Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Background Point-of-Care ultrasound (POCUS) changes the management in specific groups of patients in the Emergency Department (ED). It seems intuitive that POCUS holds an unexploited potential on a wide variety of patients. However, little is known about the effect of ultrasound on the broad spectrum of unselected patients in the ED. This study aimed to identify the effect on the clinical management if POCUS was applied on unselected patients. Secondarily the study aimed to identify predictors of ultrasound changing management. Methods This study was a blinded observational single center trial. A basic whole body POCUS protocol was performed in extension to the physical examination. The blinded treating physicians were interviewed about the presumptive diagnosis and plan for the patient. Subsequently the physicians were unblinded to the POCUS results and asked to choose between five options regarding the benefit from POCUS results. Results A total of 403 patients were enrolled in this study. The treating physicians regarded POCUS examinations influence on the diagnostic workup or treatment as following: 1) No new information: 249 (61.8%), 2) No further action: 45 (11.2%), 3) Further diagnostic workup needed: 52 (12.9%), 4) Presumptive diagnosis confirmed 38 (9.4%), and 5) Immediate treatment needed: 19 (4.7%). Predictors of beneficial ultrasound were: (a) triage > 1, (b) patient comorbidities (cardiac disease, hypertension or lung disease), or (c) patients presenting with abdominal pain, dyspnea, or syncope. Conclusion POCUS was found to be potentially beneficial in 27.0% of all patients. High triage score, known cardiac disease, hypertension, pulmonary diseases, a clinical presentation with abdominal pain, dyspnea, or syncope are predictors of this. Future research should focus on patient-important outcomes when applying POCUS on these patients. Trial registration The trail was registered prior to patient inclusion with the Danish Data Protection Agency (https://www.datatilsynet.dk/ Case no: 1–16–02-603-14) and Clinical Trials (www.clinicaltrials.gov/ Protocol ID: DNVK1305018)

A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies, quality assurance, collaboration and research in the field of clinical US used in an ED

New generation geostationary satellite observations support seasonality in greenness of the Amazon evergreen forests

Assessing the seasonal patterns of the Amazon rainforests has been difficult because of the paucity of ground observations and persistent cloud cover over these forests obscuring optical remote sensing observations. Here, we use data from a new generation of geostationary satellites that carry the Advanced Baseline Imager (ABI) to study the Amazon canopy. ABI is similar to the widely used polar orbiting sensor, the Moderate Resolution Imaging Spectroradiometer (MODIS), but provides observations every 10–15 min. Our analysis of NDVI data collected over the Amazon during 2018–19 shows that ABI provides 21–35 times more cloud-free observations in a month than MODIS. The analyses show statistically significant changes in seasonality over 85% of Amazon forest pixels, an area about three times greater than previously reported using MODIS data. Though additional work is needed in converting the observed changes in seasonality into meaningful changes in canopy dynamics, our results highlight the potential of the new generation geostationary satellites to help us better understand tropical ecosystems, which has been a challenge with only polar orbiting satellites

Generating Global Leaf Area Index from Landsat: Algorithm Formulation and Demonstration

This paper summarizes the implementation of a physically based algorithm for the retrieval of vegetation green Leaf Area Index (LAI) from Landsat surface reflectance data. The algorithm is based on the canopy spectral invariants theory and provides a computationally efficient way of parameterizing the Bidirectional Reflectance Factor (BRF) as a function of spatial resolution and wavelength. LAI retrievals from the application of this algorithm to aggregated Landsat surface reflectances are consistent with those of MODIS for homogeneous sites represented by different herbaceous and forest cover types. Example results illustrating the physics and performance of the algorithm suggest three key factors that influence the LAI retrieval process: 1) the atmospheric correction procedures to estimate surface reflectances; 2) the proximity of Landsatobserved surface reflectance and corresponding reflectances as characterized by the model simulation; and 3) the quality of the input land cover type in accurately delineating pure vegetated components as opposed to mixed pixels. Accounting for these factors, a pilot implementation of the LAI retrieval algorithm was demonstrated for the state of California utilizing the Global Land Survey (GLS) 2005 Landsat data archive. In a separate exercise, the performance of the LAI algorithm over California was evaluated by using the short-wave infrared band in addition to the red and near-infrared bands. Results show that the algorithm, while ingesting the short-wave infrared band, has the ability to delineate open canopies with understory effects and may provide useful information compared to a more traditional two-band retrieval. Future research will involve implementation of this algorithm at continental scales and a validation exercise will be performed in evaluating the accuracy of the 30-m LAI products at several field sites

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation

Background Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. Methods We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. Results A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. Conclusion The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for

Conserved Secondary Structures in Aspergillus

Background: Recent evidence suggests that the number and variety of functional RNAs (ncRNAs as well as cis-acting RNA elements within mRNAs) is much higher than previously thought; thus, the ability to computationally predict and analyze RNAs has taken on new importance. We have computationally studied the secondary structures in an alignment of six Aspergillus genomes. Little is known about the RNAs present in this set of fungi, and this diverse set of genomes has an optimal level of sequence conservation for observing the correlated evolution of base-pairs seen in RNAs. Methodology/Principal Findings: We report the results of a whole-genome search for evolutionarily conserved secondary structures, as well as the results of clustering these predicted secondary structures by structural similarity. We find a total of 7450 predicted secondary structures, including a new predicted,60 bp long hairpin motif found primarily inside introns. We find no evidence for microRNAs. Different types of genomic regions are over-represented in different classes of predicted secondary structures. Exons contain the longest motifs (primarily long, branched hairpins), 59 UTRs primarily contain groupings of short hairpins located near the start codon, and 39 UTRs contain very little secondary structure compared to other regions. There is a large concentration of short hairpins just inside the boundaries of exons. The density of predicted intronic RNAs increases with the length of introns, and the density of predicted secondary structures within mRNA coding regions increases with the number of introns in a gene

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data