Goal-directed management of shock in children

Shock is a physiologic state characterised by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery. Although the effects of inadequate tissue perfusion are initially reversible, prolonged oxygen deprivation leads to generalised cellular hypoxia and derangement of critical biochemical processes. These abnormalities rapidly become irreversible and result sequentially in cell death, end-organ damage, failure of multiple organ systems, and death. The shock syndrome is characterised by a continuum of physiologic stages and may progress through three stages if not successfully treated, culminating in end-organ damage, irreversible shock, and death. The challenge for the clinician is to recognise children in shock early (before they develop hypotension), when they are more likely to respond favourably to treatment. Although the cause of shock may not be initially apparent, treatment must begin immediately. To assist with this early recognition, a systematic approach to the evaluation of children with evidence of poor perfusion typically identifies features of the history, physical examination, and ancillary studies that suggest the underlying condition. The paediatric assessment triangle (PAT) provides this systematic approach and rapidly provides a quick evaluation of appearance, breathing, and circulation for acutely ill or injured children that should identify conditions that require immediate intervention. To direct rapid and appropriate treatment, Early goal directed therapy was developed to provide an efficient and effective means of immediate intervention. Early goal directed therapy (EGDT) for shock refers to an aggressive systematic approach to resuscitation involving a series of controlled manipulations of physiologic parameters. The goal is to carry out appropriate treatment according to the algorithm within the first hour of presentation to hospital. This protocol has been used with success in the adult population for whom it was originally designed. Evidence of EGDT effectiveness in the paediatric population has grown along with it’s steadily growing implementation

Goal-directed management of shock in children

Shock is a physiologic state characterised by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery. Although the effects of inadequate tissue perfusion are initially reversible, prolonged oxygen deprivation leads to generalised cellular hypoxia and derangement of critical biochemical processes. These abnormalities rapidly become irreversible and result sequentially in cell death, end-organ damage, failure of multiple organ systems, and death. The shock syndrome is characterised by a continuum of physiologic stages and may progress through three stages if not successfully treated, culminating in end-organ damage, irreversible shock, and death. The challenge for the clinician is to recognise children in shock early (before they develop hypotension), when they are more likely to respond favourably to treatment. Although the cause of shock may not be initially apparent, treatment must begin immediately. To assist with this early recognition, a systematic approach to the evaluation of children with evidence of poor perfusion typically identifies features of the history, physical examination, and ancillary studies that suggest the underlying condition. The paediatric assessment triangle (PAT) provides this systematic approach and rapidly provides a quick evaluation of appearance, breathing, and circulation for acutely ill or injured children that should identify conditions that require immediate intervention. To direct rapid and appropriate treatment, Early goal directed therapy was developed to provide an efficient and effective means of immediate intervention. Early goal directed therapy (EGDT) for shock refers to an aggressive systematic approach to resuscitation involving a series of controlled manipulations of physiologic parameters. The goal is to carry out appropriate treatment according to the algorithm within the first hour of presentation to hospital. This protocol has been used with success in the adult population for whom it was originally designed. Evidence of EGDT effectiveness in the paediatric population has grown along with it’s steadily growing implementation

Anti-Cancer Drugs Effect on Quasi-palindrome Mutations in Escherichia coli

Cancer is one of the world\u27s largest health problems in today’s age. The Global Burden of Disease estimates that 10 million people died as a result of cancer per year (IHME). Although there are many treatments for different types of cancer, many of the drugs used are known to have severe side effects. These known consequences include hair loss, nausea, and, unfortunately, an increase in DNA mutation, which can trigger other classes of diseases. One class of mutations that have been studied and linked to a form of cancer is Quasi-palindrome template switch mutations. Quasi-palindromes are nearly perfect inverted repeats of nucleotides able to form DNA secondary structures. These Hairpins are an example of a secondary DNA structure made by DNA repeats and are known to block the DNA replication fork (VOINEAGU et al. 2008). Once DNA replication is blocked by these secondary DNA structures, the DNA replication fork needs to find a solution to continue the replication process. At some frequency, DNA polymerase (responsible for replicating the DNA) can use alternative DNA strands as templates to make more DNA. One alternative method is called “Template-switching”, and it results in a mutation that creates a perfect palindrome from a quasi-palindromic sequence. Previous work has linked anti-cancer drugs such as 5-azacytidine to an increase of QP mutations (Laranjo 2018). Therefore, I am interested in analyzing other anti-cancer drugs and their potential to cause QP mutations. Using an FDA approved drug library, with over 300 different drugs, we will select anti-cancer drugs to screen for QP mutators. We have constructed a QP reporter in E. coli that is specific for QP mutations (Laranjo 2017). To understand the effect of anti-cancer drugs during DNA replication is critical to give us an understanding of potential side effects for patients undergoing chemotherapy

Normal and unusual transient events in IRAC images

The Spitzer Space Telescope Infrared Array Camera (IRAC) is a four-channel camera that uses two pairs of 256 x 256 pixel InSb and Si:As IBC detectors to provide simultaneous images at 3.6, 4.5, 5.8, and 8 microns. IRAC experiences a flux of cosmic rays that produce transient events in images from each of the arrays, with 5-7 pixels per second being affected in an IRAC integration. The vast majority of these transient events can be adequately characterized so they can be effectively detected and flagged by a pipeline software module. However, because of the nature of the arrays and their arrangement in the camera structure, a small fraction of the cosmic ray hits on IRAC produce transients with unusual morphologies which cannot be characterized in a general way. We present nominal cosmic ray rates observed for IRAC on-orbit and rates observed during a period of elevated solar proton flux following a series of X-class solar flares in late 2003. We also present a guide for observers to help identify unusual transient events in their data. We comment on the physical nature of the production of many o9f these unusual transients and how this mechanism differs from the production of "normal" transient events

