Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications.
The lethal triad of acidosis, hypothermia, and coagulopathy associated ...with MT is associated with a high mortality rate. Other
complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia,
hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical
care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased
infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive
approach to blood transfusion should be implemented to minimize further complications.
Quantum metrology aims to use entanglement and other quantum resources to improve precision measurement. An interferometer using N independent particles to measure a parameter χ can achieve at best ...the standard quantum limit of sensitivity, δχ ∝ N(-1/2). However, using N entangled particles and exotic states, such an interferometer can in principle achieve the Heisenberg limit, δχ ∝ N(-1). Recent theoretical work has argued that interactions among particles may be a valuable resource for quantum metrology, allowing scaling beyond the Heisenberg limit. Specifically, a k-particle interaction will produce sensitivity δχ ∝ N(-k) with appropriate entangled states and δχ ∝ N(-(k-1/2)) even without entanglement. Here we demonstrate 'super-Heisenberg' scaling of δχ ∝ N(-3/2) in a nonlinear, non-destructive measurement of the magnetization of an atomic ensemble. We use fast optical nonlinearities to generate a pairwise photon-photon interaction (corresponding to k = 2) while preserving quantum-noise-limited performance. We observe super-Heisenberg scaling over two orders of magnitude in N, limited at large numbers by higher-order nonlinear effects, in good agreement with theory. For a measurement of limited duration, super-Heisenberg scaling allows the nonlinear measurement to overtake in sensitivity a comparable linear measurement with the same number of photons. In other situations, however, higher-order nonlinearities prevent this crossover from occurring, reflecting the subtle relationship between scaling and sensitivity in nonlinear systems. Our work shows that interparticle interactions can improve sensitivity in a quantum-limited measurement, and experimentally demonstrates a new resource for quantum metrology.
Clostridium difficile infections are the leading cause of health care–associated infectious diarrhea, posing a significant risk for both medical and surgical patients. Because of the significant ...morbidity and mortality associated with C difficile infections, knowledge of the epidemiology of C difficile in combination with a high index of suspicion and susceptible patient populations (including surgical, postcolectomy, and inflammatory bowel disease patients) is warranted. C difficile infections present with a wide spectrum of disease, ranging from mild diarrhea to fulminant colitis or small bowel enteritis and recurrent C difficile infections. Early implementation of medical and operative treatment strategies for C difficile infections is imperative for optimal patient outcomes. National and international guidelines recommend early operative consultation and total abdominal colectomy with end ileostomy and preservation of rectum. Diverting loop ileostomy and colonic lavage followed by intravenous metronidazole and intracolonic vancomycin administered via the efferent limb of the ileostomy should be considered as an alternative to total colectomy in selected patients. New and emerging strategies for C difficile infection treatment include monoclonal antibodies, vaccines, probiotics, biotherapeutics, and new antibiotics. A successful C difficile prevention and eradication program requires a multidisciplinary approach that includes early disease recognition, implementation of guidelines for monitoring adherence to environmental control, judicious hand hygiene, evidence-based treatment and management strategies, and a focused antibiotic stewardship program. Surgeons are an important part of the clinical team in the management of C difficile infection prevention and treatment.
People differ in their social, emotional, and behavioral (SEB) skills: their capacities to maintain social relationships, regulate emotions, and manage goal- and learning-directed behaviors. In five ...studies using data from seven independent samples (N = 6,309), we address three key questions about the nature, structure, assessment, and outcomes of SEB skills. First, how can SEB skills be defined and distinguished from other kinds of psychological constructs, such as personality traits? We propose that SEB skills represent how someone is capable of thinking, feeling, and behaving when the situation calls for it, whereas traits represent how someone tends to think, feel, and behave averaged across situations. Second, how can specific SEB skills be organized within broader domains? We find that many skill facets can be organized within five major domains representing Social Engagement, Cooperation, Self-Management, Emotional Resilience, and Innovation Skills. Third, how should SEB skills be measured? We develop and validate the Behavioral, Emotional, and Social Skills Inventory (BESSI) to measure individuals' capacity to enact specific behaviors representing 32 skill facets. We then use the BESSI to investigate the nomological network of SEB skills. We show that both skill domains and facets converge in conceptually meaningful ways with socioemotional competencies, character and developmental strengths, and personality traits, and predict consequential outcomes including academic achievement and engagement, occupational interests, social relationships, and well-being. We believe that this work provides the most comprehensive model currently available for conceptualizing SEB skills, as well as the most psychometrically robust tool available for assessing them.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
Higher viral loads in SARS-CoV-2 infections may be linked to more rapid spread of emerging variants of concern (VOC). Rapid detection and isolation of cases with highest viral loads, even in pre- or ...asymptomatic individuals, is essential for the mitigation of community outbreaks.
In this study, we analyze Ct values from 1297 SARS-CoV-2 positive patient saliva samples collected at the Clemson University testing lab in upstate South Carolina. Samples were identified as positive using RT-qPCR, and clade information was determined via whole genome sequencing at nearby commercial labs. We also obtained patient-reported information on symptoms and exposures at the time of testing. The lowest Ct values were observed among those infected with Delta (median: 22.61, IQR: 16.72-28.51), followed by Alpha (23.93, 18.36-28.49), Gamma (24.74, 18.84-30.64), and the more historic clade 20G (25.21, 20.50-29.916). There was a statistically significant difference in Ct value between Delta and all other clades (all p.adj<0.01), as well as between Alpha and 20G (p.adj<0.05). Additionally, pre- or asymptomatic patients (n = 1093) showed the same statistical differences between Delta and all other clades (all p.adj<0.01); however, symptomatic patients (n = 167) did not show any significant differences between clades. Our weekly testing strategy ensures that cases are caught earlier in the infection cycle, often before symptoms are present, reducing this sample size in our population.
COVID-19 variants Alpha and Delta have substantially higher viral loads in saliva compared to more historic clades. This trend is especially observed in individuals who are pre- or asymptomatic, which provides evidence supporting higher transmissibility and more rapid spread of emerging variants. Understanding the viral load of variants spreading within a community can inform public policy and clinical decision making.
NUT midline carcinoma (NMC) is a rare and aggressive subtype of squamous carcinoma that typically arises from midline supradiaphragmatic structures, frequently from the head and neck area. NMC is ...genetically driven by a chromosomal rearrangement involving the
gene, which forms oncoproteins considered major pathogenic drivers of cellular transformation. Diagnosis of NMC has been made remarkably easier with the availability of a commercial antibody against NUT, and can be established through positive nuclear immunohistochemical staining. Although NMC remains an underrecognized malignancy, in recent years there has appeared to be increasing awareness of disease and frequency of diagnosis in adults. To date, a standard treatment for head and neck NMC has not been established and a multimodal approach with systemic chemotherapy, surgery and radiation therapy is currently adopted in clinical practice. Recently, BET inhibitors and histone deacetylase inhibitors have emerged as two promising classes of targeted agents, currently investigated in clinical trials for adults with head and neck NMC. At the same time, combination approaches and novel targeted agents, such as next-generation BET inhibitors and CDK9 inhibitors, have shown preclinical activity. The present review explores the clinical pathological characteristics of NMC of the head and neck and presents the current state of the art on diagnosis, prognosis, and treatment of this rare but lethal disease.
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