Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study.

Objectives: To determine the prevalence and outcomes associated with hemorrhage, disseminated intravascular coagulopathy, and thrombosis (HECTOR) complications in ICU patients with COVID-19.

Design: Prospective, observational study.

Setting: Two hundred twenty-nine ICUs across 32 countries.

Collaborative Use of Lung Mechanics Simulation for Testing and Iterative Design for Three Emergency Use Ventilation Device Projects.

We describe our collaboration with engineering, clinical, and simulation colleagues to use a lung simulator (IngMar Medical ASL 5000) to aid in the development of 3 open-source ventilation devices for patients with COVID-19.Twenty-nine test conditions were created by programming software lung models of varying disease severity in the ASL 5000 to test basic functionality, safety features, and compliance with regulatory requirements for emergency use authorization for the 3 projects' prototypes. More than 200 simulations were performed, with the design team present to enable rapid troubleshooting and design iteration in real time.

The Impact on COVID-19 by Intravenous Bevacizumab Used for Hereditary Hemorrhagic Telangiectasia: A Case Report.

Coronavirus disease 2019 (COVID-19) continues as an infectious pandemic. With emphasis on mitigating its impact globally, strategies have been emphasized on prevention to treatment in severe cases. As for pharmacotherapies, many have been researched, with a few being recommended for patients with COVID-19 depending upon their severity.

Eating quality of the longissimus thoracis muscle in beef cattle - Contributing factors to the underlying variability and associations with performance traits.

The objective was to determine the factors associated with meat tenderness, juiciness, flavour and chewiness in 4791 growing crossbred cattle. Meat quality of bulls was inferior to that of both steers and heifers with little difference between the latter two genders. Angus, Hereford and Belgian Blues had the most tender meat with the Simmental being the toughest albeit the difference was, on average, only 5%.

Factors associated with the weight of individual primal cuts and their inter-relationship in cattle.

Input parameters for decision support tools are comprised of, amongst others, knowledge of the associated factors and the extent of those associations with the animal-level feature of interest. The objective of the present study was to quantify the association between animal-level factors with primal cut yields in cattle and to understand the extent of the variability in primal cut yields independent carcass weight. The data used consisted of the weight of 14 primal carcass cuts (as well as carcass weight, conformation, and fat score) on up to 54,250 young cattle slaughtered between the years 2013 and 2017.

Linear classification scores in beef cattle as predictors of genetic merit for individual carcass primal cut yields1.

Having access to early predictions of both the genetic merit and expected phenotypic performance of an individual or its progeny can contribute to more informed decision-making. The objective here was to evaluate the usefulness of routinely available subjectively scored linear conformation information on live animals to predict genetic merit for primal carcass cut yields of their relatives. Data on 6 muscular and 6 skeletal traits on 43,078 live animals were used; the weights of up to 14 primal cuts plus 3 groups of primal cuts of 31,827 cattle were also used.

A comparison of the effects of lindane and FeCl/ADP on spontaneous contractions in isolated rat or human term myometrium.

Oxidative stress affects the contractile behavior of smooth muscle resulting in complications during labor. Toxicants such as lindane and ferric chloride (FeCl)/adenosine diphosphate (ADP) cause oxidative stress and have previously been shown to inhibit smooth muscle contraction. In this study we examined the effects of the oxygen species scavengers, ascorbic acid and N-acetylcysteine on lindane and FeCl/ADP's inhibition of spontaneous myometrial contractions in rat and human myometrium.

A Role for Adrenergic Receptors in the Uterotonic Effects of Ergometrine in Isolated Human Term Nonlaboring Myometrium.

Background: Ergometrine is a uterotonic agent that is recommended in the prevention and management of postpartum hemorrhage. Despite its long-standing use, the mechanism by which it acts in humans has never been elucidated fully. The objective of this study was to investigate the role of adrenoreceptors in ergometrine's mechanism of action in human myometrium.

Evaluation of point-of-care maternal venous lactate testing in normal pregnancy.

