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Greene M, Long G, Greene K, Wilkes M. Performance of a Chemical Heat Blanket in Dry, Damp, and Wet Conditions Inside a Mountain Rescue Hypothermia Wrap. Wilderness Environ Med 2023; 34:483-489. [PMID: 37696723 DOI: 10.1016/j.wem.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Casualties with accidental hypothermia are evacuated using multilayer wraps, typically including a chemical heat blanket (CHB), a vapor barrier, and an insulating outer bag. We investigated CHB performance against dry, damp, and wet fabric, in a multilayer wrap, in response to a case report indicating diminished performance when wet. METHODS We wrapped a torso manikin in a base layer, CHB, vapor barrier, casualty bag, and vacuum mattress, recording CHB panel temperatures at intervals of up to 7 h. Experimental conditions were dry, damp, and wet clothing, with 2 blankets tested in each condition. We subsequently used a forward-looking infrared camera to assess whether the panels heated evenly and heat flux sensors to quantify heat transfer across 2 dry, 1 damp, and 1 wet fleece under CHB panels. RESULTS Chemical heat blankets maintained heat output for >7 h inside the wraps. Median (IQR) panel steady state temperatures were 52°C (39-56°C) against dry fleece, 41°C (36-45°C) against damp fleece, and 30°C (29-33°C) against wet fleece. Peak panel temperature was 67°C. The heat flux results indicated that CHBs generated similar quantities of heat in dry and damp conditions, as the lower temperatures were compensated by more efficient transfer of heat across the moist clothing layer. Chemical heat blanket heat output was diminished in wet conditions. CONCLUSIONS Rescuers should cut off saturated clothing in a protected environment before wrapping casualties, but damp clothing need not be removed. Because of the high peak temperatures recorded on the surfaces of CHBs, they should not be placed directly against skin, and compression straps should not be placed directly over CHBs.
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Affiliation(s)
| | - Geoff Long
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
| | | | - Matt Wilkes
- School of Sport, Health and Exercise Science, University of Portsmouth, UK.
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2
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Hartley A, Greene M, Caga-Anan M, Owen S, Mullin M, Pericleous C, Scott C, Mason J, Haskard DO, Khamis R. Molecular imaging of experimental atherosclerosis using anti-malondialdehyde-modified low-density lipoprotein humanised antibody fragment targeted nanoparticles. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Oxidative modification of low-density lipoprotein (LDL), for example by malondialdehyde (MDA) adduction with subsequent uptake by macrophages to form foam cells and later the plaque necrotic core, is a key initiating event in atherogenesis. Accordingly, a larger lipid necrotic core is a key plaque vulnerability factor, predisposing plaques to rupture and subsequent thrombosis and development of an acute coronary syndrome. Thus, MDA-LDL is an attractive focus for the molecular targeting of atherosclerotic plaques.
Purpose
To develop antibody fragment-targeted nanoparticles that can be utilised for both the molecular imaging and therapeutics of vulnerable atherosclerotic plaques.
Methods
LO1 is an IgG3k natural monoclonal murine antibody that reacts with MDA-LDL. Humanised LO1Fab fragments have been engineered to reduce immunogenicity and improve lesion penetration. These humanised LO1Fab fragments were used to functionalise fluorescent poly(lactic-co-glycolic acid) (PLGA) - polyethylene glycol (PEG) nanoparticles. Nanoparticle in vitro function was assessed, prior to fluorescence molecular tomography (FMT) co-registered with micro-CT, four-hours after iv injection in atherosclerotic LDL-receptor−/− mice fed a high-fat diet for 40-weeks.
Results
Humanised LO1Fab fragment conjugated fluorescent PLGA-PEG nanoparticles were formulated with 210nm size and polydispersity index (variability of nanoparticle size around the average) of <0.2. Antibody conjugation efficiency was 30%. In vitro function was confirmed on ELISA versus the blank untargeted nanoparticles with MDA-LDL on solid phase, detecting nanoparticle presence via the conjugated LO1Fab, PEG corona or fluorescence. Fluorescence microscopy on stained aortic root cryosections from atherosclerotic mice confirmed binding to fatty lesions. Construct in vivo in half-life was 90-minutes for both the targeted and untargeted nanoparticles in a two-phase model in LDL-receptor−/− mice, based on fluorescence analysis of serial tail vein blood samples. There was greater uptake in the region-of-interest (heart and aortic arch vessels) in mice injected with LO1Fab-conjugated nanoparticles versus untargeted nanoparticles (mean ± standard deviation) (64.7±22.9 versus 25.2±26.5pmol of Cy5; n=7; p=0.02). Ex vivo analysis fluorescence reflectance imaging and quantitative FMT of the extracted aortae confirmed these findings (1.0±0.3 versus 0.5±0.2pmol of Cy5; n=7; p=0.002; Figure 1).
