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Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest, and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. We constructed the model using a red dye-filled ping pong ball (simulating the right ventricle) and a 250cc normal saline bag (simulating the effusion) encased in an artificial rib cage and held in place by gel wax. The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16-20 hours, most of which is attributed to cooling of the gel wax. Actual construction time is approximately four hours at a cost of less than $200. The model was introduced to emergency medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell’Orto.1 The learners performed ultrasound-guided pericardiocentesis using both models. Learners who completed a survey comparing realism of the two models felt our model was more realistic than the previously described model. On a scale of 1-9, with 9 being very realistic, the previous model was rated a 4.5. Our model was rated a 7.8. There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive than commercial models ($200 vs up to $16,500) while being more realistic in simulation than other described “do-it-yourself models.” This model can be easily replicated to teach the necessary skill of pericardiocentesis. [West J Emerg Med. 2017;18(1)114-116.]

After 40 years of intense interaction, the United States and China are pulling away from each other. The US believes China plans to eclipse it as the premier global power [...]

Pretreatment prognostication, on-treatment monitoring, and early detection of physiological symptoms are considerable challenges in cancer. We describe the feasibility of high-resolution wearable data (steps per day, walking speed) to longitudinally profile physiological trajectories extracted from Apple Health data in three patients with lung cancer from diagnosis through cancer treatment after obtaining informed consent. We used descriptive statistics to describe our approach of building longitudinal physiological profiles. The wearable data monitoring period ranged from 58 to 135 weeks, with between 34,319 and 103,535 distinct digital physiological measures collected during this period--the equivalent to 41 measures per day/patient. Longitudinal profiling revealed that wearable data accurately captured physiological changes linked with clinical events such as surgery and hospitalizations as well as initiation (and cessation) of systemic cancer treatment in all three patients. These findings suggest that wearable devices could play a critical role in the management of lung cancer, although larger studies are needed to confirm these preliminary observations and validate their generalizability. Wearable devices hold significant promise for the development of personalized "digital biomarkers," which may enhance risk stratification and management in oncology. [ABSTRACT FROM AUTHOR]

Surface enhanced Raman spectroscopy (SERS) is a powerful analytical technique that has found application in the trace detection of a wide range of contaminants. In this paper, we report on the fabrication of 2D silver nanodendrites, on silicon chips, synthesized by electrochemical reduction of AgNO3 at microelectrodes. The formation of nanodendrites is tentatively explained in terms of electromigration and diffusion of silver ions. Electrochemical characterization suggests that the nanodendrites do not stay electrically connected to the microelectrode. The substrates show SERS activity with an enhancement factor on the order of 106. Density functional theory simulations were carried out to investigate the suitability of the fabricated substrate for pesticide monitoring. These substrates can be functionalized with cyclodextrin macro molecules to help with the detection of molecules with low affinity with silver surfaces. A proof of concept is demonstrated with the detection of the herbicide 2-methyl-4-chlorophenoxyacetic acid (MCPA). [ABSTRACT FROM AUTHOR]

American martens (Martes americana) are typically found in late-successional forests with closed canopy cover and high structural diversity. Reintroduced populations of martens in the Northern Lower Peninsula of Michigan inhabit areas that are devoid of many of these features, which may impact their prey base. The goal of our study was to evaluate the small mammal prey base available to martens in the Northern Lower Peninsula. To assess prey availability, diversity, and composition, as well as effects of trap type and habitat features on trapping success, we sampled 24 study plots within the Manistee National Forest for small mammals in 2013 (n=24) and 2014 (n=20). Study plots were situated in four habitat types: conifer, deciduous, mixed conifer-deciduous, and mixed oak. Total capture rates were significantly and positively associated with relative deciduous tree cover. This result highlights how managing tracts of land for small mammal prey base may overlap with goals set forth bv researchers for marten habitat needs (e.g. resting site preferences). We found large Sherman traps had significantly higher total capture rates than other trap types (medium Sherman and pitfall traps), and we recommend researchers use a variety of trap types to maximize detectabilitv of small mammal species diversity and richness., Introduction Prior to European settlement, American martens (Maries americana) ranged throughout the Upper and Lower Peninsulas of Michigan, U.S.A. The old-growth coniferous forests of the Northern Lower Peninsula were ideal [...]

The United States and China are now adversaries. When and how this became true, and who bears responsibility for the wretched state of bilateral relations, are widely and fruitlessly debated. [...]

In November 2019, Henry Kissinger warned that the United States and China were in "the foothills of a Cold War" that could end in a conflict worse than World War I. Two years, one pandemic, a change of American administrations, and a brutal war in Ukraine later, the relationship is above of the foothills and nearing the summit. Cold War framing now seems inevitable. It has, at least, the virtue of focusing the world's attention. [ABSTRACT FROM AUTHOR]

