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The article discusses the neglect of lifesaving medical devices in the Federal Budget. Various essential medical devices, such as CT scans, MRIs, laboratory kits and analyzers, operation theater equipment, ICU ventilators and monitors, and blood bank screening kits, have been ignored in the budget. The importance of medical devices in diagnosing diseases and providing proper treatment is highlighted through examples, including the death of a liver specialist due to undiagnosed malaria. The article argues against the imposition of taxes on medical devices, as it will increase the cost of treatment and suggests that the authorities should consider removing or reducing the taxation on these devices. [Extracted from the article]

Surf lifesaving (SLS) clubs have been portrayed as male-dominated spaces perpetuating hegemonic masculinity. Contrary to this depiction, women and girls have participated in SLS in Aotearoa New Zealand since the 1930s, constituting approximately half of SLSNZ members. However, despite a growing body of research on women in ocean sports, studies on women's experiences in SLS are notably scarce. Addressing this gap, our interpretive research focuses on women's participation in SLS sports in Aotearoa New Zealand. Our findings reveal that the SLS community offers social and sporting opportunities for women throughout their life course. While providing a supportive environment for female friendships and mentorship, the sport fosters a sense of achievement, ocean skills and overall well-being. Nevertheless, challenges persist, as women encounter a ‘boys club’ mentality, where men are often perceived as the natural and legitimate bodies in SLS institutional contexts. Despite these perceptions, women don't necessarily feel excluded or marginalised within SLS spaces. Our research suggests that contemporary SLS clubs in Aotearoa New Zealand are more nuanced cultural spaces than previously portrayed. While still associated with masculinity, women dynamically navigate these male-defined arenas. SLS, as both a sport and lifeguard service, presents an institutional space where cultural norms reinforcing masculinity in ocean sports can be challenged. [ABSTRACT FROM AUTHOR]

Despite advancements in postoperative outcomes after Fontan surgery, there remains a risk of suboptimal outcomes and significant morbidity in the early postoperative period. Anatomical obstructions in the Fontan pathway can lead to prolonged pleural effusion or ascites, cyanosis, and low cardiac output syndrome (LCOS). Transcatheter interventions offer an alternative to early re-surgery for treating these complications. Over a 13-year period, early catheter angiography, performed within 30 days post-index procedure, was administered to 41 patients, identifying anatomical issues that necessitated re-intervention in 39 cases. This led to transcatheter interventions in 37 (10.4%) of the 344 Fontan surgery patients. The median age was 4.8 years (IQR: 4–9.4), and the median weight was 16.5 kg (IQR: 15–25.2), with females comprising 51.4% (19/37) of this group. The primary indications for the procedures were persistent pleural effusion or ascites in 27 patients (66%), LCOS in 8 patients (20%), and cyanosis in 6 patients (14%). Among the 37 undergoing transcatheter intervention, 30 were treated solely with this method and discharged, three died in ICU follow-up, and four required early re-surgery. No procedural mortality was observed. Our findings demonstrate that transcatheter interventions, including stent implantation, balloon angioplasty, and fenestration dilation, are safe and effective in the early post-Fontan period. Therefore, they should be considered an integral part of the management strategy for this patient group. [ABSTRACT FROM AUTHOR]

Coastal environments present dynamic challenges necessitating rapid and efficient responses during aquatic emergencies. Lifeguards, as pivotal links in the intervention chain, rely on various tools, with rescue time being paramount. The choice of fins, specifically long versus short ones, plays a critical role in optimizing lifeguard performance during rescues. This randomized cross-over study explores the impact of flipper size on ocean rescues, employing a sample of 14 lifeguards. Long fins (LFs) and short fins (SFs) were compared in terms of rescue time (RT) and physiological load (PL). Tests included ocean rescues without fins (R), with LF (R-LF), and with SF (R-SF). Variables recorded encompassed swim approach time, tow-in time, overall rescue time, perceived exertion rates (RPEs), and post-rescue lactate concentration. Long fins demonstrated superior performance in swim approach and tow-in times compared to both short fins and no fins (p < 0.001). Overall rescue time favored long fins significantly (p < 0.001), indicating their efficiency in practical ocean rescue scenarios. Physiologically, long fins induced lower perceived exertion in arms (p = 0.033) compared to short fins. Lactate concentrations post-rescue revealed no significant differences (p > 0.05). This study demonstrates that long fins significantly improve lifeguard performance during ocean rescues, reducing rescue times and alleviating arm fatigue. [ABSTRACT FROM AUTHOR]

