Locating ground zero: How the brain's emergency workers find the disaster area

Gardening in the Brain: Cells Called Microglia Prune the Connections Between Neurons, Shaping How the Brain Is Wired (July 21, 2011) — Gardeners know that some trees require regular pruning: some of their branches have to be cut so that others can grow stronger. The same is true of the developing brain: cells called microglia prune ...  > read moreOrigin of Immune Cells in the Brain Discovered: Could Lead to New Treatments for Degenerative Brain Diseases, Autoimmune Disorders (Oct. 22, 2010) — Researchers have discovered that microglia, the immune cells that reside in the brain, have a unique origin and are formed shortly after conception. It was previously thought that microglia ...  > read moreHow Do Microglia Examine Damaged Synapses? (Mar. 31, 2009) — Microglia, immune cells in the brain, are suggested to be involved in the repair of damaged brain. However, it is unknown how microglia diagnose damaged circuits in an in vivo brain. Now a Japanese ...  > read moreBrain Cells 'Supercharged' To Attack Plaques That Cause Alzheimer’s Disease (Aug. 25, 2008) — Researchers at the University of British Columbia have discovered a new method for developing treatments for Alzheimer's Disease (AD). They have shown that by stimulating a brain cell called a ...  > read moreSearch ScienceDailyNumber of stories in archives: 118,885Find with keyword(s):  Enter a keyword or phrase to search ScienceDaily's archives for related news topics,
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Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department?

friends or family’.

Conclusions Although there appears to be considerable potential for minor conditions to be managed in settings other than the ED, our findings indicate that patients will continue to present these conditions to the ED. Patient perceptions of the urgency of their treatment need, and also the availability and capacity of alternative services may be offsetting their potential to substitute for the ED. Advice from other services may be contributing to demands on the ED.

Emergency services utilisation patients health beliefs help seeking behaviour minor health conditions appropriateness emergency care systems intermediate care emergency departments Footnotes Competing interests None.

Ethics approval This study was conducted with the approval of the Doncaster NHS ethics committee.

Provenance and peer review Not commissioned; externally peer reviewed.

An integrated care pathway improves the management of paracetamol poisoning

0.0002); and acetylcysteine correctly prescribed (44/58 (76%) vs 71/71 (100%), p<0.0001).

Conclusions Implementation of an ICP for paracetamol poisoning significantly improved patient management and helped to standardise inter-professional decision making in this challenging patient group. This is likely to improve patient outcome.

Paracetamol overdose integrated care pathway acetylcysteine mental health overdose poisoning toxicology Footnotes Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

Emergency department crowding: towards an agenda for evidence-based intervention

crowding OR overcrowding’ and backward citation retrieval was undertaken. To help identify systematic review evidence of effective interventions, the Cochrane Database, the National Institute of Health and Clinical Excellence (NICE) and NHS Evidence were searched. A Google search was included to identify relevant grey literature.

Eligibility criteria Papers were included if they added to substantive knowledge of ED crowding. Empirical studies, studies from the UK and studies of physical space were privileged in the review.

Results There is an established international literature on ED crowding. It suggests consistently that crowding has significant negative consequences. However, the literature offers limited practical help to practitioners for a number of reasons, such as a lack of shared definition and measurement of crowding and lack of evaluation of interventions. Many studies are single case studies from the USA.

Conclusions While current evidence is poor, this does not justify maintaining current practice which risks lives. Building up an evidence base is critical, but requires agreed definitions, measures and methods, which can be applied to systematic evaluation of plausible solutions.

Emergency care systems emergency departments emergency care systems effieciency Footnotes Funding The review derives from work undertaken at the Engineering Design Centre funded by the UK Engineering and Physical Sciences Research Council (EPSRC), grant reference EP/E001777/1. The views or opinions presented expressed in this paper are those of the authors and do not necessarily represent those of EPSRC, its associates or its sponsors. The role of the EPSRC was to provide funding for ZSM's post-doctoral position and partial funding for KB's PhD training.

Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

Hyperuricemic Renal Failure in Nonhematologic Solid Tumors: A Case Report and Review of the Literature

, proposed in 2004, provided both clinical and laboratory diagnostic and grading criteria for TLS as per below:(i)laboratory TLS is defined as either a 25% change or level above or below normal for any two or more serum values of uric acid, potassium, phosphate, and calcium within 3 days before or 7 days after the initiation of chemotherapy in the setting of adequate hydration and without use of any uricosuric agent;(ii)clinical TLS is defined as laboratory TLS plus one or more of the following that was not directly attributed to a therapeutic agent: increased serum creatinine (≥1.5 times the upper limit of the normal, cardiac arrhythmia/sudden death, or a seizure);

TLS most often occurs after the initiation of cytotoxic therapy in patients with high-grade lymphomas (particularly the Burkitt subtype) and acute lymphoblastic leukemia. TLS has been rarely described after treatment of nonhematologic solid tumors including breast cancer, germ cell tumors

In Summer, Fungi Emergencies Mushroom (with video)

Videos  EmailPrintSave In Summer, Fungi Emergencies MushroomBy Kristina Fiore, Staff Writer, MedPage Today

Published: May 27, 2012

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As Memorial Day ushers in the warm, humid days of summer, emergency department staff have to keep a watchful eye out for seemingly simple gastroenteritis cases that may actually be a much more harmful condition -- mushroom toxicity.

