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1.
Artigo em Inglês | MEDLINE | ID: mdl-32552433

RESUMO

We questioned whether the respiratory muscles of humans contribute to systemic oxidative stress following inspiratory flow resistive breathing, if the amount of oxidative stress is influenced by the level of resistive load, and whether the amount of oxidative stress is related to the degree of diaphragm fatigue incurred. Eight young and healthy participants attended the laboratory for 4 visits on separate days. During the first visit, height, body mass, lung function and maximal inspiratory mouth and transdiaphragmatic pressure (Pdimax) were assessed. During visits 2-4, participants undertook inspiratory flow resistive breathing with either no resistance (Control) or resistive loads equivalent to 50 and 70% of their Pdimax (Pdimax50% and Pdimax70%) for 30 min. Participants undertook 1 resistive load per visit, and the order that they undertook the loads was randomized. Inspiratory muscle pressures were higher (P < 0.05) during the 5th and final min of Pdimax50% and Pdimax70% compared to Control. Plasma F2-isoprostanes increased (P < 0.05) following inspiratory flow resistive breathing at Pdimax70%. There were no increases in plasma protein carbonyls and total antioxidant capacity. Further, although we evidenced small reductions in transdiapragmaic twitch pressures (PdiTW) after inspiratory flow resistive breathing at Pdimax50% and Pdimax70%, this was not related to the increase in plasma F2-isoprostanes. Our novel data suggest that only when sufficiently strenuous, inspiratory flow resistive breathing in humans elicits systemic oxidative stress evidenced by elevated plasma F2-isoprostanes, and based on our data this is not related to a reduction in PdiTW.

2.
Med Sci Sports Exerc ; 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32366795

RESUMO

INTRODUCTION: Prior upper body exercise reduces the curvature constant (W') of the hyperbolic power-duration relationship without affecting critical power. This study tested the hypothesis that prior upper body exercise reduces the work done over the end-test power (WEP; analogue of W') during a 3-min all-out cycling test (3MT) without affecting the end-test power (EP; analogue of critical power). METHODS: Ten endurance-trained men (V˙O2max = 62 ± 5 mL⋅kg⋅min) performed a 3MT without (CYC) and with (ARM-CYC) prior severe-intensity, intermittent upper body exercise. EP was calculated as the mean power output over the last 30-s of the 3MT, whereas WEP was calculated as the power-time integral above EP. RESULTS: At the start of the 3MT, plasma [La] (1.8 ± 0.4 vs. 14.1 ± 3.4 mmol·L) and [H] (42.8 ± 3.1 vs. 58.6 ± 5.5 nmol·L) were higher, whereas the strong ion difference ([SID]) (41.4 ± 2.2 vs. 30.9 ± 4.6 mmol·L) and [HCO3] (27.0 ± 1.9 vs. 16.9 ± 3.2 mmol·L) were lower, during ARM-CYC than CYC (P < 0.010). EP was 12% lower during the 3MT of ARM-CYC (298 ± 52 W) than CYC (338 ± 60 W) (P < 0.001), whereas WEP was not different (CYC: 12.8 ± 3.3 kJ vs. ARM-CYC: 13.5 ± 4.1 kJ, P = 0.312). EP in CYC was positively correlated with the peak [H] (r = 0.78, P = 0008), and negatively correlated with the lowest [HCO3] (r = -0.74, P = 0.015). CONCLUSION: These results suggest that EP during a 3MT in endurance-trained men is sensitive to fatigue-related ionic perturbation.

3.
Environ Health Perspect ; 128(4): 47009, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32347764

RESUMO

BACKGROUND: High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru. OBJECTIVES: The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures. METHODS: Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM < 2.5µm in aerodynamic diameter (PM2.5)] with the Enhanced Children's MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children <1 year of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of PM2.5 exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur. CONCLUSIONS: The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. https://doi.org/10.1289/EHP6422.

4.
Environ Health Perspect ; 128(4): 47008, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32347766

RESUMO

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2.5µm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.

