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In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
Field studies were conducted at the Pontotoc Ridge–Flatwoods Branch Experiment Station in Pontotoc, MS, in 2016 and 2017 to determine sweetpotato crop response to saflufenacil and rimsulfuron/thifensulfuron-methyl. Saflufenacil treatments consisted of a factorial of two rates (25 or 50 g ai ha–1) by three application timings [0, 3, or 6 wk before transplanting (WBP)]. Rimsulfuron/thifensulfuron-methyl treatments consisted of a factorial of two rates (18/18 or 35/35 g ai ha–1) by two application timings (3 or 6 WBP). A nontreated check was included for comparison. Saflufenacil resulted in as much as 20% stunting injury in 2016, but ≤4% crop injury in 2017. Compared to the nontreated check, saflufenacil did not reduce yield of any sweetpotato grade regardless of application rate or timing. Findings from this trial indicate that saflufenacil applied in pre-transplanting burndown and field preparation procedures did not have a negative impact on the subsequent sweetpotato crop and that the current plant-back interval (4 to 5 mo) may be excessive. Applications of rimsulfuron/thifensulfuron-methyl at 35/35 g ha–1 made 3 WBP resulted in significant crop injury but did not reduce yield of any sweetpotato grade. Findings from this trial suggest that rimsulfuron/thifensulfuron-methyl applications up to 35/35 g ha–1 applied at least 6 WBP and 18/18 g ha–1 applied at least 3 WBP had little impact on sweetpotato crop growth and may be a safe preplant burndown option.
Objectives: The Wisconsin Card Sorting Test (WCST) is a complex measure of executive function that is frequently employed to investigate the schizophrenia spectrum. The successful completion of the task requires the interaction of multiple intact executive processes, including attention, inhibition, cognitive flexibility, and concept formation. Considerable cognitive heterogeneity exists among the schizophrenia spectrum population, with substantive evidence to support the existence of distinct cognitive phenotypes. The within-group performance heterogeneity of individuals with schizophrenia spectrum disorder (SSD) on the WCST has yet to be investigated. A data-driven cluster analysis was performed to characterise WCST performance heterogeneity. Methods: Hierarchical cluster analysis with k-means optimisation was employed to identify homogenous subgroups in a sample of 210 schizophrenia spectrum participants. Emergent clusters were then compared to each other and a group of 194 healthy controls (HC) on WCST performance and demographic/clinical variables. Results: Three clusters emerged and were validated via altered design iterations. Clusters were deemed to reflect a relatively intact patient subgroup, a moderately impaired patient subgroup, and a severely impaired patient subgroup. Conclusions: Considerable within-group heterogeneity exists on the WCST. Identification of subgroups of patients who exhibit homogenous performance on measures of executive functioning may assist in optimising cognitive interventions. Previous associations found using the WCST among schizophrenia spectrum participants should be reappraised. (JINS, 2019, 25, 750–760)
Introduction: Acute migraine headaches are common causes of presentation to the emergency department (ED). There is great variability in the efficacy of the available parenteral agents to manage pain, though triptans are among the recommended treatments. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review examined pain management in emergency settings and assessed the effectiveness of triptan agents. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Pain scale scores were analyzed using standardized mean difference (SMD) with 95% confidence intervals (CIs) calculated using a random effects model; heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Pain was measured within the ED or equivalent acute care setting using a variety of pain scales, most commonly the 0-10 cm or 100 mm visual analog scale. Four studies compared pain scores between patients receiving sumatriptan vs. other agents, of which, patients receiving sumatriptan reported higher pain scale scores (SMD = 0.53; 95% CI: 0.04, 1.02; I2 = 80%). In particular, patients receiving sumatriptan reported higher pain scale scores than patients receiving metoclopramide (SMD = 0.68; 95% CI: 0.31, 1.04; n = 1) or ketorolac (SMD = 1.39; 95% CI: 0.56, 2.21; n = 1). Overall, studies comparing anti-inflammatory agents (i.e., ketorolac or dexketoprofen) to other agents reported improved pain scale scores among patients receiving anti-inflammatory agents (SMD = -0.38; 95% CI: -0.73, -0.03; I2 = 66%; n = 5). Conclusion: Limited evidence suggests that patients treated with metoclopramide or anti-inflammatory agents experience greater pain reduction compared to patients treated with sumatriptan. This review will conduct a network analysis of parenteral agents to examine the comparative effectiveness of parenteral agents to manage pain among patients with acute migraine. Further analysis will also consider the balance between efficacy and adverse events.
