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Introduction: Aeromedical helicopters and fixed wing aircraft are used across Canada to transfer patients to definitive care. Given height limitation in aeromedical transport, CPR performance can be affected. An adapted manual compression technique has been proposed by H. Koch (pron. Cook) that uses the elbow to compress the sternum rather than the conventional hand. This preliminary study evaluated the quality of Koch compressions versus conventional bimanual compressions. Methods: Paramedics (5), registered nurses (3) and a physician (1) were recruited. Each participant performed a 2 minute cycle of each technique, were randomized to determine which technique was performed first, and rested 5 minutes between compression cycles. A Resusci Anne SkillReporter manikin atop a stretcher in a BK117 helicopter was used. The compressors performed without feedback or prompting. Outcomes include compression rate, depth, recoil, and fatigue. Results: The mean conventional compression rate was (bpm) 118 +/− 13 versus 111 +/− 10 in the Koch scenario (p=0.02) (target 100 to 120). Mean conventional compression depth (mm) was 44 +/− 9 versus 49 +/− 7 in the Koch scenario (p=0.01) (target 50 to 60). The mean percentage of compressions with complete release in the conventional scenario was 86 +/− 20 versus 84 +/− 22 in the Koch scenario (p=0.9) (target 100%). Using a Modified Borg Scale of 1 to 10, mean provider fatigue after conventional CPR was 7 (+/− 1.6) versus 3 (+/− 1.2) using Koch technique (p<0.001). On average, Koch technique improved the percentage of compressions at target rate by 26%, the percentage at correct depth by 9%, overall compression quality score by 13% and were more less fatiguing. Conclusion: Using an elbow in a height-restricted environment improved compression depth and reduced provider fatigue. From our limited data, Koch compressions appear to improve compression quality. Further study and external validation are required.
The frequency dependence of normal pulsar radio emission is typically observed to be a power law, with some indications of a flattening or turnover at low frequencies (≲ 100 MHz). The spectrum of the Crab pulsar’s giant pulse emission has not been examined as closely. We conducted simultaneous wideband observations of the Crab pulsar, with the Parkes radio telescope and the Murchison Widefield Array, to study the spectral behaviour of its giant pulses. Our analysis shows that the mean spectral index of Crab giant pulses flattens at low frequencies, from −2.6 ± 0.5 between the Parkes bands, to −0.7 ± 1.4 between the lowest MWA subbands.
Deficits in social cognition may be among the most profound and disabling sequelae of paediatric traumatic brain injury (TBI); however, the neuroanatomical correlates of longitudinal outcomes in this domain remain unexplored. This study aimed to characterize social cognitive outcomes longitudinally after paediatric TBI, and to evaluate the use of sub-acute diffusion tensor imaging (DTI) to predict these outcomes.
The sample included 52 children with mild complex-severe TBI who were assessed on cognitive theory of mind (ToM), pragmatic language and affective ToM at 6- and 24-months post-injury. For comparison, 43 typically developing controls (TDCs) of similar age and sex were recruited. DTI data were acquired sub-acutely (mean = 5.5 weeks post-injury) in a subset of 65 children (TBI = 35; TDC = 30) to evaluate longitudinal prospective relationships between white matter microstructure assessed using Tract-Based Spatial Statistics and social cognitive outcomes.
Whole brain voxel-wise analysis revealed significantly higher mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) in the sub-acute TBI group compared with TDC, with differences observed predominantly in the splenium of the corpus callosum (sCC), sagittal stratum (SS), dorsal cingulum (DC), uncinate fasciculus (UF) and middle and superior cerebellar peduncles (MCP & SCP, respectively). Relative to TDCs, children with TBI showed poorer cognitive ToM, affective ToM and pragmatic language at 6-months post-insult, and those deficits were related to abnormal diffusivity of the sCC, SS, DC, UF, MCP and SCP. Moreover, children with TBI showed poorer affective ToM and pragmatic language at 24-months post-injury, and those outcomes were predicted by sub-acute alterations in diffusivity of the DC and MCP.
Abnormal microstructure within frontal-temporal, limbic and cerebro-cerebellar white matter may be a risk factor for long-term social difficulties observed in children with TBI. DTI may have potential to unlock early prognostic markers of long-term social outcomes.
