Rosmarinic acid up-regulates the noise-activated Nrf2/HO-1 pathway and protects against noise-induced injury in rat cochlea.

Noise-induced hearing loss depends on progressive increase of reactive oxygen species and lipoperoxidative damage in conjunction with the imbalance of antioxidant defenses. The redox-sensitive transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) plays a critical role in the regulation of cellular defenses against oxidative stress, including heme oxygenase-1 (HO-1) activation. In this work we describe a link between cochlear oxidative stress damage, induced by noise exposure, and the activation of the Nrf2/HO-1 pathway. In our model, noise induces superoxide production and overexpression of the lipid peroxidation marker 4-hydroxy-nonenals (4-HNE). To face the oxidative stress, the endogenous defense system is activated as well, as shown by the slight activation of superoxide dismutases (SODs). In addition, we observed the activation of the Nrf2/HO-1 pathway after noise exposure. Nrf2 appears to promote the maintenance of cellular homeostasis under stress conditions. However, in this model the endogenous antioxidant system fails to counteract noise-induced cell damage and its activation is not effective enough in preventing cochlear damage. The herb-derived phenol rosmarinic acid (RA) attenuates noise-induced hearing loss, reducing threshold shift, and promotes hair cell survival. In fact, RA enhances the endogenous antioxidant defenses, as shown by decreased superoxide production, reduced expression of 4-HNE, and up-regulation of SODs. Interestingly, RA potentiates the Nrf2/HO-1 signaling pathway, as shown by immunohistochemical and Western blot analyses. Thus, protective effects of RA are associated with the induction/activation of the Nrf2-ARE signaling pathway in addition to RA direct scavenging capability.

The heme oxygenase/biliverdin reductase system in skin cancers.

The heme oxygenase/biliverdin reductase (HO/BVR) pathway enhances cell stress response by degrading excess heme or producing antioxidant and cytoprotective molecules. Recently, members of the HO/BVR system have been proposed as biomarkers for the early diagnosis of free radical-related diseases. In this study, the presence of both the inducible and constitutive HO isoforms (HO-1 and HO-2, respectively) and BVR was evaluated by immunohistochemistry in human skin cancer samples. Moderate/strong immunoreactivities against HO-1, HO-2 and BVR were detected in 100% of the nodular malignant melanoma samples, whereas in basal cell carcinoma specimens these figures were 62%, 88% and 60%, respectively, with a faint/moderate degree of expression. Faint/moderate HO-1, HO-2 and BVR immunoreactivities were detected in 33%, 66% and 100% of melanocytic nevi samples, respectively. In conclusion, HO-1 and HO-2 and BVR were expressed in the cytosols of skin cancer cells, whereas perilesional normal epidermis showed only faint staining, thus leading to the hypothesis that the HO/BVR system is activated in skin cancers.

Social capital: a novel platform for understanding social determinants of health in systemic lupus erythematosus.

OBJECTIVE: The objective of this paper is to introduce the concept of social capital as a unique and distinct entity from the traditional psychosocial factors of social support, depressive symptoms, and self-efficacy in systemic lupus erythematosus (SLE) patients, and to evaluate how social capital varies in an SLE sample according to demographic, clinical, and psychosocial variables. METHODS: In a cross-sectional study, SLE patients completed the Adapted Social Capital Assessment Tool (A-SCAT), which measures cognitive and structural social capital. Patients also completed measures of social support, depressive symptoms, and SLE self-efficacy. Correlations were evaluated between social capital scores and demographic, clinical, and psychosocial variables. RESULTS: We recruited 89 patients (mean age: 39 ± 15 years old, 83 (93): female; mean SLEDAI: 4; mean SLICC 1). The mean A-SCAT score was 34 ± 15 (normal: 0-71); higher scores were associated with female sex, older age, higher education, Caucasian race, and non-Medicaid insurance (p ≤ 0.03 for all); associations were attributable to structural social capital. Social capital was not associated with depressive symptoms, self-efficacy, or affectionate and interaction social support, but was associated with informational and tangible social support (r = 0.39, r = 0.26, respectively, p ≤ 0.02). There were no associations between SLEDAI and SLICC and social capital, social support, and depressive symptoms. CONCLUSIONS: Social capital is a novel construct that, like other traditional psychosocial measures, addresses aspects of SLE not reflected by markers of disease activity. Social capital, however, is distinct from traditional psychosocial measures and offers a new platform on which ideas of social connectedness can broaden our understanding of health and chronic illness.

