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The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.
Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]).
Results:
For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms.
Conclusion:
Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.
Drawn from the concept of the powered air purifying respirator (PAPR), the AerosolVE helmet creates a personal negative pressure space to contain aerosolized infectious particles produced by patients, making the cabin of an EMS vehicle safer for providers. The helmet was developed initially for use in hospitals and could be of significant use in the prehospital setting. The objective of this study was to determine the efficacy and safety of the helmet in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, a medical helicopter, and a medical jet. Sodium chloride particles were used to simulate infectious particles, and particle counts were obtained in numerous locations close to the helmet and around the patient compartment. Counts near the helmet were compared to ambient air with and without use of AGPs (non-rebreather mask [NRB], continuous positive airway pressure mask [CPAP], and high-flow nasal cannula [HFNC]).
Results:
Without the helmet fan on, the particle generator alone and with all AGPs produced particle counts inside the helmet significantly higher than ambient particle counts. With the fan on, there was no significant difference in particle counts around the helmet compared to baseline ambient particle counts. Particle counts at the filter exit averaged less than one despite markedly higher particle counts inside the helmet.
Conclusion:
Given the risk to EMS providers by communicable respiratory diseases, development of devices to improve safety while still enabling use of respiratory therapies is of paramount importance. The AerosolVE helmet demonstrated efficacy in creating a negative pressure environment and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
Archaeologists have long subjected Clovis megafauna kill/scavenge sites to the highest level of scrutiny. In 1987, a Columbian mammoth (Mammuthus columbi) was found in spatial association with a small artifact assemblage in Converse County, Wyoming. However, due to the small tool assemblage, limited nature of the excavations, and questions about the security of the association between the artifacts and mammoth remains, the site was never included in summaries of human-killed/scavenged megafauna in North America. Here we present the results of four field seasons of new excavations at the La Prele Mammoth site that confirm the presence of an associated cultural occupation based on geologic context, artifact attributes, spatial distributions, protein residue analysis, and lithic microwear analysis. This new work identified a more extensive cultural occupation including the presence of multiple discrete artifact clusters in close proximity to the mammoth bone bed. This study confirms the presence of a second Clovis mammoth kill/scavenge site in Wyoming and shows the value in revisiting proposed terminal Pleistocene kill/scavenge sites.
We study particle capture on an angled cylinder at a range of Péclet numbers. This system was inspired by the plumose antennae of certain species of male moths that intercept female pheromones at low Péclet numbers of 0.9–23. We use confocal microscopy to measure the branching patterns of 49 moths, spanning 12 families and two orders of magnitude in mass. Among the three levels of hierarchy in antennae, we find the middle level has a prevalent branching angle, $52^{\circ }\pm 12^{\circ }$ across our study set. Such intermediate branching angles are a surprising way to intercept molecules because they do not maximize the exposed surface area. To understand the benefits of angling cylinders into the flow, we study particle collection at high Péclet number using $10~\unicode[STIX]{x03BC}\text{m}$ drops that are several orders of magnitude larger than moth pheromones. Wind tunnel tests show that cylinders angled at $30^{\circ }{-}60^{\circ }$ are optimal for collection of particles, collecting 30 % more than when perpendicular to the flow. Simulations and smoke visualization show that angled cylinders bend incoming streamlines, creating a lingering effect near the cylinder that can enhance deposition by diffusion. We surmise that the optimal angle arises from a trade-off between the lingering effect, which decreases with increasing angle of the cylinder, and the cylinder’s increasing projected area as it is turned more perpendicular to the flow. Using a mathematical model, we show that only cylinders at low Péclet number show improved collection at intermediate angles. Thus, we cannot rationalize the high collection rates in our wind tunnel experiments at high Péclet number. We hope that our study will inspire more research into bio-inspired particle collection of angled surfaces, and find applications in sensors and filters.