Background: Postoperative pancreatic fistula (POPF) is responsible of most major complications and fatalities after PD. By avoiding POPF, TP may improve operative outcomes in high‐risk patients. The aim was to compare total pancreatectomy (TP) and pancreatoduodenectomy (PD) in high‐risk patients and evaluate results of implementing a risk‐tailored strategy in clinical practice. Methods: Between 2014 and 2023, 139 patients (76 men, median age 67 years) underwent resection of disease located in the head of the pancreas. Starting January 1, 2022, we offered TP to patients at high POPF risks (fistula risk score (FRS) ≥7) and to patients with intermediate POPF risks (FRS: 3–6) and high risks of failure to rescue (age> 75 years, ASA score ≥3). We compared outcomes of TP and PD and evaluated the results of the new strategy implementation on operative outcomes. Propensity score–based analysis was performed to limit bias of between‐group comparison. Results: Eventually, 26 (19%) patients underwent TP and 113 (81%) patients underwent PD. Severe complications occurred in 42 (30%) patients and 13 (9%) patients died. TP resulted in shorter lengths of hospital stay (median: 14 days [11; 18] vs. 17 days [13; 24], p = 0.016) and less risks of post‐pancreatectomy hemorrhage (PPH) (0% vs. 20%, p < 0.001) compared to PD. Crude and propensity match analysis showed that the implementation of a risk‐tailored strategy led to significant reduction of reoperation, POPF, PPH and mortality rates. Conclusion: The use of TP as part of a risk‐tailored strategy in high‐risk patients can be lifesaving. [ABSTRACT FROM AUTHOR]

The article explores how pulmonary surfactant has revolutionized care for premature infants, from its discovery elucidating lung surface tension to its role in treating neonatal respiratory distress syndrome (RDS). It highlights researchers like Mary Ellen Avery and events such as former U.S. President John F. Kennedy's son's death, spurring advancements in surfactant therapy.

Purpose: The purpose of this study is to analyse the impact of the FIFA World Cup Qatar 2022 on the Orthopaedic Surgery department at Hamad Medical Corporation and its response to the challenges posed by the world's largest sporting event. Methods: A retrospective analysis was conducted on the epidemiology, crisis management plan, and training program adaptations at the Orthopaedic Surgery department during the World Cup. Descriptive analysis of the number and types of surgeries performed, patient demographics, and the disaster preparedness plan were performed. Results: During the tournament period (November–December 2022), 706 patients (4.22% football fans) were operated on, with an average age of 44 ± 17 years. Most patients were males, 67%. Of the 706 patients, 60.33% were emergency cases, 38.24% were elective, 1.27% were limb-saving, and one life-saving procedure was performed, comparable to pre-tournament numbers. The patients were of 77 different nationalities, reflecting the diverse background of Qatar's population and the international fanbase of the tournament. Conclusions: This analysis provides valuable insights for future mega sporting events and highlights the importance of crisis management and training program adaptation for optimal patient care and resident training advancement. The findings demonstrate the crucial role of the Orthopaedic Surgery Department in responding to the challenges posed by large-scale events. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is a modality utilized for partially or completely supporting the cardiac and/or pulmonary function. There are multiple vascular access techniques depending upon the necessity and the mode of ECMO used. ECMO has evolved over the years as an integral part of the cardiac care discipline. Historically, this lifesaving modality began as an extension of cardiopulmonary bypass and was associated with adverse outcomes. Currently, ECMO has evolved as an accepted and viable solution to patients with severe cardiac/respiratory/cardiorespiratory failure that is refractory to conservative management. The outcomes of patients on ECMO are dependent on multiple factors originating from demographic and pathophysiological status of patients as well as the control of homeostasis during ECMO within the acceptable range. Various studies have been published by many practitioners over past decades since the dawn of ECMO era. A brief review of such experience is summated, and a conclusion is derived about the clinical course of the patients on ECMO, while adding the author's experience about the same in a tertiary care large-volume center. [ABSTRACT FROM AUTHOR]

Coastal environments present dynamic challenges necessitating rapid and efficient responses during aquatic emergencies. Lifeguards, as pivotal links in the intervention chain, rely on various tools, with rescue time being paramount. The choice of fins, specifically long versus short ones, plays a critical role in optimizing lifeguard performance during rescues. This randomized cross-over study explores the impact of flipper size on ocean rescues, employing a sample of 14 lifeguards. Long fins (LFs) and short fins (SFs) were compared in terms of rescue time (RT) and physiological load (PL). Tests included ocean rescues without fins (R), with LF (R-LF), and with SF (R-SF). Variables recorded encompassed swim approach time, tow-in time, overall rescue time, perceived exertion rates (RPEs), and post-rescue lactate concentration. Long fins demonstrated superior performance in swim approach and tow-in times compared to both short fins and no fins (p < 0.001). Overall rescue time favored long fins significantly (p < 0.001), indicating their efficiency in practical ocean rescue scenarios. Physiologically, long fins induced lower perceived exertion in arms (p = 0.033) compared to short fins. Lactate concentrations post-rescue revealed no significant differences (p > 0.05). This study demonstrates that long fins significantly improve lifeguard performance during ocean rescues, reducing rescue times and alleviating arm fatigue.

