Macrophage Extracellular Trap Formation in Response to M. Haemolytica or its Leukptoxin is altered by Co-Incubation with Bovine Herpes Virus-1 Infected Bronchiolar Epithelial Cells

Bovine respiratory disease (BRD) is the primary cause of morbidity in the U.S. beef and dairy industry. BRD is a multifactorial disease that is caused by viral and bacterial agents leading to a severe pleuropneumonia in cattle. BRD is characterized by inflammation, intense neutrophil infiltration, consolidation and recently, extensive amounts of extracellular DNA in the lungs. One possible source of the DNA is from leukocytes that release fibrillar networks of antimicrobial protein-studded DNA matrices referred to as extracellular traps (ETs). Recently, we have demonstrated that neutrophils and macrophages produce ETs in response to Mannheimia haemolytica, an important member of the BRD complex. Previous data has demonstrated that conditioned media removed from bovine herpes virus (BHV)-1 infected bovine bronchiolar epithelial (BBE) cells contain several cytokines. Here, we examined if conditioned media from BHV-1 infected BBE cells could alter ET formation from bovine neutrophils and macrophages. We observed that bovine macrophages pre-incubated with conditioned media from BHV-1 infected BBE cells had a reduced ability to produce ETs when incubated with the leukotoxin (LKT) in comparison to the control macrophages pre-incubated with conditioned media from uninfected BBE cells. In contrast, we observed that bovine macrophages treated with conditioned media demonstrated an increase in ET formation in response to intact M. haemolytica cells. However, conditioned media-treated bovine neutrophils were unaltered in their ability to produce ETs in response to M. haemolytica or LKT. Our findings suggest that BHV infection may alter macrophage production of ETs in response to M. haemolytica or LKT, which could alter host defense

Feasibility of Using Saltcedar as a Filler in Injection-Molded Polyethylene Composites

Saltcedar (Tamarix ramosissima) was investigated for use as a filler in wood-plastic composites (WPCs). The mineral content, water-soluble extractive content, and thermal stability of saltcedar flour were compared with those of a commercial pine wood flour. The wood flours were compounded with plastic, and the viscosities of the composite melts containing the two species were compared. Injection-molded composites produced from the compounded material were evaluated for mechanical performance and weatherability. Saltcedar flour had more minerals and water-soluble extractives than pine flour, which resulted in lower thermal stability, but also lower melt viscosity when compounded with high-density polyethylene. Injection-molded WPCs made from unextracted saltcedar performed similarly to those made from pine in accelerated weathering tests, but their mechanical properties were generally lower. The flexural modulus of elasticity increased when extracted wood flour was used, especially for the saltcedar composites. However, color stability and flexural strength changed little. Producing WPCs from these composites is possible, although economically feasible applications that use the advantageous properties of these species and that can tolerate or address the less desirable ones need to be identified and demonstrated

On-scene discharge by Emergency Care Practitioners – a viable option for South Africa?

Background: In South Africa, the national public health sector provides healthcare to the majority of the population, yet many hospitals are in a state of crisis. On-scene discharge or patient non-conveyance to hospital by Emergency Care Practitioners (ECP) may serve as a means for patients to access healthcare services while alleviating the burden on the hospitals. Aim: The aim of this study was to determine the number of patients being transported by ambulance to a public sector Emergency Department (ED) who could have potentially been managed and discharged on-scene by a South African pre-hospital ECP. Methods: This was a prospective, descriptive and quantitative study of patients brought to the ED by ambulance over a 72-hour weekend period. The medical care that was provided in the ED was compared to the existing ECP scope of practice. The patients’ disposition was also used as a surrogate to determine whether transportation to hospital was required.Results: A total of 118 patients were transported to the ED by ambulance, and 85 of these patients consented to participate in the study. Overall, 62.4% of these patients were ultimately discharged from the hospital (60.4% of discharged patients being trauma-related). Most of the treatment modalities prescribed for the discharged patients were within the ECP scope of practice.Conclusion: Pre-hospital on-scene discharge by ECPs may be a mechanism to alleviate hospital overcrowding in a failing public healthcare system. However, if an ambulance service condones the concept of on-scene discharge, they need to implement monitoring strategies to assess the subsequent outcomes for those patients discharged at the scene

