Hemodynamic Response to Fluid Challenge: A Means of Assessing Volume Status in the Critically Ill

Cardiovascular and oxygen transport variables were studied during fluid challenges in 50 critically ill patients. The results show three distinct patterns of response: hypovolemic, normovolemic, and hypervolemic. Colloid fluid challenge is a rapid, effective diagnostic modality for determination of cardiovascular function in the surgical critical care patient

Posttraumatic Hernia of the Bladder

Fractures of the pelvis occur commonly in patients who are involved in high speed vehicle accidents or who fall from a substantial height. Fortunately, with improved surgical management, these patients usually recover not only from the pelvic fractures but from associated visceral injuries as well. Some survivors of pelvic fractures subsequently develop unusual hernias. We report the case of a man who developed hernia of the urinary bladder following pelvic fracture. Two previous operations had failed to eliminate his hernia. We describe the technique of repair used successfully in this case and review similar reported cases. Surgeons who care for traumatized patients must be alert to the possible presence of a pelvic fracture whenever pelvic laparotomy is performed for visceral injury. Reduction of the fracture and internal fixation are necessary to prevent posttraumatic hernia

E2 strengths and transition radii difference of one-phonon 2+ states of 92Zr from electron scattering at low momentum transfer

Background: Mixed-symmetry 2+ states in vibrational nuclei are characterized by a sign change between dominant proton and neutron valence-shell components with respect to the fully symmetric 2+ state. The sign can be measured by a decomposition of proton and neutron transition radii with a combination of inelastic electron and hadron scattering [C. Walz et al., Phys. Rev. Lett. 106, 062501 (2011)]. For the case of 92Zr, a difference could be experimentally established for the neutron components, while about equal proton transition radii were indicated by the data. Method: Differential cross sections for the excitation of one-phonon 2+ and 3- states in 92Zr have been measured with the (e,e') reaction at the S-DALINAC in a momentum transfer range q = 0.3-0.6 fm^(-1). Results: Transition strengths B(E2;2+_1 -> 0+_1) = 6.18(23), B(E2; 2+_2 -> 0+_1) = 3.31(10) and B(E3; 3-_1 -> 0+_1) = 18.4(11) Weisskopf units are determined from a comparison of the experimental cross sections to quasiparticle-phonon model (QPM) calculations. It is shown that a model-independent plane wave Born approximation (PWBA) analysis can fix the ratio of B(E2) transition strengths to the 2+_(1,2) states with a precision of about 1%. The method furthermore allows to extract their proton transition radii difference. With the present data -0.12(51) fm is obtained. Conclusions: Electron scattering at low momentum transfers can provide information on transition radii differences of one-phonon 2+ states even in heavy nuclei. Proton transition radii for the 2+_(1,2) states in 92Zr are found to be identical within uncertainties. The g.s. transition probability for the mixed-symmetry state can be determined with high precision limited only by the available experimental information on the B(E2; 2+_1 -> 0+_1) value.Comment: 14 pages, 5 figures, submitted to Phys. Rev. C, revised manuscrip

A new CP-approach for a parallel machine scheduling problem with time constraints on machine qualifications

International audienceThis paper considers the scheduling of job families on parallel machines with time constraints on machine qualifications. In this problem, each job belongs to a family and a family can only be executed on a subset of qualified machines. In addition, machines can lose their qualifications during the schedule. Indeed, if no job of a family is scheduled on a machine during a given amount of time, the machine loses its qualification for this family. The goal is to minimize the sum of job completion times, i.e. the flow time, while maximizing the number of qualifications at the end of the schedule. The paper presents a new Constraint Programming (CP) model taking more advantages of the CP feature to model machine disqualifications. This model is compared with two existing models: an Integer Linear Programming (ILP) model and a Constraint Programming model. The experiments show that the new CP model outperforms the other model when the priority is given to the number of disqualifications objective. Furthermore, it is competitive with the other model when the flow time objective is prioritized

Management of Colonic Trauma: Six-Year Experience at Henry Ford Hospital

Surgical management of 114 patients with colonic injuries related to trauma who were treated over a six-year period is reviewed. Eighty-three (73%) injuries were secondary to gunshot wounds. Twenty-six patients (24%) had isolated colonic injuries. The majority of patients (60%)) were treated with colostomies: exteriorization of the injury, repair with proximal colostomy, or resection with colostomy and mucous fistula. Exteriorization of repaired colon, primary repair, and resection with primary anastomosis were performed in 40% of the patients. Six patients (5.3%) in our series died, and 24% had complications directly related to the colon injury. Based on this study, no standard method for treatment of colonic trauma is advised. Colostomy is recommended for patients with massive multiple intra-abdominal injuries and gross fecal contamination. In selected patients, primary repair may be performed

Outbreak investigation and control case report of brucellosis: experience from livestock research centre, Mpwapwa, Tanzania.

This research article published by AOSIS, 2014Brucellosis screening was conducted between 2005 and 2010 at the National Livestock Research Institute headquarters, Mpwapwa, Tanzania, following an abortion storm in cattle. The initial screening targeted breeding herds; 483 cattle were screened using the Rose Bengal Plate Test (RBPT) followed by the Competitive Enzyme-linked Immunosorbent Assay (c-ELISA) as a confirmatory test. The seropositivity on c-ELISA was 28.95% in 2005; it subsequently declined to 6.72%, 1.17%, 0.16% and 0.00% in 2006, 2007, 2009 and 2010, respectively. Brucella seropositivity was not detected in goats. Seropositivity declined following institution of stringent control measures that included: gradual culling of seropositive animals through slaughter; isolation and confinement of pregnant cows close to calving; proper disposal of placentas and aborted foetuses; the use of the S19 vaccine; and restricted introduction of new animals. It was thought that the source of this outbreak was likely to have been from the introduction of infected animals from another farm. Furthermore, humans were found with brucellosis antibodies. Out of 120 people screened, 12 (10%) were confirmed seropositive to brucella antigen exposure by c-ELISA analysis. The majority of the seropositive individuals (80%) were milkers and animal handlers from the farm. Nine individuals had clinical signs suggestive of brucellosis. All cases received medical attention from the district hospital. This achievement in livestock and human health showed that it is possible to control brucellosis in dairy farms, compared to pastoral and agro-pastoral farms, thus providing evidence to adopt these strategies in dairy farms thought to be at risk