To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Having sufficient medical countermeasures (MCMs) available for the treatment of acetylcholinesterase-inhibiting nerve agent poisoned patients following a mass chemical exposure is a challenge for communities. After stockpiles containing auto-injectors are exhausted, communities need to be aware of alternative pharmaceutical options. The Department of Homeland Security Chemical Defense Program convened a federal interagency working group consisting of first responders, clinicians, and experts from the fields of medical toxicology, pharmacology, and emergency management. A literature review of pharmaceutical alternatives for treating nerve agent toxicity was performed. Pharmaceuticals that met the federal Public Health Emergency Medical Countermeasures Enterprise Product Specific Requirements were prioritized. Food and Drug Administration approval for one indication, market availability, and alignment to government procurement strategy were considered. This article summarizes the literature on comparative pharmacokinetics and efficacy against nerve agents (where available) of Food and Drug Administration approved drugs with muscarinic acetylcholine receptor antagonist and gamma-aminobutyric acid receptor agonist effects. This work is intended to serve as a resource of pharmaceutical options that may be available to communities (ie, emergency managers, planners, clinicians, and poison centers) when faced with a mass human exposure to a nerve agent and inadequate supplies of MCMs. (Disaster Med Public Health Preparedness. 2019;13:605-612)
Background: External ventricular drain (EVD) insertion is a common neurosurgical procedure performed in patients with life-threatening conditions, but can be associated with complications. The objectives of this study are to evaluate data on national practice patterns and complications rates in order to optimize clinical care Methods: The Canadian Neurosurgery Research Collaborative conducted a prospective multi-centre registry of patients undergoing EVD insertions at Canadian residency programs Results: In this interim analysis, 4 sites had recruited 46 patients (mean age: 53.9 years, male:female 2:1). Most EVD insertions occurred outside of the operating theatre, using free-hand technique, and performed by junior neurosurgery residents (R1-R3). The catheter tip was in the ipsilateral frontal horn or body of the lateral ventricle in 76% of cases. Suboptimally placed catheters did not have higher rates of short-term occlusion. EVD-related hemorrhage occurred in 6.5% (3/45) with only 1 symptomatic patient. EVD-related infection occurred in 13% (6/46) at a mean of 6 days and was associated with longer duration of CSF drainage (P=0.039; OR: 1.13) Conclusions: Interim results indicate rates of EVD-related complications may be higher than previously thought. This study will continue to recruit patients to confirm these findings and determine specific risk factors associated with them
Soybean consultants from Arkansas, Louisiana, southeast Missouri, Mississippi, and Tennessee were surveyed in 2016 to assess weed management practices and the prevalence of herbicide-resistant weeds in midsouthern U.S. soybean production. The consultants surveyed represented 13%, 28%, 8%, 16%, and 5% of the total soybean area planted in Arkansas, Louisiana, southeast Missouri, Mississippi, and Tennessee, respectively. Of the total scouted area, 78% of the consultants said their growers planted glyphosate-resistant soybean in 2016, with 18% planting glufosinate-resistant (LibertyLink®), primarily due to familiarity with and cost of the technology. Although 94% of the consultants determined that glufosinate was most effective on killing Palmer amaranth, the primary concern associated with controlling herbicide-resistant weeds was the associated cost, followed by return profit and time constraints. Palmer amaranth, morningglory species, horseweed, barnyardgrass, and Italian ryegrass were the five most problematic weeds in soybean across the five states. Palmer amaranth was the most problematic and important weed in each state individually. The increased concern (77% of consultants) with this species was attributed to the rising concern with and occurrence of protoporphyrinogen oxidase–resistant Palmer amaranth. Consultants were of the opinion that more research was needed on cover crops and the new traited technologies in order to improve weed management in soybean.
Inadvertent hyperthermia during anaesthesia is a rare but life-threatening complication. We have encountered several cases of severe hyperthermia in paediatric patients undergoing anaesthesia for cochlear implantation.
This study aimed to describe the clinical characteristics of children who developed hyperthermia while undergoing cochlear implantation, and to explore possible mechanisms and predisposing factors. The anaesthetic charts of all patients aged under 18 years who underwent cochlear implantation, or mastoid or ophthalmic surgery, between 1 January 2006 and 31 December 2009, at Soroka Medical Center in Beer Sheva, Israel, were reviewed. Patients undergoing mastoid and ophthalmic surgical procedures were used as controls.
