Soaring over open waters: horizontal winds provide lift to soaring migrants in weak thermal conditions.

BACKGROUND: For soaring birds, the ability to benefit from variable airflow dynamics is crucial, especially while crossing natural barriers such as vast water bodies during migration. Soaring birds also take advantage of warm rising air, so-called thermals, that allow birds to ascend passively to higher altitudes with reduced energy costs. Although it is well known that soaring migrants generally benefit from supportive winds and thermals, the potential of uplifts and other weather factors enabling soaring behavior remains unsolved. METHODS: In this study, we GPS-tracked 19 Red Kites, Milvus milvus, from the Central European population that crossed the Adriatic Sea on their autumn migration. Migratory tracks were annotated with weather data (wind support, side wind, temperature difference between air and surface-proxy for thermal uplift, cloud cover, and precipitation) to assess their effect on Red Kites' decisions and soaring performance along their migration across the Adriatic Sea and land. RESULTS: Wind support affected the timing of crossing over the Adriatic Sea. We found that temperature differences and horizontal winds positively affected soaring sea movement by providing lift support in otherwise weak thermals. Furthermore, we found that the soaring patterns of tracked raptors were affected by the strength and direction of prevailing winds. CONCLUSION: Thanks to modern GPS-GSM telemetry devices and available data from online databases, we explored the effect of different weather variables on the occurrence of soaring behavior and soaring patterns of migratory raptors. We revealed how wind affected the soaring pattern and that tracked birds could soar in weak thermals by utilizing horizontal winds, thus reducing energy costs of active flapping flight over vast water bodies.

Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review.

Background: Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature. Methods: A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. Results: A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%). Conclusions: This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings. Registration: PROSPERO CRD42019146802.

Scalp laceration repair with hair apposition technique in the maritime environment under telemedicine guidance using free open-access medical resources.

Requests for medical advice to evaluate injuries sustained on board a shipping vessel make up a significant number of calls to Telemedical Maritime Assistance Services. As the maritime setting is an austere environment with regards to resources such as equipment and availability of medically trained personnel, it is important to have a set of skills and techniques to treat all manner of common injuries with the tools at hand. Here we discuss a case report of using telemedicine and free open-access medical education resources to teach the hair apposition technique to an on-board medical provider for the treatment of a scalp laceration with good outcome.

[Subsequent fate of hip joints after triple screening following neonatal screening.]. / Dalsí osudy kyclí z trojího síta novorozeneckého screeningu.

The author describes the long-term results of screening of neonatal hip joints on account of congenital dysplasia, using the method of three screening in 1987 and 1988. He examined at the beginning of school attendance clinically and by measuring the angles of the hip joints 94 children with an original post-partum finding or risk children delivered by breech presentation or with a history of inborn dysplasia, and compared the results with those of a control group of 50 healthy hip joints. He found that children with a post-partum finding and those born by breech presentation differed as to the angles of the hip joint significantly from children with normal hip joints. This was not the case in children with a history of inborn dysplasia and those delivered by breech presentation but without a post-partum finding. Of 10 children with a post-partum finding in seven instances Wiberg's angle remained above normal and four times the colodiaphyseal angle was above normal values. Catamnestically the author found on X-rays made at the age of three months a limital angle of the tectum which obviously needed further treatment. The author concludes that the method of three screenings supplemented by sonography is reliable and adequate. For further improvement of results the author recommends dynamic sonography and follow up the mobility of the head of the joint. In case of an uncertain interpretation of the sonogram classical X-ray examination at the end of the third month, and if necessary later, is indicated. The author recommends a check-up examination in all children with post-partum findings and treated inborn dysplasias at the beginning and end of compulsory school attendance to record residual findings. He emphasize not only the therapeutic but also the economic effect of this procedure. Key words: inborn dysplasia of the hip joint, neonatal screening of the hip joints, assessment of the angles of the hip joints.

[Early diagnosis of congenital hip dislocation in neonates]. / Nás príspevek k casné diagnostice vrozeného vymknutí kyclí u novorozencu.

On the basis of the analysis of the examination of hip joints in 1000 newborns the author supports his former statement that of almost the same frequency as the acknowledged symptomatology of unstable hip joint (in 6.5 per cent) is the pathological symptomatic group of increased tension of tendons of the origin of adductors (in 4.7 per cent), sometimes also with reduced abduction, less palpable head of the hip joint and the symptoms presented by him can improve the quality of screen position case of breech presentation. This was found in 5.2 per cent of deliveries. The combination of both symptomatic groups occurs in 1.4 per cent. Out of individual symptoms in the breech presentation of highest frequency--according to the author--is the increased tension of the origin of adductors (in 94.2 per cent), be it isolated form of incidence (in 25 per cent) or in combination with other symptoms. In the examination technique he includes also the symptom of the hyperextensibility of the knee and relates its frequency (82.7 per cent) with the breech presentation and with the increased joint laxicity conditioned hormonally. After the analysis of mechanical effects in the foetal stage of pregnancy he attempts to correlate clinical neonatal symptomatology with the pathological anatomical classification after Ogden. He arrives at the conclusion that only combined identification of symptoms of both the instability of the hip joint and the symptoms presented by him can improve the quality of screening and thus reduce the incidence of unidentified defect of the hip joint in 3rd month of age of the child. Further progress can be made only after the introduction of a purposeful sonographic screening of the newborn and infant hip joints. The author, however, considers for irreplaceable the method of a careful clinical examination of newborns.

[Relations of Aetiopathogenesis and Prevention of Post-traumatic Algoneurodystrophia Part I: Critical Evaluation of Pathogenetic Theories.]. / Vztahy etiopatogeneze a prevence u poúrazové algoneurodystrofie I. cást: Kritika patogenetických teorií

The author critisizes current aetiopathogenetic theories of the origin of post-traumatic algoneurodystrophia and on the basis of the available literature and his own experience he formulates his own hypothesis of the theory of the origin of this unpleasant complication. In the sense of psychosomatic perception he summarizes that it is mainly action impulses of negative emotions, especially the feelings of anxiety, but also other stresses in the sociopsychological sense of the word (arising mainly from the concerns about fulfilling oneself) which promote the basic component of chronic pain and together, be it on the prepared or unprepared neurastenic terrain, they develop, based on their sympatothetically mediated potentials of negative emotion, the prerequisites for the onset of post-traumatic algoneurodystrophia. With regard to continuous failure of the treatment of the already developed disease the author proposes as a prevention his own, time-based categorization of post-traumatic patients mainly those with the injury of a sensitive nerve. This categorization is based on tests of pain, vegetative tonus and basal neurotization, the latter in cooperation with a psychiatrist. After certain experience the evaluation of tests was simplified. According to the outcomes he classifies patients into three categories with a different subsequent therapy. He presents algorithm of preventive medical therapy with the proposal of steps to be taken in the period of three weeks following the trauma in all three categories tested. With regard to the fact that after such procedure the incidence of post-traumatic algoneurodystrophia is only minimal and the remaining cases are not complicated we recommend to generalize this therapy. This conclusion is supported both by medical and socioeconomic reasons. Key words: aetiopathogenesis of post-traumatic algoneurodystrophia, prevention of the onset of posttraumatic algoneurodystrophy.