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.
Introduction: Upper gastrointestinal bleeding (UGIB) is a common medical condition presenting to emergency departments (ED) and associated with substantial morbidity, mortality, and healthcare expenditures. Our aim was to evaluate the incidence of patients presenting to ED with UGIB in a large population-based surveillance cohort. Methods: The National Ambulatory Care Reporting System (NACRS) was used to identify all presentations to emergency departments for UGIB in Alberta from fiscal year 2010 to 2015 (n=56519) using the International Classification of Diseases Codes (ICD-10) in any diagnostic position. Baseline characteristics and UGIB incidence were calculated using descriptive statistics. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). Results: The median age of 56519 UGIB presentations was 56 years (interquartile range: 41 to 74 years), 56% were male, and 245% had at least one comorbidity. At time of disposition from the ED , 48.3% were admitted to or transferred to another hospital, 51.4% discharged, and 0.3% died in the emergency department. Further, 10.8% underwent upper endoscopy during their admission to the emergency department. The annual incidence of UGIB were 230.6 (2010), 232.8 (2011), 241.0 (2012), 242.2 (2013), 244.6 (2014), and 242.2 (2015) per 100,000 person-years. Between 2010 and 2015 the incidence of UGIB presenting to ED significantly increased overtime (AAPC=1.1; 95% CI: 0.3 to 2.0). Conclusion: UGIB is a common presentation to emergency departments and has been increasing overtime. Future studies are necessary to evaluate the underlying cause of UGIB and to determine its burden to Albertas healthcare system.
Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the emergency department (ED) accounting for significant morbidity, mortality and health care resource usage. In Alberta, a provincial care pathway was recently developed to provide an evidence informed approach to managing patients with an UGIBs in the ED. Pantoprazole infusions are a commonly used treatment despite evidence that suggests they are generally not indicated prior to endoscopy in the ED. The goal of this project was to optimize management of patients with a NVUGIB, in particular reduce pre-endoscopy pantoprazole infusions. Methods: In July 2016, we implemented a multi-faceted intervention to optimize management of ED patients with NVUGIB including 1. de-emphasizing IV pantoprazole infusions in the ED, 2. clinical decision support (CDS) embedded (for endoscopy, disposition and transfusions) within the order set and 3. educating clinicians about the care pathway. We used a pre/post-order set design, analyzing 391 days pre and 189 days post-order set changes. Data was extracted from our fully integrated electronic health records system. The primary outcome was the % of patients receiving IV pantoprazole infusion ordered by an emergency physician (EP) among all patients with NVUGIB. Secondary outcomes included % transfused with hgb >70g/L and whether using the GIB order set impacted management of NVUGIB patients. Results: In the 391 days pre-order set changes, there were 2165 patients included and in the 189 days post-order set changes, there were 901 patients. For baseline characteristics, patients in the post-order set change group were significantly older (64.4 yrs vs 60.9 yrs p-value=0.0016) and had a lower hgb (115 vs 118, p-value=0.049) but otherwise for gender, measures of severity of illness (systolic blood pressure, heart rate, CTAS, % admitted) there were no significantly differences. For the primary outcome, in the pre-order set phase, 47.1% received a pantoprazole infusion ordered by an EP, compared to 31.5% in the post-order phase, for an absolute reduction of 15.6% (p-value= <0.001). For the secondary outcomes, transfusion rates were similar pre/post (22.08% vs 22.75%). Significant inter-site variability exists with respect to the reduction in pantoprazole infusion rates across the four sites (-23.3% to +6.12%). Conclusion: Our interventions resulted in a significant overall reduction in pantoprazole infusions in ED patients with NVUGIB. Reductions in pantoprazole infusions varied significantly across the different sites, future work in our department will explore and address this variability. Keys to the success of this project included engaging clinicians as well as leveraging the SCM order sets as well as the provincial care pathway. Although there were no changes in transfusion rates, it in unclear if this a function of the CDS not being effective or whether these transfusions were clinically indicated.
The infrared-radio correlation (IRRC) offers a way to assess star formation from radio emission. Multiple studies found the IRRC to decrease with increasing redshift. This may in part be due to the lack of knowledge about the possible radio spectral energy distributions (SEDs) of star-forming galaxies. We constrain the radio SED of a complete sample of highly star-forming galaxies (SFR > 100 M⊙/ yr) based on the VLA-COSMOS 1.4 GHz Joint and 3 GHz Large Project catalogs. We reduce archival GMRT 325 MHz and 610 MHz observations, broadening the rest-frame frequency range to 0.3-15 GHz. Employing survival analysis and fitting a double power law SED, we find that the slope steepens from a spectral index of α1 = 0.51±0.04 below 4.5 GHz to α2 = 0.98±0.07 above 4.5 GHz. Our results suggest that the use of a K-correction assuming a single power-law radio SED for star forming galaxies is likely not the root cause of the IRRC trend.