Daily-life monitoring of stroke survivors motor performance: the INTERACTION sensing system.

The objective of the INTERACTION Eu project is to develop and validate an unobtrusive and modular system for monitoring daily life activities, physical interactions with the environment and for training upper and lower extremity motor function in stroke subjects. This paper describes the development and preliminary testing of the project sensing platform made of sensing shirt, trousers, gloves and shoes. Modular prototypes were designed and built considering the minimal set of inertial, force and textile sensors that may enable an efficient monitoring of stroke patients. The single sensing elements are described and the results of their preliminary lab-level testing are reported.

Performances evaluation of textile electrodes for EMG remote measurements.

This work focus on the evaluation of textile electrodes for EMG signals acquisition. Signals have been acquired simultaneously from textile electrode and from gold standard electrodes, by using the same acquisition system; tests were done across subjects and with multiple trials to enable a more complete analysis. This research activity was done in the frame of the European Project Interaction, aiming at the development of a system for a continuous daily-life monitoring of the functional performance of stroke survivors in their physical interaction with the environment.

The heme oxygenase/biliverdin reductase system: a potential drug target in Alzheimer’s disease.

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by the progressive loss of cognitive function, the inability to perform the activities of daily living and psychiatric symptoms. The formation of toxic aggregates of amyloid-beta-peptide (Abeta), through the activities of beta - and gamma- secretases, is considered as the earlier event in the pathogenesis of the disease. The deposition of both Abeta and the following hyperphosphorylation of tau protein, trigger an exaggerate immune-inflammatory response culminating with the production of excess reactive oxygen and nitrogen species responsible for damage on cellular nucleic acids, proteins and lipids. One of the mechanisms used by neural cells to counteract oxidative/nitrosative damage in AD is the enhancement of the cell stress response. Among the main components of the cell stress response is the heme oxygenase/biliverdin reductase (HO/BVR) axis, which catalyzes the degradation of heme which is toxic if produced in excess or under redox unbalanced conditions. However, the HO/BVR system and its by-products, carbon monoxide and bilirubin, have also been shown to be neuroprotective by activating pro-survival pathways and scavenging free radicals. Nevertheless, recent research demonstrated as both the inducible isoform of HO, known as HO-1, and BVR undergo oxidative/nitrosative/phosphorylative post-translational modifications in AD brain which alter the ability of HO-1 and BVR to activate the cell stress response. In this light, naturally occurring substances or drugs (e.g. statins) that prevent the post-translational modifications leading to a controlled up-regulation of the HO/BVR system have been proposed as potential new tools for the treatment of AD.

Electron shell ionization of atoms with classical, relativistic scattering.

We investigate forward scattering of ionization from neon, argon, and xenon in ultrahigh intensities of 2 × 10(19) W/cm(2). Comparisons between the gases reveal the energy of the outgoing photoelectron determines its momentum, which can be scattered as far forward as 45° from the laser wave vector k(laser) for energies greater than 1 MeV. The shell structure in the atom manifests itself as modulations in the photoelectron yield and the width of the angular distributions. We arrive at an agreement with theory by using an independent electron model for the atom, a dipole approximation for the bound state interaction, and a relativistic, three-dimensional, classical radiation field including the laser magnetic field. The studies provide the atomic physics within plasmas, radiation, and particle acceleration in ultrastrong fields.

A pilot study of office-based spirometry in patients with systemic lupus erythematosus.

