Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma

Background Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes. Methods All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P\u3c0.05 considered statistically significant. Results Sternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group. Conclusions Hemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring. Level of evidence Therapeutic study, level IV

Orion Rendezvous, Proximity Operations, and Docking Design and Analysis

The Orion vehicle will be required to perform rendezvous, proximity operations, and docking with the International Space Station (ISS) and the Earth Departure Stage (EDS)/Lunar Landing Vehicle (LLV) stack in Low Earth Orbit (LEO) as well as with the Lunar Landing Vehicle in Low Lunar Orbit (LLO). The RPOD system, which consists of sensors, actuators, and software is being designed to be flexible and robust enough to perform RPOD with different vehicles in different environments. This paper will describe the design and the analysis which has been performed to date to allow the vehicle to perform its mission. Since the RPOD design touches on many areas such as sensors selection and placement, trajectory design, navigation performance, and effector performance, it is inherently a systems design problem. This paper will address each of these issues in order to demonstrate how the Orion RPOD has been designed to accommodate and meet all the requirements levied on the system

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Objective To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study

Characterization of the nodulation plasmid encoded chemoreceptor gene mcpG from Rhizobium leguminosarum

BACKGROUND: In general, chemotaxis in Rhizobium has not been well characterized. Methyl accepting chemotaxis proteins are sensory proteins important in chemotaxis of numerous bacteria, but their involvement in Rhizobium chemotaxis is unclear and merits further investigation. RESULTS: A putative methyl accepting chemotaxis protein gene (mcpG) of Rhizobium leguminosarum VF39SM was isolated and characterized. The gene was found to reside on the nodulation plasmid, pRleVF39d. The predicted mcpG ORF displayed motifs common to known methyl-accepting chemotaxis proteins, such as two transmembrane domains and high homology to the conserved methylation and signaling domains of well-characterized MCPs. Phenotypic analysis of mcpG mutants using swarm plates did not identify ligands for this putative receptor. Additionally, gene knockouts of mcpG did not affect a mutant strain's ability to compete for nodulation with the wild type. Notably, mcpG was found to be plasmid-encoded in all strains of R. leguminosarum and R. etli examined, though it was found on the nodulation plasmid only in a minority of strains. CONCLUSIONS: Based on sequence homology R. leguminosarum mcpG gene codes for a methyl accepting chemotaxis protein. The gene is plasmid localized in numerous Rhizobium spp. Although localized to the sym plasmid of VF39SM mcpG does not appear to participate in early nodulation events. A ligand for McpG remains to be found. Apparent McpG orthologs appear in a diverse range of proteobacteria. Identification and characterization of mcpG adds to the family of mcp genes already identified in this organism

Integrated spatial multiplexing of heralded single photon sources

The non-deterministic nature of photon sources is a key limitation for single photon quantum processors. Spatial multiplexing overcomes this by enhancing the heralded single photon yield without enhancing the output noise. Here the intrinsic statistical limit of an individual source is surpassed by spatially multiplexing two monolithic silicon correlated photon pair sources, demonstrating a 62.4% increase in the heralded single photon output without an increase in unwanted multi-pair generation. We further demonstrate the scalability of this scheme by multiplexing photons generated in two waveguides pumped via an integrated coupler with a 63.1% increase in the heralded photon rate. This demonstration paves the way for a scalable architecture for multiplexing many photon sources in a compact integrated platform and achieving efficient two photon interference, required at the core of optical quantum computing and quantum communication protocols.Comment: 10 pages, 3 figures, comments welcom

Subsonic and Transonic Wind Tunnel Testing of Two Inflatable Aerodynamic Decelerators

Two inflatable aerodynamic decelerator designs were tested in the Transonic Dynamics Tunnel at the NASA Langley Research Center: a tension cone and an isotensoid. The tension cone consists of a flexible tension shell attached to a torus and the isotensoid employs a ram-air inflated envelope. Tests were conducted at Mach numbers from 0.3 to 1.08 and Reynolds numbers from 0.59 to 2.46 million. The main objective of these tests was to obtain static aerodynamic coefficients at subsonic and transonic speeds to supplement supersonic aerodynamic data for these same two designs. The axial force coefficients of both designs increased smoothly from subsonic through transonic Mach numbers. Dynamic data show significant oscillation of the tension cone and minimal oscillation of the isotensoid. The transonic and subsonic data will be used to assemble an inflatable decelerator aerodynamic database for use in computational analyses and system studies

