Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

The New and the Old: Responses to Change in the Kingdom of Saudi Arabia

This qualitative study was primarily concerned with Saudi women’s reactions to social change in the political sphere. It focused on their responses to decrees allowing women to vote in municipal elections for the first time, become candidates in such elections, and be nominated in the Shura Council by the King. Structured interviews of urban dwellers illustrated that changes, seen as opportunities, had been noted, but their impact had yet to be processed thoroughly. Attitudes towards political participation were positive and largely optimistic, but rarely seen as applying to the self. Competence, rather than gender, was seen as relevant to voters’ views of political candidates as well as of elected or appointed officials. Compared with older interviewees, young ones viewed the impact of women’s political participation, along with other social changes, as gradual, manageable, and merely one of the many articulations of the 2030 Vision, a strategic framework developed by KSA intended to reduce the country’s dependence on oil and diversify its economy. Both young and older interviewees, though, were reluctant to forecast its specific future impact. Actual political participation, in the form of either voting or running for office, was dismal. These results indicate that not only time is needed for top-down interventions to enter the social fabric of a nation and the minds of its people, but also the necessary conditions must exist that enable the genuine flourishing of human agency

Los visitantes del Parc Natural de l’Alt Pirineu y la práctica de actividades recreativo-deportivas. una propuesta de segmentación

In recent years there has been a large increase in the practice of recreational and sports activities in protected natural areas. As part of the planning and management of public use of these areas, is essential to a deeper understanding of the characteristics of the visitors. This study analyzes the characteristics of the different segments of visitors to Alt Pirineu Natural Park based on recreational and sports activities practiced. For this study, 1.600 surveys were conducted in 16 sampling points over a calendar year between the months of July 2010 and June 2011. In total we identified eight segments of visitors based on physical activity: walkers, recreational hikers, hikers, mountaineer, cyclists, mushroom picker, off road driver and skier. The results obtained here are discussed in terms of their possible applicability in the management of public use of this park and other protected natural areas and also for the development of management strategies and awareness campaigns aimed at different segments of visitors.<br><br>En los últimos años se ha registrado un gran incremento en la práctica de las actividades recreativodeportivas en los espacios naturales protegidos. En el marco de la planificación y la gestión del uso público de este tipo de espacios, resulta fundamental profundizar en el conocimiento de las características de los visitantes. En este estudio se analiza el perfil de los diferentes segmentos de visitantes del Parc Natural de l’Alt Pirineu en base a las actividades recreativo-deportivas practicadas. Para este estudio se realizaron 1.600 encuestas en 16 puntos de muestreo, a lo largo de un año natural comprendido entre los meses de Julio de 2010 y Junio de 2011. En total se identificaron ocho segmentos de visitantes en función de la actividad física: paseantes, excursionistas, senderistas, montañistas, ciclistas, recolectores de setas, motoristas y esquiadores. Los resultados aquí obtenidos son discutidos en términos de su posible aplicación en la gestión del uso público de este parque (extrapolable también a otros espacios naturales protegidos españoles), proponiendo estrategias de gestión y campañas de sensibilización dirigidas a los diferentes segmentos de visitantes

Agile at scale : a summary of the 8th International Workshop on Large-Scale Agile Development

The Large-Scale Agile Development workshop explored the main research challenges in large-scale software development. We considered multi-site organisations with large-scale projects that include a large number of teams adopting agile methods. Such topics include inter-team coordination, knowledge sharing, large project organisation, agile transformation, agile teamwork quality, project models that facilitate several self-organising teams, and practices for scaling agile methods. We accepted five full research papers, which are included in this volume. The accepted papers report empirical research studies using surveys, observations and case studies. Also, an interactive online discussion session was conducted to compare the two approaches, SAFe and Spotify. The workshop participants, which were around a hundred people, joined this discussion to compare the two approaches and suggest some future research questions about the hybridisation of SAFe and Spotify. This workshop summary contributes as a current snapshot of research along with some results from an interactive discussion about SAFe and Spotify

Upper critical field divergence induced by mesoscopic phase separation in the organic superconductor (TMTSF)2ReO4

Due to the competition of two anion orders, (TMTSF)2ReO4, presents a phase coexistence between semiconducting and metallic (superconducting) regions (filaments or droplets) in a wide range of pressure. In this regime, the superconducting upper critical field for H parallel to both c* and b' axes present a linear part at low fields followed by a divergence above a cross-over field. This cross-over corresponds to the 3D-2D decoupling transition expected in filamentary or granular superconductors. The sharpness of the transition also demonstrates that all filaments are of similar sizes and self organize in a very ordered way. The distance between the filaments and their cross-section are estimated.Comment: 4 pages, 4 figure

Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: A michigan survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98374/1/jhm2031-sup-0001-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/98374/2/jhm2031.pd

Ab initio studies of electronic structure of defects in PbTe

Understanding the detailed electronic structure of deep defect states in narrow band-gap semiconductors has been a challenging problem. Recently, self-consistent ab initio calculations within density functional theory (DFT) using supercell models have been successful in tackling this problem. In this paper, we carry out such calculations in PbTe, a well-known narrow band-gap semiconductor, for a large class of defects: cationic and anionic substitutional impurities of different valence, and cationic and anionic vacancies. For the cationic defects, we study a series of compounds RPb2n-1Te2n, where R is vacancy or monovalent, divalent, or trivalent atom; for the anionic defects, we study compounds MPb2nTe2n-1, where M is vacancy, S, Se or I. We find that the density of states (DOS) near the top of the valence band and the bottom of the conduction band get significantly modified for most of these defects. This suggests that the transport properties of PbTe in the presence of impurities can not be interpreted by simple carrier doping concepts, confirming such ideas developed from qualitative and semi-quantitative arguments