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Objective: The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet.Methods: In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as nonimprovised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good).Results: Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; ParaBelt was faster than Tourniquet Belt. Mean total time of application differed between ParaBelt-Tourniquet Belt and Tourni-belt-Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results.Conclusions: In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome. [ABSTRACT FROM AUTHOR]

Background: This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption.Methods: The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013: whites (n=171,858) and NA (n=4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1-4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2013: whites (n=1,130,658) and NA (n=21,589).Results: In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7-63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6-43.6), abstained-adjusted odds ratio (AOR): 0.64 (CI: 0.56-0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2-33.2) of whites (AOR: 1.90; CI: 1.51-2.39). NA and white binge drinking estimates were similar-17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4-17.0), respectively (AOR: 1.00; CI: 0.83-1.20). The two populations' heavy drinking estimates were also similar-8.3% (CI: 6.7-10.2) and 7.5% (CI: 7.3-7.7), respectively (AOR: 1.06; CI: 0.85-1.32). Results from the BRFSS analyses generally corroborated those from NSDUH.Conclusions: In contrast to the 'Native American elevated alcohol consumption' belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined. [ABSTRACT FROM AUTHOR]

We compared the two most commonly used sampling methods, pitfall trapping and quadrat sieving, to study community diversity and talitrid abundance on sandy beaches. They are both widely used methods, however they are related to different behaviors: surface activity (pitfall traps) and burrowing in the substrate (quadrat sieving). To detect bias intrinsically generated by the use of different sampling methods, we applied both methods on a set of five beaches in New South Wales, Australia. The set included non-contiguous beaches, exposed and sheltered, more or less affected by recreational use. The results indicated a high fluctuation in biodiversity features. However, the most human-frequented beaches were grouped together by Multi Dimensional Scaling, and substrate-modifiers talitrid amphipods (sand-hoppers), played a major role in this scaling. The analysis of similarities (ANOSIM) indicated the roles of exposure and human recreational use in shaping the community, while the methods (quadrats vs. traps) resulted in higher fluctuation within samples than between, and informative outliers. Generalized Linear Models developed to estimate the probability of capture of talitrids by sampling method pointed to a higher probability to capture both sand-hoppers and beach-hoppers with the quadrat method. We finally suggest: (1) the comparative use of both sampling methods whenever possible, to capture multiple information and avoid bias in biodiversity estimates; and (2) an ad-hoc strategy when dealing with target populations. In particular, attention should be paid when targeting co-occurring talitrid species characterized by different ecology and behavioral traits: sand-hoppers (substrate modifiers) appeared to be more sensitive than beach-hoppers (non-substrate modifiers) to the impacts considered. In terms of biodiversity assessment the methods were equal, but for talitrid sampling quadrat sieving was more efficient. [ABSTRACT FROM AUTHOR]

Highlights: [•] ASPEN PLUS process models have been developed for CLC and CLOU of coal. [•] CLOU system supports energy recovery from both the air and fuel reactors. [•] The CLC air reactor must be at a higher temperature than the fuel reactor. [•] CLC has high pressure drop due to large gasification residence time (∼10×) than CLOU. [•] CLC has higher relative capital and fluidization costs as compared to CLOU. [ABSTRACT FROM AUTHOR]

Highlights: [•] Comparative neuroimaging can identify unique features of the human brain. [•] Comparisons with chimpanzees are crucial for learning about human brain evolution. [•] Human brains are special in terms of size, cortical organization, and connectivity. [•] Human brains are special in terms of development and aging. [ABSTRACT FROM AUTHOR]

Abstract: Background: Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking. Methods: The current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n =74,139), alcohol- (n =582,771), opioid- (n =67,104), cannabis- (n =46,548), or cocaine-related disorders (n =48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated. Results: The methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81). Conclusions: Our study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use. [Copyright &y& Elsevier]

Objectives: The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Background: Prior studies have not directly compared the relative prognostic impact of CAC in smokers versus nonsmokers. In particular, although a calcium score of zero (CAC = 0) is a known favorable prognostic marker, whether smokers with CAC = 0 have as good a prognosis as nonsmokers with CAC = 0 is unknown. Given that computed tomography (CT) screening for lung cancer appears effective in smokers, the relative prognostic implications of visualizing any CAC versus no CAC on such screening also deserve study. Methods: Our study cohort consisted of 44,042 asymptomatic individuals referred for noncontrast cardiac CT (age 54 ± 11 years, 54% men). Subjects were followed for a mean of 5.6 years. The primary endpoint was all-cause mortality. Results: Approximately 14% (n = 6,020) of subjects were active smokers at enrollment. There were 901 deaths (2.05%) overall, with increased mortality in smokers versus nonsmokers (4.3% vs. 1.7%, p < 0.0001). Smoking remained a risk factor for mortality across increasing strata of CAC scores (1 to 100, 101 to 400, and >400). At each stratum of elevated CAC score, mortality in smokers was consistently higher than mortality in nonsmokers from the CAC stratum above. In multivariable analysis within these strata, we found mortality hazard ratios of 3.8 (95% confidence interval [CI]: 2.8 to 5.2), 3.5 (95% CI: 2.6 to 4.9), and 2.7 (95% CI: 2.1 to 3.5), respectively, in smokers compared with nonsmokers. However, among the 19,898 individuals with CAC = 0, the mortality hazard ratio for smokers without CAC was 3.6 (95% CI: 2.3 to 5.7), compared with nonsmokers without CAC. Conclusions: Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a “negative risk factor” in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis. [Copyright &y& Elsevier]

