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BackgroundFluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory flow and tissue oxygen delivery is critical for organ and patient survival, but these parameters are infrequently measured. Patient Blood Management is a multidisciplinary approach to manage and conserve a patient’s own blood, directing treatment options based on broad clinical assessment beyond haemoglobin alone, for which tissue perfusion and oxygenation could be useful. Our aim was to assess utility of non-invasive tissue-specific measures to compare PRBC transfusion with novel crystalloid treatments for haemorrhagic shock.MethodsA model of severe haemorrhagic shock was developed in an intensive care setting, with controlled haemorrhage in sheep according to pressure (mean arterial pressure 30–40 mmHg) and oxygen debt (lactate 4 mM) targets. We compared PRBC transfusion to fluid resuscitation with either PlasmaLyte or a novel crystalloid. Efficacy was assessed according to recovery of haemodynamic parameters and non-invasive measures of sublingual microcirculatory flow, regional tissue oxygen saturation, repayment of oxygen debt (arterial lactate), and a panel of inflammatory and organ function markers. Invasive measurements of tissue perfusion, oxygen tension and lactate levels were performed in brain, kidney, liver, and skeletal muscle. Outcomes were assessed during 4 h treatment and post-mortem, and analysed by one- and two-way ANOVA.ResultsEach treatment restored haemodynamic and tissue oxygen delivery parameters equivalently (p 0.05), despite haemodilution after crystalloid infusion to haemoglobin concentrations below 70 g/L (p 0.001). Recovery of vital organ-specific perfusion and oxygen tension commenced shortly before non-invasive measures improved. Lactate declined in all tissues and correlated with art

BackgroundFluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory flow and tissue oxygen delivery is critical for organ and patient survival, but these parameters are infrequently measured. Patient Blood Management is a multidisciplinary approach to manage and conserve a patient’s own blood, directing treatment options based on broad clinical assessment beyond haemoglobin alone, for which tissue perfusion and oxygenation could be useful. Our aim was to assess utility of non-invasive tissue-specific measures to compare PRBC transfusion with novel crystalloid treatments for haemorrhagic shock.MethodsA model of severe haemorrhagic shock was developed in an intensive care setting, with controlled haemorrhage in sheep according to pressure (mean arterial pressure 30–40 mmHg) and oxygen debt (lactate 4 mM) targets. We compared PRBC transfusion to fluid resuscitation with either PlasmaLyte or a novel crystalloid. Efficacy was assessed according to recovery of haemodynamic parameters and non-invasive measures of sublingual microcirculatory flow, regional tissue oxygen saturation, repayment of oxygen debt (arterial lactate), and a panel of inflammatory and organ function markers. Invasive measurements of tissue perfusion, oxygen tension and lactate levels were performed in brain, kidney, liver, and skeletal muscle. Outcomes were assessed during 4 h treatment and post-mortem, and analysed by one- and two-way ANOVA.ResultsEach treatment restored haemodynamic and tissue oxygen delivery parameters equivalently (p 0.05), despite haemodilution after crystalloid infusion to haemoglobin concentrations below 70 g/L (p 0.001). Recovery of vital organ-specific perfusion and oxygen tension commenced shortly before non-invasive measures improved. Lactate declined in all tissues and correlated with art

BACKGROUND: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. METHODS: Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO2), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO2) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte® was dosed to achieve MAP > 65 mm Hg. RESULTS: Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 ± 5 to 31 ± 5 mm Hg (P < 0.01), SvO2 70 ± 7 to 23 ± 8% (P < 0.05), cerebral regional tissue StO2 77 ± 11 to 65 ± 9% (P < 0.01), peripheral muscle StO2 66 ± 8 to 16 ± 9% (P < 0.01), arterial lactate 1.5 ± 1.0 to 5.1 ± 0.8 mM (P < 0.01), and base excess 1.1 ± 2.2 to -3.6 ± 1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte® improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 ± 1.2 to 5.9 ± 1.1 g/dL post-resuscitation (P < 0.01). CONCLUSION: Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation s

ImportanceBlood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes. ObjectiveTo evaluate the association of BP indexes with death and a composite CV event. Design, Setting, and ParticipantsLongitudinal population-based cohort study of 11135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016). ExposuresBlood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings). Main Outcomes and MeasuresMultivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC). ResultsAmong 11135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P<.001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an

We discuss the results of measurements in the region of Cape Baranov (the Severnaya Zemlya archipelago) of the set of physicochemical characteristics of atmospheric aerosol: aerosol optical depth, aerosol and black carbon concentrations, elemental and ion compositions of aerosol, organic and elemental carbon contents in aerosol, as well as the isotopic composition of carbon in the aerosol and snow samples. It is shown that the average values of most aerosol characteristics, measured in April–June 2018, are a little lower than in the Arctic settlement Barentsburg (Spitsbergen archipelago) and several-fold smaller than in the south of Western Siberia in the same period.

