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We offer Human Capital consulting services to companies without dedicated resources to address people issues, and companies needing support in specific areas of managing their people.
Knowing is not enough, we must apply. Willing is not enough, we must do.
PeopleSmart delivers design, development & feedback services for 360 questionnaires, personality and ability testing, MBTI steps I & II, cultural profiling, as well as a range of emotional intelligence surveys.
Today's business leaders must cope with even greater demands in terms of results, efficiency and people management.
You cannot teach a man anything. You can only help him discover it within himself.
Our coaches work with managers and senior executives to address these demands. We don't bring a ready-made answer, but help clients discover them for themselves. The insights we help to reveal will promote change and drive present and future success.
Ever flexible in terms of time and organization, our coaching processes for individuals or groups are designed to help our clients:
- manage stress, change, conflict
- develop influence, impact
- improve communication and presentation skills
- evolve in the organization
- identify more business opportunities
- overcome self-limiting beliefs
- make the most of time and other resources.
Stay in touch with us
4, chemin des Châteaux
92420 Vaucresson
Our network of highly skilled and experienced consultants all share an uncompromising dynamism and enthusiasm. All have a track record of success in business and many have either run their own businesses or spent much of their career in an international organization.
Coming together is a beginning. Keeping together is progress. Working together is success.
So we understand today's market and our clients' business. We like to be sufficiently flexible to make best use of our clients' time and our consultants will design tailored training programmes that meet clients' specific requirements. On request, they can also offer an assessment of training needs and follow-up to ensure that training is effectively implemented.
We offer a wide range of classroom-based training programmes. Most of our courses can be delivered in 1, 2 or 3 days – in several languages and/or locations. Examples include:
Advanced Presentation Skills • 2 Day
If presenting is important to your success at work and you'd like to become significantly better at it, we are there to help you achieve just that. We'll show you how to create a clear and effective message, delivered in a confident and persuasive way and fully engage with your audience. This course uses plenty of exercises with real-time video feedback and facilitation.
- Using your voice effectively
- Creating a stronger presence
- Structuring a Presentation
- Building Rapport
- Getting the Style Right
- Working with Visuals
- Dealing with Questions
- Closing a Presentation Effectively
- Personal Action Plans
People Management • 3 Day
This is a core management skills programme aimed principally at providing managers with essential knowledge and skills development so they are able to handle the challenges associated with a management role. The course uses role play simulations with assessment and feedback, a variety of exercises to enable managers to critically assess their personal strengths and weaknesses as well as those in their teams and so identify actions for continuous improvement. Learning logs and tutor facilitation are used to convert ideas into action plans for post-course implementation. The course can be customized to include our clients' internal performance reviews and best practices.
- The Systematic Approach
- SMARTER Objectives
- Giving and Receiving Feedback
- DESC model for better and more effective communication
- Verbal Behaviour Analysis in Feedback
- Motivational Profiles
- Team Member Motivation
- Leadership Styles and Delegation
- Identifying Team Roles and Behaviours
- Team Development Analysis and Performance
Developing Your Influence • 2 Day
The course is designed for people who have to positively influence others to achieve satisfactory outcomes. It covers how to communicate persuasively without resorting to high pressure tactics. Participants will develop their influencing techniques through a series of exercises based on a model with four elements which link together the topic of influencing: the sender, the message, the delivery, the receiver. Important aspects of each element are explained and the key points are applied to examples from participants' current work.
- Principles of Influencing People
- Creating Personal Impact
- SPIN Technique to assess needs and sell ideas
- Positive Behavioural Techniques
- Determining Motivation in others
- Networking to develop impact
- Persuasive Presentation
- Assertiveness Techniques
- Dealing Effectively with Objections
- Presenting Difficult Messages and the DESC technique
- Obtaining Agreement
- Action Plans and Monitoring
Behavioural Interviewing • 2 Day
Finding the right person for the right job and making sure the candidate is able to demonstrate the position's competencies. The best predictor of future performance is past behaviour and the more recent the behaviour the more likely it is to be repeated. In the long run behavioural interviewing will result in increased productivity, lower turnover, higher morale, better quality and better customer service.
- The Pitfalls of Traditional Interviewing
- The Benefits of Behavioural Interviewing
- The Principles of Competency Based Behavioural Interviewing
- Planning and Preparation
- Creating an Interview Guide
- Developing Competency Definitions
- Developing Competency Based Behavioural Interview Questions
- Verbal and Non-Verbal Communication
- High Impact Interview Questions
- Effective and Active Listening Techniques
- Probing and Follow-up Questions
- Rating Scales
- After the Interview
Coaching For Results • 2 Day
Managers need to be good coaches because they don't have all the answers and coaching helps development as well. Managers must find new ways of engaging employees to develop workable solutions. This program has been designed for Managers and team leaders who want to learn and practice fundamental coaching skills and tools. They are responsible for the performance and development of individuals and teams.
- Understand the role of a Manager as a Coach
- Learning Styles
- Leadership Styles
- Active Listening
- Questioning Techniques
- Preparation for Collaborative Development Discussions
- The method and the importance of Feedback
- Verbal Behavior Analysis
- GROW coaching Technique
- DESC coaching Technique
- Creation of an own Individual Action Plan
Handling Challenging Conversations • 2 Day
One of the fundamental skills that managers must have is the ability to lead conversations by deliver rules and messages, getting and giving feedback but also knowing when not to speak. The course is based on the acquisition of various communication techniques to provide participants with the necessary tools to handle challenging conversations with their direct reports and handle difficult situations during these dialogues with confidence. Role play simulation based on case studies and experience, practical hands-on exercises with facilitator feedback, assessment and advice make up the successful and dynamic ingredients of this course.
- Elements of a Challenging Conversation
- Understanding Different Personality and Conversation Types
- Dealing with Different Expectations and Work Ethics
- Challenging People
- Communication with Challenging People
- Giving Constructive Criticism
- Receiving Criticism
- Making and Refusing Requests
- Responding with Confidence
- Addressing Hostility
- Listening and Questioning skills
- Verbal and Non Verbal Communication
- Optional individual 1-hour coaching support from the facilitator on demand via telephone or WebEx
Leading and Managing Multicultural Teams • 3 Day
Managed well, a culturally diverse workforce can be a powerful asset of competitive value, enabling businesses to reach much wider markets. Multicultural teams can deliver huge benefits to businesses through the sharing of their perspective, knowledge and experience. This course is aimed at managers who are faced with the challenging yet rewarding task of leading culturally diverse and in some cases remote teams.
- A closer look at the relevance of the Cultural Orientations Model and mapping cultural values, orientations and communication preferences
- Positioning Culture
- Bridging Culture Gaps
- Effective Multicultural Communication
- Implementing Cultural Strategies and Best Practices for Multicultural and Remote Teams
- Leadership Styles
- Building Successful Multicultural Teams
- Strengthening a Multicultural Team
- Motivating culturally diverse employees
- Managing remote/virtual meetings
Managing Performance • 2 Day
Implementing an appraisal system is another way of improving your business performance. It represents a good opportunity to discuss with individual employees their strengths and weaknesses and agree new aims and objectives with them. Some of the benefits of having appraisal-related performance targets are that employees understand what is expected of them and how these fit into the wider aims of the business. Targets are also a way of gaining useful feedback and ideas on how your business can be more effective in the future.
- Annual Appraisal
- Best Practices in Performance Management
- Competency Framework
- Preparing the Performance Management Interview
- Role Plays/Real Plays
- Development Action Planning
- Personal Action Planning
Problem Solving and Facilitation Techniques • 2 Day
Managed well, a culturally diverse workforce can be a powerful asset of competitive value, enabling businesses to reach much wider markets. Multicultural teams can deliver huge benefits to businesses through the sharing of their perspective, knowledge and experience. This course is aimed at managers who are faced with the challenging yet rewarding task of leading culturally diverse and in some cases remote teams.
- A closer look at the relevance of the Cultural Orientations Model and mapping cultural values, orientations and communication preferences
- Positioning Culture
- Bridging Culture Gaps
- Effective Multicultural Communication
- Implementing Cultural Strategies and Best Practices for Multicultural and Remote Teams
- Leadership Styles
- Building Successful Multicultural Teams
- Strengthening a Multicultural Team
- Motivating culturally diverse employees
- Managing remote/virtual meetings
Leading Without Authority • 5 Day
The programme "Leading Without Authority" is designed to help newly appointed cross-functional team leaders deal with the challenges of their role requiring them to lead colleagues from different functions over whom they have no hierarchical authority. The specificity of this program is that it develops in three main directions:
- Influencing vs Authority
- Leading a cross-functional team
- Acquiring a broader vision It is a modular program structured around 5 training days and two peer coaching follow-up days over a period of 12 months. The metholodogy uses alternates peer discussions, practices on the tools learnt, experiential activities, peer coaching, and reviews, favoring learning and fun via the full involvement of participants.
- Working on Trust
- Managing Conflicts
- To Understand the Importance of Feedback
- To enhance Team and Communication Spirit
- Active Listening and Questioning Skills
- The Ability to Clearly Set Goals and Delegate
Leadership Skills For Project Managers • 3 Day
Projects are led to success in our business world – not just managed. To lead projects and project teams successfully and efficiently, project managers needs to motivate and engage using vital leadership and communication skills whilst managing the challenge of not having the formal line management authority. This program provides project managers with insights and practice opportunity to develop core interpersonal leadership skills around influencing, communicating and motivation that enable them to lead diverse project teams in a matrix organization. . The program has a modular structure and a high focus on transfer of skills into the workplace. Methods include: a webinar session, e-learning, pre-course reflection and development planning with the line manager, personality profiling, one 3-day classroom based workshop, peer learning support and an individual post course support session with the facilitator. This program is currently being delivered globally for an international bio-chemical business. It was developed with direct input from project managers from around the globe and is hence highly adapted to the multicultural, multi-challenge needs of this client organization. It offers practical learning opportunities on
- Interpersonal leadership skills such as managing challenging conversation, optimizing co-operation in virtual teams, motivating and leading without authority;
- Enhanced personal learning agility and self-awareness through giving and receiving personal developmental feedback;
- Knowledge and skills of key models and tools such as Push & Pull, SBI Feedback, Harvard principled negotiation strategies et al.; Best return on investment is fostered using specially developed scenarios that reflect the company's reality and a strong focus on personal action planning and transfer of learning back into the day-to-day practice.
Genos Certification Program • 2 Day
The Genos EI Certification Program is specially designed to make you the expert in applying Emotional Intelligence (EI) in the workplace. It has been created for experienced learning and organisational development professionals, human resource consultants, executive coaches, and organisational psychologists. This two day program includes inspirational content, participative methods, experiential scenarios and action planning.
- Association with the most well-recognised and respected organization
- Access to an international network of over one thousand certified learning
- Ability to design and sell Emotional Intelligence solutions to clients
- Ability to design and deliver group Emotional Intelligence development sessions
For more information, please download our PDF brochure in English or French
Reconnaissance ICF
International Coach Federation accrédite les coachs qui peuvent acquérir 14 CCE en complétant le Programme de Certification Genos IE.
Paris 12 & 13 Mars 2020
Informations et inscriptions: firstname.lastname@example.com
Tarifs préférentiels jusqu'au 20.12.2019:
Entreprise: sur demande
Indépendant: 1 500 HT (au lieu de 2 100 HT)
Leading and Motivating with Emotional Intelligence • 2 Day
The World Economic Forum has strongly promoted Emotional Intelligence among the top 10 skills to thrive in the Fourth Industrial Revolution. Managers who want to stay relevant in their jobs and employable in the future need to enhance their soft skills. Research shows that soft skills are underpinned by Emotional Intelligence and include things like motivating and engaging team members, adapting behaviour to best suit the situation and people involved, being more resilient in times of change.
This programme is designed to help leaders to learn and use Emotional Intelligence tools to lead, motivate and engage their teams as well as understanding emotionally challenging stages when facing change. Certified participants will gain full access to materials to deliver the programme internally to their organizations and ongoing support by PeopleSmart.
Programme Objectives:
For further information regarding this programme, please get in touch with our team via firstname.lastname@example.com .
This programme is designed to help leaders to learn and use Emotional Intelligence tools to lead, motivate and engage their teams as well as understanding emotionally challenging stages when facing change. Certified participants will gain full access to materials to deliver the programme internally to their organizations and ongoing support by PeopleSmart.
Programme Objectives:
- Understanding the principles of Emotional Intelligence
- Understanding why EI and applied Neuroscience are fundamental to lead and motivate employees
- Understanding what EI tools to use to build higher levels of staff motivation and engagement
- You will learn the foundations of Neuroscience of Motivation
- You will learn the Genos Model of Emotional Intelligence
- You will learn the Positive Influence Model for dealing with emotionally sensitive issues
- You will learn how to lead Engagement Review discussions
- You will learn the Change Curve and understand emotions involved at each step
For further information regarding this programme, please get in touch with our team via email@example.com .
The list is by no means exhaustive. We are happy to provide further information on other specialized interventions, such as Negotiation Skills, Sales Techniques, Managing Remote Teams, Diversity and Inclusion, Understanding Culture, Collaborating Effectively Across Cultures, Leading Global Teams and so on.


