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"Wilson, Bryan"
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Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients
Objective: Below normal end-tidal carbon dioxide measurement (ETCO2) is associated with worse outcomes in sepsis and trauma patients as compared to patients with normal ETCO2. We sought to determine if ETCO2 can be used in the prehospital setting to predict transfusion requirement, operative hemorrhage control, or mortality in the first 24 h after admission for trauma.
Methods: This is a retrospective cohort study at a suburban, academic Level 1 Trauma Center. Patients were sequentially identified as prehospital trauma alerts from a single EMS system which requires, per policy, ETCO2 for all traumas. One year of prehospital data was collected and paired with hospital trauma registry data. Comparisons were made between ETCO2 values for patients who required transfusion, operative blood loss control, or who died, and those who did not.
Results: Two hundred thirty-five trauma patients were transported via the study EMS system, of which 105 (44.7%) had documented ETCO2 values. Patient mean age was 60 (SD24) years with 59 (56.2%) male. Three patients were intubated prehospital and seven were intubated in the trauma bay. Mean prehospital ETCO2 for those who needed transfusion, surgery, or died (n = 11) was 25.7 (9.1) compared to 30.6 (7.8) for those who did not (p = 0.049). Optimal cutoff for our population was EtCO2 ≤ 27 with a sensitivity of 72.7% (95% CI 32–93) and specificity of 72.2% (62–81).
Conclusion: Below normal ETCO2 values were associated with increase need for transfusion, operative intervention, and death. Further study is warranted to determine if ETCO2 outperforms other predictors of severe trauma.
Journal Article
خفايا الاستغلال الجنسي في وسائل الإعلام
الهدف من الاستغلال الإعلامي الجنسي هو بسيط : من اجل اثارة و استغلال غرائزك الجنسية الرئيسية الموجودة في عقلك الباطن، ومن اجل اهداف ليست لك ولا يمكنك السيطرة عليها، الهدف ربما يبدو بسيطا، ولكن علم النفس والتقنيات الإعلامية الموظفة الخبيرة هي معقدة و ماكرة بشكل لا يمكن تصديقه، وهي مخادعة بشكل يكفي لدحر واجتياز كل دفاعاتك الطبيعية. هذا الكتاب غير العادي يكشف كل الطرق التي تقوم بها كل من المجلات والصحف والأقنية التلفزيونية والافلام والموسيقى الشعبية، والتي تقوم على مبدء الاغتصاب والاستغلال الفكري للشعب.
Book
Disposition, outcomes, and lengths of stay due to bupropion overdose at a tertiary care center with a medical toxicology service
Bupropion is an antidepressant with unique mechanisms of action leading to a narrow therapeutic window. Parallel to increasing indications, there is an increasing number of overdoses and fatalities attributable to bupropion overdose. Due to the serious effects of a bupropion overdose including arrhythmias and early or delayed seizures, these patients necessitate prolonged monitoring with high levels of medical care. In the setting of a tertiary care center with a medical toxicology consult service, our institution is heavily relied upon to manage these patients. This study was performed to provide clarity on the resources used, lengths-of-stay, and treatments provided for these patients.
All patients at a tertiary care center with an oral bupropion overdose and a medical toxicology consult less than 24 h after the ingestion were included between July 15, 2017 and October 14, 2021. Chart review was performed to determine lengths-of-stay, the unit of disposition, treatments provided, and outcomes.
A total of 73 cases were identified with 36 bupropion-only ingestions. Most cases were transferred from outside facilities, developed seizures, had QRS prolongation; and almost a third required intubation. The vast majority were admitted to an ICU and received GABA-A agonists. A median of 1.47 days per case was spent in the ED or ICU. There was an average of 41.9 ED or ICU bed-days per year and 68.5 non-psychiatric bed-days per year occupied by a patient after a bupropion overdose at a single center.
Bupropion overdose necessitates high resource utilization which we believe will increase with the expanding indications for its use.
Journal Article
Yoko Ono : one woman show 1960-1971
Catalog of an exhibition held at the Museum of Modern Art, New York, May 17-Sept. 7, 2015.
