Efficacy of the EZ-IO® needle driver for out-of-hospital intraosseous access - a preliminary, observational, multicenter study

Background Intraosseous (IO) access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO ® in the prehospital setting. Methods During a 24-month period, all cases of prehospital IO access using the EZ-IO ® needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device. Results 77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications) and paramedics (n = 5 applications). Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement). The majority of users (92%) were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied), provided a median score of 10 (range 1-10). Conclusions The EZ-IO ® needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

InSiGHT leads in the implementation of the Human Variome Project

Background With next gen sequencing, the human genome can be sequenced in a few weeks and for a few thousand dollars. Capability is no longer the issue: interpretation is. Assembling information to assist in interpreting the consequences of all base pair changes is the mission of the Human Variome Project (HVP). InSiGHT has collaborated with the HVP, and now, due its coherence and international organization, maintains a Locus Specific Database which is seen as an exemplar for the unfolding of the HVP across the whole genome.

Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables

Although tracheal intubation (TI) in the pre-hospital setting is regularly carried out by emergency medical service (EMS) providers throughout the world, its value is widely debated. Heterogeneity in procedures, providers, patients, systems and stated outcomes, and inconsistency in data reporting make scientific reports difficult to interpret and compare, and the majority are of limited quality. To hunt down what is really known about the value of pre-hospital TI, we determined the rate of reported Utstein airway variables (28 core variables and 12 fixed-system variables) found in current scientific publications on pre-hospital TI. Methods We performed an all time systematic search according to the PRISMA guidelines of Medline and EMBASE to identify original research pertaining to pre-hospital TI in adult patients. Results From 1,076 identified records, 73 original papers were selected. Information was extracted according to an Utstein template for data reporting from in-the-field advanced airway management. Fifty-nine studies were from North American EMS systems. Of these, 46 (78%) described services in which non-physicians conducted TI. In 12 of the 13 non-North American EMS systems, physicians performed the pre-hospital TI. Overall, two were randomised controlled trials (RCTs), and 65 were observational studies. None of the studies presented the complete set of recommended Utstein airway variables. The median number of core variables reported was 10 (max 21, min 2, IQR 8-12), and the median number of fixed system variables was 5 (max 11, min 0, IQR 4-8). Among the most frequently reported variables were "patient category" and "service mission type", reported in 86% and 71% of the studies, respectively. Among the least-reported variables were "co-morbidity" and "type of available ventilator", both reported in 2% and 1% of the studies, respectively. Conclusions Core data required for proper interpretation of results were frequently not recorded and reported in studies investigating TI in adults. This makes it difficult to compare scientific reports, assess their validity, and extrapolate to other EMS systems. Pre-hospital TI is a complex intervention, and terminology and study design must be improved to substantiate future evidence based clinical practice.

Undergraduate Research Experiences in Biology: Alternatives to the Apprenticeship Model

This is the first in a series of articles exploring some of the approaches advocated in the American Association for the Advancement of Science's (AAAS) Vision and Change in Undergraduate Biology Education (AAAS, 2011a ), an effort within the biology community to address the needs of undergraduate education in the life sciences (Woodin et al., 2009 , 2010 ) in response to the dramatic and rapid transformations in biology in recent decades (National Research Council, 2009 ). The Vision and Change report describes a number of ways to meet the needs of the 21st-century undergraduate. Here, we address one of the changes advocated in that report—the call to “introduce the scientific process to students early, and integrate it into all undergraduate biology courses.” We review a representative sampling of recent innovations integrating scientific research experiences within the biology curriculum. Most (but not all) of the examples given are drawn from the recent literature and from projects presented at a recent meeting of principal investigators from the National Science Foundation's Course, Curriculum and Laboratory Improvement/Transforming Undergraduate Education in Science, Technology, Engineering and Mathematics (STEM) program (AAAS, 2011b ). We hope that this sampling will provide new insights and ideas that will encourage more faculty members to consider ways to involve their undergraduate students in research. In addition to outlining a variety of approaches being used, this article briefly addresses, first, the way in which different biological subdisciplines (e.g., ecology, molecular biology, genomics) and different types of institutions are incorporating this approach into their curriculum and, second, the outcomes that are beginning to emerge and the tools being developed to document and evaluate these outcomes. The opportunity to conduct independent research as an undergraduate has often been cited as the compelling experience that launches a scientific career (National Research Council, 2003 ; A. Roe, as cited in Lopatto, 2010 ). The benefits of such experiences have been chronicled both anecdotally (Cejda and Hensel, 2009) and in studies that span institutional types and disciplinary approaches (Russell et al., 2007 ; Lopatto, 2010 ). The apprenticeship model, in which students conduct independent research projects in an individual faculty member's laboratory, is a well-established approach to providing independent research experiences. As the demand for undergraduate research experiences increases, the strain on institutions and faculty trying to meet this demand becomes more evident. Whereas this approach is critical for providing students with an inside view of how science proceeds and for socializing them into the scientific community, it requires a great deal of financial and faculty resources. Thus, its reach is very limited. The apprenticeship model is especially difficult for institutions where research is not a large part of their institutional mission, and many students, particularly those from populations currently underrepresented in the STEM professional community, may not seek out these opportunities. The need for alternative ways of bringing the benefits of undergraduate research experiences to students and engaging them in the scholarly community is becoming increasingly evident.

