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For mechanically ventilated patients undergoing surgery, interrupting enteral feeding to prevent pulmonary aspiration is common; however, there are no published preoperative fasting guidelines for these patients, resulting in fasting practices that often vary greatly between hospitals. This retrospective study described fasting practices and surgical outcomes of mechanically ventilated patients across five trauma centres. The primary exposure was hours nil per os before surgery and was stratified into short (

We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury.Retrospective multicenter cohort study.Three U.S. trauma centers.Twenty-eight thousand one hundred one trauma patients admitted from 2010-2014.None.Measures included occurrence of alcohol withdrawal syndrome and delirium tremens, injury characteristics, risk factors for alcohol withdrawal syndrome, clinical outcomes, pharmacologic treatment for alcohol withdrawal syndrome, and Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores. Alcohol withdrawal syndrome severity was defined by CIWA-Ar score as minimal (10), moderate (10-20), and severe (20). Alcohol withdrawal syndrome developed in 0.88% (n = 246), including 12% minimal, 36% moderate, and 53% severe. Alcohol withdrawal syndrome progressed to delirium tremens in 11%. Before adjustment, alcohol withdrawal syndrome severity was associated with injury severity, hypokalemia, baseline CIWA-Ar score, and established alcohol withdrawal syndrome risk factors. Logistic regression identified the following predictors of delirium tremens: baseline CIWA-Ar score greater than or equal to 10 (odds ratio, 6.05; p = 0.02) and age greater than or equal to 55 (odds ratio, 3.24; p = 0.03). In patients with severe alcohol withdrawal syndrome, severe head injury also predicted progression to delirium tremens (odds ratio, 6.08; p = 0.01), and hypokalemia was borderline significant (odds ratio, 3.23; p = 0.07). Clinical outcomes of hospital length of stay, ICU length of stay, and alcohol withdrawal syndrome complications differed significantly by alcohol withdrawal syndrome severity and were worse with more severe manifestations of alcohol withdrawal syndrome. Mortality also significantly differed by alcohol withdrawal syndrome severity but was only greater in patients who progressed to delirium tremens (11.1%; p = 0.02); otherwise, there were no differences in mortality by severity (4%, 4%, and 0% by minimal, moderate, and severe alcohol withdrawal syndrome).Trauma patients with alcohol withdrawal syndrome experience a high occurrence of delirium tremens that is associated with significant mortality. These data demonstrate the predictive ability of baseline CIWA-Ar score, age, and severe head injury for developing delirium tremens.

This case study used concepts associated with Black masculinity to critically analyze newspaper depictions of the Ray Rice Domestic Violence Case (RRDVC). The pattern matching and content analysis revealed the following themes: colorblindness, binary depictions, and commodification. This article used the RRDVC to establish a persistent pattern of public discourse that situates Black male athletes accused of committing crimes within a series of controlling images depicted by the media that serve to maintain White supremacist patriarchal understandings of Black masculinity. The results of the analysis reveal how hegemonic depictions of Ray Rice serve the White supremacist patriarchy in maintaining the containment and commodification of Black men and perpetuate the acceptability of violence against Black women.

As legless predators, snakes are unique in their ability to immobilize and kill their prey through the process of constriction, and yet how this pressure incapacitates and ultimately kills the prey remains unknown. In this study, we examined the cardiovascular function of anesthetized rats before, during and after being constricted by boas (Boa constrictor) to examine the effect of constriction on the prey's circulatory function. The results demonstrate that within 6 s of being constricted, peripheral arterial blood pressure (PBP) at the femoral artery dropped to 1/2 of baseline values while central venous pressure (CVP) increased 6-fold from baseline during the same time. Electrocardiographic recordings from the anesthetized rat's heart revealed profound bradycardia as heart rate (fH) dropped to nearly half of baseline within 60 s of being constricted, and QRS duration nearly doubled over the same time period. By the end of constriction (mean 6.5±1 min), rat PBP dropped 2.9-fold, fH dropped 3.9-fold, systemic perfusion pressure (SPP=PBP−CVP) dropped 5.7-fold, and 91% of rats (10 of 11) had evidence of cardiac electrical dysfunction. Blood drawn immediately after constriction revealed that, relative to baseline, rats were hyperkalemic (serum potassium levels nearly doubled) and acidotic (blood pH dropped from 7.4 to 7.0). These results are the first to document the physiological response of prey to constriction and support the hypothesis that snake constriction induces rapid prey death due to circulatory arrest.

