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Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
In this paper, we characterize a high repetition-rate regenerating plasma mirror produced by the thin film of liquid formed when two laminar streams collide. The use of a flowing liquid film is inexpensive and the interaction surface refreshes automatically, avoiding buildup of on-target debris. The composition of the liquid material and the relative angle of the film-generating nozzles was optimized for this application. Spectra measured in reflection from a water-based plasma mirror showed a blue shift but an optical reflectivity of up to 30%. The thickness of the film was found to be of the order of 2
m, and the stability of the reflected spot was
mrad. The reflected beam profile was highly distorted but stable. Further optimization of the nozzles to affect the fluid flow should enable significant improvements in control of the fluid films and increase in the reflectivity of these mirrors.
In glyphosate-resistant (GR) cropping systems, paraquat applied in mixtures with residual herbicides prior to crop emergence offers an alternative herbicide mode of action (MOA) to aid in GR weed management. Rice is sensitive to off-target herbicide movement; however, severity of injury can vary with herbicide, rate, and formulation. Therefore, research was conducted from 2015 to 2017 in Stoneville, MS, to characterize rice response to a sublethal concentration of paraquat applied at 84 g ai ha–1 in combination with common residual herbicides. Paraquat plus metribuzin injured rice 68% to 69% 14 and 28 d after treatment (DAT), which was 10% to 13% greater than injury following paraquat alone or paraquat plus fomesafen. Pooled across metribuzin and fomesafen treatments, paraquat reduced rough rice yields 23%. Paraquat plus 10 different residual herbicides injured rice ≥51% 28 DAT and reduced rough rice yields ≥21%. These studies indicate a severe negative impact on rice growth and development following exposure to a sublethal concentration of paraquat alone or in mixture with common residual herbicides. Therefore, applications of paraquat plus residual herbicides to fields in proximity to rice should be avoided if conditions are conducive for off-target movement.
To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.
Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.
Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.
The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.
The iconic Plaza Tree of Pueblo Bonito is widely believed to have been a majestic pine standing in the west courtyard of the monumental great house during the peak of the Chaco Phenomenon (AD 850–1140). The ponderosa pine (Pinus ponderosa) log was discovered in 1924, and since then, it has been included in “birth” and “life” narratives of Pueblo Bonito, although these ideas have not been rigorously tested. We evaluate three potential growth origins of the tree (JPB-99): Pueblo Bonito, Chaco Canyon, or a distant mountain range. Based on converging lines of evidence—documentary records, strontium isotopes (87Sr/86Sr), and tree-ring provenance testing—we present a new origin for the Plaza Tree. It did not grow in Pueblo Bonito or even nearby in Chaco Canyon. Rather, JPB-99 originated from the Chuska Mountains, over 50 km west of Chaco Canyon. The tree was likely carried to Pueblo Bonito sometime between AD 1100 and 1130, although why it was left in the west courtyard, what it meant, and how it might have been used remain mysteries. The origin of the Plaza Tree of Pueblo Bonito underscores deep cultural and material ties between the Chaco Canyon great houses and the Chuska landscape.
The typical onset of schizophrenia coincides with the maturational peak in cognition; however, for a significant proportion of patients the onset is before age 18 and after age 30 years. While cognitive deficits are considered core features of schizophrenia, few studies have directly examined the impact of age of illness onset on cognition.
The aim of the study was to examine if the effects of age on cognition differ between healthy controls (HCs) and patients with schizophrenia at illness onset. We examined 156 first-episode antipsychotic-naïve patients across a wide age span (12–43 years), and 161 age- and sex-matched HCs. Diagnoses were made according to ICD-10 criteria. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS), and IQ was estimated using subtests from the Wechsler adult- or child-intelligence scales. Multivariate analysis of covariance (MANCOVA) was used to examine linear and quadratic effects of age on cognitive scores and interactions by group, including sex and parental socioeconomic status as covariates.
There was a significant overall effect of age on BACS and IQ (p < 0.001). Significant group-by-age interactions for verbal memory (for age-squared, p = 0.009), and digit sequencing (for age, p = 0.01; age-squared, p < 0.001), indicated differential age-related trajectories between patients and HCs.
Cognitive functions showing protracted maturation into adulthood, such as verbal memory and verbal working memory, may be particularly impaired in both early- and late-schizophrenia onset. Our findings indicate a potential interaction between the timing of neurodevelopmental maturation and a possible premature age effect in late-onset schizophrenia.
