Mass casualty events: what to do as the dust settles?

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs

Reducing Youth Risk Behaviors Through Interactive Theater Intervention

The reduction of risk behaviors in secondary schools is a key concern for parents, teachers, and school administrators. School is one of the primary contexts of socialization for young people; thus, the investment in school-based programs to reduce risk behaviors is essential. In this study, we report on youth who participated in an intervention designed to improve decision-making skills based on positive youth development approaches. We examine changes in decision-making skills before and after involvement in the Teen Interactive Theater Education (TITE) program and retrospective self-assessment of change in knowledge, abilities, and beliefs as a result of participating in TITE (n = 127). Youth that reported increases in knowledge, abilities, and beliefs due to the intervention (n = 89) were more likely to think about the consequences of their decisions and list options before making a decision compared to their counterparts that reported less overall learning (n = 38). Implications for intervention research and stakeholders are discussed

Warming Increases Pollen Lipid Concentration in an Invasive Thistle, with Minor Effects on the Associated Floral-Visitor Community

Climate warming is likely to change the ways in which plants interact with their insect mutualists, for example through changes in phytochemistry. In particular, this may have implications for the ways in which we manage noxious weeds, which may spread more quickly if they experience stronger mutualistic interactions. We grew the invasive nodding thistle, Carduus nutans, in two experimental treatments in the field: either passively warmed with open top chambers or at ambient temperatures. We collected pollen from thistles in each treatment and analysed the total protein, lipid, and carbohydrate content. We observed no difference in the pollen protein or carbohydrate content, but the total lipid content of the pollen was significantly higher in warmed plants. We conducted a total of 12.75 h of observations of putatively mutualistic, flower-visiting insects. In addition, we spent 4.17 h collecting bees that visited thistle inflorescences in the treatments, allowing us to identify them to species. We found a significant increase in the abundance of flower-visiting insects in the observations, but not bee abundance in collections. In addition, there was no treatment effect on the number of flower-visiting morphotypes in the observations, or bee species richness in the collections. However, a nonparametric test did identify a significant effect of warming on the composition of flower-visiting morphotypes in observations and bee species in collections. Overall, the warming treatment significantly increased lipid content of the pollen, but had relatively weak effects on insect visitation patterns. However, these effects may be amplified at larger spatial and temporal scales or higher temperatures

Real-time detection of riboflavin production by Lactobacillus plantarum strains and tracking of their gastrointestinal survival and functionality in vitro and in vivo using mCherry labeling

Some strains of lactic acid bacteria (LAB) produce riboflavin, a water-soluble vitamin of the B complex, essential for human beings. Here, we have evaluated riboflavin (B2 vitamin) production by five Lactobacillus plantarum strains isolated from chicha, a traditional maize-based fermented alcoholic beverage from north-western Argentina and their isogenic riboflavin-overproducing derivatives previously selected using roseoflavin. A direct fluorescence spectroscopic detection method to quantify riboflavin production in bacterial culture supernatants has been tested. Comparison of the efficiency for riboflavin fluorescence quantification with and without prior HPLC fractionation showed that the developed method is a rapid and easy test for selection of B2 vitamin-producing strains. In addition, it can be used for quantitative detection of the vitamin production in real time during bacterial growth. On the basis of this and previous analyses, the L. plantarum M5MA1-B2 riboflavin overproducer was selected for in vitro and in vivo studies after being fluorescently labeled by transfer of the pRCR12 plasmid, which encodes the mCherry protein. The labeling did not affect negatively the growth, the riboflavin production nor the adhesion of the strain to Caco-2 cells. Thus, L. plantarum M5MA1-B2[pRCR12] was evaluated for its survival under digestive tract stresses in the presence of microbiota in the dynamic multistage BFBL gut model and in a murine model. After exposure to both models, M5MA1-B2[pRCR12] could be recovered and detected by the pink color of the colonies. The results indicated a satisfactory resistance of the strain to gastric and intestinal stress conditions but a low colonization capability observed both in vitro and in vivo. Overall, L. plantarum M5MA1-B2 could be proposed as a probiotic strain for the development of functional foods.Fil: Mohedano, Mari Luz. Consejo Superior de Investigaciones Científicas. Centro de Investigaciones Biológicas; EspañaFil: Hernández Recio, Sara. Consejo Superior de Investigaciones Científicas. Centro de Investigaciones Biológicas; EspañaFil: Yépez, Alba. Universidad de Valencia; EspañaFil: Requena, Teresa. Consejo Superior de Investigaciones Científicas. Instituto de Investigación en Ciencias de la Alimentación; EspañaFil: Martínez Cuesta, M. Carmen. Consejo Superior de Investigaciones Científicas. Instituto de Investigación en Ciencias de la Alimentación; EspañaFil: Peláez, Carmen. Consejo Superior de Investigaciones Científicas. Instituto de Investigación en Ciencias de la Alimentación; EspañaFil: Russo, Pasquale. Università di Foggia; ItaliaFil: Leblanc, Jean Guy Joseph. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Centro de Referencia para Lactobacilos; ArgentinaFil: Spano, Giuseppe. Università di Foggia; ItaliaFil: Aznar, Rosa. Universidad de Valencia; España. Consejo Superior de Investigaciones Científicas. Instituto de Agroquímica y Tecnología de Alimentos; EspañaFil: López, Paloma. Consejo Superior de Investigaciones Científicas. Centro de Investigaciones Biológicas; Españ