The isolated bile duct is sometimes observed in the right liver graft of living donor liver transplantation (LDLT). Even though, as a rescue option, it is known to use the recipient's cystic duct (CyD) for duct-to-duct anastomosis, the long-term feasibility of rescue duct-to-CyD (D-CyD) anastomosis remains unclear. We prospectively collected data in the right liver-LDLT cohort and compared rescue D-CyD anastomosis (n = 4) with standard duct-to-hepatic duct (D-HD, n = 45) anastomosis (D-CyD group, n = 4). The observation period was over 5 years (range, 68-171 mo) after LDLT. The D-CyD group included the following anastomosis procedures: anastomosis between the intrahepatic bile duct of the graft and the CyD of the recipient and anastomosis between the posterior HD and the CyD. Surgical outcomes between the 2 groups are similar, excluding the time for the biliary reconstruction (D-CyD, 116 ± 13 min vs D-HD, 57 ± 3 min). During the period, one recipient in the D-CyD group exhibited postoperative biliary stricture and biliary stone, and 6 recipients underwent those complications in the D-HD group (D-CyD, 25.0% vs D-HD, 13.3%) All recipients in the D-CyD group are presently alive and have not experienced liver dysfunction. Our findings suggest that rescue D-CyD anastomosis for an isolated bile duct in a right liver LDLT is acceptable as a life-saving option in terms of long-term feasibility. [ABSTRACT FROM AUTHOR]

Background: While there are several studies on marathon injuries worldwide, there are no related studies on the Taipei Marathon regarding the rescue time of onsite injury cases, the incidence of out-of-hospital cardiac arrest (OHCA) cases, and the success rate of recovery of spontaneous circulation (ROSC). This study aims to fill that gap. Hypothesis: The rescue time onsite of contact injury cases was in the prime time for lifesaving. Study Design: Descriptive epidemiological study. Level of Evidence: Level 2c. Methods: This is a retrospective study of numerical and timeflow data using descriptive statistics. Our data were obtained from records of the Taipei Marathon from 2013 to 2021. These included (1) notification data, (2) the time record of the emergency care personnel in contact with patients, (3) incidence of OHCA, (4) the success rate of ROSC, (5) the location of occurrence of OHCA, and (6) emergency medical service capacity and configuration. Results: The average time taken for first contact was 1.56 minutes in OHCA cases, and the total incidence rate of OHCA in 9 years was 4 people per 100,000 people, with a 100% ROSC success rate. Further, the location of OHCA cases was mostly in Q4 of the race (66.67%), followed by Q3 (22.22%) and Q2 (1.11%). The average number of emergency care personnel per marathon was 78, spread across 6 rescue and 6 medical stations and equipped with 8 ambulances and 35 automated external defibrillators. Conclusion: Shortening the arrival time of medical personnel to the scene and implementing a complete chain of survival can improve survival rates. Other ways to provide faster and more timely emergency rescue services require further study. Clinical Relevance: Contact with patients as soon as possible, timely implementation of cardiopulmonary resuscitation, and use of an automated external defibrillator are the basic requirements of the chain of survival theory. [ABSTRACT FROM AUTHOR]

In this article we use practice theory to examine kiteboarding as a routinised type of behaviour; a social practice. By 'zooming in' we show how kiteboarding involves the active and performative integration of particular meanings – especially an exhilarating 'sensation of freedom' – materials and competences, which have to be learned in order to become a practitioner. New materials, technological innovations and changed behaviours of practitioners have made the sport more safe, popular and accessible. Furthermore, a constant interplay between producers and consumers contributed to a variation in kiteboarding styles: freeriding, hydro-foiling, waving, freestyle and big air. 'Zooming out' allowed us to examine the relations between kiteboarding and other practices, such as swimming, lifesaving procedures and nature conservation. Whereas lifesaving procedures to a large extent have been integrated in the practice of kiteboarding, the relation with nature conservation still is rather tense. For this reason, we suggest nature conservationists and kiteboarders learn from each other in order to give each other 'some space'. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Medicine & Science of Physical Activity & Sport / Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte is the property of Revista Internacional de Medicina y Ciencias de la Actividad Fisica y del Deporte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article uses the COVID-19 pandemic to demonstrate how our understanding of ethnic inequalities could be improved by greater use of algorithms that infer ethnic heritage from people's names. It starts from two inter-connected propositions: the effectiveness of many public sector programs is hampered by inadequate information on how differently different ethnic groups behave, and anxiety over how to discuss matters to do with race inhibits proper evaluation of methodologies which would address this problem. This article highlights four mindsets which could benefit from challenge: the officially sanctioned categories by which ethnic data are tabulated are too crude to capture the subtler differences which are required for effective communications; while self-identification should continue to drive one-to-one communications, it should not preclude the use of more appropriate methods of recording ethnic heritage when analyzing data for population groups; public servants often fail to recognize the limitations of directional measures such as the Index of Multiple Deprivation as against "natural" classifications such as Mosaic and Acorn; and in their quest for predictive accuracy statisticians often overlook the benefit of the variables they use being "actionable," defining population groups that are easy to reach whether geographically or using one-to-one communications. [ABSTRACT FROM AUTHOR]

