Traumatismo cerebrovascular contuse

Over the past decade, the recognition and subsequent management of blunt cerebrovascular injuries has undergone a marked evolution. Originally thought to be a rare occurrence, blunt cerebrovascular injuries are now diagnosed in approximately 1% of blunt trauma patients. The recognition of a clinically silent period allows for angiographic screening for injuries based upon the mechanism of trauma and the patient's constellation of injuries. Comprehensive screening of patients has resulted in the early diagnosis of blunt cerebrovascular injuries during the asymptomatic phase, thus allowing treatment that could prevent neurologic sequelae. Although the ideal regimen of antithrombotic therapy is yet to be determined, treatment with either antiplatelet or anticoagulant agents has been shown to reduce the blunt cerebrovascular injuries related stroke rate. Blunt cerebrovascular injury is a rare but potentially devastating injury; appropriate angiographic screening in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.Durante a década passada, o reconhecimento e tratamento do traumatismo cerebrovascular contuso, sofreu importante evolução. Este tipo de ferimento era considerado como ocorrência rara, mas atualmente o quadro é diagnosticado em cerca de 1% dos pacientes. O reconhecimento da existência de um período clínico silencioso permite uma seleção angiográfica baseada no mecanismo de trauma e na sistematização dos ferimentos dos pacientes. A avaliação sistemática e a suspeita diagnóstica precoce destes pacientes tem resultado em rápido confirmação durante a fase assintomática, permitindo a instauração de tratamento cuja meta é impedir o desenvolvimento de seqüelas neurológicas. Embora o tratamento ideal, antitrombótico, ainda precise ser determinado, o uso de agentes antiplaquetários ou anticoagulantes reduz a incidência de lesões cerebrovasculares relacionada a fenômenos tromboembolíticos. O traumatismo cerebrovascular contuso é raro, porém devastador. A seleção angiográfica apropriada em pacientes de alto risco deve ser realizada e o tratamento deve ser imediatamente iniciado para impedir eventos neurológicos isquêmicos

Development of a Method for Evaluating the Yield Goal Approach

Yield goals have been used to determine N recommendations in South Dakota, North Dakota, and western Minnesota. However, some states, such as Wisconsin and Iowa have eliminated yield goals from N recommendations because of poor correlation between yield and economically optimum N rates. The objective of this study was to determine the feasibility of switching from a yield goal approach to a non-yield goal approach in South Dakota. Field experiments were conducted in Aurora, South Dakota between 2002 and 2003. Treatments were natural rainfall and natural rainfall + irrigation and four N rates (0, 60, 120, 180 kg N /ha). Plant samples were analyzed for 13C discrimination (Δ) and total N. Research results showed that; (i) adding N rates increased yield and Δ; (ii) applying supplemental irrigation increased yield and decreased Δ; (iii) yields were not influenced by an interaction between water and nitrogen; and (iv) δ15N values increased with irrigation and decreased with increasing N. These results suggest that nitrogen and water stress had independent impact on yield, and irrigation increased N mineralization. These findings partially support the hypothesis that fertilizer rates should be independent of yield goal. Research needs to be conducted to determine the long term impact of changing the recommendation approach on soil N levels

Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes

In the past three decades there has been a significant clinical shift in the performance of emergency department thoracotomy (EDT), from a nearly obligatory procedure before declaring any trauma patient to select patients undergoing EDT. The value of EDT in resuscitation of the patient in profound shock but not yet dead is unquestionable. Its indiscriminate use, however, renders it a low-yield and high-cost procedure. Overall analysis of the available literature indicates that the success of EDT approximates 35% in the patient arriving in shock with a penetrating cardiac wound, and 15% for all penetrating wounds. Conversely, patient outcome is relatively poor when EDT is done for blunt trauma; 2% survival in patients in shock and less than 1% survival with no vital signs. Patients undergoing CPR upon arrival to the emergency department should be stratified based upon injury and transport time to determine the utility of EDT. The optimal application of EDT requires a thorough understanding of its physiologic objectives, technical maneuvers, and the cardiovascular and metabolic consequences

Do Synergistic Relationships between Nitrogen and Water Influence the Ability of Corn to Use Nitrogen Derived from Fertilizer and Soil?

