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The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control.
School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm.
Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE.
After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population’s baseline knowledge of medical care, among others.
Meltwater from glaciers in the European Alps plays an important role in hydropower production, and future glacier development is thus of economic interest. However, an up-to-date and alpine-wide inventory for accurate assessment of glacier changes or modelling of future glacier development has not hitherto been available. Here we present a new alpine-wide inventory (covering Austria, France, Italy and Switzerland) derived from ten Landsat Thematic Mapper (TM) scenes acquired within 7 weeks in 2003. Combined with the globally available digital elevation model from the Shuttle Radar Topography Mission, topographic inventory parameters were derived for each of the 3770 mapped glaciers, covering 2050 km2. The area-class frequency distribution is very similar in all countries, and a mean northerly aspect (NW, N, NE) is clearly favoured (arithmetic counting). Mean glacier elevation is ~2900 m, with a small dependence on aspect. The total area loss since the previous glacier inventory (acquired around 1970±15 years) is roughly one-third, yielding a current area loss rate of ~2%a–1. Digital overlay of the outlines from the latest Austrian glacier inventory revealed differences in the interpretation of glacier extents that prohibit change assessment. A comparison of TM-derived outlines with manually digitized extents on a high-resolution IKONOS image returned 1.5% smaller glaciers with TM.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Glacier inventories provide the baseline data to perform climate-change impact assessment on a regional scale in a consistent and spatially representative manner. In particular, a more accurate calculation of the current and future contribution to global sea-level rise from heavily glacierized regions such as Alaska is much needed. We present a new glacier inventory for a large part of western Alaska (including Kenai Peninsula and the Tordrillo, Chigmit and Chugach mountains), derived from nine Landsat Thematic Mapper scenes acquired between 2005 and 2009 using well-established automated glacier-mapping techniques (band ratio). Because many glaciers are covered by optically thick debris or volcanic ash and partly calve intowater, outlineswere manually edited in these wrongly classified regions during post-processing. In total we mapped ~8830 glaciers (>0.02 km2) with a total area of ~16 250 km2. Large parts of the area (47%) are covered by a few (31) large (>100 km2) glaciers, while glaciers less than 1 km2 constitute only 7.5% of the total area but 86% of the total number. We found a strong dependence of mean glacier elevation on distance from the ocean and only a weak one on aspect. Glacier area changes were calculated for a subset of 347 selected glaciers by comparison with the Digital Line Graph outlines from the US Geological Survey. The overall shrinkage was ~23% between 1948–57 and 2005–09.
Deriving glacier outlines from satellite data has become increasingly popular in the past decade. In particular when glacier outlines are used as a base for change assessment, it is important to know how accurate they are. Calculating the accuracy correctly is challenging, as appropriate reference data (e.g. from higher-resolution sensors) are seldom available. Moreover, after the required manual correction of the raw outlines (e.g. for debris cover), such a comparison would only reveal the accuracy of the analyst rather than of the algorithm applied. Here we compare outlines for clean and debris-covered glaciers, as derived from single and multiple digitizing by different or the same analysts on very high- (1 m) and medium-resolution (30 m) remote-sensing data, against each other and to glacier outlines derived from automated classification of Landsat Thematic Mapper data. Results show a high variability in the interpretation of debris-covered glacier parts, largely independent of the spatial resolution (area differences were up to 30%), and an overall good agreement for clean ice with sufficient contrast to the surrounding terrain (differences ∼5%). The differences of the automatically derived outlines from a reference value are as small as the standard deviation of the manual digitizations from several analysts. Based on these results, we conclude that automated mapping of clean ice is preferable to manual digitization and recommend using the latter method only for required corrections of incorrectly mapped glacier parts (e.g. debris cover, shadow).