Germany has become the first country worldwide to establish a legal regulation for triage. The Federal Constitutional Court has ruled that the German legislature has violated its duty of protection under the Basic Law and must take measures to protect disabled people. The legislature has leeway to fulfill this duty, but fundamental rights must be respected and upheld. The Federal Ministry of Health has adopted a revised draft law that prescribes allocation decisions for doctors based on the criterion of "current and short-term probability of survival." However, critics argue that the protection against discrimination is not sufficiently guaranteed and that the exact definition of the criterion is unclear. The authors of the article argue that a random-based decision would be best suited from the perspective of equality and justice. [Extracted from the article]

Copyright of Humanistic Perspective is the property of Fuat Aydogdu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pharmaceutical drug prices in the United States are at the highest costs yet seen, and it looks like these prices are still continuing to climb. While people in the United States are struggling to pay for necessary medications, the prices of those same medications are drastically lower in other countries. This Article directly analyzes the issue of pharmaceutical pricing in the United States through two specific lifesaving drugs, insulin and epinephrine. Both drugs are prescriptions required to keep some people alive, and both are related to manufacturing companies with questionable, overwhelming control of the markets. While there has been recent movement in both the federal and state governments to address the issue of price, affordability continues to be in question. However, other countries manage to keep the costs of pharmaceutical drugs far below the prices of those in the United States. The United Kingdom, Canada, and Germany each has a different strategy that involves government intervention to keep prices down, using models that focus, respectively, on product price control, reference pricing, and profit control. By implementing aspects of each of these other countries' pricing models, particularly a system for reference pricing and a pharmaceutical review board, the United States can hope to make it affordable to live. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Living-donor lobar lung transplantation (LDLLT) is a life-saving procedure for critically ill patients with various lung diseases, including pulmonary hypertension (PH). However, there are concerns regarding the development of heart failure with pulmonary oedema after LDLLT in which only 1 or 2 lobes are implanted. This study aimed to compare the preoperative conditions and postoperative outcomes of LDLLT with those of cadaveric lung transplantation (CLT) in PH patients. METHODS: Between 2008 and 2021, 34 lung transplants for PH, including 12 LDLLTs (5 single and 7 bilateral) and 22 bilateral CLTs, were performed. Preoperative variables and postoperative outcomes were retrospectively compared between the 2 procedures. RESULTS: Based on the preoperative variables of less ambulatory ability (41.7% vs 100%, P < 0.001), a higher proportion of World Health Organization class 4 (83.3% vs 18.2%, P < 0.001) and higher mean pulmonary artery pressure (74.4 vs 57.3 mmHg, P = 0.040), LDLLT patients were more debilitated than CLT patients. Nevertheless, hospital death was similar between the 2 groups (8.3% vs 9.1%, P > 0.99, respectively). Furthermore, the 5-year overall survival rate was similar between the 2 groups (90.0% vs 76.3%, P = 0.489). CONCLUSIONS: Although LDLLT patients with PH had worse preoperative conditions and received smaller grafts than CLT patients, LDLLT patients demonstrated similar perioperative outcomes and prognoses as CLT patients. LDLLT is a viable treatment option for patients with PH. Lung transplantation (LTx) has been performed as the final option for saving the lives of patients with end-stage pulmonary diseases with satisfactory outcomes, and the number of LTx procedures performed has been gradually increasing [1]. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

