Παρασκευή 29 Ιουλίου 2016

Aspergillus fumigatus MADS-Box Transcription Factor rlmA Is Required for Regulation of the Cell Wall Integrity and Virulence

The Cell Wall Integrity (CWI) pathway is the primary signaling cascade that controls the de novo synthesis of the fungal cell wall and in Saccharomyces cerevisiae, this event is highly dependent on the RLM1 transcription factor. Here, we investigated the function of RlmA in the fungal pathogen Aspergillus fumigatus. We show that the rlmA strain exhibits an altered cell wall organization in addition to defects related to vegetative growth and tolerance to cell wall-perturbing agents. A genetic analysis indicated that rlmA is positioned downstream of the pkcA and mpkA genes in the CWI pathway. As a consequence, rlmA loss-of-function leads to the altered expression of genes encoding cell wall-related proteins. RlmA positively regulates the phosphorylation of MpkA and is induced at both protein and transcriptional levels during cell wall stress. The rlmA was also involved in tolerance to oxidative damage and transcriptional regulation of genes related to oxidative stress adaptation. Moreover, the rlmA strain had attenuated virulence in a neutropenic murine model of invasive pulmonary aspergillosis. Our results suggest that RlmA functions as a transcription factor in the A. fumigatus CWI pathway acting downstream of PkcA-MpkA signaling and contributing to the virulence of this fungus.



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The Evolution of the FT/TFL1 Genes in Amaranthaceae and Their Expression Patterns in the Course of Vegetative Growth and Flowering in Chenopodium rubrum

The FT/TFL1 gene family controls important aspects of plant development: MFT -like genes affect germination, TFL1 -like genes act as floral inhibitors, FT -like genes are floral activators. Gene duplications produced paralogs with modified functions required by the specific lifestyles of various angiosperm species.We constructed the transcriptome of the weedy annual plant Chenopodium rubrum and used it for the comprehensive search for the FT/TFL1 genes. We analyzed their phylogenetic relationships across Amaranthaceae and all angiosperms. We discovered a very ancient phylogenetic clade of FT genes represented by the CrFTL3 gene of C. rubrum. Another paralog CrFTL2 showed an unusual structural rearrangement which might have contributed to the functional shift. We examined the transcription patterns of the FT/TFL1 genes during the vegetative growth and floral transition in C. rubrum to get cues about their possible functions. All the genes except for the constitutively expressed CrFTL2 gene, and the CrFTL3 gene, which was transcribed only in seeds, exhibited organ-specific expression influenced by the specific light regime. The CrFTL1 gene was confirmed as a single floral activator from the FT/TFL1 family in C. rubrum. Its floral promoting activity may be counteracted by CrTFL1. C. rubrum emerges as an easily manipulated model for the study of floral induction in weedy fast-cycling plants lacking a juvenile phase.



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Characterization of a Novel MMS-Sensitive Allele of Schizosaccharomyces pombe mcm4+

The minichromosome maintenance (MCM) complex is the conserved helicase motor of the eukaryotic replication fork. Mutations in the Mcm4 subunit are associated with replication stress and double strand breaks in multiple systems. In this work we characterize a new temperature sensitive allele of Schizosaccharomyces pombe mcm4+ Uniquely amongst known mcm4 alleles, this mutation causes sensitivity to the alkylation damaging agent methyl methanesulfonate (MMS). Even in the absence of treatment or temperature shift, mcm4-c106 cells show increased repair foci of RPA and Rad52, and require the damage checkpoint for viability, indicating genome stress. The mcm4-c106 mutant is synthetically lethal with mutations disrupting fork protection complex (FPC) proteins Swi1 and Swi3. Surprisingly, we found that the deletion of rif1+ suppressed the MMS sensitive phenotype without affecting temperature sensitivity. Together, these data suggest that mcm4-c106 destabilizes replisome structure.



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Table of Contents



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Table of Contents



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Table of Contents



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Table of Contents



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Differences in bone mineral density between cortical bone trajectory and traditional lumbar pedicle screws: commentary

Mai HT, Mitchell SM, Hashmi SZ, Jenkins TJ, Patel AA, Hsu WK. Differences in bone mineral density of fixation points between lumbar cortical and traditional pedicle screws. Spine J 2016:16:835–41 (in this issue).

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Editorial Board



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A response to comments by Dr. Manchikanti and Dr. Hirsch

We would like to touch on some of the comments made in the Letter to the Editor entitled "Introduction of a Predictive Model for Epidural Steroid Injections Leads to Inappropriate and Inaccurate Conclusions."

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Meetings Calendar



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Introduction of a predictive model for epidural steroid injections leads to inappropriate and inaccurate conclusions

Sivaganesan et al.'s [1] introduction of a predictive model using the patient and the disease-specific effectiveness of lumbar epidural steroid injections in degenerative spine disorders is a worthwhile idea but suffers from limitations.

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Table of Contents



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Is early vertebroplasty/kyphoplasty justified in multiple myeloma given the rapid vertebral fracture progression?

COMMENTARY ON: Xiao R, Miller JA, Margetis K, et al. Radiographic progression of vertebral fractures in patients with multiple myeloma. Spine J 2016:16:822–32 (in this issue).

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'Hacksaw Ridge' trailer

'Hacksaw Ridge' tells the extraordinary true story of WWII army medic Desmond Doss

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'Hacksaw Ridge' trailer

'Hacksaw Ridge' tells the extraordinary true story of WWII army medic Desmond Doss

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'Hacksaw Ridge' trailer

'Hacksaw Ridge' tells the extraordinary true story of WWII army medic Desmond Doss

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'Hacksaw Ridge' trailer

'Hacksaw Ridge' tells the extraordinary true story of WWII army medic Desmond Doss

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5 intense obstacle courses for off-duty training

Training is an important component of EMS success. It takes dedication every day to become the best physical version of yourself and in turn, the best EMT you can be.

There are many opportunities for endurance – you've probably heard of obstacle events, which have been growing in popularity over the years. They are a terrific way to train and are designed to build team relationships, perfect training techniques and grow personal confidence. These events focus on fundamentals over winning a prize for completion. In our opinion, these are the best obstacle races you can explore for all-around optimal training.

