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Introduction: Improving public access and training for epinephrine auto-injectors (EAIs) can reduce time to initial treatment in anaphylaxis. Effective use of EAIs by the public requires bystanders to respond in a timely and proficient manner. We wished to examine optimal methods for assessing effective training and skill retention for public use of EAIs, including the use of microskills lists. Methods: In this prospective, stratified randomized study, 154 participants at 15 sites receiving installation of public EAIs were randomized to one of three experimental education interventions: A) didactic poster (POS) teaching; B) poster with video teaching (VID), and C) Poster, video, and simulation training (SIM). Participants were tested by participation in a standardized simulated anaphylaxis scenario at 0-months, immediately following training, and again at follow-up at 3 months. Participants’ responses were videoed and assessed by two blinded raters using microksills checklists. The microskills lists were derived from the best available evidence and interprofessional process mapping using a skills trainer. The interobserver reliability was assessed for each item in a 14 step microskill checklist composed of 3-point and 5-point Likert scale questions around EpiPen use, expressed as Kappa Values. Results: Overall there was poor agreement between the two raters. Being composed or panicked had the highest level of agreement K = 0.7, but a result that did not reach statistical significance (substantial agreement, p = 0.06) calling for EMS support has the second highest level of agreement, K = 0.6 (moderate agreement, p = 0.01), the remainder of the items had very low to moderate agreement with a Kappa value range of -103 to 0.48. Conclusion: Although microskills chesklists have been shown to identify areas where learners and interprofessional teams require deliberate practice, these results support previously published evidence that the use of microskills checklists to assess skills has poor reproducibility. Performance will be further assessed in this study using global rating scales, which have shown higher levels of agreement in other studies.
A 2018 workshop on the White Mountain Apache Tribe lands in Arizona examined ways to enhance investigations into cultural property crime (CPC) through applications of rapidly evolving methods from archaeological science. CPC (also looting, graverobbing) refers to unauthorized damage, removal, or trafficking in materials possessing blends of communal, aesthetic, and scientific values. The Fort Apache workshop integrated four generally partitioned domains of CPC expertise: (1) theories of perpetrators’ motivations and methods; (2) recommended practice in sustaining public and community opposition to CPC; (3) tactics and strategies for documenting, investigating, and prosecuting CPC; and (4) forensic sedimentology—uses of biophysical sciences to link sediments from implicated persons and objects to crime scenes. Forensic sedimentology served as the touchstone for dialogues among experts in criminology, archaeological sciences, law enforcement, and heritage stewardship. Field visits to CPC crime scenes and workshop deliberations identified pathways toward integrating CPC theory and practice with forensic sedimentology’s potent battery of analytic methods.
Introduction: Improving public access and training for epinephrine auto-injectors (EAIs) can reduce time to initial treatment in anaphylaxis. Effective use of EAIs by the public requires bystanders to respond in a timely and proficient manner. We wished to examine optimal methods for effective training and skill retention for public use of EAIs. Methods: In this prospective, stratified randomized study, 154 participants at 15 sites receiving installation of public EAIs were randomized to one of three experimental education interventions: A) didactic poster (POS) teaching; B) poster with video teaching (VID), and C) Poster, video, and simulation training (SIM). Participants were tested by participation in a standardized simulated anaphylaxis scenario at 0-months, immediately following training, and again at follow-up at 3 months. Participants responses were videoed and assessed by blinded raters. Patient recorded experience measures (PREMs) assessed participant-patient interaction for every scenario. Data that was non-normally distributed was analyzed using non-parametric testing (Kruskall-Wallis-Rank Sum-Test). Results: Initial analysis showed differences between group baseline characteristics for age and first aid training; with a multivariable analysis providing the effect size of these differences. PREM data and video assessment data were not normally distributed. Analysis of PREM data revealed significantly higher scores in the SIM group at 0-months (median=6.5, IQR=5; p=0.05) and 3-months (median=5, IQR=3; p<0.01), compared to those groups that did not receive SIM. Video assessment performance scores show trends in higher skills and knowledge retention for SIM participants at 3-months; full data analysis will be performed at a later date. Final video assessment analysis will involve a weighted scoring system, using a consensus process, and an inter-rater agreement analysis. Conclusion: Simulation training improves interaction, essential skills, and retention of knowledge in simulated anaphylaxis response with public EAIs compared to non-simulation-based training.
