摘要： BACKGROUND It is largely unknown how often physicians in emergency helicopter medical services (HEMS) encounter various critical care events and if HEMS exposure is associated with particular practice patterns or outcomes. OBJECTIVES This study aimed: to describe the frequency and distribution of critical care events;to investigate whether HEMS exposure is associated with differences in practice patterns and determine if HEMS exposure factors are associated with mortality. DESIGN A retrospective registry-based study. SETTING Physician-staffed HEMS in Finland between January 2012 and August 2019. PARTICIPANTS Ninety-four physicians who worked at least 6 months in the HEMS during the study period. Physicians with undeterminable HEMS exposure were excluded from practice pattern comparisons and mortality analysis, leaving 80 physicians. MAIN OUTCOME MEASURES The primary outcome measure was a physician's average annual frequencies for operational events and clinical interventions. Our secondary outcomes were the proportion of missions cancelled or denied, time onsite (OST) and proportion of unconscious patients intubated. Our tertiary outcome was adjusted 30-day mortality of patients. RESULTS The physicians encountered 62 [33 to 98], escorted 31 [17 to 41] and transported by helicopter 2.1 [1.3 to 3.5] patients annually, given as median [interquartile range;IQR]. Rapid sequence intubation was performed 11 [6.2 to 16] times per year. Physicians were involved in out-of-hospital cardiac arrest (OHCA) 10 [5.9 to 14] and postresuscitation care 5.5 [3.1 to 8.1] times per year. Physicians with longer patient intervals had shorter times onsite. Proportionally, they cancelled more missions and intubated fewer unconscious patients. A short patient interval [odds ratio (OR);95% confidence interval (CI)] was associated with decreased mortality (0.87;95% CI, 0.76 to1.00), whereas no association was observed between mortality and HEMS career length. CONCLUSION Prehospital exposure is

关键词： CCH‐   aaes   cellulite   collagenase   collagenase clostridium histolyticum   diluent   dilution  

摘要： Background Collagenase clostridium histolyticum (CCH-aesthetic formulation [CCH-aaes];QWO (TM) [Endo Aesthetics, Malvern PA, USA] is approved as a subcutaneous injection for treatment of cellulite. In the aesthetic practice, dilution of marketed products is commonly employed to tailor treatments to individual patients or off-label locations. Dilution beyond the 0.23 mg/ml achievable with the proprietary diluent supplied with the CCH-aaes lyophilized powder requires diluents readily available in clinic. Aim To characterize the functionality and stability of CCH-aaes when reconstituted and/or diluted with alternative diluents, including normal saline, bacteriostatic saline, and/or proprietary diluent. Patients/Methods Each dilution was assessed for purity using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE), activity using collagenase (AUX-I) and gelatinase (AUX-II) assays, and aggregation using size-exclusion chromatography. Results When reconstituted with either saline or proprietary diluent, and diluted with proprietary diluent or saline, purity, activity, and stability of CCH-aaes is maintained for up to 24 h at 5 degrees C or 25 degrees C. In contrast, use of bacteriostatic saline to reconstitute and/or dilute CCH-aaes results in up to a 40% decrease in activity and aggregation of 5.3% of CCH-aaes protein. Importantly, inclusion of 2% lidocaine and 1:200 000 epinephrine does not negatively impact CCH-aaes purity, concentration, or activity for up to 24 h at 5 degrees C or 25 degrees C. Conclusions From an efficacy and safety perspective, CCH-aaes must not be/should not be reconstituted and/or diluted with bacteriostatic saline to avoid injection of protein aggregates. Ideally, CCH-aaes should be reconstituted in proprietary diluent: further dilution with normal saline and addition of lidocaine and epinephrine is acceptable.

关键词： Human-wildlife conflict   Predator management   Vulture conservation   Wildlife crime  

摘要： The use of poison to eliminate predators is causing African vulture populations to collapse. To understand the prevalence and motivations of this practice we conducted an extensive survey with South African commercial farmers. Using a specialised questioning technique and ad hoc quantitative methods we found that an estimated 22% and 31% of farmers used poison over a 1-year and 5-year period, respectively. Poison use hotspots generally coincided with small stock farming areas. The strongest predictor of poison use was whether farmers believed the practice to be common amongst their peers. Our results suggest that farmers' attitudes to vultures are primarily positive, and farmers are less likely to use poisons if they frequently encounter vultures on their farm. Overall, our findings provide an understanding on poison use that provides leverage points to change farmers' behaviour and help avert the African vulture crisis and possible cascading ecosystem impacts.