Sport participation is one hallmark of American childhood and adolescence. Approximately 25 million children and adolescents play competitive sports within schools and 30 to 45 million participate in at least one school or community-based athletic program (NYU Child Study Center, 2010). Young people who participate in sports earn higher grades, manage their time better, make quicker decisions, and experience better professional outcomes when compared with their nonathlete peers (Engle & Gurian, 2004). Because of the mentorship, time spent, and attention given, coaches contribute enormously to the development of student-athletes. Primary and secondary school coaches might have an even greater influence over student-athletes because, in many cases, they are also their teachers. The occurrence of sexual abuse among youths, particularly those in junior high and high school participating in school sports, is a phenomenon that has received very little attention from school social workers and other related service personnel. Despite the reality that millions of children and adolescents participate in sports yearly, there is little written within the research literature on the role of related services personnel on how to protect children and adolescents from sexual abuse at the hands of teachers who serve as coaches, sports administrators, and other school-affiliated authority figures. Similarly, despite the reality that teachers, in every state, are mandated reporters, many are uneasy about making accusations against their colleagues. We know little empirically about the challenge of sexual abuse occurring between authority figures and youths in schools, yet local news outlet throughout the nation do report its occurrence and allegations. This prompts the need for greater research, education, and enhanced awareness on the topic. School social workers should be aware of the signs, symptoms, and procedures for reporting sexual abuse between authority figures in school and youths. Language: en

Every week there is a national news story involving a collegiate student-athlete, and oftentimes the tale relates to a social work education issue. There are 731 social work programs, yet none offers coursework in student-athlete behavior and their environment. Student-athletes experience the same developmental challenges as nonathletes, and mental health disorders, substance abuse challenges, and criminal justice involvement can be exacerbated by their dual roles. This article describes the structure of collegiate sports and athletic department counseling and case management strategies; explores social work education content areas, educational policy and accreditation standards, and related student-athlete vulnerabilities; and it presents avenues to explore student-athlete developmental issues within social work curricula. The article concludes with the benefits of integrating collegiate athletics into social work education.

The association between Chance fractures and intra-abdominal injuries is reported to be as high as 89 per cent. Because prior studies were small series or case reports, we conducted a multicenter review to learn the true association between Chance fractures and intra-abdominal injuries as well as diagnostic trends. Trauma registry data, medical records, and radiology reports from 7 trauma centers were used to characterize 79 trauma patients with Chance fractures. Initial methods of abdominal assessment were computed tomography (CT) scan (79%), clinical examination (16%), and diagnostic peritoneal lavage (DPL) (5%). Twenty-six (33%) patients had intraabdominal injuries of which hollow viscus injuries predominated (22%). Twenty patients (25%) underwent laparotomy. The presence of an abdominal wall contusion and automobile restraint use were highly predictive of intra-abdominal injury and the need for laparotomy. The association between a Chance fracture and intra-abdominal injury is not as high as previously reported. CT scan has become the primary modality to assess the abdominal cavity of patients with Chance fractures, whereas the role of DPL has diminished.

We have used a direct optical measurement of the distortion of the first silicon crystal of the CHESS A2 monochromator. The total X-ray power absorbed by the crystal was in the range of 2 to 190 Watts. The X-ray powers measured by a bolometer were in good agreement with the XOP calculations. In-situ optical measurements were used to measure the deformation of the crystal under the heat load between a 3-15 O angle of incidence. Simultaneously, ANSYS modeling of the effect of the heat load on the monochromator crystal with the cooling assembly was done. The measured slope error and the surface deformation profiles were in good agreement with the ANSYS simulations. A rocking curve method was used to measure the effect of a heat load on the diffraction properties of the monochromator for a range of beam-defining slit widths. We have found a good correlation between the FWHM of the rocking curves and the slope errors from the optical measurements.

(1990). An evaluation of the perceived needs of secondary science teachers in Kansas. Journal of Science Teacher Education: Vol. 1, No. 4, pp. 74-79.