Although rare, mushroom toxicity can lead to liver failure or death if not treated appropriately, and it may be cropping up in areas where it's least expected, researchers say.

Last summer, for instance, four patients in the Washington, D.C. area were treated for mushroom poisoning over a 2-week period at MedStar Georgetown University Hospital (MGUH), Maiyen Tran Hawkins, DO, and colleagues reported at Digestive Disease Week in San Diego last week.

"Patients typically present with diarrhea, abdominal pain, nausea, maybe vomiting, and it sounds a lot like viral gastroenteritis," Tran Hawkins told MedPage Today. "They go to the ER, and initially their blood work might be normal or maybe they just look a little dehydrated, so they get sent home."

But after a brief period of what seems to be recovery, patients can fall into severe liver failure, she said.

"They come back

Syria: parties to the fighting must distinguish between civilians and fighters

The International Committee of the Red Cross (ICRC) is shocked by the high number of civilian casualties caused by the tragic events in al-Holeh, in Homs governorate. It conveys its deepest sympathy with the families of the victims.

"We urge the parties to the fighting to distinguish at all times between civilians and those participating in the hostilities," said Marianne Gasser, the head of the ICRC delegation in Syria. "Especially when fighting in populated areas, the parties must constantly take care in their choice of means and method of warfare to spare civilians the effect of the hostilities. "

The ICRC remains extremely concerned about the humanitarian situation in Syria. It is calling for the civilian population to be allowed to move to safer areas should they fear for their safety. Injured people must have access to medical care without delay.

In cooperation with the Syrian Arab Red Crescent, the ICRC is providing emergency relief throughout Syria. Since the beginning of the year it has brought aid to over 300,000 displaced people and others affected by the violence in the country.

 

For further information, please contact:
Rabab Al-Rifaï, ICRC Damascus, tel:

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Low Vitamin D in diet increases stroke risk in Japanese-Americans

May 24, 2012 Study Highlights:Japanese-American men who did not eat foods rich in vitamin D had higher stroke risk.Foods rich in vitamin D are important because synthesizing vitamin D from the sun gets harder as we age.EMBARGOED UNTIL 3 pm CT/4 pm ET, Thursday, May 24, 2012DALLAS, May 24, 2012 – Japanese-American men who did not eat foods rich in vitamin D had a higher risk of stroke later in life, according to results of a 34-year study reported in Stroke, an American Heart Association journal. “Our study confirms that eating foods rich in vitamin D might be beneficial for stroke prevention,” said Gotaro Kojima, M.D., lead author of the study and geriatric medicine fellow at the John A. Burns School of Medicine at the University of Hawaii in Honolulu. Vitamin D is an essential nutrient that helps prevent rickets in children and severe bone loss in adults, and researchers believe it has the potential to lower the risk of a host of diseases including cancer and diabetes. Sunlight is generally the greatest source, but synthesizing vitamin D from the sun gets more difficult as we age, Kojima said, so older people are advised to eat more foods rich in vitamin D or take supplements. Good sources include fortified milk and breakfast cereals, fatty fish and egg yolks. Study participants included 7,385 Japanese-American men living on Oahu, Hawaii. All were participants of the Kuakini Honolulu Heart Program, a study of stroke and coronary heart disease in Japanese-American men that began in 1965 which was conducted at the Kuakini Medical Center. Participants were 45 to 68 years old in the mid- to late-1960s when they were first examined and interviewed about what they had eaten in the previous 24 hours. Food models and serving utensils were used to help participants determine their portions accurately. Researchers separated the participants into four groups of approximately 1,845 each depending on how much vitamin D they had consumed. They then analyzed their records through 1999, roughly 34 years after the initial exams, to determine the incidence of stroke. New strokes occurred in 960 men during the follow up period. Researchers calculated risk while adjusting for age, total calorie intake, body-mass index, hypertension, diabetes, cigarette smoking, physical activity, cholesterol levels and alcohol intake. Men who consumed the least dietary vitamin D had a 22 percent higher risk of stroke and a 27 percent increase risk of ischemic (blood-clot related) stroke compared to those consuming the highest levels of vitamin D. There was no difference for hemorrhagic stroke. Stroke ranks fourth among the leading causes of death in the United States. New or recurrent strokes strike about 795,000 Americans annually. Ischemic strokes account for 87 percent of all strokes, and 10 percent are from an intracranial hemorrhage (bleeding in the brain). The remaining 3 percent result from bleeding in the subarachnoid space between the brain and the tissues covering it. Kojima said it is unclear whether the study results could be applied to different ethnic groups or to women. While previous studies focused on blood concentrations of vitamin D, this investigation used dietary intake. Co-authors are Christina Bell, M.D.; Robert D. Abbott, Ph.D.; Lenore J. Launer, Ph.D.; Randi Chen, M.S.; Heather Motonaga, M.D.; G. Webster Ross, M.D.; J. David Curb, M.D.; and Kamal Masaki, M.D. Author disclosures are on the manuscript. The National Heart, Lung, and Blood Institute and the National Institute on Aging funded the study. The American Heart Association offers information on Diet and Lifestyle Recommendations. For information on stroke visit strokeassociation.org. ###Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12– 1079 (Stroke/Kojima) Additional resources, including multimedia, are availabe on the right column of this link:http://newsroom.heart.org/pr/aha/_prv-low-vitamin-d-in-diet-increases-234233.aspx For media inquiries: (214) 706-1173Karen Astle: (214) 706-1392; Karen.Astle

