A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (Part I - Protection via specific pathways).

Neurocognitive deficits are a major source of morbidity in survivors of cardiac arrest. Treatment options that could be implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation to improve these neurological deficits are limited. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following cardiac arrest with associated global cerebral ischemia. The search was limited to investigational therapies that were utilized to treat global cerebral ischemia associated with cardiac arrest. In this review we discuss potential mechanisms of neurologic protection following cardiac arrest including actions of several medical gases such as xenon, argon, and nitric oxide. The 3 included mechanisms are: 1. Modulation of neuronal cell death; 2. Alteration of oxygen free radicals; and 3. Improving cerebral hemodynamics. Only a few approaches have been evaluated in limited fashion in cardiac arrest patients and results show inconclusive neuroprotective effects. Future research focusing on combined neuroprotective strategies that target multiple pathways are compelling in the setting of global brain ischemia resulting from cardiac arrest

CONTROLLING THE POLICE: LOCAL AUTONOMY IN POLICY AND PRACTICE

This thesis assesses the influence of The Home Office, Her Majesty's Inspectorate of Constabulaiy, the Association of Chief Police Officers, the Audit Commission, the Local Police Authority, and the Chief Constable on local policy makers and impleinenters within the Devon & Cornwall Constabiilary. It is based on five policy areas: the structmre of the organisation. The Citizens' Charter, Annual Policing (now Performance) Plans, Domestic Violence Policy, and Equal Opportunities Policy. Unlike previous research, it brings together the issues of policy and practice at all levels of the organisation through interviews with senior managers in the Devon & Cornwall Constabulary and members of the Local Police Authority, and questionnaires to front line police officers; as well as analysis of Her Majesty's Inspectorate of Constabulary reports and Police Authority Policing Plans, and recomniendations made in Home Office Circulars and Audit Commission reports. The research was carried out prior to the infroduction of Crime and Disorder Partnerships and Crime Audits, required by the Crime and Disorder Act 1998. Both policy makers and policy implementers believed that there was a sfrong influence from all the key players in the policy areas examined, with the exception of the Association.of Chief Police Officers arid the Local Police Authority: There is-no'^yidence; to suggest that there has been any change in the power relationship between the Chief Constable and the Police Authority. For police officers directly iiivolved in the implementation process. The Citizens' Charter and Annual Policing (now Performance) Plans had made little differerice to the way they carried out their day-to-day work. In these more generic policy areas they saw less influence from the key players but perceived greater influence coming from consumers, public opinion, colleagues and immediate supervisors. In the tighter policy area of domestic violence, where there is greater top down confrol, the mfluence of the key players was the sfrongest, and local autonomy, both in policy and practice was hard to find. The police organisatiori retains many of the attiibutes of a classical bureaucracy and an ideal form of organisational stincture has yet to be found.Faculty of Human Science

Phase I and Phase II Therapies for Acute Ischemic Stroke: An Update on Currently Studied Drugs in Clinical Research.

Acute ischemic stroke is a devastating cause of death and disability, consequences of which depend on the time from ischemia onset to treatment, the affected brain region, and its size. The main targets of ischemic stroke therapy aim to restore tissue perfusion in the ischemic penumbra in order to decrease the total infarct area by maintaining blood flow. Advances in research of pathological process and pathways during acute ischemia have resulted in improvement of new treatment strategies apart from restoring perfusion. Additionally, limiting the injury severity by manipulating the molecular mechanisms during ischemia has become a promising approach, especially in animal research. The purpose of this article is to review completed and ongoing phases I and II trials for the treatment of acute ischemic stroke, reviewing studies on antithrombotic, thrombolytic, neuroprotective, and antineuroinflammatory drugs that may translate into more effective treatments

Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study.