Let $M$ be a regular matroid. The Jacobian group $\text{Jac}(M)$ of $M$ is a finite abelian group whose cardinality is equal to the number of bases of $M$. This group generalizes the definition of the Jacobian group (also known as the critical group or sandpile group) $\operatorname{Jac}(G)$ of a graph $G$ (in which case bases of the corresponding regular matroid are spanning trees of $G$). There are many explicit combinatorial bijections in the literature between the Jacobian group of a graph $\text{Jac}(G)$ and spanning trees. However, most of the known bijections use vertices of $G$ in some essential way and are inherently ‘nonmatroidal’. In this paper, we construct a family of explicit and easy-to-describe bijections between the Jacobian group of a regular matroid $M$ and bases of $M$, many instances of which are new even in the case of graphs. We first describe our family of bijections in a purely combinatorial way in terms of orientations; more specifically, we prove that the Jacobian group of $M$ admits a canonical simply transitive action on the set ${\mathcal{G}}(M)$ of circuit–cocircuit reversal classes of $M$, and then define a family of combinatorial bijections $\unicode[STIX]{x1D6FD}_{\unicode[STIX]{x1D70E},\unicode[STIX]{x1D70E}^{\ast }}$ between ${\mathcal{G}}(M)$ and bases of $M$. (Here $\unicode[STIX]{x1D70E}$ (respectively $\unicode[STIX]{x1D70E}^{\ast }$) is an acyclic signature of the set of circuits (respectively cocircuits) of $M$.) We then give a geometric interpretation of each such map $\unicode[STIX]{x1D6FD}=\unicode[STIX]{x1D6FD}_{\unicode[STIX]{x1D70E},\unicode[STIX]{x1D70E}^{\ast }}$ in terms of zonotopal subdivisions which is used to verify that $\unicode[STIX]{x1D6FD}$ is indeed a bijection. Finally, we give a combinatorial interpretation of lattice points in the zonotope $Z$; by passing to dilations we obtain a new derivation of Stanley’s formula linking the Ehrhart polynomial of $Z$ to the Tutte polynomial of $M$.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
The Mental Capacity Act (MCA) 2005 (Mental Capacity Act 2005) has had an unprecedented impact on psychiatric practice in England and Wales. The MCA originally arose out of the need to protect individuals lacking capacity in settings aside from mainstream mental health services, where the Mental Health Act 1983 (MHA) (Mental Health Act 1983) provided the dominant legal framework. However the Acts interact in complex ways (Brown et al., 2013; Owen et al., 2009), and increasingly it is expected that mental capacity will be assessed in the context of a decision around admission and treatment in a psychiatric hospital, even if the MHA is ultimately to be used and lack of mental capacity often may act as a gateway into the use of the MHA. Patients who are undergoing inpatient psychiatric treatment must have their authorisation of treatment carefully characterised (Care Quality Commission, 2015/2016), and the new MHA Code of Practice (Mental Health Act 2015) stresses the importance of supporting mental capacity and responding to patients’ ‘wishes and feelings’.
Consent to research with decision-making capacity for research (DMC-R) is normally a requirement for study participation. Although the symptoms of schizophrenia and related psychoses are known to affect decision-making capacity for treatment (DMC-T), we know little about their effect on DMC-R.
Aims
We aimed to determine if DMC-R differs from DMC-T in proportion and associated symptoms in an in-patient sample of people with schizophrenia and related psychoses.
Method
Cross-sectional study of psychiatric in-patients admitted for assessment and/or treatment of schizophrenia and related psychoses. We measured DMC-R and DMC-T using ‘expert judgement’ clinical assessment guided by the MacArthur Competence Assessment Tool for Clinical Research, the MacArthur Competence Assessment Tool for Treatment and the legal framework of the Mental Capacity Act (2005), in addition to symptoms of psychosis.
Results
There were 84 participants in the study. Half the participants had DMC-R (51%, 95% CI 40–62%) and a third had DMC-T (31%, 95% CI 21–43%) and this difference was statistically significant (P < 0.01). Thought disorder was most associated with lacking DMC-R (odds ratio 5.72, 95% CI 2.01–16.31, P = 0.001), whereas lack of insight was most associated with lacking DMC-T (odds ratio 26.34, 95% CI 3.60–192.66, P = 0.001). With the exception of improved education status and better DMC-R, there was no effect of sociodemographic variables on either DMC-R or DMC-T.
Conclusions
We have shown that even when severely unwell, people with schizophrenia and related psychoses in in-patient settings commonly retain DMC-R despite lacking DMC-T. Furthermore, different symptoms have different effects on decision-making abilities for different decisions. We should not view in-patient psychiatric settings as a research ‘no-go area’ and, where appropriate, should recruit in these settings.
Contrary to prior expectations that warming would cause mass addition averaged over the Greenland and Antarctic ice sheets and over the next century, the ice sheets appear to be losing mass, at least partly in response to recent warming. With warming projected for the future, additional mass loss appears more likely than not.
Vigorous flow of central regions of Ice Stream C, West Antarctica, near the UpC camp ended about the year 1830, based on analysis of a firn and ice core taken at the camp. Ice-stream flow was characterized by repeated fracturing and healing, probably subsurface, especially near the onset of streaming flow. High longitudinal stresses caused fracturing, recrystallization of the ice and elongation of bubbles, and enhanced densification rates of high-density firn indicating power-law-creep behavior.