To improve site-specific N recommendations a more complete understanding of the mechanisms responsible for synergistic relationships between N and water is needed. Th e objective of this research was to determine the influence of soil water regime on the ability of corn (Zea mays L.) to use N derived from fertilizer and soil. A randomized split-block experiment was conducted in 2002, 2003, and 2004. Soil at the site was a Brandt silty clay loam (fine-silty, mixed, superactive frigid Calcic Hapludoll). Blocks were split into moderate (natural rainfall) and high (natural + supplemental irrigation) water regimes. Nitrogen rates were 0, 56, 112, and 168 kg urea-N ha–1 that was surface applied. Water, soil N, and N fertilizer use efficiencies were determined. Plant utilization of soil N was determined by mass balance in the unfertilized control plots and by using the δ15N approach in fertilized plots. Findings showed that: (i) plants responded to N and water simultaneously; (ii) N fertilizer increased water use efficiency (170 kg vs. 223 kg grain cm–1 in 0 and 112 kg N ha–1 treatments, respectively); and (iii) water increased the ability of corn to use N derived from soil (67.7 and 61.6% efficient in high and moderate water regimes, respectively, P = 0.002) and fertilizer (48 and 44% efficient in high and moderate water regimes, respectively, P = 0.10). Higher N use efficiency in the high water regime was attributed to two interrelated factors. First, total growth and evapotranspiration (ET) were higher in the high than the moderate water regime. Second, N transport to the root increased with water transpired. For precision farming, results indicate that: (i) the amount of N fertilizer needed to produce a kg of grain is related to the yield loss due to water stress; and (ii) the rate constant used in yield goal equations can be replaced with a variable

Precision Farming Protocols. Part 2. Comparison of Sampling Approaches for Precision Phosphorus Management

Research is needed to compare the different techniques for developing site‐specific phosphorus (P) recommendations on a field‐wide basis. The objective of this study was to determine the impact different techniques for developing site‐specific P recommendation maps on yield and profitability. Enterprise analysis combined with a crop simulation model and detailed field characterization was used to estimate the value of spatial P information in a system where N was not limiting. The systems evaluated were continuous corn (Zea mays) and corn and soybean (Gfycine max) rotations where sampling and fertilizer applications were applied annually and semi‐annually, respectively. The sampling techniques tested were: (i) an unfertilized P control; (ii) whole field; (iii) whole field plus historic information (feedlot); (iv) landscape positions; (v) soil type; (vi) soil type plus historic information (feedlot); and (vii) 90‐m grid sampling. The finding of this study were based on soil samples collected from a 30 by 30‐m grid. The value of the spatial information was dependent on the crops response to P, the accuracy of the different sampling techniques, crop rotation, and the length of time between sampling dates. All of the sampling techniques produced different application maps. The recommendation map based on a single composite sample under fertilized 56.5% of the field. Increasing the sampling density reduced the percentage of under‐fertilized land. If corn had a low P response, then simulation/enterprise analysis indicated that applying P did not increased profits. For all scenarios tested: (i) the soil type + historic sampling approach had higher potential profits than the 90 m grid sampling approach; and (ii) there was no economic benefit associated with the 90‐m grid sampling. However, if research shows that amortization of sampling and analysis costs over 3 or 4 years is appropriate, then it may be possible to derive economic benefit from a 90‐m grid sampling. For a corn/soybean rotation, where fertilizer was applied when corn was planted and N and P was not applied to soybeans, enterprise/ simulation analysis (2.8 Mg ha‐1 soybean yield goal and a moderate P model) showed that soil + historic sampling approach increased profitability $3.74 ha‐1 when compared to the uniform P treatment

Great Plains Soils May be C Sinks

Numerous studies with wide-ranging results have been conducted to resolve if Great Plains soils are a C source or sink. The authors addressed the source/sink question by examining the results from producer soil samples and production surveys that were analyzed and archived by the South Dakota Soil Testing Laboratory. Results showed that between 1985 and 2010, soil organic C content increased at a rate of 326 lb C/A/year, for a total increase of 24%. The increase was attributed to planting better adapted varieties and using better management practices that on average increased corn grain yields 2.29 bu/A/year. Higher soil organic C has impacts on water quality, soil productivity, and plant nutrition. For example, if we assume that the C:N ratio of organic matter is 10:1, then these findings would indicate that soils during this 25-year period were a sink for both C and N, and could have influenced the N needed to optimize crop yields

Theoretical Derivation of Stable and Nonisotopic Approaches for Assessing Soil Organic Carbon Turnover

Techniques for measuring soil organic C (SOC) turnover in production fields are needed. The objectives of this study were to propose and test nonisotopic and 13 C stable isotopic techniques for assessing SOC turnover. Based on SOC equilibrium and mass balance relationships, an equation was derived: NHC/SOC initial=[1/(SOC× k NHC)](dSOC/dt)+ k SOC/k NHC, where dSOC/dt is the annual change in SOC, NHC is nonharvested C returned to soil, k SOC is the annual mineralization rate of SOC, and k NHC is the annual mineralization rate of NHC. This equation was used to calculate maintenance rates. An isotopic approach based on simultaneously solving the equations was developed to determine C budgets:(i) SOC retained=[SOC final (Δ soil final− Δ PCR)/(Δ SOCretained− Δ PCR)];(ii) Δ SOC retained= Δ soc initial−[ε ln (SOC retained/SOC initial)],(iii) Δ PCR= Δ NHC−[ε ln (PCR/NHC)]; and (iv) SOC fina