1. Spartan Race

There are three main race types with the Spartan: the Sprint, the Super and the Beast. The Sprint is about 3 miles with more than 20 obstacles to traverse. It's the shortest race Spartan offers and best suited for beginners. The Super spans over 8 miles with 25 obstacles. The Beast is the longest of the three. It spans over 12 miles with 30 obstacles.

If these options aren't enough for you, Spartan also offers endurance races, including the Ultra Beast, which is more than 26 miles in length and boasts more than 60 obstacles.

If you're looking for a training regimen before signing up, Spartan offers daily workout tips for you to consider.

2. Zombie Mud Run

This 5k obstacle race diversifies from the others with a unique angle. You'll complete traditional Army boot camp-like obstacles like wall climbing and also face interesting obstacles like zombies, all in the mud. You can sign up to participate as a human or as a zombie. The human team carries three flags, which represent vital organs – brains, heart and entrails. Team Zombie sets out so steal your flags (your vital organs) while you complete the other obstacles.

3. Warrior Dash

The Warrior Dash is exceptionally proud of the obstacles they've fine-tuned for their course (a 5k). They currently feature 12 obstacles like the Fisherman's Catch, where upper body strength and core stability will help you cross a net without becoming bait, or Goliath, where you'll climb to the crest of a 30-foot-high slide and descend into water. You can see a full list of obstacles on their website.

4. GORUCK Challenge

This event has wonderful roots, which is why we've selected it for this list. The GORUCK Challenge was initially developed by Jason McCarthy to:

  • Serve as a voice for good.
  • Employ more veterans of Special Operations than any organization outside the U.S. military.
  • Build a bridge between the military and civilians.

The original event is a 10-12 hour and 15-20 mile event based on Special Forces training. You'll even learn from a Special Forces Cadre while participating.

4. Civilian Military Combine (CMC)

This 5-mile race with 25 obstacles is different from the rest because of the cross-training warmup in "The PIT" at the beginning of the event. The PIT entails a five-minute AMRAP (as many reps as possible) workout of the day. We should also mention that one of the obstacles at CMC, the Flying Monkey, was featured on American Ninja Warrior. The CMC doesn't mess around.

What's the last fitness event you participated in" Would you recommend it" Share your preferred method of training in the comments below.



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Evidence of alterations in transcallosal motor inhibition as a possible long-term consequence of concussions in sports: a transcranial magnetic stimulation study

In the last two decades, concussions have been in the spotlight because of their high incidence in in youth sports such as football and ice hockey, accounting for 3-8% of all sport-related injuries presenting at the emergency (Pfister et al., 2016). Concussions are classified as mild traumatic brain injuries (mTBI) (Cassidy et al., 2014, Levin et al., 2015) and are associated with a wide range of symptoms at the physical, cognitive and affective level, including headaches, fatigue, dizziness, attention and memory problems (Lovell et al., 2006).

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Single-dose effects on the P3no-go ERP component predict clinical response to stimulants in pediatric ADHD

Attention-deficit hyperactivity disorder (ADHD) is a common developmental disorder involving problems with attention and/or hyperactivity and impulsivity. It is typically identified in childhood, with symptoms often persisting throughout adulthood (Faraone, et al. 2000). Comorbid disorders in behavior, emotion, learning, and autism spectrum are common (Hermens, et al. 2006,American Psychiatric Association. 2013). Prevalence of ADHD is approximately 3%–7% in school-aged children (Willcutt. 2012,Paule, et al.

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Pernicious anemia and colorectal cancer risk – A nested case–control study

Hypergastrinemia was shown to stimulate colonic epithelial cell proliferation.

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Total and cancer mortality in a cohort of ulcerative colitis and Crohn's disease patients: The Florence inflammatory bowel disease study, 1978–2010

There is no consensus on the leading causes of death among inflammatory bowel diseases (IBD) patients.

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Pernicious anemia and colorectal cancer risk – A nested case–control study

Hypergastrinemia was shown to stimulate colonic epithelial cell proliferation.

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Total and cancer mortality in a cohort of ulcerative colitis and Crohn's disease patients: The Florence inflammatory bowel disease study, 1978–2010

There is no consensus on the leading causes of death among inflammatory bowel diseases (IBD) patients.

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NJ EMT, officer save crash victim whose leg had been severed

HOWELL TOWNSHIP, N.J. — An EMT and police officer saved the life of an 82-year-old man after he was run over by a garbage truck Thursday. 

Howell Police EMS EMT Ryan Gerrity and Cpl. Matthew Bishop responded to the scene, where they found the man was run over by a large garbage truck. The man's leg was amputated and he suffered multiple traumatic injuries and was bleeding out. 

Bishop immediately applied a tourniquet from his medical bag to the man's thigh to stop femoral bleeding, wrote Howell Police Chief Andrew Kudrick on the department's Facebook page

Gerrity applied a tourniquet to the victim's arm, a move that likely saved the man's life, Kudrick wrote. The victim was then transported to the hospital, where he is in serious condition. 

"I was just doing my job," Cpl. Bishop said. 

While the crash is still under investigation, preliminary reports did not find the garbage truck driver at fault. 



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8-year-old donates $2.2K from lemonade stand to first responders

BATON ROUGE, La. — Benjamin Chiasson became one of the youngest and most unlikely donors to the Baton Rouge Area Foundation's First Responders Fund when he and his mother gave $2,200 to the charity this week.

The 30-year-old organization has seen a large influx of donations since July 17, when six Baton Rouge officers were attacked in the line of duty. Three officers were killed in the attack.

Upon hearing the news, Benjamin was inspired to action. He started a small lemonade stand, but no one predicted that the outcome would be so successful.

Even his mother expected he would raise a sum closer to $200 than $2,000.

"I just wanted to raise money for the officers," Benjamin told WBRZ News. "This is one thing I decided to do."

 


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The impact of repetition mechanics on the adaptations resulting from strength-, hypertrophy- and cluster-type resistance training

Abstract

Purpose

The purpose of this study was to examine the acute and chronic training responses to strength-, hypertrophy- and cluster-type resistance training.