Williams syndrome is a multisystem, congenital disorder which is commonly associated with arterial stenoses: supravalvar aortic stenosis and peripheral pulmonary artery stenosis. Venous abnormalities have not been previously reported in children with Williams syndrome. We present a case of a 3-year-old girl with Williams syndrome and diffuse venous ectasia as detected by MRI.
Little is known about who would benefit from Internet-based personalised nutrition (PN) interventions. This study aimed to evaluate the characteristics of participants who achieved greatest improvements (i.e. benefit) in diet, adiposity and biomarkers following an Internet-based PN intervention. Adults (n 1607) from seven European countries were recruited into a 6-month, randomised controlled trial (Food4Me) and randomised to receive conventional dietary advice (control) or PN advice. Information on dietary intake, adiposity, physical activity (PA), blood biomarkers and participant characteristics was collected at baseline and month 6. Benefit from the intervention was defined as ≥5 % change in the primary outcome (Healthy Eating Index) and secondary outcomes (waist circumference and BMI, PA, sedentary time and plasma concentrations of cholesterol, carotenoids and omega-3 index) at month 6. For our primary outcome, benefit from the intervention was greater in older participants, women and participants with lower HEI scores at baseline. Benefit was greater for individuals reporting greater self-efficacy for ‘sticking to healthful foods’ and who ‘felt weird if [they] didn’t eat healthily’. Participants benefited more if they reported wanting to improve their health and well-being. The characteristics of individuals benefiting did not differ by other demographic, health-related, anthropometric or genotypic characteristics. Findings were similar for secondary outcomes. These findings have implications for the design of more effective future PN intervention studies and for tailored nutritional advice in public health and clinical settings.
Research suggests that critical thinking skills are often surprisingly domain-specific. We survey the case histories of several Nobel Prize winners in the sciences to demonstrate that even extremely bright individuals can fall prey to bizarre ideas. These findings strongly suggest that intellectual brilliance and acceptance of weird ideas are not mutually incompatible. They also highlight the domain-specificity of critical thinking and the surprising independence of general intelligence from critical thinking. A number of cognitive errors, including bias blind spot and the senses of omniscience, omnipotence, and invulnerability; personality traits such as narcissism and excessive openness; and the “guru complex” may predispose highly intelligent individuals to disastrous critical thinking errors.
Rice with enhanced tolerance to herbicides that inhibit acetyl coA carboxylase (ACCase) allows POST application of quizalofop, an ACCase-inhibiting herbicide. Two concurrent field studies were conducted in 2017 and 2018 near Stoneville, MS, to evaluate control of grass (Grass Study) and broadleaf (Broadleaf Study) weeds with sequential applications of quizalofop alone and in mixtures with auxinic herbicides applied in the first or second application. Sequential treatments of quizalofop were applied at 119 g ai ha−1 alone and in mixtures with labeled rates of auxinic herbicides to rice at the two- to three-leaf (EPOST) or four-leaf to one-tiller (LPOST) growth stages. In the Grass Study, no differences in rice injury or control of volunteer rice (‘CL151’ and ‘Rex’) were detected 14 and 28 d after last application (DA-LPOST). Barnyardgrass control at 14 and 28 DA-LPOST with quizalofop applied alone or with auxinic herbicides EPOST was ≥93% for all auxinic herbicide treatments except penoxsulam plus triclopyr. Barnyardgrass control was ≥96% with quizalofop applied alone and with auxinic herbicides LPOST. In the Broadleaf Study, quizalofop plus florpyrauxifen-benzyl controlled more Palmer amaranth 14 DA-LPOST than other mixtures with auxinic herbicides, and control with this treatment was greater EPOST compared with LPOST. Hemp sesbania control 14 DA-LPOST was ≤90% with quizalofop plus quinclorac LPOST, orthosulfamuron plus quinclorac LPOST, and triclopyr EPOST or LPOST. All mixtures except quinclorac and orthosulfamuron plus quinclorac LPOST controlled ivyleaf morningglory ≥91% 14 DA-LPOST. Florpyrauxifen-benzyl or triclopyr were required for volunteer soybean control >63% 14 DA-LPOST. To optimize barnyardgrass control and rice yield, penoxsulam plus triclopyr and orthosulfamuron plus quinclorac should not be mixed with quizalofop. Quizalofop mixtures with auxinic herbicides are safe and effective for controlling barnyardgrass, volunteer rice, and broadleaf weeds in ACCase-resistant rice, and the choice of herbicide mixture could be adjusted based on weed spectrum in the treated field.
