis 2000 ...Study is a prospective longitudinal study of individuals with TSC. In phase 1 of the study, baseline measures of intellectual ability, epilepsy, cortical tuber load, and mutation were obtained for 125 children (63 females, 62 males; median age=39mo). In phase 2, at an average of 8 years later, intellectual abilities were estimated for 88 participants with TSC and 35 unaffected siblings. Structural equation modelling was used to determine the risk pathways from genetic mutation through to IQ at phase 2.
Results
Intellectual disability was present in 57% of individuals with TSC. Individuals without intellectual disability had significantly lower mean IQ compared to unaffected siblings, supporting specific genetic factors associated with intellectual impairment. Individuals with TSC who had a slower gain in IQ from infancy to middle childhood were younger at seizure onset and had increased infant seizure severity. Structural equation modelling indicated indirect pathways from genetic mutation, to tuber count, to seizure severity in infancy, through to IQ in middle childhood and adolescence.
Interpretation
Early‐onset and severe epilepsy in the first 2 years of life are associated with increased risk of long‐term intellectual disability in individuals with TSC, emphasizing the importance of early and effective treatment or prevention of epilepsy.
What this paper adds
Intellectual disability was present in 57% of individuals with tuberous sclerosis complex (TSC).
Those with TSC without intellectual disability had significantly lower mean IQ compared to unaffected siblings.
Earlier onset and greater severity of seizures in the first 2 years were observed in individuals with a slower gain in intellectual ability.
Risk pathways through seizures in the first 2 years predict long‐term cognitive outcomes in individuals with TSC.
What this paper adds
Intellectual disability was present in 57% of individuals with tuberous sclerosis complex (TSC).
Those with TSC without intellectual disability had significantly lower mean IQ compared to unaffected siblings.
Earlier onset and greater severity of seizures in the first 2 years were observed in individuals with a slower gain in intellectual ability.
Risk pathways through seizures in the first 2 years predict long‐term cognitive outcomes in individuals with TSC.
This article is commented on by Curatolo on page 269 of this issue.
MERLIN is designed to be a high intensity, medium energy resolution spectrometer. As such, it will complement the high-resolution MAPS spectrometer at ISIS. MERLIN will utilise all the latest ...advances in technology with a supermirror guide to enhance flux as well as 3
m long position-sensitive detectors in a vacuum making it ideal for single-crystal users. The detector bank will cover a massive π steradians of solid angle with an angular range from −45° to +135° degrees in the horizontal plane and ±30° degrees in the vertical plane. This will allow large swathes of
Q,
ω space to be accessed in a single run. The instrument will be ready for commissioning in February 2006. This paper presents details of design and performance of this new instrument.
Dimensionality is one of the most important parameters of physical phenomena. Only two things determine the universality class of a phase transition: the dimensionality of a given system and the ...symmetry of the order parameter. In most cases, the dimensionality of a substance is predetermined by its crystal structure. Examples in which the effective dimensionality is reduced are quite rare. Here we show that the three-dimensional cubic system of Tl(2)Ru(2)O(7) most probably evolves into a one-dimensional spin-one Haldane system with a spin gap below 120 K, accompanied by anomalies in the structure, resistivity and susceptibility. We argue that these anomalies are due to an orbital ordering of Ru 4d electrons, with a strong coupling among three degrees of freedom: orbital, spin and lattice. Our work provides a unique example of the spontaneous formation of Haldane system with an insight into the intriguing interplay of different degrees of freedom.
We present bulk property measurements of NpIr, a newly synthesized member of the Np-Ir binary phase diagram, which is isostructural to the noncentrosymmetric pressure-induced ferromagnetic ...superconductor UIr. Magnetic susceptibility, electronic transport properties at ambient and high pressure, and heat capacity measurements have been performed for temperatures T = 0.55-300 K in a range of magnetic fields up to 14 T and under pressure up to 17.3 GPa. These reveal that NpIr is a moderately heavy fermion Kondo system with strong antiferromagnetic interactions, but there is no evidence of any phase transition down to 0.55 K or at the highest pressure achieved. Experimental results are compared with ab initio calculations of the electronic band structure and lattice heat capacity. An extremely low lattice thermal conductivity is predicted for NpIr at temperatures above 300 K.
Competency-based medical education (CBME) curricula are becoming increasingly common in graduate medical education. Put simply, CBME is focused on educational outcomes, is independent of methods and ...time, and is composed of achievable competencies.1 In spite of widespread uptake, there remains much to learn about implementing CBME at the program level. Leveraging the collective experience of program leaders at Queen’s University, where CBME simultaneously launched across 29 specialty programs in 2017, this paper leverages change management theory to provide a short summary of how program leaders can navigate the successful preparation, launch, and initial implementation of CBME within their residency programs.
The current pandemic of a novel influenza A (H1N1) virus, commonly referred to as "swine flu", began in Mexico in March 2009 and reached the UK in April 2009. By 21 July 2009, more than 850 suspected ...cases of influenza had been seen at Birmingham Heartlands Hospital (BHH), including 52 adults with laboratory-confirmed pandemic H1N1 influenza who were admitted. Of seven patients (13%) requiring intensive care, six needed mechanical ventilation, two needed extra-corporeal membrane oxygenation (ECMO) and one died. Of the 52 admitted adults, 42 (81%) had respiratory symptoms or signs and positive PCR tests for novel Influenza A (H1N1) virus. These patients also had chest radiographs (CXR) taken, which were abnormal for 12 patients (29%). Of these, six patients had bilateral consolidation, which was bibasal in three and widespread in three; all six had pleural effusions. A further six patients had unilateral consolidation with predominantly basal changes; one of these patients had a pleural effusion. The odds ratio for requiring intubation and ventilation with H1N1 influenza and an abnormal CXR was 29.0 (95% confidence interval 2.93-287.0). CXR changes were not common in swine flu, but a significant minority of those requiring admission had consolidation on their CXR. Those who required admission and had CXR changes are more likely to require intubation and ventilation than those without abnormalities on CXR.
Abstract
Next-generation surveys like the Legacy Survey of Space and Time (LSST) on the Vera C. Rubin Observatory (Rubin) will generate orders of magnitude more discoveries of transients and variable ...stars than previous surveys. To prepare for this data deluge, we developed the Photometric LSST Astronomical Time-series Classification Challenge (PLAsTiCC), a competition that aimed to catalyze the development of robust classifiers under LSST-like conditions of a nonrepresentative training set for a large photometric test set of imbalanced classes. Over 1000 teams participated in PLAsTiCC, which was hosted in the Kaggle data science competition platform between 2018 September 28 and 2018 December 17, ultimately identifying three winners in 2019 February. Participants produced classifiers employing a diverse set of machine-learning techniques including hybrid combinations and ensemble averages of a range of approaches, among them boosted decision trees, neural networks, and multilayer perceptrons. The strong performance of the top three classifiers on Type Ia supernovae and kilonovae represent a major improvement over the current state of the art within astronomy. This paper summarizes the most promising methods and evaluates their results in detail, highlighting future directions both for classifier development and simulation needs for a next-generation PLAsTiCC data set.
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