Navigating a Pandemic: The Unique Role of the Medical Director.

The sudden emergence of the COVID-19 pandemic in early 2020 presented a unique challenge for medical directors of life insurance companies. Company leadership required quick answers about many issues, but two in particular: 1) the magnitude of the pandemic's impact on the insured lives portfolio and 2) the underwriting of new applicants during a pandemic. This article will describe the experiences of a global team of reinsurance medical directors during a pandemic.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy.

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation.

Superior Capsular Reconstruction for Massive Rotator Cuff Tear with Malunion of the Greater Tuberosity in a Young Patient: A Case Report and Review of the Literature.

We describe a 37-year-old female treated with superior capsular reconstruction (SCR) for a nonfunctional rotator cuff in a patient with surgical malunion of the greater tuberosity of the proximal humerus. Despite initially improving, at one year follow-up the patient's acromiohumerual distance had narrowed and pain had increased, resulting in loss of motion. A nonfunctional rotator cuff in the setting of greater tuberosity malunion and superior humeral head migration may not be amenable to SCR.

Differential effects and potential adverse outcomes of ionic silver and silver nanoparticles in vivo and in vitro.

Nanoparticles are of concern because of widespread use, but it is unclear if metal nanoparticles cause effects directly or indirectly. We explored whether polyvinylpyrrolidone-coated silver nanoparticles (PVP-AgNPs) cause effects through intact nanoparticles or dissolved silver. Females of the model species fathead minnow (Pimephales promelas) were exposed to either 4.

Antifreeze proteins modify the freezing process in planta.

During cold acclimation, winter rye (Secale cereale L. cv Musketeer) plants accumulate antifreeze proteins (AFPs) in the apoplast of leaves and crowns. The goal of this study was to determine whether these AFPs influence survival at subzero temperatures by modifying the freezing process or by acting as cryoprotectants.