Critical Care Ultrasonography and Its Application for COVID-19

Ultrasound has developed as an invaluable tool in diagnosis and proper management in the intensive care unit (ICU). Application of critical care ultrasonography is quite distinct from the routine comprehensive diagnostic ultrasound exam, because the urgent setting mandates a goal-directed approach. Performing accurate and efficient critical care ultrasound requires ultrasound providers to first understand the pathophysiology of the disease and related imaging findings, and then follow the protocols to perform a focused ultrasound exam. In the ongoing coronavirus disease 2019 (COVID-19) pandemic, ultrasound plays an essential role in diagnosing and monitoring critically ill COVID-19 patients in the ICU. Our review focuses on the basics and clinical application of critical care ultrasound in diagnosing common lung disease, COVID-19 pulmonary lesions, pediatric COVID-19, and cardiovascular dysfunction as well as its role in ECMO and interventional ultrasonography

Improving Proficiency in Central Venous Catheter Insertion: Standardized Simulation Based Training for Internal Medicine House Staff

Objectives: The objectives of this study are to assess residents\u27 pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.https://jdc.jefferson.edu/patientsafetyposters/1063/thumbnail.jp

Assessing Variability in End-of-Life Intensity of Care After Out-of-Hospital Cardiac Arrest

Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an opportunity to improve outcomes. In our project, we focus on lifesustaining procedures administered by hospitals upon receiving and admitting individuals experiencing OHCA. We used previously validated measures as defined by Barnato et al as “life sustaining end of life (EOL) measures”:4 • Intubation and mechanical ventilation • Tracheostomy • Gastrostomy tube insertion • Hemodialysis • Enteral/parenteral nutrition • CPRhttps://jdc.jefferson.edu/cwicposters/1035/thumbnail.jp

Arctic Soil Governs Whether Climate Change Drives Global Losses or Gains in Soil Carbon

Key uncertainties in terrestrial carbon cycle projections revolve around the timing, direction, and magnitude of the carbon cycle feedback to climate change. This is especially true in carbon-rich Arctic ecosystems, where permafrost soils contain roughly one third of the world's soil carbon stocks, which are likely vulnerable to loss. Using an ensemble of soil biogeochemical models that reflect recent changes in the conceptual understanding of factors responsible for soil carbon persistence, we quantify potential soil carbon responses under two representative climate change scenarios. Our results illustrate that models disagree on the sign and magnitude of global soil changes through 2100, with disagreements primarily driven by divergent responses of Arctic systems. These results largely reflect different assumptions about the nature of soil carbon persistence and vulnerabilities, underscoring the challenges associated with setting allowable greenhouse gas emission targets that will limit global warming to 1.5°C

War of the Worlds Revisited: The Effect of Watching The Day After on Mood State

In the fall of 1983, The Day After, a fictional account of a nuclear attack on a civilian population, was broadcast on television in the United States and viewed by I00 million Americans . The Day After was said to differ from previous movie treatments of nuclear war by the vividness with which it forced its audience to experience the ground zero effects of a nuclear blast on human beings (I) . In what was described as the most horrifically searing footage ever to pass a network censor, the audience was shown group immolation, a carnage of mass vaporization and graphic images of death (I). It was widely predicted that this movie would have stressful psychological effects because it dealt with a potentially real disaster. Warnings of possible psychiatric side effects of the film were issued by the American Psychiatric Association , the American Academy of Child Psychiatry, the American Academy of Pediatrics, and the American Broadcasting Company (1,2,3). So seriously were these warnings taken that the Federal Emergency Management Agency increased its staffing in anticipation of the movie\u27s psychological fallout (2). After the movie was shown, however, there was little systematic documentation of its psychological effects on the public. Since similarly graphic movies addressing the effects of nuclear war continue to be released and a replanned for the future, we feel the issue of the psychological effects of these films remains salient

Splenic infarction: an update on William Osler\u27s observations.

BACKGROUND: Osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a peritoneal friction rub. Splenic infarction is classically associated with bacterial endocarditis and sickle cell disease. OBJECTIVES: To describe the contemporary experience of splenic infarction. METHODS: We conducted a chart review of inpatients diagnosed with splenic infarction in a Jerusalem hospital between 1990 and 2003. RESULTS: We identified 26 cases with a mean age of 52 years. Common causes were hematologic malignancy (six cases) and intracardiac thrombus (five cases). Only three cases were associated with bacterial endocarditis. In 21 cases the splenic infarction brought a previously undiagnosed underlying disease to attention. Only half the subjects complained of localized left-sided abdominal pain, 36% had left-sided abdominal tenderness; 31% had no signs or symptoms localized to the splenic area, 36% had fever, 56% had leukocytosis and 71% had elevated lactate dehydrogenase levels. One splenectomy was performed and all patients survived to discharge. A post hoc analysis demonstrated that single infarcts were more likely to be associated with fever (20% vs. 63%, p \u3c 0.05) and leukocytosis (75% vs. 33%, P = 0.06) CONCLUSIONS: The clinical presentation of splenic infarction in the modern era differs greatly from the classical teaching, regarding etiology, signs and symptoms. In patients with unexplained splenic infarction, investigation frequently uncovers a new underlying diagnosis

Deletion of annexin 2 light chain p11 in nociceptors causes deficits in somatosensory coding and pain behavior

The S100 family protein p11 (S100A10, annexin 2 light chain) is involved in the trafficking of the voltage-gated sodium channel Na(V)1.8, TWIK-related acid-sensitive K+ channel (TASK-1), the ligand-gated ion channels acid-sensing ion channel 1a (ASIC1a) and transient receptor potential vanilloid 5/6 (TRPV5/V6), as well as 5-hydroxytryptamine receptor 1B (5-HT1B), a G-protein-coupled receptor. To evaluate the role of p11 in peripheral pain pathways, we generated a loxP-flanked (floxed) p11 mouse and used the Cre-loxP recombinase system to delete p11 exclusively from nociceptive primary sensory neurons in mice. p11-null neurons showed deficits in the expression of NaV1.8, but not of annexin 2. Damage-sensing primary neurons from these animals show a reduced tetrodotoxin-resistant sodium current density, consistent with a loss of membrane-associated NaV1.8. Noxious coding in wide-dynamic-range neurons in the dorsal horn was markedly compromised. Acute pain behavior was attenuated in certain models, but no deficits in inflammatory pain were observed. A significant deficit in neuropathic pain behavior was also apparent in the conditional-null mice. These results confirm an important role for p11 in nociceptor function

Observation of fractional quantum Hall effect in an InAs quantum well

The two-dimensional electron system in an InAs quantum well has emerged as a prime candidate for hosting exotic quasi-particles with non-Abelian statistics such as Majorana fermions and parafermions. To attain its full promise, however, the electron system has to be clean enough to exhibit electron-electron interaction phenomena. Here we report the observation of fractional quantum Hall effect in a very low disorder InAs quantum well with a well-width of 24 nm, containing a two-dimensional electron system with a density $n=7.8 \times 10^{11}$ cm$^{-2}$ and low-temperature mobility $1.8 \times 10^6$ cm$^2$/Vs. At a temperature of $\simeq35$ mK and $B\simeq24$ T, we observe a deep minimum in the longitudinal resistance, accompanied by a nearly quantized Hall plateau at Landau level filling factor $\nu=4/3$