Clinical review: Mass casualty triage – pandemic influenza and critical care

Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process

The Ursinus Weekly, April 26, 1943

College thespians to give two plays as climax to May Day celebration • Year book published by France forever for current year • Crowning of May queen Nancy Landis to highlight Mother\u27s Day Saturday • Rev. Tovey downs might rules right • Musical portrays Easter scriptures • Girls draw for rooms tonight and tomorrow • Walter Sanborn to speak at annual Weekly banquet • Volunteers donate blood • Education 5-6 scheduled for September-October • Dr. Appleton will address pre-med society Thursday • Phys-edders to swim in Norristown Wednesday • Dramatists elect officers • Speaker to show slides at vespers Sunday night • Men debaters reorganize; to hold banquet Thursday • Girls\u27 varsities to open season with Penn and Temple teams • Track meet will decide class champs and winners of intramural plaque • Bayne is undefeated in college competition after four seasons • Men begin baseball games • Golfers to have tourney if enough players report • Shreiner-Clamer takes close softball tilt from 612-Maples • Girls to play off matches • Miss Nat Hogeland guides students riding each week • Keep courts in condition • Student enjoys vacations thoroughly but needs rest after reaching Ursinus • Students to visit library of pastor near Norristown • German Club to entertain • WSGA to install officershttps://digitalcommons.ursinus.edu/weekly/1762/thumbnail.jp

The Ursinus Weekly, October 21, 1976

Ursinus news in brief: Parsons recovering; Damage fines abolished; Young Democrats revived; Homecoming planned; Voter registration held; MBA fair planned • Messiah cut back • Placement meetings set • Commuters organize • SAC reports • Comment: The ugly American lives on • Richter talks to freshmen • Comment: Alumni-student relations • Rheinpfalz folk culture • Bob Dean: Artist • proTheatre produces one acts • Beautiful noise • Operation: White Cloud • Coming campus events • Handwerk replaces Fry • Soccer drops three • Bears lose • X-Country splits • Kang\u27s return • McGinnis views NBA and Sixershttps://digitalcommons.ursinus.edu/weekly/1059/thumbnail.jp

Physiological-social score (PMEWS) vs. CURB-65 to triage pandemic influenza: a comparative validation study using community-acquired pneumonia as a proxy

BACKGROUND: An influenza pandemic may increase Emergency Department attendance 7-fold. In the absence of a validated "flu score" to assess severity and assist triage decisions from primary into secondary care, current UK draft management recommendations have suggested the use of CURB-65 and chest X-ray as a proxy. We developed the Pandemic Medical Early Warning Score (PMEWS) to track and triage flu patients, taking into account physiological and social factors and without requiring laboratory or radiology services. METHODS: Validation of the PMEWS score against an unselected group of patients presenting and admitted to an urban UK teaching hospital with community acquired pneumonia. Comparison of PMEWS performance against CURB-65 for three outcome measures: need for admission, admission to high dependency or intensive care, and inpatient mortality using area under ROC curve (AUROC) and the Hanley-McNeil method of comparison. RESULTS: PMEWS was a better predictor of need for admission (AUROC 0.944) and need of higher level of care (AUROC 0.83) compared with CURB-65 (AUROCs 0.881 and 0.640 respectively) but was not as good a predictor of subsequent inpatient mortality (AUROC 0.663). CONCLUSION: Although further validation against other disease datasets as a proxy for pandemic flu is required, we show that PMEWS is rapidly applicable for triage of large numbers of flu patients to self-care, hospital admission or HDU/ICU care. It is scalable to reflect changing admission thresholds that will occur during a pandemic

Measuring moral distress and moral injury:A systematic review and content analysis of existing scales

BACKGROUND: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.METHOD: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale.RESULTS: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.CONCLUSIONS: Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.</p

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries

This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors

Palmitoylethanolamide exerts neuroprotective effects in mixed neuroglial cultures and organotypic hippocampal slices via peroxisome proliferator-activated receptor-α

