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Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.
Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.
The development and maintenance of an alcohol addiction is a complex interaction between genetic and environmental factors. Genetic effects seem to contribute substantially to the risk of developing an addiction, but also to its course and patients’ responses to different treatments. Recent studies identified associations between polymorphisms in the genes of glutamate and μ-opioid receptors and addiction risk. Those receptors are of special interest, because they are targets of therapeutic agents, such as acamprosate and topiramate.
Objectives and aims
Several studies were conducted, in order to further determine the effects of genetic polymorphisms in glutamate and opioid receptor genes on addictive behavior, neural response to alcohol cues and relapse risk.
Genetic effects were investigated in samples of alcohol-dependent patients using functional imaging techniques, neuropsychological tests and follow-up investigation after standard clinical treatment. Data on clinical parameters, neuronal response to alcohol cues, functional neuronal connectivity and relapse risk were collected and analyzed.
Results demonstrate effects of genetic polymorphisms in glutamate and opioid receptors on neuronal response to alcohol cues in frontal and mesolimbic brain areas, subjective craving and time to first relapse. Current findings will be discussed in the light of existing evidence on the contribution of genetic effects to treatment outcome and patient stratification.
The investigation of genetic risk factors and mechanisms by which they affect addiction related phenotypes seems to be a promising tool to identify molecular treatment targets and predictors for successful treatment strategies.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We present the first snow/ice chemistry and ice radar results ever collected from South Georgia as part of an initial reconnaissance with the ultimate goal of assessing the feasibility of a South Georgia ice core to reconstruct past climate in the South Atlantic. South Georgia is well situated to capture a record of past atmospheric chemical composition over the South Atlantic and of past variability in the position and intensity of the austral westerlies. The question is how well preserved an ice core record can be recovered from a region experiencing accelerated melting? The results presented in this paper offer only a preliminary step in determining the feasibility of future deep ice coring on South Georgia. However, this initial reconnaissance does provide some basic information including: the chemistry of the atmosphere over South Georgia relative to other Southern Hemisphere ice coring sites; the potential for preservation of ‘annual layers’ in old ice on the island; a possible age for deep ice in the region; and an estimate of glacier health in the lower elevation regions of the island.
We report experiments and molecular dynamics calculations on the kinetics of electrodeposited lithium dendrites relaxation as a function of temperature and time. We found that the experimental average length of dendrite population decays via stretched exponential functions of time toward limiting values that depend inversely on temperature. The experimental activation energy derived from initial rates as Ea∼ 6-7 kcal/mole, which is closely matched by MD calculations, based on the ReaxFF force field for metallic lithium. Simulations reveal that relaxation proceeds in several steps via increasingly larger activation barriers. Incomplete relaxation at lower temperatures is therefore interpreted a manifestation of cooperative atomic motions into discrete topologies that frustrate monotonic progress by ‘caging’.
The Dawn spacecraft orbited Asteroid (4) Vesta for a year, and returned disk-resolved images and spectra covering visible and near-infrared wavelengths at scales as high as 20 m/pix. The visible geometric albedo of Vesta is ~ 0.36. The disk-integrated phase function of Vesta in the visible wavelengths derived from Dawn approach data, previous ground-based observations, and Rosetta OSIRIS observations is consistent with an IAU H-G phase law with H=3.2 mag and G=0.28. Hapke's modeling yields a disk-averaged single-scattering albedo of 0.50, an asymmetry factor of -0.25, and a roughness parameter of ~20 deg at 700 nm wavelength. Vesta's surface displays the largest albedo variations observed so far on asteroids, ranging from ~0.10 to ~0.76 in geometric albedo in the visible wavelengths. The phase function of Vesta displays obvious systematic variations with respect to wavelength, with steeper slopes within the 1- and 2-micron pyroxene bands, consistent with previous ground-based observations and laboratory measurement of HED meteorites showing deeper bands at higher phase angles. The relatively high albedo of Vesta suggests significant contribution of multiple scattering. The non-linear effect of multiple scattering and the possible systematic variations of phase function with albedo across the surface of Vesta may invalidate the traditional algorithm of applying photometric correction on airless planetary surfaces.