Utility of FMS to Understand Injury Incidence in Sports: Current Perspectives

The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen

The cost-effectiveness of upfront point-ofcare testing in the emergency department : a secondary analysis of a randomised, controlled trial

Abstract: Background: Time-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the timesaving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints. Methods: This was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost- Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account. Results: There were 897 medical patients randomised to receive various combinations of POC tests. The most costeffective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical. Conclusions: In certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations – the most economical POC test combination being the i- STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money

Angiotensin II-Induced Hypertension in Apolipoprotein E-Deficient Rats

Abdominal aortic aneurysms (AAAs) are characterized by a weakened vessel wall and a diameter 50% greater than normal. AAA are usually asymptomatic until they are near rupturing, which can be fatal if not treated immediately. Apolipoprotein E-deficient (ApoE) mice are commonly used as a model to study aneurysm growth. Our lab has created a similar model using rats, which are more similar to humans. This study focuses on the analysis of blood pressures collected from ApoE rats for comparison with a known mouse model. Five ApoE rats (1 female, 4 males) received subcutaneous implants of osmotic mini pumps that released a continuous flow of angiotensin II (AngII) at 200 ng/kg/min. AngII is a protein known to increase blood pressure by acting on the renin-angiotensin system. Systolic, diastolic, and mean arterial pressures were measured using a non-invasive tail cuff system (CODA, Kent Scientific). Measurements were taken before pump implantation and on days 3, 7, 14, 21, and 28 after implantation. Mean arterial pressure increased from 133.8 ± 21.2 mmHg before pump implantation to 169.4 ± 20.3 mmHg on day 28. Systolic and diastolic pressures rose in a similar manner. Although the blood pressure increased in a manner similar to the mice, no aneurysms were observed in any of the rats. This may be due to species differences that affect vessel thickness and metabolic rate. Further investigations will be needed to determine why ApoE rats become hypertensive due to AngII, but do not develop suprarenal dissecting aortic aneurysms

Implementation of a Single-Patient-Use Airway Taping Product in the Operating Room

BACKGROUND: Anesthesia providers use adhesive tape to secure advanced airway devices. Rolls of adhesive tape serve as reservoirs for pathogens. Rolls of tape do not have instructions on how they are to be reused, cannot be disinfected, and should not be repurposed. The re-use of rolls of tape poses a risk to patient safety. LOCAL PROBLEM: The project facility was an academic medical center in the Southeast region of the United States. The facility does not have taping practice guidelines in place. Rolls of tape are handled without gloves, used by several providers, placed on multiple patients’ faces, and stored in areas that are not routinely cleaned. The purpose of this evidence-based practice quality improvement project was to implement a single-patient-use taping product for anesthesia providers to utilize when securing advanced airways. The AIM was: After six weeks of implementation of a single-patient-use taping product in the main operating rooms of the facility, 60% of providers will report satisfaction and compliance with the new taping product. METHODS: The Evidence-Based Practice Improvement model was used to outline this project. The measured outcomes were anesthesia provider satisfaction and compliance with the single-patient-use taping product, which was evaluated by a questionnaire. INTERVENTIONS: A single-patient-use taping product was distributed to anesthesia providers to secure advanced airway devices perioperatively. Providers then completed a questionnaire designed to assess their satisfaction and compliance with the product. RESULTS: The project AIM for satisfaction and compliance were met as 61% of anesthesia providers agreed that they would continue using the product if available, and 61% of providers were satisfied with the product. CONCLUSIONS: Anesthesia providers were satisfied and compliant with the product. Incorporating a single-patient-use product aligns with accrediting agencies’ strategic goals and priorities and allows anesthesia providers to increase patient safety. To sustain product use, the facility would need to continue to purchase the product at non-educational pricing

Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa : a prospective study

Abstract: Introduction: Normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa. Methods: Core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming. Results: Seventy-two (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. Twenty-nine (21%) the cases were considered clinically hypothermic (core temperatures of less than <35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming. Conclusion: Fifty-one percent of the trauma cases arriving by ambulance had core temperature <36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances