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In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Introduction: Situational awareness (SA) is the team understanding patient stability, presenting illness and future clinical course. Losing SA has been shown to increase safety-critical events in multiple industries. SA can be measured by the previously validated Situational Awareness Global Assessment Tool (SAGAT). Checklists are used in many safety-critical industries to reduce errors of omission and commission. An RSI checklist was developed from case review and published evidence.The New Brunswick Trauma Program supports an inter-professional simulation-based medical education program Methods: Simulations were facilitated in three hospitals in New Brunswick from April 2017 to October 2017. Learner profiles were collected. The SAGAT tool was completed by a research nurse at the end of each scenario. SAGAT scores were non-normally distributed, so results were expressed as medians and interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. To understand the effect of the of an RSI checklist a comparison was made between SAGAT scores at baseline in scenario 1, and the same first scenario completed after a washout period. A Poisson regression analysis will be used to account for the effect of confounding variables in further analyses. Results: The group was composed of Registered Nurses (8), Physicians (7), and Respiratory Therapists (2). Situational awareness increased significantly with the use of an RSI checklist after 1 day of 4 simulations. The washout period ranged between 5 weeks and 8 weeks. The baseline situational awareness of the whole group during scenario 1 was 9 +/− 0.5 (median, IQR), and with the RSI checklist was 12 +/−1 (median, IQR). The difference was highly statistically significant, p=< 0.001. This level of situational awareness using checklist is comparable to the SAGAT scores after 10 scenarios. Conclusion: In this provisional analysis, the use of an RSI checklist was associated with an increase in measured situational awareness. Higher levels of situational awareness are associated with greater patient safety. A Poisson regression model will be used to understand the confounding effects of user expertise and the likely interaction with simulation exposure.
Labour constitutes a major and increasing cost on dairy farms, while at the same time, the availability of skilled labour is decreasing. In addition, younger farmers are placing an increasing emphasis on lifestyle. Consequently, there is an increased interest in milk production systems involving reduced labour inputs. In view of the fact that approximately 33% (O’Brien et al., 2002) of the daily labour input on dairy farms is associated with the milking routine (herding, milking and washing), the adoption of once daily milking would appear to offer considerable potential to reduce labour inputs. This study examined the effect of once-daily milking, in late lactation, on animal performance.
Operational stress describes individual behavior in response to the occupational demands and tempo of a mission. The stress response of military personnel involved in combat and peace-keeping missions has been well-described. The spectrum of effect on medical professionals and support staff providing humanitarian assistance, however, is less well delineated. Research to date concentrates mainly on shore-based humanitarian missions.
The goal of the current study was to document the pattern of operational stress, describe factors responsible for it, and the extent to which these factors impact job performance in military and civilian participants of Continuing Promise 2011 (CP11), a ship-based humanitarian medical mission.
This was a retrospective study of Disease Non-Battle Injury (DNBI) data from the medical sick-call clinic and from weekly self-report questionnaires for approximately 900 US military and civilian mission participants aboard the USNS COMFORT (T-AH 20). The incidence rates and job performance impact of reported Operational Stress/Mental Health (OS/MH) issues and predictors (age, rank, occupation, service branch) of OS/MH issues (depression, anxiety) were analyzed over a 22-week deployment period.
Incidence rates of OS/MH complaints from the sick-call clinic were 3.7% (4.5/1,000 persons) and 12.0% (53/1,000 persons) from the self-report questionnaire. The rate of operational stress increased as the mission progressed and fluctuated during the mission according to ship movement. Approximately 57% of the responders reported no impact on job performance. Younger individuals (enlisted ranks E4-6, officer ranks O1-3), especially Air Force service members, those who had spent only one day off ship, and those who were members of specific directorates, reported the highest rates of operational stress.
The overall incidence of OS/MH complaints was low in participants of CP11 but was under-estimated by clinic-based reporting. The OS/MH complaints increased as the mission progressed, were more prevalent in certain groups, and appeared to be related to ship’s movement. These findings document the pattern of operational stress in a ship-based medical humanitarian mission and confirm unique ship-based stressors. This information may be used by planners of similar missions to develop mitigation strategies for known stressors and by preventive medicine, behavioral health specialists, and mission leaders to develop sensitive surveillance tools to better detect and manage operational stress while on mission.