Vitamin A deficiency (VAD) persists in Uganda and the consumption of -carotene-rich orange sweet potato (OSP) may help to alleviate it. Two large-scale, 2-y intervention programs were implemented among Ugandan farmer households to promote the production and consumption of OSP. The programs differed in their inputs during year 2, with one being more intensive (IP) and the other being reduced (RP). A randomized, controlled effectiveness study compared the impact of the IP and RP with a control on OSP and vitamin A intakes among children aged 6-35 mo (n = 265) and 3-5 y (n = 578), and women (n = 573), and IP compared with control on vitamin A status of 3- to 5-y-old children (n = 891) and women (n = 939) with serum retinol <1.05 ¿imol/L at baseline. The net OSP intake increased in both the IP and RP groups (P< 0.01), accounting for 44-60% of vitamin A intake at follow-up. The prevalence of inadequate vitamin A intake was reduced in the IP and RP groups compared with controls among children 6-35 mo of age (>30 percentage points) and women (>25 percentage points) (P< 0.01), with no differences between the IP and RP groups of children (P = 0.75) or women (P = 0.17). There was a 9.5 percentage point reduction in prevalence of serum retinol <1.05 /xmol/L for children with complete data on confounding factors (n = 396; P < 0.05). At follow-up, vitamin A intake from OSP was positively associated with vitamin A status (P < 0.05). Introduction of OSP to Ugandan farming households increased vitamin A Intakes among children and women and was associated with improved vitamin A status among children. [ABSTRACT FROM AUTHOR]

Abstract: Stripping of CO2-loaded monoethanolamine (MEA) solutions was carried out with the addition of a low latent energy of vaporization compound as a stripping carrier. The compound used in the stripper was immiscible with the aqueous MEA solution. The impact of the carrier in the stripping experiments was compared with control experiments with no carrier at 90, 100, and 108°C. The carrier contributed significantly to increase the amount of CO2 stripped from the solution at the lower temperatures (<100°C) when there was reduced water vapor generated from the aqueous MEA solution. The potential of using the process to reduce steam and the consequent energy savings in solvent regeneration have been highlighted. [Copyright &y& Elsevier]

Abstract: Pulsed OSL is applied to nine fine-grained sediment samples from Sichuan province, China, using stimulating pulses of 10μs on and 240μs off, with an infrared exposure prior to each OSL measurement. Comparison of fading rates between pulsed and non-pulsed signals, the latter also obtained with a preceding IR exposure, shows that fading is significant for mainly the non-pulsed signals. Presence of a pulsed IRSL and the magnitudes of b-value to correct for lower alpha efficiency suggest that pulsing does not fully remove a significant feldspar signal, only a fading component. Comparison with ages of quartz extracts shows that pulsed OSL ages are consistent, while CW-OSL ages are slightly older and CW-IRSL ages are much older. The older ages suggest a less well-bleached feldspar component. [Copyright &y& Elsevier]

Objectives: This study assessed the diagnostic performance of coronary computed tomography angiography (CTA) for the detection and exclusion of significant coronary artery stenosis as remotely interpreted on a mobile handheld device with dedicated medical imaging software. Background: Recent advances in technology now permit remote interpretation of medical imaging studies on mobile handheld devices, although the diagnostic performance of this approach is unknown. Methods: We evaluated 102 patients with stable chest pain and both 64-detector row coronary CTA and quantitative invasive coronary angiography. The diagnostic performance of remote coronary CTA interpretation was assessed using a mobile handheld device and employing dedicated software. The coronary CTA studies were examined in an intent-to-diagnose manner for the presence or absence of coronary artery stenosis ≥50% on a per-artery and per-patient level; results were compared with quantitative invasive coronary angiography. Two blinded imagers independently interpreted coronary CTA studies, with a third imager achieving consensus for discordance. Coronary CTAs were re-interpreted in random order to determine interobserver agreement. Finally, coronary CTAs were evaluated on a dedicated 3-dimensional imaging workstation; results were compared to mobile handheld device findings for intertechnology agreement. Results: The prevalence of significant coronary artery stenosis was 25% (26 of 102) at the per-patient level and 10% (40 of 405) at the per-artery level. Per-patient and per-artery sensitivity, specificity, and positive and negative predictive values were: 100% (26 of 26), 78% (59 of 76), 60% (26 of 43), and 100% (59 of 59), respectively; and 95% (38 of 40), 85% (310 of 365), 41% (38 of 93), and 99% (310 of 312), respectively. At the per-artery level, interobserver, intraobserver, and intertechnology agreement was 0.74, 0.89, and 0.75, respectively (p < 0.01 for all). Conclusions: The interpretation of coronary CTA using a mobile handheld device with dedicated software for medical image evaluation possesses high diagnostic accuracy for detection and exclusion of significant coronary stenosis. [Copyright &y& Elsevier]

