Recent advances in the additive manufacturing technology now enable fused filament fabrication of polyetheretherketone (PEEK). A standardized lumbar fusion cage design was 3D printed with different speeds of the printhead nozzle to investigate whether 3D-printed PEEK cages exhibit sufficient material properties for lumbar fusion applications. It was observed that the compressive and shear strength of the 3D-printed cages were 63–71% of the machined cages, whereas the torsion strength was 92%. The printing speed is an important printing parameter for 3D-printed PEEK, which resulted in up to 20% porosity at the highest speed of 3000 mm/min, leading to reduced cage strength. Printing speeds below 1500 mm/min can be chosen as the optimal printing speed for this printer to reduce the printing time while maintaining strength. The crystallinity of printed PEEK did not differ significantly from the as-machined PEEK cages from extruded rods, indicating that the processing provides similar microstructure.

Coastal environments are faced with constant habitat modification and biodiversity loss due to human occupation. Estuaries are considered to be highly productive and shelter heterogeneous habitats such as mangrove forests, tidal creeks, tidal mud flats and sandy beaches, which are important for the maintenance of natural resources. The present study aims to evaluate how different shallow juvenile habitats (sandy beaches, mangrove shoreline habitats and dense macrophyte habitats) influence fish during their early life stages in a tropical estuary of Brazil. Monthly samples using a beach seine net from July 2012 to June 2013 were collected in eight shallow areas of the São Mateus River estuary. The fish assemblage comprised mainly juvenile and small-sized fish, which included ecologically and commercially important species. Small recruits of Atherinella brasiliensis and Ctenogobius boleosoma were most abundant in the autumn, while Rhinosardinia bahiensis and Centropomus undecimalis were highly abundant during the winter. The water salinity recorded in the mid and lower estuarine portions was the most important variable for the distribution of A. brasiliensis and Sphoeroides spengleri, whereas Anchovia clupeoides, C. undecimalis, C. parallelus and Gobionellus oceanicus were positively correlated with the water depth of the upper estuarine portion. The fish species T. paulistanus, Genidens genidens and Achirus lineatus were related to the water turbidity in the upper portion. Thus, the heterogeneous shallow water habitats (and their associated environmental parameters) of the São Mateus River estuary are potential nursery grounds for the early life stages of a variety of fish species, which highlights the importance of these areas for local biodiversity management.

Objectives: The aim of this study was to illustrate the contribution of stakeholder engagement to the impact of health technology assessment (HTA) using an Irish HTA of a national public access defibrillation (PAD) program.

Background: In response to draft legislation that proposed a PAD program, the Minister for Health requested that Health Information and Quality Authority undertake an HTA to inform the design and implementation of a national PAD program and the necessary underpinning legislation. The draft legislation outlined a program requiring widespread installation and maintenance of automatic external defibrillators in specified premises.

Methods: Stakeholder engagement to optimize the impact of the HTA included one-to-one interviews with politicians, engagement with an Expert Advisory Group, public and targeted consultation, and positive media management.

Results: The HTA quantified the clinical benefits of the proposed PAD program as modest, identified that substantial costs would fall on small/medium businesses at a time of economic recession, and that none of the programs modeled were cost-effective. The Senator who proposed the Bill actively publicized the HTA process and its findings and encouraged participation in the public consultation. Participation of key stakeholders was important for the quality and acceptability of the HTA findings and advice. Media management promoted public engagement and understanding. The Bill did not progress.

Conclusions: The HTA informed the decision not to progress with legislation for a national PAD program. Engagement was tailored to ensure that key stakeholders including politicians and the public were informed of the HTA process, the findings, and the advice, thereby maximizing acceptance. Appropriate stakeholder engagement optimizes the impact of HTA.

Tidal flexure in ice shelf grounding zones has been used extensively in the past to determine grounding line position and ice properties. Although the rheology of ice is viscoelastic at tidal loading frequencies, most modelling studies have assumed some form of linear elastic beam approximation to match observed flexure profiles. Here we use density, radar and DInSAR measurements in combination with full-Stokes viscoelastic modelling to investigate a range of additional controls on the flexure of the Southern McMurdo Ice Shelf. We find that inclusion of observed basal crevasses and density dependent ice stiffness can greatly alter the flexure profile and yet fitting a simple elastic beam model to that profile will still produce an excellent fit. Estimates of the effective Young's modulus derived by fitting flexure profiles are shown to vary by over 200% depending on whether these factors are included, even when the local thickness is well constrained. Conversely, estimates of the grounding line position are relatively insensitive to these considerations for the case of a steep bed slope in our study region. By fitting tidal amplitudes only, and ignoring phase information, elastic beam theory can provide a good fit to observations in a wide variety of situations. This should, however, not be taken as an indication that the underlying rheological assumptions are correct.

