Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients

BACKGROUND: Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements. METHODS: In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2–D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH). RESULTS: SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R2 = 0.48 to 0.52) compared to initial BD (R2 = 0.32) and minimum pH (R2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH. CONCLUSION: SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury. LEVEL OF EVIDENCE: Prognostic study, level III

SHOCK VOLUME: A PRECISION MEDICINE BASED INDEX THAT PREDICTS TRANSFUSION REQUIREMENTS AND ORGAN DYSFUNCTION IN MULTIPLY INJURED PATIENTS

poster abstractIntroduction: Multiply injured patients (MIPs) in hemorrhagic shock develop oxygen debt, which causes organ dysfunction and can lead to death. Clinicians monitor hypoperfusion by interpreting progression of traditional hemodynamic measures along with serum markers of hypoperfusion, which reflect current hemodynamic and metabolic status. However, these indices are sampled at discrete time points and poorly reflect cumulative hypoperfusion. Shock Volume (SV) is a novel, non-invasive, patient-specific index developed to quantify cumulative hypoperfusion. SV integrates the time and magnitude of shock index (Heart Rate/Systolic Blood Pressure) values above 0.9 (known threshold of hypoperfusion) using serial individual vital sign data. SV can be monitored in real time to assess ongoing hypoperfusion. The goal of this study was to determine how SV corresponded to transfusion requirements and organ dysfunction. Methods: SV was measured in six hour increments for 48 hours after injury in a retrospective cohort of 74 MIPs (18-65; Injury Severity Score > 18). SV was compared to base deficit (BD) in predicting mass transfusions (MT) and critical administration transfusions (CATs). Presence of multiple organ failure (MOF) was determined using the Denver Organ Failure assessment score, while Sequential Organ Failure Assessment scores were used to determine magnitude of organ dysfunction. Results: Patients who had accumulated 40 units of SV within six hours of injury and 100 units of SV within twelve hours of injury were at high risk for requiring MT or multiple CATs. SV measurements were equally sensitive and specific as compared to BD values in predicting transfusions. SV measurements at six hours after injury stratified patients at risk for MOF and corresponded to the magnitude of organ failure. Conclusions: SV is a patient-specific index that can be quantified in real-time in critically injured patients. SV is a non-invasive surrogate for cumulative hypoperfusion and predicts high volume transfusions and organ dysfunction

Horizontal And Vertical Movements Of Juvenile Bluefin Tuna (Thunnus Thynnus), In Relation To Oceanographic Conditions Of The Western North Atlantic, Determined With Ultrasonic Telemetry

We employed ultrasonic transmitters to follow (for up to 48 h) the horizontal and vertical movements of five juvenile (6.8-18.7 kg estimated body mass) bluefin tuna (Thunnus thynnus) in the western North Atlantic (off the eastern shore of Virginia). Our objective was to document the fishes\u27 behavior and distribution in relation to oceanographic conditions and thus begin to address issues that currently limit population assessments based on aerial surveys. Estimation of the trends in adult and juvenile Atlantic bluefin tuna abundance by aerial surveys, and other fishery-independent measures, is considered a priority. Juvenile bluefin tuna spent the majority of their time over the continental shelf in relatively shallow water (generally less then 40 m deep). Fish used the entire water column in spite of relatively steep vertical thermal gradients (approximate to24degreesC at the surface and approximate to12degreesC at 40 m depth), but spent the majority of their time (approximate to90%) above 15 m and in water warmer then 20degreesC, Mean swimming speeds ranged from 2.8 to 3.3 knots, and total distance covered from 152 to 289 km (82-156 nmi). Because fish generally remained within relatively confined areas, net displacement was only 7.7-52.7 km (4.1-28.4 nmi). Horizontal movements were not correlated with sea surface temperature. We propose that it is unlikely that juvenile bluefin tuna in this area can detect minor horizontal temperature gradients (generally less then 0.5degreesC/km) because of the steep vertical temperature gradients (up to approximate to0.6degreesC/m) they experience during their regular vertical movements. In contrast, water clarity did appear to influence behavior because the fish remained in the intermediate water mass between the turbid and phytoplankton-rich plume exiting Chesapeake Bay (and similar coastal waters) and the clear oligotrophic water east of the continental shelf

Iron Mountain: A Journal of Magical Religion (Artemisia Press) 1, no.4 (Spring 1986).

