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Introduction: In the province of Québec, roughly 20% of the population lives in rural areas. Rural emergency departments (EDs) face different challenges than their urban counterparts. Yet, few studies have sought to understand these challenges. This study aims to survey Québec’s emergency physicians to: 1) identify problems specific to rural EDs, 2) find solutions for improving accessibility and quality of care offered in rural regions and, 3) rank solutions in order of priority. These results will allow data triangulation with other of our studies that seek to identify challenges faced by rural EDs and potential solutions. Methods: During the 2016 annual conference of the Québec Emergency Physicians’ Association, we asked physicians and residents (including those from urban EDs), to complete a survey about the challenges faced by rural EDs. The survey contained two sections. The first took the form of open-ended questions in which respondents could write three challenges about accessibility and quality of care in rural EDs (objective 1) and three solutions to address these challenges (objective 2). The second section listed 11 potential solutions identified in our previous study. The solutions were ranked based on their priority level on a five-point Likert scale that ranged from “not a priority” to “an absolute priority” (objective 3). We added the total number of points for each solution and produced a ranking list. Results: Ninety-one physicians out of the 417 at the conference completed the survey; 58% came from urban EDs and 42% from rural EDs. Open-ended questions suggest that access to specialists and interfacility transfers are the principal challenges faced by rural EDs. The top five solutions identified as the highest priorities were: 1) care protocols, 2) improvement of interfacility transfers, 3) training with simulators, 4) targeted ultrasound and, 5) implementation of staff retention and recruitment strategies. Conclusion: This study is relevant and useful as roughly a quarter of attendants at the conference spontaneously volunteered to help identify and prioritize solutions to foster the accessibility and quality of care in rural EDs. Furthermore, it represents a stepping stone for our recently-launched wide-scope study, Urgences Rurales 360, that aims to explore problems faced by every of the 28 rural EDs in Québec and the solutions that could be implemented to resolve them.
Young children are slow to master conventional intonation patterns in their yes/no questions, which may stem from imperfect understanding of the links between terminal pitch contours and pragmatic intentions. In Experiment 1, five- to ten-year-old children and adults were required to judge utterances as questions or statements on the basis of intonation alone. Children eight years of age or younger performed above chance levels but less accurately than adult listeners. To ascertain whether the verbal content of utterances interfered with young children's attention to the relevant acoustic cues, low-pass filtered versions of the same utterances were presented to children and adults in Experiment 2. Low-pass filtering reduced performance comparably for all age groups, perhaps because such filtering reduced the salience of critical pitch cues. Young children's difficulty in differentiating declarative questions from statements is not attributable to basic perceptual difficulties but rather to absent or unstable intonation categories.
In 2008, Granett et al. claimed a direct detection of the integrated Sachs-Wolfe (iSW) effect, through the stacking of CMB patches at the positions of identified superstructures. Additionally, the high amplitude of their measured signal was reported to be at odds with predictions from the standard model of cosmology. However, a closer inspection of these results prompts multiple questions, more specifically about the amplitude and significance of the expected signal. We propose here an original theoretical prediction of the iSW effect produced by such superstructures. We use simulations based on GR and the LTB metric to reproduce cosmic structures and predict their exact theoretical iSW effect on the CMB. The amplitudes predicted with this method are consistent with the signal measured when properly accounting the contribution of the non-negligible (and fortuitous) primordial CMB fluctuations to the total signal. It also highlights the tricky nature of stacking measurements and their interpretation.
Tidewater glaciers in Greenland experienced widespread retreat during the last century. Information on their behaviour prior to this is often poorly constrained due to lack of observations, while determining the drivers prior to instrumental records is also problematic. Here we present a record of the dynamics of Kangiata Nunaata Sermia (KNS), southwest Greenland, from its Little Ice Age maximum (LIAmax) to 1859 – the period before continuous air temperature observations began at Nuuk in 1866. Using glacial geomorphology, historical accounts, photographs and GIS analyses, we provide evidence KNS was at its LIAmax by 1761, had retreated by ~5 km by 1808 and a further 7 km by 1859. This predates retreat at Jakobshavn Isbræ by 43–113 years, demonstrating the asynchroneity of tidewater glacier terminus response following the LIA. We use a one-dimensional flowband model to determine the relative sensitivity of KNS to atmospheric and oceanic climate forcing. Results demonstrate that terminus forcing rather than surface mass balance drove the retreat. Modelled glacier sensitivity to submarine melt rates is also insufficient to explain the retreat observed. However, moderate increases in crevasse water depth, driving an increase in calving, are capable of causing terminus retreat of the observed magnitude and timing.
