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Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.
A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from “always” to “never” to capture usual practice.
The survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would “always/often” be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would “always/often” administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00).
Most EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.
Number of patients who are again unexpectedly admitted to hospital after a previous hospitalization are used to evaluating the quality of hospital care. Readmission can be represented by the total number and by readmission rate.
Understanding the risk factors that can lead to readmission is a factor for the development of interventions that can improve the quality of care.
The purpose of this study was to examine number and predictors of psychiatric readmission within 14 days, 30 days and, 3 and 6 months.
In this retrospective study, analyses were conducted in a sample of 566 discharge adult patients who were admitted to a Psychiatric Hospital of Sarajevo Canton from 1st January to 31st December 2013.
Total number of readmission was 14%. The readmission rate within 30 days was 2.8%, number of readmission quarterly was 9.1%, number of readmission within 6 months after discharge was 13%.
In the study, several factors were significantly associated with increased risk of readmission including non-compliance with drug treatment, social problems, aggressiveness, suicidality.
Our study suggesting that the prevention of psychiatric readmission requires continuous multidisciplinary work with patients and family members.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
PTSD has a significant influence on all aspects of the affected person's life including one's ability to work, which is indicated by absenteeism, unemployment, and work ability.
Aims and Objectives
The aim of this study was to see how symptoms of PTSD affect work capacity of the population of the two Bosnian Cantons in the period of 5 years, years after traumatic events.
This study was epidemiological, cross-sectional, and has included 16157 assessments of the capacity to work, those evaluated at the Institute for medical expertise of health condition Federation of Bosnia and Herzegovina-Sarajevo Department, in the period between 01.01.2006 until 31.12.2010. All patients with diagnose of PTSD, were observed according to the determined disability level, and that data was correlated with the soci-demographic variables.
In the observed period, there were 1656 patients with PTSD, 10.2% of all patients. In 5,6% of all patients, and 33.2 % of patients with PTSD, illness, alone or with somatic comorbidity and injuries, has disqualified or significantly interfered with their ability to perform the duties of their occupation. The predictors for the inability to work were: male, middle-aged, and unemployed.
With this study, we have proven that symptoms of PTSD have an lifetime effect on the ability to work. The limit of this study is the fact that only 20% of the FB&H population were observed. We were not able to calculate a trend because of the short period of observation. That should be the aim of some future studies.
Behavioural and cardiac responses of multiparous dairy cows (n=24) during milking in a 2×4 stall herringbone milking system were evaluated in this study. Heart rate (HR), parasympathetic tone index (high frequency component, HF) of heart rate variability and sympathovagal balance indicator LF/HF ratio (the ratio of the low frequency (LF) and the HF component) were analysed. Measurement periods were established as follows: (1) standing calm (baseline), (2) udder preparation, (3) milking, (4) waiting after milking in the milking stall and (5) in the night (2 h after milking). Step behaviour was recorded and calculated per minute for the three phases of the milking process (udder preparation, milking and waiting after milking). HR was higher during udder preparation and milking compared with baseline (P=0.03, 0.027, respectively). HF was significantly lower than baseline levels during waiting in the milking stall after milking (P=0.009), however, during udder preparation, milking and 2 h after milking did not differ from baseline (P>0.05, in either case). LF/HF during the three phases of the milking process differed neither from baseline levels nor from each other. Steps occurred more often during waiting after milking than during udder preparation (P=0.042) or during milking (23; P=0.017). Our results suggest that the milking procedure itself was not stressful for these animals. After milking (following the removal of the last teat cup and before leaving the milking stall), both decreased parasympathetic tone (lower HF) and increased stepping rate indicated a sensitive period for animals during this phase.
We use a WISE-2MASS-Pan-STARRS1 galaxy catalog to search for a supervoid in the direction of the Cosmic Microwave Background Cold Spot. We obtain photometric redshifts using our multicolor data set to create a tomographic map of the galaxy distribution. The radial density profile centred on the Cold Spot shows a large low density region, extending over 10's of degrees. Motivated by previous Cosmic Microwave Background results, we test for underdensities within two angular radii, 5°, and 15°. Our data, combined with an earlier measurement by Granett et al. 2010, are consistent with a large Rvoid=(192 ± 15)h−1 Mpc (2σ) supervoid with δ ≃ −0.13 ± 0.03 centered at z=0.22 ± 0.01. Such a supervoid, constituting a ∼3.5 σ fluctuation in the ΛCDM model, is a plausible cause for the Cold Spot.