A larger percentage of patients who underwent cochlear implant surgery (10 per cent) developed hyperthermia compared to controls (0.7 per cent, p < 0.05). In five of the seven cases, hyperthermia appeared in combination with tachycardia and hypercapnia, adhering to the clinical triad of malignant hyperthermia.
Patients undergoing cochlear implantation are susceptible to developing intra-operative hyperthermia. This article describes the hyperthermic events that occur during paediatric cochlear implantation, and attempts to identify potential triggers of hyperthermia.
Several lines of evidence suggest that the x-ray spectra of quasars are not simple, exact power laws: 1. when Wilkes and Elvis (1987) analyzed quasars as power laws they found an absorption less than that due to our galaxy; 2. The mean 0.3 to 3.5 keV spectral index is steeper than the mean for the 2 to 20 keV range; 3. although several lines of evidence argue that AGN provide a significant portion (perhaps all) of the x-ray background, the diffuse background spectrum does not agree with the x-ray power-law indices measured for quasars or Seyfert galaxies. Schwartz and Tucker (1988) have suggested that all the above conflicts are reconciled if the slope in the Log(flux density) vs. Log(energy) plot flattens continuously with increasing energy. In this paper we utilize one particular parameterization suggested for the flux density, which we call the “log-slope” model:
where f is the flux density, K a normalization parameter which is not of interest here, and a and b are the two parameters of our fit.
A sample of Active Galactic Nuclei (AGN) have been discovered during a program to identify the optical counterparts of X-ray sources detected by the Modulation Collimator experiment of the High Energy Astronomy Observatory-1 (HEAO-1). UV-excess techniques were used to identify the X-ray sources (Remillard et al. 1986) and the details of the identifications are given elsewhere (Remillard et al. 1988, Brissenden et al. 1988). We report here the preliminary results of a multi-wavelength study of these new AGN.
Most of our understanding of BPF's is based on observations of the neutral and ionized gas in bright, high luminosity sources. Data on low luminosity (L ≲ 30 L⊙) objects has now become more available (e.g. Frerking and Langer, Astrophys. J. 256, 523, 1982) permitting a test of models at this end of the luminosity range. We have performed a series of multi-wavelength observations, emphasizing low luminosity objects.
The class of Low-Excitation Herbig-Haro Objects are characterised by [SII] and [OI] lines which are comparable in strength to H-Alpha, by [NI] lines that are comparable to H-Beta, relatively weak [NII] and [OII] lines, little or no [OIII] emission and a very strong blue-UV “excess”. This blue and UV continuum in low-excitation HH Objects was noted as a problem by Brugel, Böhm and Mannery (1981), Ortalani and D'Odorico (1980) and Böhm, Böhm-Vitense and Brugel (1981). The first suggestion that it results from collisionally enhanced Hydrogen two-photon (2q) continuum was by Dopita (1981). The subsequent observations of Dopita, Binette and Schwartz (1982) proved that this was indeed the case. However, although very close correlations between this enhancement and the emission-line spectrum were found, a fair theoretical description could only be obtained for very youthful shock models with ages of order 30 years. However, there seems to be no reason why low excitation HH shocks should be much younger than the high excitation shocks.
We present high resolution (HPBW = 5 arcsec) continuum and molecular-line observations of the circumstellar environment of the emission-line star LkHα 234 made with the Owens Valley Millimeter-Wave Interferometer. These 98 GHz observations have revealed an unresolved continuum source coincident with the star and a 10 000 by 17000 A.U. ridge of enhanced CS(2-1) emission which peaks ∼ 4″ east of the star. The resulting spectral dependence for the radio continuum emission of ν1.5 is most easily interpreted as arising from a partially ionized stellar wind. Attempts are made to describe the properties of the CS emission in terms of a rotating molecular disk which would link LkHα 234 with large scale mass loss activity in the cloud. However, it appears most likely that the CS emission is arising from a dense (n(H2) ∼ 106 cm −3) condensation of gas adjacent to, but not dynamically associated with, the star.
The U.S. Naval Observatory is responsible for the determination and prediction of UT1-UTC. An investigation was begun to determine if atmospheric angular momentum (AAM) data could be useful in the National Earth Orientation Service (NEOS) combined solution and in the prediction of UT1-UTC. The investigation found AAM data to be useful possibly in the combined solution, but predictions of UT1-UTC were adversely affected when predictions of AAM data were introduced.