5.
J Appl Psychol ; 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32105096

RESUMO

Job applicants are increasingly turning to LinkedIn for their job search, so much so that it is supplanting traditional job search tools in many ways. Despite this widespread usage, scholarly research that explores its efficacy and the mechanisms for job search success (or failure) in this context is lacking. Accordingly, we rely upon social-cognitive theory and self-regulation theory to explore beneficial and adverse outcomes of searching for a job on LinkedIn as well as these outcomes' influence on job search success. Using a multivariate latent change analysis model, our longitudinal data across 2 samples support a self-regulatory frame but not a social-cognitive view, suggesting that a change in LinkedIn use for job search is positively related to a subsequent change in ego depletion, which leads to an ensuing adverse change in job search success. Additionally, as opposed to what is predicted by social-cognitive theory and typically found in the literature, an increase in job search behavior on LinkedIn was found to lead to poorer job search self-efficacy. In Study 3, we conduct a between-person experiment that explores this finding with results showing that upward social comparisons on LinkedIn lead to lower levels of self-efficacy. In all, the more that individuals use LinkedIn for job search, the worse their job search self-efficacy becomes, the more they become depleted, and the poorer their ensuing job search success. Results suggest some caution should be taken when conducting a job search on LinkedIn. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

6.
Sci Rep ; 10(1): 3313, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32094359

RESUMO

One of the most interesting and everyday natural phenomenon is the formation of different patterns after the evaporation of liquid droplets on a solid surface. The analysis of dried patterns from blood droplets has recently gained a lot of attention, experimentally and theoretically, due to its potential application in diagnostic medicine and forensic science. This paper presents evidence that images of dried blood droplets have a signature revealing the exhaustion level of the person, and discloses an entirely novel approach to studying human dried blood droplet patterns. We took blood samples from 30 healthy young male volunteers before and after exhaustive exercise, which is well known to cause large changes to blood chemistry. We objectively and quantitatively analysed 1800 images of dried blood droplets, developing sophisticated image processing analysis routines and optimising a multivariate statistical machine learning algorithm. We looked for statistically relevant correlations between the patterns in the dried blood droplets and exercise-induced changes in blood chemistry. An analysis of the various measured physiological parameters was also investigated. We found that when our machine learning algorithm, which optimises a statistical model combining Principal Component Analysis (PCA) as an unsupervised learning method and Linear Discriminant Analysis (LDA) as a supervised learning method, is applied on the logarithmic power spectrum of the images, it can provide up to 95% prediction accuracy, in discriminating the physiological conditions, i.e., before or after physical exercise. This correlation is strongest when all ten images taken per volunteer per condition are averaged, rather than treated individually. Having demonstrated proof-of-principle, this method can be applied to identify diseases.

7.
ACS Appl Mater Interfaces ; 12(5): 6736-6741, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31934741

RESUMO

Direct ink writing (DIW) three-dimensional (3D) printing provides a revolutionary approach to fabricating components with gradients in material properties. Herein, we report a method for generating colloidal germania feedstock and germania-silica inks for the production of optical quality germania-silica (GeO2-SiO2) glasses by DIW, making available a new material composition for the development of multimaterial and functionally graded optical quality glasses and ceramics by additive manufacturing. Colloidal germania and silica particles are prepared by a base-catalyzed sol-gel method and converted to printable shear-thinning suspensions with desired viscoelastic properties for DIW. The volatile solvents are then evaporated, and the green bodies are calcined and sintered to produce transparent, crack-free glasses. Chemical and structural evolution of GeO2-SiO2 glasses is confirmed by nuclear magnetic resonance, X-ray diffraction, and Raman spectroscopy. UV-vis transmission and optical homogeneity measurements reveal comparable performance of the 3D printed GeO2-SiO2 glasses to glasses produced using conventional approaches and improved performance over 3D printed TiO2-SiO2 inks. Moreover, because GeO2-SiO2 inks are compatible with DIW technology, they offer exciting options for forming new materials with patterned compositions such as gradients in the refractive index that cannot be achieved with conventional manufacturing approaches.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31881652