The Cold Spot is an anomalously cold region in the Cosmic Microwave Background (Vielva et al. 2004), either caused by a structure in the line of sight or could be of primordial origin. We search for a supervoid aligned with the Cold Spot region, filling the gap in redshift at z<0.3 which has never been explored in details. We find a large projected under density in the recently constructed WISE-2MASS catalogue, whose median redshift is z ≃ 0.14, with an angular size of 30 degrees. We show that a spherically symmetric Lemaitre-Tolman-Bondi (LTB) void model can simultaneously fit the δgal/b=δ2D≃ −0.12 underdensity in the WISE-2MASS catalogue, and the Cold Spot as observed by both the WMAP and Planck satellites. Such an LTB supervoid gives a plausible explanation of the Cold Spot anomaly, and is preferred over the null hypothesis or a texture model.
Dirofilariosis is considered to be the arthropod vector-borne disease with the fastest spread in Europe. Slovakia belongs to new endemic regions for canine and human infections. This paper reports the fourth human case, where diagnosis was confirmed using computed tomography (CT), histological and molecular examinations – for the first time in this endemic region. The epidemiological history of this case indicated the autochthonous origin, and infection manifested by intense swelling in the periocular region, where a subcutaneous nodule was localized. Microscopic analysis of cross-sections of the surgically removed nodule confirmed the presence of a single male worm of Dirofilaria repens, indicated by the external cuticular ridges, the robust muscle cells and a single male sex organ seen as one tube beside the intestine. Considering that the worm morphology was partially damaged, molecular study was performed using DNA isolated from formalin-fixed and paraffin-embedded tissue sections of the worm. In polymerase chain reactions (PCR) a set of primers specific for D. repens DNA for the CO1-encoding gene amplified the expected 246 bp product using a high concentration of DNA template. Our diagnostic approach, involving molecular techniques, showed that identification of D. repens from excised tissues is possible even when the morphology of the worm and DNA are damaged during tissue processing. It is expected that the spread of this disease will continue due to climatic changes in central Europe. This warrants higher awareness among clinicians, who will initially be approached by patients, and better co-operation with parasitologists in newly endemic countries.
The effect of different weaning ages, that is, 21 (G21), 28 (G28) or 35 (G35) days, on growth and certain parameters of the digestive tract was examined in rabbits to assess the risk of early weaning attributable to the less-developed digestive system. On days 35 and 42, G35 rabbits had 10% to 14% and 10% higher BW, respectively (P < 0.05), than those weaned at days 21 and 28. In the 4th week of life, early weaned animals had 75% higher feed intake than G28 and G35 rabbits (P < 0.05). The relative weight of the liver increased by 62% between 21 and 28 days of age, and thereafter it decreased by 76% between 35 and 42 days of age (P < 0.05), with G21 rabbits having 29% higher weight compared with G35 animals on day 35 (P < 0.05). The relative weight of the whole gastrointestinal (GI) tract increased by 49% and 22% after weaning in G21 and G28 rabbits, respectively (P < 0.05). On day 28, the relative weight of the GI tract was 19% higher in G21 than in G28 rabbits, whereas on day 35 G21 and G28 animals had a 12% heavier GI tract compared with G35 rabbits (P < 0.05). Age influenced the ratio of stomach, small intestine and caecum within the GI tract; however, no effect of different weaning age was demonstrated. The pH value of the stomach and caecum decreased from 5.7 to 1.6 and from 7.1 to 6.3, respectively, whereas that of the small intestine increased from 6.8 to 8.4 (P < 0.05); the differences between groups were not statistically significant. Strictly anaerobic culturable bacteria were present in the caecum in high amounts (108), already at 14 days of age; no significant difference attributable to weaning age was demonstrable. The concentration of total volatile fatty acids (tVFA) was higher in G21 than in G28 and G35 throughout the experimental period (P < 0.05). The proportion of acetic and butyric acid within tVFA increased, whereas that of propionic acid decreased, resulting in a C3 : C4 ratio decreasing with age. Early weaning (G21) resulted in higher butyric acid and lower propionic acid proportions on day 28 (P < 0.05). No interaction between age and treatment was found, except in relative weight of the GI tract and caecal content. In conclusion, early weaning did not cause considerable changes in the digestive physiological parameters measured, but it resulted in 10% lower growth in rabbits.
The structure and magnetic properties of the nanoparticles of immiscible
system Co20Cu80 prepared by means of arc-discharge, have been
studied in detail. The diameters of the particles are about 20 ~ 30 nm
and a core/shell structure forms. The cores are Co-Cu solutions, which show
some small Co precipitates, encapsulated with a shell of cupper oxide or
cobalt oxide as observed by means of high-resolution transmission electron
microscope (HRTEM) and energy dispersive X-ray (EDS). The loop shift in the
hysteresis loop indicates the existence of the exchange bias between
ferromagnetic and antiferromagnetic components at low temperatures. A block
temperature about 180 K has been observed for as-deposited nanoparticles.
For the annealed nanoparticles, the thermal magnetization at low
temperatures is satisfied with Bloch's law.
