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Factors associated with refractory pain in emergency patients admitted to emergency general surgery

World Journal of Emergency Medicine 2021年第1期12卷 12-17页

作者： William Gilliam Jackson FBarr Brandon Bruns Brandon Cave Jordan Mitchell Tina Nguyen Jamie Palmer mark rose Safura Tanveer Chris Yum Quincy K.Tran Johns Hopkins University Baltimore 21218USA Research Associate Program in Emergency Medicine and Critical Care Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA R Adams Cowley Shock Trauma Center University of Maryland School of MedicineBaltimore 21201USA Department of Surgery University of Maryland School of MedicineBaltimore 21201USA Louisiana State University Louisiana 70803USA University of Maryland School of Medicine Baltimore 21201USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA

BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical ***: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED ***: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory ***: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.

关键词： Serum lactate Refractory pain Emergency general surgery Emergency department

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Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

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World Journal of Emergency Medicine 2019年第2期10卷 94-100页

作者： mark rose Carina Newton Benchaa Boualam Nancy Bogne Adam Ketchum Umang Shah Jordan Mitchell Safura Tanveer Tucker Lurie Walesia Robinson Rebecca Duncan Stephen Thom Quincy Khoi Tran Department of Emergency Medicine University of Maryland School of Medicine University of Maryland at College Park University of Maryland School of Medicine Program of Trauma The R Adams Cowley Shock Trauma Center University of Maryland School of Medicine

BACKGROUND: Acute aortic dissection(AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act(EMTALA) is crucial. The study assessed emergency providers(EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD ***: This retrospective study examined adult patients transferred directly from a referring emergency department(ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care(ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance(ADoEMTALA). RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five(36.6%) patients had ADoCC while 166(57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA(IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association(AHA) ED Departure SBP guideline(OR 1.8, 95% CI 1.03–3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care(IDoCC), while receiving continuous infusion was associated with higher risk of ***: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

关键词： Acute aortic dissection EMTALA Interhospital transfer Documentation Compliance

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早期预警系统能否预报金融危机

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中国贸易救济 2009年第10期 9-11页

作者： Andrew K．rose mark M．Spiegel

2008年爆发的全球金融危机再次使人们开始考虑建立金融危机的“早期预警系统”。但分析人士指出，属于金融危机潜在诱因的特征指标几乎无法对未来发生的金融危机的强度和严重程度进行准确预测。这为金融危机“早期预警系统”的使用前景... 详细信息

2008年爆发的全球金融危机再次使人们开始考虑建立金融危机的“早期预警系统”。但分析人士指出，属于金融危机潜在诱因的特征指标几乎无法对未来发生的金融危机的强度和严重程度进行准确预测。这为金融危机“早期预警系统”的使用前景蒙上了阴影。2008年爆发的全球金融危机具有诸多显著特征。

关键词：金融危机预警系统早期预报特征指标全球金融爆发

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Size specific boldness associated with differences in resource requirements and habitat use: a cross-sectional study in hermit crabs

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Current Zoology 2023年第3期69卷 360-366页

作者： mark Briffa rose Archer School of Biological and Marine Sciences University of PlymouthPlymouth PL48AAUK

Animal personality is often studied within compressed periods of observation that represent narrow windows in comparison to animal *** much is known about the relations between repeatable personality traits and cross-situational behavioral plasticity,less is known about how such traits might differ across age classes or life history *** conducted a cross-sectional study of startle response duration in 3 size classes of Pagurus bernhardus,the common European hermit *** defined size classes using transitions in the preferred species of gastropod shells that accompany growth,and this change in preference is in turn associated with a transition from intertidal to subtidal *** with small-and medium-sized intertidal individuals the larger subtidal hermit crabs behaved cautiously by showing startle responses of greater duration following *** responses were also repeatable within all 3 size classes,confirming the presence of animal personality in intertidal hermit crabs and demonstrating that this pattern is retained within the largest size classes,which have undergone the transition from intertidal to subtidal ***,there was a trend for the pattern of repeatable startle response durations to increase with size class,with the highest value for repeatability and the greatest range of startle response durations being present within the large subtidal *** greater range of startle responses indicates that the longer startle response durations in some larger individuals are more likely due to developmental changes with age and habitat use than reflecting selection against the boldest individuals during earlier stages of life.

