Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy

Background: Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20. mmHg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20. mmHg). Methods: A retrospective analysis of consecutive trauma patients admitted to a level 1 trauma centre in Australia between January 1, 1995 and January 31, 2010 was performed. A comparison was made between characteristics of patients who developed high-grade IAH following trauma laparotomy versus those who did not. Results: A total of 567 patients (median age 31 years) were included in this study. Of these patients 10.2% (58/567) developed high-grade IAH of which 51.7% (30/58) developed ACS. Patients with high-grade IAH were older (p <. 0.001), had a higher Injury Severity Score (p <. 0.001), larger base deficit (p <. 0.001) and lower temperature at admission (p = 0.011). In the first 24. h of admission, patients with high-grade IAH received larger volumes of crystalloids (p <. 0.001), larger volumes of colloids (p <. 0.001) and more units of packed red blood cells (p <. 0.001). Following surgery prolonged prothrombin (p <. 0.001) and partial thromboplastin times (p <. 0.001) were seen. The patients with high-grade IAH suffered higher mortality rates (25.9% (15/58) vs. 12.2% (62/509); p = 0.012). Conclusion: Of all patients who underwent a trauma laparotomy, 10.2% developed high-grade IAH, which increases the risk of mortality. Patients with acidosis, coagulopathy, and hypothermia were especially at risk. In these patients, the abdomen should be left open until adequate resuscitation has been achieved, allowing for definitive surgery. Level of evidence: This is a level III retrospective study

Primordial magnetic fields and the HI signal from the epoch of reionization

The implication of primordial magnetic-field-induced structure formation for the HI signal from the epoch of reionization is studied. Using semi-analytic models, we compute both the density and ionization inhomogeneities in this scenario. We show that: (a) The global HI signal can only be seen in emission, unlike in the standard $\Lambda$CDM models, (b) the density perturbations induced by primordial fields, leave distinctive signatures of the magnetic field Jeans' length on the HI two-point correlation function, (c) the length scale of ionization inhomogeneities is \la 1 \rm Mpc. We find that the peak expected signal (two-point correlation function) is $\simeq 10^{-4} \rm K^2$ in the range of scales $0.5\hbox{-}3 \rm Mpc$ for magnetic field strength in the range $5 \times 10^{-10} \hbox{-}3 \times 10^{-9} \rm G$. We also discuss the detectability of the HI signal. The angular resolution of the on-going and planned radio interferometers allows one to probe only the largest magnetic field strengths that we consider. They have the sensitivity to detect the magnetic field-induced features. We show that thefuture SKA has both the angular resolution and the sensitivity to detect the magnetic field-induced signal in the entire range of magnetic field values we consider, in an integration time of one week.Comment: 19 pages, 5 figures, to appear in JCA

Orphan love in the age of capital

As we enter the second decade of the twenty-first century, who is to be served by institutions of care and to what ends becomes a pressing matter of concern. Foucault has suggested that the capitalist regime of rule in the twentieth century deployed residential settings as disciplinary apparatuses for shaping subjects to its colonial and industrial interests. However, in the twenty-first century, Deleuze has proposed that it is no longer discipline that is of primary concern for capitalism, but control through an ever-proliferating system of abstract code. It is within this context that terms, such as care within institutional residential encounters, open themselves to the necessity of interrogation. This paper will argue that residential care is a field of encounter saturated with a complex and intricate array of affects. If the rule of capitalism is designed to abstract lived experience, then any affirmation of the corporeal experience of encounter as lived experience might well constitute an alternative affirmation of life and hence a revolutionary set of possibilities. This paper will argue that it is love as creative desire that holds the most powerful possibilities for affirming the lived encounter to be found in residential care

Pathological Knee Dislocation in the Morbidly Obese

AbstractKnee dislocation is often related to high-energy trauma and may be associated with neurovascular damage. Body weight is not usually recognized as a causative factor. However, morbid obesity may be associated with pathological dislocation. We present two cases of pathological knee dislocation, with concomitant popliteal artery and nerve damage. Late presentation and delay in diagnosis culminated in eventual lower limb amputation

Generalized pricing formulas for stochastic volatility jump diffusion models applied to the exponential Vasicek model

