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Innovation Concept: Resuscitative thoracotomy (RT) is a life-saving procedure in select trauma patients. However, RT is infrequently performed, limiting trainee exposure. In a survey of American training programs, graduating residents had performed an average of 3 RTs. There is no published data regarding the number of RTs observed and performed by Canadian trainees. We theorized that RT procedural exposure and comfort level would be low in emergency medicine (EM) trainees at our institution due to lack of exposure. Thus, we aimed to create a first person procedural video using local resources to teach RT. Methods: We first created a needs assessment survey conducted within Western University Division of Emergency Medicine over two months in 2018. Senior residents observed an average of 1.5 RT procedures and participated in an average of 0.6. Furthermore, 88% of senior residents cited a lack of confidence in their ability to perform this procedure and 87% indicated an instructional video would be a valuable educational tool. We created a video described in detail below. Prior to video distribution a survey was distributed asking respondents to list the critical steps in performing an RT. Participants were then asked to view the video and complete the survey again. Responses were scored by two independent reviewers. Curriculum, Tool or Material: An immersive cadaveric simulation video was developed in collaboration with a trauma surgeon at our institution. The video reviewed our thoracotomy tray, RT indications/contraindications, and demonstrated a narrated first-person RT on a floppy embalmed cadaver. Potential difficulties encountered during the procedure are highlighted throughout the video with troubleshooting tips suggested. Conclusion: We had 46 survey respondents from our division (25 residents and 21 consultants). After viewing the video, procedural step scores were significantly higher for junior FRCPC (p = 0.001), senior FRCPC (p = 0.013), and CCFP-EM (p < 0.001) residents as well as consultants (p = 0.016). There was also an increase in the number of respondents who reported confidence in their ability to perform RT post-video (n = 4 pre-video; n = 11 post-video). This video is an inexpensive, effective way to teach the critical procedural steps of RT and can be easily adapted for use at other institutions. Next steps for further education in this topic include development of a hands-on cadaveric simulation curriculum for residents.
Williams syndrome is a rare genetic disease that affects elastin production, leading to medium and large vessel stenoses and other abnormalities. Cardiac manifestations of Williams syndrome are the most life-threatening, occurring in 80% of children. Children with Williams syndrome are known to be at risk for sudden cardiac death. These tragic events are often precipitated by diagnostic or therapeutic procedures requiring anaesthesia or sedation, such as cardiac catheterisation. We present the case of a 3-month-old infant with Williams syndrome who suffered sudden cardiac arrest during cardiac catheterisation and subsequent arrest approximately 48 hours after the procedure. We also review the current literature focused on children with Williams syndrome who have suffered sudden cardiac arrest during or after cardiac catheterisation procedures.
Greenhouse and field studies were conducted to determine tolerance of blueberry to saflufenacil. Greenhouse studies included five saflufenacil rates (0, 50, 100, 200, and 400 g ai ha−1) and three southern highbush blueberry cultivars (‘Legacy’, ‘New Hanover’, and ‘O’Neal’) and one rabbiteye blueberry cultivar (‘Columbus’). Saflufenacil treatments were soil applied into each pot when blueberry plants were approximately 30-cm tall. Visible injury (purpling/reddening of foliage and leaf abscission) ranged from 3% to 12%, 3% to 42%, 0% to 43%, and 0% to 29% with saflufenacil from 50 to 400 g ha−1 in Columbus, Legacy, New Hanover, and O’Neal, respectively, at 28 d after treatment. Regardless of injury, plant growth (change in height), soil plant analysis development, and whole-plant dry biomass of all cultivars did not differ among saflufenacil rates. Field studies were conducted in Burgaw, NC, to determine the tolerance of nonbearing (<3-yr-old and not mature enough to produce fruit) and bearing (>3-yr-old and mature enough to produce fruit) southern highbush blueberry (‘Duke’) to saflufenacil application at pre-budbreak or during the vegetative growth stage. Treatments included three rates of saflufenacil (50, 100, and 200 g ha−1), glyphosate (870 g ae ha−1), glufosinate (1096 g ai ha−1), glyphosate (870 g ha−1) + saflufenacil (50 g ha−1), glufosinate (1096 g ha−1) + saflufenacil (50 g ha−1), and hexazinone (1,120 g ai ha−1), applied POST-directed to the soil surface beneath blueberry plants in a 76-cm band on both sides of the blueberry planting row. The maximum injury from treatments containing saflufenacil was ≤11% in both nonbearing and bearing blueberry. No negative effects on plant growth or fruit yield were observed from any treatments. Results from both greenhouse and field studies suggest that saflufenacil applied at 50 (1X commercial use rate) and 100 g ha−1 is safe to use in blueberry.
