Targeted temperature management in emergency medicine: current perspectives

Landmark trials in 2002 showed that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation resulted in improved likelihood of good neurologic recovery compared to standard care without TH. Since that time, TH has been frequently instituted in a wide range of cardiac arrest patients regardless of initial heart rhythm. Recent evidence has evaluated how, when, and to what degree TH should be instituted in cardiac arrest victims. We outline early evidence, as well as recent trials, regarding the use of TH or targeted temperature management in these patients. We also provide evidence-based suggestions for the institution of targeted temperature management/TH in a variety of emergency medicine settings

New research on bioregenerative air/water purification systems

For the past several years, air and water purification systems have been developed and used. This technology is based on the combined activities of plants and microorganisms as they function in a natural environment. More recently, researchers have begun to address the problems associated with indoor air pollution. Various common houseplants are currently being evaluated for their abilities to reduce concentrations of volatile organic compounds (VOCS) such as formaldehyde and benzene. With development of the Space Exploration Initiative, missions will increase in duration, and problems with resupply necessitates implementation of regenerative technology. Aspects of bioregenerative technology have been included in a habitat known as the BioHome. The ultimate goal is to use this technology in conjunction with physicochemical systems for air and water purification within closed systems. This study continued the risk assessment of bioregenerative technology with emphasis on biological hazards. In an effort to evaluate the risk for human infection, analyses were directed at enumeration of fecal streptococci and enteric viruses with the BioHome waste water treatment system

Quantifying the annual fish harvest from South Africa’s largest freshwater reservoir

South African inland fisheries are poorly developed and their contribution to near-shore communities is poorly understood. This study is the first comprehensive assessment of recreational and subsistence angling undertaken in an inland fishery in South Africa. The study was conducted on the 360 km2 Lake Gariep, South Africa’s largest freshwater reservoir. A total of 508 anglers were interviewed between February 2007 and January 2008. Of those interviewed, 67% were subsistence anglers and 33% recreational anglers. Catch per unit effort (CPUE) did not differ significantly between sectors. CPUE fluctuated seasonally, ranging between 0.37 (95% CI= 0.26 to 0.51) kg·angler-1·h-1 in winter and 0.88 (0.67 to 1.17) kg·angler- 1·h-1 in summer. The duration of a fishing day ranged from 5.99 (5.24 to 6.74) h in mid-winter to 7.26 (6.88 to 7.63) h in early summer. Expected end-of-day catch (CPUE × fishing-trip duration) ranged from 2.2 to 6.4 kg·angler-1·d-1 depending on the season. The number of anglers ranged from 22 (8 to 53) anglers·d-1 in June/July to 74 (25 to 176) anglers·d-1 in April. Total annual catch from the roving creel survey was estimated at 71.4 (57.4 to 91.4) t·yr-1. Another 7.5 t∙yr-1 were landed during recreational angling competitions. The resultant total catch divided by the lakeshore population equated to a per capita fish supply of 11.1 kg·yr-1. More than 70% of the catch was the alien invasive carp Cyprinus carpio and there was no evidence of overfishing. The fish resource of Lake Gariep is of significant recreational and subsistence value. As a result of the low fish price (ZAR5.72 ± 2.60·kg-1) subsistence fishing was considered a low-revenue activity that mainly augmented food security in lakeshore communities. The relatively high CPUE indicated that the fishery may be an important safety-net during periods when alternate sources of livelihoods are limited. Consequently, we recommend that the importance of angling to local communities needs to be taken into account when planning fisheries development and developing an inland fisheries polic

Who uses the fishery resources in South Africa’s largest impoundment? Characterising subsistence and recreational fishing sectors on Lake Gariep

