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Prehospital care is a key component of an emergency care system. Prehospital providers initiate patient care in the field and transition it to the emergency department. Emergency Medicine (EM) specialist training programs are growing rapidly in low- and middle-income countries (LMICs), and future emergency physicians will oversee emergency care systems. Despite this, no standardized prehospital care curriculum exists for physicians in these settings. This report describes the development of a prehospital rotation for an EM residency program in Central Haiti.
Using a conceptual framework, existing prehospital curricula from high-income countries (HICs) were reviewed and adapted to the Haitian context. Didactics covering prehospital care from LMICs were also reviewed and adapted. Regional stakeholders were identified and engaged in the curriculum development.
A one-week long, 40-hour curriculum was developed which included didactic, clinical, evaluation, and assessment components. All senior residents completed the rotation in the first year. Feedback was positive from residents, field sites, and students.
A standardized prehospital rotation for EM residents in Haiti was successfully implemented and well-received. This model of adaptation and local engagement can be applied to other residency programs in low-income countries to increase physician engagement in prehospital care.
This study describes a procedural blank assessment of the ultraviolet photochemical oxidation (UV oxidation) method that is used to measure carbon isotopes of dissolved organic carbon (DOC) at the National Ocean Sciences Accelerator Mass Spectrometry Facility (NOSAMS). A retrospective compilation of Fm and δ13C results for secondary standards (OX-II, glycine) between 2009 and 2018 indicated that a revised blank correction was required to bring results in line with accepted values. The application of a best-fit mass-balance correction yielded a procedural blank of 22.0 ± 6.0 µg C with Fm of 0.30 ± 0.20 and δ13C of –32.0 ± 3.0‰ for this period, which was notably higher and more variable than previously reported. Changes to the procedure, specifically elimination of higher organic carbon reagents and improved sample and reactor handling, reduced the blank to 11.0 ± 2.75 µg C, with Fm of 0.14 ± 0.10 and δ13C of –31.0 ± 5.5‰. A thorough determination of the entire sample processing blank is required to ensure accurate isotopic compositions of seawater DOC using the UV oxidation method. Additional efforts are needed to further reduce the procedural blank so that smaller DOC samples can be analyzed, and to increase sample throughput.
Collaborative quality improvement and learning networks have amended healthcare quality and value across specialities. Motivated by these successes, the Pediatric Acute Care Cardiology Collaborative (PAC3) was founded in late 2014 with an emphasis on improving outcomes of paediatric cardiology patients within cardiac acute care units; acute care encompasses all hospital-based inpatient non-intensive care. PAC3 aims to deliver higher quality and greater value care by facilitating the sharing of ideas and building alignment among its member institutions. These aims are intentionally aligned with the work of other national clinical collaborations, registries, and parent advocacy organisations. The mission and early work of PAC3 is exemplified by the formal partnership with the Pediatric Cardiac Critical Care Consortium (PC4), as well as the creation of a clinical registry, which links with the PC4 registry to track practices and outcomes across the entire inpatient encounter from admission to discharge. Capturing the full inpatient experience allows detection of outcome differences related to variation in care delivered outside the cardiac ICU and development of benchmarks for cardiac acute care. We aspire to improve patient outcomes such as morbidity, hospital length of stay, and re-admission rates, while working to advance patient and family satisfaction. We will use quality improvement methodologies consistent with the Model for Improvement to achieve these aims. Membership currently includes 36 centres across North America, out of which 26 are also members of PC4. In this report, we describe the development of PAC3, including the philosophical, organisational, and infrastructural elements that will enable a paediatric acute care cardiology learning network.
Compound-specific radiocarbon analysis (CSRA) of benzene polycarboxylic acids (BPCAs) yields molecular-level, source-specific information necessary to constrain isotopic signatures of pyrogenic carbon. However, the purification of individual BPCAs requires a multistep procedure that typically results in only microgram quantities of the target analyte(s). Such small samples are highly susceptible to contamination by extraneous carbon, which needs to be minimized and carefully accounted for in order to yield accurate results. Here, we undertook comprehensive characterization and quantification of contamination associated with molecular radiocarbon (14C) BPCA analyses through systematic processing of multiple authentic standards with both fossil and modern 14C signatures at various concentrations. Using this approach, we precisely apportion the contribution of extraneous carbon with respect to the four implemented subprocedures. Assuming a constant source and quantity of extraneous carbon we correct and statistically evaluate uncertainties in resulting 14C data. Subsequently, we examine the results of triplicate analyses of reference materials representing four different environmental matrices (sediment, soil, aerosol, riverine natural organic matter) and apportion their BPCA sources in terms of carbon residues derived from biomass or fossil fuel combustion. This comprehensive approach to CSRA facilitates retrieval of robust 14C data, with application in environmental studies of the continuum of pyrogenic carbon.
Short-range elephant Loxodonta africana movements were examined in a heterogeneous landscape mosaic of settlements, crop fields and remnant forest in the Caprivi Strip, Namibia. We explored the penetration of the landscape through the use of permanent pathways and determined the impact of pathway use on crop-raiding location. Pathways were linear, devoid of vegetation and maintained by repeated movement. Functional connectivity of pathways was not species-specific, and pathways were used by various species. Elephants travelled in single file at night and we recorded selective pathway use: females selected pathways away from settlements to access water, whereas males used pathways among settlements to launch crop raids. Proximity of raided fields to the nearest pathway was the only significant spatial variable explaining crop-raiding location. Bulls were responsible for all crop-raiding incidents. We conclude that (1) pathways were the most significant spatial variable influencing which fields were raided, (2) crop-raiding from pathways may maximize foraging efficiency by reducing time spent and distance travelled while foraging, (3) pathways may facilitate penetration of the matrix by connecting predictable resources (crops) with preferred shelter areas, crossing points at roads and preferred drinking spots, and (4) access to the Kwandu River is restricted by settlements, predictably resulting in human–elephant conflict. By highlighting the relevance of pathways for movement of elephants we show that an understanding of the use of pathways is important for land-use planning in conservation landscapes, specifically with regard to human–elephant conflict. We also argue for the need to more fully explore pathway occurrence and use at larger spatial scales.
