Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians – an observational study

Background: Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge. Methods: During a 3.5 year period, the GS-R was available to be used either as the primary or backup tool for pre-hospital intubation by anaesthesia trained EP with limited expertise using angulated videolaryngoscopes. Results: During this period 672 patients needed pre-hospital intubation of which the GS-R was used in 56 cases. The overall GS-R success rate was 66 % (range of 34–100 % among EP). The reasons for difficulties or failure included inexperience of the EP with the GS-R, impaired view due to secretion, vomitus, blood or the inability to see the screen in very bright environment due to sunlight. Conclusion: Special expertise and substantial training is needed to successfully accomplish tracheal intubation with the GS-R in the pre-hospital setting. Providers inexperienced with DL as well as video-assisted intubation should not expect to be able to perform tracheal intubation easily just because a videolaryngoscope is available. Additionally, indirect laryngoscopy might be difficult or even impossible to achieve in the pre-hospital setting due to impeding circumstances such as blood, secretions or bright sun-light. Therefore, videolaryngoscopes, here the GS-R, should not be considered as the “Holy Grail” of endotracheal intubation, neither for the experts nor for inexperienced providers. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0069-2) contains supplementary material, which is available to authorized users

Proton Radiation Hardness of Perovskite Tandem Photovoltaics.

Monolithic [Cs0.05(MA0. 17FA0. 83)0.95]Pb(I0.83Br0.17)3/Cu(In,Ga)Se2 (perovskite/CIGS) tandem solar cells promise high performance and can be processed on flexible substrates, enabling cost-efficient and ultra-lightweight space photovoltaics with power-to-weight and power-to-cost ratios surpassing those of state-of-the-art III-V semiconductor-based multijunctions. However, to become a viable space technology, the full tandem stack must withstand the harsh radiation environments in space. Here, we design tailored operando and ex situ measurements to show that perovskite/CIGS cells retain over 85% of their initial efficiency even after 68 MeV proton irradiation at a dose of 2 × 1012 p+/cm2. We use photoluminescence microscopy to show that the local quasi-Fermi-level splitting of the perovskite top cell is unaffected. We identify that the efficiency losses arise primarily from increased recombination in the CIGS bottom cell and the nickel-oxide-based recombination contact. These results are corroborated by measurements of monolithic perovskite/silicon-heterojunction cells, which severely degrade to 1% of their initial efficiency due to radiation-induced recombination centers in silicon.F.L. acknowledges financial support from the Alexander von Humboldt Foundation via the Feodor Lynen program and thanks Prof. Sir R. Friend for supporting his Fellowship at the Cavendish Laboratory. This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (HYPERION, grant agreement number 756962). M.J, A.A.A., E.K., and S.A. acknowledge financial support from the German Federal Ministry of Education and Research (BMBF) via program “Materialforschung für die Energiewende” (grant no. 03SF0540), by the German Federal Ministry for Economic Affairs and Energy (BMWi) through the ‘PersiST’ project (Grant No. 0324037C). T.B. C.A.K. and R.S. acknowledge funding by BMWi through the speedCIGS (grant no. 0324095E) and EFFCIS project (grant no. 0324076D). D.K. and M.C. acknowledge financial support from the Dutch Ministry of Economic Affairs, via The Top-consortia Knowledge and Innovation (TKI) Program ‘‘Photovoltaic modules based on a p-i-n stack, manufactured on a roll-to-roll line featuring high efficiency, stability and strong market perspective’’ (PVPRESS) (TEUE118010) and “Bridging the voltage gap” (BRIGHT) (1721101). K. F. acknowledges the George and Lilian Schiff Fund, the Engineering and Physical Sciences Research Council (EPSRC), the Winton Sustainability Fellowship, and the Cambridge Trust for funding. S.D.S. acknowledges the Royal Society and Tata Group (UF150033). The authors acknowledge the EPSRC for funding (EP/R023980/1). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 841265. A.R.B. acknowledges funding from a Winton Studentship, Oppenheimer Studentship, and funding from the Engineering and Physical Sciences Research Council (EPSRC) Doctoral Training Centre in Photovoltaics (CDT-PV). K.G. acknowledges the Polish Ministry of Science and Higher Education within the Mobilnosc Plus program (Grant No. 1603/MOB/V/2017/0)

Burn Injury–Induced Alterations in Wound Inflammation and Healing Are Associated with Suppressed Hypoxia Inducible Factor-1α Expression

A major complication associated with burn injury is delayed wound healing. While healing of the burn injury site is essential, healing of distal injury sites caused by surgical interventions and other processes also is important. The impact of burn injury on healing of these distal wound sites is not understood clearly. To study this, mice were subjected to major burn injury or a sham procedure. Immediately following, excisional wounds were made on the dorsal surface caudal to the burn site and wound closure was monitored over a 7-d period by planimetry. In a second series of experiments, plasma and excisional wounds were collected for in vitro analysis of cyto- and chemokine levels, L-arginine metabolism, and hypoxia-inducible factor (HIF)-1α expression. At 1–7 d post-injury, a significant inflammatory response was evident in both groups, but the healing process was delayed in the burn-injured mice. At 3 d post-injury, wound levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and keratinocyte-derived chemokine were suppressed in the burn group. This difference in the wound inflammatory response was independent of changes in L-arginine metabolism (nitrate levels, inducible nitric oxide synthase expression, arginase activity), but correlated with a marked reduction in HIF-1α protein levels. In conclusion, these findings suggest that HIF-1α and the inflammatory response play a significant role in wound healing, and reduced levels of HIF-1α contribute to the impaired healing response post-burn