Prehospital Needle Decompression of Suspected Tension Pneumothorax: Outcomes and Consequences.

Tension pneumothorax (TPT) identified in the prehospital setting requires prehospital needle decompression (PHND). This study aimed to evaluate complications from PHND when it was performed without meeting clinical criteria. A retrospective review was performed of patients undergoing (PHND) from 2016 through 2022 at a level 1 trauma center. Patient data who received PHND were reviewed. Of 115 patients, 85 did not meet at least one clinical criterion for PHND. The majority of patients in this cohort 76 (89%) required a chest tube and 22 (25%) had an iatrogenic pneumothorax from PHND. 5 patients (6%) were admitted due to iatrogenic PHND. Two vascular injuries in this population were directly due to PHND and required emergency operative repair. This study shows the negative consequences of PHND when performed without clear indications. Several patients underwent unnecessary procedures with significant clinical consequences.

Considerations for Health Researchers Using Social Media for Knowledge Translation: Multiple Case Study.

BACKGROUND: Despite extensive literature describing the use of social media in health research, a gap exists around best practices in establishing, implementing, and evaluating an effective social media knowledge translation (KT) and exchange strategies. OBJECTIVE: This study aims to examine successes, challenges, and lessons learned from using social media within health research and to create practical considerations to guide other researchers. METHODS: The Knowledge Translation Platform of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit formed a national working group involving platform staff, academics, and a parent representative with experience using social media for health research. We collected and analyzed 4 case studies that used a variety of social media platforms and evaluation methods. The case studies covered a spectrum of initiatives from participant recruitment and data collection to dissemination, engagement, and evaluation. Methods and findings from each case study as well as barriers and facilitators encountered were summarized. Through iterative discussions, we converged on recommendations and considerations for health researchers planning to use social media for KT. RESULTS: We provide recommendations for elements to consider when developing a social media KT strategy: (1) set a clear goal and identify a theory, framework, or model that aligns with the project goals and objectives; (2) understand the intended audience (use social network mapping to learn what platforms and social influences are available); (3) choose a platform or platforms that meet the needs of the intended audience and align well with the research team's capabilities (can you tap into an existing network, and what mode of communication does it support?); (4) tailor messages to meet user needs and platform requirements (eg, plain language and word restrictions); (5) consider timing, frequency, and duration of messaging as well as the nature of interactions (ie, social filtering and negotiated awareness); (6) ensure adequate resources and personnel are available (eg, content creators, project coordinators, communications experts, and audience stakeholder or patient advocate); (7) develop an evaluation plan a priori driven by goals and types of data available (ie, quantitative and qualitative); and (8) consider ethical approvals needed (driven by evaluation and type of data collection). CONCLUSIONS: In the absence of a comprehensive framework to guide health researchers using social media for KT, we provide several key considerations. Future research will help validate the proposed components and create a body of evidence around best practices for using and evaluating social media as part of a KT strategy.

The Case for Extant Life on Mars and Its Possible Detection by the Viking Labeled Release Experiment.

The 1976 Viking Labeled Release (LR) experiment was positive for extant microbial life on the surface of Mars. Experiments on both Viking landers, 4000 miles apart, yielded similar, repeatable, positive responses. While the authors eventually concluded that the experiment detected martian life, this was and remains a highly controversial conclusion. Many believe that the martian environment is inimical to life and the LR responses were nonbiological, attributed to an as-yet-unidentified oxidant (or oxidants) in the martian soil. Unfortunately, no further metabolic experiments have been conducted on Mars. Instead, follow-on missions have sought to define the martian environment, mostly searching for signs of water. These missions have collected considerable data regarding Mars as a habitat, both past and present. The purpose of this article is to consider recent findings about martian water, methane, and organics that impact the case for extant life on Mars. Further, the biological explanation of the LR and recent nonbiological hypotheses are evaluated. It is concluded that extant life is a strong possibility, that abiotic interpretations of the LR data are not conclusive, and that, even setting our conclusion aside, biology should still be considered as an explanation for the LR experiment. Because of possible contamination of Mars by terrestrial microbes after Viking, we note that the LR data are the only data we will ever have on biologically pristine martian samples. Key Words: Extant life on Mars-Viking Labeled Release experiment-Astrobiology-Extraterrestrial life-Mars. Astrobiology 16, 798-810.

Red blood cells mediate the onset of thrombosis in the ferric chloride murine model.