Path integral techniques for the pricing of financial options are mostly based on models that can be recast in terms of a Fokker-Planck differential equation and that, consequently, neglect jumps and only describe drift and diffusion. We present a method to adapt formulas for both the path-integral propagators and the option prices themselves, so that jump processes are taken into account in conjunction with the usual drift and diffusion terms. In particular, we focus on stochastic volatility models, such as the exponential Vasicek model, and extend the pricing formulas and propagator of this model to incorporate jump diffusion with a given jump size distribution. This model is of importance to include non-Gaussian fluctuations beyond the Black-Scholes model, and moreover yields a lognormal distribution of the volatilities, in agreement with results from superstatistical analysis. The results obtained in the present formalism are checked with Monte Carlo simulations.Comment: 9 pages, 2 figures, 1 tabl

Development of a TB vaccine trial site in Africa and lessons from the Ebola experience

Tuberculosis is the deadliest infection of our time. In contrast, about 11,000 people died of Ebola between 2014 and 2016. Despite this manifest difference in mortality, there is now a vaccine licensed in the United States and by the European Medicines Agency, with up to 100% efficacy against Ebola. The developments that led to the trialing of the Ebola vaccine were historic and unprecedented. The single licensed TB vaccine (BCG) has limited efficacy. There is a dire need for a more efficacious TB vaccine. To deploy such vaccines, trials are needed in sites that combine high disease incidence and research infrastructure. We describe our twelve-year experience building a TB vaccine trial site in contrast to the process in the recent Ebola outbreak. There are additional differences. Relative to the Ebola pipeline, TB vaccines have fewer trials and a paucity of government and industry led trials. While pathogens have varying levels of difficulty in the development of new vaccine candidates, there yet appears to be greater interest in funding and coordinating Ebola interventions. TB is a global threat that requires similar concerted effort for elimination

Application of PILATUS II Detector Modules for High Resolution X-Ray Imaging Crystal Spectrometers on the Alcator C-Mod Tokamak

A new type of X-ray imaging crystal spectrometer for Doppler measurements of the radial profiles of the ion temperature and plasma rotation velocity in tokamak plasmas is presently being developed in a collaboration between various laboratories. The spectrometer will consist of a spherically bent crystal and a two-dimensional position sensitive detector; and it will record temporally and spatially resolved X-ray line spectra from highly-charged ions. The detector must satisfy challenging requirements with respect to count rate and spatial resolution. The paper presents the results from a recent test of a PILATUS II detector module on Alcator C-Mod, which demonstrate that the PILATUS II detector modules will satisfy these requirements

Three Drinking-Water–Associated Cryptosporidiosis Outbreaks, Northern Ireland

Three recent drinking-water–associated cryptosporidiosis outbreaks in Northern Ireland were investigated by using genotyping and subgenotyping tools. One Cryptosporidium parvum outbreak was caused by the bovine genotype, and two were caused by the human genotype. Subgenotyping analyses indicate that two predominant subgenotypes were associated with these outbreaks and had been circulating in the community

Making things happen : a model of proactive motivation

Being proactive is about making things happen, anticipating and preventing problems, and seizing opportunities. It involves self-initiated efforts to bring about change in the work environment and/or oneself to achieve a different future. The authors develop existing perspectives on this topic by identifying proactivity as a goal-driven process involving both the setting of a proactive goal (proactive goal generation) and striving to achieve that proactive goal (proactive goal striving). The authors identify a range of proactive goals that individuals can pursue in organizations. These vary on two dimensions: the future they aim to bring about (achieving a better personal fit within one’s work environment, improving the organization’s internal functioning, or enhancing the organization’s strategic fit with its environment) and whether the self or situation is being changed. The authors then identify “can do,” “reason to,” and “energized to” motivational states that prompt proactive goal generation and sustain goal striving. Can do motivation arises from perceptions of self-efficacy, control, and (low) cost. Reason to motivation relates to why someone is proactive, including reasons flowing from intrinsic, integrated, and identified motivation. Energized to motivation refers to activated positive affective states that prompt proactive goal processes. The authors suggest more distal antecedents, including individual differences (e.g., personality, values, knowledge and ability) as well as contextual variations in leadership, work design, and interpersonal climate, that influence the proactive motivational states and thereby boost or inhibit proactive goal processes. Finally, the authors summarize priorities for future researc