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We report a case of new-onset atrial fibrillation with rapid ventricular response in a 37-year-old malewho presented to the emergency department. This patient was not admitted to the hospital or placed onobservation, but rather placed on a cellular outpatient 12-lead telemetry (COTLT) device with emergencyresponse capabilities and discharged home. We define a new modality that allows these patients tobe managed via telemedicine and receive care similar to that which would be rendered in a hospital orobservation unit.

This is a case report describing the ultrasound-guided placement of a peripheral intravenous catheter into the internal jugular vein of a patient with difficult vascular access. Although this technique has been described in the past, this case is novel in that the Seldinger technique was used to place the catheter. This allows for safer placement of a longer catheter (2.25”) without the need for venous dilation, which is potentially hazardous.

We present a new method to estimate individual knot volumes based on a knot geometry model coupled with observations on branch characteristics. X-ray computer tomography and image analysis were used to measure the volume and geometry of 424 knots of Sitka spruce (Picea sitchensis (Bong.) Carriere). Knot geometry can be described mathematically by deriving functions for relative vertical position, diameter, and slope dependent on radial position in the stem. These functions were parameterized using 'seemingly unrelated regression' and mixed-modelling techniques. This provided a base model for typical knots. To estimate individual knot volume, we used available data for branch diameter and insertion angle to obtain conditional predictions. We imputed the most likely knot trajectory, as relative vertical position cannot be measured on branches. The model explained up to 96% of the variability in knot volume by incorporating the branch measurements, in contrast to the 43% explained using the typical knot model. Knot volume assessment based only on conditional predictions of diameter and marginal predictions of vertical position also accounted for 96% of the variability. Therefore, measurements of branch diameter alone would be enough to obtain highly precise predictions of individual knot volume. This estimator is a first step towards a knot model to be used for the management of Sitka spruce in Great Britain. Key words: knot geometry, seemingly unrelated regression, Sitka spruce, mixed models, BLUPs. Nous presentons une nouvelle methode pour estimer le volume de chaque noeud sur la base d'un modele de geometrie des noeuds couple a des informations sur les caracteristiques des branches. La tomographie aux rayons x et l'analyse d'images ont ete utilisees pour mesurer le volume et la geometrie de 424 noeuds chez l'epinette de Sitka (Picea sitchensis (Bong.) Carriere). On peut decrire la geometrie d'un noeud de facon mathematique en derivant des equations pour la position verticale relative, le diametre et la pente qui dependent de la position radiale dans le tronc. Ces equations ont ete parametrees a l'aide de methodes de << seemingly unrelated regression >> et de modelisation a effets mixtes. Cela a fourni un modele de base pour les noeuds typiques. Pour estimer le volume d'un noeud, nous avons utilise les donnees disponibles pour le diametre et l'angle d'insertion des branches afin d'obtenir des predictions conditionnelles. Nous avons impute la trajectoire des noeuds la plus probable etant donne que la position verticale relative ne peut etre mesuree sur les branches. Le modele explique jusqu'a 96 % de la variation du volume des noeuds si on incorpore les mesures des branches contrairement a 43 % pour le modele de noeuds typiques. De plus, l'evaluation du volume des noeuds seulement sur la base de predictions conditionnelles du diametre et de predictions marginales de la position verticale explique aussi 96 % de la variation. La seule mesure du diametre des branches serait par consequent suffisante pour obtenir des predictions tres precises du volume de chaque noeud. Cet estimateur n'est que la premiere etape vers un modele de noeuds utile a des fins d'amenagement de l'epinette de Sitka en Grande-Bretagne. [Traduit par la Redaction] Mots-cles : geometrie des noeuds, regression sans relation apparente, epinette de Sitka, modele a effets mixtes, methode BLUP de Henderson., 1. Introduction The occurrence of knots in the wood of commercial species is a long-standing issue for the sawn-wood industries. Knot frequency and size, often jointly referred to as knot [...]

The American College of Emergency Physicians Emergency Telehealth Section was charged with development of a working definition of emergency telehealth that aligns with the College's definition of emergency medicine. A modified Delphi method was used by the section membership who represented telehealth providers in both private and public health-care delivery systems, academia and industry, rural and urban settings. Presented in this manuscript is the final definition of emergency telehealth developed with an additional six clarifying statements to address the context of the definition. Emergency telehealth is a core domain of emergency medicine and is inclusive of remotely providing all types of care for acute conditions of any kind requiring expeditious care irrespective of any prior relationship. The development of this definition is important to the global community of emergency physicians and all patients seeking acute care to ensure that appropriately trained clinicians are providing the highest quality of emergency services via the telehealth modality. We recommend implementing emergency telehealth in a manner that ensures appropriate qualifications of providers, appropriate/parity reimbursement for telehealth services and, most importantly, the delivery of quality care to patients in a safe, efficient, timely and cost-effective manner. [ABSTRACT FROM AUTHOR]

The effect of clearfell harvesting on soil greenhouse gas (GHG) fluxes of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) was assessed in a Sitka spruce forest growing on a peaty gley organo-mineral soil in northern England. Fluxes from the soil and litter layer were measured monthly by the closed chamber method and gas chromatography over four years in two mature stands, with one area harvested after the first year. Concurrent measurements of soil temperature and moisture helped to elucidate reasons for the changes in fluxes. In the three years after felling, there was a significant increase in the soil temperature, particularly between June and November (3 to 5 °C higher), and in soil moisture which was 62 % higher in the felled area, and these had pronounced effects on the GHG balance, in addition to the removal of the trees and their carbon input to the soil. Annual soil CO2 effluxes reduced to almost a third in the first year after felling (a drop from 24.0 to 8.9 t CO2 ha-1 yr-1) and half in the second and third year (mean 11.8 t CO2 ha-1 yr-1) compared to before felling, while those from the unfelled area were little changed. Annual effluxes of N2O more than doubled in the first two years (from 1.0 to 2.3 and 2.5 t CO2e ha-1 yr-1, respectively), although by the third year they were only 20 % higher (1.2 t CO2e ha-1 yr-1). CH4 fluxes changed from a small net uptake of -0.03 t CO2e ha-1 yr-1 before felling to a small efflux increasing over the 3 years to 0.34 t CO2e ha-1 yr-1, presumably because of the wetter soil after felling. Soil CO2 effluxes dominated the total net GHG emission calculated using the global warming potential (GWP) of the three gases, but N2O contributed up to 20 % of the total annual emissions. This study showed fluxes of CO2, CH4 and N2O responded differently to clearfelling due to the significant changes in soil biotic and abiotic factors and showed large variations between years. This demonstrates the need for multi-year measurements of all GHGs to enable a robust estimate of the effect of the clearfell phase on the GHG balance of managed forests. This is one of a very few multi-year monitoring studies to assess the effect of clearfell harvesting on soil GHG fluxes. [ABSTRACT FROM AUTHOR]

The article presents a case of an obese 61-year-old man diagnosed with ruptured abdominal aortic aneurysm (AAA). The man was brought to the hospital after he had fallen onto his buttocks on a sidewalk. A computed tomography (CT) scan of his abdomen and pelvis with intravenous contrast revealed a large infrarenal AAA with a right-sided retroperitoneal hematoma. Preventive medical services for the disease are also provided.