Methods

Thirty-four trained males were assigned to a strength [STR: 4 × 6 repetitions, 85 % of one repetition maximum, (1RM), 900 s total rest], hypertrophy (HYP: 5 × 10 repetitions, 70 % 1RM, 360 s total rest), cluster 1 (CL-1: 4 × 6/1 repetitions, 85 % 1RM, 1400 s total rest), and cluster 2 (CL-2: 4 × 6/1 repetitions, 90 % 1RM, 1400 s total rest) regimens which were performed twice weekly for a 6-week period. Measurements were taken before, during and following the four workouts to investigate the acute training stimulus, whilst similar measurements were employed to examine the training effects before and after the intervention.

Results

The improvements in 1RM strength were significantly greater for the STR (12.09 ± 2.75 %; p < 0.05, d = 1.106) and CL-2 (13.20 ± 2.18 %; p < 0.001, d = 0.816) regimens than the HYP regimen (8.13 ± 2.54 %, d = 0.453). In terms of the acute responses, the STR and CL-2 workouts resulted in greater time under tension (TUT) and impulse generation in individual repetitions than the HYP workout (p < 0.05). Furthermore, the STR (+3.65 ± 2.54 mmol/L−1) and HYP (+6.02 ± 2.97 mmol/L−1) workouts resulted in significantly greater elevations in blood lactate concentration (p < 0.001) than the CL-1 and CL-2 workouts.

Conclusion

CL regimens produced similar strength improvements to STR regimens even when volume load was elevated (CL-2). The effectiveness of the STR and CL-2 regimens underlines the importance of high loads and impulse generation for strength development.



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Low-volume high-intensity swim training is superior to high-volume low-intensity training in relation to insulin sensitivity and glucose control in inactive middle-aged women

Abstract

Purpose

We tested the hypothesis that low-volume high-intensity swimming has a larger impact on insulin sensitivity and glucose control than high-volume low-intensity swimming in inactive premenopausal women with mild hypertension.

Methods

Sixty-two untrained premenopausal women were randomised to an inactive control (n = 20; CON), a high-intensity low-volume (n = 21; HIT) or a low-intensity high-volume (n = 21; LIT) training group. During the 15-week intervention period, HIT performed 3 weekly 6–10 × 30-s all-out swimming intervals (average heart rate (HR) = 86 ± 3 % HRmax) interspersed by 2-min recovery periods and LIT swam continuously for 1 h at low intensity (average HR = 73 ± 3 % HRmax). Fasting blood samples were taken and an oral glucose tolerance test (OGTT) was conducted pre- and post-intervention.

Results

After HIT, resting plasma [insulin] was lowered (17 ± 34 %; P < 0.05) but remained similar after LIT and CON. Following HIT, 60-min OGTT plasma [insulin] and [glucose] was lowered (24 ± 30 % and 10 ± 16 %; P < 0.05) but remained similar after LIT and CON. Total area under the curve for plasma [glucose] was lower (P < 0.05) after HIT than LIT (660 ± 141 vs. 860 ± 325 mmol min L−1). Insulin sensitivity (HOMA-IR) had increased (P < 0.05) by 22 ± 34 % after HIT, with no significant change after LIT or CON, respectively. Plasma soluble intracellular cell adhesion molecule 1 was lowered (P < 0.05) by 4 ± 8 and 3 ± 9 % after HIT and CON, respectively, while plasma soluble vascular cell adhesion molecule 1 had decreased (P < 0.05) by 8 ± 23 % after HIT only.

Conclusions

These findings suggest that low-volume high-intensity intermittent swimming is an effective and time-efficient training strategy for improving insulin sensitivity, glucose control and biomarkers of vascular function in inactive, middle-aged mildly hypertensive women.



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Does knee joint cooling change in vivo patellar tendon mechanical properties?

Abstract

Purpose

This study aimed to assess the influence of knee joint cooling on the in vivo mechanical properties of the patellar tendon.

Methods

Twenty young, healthy women volunteered for the study. B-mode ultrasonography was used to record patellar tendon elongation during isometric ramp contraction of the knee extensors (5–7 s, 90° knee angle) and calculate tendon stiffness. Skin temperature was measured by infrared thermometry. Data were acquired before and after 30 min of local icing of the knee joint and compared by paired samples t-tests.

Results

After cold exposure, skin temperature as measured over the patellar tendon dropped by 16.8 ± 2.0 °C. Tendon stiffness increased from 2189 ± 551 to 2705 ± 902 N mm−1 (+25 %, p = 0.007). Tendon strain decreased by 9 % (p = 0.004). A small, albeit significant reduction in maximum tendon force was observed (−3.3 %, p = 0.03).

Conclusions

Knee cooling is associated with a significant increase in patellar tendon stiffness. The observed tendon stiffening may influence the operating range of sarcomeres, possibly limiting the maximal force generation capacity of knee extensor muscles. In addition, a stiffer tendon might benefit rate of force development, thus countering the loss in explosiveness typically described for cold muscles.



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A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration

Abstract

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4–23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322–1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.



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Funeral home treats police, EMS to thank-you lunch

By Brie Handgraaf
The Wilson Daily Times

The lunch provided to area emergency personnel on Thursday at Joyner's Funeral Home was more than just a meal. It was a thank-you.

"We're a small community and we should look out for each other," said Dell Joyner, fourth-generation owner of the funeral home on Raleigh Road Parkway. "That is what life is supposed to be like. Imagine how much better the world would be if we all did just a little to help one another."

The idea for the lunch was spurred by the growing animosity for law enforcement — whether local police, sheriff's deputies or highway patrolmen — across the country as a way to reassure forces in Wilson and Nash counties that their efforts are appreciated.

"Law enforcement is our first line of defense against anarchy," Joyner said. "You can't truly lay your head down at night to rest if they weren't working. With all of our emergency services, you can call 24/7 and get friendly people at your door ready to help."

For that reason, the luncheon was opened up to all emergency personnel with hundreds cycling through the business for food and fellowship.

"It is great for them to show their appreciation by feeding us and having us come together as law enforcement and emergency service partners," said Wilson police spokesman Sgt. Steve Stroud. "It is not very often where we get to meet each other in a pleasant environment instead of at critical incidents."