Introduction: Although a variety of parenteral agents exist for the treatment of acute migraine, relapse after an emergency department (ED) visit is still a common occurrence. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review focused on those studies aiming a reduction in relapse after an ED visit. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to identify comparative studies to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Relapse was reported in 44 (38%) included studies and occurred commonly in patients receiving placebo or no interventions (median = 39%; IQR: 14%, 47%). Overall, no differences in headache relapse were found between patients receiving sumatriptan or placebo (RR = 1.09; 95% CI: 0.55, 2.17; I2 = 93%; n = 8). Conversely, patients receiving neuroleptic agents experienced fewer relapses compared to placebo (RR = 0.27; 95% CI: 0.12, 0.58; I2 = 0%; n = 3); however, patients receiving neuroleptics reported an increase in adverse events (RR = 1.87; 95% CI: 1.17, 3.00; I2 = 0%; n = 3). Compared to placebo, patients receiving dexamethasone were less likely to experience a headache recurrence (RR = 0.71; 95% CI: 0.53, 0.95; I2 = 60%, n = 9); however, no differences were found in reported adverse events (RR = 1.09; 95% CI: 0.81, 1.47; I2 = 0%; n = 3). Conclusion: Relapse is a common occurrence for patients with migraine headaches. This review found patients receiving neuroleptics or dexamethasone experienced fewer headache recurrences. Conversely, triptan agents appear to have minimal effect on reducing the risk for headache recurrence following discharge from an acute care setting. Limited available data on adverse events is an important limitation to inform decision-making. Guidelines should be revised to reflect these results.
The investigation of potential herbicides for weed control in sweetpotato is critical due to the limited number of registered herbicides and the development of populations of herbicide- resistant weeds. Therefore, field studies were conducted at the Horticultural Crops Research Station, Clinton, NC and the Pontotoc Ridge–Flatwoods Branch Experiment Station, Pontotoc, MS to determine the effect of oryzalin application rate and timing on sweetpotato tolerance. Oryzalin at 0.6, 1.1, 2.2, 3.4, and 4.5 kg ai ha–1 was applied immediately after transplanting or 14 d after sweetpotato transplanting (DAP). At Clinton, oryzalin applied immediately after transplanting resulted in ≤1% leaf distortion 4 and 6 wk after transplanting (WAP) regardless of application rate. However, when oryzalin was applied 14 DAP, greater sweetpotato leaf distortion was observed from 2.2, 3.4, and 4.5 kg ha–1 (≤8%) than 0.6 and 1.1 kg ha–1 (≤4%). At Pontotoc, oryzalin applied immediately after transplanting resulted in ≤6% leaf distortion 4 WAP regardless of application rate. However, when oryzalin was applied at 14 DAP, greater leaf distortion was reported from 3.4 and 4.5 kg ha–1 (11 to 13%) than 0.6, 1.1, and 2.2 kg ha–1 (4 to 6%). Oryzalin application rate and timing did not affect yield of no.1, jumbo, or marketable sweetpotato. Based on these results, oryzalin herbicide has potential for registration in sweetpotato.
Studies were conducted to determine the tolerance of sweetpotato and Palmer amaranth control to a premix of flumioxazin and pyroxasulfone pretransplant (PREtr) followed by (fb) irrigation. Greenhouse studies were conducted in a factorial arrangement of four herbicide rates (flumioxazin/pyroxasulfone PREtr at 105/133 and 57/72 g ai ha–1, S-metolachlor PREtr 803 g ai ha–1, nontreated) by three irrigation timings [2, 5, and 14 d after transplanting (DAP)]. Field studies were conducted in a factorial arrangement of seven herbicide treatments (flumioxazin/pyroxasulfone PREtr at 40/51, 57/72, 63/80, and 105/133 g ha–1, 107 g ha–1 flumioxazin PREtr fb 803 g ha–1S-metolachlor 7 to 10 DAP, and season-long weedy and weed-free checks) by three 1.9-cm irrigation timings (0 to 2, 3 to 5, or 14 DAP). In greenhouse studies, flumioxazin/pyroxasulfone reduced sweetpotato vine length and shoot and storage root fresh biomass compared to the nontreated check and S-metolachlor. Irrigation timing had no influence on vine length and root fresh biomass. In field studies, Palmer amaranth control was≥91% season-long regardless of flumioxazin/pyroxasulfone rate or irrigation timing. At 38 DAP, sweetpotato injury was≤37 and≤9% at locations 1 and 2, respectively. Visual estimates of sweetpotato injury from flumioxazin/pyroxasulfone were greater when irrigation timing was delayed 3 to 5 or 14 DAP (22 and 20%, respectively) compared to 0 to 2 DAP (7%) at location 1 but similar at location 2. Irrigation timing did not influence no.1, jumbo, or marketable yields or root length-to-width ratio. With the exception of 105/133 g ha–1, all rates of flumioxazin/pyroxasulfone resulted in marketable sweetpotato yield and root length-to-width ratio similar to flumioxazin fb S-metolachlor or the weed-free checks. In conclusion, flumioxazin/pyroxasulfone PREtr at 40/51, 57/72, and 63/80 g ha–1 has potential for use in sweetpotato for Palmer amaranth control without causing significant crop injury and yield reduction.