The deafening effect of high intensity noise is well known—from rock music, aircraft, snowmobiles, motorcycles and the shooting of guns. The effects of hospital noise and its interaction with ototoxic drugs are less well known. The subject is of particular importance to pediatricians, because infants in incubators are exposed to substantial noise from the motor, airflow, respirators, slamming of incubator doors and the baby's own crying. Furthermore, animal experimentation1 shows that the ototoxic drug, kanamycin (often given to the premature infant to combat sepsis), can potentiate the effect of noise on hearing loss as much as 100-fold. Whether or not an interaction between noise and potentially ototoxic drugs occurs in man is as yet unknown. MEASUREMENT Noise has frequency and intensity. Frequency is measured in cycles per second, designated hertz (Hz). The young human ear is sensitive to a frequency range of 20 to 20,000 Hz. White noise, the auditory counterpart of white light, has equal energy in each frequency in the audible range. Intensity is measured in decibels on a scale which is linear with respect to audible frequencies. This measurement is designated dB (linear). Since the human ear is more sensitive to the damaging effects of high frequency sound than to low frequency, a better correlate with noise-induced hearing loss can be obtained when low frequencies are filtered out. Filtered sound level, measured on a so-called A-weighted scale, is designated dB(A). Room conversation produces 60 to 70 dB(A), rock music 100 to 120 dB(A) and snowmobiles 105 to 135 dB(A) for the driver.

A case is presented of a patient with Letterer-Siwe disease who manifested features of primary liver disease upon admission. A brief review of the reticuloendothelioses is also given.

The Committee on Environmental Hazards has recommended that the American National Standards Institute (ANSI) revise that portion of the American Standard Z66.1/64 pertaining to the lead content of paint downward from the present 1% to "minimum traces" or < 0.06% of the total weight of the contained solid, including pigment, film solids, and driers. This recommendation is based on a study of recently published materials which appeared after the 1% voluntary standard for lead was originally established in 1955 by ANSI. At the same time, in response to the notice in the Federal Register of November 2, 1971 (21 CFR Part 191), the Committee recommended that Federal standards for lead content of paint used on surfaces accessible to young children be reduced to "minimum traces" on < 0.06%, and that paints containing more than this amount of lead be banned as hazardous substances. On review and evaluation of available data in children and adults, an ad hoc committee (B. G. King, Chairman) recently concluded that, for children, the maximum daily permissible intake (DPI) of lead from all sources should not exceed 300 µg Pb/day. If average daily intake is maintained below this level, blood lead concentrations are unlikely to exceed 40 µg Pb/100 gm whole blood. At this level of intake, it is estimated that the amount assimilated by 1- to 3-year-old children could probably be excreted so no net increment in total body lead burden would be anticipated. It is estimated that approximately one half of this 300 µg Pb/day intake would be derived from usual food, water, and air, so intake from all other sources, on the average, should not exceed 150 µg Pb/day.

Cincinnati's new administrative code is a marvel in simplicity. Number of departments is reduced to four, with jive independent non-departmental staf ofies. Power is vested in manager to organize subdiwisions and bureaus.

Two types of multifunction keyboards (MFKs), projection switches, and plasma panel were designed to consolidate many of the aircraft controls/displays into a single, easily-reachable control panel. Pilot performance while operating each type of MFK during simulated flight was examined. Also examined were four different arrangements of the task steps or logic levels across keyboards and the impact of both a center and side control stick location on front panel and right console MFK operation.

Charging effects in stroboscopic voltage contrast imaging of passivated devices may be reduced by pulsing the electron beam many times during each repetition of the test vector sequence. Signal pulses representing a single timing state are then separated from the others by sample-and-hold gating techniques. The multiple beam pulses during all portions of the test sequence produce a stable average surface charge which prevents fading of image contrast, permitting viewing of the image for extended periods. Results and comparisons with standard stroboscopy and low frequency sample-and-hold imaging are presented.

Amelioration de la fiabilite des moteurs diesel semi-rapides utilises pour les generateurs de reserve dans les centrales nucleaires

THE presence of a foreign body in the extrahepatic biliary tract is extremely infrequent judging from the paucity of reports in the medical literature.1 2 3 4 5 6 7 8 9 10 11 Having recently been confronted by the problem of obstructive jaundice developing several years after a wound, we believe that the case, together with its diagnostic and pathogenetic aspects, merits reporting. Previously reported cases are presented in Table 1. Case Report J.D., a 29-year-old man, was admitted to the hospital on December 2, 1953. During combat activity in 1944 he received several gunshot wounds of the right lateral and posterior aspects of the chest. Surgical operation was performed . . .