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Jill Shaffer brings her detailed understanding of accounting and a professional perspective on bookkeeping to the role of Controller of Austin Emergency Centers.
Ms. Shaffer earned a Bachelors of Science in Accounting from Wayne State University. She has over 10 years of experience as an accountant and financial controller in the wholesale, financial, medical and engineering industries.
Ms. Shaffer volunteers with many local organizations such as Rebuild Together Houston and The Girls Scouts of San Jacinto County. Jill also enjoys traveling and is always planning the next trip!

subset: commoncrawl


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A skim latte, 200 grams of imported Italian prosciutto and a butt plug please.
This was our Thursday afternoon, as we wandered through the neighbourhood we used to live in. The neighbourhood – the nicest downtown neighbourhood in our mid-sized hometown – is a yuppie Eden. High end clothings stores, gourmet food, amazing restaurants, coffee shops, cocktail bars. It really is as nice a downtown neighbourhood as you could imagine. And recently, right beside a bistro cafe and a trendy women's shoe store, an adult sex shop opened.
The new sex shop… beautiful. It has high end sex toys, a very significant BDSM section running from entry level to pretty had core, sexy but pretty cheap lingerie, and an awesome variety of adult games and books. It really is a nice store. But seeing it in that neighbourhood was still surprising.
We had a long talk with the owner about how he was doing, and fitting into the neighbourhood. It was fascinating. He said most customers love it and like both having a sex store nearby and the quality and classiness he's trying to create. But he said there is definitely a vocal and powerful minority thats very unhappy that a sex shop would be in their neighbourhood.
The owner has responded well I think. He understands the power that a small number of motivated haters can have so he's tried to accommodate. His window displays are pretty cautious.. which is probably reasonable… he's three doors down from a children's toy store. He's also invited these angry neighbours into his shop whenever they would like to have coffee and discuss why he thinks making sexual products available is a worthy endeavour. And he seems very genuine in that.
For us, we got a new Liberator Wedge that we've wanted for a while and a beginners rope kits to try out. Loved the place!


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|KinDex Pharmaceuticals CEO Jeffrey Bland
KinDex Pharmaceuticals began in 2009 with a promising hypothesis: that the hops found in beer could be broken down and spun out into therapeutic molecules, regulating body weight and glucose metabolism. Now, after years of confirmatory lab work, the Seattle biotech is ready for a make-or-break Phase II trial, banking a $5 million round led by venture stalwart Polaris and planning to test whether its candidate can treat Type 2 diabetes.
The company's lead prospect, KDT 501, is a hops-derived compound KinDex said can help regulate the intracell communications that drive inflammation. In early-phase studies, the drug has shown promise in preventing the immune response that leads to insulin resistance, the company said, giving it a chance to normalize glucose levels in diabetics. Furthermore, KinDex's molecule has moved the needle in lowering cholesterol and triglycerides and curbing weight gain, according to the company, and the drug proved safe and well-tolerated in a Phase I endeavor.
Now, with Polaris providing cash and guidance, KinDex is plotting a Phase II trial involving about 200 Type 2 diabetes patients, CEO Jeffrey Bland told Xconomy, looking to study the drug both as a monotherapy and in combination with the long-generic metformin. KinDex figures KDT 501 could serve as an ideal partner for a slew of Type 2 diabetes treatments, possibly reducing side effects and allowing for lower doses.
If the drug comes through on all of its early promise, KinDex will likely seek out a deep-pocketed partner to pave the way to Phase III, Bland told Xconomy, but the focus, for now, is on designing and executing a trial that can help KDT 501 stand out in the crowded diabetes field.
Beyond its lead program, KinDex has a preclinical effort underway to study KDT 501, and the biotech is in the discovery stage with KDT 600 for obesity alongside other undisclosed candidates.
- read the release (PDF)
- check out Xconomy's story