Wilson County Emergency Medical Services Director Terry Barber said he was thankful EMTs were included in the event.

"I think it really shows the partnership we have with other emergency agencies," Barber said. "Law enforcement is being persecuted, but as a whole, we stand together as first responders doing important jobs in trying circumstances."

Joyner said the event involved an outpouring of support from staff and volunteers combined with contributions from other businesses.

"Several things were donated like the bread and beans by Bailey Cafe," he said. "We asked them to get it at-cost for us, but they gave it to us instead. Others donated some items and a local farmer donated the watermelon that we iced down overnight so it just melts in your mouth.

"We didn't care if we bought it all since we wanted to do this, but when word got out, the community wrapped its arms around us because they saw the importance in doing this for our emergency personnel."

Even when temperatures reached 100 degrees, Don Taylor of Road Hogs BBQ kept the grill filled with hot dogs and burgers while others helped fill up the plates of responders who took a break to eat in air-conditioning with coworkers or took it to go.

"This is a chance for the community efforts of our officers to come full-circle," Stroud said. "The police department wants to reach out to the community, but we also want them to reach back out to us. That is what partnerships are all about."

Copyright 2016 The Wilson Daily Times



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Paramedic Andy Bruch embraces EMS in the bayou

When Andy Bruch relocated from Bluefield, West Virginia to New Iberia, Louisiana in 1981, he adapted to local protocols and customs fairly quickly.

Learning about Louisiana wildlife took a little longer.

"I'd just started working for Acadian in New Iberia when we were sent to an MVC in the swamp," says Bruch. "I opened the back doors of the ambulance and left to check on our patient.

"When we came back to the unit, I noticed the white interior had turned totally black thanks to the state bird of Louisiana, the mosquito. There were so many bugs in the truck we had to clear them out before we could put the patient in."

That wasn't Bruch's only reminder he wasn't in West Virginia anymore.

"We were working an overturn on Highway 90 between Lafayette and New Iberia. I was on the ground helping to extricate the patient when I felt something strange on my legs. I looked down and I was covered with fire ants.

"When they started biting in unison, I did this little dance to try shaking them off. That didn't help, so I ended up having to pull my pants off right there on the side of a major road. The cop directing traffic was laughing so hard, I thought he was going to cause another wreck.

"Good thing I wasn't going commando that day."

EMS in his blood
Bruch comes by his interest in EMS genetically, or so it seems. Older brother Bobby, 60, is a paramedic and sister Katherine, 49, is a full-bird Army colonel who began her career as a combat medic.

"I started volunteering in Bluefield in 1974 when I was 16," says Andy. "They let me ride as an 'ambulance attendant' because I'd learned advanced first-aid already, through the Boy Scouts."

Bruch says EMS in West Virginia was pretty informal back then.


Paramedic Bruch in 1986.

"The camaraderie was great. We'd play pool and ping pong at headquarters, then go down the street to the Bluefield Auditorium and stand by at what we called the 'hog stomp' — a good old mountain music festival every Saturday night.

"My brother and I used to bring the ambulance home sometimes, too. If we got a call, we'd go out and run it, then come back. Our parents were very understanding about those interruptions."

A passion for education
Bruch became one of West Virginia's first EMTs shortly after that certification was introduced in the mid-'70s. By 1978 he'd upgraded to EMT-I, then graduated from Marshall University's paramedic program in '79. He didn't stop there, though.

"I got my B.S. in biology from Bluefield State College in 1981," Bruch says. "Right after that I was recruited by Acadian and moved to Louisiana."


Bruch plays a STEMI patient for his students.

Bruch added a Master's in Health Science Administration in 1987 and a Nursing degree in '93. By then he'd gained experience as an instructor and supervisor at Acadian. He says the late Norman McSwain was a big help along the way.

"The thing that impressed me most about Dr. McSwain is that he wasn't too good to help with anything. If somebody needed a chuck bucket, by golly, he'd go in there and hold the chuck bucket.

"He'd ask us, 'What have you done to benefit mankind lately?' He didn't mean, what did you do last week; he meant today. He believed you shouldn't rest on your laurels."

After 42 years in EMS, Bruch tries to pass along experience plus advice he's accumulated from McSwain and other mentors.

"You'll have good days and bad days," he says. "Most days are good, just like most people in this world are good, but you will have that day from hell. It will test you and try you and weigh on you heavily. You just have to work through it.

"A friend of mine had four pediatric cardiac arrests in a very short period of time. He dealt with the first one and the second one fairly well, but eventually couldn't work in the field because they weighed too heavily on his mind.

"You just have to understand everything comes in cycles. Don't dwell on it — there are better times ahead."

Whole lotta shakin'
For Bruch, some of those better times are combinations of EMS and another interest of his, music.

"I was working a jazz festival in New Orleans, where Jerry Lee Lewis was opening for Elton John," he remembers. "Well, 'The Killer' comes on and starts doing Whole Lotta Shakin' Goin' On. You can probably guess what happened next: one of the folks in the crowd got all worked up and went into a grand mal seizure. Not that I'd take delight at anyone's misfortune, but you can't help appreciating the irony.

"Another time I was dispatched with my good friend Kevin Freeman to a cardiac arrest at a Fleetwood Mac concert. We heard CPR was in progress, so we ran out in front of the crowd and climbed up the railings to see if we could spot the patient. I remember glancing up on stage and seeing Stevie Nicks looking at me like, what in the world are you doing?

"We finally found the patient, who was not in cardiac arrest, but had heat exhaustion. However, some guy in the crowd claimed he did five chest compressions before the patient came around, so Kevin and I figured we could brag about it as a 'save.'"

Don't stop thinking about tomorrow
At 58, Bruch says he doesn't plan on leaving EMS anytime soon.

"Thanks to the benefits they have here at Acadian, I could retire in a few years, but I don't see any reason to. I still enjoy it. As long as I'm physically and mentally capable of handling the job, I plan on doing what I've been doing.

"Except maybe dancing with fire ants."

Andy rocking the colors of Acadian Ambulance.

