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Use of ketamine in the prehospital setting may be advantageous due to its potent analgesic and sedative properties and favorable risk profile. Use in the military setting has demonstrated both efficacy and safety for pain relief. The purpose of this study was to assess ketamine training, use, and perceptions in the civilian setting among nationally certified paramedics (NRPs) in the United States.
A cross-sectional survey of NRPs was performed. The electronic questionnaire assessed paramedic training, authorization, use, and perceptions of ketamine. Included in the analysis were completed surveys of paramedics who held one or more state paramedic credentials, indicated “patient care provider” as their primary role, and worked in non-military settings. Descriptive statistics were calculated.
A total of 14,739 responses were obtained (response rate=23%), of which 10,737 (73%) met inclusion criteria and constituted the study cohort. Over one-half (53%) of paramedics reported learning about ketamine during their initial paramedic training. Meanwhile, 42% reported seeking ketamine-related education on their own. Of all respondents, only 33% (3,421/10,737) were authorized by protocol to use ketamine. Most commonly authorized uses included pain management (55%), rapid sequence intubation (RSI; 72%), and chemical restraint/sedation (72%). One-third of authorized providers (1,107/3,350) had never administered ketamine, with another 32% (1,070/3,350) having administered ketamine less than five times in their career. Ketamine was perceived to be safe and effective as the vast majority reported that they were comfortable with the use of ketamine (94%) and would, in similar situations (95%), use it again.
This was the first large, national survey to assess ketamine training, use, and perceptions among paramedics in the civilian prehospital setting. While training related to ketamine use was commonly reported among paramedics, few were authorized to administer the drug by their agency’s protocols. Of those authorized to use ketamine, most paramedics had limited experience administering the drug. Future research is needed to determine why the prevalence of ketamine use is low and to assess the safety and efficacy of ketamine use in the prehospital setting.
BucklandDM, CroweRP, CashRE, GondekS, MalusoP, SirajuddinS, SmithER, DangerfieldP, ShapiroG, WankaC, PanchalAR, SaraniB. Ketamine in the Prehospital Environment: A National Survey of Paramedics in the United States. Prehosp Disaster Med. 2018;33(1):23–28.
We present the results from mid-infrared spectro-polarimetric observations of a number of bi-polar outflow sources. The specto-polarimetric data provides information on the polarization mechanism and the magnetic field direction. The field direction in the disks of the observed sources is most often normal to the ambient field direction and lies in the plane of the disk, indicating a toroidal rather than poloidal field configuration.
We previously reported an association between 5HTTLPR genotype and
outcome following cognitive–behavioural therapy (CBT) in child anxiety
(Cohort 1). Children homozygous for the low-expression short-allele
showed more positive outcomes. Other similar studies have produced mixed
results, with most reporting no association between genotype and CBT
To replicate the association between 5HTTLPR and CBT outcome in child
anxiety from the Genes for Treatment study (GxT Cohort 2,
n = 829).
Logistic and linear mixed effects models were used to examine the
relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both
cohorts were performed.
There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2.
