Abstract 192: Pressure Methods for Primary Hemorrhage Control

Introduction: Hemorrhage is the primary cause of death in 35% of traumatic mortalities. However, guidelines give little guidance regarding the best method of applying direct pressure including the mechanics of applying the pressure. Hypothesis: The purpose of this study is to compare the force generated using different techniques of force application. Additionally, we aimed to measure the pressure generated by a pressure wrap using two commonly used types of bandages in comparison to manual pressure. Methods: In this IRB approved study, subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) with a flat force sensitive resistor was used in this study to measure force. Subjects were randomized to application order of each of the following techniques: the finger pads of 3 digits of the right hand, 3 fingers of the right hand with the opposing hand applying counter pressure, or 3 digits of each of two hands on top of the other. The subjects were asked to hold pressure at each application for 10 seconds and all completed each method sequentially. Subjects then applied a compression wrap using either an elastic wrap or self-adhesive wrap. Researchers were not blinded during data collection, but data analysts were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age was 34.2 years (range 26-63). Two hand pressure application generated the most amount of force averaging a constant of 3.75 (SD 1.54) lbs. This was statistically different from one hand application which generated an average of 3.00 (SD 1.29) lbs of force (p <0.001). Comparison of opposing hands to single hand and two hands to opposing hands did not reach statistical significance. Neither pressure wrap technique generated a comparable amount of force to that of manual pressure [0.70 (SD 0.49) lbs vs 1 hand with 10 4x4” gauze pads (p <0.001)]. Conclusions: In this model of bleeding, medical personnel generated the most force when two hands were used to apply pressure over the wound. This study also demonstrated direct manual pressure generated much higher pressures than a pressure dressing.

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Abstract 237: Less is More When Using Gauze to Stop Bleeding

Circulation ◽

10.1161/circ.138.suppl_2.237 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Nathan P Charlton ◽

Robert Solberg ◽

Justin Rizer ◽

Eunice Singletary ◽

William Woods

Keyword(s):

Data Collection ◽

Medical Personnel ◽

First Aid ◽

Dominant Hand ◽

Medical Providers ◽

Hemorrhage Control ◽

Convenience Sample ◽

Bleeding Vessel ◽

Less Is More ◽

Attending Physicians

Introduction: In first aid gauze is often used over the wound to absorb blood while applying pressure. Several sources recommend that if the gauze becomes saturated with blood, add more gauze and apply more pressure but offer no supporting data. However, adding more gauze will theoretically dissipate the force applied to the wound, thereby decreasing the pressure on the required area. Hypothesis: The purpose of this study is to evaluate the pressure generated when adding increasing layers of gauze to a simulated wound. Methods: In this IRB approved study subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) and a flat (<0.5 mm) force sensitive resistor were used to measure force. Subjects were randomized to order of gauze application and were instructed to apply pressure to the simulated wound with three different layers of gauze (10, 20 & 30 4x4 inch cotton gauze, respectively) with the finger pads of 3 digits of the dominant hand as they would to stop bleeding. Subjects were asked to hold pressure for ten seconds and then release. All subjects completed application with each of the three stacks. Researchers were not blinded during data collection, but researchers analyzing data were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age of the subjects was 34.2 years (range 26-63). A steady decline in pressure with increasing amounts of gauze occurred. A stack of 10 4x4 inch gauze pads generated a constant of 3.20 (SD 1.11) lbs of force, 20 gauze pads 2.25 (SD 0.77) lbs of force, 30 gauze pads generated an average constant of only 1.5 (SD 0.54) lbs of force (p <0.001). Conclusions: In this simulated model of bleeding, medical personnel generated the most force on a wound when a stack of 10 4x4 inch gauze was used to apply pressure over the wound. From this study, it is apparent that increasing the amount of gauze will decrease the amount of pressure generated on the wound. As pressure on the bleeding vessel is important in stopping bleeding, this is likely detrimental to hemorrhage control.

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Editorial Note

Journal of Speech Disorders ◽

10.1044/jshd.1101.02 ◽

1946 ◽

Vol 11 (1) ◽

pp. 2-2

Keyword(s):

Editorial Note ◽

Speech Sounds ◽

Left Hand ◽

Hand Column ◽

Right Hand ◽

Infant Speech ◽

The Right

In the article “Infant Speech Sounds and Intelligence” by Orvis C. Irwin and Han Piao Chen, in the December 1945 issue of the Journal, the paragraph which begins at the bottom of the left hand column on page 295 should have been placed immediately below the first paragraph at the top of the right hand column on page 296. To the authors we express our sincere apologies.