Sudden cardiac death higher in men with slower electrical impulses through heart

May 21, 2012 Study Highlights: Men whose electrical impulses take a few milliseconds longer to travel through the lower chambers of the heart had an increased risk of sudden cardiac death.On an electrocardiogram, the delay is shown on the QRS complex.The longer the QRS duration, the higher the sudden cardiac death risk.EMBARGOED UNTIL 3 pm CT/4 pm ET, Monday, May 21, 2012DALLAS, May 21, 2012 — Men whose electrical impulses take a few milliseconds longer to travel through the lower chambers of the heart have an increased risk for sudden cardiac death (SCD), according to research reported in Circulation, an American Heart Association journal. An electrocardiogram (ECG) measures electrical impulses, or waves, that travel through the heart and cause it to pump blood through its four chambers. The waves have distinct patterns and are labeled on the ECG printout alphabetically from P to T. The electrical waves traveling through the lower chambers (ventricles) are shown on the ECG as the “QRS complex.” “Our results suggest that prolonged QRS duration is a potentially important predictor of sudden cardiac death,” said Sudhir Kurl, M.D., lead author of the study and a research physician at the University of Eastern Finland in Kuopio. “It will be clinically important to find even more specific risk markers for sudden cardiac death in the general population.” In this study, researchers defined sudden cardiac death as death within an hour after symptoms start or change abruptly, or within 24 hours if there’s no other non-cardiac cause of sudden death. However, they say there isn’t an easy, inexpensive way to screen a lot of people for risk factors that could predict SCD. “An essential part of our study is to bring the results to healthcare professionals — including those in preventive medicine — to make them aware that the simple, cheap and widely available ECG may have practical use in SCD risk stratification,” Kurl said. In the prospective study, researchers recruited 2,049 Finnish men, ages 42 to 60, between March 1984 and December 1989 and tracked them for 19 years. They evaluated their ECG records, heart risk factors, heart disease they developed during the study, whether they died, and the cause of death. They then divided the men into five groups according to their QRS durations. Among the men, 156 died from SCD. The study’s significant results included:The risk of SCD rose 27 percent for every 10 milliseconds (ms) increase in the QRS duration.The larger the QRS increase, the greater the SCD risk.Men with QRS duration longer than 110 ms had 150 percent (or 2.5-fold) higher SCD risk than those with QRS of less than 96 ms, after researchers accounted for such factors as age, a previous heart attack, blood pressure, type 2 diabetes and fitness level.Total deaths from any cause numbered 557. The 156 SCDs were compared with 185 non-sudden deaths from coronary heart disease, a narrowing of the arteries that supply blood to the heart.QRS duration posed a higher risk of SCD than cigarette smoking, poor physical fitness, high systolic blood pressure, body mass index and C-reactive protein.Only a prior heart attack and type 2 diabetes increased risk of SCD more than QRS duration.“Our study shows that QRS duration is one of the strongest risk factors for sudden cardiac death, although left ventricular function was taken into account,” Kurl said. “We believe resting ECG should be used to help assess the risk of sudden cardiac death in particular patients.” People most likely to benefit from such testing include those with known cardiovascular disease, cardiovascular risk factors and symptoms, and those who are inactive and plan to begin exercising, researchers said. The study findings apply to women and men, other nationalities, and ethnic and racial groups throughout the world, Kurl said. “There might be small differences between the different groups. Further studies are needed to confirm this.” For example, additional studies in women would be particularly important, because there are no similar findings among women. Sorting out differences among the groups may also help researchers know how reliable the risk factors are, Kurl said. Co-authors are Timo H. Mäkikallio, M.D, Ph.D.; Pentti Rautaharju, M.D., Ph.D.; Vesa Kiviniemi, LicPhil.; and Jari A. Laukkanen, M.D., Ph.D. Author disclosures are on the manuscript. The Finnish Academy and Finnish Medical Foundation funded the study. Read American Heart Association/American College of Cardiology guidelines for assessing risk in asymptomatic adults. ### Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position.  The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12 – 1081 (Circ/Kurl) Additional resources, including multimedia, are availabe in the right column. For media inquiries: (214) 706-1173For other information, contact:Tagni McRae: (214) 706-1383; Tagni.McRae

Hunter-gatherers and horticulturalist lifestyle linked to lower blood pressure increases, atherosclerosis risks

