Revealing the hidden carbon in forested wetland soils.

Inland wetlands are critical carbon reservoirs storing 30% of global soil organic carbon (SOC) within 6% of the land surface. However, forested regions contain SOC-rich wetlands that are not included in current maps, which we refer to as 'cryptic carbon'. Here, to demonstrate the magnitude and distribution of cryptic carbon, we measure and map SOC stocks as a function of a continuous, upland-to-wetland gradient across the Hoh River Watershed (HRW) in the Pacific Northwest of the U.S., comprising 68,145 ha. Total catchment SOC at 30 cm depth (5.0 TgC) is between estimates from global SOC maps (GSOC: 3.9 TgC; SoilGrids: 7.8 TgC). For wetland SOC, our 1 m stock estimates are substantially higher (Mean: 259 MgC ha-1; Total: 1.7 TgC) compared to current wetland-specific SOC maps derived from a combination of U.S. national datasets (Mean: 184 MgC ha-1; Total: 0.3 TgC). We show that total unmapped or cryptic carbon is 1.5 TgC and when added to current estimates, increases the estimated wetland SOC stock to 1.8 TgC or by 482%, which highlights the vast stores of SOC that are not mapped and contained in unprotected and vulnerable wetlands.

From Concept to Counter: A Review of Bringing an Orthopaedic Implant to Market.

Physicians offer unique contributions to the orthopaedic implant design process by providing creative ideas and insightful clinical expertise. This article provides a brief overview of the pertinent considerations of transforming a concept into an orthopaedic implant and bringing it to the market. Implant concept choice should consider medical or surgical necessity, regional variability, market characteristics, cost of goods sold, and average selling price. Implant development requires adherence to regulatory requirements and device classification. Implant production incorporates design specifications, mechanical testing, sterilization, packaging, and marketing and sales. Orthopaedic implant company agreements determine physician compensation through royalties and/or the purchase of intellectual property. After rollout, physicians participate in monitoring for device safety. Bringing an orthopaedic implant from a concept to the market can be lengthy and complicated, but innovation is essential for advancing patient care and well-being.

Finding Cactus Roots in Polynomial Time.

A graph H is a square root of a graph G, or equivalently, G is the square of H, if G can be obtained from H by adding an edge between any two vertices in H that are of distance 2. The Square Root problem is that of deciding whether a given graph admits a square root. The problem of testing whether a graph admits a square root which belongs to some specified graph class ℋ is called the ℋ -Square Root problem. By showing boundedness of treewidth we prove that Square Root is polynomial-time solvable on some classes of graphs with small clique number and that ℋ -Square Root is polynomial-time solvable when ℋ is the class of cactuses.

Lipid membrane-assisted condensation and assembly of amphiphilic Janus particles.

Amphiphilic Janus particles self-assemble into complex metastructures, but little is known about how their assembly might be modified by weak interactions with a nearby biological membrane surface. Here, we report an integrated experimental and molecular dynamics simulation study to investigate the self-assembly of amphiphilic Janus particles on a lipid membrane. We created an experimental system in which Janus particles are allowed to self-assemble in the same medium where zwitterionic lipids form giant unilamellar vesicles (GUVs). Janus particles spontaneously concentrated on the inner leaflet of the GUVs. They exhibited biased orientation and heterogeneous rotational dynamics as revealed by single particle rotational tracking. The combined experimental and simulation results show that Janus particles concentrate on the lipid membranes due to weak particle-lipid attraction, whereas the biased orientation of particles is driven predominantly by inter-particle interactions. This study demonstrates the potential of using lipid membranes to influence the self-assembly of Janus particles.

Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run Immunization Clinic at the Veterans Affairs San Diego Healthcare System.

