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The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
Methods
The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
Results
Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling.
Conclusion
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
Because polarization encodes geometrical information about unresolved scattering regions, it provides a unique tool for analyzing the 3-D structures of supernovae (SNe) and their surroundings. SNe of all types exhibit time-dependent spectropolarimetric signatures produced primarily by electron scattering. These signatures reveal physical phenomena such as complex velocity structures, changing illumination patterns, and asymmetric morphologies within the ejecta and surrounding material. Interpreting changes in polarization over time yields unprecedentedly detailed information about supernovae, their progenitors, and their evolution.
Begun in 2012, the SNSPOL Project continues to amass the largest database of time-dependent spectropolarimetric data on SNe. I present an overview of the project and its recent results. In the future, combining such data with interpretive radiative transfer models will further constrain explosion mechanisms and processes that shape SN ejecta, uncover new relationships among SN types, and probe the properties of progenitor winds and circumstellar material.
As part of the Canadian Journal of Emergency Medicine’s (CJEM) developing social media strategy,1 we are collaborating with the Skeptics’ Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine (EM) literature using evidence-based medicine principles. In the “Hot Off the Press” series, we select original research manuscripts published in CJEM to be featured on the SGEM website/podcast2 and discussed by the study authors and the online EM community. A similar collaboration is underway between the SGEM and Academic Emergency Medicine. What follows is a summary of the selected article the immediate post-publication synthesis from the SGEM podcast, commentary by the first author, and the subsequent discussion from the SGEM blog and other social media. Through this series, we hope to enhance the value, accessibility, and application of important, clinically relevant EM research. In this, the third SGEM HOP hosted collaboratively with CJEM, we discuss Olszynski et al.’s randomized crossover study evaluating the use of ultrasound simulator devices during critical care simulation.3
We present the observed “continuum” levels of polarization as a function of time for four well-observed Type II-Plateau supernovae (SNe II-P; Fig. 1), the class of SNe decisively determined to arise from red supergiant stars (Smartt 2009). All four objects show temporally increasing degrees of polarization through the end of the photospheric phase, with some exhibiting early-time polarization that challenge existing models (e.g., Dessart and Hillier 2011) to reproduce. A fundamental ejecta asymmetry is present in this photometrically diverse sample of type II SNe, and it probably takes different forms (e.g., 56Ni blobs/fingers, large scale deformation). We acknowledge support from NSF grants AST-1009571 and AST-1210311.
Morphological variation was studied in the crania of seven species of kangaroos and wallabies (Macropus). How function and phylogeny interact to influence cranial form amongst adults of diverse species was considered. Thirty-six, three-dimensional landmarks were acquired on each of 65 adult Macropus specimens from Western Australia. The different species occupy a wide range of habitats and latitudes and there are well-known differences in diet among the species. Size and shape variability was examined using the methods of geometric morphometrics. Aspects of inter-specific variation explained by principal components were visualized and examined for correlations with size, latitude, and diet. The first principal component correlates strongly with inter-specific differences in latitude and it primarily contrasts species on the basis of the relative length of the snout anterior to the molar teeth, this being greater in species that live in cooler climates. Species scores on the second principal component correlate strongly with centroid size such that smaller crania have more flexed muzzles. Principal component three separates the short grass-eating, red kangaroo M. rufus, from all other species (most of which eat tough herbage from trees and shrubs). This principal component represents differences in the masticatory apparatus. Variation on the fourth principal component also seems to be functionally interpretable in terms of further differences in the masticatory apparatus of M. agilis. The relationship between phylogeny and cranial form was investigated by comparing a phenogram based on the shape distances between taxa with a consensus phylogeny drawn from the literature on Macropus genetics, ecology and morphology. The phenogram shows considerable similarity to current taxonomic views, but, our results also indicate differences that are related to function. Thus, this study serves to unravel the interaction of functional and phylogenetic influences on cranial form amongst Macropus species and raises further issues relating to ontogeny and phylogeny.