摘要： Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW) stepped outside known approaches (e.g., women's leadership plans and programming) to design and implement a strategic campaign that promotes gender equity through fostering change in systems and social norms. This campaign, IWill MCW (launched in 2019), emphasizes the power of individual responsibility for positive change. The IWill MCW campaign employs a 2-pronged approach. The first is the creation of personal call-to-action public pledges focused on 5 aspects of gender equity, along with the provision of supportive resources to reinforce positive change. The second is the use of those pledges to raise awareness of gender inequity in academic medicine by fostering meaningful dialogue meant to alter mental models of equity, relationships, and power dynamics. In the initial 6-week phase of the IWill MCW campaign, leaders reached out to all MCW faculty (2,002), staff (4,522), and learners (1,483) at multiple campuses. This outreach resulted in nearly 1,400 pledges, including 30% (n = 420) from men. The effort also engaged over 90% (n = 101) of members of MCW senior leadership teams. The feedback from the initial campaign has been positive. Lessons learned include realizing the importance of public pledges, engaging male allies, and following up. The authors suggest that the IWill MCW campaign provides a model for academic health centers to advance gender equity and shape an environment in which people of all genders can thrive.

摘要： COVID-19 is a worldwide pandemic, with frontlines that look drastically different than in past conflicts: that is, women now make up a sizeable majority of the health care workforce. American women have a long history of helping in times of hardship, filling positions on the home front vacated by men who enlisted as soldiers during World War I and similarly serving in crucial roles on U.S. military bases, on farms, and in factories during World War II. The COVID-19 pandemic has represented a novel battleground, as the first in which women have taken center stage, not only in their roles as physicians, respiratory therapists, nurses, and the like, but also by serving in leadership positions and facilitating innovations in science, technology, and policy. Yet, the pandemic has exacerbated multiple pain points that have disproportionally impacted women in health care, including shortages in correctly sized personal protective equipment and uniforms, inadequate support for pregnant and breastfeeding providers, and challenges associated with work-life balance and obtaining childcare. While the pandemic has facilitated several positive advancements in addressing these challenges, there is still much work to be done for women to achieve equity and optimal support in their roles on the frontlines.

关键词： Soil balancing   Organic farming   Community of practice   Ways of knowing   Soil science   Farmer experience  

摘要： Soil balancing is widely used in organic farming, but little is known about the practice because technical knowledge and goals for the practice are produced and negotiated within an alternative community of practice (CoP). We used a review of the private soil balancing literature and semi-structured interviews with farmers and consultants to document the knowledge, shared meanings, and goals of key actors within the soil balancing CoP. Our findings suggest this CoP is dominated by discourse between private consultants and farmers, with few contributions to or from scientists or the peer reviewed literature. The idea of soil balancing is centered around improving soil quality through adjustments in Base Cation Saturation Ratios (BCSR), and practitioners report a wide range of positive agronomic outcomes. For most soil balancers, however, BCSR is only one part of a broader approach to soil health management that also utilizes traditional soil fertility recommendations and soil health-building cultural management practices. Meanwhile, a survey of land grant university soil fertility specialists and the peer-reviewed literature documented a high degree of skepticism and a lack of scientific evidence that BCSR can boost crop yields. We conclude that this scientific discourse reflects a disconnect from the practices and meanings used in the soil balancing CoP. While tensions between the dominant and niche agricultural knowledge systems are not unique, we believe a better appreciation for the nuanced meanings and goals within the soil balancing CoP present an opening for expanded collaborations with scientists doing research on soil health.

