Filamentary structures can form within the beam of protons accelerated during the interaction of an intense laser pulse with an ultrathin foil target. Such behaviour is shown to be dependent upon the formation time of quasi-static magnetic field structures throughout the target volume and the extent of the rear surface proton expansion over the same period. This is observed via both numerical and experimental investigations. By controlling the intensity profile of the laser drive, via the use of two temporally separated pulses, both the initial rear surface proton expansion and magnetic field formation time can be varied, resulting in modification to the degree of filamentary structure present within the laser-driven proton beam.

We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽−2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score −2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3–99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.

Introduction: Emergency Department Overcrowding (EDOC) is a multifactorial issue that leads to Access Block for patients needing emergency care. Identified as a national problem, patients presenting to a Canadian Emergency Department (ED) at a time of overcrowding have higher rates of admission to hospital and increased seven-day mortality. Using the well accepted input-throughput-output model to study EDOC, current research has focused on throughput as a measure of patient flow, reported as ED length of stay (LOS). In fact, ED LOS and ED beds occupied by inpatients are two “extremely important indicators of EDOC identified by a 2005 survey of Canadian ED directors. One proposed solution to improve ED throughput is to utilize a physician at triage (PAT) to rapidly assess newly arriving patients. In 2017, a pilot PAT program was trialed at Kelowna General Hospital (KGH), a tertiary care hospital, as part of a PDSA cycle. The aim was to mitigate EDOC by improving ED throughput by the end of 2018, to meet the national targets for ED LOS suggested in the 2013 CAEP position statement. Methods: During the fiscal periods 1-6 (April 1 to September 7, 2017) a PAT shift occurred daily from 1000-2200, over four long weekends. ED LOS, time to inpatient bed, time to physician initial assessment (PIA), number of British Columbia Ambulance Service (BCAS) offload delays, and number of patients who left without being seen (LWBS) were extracted from an administrative database. Results were retrospectively analyzed and compared to data from 1000-2200 of non-PAT trial days during the trial periods. Results: Median ED LOS decreased from 3.8 to 3.4 hours for high-acuity patients (CTAS 1-3), from 2.1 to 1.8 hours for low-acuity patients (CTAS 4-5), and from 9.3 to 8.0 hours for all admitted patients. During PAT trial weekends, there was a decrease in the average time to PIA by 65% (from 73 to 26 minutes for CTAS 2-5), average number of daily BCAS offload delays by 39% (from 2.3 to 1.4 delays per day), and number of patients who LWBS from 2.4% to 1.7%. Conclusion: The implementation of PAT was associated with improvements in all five measures of ED throughput, providing a potential solution for EDOC at KGH. ED LOS was reduced compared to non-PAT control days, successfully meeting the suggested national targets. PAT could improve efficiency, resulting in the ability to see more patients in the ED, and increase the quality and safety of ED practice. Next, we hope to prospectively evaluate PAT, continuing to analyze these process measures, perform a cost-benefit analysis, and formally assess ED staff and patient perceptions of the program.

In sub-Saharan Africa (SSA), the association of crops and livestock in mixed farming systems generally benefits both enterprises. This paper focuses on the main contributions of livestock to crop production: the use of manure and animal draught power to produce crops and the investment of income from livestock into technologies that benefit crop production. In low-input, grazing-based feeding operations, manure is a vital soil fertility amendment. In these systems, penning livestock overnight on fields, fallow between cropping periods, returns both manure and urine to the soil and results in much higher crop yields than if manure only is gathered from stalls and spread onto fields. However, most farmers have insufficient manure to sustain food production. Nutrient harvests often exceed nutrient inputs, requiring a much greater use of fertilizers to arrest soil nutrient depletion. The opposite may be true for mixed farming where livestock are given food in confinement. In these emerging systems, the continuous importation of food (and fertilizer) can result in nutrient surpluses with subsequent soil nutrient build-up and loss. The contribution of animal power to crop production is relatively new in Africa. Animal power affects the amount of land cultivated by farmers, crop selection, the yield per farm and per ha, and on the participation and work load of people (family members and outside labour) involved in crop production and its associated activities. In addition to the impacts of manure and draught power on crop production, income derived from livestock is often invested in inputs that enhance crop production. At the ‘micro’ level, livestock income influences crop production (1) directly by allowing households to invest in productive inputs such as fertilizer, hired labour, and carts and (2) indirectly by allowing poor households to improve their nutritional status and, therefore, the productivity of their most important resource, their own labour. At the ‘macro’ level, increased livestock exports have a large stimulating effect on the demand for locally produced goods and services, particularly basic food crops. Thus, increasing the productivity of the livestock sector, including an emphasis on the policy and institutional environment influencing marketing and trade, is an important element of a development strategy focused on stimulating economic growth and alleviating poverty.

The utilization of taphonomic information to formulate biostratinomic models for modern and ancient assemblages has become a potentially powerful tool in paleoecologic analysis. The division of fossil assemblages into discrete suites of taphonomically-similar material adds an extra dimension to the interpretation of depositional setting and paleoecologic structure (Brett and Baird, 1986; Speyer and Brett, 1986, 1988; Speyer, 1987). This approach uses the hypothesis that taphonomic alteration varies in a predictable way with depositional setting. In other words, each specific environment (e.g., low-salinity muddy bay, storm-dominated clastic shelf) is characterized by a unique suite of physical, chemical and biological processes: these processes imprint a unique and predictable “taphonomic signature” on the death assemblage.

Leprocaulon calcicola is described as new from walls in SE England; it is leprose, pale to mid blue-grey, and contains zeorin and usnic acid. It differs from L. knudsenii from North America in its habitat on mortared walls rather than non-calcareous rock and in its ITS sequence. ‘Lecanora’ ecorticata differs in the yellower colour, and the presence of unidentified fatty acids and traces of unknown terpenoids (but not zeorin) by thin-layer chromatography. Leprose lichens with usnic acid are still poorly known and sequencing must be used to support morphological and chemical studies.

The collective response of electrons in an ultrathin foil target irradiated by an ultraintense ( ${\sim}6\times 10^{20}~\text{W}~\text{cm}^{-2}$ ) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.

Background: Research has suggested that female athletes have a higher incidence of concussion compared to their male counterparts. As such, programs designed to improve knowledge and attitudes of concussion should target this high-risk population. Previous work demonstrated the effect of a novel Concussion-U educational presentation on knowledge and attitudes of concussion amongst male Bantam and Midget AAA hockey players. The objective of this study was to determine if the same presentation was effective in improving the knowledge and attitudes of concussion in a cohort of elite female hockey players. Methods: 26 elite female high-school aged (14-17) hockey players from the province of New Brunswick consented to participate in the study. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey questionnaire immediately before and after a Concussion-U educational presentation. Results were compared across the two time-points to assess the effectiveness of the presentation. Results: Concussion knowledge and attitude scores significantly (p<.001) increased from pre-presentation to post-presentation by 12.5% and 13.4%, respectively. Conclusions: A Concussion-U educational presentation resulted in increased knowledge and improved attitudes towards concussion in elite female hockey players. Future research should examine the long-term retention of these improvements.

Background: The diagnosis of a concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving athlete’s knowledge and attitudes towards concussions may increase self-reporting behavior; however, research in this area is inconclusive. The objective of this study is to determine if a Concussion-U educational presentation improves knowledge and attitudes of youth hockey players towards concussions. This is part of a larger study designed to determine the impact of an informational presentation on the knowledge and attitudes over a full hockey season. Methods: 56 elite male Bantam and Midget hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey (RoCKAS) questionnaire immediately before and after a Concussion-U educational presentation on the subject. Results: Concussion knowledge and attitude scores significantly (p<.001) increased from pre-presentation to post-presentation by 13.1% and 8.7%, respectively. Discussion: A Concussion-U educational presentation designed to improve concussion knowledge and attitudes in youth hockey players resulted in increased knowledge and improved attitudes towards concussion in elite male Bantam and Midget hockey players. Future research should examine the long-term effects of such presentations.