World Englishes and Critical Thinking

With the founding of the new Department of World Englishes at Chukyo University, the possibilities of the \u27New Japanese University\u27 begin to come into focus. The author argues that we must achieve two ends. One is to deliver true, significant gains in language proficiency. The second, and that which is the focus of this article, is the need for making major strides in developing our students\u27 ability to think critically. This goal arises out of the growing need for Japanese to act in a flexible, entrepreneurial manner, play a larger role on the world stage, and find fulfillment in life. The author is optimistic and suggests several possible routes towards this end

The StO2 non-invasive tissue hypoperfusion monitor as a screening tool for early sepsis detection in the emergency department

Background: Early Recognition of patients with sepsis induced tissue hypoperfusion (SITH) Remains a significant clinical challenge. Non--‐invasive Tissue oxygenation saturation (StO2) Monitors have been developed to provide rapid, low--‐cost, and non--‐invasive bedside assessments of tissue oxygen extraction; they have not been well validated as an initial screening tool for sepsis in the ED. Objectives: To Assess the efficacy of initial bedside StO2 Readings in the early identification of patients with SITH And to compare StO2 Readings with lactate levels. Methods: IRB approved, prospective, observational pilot study of a convenience sample of ED Patients presenting with a sepsis continuum diagnosis. Setting: Urban Tertiary care center with 90k visits/yr. Inclusion criteria: Suspicion Of new infection plus 2 SIRS criteria. Exclusion criteria: \u3c18 Or no suspicion of infection. Study procedures: Demographics, co--‐morbidities, clinical data, treatment, disposition, and mortality were collected. A Portable In--‐Spectra ‘Spot Check’ StO2 Monitor was used totake a StO2 Reading at the thenar eminence; a second reading was taken three hours later. All Investigators were trained with the device to record data with a high degree of accuracy and reliability. Abnormal StO2 Was defined as \u3c80% or\u3e91%. The Study was observational and there were no clinical interventions. Descriptive Statistics were employed and Sensitivity/Specificity, Likelihood ratios, andNPV/PPV Were calculated with 95% Confidence intervals (in parenthesis) where appropriate. Results: 79 Patients were enrolled into the study. Mean Age 63 (range 21--‐96). 61 Were admitted to the hospital, 5 To ICU (100% With St02\u3c74%). 3 Mortalities (100% With St02\u3c72%). 75% (9/12) Of patients with an ED Lactate \u3e2.3 Had an abnormal St02. 80% (4/5) For lactate \u3e3, And 100%(3/3) For Lactate \u3e4. For Any initial SITH (MAP\u3c65 Or Lactate \u3e2.3): Sensitivity: 92% (77.5--‐98.2), Specificity: 82.2% (67.9--‐92), +LR: 5.2 (2.7--‐9.7), --‐LR: 0.1 (0.03--‐0.3), PPV: 80.5% (65.1--‐91.2), NPV: 92.5% (80--‐98.3). Conclusions: StO2 May be a useful, rapid, low--‐cost, and non--‐invasive bedside screening tool for SITH In the ED, Particularly for severely ill patients. Further Studies are needed to determine StO2’s Ability to predict mortality and assess response to therapy

Nighttime Traffic Volume Predicts Risk of Deer–Vehicle Collisions

Annually, in the United States, \u3e1 million deer (Odocoileus spp.)–vehicle collisions are reported, resulting in losses of $4.6 billion in vehicle damage and medical expenses. Wildlife and transportation managers require better information about traffic volumes relative to seasonal and diurnal deer movement patterns to appropriately evaluate the risks associated with deer–vehicle collisions (DVCs). We incorporated traffic volume data with DVC data and the movement rates and incidences of road crossings by white-tailed deer (O. virginianus) to evaluate if traffic volume or deer behaviors mediate the incidence of DVCs along a high-volume interstate highway in Morgan County in central Georgia, USA. From May 2012 to July 2014, we monitored the movements and survival of 25 deer (13 males, 12 females) instrumented with global positioning system (GPS) collars in an area 1.6 km north and south of a 7.7-km section of Interstate 20 in our study area. We used a linear mixed model to quantify the effects of mean traffic volume and total road crossings on DVCs for each hour of the day. Deer movements and DVCs were primarily crepuscular. Approximately 60% of GPS-collared deer crossed roads; 7 deer accounted for \u3e90% of all road crossings. Approximately 73% of daily traffic occurred between 0700 and 1859 hours. Nearly twice the number of daily DVCs occurred during the fall (9.8 DVCs/day) than during the next highest season (winter; 4.9 DVCs/day). Although DVCs occurred at greater frequencies during crepuscular periods, results of our linear mixed model suggested only nighttime traffic volume predicted DVCs. The relationship between nighttime DVCs and traffic volume is likely due to the inability of drivers to perceive deer in a roadway during this time. We recommend mitigation efforts focus on increasing driver vigilance and reducing vehicle speed during nighttime periods, especially during the fall season

Comparison of Fencing Designs for Excluding Deer from Roadways

We evaluated the efficacy of several fencing designs for restricting movements of 18 captive, female white-tailed deer (Odocoelus virginianus), including standard wovenwire fencing (1.2-m, 1.5-m, 1.8-m, 2.1-m, and 2.4-m tall), opaque fencing (1.2-m, 1.5-m, and 1.8-m tall), and an outrigger fence (i.e., 0.6-m outriggers attached to a 1.2-m-tall wire fence angled at 45º). We recorded the number of successful fence crossings for each deer and characterized behaviors associated with each failed crossing attempt. No deer crossed the 2.4-m fence, whereas all deer crossed the 1.2-m fence. We observed no differences in crossing success between woven-wire and opaque fencing at height