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The utility and efficacy of bolus dose vasopressors in hemodynamically unstable patients is well-established in the fields of general anesthesia and obstetrics. However, in the prehospital setting, minimal evidence for bolus dose vasopressor use exists and is primarily limited to critical care transport use. Hypotensive episodes, whether traumatic, peri-intubation-related, or septic, increase patient mortality. The purpose of this study is to assess the efficacy and adverse events associated with prehospital bolus dose epinephrine use in non-cardiac arrest, hypotensive patients treated by a single, high-volume, ground-based Emergency Medical Services (EMS) agency.
This is a retrospective, observational study of all non-cardiac arrest EMS patients treated for hypotension using bolus dose epinephrine from September 12, 2018 through September 12, 2019. Inclusion criteria for treatment with bolus dose epinephrine required a systolic blood pressure (SBP) measurement <90mmHg. A dose of 20mcg every two minutes, as needed, was allowed per protocol. The primary data source was the EMS electronic medical record.
Forty-two patients were treated under the protocol with a median (IQR) initial SBP immediately prior to treatment of 78mmHg (65-86) and a median (IQR) initial mean arterial pressure (MAP) of 58mmHg (50-66). The post-bolus SBP and MAP increased to 93mmHg (75-111) and 69mmHg (59-83), respectively. The two most common patient presentations requiring protocol use were altered mental status (55%) and respiratory failure (31%). Over one-half of the patients treated required both advanced airway management (62%) and multiple bolus doses of vasopressor support (55%). A single episode of transient severe hypertension (SBP>180mmHg) occurred, but there were no episodes of unstable tachyarrhythmia or cardiac arrest while en route or upon arrival to the receiving hospitals.
These preliminary data suggest that the administration of bolus dose epinephrine may be effective at rapidly augmenting hypotension in the prehospital setting with a minimal incidence of adverse events. Paramedic use of bolus dose epinephrine successfully increased SBP and MAP without clinically significant side effects. Prospective studies with larger sample sizes are needed to further investigate the effects of prehospital bolus dose epinephrine on patient morbidity and mortality.
Radnor Lake State Natural Area in Nashville, TN, has cedar glades that contain the endangered perennial herb wild dill [Perideridia americana (Nutt. ex DC.) Rchb.] and the invasive shrub Amur honeysuckle [Lonicera maackii (Rupr.) Herder]. This research examined whether L. maackii treatment in the Radnor Lake State Natural Area cedar glades is followed by an increase in P. americana plants. A grid of 60 adjacent 2 m by 4 m plots was placed in five cedar glades to encompass the P. americana population. With great care to protect P. americana, the annual treatment for L. maackii was to pull plants ≤1-m tall from the ground; and to cut stems >1-m tall and then treat the stumps with glyphosate. The t-tests of means for the log natural of the number of plants in the 60 plots (significance level of P-value = 0.05) were used to compare pretreatment L. maackii and P. americana counts with posttreatment counts in 2018 and P. americana counts at leaf out and flowering in 2018. The L. maackii population was significantly smaller (P-value < 0.001) in 2018 than pretreatment at all five sites. When pretreatment in 2014 and 2015 was compared with posttreatment in 2018 for the P. americana populations, the increases were significant at the Cheek, Harris 2, Hideaway, and Norfleet sites, but the increase at East Hall Farm was not significant. White-tailed deer (Odocoileus virginianus Zimmermann) trampling was the explanation given for the decreases in P. americana from leaf out to flowering at all five sites in 2018. Browsing was evident only at Hideaway, which had a greater loss for P. americana from leaf out to flowering in 2018 than the combined losses for the Cheek, East Hall Farm, Harris 2, and Norfleet sites. The research informed the creation of adaptive management decisions regarding monitoring and treatment of the invasive species L. maackii for an endangered species.
Amur honeysuckle recovery following treatments annually and only in 1-year, during 2002 to 2009, was compared in the forests of Radnor Lake State Natural Area in Nashville, TN. Annual treatment areas had significantly lower mean Amur honeysuckle plant counts than 1-yr treatment areas for both ≤ 1 m (3.3 ft) and > 1 m plant heights and on both sloped and level areas, except for plants ≤ 1 m tall on level areas, which most likely indicated more soil moisture increasing seedling establishment and root sprouting in the first year after treatment. The significant, positive Pearson's product moment correlations for Amur honeysuckle counts of plants ≤ 1 m tall, with arboreal basal area and with canopy species diversity in the level areas of the annual treatment plots, were also most likely evidence for the importance of greater soil moisture during the first year after treatment for greater Amur honeysuckle recovery. For land managers interested in native vegetation restoration, guidance is provided to plan for long-term, invasive plant species treatment and recovery monitoring.
