Ergonomia pracy w karetce pogotowia ratunkowego : opinie ratowników medycznych

Wprowadzenie. Ergonomia miejsca pracy jest tematyka budzącą już od wielu tak rosnącezainteresowanie. Dużą aktualność tematyki skłoniła mnie do podjęcia badan własnych. Cel badań. Celem pracy jest przestawienie opinii ratowników medycznych w zakresie ergonomicznych warunków pracy wewnątrz karetki pogotowia ratunkowego. Materiał i metody. Badaniom prospektywnym poddana grupa 50 (48 mężczyzn oraz 2 kobiety) w wieku od 25 do 65 lat ratowników medycznych. Badania ankietowe, bezpośrednie przeprowadzono w okresie od 1 stycznia 2015 do 30 maja 2015. Ankietę oparto na liście kontrolnej K. F. H. Murrella zawierającej 11 pytań-problemów. Wyniki i wnioski. Przeprowadzone badania pozwoliły stwierdzić, że 74% respondentów uważało, że podczas pracy wewnątrz karetki pogotowia ratunkowego mogą w sposób optymalny wykorzystywać posiadane umiejętności. 48% badanych wskazało, że urządzenia, jakie znajdują się w karetce są dostosowane do czynności, jakie wykonuje ratownik. 90% badanych ratowników medycznych jest zdania , że wnętrze karetki zostało zaprojektowane z myślą o przyszłych użytkownikach. Dla ratowników pracujących wewnątrz karetki najważniejszym kanałem komunikacji jest kanał słuchowy. Jednakowa liczba respondentów jest zdania , że najlepszym systemem łączności wewnątrz karetki jest : intercom – takiego zdania było 37% badanych i łączność głosowa- ten sposób komunikacji preferowało 37% badanych. 80% ankietowanych ratowników podkreśla, że łączność w karetce pogotowia powinna być przede wszystkim słowna. 72% badanych skarżyła się, że łączność słowna w karetce może być zakłócana przez hałas. Wszyscy badani ratownicy medyczni wskazują, że wymagania fizyczne bądź umysłowe, jakie powstają podczas wykonywania pracy w karetce pogotowia mogą prowadzić do nadmiernego przeciążenia ratownika. Wśród wielu postulatów zgłaszanych przez ankietowanych, mogących poprawić pracę wewnątrz karetki pogotowia ratunkowego dominowały dwa podstawowe: nowoczesny sprzęt i zapewnienie optymalnej liczby członków w zespole.Introduction. Workplace ergonomics has been a topic of increasing interest for many years. The ever-greater importance of this issue has encouraged the authors to pursue their own research. Aim of the study. The purpose of the study is to present the opinion of paramedics related to the ergonomics of work aboard an ambulance. Materials and methods. A group of 50 paramedics (48 men and 2 women) aged from 25 to 65 were suspected to a prospective study.The survey was conducted directly in the period from 1 January 2015 to 30 May 2015. It was based on the checklist by K. F. H. Murrell comprising 11 problem questions. Results and conclusions. The study conducted made it possible to conclude that 74% of the respondents believed that during work in an ambulance they could make optimum use of their skills. 48% of the people surveyed indicated that the equipment in the ambulance was adapted to the tasks carried out by the paramedics. 90% of the paramedics surveyed believed that the ambulance’s interior has been designed with future users in mind. The auditory channel is the most important communication channel for paramedics working on the ambulance. The same numbers of respondents were of the opinion that the best communication system inside the ambulance was intercom – such was the conviction of 37% of respondents, and voice communication – this method was preferred by 37% of those surveyed. 80% of the paramedics questioned emphasized that verbal communication especially should be used in the ambulance. 72% of the surveyed complained that verbal communication in the ambulance may be disturbed by noise. All the paramedics surveyed pointed out that both the physical or mental demands arising during work in the ambulance may lead to the paramedic becoming overburdened. Among the suggestions put forward by the surveyed, which could improve work in the ambulance, the following two were predominant: modern equipment and an optimum number of team members

32 Bezpośrednie wstrzykiwanie rTNFα do guzów nowotworowych wątroby

W około 70% badań sekcyjnych stwierdza się obecność guzów nowotworowych w wątrobie i są to głównie guzy przerzutowe. rTNFα jest cytokiną wykazującą cytotoksyczne działanie na komórki nowotworowe i jest stosowany w terapii eksperymentalnej nowotworów.W okresie od grudnia 1993 do stycznia 1995 r. rTNFα wstrzyknięto doguzowo z powodu zmian ogniskowych w wątrobie u 18 chorych (11 kobiet, 7 mężczyzn), badaniu klinicznemu zostali poddani chorzy z rozpoznaniami: pierwotny rak wątroby – 2 chorych, rak jelita grubego – 12 chorych, rak pęcherzyka żółciowego – 1 chorych, czerniak złośliwy – 1 chory, rak sutka – 1 chory, rak trzustki – 1 chory. rTNFα wstrzykiwano bezpośrednio do ognisk nowotworowych w wątrobie pod kontrolą ultrasonograficzną, w dawce od 100 do 500 μg (śr. 300 μg).U wszystkich chorych oceniano parametry kliniczne tj. temperaturę, czynność serca, ciśnienie tętnicze oraz laboratoryjne (biochemiczne i morfologiczne z krwi obwodowej). Dodatkowo u 6 chorych a rakiem jelita grubego, którzy otrzymywali 500μg rTNFα w surowicy oceniano kinetykę zmian stężenia rTNFα. Zmiany w obrębie ognisk nowotworowych oceniano w badaniu ultrasonograficznym.W badanej grupie chorych stwierdzono, że u 1 chorego z pierwotnym rakiem wątroby nie uzyskano zmiany obrazu ognisk patologicznych pod wpływem podawania rTNFα. U pozostałych 17 chorych stwierdzono zmiany w obrębie guzów obstrzykniętych tą cytokiną o charakterze hiperechogenicznym. W okresie od kilku do 72 godzin od chwili wstrzyknięcia stwierdzono normalizację parametrów klinicznych, biochemicznych i morfologicznych krwi. Największe stężenie rTNFα w surowicy krwi obwodowej stwierdzono w 1 godzinę od chwili wstrzyknięcia rTNFα −133,96 +/−291,40 pg/ml (ta wartość przed leczeniem wynosiła 279,72+/−23,20 pg/ml). Czas przeżycia chorych od chwili doguzowego wstrzyknięcia rTNFα wynosił od4 do 43 tygodni (mediana 18,8 tygodni)