Numerous studies have demonstrated that genetic and environmental factors interact to influence alcohol problems. Yet prior research has primarily focused on samples of European descent and little is known about gene–environment interactions in relation to alcohol problems in non-European populations. In this study, we examined whether and how genetic risk for alcohol problems and peer deviance and interpersonal traumatic events independently and interactively influence trajectories of alcohol use disorder symptoms in a sample of African American students across the college years (N = 1,119; Mage = 18.44 years). Data were drawn from the Spit for Science study where participants completed multiple online surveys throughout college and provided a saliva sample for genotyping. Multilevel growth curve analyses indicated that alcohol dependence genome-wide polygenic risk scores did not predict trajectory of alcohol use disorder symptoms, while family history of alcohol problems was associated with alcohol use disorder symptoms at the start of college but not with the rate of change in symptoms over time. Peer deviance and interpersonal traumatic events were associated with more alcohol use disorder symptoms across college years. Neither alcohol dependence genome-wide polygenic risk scores nor family history of alcohol problems moderated the effects of these environmental risk factors on alcohol use disorder symptoms. Our findings indicated that peer deviance and experience of interpersonal traumatic events are salient risk factors that elevate risk for alcohol problems among African American college students. Family history of alcohol problems could be a useful indicator of genetic risk for alcohol problems. Gene identification efforts with much larger samples of African descent are needed to better characterize genetic risk for alcohol use disorders, in order to better understand gene–environment interaction processes in this understudied population.
In this study, we report on the mechanical cleavage of conductive metal-based aluminum diboride (AlB2) flakes. The cleavage resulted in a highly single crystalline 2D material and had an atomically flat and smooth surface as shown by atomic force microscopy (AFM) and secondary ion mass spectrometry. Nanoindentation and AFM imaging of freshly cleaved specimens revealed sub-nm roughness and 30% improvement in the nanomechanical properties as compared to the as-grown AlB2 flakes. Once exposed to ambient air, the cleaved AlB2 flakes formed a superficial oxidation layer of less than 1 nm thickness within 5 min. Owing to the smooth surface, ultra-thin and stable oxide layer, and the excellent mechanical and electrical characteristics of AlB2, the cleaved flakes present an ideal 2D material for emerging applications in microfabrication such as the growth of epitaxial thin films. To prove the sub-nm surface characteristics of cleaved AlB2, a 10-nm thick TiO2 film was deposited on a freshly cleaved AlB2 using atomic layer deposition. Surface roughness and compositional consistency of this film were compared with a control sample deposited on Si. The TiO2 film on AlB2 showed a distinct thin interface layer with fewer defects than TiO2 on Si and superior flatness.
The Batocrinidae are characteristic faunal elements in Lower Mississippian shallow-marine settings in North America. Recent delineation of objectively defined genera allows a reexamination of batocrinid species and their distribution in the Fort Payne Formation (early Viséan, late Osagean), a well-studied array of carbonate and siliciclastic facies. The Fort Payne batocrinid fauna has 14 species assigned to six genera, plus hybrid specimens. Magnuscrinus spinosus (Miller and Gurley, 1895a) is reassigned to its original placement in Eretmocrinus. Hybrid specimens (Ausich and Meyer, 1994) are regarded as Eretmocrinus magnificus×Eretmocrinus spinosus. Macrocrinus casualis is the dominant species of Macrocrinus in the Fort Payne, and M. mundulus and M. strotobasilaris are recognized in the Fort Payne Formation for the first time. Magnuscrinus cumberlandensis n. sp. is named, 13 species are designated as junior synonyms, the name for the hybrid specimens is changed to Eretmocrinus magnificus×Eretmocrinus spinosus, and the previous occurrences of two species in the Fort Payne are rejected. The Eastern Interior Seaway was a mixed carbonate-siliciclastic setting with both shallow- and deep-water epicontinental sea facies ranging from relatively shallow autochthonous green shales to deep-water turbidite facies. Dizygocrinus was restricted to shallow-water carbonate and siliciclastic facies, Eutrochocrinus was restricted to shallow-water carbonate facies, and Magnuscrinus was restricted to deep-water facies. Species distributions varied from Abatocrinus steropes, Alloprosallocrinus conicus, Macrocrinus mundulus, and Uperocrinus nashvillae, which occurred throughout the Eastern Interior Seaway, to species that were restricted to a single facies. Eretmocrinus magnificus, Alloprosallocrinus conicus, and Uperocrinus robustus were the dominant batocrinids in the Fort Payne Formation.