Mega-analyses identified a significant association between 5HTTLPR and
remission from all anxiety disorders at follow-up (odds ratio 0.45,
P = 0.014), but not primary anxiety disorder
The association between 5HTTLPR genotype and CBT outcome did not
replicate. Short-allele homozygotes showed more positive treatment
outcomes, but with small, non-significant effects. Future studies would
benefit from utilising whole genome approaches and large, homogenous
The aim of this study was to examine whether people differed in change in performance across the first five blocks of an online flanker task and whether those trajectories of change were associated with self-reported aerobic or resistance exercise frequency according to age. A total of 8752 men and women aged 13–89 completed a lifestyle survey and five 45-s games (each game was a block of ~46 trials) of an online flanker task. Accuracy of the congruent and incongruent flanker stimuli was analyzed using latent class and growth curve modeling adjusting for time between blocks, whether the blocks occurred on the same or different days, education, smoking, sleep, caffeinated coffee and tea use, and Lumosity training status (“free play” or part of a “daily brain workout”). Aerobic and resistance exercise were unrelated to first block accuracies. For the more cognitively demanding incongruent flanker stimuli, aerobic activity was positively related to the linear increase in accuracy [B=0.577%, 95% confidence interval (CI), 0.112 to 1.25 per day above the weekly mean of 2.8 days] and inversely related to the quadratic deceleration of accuracy gains (B=−0.619% CI, −1.117 to −0.121 per day). An interaction of aerobic activity with age indicated that active participants younger than age 45 had a larger linear increase and a smaller quadratic deceleration compared to other participants. Age moderates the association between self-reported aerobic, but not self-reported resistance, exercise and changes in cognitive control that occur with practice during incongruent presentations across five blocks of a 45-s online, flanker task. (JINS, 2015, 21, 802–815)
A novel approach to fabricate CuIn(S,Se)2 (CIS) thin films through ultrasonically spraying a hydrazine-based precursor solution onto a heated substrate is reported. The effects of the composition of the precursor solutions and the deposition temperature on the CIS film properties were investigated by comparing thin films fabricated using aqueous metal salt solution, anhydrous hydrazine solution, and hydrazine hydrate solution at various deposition temperatures. Crystallite size and texture coefficient in the preferred (112) orientation in the sprayed films increased when the aqueous solution was replaced by hydrazine-based solutions. Additionally, the hydrazine-based precursor solutions resulted in films with better surface smoothness and compositional uniformity than those fabricated using water-based solutions and the hydrazine hydrate solution resulting in the smoothest, most uniform films. The sprayed films were used to fabricate preliminary solar cells that demonstrated a modest photovoltaic response. With optimization, the synthesis of high-quality CIS films by spray pyrolysis from a hydrazine hydrate solution could demonstrate the potential for a low-cost, high-throughput manufacturing process.
Background: Individuals with bipolar disorder often endorse dysfunctional beliefs consistent with cognitive models of bipolar disorder (Beck, 1976; Mansell, 2007). Aims: The present study sought to assess whether young adult offspring of those with bipolar disorder would also endorse these beliefs, independent of their own mood episode history. Method: Participants (N = 89) were young adult college students with a parent with bipolar disorder (n = 27), major depressive disorder (MDD; n = 30), or no mood disorder (n = 32). Semi-structured interviews of the offspring were used to assess diagnoses. Dysfunctional beliefs related to Beck and colleagues’ (2006) and Mansell's (2007) cognitive models were assessed. Results: Unlike offspring of parents with MDD or no mood disorder, those with a parent with bipolar disorder endorsed significantly more dysfunctional cognitions associated with extreme appraisal of mood states, even after controlling for their own mood diagnosis. Once affected by a bipolar or depressive disorder, offspring endorsed dysfunctional cognitions across measures. Conclusions: Dysfunctional cognitions, particularly those related to appraisals of mood states and their potential consequences, are evident in young adults with a parent who has bipolar disorder and may represent targets for psychotherapeutic intervention.
Partitioning during rapid solidification of dilute Al-Ge alloys has been investigated. Implanted thin films of Al have been pulsed-laser melted to obtain solidification at velocities in the range of 0.01 m/s to 3.3 m/s, as measured by the transient conductance technique. Previous and subsequent Rutherford Backscattering depth profiling of the Ge solute in the Al alloys has been used to determine the nonequilibrium partition coefficient k. A significant degree of lateral film growth during solidification confines determination of k to the placing of an upper bound of 0.22 on k for solidification velocities in this range. We place a lower limit of 10m/s on the “diffusive velocity,” which locates the transition from solute paritioning to solute trapping in the Continuous Growth Model.
The congruent melting point, or To curve, of crystalline Si-As alloys has been measured in the range of 1.6 to 18.1 at. % arsenic by line source electron beam annealing. Alloys were created by ion implantation of As into 0.1mm Si-on-sapphire and crystallized by pulsed laser melting. To temperatures decrease from 1673±10K at 2.0 at.% As to 1516±30K at 18.1 at.% As. The results of these measurements are significantly higher than the previous results of studies using pulsed laser melting techniques. Advantages of the e-beam technique over previous techniques are discussed. Chemical free energy functions of the solid and liquid phases were calculated from existing thermodynamic data. The calculated To curve agrees with the measured values only in low concentration region (less than 8 at.%).