关键词： boldness development habitat hermit crab personality resources

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Dietary supplementation of sulfur amino acids improves intestinal immunity to Eimeria in broilers treated with anti-interleukin-10 antibody

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Animal Nutrition 2022年第3期10卷 382-389页

作者： Zhouzheng Ren Jiakun Yan rose Whelan Xujie Liao Daniel E.Bütz Maria K.Arendt mark E.Cook Xiaojun Yang Thomas D.Crenshaw College of Animal Science and Technology Northwest A&F UniversityYanglingShaanxiChina Department of Animal Sciences University of WisconsinMadisonWIUSA Evonik Operations GmbH Hanau-WolfgangGermany

Oral antibody to interleukin-10(anti-IL-10)enhances the intestinal immune defense against *** sulfur amino acids methionine and cysteine(MtC)play essential roles in inducing and maintaining protective immune responses during intestinal ***,increased dietary MtC may support the anti-IL-10-induced intestinal immunity to ***(n=640)were arranged in a 2×2×2 factorial design with 2 levels of each of the 3 main factors:dietary standardized ileal digestible(SID)MtC levels(0.6%or 0.8%),dietary anti-IL-10 supplementation(with or without),and coccidiosis challenge(control or challenge).Briefly,the broilers were supplied with either 0.6%or 0.8%SID MtC,each with or without anti-IL-10(300 mg/kg),from d 10 to *** d 14,broilers from each diet were gavaged with either PBS or *** resulting Eimeria infection induced fecal oocyst shedding and intestinal *** fed 0.8%SID MtC(main effects,P≤0.05)had decreased feed-to-gain ratio,increased duodenum and cecum luminal anti-Eimeria IgA titers,and decreased fecal oocyst counts,when compared to 0.6%SID *** supplementation of anti-IL-10(main effects,P≤0.05)increased cecum luminal total IgA concentration and decreased cecum ***(P≤0.05)were detected for growth performance and cecum luminal IFN-γ.Briefly,the highest body weight gain and feed intake were reached in PBS-gavaged broilers fed 0.8%SID MtC with no anti-IL-10 and in Eimeria-challenged broilers fed 0.8%SID MtC with *** Eimeria-infected broilers,anti-IL-10 increased intestinal luminal IFN-γ and body weight gain only at 0.8%SID ***,anti-IL-10 increased intestinal luminal IFN-γ levels,decreased cecum lesions and restored growth only when fed with adequate amounts of sulfur amino *** findings underscore the importance of providing sufficient essential nutrients to support the anti-IL-10 induced immunity against coccidiosis.

关键词： Chicken Coccidiosis Egg yolk antibody Interleukin-10 Sulfur amino acid

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Recycling Tailings Seepage Water for Diogo Heavy Minerals Mine Sustainability (Northern Senegal)

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Journal of Water Resource and Protection 2018年第1期10卷 121-144页

作者： Mouhamat Seck Serigne Faye mark Robertson Michael rose Department of Geology University Cheikh Anta Diop Dakar Senegal Grande Cote Operations (GCO) Dakar Senegal GEO-ENG Queensland Australia

The sandy Quaternary and the deep Maastrichtian aquifers located in the northern coastal zone of Senegal, from the locality of Kayar in the south to Saint-Louis in the north, constitute the main sources of water supply for urban and local needs as well as mining activities. The Quaternary aquifer that provides the water required for the irrigation of local farmlands, hosts a significant heavy mineral sands deposit currently being mined by the Grande Cote Operations (GCO). As a result of variable rainfall and increased water abstraction, this shallow aquifer has recorded a continuous water level decline since 1970, with potential negative effects on both the social and economic development of the region. The mining of heavy minerals (zircon, ilmenite, leucoxene and rutile) at GCO is realised through conventional dredging techniques that require large volumes of water (up to 60,000 m3/d). The water pumped by the dredge to enable the extraction of the heavy minerals, infiltrates into the shallow aquifer, runs-off into the dredge pond or evaporates. The objective of this study is to evaluate a water balance that enables the provision of a permanent water supply to the dredge pond, whilst minimising the risk of flooding of the cropping depressions adjacent to the mine site or drying out of the farming wells. The hydrodynamic model implemented for this purpose was calibrated and tested during the first year of operation. The Root Mean Squared Error (RMSE) obtained for the calibration is approximately 0.52 m. The predictions indicate a requirement for the system to recover part of the tailings infiltration through dewatering boreholes. The quantity of recycled water is estimated at 16,000 m3/d on average. The model simulations show an additional water requirement, extracted from the deep Maastrichtian aquifer, varying between 23,000 and 28,000 m3/d to achieve the optimum pond water level.

关键词： Mineral Sands Groundwater Modelling Dredge Pond Grande Cote Operations Fe Flow

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Wavefront-optimized surface retreatments of refractive error following previous laser refractive surgery: a retrospective study

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Eye and Vision 2016年第1期3卷 22-28页

作者： Kevin M.Broderick rose K Sia Denise S.Ryan Richard D.Stutzman Michael J.Mines Travis C.Frazier mark F.Torres Kraig S.Bower Ophthalmology Service Walter Reed National Military Medical Center8901 Wisconsin AvenueBethesdaMD 20814USA Warfighter Refractive Eye Surgery Program and Research Center Ft.BelvoirVAUSA Ophthalmology Service Madigan Army Medical CenterTacomaWAUSA The Wilmer Eye Institute Johns Hopkins UniversityBaltimoreMDUSA

Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive *** different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive *** study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical *** were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M ***:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study *** surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 *** mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M *** was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M *** was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M ***:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective *** studies are necessary to determine the long-term safety and stability of outcomes.