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text: Critical Care, Trauma, and Resuscitation: Review ArticleUpdate in Trauma Anesthesiology: Perioperative Resuscitation ManagementTobin, Joshua M. MD*; Varon, Albert J. MD, MHPE†Author Information From the *Department of Anesthesiology, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland; and †Department of Anesthesiology, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida. Accepted for publication June 4, 2012. Published ahead of print July 4, 2012 The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joshua M. Tobin, MD, University of Maryland/R Adams Cowley Shock Trauma Center, 22 South Greene St., T1R77, Baltimore, MD 21201. Address e-mail to firstname.lastname@example.com Anesthesia & Analgesia: December 2012 - Volume 115 - Issue 6 - p 1326-1333 doi: 10.1213/ANE.0b013e3182639f20 Free SDC Take the CME Test Metrics AbstractIn Brief The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. Resuscitation with packed red blood cells and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive pharmacologic therapy can assist with resuscitation. Tranexamic acid is used in Europe with good results, but the drug is slowly being added to the pharmacy formulary of trauma centers in United States. Recombinant factor VIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit. Published ahead of print July 4, 2012 Supplemental Digital Content is available in the text. In the United States (US), trauma is the third leading cause of death in people of all ages (after heart disease and cancer) and the leading cause of death in children and adults up to 44 years of age. The development of trauma systems throughout the US in the 1970s addressed the urgent need to treat the victims of trauma in a standardized, systematic format. R Adams Cowley was one of the first physicians to advocate treatment of trauma patients at trauma centers and innovated the concept of the "Golden Hour" when he stated, "… there is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later—but something has happened in your body that is irreparable." The concept of the Golden Hour has, however, been criticized for lacking strong scientific evidence.1 The Golden Hour is based on data from the French military in World War I, in which patients treated by advanced medical care within 1 hour had 10% mortality, whereas those seen after 8 hours had 75% mortality.2 This concept proposes that trauma patients benefit from rapid transport to dedicated trauma centers with specialized trauma teams. Injury initiates processes, which, if not aborted, will eventually kill the patient. Prompt resuscitation can attenuate the systemic inflammatory response of trauma. Rapid evaluation of life-threatening injuries, as well as clear decision points for intervention, are keystones of this approach. Although it is difficult to correlate a discrete minute value to the window of opportunity for trauma patients, it is fair to say that the faster a patient is resuscitated, the better. The Advanced Trauma Life Support course developed by the Committee on Trauma of the American College of Surgeons helps physicians maximize their resuscitative efforts and avoid missing life-threatening injuries by using an organized approach in trauma care. Although few anesthesiologists participate in these courses, familiarity with Advanced Trauma Life Support guidelines facilitates more effective participation in the trauma resuscitation team and allows the formulation of perioperative management plans. THE RESUSCITATION CONTINUUM The continuum of resuscitation begins at the point of injury, carries on through the operating room, and extends into the intensive care unit (ICU). Prompt transportation to designated trauma centers is an important component of a coordinated approach to trauma. Recognition of the role that early resuscitation and trauma management have in the resuscitation continuum is key to successful outcomes. Clinical decisions regarding resuscitation in the field, emergency department, and operating room can have far-reaching consequences. TRAUMA CENTER CARE Specialized care for patients at designated trauma centers has demonstrated improvement in outcome. In one study of 18,103 patients, 56% of patients were taken to level I trauma centers.3 Although patients that were taken to level I trauma centers had more severe injuries and more penetrating injuries than those transported to level II trauma centers, they had similar mortality. In a propensity-adjusted multivariate logistic regression analysis, patients taken to level I trauma centers had improved survival and were more likely to be discharged to a rehabilitation/skilled nursing facility or home. This included patients with serious injury (e.g., Injury Severity Score >15, Glasgow Coma Scale score <9). Not surprisingly, patients also do better if taken directly to a trauma center.4 Patients transferred to a level I trauma center after initial treatment at another facility had higher mortality than those transported directly to a level I trauma center. Transferred patients also had longer ICU and hospital length of stay. MILITARY CARE Forward critical care resuscitation is an important component of the trauma care continuum in the military. Tactical Combat Casualty Care beginning at the point of injury helps mitigate blood loss, treats pain, and provides for immediate antibiotic therapy.5 In current military operations, a variety of medical echelons initiate damage control resuscitation en route to the combat trauma center, where surgical and radiologic intervention is undertaken in parallel with continued resuscitation. Critical Care Air Transport Teams in the US Air Force use an intensivist, nurse, and respiratory therapist, together with their equipment, to turn large cargo aircraft into an airborne critical care unit. They are able to transport 6 "stabilized," but not necessarily stable, patients (up to 3 of whom can be ventilated) to definitive surgical care outside of the war zone.6,7 The British Medical Emergency Response Team uses a physician, nurse, and 2 paramedics to transport patients via helicopter to the combat trauma center. Their physician-based model has demonstrated improved survival in traumatic brain injury (attributable to emergency anesthesia and ventilation) and improved survival in thoracic injury (attributable to emergency anesthesia, ventilation, and chest tube drainage).8 Current discussion in the US military addresses the potential need to develop a rotary wing critical care element to bridge the gap in the continuum of care from wounding to advanced surgical intervention.9,10 DAMAGE CONTROL In the US Navy, the term "damage control" (DC) is used for the emergency control of situations that may hazard the sinking of a ship. In the context of trauma, the term refers to providing only interventions necessary to control hemorrhage and contamination and focusing on reestablishing a survivable physiologic status. This approach consists of a rapid abbreviated laparotomy to stop hemorrhage and peritoneal contamination, and staged sequential repair.11 Patients would then undergo continued resuscitation and aggressive correction of the "lethal triad" of coagulopathy, hypothermia, and acidosis in the ICU before returning to the operating room for definitive repair. The DC strategy has been shown to lead to better than expected survival rates for abdominal trauma.12,13 Based on the DC strategy for abdominal injuries, similar principles have been applied to the management of multiply injured patients with associated long-bone and pelvic fractures (i.e., "damage control orthopedics") or with traumatic brain injury (i.e., "damage control neurosurgery"). DC orthopedics is a safer initial approach in unstable patients by significantly decreasing the initial operative exposure and blood loss.14,15 DC neurosurgery involves stopping intracranial bleeding, evacuation of intracranial hematomas, and early surgical debridement to limit wound contamination.16 Although DC neurosurgery may also include decompressive craniectomy, surgical reduction of intracranial pressure has not resulted in better outcomes in patients with severe traumatic brain injury.17 Damage control resuscitation (DCR) is a concept that has been made popular by the military and is now being investigated in the civilian trauma setting. DCR differs from current resuscitation approaches by attempting to couple the surgical control of life-threatening injury with earlier and more aggressive correction of the coagulation derangements that exacerbate hemorrhage in trauma patients. DCR centers on the application of several principles including "hypotensive resuscitation," use of blood products over isotonic fluid for intravascular volume replacement, and rapid and early correction of coagulopathy with component therapy.18 This resuscitation strategy begins in the prehospital and emergency department settings and continues through the operating room and ICU until the resuscitation is complete. "HYPOTENSIVE RESUSCITATION" Over the past few years, an alternative to high-volume fluid resuscitation termed "permissive hypotension" or "hypotensive resuscitation" has been actively investigated in the trauma setting. In contrast to standard fluid resuscitation, this strategy uses less fluids and blood products during the early treatment of hemorrhagic shock. Animal studies indicate that hypotensive resuscitation reduces blood loss and transfusion requirements in both blunt and penetrating trauma. However, in human studies, decreased blood loss and transfusion requirements have only been confirmed in penetrating injury.19 The evidence supporting hypotensive resuscitation in patients with blunt trauma or traumatic brain injury is limited and the overall long-term outcome of this fluid resuscitation strategy has not been determined.20,21 Concerns about the use of hypotensive resuscitation include the possibility of cardiac arrest (if small volumes of fluid are insufficient to prevent exsanguination) and late complications from organ damage sustained during hypotension. Recommendations based on expert opinion and the results of the above studies suggest titrating fluid to restore consciousness, radial pulse, and a systolic blood pressure of 80 to 90 mm Hg until definitive surgical control of bleeding can be achieved. Fluid treatment is aimed to a systolic blood pressure of at least 100 mm Hg in patients with hemorrhagic shock and head trauma. BLOOD PRODUCT ADMINISTRATION Key concepts in trauma care are source control of hemorrhage and resuscitation with blood products. A careful evaluation of the fluids and blood products needed to resuscitate these patients is an important component of the anesthetic contribution to DCR.22,23 Better understanding of transfusion practices, and a more refined definition of "massive transfusion" in the trauma patient, has led to improved resuscitation with blood products.24 In addition, appreciation for trauma-induced coagulopathy has prompted early empiric treatment, rather than a more reactive response to documented coagulation abnormalities. Many institutions have revised their massive transfusion protocols to include the use of 1:1 ratios of red blood cells (RBCs) to fresh frozen plasma (FFP) transfusion.25 Military studies on the ratio of RBCs to FFP reported improved survival in the wounded combatant.26 In one study, the FFP to RBC ratio was evaluated in 246 battle-wounded patients. Mortality decreased from 65% with a 1:8 ratio, to 19% with a 1:1.4 ratio. This translated well into a civilian study with equally compelling data, in which 467 massively transfused trauma patients were examined. Thirty-day survival improved in patients with FFP to RBC ratios >1:2, and platelet to RBC ratios >1:2.27 However, the apparent survival advantage associated with high FFP to RBC transfusion ratios could be explained by a survival bias. Because component blood products are not administered evenly and simultaneously in clinical practice, and many deaths occur early, it is possible that the survival benefit observed among patients receiving a higher FFP to RBC ratio may merely reflect the fact that they live long enough to receive the higher ratio of products. Several investigations have reported that the association between higher FFP to RBC ratios and improved survival is not statistically significant when adjusted for survival bias.28,29 A recent prospective observational study indicates that a 1:1 FFP to RBC ratio does not provide any additional benefit over ratios of 1:2 to 3:4 and that the hemostatic benefits of plasma therapy are limited to patients with coagulopathy.30 Some authors believe that one of the reasons for these conflicting results is that the survival benefit of using 1:1 FFP to RBCs is relatively small and only apparent within the first 3 hours of resuscitation.31 The American Association of Blood Banks and the European task force recommend early intervention with FFP but without a preset FFP to RBC ratio. In a recent review, Ho et al.32 evaluated the presence of survivor bias in studies in which 1:1 FFP to RBC ratios were used during massive transfusion of trauma patients. Massive transfusion was defined as ≥10 U of packed RBCs (PRBCs) transfused over the first 24 hours of hospitalization. Twenty-six studies were identified from an initial pool of 216 abstracts selected from a MEDLINE search. Studies in which cohorts were compared before and after a massive transfusion ratio of 1:1 was implemented (so-called "before and after" studies) were not considered to have a survivor bias, nor were studies in which the FFP:RBC ratio was considered a time-dependent covariate in the statistical analysis. Studies were considered "survivor bias-prone" if they included all patients from time of hospital admission (given that early deaths often received a lower FFP:RBC ratio). Studies in which patients were included only if they survived the first few hours of resuscitation or until ICU admission were also considered to have a survivor bias. Overall, 21 of the 26 studies evaluated demonstrated an association between 1:1 and survival. Of those, only 10 did not have a survivor bias for or against 1:1 transfusion ratios. Ideally, a well-controlled randomized trial could answer the question of survivor bias more conclusively. The Pragmatic Randomized Optimum Platelet and Plasma Ratio (PROPPR) trial is an ongoing multicenter, prospective, randomized study that will evaluate different blood product ratios to be administered to trauma patients in need of >10 U of PRBCs in the first 24 hours. This will offer an opportunity to prospectively evaluate the ideal ratio of blood products for use in trauma. PHARMACOLOGIC ADJUNCTS In addition to appropriately aggressive blood product administration, there are a number of pharmacologic modalities that can maintain arterial blood pressure, attenuate the systemic inflammatory response, and improve outcome in trauma. This is especially important in situations where a massive transfusion may not be possible, or where the patient continues to deteriorate despite massive transfusion and surgical control of bleeding. TRANEXAMIC ACID Tranexamic acid is a synthetic lysine derivative that competitively inhibits lysine binding sites on plasminogen, blocking the conversion of plasminogen to plasmin. This inhibits the proteolytic action of plasmin on fibrin clot and platelet receptors, and serves as an effective antifibrinolytic. In the CRASH-2 trial, 20,211 trauma patients were randomized to receive either tranexamic acid (1 g initial loading followed by 1 g over 8 hours) or placebo.33 This multicenter, prospective trial demonstrated significant reductions in all-cause mortality, and in deaths due to bleeding, without increasing vascular occlusive events in the tranexamic acid group, compared with the placebo group. Further analysis by the investigators revealed that the benefit was