Peroxisomal beta-oxidation and catalase activity were investigated in liver, kidney and heart from pigs at the following timepoints: within 0.5 h after birth (0 h, unfed) and at 24 h (suckled or unsuckled), 10 d (suckled or 24-h food-deprived), 21 d (suckled or 24-h food-deprived) and 5 mo (overnight food-deprived). In liver, peroxisomal beta-oxidation increased about twofold at 24 h for suckled pigs (P < 0.001) but did not change for unsuckled pigs. The rate was further increased in 21-d-old pigs compared with 0- (P < 0. 001) or 24-h-old (P < 0.05) pigs, but was lower at 5 mo than at 10 or 21 d (P < 0.01). The rate was higher for food-deprived pigs than suckled pigs at 10 d (P < 0.001) of age. In kidney, peroxisomal beta-oxidation was unchanged during the first 24 h but was higher (P < 0.05) at 10 d for suckled pigs and at 21 d than at 0 h. Nutritional state did not influence renal peroxisomal beta-oxidation. In heart, peroxisomal beta-oxidation did not change with age or nutritional state. The developmental pattern of fatty acyl-CoA oxidase activity was similar to that of peroxisomal beta-oxidation in each tissue. Developmental increases of peroxisomal beta-oxidation were greater than those for first-cycle peroxisomal beta-oxidation reported earlier, suggesting that peroxisomal beta-oxidation became more complete in older pigs. Catalase activity did not change during the first 24 h after birth but then increased 10.5-, 2.9-fold and 33% at 10 d in liver, kidney and heart, respectively. The concentration of catalase mRNA was only 1.1- and 1. 3-fold higher at 10 d than at 24 h in liver and kidney, respectively. Catalase activity was not affected by food deprivation. We concluded the following: 1) peroxisomal beta-oxidation develops rapidly after birth and may be important for piglets to oxidize milk fatty acids; 2) food is required for the initial induction after birth; and 3) rapidly increased catalase activity during the first 10 d of life resulted from both pretranslational and post-translational regulation. [ABSTRACT FROM AUTHOR]

Background: Myomectomy is associated with a significant risk of hemorrhage. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery. However, its utility in gynecologic surgery is not well understood.Objective: This study aimed to determine the effect of early administration of intravenous tranexamic acid on perioperative bleeding and blood transfusion requirements in women undergoing myomectomy.Study Design: This study was a double-blinded, randomized, placebo-controlled trial conducted in an academic teaching hospital. Women with symptomatic fibroids thought to be at risk for large intraoperative blood loss who met the following criteria were included in the study: (1) at least 1 fibroid ≥10 cm, (2) any intramural or broad ligament fibroid ≥6 cm, and/or (3) at least 5 total fibroids based on preoperative imaging. Patients were randomized to receive a single intravenous bolus injection of tranexamic acid 15 mg/kg (intervention group) versus an intravenous bolus injection of saline of equivalent volume (placebo group) 20 minutes before the initial surgical incision. Perioperative bleeding was defined by measuring intraoperative estimated blood loss, change between pre- and postoperative hemoglobin, and frequency of blood transfusions. Estimated blood loss was calculated by combining the blood volume collected within the suction canister and the weight of used sponges. The 2 groups were compared for age; body mass index; perioperative hemoglobin and hematocrit; perioperative blood loss; duration of surgery; blood transfusion requirements; and the number, total weight, and volume of myomas removed.Results: A total of 60 patients (30 per arm) were enrolled into the study between March 1, 2015, and January 29, 2018. Age, body mass index, baseline hemoglobin and/or hematocrit, number and total weight of myomas removed, and size of myomas did not differ between arms. Of 60 patients, 32 (53%) had laparoscopic myomectomy, 24 (40%) had robotic myomectomy, and 4 (7%) had laparotomy. Median estimated blood loss was 200 mL for the tranexamic acid group and 240 mL for the placebo group (P=.88). There was no difference in median duration of surgery (165 vs 164 minutes; P=.64) or change in perioperative hemoglobin (1.00 vs 1.1 g/dL; P=.64). Patients in the tranexamic acid group did not require blood transfusions; however, 4 patients (13.3%) in the placebo group (P=.11) required blood transfusions.Conclusion: Intravenous administration of tranexamic acid in patients undergoing laparoscopic or robotic myomectomies was not associated with decreased blood loss. [ABSTRACT FROM AUTHOR]

Background: Detection of ≥50% diameter stenosis left main coronary artery disease (LMD) has prognostic and therapeutic implications. Noninvasive stress imaging or an exercise tolerance test (ETT) are the most common methods to detect obstructive coronary artery disease, though stress test markers of LMD remain ill-defined.Objectives: The authors sought to identify markers of LMD as detected on coronary computed tomography angiography (CTA), using clinical and stress testing parameters.Methods: This was a post hoc analysis of ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), including randomized and nonrandomized participants who had locally determined moderate or severe ischemia on nonimaging ETT, stress nuclear myocardial perfusion imaging, or stress echocardiography followed by CTA to exclude LMD. Stress tests were read by core laboratories. Prior coronary artery bypass grafting was an exclusion. In a stepped multivariate model, the authors identified predictors of LMD, first without and then with stress testing parameters.Results: Among 5,146 participants (mean age 63 years, 74% male), 414 (8%) had LMD. Predictors of LMD were older age (P < 0.001), male sex (P < 0.01), absence of prior myocardial infarction (P < 0.009), transient ischemic dilation of the left ventricle on stress echocardiography (P = 0.05), magnitude of ST-segment depression on ETT (P = 0.004), and peak metabolic equivalents achieved on ETT (P = 0.001). The models were weakly predictive of LMD (C-index 0.643 and 0.684).Conclusions: In patients with moderate or severe ischemia, clinical and stress testing parameters were weakly predictive of LMD on CTA. For most patients with moderate or severe ischemia, anatomical imaging is needed to rule out LMD. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522). [ABSTRACT FROM AUTHOR]