Attention and motor profiles in children with developmental coordination disorder: A neuropsychological and neuroimaging investigation

AIM: This study aimed to (1) quantify attention and executive functioning in children with developmental coordination disorder (DCD), (2) assess whether some children with DCD are more likely to show attention difficulties, and (3) characterize brain correlates of motor and attention deficits. METHOD: Fifty-three children (36 with DCD and 17 without) aged 8 to 10 years underwent T1-weighted and diffusion-weighted magnetic resonance imaging, and standardized attention and motor assessments. Parents completed questionnaires of executive functioning and symptoms of inattention and hyperactivity. We assessed regional cortical thickness and surface area, and cerebellar, callosal, and primary motor tract structure. RESULTS: Analyses of covariance and one-sample t-tests identified impaired attention, non-motor processing speed, and executive functioning in children with DCD, yet partial Spearman's rank correlation coefficients revealed these were unrelated to one another or the type or severity of the motor deficit. Robust regression analyses revealed that cortical morphology in the posterior cingulate was associated with both gross motor skills and inattentive symptoms in children with DCD, while gross motor skills were also associated with left corticospinal tract (CST) morphology. INTERPRETATION: Children with DCD may benefit from routine attention and hyperactivity assessments. Alterations in the posterior cingulate and CST may be linked to impaired forward modelling during movements in children with DCD. Overall, alterations in these regions may explain the high rate of non-motor impairments in children with DCD

The Protostellar Mass Function

The protostellar mass function (PMF) is the Present-Day Mass Function of the protostars in a region of star formation. It is determined by the initial mass function weighted by the accretion time. The PMF thus depends on the accretion history of protostars and in principle provides a powerful tool for observationally distinguishing different protostellar accretion models. We consider three basic models here: the Isothermal Sphere model (Shu 1977), the Turbulent Core model (McKee & Tan 2003), and an approximate representation of the Competitive Accretion model (Bonnell et al. 1997, 2001a). We also consider modified versions of these accretion models, in which the accretion rate tapers off linearly in time. Finally, we allow for an overall acceleration in the rate of star formation. At present, it is not possible to directly determine the PMF since protostellar masses are not currently measurable. We carry out an approximate comparison of predicted PMFs with observation by using the theory to infer the conditions in the ambient medium in several star-forming regions. Tapered and accelerating models generally agree better with observed star-formation times than models without tapering or acceleration, but uncertainties in the accretion models and in the observations do not allow one to rule out any of the proposed models at present. The PMF is essential for the calculation of the Protostellar Luminosity Function, however, and this enables stronger conclusions to be drawn (Offner & McKee 2010).Comment: 16 pages, 8 figures, published in Ap

Promoter effects of alkali metal cations on the electrochemical reduction of carbon dioxide

The electrochemical reduction of CO_2 is known to be influenced by the identity of the alkali metal cation in the electrolyte; however, a satisfactory explanation for this phenomenon has not been developed. Here we present the results of experimental and theoretical studies aimed at elucidating the effects of electrolyte cation size on the intrinsic activity and selectivity of metal catalysts for the reduction of CO_2. Experiments were conducted under conditions where the influence of electrolyte polarization is minimal in order to show that cation size affects the intrinsic rates of formation of certain reaction products, most notably for HCOO–, C_2H_4, and C_2H_5OH over Cu(100)- and Cu(111)-oriented thin films, and for CO and HCOO– over polycrystalline Ag and Sn. Interpretation of the findings for CO_2 reduction was informed by studies of the reduction of glyoxal and CO, key intermediates along the reaction pathway to final products. Density functional theory calculations show that the alkali metal cations influence the distribution of products formed as a consequence of electrostatic interactions between solvated cations present at the outer Helmholtz plane and adsorbed species having large dipole moments. The observed trends in activity with cation size are attributed to an increase in the concentration of cations at the outer Helmholtz plane with increasing cation size