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Most oviposition by Helicoverpa zea (Boddie) occurs near the top of the canopy in soybean, Glycine max (L.) Merr, and larval abundance is influenced by the growth habit of plants. However, the vertical distribution of larvae within the canopy is not as well known. We evaluated the vertical distribution of H. zea larvae in determinate and indeterminate varieties, hypothesizing that larval distribution in the canopy would vary between these two growth habits and over time. We tested this hypothesis in a naturally infested replicated field experiment and two experimentally manipulated cage experiments. In the field experiment, flowering time was synchronized between the varieties by manipulating planting date, while infestation timing was manipulated in the cage experiments. Larvae were recovered using destructive sampling of individual soybean plants, and their vertical distribution by instar was recorded from three sampling points over time in each experiment. While larval population growth and development varied between the determinate and indeterminate varieties within and among experiments, we found little evidence that larvae have preference for different vertical locations in the canopy. This study lends support to the hypothesis that larval movement and location within soybean canopies do not result entirely from oviposition location and nutritional requirements.
Despite considerable efforts to control tuberculosis (TB) among Ethiopian immigrants in Israel, an outbreak of TB among second-generation Ethiopian immigrants that involved native Israelis occurred between January 2011 and December 2019. The aim of this article is to report on this outbreak and discuss the patient and health system barriers that led to its propagation. Overall, 13 culture-positive TB patients were diagnosed in this outbreak. An additional 36 cases with identical mycobacterium tuberculosis genotypes were identified through cross-checking with the National TB Laboratory Registry. Among the 32 close contacts of the index case, 18 (56.3%) reported for screening and treatment of latent TB infection (LTBI) was recommended for 11 (61.1%) of them. However, none completed treatment and eight eventually developed TB. Of the 385 close contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) were recommended LTBI treatment, but only 26 (16.9%) completed the treatment. Routine contact investigation and treatment practice measures failed to contain the cascade of infection and disease, leading to the spread of the infecting strain of TB. This report highlights the challenges to identify the high-risk group and address barriers to care among such a vulnerable population.
Helicoverpa zea (Boddie) is a damaging pest of many crops including soybean, Glycine max (L.), especially in the southern United States. Previous studies have concluded that oviposition and development of H. zea larvae mirror the phenology of soybean, with oviposition occurring during full bloom, younger larvae developing on blooms and leaves, intermediate aged larvae developing on varying tissue types, and older larvae developing on flowers and pods. In a field trial, we investigated the presence of natural infestations of H. zea larvae by instar in determinate and indeterminate soybean varieties. In complementary experiments, we artificially infested H. zea and allowed them to oviposit on plants within replicated cages (one with a determinate variety and two with an indeterminate variety). Plants were sampled weekly during the time larvae were present. In the natural infestation experiment, most larvae were found on blooms during R3 and were early to middle instars; by R4, most larvae were found on leaves and were middle to late instars. In contrast, in the cage study, most larvae were found on leaves regardless of soybean growth stage or larval stage. Determinate and indeterminate growth habit did not impact larval preference for different soybean tissue types. Our studies suggest H. zea larvae prefer specific tissue types, but also provide evidence that experimental design can influence the results. Finally, our finding of larval preference for leaves contrasts with findings from previous studies.
Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
Introduction: Paramedics commonly administer intravenous dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may be unnecessary and lead to harm or difficulties regulating blood glucose post treatment. We hypothesize that a lower dose such as dextrose 10% (D10) or titrating the D50 to desired level of consciousness may be optimal and avoid adverse events. Methods: We systematically searched Medline, Embase, CINAHL and Cochrane Central on June 5th 2019. PRISMA guidelines were followed. The GRADE methods and risk of bias assessments were applied to determine the certainty of the evidence. We included primary literature investigating the use of intravenous dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department. Outcomes of interest were related to the safe and effective reversal of symptoms and blood glucose levels (BGL). Results: 660 abstracts were screened, 40 full text articles, with eight studies included. Data from three randomized controlled trials and five observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2 mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies we find higher symptom resolution in the D10 group compared to the D50 group; at 99.8% and 94.9% respectively. However, the mean time to resolution was approximately 4 minutes longer in the D10 group (4.1 minutes (D50) and 8 minutes (D10)). There was more need for subsequent doses in the D10 group at 23.0% versus 16.5% in the D50 group. The post treatment glycemic profile was lower in the D10 group at 5.9 mmol/L versus 8.5 mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia; 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/871) compared to 12/133 adverse events in the D50 group. Conclusion: D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer there appear to be fewer adverse events. The post treatment glycemic profile may facilitate less challenging ongoing glucose management by the patients.
