Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

Introduction: We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.Methods: Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4-6 hours.Results: We approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.Conclusion: Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints

Simulation of the synergistic low Earth orbit effects of vacuum thermal cycling, vacuum UV radiation, and atomic oxygen

In order to assess the low Earth orbit (LEO) durability of candidate space materials, it is necessary to use ground laboratory facilities which provide LEO environmental effects. A facility combining vacuum thermal cycling and vacuum ultraviolet (VUV) radiation has been designed and constructed at NASA Lewis Research Center for this purpose. This facility can also be operated without the VUV lamps. An additional facility can be used to provide VUV exposure only. By utilizing these facilities, followed by atomic oxygen exposure in an RF plasma asher, the effects of the individual vacuum thermal cycling and VUV environments can be compared to the effect of the combined vacuum thermal cycling/VUV environment on the atomic oxygen durability of materials. The synergistic effects of simulated LEO environmental conditions on materials were evaluated by first exposing materials to vacuum thermal cycling, VUV, and vacuum thermal cycling/VUV environments followed by exposure to atomic oxygen in an RP plasma asher. Candidate space power materials such as atomic oxygen protected polyimides and solar concentrator mirrors were evaluated using these facilities. Characteristics of the Vacuum Thermal Cycling/VUV Exposure Facility which simulates the temperature sequences and solar ultraviolet radiation exposure that would be experienced by a spacecraft surface in LEO are discussed. Results of durability evaluations of some candidate space power materials to the simulated LEO environmental conditions will also be discussed. Such results have indicated that for some materials, atomic oxygen durability is affected by previous exposure to thermal cycling and/or VUV exposure

Factorial Invariance of Self-efficacy in Physical Health Care Scale for Men and Women University Students

The present study analyses the psychometric properties of the Selfefficacy in Physical Health Care Scale. The overall sample consisted of 2006 subjects: 902 women and 1104 men, with a mean age of 18.53 years (SD= 1.52) and 18.84 years (SD= 1.55) respectively. The Factorial Psychometric analysis showed that a three-factorial structure (nutrition, physical health and hydration) was viable and adequate for both populations (men and woman) according to the established psychometric requirements when the informers are the students themselves. The results showed that factor structure, factor loadings and intercepts of the instrument could be considered invariant across groups; however, there are differences between groups in favor of men for the means of the nutrition and physical health factors

Prevalence of internal parasites in beef cows in the United States: Results of the National Animal Health Monitoring System’s (NAHMS) beef study, 2007–2008

During the United States Department of Agriculture (USDA) National Animal Health Monitoring System’s (NAHMS) 2007–2008 beef study, 567 producers from 24 US States were offered the opportunity to collect fecal samples from weaned beef calves and have them evaluated for the presence of parasite eggs (Phase 1). Participating producers were provided with instructions and materials for sample collection. Up to 20 fresh fecal samples were collected from each of the 99 participating operations. Fresh fecal samples were submitted to one of 3 randomly assigned laboratories for evaluation. Upon arrival at the laboratories, all samples were processed for the enumeration of strongyle, Nematodirus, and Trichuris eggs using the modified Wisconsin technique. The presence or absence of coccidian oocysts and tapeworm eggs was also noted. In submissions where the strongyle eggs per gram exceeded 30, aliquots from 2 to 6 animals were pooled for DNA extraction. Extracted DNA was subjected to genus level polymerase chain reaction (PCR) identification for the presence of Ostertagia, Cooperia, Haemonchus, Oesophagostomum, and Trichostrongylus. In this study, 85.6% of the samples had strongyle type, Nematodirus, and Trichuris eggs. Among the samples evaluated, 91% had Cooperia, 79% Ostertagia, 53% Haemonchus, 38% Oesophagostomum, 18% Nematodirus, 7% Trichuris, and 3% Trichostrongylus. The prevalence of coccidia and tapeworm eggs was 59.9% and 13.7%, respectively

Spitzer observations of HH54 and HH7-11: mapping the H2 ortho-to-para ratio in shocked molecular gas