only seen when tranexamic acid was administered within 3 hours of injury and that increase in mortality occurred when the drug was given after this period. Surprisingly, however, there was no statistical difference in blood transfusion between the tranexamic acid and placebo groups. Exactly how tranexamic acid reduced the risk of death in bleeding patients remains unanswered. A subgroup analysis of the CRASH-2 trial included 270 adult trauma patients at risk for extracranial bleeding who also had a traumatic brain injury.34 These patients received tranexamic acid (1 g bolus followed by infusion, as in the CRASH-2 trial) or placebo. Intracranial hemorrhage growth as measured by computed tomography was examined. Mean total hemorrhage growth between the tranexamic acid arm and placebo was no different. Likewise, new focal ischemic lesions were not significantly different in the 2 groups. The authors speculated that a decrease in the size of the intracranial hemorrhage would decrease local pressure on arteries and, therefore, decrease the risk of ischemia. This effect, however, was not demonstrated here. A follow-up study, the CRASH-3 trial, will examine head injury more closely. The Military Application of Tranexamic Acid in Trauma and Emergency Resuscitation (MATTERs) study35 evaluated the use of tranexamic acid in hemorrhagic shock after combat injury in 896 consecutive trauma admissions, 293 of whom received the drug. Unadjusted mortality was lower in the tranexamic acid group, despite being more severely injured. Patients who received massive transfusion (>10 U of PRBCs within 24 hours) benefited the most from the administration of tranexamic acid, with improved survival and less coagulopathy. Tranexamic acid can improve survival, reduce transfusion requirements, and offer a lower cost alternative in resuscitation of the trauma patient. Western European militaries (specifically the United Kingdom) use tranexamic acid as part of their resuscitation plan for the wounded combatant. The use of tranexamic acid within the first 3 hours of injury may also offer benefit to the severely injured trauma patient in the US. RECOMBINANT FACTOR VIIA Recombinant activated factor VII (rFVIIa) is thought to act locally at the site of tissue injury by binding to exposed tissue factor and generating a tight fibrin hemostatic plug through increased thrombin generation. The use of rFVIIa in trauma has been the subject of great interest and investigation. An audit of a multicenter trauma registry identified 380 patients who received rFVIIa.36 Death from hemorrhage was reported at a rate of 30%. rFVIIa nonresponders tended to have a pH <7.1, platelet counts <100,000, and systolic blood pressure ≤90 mm Hg. A wide range of rFVIIa doses, as well as a wide range of "time to first dose of rFVIIa," make interpretation of these data difficult. A case series of 81 diverse trauma patients reported that rFVIIa successfully reversed coagulopathy, as measured by a decrease in prothrombin time, in 75% of patients.37 Although coagulation abnormalities were corrected, a demonstrated benefit against controls was not demonstrated. Lower arterial pH, higher lactate, and worse base deficit were most predictive of rFVIIa nonresponders. A retrospective database review evaluated the use of rFVIIa in combat casualties with high injury severity scores who had received massive blood transfusions.38 Forty-nine of these patients received rFVIIa, and 75 did not. Patients who did not receive rFVIIa were colder and had a lower admission systolic blood pressure. Twenty-four-hour and 30-day mortality were significantly decreased in the rFVIIa group. However, there was no statistically significant difference in death from hemorrhage between the 2 groups, nor was there an increase in the risk of pulmonary embolism, deep vein thrombosis, or stroke. Currently, there are only 2 published studies that included randomized clinical trials evaluating the use of factor VIIa in the exsanguinating trauma patient.39,40 These studies, which were supported by the drug manufacturer, reported a decrease in blood product use but no effect in mortality. Therefore, although rFVIIa can reverse coagulation abnormalities and decrease blood loss, a well-defined outcome benefit is less clear. VASOPRESSIN Vasopressin is a potent vasoconstrictor that spares cerebral, pulmonary, and cardiac vascular beds, essentially shunting blood above the diaphragm. Pharmacologic amplification of the neuroendocrine stress response with vasopressin may provide further benefit.41 Vasopressin levels are low in vasodilatory shock, perhaps due to depletion of neurohypophyseal stores.42 Vasopressin is significantly more potent than norepinephrine and angiotensin II, and maintains its efficacy in hypoxia and severe acidosis, where catecholamines may not be as effective.43 Several studies have demonstrated improved arterial blood pressure and survival in animals with profound hypovolemic shock treated with vasopressin. One porcine model using liver injury to produce hemorrhagic shock demonstrated improved short-term survival with vasopressin.44 In a similar study, 21 pigs subjected to a standardized liver injury were resuscitated with vasopressin (0.4 U/kg then 0.04 U/kg/min), epinephrine (45 µg/kg then 5 µg/kg/min), or saline placebo.45 Mean arterial blood pressure was higher in the vasopressin group with no increased bleeding. Survival was also improved. In a canine hemorrhagic shock model, 7 animals were resuscitated with vasopressin with improvement in the mean arterial blood pressure.46 Plasma vasopressin levels, although elevated initially, were low immediately before vasopressin administration, suggesting the possibility of vasopressin depletion in late-stage hemorrhagic shock. Although animal studies have been encouraging, human data are mainly in the form of case reports. In one remarkable case report, a 41-year-old woman suffered a fall from a roof and was resuscitated with RBCs and coagulation factors before transport to a trauma center.47 At the trauma center, aggressive resuscitation was continued with fluids and norepinephrine; however, the patient continued to be hemodynamically unstable. An infusion of high-dose vasopressin (10 IU/min) was initiated with sufficient stabilization of the arterial blood pressure to emergently embolize bleeding pelvic blood vessels. Despite numerous orthopedic injuries, a liver injury, and a subdural hematoma, the patient was discharged from the ICU to the ward 39 days after injury with no neurologic deficit. In other case reports of patients who had intraoperative or postoperative bleeding, low-dose vasopressin infusions (0.04 U/min) improved short-term survival.48 One patient had systolic blood pressures in the 50s with a base deficit of −21 after a portal vein injury during surgery. After surgical correction of the injury, fluid resuscitation, and a norepinephrine infusion, the patient continued to be resuscitated in the ICU with a regimen that included a low-dose vasopressin infusion. The authors speculate that in cases of advanced hemorrhagic shock, acidotic, vasodilated patients who are poorly responsive to intravascular fluid administration and catecholamines may benefit from vasopressin. Other reports document cases of aortic and liver surgery in which patients had profound and prolonged hypotension secondary to hemorrhage.49 Low-dose vasopressin infusions were part of an aggressive resuscitation in which patients survived. Despite evidence of the utility of vasopressin in animal models, there is a paucity of data in human trials. Because the limitations of case report data are well described, more detailed investigations of vasopressin in hemorrhagic shock have been suggested.50,51 There is an ongoing multicenter European trial that will evaluate prehospital administration of vasopressin versus normal saline.52,53 Further clinical trials will help define the role of vasopressin in the trauma patient with hemorrhagic shock. OTHER PHARMACOLOGIC ADJUNCTS Administration of hydrocortisone can help compensate for the exhaustion of the hypothalamic-pituitary-adrenal axis seen during critical illness.54,55 The intense mineralocorticoid activity of hydrocortisone improves sensitivity to catecholamines, decreases inflammatory markers, and decreases vasopressor requirements, while avoiding some of the unwanted side effects of glucocorticoid administration. Although it would be ideal to verify a cortisol level before administration of hydrocortisone, one can assume some degree of adrenal insufficiency and catecholamine depletion in a trauma patient with hemorrhagic shock. Thirty-four trauma patients were stimulated with cosyntropin and defined as "nonresponders" if serum cortisol increased <9 µg/dL.56 Forty-seven percent of patients were nonresponders immediately after the early resuscitative phase, with 25% of those patients remaining as nonresponders after 1 week. Although mortality between responders and nonresponders was similar, nonresponders had a longer duration of norepinephrine infusion and more total infused drug. Administration of hydrocortisone can decrease vasopressor requirements in trauma patients.57 Twenty-three trauma patients at the end of the resuscitative period (27 ± 15 hours after trauma) received a stepwise dose of phenylephrine before and after a dose of hydrocortisone 50 mg. Hydrocortisone decreased the ED50 (dose leading to half-maximum theoretical effect on mean arterial blood pressure) of the phenylephrine infusion by 37%. The benefit of hydrocortisone in other critically ill patient populations is less clear. Patients who were given etomidate to facilitate endotracheal intubation were randomized to receive either hydrocortisone or placebo for etomidate-related adrenal insufficiency. There was no significant difference in the proportion of patients with Sequential Organ Failure Assessment (SOFA) scores of 3 or 4. The hydrocortisone group did, however, show a decrease in required norepinephrine dose.58 The citrate preservative in blood products can chelate calcium during administration of blood and contribute to hypotension. Administration of calcium chloride improves smooth muscle tone and is a simple, often overlooked therapy for hypotension in the context of resuscitation. The risks of hypocalcemia, such as unremitting hypotension, are greater than the risks of mild hypercalcemia (e.g., nausea, vomiting, constipation, ileus, shortened QT interval, nephrocalcinosis). In one cohort study, ionized calcium concentration was related to mortality in 352 patients experiencing "critical bleeding requiring massive transfusion." A concentration-dependent increase in mortality was seen in patients with hypocalcemia. Acidosis and the amount of FFP transfused were identified as the main risk factors for hypocalcemia.59 The use of sodium bicarbonate for the treatment of severe lactic acidosis from shock remains controversial, because it has not been shown to improve outcomes. Although sodium bicarbonate has been reported to improve cardiac contractility in animal models,60 its use can exacerbate intracellular hypercarbia and acidosis and have a negative impact in patients.61 Some authors have suggested that if bicarbonate therapy is used, it should only be considered if the pH is less than 7.0 to 7.2.61,62 In addition, simple correction of the acidosis by bicarbonate therapy does not seem to correct the negative effects of acidemia on coagulation.63 POSTRESUSCITATIVE CARE The postresuscitative phase carries the continuum of care into the ICU where appropriate critical care can improve outcomes in trauma. The acute respiratory distress syndrome (ARDS) is a well-known entity in critical illness. The resulting decrease in lung compliance causes an increase of plateau pressures and makes ventilation difficult. Lower tidal volumes offer some relief from poor compliance,64 even though hypercarbia sometimes results from decreasing minute ventilation ("permissive hypercarbia"). Oxygenation is maintained with the use of positive end-expiratory pressure and escalating concentrations of oxygen. This lung-protective strategy is the only strategy that has been demonstrated to reduce mortality for patients with ARDS. Although outcome improvements from other interventions have been difficult to quantify, a recent study evaluating the use of neuromuscular blockade with cisatracurium demonstrated a survival benefit.65 However, confounding variables such as off-label use of cisatracurium, and the use of prone positioning and inhaled nitric oxide, make the results of this study difficult to interpret. Acute tubular necrosis in the trauma patient can result from a low intravascular volume state. Hypovolemia leads to a prerenal syndrome resulting in tubular necrosis. Urine output often remains low even after normal renal hemodynamics have been restored. This is thought to be attributable to tubular obstruction by necrotic cells at the pars recta, where the proximal tubule meets the loop of Henle. Fluid resuscitation is the therapy of choice, with the objective being urine output of 1 to 2 mL/kg/h. Prompt fluid resuscitation can decrease the incidence of posttraumatic acute kidney injury (AKI).66 Although dopamine in low doses of approximately 2 µg/kg/min (so-called "renal dose") can increase renal and mesenteric blood flow, it does not affect the prevention, development, or course of AKI. It also does not decrease mortality or the need for renal replacement therapy, including hemodialysis. In short, there is no role for low-dose dopamine in the treatment of posttraumatic AKI.67 The inflammatory response that accompanies hemorrhagic shock is not unlike that of sepsis. A similar approach to these patients may offer clues to treatment, particularly in the postresuscitative phase. The concept of early goal-directed therapy used in sepsis may be applicable in trauma as well.68 Early resuscitation with blood products and adjunctive pharmacologic therapy may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach also offers a survival benefit. AREAS FOR POTENTIAL INVESTIGATION Therapeutic hypothermia has been identified as a modality that can improve survival in out-of-hospital cardiac arrest due to ventricular fibrillation.69 Although hypothermia (along with acidemia and coagulopathy) is a component of the trauma "triad of death," therapeutic hypothermia has been encouraging in animal models of hemorrhagic shock.70 In one study, 27 dogs were exsanguinated over 5 minutes.71 The animals then received an aortic flush with 2°C isotonic saline until temperatures of 20°C, 15°C, or 10°C were reached. The animals underwent closed chest cardiopulmonary bypass and 12 hours of postarrest hypothermia to 34°C. Outcome was evaluated via Overall Performance Category (OPC), Neurologic Deficit Score (NDS), and Histologic Damage Score (HDS). Normal OPC and NDS and mild HDS were seen in animals at 15°C for 60 minutes, and at 10°C for 60 and 90 minutes. Results were less promising for dogs at 20°C for 60 minutes, as well as for dogs at 10°C for 120 minutes, suggesting a threshold for temperature and length of cooling, beyond which hypothermia is less effective. A thorough review of induced hypothermia finds encouraging preclinical data and describes an upcoming human trial in penetrating trauma that will induce temperatures of 10° centigrade using cardiopulmonary bypass. The benefit of induced hypothermia is less clear, however, for blunt trauma and head injury.72 In spinal cord injury, therapeutic hypothermia to 33° centigrade via intravascular cooling devices offers some improvement in function. The number of patients in many of these studies, however, is small. Larger randomized, multicenter trials would offer more powerful evidence of the benefit of therapeutic hypothermia.73 Although the potential for induced hypothermia is exciting, it should be noted that nontherapeutic hypothermia can potentially worsen the aforementioned trauma triad of death. As such, the role of therapeutic hypothermia in the resuscitation of trauma patients has yet to be determined. CONCLUSION Prompt transportation to designated trauma centers and immediate management of threats to life are the first steps in the resuscitation continuum. Resuscitation with RBCs and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive therapy can assist with resuscitation. Tranexamic acid is used in Europe with promising results, and its use is now steadily increasing in the US. rFVIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. Appropriate critical care management of ARDS and acute tubular necrosis extends the resuscitation continuum into the ICU, where future therapies may involve therapeutic hypothermia. DISCLOSURES Name: Joshua M. Tobin, MD. Contribution: This author helped design the study, conduct the study, analyze the data, and write the manuscript. Attestation: Joshua M. Tobin approved the final manuscript. Name: Albert J. Varon, MD, MHPE. Contribution: This author helped design the study, conduct the study, analyze the data, and write the manuscript. Attestation: Albert J. Varon approved the final manuscript. This manuscript was handled by: Michael Murray, MD, PhD.REFERENCES 1. Lerner EB, Moscati RM. The golden hour: scientific fact or medical "urban legend"? Acad Emerg Med. 2001;8:758–60 Cited Here 2. Santy P. Shock tramatique dans les blessures de guerre, analysis d'observations. Bull Med Soc Chir. 1918;44:205 Cited Here 3. Cudnik MT, Newgard CD, Sayre MR, Steinberg SM. Level I versus level II trauma centers: an outcomes-based assessment. J Trauma. 