Application of ferric chloride (FeCl(3)) to exposed blood vessels is widely used to initiate thrombosis in laboratory mice. Because the mechanisms by which FeCl(3) induces endothelial injury and subsequent thrombus formation are little understood, we used scanning electron and brightfield intravital microscopy to visualize endothelial damage and thrombus formation occurring in situ. Contrary to generally accepted belief, FeCl(3) does not result in appreciable subendothelial exposure within the time frame of thrombosis. Furthermore, the first cells to adhere to FeCl(3)-treated endothelial surfaces are red blood cells (RBCs) rather than platelets. Energy dispersive x-ray spectroscopy demonstrated that ferric ions predominantly localize to endothelial-associated RBCs and RBC-derived structures rather than to the endothelium. With continuing time points, RBC-derived structures rapidly recruit platelets, resulting in large complexes that subsequently enlarge and coalesce, quickly covering the endothelial surface. Further studies demonstrated that neither von Willebrand factor nor platelet glycoprotein Ib-α receptor (GPIb-α) is required for RBCs to adhere to the endothelium, and that deficiency of GPIb-α greatly abrogated the recruitment of platelets to the endothelial-associated RBC material. These findings illuminate the mechanisms of FeCl(3)-mediated thrombosis and reveal a previously unrecognized ability of RBCs to participate in thrombosis by mediating platelet adhesion to the intact endothelial surface.

Prognostic value of electron-beam computed tomography-derived coronary calcium scores compared with clinical parameters in patients evaluated for coronary artery disease. Prognostic value of EBCT in symptomatic patients.

OBJECTIVE: The electron-beam computed tomography-(EBCT-)derived calcium score provides a measure of coronary atherosclerotic plaque disease which may allow for more precise risk stratification in symptomatic patients. However, it remains unclear if EBCT can add prognostic information compared with the clinical information derived from risk factor assessment, exercise stress testing, and coronary angiography. METHODS AND RESULTS: A cohort of 300 consecutive patients with recent (<3 months) onset of symptoms was retrospectively identified who were examined for possible coronary artery disease (CAD) and who all underwent EBCT. Successful follow-up after 3.5 years was obtained in 255 (85%) patients whose mean age at baseline was 58+/-11 years (n = 181 (71%), males). Four clinical categories with increasing evidence of CAD were constructed on the basis of risk factor assessment, exercise stress testing, coronary angiographic anatomy, and coronary revascularization at baseline. During follow-up, major adverse cardiac events (MACE: myocardial infarction, cardiac death, revascularization) were observed in 40 (16%) patients, including myocardial infarction and cardiac death in 5 patients. The 4 clinical categories were highly predictive of MACE, with a relative risk estimate of 28.3 (95% CI, 6.7-119.1) in the upper vs. the reference category. In univariate analysis, the relative risk estimate of MACE associated with a calcium score > or =100 was 12.0 (95% CI, 4.7-30.6). After adjustment for the clinical categories and for age, this estimate decreased in multivariate analysis, but remained predictive at 4.4 (95% CI, 1.5-12.6). CONCLUSION: In patients with first-time evaluation of possible CAD, EBCT-derived coronary calcium is suggested to provide for independent and additional information compared with the clinically available information.

Supply curves for using powder river basin coal to reduce sulfur emissions.

Supply curves were prepared for coal-fired power plants in the contiguous United States switching to Wyoming's Powder River Basin (PRB) low-sulfur coal. Up to 625 plants, representing approximately 44% of the nameplate capacity of all coal-fired plants, could switch. If all switched, more than dollars 8.8 billion additional capital would be required and the cost of electricity would increase by up to dollars 5.9 billion per year, depending on levels of plant derating. Coal switching would result in sulfur dioxide (SO2) emissions reduction of 4.5 million t/yr. Increase in cost of electricity would be in the range of 0.31-0.73 cents per kilowatt-hour. Average cost of S emissions reduction could be as high as dollars 1298 per t of SO2. Up to 367 plants, or 59% of selected plants with 32% of 44% nameplate capacity, could have marginal cost in excess of dollars 1000 per t of SO2. Up to 73 plants would appear to benefit from both a lowering of the annual cost and a lowering of SO2 emissions by switching to the PRB coal.

Tagatose, the new GRAS sweetener and health product.