May 21, 2012 Study Highlights:Traditional “hunter-gatherer” and “horticulturalist” populations have significantly lower age-related increases in blood pressure and less risks of atherosclerosis than “modernized” populations.Lifestyle factors of these traditional populations — high physical activity and high fruit and vegetable diets — may protect against normal aging phenomena, high blood pressure and hardening of the arteries.EMBARGOED UNTIL 3 pm CT/4 pm ET, Monday, May 21, 2012DALLAS, May 21, 2012 — Hunter-gatherers and forager-horticulturalists who live off the land and grow what they need to survive have lower age-related increases in blood pressure and less risks of atherosclerosis, according to two new studies in the American Heart Association journal Hypertension. High blood pressure and atherosclerosis — a disease in which arteries stiffen and fill with plaque — increase with age in the United States and other countries, raising risks for heart attack, stroke, kidney disease and death. Age-related increases in blood pressure have been observed in almost every population, except among hunters-gatherers, farmers and pastoralists. “Surprisingly, heart disease and stroke aren’t necessarily inevitable with age,” said Michael Gurven, Ph.D., study author and anthropology professor and chairman of the University of California-Santa Barbara’s Integrative Anthropological Sciences Unit. Gurven’s team followed 2,296 indigenous adults in 82 Tsimane villages, an area in the tropical lowlands of Bolivia’s Amazon basin. Tsimane are lowland forager-horticulturalists (pop.

Haiti: new centre for disabled rekindles hope

The Special Fund for the Disabled of the International Committee of the Red Cross (ICRC) officially inaugurated a new physical rehabilitation centre in Port-au-Prince today. The facility opened its doors following a year of rebuilding and repair work on the previous structure, which was destroyed by the earthquake of 12 January 2010.

According to government figures, one of every 10 Haitians lives with a physical disability. The new centre, which will be run by Healing Hands for Haiti, a non-governmental organization, will be able to treat approximately 1,000 patients a year, for whom it will provide prosthetic and lightweight orthotic devices, walking aids and physical therapy services. In addition, the centre has a state-of-the-art workshop.

"It was urgent to reopen the centre in an earthquake-resistant structure," said François Blaise, a prosthetist-orthotist with the Special Fund for the Disabled, who is in charge of the project. "The work can now be performed in better conditions, and quality services can be provided for the many patients."

"Few other places in Haiti offer services that can meet so many needs. Disabled people need follow-up services along with good care throughout their lives," said Mr Blaise. "Access to physical rehabilitation services can enable them to recover a certain degree of independence and resume normal lives."

Over the next five years, the ICRC's Special Fund for the Disabled will maintain its support for the centre's production of artificial limbs and other devices suited to patients' needs, and for its training of staff. "This centre is currently the biggest project of the Special Fund for the Disabled," said Mr Blaise. "With over 1,300 square metres of floor space, it is bigger than the previous centre. The reconstruction work lasted over a year."

The centre was rebuilt and equipped thanks to financial support from the American Red Cross, the Australian Red Cross and the Norwegian Red Cross.

Healing Hands for Haiti, founded in 1999, endeavours to provide physical rehabilitation and medical services with the aim of eventually turning them over to Haitian management.

The Special Fund for the Disabled was set up by the ICRC in 1983. It supports physical rehabilitation services in more than 30 countries by providing supplies and training that enable local professionals to produce prostheses and other mobility devices using low-cost technology.

For further information, please contact:
Jean Jacob Charles, ICRC Port-au-Prince, tel:

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Improving Teamwork and Communication in Trauma Care Through In Situ Simulations

 0.92). Nonparametric procedures (Kruskal‐Wallis) were used to test the hypothesis that the scores observed during the various phases were different and to compare each individual phase to baseline scores.

Results:  The ISTS program was implemented and achieved regular participation of all components of our trauma team. Data were collected on 39 cases. The scores for 11 of 14 measures improved from the baseline to the didactic phase, and the mean and median scores of all CTS component measures were greatest during the ISTS phase. When each phase was compared to baseline scores, using the baseline as a control, there were no significant differences seen during the didactic or the decay phases, but 12 of the 14 measures showed significant improvements from the baseline to the simulation phase. However, when the Kruskal‐Wallis test was used to test for differences across all phases, only overall communication showed a significant difference. During the potential decay phase, the scores for every measure returned to baseline phase values.

Conclusions:  This study shows that an ISTS program can be implemented with participation from all members of a multidisciplinary trauma team in the ED of a Level I trauma center. While teamwork and communication in the clinical setting were improved during the ISTS program, this effect was not sustained after ISTS were stopped.

