Assessment of acute headache in adults - what the general physician needs to know.

Headache is common. Up to 5% of attendances to emergency departments and acute medical units are due to headache. Headache is classified as either primary (eg migraine, cluster headache) or secondary to another cause (eg meningitis, subarachnoid haemorrhage). Even in the acute setting the majority of cases are due to primary causes. The role of the attending physician is to take a comprehensive history to diagnose and treat benign headache syndromes while ruling out sinister aetiologies. This brief article summarises the approach to assessment of headache presenting in acute and emergency care

Tuning the effects of Landau-level mixing on anisotropic transport in quantum Hall systems

Electron-electron interactions in half-filled high Landau levels in two-dimensional electron gases in a strong perpendicular magnetic field can lead to states with anisotropic longitudinal resistance. This longitudinal resitance is generally believed to arise from broken rotational invariance, which is indicated by charge density wave (CDW) order in Hartree-Fock calculations. We use the Hartree-Fock approximation to study the influence of externally tuned Landau level mixing on the formation of interaction induced states that break rotational invariance in two-dimensional electron and hole systems. We focus on the situation when there are two non-interacting states in the vicinity of the Fermi level and construct a Landau theory to study coupled charge density wave order that can occur as interactions are tuned and the filling or mixing are varied. We examine in detail a specific example where mixing is tuned externally through Rashba spin-orbit coupling. We calculate the phase diagram and find the possibility of ordering involving coupled striped or triangular charge density waves in the two levels. Our results may be relevant to recent transport experiments on quantum Hall nematics in which Landau-level mixing plays an important role.Comment: 25 pages, 6 figure

Cohort profile: the avon longitudinal study of parents and children: ALSPAC mothers cohort

The Avon Longitudinal Study of Children and Parents (ALSPAC) was established to understand how genetic and environmental characteristics influence health and development in parents and children. All pregnant women resident in a defined area in the South West of England, with an expected date of delivery between 1st April 1991 and 31st December 1992, were eligible and 13 761 women (contributing 13 867 pregnancies) were recruited. These women have been followed over the last 19–22 years and have completed up to 20 questionnaires, have had detailed data abstracted from their medical records and have information on any cancer diagnoses and deaths through record linkage. A follow-up assessment was completed 17–18 years postnatal at which anthropometry, blood pressure, fat, lean and bone mass and carotid intima media thickness were assessed, and a fasting blood sample taken. The second follow-up clinic, which additionally measures cognitive function, physical capability, physical activity (with accelerometer) and wrist bone architecture, is underway and two further assessments with similar measurements will take place over the next 5 years. There is a detailed biobank that includes DNA, with genome-wide data available on >10 000, stored serum and plasma taken repeatedly since pregnancy and other samples; a wide range of data on completed biospecimen assays are available. Details of how to access these data are provided in this cohort profile

Numerical models of collisions between core-collapse supernovae and circumstellar shells

Recent observations of luminous Type IIn supernovae (SNe) provide compelling evidence that massive circumstellar shells surround their progenitors. In this paper we investigate how the properties of such shells influence the SN lightcurve by conducting numerical simulations of the interaction between an expanding SN and a circumstellar shell ejected a few years prior to core collapse. Our parameter study explores how the emergent luminosity depends on a range of circumstellar shell masses, velocities, geometries, and wind mass-loss rates, as well as variations in the SN mass and energy. We find that the shell mass is the most important parameter, in the sense that higher shell masses (or higher ratios of M_shell/M_SN) lead to higher peak luminosities and higher efficiencies in converting shock energy into visual light. Lower mass shells can also cause high peak luminosities if the shell is slow or if the SN ejecta are very fast, but only for a short time. Sustaining a high luminosity for durations of more than 100 days requires massive circumstellar shells of order 10 M_sun or more. This reaffirms previous comparisons between pre-SN shells and shells produced by giant eruptions of luminous blue variables (LBVs), although the physical mechanism responsible for these outbursts remains uncertain. The lightcurve shape and observed shell velocity can help diagnose the approximate size and density of the circumstellar shell, and it may be possible to distinguish between spherical and bipolar shells with multi-wavelength lightcurves. These models are merely illustrative. One can, of course, achieve even higher luminosities and longer duration light curves from interaction by increasing the explosion energy and shell mass beyond values adopted here.Comment: Accepted for publication in MNRAS. Tables of numerical results (SN lightcurves and velocities) to be published online. (Updated to fix figures

Ecological values of Hamilton urban streams (North Island, New Zealand): constraints and opportunities for restoration

