Huddle Up: Using Mediation to Help Settle the National Football League Labor Dispute

In a patient transferred from Togo to Cologne, Germany, Lassa fever was diagnosed 12 days post mortem. Sixty-two contacts in Cologne were categorised according to the level of exposure, and gradual infection control measures were applied. No clinical signs of Lassa virus infection or Lassa specific antibodies were observed in the 62 contacts. Thirty-three individuals had direct contact to blood, other body fluids or tissue of the patients. Notably, with standard precautions, no transmission occurred between the index patient and healthcare workers. However, one secondary infection occurred in an undertaker exposed to the corpse in Rhineland-Palatinate, who was treated on the isolation unit at the University Hospital of Frankfurt. After German authorities raised an alert regarding the imported Lassa fever case, an American healthcare worker who had cared for the index patient in Togo, and who presented with diarrhoea, vomiting and fever, was placed in isolation and medevacked to the United States. The event and the transmission of Lassa virus infection outside of Africa underlines the need for early diagnosis and use of adequate personal protection equipment (PPE), when highly contagious infections cannot be excluded. It also demonstrates that larger outbreaks can be prevented by infection control measures, including standard PPE

Comparison of the Avalon Dual-Lumen Cannula with Conventional Cannulation Technique for Venovenous Extracorporeal Membrane Oxygenation

Background Comparison of two kinds of cannulation (double-lumen cannula [DLC, Avalon Elite Bicaval Dual Lumen Catheter] and conventional cannulation with two cannulas) for venovenous extracorporeal membrane oxygenation (ECMO) therapy in terms of effectiveness, usage complexity, and costs. Methods Retrospective case series of 17 patients who received venovenous ECMO therapy due to acute respiratory distress syndrome (ARDS) between January 2010 and March 2012. Nine patients were treated with the DLC and eight patients with conventional cannulation. We analyzed the outcome data, ECMO values, respirator settings, blood gas values, realized prone positioning, and costs, and compared both methods. Results Both kinds of cannulation are efficient regarding oxygenation and decarboxylation. There is no significant difference in mortality, hospitalization time (intensive care unit [ICU] and hospital) and complications during ECMO therapy between both groups. Cannula implantation is much more complex in the DLC group and requires more experience in TEE (transesophageal echocardiography) diagnostics and cannulation technique. In addition, the costs for the Avalon (MAQUET Cardiopulmonary AG, Germany) cannula are significantly higher than for conventional cannulation. Furthermore, prone positioning could be easier achieved in the DLC group. Conclusion In summary, double-lumen cannulation allows sufficient gas exchange with more effort (material, technical, and physicians' experience) and higher costs but better mobilization possibilities (particularly prone position) and potential avoidance of deep sedation and mechanical ventilation. From the current point of view, the DLC should be reserved for special cases

Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed to show a benefit of prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims to redefine the effects of this treatment modality in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists of relevant articles were searched for full-text articles of RCTs in English or German. Assessments for eligibility, relevance, study validity and data extraction were performed by two reviewers independently using prespecified criteria. The primary outcome was hospital mortality. A total of nine eligible RCTs with 1171 patients were identified: 577 patients were treated preoperatively with intra-aortic balloon pump (IABP) and 594 patients served as controls. The pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629; P < 0.001). The pooled analyses of five RCTs including only patients undergoing isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] = 347) also showed a statistically significant improvement in mortality for preoperative IABP implantation (fixed-effects model: OR 0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital mortality from two randomized off-pump trials was 0.556 (fixed-effects model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic counterpulsation was associated with a significant reduction in low cardiac output syndrome (LCOS) in the total population (fixed-effects model: OR 0.330, 95% CI 0.214-0.508, P < 0.001) as well as in the subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI 0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238). Preoperative IABP implantation was associated with a reduction of intensive care unit (ICU) stay in all investigated populations with a greater effect in the total population [fixed-effects model: standard mean difference (SMD) -0.931 +/- 0.198, P < 0.001] as well as in the subgroup of CAGB patients (fixedeffects model: SMD -1.240 +/- 0.156, P < 0.001), compared with the off-pump group (fixed-effects model: SMD -0.723 +/- 0.128, P < 0.001). Despite contradictory results from recent trials, the present study confirms the findings of previous meta-analyses that prophylactic aortic counterpulsation reduces hospital mortality, incidence of LCOS and ICU requirement in high-risk patients undergoing on-pump cardiac surgery. However, owing to small sample sizes and the lack of a clear-cut definition of high-risk patients, an adequately powered, prospective RCT is necessary to find a definite answer to the question, if certain groups of patients undergoing cardiac surgery benefit from a prophylactic IABP insertion