Observations show that glaciers around the world are in retreat and losing mass. Internationally coordinated for over a century, glacier monitoring activities provide an unprecedented dataset of glacier observations from ground, air and space. Glacier studies generally select specific parts of these datasets to obtain optimal assessments of the mass-balance data relating to the impact that glaciers exercise on global sea-level fluctuations or on regional runoff. In this study we provide an overview and analysis of the main observational datasets compiled by the World Glacier Monitoring Service (WGMS). The dataset on glacier front variations (∼42 000 since 1600) delivers clear evidence that centennial glacier retreat is a global phenomenon. Intermittent readvance periods at regional and decadal scale are normally restricted to a subsample of glaciers and have not come close to achieving the maximum positions of the Little Ice Age (or Holocene). Glaciological and geodetic observations (∼5200 since 1850) show that the rates of early 21st-century mass loss are without precedent on a global scale, at least for the time period observed and probably also for recorded history, as indicated also in reconstructions from written and illustrated documents. This strong imbalance implies that glaciers in many regions will very likely suffer further ice loss, even if climate remains stable.
Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31–17·45], male gender (aOR 1·74, 95% CI 1·06–2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03–0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01–4·09).
Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.
We use a WISE-2MASS-Pan-STARRS1 galaxy catalog to search for a supervoid in the direction of the Cosmic Microwave Background Cold Spot. We obtain photometric redshifts using our multicolor data set to create a tomographic map of the galaxy distribution. The radial density profile centred on the Cold Spot shows a large low density region, extending over 10's of degrees. Motivated by previous Cosmic Microwave Background results, we test for underdensities within two angular radii, 5°, and 15°. Our data, combined with an earlier measurement by Granett et al. 2010, are consistent with a large Rvoid=(192 ± 15)h−1 Mpc (2σ) supervoid with δ ≃ −0.13 ± 0.03 centered at z=0.22 ± 0.01. Such a supervoid, constituting a ∼3.5 σ fluctuation in the ΛCDM model, is a plausible cause for the Cold Spot.
Most of Southern California's wetlands have disappeared despite being critical ecosystems with many valuable attributes. Many of the wetlands that remain are in relatively urban areas, are severely degraded, and may not function properly. Using hedonic spatial error models, we measure the economic value of living near an urban multi-use wetland in Long Beach, California. Both sales prices and estimated values are used in the analysis. Results show that proximity to wetlands increases residential property values in the focus area. This analysis provides important information for policymakers to justify ongoing restoration projects and prevent further degradation of urbanized natural resources.
National health statistics report a 2·5-fold increase in laboratory-confirmed Chlamydia trachomatis (CT) cases over the last decade in Switzerland where no CT screening programme exists. We obtained essential denominator information to describe the epidemiology of CT in the canton of Basel-Stadt, an urban canton in north-western Switzerland. Laboratories reporting at least two CT infections from Basel-Stadt residents to the SFOPH in 2010 provided demographic and test-related data. CT positivity rates were calculated for 2002–2010. The influences of test year, age, sex and laboratory on CT positivity were investigated in a multivariable model. Positivity differed between sexes and age groups. In our sample of 32 034 records, female and male CT positivity rates were 4·7% and 11·1%, respectively. Test year was significantly associated with test outcome in the multivariable analysis but no time trend was observed. CT positivity did not change over the past 9 years in Basel-Stadt. In contrast to other European countries without CT screening, we found no evidence that the observed increase of Chlamydia cases in the national notification system represents an epidemiological trend, but rather results from an increased testing frequency.
Carrier concentration and mobility were measured for intrinsic cubic InN and GaN, and for Si-doped cubic GaN as a function of temperature. Metallic n-type conductivity was found for the InN, while background p-type conductivity was observed for the intrinsic GaN layer. Doping the cubic GaN with Si two regimes were observed. For low Si-doping concentrations, the samples remain p-type. Increasing the Si-doping level, the background acceptors are compensated and the samples became highly degenerated n-type. From the carrier concentration dependence on temperature, the activation energy of the donor and acceptor levels was determined. Attempts were made to determine the scattering mechanisms responsible for the behavior of the mobility as a function of temperature.