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National Study of Antibiotic Use in Emergency Department Visits for Pneumonia, 1993 Through 2008

 0.055). Overall, 66% of adult patients with a primary diagnosis of pneumonia had documentation of an antibiotic administered while in the ED. There was an increase in antibiotic administration for adults with pneumonia from 1993 through 2008 (49% to 80%; p trend < 0.001). Specifically, there was an increase in use of macrolides from 1993 to 2006 (20% to 30%, p trend < 0.001) and a marked increase in use of quinolones from 0% to 39% from 1993 through 2008 (p trend < 0.001). Penicillin and cephalosporin use remained stable. Use of an antibiotic consistent with 2007 IDSA/ATS guidelines increased from 22% (95% confidence interval

Effect of Testing and Treatment on Emergency Department Length of Stay Using a National Database

) and treatment (providing a medication or performance of a procedure) according to disposition (discharged or admitted status). Two sets of multivariable models were developed to assess the contribution of testing and treatment to LOS, also stratified by disposition. The first was a series of logistic regression models to provide an overview of how testing and treatment activity affects three dichotomized LOS cutoffs at 2, 4, and 6 hours. The second was a generalized linear model (GLM) with a log‐link function and gamma distribution to fit skewed LOS data, which provided time costs associated with tests and treatment.

Results:  Among 360 million weighted ED visits included in this analysis, 227 million (63%) involved testing, 304 million (85%) involved treatment, and 201 million (56%) involved both. Overall, visits with any testing were associated with longer LOS (median 

Combination of Copeptin and Troponin Assays to Rapidly Rule Out Non‐ST Elevation Myocardial Infarction in the Emergency Department

Academic Emergency MedicineVolume 19, Issue 5, pages 517–524, May 2012

Additional Information

How to CiteCharpentier, S., Maupas‐Schwalm, F., Cournot, M., Elbaz, M., Botella, J. M. and Lauque, D. (2012), Combination of Copeptin and Troponin Assays to Rapidly Rule Out Non‐ST Elevation Myocardial Infarction in the Emergency Department. Academic Emergency Medicine, 19: 517–524. doi: 10.1111/j.1553-2712.2012.01350.x

Author Information

From the Emergency Department, Purpan University Hospital (SC, DL), Toulouse, France; Team5 INSERM 1027 Toulouse University (SC), Toulouse, France; the Department of Biochemistry and Team 10 u858 I2MR IFR31, Rangueil University Hospital (FMS, JMB), Toulouse, France; Université Toulouse III–Paul Sabatier (FMS, ME, DL), Toulouse, France; the Department of Epidemiology, Val d’Ariège Hospital (MC), Foix, France; and the Department of Cardiology, Rangueil University Hospital (ME), Toulouse, France.

Ureteric stent placement with extraction string: no strings attached?

uiowa.edu

Publication HistoryArticle first published online: 11 MAY 2012Accepted for publication 29 February 2012 SEARCH Search Scope All contentPublication titlesIn this journalIn this issue Search String Advanced >Saved Searches > SEARCH BY CITATION Volume: Issue: Page: ARTICLE TOOLSGet PDF (170K)Save to My ProfileE-mail Link to this ArticleExport Citation for this ArticleGet Citation AlertsRequest Permissions AbstractArticleReferencesCited By View Full Article (HTML) Get PDF (170K) Keywords:ureter;stent;urolithiasis;complications;postoperative

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

Of patients treated with an indwelling ureteric stent 80–90% experience lower urinary tract symptoms that are a hindrance to health‐related quality of life. The prevalence of the extraction/retrieval string after ureteroscopy for stone disease and stent placement varies significantly between surgeons and published series, but the benefits of eliminating the need for a secondary procedure such as cystoscopy and stent removal, as well as the decrease in cost to the patient are well established.

Published reports have not addressed the prevalence of post‐procedure related events (PREs) in patients who have received an indwelling ureteric stent with the extraction/retrieval string still intact after ureteroscopy for stone disease. By analysing PREs (Emergency Room visits, unscheduled clinic visits, and telephone calls) related to their stent or procedure for patients with and without an extraction/retrieval string, the feasibility of the extraction string can be validated and the misconceptions about their use can be alleviated.

OBJECTIVE• To review a retrospective ureteric stent cohort with and without extraction string to compare post‐procedure related events (PRE), as ureteric stent placement after endoscopic management of urolithiasis is common, but data regarding the potential benefits or disadvantages of ureteric stent placement with extraction string are sparse.PATIENTS AND METHODS• Between June 2009 and June 2010, 293 patients underwent ureteroscopy with or without lithotripsy for stone disease.• In all, 181 patients had a unilateral procedure and underwent stent placement postoperatively.• Records were retrospectively reviewed for operative data and PRE occurring within the first 6 weeks after surgery, defined as unscheduled clinic or Emergency Room visits, or adverse event telephone calls.RESULTS• Of 181 patients who underwent ureteric stent placement, 43 (23.8%) included an extraction string.• In all, 34.3% of all patients had a PRE, including 37.2% and 33.3% of patients with and without extraction string, respectively (P

Emergency Laparoscopic Repair for Strangulated Groin Hernias – a single centre experience

Surgical PracticeAccepted Article (Accepted, unedited articles published online for future issues)

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Author Information

Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR

Waiting rooms and the unconscious

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Pleural lipoma: a non-surgical lesion?

72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas.

