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: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED <48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.
Microorganisms are the most abundant organisms on Earth, and microbial abundance records preserved in ice cores have been connected to records of environmental change. As an alternative to high resolution abundance records, which can be difficult to recover, we used culture-dependent and culture-independent methods to examine bacteria in glacier ice from the Tibetan Plateau (TP). We recovered a total of 887 bacterial isolates from ice cores of up to 164 m in depth retrieved from seven glaciers, located across the TP. These isolates were related to 53 genera in the Actinobacteria, Firmicutes, Bacteroidetes, and Proteobacteria, with 13 major genera accounting for 78% of isolates. Most of the genera were common across the geographic region covered by our sampling, but there were differences in the genera recovered from different depths in the ice, with the deepest portions of the ice cores dominated by a single genus (Sporosarcina). Because microorganisms deposited on glaciers must survive atmospheric transport under a range of temperatures, temperature tolerance should be an important survival mechanism. We tested isolate growth across a range of temperatures (0–35 °C), and found psychrotolerance to be common. Together, our results show that ice depth, and by extension age, are characterized by different types of microorganisms, providing new information about microbial records in ice.
Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS bypass protocol allowing paramedics to transport intoxicated patients directly to an alternate facility [Withdrawal Management Services (WMS)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS level III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on intoxicated patients presenting to Sudbury EMS. Data was abstracted from EMS reports, hospital medical records, and discharge forms from WMS. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 681 calls for intoxication. Of the 568 taken directly to the ED, 65 met diversion criteria; these were missed protocol opportunities (11%). 113 patients were diverted. There was protocol noncompliance in 41 cases (36%), but 35 were due to incomplete recording of vital signs. There were direct protocol violations in only 6 cases (5%). There was protocol failure in 16 cases (22%), and patient morbidity in 1 case (1%). No patients died within 48 hours of diversion. Conclusion: EMS providers were fairly compliant with the protocol when transporting patients directly to the ED. There was some protocol non-compliance with patients diverted to WMS, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides high levels of safety for patients diverted to WMS. Broader implementation of the protocol could reduce the volume of intoxicated patients seen in the ED, and improve quality of care received by this population.
Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS protocol allowing paramedics to transport medically stable patients with psychiatric issues directly to an alternate facility [Crisis Intervention (CI)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on patients presenting to Sudbury EMS with behavioural or psychiatric issues. Data was abstracted from EMS reports, hospital medical records, and discharge forms from CI. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 695 calls with psychiatric complaints. Of the 650 taken directly to the ED, 18 met diversion criteria; these were missed protocol opportunities (3%). 45 patients were diverted. There was protocol noncompliance in 36 cases (80%), but 34 were due to incomplete recording of vital signs. There were direct protocol violations in only 2 cases (4%). There was protocol failure in 3 cases (33%), and patient morbidity in 8 cases (18%). No patients died within 48 hours of diversion. Conclusion: EMS providers were highly compliant with the protocol when transporting patients directly to the ED. There were high levels of protocol non-compliance in diverting patients to CI, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides moderate levels of safety in diverted patients. Broader implementation of a diversion protocol could reduce the volume of mental health patients seen in the ED, and improve quality of care received by this patient population.
The cubic polytype of silicon carbide is a stimulating candidate for Micro-Electro-Mechanical-Systems (MEMS) applications due to its interesting physical and chemical properties. Recently, we demonstrated the possibility to elaborate 3C-SiC membranes on 3C-SiC pseudo-substrates, using a silicon epilayer grown by Low Pressure Chemical Vapor Deposition as a sacrificial layer. Such structures could be the starting point for the elaboration of new MEMS devices. However, the roughness still represents a major concern. Therefore, in this contribution, we investigate the influence of an excimer laser irradiation on the Si epilayer surface prior to the 3C-SiC epilayer growth. We compare these results with the 3C-SiC epilayer grown directly on the as-grown Si epilayer.
Muscular dystrophies can show clinical and muscle biopsy features that mimic or overlap the changes seen in a primary myositis, particularly in the early stages of disease or when the clinical onset is abrupt. We present a child who was eventually diagnosed with limb girdle muscular dystrophy type 2I (LGMD2i). she presented with mild hip-girdle weakness and post-infectious myalgia. although her clinical symptoms favoured a muscular dystrophy, her muscle biopsy showed inflammatory infiltrates within muscle fibres and around blood vessels that were more typical of juvenile polymyositis. additional immunocytochemical antibody tests and genetic sequencing were key to obtaining an accurate diagnosis and avoiding immunosuppressant therapy.
The Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project will test the overarching hypothesis that an active hydrological system exists beneath a West Antarctic ice stream that exerts a major control on ice dynamics, and the metabolic and phylogenetic diversity of the microbial community in subglacial water and sediment. WISSARD will explore Subglacial Lake Whillans (SLW, unofficial name) and its outflow toward the grounding line where it is thought to enter the Ross Ice Shelf seawater cavity. Introducing microbial contamination to the subglacial environment during drilling operations could compromise environmental stewardship and the science objectives of the project, consequently we developed a set of tools and procedures to directly address these issues. WISSARD hot water drilling efforts will include a custom water treatment system designed to remove micron and sub-micron sized particles (biotic and abiotic), irradiate the drilling water with germicidal ultraviolet (UV) radiation, and pasteurize the water to reduce the viability of persisting microbial contamination. Our clean access protocols also include methods to reduce microbial contamination on the surfaces of cables/hoses and down-borehole equipment using germicidal UV exposure and chemical disinfection. This paper presents experimental data showing that our protocols will meet expectations established by international agreement between participating Antarctic nations.
