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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
Various genetic models have been proposed for the supergiant Proterozoic Broken Hill Pb–Zn–Ag deposit largely based on geological and geochronological evidence. Here we present Zn, Cd and S isotope compositions as well as Zn/Cd ratios of sphalerite from Broken Hill and minor Broken Hill-type deposits (Australia) to help constrain these models but focus on syngenetic and magmatic–hydrothermal processes, since epigenetic models can be rejected because the orebodies were deformed and metamorphosed by the Olarian Orogeny. Values of δ34SVCDT, δ66ZnAA-ETH and δ114CdNIST SRM 3108 for sphalerite from Broken Hill range from +0.27 to +4.73 ‰, −1.15 to +0.46 ‰ and −0.48 to +0.01 ‰, respectively, while those for the smaller Broken Hill-type deposits range from −5.11 to +1.28 ‰, −0.97 to +0.10 ‰ and −1.02 to +2.59 ‰, respectively. By combining published S isotope data of sulfides from the Broken Hill district with those obtained here, the sources of sulfur via thermochemical sulfate reduction, bacterial sulfate reduction and a magmatic origin cannot be distinguished. However, when the S isotope compositions are considered along with the broad range of Cd and Zn isotope data for sphalerite, which are among the lightest and heaviest yet reported for a sulfide deposit, the isotopic datasets are consistent with low-temperature biogenic processes associated with syngenetic deposition of sulfides. Cadmium isotope compositions when coupled with Zn/Cd ratios of sphalerite have previously been used to classify Pb–Zn deposits, including low-temperature, high-temperature and exhalative ores. However, the Zn/Cd ratios of sphalerite from Broken Hill cannot be used for such classification purposes.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Experiencing traumatic life events is associated with an increased risk of common mental disorders (CMDs), but studies investigating this association within Indigenous populations are limited.
Aims
The aim of this study was to investigate associations between trauma and CMDs after controlling for other exposures.
Method
Trauma exposures and CMD diagnoses were determined in a broadly representative sample of 544 Indigenous Australians, using a diagnostic clinical interview. Associations were determined by multivariate logistic regression.
Results
Trauma exposure independently predicted CMDs. After adjustment for potential confounders, trauma exposure was associated with a 4.01-fold increased risk of a diagnosis of a CMD in the past 12 months. The increased risks were 4.38-, 2.65- and 2.78-fold of having an anxiety disorder, mood disorder or a substance use disorder, respectively. Trauma exposure and comorbid post-traumatic stress disorder was associated with a 4.53-fold increased risk of a diagnosis of a mood disorder, 2.47-fold increased risk of a diagnosis of a substance use disorder, and 3.58-fold increased risk of any diagnosis of a CMD, in the past 12 months. Experiencing both sexual and physical violence was associated with a 4.98-fold increased risk of a diagnosis of an anxiety disorder in the past 12 months.
Conclusions
Indigenous Australians experience significantly increased exposure to potentially harmful trauma compared with non-Indigenous Australians. Preventing and healing trauma exposure is paramount to reduce the high burden of CMDs in this population.
Evidence suggests that pregnant women who test positive for COVID-19 may develop more severe illness than non-pregnant women and may be at greater risk for psychological distress. The relationship between COVID-19 status (positive, negative, never tested) and symptoms of depression was examined in a survey study (May to September 2020) of pregnant women (n = 869). Pregnant women who reported testing positive for COVID-19 were significantly more likely to report depressive symptoms compared with women who tested negative (P = 0.027) and women who were never tested (P = 0.005). Findings indicate that pregnant women who test positive for COVID-19 should be screened and monitored for depressive symptoms.
To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.
Materials and methods
An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.
Results
The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.
Conclusions
3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
Introduction: Most current cricothyroidotomy simulation models are either expensive or low fidelity and limit the learner to an unrealistic simulation experience. The goal of this project is to innovate current simulation techniques by 3D printing anatomically accurate trachea models. By doing so emergency cricothyroidotomy simulation can be accessible, high fidelity, cost effective and replicable. Methods: 3D modelling software was used in conjunction with a desktop 3D printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies measuring the dimensions of tracheal anatomy. This ensured an appropriate anatomical landmark design was achieved. Several revisions of the model were designed and qualitatively assessed by medical and simulation professionals to ensure anatomical accuracy that exceeded that of the currently used, low cost, cricothyroidotomy simulation model in St. John’s. Results: Using an entry level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in under 3 hours. Due to its anatomical accuracy, flexibility and durability, this model is ideal for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments and skin for appearance. Conclusion: The end result is a high fidelity simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically land marking, incision and intubation. This design is a novel, easy to manufacture, replicable, low fidelity trachea model that can be used by educators with limited resources such as those in rural and remote areas.