ScoutenWT, MehalickML, YoderE, McCoyA, BrannockT, RiddleMS. The Epidemiology of Operation Stress during Continuing Promise 2011: A Humanitarian Response and Disaster Relief Mission aboard a US Navy Hospital Ship. Prehosp Disaster Med. 2017;32(4):393–402.
Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis.
Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted.
The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = −0.25, 95% CI −0.39 to −0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6–8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = −4.17, 95% CI −8.01 to −0.32).
The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.
Introduction: A novel bladder stimulation technique has been described for midstream urine (MSU) collection in well-feeding, inpatient newborns. We sought to determine the performance of this technique amongst infants presenting to the Emergency Department (ED). Methods: Our prospective ED-based study enrolled a convenience cohort of infants aged ≤ 90 days who required urine testing. Infants with significant feeding issues, moderate to severe dehydration, or critical illness were excluded. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. Healthcare providers received standardized training in the technique. Primary outcome was the proportion of infants with successful MSU collection via the technique. Success was defined as adequate sample collection (≥ 1 mL urine) within 5 minutes of initiating stimulation. Secondary outcomes included the proportion of contaminated MSU samples, time required for MSU collection and full protocol completion, and patient discomfort as perceived by parent/guardian using a 100 mm visual analog scale [VAS]. Assuming success a priori in 50% of infants, a sample size of 115 allowed a 95% confidence interval of +/- 9.1% around the point estimate. Results: We enrolled 115 infants. Mean age was 53.0 days old (interquartile range [IQR] 26.7-68.0); 58.3% were male (69.2% uncircumcised). Midstream urine was successfully collected in 61 infants (53.0%; 95% CI 0.44,0.62). Thirty-one MSU samples (50.8%) were contaminated; uncircumcised males held the highest proportion (55.0%). Most contaminated samples (83.9%) were reported as “non-significant growth” or “growth of ≥ 3 organisms” and were easily identifiable as contaminants with minimal impact on clinical care. Only 4 (8.5%) of the 47 patients discharged home after successful MSU collection had a repeat ED visit for urine testing. Median stimulation time for MSU collection was 45 seconds (IQR 20-99 secs). Median time for full protocol completion was 30.83 minutes (IQR 24.42-46.83 mins). Mean VAS for infant discomfort was 20.2 mm (SD +/- 20.4 mm). Conclusion: Our pragmatic, ED-based study found the success rate of this bladder stimulation technique to be significantly lower (53%) than its published rate (86%). The contamination rate was high but most contaminated specimens were easily identifiable as such and had minimal clinical impact.
Develop and implement an effective program for hazard analysis and control of waterborne pathogens at a multicampus hospital with clinics.
A longitudinal study. Several-year study including analysis of results from monitoring and tests of 26 building water systems.
Outpatient and inpatient healthcare facilities network.
The hazard analysis and critical control point (HACCP) process was used to develop a water management program (WMP) for the hospital campuses. The HACCP method systematically addressed 3 questions: (1) What are the potential waterborne hazards in the building water systems of these facilities? (2) How are the hazards being controlled? (3) How do we know that the hazards have been controlled? Microbiological and chemical tests of building water samples were used to validate the performance of the WMP; disease surveillance data further validated effective hazard control.
Hazard analysis showed that waterborne pathogens were generally in good control and that the water quality was good in all facilities. The hospital network has had several legionellosis cases that were identified as presumptive hospital acquired, but none was confirmed or substantiated by water testing in follow-up investigations. Building water system studies unrelated to these cases showed that pressure tanks and electronic automatic faucets required additional hazard control.
Application of the HACCP process for long-term building water systems management was practical and effective. The need for critical control point management of temperature, flow, and oxidant (chlorine) residual concentration was emphasized. The process resulted in discovery of water system components requiring additional hazard control.
