The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review.

ABSTRACTObjective:A systematic literature review (SLR) was performed to elucidate the current triage and treatment of an entrapped or mangled extremity in resource scarce environments (RSEs).Methods:A lead researcher followed the search strategy following inclusion and exclusion criteria. A first reviewer (FR) was randomly assigned sources. One of the 2 lead researchers was the second reviewer (SR). Each determined the level of evidence (LOE) and quality of evidence (QE) from each source. Any differing opinions between the FR and SR were discussed between them, and if differing opinions remained, then a third reviewer (the other lead researcher) discussed the article until a consensus was reached. The final opinion of each article was entered for analysis.Results:Fifty-eight (58) articles were entered into the final study. There was 1 study determined to be LOE 1, 29 LOE 2, and 28 LOE 3, with 15 determined to achieve QE 1, 37 QE 2, and 6 QE 3.Conclusion:This SLR showed that there is a lack of studies producing strong evidence to support the triage and treatment of the mangled extremity in RSE. Therefore, a Delphi process is suggested to adapt and modify current civilian and military triage and treatment guidelines to the RSE

Calcification-driven CO2emissions exceed blue Carbon sequestration in a carbonate seagrass meadow

Long-term Blue Carbon burial in seagrass meadows is complicated by other carbon and alkalinity exchanges that shape net carbon sequestration. We measured a suite of such processes, including denitrification, sulfur, and inorganic carbon cycling, and assessed their impact on air-water CO2 exchange in a typical seagrass meadow underlain by carbonate sediments. Eddy covariance measurements reveal a consistent source of CO2 to the atmosphere at an average rate of 610 ± 990 μmol m-2 hour-1 during our study and 700 ± 660 μmol m-2 hour-1 (6.1 mol m-2 year-1) over an annual cycle. Net alkalinity consumption by ecosystem calcification explains \u3e95% of the observed CO2 emissions, far exceeding organic carbon burial and anaerobic alkalinity generation. We argue that the net carbon sequestration potential of seagrass meadows may be overestimated if calcification-induced CO2 emissions are not accounted for, especially in regions where calcification rates exceed net primary production and burial

Invisible Z-Boson Decays at e+e- Colliders

The measurement of the invisible Z-boson decay width at e+e- colliders can be done "indirectly", by subtracting the Z-boson visible partial widths from the Z-boson total width, or "directly", from the process e+e- -> \gamma \nu \bar{\nu}. Both procedures are sensitive to different types of new physics and provide information about the couplings of the neutrinos to the Z-boson. At present, measurements at LEP and CHARM II are capable of constraining the left-handed Z\nu\nu-coupling, 0.45 <~ g_L <~ 0.5, while the right-handed one is only mildly bounded, |g_R| <= 0.2. We show that measurements at a future e+e- linear collider at different center-of-mass energies, \sqrt{s} = MZ and \sqrt{s}s ~ 170 GeV, would translate into a markedly more precise measurement of the Z\nu\nu-couplings. A statistically significant deviation from Standard Model predictions will point toward different new physics mechanisms, depending on whether the discrepancy appears in the direct or the indirect measurement of the invisible Z-width. We discuss some scenarios which illustrate the ability of different invisible Z-boson decay measurements to constrain new physics beyond the Standard Model

Top Quarks and Electroweak Symmetry Breaking in Little Higgs Models

`Little Higgs' models, in which the Higgs particle arises as a pseudo-Goldstone boson, have a natural mechanism of electroweak symmetry breaking associated with the large value of the top quark Yukawa coupling. The mechanism typically involves a new heavy SU(2)_{L} singlet top quark, T. We discuss the relationship of the Higgs boson and the two top quarks. We suggest experimental tests of the Little Higgs mechanism of electroweak symmetry breaking using the production and decay of the T at the Large Hadron Collider.Comment: 28 pages, 6 figures; new ST fits (Fig. 3,4

Ferrimagnetism and disorder in epitaxial Mn(2-x)Co(x)VAl thin films

The quaternary full Heusler compound Mn(2-x)Co(x)VAl with x = 1 is predicted to be a half-metallic antiferromagnet. Thin films of the quaternary compounds with x = 0...2 were prepared by DC and RF magnetron co-sputtering on heated MgO (001) substrates. The magnetic structure was examined by x-ray magnetic circular dichroism and the chemical disorder was characterized by x-ray diffraction. Ferrimagnetic coupling of V to Mn was observed for Mn2VAl (x = 0). For x = 0.5, we also found ferrimagnetic order with V and Co antiparallel to Mn. The observed reduced magnetic moments are interpreted with the help of band structure calculations in the coherent potential approximation. Mn2VAl is very sensitive to disorder involving Mn, because nearest-neighbor Mn atoms couple anti-ferromagnetically. Co2VAl has B2 order and has reduced magnetization. In the cases with x >= 0.9 conventional ferromagnetism was observed, closely related to the atomic disorder in these compounds.Comment: 10 pages, 4 figure

