Recognizing Fatal Electrocardiography Rhythm Changes in a patient with Severe Hyperkalemia and Prevention of Cardiac Arrest with medical management in small hospitals

Background: Hyperkalemia is one of the most potentially lethal electrolyte disorders. Severe hyperkalemia is defined as a serum potassium level of \u3e6.5 mEq/L. The risk of arrhythmias increases with potassium values \u3e6.5 mEq/L. Small elevation above this value can cause peaked T waves to quickly progress to ventricular fibrillation or asystole. The longer the patient has elevated potassium concentrations, the greater the risk of sudden deterioration. Therefore, recognizing ECG changes and acting quickly to decrease potassium concentration is important to prevent hyperkalemic cardiac arrest. Case Presentation: A 26-Year-old man with a history of congenital hypoaldosteronism presented to the emergency department with a complaint of palpitations, lightheadedness, bilateral extremity weakness, and generalized muscle aches of 4 hours duration, culminating in collapse. He denied shortness of breath, chest pain, blurring of vision. On examination he was afebrile, tachycardic, and normotensive. Cardiac and respiratory exams were unremarkable, on neurology examination patient was alert and oriented x3, strength 0/5 in 4 extremities. Initial EKG revealed Sinus tachycardia with flattened P waves, wide and bizarre QRS morphology. On laboratory sodium was 119, potassium 9.4, chloride 87, co2 17, creatinine 1.5, and BUN of 33. The patient was managed with emergent calcium gluconate supplementation, sodium bicarbonate, albuterol via nebulizer, insulin, and glucose. Repeat potassium after 2 hours of presentation was 9.0 mEq/L without EKG changes from baseline. Repeated administration of the above medications resulted in only partial improvement of the serum potassium, with the patient reporting improvement in motor strength, and muscle aches. Emergent hemodialysis was recommended, but delayed due to logistics, with initial medical management avoiding immediate complications. Ultimate hemodialysis resulted in rapid correction of his hyperkalemia several hours after presentation. Conclusion: Hyperkalemia is a common electrolyte abnormality and is associated with increased mortality. It is important to recognize clinical presentation and abnormal ECG changes of severe hyperkalemia in order to prevent hyperkalemic cardiac arrest by initiating medical management to antagonize the effect of potassium on excitable membranes, rapidly shift potassium into cells, and enhance potassium elimination to preventing hyperkalemic cardiac arrest. This is more useful in small community hospitals where urgent hemodialysis is not easily accessible 24 hours a day

Rare Atypical Presentation of Ogilvie Syndrome in a Hispanic Man

Background: Ogilvie syndrome (OS) also known as acute pseudo-obstruction of the colon is a bowel motility disorder characterized by features of intestinal obstruction in the absence of an anatomical or mechanical cause. Typical presentation is with abdominal distension but atypical and more rare presenting features have also been reported including respiratory distress. Thus, we present the first case of Ogilvie syndrome presenting with respiratory distress in a Hispanic man. Case Presentation: A 71-year-old gentleman with a history of diabetes mellitus, functional quadriplegia and other comorbidities was brought to the ED via EMS on account of altered metal status and constipation for about three days. Pertinent findings from the examination showed a chronically ill looking gentleman with a GCS of 8/15, respiratory rate of 34, pulse oximeter saturating at 86% on ambient air, and the usage of accessory muscles. Abdominal examination showed a mildly distended abdomen with tympanitic percussion notes and hypoactive bowel sounds in all the quadrants. Digital rectal examination revealed soft non bloody loose brown stools. Three was global muscle wasting and reduced muscle strength. Blood gas showed a pH of 7.12, pCO2- 117.4 and pO2- 74 suggestive of severe hypoxic and hypercapnic respiratory acidosis. Plain KUB X-ray and CT scan showed significant colonic distension with no fecal or anatomic obstruction. Patient was intubated for airway protection and abdominal distension was managed conservatively with discontinuation of enteral feeding, nasogastric tube decompression, potassium and magnesium replacement. Management can be escalated in patients who failed to respond to conservative measures or in those with complications like intestinal ischemia and perforation. in patients with colonic diameter \u3e 12 cm who failed 48 to 72 hours (about 3 days) of conservative therapy, pharmacologic therapy with neostigmine can be used. Conclusion: Our patient responded to conservative measures including withholding of enteral feeding, nasogastric tube decompression, potassium and magnesium replacement. Management can be escalated in patients who failed to respond to conservative measures or in those with complications like intestinal ischemia and perforation. In patients with colonic diameter \u3e 12 cm who failed 48 to 72 hours (about 3 days) of conservative therapy, pharmacologic therapy with neostigmine can be used

Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

This paper presents measurements of the $W^+ \rightarrow \mu^+\nu$ and $W^- \rightarrow \mu^-\nu$ cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

The contribution of metacognitions and attentional control to decisional procrastination

Earlier research has implicated metacognitions and attentional control in procrastination and self-regulatory failure. This study tested several hypotheses: (1) that metacognitions would be positively correlated with decisional procrastination; (2) that attentional control would be negatively correlated with decisional procrastination; (3) that metacognitions would be negatively correlated with attentional control; and (4) that metacognitions and attentional control would predict decisional procrastination when controlling for negative affect. One hundred and twenty-nine participants completed the Depression Anxiety Stress Scale 21, the Meta-Cognitions Questionnaire 30, the Attentional Control Scale, and the Decisional Procrastination Scale. Significant relationships were found between all three attentional control factors (focusing, shifting, and flexible control of thought) and two metacognitions factors (negative beliefs concerning thoughts about uncontrollability and danger, and cognitive confidence). Results also revealed that decisional procrastination was significantly associated with negative affect, all measured metacognitions factors, and all attentional control factors. In the final step of a hierarchical regression analysis only stress, cognitive confidence, and attention shifting were independent predictors of decisional procrastination. Overall these findings support the hypotheses and are consistent with the Self-Regulatory Executive Function model of psychological dysfunction. The implications of these findings are discussed

Exposure assessment of process-related contaminants in food by biomarker monitoring

Exposure assessment is a fundamental part of the risk assessment paradigm, but can often present a number of challenges and uncertainties. This is especially the case for process contaminants formed during the processing, e.g. heating of food, since they are in part highly reactive and/or volatile, thus making exposure assessment by analysing contents in food unreliable. New approaches are therefore required to accurately assess consumer exposure and thus better inform the risk assessment. Such novel approaches may include the use of biomarkers, physiologically based kinetic (PBK) modelling-facilitated reverse dosimetry, and/or duplicate diet studies. This review focuses on the state of the art with respect to the use of biomarkers of exposure for the process contaminants acrylamide, 3-MCPD esters, glycidyl esters, furan and acrolein. From the overview presented, it becomes clear that the field of assessing human exposure to process-related contaminants in food by biomarker monitoring is promising and strongly developing. The current state of the art as well as the existing data gaps and challenges for the future were defined. They include (1) using PBK modelling and duplicate diet studies to establish, preferably in humans, correlations between external exposure and biomarkers; (2) elucidation of the possible endogenous formation of the process-related contaminants and the resulting biomarker levels; (3) the influence of inter-individual variations and how to include that in the biomarker-based exposure predictions; (4) the correction for confounding factors; (5) the value of the different biomarkers in relation to exposure scenario’s and risk assessment, and (6) the possibilities of novel methodologies. In spite of these challenges it can be concluded that biomarker-based exposure assessment provides a unique opportunity to more accurately assess consumer exposure to process-related contaminants in food and thus to better inform risk assessment

Measurements of long-range azimuthal anisotropies and associated Fourier coefficients for pp collisions at √s=5.02 and 13 TeV and p+Pb collisions at √sNN=5.02 TeV with the ATLAS detector

ATLAS measurements of two-particle correlations are presented for √s=5.02 and 13 TeV ppcollisions and for √sNN=5.02 TeV p+Pb collisions at the LHC. The correlation functions are measured as a function of relative azimuthal angle Δϕ, and pseudorapidity separation Δη, using charged particles detected within the pseudorapidity interval |η|2, is studied using a template fitting procedure to remove a “back-to-back” contribution to the correlation function that primarily arises from hard-scattering processes. In addition to the elliptic, cos (2Δϕ), modulation observed in a previous measurement, the pp correlation functions exhibit significant cos (3Δϕ) and cos (4Δϕ) modulation. The Fourier coefficients vn, n associated with the cos (nΔϕ) modulation of the correlation functions for n=2–4 are measured as a function of charged-particle multiplicity and charged-particle transverse momentum. The Fourier coefficients are observed to be compatible with cos (nϕ) modulation of per-event single-particle azimuthal angle distributions. The single-particle Fourier coefficients vn are measured as a function of charged-particle multiplicity, and charged-particle transverse momentum for n=2–4. The integrated luminosities used in this analysis are, 64nb−1 for the √s=13 TeV pp data, 170 nb−1 for the √ s = 5.02 TeV pp data, and 28 nb−1 for the √sNN = 5.02 TeV p+Pb data