Background: Although nearly two-third of bankruptcy in the United States is medical in origin, a common assumption is that individuals facing a potentially lethal disease opt for cure at any cost. This assumption has never been tested, and knowledge of how the American population values a trade-off between cure and bankruptcy is unknown.Objectives: To determine the relative importance among the general American population of improved health versus improved financial risk protection, and to determine the impact of demographics on these preferences.Methods: A discrete-choice experiment was performed with 2359 members of the US population. Respondents were asked to value treatments with varying chances of cure and bankruptcy in the presence of a lethal disease. Latent class analysis with concomitant variables was performed, weighted for national representativeness. Sensitivity analyses were undertaken to test the robustness of the results.Results: It was found that 31.3% of the American population values cure at all costs. Nevertheless, for 8.5% of the US population, financial solvency dominates concerns for health in medical decision making. Individuals who value cure at all costs are more likely to have had experience with serious disease and to be women. No demographic characteristics significantly predicted individuals who value solvency over cure.Conclusions: Although the average American values cure more than financial solvency, a cure-at-all-costs rubric describes the preferences of a minority of the population, and 1 in 12 value financial protection over any chances of cure. This study provides empirical evidence for how the US population values a trade-off between avoiding adverse health outcomes and facing bankruptcy. These findings bring to the fore the decision making that individuals face in balancing the acute financial burden of health care access. [ABSTRACT FROM AUTHOR]

Objective/background: To compare sleep and circadian variability in adults with delayed sleep-wake phase disorder (DSWPD) to healthy controls.Patients/methods: Forty participants (22 DSWPD, 18 healthy controls) completed a ten-day protocol, consisting of DLMO assessments on two consecutive nights, a five-day study break, followed by two more DLMO assessments. All participants were instructed to sleep within one hour of their self-reported average sleep schedule for the last four days of the study break. We analyzed the participants' wrist actigraphy data during these four days to examine intraindividual variability in sleep timing, duration and efficiency. We also examined shifts in the DLMO from before and after the study break.Results and Conclusions: Under the same conditions, people with DSWPD had significantly more variable wake times and total sleep time than healthy controls (p ≤ 0.015). Intraindividual variability in sleep onset time and sleep efficiency was similar between the two groups (p ≥ 0.30). The DLMO was relatively stable across the study break, with only 11% of controls but 27% of DSWPDs showed more than a one hour shift in the DLMO. Only in the DSWPD sample was greater sleep variability associated with a larger shift in the DLMO (r = 0.46, p = 0.03). These results suggest that intraindividual variability in sleep can be higher in DSWPD versus healthy controls, and this may impact variability in the DLMO. DSWPD patients with higher intraindividual variability in sleep are more likely to have a shifting DLMO, which could impact sleep symptoms and the optimal timing of light and/or melatonin treatment for DSWPD.Clinical Trial: Circadian Phase Assessments at Home, http://clinicaltrials.gov/show/NCT01487252, NCT01487252. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare long-term microtensile bond strength of zirconia, surface-modified via a novel treatment, to current surface conditioning methods for zirconia, when resin bonded to dental composite. Methods: Two ProCAD (porcelain) and 10 sintered ZirCAD (ZrO2) blocks (18mm×14mm×12mm) were obtained from manufacturers. Twelve Herculite XRV composite blocks were fabricated (18mm×14mm×12mm). Bonding surface of blocks was polished through 1200-grit SiC and air-abraded (50μm alumina, 0.28MPa, 20s). Blocks were then separated into six groups: (1) porcelain (control), HF-etched/silane-treated, (2) ZrO2, tribochemical-coated/silane-treated, (3) ZrO2, primer-treated, (4) ZrO2, modified via novel 3.2nm silica layer/silane-treated, (5) ZrO2, modified via novel 5.8nm silica layer/silane-treated, and (6) ZrO2, modified via novel 30.4nm silica layer/silane-treated. Blocks were bonded to composite using Clearfil Esthetic cement. Blocks were stored in distilled water (37°C, 24h), then cut into microtensile bars (n =8/gp), then bond strengths were measured using a universal testing machine at 0, 1, 3, and 6 months. All groups were statistically analyzed (ANOVA, Tukey''s, p <0.05). Results: At 6 months (aging), all silica seed layer specimens displayed microtensile bond strength similar to CoJet specimens but less than that of silane-modified dental porcelain. Conclusion: The deposition of a silica layer on zirconia resulted in similar or superior long-term resin bond strength when compared to traditional silanation and bonding techniques for zirconia but lower than that for silane-treated dental porcelain. [Copyright &y& Elsevier]

Toxicities of the radiolytically generated oxidizing radicals HO˙, CO3˙−a, and NO2˙ toward suspension cultures of a bacterium (Escherichia coli) and a yeast (Saccharomyces cerevisiae) were examined. As demonstrated by the absence of protection from the membrane-impermeable HO˙ scavenger polyethylene glycol (PEG), externally generated HO˙ was not bactericidal under these conditions; however, partial protection by PEG was observed for S. cerevisiae, indicating the presence of a fungicidal pathway involving external HO˙. For both organisms, conversion of external HO˙ to the secondary radical, CO3˙−, by reaction with HCO3− increases their susceptibility to radiolytic killing. In contrast, externally generated NO2˙ exhibited toxicity comparable to that of CO3˙− toward E. coli, but completely blocked the extracellular toxicity of HO˙ toward S. cerevisiae. Cogeneration of equal fluxes of NO2˙− and either HO˙ or CO3˙− also essentially eliminated the extracellular microbicidal reactions. This behavior is consistent with expectations based upon relative rates of radical–radical self-coupling and cross-coupling reactions. The different patterns of toxicity observed imply fundamentally different microbicidal mechanisms for the two organisms, wherein the bacterium is susceptible to killing by oxidation of highly reactive targets on its cellular envelope but, despite undergoing similar oxidative insult, the fungus is not. [Copyright &y& Elsevier]

: ObjectivesWe sought to study the effect of long-term statin use on psychometric measures in an adult population with underlying coronary artery disease (CAD).: BackgroundPrevious studies have suggested associations between cholesterol lowering and psychological well-being.: MethodsStudy subjects were recruited from an outpatient cardiology clinic. Psychological well-being was assessed at baseline and annually during follow-up. The exposure of interest was long-term statin use and the outcomes of interest were depression, anxiety, and hostility. We estimated the odds ratios (ORs) and 95% confidence intervals (CI) that represented the strength of association between statin use (vs. no use of any cholesterol-lowering drug) and the risk of having abnormal depression, anxiety, and hostility scores.: ResultsStudy subjects had an average follow-up of four years and maximum of seven years. Comparing the 140 patients who had continuous use of statins with the 231 patients who did not use any cholesterol-lowering drugs, statin use was associated with lower risk of abnormal depression scores (OR 0.63, 95% CI 0.43 to 0.93), anxiety (OR 0.69, 95% CI 0.47 to 0.99), and hostility (OR 0.77, 95% CI 0.58 to 0.93) after adjustment for the propensity for statin use and potential confounders. The beneficial psychological effects of the statins appeared to be independent of the drugs'' cholesterol-lowering effects.: ConclusionsLong-term use of statins among patients with CAD appeared to be associated with reduced risk of anxiety, depression, and hostility. [Copyright &y& Elsevier]

The social value of risk reduction (SVRR) is the marginal social value of reducing an individual's fatality risk, as measured by some social welfare function (SWF). This Article investigates SVRR, using a lifetime utility model in which individuals are differentiated by age, lifetime income profile, and lifetime risk profile. We consider both the utilitarian SWF and a "prioritarian" SWF, which applies a strictly increasing and strictly concave transformation to individual utility. We show that the prioritarian SVRR provides a rigorous basis in economic theory for the "fair innings" concept, proposed in the public health literature: as between an older individual and a similarly situated younger individual (one with the same income and risk profile), a risk reduction for the younger individual is accorded greater social weight even if the gains to expected lifetime utility are equal. The comparative statics of prioritarian and utilitarian SVRRs with respect to age, and to (past, present, and future) income and baseline survival probability, are significantly different from the conventional value per statistical life (VSL). Our empirical simulation based upon the U.S. population survival curve and income distribution shows that prioritarian SVRRs with a moderate degree of concavity in the transformation function conform to widely held views regarding lifesaving policies: the young should take priority but income should make no difference. [ABSTRACT FROM AUTHOR]

Background: Current resuscitation guidelines emphasize the use of waveform capnography to help guide rescuers during cardiopulmonary resuscitation (CPR). However, chest compressions often cause oscillations in the capnogram, impeding its reliable interpretation, either visual or automated. The aim of the study was to design an algorithm to enhance waveform capnography by suppressing the chest compression artefact.Methods: Monitor-defibrillator recordings from 202 patients in out-of-hospital cardiac arrest were analysed. Capnograms were classified according to the morphology of the artefact. Ventilations were annotated using the transthoracic impedance signal acquired through defibrillation pads. The suppression algorithm is designed to operate in real-time, locating distorted intervals and restoring the envelope of the capnogram. We evaluated the improvement in automated ventilation detection, estimation of ventilation rate, and detection of excessive ventilation rates (over-ventilation) using the capnograms before and after artefact suppression.Results: A total of 44 267 ventilations were annotated. After artefact suppression, sensitivity (Se) and positive predictive value (PPV) of the ventilation detector increased from 91.9/89.5% to 98.0/97.3% in the distorted episodes (83/202). Improvement was most noticeable for high-amplitude artefact, for which Se/PPV raised from 77.6/73.5% to 97.1/96.1%. Estimation of ventilation rate and detection of over-ventilation also upgraded. The suppression algorithm had minimal impact in non-distorted data.Conclusion: Ventilation detection based on waveform capnography improved after chest compression artefact suppression. Moreover, the algorithm enhances the capnogram tracing, potentially improving its clinical interpretation during CPR. Prospective research in clinical settings is needed to understand the feasibility and utility of the method. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that the immune system can recognize polyethylene glycol (PEG), leading to the accelerated blood clearance (ABC) of PEGylated particles. Our aim here was to study the generation of anti-PEG immunity and changes in PEGylated microbubble pharmacokinetics during repeated contrast-enhanced ultrasound imaging in rats. We administered homemade PEGylated microbubbles multiple times over a 28-d period and observed dramatically accelerated clearance (4.2 × reduction in half-life), which was associated with robust anti-PEG IgM and anti-PEG IgG antibody production. Dosing animals with free PEG as a competition agent before homemade PEGylated microbubble administration significantly prolonged microbubble circulation, suggesting that ABC was largely driven by circulating anti-PEG antibodies. Experiments with U.S. Food and Drug Administration-approved Definity microbubbles similarly resulted in ABC and the generation of anti-PEG antibodies. Experiments repeated with non-PEGylated Optison microbubbles revealed a slight shift in clearance, indicating that immunologic factors beyond anti-PEG immunity may play a role in ABC, especially of non-PEGylated agents. [ABSTRACT FROM AUTHOR]

