An Emergency Medical Services Toolkit for Improving Systems of Care for Stroke in North Carolina

The Centers for Disease Control and Prevention is partnering with the National Association of Chronic Disease Directors and the North Carolina Office of EMS to design, develop, and implement an emergency medical services (EMS) performance improvement toolkit to evaluate opportunities to improve the emergency identification and treatment of acute stroke. The EMS Acute Stroke Care Toolkit is being developed, tested, and implemented in all 100 counties in the state by the EMS Performance Improvement Center, the agency that provides technical assistance for EMS in North Carolina. The toolkit helps each EMS system in defining, measuring, and analyzing their system of care and promotes collaboration through public education, regional stroke planning with hospitals, EMS service configuration, EMS staffing patterns, EMS education, and timely care delivery. We outline the issues surrounding acute stroke care, the role of emergency medical systems in stroke care, and the components of the EMS Acute Stroke Care Toolkit designed to improve EMS systems and outcomes for stroke patients

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Polybrominated Diphenyl Ether Accumulation in an Agricultural Soil Ecosystem Receiving Wastewater Sludge Amendments

Few studies have addressed bioaccumulation of organic pollutants associated with land-application of biosolids. We thus examined PBDE burdens within a soil ecosystem receiving long-term sludge amendments and a reference soil ecosystem receiving only manure inputs. No PBDEs were detected in reference site samples, but sludge-amended soils contained 17 600 ± 2330 μg/kg ∑_3–7PBDE (total organic carbon (TOC) basis). ∑_3–7PBDE burdens were highest in soil invertebrates with the greatest contact with sludge-amended soil (e.g., ∑_3–7PBDE of 10 300 ± 2670 and 3000 ± 200 μg/kg lipid for earthworms and detritivorous woodlice, respectively). PBDEs were below quantitation limits in vegetation from the sludge-amended site. Surprisingly, we measured quantifiable PBDE burdens in only a single sample of predaceous ground spiders from the sludge-amended site. BDE-209 burdens in sludge-amended soil and earthworms were 7500 ± 2800 μg/kg TOC and 6500 ± 4100 μg/kg lipid, respectively. BDE 209 was detected in fewer taxa, but the burden in a detritivorous millipede composite was high (86 000 μg/kg lipid). PBDE congener patterns differed among species, with worms and ground beetles exhibiting Penta-BDE-like patterns. Penta-BDE biota-soil accumulation factors (BSAFs) ranged from 0.006 to 1.2, while BDE-209 BSAFs ranged from 0.07 to 10.5. δ¹³C and δ¹⁵N isotope signatures were poorly correlated with PBDE burdens, but sludge-amended samples were significantly δ¹⁵N enriched

Radiosondes Show That After Decades of Cooling, the Lower Stratosphere Is Now Warming

Since the mid-twentieth century, radiosonde and satellite measurements show that the troposphere has warmed and the stratosphere has cooled. These changes are primarily due to increasing concentrations of well-mixed greenhouse gases and the depletion of stratospheric ozone. In response to continued greenhouse gas increases and stratospheric ozone depletion, climate models project continued tropospheric warming and stratospheric cooling over the coming decades. Global average satellite observations of lower stratospheric temperatures exhibit no significant trends since the turn of the century. In contrast, an analysis of vertically resolved radiosonde measurements from 60 stations shows an increase of lower stratospheric temperature since the turn of the century at altitudes between 15 and 30 km and over most continents. Trend estimates are somewhat sensitive to homogeneity assessment choices, but all investigated radiosonde data sets suggest a change from late twentieth century cooling to early 21st century warming in the lower stratosphere, which is consistent with a reversal from ozone depletion to recovery from the effects of ozone-depleting substances. In comparison, satellite observations at the radiosonde locations show only minor early 21st century warming, possibly due to the compensating effects of continued cooling above the radiosonde altitude range