In the field of flat panel displays, the current leading technology is the Active Matrix liquid Crystal Display; this uses a-Si:H based thin film transistors (TFTs) as the switching element in each pixel. However, under gate bias a-Si:H TFTs suffer from instability, as is evidenced by a shift in the gate threshold voltage. The shift in the gate threshold voltage is generally measured from the gate transfer characteristics, after subjecting the TFT to prolonged gate bias. However, a major drawback of this measurement method is that it cannot distinguish whether the shift is caused by the change in the midgap states in the a-Si:H channel or by charge trapping in the gate insulator. In view of this, we have developed a capacitance-voltage (C-V) method to measure the shift in threshold voltage. We employ Metal-Insulator-Semiconductor (MIS) structures to investigate the threshold voltage shift as they are simpler to fabricate than TFTs. We have investigated a large of number Metal/a-Si:H/Si3N4/Si+n structures using our C-V technique. From, the C-V data for the MIS structures, we have found that the relationship between the thermal energy and threshold voltage shift is similar to that reported by Wehrspohn et. al in a-Si:H TFTs (J Appl. Phys, 144, 87, 2000). The a-Si:H and Si3N4 layers were grown using the radiofrequency plasma-enhanced chemical vapour deposition technique.
Using basic harmonic analysis on the n-torus, it is shown that the non-commutative n-tori are the only primitive C*-algebras (up to isomorphism) on which the n-torus []n acts freely and ergodically. An explicit construction recovers the generating unitaries in a natural way from the action.
This paper is centred around a single question: can a minimal left ideal L in G[Lscr][Uscr][Cscr], the largest semi-group compactification of a locally compact group G, be itself algebraically a group? Our answer is no (unless G is compact). In deriving this conclusion, we obtain for nearly all groups the stronger result that no maximal subgroup in L can be closed. A feature of our work is that completely different techniques are required for the connected and totally disconnected cases. For the former, we can rely on the extensive structure theory of connected, non-compact, locally compact groups to derive the solution from the commutative case, using some reduction lemmas. The latter directly involves topological dynamics; we construct a compact space and an action of G on it which has pathological properties. We obtain other results as tools towards our main goal or as consequences of our methods. Thus we find an extension to earlier work on the relationship between minimal left ideals in G[Lscr][Uscr][Cscr] and H[Lscr][Uscr][Cscr] when H is a closed subgroup of G with G/H compact. We show that the distal compactification of G is finite if and only if the almost periodic compactification of G is finite. Finally, we use our methods to show that there is no finite subset of G[Lscr][Uscr][Cscr] invariant under the right action of G when G is an almost connected group or an IN-group.
Visual analysis, or “eyeballing”, of single subject (N=l) data is the commonest technique for analysing time series data. The present study examined firstly, psychologists' abilities to determine significant change between baseline (A) and therapeutic (B) phases, and secondly, the decision making process in relation to the visual components of such graphs. Thirdly, it looked at the effect that a training programme had on psychologists' abilities to identify significant A−B change. The results revealed that the participants were poor at identifying significant effects from non-significant changes. In particular, the study found a high rate of false alarms (Type 1 errors), and a low rate of misses (Type 2 errors), i.e. high sensitivity but poor specificity. The only visual components to significantly alter decisions were the degree of serial dependency and the mean shift component. The teaching influenced the participants' judgements. In general, participants became more conservative, but there was limited evidence of a significant improvement in their judgements following the teaching.
Compact right topological groups arise naturally as the enveloping semigroups of distal flows. Recently, John Pym and the author established the existence of Haar measure μ on such groups, which invites the consideration of the regular representations. We start here by characterizing the continuous representations of a compact right topological group G, and are led to the conclusion that the right regular representation r is not continuous (unless G is topological). The domain of the left regular representation l is generally taken to be the topological centre
or a tractable subgroup of it, furnished with a topology stronger than the relative topology from G (the goals being to have l both defined and continuous). An analysis of l and r on H = L2(G) for some non-topological compact right topological groups G shows, among other things, that:
(i) for the simplest (perhaps) G generated by ℤ, (l, H) decomposes into one copy of each irreducible representation of ℤ and c copies of the regular representation.
(ii) for the simplest (perhaps) G generated by the euclidean group of the plane , (l, H) decomposes into one copy of each of the continuous one-dimensional representations of and c copies of each continuous irreducible representation Ua,a > 0.
(iii) when Λ(G) is not dense in G, it can seem very reasonable to regard r as a continuous representation of a related compact topological group, and also, G can be almost completely "lost" in the measure space (G, μ).