ObjectiveThis study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type.MethodsThe 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants selected face-to-face interviews, 53 applicants selected web-based interviews, and 17 applicants declined to interview. Data regarding applicants' reasons for selecting a particular interview type were gathered using an anonymous online survey after interview completion. Residency program admission rates and survey answers were compared between applicants completing face-to-face versus web-based interviews.ResultsOne hundred twenty-seven (75.1%) applicants completed face-to-face and 42 (24.9%) completed web-based interviews. The admission rate to our residency program was not significantly different between applicants completing face-to-face versus web-based interviews. One hundred eleven applicants completed post-interview surveys. The most common reasons for selecting web-based interviews were conflict of interview dates between programs, travel concerns, or financial limitations. Applicants selected face-to-face interviews due to a desire to interact with current residents, or geographic proximity to the residency program.ConclusionsThese results suggest that completion of web-based interviews is a viable alternative to completion of face-to-face interviews, and that choice of interview type does not affect the rate of applicant admission to the residency program. Web-based interviews may be of particular interest to applicants applying to a large number of programs, or with financial limitations

Panel 1 Electronic Commerce in the Year 2006

This panel considers the nature of electronic commerce in the year 2006. It is easy to predict that the technological foundations of electronic commerce will fall neatly into place in just a year or so. But what happens after that? How will electronic commerce evolve over the next decade? By thinking creatively about the world of tomorrow, our three panelists will present three diverse characterizations of electronic commerce in the future. Each panelist’s view is a personal one, emphasizing different issues. Their characterizations of electronic commerce in 2006 will emphasize insight, not forecasting, with an eye toward learning, not planning

Cognitive dysfunction following desflurane versus sevoflurane general anesthesia in elderly patients: a randomized controlled trial.

UnlabelledAs life expectancy increases, more patients ≥65 years undergo general anesthesia. Anesthetic agents may contribute to postoperative cognitive dysfunction, and incidence may differ with anesthetic agents or intraoperative anesthesia depth. Responses to anesthetic adjuvants vary among elderly patients. Processed electroencephalography guidance of anesthetic may better ensure equivalent cerebral suppression. This study investigates postoperative cognitive dysfunction differences in elderly patients given desflurane or sevoflurane using processed electroencephalography guidance.IRB approved, randomized trial enrolled consenting patients ≥65 years scheduled for elective surgery requiring general anesthesia ≥120 minute duration. After written informed consent, patients were randomly assigned to sevoflurane or desflurane. No perioperative benzodiazepines were administered. Cognitive impairment was measured by an investigator blinded to group assignment using mini-Mental Status Examination (MMSE) at baseline; 1, 6, and 24 hours after the end of anesthesia. Mean arterial pressure was maintained within 20% of baseline. Anesthetic dose was adjusted to maintain moderate general anesthesia per processed electroencephalograpy (Patient State Index 25 to 50). The primary outcome measure was intergroup difference in MMSE change 1 hour after anesthesia (median; 95% confidence interval).110 patients consented; 26 were not included for analysis (no general anesthesia; withdrew consent; baseline MMSE abnormality; inability to perform postoperative MMSE; data capture failure); 47 sevoflurane and 37 desflurane were analyzed. There were no significant differences in patient characteristics; intraoperative mean blood pressure (desflurane 86.4; 81.3 to 89.6 versus sevoflurane 82.5; 80.2 to 86.1 mmHg; p = 0.42) or Patient State Index (desflurane 41.9; 39.0 to 44.0 versus sevoflurane 41.0; 37.5 to 44.0; p = 0.60) despite a lower MAC fraction in desflurane (0.82; 0.77 to 0.86) versus sevoflurane (0.96; 0.91 to 1.03; p < 0.001). MMSE decreased 1 hour after anesthesia (p < 0.001). The decrease at one hour was larger in sevoflurane (-2.5; -3.3 to -1.8) than desflurane (-1.3; -2.2 to -0.5; p = 0.03). MMSE returned to baseline by 6 hours after anesthesia.ConclusionsFor elderly patients in whom depth of anesthesia is maintained in the moderate range, both desflurane and sevoflurane are associated with transient decreases in cognitive function as measured by MMSE after anesthesia, with clinically insignificant differences between them in this setting.Trial registryClinicalTrials.gov NCT01199913

Corixidae (Water Boatmen) Abundance and Contribution to Littoral Zone Fish Forage in Lake Poinsett, South Dakota