OBJECTIVE: The aim was to measure patient satisfaction with the Pharmacy Specialty Immunization Clinic (PSIC), a pharmacist-run vaccination clinic. METHODS: Patient satisfaction was measured using a non-validated instrument containing 10 items with a five-point Likert scale (strongly agree, agree, not sure, disagree and strongly disagree). Patients who were seen at the PSIC and who received at least one vaccination were eligible to take part in the patient satisfaction survey. Priority index, a method used to identify areas where limited resources can be used to maximize patient satisfaction, was calculated for the different items of the instrument to determine areas for quality improvement. This study was conducted at the Veterans Affairs San Diego Healthcare System (VASDHS). KEY FINDINGS: A total of 188 (55.1%) out of 341 patients who received at least one vaccine in the PSIC completed the survey. Prior to any encounter with the PSIC, patients perceived that the VASDHS was doing a good job providing vaccinations (92.5% answered agree or strongly agree). This perception continued when asked about overall satisfaction after receiving vaccination through the PSIC (86.9% answered agree or strongly agree). When asked about the time the pharmacist spent with the patient, nearly all answered that the pharmacist spent as much time as necessary (97.8% answered agree or strongly agree). Patient satisfaction with pharmacist counselling was equally well received and reflected good communication between patient and pharmacist (97.8% answered agree or strongly agree). In regard to pharmacist competency, 98.9% (n = 184) of patients agreed that pharmacists in the PSIC administered vaccinations appropriately. Priority index identified access to the vaccine as an area where performance-improvement efforts should be committed to improve patient satisfaction. CONCLUSIONS: Patients perceived good overall satisfaction with the pharmacist-run immunization clinic in terms of professionalism and access to vaccination. Priority index identified access to vaccination as a focus for future quality improvement.

Are hard-to-reach populations being reached with immunization services? Findings from the 2005 Papua New Guinea national immunization coverage survey.

OBJECTIVE: To measure immunization coverage among children aged 12-23 months in Papua New Guinea (PNG) and to assess if and why there are differences between hard-to-reach and more accessible communities. METHODS: WHO cluster sampling methodology was employed to measure immunization coverage in PNG's four regions. Survey data were re-analyzed according to a local assessment of geographical accessibility indicated by census unit type: urban, rural and hard-to-reach. Census units were designated as hard-to-reach if they were five or more km from a health centre. FINDINGS: Nationwide coverage for most antigens falls below the national target of 80% although there are regional differences with Islands performing the best. Late doses are a major concern: just 4% were fully immunized with valid ("on time") doses by 1 year of age. Coverage was lower in both rural and remote communities: at 6 months 48% of children from urban units had received three valid doses of DTP-3 but only 16% in rural areas and 13% in hard-to-reach communities. Reasons for failure to immunize varied: 21% of mothers said their child was not immunized because distance, travel conditions or cost of transportation prevented access to local health centres; 27% cited a lack of knowledge or misconceptions about immunization; while 29% believed it was because of an issue with the health system. CONCLUSIONS: Throughout PNG there is an urgent need to increase immunization coverage and to ensure that children are immunized on time according to the schedule. Both coverage and timeliness of doses are worse for children living in hard-to-reach and rural areas. Achieving national immunization targets requires improvements in health service delivery, including outreach, especially for remote and rural communities, as well as greater community education and social mobilisation in support of immunization services.

Clinical examination is an inaccurate predictor of intraabdominal pressure.

This study was designed to establish if clinical examination can accurately predict intraabdominal pressure (IAP). Between August 1998 and March 2000 a prospective blinded observational study of postoperative intensive care unit patients was undertaken at a major trauma center. IAP was measured using an intravesicular technique and compared with clinical evaluation. An IAP of at least 18 mmHg was considered elevated. The sensitivity, specificity, positive predicative value (ppv), negative predictive value (npv), kappa score, and reliability analysis were calculated. A total of 110 patients provided 150 estimates of IAP, which was elevated in 21%. The kappa score was 0.37; sensitivity, 60.9%; specificity, 80.5%; ppv, 45.2%; npv, 88.6%. The mean difference in IAP values between intravesicular readings and clinical estimates was -1.0 +/- 4.1. Prediction of IAP using clinical examination is not accurate enough to replace intravesicular IAP measurements.