External ventricular drain (EVD) insertion is often a lifesaving procedure frequently used in neurosurgical emergencies. It is routinely done at the bedside in the neurocritical care unit or in the emergency room. However, there are infectious and noninfectious complications associated with this procedure. This meta-analysis sought to evaluate the absolute risk associated with EVD hemorrhages, infections, and revisions. The secondary purpose was to identify and characterize risk factors for EVD complications. We searched the MEDLINE (PubMed) database for "external ventricular drain," "external ventricular drain" + "complications" or "Hemorrhage" or "Infection" or "Revision" irrespective of publication year. Estimates from individual studies were combined using a random effects model, and 95% confidence intervals (CIs) were calculated with maximum likelihood specification. To investigate heterogeneity, the t2 and I2 tests were utilized. To evaluate for publication bias, a funnel plot was developed. There were 260 total studies screened from our PubMed literature database search, with 176 studies selected for full-text review, and all of these 176 studies were included in the meta-analysis as they met the inclusion criteria. A total of 132,128 EVD insertions were reported, with a total of 130,609 participants having at least one EVD inserted. The pooled absolute risk (risk difference) and percentage of the total variability due to true heterogeneity (I2) for hemorrhagic complication was 1236/10,203 (risk difference: −0.63; 95% CI: −0.66 to −0.60; I2: 97.8%), infectious complication was 7278/125,909 (risk difference: −0.65; 95% CI: −0.67 to −0.64; I2: 99.7%), and EVD revision was 674/4416 (risk difference: −0.58; 95% CI: −0.65 to −0.51; I2: 98.5%). On funnel plot analysis, we had a variety of symmetrical plots, and asymmetrical plots, suggesting no bias in larger studies, and the lack of positive effects/methodological quality in smaller studies. In conclusion, these findings provide valuable information regarding the safety of one of the most important and most common neurosurgical procedures, EVD insertion. Implementing best-practice standards is recommended in order to reduce EVD-related complications. There is a need for more in-depth research into the independent risk factors associated with these complications, as well as confirmation of these findings by well-structured prospective studies. [ABSTRACT FROM AUTHOR]

The rivastigmine patch is the only existing transdermal delivery system used for the treatment of Alzheimer disease. Among the most common adverse events derived from its use are gastrointestinal events, particularly diarrhea. We report a clinical case of an 81-year-old patient admitted to our hospital under long-standing treatment with rivastigmine transdermal patch who presented with atypical watery diarrhea. Anamnesis showed that the patient presented with a likely infectious gastroenteric event, the diarrheal symptoms of which persisted upon resolution of the event and resolved only upon temporary discontinuation of acetylcholinesterase inhibitors. Failure to rapidly identify the causes of profuse diarrhea in older adults can have lethal consequences. When these symptoms occur, quickly recognizing the causes and providing proper management can be lifesaving. [ABSTRACT FROM AUTHOR]

While Australia sees a high proportion of coastal drownings involving overseas-born beachgoers every year, it should not be forgotten that professional lifeguards and surf lifesavers carry out about 11,000 rescues and 1,800,000 preventative actions every year. Given these figures, lifeguards and surf lifesavers would be assumed to have ways of identifying overseas-born beachgoers who are not familiar with Australian beaches and to take special precautions in relation to them. This study aims to explore the ways by which surf lifesavers are able to identify overseas-born beachgoers who have no or little understanding of Australian beaches, and identify the surf lifesavers??? perceptions as to the effectiveness of currently available public beach safety signage, as well as educational messages communicated by the popular TV show, Bondi Rescue. One-on-one in-depth interviews were carried out with 20 lifesavers from three popular Australian tourist beaches???Bondi and Tamarama beaches in Sydney, and Glenelg beach in Adelaide. The semistructured interviews were conducted using a fixed list of questions, and a code analysis was conducted employing the program NVivo 12 (version 12.70). Based on the interview data, surf lifesavers identified a number of characteristics that suggested a lack of familiarity with Australian beaches and differentiated overseas-born beachgoers from regular beachgoers, including wearing jeans near water, particular ways of approaching the water, and the use of inflatable toys. More than half of the lifesavers said that in general beachgoers were more likely to swim outside the flags, but some said that beachgoers stay between the flags because professional lifeguards and surf lifesavers enforce this regulation. Many lifesavers cast doubts on the effectiveness of public signage, and a majority singled out the popular TV show Bondi Rescue as a powerful tool for revealing the real dangers of Australian beaches. One interview, however, warned that Bondi Rescue might lead to the misunderstanding that ???all??? Australian beaches are patrolled and, therefore, ???safe.??? It is important to address safety issues such as the fact that wearing heavy clothing and using inflatable toys can cause problems on Australian beaches with dangerous waves and rip currents. Effective ways of delivering safety messages to the public, especially to overseas-born beachgoers, still need to be developed. [ABSTRACT FROM AUTHOR]

The ingestion of button batteries (BB) by children has become more common, and this can cause oesophageal injury, perforation and even life-threatening haemorrhage. A 1-year-old infant who presented to the emergency room with loss of appetite and vomiting, and was discharged with suspected gastro-enteritis is described. One week later she returned with haematemesis. Chest radiography detected a BB in the stomach and it was removed operatively. Haematemesis and hypovolaemic shock ensued and, while waiting for the paediatric cardiothoracic team, the profuse oesophageal bleeding was controlled using an adult-size Sengstaken—Blakemore tube (SBT). An aorto-oesophageal fistula at the aortic arch was identified and repaired. This case highlights the importance of suspecting ingestion of BB, and performing a chest radiography in children who present with swallowing difficulties, haematemesis and haemodynamic instability. The adult-size SBT was well tolerated by the child and was lifesaving in controlling the bleeding from the aorta. AEF: aorto-oesophageal fistula; BB: button battery; CTA: computed tomography angiography; ER: emergency room; GI: gastro-intestinal; SBT: Sengstaken–Blakemore tube [ABSTRACT FROM AUTHOR]