Matching for Several Sparse Nominal Variables in a Case-Control Study of Readmission Following Surgery

Matching for several nominal covariates with many levels has usually been thought to be difficult because these covariates combine to form an enormous number of interaction categories with few if any people in most such categories. Moreover, because nominal variables are not ordered, there is often no notion of a "close substitute" when an exact match is unavailable. In a case-control study of the risk factors for read-mission within 30 days of surgery in the Medicare population, we wished to match for 47 hospitals, 15 surgical procedures grouped or nested within 5 procedure groups, two genders, or 47 × 15 × 2 = 1410 categories. In addition, we wished to match as closely as possible for the continuous variable age (65-80 years). There were 1380 readmitted patients or cases. A fractional factorial experiment may balance main effects and low-order interactions without achieving balance for high-order interactions. In an analogous fashion, we balance certain main effects and low-order interactions among the covariates; moreover, we use as many exactly matched pairs as possible. This is done by creating a match that is exact for several variables, with a close match for age, and both a "near-exact match" and a "finely balanced match" for another nominal variable, in this case a 47 × 5 = 235 category variable representing the interaction of the 47 hospitals and the five surgical procedure groups. The method is easily implemented in R.

Multisensor Remote Sensing of Forest Dynamics in Central Siberia

The forested regions of Siberia, Russia are vast and contain about a quarter of the world's forests that have not experienced harvesting. However, many Siberian forests are facing twin pressures of rapidly changing climate and increasing timber harvest activity. Monitoring the dynamics and mapping the structural parameters of the forest is important for understanding the causes and consequences of changes observed in these areas. Because of the inaccessibility and large extent of this forest, remote sensing data can play an important role for observing forest state and change. In Central Siberia, multi-sensor remote sensing data have been used to monitor forest disturbances and to map above-ground biomass from the Sayan Mountains in the south to the taiga-tundra boundaries in the north. Radar images from the Shuttle Imaging Radar-C (SIR-C)/XSAR mission were used for forest biomass estimation in the Sayan Mountains. Radar images from the Japanese Earth Resources Satellite-1 (JERS-1), European Remote Sensing Satellite-1 (ERS-1) and Canada's RADARSAT-1, and data from ETM+ on-board Landsat-7 were used to characterize forest disturbances from logging, fire, and insect damage in Boguchany and Priangare areas.

“The Universal Alliance of All Peoples”: Romantic Socialists, the Human Family, and the Defense of Empire during the July Monarchy, 1830–1848

