British Foreign Policy Under Canning

This paper is an examination of British foreign policy under the guidance of George Canning. As foreign minister from 1822-1827, Canning pursued a conservative and traditionally British policy. Canning was loved by liberals across Europe for achieving several liberal goals. Yet Canning himself was not interested in promoting liberalism, he sought only to further the interests of Britain. Canning worked to disentangle Britain from the Congress System, and pursue goals in the British national interest. The major focus of this work is to examine Canning’s policy during three major crises of his tenure. Each crisis involved revolution and ideology. Yet Canning promoted non-interference in the domestic affairs of other states. Canning tried to co-operate with the other powers over solutions to these problems, but was willing to forego his allies when they threatened policy objectives. By the end of his life, he had altered the balance of power in Europe to Britain’s favor. The first major crisis was over Revolution in Spain. Canning’s allies wanted to put down the revolution and restore the king. The Congress of Verona approved French intervention, over British objections. Canning successfully managed to protect British interests while preventing the war from escalating. Canning also worked to stabilize Portugal, as it faced its own political reform and civil war. The Spanish Empire in the Americas was reaching the end of a long process of gaining independence. Canning moved slowly but surely to recognize these new republics, and worked to prevent other European powers from seizing them. Canning recognized these new states and normalized relations with them. More importantly for Britain, Canning helped to ensure British commercial access to Latin America, helping to ensure a century of British economic control of the region. The final crisis centered on the Greek uprising against their Ottoman rulers. Canning remained neutral for much of the conflict. Yet when Russia seemed on the verge of war, Canning worked to intervene with Russia and France to impose a settlement on the Ottoman Empire. Ultimately, Canning’s treaty led to naval intervention and left the door open for Russia to go to war

Inhalation injury: epidemiology, pathology, treatment strategies

Lung injury resulting from inhalation of smoke or chemical products of combustion continues to be associated with significant morbidity and mortality. Combined with cutaneous burns, inhalation injury increases fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. While many products and techniques have been developed to manage cutaneous thermal trauma, relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury. Several factors explain slower progress for improvement in management of patients with inhalation injury. Inhalation injury is a more complex clinical problem. Burned cutaneous tissue may be excised and replaced with skin grafts. Injured pulmonary tissue must be protected from secondary injury due to resuscitation, mechanical ventilation and infection while host repair mechanisms receive appropriate support. Many of the consequences of smoke inhalation result from an inflammatory response involving mediators whose number and role remain incompletely understood despite improved tools for processing of clinical material. Improvements in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation. Morbidity associated with inhalation injury is produced by heat exposure and inhaled toxins. Management of toxin exposure in smoke inhalation remains controversial, particularly as related to carbon monoxide and cyanide. Hyperbaric oxygen treatment has been evaluated in multiple trials to manage neurologic sequelae of carbon monoxide exposure. Unfortunately, data to date do not support application of hyperbaric oxygen in this population outside the context of clinical trials. Cyanide is another toxin produced by combustion of natural or synthetic materials. A number of antidote strategies have been evaluated to address tissue hypoxia associated with cyanide exposure. Data from European centers supports application of specific antidotes for cyanide toxicity. Consistent international support for this therapy is lacking. Even diagnostic criteria are not consistently applied though bronchoscopy is one diagnostic and therapeutic tool. Medical strategies under investigation for specific treatment of smoke inhalation include beta-agonists, pulmonary blood flow modifiers, anticoagulants and antiinflammatory strategies. Until the value of these and other approaches is confirmed, however, the clinical approach to inhalation injury is supportive

Burn Resuscitation

Fluid resuscitation following burn injury must support organ perfusion with the least amount of fluid necessary and the least physiological cost. Under resuscitation may lead to organ failure and death. With adoption of weight and injury size-based formulas for resuscitation, multiple organ dysfunction and inadequate resuscitation have become uncommon. Instead, administration of fluid volumes well in excess of historic guidelines has been reported. A number of strategies including greater use of colloids and vasoactive drugs are now under investigation to optimize preservation of end organ function while avoiding complications which can include respiratory failure and compartment syndromes. Adjuncts to resuscitation, such as antioxidants, are also being investigated along with parameters beyond urine output and vital signs to identify endpoints of therapy. Here we briefly review the state-of-the-art and provide a sample of protocols now under investigation in North American burn centers

Investigating the Effectiveness of the Tutorials in Introductory Physics in Multiple Instructional Settings

This paper examines the educational impact of the implementation of "Changes in Energy and Momentum" from the Tutorials in Introductory Physics in five different instructional settings. These settings include (1) a completely computer-based learning environment and (2) use of cooperative learning groups with varying levels of instructor support. Pre- and post-tests provide evidence that a computer-based implementation falls significantly short of classroom implementations which involve both collaborative learning groups and interactions with a teaching assistance. Other findings provide insight into the importance of certain elements of instructor training and the appropriate use of the tutorial as an initial introduction to a new concept.Comment: 8 Pages, 3 figures, 4 table

Late diagnosed necrotizing fasciitis as a cause of multiorgan dysfunction syndrome: A case report

Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue bacterial infection. We present a serious case of a 43-year-old male who suffered from necrotizing fasciitis of the left leg in whom a delayed diagnosis caused multiorgan dysfunction

The strangeonium spectrum seen in LASS; implications for glueball spectroscopy

The status of strangeonium spectroscopy is re-assessed following our recent high statistics study of K/sup /minus// induced hypercharge exchange reactions. The implications of our results for the status of glueball, or otherwise exotic, candidates observed in the same decay modes but produced by different mechanisms are also discussed. 11 refs., 8 figs

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research