2009;66:1321–6 Cited Here | View Full Text | PubMed | CrossRef 4. Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma. 1997;43:288–95 Cited Here | View Full Text | PubMed | CrossRef 5. Butler FK Jr, Hagmann J, Butler EG. Tactical combat casualty care in special operations. Mil Med. 1996;161:3–16 Cited Here | PubMed 6. Johannigman JA. Maintaining the continuum of en route care. Crit Care Med. 2008;36:S377–82 Cited Here | View Full Text | PubMed | CrossRef 7. Grissom TE, Farmer JC. The provision of sophisticated critical care beyond the hospital: lessons from physiology and military experiences that apply to civil disaster medical response. Crit Care Med. 2005;33:S13–21 Cited Here | View Full Text | PubMed | CrossRef 8. Davis PR, Rickards AC, Ollerton JE. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting. J R Army Med Corps. 2007;153:269–73 Cited Here | PubMed | CrossRef 9. Tobin JM, Via DK, Carter T. Tactical evacuation: extending critical care on rotary wing platforms to forward surgical facilities. Mil Med. 2011;176:4–6 Cited Here | PubMed | CrossRef 10. Bickey NW, Jenkins D, Butler FKTactical Evacuation Care Improvements Within the Department of Defense 2011–03.. Proceedings of Defense Health Board. Available at http://www.health.mil/dhb/recommendations.cfm. Accessed March 11, 2012 Cited Here 11. Lee JC, Peitzman AB. Damagecontrol laparotomy. Curr Opin Crit Care. 2006;12:346–50 Cited Here | View Full Text | PubMed 12. Duchesne JC, Kimonis K, Marr AB, Rennie KV, Wahl G, Wells JE, Islam TM, Meade P, Stuke L, Barbeau JM, Hunt JP, Baker CC, McSwain NE Jr. Damage control resuscitation in combination with damage control laparotomy: a survival advantage. J Trauma. 2010;69:46–52 Cited Here | View Full Text | PubMed | CrossRef 13. Duchesne JC, McSwain NE Jr, Cotton BA, Hunt JP, Dellavolpe J, Lafaro K, Marr AB, Gonzalez EA, Phelan HA, Bilski T, Greiffenstein P, Barbeau JM, Rennie KV, Baker CC, Brohi K, Jenkins DH, Rotondo M. Damage control resuscitation: the new face of damage control. J Trauma. 2010;69:976–90 Cited Here | View Full Text | PubMed | CrossRef 14. Tuttle MS, Smith WR, Williams AE, Agudelo JF, Hartshorn CJ, Moore EE, Morgan SJ. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma. 2009;67:602–5 Cited Here | View Full Text | PubMed | CrossRef 15. Pape HC, Tornetta P III, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17:541–9 Cited Here | View Full Text | PubMed | CrossRef 16. Rosenfeld JV. Damage control neurosurgery. Injury. 2004;35:655–60 Cited Here | PubMed | CrossRef 17. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502 Cited Here | View Full Text | PubMed | CrossRef 18. Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, Cox ED, Gehrke MJ, Beilman GJ, Schreiber M, Flaherty SF, Grathwohl KW, Spinella PC, Perkins JG, Beekley AC, McMullin NR, Park MS, Gonzalez EA, Wade CE, Dubick MA, Schwab CW, Moore FA, Champion HR, Hoyt DB, Hess JR. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307–10 Cited Here | View Full Text | PubMed | CrossRef 19. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–9 Cited Here | View Full Text | PubMed | CrossRef 20. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on inhospital mortality. J Trauma. 2002;52:1141–6 Cited Here | View Full Text | PubMed | CrossRef 21. Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, Liscum KR, Wall MJ Jr, Mattox KL. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011;70:652–63 Cited Here | View Full Text | PubMed | CrossRef 22. Hess JR, Holcomb JB, Hoyt DB. Damage control resuscitation: the need for specific blood products to treat the coagulopathy of trauma. Transfusion. 2006;46:685–6 Cited Here | View Full Text | PubMed | CrossRef 23. Gunter OL Jr, Au BK, Isbell JM, Mowery NT, Young PP, Cotton BA. Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival. J Trauma. 2008;65:527–34 Cited Here | View Full Text | PubMed | CrossRef 24. Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR. Blood transfusion rates in the care of acute trauma. Transfusion. 2004;44:809–13 Cited Here | View Full Text | PubMed | CrossRef 25. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006;60:S91–6 Cited Here | View Full Text | PubMed | CrossRef 26. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Wade CE, Holcomb JB. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–13 Cited Here | View Full Text | PubMed | CrossRef 27. Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, Gonzalez EA, Pomper GJ, Perkins JG, Spinella PC, Williams KL, Park MS. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–58 Cited Here | View Full Text | PubMed 28. Snyder CW, Weinberg JA, McGwin G Jr, Melton SM, George RL, Reiff DA, Cross JM, HubbardBrown J, Rue LW III, Kerby JD. The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma. 2009;66:358–62 Cited Here 29. Magnotti LJ, Zarzaur BL, Fischer PE, Williams RF, Myers AL, Bradburn EH, Fabian TC, Croce MA. Improved survival after hemostatic resuscitation: does the emperor have no clothes? J Trauma. 2011;70:97–102 Cited Here 30. Davenport R, Curry N, Manson J, De'Ath H, Coates A, Rourke C, Pearse R, Stanworth S, Brohi K. Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2. J Trauma. 2011;70:90–5 Cited Here | View Full Text | PubMed | CrossRef 31. De Biasi AR, Stansbury SL, Dutton RP, Stein DM, Scalea TM, Hess JR. Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma. Transfusion. 2011;51:1925–32 Cited Here | View Full Text | PubMed 32. Ho AM, Dion PW, Yeung JH, Holcomb JB, Critchley LA, Ng CS, Karmakar MK, Cheung CW, Rainer TH. Prevalence of survivor bias in observational studies on fresh frozen plasma:erythrocyte ratios in trauma requiring massive transfusion. Anesthesiology. 2012;116:716–28 Cited Here | View Full Text | PubMed | CrossRef 33. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, ElSayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, MejiaMantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32 Cited Here 34. CRASH-2 Collaborators, Intracranial Bleeding Study.. Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ. 2011;343:d3795 Cited Here 35. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147:113–9 Cited Here | View Full Text | PubMed | CrossRef 36. Knudson MM, Cohen MJ, Reidy R, Jaeger S, Bacchetti P, Jin C, Wade CE, Holcomb JB. Trauma, transfusions, and use of recombinant factor VIIa: a multicenter case registry report of 380 patients from the Western Trauma Association. J Am Coll Surg. 2011;212:87–95 Cited Here | PubMed | CrossRef 37. Dutton RP, McCunn M, Hyder M, D'Angelo M, O'Connor J, Hess JR, Scalea TM. Factor VIIa for correction of traumatic coagulopathy. J Trauma. 2004;57:709–18 Cited Here | View Full Text | PubMed | CrossRef 38. Spinella PC, Perkins JG, McLaughlin DF, Niles SE, Grathwohl KW, Beekley AC, Salinas J, Mehta S, Wade CE, Holcomb JB. The effect of recombinant activated factor VII on mortality in combatrelated casualties with severe trauma and massive transfusion. J Trauma. 2008;64:286–93 Cited Here | View Full Text | PubMed | CrossRef 39. Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, Axelsen M, Kluger Y. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, doubleblind clinical trials. J Trauma. 2005;59:8–15 Cited Here | View Full Text | PubMed | CrossRef 40. Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, Leppaniemi A, Parr M, Vincent JL, Tortella BJ, Dimsits J, Bouillon B. Results of the CONTROL trial: efficacy and safety of recombinant activated factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010;69:489–500 Cited Here | View Full Text | PubMed | CrossRef 41. Raab H, Lindner KH, Wenzel V. Preventing cardiac arrest during hemorrhagic shock with vasopressin. Crit Care Med. 2008;36:S474–80 Cited Here | View Full Text | PubMed | CrossRef 42. Robin JK, Oliver JA, Landry DW. Vasopressin deficiency in the syndrome of irreversible shock. J Trauma. 2003;54:S149–54 Cited Here | View Full Text | PubMed 43. Krismer AC, Dunser MW, Lindner KH, Stadlbauer KH, Mayr VD, Lienhart HG, Arntz RH, Wenzel V. Vasopressin during cardiopulmonary resuscitation and different shock states: a review of the literature. Am J Cardiovasc Drugs. 2006;6:51–68 Cited Here | View Full Text | PubMed | CrossRef 44. Raedler C, Voelckel WG, Wenzel V, Krismer AC, Schmittinger CA, Herff H, Mayr VD, Stadlbauer KH, Lindner KH, Konigsrainer A. Treatment of uncontrolled hemorrhagic shock after liver trauma: fatal effects of fluid resuscitation versus improved outcome after vasopressin. Anesth Analg. 2004;98:1759–66 Cited Here | View Full Text | PubMed | CrossRef 45. Voelckel WG, Raedler C, Wenzel V, Lindner KH, Krismer AC, Schmittinger CA, Herff H, Rheinberger K, Konigsrainer A. Arginine vasopressin, but not epinephrine, improves survival in uncontrolled hemorrhagic shock after liver trauma in pigs. Crit Care Med. 2003;31:1160–5 Cited Here | View Full Text | PubMed | CrossRef 46. Morales D, Madigan J, Cullinane S, Chen J, Heath M, Oz M, Oliver JA, Landry DW. Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock. Circulation. 1999;100:226–9 Cited Here | View Full Text | PubMed | CrossRef 47. Krismer AC, Wenzel V, Voelckel WG, Innerhofer P, Stadlbauer KH, Haas T, Pavlic M, Sparr HJ, Lindner KH, Koenigsrainer A. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock: three cases and a brief analysis of the literature. Anaesthesist. 2005;54:220–4 Cited Here | PubMed | CrossRef 48. Sharma RM, Setlur R. Vasopressin in hemorrhagic shock. Anesth Analg. 2005;101:833–4 Cited Here | View Full Text | PubMed | CrossRef 49. Tsuneyoshi I, Onomoto M, Yonetani A, Kanmura Y. Lowdose vasopressin infusion in patients with severe vasodilatory hypotension after prolonged hemorrhage during general anesthesia. J Anesth. 2005;19:170–3 Cited Here | PubMed | CrossRef 50. Rajani RR, Ball CG, Feliciano DV, Vercruysse GA. Vasopressin in hemorrhagic shock: review article. Am Surg. 2009;75:1207–12 Cited Here | PubMed 51. Stadlbauer KH, Wenzel V, Krismer AC, Voelckel WG, Lindner KH. Vasopressin during uncontrolled hemorrhagic shock: less bleeding below the diaphragm, more perfusion above. Anesth Analg. 2005;101:830–2 Cited Here | View Full Text | PubMed | CrossRef 52. Lienhart HG, Wenzel V, Braun J, Dorges V, Dunser M, Gries A, Hasibeder WR, Helm M, Lefering R, Schlechtriemen T, Trimmel H, Ulmer H, Ummenhofer W, Voelckel WG, Waydhas C, Lindner K. Vasopressin for therapy of persistent traumatic hemorrhagic shock: the VITRIS.at study [in German]. Anaesthesist. 2007;56:145–8 Cited Here | PubMed | CrossRef 53. Lienhart HG, Lindner KH, Wenzel V. Developing alternative strategies for the treatment of traumatic haemorrhagic shock. Curr Opin Crit Care. 2008;14:247–53 Cited Here | View Full Text | PubMed | CrossRef 54. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348:727–34 Cited Here | View Full Text | PubMed | CrossRef 55. Burchard K. A review of the adrenal cortex and severe inflammation: quest of the "eucorticoid" state. J Trauma. 2001;51:800–14 Cited Here | View Full Text | PubMed | CrossRef 56. Hoen S, Asehnoune K, BraillyTabard S, Mazoit JX, Benhamou D, Moine P, Edouard AR. Cortisol response to corticotropin stimulation in trauma patients: influence of hemorrhagic shock. Anesthesiology. 2002;97:807–13 Cited Here | View Full Text | PubMed | CrossRef 57. Hoen S, Mazoit JX, Asehnoune K, BraillyTabard S, Benhamou D, Moine P, Edouard AR. Hydrocortisone increases the sensitivity to alpha1-adrenoceptor stimulation in humans following hemorrhagic shock. Crit Care Med. 2005;33:2737–43 Cited Here | View Full Text | PubMed | CrossRef 58. Payen JF, Dupuis C, TrouveBuisson T, Vinclair M, Broux C, Bouzat P, Genty C, Monneret D, Faure P, Chabre O, Bosson JL. Corticosteroid after etomidate in critically ill patients: a randomized controlled trial. Crit Care Med. 2012;40:29–35 Cited Here | View Full Text | PubMed | CrossRef 59. Ho KM, Leonard AD. Concentrationdependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39:46–54 Cited Here | PubMed 60. Sonett J, Pagani FD, Baker LS, Honeyman T, Hsi C, Knox M, Cronin C, Landow L, Visner MS. Correction of intramyocardial hypercarbic acidosis with sodium bicarbonate. Circ Shock. 1994;42:163–73 Cited Here | PubMed 61. Forsythe SM, Schmidt GA. Sodium bicarbonate for the treatment of lactic acidosis. Chest. 2000;117:260–7 Cited Here | View Full Text | PubMed | CrossRef 62. Boyd JH, Walley KR. Is there a role for sodium bicarbonate in treating lactic acidosis from shock? Curr Opin Crit Care. 2008;14:379–83 Cited Here 63. Martini WZ, Dubick MA, Pusateri AE, Park MS, Ryan KL, Holcomb JB. Does bicarbonate correct coagulation function impaired by acidosis in swine? J Trauma. 2006;61:99–106 Cited Here 64. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301–8 Cited Here 65. Papazian L, Forel JM, Gacouin A, PenotRagon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16 Cited Here | View Full Text | PubMed | CrossRef 66. Butkus DE. Posttraumatic acute renal failure in combat casualties: a historical review. Mil Med. 1984;149:117–24 Cited Here | PubMed 67. Holmes CL, Walley KR. Bad medicine: lowdose dopamine in the ICU. Chest. 2003;123:1266–75 Cited Here | View Full Text | PubMed | CrossRef 68. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goaldirected therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77 Cited Here | View Full Text | PubMed 69. Hypothermia after Cardiac Arrest Study Group.. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56 Cited Here 70. Tisherman SA. Suspended animation for resuscitation from exsanguinating hemorrhage. Crit Care Med. 2004;32:S46–50 Cited Here | View Full Text | PubMed | CrossRef 71. Behringer W, Safar P, Wu X, Kentner R, Radovsky A, Kochanek PM, Dixon CE, Tisherman SA. Survival without brain damage after clinical death of 60–120 mins in dogs using suspended animation by profound hypothermia. Crit Care Med. 2003;31:1523–31 Cited Here | View Full Text | PubMed | CrossRef 72. Finkelstein RA, Alam HB. Induced hypothermia for trauma: current research and practice. J Intensive Care Med. 2010;25:205–26 Cited Here | View Full Text | PubMed | CrossRef 73. Dietrich WD, Cappuccino A, Cappuccino H. Systemic hypothermia for the treatment of acute cervical spinal cord injury in sports. Curr Sports Med Rep. 2011;10:50–4 Cited Here | View Full Text | PubMed | CrossRef © 2012 International Anesthesia Research Society View full article text


