Vascular pedicle width in acute lung injury: correlation with intravascular pressures and ability to discriminate fluid status

Abstract Introduction Conservative fluid management in patients with acute lung injury (ALI) increases time alive and free from mechanical ventilation. Vascular pedicle width (VPW) is a non-invasive measurement of intravascular volume status. The VPW was studied in ALI patients to determine the correlation between VPW and intravascular pressure measurements and whether VPW could predict fluid status. Methods This retrospective cohort study involved 152 patients with ALI enrolled in the Fluid and Catheter Treatment Trial (FACTT) from five NHLBI ARDS (Acute Respiratory Distress Syndrome) Network sites. VPW and central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) from the first four study days were correlated. The relationships between VPW, positive end-expiratory pressure (PEEP), cumulative fluid balance, and PAOP were also evaluated. Receiver operator characteristic (ROC) curves were used to determine the ability of VPW to detect PAOP <8 mmHg and PAOP ≥18 mm Hg. Results A total of 71 and 152 patients provided 118 and 276 paired VPW/PAOP and VPW/CVP measurements, respectively. VPW correlated with PAOP (r = 0.41; P < 0.001) and less well with CVP (r = 0.21; P = 0.001). In linear regression, VPW correlated with PAOP 1.5-fold better than cumulative fluid balance and 2.5-fold better than PEEP. VPW discriminated achievement of PAOP <8 mm Hg (AUC = 0.73; P = 0.04) with VPW ≤67 mm demonstrating 71% sensitivity (95% CI 30 to 95%) and 68% specificity (95% CI 59 to 75%). For discriminating a hydrostatic component of the edema (that is, PAOP ≥18 mm Hg), VPW ≥72 mm demonstrated 61.4% sensitivity (95% CI 47 to 74%) and 61% specificity (49 to 71%) (area under the curve (AUC) 0.69; P = 0.001). Conclusions VPW correlates with PAOP better than CVP in patients with ALI. Due to its only moderate sensitivity and specificity, the ability of VPW to discriminate fluid status in patients with acute lung injury is limited and should only be considered when intravascular pressures are unavailable

Evaluation of the Workplace Environment in the UK, and the Impact on Users’ Levels of Stimulation

The purpose of this study is to evaluate a number of recently completed workplaces in the UK. The first aim is to assess the impact of various aspects of the workplace environment on users’ levels of stimulation. The body of previous research undertaken into the workplace environment, identified the aspects to be investigated. Samples of employees from the sixteen businesses were surveyed to determine their perceptions of the workplaces. The results were entered into a regression analysis, and the most significant predictors of perceived stimulation identified. The data also revealed a dramatic reduction in staff arousal levels from mornings to afternoons. Thus, there is a second aim to determine whether changes to significant aspects of the workplace environment during the day can counteract the reduction in users’ stimulation. Two further workplaces were studied to enable changes to be made over a 12-week period. A sample of employees completed questionnaires, and semi-structured interviews revealed the reasons behind the results. It was found that provision of artwork, personal control of temperature and ventilation and regular breaks were the most significant contributions to increasing stimulation after lunch; while user choice of layout, and design and décor of workspaces and break areas, were the most significant aspects at design stage

Announcing the Minderoo - Monaco Commission on Plastics and Human Health.

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Landrigan, P., Raps, H., Symeonides, C., Chiles, T., Cropper, M., Enck, J., Hahn, M., Hixson, R., Kumar, P., Mustapha, A., Park, Y., Spring, M., Stegeman, J., Thompson, R., Wang, Z., Wolff, M., Yousuf, A., & Dunlop, S. Announcing the Minderoo – Monaco Commission on Plastics and Human Health. Annals of Global Health, 88(1), (2022): 73, https://doi.org/10.5334/aogh.3916.Plastic is the signature material of our age. In the 75 years since large-scale production began in the aftermath of World War II, plastic has transformed our world, supported many of the most significant advances of modern civilization, and enabled breakthroughs in virtually every field of human endeavor. But plastic also poses great and growing dangers to human health and the environment, harms that fall disproportionately on the world’s poorest and most vulnerable populations. The extent and magnitude of these dangers are only beginning to be understood.The funding is from the Minderoo Foundation, the Centre Scientifique de Monaco, and the Prince Albert II of Monaco Foundation