The Holocene portion of the Siple Dome (Antarctica) ice core was dated by interpreting the electrical, visual and chemical properties of the core. The data were interpreted manually and with a computer algorithm. The algorithm interpretation was adjusted to be consistent with atmospheric methane stratigraphic ties to the GISP2 (Greenland Ice Sheet Project 2) ice core, 10Be stratigraphic ties to the dendrochronology 14 C record and the dated volcanic stratigraphy. The algorithm interpretation is more consistent and better quantified than the tedious and subjective manual interpretation.
The WAIS (West Antarctic Ice Sheet) Divide deep ice core was recently completed to a total depth of 3405 m, ending 50 m above the bed. Investigation of the visual stratigraphy and grain characteristics indicates that the ice column at the drilling location is undisturbed by any large-scale overturning or discontinuity. The climate record developed from this core is therefore likely to be continuous and robust. Measured grain-growth rates, recrystallization characteristics, and grain-size response at climate transitions fit within current understanding. Significant impurity control on grain size is indicated from correlation analysis between impurity loading and grain size. Bubble-number densities and bubble sizes and shapes are presented through the full extent of the bubbly ice. Where bubble elongation is observed, the direction of elongation is preferentially parallel to the trace of the basal (0001) plane. Preferred crystallographic orientation of grains is present in the shallowest samples measured, and increases with depth, progressing to a vertical-girdle pattern that tightens to a vertical single-maximum fabric. This single-maximum fabric switches into multiple maxima as the grain size increases rapidly in the deepest, warmest ice. A strong dependence of the fabric on the impurity-mediated grain size is apparent in the deepest samples.
The Wold Bison Jump (48JO966) is a communal bison (Bison bison) hunting site in Johnson County, Wyoming. It likely represents a single kill event precipitated by Great Plains foragers between A.D. 1433 and 1643. Operating the jump required that prehistoric hunters drive stampeding bison up a steep slope in order to position them within a V-shaped drive line configured to funnel them toward a cliff. Using iterative models of least cost paths, topographic cross-sections, and visibility analysis, we test which landscape-embedded variables are optimized at the jump site as compared to other potential localities across the study area. We find that this site’s placement is primarily explained by minimizing the distance at which the cliff face is visible and secondarily by minimizing the cost of slope and curvature routes ascending into the drive lines. Our procedure could hypothetically be used to predict optimal jump locations on similar landscapes.
Charles Darwin's tangled bank provides one of the best-known early descriptions of an ecosystem:
It is interesting to contemplate a tangled bank, clothed with many plants of many kinds, with birds singing on the bushes, with various insects flitting about, and with worms crawling through the damp earth, and to reflect that these elaborately constructed forms, so different from each other, and dependent on each other in so complex a manner…
This description highlights much of the complexity of ecosystems, comprising various biotic components (plants, vertebrates and invertebrates), abiotic factors (soil) and environmental conditions (humidity). Even though this list comprises only a fraction of the likely diversity within the ecosystem, and Darwin has combined many individual species into single groups (plants, birds, insects), the stated inter-dependencies emphasise the large number of potential direct and indirect interactions that may occur among the various components, and between them and the environment.
Understanding the functioning of ecosystems, determining the factors underlying their structure and predicting their responses to perturbations are major challenges that have formed the lifeblood of population, community and ecosystem ecology for decades. Given the daunting task of addressing these issues empirically, mathematical models have played a vital role in this research. By simplifying the complexity of an ecosystem, formalising hypotheses and often producing testable predictions, mathematical models can provide invaluable insights into the processes shaping ecosystems and, from an applied perspective, inform the development of management policies (e.g. species conservation, land management, harvesting regimes).
The role of the primary care mental health worker (PCMHW) in providing self-help and signposting to people referred for mild-moderate anxiety and depression is currently being complemented by low-intensity workers training under the government’s improving access to psychological therapies (IAPT) programme.
Aim
This study aims to explore the experiences of five PCMHWs working in the context of a newly designed primary care mental health team in London.
Methods
Thematic analysis of participants’ written reflective papers provides a qualitative exploration of issues and concerns raised by PCMHWs during a fortnightly reflective practice group.
Results
Themes emerging from participants’ written accounts highlight: difficulties in applying academic and skills training to the real-life world of clinical practice; difficulties in managing issues of risk and complexity; role confusion; and the need for a visible and coherent career structure.
Conclusions
The study highlights the psychological impact on PCMHWs of managing complex client referrals. This is discussed in the context of the high volume case turnover anticipated by IAPT training curricula. Implications for the training and education of IAPT low-intensity workers are briefly considered.