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Introduction: 9-1-1 telecommunicators receive minimal education on agonal breathing, often resulting in unrecognized out-of-hospital cardiac arrest (OHCA). We successfully piloted an educational intervention that significantly improved telecommunicators’ OHCA recognition and bystander CPR rates in Ottawa. We sought to better understand the operations of Canadian 9-1-1 communications centers (CC) in preparation for a multi-centre study of this intervention. Methods: We conducted a National survey of all Canadian CCs. Survey domains included information on organizational structure, dispatch system used, education curriculum, and performance monitoring. It was peer-reviewed, translated in French, pilot-tested, and distributed electronically using a modified Dillman method. We designated respondents in each CC before distribution and used targeted follow-up and small incentives to increase response rate. Respondents also described functioning of neighboring CCs if known. Results: We received information from 51/51 provincial and 1/25 territorial CCs, representing 99.7% of the Canadian population. CCs largely utilize the Medical Dispatch Priority System (MPDS) platform (93%), many are Province/Ministry regulated (50%) and most require a High School diploma as minimum entry level education (78%). Telecommunicators receive initial in-class training (median 1.3 months, IQR 0.3-1.9; range 0.1-2.2), often followed by a preceptorship (84.4%) (median 1.0 months, IQR 0.7-1.7; range 0.4-6.0). Educational curriculum includes information on agonal breathing in 41% of CC, without audio examples in 34%. Among responding CCs, over 39,000 suspected OHCA 9-1-1 calls are received annually. Few CCs maintain local performance statistics on OHCA recognition (25%), bystander CPR rates (25%) or survival rates (50%). Most (97%) expressed interest in future research collaborations. Conclusion: Most Canadian telecommunicators receive no or minimal education in recognizing agonal breathing. Further training and improved OHCA monitoring may assist recognition and enhance outcomes.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
A significant number of X-ray binaries are now known to exhibit long-term periodicities on timescales of ~10 - 100 days. Several physical mechanisms have been proposed that give rise to such periodicities, one of which is radiation-driven warping and precession of the accretion disk. Recent theoretical work predicts the stability to disk warping as a, function of the mass ratio, binary radius, viscosity and accretion efficiency. We investigate the stability of the superorbital periodicities in the neutron star X-ray binaries Cyg X-2, LMC X-4, SMC X-l and Her X-l, and thereby confront stability predictions with observation. We find that the period and nature of the superorbital variations in these sources is consistent with the predictions of warping theory.
The incidence of oropharyngeal squamous cell carcinoma in the Western world is increasing, with the human papillomavirus epidemic implicated in this observed trend. The optimal treatment modality is yet undetermined regarding oncological outcomes.
This study comprised 98 patients with oropharyngeal squamous cell carcinoma, treated with either primary transoral surgery with adjuvant therapy or primary chemoradiotherapy with curative intent, between 2008 and 2012. Clinicopathological characteristics including tumour–node–metastasis stage, human papillomavirus status, treatment modality, recurrence and overall survival were collated.
Five per cent of primary surgical patients had locoregional recurrences compared with 25 per cent of primary chemoradiotherapy patients. A lower rate of locoregional recurrence was observed in the human papillomavirus positive group.
This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.
The objective of the present study was to investigate live weight (LW) gain, urinary nitrogen (UN) excretion and urination behaviour of dairy heifers grazing pasture, chicory and plantain in autumn and spring. The study comprised a 35-day autumn trial (with a 7-day acclimation period) and a 28-days spring trial (with a 7-day acclimation period). For each trial, 56 Friesian × Jersey heifers were blocked into five dietary treatments balanced for their LW and breeding worth (i.e. genetic merit of a cow for production and reproduction): 1·00 perennial ryegrass–white clover pasture (PA); 1·00 chicory (CH); 1·00 plantain (PL); 0·50 pasture + 0·50 chicory (PA + CH); and 0·50 pasture + 0·50 plantain (PA + PL). A fresh allocation of the herbage was offered every 3 days with allowance calculated according to feed requirement for maintenance plus gain of 1·0 kg LW/day. In both trials, LW gain was lower on CH than other treatments. In the spring trial, UN concentration and UN excretion were lower in CH and PL than other treatments. In autumn, a higher urination frequency was observed over the first 6 h after forage allocation in CH and PA + CH than other treatments. Data from the present study indicate that feeding CH alone limited heifer LW gain. However, heifers grazing swards containing chicory (CH and PA + CH) and plantain (PL and PA + PL) had the potential to lower nitrous oxide emissions and nitrate leaching from soil compared with heifers grazing PA, by reducing N loading in urine patches.
To evaluate the prevalence of variations in the anatomical route of the spinal accessory nerve from the base of the skull to the point where it enters the trapezius muscle. A case report is used to demonstrate an example of a rare but clinically important anatomical variant of this nerve.
An independent review of the literature using Medline, PubMed and Q Read databases was performed using combinations of terms including ‘spinal accessory nerve’, ‘anatomy’, ‘surgical anatomy’, ‘anatomical variant’, ‘cranial nerve XI’ and ‘shoulder syndrome’.