The first part of this presentation will be devoted to the description of the two nanoporous crystalline forms and of the various co-crystalline structures which can be obtained with syndiotactic polystyrene (s-PS). Then, the second part will deal with the co-crystals formed with active guest molecules (nonlinear active, fluorescent, photoreactive, chiral, ...) while the final part of the lecture will focus on the possible applications of materials characterized by nanoporous crystalline s-PS phases.
Atomic layer deposition (ALD) has been used to coat SBA-15 and functionalized SBA-15 with various metal oxides. Use of SBA-15 coated with 4-10 ALD cycles of titania, alumina, niobia, or zirconia in the acid-catalyzed dehydration of fructose to 5-hydroxymethylfurfural (HMF) resulted in 24-57% conversion, with 0-22% selectivity, at 130 °C with 2 wt % fructose in 4:1 THF:H2O. Propylsulfonic acid functionalized SBA-15 (SBA-15-PrSO3H) had a 25% conversion and 48% selectivity for HMF under the same conditions. SBA-15-PrSO3H was also coated with 2 ALD cycles of titania followed by 8 ALD cycles silica. The deactivation rate constant for SBA-15-PrSO3H was 2.7 x 10-2 h-1 for the dehydration of fructose to HMF in a flow reactor at 130 °C with a feed of 2 wt % fructose in 4:1 THF:H2O. In comparison, the deactivation rate constant for the ALD coated SBA-15-PrSO3H-ALD was 7.9 x 10-3 h-1.
The sodium in synthetic faujasite, commercial zeolite-X, was exchanged with copper cations at room temperature. A maximum number of 70 out of 86 Na cations were replaced with 35 copper cations (1). The copper exchanged zeolite was divided in six equal parts. Five of them were calcined at 43, 73, 112, 150 and 195 deg C. After calcination the samples were eluted with saturated solution of ammonium chloride to remove copper cations from open sites (super-cages) of the zeolite (Fig 1). The remaining copper cations were in locked sites (sodalite-cages or hexagonal-prisms). Using XAS edge-jump as a measure of quantitative analysis, we found that 9.0, 11.5, 12.7, 13.3 and 20.0 copper cations were locked at calcination temperatures of 43, 73, 112, 150 and 195 deg C respectively. The analysis of the first shell Fourier Transformed radial distribution shows that cations at site I in the hexagonal-prism and site I ‘ and II ’ in the sodalite-cages, adjacent to site I, are distributed at equal proportion, independent of temperature.
As a part of a systematic study on cation-exchanged MOF-74-M, we report a partial snapshot of our recent work achieved via a fully periodic first principle approach. Structures are reported for bulk MOF-74-Mg, Mn, Ni, and Zn as computed at DFT-B3LYP level of theory; enthalpies of adsorption for CO and CO2 in interaction with MOF-74-Ni, and Zn are also investigated as obtained at B3LYP+D* level, which is able to take into account the long-range dispersion interaction between adsorbate and adsorbant, through an a-posteriori scheme. Results are discussed and compared with available experimental data. To the authors’ knowledge this represents the first description of MOF-74-Mn structure and of the interaction of the mentioned molecules with MOF-74-Zn.
Metal organic framework (MOF) materials are a class of hybrid organic-inorganic crystalline materials whose pore structures and chemical properties can be tailored by the selection of component chemical moieties. Many MOFs have extraordinary intrinsic surface areas, capable of adsorbing large quantities of other chemicals, such as volatile organic compounds or moisture. Upon absorption of guest molecules, many MOFs undergo reversible changes in the dimensions of their unit cells. These properties suggest several routes to chemical sensing in which the transduction mechanisms are: 1) the stress induced at an interface between a flexible MOF layer and a static microcantilever fabricated with a built-in piezoresistive stress sensor; 2) the change in the resonant frequency of an oscillating microcantilever induced by mass adsorption; and 3) the change in the resonant frequency of a acoustic sensor, such as a surface acoustic wave (SAW) sensor through changes in mass loading and film moduli. This paper focuses on humidity sensing by SAWs coated with Cu3(BTC)2 (HKUST-1) over a very broad concentration range.
Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy’s National Nuclear Security Administration under contract DE-AC04-94AL85000.