Sedimentation of lochkovian-lower emsian volcanoklastic deposits of the West-Magnitogorsk zone of the South Ural

Актуальность исследования. Раннедевонский этап формирования Магнитогорской островодужной системы, несмотря на многолетнюю историю исследований и достаточно большой объем полученных данных, остается малоизученным. Данному этапу соответствуют лохков-нижнеэмсские вулканокластические, карбонатные и кремнистые породы, широко распространенные на севере Западно-Магнитогорской зоны Южного Урала. Расположены они в зоне Главного Уральского разлома и поэтому подвержены вторичным изменениям, а разрезы их имеют фрагментарное строение. Вулканокластические разности, пользующиеся наибольшим распространением, практически не изучались. Исследование их и фациальных взаимоотношений между нижнедевонскими отложениями позволяет реконструировать обстановки седиментации раннедевонского бассейна и детализировать историю развития Магнитогорской островодужной системы на начальном этапе ее образования. Цель исследования состоит в выявлении источников сноса и реконструкции обстановок седиментации нижнедевонских вулканокластических отложений Западно-Магнитогорской зоны Южного Урала. Методы. Реконструкция обстановок накопления проведена на основе изучения структурно-текстурных особенностей, минералого-петрографического и литогеохимического состава вулканокластических пород и корреляции нижнедевонских отложений по биостратиграфическим данным. Полученные результаты сопоставлялись с данными ведущих исследователей по современным обстановкам седиментации. Результаты. Нижнедевонские вулканокластические отложения Западно-Магнитогорской зоны Южного Урала являются турбидитами и дебритами. Они сложены преимущественно пирокластическим и вулканотерригенным материалом основного и среднего состава. Впервые показано, что накопление их происходило в проксимальной и дистальной части островной дуги. В дистальной части накапливались отложения ильтибановской и мансуровской толщ, в проксимальной - ускульской и рыскужинской толщ. Формирование Магнитогорской островодужной системы могло начаться в раннеэмсское время или даже раньше.The relevance of research. The Early Devonian stage of formation of the Magnitogorsk islandarc system remains poorly understood, despite the long history of research and rather large amount of data obtained. This stage corresponds to Lochkovian-Lower Emsian volcanoclastic, carbonate and siliceous rocks, widespread in the north of the West-Magnitogorsk zone. They are located in the zone of the Main Ural Fault and are therefore subject to secondary changes, and their sections have a fragmentary structure. Volcanoclastic rocks, the most widely spread, have not been studied. Their study and the study of facies relationships between them allows us to reconstruct the situation of sedimentation of the early Devonian basin and to detail the history of the development of the Magnitogorsk island arc system at the initial stage of its formation. The main aim of this work is to identify the sources of demolition and sedimentation environments of the Lower Devonian volcaniclastic deposits of the West­ Magnitogorsk zone of the Southern Urals. Methods. Reconstruction of accumulation environments was carried out on the basis of studying structural and texture features, mineralogical-petrographic and lithogeochemical composition of volcaniclastic rocks and correlation of Lower Devonian deposits by biostra-tigraphic data. The results obtained were compared with the data of leading researchers on modern sedimentation environments. Results. The Lower Devonian volcaniclastic deposits of the West-Magnitogorsk zone of the Southern Urals are turbidites and debris. They are composed mainly of pyroclastic and volcanic-terrigenous material of basalt and andesibasalt composition. It is shown that their accumulation took place in the proximal and distal part of the island arc. Deposits of the Itlibanskay and Mansurovskay strata were accumulated in the distal part, in the proximal - the Uskulskay and the Ryskuzhinskay strata. The formation of the Magnitogorsk island arc system could begin in the earlyems time or even earlier