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A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
X-ray windows are used in sources and detectors to separate the neighborhood of the x-ray generation or detection from the use environment. While each use has its own requirements, there are some principles that should be used in designing an optimal x-ray window. Because x rays are absorbed to some extent by all materials, minimizing absorption is one criterion in preparing windows. Also, for most uses there is a pressure difference across the window so that ensuring pinhole-free structure and sufficient mechanical strength to support the differential is another criterion for window design. Traditionally, absorption, is minimized by fabricating the window with lower atomic number (low Z) elements such as Be, B or C. However, the wavelength (energy) region of interest becomes a very important complicating factor.
The current study advanced research on the link between community violence exposure and aggression by comparing the effects of violence exposure on different functions of aggression and by testing four potential (i.e., callous–unemotional traits, consideration of others, impulse control, and anxiety) mediators of this relationship. Analyses were conducted in an ethnically/racially diverse sample of 1,216 male first-time juvenile offenders (M = 15.30 years, SD = 1.29). Our results indicated that violence exposure had direct effects on both proactive and reactive aggression 18 months later. The predictive link of violence exposure to proactive aggression was no longer significant after controlling for proactive aggression at baseline and the overlap with reactive aggression. In contrast, violence exposure predicted later reactive aggression even after controlling for baseline reactive aggression and the overlap with proactive aggression. Mediation analyses of the association between violence exposure and reactive aggression indicated indirect effects through all potential mediators, but the strongest indirect effect was through impulse control. The findings help to advance knowledge on the consequences of community violence exposure on justice-involved youth.
This study examined the qualitative differences between the types of strengths identified by satisfied versus distressed couples seeking a Marriage Checkup. We hypothesised that distressed couples would nominate less intimate strengths, while satisfied couples would nominate more intimate strengths. We found that distressed partners were significantly more likely to nominate items from a Parallel Support category, whereas satisfied women, but not men, were significantly more likely to nominate items from an Intimate/Affectionate category. These findings suggest that an indicator of developing couple distress is the point where couples begin to focus their attention on less emotionally vulnerable relationship aspects.
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Shallow ice cores were obtained from widely distributed sites across the West Antarctic ice sheet, as part of the United States portion of the International Trans-Antarctic Scientific Expedition (US ITASE) program. The US ITASE cores have been dated by annual-layer counting, primarily through the identification of summer peaks in non-sea-salt sulfate (nssSO42–) concentration. Absolute dating accuracy of better than 2 years and relative dating accuracy better than 1 year is demonstrated by the identification of multiple volcanic marker horizons in each of the cores, Tambora, Indonesia (1815), being the most prominent. Independent validation is provided by the tracing of isochronal layers from site to site using high-frequency ice-penetrating radar observations, and by the timing of mid-winter warming events in stable-isotope ratios, which demonstrate significantly better than 1 year accuracy in the last 20 years. Dating precision to ±1 month is demonstrated by the occurrence of summer nitrate peaks and stable-isotope ratios in phase with nssSO42–, and winter-time sea-salt peaks out of phase, with phase variation of <1 month. Dating precision and accuracy are uniform with depth, for at least the last 100 years.
The American Heart Association (AHA; Dallas, Texas USA) and European Resuscitation Council (Niel, Belgium) cardiac arrest (CA) guidelines recommend the intraosseous (IO) route when intravenous (IV) access cannot be obtained. Vasopressin has been used as an alternative to epinephrine to treat ventricular fibrillation (VF).
Limited data exist on the pharmacokinetics and resuscitative effects of vasopressin administered by the humeral IO (HIO) route for treatment of VF. The purpose of this study was to evaluate the effects of HIO and IV vasopressin, on the occurrence, odds, and time of return of spontaneous circulation (ROSC) and pharmacokinetic measures in a swine model of VF.