Introduction: The Prehospital Evidence-based Practice (PEP) program is an online, freely accessible, continuously updated repository of appraised EMS research evidence. This report is an analysis of published evidence for EMS interventions used to assess and treat patients suffering from hypoglycemia. Methods: PubMed was systematically searched in June 2019. One author screened titles, abstracts and full-texts for relevance. Trained appraisers reviewed full text articles, scored each on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings for each intervention's primary outcome), abstracted the primary outcome, setting and assigned an outcome category (patient or process). Second party appraisal was conducted for all included studies. The level and direction of each intervention was plotted in an evidence matrix, based on appraisals. Results: Twenty-nine studies were included and appraised for seven interventions: 5 drugs (Dextrose 50% (D50), Dextrose 10% (D10), glucagon, oral glucose and thiamine), one assessment tool (point-of-care (POC) glucose testing) and one call disposition (treat-and-release). The most frequently reported study primary outcomes were related to: clinical improvement (n = 15, 51.7%), feasibility/safety (n = 8, 27.6%), and diagnostics (n = 6, 20.7%). The majority of outcomes were patient focused (n = 18, 62.0%). Conclusion: EMS interventions for treating hypoglycemia are informed by high-quality supportive evidence. Both D50 and D10 are supported by high-quality evidence; suggesting D10 may be an effective alternative to the standard D50. “Treat-and-release” practices for hypoglycemia are supported by moderate-quality evidence for the patient related outcomes of relapse, patient preference and complications. This body of evidence is high-quality, patient-focused and conducted in the prehospital setting thus generalizable paramedic practice.
In the winter of 1928, Herbert Hensley Henson, Lord Bishop, delivered his second quadrennial charge to the diocese of Durham. This was no ordinary visitation document. Its 83-page ‘Introduction’ outlined a compelling argument in favour of the disestablishment of the Church of England. That so senior a bishop of the realm should have publicly advocated so subversive a measure was strange in itself. To be sure, many disgruntled clergymen had conceived of suitably drastic solutions in the wake of the parliamentary defeat of the proposed revision of The book of common prayer the previous year. But no comparably significant figure had openly declared the necessity of such a fundamental dislocation in England's ecclesiastical state. Disestablishment had been the great dissenting cause of the nineteenth century. Suddenly, it was espoused by the most articulate prelate on the bench. Moreover, Disestablishment was a report conceived with a vengeance. It called for immediate separation, it envisaged speedy disendowment, it pointed to the desirability of strengthening the ecclesiastical courts, and it insisted upon a thorough reworking of the Church’s administrative machinery. It was cast as a polemic; but it meant business.
No small part of Disestablishment's intellectual force lay in the fact that it did not represent Henson's first statement of his highly unorthodox case. That had been rehearsed in a dramatic sermon, delivered before the bishop of London and the editor of The Tablet, at St Mary's Church in the University of Cambridge, on 29 January 1928. Instead, it described what had by then become Henson's definitive word on the matter. The still greater extent of the political shock waves that this book provoked can be explained only in terms of its author’s personal history. For Henson was not merely a curious convert to this heterodox plan. He was a notorious ‘turncoat’ too. From 1886, Henson had fought with every available weapon at his disposal, whether institutional position, personal connection, crusading pen or even waspish tongue for the continued establishment of the Church of England. After the House of Commons rejected the revised prayer book, first in 1927 and then again in 1928, he devoted all those same endowments to a pursuit of the opposite end.
22q11.2 deletion syndrome (22q11.2DS) and Williams syndrome (WS) are common neurogenetic microdeletion syndromes. The aim of the present study was to compare the neuropsychiatric and neurocognitive phenotypes of 22q11.2DS and WS.
Forty-five individuals with 22q11.2DS, 24 with WS, 22 with idiopathic developmental disability (DD) and 22 typically developing (TD) controls were compared for the rates of psychiatric disorders as well as cognitive executive and visuospatial functions.
We found that while anxiety, mood and disruptive disorders had an equally high prevalence among individuals with 22q11.2DS, WS and DDs, the 22q11.2DS group had the highest rates of psychotic disorders and the WS group had the highest rates of specific phobia. We also found that the WS group demonstrated more severe impairments in both executive and visuospatial functions than the other groups. WS and 22q11.2DS subjects had worse Performance-IQ than Verbal-IQ, a feature typical of non-verbal learning disorders.
These findings offer a wide perspective on unique versus common phenotypes in 22q11.2DS and WS.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
The MEDDINI intervention study investigated how advice improved the adoption of a Mediterranean diet (MD) in cardiovascular disease patients. Earlier research profiled the levels of blood metabolites in MEDDINI participants, in the process discovering a number dietary biomarkers indicative of a MD. However, a potential limitation of this approach is that MD scores are semi-quantitative, and don't reflect the absolute amounts of food consumed. Therefore, the present study identified distinct dietary patterns based on quantified food diary data from 58 MEDDINI participants by applying k-means clustering analysis. Previously measured blood metabolites (90) using targeted and untargeted methods were then assessed for their performance as dietary biomarkers. After careful standardisation (z-scores), optimisation and cross-validation dietary data were reduced to 6 specific food groups and this led to the formation of two clusters. Cluster 1 included participants who had the lowest intakes of fruit and vegetables, legumes, fish and whole grain cereals and the highest intake of meat and sweet foods (including carbonated drinks). Cluster 2 comprised the participants with highest intake of fruit and vegetables, legumes, fish and whole grain cereals and the lowest intake of meat and sweet foods (including carbonated drinks). Discriminatory metabolites (p derived from untargeted analysis included Citric acid, Tyrosine, Malonate, Pyroglutamic acid, Succinate, Betaine, L-asparagine and Fumaric acid which were significantly increased in cluster 2, and 2-Hydroxybutyric acid and Pyruvic acid which were significantly decreased in cluster 2. Targeted biomarker analysis showed 8 discriminatory metabolites which were significantly (p increased in cluster 2. These were Docosahexaenoic acid (DHA), alpha-Carotene, beta-Carotene, beta-Cryptoxanthin, Vitamin C, Lutein, alpha-Linolenic acid and Lycopene. Conversely Osbond acid, Cholesterol and Dihomo-γ-linolenic acid (DGLA) were significantly lower in cluster 2. Metabolites significantly correlated with some of the 6 groups in the clusters. For example, Citric acid, Betaine and Vitamin C positively correlated with combined fruit, fruit juice and vegetable intake: (r = 0.20, p = 0.018; r = 0.20, p = 0.02 and r = 0.34, p = 5.7E-5 respectively). DHA, alpha-Carotenoid and beta-Carotenoid significantly correlated with fish intake (r = 0.58, p = 1.94E-13; r = 0.40, p = 2E-6 and r = 0.30, p = 3.5E-4 respectively). The present study demonstrates the utility of clustering analysis for effectively assessing adherence to healthy dietary patterns and the discovery of novel dietary biomarkers.
