Background
Prehospital chest decompression can be a lifesaving procedure in severe chest trauma. Studies investigating prehospital chest decompression are mostly European where physicians are ...assigned to prehospital care units. This report is one of the first to compare demographics and outcomes in patients undergoing prehospital chest decompression by trained aeromedical nonphysician personnel to hospital chest decompression by physicians.
Methods
Prehospital tube thoracostomy (PTT) patients were identified from January 2014 to January 2019 and were matched in a 1:2 ratio based on age, Injury Severity Score (ISS), and chest Abbreviated Injury Score (AIS) to patients who underwent hospital tube thoracostomy (HTT) within 24 hours of admission.
Results
Forty-nine PTT patients were matched to 98 HTT patients. PTT patients had lower admission Glasgow Coma Scale (GCS), a higher rate of pre-chest tube needle decompression, and higher level 1 trauma activation. PTT were placed sooner (21.9 vs 157.0 minutes, P < .001). Rates of tube malposition, organ injury, tube dislodgement, empyema, and hospital-acquired pneumonia over the course of hospital admission were not significantly different between the 2 groups. PTT patients had longer intensive care unit length of stay (LOS), but similar hospital LOS, and overall mortality.
Discussion
This report demonstrates that PTT is performed sooner than hospital placed tubes. Complication rates associated with tube thoracostomy and patient outcomes were not statistically different between PTT and HTT groups.
The male terminalia character system in Diptera is reviewed. The phylogenetic implications of apomorphic changes are traced on published cladograms. New synapomorphies include: anteroventral ...parameral apodeme for the Tipulomorpha; parameral sheath encompassing desclerotized aedeagus for Neodiptera (exclusive of Axymyiidae); endoaedeagus for Xylophagomorpha + Tabanomorpha. Apystomyiidae are classified as the sister group to the Eremoneura based on four synapomorphies (lateral ejaculatory processes absent, subepandrial sclerite extending from base of hypoproct to phallus, bacilliform sclerites extending to tips of the epandrium and surstyli functionally developed, but not articulated) and lack of eremoneuran synapomorphies (i.e., loss of gonostyli, presence of postgonites and phallic plate). The Diptera sperm pump with a functional ejaculatory apodeme is a possible autapomorphy of Diptera, exclusive of Nymphomyiidae and Deuterophlebiidae. Internal details of the male terminalia of Sylvicola and Mycetobia (Anisopodidae), Hilarimorpha (Hilarimorphidae) and Apystomyia (Apystomyiidae) are newly illustrated and homologies of the aedeagus, paramere and sperm pump of the Tipuloidea are clarified.
The western spruce budworm (WSB; Choristoneura freemani Razowski) shapes Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) forests throughout western North America with periodic, severe ...landscape-level defoliation events. The largest and most continuous recorded defoliation occurred in the 2000s, largely centered in the Williams Lake and 100 Mile House WSB outbreak regions, peaking in 2007 at 847 000 ha defoliated in British Columbia (B.C.). Unique WSB outbreak regions in south-central B.C. are described using biogeoclimatic ecosystem classification, geography, 106 years of documented defoliation, and 46 stand-level Douglas-fir host tree-ring chronologies. Since the 1980s, recorded defoliation in B.C. has shifted from coastal ecosystems and become a dominant disturbance in drier, colder, interior Douglas-fir ecosystems. Defoliation records demarcate four outbreaks from 1950–2012 and up to three growth suppression events from 1937–2012. Outbreak duration was shorter in the north and far south of B.C., with recovery periods (no trees showing growth suppression) shorter over all WSB outbreak regions in the 2000s, suggesting that trees may be increasingly susceptible to each successive defoliation event. Knowing the regional outbreak periodicity may facilitate early detection of incipient WSB populations, which is critical for management as many of our low-elevation Douglas-fir forests become more stressed with changing and unpredictable climate regimes.
The practice of sacrifice has occurred in several cultures and religions throughout history and still exists today. Candomblé, a syncretical Afro-Brazilian religion, practices the sacrificial ritual ...called "Orô" by its adherents. The present work aims to document the use of animal species in these sacrificial practices in the cities of Caruaru (PE) and Campina Grande (PB) in Norteastern Brazil, and to further understand the symbolism of these rituals.
Semi-structured and unstructured interviews and informal discussions were held with 11 Candomblé priests and priestesses between the months of August 2007 and June 2008. We attended rituals performed at "terreiros" where animals were sacrificed, in order to obtain photographic material and observe the procedures and techniques adopted.
