Abstract
Difficulties with tracheal intubation commonly arise and impact patient safety. This systematic review evaluates whether videolaryngoscopes reduce intubation failure and complications ...compared with direct laryngoscopy in adults. We searched CENTRAL, MEDLINE, Embase and clinicaltrials.gov up to February 2015, and conducted forward and backward citation tracking. We included randomized controlled trials that compared adult patients undergoing laryngoscopy with videolaryngoscopy or Macintosh laryngoscopy. We did not primarily intend to compare individual videolaryngoscopes. Sixty-four studies (7044 participants) were included. Moderate quality evidence showed that videolaryngoscopy reduced failed intubations (Odds Ratio (OR) 0.35, 95% Confidence Interval (CI) 0.19-0.65) including in participants with anticipated difficult airways (OR 0.28, 95% CI 0.15-0.55). There was no evidence of reduction in hypoxia or mortality, but few studies reported these outcomes. Videolaryngoscopes reduced laryngeal/airway trauma (OR 0.68, 95% CI 0.48-0.96) and hoarseness (OR 0.57, 95% CI 0.36-0.88). Videolaryngoscopy increased easy laryngeal views (OR 6.77, 95% CI 4.17-10.98) and reduced difficult views (OR 0.18, 95% CI 0.13-0.27) and intubation difficulty, typically using an 'intubation difficulty score' (OR 7.13, 95% CI 3.12-16.31). Failed intubations were reduced with experienced operators (OR 0.32, 95% CI 0.13-0.75) but not with inexperienced users. We identified no difference in number of first attempts and incidence of sore throat. Heterogeneity around time for intubation data prevented meta-analysis. We found evidence of differential performance between different videolaryngoscope designs. Lack of data prevented analysis of impact of obesity or clinical location on failed intubation rates. Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a videolaryngoscope reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a videolaryngoscope affects time required for intubation.
Data correction is probably the least favourite activity amongst users experimenting with small‐angle X‐ray scattering: if it is not done sufficiently well, this may become evident only during the ...data analysis stage, necessitating the repetition of the data corrections from scratch. A recommended comprehensive sequence of elementary data correction steps is presented here to alleviate the difficulties associated with data correction, both in the laboratory and at the synchrotron. When applied in the proposed order to the raw signals, the resulting absolute scattering cross section will provide a high degree of accuracy for a very wide range of samples, with its values accompanied by uncertainty estimates. The method can be applied without modification to any pinhole‐collimated instruments with photon‐counting direct‐detection area detectors.
A data correction sequence is presented, consisting of ordered elementary steps that extract the small‐angle X‐ray scattering cross section from the original detector signal(s). It is applicable to a wide range of samples, including solids and dispersions.
The optical properties of metal nanomaterials are determined by a set of parameters that include composition, particle size and shape, overall architecture, and local environment. This Tutorial ...Review examines the influence of each of these factors on the localized surface plasmon resonance of colloidal metal nanoparticles. This examination is paralleled with a discussion of the advances which have enabled the synthesis of structurally defined metal nanomaterials, as these samples serve as the best platforms for elucidating the fundamental properties of plasmonic colloids. Based on the analysis of such samples, five guidelines are presented to aid the rational design and synthesis of new metal nanostructures for advanced applications in nanomedicine, energy, chemical sensing, and colloidal plasmonics in general.
Summary
This article outlines recent developments in safety science. It describes the progression of three ‘ages’ of safety, namely the ‘age of technology’, the ‘age of human factors’ and the ‘age of ...safety management’. Safety science outside healthcare is moving from an approach focused on the analysis and management of error (‘Safety‐1’) to one which also aims to understand the inherent properties of safety systems that usually prevent accidents from occurring (‘Safety‐2’). A key factor in the understanding of safety within organisations relates to the distinction between ‘work as imagined’ and ‘work as done’. ‘Work as imagined’ assumes that if the correct standard procedures are followed, safety will follow as a matter of course. However, staff at the ‘sharp end’ of organisations know that to create safety in their work, variability is not only desirable but essential. This positive adaptability within systems that allows good outcomes in the presence of both favourable and adverse conditions is termed resilience. We argue that clinical and organisational work can be made safer, not only by addressing negative outcomes, but also by fostering excellence and promoting resilience. We outline conceptual and investigative approaches for achieving this that include ‘appreciative inquiry’, ‘positive deviance’ and excellence reporting.
A recently published theory has suggested that a cloak of invisibility is in principle possible, at least over a narrow frequency band. We describe here the first practical realization of such a ...cloak; in our demonstration, a copper cylinder was "hidden" inside a cloak constructed according to the previous theoretical prescription. The cloak was constructed with the use of artificially structured metamaterials, designed for operation over a band of microwave frequencies. The cloak decreased scattering from the hidden object while at the same time reducing its shadow, so that the cloak and object combined began to resemble empty space.
Ediacaran Extinction and Cambrian Explosion Darroch, Simon A.F.; Smith, Emily F.; Laflamme, Marc ...
