WSES classification and guidelines for liver trauma

The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines

Adaptive rationality: An evolutionary perspective on cognitive bias

A casual look at the literature in social cognition reveals a vast collection of biases, errors, violations of rational choice, and failures to maximize utility. One is tempted to draw the conclusion that the human mind is woefully muddled. We present a three-category evolutionary taxonomy of evidence of biases: biases are (a) heuristics, (b) error management effects, or (c) experimental artifacts. We conclude that much of the research on cognitive biases can be profitably reframed and understood in evolutionary terms. An adaptationist perspective suggests that the mind is remarkably well designed for important problems of survival and reproduction, and not fundamentally irrational. Our analysis is not an apologia intended to place the rational mind on a pedestal for admiration. Rather, it promises practical outcomes including a clearer view of the architecture of systems for judgment and decision making, and exposure of clashes between adaptations designed for the ancestral past and the demands of the present

Therapeutic distant organ effects of regional hypothermia during mesenteric ischemia-reperfusion injury

IntroductionMesenteric ischemia-reperfusion injury (IRI) leads to systemic inflammation and multiple organ failure in clinical and laboratory settings. We investigated the lung structural, functional, and genomic response to mesenteric IRI with and without regional intraischemic hypothermia (RIH) in rodents and hypothesized that RIH would protect the lung and preferentially modulate the distant organ transcriptome under these conditions.MethodsSprague-Dawley rats underwent sham laparotomy or superior mesenteric artery occlusion (SMAO) for 60 minutes with or without RIH. Gut temperature was maintained at 15°-20°C during SMAO, and systemic normothermia (37°C) was maintained throughout the study period. At 6 or 24 hours, lung tissue was collected for (1) histology, (2) myeloperoxidase activity, (3) bronchoalveolar lavage (BAL) fluid protein concentrations, (4) lung wet/dry ratios, and (5) total RNA isolation and hybridization to Illumina's Sentrix BeadChips (>22,000 probes) for gene expression profiling. Significantly affected genes (false discovery rate <5% and fold change ≥1.5) were linked to gene ontology (GO) terms using MAPPFinder, and hypothermia-suppressed genes were further analyzed with Pubmatrix.ResultsMesenteric IRI-induced lung injury, as evidenced by leukocyte trafficking, alveolar hemorrhage, and increased BAL protein and wet/dry ratios, and activated a proinflammatory lung transcriptome compared with sham. In contrast, rats treated with RIH exhibited lung histology, BAL protein, and wet/dry ratios similar to sham. At 6 hours, GO analysis identified 232 hypothermia-suppressed genes related to inflammation, innate immune response, and cell adhesion, and 33 hypothermia-activated genes related to lipid and amine metabolism and defense response. Quantitative real-time polymerase chain reaction validated select array changes in top hypothermia-suppressed genes lipocalin-2 (lcn-2) and chemokine ligand 1 (CXCL-1), prominent genes associated with neutrophil activation and trafficking.ConclusionsTherapeutic hypothermia during SMAO provides distant organ protection and preferentially modulates the IRI-activated transcriptome in the rat lung. This study identifies potential novel diagnostic and therapeutic targets of mesenteric IRI and provides a platform for further mechanistic study of hypothermic protection at the cellular and subcellular level.Clinical RelevanceVisceral organ ischemia-reperfusion injury (IRI) is a common clinical problem in the settings of shock, sepsis, vascular surgery, and organ transplantation and is a particularly vexing problem in the repair of complex aortic aneurysms. IRI is associated with considerable patient morbidity and mortality, for which there are virtually no therapeutic options. It systematically causes local organ injury and dysfunction, systemic inflammation, and multiple organ failure. Clinical trials investigating the efficacy of pharmacologic blockade of individual downstream inflammatory mediators in critically ill patients have been largely unsuccessful, and such studies highlight the need for novel top-down approaches, such as gene expression profiling for biologic discovery, as well as application of broader therapeutic interventions, such as targeted hypothermia. In this study, we demonstrate the potential application of visceral cooling for distant organ protection during mesenteric IRI, identify broad changes in lung gene expression under these conditions, and have elucidated potential novel diagnostic and therapeutic targets for disease targeting

Position paper: management of perforated sigmoid diverticulitis

Peer reviewe

Early marine survival of steelhead smolts in Puget Sound

Smolt-to adult survival rates for Puget Sound steelhead populations have declined substantially over the last 25 years and remain at or near historic lows. From 2006-2009, nearly 1,400 steelhead smolts from 9 watersheds within Puget Sound were tracked from river mouth to the Pacific Ocean using acoustic telemetry to: (1) estimate early marine survival through Puget Sound, (2) identify common areas of abnormally high mortality along the migration route, and (3) to identify factors that may influence survival. Cormac-Jolly-Seber mark-recapture models were used to jointly estimate survival and detection rate at telemetry arrays. Estimated survival rates from river mouths to near the Pacific Ocean ranged from 1.5% (Skokomish River hatchery smolts in 2009) to 34.0% (Big Beef Creek wild smolts in 2006), and averaged 14.9% for all populations. Factors influencing survival included population, migration segment, migration year, and rearing type (i.e., hatchery or wild), while geographic region, body length, and tag type (i.e., 7mm or 9mm) showed lesser effects. Comparison of survival rates between migration segments implicated central Puget Sound and Admiralty Inlet as potential areas of heightened mortality. Early marine survival rates estimated here are very low considering that steelhead smolts spend only about two to three weeks in Puget Sound before entering the Pacific Ocean. Mortality in Puget Sound may be a major driver behind low observed smolt-to adult survival rates. This study addresses a major gap in steelhead marine life history knowledge and can help to inform future Puget Sound steelhead recovery planning efforts