Our report demonstrates marked variation in spinal accessory nerve anatomy. At the point of crossing over the internal jugular vein, the spinal accessory nerve passes most commonly laterally (anterior) to the internal jugular vein. The reported incidence of this lateral relationship varies from 67 to 96 per cent. The nerve can also pierce the internal jugular vein, as demonstrated in our case study, with incidence ranging from 0.48 to 3.3 per cent.
Anatomical variations of the spinal accessory nerve are not uncommon, and it is important for the surgeon to be aware of such variations when undertaking surgery in both the anterior and posterior triangles of the neck.
The present Report covers the period 1982-1984. As with previous Reports, it has not been possible to cover all publications or even every field of research. Some subsections of this Report, the Magellanic Clouds for example, report a body of work as extensive as that in some commissions.
In 2011 we carried out the first systematic survey to determine the density and abundance of endemic forest primates in Siberut National Park, in the Mentawai Islands of West Sumatra, Indonesia. Distance sampling was employed to survey 18 transects located systematically throughout the Park, yielding a total survey effort of 192 km and 285 observations of primates for data analysis. From density estimates for the four resident primate species, the Siberut langur Presbytis siberu, the pig-tailed snub-nosed langur Simias concolor, Kloss's gibbon Hylobates klossii and the Siberut macaque Macaca siberu, we extrapolated a total population of c. 51,000 primates within the Park. We conclude that Siberut National Park is of major significance for the continued survival of Siberut's endemic primates, and provide recommendations to help ensure that it will continue to function as a refuge for primates.
The partial excavation under rescue conditions in 1961–63 of the ditches and
interior of an enclosure of the earlier neolithic period is described. The
enclosure, covering a total area of approximately 2.4 ha, was defined by
double concentric interrupted ditches, which were for the most part
naturally filled. There were many traces of activity within the interior,
presumed to be contemporary with the ditches, including pits, gullies, post-
and stake-holes, and varying concentrations of struck and burnt flint and
pottery. Human burials were found. There is a little Ebbsfleet pottery in
secondary contexts and there are later prehistoric, Roman and medieval
finds. It is probably not possible to ascribe a single or specific role to
the site, which may have been important as a place where several activities
were concentrated, including occupation, subsistence, exchange, enclosure or
defence, burial and ritual.
Motivated by a wide range of applications, we consider a development of Whittle's restless bandit model in which project activation requires a state-dependent amount of a key resource, which is assumed to be available at a constant rate. As many projects may be activated at each decision epoch as resource availability allows. We seek a policy for project activation within resource constraints which minimises an aggregate cost rate for the system. Project indices derived from a Lagrangian relaxation of the original problem exist provided the structural requirement of indexability is met. Verification of this property and derivation of the related indices is greatly simplified when the solution of the Lagrangian relaxation has a state monotone structure for each constituent project. We demonstrate that this is indeed the case for a wide range of bidirectional projects in which the project state tends to move in a different direction when it is activated from that in which it moves when passive. This is natural in many application domains in which activation of a project ameliorates its condition, which otherwise tends to deteriorate or deplete. In some cases the state monotonicity required is related to the structure of state transitions, while in others it is also related to the nature of costs. Two numerical studies demonstrate the value of the ideas for the construction of policies for dynamic resource allocation, most especially in contexts which involve a large number of projects.
Monolithic Ni 3Al and composite Ni3Al/ceramic whisker bodies were fabricated by combined Self Propagating High Temperature Synthesis and in situ containerless Hot Isostatic Pressing (SHS/HIP), starting from cold pressed blends of nickel, aluminum, and boron powders, with and without additions of alumina whiskers. The resultant bodies were dense and had good ductility and mechanical strength at room temperature.
Single crystal silicon wafers have been oxidised by exposure to an oxygen ambient at atmospheric pressure during RTP using an A G Associates Heatpulse 2101 Rapid Thermal Annealer. Wafers of the standard orientations used in silicon device processing <100>, <111> and <110> were studied. Oxidation was carried out in the temperature range 900 to 1250°C for times of RTP from 4 to 25U seconds producing oxides up to 60nm in thickness. Oxidation rates and their orientation and temperature dependence were derived from ellipsometric measurements of oxide thickness. X-ray photoelectron spectroscopy (XPS) and infra-red absorption spectrophotometry were also employed in the oxide characterisation. Preliminary electrical characterisation of the oxides, investigated using MOS C-V analyses, showed that the interface state densities were comparable to those in conventional furnace grown oxides.
Focused 30keV gallium ion beam, single-pixel drilling combined with backside particle detection is used to fabricate pores having exit diameters as small as ~11 nm in 200 nm-thick silicon nitride membranes. The backside channelplate detector response obtained about the onset of breakthrough is interpreted by plan-view transmission electron microscopy investigations of hole morphology. Immediately prior to breakthrough, there is a rise in detector signal as the local membrane thickness is reduced. This likely occurs as a result of ion transmission and, possibly, forward sputtering. At the dose required for breakthrough a maximum detector signal is obtained thus providing a potential method for end point detection. The focused ion drilling technique avoids broad area beam exposure methods that are often used to reduce hole diameter to nanometer dimension. In addition, the current approach overcomes difficulties in determining a required dose for breakthrough such as those that arise from an inhomogeneous membrane thickness, redeposition, or ion channeling.
