Although the malignancy rate in surgically excised Bosniak IIF and Bosniak III cystic renal lesions was 25% and 54%, respectively, in our study, the malignancy rate was higher in patients with a history of primary renal malignancy or coexisting Bosniak IV lesion and/or solid renal neoplasm.

The environmental benefi ts and trade-offs of automotive biofuels are well known, but less is known about aviation biofuels. We modeled the environmental impacts of three pathways for aviation biofuel in Australia (from microalgae, pongamia, and sugarcane molasses) using attributional life cycle assessments (LCAs), applying both economic allocation and system expansion. Based on economic allocation, sugarcane molasses has the better fossil energy ratio FER (1.7 MJ out/MJ in) and GHG abatement (73% less than aviation kerosene) of the three, but with trade-offs of higher water use and eutrophication potential. Microalgae and pongamia have lower FER and GHG abatement (1.0 and 1.1; 53% and 43%), but mostly avoid eutrophication and reduce water use trade-offs. All have similar and relatively low land use intensities. If produced on land where existing carbon stocks are not compromised, the sugarcane and microalgae pathways would currently meet a 50% GHG abatement requirement. Based on system expansion, microalgae and pongamia had lower impacts than sugarcane for all categories except energy input, highlighting the positive aspects of these next-generation feedstocks. The low fossil energy conservation potential of these pathways was found to be a drawback, and significant energy effi ciencies will be needed before they can affect fossil energy conservation. Energy recovery from processing residues (base case) was preferable over use as animal feed (variant case), and crucial for favorable energy and GHG conservation. However this fi nding is at odds with the economic 580

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IntroductionPre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system.MethodsWe retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant.Results4,871 patients had active airway management, including 2,186 (44.9%) medical and 2,685 (55.1%) trauma cases. There were 4,390 (90.1%) adult and 256 (5.3%) pediatric (age ≤ 14) intubations; 225 (4.6%) did not have an age recorded. 4,703 (96.6%) had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9%) and was ultimately successful in 4,313 (91.7%). Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test). 168 encounters were managed primarily with an extraglottic device (EGD). Cricothyrotomy was performed 35 times (0.7%) and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7%) encounters. There were no reported deaths from a failed airway.ConclusionAirway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system.