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Surround Elton John - Peachtree Road (2004) SACD-R multichannel music
Category: Rock / Pop Surround Music Download
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Tags: SACD-R, Elton John, 2004, Pop, Rock
Added: 3-05-2018, 09:05
Artist: Elton John | Album: Peachtree Road | Released: 2004 | Quality: SACD-R ( DST 5.1, DST 2.0 Bitrate: 1 Bit/2.8MHz ) | Label: The Rocket Record Company, Mercury | Catalog #: 9867612 | Genre: Pop, Rock
Elton John returned to the sound and aesthetic of his classic early-'70s work with 2001's Songs From the West Coast, finding critical acclaim, if not much commercial success. Not that the lack of sales greatly bothered Elton -- in many interviews, including one with Entertainment Weekly the week before Peachtree Road was released in November 2004, he claimed he was "disappointed" that it just barely went gold, but he was tired of making "uneven" records. John wasn't merely doing publicity: Peachtree Road proves that he's back to making good, solid records focused on songs, not hits, the way he did at the outset of his career. Since this is an album by a veteran, not an artist on the rise, it doesn't have the sense of discovery, or the hunger, that the early records still retain, and the production -- the first self-production by John with no collaborators -- is a little cleaner and crisper than the rich, warm sound of the late Gus Dudgeon (to whom this record is dedicated), who helmed such masterworks as Tumbleweed Connection. This means Peachtree Road is about craft, both in the writing and recording, which also means that it's a grower, with each song sounding stronger, better with each spin. While the sound of the record is bright and polished, this album makes few concessions to radio: this is certainly adult pop, but it never panders to adult contemporary radio, and the music is a little too rugged and sturdy to fit alongside the stubbornly sweet sounds of 21st century MOR. Which is precisely the point, of course: Elton has consciously returned to the reflective singer/songwriter template of the early '70s, both in his writing and production. Not that this is as lush as Elton John or country-tinged as Tumbleweed Connection -- "Answer in the Sky" recalls the high-flying disco of "Philadelphia Freedom" quite deliberately, and "They Call Her the Cat" finds a halfway point between "Honkey Cat" and "The Bitch Is Back" -- but it fits alongside those albums quite nicely because the focus is on songs, not trying to have hits. These songs may not rival his standards, but they're in the same tradition, and there's not a bad song in the bunch, resulting in a sturdy, satisfying record that proves that the comeback on Songs From the West Coast was no fluke and, hopefully, this latter-day renaissance for Elton will not be short-lived either.
01. The Weight Of The World
02. Porch Swing In Tupelo
03. Answer In The Sky
04. Turn The Lights Out When You Leave
05. My Exclusive Drug
06. They Call Her The Cat
07. Freaks In Love
08. All That I'm Allowed
09. I Stop And I Breathe
10. Too Many Tears
11. It's Getting Dark In Here
12. Can't Keep This From You


