The Efficacy of Analgesic Subdissociative Dose Ketamine in Trauma Casualties Treated by U.S. Military Special Operations Medical Professionals in a Prehospital Environment

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty data collection tool. Quantitative study inclusion criteria were adult casualties treated by U.S. military medical professionals with ketamine in a prehospital environment, had documented injury data, and had both pre- and post-ketamine pain scores. Descriptive statistics, followed by inferential statistical analyses using Shapiro-Wilkes, Wilcoxon Signed Rank, Spearman rho, and Kruskal Wallis tests were used. Additionally, phenomenology guided the analysis of two (n = 2) case studies. In vivo coding was used to develop themes and subthemes. Case studies collected from U.S. military medical professionals provided qualitative insight that reinforced the quantitative data and provided clinical validity to the study. Research Results/Findings. The study showed safe, efficacious use of analgesic sub-disociative ketamine use in prehospital trauma casualties relative to the 0–10 NRS for pain. The median reported pre-ketamine pain scale for casualties was 9.0 (IQR 2). The median post-ketamine pain scale was 0.0 (IQR 3). The mean total dosage of ketamine administered was 98.19 mg (SE = 9.545). There were 6 (12.8%) casualties who experienced side effects from ketamine that were neither permanent nor life-threatening. The case studies provided the human aspect of the study, reinforced the quantitative data, and provided clinical validity. Post-ketamine pain scores were better than pre-ketamine pain scores. Higher dosages of ketamine provided greater pain relief. No life threatening nor adverse drug reactions were found in this study. Conclusions From Research. This study demonstrated a safe, efficacious analgesic ketamine use in prehospital trauma casualties used by U.S. military special operations medical professionals relative to the 0–10 NRS for pain. The results of this study may inform medical practitioners and policymakers regarding the efficacy of analgesic ketamine in a prehospital environment, aid in making informed treatment decisions regarding trauma casualties, and provide facts for updating and improving clinical practice guidelines and policies focused on the U.S. military. Advancing the understanding to promote better prehospital pain management guidelines, procedures, and practices is essential. Education efforts will make medical professionals aware of the importance of analgesic ketamine for trauma casualties in a prehospital environment. @font-face {font-family: Cambria Math ; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;}@font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-536859905 -1073732485 9 0 511 0;}@font-face {font-family: Calibri $Headings$ ; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-alt:Calibri; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:auto; mso-font-signature:0 0 0 0 0 0;}p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent: ; margin:0in; mso-pagination:widow-orphan; font-size:11.0pt; font-family: Calibri ,sans-serif; mso-fareast-font-family:Arial; mso-bidi-font-family: Calibri $Headings$ ; color:black; mso-themecolor:text1;}.MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:11.0pt; mso-ansi-font-size:11.0pt; mso-bidi-font-size:11.0pt; font-family: Calibri ,sans-serif; mso-ascii-font-family:Calibri; mso-fareast-font-family:Arial; mso-hansi-font-family:Calibri; mso-bidi-font-family: Calibri $Headings$ ; color:black; mso-themecolor:text1; mso-font-kerning:0pt; mso-ligatures:none;}div.WordSection1 {page:WordSection1;

Identification of Erosional Terraces on Seamounts: Implications for Interisland Connectivity and Subsidence in the Galápagos Archipelago