The emergency department of hospitals receives a massive number of patients with wrist fracture. For the clinical diagnosis of a suspected fracture, X-ray imaging is the major screening tool. A wrist fracture is a significant global health concern for children, adolescents, and the elderly. A missed diagnosis of wrist fracture on medical imaging can have significant consequences for patients, resulting in delayed treatment and poor functional recovery. Therefore, an intelligent method is needed in the medical department to precisely diagnose wrist fracture via an automated diagnosing tool by considering it a second option for doctors. In this research, a fused model of the deep learning method, a convolutional neural network (CNN), and long short-term memory (LSTM) is proposed to detect wrist fractures from X-ray images. It gives a second option to doctors to diagnose wrist facture using the computer vision method to lessen the number of missed fractures. The dataset acquired from Mendeley comprises 192 wrist X-ray images. In this framework, image pre-processing is applied, then the data augmentation approach is used to solve the class imbalance problem by generating rotated oversamples of images for minority classes during the training process, and pre-processed images and augmented normalized images are fed into a 28-layer dilated CNN (DCNN) to extract deep valuable features. Deep features are then fed to the proposed LSTM network to distinguish wrist fractures from normal ones. The experimental results of the DCNN-LSTM with and without augmentation is compared with other deep learning models. The proposed work is also compared to existing algorithms in terms of accuracy, sensitivity, specificity, precision, the F1-score, and kappa. The results show that the DCNN-LSTM fusion achieves higher accuracy and has high potential for medical applications to use as a second option. [ABSTRACT FROM AUTHOR]

Signed into law in 2016, the 21st Century Cures Act offers new hope to patients by empowering the FDA to expedite review of innovative, potentially lifesaving drugs. But these expedited approvals raise the risk that pivotal drug safety and efficacy data will not arise until after the drug is already on the market. The Cures Act failed to respond to two key aspects of shifting the discovery of safety and efficacy data to the postmarket phase. First, the Cures Act did not correspondingly enhance the FDA's authority to require manufacturers to generate and disclose postmarket information. Second, it did not guard against the potential rise in postmarket failure-to-warn liability for manufacturers, which could discourage them from investing in the development of lifesaving drugs. As interpreted by the Supreme Court, the FDA's current brand-name labeling rules exacerbate these two issues by discouraging meaningful postmarket disclosures to the FDA and enabling costly failure-to-warn suits against manufacturers. This Note discusses these two postmarket issues and proposes new drug labeling rules that would minimize their impact while maintaining the Cures Act's efforts to promote patient access to potentially lifesaving treatments. [ABSTRACT FROM AUTHOR]

Surf lifesaving in Australia is an iconic community volunteer service. Surf lifesaving members must attain their bronze medallion, which includes fundamental first aid and cardiopulmonary resuscitation (CPR) techniques in order to patrol the beaches. Each year thousands of rescues and first aid procedures are conducted on the beaches of Australia as volunteer patrolling surf lifesavers carry out their community service. However, there is a sport attached to this community service, which has arguably become the 'face' of surf lifesaving in Australia. Some athletes are professional, and others gain a range of sponsorships. Many others are juniors and Masters competitors. The national championships each year draw anywhere between 5000 and 8000 competitors and spectators. Not without its critics, the masculinised nature of surf lifesaving has come under scrutiny in the past (Booth, 2001). Significantly, this is a paper about young males and the way in which masculinity is socially constructed within both a sporting and broader social and cultural context. It is also a paper that challenges the way in which the male body is endorsed, perceived, and used in a utilitarian manner from boyhood through to early male adulthood, across a range of settings thereby creating a normalised conception of the male body throughout life. Using surf lifesaving as vehicle through which young males can be explored, it identifies the role of sport in the creation of this normalisation and specifically highlights, through an autoethnographic account, the expectation placed on young males within the masculinised sporting setting of surf lifesaving in Australia. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of First Aid Education is the property of International Journal of First Aid Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study was designed to validate an incremental test predicting maximum oxygen uptake for lifeguards. A maximum incremental test was performed in the laboratory (i.e., treadmill run) and in the pool (i.e., swim) by 10 certified lifeguards. The values of maximum oxygen uptake (VO2Max), maximum heart rate (HRMax), and lactate (LaMax) achieved during both tests were analyzed. The VO2Max (0.87, p =.001), HRmax (0.85, p = .002) and LaMax (0.67, p <.05) values showed significant correlations between the laboratory tests and the pool tests. These results showed that the Incremental Pool Test for Lifeguards (IPTL) was valid (i.e., concurrent validity) for obtaining the maximum oxygen uptake of a rescuer. Using this swim test, lifeguards and their supervisors will be able to individualize their training in order to improve their performance in a water rescue and perhaps reduce the numbers of fatal drownings. [ABSTRACT FROM AUTHOR]

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.