✓ The clinical results of lyophilized human cadaver dura transplantation in 170 neurosurgical patients show that it is a safe and effective material for dural closure. It is associated with low complication rates and minimal cortical scarring and adhesions. The successful results have been attributed to the minimal foreign body reaction stimulated by freeze-dried tissue. These factors plus its capacity for safe and convenient long-term storage at room temperature make lyophilization the method of choice for preserving dura mater.

AMONG the complications associated with chronic ulcerative colitis has been the development of associated "rheumatoid arthritis." The frequency of occurrence has been estimated at between 5 and 10 ...

Thromboembolism as a complication of ulcerative colitis has received scant attention in the medical literature. In most treatises on the disease either it is not mentioned at all or it receives only passing notice. Between 7% and 30% of patients with ulcerative colitis are said to develop nonpostoperative intravascular thromboses. Usually only the more seriously ill patients are affected. That phlebitis and arterial occlusion may be a serious and, at times, grave occurrence in ulcerative colitis is borne out by the following two cases in both of which autoimmune mechanisms may have played an important role. Report of Cases Case 1. —This 20-year-old white soldier with two years of active military service was in good health until March, 1961, when he noted fatigue, loss of energy, pallor, and increased frequency of bowel movements. Initially, he passed two to six loose stools daily which, at times, contained bright red blood. There

Lead poisoning in childhood is a preventable disease. Virtually all cases occur in children who live in old, deteriorated houses which were built and painted years ago when the use of lead-based paints on housing surfaces was widespread. Eighty-five percent of recognized cases occur in children in the 1- to 3-year age range in which pica (the habit of eating non-food substances) is prevalent. Consequently, the disease results from the interaction between hazardous housing and the child with pica. Early diagnosis of plumbism on clinical grounds alone is exceedingly difficult, and often impossible. Furthermore, by the time the clinical diagnosis is obvious, permanent brain damage which cannot be modified by therapy may already have taken place. Although the true incidence of plumbism is not known, careful surveys have revealed that 10 to 25% of young children who live in deteriorated urban slum housing show evidence of increased absorption of lead and that 2 to 5% show evidence of poisoning. While recent therapeutic advances have reduced the mortality of acute lead encephalopathy, it is now apparent that at least one-third of the survivors of encephalopathy sustain permanent irreversible damage to the brain. Significant reduction in the risk of permanent brain damage, therefore, requires identification of the child with increased body lead burden prior to the onset of poisoning. Fundamentally, both the prevention of adverse health effects due to lead and the treatment of identified cases depend upon the elimination of the housing hazard which lies at the root of the problem.

This narrated, color, 16 1/2 minute film describes the type of experiments being performed in the Air Force's Flight Dynamics Laboratory's Digital Synthesis Simulator. The purpose of these experiments is to develop new controls/displays concepts for the next generation fighter aircraft. The simulator is fixed-base and its cockpit is the size of an A-7. The cockpit's electro-mechanical instruments have been replaced with six cathode ray tubes (CRTs). Two of the CRTs are color and four are black-and-white. Through software programming, new display and control concepts are implemented on the display surfaces. Past work discussed in the film includes: development of multifunction control logic, design of integrated monochrome display formats, and development of color-coded formats. On-going projects discussed in the film include: designing pictorial formats to replace current alphanumeric formats; designing computer-generated synthetic terrain displays to replace current radar displays; and designing algorithms which enable the cockpit computer to identify emergency conditions and perform the necessary emergency procedures for the pilot. The film emphasizes the necessity of a research team composed of members with different areas of expertise. For example, the Digital Synthesis Simulation team is composed of human factors psychologists, pilots, engineers, and software and hardware experts. It also emphasizes the necessity to examine the human factors design of equipment in as near an operational setting as possible before production is pursued.