Conclusions
Humanised antibody Fab fragment fluorescent nanoparticles have been developed that successfully target MDA-LDL and localise to atherosclerotic plaques in murine experimental atherosclerosis. These targeted nanoparticles have the potential to amplify fluorescent signal for imaging and carry a therapeutic cargo for targeted drug delivery direct to atherosclerotic plaques.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Wellcome Trust Clinical Research Fellowship
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Affiliation(s)
- A Hartley
- Imperial College London , London , United Kingdom
| | - M Greene
- Queen's University of Belfast , Belfast , United Kingdom
| | - M Caga-Anan
- Imperial College London , London , United Kingdom
| | - S Owen
- Imperial College London , London , United Kingdom
| | - M Mullin
- GSK , Stevenage , United Kingdom
| | - C Pericleous
- Imperial College London , London , United Kingdom
| | - C Scott
- Queen's University of Belfast , Belfast , United Kingdom
| | - J Mason
- Imperial College London , London , United Kingdom
| | - D O Haskard
- Imperial College London , London , United Kingdom
| | - R Khamis
- Imperial College London , London , United Kingdom
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Sumann G, Moens D, Brink B, Brodmann Maeder M, Greene M, Jacob M, Koirala P, Zafren K, Ayala M, Musi M, Oshiro K, Sheets A, Strapazzon G, Macias D, Paal P. Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand J Trauma Resusc Emerg Med 2020; 28:117. [PMID: 33317595 PMCID: PMC7737289 DOI: 10.1186/s13049-020-00790-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.
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Affiliation(s)
- G Sumann
- Austrian Society of Mountain and High Altitude Medicine, Emergency physician, Austrian Mountain and Helicopter Rescue, Altach, Austria
| | - D Moens
- Emergency Department Liège University Hospital, CMH HEMS Lead physician and medical director, Senior Lecturer at the University of Liège, Liège, Belgium
| | - B Brink
- Mountain Emergency Paramedic, AHEMS, Canadian Society of Mountain Medicine, Whistler Blackcomb Ski Patrol, Whistler, Canada
| | - M Brodmann Maeder
- Department of Emergency Medicine, University Hospital and University of Bern, Switzerland and Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - M Greene
- Medical Officer Mountain Rescue England and Wales, Wales, UK
| | - M Jacob
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospitallers Brothers Saint-Elisabeth-Hospital Straubing, Bavarian Mountain Rescue Service, Straubing, Germany
| | - P Koirala
- Adjunct Assistant Professor, Emergency Medicine, University of Maryland School of Medicine, Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - K Zafren
- ICAR MedCom, Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA.,Alaska Native Medical Center, Anchorage, AK, USA
| | - M Ayala
- University Hospital Germans Trias i Pujol, Badalona, Spain
| | - M Musi
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - K Oshiro
- Department of Cardiovascular Medicine and Director of Mountain Medicine, Research, and Survey Division, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,The Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - D Macias
- Department of Emergency Medicine, International Mountain Medicine Center, University of New Mexico, Albuquerque, NM, USA
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
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4
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Zepf R, Greene M, Hessol NA, Johnson MO, Santos GM, John MD, Dawson-Rose C. Syndemic conditions and medication adherence in older men living with HIV who have sex with men. AIDS Care 2020; 32:1610-1616. [PMID: 32468831 PMCID: PMC7784841 DOI: 10.1080/09540121.2020.1772954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For people living with HIV, lack of adherence to antiretroviral therapy (ART) is a serious problem and frequently results in HIV disease progression. Reasons for non-adherence include concomitant psychosocial health conditions – also known as syndemic conditions – such symptoms of depression or posttraumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. The aim of this study was to investigate the association between syndemic conditions and medication adherence. The sample included 281 older men living with HIV who have sex with men (MSM). The study period was December 2012–July 2016. We observed the following syndemic conditions significantly decreased medication adherence: symptoms of depression (p = .008), PTSD (p = .002), and stimulant use (p < .0001). Past physical or sexual abuse, IPV, and binge drinking were not significantly associated with decreased medication adherence. The findings suggest that syndemic conditions may impact medication adherence in older MSM living with HIV.
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Affiliation(s)
- R Zepf
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - M Greene
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - N A Hessol
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA.,Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - M O Johnson
- Department of Medicine, Division of Epidemiology, University of California, San Francisco, CA, USA
| | - G M Santos
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,HIV Prevention, San Francisco Department of Public Health, San Francisco, CA, USA
| | - M D John
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - C Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
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6
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Greene M, Britt J, Miller M, Adams S, Duckett S. 440 Impacts of Ergot Alkaloid Exposure During Mid and Late Gestation on Maternal Glucose, Insulin, and NEFA Concentrations and the Effects on Offspring Birth Weight. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Greene
- Clemson University,Clemson, SC, United States
| | - J Britt
- Clemson University,Clemson, SC, United States
| | - M Miller
- Clemson University,Clemson, SC, United States
| | - S Adams
- Clemson University,Clemson, SC, United States
| | - S Duckett
- Clemson University,Clemson, SC, United States
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7
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Greene M, Britt J, Miller M, Adams S, Duckett S. 446 Impacts of Ergot Alkaloid Exposure During Mid and Late Gestation on Wether Performance and Glucose, Insulin, and NEFA Values. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Greene
- Clemson University,Clemson, SC, United States
| | - J Britt
- Clemson University,Clemson, SC, United States
| | - M Miller
- Clemson University,Clemson, SC, United States
| | - S Adams
- Clemson University,Clemson, SC, United States
| | - S Duckett
