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A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs.
Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices.
The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis.
This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.
We analyzed the impact of a fluoroquinolone patient safety initiative on the weekly fluoroquinolone prescription rate in Veterans Affairs community-based outpatient clinics. We observed a significant initial but unsustained reduction. Such an initiative can function as an antimicrobial stewardship intervention; however, strategies to promote sustainability should be explored.
Objectives: This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. Methods: Participants were children with traumatic brain injury (N=82; 8–13 years of age), arterial ischemic stroke (N=36; 6–16 years of age), and brain tumor (N=74; 9–18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children’s Version (TEA-Ch) subtests: Creature Counting, Walk-Don’t-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. Results: As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. Conclusions: Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529–538)
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
The compound interferometer at Fleurs, N.S.W., consists of the separate arms of the Christiansen grating interferometer with the addition of two 45-ft dishes to each to give maximum spacings of 3710λ at 1415 MHz. The closest physical spacing is 60 ft and the spacings progress at 40-ft intervals to a maximum of 2580 ft as shown in Figure 1.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
A survey of Ingleborough was undertaken by RCHME in the summer of 1988 at the request of the Yorkshire Dales National Park who are concerned by the considerable erosion and damage occurring on the Peak as a result of the popularity of the Three Peaks footpath. This is affecting not only the natural surface of the hill but also the archaeological remains.
The summit of Ingleborough, one of the Three Peaks of the Yorkshire Dales, is a gritstone cap overlying the sandstone, shale and limestone beds of the Yoredale Series which, in turn, overlie the Great Scar Limestone. This formation gives Ingleborough its distinctive stepped profile, created by differential weathering, except where glacial drift forms smoother slopes on the flanks (Crutchley 1981, 41–44). The coarse gritstone forms a roughly triangular, plateau-like summit with only a slight rise from the rim to the highest point, at 723 m OD, now occupied by a triangulation pillar and cruciform walkers's shelter.
Major depression is associated with abnormalities in the function and structure of the hippocampus. However, it is unclear whether these abnormalities might also be present in people ‘at risk’ of illness.
We studied 62 young people (mean age 18.8 years) at familial risk of depression (FH+) but who had never been depressed themselves. Participants underwent magnetic resonance imaging to assess hippocampal structure and neural responses to a task designed to activate hippocampal memory networks. Magnetic resonance spectroscopy was used to measure levels of a combination of glutamine and glutamate (Glx) in the right hippocampus. A total of 59 matched controls with no history of mood disorder in a first-degree relative underwent the same investigations.
Hippocampal volume did not differ between FH+ participants and controls; however, relative to controls, during the memory task, FH+ participants showed increased activation in brain regions encompassing the insular cortices, putamen and pallidum as well as the dorsal anterior cingulate cortex (ACC). FH+ participants also had increased hippocampal levels of Glx.
Euthymic individuals with a parental history of depression demonstrate increased activation of hippocampal-related neural networks during a memory task, particularly in brain regions involved in processing the salience of stimuli. Changes in the activity of the ACC replicate previous findings in FH+ participants using different psychological tasks; this suggests that task-related abnormalities in the ACC may be a marker of vulnerability to depression. Increased levels of Glx in the hippocampus might also represent a risk biomarker but follow-up studies will be required to test these various possibilities.
Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction.
Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures.
Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively, p < 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3, p < 0.001) and mean snoring severity scores (from 6.9 to 1.3, p < 0.001). Body mass index remained unchanged.
Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.
Obstructive sleep apnoea is a common condition that is unfortunately associated with a high rate of patient non-compliance regarding device use. Newer surgical interventions have focused on procedures at the palate level, using variants of palatoplasty and transpalatal advancement. However, the extent of tongue reduction surgery required remains controversial. The authors propose an in-between variant that combines midline glossectomy resection (with minimal mucosal sacrifice) and lateral coblation tongue channelling.
Four patients underwent a coblation-assisted Lewis and MacKay operation, which is a new technique for tongue reduction. This involved a midline glossectomy combined with lateral coblation channelling of the tongue, alone or as part of major airway reconstruction. Demographic, polysomnographic and quality of life questionnaire data were collected prospectively and analysed.
Results and conclusion:
No significant complications were noted in the four patients. (Results of the post-surgical outcomes are presented in another paper.) The coblation-assisted Lewis and MacKay operation reduced the potential complications of aggressive tongue surgery. The contours of the tongue were maintained, but significant reduction was still achieved.
PILOT (the Pathfinder for an International Large Optical Telescope) is a proposed 2.5-m optical/infrared telescope to be located at Dome C on the Antarctic plateau. Conditions at Dome C are known to be exceptional for astronomy. The seeing (above ∼30 m height), coherence time, and isoplanatic angle are all twice as good as at typical mid-latitude sites, while the water-vapour column, and the atmosphere and telescope thermal emission are all an order of magnitude better. These conditions enable a unique scientific capability for PILOT, which is addressed in this series of papers. The current paper presents an overview of the optical and instrumentation suite for PILOT and its expected performance, a summary of the key science goals and observational approach for the facility, a discussion of the synergies between the science goals for PILOT and other telescopes, and a discussion of the future of Antarctic astronomy. Paper II and Paper III present details of the science projects divided, respectively, between the distant Universe (i.e. studies of first light, and the assembly and evolution of structure) and the nearby Universe (i.e. studies of Local Group galaxies, the Milky Way, and the Solar System).
Past environmental changes based on diatom relative abundances have been inferred from the maar Lake Erlongwan in northeast China. The limnology of Lake Erlongwan is affected by the strongly seasonal regional climate. The composition of diatom assemblages, in turn, responds to changes in the seasonal duration of ice cover in winter, water-column turnover in spring and autumn, and thermal stratification in summer. Statistical analysis of the sedimentary diatom assemblages reveals three significant stratigraphic zones over the past 1000 yr. The highest abundance of the planktonic species Discostella species occurs between AD 1050 and 1400 and suggests an annual ice-free period of long duration and well-developed summer stratification of the water column. This planktonic diatom peak between ca. AD 1150 and 1200 suggests that this period was the warmest over the past 1000 yr. The interval between AD 1400 and 1800 is marked by a decline in planktonic diatoms and suggests shorter duration of the ice-free season, weaker water stratification and possibly generally cold conditions. After AD 1800 relative abundances of planktonic diatoms, including Puncticulata praetermissa and Asterionella formosa, increase again, which indicates lengthening of the duration of the annual ice-free period and a stronger overturn of the water column. All these data imply that the pattern of the seasons is different between the MWP and the 20th century.
We previously demonstrated that intra-uterine growth-restricted (IUGR) Yucatan miniature pigs develop modestly elevated blood pressure (BP) as young adults. The present study evaluated the effects of a post-weaning Western-style, high-salt-fat-sugar (HSFS) diet on early programming of BP. IUGR piglets (3 d old, 0·77 (sem 0·04) kg, n 6) were paired with normal weight (NW) same-sex littermates (1·14 (sem 0·03) kg, n 6) and fed milk replacer for 4 weeks. A third littermate was left with the sow (SF; 1·01 (sem 0·05) kg, n 6). When 4 weeks old, all pigs were placed on a HSFS diet ad libitum for 5 h/d. When 11 months old, telemeters were implanted to measure BP in pigs before (4·5 % NaCl) and after (0·5 % NaCl) a 7 d reduced salt challenge. At necropsy, nephron numbers were determined. Before sexual maturity, IUGR pigs had greater relative feed intake (P < 0·05), and experienced catch-up growth with greater adiposity, with correlations between adiposity and BP (P < 0·05). Adult IUGR pigs had 26–34 % fewer nephrons and higher diastolic BP (107·7 (sem 4·9) mmHg, P = 0·044) than NW (97·2 (sem 1·8) mmHg) and SF (98·9 (sem 5·3) mmHg) pigs. Systolic BP was similar among the three groups, but was significantly elevated compared with levels previously reported for a control diet. Salt restriction reduced BP in all groups (P < 0·05), but with no differences (P>0·05) in the degree of salt sensitivity among groups. In conclusion, a post-weaning Western-style diet exacerbates early programming of diastolic BP in Yucatan miniature swine, whereas systolic BP is more sensitive to postnatal diet.
This study explores the consequences of structure on the electronic properties of magnetic multilayers. Epitaxial layers of Co and Cu are grown on Cu(100) in a new deposition system that couples sputter-deposition with MBE and contains a wide range of characterization tools, including RHEED, LEED, and Kerr effect. This system can be coupled in situ to spin-polarized, angle-resolved photoemission and to resonant, magnetic X-ray scattering, both employing synchrotron radiation. The interface structure turns out to be critical in determining the coercivity and the presence of quantum well states, which determine oscillatory magnetic coupling.
ZnO is known to produce a wide variety of nanostructures that have enormous scope for optoelectronic applications. Using an aqueous electrochemical deposition technique, we are able to tightly control a wide range of deposition parameters (Zn2+ concentration, temperature, potential, time) and hence the resulting deposit morphology. By simultaneously conducting synchrotron x-ray absorption spectroscopy (XAS) experiments during the deposition, we are able to directly monitor the growth rates of the nanostructures, as well as providing direct chemical speciation of the films. In situ experiments such as these are critical to understanding the nucleation and growth of such nanostructures.
Recent results from in situ XAS synchrotron experiments demonstrate the growth rates as a function of potential and Zn2+ concentration. These are compared with the electrochemical current density recorded during the deposition, and the final morphology revealed through ex situ high resolution electron microscopy. The results are indicative of two distinct growth regimes, and simultaneous changes in the morphology are observed.
These experiments are complemented by modelling the growth of the rods in the transport-limited case, using the Nernst-Planck equations in 2 dimensions, to yield the growth rate of the volume, length, and radius as a function of time.