A Francisella tularensis Live Vaccine Strain That Improves Stimulation of Antigen-Presenting Cells Does Not Enhance Vaccine Efficacy

Vaccination is a proven strategy to mitigate morbidity and mortality of infectious diseases. The methodology of identifying and testing new vaccine candidates could be improved with rational design and in vitro testing prior to animal experimentation. The tularemia vaccine, Francisella tularensis live vaccine strain (LVS), does not elicit complete protection against lethal challenge with a virulent type A Francisella strain. One factor that may contribute to this poor performance is limited stimulation of antigen-presenting cells. In this study, we examined whether the interaction of genetically modified LVS strains with human antigen-presenting cells correlated with effectiveness as tularemia vaccine candidates. Human dendritic cells infected with wild-type LVS secrete low levels of proinflammatory cytokines, fail to upregulate costimulatory molecules, and activate human T cells poorly in vitro. One LVS mutant, strain 13B47, stimulated higher levels of proinflammatory cytokines from dendritic cells and macrophages and increased costimulatory molecule expression on dendritic cells compared to wild type. Additionally, 13B47-infected dendritic cells activated T cells more efficiently than LVS-infected cells. A deletion allele of the same gene in LVS displayed similar in vitro characteristics, but vaccination with this strain did not improve survival after challenge with a virulent Francisella strain. In vivo, this mutant was attenuated for growth and did not stimulate T cell responses in the lung comparable to wild type. Therefore, stimulation of antigen-presenting cells in vitro was improved by genetic modification of LVS, but did not correlate with efficacy against challenge in vivo within this model system

Lipid-rich histology in a basal-type immuno-profile breast carcinoma: a clinicopathological histochemical and immunohistochemical analysis of a case

We describe the clinicopathological and morphological features of an unusual breast carcinoma classifiable as a lipid-rich variant of ductal invasive carcinoma, with a basal-type immunohistochemical profile. Basal-type breast cancers show no hormonal receptor expression, rarely over-express HER-2 but exhibit molecular high weight cytokeratins, EGFR and c-kit positivity. Special stains and histochemistry tests were used to elucidate the nature of vescicles in the neoplastic cells. Sudan IV was performed on formalin-fixed tissue. Commercially available antibodies tested were: ER, PgR, EGFR, HER2, c-kit, high molecular weight cytokeratins. Cytoplasmic lipids were highlighted as red-orange droplets on Sudan IV staining. As for immunohistochemistry, the tumor showed no reactivity to ER, PgR and HER2 (triple negative), and diffuse and strong positivity to high weight cytokeratins, EGFR and c-kit, such as a basal-type breast carcinoma. A basaloid phenotype in a lipid-rich carcinoma has not been previously reported

Delays in Leniency Application: Is There Really a Race to the Enforcer's Door?

This paper studies cartels’ strategic behavior in delaying leniency applications, a take-up decision that has been ignored in the previous literature. Using European Commission decisions issued over a 16-year span, we show, contrary to common beliefs and the existing literature, that conspirators often apply for leniency long after a cartel collapses. We estimate hazard and probit models to study the determinants of leniency-application delays. Statistical tests find that delays are symmetrically affected by antitrust policies and macroeconomic fluctuations. Our results shed light on the design of enforcement programs against cartels and other forms of conspiracy

Hawking Radiation as Tunneling through the Quantum Horizon

Planck-scale corrections to the black-hole radiation spectrum in the Parikh-Wilczek tunneling framework are calculated. The corrective terms arise from modifications in the expression of the surface gravity in terms of the mass-energy of the black hole-emitted particle system. The form of the new spectrum is discussed together with the possible consequences for the fate of black holes in the late stages of evaporation.Comment: 13 pages; the contents of this paper overlap somewhat with the earlier submissions hep-th/0504188 and gr-qc/0505015; (v2) references added and various cosmetic (but no physics) changes, to appear in JHE

Phases of planar 5-dimensional supersymmetric Chern-Simons theory

In this paper we investigate the large-$N$ behavior of 5-dimensional $\mathcal{N}=1$ super Yang-Mills with a level $k$ Chern-Simons term and an adjoint hypermultiplet. As in three-dimensional Chern-Simons theories, one must choose an integration contour to completely define the theory. Using localization, we reduce the path integral to a matrix model with a cubic action and compute its free energy in various scenarios. In the limit of infinite Yang-Mills coupling and for particular choices of the contours, we find that the free-energy scales as $N^{5/2}$ for $U(N)$ gauge groups with large values of the Chern-Simons 't\,Hooft coupling, $\tilde\lambda\equiv N/k$. If we also set the hypermultiplet mass to zero, then this limit is a superconformal fixed point and the $N^{5/2}$ behavior parallels other fixed points which have known supergravity duals. We also demonstrate that $SU(N)$ gauge groups cannot have this $N^{5/2}$ scaling for their free-energy. At finite Yang-Mills coupling we establish the existence of a third order phase transition where the theory crosses over from the Yang-Mills phase to the Chern-Simons phase. The phase transition exists for any value of $\tilde\lambda$, although the details differ between small and large values of $\tilde\lambda$. For pure Chern-Simons theories we present evidence for a chain of phase transitions as $\tilde\lambda$ is increased. We also find the expectation values for supersymmetric circular Wilson loops in these various scenarios and show that the Chern-Simons term leads to different physical properties for fundamental and anti-fundamental Wilson loops. Different choices of the integration contours also lead to different properties for the loops.Comment: 40 pages, 17 figures, Minor corrections, Published versio