The article discusses the issue of health inequities in accessing life-saving transplant procedures in India. While transplant facilities are available in some corporate hospitals, they are primarily focused on adult transplants. The high cost of transplants, including recurring expenses for medications and follow-up care, is a major barrier. The government has implemented some programs to address this issue, but they have not completely bridged the gap. Crowdfunding and social media have emerged as popular resources for funding transplants. The article emphasizes the need for collective efforts to improve access to life-saving transplants, advocate for inclusive healthcare policies, and ensure that no child is denied a chance at a healthy future due to financial or logistical barriers. The article also briefly mentions the prevalence and risks of viral hepatitis in children and the importance of other transplants such as renal and hematopoietic stem cell transplants. The hurdles in pediatric transplant in India include a lack of donors and registries, experienced physicians and transplant teams, and infrastructure. [Extracted from the article]

During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions--governance, securing finance, capacity-building, and production and use of research--and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges. We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries. [ABSTRACT FROM AUTHOR]

Bariatric surgery (BS) has been shown to effectively treat morbid obesity and improve obesity-related comorbidities. Nonetheless, BS remains underutilized among qualified patients. PubMed, SCOPUS, and OVID databases were searched to identify published comparative studies examining BS referral patterns. Data on barriers to BS referrals were examined and summarized. Barriers to referrals stemmed largely from a lack of familiarity with safety, efficacy, and postoperative care amongst providers. Providers with previous referrals were more likely to report higher knowledge, comfort in referring patients, and ability to provide postoperative care. Provider initiated discussion of BS was positively associated with referrals. Female and younger patients were more likely to receive referrals. Furthermore, access to appropriate peri-operative resources, local bariatric programs, and insurance eligibility were associated with referral rates. Encouragingly, providers across specialties report eagerness to gain exposure and training in BS. Lack of provider familiarity with BS efficacy, safety and postoperative care likely contributes to low utilization rates of BS. Further potential barriers in access to BS are logistic factors such as insurance coverage, limited local perioperative resources, and clinic time constraints for patient counseling. Promotion of BS amongst providers and both surgical and non-surgical trainees will likely have a significant impact on referral rates and access to this life-saving procedure. Future studies should further investigate the barriers to BS and delineate the effect size of each barrier on referral rates to efficiently increase access. • Provider familiarity with bariatric surgery (BS) is associated with referrals. • Provider perception of BS safety and efficacy is inconsistent with the literature. • Provider initiated discussion of surgery is associated with increased referrals. • Paperless referrals and billing for counseling may increase referral rates. • Providers across specialties are eager to learn more about bariatric patient care. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyze perioperative complications and postoperative mortality in patients of acute Stanford type A aortic dissection(ATAAD)combined with cardiac tamponade (TMP). In this study, we identified a total of 242 ATAAD patients who underwent surgery from January 2016 to December 2020. Of the 242 patients, 44(18.2%) patients were combined with TMP and 198(81.8%) patients without TMP. We compared perioperative complications and postoperative mortality between the two groups. The postoperative mortality was significantly higher in patients with TMP (29.5% vs 14.1%, p = 0.014). The incidence of postoperative acute kidney injury (75.0% vs 51.5%, p = 0.005), acute hepatic injury (45.5% vs 20.7%, p = 0.001), cerebral infarction (27.3% vs 13.1%, p = 0.020), low cardiac output syndrome (50.0% vs 33.3%, p = 0.038) and respiratory failure (36.4% vs 22.2%, p = 0.049) in patients with TMP was significantly higher than those without TMP. Binary logistic regression analysis showed that age [odds ratio(OR) 1.063, 95% confidence interval (CI) 1.023∼1.105; p = 0.002], surgical time[odds ratio(OR)1.393, 95% confidence interval (CI) 1.006∼1.929; p = 0.046], cardiac tamponade[odds ratio(OR)3.010, 95% confidence interval (CI) 1.166∼7.767; p = 0.023], circulatory arrest time[odds ratio(OR)1.044, 95% confidence interval (CI) 1.001∼1.088; p = 0.045] were independent risk factors for postoperative mortality in ATAAD patients. Cardiac tamponade increases the difficulty of perioperative management in ATAAD patients, the incidence of postoperative complications and postoperative mortality, which requires the cooperation of anesthesiologists, intensivists and surgeons to save and improve patients' lives. [ABSTRACT FROM AUTHOR]

Introduction: A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. Material and methods: Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. Results: The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). Conclusions: The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications. [ABSTRACT FROM AUTHOR]

