Healthcare Personnel And Nosocomial Transmission Of Pandemic 2009 Influenza

Knowledge regarding the modes of transmission of pandemic 2009 H1N1 influenza continues to develop, as do recommendations for the prevention of spread within healthcare facilities. The adoption of the most prudent, multifaceted approaches is recommended until there is significant evidence to reduce protective measures. The greatest threat to healthcare personnel and patients appears to be exposure to patients, healthcare personnel, or visitors who have not been recognized as contagious. The processes used within healthcare facilities must hold this concept central to any infection control plan and act in a preventive manner. This article focuses on the development of an algorithm for intensive care unit intake precautions, based on the early identification of potential source patients, as well as appropriate selection and adequate use of personal protective equipment. Visitor management, hand and respiratory hygiene, and cough etiquette have been used as measures to decrease the spread of infection. Vaccination of healthcare personnel, combined with work furlough for ill workers, is also explored. Recommendations include the elimination of potential exposures, engineering and administrative controls, and utilization of personal protective equipment. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Induction of cortical endoplasmic reticulum by dimerization of a coatomer-binding peptide anchored to endoplasmic reticulum membranes

Cortical endoplasmic reticulum (cER) is a permanent feature of yeast cells but occurs transiently in most animal cell types. Ist2p is a transmembrane protein that permanently localizes to the cER in yeast. When Ist2 is expressed in mammalian cells, it induces abundant cER containing Ist2. Ist2 cytoplasmic C-terminal peptide is necessary and sufficient to induce cER. This peptide sequence resembles classic coat protein complex I (COPI) coatomer protein-binding KKXX signals, and indeed the dimerized peptide binds COPI in vitro. Controlled dimerization of this peptide induces cER in cells. RNA interference experiments confirm that coatomer is required for cER induction in vivo, as are microtubules and the microtubule plus-end binding protein EB1. We suggest that Ist2 dimerization triggers coatomer binding and clustering of this protein into domains that traffic at the microtubule growing plus-end to generate the cER beneath the plasma membrane. Sequences similar to the Ist2 lysine-rich tail are found in mammalian STIM proteins that reversibly induce the formation of cER under calcium control

Definitive Care for the Critically Ill During a Disaster: a Framework for Optimizing Critical Care Surge Capacity: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL

BACKGROUND: Plausible disasters may yield hundreds or thousands of critically ill victims. However, most countries, including those with widely available critical care services, lack sufficient specialized staff, medical equipment, and ICU space to provide timely, usual critical care for a large influx of additional patients. Shifting critical care disaster preparedness efforts to augment limited, essential critical care (emergency mass critical care [EMCC]), rather than to marginally increase unrestricted, individual-focused critical care may provide many additional people with access to life-sustaining interventions. In 2007, in response to the increasing concern over a severe influenza pandemic, the Task Force on Mass Critical Care (hereafter called the Task Force) convened to suggest the essential critical care therapeutics and interventions for EMCC. TASK FORCE SUGGESTIONS: EMCC should include the following: (1) mechanical ventilation, (2) IV fluid resuscitation, (3) vasopressor administration, (4) medication administration for specific disease states (eg, antimicrobials and antidotes), (5) sedation and analgesia, and (6) select practices to reduce adverse consequences of critical illness and critical care delivery. Also, all hospitals with ICUs should prepare to deliver EMCC for a daily critical care census at three times their usual ICU capacity for up to 10 days. DISCUSSION: By using the Task Force suggestions for EMCC, communities may better prepare to deliver augmented critical care in response to disasters. In light of current mass critical care data limitations, the Task Force suggestions were developed to guide preparedness but are not intended as strict policy mandates. Additional research is required to evaluate EMCC and revise the strategy as warranted

Resource-poor settings: infrastructure and capacity building: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

BACKGROUND: Planning for mass critical care (MCC) in resource-poor or constrained settings has been largely ignored, despite their large populations that are prone to suffer disproportionately from natural disasters. Addressing MCC in these settings has the potential to help vast numbers of people and also to inform planning for better-resourced areas. METHODS: The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of disaster (mitigation/preparedness/response/recovery), literature searches were conducted to identify evidence on which to answer the key questions in these areas. Given a lack of data upon which to develop evidence-based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process. RESULTS: The five key questions were then separated as follows: definition, infrastructure and capacity building, resources, response, and reconstitution/recovery of host nation critical care capabilities and research. Addressing these questions led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part 1, Infrastructure/Capacity in this article, and part 2, Response/Recovery/Research in the accompanying article. CONCLUSIONS: Lack of, or presence of, rudimentary ICU resources and limited capacity to enhance services further challenge resource-poor and constrained settings. Hence, capacity building entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is needed to mount a surge response. Moreover, planning should include when to disengage and how the host nation can provide capacity beyond the mass casualty care event

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

BACKGROUND: Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS: The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians

Bedeutung und Anwendung

Title Page, Table of Contents, Motivation iv Concepts v Introduction vii 1 Fundamentals 1 1.1 Meaning of isostasy and rigidity 1 1.1.1 Isostasy according to Pratt 1 1.1.2 Isostasy according to Airy 2 1.1.3 Isostasy according to Vening-Meinesz 2 1.1.4 Elastic thickness and flexural rigidity 4 1.2 Methods for estimation of flexural parameters 5 1.2.1 Spectral methods 5 1.2.2 Advantage and disadvantage of spectral methods 10 1.2.3 Convolution method 11 1.2.4 Advantage and disadvantage of the convolution method 12 1.2.5 Conclusion 12 1.3 Gravity inversion according to Parker algorithm 13 1.3.1 Introduction 13 1.3.2 Method 13 1.3.3 Synthetic example 14 1.4 Internal loads 16 1.4.1 Calculation of gravity effect of sediments with slice program 16 1.4.2 Pseudo topography 17 2 Theoretical basics and development of the analytical solution 19 2.1 Differential equation 19 2.1.1 Plate theory according to Kirchhoff 19 2.1.2 Beam on elastic foundation 20 2.1.3 Application in geological sciences 23 2.2 Formula according to Hertz 25 2.2.1 Investigation of the Logarithm function 27 2.2.2 Investigation of the Sine function 29 2.2.3 Summary of the behavior of the functions 30 2.3 New analytical solution 31 2.3.1 Introduction 31 2.3.2 Modification and substitution 31 2.3.3 Investigation of the graph 33 2.3.4 Unification of the analytical solution 35 2.4 Transfer function 38 2.4.1 Introduction 38 2.4.2 Transfer function 39 2.4.3 Verification of the analytical solution 41 2.4.4 Conclusion. 42 2.5 Comparison with FFT solution 43 2.5.1 Comparison with flexure curves 43 2.5.2 Investigation of dependence from grid parameters 44 2.5.3 Boundary cases for elastic thickness 47 2.5.4 Comparison with Vening-Meinesz solution 49 2.5.5 Conclusion 50 2.6 Software concept 51 2.6.1 Introduction 51 2.6.2 Flexure curves and CMI 52 2.6.3 Radius of convolution 52 2.6.4 Iterative estimation of elastic thickness 54 2.6.5 Elastic thickness distribution 56 2.6.6 Reference depth 57 2.7 Comparison with Finite Element modeling 59 2.7.1 Influence of input parameters 61 2.7.2 Conclusion 69 3\. Application of the analytical solution 70 3.1 Pacific Ocean 71 3.1.1 Input data 71 3.1.2 Preliminary investigations 72 3.1.3 Estimation of gravity CMI 73 3.1.4 Estimation of rigidity And elastic thickness 76 3.1.5 Discussion and conclusion. 77 3.2 Central Andes 80 3.2.1 Input data 80 3.2.2 Preliminary investigation 82 3.2.3 Estimation of rigidity and elastic thickness 83 3.2.4 Discussion and conclusion. 86 3.3 Southern Andes 91 3.3.1 Input data 91 3.3.2 Estimation of rigidity and elastic thickness 92 3.3.3 Discussion and conclusion. 93 4 Discussion of results 98 4.1 Thick plate theory 98 4.2 Influence of temperature 99 4.2.1 Introduction 99 4.2.2 Synthetic example 99 4.2.3 Application in geological sciences 101 4.3 Significance of input parameters 105 4.3.1 Deviation of height 106 4.3.2 Deviation of gravity 107 4.3.3 Deviation of Young's modulus 107 4.3.4 Deviation of Poisson ratio 108 4.3.5 Deviation of density of crust 109 4.3.6 Deviation of density of mantle 109 4.3.7 Deviation of elastic thickness 110 4.3.8 Conclusion 111 4.4 Variation of Young's modulus 112 4.5 Visco-elastic behavior 116 4.6 Final comments and future directions 122 5 Appendix I 5.1 Density-porosity formula I 5.2 Comparison of flexure curves III 5.2.1. FFT solution compared with Logarithm and Sine function III 5.2.2. Comparison of output from computer program with FFT IV 5.3 FE models V 5.3.1. Calculation input parameters and results VI 5.3.2. Settings of the FE models IX Acknowledgement, References X Notation XI Abbreviations XIV Index of Tables XV Index of Figures XVI ReferencesIn 1939 a new concept was introduced by Vening-Meinesz proposing that the flexural strength of the lithosphere must be considered for isostatic models. A 4th order differential equation describing the flexure of a thin plate was developed. In the past the equation has been solved in frequency space using spectral methods (coherence and admittance). However, the admittance and coherence techniques have been questioned when applied to continental lithosphere. Both methods require an averaging process; therefore the variation in rigidity may be retrieved only to a limited extent. A large spatial window with a side length of at least 375 km is required over the study area. And, in where the input topography is characterized by low topographic variation, the method becomes unstable. These problems can be overcome by calculating the flexural rigidity with the convolution approach and furthermore with the use of a newly derived analytical solution of the differential equation mentioned above. This solution was developed out of three solutions from Hertz and has been made applicable to geological science. The analytical solution has been applied to both oceanic lithosphere (Nazca plate) and continental lithosphere (Central and Patagonian Andes). The resulting flexural rigidity values and their variations have been compared with the ideas and concepts developed by the members of the SFB267 community, and correlate well with tectonic units and fault systems. In the past the elastic thickness has been used synonymously for the flexural rigidity. However, the analytical solution leads to a new interpretation and meaning of the elastic thickness. It is shown that it is sufficient to operate with a constant value for both gravity and Poisson's ratio, as the variation of either parameter does not lead to a significant change in the distribution of flexural rigidity. Young's modulus is shown to be the driving factor for the flexural deformation. A temperature moment must also be taken into account in flexural investigations. Thus, the variation of the elastic thickness can be explained by temperature distribution and a change of the Young's modulus. A new definition of elastic thickness can be obtained: the value of the calculated elastic thickness is equivalent to the value of thickness of a corresponding plate described by a constant Young's modulus. Computations using the differential equation are valid for the crust/mantle interface (Moho) as well as the lithosphere/ asthenosphere boundary. The calculated boundary surface can be shifted at the position of the boundary at which a significant change of Young's modulus takes place.Im Jahre 1939 wurde von Vening-Meinesz eine Theorie entwickelt, welche die Rigidität der Lithosphärenplatte innerhalb isostatischer Betrachtungen berücksichtigte. Dazu wurde eine Differentialgleichung 4. Ordnung verwendet, welche die Deformation einer dünnen Platte beschreibt. In der Vergangenheit wurde die Gleichung mittels der Spektralmethoden im Frequenz-Bereich gelöst. Aber bezüglich der Anwendung der Kohärenz- und Admittanzmethode auf die Kontinente wurde ihre Nützlichkeit aufgrund der Nachteile, welche durch den Spektralansatz entstehen, in Frage gestellt. Dieser Ansatz bedingt eine Durchschnittsbildung, welche im Falle einer sich räumlich stark variierenden Rigidität dazu führen kann, dass jene Variation nur bis zu einem begrenzten Mabe aufgelöst wird. Für das Untersuchungsgebiet ist eine Seitenlänge von mindestens erforderlich. Ein weiteres Problem tritt im Falle niedriger Topographie auf, da kleinere Spektralwerte zu Instabilitaeten innerhalb der Anwendung führen können. Durch die Verwendung der Konvolutionsmethode und der neu entwickelten analytischen Lösung der obig eingeführten Differentialgleichung werden diese Nachteile überwunden. Diese analytische Lösung wurde aus drei verschiedenen Lösungen nach Hertz entwickelt und für die geologischen Wissenschaften anwendbar gemacht. Die analytische Lösung wurde auf die ozeanische Lithosphäre im Bereich des Pazifik (Nazca-Platte) und auf die kontinentale Lithosphäre im Bereich der Zentral - und der Patagonischen Anden angewendet. Die resultierende Rigiditätsverteilung wird mit den von den Mitgliedern der SFB267 Gemeinschaft entwickelten Ideen und Konzepten verglichen, und ist durch eine gute Korrelation mit den tektonischen Einheiten und Störungssystemen charakterisiert. Bisher wurde die elastische Dicke und die flexurelle Rigidität synonym verwendet. Aber die analytische Lösung führte zu einem neuen Verständnis und Interpretation der elastischen Dicke. In Anbetracht der Untersuchungen zur Signifikanz der Inputparameter ist es zulässig mit einem konstanten Wert für die Schwere und dem Poisson-Verhältnis zu arbeiten, denn dies wird nicht zu signifikanten Unterschieden im Ergebnis führen. Dies gilt nicht für das Elastizitätsmodul, denn dieser Parameter ist ein entscheidender Faktor für das Deformationsverhalten. Daher kann die elastische Dicke auch als äquivalente Plattendicke für eine Platte konstanten Elastizitätsmoduls definiert werden. Zudem wurde herausgefunden, daß das Temperaturmoment in den weiteren Untersuchungen mit berücksichtigt werden muss. Damit kann die beobachtete Variation der elastischen Dicke durch die Temperaturverteilung und die Veränderung des Elastizitätsmoduls erklärt werden. Zusätzlich wurde gezeigt, daß die Berechnungen mittels der Differentialgleichung und der analytischen Lösung sowohl für die Krusten/Mantel Grenze als auch die Lithosphären/Asthenosphären Grenze gültig sind. Dabei ist entscheidend, an welcher Grenzfläche sich das Elastizitätsmodul ändert