BACKGROUND: Although pulmonary involvement is common in systemic lupus erythematosus (SLE), its effects on healthy lifestyle physical activity and its association with fatigue have not been well characterized. The goals of this study were to describe pulmonary function measured by office-based spirometry in patients with SLE and to compare spirometry with physical activity and systemic fatigue. METHODS: During an office visit, 49 patients with SLE completed spirometry assessing: a) forced expiratory volume in 1 s (FEV(1), a measure of airway patency and responsiveness); b) forced vital capacity (FVC, a measure of lung volume); and c) maximum voluntary ventilation (MVV, a measure of volume of air moved during rapid breathing) which has been hypothesized to be decreased in SLE due to muscle fatigue. Patients also performed a 2-min corridor walking test and completed self-reported questionnaires measuring weekly physical activity and systemic fatigue. RESULTS: Mean age was 45 years, 45 (92%) were women, mean SLEDAI and SLICC scores were 2.8 and 1.0, respectively. Some 24 patients had a smoking history, and 15 had a history of SLE-related pleuritis, which was not active at enrollment. FEV(1) and FVC were 96% of predicted, but MVV was only 55% of predicted. The distance walked during the corridor test was similar to that of patients with other chronic diseases; however, self-reported physical activity was less than recommended by national guidelines. There were no associations between spirometry values and history of pleuritis, other pulmonary diagnoses, or smoking (p > .10 for all comparisons), however, better FEV(1) (p = .04) and better FVC (p = .04) were associated with more self-reported activity and better FEV(1) (p = .03) was associated with longer distance walked during the corridor test. Most patients reported marked systemic fatigue; however, there were no associations between spirometry values and fatigue scores (p > .10 for all comparisons). CONCLUSIONS: MVV was markedly diminished, which supports the hypothesis that SLE may be associated with respiratory muscle fatigue during rapid breathing. MVV was not associated with mild-to-moderate patient-directed physical activity; however, lower FEV(1) and FVC were associated with less self-reported and performance-based physical activity.

Perceptions and measurements of physical activity in patients with systemic lupus erythematosus.

Promoting physical activity should be a priority for patients with systemic lupus erythematosus (SLE) because a sedentary lifestyle compounds patients' already disproportionately high risk for cardiovascular events and other adverse health outcomes. The objectives of this pilot study were to assess physical activity in 50 patients with SLE and to compare activity levels with clinical and psychosocial variables, such as fatigue, depressive symptoms, and social support and stress. Patients were asked open-ended questions about physical activity, and responses were coded according to Grounded Theory. Patients then completed the Paffenbarger Physical Activity and Exercise Index, a survey of lifestyle energy expenditure reported in kilocalories/week, performed a 2-minute walk test according to a standard protocol, and completed questionnaires measuring fatigue, depressive symptoms and social support and stress. Most patients (92%) were women, had a mean age of 45 years, and did not have extensive SLE. In response to open-ended questions, patients reported they avoided physical activity because they did not want to exacerbate SLE in the short term. However, if they could overcome initial hurdles, 46 patients (92%) thought physical activity ultimately would improve SLE symptoms. Walking was the preferred activity and 45 (90%) thought they could walk more. According to the Paffenbarger Index, mean energy expenditure was 1466 ± 1366 kilocalories/week and mean time spent in moderate-intensity activity was 132 ± 222 min/week. In total, 18 patients (36%) and 14 patients (28%) met physical activity goals for these values, respectively. Mean distance walked during the 2-minute test was 149 ± 28 m, equivalent to two blocks, which is similar to reports for stable patients with other chronic diseases. Patients with more social stress and more fatigue reported less physical activity. We conclude that the proportion of patients meeting physical activity goals was low; however, patients performed well on a standard walking test. Most patients believed physical activity provided long-term benefits for SLE and that they could be more physically active.

In vivo protective effect of ferulic acid against noise-induced hearing loss in the guinea-pig.

Ferulic acid (FA) is a phenolic compound whose neuroprotective activity was extensively studied in vitro. In this study, we provided functional in vivo evidence that FA limits noise-induced hearing loss. Guinea-pigs exposed to acoustic trauma for 1 h exhibited a significant impairment in auditory function; this injury was evident as early as 1 day from noise exposure and persisted over 21 days. Ferulic acid (150 mg/kg i.p. for 4 days) counteracted noise-induced hearing loss at days 1, 3, 7 and 21 from noise exposure. The improvement of auditory function by FA was paralleled by a significant reduction in oxidative stress, apoptosis and increase in hair cell viability in the organ of Corti. Interestingly in the guinea-pig cochleae, the neuroprotective effect of FA was functionally related not only to its scavenging ability in the peri-traumatic period but also to the up-regulation of the cytoprotective enzyme heme oxygenase-1 (HO-1); in fact, FA-induced improvement of auditory function was counteracted by the HO inhibitor zinc-protoporphyrin-IX and paralleled the time-course of HO-1 induction over 3-7 days. These results confirm the antioxidant properties of FA as free-radical scavenger and suggest a role of HO-1 as an additional mediator against noise-induced ototoxicity.