关键词： MALDI-TOF MS   Typing   Clostridioides difficile  

摘要： Clostridioides difficile is an important organism causing healthcare-associated infections. It has been documented that specific strains caused multiple outbreaks globally, and patients infected with those strains are more likely to develop severe C. difficile infection (CDI). With the appearance of a variant strain, BI/NAP1 ribotype 027, responsible for several outbreaks and high mortality rates worldwide, the epidemiology of the CDI changed drastically in the United States, Europe, and some Latin American countries. Although the epidemic strain 027 was not yet detected in Brazil, there are ribotypes exclusively found in the country, such as, 131, 132, 133, 135, 142 and 143, which are responsible for outbreaks in Brazilian hospitals and nursing homes. Although PCR-ribotyping is the most used method in epidemiology studies of C. difficile, it is not available in Brazil. This study aimed to develop and validate an inhouse database for detecting C. difficile ribotypes, usually involved in CDI in Brazilian hospitals, by using MALDI-TOF MS. A database with 19 different ribotypes, 13 with worldwide circulation and 6 Brazilian-restricted, was created based on 27 spectra readings of each ribotype. After BioNumerics analysis, neighbor-joining trees revealed that spectra were distributed in clusters according to ribotypes, showing that MALDI-TOF MS could discriminate all 19 ribotypes. Moreover, each ribotype showed a different profile with 42 biomarkers detected in total. Based on their intensity and occurrence, 13 biomarkers were chosen to compose ribotype-specific profiles, and in silico analysis showed that most of these biomarkers were uncharacterized proteins or well-conserved peptides, such as ribosomal proteins. A double-blind assessment using the 13 biomarkers correctly assigned the ribotype in 73% of the spectra analyzed, with 94%-100% of correct hits for 027 and for Brazilian ribotypes. Although further analyses are required, our results show that MALDI-TOF MS migh

关键词： Nickel alloys  

摘要： Brazing is a crucial joining technology in industries where nickel-superalloy components must be joined. Nickel-based brazing filler metals are extensively employed, possessing excellent mechanical properties, corrosion resistance, and retained strength at elevated temperatures. To function as a filler metal, the alloy melting point must be reduced to below that of the materials being joined, but the addition of melting point depressants (MPDs) such as boron, silicon, and phosphorus can, however, lead to the formation of brittle intermetallics, potentially compromising the joint performance. In the present work, a novel multi-principal element brazing alloy (in the style of a high entropy alloy), utilizing Ge as an alternative MPD along with a reduced B addition, is investigated. The design process considered binary phase diagrams and predictions based on Thermo-Calc software and empirical thermodynamic parameters. The alloy was used to vacuum braze nickel-superalloy Inconel-718, and microstructural and mechanical investigations are reported. The maximum shear strength achieved was 297 MPa with a brazing temperature of 1100 degrees C and 60-minute hold time, with isothermal solidification completed. Shear strength was only slightly reduced with increased joint width. Assessments are made of the ability to accurately predict properties of multi-principle element alloys using Thermo-Calc software and empirical thermodynamic parameters.

关键词： Tomatoes   Alternaria   Penicillium   Aspergillus   Mycotoxins   GRAS substances  

摘要： Tomato fruit represent a valuable but perishable commodity due to postharvest fungal spoilage. In the present investigation, greenhouse-grown tomatoes were analysed, particularly for the contamination by mycotoxigenic fungi. Collected isolates were characterized by morphological features and sequencing of barcoding genes. Alternaria, Aspergillus, and Penicillium proved to be the most represented genera. Particularly, Alternaria strains were mostly A. alternata morphotype alternata, genetically able to produce alternariol and alternariol monomethyl ether. Aspergillus strains were divided into yellow and black aspergilli;the former included the species A. westerdijkiae, A. ochraceus, and A. occultus, able to produce ochratoxin A (OTA), the latter included an A. welwitschiae strain, genetically able to produce OTA and fumonisins. Most Penicillium strains were represented by P. olsonii, not able to produce regulated mycotoxins. Commercial Generally Recognized As Safe (GRAS) and biostimulant formulations were tested for controlling those pathogens and related decays. Potassium bicarbonate and the combination peracetic acid+hydrogen peroxide proved to completely prevent fungal growth. The same formulations were tested on tomato fruit against A. alternata morphotype alternata, which proved to be the most aggressive pathogen. Tests confirmed potassium bicarbonate and the combination peracetic acid+hydrogen peroxide as effective against disease incidence and severity, particularly when applied by dipping. These promising results support their use in larger-scale trials.