 


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EMS Specialist II - Mountain-Valley EMS Agency

Perform various administrative, analytical and oversight activities related to specialty healthcare facilities for a multi-county EMS Agency. Coordinate disaster preparedness plans and activities. Knowledge of prehospital emergency medical care procedures, techniques and protocols; prehospital systems operations and procedures; data analysis techniques; law and regulations related to prehospital care ...

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Paramedic Andy Bruch embraces EMS in the bayou

When Andy Bruch relocated from Bluefield, West Virginia to New Iberia, Louisiana in 1981, he adapted to local protocols and customs fairly quickly.

Learning about Louisiana wildlife took a little longer.

"I'd just started working for Acadian in New Iberia when we were sent to an MVC in the swamp," says Bruch. "I opened the back doors of the ambulance and left to check on our patient.

"When we came back to the unit, I noticed the white interior had turned totally black thanks to the state bird of Louisiana, the mosquito. There were so many bugs in the truck we had to clear them out before we could put the patient in."

That wasn't Bruch's only reminder he wasn't in West Virginia anymore.

"We were working an overturn on Highway 90 between Lafayette and New Iberia. I was on the ground helping to extricate the patient when I felt something strange on my legs. I looked down and I was covered with fire ants.

"When they started biting in unison, I did this little dance to try shaking them off. That didn't help, so I ended up having to pull my pants off right there on the side of a major road. The cop directing traffic was laughing so hard, I thought he was going to cause another wreck.

"Good thing I wasn't going commando that day."

EMS in his blood
Bruch comes by his interest in EMS genetically, or so it seems. Older brother Bobby, 60, is a paramedic and sister Katherine, 49, is a full-bird Army colonel who began her career as a combat medic.

"I started volunteering in Bluefield in 1974 when I was 16," says Andy. "They let me ride as an 'ambulance attendant' because I'd learned advanced first-aid already, through the Boy Scouts."

Bruch says EMS in West Virginia was pretty informal back then.


Paramedic Bruch in 1986.

"The camaraderie was great. We'd play pool and ping pong at headquarters, then go down the street to the Bluefield Auditorium and stand by at what we called the 'hog stomp' — a good old mountain music festival every Saturday night.

"My brother and I used to bring the ambulance home sometimes, too. If we got a call, we'd go out and run it, then come back. Our parents were very understanding about those interruptions."

A passion for education
Bruch became one of West Virginia's first EMTs shortly after that certification was introduced in the mid-'70s. By 1978 he'd upgraded to EMT-I, then graduated from Marshall University's paramedic program in '79. He didn't stop there, though.

"I got my B.S. in biology from Bluefield State College in 1981," Bruch says. "Right after that I was recruited by Acadian and moved to Louisiana."


Bruch plays a STEMI patient for his students.

Bruch added a Master's in Health Science Administration in 1987 and a Nursing degree in '93. By then he'd gained experience as an instructor and supervisor at Acadian. He says the late Norman McSwain was a big help along the way.

"The thing that impressed me most about Dr. McSwain is that he wasn't too good to help with anything. If somebody needed a chuck bucket, by golly, he'd go in there and hold the chuck bucket.

"He'd ask us, 'What have you done to benefit mankind lately"' He didn't mean, what did you do last week; he meant today. He believed you shouldn't rest on your laurels."

After 42 years in EMS, Bruch tries to pass along experience plus advice he's accumulated from McSwain and other mentors.

"You'll have good days and bad days," he says. "Most days are good, just like most people in this world are good, but you will have that day from hell. It will test you and try you and weigh on you heavily. You just have to work through it.

"A friend of mine had four pediatric cardiac arrests in a very short period of time. He dealt with the first one and the second one fairly well, but eventually couldn't work in the field because they weighed too heavily on his mind.

"You just have to understand everything comes in cycles. Don't dwell on it — there are better times ahead."

Whole lotta shakin'
For Bruch, some of those better times are combinations of EMS and another interest of his, music.

"I was working a jazz festival in New Orleans, where Jerry Lee Lewis was opening for Elton John," he remembers. "Well, 'The Killer' comes on and starts doing Whole Lotta Shakin' Goin' On. You can probably guess what happened next: one of the folks in the crowd got all worked up and went into a grand mal seizure. Not that I'd take delight at anyone's misfortune, but you can't help appreciating the irony.

"Another time I was dispatched with my good friend Kevin Freeman to a cardiac arrest at a Fleetwood Mac concert. We heard CPR was in progress, so we ran out in front of the crowd and climbed up the railings to see if we could spot the patient. I remember glancing up on stage and seeing Stevie Nicks looking at me like, what in the world are you doing"

"We finally found the patient, who was not in cardiac arrest, but had heat exhaustion. However, some guy in the crowd claimed he did five chest compressions before the patient came around, so Kevin and I figured we could brag about it as a 'save.'"

Don't stop thinking about tomorrow
At 58, Bruch says he doesn't plan on leaving EMS anytime soon.

"Thanks to the benefits they have here at Acadian, I could retire in a few years, but I don't see any reason to. I still enjoy it. As long as I'm physically and mentally capable of handling the job, I plan on doing what I've been doing.

"Except maybe dancing with fire ants."

Andy rocking the colors of Acadian Ambulance.



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Omega-3 fatty acids control productions of superoxide and nitrogen oxide and insulin content in INS-1E cells

Abstract

Omega-3 fatty acids have multiple effects in peripheral tissues and pancreatic beta cell function. Dietary depletion of omega-3 fatty acids is associated with pancreatic islet dysfunction and insulin resistance in rats. Herein, the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on pancreatic beta cell redox state and function were investigated. INS-1E insulin-secreting cells were incubated with EPA and DHA in combination with palmitic acid, and productions of reactive oxygen species (ROS), nitric oxide (NO) and insulin were measured. The involvement of the NADPH oxidase complex in ROS production and expression of the antioxidant enzymes was also investigated. After incubation for 1 or 48 h, productions of superoxide (by hydroethidine method), nitric oxide (by 4,5-diaminofluorescein diacetate-DAF-2DA assay), insulin (by radioimmunoassay), and expressions (by western blot analysis) of glutathione peroxidase (GPx-1) and gp91PHOX were measured. EPA and DHA reduced superoxide production after 1-h incubation. After 48 h, palmitic acid reduced superoxide production that was normalized by EPA treatment. Palmitic acid increased NO production that was reverted by EPA and DHA. Palmitic acid increased insulin secretion after 48 h, whereas both omega-3 fatty acids increased intracellular insulin content. EPA and DHA enhanced GPx-1 expression as well as gp91PHOX glycosylated form. In conclusion, EPA and DHA increased intracellular insulin content and antioxidant enzymatic defense capacity and decreased pro-oxidant generating activities that are associated with maintenance of pancreatic beta cell redox state in response to palmitic acid.



