Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European ...Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence‐based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life‐threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First‐line treatment for anaphylaxis is intramuscular adrenaline. Useful second‐line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high‐flow oxygen, intravenous fluids, inhaled short‐acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto‐injector. If an adrenaline auto‐injector is prescribed, education on when and how to use the device should be provided. Specialist follow‐up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.
Introduction
Lateral lymph node dissection (LLND) for rectal cancer is still not a widely established technique owing to the existing controversy between Eastern and Western countries and the lack of ...well-designed studies. The risk of complications and the paucity of long-term oncological results are significant drawbacks for further applying this technique. The use of indocyanine green (ICG) near-infrared (NIR) fluorescence for LLND appears as a promising technique for enhancing postoperative and oncological outcomes. This review aims to evaluate the emerging role of ICG during LLND and present the benefits of its application.
Materials and methods
Systematic electronic research was conducted in PubMed and Google Scholar using a combination of medical subject headings (MeSH). Studies presenting the use of ICG during LLND, especially in terms of harvested lymph nodes, were included and reviewed. Studies comparing LLND with ICG (LLND + ICG) or without ICG (LLND-alone) were further analyzed for the number of lymph nodes and postoperative outcomes.
Results
In total, 13 studies were found eligible and analyzed for different parameters. LLND + ICG is associated with significantly increased number of harvested lateral lymph nodes (
p
< 0.05), minor blood loss, decreased operative time, and probably decreased urinary retention postoperatively compared with LLND-alone.
Conclusions
The use of ICG fluorescence during LLND is a safe and feasible technique for balancing postoperative outcomes and the number of harvested lymph nodes. Well-designed studies with long-term results are required to elucidate the oncological benefits and establish this promising technique.
► An integrated framework identify the origin of Cr(VI) in Oropos plain. ► Geogenic Cr(VI) is evident in Oropos plain. ► Cr(VI) leaching rates calculated for two soils. ► Heavy liquid separation ...showed chromite grains (clasts) in alluvial sediments. ► Princeton Transport Code model simulates geogenic origin Cr(VI) in groundwater.
An integrated framework that is comprised of field surveys of groundwater, surface water and soils, laboratory process experiments and hydrologic and geochemical modeling is used to identify the origin (anthropogenic versus geogenic sources), fate and transport of hexavalent Cr in Tertiary and Quaternary deposits of Oropos plain in Greece. Groundwater and soils were analyzed in May 2008 and exhibited considerable Cr concentrations. Mineralogical analysis and micro-XRF analysis of the heavy soil fractions (metallic components) showed Cr bearing phases like chromites, Cr-silicate phases with positive correlation between Si, Al, Fe and Cr soil concentrations. Column experiments showed the Cr(VI) desorption ability of soils, e.g. concentration of 20μgL−1 was detected after the application of 50mm of rain. The groundwater model simulated the variability of Cr concentrations emanating from both anthropogenic and geogenic sources, successfully using rate constants obtained from the laboratory experiments, e.g. 4.24nMh−1 for serpentine soil and 0.77nMh−1 for soil in alluvial deposits. The mineralogical and geochemical results support a geogenic origin for Cr in soils and groundwater of Oropos plain while modeling results suggest that contaminants transported by Asopos River have affected only the upper layers of the subsurface in the vicinity of the river. The framework can be used to establish background concentrations or clean up levels of Cr-contaminated soils and groundwater.
Strain hardening in metallic multilayers is shown experimentally to be greater in trilayer films of Cu–Ni–Nb than bilayer films of Cu–Ni or Cu–Nb using both direct measurements of flow strength at ...different effective strains and an analysis of the out-of-plane deformation around nanoindentation impressions. The mechanism that accounts for increased strain hardening in the trilayer is a proposed super-threader dislocation and cross-slip mechanism, modeled using three-dimensional dislocation dynamics simulations.
The mechanical properties of arrays of curved, intertwined, but nominally vertical carbon nanotubes (CNTs), referred to as turfs, have been measured using nanoindentation. The elastic properties ...appear to be non-linear; as noted in prior studies the observed tangent modulus decreases with increasing strain. Decreasing adhesion between the turf and probe lowers the perceived stiffness of the material. The elastic properties do not vary significantly between the top and the bottom of a particular carbon nanotube turf; both ends of the turf exhibit an effective modulus on the order of 50
MPa when several cubic microns of material are tested. Within a single turf the spatial variation in elastic properties is less than 10%, turfs from different growth runs can vary by up to 50%. These observations, in conjunction with
in situ compression tests of turfs that buckle near the base rather than in the center of the structure (as would be found during Euler buckling), justifies the use of average mechanical properties for a given vertically aligned turf for design purposes without the need to account for spatial variation in structure. A turf’s mechanical properties may depend on imposed strain, and may exhibit local buckling without a gradient in structure.
