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An essential resource for practitioners in infectious diseases and microbiology, studying for the new FRCPath Part 1 infection examination accredited by the Royal College of Pathologists, and trainees sitting the membership exams of the Royal College of Physicians. Including over 300 multiple choice questions in an exam-style Q&A format, this guide provides an invaluable revision platform for domestic and international trainees alike, with scope to present infection-based support for other medical specialties, where infection forms a core component, including intensive care. Authored by leading specialists in infectious diseases and microbiology, this invaluable training guide is the first of its kind to cover both undergraduate and postgraduate material in infectious diseases. Mapping directly from the FRCPath and RCP infection curricula, students are able to explore areas of curriculum to gain knowledge and optimise decision-making skills, under pressure.
Arakawa and colleagues (2011) use temporal changes in obsidian source patterns to link the late thirteenth-century abandonment of the Mesa Verde region to Ortman's (2010, 2012) model of Tewa migration to the northern Rio Grande. They employ Anthony's (1990) concept of reverse migration, inferring that an increase in Mesa Verde–region obsidian from a specific Jemez Mountain source reflects the scouting of an eventual migration path. Weaknesses of this inference are that only obsidian data from the Mesa Verde region were used in its development and that the model does not consider the complexities of previously documented patterns of settlement and stone raw material use in the northern Rio Grande. By examining source data from parts of northwestern and north-central New Mexico, we find that the patterning seen in the Mesa Verde obsidian data is widespread both geographically and temporally. The patterns are more indicative of a change in acquisition within a down-the-line exchange system than a reverse migration stream. Population trends on the southern Pajarito Plateau, the probable source of the acquisition change, suggest ancestral Keres rather than Tewa involvement in thirteenth-century obsidian distribution.
With regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.
We conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).
We included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).
Initial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
This chapter summarizes our current understanding of the ionosphere of Saturn. We give an overview of Saturn ionospheric science from the Voyager era to the present, with a focus on the wealth of new data and discoveries enabled by Cassini, including a massive increase in the number of electron density altitude profiles. We discuss recent ground-based detections of the effect of “ring rain” on Saturn’s ionosphere, and present possible model interpretations of the observations. Finally, we outline current model-data discrepancies and indicate how future observations can help in advancing our understanding of the various controlling physical and chemical processes.
Liebmann's (2017) essay on the relationship between Jemez Pueblo and the Valles Caldera of northern New Mexico seems to imply that the Jemez Pueblo had an exclusive relationship with the caldera, particularly Redondo Peak, and the major obsidian source Cerro del Medio (CDM). This is curious given that abundant obsidian provenance studies from the region exhibit equal to or nearly equal proportions of Cerro del Medio obsidian that are not considered ancestral to Jemez Pueblo. Liebmann's regional perspective based on landscape theory appears flawed by a lack of regionally specific data.
Anthropologists have become increasingly aware of the importance of population as a factor in a systematic view of human biological and cultural development. This awareness has generated an interest in the field of demography, and consequently, techniques once utilized almost exclusively by demographers are now frequently utilized for anthropological studies. Anthropological-paleodemographic inquiry traditionally starts with the excavation of a skeletal population sample. The sample is aged and sexed, and the data are put into a descriptive analytic model–the life table. The life table, through a process of inference, is taken to represent the life processes of a local biological population and often forms the basis for further inference on the relationships between populational and cultural processes (Green and others 1974; Howell-Lee 1971).
Critics have questioned the assumption of life table construction and cited various sources of error in data collection to argue against the use of life tables as a source of inference concerning the biological population. In this paper we will attempt to address some of these sources of error. Specifically, we will discuss the effects of enumeration errors, population growth, and small population size on life table values. To assess the impact of these errors on life table values of “anthropological” populations, we make use of computer simulation. We conclude that, once the implications of these factors are understood, the life table can provide a useful model for paleodemographic research.
The final rule for the protection of human subjects requires that informed consent be “in language understandable to the subject” and mandates that “the informed consent must be organized in such a way that facilitates comprehension.” This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention.
Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year.
The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade.
Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.