A longstanding issue in the field of nutrition is the potential inaccuracy of methods traditionally used for dietary assessment (i.e. food diaries and food frequency questionnaires). It is possible to overcome the limitations and biases of these techniques by combining them with analytical measurements in human biofluids. Metabolomic technologies are gaining popularity as nutritional tools due to their capacity to measure metabolic responses to external stimuli, such as the ingestion of certain foods. This project performed both LC-MS and 1H-NMR metabolomic profiling on serum samples collected as part of the NICOLA study (Northern Irish Cohort for the Longitudinal Study of Aging) in order to discover novel dietary biomarkers. A dietary validation cohort (NIDAS) was incorporated within NICOLA, involving 45 males and 50 females, aged 50 years and over. Participants provided detailed dietary data (4-day food diary) and blood samples at two time-points, six months apart. Serum samples were processed on two analytical platforms. 1H-NMR spectra were acquired using a Bruker 600 MHz Ascent coupled to a TCI cryoprobe and processed using Bayesil (University of Alberta, Canada). A Waters TQ-S coupled with an Acquity I-class UPLC was used in combination with a targeted commercially available kit (AbsoluteIDQ p180 kit, Biocrates). Mass spectra obtained were processed with MetIDQ and verified using MassLynx (v4.1). Data were tested for normality, and metabolite concentrations were correlated with recorded dietary intake of each food type using SPSS. Additional tests (PCA, PLS-DA, ROC Curves) were performed on MetaboAnalyst 4.0 (University of Alberta, Canada). More than 50 statistically significant (P < 0.05) food-metabolite correlations were detected, 15 of which remained significant after eliminating potential confounding from sex, age and BMI. The strongest correlations were between fruit consumption and acetic acid, and between dairy consumption and certain glycerophospholipids (e.g. LysoPC aa C20:3). Stratifying the cohort by gender yielded further correlations, including PC ae C38:2 (dairy; males), PC aa C34:4 (dairy; females), PC aa C36:4 (dairy; females) and trans-4-Hydroxyproline (meat; males). A number of potential blood-based food biomarkers were detected, many of which are gender-specific, and some are corroborated by previously published studies. However, further validation work is required. For example, biological plausibility needs to be established, and the findings need to be reproduced in other cohorts to demonstrate their applicability in larger and more diverse populations. These results contribute greatly to the ongoing efforts to discover and validate reliable nutritional biomarkers as an objective and unbiased measurement of food intake.
Horseweed is one of Kentucky’s most common and problematic weeds in no-till soybean production systems. Emergence in the fall and spring necessitates control at these times because horseweed is best managed when small. Control is typically achieved through herbicides or cover crops (CCs); integrating these practices can lead to more sustainable weed management. Two years of field experiments were conducted over 2016 to 2017 and 2017 to 2018 in Versailles, KY, to examine the use of fall herbicide (FH; namely, saflufenacil or none), spring herbicide (SH; namely, 2,4-D; dicamba; or none), and CC (namely, cereal rye or none) for horseweed management prior to soybean. Treatments were examined with a fully factorial design to assess potential interactions. The CC biomass in 2016 to 2017 was higher relative to 2017 to 2018 and both herbicide programs reduced winter weed biomass in that year. The CC reduced horseweed density while growing and after termination in 1 yr. The FH reduced horseweed density through mid-spring. The FH also killed winter weeds that may have suppressed horseweed emergence; higher horseweed density resulted by soybean planting unless the CC was present to suppress the additional spring emergence. If either FH or CC was used, SH typically did not result in additional horseweed control. The SH killed emerged plants but did not provide residual control of a late horseweed flush in 2017 to 2018. These results suggest CCs can help manage spring flushes of horseweed emergence when nonresidual herbicide products are used, though this effect was short-lived when less CC biomass was present.
In the United States, both tort and contract law are generally matters of state rather than federal law. While there is a common core to both tort and contract doctrines in the US, one can find variation – sometimes narrow but sometimes broad – across the 51 independent state jurisdictions. In this United States country report, we attempt to provide a synthesis of state law while also trying to point out states whose laws deviate significantly from the synthesis.
TRACING THE BORDERLINES
The bases for liability in tort and contract are thought of as distinct in the US. The phrase ‘law of obligations’ is largely unknown in the United States. Contractual obligations are derived from the agreement of the parties to a contract that sets forth the bilateral obligations of the parties. By contrast, tort duties are imposed on parties by operation of law. This clean conceptual separation can break down in a number of contexts in which a tort occurs in a relationship where there is also a contract or potential contract between the parties, and where a contract is meant to benefit a third party. Medical and other professional malpractice, products liability, landlords’ obligations for defects in rented premises, implied warranties and other terms in contracts, and contractual waivers of tort liability are among the instances in which this occurs.