The Committee on Environmental Health of the Indiana Chapter of the American Academy of Pediatrics sought the assistance of the Academy's Committee on Environmental Hazards regarding a developing health risk to children in Indiana. A cattle feedlot was developed along the shores of a creek which empties into a lake where recreational use included an area specifically designated for swimming. The Environmental Protection Agency estimates that the wastes produced by farm animals in the United States are equivalent to the wastes of 2 billion people, more than half the world population of 3.7 billion people. It has further estimated that more than half of these wastes are produced in feedlots. Feedlots for livestock and poultry are a relatively new industry that has developed since World War II in various parts of the United States. Significant changes are occurring in the increased demand for meats and in the manner of feeding, processing, and marketing livestock. Feedlots are now being established closer to market areas throughout the nation. With the increasing number of animals and the increasing use of feedlots, it is necessary that some wastes management system be required to protect the human population from a number of infectious diseases. Animal wastes from feedlots are more infectious than wastes from grazing farm animals because of naturally occurring epizootics within such confined feeding facilities. Chemical pollution by animal wastes or chemical changes incident to microbiologic or chemical pollution are also a concern. In the interest of our domestic water supply and the safe use of recreational waters, both vital to the health of children, the Committee has approved the following statement

Excerpt It is now well established that all types of porphyria are familial diseases in which the underlying mechanism is an inborn error of pigment metabolism. Patients with the condition often gi...

Excerpt Reports of psittacosis are by no means uncommon in the medical literature of recent years, and further individual case reports might seem superfluous. Recently, a patient was observed, howe...

tO A s % club, whose members, responsive to his beauties, have enriched their minds and emotions by reading his works or elevated his reputation by spreading his fame beyond their own circle. There is probably no way of knowing now just when the first association of this nature was formed, but certainly one of the earliest was the "Shakespeare Ladies Club" which was organized in the late months of I736 and which set about promptly to persuade London's theatrical managers to give Shakespeare a greater share in their repertories. Genuinely successful in their efforts, these women, whose identity has eluded our times,1 began a movement which restored many of Shakespeare's neglected plays to the boards, increased the frequency with which many of the familiar ones were presented, brought his works a great deal of publicity in an exceedingly short time, and became a model to later groups which similarly wished to improve the stage. The Club arose at an opportune moment when numerous writers of prologues, epilogues, essays, and periodicals lamented that tragedy lay dying, that pantomime and spectacle had threatened to banish Shakespeare and Jonson, and that Italian opera, with an almost hysterical adulation of foreign singers like Senesino, Farinelli, Signora Cuzzoni, and Signora Faustina, had feminized the robust English spirit of earlier days. Depressed by these trends, Aaron Hill, for example, had in his periodical The Prompter urged action to counteract these subversive tendencies. In No. 93 (30 September I735) he advocated the formation of "An Association for the Support of the Stage" by "Men of Quality, Taste, and Fortune", with special emphasis upon the support of new playwrights as well, a point he re-emphasized on 3 October I735 and 27 February I736. At much the same time an appeal was made to the "Public-Spirited" officers of the "Society for the Encouragement of Learning" by the anonymous author of The Tears of the Muses (I737), who argued that "our present low Relish for dramatical Buffoonery" would give way to "good Tragedy and Comedy" if the "Concurrence of your munificent Endeavours, but for one or two short Winters" would turn to augmenting the reasonableness of applauding good drama by making it fashionable as well. Stimulated by this type of appeal, the Shakespeare Ladies Club

There has been increasing concern by several groups about the plight of children whose lives are harmed by their housing environment, which results in an increased risk of accidents, infectious diseases, and in particular, lead poisoning. The Committee on Environmental Hazards has also been vitally concerned with these problems, and several of its members have served as expert witnesses in congressional hearings on related bills. However, efforts up to the present have been insufficient to alleviate illnesses which, though ill-defined, are clearly preventable. The Committee on Environmental Hazards recommends that the Academy encourage national and local governments to support, at the economic and law enforcement levels (including health departments), those measures necessary to alleviate the problems of childhood lead poisoning. Deteriorated housing is an essential feature of lead poisoning, and it is related to the increased risk of accidents and the incidence of infectious diseases. Action is needed to urge landlords, by whatever means possible, to improve those housing conditions which are a danger to the health of children. It may be economically unfeasible for landlords of deteriorated housing in inner cities to improve their buildings, and both legislative action and financial commitment from government may be necessary to bring about required action.