The present work shows results on elemental distribution analyses in Cu(In,Ga)Se2 thin films for solar cells performed by use of wavelength-dispersive and energy-dispersive X-ray spectrometry (EDX) in a scanning electron microscope, EDX in a transmission electron microscope, X-ray photoelectron, angle-dependent soft X-ray emission, secondary ion-mass (SIMS), time-of-flight SIMS, sputtered neutral mass, glow-discharge optical emission and glow-discharge mass, Auger electron, and Rutherford backscattering spectrometry, by use of scanning Auger electron microscopy, Raman depth profiling, and Raman mapping, as well as by use of elastic recoil detection analysis, grazing-incidence X-ray and electron backscatter diffraction, and grazing-incidence X-ray fluorescence analysis. The Cu(In,Ga)Se2 thin films used for the present comparison were produced during the same identical deposition run and exhibit thicknesses of about 2 μm. The analysis techniques were compared with respect to their spatial and depth resolutions, measuring speeds, availabilities, and detection limits.
Milk yield per cow has continuously increased in many countries over the last few decades. In addition to potential economic advantages, this is often considered an important strategy to decrease greenhouse gas (GHG) emissions per kg of milk produced. However, it should be considered that milk and beef production systems are closely interlinked, as fattening of surplus calves from dairy farming and culled dairy cows play an important role in beef production in many countries. The main objective of this study was to quantify the effect of increasing milk yield per cow on GHG emissions and on other side effects. Two scenarios were modelled: constant milk production at the farm level and decreasing beef production (as co-product; Scenario 1); and both milk and beef production kept constant by compensating the decline in beef production with beef from suckler cow production (Scenario 2). Model calculations considered two types of production unit (PU): dairy cow PU and suckler cow PU. A dairy cow PU comprises not only milk output from the dairy cow, but also beef output from culled cows and the fattening system for surplus calves. The modelled dairy cow PU differed in milk yield per cow per year (6000, 8000 and 10 000 kg) and breed. Scenario 1 resulted in lower GHG emissions with increasing milk yield per cow. However, when milk and beef outputs were kept constant (Scenario 2), GHG emissions remained approximately constant with increasing milk yield from 6000 to 8000 kg/cow per year, whereas further increases in milk yield (10 000 kg milk/cow per year) resulted in slightly higher (8%) total GHG emissions. Within Scenario 2, two different allocation methods to handle co-products (surplus calves and beef from culled cows) from dairy cow production were evaluated. Results showed that using the ‘economic allocation method’, GHG emissions per kg milk decreased with increasing milk yield per cow per year, from 1.06 kg CO2 equivalents (CO2eq) to 0.89 kg CO2eq for the 6000 and 10 000 kg yielding dairy cow, respectively. However, emissions per kg of beef increased from 10.75 kg CO2eq to 16.24 kg CO2eq due to the inclusion of suckler cows. This study shows that the environmental impact (GHG emissions) of increasing milk yield per cow in dairy farming differs, depending upon the considered system boundaries, handling and value of co-products and the assumed ratio of milk to beef demand to be satisfied.
Between 1985 and 2008, a total of 102 387 wild boar sera originating from Eastern Germany covering an area of 108 589 km2 were tested for the presence of Aujeszky's disease virus (ADV)-specific antibodies. From 1985 until 1991 and from 1992 until 2008, wild boar sera were exclusively investigated using either conventional seroneutralization assays (n=39 621) or commercial gB and full antigen ELISAs (n=62 766), respectively. Spatial-temporal analysis revealed an increasing ADV seroprevalence from 0·4% to 15·9%, on average, during the 24-year observation period that went along with a continuous spread of the infection in a western direction. During 2006 and 2008, 18% of the 66 affected districts had ADV seroprevalences >30%. There was a significant correlation between ADV seroprevalence and the hunting index of population density (HIPD) of wild boar in the entire study area, although this did not hold true for some regions. Seroprevalences did not differ between sexes but were age-dependent. East Germany has been officially free of Aujeszky's disease (pseudorabies) in domestic pigs since 1985. Although a risk for domestic pigs cannot be completely ruled out, experience has shown that ADV in domestic pigs could be eliminated although the virus was present in the wild boar population. Despite increasing ADV seroprevalence in the East German wild boar population no spillover infections from wild boar to domestic pigs have been reported. To further trace ADV infections in the wild boar population in Germany, a nationwide serological monitoring programme should be implemented.
In order to obtain efficient light trapping within a thin-film silicon solar cell, randomly textured interfaces are used. The texture can be introduced by wet-chemical etching in diluted hyrdofluoric acid (HF). By varying of the HF concentration, a continuous transition to smaller surface structures can be achieved. Near-field scanning optical microscopy is applied to measure scattered light with sub-wavelength resolution. On those different surfaces, using Fourier high-pass filters on the measured near-field images, surface features with a high light trapping potential are identified. Finally, criteria for optimized scattering surfaces are obtained.