We have performed nanosecond-resolution measurements of the lateral electrical resistivity of thin metal films on insulating substrates. Comparison of transient resistivity measurements with optical reflectivity measurements and heat-flow calculations permits the determination of the position and velocity of a planar crystal/melt interface, and an estimate of undercooling during pulsed laser melting of metals. We report detailed results for rapid solidification of Ni, including the observation of hypercooling of .liquid Ni.
Many of the advances in rapid solidification processing of metallic alloys exploit the trapping of solute which occurs at high solidification velocities. The difficulty of performing experiments which measure such high solidification velocities in metals has until now prevented accurate measurements of solute trapping in these systems. We have observed the transition from near-equilibrium solute partitioning to solute trapping during solidification at m/s velocities in aluminum alloys, and have compared the predictions of various solute trapping models. Aluminum thin films deposited on insulators were ion-implanted with Sn, Cu, Ge, and In, and were pulsed-laser melted; plane-front solidification was achieved, and regrowth velocities of 0.6 m/s to 5 m/s were measured with the transient conductance technique. Of the existing solute trapping models, the Continuous Growth Model of Aziz was found to fit the observed dependence of the partition coefficient on solidification velocity more closely than any other single-parameter model. The diffusive speed, which locates the transition from solute partitioning to solute trapping, was found to vary from 6 m/s to 38 m/s for various solutes in aluminum. We have examined correlations between the diffusive speed in the Continuous Growth Model and known alloy properties in order to allow better estimates of the diffusive speed to be made for alloy systems in which it has not been measured; the relation between the diffusive speed and the equilibrium partition coefficient will be discussed.
Co-deposition of copper-palladium alloy films was demonstrated using low-pressure CVD from individual precursors - (hexafluoroacetylacetonato)copper(I)(vinyltrimethylsilane) [(hfac)Cu(I)vtms] and palladium(II)bis(hexafluoroacetylacetonate) [Pd(hfac)2], for Cu and Pd respectively. High-purity alloy films with controlled composition, microstructure and morphology were prepared and their oxidation behavior was examined at different temperatures and compared with that of pure copper CVD films with similar morphology. As-deposited copper-palladium alloy films showed improved resistance to oxidation up to 300°C in air. Enhanced oxidation resistance compared to Cu CVD films was observed at concentrations of palladium as low as 0.5 at. %.
At the high growth rates accessible during pulsed-laser induced melting and
solidification and explosive crystallization, crystal growth kinetics are
dominated not by equilibrium thermodynamics, but by the atomistic mechanisms
by which crystallization proceeds. These Mechanisms can be probed by testing
the predictions of solute trapping models based on various crystal/Melt
interface structures against Measurements. We have measured the dependence
of solute trapping of several group III, IV, and V elements in silicon on
both interface orientation and crystallization speed. The Aperiodic Stepwise
Growth Model of Goldman and Aziz accurately fits both the velocity and
orientation dependence of the solute trapping observed in these systems. The
success of the model implies a ledge structure for the crystal/Melt
interface and a step-flow mechanism for crystal growth. In addition, we have
observed an empirical inverse correlation between the two free parameters
(“diffusive speeds”) in this model and the equilibrium solute partition
coefficient of a system. This correlation may be used to estimate values of
the diffusive speeds for other systems in which solute trapping has not been
or cannot be Measured.
The paper is built around a nonexhaustive review of the literature on the role of grain boundaries in reactive phase formation. Examples are chosen to illustrate these effects in silicide and oxide growths, and later on in metal-metal interactions. A short section deals with the effect of grain boundaries and grain boundary adsorption of impurities on the kinetics of growth and on the morphology of the growing layer. Some attempts at understanding the mechanisms of phase growth from the tracking of isotopes are briefly analyzed.