<p>Abstract</p> <p>Background</p> <p>In addition to cytotoxic mechanisms directly impacting neurons, β-amyloid (Aβ)-induced glial activation also promotes release of proinflammatory molecules that may self-perpetuate reactive gliosis and damage neighbouring neurons, thus amplifying neuropathological lesions occurring in Alzheimer's disease (AD). Palmitoylethanolamide (PEA) has been studied extensively for its anti-inflammatory, analgesic, antiepileptic and neuroprotective effects. PEA is a lipid messenger isolated from mammalian and vegetable tissues that mimics several endocannabinoid-driven actions, even though it does not bind to cannabinoid receptors. Some of its pharmacological properties are considered to be dependent on the expression of peroxisome proliferator-activated receptors-α (PPARα).</p> <p>Findings</p> <p>In the present study, we evaluated the effect of PEA on astrocyte activation and neuronal loss in models of Aβ neurotoxicity. To this purpose, primary rat mixed neuroglial co-cultures and organotypic hippocampal slices were challenged with Aβ_1-42and treated with PEA in the presence or absence of MK886 or GW9662, which are selective PPARα and PPARγ antagonists, respectively. The results indicate that PEA is able to blunt Aβ-induced astrocyte activation and, subsequently, to improve neuronal survival through selective PPARα activation. The data from organotypic cultures confirm that PEA anti-inflammatory properties implicate PPARα mediation and reveal that the reduction of reactive gliosis subsequently induces a marked rebound neuroprotective effect on neurons.</p> <p>Conclusions</p> <p>In line with our previous observations, the results of this study show that PEA treatment results in decreased numbers of infiltrating astrocytes during Aβ challenge, resulting in significant neuroprotection. PEA could thus represent a promising pharmacological tool because it is able to reduce Aβ-evoked neuroinflammation and attenuate its neurodegenerative consequences.</p

The Evolution of Host Specialization in the Vertebrate Gut Symbiont Lactobacillus reuteri

Recent research has provided mechanistic insight into the important contributions of the gut microbiota to vertebrate biology, but questions remain about the evolutionary processes that have shaped this symbiosis. In the present study, we showed in experiments with gnotobiotic mice that the evolution of Lactobacillus reuteri with rodents resulted in the emergence of host specialization. To identify genomic events marking adaptations to the murine host, we compared the genome of the rodent isolate L. reuteri 100-23 with that of the human isolate L. reuteri F275, and we identified hundreds of genes that were specific to each strain. In order to differentiate true host-specific genome content from strain-level differences, comparative genome hybridizations were performed to query 57 L. reuteri strains originating from six different vertebrate hosts in combination with genome sequence comparisons of nine strains encompassing five phylogenetic lineages of the species. This approach revealed that rodent strains, although showing a high degree of genomic plasticity, possessed a specific genome inventory that was rare or absent in strains from other vertebrate hosts. The distinct genome content of L. reuteri lineages reflected the niche characteristics in the gastrointestinal tracts of their respective hosts, and inactivation of seven out of eight representative rodent-specific genes in L. reuteri 100-23 resulted in impaired ecological performance in the gut of mice. The comparative genomic analyses suggested fundamentally different trends of genome evolution in rodent and human L. reuteri populations, with the former possessing a large and adaptable pan-genome while the latter being subjected to a process of reductive evolution. In conclusion, this study provided experimental evidence and a molecular basis for the evolution of host specificity in a vertebrate gut symbiont, and it identified genomic events that have shaped this process

A Delphi assessment of climate change risks in southern Africa in the 21st century

DATA AVAILABILITY : Data will be made available on request.Climate change is acknowledged as one of the greatest environmental and development challenges society faces. Many organisations are now encouraged to conduct assessments of the climate risks they will be exposed to over the next decades. The Global Change Institute (University of Witwatersrand, South Africa) conducted such an assessment for the southern Africa region, to identify some of the main clusters of climate-change related risks. A list of over fifty risks was scored and ranked using a modified-Delphi process; an iterative process of expert-driven risk identification and ranking that was informed from our collective experience and the literature. We focused on the likelihood and consequence in the mid-term (2041–2060) and scored each risk according to this time frame (risk score = [likelihood of event occurring] × [the impact of the event], moderated by the multiple lines of evidence available (Evidence confidence), and the expert rankings of the assessors (Scorer confidence)), using the assumption of the IPCC RCP8.5 climate scenario. The top quartile was organized into five clusters of risk: food insecurity; water shortages; failed energy transition; human heat stress; and risks to nature and the bioeconomy. This paper describes these risk clusters, explored through the lens of available literature, and analysed within the broader framework of the sustainable development goals (SDGs), and the individual and collective actions that can be taken to reduce or adapt to these risks. There are many technical solutions to these risks, but these typically are costly and only function up to a point where the risks become unmanageable. For solutions to be successful, a ‘systems view’ and the complex interlinkages between climate change and socio-economic development must be addressed. The interconnected and cross-sectoral nature of the climate risk domains certainly presents a challenge for governance; the success of some of the measures discussed in this paper depends on the existence of strong, well-resourced, well-coordinated and influential governance mechanisms and state institutions and focusing on investigating the many synergies that exist among solutions.The Carnegie Corporation of New York (Next Generation of African Scholars programme), awarded to the Global Change Institute, University of the Witwatersrand; the Jennifer Ward Oppenheimer Research Grant and the National Research Foundation (NRF) Global Change Social Science Research Programme.http://www.elsevier.com/locate/crmam2024Geography, Geoinformatics and MeteorologyZoology and EntomologySDG-13:Climate actio