RESUMO

BACKGROUND: Globally, an estimated 3.6 billion people rely on solid fuels for cooking over open fires or in simple cookstoves. Universal access to clean cooking fuels and technology by 2030 is a United Nations' Sustainable Development Goal. METHODS: The Mediae Company created a home makeover television and radio show, Shamba Chef, designed to promote modern, cleaner, safer cooking methods and improved nutrition in Kenya, which reached 5 million homes in late 2017. This was accompanied by a mobile phone platform called iChef. Researchers evaluated the effects of Shamba Chef on cookstove purchase, use, and attitudes, beliefs, and intentions. RESULTS: The study revealed dose-response effects of Shamba Chef exposure on several key outcomes. Exposure to the program was associated with an awareness of improved biomass stoves (OR 4.4; 95% CI 2.8 to 6.9), and aspirations to own an improved biomass stove (OR 2.0; 95% CI 1.4 to 2.9). Receiving information about modern stoves from two or more sources generated greater awareness of liquefied petroleum gas (LPG) stoves (OR 2.0; 95% CI 1.3 to 3.1). The qualitative study revealed that Shamba Chef explained how the stoves worked, communicated their benefits, and encouraged participants to trust and purchase those cookstoves. CONCLUSION: Shamba Chef was successful in influencing determinants of cookstove purchase and use, and there is evidence from the qualitative study that it influenced the purchase and use of improved biomass stoves.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Comportamento do Consumidor , Culinária/métodos , Utensílios Domésticos , Adulto , Atitude , Feminino , Fogo , Conhecimentos, Atitudes e Prática em Saúde , Produtos Domésticos , Humanos , Quênia , Ciências da Nutrição , Tecnologia , Televisão
9.
J Appl Psychol ; 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31670528

RESUMO

Obesity is a condition that affects much of the world's population and generates substantial costs to organizations and their employees. Multiple scholarly disciplines have generated a significant body of literature on the workplace consequences of obesity. Strikingly, however, the applied psychology and management literatures-a natural home for such research-have largely ignored this topic while embracing related issues like health, wellness, disability, and others. This paper seeks to invigorate organizational research on obesity by collecting, cataloging, integrating, and extending the disparate research streams that have explored the workplace consequences of obesity. To do so, this paper reviews empirical and conceptual studies on the workplace consequences of obesity, identifies weaknesses limiting the field's growth and impact, and builds an integrative theoretical framework that addresses these weaknesses. In doing so, we extend the field's understanding of the processes leading to-and the boundary conditions related to-obesity's influence on work outcomes for employees. Specifically, we broaden the field's focus by looking beyond the psychological processes (primarily stigmatization) that underlie obesity effects to consider the impact of both economic and medical perspectives as well. In all, this review integrates the multidisciplinary obesity literature by challenging the view that obesity effects can be primarily understood through a stigma-based lens. In so doing, we offer contributions not just to the obesity literature, but to related areas of health and social categorizations as well, and hope to revitalize work on a serious issue facing today's organizations and the people who work in them. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

10.
Artigo em Inglês | MEDLINE | ID: mdl-31576422

RESUMO

PURPOSE: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. METHODS: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. RESULTS: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98-108) versus 117 (115-124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (- 406 ± 127 versus - 299 ± 175 HFU, P = 0.256). CONCLUSIONS: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.

11.
ACS Appl Mater Interfaces ; 11(25): 22684-22691, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31137930

RESUMO

A key challenge for metasurface research is locally controlling at will the nanoscale geometric features on meter-scale apertures. Such a technology is expected to enable large aperture meta-optics and revolutionize fields such as long-range imaging, lasers, laser detection and ranging (LADAR), and optical communications. Furthermore, these applications are often more sensitive to light-induced and environmental degradation, which constrains the possible materials and fabrication process. Here, we present a relatively simple and scalable method to fabricate a substrate-engraved metasurface with locally printed index determined by induced illumination, which, therefore, addresses both the challenges of scalability and durability. In this process, a thin metal film is deposited onto a substrate and transformed into a mask via local laser-induced dewetting into nanoparticles. The substrate is then dry-etched through this mask, and selective mask removal finally reveals the metasurface. We show that masking by the local nanoparticle distribution, and, therefore, the local index, is dependent on the local light-induced dewetting temperature. We demonstrate printing of a free-form pattern engraved into a fused silica glass substrate using a laser raster scan. Large-scale spatially controlled engraving of metasurfaces has implications on other technological fields beyond optics, such as surface fluidics, acoustics, and thermomechanics.

12.
Behav Brain Res ; 362: 319-322, 2019 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-30630020

RESUMO

Chemotherapy related cognitive impairment (CTRC; "chemobrain") is a syndrome that is associated with the impairment of various aspects of cognition, including executive function, processing speed, and multitasking. The role of neurotransmitter release in the expression of cognitive impairments is not well known. In this work we employed a newly developed behavioral paradigm to measure attentional shifting, a fundamental component of executive function, in rats treated with 5-fluorouracil (5-FU), a commonly used cancer chemotherapy agent. We found that one and two weeks of 5-FU treatment significantly impaired attentional shifting compared to baseline, while saline treatment had no effect. Post-mortem analysis of these rats revealed that 5-FU caused a significant overall decrease in dopamine release as well. Collectively, these results demonstrate the feasibility of our attentional shifting paradigm for evaluating the cognitive effects of chemotherapy treatment. Moreover, these results support the need for additional studies to determine if impaired dopamine release plays a role in chemobrain.


