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Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.
Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.
The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.
This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.
Using validated psychological assessment instruments, this study examined the psychological distress associated with potential language barriers experienced by over 135 000 Puerto Rican residents who either temporarily or permanently migrated to the continental United States with the landfall of Hurricane Maria in 2017.
Participants were Puerto Rican residents (n = 107) who remained in Puerto Rico (control) or left the island for at least 3 months because of Hurricane Maria (migrants). Participants completed an online survey in their preferred language (Spanish or English), which assessed self-reported English language proficiency, Kessler Psychological Distress Scale (K6), Posttraumatic Stress Disorder Checklist for DSM 5, Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. It was hypothesized that migrants with lower self-reported English proficiency would have comparatively higher indices of post-disaster distress than those with a higher proficiency.
Dividing the migrant group by preferred language for questionnaire completion, the Fisher’s exact test showed significant differences in prevalence of severe mental distress, as defined by K6 scores above 13, between the Spanish-preferring migrants (30.4%), English-preferring migrants (0%), and controls (9.6%).
Our results support a possible correlation between decreased language proficiency in post-disaster migrants and a higher risk factor for severe mental distress.
We have developed a novel strategy for elaborating composite plasmonic nanomaterials in a well controlled manner. Combining several techniques commonly used in microelectronic engineering, namely sputtering deposition, thermal oxidation, ultra low energy ion implantation, focused ion beam lithography, thermal or laser annealing, we have obtained 3D patterned optical layers. Their spatial and spectral responses take benefit of optical interference, plasmonic resonance effects and coupling between excitations in both near and far field regime. Moreover these structures show high level of uniformity, reproducibility and stability, and they preserve flat and chemically uniform surfaces.
X-ray powder diffraction (XRD) is widely used for qualitative analysis of the phases in multiphase mixtures. To extend the characterization to the level of quantitative analysis (QA) requires solution of many challenging problems such as elimination of preferred orientation (1,2,3); selection of an appropriate reference standard which closely matches the analyte phase in crystallite size, thermal history, stoichiometry etc. (4); effectively collecting the experimental intensities (5,6); and finally, performing the data reduction and analysis.
The desire to solve the last problem in a general way and to incorporate the “best” procedures developed in several laboratories into one package was one of the stimuli for developing the NBS*QUANT82 system of programs. This system is integrally coupled with the data collection system AUTO (6,7).
The purpose of this paper is to record some progress on the problem of determining which (bounded, linear) operators A on a separable Hilbert space H are commutators, in the sense that there exist bounded operators B and C on H satisfying A = BC — CB. It is thus natural to consider this paper as a continuation of the sequence (2; 3; 5). In §2 we show that many infinite diagonal matrices (with scalar entries) are commutators and that every weighted unilateral and bilateral shift is a commutator.
Taphonomic factors may significantly alter faunal assemblages at varying scales. An exceptional record of late Holocene (<4000 yr old) mammal faunas establishes a firm baseline to investigate the effects of scale on taphonomy. Our sample contains 73 sites within four contiguous states (North Dakota, South Dakota, Iowa, and Illinois, USA) that transect a strong modern and late Holocene environmental gradient, the prairie–forest ecotone. We performed detrended correspondence (DCA) and non-metric multidimensional scaling (NMDS) analyses. Both DCA and NMDS analyses of the data sets produced virtually the same results, and both failed to reveal the known ecological gradient within each state. However, both DCA and NMDS analyses of the unfiltered multistate data set across the entire gradient clearly reflect an environmental, rather than taphonomic, signal. DCA tended to provide better separation of some clusters than did NMDS in most of the analyses. We conclude that a robust mammal data set collected across a strong environmental gradient will document species turnover without the removal of taphonomic factors. In other words, taphonomy exhibits varying scale-dependent effects.
Yawing wind turbines has emerged as an appealing method for wake deflection. However, the associated flow properties, including the magnitude of the transverse velocity associated with yawed turbines, are not fully understood. In this paper, we view a yawed turbine as a lifting surface with an elliptic distribution of transverse lift. Prandtl’s lifting line theory provides predictions for the transverse velocity and magnitude of the shed counter-rotating vortex pair known to form downstream of the yawed turbine. The streamwise velocity deficit behind the turbine can then be obtained using classical momentum theory. This new model for the near-disk inviscid region of the flow is compared to numerical simulations and found to yield more accurate predictions of the initial transverse velocity and wake skewness angle than existing models. We use these predictions as initial conditions in a wake model of the downstream evolution of the turbulent wake flow and compare predicted wake deflection with measurements from wind tunnel experiments.