We report on direct numerical simulations to examine the spectral behaviour of turbulence close to and at a flat, stress-free surface. We find, consistent with field measurements near such a free surface, that an inertial-range type of behaviour is obtained for the horizontal components of the velocity at and near the stress-free surface, at horizontal wavelengths for which the vertical velocity is much smaller than the horizontal components. At approximately an integral length scale from the stress-free surface, the flow has adjusted back to more classical isotropic turbulence. The behaviour of the turbulence near the stress-free surface is similar to that observed recently for strongly stratified flows, and we argue that the causes of that behaviour are the same in both flows: the suppression of the large-scale vertical velocity and the allowance of strong vertical shearing of the horizontal velocity leading to a downscale transfer of energy and to the development of the
spectra for the horizontal velocities.
Global VLBI snapshot observations at 1.6 GHz (5 EVN + 4 VLBA) of a sample of low-frequency variable (LFV) radio sources found using the Cambridge Low Frequency Synthesis Telescope (CLFST) are presented. Variability at 151 MHz is almost certainly due to propagation effects in our Galaxy (e.g., refractive interstellar scintillation). Theory indicates that only sources with a significant fraction of their low-frequency flux coming from components with angular sizes ≲ 30 mas will show such effects. This is confirmed by the VLBI images.
Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI.
A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.
Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80–10.04) and corticosteroid (1.81; 1.15–2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52–9.12), renal failure (2.64; 1.23–5.68), hematologic cancer (1.75; 1.02–5.68), and diabetes mellitus (1.15; 1.05–1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years.
Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
Individuals at ultra-high risk (UHR) for psychosis show reduced neurocognitive performance across domains but it is unclear which reductions are associated with transition to frank psychosis. The aim of this study was to investigate differences in baseline neurocognitive performance between UHR participants with (UHR-P) and without transition to psychosis (UHR-NP) and a healthy control (HC) group and examine neurocognitive predictors of transition over the medium to long term.
A sample of 325 UHR participants recruited consecutively from the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne and 66 HCs completed a neurocognitive assessment at baseline. The UHR group was followed up between 2.39 and 14.86 (median = 6.45) years later. Cox regression was used to investigate candidate neurocognitive predictors of psychosis onset.
The UHR group performed more poorly than the HC group across a range of neurocognitive domains but only performance on digit symbol coding and picture completion differed between the groups. The risk of transition was only significantly associated with poorer performance on visual reproduction [hazard ratio (HR) 0.919, 95% confidence interval (CI) 0.876–0.965, p = 0.001] and matrix reasoning (HR 0.938, 95% CI 0.883–0.996, p = 0.037). These remained significant even after controlling for psychopathology at baseline.
This study is the longest follow-up of an UHR sample to date. UHR status was associated with poorer neurocognitive performance compared to HCs on some tasks. Cognition at identification as UHR was not a strong predictor of risk for transition to psychosis. The results suggests the need to include more experimental paradigms that isolate discrete cognitive processes to better understand neurocognition at this early stage of illness.
In this study, we examine a steady two-dimensional slow flow past a rigid cylinder coated with a thin layer of immiscible fluid. The Reynolds number for the external bulk flow is assumed small and flow within the film is driven by the action of the bulk fluid’s tangential viscous stress acting at the interface. Using double asymptotic expansions based on the bulk fluid’s Reynolds number and the aspect ratio of the film thickness to the cylinder’s radius, we derive the leading- and first-order equations governing the steady-state film dynamics, and obtain analytical solutions, in terms of the film thickness, for the bulk flow. We solve the governing film equations, finding that solutions feature a drained region. We briefly discuss the influence of the Capillary number and fluid viscosities, and conclude by showing how the presence of the film affects the drag on the film-coated cylinder.
The Mesozoic fore-arc of the Antarctic Peninsula is exposed along its west coast. On Adelaide Island, a 2–3 km succession of turbiditic coarse sandstones and volcanic rocks is exposed. Four U–Pb (zircon) ages are presented here that, in combination with a new stratigraphy, have permitted a robust chrono- and lithostratigraphy to be constructed, which in turn has allowed tentative correlations to be made with the Fossil Bluff Group of Alexander Island, where the ‘type’ fore-arc sequences are described. The lithostratigraphy of Adelaide Island includes the definition of five volcanic/sedimentary formations. The oldest formation is the Buchia Buttress Formation (149.5 ± 1.6 Ma) and is correlated with the Himalia Ridge Formation of Alexander Island. The sandstone–conglomerate dominated succession of the Milestone Bluff Formation (113.9 ± 1.2 Ma) is tentatively correlated with the Pluto Glacier Formation of Alexander Island. Three dominantly volcanic formations are recognized on Adelaide Island, akin to the volcanic rocks of the Alexander Island Volcanic Group; the Mount Liotard Formation is formed of 2 km of basaltic andesite lavas, whilst the Bond Nunatak Formation is also dominated by basaltic andesite lavas, but interbedded with volcaniclastic rocks. The Reptile Ridge Formation has been dated at 67.6 ± 0.7 Ma and is characterized by hydrothermally altered rhyolitic crystal-lithic tuffs. Tentative correlations between Adelaide Island and Alexander Island preclude the two areas forming part of distinct terranes as has been suggested previously, and a proximal source for volcaniclastic sediments also indicates an exotic terrane origin is unlikely.