Hyperbolic polariton modes are highly appealing for a broad range of applications in nanophotonics, including surfaced enhanced sensing, sub-diffractional imaging, and reconfigurable metasurfaces. Here we show that attenuated total reflectance (ATR) micro-spectroscopy using standard spectroscopic tools can launch hyperbolic polaritons in a Kretschmann–Raether configuration. We measure multiple hyperbolic and dielectric modes within the naturally hyperbolic material hexagonal boron nitride as a function of different isotopic enrichments and flake thickness. This overcomes the technical challenges of measurement approaches based on nanostructuring, or scattering scanning near-field optical microscopy. Ultimately, our ATR approach allows us to compare the optical properties of small-scale materials prepared by different techniques systematically.
Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor’s impact in clinical practice. Patients aged 0–18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.
The archaeology of the nineteenth-century Chinese diaspora is a well-developed archaeological subfield, but research on Chinese migrants’ homelands is lacking. Survey of a qiaoxiang (home village) in China's Pearl River Delta provides the first archaeological evidence from a home village of Chinese migrants. Transnational comparative analysis with collections recovered from Chinese diaspora settlements reveals stark differences in the use of China-produced goods between qiaoxiang and Chinese settlements abroad. Qiaoxiang residents primarily used locally produced ceramics, while residents of Chinese diaspora settlements consumed ceramics produced in Gaobei and Jingdezhen, major pottery centers located in northeast Guangdong Province and Jiangxi Province, hundreds of kilometers to the north. Additionally, qiaoxiang residents were engaged in global networks of consumption, using British refined earthenwares and other products produced in Europe and the United States. These findings challenge the common assumption made in diaspora research that artifacts produced in migrants’ homelands are evidence of tradition, while those produced in migrants’ adopted countries are evidence of culture change. Instead, the results of qiaoxiang archaeology indicate the significance of nonstate actors, especially import-export companies, in shaping the material worlds of both homeland and diaspora communities. (Spanish abstract available as Supplemental Text 1.)
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
We report the breeding success of four species of burrow-nesting petrels at sub-Antarctic Marion Island where house mice Mus musculus are the sole introduced mammal. Feral cats Felis catus were present on Marion for four decades from 1949, killing millions of seabirds and greatly reducing petrel populations. Cats were eradicated by 1991, but petrel populations have shown only marginal recoveries. We hypothesize that mice are suppressing their recovery through depredation of petrel eggs and chicks. Breeding success for winter breeders (grey petrels Procellaria cinerea (34±21%) and great-winged petrels Pterodroma macroptera (52±7%)) were lower than for summer breeders (blue petrels Halobaena caerulea (61±6%) and white-chinned petrels Procellaria aequinoctialis (59±6%)) and among winter breeders most chick fatalities were of small chicks up to 14 days old. We assessed the extent of mouse predation by monitoring the inside of 55 burrow chambers with video surveillance cameras (4024 film days from 2012–16) and recorded fatal attacks on grey (3/18 nests filmed, 17%) and great-winged petrel chicks (1/19, 5%). Our results show that burrow-nesting petrels are at risk from mouse predation, providing further motivation for the eradication of mice from Marion Island.