We discuss the results of measurements in the region of Cape Baranov (the Severnaya Zemlya archipelago) of the set of physicochemical characteristics of atmospheric aerosol: aerosol optical depth, aerosol and black carbon concentrations, elemental and ion compositions of aerosol, organic and elemental carbon contents in aerosol, as well as the isotopic composition of carbon in the aerosol and snow samples. It is shown that the average values of most aerosol characteristics, measured in April–June 2018, are a little lower than in the Arctic settlement Barentsburg (Spitsbergen archipelago) and several-fold smaller than in the south of Western Siberia in the same period.

Objectives: The aim was to assess the reliability and validity of the quality of life (QoL) instrument CASP-19, and three shorter versions of CASP-12 in large population sample of older adults from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study.Methods: From the Czech Republic, Russia, and Poland, 13,210 HAPIEE participants aged 50 or older completed the retirement questionnaire including CASP-19 at baseline. Three shorter 12-item versions were also derived from original 19-item instrument. Psychometric validation used confirmatory factor analysis, Cronbach's alpha, Pearson's correlation, and construct validity.Results: The second-order four-factor model of CASP-19 did not provide a good fit to the data. Two-factor CASP-12v.3 including residual covariances for negative items to account for the method effect of negative items had the best fit to the data in all countries (CFI = 0.98, TLI = 0.97, RMSEA = 0.05, and WRMR = 1.65 in the Czech Republic; 0.96, 0.94, 0.07, and 2.70 in Poland; and 0.93, 0.90, 0.08, and 3.04 in Russia). Goodness-of-fit indices for the two-factor structure were substantially better than second-order models.Conclusions: This large population-based study is the first validation study of CASP scale in Central and Eastern Europe (CEE), which includes a general population sample in Russia, Poland, and the Czech Republic. The results of this study have demonstrated that the CASP-12v.3 is a valid and reliable tool for assessing QoL among adults aged 50 years or older. This version of CASP is recommended for use in future studies investigating QoL in the CEE populations.

Background The growing awareness of transfusion-associated morbidity and mortality necessitates investigations into the underlying mechanisms. Small animals have been the dominant transfusion model but have associated limitations. This study aimed to develop a comprehensive large animal (ovine) model of transfusion encompassing: blood collection, processing and storage, compatibility testing right through to post-transfusion outcomes. Materials and methods Two units of blood were collected from each of 12 adult male Merino sheep and processed into 24 ovine-packed red blood cell (PRBC) units. Baseline haematological parameters of ovine blood and PRBC cells were analysed. Biochemical changes in ovine PRBCs were characterized during the 42-day storage period. Immunological compatibility of the blood was confirmed with sera from potential recipient sheep, using a saline and albumin agglutination cross-match. Following confirmation of compatibility, each recipient sheep (n = 12) was transfused with two units of ovine PRBC. Results Procedures for collecting, processing, cross-matching and transfusing ovine blood were established. Although ovine red blood cells are smaller and higher in number, their mean cell haemoglobin concentration is similar to human red blood cells. Ovine PRBC showed improved storage properties in saline–adenine–glucose–mannitol (SAG-M) compared with previous human PRBC studies. Seventy-six compatibility tests were performed and 17·1% were incompatible. Only cross-match compatible ovine PRBC were transfused and no adverse reactions were observed. Conclusion These findings demonstrate the utility of the ovine model for future blood transfusion studies and highlight the importance of compatibility testing in animal models involving homologous transfusions.

Background: Extra corporeal membrane oxygenation (ECMO) is a complex rescue therapy used to provide cardiac and/or respiratory support for critically ill patients who have failed maximal conventional medical management. ECMO is based on a modified cardiopulmonary bypass (CPB) circuit, and can provide cardiopulmonary support for up-to several months. It can be used in a veno venous configuration for isolated respiratory failure, (VV-ECMO), or in a veno arterial configuration (VA-ECMO) where support is necessary for cardiac +/- respiratory failure. The ECMO circuit consists of five main components: large bore cannulae (access cannulae) for drainage of the venous system, and return cannulae to either the venous (in VV-ECMO) or arterial (in VA ECMO) system. An oxygenator, with a vast surface area of hollow filaments, allows addition of oxygen and removal of carbon dioxide; a centrifugal blood pump allows propulsion of blood through the circuit at upto 10 L/minute; a control module and a thermoregulatory unit, which allows for exact temperature control of the extra corporeal blood. Methods: The first successful use of ECMO for ARDS in adults occurred in 1972, and its use has become more commonplace over the last 30 years, supported by the improvement in design and biocompatibility of the equipment, which has reduced the morbidity associated with this modality. Whilst the use of ECMO in neonatal population has been supported by numerous studies, the evidence upon which ECMO was integrated into adult practice was substantially less robust. Results: Recent data, including the CESAR study (Conventional Ventilatory Support versus Extra corporeal membrane oxygenation for Severe Respiratory failure) has added a degree of evidence to the role of ECMO in such a patient population. The CESAR study analysed 180 patients, and confirmed that ECMO was associated with an improved rate of survival. More recently, ECMO has been utilized in numerous situations within the critical care are

