THE INSTITUTE OF PLEA BARGAINING IN GEORGIA

Since 2004, a completely new institution for the legal system of Georgia was introduced and actively used in the criminal law on the legislative level, which has changed the traditional procedural course of reviewing criminal cases. This institution is plea bargaining i.e. the bargaining between the prosecution and defence when it is possible the court to reach the verdict without reviewing the case thoroughly. In the article are reviewed new statutes of the Criminal Procedural Code of Georgia as well as the statistical analysis of jurisprudence. Special emphasis is made on the Institute of plea agreement as one of the most significant changes in the criminal proceedings

Pediatric Emergency Cases Managed with Intraosseous Access: Indications, Complication and Outcomes

Intraosseous (IO) access is an alternative way of administering fluid and drug and also taking biopsies needed for clinical and laboratory tests in cases when peripheral venous access couldn’t be established. The IO route was successfully secured in all cases with a significant shorter time of vascular access insertion, shorter length of stay and reduction in mortality in IO group vs. IV group.  IO access was first used in 1922. This technique was widely used during 1940’s when emergency medical care was routinely needed for seriously injured patients in World War II. Since 1950’s after the introduction of peripheral venous access technique IO access lost its actuality. In management of Pediatric emergencies intravascular (venous) access is prior but sometimes establishing peripheral venous access is impossible or it may take too much time because of anatomical or physiological characteristics, such as an excessive subcutaneous fatty tissue and veins with a small diameter. Vasoconstriction, reduction of circulating blood volume and peripheral venous collapse takes place during cardiopulmonary arrest, septic or hypovolemic shock and prolonged status epilepticus. This features alone or in combination can make venous catheterization impossible.For pediatric resuscitation, vascular access must be established quickly, often in difficult circumstances. Alternative methods of peripheral access, such as umbilical catheter, central venous lines, venous cut-down, and ultrasound guided access, may be poor options because of the patient’s age or condition, the urgency of resuscitation, and/or the skill of available clinicians. Anatomically, the described site is suggested to offer a safe alternative access point for emergency infusion in severely hypovolemic newborns and infants, without the risk of damage to any anatomical structures. IO access complications are infection - cellulites, abscess, osteomyelitis and fracture. The most widespread complication is extravasation, which, if left unidentified, can cause compartment syndrome. The EZ-IO® device is easy to use and requires minimal training. These studies suggest that the EZ-IO® is an easy to use, easy to learn tool that can be used successfully in resuscitation scenarios with minimal training.  It is evident that blood samples drawn immediately after intraosseous cannulation can provide accurate laboratory and blood bank data to aid in resuscitation. More recently, the pharmacokinetics of intraosseous drug delivery has been compared with central venous drug delivery

A Dual-Tracer Method for Differentiating Transendothelial Transport from Paracellular Leakage in Vivo and in Vitro

Inflammation-induced impaired function of vascular endothelium may cause leakage of plasma proteins that can lead to edema. Proteins may leave the vascular lumen through two main paracellular and transcellular pathways. As the first involves endothelial cell (EC) junction proteins and the second caveolae formation, these two pathways are interconnected. Therefore, it is difficult to differentiate the prevailing role of one or the other pathway during pathology that causes inflammation. Here we present a newly developed dual-tracer probing method that allows differentiation of transcellular from paracellular transport during pathology. This fluorescence-based method can be used in vitro to test changes in EC layer permeability and in vivo in various animal vascular preparations. The method is based on comparison of low molecular weight molecule (LMWM) transport to that of high molecular weight molecule (HMWM) transport through the EC layer or the vascular wall during physiological and pathological conditions. Since the LMWM will leak through mainly the paracellular and HMWM will move through paracellular (when gaps between the ECs are wide enough) and transcellular pathways, the difference in transport rate (during normal conditions and pathology) of these molecules will indicate the prevailing transport pathway involved in overall protein crossing of vascular wall. Thus, the novel approach of assessing the transport kinetics of different size tracers in vivo by intravital microscopy can clarify questions related to identification of target pathways for drug delivery during various pathologies associated with elevated microvascular permeability

Role of Fibrinogen in Vascular Cognitive Impairment in Traumatic Brain Injury

Fibrinogen (Fg) is one of the biomarkers of inflammation and a high risk factor for many cardiovascular and cerebrovascular diseases. Elevated levels of Fg (hyperfibrinogenemia, HFg) are also associated with traumatic brain injury (TBI). HFg in blood alters vascular reactivity and compromises integrity of endothelial cell layer that ultimately can result in extravasation of Fg and other plasma proteins. Proteins deposited in extravascular space may form plaques which can lead to neurodegeneration. Among these plasma proteins are amyloid beta (Aβ) and/or cellular prion protein (PrPC) that can form degradation resistant complexes with Fg and are known to be involved in memory impairment. The purpose of this chapter is to propose and discuss some possible mechanisms involved in HFg-mediated cerebrovascular dysfunction leading to neuronal degeneration during TBI

