Paramedic students need more training in left ventricular assist device — a pilot simulation study

INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study. RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation. CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice

Doskonalenie procesu produkcji I logistyki w badanym przedsiębiorstwie

Manufacturing and logistics process in conditions of the contemporary market must be multidimensional and multicriterial. Activities associated with production and logistics are closely related. Improvement of the manufacturing process and logistics areas in enterprises has a great importance and can bring a lot of benefits. Each optimization of the manufacturing and logistics proces should be analyzed, adapted to needs of the given enterprise and successively implemented. The article describes proposals to improve the manufacturing and Logistics process in researched enterprise, through identification of functional problems. In addition, indicates important possible benefits, resulting from the use of tools, systems and techniques to optimize production and logistics areas in the organization.W warunkach współczesnego rynku proces produkcji i logistyki musi mieć charakter wielowymiarowy i wielokryterialny. Działania związane z produkcją i logistyką są ze sobą ściśle powiązane. Doskonalenie procesu produkcji i obszarów logistyki w przedsiębiorstwach ma ogromne znaczenie i może przynieść wiele korzyści. Każda optymalizacja procesu produkcji i logistyki powinna być przeanalizowana, dostosowana do potrzeb danego przedsiębiorstwa i sukcesywnie wdrażana. Niniejszy artykuł przedstawia propozycje doskonalenia procesu produkcji i logistyki w badanym przedsiębiorstwie, poprzez identyfikację problemów funkcjonalnych. Ponadto wskazuje istotne możliwe do uzyskania korzyści, wynikające z zastosowania narzędzi, systemów i technik optymalizujących obszary produkcji i logistyki w organizacji

Transitioning without confrontation? Shared food growing niches and sustainable food transitions in Singapore

https://doi.org/10.1016/j.geoforum.2018.07.016Following a series of global food crises and an increasing dependence on food imports, the Singaporean government has begun to support local food production as a means to improve the sustainability of its food regime. This extends to the development of state-led ventures which support shared food growing in the city. In parallel, informal citizens\u27 groups are experimenting with collaborative forms of food provisioning. Both types of initiatives utilise Information and Communication Technologies (ICT) to facilitate their practices of shared growing and seek to reorient the current food regime onto a more sustainable pathway. Drawing on ethnographic research conducted with two initiatives representative of both organisational positions, this paper critically examines the efficacy of using a transitions thinking approach to assess their actual and potential contribution to the disruption of the food regime in Singapore. The paper first reviews existing approaches to transitions thinking in order to distil insights for examining shared food growing initiatives in Singapore as niche projects. The broader socio-cultural and political context of Singapore\u27s food system and the food growing niche projects which are emerging within it are then delineated, followed by a strategic niche management (SNM) analysis of the two initiatives. Ultimately, the paper makes two linked contributions: firstly, it diversifies the empirical foundations and the sectoral and geographical reach of sustainability transitions research. Secondly, it provides space for critical reflection on transitions thinking when applied beyond the Western liberal democratic settings from which it emerged

For a sustainable future, we need to reconnect with what we’re eating – and each other

Eating alone, once considered an oddity, has become commonplace for many across the Western world. Fast food chains are promoting eating on the go or “al desko”. Why waste time in your busy day sitting down at a table with others? Surveys indicate that a third of Britons regularly eat on their own. Open Table, an online restaurant booking app, found that solo dining in New York increased by 80% between 2014-2018. And in Japan, the world capital of solo dining, a trend for “low-interaction dining” has taken off. Restaurants are opening which facilitate the ultimate solo dining experience: passing bowls of noodles through black curtains into individual booths. Is this a worrying trend? We think so. Research is revealing the negative impacts of eating alone, which has been found to be linked to a variety of mental and physical health conditions, from depression and diabetes to high blood pressure. So it’s cheering that hundreds of food sharing initiatives have sprung up around the world which aim to improve food security and sustainability while combating loneliness

Creative construction: Crafting, negotiating and performing urban food sharing landscapes.

Arbuscular mycorrhizal fungi arguably form the most successful and wide-spread endosymbiosis with plants. In general terms there is very little host-specificity in this interaction, indicating an extremely broad compatibility. However, host preferences as well as varying symbiotic efficiencies have been observed, the molecular basis of which is still largely unknown. Secreted proteins (SPs) may act as fungal effectors to control symbiotic efficiency in a host-dependent manner. Therefore, we studied whether AM fungi adjust their secretome in a host- and stage-dependent manner to contribute to their extremely wide host-range. We investigated the expression of SP encoding genes of R. irregularis DAOM197198 in three evolutionary distantly related plant species, Medicago truncatula (Medicago), Nicotiana benthamiana (Nicotiana) and Allium schoenoprasum (Chives). In addition we used laser microdissection in combination with RNAseq to study SP expression at different stages of the symbiotic interaction in Medicago. Our data indicate that the vast majority of 288 expressed SPs show equal expression levels in the interaction with all three host plants. In addition, a subset (~15%) of the SPs show significant differential expression depending on the host plant and/or environmental condition. This host-dependent expression appears to be controlled locally in the hyphal network in response to host metabolic cues. Overall, this study offers a comprehensive analysis of the R. irregularis secretome, which now offers a solid basis to direct functional studies on the role of fungal SPs in AM symbiosis