Measurement of the W-boson mass in pp collisions at √s=7 TeV with the ATLAS detector

A measurement of the mass of the W boson is presented based on proton–proton collision data recorded in 2011 at a centre-of-mass energy of 7 TeV with the ATLAS detector at the LHC, and corresponding to 4.6 fb−1 of integrated luminosity. The selected data sample consists of 7.8×106 candidates in the W→μν channel and 5.9×106 candidates in the W→eν channel. The W-boson mass is obtained from template fits to the reconstructed distributions of the charged lepton transverse momentum and of the W boson transverse mass in the electron and muon decay channels, yielding mW=80370±7 (stat.)±11(exp. syst.) ±14(mod. syst.) MeV =80370±19MeV, where the first uncertainty is statistical, the second corresponds to the experimental systematic uncertainty, and the third to the physics-modelling systematic uncertainty. A measurement of the mass difference between the W+ and W−bosons yields mW+−mW−=−29±28 MeV

Probing the W tb vertex structure in t-channel single-top-quark production and decay in pp collisions at s√=8 TeV with the ATLAS detector

To probe the W tb vertex structure, top-quark and W -boson polarisation observables are measured from t-channel single-top-quark events produced in proton-proton collisions at a centre-of-mass energy of 8 TeV. The dataset corresponds to an integrated luminosity of 20.2 fb−1, recorded with the ATLAS detector at the LHC. Selected events contain one isolated electron or muon, large missing transverse momentum and exactly two jets, with one of them identified as likely to contain a b-hadron. Stringent selection requirements are applied to discriminate t-channel single-top-quark events from background. The polarisation observables are extracted from asymmetries in angular distributions measured with respect to spin quantisation axes appropriately chosen for the top quark and the W boson. The asymmetry measurements are performed at parton level by correcting the observed angular distributions for detector effects and hadronisation after subtracting the background contributions. The measured top-quark and W -boson polarisation values are in agreement with the Standard Model predictions. Limits on the imaginary part of the anomalous coupling gR are also set from model-independent measurements.We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; SRNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZS, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, ERDF, FP7, Horizon 2020 and Marie Sklodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Region Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; CERCA Programme Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom.The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN, the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CC-IN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NL-T1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (UK) and BNL (USA), the Tier-2 facilities worldwide and large non-WLCG resource providers. Major contributors of computing resoinfo:eu-repo/semantics/publishedVersio

Measurement of jet fragmentation in Pb+Pb and pp collisions at √s NN =5.02 TeV with the ATLAS detector

This paper presents a measurement of jet fragmentation functions in 0.49 nb −1 of Pb+Pb collisions and 25 pb −1 of pp collisions at √ sNN =5.02 TeV collected in 2015 with the ATLAS detector at the LHC. These measurements provide insight into the jet quenching process in the quark-gluon plasma created in the aftermath of ultra-relativistic collisions between two nuclei. The modifications to the jet fragmentation functions are quantified by dividing the measurements in Pb+Pb collisions by baseline measurements in pp collisions. This ratio is studied as a function of the transverse momentum of the jet, the jet rapidity, and the centrality of the collision. In both collision systems, the jet fragmentation functions are measured for jets with transverse momentum between 126 GeV and 398 GeV and with an absolute value of jet rapidity less than 2.1. An enhancement of particles carrying a small fraction of the jet momentum is observed, which increases with centrality and with increasing jet transverse momentum. Yields of particles carrying a very large fraction of the jet momentum are also observed to be enhanced. Between these two enhancements of the fragmentation functions a suppression of particles carrying an intermediate fraction of the jet momentum is observed in Pb+Pb collisions. A small dependence of the modifications on jet rapidity is observed