The strength of Mo/Pt multilayers of varying thicknesses has been investigated using nanoindentation. Metallic composites with individual layer thicknesses ranging from 100 to 20 nm were fabricated. ...Of specific interest in this study was the strength of the nanocomposites after annealing in air at relatively high temperatures (475 °C) since potential applications involve high temperature and oxidizing environments. Annealing causes significant losses in strength, with the highest losses corresponding to the structures with the thinner Pt layers. Annealing caused grain coarsening as well as loss of the continuous interface between the individual layers when the Pt thickness was less than 35 nm. Oxidation of the Mo layers occurred during annealing, causing an increase in the thickness of the Mo containing layers. The oxidation of Mo occurs in a uniform manner which results in an increase of the total film thickness while the layered structure is maintained. Deconvolution of the Mo 3d spectrum from X-ray Photoelectron Spectroscopy revealed several oxide species, and no Pt–Mo intermetallics were detected. The changes in microstructure are related to the changes in mechanical properties. Films with thinner layer thicknesses were stronger prior to annealing; however, they showed larger losses in strength after the thermal treatment. Structures with thicker Pt layers should be used when the multilayers are exposed to elevated temperatures.
The strength of Mo/Pt multilayers as a function of layer thickness has been investigated using nanoindentation. Structures with layer thicknesses varying from 20 to 100 nm were sputter deposited and ...the hardness of the films was measured using nanoindentation. It is shown that at this length scale the strengthening behavior of the films can be described by the confined layer slip model which has been proposed for other multilayered systems. Of specific interest in this study was the increase in the strength of the films after aging in ambient conditions with no apparent change in modulus. X-ray photoelectron spectroscopy revealed partial oxidation of the Mo layers in the aged samples which was associated with an increase in the residual compressive stress of the films measured by the bulge testing technique. The formation of molybdenum oxides in the Mo layer could account for the increase in strength through a second phase precipitation strengthening mechanism.
Abstract Older people represent a growing proportion of attendees in Emergency Departments across Europe. Traditionally Emergency Departments have not focused on care for older people, especially ...those with frailty. Similarly, geriatric services have not traditionally focused upon the care of older people in Emergency Departments. This work seeks to bring together the two disciplines of Geriatric and Emergency Medicine through a defined and validated curriculum on Geriatric Emergency Medicine. Domains and items for inclusion in the curriculum were derived through a combination of literature reviewing and a nominal group workshop. The domains and items underwent validation using a Delphi technique involving the European Societies of Geriatric and Emergency Medicine. In the development stage, 100 individual learning outcomes were identified, reflecting 16 domains; following the stage 2 validation process, 98 items remained. All items were approved by the relevant EU societies. In the final validation step, the curriculum was formally approved by the UEMS sections for Geriatric Medicine and Emergency Medicine (responsible for curriculae in the respective disciplines).
Fluidized bed technology is being implemented commercially to produce polycrystalline silicon that is used as a precursor for silicon ingot growth for the photovoltaic industry. The fluidized bed ...reactor produces polysilicon in a granular form, usually at lower temperatures than the traditional Siemens process. This current study documents for the first time grain growth and mechanical properties of polysilicon grown via a fluidized bed. In the as-grown state the granules produced by the fluidized bed reactor consist of equiaxed grains that are approximately 30
nm in diameter. Annealing at temperatures above 1000
°C causes significant grain growth to occur resulting in grains up to 300
nm. The hardness of the granular material was 10% less than that of single crystal silicon, which can be attributed to grain boundary sliding. Understanding the effect of annealing on microstructure, grain growth, and mechanical properties of the granules is critical for establishing appropriate techniques for handling the material.
Résumé
Les retours précoces aux urgences peuvent être liés à un événement indésirable associé aux soins (EIAS) survenu lors du premier passage aux urgences. Cette revue de 24 études fait le point de ...l’utilisation des retours précoces comme indicateur qualité et comme événement sentinelle dans le cadre d’une démarche qualité de gestion des risques. La plupart des retours précoces ne sont pas dus à des erreurs mais à des facteurs liés aux patients, à l’évolution de leur maladie ou au système de soin en aval des urgences. Cependant, les patients qui reviennent pour un EIAS présentent souvent une pathologie sévère nécessitant une hospitalisation. Ils ont un âge élevé, des comorbidités, ils sont mal assurés et ont un tableau clinique sévère lors de leur premier passage. Les retours précoces ne devraient pas être utilisés comme indicateur de qualité des soins puisque la plupart ne sont pas liés à un EIAS mais comme événement sentinelle pour dépister ceux qui sont liés à un EIAS. L’analyse ciblée des dossiers de ces patients permet de caractériser ces EIAS, d’identifier les causes évitables et de mettre en place des actions d’amélioration.
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