- Clemson University,Clemson, SC, United States
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Higgins J, Carpenter E, Christianson L, Everett B, Greene M, Haider S, Hendrick CE, Powell J. “Will taking the pill make me less gay?”: contraceptive norms, contexts and conflicts among sexual minority women from three cities. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Smith K, Rundquist S, Greene M, Frugé A. Development of the Dietary Habits and Colon Cancer Beliefs Survey (DHCCBS): An Instrument Assessing Health Beliefs Related to Red Meat and Green Leafy Vegetable Consumption. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Jonchere V, Marisa L, Greene M, Guilloux A, Collura A, De Reynies A, Duval A. Identification of positively and negatively selected driver gene mutations associated with colorectal cancer with microsatellite instability. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, Wheeler AR, Roy S, Brugger H, Greene M, Paal P. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2018; 19:131-140. [PMID: 29446647 PMCID: PMC6014052 DOI: 10.1089/ham.2017.0143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
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Affiliation(s)
- Marc Blancher
- 1 Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France .,2 The French Mountain Rescue Association (ANMSM) , Grenoble, France
| | - François Albasini
- 2 The French Mountain Rescue Association (ANMSM) , Grenoble, France .,3 Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
| | | | - Ken Zafren
- 4 ICAR MedCom , Roethis, Austria .,5 Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.,6 Alaska Mountain Rescue Group , Anchorage, Alaska
| | - Natalie Hölzl
- 7 Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany
| | - Kyle McLaughlin
- 8 Department of Emergency Medicine, Canmore, Canada .,9 Department of Emergency Medicine, University of Calgary , Calgary, Canada
| | - Albert R Wheeler
- 10 Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.,11 Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming
| | - Steven Roy
- 12 Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada
| | - Hermann Brugger
- 13 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Mike Greene
- 14 Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England
| | - Peter Paal
- 15 Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria
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Justice SMM, Britt J, Jr. MM, Greene M, Davis C, Koch B, Duckett S, Jesch E. Predictions of Lean Meat Yield in Lambs Using Dexa and Chemical Analyses Proximate. Meat and Muscle Biology 2018. [DOI: 10.22175/rmc2018.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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13
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Willis A, Brown O, Greene M. Development of Education Program for Clinical Studies to Reduce Cardiovascular Disease Risk Factors. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu Z, Ostrenga D, Vollmer B, Deshong B, MacRitchie K, Greene M, Kempler S. Global Precipitation Measurement (GPM) Mission Products and Services at the NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC). Bull Am Meteorol Soc 2017; Volume 98:437-444. [PMID: 31534264 PMCID: PMC6749173 DOI: 10.1175/bams-d-16-0023.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article describes NASA/JAXA Global Precipitation Measurement (GPM) mission products and services at the NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC). Built on the success of the Tropical Rainfall Measuring Mission (TRMM), the next generation GPM mission consists of new precipitation measurement instruments and a constellation of international research and operational satellites to provide improved measurements of precipitation globally. To facilitate data access, research, applications, and scientific discovery, the GES DISC has developed a variety of data services for GPM. This article is intended to guide users in choosing GPM datasets and services at the GES DISC.
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Affiliation(s)
- Z Liu
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
- Center for Spatial Information Science and Systems (CSISS), George Mason University
| | - D Ostrenga
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
- Adnet Systems, Inc
| | - B Vollmer
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
| | - B Deshong
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
- Adnet Systems, Inc
| | - K MacRitchie
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
- Adnet Systems, Inc
| | - M Greene
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
- Wyle Information Systems, LLC
| | - S Kempler
- NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC)
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Bottcher M, Marincic P, Nahay K, Baerlocher B, Willis A, Greene M. Nutrition Knowledge and Mediterranean Diet Adherence: Validation of a Field Based Survey Instrument. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Runcie H, Greene M. Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? That Is the Question. Wilderness Environ Med 2015; 26:305-11. [PMID: 25819110 DOI: 10.1016/j.wem.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the incidence of femur fractures in mountain rescue in England and Wales. To investigate the attitudes of rescuers toward the use of femoral traction splints. To review the literature for evidence on the use of traction splints in prehospital medicine and test the hypothesis that femoral traction splints reduce morbidity and mortality in patients with a fractured femur. METHODS The Mountain Rescue England and Wales database was searched for cases of suspected fractured femur occurring between 2002 and 2012, a questionnaire was sent to all mountain rescue teams in England and Wales, and a literature review was performed. Relevant articles were critically reviewed to identify the evidence base for the use of femoral traction splints. RESULTS Femur fractures are uncommon in mountain rescue, with an incidence of suspected femur fractures on scene at 9.3 a year. Traction splints are used infrequently; 13% of the suspected femur fractures were treated with traction. However, rescuers have a positive attitude toward traction splints and perceive few disadvantages to their use. No trials demonstrate that traction splints reduce morbidity or mortality, but a number describe complications resulting from their use. CONCLUSIONS Femur fractures are rare within mountain rescue. Traction splints may be no more effective than other methods of splinting in prehospital care. We failed to identify evidence that supports the hypothesis that traction splints reduce morbidity or mortality. We advocate the use of a femoral traction splints but recognize that other splints may also be appropriate in this environment.