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Innovation Zone - Black-Fire Gloves

See how the new Halyard Health's BLACK-FIRE* Nitrile Exam Glove protects you when working with patients, when you need to direct traffic – it can even alert you when there's a dangerous rip or tear.

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Innovation Zone - Black-Fire Gloves

See how the new Halyard Health's BLACK-FIRE* Nitrile Exam Glove protects you when working with patients, when you need to direct traffic – it can even alert you when there's a dangerous rip or tear.

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Innovation Zone - Black-Fire Gloves

See how the new Halyard Health's BLACK-FIRE* Nitrile Exam Glove protects you when working with patients, when you need to direct traffic – it can even alert you when there's a dangerous rip or tear.

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Morbidly obese patient slides out of her chair; needs help up

Paramount EMS paramedic takes the time to explain the new lift equipment he is about to use

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Innovation Zone - Black-Fire Gloves

See how the new Halyard Health's BLACK-FIRE* Nitrile Exam Glove protects you when working with patients, when you need to direct traffic – it can even alert you when there's a dangerous rip or tear.

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An observational prospective study on prescribing pattern of drugs among pregnant women admitted in antenatal ward of a tertiary care teaching hospital in coastal town of South India

2016-07-29T09-04-35Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Prasanand Sasidharan, Bhanu Prakash Kolasani, Divyashanthi CM.
Background: Pharmacoepidemiological studies may provide an insight regarding the existing drug use pattern and in planning appropriate interventions to ensure rational drug therapy. Aims and Objectives: This study is aimed to evaluate the prescribing pattern of drugs among pregnant women admitted in antenatal ward of our hospital. Materials and Methods: An observational prospective study was conducted in 72 pregnant women for a period of 6 months. Each prescription was analyzed for demographic variables, various categories of drugs prescribed, individual drugs prescribed in that category, their dosage forms, the World Health Organization core prescribing indicators, and their teratogenic risk. Results: Overall 358 medications were prescribed among which vitamin and mineral supplements (57.26%) were the most commonly prescribed category followed by intravenous fluids (IVFs) (12.57%) and antiemetics (8.38%). Among vitamin and mineral supplements, folic acid (30.24%) was the most commonly prescribed drugs. Ringer lactate (46.67%) was the most commonly prescribed IVF. Ondansetron (66.67%) was the commonly prescribed antiemetics. Most commonly prescribed antimicrobial agents were metronidazole and mebendazole (27.59% each), antiulcer drug was ranitidine (87.5%), analgesic was paracetamol (58.33%), and tetanus toxoid was the only vaccine prescribed. Majority of drugs (75.69%) were prescribed by generic name. Average number of drugs per prescription was 4.97. Percentages of encounters with antibiotic prescribed were 8.10%. The percentage of injections prescribed was 22.91% and that of drugs prescribed from the National List of Essential Medicines (NLEM) was 95.53%. Tablet (43.58%) was the common drug formulation. According to teratogenic risk, category B (56.25%) was highest. Conclusion: On the whole, vitamin and mineral supplements were the most commonly prescribed drugs in our study. Prescription by generic name was high, usage of antibiotics and injections was less, and nearly all drugs were prescribed from NLEM, which indicates rational prescription. Usage of category B drugs must be reduced, and complete avoidance of category D drugs is advised.


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The effect of slow and fast musical tempo on post-exercise recovery on recovery period in young adults

2016-07-29T09-04-35Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Priyanka Ramdas Rane, Jayashree V Gadkari.
Background: Music is a magical medium and powerful too, can be used to soothe and relax. Listening to music reduces muscular and mental tension and thereby decreases sympathetic stimulation and sustains motivation to resist mental and emotional fatigue, and it may even facilitate physical and athletic performance. Aims and Objectives: To determine the effectiveness on various parameters of listening to slow and fast music tempo during post-exercise recovery in young adults. Materials and Methods: The study procedure was carried out on 50 untrained participants of the age group between 18 and 25 years, at the tertiary health center. Each participant performed the Queens step test for 3 min. The recovery period of pulse rate, respiratory rate, and blood pressure (BP) during post-exercise without music on the 1st day, with slow on the 2nd day, and fast music tempo on the 3rd day were recorded. The study was conducted in 3 visits. Results: The data analysis was done by SPSS-IS software. ANNOVA test was used for statistical analysis. The P

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Association between glycemic control and intraocular pressure in patients with Type II diabetes mellitus

2016-07-29T09-04-35Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Shikha Baisakhiya, Punita Garg, Surjit Singh.
Background: Diabetes mellitus is becoming an epidemic in our country and worldwide. It is an important risk factor for raised intraocular pressure (IOP). Raised IOP is associated with a potentially blinding condition known as glaucoma. Identification of factors, which increase the risk of glaucoma, is a mainstay in the early detection and prevention of blindness due to the disease. Aim and Objectives: To investigate the association between glycemic control and IOP in patients of Type II diabetes mellitus. Materials and Methods: The study included 180 participants. Group I included 80 age- and sexmatched normal healthy participants constituting the control group. Group II consisted of 100 diabetic patients. Group II was further subdivided into 3 subgroups according to glycemic control: Group IIA consisted of 36 patients diagnosed with Type II diabetes mellitus with hemoglobin A1c (HbA1C) levels 8% indicating poor glycemic control. The patients were investigated for fasting blood glucose levels, postprandial blood glucose levels, and HbA1C. All participants underwent routine ocular examination including IOP measurement by Goldmann applanation tonometer. Results: The mean IOP in fasting state was statistically significantly lower than IOP in postprandial state (P

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Man reunites with 4 who performed CPR on him at hip-hop concert

By Lauren Williams
The Orange County Register

SANTA ANA, Calif. — Although he remembers nothing of the night, Jesse Anderson knows he owes his life to four men.