Fully dense, bulk Bi2Sr1.7CaCu2Ox (2212) superconductor pellets were made by hot isostatic pressing in an inert atmosphere. Electron microscopy revealed that rotation and bending of the platelike 2212 grains were responsible for much of the densification. Under processing conditions of 825°C and 105 MPa, dense pellets were obtained in 15 min. Many dislocations, planar faults, and, perhaps, intergrowths of the Bi2Sr2CuOx phase were produced during pressing. The dislocations were largely present in subgrain boundaries when the pressing times were increased to 45–120 min.
In situ reinforced (ISR) silicon nitride ceramics have been developed to have microstructures that mimic the best whisker containing ceramic matrix composites. Large, interlocking needle-like grains of beta silicon nitride can be produced throughout these materials to create an isotropic, high-temperature ceramic with high fracture toughness (˜9 MPa√m), good high-temperature strength (4 Pt MOR = 750 MPa at 25°C and 500 MPa at 1375°C), high Weibull modulus (m >20), and low creep at high temperature. Since these materials do not rely on transforming metastable phase inclusions as a toughening mechanism, their fracture resistance is virtually insensitive to temperature. The high crack growth resistance of these ceramics also yields a material which is extremely defect tolerant. Residual MOR strengths of 300–400 MPa are typical after multiple 50-kg Vicker's indentations of the sample tensile surface. After abrasive particle impact, the biaxial strengths of the in situ reinforced ceramics are typically more than twice that of traditional, fine-grained silicon nitrides.
Unlike ceramic composites toughened using whisker additives, the in situ reinforcement approach to silicon nitride development does not require the use of complicated whisker dispersion techniques for green processing, nor is shape-limiting hot pressing required for densification during sintering.
Embedded piezoresistive microcantilever (EPM) sensors have been used in the detection of a variety of analyte species. EPM sensors utilize a tiny piezoresistive microcantilever partially embedded into a sensing material to produce a sensing element that is compact, simple, resistant to movement and shock, and suitable for remote sensing applications. In the current project, we have used sensing materials comprised of an immobilizing polymer functionalized with either target enzymes or antibodies to detect two biological agents, Bacillus subtilis and Diisopropyl fluorophosphate (DFP). DFP is used as a simulant for organophosphate nerve agents, while BG is a large bacterial spore used as a simulant for other bacterial spores such as bacillus anthracis. Sensing results are presented for both types of EPM sensors.
Our recent progress in elevated temperature nanoindentation is reviewed, with an emphasis on the study of discrete events (i.e., pop-in phenomena) observed during nanoindentation. For crystalline materials the incipient plasticity problem is associated with the nucleation of dislocations, an effect which we show to be significantly temperature dependent. For metallic glasses it is the operation of individual shear bands beneath the indenter that gives rise to pop-in events; here we also show this to be a temperature dependent phenomenon. Approaches to extract the activation volume and energy of defects involved in plastic flow beneath the indenter are also briefly described.
We have synthesized polyester systems containing pendant iptycene units and compared their mechanical/structural properties to a homologous reference polymer wherein benzene replaces iptycene units. Iptycenes have unique structural properties called internal molecular free volume (IMFV). The incorporation of iptycene into polyester backbones results in a polymer chain contour resembling “molecular barbed wire.” The contribution of iptycene to the mechanical properties of polyesters is significant and robust across concentration and processing conditions. The triptycene polyester films displayed a nearly 3-fold increase in Young's modulus, an approximately 3-fold increase in strength, and a more than 20-fold increase in strain to failure. We proposed that the presence of triptycene introduces two mechanisms for the enhancement of tensile mechanical properties: molecular threading and molecular interlocking.
This review compares and contrasts postharvest food losses (PHLs) and waste in developed countries (especially the USA and the UK) with those in less developed countries (LDCs), especially the case of cereals in sub-Saharan Africa. Reducing food losses offers an important way of increasing food availability without requiring additional production resources, and in LDCs it can contribute to rural development and poverty reduction by improving agribusiness livelihoods. The critical factors governing PHLs and food waste are mostly after the farm gate in developed countries but before the farm gate in LDCs. In the foreseeable future (e.g. up to 2030), the main drivers for reducing PHLs differ: in the developed world, they include consumer education campaigns, carefully targeted taxation and private and public sector partnerships sharing the responsibility for loss reduction. The LDCs’ drivers include more widespread education of farmers in the causes of PHLs; better infrastructure to connect smallholders to markets; more effective value chains that provide sufficient financial incentives at the producer level; opportunities to adopt collective marketing and better technologies supported by access to microcredit; and the public and private sectors sharing the investment costs and risks in market-orientated interventions.