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Introduction: There is currently no protocol for the initiation of extra corporeal cardiopulmonary resuscitation (ECPR) in out of hospital cardiac arrest (OHCA) in Atlantic Canada. Advanced care paramedics (ACPs) perform advanced cardiac life support in the prehospital setting often completing the entire resuscitation on-scene. Implementation of ECPR will present a novel intervention that is only available at the receiving hospital, altering how ACPs manage selected patients. Our objective is to determine if an educational program can improve paramedic identification of ECPR candidates. Methods: An educational program was delivered to paramedics including a short seminar and pocket card coupled with simulations of OHCA cases. A before and after study design using a case-based survey was employed. Paramedics were scored on their ability to correctly identify OHCA patients who met the inclusion criteria for our ECPR protocol. Scores before and after the education delivery were compared using a two tailed t-test. A 6-month follow-up is planned to assess knowledge retention. Qualitative data was also collected from paramedics during simulation to help identify potential barriers to implementation of our protocol in the prehospital setting. Results: Nine advanced care paramedics participated in our educational program. Mean score pre-education was 9.7/16 (61.1%) compared to 14/16 (87.5%) after education delivery. The mean difference between groups was 4.22 (CI = 2.65-5.80, p = 0.0003). There was a significant improvement in the paramedics’ ability to correctly identify ECPR candidates after completing our educational program. Conclusion: Paramedic training through a didactic session coupled with a pocket card and simulation appears to be a feasible method of knowledge translation. 6-month retention data will help ensure knowledge retention is achieved. If successful, this pilot will be expanded to train all paramedics in our prehospital system as we seek to implement an ECPR protocol at our centre.
The article presents the experimental evaluation of an integrated approach for path following and obstacle avoidance, implemented on wheeled robots. Wheeled robots are widely used in many different contexts, and they are usually required to operate in partial or total autonomy: in a wide range of situations, having the capability to follow a predetermined path and avoiding unexpected obstacles is extremely relevant. The basic requirement for an appropriate collision avoidance strategy is to sense or detect obstacles and make proper decisions when the obstacles are nearby. According to this rationale, the approach is based on the definition of the path to be followed as a curve on the plane expressed in its implicit form f(x, y) = 0, which is fed to a feedback controller for path following. Obstacles are modeled through Gaussian functions that modify the original function, generating a resulting safe path which – once again – is a curve on the plane expressed as f′(x, y) = 0: the deformed path can be fed to the same feedback controller, thus guaranteeing convergence to the path while avoiding all obstacles. The features and performance of the proposed algorithm are confirmed by experiments in a crowded area with multiple unicycle-like robots and moving persons.
Using multilevel models, we examined mother-, father-, and child-reported (N = 1,336 families) externalizing behavior problem trajectories from age 7 to 14 in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). The intercept and slope of children's externalizing behavior trajectories varied both across individuals within culture and across cultures, and the variance was larger at the individual level than at the culture level. Mothers’ and children's endorsement of aggression as well as mothers’ authoritarian attitudes predicted higher age 8 intercepts of child externalizing behaviors. Furthermore, prediction from individual-level endorsement of aggression and authoritarian attitudes to more child externalizing behaviors was augmented by prediction from cultural-level endorsement of aggression and authoritarian attitudes, respectively. Cultures in which father-reported endorsement of aggression was higher and both mother- and father-reported authoritarian attitudes were higher also reported more child externalizing behavior problems at age 8. Among fathers, greater attributions regarding uncontrollable success in caregiving situations were associated with steeper declines in externalizing over time. Understanding cultural-level as well as individual-level correlates of children's externalizing behavior offers potential insights into prevention and intervention efforts that can be more effectively targeted at individual children and parents as well as targeted at changing cultural norms that increase the risk of children's and adolescents’ externalizing behavior.