Nonsynthetic herbicides offer a potentially useful addition to the suite of weed management tools available to organic growers, but limited information is available to guide the optimal use of these products. The objectives of this research were to (1) evaluate the efficacy of clove oil– and vinegar-based herbicides on weeds across multiple states, and (2) assess the potential role of temperature, relative humidity (RH), and cloud cover in explaining inter-state variations in results. From 2006 to 2008, a total of 20 field trials were conducted in seven states using an identical protocol. Seeds of brown mustard were sown and herbicides applied to both mustard and emerged weeds when mustard reached the three- to four-leaf stage. Treatments included clove oil at 2.5, 5, 7.5, and 10% v/v concentrations at 54 L ha−1, and vinegar at 5, 10, 15, and 20% v/v concentrations at 107 L ha−1. Results varied widely across trials. In general, concentrations of at least 7.5% for clove oil and 15% for vinegar were needed for adequate control of mustard. Both products were more effective at suppressing mustard than Amaranthus spp. or common lambsquarters. Poor control was observed for annual grasses. No significant effects of cloud cover on the efficacy of either product were detected. In contrast, RH was positively correlated with control of brown mustard by both clove oil and vinegar with improved control at higher RH. Temperature had no detectable effect on the efficacy of clove oil, but higher temperatures improved control of brown mustard by vinegar.
Ten ice-sheet models are used to study sensitivity of the Greenland and Antarctic ice sheets to prescribed changes of surface mass balance, sub-ice-shelf melting and basal sliding. Results exhibit a large range in projected contributions to sea-level change. In most cases, the ice volume above flotation lost is linearly dependent on the strength of the forcing. Combinations of forcings can be closely approximated by linearly summing the contributions from single forcing experiments, suggesting that nonlinear feedbacks are modest. Our models indicate that Greenland is more sensitive than Antarctica to likely atmospheric changes in temperature and precipitation, while Antarctica is more sensitive to increased ice-shelf basal melting. An experiment approximating the Intergovernmental Panel on Climate Change’s RCP8.5 scenario produces additional first-century contributions to sea level of 22.3 and 8.1 cm from Greenland and Antarctica, respectively, with a range among models of 62 and 14 cm, respectively. By 200 years, projections increase to 53.2 and 26.7 cm, respectively, with ranges of 79 and 43 cm. Linear interpolation of the sensitivity results closely approximates these projections, revealing the relative contributions of the individual forcings on the combined volume change and suggesting that total ice-sheet response to complicated forcings over 200 years can be linearized.
The present work reports the covalent functionalization of single-walled carbon nanotubes (SWCNTs) by ferrocene derivatives with polyethyleneglycol linkers. A very clean initial sample was chosen to avoid any residual catalyst and carbon impurities. Functionalized SWCNTs (f-CNTs) are deposited on the surface of a glassy carbon electrode (GCE) and this modified electrode is used for oxidizing the cofactor NADH (dihydronicotinamide adenine dinucleotide) in the presence of diaphorase. A clear electrocatalytic effect is evidenced, which can only be attributed to the f-CNTs.
The growing number of spastic ataxia of Charlevoix-Saguenay (SACS) gene mutations reported worldwide has broadened the clinical phenotype of autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). The identification of Quebec ARSACS cases without two known SACS mutation led to the development of a multi-modal genomic strategy to uncover mutations in this large gene and explore phenotype variability.
Search for SACS mutations by combining various methods on 20 cases with a classical French-Canadian ARSACS phenotype without two mutations and a group of 104 sporadic or recessive spastic ataxia cases of unknown cause. Western blot on lymphoblast protein from cases with different genotypes was probed to establish if they still expressed sacsin.
A total of 12 mutations, including 7 novels, were uncovered in Quebec ARSACS cases. The screening of 104 spastic ataxia cases of unknown cause for 98 SACS mutations did not uncover carriers of two mutations. Compounds heterozygotes for one missense SACS mutation were found to minimally express sacsin.
