Barriers to inclusion: Service dog handlers in science laboratories.

Despite institutional claims of the importance of diversity, equity, and inclusion in STEM, people with disabilities remain under-represented. Current policies neglect to explicitly address inclusion of the growing population of students with disabilities who rely on service dogs, specifically in accessing teaching and research laboratories. With the increase in students registering for post-secondary disability services, the science community has outgrown general policies that primarily outline steps for exclusion of student service dog handlers. Here we discuss barriers and areas in need of improvement and then outline explicit guidelines for inclusion that are currently absent from existing policies. Particular concerns arise in teaching and research laboratories where live animals are present, and we recommend further research is needed to make informed decisions. In order to realize our vision of a diverse STEM workforce, academic institutions and professionals need to recognize barriers to inclusion and consider their role in making science accessible.

Affinity binding assay of glycohemoglobin by two-dimensional centrifugation referenced to hemoglobin A1c.

We describe an automated assay of glycohemoglobin performed with the Abbott Vision analyzer. The assay is based on batch affinity-extraction with 3-aminophenylboronic acid-derivatized agarose beads. Reagents are packaged in a disposable test pack. Whole-blood specimens are hemolyzed with saponin within a glass capillary tube inserted into the test pack. The sample is automatically diluted with, mixed with, and separated from the solid-phase reagent. Bichromatic absorbance readings are used to calculate the percentage of hemoglobin bound. Based on the linear correlation between affinity-measured glycohemoglobin and HPLC-measured hemoglobin A1c, the percentage of hemoglobin bound is converted to a "standardized %HbA1c" result by use of regression parameters stored during a calibration run. The combination of affinity methodology with standardization by reference to HPLC produces values directly comparable with those obtained by methods specific for HbA1c. The method produces 10 results within 15 min. The assay operates with CVs < 5%, and the results correlate highly with those by ion-exchange and affinity minicolumn methods, and by ion-exchange HPLC.

Adaptation during surgical stress. A reevaluation of the role of glucocorticoids.

Pharmacologic doses of glucocorticoids are administered to patients with adrenal insufficiency during operative procedures to prevent hemodynamic instability, cardiovascular collapse, and death. Since these supraphysiologic doses might not be necessary and might have adverse effects, we examined the effects of different doses of glucocorticoids on hemodynamic adaptation during surgical stress in adrenalectomized primates. Sham-adrenalectomized placebo-treated animals served as controls. Adrenalectomized monkeys were maintained for 4 mo on physiologic glucocorticoid and mineralocorticoid replacement. The adrenalectomized monkeys were then stratified into three groups receiving, respectively, subphysiological (one-tenth the normal cortisol production rate), physiological, or supraphysiological (10 times the normal cortisol production rate) cortisol (hydrocortisone) treatment. 4 d later a cholecystectomy was performed. The intraoperative hemodynamic and metabolic parameters, perioperative survival rates, and postoperative wound healing were compared. The subphysiologically treated group was hemodynamically unstable before, during, and after surgery and had a significantly higher mortality rate than control. In this group, arterial blood pressure was low, and the cardiac index, systemic vascular resistance index, and left ventricular stroke work index were all reduced, suggesting decreased cardiac contractility and blood vessel tone. In contrast, the physiologically replaced group was indistinguishable from either supraphysiologically treated animals or sham-operated controls. All groups had similar metabolic profiles and normal wound healing. These findings suggest that the permissive actions of physiologic glucocorticoid replacement are both necessary and sufficient for primates to tolerate surgical stress. Supraphysiological glucocorticoid treatment has no apparent advantage during this form of stress in the primate.

An emergency medical system approach to disaster planning.

The increasing prevalence of terrorist attacks and natural disasters has mandated that more emphasis be placed on emergency disaster planning. The report focuses on the 1976 Courthouse bombing in Boston, which generated 20 casualties. Ambulance response by Boston's Emergency Medical Service system was made in 2.5 minutes and all victims were transported from the scene within 20 minutes. Successful management of this incident employed several important principles of disaster planning. These include the initial medical response, staging at the scene, and hospital notification. Additionally, the concept of triage as an integral part of disaster planning is explained with examples of the on-site medical stabilization and treatment of casualties. The importance of these concepts in practice and the necessity of close coordination of ambulance response and the responses of other emergency agencies, i.e., Police and Fire, were clearly demonstrated in the disaster which resulted from the Courthouse bombing.

Management of penetrating heart wounds.

The records of ninety-two patients treated between 1965 and 1976 at the Boston City Hospital for penetrating wounds of the heart were reviewed and the results were compared with a previous series of twenty-five patients admitted to the same institution between 1956 and 1964. The annual incidence rose from 2.8 cases during the first period to 8.0 during the more recent years. Gunshot wounds increased in frequency in the second period. The overall mortality was similar in the two series. However, there were more complex wounds and agonal patients subjected to immediate emergency room thoracotomy during the second phase of this experience. The salvage rate in the latter group of patients gradually improved and averaged 24% between 1965 and 1976. These data indicate that an aggressive approach, including the use of immediate thoracotomy, to the agonal patient with a heart wound will be rewarded with salvage of some patients.