Four months ago, Anderson's heart stopped while at a hip-hop show at The Observatory in Santa Ana. Amid a crowd growing around them, a cadre of first responders worked to revive the Cypress resident, performing CPR while pleading with him to fight on.

With a heavy sigh on Wednesday, the 20-year-old walked back into the music venue alongside his parents and girlfriend and shook the hands of the four who worked ceaselessly to restore his pulse and breathing.

"What a beautiful day," said the young man's father, Jeff Anderson. "Thanks to these men my son is still alive. These are my heroes right here."

Minutes before midnight on March 6 at a concert for hip-hop group Flosstradamus, Jesse Anderson collapsed onto his girlfriend, Jenna Wood, inside the Observatory. He had just asked for water when his body crumpled.

With the help of a dozen friends and strangers, Wood carried Anderson's 6-foot 5 frame outside, laying him out in the parking lot. He would later learn, after 10 days in the hospital, that severe dehydration had created an imbalance in electrolytes and denied his heart what it needed to pump blood.

"It was just a complete failure," Anderson said.

The Observatory's medic, Ken Decou, pumped air into Anderson's chest with a bag valve mask, and security guard Duane Lewis pounded on the man's chest to revive his heart.

Santa Ana police Corporal Oscar Lizardi saw Lewis growing tired and took over chest compressions while Officer John Rodriguez kept the crowd at bay. Both Santa Ana policemen were posted at The Observatory for the concert.

They kept going – and kept going.

"I was so far gone people told them to stop CPR," Jesse Anderson said. "I can't thank them enough for sticking to their training."

While concertgoers told the four to stop their efforts, Lizardi thought of his 14-year-old son.

"We did hear comments like, 'Stop. Stop. He's dead,'" Lizardi recalled. "The first thing that came to mind is, 'This is someone's son, and I'm not going to stop.'"

Decou gazed into Anderson's glassy eyes and continued his efforts despite seeing a vacancy.

"The whole time I'm looking into his eyes thinking the worst," Decou said. "He passed away in our minds."

They continued lifesaving efforts until paramedics arrived and took Anderson to Fountain Valley Medical Center. He later was transferred to a Los Angeles hospital.

Now, months later, Anderson has recovered. He and his father set out to arrange a meeting with the four men who saved the 20-year-old.

"I owe everything to them right now," Anderson said. "I can't be happier to be here."

The rescuers were pretty happy, too.

"It's one of the happier moments of my career," said Rodriguez, a 28-year veteran of Santa Ana's force.

"It's like winning the lottery," Decou said.

Copyright 2016 The Orange County Register

 



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EMS providers are held to a higher standard, which includes social media

Negative Facebook comments about protestors may have been wrong, but were their terminations right?

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EMS providers are held to a higher standard, which includes social media

As an EMS provider, what you post online, you post for everyone and forever. You can't take it back and my legal objections to your wrongful termination might not be enough to help you get your job back.

Don't believe me"

Ask the seven South Carolina paramedics and firefighters who were fired over posts they made about Black Lives Matter protesters following a demonstration on July 10, 2016.

I can see three distinct points of view from which to view their terminations.

The first point of view is first responders who believe protesters don't seem to have articulated what exactly they want other than sweeping and dramatic societal change —an understandable perspective for anyone who's had to work demonstrations that have devolved into destruction of property and threat of violence to both the community and the providers themselves. Facebook and other social media outlets are a convenient and peaceful way to vent. Nobody gets physically hurt and frustrated providers are not silenced — no harm, no foul.

From the second vantage point, like it or not, EMS providers are held to a higher standard. You can read my earlier discussion about why that higher standard exists. Among the countless elements of that higher standard is maintaining, not only the perception, but the reality of objective, unbiased care for all in need.

EMS providers are perhaps the most human of humans, but they, like no other humans, cannot allow their objectivity be clouded by political, social, religious or other beliefs. The public trust is the best currency EMS has to accomplish what is expected; it is a currency that cannot afford to be gambled away.

Surely, openly and unabashedly describing humans as speed bumps or targets for water cannons severely undermines the public trust in individual providers and thus undermining all of EMS.

EMS providers are expected to rise above emotion, to be better than that. Facebook and other social media outlets are dangerous and harmful ways to vent. The entire industry gets hurt and EMS providers become targets. Plenty of harm, plenty of foul.

The third vantage point is the whisky-tango-foxtrot side. What were they thinking" What did they honestly think was going to happen"

Social media has made an infinite world entirely finite, if not altogether tiny. In the U.S. there are more registered Facebook users than there are people (I don't understand the math either, but it's true). How can you expect anything you post not to be seen by the wrong people"

Worse yet, as EMS providers, constantly subject to litigation for any of a million reasons, you have to expect that everything and anything you post to a social network can be captured and blown up on a giant screen in a courtroom for the world to see.

Those pictures of you beer-bonging at the river would make great art for a plaintiff's attorney seeking to damage your credibility — for any reason.

Those posts where you describe protesters as speed bumps and threaten to run them over will be manna from heaven to a plaintiff's attorney seeking a zillion dollar settlement for a civil rights violation against your agency, city or county. A plaintiff's attorney will easily show your testimony is not credible, based on the culture of racism and intolerance demonstrated by your posts. It does not have to be true, it only has to look true.

I get it. EMS providers are human; we feel things. But we don't get to vent them publicly. Not anymore. We just don't and that's the way it is.

As for firing the providers … I object!
I am a lawyer. I am quite sure that it was the lawyers who consulted with the agency leaders and recommended termination of these employees to save face and heal whatever wounds may or may not have been opened. This is damage control.

I object to employees being played like pawns and treated like fungible chattel. I invite the agency leaders and their lawyers to take a deep breath and look at the big picture:

These terminated first responders are frustrated human beings. They are called to the front lines of health care and homeland security in ways nobody else in the world is. EMS providers place themselves directly in the line of fire, literally and figuratively, for imperfect strangers.