The association between harmful use of alcohol and HIV infection is well documented. To address this dual epidemic, the US President's Emergency Plan for AIDS Relief (PEPFAR) developed and implemented a multi-pronged approach primarily in Namibia and Botswana. We present the approach and preliminary results of the public health investigative and programmatic activities designed, initiated and supported by PEPFAR to combat the harmful use of alcohol and its association as a driver of HIV morbidity and mortality from 2008 to 2013.
PEPFAR supported comprehensive alcohol programming using a matrix model approach that combined the socio-ecological framework and the Alcohol Misuse Prevention and Intervention Continuum. This structure enabled seven component objectives: (1) to quantify harmful use of alcohol through rapid assessments; (2) to develop and evaluate alcohol-based interventions; (3) to promote screening programs and alcohol abuse resource services; (4) to support stakeholder networks; (5) to support policy interventions and (6) structural interventions; and (7) to institutionalize universal prevention messages.
Targeted PEPFAR support for alcohol activities resulted in several projects to address harmful alcohol use and HIV. Components are graphically conceptualized within the matrix model, demonstrating the intersections between primary, secondary and tertiary prevention activities and individual, interpersonal, community, and societal factors. Key initiative successes included leveraging alcohol harm prevention activities that enabled projects to be piloted in healthcare settings, schools, communities, and alcohol outlets. Primary challenges included the complexity of multi-sectorial programming, varying degrees of political will, and difficulties monitoring outcomes over the short duration of the program.
The frequency of full syndromal and subsyndromal delirium is understudied.
We conducted a point prevalence study in a general hospital.
Possible delirium identified by testing for inattention was evaluated regarding delirium status (full/subsyndromal delirium) using categorical (Confusion Assessment Method (CAM), DSM-IV) and dimensional (Delirium Rating Scale-Revised-98 (DRS-R98) scores) methods.
In total 162 of 311 patients (52%) screened positive for inattention. Delirium was diagnosed in 55 patients (17.7%) using DSM-IV, 52 (16.7%) using CAM and 58 (18.6%) using DRS-R98⩾12 with concordance for 38 (12.2%) individuals. Subsyndromal delirium was identified in 24 patients (7.7%) using a DRS-R98 score of 7–11 and 41 (13.2%) using 2/4 CAM criteria. Subsyndromal delirium with inattention (v. without) had greater disturbance of multiple delirium symptoms.
The point prevalence of delirium and subsyndromal delirium was 25%. There was modest concordance between DRS-R98, DSM-IV and CAM delirium diagnoses. Inattention should be central to subsyndromal delirium definitions.
Iron oxides resulting from the corrosion of large quantities of steel that are planned to be installed throughout a deep geological disposal facility (GDF) are expected to be one of the key surfaces of interest for controlling radionuclide behaviour under disposal conditions. Over the lengthy timescales associated with a GDF, the system is expected to become anoxic so that reduced Fe(II) phases will dominate. Batch experiments have therefore been completed in order to investigate how a model reduced Fe-oxide surface (wüstite, Fe1–xO) alters as a function of exposure to aqueous solutions with compositions representative of conditions expected within a GDF. Additional experiments were performed to constrain the effect that highly alkaline solutions (up to pH 13) have on the adsorption behaviour of the uranyl (UO22+) ion onto the surfaces of both wüstite and portlandite [Ca(OH)2; representative of the expected cementitious phases]. Surface co-ordination chemistry and speciation were determined by ex situ X-ray absorption spectroscopy measurements (both X-ray absorption near-edge structure analysis (XANES) and extended X-ray absorption fine structure analysis (EXAFS)). Diffraction, elemental analysis and XANES showed that the bulk solid composition and Fe oxidation state remained relatively unaltered over the time frame of these experiments (120 h), although under alkaline conditions possible surface hydroxylation is observed, due presumably to the formation of surface hydroxyl complexes. The surface morphology, however, is altered significantly with a large degree of roughening and an observed decrease in the average particle size. Reduction of U(VI) to U(IV) occurs during adsorption in almost all cases and this is interpreted to indicate that wüstite may be an effective reductant of U during surface adsorption. This work also shows that increasing the carbonate concentration in reactant solutions dramatically decreases the adsorption coefficients for U on both wüstite and portlandite, consistent with U speciation and surface reactivity determined in other studies. Finally, the EXAFS results include new details about exactly how U bonds to this metal oxide surface.