This article documents the procolonial rhetoric among romantic socialists in France during the July Monarchy (1830–48), demonstrating its pervasiveness. It argues that these years must be highlighted as key to the transition from eighteenthcentury universalist ideas of humanity toward taxonomies of national, racial, and sexual difference that underpinned the rationale of empire in the second half of the nineteenth century. It explores the views on colonialism espoused by socialists such as Etienne Cabet, Pierre Leroux, Constantin Pecqueur, and Jean Reynaud; situates them in the broad socialist consensus on empire; and demonstrates the relationship between these men’s socialism and their colonialism. Further, it contextualizes their advocacy for colonialism in relation to contemporary debates about the abolition of slavery and free trade. Finally, it demonstrates the coexistence of universalist and particularist language in romantic socialist discourse on colonial expansion and its importance to the developing logic of the mission civilisatrice. Colonies are the offspring of nations. Through colonies nations multiply and perpetuate themselves and, becoming truly productive, give birth to regular families; reciprocal ties of affection bind one to another from lands that, without this kinship of populations, would remain strangers and perhaps enemies; and by progress toward the universal alliance of all peoples, political societies are established in the heart of which war is a crime and peace a duty. Jean Reynaud, 1837 Jean Reynaud, the author of the 1837 entry “Colonies” in the Encyclopédie nouvelle (the nineteenthcentury socialist “addendum” to the masterwork of Diderot and d’Alembert), presented a mandate for French colonial expansion in exceptionally idealistic and universalist terms. “Here is the colonial order,” he tells his audience, “such as reason might conceive it, such as our children will doubtless institute it, but not as the crude past has revealed it.”1 In describing the colonial Naomi J. Andrews is assistant professor of history at Santa Clara University. Her most recent book is Socialism’s Muse: Gender in the Intellectual Landscape of French Romantic Socialism (2006). The author would like to thank Michelle Burnham, Katharine Hamerton, Amy Randall, Jennifer Sessions, and Nancy Unger for their comments on previous versions of this article, as well as the anonymous readers for their insightful suggestions. 1 Jean Reynaud, “Colonies,” in Encyclopédie nouvelle, ed. Pierre Leroux and Jean Reynaud, vol. 3 (1837; repr. Geneva, 1991), 681–86. 474 FRENCH HISTORICAL STUDIES project in this way, Reynaud both valorized the abstract concept of colonization and condemned previous colonial orders for their inhumanity and brutality. Reynaud’s juxtaposition of a humanitarian agenda with an unequivocal endorsement of colonial expansion is evidence of an intellectual transition under way in his day that reshaped the logic of empire in the era of the abolition of slavery and that redefined the way that diversity within the human community was understood and delineated. The rhetorical negotiation of this transition, in this instance by romantic socialists, affords us insight into the forces impinging on the universalist ideals of the Enlightenment at the beginning of the nineteenth century. The postrevolutionary history of France marks a profound shift away from Enlightenment aspirations—however grandiose and incomplete in their implementation—of the eighteenth century.2 Framed by a series of imperial, national, and conceptual transitions, the romantic period was characterized by shifts in the discourses of race and nation, shifts informed by the necessity to reinvent empire in the era of the abolition of slavery.3 During these decades, social theorists in Europe developed increasingly polarized definitions of human populations based on perceived biological and ethnic differences, marking a move away from the environmentalism of prerevolutionary thinkers.4 2 The shortcomings of French universalism are central to the historiography of modern France and are particularly carefully explored in regard to republican political institutions in Joan W. Scott, Only Paradoxes to Offer: French Feminists and the Rights of Man (Cambridge, MA, 1996); Scott, Parité! Sexual Equality and the Crisis of French Universalism (Chicago, 2005); and Scott, The Politics of the Veil (Princeton, NJ, 2007). Internal contradictions exist in both the “ideal” and the “real” forms of universalism, as Margaret A. Majumdar notes: “The contradiction between the particular and the universal is there from the outset of the revolutionary period, when the legitimacy of the political state is derived from a universalist concept of human rights and natural justice, but incarnated in the sovereignty of the particular nation” (“Exceptionalism and Universalism: The Uneasy Alliance in the FrenchSpeaking World,” in The French Exception, ed. Emmanuel Godin and Tony Chafer [New York, 2005], 17). For a discussion of French universalism as it pertains to slavery and empire in the revolutionary era, see Alyssa Goldstein Sepinwall, The Abbé Grégoire and the French Revolution: The Making of Modern Universalism (Berkeley, CA, 2005). 3 This was a process initiated in the British Empire somewhat earlier; see Christopher Leslie Brown, Moral Capital: Foundations of British Abolitionism (Chapel Hill, NC, 2006). For the impact of abolition on race thinking, see Catherine Hall, Civilising Subjects: Metropole and Colony in the English Imagination, 1830–1867 (Chicago, 2002); Frederick Cooper, Thomas C. Holt, and Rebecca J. Scott, Beyond Slavery: Explorations of Race, Labor, and Citizenship in Postemancipation Societies (Chapel Hill, NC, 2000); and Holt, The Problem of Freedom: Race, Labor, and Politics in Jamaica and Britain, 1832–1938 (Baltimore, MD, 1991). 4 Progressive models of human development originated in Enlightenment thought, of course, but took on hierarchical permanence in the nineteenth century. See Martin S. Staum, Labeling People: French Scholars on Society, Race, and Empire, 1815–1848 (Montreal, 2003); Claude Blanckaert, “On the Origins of French Ethnology,” in Bones, Bodies, Behavior: Essays on Biological Anthropology, ed. George Stocking Jr. (Madison, WI, 1988), 18–55. On socialist involvement, see Loïc Rignol and Philippe Régnier, “Races et politique dans l’histoire de France chez Victor Courtet de l’Isle (1813–1867): Enjeux de savoir et luttes de pouvoir aux XIXe siècle,” and Sandrine Lemaire, “Gustave d’Eichthal, ou les ambiguïtés d’une ethnologie saintsimonienne,” in Etudes saintsimoniennes, ed. Philippe Régnier (Lyon, 2002), 127–52, 153–76. ROMANTIC SOCIALISTS 475 For scholars of this transition, the exigencies of democratization, fed by nationalism, hobbled the universalist ambitions of the prerevolutionary decades.5 Sorting humanity according to biological criteria of difference and along progressive indices, these theories came to legitimate a global hierarchy of inequity unrivaled in prior or subsequent eras.6 Where Enlightenment critics had seen parallels between imperialism and slavery, by the era of the Restoration and the July Monarchy these two issues had become disengaged.7 Like many of their contemporaries, romantic socialists in these years were both antislavery and proempire, advocating the colonization not only of Algeria but of Madagascar and Guyana as well.8 If a common thread runs through their colonialism, it is their preoccupation with metropolitan social problems and the potential of the colonies to remedy them.9 Moreover, their stance on empire exemplifies the coexistence of multiple ways of defining humanity during this transitional period, as they were at once universalist and particularist, internationalist and nationalist. Thus although aspects of socialist philosophy were articulated in universalist language, often through the metaphor of the family, the movement also exemplified the conceptual move away from allinclusive notions of humanity and toward the hierarchical taxonomies that became hegemonic later in the nineteenth century. Drawing on both Enlightenment and Christian themes, romantic socialists articulated a view of empire that both redeemed the crimes of slavery and envisioned solutions to the increasingly urgent problems of modernizing, industrial European society and, in particular, of the working classes. During these years, then, even the most “utopian” and “universal” thinkers of the nineteenth century, the preMarxian romantic socialists, participated in the project of biological differentiation and contributed to constructing a logic of difference 5 Jennifer Pitts, A Turn to Empire: The Rise of Imperial Liberalism in Britain and France (Princeton, NJ, 2005). 6 These theories reach their apogee throughout Europe after 1850. See Neil MacMaster, Racism in Europe, 1870–2000 (New York, 2001), 13. 7 For more on this disconnect, see Sankar Muthu, Enlightenment against Empire (Princeton, NJ, 2003), and Pitts, Turn to Empire, which act as “bookends” to this transition. 8 See Desiré Laverdant, Colonisation de Madagascar (Paris, 1844); and Jules Lechevalier, Notes sur la fondation d’une nouvelle colonie dans la Guyane Française (Paris, 1844). On Lechevalier’s “associationist” scheme for Guyana, see Lawrence Jennings, “French Slave Liberation and Socialism: Projects for ‘Association’ in Guadeloupe, 1845–48,” Slavery and Abolition 17, no. 2 (1996): 93–111; Jack Haywood, “From Utopian Socialism, via Abolitionism to the Colonisation of French Guiana: Jules Lechevalier’s West Indian Fiasco, 1833–1844,” in De la traite à l’esclavage: Actes du Colloque international sur la traite des noirs, Nantes, 1985, ed. Serge Daget, vol. 2 (Nantes, 1988), 603–26; and Olivier Chaïbo, Jules Lechevalier, pionnier de l’économie sociale (1806–1862) (Paris, 2009). 9 Although this argument bears a relationship to the social imperialism model proposed

