Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers

BACKGROUND: The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. METHODS: ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling. RESULTS: Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p \u3c 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling. CONCLUSIONS: In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options

National inventory of emergency departments in Singapore

Background: Emergency departments (EDs) are the basic units of emergency care. We performed a national inventory of all Singapore EDs and describe their characteristics and capabilities. Methods: Singapore EDs accessible to the general public 24/7 were surveyed using the National ED Inventories instrument ( http://www.emnet-nedi.org). ED staff members were asked about ED characteristics with reference to calendar year 2007. Results: Fourteen EDs participated (100% response). All EDs were located in hospitals, and most (92%) were independent departments. One was a psychiatric ED; the rest were general EDs. Among general EDs, all had a contiguous layout, with medical and surgical care provided in one area. All but two EDs saw both adults and children; one ED was adult-only, and the other saw only children. Six were in the public sector and seven in private health-care institutions, with public EDs seeing the majority (78%) of ED patients. Each private ED had an annual patient census of 60,000. They received 98% of ambulances and had an inpatient admission rate of 30%. Two public EDs reported being overcapacity; no private EDs did. For both public and private EDs, availability of consultant resources in EDs was high, while technological resources varied. Conclusion: Characteristics and capabilities of Singapore EDs varied and were largely dependent on whether they are in public or private hospitals. This initial inventory establishes a benchmark to further monitor the development of emergency care in Singapore

Sub-luminous type Ia supernovae from the mergers of equal-mass white dwarfs with M~0.9 M_sun

Type Ia supernovae (SNe Ia) are thought to result from thermonuclear explosions of carbon-oxygen white dwarf stars. Existing models generally explain the observed properties, with the exception of the sub-luminous 1991-bg-like supernovae. It has long been suspected that the merger of two white dwarfs could give rise to a type Ia event, but hitherto simulations have failed to produce an explosion. Here we report a simulation of the merger of two equal-mass white dwarfs that leads to an underluminous explosion, though at the expense of requiring a single common-envelope phase, and component masses of ~0.9 M_sun. The light curve is too broad, but the synthesized spectra, red colour and low expansion velocities are all close to what is observed for sub-luminous 1991bg-like events. While mass ratios can be slightly less than one and still produce an underluminous event, the masses have to be in the range 0.83-0.9 M_sun.Comment: Accepted to Natur

Is Mitigation Translocation an Effective Strategy for Conserving Common Chuckwallas?

Mitigation translocation remains a popular conservation tool despite ongoing debate regarding its utility for population conservation. To add to the understanding of the effectiveness of mitigation translocation, in 2017 and 2018 we monitored a population of protected common chuckwallas (Sauromalus ater) following translocation away from the area of construction of a new highway near the South Mountains, Phoenix, Arizona, USA. We removed chuckwallas from the construction right-of-way, paint-marked and pit-tagged them, and then released them in a nearby municipal preserve. We deployed very high frequency radio-telemetry transmitters on a sub-sample of 15 translocated adult chuckwallas. We monitored the radio-marked chuckwallas once a day at 1- to 3-day intervals for up to 46 days to document survival, body mass, and post-release movements. The average distance moved following translocation was 359 ± 53 m. Using minimum convex polygons, the average home range size of translocated lizards was 0.9 ± 0.3 ha, which was 18–45 times larger than expected for the species. Following translocations, we surveyed the translocation sites 1 month later and again 1 year later to determine the presence of translocated chuckwallas. Translocated individuals were rarely observed a second time: in 2017, only 11 of 160 translocated chuckwallas were seen again, and in 2018, only 11 of 192 translocated chuckwallas were detected. In the light of low recapture rate, consistent loss of body mass, and large movements of marked lizards, we conclude that survival of translocated chuckwallas was low over a single year. In the future, efficacy of mitigation translocation could be better evaluated by assessing the spatial ecology of both resident and translocated individuals simultaneously using radio-telemetry

The late-time light curve of the type Ia supernova SN 2011fe

We present late-time optical $R$-band imaging data from the Palomar Transient Factory (PTF) for the nearby type Ia supernova SN 2011fe. The stacked PTF light curve provides densely sampled coverage down to $R\simeq22$ mag over 200 to 620 days past explosion. Combining with literature data, we estimate the pseudo-bolometric light curve for this event from 200 to 1600 days after explosion, and constrain the likely near-infrared contribution. This light curve shows a smooth decline consistent with radioactive decay, except over ~450 to ~600 days where the light curve appears to decrease faster than expected based on the radioactive isotopes presumed to be present, before flattening at around 600 days. We model the 200-1600d pseudo-bolometric light curve with the luminosity generated by the radioactive decay chains of $^{56}$Ni, $^{57}$Ni and $^{55}$Co, and find it is not consistent with models that have full positron trapping and no infrared catastrophe (IRC); some additional energy escape other than optical/near-IR photons is required. However, the light curve is consistent with models that allow for positron escape (reaching 75% by day 500) and/or an IRC (with 85% of the flux emerging in non-optical wavelengths by day 600). The presence of the $^{57}$Ni decay chain is robustly detected, but the $^{55}$Co decay chain is not formally required, with an upper mass limit estimated at 0.014 M$_{\odot}$. The measurement of the $^{57}$Ni/$^{56}$Ni mass ratio is subject to significant systematic uncertainties, but all of our fits require a high ratio >0.031 (>1.3 in solar abundances).Comment: 17 pages, 12 figures; accepted for publication in MNRA