A court's characterization of an action as tort or contract matters for several reasons. Statutes of limitations typically limit tort actions to two years from the date of discovery of injury; contract actions typically are given four years from the date of material breach. Insurance contracts and principles of governmental immunity sometimes turn on the nature of the claim. The standard for liability is also quite different – to prevail in the typical tort case, a plaintiff must prove negligence; breach of contract requires no such proof, but merely that the defendant breached the agreed-upon terms. In addition, the applicable damages rules are different – rules regarding mitigation, scope of liability (proximate cause), non-pecuniary losses, and punitive damages are much more permissive in the tort context than in contract. Indeed, even some rules that tort and contract actions share – eg causation – are applied differently in sometimes outcome-determinative ways.
Horseweed, also known as marestail, is a problematic weed for no-till soybean producers that can emerge from late summer through the following spring. Overwintering cover crops can reduce both the density and size of fall-emerged weeds such as horseweed and reduce further spring emergence, although typically cover crops do not provide complete control. Cover crops may be integrated with additional spring herbicide applications to control emerged horseweed, and selective herbicides such as 2,4-D may be used to target horseweed while maintaining small grain cover crop growth. However, cover crops may affect herbicide deposition, which could reduce their efficacy to control weeds. The objective of this study was to determine how the amount and variability of 2,4-D ester spray solution deposition, measured with water-sensitive paper, was affected by a cereal rye cover crop and fall-applied saflufenacil. We also examined deposition at the soil surface relative to the cereal rye row position. In a year with greater cereal rye biomass accumulation, there was 44% less coverage and average deposit size was 45% smaller immediately adjacent to cereal rye rows compared with between rows and areas without cereal rye. Greater variability in these measurements was also noted in this position. Percent spray solution coverage was also 22% greater in plots that received saflufenacil in the fall, and deposits were 28% larger. In a year with less cover crop and winter weed biomass, no differences in spray deposition were observed. This suggests that small horseweed plants and other weeds immediately adjacent to cereal rye cover crop rows may be more likely to survive early spring herbicide applications, though the suppressive effects of cover crops may mitigate this concern.
The first case of evolved protoporphyrinogen oxidase (PPO)-inhibitor resistance was observed in 2001 in common waterhemp [Amaranthus tuberculatus (Moq.) Sauer var. rudis (Sauer) Costea and Tardif]. This resistance in A. tuberculatus is most commonly conferred by deletion of the amino acid glycine at the 210th position (ΔGly-210) of the PPO enzyme (PPO2) encoded by PPX2. In a field in Kentucky in 2015, inadequate control of Amaranthus plants was observed following application of a PPO inhibitor. Morphological observations indicated that survivors included both A. tuberculatus and Palmer amaranth (Amaranthus palmeri S. Watson). Research was conducted to confirm species identities and resistance and then to determine whether resistance evolved independently in the two species or via hybridization. Results from a quantitative PCR assay based on the ribosomal internal transcribed spacer confirmed that both A. tuberculatus and A. palmeri coexisted in the field. The mutation conferring ΔGly-210 in PPO2 was identified in both species; phylogenetic analysis of a region of PPX2, however, indicated that the mutation evolved independently in the two species. Genotyping of greenhouse-grown plants that survived lactofen indicated that all A. tuberculatus survivors, but only a third of A. palmeri survivors, contained the ΔGly-210 mutation. Consequently, A. palmeri plants were evaluated for the presence of an arginine to glycine or methionine substitution at position 128 of PPO2 (Arg-128-Gly and Arg-128-Met). The Arg-128-Gly substitution was found to account for resistance that was not accounted for by the ΔGly-210 mutation in plants from the A. palmeri population. Results from this study provide a modern-day example of both parallel and convergent evolution occurring within a single field.
Sintered nanoparticle structures are macroscopically brittle but quite robust if deposited on a flexible substrate. The effects of a polymer substrate on the stretchability of both brittle and ductile coatings and traces are well established. Systematic effects of substrate properties on the fatigue resistance of aerosol printed nano-Ag are slightly more complex. The present work is focused on the early stages of fatigue, where the resistance increases significantly but cracks are not yet visible. Overall, the fatigue behavior is seen to vary with the combination of substrate modulus and viscoelastic deformation properties. Comparing two common polyimides, the rate of damage was seen to increase faster with increasing amplitude on the less compliant one. Consistently with this increasing the minimum strain in the cycle led to a significantly stronger reduction in damage rates. However, the damage rate remained lower on the less compliant substrate at all amplitudes and strain ranges of practical concern.