A clean hot-water drill was used to gain access to Subglacial Lake Whillans (SLW) in late January 2013 as part of the Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project. Over 3 days, we deployed an array of scientific tools through the SLW borehole: a downhole camera, a conductivity–temperature–depth (CTD) probe, a Niskin water sampler, an in situ filtration unit, three different sediment corers, a geothermal probe and a geophysical sensor string. Our observations confirm the existence of a subglacial water reservoir whose presence was previously inferred from satellite altimetry and surface geophysics. Subglacial water is about two orders of magnitude less saline than sea water (0.37–0.41 psu vs 35 psu) and two orders of magnitude more saline than pure drill meltwater (<0.002 psu). It reaches a minimum temperature of –0.55~C, consistent with depression of the freezing point by 7.019 MPa of water pressure. Subglacial water was turbid and remained turbid following filtration through 0.45 µm filters. The recovered sediment cores, which sampled down to 0.8 m below the lake bottom, contained a macroscopically structureless diamicton with shear strength between 2 and 6 kPa. Our main operational recommendation for future subglacial access through water-filled boreholes is to supply enough heat to the top of the borehole to keep it from freezing.
Clinician education and prospective audit and feedback interventions, deployed separately and concurrently, did not reduce antimicrobial use errors or rates compared to a control group of general medicine inpatients at our public hospital. Additional research is needed to define the optimal scope and intensity of hospital antimicrobial stewardship interventions.
Background: The Canadian Neurosurgery Research Collaborative (CNRC) was founded in November 2015 as a resident-led national network for multicentre research. We present an annual report of our activities. Methods: CNRC meetings and publications were reviewed and summarized. The status of ongoing and future studies was collected from project leaders. Results: In its first year, the CNRC produced two papers accepted for publication in the Canadian Journal of Neurological Sciences: A CNRC launch letter and a study of operative volume at Canadian neurosurgery residency programs. Three manuscripts are in preparation: 1) a study of the demographics of Canadian neurosurgery residents, 2) an assessment of mobile devices usage patterns and 3) a validation study of the most utilized neurosurgery mobile apps. In addition, protocols for two multi-centre studies are currently undergoing national Research Ethics Board review: A retrospective study of the incidence and predictors of cerebellar mutism and a prospective registry of external ventricular drain procedures and complications. The network is now a registered not-for-profit organization endorsed by the Canadian Neurosurgical Society. Conclusions: The CNRC is a feasibile, relevant and productive resident-led national research network. As the CNRC matures, we look forward to expanding the scope and impact of its projects.
Background: No standardized method of resident operative-case logging exists. Our study sought to develop a standardized form used by residents to log operative-cases. Methods: Members of the Canadian Neurosurgery Research Collaborative (CNRC), a national resident-led research organization have created a standardized document based on the current Royal College objectives for operative procedures (section 5). Modifications to structure and content will be guided via consensus from Canadian neurosurgery program-directors. Results: Program directors in each CNRC collaborative institution will be asked to modify the standardized form. The CNRC currently involves thirteen of the fourteen Canadian neurosurgery residency programs. Additional consensus, if necessary, can be reached at the Royal College meeting for program directors of neurosurgery March 20th 2017. Conclusions: A standardized operative-case log represents the first step in a prospective study towards compiling operative volume of all Canadian neurosurgical residents over one academic year. Such data will be essential to guide informed decisions with regard to Royal College requirements as Canadian neurosurgical programs transition to a competency based framework.
Background: Communicating with senior neurosurgical colleagues during residency necessitates a reliable and versatile smartphone. Smartphones and their apps are commonplace. They enhance communication with colleagues, provide the ability to access patient information and results, and allow access to medical reference applications. Patient data safety and compliance with the Personal Health Information Protection Act (PHIPA, 2004) in Canada remain a public concern that can significantly impact the way in which mobile smartphones are utilized by resident physicians Methods: Through the Canadian Neurosurgery Research Collaborative (CNRC), an online survey characterizing smartphone ownership and utilization of apps among Canadian neurosurgery residents and fellows was completed in April 2016. Results: Our study had a 47% response rate (80 surveys completed out of 171 eligible residents and fellows). Smartphone ownership was almost universal with a high rate of app utilization for learning and facilitating the care of patients. Utilization of smartphones to communicate and transfer urgent imaging with senior colleagues was common. Conclusions: Smartphone and app utilization is an essential part of neurosurgery resident workflow. In this study we characterize the smartphone and app usage within a specialized cohort of residents and suggest potential solutions to facilitate greater PHIPA adherence