Manusia Sempurna Menurut Ibnu Miskawaih

Setelah mengadakan pembahasan tentang manusia sempurna munurut Ibnu Miskawaih, sebagai makhluk yang berakhlak mulia maka hakekat manusia sempurna ada pada akal, sebab akal adalah daya berpikir yang terdapat dalam jiwa manusia. Jika sudah sampai pada akal mustafad, akal akan menerima pancaran dari akal kesepuluh berupa nur, ilmu berasal dari Tuhan dan itulah manusia sempurna. kesempurnaan manusia ada dua macam daya yang dimilikinya: daya kognitif dan daya praktis apabila kedua ini dimiliki manusia secara seimbang dan selaras sesuai dengan fungsi masing-masing maka manusia akan menjadi manusia yang sempurna. Maka keutamaan manusia sempurna tentu berasal dari keutamaan akhlak yang merupakan makhluk yang paling mulia dan sempurna. kebijaksanaan (al-hikmah), keberanian (as-syaja’ah), kesucian diri (al-iffah), keadilan (al-adalah), Jalan tengah dari ketiga keutamaan akhlak, keutamaan hikmah, keberanian dan kesucian diri, adalah keutamaan keadilan (al-adalah atau justice). Keadilan adalah kesempurnaan dan pemenuhan ketiga keutamaan tersebut, yang menghasilkan keseimbangan dan persesuaian antara jiwa natiqah, ghadabiyyah, dan bahimiyyah. Keseimbangan tersebut merupakan cara penyatuan, bahwa prinsip utama hidup di dunia adalah pengganti atau bayangan dari keesaan Tuhan

Normal and unusual transient events in IRAC images

The Spitzer Space Telescope Infrared Array Camera (IRAC) is a four-channel camera that uses two pairs of 256 x 256 pixel InSb and Si:As IBC detectors to provide simultaneous images at 3.6, 4.5, 5.8, and 8 microns. IRAC experiences a flux of cosmic rays that produce transient events in images from each of the arrays, with 5-7 pixels per second being affected in an IRAC integration. The vast majority of these transient events can be adequately characterized so they can be effectively detected and flagged by a pipeline software module. However, because of the nature of the arrays and their arrangement in the camera structure, a small fraction of the cosmic ray hits on IRAC produce transients with unusual morphologies which cannot be characterized in a general way. We present nominal cosmic ray rates observed for IRAC on-orbit and rates observed during a period of elevated solar proton flux following a series of X-class solar flares in late 2003. We also present a guide for observers to help identify unusual transient events in their data. We comment on the physical nature of the production of many o9f these unusual transients and how this mechanism differs from the production of "normal" transient events

Spitzer/IRAC Limits to Planetary Companions of Fomalhaut and epsilon Eridani

Fomalhaut and epsilon Eridani are two young, nearby stars that possess extended debris disks whose structures suggest the presence of perturbing planetary objects. With its high sensitivity and stable point spread function, Spitzer/IRAC is uniquely capable of detecting cool, Jupiter-like planetary companions whose peak emission is predicted to occur near 4.5 um. We report on deep IRAC imaging of these two stars, taken at 3.6 and 4.5 um using subarray mode and in all four channels in wider-field full array mode. Observations acquired at two different telescope roll angles allowed faint surrounding objects to be separated from the stellar diffraction pattern. No companion candidates were detected at the reported position of Fomalhaut b with 3 sigma model-dependent mass upper limits of 3 MJ (for an age of 200 Myr). Around epsilon Eridani we instead set a limit of 4 and <1 MJ (1 Gyr model age) at the inner and outer edge of the sub-millimeter debris ring, respectively. These results are consistent with non-detections in recent near-infrared imaging searches, and set the strongest limits to date on the presence of planets outside epsilon Eridani sub-millimeter ring.Comment: Accepted by The Astrophysical Journal. Request electronic-only plates to M. Marengo ([email protected]

History in schools and the problem of 'the nation'

The article examines the enduring popularity of a form of school history which is based predominantly on the idea that the transmission of a positive story about the national past will inculcate in young people a sense of loyalty to the state; a reassuring and positive sense of identity and belonging; and a sense of social solidarity with fellow citizens. England is one of the countries which has to at least some extent moved away from this model of school history; but the past few years have seen suggestions for a move back to a history curriculum which focuses predominantly on the transmission of ‘Our Island Story’; and which presents a positive rendering of that story. The history curriculum in England is currently under review; and public pronouncements by politicians; academic historians and newspaper editorials suggest strong pressures towards a restoration of what is often termed ‘traditional’ school history; which was prevalent in English schools before the advent of what has been termed ‘New history’ in the 1970s. The paper questions some of the arguments which have been put forward in order to justify a return to a history curriculum based on a positive and unproblematic narrative of the national story and suggests that such a course of action is based on some unexamined assumptions and a limited understanding of pedagogy and learning. The final section of the paper outlines several weaknesses and flaws in the arguments for reverting to a traditional (i.e. ‘nation-based’ and celebratory) form of school history; and some of the dangers inherent in such a project