Foodborne non-typhoidal salmonellosis causes approximately 1 million illnesses annually in the USA. In April 2015, we investigated a multistate outbreak of 65 Salmonella Paratyphi B variant L(+) tartrate(+) infections associated with frozen raw tuna imported from Indonesia, which was consumed raw in sushi. Forty-six (92%) of 50 case-patients interviewed ate sushi during the week before illness onset, and 44 (98%) of 45 who specified ate sushi containing raw tuna. Two outbreak strains were isolated from the samples of frozen raw tuna. Traceback identified a single importer as a common source of tuna consumed by case-patients; this importer issued three voluntary recalls of tuna sourced from one Indonesian processor. Four Salmonella Weltevreden infections were also linked to this outbreak. Whole-genome sequencing was useful in establishing a link between Salmonella isolated from ill people and tuna. This outbreak highlights the continuing foodborne illness risk associated with raw seafood consumption, the importance of processing seafood in a manner that minimises contamination with pathogenic microorganisms and the continuing need to ensure imported foods are safe to eat. People at higher risk for foodborne illness should not consume undercooked animal products, such as raw seafood.
Endogenous melatonin is a hormone secreted by pineal gland; it has several roles in metabolism, reproduction, and remarkable antioxidant properties. Studies on the melatonin effect on the adrenal glands which are important endocrine organs, controlling essential physiological functions, are still deficient. In this study, we attempted to investigate the effect of exogenous melatonin treatment on the adrenal cortex and medulla using several approaches. Adrenal glands of 15 Soay ram were examined to detect the effect of melatonin treatment. Our results revealed that the cells of adrenal cortex of the treated animals were separated by wide and numerous blood sinusoids and showed signs of increase steroidogenic activity, which are evidenced by functional hypertrophy with increase profiles of mitochondria, smooth endoplasmic reticulum, and lipid droplets. The most striking ultrastructural features in the medulla of the treated group were the engorgement of chromaffin cells with enlarged secretory granules enclosed within a significantly increased diameter of these cells. The cytoplasm of these cells showed numerous mitochondria, rough endoplasmic reticulum (rER), Golgi apparatus, lysosomes, and glycogen granules. Exocytosis of secretory granules to the lumen of blood vessels was evident in the treated group. Piecemeal degranulation mode of secretion was recorded after melatonin treatment. Chromaffin cells in the control group expressed moderate immunoreactivity to Synaptophysin and tyrosine hydroxylase, compared with intensified expression after melatonin treatment. The ganglion cells of the melatonin-treated group showed a significant increase in diameter with numerous rER. The most interesting feature in this study is the presence of small granule chromaffin cells (SGC) and telocytes (TCs) for the first time in the adrenal glands of sheep. Moreover, these SGC cells, Schwann cells, fibroblasts, and progenitor stem cells showed a stimulatory response. The TCs were small branched cells scattered in the adrenal glands around cortical cells, chromaffin cells, nerve fibers, and blood vessels. These cells increased significantly in number, length of their telopodes, and secretory activity after melatonin treatment. In addition, multiple profiles of unmyelinated nerve fibers were demonstrated in all treated specimens. These results indicated that melatonin treatment caused a stimulatory action on all cellular and neuronal elements of the adrenal gland. This study may act as a new direction for treatment of adrenal insufficiency.
Using data from 1,177 families in eight countries (Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States), we tested a conceptual model of direct effects of childhood family adversity on subsequent externalizing behaviors as well as indirect effects through psychological mediators. When children were 9 years old, mothers and fathers reported on financial difficulties and their use of corporal punishment, and children reported perceptions of their parents’ rejection. When children were 10 years old, they completed a computerized battery of tasks assessing reward sensitivity and impulse control and responded to questions about hypothetical social provocations to assess their hostile attributions and proclivity for aggressive responding. When children were 12 years old, they reported on their externalizing behavior. Multigroup structural equation models revealed that across all eight countries, childhood family adversity had direct effects on externalizing behaviors 3 years later, and childhood family adversity had indirect effects on externalizing behavior through psychological mediators. The findings suggest ways in which family-level adversity poses risk for children's subsequent development of problems at psychological and behavioral levels, situated within diverse cultural contexts.
Next-generation 21cm observations will enable imaging of reionization on very large scales. These images will contain more astrophysical and cosmological information than the power spectrum, and hence providing an alternative way to constrain the contribution of different reionizing sources populations to cosmic reionization. Using Convolutional Neural Networks, we present a simple network architecture that is sufficient to discriminate between Galaxy-dominated versus AGN-dominated models, even in the presence of simulated noise from different experiments such as the HERA and SKA.
