Search

BACKGROUND Asthma is a common pediatric diagnosis for emergency medical services (EMS) transports, however there is a paucity of data on prehospital asthma management. The purpose of this study was to describe prehospital management of pediatric patients with suspected asthma exacerbation. METHODS We conducted a retrospective review of electronic medical records from 24 ground EMS agencies in Southwestern Pennsylvania between 1 January 2014 to 31 December 2017. We identified patients 2 to 17 years with documented wheezing, excluding those with suspected anaphylaxis. Patients with documented respiratory distress were classified as severe asthma. We report descriptive statistics of demographics, vital signs, and management including administration of medications and performance of procedures. RESULTS Of 19 246 pediatric transports, 1078 (5.6%) patients had wheezing. Of these, 532 (49%) met criteria for severe asthma. Patients with severe asthma were more likely to be adolescents compared to those with nonsevere asthma (49.6% vs 6%; P < .001). While rates of intravenous methylprednisolone administration were higher in patients with severe asthma (68/532, 12.8%) compared to those with nonsevere asthma (13/546, 2.4%; P < .001), overall use of steroids was low (7.5%). Other therapies provided included albuterol (n = 699, 64.8%), ipratropium bromide (n = 271, 25.1%), and oxygen (n = 280, 26.0%). One hundred eighty patients (16.7%) received a peripheral IV line. Two patients (0.4%) were given continuous positive airway pressure. CONCLUSION Approximately 6% of pediatric EMS transports are for asthma. Steroid usage was low in even those with severe asthma, representing an area of process improvement. These data provide a baseline to future research to identify interventions that may improve outcomes.

This paper explores the potential negative side-effects of the sustainability movement in societies with large segments of materialistic consumers. Across three studies, there is evidence that a conflict between materialistic and green value profiles can arise in consumers. When it arises, it seems to be related to diminished well-being. Study 1 shows that consumers with a higher value conflict (VC) experienced higher levels of stress. Consumers with higher degrees of stress then reported lower satisfaction with life. Study 2 reveals the underlying process by which this value conflict affects well-being. The results suggest that the value conflict is related to a reduced clarity of consumers’ self-concept (SCC), which in turn is related to increased levels of stress and a lower satisfaction with life. Results of Study 3 show that preference for consistency (PfC) serves as a boundary condition to this effect. The negative effect of VC on SCC is most pronounced among consumers high in PfC, while low PfC consumers seem to suffer less from the negative consequences of a conflict between green and materialistic values. Conceptual and public-policy implications of these results are discussed.

Objective To assess the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of ST-segment elevation myocardial infarction (STEMI) patients on the incidence of acute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI). Background STEMI patients who receive pPCI have an increased risk of AKI for which there is no well-defined prophylactic therapy in the setting of emergent pPCI. Methods Using the ACTION Registry-GWTG, we evaluated the impact of RIPC applied during inter-facility helicopter transport of STEMI patients from non-PCI capable hospitals to 2 PCI-hospitals in the United States between March, 2013 and September, 2015 on the incidence of AKI following pPCI. AKI was defined as ≥0.3 mg/dL increase in creatinine within 48–72 hours after pPCI. Results Patients who received RIPC (n = 127), compared to those who did not (n = 92), were less likely to have AKI (11 of 127 patients [8.7%] vs. 17 of 92 patients [18.5%]; adjusted odds ratio = 0.32, 95% CI 0.12–0.85, P = 0.023) and all-cause in-hospital mortality (2 of 127 patients [1.6%] vs. 7 of 92 patients [7.6%]; adjusted odds ratio = 0.14, 95% CI 0.02–0.86, P = 0.034) after adjusting for socio-demographic and clinical characteristics. There was no difference in hospital length of stay (3 days [interquartile range, 2–4] vs. 3 days [interquartile range, 2–5], P = 0.357) between the 2 groups. Conclusion RIPC applied during inter-facility helicopter transport of STEMI patients for pPCI is associated with lower incidence of AKI and in-hospital mortality. The use of RIPC for renal protection in STEMI patients warrants further in depth investigation.