The African Union’s prioritisation of inland fisheries as an investment area for poverty alleviation and regional economic development will require the development of management plans. These should be based on sound knowledge of the social dynamics of the resource users. In South Africa the social dynamics of resource users of inland fisheries have never been assessed. The purpose of this study was to assess the human dimensions of the anglers utilising the fishery in Lake Gariep, South Africa’s largest impoundment. The study was based on 357 first-time interviews conducted on the lakeshore between October 2006 and December 2007. Anglers were categorised as recreational (39%) or subsistence (61%) based on their residency, occupation, primary motivation for angling, mode of transport and gear use. Subsistence anglers were local (99%), residing within 10 km of the place where they were interviewed, while recreational anglers included both local resident and non-resident members. The racial composition of anglers was dependent on user group and differed significantly (p ≤ 0.05) from the demographic composition of the regional population. Recreational anglers were predominantly White (≥ 60% of interviews) and Coloured (≥ 25%), while 84% of subsistence anglers were Coloured and 16% Black African. Most recreational anglers had permanent employment or were pensioners while <30% of subsistence anglers were permanently employed. Most recreational users (82%) accessed the lake with their own vehicle while subsistence anglers mainly walked (63%) or used a bicycle (28%). Recreational interviewees either consumed (59%), sold (11%), gave away (10%) or released (20%) some of their catch. Subsistence anglers either ate their catch (53%) and/or sold (41%) their catch. Within the subsistence sector no anglers released fish after capture or gave some of the catch away. We conclude that this inland fishery contributes to the livelihood of the rural poor who use the lake on a subsistence basis and that recreational-angler based tourism may contribute to increased income and employment opportunities through related service industries

Growing Gaps: Children\u27s Experiences of Inequality in a Faith-based Afterschool Program in the U.S. South

This ethnographic research examines the social service encounter between private providers and child recipients involved in a faith-based afterschool program located in a southern US city. I specifically focus on the tensions and divisions that developed between staff members and participating families in daily programmatic interactions and rhetoric. I highlight how race, class, and gender intersected with age to shape children’s different experiences of the afterschool program and their lives beyond the agency. I also show how these social categories converged in local stories of religious poverty relief, which build upon cultural narratives about American welfare, to blind staff to the realities of children’s lives. These issues resulted in a program where staff members sought to transform children away from imagined social ills they associated with guardians to ideologically and programmatically isolate children from their families. I explore these conditions to draw attention to some of the ways structural inequalities can be reproduced and maintained in private service provision. It is in this context that I examine the increasing prominence of faith-based organizations within domestic poverty policy and relief services

Feasibility of upright patient positioning and intubation success rates at two academic emergency departments

Objectives Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions. Methods This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0–10° (supine), 11–44° (inclined), and ≥ 45° (upright); first past success was also analyzed in 5 degree angle increments. Results A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p = 0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR = 1.11; 95% CI = 1.01–1.22, p = 0.043). Conclusions In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted

Improvement Of Character Education Through Integrating Teaching Of Holiday In The Second Grade Of Douglass Elementary School, Pittsburg, Texas

Much consideration is now being given to the development of moral and spiritual values in children and youth. However, only a minority of the teaching personnel is really aware of the part the public school can play in the development of such values. The Educational Policies Commission of the National Education Association^- has given much consideration and thought to Moral and Spiritual Values in Public Schools, and it is believed that schools can and should increase their effectiveness in the development of such values. Values should permeate the entire educational process. Although the teaching of values, perhaps more than any other kind of teaching, depends on many variable circumstances, it should be kept in mind that character cannot be taught by simply scheduling so many minutes a day to the task

