Water use strategy determines the effectiveness of internal water storage for trees growing in biofilters subject to repeated droughts.

Impervious surfaces create large volumes of stormwater which degrades receiving waterways. Incorporating trees into biofilters can increase evapotranspiration and therefore reduce stormwater runoff. Tree species with i) high water use, ii) drought tolerance and iii) rapid and full recovery after drought have been suggested for biofilters to maximise runoff reduction while minimising drought stress. Moisture availability fluctuates greatly in biofilter substrates and trees growing in biofilters will likely experience multiple, extended drought events that increase trade-offs between these traits. Providing an internal water storage has the potential to reduce tree drought stress and increase evapotranspiration. Two urban tree species (Agonis flexuosa and Callistemon viminalis) were grown in plastic drums with biofilter profiles. Three irrigation treatments were used: well-watered, drought with an internal water storage and drought without an internal water storage. Transpiration, leaf water potential and biomass were measured to determine the effect of biofilter internal water storage and repeated drought events on tree water use, drought stress and growth. Biofilter internal water storage improved water use and reduced drought stress for A. flexuosa, whereas C. viminalis reduced leaf loss but saw no change in water use or drought stress. A. flexuosa with biofilter internal water storage was able to recover transpiration to well-watered levels after repeated droughts, while C. viminalis experienced reduced recovery ability. It is recommended all biofilters planted with trees should have internal water storage. In systems with lower moisture availability a species with more stomatal control, such as A. flexuosa, is recommended. If selecting a species with less stomatal control, such as C. viminalis, the internal water storage volume needs to be increased to avoid drought stress.

Pattern analysis of vegan eating reveals healthy and unhealthy patterns within the vegan diet.

OBJECTIVE: This study aimed to identify the types of foods that constitute a vegan diet and establish patterns within the diet. Dietary pattern analysis, a key instrument for exploring the correlation between health and disease, was used to identify patterns within the vegan diet. DESIGN: A modified version of the EPIC-Norfolk FFQ was created and validated to include vegan foods and launched on social media. SETTING: UK participants, recruited online. PARTICIPANTS: A convenience sample of 129 vegans voluntarily completed the FFQ. Collected data were converted to reflect weekly consumption to enable factor and cluster analyses. RESULTS: Factor analysis identified four distinct dietary patterns including: (1) convenience (22 %); (2) health conscious (12 %); (3) unhealthy (9 %) and (4) traditional vegan (7 %). Whilst two healthy patterns were defined, the convenience pattern was the most identifiable pattern with a prominence of vegan convenience meals and snacks, vegan sweets and desserts, sauces, condiments and fats. Cluster analysis identified three clusters, cluster 1 'convenience' (26·8 %), cluster 2 'traditional' (22 %) and cluster 3 'health conscious' (51·2 %). Clusters 1 and 2 consisted of an array of ultraprocessed vegan food items. Together, both clusters represent almost half of the participants and yielding similar results to the predominant dietary pattern, strengthens the factor analysis. CONCLUSIONS: These novel results highlight the need for further dietary pattern studies with full nutrition and blood metabolite analysis in larger samples of vegans to enhance and ratify these results.

Relating the climate envelopes of urban tree species to their drought and thermal tolerance.

Analysing the climate envelope of plant species has been suggested as a tool to predict the vulnerability of tree species in future urban climates. However, there is little evidence that the climate envelope of a plant species directly relates to the drought and thermal tolerance of that species, at least not at the resolution required to identify or rank species vulnerability. Here, we attempted to predict drought and thermal tolerance of commonly used urban tree species using climate variables derived exclusively from open-source global occurrence data. We quantified three drought and thermal tolerance traits for 43 urban tree species in a common garden experiment: stomatal sensitivity to vapour pressure deficit, leaf water potential at the turgor loss point, and leaf thermal tolerance. We then attempted to predict each tolerance trait from variables derived from the climate envelope of each species, using occurrence data from the Global Biodiversity Information Facility. We found no strong relationships between drought and thermal tolerance traits and climatic variables. Across wide environmental gradients, plant tolerance and climate are inherently linked. But our results suggest that climate envelopes determined from species occurrence data alone may not predict drought or thermal tolerance at the resolution required to select tree species for future urban forests. We should focus on identifying the most relevant strategies and traits required to describe tolerance which in combination with climate envelope analysis should ultimately predict growth and mortality of trees in urban landscapes.

Two cases of penetrating left ventricular cardiac trauma: Pre-hospital ultrasound and direct to theatre.

Left ventricular (LV) Cardiac penetrating trauma is a rare and grave injury. In cases of penetrating cardiac trauma, pre-hospital Ultrasound by flight doctors can assist identify specific pathology. This pre-hospital triage has now been linked to a change in both pre-hospital and in-hospital management. There are minimal cases reported where Pre-Hospital ultrasound provided definitive diagnosis and, while providing Pre-Hospital blood transfusion, informed a direct to theatre approach. In 2017 in New South Wales, Australia, a new protocol "Code Crimson" has been introduced to formalise a system wide process where Pre-Hospital medical teams can expedite a straight to Theatre approach.

