Use, outcomes and policy on the placement of Automated External Defibrillators on commercial aircraft for the management of in-flight cardiac arrest : a scoping review

ABSTRACTIntroduction Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).MethodsA scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.Results  9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery.  Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.ConclusionDespite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.Keywords: cardiac arrest; defibrillators; AED; aircraft; flight

Incentivizing co-management for impact: mechanisms driving the successful national expansion of Tonga's Special Management Area program

The expansion of coastal marine protected areas can suffer from two key drawbacks: (a) the difficulty of incentivizing local communities to manage areas for conservation when their livelihoods also depend on resource use; and (b) that many protected areas get situated residually, or in locations with limited value for either biodiversity conservation or livelihoods. Here, we discuss and analyze key characteristics of Tonga's Special Management Area (SMA) program, including both the mechanisms that have motivated its successful national expansion and its ability to configure no-take reserves in areas that are considered to have high value to resource users. Granting communities exclusive access zones in exchange for implementing no-take reserves has encouraged conservation actions while fostering long-term relationships with resources. Ensuring no-take reserves occurred within the boundaries of exclusive access zones enabled communities to protect areas of greater extractive values than they would have otherwise. We conclude that the success of this program offers a way forward for achieving targets in the global expansion marine protected areas

Effect of Pseudomonas fluorescens proteases on the quality of Cheddar cheese

peer-reviewedThe objective of this study was to investigate the effect of adding different levels of a thermoresistant protease produced by a Pseudomonas fluorescens strain to milk on the manufacture and quality of Cheddar cheese. Fresh raw milk was collected, standardized, and pasteurized at 72°C for 15 s, and the enzyme was added to give a protease activity of 0.15 or 0.60 U/L (treatments P1 and P4, respectively), while one sample had no enzyme added (control). Milk was stored at 4°C for 48 h and Cheddar cheese was manufactured after 0 and 48 h of storage. Results indicated that the protease was active in milk during 48 h of storage; however, its effect on milk composition was minimal. The protein that was preferentially hydrolyzed by the protease over storage was β-casein, followed by κ-casein. The mean cheese yield and recovery of fat and protein obtained for all cheeses were not affected by protease activity. The protease showed low activity during cheese manufacture, possibly because of unfavorable conditions, including low pH. One of the factors that might have influenced protease activity was the pH of the curd (approximately 6.55 after acidification and 5.35 at milling), which was lower than that at which the enzyme would have optimum activity (pH 7 to 9). Consequently, the composition, pH, patterns of proteolysis, and hardness of all cheeses produced were similar and in accordance with values expected for that type of cheese, independently of the protease activity level. However, slight increases in proteolysis were observed in P4 cheeses and produced using milk stored for 48 h. Both the P1 and P4 cheeses had higher concentrations of free amino acids (FAA) compared with the control, whereas urea-PAGE electrophoretograms indicated a greater breakdown of caseins in the P4 cheese samples, which may be related to possible increases in numbers of proteolytic bacteria in milk during storage. Therefore, the thermoresistant psychrotrophic bacterial protease(s) tested in this study may affect the manufacture or quality of Cheddar cheese during ripening to a relatively limited extent. However, controlling initial levels of proteolytic bacteria in raw milk remains essential, because proteolysis affects the development of flavor and texture in cheese

Robust paths to net greenhouse gas mitigation and negative emissions via advanced biofuels

ACKNOWLEDGEMENTS We thank Dennis Ojima and Daniel L. Sanchez for their encouragement on this topic. The authors gratefully acknowledge partial support as follows: J.L.F., L.R.L., T.L.R., E.A.H.S., and J.J.S., the Sao Paulo Research Foundation (FAPESP grant# 2014/26767-9); J.L.F., L.R.L., K.P., and T.L.R., The Center for Bioenergy Innovation, a U.S. Department of Energy Research Center supported by the Office of Biological and Environmental Research in the DOE Office of Science (grant# DE-AC05-00OR22725); L.R.L., the Sao Paulo Research Foundation, and the Link Foundation; J.L.F. and K.P., USDA/NIFA (grant# 2013-68005-21298 and 2017-67019-26327); T.L.R., USDA/NIFA (grant# 2012-68005-19703); D.S.L. and S.P.L., the Energy Biosciences Institute. Data availability The DayCent model (https://www2.nrel.colostate.edu/projects/daycent/) is freely available upon request. Specification of DayCent model runs and automated model initialization, calibration, scenario simulation, results analysis, and figure generation were implemented in Python 2.7, using the numpy module for data processing and the matplotlib module for figure generation. Analysis code is available in a version-controlled repository (https://github.com/johnlfield/Ecosystem_dynamics). A working copy of the code, all associated DayCent model inputs, and analysis outputs are also available in an online data repository (https://figshare.com/s/4c14ec168bd550db4bad; note this URL is for accessing a private version of the repository, and will eventually be replaced with an updated URL for the public version of the repository, which will only be accessible after the journal-specified embargo date).Peer reviewedPostprintPublisher PD