Low tidal volume (Vt) ventilation is protective against ventilator-induced lung injury but can promote development of atelectasis. Periodic deep inflation (DI) can open the lung, but if delivered too ...frequently may cause damage via repeated overdistention. We therefore examined the effects of varying DI frequency on lung mechanics, gas exchange, and biomarkers of injury in mice. C57BL/6 males were mechanically ventilated with positive end-expiratory pressure (PEEP) of 2 cmH^sub 2^O for 2 h. One high Vt group received a DI with each breath (HV). Low Vt groups received 2 DIs after each hour of ventilation (LV) or 2 DIs every minute (LVDI). Control groups included a nonventilated surgical sham and a group receiving high Vt with zero PEEP (HVZP). Respiratory impedance was measured every 4 mm, from which tissue elastance (H) and damping (G) were derived. G and H rose progressively during LV and HVZP, but returned to baseline after hourly DI during LV. During LVDI and HV, G and H remained low and gas exchange was superior to that of LV. Bronchoalveolar lavage fluid protein was elevated in HV and HVZP but was not different between LV and LVDI. Lung tissue IL-6 and IL-1ß levels were elevated in HVZP and lower in LVDI compared with LV. We conclude that frequent DI can safely improve gas exchange and lung mechanics and may confer protection from biotrauma. Differences between LVDI and HV suggest that an optimal frequency range of DI exists, within which the benefits of maintaining an open lung outweigh injury incurred from overdistention. PUBLICATION ABSTRACT
Neutrophils are considered to play a central role in ventilator-induced lung injury (VILI). However, the pulmonary consequences of neutrophil accumulation have not been fully elucidated. Matrix ...metalloproteinase-9 (MMP-9) had been postulated to participate in neutrophil transmigration. The purpose of this study was to investigate the role of MMP-9 in the neutrophilic inflammation of VILI. Male Sprague-Dawley rats were divided into three groups: 1) low tidal volume (LVT), 7 ml/kg of tidal volume (V^sub T^); 2) high tidal volume (HVT), 30 ml/kg of V^sub T^; and 3) HVT with MMP inhibitor (HVT+MMPI). As a MMPI, CMT-3 was administered daily from 3 days before mechanical ventilation. Degree of VILI was assessed by wet-to-dry weight ratio and acute lung injury (ALT) scores. Neutrophilic inflammation was determined from the neutrophil count in the lung tissue and myeloperoxidase (MPO) activity in the bronchoalveolar lavage fluid (BALF). MMP-9 expression and activity were examined by immunohistochemical staining and gelatinase zymography, respectively. The wet-to-dry weight ratio, ALT score, neutrophil infiltration, and MPO activity were increased significantly in the HVT group. However, in the HVT+MMPT group, pretreatment with MMPT decreased significantly the degree of VILT, as well as neutrophil infiltration and MPO activity. These changes correlated significantly with MMP-9 immunoreactivity and MMP-9 activity. Most outcomes were significantly worse in the HVT+MMPT group compared with the LVT group. In conclusion, VILI mediated by neutrophilic inflammation is closely related to MMP-9 expression and activity. The inhibition of MMP-9 protects against the development of VILI through the downregulation of neutrophil-mediated inflammation. PUBLICATION ABSTRACT
In Doe v. Etihad Airways, PJ.S.C., the U.S. Court of Appeals for the Sixth Circuit radically altered the scope of an air carrier's liability under the Montreal Convention, the international treaty ...controlling an air carrier's liability to passengers for damage to persons or property during international flight.1 Prior to Etihad, courts almost universally held that a passenger who suffers bodily injury as a result of an accident is entitled to physical damages, but is only eligible for emotional damages to the extent any such damages are attributable to the bodily injury sustained....relatedly, plaintiffs' attorneys will undoubtedly rely on Etihad to try and expand the scope of potential damages, as Etihad opens the door for "tag-along" claims of emotional damages completely unrelated to the bodily injury....even if an assault constitutes an accident, as discussed above, the passenger must still incur "bodily injury" in order to recover under Article 17....foreign carriers that conduct any flights or business within the Sixth Circuit (Michigan, Ohio, Kentucky, and Tennessee) are more likely to be sued in this jurisdiction, even if the claim arose elsewhere.
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Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not ...substantially lower than those of emergency department physicians.
We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%.
In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval CI 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown.
In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radial-head subluxation.
Clinical Trials.gov, no. NCT00993954.
