Portable point-of-care devices for pathogen detection require easy, minimal and user-friendly handling steps and need to have the same diagnostic performance compared to centralized laboratories. In ...this work we present a fully automated sample-to-answer detection of influenza A H3N2 virus in a centrifugal LabDisk with complete prestorage of reagents. Thus, the initial supply of the sample remains the only manual handling step. The self-contained LabDisk automates by centrifugal microfluidics all necessary process chains for PCR-based pathogen detection: pathogen lysis, magnetic bead based nucleic acid extraction, aliquoting of the eluate into 8 reaction cavities, and real-time reverse transcription polymerase chain reaction (RT-PCR). Prestored reagents comprise air dried specific primers and fluorescence probes, lyophilized RT-PCR mastermix and stick-packaged liquid reagents for nucleic acid extraction. Employing two different release frequencies for the stick-packaged liquid reagents enables on-demand release of highly wetting extraction buffers, such as sequential release of lysis and binding buffer. Microfluidic process-flow was successful in 54 out of 55 tested LabDisks. We demonstrate successful detection of the respiratory pathogen influenza A H3N2 virus in a total of 18 LabDisks with sample concentrations down to 2.39 × 10(4) viral RNA copies per ml, which is in the range of clinical relevance. Furthermore, we detected RNA bacteriophage MS2 acting as internal control in 3 LabDisks with a sample concentration down to 75 plaque forming units (pfu) per ml. All experiments were applied in a 2 kg portable, laptop controlled point-of-care device. The turnaround time of the complete analysis from sample-to-answer was less than 3.5 hours.
A reliable and precise in situ CO2 and CO analysis system has been developed and deployed at eight sites in the NOAA Earth System Research Laboratory's (ESRL) Global Greenhouse Gas Reference Network. ...The network uses very tall (> 300 m) television and radio transmitter towers that provide a convenient platform for mid-boundary-layer trace-gas sampling. Each analyzer has three sample inlets for profile sampling, and a complete vertical profile is obtained every 15 min. The instrument suite at one site has been augmented with a cavity ring-down spectrometer for measuring CO2 and CH4 . The long-term stability of the systems in the field is typically better than 0.1 ppm for CO2 , 6 ppb for CO, and 0.5 ppb for CH4 , as determined from repeated standard gas measurements. The instrumentation is fully automated and includes sensors for measuring a variety of status parameters, such as temperatures, pressures, and flow rates, that are inputs for automated alerts and quality control algorithms. Detailed and time-dependent uncertainty estimates have been constructed for all of the gases, and the uncertainty framework could be readily adapted to other species or analysis systems. The design emphasizes use of off-the-shelf parts and modularity to facilitate network operations and ease of maintenance. The systems report high-quality data with > 93% uptime. Recurrent problems and limitations of the current system are discussed along with general recommendations for high-accuracy trace-gas monitoring. The network is a key component of the North American Carbon Program and a useful model for future research-grade operational greenhouse gas monitoring efforts.
Despite increased concerns regarding the heavy reliance of many cropping systems on chemical weed control, adoption of ecological weed management practices is only steadily progressing. For this ...reason, this paper reflects on both the possibilities and limitations of cultural weed control practices. Cultural weed control utilises a number of principles, predominantly: (i) a reduced recruitment of weed seedlings from the soil seedbank, (ii) an alteration of crop-weed competitive relations to the benefit of the crop and (iii) a gradual reduction of the size of the weed seedbank. Compared with chemical control, the general applicability, reliability and efficacy of most measures is only moderate, and consequently, cultural control strategies need to consist of a combination of measures, resulting in increased systems complexity. Combined with the trade-offs connected to some of the measures, this hampers large-scale implementation. It is argued that tailoring cultural weed management strategies to the needs and skills of individual farmers would be an important step forward. Research can aid in improving the utilisation of cultural weed control strategies by focussing on a broadening of the range of available measures and by providing clear quantitative insight in efficacy, variability in outcome and trade-offs of these measures.