We present a critical reanalysis of the black-hole binary coalescences detected during LIGO’s first observing run under different Bayesian prior assumptions. We summarize the main findings of Vitale et al. (2017) and show additional marginalized posterior distributions for some of the binaries’ intrinsic parameters.
These findings were presented at IAU Symposium 338, held on October 16-19, 2017 in Baton Rouge, LA, USA.
A numerical model for an interacting ice shelf and ocean is presented in which the ice- shelf base exhibits a channelized morphology similar to that observed beneath Petermann Gletscher’s (Greenland) floating ice shelf. Channels are initiated by irregularities in the ice along the grounding line and then enlarged by ocean melting. To a first approximation, spatially variable basal melting seaward of the grounding line acts as a steel-rule die or a stencil, imparting a channelized form to the ice base as it passes by. Ocean circulation in the region of high melt is inertial in the along-channel direction and geostrophically balanced in the transverse direction. Melt rates depend on the wavelength of imposed variations in ice thickness where it enters the shelf, with shorter wavelengths reducing overall melting. Petermann Gletscher’s narrow basal channels may therefore act to preserve the ice shelf against excessive melting. Overall melting in the model increases for a warming of the subsurface water. The same sensitivity holds for very slight cooling, but for cooling of a few tenths of a degree a reorganization of the spatial pattern of melting leads, surprisingly, to catastrophic thinning of the ice shelf 12 km from the grounding line. Subglacial discharge of fresh water along the grounding line increases overall melting. The eventual steady state depends on when discharge is initiated in the transient history of the ice, showing that multiple steady states of the coupled system exist in general.
We systematically compare methods used for topographical mapping of the archaeological site of Matacanela, located in the Tuxtla Mountains of Veracruz. Specifically, we compare the results of ArcMap 10.2–processed, publically accessible LiDAR-derived data, collected and distributed for no charge by the Instituto Nacional de Estadística y Geografía (INEGI) in Mexico–with the results of traditional topographical mapping, undertaken using a Sokkia total station. These INEGI data are coarse-grained in comparison to many of the pay-for-service LiDAR datasets that have been generated for Mesoamerican sites and regions, such as Caracol (Chase et al. 2011, 2012, 2014), Izapa (Rosenswig et al. 2013), and Tres Zapotes (Loughlin et al. 2016). Here, we consider the two approaches and the type and quality of data achieved by each, as well as the benefits and drawbacks of using either approach alone. We strongly encourage scholars working in Mexico to avail themselves of these data whenever appropriate.
High precision measurements of the celestial coordinates of pulsars are desirable for a number of reasons. If carried out at several epochs, the measurements can yield angular proper motions; together with distance estimates based on dispersion measure, the proper motion of a pulsar reveals two of three components of its space velocity, and consequently provides important kinematic information on pulsar ages (see, for example, Manchester, Taylor and Van 1974; Lyne, Anderson and Salter 1982; and references therein). Direct measurements of annual parallaxes are also possible in principle, and are marginally feasible with present techniques for a few of the closest pulsars. Model independent distances obtained from parallax measurements, together with observed pulsar dispersion measures, yield the electron density along the line of sight to the pulsar. Knowledge of the interstellar electron density in the solar neighborhood provides a calibration of the dispersion-based distance scale that is complementary to the calibration derived from neutral hydrogen absorption measurements of more distant pulsars (Weisberg et al. 1980), and permits appropriate statistical analyses to be made of the local space density of pulsars and their birthrate (e.g. Taylor and Manchester 1977). Finally, pulsar astrometry can be expected to yield important information on the relative orientations of fundamental reference frames. In particular, pulse timing observations yield positions in a reference frame based on motions of the planets, while interferometric position measurements are based on an Earth-equatorial system. At present the relative orientation of these two coordinate systems is known to only accuracy, though the potential precision of both types of measurements is much higher.
The strong water maser line at 22 GHz is an excellent tool for studying shocked and turbulent interstellar regions, especially, if simultaneous single-dish and VLBI data are available. After a brief review of 22 GHz time variation studies, we focus on effects caused by magnetic field pressure on observed properties of water masers. We use the powerful and rich maser cluster W49N as an example. Furthermore, we point out the connection between postshock wave damping and observed excess in single-dish flux density and line width.
