Intraosseous vascular access in critically ill adults-a review of the literature

Aim & objectives. This literature review aim is to present a detailed investigation critiquing contemporary practices of intraosseous vascular access in adult patients. Specific objectives identified led to the exploration of clinical contexts, IO device/s and anatomical sites; education and training requirements; implications and recommendations for emergency healthcare practice and any requirements for further research. Background. The intraosseous route is an established method of obtaining vascular access in children in acute and emergency situations and is now increasingly being used in adults as an alternative to intravenous access, yet a paucity of evidence exists regarding its use, effectiveness and implementation. Search strategies. An exploratory literature review was undertaken in acknowledgement of the broad and complex nature of the project aim. Five electronic search engines were examined iteratively from June 2013 to February 2014. The search terms were ‘intraosseous’ AND ‘adult’ which were purposely limited due to the exploratory nature of the review. Studies that met the inclusion criteria of primary research articles with adult focus, paediatric lead research were excluded. Primary research international also included. Secondary research, reviews, case reports, editorials and opinion papers were excluded. Conclusion. Intraosseous vascular access is considered an alternative vascular access route although debate considering the preferred anatomical site is ongoing. Documented practices are only established in pre-hospital and specialist Emergency Department settings, however variety exists in policy and actual practice. Achieving insertion competence is relatively uncomplicated following minimal preparation although ongoing skill maintenance is less clear. Intraosseous vascular access is associated with minimal complications although pain is a significant issue for the conscious patient especially during fluid administration. Relevance to clinical practice. The intraosseous route is clearly a valuable alternative to problematic intravascular access. However further research, including cost effectiveness reviews, is required to gain clarity of whole acute care approaches

Food Safety Posters for Safe Handling of Leafy Greens

This article describes food safety educational tools depicting safe handling of leafy greens that are available as downloadable posters to Extension educators and practitioners (www.extension.iastate.edu). Nine visual-based minimal-text colored posters in English, Chinese, and Spanish were developed for use when formally or informally educating foodservice workers about safely handling leafy greens. A three-phase methodology included the use of expert knowledge, microbial sampling, and observational study in Iowa and Kansas foodservice operations. Use of the posters was shown to have positive impacts on both microbial levels and food safety behaviors, suggesting that the posters can be useful tools for Extension personnel

Experimental study of the role of physicochemical surface processing on the IN ability of mineral dust particles

During the measurement campaign FROST 2 (FReezing Of duST 2), the Leipzig Aerosol Cloud Interaction Simulator (LACIS) was used to investigate the influence of various surface modifications on the ice nucleating ability of Arizona Test Dust (ATD) particles in the immersion freezing mode. The dust particles were exposed to sulfuric acid vapor, to water vapor with and without the addition of ammonia gas, and heat using a thermodenuder operating at 250 °C. Size selected, quasi monodisperse particles with a mobility diameter of 300 nm were fed into LACIS and droplets grew on these particles such that each droplet contained a single particle. Temperature dependent frozen fractions of these droplets were determined in a temperature range between −40 °C ≤T≤−28 °C. The pure ATD particles nucleated ice over a broad temperature range with their freezing behavior being separated into two freezing branches characterized through different slopes in the frozen fraction vs. temperature curves. Coating the ATD particles with sulfuric acid resulted in the particles' IN potential significantly decreasing in the first freezing branch (T>−35 °C) and a slight increase in the second branch (T≤−35 °C). The addition of water vapor after the sulfuric acid coating caused the disappearance of the first freezing branch and a strong reduction of the IN ability in the second freezing branch. The presence of ammonia gas during water vapor exposure had a negligible effect on the particles' IN ability compared to the effect of water vapor. Heating in the thermodenuder led to a decreased IN ability of the sulfuric acid coated particles for both branches but the additional heat did not or only slightly change the IN ability of the pure ATD and the water vapor exposed sulfuric acid coated particles. In other words, the combination of both sulfuric acid and water vapor being present is a main cause for the ice active surface features of the ATD particles being destroyed. A possible explanation could be the chemical transformation of ice active metal silicates to metal sulfates. The strongly enhanced reaction between sulfuric acid and dust in the presence of water vapor and the resulting significant reductions in IN potential are of importance for atmospheric ice cloud formation. Our findings suggest that the IN concentration can decrease by up to one order of magnitude for the conditions investigated

Corrigendum to "Experimental study of the role of physicochemical surface processing on the IN ability of mineral dust particles" published in Atmos. Chem. Phys., 11, 11131–11144, 2011

In the abstract of the manuscript, the following sentence needs to be corrected: “A possible explanation could be the chemical transformation of ice active metal silicates to metal sulfates.” “metal silicates” is wrong. It should be “aluminosilicates”

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes