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Critical Incident Response

Curtis Harris, Kelli McCarthy, E Liang Liu, Kelly Klein, Raymond Swienton, Parker Prins, Tawny Waltz
2017 was a record year for disasters and disaster response in the U.S. Redefining and differentiating key response roles like "immediate responders" and "first responders" is critical. Traditional first responders are not and cannot remain the only cadre of expected lifesavers following a mass casualty event. The authors argue that the U.S. needs to expand its understanding of response roles to include that of the immediate responders, or those individuals who find themselves at the incident scene and are able to assist others...
March 16, 2018: International Journal of Environmental Research and Public Health
Elizabeth W Uhl
Although vitamin D is critical to calcium/phosphorus homeostasis, bone formation and remodeling, there is evolution-based variation between species in vitamin D metabolism and susceptibility to rickets and osteomalacia. Most herbivores produce vitamin D3 in response to sunlight, but dogs and cats have generally lost the ability as carnivore diets are rich in vitamin D. Nutritional deficiencies and/or poor exposure to sunlight can induce rickets in birds, swine, cattle and sheep, but horses are less susceptible as they have evolved a calcium homeostasis that is quite different than other animals...
March 13, 2018: International Journal of Paleopathology
Stacy A Voils, Mohamed H Shahin, Timothy J Garrett, Reginald F Frye
OBJECTIVE: Incidence of venous thromboembolism (VTE) in critically ill patients remains unacceptably high despite widespread use of thromboprophylaxis. A systems biology approach may be useful in understanding disease pathology and predicting response to treatment. Metabolite profile under specific environmental conditions provides the closest link to phenotype, but the relationship between metabolomics and risk of VTE in critically ill patients is unknown. In this study, metabolomics signatures are compared in patients with and without VTE...
March 8, 2018: Thrombosis Research
Marie C Matrka, Katherine A Cimperman, Sarah R Haas, Geraldine Guasch, Lisa A Ehrman, Ronald R Waclaw, Kakajan Komurov, Adam Lane, Kathryn A Wikenheiser-Brokamp, Susanne I Wells
Esophageal cancer occurs as either squamous cell carcinoma (ESCC) or adenocarcinoma. ESCCs comprise almost 90% of cases worldwide, and recur with a less than 15% five-year survival rate despite available treatments. The identification of new ESCC drivers and therapeutic targets is critical for improving outcomes. Here we report that expression of the human DEK oncogene is strongly upregulated in esophageal SCC based on data in the cancer genome atlas (TCGA). DEK is a chromatin-associated protein with important roles in several nuclear processes including gene transcription, epigenetics, and DNA repair...
March 14, 2018: PLoS Genetics
Tokiko Suzuki, Mari Sakai, Shigeyuki Yamashita, Kengo Tomita, Yuichi Hattori
Sepsis is the leading cause of death in critically ill patients, and its incidence continues to rise. Sepsis was defined as a systemic inflammatory response syndrome with an identifiable focus of infection, but therapeutic strategies aimed at eliminating the inflammatory response have only modest clinical benefit. The development of a failure of one or more organs poses a major threat to the survival of patients with sepsis, and mortality in sepsis is most often attributed to multiple organ dysfunction. Accordingly, sepsis has been recently redefined as life-threatening organ dysfunction due to a dysregulated host response to infection...
2018: Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica
Silvano Esposito, Silvana Noviello, Francesco De Caro, Giovanni Boccia
Skin and soft tissue infections (SSTIs) involve a heterogeneous group of entities with different clinical presentations classified according to several specific criteria. Because of their great variability, their incidence and prevalence is difficult to accurately determine. Yet it is generally thought that the rate of SSTIs is globally increasing due to an aging population, strictly associated with the increase in the number of critical and immunocompromised patients. The aetiology of SSTIs is also extremely variable, reflecting the noteworthy heterogeneity of their clinical presentations and their epidemiology...
March 1, 2018: Le Infezioni in Medicina
Floyd W van de Graaf, Jacqueline van den Bos, Laurents P S Stassen, Johan F Lange
BACKGROUND: Bile duct injury remains a dilemma in laparoscopic cholecystectomy, with an incidence still higher than in conventional cholecystectomy. The Critical View of Safety technique is used as one of the important operating technique to reduce bile duct injury incidence. The objective of this study was to determine current practices in laparoscopic cholecystectomy and the use of the Critical View of Safety technique among surgeons and residents in surgical training. METHODS: We conducted an electronic survey among all affiliated members of the Association of Surgeons of the Netherlands containing questions regarding the current practice of laparoscopic cholecystectomy, essential steps of the Critical View of Safety technique, reasons for conversion to open cholecystectomy, and the use of other safety techniques...
March 7, 2018: Surgery
Rachael Piltch-Loeb, John Kraemer, Christopher Nelson, Elena Savoia, David R Osborn, Michael A Stoto
To demonstrate how public health systems can use root-cause analysis (RCA) to improve learning from critical incidents, the research team utilized a facilitated look-back meeting to examine the public health systems' response to a Salmonella outbreak in the water supply in Alamosa, Colorado. We worked with public health, emergency management agencies, and other stakeholders to identify response challenges related to public health emergency preparedness capabilities, root causes, and lessons learned. The results demonstrate that RCA can help identify systems issues that, if addressed, can improve future responses...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
Megan B Blackburn, Maj Michael D April, Cpt Derek J Brown, Robert A DeLorenzo, Kathy L Ryan, August N Blackburn, Maj Steven G Schauer
BACKGROUND: Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4-7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Marja K Puurunen, Shih-Jen Hwang, Martin G Larson, Ramachandran S Vasan, Christopher J O'Donnell, Geoffrey Tofler, Andrew D Johnson
BACKGROUND: Platelet function is associated with adverse events in patients with cardiovascular disease (CVD). METHODS AND RESULTS: We examined associations of baseline platelet function with incident CVD events in the community-based FHS (Framingham Heart Study). Participants free of prevalent CVD and without recent aspirin treatment with available data in the Framingham Offspring cohort (1991-1995) and Omni cohort (1994-1998) were included. Platelet function was measured with light transmission aggregometry using collagen (1...
