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Background: The tuberculosis (TB) incidence rate for northern Saskatchewan First Nations on-reserve is 1.5 higher than the national average. In December 2018 a member of one of these communities was diagnosed with 4+ smear-positive TB, spurring an outbreak investigation. Objectives: To describe the public health response to TB outbreak investigation and highlight the risk factors associated with TB transmission in northern Saskatchewan; and to highlight the relevance of social network contact investigation tool in outbreak management. Methods: Descriptive analysis included active TB cases and latent TB infection (LTBI) cases linked by contact investigation to the index case. Data were collected from active TB case files. Statistical analyses were performed and social network analysis conducted using household locations as points of contact between cases. Results: A total of eight active TB cases and 41 LTBI cases were identified as part of the outbreak between December 2018 and May 2019. Half of the cases (4/8) were 25 to 34 years old, and five were smear negative. One-third of the people with LTBI were 15 to 24 years old, and about a half tested positive to the new tuberculin skin test (TST). The commonly reported risk factors for TB and LTBI cases were alcohol use, cigarette use, marijuana use, previous TB infection and homelessness. Social network analysis indicated a relationship between increased node centrality and becoming an active case. Conclusion: Real-time social network contact investigation used in active-case finding was very successful in identifying cases, and enhanced nursing support, mobile clinics and mobile X-ray worked well as a means of confirming cases and offering treatment. TB outbreaks in northern Saskatchewan First Nations on-reserve communities are facilitated by population-specific factors. Efforts to implement context-specific interventions are paramount in managing TB outbreaks and preventing future transmission.

Contexte : Le taux d’incidence de la tuberculose chez les Premières Nations du nord de la Saskatchewan vivant dans les réserves est 1,5 fois plus élevé que la moyenne nationale. En décembre 2018, un membre de l’une de ces communautés a été diagnostiqué avec une tuberculose avec un frottis positif 4+, ce qui a déclenché une enquête sur l’éclosion. Objectifs : Décrire la réponse de la santé publique à l’enquête sur l’éclosion de tuberculose et mettre en évidence les facteurs de risque associés à la transmission de la tuberculose dans le nord de la Saskatchewan; et souligner la pertinence de l’outil de recherche des contacts basée sur les réseaux sociaux dans la gestion des éclosions. Méthodes : L’analyse descriptive comprenait les cas de tuberculose active et les cas d’infection tuberculeuse latente (ITL) liés au cas index par une recherche des contacts. Les données ont été recueillies à partir des cas de tuberculose active. Des analyses statistiques ont été effectuées et une analyse des réseaux sociaux a été réalisée en utilisant les lieux de résidence comme points de contact entre les cas. Résultats : Au total, huit cas de tuberculose active et 41 cas d’ITL ont été identifiés dans le cadre de cette éclosion entre décembre 2018 et mai 2019. La moitié des cas (4/8) étaient âgés de 25 à 34 ans, et cinq d’entre eux avaient un frottis négatif. Un tiers des personnes atteintes d’ITL étaient âgées de 15 à 24 ans, et environ la moitié d’entre elles ont obtenu un résultat positif au nouveau test cutané à la tuberculine (TCT). Les facteurs de risque couramment rapportés pour les cas de tuberculose et d’ITL étaient : la consommation d’alcool, le tabagisme, la consommation de marijuana, une infection tuberculeuse antérieure et être en situation d’itinérance. L’analyse des réseaux sociaux a indiqué une relation entre l’augmentation de la centralité du nœud et le fait de devenir un cas actif. Conclusion : La recherche en temps réel de contacts basée sur les réseaux sociaux, utilisée dans le cadre de la recherche active de cas, a été très efficace pour identifier les cas, et le soutien infirmier renforcé, les cliniques mobiles et la radiographie mobile ont bien fonctionné comme moyen de confirmer les cas et de proposer un traitement. Les éclosions de tuberculose dans les communautés des Premières Nations du nord de la Saskatchewan vivant dans les réserves sont favorisées par des facteurs propres à la population. Les efforts visant à mettre en œuvre des interventions adaptées au contexte sont primordiaux pour gérer les éclosions de tuberculose et prévenir leur transmission future.