Permission for the creation of this digital asset was granted by Chas S. Clifton who also graciously loaned his personal copies to be digitized for inclusion in Valdosta State University Archives and Special Collections’ New Age Movements, Occultism, and Spiritualism Research Library. On the Slopes of Iron Mountain -- Letters to the Editor: Doreen Valiente -- Re-vamping the World: On the Return of the Holy Prostitute / by Deena Metzger -- Magical Religion Pervades Brazil / by Carol Dow, Ph.D. -- Book Reviews: Straight With the Medicine: Narratives of Washoe Followers of the Tipi Way as told to Warren L. D’Azevedo / by Greg Heming ; Dancers to the Gods: The Magical Records of Charles Seymour and Christine Hartley 1937-1939 / Edited and introduced by Alan Richardson / by Chas S. Clifton ; Deviance and Moral Boundaries: Witchcraft, the Occult Science Fiction Deviant Sciences and Scientists by Nachman Ben-Yehuda ; Magical Blend ; Shaman’s Drum ; Gnosis ; Handbooks for Urban Shamans by Church of Seven Arrows ; The Kwan Yin Book of Changes by Diane Stein ; Don Juan, Mescalito and Modern Magic: The Mythology of Inner Space by Nevill Drury ; The Witches’ Qabala: Book 1, The Goddess and the Tree by Ellen Cannon Reed / by Carrie Brennan ; The Sacred Paw: The Bear in Nature, Myth and Literature by Paul Shepard and Barry Sanders ; Asatru Anthology by Asatru Free Assembly ; Cunningham’s Encyclopedia of Magical Herbs by Scott Cunningham -- Photographs by Carol Dow: The Blending of elements from several traditions is apparent in the furnishing of this altar ; Food, flowers and candles are offered to Yemanjá on a Beach in Rio de Janeiro ; White-clad Worshippers Gather on Rio Beach for festival of YemanjáIron Mountain was Chas Clifton’s attempt to bring together the “professors and the practitioners” into a single source and provided an avenue for the Wiccans and Pagans being studied to respond to research being done on them. Although only four issues were published the contents are well stocked with articles and rebuttals from contemporary scholars and practitioners recognized as shapers of the Wiccan movement that we know today. It is a publication “devoted to the exploration of religious forms, practices, both ancient and modern, which emphasize the magical, shamanic and metaphysical elements.” Articles are topped off with reviews, poetry, artwork and photographs. It also holds the honor for being the inspiration of the first Pagan peer-reviewed Journal: The Pomegranate

WHOOPING CRANE STAY LENGTH IN RELATION TO STOPOVER SITE CHARACTERISTICS

Whooping crane (Grus americana) migratory stopovers can vary in length from hours to more than a month. Stopover sites provide food resources and safety essential for the completion of migration. Factors such as weather, climate, demographics of migrating groups, and physiological condition of migrants influence migratory movements of cranes (Gruidae) to varying degrees. However, little research has examined the relationship between habitat characteristics and stopover stay length in cranes. Site quality may relate to stay length with longer stays that allow individuals to improve body condition, or with shorter stays because of increased foraging efficiency. We examined this question by using habitat data collected at 605 use locations from 449 stopover sites throughout the United States Great Plains visited by 58 whooping cranes from the Aransas–Wood Buffalo Population tracked with platform transmitting terminals. Research staff compiled land cover (e.g., hectares of corn; landscape level) and habitat metric (e.g., maximum water depth; site level) data for day use and evening roost locations via site visits and geospatial mapping. We used Random Forest regression analyses to estimate importance of covariates for predicting stopover stay length. Site-level variables explained 9% of variation in stay length, whereas landscape-level variables explained 43%. Stay length increased with latitude and the proportion of land cover as open-water slough with emergent vegetation as well as alfalfa, whereas stay length decreased as open-water lacustrine wetland land cover increased. At the site level, stopover duration increased with wetted width at riverine sites but decreased with wetted width at palustrine and lacustrine wetland sites. Stopover duration increased with mean distance to visual obstruction as well as where management had reduced the height of vegetation through natural (e.g., grazing) or mechanical (e.g., harvesting) means and decreased with maximum water depth. Our results suggest that stopover length increases with the availability of preferred land cover types for foraging. High quality stopover sites with abundant forage resources may help whooping cranes maintain fat reserves important to their annual life cycle