Stellar models including atomic diffusion processes (gravitational settling, radiative accelerations, thermal diffusion, in addition to the purely diffusive term) have now been evolved throughout most of stellar evolution. We review some of the major roles of diffusion processes in stellar evolution. The emphasis is on interior properties. Examples include Populations I and II stars. It is emphasized that competing advective processes such as mass loss or meridional circulation modify internal concentrations differently from turbulent diffusion even when they lead to the same surface abundances. Radiative accelerations play a major role in horizontal branch and sdB stars.
Managed grasslands provide environmental and agronomic services that can be predicted from the botanical and functional composition of the vegetation. These are influenced by management, edaphic and climatic factors. The present report set out to estimate and analyse the relative importance of management, soil and climate factors on botanical and functional characteristics of grassland vegetation. A set of 178 French grasslands having a large pedoclimatic and management gradient was selected, and information collected on botanical composition, pedoclimatic factors and management. Six vegetation characteristics were considered: two botanical (floristic composition and species dominance) and four functional (proportion of entomophilous species, number of oligotrophic species, leaf dry matter content and date of flowering). First, the links between the characteristics of the vegetation were analysed to check for any redundancy among them; all were kept. Second, it was demonstrated that botanical and functional characteristics were not driven by the same factors: functional composition was characterized by management, edaphic and climatic factors, whereas botanical composition was influenced mainly by climatic and edaphic factors plus other factors. Interactions between factors also have to be taken into consideration to predict botanical and functional composition of grasslands. Functional and botanical characteristics of vegetation help to predict ecosystem services delivered by grasslands and may be used in combination.
We review the interaction in intermediate and high mass stars between their evolution and magnetic and chemical properties. We describe the theory of Ap-star ‘fossil’ fields, before touching on the expected secular diffusive processes which give rise to evolution of the field. We then present recent results from a spectropolarimetric survey of Herbig Ae/Be stars, showing that magnetic fields of the kind seen on the main-sequence already exist during the pre-main sequence phase, in agreement with fossil field theory, and that the origin of the slow rotation of Ap/Bp stars also lies early in the pre-main sequence evolution; we also present results confirming a lack of stars with fields below a few hundred gauss. We then seek which macroscopic motions compete with atomic diffusion in determining the surface abundances of AmFm stars. While turbulent transport and mass loss, in competition with atomic diffusion, are both able to explain observed surface abundances, the interior abundance distribution is different enough to potentially lead to a test using asterosismology. Finally we review progress on the turbulence-driving and mixing processes in stellar radiative zones.
In this work, non-intentionally doped 3C-SiC epilayers were implanted using phosphorus at different energies and subsequently annealed at temperatures between 1100°C and 1350°C in order to form n+ implanted layers. Different techniques such as Fourier Transformed InfraRed spectroscopy (FTIR) and Secondary Ion Mass Spectroscopy (SIMS) were used to characterize implanted 3C-SiC epilayers after the different annealing steps. Successively, metal layers were sputtered in order to form the contacts. The specific contact resistance (ñC) was determined by using circular Transfer Length Method (c-TLM) patterns. Specific contact resistance values were investigated as a function of doping and contact annealing conditions and compared to those obtained for highly doped 3C-SiC epilayers. As expected, ñC value is highly sensitive to post-implantation annealing and metal contact annealing. This work demonstrates that low resistance values can be achieved using phosphorus implantation and, hence, enabling device processing.
The accuracy with which it is possible to calculate theoretically the positions of
energy levels and the low density (in frequency) of the grid on which opacity sampling is calculated both
limit the accuracy with which the effect of
blends can be determined. For species such as Fe for which a large number of transitions
are involved in calculations, this leads to a small effect since, statistically, cancellations occur.
However the effect can be large for an element such as Li with only a few transitions contributing to its radiative acceleration, grad(Li), at
any given stellar radius. In particular, the Fe lines are shown to
modify grad(Li) in and below the Fe convection zone but the modification depends on Fe level positions.
This is analyzed quantitatively here using the OPAL data base. The grad(Li) are found to be uncertain by a factor of 2 in Pop I stars but of 1.03 in Pop II stars.
Abundance anomalies in the Sun, main sequence F, A and B stars, turnoff Pop II stars, the horizontal branch and white dwarfs are caused at least partly by particle transport processes. Detailed evolutionary models have been calculated for most of those objects taking into account the gravitational settling, thermal diffusion and radiative accelerations of 28 isotopes (24 atomic species). These will be used together with the observed abundances to put constraints on the mixing that rotationnally induced turbulence may lead to. The link between abundance anomalies and rotation on the HB is explained by the variation with log g of the ratio of the Eddington-Sweet and atomic diffusion velocities.