Geographic access to high capability severe acute respiratory failure centers in the United States

Objective: Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Design: Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008-2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Setting: Nonfederal acute care hospitals in the United States. Measurements and Main Results: We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Conclusions: Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will depend highly on local and regional care coordination across political boundaries. © 2014 Wallace et al

High resolution mapping of strains and rotations using electron backscatter diffraction

The angular resolution of electron backscatter diffraction (EBSD) measurements can be significantly improved using an analysis based on determination of small shifts in features from one pattern to the next using cross-correlation functions. Using pattern shift measurements at many regions of the pattern, errors in the best fit strain and rotation tensors can be reduced. The authors show that elements of the strain tensor and small misorientations can be measured to ± 10−4 and ±0·006° for rotations. We apply the technique to two quite different materials systems. First, we determine the elastic strain distribution near the interface in a cross-sectioned SiGe epilayer, Si substrate semiconductor heterostructure. The plane stress boundary conditions at the sample surface are used to separate every term in the strain tensor. Second, the applicability to structural materials is illustrated by determining the lattice curvature caused by dislocations within the plastic zone associated with the wake and tip of a fatigue crack in a Ni based superalloy. The lattice curvatures are used to calculate the geometrically necessary dislocation content in the plastic zone

Quantifying the relative contributions of habitat modification and mammalian predators on landscape-scale declines of a threatened river specialist duck

Habitat modification and introduced mammalian predators are linked to global species extinctions and declines, but their relative influences can be uncertain, often making conservation management difficult. Using landscape-scale models, we quantified the relative impacts of habitat modification and mammalian predation on the range contraction of a threatened New Zealand riverine duck. We combined 38 years of whio (Hymenolaimus malacorhynchos) observations with national-scale environmental data to predict relative likelihood of occurrence (RLO) under two scenarios using bootstrapped boosted regression trees (BRT). Our models used training data from contemporary environments to predict the potential contemporary whio distribution across New Zealand riverscapes in the absence of introduced mammalian predators. Then, using estimates of environments prior to human arrival, we used the same models to hindcast potential pre-human whio distribution prior to widespread land clearance. Comparing RLO differences between potential pre-human, potential contemporary and observed contemporary distributions allowed us to assess the relative impacts of the two main drivers of decline; habitat modification and mammalian predation. Whio have undergone widespread catastrophic declines most likely linked to mammalian predation, with smaller declines due to habitat modification (range contractions of 95% and 37%, respectively). We also identified areas of potential contemporary habitat outside their current range that would be suitable for whio conservation if mammalian predator control could be implemented. Our approach presents a practical technique for estimating the relative importance of global change drivers in species declines and extinctions, as well as providing valuable information to improve conservation planning

Super-resolution electron ptychography of low dimensional materials at 30 keV: beyond the detector limit

We demonstrate that electron ptychographic phase reconstruction can recover spatial frequencies higher than those directly recorded in the experimental electron diffraction patterns. This ability to recover high angle information from the oversampled low angle information allows an annular detector to be inserted which partially shadows a lower pixelated detector to simultaneously record a conventional annular dark field image and a ptychographic dataset. We apply this approach to 30 keV imaging of monolayer molybdenum disulfide and achieve an Abbe limited resolution of 1.2 ± 0.1Å in our reconstructions

The R136 star cluster dissected with Hubble Space Telescope/STIS. I. Far-ultraviolet spectroscopic census and the origin of He II lambda 1640 in young star clusters

