Abdominal Compartment Syndrome: pathophysiology and definitions

"Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous system function. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. A thorough understanding of the pathophysiologic implications of elevated intra-abdominal pressure is fundamental to 1) recognizing the presence of intra-abdominal hypertension and abdominal compartment syndrome, 2) effectively resuscitating patients afflicted by these potentially life-threatening diseases, and 3) preventing the development of intra-abdominal pressure-induced end-organ dysfunction and failure. The currently accepted consensus definitions surrounding the diagnosis and treatment of intra-abdominal hypertension and abdominal compartment syndrome are presented

Kids Say the Darnedest Things: A Call for Adoption of a Statutory Parent-Child Confidential Communications Privilege in Response to Tougher Juvenile Sentencing Guidelines

This Comment addresses the need for a narrowly tailored, statutorily created privilege protecting confidential communications made to a parent by a child who is seeking advice or guidance and how crucial that privilege has become for today\u27s juveniles, who face tougher guidelines for juvenile sentencing and adult certification. Part II provides an overview of the historical background of the parent-child privilege and its current legal status, both at the state and federal levels. Part III explains how the get-tough legislation that has made juvenile courts parallel to adult courts, along with the movement to completely abolish juvenile courts, necessitates legislative approval of a parent-child privilege. Part IV discusses past proposals for parentchild privileges that have failed and proposes that the reason for their failure is that the proposals were overly broad. Finally, Part V proposes a narrowly tailored statute designed to protect only those confidential communications from the child to the parent when the child is seeking parental guidance or advice

A multi-sensor system for robotics proximity operations

Robots without sensors can perform only simple repetitive tasks and cannot cope with unplanned events. A multi-sensor system is needed for a robot to locate a target, move into its neighborhood and perform operations in contact with the object. Systems that can be used for such tasks are described

Executive functions and the ω-6-to-ω-3 fatty acid ratio: a cross-sectional study

BACKGROUND: The ω-6 (n-6) to ω-3 (n-3) fatty acid (FA) ratio (n-6:n-3 ratio) was previously shown to be a predictor of executive function performance in children aged 7-9 y. OBJECTIVE: We aimed to replicate and extend previous findings by exploring the role of the n-6:n-3 ratio in executive function performance. We hypothesized that there would be an interaction between n-3 and the n-6:n-3 ratio, with children with low n-3 performing best with a low ratio, and those with high n-3 performing best with a high ratio. DESIGN: Children were recruited on the basis of their consumption of n-6 and n-3 FAs. The executive function performance of 78 children aged 7-12 y was tested with the use of the Cambridge Neuropsychological Test Automated Battery and a planning task. Participants provided blood for plasma FA quantification, and the caregiver completed demographic and activity questionnaires. We investigated the role of the n-6:n-3 ratio in the entire sample and separately in children aged 7-9 y (n = 41) and 10-12 y (n = 37). RESULTS: Dietary and plasma n-6:n-3 ratio and n-3 predicted performance on working memory and planning tasks in children 7-12 y old. The interaction between dietary n-6:n-3 ratio and n-3 predicted the number of moves required to solve the most difficult planning problems in children aged 7-9 y and those aged 10-12 y, similar to results from the previous study. There was also an interaction between the plasma n-6:n-3 ratio and n-3 predicting time spent thinking through the difficult 5-move planning problems. The n-6:n-3 ratio and n-3 predicted executive function performance differently in children aged 7-9 y and in those aged 10-12 y, indicating different optimal FA balances across development. CONCLUSIONS: The n-6:n-3 ratio is an important consideration in the role of FAs in cognitive function, and the optimal balance of n-6 and n-3 FAs depends on the cognitive function and developmental period studied. This trial was registered at clinicaltrials.gov as NCT02199808

The Lawyer and the Private Legal Process

Private law--particular rules created for and applied to particular individuals to govern their relationships with each other--is a marked characteristic of society. People in a nation of free enterprise with a developing, malleable economy must have the freedom and the power to shape their legal relations with one another through the use of rules of law suited to their goals. Most of this law--contracts, wills, and trusts--has only temporary effect. The terms are limited, and all of it is for a private, rather than a public purpose. The limited scope of private law, however, is not a good measure of its influence. The private legal process as a part of our system of jurisprudence makes a great contribution to the social life. Many new forms of legal relations trace their origins not to the courts or to the legislature, but to a new kind of instrument first created in the lawyer\u27s office

Multiple cyclotron line-forming regions in GX 301-2

We present two observations of the high-mass X-ray binary GX 301-2 with NuSTAR, taken at different orbital phases and different luminosities. We find that the continuum is well described by typical phenomenological models, like a very strongly absorbed NPEX model. However, for a statistically acceptable description of the hard X-ray spectrum we require two cyclotron resonant scattering features (CRSF), one at ~35 keV and the other at ~50 keV. Even though both features strongly overlap, the good resolution and sensitivity of NuSTAR allows us to disentangle them at >=99.9% significance. This is the first time that two CRSFs are seen in GX 301-2. We find that the CRSFs are very likely independently formed, as their energies are not harmonically related and, if it were a single line, the deviation from a Gaussian shape would be very large. We compare our results to archival Suzaku data and find that our model also provides a good fit to those data. We study the behavior of the continuum as well as the CRSF parameters as function of pulse phase in seven phase bins. We find that the energy of the 35 keV CRSF varies smoothly as function of phase, between 30-38 keV. To explain this variation, we apply a simple model of the accretion column, taking the altitude of the line-forming region, the velocity of the in-falling material, and the resulting relativistic effects into account. We find that in this model the observed energy variation can be explained simply due to a variation of the projected velocity and beaming factor of the line forming region towards us.Comment: 18 pages, 10 figures, accepted for publication in A&

The Impact of Family Resilience Factors and Parent Gender on Stress Among Parents of Children with Autism

Parents of children with autism experience high degrees of stress. Research pertaining to the reduction of parental stress in families with a child with autism is needed. In this study, the relationship between family resilience, parent gender, and parental stress was examined. Seventy-one parents of young children with autism were surveyed. Regression and correlational analyses were performed. Results indicated that the vast majority of respondents reported significantly high levels of stress. Lower degrees of parental stress were correlated with higher degrees of family resilience. Family resiliency factors were significant contributors to the shared variance in parental stress. Mothers of children demonstrated higher levels of stress than fathers. Suggested explanations of these findings are presented and clinical and research implications are provided. The findings of this study provide evidence for the importance of facilitating family resilience for parents of children with autism and affirm differing stress levels between mothers and fathers

Mass casualty events: what to do as the dust settles?

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs

A clinician’s guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901