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Product Description
More than just a detangler, EMERA Nourishing CBD Detangler Plus is the perfect companion for your styling needs. With the ability to protect against the damaging effects of hot tools and help prevent color fadeage, this multi-tasking spray provides powerful support to keep your hair looking healthy, vibrant, and shiny.
As part of our commitment to the planet, EMERA products are 100% Vegan, Cruelty-Free, and made in a solar powered facility in California. 5% of all EMERA sales are donated to the nonprofit, Get Together Foundation, to help further their efforts in helping the homeless community and doing their part to help make the world a better place.


text: This is just a dream, for now. I want to be present in my home, my cooking, my family, and have a social life. What I mean by "present" is being able to focus on and give my attention to all these things. It can be hard to wear several hats and be expected to… Continue reading My Dream To Manage My Life, My Home, My Family


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Tripartie: Conduct secure transactions online
Tripartie offers an escrow payment platform to secure freelance jobs and sales between private consumers. A commission is charged for each transaction.
Unique Value Proposition
Sale of goods: The buyer is protected against non-compliance and delivery failure. The buyer is paid in full and on time.
Freelancing activities: The client is protected against late and poor-quality deliveries. The freelancer is paid on time in full.
For both types of transactions, a fair and quick litigation process is offered.
Origin of the Project
Tripartie was launched in 2018 by former freelancers Victorien De Doncker, Christophe Boucrot and Andreas Lambropoulos who faced the same problems at work and while making transactions when shopping online. The three entrepreneurs share the same ambition but have diverse qualifications and professional experiences.
- Financial support to move from a V.1 hybrid app to an iOS and a final Android product.
- Support from SKEMA community to share Tripartie's updates on social media platforms.
Contact details
- Website: https://tripartie.com
- Email: firstname.lastname@example.com
- Contact number: N/A
Skema Ventures View All
SKEMA Ventures is a business unit created by SKEMA Business School dedicated to entrepreneurship and innovation. Through a unique value chain, that encompasses teaching, coaching, incubation, and acceleration, SKEMA Ventures allows each SKEMA student and alumni to think, design, test and launch an entrepreneurial project in a global context, on six innovative territories on four continents, benefiting from the best of each local ecosystem. With SKEMA Ventures, GloCal entrepreneurship is born!
Watch this video to know more: https://youtu.be/OAYVo9wtWZM


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Пухначев В.В. Гончарова О.Н.
Construction of the exact solutions of the three-dimensional problems of convection
Reporter: Пухначев В.В.
The exact solutions of the three dimensional problems of convection of two immiscible viscous fluids in an infinite channel with a rectangular cross-section are studied (Pukhnachov V.V., 2000). The stationary solution can be called a three dimensional generalization of the well-known exact solution (Birikh R.V., 1966) because of a constant relative to the longitudinal coordinate temperature gradient given along the interface. Convective fluid flows are described by the Oberbeck-Boussinesq equations. Under assumption of non-deformability of interface by thermocapillary forces, the kinematic and dynamic conditions and also the conditions of continuity of temperature and heat flux are fulfilled exactly. The group-theoretical nature of the constructed solutions and the questions of solvability of the initial boundary value problems are investigated.
Analytical construction of the exact solutions of the stationary problems is added by the numerical investigation. Reduction to the two dimensional problem statements is performed. By construction of the numerical algorithm the new input functions are introduced: they are the analogues of the stream function and vorticity instead of the transversal components of the velocity. A possibility of a control of the convection mechanisms is investigated under conditions of normal gravity, microgravity and weightlessness. The catalogues of the three dimensional flows in a channel are presented in the case with heat-insulated solid boundaries and in the case of heating of one of the vertical walls.
The research has been supported by the Joint Integrated Project No.116 of Siberian, Ural and Far East Branches of the Russian Academy of Sciences, by the Russian Foundation for Basic Research (Grants No. 10-01-00007, No. 09-08-01127) and by the Russian Federal Program "Scientific and Pedagogical Staff" (Contract No. 14.740.11.0355).
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BOGOTA, Colombia — A Colombian woman declared dead of a heart attack moved one of her arms just as an undertaker was about to embalm her, doctors said Wednesday.
Don't miss these Health stories
More women opting for preventive mastectomy - but should they be?
Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.
- Larry Page's damaged vocal cords: Treatment comes with trade-offs
- Report questioning salt guidelines riles heart experts
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Noelia Serna, 45, was rushed to a hospital in the city of Cali, where she was in critical condition in an intensive care unit Wednesday, said hospital director Luis Fernando Rendon.
"Her chances of survival are slim," Rendon said.
Serna, who has multiple sclerosis, was admitted to the same Cali University Hospital on Monday after a heart attack, Rendon said. She survived for about 10 hours on life support, but then seemingly didn't respond to resuscitation efforts following a second attack. She was declared dead early Tuesday.
About two hours later, funeral home employee Jaime Aullon was just about to inject embalming fluid into Serna's left leg when he saw her move.
"She was moving her right arm," he said. "I stopped the procedure and brought her back to the hospital to be treated."
On rare occasions, a person's heart rate and breathing can drop to undetectable levels, leading doctors to erroneously declare a patient dead, said neurosurgeon Juan Mendoza Vega, a member of the Colombian National Medical Ethics Board.
"It can happen," he said. "But it's not a matter of coming back to life because the person was never dead."
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Aerolith Hoodie
Aerolith Hoodie
Ok, we all agree the Earth is a sinking ship and you are stuck on this fetid pile of decayed life set ablaze by man's blind disregard for nature's fury. The world's best and brightest are fleeing to make a new life among the stars, and even though you were deemed unfit for recruitment, you can still show your support for humanity's last and greatest hope: Ærolith Dynamics.
A terrestrial shipping address is required for this order. No interplanetary deliveries will be made: sorry Mimir-9.
Geekly is a podcast network that covers the latest on pop culture. Movies, comics, gaming, and whatever else comes across the host's minds.
Geekly has been a long time client of WallyHawk's and in addition to all the products found on their page we have worked together to create some amazing products for conventions and shows Geekly has put on.
The Aerolith Hoodie is a comfortable 50/50 cotton/poly blend. The design is done with the highest quality inks and transfer process for a long and vibrant life.