A total of 29 animal species were used during sacrificial rituals according to the priests and priestesses. These species were classified in 5 taxanomic groups: Molluscs (n = 1), Amphibians (n = 2), Reptiles (n = 2), Birds (n = 10) and Mammals (n = 14). According to Candomblé beliefs, animals are sacrificed and offered to their deities, known as orishas, for the prosperity of all life. There is a relationship between the colour, sex and behaviour of the animal to be sacrificed, and the orisha to whom the animal is going to be offered. The many myths that form the cosmogony of Candomblé can often explain the symbolism of the rituals observed and the animal species sacrificed. These myths are conveyed to adherants by the priests and priestesses during the ceremonies, and are essential to the continuation of this religion.
Candomblé is a sacrificial religion that uses animals for its liturgical purposes. The principal reason for sacrifice is to please supernatural deities known as orishas in order to keep life in harmony. This is accomplished through feeding them in a spiritual sense through sacrifice, maintaining a perfect link between men and the gods, and a connection between the material world (called Aiyê) and the supernatural world (called Orun).
Management indecision Brooks, Margaret E
Management decision,
05/2011, Letnik:
49, Številka:
5
Journal Article
Recenzirano
Purpose - Indecision is not the hallmark of a great manager, but what do we know about when and why managers avoid or postpone decisions? The purpose of this paper is to discuss the limited research ...on indecision.Design methodology approach - This article reviews research from judgment and decision making, psychology, management, and marketing literatures to assemble what we already know about indecision. The review spans situational and personal determinants of indecision, highlighting what we know about when and why people experience indecision as well as who is predictably indecisive.Findings - Decisions are avoided when people are asked to justify them, when options are similar in attractiveness, and when there are a large number of options to consider. Indecision may sometimes be a result of systematic biases (i.e. omission bias and status quo bias), and indecisive people may be more prone to confirmation bias. Finally, indecisiveness is related to numerous other individual differences, many of which are negative.Practical implications - Specific recommendations for managers include evaluating options separately rather than comparing options, structuring incentive systems to reward decisive action, and explicitly considering the risk of lost opportunity when deciding whether to put off making a decision.Originality value - The literature reviewed in this paper spans diverse disciplines and perspectives. This paper provides a starting point for managers and researchers interested in understanding indecision: when and why it occurs, who is likely to be most indecisive, and what we might do to counter indecision.
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating pandemic. Although its respiratory ...effects can be deadly and debilitating, it can lead to other systemic disorders, such as those causing eye pain and headache. This literature review aims to describe presentations of eye pain and headache in relation to COVID-19, with an emphasis on how these disorders help us to understand the pathophysiology of COVID-19.
Literature was mined from the PubMed database using the key terms: "eye pain," "conjunctivitis," "episcleritis," "optic neuritis," "migraine," and "headache" in conjunction with "COVID-19" and "SARS-CoV-2." With the exception of general background pathology, articles that predated 2006 were excluded. Case reports, literature reviews, and meta-analyses were all included. Where SARS-CoV-2 research was deficient, pathology of other known viruses was considered. Reports of ocular manifestations of vision loss in the absence of eye pain were excluded. The primary search was conducted in June 2021.
The literature search led to a focused review of COVID-19 associated with conjunctivitis, episcleritis, scleritis, optic neuritis, and myelin oligodendrocyte glycoprotein-associated optic neuritis. Four distinct COVID-19-related headache phenotypes were identified and discussed.
Eye pain in the setting of COVID-19 presents as conjunctivitis, episcleritis, scleritis, or optic neuritis. These presentations add to a more complete picture of SARS-CoV-2 viral transmission and mechanism of host infection. Furthermore, eye pain during COVID-19 may provide evidence of hypersensitivity-type reactions, neurovirulence, and incitement of either novel or subclinical autoimmune processes. In addition, investigation of headaches associated with COVID-19 demonstrated 4 distinct phenotypes that follow third edition of the International Classification of Headache Disorders categories: headaches associated with personal protective equipment, migraine, tension-type headaches, and COVID-19-specific headache. Early identification of headache class could assist in predicting the clinical course of disease. Finally, investigation into the COVID-19-associated headache phenotype of those with a history of migraine may have broader implications, adding to a more general understanding of migraine pathology.
This article discusses the diagnosis and medical treatment of stromal keratomalacia or "melting ulcers," stromal abscesses, eosinophilic keratitis (EK), and calcific band keratopathy. These are ...common and important inflammatory keratopathies of the equine corneal stroma. Keratomalacia and stromal abscesses are associated with infection, leukocytic invasion of the stroma, and loss of tissue and tear film proteinase homeostasis. Eosinophils infiltrate the stroma in response to unknown stimuli in EK. Calcium is deposited in the stroma and epithelium secondary to chronic equine recurrent uveitis in calcific band keratopathy. They are all associated with varying degrees of iridocyclitis.
Schwann cells (SCs) have been shown to play an essential role in axon regeneration in both peripheral nerve injuries (PNIs) and spinal cord injuries (SCIs). The transplantation of SCs as an ...adjunctive therapy is currently under investigation in human clinical trials due to their regenerative capacity. Therefore, a reliable method for procuring large quantities of SCs from peripheral nerves is necessary. This paper presents a well-developed, validated, and optimized manufacturing protocol for clinical-grade SCs that are compliant with Current Good Manufacturing Practices (CGMPs).
The authors evaluated the SC culture manufacturing data from 18 clinical trial participants who were recruited for autologous SC transplantation due to subacute SCI (n = 7), chronic SCI (n = 8), or PNIs (n = 3). To initiate autologous SC cultures, a mean nerve length of 11.8 ± 3.7 cm was harvested either from the sural nerve alone (n = 17) or with the sciatic nerve (n = 1). The nerves were digested with enzymes and SCs were isolated and further expanded in multiple passages to meet the dose requirements for transplantation.
An average yield of 87.2 ± 89.2 million cells at P2 and 150.9 ± 129.9 million cells at P3 with high viability and purity was produced. Cell counts and rates of expansion increased with each subsequent passage from P0 to P3, with the largest rate of expansion between P2 and P3. Larger harvest nerve lengths correlated significantly with greater yields at P0 and P1 (p < 0.05). In addition, a viability and purity above 90% was sustained throughout all passages in nearly all cell products.
This study presents reliable CGMP-compliant manufacturing methods for autologous SC products that are suitable for regenerative treatment of patients with SCI, PNI, or other conditions.
Aβ1–42 is involved in Alzheimer’s disease (AD) pathogenesis and is prone to glycation, an irreversible process where proteins accumulate advanced glycated end products (AGEs). N∈-(Carboxyethyl)lysine ...(CEL) is a common AGE associated with AD patients and occurs at either Lys-16 or Lys-28 of Aβ1–42. Methyglyoxal is commonly used for the unspecific glycation of Aβ1–42, which results in a complex mixture of AGE-modified peptides and makes interpretation of a causative AGE at a specific amino acid residue difficult. We address this issue by chemically synthesizing defined CEL modifications on Aβ1–42 at Lys-16 (Aβ-CEL16), Lys-28 (Aβ-CEL28), and Lys-16 and -28 (Aβ-CEL16&28). We demonstrated that double-CEL glycations at Lys-16 and Lys-28 of Aβ1–42 had the most profound impact on the ability to form amyloid fibrils. In silico predictions indicated that Aβ-CEL16&28 had a substantial decrease in free energy change, which contributes to fibril destabilization, and a increased aggregation rate. Single-CEL glycations at Lys-28 of Aβ1–42 had the least impact on fibril formation, whereas CEL glycations at Lys-16 of Aβ1–42 delayed fibril formation. We also tested these peptides for neuronal toxicity and mitochondrial function on a retinoic acid-differentiated SH-SY5Y human neuroblastoma cell line (RA-differentiated SH-SY5Y). Only Aβ-CEL16 and Aβ-CEL28 were neurotoxic, possibly through a nonmitochondrial pathway, whereas Aβ-CEL16&28 showed no neurotoxicity. Interestingly, Aβ-CEL16&28 had depolarized the mitochondrial membrane potential, whereas Aβ-CEL16 had increased mitochondrial respiration at complex II. These results may indicate mitophagy or an alternate route of metabolism, respectively. Therefore, our results provides insight into potential therapeutic approaches against neurotoxic CEL-glycated Aβ1–42.
We recently reported the synthesis and testing of a new class of unimolecular micelles based on hyperbranched polyglycerols as second generation synthetic plasma expanders and as general drug ...delivery vehicles. A detailed biodistribution study of two derivatized hyperbranched polyglycerols of different molecular weights derivatized with hydrophobic groups and short poly(ethylene glycol) chains is reported in this article. In mice, these materials are nontoxic with circulation half-lives as high as 31 h, controllable by manipulating the molecular weight and the degree of PEG derivatization. Organ accumulation is low, presumably due to the “pegylation” effect. Thermal degradation and hydrolysis data suggest that these polymers are highly stable with a long shelf life, a major advantage for a pharmaceutical product. Degradation under acidic conditions has been observed for these polymers.
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