Tagatose, a low-calorie, full-bulk natural sugar, has just attained GRAS (Generally Recognized As Safe) status under U.S. Food and Drug Administration (FDA) regulations, thereby permitting its use as a sweetener in foods and beverages. This paper presents all current aspects of tagatose with respect to demonstrated food and beverage applications and the potential health and medical benefits of this unique substance. Summarized studies are referenced to detailed peer-reviewed papers. The safety studies followed the recommendations in the FDA "Red Book." Results were submitted to an Expert Panel for determination of GRAS status under FDA regulation. Small phase 2 clinical trials showed tagatose to be effective in treating type 2 diabetes. The results, buttressed by the references cited, support the efficacy of the various applications disclosed for tagatose. Tagatose has been found to be safe and efficacious for use as a low-calorie, full-bulk sweetener in a wide variety of foods, beverages, health foods, and dietary supplements. It fills broad, heretofore unmet needs for a low-calorie sweetener in products in which the bulk of sugar is important, such as chocolates, chewing gum, cakes, ice cream, and frosted cereals. Its synergism with high-intensity sweeteners also makes it useful in sodas. Various health and medical benefits are indicated, including the treatment of type 2 diabetes, hyperglycemia, anemia, and hemophilia and the improvement of fetal development.

Shifting percussion dullness of the chest: a sign of pleural effusion.

Early physicians diagnosed pleural effusion by detecting shifting percussion dullness of the chest. However, the lateral decubitus positions have not been routinely used to distinguish this condition from atelectasis or pneumonia. In this report, postural alterations of percussion dullness established the diagnosis of pleural effusion in a 49-year-old patient with a cough. Percussion in the lateral decubitus positions may enhance the value of examinations of the chest.

Detection of the liver below the costal margin: comparative value of palpation, light percussion, and auscultatory percussion.

The comparative value of palpation, light percussion, and auscultatory percussion for detecting the liver below costal margin was studied in 45 normal subjects and 20 patients. The presence of the liver 2 cm or more below the costal margin was considered abnormal, since this organ was found no more than 1 cm below in a few normal subjects only by auscultatory percussion. In the patient group, auscultatory percussion detected the liver of 12; four livers and one case of gallbladder-hydrops were detected only by this method. Also, auscultation behind the right flank during percussion identified one hydronephrotic kidney. The liver was detected by palpation in 12 patients and was found only by this method in 6 of them. Light percussion detected the liver in only 6 patients, but was useful in 2 for determining that the liver dome had been depressed in the rib cage. Results of liver function tests were abnormal in 15. These findings suggest that these methods were valuable for detecting liver diseases in patients.

Immediate orthostatic hypotension: diagnostic value in acutely ill patients.

Hypotension (systolic blood pressure less than 90 mm Hg) was induced immediately in 21 acutely ill normotensive patients when they were raised from a supine to an upright position. Systolic blood pressure declined to 80 mm Hg or lower in all patients and to 65 mm Hg or lower in 10 patients when they assumed an upright posture. Immediate orthostatic hypotension observed in 9 patients suggested hypovolemia, which was promptly corrected by rapid infusion of large volumes of normal saline and/or albumin. Orthostatic hypotension was of diagnostic aid in 16 patients, including 4 with infections (pelvic inflammatory disease, occult septic shock, legionnaires' disease, Rocky Mountain spotted fever), 3 with adrenal insufficiency, 2 with acute myocardial infarction, 1 with hypoglycemia, 2 with severe cardiac valvular obstruction, and 4 with inappropriate drug use (enalapril or trazodone). These findings suggest that immediate orthostatic hypotension in acutely ill patients is a physical sign that might have valuable diagnostic and therapeutic implications.

Detection of pneumonia by auscultation of the lungs in the lateral decubitus positions.

Forty-five acutely ill, coughing patients, three with acute dyspnea and cardiomegaly, and 37 control subjects were placed in lateral decubitus positions for auscultation of their dependent lungs to determine if this maneuver would elicit inspiratory crackles, signs of pneumonia. In the upright position, auscultation of the lungs was normal in all control subjects and in lateral decubitus positions their dependent lungs revealed transient late inspiratory crackles in seven of the 37 (18.9%), and transient inspiratory peeling sounds in two others (5.4%). Thirteen acutely ill, coughing patients, free of prior cardiac and pulmonary diseases, had persistent late inspiratory crackles induced in one or both dependent lungs when placed in lateral decubitus positions. These dependent lungs also revealed increased numbers of crackles in three patients, late inspiratory squeaks in four, and wheezes in three others. In the upright position, auscultation of the lungs was normal in 10 of these patients, and a few basilar crackles were heard in three others. All of these abnormal findings cleared after treatment with antibiotics. Thirty-one of 32 acutely ill, coughing patients with bronchitis, sinusitis, or pharyngitis were free of induced crackles in dependent lungs in lateral decubitus positions. However, placement of two other patients in these positions appeared to have elicited the inspiratory crackles of chronic pulmonary disease and early congestive heart failure. These observations suggest that placement of acutely ill, coughing patients into lateral decubitus positions for auscultation of the dependent lungs may be a valuable maneuver for diagnosis of pneumonia.