Shallow seamounts at ocean island hotspots and in other settings may record emergence histories in the form of submarine erosional terraces. Exposure histories are valuable for constraining paleo-elevations and sea levels in the absence of more traditional markers, such as drowned coral reefs. However, similar features can also be produced through primary volcanic processes, which complicate the use of terraced seamounts as an indicator of paleo-shorelines. In the western Galápagos Archipelago, we utilize newly collected bathymetry along with seafloor observations from human-occupied submersibles to document the location and depth of erosional terraces on seamounts near the islands of Santiago, Santa Cruz, Floreana, Isabela, and Fernandina. We directly observed erosional features on 22 seamounts with terraces. We use these observations and bathymetric analysis to develop a framework to identify terrace-like morphologic features and classify them as either erosional or volcanic in origin. From this framework we identify 79 erosional terraces on 30 seamounts that are presently found at depths of 30 to 300 m. Although intermittent subaerial connectivity between the islands has been hypothesized, the depths of these erosional terraces in the Santiago region are the first direct evidence of paleo-connectivity in the modern archipelago. Collectively, the terraces have non-randomly distributed depths. We suggest that peaks in the distribution of terrace depths likely represent long durations of exposure (i.e., sea-level still or lowstands). By comparing these peaks to those of subsidence adjusted sea-level curves, we identify the average subsidence rate that best reproduces the observed terrace distributions. These rates are 0.2–0.4 m/ka for this portion of the central Galápagos, since the formation of the seamounts, consistent with previous independent estimates. Using these subsidence rates and evidence for erosional terraces at depths up to 300 m, we conclude that all islands in the central archipelago have been intermittently connected starting between 435 and 900 ka. Individual island pairs have likely been repeatedly subaerially connected for short intervals since that time

Monogenetic near-island seamounts in the Galapagos Archipelago

Author Posting. © American Geophysical Union, 2020. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry, Geophysics, Geosystems 21(12), (2020): e2020GC008914, https://doi.org/10.1029/2020GC008914.Rarely have small seamounts on the flanks of hotspot derived ocean‐island volcanoes been the targets of sampling, due to sparse high‐resolution mapping near ocean islands. In the Galápagos Archipelago, for instance, sampling has primarily targeted the subaerial volcanic edifices, with only a few studies focusing on large‐volume submarine features. Sampling restricted to these large volcanic features may present a selection bias, potentially resulting in a skewed view of magmatic and source processes because mature magmatic systems support mixing and volcanic accretion that overprints early magmatic stages. We demonstrate how finer‐scale sampling of satellite seamounts surrounding the volcanic islands in the Galápagos can be used to lessen this bias and thus, better constrain the evolution of these volcanoes. Seamounts were targeted in the vicinity of Floreana and Fernandina Islands, and between Santiago and Santa Cruz. In all regions, individual seamounts are typically monogenetic, but each seamount field requires multigenerational magmatic episodes to account for their geochemical variability. This study demonstrates that in the southern and eastern regions the seamounts are characterized by greater geochemical variability than the islands they surround but all three regions have (Sr‐Nd‐He) isotopic signatures that resemble neighboring islands. Variations in seamount chemistry from alkalic to tholeiitic near Fernandina support the concept that islands along the center of the hotspot track undergo greater mean depths of melting, as predicted by plume theory. Patterns of geochemical and isotopic enrichment of seamounts within each region support fine‐scale mantle heterogeneities in the mantle plume sourcing the Galápagos hotspot.This work was carried out with funding from National Science Foundation Division of Ocean Sciences (OCE‐1634952 to V. D. Wanless, OCE‐1634685 to S. A. Soule). The authors have no competing interests to declare. We thank Sally Gibson and three anonymous reviewers for providing detailed and critical feedback on this manuscript.2021-05-0

Electrochemically Induced Amorphous-to-Rock-Salt Phase Transformation in Niobium Oxide Electrode for Li-Ion Batteries

Intercalation-type metal oxides are promising negative electrode materials for safe rechargeable lithium-ion batteries due to the reduced risk of Li plating at low voltages. Nevertheless, their lower energy and power density along with cycling instability remain bottlenecks for their implementation, especially for fast-charging applications. Here, we report a nanostructured rock-salt Nb2O5 electrode formed through an amorphous-to-crystalline transformation during repeated electrochemical cycling with Li+. This electrode can reversibly cycle three lithiums per Nb2O5, corresponding to a capacity of 269 mAh g−1 at 20 mA g−1, and retains a capacity of 191 mAh g−1 at a high rate of 1 A g−1. It exhibits superb cycling stability with a capacity of 225 mAh g−1 at 200 mA g−1 for 400 cycles, and a Coulombic efficiency of 99.93%. We attribute the enhanced performance to the cubic rock-salt framework, which promotes low-energy migration paths. Our work suggests that inducing crystallization of amorphous nanomaterials through electrochemical cycling is a promising avenue for creating unconventional high-performance metal oxide electrode materials