Impending Regeneration Failure of the IUCN Vulnerable Borneo Ironwood (Eusideroxylon zwageri)

The regeneration of many climax species in tropical forest critically depends on adequate seed dispersal and seedling establishment. Here, we report the decreased abundance and increased spatial aggregation of younger trees of the Borneo ironwood (Eusideroxylon zwageri) in a protected forest in Sabah Malaysia. We observed a high level of seedling herbivory with strong density dependence, likely exacerbated by local aggregation and contributing to the progressively shrinking size distribution. We also note the largely undocumented selective herbivory by sambar deer on E. zwageri seedlings. This study highlights the combined impact of altered megafauna community on a tree population through interlinked ecological processes and the need for targeted conservation intervention for this iconic tropical tree species

Opportunity Mars Rover mission: Overview and selected results from Purgatory ripple to traverses to Endeavour crater

Opportunity has been traversing the Meridiani plains since 25 January 2004 (sol 1), acquiring numerous observations of the atmosphere, soils, and rocks. This paper provides an overview of key discoveries between sols 511 and 2300, complementing earlier papers covering results from the initial phases of the mission. Key new results include (1) atmospheric argon measurements that demonstrate the importance of atmospheric transport to and from the winter carbon dioxide polar ice caps; (2) observations showing that aeolian ripples covering the plains were generated by easterly winds during an epoch with enhanced Hadley cell circulation; (3) the discovery and characterization of cobbles and boulders that include iron and stony‐iron meteorites and Martian impact ejecta; (4) measurements of wall rock strata within Erebus and Victoria craters that provide compelling evidence of formation by aeolian sand deposition, with local reworking within ephemeral lakes; (5) determination that the stratigraphy exposed in the walls of Victoria and Endurance craters show an enrichment of chlorine and depletion of magnesium and sulfur with increasing depth. This result implies that regional‐scale aqueous alteration took place before formation of these craters. Most recently, Opportunity has been traversing toward the ancient Endeavour crater. Orbital data show that clay minerals are exposed on its rim. Hydrated sulfate minerals are exposed in plains rocks adjacent to the rim, unlike the surfaces of plains outcrops observed thus far by Opportunity. With continued mechanical health, Opportunity will reach terrains on and around Endeavour’s rim that will be markedly different from anything examined to date.Additional co-authors: RM Haberle, KE Herkenhoff, JA Herman, KD Iagnemma, BL Jolliff, JR Johnson, G Klingelhöfer, AH Knoll, AT Knudson, R Li, SM McLennan, DW Mittlefehldt, RV Morris, TJ Parker, MS Rice, LA Soderblom, SW Squyres, RJ Sullivan, MJ Wolf

Population Pharmacokinetics of Piperacillin Using Scavenged Samples From Preterm Infants

Piperacillin is often used in preterm infants for intra-abdominal infections; however, dosing has been derived from small single-center studies excluding extremely preterm infants at highest risk for these infections. We evaluated the population pharmacokinetics (PK) of piperacillin using targeted sparse sampling and scavenged samples obtained from preterm infants ≤32 weeks gestational age at birth and <120 postnatal days

Population Pharmacokinetics of Metronidazole Evaluated Using Scavenged Samples from Preterm Infants

ABSTRACT Pharmacokinetic (PK) studies in preterm infants are rarely conducted due to the research challenges posed by this population. To overcome these challenges, minimal-risk methods such as scavenged sampling can be used to evaluate the PK of commonly used drugs in this population. We evaluated the population PK of metronidazole using targeted sparse sampling and scavenged samples from infants that were ≤32 weeks of gestational age at birth and 8 mg/liter was calculated. Monte Carlo simulations were performed to evaluate the adequacy of different dosing recommendations per gestational age group. Thirty-two preterm infants were enrolled: the median (range) gestational age at birth was 27 (22 to 32) weeks, postnatal age was 41 (0 to 97) days, postmenstrual age (PMA) was 32 (24 to 43) weeks, and weight was 1,495 (678 to 3,850) g. The final PK data set contained 116 samples; 104/116 (90%) were scavenged from discarded clinical specimens. Metronidazole population PK was best described by a 1-compartment model. The population mean clearance (CL; liter/h) was determined as 0.0397 × (weight/1.5) × (PMA/32) 2.49 using a volume of distribution ( V ) (liter) of 1.07 × (weight/1.5). The relative standard errors around parameter estimates ranged between 11% and 30%. On average, metronidazole concentrations in scavenged samples were 30% lower than those measured in scheduled blood draws. The majority of infants (>70%) met predefined pharmacodynamic efficacy targets. A new, simplified, postmenstrual-age-based dosing regimen is recommended for this population. Minimal-risk methods such as scavenged PK sampling provided meaningful information related to development of metronidazole PK models and dosing recommendations