Given the finite nature of global phosphorus (P) resources, there is an increasing concern about balancing agronomic and environmental impacts from P usage on dairy farms. Data from a 3-year (2009–2011) survey were used to assess farm-gate P balances and P use efficiency (PUE) on 21 intensive grass-based dairy farms operating under the good agricultural practice (GAP) regulations in Ireland. Mean stocking rate (SR) was 2·06 livestock units (LU)/ha, mean P surplus was 5·09 kg/ha, or 0·004 kg P/kg milk solids (MS), and mean PUE was 0·70. Phosphorus imports were dominated by inorganic fertilizer (7·61 kg P/ha) and feeds (7·62 kg P/ha), while exports were dominated by milk (6·66 kg P/ha) and livestock (5·10 kg P/ha). Comparison to similar studies carried out before the introduction of the GAP regulations in 2006 indicated that P surplus, both per ha and per kg MS, has significantly decreased (by 74 and 81%, respectively) and PUE increased (by 48%), mostly due to decreased inorganic fertilizer P import and improvements in P management. There has been a notable shift towards spring application of organic manures, indicating improved awareness of the fertilizer value of organic manures and good compliance with the GAP regulations regarding fertilizer application timing. These results suggested a positive impact of the GAP regulations on dairy farm P surplus and PUE, indicating an improvement in both environmental and economic sustainability of dairy production through improved resource use efficiencies. Such improvements will be necessary to achieve national targets of improved water quality and increased dairy production. Results suggest that optimizing fertilizer and feed P imports combined with improved on-farm P recycling are the most effective way to increase PUE. Equally, continued monitoring of soil test P (STP) and P management will be necessary to ensure that adequate soil P fertility is maintained. Mean P surplus was lower and PUE was much higher than the overall mean surplus (15·92 kg P/ha) and PUE (0·47) from three studies of continental and English dairy farms, largely due to the low import system that is more typical in Ireland, with seasonal milk production (compact spring calving), low use of imported feeds and high use of grazed grass.
There is increasing concern about balancing agronomic and environmental gains from nitrogen (N) usage on dairy farms. Data from a 3-year (2009–2011) survey were used to assess farm-gate N balances and N use efficiency (NUE) on 21 intensive grass-based dairy farms operating under the good agricultural practice (GAP) regulations in Ireland. Mean stocking rate (SR) was 2·06 livestock units (LU)/ha, mean N surplus was 175 kg/ha, or 0·28 kg N/kg milk solids (MS), and mean NUE was 0·23. Nitrogen inputs were dominated by inorganic fertilizer (186 kg N/ha) and concentrates (26·6 kg N/ha), whereas outputs were dominated by milk (40·2 kg N/ha) and livestock (12·8 kg N/ha). Comparison with similar studies carried out before the introduction of the GAP regulations in 2006 would suggest that N surplus, both per ha and per kg MS, have significantly decreased (by 40 and 32%, respectively) and NUE increased (by 27%), mostly due to decreased inorganic fertilizer N input and improvements in N management, with a notable shift towards spring application of organic manures, indicating improved awareness of the fertilizer value of organic manures and good compliance with the GAP regulations regarding fertilizer application timing. These results would suggest a positive impact of the GAP regulations on dairy farm N surplus and NUE, indicating an improvement in both environmental and economic sustainability of dairy production through improved resource-use efficiencies. Such improvements will be necessary to achieve national targets of improved water quality and increased efficiency/sustainability of the dairy industry. The weak impact of SR on N surplus found in the present study would suggest that, with good management, increased SR and milk output per ha may be achievable, while decreasing N surplus per ha. Mean N surplus was lower than the overall mean surplus (224 kg N/ha) from six studies of northern and continental European dairy farms, while mean NUE was similar, largely due to the low input/output system that is more typical in Ireland, with seasonal milk production (compact spring calving), low use of concentrates, imported feed and forages, high use of grazed grass and lower milk yields per ha.
Rapid and wide dispersal of passengers after flights makes investigation of flight-related outbreaks challenging. An outbreak of Salmonella Heidelberg was identified in a group of Irish travellers returning from Tanzania. Additional international cases sharing the same flight were identified. Our aim was to determine the source and potential vehicles of infection. Case-finding utilized information exchange using experts' communication networks and national surveillance systems. Demographic, clinical and food history information was collected. Twenty-five additional cases were identified from Ireland, The Netherlands, Norway, USA and Canada. We conducted a case-control study which indicated a significant association between illness and consumption of milk tart (OR 10·2) and an egg dish (OR 6) served on-board the flight. No food consumed before the flight was associated with illness. Cases from countries other than Ireland provided supplementary information that facilitated the identification of likely vehicles of infection. Timely, committed international collaboration is vital in such investigations.
Using longitudinal and prospective measures of psychotic experiences during adolescence, we assessed the risk of developing psychosis in three groups showing low, increasing and elevated psychotic experiences associated with bullying by peers and cannabis use in a UK sample of adolescents.
Data were collected by self-report from 1098 adolescents (mean age 13.6 years; 60.9% boys) at five separate time points, equally separated by 6 months, across a 24-month period. General growth mixture modelling identified three distinct trajectories of adolescents reporting psychotic experiences: elevated, increasing and low.
Controlling for cannabis use, bullying by peers significantly predicted change in psychotic experiences between Time 2 and Time 5 in adolescents belonging to the increasing group. No effect was found for the elevated or low groups. Controlling for bullying, an earlier age of cannabis use and cannabis use more than twice significantly predicted change in psychotic experiences in adolescents belonging to the increasing group. Cannabis use at any age was significantly associated with subsequent change in psychotic experiences in the low group. Reverse causal associations were examined and there was no evidence for psychotic experiences at Time 1 predicting a subsequent change in cannabis use between Times 2 and 5 in any trajectory group.
Bullying by peers and cannabis use are associated with adolescents' reports of increasing psychotic experiences over time. Further research into the longitudinal development of psychosis in adolescence and the associated risk factors would allow for early intervention programmes to be targeted more precisely.
By use of Kerr microscopy, the domain patterns of thin Fe films (10 nm) grown on Inx Ga1-x As (0.09 ≤ x ≤ 0.25)/GaAs substrates have been investigated. For This nvestigation, two types of InGaAs buffer layers were prepared. One consisted of a single, thick InGaAs layer and the second composed of an InGaAs strained layer superlattice. Both were grown on (100) GaAs substrates. The study showed that many of the domain walls were approximately parallel to the easy axis of Fe for those films grown on the low x alloy, e.g. x-0.1, InGaAs buffer layers. In the alloy films with larger values of x, e.g. x-0.2, the domain pattern of the Fe overlayer was strongly influenced by dislocations of the strain relieved InGaAs buffer layer. These dislocations manifested themselves as corrugations parallel to the <110> directions in the InGaAs. Kerr microscopy of a x-0.2 film indicated the presence of long, narrow domains with their long axes parallel to the striations. Although shape anisotropy arguments predicted that the magnetization should be parallel to the striations, magnetometer data indicated that a substantial component of magnetization was oriented perpendicular to the corrugations at low fields. The Fe film grown on the superlattice had magnetic domains very similar to a thick Fe film (0.5 μm) grown on GaAs.
Localized heating of metals and alloys using a focused laser beam in ambient atmosphere produces dielectric oxide layers that have characteristic optical appearances including different colors. Nanoindentation probed the deformation and fracture of laser-fabricated oxides on 304L stainless steel. Conductive nanoindentation measured electrical contact resistance (ECR) of the same colored oxides indicating a correlation between laser exposure, conductance during loading, current-voltage (I-V) behavior at constant load, and indentation response. Microscopy and X-ray diffraction examined the microstructure and chemical composition of the oxides. Combining techniques provides a unique approach for correlating mechanical behavior and the resulting performance of the films in conditions that cause wear.