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Affiliation(s)
- Harriet Runcie
- North Cumbria University Hospitals NHS Trust, Emergency Department (Dr Runcie), and Emergency Medicine (Mr Greene), West Cumberland Hospital, Whitehaven, UK.
| | - Mike Greene
- North Cumbria University Hospitals NHS Trust, Emergency Department (Dr Runcie), and Emergency Medicine (Mr Greene), West Cumberland Hospital, Whitehaven, UK
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Greene M. Human estimates of object frequency are frequently over-estimated. J Vis 2014. [DOI: 10.1167/14.10.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Greene M, Botros A, Beck D, Fei-Fei L. Discovering mental representations of complex natural scenes. J Vis 2013. [DOI: 10.1167/13.9.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chen SY, Lee YC, Alas V, Greene M, Brixner D. Outcomes associated with concordance of oral antidiabetic drug treatments to prescribing information in patients with type 2 diabetes mellitus and chronic kidney disease. J Med Econ 2013; 16:586-95. [PMID: 23402560 DOI: 10.3111/13696998.2013.775135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This retrospective study aims to examine the association between prescribing information (PI)-concordant oral antidiabetic drug (OAD) treatment and clinical and economic outcomes in patients with type 2 diabetes mellitus and stages 3-5 chronic kidney disease (CKD). METHODS The study used a large, national administrative claims database with laboratory findings to identify patients with a diagnosis of diabetes and indication of stages 3-5 CKD (first observed indication as the index date) between 1/1/2005 and 30/06/2009. OADs prescribed during 6 months following the index date (baseline period) were evaluated and patients were considered non-PI-concordant if any did not meet the recommendations regarding patients with renal impairment. Glycemic control and measures of healthcare costs (standardized to 2010 US dollars using the Consumer Price Index) and resource utilization were assessed during the 12 months following the baseline period. Severe hypoglycemic events were assessed after the baseline period until lost to follow-up. Regression analyses were performed after adjusting for demographic and clinical characteristics. RESULTS Among the 3300 patients included in the study, 2454 (74.4%) were non-PI-concordant. The non-PI-concordant patients had higher risk of severe hypoglycemic events identified in all settings (HR = 1.35, 95% CI: 1.10-1.67) and events identified in inpatient hospital setting (HR = 2.51, 95% CI: 1.49-4.22), were more likely to have inpatient hospital admissions (OR = 1.27, 95% CI: 1.02-1.57), and were less likely to have glycemic control (OR = 0.56, 95% CI: 0.44-0.71). Annual diabetes-related cost was $1638 higher in the non-PI-concordant cohort (p = 0.0048). LIMITATION The retrospective cohort design does not allow for conclusions to be drawn on the causal effect of PI-concordant use based on the associations observed. CONCLUSION Our findings suggest PI-concordant treatment to be associated with better clinical and diabetes-associated economic outcomes. Future research is warranted to confirm the associations found in this study.
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Affiliation(s)
- S Y Chen
- United BioSource Corporation, Lexington, MA, USA
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Greene M, Fei-Fei L. A large-scale taxonomy of real-world scenes. J Vis 2012. [DOI: 10.1167/12.9.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Witherspoon R, Greene M, Castelhano M. The Relative Effectiveness of Different vs. Shared Mask Features on the Processing of Scene Gist. J Vis 2012. [DOI: 10.1167/12.9.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Stananought N, Greene M, Sutherland J, Midgley C, Asiam E. 'A foot in the door' - an introductory programme for patients with early stage motor neuron disease. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Greene M, Park S, Oliva A. Rapid scene understanding: Evidence of global property processing before basic-level categorization. J Vis 2010. [DOI: 10.1167/9.8.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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26
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Park S, Greene M, Brady TF, Oliva A. Natural scene categorization by global scene properties: Evidence from patterns of fMRI activity. J Vis 2010. [DOI: 10.1167/9.8.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Greene M, Oliva A, Wolfe J, Torralba A. What's behind the box? Measuring scene context effects with Shannon's guessing game on indoor scenes. J Vis 2010. [DOI: 10.1167/10.7.1259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Greene M, Merhige M, Leonard D. Abstract: P879 DIFFERENTIAL EXPRESSION OF INTERLEUKIN-5 RECEPTOR ISOFORMS IN PATIENTS WITH OBSTRUCTIVE CORONARY ARTERY DISEASE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tam P, Greene M, Smith P, Bigelow J, Rabel M, Klima DW. BALANCE CONFIDENCE IN COMMUNITY-DWELLING OLDER ADULT MEN. J Geriatr Phys Ther 2007. [DOI: 10.1519/00139143-200712000-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Quigley F, Greene M, O'Connor D, Kelly F. A survey of the causes of sudden cardiac death in the under 35-year-age group. Ir Med J 2005; 98:232-5. [PMID: 16255113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CRY (Cardiac Risk in the Young) is a registered Irish charity established by parents who are bereaved as a result of sudden cardiac death. The aim of this study is to establish the incidence and causes of sudden cardiac death in Dublin city in the 10-year period from 1st January 1993 to 31st December 2002. All sudden cardiac deaths in the under 35-year age group which were reported to the city coroner in the study period were examined. Details regarding age, sex, previous symptoms, investigations, circumstances of death and main pathological finding were recorded in each case. A total of 72 cases of sudden cardiac death in the under-35 year age group were reported. 52 were men. The median age was 26.5 years (range 12-34 years). The cause of death in 20 cases was reported as atherosclerotic Coronary Artery Disease. The second commonest cause of death (24% cases) was Hypertrophic Cardiomyopathy. Hypertrophic Cardiomyopathy was the commonest cause of death under the age of 25 years. Overall atherosclerotic coronary artery disease was the commonest cause of death in this group. The importance of Hypertrophic Cardiomyopathy is highlighted by the fact it was the commonest cause of death in the under 25-year age group. Screening those at high risk of sudden cardiac death especially the relatives of those affected by Hypertrophic Cardiomyopathy need to be discussed and implemented.
