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Pre-hospital providers (PHPs) undertake initial patient assessment, often spending considerable time with patients prior to arrival at ED. However, continuity of this assessment with ongoing care of patients in the ED is limited, with repeated assessment in the ED, starting with the process of triage in hospital. A systematic review of the literature was conducted to assess the ability of PHPs to predict patient outcomes in the ED. Manuscripts were screened and were eligible for inclusion if they included patients transported by non-physician PHPs to the ED and assessed ability of PHPs to predict triage scores, clinical course, treatment requirements or disposition from ED. The initial search returned 10 753 unique articles. find more After screening and full text review, 10 studies were included in data analysis. Of these, six assessed prediction of disposition (admission versus discharge) from ED, two compared triage score application, one assessed prediction of clinical requirements and one assessed prediction of mortality prior to discharge. Prediction of admission across five studies had a pooled sensitivity of 0.73 (95% confidence interval 0.67-0.79) and specificity of 0.78 (95% confidence interval 0.69-0.85). Triage score application had weighted kappa variables of 0.409 and 0.452 indicating moderate agreement on assessment priority between PHPs and triage nurses. The ability of PHPs to assign triage scores, predict clinical course and predict disposition from the ED have mild concordance with clinical assessment by ED staff. This is an area of potential expansion in PHPs’ role; however, training would be required prior to implementation.

To investigate and improve the level of equivalency of Varian TrueBeam linear accelerators (linacs) in energy-, dosimetric leaf gap- (DLG) and jaw calibration.

Eight linacs with four photon energies 6MV, 6MV FFF, 10MV FFF, and 15MV, and three electron energies (on two linacs) 6, 9, and 12MeV were commisioned and beam-matched. Initially, symmetry of lateral profiles was calibrated for maximum field size. Energy-matching was then performed for photons by adjusting diagonal profiles at maximum field size and depth of maximum dose to coincide with the reference linac, and for electrons by matching the range at percentage depth of ionization of 90%, 80%, and 50%. Calibration of DLG was performed for 6MV and evaluated among the linacs. The relationship between DLG and the Gap value was investigated. A method using electronic portal imaging device (EPID) was developed and implemented for jaw calibration.

Symmetry calibration for photons (electrons) was within 1% (0.7%), further improving the vendor’s acceptance criteria. Photon and electron energy-matching was within 0.5% and 0.1mm, respectively. Calibration of DLG was within 0.032mm among the linacs and utilizing the relationship between DLG and the Gap value resulted in an empirical calibration method which was implemented to simplify DLG adjustment. Using EPID-based method of calibration, evaluation of the jaw-positioning among the linacs for 30cm×30cm field size was within 0.4mm and in the junction area within 0.2mm. Dose delivery error of VMAT-plans were at least 99.2% gamma pass rate (1%, 1mm).

High level of equivalency, beyond clinically accepted criteria, of TrueBeam linacs could be achieved which reduced dose delivery systematic errors and increased confidence in interchanging patients among linacs.

High level of equivalency, beyond clinically accepted criteria, of TrueBeam linacs could be achieved which reduced dose delivery systematic errors and increased confidence in interchanging patients among linacs.Since 2010, considerable efforts have been undertaken to monitor the environmental status of European marine waters and ensuring the development of methodological standards for the evaluation of this status. However, the current routine biomonitoring implicates time-consuming and costly manual sorting and morphological identification of benthic macrofauna. Environmental DNA (eDNA) metabarcoding represents an alternative to the traditional monitoring method with very promising results. Here, we tested it further by performing eDNA metabarcoding of benthic eukaryotic communities in the vicinity of two offshore oil and gas platforms in the North Sea. Three different genetic markers (18S V1V2, 18S V9 and COI) were used to assess the environmental pressures induced by the platforms. All markers showed patterns of alpha and beta diversity consistent with morphology-based macrofauna analyses. In particular, the communities’ structure inferred from metabarcoding and morphological data significantly changed along distance gradients from the platforms. The impact of the operational discharges was also detected by the variation of biotic index values, AMBI index showing the best correlation between morphological and eDNA data sets. Finally, the sediment physicochemical parameters were used to build a local de novo pressure index that served as benchmark to test the potential of a taxonomy-free approach. Our study demonstrates that metabarcoding approach outperforms morphology-based approach and can be used as a cost and time-saving alternative solution to the traditional morphology-based monitoring in order to monitor more efficiently the impact of industrial activities on marine biodiversity.Cognitive flexibility is an important executive function and refers to the ability to adapt behaviors in response to changes in the environment. Of note, many brain disorders are associated with impairments in cognitive flexibility. Several classical neurotransmitter systems including dopamine, acetylcholine and noradrenaline are shown to be important for cognitive flexibility, however, there is not much known about the role of neuropeptides. The neuropeptide orexin, which is brain-widely released by neurons in the lateral hypothalamus, is a major player in maintaining sleep/wake cycle, feeding behavior, arousal, and motivational behavior. Recent studies showed a role of orexin in attention, cognition and stress-induced attenuation of cognitive flexibility by disrupting orexin signaling locally or systemically. However, it is not known so far whether brain-wide reduction or loss of orexin affects cognitive flexibility. We investigated this question by testing male and female orexin-deficient mice in the attentional set shifting task (ASST), an established paradigm of cognitive flexibility.