This study compares the earth orientation results obtained by the NASA CDP and the NGS IRIS experiments. The results agree at about one combined formal error (two milliarcseconds) after small biases (one to three milliarcseconds) have been removed from each component. Furthermore the biases are found to correspond to small rotations between the reference frames, principally the terrestrial frame, for the two sets of experiments. In the past the CDP data has not been used in combined solutions of earth orientation parameters prepared by the data centers at the U.S.N.O. and the B.I.H. The authors propose that these data should be included because they are distinct from the IRIS data and represent an important supplement to those data. We also point out that the total number of observations is about equal in the CDP and IRIS experiment sets.
The NASA Crustal Dynamics Project (CDP) has been using VLBI on intercontinental baselines to measure tectonic plate motions since 1979. We report on measurements between sites on the North American plate (Haystack/Westford, MA; Owens Valley and Mojave, CA; Ft. Davis, TX and Gilmore Creek, AK), the Eurasian plate (Onsala, Sweden; Wettzell, West Germany, and Shanghai, China), the Pacific plate (Kauai, HI; Kwajalein in the Marshall Islands, and Vandenberg AFB, CA), the African plate (Hartebesthoek, RSA), and Japan (Kashima).
Post-traumatic stress disorder (PTSD) is often associated with attention allocation and emotional regulation difficulties, but the brain dynamics underlying these deficits are unknown. The emotional Stroop task (EST) is an ideal means to monitor these difficulties, because participants are asked to attend to non-emotional aspects of the stimuli. In this study, we used magnetoencephalography (MEG) and the EST to monitor attention allocation and emotional regulation during the processing of emotionally charged stimuli in combat veterans with and without PTSD.
A total of 31 veterans with PTSD and 20 without PTSD performed the EST during MEG. Three categories of stimuli were used, including combat-related, generally threatening and neutral words. MEG data were imaged in the time-frequency domain and the network dynamics were probed for differences in processing threatening and non-threatening words.
Behaviorally, veterans with PTSD were significantly slower in responding to combat-related relative to neutral and generally threatening words. Veterans without PTSD exhibited no significant differences in responding to the three different word types. Neurophysiologically, we found a significant three-way interaction between group, word type and time period across multiple brain regions. Follow-up testing indicated stronger theta-frequency (4–8 Hz) responses in the right ventral prefrontal (0.4–0.8 s) and superior temporal cortices (0.6–0.8 s) of veterans without PTSD compared with those with PTSD during the processing of combat-related words.
Our data indicated that veterans with PTSD exhibited deficits in attention allocation and emotional regulation when processing trauma cues, while those without PTSD were able to regulate emotion by directing attention away from threat.
This study examined whether the association between age and amygdala–medial prefrontal cortex (mPFC) connectivity in typically developing 6- to 10-year-old children is correlated with parental care. Resting-state functional magnetic resonance imaging scans were acquired from 124 children of the Generation R Study who at 4 years old had been observed interacting with their parents to assess maternal and paternal sensitivity. Amygdala functional connectivity was assessed using a general linear model with the amygdalae time series as explanatory variables. Higher level analyses assessing Sensitivity × Age as well as exploratory Sensitivity × Age × Gender interaction effects were performed restricted to voxels in the mPFC. We found significant Sensitivity × Age interaction effects on amygdala–mPFC connectivity. Age was related to stronger amygdala–mPFC connectivity in children with a lower combined parental sensitivity score (b = 0.11, p = .004, b = 0.06, p = .06, right and left amygdala, respectively), but not in children with a higher parental sensitivity score, (b = –0.07, p = .12, b = –0.06, p = .12, right and left amygdala, respectively). A similar effect was found for maternal sensitivity, with stronger amygdala–mPFC connectivity in children with less sensitive mothers. Exploratory (parental, maternal, paternal) Sensitivity × Age × Gender interaction analyses suggested that this effect was especially pronounced in girls. Amygdala-mPFC resting-state functional connectivity has been shown to increase from age 10.5 years onward, implying that the positive association between age and amygdala–mPFC connectivity in 6- to 10-year-old children of less sensitive parents represents accelerated development of the amygdala–mPFC circuit.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
We describe bright microwave events that were first detected with the Parkes 64-m telescope at 8.4 or 22 GHz from six active-chromosphere stars. In some flares spectral data were obtained over a large frequency range from simultaneous measurements with the Parkes reflector (8.4 or 22 GHz), the Tidbinbilla interferometer (8.4 and 2.29 GHz), the Fleurs synthesis telescope (1.42 GHz) and the Molonglo Observatory synthesis telescope (0.843 GHz). Data on circular polarization were obtained from the Parkes observations at 8.4 GHz.