March 3, 2018: Journal of the American Heart Association
Kristin Van Heertum, Rachel Weinerman
In vitro fertilization (IVF) and embryo cryopreservation have become increasingly common in recent years. As utilization increases, it is important to understand the clinical effects these technologies have on offspring, as well as the mechanisms behind these effects. Many epidemiologic studies have observed that pregnancies following IVF are more likely to be affected by obstetric complications such as pre-eclampsia, preterm birth, and small for gestational age neonates compared with naturally conceived pregnancies...
March 1, 2018: Birth Defects Research
Bram Verstockt, Kenneth Gc Smith, James C Lee
Over the course of the past decade, genome-wide association studies (GWAS) have revolutionised our understanding of complex disease genetics. One of the diseases that has benefitted most from this technology has been Crohn's disease (CD), with the identification of autophagy, the IL-17/IL-23 axis and innate lymphoid cells as key players in CD pathogenesis. Our increasing understanding of the genetic architecture of CD has also highlighted how a failure to suppress aberrant immune responses may contribute to disease development - a realisation that is now being incorporated into the design of new treatments...
2018: Clinical & Translational Immunology
Pei-Jiang Wang, Nicola Ferralis, Claire Conway, Jeffrey C Grossman, Elazer R Edelman
Polymer-based bioresorbable scaffolds (BRS) seek to eliminate long-term complications of metal stents. However, current BRS designs bear substantially higher incidence of clinical failures, especially thrombosis, compared with metal stents. Research strategies inherited from metal stents fail to consider polymer microstructures and dynamics--issues critical to BRS. Using Raman spectroscopy, we demonstrate microstructural heterogeneities within polymeric scaffolds arising from integrated strain during fabrication and implantation...
February 26, 2018: Proceedings of the National Academy of Sciences of the United States of America
Zhengrui Fan, Jianxiong Ma, Mingjie Kuang, Lukai Zhang, Biao Han, Baocheng Yang, Ying Wang, Xinlong Ma
BACKGROUND: Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, Perioperative dexamethasone treatment is still a controversial subject in total knee arthroplasty. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of dexamethasone on pain and recovery after Total knee Arthroplasty. MATERIALS AND METHODS: Embase, Pubmed, and Cochrane Library were comprehensively searched...
February 23, 2018: International Journal of Surgery
Aine Marie Kelly, Patricia B Mullan
Teaching and assessing trainees' professionalism now represents an explicit expectation for Accreditation Council Graduate Medical Education-accredited radiology programs. Challenges to meeting this expectation include variability in defining the construct of professionalism; limits of traditional teaching and assessment methods, used for competencies historically more prominent in medical education, for professionalism; and emerging expectations for credible and feasible professionalism teaching and assessment practices in the current context of health-care training and practice...
February 22, 2018: Academic Radiology
Nicholas West, Paul B McBeth, Sonia M Brodie, Klaske van Heusden, Sarah Sunderland, Guy A Dumont, Donald E G Griesdale, J Mark Ansermino, Matthias Görges
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU...
February 20, 2018: Journal of Clinical Monitoring and Computing
Guojun Li, Erich Sturgis, Ye Tao, Zhigang Huang, Qingyi Wei, Ying Wang, Peng Wei, Rui Wang
PURPOSE: Transforming growth factor-β1 (TGF-β1) plays a critical role in inflammation and immune responses and treatment response and survival. TGF-β1 variants may affect its expression level or functional efficiency, thus modifying tumor status and survival in HPV-positive squamous cell carcinoma of the oropharynx (SCCOP). EXPERIMENTAL DESIGN: We determined tumor HPV16 status and genotyped three TGF-β1 polymorphisms in 564 incident SCCOP patients treated with radiotherapy or chemoradiation...
February 20, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Tracey L Yap, Susan M Kennerly, Susan D Horn, Nancy Bergstrom, Santanu Datta, Cathleen Colon-Emeric
BACKGROUND: Pressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. PrUs occur most commonly in older adults and NH residence is a risk factor for their development, with at least one of every nine U.S. NH residents experiencing a PrU and many NHs having high incidence and prevalence rates, in some instances well over 20%. PrU direct treatment costs are greater than prevention costs, making prevention-focused protocols critical...
February 20, 2018: BMC Geriatrics
Sven Bercker, Tanja Winkelmann, Thilo Busch, Sven Laudi, Dirk Lindner, Jürgen Meixensberger
BACKGROUND: Hydroxyethyl starch (HES) was part of "triple-H" therapy for prophylaxis and therapy of vasospasm in patients with subarachnoid haemorrhage (SAH). The European Medicines Agency restricted the use of HES in 2013 due to an increase of renal failure in critically ill patients receiving HES compared to crystalloid fluids. The occurrence of renal insufficiency in patients with SAH due to HES is still uncertain. The purpose of our study was to evaluate whether there was an association with renal impairment in patients receiving HES after subarachnoid haemorrhage...
2018: PloS One
Marc Blancher, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R Wheeler, Steven Roy, Hermann Brugger, Mike Greene, Peter Paal
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue. High Alt Med Biol. 00:000-000, 2018. INTRODUCTION: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas...
February 15, 2018: High Altitude Medicine & Biology
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