Impact of prehospital care on outcomes in sepsis : a systematic review

Introduction: Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients. Methoda: We systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation) methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations to report findings. Results: Nine studies met the eligibility criteria – one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted. Conclusion: There is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient’s passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking. [West J Emerg Med. 2017;17(4)427-437.

Multiple foil lunar environmental analyser (FLEA package) for the evaluation of meteoroid primary impact penetration, radiant, velocity and composition, meteoroid impact ejecta and comminution products, solar wind composition, medium energy solar flare composition, solar wind sputter rate, meteoroid bumper efficiency

The conception of a multiple thin foil sensor has been investigated and is suggested as a very valuable tool for the accumulation of data over long exposure periods on the lunar surface. Data will lead to the evaluation of specific parameters of the meteor environment, of the solar wind spectrum and of the overall environmental erosion rates from both impact and sputtering.by J.A.M. McDonnell and Otto E. Berg.Summary -- Introduction -- Proposal -- Scientific background -- Environmental stability of FLEA system -- Data evaluation -- Support details and personne

A randomized, controlled trial to assess a novel colorectal cancer screening strategy: the conversion strategy

Our study was a randomized, controlled trial to assess a novel strategy that provides comprehensive colorectal cancer screening in a single visit versus traditional sigmoidoscopy and, where appropriate, colonoscopy on a subsequent day. METHODS : Consecutive patients referred for screening were randomized to control or so-called “conversion” groups. Patients in the control group were prepared for sigmoidoscopy with oral phospho-soda. Those with an abnormal sigmoidoscopy were scheduled for colonoscopy on a future day after oral polyethylene glycol preparation. In the conversion group, patients were prepared with oral phospho-soda. Patients with a polyp >5 mm or multiple diminutive polyps were converted from sigmoidoscopy to colonoscopy, allowing comprehensive screening in a single visit. Clinical outcomes were assessed by postprocedure physician and patient questionnaires. RESULTS : Two hundred thirty-five patients were randomized (control = 121, conversion = 114). In the control group, 28% had an indication for colonoscopy. Three of 33 (9%) with an abnormal sigmoidoscopy did not return for colonoscopy. At colonoscopy, 27% had a proximal adenoma. In the conversion group, 28% had an abnormal sigmoidoscopy and underwent conversion to colonoscopy. Forty-one percent undergoing colonoscopy in the conversion group had a proximal adenoma. Physicians reported no differences in preparation or procedure difficulty, whereas patients reported no differences in the level of comfort or overall satisfaction between groups. When queried regarding preferences for future screening, 96% chose the conversion strategy. CONCLUSIONS : The conversion strategy led to similar outcomes compared to traditional screening while improving compliance with colonoscopy in patients with an abnormal sigmoidoscopy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73097/1/j.1572-0241.2000.02231.x.pd

3 - 14 Micron Spectroscopy of Comets C/2002 O4 (Honig), C/2002 V1 (NEAT), C/2002 X5 (Kudo-Fujikawa), C/2002 Y1 (Juels-Holvorcem), 69P/Taylor, and the Relationships among Grain Temperature, Silicate Band Strength and Structure among Comet Families

We report 3 - 13 micron spectroscopy of 4 comets observed between August 2002 and February 2003: C/2002 O4 (Honig) on August 1, 2002, C/2002 V1 (NEAT) on Jan. 9 and 10, 2003, C/2002 X5 (Kudo-Fujikawa) on Jan. 9 and 10, 2003, and C/2002 Y1 (Juels-Holvorcem) on Feb. 20, 2003. In addition, we include data obtained much earlier on 69P/Taylor (February 9, 1998) but not previously published. For Comets Taylor, Honig, NEAT, and Kudo-Fujikawa, the silicate emission band was detected, being approximately 23%, 12%, 15%, and 10%, respectively, above the continuum. The data for Comet Juels-Holvorcem were of insufficient quality to detect the presence of a silicate band of comparable strength to the other three objects, and we place an upper limit of 24% on this feature. The silicate features in both NEAT and Kudo-Fujikawa contained structure indicating the presence of crystalline material. Combining these data with those of other comets, we confirm the correlation between silicate band strength and grain temperature of Gehrz & Ney (1992) and Williams et al. (1997) for dynamically new and long period comets, but the majority of Jupiter family objects may deviate from this relation. The limited data available on Jupiter family objects suggest that they may have silicate bands that are slightly different from the former objects. Finally, when compared to the silicate emission bands observed in pre-main sequence stars, the dynamically new and long period comets most closely resemble the more evolved stellar systems, while the limited data (in quantity and quality) on Jupiter family objects seem to suggest that these have spectra more like the less-evolved stars.Comment: 45 pages, 12 figure