The method of ion implantation and spike annealing for preparing shallow junctions suitable for the extension regions bridging the channel and source/drain contacts of CMOS transistors are studied by annealing blanket implants. Junction depths at a given sheet resistance for low energy B implants are minimized for the combination of a fast ramp with a sharp-spike anneal. This is shown to be physically based on activation energy phenomenology. The fraction of electrically activated B is insensitive to implant dose, unlike the case of transient enhanced diffusion. Arsenic implants show higher activation fraction than comparably annealed P implants, without the large transient enhanced diffusion which is attributed to P and Si-interstitial coupled diffusion. For targeted sheet resistance and junction depth, spiking temperature trends lower with implant dose, concomitant with decreasing fraction of activated dopant.
The creation of ultra-shallow junction for CMOS devices at the sub-100 nm node is driving significant efforts in developing thermal processing to give rise to high dopant activation in combination with limited diffusion. Flash-assist Rapid Thermal Annealing™ (fRTP™) is a promising new annealing technique, which involves the heating of the bulk of the wafer to an intermediate temperature using rather conventional spike RTP, followed by a short and intense pulse of light localized on the implanted wafer surface.
In this work, we have systematically investigated the junction formation of different implants under fRTP anneals in terms of profile and devices. Co-implanted Ge and F species provide more box-like profiles with improved activation. Although leakage currents are higher for fRTP-annealed junctions than for spike-annealed junctions, appropriate fRTP process parameters and correct process conditions provide a critical tool to control and reduce the leakage current of co-implanted fRTP junctions to acceptable levels. Proper implant and anneal are requested for minimizing pattern effect and improving device performance.
The free fall of a liquid-metal drop and heat transfer from the drop to its environment are described for both a gaseous atmosphere and vacuum. A simple model, in which the drop is assumed to fall rectilinearly with behavior like that of a rigid particle, is developed first, then possible causes of deviation from this behavior are discussed. The model is applied to describe solidification of drops in a drop tube. Possible future develop-ments of the model are suggested.
The microstructural development of Ti:LiNbO3 optical waveguides as a function of annealing time and temperature was studied using transmission electron microscopy. The morphological evolution of the deposited Ti film can be characterized by three stages: (i) oxidation beginning at low temperatures, (ii) coarsening and secondary grain growth of the oxide film at higher temperatures and (iii) eventual film breakup and void formation. Secondary grain growth is driven by minimization of interfacial energy of grains which have a special epitaxial relationship with respect to the LiNbO3 substrate.
The dielectric elastomer, a particularly attractive type of electroactive polymer, uses commercial polymers such as acrylic and silicone elastomers. The technology has been limited in application by perceived lifetime issues. By addressing several lifetime issues, lifetimes of more than one million cycles, and in some cases beyond ten million cycles, were achieved with a variety of transducer configurations (including operation in generator mode) under a variety of operating conditions (including high humidity). Dielectric elastomers can produce maximum actuation strains of more than 100% and specific energy density exceeding that of known electric-field induced technology. Performance testing for dielectric elastomer actuators has typically been for peak-performance or “over-driven” conditions with short operational lifetimes (typically 100s or 1000s of cycles), particularly under conditions such as high humidity. By minimizing electric field and mechanical strain concentration factors, long lifetimes (>1 million cycles) with acrylic transducers were achieved with actuation strains as great as 40% areal strain (and up to 100% areal strain in generator mode). Actuators in a dry environment had an almost 20x increase in lifetime over actuators at ambient humidity (about 50% RH) at the same driving field conditions. Long actuation lifetimes were also achieved in a 100% RH environment and when fully submerged in salt water at reduced operating strain and field. In 100% RH, lifetimes of several million cycles were achieved at 4% strain. In underwater operation, 6 out of 11 actuators survived for >10 million cycles with an electric field limited to 32 MV/m and approximately 2% strain. The demonstrated lifecycle improvements are applicable to a variety of uses of dielectric elastomers, including haptic interface devices, pumps (implantable and external), optical positioners, and “artificial muscles” to replace small damaged muscles. Continued improvements in materials, actuator design, and packaging, combined with management of operational conditions as described here, should support new practical application of this promising technology.