The seventh annual Teaching and Learning Conference (TLC) was held in Philadelphia, Pennsylvania, from February 5 to 7, 2010, with 224 attendees onsite. The theme for the meeting was “Advancing Excellence in Teaching Political Science.” Using the working-group model, the TLC track format encourages in-depth discussion and debate on research dealing with the scholarship of teaching and learning.
The X-ray populations of spiral galaxies consist almost entirely of accreting X-ray binaries and supernova remnants. For the most luminous sources, it is possible to use X-ray spectroscopy and variability studies to gain insights into the nature of the sources. However, without unambiguously identified optical counterparts, it is impossible to definitively classify sources as, e.g. high-mass or low-mass X-ray binaries. The nearby interacting galaxy M51 is one of the best-studied galaxies across all wavelengths. At a distance of around 8 Mpc, it is possible to resolve features on scales of a few parsecs both in the X-ray and the optical. Recently, M51 was observed with the Advanced Camera for Surveys on the Hubble Space Telescope as part of a Hubble Legacy program. M51 has also been observed 3 times with the Chandra X-ray observatory. Combining these two datasets, we present initial results on the optical environments of M51 X-ray sources as the first part of a truly multi-wavelength study of X-ray sources in nearby galaxies.
Evidence from epidemiological and animal-feeding trials suggests that a western-style diet that is high in fat, and low in Ca, vitamin D and folic acid may result in low bone mass and poor bone quality: this leads to an increased risk of fragility fracture. The overall objective of the present study was to determine the effect of feeding a western-style diet (low in Ca (0·4 g/kg diet, Ca:P ratio 1:10), cholecalciferol (3 μg/kg diet), folic acid (0·23 mg/kg diet) and fibre (20 g/kg diet), and high in fat (200 g/kg diet)) for 17 weeks on bone mineral content (BMC) and the biomechanical bone strength of rat femurs. A secondary objective was to determine whether femurs from male and female rats (seven to eight rats per group) respond differently to the western-style diet. Male and female rats weighing 150–180 g were fed a western-style diet or a control diet for 17 weeks. At the end of the feeding trial, femur BMC was measured by ashing, and biomechanical properties were determined by three-point bending. Femur BMC and the majority of biomechanical properties measured were lower (P<0·05) among male and female rats fed a western-style diet compared with a control diet, despite similar weight gain and final body weight within genders. However, the western-style diet had a greater negative effect on femur BMC and biomechanical strength properties among male rats compared with females. This may be because male rats experienced greater overall body growth, as assessed by weight gain, than female rats, and suggests that the nutrient composition of the western-style diet did not support the development of strong femurs.
Molecular analyses based on plasmid profile typing and pulsed-field
gel electrophoresis have
defined a strain of Salmonella enterica serotype
Anatum associated with the consumption of a
particular brand of formula-dried milk responsible for an outbreak in late
involving 15 infants and 2 relatives in the UK, and 2 infants in France.
The study has
demonstrated the value of laboratory-based surveillance involving identification
of the outbreak
strain at the molecular level coupled with food microbiology and targeted
investigations, and has highlighted the importance of rapid communication
international collaboration through the European Union-funded Salm-Net
This paper determines the asymptotic solution of certain
initial-boundary value problems for
singularly-perturbed reaction-diffusion equations, including the
Allen–Cahn and Cahn–Hilliard equations, on bounded
one-dimensional spatial domains for r[ges ]0. Attention is
focused on the metastable evolution of a transition layer over an
asymptotically exponentially-long time interval.
Electroencephalogram (EEG) alpha power has been
demonstrated to be inversely related to mental activity
and has subsequently been used as an indirect measure of
brain activation. The thalamus has been proposed as an
important site for modulation of rhythmic alpha activity.
Studies in animals have suggested that cortical alpha rhythms
are correlated with alpha rhythms in the thalamus. However,
little empirical evidence exists for this relation in humans.
In the current study, resting EEG and a fluorodeoxyglucose
positron emission tomography scan were measured during
the same experimental session. Over a 30-min period, average
EEG alpha power across 28 electrodes from 27 participants
was robustly inversely correlated with glucose metabolic
activity in the thalamus. These data provide the first
evidence for a relation between alpha EEG power and thalamic
activity in humans.