Primary pericardial malignant mesothelioma and response to radiation therapy

We report a case of a primary pericardial malignant mesothelioma. A 59-year-old male presented with episodic chest pain and dyspnea on exertion. Cardiac magnetic resonance imaging revealed a large mass in the pericardium attached to the right ventricle. Partial resection of the mass was undertaken revealing malignant mesothelioma, byphasic type. The patient was treated with chemotherapy intermittently over a period of 3 years, but his disease continued to progress. The patient was then treated with definitive radiation therapy to 64 Gy to the primary tumor using a six field 3D conformal technique. The patient remains free of progressive disease 86 months from the time of diagnosis and 50 months from the completion of his radiotherapy

Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases

The purpose of this study was to determine the image quality and diagnostic accuracy of three-dimensional (3D) unenhanced steady state free precession (SSFP) magnetic resonance angiography (MRA) for the evaluation of thoracic aortic diseases. Fifty consecutive patients with known or suspected thoracic aortic disease underwent free-breathing ECG-gated unenhanced SSFP MRA with non-selective radiofrequency excitation and contrast-enhanced (CE) MRA of the thorax at 1.5 T. Two readers independently evaluated the two datasets for image quality in the aortic root, ascending aorta, aortic arch, descending aorta, and origins of supra-aortic arteries, and for abnormal findings. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were determined for both datasets. Sensitivity, specificity, and diagnostic accuracy of unenhanced SSFP MRA for the diagnosis of aortic abnormalities were determined. Abnormal aortic findings, including aneurysm (n = 47), coarctation (n = 14), dissection (n = 12), aortic graft (n = 6), intramural hematoma (n = 11), mural thrombus in the aortic arch (n = 1), and penetrating aortic ulcer (n = 9), were confidently detected on both datasets. Sensitivity, specificity, and diagnostic accuracy of SSFP MRA for the detection of aortic disease were 100% with CE-MRA serving as a reference standard. Image quality of the aortic root was significantly higher on SSFP MRA (P < 0.001) with no significant difference for other aortic segments (P > 0.05). SNR and CNR values were higher for all segments on SSFP MRA (P < 0.01). Our results suggest that free-breathing navigator-gated 3D SSFP MRA with non-selective radiofrequency excitation is a promising technique that provides high image quality and diagnostic accuracy for the assessment of thoracic aortic disease without the need for intravenous contrast material

Caracterização e análise financeira do processo de extração de óleo de polpa de pequi no Cerrado brasileiro.

Resumo ? O presente estudo realizou caracterização e análise financeira do processo de extração de óleo de polpa de pequi, uma atividade secular de populações tradicionais do Território da Cidadania Alto Rio Pardo (MG). O estudo considerou os custos de insumos e de trabalho das sete etapas do processo produtivo, além da consideração dos riscos de contaminação de ferro no cozimento e na despolpa, mas desconsiderou a comparação entre o lucro obtido por hora de trabalho e o valor da diária de trabalho local, afinal, as relações capitalistas de produção não estão plenamente inseridas na realidade local. Entre as sete etapas analisadas, três apresentaram variações, sendo elas, a colheita (duas variáveis), cozimento (seis variáveis) e despolpa (quatro variáveis), resultando em 48 cenários hipotéticos de processos de extração. Entre eles, quatro combinações são recomendadas ao contexto de vida das famílias rurais locais (colheita na unidade de produção; cozimento no tacho de cobre ou na panela de alumínio; despolpa no engenho manual ou no engenho a motor) e uma combinação é mais adequada ao contexto dos processos agroindustriais coletivos presentes na região (colheita na unidade de produção; cozimento na panela de inox; despolpa no engenho a motor)

The first bite: Imaginaries, promotional publics and the laboratory grown burger

In this paper we analyse a 2013 press conference hosting the world’s first tasting of a laboratory grown hamburger. We explore this as a media event: an exceptional performative moment in which common meanings are mobilised and a connection to a shared centre of reality is offered. We develop our own theoretical contribution – the promotional public – to characterise the affirmative and partial patchwork of carefully selected actors invoked during the burger tasting. Our account draws upon three areas of analysis: interview data with the scientists who developed the burger, media analysis of the streamed press conference itself, and media analysis of the social media tail during and following the event. We argue that the call to witness an experiment is a form of promotion but that such promotional material also offers an address that invokes a public with its attendant tensions.The research leading to this publication has received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement number 288971 (EPINET). Neil Stephens’ involvement has also received the support of the Economic and Social Research Council (ESRC). His work is part of the Research Programme of the ESRC Genomics Network at Cesagen (ESRC Centre for Economic and Social Aspects of Genomics). Neil Stephens’ work was also supported by the Wellcome Trust (WT096541MA) and a visiting scholarship to CGS Centre for Society and Genomics in The Netherlands, May to July 2011. This support is gratefully acknowledge