Assuntos
Atenção/efeitos dos fármacos , Cognição/efeitos dos fármacos , Dopamina/metabolismo , Fluoruracila/farmacologia , Animais , Comportamento Animal/efeitos dos fármacos , Transtornos Cognitivos/tratamento farmacológico , Função Executiva/efeitos dos fármacos , Masculino , Ratos Wistar
13.
Electroanalysis ; 30(6): 1066-1072, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29955208

RESUMO

Huntington's disease (HD) is a fatal neurodegenerative disorder that is characterized by degeneration of the striatum. Here, fast-scan cyclic voltammetry at carbon-fiber microelectrodes was used to uncover regional differences in dopamine (DA) release in the caudate putamen of R6/2 and wild-type control mice. We found a decreasing ventral-to-dorsal gradient in DA release, evoked by a single electrical stimulus pulse, in aged R6/2 mice. Moreover, under more intense stimulation conditions (120 pulses), DA release was significantly attenuated in the dorsal, but not in the ventral caudate. Autoradiography measurements using [3H]WIN 35,428 revealed that the overall density of DA transporter (DAT) protein molecules was significantly less in R6/2 mice compared to WT control mice; however, quadrants of the caudate putamen were not differentially altered in the R6/2 mice. These data collectively suggest that DA release in the dorsal caudate region is more vulnerable with age progression compared to the ventral region.

14.
Chemphyschem ; 19(10): 1192-1196, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29573086

RESUMO

Post-chemotherapy cognitive impairment, also known as 'chemobrain,' is a neurological condition in which cognitive function is impaired as a result of cancer chemotherapy treatment. In this work, we used fast-scan cyclic voltammetry (FSCV) to measure electrically evoked dopamine release and uptake in whole brain preparations from zebrafish that have been treated with carboplatin, an agent associated with chemobrain. We administered carboplatin by addition to the fish's tank water or their food. One week of treatment with 100 µM carboplatin in the water was needed to significantly impair dopamine release (∼40 % of control); however, only one day of treatment through the zebrafish's food was needed to cause a similar impairment. Atomic absorption spectroscopy measurements suggested that administration through food resulted in higher initial levels of carboplatin compared to water administration, but water administration resulted in an increase over time. Uptake, determined by modeling stimulated release plots, was unaffected. These results are consistent with our previous findings of diminished neurotransmitter release in rats and support a role for zebrafish in chemobrain-related studies.


Assuntos
Carboplatina/farmacocinética , Dopamina/metabolismo , Técnicas Eletroquímicas , Animais , Artemia , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Carboplatina/administração & dosagem , Carboplatina/metabolismo , Relação Dose-Resposta a Droga , Ratos , Peixe-Zebra
15.
J Trauma Acute Care Surg ; 84(6S Suppl 1): S69-S76, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29554046

RESUMO

BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score were excluded. Volumes of crystalloid, packed red blood cells (PRBC), whole blood, plasma, and platelets (PLT) given in the first 24 hours were calculated per kilogram body weight. Tranexamic acid use was also determined. Patients were divided into Early (2001-2005) and Late (2006-2013) cohorts, and subgroups of transfused (TX+) and massively transfused (MT+) patients were created. Intensive care unit and hospital length of stay and 24-hour and in-hospital mortality rates were compared. RESULTS: A total of 4,358 patients met inclusion criteria. Comparing Early versus Late, injuries from explosions, isolated or predominant head injuries, and injury severity score all increased. The proportion of TX+ patients also increased significantly (13.6% vs 37.4%, p < 0.001) as did the number of MT+ patients (2.1% vs 15.5%, p < 0.001). Transfusion of high plasma:RBC and PLT:RBC ratios increased in both the TX+ and MT+ subgroups, although overall, PLT and whole blood use was low. After adjusting for differences between groups, the odds of death was no different Early versus Late but decreased significantly in the MT+ patients with time as a continuous variable. CONCLUSION: Transfusion practice in pediatric combat casualty care shifted toward a more hemostatic approach over time. All-cause mortality was low and remained stable overall and even decreased in MT+ patients despite more injuries due to explosions, more head injuries, and greater injury severity. However, further study is required to determine the optimal resuscitation practices in critically injured children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.