Objectives: Emergency medical services (EMS) was recently approved as a subspecialty by the American Board of Medical Specialties, highlighting the core content of knowledge that encompasses prehospital emergency patient care. This study aimed to describe the current state of EMS education at emergency medicine (EM) residency programs in the United States. Methods: The authors distributed an online survey containing multiple-choice and free-response questions pertaining to resident EMS education to the directors of EM residency programs in the United States between July 21 and September 10, 2010. Results: Of 154 programs, 117 (75%) responded to the survey, and 108 (70%) completed the survey by answering all required questions. Of completed surveys, 82 programs (76%) reported the cumulative time devoted to EMS didactic education during the course of residency training, a median of 20 hours (range = 3 to 300 hours; interquartile range [IQR] = 12 to 36 hours). There is a designated EMS rotation in 89% of programs, with a median duration of 3 weeks (range = 1 to 9 weeks; IQR = 2 to 4 weeks). Most programs involve residents on EMS rotations strictly as in-field observers (63%), some as in-field providers (20%), and the rest with some combination of the two roles. Ground ride-along is required in 94% of programs, while air ride-along is mandatory in 4% and optional in 81% of programs. Direct medical oversight (DMO) certification is required in 41% of residency programs, but not available in 26% of program jurisdictions. Residents in 92% of programs provide DMO. In those programs, most residents (77%) provide DMO primarily while working in the emergency department (ED), 13% during dedicated EMS or medical oversight shifts, and 4% during a combination of these shifts. Disaster-preparedness was most frequently listed as the component programs would like to add to their EMS curricula. Conclusions: There is a wide range in the didactic, online, and in-field EMS educational experiences provided as part of EM training. Most residents participate in ground ride-along activities, provide DMO, and have a dedicated EMS rotation. Disaster-preparedness is the most common desired addition to existing EMS rotations. ACADEMIC EMERGENCY MEDICINE 2012; 19:1–6 © 2012 by the Society for Academic Emergency Medicine

The unique voltage- and Ca2+-dependent K+ (BK) channel, prominently expressed in airway smooth muscle cells, has been suggested as an important effector in controlling airway contractility. Its deletion in mice depolarized resting membrane potential of tracheal cells, suggesting an increased open-probability of voltage-gated Ca2+ channels. While carbachol concentration-dependently increased the tonic tension of wild-type (WT) trachea, mutant trachea showed a different response with rapid tension development followed by phasic contractions superimposed on a tonic component. Tonic contractions were substantially more dependent on L-type Ca2+ current in mutant than in WT trachea, even though L-type Ca2+ channels were not up-regulated. In the absence of L-type Ca2+ current, half-maximal contraction of trachea was shifted from 0.51 to 1.7 microM. In agreement, cholinergic bronchoconstriction was reduced in mutant lung slices, isolated-perfused lungs and, most impressively, in mutant mice analyzed by body plethysmography. Furthermore, isoprenaline-mediated airway relaxation was enhanced in mutants. In-depth analysis of cAMP and cGMP signaling revealed up-regulation of the cGMP pathway in mutant tracheal muscle. Inhibition of cGMP kinase reestablished normal sensitivity toward carbachol, indicating that up-regulation of cGMP signaling counterbalances for BK channel ablation, pointing to a predominant role of BK channel in regulation of airway tone.

Zusammenfassung This article explains political radicalism by the number of voters who are biased towards a party. With little voters biased in favor of a party, this party has to rely more heavily on its programmatic distance to other parties. Because large parties – i.e.: parties with a high number of biased voters – gain votes when they move to the center of the political spectrum, parties with a lower number of voters that are biased in their favor are forced to the edges of the policy space. We draw on a computational model of political competition between four parties in a two-dimensional policy space to investigate this relationship. We use panel corrected OLS estimates to analyze the data generated by the computer simulation. Our results substantiate the hypothesis of a negative relationship between the number of biased voters and the inclination of a party to adopt a more extreme policy stance.

The influence of grain boundaries on heat transfer through polycrystalline alumina has been investigated between 20° and 500°C. The thermal conductivities of small-grained porous ceramics and large-grained dense ceramics have been measured using the laser-flash technique. Two methods have been developed to assess the average thermal resistance of a grain boundary. The first method is based on the comparison of room-temperature thermal conductivities for dense ceramics that have various average grain sizes. This method yields a value of 0.9 × 10−8 m2·K·W−1. The second method, particularly suitable for porous ceramics, is based on the extrapolation of the inverse of the thermal conductivity versus temperature to give an intercept with the axis at T= 0 K. This value is attributed to the thermal resistance of grain boundaries. By taking into account the influence of the pore content using an effective medium theory, the average thermal resistance of a grain boundary has been evaluated to be 1.3 × 10−8 m2·K·W−1 in dense alumina and 2.2 × 10−8 m2·K·W−1 in alumina containing a pore volume fraction of 0.3.

Zusammenfassung Dieser Beitrag setzt sich kritisch mit der unter anderem von Herbert Obinger formulierten Hypothese auseinander, derzufolge zwischen dem Regimetyp und dem langfristigen Wirtschaftswachstum kein Zusammenhang besteht. Entgegen dieser These zeigen wir einen systematischen, wenngleich nicht-linearen Zusammenhang auf. Daruber hinaus unterstreichen wir zwar Obingers Ergebnis, die institutionelle Qualitat eines Staates sei entscheidend fur sein langfristiges Wirtschaftswachstum. Wir bezweifeln jedoch, dass eine hohe institutionelle Qualitat unabhangig von der konstitutionellen Verfasstheit der Staaten in Autokratien und Demokratien gleichermassen wahrscheinlich ist. Wir finden einen positiven Einfluss des Demokratieniveaus auf die Qualitat wirtschaftlicher Institutionen.

We characterized the responses of murine airways and pulmonary vessels to a variety of endogenous mediators in the isolated perfused and ventilated mouse lung (IPL) and compared them with those in precision-cut lung slices. Airways: The EC50 (μM) for contractions of airways in IPL/slices was methacholine (Mch), 6.1/1.5>serotonin, 0.7/2.0>U46619 (TP-receptor agonist), 0.1/0.06>endothelin-1, 0.1/0.05. In the IPL, maximum increase in airway resistance (RL) was 0.6, 0.4, 0.8 and 11 cmH2O s ml−1, respectively. Adenosine (⩽1 mM), bombesin (⩽100 μM), histamine (⩽10 mM), LTC4 (⩽1 μM), PAF (0.25 μM) and substance P (⩽100 μM) had only weak effects (U46619, 0.05

Objective: 1) Assess the influence of word familiarity, phonological neighborhood, and acoustic patterns on speech audiometry variability. 2) Evaluate the interaction between those factors and patients’ age and years of education.Method: Patients (n = 160) underwent otoscopy, tympanometry, pure-tone, and speech audiometry. At an intensity level corresponding to a speech score between 40% and 60%, patients were presented 6 lists of 10 spondees, taken from a standard material used in France. Linguistic characteristics of the spondees and spectral acoustic patterns were characterized. PLS regression analysis was used to determine the factors influencing the percent score recognition for each word (PC).Results: PC varied from 18% to 92%. PC rose significantly with word familiarity (r = 0.38, P = .005) and 1 kHz frequency band amplitude of each word’s acoustic spectrum (r = 0.60, P = .001). The percentage variability due to linguistic factors decreased significantly with age (from 30% below 50 years old to les...

We report on two patients with an objective tinnitus. In the first one, the objective tinnitus was unique as it was due to bilateral rhythmic contractions of the vocal cords. In the second, the objective tinnitus arose from Eustachian tube contractions and was associated with up and down movements of the larynx. In both patients, the abnormal laryngeal movement shared most of the characteristics of palatal or palatolaryngeal myoclonus and was thought to be laryngeal myoclonus. Its origin remained essential as all the investigations were negative.

Heteroarylmethylation of halogenobenzonitriles in the presence of air (O 2 ) gives 1-hydroxy-3-oxo-1-aryl-1H,3H-isoindoles in liquid ammonia. A one-pot or two-step synthesis is described and a mechanism is proposed

When 42 field trials, carried out from 1975 to 1989 in the Perpignan region (France) for control of lettuce drop caused by Sclerotinia minor, were compared, a decrease in the field effectiveness of cyclic imides was perceptible, beginning approximately in 1985. Moreover, in 15 out of 46 commercial lettuce fields surveyed in 1988 and 1989, the effectiveness of iprodione was less than 80%, the level of acceptability for the growers. In these fields, fungicide degradation, estimated by 3,5-dichloroaniline formation, was faster than in soils in which S. minor was adequately controlled. Statistical analyses showed that the iprodione degradation index was strongly linked to the history of fungicide treatment and was weakly correlated to soil pH or clay content. All the fields characterized by low iprodione effectiveness were associated with high levels of fungicide treatment and high degradation index. Moreover, we observed that soil from a field which had received iprodione for more than ten years did not degrade vinclozolin quickly, while soil from another part of the same field which had been treated with vinclozolin for eight years degraded vinclozolin faster than iprodione.