Anesthesia in disaster medicine, especially as practiced in developing countries, is fundamentally different from the anesthesia that is practiced during normal situations. Anesthetic procedures suitable for disaster situations must often take place under minimal conditions of instrumental availability and in a setting of less than modern technology. Such conditions, of course, limit the use of inhalatory anesthetics.
The key factor present in disaster situations is the disturbed relationship between the number of injured, on the one hand, and the available resources to treat them, on the other. This includes medical personnel—both professional and para-professional. This has been substantiated by the earthquakes in Iran, Guatemala, China and Turkey. The earthquake which occurred in Tabas, Iran in December 1978, for example, lasted only thirty seconds, but left behind more than 20,000 dead and countless thousands of injured.
We demonstrate improved compatibility of poly(ethylene dioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) hole transport layer with acid-sensitive materials by addition of a simple base, NaOH or NH4OH, to the aqueous suspension to increase pH. Addition of NaOH to the acidic PEDOT:PSS allowed the deposition of PEDOT:PSS on top of an inverted poly(3-hexylthiophene):ZnO nanoparticle blend hybrid photovoltaic device, and improved device performance due to preservation of the ZnO electron acceptor. To quantitatively investigate the impact of base addition to hole transport layer properties and device performance, we deposited PEDOT:PSS with different pH values on inverted poly(3-hexylthiophene):[6,6]-phenyl-C61-butyric acid methyl ester bulk heterojunction devices. We find that NaOH modification results in a substantial work function decrease and series resistance increase. In contrast, the volatile NH4OH leaves PEDOT:PSS with minimal changes in film properties and device performance.
The Lagrangian theory developed for fountains in a stationary fluid is extended to predict the path and breadth of a fountain in a one- and two-layer fluid with a moderate crossflow. The predictions compare well with the results of laboratory experiments of fountains in a one-layer fluid. The empirical spreading parameter determined from the one-layer experiments is used in the theory for fountains in a two-layer crossflow. Though qualitatively correct, the theory underpredicts the height and radius of the fountains. Similar to the behaviour of fountains in two-layer stationary ambients, the fountain in a two-layer crossflow is observed to exhibit three regimes of flow: it may penetrate the interface, eventually returning to the level of the source where it spreads as a propagating gravity current; upon descent, it may be trapped at the interface where it spreads as a propagating intrusion; it may do both, partially descending to the source and partially being trapped at the interface. These regimes are classified theoretically and empirically. The theoretical classification compared the buoyancy excess of the descending flow to the density difference between the two layers. The regimes are also classified using empirically determined regime parameters which govern the relative initial momentum of the fountain and the relative density difference of the fountain and the ambient fluid.
Fatty acid transport protein 6 (FATP6) is primarily expressed in the heart and seems to be involved in cardiac fatty acid uptake. Therefore, we investigated whether a variation in the 5′-untranslated region of the FATP6 gene is associated with features of the metabolic syndrome and signs of myocardial alteration or heart failure. A total of 755 male participants from a Metabolic Intervention Cohort Kiel were genotyped for the FATP6–7T>A polymorphism (rs2526246) and phenotyped for features of the metabolic syndrome. Participants underwent a glucose tolerance test and the postprandial assessment of metabolic variables after a standardised mixed meal. Left ventricular heart function was evaluated in fifty-four participants. Fasting (P = 0·01) and postprandial (P = 0·02) TAG concentrations were significantly lower in AA homozygotes when compared with wild-type carriers. Homozygosity of allele A was associated with significantly lower postprandial insulin concentrations after a glucose load and significantly lower systolic (P = 0·01) and diastolic (P = 0·01) blood pressure values compared with wild-type carriers. Accordingly, left ventricular heart mass was significantly lower in twenty-seven AA homozygotes in comparison with twenty-seven TT homozygotes, matched for BMI (P = 0·04). In conclusion, the effects of the FATP6 polymorphism on TAG are mediated by affluent dietary fat. The FATP6–7T>A polymorphism may protect from traits of the metabolic syndrome and CVD.