© 2016 by iSER, International Society of Educational Research. In today's world the development of pedagogical science is influenced by a number of global trends, one of which is the dynamism of social processes. The relevance of understanding the problem of social adaptation of pedagogical support of students is determined by processes that occur in modern society. The purpose of the article is to determine the content of pedagogical support of students’ social adaptation. The leading method is the method of unfinished sentences, allowing to define a set of personal qualities, knowledge, skills and values, the formation of which in the course of purposeful activity of teachers, ensure successful social adaptation of students. An analysis of empirical data allowed to identify features of the implementation of pedagogical support of social adaptation of students in various fields of social adaptation (society, family, educational organizations, including informal communication, the sphere of personal adaptation). For each field there was identified a set of knowledge, life values, skills and social roles, the formation of which should be motivated by teachers in the course of carrying out their support. The findings of the article will enable practical education staff to carry out pedagogical support of social adaptation of students purposefully and systematically.

© 2016 by author/s.The urgency of the problem stated in the article is caused by the need of pedagogical support of students’ social adaptation on the basis of systematicity, which is achieved if we correctly define the components of the process. The aim of the article is to determine the pedagogical support components of students’ social adaptation. The leading approach underlying the research is a system-based synergetic approach. The selection of components and their layout was carried out on the system-based synergetic approach, mainly from the standpoint of classical theory of systems. The pedagogical support of students’ social adaptation includes theoretical and methodological, information-analytical, content-related, technological, management and expert components. The content of each component used in the process of pedagogical support offered in the article ensures the effectiveness of the professional work of teachers, who support students' social adaptation. The data of the article are of theoretical and practical importance for researchers in the sphere of social adaptation of personality, and also for education professionals, who realize the pedagogical support of students’ social adaptation in practice.

© 2016 Simonova.The relevance of the problem stated in the article is determined by the need of developing technological approaches to pedagogical support of students' social adaptation. The purpose of this paper is to position the technological sequence of pedagogical support of students' social adaptation in the activities of the socio-pedagogical complex. The leading method in the study of this problem was the method of modeling, which allowed us to identify the components and structure of the socio-pedagogical complex, the implementation of which optimizes the process of students' social adaptation. The article presents and characterizes the components of the socio-pedagogical complex revealed in the course of the study; proposes activities for the centers and services that provide pedagogical support of students' social adaptation; proves the efficiency of the socio-pedagogical complex technology on the basis of children's additional education institutions. The materials of the article are of theoretical and practical value for both researchers of the problems of personality social adaptation and for educational professionals implementing pedagogical support of students' social adaptation.

© 2016 by author/s.The urgency of the problem stated in the article is caused by the need of pedagogical support of students’ social adaptation on the basis of systematicity, which is achieved if we correctly define the components of the process. The aim of the article is to determine the pedagogical support components of students’ social adaptation. The leading approach underlying the research is a system-based synergetic approach. The selection of components and their layout was carried out on the system-based synergetic approach, mainly from the standpoint of classical theory of systems. The pedagogical support of students’ social adaptation includes theoretical and methodological, information-analytical, content-related, technological, management and expert components. The content of each component used in the process of pedagogical support offered in the article ensures the effectiveness of the professional work of teachers, who support students' social adaptation. The data of the article are of theoretical and practical importance for researchers in the sphere of social adaptation of personality, and also for education professionals, who realize the pedagogical support of students’ social adaptation in practice.

© 2016 Simonova.The relevance of the problem stated in the article is determined by the need of developing technological approaches to pedagogical support of students' social adaptation. The purpose of this paper is to position the technological sequence of pedagogical support of students' social adaptation in the activities of the socio-pedagogical complex. The leading method in the study of this problem was the method of modeling, which allowed us to identify the components and structure of the socio-pedagogical complex, the implementation of which optimizes the process of students' social adaptation. The article presents and characterizes the components of the socio-pedagogical complex revealed in the course of the study; proposes activities for the centers and services that provide pedagogical support of students' social adaptation; proves the efficiency of the socio-pedagogical complex technology on the basis of children's additional education institutions. The materials of the article are of theoretical and practical value for both researchers of the problems of personality social adaptation and for educational professionals implementing pedagogical support of students' social adaptation.

© 2016 by iSER, International Society of Educational Research. In today's world the development of pedagogical science is influenced by a number of global trends, one of which is the dynamism of social processes. The relevance of understanding the problem of social adaptation of pedagogical support of students is determined by processes that occur in modern society. The purpose of the article is to determine the content of pedagogical support of students’ social adaptation. The leading method is the method of unfinished sentences, allowing to define a set of personal qualities, knowledge, skills and values, the formation of which in the course of purposeful activity of teachers, ensure successful social adaptation of students. An analysis of empirical data allowed to identify features of the implementation of pedagogical support of social adaptation of students in various fields of social adaptation (society, family, educational organizations, including informal communication, the sphere of personal adaptation). For each field there was identified a set of knowledge, life values, skills and social roles, the formation of which should be motivated by teachers in the course of carrying out their support. The findings of the article will enable practical education staff to carry out pedagogical support of social adaptation of students purposefully and systematically.