Identification of Galaxy-Galaxy Strong Lens Candidates in the DECam Local Volume Exploration Survey Using Machine Learning

We perform a search for galaxy-galaxy strong lens systems using a convolutional neural network (CNN) applied to imaging data from the first public data release of the DECam Local Volume Exploration Survey, which contains 1/4520 million astronomical sources covering 1/44000 deg2 of the southern sky to a 5σ point-source depth of g = 24.3, r = 23.9, i = 23.3, and z = 22.8 mag. Following the methodology of similar searches using Dark Energy Camera data, we apply color and magnitude cuts to select a catalog of 1/411 million extended astronomical sources. After scoring with our CNN, the highest-scoring 50,000 images were visually inspected and assigned a score on a scale from 0 (not a lens) to 3 (very probable lens). We present a list of 581 strong lens candidates, 562 of which are previously unreported. We categorize our candidates using their human-assigned scores, resulting in 55 Grade A candidates, 149 Grade B candidates, and 377 Grade C candidates. We additionally highlight eight potential quadruply lensed quasars from this sample. Due to the location of our search footprint in the northern Galactic cap (b > 10 deg) and southern celestial hemisphere (decl. < 0 deg), our candidate list has little overlap with other existing ground-based searches. Where our search footprint does overlap with other searches, we find a significant number of high-quality candidates that were previously unidentified, indicating a degree of orthogonality in our methodology. We report properties of our candidates including apparent magnitude and Einstein radius estimated from the image separation

The DECam Local Volume Exploration Survey Data Release 2

We present the second public data release (DR2) from the DECam Local Volume Exploration survey (DELVE). DELVE DR2 combines new DECam observations with archival DECam data from the Dark Energy Survey, the DECam Legacy Survey, and other DECam community programs. DELVE DR2 consists of similar to 160,000 exposures that cover >21,000 deg(2) of the high-Galactic-latitude ( divide b divide > 10 degrees) sky in four broadband optical/near-infrared filters (g, r, i, z). DELVE DR2 provides point-source and automatic aperture photometry for similar to 2.5 billion astronomical sources with a median 5 sigma point-source depth of g = 24.3, r = 23.9, i = 23.5, and z = 22.8 mag. A region of similar to 17,000 deg(2) has been imaged in all four filters, providing four-band photometric measurements for similar to 618 million astronomical sources. DELVE DR2 covers more than 4 times the area of the previous DELVE data release and contains roughly 5 times as many astronomical objects. DELVE DR2 is publicly available via the NOIRLab Astro Data Lab science platform

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

RNA delivery by extracellular vesicles in mammalian cells and its applications.

The term 'extracellular vesicles' refers to a heterogeneous population of vesicular bodies of cellular origin that derive either from the endosomal compartment (exosomes) or as a result of shedding from the plasma membrane (microvesicles, oncosomes and apoptotic bodies). Extracellular vesicles carry a variety of cargo, including RNAs, proteins, lipids and DNA, which can be taken up by other cells, both in the direct vicinity of the source cell and at distant sites in the body via biofluids, and elicit a variety of phenotypic responses. Owing to their unique biology and roles in cell-cell communication, extracellular vesicles have attracted strong interest, which is further enhanced by their potential clinical utility. Because extracellular vesicles derive their cargo from the contents of the cells that produce them, they are attractive sources of biomarkers for a variety of diseases. Furthermore, studies demonstrating phenotypic effects of specific extracellular vesicle-associated cargo on target cells have stoked interest in extracellular vesicles as therapeutic vehicles. There is particularly strong evidence that the RNA cargo of extracellular vesicles can alter recipient cell gene expression and function. During the past decade, extracellular vesicles and their RNA cargo have become better defined, but many aspects of extracellular vesicle biology remain to be elucidated. These include selective cargo loading resulting in substantial differences between the composition of extracellular vesicles and source cells; heterogeneity in extracellular vesicle size and composition; and undefined mechanisms for the uptake of extracellular vesicles into recipient cells and the fates of their cargo. Further progress in unravelling the basic mechanisms of extracellular vesicle biogenesis, transport, and cargo delivery and function is needed for successful clinical implementation. This Review focuses on the current state of knowledge pertaining to packaging, transport and function of RNAs in extracellular vesicles and outlines the progress made thus far towards their clinical applications

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (&lt;50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, &lt;50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters