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1.
Prehosp Emerg Care ; : 1-6, 2023 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-37800855

RESUMEN

INTRODUCTION: Emergency medical services (EMS) facilitated telemedicine encounters have been proposed as a strategy to reduce transports to hospitals for patients who access the 9-1-1 system. It is unclear which patient impressions are most likely able to be treated in place. It is also unknown if the increased time spent facilitating the telemedicine encounter is offset by the time saved from reducing the need for transport. The objective of this study was to determine the association between the impressions of EMS clinicians of the patients' primary problems and transport avoidance, and to describe the effects of telemedicine encounters on prehospital intervals. METHODS: This was a retrospective review of EMS records from two commercial EMS agencies in New York and Tennessee. For each EMS call where a telemedicine encounter occurred, a matched pair was identified. Clinicians' impressions were mapped to the corresponding category in the International Classification of Primary Care, 2nd edition (ICPC-2). Incidence and rates of transport avoidance for each category were determined. Prehospital interval was calculated as the difference between the time of ambulance dispatch and back-in-service time. RESULTS: Of the 463 prehospital telemedicine evaluations performed from March 2021 to April 2022, 312 (67%) avoided transports to the hospital. Respiratory calls were most likely to result in transport avoidance (p = 0.018); no other categories had statistically significant transport rates. Four hundred sixty-one (99.6%) had matched pairs identified and were included in the analysis. When compared to the matched pair, telemedicine without transport was associated with a prehospital interval reduction in 68% of the cases with a median reduction of 16 min; this is significantly higher than telemedicine with transport when compared to the matched pair with a median interval increase in 27 min. Regardless of transport status, the prehospital interval was a median of 4 min shorter for telemedicine encounters than non-telemedicine encounters (p = 0.08). CONCLUSION: In this study, most telemedicine evaluations resulted in ED transport avoidance, particularly for respiratory issues. Telemedicine interventions were associated with a median four-minute decrease in prehospital interval per call. Future research should investigate the long-term effects of telemedicine on patient outcomes.

3.
J Vasc Surg ; 72(3): 790-798, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32497747

RESUMEN

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Síndrome del Desfiladero Torácico/diagnóstico , Triaje/normas , COVID-19 , Consenso , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Descompresión Quirúrgica/normas , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/normas , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Humanos , Control de Infecciones/normas , Comunicación Interdisciplinaria , Recuperación del Miembro/métodos , Recuperación del Miembro/normas , Selección de Paciente , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , SARS-CoV-2 , Telemedicina/normas , Síndrome del Desfiladero Torácico/etiología , Síndrome del Desfiladero Torácico/terapia , Terapia Trombolítica/métodos , Terapia Trombolítica/normas , Tiempo de Tratamiento/normas
4.
Nature ; 507(7493): 480-3, 2014 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-24670767

RESUMEN

Photosynthesis in the surface ocean produces approximately 100 gigatonnes of organic carbon per year, of which 5 to 15 per cent is exported to the deep ocean. The rate at which the sinking carbon is converted into carbon dioxide by heterotrophic organisms at depth is important in controlling oceanic carbon storage. It remains uncertain, however, to what extent surface ocean carbon supply meets the demand of water-column biota; the discrepancy between known carbon sources and sinks is as much as two orders of magnitude. Here we present field measurements, respiration rate estimates and a steady-state model that allow us to balance carbon sources and sinks to within observational uncertainties at the Porcupine Abyssal Plain site in the eastern North Atlantic Ocean. We find that prokaryotes are responsible for 70 to 92 per cent of the estimated remineralization in the twilight zone (depths of 50 to 1,000 metres) despite the fact that much of the organic carbon is exported in the form of large, fast-sinking particles accessible to larger zooplankton. We suggest that this occurs because zooplankton fragment and ingest half of the fast-sinking particles, of which more than 30 per cent may be released as suspended and slowly sinking matter, stimulating the deep-ocean microbial loop. The synergy between microbes and zooplankton in the twilight zone is important to our understanding of the processes controlling the oceanic carbon sink.


Asunto(s)
Organismos Acuáticos/metabolismo , Ciclo del Carbono , Carbono/metabolismo , Agua de Mar , Animales , Océano Atlántico , Biota , Dióxido de Carbono/metabolismo , Secuestro de Carbono , Respiración de la Célula , Cadena Alimentaria , Observación , Agua de Mar/química , Agua de Mar/microbiología , Incertidumbre , Zooplancton/metabolismo
5.
Aust N Z J Psychiatry ; 54(10): 970-984, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32475125

RESUMEN

BACKGROUND: Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders; yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. METHOD: MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old individuals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. RESULTS: A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist; both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3-21%) and anxiety disorders (7-34%) were the most prevalent conditions. CONCLUSION: This review consists of the largest sample hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management.


Asunto(s)
Discapacidad Intelectual , Adolescente , Adulto , Trastornos de Ansiedad , Niño , Comorbilidad , Humanos , Discapacidad Intelectual/epidemiología , Salud Mental , Prevalencia , Adulto Joven
6.
Proc Natl Acad Sci U S A ; 112(4): 1089-94, 2015 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-25561526

RESUMEN

The biological carbon pump, which transports particulate organic carbon (POC) from the surface to the deep ocean, plays an important role in regulating atmospheric carbon dioxide (CO2) concentrations. We know very little about geographical variability in the remineralization depth of this sinking material and less about what controls such variability. Here we present previously unpublished profiles of mesopelagic POC flux derived from neutrally buoyant sediment traps deployed in the North Atlantic, from which we calculate the remineralization length scale for each site. Combining these results with corresponding data from the North Pacific, we show that the observed variability in attenuation of vertical POC flux can largely be explained by temperature, with shallower remineralization occurring in warmer waters. This is seemingly inconsistent with conclusions drawn from earlier analyses of deep-sea sediment trap and export flux data, which suggest lowest transfer efficiency at high latitudes. However, the two patterns can be reconciled by considering relatively intense remineralization of a labile fraction of material in warm waters, followed by efficient downward transfer of the remaining refractory fraction, while in cold environments, a larger labile fraction undergoes slower remineralization that continues over a longer length scale. Based on the observed relationship, future increases in ocean temperature will likely lead to shallower remineralization of POC and hence reduced storage of CO2 by the ocean.

7.
J Vasc Surg ; 64(3): 797-802, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27565596

RESUMEN

Thoracic outlet syndrome (TOS) is a group of disorders all having in common compression at the thoracic outlet. Three structures are at risk: the brachial plexus, the subclavian vein, and the subclavian artery, producing neurogenic (NTOS), venous (VTOS), and arterial (ATOS) thoracic outlet syndromes, respectively. Each of these three are separate entities, though they can coexist and possibly overlap. The treatment of NTOS, in particular, has been hampered by lack of data, which in turn is the result of inconsistent definitions and diagnosis, uncertainty with regard to treatment options, and lack of consistent outcome measures. The Committee has defined NTOS as being present when three of the following four criteria are present: signs and symptoms of pathology occurring at the thoracic outlet (pain and/or tenderness), signs and symptoms of nerve compression (distal neurologic changes, often worse with arms overhead or dangling), absence of other pathology potentially explaining the symptoms, and a positive response to a properly performed scalene muscle test injection. Reporting standards for workup, treatment, and assessment of results are presented, as are reporting standards for all phases of VTOS and ATOS. The overall goal is to produce consistency in diagnosis, description of treatment, and assessment of results, in turn then allowing more valuable data to be presented.


Asunto(s)
Medicina Basada en la Evidencia/normas , Proyectos de Investigación/normas , Terminología como Asunto , Síndrome del Desfiladero Torácico , Consenso , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Síndrome del Desfiladero Torácico/clasificación , Síndrome del Desfiladero Torácico/complicaciones , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/terapia
8.
J Vasc Surg ; 64(3): e23-35, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27565607

RESUMEN

Thoracic outlet syndrome (TOS) is a group of disorders all having in common compression at the thoracic outlet. Three structures are at risk: the brachial plexus, the subclavian vein, and the subclavian artery, producing neurogenic (NTOS), venous (VTOS), and arterial (ATOS) thoracic outlet syndromes, respectively. Each of these three are separate entities, though they can coexist and possibly overlap. The treatment of NTOS, in particular, has been hampered by lack of data, which in turn is the result of inconsistent definitions and diagnosis, uncertainty with regard to treatment options, and lack of consistent outcome measures. The Committee has defined NTOS as being present when three of the following four criteria are present: signs and symptoms of pathology occurring at the thoracic outlet (pain and/or tenderness), signs and symptoms of nerve compression (distal neurologic changes, often worse with arms overhead or dangling), absence of other pathology potentially explaining the symptoms, and a positive response to a properly performed scalene muscle test injection. Reporting standards for workup, treatment, and assessment of results are presented, as are reporting standards for all phases of VTOS and ATOS. The overall goal is to produce consistency in diagnosis, description of treatment, and assessment of results, in turn then allowing more valuable data to be presented.


Asunto(s)
Medicina Basada en la Evidencia/normas , Proyectos de Investigación/normas , Terminología como Asunto , Síndrome del Desfiladero Torácico , Consenso , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Síndrome del Desfiladero Torácico/clasificación , Síndrome del Desfiladero Torácico/complicaciones , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/terapia
9.
Bioessays ; 36(12): 1132-7, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25220362

RESUMEN

Sinking organic particles transfer ∼10 gigatonnes of carbon into the deep ocean each year, keeping the atmospheric CO2 concentration significantly lower than would otherwise be the case. The exact size of this effect is strongly influenced by biological activity in the ocean's twilight zone (∼50-1,000 m beneath the surface). Recent work suggests that the resident zooplankton fragment, rather than ingest, the majority of encountered organic particles, thereby stimulating bacterial proliferation and the deep-ocean microbial food web. Here we speculate that this apparently counterintuitive behaviour is an example of 'microbial gardening', a strategy that exploits the enzymatic and biosynthetic capabilities of microorganisms to facilitate the 'gardener's' access to a suite of otherwise unavailable compounds that are essential for metazoan life. We demonstrate the potential gains that zooplankton stand to make from microbial gardening using a simple steady state model, and we suggest avenues for future research.


Asunto(s)
Dióxido de Carbono/química , Cilióforos/fisiología , Cadena Alimentaria , Microbiología del Agua , Zooplancton/fisiología , Animales , Biomasa , Ciclo del Carbono , Dióxido de Carbono/metabolismo , Conducta Alimentaria/fisiología , Consorcios Microbianos/fisiología , Océanos y Mares
10.
J Vasc Surg ; 61(3): 821-5, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25600336

RESUMEN

The supraclavicular approach to scalenectomy and first rib resection has been modified since the original description in 1985. The incision is 1 to 2 cm above the clavicle, 1 cm lateral to the midline, and 5 to 7 cm long. Subplatysmal skin flaps are created. The sternocleidomastoid muscle is mobilized on its lateral edge and retracted but not divided. The scalene fat pad is split vertically, the omohyoid muscle excised, and the C5 nerve root dissected free. The accessory phrenic nerve is identified, if present, arising medially from C5, and preserved. The rest of the plexus is dissected free, muscular and connective tissue removed from all nerve roots and trunks, and the subclavian artery identified. The phrenic nerve is identified on the medial edge of the anterior scalene muscle (ASM). The ASM is divided on the first rib. The ASM is elevated, freed, and divided as high as possible and free of C5. The middle scalene muscle is dissected. C5 and C6 branches of the long thoracic nerve are identified and protected as the portion of middle scalene muscle adjacent to the nerves of the plexus is excised. The decision on whether the first rib is to be removed is determined by whether the lower trunk of the plexus is touching the first rib. If the rib is removed, its posterior end is freed, divided, and 1 cm excised. The rest of the rib is freed from the intercostal muscles with a periosteal elevator or harmonic scalpel, the pleura is separated from the inner surface of the rib, and the anterior end divided with an infraclavicular rib cutter. The operation has been made safer by identifying and dissecting the C5 nerve root before looking for the phrenic nerve.


Asunto(s)
Plexo Braquial/fisiopatología , Clavícula/inervación , Descompresión Quirúrgica/métodos , Osteotomía/métodos , Costillas/cirugía , Síndrome del Desfiladero Torácico/cirugía , Puntos Anatómicos de Referencia , Descompresión Quirúrgica/efectos adversos , Disección , Humanos , Posicionamiento del Paciente , Radiografía , Recurrencia , Reoperación , Costillas/diagnóstico por imagen , Colgajos Quirúrgicos , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/fisiopatología , Resultado del Tratamiento
11.
Nature ; 457(7229): 577-80, 2009 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-19177128

RESUMEN

The addition of iron to high-nutrient, low-chlorophyll regions induces phytoplankton blooms that take up carbon. Carbon export from the surface layer and, in particular, the ability of the ocean and sediments to sequester carbon for many years remains, however, poorly quantified. Here we report data from the CROZEX experiment in the Southern Ocean, which was conducted to test the hypothesis that the observed north-south gradient in phytoplankton concentrations in the vicinity of the Crozet Islands is induced by natural iron fertilization that results in enhanced organic carbon flux to the deep ocean. We report annual particulate carbon fluxes out of the surface layer, at three kilometres below the ocean surface and to the ocean floor. We find that carbon fluxes from a highly productive, naturally iron-fertilized region of the sub-Antarctic Southern Ocean are two to three times larger than the carbon fluxes from an adjacent high-nutrient, low-chlorophyll area not fertilized by iron. Our findings support the hypothesis that increased iron supply to the glacial sub-Antarctic may have directly enhanced carbon export to the deep ocean. The CROZEX sequestration efficiency (the amount of carbon sequestered below the depth of winter mixing for a given iron supply) of 8,600 mol mol(-1) was 18 times greater than that of a phytoplankton bloom induced artificially by adding iron, but 77 times smaller than that of another bloom initiated, like CROZEX, by a natural supply of iron. Large losses of purposefully added iron can explain the lower efficiency of the induced bloom(6). The discrepancy between the blooms naturally supplied with iron may result in part from an underestimate of horizontal iron supply.


Asunto(s)
Carbono/metabolismo , Hierro/metabolismo , Agua de Mar/química , Regiones Antárticas , Clorofila/análisis , Clorofila/metabolismo , Clorofila A , Eutrofización , Geografía , Sedimentos Geológicos/química , Océanos y Mares , Fitoplancton/metabolismo , Estaciones del Año , Factores de Tiempo
12.
Telemed J E Health ; 21(5): 374-81, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25671795

RESUMEN

BACKGROUND: One of the major barriers to the practice of telemedicine is the state-to-state inconsistency and variability of requirements for physicians to obtain a medical license. MATERIALS AND METHODS: Invitations were extended to 61 individuals, representing 21 companies and healthcare systems. The participants had to meet strict inclusion criteria. Health professionals who process well over 1,000 applicants a year were provided a 30-question survey asking about state medical boards and their assessment, including ease of obtaining a license as well as difficulties. RESULTS: Responses were received from 40 of 61 (66%) individuals. Responders ranked their expectations of state medical boards for the following qualities: responsiveness to questions, cooperation, willingness to expedite the application, and knowledge. Although 46% of respondents perceived the state medical board licensing to be reasonable, 54% reported a prolonged application process owing to variable requirements and a deficiency of board office assistance. When respondents were asked about difficulty in dealing with the state medical boards, the reasons listed included the following: failure to respond to e-mails or calls, failure to provide updates on missing content, lack of cooperation, lack of uniform process/consistency, provision of erroneous information, and failure to use the Federation Credentials Verification Service. Lost documents was a problem in that 79% had to resubmit documents that were lost. CONCLUSIONS: The rapid growth of telemedicine is consistently meeting resistance because of the timely, costly, and variable process of medical license portability. A survey of professionals who, combined, annually process over 1,000 applications revealed major disparities among states. The survey demonstrated delayed responsiveness by the medical board, lost documents, and lack of access online as to the current applicant's status. Many of the respondents felt a standardized process or even a national license was a viable solution. Several models for a solution are presented.


Asunto(s)
Licencia Médica/legislación & jurisprudencia , Consejos de Especialidades/normas , Encuestas y Cuestionarios , Telemedicina/legislación & jurisprudencia , Femenino , Humanos , Licencia Médica/estadística & datos numéricos , Masculino , Evaluación de Necesidades , Estados Unidos
13.
Geophys Res Lett ; 41(23): 8460-8468, 2014 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-26074644

RESUMEN

Correlations between particulate organic carbon (POC) and mineral fluxes in the deep ocean have inspired the inclusion of "ballast effect" parameterizations in carbon cycle models. A recent study demonstrated regional variability in the effect of ballast minerals on the flux of POC in the deep ocean. We have undertaken a similar analysis of shallow export data from the Arctic, Atlantic, and Southern Oceans. Mineral ballasting is of greatest importance in the high-latitude North Atlantic, where 60% of the POC flux is associated with ballast minerals. This fraction drops to around 40% in the Southern Ocean. The remainder of the export flux is not associated with minerals, and this unballasted fraction thus often dominates the export flux. The proportion of mineral-associated POC flux often scales with regional variation in export efficiency (the proportion of primary production that is exported). However, local discrepancies suggest that regional differences in ecology also impact the magnitude of surface export. We propose that POC export will not respond equally across all high-latitude regions to possible future changes in ballast availability.