Trends in ecology & evolution (Amsterdam),
September 2018, 2018-09-00, 20180901, Letnik:
33, Številka:
9
Journal Article
Recenzirano
Odprti dostop
The Ediacaran–Cambrian (E–C) transition marks the most important geobiological revolution of the past billion years, including the Earth’s first crisis of macroscopic eukaryotic life, and its most ...spectacular evolutionary diversification. Here, we describe competing models for late Ediacaran extinction, summarize evidence for these models, and outline key questions which will drive research on this interval. We argue that the paleontological data suggest two pulses of extinction – one at the White Sea–Nama transition, which ushers in a recognizably metazoan fauna (the ‘Wormworld’), and a second pulse at the E–C boundary itself. We argue that this latest Ediacaran fauna has more in common with the Cambrian than the earlier Ediacaran, and thus may represent the earliest phase of the Cambrian Explosion.
We provide evidence for a two-phased biotic turnover event during the Ediacaran–Cambrian transition (about 550–539 Ma), which both comprises the Earth’s first major biotic crisis of macroscopic eukaryotic life (the disappearance of the enigmatic ‘Ediacara biota’) and immediately precedes the Cambrian explosion.
We summarize two competing models for the turnover pulses – an abiotically driven model (catastrophe) analogous to the ‘Big 5’ Phanerozoic mass extinction events, and a biotically driven model (biotic replacement) suggesting that the evolution of bilaterian metazoans and ecosystem engineering were responsible.
We summarize the evidence in support of both models and identify several key research questions which will help to distinguish between them, and thus shed light on the origins of the modern, animal-dominated biosphere.
We argue that the first turnover pulse (about 550 Ma) marks the greatest change in organismal and ecological complexity, leading to a more recognizably metazoan global fauna that has much more in common with the Cambrian than the earlier Ediacaran. This latest Ediacaran interval (the ‘Nama’) may therefore represent the earliest phase of the Cambrian Explosion.
Background
Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical ...data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty.
Aim
To formulate statements using a Delphi consensus approach employing a group of expert clinicians, that reflect current knowledge of CA, aspects that can be implemented in TBI management and CA research priorities.
Methods
A group of 25 international academic experts with clinical expertise in the management of adult severe TBI patients participated in this consensus process. Seventy-seven statements and multiple-choice questions were submitted to the group in two online surveys, followed by a face-to-face meeting and a third online survey. Participants received feedback on average scores and the rationale for resubmission or rephrasing of statements. Consensus on a statement was defined as agreement of more than 75% of participants.
Results
Consensus amongst participants was achieved on the importance of CA status in adult severe TBI pathophysiology, the dynamic non-binary nature of CA impairment, its association with outcome and the inadvisability of employing universal and absolute cerebral perfusion pressure targets. Consensus could not be reached on the accuracy, reliability and validation of any current CA assessment method. There was also no consensus on how to implement CA information in clinical management protocols, reflecting insufficient clinical evidence.
Conclusion
The Delphi process resulted in 25 consensus statements addressing the pathophysiology of impaired CA, and its impact on cerebral perfusion pressure targets and outcome. A research agenda was proposed emphasizing the need for better validated CA assessment methods as well as the focused investigation of the application of CA-guided management in clinical care using prospective safety, feasibility and efficacy studies.
Summary
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of ...i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre‐existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high‐risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri‐operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg‐1, calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg‐1.h‐1 for no longer than 24 h is recommended, subject to review and re‐assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
The human mannose receptor expressed on macrophages and hepatic endothelial cells scavenges released lysosomal enzymes, glycopeptide fragments of collagen, and pathogenic microorganisms and thus ...reduces damage following tissue injury. The receptor binds mannose, fucose, or N-acetylglucosamine (GlcNAc) residues on these targets. C-type carbohydrate-recognition domain 4 (CRD4) of the receptor contains the site for Ca2+-dependent interaction with sugars. To investigate the details of CRD4 binding, glycan array screening was used to identify oligosaccharide ligands. The strongest signals were for glycans that contain either Manα1-2Man constituents or fucose in various linkages. The mechanisms of binding to monosaccharides and oligosaccharide substructures present in many of these ligands were examined in multiple crystal structures of CRD4. Binding of mannose residues to CRD4 results primarily from interaction of the equatorial 3- and 4-OH groups with a conserved principal Ca2+ common to almost all sugar-binding C-type CRDs. In the Manα1-2Man complex, supplementary interactions with the reducing mannose residue explain the enhanced affinity for this disaccharide. Bound GlcNAc also interacts with the principal Ca2+ through equatorial 3- and 4-OH groups, whereas fucose residues can bind in several orientations, through either the 2- and 3-OH groups or the 3- and 4-OH groups. Secondary contacts with additional sugars in fucose-containing oligosaccharides, such as the Lewis-a trisaccharide, provide enhanced affinity for these glycans. These results explain many of the biologically important interactions of the mannose receptor with both mammalian glycoproteins and microbes such as yeast and suggest additional classes of ligands that have not been previously identified.
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