Background
Our objective was to quantify trends in emergency medical services (EMS) incidents as the effects of the COVID‐19 pandemic spread across the United States and to determine if there was an ...increase in EMS‐attended deaths.
Methods
We conducted a 3‐year comparative retrospective cohort analysis of data from the National EMS Information System. Data were included if care was provided between the 40th and 21st weeks of the next year and compared over 3 years. We included incidents identified through 9‐1‐1 where patient contact was made. The total number of EMS incidents per week was used as the denominator to calculate the rate of patient deaths and possible injury. We assessed for temporal and seasonal trends.
Results
Starting in the 10th week of 2020 there was a decrease in the number of EMS activations in the United States compared to the prior weeks and the same time period in previous years. The number of activations between week 10 and week 16 decreased by 140,292 or 26.1%. The portion of EMS activations reporting a patient disposition of death nearly doubled between the 11th and 15th weeks of 2020 (1.49%–2.77% of all activations). The number of EMS activations documenting a possible injury decreased from 18.43% to 15.27% between weeks 10 and 13.
Conclusion
We found that early in the COVID‐19 outbreak there was a significant decrease in the number of EMS responses across the United States. Simultaneously the rate of EMS‐attended death doubled, while the rate of injuries decreased.
Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific ...opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non‐natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.
This is the first complete biography of Ernst Kantorowicz (18951963), an influential and controversial German-American intellectual whose colorful and dramatic life intersected with many of the great ...events and thinkers of his time. A medieval historian whose ideas exerted an influence far beyond his field, he is most famous for two booksa notoriously nationalistic 1927 biography of the Holy Roman Emperor Frederick II and The King's Two Bodies (1957), a classic study of medieval politics.Born into a wealthy Prussian-Jewish family, Kantorowicz fought on the Western Front in World War I, was wounded at Verdun, and earned an Iron Cross; later, he earned an Iron Crescent for service in Anatolia before an affair with a generals mistress led to Kantorowicz being sent home. After the war, he fought against Poles in his native Posen, Spartacists in Berlin, and communists in Munich. An ardent German nationalist during the Weimar period, Kantorowicz became a member of the elitist Stefan George circle, which nurtured a cult of the Secret Germany. Yet as a professor in Frankfurt after the Nazis came to power, Kantorowicz bravely spoke out against the regime before an overflowing crowd. Narrowly avoiding arrest after Kristallnacht, he fled to England and then the United States, where he joined the faculty at Berkeley, only to be fired in 1950 for refusing to sign an anticommunist loyalty oath. From there, he fell up the ladder to Princetons Institute for Advanced Study, where he stayed until his death.Drawing on many new sources, including numerous interviews and unpublished letters, Robert E. Lerner tells the story of a major intellectual whose life and times were as fascinating as his work.
Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a ...prospective pediatric cohort and compare them to a de novo risk model.
We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model.
Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%-97.2%) sensitive and 45.6% (44.0%-47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%-98.1%) sensitive and 50.3% (48.7%-51.8%) specific.
Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.
In Southern British Columbia (BC), Canada, declines in southern resident killer whale (SRKW-Orcinus orca) populations have been linked to declines in numbers and average size of their preferred prey, ...Chinook salmon (Oncorhynchus tshawytscha). However, the life history diversity of Chinook suggests that there is a need to assess stock-specific differences in energy density to evaluate prey quality as a factor in SRKW declines. In this study, we calibrated a Distell fat meter to estimate Chinook whole-body lipid content, a proxy for energy density. The fat meter was deployed at the Fraser River, BC, Chinook test fishery during 2020, collecting lipid, weight, and length measurements from 1566 genetically stock identified individuals encompassing all major Fraser River Chinook population units (management units, MUs) at river entry. We found that MU-specific lipid content increased with distance and elevation to spawning grounds and was highest in the Spring-5
(12.8%) and Summer-5
(12.7%) MUs, intermediate in the Summer-4
MU (10.8%), and lowest in the Fall-4
MU (7.3%). Lipid content also decreased by up to 6 percentage points within MUs from the beginning to end of their migration period. Our data revealed SRKWs' most endangered prey sources, the Spring-5
and Summer-5
MUs, are also its most energy rich. It also indicated SRKWs have access to progressively lower energy density Chinook through the year, requiring up to ~ 30% more fish to meet energy demands in the fall than in the spring.
Functional calcium-phosphate-chitosan adsorbents for fluoride (F−) removal from water with different proportions of calcium (0.7 or 1.4 % w/v) were synthesized by: i) ionotropic gelation technique ...followed by drying in a convection oven (IGA) or freeze drying (FDA); ii) freeze-gelation followed by drying in a convection oven (FGA). Adsorbents were analyzed by SEM-EDX and FTIR- ATR. F− removal percentages higher than 45 % were obtained with calcium-phosphate-chitosan adsorbents for an initial F− concentration of 9.6 mg L−1. Optimal conditions for F− removal were attained, using calcium-phosphate- chitosan adsorbents synthesized by ionotropic gelation with 0.7 % of Ca (IGA0.7). Under these conditions, initial F− concentration of 5 mg L−1, was reduced below the maximum limit of 1.5 mg L−1 established by WHO. Regeneration of IGA0.7 was achieved in acid media. The performance of IGA0.7 was slightly reduced in the presence of coexisting anions (nitrate, carbonate, arsenate). Adsorption kinetics was represented satisfactorily by the pseudo-second order equation; Langmuir isotherm provided the best fit to the equilibrium data and IGA0.7 exhibited a maximum F− adsorption capacity qL = 132.25 mg g−1. IGA0.7 particles were characterized by thermogravimetry coupled to FTIR, XRD, XPS and SEM-EDX. The calcium-phosphate-chitosan adsorbents constitute a suitable and emerging material for water defluorination.
•Ionotropic gelation, freeze drying and freeze-gelation methods were applied.•Calcium-phosphate-chitosan adsorbents were synthesized.•Removal of fluoride higher than 45 % was obtained.•A slightly effect of pH and presence of coexist anions were observed.•Experimental kinetic and adsorption isotherm were modeled.
Given
n
men,
n
women, and
n
dogs, let each man have a complete preference list of women, each woman have a complete preference list of dogs, and each dog have a complete preference list of men ...(three-dimensional problem with cyclic preferences, also known as the so-called 3D-CYC problem). A matching is a collection of
n
nonintersecting triples, each of which contains one representative of each gender. A matching is called a stable matching (SM) if one cannot find a man, a woman, and a dog belonging to different triples and preferring each other to their current partners in the corresponding triples. Eriksson et al. 2 hypothesized that the 3DSM-CYC problem, which implies the search of SM, always has a stable matching. Gradually the conjecture was proved for all
n
≤ 5. However, Lam and Plaxton 1 proposed an algorithm for constructing preference lists for the 3DSM-CYC problem of size
n
= 90, for which no SM exists. The question on the existence of counterexamples of a lesser size remained open. In this paper, we construct a vivid counterexample of the 3DSM-CYC problem of size
n
= 24.
This work details the process of developing the updated field triage guideline, the supporting evidence, and the final version of the 2021 National Guideline for the Field Triage of Injured Patients.
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