Their Facebook posts were ill-conceived, inappropriate and irresponsible.

But come on, did anyone think they were serious about harming or killing a protestor" Do their comments undo decades of service and commitment to EMS" Doesn't the agency owe some loyalty and empathy to the providers"

Unfortunately, lawyers have likely turned doing what's right into doing what's expedient. EMS providers deserve better from their agency leaders.

What if, instead of firing these guys, they were retained and debriefed" What if their leaders created opportunities to understand what is frustrating their field personnel and worked to manage those frustrations" What if we could take good people and help them become better" Isn't that what EMS should be doing for its own"

Lastly, this is the time to look at your department and measure the pressure. Maybe it's time to think about how you can prevent this type of situation from occurring at all.



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Spatial orientation in patients with chronic unilateral vestibular hypofunction is ipsilesionally distorted

Innervation of the vestibular organs is provided by two branches of the vestibular nerve: the superior branch receives input from the horizontal and anterior semicircular canal (SCC) and the utriculus, the inferior branch contains axons from the posterior SCC and the sacculus (Gianoli et al., 2005; Curthoys, 2010). Sudden unilateral peripheral-vestibular hypofunction (UVH) typically presents as acute vestibular syndrome (AVS) (Tarnutzer et al., 2011a), i.e., prolonged vertigo/dizziness accompanied by nausea/vomiting nystagmus, gait ataxia and motion intolerance, and may result from isolated superior vestibular neuropathy (SVN), inferior vestibular neuropathy (IVN) or a combination of both (CVN).

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Man reunites with four heroes who performed CPR on him at hip-hop concert

By Lauren Williams
The Orange County Register

SANTA ANA, Calif. — Although he remembers nothing of the night, Jesse Anderson knows he owes his life to four men.

Four months ago, Anderson's heart stopped while at a hip-hop show at The Observatory in Santa Ana. Amid a crowd growing around them, a cadre of first responders worked to revive the Cypress resident, performing CPR while pleading with him to fight on.

With a heavy sigh on Wednesday, the 20-year-old walked back into the music venue alongside his parents and girlfriend and shook the hands of the four who worked ceaselessly to restore his pulse and breathing.

"What a beautiful day," said the young man's father, Jeff Anderson. "Thanks to these men my son is still alive. These are my heroes right here."

Minutes before midnight on March 6 at a concert for hip-hop group Flosstradamus, Jesse Anderson collapsed onto his girlfriend, Jenna Wood, inside the Observatory. He had just asked for water when his body crumpled.

With the help of a dozen friends and strangers, Wood carried Anderson's 6-foot 5 frame outside, laying him out in the parking lot. He would later learn, after 10 days in the hospital, that severe dehydration had created an imbalance in electrolytes and denied his heart what it needed to pump blood.

"It was just a complete failure," Anderson said.

The Observatory's medic, Ken Decou, pumped air into Anderson's chest with a bag valve mask, and security guard Duane Lewis pounded on the man's chest to revive his heart.

Santa Ana police Corporal Oscar Lizardi saw Lewis growing tired and took over chest compressions while Officer John Rodriguez kept the crowd at bay. Both Santa Ana policemen were posted at The Observatory for the concert.

They kept going – and kept going.

"I was so far gone people told them to stop CPR," Jesse Anderson said. "I can't thank them enough for sticking to their training."

While concertgoers told the four to stop their efforts, Lizardi thought of his 14-year-old son.

"We did hear comments like, 'Stop. Stop. He's dead,'" Lizardi recalled. "The first thing that came to mind is, 'This is someone's son, and I'm not going to stop.'"

Decou gazed into Anderson's glassy eyes and continued his efforts despite seeing a vacancy.

"The whole time I'm looking into his eyes thinking the worst," Decou said. "He passed away in our minds."

They continued lifesaving efforts until paramedics arrived and took Anderson to Fountain Valley Medical Center. He later was transferred to a Los Angeles hospital.

Now, months later, Anderson has recovered. He and his father set out to arrange a meeting with the four men who saved the 20-year-old.

"I owe everything to them right now," Anderson said. "I can't be happier to be here."

The rescuers were pretty happy, too.

"It's one of the happier moments of my career," said Rodriguez, a 28-year veteran of Santa Ana's force.

"It's like winning the lottery," Decou said.

Copyright 2016 The Orange County Register

 



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Regression model analysis of the decreasing trend of cesium-137 concentration in the atmosphere since the Fukushima accident

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Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Kyo Kitayama, Kenji Ohse, Nagayoshi Shima, Kencho Kawatsu, Hirofumi Tsukada
The decreasing trend of the atmospheric 137Cs concentration in two cities in Fukushima prefecture was analyzed by a regression model to clarify the relation between the parameter of the decrease in the model and the trend and to compare the trend with that after the Chernobyl accident. The 137Cs particle concentration measurements were conducted in urban Fukushima and rural Date sites from September 2012 to June 2015. The 137Cs particle concentrations were separated in two groups: particles of more than 1.1 μm aerodynamic diameters (coarse particles) and particles with aerodynamic diameter lower than 1.1 μm (fine particles). The averages of the measured concentrations were 0.1 mBq m−3 in Fukushima and Date sites. The measured concentrations were applied in the regression model which decomposed them into two components: trend and seasonal variation. The trend concentration included the parameters for the constant and the exponential decrease. The parameter for the constant was slightly different between the Fukushima and Date sites. The parameter for the exponential decrease was similar for all the cases, and much higher than the value of the physical radioactive decay except for the concentration in the fine particles at the Date site. The annual decreasing rates of the 137Cs concentration evaluated by the trend concentration ranged from 44 to 53% y−1 with average and standard deviation of 49 ± 8% y−1 for all the cases in 2013. In the other years, the decreasing rates also varied slightly for all cases. These indicated that the decreasing trend of the 137Cs concentration was nearly unchanged for the location and ground contamination level in the three years after the accident. The 137Cs activity per aerosol particle mass also decreased with the same trend as the 137Cs concentration in the atmosphere. The results indicated that the decreasing trend of the atmospheric 137Cs concentration was related with the reduction of the 137Cs concentration in resuspended particles.



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