Method and Apparatus for Enabling Digital Rights Management in File Transfers

Embodiments of the invention generally provide a method and apparatus for enabling digital rights management in file transfers. One embodiment of a method for transferring digital content from a first user to a second user, includes transferring ownership of an instance of the digital content to the second user, where the instance of the digital content resides on a first device belonging to the first user. Copies of the digital content are then deleted from one or more additional devices belonging to the first user (including at least one offline device)

Older adults and mobile technology: Factors that enhance and inhibit utilization in the context of behavioral health

While numbers and proportions of older adults with behavioral health issues are expected to substantially increase, there is also a widening gap in available services for older adults. Mobile health interventions (mhealth) are a way to address existing barriers to treatment, provide frontline assessment and increase access to services for older adults. Due to perpetuated stereotypes, many assume that older adults do not utilize mobile technology nor will they accept a mHealth intervention. The purpose of this paper is to synthesize contemporary literature from information technology and healthcare regarding: (1) current mobile technology utilization by older adults, particularly in regards to health; (2) factors affecting older adult motivation to engage with mobile technology; and (3) older adult preferences for interacting with mobile technology. Findings reveal that significant proportions of older adults: already utilize mobile technology; are willing to engage in existing mobile interventions for health reasons; and have positive attitudes overall towards mobile technology. Finally, recommendations for optimizing mobile interventions to better suit older adults with behavioral health problems are reviewed

An assessment of temporal, spatial and taxonomic trends in harmful algal toxin exposure in stranded marine mammals from the US New England coast

© The Author(s), 2021. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Fire, S. E., Bogomolni, A., DiGiovanni, R. A., Jr., Early, G., Leighfield, T. A., Matassa, K., Miller, G. A., Moore, K. M. T., Moore, M., Niemeyer, M., Pugliares, K., Wang, Z., & Wenzel, F. W. An assessment of temporal, spatial and taxonomic trends in harmful algal toxin exposure in stranded marine mammals from the US New England coast. Plos One, 16(1),(2021): e0243570, https://doi.org/10.1371/journal.pone.0243570.Despite a long-documented history of severe harmful algal blooms (HABs) in New England coastal waters, corresponding HAB-associated marine mammal mortality events in this region are far less frequent or severe relative to other regions where HABs are common. This long-term survey of the HAB toxins saxitoxin (STX) and domoic acid (DA) demonstrates significant and widespread exposure of these toxins in New England marine mammals, across multiple geographic, temporal and taxonomic groups. Overall, 19% of the 458 animals tested positive for one or more toxins, with 15% and 7% testing positive for STX and DA, respectively. 74% of the 23 different species analyzed demonstrated evidence of toxin exposure. STX was most prevalent in Maine coastal waters, most frequently detected in common dolphins (Delphinus delphis), and most often detected during July and October. DA was most prevalent in animals sampled in offshore locations and in bycaught animals, and most frequently detected in mysticetes, with humpback whales (Megaptera novaeangliae) testing positive at the highest rates. Feces and urine appeared to be the sample matrices most useful for determining the presence of toxins in an exposed animal, with feces samples having the highest concentrations of STX or DA. No relationship was found between the bloom season of toxin-producing phytoplankton and toxin detection rates, however STX was more likely to be present in July and October. No relationship between marine mammal dietary preference and frequency of toxin detection was observed. These findings are an important part of a framework for assessing future marine mammal morbidity and mortality events, as well as monitoring ecosystem health using marine mammals as sentinel organisms for predicting coastal ocean changes.S.F. - NOAA John H. Prescott Marine Mammal Rescue Assistance Grant Program #NA16NMF4390151 S.F. - NOAA John H. Prescott Marine Mammal Rescue Assistance Grant Program #NA17NMF4390082 S.F. - Florida Tech Department of Biological Sciences S.F. - Florida Tech John H. Evans Library Open Access Subvention Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Recommendations for Child Care Centers

Design guide for planning, programming and designing different types of child care facilities. Includes 115 patterns for the policy, planning and design of large centers, neighborhood centers and family day-care homes. Based on current research information. Highly illustrated with photographs and sketches. Received an Award for Applied Research from Progressive Architecture, 1980, and received the 1980 UWM Foundation Research Award. Reprinted 1981, with new photographs in 1984, 1988 and in 1991. Revised edition 1994.https://dc.uwm.edu/caupr_mono/1032/thumbnail.jp