The Detroit Lakes chain of lakes consists of five basins in northwest Minnesota adjacent to the town of Detroit Lakes. Flowering rush has been established in these basins since the 1960s. We evaluated the distribution of flowering rush in the five basins using a point intercept method, with 830 points distributed in a grid with points 150 m apart. These data were analyzed to determine whether invasive and native species frequencies were different between 2010 and 2011. We also assessed co-occurrence of flowering rush with native hardstem bulrush. The distribution of both flowering rush and hardstem bulrush was unchanged from 2010 to 2011. Flowering rush is invading areas with native plants and not establishing in unvegetated areas. Although flowering rush is found as deep as 4.5 m, it is most frequent at a depth of 1.3 m. We also examined the distribution of biomass and growth across a depth gradient from 0.3 to 3.0 m in 0.3-m intervals. At each 0.3-m interval, three biomass samples were collected at each of 10 transects for a total of 30 samples per depth interval or 300 biomass samples. At each point, leaf height, emergent leaf height, water depth, number of ramets, and number of rhizome buds were counted. Biomass samples were collected in a 0.018-m2 core sampler, sorted to shoots and belowground biomass. We found that flowering rush height and biomass peaked at 1.3 m and declined with greater depth. Bud density was negatively related to water depth. Bud density averaged 300 buds m–2, which was three times the average ramet density (100 ramets m–2).

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa, with its first cases documented in March 2014, has claimed the lives of thousands of people, and it has devastated the health care infrastructure and workforce in affected countries. Throughout this outbreak, there has been a critical lack of health care workers (HCW), including physicians, nurses, and other essential non-clinical staff, who have been needed, in most of the affected countries, to support the medical response to EVD, to attend to the health care needs of the population overall, and to be trained effectively in infection protection and control. This lack of sufficient and qualified HCW is due in large part to three factors: 1) limited HCW staff prior to the outbreak, 2) disproportionate illness and death among HCWs caused by EVD directly, and 3) valid concerns about personal safety among international HCWs who are considering responding to the affected areas. These guidelines are meant to inform institutions who deploy professional HCWs. (Disaster Med Public Health Preparedness. 2015;9:586–590)

More than 60 GRBs at z ≳ 1.5 reside in the vicinity of dense, cold gas as probed by the measured neutral hydrogen via afterglow absorption spectroscopy. We present the largest sample of GRB-DLAs to date in comparison with a sample of DLAs along quasars: the metallicity of the GRB hosts represents a unique tool to understand if this particular subset of galaxies can be the key ingredient for GRB formation (and massive stars) at any redshift as well as the overall cosmic star-formation rate. We show that GRB-DLAs live in a metal enriched environment, especially at z ≳ 4, likely the result of recent intense star formation and/or SNe episodes. We also derive that our metallicity measurements are broadly consistent with a mild metallicity bias for the GRB formation.

The current Ebola outbreak is the worst global public health emergency of our generation, and our global health care community must and will rise to serve those affected. Aid organizations participating in the Ebola response must carefully plan to carry out their responsibility to ensure the health, safety, and security of their responders. At the same time, individual health care workers and their employers must evaluate the ability of an aid organization to protect its workers in the complex environment of this unheralded Ebola outbreak. We present a minimum set of operational standards developed by a consortium of Boston-based hospitals that a professional organization should have in place to ensure the health, safety, and security of its staff in response to the Ebola virus disease outbreak. (Disaster Med Public Health Preparedness. 2014;0:1-2)

Objectives: When incorporating treatment effect estimates derived from a random-effect meta-analysis it is tempting to use the confidence bounds to determine the potential range of treatment effect. However, prediction intervals reflect the potential effect of a technology rather than the more narrowly defined average treatment effect. Using a case study of robot-assisted radical prostatectomy, this study investigates the impact on a cost-utility analysis of using clinical effectiveness derived from random-effects meta-analyses presented as confidence bounds and prediction intervals, respectively.

Methods: To determine the cost-utility of robot-assisted prostatectomy, an economic model was developed. The clinical effectiveness of robot-assisted surgery compared with open and conventional laparoscopic surgery was estimated using meta-analysis of peer-reviewed publications. Assuming treatment effect would vary across studies due to both sampling variability and differences between surgical teams, random-effects meta-analysis was used to pool effect estimates.

Results: Using the confidence bounds approach the mean and median ICER was €24,193 and €26,731/QALY (95%CI: €13,752 to €68,861/QALY), respectively. The prediction interval approach produced an equivalent mean and median ICER of €26,920 and €26,643/QALY (95%CI: -€135,244 to €239,166/QALY), respectively. Using prediction intervals, there is a probability of 0.042 that robot-assisted surgery will result in a net reduction in QALYs.

Conclusions: Using prediction intervals rather than confidence bounds does not affect the point estimate of the treatment effect. In meta-analyses with significant heterogeneity, the use of prediction intervals will produce wider ranges of treatment effect, and hence result in greater uncertainty, but a better reflection of the effect of the technology.