The interplay between glottis and vocal tract during the male passaggio

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich. - This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. - Primärausgabe im Karger-Verlag (www.karger.com/?doi=10.1159/000087084) erschienen

Sicherheitsaspekte und Vorbereitung zur Notfallvorsorge und Gefahrenabwehr in Kliniken bei MANV/TerrorMANV

Background!#!Worldwide terrorist activities since '9/11' and subsequently also in the European region have led to a rethinking in the context of the evaluation of critical infrastructure in Germany, also with respect to security at and in hospitals.!##!Objective!#!This publication deals with the evaluation of existing concepts on topics such as 'alerting', 'security', 'communication' and 'preparation' in the aforementioned context.!##!Material and methods!#!Based on a literature review as well as a survey among participants of the 3rd emergency conference of the DGU (German Society for Trauma Surgery), this topic and the currently existing situation are further analyzed and presented.!##!Results!#!The data obtained illustrate that while the majority of hospitals have a hospital alert and response planning, the frequency of updates and intrahospital communication to increase awareness show significant variation. Furthermore, the results illustrate a heterogeneity of the existing intrahospital alerting concepts as well as a lack of security concepts and cooperation with security and guard services. Furthermore, it is evident that the topic of a possible CBRN (chemical, biological, radiological, nuclear) threat is not yet adequately perceived or implemented in the risk analysis.!##!Discussion!#!The latent threat of terrorist activities appears to have led German hospitals to address the issue of hospital alarm and response planning in their assessment as critical infrastructure and to have implemented this for the most part; however, the subordinated areas and the consequences that can be derived from alarm planning do not yet show the necessary stringency to ultimately ensure adequate responses in these special scenarios with respect to security in and at German hospitals

Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

BACKGROUND Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. METHODS The Terror and Disaster Surgical Care (TDSC®) - Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. RESULTS The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1-T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). CONCLUSION The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. mass-casualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed

A novel K+ channel expressed in carrot roots with a low susceptibility towards metal ions

Kdc1 is a novel K+-channel gene cloned from carrot roots, and which is also present in cultured carrot cells. We investigated the characteristics of the ionic current elicited in Xenopus oocytes coinjected with KDC1 (K+-Daucus carota 1) and KAT1 (from Arabidopsis thaliana) RNA. Expressed heteromeric channels displayed inward-rectifying potassium currents whose kinetics, voltage characteristics, and inhibition by metal ions depended on KDC1:KAT1 ratios. At low KDC1:KAT1 ratios, Zn2+ inhibition of heteromeric K+ current was less pronounced compared to homomeric KAT1 channels, while at higher KDC1:KAT1 ratios, the addition of Zn2+ even produced an increase in current. Under the same conditions, the Ni2+ inhibition of the current was also reduced, but no current increase was observed. These effects might be explained by the unusual amino acid composition of the KDC1 protein in terms of histidine residues that are absent in the pore region, but abundant (four per subunit) in the proximity of the pore entrance. Channels like KDC1 could be at least partially responsible for the higher resistance of carrot cells in the presence of metals

Availability and use of institutional support programs for emergency department healthcare personnel during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic placed health care personnel (HCP) at risk for stress, anxiety, burnout, and post-traumatic stress disorder (PTSD). To address this, hospitals developed programs to mitigate risk. The objectives of the current study were to measure the availability and use of these programs in a cohort of academic emergency departments (EDs) in the United States early in the pandemic and identify factors associated with program use. METHODS: Cross-sectional survey of ED HCP in 21 academic EDs in 15 states between June and September 2020. Site investigators provided data on the availability of 28 programs grouped into 9 categories. Individual support programs included: financial, workload mitigation, individual COVID-19 testing, emotional (e.g., mental health hotline), and instrumental (e.g., childcare) Clinical work support programs included: COVID-19 team communication (e.g., debriefing critical incident), patient-family communication facilitation, patient services (e.g., social work, ethics consultation), and system-level exposure reduction. Participants provided corresponding data on whether they used the programs. We used generalized linear mixed models clustered on site to measure the association between demographic and facility characteristics and program use. RESULTS: We received 1,541 survey responses (96% response rate) from emergency physicians or advanced practice providers, nurses, and nonclinical staff. Program availability in each of the 9 categories was high (>95% of hospitals). Program use was variable, with clinical work support programs used more frequently (28-50% of eligible HCP across categories) than individual employee support programs (6-13% of eligible HCP across categories). Fifty-seven percent of respondents reported that the COVID-19 pandemic had affected their stress and anxiety, and 12% were at elevated risk for PTSD. Program use did not significantly differ for HCP who reported symptoms of anxiety and/or stress compared to those who did not. CONCLUSIONS: Early in the pandemic, support programs were widely available to ED HCP, but program use was low. Future work will focus on identifying barriers and facilitators to use and specific programs most likely to be effective during periods of highest occupational stress

sj-docx-6-jpx-10.1177_23743735231151539 - Supplemental material for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic

Supplemental material, sj-docx-6-jpx-10.1177_23743735231151539 for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic by Alpana Garg, Maran Subramain, Patrick B Barlow, Lauren Garvin, Karin F Hoth, Kimberly Dukes, Richard M Hoffman and Alejandro P Comellas in Journal of Patient Experience</p

sj-docx-3-jpx-10.1177_23743735231151539 - Supplemental material for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic

Supplemental material, sj-docx-3-jpx-10.1177_23743735231151539 for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic by Alpana Garg, Maran Subramain, Patrick B Barlow, Lauren Garvin, Karin F Hoth, Kimberly Dukes, Richard M Hoffman and Alejandro P Comellas in Journal of Patient Experience</p

sj-docx-5-jpx-10.1177_23743735231151539 - Supplemental material for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic

Supplemental material, sj-docx-5-jpx-10.1177_23743735231151539 for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic by Alpana Garg, Maran Subramain, Patrick B Barlow, Lauren Garvin, Karin F Hoth, Kimberly Dukes, Richard M Hoffman and Alejandro P Comellas in Journal of Patient Experience</p

sj-docx-2-jpx-10.1177_23743735231151539 - Supplemental material for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic

Supplemental material, sj-docx-2-jpx-10.1177_23743735231151539 for Patient Experiences with a Tertiary Care Post-COVID-19 Clinic by Alpana Garg, Maran Subramain, Patrick B Barlow, Lauren Garvin, Karin F Hoth, Kimberly Dukes, Richard M Hoffman and Alejandro P Comellas in Journal of Patient Experience</p