14.
Telemed J E Health ; 20(10): 902-8, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24660844

RESUMEN

BACKGROUND: A critical shortage in the supply of physicians in the United States has necessitated innovative approaches to physician service delivery. Telemedicine is a viable service delivery model for a variety of physician and health services. Telemedicine is most effective when applied where physician resources are scarce, patient care is time sensitive, and service volume may be distributed across a network. Shortages in critical care and neurology specialists have led to the use of tele-intensive care unit and telestroke services in hospital settings. These hospital-based telemedicine services have gained acceptance and recommendation. Hospitalist staffing shortages may provide an opportunity to apply similar telemedicine models to hospitalist medicine. This study assesses the potential market for a nighttime telehospitalist service. MATERIALS AND METHODS: An analysis of the Florida state hospital discharge dataset investigated the potential market for a new nighttime telehospitalist service. Admissions were filtered and stratified for common hospitalist metrics, time of day, and age of patients. Admissions were further expressed by hour of day and location. RESULTS: Nineteen percent of common hospitalist admissions occurred between 7:00 p.m. and 7:00 a.m., with a range of 17%-27% or 0.23-10.09 admissions per night per facility. Eighty percent of admissions occurred prior to midnight. Nonrural facilities averaged 6.69 hospitalist admissions per night, whereas rural facilities averaged 1.35 admissions per night. CONCLUSIONS: The low volume of nighttime admissions indicates an opportunity to leverage a telehospitalist physician service to deliver inpatient medical admission services across a network. Lower volumes of nighttime admissions in rural facilities may indicate a market for telehospitalist solutions to address the dilemma of hospitalist staffing shortages.


Asunto(s)
Médicos Hospitalarios , Cuidados Nocturnos , Telemedicina , Florida , Humanos , Admisión del Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Recursos Humanos
15.
Front Psychiatry ; 15: 1359505, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38832329

RESUMEN

Introduction: Estimates of the prevalence of intellectual disability or autism spectrum disorder (ASD) may vary depending on the methodology, geographical location, and sources of ascertainment. The National Disability Insurance Scheme (NDIS) in Australia was introduced progressively from 2016 to provide individualized funding for eligible people with a significant and permanent disability. Methods: Its recent inclusion as a source of ascertainment in the population-based Intellectual Disability Exploring Answers (IDEA) database in Western Australia has allowed comparisons of the prevalence of intellectual disability and ASD before and after its introduction. Results: Prevalence of intellectual disability in 2020 was 22.5 per 1,000 (/1,000) live births compared with previous estimates in 2010 of 17/1,000, and for ASD, the estimate was 20.7/1,000 in 2020 compared with 5.1 /1,000 in 2010. Whilst the prevalence of ASD in Aboriginal individuals was about two-thirds that of non-Aboriginals, there was an increased prevalence of ASD in Aboriginal children under 10 years compared with non-Aboriginal children. Discussion: The concurrent relaxation of ASD diagnostic practice standards in Western Australia associated with the administration of access to the NDIS and the release of the National Guidelines empowering single diagnosticians to determine the appropriateness of engaging additional diagnosticians to form a multidisciplinary team on ASD diagnosis, appear to be important factors associated with the increase in ASD diagnoses both with and without intellectual disability.