We report the results of spectroscopic mapping observations carried out toward the Herbig-Haro objects HH7-11 and HH54 over the 5.2 - 37 micron region using the Infrared Spectrograph of the Spitzer Space Telescope. These observations have led to the detection and mapping of the S(0) - S(7) pure rotational lines of molecular hydrogen, together with emissions in fine structure transitions of Ne+, Si+, S, and Fe+. The H2 rotational emissions indicate the presence of warm gas with a mixture of temperatures in the range 400 - 1200 K, consistent with the expected temperature behind nondissociative shocks of velocity ~ 10 - 20 km/s, while the fine structure emissions originate in faster shocks of velocity 35 - 90 km/s that are dissociative and ionizing. Maps of the H2 line ratios reveal little spatial variation in the typical admixture of gas temperatures in the mapped regions, but show that the H2 ortho-to-para ratio is quite variable, typically falling substantially below the equilibrium value of 3 attained at the measured gas temperatures. The non-equilibrium ortho-to-para ratios are characteristic of temperatures as low as ~ 50 K, and are a remnant of an earlier epoch, before the gas temperature was elevated by the passage of a shock. Correlations between the gas temperature and H2 ortho-to-para ratio show that ortho-to-para ratios < 0.8 are attained only at gas temperatures below ~ 900 K; this behavior is consistent with theoretical models in which the conversion of para- to ortho-H2 behind the shock is driven by reactive collisions with atomic hydrogen, a process which possesses a substantial activation energy barrier (E_A/k ~ 4000 K) and is therefore very inefficient at low temperature.Comment: 45 pages, including 16 figures. Accepted for publication in Ap

Controls of the Lithospheric Thermal Field of an OceanContinent Subduction Zone: The Southern Central Andes

In an ocean-continent subduction zone, the assessment of the lithospheric thermal state is essential to determine the controls of the deformation within the upper plate and the dip angle of the subducting lithosphere. In this study, we evaluate the degree of influence of both the configuration of the upper plate (i.e., thickness and composition of the rock units) and variations of the subduction angle on the lithospheric thermal field of the southern Central Andes (29°–39°S). Here, the subduction angle increases from subhorizontal (5°) north of 33°S to steep (~30°) in the south. We derived the 3D temperature and heat flow distribution of the lithosphere in the southern Central Andes considering conversion of S wave tomography to temperatures together with steady-state conductive thermal modeling. We found that the orogen is overall warmer than the forearc and the foreland and that the lithosphere of the northern part of the foreland appears colder than its southern counterpart. Sedimentary blanketing and the thickness of the radiogenic crust exert the main control on the shallow thermal field (50 km, the temperatures of the overriding plate are mainly controlled by the mantle heat input and the subduction angle. The thermal field of the upper plate likely preserves the flat subduction angle and influences the spatial distribution of shortening.Fil: Rodriguez Piceda, Constanza. German Research Centre for Geosciences; AlemaniaFil: Scheck Wenderoth, Magdalena. German Research Centre for Geosciences; AlemaniaFil: Bott, Judith. German Research Centre for Geosciences; AlemaniaFil: Gómez Dacal, María Laura. German Research Centre for Geosciences; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cacace, M.. German Research Centre for Geosciences; AlemaniaFil: Pons, Michaël. German Research Centre for Geosciences; AlemaniaFil: Prezzi, Claudia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Strecker, Manfred. German Research Centre for Geosciences; Alemani

Resistance of cactus pear (Opuntia ficus-indica) against Pseudocercospora opuntiae through β‑1,3‑glucanase activity and polyphenolic compounds in cladodes