Introduction: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the Emergency Department (ED) associated with significant mortality and morbidity. Recent evidence suggests that overt-transfusion is associated with poor patient outcomes and that stable patients above a hemoglobin (hgb) above 70 g/L should be transfused judiciously. This retrospective health records review aims to determine the proportion of NVUGIB patients with hemoglobin greater than 70 g/L who were still appropriately transfused based on clinical parameters. Methods: A retrospective review was conducted on randomly selected patients that presented to one of two major tertiary hospitals with a primary diagnosis of NVUGIB who received blood products, despite a presenting hemoglobin >70 g/L. Standardized case report forms were developed through chart abstraction using a pilot-tested template. The appropriateness of transfusion was then adjudicated separately by a trained medical student and an emergency physician; discrepancies were resolved by discussion. Results: Following independent review of the charts, agreement was met on 94% (45/48) of the charts and after collective discussion 100% consensus was reached and all 48 patients’ transfusion appropriateness and categorized into one of three groups: Appropriate, Potentially avoidable, and clearly avoidable. Only in 22.9% (11/48) of the cases was transfusion deemed to be clearly avoidable while emergency physicians appropriately transfused 45.8% (22/48) of patients based on clinical status and other factors. In 31.3% (15/48) of the cases, transfusion was potentially avoidable in favor of other management options. We calculated the mean GBS for the appropriate, potentially avoidable, and clearly avoidable categories yielding 12.8, 12.7, and 10.2 respectively. Mortality occurred in 2 of the 48 cases (4%). Conclusion: In most instances, emergency physicians are effectively integrating hemoglobin thresholds and clinical status to determine if a patients with NVUGIB and hgb >70 require blood products.
Polarimetry of the far infrared emission from magnetically-aligned interstellar grains is one of the best ways of studying the magnetic field at the Galactic center. We describe the HAWC+ instrument, under development for flight on SOFIA starting in 2015, which will provide a major advance in capability for these critically important measurements.
Polarimetry at far-infrared wavelengths is a key tool for studying physical processes on size scales ranging from interstellar dust grains to entire galaxies. A multi-wavelength continuum polarimeter at these wavelengths will allow studies of thermal dust polarization in an effort to constrain the grains’ physical properties and test grain alignment theory. High spatial resolution (5–30 arcsec) and sensitive observations will measure the influence of magnetic fields on infrared cirrus clouds, the envelopes and disks of YSOs, outflows from both low- and high-mass star forming regions, and the relative strength of magnetic, gravitational, and turbulent effects in star- and cloud-formation.
There are a lot of synthetic polymers which can be used for controlled drug delivery, however they are not easily accepted by the organism. Also incorporation of drugs into carriers runs under difficult conditions. Therefore scientists have been inclined to use natural-origin polymers, such as proteins and polysaccharides. Some of these promising natural polysaccharidic candidates are alginic acid sodium salt, guar gum and chitosan due to their outstanding merits. They are similar to extracellular matrix having high chemical versatility, good biological performance and cell or enzyme-controlled degradability. Many polysaccharidic hydrogels for drug delivery have already been prepared, but one of their weakness is their short life in dry air conditions; thus, special coating materials are being developed for enhancing their life time.
Alginates were used in the present research for synthesis of organic biodegradable gels by sol-gel process, which were further easily converted to aerogels by supercritical drying. They are safe for use, nontoxic, and derived from renewable sources. Aerogels made of alginate are dry and stable materials, which makes them interesting as a substitute to hydrogels. Alginates undergo reversible gelation in aqueous solution through interaction with divalent cations such as Ca2+, which create ionic inter-chain bridges. Two fundamental methods of ionic cross-linking were used to prepare alginate hydrogels: the diffusion method, where spheres are created and the internal setting method resulting in monoliths. After producing the hydrogel, alcogels were formed by solvent exchange using 100% ethanol. Ethanol was later replaced by supercritical CO2 with supercritical drying (100 bar, 35°C). Aerogels made from natural polysaccharides combine both biocharacteristics and aerogel characteristics such as high porosity and specific surface area, which makes them really attractive in drug delivery applications. The aerogels obtained in present research were therefore studied as drug carriers. The effects of the alginate composition and synthesis method on model drug nicotinic acid release were investigated. The results indicated that by using the internal setting cross-linking method for obtaining aerogels nicotinic acid was released in a more controlled manner. That is why further investigation was done on alginate spherical beads for prolonging their drug release. A multi-step sol-gel process was applied to generate complex aerogels with multi-membranes. First ionically cross-linked spherical cores were obtained by dropwise addition of sodium alginate solution into a CaCl2 solution. These cores were further immersed into alginate solution, filtered through a sieve and dropped into a salt solution again. By repeating the above process, different multi-membrane hydrogels were produced and further converted to aerogels. By adding more membranes around core burst drug release was successfully inhibited.