The hormetic role of dietary antioxidants in free radical-related diseases.

Regular consumption of cruciferous vegetables or spices is associated with a reduced incidence of cancer and reduction of markers for neurodegenerative damage. Furthermore, greater health benefit may be obtained from raw as opposed to cooked vegetables. Nutritional interventions, by increasing dietary intake of fruits and vegetables, can retard and even reverse age-related declines in brain function and cognitive performance. The mechanisms through which dietary supplementation with antioxidants may be useful to prevent free radical-related diseases is related to their ability to counteract toxic production of both reactive oxygen and nitrogen species, along with the up-regulation of vitagenes, such as members of the heat shock protein (Hsp) family heme oxygenase-1 and Hsp70. The most prominent dietary factor that affects the risk of many different chronic diseases is energy intake - excessive calorie intake increases the risk. Reducing energy intake by controlled caloric restriction or intermittent fasting increases lifespan and protects various tissues against diseases, in part, by hormetic mechanisms that increase cellular stress resistance. This biphasic dose-response relationship, referred to here as hormesis, display low-dose stimulation and a high-dose inhibition. Despite the current interest in hormesis by the toxicology community, quantitatively similar U-shaped dose responses have long been recognized by researchers to be involved with factors affecting memory, learning, and performance, as well as nutritional antioxidants and oxidative stress-mediated degenerative reactions. Dietary polyphenols present strong cytoprotective effects, however under uncontrolled nutritional supplementation gene induction effects and the interaction with detoxification responses can have negative consequences through the generation of more reactive and harmful intermediates.

The heme oxygenase/biliverdin reductase pathway in drug research and development.

The heme oxygenase/biliverdin reductase (HO/BVR) axis catalyzes the degradation of heme, but this system and its by-products, carbon monoxide (CO) and bilirubin, have also been shown to exert cytoprotective effects by activating pro-survival pathways and scavenging free radicals. Naturally occurring substances that upregulate the inducible isoform of HO (HO-1) have therefore been proposed as potential new drugs for the treatment of free radical-induced disease. A number of existing drugs have also been shown to regulate the HO/BVR system, and this capacity is considered an additional mechanism for their therapeutic activity. However, upregulation of the HO/BVR axis is not always beneficial for cells: the heme depletion and accumulation of CO and bilirubin it causes are potentially toxic. Therefore, new pharmacological modulators of HO/BVR activity must act in a dose-dependent manner. This would allow dose titration to achieve a desired pharmacologic effect without producing toxicity. Unfortunately, this goal is more complicated than it seems because toxicity has to be defined in terms of each of the main products of heme metabolism. Furthermore, sensitivity to the therapeutic/toxic effects of these products is likely to be tissue- or cell-type specific. The solution may lie in the use of novel drug-delivery systems that allow targeted delivery of low doses of the HO/BVR modulator to selected tissues.

Oxidatively-modified and glycated proteins as candidate pro-inflammatory toxins in uremia and dialysis patients.

End stage renal disease (ESRD) patients accumulate blood hallmarks of protein glycation and oxidation. It is now well established that these protein damage products may represent a heterogeneous class of uremic toxins with pro-inflammatory and pro-oxidant properties. These toxins could be directly involved in the pathogenesis of the inflammatory syndrome and vascular complications, which are mainly sustained by the uremic state and bioincompatibility of dialysis therapy. A key underlying event in the toxicity of these proteinaceous solutes has been identified in scavenger receptor-dependent recognition and elimination by inflammatory and endothelial cells, which once activated generate further and even more pronounced protein injuries by a self-feeding mechanism based on inflammation and oxidative stress-derived events. This review examines the literature and provides original information on the techniques for investigating proteinaceous pro-inflammatory toxins. We have also evaluated therapeutic - either pharmacological or dialytic - strategies proposed to alleviate the accumulation of these toxins and to constrain the inflammatory and oxidative burden of ESRD.

