A pilot study of the King LT supralaryngeal airway use in a rural Iowa EMS system

Introduction In 2003, the King Laryngeal Tube (LT) received FDA approval for US sales. Prehospital systems in urban setting have begun evaluating and adopting the LT for clinical airway management. However, it is not routinely approved by State EMS Boards for use by all prehospita

Accumulation of plutonium in mammalian wildlife tissues: comparison of recent data with the ICRP distribution models

We examined the distribution of plutonium (Pu) in the tissues of mammalian wildlife to address the paucity of such data under environmental exposure conditions. Pu activity concentrations were measured in Macropus rufus (red kangaroo), Oryctolagus cuniculus (European rabbit), and Pseudomys hermannsburgensis (sandy inland mouse)inhabiting the relatively undisturbed, semi-arid conditions at the former Taranaki weapons test site at Maralinga, Australia. Of the absorbed Pu (distributed via circulatory and lymph systems) accumulation was foremost in bone (83% ±10% SD), followed by muscle (9% ±10%), liver (7% ±7%), kidneys (0.5% ±0.3%), and heart (0.4% ±0.4%). The bone values are higher than those reported in ICRP 19 and 48 (45-50% bone), while the liver values are lower than ICRP values (30-45% liver). The ICRP values were based on data dominated by relatively soluble forms of Pu, including prepared solutions and single-atom ions produced by decay following the volatilisation of uranium during nuclear detonation (fallout Pu, ICRP 1986). In contrast, the Maralinga data relates to low-soluble forms of Pu used in tests designed to simulate accidental release and dispersal. We measured Pu in lung, GI-tract and the skin and fur as distinct from the absorbed Pu in bone, liver, muscle, and kidneys. Compared with the mean absorbed activity concentrations, the results for lung tissues were higher by up to one order of magnitude, and those in the GI tract contents and the washed skin/fur were higher by more than two orders of magnitude. These elevated levels are consistent with the presence of low-soluble Pu, including particulate forms, which pass through, or adhere upon, certain organs, but are not readily absorbed into the bloodstream. This more transitory Pu can provide dose to the lung and GI tract organs, as well as provide potential transfer of contamination when consumed in predator-prey food chains, or during human foodstuff consumption. For example, activity concentrations in O. cuniculus edible samples prepared according to traditional aboriginal methods were more than two orders of magnitude higher than in muscle alone. The increase was due to inclusion of GI tract components and contents in the traditional method. Our results provide new insights into the sequestration of Pu in mammalian tissues under environmental exposure conditions. These results contrast with those related to the specific forms of Pu and exposure conditions upon which the ICRP models were based. However, they provide data relevant to the assessment of key environmental legacy waste sites, and of potential release scenarios for the low-soluble oxide forms in the growing worldwide inventory of Pu associated with power production

Moving from evidence-based medicine to evidence-based health.

While evidence-based medicine (EBM) has advanced medical practice, the health care system has been inconsistent in translating EBM into improvements in health. Disparities in health and health care play out through patients' limited ability to incorporate the advances of EBM into their daily lives. Assisting patients to self-manage their chronic conditions and paying attention to unhealthy community factors could be added to EBM to create a broader paradigm of evidence-based health. A perspective of evidence-based health may encourage physicians to consider their role in upstream efforts to combat socially patterned chronic disease

The role of mindfulness in distress and quality of life for men with advanced prostate cancer.

OBJECTIVE: To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer. PATIENTS AND METHODS: A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40-91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes. RESULTS: Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months. Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001). Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress was also related to higher non-reactivity to inner experience and a lower level of observing (p < 0.05). CONCLUSIONS: Men with advanced prostate cancer are at risk of poor psychological outcomes. Psychological flexibility may be a promising target for interventions to improve adjustment outcomes in this patient group. CLINICAL TRIAL REGISTRY: Trial Registration: ACTRN12612000306819

Planet Formation by Coagulation: A Focus on Uranus and Neptune

Planets form in the circumstellar disks of young stars. We review the basic physical processes by which solid bodies accrete each other and alter each others' random velocities, and we provide order-of-magnitude derivations for the rates of these processes. We discuss and exercise the two-groups approximation, a simple yet powerful technique for solving the evolution equations for protoplanet growth. We describe orderly, runaway, neutral, and oligarchic growth. We also delineate the conditions under which each occurs. We refute a popular misconception by showing that the outer planets formed quickly by accreting small bodies. Then we address the final stages of planet formation. Oligarchy ends when the surface density of the oligarchs becomes comparable to that of the small bodies. Dynamical friction is no longer able to balance viscous stirring and the oligarchs' random velocities increase. In the inner-planet system, oligarchs collide and coalesce. In the outer-planet system, some of the oligarchs are ejected. In both the inner- and outer-planet systems, this stage ends once the number of big bodies has been reduced to the point that their mutual interactions no longer produce large-scale chaos. Subsequently, dynamical friction by the residual small bodies circularizes and flattens their orbits. The final stage of planet formation involves the clean up of the residual small bodies. Clean up has been poorly explored.Comment: to appear in ARA&A (2004), 51 pages, 3 figure