Objective: There is little information about whether the established non-pregnant adult venous lactate reference range is appropriate for pregnancy. This prospective observational study examined whether the non-pregnant adult reference range is appropriate during pregnancy.

Methods: Women attending for routine prenatal appointments or elective cesarean delivery in a tertiary hospital were recruited.

Validity, discriminative ability, and reliability of the hearing-related quality of life questionnaire for adolescents.

Objectives/hypothesis: The prevalence of hearing loss (HL) in adolescents has grown over the past decade, but hearing-related quality of life (QOL) has not been well-measured. We sought to develop a reliable, valid measure of hearing-related QOL for adolescents and the Hearing Environments And Reflection on Quality of Life (HEAR-QL).

Study Design: Multisite observational study.

Effects of tubing length and coupling method on hearing threshold and real-ear to coupler difference measures.

Purpose: This tutorial demonstrates the effects of tubing length and coupling type (i.e., foam tip or personal earmold) on hearing threshold and real-ear-to-coupler difference (RECD) measures.

Opioid mediated activity and expression of mu and delta opioid receptors in isolated human term non-labouring myometrium.

The existence of opioid receptors in mammalian myometrial tissue is now widely accepted. Previously enkephalin degrading enzymes have been shown to be elevated in pregnant rat uterus and a met-enkephalin analogue has been shown to alter spontaneous contractility of rat myometrium. Here we have undertaken studies to determine the effects of met-enkephalin on in vitro human myometrial contractility and investigate the expression of opioid receptors in pregnant myometrium.

The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage--an observational study.

Background: Fibrinogen replacement is critical in major obstetric haemorrhage (MOH). Purified, pasteurised fibrinogen concentrate appears to have benefit over cryoprecipitate in ease of administration and safety but is unlicensed in pregnancy. In July 2009, the Irish Blood Transfusion Service replaced cryoprecipitate with fibrinogen.

Research regarding debriefing as part of the learning process.

Introduction: Debriefing is a process involving the active participation of learners, guided by a facilitator or instructor whose primary goal is to identify and close gaps in knowledge and skills. A review of existing research and a process for identifying future opportunities was undertaken.

Methods: A selective critical review of the literature on debriefing in simulation-based education was done.

Quality of care in the management of major obstetric haemorrhage.

Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM).

Leadership lessons from military education for postgraduate medical curricular improvement.

Background: quality medical education includes both teaching and learning of data-driven knowledge, and appropriate technical skills and tacit behaviours, such as effective communication and professional leadership. But these implicit behaviours are not readily adaptable to traditional medical curriculum models. This manuscript explores a medical leadership curriculum informed by military education.

Use of medical simulation to explore equipment failures and human-machine interactions in anesthesia machine pipeline supply crossover.

Background: High-fidelity medical simulation can be used to explore failure modes of technology and equipment and human-machine interactions. We present the use of an equipment malfunction simulation scenario, oxygen (O(2))/nitrous oxide (N(2)O) pipeline crossover, to probe residents' knowledge and their use of anesthetic equipment in a rapidly escalating crisis.

Methods: In this descriptive study, 20 third-year anesthesia residents were paired into 10 two-member teams.

Patient simulation: a literary synthesis of assessment tools in anesthesiology.

High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology.

Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

Background And Objective: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice.

A comparison of the inhibitory effects of bupivacaine and levobupivacaine on isolated human pregnant myometrium contractility.

Background: Epidural analgesia with levobupivacaine and bupivacaine is a common and effective method of labor pain relief. However, its use is associated with an increased instrumental delivery rate. One of the mechanisms postulated to account for this unwanted effect is the direct effect of local anesthetics on myometrial contractility.

Monitoring during sedation given by non-anaesthetic doctors.

Conscious sedation is routinely performed by non-anaesthetic doctors. Although guidelines exist to help promote patient safety, it is not clear how stringently these are adhered to. We circulated a questionnaire to non-anaesthetic doctors in training to assess sedation practices.