A fresh look at paralytics in the critically ill: real promise and real concern.

Neuromuscular blocking agents (NMBAs), or "paralytics," often are deployed in the sickest patients in the intensive care unit (ICU) when usual care fails. Despite the publication of guidelines on the use of NMBAs in the ICU in 2002, clinicians have needed more direction to determine which patients would benefit from NMBAs and which patients would be harmed. Recently, new evidence has shown that paralytics hold more promise when used in carefully selected lung injury patients for brief periods of time. When used in early acute respiratory distress syndrome (ARDS), NMBAs assist to establish a lung protective strategy, which leads to improved oxygenation, decreased pulmonary and systemic inflammation, and potentially improved mortality. It also is increasingly recognized that NMBAs can cause harm, particularly critical illness polyneuromyopathy (CIPM), when used for prolonged periods or in septic shock. In this review, we address several practical considerations for clinicians who use NMBAs in their practice. Ultimately, we conclude that NMBAs should be considered a lung protective adjuvant in early ARDS and that clinicians should consider using an alternative NMBA to the aminosteroids in septic shock with less severe lung injury pending further studies

Can\u27t You Smell That Smell? Clean Air Act Fixes for Factory Farm Air Pollution

Massive facilities that keep large numbers of livestock have overtaken small, independent farms as the primary source of meat, eggs, and dairy in the United States. These concentrated animal feeding operations ( CAFOs) compare more to industrial manufacturing operations than to traditional farms, and emit huge quantities of air pollutants that are harmful to public health, sickening people and damaging the environment. The Environmental Protection Agency ( EPA ) possesses statutorily provided tools under the Clean Air Act that it uses to regular other polluting industries. However, this article - after reviewing the rise of CAFOs, examining the threats they pose, and surveying current regulation - suggests that the EPA\u27s approach to CAFOs is grossly inadequate. The article argues that the agency, under the Clean Air Act, should regulate the emissions of hydrogen sulfide and ammonia, two pollutants for which factory farms are major sources. This approach is incomplete, however. Pollutant-based regulation is both overbroad in that it will regulate other sources of these pollutants and underbroad because CAFO air pollution includes more than just these pollutants. The EPA should therefore additionally or alternatively rely on a more thorough and flexible pollution source-specific tool, the New Source Performance Standards ( NSPS ). NSPS are analogous to the rigorous source-specific approach used to regulate CAFO water pollution under the Clean Water Act, and will provide a comprehensive antidote to the ills of modern, industrial animal agriculture

Intermittent Presumptive Treatment for Malaria

A better understanding of the pharmacodynamics of intermittent presumptive treatment, says White, will guide more rational policymakin

Goodwillie towers and chromatic homotopy: an overview

This paper is based on talks I gave in Nagoya and Kinosaki in August of 2003. I survey, from my own perspective, Goodwillie's work on towers associated to continuous functors between topological model categories, and then include a discussion of applications to periodic homotopy as in my work and the work of Arone-Mahowald.Comment: This is the version published by Geometry & Topology Monographs on 29 January 200

Impact of Sexuality on the Ultimatum Game

This project focuses on the ultimatum game—an experiment done by many economists to determine levels of altruism, fairness, equality, and financial responsibility individuals possess. It involves two players bargaining over a sum of money and is often used as a proxy for how people manage their income, negotiate for salaries, or think about fairness. Many identities have been tested, such as age, race, and gender, and while differences have been found based on gender, nobody has controlled the study for sexuality. The goal of this study was to determine whether sexuality has an impact on the results of the ultimatum game specifically by comparing gay and straight men. A total of 18 gay men and 30 straight men participated in this game. I analyzed the means of each group’s data points using t-tests and ran two regressions with variables collected in the demographic survey; ultimately, there was little difference in offers made or minimum acceptance thresholds based on sexuality. Therefore, it is impossible to reject the hypothesis that there is no significant difference between the way in which straight and gay males play the ultimatum game. The results suggest that gay and straight men do not act differently when given the prompts of this game, thus they may make similar financial decisions and bargaining choices