Herbicide applications often do not reach their full potential because only a small amount of the active ingredients reaches the intended targets. Selecting the appropriate application parameters and equipment can allow for improved efficacy. The objective of this research was to evaluate the effect of droplet size on efficacy of six commonly used herbicides. Atrazine (1.12 kg ai ha−1), cloransulam-methyl (0.18 g ai ha−1), dicamba (0.14 kg ae ha−1), glufosinate (0.59 kg ai ha−1), saflufenacil (12.48 g ai ha−1), and 2,4-D (0.20 kg ae ha−1) were applied to seven plant species using an XR11003 nozzle at 138, 276, and 414 kPa and a AI11003 nozzle at 207, 345, and 483 kPa. Each herbicide, nozzle, and pressure combination was evaluated for droplet size spectra. Treatments were applied at 131 L ha−1 to common lambsquarters, common sunflower, shattercane, soybean, tomato, velvetleaf, and volunteer corn. Control from 2,4-D was observed to increase approximately 12% on average for all species except common lambsquarters as droplet size increased from medium to very coarse (Dv0.5 303 to 462 μm; Dv0.5 is droplet size such that 50% of spray volume is contained in droplets of equal or smaller size). Control with atrazine was near 95% for common lambsquarters, common sunflower, and soybean. Atrazine provided the greatest shattercane control using a medium (Dv0.5 325 μm) droplet, whereas the same droplet size provided the lowest tomato control. Control of common lambsquarters, shattercane, and tomato with cloransulam-methyl increased 79% when decreasing droplet size from extremely coarse to fine (Dv0.5 637 to 228 μm). Dicamba control of common lambsquarters increased 17% using a medium droplet compared with a fine droplet (Dv0.5 279 to 204 μm). Dry weight of common sunflower and soybean was reduced 21% using dicamba when using a very coarse spray compared with a fine spray classification (Dv0.5 491 to 204 μm). Common lambsquarters control using glufosinate increased 18% using a fine spray classification (Dv0.5 186 μm) compared with medium (Dv0.5 250 μm) and both very coarse droplet sizes (Dv0.5 470 and 516 μm). Conversely, tomato and velvetleaf control with glufosinate was maximized using a very coarse (Dv0.5 470 and 516 μm) or extremely coarse droplet (Dv0.5 628 μm) with increases of 11 and 25% compared with a fine spray (Dv0.5 186 μm). Saflufenacil control of volunteer corn was 38% greater using extremely coarse droplets (Dv0.5 622 μm) than fine, medium, and very coarse spray classifications (Dv0.5 257 to 514 μm). Overall, spray classifications for the herbicides evaluated play an important role in herbicide efficacy and should be tailored to the herbicide being used and the targeted weed species.
Genomics programs in the weed science community have not developed as rapidly as that of other crop, horticultural, forestry, and model plant systems. Development of genomic resources for selected model weeds are expected to enhance our understanding of weed biology, just as they have in other plant systems. In this report, we describe the development, characteristics, and information gained from an expressed sequence tag (EST) database for the perennial weed leafy spurge. ESTs were obtained using a normalized cDNA library prepared from a comprehensive collection of tissues. During the EST characterization process, redundancy was minimized by periodic subtractions of the normalized cDNA library. A sequencing success rate of 88% yielded 45,314 ESTs with an average read length of 671 nucleotides. Using bioinformatic analysis, the leafy spurge EST database was assembled into 23,472 unique sequences representing 19,015 unigenes (10,293 clusters and 8,722 singletons). Blast similarity searches to the GenBank nonredundant protein database identified 18,186 total matches, of which 14,205 were nonredundant. These data indicate that 77.4% of the 23,472 unique sequences and 74.7% of the 19,015 unigenes are similar to other known proteins. Further bioinformatics analysis indicated that 2,950, or 15.5%, of the unigenes have previously not been identified suggesting that some may be novel to leafy spurge. Functional classifications assigned to leafy spurge unique sequences using Munich Information Center for Protein or Gene Ontology were proportional to functional classifications for genes of arabidopsis, with the exception of unclassified or unknowns and transposable elements which were significantly reduced in leafy spurge. Although these EST resources have been developed for the purpose of constructing high-density leafy spurge microarrays, they are already providing valuable information related to sugar metabolism, cell cycle regulation, dormancy, terpenoid secondary metabolism, and flowering.
Chamorro-Premuzic, Winsborough, Sherman, and Hogan (2016) note that new talent signals recently adopted by organizations are related to older selection and assessment methods. Drawing this connection between old and new technologies is helpful; however, viewing new technology as either shiny new objects or a brave new world creates a false dichotomy. Recent technology-enhanced human resources (HR) processes like the widespread use of gamified practices and video-recorded interviewing are not just fads or the beginning of a transformation in HR but rather natural evolutions of methods that differ across specific dimensions that can be identified and measured. It is important to view these recent advances as extensions of the existing methods. That is, we need to focus on how these new methods are different and not on that they are different.