Hydrogen implantation into either n-GaAs:Si or p-GaAs:Zn crystals leads to a neutralization of charge carriers, primarily through induced crystal damage. The resulting decrease in carriers is useful in opto-electronics applications for confining electrical current or optical radiation. Exposure of the same crystal materials to a hydrogen plasma also leads to reduction of the charge carriers, but through a passivation mechanism involving hydrogen-dopant atom complexes. This technique may be useful for opto-electronics device processing but further details converning the physical mechanisms need to be established. Here we present the results of investigations aimed at correlating the changes in carrier concentration as determined by infrared reflectivity measurements with atomic depth profiles obtained from secondary ion mass spectrometry (SIMS). Differences between the use of hydrogen or deuterium plasmas are also reported.
Indium phosphide (InP) and its related alloys have gained increased importance in recent years due to their widespread application in opto-electronics and high speed microelectronics. Ion beam processing has been used to produce electrical activity in selective areas of wafers and for device isolation. However, major problems remain concerning the location, electrical/chemical activity, and thermal stability of the implanted atoms in such devices. In this paper, we present detailed results concerning the distribution of 1H and Be atoms implanted into single crystal InP wafers. Secondary ion mass spectrometry has been used to depth profile 1H and Be implanted at different engergies, from 0.1 to 1.0 MeV, and with fluences up to 1016 cm2. Implanted samples have also been examined after furnace annealing to determine the onset and extent of thermal redistribution. Resulting profiles have been compared with corresponding implants into single crystal GaAs to help clarify diffusion behavior.
In this paper we report on the depth distributions of implanted hydrogen in GaP crystals and the subsequent changes produced by post- implantation furnace annealing. A sulfur doped n+ GaP wafer has been implanted with 333 keV protons to a fluence of 5E15/cm+2. A similar wafer was implanted with 350 keV deuterons to the same fluence. Portions of each wafer have been furnace annealed at temperatures up to 500°C. The implanted hydrogen and the dopant S atoms were then depth profiled using secondary ion mass spectrometry (SIMS). The measurements show that the redistribution of hydrogen begins with annealing at about 300°C and proceeds both towards the surface and deeper into the substrate. The overall behavior is similar to that found previously for hydrogen in GaAs. However, in GaP crystals this redistribution begins at a higher temperature and proceeds more slowly in the implanted region. Based on the SIMS profiles, diffusion coefficients for hydrogen migrating into substrate are obtained.
Results are presented on the fabrication of optical gratings on an Al0.3Ga0.7As/GaAs superlattice (SL) with equal 3.5 nm barrier and well widths, by using locally FIB-enhanced mixing. As the first step, the mechanism of the mixing was studied. Si++ was accelerated to 50 kV and lOOkV and implanted at doses ranging from 1013 to 1015/cm2. A rapid thermal anneal of 10 s at 950°C was utilized. The average Al inter-diffusion coefficient and length were calculated as a function of FIB dose from SIMS depth profiling. The mixing was significantly enhanced by the FIB implantation. The ion dose as low as l×1014/cm2 followed by RTA yields a mixing parameter of ∼90% and results in a two-order of magnitude increase in the diffusion coefficient, to a value of 4.5×10−14cm2/sec, in contrast to 1.3×10−16cm2/sec from RTA-only. The maximum mixing occurred in the region where neither Si ions nor vacancies have their maximum concentration. Instead, it coincides with the location of the positive maximum of the second derivative of the vacancy concentration profile. This fact suggests that in the time frame of RTA and with low dose, the diffusion of nonequilibrium point defects plays a major role in the process of enhancing Al-Ga interdiffusion. DBR optical gratings, consisting of thousands of spacing lines with 350nm period, were fabricated with a lOOkV FIB dose of 2×1013 andl×1014/cm2. Photoluminescence (PL) spectra were taken from the grating region as well as the unimplanted superlattice region. The PL intensity from cavity region of the DBR was about 16 times higher than that from the original SL. This PL enhancement was verified to occur in the cavity region only by spatially scanning over the entire sample. A possible mechanism for this PL enhancement is optical feedback provided by the gratings.
