The State of Nature X: Why Leave? A Preface on the State of Nature Theory

Great minds have addressed the issue of forming a polity, dating back to Plato. Yet, most of these great minds, such as Thomas Hobbes, John Locke and Jean-Jacques Rousseau, argue for the need to escape the state of nature into a civil form of government. However, after taking the three essential elements of man that these philosophers all comment on, self-preservation, reason, and will, a new state of nature model is created that is stronger. It is stronger because of its definition of man and the analytic inferences that flow from that definition. Therefore, the state of nature theory does not preclude man from living outside the bounds of government

A Severe Case of Odontogenic Infection and Necrotizing Fasciitis of the Anterior Chest Wall and Neck.

Necrotizing fasciitis is a life-threatening infection that can be rapidly fatal. Early identification and emergent surgical management are essential to minimize morbidity and mortality. This case report describes a 25-year-old male who presented to the emergency department with a three-day history of worsening left lower dental infection and new-onset neck pain and swelling. He received broad-spectrum antibiotics and intravenous fluid resuscitation and underwent computed tomography of the neck and chest. Following intensive care unit admission, he underwent tooth extraction where intraoperative evaluation revealed subcutaneous crepitus. Immediate debridement was performed, revealing copious foul-smelling purulent discharge and necrotic tissue extending over the anterior chest wall and neck. During his hospital course, he underwent multiple debridements to manage the expanding infection. The final tissue defect was substantial, with deep dissection to muscle extending over the entire anterior surface of the rib cage to just inferior to the clavicles. This significant tissue defect was managed with skin grafts, and he was discharged home in stable condition. The patient is doing well almost a year after discharge. The key to our patient\u27s survival was the early identification and debridement of the affected tissue. Our study reinforces the tenants of wound care and aggressive management required to bolster patient odds of survival in the setting of necrotizing fasciitis and underscores the importance of maintaining vigilance in patients presenting with dental infections. This study is unique in that our patient was young, with a past medical history significant for polydrug use, and the area of debridement was substantial

An in-vitro evaluation of pressure generated by Programmed Intermittent Generated Bolus (PIEB) or Continuous Epidural Infusion (CEI)

PIEB has been reported as being superior to CEI for labor analgesia. The aim of this study was to measure the pressures generated by two commercially available pumps (CADD PIB, Smiths and Gemstar, Hospira) when delivering PIEB or CEI at 2 commonly used rates of infusion (10 or 5 mL). The two pumps were set to deliver fluid at four rates (CEI: 5 or 10 mL/h; PIEB: 5 or 10 mL every h) and connected to a pressure transducer (PCB Piezotronics 1500 connected to a NI USB-6251 Screw Terminal) to determine the pressures applied during each infusion. The peak pressure generated during the PIEB mode was consistently higher when compared to the CEI mode in both pumps. When comparing the two pumps in the PIEB 10 mL every hour mode, the peak pressures were approximately the same, while the pressure pattern differed. For each cycle the pressure generated by Gemstar oscillated from 25 mmHg to 0 mmHg; whereas with the CADD pump the baseline pressure was above 0. The Gemstar pump piston frequency (1.2 Hz) was twice as high as the CADD (0.5 Hz), so the volume delivered per cycle was lower. In the PIEB 5 mL every hour mode the peak pressures followed the same wave patterns. However, unlike the 10 mL mode, the pump piston frequency was approximately the same in both pumps. In both the CEI 5 or 10 mL/h modes, the CADD peak pressure was four times greater than the Gemstar. Both cycled between their respective peak pressures and 0 mmHg. Since the peak pressure of the CADD was approximately the same with PIEB and CEI, we speculated that the most important factor affecting the distribution of the solution in the epidural space was not the peak pressure per se, but the mode of delivery of the bolus

Discrepancies between Europena countries and USA and Canada in the availability of triptans and their licensed clinical properties.

Triptans are presently a milestone in the treatment of migraine patients. Because of their effectiveness and safety, they have radically improved migraine treatment but their use has meant a substantial increase in spending for medicines. We compared available pharmaceutical forms, pack sizes, indications and dosages of triptans as listed in the summary of product characteristics of eight countries. We found that several differences exist between countries in the presentations of the triptans and in their licensing

Urban Green Spaces and Public Health Outcomes: a systematic review of literature

Background. As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity. Methods. In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included. Results. Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects. Conclusions. To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity

Price differentials of oral triptans in eight European Union countries.

Triptans are presently a milestone in the treatment of migraine patients. Because of their effectiveness and safety, they have radically improved migraine treatment but their use has meant a substantial increase in spending for medicines. We thus compared retail prices of triptans in eight European Union member states to establish the existence and the amount of price differentials. We found wide price differentials between countries (from 83% to 140%) and within countries, where they attained 191% in Belgium. The least and most expensive products differed from country to country. These differentials mean that the most cost-effective triptans differ from country to country and this can be an important source of variation in the treatment of migraineurs. A better-harmonised European system of pricing could limit these unethical variations