OBJECTIVES/SPECIFIC AIMS: Develop a plain language informed consent template that met IRB and regulatory requirements. Evaluate the effectiveness of the template at improving the readability of informed consents. Field test the informed consent with low health literacy. METHODS/STUDY POPULATION: We conducted a retrospective analysis of over 200 UAMS IRB approved, investigator initiated informed consents from 2013 to 2015 to determine the readability before intervention. The mean grade level readabilities were derived from the results of 3 readability formulas (Flesch-Kincaid, SMOG, and Fry) using open-source readability tools. A plain language informed consent template that meets IRB and regulatory requirements was developed, adhering to health literacy best practices for written communication. The template was made available to investigators as an optional resource, and IRB committees were trained on use of the template. In addition, a focus group will be conducted to qualitatively assess understandability of the template with study participants identified as having inadequate health literacy. Data analysis will include readability assessment of IRB approved informed consents post intervention with and without use of the plain language template, as well as qualitative feedback from focus group participants. RESULTS/ANTICIPATED RESULTS: The retrospective analysis revealed a mean readability of 10th grade for IRB approved informed consents from 2013 to 2015 (n=217). The readability of the developed plain language template was 5th grade. Preliminary post-intervention results show adoption of the template by investigators (n=16) resulted in informed consents with a mean readability of 7th grade (range 6–9th grade), compared to a mean of 10th grade (range 7–11th grade) for the comparator (“no adoption” group, n=24). Data collection will continue through May 2017. The focus group is forthcoming and results will be included in the poster. DISCUSSION/SIGNIFICANCE OF IMPACT: Low health literacy is common in individuals with healthcare disparities and can limit their participation in clinical research. Few studies have examined interventions to address this barrier to research. Preliminary results of this study support the utilization of a plain language informed consent template in investigator-initiated research. Moreover, this study demonstrates the importance of stakeholder engagement among CTSA leadership, health literacy experts, the institutional review board, investigators, and research subjects in the development and testing of this intervention to make informed consents “understandable to the subject” while containing all required elements.
Electrochemical sensing systems are advancing into a wide range of new applications, moving from the traditional lab environment into disposable devices and systems, enabling real-time continuous monitoring of complex media. This transition presents numerous challenges ranging from issues such as sensitivity and dynamic range, to autocalibration and antifouling, to enabling multiparameter analyte and biomarker detection from an array of nanosensors within a miniaturized form factor. New materials are required not only to address these challenges, but also to facilitate new manufacturing processes for integrated electrochemical systems. This paper examines the recent advances in the instrumentation, sensor architectures, and sensor materials in the context of developing the next generation of nanoenabled electrochemical sensors for life sciences applications, and identifies the most promising solutions based on selected well established application exemplars.
CdTe solar cells with a Te-buffer layer adjacent to the back contact were fabricated. The effects of the Te layer on cell performance were evaluated in detail. The carrier density of the Te layer (1018 cm-3) was measured. The valence band offset of the CdTe/Te interface (∼0.3-0.5 eV) was determined from current-voltage-temperature measurements and published reports. These values were incorporated into a simulation model and compared to the measured experimental performance with good agreement. Most notably, it was found that the Te layer allowed improved cell performance with less Cu required to form the back contact.
Small marine snails and abalone have been identified as high- and low-risk prey items, respectively, for exposure of threatened southern sea otters to Toxoplasma gondii, a zoonotic parasite that can cause fatal encephalitis in animals and humans. While recent work has characterized snails as paratenic hosts for T. gondii, the ability of abalone to vector the parasite has not been evaluated. To further elucidate why abalone predation may be protective against T. gondii exposure, this study aimed to determine whether: (1) abalone are physiologically capable of acquiring T. gondii; and (2) abalone and snails differ in their ability to concentrate and retain the parasite. Abalone were exposed to T. gondii surrogate microspheres for 24 h, and fecal samples were examined for 2 weeks following exposure. Concentration of surrogates was 2–3 orders of magnitude greater in abalone feces than in the spiked seawater, and excretion of surrogates continued for 14 days post-exposure. These results indicate that, physiologically, abalone and snails can equally vector T. gondii as paratenic hosts. Reduced risk of T. gondii infection in abalone-specializing otters may therefore result from abalone's high nutritional value, which implies otters must consume fewer animals to meet their caloric needs.
The most extremely osmotolerant microbial isolates are fungi from high-sugar environments that tolerate the lowest water activity (0.61) for growth yet reported. Studies of osmotolerant bacteria have focused on halotolerance rather than sucretolerance (ability to grow in high sugar concentrations). A collection of salinotolerant (≥10% NaCl or ≥50% MgSO4) bacterial isolates from the Great Salt Plains of Oklahoma and Hot Lake in Washington were screened for sucretolerance in medium supplemented with ≥50% fructose, glucose or sucrose. Tolerances significantly differed between solutes, even though water activities for saline media (0.92 and 0.85 for 10 and 20% NaCl Salt Plains media, respectively) were comparable or lower than water activities for high-sugar media (0.93 and 0.90 for 50 and 70% sucrose artificial nectar media, respectively). These specific solute effects were differentially expressed among individual isolates. Extrapolating the results of earlier food science studies with yeasts at high sugar concentrations to bacteria in salty environments with low water activity should be done with caution. Furthermore, the discussion of habitable Special Regions on Mars and the icy worlds should reflect an understanding of specific solute effects.