Generic guidance on the withdrawal of sheltering, withdrawal of evacuation and evacuation
of sheltered populations (displacement) has been developed based on previously unpublished
work in the UK and France and on input from stakeholder panels in Germany, Belgium, France
and the UK. The guidance is a living document that can be developed further in the future,
both in its generic form and also as customised versions in some Member States. The
guidance outlines the many factors which influence the withdrawal of emergency
countermeasures: official confirmation that any release has stopped; adequacy of
monitoring data; radiological criteria; radiological protection advice; availability of
resources; social and psychological needs; stakeholder dialogue; and communication
strategy. The relative importance placed by decision makers on each of these criteria
would vary according to the nature and scale of the accident and also on socio-political,
economic and cultural perspectives. In the event of a radiological incident, decision
makers will need to be in a position to construct a strategy for managing the withdrawal
of emergency countermeasures. For larger scale, longer duration releases involving several
nuclides, a management strategy is likely to be complex. The guidance therefore includes a
series of checklists which have been developed in conjunction with stakeholders to take
into account the main criteria and factors which should be considered.
Throughout the last decades, development of low-temperat- ure detectors focused mainly on the design of high-sensitivity, single-pixel devices. This includes such devices as semiconductor-based photodetectors and bolometers, Magnetic Metallic Calorimeters (MMC), Superconducting Tunnel Junctions (STJ), and Transition Edge Sensors (TES). However, these devices have had limited success in achieving the simultaneous large-scale array sizes and large-bandwidth operation necessary for high-speed, high-resolution detection. To overcome this performance limitation, it is advisable to focus on low-temperature detectors which are intrinsically adapted to giant-array multiplexing and ultra-fast readout. To adopt large scale frequency-domain multiplexing for low-temperature detectors, it is necessary to find detectors which“broadcast” at microwave frequencies. Superconducting microwave resonators naturally lend themselves to this task. One recent demonstration is an implementation known as Kinetic Inductance Detectors (KIDs). This detection mechanism can be adopted for low-energy EM radiation (radio, mm, THz) in continuous mode, or in pulsed mode for higher energy radiation and particles. We present an ongoing development for a KIDs instrument dedicated to millimetric ground-based observations at the 30m IRAM telescope at Pico Veleta. The Neel IRAM KIDs Array (NIKA) project is coordinated in Grenoble and involves groups in Holland (SRON), UK (Cardiff) and Italy (Roma).
We perform the analysis of the Rayleigh–Taylor instability of
thin perfectly elastic solid plates using the analytical approach recently
developed by Piriz and coworkers. The model describes the evolution of the
perturbation amplitude from the initial conditions and at relatively long
times it yields the asymptotic growth rate. It applies to
solid/inviscid fluid interfaces. For the particular case of
solid/vacuum interface, the model has been compared with the exact
results by Plohr and Sharp and an excellent agreement has been found. In
general, thinner plates are found to be more unstable and, in the presence
of a fluid below the elastic plate, the growth rate is reduced.
To specify the principles, definition and dimensions of the new nutrition science.
To identify nutrition, with its application in food and nutrition policy, as a science with great width and breadth of vision and scope, in order that it can fully contribute to the preservation, maintenance, development and sustenance of life on Earth.
A brief overview shows that current conventional nutrition is defined as a biological science, although its governing and guiding principles are implicit only, and no generally agreed definition is evident. Following are agreements on the principles, definition and dimensions of the new nutrition science, made by the authors as participants at a workshop on this theme held on 5–8 April 2005 at the Schloss Rauischholzhausen, Justus-Liebig University, Giessen, Germany.
Nutrition science as here specified will retain its current [classical] identity as a biological science, within a broader and integrated conceptual framework, and will also be confirmed as a social and environmental science. As such it will be concerned with personal and population health, and with planetary health – the welfare and future of the whole physical and living world of which humans are a part.
This paper reports on the status of the PHELIX petawatt laser which is
built at the Gesellschaft fuer Schwerionenforschung (GSI) in close
collaboration with the Lawrence Livermore National Laboratory (LLNL), and
the Commissariat à l'Energie Atomique (CEA) in France. First
experiments carried out with the chirped pulse amplification (CPA)
front-end will also be briefly reviewed.