Scrap yards have long been responsible for identifying and sorting specific alloys from large quantities of mixed metals by means of visual and cognitive recognition with the aid of a few standard tools (a magnet, file, acids, and/or grinding wheel). Performing visual inspection successfully requires extensive knowledge obtained through years of experience physically handling material. This level of expertise cannot reasonably be expected of all those in the operations process but, the right instrumentation in capable, well-trained hands could work to bridge the difference between an expert and a novice. Handheld analyzers (HHs) that utilize X-ray fluorescence (XRF) and laser induced breakdown spectroscopy (LIBS) technology offer a level of technological assistance that could improve identification during the inspection process. Although the technology harnessed by these instruments is not new, the accessibility of it is- which has allowed the functionality, performance, and purpose of these HHs to expand. Subsequently, the attractiveness of these instruments goes beyond being able to obtain results similar to laboratory analysis. HHs are in-field ready, and the ergonomics, safety settings, read times, data sharing and accessibility are continually improving. Additionally, the costs of HHs are shrinking; this coupled with the opportunity to improve profit and avoid loss through reducing incorrect identification produces the more immediate return on investment (ROI) that yards require. Currently, we have a good indication of how HHs perform on material that has clean, smooth, uncoated surfaces but, what we aim to find is their response when used on “unprepared materials,” like those coming out of stock that are old, used, weathered, and/or warped. For these instruments to be deemed useful for inbound inspection/ identification purposes, it is crucial to understand and evaluate their limitations on scrap that is not altered and thus, true to a yard setting. Our results indicate that in their current state, HHs can inform and verify content for a significant range of materials, but there are still metal types and conditions that exist that lead to unreliable reporting of compositional percentages.

Background: Psychologically stressful events can be particularly challenging in the wilderness or extreme environments due to a lack of immediate medical or psychological support. Telemedicine consultations may provide a means to supply medical providers in austere environments with expertise when confronted with these situations. Methods: In this study, we detail a case of psychological care imparted to residents at a remote, arctic research station after they encountered a polar bear. The health care provider at the camp was not a dedicated mental health professional but was able to deliver psychological care with assistance from a trained provider through use of telemedicine. We provide a brief overview of the evidence behind psychological first aid and incident support sessions for the treatment of stress injuries. We also review the evidence for telemedicine for psychological care in wilderness situations and describe its use in this scenario. Results: All station residents were able to resume regular arctic activities. Resident feedback was that the sessions were advantageous. Conclusions: We anticipate the need for psychological care in austere situations to increase in the future, and further training in this field and the advancement of telemedicine consultation will be of benefit to wilderness providers.

Recycling is a critical part of obtaining a more circular economy. In the metals secondary industry, traditional equipment (a magnet, file, and/or grinding wheel) used to identify and sort materials at their end of life can aid in grouping metals (i.e. Al + Mg alloys, ferrous, high temperature alloys, etc.), but they are incapable of identifying the alloy’s elemental composition; a necessity for preventing downcycling and maximizing secondary utilization rates. Handheld analyzers that utilize X-ray fluorescence (XRF) and spectroscopy (LIBS) technology may offer technological assistance that is helpful for achieving this level of analysis, often referred to as Positive Material Identification (PMI). This work tests the performance of these units under the challenging conditions present in yards (contaminated, unpolished, rugged scraps). These instruments, with their increasing safety settings, ruggedness, ease of point-click use and quick read times (for both XRF and LIBS) have significant potential, especially with ability to ID metal faster than cognitive recognition. Additionally, as unit costs of these instruments continue to decrease and the range of varying types of metal entering yards continues to widen, the return on investment becomes more immediate. However, extreme fluctuations of reported elemental compositions are being seen even when measurements have been taken in the same place consecutively; indicating that in their current state, they can inform content of material but aren’t necessarily reliable for reporting accurate and precise compositional percentages.

Emissions from the transportation industry combined with increasing consumption of materials have inspired the automotive industry to use lightweight materials in auto-bodies. A wide diversity of materials is being used, for example, aluminum, magnesium, and plastic composites. This light weighting approach is a proven sustainability strategy improving fuel economy and thereby reducing greenhouse gas emissions. However, increasing the number of differing types of materials in cars is actually complicating recycling operations. Critical metals used as alloying additions are dissipatively lost in the recycling process and can also negatively impact recycling rates by accumulating as tramp elements. This work combines compositional characterization of automotive materials, material flow analysis, and techno-economic assessment to better understand this problem and inform solutions. Results show that both technical solutions like sensor-based sorting and operational solutions like compositionally based blending can decrease material losses, thereby reducing the negative impacts and inching closer to a circular economy.