A study of the growth of thin Ir silicide films on (111)Si substrates has been undertaken. Thin (2.0nm) ir films deposited onto Si substrates under ultra-high vacuum conditions have been observed to display remarkable film continuity and fine grain structure (lnm). In situ annealing at 1000°C resulted in the formation of large regions (>10µm) of epitaxial IrSi3 islands (∼1µm) with identical epitaxial orientations. By means of annealing an as-deposited (2.0nm) Ir film stepwise to 1000°C within a transmission electron microscope the evolution of Ir silicide phases and morphologies were observed. The epitaxial growth of the semiconducting IrSi1.75 phase is reported along with the formation of Ir silicide islands at temperatures between 700°C and 800°C.
This paper outlines our current approach to utilize infrared reflectance spectroscopy for thin film measurement in the semiconductor industry. The multi-layer thickness and doping concentration of IC wafers can be determined by a single angle, unpolarized infrared reflectance measurement performed using Fourier transform infrared spectrometer. A computer algorithm, which matches theoretical tc measured infrared reflectance spectra, was successfully employed to determine multiple thin film properties.
This paper outlines our current approach to utilize infrared reflectance spectroscopy for thin film measurement in the semiconductor industry. The multi-layer thickness and doping concentration of IC wafers can be determined by a single angle, unpolarized infrared reflectance measurement performed using Fourier transform infrared spectrometer. A computer algorithm, which matches theoretical to measured infrared reflectance spectra, was successfully employed to determine multiple thin film properties.
Sellafield Ltd operates a Waste Vitrification Plant (WVP) to immobilise the arisings from the reprocessing of spent nuclear fuel. Washout of solids from the base of waste storage tanks in preparation for decommissioning is likely to produce feeds enriched in molybdenum to the WVP. Vitrification of such feeds in the borosilicate glass formulation currently used by the WVP for vitrification of reprocessing waste has been investigated to determine the maximum achievable loading of MoO3.
The vitrification of molybdenum in the absence and presence of reprocessing waste was studied. A number of glasses were manufactured in the laboratory containing various waste loadings. The resultant glasses were examined both visually and under the scanning electron microscope for the presence of any phase separation. Additional aluminium was added to the glasses manufactured in the absence of reprocessing waste to improve the durability of the glass. In borosilicate glass containing 3.5 wt% Al2O3 the onset of a molybdenum phase separation was observed in glasses containing 2.6 wt% MoO3. In the presence of Magnox reprocessing waste, phase separation was observed when the product contained >3.8 wt% MoO3. Soxhlet durability testing of a selection of the glasses manufactured was carried out. The Soxhlet durability of glasses in the absence of phase separation was good.
Two photocatalytic systems consisting of spatially organized electron donor/photosensitizer/oxide semiconductor/catalyst assemblies are described. The first consists of an aluminosilicate zeolite (mordenite or zeolite L) containing Pt clusters, methylviologen, and titanium oxide within the linear channels, together with a size-excluded photosensitizer RuL32+ (L = 4, 4-dicarboxy-2, 2-bipyridine) adsorbed at the TiO2 surface. The kinetics of photochemical charge separation and hydrogen evolution in the presence of sacrificial electron donors are reported. In the second system, a layered oxide semiconductor, K4−xHxNb6O17·nH2O, replaces the zeolite/TiO2/MV2+ composite. Using adsorbed RuL3 and visible light excitation, this material decomposes acidic iodide solutions into H2 and I3− with a quantum efficiency of 0.3 %.
For GaAs (001) and (III) we have measured the photoelectron diffraction patterns at a kinetic energy of 86 eV. We applied an extended Fourier-transform algorithm to the (001) data to obtain real space images. The origin of structures in these images not representing atomic positions is investigated with the help of single scattering calculations