A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (Part I - Protection via specific pathways).

Neurocognitive deficits are a major source of morbidity in survivors of cardiac arrest. Treatment options that could be implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation to improve these neurological deficits are limited. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following cardiac arrest with associated global cerebral ischemia. The search was limited to investigational therapies that were utilized to treat global cerebral ischemia associated with cardiac arrest. In this review we discuss potential mechanisms of neurologic protection following cardiac arrest including actions of several medical gases such as xenon, argon, and nitric oxide. The 3 included mechanisms are: 1. Modulation of neuronal cell death; 2. Alteration of oxygen free radicals; and 3. Improving cerebral hemodynamics. Only a few approaches have been evaluated in limited fashion in cardiac arrest patients and results show inconclusive neuroprotective effects. Future research focusing on combined neuroprotective strategies that target multiple pathways are compelling in the setting of global brain ischemia resulting from cardiac arrest

Interim Land Use Control Implementation Plan

This Interim Land Use Control Implementation Plan (LUCIP) has been prepared to inform current and potential future users of the Kennedy Space Center (KSC) Contractors Road Heavy Equipment (CRHE) Area (SWMU 055; "the Site") of institutional controls that have been implemented at the Site1. Although there are no current unacceptable risks to human health or the environment associated with the CRHE Area, an interim institutional land use control (LUC) is necessary to prevent human health exposure to volatile organic compound (VOC)-affected groundwater at the Site. Controls will include periodic inspection, condition certification, and agency notification

Archaeological Evidence of Historic Mining at Forestville Saltpeter Cave (15Ht94), Hart County, Kentucky

Forestville Saltpeter Cave is 1.5 km east of Mammoth Cave National Park on the WKU Green River Preserve. Historically, miners removed sediment from the cave to extract saltpeter for the production of gunpowder. Though dozens of peter-mining sites are known in western Kentucky, Forestville Saltpeter Cave is only the third site investigated by archaeologists. Intensive surface survey documented evidence of mining activity in the cave: working bays, rock piles, tally and other marks, tool marks, inscriptions, and lighting material. The mining likely occurred during the early nineteenth century. The operations were extensive throughout all passages and extracted 856 cu m of sediment

The Yellowstone Permutation

Define a sequence of positive integers by the rule that a(n) = n for 1 <= n = 4, a(n) is the smallest number not already in the sequence which has a common factor with a(n-2) and is relatively prime to a(n-1). We show that this is a permutation of the positive integers. The remarkable graph of this sequence consists of runs of alternating even and odd numbers, interrupted by small downward spikes followed by large upward spikes, suggesting the eruption of geysers in Yellowstone National Park. On a larger scale the points appear to lie on infinitely many distinct curves. There are several unanswered questions concerning the locations of these spikes and the equations for these curves.Comment: 10 pages, 6 figures. Mar 7 2015: mostly stylistic change

Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study.

ObjectiveThis study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type.MethodsThe 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants selected face-to-face interviews, 53 applicants selected web-based interviews, and 17 applicants declined to interview. Data regarding applicants' reasons for selecting a particular interview type were gathered using an anonymous online survey after interview completion. Residency program admission rates and survey answers were compared between applicants completing face-to-face versus web-based interviews.ResultsOne hundred twenty-seven (75.1%) applicants completed face-to-face and 42 (24.9%) completed web-based interviews. The admission rate to our residency program was not significantly different between applicants completing face-to-face versus web-based interviews. One hundred eleven applicants completed post-interview surveys. The most common reasons for selecting web-based interviews were conflict of interview dates between programs, travel concerns, or financial limitations. Applicants selected face-to-face interviews due to a desire to interact with current residents, or geographic proximity to the residency program.ConclusionsThese results suggest that completion of web-based interviews is a viable alternative to completion of face-to-face interviews, and that choice of interview type does not affect the rate of applicant admission to the residency program. Web-based interviews may be of particular interest to applicants applying to a large number of programs, or with financial limitations

Diffusive behavior of a greedy traveling salesman

Using Monte Carlo simulations we examine the diffusive properties of the greedy algorithm in the d-dimensional traveling salesman problem. Our results show that for d=3 and 4 the average squared distance from the origin is proportional to the number of steps t. In the d=2 case such a scaling is modified with some logarithmic corrections, which might suggest that d=2 is the critical dimension of the problem. The distribution of lengths also shows marked differences between d=2 and d>2 versions. A simple strategy adopted by the salesman might resemble strategies chosen by some foraging and hunting animals, for which anomalous diffusive behavior has recently been reported and interpreted in terms of Levy flights. Our results suggest that broad and Levy-like distributions in such systems might appear due to dimension-dependent properties of a search space.Comment: accepted in Phys. Rev.

Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial.

UnlabelledAs life expectancy increases, more patients ≥65 years undergo general anesthesia. Anesthetic agents may contribute to postoperative cognitive dysfunction, and incidence may differ with anesthetic agents or intraoperative anesthesia depth. Responses to anesthetic adjuvants vary among elderly patients. Processed electroencephalography guidance of anesthetic may better ensure equivalent cerebral suppression. This study investigates postoperative cognitive dysfunction differences in elderly patients given desflurane or sevoflurane using processed electroencephalography guidance.IRB approved, randomized trial enrolled consenting patients ≥65 years scheduled for elective surgery requiring general anesthesia ≥120 minute duration. After written informed consent, patients were randomly assigned to sevoflurane or desflurane. No perioperative benzodiazepines were administered. Cognitive impairment was measured by an investigator blinded to group assignment using mini-Mental Status Examination (MMSE) at baseline; 1, 6, and 24 hours after the end of anesthesia. Mean arterial pressure was maintained within 20% of baseline. Anesthetic dose was adjusted to maintain moderate general anesthesia per processed electroencephalograpy (Patient State Index 25 to 50). The primary outcome measure was intergroup difference in MMSE change 1 hour after anesthesia (median; 95% confidence interval).110 patients consented; 26 were not included for analysis (no general anesthesia; withdrew consent; baseline MMSE abnormality; inability to perform postoperative MMSE; data capture failure); 47 sevoflurane and 37 desflurane were analyzed. There were no significant differences in patient characteristics; intraoperative mean blood pressure (desflurane 86.4; 81.3 to 89.6 versus sevoflurane 82.5; 80.2 to 86.1 mmHg; p = 0.42) or Patient State Index (desflurane 41.9; 39.0 to 44.0 versus sevoflurane 41.0; 37.5 to 44.0; p = 0.60) despite a lower MAC fraction in desflurane (0.82; 0.77 to 0.86) versus sevoflurane (0.96; 0.91 to 1.03; p &lt; 0.001). MMSE decreased 1 hour after anesthesia (p &lt; 0.001). The decrease at one hour was larger in sevoflurane (-2.5; -3.3 to -1.8) than desflurane (-1.3; -2.2 to -0.5; p = 0.03). MMSE returned to baseline by 6 hours after anesthesia.ConclusionsFor elderly patients in whom depth of anesthesia is maintained in the moderate range, both desflurane and sevoflurane are associated with transient decreases in cognitive function as measured by MMSE after anesthesia, with clinically insignificant differences between them in this setting.Trial registryClinicalTrials.gov NCT01199913

Timing of the 2008 Outburst of SAX J1808.4-3658 with XMM-Newton: A Stable Orbital Period Derivative over Ten Years

We report on a timing analysis performed on a 62-ks long XMM-Newton observation of the accreting millisecond pulsar SAX J1808.4-3658 during the latest X-ray outburst that started on September 21, 2008. By connecting the time of arrivals of the pulses observed during the XMM observation, we derived the best-fit orbital solution and a best-fit value of the spin period for the 2008 outburst. Comparing this new set of orbital parameters and, in particular, the value of the time of ascending-node passage with the orbital parameters derived for the previous four X-ray outbursts of SAX J1808.4-3658 observed by the PCA on board RXTE, we find an updated value of the orbital period derivative, which turns out to be $\dot P_{\rm orb} = (3.89 \pm 0.15) \times 10^{-12}$ s/s. This new value of the orbital period derivative agrees with the previously reported value, demonstrating that the orbital period derivative in this source has remained stable over the past ten years. Although this timespan is not sufficient yet for confirming the secular evolution of the system, we again propose an explanation of this behavior in terms of a highly non-conservative mass transfer in this system, where the accreted mass (as derived from the X-ray luminosity during outbursts) accounts for a mere 1% of the mass lost by the companion.Comment: 4 pages, 3 figures. Final version, including editing corrections, to appear on A&A Letter

The role of Volatile Anesthetics in Cardioprotection: a systematic review.

This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery

Spectral triangulation molecular contrast optical coherence tomography with indocyanine green as the contrast agent

We report a new molecular contrast optical coherence tomography (MCOCT) implementation that profiles the contrast agent distribution in a sample by measuring the agent's spectral differential absorption. The method, spectra triangulation MCOCT, can effectively suppress contributions from spectrally dependent scatterings from the sample without a priori knowledge of the scattering properties. We demonstrate molecular imaging with this new MCOCT modality by mapping the distribution of indocyanine green, a FDA-approved infrared red dye, within a stage 54 Xenopus laevis