We introduce a Hubble Space Telescope (HST)/Space Telescope Imaging Spectrograph (STIS) stellar census of R136a, the central ionizing star cluster of 30 Doradus. We present low resolution far-ultraviolet STIS spectroscopy of R136 using 17 contiguous 52 arcsec × 0.2 arcsec slits which together provide complete coverage of the central 0.85 parsec (3.4 arcsec). We provide spectral types of 90 per cent of the 57 sources brighter than mF555W = 16.0 mag within a radius of 0.5 parsec of R136a1, plus 8 additional nearby sources including R136b (O4 If/WN8). We measure wind velocities for 52 early-type stars from C IVλλ1548–51, including 16 O2–3 stars. For the first time, we spectroscopically classify all Weigelt and Baier members of R136a, which comprise three WN5 stars (a1–a3), two O supergiants (a5–a6) and three early O dwarfs (a4, a7, a8). A complete Hertzsprung–Russell diagram for the most massive O stars in R136 is provided, from which we obtain a cluster age of 1.5 +0.3−0.7 −0.7+0.3 Myr. In addition, we discuss the integrated ultraviolet spectrum of R136, and highlight the central role played by the most luminous stars in producing the prominent He II λ1640 emission line. This emission is totally dominated by very massive stars with initial masses above ∼100 M⊙. The presence of strong He II λ1640 emission in the integrated light of very young star clusters (e.g. A1 in NGC 3125) favours an initial mass function extending well beyond a conventional upper limit of 100 M⊙. We include montages of ultraviolet spectroscopy for Large Magellanic Cloud O stars in the appendix. Future studies in this series will focus on optical STIS medium resolution observations

Exogenous spatial precuing reliably modulates object processing but not object substitution masking

Object substitution masking (OSM) is used in behavioral and imaging studies to investigate processes associated with the formation of a conscious percept. Reportedly, OSM occurs only when visual attention is diffusely spread over a search display or focused away from the target location. Indeed, the presumed role of spatial attention is central to theoretical accounts of OSM and of visual processing more generally (Di Lollo, Enns, & Rensink, Journal of Experimental Psychology: General 129:481–507, 2000). We report a series of five experiments in which valid spatial precuing is shown to enhance the ability of participants to accurately report a target but, in most cases, without affecting OSM. In only one experiment (Experiment 5) was a significant effect of precuing observed on masking. This is in contrast to the reliable effect shown across all five experiments in which precuing improved overall performance. The results are convergent with recent findings from Argyropoulos, Gellatly, and Pilling (Journal of Experimental Psychology: Human Perception and Performance 39:646–661, 2013), which show that OSM is independent of the number of distractor items in a display. Our results demonstrate that OSM can operate independently of focal attention. Previous claims of the strong interrelationship between OSM and spatial attention are likely to have arisen from ceiling or floor artifacts that restricted measurable performance

Pseudomonas aeruginosa Adaptation to Lungs of Cystic Fibrosis Patients Leads to Lowered Resistance to Phage and Protist Enemies

Pathogenic life styles can lead to highly specialized interactions with host species, potentially resulting in fitness trade-offs in other ecological contexts. Here we studied how adaptation of the environmentally transmitted bacterial pathogen, Pseudomonas aeruginosa, to cystic fibrosis (CF) patients affects its survival in the presence of natural phage (14/1, ΦKZ, PNM and PT7) and protist (Tetrahymena thermophila and Acanthamoebae polyphaga) enemies. We found that most of the bacteria isolated from relatively recently intermittently colonised patients (1-25 months), were innately phage-resistant and highly toxic for protists. In contrast, bacteria isolated from long time chronically infected patients (2-23 years), were less efficient in both resisting phages and killing protists. Moreover, chronic isolates showed reduced killing of wax moth larvae (Galleria mellonella) probably due to weaker in vitro growth and protease expression. These results suggest that P. aeruginosa long-term adaptation to CF-lungs could trade off with its survival in aquatic environmental reservoirs in the presence of microbial enemies, while lowered virulence could reduce pathogen opportunities to infect insect vectors; factors that are both likely to result in poorer environmental transmission. From an applied perspective, phage therapy could be useful against chronic P. aeruginosa lung infections that are often characterized by multidrug resistance: chronic isolates were least resistant to phages and their poor growth will likely slow down the emergence of beneficial resistance mutations

Diagnosing problems of fine sediment delivery and transfer in a lowland catchment

This paper is a product of research conducted within the REFORM collaborative project funded by the European Union Seventh Framework Programme under grant agreement 282656