Pica and refractory iron deficiency anaemia: a case report

INTRODUCTION: Iron deficiency is the most common cause of anaemia worldwide. Pica, the ingestion of substances that are inappropriate for consumption, is associated with iron deficiency and may be under-diagnosed. CASE PRESENTATION: A 34-year-old woman presented with iron deficiency anaemia refractory to treatment for more than a decade. The clinical presentation, endoscopic findings and laboratory investigations were consistent with pica. Subsequent geophysical analysis confirmed that the ingested material was kaolin, a negatively charged silicate. CONCLUSION: Prolonged unexplained iron deficiency anaemia should prompt clinicians to remember and inquire about pica. In our patient, this would have averted numerous unnecessary investigations and prevented a decade-long suffering

TIMolol Nasal Spray as a Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia (TIM-HHT)—A Prospective, Randomized, Double-Blind, Controlled, Cross-Over Trial

To date, there is no approved local therapeutic agent for the treatment of epistaxis due to hereditary hemorrhagic telangiectasia (HHT). Several case reports suggest the topical use of timolol. This monocentric, prospective, randomized, placebo-controlled, double-blinded, cross-over study investigated whether the effectiveness of the standard treatment with a pulsed diode laser can be increased by also using timolol nasal spray. The primary outcome was severity of epistaxis after three months, while the main secondary outcome was severity of epistaxis and subjective satisfaction after one month. Twenty patients were allocated and treated, of which 18 patients completed both 3-month treatment sequences. Timolol was well tolerated by all patients. Epistaxis Severity Score after three months, the primary outcome measure, showed a beneficial, but statistically nonsignificant (p = 0.084), effect of additional timolol application. Epistaxis Severity Score (p = 0.010) and patients’ satisfaction with their nosebleeds after one month (p = 0.050) showed statistically significant benefits. This placebo-controlled, randomized trial provides some evidence that timolol nasal spray positively impacts epistaxis severity and subjective satisfaction in HHT patients when additively applied to standard laser therapy after one month. However, the effect of timolol was observed to diminish over time. Trials with larger sample sizes are warranted to confirm these findings

The Truth, the Whole Truth, and Nothing but the Truth: A Pragmatic Guide to Assessing Empirical Evaluations

An unsound claim can misdirect a field, encouraging the pursuit of unworthy ideas and the abandonment of promising ideas. An inadequate description of a claim can make it difficult to reason about the claim, for example to determine whether the claim is sound. Many practitioners will acknowledge the threat of un- sound claims or inadequate descriptions of claims to their field. We believe that this situation is exacerbated and even encouraged by the lack of a systematic approach to exploring, exposing, and addressing the source of unsound claims and poor exposition. This paper proposes a framework that identifies three sins of reasoning that lead to unsound claims and two sins of exposition that lead to poorly described claims. Sins of exposition obfuscate the objective of determining whether or not a claim is sound, while sins of reasoning lead directly to unsound claims. Our framework provides practitioners with a principled way of critiquing the integrity of their own work and the work of others. We hope that this will help individuals conduct better science and encourage a cultural shift in our research community to identify and promulgate sound claims

Rearrangement of the RNA polymerase subunit H and the lower jaw in archaeal elongation complexes

The lower jaws of archaeal RNA polymerase and eukaryotic RNA polymerase II include orthologous subunits H and Rpb5, respectively. The tertiary structure of H is very similar to the structure of the C-terminal domain of Rpb5, and both subunits are proximal to downstream DNA in pre-initiation complexes. Analyses of reconstituted euryarchaeal polymerase lacking subunit H revealed that H is important for open complex formation and initial transcription. Eukaryotic Rpb5 rescues activity of the ΔH enzyme indicating a strong conservation of function for this subunit from archaea to eukaryotes. Photochemical cross-linking in elongation complexes revealed a striking structural rearrangement of RNA polymerase, bringing subunit H near the transcribed DNA strand one helical turn downstream of the active center, in contrast to the positioning observed in preinitiation complexes. The rearrangement of subunits H and A′′ suggest a major conformational change in the archaeal RNAP lower jaw upon formation of the elongation complex