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Introduction: Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to traditional laboratory analysis, may offer a solution, but limited research exists on CP POCT. The objective of this study is to compare the validity of two POCT devices (Abbott i-STAT® and Alere epoc®) and their use by CPs in the community. Methods: In a CP programme responding to 6,000 annual patient care events, a split sample validation of POCT against traditional laboratory analysis for seven analytes (sodium, potassium, chloride, creatinine, hemoglobin, hematocrit, and glucose) was conducted on a consecutive sample of patients. The difference of proportion of discrepant results between POCT and laboratory was compared using a two sample proportion test. Usability was analysed by survey of CP experience, an expert heuristic evaluation of devices, a review of device-logged errors, coded observations of POCT use during quality control testing, and a linear mixed effects model of Systems Usability Scale (SUS) adjusted for CP clinical and POCT experience. Results: Of 1,649 CP calls for service screened for enrollment, 174 had a blood draw, with 108 patient care encounters (62.1%) enrolled from 73 participants. Participants had a mean age of 58.7 years (SD16.3); 49% were female. In 4 of 646 (0.6%) individual comparisons, POCT reported a critical value that the laboratory did not; with no statistically significant difference in the number of discrepant critical values reported with epoc® compared to i-STAT®. There were no instances of the laboratory reporting a critical value when POCT did not. In 88 of 1,046 (8.4%) individual comparisons, the a priori defined acceptable difference between POCT and the laboratory was exceeded; occurring more often in epoc® (10.7%;95%CI:8.1%,13.3%) compared to i-STAT® (6.1%;95%CI:4.1%,8.2%)(p=0.007). Eighteen of 19 CP surveys were returned, with 11/18 (61.1%) preferring i-STAT® over epoc®. The i-STAT® had a higher mean SUS score (higher usability) compared to the epoc® (84.0/100 vs. 59.6/100; p=0.011). Fewer field blood analysis device-logged errors occurred in i-STAT® (7.8%;95%CI:2.9%,12.7%) compared to epoc® (15.5%;95%CI:9.3%,21.7%) although not statistically significant (p=0.063). Conclusion: CP programs can expect valid results from POCT. Usability assessment suggests a preference for i-STAT.
The aim of the present paper is to summarise current and future applications of dietary assessment technologies in nutrition surveys in developed countries. It includes the discussion of key points and highlights of subsequent developments from a panel discussion to address strengths and weaknesses of traditional dietary assessment methods (food records, FFQ, 24 h recalls, diet history with interviewer-assisted data collection) v. new technology-based dietary assessment methods (web-based and mobile device applications). The panel discussion ‘Traditional methods v. new technologies: dilemmas for dietary assessment in population surveys’, was held at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, September 2015. Despite respondent and researcher burden, traditional methods have been most commonly used in nutrition surveys. However, dietary assessment technologies offer potential advantages including faster data processing and better data quality. This is a fast-moving field and there is evidence of increasing demand for the use of new technologies amongst the general public and researchers. There is a need for research and investment to support efforts being made to facilitate the inclusion of new technologies for rapid, accurate and representative data.
Latest Sandbian to early Katian sequences across Laurentia's epicontinental sea exhibit a transition from lithologies characterized as ‘warm-water’ carbonates to those characterized as ‘cool-water'carbonates. This shift occurs across the regionally recognized M4/M5 sequence stratigraphic boundary and has been attributed to climatic cooling and glaciation, basin reorganization and upwelling of open ocean water, and/or increased water turbidity and terrigenous input associated with the Taconic tectophase. Documentation of oxygen isotopic trends across the M4/M5 and through bracketing strata provides a potential means of distinguishing among these alternative scenarios; however, oxygen isotopic records generated to date have failed to settle the debate. This lack of resolution is because δ18O records are open to multiple interpretations and potentially confounding factors related to local environmental conditions have not been tested by examining the critical interval in multiple areas and different depositional settings. To begin to address this shortcoming, we present new species-specific and mixed assemblage conodont δ18O values in samples spanning the M4/M5 boundary from the Upper Mississippi Valley, Alabama, and Virginia. The new results are combined with previous studies, providing a record of δ18O variability across SE Laurentia. The combined dataset allows us to test for regional trends at a resolution not previously available. Our results document a ~1.5‰ decrease in values across Laurentia instead of increasing δ18O values across the M4/M5 as predicted in various ‘cool-water’ scenarios. In short, these results do not support a shift to ‘cool-water’ conditions as an explanation for changes in early Katian carbonates across the M4/M5.