Background: Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated.Methods: CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization.Results: A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07-0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06-0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1-99 or ≥100) and SIS.Conclusion: In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy. [ABSTRACT FROM AUTHOR]

Background: Patients with acute myocardial infarction (AMI) complicated by acute heart failure or cardiogenic shock have high mortality with conventional management.Objectives: This study evaluated outcomes of patients with AMI who received durable ventricular assist devices (VAD).Methods: Patients in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry who underwent VAD placement in the setting of AMI were included and compared with patients who received VAD for non-AMI indications.Results: VAD were implanted in 502 patients with AMI: 443 left ventricular assist devices; 33 biventricular assist devices; and 26 total artificial hearts. Median age was 58.3 years, and 77.1% were male. At implantation, 66% were INTERMACS profile 1. A higher proportion of AMI than non-AMI patients had pre-operative intra-aortic balloon pumps (57.6% vs. 25.3%; p < 0.01), intubation (58% vs. 8.3%; p < 0.01), extracorporeal membrane oxygenation (17.9% vs. 1.7%, p < 0.01), cardiac arrest (33.5% vs. 3.3%, p < 0.01), and higher-acuity INTERMACS profiles. At 1 month post-VAD, 91.8% of AMI patients were alive with ongoing device support, 7.2% had died on device, and 1% had been transplanted. At 1-year post-VAD, 52% of AMI patients were alive with ongoing device support, 25.7% had been transplanted, 1.6% had left VAD explanted for recovery, and 20.7% had died on device. The AMI group had higher unadjusted early phase hazard (hazard ratio [HR]: 1.24; p = 0.04) and reduced late-phase hazard of death (HR: 0.57; p = 0.04) than the non-AMI group did. After accounting for established risk factors, the AMI group no longer had higher early mortality hazard (HR: 0.89; p = 0.30), but it had lower late mortality hazard (HR: 0.55; p = 0.02).Conclusions: Patients with AMI who receive VAD have outcomes similar to other VAD populations, despite being more critically ill pre-implantation. VAD therapy is an effective strategy for patients with AMI and acute heart failure or shock in whom medical therapy is failing. [ABSTRACT FROM AUTHOR]

Aim: To develop and evaluate a method to detect circulation in the presence of organized rhythms (ORs) during resuscitation using signals acquired by defibrillation pads.Methods: Segments containing electrocardiogram (ECG) and thoracic impedance (TI) signals free of artifacts were used. The ECG corresponded to ORs classified as pulseless electrical activity (PEA) or pulse-generating rhythm (PR). A first dataset containing 1091 segments was split into training and test sets to develop and validate the circulation detector. The method processed ECG and TI to obtain the impedance circulation component (ICC). Morphological features were extracted from ECG and ICC, and combined into a classifier to discriminate between PEA and PR. The performance of the method was evaluated in terms of sensitivity (PR) and specificity (PEA). A second dataset (86 segments from different patients) was used to assess two application of the method: confirmation of arrest by recognizing absence of circulation during ORs and detection of return of spontaneous circulation (ROSC) during resuscitation. In both cases, time to confirmation of arrest/ROSC was determined.Results: The method showed a sensitivity/specificity of 92.1%/90.3% and 92.2%/91.9% for training and test sets respectively. The method confirmed cardiac arrest with a specificity of 93.3% with a median delay of 0s after the first OR annotation. ROSC was detected with a sensitivity of 94.4% with a median delay of 57s from ROSC onset.Conclusion: The method showed good performance, and can be reliably used to distinguish perfusing from non-perfusing ORs. [ABSTRACT FROM AUTHOR]

Background: The purpose of these studies was to determine the incidence and survival of patients with specific malignancies with respect to age and transplant year and to compare the data with the normal non-transplant population. Methods: Data from 6,211 primary cardiac transplants between July 31, 1993, and December 30, 2008, were collected by 35 institutions participating in the Cardiac Transplant Research Database. Data were compared with information collected by the Surveillance Epidemiology and End Results (SEER) Cancer Statistics Review 1975–2006. Results: Multivariable analysis showed older age (relative risk [RR], 2.1; p < 0.0001) and earlier transplant year (RR, 1.8; p < 0.0001) were highly significant risk factors. Aggregate malignancy incidence in the modern era (2001 to 2008) did not differ significantly from the normal population, which appeared to be attributable to a lower rate of malignancies other than lung cancer, lymphoma, and melanoma (actual/expected ratio, 0.71). From 2001 to 2008, rates were significantly higher for lung cancer (actual/expected ratio, 1.86; p = 0.006) and lymphoma (actual/expected ratio, 4.3, p < 0.0001) than in the normal population. The highest risk for lymphoma was in younger adults who received transplants at ages 18 to 35 years (actual/expected ratio, 27). The highest risk for lung cancer was in patients who underwent transplantation at ages 55 to 65 years (actual/expected ratio, 28). Once diagnosed with malignancy, subsequent survival at 5 years was 21% for lung cancer and 32% for lymphoma. Conclusions: The risk of malignancy has markedly declined during a 15-year period such that the aggregate rate of malignancy approached that of the general population in the United States. However, the distribution of malignancies was not the same, with a greater prominence of lung cancer and lymphoproliferative disease. [Copyright &y& Elsevier]