Assessment of rotator cuff repair integrity using ultrasound and magnetic resonance imaging in a multicenter study

Background: This study compared ultrasound and magnetic resonance imaging (MRI) evaluation of the repaired rotator cuff to determine concordance between these imaging studies. Methods: We performed a concordance study using the data from a prospective nonrandomized multicenter study at 13 centers. A suture bridge technique was used to repair 113 rotator cuff tears that were between 1 and 4 cm wide. Repairs were evaluated with MRI and ultrasound at multiple time points after surgery. The MRI scans were read by a central radiologist and the surgeon, and the ultrasounds were read by a local radiologist or the surgeon who performed the ultrasound. Results: The concordance between the central radiologist's MRI reading and the investigator's MRI readings at all time points was 89%, with a k coefficient of 0.60. The concordance between the central radiologist's MRI and ultrasound readings at all time points was 85%, with a k coefficient of 0.40. The concordance between the investigator's MRI and ultrasound readings was 92%, with a k coefficient of 0.70. Conclusions: In the community setting, ultrasound may be used to evaluate the integrity of a repaired rotator cuff tendon and constitutes a comparable alternative to MRI when evaluating the integrity of a rotator cuff repair. Clinical investigators should compare their postoperative ultrasound results with their postoperative MRI results for a certain time period to establish the accuracy of ultrasound before relying solely on ultrasound imaging to evaluate the integrity of their rotator cuff repairs. Level of evidence: Level III, Diagnostic Study

Recombinant Acid Ceramidase Reduces Inflammation and Infection in Cystic Fibrosis.

Rationale: In cystic fibrosis the major cause of morbidity and mortality is lung disease characterized by inflammation and infection. The influence of sphingolipid metabolism is poorly understood with a lack of studies using human airway model systems. Objectives: To investigate sphingolipid metabolism in cystic fibrosis and the effects of treatment with recombinant human acid ceramidase on inflammation and infection. Methods: Sphingolipids were measured using mass spectrometry in fully-differentiated cultures of primary human airway epithelial cells and co-cultures with Pseudomonas aeruginosa. In situ activity assays, Western blotting and quantitative polymerase chain reaction were used to investigate function and expression of ceramidase and sphingomyelinase. Effects of treatment with recombinant human acid ceramidase on sphingolipid profile and inflammatory mediator production were assessed in cell cultures and murine models. Measurements and Main Results: Ceramide is increased in cystic fibrosis airway epithelium due to differential function of enzymes regulating sphingolipid metabolism. Sphingosine, a metabolite of ceramide with antimicrobial properties, is not upregulated in response to Pseudomonas aeruginosa by cystic fibrosis airway epithelia. Tumor necrosis factor receptor 1 is increased in the apical membrane of cystic fibrosis epithelia and activates NF-κB signaling, generating inflammation. Treatment with recombinant human acid ceramidase, to decrease ceramide, reduced both inflammatory mediator production and susceptibility to infection. Conclusions: Sphingolipid metabolism is altered in airway epithelial cells cultured from people with cystic fibrosis. Treatment with recombinant acid ceramidase ameliorates the two pivotal features of cystic fibrosis lung disease, inflammation and infection, and thus represents a therapeutic approach worthy of further exploration. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)