Protective role of MnSOD and redox regulation of neuronal cell survival.

Reactive oxygen species (ROS) play a central role in neuronal pathophysiology and in neurodegenerative disorders. However, recent evidence indicates that these molecules also operate as signaling intermediates in a variety of physiological settings, including cell protection from apoptosis. Data presented here strongly support such a dual role for oxidants in neuronal cell homeostasis. In rat pheocromocytoma cells, cell rescue by the nerve growth factor (NGF) is accompanied by a transient burst of ROS generated in the cytosol by a GTPase-dependent mechanism. Within the NGF signaling cascade, ROS lie upstream and are necessary for activation/phosphorylation of AKT/PKB and of the antiapoptotic transcription factor cAMP-responsive element-binding protein (CREB). Conversely, an increase in mitochondrial oxygen species heralds apoptosis of serum-deprived cells, and these events can be prevented by cell exposure to NGF or by treatment with the mitochondrially targeted antioxidant MitoQ. Importantly, NGF-mediated decrease of mitochondrial ROS is dependent on the transcriptional up-regulation of the manganese superoxide dismutase (MnSOD) by active CREB. These observations therefore outline a circuitry whereby cytosolic redox signaling promotes neuronal cell survival by increasing the mitochondrial antioxidant defenses.

How do cancer patients who try to take control of their disease differ from those who do not?

The objective of this study was to compare patients who do and do not describe their coping strategies as attempts to control their cancer. This was a cross-sectional study of adult, oncology outpatients from an urban medical centre diagnosed 6-24 months previously. Using open-ended questions, we asked participants if they tried to 'control' their cancer or situation. If 'yes', how? If 'no', how had they 'dealt with' it? The Hospital Anxiety and Depression Scale (HAD) measured anxiety and depression. The Mental Adjustment to Cancer Scale (MAC) assessed six coping styles. Of the 44 participants, 57% were female. The mean age was 57 years. Eighteen (41%) said they used control strategies (control-yes), 11 (25%) said they did not (control-no), and 15 (34%) gave unclear responses (control-unclear). Participants cited 97 different coping strategies that were grouped into proactive (e.g. lifestyle changes) and reactive strategies (e.g. stoic behaviour). In comparing these groups, the control-yes group was more likely to be younger (P = 0.0001), live with other(s) (P = 0.003), be confident of being cured (P = 0.006), have greater 'fighting spirit' on the MAC (P = 0.04) and use more proactive strategies (P = 0.0001). The conclusion of this study is that cancer patients use many coping strategies, but those who think of them as methods of control are younger and more confident of being cured, and use more proactive strategies.

Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma.

BACKGROUND: Certain psychosocial variables are relatively unexplored as possible predictors of asthma outcomes. OBJECTIVE: To determine if asthma self-efficacy, depressive symptoms, and unrealistic expectations predict urgent care use and change in health-related quality of life measured by the Asthma Quality of Life Questionnaire and the SF-36 during 2 years. RESEARCH DESIGN: Prospective cohort study in a primary care internal medicine practice at a tertiary care center in New York City. PATIENTS: Adults with moderate asthma who were fluent in either English or Spanish. MEASUREMENTS: At enrollment patients were interviewed in-person and completed a series of questionnaires including the Asthma Quality of Life Questionnaire (AQLQ), the SF-36, the Asthma Self-efficacy Scale, the Geriatric Depression Scale, and open-ended questions regarding their expectations of treatment. Patients also completed the AQLQ and SF-36 at various time intervals throughout the study and were interviewed by telephone every 3 months to record recent hospitalizations, emergency department visits and nonroutine office visits for asthma. RESULTS: A total of 224 patients were followed for a mean of 23.8 months. In hierarchical analysis, independent predictors of lower AQLQ scores were less self-efficacy, more depressive symptoms, expecting to be cured of asthma, requiring methylxanthines, being Hispanic or black, and having difficult or very difficult access to asthma care (all at P <0.05). Similar predictors were found for lower SF-36 scores. Another outcome, use of urgent care, was required by 60% of patients during the study period. Predictors of using urgent care were having more depressive symptoms, expecting a cure, being female, requiring oral beta-agonists, and having a history of prior hospitalizations for asthma (all at P <0.05). CONCLUSIONS: Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.