The N distribution and bonding in five types of oxynitride films have been investigated using SIMS and XPS. Films were grown using N2O, NO-O2 and NH3 gas sources, a remote plasma N source and a Helicon plasma source. The SIMS measurements show different N distributions for each type of sample. XPS measurements show only N≡Si3 bonding in the gas source films, N≡Si3 and O-N-Si2 bonding in the remote plasma sample, and N≡Si3, O-N≡Si2, and O2≡N-Si bonding in the Helicon plasma sample. Angle-resolved XPS measurements show that the O2≡N-Si bonding is deepest in the sample whereas the O-N≡Si2 bonding is associated with a surface oxide.
In spring of 1846, the George and Jacob Donner families and some 80 traveling companions began their overland trek to California. When the party ascended the Sierra Nevada in late October, a snowstorm forced the group to bivouac. At this point, the train became separated into two contingents; the larger party camped near Donner Lake and the smaller group—including the Donner families—settled at Alder Creek. Though written accounts from the Lake site imply many resorted to cannibalism, no such records exist for Alder Creek. Here we present archaeological findings that support identification of the Alder Creek camp. We triangulate between historical context, archaeological traces of the camp, and osteological remains to examine the human condition amid the backdrops of starvation and cannibalism. A stepped analytical approach was developed to examine the site’s fragmentary bone assemblage (n = 16,204). Macroscopic and histological analyses indicate that the emigrants consumed domestic cattle and horse and procured wild game, including deer, rabbit, and rodent. Bladed tools were used to extensively process animal tissue. Moreover, bone was being reduced to small fragments; pot polish indicates these fragments were boiled to extract grease. It remains inconclusive, however, whether such processing, or the assemblage, includes human tissue.
Objectives: In the Netherlands, allocation decisions have not yet been explicitly based on the Value of Statistical Life. However, when policy makers decide whether or not to implement life saving interventions this trade-off is made implicitly. This study aimed to gain insights into this trade-off, hereafter referred to as Implicit Value of Statistical Life (IVSL), by means of a retrospective investment analysis of life saving interventions implemented in the Netherlands.
Methods: A literature search was conducted to find life saving intervention cases meeting the requirements for IVSL calculation. A final sample of ten cases was included in the study concerning interventions implemented in different societal sectors. For each case, an IVSL estimate was calculated according to a uniform method.
Results: IVSL estimates derived from the intervention cases differed considerably and ranged from €1 to almost €11 million. Differences were most extreme when comparing IVSL estimates concerning interventions implemented in different societal sectors. However, IVSL estimates also varied greatly between interventions in the same sector and even within the same interventions when critical assumptions were altered.
Conclusion: Our findings suggest that there are great imbalances between societal investments for preventing a statistical death. This highlights the need for further deliberation about how to improve transparency of policy decisions. An approach ex ante determining the Value of Statistical Life by means of empirical methods and based on societal preferences might circumvent the problems associated with the IVSL and needs further exploration.
Using proton nuclear magnetic resonance (1H-NMR), we have studied the thermally activated hydrolysis of aluminum nitride admixed into Al2O3 aqueous suspensions. We paid special attention to the formation of aluminum hydroxide and its role in binding the host ceramic particles into a stiff solid matrix. The water–proton NMR spin-spin relaxation time (T2) was continuously measured as a function of the time of the AlN hydrolysis in the host Al2O3 ceramic suspension. T2 was found to correlate with an increasing fraction of bound water at the surface of the formed hydrogel and so provided us with information about the gel-surface growth during the hydrolysis process. These results are in good agreement with the observed time- and composition-related increases in high-frequency impedance for the analyzed suspensions.
The monoclinic structural distortion in lead phosphate and lead arsenate is correlated with the ferroelastic phase transition R3̄m → C2/c and R3̄m → P21/c respectively. The resulting domain patterns in the mixed compounds depend on their chemical composition. The intersection of ferroelastic W domain walls with the (100) surface of lead phosphate-arsenate mixed crystals has been imaged using tapping mode atomic force microscopy. Dilution of the strain leads to characteristic surface deformations which deviate from those in pure lead phosphate. In high twinned lead phosphate-arsenate, X-ray diffraction (XRD) was used to show renormalization effects and scattering phenomena stemming from the twin walls. The wall trajectory was found to be independent of chemical variations using transmission electron microscopy.