Liver transplantation (LTX) has been described as a rescue treatment option in severe, intractable post-hepatectomy liver failure (PHLF), but is not considered to be indicated for this condition by many hepatobiliary and transplant surgeons. In this article we describe the clinical experience of five northern European tertiary centers in using LTX to treat selected patients with severe PHLF. All patients subjected to LTX due to PHLF at the participating centers were identified from prospective clinical databases. Preoperative variables, surgical outcome (both resection surgery and LTX) and follow-up data were assessed. A total of 10 patients treated with LTX due to severe PHLF from September 2008 to May 2020 were identified and included in the study. All patients but one were male and the median age was 70 years (range 49–72). In all patients the indication for liver resection was suspected malignancy, but in six patients post-resection pathology revealed benign or pre-malignant disease. There was no 90-day mortality after LTX. Patients were followed for a median of 49 months (13–153) and eight patients were alive without recurrence at last follow-up. In selected patients with PHLF LTX can be a life-saving procedure with low short-term risk. [ABSTRACT FROM AUTHOR]

Objectives: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients.Methods: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed.Results: A total of 363 patients with mean age of 65.7 ± 13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n = 99), LCCA (n = 25), B-CCA (n = 52), CCA (n = 131), IA (n = 19), and LSA (n = 8). Time from onset of neurological symptoms to surgery was 13.3 h. Antegrade and/or retrograde cerebral perfusion were applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients.Conclusion: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy. Methods: Thirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed. Results: All 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55-85.15; p=0.017). Conclusion: Decompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy. [ABSTRACT FROM AUTHOR]

Two months of post‐transplant survival were achieved in an end‐stage heart disease patient with a porcine heart from a pig whose genome had been modified in 10 of its genes. This first‐ever life‐saving cardiac xenotransplantation was the result of decades of work and close coordination by researchers in genetic engineering, animal cloning, immunology, ex vivo organ perfusion, and thoracic surgery. [ABSTRACT FROM AUTHOR]

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term clinical outcomes of children with rheumatic heart disease (RHD) in Uganda, and determine characteristics that predict adverse outcomes.Methods: This retrospective cohort study evaluated the risk of death in Ugandan children with clinical RHD from 2010 to 2018; enrolling children aged 5-18 years old from an existing registry. Demographic data and clinical data (baseline complications, RHD severity, cardiac interventions) were collected. The primary outcome was survival. Univariable and multivariable hazard ratios (HR) were obtained from Cox proportional hazards regression. Survival probabilities were developed using Kaplan-Meier curves; log-rank tests compared survival based on cardiac interventions, disease severity and time of enrolment.Results: 612 cases met inclusion criteria; median age 12.8 years (IQR 5.3), 37% were male. Thirty-one per cent (187 of 612) died during the study period; median time to death 7.8 months (IQR 18.3). In univariable analysis, older age (HR 1.26, 95% CI=1.0 to 1.58), presence of baseline complications (HR 2.06, 95% CI=1.53 to 2.78) and severe RHD (HR 5.21, 95% CI=2.15 to 12.65) were associated with mortality. Cardiac intervention was associated with a lower risk of mortality (HR 0.06, 95% CI=0.02 to 0.24). In multivariable models, baseline complications (HR 1.78, 95% CI=1.31 to 2.41), severe RHD (HR 4.58, 95% CI=1.87 to 11.23) and having an intervention (HR 0.05, 95% CI=0.01 to 0.21) remained statistically significant. Kaplan-Meier survival curves demonstrated >25% mortality in the first 30 months, with significant differences in mortality based on intervention status and severity of disease.Conclusions: The mortality rate of children with clinical RHD in Uganda exceeds 30%, over an 8-year time frame, despite in-country access to cardiac interventions. Children at highest risk were those with cardiac complications at baseline and severe RHD. [ABSTRACT FROM AUTHOR]

Background: Acute gastrointestinal bleeding is a potentially life-threatening condition that requires rapid intervention. In critically ill patients who are refractory to other therapies, balloon tamponade devices can be lifesaving.Objective: We provide a review of balloon tamponade devices for gastric and esophageal variceal bleeding for emergency clinicians.Discussion: Balloon tamponade is intended for hemodynamically unstable patients with massive gastrointestinal bleeding and inability to perform endoscopy, failed endoscopy, delay in endoscopy, or the need to stabilize before transfer. There are 3 main tamponade devices: the Linton-Nachlas tube, the Sengstaken-Blakemore tube, and the Minnesota tube. Each tamponade device has some unique features including the number of balloons and ports. We describe the technique with pearls and pitfalls for placement.Conclusions: It is essential for emergency physicians to be familiar with balloon tamponade for acute gastrointestinal bleeding. We review the common balloon tamponade devices, and this article is intended to serve as a resource for those interested in expanding their knowledge of balloon tamponade. © 2022 Elsevier Inc. [ABSTRACT FROM AUTHOR]