Ask me about 27

Worldwide, there are 27 million victims of trafficking. With that in mind, this project intended to help students (a) gain an understanding of social issues throughout the world, (b) become activists on behalf of victims of social injustice, and (c) educate others about social injustice and what can be done to reform it. A 26-item survey assessed student knowledge about trafficking. Clemson students correctly answered just over half of the survey questions (M = 16.84; SD = 2.37). The team then designed activities to raise awareness about trafficking. Activities included a venue for students to create Valentine\u27s for trafficking victims, a campus showing of the film Not My Life and an invited speaker an expert on trafficking. At all events bookmarks containing survey results were distributed

Free abdominal fluid without obvious solid organ injury upon CT imaging: an actual problem or simply over-diagnosing?

Whereas a non-operative approach for hemodynamically stable patients with free intraabdominal fluid in the presence of solid organ injury is generally accepted, the presence of free fluid in the abdomen without evidence of solid organ injury not only presents a challenge for the treating emergency physician but also for the surgeon in charge. Despite recent advances in imaging modalities, with multi-detector computed tomography (CT) (with or without contrast agent) usually the imaging method of choice, diagnosis and interpretation of the results remains difficult. While some studies conclude that CT is highly accurate and relatively specific at diagnosing mesenteric and hollow viscus injury, others studies deem CT to be unreliable. These differences may in part be due to the experience and the interpretation of the radiologist and/or the treating physician or surgeon

Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

Background This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This "open abdomen'' must then be temporarily closed. However, the FC rate varies between techniques. Methods The Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) "open abdomen,'' "fascial closure,'' "vacuum,'' "reapproximation,'' and "ventral hernia.'' Open abdomen was defined as "the inability to close the abdominal fascia after laparotomy.'' Two reviewers independently extracted data from original articles by using a predefined checklist. Results The search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%). Conclusions These results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rate

Elucidating a Unified Mechanistic Scheme for the DBU-Catalyzed Ring-Opening Polymerization of Lactide to Poly(lactic acid)

The synthesis of poly­(lactic acid), PLA, is facile in the presence of the cyclic, organic amidine catalyst 1,8-diazabicyclo[5.4.0]­undec-7-ene, DBU. Since DBU’s catalytic capability was first reported by Lohmeijer and colleagues in 2006 for ring-opening polymerizations (ROP), there have been numerous studies conducted by a variety of groups on the catalytic functioning of DBU in the ROPs of cyclic esters resulting in a large body of ununified material from a mechanistic standpoint. This lack of clarity will hamper engineering polymers with desired characteristics from cyclic ester and lactone monomers. The work outlined in this paper seeks to propose a unified picture of the mechanisms in the DBU-catalyzed ROP of lactide. In providing this unified picture of the ROP, our work encompassed (i) proposing a detailed reaction network scheme, (ii) conducting syntheses of lactide and DBU over a range of initial concentrations, and (iii) kinetic modeling to further support the proposed reaction network. As a result, our work has produced (i) kinetic data, (ii) a consistent, viable reaction scheme verified through kinetic modeling, (iii) deduced and quantified the interplay between polymerization routes facilitated by the presence of DBU, thus demonstrating the need for detailed kinetic studies to deconstruct complex reaction networks, (iv) the first experimental evidence in support of the combination of ketene aminal-ended chains with alcohol-ended chains, and (v) analyzed the robustness of the catalyst to acid contamination

Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms

BACKGROUND: Open abdomen treatment (OAT) is considered a lifesaving procedure in patients with abdominal compartment syndrome (ACS) after endovascular or open intervention for ruptured abdominal aortic aneurysms (RAAA). Standardized treatment methods and algorithms for its use are still lacking. The high, published mortality rates may reflect difficulties in detecting and treating ACS, especially in patients treated by emergency endovascular aneurysm repair (eEVAR). Presented are standardized algorithms for OAT, including a new technique using the vacuum-assisted closure (VAC) system developed during 10 years of experience with eEVAR for RAAA. METHODS: We retrospectively analyzed 102 patients with RAAA treated by eEVAR from January 1998 to April 2008. Abdominal decompression was done when intravesical pressure >20 mm Hg or when abdominal perfusion pressure was <50 to 60 mm Hg and concomitant organ deterioration occurred. OAT was initially done with a subcutaneously sutured plastic bag or with a nonsutured zipper drape combined with a VAC device (VAC/ETHIZIP; KCI International Inc, Amstelveen, The Netherlands; Ethicon, Somerville, NJ). All patients were switched to VAC/ETHIZIP as soon as possible. Dressings were generally changed every 3 to 5 days. Intra-abdominal pressure was monitored until stability was observed after delayed direct abdominal closure. RESULTS: Overall 30-day mortality for eEVAR was 13% (13 of 102); 8% (7 of 82) for patients without ACS and 30% (6 of 20) for those with ACS. Decompression for ACS was needed in 20 patients (20%) primarily during the intervention (n = 14) or secondarily in the intensive care unit (n = 6). Six of 20 (30%) patients requiring OAT died <or=30 days (4 primary, 2 secondary). A mean of 3.6 (range, 1-12) planned second-look interventions were done per patient at an interval of 3 to 5 days. No bowel lesions were observed. Four patients required antibiotic therapy for abdominal infection, and all infections resolved. Delayed abdominal wall closure (direct closure, 11; closure with polypropylene mesh, 3; bilateral anterior rectus abdominis sheath turnover flap, 1) was achieved after a median of 6 days (range, 1-47 days). CONCLUSION: The use of standardized novel techniques and a treatment protocol and algorithm for OAT after eEVAR for RAAA were feasible and safe. It decreased the workload of the medical and nursing staff, enhanced patient comfort because the need for dressing changes was minimized, and likely contributed to lower overall mortality in RAAA patients. Delayed direct fascial closure was possible in most patients