Highlights: [•] Dispersed citrate capped silver nanoparticles were synthesised and characterised. [•] Nanoparticle aggregation was assessed in Daphnia magna diluted and undiluted media. [•] Aggregation was assessed by TEM and AFM measurements. [•] There was a significant reduction in toxicity in media1 compared to that in media10. [Copyright &y& Elsevier]

The performance of a proprietary solvent (CAER-B2), an amine-carbonate blend, for the absorption of CO2 from coal-derived flue gas is evaluated and compared with state-of-the-art 30 wt% monoethanolamine (MEA) under similar experimental conditions in a 0.1 MWth pilot plant. The evaluation was done by comparing the carbon capture efficiency, the overall mass transfer rates, and the energy of regeneration of the solvents. For similar carbon loadings of the solvents in the scrubber, comparable mass transfer rates were obtained. The rich loading obtained for the blend was 0.50 mol CO2/mol amine compared to 0.44 mol CO2/mol amine for MEA. The energy of regeneration for the blend was about 10% lower than that of 30 wt% MEA. At optimum conditions, the blend shows promise in reducing the energy penalty associated with using industry standard, MEA, as a solvent for CO2 capture. [ABSTRACT FROM AUTHOR]

Background: Patients listed for transplant after the bidirectional Glenn (BDG) may have better outcomes than patients listed after Fontan. This study examined and compared outcomes after listing for BDG and Fontan patients. Methods: All patients listed for transplant after the BDG in the Pediatric Heart Transplant Study between January 1993 and December 2008 were evaluated. Comparisons were made with Fontan patients and with a matched cohort of congenital heart disease patients. Competing outcomes analysis and actuarial survival were evaluated for the study populations, including an examination of various risk factors. Results: Competing outcomes analysis for BDG and Fontan patients after listing were similar. There was no difference in actuarial survival after listing or transplant among the 3 cohorts. Mechanical ventilation, United Network of Organ Sharing status, and age were risk factors for death after listing in BDG and Fontan patients, but ventilation at the time of transplant was significant only for the Fontan patients. Mortality was increased in Fontan patients listed < 6 months after surgery compared with patients listed > 6 months after surgery, but no difference was observed in BDG patients. There was a trend toward improved survival after listing for both populations across 3 eras of the study, but this did not reach statistical significance. Conclusion: Outcomes after listing for BDG and Fontan patients are similar. Mechanical ventilation at the time of transplant remains a significant risk factor for death in the Fontan population, as does listing for transplant soon after the Fontan, suggesting that some patients may benefit from transplant instead of Fontan completion. [ABSTRACT FROM AUTHOR]

Abstract: Background: Rho-associated kinases (ROCKs) have been shown to be involved in the pathogenesis of atherosclerosis. It is clinically important to estimate the degree of ROCK activity in humans. The purpose of this study was to confirm the validity of a leukocyte ROCK parameter as an index of ROCK activity in comparison with vascular response to a ROCK inhibitor. Methods and results: We evaluated the ratio of phospho myosin-binding subunit (p-MBS) on myosin light-chain phosphatase to total MBS in peripheral leukocytes by Western blot analysis and forearm blood flow (FBF) response to the ROCK inhibitor fasudil using strain-gauge plethysmography in 36 healthy subjects and 39 patients with cardiovascular diseases. Fasudil (3, 10, 30μg/min) was infused intra-arterially for 5min at each dose. Leukocyte p-MBS/total-MBS was higher in cardiovascular diseases than in healthy subjects (0.97±0.37 vs. 0.51±0.14; P =0.002). Fasudil increased FBF from 4.9±1.2 to 14.5±5.7mL/min/100mL tissue (P <0.0001) in patients with cardiovascular diseases, while fasudil did not alter FBF in healthy subjects. There was a significant relationship between leukocyte p-MBS/total-MBS and maximal FBF response to fasudil in all subjects (r =0.72, P <0.0001). There was also a significant correlation between p-MBS/total-MBS and maximal FBF response to fasudil in patients with cardiovascular diseases (r =0.59, P <0.0001). In healthy subjects, there was no significant correlation between the two parameters. Conclusions: These findings suggest that assessment of leukocyte ROCK activity is minimally invasive and does not require pharmacologic intervention using ROCK inhibitors. Leukocyte p-MBS/total-MBS may be useful for evaluating ROCK activity in a clinical setting. [ABSTRACT FROM AUTHOR]