Background: The game of water polo has become more familiar to all the athletes and coaches as the time has passed. It has been played as a sport for more than a century Although anatomical shoulder ...movement strength balance is a crucial factor in overhead throwers’ performance, it has not been studied extensively in the previous research. Objective: This study examined shoulder movement imbalance in bilateral and dominant anterior-posterior shoulder among 42 elite water polo players in Malaysia. Method: The t-test analyses of data obtained through several tests proved that water polo players had statistically significant difference between their right hand anatomical shoulder movement strength and their left hand anatomical shoulder movement strength in all eight shoulder movements, i.e. Flexion, Extension, Abduction, Adduction, Horizontal Adduction, Horizontal Abduction, Rotation and External Rotation. Results: The results of this study showed that there are significant differences of anatomical shoulder movement strength in both bilateral and Anterior-posterior shoulder movement among water polo players. The statistics results for bilateral shoulder movement of Flexion (t= 136.09 and p<.001), Extension (t= 110.92 and p<.001), Abduction (t= 121.89 and p<.001), Adduction (t= 101.47 and p<.001), Horizontal Adduction (t= 92.3 and p<.001), Horizontal Abduction (t= 95.6 and p<.001), Internal rotations (t= 109.6 and p<.001) and External rotations (t= 102.18 and p<.001) showed the p-value to be less than 0.05 for all variables of the test. The result of paired samples t-test showed there is a statistically significant difference between the mean of bilateral anatomical shoulder movement strength among water polo players. Conclusion: These findings suggest that coaches and players should take into account the shoulder movement strength imbalance in their trainings and design specific training programs to improve overhead throwers’ shoulder movement strength balance and hence their throwing performance in sports such as water polo.
The definition of violence the actual bodily harm inflicted by one person on another person where the body boundary is breached and physical injury occurs. Research indicates that different types of ...violence are used as a means of enforcing discipline in the family and the school context. Children and adolescents who grow up in an environment where violence has a natural place tend to resort to violence at every stage of their lives without question.Purpose. The aim of this research was therefore to determine adolescents perception of the concept of violence through the use of metaphors. Accordingly, answers to the following questions were sought: What metaphors do the youth use to describe the concept of violence? Under which conceptual categories can these metaphors be grouped in terms of their common features? How do the conceptual categories vary in relation to the students gender and the subjects they study at unversity? Method. The study was conducted in 2009 with the help of 303 students at Mersin University and Eskiehir Osmangazi University (Faculty of Education). Incomplete statements such as Violence is like ..., because ... were used in an attempt to understand the students perception of violence. The students were given 15 minutes to complete the statements. Demographic questions were also asked on the the students age, gender and study directions. The data were analyzed through qualitative analysis, and processes such as frequency distribution and quantitative correlation data were evaluated through SPSS data analysis. Findings. It emerged that the students used 74 metaphors of violence that could be divided into seven categories: (1) Violence as a way of controlling others; 2) Violence as part of social and affective life; (3) Violence as devastation; (4) Violence as learned helplessness; (5) Violence as a consequence of poor communication; (6)Violence as a phenomenon with psychological and physical effects; (7) Violence as a state of mind with long-term ongoing effects. The findings on these categories are presented and recommendations made. Conclusions and Recommendations. The analysis of the research results according to the students field of study indicated that the metaphors describing violence were grouped mainly under the theme (category) of violence as a way of controlling others. As the students in these fields of study received an education focused more on concrete and precise facts, they tended to perceive violence in a more conceptual way. Reprinted by permission of Croatian Anthropological Society and Institute for Anthropological Research, Zagreb, Croatia
•Traffic related disabilities cost 2% of total annual long-term care costs in Spain.•Long-term care cost due to traffic related disabilities was 0.04% of the GDP in 2008.•Impact of traffic accidents ...on long-term care costs is considerably higher under age 65.•Impairments in adults that have suffered a traffic accident mostly affect their mobility.
Road traffic injuries are one of the leading causes of increasing disability-adjusted life expectancy. We analyze long-term care needs associated with motor vehicle crash-related disability in Spain and conclude that needs attributable traffic injuries are most prevalent during victims’ mid-life years, they create a significant burden for both families and society as a whole given that public welfare programmes supporting these victims need to be maintained over a long time frame. High socio-economic costs of road traffic accidents (in Spain 0.04% of the GDP in 2008) are clearly indicative of the need for governments and policymakers to strengthen road accident preventive measures.