A Multi-Color Optical Survey of the Orion Nebula Cluster. Part I: the Catalog

We present U, B, V, I broad-band, 6200A TiO medium-band and Halpha photometry of the Orion Nebula Cluster obtained with the WFI imager at the ESO/MPI 2.2 telescope. The nearly-simultaneous observations cover the entire ONC in a field of about 34x34 arcmin. They enable us to determine stellar colors avoiding the additional scatter in the photometry induced by stellar variability typical of pre-main sequence stars. We identify 2,612 point-like sources in I band, 58%, 43% and 17% of them detected also in V, B and U, respectively. 1040 sources are identified in Halpha band. In this paper we present the observations, the calibration techniques, and the resulting catalog. We show the derived CMD of the population and discuss the completeness of our photometry. We define a spectro-photometric TiO index from the fluxes in V, I, and TiO-band. We find a correlation between the index and the spectral type valid for M-type stars, that is accurate to better than 1 spectral sub-class for M3-M6 types and better than 2 spectral subclasses for M0-M2 types. This allows us to newly classify 217 stars. We subtract from our Halpha photometry the photospheric continuum at its wavelength, deriving calibrated line excess for the full sample. This represents the largest Halpha star catalog obtained to date on the ONC. This data set enables a full re-analysis of the properties of the Pre-Main Sequence population in the Orion Nebula Cluster to be presented, in an accompanying paper.Comment: 15 pages, 15 figures. To be published in The Astrophysical Journal Supplement Serie

An agile standardized work procedure for cleaning the operating room

Purpose: This research aimed to reduce the turnover time (non-operative time) in the operating room (OR) at a US Northwestern hospital. Design/methodology/approach: Data collection consisted of observation and interviews of the aides, circulating nurses, and surgical techs to identify causes of delays and long turnovers. It was determined that the turnover could be divided into two stages: cleaning the room and setting up for the next surgery. The research team met with the staff (aides) to create a standard operating procedure for the cleaning stage. It was decided to create an agile standard procedure that would allow the process to be completed the same way effectively with any number of people ranging from 1 to 3. The flexibility accounts for the number of people who are to complete the procedure and considers that some of them are only available during portions of the cleaning stage due to multiple turnovers or duties. Findings: The agile cleaning procedure reduced the cleaning time by 2.2 minutes (15.7% of the total time) and the standard deviation by 3.30 minutes. A decrease in variability represents more consistent turnovers, creating more predictable times for scheduling surgeries in the future. Originality/value: This research proposes a novel approach to standardized work that quickly adapts to the number of workers available. The agile standardized work procedure (ASWP) allows the process to be completed the same way every time effectively with any number of peoplePeer Reviewe

New 1,2,3-Triazole Containing Polyesters via

High-molecular-weight AA-BB-type aliphatic polyesters were synthesized via Cu(I)-catalyzed click step-growth polymerization (SGP) following a new synthetic strategy. The synthesis was performed between diyne and diazide monomers in an organic solvent as one pot process using three components and two stages. The dipropargyl esters of dicarboxylic acids (component 1) were used as diyne monomers, di-(bromoacetic acid)-alkylene diesters (component 2) were used as precursors of diazide monomers, and sodium azide (component 3) was used for generating diazide monomers. The SGP was carried out in two steps: at Step  1 dibromoacetates interacted with two moles of sodium azide resulting in diazide monomers which interacted in situ with diyne monomers at Step  2 in the presence of Cu(I) catalyst. A systematic study was done for optimizing the multiparameter click SGP in terms of the solvent, duration of both Step  1 and Step  2, solution concentration, catalyst concentration, catalyst and catalyst activator (ligand) nature, catalyst/ligand mole ratio, and temperature of both steps of the click SGP. As a result, high-molecular-weight (MW up to 74 kDa) elastic film-forming click polyesters were obtained. The new polymers were found suitable for fabricating biodegradable nanoparticles, which are promising as drug delivery containers in nanotherapy

Improving the registration process in a healthcare facility with lean principles

Purpose: Process improvement in service industries, like the registration process in a hospital, can be achieved with the application of lean principles. In this specific case, lean principles were essential to analyze and improve patient satisfaction in a hospital in Montana. The clinics involved in the study included pediatrics (P), internal medicine (IM), and cardiology/pulmonary (CP). The purpose of this study was to address difficulties regarding patient satisfaction on the registration and check-in processes. Design/methodology/approach: Direct observations and patient surveys were initially made to understand the processes and identify the initial causes of dissatisfaction. A value stream map (VSM) was then used to further break down the patient flow’s complexity. A Fishbone diagram and a Concept Map were completed to find the root of the dissatisfaction. Findings: The information obtained from the lean tools showed that patients questioned the need for having a central registration in combination with the check-in process when this combination generates duplications of steps that cause unwanted delays. Several recommendations were explored by the engineering team to mitigate these delays and improve the registration process reducing the number of patients complaints by 40%. Practical implications: This project illustrated the application of lean principles to resolve issues regarding a central registration format in a healthcare facility. Originality/value: A Concept Map was used as a tool to help the organization develop creative and new ways of looking at and solving process deficienciesPeer Reviewe