Grace University

Initial healthcare delivery after warfront injury is unpredictably challenging for military forces. As preparatory training, healthcare providers use simulation to improve their performance in stressful critical situations. This study investigated whether a digital CA held by the team leader improved performance in simulated combat casualty care. This randomized controlled trial was performed during a combat casualty training course for military physicians and nurses in France. Each pair of care providers completed 2 scenarios randomized to be undertaken either with or without a digital CA. The primary end point was the technical performance evaluated from a video recording by 2 independent raters using a pre-established score grid (up to 100%) according to military protocols. The secondary end point was the nontechnical performance (TEAM scale, maximum: 54 points). Thirty-six pairs of participants were included. Use of the digital CA improved both technical (74% vs 53%, P < 0.001) and nontechnical (42 vs 32, P < 0.001) performance. The digital CA improved technical and nontechnical performance during training of medical care for military combat casualties. Use of a dedicated digital CA might improve care in a combat environment. This study is a randomized controlled trial.

In the early eighteenth century nature seemed to be governed by universal mathematical laws benevolently established by the Creator. Over the next hundred years, philosophical and cultural changes led to a new experience of nature’s meaning. Kant concluded that the tension between inert matter and living beings, between necessity and freedom, means that we cannot ultimately understand nature (the ground and origin of everything). Schelling’s idealism and its presumption of an immanent pre-existing harmony of mind and nature undermined this conclusion and ultimately led to new expectations for nature. Romantic ideas, from Schleiermacher (who located the religious impulse in the intuition of the universe as a whole) to Goethe, Wordsworth, Coleridge, Emerson, and Thoreau (with their faith that an encounter with nature could be suffused with holiness) came to be central to the modern environmental movement. The ideas of Charles Darwin changed how Christians came to understand the natural world.

Previous research suggests a need for improved matching of treatment delivery to specificity of depressive symptoms. Social work practitioners in mental health treatment settings may begin to meet this need through improved classification of symptoms associated with major depressive disorder (MDD). This study seeks to establish empirically derived MDD symptom profiles among individuals who experience major depressive episodes (MDEs). Data from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys examined symptoms of MDD among respondents with a past-year MDE (N = 1,543). Latent class analysis established symptom profiles, and multinomial regression models examined social and clinical correlates of symptom profiles. Four symptom profiles emerged: high cognitive functioning (3.8%), absolute depression (63.7%), diminished cognitive functioning and low suicidal ideation (24.7%), and diminished cognitive functioning and high suicidal ideation (7.7%). Regression models showed that race or ethnicity, age, and histories of posttraumatic stress disorder were correlates of class membership. MDD profiles may assist social work research and practice through improved assessment of cognition and suicidality and improved recognition of how clinical factors, including co-occurring mental health problems, relate to specific MDD profiles.

Background: Vascular-constrained fibrin-specific nanolytic agents could permit early revascularization in the setting of acute ischemic stroke. Development of fibrin-targeted nanolytics requires optimized surface co-presentation of homing ligands and fibrinolytic enzymes on nanoparticles without compromising bioactivity. Objective : The study optimized human urokinase coupling and anti-fibrin homing ligand density for targeted thrombolytic efficacy and demonstrated the concept in vivo. Methods and Results: Minimal thiolation (N-succinimidyl-S-acetylthioacetate, SATA) of urokinase (i.e., 1 to 3 SATA/molecule) diminished human clot dissolution time relative to the native molecule; greater degrees of thiolation (3 to 6 SATA/molecule) severely decreased activity. For dog clots, which digested slower than human clots, 1 to 3 SATA/urokinase did not further impair fibrinolysis rate. Concomitant coupling of thiolated urokinase and anti-fibrin antibody (50:5, 100:10, 200:20, and 400:40 ratio, respectively) to perfluorocarbon nanoparticles resulted in optimal clot dissolution for the 100:10 and 200:20 formulations. Increasing the surface urokinase-to-antibody ratio from 0:10 to 50:10, 100:10, 200:10, and 400:10 increased particle size from 273 nm (0:10) to 340 nm at the 50:10 and 100:10 enzyme levels, and to more than 400 nm with 200 urokinase molecules per particle. Acoustic microscopy (25MHz) was used to quantify binding of the fibrin-targeted PFC nanoparticles to acoustically transparent human clots. Fibrin targeting with 10 antibodies per particle provided minimal acoustic enhancement in comparison with the relatively increased (p&lt;0.05) but equivalent signals obtained with 20 or 40 antibodies per particle. Dissolution of canine femoral clots, created by electrical injury, was monitored with low MI ultrasound under open circulation conditions following in situ targeting with the nanolytic system. Substantial subjective clot dissolution and fragmentation was observed in three animals over 60 minutes, demonstrating the nanolytic concept. Conclusion: Nanolytic agents can target fibrinolytic enzymes to lyse nascent thrombus, which may permit early revascularization in acute ischemic stroke with minimal hemorrhagic risk.

Meningococcal vaccination and chronic kidney diseaseSir, We read with great interest the editorial review about vaccination and chronic kidney disease by Janus et al [1].Although this article is focused on end-stage renal disease patients, we think that it is possible to mention the meningococcal vaccine.This immunization is usually recommended for people exposed to a case of severe meningococcal infection, or for people travelling in endemic zones (sub-Saharan meningitis belt) in close contact with the local population.In some countries, this vaccine is incorporated in national vaccination programmes [2].A few years ago, a risk of relapse of nephrotic syndrome was signalled, after meningococcal C conjugate vaccine [3].However, that has been invalidated by a more recent study where no link was found between vaccination and a risk of relapse [4].Thus the use of this vaccine, when necessary, can be recommended.However, there is a lack of data upon the degree of the immune response to this kind of vaccine in immunosuppressed patients.For asplenic individuals, for example, a double dose of vaccine has been proposed [5].

This article and webography is based Oil a workshop of the same title presented at the /999 ACL Annual Conference. It discusses the growing number of resources on the World Wide Web that may be useful for doing acquisitions and collection development. It begins by introducing librarians to AcqWeb, an excellent site for librarians who do acquisitions and collection development. Then representative web sites which may be useful as verification tools, review sources, collection development resources or in finding out-of print materials are listed in an annotated webography.

The development of the Illinois Test of Psycholinguistic Abilities has created a new tool for investigations of the characteristics of speech problems. Forty intellectually and physically normal children with functional defects of articulation were tested with the ITPA. Performance of the group was compared with normative data reported for the test. The subjects scored lower than the norms on all subtests at the two levels of the test. Subtests most affected were in the auditory vocal channel.