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Oxmoor House
Warm and cheesy...these potatoes are always a favorite.
How to Make It
Step 1
Arrange half the potato slices in a greased 1 1/2-quart casserole dish. Top with onion and remaining potatoes; add salt and pepper to taste.
Step 2
In a medium saucepan, melt butter over medium heat. Add flour and salt; stir constantly with a whisk one minute. Stir in milk; cook until thickened. Stir in 1 1/2 cups cheese; continue to stir until melted.
Step 3
Pour over potatoes; cover with aluminum foil. Bake at 400° for one hour. Uncover, sprinkle with remaining cheese. Bake 10 to 15 more minutes or until lightly browned.
Gooseberry Patch Homestyle Family Favorties


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Vestibular schwannomas, also known as acoustic neuromas, are benign brain tumors located on the auditory-vestibular nerve. It is a slow-growing tumor that presses against the hearing and balance nerve causing dizziness, or one-sided ringing buzzing or hearing loss. It can also cause facial numbness or paralysis. When tumors grow large enough, they can even press against the brain stem, resulting in life-threatening symptoms. Vestibular schwannomas are usually diagnosed with magnetic resonance imaging (MRI) and there are two different treatment options possible: microsurgery and radiosurgery. Microsurgery involves open skull base surgery in which the tumor is partially or fully removed. With radiosurgery, like Gamma Knife radiosurgery, the tumor is subjected to high-precision radiation. Due to the difficult location of the tumor, microsurgery is not the preferred treatment modality. It is very invasive for the patient, involving hospitalization (5-8 days), including 1 or 2 days on the intensive care, a long recovery time (4 to 6 weeks) and high risk of complications. Radiosurgical treatment however is less invasive and is performed in a single day, without the need for hospitalization. The risk for complications is also significantly lower with respect to the risks involved in the microsurgical removal of the tumor. It is however necessary to have a life-long surveillance of the tumor after radiosurgery, because some tumors might not respond to the treatment and will continue to grow. Because of this, a secondary treatment may be necessary. It is therefore very valuable to predict whether the tumor will respond to the treatment or not. Such prediction is of crucial importance for each specific patient to choose the most suited treatment modality. Furthermore, an estimation of the likelihood of tumor control after Gamma Knife radiosurgery can potentially provide a basis for an individualized surveillance protocol, reducing the overall number of follow-up hospital visits and MRI scans.
Currently, it is not possible to predict the Gamma Knife treatment outcome of vestibular schwannomas. Some reported influential parameters are the tumor volume and the pretreatment growth speed of the tumor, although these are also disputed. Therefore, in this project, we aim to find discriminative parameters that can be used to predict the radiosurgical treatment outcome. This involves discovering possible MRI characteristics of the tumor that can be used in a machine learning environment in order to find a model that can accurately predict the Gamma Knife treatment response of a vestibular schwannoma.


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Welcome to Hanoi Sky Hotel
Located in Food Street, well-positioned in Old Quarter, Hanoi Sky Hotel is the ideal point of departure for your excursions.
From here, guests can easy reach of Hanoi's major attractions. You only take 3 to 10 minutes to walk to visit places like: Hoan Kiem Lake, St. Joseph Cathedral, Temple of Literature, Dong Xuan Market, Water Puppet Theate, Ha Noi Flag Tower, Ho Chi Minh Mausoleum, Museums, Ha Noi Train Station...
At Hanoi Sky Hotel, the excellent service and superior facilities make for an unforgettable stay. The hotel offers access to a vast array of services, including 24-hour room service, free Wi-Fi in all rooms, Wi-Fi in public areas, room service, airport transfer. Guests can choose from 40 rooms, all of which exude a cozy atmosphere.
Hanoi Sky Hotel is your one-stop destination for quality hotel accommodations in Hanoi.


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Hi Team,
I have created a flow that reads data from an email, parses it and finds a specific file in the appropriate folder in One Drive for Business.
This flow successfully works on a different user, using One Drive (Not Business).
When i run the exact same flow the business version does not show any details in the body of the Find Files in Folder.
Below copied from test flow. Refer to red [] where the file information should be.
Solved! Go to Solution.
Hi @Otto,
I tested it with the expression you provided and found that the output would contain a blank line.
You could avoid this problem by using the trim() function on this basis.
And even if the string contains spaces, it seems that the space will still be preserved and will not be affected by the function.
Image reference:
Please take a try.
Best Regards,
Hi @Otto,
I did a test on my side and found the issue you mentioned. When I use the OneDrive-Personal-Find files in folder, the content of the Body output is the expected file-related information.
However, when using the OneDrive for Business-Find files in folder test, the body outputs '[]'.
Not only that, if the folder selects the root directory, both connectors will report an error.
Please take a try to use Find files in folder by path, which does not have the issue mentioned above.
Same as configuring Find file in folder action:
It works fine and get file metadata, as below:
Best Regards,
@v-bacao-msftthanks for your reply.
I am searching for a file name that is supplied from body of an email.
When i add in the output taken from the email i am still getting the same problem.
The outputs are working as expected everywhere else, just not this one drive for business function. (the personal one drive on another account works with the same flow setup)
Hi @Otto,
I did the test later, and if the value in Search Query is the filename containing the extension, I can get the expected result.
Otherwise I get the information of the folder.
Search Query - does not include an extension:
Search Query - contains the extension:
Please configure the file name with the extension in Search Query so that no similar issue will occur.
Please take a try again and feel free let me know if issue still exist.
Best Regards,
@v-bacao-msftthanks for your reply.
I tried and got the same result, then I changed my mail structure and it started working.
I noticed a difference between our 2 flows.
You will see below that my testdoc.docx has a space under it, but your example does not.
I am using the following expressions in this test. I know this is a different question now, but hope you may have an answer as i wonder if that is contributing to my initial problem.
Client Name:Otto Test
Agent:Conroy Test
Agent Email:email@example.com
MM Name:Otto 2
MM Email:email@example.com
Message:Thank you for choosing Domain dot Com! Please see document
Sign off:Kind Regards
Company:Domain Dot Com
Hi @Otto,
I tested it with the expression you provided and found that the output would contain a blank line.
You could avoid this problem by using the trim() function on this basis.
And even if the string contains spaces, it seems that the space will still be preserved and will not be affected by the function.
Image reference:
Please take a try.
Best Regards,
@v-bacao-msftthat worked!
Thank you so much for your help on this!
Check out the on demand sessions that are available now!
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Una semana de contenido con +100 sesiones educativas, consultorios, +10 workshops Premium, Hackaton, EXPO, Networking Hall y mucho más!


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In a scathing new BBC documentary airing on Monday in the UK, commodities trader Glencore, is accused of allowing dumping of acid into streams, child labour and deadly underground working conditions at its copper and cobalt mine in the Democratic Republic of Congo.
The Guardian reports that the Panorama program titled "Billionaires Behaving Badly?" is also the first interview granted by the secretive head of Switzerland-based Glencore, Ivan Glasenberg.
The documentary makers working under cover found children "as young as 10" toiling at the Tilwezembe mine "who climbed down hand-dug mineshafts 150ft deep without safety or breathing equipment."
Glencore, which currently has a proposal for a $90 billion merger with miner Xstrata before shareholders, closed down the copper and cobalt mine in in 2008, but in the interview Glasenberg said the company's land was "raided" in 2010: "We are pleading with the government to remove the artisanal miners from our concession," he said.
The Guardian quotes from the show saying "the number of accidents at Tilwezembe is extraordinarily high: Panorama was told that 60 miners died there last year, making the mine one of the most dangerous in the world."
The Tilwezembe mine is located in the Katanga province in the south of the country close to the Zambian border. Glencore in partnership with Gecamines, the DRC's state-owned mining firm, has plans to restart mining and says that the acid drainage has been contained.
The DRC's mining industry has been in flux since the death in February of Augustin Katumba Mwanke, widely believed to be power behind the throne in the war-torn country. It was said that "every major player in the mining sector has negotiated with him or through him."
The DRC is home to the world's largest cobalt resource and second globally in terms of copper deposits.
It also not the first time Glencore has come under fire in Central Africa. In March health and environment officials over the border in Zambia ordered the closure of part of Glencore's Mopani copper operations over complaints from residents of a nearby town over pollution. The processing plant should re-open at the end of the month.
Thisismoney, a UK business blog, says the fact that "NGOs are crawling over Glencore's environmental behaviour" in Zambia and the DRC is another obstacle in the proposed merger already facing opposition from Xstrata shareholders who say Glencore is not paying enough for the coal giant.
Image is of DRC refugees in Uganda in 2008 – Sam DCruz | Shutterstock.com


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What up guys!
Ok so my last blog was about my amazing time in the Mentawai Islands in Indo, and I went on that boat with my sponsor Nike.
Right after we got home Nike wanted me to fly up to Oregon. Yes, Oregon. The reason being because it is where Nike was founded and that is where its main headquarters is. I am a new Nike athlete so that was the first time I have ever been up there.
Lakey takes some video from inside Nike Headquarters
All I really have to say about the headquarters is WOW!!!!!!!!!!!!!!!!!!! The campus is 200 acres and, oh-my-gosh, it is so epic! I really can't describe it. You just kinda have to go to see what I mean.
I was able to meet with the main designers and tell them what I think Nike could use and what style I'm into. I brought some clothes up to show them what I think their next line should consist of.
It was really great to meet everyone that works up at Nike and maybe one day I can meet Mr. Nike Phil Knight himself.
Well, I hope you guys are all good… I have a bunch of big contests coming up soon that I think you can watch on the live webcam. If you go to SurfingAmerica.com that contest is all next week and the week after that is the NSSA national championships and for that you can just go to NSSA.org.
Thanks guys and hope you're all having a great summer!
Lakey P.


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Everyone wants to add a value to their home. It is not easy to find out what are the best home improvement projects to undertake? You have shared great tips here. Thanks for sharing such an informative information.
Beltsville, MD Roofing Company :)
When considering what kind of shed you want to build, you want to check into designs that will go with the style of house you have. If you home has a Victorian style to it, then you would want to find a shed with the same kind of style. With country style houses, you will want a country style type shed. Some houses have a special decor to them, like arches and other unique decor. You might want to add some of these special items into your shed as well. These little things can make your shed look like it was built when the house was built. cutthewood.comReplyDelete