Byron’s scientific context was no longer natural philosophy, but was not yet modern science. Through the eighteenth century, “natural philosophy” – traceable back to classical philosophia naturalis – had been the primary rubric organizing the investigation of natural phenomena. It was one of a set of English terms, including “natural religion” and “natural history,” that together positioned the study of nature as continuous with Anglican orthodoxy. “Science,” meanwhile, had a much wider field of reference than it does today. It named literate knowledge generally, and was often used synonymously with “literature,” which, prior to its Romantic-period redefinition as imaginative writing, likewise referred to all forms of knowledge communicated through the medium of letters. But from the late eighteenth century, just as “literature” was taking on a newly specialized meaning, “science” too was being redefined as the collective term for an emergent series of specialized disciplinary fields of research.
This chapter provides a brief review of missions using X-ray, gamma-ray, and neutron spectroscopy to determine the chemical composition of planetary surfaces. This chapter presents the history of planetary radiation measurements, including significant discoveries. Summary tables with links to the archived data provide a resource for readers interested in working in this field. Upcoming missions and possible future directions are described.
Neutrons, gamma rays, and X-rays are used to measure the subsurface elemental composition of Solar System bodies, providing insights into their formation and evolution. Neutrons and gamma rays are highly penetrating particles made by the steady bombardment of the regolith of airless bodies by galactic cosmic rays. Gamma rays are also made by the decay of natural radioelements. The escaping radiation can be detected in close-proximity orbits and analyzed to determine subsurface elemental composition to depths of a few decimeters. Because the radiation sensors have nearly omnidirectional response, spatial resolution depends on orbital altitude. X-ray fluorescence is induced by solar X-rays. Consequently, X-ray spectroscopy is most useful for studies of objects in the inner Solar System. Characteristic elemental X-rays are made within the uppermost ~100 micrometers of the surface. The suite of elements analyzed overlaps that of nuclear spectroscopy, providing complementary geochemical information. Because X-rays are easily collimated, relatively high spatial resolution measurements are possible. This chapter presents the fundamentals of neutron, gamma-ray, and X-ray production, transport, and detection along with an overview of the measurement principles, including modeling, analysis, and mapping methods.
There is no single ultrasound probe available that allows visualization of all airway structures in children of all ages. In larger children above approximately 8 years of age, the linear medium-to-high frequency (5–14 MHz) transducer is suitable for imaging superficial airway structures (within 0–5 cm beneath the skin surface). The curved low-frequency transducer (~4.0 MHz) is most suitable for obtaining sagittal and parasagittal views of the tongue and structures in the submandibular and supraglottic regions, mainly because of its wider field of view. Linear transducers, which are used for assessment of the upper airways, provide excellent images of superficial structures, such as ribs and the pleura, but deeper structures can be difficult to assess. A micro-convex transducer (~8.0 MHz) is a good all-round transducer for focused ultrasonographic examination of the lungs, since most micro-convex transducers have an acceptable image quality of both superficial (pleura) and deeper structures (e.g., lung consolidation, atelectasis). Furthermore, micro-convex transducers are often small, which makes it easier to access the posterior thoracic wall, when the patient can only be examined in the supine position. An alternative to the micro-convex transducer for examination of the lungs is the curved low-frequency transducer (~4.0 MHz), which also has an acceptable image quality of both superficial and deeper structures. Since visualization of superficial and deep structures is needed, it is important to continuously optimize transducer frequency to obtain the best possible images. The presence or absence of artifacts are an important part of lung ultrasonography; hence, one should be mindful to deactivate any image optimization software that is inherently built into newer ultrasound machines as this would remove or diminish the presence of these useful artifacts when performing lung ultrasonography.
While much of the literature on bilingualism and cognition focuses on group comparisons (monolinguals vs bilinguals or language learners vs controls), here we examine the potential differential effects of intensive language learning on subjects with distinct language experiences and demographic profiles. Using an individual differences approach, we assessed attentional performance from 105 university-educated Gaelic learners aged 21–85. Participants were tested before and after beginner, elementary, and intermediate courses using tasks measuring i.) sustained attention, ii.) inhibition, and iii.) attention switching. We examined the relationship between attentional performance and Gaelic level, previous language experience, gender, and age. Gaelic level predicted attention switching performance: those in higher levels initially outperformed lower levels, however lower levels improved the most. Age also predicted performance: as age increased attention switching decreased. Nevertheless, age did not interact with session for any attentional measure, thus the impact of language learning on cognition was detectable across the lifespan.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.