Plastic instabilities were investigated by the depth-sensing microhardness test in binary high-purity Al–Mg alloys with different Mg contents. During the tests the applied load was increased from 0 to 2000 mN at constant loading rate. The instabilities appeared as characteristic steps in the load–depth curves during indentation. It was shown that the occurrence and development of the plastic instabilities depend strongly on the solute content. Furthermore, the plastic instabilities occurred only when the solute concentration was larger than a critical value, C0. From room-temperature tests on Al–Mg alloys, C0 was found to be 0.86 wt% Mg. The critical concentration, which is necessary to get plastic instabilities, was also interpreted theoretically.
In a multicentre, randomized, double-blind, placebo-controlled dose-ranging study, 1030 patients undergoing outpatient surgery with general anaesthesia received i.v. dolasetron mesylate (12.5, 25, 50, or 100 mg) or placebo. The principal outcome measure was the proportion of patients who were free of emesis or rescue medication for the 24-h period after the study drug was given; the subsidiary outcome measure was survival time without rescue medication. Effects on nausea were quantified using a visual analogue scale. Compared with placebo, a complete response was significantly higher when all four dolasetron doses were combined (49% vs. 58%, P = 0.025). In females, dolasetron, 12.5-mg, dolasetron provided maximum clinical benefit (effectiveness compared with adverse events), with no additional benefit in complete response rates or nausea visual analogue scale scores at higher doses. No significant differences were observed in complete response for any dolasetron dose in males compared with placebo. The majority of adverse events reported were mild or moderate. Dolasetron provided well-tolerated, safe, and effective prophylaxis for post-operative nausea and vomiting with maximum effectiveness observed at a dose of 12.5 mg.
The seasonality and factors associated with Cryptosporidium
infection were assessed in a cohort
of HIV-infected patients in Los Angeles County to better define the epidemiology
cryptosporidiosis among individuals with HIV. Data were analysed from a
cohort of 4247
patients [ges ]13 years of age with HIV infection enrolled from four outpatient
facilities in Los
Angeles, 1990–6. Cryptosporidiosis was diagnosed in 120 (2·8%)
patients. Among the 1296 individuals with complete follow-up until death,
cryptosporidiosis occurred in 69 (5·3%). The
seasonal rate of cryptosporidiosis showed a modest bimodal trend with the
occurring in March–May and September–October. There
was no difference in the rate of
cryptosporidiosis for the periods of heaviest rainfall (December–March)
and low rainfall
(April–November). Infection rates were higher among males
(1·59 per 100 person-years) than
females (0·92) and lower in blacks (0·98) than other
racial/ethnic groups (1·80). A significant
trend of decreasing cryptosporidiosis was observed with increasing age,
with the highest rate
(2·34) in the 13–34 year age group. A strong association
between cryptosporidiosis and
CD4+ count was noted. These data suggest that cryptosporidiosis
among HIV-infected individuals in
Los Angeles County exhibits a modest spring and fall seasonality. This
pattern of occurrence
of cryptosporidiosis appears temporally unrelated to local rainfall patterns.
suggest that HIV-infected men, individuals in younger age groups and those
CD4+ lymphocyte counts <100×106/l are at
increased risk of cryptosporidiosis. Blacks with HIV
infection appear less likely than other racial/ethnic groups to be
Cryptosporidium infection. These results may provide insight into
possible routes of
transmission and sources of cryptosporidiosis infection in individuals
The European Union Network ANTENA started to work in October 1993. During these last three years, several collaborative projects have been undertaken. ANTENA has offered a very good opportunity for most of the European people doing asteroseismology to work together. The asteroseismological networks STEPHI and STACC have run within the framework of the project, obtaining fairly good results. New instrumentation has also been developed, such as the Four-Channel Stellar Photometer.
During March-May 1976, a combination of laser and radar ranging systems was used to study the motion of both the fast ice and the pack ice near Narwhal and Cross Islands, two barrier islands located 16 and 21 km offshore in the vicinity of Prudhoe Bay, Alaska. Laser measurements of targets on the fast ice near Narwhal Island indicate small net displacements of approximately 1 m over the period of study (71 d) with short-term displacements of up to 40 cm occurring over 3 d periods. The main motion was outward normal to the coast and was believed to be the result of thermal expansion of the ice. The radar records of fast-ice sites farther offshore show a systematic increase in the standard deviation of the displacements as measured parallel to the coast, reaching a value of ±6.6 m at 31 km. The farthest fast-ice sites show short-term displacements of up to 12 m. There are also trends in the records that are believed to be the result of the general warming of the fast ice with time.
Radar targets located on the pack ice showed large short-term displacements (up to 2.7 km) but negligible net ice drift along the coast. There was no significant correlation between the movement of the pack and the local wind, suggesting that coastal ice prediction models can only succeed if handled as part of a regional model which incorporates stress transfer through the pack. The apparent fast-ice-pack-ice boundary in the study area was located in 30-35 m of water.