Objective: To analyse the relationship between health app quality with user ratings and the number of downloads of corresponding health apps. Materials and methods: Utilising a dataset of 881 Android-based health apps, assessed via the 300-point objective Organisation for the Review of Care and Health Applications (ORCHA) assessment tool, we explored whether subjective user-level indicators of quality (user ratings and downloads) correlate with objective quality scores in the domains of user experience, data privacy and professional/clinical assurance. For this purpose, we applied spearman correlation and multiple linear regression models. Results: For user experience, professional/clinical assurance and data privacy scores, all models had very low adjusted R squared values (<.02). Suggesting that there is no meaningful link between subjective user ratings or the number of health app downloads and objective quality measures. Spearman correlations suggested that prior downloads only had a very weak positive correlation with user experience scores (Spearman =.084, p =.012) and data privacy scores (Spearman =.088, p =.009). There was a very weak negative correlation between downloads and professional/clinical assurance score (Spearman = -.081, p =.016). Additionally, user ratings demonstrated a very weak correlation with no statistically significant correlations observed between user ratings and the scores (all p > 0.05). For ORCHA scores multiple linear regression had adjusted R-squared = -.002. Conclusion: This study highlights that widely available proxies which users may perceive to signify the quality of health apps, namely user ratings and downloads, are inaccurate predictors for estimating quality. This indicates the need for wider use of quality assurance methodologies which can accurately determine the quality, safety, and compliance of health apps. Findings suggest more should be done to enable users to recognise high-quality health apps, including digital health literacy training and the provision of nationally endorsed "libraries". [ABSTRACT FROM AUTHOR]

What is the relationship between the conversion (I) of the elements into the (real) Body of Christ and (2) of the participants into the (mystical) Body of Christ? When we bring this and related questions to the early church, the Middle Ages, and the Reformation, we find that the conversion of the eucharistic elements has indeed been understood by unimpeachably sincere Christians in a broad variety of ways. In contrast, there has been a remarkably constant convergence regarding the all-importance of the conversion of the participants. Were this taken as the starting point, we might discover that we have much more ecumenical unity regarding the Eucharist than is usually thought to be the case. Keywords consubstantiation, conversion, deification, early church, ecumenical, English reformers, Eucharist, eucharistic elements, Franciscan theologians, Middle Ages, Real Presence, Reformation, spiritual communion, symbolic reception, transelementation, The relationship between the two eucharistic conversions--(1) the conversion of the elements of bread and wine into the real Body and Blood of Christ and (2) the conversion of the [...]

Can there be empirical evidence for a universal mechanism of salvation? To take up such a question will require students of both theology and the social and natural sciences to be in serious conversation with one another. Robert Doran suggests a possible beginning by bringing Bernard Lonergan's 'Law of the Cross' and theology of conversion into conversation with Rene Girard's mimetic theory. The result falls well short of a full phenomenology of redemption but is sufficiently promising to allow us to begin thinking about a possible universal theory of sanctification., PHENOMENOLOGY OF REDEMPTION? (1) The question mark points to the particular challenge of this article. It attempts to bring together two genres of discourse that normally have little to do [...]

Given renewed interest in the role of human action in the development of depression, I re-examine a tradition in the West which interpreted phenomena akin to the symptoms and signs of modern depression as 'a spiritual disease.' In medieval Europe, acedia was a vice, an undesirable trait of character acquired in the course of living a life. Persons suffering from the vice of acedia were implicated as agents in its development and to some extent responsible for overcoming it. In Part I of this paper, I note the contemporary interest of psychiatrists and others in this vice, consider the warrants for asserting that it is akin to some forms of depression, and recount, in brief, the history of this vice from the fourth to the fifteenth centuries. In Part II, I discuss how medieval scholars, confessors, and spiritual guides understood the question of responsibility for acedia and how they distinguished between this vice and melancholia. I argue that acedia was a vice that could be distinguished from melancholia and that, while akin to clinical depression, this vice should not be identified with depression. This investigation of and commentary on acedia is intended as a contribution to the contemporary discussion of the role of human agency in the development of depression and in its treatment.

Overly logical applications of some of Paul's metaphors have led to widely accepted atonement theories that, because they project human legalistic and transactional thinking onto the image of God, have been egregiously contradictory to an authentic trinitarian and incarnational view of sacrifice and atonement. The Eastern emphasis on apophatic theology and theosis coupled with the Western development of and confidence in historical critical analysis suggest ways in which theologians can come to a better understanding of these issues., BAD THEOLOGY LEADS TO BAD MORALITY. This statement was the title and the thesis of the first version of this article. (1) It was inspired by the pregnant statement of [...]

[Reviewing 20th-century research into the origins of the Eucharist, the author observes that many of the Church's theologians have yet to appropriate the significance of what is commonly accepted as historical fact by exegetes and liturgical theologians, namely, that there is no clear line of development from the Last Supper of Jesus to the theologically rich Eucharistic Prayers of the patristic golden age. The implications of this for methodology, for systematic theology and ecclesiology, for liturgical and ecumenical theology, and for pastoral theology and homiletics are then briefly discussed.], MANY A LITURGICAL THEOLOGIAN has inwardly groaned on Holy Thursday upon hearing the assembly sing 'At that first Eucharist ...' or upon hearing the homilist proclaim that we are 'doing [...]

[Recognizing that the Christ event has done away with sacrifice in the history-of-religions sense of the word, this article attempts to unveil the true meaning of Christian sacrifice from trinitarian and liturgical perspectives which enable us to see that sacrifice is, first, the self-offering of the Father in the gift of the Son, and then the free self-offering response of the Son in his humanity, and in completion, the faithful, in the power of the Spirit, being taken up into that Father-Son relationship.], IN ONE FORM OR ANOTHER, sacrifice plays an important role in all the major cultures and religions of the world. Because of this, general treatments usually survey the history of [...]