Neutrophil-lymphocyte ratio and creatinine reduction ratio predict good early graft function among adult cadaveric donor renal transplant recipients. Single institution series

The Background Delayed graft function (DGF) is a common complication following kidney transplantation and is associated with ischemia-reperfusion injury (IRI). Lymphocytes contribute to the pathogenesis of IRI and ischemia-reperfusion related to delayed graft function. Materials and Methods : 135 Caucasian patients received a kidney graft from deceased heart-beating organ donors. We divided patients into 2 groups - patients with the eGFR>=30 on the 21st day post-transplantation (n=36) and patients with the eGFR=30 groups in the average lnLymphocytes (0.36 +/-0.6 vs. -0.016 +/-0.74, respectively p=0.004) lnNLR (1,27 +/-0.92 vs. 1.73+/-1.08 p=0.016) lnLMR (1.01 +/-0.57 vs. 0.73 +/-0.64 p=0.02), lnPLR (4.97 +/-0.55 vs. 5.26 +/- 0.67 p=0.023), and CCR 2% (-20.20 +/- 21.55 vs. -4.29 +/- 29.62 p=0.004. In the univariate analysis, factors of lnLymphocytes >=0.22 (OR=0.331 95%CI 0.151-0.728 p=0.006), lnLMR>=1.4 (OR=0.255 95%CI 0.072-0.903 p=0.034) were associated with a worse graft function, while lnNLR>=1.05 (OR=2.653 95%CI 1.158-6,078 p=0.021), lnPLR>=5.15 (OR=2.536 95%CI 1.155-5.566 p=0.02) and CRR2 (OR=3.286 95% CI 1.359-7.944 p=0.008) indicated a better graft function. Conclusion: A higher absolute lymphocyte count (lnLymphocytes) and lnLMR, as well as lower lnNLR and lnPLR were associated with a lower eGFR on the 21st day after kidney transplantation. In the multivariate analysis, CRR2 in combination with either lnLymphocytes, lnNLR or lnPLR improved the accuracy of detecting patients with poor graft function

Stosunek liczby neutrofilów do limfocytów oraz wskaźnik redukcji kreatyniny pozwalają na przewidzenie dobrej wczesnej czynności przeszczepu nerki u dorosłych

Opóźniona funkcja nerki przeszczepionej (DGF) jest częstym powikłaniem po transplantacji nerki. Jest związana z uszkodzeniem niedokrwienno-reperfuzyjnym (IRI). Do patogenezy uszkodzenia niedokrwienno-reperfuzyjnego związanego z opóźnioną funkcją przeszczepu przyczyniają się limfocyty. Materiał i metody: 135 pacjentów rasy kaukaskiej otrzymało przeszczep nerki od zmarłych dawców z bijącym sercem. W celu oceny funkcji przeszczepu pacjenci zostali podzieleni na dwie grupy – pacjentów z eGFR30 w 21. dniu po przeszczepieniu (n = 36) oraz pacjentów z eGFR <30 w 21. dniu po przeszczepieniu (n = 99). Zmierzony został poziomy kreatyniny w surowicy w 1. oraz 2. dniu po przeszczepie oraz przedoperacyjne ilość monocytów, limfocytów, płytek krwi i neutrofilów, jak również proporcje pomiędzy nimi. Wyniki: Stwierdzono statystycznie istotne różnice między grupami eGFR <30 i eGFR 30 w ilości limfocytów (0,36 +/- 0,6 vs -0,016 +/- 0,74; odpowiednio p = 0,004) lnNLR (stosunek neutrofili do limfocytów) (1,27 +/- 0,92 vs 1,73 +/- 1,08; p = 0,016) lnLMR (stosunek limfocytów do monocytów) (1,01 +/- 0,57 vs 0,73 +/- 0,64; p = 0,02), lnPLR (stosunek płytek do limfocytów) (4,97 +/- 0,55 vs 5,26 +/- 0,67; p = 0,023), i CCR 2% (-20,20 +/- 21,55 vs -4,29 +/- 29,62; p = 0,004). W analizie jednowymiarowej, czynniki, takie jak: ilość limfocytów 0,22 (OR = 0,331; 95% CI 0,151–0,728; p = 0,006), LnLMR1,4 (OR = 0,255; 95% CI 0,072–0,903; p = 0,034) były związane z gorszą funkcją przeszczepu, podczas gdy lnNLR 1,05 (OR = 2,653 95% CI 1,1158–6,078; p = 0,021), lnPLR 5,15 (OR = 2,536; 95% CI 1,155–5,566; p = 0,02) i CRR2 (współczynnik redukcji kreatyniny w drugim dniu) (OR = 3,286; 95% CI 1,359 –7,944; p = 0,008) wskazywało na lepszą funkcję przeszczepu. Podsumowanie: Wyższa bezwzględna liczba limfocytów (lnLymphocytes) i lnLMR, a także niższy poziom lnNLR i lnPLR były związane z niższym eGFR w 21. dniu po przeszczepie nerki. W analizie wieloczynnikowej CRR2 w połączeniu z limfocytami lnNLR lub lnPLR umożliwiły wyższą dokładność w identyfikacji pacjentów z nieprawidłową funkcją przeszczepu