Previous studies reported an association between leukemia rates and amounts of fallout in southwestern Utah from nuclear tests (1952 to 1958), but individual radiation exposures were unavailable. ...Therefore, a case-control study with 1177 individuals who died of leukemia and 5330 other deaths (controls) was conducted using estimates of dose to bone marrow computed from fallout deposition rates and subjects' residence locations. A weak association between bone marrow dose and all types of leukemia, all ages, and all time periods after exposure was found. This overall trend was not statistically significant, but significant trends in excess risk were found in subgroups defined by cell type, age, and time after exposure. The greatest excess risk was found in those individuals in the high-dose group with acute leukemia who were younger than 20 years at exposure and who died before 1964. These results are consistent with previous studies and with risk estimates for other populations exposed to radiation.
There is limited published data on combat ocular trauma (COT) among local nationals managed at deployed United States (US) and United Kingdom (UK) military hospitals in recent conflicts. We report ...the epidemiology and outcomes of COT from a deployed military hospital in Afghanistan.
In this retrospective case series, consecutive injuries requiring ophthalmic surgery at a military hospital in Afghanistan where the sole US and UK ophthalmologist(s) were deployed between January 2017 and September 2019 were reviewed. The main outcomes were mean post-operative visual acuity (VA) in open and closed globe injury and the incidence of retinal detachment after open globe repair.
There were 102 eyes of 84 patients who had ocular injuries and underwent ophthalmic surgery at the military hospital. Most patients were male (81 96%) and were local nationals (71 85%). Blast exposure (82 80%) was the most common mechanism of injury. Mean post-operative VA was 1.24 ± 2.29 logMAR (20/348 Snellen equivalent) in open globe injury and 1.59 ± 1.17 logMAR (20/778 Snellen equivalent) in closed globe injury. After open globe repair, retinal detachment developed in 8 of 18 (44%) eyes.
COT injuries often resulted in poor post-operative VA and retinal detachment after open globe repair was common. The high incidence and severity of COT sustained by local civilians and combatants in this study may support programs to increase the availability and wear of combat eye protection among local nationals partnered with US and coalition troops.
Improving CPR Performance Nassar, Boulos S.; Kerber, Richard
Chest,
November 2017, 2017-11-00, 20171101, Letnik:
152, Številka:
5
Journal Article
Recenzirano
Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. CPR is a complex set of interventions requiring leadership, coordination, and best practices. ...Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations. Key steps health-care systems can take to enhance the quality of CPR and, potentially, to improve outcomes, include optimizing chest compressions, avoiding hyperventilation, encouraging intraosseous access, and monitoring capnography. Feedback devices provide instantaneous guidance to the rescuer, improve rescuer technique, and could impact patient outcomes. New technologies promise to improve the resuscitation process: mechanical devices standardize chest compressions, capnography guides resuscitation efforts and signals the return of spontaneous circulation, and intraosseous devices minimize interruptions to gain vascular access. This review aims at identifying a discreet group of interventions that health-care systems can use to raise their standard of cardiac resuscitation.
Cardiac arrest in patients on mechanical support is a new phenomenon brought about by the increased use of this therapy in patients with end-stage heart failure. This American Heart Association ...scientific statement highlights the recognition and treatment of cardiovascular collapse or cardiopulmonary arrest in an adult or pediatric patient who has a ventricular assist device or total artificial heart. Specific, expert consensus recommendations are provided for the role of external chest compressions in such patients.
Humans are unconditionally confronted with social expectations and norms, up to a degree that they, or some of them, have a hard time recognizing what they actually want. This renders them ...susceptible for introjection, that is, to unwittingly or "unconsciously" mistake social expectations for self-chosen goals. Such introjections compromise an individual's autonomy and mental health and have been shown to be more prevalent in individuals with rumination tendencies and low emotional self-awareness. In this brain imaging study, we draw on a source memory task and found that introjections, as indicated by imposed tasks that are falsely recognized as self-chosen, involved the bilateral medial prefrontal cortex (MPFC) and the dorsal anterior cingulate cortex (ACC). Notably, reduced right MPFC activation within this condition correlated with trait scores of ruminations and reduced emotional self-awareness, but also introversion. Moreover, correct recognition of tasks as self-chosen involved the right MPFC. Accordingly, the right MPFC may play a role in supporting the maintenance of psychological autonomy and counteract introjection, which individuals with certain personality traits seem to be prone to. This research has significant implications for the study of mechanisms underlying autonomous motivation, goal and norm internalization, decision-making, persuasion, education, and clinical conditions such as depression and burnout.