Twenty-seven Yorkshire-cross swine (60 to 80 kg) were assigned randomly to three groups: HIO (n=9), IV (n=9), and a control group (n=9). Ventricular fibrillation was induced and untreated for two minutes. Chest compressions began at two minutes post-arrest and vasopressin (40 U) administered at four minutes post-arrest. Serial blood specimens were collected for four minutes, then the swine were resuscitated until ROSC or 29 post-arrest minutes elapsed.
Fisher’s Exact test determined ROSC was significantly higher in the HIO 5/7 (71.5%) and IV 8/11 (72.7%) groups compared to the control 0/9 (0.0%; P=.001). Odds ratios of ROSC indicated no significant difference between the treatment groups (P=.68) but significant differences between the HIO and control, and the IV and control groups (P=.03 and .01, respectively). Analysis of Variance (ANOVA) indicated the mean time to ROSC for HIO and IV was 621.20 seconds (SD=204.21 seconds) and 554.50 seconds (SD=213.96 seconds), respectively, with no significant difference between the groups (U=11; P=.22). Multivariate Analysis of Variance (MANOVA) revealed the maximum plasma concentration (Cmax) and time to maximum concentration (Tmax) of vasopressin in the HIO and IV groups was 71753.9 pg/mL (SD=26744.58 pg/mL) and 61853.7 pg/mL (SD=22745.04 pg/mL); 111.42 seconds (SD=51.3 seconds) and 114.55 seconds (SD=55.02 seconds), respectively. Repeated measures ANOVA indicated no significant difference in plasma vasopressin concentrations between the treatment groups over four minutes (P=.48).
The HIO route delivered vasopressin effectively in a swine model of VF. Occurrence, time, and odds of ROSC, as well as pharmacokinetic measurements of HIO vasopressin, were comparable to IV.
BurgertJM, JohnsonAD, Garcia-BlancoJ, FultonLV, LoughrenMJ. The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation. Prehosp Disaster Med. 2017;32(3):305–310.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
New data on bat ectoparasites from Mindoro Island, Philippines are reported. Eighty-three individuals of ectoparasitic insects representing seven species of Nycteribiidae and five species of Streblidae (both Diptera), and one species of Ischnopsyllidae (Siphonaptera) were recorded from 11 bat species captured in Naujan Lake National Park, Mindoro Oriental Province, Philippines. Raymondia pagodarum is a new record for the country. Eight species are also newly recorded for Mindoro Island, including Cyclopodia garrula, Leptocyclopodia ferrarii mabuhai, Megastrebla parvior, Brachytarsina amboinensis, B. werneri, R. pagodarum, R. pseudopagodarum and Thaumapsylla longiforceps. Five species are newly documented on various hosts: C. horsfieldi on Pteropus pumilus, M. parvior on Macroglossus minimus, B. amboinensis on Hipposideros diadema, B. werneri on Rhinolophus arcuatus and R. pagodarum on Hipposideros bicolor.
To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions.
Retrospective cohort study.
SETTING AND POPULATION
Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008.
We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients’ demographic characteristics, comorbidities, and choice of graft.
On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%–1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%–3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8–12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3–4.8).
The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients.
Alligatorweed is a perennial, invasive weed in southern United States rice production, but knowledge on effective management of this weed is limited, especially in conventional (non-imidazolinone-resistant) rice fields. Field studies were conducted in multiple environments in southeastern Texas to evaluate different herbicide options involving penoxsulam, propanil, triclopyr, halosulfuron, bispyribac-sodium, bensulfuron, and quinclorac for alligatorweed control in conventional drill-seeded rice when applied at early POST (EPOST), late POST (LPOST), or both. Among the herbicide options evaluated, penoxsulam alone (up to 83%), penoxsulam plus triclopyr (up to 87%), or bispyribac-sodium plus triclopyr (92%) provided superior alligatorweed control. Plots treated with penoxsulam plus triclopyr EPOST produced the highest yields (9,550 kg ha−1), which were comparable to plots receiving penoxsulam plus triclopyr LPOST (9,320 kg ha−1), penoxsulam alone EPOST (9,280 kg ha−1), and penoxsulam plus halosulfuron LPOST (9,180 kg ha−1). Considering both weed control and rice grain yields, penoxsulam plus triclopyr applied EPOST was found to be the best option among the treatments tested. The treatments bensulfuron alone, bensulfuron plus propanil, penoxsulam plus propanil, triclopyr plus propanil, and bispyribac-sodium plus propanil provided poor (≤ 65%) alligatorweed control. Results also suggest the likelihood for antagonistic interactions when tank-mix combinations tested in this study included propanil.