The physiology of mesophotic Scleractinia varies with depth in response to environmental change. Previous research has documented trends in heterotrophy and photosynthesis with depth, but has not addressed between-site variation for a single species. Environmental differences between sites at a local scale and heterogeneous microhabitats, because of irradiance and food availability, are likely important factors when explaining the occurrence and physiology of Scleractinia. Here, 108 colonies of Agaricia lamarcki were sampled from two locations off the coast of Utila, Honduras, distributed evenly down the observed 50 m depth range of the species. We found that depth alone was not sufficient to fully explain physiological variation. Pulse Amplitude-Modulation fluorometry and stable isotope analyses revealed that trends in photochemical and heterotrophic activity with depth varied markedly between sites. Our isotope analyses do not support an obligate link between photosynthetic activity and heterotrophic subsidy with increasing depth. We found that A. lamarcki colonies at the bottom of the species depth range can be physiologically similar to those nearer the surface. As a potential explanation, we hypothesize sites with high topographical complexity, and therefore varied microhabitats, may provide more physiological niches distributed across a larger depth range. Varied microhabitats with depth may reduce the dominance of depth as a physiological determinant. Thus, A. lamarcki may ‘avoid’ changes in environment with depth, by instead existing in a subset of favourable niches. Our observations correlate with site-specific depth ranges, advocating for linking physiology and abiotic profiles when defining the distribution of mesophotic taxa.
We present ALMA [CII] line and far-infrared (FIR) continuum observations of seven z > 6 low-luminosity quasars (M1450 > −25 mag) discovered by our on-going Subaru Hyper Suprime-Cam survey. The [CII] line was detected in all targets with luminosities of ∼(2−10) × 108 L⊙, about one order of magnitude smaller than optically luminous quasars. Also found was a wide scatter of FIR continuum luminosity, ranging from LFIR < 1011L⊙ to ∼2 × 1012L⊙. With the [CII]-based dynamical mass, we suggest that a significant fraction of low-luminosity quasars are located on or even below the local Magorrian relation, particularly at the massive end of the galaxy mass distribution. This is a clear contrast to the previous finding that luminous quasars tend to have overmassive black holes relative to the relation. Our result is expected to show a less-biased nature of the early co-evolution of black holes and their host galaxies.
Introduction: Early and accurate diagnosis of critical conditions is essential in emergency medical services (EMS). Serum lactate testing may be used to identify patients with worse prognosis, including sepsis. Recently, the use of a point-of-care lactate (POCL) test has been evaluated in guiding treatment in patients with sepsis. Operating as part of the Prehospital Evidence Based Practice (PEP) Program, the authors sought to identify and describe the body of evidence for POCL use in EMS and the emergency department (ED) for patients with sepsis. Methods: Following PEP methodology, in May 2018, PubMed was searched in a systematic manner. Title and abstract screening were conducted by the program coordinator. These studies were collected, appraised and added to the existing body of literature contained within the PEP database. Evidence appraisal was conducted by two reviewers who assigned both a level of evidence (LOE) on a novel three tier scale and a direction of evidence (supportive, neutral or opposing; based on primary outcome). Data on setting and study design were also extracted. Results: Eight studies were included in our analysis. Three of these studies were conducted in the ED setting; each investigating the POCL test's ability to predict severe sepsis, ICU admission or death. All three studies found supportive results for POCL. A systematic review on the use of POCL in the ED determined that this test can also improve time to treatment. Five of the total 8 studies were conducted prehospitally. Two of these studies were supportive of POCL use in the prehospital setting; in terms of feasibility and the ability to predict sepsis. Both of these study sites used this early information as part of initiating a “sepsis alert” pathway. The other three prehospital studies provide neutral support for POCL. One study demonstrated moderate ability of POCL to predict severe illness. Two studies found poor agreement between prehospital POCL and serum lactate values. Conclusion: Limited low and moderate quality evidence suggest POCL may be feasible and helpful in predicting sepsis in the prehospital setting. However, there is sparse and inconsistent support for specific important outcomes, including accuracy.