Urban streams globally are characterised by degraded habitat conditions and low aquatic biodiversity, but are increasingly becoming the focus of restoration activities. We investigated habitat quality, ecological function, and fish and macroinvertebrate community composition of gully streams in Hamilton City, New Zealand, and compared these with a selection of periurban sites surrounded by rural land. A similar complement of fish species was found at urban and periurban sites, including two threatened species, with only one introduced fish widespread (Gambusia affinis). Stream macroinvertebrate community metrics indicated low ecological condition at most urban and periurban sites, but highlighted the presence of one high value urban site with a fauna dominated by sensitive taxa. Light-trapping around seepages in city gullies revealed the presence of several caddisfly species normally associated with native forest, suggesting that seepage habitats can provide important refugia for some aquatic insects in urban environments. Qualitative measures of stream habitat were not significantly different between urban and periurban sites, but urban streams had significantly lower hydraulic function and higher biogeochemical function than periurban streams. These functional differences are thought to reflect, respectively, (1) the combined effects of channel modification and stormwater hydrology, and (2) the influence of riparian vegetation providing shade and enhancing habitat in streams. Significant relationships between some macroinvertebrate community metrics and riparian vegetation buffering and bank protection suggest that riparian enhancement may have beneficial ecological outcomes in some urban streams. Other actions that may contribute to urban stream restoration goals include an integrated catchment approach to resolving fish passage issues, active reintroduction of wood to streams to enhance cover and habitat heterogeneity, and seeding of depauperate streams with native migratory fish to help initiate natural recolonisation

Buffalo National River Ecosystems - Part II

The priorities were established for the Buffalo National River Ecosystem Studies through meetings and correspondence with Mr. Roland Wauer and other personnel of the Office of Natural Sciences, Southwest Region of the National Park Service. These priorities were set forth in the appendix of contract no. CX 700050443 dated May 21, 1975

What are the ‘active ingredients’ of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

Objectives. Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. Methods. The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Results. Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly ‘Knowledge’ and ‘Environmental context and resources’. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly ‘Information about health consequences’, ‘Credible source’, and ‘Instruction on how to perform the behaviour’. Conclusions. We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content

Rising minimum daily flows in northern Eurasian rivers: A growing influence of groundwater in the high‐latitude hydrologic cycle

A first analysis of new daily discharge data for 111 northern rivers from 1936–1999 and 1958–1989 finds an overall pattern of increasing minimum daily flows (or “low flows”) throughout Russia. These increases are generally more abundant than are increases in mean flow and appear to drive much of the overall rise in mean flow observed here and in previous studies. Minimum flow decreases have also occurred but are less abundant. The minimum flow increases are found in summer as well as winter and in nonpermafrost as well as permafrost terrain. No robust spatial contrasts are found between the European Russia, Ob\u27, Yenisey, and Lena/eastern Siberia sectors. A subset of 12 unusually long discharge records from 1935–2002, concentrated in south central Russia, suggests that recent minimum flow increases since ∼1985 are largely unprecedented in the instrumental record, at least for this small group of stations. If minimum flows are presumed sensitive to groundwater and unsaturated zone inputs to river discharge, then the data suggest a broad‐scale mobilization of such water sources in the late 20th century. We speculate that reduced intensity of seasonal ground freezing, together with precipitation increases, might drive much of the well documented but poorly understood increases in river discharge to the Arctic Ocean

Multiple large clusters of tuberculosis in London: a cross-sectional analysis of molecular and spatial data

Large outbreaks of tuberculosis (TB) represent a particular threat to disease control because they reflect multiple instances of active transmission. The extent to which long chains of transmission contribute to high TB incidence in London is unknown. We aimed to estimate the contribution of large clusters to the burden of TB in London and identify risk factors. We identified TB patients resident in London notified between 2010 and 2014, and used 24-locus mycobacterial interspersed repetitive units-variable number tandem repeat strain typing data to classify cases according to molecular cluster size. We used spatial scan statistics to test for spatial clustering and analysed risk factors through multinomial logistic regression. TB isolates from 7458 patients were included in the analysis. There were 20 large molecular clusters (with n>20 cases), comprising 795 (11%) of all cases; 18 (90%) large clusters exhibited significant spatial clustering. Cases in large clusters were more likely to be UK born (adjusted odds ratio 2.93, 95% CI 2.28-3.77), of black-Caribbean ethnicity (adjusted odds ratio 3.64, 95% CI 2.23-5.94) and have multiple social risk factors (adjusted odds ratio 3.75, 95% CI 1.96-7.16). Large clusters of cases contribute substantially to the burden of TB in London. Targeting interventions such as screening in deprived areas and social risk groups, including those of black ethnicities and born in the UK, should be a priority for reducing transmission