This study employed a novel methodological design to explore how couples transition out of a disagreement that they do not have time to resolve. Thirty college-aged dating couples participated in a 20-minute interaction with their partner where they were required to transition from a conflict conversation to the story of how they met, in a time-limited paradigm. Independent coders coded transition styles and couples completed self-report measures of relationship satisfaction pre, post, and at 6-month follow-up. We identified four transition styles: Mutual Avoidant, Mutual Collaborative, Abrupt/Controlling, and Resign/Withdraw. Couples with a Resign/Withdraw style deteriorated over time compared to couples with the other three styles. Further, couples also varied in terms of transition qualities, including how easily they disengaged and how deeply meaningful the conversation was. Ease of transition was associated with increases in relationship satisfaction at 6 months, whereas depth was associated with decreases in relationship satisfaction both immediately after the interaction and at 6 months. Implications are discussed.
The Spacewatch Project uses four telescopes of apertures 0.9-m, 1.8-m, 2.3-m, and 4-m on Kitt Peak mountain in Arizona for followup astrometry of priority NEOs. Objects as faint as V=23 on the MPC's NEO Confirmation Page, targets of radar, potential impactors, targets of spacecraft observations or visits, and PHAs with future close approaches to Earth receive priority for astrometry.
This paper will discuss the structure-property model developed that correlates the tensile modulus to the elastic properties and angular distribution of constituent graphitic layers for carbon fiber derived from a polyethylene precursor. In addition, a high-temperature fiber tensile device was built to enable heating of carbon fiber bundles at a variable rate from 25 °C to greater than ∼2300 °C, while simultaneously applying a tensile stress. This capability combined with synchrotron wide-angle x-ray diffraction (WAXD), enabled observation in situ and in real time of the microstructural transformation from different carbon fiber precursors to high-modulus carbon fiber. Experiments conducted using PAN- and PE-derived fiber precursors reveal stark differences in their carbonization and high-temperature graphitization behavior.
Mesotrione, a 4-hydroxyphenylpyruvate dioxygenase-inhibiting herbicide, is labeled for PRE and POST crabgrass control. It has enhanced efficacy on smooth and large crabgrass when applied in conjunction with soil-applied nitrogen (N). The objectives of this study, using crabgrass as the weed species, were to (1) determine the influence of N rate and tissue N concentration on mesotrione activity, (2) determine the influence of N source on mesotrione activity, and (3) determine the influence of N application timing on mesotrione activity. Large crabgrass plants that received 12 kg N ha−1 or more before mesotrione application had more bleached and necrotic leaves compared with plants that received 0 kg N ha−1 7 d after treatment (DAT) in the greenhouse. Although N application rates as high as 98 kg N ha−1 were tested, 90% leaf bleaching and necrosis were observed with rates of 8.9 or 10.1 kg N ha−1 in Tennessee and Indiana, respectively. Nitrogen concentration in large crabgrass leaf and stem tissue on the day of the mesotrione application was closely related to the bleaching and necrosis symptoms observed 7 DAT. Although N rate influenced mesotrione activity, N source did not. Nitrogen application timing was also important, with N applications 3, 1, and 0 d before a mesotrione application having the highest percentage of bleached and necrotic leaves in greenhouse experiments. Both greenhouse and field trials support the finding that N applications in proximity to the mesotrione application enhance herbicide activity. Thus, practitioners can pair N and POST mesotrione applications together or in proximity to enhance crabgrass control.