The stars were in a wide variety of evolutionary states, ranging from a single pre-main-sequence star (HD 36705), two RS CVn binaries (HD 127535, HD 128171), an Algol (HD 132742) and two apparently single K giants (HD 32918 and HD 196818). Their high brightness temperatures, positive spectral indices and low polarization are consistent with optically thick gyrosynchrotron emission from mildly relativistic electrons with average energies 0.5 to 3 MeV gyrating in inhomogeneous magnetic fields of 5 to 100 G.
We estimate the 1.8 MeV luminosity of the Sco-Cen association due to radioactive decay of 26A1 to (4 – 15) 10−5ph cm−2 s−1. We propose a low surface brightness, limb brightened bubble for the 1.8 MeV intensity distribution. The detectibility of this distribution with existing γ-ray telescopes is discussed.
The Compton Gamma-Ray Observatory (C-GRO) has completed a full-sky survey during which the number of known γ-ray pulsars has more than doubled. COMPTEL has observed the classical pulsars Crab and Vela on several occasions and has derived detailed pulse patterns and spectral parameters in the 0.7-30 MeV energy interval. The new C-GROγ-ray pulsars have different properties in terms of energy spectra and light-curve shapes, and, in fact, only the Crab is seen by all four C-GRO instruments. This raises intriguing questions about the particle acceleration processes and beaming taking place in the neutron magnetosphere. We have examined the COMPTEL data to add information on these objects in the 0.7-30 MeV energy interval and present evidence for the detection of one of them, PSR B1509-58. We have also undertaken a search for candidate radio pulsars whose ephemerides are well defined. The results of these analyses are presented.
Subject headings: gamma rays: observations — pulsars: general
26Al radioactivity is believed to originate predominantly from massive stars, ejected into interstellar medium in wind phases and/or supernova events. With its million-year decay time, penetrating γ-rays from 26Al decay measure the massive-star history averaged over a time scale of ≃million years, thus extending times cales accessible otherwise. The COMPTEL 1.809 MeV all-sky data from 5 years of observations show irregularities and features at intermediate latitudes, which may have a more local origin (≃ 1 kpc). We find that the large scale emission can be characterized by a Galactic scale height of ≃ 130 pc, and a Galactocentric scale radius of ≃ 5 kpc, with features from spiral structure. Catalogues from massive-star related objects do not significantly improve the description of COMPTEL data above this. Emission associated with nearby structures such as the Gould Belt, Loop I, or stellar aggregates, is indicated, yet cannot be clearly detected. Combined with our imaging results, this suggests that 26A1 yields from massive star ensembles depend on specifics of those stars and their history. Further 26A1 γ-ray studies are underway to help mapping of the massive star history in the solar vicinity.
Radio interferometric observations of extragalactic radio sources have been made with antennas at the Haystack Observatory in Massachusetts and the Owens Valley Radio Observatory in California during fourteen separate experiments distributed between September 1976 and May 1978. The components of the baseline vector and the coordinates of the sources were estimated from the data from each experiment separately. The root-weighted-mean-square scatter about the weighted mean (“repeatability”) of the estimates of the length of the 3900 km baseline was approximately 7 cm, and of the source coordinates, approximately or less, except for the declinations of low-declination sources. With the source coordinates all held fixed at the best available, a posteriori, values, and the analyses repeated for each experiment, the repeatability obtained for the estimate of baseline length was 4 cm. From analyses of the data from several experiments simultaneously, estimates were obtained of changes in the x component of pole position and in the Earth's rotation (UT1). Comparison with the corresponding results obtained by the Bureau International de l'Heure (BIH) discloses systematic differences. In particular, the trends in the radio interferometric determinations of the changes in pole position agree more closely with those from the International Polar Motion Service (IPMS) and from the Doppler observations of satellites than with those from the BIH.