The correlation coefficient (ρ) is an important metric for the evaluation of multiple-input–multiple-output (MIMO) antenna systems because it describes the relationship between the channels in a particular propagation environment. Highly correlated channels will degrade the MIMO system performance. Various methods to calculate ρ are analyzed in this work using three different types of antennas with different efficiencies and radiating properties. While the field-based method for finding ρ gives the most accurate results and should be used all the time. It is independent of antenna efficiency. The the S-parameter-based method might give reasonable results only when the antenna efficiency is very high and the patterns are separated in space, but in most cases, it underestimates ρ values and thus is not a reliable method and should be avoided. Incorporating the antenna efficiency can improve the ρ estimates using the S-parameters method under some specific conditions. The equivalent circuit method provides reasonable results for symmetric antenna structures only, and is the most complex in formulation. As part of the evaluation, two existing methods incorporating the radiation efficiency of the antennas are generalized to N-ports for the first time. Although less accurate than the field-based method, these extensions allow the evaluation of ρ for N-port antennas using only the radiation efficiency and the S-parameters of the antenna. The effect of the beam tilts on ρ estimation is investigated for the first time.
In temperate zones, human respiratory syncytial virus (HRSV) outbreaks typically occur in cold weather, i.e. in late autumn and winter. However, recent outbreaks in Japan have tended to start during summer and autumn. This study examined associations of meteorological conditions with the numbers of HRSV cases reported in summer in Japan. Using data from the HRSV national surveillance system and national meteorological data for summer during the period 2007–2014, we utilized negative binomial logistic regression analysis to identify associations between meteorological conditions and reported cases of HRSV. HRSV cases increased when summer temperatures rose and when relative humidity increased. Consideration of the interaction term temperature × relative humidity enabled us to show synergistic effects of high temperature with HRSV occurrence. In particular, HRSV cases synergistically increased when relative humidity increased while the temperature was ⩾28·2 °C. Seasonal-trend decomposition analysis using the HRSV national surveillance data divided by 11 climate divisions showed that summer HRSV cases occurred in South Japan (Okinawa Island), Kyushu, and Nankai climate divisions, which are located in southwest Japan. Higher temperature and higher relative humidity were necessary conditions for HRSV occurrence in summer in Japan. Paediatricians in temperate zones should be mindful of possible HRSV cases in summer, when suitable conditions are present.
Visual retrieval and classification are of growing importance for a number of applications, including surveillance, automotive, as well as web and mobile search. To facilitate these processes, features are often computed from images to extract discriminative aspects of the scene, such as structure, texture or color information. Ideally, these features would be robust to changes in perspective, illumination, and other transformations. This paper examines two approaches that employ dimensionality reduction for fast and accurate matching of visual features while also being bandwidth-efficient, scalable, and parallelizable. We focus on two classes of techniques to illustrate the benefits of dimensionality reduction in the context of various industrial applications. The first method is referred to as quantized embeddings, which generates a distance-preserving feature vector with low rate. The second method is a low-rank matrix factorization applied to a sequence of visual features, which exploits the temporal redundancy among feature vectors associated with each frame in a video. Both methods discussed in this paper are also universal in that they do not require prior assumptions about the statistical properties of the signals in the database or the query. Furthermore, they enable the system designer to navigate a rate versus performance trade-off similar to the rate-distortion trade-off in conventional compression.
This study advances understanding of predictors of child abuse and neglect at multiple levels of influence. Mothers, fathers, and children (N = 1,418 families, M age of children = 8.29 years) were interviewed annually in three waves in 13 cultural groups in nine countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States). Multilevel models were estimated to examine predictors of (a) within-family differences across the three time points, (b) between-family within-culture differences, and (c) between-cultural group differences in mothers' and fathers' reports of corporal punishment and children's reports of their parents' neglect. These analyses addressed to what extent mothers' and fathers' use of corporal punishment and children's perceptions of their parents' neglect were predicted by parents' belief in the necessity of using corporal punishment, parents' perception of the normativeness of corporal punishment in their community, parents' progressive parenting attitudes, parents' endorsement of aggression, parents' education, children's externalizing problems, and children's internalizing problems at each of the three levels. Individual-level predictors (especially child externalizing behaviors) as well as cultural-level predictors (especially normativeness of corporal punishment in the community) predicted corporal punishment and neglect. Findings are framed in an international context that considers how abuse and neglect are defined by the global community and how countries have attempted to prevent abuse and neglect.