Persistence of intense, climate-driven runoff late in Mars history

Mars is dry today, but numerous precipitation-fed paleo-rivers are found across the planet’s surface. These rivers’ existence is a challenge to models of planetary climate evolution. We report results indicating that, for a given catchment area, rivers on Mars were wider than rivers on Earth today. We use the scale (width and wavelength) of Mars paleo-rivers as a proxy for past runoff production. Using multiple methods, we infer that intense runoff production of >(3–20) kg/m2 per day persisted until 1 Ga. Our improved history of Mars’ river runoff places new constraints on the unknown mechanism that caused wet climates on Mars.Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial license, which permits use, distribution, and reproduction in any medium, so long as the resultant use is not for commercial advantage and provided the original work is properly cited

Fine-scale spatial variability of heat-related mortality in Philadelphia County, USA, from 1983-2008: a case-series analysis

<p>Abstract</p> <p>Background</p> <p>High temperature and humidity conditions are associated with short-term elevations in the mortality rate in many United States cities. Previous research has quantified this relationship in an aggregate manner over large metropolitan areas, but within these areas the response may differ based on local-scale variability in climate, population characteristics, and socio-economic factors.</p> <p>Methods</p> <p>We compared the mortality response for 48 Zip Code Tabulation Areas (ZCTAs) comprising Philadelphia County, PA to determine if certain areas are associated with elevated risk during high heat stress conditions. A randomization test was used to identify mortality exceedances for various apparent temperature thresholds at both the city and local scale. We then sought to identify the environmental, demographic, and social factors associated with high-risk areas via principal components regression.</p> <p>Results</p> <p>Citywide mortality increases by 9.3% on days following those with apparent temperatures over 34°C observed at 7:00 p.m. local time. During these conditions, elevated mortality rates were found for 10 of the 48 ZCTAs concentrated in the west-central portion of the County. Factors related to high heat mortality risk included proximity to locally high surface temperatures, low socioeconomic status, high density residential zoning, and age.</p> <p>Conclusions</p> <p>Within the larger Philadelphia metropolitan area, there exists statistically significant fine-scale spatial variability in the mortality response to high apparent temperatures. Future heat warning systems and mitigation and intervention measures could target these high risk areas to reduce the burden of extreme weather on summertime morbidity and mortality.</p

An extracellular steric seeding mechanism for Eph-ephrin signaling platform assembly

Erythropoetin-producing hepatoma (Eph) receptors are cell-surface protein tyrosine kinases mediating cell-cell communication. Upon activation, they form signaling clusters. We report crystal structures of the full ectodomain of human EphA2 (eEphA2) both alone and in complex with the receptor-binding domain of the ligand ephrinA5 (ephrinA5 RBD). Unliganded eEphA2 forms linear arrays of staggered parallel receptors involving two patches of residues conserved across A-class Ephs. eEphA2-ephrinA5 RBD forms a more elaborate assembly, whose interfaces include the same conserved regions on eEphA2, but rearranged to accommodate ephrinA5 RBD. Cell-surface expression of mutant EphA2s showed that these interfaces are critical for localization at cell-cell contacts and activation-dependent degradation. Our results suggest a 'nucleation' mechanism whereby a limited number of ligand-receptor interactions 'seed' an arrangement of receptors which can propagate into extended signaling arrays

A reverse engineering approach to the suppression of citation biases reveals universal properties of citation distributions

The large amount of information contained in bibliographic databases has recently boosted the use of citations, and other indicators based on citation numbers, as tools for the quantitative assessment of scientific research. Citations counts are often interpreted as proxies for the scientific influence of papers, journals, scholars, and institutions. However, a rigorous and scientifically grounded methodology for a correct use of citation counts is still missing. In particular, cross-disciplinary comparisons in terms of raw citation counts systematically favors scientific disciplines with higher citation and publication rates. Here we perform an exhaustive study of the citation patterns of millions of papers, and derive a simple transformation of citation counts able to suppress the disproportionate citation counts among scientific domains. We find that the transformation is well described by a power-law function, and that the parameter values of the transformation are typical features of each scientific discipline. Universal properties of citation patterns descend therefore from the fact that citation distributions for papers in a specific field are all part of the same family of univariate distributions.Comment: 9 pages, 6 figures. Supporting information files available at http://filrad.homelinux.or

A Simple Iterative Model Accurately Captures Complex Trapline Formation by Bumblebees Across Spatial Scales and Flower Arrangements

PMCID: PMC3591286This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited