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Introduction: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED <48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.
Policy-critical, micro-level statistical data are often unavailable at the desired level of disaggregation. We present a Bayesian methodology for “downscaling” aggregated count data to the micro level, using an outside statistical sample. Our procedure combines numerical simulation with exact calculation of combinatorial probabilities. We motivate our approach with an application estimating the number of farms in a region, using count totals at higher levels of aggregation. In a simulation analysis over varying population sizes, we demonstrate both robustness to sampling variability and outperformance relative to maximum likelihood. Spatial considerations, implementation of “informative” priors, non-spatial classification problems, and best practices are discussed.
The egg parasitoid Trissolcus vassilievi (Mayr) (Hymenoptera: Scelionidae) is a significant natural enemy of the sunn pest, Eurygaster integriceps Puton (Hemiptera: Scutelleridae), the most important pest of wheat in Iran. This study examined the developmental time and egg-to-adult survival of two geographically separate populations of T. vassilievi on two corresponding host populations at five constant temperatures ranging from 15.0 to 35.0±1°C. No wasps of either population emerged at 15.0°C and the temperature threshold for development was similar between populations, ranging from 13.1±0.3 to 13.8±0.4°C for males and 12.2±0.1 to 12.6±0.1°C for females, but the thermal constant varied with gender and parasitoid population. Development of wasps from the colder Tabriz location was slower, with thermal constants for males and females of 172.6±3.1 and 204.1±1.2 degree-days, respectively, compared to Varamin wasps with 164.7±3.0 and 195.6±1.3 degree-days, respectively. Based on genetic inheritance patterns, reciprocal crosses between the two populations were expected to result in females with thermal phenotypes intermediate to their parental populations, and males that resembled their mothers. However, female progeny of crosses more closely resembled their maternal population, indicating a maternal effect on thermal phenotype. Furthermore, the magnitude of the maternal effect on the thermal constant was asymmetric and was more strongly expressed by Varmin than Tabriz females. These results suggest the possibility of using selective crosses between wasp populations, in combination with artificial selection in the laboratory, to tune the thermal phenotype of parasitoids to specific regions prior to augmentative releases.
The standard model of intertemporal choice assumes risk neutrality towards the length of life: under additivity of lifetime utility and expected utility assumptions, agents are not sensitive to a mean preserving spread in the length of life. Using a survey fielded in the RAND American Life Panel, this paper provides empirical evidence on possible deviation from risk neutrality with respect to longevity in the US population. The questions we ask allow to find the distribution as well as to quantify the degree of risk aversion with respect to the length of life in the population. We find evidence that roughly 75% of respondents were not neutral with respect to longevity risk. Hence, there is a little empirical support for the joint use of the expected utility and additive lifetime utility assumptions in life-cycle models. Higher income households are more likely to be risk averse towards the length of life. We do not find evidence that the degree of risk aversion varies with age or education.
Managed grasslands provide environmental and agronomic services that can be predicted from the botanical and functional composition of the vegetation. These are influenced by management, edaphic and climatic factors. The present report set out to estimate and analyse the relative importance of management, soil and climate factors on botanical and functional characteristics of grassland vegetation. A set of 178 French grasslands having a large pedoclimatic and management gradient was selected, and information collected on botanical composition, pedoclimatic factors and management. Six vegetation characteristics were considered: two botanical (floristic composition and species dominance) and four functional (proportion of entomophilous species, number of oligotrophic species, leaf dry matter content and date of flowering). First, the links between the characteristics of the vegetation were analysed to check for any redundancy among them; all were kept. Second, it was demonstrated that botanical and functional characteristics were not driven by the same factors: functional composition was characterized by management, edaphic and climatic factors, whereas botanical composition was influenced mainly by climatic and edaphic factors plus other factors. Interactions between factors also have to be taken into consideration to predict botanical and functional composition of grasslands. Functional and botanical characteristics of vegetation help to predict ecosystem services delivered by grasslands and may be used in combination.
New composite materials based on aluminosilicate materials were developed to be
used in orthopaedic or maxillo-facial surgery. They are called geopolymers or polysialate-siloxo (PSS) and were studied alone or mixed with hydroxyapatite (HAP). The properties of
these materials were investigated for potential use in biological or surgery applications. In this
work, the chemistry involved in materials preparation was described. Samples were
characterized by some physico-chemical methods like X-ray diffraction (XRD), infrared
spectrometry (IR) and electron dispersion X-ray spectrometry (EDX). Results indicate that the
mixing hydroxyapatite-geopolymer (PSS) leads to a neutral porous composite material with
interesting physico-chemical properties. A preliminary evaluation of its cytotoxicity reveals
an harmlessness towards fibroblasts. These properties allow to envisage this association as a