Rewarming Severe Hypothermia Using Esophageal Temperature Management Device

Objectives: External rewarming often fails to correct the temperature of patients with severe hypothermia. In these cases, various invasive techniques have classically been utilized, including intubation with heated ventilation, heated peritoneal dialysis, thoracic lavage, gastric or colonic lavage, mediastinal irrigation (in arrest), central venous temperature management catheters, and extracorporeal rewarming. All of the invasive procedures above are associated with various procedural complications, and most of the vascular interventions above are limited to regional centers with the necessary equipment and expertise. Esophageal temperature management (ETM) devices present a novel option for rewarming. While their use in cooling as part of post-arrest targeted temperature management has been well-described, we are only aware of one reported case using an ETM device to reverse hypothermia.1 We aim to add to this knowledge base by describing a patient presenting with altered mental status and severe hypothermia of undetermined cause who was successfully rewarmed using an ETM device.Methods: This is a single patient case report.Results: A 69-year-old female (157.5 cm, 57.4 kg) was admitted from a nursing home with a minimum recorded temperature of 26.9 °C (rectal). The patient’s hypothermia was complicated by sinus arrest with junctional bradycardia and hypotension requiring transcutaneous pacing. After warmed intravenous fluids and warming blanket, the patient’s temperature only improved to 28.7 °C (bladder).At this point, an ETM device was inserted to aid warming, and the patient was successfully rewarmed to 37.2 °C. We observed no major adverse effects. Conclusions: Rewarming from severe hypothermia was possible using the ETM device as the sole invasive rewarming method.https://scholarlycommons.henryford.com/merf2019caserpt/1023/thumbnail.jp

Generation of MLE-15 IRF9 knockdown cells for studying the antimicrobial role of TLRs agonist-induced lung epithelium’s reactive oxygen species

https://openworks.mdanderson.org/sumexp23/1087/thumbnail.jp

Reducing Treble with Performance Focused Music Programs in Medical School: A Student Driven Needs Assessment to Clarify Participation Barriers Amongst Undergraduate Medical Students

Integration of the arts into medical education has numerous benefits, including reducing burnout and producing empathetic physicians. Investment in arts-related activities has expanded considerably. However, funding remains a common limitation for further integration of arts into medical education. Clarifying student preferences and barriers to music programs can optimize such limited resources to best suit medical student needs.https://digitalcommons.unmc.edu/emet_posters/1033/thumbnail.jp

Increases in shared custody after divorce in the United States

Background: While a striking rise in shared physical custody after divorce has been observed in Wisconsin and some European countries, the same trend in shared custody has not been documented in US national data. Objective: We provide new evidence on the time trend in shared physical custody after divorce in the United States. Methods: We use eight waves of data from the Current Population Survey - Child Support Supplement to estimate logit models and conduct a formal decomposition. Results: The likelihood of shared physical custody after divorce more than doubled in the United States from before 1985 until 2010-2014, from 13Š to 34Š. Non-linear probability (logit) models show that non-Hispanic Whites and more advantaged individuals are more likely to report shared physical custody. Both sequential multivariate models and a more formal decomposition show that the increase cannot be explained by changes in the characteristics of those divorcing; rather we find that several characteristics become more strongly associated with shared physical custody over time. Conclusions: Our results suggest that shared physical custody is increasing in the United States as a whole, and this increase appears to reflect changing norms and policies that favor shared custody. These changing patterns have important implications for children's living arrangements and for the parental investments that children receive after their parents' divorce - and more broadly for the rise in inequality across families over recent decades. Contribution: This paper complements previous analyses using court record data from a single US state (Wisconsin) and shows that a large increase in shared physical custody after divorce has occurred in the United States as a whole over the past three decades

Fifty years of spellchecking

A short history of spellchecking from the late 1950s to the present day, describing its development through dictionary lookup, affix stripping, correction, confusion sets, and edit distance to the use of gigantic databases

Genetic variation in the HLA region is associated with susceptibility to herpes zoster.

Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22,981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P>1.0 × 10(-8)). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine

Automated data analysis to rapidly derive and communicate ecological insights from satellite-tag data: A case study of reintroduced red kites

Analysis of satellite-telemetry data mostly occurs long after it has been collected, due to the time and effort needed to collate and interpret such material. Such delayed reporting does reduce the usefulness of such data for nature conservation when timely information about animal movements is required. To counter this problem we present a novel approach which combines automated analysis of satellite-telemetry data with rapid communication of insights derived from such data. A relatively simple algorithm (comprising speed of movement and turning angle calculated from fixes), allowed instantaneous detection of excursions away from settlement areas and automated calculation of home ranges on the remaining data Automating the detection of both excursions and home range calculations enabled us to disseminate ecological insights from satellite-tag data instantaneously through a dedicated web portal to inform conservationists and wider audiences. We recommend automated analysis, interpretation and communication of satellite tag and other ecological data to advance nature conservation research and practice