The large number of SACS mutations present even in Quebec suggests that the size of the gene alone may explain the great genotypic diversity. This study does not support an expanding ARSACS phenotype in the French-Canadian population. Most mutations lead to loss of function, though phenotypic variability in other populations may reflect partial loss of function with preservation of some sacsin expression. Our results also highlight the challenge of SACS mutation screening and the necessity to develop new generation sequencing methods to ensure low cost complete gene sequencing.
Despite electrification, over 90% of rural households in certain areas of South Africa continue to depend on fuelwood, and this affects woody vegetation structure, with associated cascading effects on biodiversity within adjacent lands. To promote sustainable use, the interactions between anthropogenic and environmental factors affecting vegetation structure in savannahs need to be understood. Airborne light detection and ranging (LiDAR) data collected over 4758 ha were used to examine woody vegetation structure in five communal rangelands around 12 settlements in Bushbuckridge, a municipality in the Kruger to Canyons Biosphere Reserve (South Africa). The importance of underlying abiotic factors was evaluated by measuring size class distributions across catenas and using canonical correspondence analysis. Landscape position was significant in determining structure, indicating the importance of underlying biophysical factors. Differences in structure were settlement-specific, related to mean annual precipitation at one site, and human population density and intensity of use at the other four sites. Size class distributions of woody vegetation revealed human disturbance gradients around settlements. Intensity of use affected the amplitude, not the shape, of the size class distribution, suggesting the same height classes were being harvested across settlements, but amount harvested varied between settlements. Highly used rangelands result in a disappearance of disturbance gradients, leading to homogeneous patches of low woody cover around settlements with limited rehabilitation options. Reductions in disturbance gradients can serve as early warning indicators of woodland degradation, a useful tool in planning for conservation and sustainable development.
We have measured the glacier area changes in the central Southern Alps, New Zealand, between 1978 and 2002 and have compiled the 2002 glacier outlines using an image scene from the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER). Three automated classification methods were tested: (1) band ratio, (2) normalized-difference snow index and (3) supervised classification. The results were compared with the glacier outlines photo-interpreted from the ASTER data, and were further validated using GPS-aided field mapping of selected test glaciers. The ASTER 3/4 band ratio provided the best results. However, all the classification methods failed to extract extensive debris-covered parts of the glaciers. Therefore, the photo-interpreted 2002 outlines were used when comparing with the existing 1978 glacier inventory derived from aerial photographs. Our results show a ∼17% reduction of glacier area, mainly driven by the retreat of the large valley glaciers. Despite the large climatic gradient from west to east, glaciers on both sides of the Main Divide lost similar percentages of area, except Franz Josef and Fox Glaciers which advanced. Smaller glaciers were found to have changed very little in the study period.
Objectives: The objective of this study is to profile the health technology assessments (HTAs) produced in Canada and other selected countries and assess their potential to inform policy making about health systems in jurisdictions other than the ones for which they were produced, and to develop and pilot test prototypes for packaging and assessing the relevance of HTAs for health system managers and policy makers.
Methods: We compiled an inventory of all HTAs that were produced by nine HTA agencies between September 2003 and August 2006; coded the title and abstract of each HTA according to the technologies assessed, methods used, and whether or not context-specific actionable messages were provided; developed a prototype for a structured, decision-relevant HTA summary and for a relevance-assessment form; and pilot-tested the prototypes using semistructured telephone interviews with a purposive sample of Canadian healthcare managers and policy makers.
Results: Our review of the 223 HTAs identified that: (i) 44 HTAs addressed health system arrangements (20 percent); (ii) 205 incorporated a systematic review (92 percent), whereas only 12 incorporated a sociopolitical assessment using explicit methods (5 percent); and (iii) 50 contained context-specific actionable messages (22 percent). Our interviews identified significant support for both the general idea of an HTA summary and the prototype's specific elements, but mixed views about using peer assessments of relevance.
Conclusions: Those involved in supporting the use of HTAs in policy making about health systems may wish to produce structured decision-relevant summaries for their systematic review-containing HTAs to increase the prospects for their HTAs being used outside the jurisdiction for which they were produced.