Assuntos
Transfusão de Sangue , Medicina Militar , Ferimentos e Lesões/terapia , Adolescente , Campanha Afegã de 2001- , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Guerra do Iraque 2003-2011 , Masculino , Medicina Militar/métodos , Medicina Militar/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos
16.
Am J Emerg Med ; 36(8): 1397-1404, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29402689

RESUMO

OBJECTIVES: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. METHODS: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. POPULATION: Consecutive adults (≥18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. OUTCOME: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). ANALYSIS: Multivariable logistic regression using generalized estimating equations was used. RESULTS: Among 1053 patients, ED care was adherent in 84% with significant differences in adherence between CPGs (p<0.001) and across institutions (p=0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95% CI 0.4-0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95% CI 0.3-0.9) and 0.3 (95% CI 0.2-0.5) for unrelated primary diagnoses. CONCLUSIONS: Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.


Assuntos
Síndrome Coronariana Aguda/terapia , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Acidente Vascular Cerebral/terapia , Síndrome Coronariana Aguda/mortalidade , Idoso , Colorado/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Acidente Vascular Cerebral/mortalidade
18.
Br J Nutr ; 117(10): 1379-1389, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28606216

RESUMO

Although high dose n-3 PUFA supplementation reduces exercise- and hyperpnoea-induced bronchoconstriction (EIB/HIB), there are concurrent issues with cost, compliance and gastrointestinal discomfort. It is thus pertinent to establish the efficacy of lower n-3 PUFA doses. Eight male adults with asthma and HIB and eight controls without asthma were randomly supplemented with two n-3 PUFA doses (6·2 g/d (3·7 g EPA and 2·5 g DHA) and 3·1 g/d (1·8 g EPA and 1·3 g DHA)) and a placebo, each for 21 d followed by 14 d washout. A eucapnic voluntary hyperpnoea (EVH) challenge was performed before and after treatments. Outcome measures remained unchanged in the control group. In the HIB group, the peak fall in forced expiratory volume in 1 s (FEV1) after EVH at day 0 (-1005 (sd 520) ml, -30 (sd 18) %) was unchanged after placebo. The peak fall in FEV1 was similarly reduced from day 0 to day 21 of 6·2 g/d n-3 PUFA (-1000 (sd 460) ml, -29 (sd 17) % v. -690 (sd 460) ml, -20 (sd 15) %) and 3·1 g/d n-3 PUFA (-970 (sd 480) ml, -28 (sd 18) % v. -700 (sd 420) ml, -21 (sd 15) %) (P<0·001). Baseline fraction of exhaled nitric oxide was reduced by 24 % (P=0·020) and 31 % (P=0·018) after 6·2 and 3·1 g/d n-3 PUFA, respectively. Peak increases in 9α, 11ß PGF2 after EVH were reduced by 65 % (P=0·009) and 56 % (P=0·041) after 6·2 and 3·1 g/d n-3 PUFA, respectively. In conclusion, 3·1 g/d n-3 PUFA supplementation attenuated HIB and markers of airway inflammation to a similar extent as a higher dose. Lower doses of n-3 PUFA thus represent a potentially beneficial adjunct treatment for adults with asthma and EIB.


Assuntos
Asma/tratamento farmacológico , Broncoconstrição/efeitos dos fármacos , Suplementos Nutricionais , Ácidos Graxos Ômega-3/farmacologia , Inflamação/metabolismo , Adulto , Biomarcadores , Relação Dose-Resposta a Droga , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Inflamação/patologia , Masculino , Fosfolipídeos/metabolismo , Adulto Jovem
19.
ACS Chem Neurosci ; 8(9): 1880-1888, 2017 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-28617576

RESUMO

Zebrafish (Danio rerio) have recently emerged as useful model organism for the study of neuronal function. Here, fast-scan cyclic voltammetry (FSCV) at carbon-fiber microelectrodes was used to measure locally evoked dopamine release and uptake in zebrafish whole brain preparations and results were compared with those obtained from brain slices. Evoked dopamine release ([DA]max) was similar in whole brain and sagittal brain slice preparations (0.49 ± 0.13 µM in whole brain and 0.59 ± 0.28 µM in brain slices). Treatment with α-methyl-p-tyrosine methyl ester (αMPT), an inhibitor of tyrosine hydroxylase, diminished release and the electrochemical signal reappeared after subsequent drug washout. No observed change in stimulated release current occurred after treatment with desipramine or fluoxetine in the whole brain. Treatment with the uptake inhibitors, nomifensine or GBR 12909 increased [DA]max, while treatment with sulpiride, a D2 dopamine autoreceptor antagonist, resulted in increased stimulated dopamine release in whole brain, but had no effect on release in slices. Dopamine release in whole brains increased progressively up to an electrical stimulation frequency of 25 Hz, while release in slices increased up to a frequency of only 10 Hz and then plateaued, highlighting another key difference between these preparations. We observed a lag in peak dopamine release following stimulation, which we address using diffusion models and pharmacological treatments. Collectively, these results demonstrate the electrochemical determination of dopamine release in the whole, intact brain of a vertebrate species ex vivo and are an important step for carrying out further experiments in zebrafish.


Assuntos
Encéfalo/metabolismo , Dopamina/metabolismo , Estimulação Elétrica , Microeletrodos , Técnicas de Cultura de Tecidos , Animais , Autorreceptores/antagonistas & inibidores , Autorreceptores/metabolismo , Encéfalo/efeitos dos fármacos , Difusão , Antagonistas dos Receptores de Dopamina D2/farmacologia , Estimulação Elétrica/instrumentação , Estimulação Elétrica/métodos , Inibidores Enzimáticos/farmacologia , Modelos Neurológicos , Inibidores da Captação de Neurotransmissores/farmacologia , Receptores de Dopamina D2/metabolismo , Técnicas de Cultura de Tecidos/métodos , Tirosina 3-Mono-Oxigenase/antagonistas & inibidores , Tirosina 3-Mono-Oxigenase/metabolismo , Peixe-Zebra
20.
J Trauma Acute Care Surg ; 83(2): 211-217, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28481839

RESUMO

BACKGROUND: Damage control resuscitation including balanced resuscitation with high ratios of plasma (PLAS) and platelets (PLT) to packed red blood cells (PRBC) improves survival in adult patients. We sought to evaluate the effect of a high ratio PLAS to PRBC resuscitation strategy in massively transfused pediatric patients with combat injuries. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric trauma patients (<18 years). Burns, drowning, isolated head trauma, and older teens were excluded. Those who received massive transfusion (≥40 mL/kg total blood products in 24 hours) and early deaths who received any blood products were then evaluated. Primary outcomes were mortality at 24 hours and in-hospital. Secondary outcomes included blood product utilization over 24 hours, ventilator-free days, intensive care unit-free days, and hospital length of stay. RESULTS: The Department of Defense Trauma Registry yielded 4,980 combat-injured pediatric trauma patients, of whom 364 met inclusion criteria. Analysis of PLAS/PRBC ratios across the entire spectrum of possible ratios in these patients demonstrated no clear inflection point for mortality. Using a division between low (LO) and high (HI) ratios of PLAS/PRBC 1:2, there was no difference in all-cause mortality at 24 hours (LO, 9.2% vs. HI, 8.0%; p = 0.75) and hospital discharge (LO, 21.5% vs. HI, 17.1%; p = 0.39). HI ratio patients received less PRBC but more PLAS and PLT and more total blood products. Those in the HI ratio group also had longer hospital length of stay. Regression analysis demonstrated no associated mortality benefit with a HI ratio (hazards ratio, 2.04; 95% confidence interval, 0.48-8.73; p = 0.34). CONCLUSION: In combat-injured children undergoing a massive transfusion, a high ratio of PLAS/PRBC was not associated with improved survival. Further prospective studies should be performed to determine the optimal resuscitation strategy in critically injured pediatric patients. LEVEL OF EVIDENCE: Therapeutic study, level III.


Assuntos
Campanha Afegã de 2001- , Transfusão de Eritrócitos/métodos , Hemorragia/terapia , Guerra do Iraque 2003-2011 , Plasma , Transfusão de Plaquetas/métodos , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Causas de Morte , Criança , Pré-Escolar , Serviços Médicos de Emergência/métodos , Feminino , Mortalidade Hospitalar , Hospitais Militares , Humanos , Masculino , Modelos de Riscos Proporcionais , Sistema de Registros , Ferimentos e Lesões/mortalidade
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