Characterisation of genetic diversity in a large number of European pig populations has been undertaken with EC support. The populations sampled included local (rare) breeds, national varieties of the major international breeds, commercial lines and the Chinese Meishan breed. A second phase of the project will sample a further 50 Chinese breeds. Neutral genetic markers (AFLP and microsatellites), with individual or bulk typing, were used and compared.
DNA from 59 European pig populations was extracted on samples of about 50 individuals per population. Individuals were typed for 50 microsatellites and for 148 AFLP bands. A subset of 25 populations was typed for 20 microsatellites on pools of DNA. Allele frequencies were estimated by direct allele counting for the co-dominant markers. Frequencies of AFLP negative alleles (absent bands) were obtained by taking the square root of absent band frequencies. Within-breed variability was summarised using standard statistics: expected and observed heterozygosity, mean observed and effective numbers of alleles, and F statistics. Between-breed diversity analysis was based on a bootstrapped Neighbor-Joining (NJ) tree derived from Reynolds distances (DR). The standard distance of Nei (DS) was also calculated.
We have explored the thermodynamics of compressed magnetized plasmas in laboratory experiments and we call these studies ‘magnetothermodynamics’. The experiments are carried out in the Swarthmore Spheromak eXperiment device. In this device, a magnetized plasma source is located at one end and at the other end, a closed conducting can is installed. We generate parcels of magnetized plasma and observe their compression against the end wall of the conducting cylinder. The plasma parameters such as plasma density, temperature and magnetic field are measured during compression using HeNe laser interferometry, ion Doppler spectroscopy and a linear
probe array, respectively. To identify the instances of ion heating during compression, a PV diagram is constructed using measured density, temperature and a proxy for the volume of the magnetized plasma. Different equations of state are analysed to evaluate the adiabatic nature of the compressed plasma. A three-dimensional resistive magnetohydrodynamic code (NIMROD) is employed to simulate the twisted Taylor states and shows stagnation against the end wall of the closed conducting can. The simulation results are consistent to what we observe in our experiments.
Exposure to child maltreatment has been shown to increase lifetime risk for substance use disorders (SUD). However, this has not been systematically examined among race/ethnic groups, for whom rates of exposure to assaultive violence and SUD differ. This study examined variation by race/ethnicity and gender in associations of alcohol (AUD), cannabis (CUD), and tobacco (TUD) use disorders with three types of childhood interpersonal violence (cIPV): physical abuse, sexual abuse, and witnessing parental violence.
Data from the National Epidemiologic Survey of Alcohol-Related Conditions-III (N: 36 309), a US nationally representative sample, was utilized to examine associations of DSM-5 AUD, CUD and TUD with cIPV among men and women of five racial/ethnic groups. Models were adjusted for additional risk factors (e.g. parental substance use problems, participant's co-occurring SUD).
Independent contributions of childhood physical and sexual abuse to AUD, CUD, and TUD, and of witnessing parental violence to AUD and TUD were observed. Associations of cIPV and SUD were relatively similar across race/ethnicity and gender [Odds Ratios (ORs) ranged from 1.1 to 1.9], although associations of physical abuse with AUD and TUD were greater among males, associations of parental violence and AUD were greater among females, and associations of parental violence with AUD were greater among Hispanic women and American Indian men.
Given the paucity of research in this area, and the potential identification of modifiable risk factors to reduce the impact of childhood interpersonal violence on SUDs, further research and consideration of tailoring prevention and intervention efforts to different populations are warranted.
Postinjection delirium/sedation syndrome (PDSS) has been reported uncommonly during treatment with olanzapine long-acting injection (LAI), a sustained-release formulation of olanzapine.
The primary aim of the study was to estimate the incidence per injection and per patient of PDSS events in adult patients with schizophrenia who were receiving olanzapine LAI in real-world clinical practice. Secondary aims were to further characterise the clinical presentation of PDSS events, to identify potential risk factors associated with PDSS events and to characterise hospitalisations at baseline and post-baseline.
A prospective observational study of adult patients with schizophrenia receiving olanzapine LAI from 24 countries. Data were collected on patient characteristics, olanzapine LAI treatment and any adverse events (AEs). All AEs were reviewed and adjudicated for PDSS using predetermined criteria.
There were 46 confirmed PDSS events (0.044% of the 103 505 injections) in 45 patients (1.17% of the 3858 patients). Based on 45 confirmed events with time-to-onset information, 91.1% (n=41) occurred within 1 h of injection. Time-to-recovery from the event was within 72 h for 95.6% of patients (range 6 h to 11 days). Risk factors for PDSS (per-injection) included high dose (odds ratio (OR)high/low=3.95; P=0.006) and male gender (ORfemale/male=0.42; P=0.017).
Results of this study confirm previously reported PDSS rates, time to onset and recovery, and the severity of PDSS events, and suggest that higher doses and male gender are potential risk factors associated with PDSS.