Book
Half of Atlantic reef-building corals at elevated risk of extinction due to climate change and other threats
Atlantic reef-building corals and coral reefs continue to experience extensive decline due to increased stressors related to climate change, disease, pollution, and numerous anthropogenic threats. To understand the impact of ocean warming and reef loss on the estimated extinction risk of shallow water Atlantic reef-building scleractinians and milleporids, all 85 valid species were reassessed under the IUCN Red List Categories and Criteria, updating the previous Red List assessment of Atlantic corals published in 2008. For the present assessment, individual species declines were estimated based on the modeled coral cover loss (1989–2019) and projected onset of annual severe bleaching events (2020–2050) across the Atlantic. Species traits were used to scale species’ relative vulnerability to the modeled cover declines and forecasted bleaching events. The updated assessments place 45.88%–54.12% of Atlantic shallow water corals at an elevated extinction risk compared to the previous assessments conducted in 2008 (15.19%–40.51%). However, coral cover loss estimates indicate an improvement in reef coverage compared to the historic time-series used for the 2008 assessments. Based on this, we infer that, although remaining dangerously high, the rate of Atlantic reef coral cover decline has surprisingly slowed in recent decades. However, based on modeled projections of sea-surface temperature that predict the onset of annual severe bleaching events within the next 30 years, we listed 26 (out of 85) species as Critically Endangered in the IUCN Red List. Each of these species had previously been listed under a lower threatened category and this result alone highlights the severe threat future bleaching events pose to coral survival and the reef ecosystems they support.
Journal Article
Flecainide poisoning and prolongation of elimination due to alkalinization
Flecainide is a 1C antidysrhythmic that is primarily used for ventricular tachycardia or premature ventricular contractions when other treatment is ineffective. It has a very narrow therapeutic window which may cause death in a double dose and requires inpatient initiation for cardiac monitoring. Despite established pharmacokinetic data from flecainide in therapeutic dosing, there is negligible data on flecainide toxicokinetics after an intentional overdose. Due to the inherent differences in pharmacokinetic and toxicokinetic principles, rarely can the peak effect or elimination half-life accurately be applied to the poisoned patient after an overdose. In overdose, flecainide can cause a variety of fatal dysrhythmias which may require sodium bicarbonate for stabilization but also may reduce the renal elimination of flecainide, meaning the life-saving treatment may prolong the time of toxicity.
We present a case of an acute ingestion of flecainide with a known time of ingestion and known amount of ingestion who experienced subsequent life-threatening effects which required endotracheal intubation, sodium bicarbonate, aggressive electrolyte repletion, and multiple days in an intensive care unit.
Serial serum and urine samples revealed a prolonged toxic serum concentration of flecainide.
These results demonstrate the change in elimination kinetics of flecainide in the setting of urinary alkalization which is evident through prolonged morphologic changes present on serial electrocardiograms.
Journal Article
Kiki Smith : procession
Artist Kiki Smith has produced an astoundingly varied body of work that deals powerfully with the political, social, philosophical, and spiritual aspects of human nature-especially in the way they relate to women. Smith's earlier works reflect the social discourse of the 1980s, particularly focusing on death and the AIDS epidemic. She later turned to issues of feminism, abortion rights, and animal rights. This comprehensive book provides an overview of Smith's artistic development, focusing on her sculpture, from the early 1980s to the present day. Images of her radical, unflinching work reveal an artist who is not afraid to explore subjects such as the human body or a society's archetypes. Filled with the beauty, vitality, and charm that are the hallmarks of Kiki Smith's art, this book urges viewers to think and feel.
Book
Explosive Pleistocene range expansion leads to widespread Amazonian sympatry between robust and gracile capuchin monkeys
Aim: Capuchin monkey species are widely distributed across Central and South America. Morphological studies consistently divide the clade into robust and gracile forms, which show extensive sympatry in the Amazon Basin. We use genetic data to test whether Miocene or Plio-Pleistocene processes may explain capuchin species' present distributions, and consider three possible scenarios to explain widespread sympatry. Location: The Neotropics, including the Amazon and Atlantic Coastal Forest. Methods: We sequenced the 12S ribosomal RNA and cytochrome b genes from capuchin monkey specimens. The majority were sampled from US museum collections and were wild-caught individuals of known provenance across their distribution. We applied a Bayesian discrete-states diffusion model, which reconstructed the most probable history of invasion across nine subregions. We used comparative methods to test for phylogeographic association and dispersal rate variation. Results: Capuchins contained two well supported monophyletic clades, the morphologically distinct 'gracile' and 'robust' groups. The time-tree analysis estimated a late Miocene divergence between Cebus and Sapajus and a subsequent Plio-Pleistocene diversification within each of the two clades. Bayesian analysis of phylogeographic diffusion history indicated that the current wide-ranging sympatry of Cebus and Sapajus across much of the Amazon Basin was the result of a single explosive late Pleistocene invasion of Sapajus from the Atlantic Forest into the Amazon, where Sapajus is now sympatric with gracile capuchins across much of their range. Main conclusions: The biogeographic history of capuchins suggests late Miocene geographic isolation of the gracile and robust forms. Each form diversified independently, but during the Pleistocene, the robust Sapajus expanded its range from the Atlantic Forest to the Amazon, where it has now encroached substantially upon what was previously the exclusive range of gracile Cebus. The genus Cebus, as currently recognized, should be split into two genera to reflect the Miocene divergence and two subsequent independent Pliocene radiations: Cebus from the Amazon and Sapajus from the Atlantic Forest.
Journal Article