Studies of H2O masers have demonstrated the power of VLBI techniques to measure relative positions with sufficient accuracy (∼ 10 μas) to determine proper motions and to estimate distances to maser sources throughout the Galaxy. The distance to four H2O masers have been determined, and the distance to the center of the Galaxy has been determined to be 7.1 ± 1.5 kpc from observations of the H2O masers in Sgr-B2. Proper motion distances for other H2O masers, and possibly for OH masers, may allow the determination of the fundamental parameters describing the size (Ro) and rotation rate (Θo) of the Galaxy with accuracies of better than 10%. Finally, the measurement of the proper motions of H2O masers in nearby galaxies (< 10 Mpc) is feasible and offers the possibility of direct calibration of the extragalactic distance scale.
We assess the runoff and surface mass balance (SMB) of the Greenland ice sheet in the Nuuk region (southwest) using output of two regional climate models (RCMs) evaluated by observations. The region encompasses six glaciers that drain into Godthåbsfjord. RCM data (1960–2012) are resampled to a high spatial resolution to include the narrow (relative to the native grid spacing) glacier trunks in the ice mask. Comparing RCM gridded results with automatic weather station (AWS) point measurements reveals that locally models can underestimate ablation and overestimate accumulation by up to tens of per cent. However, comparison with lake discharge indicates that modelled regional runoff totals are more accurate. Model results show that melt and runoff in the Nuuk region have doubled over the past two decades. Regional SMB attained negative values in recent high-melt years. Taking into account frontal ablation of the marine-terminating glaciers, the region lost 10–20 km3 w.e. a–1 in 2010–12. If 2010 melting prevails during the remainder of this century, a low-end estimate of sea-level rise of 5 mm is expected by 2100 from this relatively small section (2.6%) of the ice sheet alone.
To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).
A multicenter randomized trial.
In total,16 acute-care hospitals in northeastern Ohio participated in the study.
We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.
Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.
An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.
Intercultural cinema moves through space, gathering up histories and memories that are lost or covered over in the movement of displacement, and producing new knowledges out of the condition of being between cultures.
(Marks 2000: 78)
A brief, seemingly inconsequential encounter between two anthropomorphised objects – one red, the other blue – occurs in Albert Lamorrise's Le ballon rouge (The Red Balloon, 1956). That meeting, which has generally been overlooked by critics writing about this French classic of pre-New Wave cinema, occurs after the mid-point of the narrative, in the moments leading up to the film's initially tragic, eventually transcendent, ending. The camera, which has been tracking the street-to-street wanderings of a Parisian schoolboy named Pascal (who has befriended an inquisitive, mischievous balloon), suddenly pans from left to right to pick up the movement of a young girl and her own magically endowed balloon as they pass by the protagonist going in the opposite direction. Pascal turns on his feet and sees that his helium-filled companion has momentarily left him, drifting towards the other balloon much like it had sidled up to its own mirror-reflected image in an earlier scene set in an outdoor antiques market. The boy quickly fetches the red balloon by its string, an action that recalls his first encounter with it (climbing a streetlamp where it was stuck and descending with the thing in tow). Separated from its new ‘friend’, the girl's blue balloon pursues the red one, a paradoxically animated inanimate object whose mysterious driftings through Paris have thus far gone unexplained. Repeating Pascal's earlier action, the girl chases after her balloon, retrieving it and whisking it away, never to be seen again.
This strange convergence, where red and blue, boy and girl, action and reaction, come together in the calm interlude that precedes the film's penultimate scene (showing the titular object being chased and eventually destroyed by a gang of street urchins), stands out for a number of reasons. In addition to suggesting a ‘shadow movie’ of sorts, one that follows not the young boy and his red balloon but rather the young girl and her blue balloon (an alternative story tucked away in the folds of Lamorrise's film, one whose outcome can only be imagined by the spectator), this encounter materialises an otherwise immaterial idea.
This essay argues that Acts is essentially kerygmatic in its literary texture and purpose. It assumes that literary purpose, even genre to some extent, can be determined by examining how language is used in two respects: (1) through the authorial voice of the narrative, and (2) by the direct speech of characters within the story. This is especially the case when there is a strong convergence in the pattern of usage in the narrative voice and the dialogical voice. Three literary aspects are investigated: (1) kerygmatic vocabulary, (2) the speeches, and (3) the expression ὁ λόγος τοῦ θεοῦ/ὁ λόγος τοῦ κυρίου. The operative kerygmatic vocabulary in Acts is displayed in two appendices containing statistical information comparing Lukan usage with other NT writings.