The consideration of compact right topological groups goes back at least to a paper of Ellis in 1958, where it is shown that a flow is distal if and only if the enveloping semigroup of the flow is such a group (now called the Ellis group of the distal flow). Later Ellis, and also Namioka, proved that a compact right topological group admits a left invariant probability measure. As well, Namioka proved that there is a strong structure theorem for compact right topological groups. More recently, John Pym and the author strengthened this structure theorem enough to be able to establish the existence of Haar measure on a compact right topological group, a probability measure that is invariant under all continuous left and right translations, and is unique as such. Examples of compact right topological groups have been considered earlier. In the present paper, we give concrete representations of several Ellis groups coming from low dimensional nilpotent Lie groups. We study these compact right topological groups, and two others, in some detail, paying attention in particular to the structure theorem and Haar measure, and to the question: is Haar measure uniquely determined by left invariance alone? (It is uniquely determined by right invariance alone.) To assist in answering this question, we develop some sufficient conditions for a positive answer. We suspect that one of the examples, a compact right topological group coming from the Euclidean group of the plane, does not satisfy these conditions; we don't know if the question has a positive answer for this group.
The first examples of Bohr almost periodic functions that are not almost periodic were given by T. -S. Wu. Later, the present author showed that Bohr almost periodic functions could be distal (and not almost periodic) and even merely minimal. Here it is proved that all Bohr almost periodic functions are minimal. The proof yields an unusual feature about the orbit of a Bohr almost periodic function, one which does not characterize Bohr almost periodic functions, but can be used to show that a Bohr almost periodic function f that is point distal must be distal or, if f is almost automorphic, it must be almost periodic. Some pathologies of Bohr almost periodic functions are discussed.
This paper describes the optical and electrical properties of silicon oxide thin films produced using a novel photoenhanced deposition technique. Since there is no damage to the growing film surface from energetic ions, this process has the potential to produce better semiconductor/insulator interfaces than those grown using conventional RF glow discharge techniques. The deposition system is comprised of a windowless nitrogen discharge lamp contained within the reaction vessel. This unified approach allows the low wavelength UV light from the lamp to couple directly into the reaction gases without attenuation by a window material or the need for mercury sensitisation. Thin films of silicon oxide have been deposited onto single crystal silicon wafer substrates from a nitrous oxide/monosilane reaction gas mixture. The deposition rate and physical properties of films produced in this way are comparable to those of high quality insulator films deposited by plasma enhanced CVD techniques. The results of electrical tests indicate that this material could be used as a low temperature deposited insulator for thin film devices.
1.1. The work for the paper was carried out by the authors as members of the Bonus and Valuation Research Group of the Faculty of Actuaries. The previous paper produced as a result of work done in the Bonus Research Group (Studies of Reversionary Bonus using a Model Office, TFA 37, 91) used a deterministic model office. Future interest rates and returns from equity investment were assumed known and the effects on reversionary bonus of variations in the valuation bases, rates of expansion and inflation of expenses were examined. The assumption of an exact knowledge of future investment returns was a great simplification and begged many of the important questions facing a life office actuary. In this paper the Research Group has paid attention to the change in the value of the assets under variations in financial conditions.
A classical result of I. Glicksberg and K. de Leeuw asserts that the almost periodic compactification of a direct product S × T of abelian semigroups with identity is (canonically isomorphic to) the direct product of the almost periodic compactiflcations of S and T. Some efforts have been made to generalize this result and recently H. D. Junghenn and B. T. Lerner have proved a theorem giving necessary and sufficient conditions for an F-compactification of a semidirect product S⊗σT to be a semidirect product of compactiflcations of S and T. A different such theorem is presented here along with a number of corollaries and examples which illustrate its scope and limitations. Some behaviour that can occur for semidirect products, but not for direct products, is exposed
Compact right topological groups appear naturally in topological dynamics. Some continuity properties of the one arising as an enveloping semigroup from the distal function are considered here (and, by way of comparison, the enveloping semigroups arising from two almost automorphic functions are discussed). The continuity properties are established either explicitly or by citing a theorem which is proved here and gives some characterizations of almost periodic functions. One characterization is proved using the result (essentially due to W. A. Veech) that a distal, almost automorphic function is almost periodic. A proof of this last result is also given.