Shifts in the frequency and intensity of high discharge events due to climate change may have important consequences for the hydrology and biogeochemistry of rivers. However, our understanding of ...event‐scale biogeochemical dynamics in large rivers lags that of small streams. To fill this gap, we used high‐frequency sensor data collected during four consecutive summers from a main channel and backwater site of the Upper Mississippi River. We identified high discharge events and calculated event concentration‐discharge responses for both physical‐chemical (nitrate, turbidity, and fluorescent dissolved organic matter) and biological (chlorophyll‐a and cyanobacteria) constituents using metrics of hysteresis and slope. We found a range of responses across events, particularly for nitrate. Although fluorescent dissolved organic matter (FDOM) and turbidity exhibited more consistent responses across events, contrasting hysteresis metrics indicated that FDOM was flushed to the river from more distant sources than turbidity. Biological responses (chlorophyll a and cyanobacteria) differed more between sites than physical and chemical constituents. Lastly, we found that the event characteristics best explaining concentration responses differed between sites, with event magnitude more frequently related to responses in the main channel, and antecedent wetness conditions associated with response variation in the backwater. Our results indicate that event responses in large rivers are distinct across the diverse habitats and biogeochemical components of a large floodplain river, which has implications for local and downstream ecosystems as the climate shifts.
Plain Language Summary
How sediment, nutrients, and organic matter enters and moves throughout large rivers has important implications for water quality both locally and globally. One way to study these dynamics is to observe how these materials react to periods of high streamflow. We used this approach to analyze sources and movement of nitrate, organic matter, sediment, and biological indicators in the Upper Mississippi River (UMR). The data indicated that sediment and organic matter likely came from sources that were closer and farther from the river, respectively, and that these patterns were more evident during more extreme high streamflow periods. We also found that materials, particularly biological indicators (chlorophyll a and cyanobacteria), behaved differently in the main channel of the river compared to a slower‐flowing backwater area. These results are relevant to management of water quality in the UMR, particularly given that high streamflow periods will likely increase in frequency and magnitude due to climate change.
Key Points
Event‐scale concentration‐discharge analysis revealed distinct dynamics among several biogeochemical constituents in a large river
Responses of biological constituents to events differed more between channel and backwater areas than among physical‐chemical constituents
Constituent event responses varied with event magnitude in the main channel but antecedent flow conditions in backwaters
Purpose
While many factors have been correlated with lesser outcomes in abdominal wall reconstruction (AWR), the impact of surgeon experience has yet to be elucidated. We sought to evaluate the ...effect of cumulative surgeon experience on long-term complex AWR outcomes.
Methods
We conducted a comprehensive review of all consecutive patients who underwent AWR using biologic mesh for the repair of ventral hernias or tumor resection defects from March 2005 to June 2019. The primary outcome measure was hernia recurrence (HR). Secondary outcomes were surgical site occurrences (SSOs) and surgical site infections (SSIs). Patients were a priori categorized into the following groups according to the cumulative number of hernia repairs performed by their surgeons: low (< 50), moderate experience (50–100), and high (> 100) experience.
Results
We identified 60 surgeons and 650 consecutive patients (62% women) who met our inclusion criteria. In adjusted models, AWR performed by surgeons with high experience was associated with a fourfold lower risk of HR (hazard ratio, 0.28; 95% confidence interval, 0.08 to 0.87), but the odds of surgical site occurrences (odds ratio, 0.72, 95% confidence interval, 0.34 to 1.52) and surgical site infections (odds ratio, 0.89, 95% confidence interval, 0.26 to 2.86) did not differ significantly in the high-experience group.
Conclusions
High surgical experience, defined as > 100 cumulative hernia repairs, is predictive for markedly lower HR rates in complex AWR. These findings have potential implications for preoperative risk assessment, patient-centered surgeon selection, regulatory oversight, specific referral patterns, designations of centers of excellence, and individual provider or trainee quality improvement.
Participatory projects supporting the farmer-based seed management of agrobiodiverse varieties including landraces have proliferated globally in response to nutritional insecurity and climate change. ...This research examines the agroecological landscape knowledge of farmers in a recent participatory seed project using the tricot approach in Central America. Over 800 smallholder farmers in Nicaragua facilitated on-farm trials of diverse common bean varieties that are nutritiously valuable and potentially well-adapted to increased temperatures and variable precipitation. Our article integrates relevant research concepts in a case study of the agroecological landscape knowledge of 52 participating farmers. Participatory sketch maps, transect walks, and semi-structured interviews were used to identify key areas of farmers' agroecological landscape knowledge in crop and seed management. Results indicate the prevalence of nine themes of farmer agroecological landscape knowledge. This landscape knowledge exerts major influence on the choice, placement, and management of common bean varieties and associated land use decisions. Our analysis reveals that farmers use this knowledge to manage their landholdings as landscapes of agroecological interactions that guide seed and variety management and affect potential sustainability. Results demonstrate that local agroecological landscape learning is strengthened through and benefits participatory seed projects.
Reliability and Validity of DSM-IV Axis V Hilsenroth, Mark J.; Ackerman, Steven J.; Blagys, Matthew D. ...
The American journal of psychiatry,
11/2000, Volume:
157, Issue:
11
Journal Article
Peer reviewed
OBJECTIVE: The authors investigated the reliability and convergent and discriminant validity of the DSM-IV Global Assessment of Functioning Scale and two experimental DSM-IV axis V global rating ...scales, the Global Assessment of Relational Functioning Scale and the Social and Occupational Functioning Assessment Scale. METHOD: Forty-four patients admitted to a university-based outpatient community clinic were rated by trained clinicians on the three DSM-IV axis V scales. Patients also completed self-report measures of DSM-IV symptoms as well as measures of relational, social, and occupational functioning. RESULTS: The Global Assessment of Functioning Scale, Global Assessment of Relational Functioning Scale, and Social and Occupational Functioning Assessment Scale all exhibited very high levels of interrater reliability. Factor analysis revealed that the Global Assessment of Relational Functioning Scale and the Social and Occupational Functioning Assessment Scale are each more related to the Global Assessment of Functioning Scale individually than they are to each other. The Global Assessment of Functioning Scale was significantly related to concurrent patient responses on the SCL-90-R global severity index. The Social and Occupational Functioning Assessment Scale was significantly related to concurrent patient responses on the SCL-90-R global severity index and to a greater degree with both the Social Adjustment Scale global score and the Inventory of Interpersonal Problems total score. Although the Global Assessment of Relational Functioning Scale was not significantly related to any of the three self-report measures, it was related to the presence of clinician-rated axis II pathology. CONCLUSIONS: The three axis V scales can be scored reliably. The Global Assessment of Relational Functioning Scale and the Social and Occupational Functioning Assessment Scale evaluate different constructs. These findings support the validity of the Global Assessment of Functioning Scale as a scale of global psychopathology; the Social and Occupational Functioning Assessment Scale as a measure of problems in social, occupational, and interpersonal functioning; and the Global Assessment of Relational Functioning Scale as an index of personality pathology. The authors discuss further refinement and use of the three axis V measures in treatment research.
A commercially available differential fuel-cell analyzer has been adapted to make field-based ppm-level measurements of atmospheric O2 variations. With the implementation of rapid calibrations and ...active pressure and flow control, the analysis system described here has a 1 precision of c2.5 per meg (asymptotically =0.5 ppm) for a 2-min measurement. Allowing for system stabilization after switching inlet lines, a 6-min measurement with a precision of c1.4 per meg (asymptotically =0.3 ppm) every 20 min is obtained. The elimination of biases in any atmospheric O2 measurement depends critically on careful gas-handling procedures, and after screening for known sources of bias a comparability of c10 per meg (asymptotically =2 ppm) with the present setup is estimated. In comparison to existing techniques, the relatively small size, low cost, fast response, motion insensitivity, and ease of implementation of the fuel-cell analyzer make it particularly useful for a wide range of unattended field applications. This system has been used to measure atmospheric O2 concentrations at the WLEF tall-tower research site in northern Wisconsin semicontinuously from June 2000 to December 2003. These measurements represent the first extended O2 record in and above a forest ecosystem, and are being used to investigate global carbon budgeting, plant physiology, continental boundary layer mixing and synoptic transport, and potential means of industrial emission verification. In this paper, the measurement technique is described in detail and several weeks of data are presented to illustrate its performance. PUBLICATION ABSTRACT
Medication errors occur frequently and are a risk to patient safety. To reduce mistakes in the medication process in emergencies, a mobile app has been developed supporting the calculation of doses ...and administration of drugs. A simulation study was performed to validate the app as a tool to reduce medication errors. This was a randomised crossover study conducted in the Academic Hospital. The participants included were residents and attendings in anaesthesiology. 74 Participants performed four simulation scenarios in which they had to calculate and administer drugs for emergencies. Two scenarios were performed with the app (“app scenarios”) and the other two scenarios were performed without the use of the app (“control scenarios”). The order of drugs, simulation patients and usage of aid were randomized. The accuracy of administered drug doses were measured. Medications were categorised as either “accurate” (
±
20
% of target dosage) or “wrong” (less than 50% or more than 200% of target dosage). The dosage calculated and the dosage administered were documented separately to differentiate between calculation and handling errors. During app scenarios, there were no “wrong” dosages, whereas 6.8 (95% CI 2.7–10.8%) of dosages in control scenarios were evaluated as “wrong”. The probability of giving an “accurate” dosage was increased from 77.7 (70.9–84.5%) in control scenarios to 93.9 (90–97.8%) in app scenarios. Calculation errors were the main cause for wrong dosing. The app is an appropriate and feasible tool to reduce calculation and handling errors and may increase patient safety.
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