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Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽

10.1024/0301-1526/a000060 ◽

2010 ◽

Vol 39 (4) ◽

pp. 344-348 ◽

Cited By ~ 3

Author(s):

Jandus ◽

Bianda ◽

Alerci ◽

Gallino ◽

Marone

Keyword(s):

Skin Biopsy ◽

Intravenous Iron ◽

Small Vessel Vasculitis ◽

High Dose ◽

Raynaud Phenomenon ◽

The Third ◽

Left Elbow ◽

Right Hand ◽

The Right ◽

Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

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Correlation of Metabolic Risk Factors with Sessile Serrated Lesions

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-507 ◽

2020 ◽

Vol 29 (2) ◽

pp. 175-179

Author(s):

Melania Macarie ◽

Simona Bataga ◽

Simona Mocan ◽

Monica Pantea ◽

Razvan Opaschi ◽

...

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Interval Cancer ◽

Metabolic Risk Factors ◽

Control Group ◽

Anatomical Site ◽

Metabolic Risk ◽

Right Colon ◽

Serrated Lesions ◽

The Right

Background and Aims: The importance of sessile serrated lesions (SSLs) in the pathogenesis of colorectal carcinoma has been recently established. These are supposed to cause the so-called “interval cancer”, having a rapidly progressive growth and being difficult to detect and to obtain an endoscopic complete resection. We aimed to establish the most important metabolic risk factors for sessile serrated lesions. Methods: We performed a retrospective case-control study, on a series of 2918 consecutive patients who underwent colonoscopy in Gastroenterology and Endoscopy Unit, County Clinical Emergency Hospital, Târgu-Mureș, Romania between 1 st of January 2015-31 th of December 2017. In order to evaluate the metabolic risk factors for polyps’ development, enrolled participants were stratified in two groups, a study group, 33 patients with SSLs lesions, and a control group, 138 patients with adenomatous polyps, selected by systematic sampling for age and anatomical site. Independent variables investigated were: gender, smoking, alcohol consumption, obesity, arterial hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, nonalcoholic liver disease. Results: For SSLs the most common encountered localization was the right colon in 30.55% of cases. By comparative bivariate analysis between SSLs group and control group, it was observed that hypertension (p=0.03, OR 2.33, 95 %CI 1.03-5.24), obesity (p=0.03, OR 2.61, 95 %CI 1.08-6.30), hyperuricemia (p=0.04, OR 2.72, 95 %CI 1.28-7.55), high cholesterol (p=0.002, OR 3.42; 95 %CI 1.48-7.87), and high triglycerides level (p=0.0006, OR 5.75; 95 %CI 1.92-17.2) were statistically associated with SSLs development. By multivariate analysis hypertension and hypertriglyceridemia retained statistical significance. Conclusions: Our study showed that the highest prevalence of SSLs was in the right colon and hypertension and increased triglycerides levels were associated with the risk of SSLs development. These risk factors are easy to detect in clinical practice and may help identifying groups with high risk for colorectal cancer, where screening is recommended.

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Detection of Sarcoidosis Based on Subcutaneous Nodules in the Dorsum of the Right Hand

Nishi Nihon Hifuka ◽

10.2336/nishinihonhifu.76.14 ◽

2014 ◽

Vol 76 (1) ◽

pp. 14-17

Author(s):

Yoshiyuki KUWAE ◽

Kunitaka HARUNA ◽

Yasushi SUGA

Keyword(s):

Subcutaneous Nodules ◽

Right Hand ◽

The Right

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Awareness of radiation doses and risks among radiology residents, fellows, specialists, consultants and technologists in Jeddah, Saudi Arabia: Cross-Sectional Study. (Preprint)

10.2196/preprints.14460 ◽

2019 ◽

Author(s):

Bashayer Hassan Shuaib ◽

Rahaf Hisham Niazi ◽

Ahmed Haitham Abduljabbar ◽

Mohammed Abdulraheem Wazzan

Keyword(s):

Interventional Radiology ◽

Ionizing Radiation ◽

Statistical Significance ◽

Knowledge Score ◽

P Value ◽

Radiation Doses ◽

Cross Sectional ◽

The Right ◽

Interventional Radiology Procedures ◽

Radiology Staff

BACKGROUND Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. OBJECTIVE This study aimed to discover and compare the awareness level of radiation doses, protection issues, and risks among radiology staff in Jeddah hospitals. METHODS A cross-sectional survey containing 25 questions on personal information and various aspects of radiation exposure doses and risks was designed using an online survey tool and the link was emailed to all radiology staff in eight tertiary hospitals in Jeddah. The authors were excluded from the study. A P-value of < .05 was used to identify statistical significance. All analyses were performed using SPSS, version 21. RESULTS Out of 156 participants the majority 151 (96.8%) had poor knowledge score, where the mean scores were 2.4±1.3 for doses knowledge, 2.1±1.1for cancer risks knowledge, 2.3±0.6 for general information, and 6.7±1.9 for the total score. Only 34.6% of the participants were aware of the dosage of a single-view chest x-ray, and 9.0% chose the right answer for the approximate effective dose received by a patient in a two-view. 42.9% were able to know the correct dose of CT abdomen single phase. There is a significant underestimation of cancer risk of CT studies especially for CT abdomen where only 23.7% knew the right risk. A p-value of <0.05 was used to identify statistical significance. No significant difference of knowledge score was detected regarding gender (P =.2) or work position (P=.66). CONCLUSIONS Our survey results show considerable inadequate knowledge in all groups without exception. We recommended a conscientious effort to deliver more solid education and obtain more knowledge in these matters and providing periodic training courses to teach how to minimize the dose of radiation and to avoid risk related. CLINICALTRIAL not applicable

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Construct Validity

10.1093/oso/9780190661557.003.0008 ◽

2017 ◽

Author(s):

Richard McCleary ◽

David McDowall ◽

Bradley J. Bartos

Keyword(s):

Time Series ◽

Construct Validity ◽

Hypothesis Test ◽

Secondary Data ◽

Time Frame ◽

Primary Data ◽

Optimal Time ◽

Intervention Model ◽

Right Hand ◽

The Right

Chapter 8 focuses on threats to construct validity arising from the left-hand side time series and the right-hand side intervention model. Construct validity is limited to questions of whether an observed effect can be generalized to alternative cause and effect measures. The “talking out” self-injurious behavior time series, shown in Chapter 5, are examples of primary data. Researchers often have no choice but to use secondary data that were collected by third parties for purposes unrelated to any hypothesis test. Even in those less-than-ideal instances, however, an optimal time series can be constructed by limiting the time frame and otherwise paying attention to regime changes. Threats to construct validity that arise from the right-hand side intervention model, such as fuzzy or unclear onset and responses, are controlled by paying close attention to the underlying theory. Even a minimal theory should specify the onset and duration of an impact.

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Digit Variability in Carotenoid Scores Obtained with the Veggie Meter: A Pilot Study (P02-001-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz029.p02-001-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Velarie Ansu ◽

Stephanie Dickinson ◽

Alyce Fly

Keyword(s):

Indiana University ◽

Left Hand ◽

Funding Sources ◽

Right Hand ◽

Period Data ◽

The Mean ◽

The Right ◽

Post Hoc ◽

Main Effects ◽

Mean Square Errors

Abstract Objectives To determine which digit and hand have the highest and lowest skin carotenoid scores, to compare inter-and-intra-hand variability of digits, and to determine if results are consistent with another subject. Methods Two subjects’ first(F1), second(F2), third(F3) and fifth(F5) digits on both hands were measured for skin carotenoids with a Veggie Meter, for 3 times on each of 18 days over a 37-day period. Data were subjected to ANOVA in a factorial treatment design to determine main effects for hand (2 levels), digits (4), and days (18) along with interactions. Differences between digits were determined by Tukey's post hoc test. Results There were significant hand x digit, hand x day, digit x day, and hand x digit x day interactions and significant simple main effects for hand, digit, and day (all P < 0.001). Mean square errors were 143.67 and 195.62 for subject A and B, respectively, which were smaller than mean squares for all main effects and interactions. The mean scores ± SD for F1, F2, F3, and F5 digits for the right vs left hands for subject A were F1:357.13 ± 45.97 vs 363.74 ± 46.94, F2:403.17 ± 44.77 vs. 353.20 ± 44.13, F3:406.76 ± 43.10 vs. 357.11 ± 45.13, and F5:374.95 ± 53.00 vs. 377.90 ± 47.38. For subject B, the mean scores ± SD for digits for the right vs left hands were F1:294.72 ± 61.63 vs 280.71 ± 52.48, F2:285.85 ± 66.92 vs 252.67 ± 67.56, F3:268.56 ± 57.03 vs 283.22 ± 45.87, and F5:288.18 ± 34.46 vs 307.54 ± 40.04. The digits on the right hand of both subjects had higher carotenoid scores than those on the left hands, even though subjects had different dominant hands. Subject A had higher skin carotenoid scores on the F3 and F2 digits for the right hand and F5 on the left hand. Subject B had higher skin carotenoid scores on F5 (right) and F1 (left) digits. Conclusions The variability due to hand, digit, and day were all greater than that of the 3 replicates within the digit-day for both volunteers. This indicates that data were not completely random across the readings when remeasuring the same finger. Different fingers displayed higher carotenoid scores for each volunteer. There is a need to conduct a larger study with more subjects and a range of skin tones to determine whether the reliability of measurements among digits of both hands is similar across the population. Funding Sources Indiana University.

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Approximating pointwise products of quasimodes

Forum Mathematicum ◽

10.1515/forum-2019-0208 ◽

2020 ◽

Vol 32 (3) ◽

pp. 541-552

Author(s):

Mei Ling Jin

Keyword(s):

Vector Space ◽

Harmonic Analysis ◽

Riemannian Manifolds ◽

Spectral Projection ◽

Beltrami Operator ◽

Singular Potentials ◽

Link Type ◽

Right Hand ◽

Low Degree ◽

The Right

AbstractWe obtain approximation bounds for products of quasimodes for the Laplace–Beltrami operator on compact Riemannian manifolds of all dimensions without boundary. We approximate the products of quasimodes uv by a low-degree vector space {B_{n}}, and we prove that the size of the space {\dim(B_{n})} is small. In this paper, we first study bilinear quasimode estimates of all dimensions {d=2,3}, {d=4,5} and {d\geq 6}, respectively, to make the highest frequency disappear from the right-hand side. Furthermore, the result of the case {\lambda=\mu} of bilinear quasimode estimates improves {L^{4}} quasimodes estimates of Sogge and Zelditch in [C. D. Sogge and S. Zelditch, A note on L^{p}-norms of quasi-modes, Some Topics in Harmonic Analysis and Applications, Adv. Lect. Math. (ALM) 34, International Press, Somerville 2016, 385–397] when {d\geq 8}. And on this basis, we give approximation bounds in {H^{-1}}-norm. We also prove approximation bounds for the products of quasimodes in {L^{2}}-norm using the results of {L^{p}}-estimates for quasimodes in [M. Blair, Y. Sire and C. D. Sogge, Quasimode, eigenfunction and spectral projection bounds for Schrodinger operators on manifolds with critically singular potentials, preprint 2019, https://arxiv.org/abs/1904.09665]. We extend the results of Lu and Steinerberger in [J. F. Lu and S. Steinerberger, On pointwise products of elliptic eigenfunctions, preprint 2018, https://arxiv.org/abs/1810.01024v2] to quasimodes.

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Differences in digit ratios between gay men who prefer receptive versus insertive sex roles indicate a role for prenatal androgen

Scientific Reports ◽

10.1038/s41598-021-87338-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ashlyn Swift-Gallant ◽

Victor Di Rita ◽

Christina A. Major ◽

Christopher J. Breedlove ◽

Cynthia L. Jordan ◽

...

Keyword(s):

Gay Men ◽

Sex Role ◽

Gender Nonconformity ◽

Critical Periods ◽

Same Sex ◽

Digit Ratios ◽

Right Hand ◽

Prenatal Androgens ◽

The Right ◽

Prenatal Androgen

AbstractAmong non-human mammals, exposure to androgens during critical periods of development leads to gynephilia (attraction to females), whereas the absence or low levels of prenatal androgens leads to androphilia (attraction to males). However, in humans, retrospective markers of prenatal androgens have only been associated with gynephilia among women, but not with androphilia among men. Here, we asked whether an indirect indication of prenatal androgen exposure, 2D:4D, differs between subsets of gay men delineated by anal sex role (ASR). ASR was used as a proxy for subgroups because ASR groups tend to differ in other measures affected by brain sexual differentiation, such as gender conformity. First, we replicated the finding that gay men with a receptive ASR preference (bottoms) report greater gender nonconformity (GNC) compared to gay men with an insertive ASR preference (tops). We then found that Tops have a lower (male-typical) average right-hand digit ratio than Bottoms, and that among all gay men the right-hand 2D:4D correlated with GNC, indicating that a higher (female-typical) 2D:4D is associated with increased GNC. Differences were found between non-exclusive and exclusive same-sex attraction and GNC, and ASR group differences on digit ratios do not reach significance when all non-heterosexual men are included in the analyses, suggesting greater heterogeneity in the development of non-exclusive same-sex sexual orientations. Overall, results support a role for prenatal androgens, as approximated by digit ratios, in influencing the sexual orientation and GNC of a subset of gay men.

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