Amphiphilic diacetylenes (DAs) can self-assemble into photopolymerizable liposomes that can be used to construct effective pathogen sensors. Here, modified commercial inkjet printers are used to disperse DAs into water, facilitating self-assembly. The liposomes are of similar size, but are significantly less polydisperse than liposomes formed using conventional sonication methods. The process is efficient, readily scalable and tolerant of structural modification. The derivitization of approximately 5% of the DA head groups and the incorporation of fluorophores into the hydrophobic bilayer allows for the preparation of novel multifluorophore PDA sensing systems that can provide enhanced bacterial discrimination in a single experiment by way of a fluorescent fingerprint.
Two species in the genus Monochamus Dejean (Coleoptera: Cerambycidae: Lamiinae) have recently been shown to have the same male-produced sex pheromone, 2-undecyloxy-1-ethanol (monochamol), suggesting that other congeners may share the same pheromone. We tested that hypothesis by conducting field bioassays of monochamol, in combination with bark-beetle pheromones and the host plant volatiles ethanol and α-pinene, in southern British Columbia, Canada. We captured 603 Monochamus clamator (LeConte), 63 Monochamus obtusus Casey, 245 Monochamus scutellatus (Say) (tribe Monochamini), and 42 Acanthocinus princeps (Walker) (tribe Acanthocinini). All three Monochamus species were significantly attracted to the combination of monochamol and host plant volatiles, whereas bark-beetle pheromones plus plant volatiles and plant volatiles alone were minimally attractive. Adding bark-beetle pheromones to the monochamol plus plant volatiles treatment synergised attraction of M. clamator, but not the other two Monochamus species. Acanthocinus princeps was most strongly attracted to the combination of bark-beetle pheromones and plant volatiles, and did not appear to be affected by the presence or absence of monochamol in baits. We conclude that monochamol is a likely pheromone component for the three Monochamus species, and that monochamol plus host plant volatiles is an effective attractant for these and perhaps other North American Monochamus species.
In this study, we assessed the relationship between the size of bolts cut from pin oak trees, Quercus palustris Münchhausen (Fagaceae), and eastern white pines, Pinus strobus Linnaeus (Pinaceae), and the number and body size of cerambycid beetles (Coleoptera: Cerambycidae) that develop within them. From oak bolts emerged adult Graphisurus fasciatus (De Geer) (98% of beetles) and Xylotrechus colonus (Fabricius), while pine bolts produced Monochamus carolinensis (Olivier) (95%) and Astylopsis sexguttata (Say). The number of G. fasciatus was positively correlated with the diameter of the oak bolts, while the greatest number of M. carolinensis emerged from pine bolts of intermediate diameter. Body size of both species was positively correlated with bolt diameter. Rates of parasitism were very low, only 0.9% for oaks, and averaging 5.3 ± 8.6% across pine bolts. Oak bolts yielded the braconid wasps (Hymenoptera: Braconidae) Wroughtonia ferruginea (Brues) and a species in the genus Atanycolus Förster (similar to Atanycoluscharus (Riley)), and an ichneumonid (Hymenoptera: Ichneumonidae) in the genus Demopheles Förster. Pine bolts produced a braconid in the genus Digonogastra Viereck, and the tachinid fly (Diptera: Tachinidae) Billaea monohammi (Townsend).
Social Complexity in Prehistoric Eurasia challenges current interpretations of the emergence, development, and decline of social complexity in the steppe region of China and the former Soviet Union. Through a thematic investigation of archaeological patterns ranging from monument construction and use and production and consumption of metals to the nature of mobility among societies, the essays in this volume provide the most up-to-date thinking on social and cultural change in prehistoric Eurasia. Collectively, they challenge broader theoretical trends in Anglo-American archaeology, which have traditionally favored comparative studies of sedentary agricultural societies over mobile pastoralist or agro-pastoralist communities. By highlighting the potential and limitations of comparative studies of social complexity, this volume sets the agenda for future studies of this region of the world. It emphasizes how the unique nature of early steppe societies can contribute to more comprehensive interpretations of social trajectories in world prehistory.
This volume brings together a collection of essays that focuses specifically on themes connected with the analysis of social complexity in the third to first millennium bce in the Eurasian steppe. This dialogue stems from a symposium held at the University of Pittsburgh in February 2006 that sought to evaluate current trends and to determine new directions for the study of Eurasian steppe archaeology. What became apparent during this meeting was that the steppe region has moved firmly into the spotlight of world prehistory and contemporary archaeological theory. No longer viewed as closed geopolitical spheres, the territories of the former Soviet Union and neighboring regions, and the traditions of research that have addressed these areas, have become promising new arenas of international collaboration. Important questions surrounding the emergence and diffusion of agricultural and pastoral adaptations, early metallurgical technologies and their use, and the role of mobile pastoralist societies in China, Central Asia, and Europe have become significant topics within scholarly discourse in recent years. Such issues are clearly reflected in the publication of three new, seminal books in 2007 on the Bronze and Iron Ages of the steppe region (Anthony 2007 ; Kohl 2007 ; Koryakova and Epimakhov 2007).
The chapters offered within this volume not only examine these important issues in steppe archaeology but also seek to contribute more specifically to a broader comparative theoretical analysis of early social complexity in world prehistory.