Foodborne disease outbreaks are increasingly being seen as a greater concern by public health authorities. It has also become a global research agenda to identify improved pathways to coordinating outbreak detection. Furthermore, a significant need exists for timely coordination of the detection of potential foodborne disease outbreaks to reduce the number of infected individuals and the overall impact on public health security. This study aimed to offer an effective approach for coordinating foodborne disease outbreaks. First, we identify current coordination processes, complexities, and challenges. We then explore social media surveillance strategies, usage, and the power of these strategies to influence decision-making. Finally, based on informal (social media) and formal (organizational) surveillance approaches, we propose a hybrid information network model for improving the coordination of outbreak detection. (Disaster Med Public Health Preparedness. 2015;9:186-198)
Pollen assemblages from the base of silty alluvium in three wadi-fills in Cyrenaica are described. They show evidence for forest clearance and cultivation, including the likely cultivation of olive. This suggests that the samples are broadly of Graeco-Roman age, and that the silty alluvium started to accumulate in these wadis as the result of the landscape impact of agricultural expansion.
To determine whether a threshold apparent diffusion coefficient value may help to differentiate laryngeal carcinomas from benign lesions.
Fifty-three patients with laryngeal masses were recruited; four of them were excluded because of susceptibility artefacts. In the remaining 49 patients, the pathological results showed 32 laryngeal carcinomas and 17 benign lesions. The diagnostic value of diffusion-weighted magnetic resonance imaging for the identification of malignant lesions was determined. In addition, the agreement between diffusion-weighted magnetic resonance imaging and histopathology was assessed. Moreover, the sensitivity, specificity, and negative and positive predictive values of the apparent diffusion coefficient in detecting benign and malignant lesions were analysed. An apparent diffusion coefficient histogram was also produced.
An apparent diffusion coefficient value of 1.1 × 10−3 mm2/second produced the best result when used as the cut-off point to differentiate malignant from benign masses.
An apparent diffusion coefficient threshold of 1.1 × 10−3 mm2/second is optimal for distinguishing laryngeal carcinomas from benign lesions. Apparent diffusion coefficient values were lower for patients with laryngeal carcinomas than for those with benign lesions.
The early Miocene site of Wadi Moghra, Qattara Depression, Egypt, is important for interpreting anthracothere (Mammalia, Artiodactyla) evolution, because the Moghra sediments preserve a higher diversity of anthracotheres than any other pene-contemporaneous site. New specimens from Moghra are described and form the basis for the systematic revision of Moghra anthracotheres provided here. Among the important discoveries recently made at Moghra is the first complete skull of Sivameryx moneyi. Other new specimens described here include two new species of Afromeryx, and a new genus and species, all of which are unique to Moghra. A review of biogeographic information supports the conclusion that three of the Moghra anthracotheres (Brachyodus depereti, B. mogharensis, and Jaggermeryx naida, n. gen. n. sp.) are members of late surviving lineages with a long history in Africa, while three other species (Afromeryx grex, n. sp., A. palustris, n. sp., and Sivameryx moneyi) represent more recent immigrants from Eurasia.
The effect of strain rate on hydrogen embrittlement of low alloy 4340 steel was studied using double-notched tensile samples electrochemically charged in-situ with hydrogen in 1N H2SO4 + 5 mg/l As2O3 solution. The mechanical response of samples with prior austenitic grain sizes of 10 and 40 μm and martensitic hardness of 43-52 HRC were examined after hydrogen charging times of 0-20 min. Increasing the strain rate for hydrogen charged samples resulted in decreased failure strains and increased evidence of brittle fracture. Brittle fracture surfaces for the harder samples showed primarily intergranular fracture while softer samples exhibited predominantly quasi-cleavage.
This study examined whether parents’ social information processing was related to their subsequent reports of their harsh discipline. Interviews were conducted with mothers (n = 1,277) and fathers (n = 1,030) of children in 1,297 families in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States), initially when children were 7 to 9 years old and again 1 year later. Structural equation models showed that parents’ positive evaluations of aggressive responses to hypothetical childrearing vignettes at Time 1 predicted parents’ self-reported harsh physical and nonphysical discipline at Time 2. This link was consistent across mothers and fathers, and across the nine countries, providing support for the universality of the link between positive evaluations of harsh discipline and parents’ aggressive behavior toward children. The results suggest that international efforts to eliminate violence toward children could target parents’ beliefs about the acceptability and advisability of using harsh physical and nonphysical forms of discipline.