Retrospectively gated helical cardiac computed tomographic angiography (CCTA) has been reported accurate in the evaluation of isolated valvular abnormalities, but its ability to provide comprehensive assessment of common valvular lesions is not established. We evaluated 56 consecutive patients undergoing 64-detector retrospective electrocardiogram-gated CCTA and transesophageal echocardiography for the presence of aortic and mitral stenoses, aortic and mitral regurgitations, mitral valve prolapse, and tricuspid regurgitation. Two cardiac computed tomographic angiographic readers measured maximum aortic and mitral valve opening areas, assessed for aortic or mitral valve regurgitant area, and evaluated for mitral valve prolapse. Tricuspid regurgitation was assessed by the contrast ratio of the inferior vena cava to the right heart. After excluding nondiagnostic valves on CCTA (mitral valve n = 4, aortic valve n = 2), the sensitivity, specificity, positive predictive values, and negative predictive values of CCTA compared to transesophageal echocardiography were 100%, 96%, 50%, and 100% for aortic stenosis, 44%, 96%, 67%, and 90% for aortic regurgitation, 100% each for mitral stenosis, 13%, 95%, 80%, and 45% for mitral regurgitation, and 50%, 98%, 80%, and 91% for mitral valve prolapse. There was no relation between tricuspid regurgitation grade and contrast ratio (p = 0.53). There was excellent interobserver agreement for aortic and mitral stenoses (kappa = 1.0 for each), and good agreement for aortic regurgitation, mitral regurgitation, and mitral valve prolapse (kappa = 0.81, 0.78, and 0.88, respectively). In conclusion, CCTA exhibited high diagnostic performance for detection of aortic and mitral stenoses and limited diagnostic performance for aortic regurgitation, mitral regurgitation, and mitral valve prolapse; tricuspid regurgitation could not be evaluated. The ability of CCTA to provide comprehensive assessment of valvular function is variable. [Copyright &y& Elsevier]

Background: To assess GABAA receptor subtypes involved in benzodiazepine tolerance and dependence, we evaluated the ability of subtype-selective and non-selective ligands to substitute for (i.e., produce "cross-tolerance") or precipitate withdrawal during chronic alprazolam treatment.Methods: Four female rhesus monkeys (Macaca mulatta) were implanted with chronic intravenous catheters and administered alprazolam (1.0 mg/kg every 4 h). Following 14+ days of chronic alprazolam, acute administration of selected doses of non-selective and subtype-selective ligands were substituted for, or administered with, alprazolam, followed by quantitative behavioral observations. The ligands included alprazolam and midazolam (positive modulators, non-selective), zolpidem (positive modulator, preferential affinity for α1-containing GABAA receptors), HZ-166 (positive modulator, preferential efficacy at α2- and α3-containing GABAA receptors), and βCCT (antagonist, preferential affinity for α1-containing GABAA receptors).Results: Acutely, alprazolam and midazolam both induced observable ataxia along with a mild form of sedation referred to as "rest/sleep posture" at a lower dose (0.1 mg/kg, i.v.), whereas at a higher dose (1.0 mg/kg, i.v.), induced deep sedation and observable ataxia. With chronic alprazolam treatment, observable ataxia and deep sedation were reduced significantly, whereas rest/sleep posture was unchanged or emerged. Zolpidem showed a similar pattern of effects, whereas no behaviors engendered by HZ-166 were changed by chronic alprazolam. Administration of βCCT, but not HZ-166, resulted in significant withdrawal signs.Conclusions: These results are consistent with a role for α1-containing GABAA receptor subtypes in tolerance and dependence observed with chronic alprazolam, although other receptors may be involved in the withdrawal syndrome. [ABSTRACT FROM AUTHOR]

The cave-dwelling (hypogean) form of the teleost Astyanax fasciatus is blind, having only subdermal eye rudiments, but nevertheless maintains intact opsin genes. Second generation offspring of a cross between these and the normally sighted surface (epigean) form inherit opsin genes from both ancestries. A study of the expressed hypogean opsins of the hybrids, in comparison to the epigean forms, was undertaken by microspectrophotometry. The hybrid population showed considerable variation in the visual pigments of double cones, with evidence for two groups of cells with λmax intermediate to those of the epigean pigments. Possible explanations for these intermediate pigments are discussed, including the hypothesis that they may represent hybrid genes similar to the genes for anomalous cone pigments in humans. Evidence was also found for ultraviolet-sensitive single cones and for an additional MWS pigment. [Copyright &y& Elsevier]

[Display omitted] The objective of this work was to investigate the effect of microfluidics on the quality attributes of metformin hydrochloride-loaded poly lactic-co-glycolic acid polymeric particles (MFH-PLGA PPs) when compared to a traditional double emulsion batch method. The relationship of encapsulation and loading efficiencies, yield %, particle size, surface morphology, and release profile with process and formulation variables were determined using design of experiments (DoE). The effects of the dispersal method of the primary (sonication vs. vortex) or secondary emulsion (microfluidics vs. batch), polyvinyl alcohol concentration (PVA), and drug to polymer ratio were investigated. The PPs' size was impacted by both the PVA concentration and the type of primary and secondary emulsion dispersion methods. Microfluidics significantly increased the PPs' yield %, particle size, encapsulation, and loading efficiencies. The higher loaded microfluidic-based PPs had more burst release, following first-order release kinetics when compared to the lower loaded batch-based particles, which followed the Korsmeyer-Peppas model for release kinetics. Microfluidic-based PPs exhibited a smooth, porous, more uniform, and larger particle size with hollow structure than the batch-based PPs with a matrix-like structure. In conclusion, we have elucidated the effect of microfluidics on the quality attributes of MFH-PLGA PPs and their comparison to the traditional batch technique. [ABSTRACT FROM AUTHOR]