Using a hard exotemplate procedure, hierarchically structured carbonaceous foams have been designed, using silica monolith as inorganic template and phenolic resin as carbon precursor. The open cell carbonaceous monoliths exhibit specific surface areas from 500 to 800 m2.g-1, essentially based on microporosity and macropores ranging from 0.05 up to 50 μm. Application as electrochemical energy storage devices have been checked and discuss inhere.
European gorse (Ulex europaeus L.) is a spiny shrub that grows spontaneously in the understorey of forests and heathlands in western Europe. Gorse is a pioneer species and forms large seed banks that can persist for a long time while buried deeply in the soil. Although many studies have been conducted on gorse seed banks in invasive contexts and in scrubland ecosystems, few data are available on forests in a native context. The aim of the present study was thus to report on the variability of seed-bank density in ‘critical’ stages in the forest management of pine stands (five stands) in south-western France. We examined variations in the number of gorse seeds as a function of soil depth but also of the presence and abundance of adult gorse in the understorey. Seed-bank density did not show a clear decrease in seed number with pine stand age, principally because gorse also appears to be able to establish itself in mature pine stands, probably thanks to local disturbances. In the pine stands in our study, the presence and abundance of seeds in the soil appeared to depend mostly on the presence of adult gorse as seeders in the understorey. Finally, we observed that, contrary to what has generally been found in scrubland ecosystems, most gorse seeds were located in the 5–10 cm soil layer rather than in the 0–5 cm soil layer. This depletion of the first 5 cm may be linked to seed germination that was not compensated for by the production of new seeds.
We present a direct N-body simulation modeling the evolution of the old (7 Gyr) open cluster NGC 188. This is the first N-body open cluster simulation whose initial binary population is directly defined by observations of a specific open cluster: M35 (150 Myr). We compare the simulated color–magnitude diagram at 7 Gyr to that of NGC 188, and discuss the blue stragglers produced in the simulation. We compare the solar-type main-sequence binary period and eccentricity distributions of the simulation to detailed observations of similar binaries in NGC 188. These results demonstrate the importance of detailed observations in guiding N-body open cluster simulations. Finally, we discuss the implications of a few discrepancies between the NGC 188 model and observations and suggest a few methods for bringing N-body open cluster simulations into better agreement with observations.
High-resolution synchrotron radiation X-ray photoelectron spectroscopy (HRXPS) is used to study the chemical bonding at the Al2O3/Si(001) and Al2O3/Si(111) interfaces. In both cases, the Si2p spectra recorded at 180 eV photon energy provides evidence a thin interfacial layer rich in Si-O bonding. On the other hand, conventional AlKα X-ray source angular measurements clearly indicate that there are two in-plane orientations for Al2O3/Si(111) : [11-2]Al2O3(111)//[11-2]Si(111) and [-1-12] Al2O3(111)//[11-2]Si(111) but four in-plane orientations for Al2O3/Si(001) : [11-2] Al2O3(111)//Si(001), [11-2]Al2O3(111)//Si(001), [11-2]Al2O3(111)//[-100]Si(001), and [11-2]Al2O3(111)//[0-10]Si(001).
We present preliminary results from an observational campaign aimed at the study of the binary fraction and binary radial distribution in Galactic globular clusters. In particular, we concentrate on the ongoing observational campaign for the search of spectroscopic binaries.
A long-standing understanding of the Maya highlands suggests that the Postclassic period was characterized by increased warfare and conflict over the preceding Classic period, as seen in settlement patterns and defensive features. Based on recent archaeological work in Guatemala's western highlands, we argue that the archaeological evidence does not support this conclusion; defensive characteristics are also common in the Classic period. Drawing on examples from the Huista-Acatec region of the Cuchumatán Mountains, a typology of defensive characteristics is presented, along with comparative examples elsewhere in the Maya highlands. We suggest that these material correlates of defensibility, while showing that conflict was a central concern in both the Classic and Postclassic periods, lay the foundation for future studies of warfare in the Maya highlands. These insights have implications for the study of settlement pattern defensibility beyond the Maya highlands, including the construction and use of defensive feature typologies, the appropriateness of categorizing societies as either peaceful or militaristic, and the wider identification of cultural continuity.