16.
Environ Pollut ; : 124483, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38960123

RESUMEN

Seagrass meadows are one of the world's most diverse ecosystems offering habitats for an extensive array of species, as well as serving as protectors of coral reefs and vital carbon sinks. Furthermore, they modify hydrodynamics by diminishing water flow velocities and enhancing sediment deposition, indicating the potential for microplastic accumulation in their sediments. The build-up of microplastics could potentially have ecological impacts threatening to ecosystems, however little is known about microplastic abundance and controlling factors in seagrass sediments. Here we investigated microplastic characteristics and abundances within sediments underlying four seagrass meadow sites on the Turneffe Atoll, Belize. Sediment cores were collected and sub-sampled to include a range of replicate surface sediments (0-4 cm) and depth cores (sediment depths 0-2, 2-5, 5-10, 10-20 and 20-30 cm). These were analysed using 25 µm resolution µFTIR, with spectral maps processed using siMPle software. Microplastics were prevalent across the sites with an abundance range (limit of detection (LOD) blank-corrected) of < LOD to 17137 microplastics kg-1 dw found on the east side of the atoll. However, their abundances varied greatly between the replicate samples. Polyethylene and polypropylene were the most commonly detected polymers overall, although the dominant polymer type varied between sites. There were no differences in the abundance of microplastics between sites, nor could abundance distributions be explained by seagrass cover. However, abundances of microplastics were highest in sediments with lower proportions of fine grained particles (clay, <4 µm) suggesting that hydrodynamics override seagrass effects. Additionally, no patterns were seen between microplastic abundance and depth of sediment. This suggests that microplastic abundance and distribution in seagrass meadows may vary significantly depending on the specific geographical locations within those meadows, and that more complex hydrodynamic factors influence spatial variability at a localised scale.

17.
Nature ; 437(7059): 728-32, 2005 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-16193051

RESUMEN

Diatoms are unicellular or chain-forming phytoplankton that use silicon (Si) in cell wall construction. Their survival during periods of apparent nutrient exhaustion enhances carbon sequestration in frontal regions of the northern North Atlantic. These regions may therefore have a more important role in the 'biological pump' than they have previously been attributed, but how this is achieved is unknown. Diatom growth depends on silicate availability, in addition to nitrate and phosphate, but northern Atlantic waters are richer in nitrate than silicate. Following the spring stratification, diatoms are the first phytoplankton to bloom. Once silicate is exhausted, diatom blooms subside in a major export event. Here we show that, with nitrate still available for new production, the diatom bloom is prolonged where there is a periodic supply of new silicate: specifically, diatoms thrive by 'mining' deep-water silicate brought to the surface by an unstable ocean front. The mechanism we present here is not limited to silicate fertilization; similar mechanisms could support nitrate-, phosphate- or iron-limited frontal regions in oceans elsewhere.


Asunto(s)
Carbono/metabolismo , Diatomeas/metabolismo , Silicatos/metabolismo , Océano Atlántico , Transporte Biológico , Biomasa , Clorofila/metabolismo , Nitratos/metabolismo , Fosfatos/metabolismo , Fotosíntesis , Fitoplancton/metabolismo
18.
Ann Vasc Surg ; 24(6): 701-8, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20471786

RESUMEN

BACKGROUND: Since 2005 when we became aware of pectoralis minor syndrome (PMS), more than 75% of patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) also have neurogenic PMS (NPMS), and about 30% have only NPMS, without NTOS. METHODS: Diagnosis was made based on history, physical examination, pectoralis minor (PM), and scalene muscle blocks with lidocaine. Pectoralis minor tenotomy was performed as an outpatient procedure under local anesthesia with heavy sedation through a 5-7 cm transaxillary incision. RESULTS: The clinical picture included pain or tenderness in the anterior chest wall and axilla, together with physical findings of tenderness over the pectoralis minor tendon. Other symptoms were extremity pain, weakness, and paresthesia, similar to symptoms of NTOS. In 76 patients, 100 operations were performed: 48 for NPMS combined with NTOS and 52 for NPMS-alone. Features distinguishing the PM-alone group were fewer and milder occipital headaches, less neck pain, and fewer positive physical findings. Preoperatively, 85% of the of the PM-alone group were still employed compared to only 57% of the combined group (p=0.01). Success rates with 1-3-year follow-up for the PM-alone group were 90% good-excellent, 2% fair, and 8% failed; for the combined group success rates were 35% good-excellent, 19% fair, and 46% failed. All but one of the failures was immediate, only one was late. The only complication was 3 wound infections. Most patients returned to work within a few days. In the combined PMS/TOS group, most of the failed patients subsequently had thoracic outlet operations. CONCLUSION: PMS commonly accompanies NTOS and frequently exists alone. Its recognition is important as many patients with suspected NTOS can be treated successfully with a simple, essentially risk-free PM tenotomy. Should this fail, thoracic outlet decompression can always be performed at a later date.


Asunto(s)
Descompresión Quirúrgica/métodos , Síndromes de Compresión Nerviosa/cirugía , Procedimientos Ortopédicos , Músculos Pectorales/cirugía , Síndrome del Desfiladero Torácico/cirugía , Adolescente , Adulto , Anciano , Colorado , Descompresión Quirúrgica/efectos adversos , Diagnóstico Diferencial , Evaluación de la Discapacidad , Electromiografía , Empleo , Femenino , Cefalea/etiología , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso , Síndromes de Compresión Nerviosa/complicaciones , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/fisiopatología , Procedimientos Ortopédicos/efectos adversos , Dolor/etiología , Parestesia/etiología , Músculos Pectorales/inervación , Examen Físico , Recurrencia , Síndrome del Desfiladero Torácico/complicaciones , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
19.
Schizophr Res ; 108(1-3): 163-9, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19108992

RESUMEN

BACKGROUND: Neurological Examination Abnormalities (NEA, often called "neurological soft signs") have been observed in early schizophrenia and may be heritable. We investigated the prevalence, and neurocognitive and psychopathological correlates of NEA among offspring of schizophrenia patients who are at increased genetic risk for this illness. METHODS: Neurological examinations were conducted on high risk (HR, n=74) and healthy comparison subjects (HS, n=86), using the Heinrichs-Buchanan scale. Cognitive-perceptual (CogPer) and repetitive motor (RepMot) subscores, and total NEA scores were computed. All HR and HS were assessed using K-SADS/SCID for diagnoses. Schizotypy was measured using the Magical Ideation and the Perceptual Aberration subscales (Chapman scale), attention using Continuous Performance Test (CPT-IP) and executive functions using the Wisconsin Card Sorting Test (WCST). RESULTS: CogPer (F(1,160)=7.14, p=0.008) but not RepMot NEA scores were higher in HR subjects compared to HS after controlling for age and sex. CogPer NEA scores were higher in HR subjects with axis I psychopathology compared to those without (F(2,170)-6.41, p=0.002). HR subjects had higher schizotypy scores (composite of the magical ideation and perceptual aberration scales) (F(1,141)=23.25, p=0.000004). Schizotypy scores were negatively correlated with sustained attention and executive functions. In addition, schizotypy was positively correlated with CogPer NEA scores. CONCLUSIONS: Young relatives at increased genetic risk for schizophrenia show more frequent NEA. CogPer but not RepMot NEA scores were elevated, consistent with our prior observation of CogPer NEA being relatively specific for schizophrenia. The observed relationships between NEA, cognitive impairments, schizotypy and axis I disorders suggest that NEA may characterize a subgroup of HR offspring at an elevated risk for psychopathology.


Asunto(s)
Hijo de Padres Discapacitados/psicología , Enfermedades del Sistema Nervioso/genética , Psicopatología , Esquizofrenia/genética , Psicología del Esquizofrénico , Adolescente , Análisis de Varianza , Niño , Cognición/fisiología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Control Interno-Externo , Masculino , Enfermedades del Sistema Nervioso/psicología , Examen Neurológico/métodos , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Adulto Joven
20.
Sci Data ; 6(1): 22, 2019 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-30967554

RESUMEN

Through regular sampling surveys, the Flanders Marine Institute is generating long term data series for the Belgian coastal water and sand bank systems, a designated site in the Long Term Ecological Research (LTER) network. The data series is built on sampling activities initiated in 2002, but gradually upgraded and extended in the framework of the LifeWatch marine observatory and the Integrated Carbon Observation System (ICOS) participation. Nine nearshore stations are sampled monthly, with additional seasonal sampling of eight offshore stations. This paper presents the generated data series for nutrients, pigments, suspended matter and turbidity. The collection, methodology and processing of the 2002-2018 dataset is described, along with its data curation, integration and quality control. Yearly versions of the data are published online in a standardized format, accompanied with extensive metadata description and labelled with digital identifiers for traceability. Data is published under a CC-BY license, allowing use of the data under the condition of providing reference to the original source.

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