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INTRODUCTION: Tissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting. HYPOTHESIS: Many who suffer prehospital deaths might be eligible for non-organ tissue donation. METHODS: A retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated. RESULTS: Over 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%). CONCLUSIONS: After prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.
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Serviços Médicos de Emergência/estatística & dados numéricos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Estudos RetrospectivosRESUMO
OBJECTIVE: To examine the efficacy and tolerability of ethyl-eicosapentaenoate (EPA-E) monotherapy for major depressive disorder (MDD). METHOD: Fifty-seven adults with DSM-IV MDD were randomly assigned from January 2003 until June 2006 to receive 1 g/d of eicosapentaenoic acid (EPA) or placebo for 8 weeks in a double-blind, randomized, controlled pilot study. Response criteria were on the basis of the 17-item Hamilton Depression Rating Scale (HDRS-17). Subjects' plasma lipid profiles were examined by gas chromatography. RESULTS: Thirty-five subjects (63% female; mean +/- SD age = 45 +/- 13 years) were eligible for the intent-to-treat (ITT) analysis. In the ITT sample, mean +/- SD HDRS-17 scores decreased from 21.6 +/- 2.7 to 13.9 +/- 8.9 for the EPA group (n = 16) and from 20.5 +/- 3.6 to 17.5 +/- 7.5 for the placebo group (n = 19) (P = .123); the effect size for EPA was 0.55. ITT response rates were 38% (6/16) for EPA, and 21% (4/19) for placebo (P = .45). Among the 24 study completers, mean +/- SD HDRS-17 scores decreased from 21.3 +/- 3.0 to 11.1 +/- 8.1 for the EPA group and from 20.5 +/- 3.8 to 16.3 +/- 6.9 for the placebo group (P = .087); the effect size for EPA was 0.73. Completer response rates were 45% (5/11) for EPA, and 23% (3/13) for placebo (P = .39). Among EPA subjects, baseline n-6/n-3 ratio was associated with decrease in HDRS-17 score (r = -0.686, P = .030) and with treatment response (P = .032); change in n-6/n-3 ratio was associated with change in HDRS-17 score (r = .784, P = .032). Side effects, reported in 2 EPA subjects and 5 placebo subjects, were exclusively gastrointestinal, mild, and not associated with discontinuation. CONCLUSIONS: EPA demonstrated an advantage over placebo that did not reach statistical significance, possibly due to the small sample and low completer rates, which were the major study limitations. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00096798.
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Transtorno Depressivo Maior/tratamento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Inibidores da Agregação Plaquetária/uso terapêutico , Adulto , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/diagnóstico , Método Duplo-Cego , Ácido Eicosapentaenoico/uso terapêutico , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placebos , Escalas de Graduação Psiquiátrica , Resultado do TratamentoRESUMO
We demonstrate new principles of microfluidic pumping and mixing by electronic components integrated into a microfluidic chip. The miniature diodes embedded into the microchannel walls rectify the voltage induced between their electrodes from an external alternating electric field. The resulting electroosmotic flows, developed in the vicinity of the diode surfaces, were utilized for pumping or mixing of the fluid in the microfluidic channel. The flow velocity of liquid pumped by the diodes facing in the same direction linearly increased with the magnitude of the applied voltage and the pumping direction could be controlled by the pH of the solutions. The transverse flow driven by the localized electroosmotic flux between diodes oriented oppositely on the microchannel was used in microfluidic mixers. The experimental results were interpreted by numerical simulations of the electrohydrodynamic flows. The techniques may be used in novel actively controlled microfluidic-electronic chips.
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Microfluídica/instrumentação , Fluorescência , Concentração de Íons de Hidrogênio , Cinética , Microeletrodos , Microfluídica/métodos , SemicondutoresRESUMO
Emotional inhibition in recollection of specific autobiographical memories (Conway & Pleydell-Pearce, 2000) is investigated in two experiments. Less complete emotional inhibition was hypothesised to correspond to a reduced sense of psychological closure. Emotional inhibition was identified by comparing the effect of emotion words relative to lifetime period words as primes. In Experiment 1, emotion words facilitated recognition judgements of descriptions of remembered experiences rated low in closure. In Experiment 2, emotion words facilitated recognition judgements of descriptions of a laboratory experience made lower in closure. A sense of psychological closure may therefore be a prerequisite for strategic emotional inhibition. Implications for adjustment and goal pursuit are discussed.
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Emoções , Inibição Psicológica , Memória , Processos Mentais , Análise de Variância , Autobiografias como Assunto , Feminino , Humanos , Masculino , Autoimagem , Fatores Sexuais , Fatores de TempoRESUMO
A theory is proposed that life events are remembered with a satisfying sense of closure when there is decreased emotional detail in the constructed autobiographical memory representation. The first three studies show that, although properties of the experienced event (such as valence and recency) accounted for some variance in participants' sense of closure, the amount of emotional detail in the memory was also a significant predictor. The third study shows that emotion-focused biased retelling of the experience increased emotional detail and decreased the sense of closure participants reported. Related approaches and implications for psychological adjustment are discussed.
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Emoções , Memória , Modelos Psicológicos , Adaptação Psicológica , Feminino , Humanos , Relações Interpessoais , Masculino , Rememoração Mental , Testes Psicológicos , Análise de Regressão , Fatores Sexuais , Estresse Psicológico/psicologia , Fatores de TempoRESUMO
BACKGROUND: Depression is a disorder that causes disability, with a profound adverse impact on all areas of psychosocial functioning. This is particularly true for those with treatment resistant depression (TRD). However, to date, no systematic assessments of psychosocial functioning for patients with TRD have been conducted. METHODS: In the present study, we used the Longitudinal Interval Follow-up Evaluation (LIFE) scale to measure psychosocial functioning in 92 patients with TRD. These patients met formal criteria for TRD and were part of a clinical trial examining the efficacy of lithium augmentation of nortriptyline. RESULTS: Clinicians rated this sample of patients as experiencing mild to moderate impairment in work-related activities, good to fair interpersonal relations, poor level of involvement in recreational activities, and mild impairment of ability to enjoy sexual activity. Patients and clinicians rated global social adjustment as poor. CONCLUSIONS: Patients with formally defined TRD experience significant impairment in psychosocial functioning. In this sample a tendency existed for both clinicians and patients to assign more severely impaired global ratings when compared with ratings for specific functional areas.
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Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/psicologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/psicologia , Falha de TratamentoRESUMO
The present research examined the nature of autobiographical memory event clusters. Specifically we were interested in the interplay between the content and organisation of autobiographical memory with retrieval in determining the similarity of event memories across time. Using an event cueing procedure, clusters of related event memories were generated. Participants sorted these events into meaningful groups after a delay of several weeks. The results suggest that participants' ability to perform this sorting task is dependent on their ability to reinstate the retrieval context. Further our results suggest that event clusters are chains of related event memories as opposed to clusters of interrelated event memories.