Key words Pleural disease Lipoma Thoracic surgery Video-assisted thoracic surgery

FEMA’s wireless emergency alerts to launch this month

It’s True: Zombies Love the Red Cross

In Portland, the Zombie Squad took it upon themselves to partner with the local Red Cross to host a blood drive to help them be prepared in case of a zombie invasion. The Zombie Squad has been a great Red Cross partner over the years by helping us spread important disaster preparedness messages (I particularly like their Bug Out Bag) – in fact, their mission is similar to ours: “Zombie Squad’s mission is to educate the public about the importance of personal preparedness and community service, to increase its readiness to respond to disasters such as earthquakes, floods or zombie outbreaks.” Neat-o!

'Spice'-y Party Drugs Can Lead to the ED (CME/CE)

Videos  EmailPrintSave 'Spice'-y Party Drugs Can Lead to the EDBy Michael Smith, North American Correspondent, MedPage Today

Published: May 15, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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Configurations of power relations in the Brazilian emergency care system: analyzing a context of visible practices

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Publication HistoryArticle first published online: 16 MAY 2012Accepted for publication 31 March 2012 SEARCH Search Scope All contentPublication titlesIn this journalIn this issue Search String Advanced >Saved Searches > SEARCH BY CITATION Volume: Issue: Page: ARTICLE TOOLSGet PDF (117K)Save to My ProfileE-mail Link to this ArticleExport Citation for this ArticleGet Citation AlertsRequest Permissions AbstractArticleReferencesCited By View Full Article (HTML) Get PDF (117K) Keywords:Brazil;foucault;inter‐professional relations;practice development;power relations;pre‐hospital care

VELLOSO I, CECI C and ALVES M. Nursing Inquiry 2012

Union workers authorize strike at Twin Cities hospitals

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Unionized workers at eight Twin Cities hospitals have voted to authorize a strike.

The Pioneer Press reports that 91 percent of 3,500 members of the Service Employees International Union Healthcare Minnesota union voted in favor of a two- to-five-day strike.

The workers include nursing assistants, emergency room technicians, maintenance workers and food service personnel, but not physicians or registered nurses.

The hospitals that would be affected are Children's Hospitals in Minneapolis and St. Paul, Bethesda Hospital in St. Paul, St. John's Hospital    St. John's Hospital Latest from The Business Journals HealthEast Care System hires new CEOAscension gets .9M to study birth complicationsBriefs: Houston ranks fifth for corporate projects Follow this company in Maplewood, Fairview Southdale Hospital    Fairview Southdale Hospital Latest from The Business Journals Union, hospitals reach deal, averting strikeEdina-based Clinic Sofia expanding to Maple GroveMedical office building proposed near Edina hospital Follow this company in Edina, University of Minnesota Medical Center-Fairview in Minneapolis, North Memorial Medical Center    North Memorial Medical Center Latest from The Business Journals Healthiest Employers: Editor's Note and List of WinnersHealthiest Employers: North Memorial Medical CenterMinntech CEO seriously hurt in plane crash Follow this company in Robbinsdale, and Methodist Hospital in St. Louis Park.

The unions would have to give the hospitals 10-day notice of a strike.

The union members are unhappy about work changes the hospitals are seeking in negotiations that are to start this week.

Quality Systems buys The Poseidon Group

Jacques Couret Senior Online Editor- Atlanta Business Chronicle Email

Quality Systems Inc. bought Atlanta-based emergency department documentation and web-based electronic medical record provider The Poseidon Group Inc.

Financial terms were not disclosed.

Irvine, Calif.-based Quality Systems (NASDAQ: QSII) said the acquisition will expand its NextGen Inpatient Solutions product.

Poseidon Group Chief Operating Officer Carr Scott and Chief Technology Officer W. Kyle Taylor will take senior roles within NextGen Healthcare.

‘Blast Wind’ Linked to Chronic Brain Injuries in Military

are structural brain disorders that can emerge as a result of brain injury on the battlefield or playing field," Goldstein said. "Now that we have identified the mechanism responsible for CTE, we can work on developing ways to prevent it so that we can protect athletes and our military service personnel."

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about traumatic brain injury.