The best way to predict the future of library is to invent it : Concept, vision, mission and action of the Code4Lib JAPAN

Heart Rate Response during Mission-Critical Tasks after Space Flight

Adaptation to microgravity could impair crewmembers? ability to perform required tasks upon entry into a gravity environment, such as return to Earth, or during extraterrestrial exploration. Historically, data have been collected in a controlled testing environment, but it is unclear whether these physiologic measures result in changes in functional performance. NASA?s Functional Task Test (FTT) aims to investigate whether adaptation to microgravity increases physiologic stress and impairs performance during mission-critical tasks. PURPOSE: To determine whether the well-accepted postflight tachycardia observed during standard laboratory tests also would be observed during simulations of mission-critical tasks during and after recovery from short-duration spaceflight. METHODS: Five astronauts participated in the FTT 30 days before launch, on landing day, and 1, 6, and 30 days after landing. Mean heart rate (HR) was measured during 5 simulations of mission-critical tasks: rising from (1) a chair or (2) recumbent seated position followed by walking through an obstacle course (egress from a space vehicle), (3) translating graduated masses from one location to another (geological sample collection), (4) walking on a treadmill at 6.4 km/h (ambulation on planetary surface), and (5) climbing 40 steps on a passive treadmill ladder (ingress to lander). For tasks 1, 2, 3, and 5, astronauts were encouraged to complete the task as quickly as possible. Time to complete tasks and mean HR during each task were analyzed using repeated measures ANOVA and ANCOVA respectively, in which task duration was a covariate. RESULTS: Landing day HR was higher (P mission-critical tasks is suggestive of spaceflight-induced deconditioning. Following short-duration microgravity missions (< 16 d), work performance may be transiently impaired, but recovery is rapid.

Soldiers' Physical, Emotional And Cognitive Sustainability During The ISAF (International Security Assistance Force) Mission