Geographic variation of dental utilization among low income children.

Spatial accessibility of dental care is mediated by dentist workforce availability and travel costs. In this study, we generated dental service areas through small area analysis of Medicaid administrative data and claims. Service areas were then used to assess dimensions of spatial accessibility, including dentist-to-population ratios, and examine relationships in geographic variation of routine dental care among Medicaid-enrolled children. Our findings indicate significant geographic differences in accessibility for Hispanic children compared to other children, even after controlling for individual and service area characteristics.

Epidemiology and spatial examination of bicycle-motor vehicle crashes in Iowa, 2001-2011.

Purpose: To identify how person, crash, environment, and population characteristics differ between bicycle-motor vehicle crashes that occur at intersections and non-intersections. Methods: The Iowa Department of Transportation crash database for the years 2001 through 2011 was used to identify bicycle-motor vehicle (BMV) crashes and associated person, crash, and environment characteristics. Population-level data were drawn from the 2010 U.S. Census and the 2010 American Community Survey. Descriptive statistics, GIS mapping, and multivariable logistic regression were used to examine factors associated with crash risk and crash location. Results: Compared to intersections, non-intersection BMV crashes had higher odds of involving young bicyclists (<10 years old; OR: 1.8, 95%CI: 1.2-2.6), location outside city limits (OR: 5.7, 95%CI: 3.9-8.3), with driver vision obscured (OR: 1.5, 95% CI: 1.2-1.8), reduced lighting on roadway (OR: 1.9, 95% CI: 1.5-2.4), and lower odds when the bicyclist (OR: 0.4, 95% CI: 0.3-0.6) or motorist (OR: 0.6, 95% CI: 0.4-0.8) failed to yield right of way. Conclusions: Environmental factors, as well as developmental (age) and behavioral factors of bicycle-motor vehicle crashes vary by location (intersection/non-intersection). Results from this study can be used to tailor and target multiple intervention approaches, such as making infrastructure changes, increasing safety behavior among both motorists and bicyclists, and identifying which age groups and locations would most benefit from intervention.

Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents.

OBJECTIVES: To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. METHODS: We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. RESULTS: The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. CONCLUSIONS: Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.

Bias caused by self-reporting distraction and its impact on crash estimates.

Over the last decade, driver distractions, such as cell phone use and texting, have become a significant contributor to roadway crashes. Some states now have legislation that severely restricts or bans driver activities deemed distracting. However, many policies and engineered countermeasures are based on self-reported crash data. This raises the issue of potential bias and when not controlled for in analysis supporting policy decisions, can lead to poor allocation of public resources. This study explores the impact of self-reporting driver distraction on the likelihood estimates of the injury severity category of vehicle crashes. Using a two-step correction technique, the presence of bias is tested, when present corrected, and its impact is interpreted. The findings show that self-reporting bias is present in the national database, a database often used to help evaluate policy and engineering options, self-reporting bias understates the true effect of driver distraction on injury severity, and it is not uniform across injury categories. As a result, the forecast of potential savings of countermeasure policies or in-vehicle devices will be distorted leading to inefficient allocation of public resources.

Computed tomography pulmonary angiography: a sample of experience at a District General Hospital.

PURPOSE: Pulmonary embolism (PE) has a significant associated morbidity and mortality. The role of diagnostic imaging in PE is being increasingly undertaken by computed tomography pulmonary angiography (CTPA). An advantage of CTPA is its ability to simultaneously provide information on the lung parenchyma, mediastinum, pleural spaces, and chest wall. A sample of CTPAs was therefore reviewed to identify the types of additional pathology demonstrated. MATERIALS AND METHODS: One hundred and ninety-eight CTPA examinations were retrospectively reviewed. A record was made of the presence of PE and any additional pathology, with particular interest given to "incidental" pathology, or pathology that was unsuspected but which was significant enough to change the patient's management. A note was also made as to the adequacy of the study. D-Dimer values were recorded when available. RESULTS: PE was demonstrated in 56 studies (28.3%). Additional pathology was seen in 112 studies (56.6%), of which 17 were categorised as incidental. These included multiple pulmonary nodules, solitary lung lesions, destructive bony lesions, pancreatitis, a solid renal mass, mesothelioma, reactivated pulmonary tuberculosis, recurrent bronchial carcinoma, pulmonary fibrosis, an SVC filling defect, and a compression fracture of T10. CONCLUSION: The prevalence of PE in our sample was 28.3%, compared with a reported prevalence, mainly by pulmonary angiography, of between 19% and 79%. Secondary findings were found in 56.6% of scans, with completely incidental findings demonstrated in 17 patients (9%). This emphasizes the usefulness of CTPA in providing additional diagnostic information and alternative diagnoses in patients with suspected PE.