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Abstract
In the first step of IS2 transposition, the formation of an IS2 minicircle, the roles of the two IS ends differ. Terminal cleavage initiates exclusively at the right inverted repeat (IRR) - the donor end - whereas IRL is always the target. At the resulting minicircle junction, the two abutted ends are separated by a spacer of 1 or 2 basepairs. In this study, we have identified the determinants of donor and target function. The inability of IRL to act as a donor results largely from two sequence differences between IRL and IRR - an extra basepair between the conserved transposase binding sequences and the end of the element, and a change of the terminal dinucleotide from CA-3' to TA-3'. These two changes also impose a characteristic size on the minicircle junction spacer. The only sequences required for the efficient target function of IRL appear to be contained within the segment from position 11-42. Although IRR can function as a target, its shorter length and additional contacts with transposase (positions 1-7) result in minicircles with longer, and inappropriate, spacers. We propose a model for the synaptic complex in which the terminus of IRL makes different contacts with the transposase for the initial and final strand transfer steps. The sequence differences between IRR and IRL, and the behavioural characteristics of IRL that result from them, have probably been selected because they optimize expression of transposase from the minicircle junction promoter, Pjunc.
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Affiliation(s)
- L A Lewis
- Department of Biology, York College and Program in Cellular, Molecular and Developmental Biology, Graduate School and University Center, City University of New York, Jamaica, NY 11451, USA.
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Affiliation(s)
- M Greene
- University of Puget Sound, Tacoma, Washington 98416, USA
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Abstract
Although ICD therapy is seen as an irrevocable mode of therapy in most patients, a small number of patients do have their devices permanently explanted. The long-term outcome in these patients has not been described. The purpose of this single center study was to evaluate the long-term outcome of patients whose ICD was explanted and not replaced and to propose clinical variables that can be considered when making the decision to discontinue therapy. Ten of 323 (3.1%) patients in our ICD registry had their devices permanently explanted or turned off between 1986 and December 1998. The devices had been in place for 39 +/- 31 months preexplant. No patient had received appropriate therapy prior to surgery, which was indicated for infection or lead fracture. All patients are alive and well 75 +/- 30 months postexplant with 1 (10%) patient requiring late reimplantation. We reviewed the English language literature describing ICD explanation without replacement. A total of 151 patients were reported in eight studies and were followed for up to 30 months postexplant. Excluding patients with terminal illness or heart transplantation 57.6% survived without reimplantation. In selected patients, after not using an ICD for a long period and when clinical circumstances justify, device therapy may be discontinued with some degree of safety.
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Affiliation(s)
- M Geist
- Division of Cardiology, St. Michael's Hospital and University of Toronto, Canada.
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Abstract
The development of a set of everyday, nonverbal, digitized sounds for use in auditory confrontation naming applications is described. Normative data are reported for 120 sounds of varying lengths representing a wide variety of acoustic events such as sounds produced by animals, people, musical instruments, tools, signals, and liquids. In Study 1, criteria for scoring naming accuracy were developed and rating data were gathered on degree of confidence in sound identification and the perceived familiarity, complexity, and pleasantness of the sounds. In Study 2, the previously developed criteria for scoring naming accuracy were applied to the naming responses of a new sample of subjects, and oral naming times were measured. In Study 3 data were gathered on how subjects categorized the sounds: In the first categorization task - free classification - subjects generated category descriptions for the sounds; in the second task - constrained classification - a different sample of subjects selected the most appropriate category label for each sound from a list of 27 labels generated in the first task. Tables are provided in which the 120 stimuli are sorted by familiarity, complexity, pleasantness, duration, naming accuracy, speed of identification, and category placement. The. WAV sound files are freely available to researchers and clinicians via a sound archive on the World Wide Web; the URL is http://www.cofc.edu/~marcellm/confront.htm.
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Affiliation(s)
- M M Marcell
- Department of Psychology, College of Charleston, Charleston, SC 29424, USA.
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Greene M, Newman D, Geist M, Paquette M, Heng D, Dorian P. Is electrical storm in ICD patients the sign of a dying heart? Outcome of patients with clusters of ventricular tachyarrhythmias. Europace 2000; 2:263-9. [PMID: 11227599 DOI: 10.1053/eupc.2000.0104] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electrical storm in patients with implanted cardioverter defibrillators (ICDs) is purported to carry an ominous prognosis. METHODS AND RESULTS We retrospectively compared 40 patients with electrical storm (defined as three or more episodes of ventricular arrhythmia requiring ICD therapy in a 24 h period) with those only having isolated appropriate ICD therapy (n=57) and with patients having no or only inappropriate ICD therapy (n=125). All patients received ICDs for documented sustained VT or VF. There was no significant difference in age, sex, ejection fraction, total follow-up time, or underlying heart disease between any of the three groups. Patients who had electrical storm received their first appropriate ICD therapy 275 +/- 369 days post-implant (35% had storm as their first event) with storm occurring an average of 599 +/- 710 days post-implant. Patients had 1.5 +/- 1.0 storms in total (median= 1), with 55 +/- 91 episodes per storm. There were no significant differences in actuarial survival at 5-year follow-up between the three groups. Eighty percent of storm patients were alive 5 years post-implant. CONCLUSION Storm is a common occurrence in ICD patients, can occur at any time during the follow-up period, and does not independently confer increased mortality.