SOURCE: Boston University Medical Center, news release, May 16, 2012

Physical fitness may reduce hypertension risk in people with family history

May 14, 2012 Study Highlights:If your parents have high blood pressure, you can significantly lower your risk of developing the disease with moderate exercise and increased cardiovascular fitness.People with low fitness levels and hypertensive parents have a significantly higher risk for developing the disease.EMBARGOED UNTIL 3 pm CT/4 pm ET, Monday, May 14, 2012DALLAS, May 14, 2012 — If your parents have a history of high blood pressure, you can significantly reduce your risk of developing the disease with moderate exercise and increased cardiovascular fitness, according to new research in the American Heart Association’s journal Hypertension. In a study of more than 6,000 people, those who had a parent with high blood pressure but were highly fit had a 34 percent lower risk of developing high blood pressure themselves, compared to those with a low-fitness level who had the same parental history. “Understanding the roles that family history and fitness play in chronic diseases is critically important,” said Robin P. Shook, M.S., study lead author and a doctoral graduate student in the Arnold School of Public Health at the University of South Carolina in Columbia. “The results of this study send a very practical message, which is that even a very realistic, moderate amount of exercise — which we define as brisk walking for 150 minutes per week — can provide a huge health benefit, particularly to people predisposed to hypertension because of their family history.” Previous research indicates that parental history accounts for about 35 percent to 65 percent of the variability in blood pressure among offspring, with varying levels of risk based on which parent developed it and the age of onset. Researchers followed a group of 6,278 predominantly Caucasian adults 20- to 80-years-old for an average 4.7 years. The participants were patients of the Cooper Clinic, a non-profit organization dedicated to preventive medicine, research and education in Dallas. Thirty-three percent of participants reported that a parent had hypertension. When the study began, all participants were healthy, reported no physician diagnosis of hypertension, and achieved an exercise test score of at least 85 percent of their age-predicted maximal heart rate. Researchers determined participants’ cardiorespiratory fitness using a maximal treadmill exercise test. During the study, 1,545 participants reported they had developed hypertension.Researchers found that:Combining those with and without a family history of high blood pressure, high levels of fitness were associated with a 42 percent lower risk of developing hypertension, and moderate levels of fitness with a 26 percent lower risk.People with both a low level of fitness and a parent with hypertension had a 70 percent higher risk for developing hypertension compared with highly fit people with no parental history.Those with a high level of fitness and a parent with hypertension experienced only a 16 percent higher risk of developing hypertension compared to those who were fit and had no parental history.“The correlation between fitness levels, parental history and risk are impossible to ignore,” Shook said. “This awareness can serve the clinician and the patient, as they work together to find effective and reasonable ways to avoid the diseases that have affected their family members — in some cases, for generations.” The research findings may not apply to all people because the majority of the study participants were relatively fit, well-educated, middle to upper class white men. The findings support the American Heart Association’s recommendations of moderately intense physical activity, such as brisk walking, for 30 minutes or longer at least five days a week. Co-authors are Duck-chul Lee, Ph.D.; Xumei Sui, M.D., M.P.H.; Vivek Prasad, M.B.B.S.; Steven P. Hooker, Ph.D.; Timothy S. Church, M.D., M.P.H., Ph.D. and Steven N. Blair, P.E.D. Author disclosures are on the manuscript. The National Institutes of Health and an unrestricted research grant from The Coca-Cola Company funded the study.Learn more about your risks for high blood pressure and how to be physically fit. ### Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. NR12– 1077 (Hypertension/Shook) Additional resources, including multimedia, are available in the right column. For Media inquiries: (214) 706-1173Karen Astle: (214) 706-1392; Karen.astle

Panic on the Bering Sea

Comments (7)See All PostsSharePrevLeave a CommentCommentsMay 16, 2012 at 4:35 am(1) foolio says:

Wow, just got done watching and wanted a trained responder to comment on what it was. Interesting theory. Surprising that he would start to panic at that point. Sky was clear, water was calm and seemed tame compared to stuff he had already been through. I was thinking some sort of stroke / heart condition although he’s obviously young. And I guess he was complaining about his right arm instead of his left.

Is he in danger? You gotta figure the chopper is at least 20 mins out and he’s starting to convulse.

Great cliffhanger…awesome show.

May 16, 2012 at 7:39 pm(2) Rod says:

foolio, I doubt this deckhand is in real danger, but I understand the crew’s concern.

May 16, 2012 at 7:30 am(3) kjbassjr says:

Great Rod & ‘Foolio’ a left arm symptom

Yemen: scores of civilian casualties in intense fighting in Abyan

Over the past few days, an escalation in fighting has resulted in scores of civilian casualties in Ja'ar, Abyan governorate.

"We are extremely concerned about the increasing number of casualties and about allegations of air strikes in civilian locations," said Eric Marclay, the head of the ICRC delegation in Yemen.

The ICRC calls upon all parties involved in the fighting to distinguish at all times between civilians and fighters and to take all feasible precautions to spare civilian lives. Medical staff and facilities must also be protected and respected. "We ask the parties involved to protect civilians and allow health-care workers to do their job safely," said Mr Marclay. "We also ask that injured persons be allowed to seek medical attention in safety."

Within the past three months, the ICRC has distributed food and other items to around 100,000 internally displaced people and residents in Abyan governorate. It has also provided medical treatment for people wounded in the fighting and medical supplies for health-care facilities, in addition to completing a water project supplying clean water to more than 100,000 people. It stands ready to further scale up its humanitarian assistance in the area and to support medical facilities providing treatment for war-wounded patients.

For further information, please contact:
Dibeh Fakhr, ICRC Sana'a, tel:

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South Sudan: thousands displaced as fighting escalates

16-05-2012 Operational Update

Since the beginning of the year, the ICRC has stepped up its efforts to respond to mounting humanitarian needs in South Sudan. In early April, needs increased further when hostilities erupted along the border with Sudan. The ICRC is striving to help people affected by armed violence in South Sudan.