This paper presents an overview of the active microwave tools becoming available to the glaciologist with emphasis on recent radar developments as applied to floating ice. Sufficient theory is presented for the user to understand the techniques. Side-looking radar imagery is discussed using a number of examples resulting from the use of real and synthetic aperture, single and dual polarization. Recent studies of the microwave properties of ice and snow are reviewed, and are shown to be leading to significant advances in high-resolution radar techniques for accurate sounding of these materials. Remote sensing of fresh-water ice thickness is shown to be well established and operational, with similar techniques feasible in the near future for sea ice. It is pointed out that both imaging and probing radars applied to studies of sea ice and snow usually must be used in association with data from other sensors.
Lycopene (LYC) bioavailability is relatively low and highly variable, because of the influence of several factors. Recent in vitro data have suggested that dietary Ca can impair LYC micellarisation, but there is no evidence whether this can lead to decreased LYC absorption efficiency in humans. Our objective was to assess whether a nutritional dose of Ca impairs dietary LYC bioavailability and to study the mechanism(s) involved. First, in a randomised, two-way cross-over study, ten healthy adults consumed either a test meal that provided 19-mg (all-E)-LYC from tomato paste or the same meal plus 500-mg calcium carbonate as a supplement. Plasma LYC concentration was measured at regular time intervals over 7 h postprandially. In a second approach, an in vitro digestion model was used to assess the effect of increasing Ca doses on LYC micellarisation and on the size and zeta potential of the mixed micelles produced during digestion of a complex food matrix. LYC bioavailability was diminished by 83 % following the addition of Ca in the test meal. In vitro, Ca affected neither LYC micellarisation nor mixed micelle size but it decreased the absolute value of their charge by 39 %. In conclusion, a nutritional dose of Ca can impair dietary LYC bioavailability in healthy humans. This inhibition could be due to the fact that Ca diminishes the electrical charge of micelles. These results call for a thorough assessment of the effects of Ca, or other divalent minerals, on the bioavailability of other carotenoids and lipophilic micronutrients.
All products, including bioproducts, have an impact on the environment by consuming resources and releasing emissions during their production. Biochar, a bioproduct, has received considerable attention because of its potential to sequester carbon in soil while enhancing productivity, thus aiding sustainable supply chain development. In this chapter, the environmental impacts of producing biochar using a holistic method called life-cycle assessment (LCA) or more generally life-cycle analysis are discussed. LCA is an internationally accepted method that can calculate greenhouse gas (GHG) and other emissions for part or all of a product life cycle. The present chapter will show how LCA can assess environmental impacts of the entire supply chain associated with all steps of the biochar system, from biomass harvesting through biochar production to soil amendment, with a focus on the production stage. Exploring a biochar system from a forestry LCA perspective, a new thermochemical conversion technology developed in the United States and used to process waste woody biomass, will be described. In particular, the conversion unit’s environmental performance based on the LCA research conducted so far will be described. Although this chapter will present LCA mostly from a forestry perspective, non-forestry agricultural activities will also be discussed.
Biochar may be useful for restoring or revitalizing degraded forest soils and help with carbon sequestration, nutrient leaching losses, and reducing greenhouse gas emissions. However, biochar is not currently widely used on forested lands across North America. This chapter provides an overview of several biochar experiments conducted in North America and discusses the feasibility of using in-woods mobile pyrolysis systems to convert excess forest biomass into biochar. Biochar may be applied to forest sites in order to positively influence soil properties (nutrient leaching, water holding capacity), but its biggest benefit may be in facilitating reforestation of degraded or contaminated sites, and in sequestering carbon in soils. The majority of data on biochar applications on forest sites focus on seedling responses and short-term impacts on nutrients, soil physical properties and microbial changes. Long-term field research is necessary to determine water use, carbon sequestration, nutrient use, and greenhouse gas emissions, and the subsequent alteration of forest growth and stand dynamics.
Biochar systems are designed to meet four related primary objectives: improve soils, manage waste, generate renewable energy, and mitigate climate change. Supply chain models provide a holistic framework for examining biochar systems with an emphasis on product life cycle and end use. Drawing on concepts in supply chain management and engineering, this chapter presents biochar as a manufactured product with a wide range of feedstocks, production technologies, and end use options. Supply chain segments are discussed in detail using diverse examples from agriculture, forestry and other sectors that cut across different scales of production and socioeconomic environments. Particular attention is focused on the environmental impacts of different production and logistics functions, and the relationship between supply chain management and life cycle assessment. The connections between biochar supply chains and those of various co-products, substitute products, and final products are examined from economic and environmental perspectives. For individuals, organizations, and broad associations connected by biochar supply and demand, achieving biochar’s potential benefits efficiently will hinge on understanding, organizing, and managing information, resources and materials across the supply chain, moving biochar from a nascent to an established industry.
