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Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing.
Methods
EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR).
Results
389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation.
Conclusion
The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.
A wave of recent research challenges the role of regime type in international relations. One striking takeaway is that democratic and autocratic leaders can often achieve similar levels of domestic constraint, which in many issue areas results in similar international outcomes—leading many to question traditional views of democracies as distinctive in their international relations. In this review essay, we use recent contributions in the field to build what we call a “malleable constraints” framework, in which all governments have an institutionally defined default level of domestic audience constraint that is generally higher in democracies, but leaders maintain some agency within these institutions and can strategically increase their exposure to or insulation from this constraint. Using this framework, we argue that regime type is still a crucial differentiator in international affairs even if, as recent studies suggest, democratic and autocratic leaders can sometimes be similarly constrained by domestic audiences and thus achieve similar international outcomes. This framework helps reconcile many competing claims in recent scholarship, including the puzzle of why autocracies do not strategically increase domestic audience constraint more often. Just because autocracies can engage audience constraints and democracies can escape them does not mean that they can do so with equal ease, frequency, or risk.
This paper reports the case of a 13-year-old girl with a 2-year history of left cervical lymph node swelling that was diagnosed as metastatic cribriform adenocarcinoma of the tongue and minor salivary gland.
Case report:
A 13-year-old girl with a left, level II cervical lymph node underwent excisional biopsy after an ultrasound suggested suspicious features. The histology indicated polymorphous low-grade adenocarcinoma, and a primary lesion in the left palate was identified. The patient underwent left maxillectomy, neck dissection and reconstruction. Histological analysis of resection specimens led to a revised diagnosis of cribriform adenocarcinoma of the tongue and minor salivary gland.
Conclusion:
Cribriform adenocarcinoma of the tongue and minor salivary gland has recently been described as a separate entity to polymorphous low-grade adenocarcinoma in light of histological and behavioural differences, including higher rates of metastasis at presentation. This is the first report in the world literature of an adolescent with this entity. It is possible that some previous reports of polymorphous low-grade adenocarcinoma in childhood would have been more accurately described as cribriform adenocarcinoma of the tongue and minor salivary gland.
The human malaria parasite, Plasmodium falciparum, is currently being actively studied by molecular biologists. It is hoped that the use of recombinant DNA techniques in this area will give new insights into the biology of the organism and, at the same time, provide new approaches to diagnosis and vaccine development.
Our own studies employ the blood stages of the parasite and cover three main areas: enzymes of importance in parasite metabolism; antigens of potential use in a subunit vaccine; and repetitive DNA as a probe able to distinguish genetically different isolates of P. falciparum and as a species-specific diagnostic tool in human and mosquito infections.
Micro-scale woven structures were replicated 3 dimensionally by conformal coating onto natural woven cotton using a binary reaction of trimethylaluminum and water at 100°C. Even after the woven cotton was removed at 450°C, the woven structures completely remained. Results demonstrate the capability of ALD to penetrate into the complex 3D network structure of natural woven cotton to form uniform coating at low temperature and give insight into general understanding of methodology to translate deposition processes from 2D surface to a 3D network to obtain a uniform coating throughout the sample network bulk. It also shows the possibility of replication of micro-scale structures from highly conformal coatings to give the unique synthesis root of hollow structures.
Throughout his career, Philip C. Jessup was passionately committed to the use of law and diplomacy for the peaceful settlement of international disputes. He provided a generation of leadership in the wide and difficult endeavor that he characterized as “transnational law”—by which he meant to emphasize the importance of a wider storehouse of rules and avoidance of the dogmas and fictions associated with traditional international law.
Litigation of contentious cases before the International Court of Justice has in some instances been a lengthy and comparatively expensive procedure. However, it is not necessarily the Court or its procedure that produces this situation, because governments parties to litigation sometimes feel it is important to retain a number of advocates to plead, and they agree on comparatively long periods for the preparation of written pleadings. Comparing this procedure with ad hoc arbitration before a referee and two arbitrators, the latter looks comparatively swift and inexpensive. However, there are as yet unused possibilities for the International Court to adjudicate cases on a basis comparable in time and expense to ad hoc arbitration. The use of the Court for what might be less important cases would also contribute to its institutional development.