See also:

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Middleton, Mass., manufacturer pays $600,000 in fines, takes corrective steps following legal action by US Labor Department after 2011 explosion

dol.gov

Middleton, Mass., manufacturer pays $600,000 in fines, takes corrective steps
following legal action by US Labor Department after 2011 explosion

BOSTON – The U.S. Department of Labor has secured a settlement agreement with Bostik Inc., a Middleton-based adhesives manufacturer, to resolve litigation stemming from citations issued by the department's Occupational Safety and Health Administration for safety violations following a March 2011 explosion.

OSHA cited Bostik in September after a six-month investigation found numerous violations of the agency's process safety management standard, which is a detailed set of requirements and procedures that employers must follow to proactively address hazards associated with processes and equipment involving large amounts of hazardous chemicals. In this case, the chemical was acetone, which was used in a PSM standard-covered process known as direct solvation.

According to the settlement, Bostik has taken and continues to take corrective action to address deficiencies in its PSM program and enhance the program's effectiveness, and also agrees to submit proof of abatement to OSHA. Bostik paid a fine of $600,000 and is no longer using the direct solvation process at the Middleton facility. OSHA originally proposed $917,000 in fines.

"This resolution speeds corrective action that might otherwise have been delayed through lengthy litigation," said Michael Felsen, the Labor Department's regional solicitor in Boston.

"Just as important, the settlement commits Bostik to strengthening its PSM program to prevent the possibility of a similar incident in the future, and to apprise us of its progress in abating the hazards," said Jeffrey A. Erskine, OSHA's area director for northeastern Massachusetts.

The explosion was investigated by OSHA's Andover Area Office, and the case was litigated by the Labor Department's Regional Office of the Solicitor in Boston.

To ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742).

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit http://www.osha.gov.

# # #

U.S. Department of Labor news materials are accessible at http://www.dol.gov. The information above is available in large print, Braille or CD from the COAST office upon request by calling 202-693-7828 or TTY 202-693-7755.

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Diseases spread as food supplies dwindle

In February, an MSF team discovered that one in four children under the age of five in Biltine was acutely malnourished. In response, MSF opened an emergency nutrition program in April, which enrolled 67 children for treatment in its first week, eight of whom were so seriously malnourished that they are receiving intensive inpatient care. The program will run for the next nine months.

Urgent need for food distributions

Democratic Republic of the Congo: Red Cross evacuates 65 war patients from Masisi

On 3 May, the International Committee of the Red Cross (ICRC) evacuated 40 injured people, including 27 who were seriously injured, from Saké and Kirolirwe in the Masisi territory of North Kivu province.

The Red Cross Society of the Democratic Republic of the Congo has evacuated 25 other casualties from Saké since 30 April. The patients were all transferred to the CBCA civilian hospital in N'Dosho or to the Katindo military hospital in Goma.

"It is imperative that the ICRC, the Congolese Red Cross and health-care services have access to all victims, no matter who they are," said Frédéric Boyer, the head of the ICRC sub-delegation in Goma. "The cooperation of the authorities and of all parties to the conflict is essential if we are to reach the casualties and evacuate them quickly."

The 65 evacuees

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Bangladesh: the legacy of the Red Cross and Red Crescent, forty years on

08-05-2012 Feature

Following World Red Cross and Red Crescent Day on 8 May, two workers of the Movement and a former beneficiary talk about their roles in the humanitarian family.

A life spent tracing missing persons

"It was challenging and exciting at the same time," Monwara Sarkar runs the tracing department at the Bangladesh Red Crescent Society (BDRCS). She looks back on her involvement with the Red Cross and Red Crescent Movement since 1971.

That year, civil war broke out in what was then East Pakistan (now Bangladesh). At just 17, Monwara was recruited to trace people displaced during the fighting. Women were often attacked, and this was a dangerous time for her to be working outside the safety of an office.

"When the air attacks started in the first week of December 1971, my family decided to move away from Dhaka. For my safety, the ICRC delegates organized accommodation for me at what was then the Hotel Intercontinental. This was a neutral zone, accepted by both the Pakistani army and the Muktibahini (Bengali liberation fighters)."

In 1975, after Bangladesh and Pakistan had established diplomatic relations, the ICRC closed down its operation in Bangladesh. The remaining tracing requests from Bangladesh were handed over to the BDRCS and Monwara was given the responsibility of identifying a suitable successor. But she herself carried on with the Movement for the next three decades.

"During the war I saw how the Movement worked to keep people safe, so I continued to help the victims of man-made and natural disasters."

Memories of a reassuring emblem

The Movement gained popularity on the subcontinent in the 1970s when it launched a huge programme to repatriate people stranded in Pakistan, India and Bangladesh after the war.

One of the beneficiaries of that programme was Group Captain Mahbubul Huq, who had been stationed at a Pakistan Air Force base in Karachi when war broke out. After the war, all Bengali military personnel who, like Huq, had declared their allegiance to Bangladesh, were taken to repatriation camps. Huq was held in Shagai Fort, in the north-western province of Pakistan.

"We were not sure if the world knew that we were interned in such camps till the ICRC visited us,

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