Black spot disease, caused by the hemibiotrophic fungus Pseudocercospora opuntiae, is one of the main phytosanitary problems of cactus (Opuntia spp.). Through mass selection, one cultivar of Opuntia ficus-indica (L.) Mill. resistant to colonization by P. opuntiae was identified. The ethanolic extract of resistant cladodes showed higher levels of total condensed tannins, flavonoids and polyphenols than those of the susceptible genotypes, generating 93% inhibition of P. opuntiae conidial germination in vitro. The total protein in the resistant genotype showed 300% higher β-1,3-glucanase than the susceptible genotype. This increased activity was able to inhibit germination of conidia by 90%, a similar effect to that of the fungicide Captan® (N‑trichloromethylthio-4-cyclohexene 1,2-dicarboximide). It was shown, for the first time, that the combined action of cactus polyphenols and β-1,3-glucanase contributes significantly to resistance against P. opuntiae. Activity of this enzyme and the phytochemical profile can be used as criteria to predict and detect cactus germplasm with resistance to black spot.Fil: Ochoa, Maria Judith. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: González Flores, L. M.. Instituto Tecnológico de Tlajomulco; MéxicoFil: Cruz Rubio, J. M.. Instituto Tecnológico de Tlajomulco; MéxicoFil: Rivera López, L. A.. Instituto Tecnológico de Tlajomulco; MéxicoFil: Rodriguez, Sergio A.. Universidad Nacional de Santiago del Estero; ArgentinaFil: Nazareno, Mónica Azucena. Universidad Nacional de Santiago del Estero; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán; ArgentinaFil: Gómez Leyva, J. F.. Instituto Tecnológico de Tlajomulco; Méxic

Blocking Complement Factor B Activation Reduces Renal Injury and Inflammation in a Rat Brain Death Model

Introduction: The majority of kidneys used for transplantation are retrieved from brain-dead organ donors. In brain death, the irreversible loss of brain functions results in hemodynamic instability, hormonal changes and immunological activation. Recently, brain death has been shown to cause activation of the complement system, which is adversely associated with renal allograft outcome in recipients. Modulation of the complement system in the brain-dead donor might be a promising strategy to improve organ quality before transplantation. This study investigated the effect of an inhibitory antibody against complement factor B on brain death-induced renal inflammation and injury. Method: Brain death was induced in male Fischer rats by inflating a balloon catheter in the epidural space. Anti-factor B (anti-FB) or saline was administered intravenously 20 min before the induction of brain death (n = 8/group). Sham-operated rats served as controls (n = 4). After 4 h of brain death, renal function, renal injury, and inflammation were assessed. Results: Pretreatment with anti-FB resulted in significantly less systemic and local complement activation than in saline-treated rats after brain death. Moreover, anti-FB treatment preserved renal function, reflected by significantly reduced serum creatinine levels compared to saline-treated rats after 4 h of brain death. Furthermore, anti-FB significantly attenuated histological injury, as seen by reduced tubular injury scores, lower renal gene expression levels (>75%) and renal deposition of kidney injury marker-1. In addition, anti-FB treatment significantly prevented renal macrophage influx and reduced systemic IL-6 levels compared to saline-treated rats after brain death. Lastly, renal gene expression of IL-6, MCP-1, and VCAM-1 were significantly reduced in rats treated with anti-FB. Conclusion: This study shows that donor pretreatment with anti-FB preserved renal function, reduced renal damage and inflammation prior to transplantation. Therefore, inhibition of factor B in organ donors might be a promising strategy to reduce brain death-induced renal injury and inflammation.Nephrolog

Sustained high serum malondialdehyde levels are associated with severity and mortality in septic patients

This book digs into an area of international migration studies that has gained prominence in the past couple of decades: migrant smuggling. The regional focus is southern Europe, which receives immigrants from many African and Asian countries. Migrant smuggling is discussed in relation to EU and national policies, aimed at combating irregular migration, including increased surveillance and border controls.The authors are no newcomers to the field. Anna Triandafyllidou is a leading scholar in migration studies, having published extensively on various topics dealing with migration in Europe, and with a special interest in Greece and southern Europe. Thanos Maroukis, on the other hand, is an early career academic whose publications have focused specifically on migration in Greece. It is, therefore, not surprising that the authors approached this topic of migrant smuggling from Africa and Asia to Europe by focusing mainly on the situation in Greece and the Turkish-Greek route. The book is based on fieldwork, participant observation and interviews conducted in Athens. The empirical material is extensive, covering a broad range of actors.peer-reviewe