We describe bright microwave events that were first detected with the Parkes 64-m telescope at 8.4 or 22 GHz from six active-chromosphere stars. In some flares spectral data were obtained over a large frequency range from simultaneous measurements with the Parkes reflector (8.4 or 22 GHz), the Tidbinbilla interferometer (8.4 and 2.29 GHz), the Fleurs synthesis telescope (1.42 GHz) and the Molonglo Observatory synthesis telescope (0.843 GHz). Data on circular polarization were obtained from the Parkes observations at 8.4 GHz.
The stars were in a wide variety of evolutionary states, ranging from a single pre-main-sequence star (HD 36705), two RS CVn binaries (HD 127535, HD 128171), an Algol (HD 132742) and two apparently single K giants (HD 32918 and HD 196818). Their high brightness temperatures, positive spectral indices and low polarization are consistent with optically thick gyrosynchrotron emission from mildly relativistic electrons with average energies 0.5 to 3 MeV gyrating in inhomogeneous magnetic fields of 5 to 100 G.
Seeing measured in the open air with a differential image motion monitor (DIMM) is compared with seeing measured simultaneously at the Cassegrain focus of the Anglo-Australian Telescope (AAT). It is shown that when the mirror is hotter than the dome air, the AAT’s seeing is degraded by ~1 arcsec per Celsius degree of excess mirror temperature. The consequence of this is that mirror seeing currently contributes significantly to the seeing at the AAT on many nights. A mirror colder than the dome air does not seem to degrade seeing, and neither does an internal-to-external air temperature difference of up to at least 3°C when the venting fans are on.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
To describe the current state of academic emergency medicine (EM) funding in Canada and develop recommendations to grow and establish sustainable funding.
Methods
A panel of eight leaders from different EM academic units was assembled. Using mixed methods (including a literature review, sharing of professional experiences, a survey of current EM academic heads, and data previously collected from an environmental scan), 10 recommendations were drafted and presented at an academic symposium. Attendee feedback was incorporated, and the second set of draft recommendations was further distributed to the Canadian Association Emergency Physicians (CAEP) Academic Section for additional comments before being finalized.
Results
Recommendations were developed around the funding challenges identified and solutions developed by academic EM university-based units across Canada. A strategic plan was seen as integral to achieving strong funding of an EM unit, especially when it aligned with departmental and institutional priorities. A business plan, although occasionally overlooked, was deemed an important component for planning and sustaining the academic mission. A number of recommendations surrounding philanthropy consisted of creating partnerships with existing foundations and engaging multiple stakeholders and communities. Synergy between academic and clinical EM departments was also viewed as an opportunity to ensure integration of common missions. Education and networking for current and future leaders were also viewed as invaluable to ensure that opportunities are optimized through strong leadership development and shared experiences to further the EM academic missions across the country.
Conclusions
These recommendations were designed to improve the financial circumstances for many Canadian EM units. There is a considerable wealth of resources that can contribute to financial stability for an academic unit, and an annual networking meeting and continuing education on these issues will facilitate more rapid implementation of these recommendations.
Against a backdrop of increasing research, clinical and taxonomic attention in non-suicidal self-injury (NSSI), evidence suggests a link between NSSI and eating disorders (ED). The frequency estimates of NSSI in ED vary widely. Little is known about the sources of this variation, and no meta-analysis has quantified the association between ED and NSSI.
Method
Using random-effects meta-analyses, meta-regression analyses, and 1816–6466 unique participants with various ED, we estimated the weighted average percentage of individuals with ED, those with anorexia nervosa (AN) and those with bulimia nervosa (BN) who are reported to have a lifetime history of NSSI across studies. We further examined predictors of NSSI in ED.
Results
The weighted average percentage of patients with a lifetime history of NSSI was 27.3% [95% confidence interval (CI) 23.8–31.0%] for ED, 21.8% (95% CI 18.5–25.6%) for AN, and 32.7% (95% CI 26.9–39.1%) for BN. The difference between BN and AN was statistically significant [odds ratio (OR) 1.77, 95% CI 1.14–2.77, p = 0.013]. The odds of NSSI increased by 24% for every 10% increase in the percentage of participants with histories of suicide attempts (OR 1.24, 95% CI 1.04–1.48, p = 0.020) and decreased by 26% for every 10% increase in the percentage of participants with histories of substance abuse (OR 0.74, 95% CI 0.58–0.95, p = 0.023).
Conclusions
In the specific context of ED, NSSI is highly prevalent and correlates positively with attempted suicide, urging for NSSI-focused treatments. A novel finding is that NSSI is potentially antagonized by substance abuse.
We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.
Methods
We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.
Results
We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.
Conclusions
The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
Congenital abnormalities of the coronary arteries in the absence of structural heart disease account for a small but interesting percentage of cardiac lesions in children. Their presentation may vary from incidental identification to aborted/sudden cardiac death. Patients with aborted sudden death episodes will require significant support if they develop extensive ischaemic myocardial injury. Ultimately, surgical repair should be carried out as soon as haemodynamic stability is attained and the neurological status is evaluated. The aims of this article were to provide a review of congenital abnormalities of the coronary arteries most commonly seen in children in the ICU as well as to review the current critical-care management thereof.