Metabolism and Nutrition in Sepsis: In Need of a Paradigm Shift.

BACKGROUND: Sepsis continues to cause significant morbidity and mortality despite technological advancements in medical management. While sepsis is defined as organ dysfunction owing to the dysregulated host response to infection, our understanding of the dysregulation of the host response remains incomplete. SUMMARY: Many metabolic derangements that occur during sepsis, including those associated with anorexia, hyperglycemia, and proteolysis, have largely been considered maladaptive. Supportive medical and nutritional interventions targeted at correcting these metabolic derangements have not led to improved outcomes, suggesting a reappraisal of our approach to metabolism and nutrition in critically ill septic patients is needed. KEY MESSAGES: Explanations of the lack of efficacy of these clinical interventions may include targeting the wrong metric or patient population, or the possibility that some of these metabolic changes could be protective. In this mini-review, we propose a paradigm shift that is needed in metabolism and nutrition management in sepsis.

Grape Version 1: First prototype of the low-cost personal space weather station receiver.

Crowd sourced data collection among the international community of amateur radio operators and shortwave listeners has great potential for addressing problems of under-sampling in the geospace system. Quantitative Doppler measurements of high frequency (HF) time standard stations, used in bottom side ionospheric sensing, have been accomplished using existing radio hardware belonging to volunteers in distributed campaigns. However, typical shortwave receivers cannot be put to ordinary use while these measurements are being taken, do not have standardized signal chains, and are generally too expensive to be purchased for the sole purpose of taking Doppler measurements. Here, we provide documentation for a low-cost intermediate frequency receiver, the Grape Version 1, which is designed specifically for measurements of North American time standard stations. Grape receivers can be easily constructed and deployed by amateur scientists in order to gain a deeper understanding of variations in radio propagation in their local environment. When compared over long periods and across distributed networks of stations, the resulting data yield insights on greater spatial and time scales. At the time of writing, several of these receivers have been deployed across the United States and are actively collecting data. These receivers form the first iteration of the Low-Cost Personal Space Weather Station network.

Efficacy and Toxicity of Fexinidazole and Nifurtimox Plus Eflornithine in the Treatment of African Trypanosomiasis: A Systematic Review.

Human African trypanosomiasis (HAT), or sleeping sickness disease, is an infection caused mainly by Trypanosoma brucei gambiense-human African trypanosomiasis (g-HAT) and is transmitted by tsetse flies. The disease goes through two stages: hemolymphatic and meningo-encephalic phases. The treatment for the second stage has changed from melarsoprol or eflornithine to nifurtimox-eflornithine combination therapy (NECT) and fexinidazole. We aimed to systematically review the literature on the efficacy and toxicity of fexinidazole and NECT. We used PubMed advanced strategy and Google Scholar databases, including clinical trials and observational studies on humans in the last 20 years in the English literature. Applying the inclusion/exclusion criteria, we reviewed eight studies. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol. For assessing bias, we used the Cochrane Collaboration's tool for risk assessment of the clinical trials and the Robins-I tool for the observational studies. Overall, the clinical trials showed that NECT was non-inferior to eflornithine. The proportion of patients discharged alive is higher in patients treated with NECT vs. patients treated with eflornithine. Gastrointestinal complaints are a common side effect of NECT therapy, while fearful but relatively rare convulsions can also occur. The main limitation among the studies of NECT was the lack of blinding because most of them were open-label. Fexinidazole, the new oral medication showed is effective and safe for the treatment of g-HAT infection. Because of their convenience, fexinidazole is preferred over NECT therapy, oral vs. IV infusion in the first and second stages of the disease. Compared to older therapies, fexinidazole and NECT are more effective and safer than eflornithine and melarsoprol monotherapy.

Occupational Outcomes of a Physical Activity Intervention for Post-Secondary Student Mental Health.

BACKGROUND.: Physical activity (PA) is a therapeutic approach to address post-secondary student mental health, yet the effect of PA on occupational outcomes has been understudied among students. PURPOSE.: This study (1) identified and described occupational performance issues (OPIs) among post-secondary students seeking mental health support and (2) assessed pre- and post-intervention differences in occupational performance and performance satisfaction. METHOD.: Using a single group pre-test post-test pilot study design, participants (N = 20) completed a 6-week, 1-hour PA intervention. The Canadian Occupational Performance Measure was administered pre- and post-intervention. FINDINGS.: The most commonly reported OPIs included academics, PA, and sleep hygiene. There were significant improvements in participants' occupational performance (mean change: 2.7, p < .001; dz = 2.28) and performance satisfaction (mean change: 3.7, p < .001; dz = 3.04). IMPLICATIONS.: Results provide an initial demonstration of the benefits of PA for occupational outcomes within a post-secondary mental health context.

Hair Transplantation and Follicular Unit Extraction.

This article introduces the reader to the key components of hair transplantation, including evaluating the surgical patient, deciding whether to perform follicular unit transplantation (FUT) or follicular unit extraction (FUE), understanding the key components of these procedures, and establishing practical preoperative and postoperative protocols.

Randomized Controlled Trial of Exercise to Improve Walking Energetics in Older Adults.

BACKGROUND AND OBJECTIVES: Mobility limitation is common and has been linked to high energetic requirements of daily activities, including walking. The study objective was to determine whether two separate forms of exercise could reduce the energy cost of walking and secondary outcomes related to activity and participation domains among older adults with mobility limitation. RESEARCH DESIGN AND METHODS: Community-dwelling older adults with self-reported mobility limitation (n = 72) were randomized to 12 weeks of twice-weekly, group-based, instructor-led timing and coordination, aerobic walking, or stretching and relaxation (active control) programs. The primary outcome was the energy cost of walking (mL O2/kg/m), assessed by a 5-minute treadmill walking test (0.8 m/s). Secondary outcomes were fatigability, physical activity, endurance, physical function, and life-space. Baseline-adjusted ANCOVAs were used to determine mean differences between exercise and control groups at 12 and 24 weeks. RESULTS: Exercise session attendance was high: 86% for timing and coordination, 81% for aerobic walking, and 90% for stretching and relaxation. At 12 weeks, timing and coordination reduced the mean energy cost of walking by 15% versus stretching and relaxation (p = .008). Among those with high baseline cost, timing and coordination reduced mean energy cost by 20% versus stretching and relaxation (p = .055). Reductions were sustained at 24 weeks. Aerobic walking had no effect on the energy cost of walking at 12 or 24 weeks. At 12 weeks, there was a trend toward faster gait speed (by 0.1 m/s) in timing and coordination versus stretching and relaxation (p = .074). Fatigability, physical activity, endurance, physical function, and life-space did not change with timing and coordination or aerobic walking versus stretching and relaxation at 12 or 24 weeks. DISCUSSION AND IMPLICATIONS: Twelve weeks of timing and coordination, but not aerobic walking, reduced the energy cost of walking among older adults with mobility limitation, particularly among those with high baseline energy cost; reductions in energy cost were sustained following training cessation. Timing and coordination also led to a trend toward faster gait speed.

Undergraduate research experiences: mentoring, awareness, and perceptions-a case study at a Hispanic-serving institution.

BACKGROUND: Undergraduate research experiences (UREs) have been proposed as means to increase the retention and engagement of minority-and more specifically Hispanic-college students in science, technology, engineering, and mathematics (STEM) majors. This study explores the impact of student characteristics such as gender, classification, ethnicity, and first-generation status on UREs of STEM students through four specific constructs that current literature deem particularly important: (1) research experiences, (2) mentoring experiences, (3) awareness of research opportunities and activities, and (4) perceptions on research. These constructs are here forth referred to as Experiences, Mentoring, Awareness, and Perceptions. The study was conducted at a Hispanic-serving institution (HSI) in Texas, United States (U.S.), where the overall increase in enrollment has been driven by growth in Hispanic student numbers, reflecting the demographic shift of the state and the nation. RESULTS: Participants were recruited to be part of a STEM open house. Thirty-five students participated in the Undergraduate Research Experiences: Mentoring, Awareness, and Perceptions Survey (URE MAPS). This exploratory case study sought to look at student characteristics such as gender, classification, ethnicity, and first-generation status as predictors of UREs. Results show that classification and ethnicity student characteristics are statistically significant predictors of UREs. Although gender and first-generation status regression analysis did not show statistically significant results, crosstabulations looking at correlation among variables yield interesting results. Seven percent of the female respondents responded that they "somewhat agree" with the statement that research is a lonely activity in comparison with 23% of males. The majority (60%) of all respondents who "strongly agreed" with the statement that "research is only for future scientists" were Hispanic, indicating a need to clarify such misconceptions to encourage Hispanic student participation. Most self-identified first-generation participants, of whom 80% were female, reported awareness of faculty research activities, again pointing out gender as an important factor among students' relationship with their professors. Although less than 23% of students noted current participation in mentorship, most of those did report positive impact of this relationship on their attitude and perspective toward their major. CONCLUSIONS: Despite the small sample size and inherent bias in the characteristics of the STEM open house participants, regression analysis informed by crosstabs analysis revealed some important findings. The research suggested higher-than-expected awareness of Latinos and first-generation students of institutional research activities; however, this awareness has not translated in engagement in research activities. The data also indicates the critical need for high-impact UREs and mentorship relationships, as well as for efforts to battle student preconceptions of who can benefit from such experiences. Although this case study focused on LatinX students (LatinX is a gender-neutral term for people of Latin American heritage used in the U.S.) in the U.S., retention of historically underrepresented students in STEM disciplines is a concern shared by many countries around the world. The successful recruitment, retention, and eventual success of students in STEM degrees depend greatly on the type of pathways and support that are offered. UREs might be one of those pathways.

Heart disease awareness among college students.

The purpose of this research was to explore college students' attitudes about heart disease risks and preventive strategies. The survey population consisted of students enrolled in selected lecture courses at Arizona State University. A total of 1481 surveys were used in data analysis. Respondents indicated a lower perception of heart disease risk for women than for men, and a majority of students incorrectly believed that breast cancer is a more significant health concern for women than heart disease. Respondents in most ethnic groups believed that whites are most at risk for developing heart disease. Students overall had relatively low levels of knowledge about heart disease and its risk factors compared to other health issues, such as sexually transmitted diseases (STDs) and psychological disorders. The results suggest that educational intervention is necessary to increase college students' knowledge about heart disease; and, in particular, efforts need to be made to raise awareness about heart disease among women and minorities. Guidelines for future educational intervention must address common misconceptions about which demographic groups are at risk for developing heart disease and address gaps in knowledge that young people have regarding heart disease prevention.