Smoking cessation following CT screening for early detection of lung cancer.

BACKGROUND: This study was conducted to assess the impact of lung cancer screening participation on smoking cessation. METHODS: Individuals (n = 134) who reported active smoking at the time of enrollment in our Early Lung Cancer Action Program (ELCAP) completed a brief, follow-up telephone interview assessing any changes in smoking patterns following lung cancer screening. Using logistic regression, we estimated the probability of decreasing or quitting smoking using each enrollee's background information and computed tomography (CT) scan results. RESULTS: Most survey respondents (74%) agreed that participation in the ELCAP increased their motivation for quitting smoking. In terms of self-reported changes in smoking behavior, 31 (23%) reported that they had quit and 35 (27%) decreased their smoking patterns. Several significant covariates of smoking cessation were identified: perceived benefit of quitting (OR 4.02), cancer anxiety (OR 2.49), younger age (OR 2.47), and abnormal CT finding (1.97). CONCLUSIONS: Our analyses suggest that low-dose helical CT scanning may serve as a strong catalyst for smoking cessation and that delivery of effective smoking cessation interventions along with CT scanning represents a potential opportunity to increase the overall cancer prevention benefit of lung cancer screening.

Patients' expectations of knee surgery.

BACKGROUND: Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our goals were to measure patients" preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. METHODS: An initial sample of 377 patients (mean age, 54.6 18.2 years; 52% women) was enrolled in the survey-development phase. One hundred and sixty-one (43%) of these patients subsequently underwent total knee arthroplasty; seventy-five (20%), cruciate ligament repair; eighty-five (23%), meniscal surgery; and fifty-six (15%), surgery for another knee condition. Preoperatively, these patients were asked open-ended questions about their expectations of knee surgery. Their responses were grouped with use of qualitative research techniques to generate categories of expectations. Categories were transformed into specific questions and were formatted into two draft surveys, one for patients undergoing total knee arthroplasty and one for patients undergoing other surgical procedures on the knee. A second sample of 163 patients (mean age, 55.1 17.5 years; 49% women) was enrolled in the survey-testing phase, and they completed the draft surveys on two separate occasions to establish test-retest reliability. Items were selected for the final surveys if they were cited by 5% of the patients, if they represented important functional changes resulting from surgery, or if they represented potentially unrealistic expectations. All selected items fulfilled reliability criteria, defined as a kappa (or weighted kappa) value of 0.4, or were deemed to be clinically relevant by a panel of orthopaedic surgeons. RESULTS: From the survey-development phase, a total of fifty-two categories of expectations were discerned; they included both anticipated items such as pain relief and improvement in walking ability and unanticipated items such as improving psychological well-being. Expectations varied by diagnosis and patient characteristics, including functional status. Two final surveys were generated: the seventeen-item Hospital for Special Surgery Knee Replacement Expectations Survey and the twenty-item Hospital for Special Surgery Knee Surgery Expectations Survey. Each required less than five minutes to complete. CONCLUSIONS: Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients' responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.

The "Airmedical F.A.S.T." for trauma patients--the initial report of a novel application for sonography.

BACKGROUND: While established as an initial screening tool for the evaluation of injured patients at the trauma center, sonographic evaluation of the patient in the prehospital setting remains untested. The purpose of this study was to determine the feasibility of this procedure during prehospital helicopter transport. METHODS: Two qualified flight surgeons performed all imaging studies. Confirmatory endpoints were documented for all images obtained in flight. RESULTS: For this preliminary study, 100 patients are presented; 84 studies were analyzed; 16 were excluded due to patient weight (8), hemodynamic instability (6), or problems with machine calibration (2). Sensitivity was 81.3%; specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.7%. The accuracy was 96.4%. CONCLUSION: Sonographic studies obtained during air-medical transport are of similar quality and consistency as those obtained in the emergency department. The ability to detect hemoperitoneum in the field may challenge traditional algorithms for prehospital care as a result.