Full-Length Genome Sequences of Senecavirus A from Recent Idiopathic Vesicular Disease Outbreaks in U.S. Swine

Since July 2015, vesicular lesions affecting growing pigs and sows accompanied with neonatal mortality have been reported in multiple U.S. states. Senecavirus A has been consistently detected from these cases. The complete genome sequences of 3 recent U.S. Senecavirus A isolates were determined to further characterize this virus

Novel Senecavirus A in Swine with Vesicular Disease, United States, July 2015

To the Editor: Senecavirus A (SVA; formerly known as Seneca Valley virus [SVV] belongs to the genus Senecavirus, family Picornaviridae (1,2). SVA was first isolated in 2001 as a contaminant of the PER.C6 cell line and designated as SVV-001 (1,3). Since its discovery, SVA has been infrequently detected in swine with idiopathic vesicular disease (IVD) (4–6), which clinically resembles foot-and-mouth disease, swine vesicular disease, vesicular exanthema of swine, and vesicular stomatitis. The virus has also been retrospectively detected in previous cases with various clinical conditions in the United States during 1988–2001 (7). However, the clinical significance of SVA in swine could not be determined (7,8)

Diagnosis and management of bone fragility in diabetes: an emerging challenge

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk

VOLCANIC, STRUCTURAL, AND MORPHOLOGICAL HISTORY OF SANTA CRUZ ISLAND, GALÁPAGOS ARCHIPELAGO

Santa Cruz Island is one of the oldest volcanoes in the Galápagos Archipelago; little is known about its history or its evolutionary relationship to the younger western shield volcanoes. Of particular note, the island's northern and southern flanks are deformed by a series of major normal faults of unknown origin. Using an array of multidisciplinary tools, including field mapping, global positioning satellite measurements, gravity measurements, 40Ar/39Ar geochronology, and 3He exposure dating, I construct a structural and volcanic history of Santa Cruz. The 40Ar/39Ar ages reveal that since ~1.5 Ma, the island has experienced two phases of volcanism, separated by ~400 ky. The first occurred from 1620 ± 15 to 1160 ± 35 ka (1σ); the second lasted from 699 ± 45 to 74 ± 19 ka. Volcanism during the second phase was focused along an E-W trending summit vent system, from which all lavas erupted masters, M.S., Geology -- University of Idaho - College of Graduate Studies, 201

Insights into the Evolution of the Galápagos Archipelago and Its Mantle Source from Monogenetic Near-Island Seamounts

Lavas erupted at ocean island volcanoes are classically used as probes of the deep Earth, with ultimate goals of discerning the compositional heterogeneity, structure and dynamics of the Earth’s mantle. However, sampling restricted to volcanic islands and large, submarine volcanic constructs alone likely results in limited spatial resolution of the mantle’s composition and structure, owing to homogenization in sub-island magma reservoirs. Further, islands provide poor temporal resolution given that their multigenetic construction can overprint any time progressive chemical variations and they subside with age making detailed sampling difficult. For my dissertation I investigate whether seamounts surrounding islands in the Galápagos Archipelago preserve a more spatially distributed record of punctuated, point-source magmatism providing a different perspective on these deeper processes. The first chapter investigates the physical characteristics of the near-island seamounts resulting in the derivation of a 0.2-0.4 m/ka subsidence rate for the archipelago. Chapters two and three evaluate the magmatic relationship of the seamounts to the islands that they surround. From this, it appears seamounts are closely related to the islands but do indeed preserve a higher resolution picture related to evolution and mantle zonation. An important component of my dissertation has been to mix and calibrate a Pb double spike for internal mass-dependent fractionation correction of Pb isotope measurements at Boise State University in an effort to collect highly accurate and precise isotopic data of the seamount lavas to complement the high-resolution sampling of the seamounts themselves (Chapter 4). Finally, the fifth chapter uses high precision Pb isotopes to show that all of the isotopic end members in the Galápagos can be produced from the recycling of a single oceanic package