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Although much has been learned in recent decades about the deterioration of muscular strength, gait adaptations, and sensory degradation among older adults, little is known about how these intrinsic ...changes affect biomechanical parameters associated with slip-induced fall accidents. In general, the objective of this laboratory study was to investigate the process of initiation, detection, and recovery of inadvertent slips and falls. We examined the initiation of and recovery from foot slips among three age groups utilizing biomechanical parameters, muscle strength, and sensory measurements. Forty-two young, middle-age, and older participants walked around a walking track at a comfortable pace. Slippery floor surfaces were placed on the track over force platforms at random intervals without the participants' awareness. Results indicated that younger participants slipped as often as the older participants, suggesting that the likelihood of slip initiation is similar across all age groups; however, older individuals? recovery process was much slower and less effective. The ability to successfully recover from a slip (thus preventing a fall) is believed to be affected by lower extremity muscle strength and sensory degradation among older individuals. Results from this research can help pinpoint possible intervention strategies for improving dynamic equilibrium among older adults.
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Objectives:
The teres minor has received increased attention in its role as a rotator cuff muscle, particularly in the setting of large infraspinatus tears. Studies have shown that it plays an ...important beneficial role after total (TSA) and reverse (RSA) shoulder arthroplasty, as well as in maintenance of function in the setting of infraspinatus wasting in patients with large rotator cuff tears. No study, however, has investigated how often teres minor hypertrophy occurs in a population of rotator cuff tears, whether it occurs in the absence of infraspinatus tearing, or whether it is a positive or negative prognostic indicator on outcomes after rotator cuff repair. The purpose of this study was to determine the prevalence of teres minor hypertrophy in a cohort of patients undergoing rotator cuff repair, and to determine its prognostic effect, if any, on outcomes after surgical repair.
Methods:
Over a 3 year period, all rotator cuff repairs performed in a single practice by 3 American Shoulder and Elbow Society (ASES) member surgeons were collected. One hundered forty-four patients who had preoperative and postoperative (ASES) outcomes (minimum 2 year), and preoperative Magnetic Resonance Imaging (MRI) were included in the study. All MRIs were evaluated for rotator cuff tear tendon involvement, tear size, and Goutallier changes of each muscle. In addition, occupational ratios were determined for the supraspinatus, infraspinatus, and teres minor muscles. Patients were divided into 2 groups, based upon whether they had teres minor hypertrophy or not, based on a previously established definition. A 2 way univariate ANOVA was used to determine the effect of teres minor hypertrophy(tear size by hypertrophy) and Goutallier changes(tear size by fatty infiltration) on ASES change scores(α=0.05)
Results:
Teres minor hypertrophy was a relatively common finding in this cohort of rotator cuff patients, with 51% of all shoulders demonstrating hypertrophy. Interestingly, in patients without an infraspinatus tear, teres minor hypertrophy was still present in 19/40 (48%) of patients. Teres minor hypertrophy had a significant, negative effect ASES scores after rotator cuff repair in patients with and without infraspinatus tearing, infraspinatus atrophy, and fatty infiltrative changes(P<0.05). In general, the presence of teres minor hypertrophy demonstrated a 15% lower score (Figure 1) than when no hypertrophy was present, and this was consistent across all tear sizes, independent of Goutallier changes.
Conclusion:
Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing, including in the absence of infraspinatus tearing. Contrary to previous publications, the presence of teres minor hypertrophy in patients with rotator cuff repair does not appear to be protective as a compensatory mechanism. While further study is necessary to determine the mechanism or implication of teres minor hypertrophy in setting of rotator cuff repair, our results show it is not a positive predictor of outcomes following rotator cuff repair.
Summary Sentence:
The mechanism of teres minor hypertrophy was found to be a negative predictor in rotator cuff repair after pre and post-op measures were collected on patients undergoing cuff repair.
United States v. Smith
Harvard law review,
06/2016, Volume:
129, Issue:
8
Journal Article
Peer reviewed
Under the Controlled Substances Act, "if death or serious bodily injury results from the use of" an illegally distributed Schedule I or II drug, then the distributor of that drug faces a twenty-year ...minimum prison sentence. This "results from" penalty enhancement has been susceptible to varying interpretations among the courts. Recently, in US v. Smith, the US District Court for the Eastern District of Kentucky applied the Burrage vs. US framework to uphold a "results from" penalty enhancement based on an oxycodone overdose. The court was correct to determine that the evidence supported the finding that the oxycodone was a "but-for" cause of the victim's death. However, the court's examination of other substances found in the victim's system highlights a question left open by Burrage: whether the but-for causation requirement of the "results from" enhancement is inapplicable when the drug distributed is "an independently sufficient cause of the victim's death or serious bodily injury. Without such an interpretation, the enhancement may fail to apply to anyone in cases where a victim is harmed by multiple sufficient causes.
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