In this study, we examine the association between having a family history of breast cancer and survival after diagnosis with breast cancer. Data for this study were from the Utah Population Database, ...a linked database consisting of genealogy data of Mormon pioneer families, Utah Cancer Registry data, and Vital Statistics data. We observed that women who had a mother with breast cancer were more likely to die of any cause than women without a mother with breast cancer hazard rate ratio (HRR) = 1.36, 95% confidence limits (CL) = 1.04, 1.79, as were women with over 30 female relatives with breast cancer (HRR = 1.69, 95% CL = 1.16, 2.45). Similar findings were observed for women dying of breast cancer. Other indicators of family history were not associated with survival except within specific age groups. Women diagnosed with breast cancer at age 50 or before had poorer survival if they had a family history of breast cancer. Relative risk estimates were 1.54 (95% CL = 0.98, 2.41) for first degree relative, 1.55 (95% CL = 0.87, 2.78) for mother, and 2.65 (95% CL = 1.23, 5.74) for more than 30 female relatives with breast cancer.
The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must ...coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF. Further data are needed to refine recommendations for energy levels for defibrillation and cardioversion using biphasic waveforms.
We analyse deep images from the VISTA survey of the Magellanic Clouds in the
$YJ{K_{\rm s}}$
filters, covering 14 deg2 (10 tiles), split into 120 subregions, and comprising the main body and Wing of ...the Small Magellanic Cloud (SMC). We apply a colour–magnitude diagram reconstruction method that returns their best-fitting star formation rate SFR(t), age–metallicity relation (AMR), distance and mean reddening, together with 68 per cent confidence intervals. The distance data can be approximated by a plane tilted in the East–West direction with a mean inclination of 39°, although deviations of up to ±3 kpc suggest a distorted and warped disc. After assigning to every observed star a probability of belonging to a given age–metallicity interval, we build high-resolution population maps. These dramatically reveal the flocculent nature of the young star-forming regions and the nearly smooth features traced by older stellar generations. They document the formation of the SMC Wing at ages <0.2 Gyr and the peak of star formation in the SMC Bar at ∼40 Myr. We clearly detect periods of enhanced star formation at 1.5 and 5 Gyr. The former is possibly related to a new feature found in the AMR, which suggests ingestion of metal-poor gas at ages slightly larger than 1 Gyr. The latter constitutes a major period of stellar mass formation. We confirm that the SFR(t) was moderately low at even older ages.
Strokes can be distinguished from benign peripheral causes of acute vestibular syndrome using bedside oculomotor tests (head impulse test, nystagmus, test-of-skew). Using head impulse test, ...nystagmus, test-of-skew is more sensitive and less costly than early magnetic resonance imaging for stroke diagnosis in acute vestibular syndrome but requires expertise not routinely available in emergency departments. We sought to begin standardizing the head impulse test, nystagmus, test-of-skew diagnostic approach for eventual emergency department use through the novel application of a portable video-oculography device measuring vestibular physiology in real time. This approach is conceptually similar to ECG to diagnose acute cardiac ischemia.
Proof-of-concept study (August 2011 to June 2012). We recruited adult emergency department patients with acute vestibular syndrome defined as new, persistent vertigo/dizziness, nystagmus, and (1) nausea/vomiting, (2) head motion intolerance, or (3) new gait unsteadiness. We recorded eye movements, including quantitative horizontal head impulse testing of vestibulo-ocular-reflex function. Two masked vestibular experts rated vestibular findings, which were compared with final radiographic gold-standard diagnoses. Masked neuroimaging raters determined stroke or no stroke using magnetic resonance imaging of the brain with diffusion-weighted imaging obtained 48 hours to 7 days after symptom onset.
We enrolled 12 consecutive patients who underwent confirmatory magnetic resonance imaging. Mean age was 61 years (range 30-73), and 10 were men. Expert-rated video-oculography-based head impulse test, nystagmus, test-of-skew examination was 100% accurate (6 strokes, 6 peripheral vestibular).
Device-based physiological diagnosis of vertebrobasilar stroke in acute vestibular syndrome should soon be possible. If confirmed in a larger sample, this bedside eye ECG approach could eventually help fulfill a critical need for timely, accurate, efficient diagnosis in emergency department patients with vertigo or dizziness who are at high risk for stroke.
PDF