Corixids were sampled each week in littoral zone areas of Lake Poinsett during the open water seasons, April-October, in 1970, 1971, and 1972. Fish were sampled each week in littoral zone areas in 1970 and food habits studies were conducted to determine if fish predation would influence corixid population dynamics. Seven genera and 15 species of the family Corixidae were collected. Major indigenous species were Palmarcorixa buenoi Abbott, Trichocorixa borealis Sailer, Cenocorixa dakotensis (Hungerford), and Sigara conocephala (Hungerford). Species migrating to Lake Poinsett in the fall to overwinter were Sigara alternata (Say), S. solensis (Hungerford), S. bicoloripennis (Walley), Hesperocorixa vulgaris (Hungerford), and Callicorixa audeni Hungerford. Corixid population density increased from a mean annual standing crop of 4.9/m2 in 1970 to 17.6/m2 in 1971 and 56.9/m2 in 1972. The mean density of P. buenoi (19.8/m2) was approximately five fold greater than that of T. borealis (3.8/m2), the second most abundant species, and in combination with T. borealis represented 95 percent of the three year mean standing crop (24.7/m2) of Corixidae in Lake Poinsett. Both P. buenoi and T. borealis produced two generations each year, but P. buenoi overwintered as primarily fourth instar nymphs and T. borealis overwintered as adults. Food habits analysis of littoral zone fishes, Pimephales promelas Rafinesque, Etheostoma nigrum Rafinesque, Ictiobus cyprinellus (Valenciennes), Percopsis omiscomaycus (Walbaum), Notropis hudsonius (Clinton), N. stramineus (Cope), and N. lutrensis {Baired and Girard), indicated that corixids were not prey species and that littoral zone fish predation had no significant effects on corixid population dynamics. The lack of predation of littoral zone fishes on corixids appeared to be primarily related to the fish species composition and to the high densities of more vulnerable prey

The role of Volatile Anesthetics in Cardioprotection: a systematic review.

This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery

Free-ranging, Northern Bobwhite Submissions to the Southeastern Cooperative Wildlife Disease Study (1982-2015)

There are concerns regarding population declines of northern bobwhite (Colinus virginianus) over the past 4 decades (Palmer et al. 2011). Infectious and noninfectious diseases are among the limiting factors that potentially influence bobwhite demographics (Applegate 2014). The last update of diseases of bobwhite was presented at the Second National Quail Symposium in 1982 (Davidson et al. 1982). Since that report, scientists at the Southeastern Cooperative Wildlife Disease Study (SCWDS) have examined 133 wild bobwhites from 13 states. The SCWDS is a cooperative between states and the University of Georgia and obtains cases from the cooperating states. In this update, we focus on the diagnostic testing results from wild birds and exclude other cases that were examined during this period. We searched the SCWDS database for all bobwhite cases 1985–2016 and examined the individual case reports for 133 wild bobwhite quail. During this period, the majority of cases originated from Florida, Georgia, and Kansas, where research was being conducted on bobwhite populations. A diagnosis could not be clearly identified in all cases and some otherwise healthy bobwhites were submitted for screening; therefore, we have narrowed the focus of this report to a subset of 78 bobwhites. Wild bobwhites that were submitted by SCWDS state cooperators had an approximately even distribution between male and female birds (26 F: 19 M; 2 unknown sex). Adults (20 F, 10 M) predominated over juvenile birds (6 F, 7 M, 2 unknown sex). Trauma (physical injury) was the diagnosis in 17 female and 38 male bobwhites submitted during this period. Three each of male and female birds were considered to have no health problems. Some of the most frequent findings in diagnosed bobwhites were possible Physaloptera sp. infection (n = 9, 17.0%), avian pox (n = 7, 14.9%), intoxication (lead and carbamate; n = 5, 10.6%), corneal opacity (n = 4, 8.5%), Sarcocystis sp. infection (n = 3, 6.4%), and fungal pneumonia (n = 2, 4.25%). Some parasitic infections (e.g., coccidiosis) were thought to be associated with mortality based on necropsy and laboratory findings while a number of the parasites were determined to be incidental findings (e.g., Sarcocystis and Physaloptera) based on necropsy and laboratory findings. Corneal opacity was found in 4 birds, but the cause was not determined. The most striking findings were that trauma (e.g., physical injury) or avian pox were among the most common causes of mortality in free-ranging quail. Iatrogenic (researcher) causes of mortality (n = 5, 10.6%) associated with complications from radiotransmitters and small mammal trapping also occurred. This latter urges careful consideration among bobwhite researchers. The cause of population declines in bobwhites are likely multifactorial. We hope that morbidity and mortality investigations can provide some insight into potential limiting factors for bobwhites and assist wildlife managers with population management decisions