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The Missouri River is a continent-scale river that has thus far escaped a rigorous reporting of valley fill trends within its trunk system. This study summarizes evolution of the lower Missouri River profile from the time of outwash in the Last Glacial Maximum (LGM) until establishment of the modern dominantly precipitation-fed river. This work relies on optically stimulated luminescence (OSL) dating, water-well data, and a collection of surficial geological maps of the valley compiled from U.S. Geological Survey EDMAP and National Science Foundation Research Experience for Undergrads projects. Mapping reveals five traceable surfaces within valley fill between Yankton, South Dakota, USA, and Columbia, Missouri, USA, that record two cycles of incision and aggradation between ca. 23 ka and ca. 8 ka. The river aggraded during the LGM to form the Malta Bend surface by ca. 26 ka. The Malta Bend surface is buried and fragmented but presumed to record a braided outwash plain. The Malta Bend surface was incised up to 18 m between ca. 23 ka and ca. 16 ka to form the Carrolton surface (ca. 16 ka to ca. 14 ka). The Carrollton surface ghosts a braided outwash morphology locally through overlying mud. Aggradation followed (ca. 14 ka to ca. 13.5 ka) to within 4 m of the modern floodplain surface and generated the Salix surface (ca. 13.5 to ca. 12 ka). By Salix time, the Missouri River was no longer an outwash river and formed a single-thread meandering pattern. Reincision at ca. 12 ka followed Salix deposition to form the short-lived Vermillion surface at approximately the grade of the earlier Carrolton surface. Rapid aggradation from ca. 10 ka to ca. 8 ka followed and formed the modern Omaha surface (ca. 8 ka to Present). The higher Malta Bend and Omaha profiles are at roughly the same grade, as are the lower Carrolton and Vermillion surfaces. The Salix surface is in between. All surfaces converge downstream as they enter the narrow and shallow bedrock valley just before reaching Columbia, Missouri. The maximum departure of the profiles is 18 m near Sioux City, Iowa, USA, at ∼100 km downstream from the James Lobe glacial input near Yankton, South Dakota. Incision and aggradation appear to be driven by relative changes in input of sediment and water related to glacial advance and retreat and then later by climatic changes near the Holocene transition. The incision from the Malta Bend to the Carrolton surface records the initial breakdown of the cryosphere at the end of the LGM, and this same incisional event is found in both the Ohio and Mississippi valleys. This incisional event records a “big wash” that resulted in the evacuation of sediment from each of the major outwash rivers of North America. The direction and magnitude of incision from the LGM to the modern does not fit with modeled glacioisostatic adjustment trends for the Missouri Valley. Glaciotectonics likely influenced the magnitude of incision and aggradation secondarily but does not appear to have controlled the overall timing or magnitude of either. Glaciotectonic valley tilting during the Holocene, however, did likely cause the Holocene channel to consistently migrate away from the glacial front, which argues for a forebulge axis south of the Missouri Valley during the Holocene and, by inference, earlier. This is at least 200 km south of where models predict the Holocene forebulge axis. The Missouri Valley thus appears to reside in the tectonic low between the ice front and the forebulge crest. The buffer valley component of incision caused by profile variation could explain as much as 25 m of the total ∼40 m of valley incision at Sioux City, Iowa. The Missouri Valley also hosted a glacial lobe as far south as Sioux City, Iowa, in pre-Wisconsinan time, which is also a factor in valley excavation.

Calcium plays an essential role in physiologic processes, including trauma's "Lethal Diamond." Thus, inadequate serum calcium in trauma patients exacerbates the effects of hemorrhagic shock secondary to traumatic injury and subsequently poorer outcomes compared to those with adequate calcium levels. Evidence to date supports the consideration of calcium derangements when assessing the risk of mortality and the need for blood product transfusion in trauma patients. This review aims to further elucidate the predictive strength of this association for future treatment guidelines and clinical trials.Publications were collected on the relationship between i-Ca and the outcomes of traumatic injuries from PubMed, Web of Science, and CINAHL. Manuscripts were reviewed to select for English language studies. Hypocalcemia was defined as i-Ca1.2 mmol/L.Using PRISMA guidelines, we reviewed 300 studies, 7 of which met our inclusion criteria. Five papers showed an association between hypocalcemia and mortality.In adult trauma patients, there has been an association seen between hypocalcemia, mortality, and the need for increased blood product transfusions. It is possible we are now seeing an association between low calcium levels prior to blood product administration and an increased risk for mortality and need for transfusion. Hypocalcemia may serve as a biomarker to show these needs. Therefore, hypocalcemia could potentially be used as an independent predictor for multiple transfusions such that ionized calcium measurements could be used predictively, allowing faster administration of blood products.

Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a form of profound cardiac shock defined as measurable cardiac activity without clinically detectable pulses. p-PEA has a distinct physiology and etiology from VF and true-PEA, and may constitute up to 40% of reported cases of cardiac arrest. Electrical impedance tomography (EIT) uses cutaneous electrodes to generate images based on cross sectional resistance. We utilized EIT to predict the number of interventions required to achieve ROSC from p-PEA. Methods: Female swine (N = 14) under intravenous anesthesia were instrumented with aortic and central venous micromanometer catheters. p-PEA was induced by ventilation with 6% oxygen in 94% nitrogen and was defined as a systolic aortic pressure less than 40 mmHg. Continuous EIT renderings were obtained from circumferential cutaneous thoracic and abdominal electrode arrays. A deep learning model was utilized to detect features within the EIT video clips of the p-PEA disease state to predict the number of treatments required to achieve ROSC. Twelve pigs were randomly selected as training data and 2 pigs as a test set. EIT images were saved as 30 second clips, resulting in 1630 clips generated. To increase generalizability, random epochs ranging from 30 - 100% of the total clip length were generated, resulting in a model capable of detecting this disease state with limited video fragments. Data were labeled based on the number of interventions required to achieve ROSC (100% O 2 , 100% O 2 + CPR, 100% O 2 + CPR + Epi, ROSC not achieved). Results: This approach yielded receiver operator characteristic curves - area under the curve (ROC-AUC, Figure 1) values of 0.75 for micro (weighted) AUC and 0.78 for macro (unweighted) AUC on a 4 class prediction model. Conclusion: EIT combined with machine learning may differentiate the required treatments needed to achieve ROSC in p-PEA.

Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. p-PEA may constitute up to 40% of reported cases of cardiac arrest and its management may be different from ventricular fibrillation or even true-PEA. Currently, diagnosis of p-PEA requires either echocardiography or intravascular catheterization, neither of which are ideal in the prehospital setting. Electrical impedance tomography (EIT) uses skin surface electrodes to generate images based on cross sectional resistance. We investigated the ability of EIT and machine learning (ML) to detect p-PEA. Methods: Female swine (N = 14) under intravenous anesthesia were instrumented with aortic and central venous micromanometer catheters. p-PEA was induced by ventilation with 6% O 2 in 94% N 2 , defined as a systolic aortic pressure less than 40 mmHg. Continuous EIT renderings were obtained from circumferential thoracic and abdominal electrode arrays. A deep learning model was utilized to detect p-PEA using EIT sequences. Twelve pigs were randomly selected as training data and 2 pigs as a test set. EIT images were saved as 30 second clips, resulting in 3033 clips generated. To increase generalizability, random epochs ranging from 30 - 100% of the total clip length were generated, resulting in a model capable of detecting this disease state with limited video fragments. Results: This technique yielded a receiver operator characteristic curve - area under the curve (ROC-AUC) of 0.91 for detection of p-PEA in the testing dataset (Figure 1), with 84% accuracy, 88% sensitivity, and 84% specificity. Conclusions: EIT combined with machine learning may be able to reliably delineate p-PEA in a hypoxic porcine model. This approach may be promising for non-invasive operator-independent p-PEA detection.

Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Patients in pseudo-PEA carry different prognoses than those in true PEA and may require different therapies. Noninvasive technologies capable of detecting return of spontaneous circulation (ROSC) are needed to guide transition therapy from ACLS to critical care. Electrical impedance (EI) measurements across the thorax and abdomen may reflect the state of the cardiovascular system and change with ROSC. Hypothesis: EI measured across the chest wall or abdomen can detect ROSC in p-PEA. Methods: Female swine (N = 14) under intravenous anesthesia were instrumented with aortic and central venous micromanometer catheters. EI was measured with cutaneous belts around the chest and abdomen (Swisstom). p-PEA was induced by ventilation with 6% oxygen in 94% nitrogen and was defined as a systolic aortic pressure < 40 mmHg. Experiments in which ROSC occurred within 20 seconds of starting 100% FiO 2 were studied. EI waveforms were analyzed with fast fourier transforms, and the dominant frequencies of p-PEA and ROSC signals were subtracted to create a difference distribution. Results: With onset of ROSC, there was a characteristic frequency increase in EI measurable across both chest and abdominal bands. Fourier transform analysis demonstrated a significant difference in dominant frequencies between resuscitation and p-PEA. The median difference between resuscitation and p-PEA dominant frequencies were 5.49 in the thorax [95% CI 3.48 - 7.50] and 6.65 in the abdomen [95% CI 3.63 - 9.67]. Conclusions: There appear to be characteristic EI frequency patterns and changes in p-PEA and ROSC. If confirmed clinically, this indicates that EI may be a promising technology for non-invasive monitoring in cardiac arrest.

Courses: Interpersonal Communication, Health Communication, Intercultural CommunicationObjectives: After completing this semester-long activity students, should be able to (1) apply course concepts (i.e., stereotypes, identity, listening, language, and conflict) to diverse real-world scenarios; (2) explain the utility of intergroup contact theory in relationship to communication and social diversity; (3) critically reflect on social diversity explored through communication behaviors; and (4) develop communication competence toward diverse others, specifically persons with disabilities (PWDs).

With the development of mobile wireless technology, more people are using their smart phones to browse Web sites, do social networking, and play online games. However, a significant fraction of people in developing regions are still using simple low-end devices with limited processing and communication capabilities. Access to Internet contents and services is currently available only for Internet-enabled, Internet- capable smart devices. To address this problem, in this paper, we propose a Short Messaging Service (SMS)- based service to enable low-end cell phones to access Internet and Web services. In particular, we designed a service called iTex, allowing users to use Google web services through text messages even if they do not own Internet-enabled and Internet-capable smart devices.

The aim of this study was to compare IMRT optimization in the CMS XiO radiotherapy treatment planning system, with and without segment weight optimization. Twenty‐one prostate cancer patients were selected for this study. All patients were initially planned with step‐and‐shoot IMRT (S‐IMRT). A new plan was then created for each patient by applying the segment weight optimization tool (SWO‐IMRT). Analysis was performed on the (SWO‐IMRT) and (S‐IMRT) plans by comparing the total number of segments, monitor units, rectal and bladder dose. The study showed a statistically significant reduction in the total number of segments (mean: 25.3%; range: 16.8%–31.1%) with SWO‐IMRT as compared to S‐IMRT (p

Dust deposition to mountain snow cover, which has increased since the late 19 th century, accelerates the rate of snowmelt by increasing the solar radiation absorbed by the snowpack. Snowmelt occurs earlier, but is decoupled from seasonal warming. Climate warming advances the timing of snowmelt and early season phenological events (e.g., the onset of greening and flowering); however, earlier snowmelt without warmer temperatures may have a different effect on phenology. Here, we report the results of a set of snowmelt manipulations in which radiation-absorbing fabric and the addition and removal of dust from the surface of the snowpack advanced or delayed snowmelt in the alpine tundra. These changes in the timing of snowmelt were superimposed on a system where the timing of snowmelt varies with topography and has been affected by increased dust loading. At the community level, phenology exhibited a threshold response to the timing of snowmelt. Greening and flowering were delayed before seasonal warming, after which there was a linear relationship between the date of snowmelt and the timing of phenological events. Consequently, the effects of earlier snowmelt on phenology differed in relation to topography, which resulted in increasing synchronicity in phenology across the alpine landscape with increasingly earlier snowmelt. The consequences of earlier snowmelt from increased dust deposition differ from climate warming and include delayed phenology, leading to synchronized growth and flowering across the landscape and the opportunity for altered species interactions, landscape-scale gene flow via pollination, and nutrient cycling.

Empirical assessment has been proposed as a process for evaluating the fairness of lineups in forensic settings. The mock witness paradigm, which asks a nonwitnesses to choose lineup members best fitting a given description, was used in a 2×2 ANOVA design (N=165) to evaluate two photospreads (same defendant, different foils) from an actual rape case. Two groups (context 1) were asked to pick the best matching photo from the two photospreads after hearing the real witnesses' description and to estimate the features of each foil. Two groups (context 2) were asked for feature estimates only. A significantcontext effect (p