Oceanic uptake and transport of bomb radiocarbon as 14CO2 created by atmospheric nuclear weapons testing in the 1950s and 1960s has been a useful diagnostic for determining the carbon transfer between the ocean and atmosphere. In addition, the distribution of 14C in the ocean can be used as a tracer of oceanic circulation. Results obtained on samples collected in the Gulf of Alaska in the summer of 2002 provide a direct comparison with results in the 1970s during GEOSECS and in the early 1990s during WOCE. The open gyre values are 20–40% lower than those documented in 1991 and 1993 (WOCE), although the general trends as a function of latitude are reproduced. Surface values are still significantly higher than pre-bomb levels (∼ −105% or lower). In the central gyre, we observe Δ14C values that are lower in comparison to GEOSECS (stn 218) and WOCE P16/P17 to a density of ∼26.8 σt. This observation is consistent with the overall decrease in surface Δ14C values and reflects the erosion of the bomb-14C transient. We propose that erosion of the bomb-14C transient is accomplished by entrainment of low-14C water via vertical exchange within the Gulf of Alaska and replenishment of surface and subther-mocline waters with waters derived from the far northwest Pacific.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
The interpretation of Soft–Gamma–Repeaters (SGRs) and Anomalous X–Ray Pulsars (AXPs) as Magnetars (Thompson & Duncan 1996) raises again the issue of the generation of the ultra–strong magnetic fields (MFs) in neutron stars (NSs) and the related question of where these fields are anchored: in the core, penetrating the whole star, or confined to the crust. Recently, Heyl & Kulkarni (1998) considered the magneto–thermal evolution of magnetars with a core field. Since the assumption of a crustal field is at least not in disagreement with the observations of isolated pulsars (Urpin & Konenkov 1997) and of NSs in binary systems (Urpin, Geppert & Konenkov 1998, Urpin, Konenkov & Geppert 1998), here we would like to address the question whether the observations of SGRs and AXPs can be interpreted as magnetars having a crustal MF. Given the strength of the MF in magnetars we take into account, in an approximate manner, the strongly non–linear Hall effect on its decay. We intend to provide a contribution to an unified picture of NS MF evolution based on the crustal field hypothesis.
There has been increasing emphasis on performing ‘same-day’ or ‘out-patient’ thyroidectomy to reduce associated costs. However, acceptance has been limited by the risk of potentially life-threatening post-operative bleeding. This study aimed to review current rates of post-operative bleeding in a metropolitan teaching hospital and identify risk factors.
Medical records of patients undergoing thyroidectomy between January 2007 and March 2012 were reviewed retrospectively. Pre-operative, operative and pathological data, and post-operative complication data, were examined.
The study comprised 205 thyroidectomy cases. Mean age was 51.6 years (standard deviation = 14.74), with 80 per cent females. Unilateral thyroidectomy was performed in 81 cases (39.5 per cent) and total thyroidectomy was performed in 74 cases (36.1 per cent; 5.3 per cent with concomitant lymph node dissection). Nine patients (4.4 per cent) suffered post-operative bleeding, of which six required re-operation. Analysis showed that post-operative systolic blood pressure of 180 mmHg or greater was associated with post-operative bleeding (p = 0.003, chi-square test).
Rates of significant post-operative bleeding are consistent with recent literature. Post-operative hypertension, diabetes and high post-operative drain output were identified as independent risk factors on multivariate analysis; when identified, these may be caveats to same-day discharge of thyroidectomy patients.
Vertically aligned graphene was grown by plasma-enhanced chemical vapor deposition using methane feedstock. Optical emission spectroscopy (OES) was used to monitor the plasma species, and Raman spectroscopy was used for characterizing the properties of as-grown vertically aligned graphene. OES-derived information on plasma species, such as C, C2, CH, and H, are correlated with the properties of the vertically aligned graphene. Graphene grown at 250 W and 15 sccm exhibited the lowest amount of defects. Although OES peak intensities occurred at the highest power and lowest flow conditions, the OES peak ratios of plasma species had a greater dependence on flow rate and exhibited a saddle point in the atomic C/H ratio corresponding to optimal growth involving the lowest amount of overall defects. Plasma diagnostics provides a valuable approach to optimize growth characteristics and material properties.