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Affiliation(s)
- M Greene
- Division of Cardiology, St Michael's Hospital, University of Toronto, Canada
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Nanthakumar K, Paquette M, Newman D, Deno DC, Malden L, Gunderson B, Gilkerson J, Greene M, Heng D, Dorian P. Inappropriate therapy from atrial fibrillation and sinus tachycardia in automated implantable cardioverter defibrillators. Am Heart J 2000; 139:797-803. [PMID: 10783212 DOI: 10.1016/s0002-8703(00)90010-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inappropriate therapy from supraventricular tachyarrhythmias (atrial fibrillation [AF] and sinus tachycardia [ST]) in patients with implanted cardioverter defibrillators is a major challenge. We tested the performance of stability algorithms from 3 manufacturers for episodes of inappropriate therapy delivered because of AF and an onset algorithm for all episodes of inappropriate therapy caused by ST. METHODS Therapy was classified as caused by ventricular tachycardia (VT), ST, or AF from review of stored intracardiac electrograms, history, clinical information, and R-R data before study inception. By using 30 to 60 R-R intervals before therapy, sensitivity and specificity for a family of stability values and percentage of onset values were calculated for each manufacturer and receiver operating characteristic curves generated. RESULTS Of the 217 patients monitored, 62 (29%) received inappropriate therapy, and 40 had complete R-R information available. Of the 40 patients, 21 patients received therapy for AF, 19 for ST, and 1 patient for noise; 15 (38%) also received appropriate therapy for VT. We analyzed 83 episodes of VT from 18 patients, 94 episodes of AF from 21 patients, and 56 episodes of ST from 19 patients. Specificity, in the clinically relevant sensitivity range of >/=95%, was comparable across manufacturers at about 40%. An onset value of 80% was associated with 91% sensitivity and 95% specificity for the specific algorithm tested. CONCLUSIONS Inappropriate therapy is a common problem in implantable cardiac defibrillators. The performance of the stability algorithms used to differentiate AF from VT was less than ideal, though comparable across manufacturers. The onset algorithm accurately differentiates ST from VT.
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Affiliation(s)
- R Shine
- School of Biological Sciences, University of Sydney
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40
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Abstract
Prior research in newborns has shown that head-up and head-down tilting elicits sustained increases and decreases in heart rate, respectively. Other studies in older infants have suggested that the pattern of heart rate responses to head-up tilting varies with risk for sudden infant death syndrome (SIDS). In this study, heart and respiratory rate changes following bidirectional tilting were recorded in sleeping infants on Day 1 or 2 of life, and during the period of maximum risk for SIDS, at 2 and 4 months of age. Newborns show increases in heart rate following 30 degrees head-up tilts and decreases in heart rate to 300 head-down tilting. Respiratory rates decreased to head-up tilting but did not change significantly to head-down tilting. While respiratory rate changes at 2 and 4 months of age are comparable to those of newborns, and decreases in heart rate to head-down tilting are similar across ages, sustained elevations in heart rate following head-up tilting are no longer apparent at the older ages. These results are consistent with the hypothesis that, during the period of maximum risk for SIDS, infants may have reduced ability to compensate for challenges that lead to decreases in blood pressure.
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Affiliation(s)
- W P Fifer
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York 10032, USA.
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Abstract
In fish, growth hormone (GH), prolactin (PRL) and somatolactin (SL) are three major peptide hormones produced in the pituitary gland. Using reverse transcription-polymerase chain reaction (RT-PCR) and Southern blot analysis of the amplified products, the expression of GH, PRL, and SL genes were determined during the embryonic development in rainbow trout (Oncorhynchus mykiss). The mRNA for GH, PRL and SL were detected not only in embryos prior to or after organogenesis of the pituitary gland but also in mature oocytes as maternal messages. After hatching, all of these three mRNA species were detected at very high levels. Since the ontogenesis of the pituitary gland takes place on embryonic day (ED) 14, these observations suggest that the GH family protein genes are expressed in the developing embryos prior to the formation of the pituitary gland. Using the same RT-PCR assay, PRL mRNA was detected only in the head part of the fry whereas GH and SL mRNA were detected in both the head and trunk. In adult animals, though high levels of GH mRNA were primarily detected in the pituitary gland, brain, gill, and heart, low levels of GH mRNA were also detected in the kidney, liver, pyloric ceaca, and ovary. Results of the current study and those reported by Yang et al. (1997. Gen Comp Endocrinol 106:271-281) suggest that GH and SL genes are also expressed in extrapituitary tissues even after the organogenesis of the pituitary gland. Furthermore, these results suggest that these hormones may play important roles yet to be identified during embryonic development in fish.
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Affiliation(s)
- B Y Yang
- Biotechnology Center and Department of Molecular and Cell Biology, University of Connecticut, Storrs 06269-4156, USA
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Martin Flores-Stadler E, Gonzalez-Crussi F, Greene M, Thangavelu M, Kletzel M, Chou PM. Indeterminate-cell histiocytosis: immunophenotypic and cytogenetic findings in an infant. Med Pediatr Oncol 1999; 32:250-4. [PMID: 10102017 DOI: 10.1002/(sici)1096-911x(199904)32:4<250::aid-mpo2>3.0.co;2-#] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors report the immunohistochemical, ultrastructural, and cytogenetic findings in a case of malignant histiocytic proliferation in an infant. PROCEDURE The patient presented initially with bone lesions without skin or systemic involvement. Multiple biopsies were studied extensively by immunohistochemistry and electron microscopy. Cytogenetic studies of cell cultures supplemented with granulocyte-monocyte colony stimulating factor (GM-CSF) were also performed. RESULTS Morphologically, the cells resembled Langerhans cells, although with greater pleomorphism, as evinced by cells with usual polylobated nuclei. These cells expressed markers for macrophages and antigen presenting cells and were CD1a- and S-100-positive, but lacked Birbeck granules. The cells grown in culture supplemented with GM-CSF showed a unique combination of numerical and structural abnormalities affecting chromosomes 1, 6, 8, and 10. The disease followed a malignant course leading to the patient's demise despite aggressive chemotherapy and bone marrow transplant. CONCLUSIONS The findings suggest a malignant hematopoietic stem-cell neoplasm with a capacity for macrophage or dendritic-cell differentiation. Morphology and immunophenotypic features place this neoplasm within the group recently conceptualized as indeterminate-cell histiocytosis.
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Lestina DC, Greene M, Voas RB, Wells J. Sampling procedures and survey methodologies for the 1996 survey with comparisons to earlier national roadside surveys. Eval Rev 1999; 23:28-46. [PMID: 10346071 DOI: 10.1177/0193841x9902300102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article describes the multistage sampling system employed in the 1996 national roadside survey and compares it to the sampling methods employed in the two prior surveys in 1973 and 1986. Also described are the data collection procedures at the selected sites, the breath-test devices used to collect blood alcohol concentration (BAC) data, and the methods used to impute BAC values where breath-test measures were not obtained. Overall, almost twice as many (6,298 in 1996 compared to 3,698 in 1973 and 3,043 in 1986) drivers were interviewed in the most recent national survey as in the previous efforts. The procedures implemented in the three surveys are sufficiently similar to permit comparison of these surveys conducted at 10-year intervals.
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Dorian P, Newman D, Greene M. Implantable defibrillators and/or amiodarone: alternatives or complementary therapies. Int J Clin Pract 1998; 52:425-8. [PMID: 9894382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Many patients with an implanted cardioverter defibrillator (ICD) also receive antiarrhythmic drug therapy. Although an expanding number of patients are receiving ICD therapy, many will not have received previous antiarrhythmic treatment. For patients with an ICD, infrequent arrhythmias and a low probability of inappropriate device discharges, no antiarrhythmic therapy is required. However, for those patients who require an antiarrhythmic drug, amiodarone is a reasonable first choice because of safety in patients with poor LV function. It may be particularly useful for patients with high density ventricular arrhythmias. However, the interactions between ICDs and antiarrhythmic therapy requires close monitoring in order that patient benefit can be optimised, and this review focuses on those interactions.
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Affiliation(s)
- P Dorian
- Division of Cardiology, St Michael's Hospital, Toronto, Canada
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Abstract
BACKGROUND Duplex ultrasonography is used increasingly to select patients for carotid endarterectomy. This study aims to clarify whether arteriography is still required. METHODS A total of 272 patients in whom duplex imaging indicated significant disease of the internal carotid artery underwent arteriography and the results were compared. Regarding the arteriogram as the 'gold standard', three aspects were considered: the accuracy of duplex ultrasonography in detecting significant stenosis, the ability of duplex imaging to identify patients who should have arteriography and whether the arteriogram provided important additional information that might influence a decision to operate. RESULTS Three patients (1 per cent) suffered a permanent neurological deficit as a result of arteriography. Of the 272 patients with significant stenosis identified by duplex ultrasonography, 241 (89 per cent) were confirmed as significant on arteriography. Duplex imaging was not able to predict accurately which arteriograms would provide useful additional information (sensitivity 59 per cent, specificity 65 per cent), whereas 89 arteriograms (33 per cent) contained information that might have influenced subsequent management. CONCLUSION Duplex imaging is unable to detail the anatomy or determine the extent of carotid disease and may therefore lead to an inappropriate decision to perform carotid endarterectomy. Duplex imaging alone is not adequate before carotid endarterectomy.
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Affiliation(s)
- D J Bain
- Department of General and Vascular Surgery, Gartnavel General Hospital, Glasgow, UK
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Affiliation(s)
- P A Supon
- Department of Pathology, Fitzsimons Army Medical Center, Aurora, CO, USA
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Abstract
Following the same general principles of its two predecessors in 1973 and 1986, the 1996 National Roadside Survey of weekend, nighttime drivers in the 48 contiguous states interviewed and breath tested over 6000 noncommercial four-wheel vehicle operators between September 6 and November 9, 1996. Results indicated that the total number of drinking drivers fell by about one-third between 1986 and 1996; however, there was no significant change in the number of drivers at blood alcohol concentrations (BACs) at or above 0.05. Compared to 1973, the proportion of women drivers on the roads during weekend nights has increased significantly. Moreover, relative to males, the proportion of female drivers who have been drinking has increased over the last decade. The number of drivers under the age of 21 with a BAC at or above 0.10 decreased significantly from 1986 to 1996.
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Affiliation(s)
- R B Voas
- Pacific Institute for Research and Evaluation, West Bethesda, MD 20814, USA
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Nanthakumar K, Newman D, Paquette M, Greene M, Rakovich G, Dorian P. Circadian variation of sustained ventricular tachycardia in patients subject to standard adrenergic blockade. Am Heart J 1997; 134:752-7. [PMID: 9351744 DOI: 10.1016/s0002-8703(97)70060-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Morning peaks in the circadian variation of sustained ventricular tachycardia (VT) may reflect the contribution of sympathetic activation to onset of VT. We hypothesized that adrenergic blockade would eliminate this morning peak. Fifty-four patients using a defibrillator had 1114 time-stamped episodes of VT requiring therapy with a device: 1012 episodes with and 102 episodes without antiadrenergic medications. Nine patients had episodes both with and without antiadrenergic medication and were examined separately. In patients taking antiadrenergic agents, data fitted to a harmonic regression model revealed a morning peak at 9:00 AM (R2= 0.542; p < 0.05), with a secondary peak at 4 PM. Those not receiving antiadrenergic therapy had a similar morning peak. Antiadrenergic agents as used in standard clinical practice do not prevent circadian variation in onset of VT. This variation may be mediated by systems other than adrenergic receptor-linked activation or may reflect inadequacy of adrenergic blockade in standard clinical dosing.
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Affiliation(s)
- K Nanthakumar
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Jahr JS, Keller T, Williams MD, Liukkonen JR, Anwar M, Paxtor CG, Greene M, Gitlin MC. To reverse or not to reverse: an evaluation of reversal of mivacurium chloride in women undergoing outpatient gynecological procedures. Am J Ther 1997; 4:315-22. [PMID: 10423625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND A double-blind, randomized study compared differences between patients administered edrophonium and those administered placebo after mivacurium infusion. Neuromuscular blockade was quantified using the ParaGraph 1800 nerve stimulator-monitor (Vital Signs, Totowa, NJ), which can deliver a train-of-four stimulus to the ulnar nerve and quantify the ratio of the fourth twitch to the first twitch. METHODS With Investigational Review Board approval and informed consent, 30 healthy outpatient gynecological surgery patients ASA I or II, aged 21 to 37 years, were randomly assigned to treatment or placebo. In a double-blind manner, one group received edrophonium (1 mg/kg) and atropine (0.01 mg/kg) reversal (E/A) and the other group received placebo (P) to recover spontaneously from a mivacurium infusion. Anesthesia was induced and a rapid infusion of mivacurium chloride (0.2 mg/kg) was administered. An infusion of mivacurium chloride was then initiated at a rate of 6-7 microg/kg/min to maintain neuromuscular blockade. Group differences in recovery time (time between administration of the edrophonium or placebo and a 5-second head lift followed by tracheal extubation) were compared, as was time from tracheal extubation to discharge from the postanesthesia care unit (PACU). Nausea and vomiting were documented until the patient was discharged from the hospital; a 24-hour follow-up evaluation was completed by telephone. RESULTS Each group contained 15 patients, and their demographics were similar. The mean recovery time for E/A was statistically shorter than for P (P, 9.7 +/- 4.8 minutes; E/A, 6.1 +/- 3.9 minutes; p = 0. 017). There were no statistically significant differences found in the incidence of nausea and vomiting (P, 4; E/A, 6) or in time to discharge from the PACU. CONCLUSION Recovery from a mivacurium chloride infusion is shorter by 3.6 minutes (margin of error +/- 3.3 minutes) when reversal with edrophonium/atropine is used. There is no difference in time to discharge from PACU and no evidence of differences in nausea and vomiting.
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Affiliation(s)
- J S Jahr
- Department of ANesthesiology, University of California, Davis Medical Center, Sacramento 95817, USA
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Newman D, Barr A, Greene M, Martin D, Ham M, Thorne S, Dorian P. A population-based method for the estimation of defibrillation energy requirements in humans. Assessment of time-dependent effects with a transvenous defibrillation system. Circulation 1997; 96:267-73. [PMID: 9236444 DOI: 10.1161/01.cir.96.1.267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A weighted logistic regression analysis was developed to allow pooling of patient data for the study of the stability of defibrillation energy requirements with a new nonthoracotomy lead defibrillation system. METHODS AND RESULTS One hundred twenty patients were prospectively studied with a single-model nonthoracotomy implantable cardioverter defibrillator (ICD) system at the time of implant and at 3 months. The pooled data of all shocks delivered to all patients were fitted to a logistic function to construct a defibrillation voltage/energy dose-response relationship. The crude logit curve was weighted in quartiles according to the average shock energy delivered per patient. Shocks at implant (n = 802; 6.6 +/- 2.5 shocks/patient) and follow-up (n = 292; 2.4 +/- 1.2 shocks/patient) were analyzed. The modeled voltage/energy required for 50% successful defibrillation (95% CI) in the pooled data was 367 V (273, 461) and 9.8 J (6.7, 12.9) at implant and 338 V (264, 412) and 10.5 J (8, 13.0) at follow-up. The conventional measure of lowest successful voltage/energy (95% CI) was 430 V (411, 449) and 12.1 J (11, 13.2) at implant and 415 V (391, 439) and 11.3 J (10, 12.6) at follow-up. There were no statistically significant differences between implant and follow-up energy requirements with either method. CONCLUSIONS The nonthoracotomy lead system used in this study demonstrated stability of defibrillation energy requirements at implant and 3-month follow-up. A new technique for the estimation of the defibrillation energy dose-response relationship was derived by using a weighted logistic regression analysis.
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Affiliation(s)
- D Newman
- Division of Cardiology, St. Michael's Hospital, University of Toronto, ON, Canada.
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