Transition to secondary school by children with special educational needs

The last 40 years have witnessed huge changes in the educational experiences of children with Special Educational Needs (SEN), with increased emphasis on inclusive approaches to meeting their needs. This has been reflected in international agreements, also in UK Government legislation and reports during this period. Increasingly, pupils with SEN were educated in mainstream schools and so required to make a transition between schools at age 11. Successful transition from primary to secondary education is important for later wellbeing and attainment (West et al 2010). Pupils with SEN face increased demands as they move from spending most of the day with a single class teacher in their primary school to the organisational and relationship complexities of needing to work with several different adults during the week in the secondary setting. This research investigated the experiences of children with SEN statements as they made the potentially difficult transition from mainstream primary to mainstream secondary school. It explored those social, academic and personal organisation matters often mentioned by children as of concern to them at time of transition. A largely qualitative approach was adopted, exploring the views of children, parents and school staff about this process and the approaches taken by mainstream schools in an English Local Authority to facilitate the transition experience for the children involved. Evidence was collected through questionnaires and interviews, and analysed for purposes of this research with the use of vignettes. It was found that the children interviewed looked forward with a mixture of excitement and concern. Most optimism was expressed about the prospect of enhanced opportunities in sport, science and school lunch! There were three broad areas of concern; social concerns ranging from making new friendships to fear of bullying; academic concerns relating to the anticipated increased amount/complexity of the work and decreased support for their specific difficulties; and worries about personal organisation in a larger school with different subjects each requiring specific materials. The eight primary and three secondary schools visited during this research all made arrangements to introduce children to their new school in advance of transfer, with additional activities for children with SEN. Post-transition interviews with the remaining seven participants demonstrated that transition proceeded smoothly, and that any concerns expressed in year 6 were unfounded. The original contribution of this longitudinal research has been to demonstrate the difference between participants' pre-transition expectations and eventual reality, also to ascertain what features participants identified as the most effective in facilitating transition, for a sample of pupils with widely varying SEN

Cholecystokinin-expressing neurons of the ventromedial hypothalamic nucleus control energy homeostasis

The hypothalamus is the primary center of the brain that regulates energy homeostasis. The ventromedial hypothalamus (VMH) plays a central role in maintaining energy balance by regulating food intake, energy expenditure, and glucose levels. However, the cellular and molecular mechanisms underlying its functions are still poorly understood. Cholecystokinin (CCK) is one of many genes expressed in this hypothalamic nucleus. Peripheral CCK regulates food intake, body weight, and glucose homeostasis. However, current research does not explain the function of CCK neurons in specific nuclei of the hypothalamus and their likely roles in network dynamics related to energy balance and food intake. This study uses genetic and pharmacological methods to examine the role of CCK-expressing neurons in the VMH (CCKVMH). Namely, using a previously generated BAC transgenic line expressing Cre recombinase under the CCK promoter, we performed targeted manipulations of CCKVMH neurons. Histological and transcriptomic database analysis revealed extensive distribution of these neurons in the VMH, with significant heterogeneity in gene expression related to energy balance, including co-expression with PACAP and somatostatin. Pharmacogenetic acute inhibition via Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) resulted in increased food intake and altered meal patterns, characterized by higher meal frequency and shorter intermeal intervals. Furthermore, diphtheria toxin-mediated ablation of CCKVMH neurons led to significant weight gain and hyperphagia over time, increasing meal size and duration. These mice also exhibited impaired glucose tolerance, indicative of disrupted glucose homeostasis. Our findings underscore the integral role of CCKVMH neurons in modulating feeding behavior, energy homeostasis, and glucose regulation. This study enhances our understanding of the neurohormonal mechanisms underlying obesity and metabolic disorders, providing potential targets for therapeutic interventions

The Many Tunes of Perisomatic Targeting Interneurons in the Hippocampal Network

The axonal targets of perisomatic targeting interneurons make them ideally suited to synchronize excitatory neurons. As such they have been implicated in rhythm generation of network activity in many brain regions including the hippocampus. However, several recent publications indicate that their roles extend beyond that of rhythm generation. Firstly, it has been shown that, in addition to rhythm generation, GABAergic perisomatic inhibition also serves as a current generator contributing significantly to hippocampal oscillatory EEG signals. Furthermore, GABAergic interneurons have a previously unrecognized role in the initiation of hippocampal population bursts, both in the developing and adult hippocampus. In this review, we describe these new observations in detail and discuss the implications they have for our understanding of the mechanisms underlying physiological and pathological hippocampal network activities. This review is part of the Frontiers in Cellular Neuroscience's special topic entitled “GABA signaling in health and disease” based on the meeting at the CNCR Amsterdam