Tamoxifen-Induced Cre-loxP Recombination Is Prolonged in Pancreatic Islets of Adult Mice

Tamoxifen (Tm)-inducible Cre recombinases are widely used to perform gene inactivation and lineage tracing studies in mice. Although the efficiency of inducible Cre-loxP recombination can be easily evaluated with reporter strains, the precise length of time that Tm induces nuclear translocation of CreERTm and subsequent recombination of a target allele is not well defined, and difficult to assess. To better understand the timeline of Tm activity in vivo, we developed a bioassay in which pancreatic islets with a Tm-inducible reporter (from Pdx1PB-CreERTm;R26RlacZ mice) were transplanted beneath the renal capsule of adult mice previously treated with three doses of 1 mg Tm, 8 mg Tm, or corn oil vehicle. Surprisingly, recombination in islet grafts, as assessed by expression of the β-galactosidase (β-gal) reporter, was observed days or weeks after Tm treatment, in a dose-dependent manner. Substantial recombination occurred in islet grafts long after administration of 3×8 mg Tm: in grafts transplanted 48 hours after the last Tm injection, 77.9±0.4% of β-cells were β-gal+; in β-cells placed after 1 week, 46.2±5.0% were β-gal+; after 2 weeks, 26.3±7.0% were β-gal+; and after 4 weeks, 1.9±0.9% were β-gal+. Islet grafts from mice given 3×1 mg Tm showed lower, but notable, recombination 48 hours (4.9±1.7%) and 1 week (4.5±1.9%) after Tm administration. These results show that Tm doses commonly used to induce Cre-loxP recombination may continue to label significant numbers of cells for weeks after Tm treatment, possibly confounding the interpretation of time-sensitive studies using Tm-dependent models. Therefore, investigators developing experimental approaches using Tm-inducible systems should consider both maximal recombination efficiency and the length of time that Tm-induced Cre-loxP recombination occurs

Genome-wide association and functional follow-up reveals new loci for kidney function

Chronic kidney disease (CKD) is an important public health problem with a genetic component. We performed genome-wide association studies in up to 130,600 European ancestry participants overall, and stratified for key CKD risk factors. We uncovered 6 new loci in association with estimated glomerular filtration rate (eGFR), the primary clinical measure of CKD, in or near MPPED2, DDX1, SLC47A1, CDK12, CASP9, and INO80. Morpholino knockdown of mpped2 and casp9 in zebrafish embryos revealed podocyte and tubular abnormalities with altered dextran clearance, suggesting a role for these genes in renal function. By providing new insights into genes that regulate renal function, these results could further our understanding of the pathogenesis of CKD

Binary systems and their nuclear explosions

Peer ReviewedPreprin

Climate response to projected changes in short-lived species under an A1B scenario from 2000-2050 in the GISS climate model

We investigate the climate forcing from and response to projected changes in short-lived species and methane under the A1B scenario from 2000-2050 in the GISS climate model. We present a meta-analysis of new simulations of the full evolution of gas and aerosol species and other existing experiments with variations of the same model. The comparison highlights the importance of several physical processes in determining radiative forcing, especially the effect of climate change on stratosphere-troposphere exchange, heterogeneous sulfate-nitrate-dust chemistry, and changes in methane oxidation and natural emissions. However, the impact of these fairly uncertain physical effects is substantially less than the difference between alternative emission scenarios for all short-lived species. The net global mean annual average direct radiative forcing from the short-lived species is .02 W/m{sup 2} or less in our projections, as substantial positive ozone forcing is largely offset by negative aerosol direct forcing. Since aerosol reductions also lead to a reduced indirect effect, the global mean surface temperature warms by {approx}0.07 C by 2030 and {approx}0.13 C by 2050, adding 19% and 17%, respectively, to the warming induced by long-lived greenhouse gases. Regional direct forcings are large, up to 3.8 W/m{sup 2}. The ensemble-mean climate response shows little regional correlation with the spatial pattern of the forcing, however, suggesting that oceanic and atmospheric mixing generally overwhelms the effect of even large localized forcings. Exceptions are the polar regions, where ozone and aerosols may induce substantial seasonal climate changes