The ability to aggregate clinical data across multiple diverse organizations and to use it for performance measurement, quality improvement, evaluation, and research is rapidly becoming a national necessity, but there are few examples of how to do that. This article uses lessons from a national effort to implement the collaborative care management model for patients with both depression and diabetes or heart disease across 8 partner organizations, 18 medical groups, and more than 170 clinics in 8 states to identify the challenges and provide experience-based recommendations for those tasks. The challenges are divided into those needed for (1) collecting similar data, (2) aggregating those data across care systems, and (3) using the data to both improve and evaluate care. Start with agreement on goals, methods, transparency, and a data system integrated into the electronic medical record while promptly addressing all the legal, regulatory, and human subject requirements.

The capacity to utilize geographic information is a critical element of disaster risk management. Although access to and use of geographic information system (GIS) technology continues to grow, there remain significant gaps in approaches used by disaster risk management stakeholders to understand geographic information needs, sources, and information flow—ultimately limiting the efficacy of management efforts. To address this problem, we introduce the concept of geographic information capacity (GIC) to measure and analyze the ability of stakeholders to understand, access, and work with geographic information for disaster risk management. We propose a framework for assessing GIC, the GIC Profile, which we situate within a review of disaster risk management-relevant frameworks. We evaluate the GIC Profile using two case study countries at the first (sub-national) geo-administrative boundary level. Chi-square analyses suggest GIC across equivalent regional units within each country is relatively uniform, and that this uniformity is comparable between nations despite significant difference in overall capacity. Contributions of the GIC Profile to disaster risk management research are twofold. First, this is a first attempt to develop a profile based on key indicators for quantifying GIC highlights critical areas for capacity improvement, allowing decision makers to identify and prioritize pathways to strengthen disaster risk management programs. Through this initial effort, a decision tool has been developed which may enhance decisions on how to utilize GIS in support of disaster risk management. This tool is iterative and can be updated as new events occur to maximize GIS benefits, ultimately reducing disaster risks and their potential consequences.

Metals recycling is one of the oldest industries in the United States that now employs over 530,000 individuals. It has always played a significant role in the economy, supplied extensive goods and services, and the costs and benefits directly and/or indirectly extend worldwide. Improved efficiency in metals recycling is crucial to achieving a more circular economy; to enable this requires understanding how the industry operates and the challenges it must overcome. Increasing metal product diversity and design complexity combined with increased feed volumes has introduced recent additional challenges. This review explores the current status and state of the industry and examines potential technology solutions that address inbound inspection and material identification challenges.

Positive material identification (PMI) is a challenge in the metals secondary industry that remains persistent as products are designed with increasing complexity. Strategies in the automotive industry to improve fuel efficiency include development of lightweight wrought aluminum and magnesium alloys to replace heavier steel components in vehicles. These alloys have tight compositional requirements and the traditional equipment for sorting and identifying this scrap (i.e. a magnet, file, and/or grinding wheel) is inadequate. Handheld analyzers that utilize X-ray fluorescence and spectroscopy technology may offer technological assistance that is helpful for PMI. This work tests the performance of these units under the challenging conditions present in yards (contaminated, unpolished, comingled scraps). As the costs of these units have decreased substantially over time, results have shown there are more opportunities for quicker return on investment under a variety of scenarios; yard volume, incoming grades, and diversity of suppliers have the largest impact on pay-off.

To improve properties such as weldability, corrosion resistance, strength, etc. the aluminum industry, in recent years, has enhanced functionality of aluminum alloys by increasing diversity of metals being used for alloying. These metals often include critical ones i.e. those that are geologically scarce, highly prone to supply bottleneck and/or highly demanded with no known substitute. A logical solution to the above-mentioned identifiers would be the recovery of these critical materials from the finished products at their end of life. Unfortunately, the yield of the critical metals, on recovery, is too low for feasible economic recovery and therefore they are dissipatively lost. This work quantifies the impacts of such losses using material flow analysis and life-cycle assessment in order to suggest best practices to minimize these impacts. Results show circular economy strategies can be effective for mitigating criticality risk in the aluminum industry.