关键词： Wavefront-optimized PRK LASIK LASEK Retreatment Enhancement

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An examination of the population dynamics of syngnathid fishes within Tampa Bay,Florida,USA

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Current Zoology 2010年第1期56卷 118-133页

作者： Heather D.MASONJONES Emily rose Lori Benson McRAE Danielle L.DIXSON Biology Department University of Tampa Biology Department Texas A & M University School of Marine and Tropical Biology James Cook University

Seagrass ecosystems worldwide have been declining, leading to a decrease in associated fish populations, especially those with low mobility such as syngnathids （pipefish and seahorses）. This two-year pilot study investigated seasonal patterns in density, growth, site fidelity, and population dynamics of Tampa Bay （FL） syngnathid fishes at a site adjacent to two marinas under construction. Using a modified mark-recapture technique, fish were collected periodically from three closely located sites that varied in seagrass species （Thalassia spp., Syringodium spp., and mixed-grass sites） and their distance from open water, but had consistent physical/chemical environmental characteristics. Fish were marked, photographed for body size and gender measurements, and released the same day at the capture site. Of the 5695 individuals surveyed, 49 individuals were recaptured, indicating a large, flexible population. Population density peaks were observed in July of both years, with low densities in late winter and late summer. Spatially, syngnathid densities were highest closest to the mouth of the bay and lowest near the shoreline. Seven species of syngnathid fishes were observed, and species-specific patterns of seagrass use emerged during the study. However, only two species, Syngnathus scovelli and Hippoeampus zosterae, were observed at high frequencies. For these two species, body size decreased across the study period, but while S. scovelli＇s population density decreased, H. zosterae＇s increased. Across six of the seven species, population size declined over the course of this preliminary study; however, seasonal shifts were impossible to distinguish from potential anthropogenic effects of construction [Current Zoology 56 （1）： 118-133, 2010].

关键词： Syngnathids Habitat-use Seahorse Pipefish Population density mark-recapture

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Polymer-mediated immunocamouflage of red blood cells: Effects of polymer size on antigenic and immunogenic recognition of allogeneic donor blood cells

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Science China(Life Sciences) 2011年第7期54卷 589-598页

作者： WANG DunCheng Dana L. KYLUIK Kari L. MURAD Wendy M. TOYOFUKU mark D. SCOTT Canadian Blood Services Vancouver V6T 1Z3 British Columbia Canada Centre for Blood Research and the Department of Pathology and Laboratory Medicine University of British Columbia Vancouver V6T 1Z3 British Columbia Canada Department of Biology College of St. Rose Albany 12208 New York USA

Developing a practical means of reducing alloimmunization in chronically transfused patients would be of significant clinical benefit. Immunocamouflaging red blood ceils （RBCs） by membrane grafting of methoxypoly（ethylene glycol）（mPEG） may reduce the risk of allo-immunization. The results of this study showed that antibody recognition of non-ABO antigens was sig- nificantly reduced in an mPEG-dose- and polymer size-dependent manner, with higher molecular weight mPEGs providing better immunoprotection. Furthermore, in vivo immunogenicity was significantly reduced in mice serially transfused with mPEG-modified xenogeneic （sheep; sRBCs）, allogeneic （C57B1/6）, or syngeneic （Balb/c） RBCs. Following a primary transfu- sion of sRBCs, mice receiving mPEG-sRBCs showed a 〉90% reduction in anti-sRBC IgG antibody levels. After two transfusions, mice receiving mPEG-sRBCs showed reductions of 〉80% in anti-sRBC IgG levels. Importantly, mPEG-modified autologous cells did not induce neoantigens or an immune （IgG or IgM） response. These data suggest that the global immuno- camouflage of RBCs by polymer grafting may provide a safe and cost-effective means of reducing therisk of alloimmunization.

关键词： methoxypoly(ethylene glycol) erythrocyte blood group antigens mice alloimmunization

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戈尔与他的世代投资

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金融客 2015年第1期 12-21页

作者： Imogen rose-Smith

十年前,大卫·布拉德(David Blood)和阿尔·戈尔(Al Gore)成立了世代投资管理公司(Generation Investment Management),目标是要改变投资者们的思考方式。联席首席投资官马克·弗格森(mark Ferguson)和米格尔·诺加莱斯(Miguel Nogales... 详细信息

十年前,大卫·布拉德(David Blood)和阿尔·戈尔(Al Gore)成立了世代投资管理公司(Generation Investment Management),目标是要改变投资者们的思考方式。联席首席投资官马克·弗格森(mark Ferguson)和米格尔·诺加莱斯(Miguel Nogales)已经证明,公司关于可持续性投资的理念是正确的。现在,布拉德和戈尔需要努力进入下一个新世代。

关键词：世代布拉德戈尔投资财政管理

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