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Brian E Perron1, Joseph E Glass2, Brian K Ahmedani3, Michael G Vaughn4, Daniel E Roberts1, Li-Tzy Wu51University of Michigan, Ann Arbor, MI, USA; 2Washington University, St Louis, MO, USA; 3Henry Ford Health System, Detroit, MI, USA; 4St Louis University, St Louis, MO, USA; 5Duke University, Durham, NC, USABackground: Inhalants are among the most common and dangerous forms of substance use, but very little research on inhalant use disorders exist. Unlike other substances, the Diagnostic and Statistical Manual, 4th edition (DSM-IV) indicates that inhalants do not have an associated withdrawal syndrome among persons who meet criteria for inhalant dependence.Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, this study examines the prevalence of withdrawal symptoms among inhalant users. Prevalence of inhalant withdrawal symptoms for inhalants was also compared with the prevalence of cocaine withdrawal symptoms to help determine the presence of an inhalant withdrawal syndrome.Results: Approximately 47.8% of persons who met criteria for inhalant dependence reported experiencing three or more inhalant-related withdrawal symptoms that were clinically significant. Among those with inhalant dependence, almost half of the withdrawal symptoms were as common as the corresponding withdrawal symptoms experienced by persons with cocaine dependence. Furthermore, the percentage of persons with inhalant dependence reporting clinically significant inhalant withdrawal symptoms was almost equal to the percentage of persons with cocaine dependence reporting clinically significant cocaine withdrawal symptoms.Conclusions: These data provide evidence for an inhalant-related withdrawal syndrome among persons with inhalant dependence. Revisions to DSM-IV should consider including inhalant withdrawal as a diagnostic criterion for this disorder.Keywords: Inhalants, volatile solvents, withdrawal, inhalant use disorders

BACKGROUND AND PURPOSE The Na(+) /Ca(2+) exchanger is a bi-directional transporter that plays an important role in maintaining the concentration of cytosolic Ca(2+) ([Ca(2+) ](i) ) of quiescent platelets and increasing it during activation with some, but not all, agonists. There are two classes of Na(+) /Ca(2+) exchangers: K(+) -independent Na(+) /Ca(2+) exchanger (NCX) and K(+) -dependent Na(+) /Ca(2+) exchanger (NCKX). Platelets have previously been shown to express NCKX1. However, initial studies from our laboratory suggest that NCX may also play a role in platelet activation. The objective of this study was to determine if the human platelet expresses functional NCXs. EXPERIMENTAL APPROACH RT-PCR, DNA sequencing and Western blot analysis were utilized to characterize the human platelet Na(+) /Ca(2+) exchangers. Their function during quiescence and collagen-induced activation was determined by measuring [Ca(2+) ](i) with calcium-green/fura-red in response to: changes in the Na(+) and K(+) gradient, NCX pharmacological inhibitors (CBDMB, KB-R7943 and SEA0400) and antibodies specific to extracellular epitopes of the exchangers. KEY RESULTS Human platelets express NCX1.3, NCX3.2 and NCX3.4. The NCXs operate in the Ca(2+) efflux mode in resting platelets and also during their activation with thrombin but not collagen. Collagen-induced increase in [Ca(2+) ](i) was reduced with the pharmacological inhibitors of NCX (CBDMB, KB-R7943 or SEA0400), anti-NCX1 and anti-NCX3. In contrast, anti-NCKX1 enhanced the collagen-induced increase in [Ca(2+) ](i) . CONCLUSIONS AND IMPLICATIONS Human platelets express K(+) -independent Na(+) /Ca(2+) exchangers NCX1.3, NCX3.2 and NCX3.4. During collagen activation, NCX1 and NCX3 transiently reverse to promote Ca(2+) influx, whereas NCKX1 continues to operate in the Ca(2+) efflux mode to reduce [Ca(2+) ](i) . [ABSTRACT FROM AUTHOR]

Abstract Background Nutrition is often a casualty of the busy work day for physicians. We aimed to explore physicians' views of their nutrition in the workplace including their perceptions of the impact of inadequate nutrition upon their personal wellness and their professional performance. Methods This is a qualitative study of a sample of 20 physicians practicing in a large urban teaching hospital. Semi-structured open ended interviews were conducted to explore physicians' views of workplace nutrition. The same physicians had agreed to participate in a related nutrition based wellness intervention study that compared nutritional intake and cognitive function during a day of usual nutrition patterns against another day with scheduled nutrition breaks. A second set of interviews was conducted after the intervention study to explore how participation in the intervention impacted these views. Detailed interview content notes were transcribed and analyzed independently with differences reconciled by discussion. Results At initial interview, participants reported difficulty accessing adequate nutrition at work, linking this deficit with emotional (irritable and frustrated), physical (tired and hungry), and cognitive (difficulty concentrating and poor decision making) symptoms. In addition to identifying practical barriers such as lack of time to stop and eat, inconvenient access to food and poor food choices, the physicians described how their sense of professionalism and work ethic also hinder their work nutrition practices. After participating in the intervention, most physicians reported heightened awareness of their nutrition patterns and intentions to improve their workplace nutrition. Conclusions Physicians report that inadequate workplace nutrition has a significant negative impact on their personal wellness and professional performance. Given this threat to health care delivery, health care organizations and the medical profession need to address both the practical and professional barriers identified.

Abstract Background Physicians are often unable to eat and drink properly during their work day. Nutrition has been linked to cognition. We aimed to examine the effect of a nutrition based intervention, that of scheduled nutrition breaks during the work day, upon physician cognition, glucose, and hypoglycemic symptoms. Methods A volunteer sample of twenty staff physicians from a large urban teaching hospital were recruited from the doctors' lounge. During both the baseline and the intervention day, we measured subjects' cognitive function, capillary blood glucose, "hypoglycemic" nutrition-related symptoms, fluid and nutrient intake, level of physical activity, weight, and urinary output. Results Cognition scores as measured by a composite score of speed and accuracy (Tput statistic) were superior on the intervention day on simple (220 vs. 209, p = 0.01) and complex (92 vs. 85, p < 0.001) reaction time tests. Group mean glucose was 0.3 mmol/L lower (p = 0.03) and less variable (coefficient of variation 12.2% vs. 18.0%) on the intervention day. Although not statistically significant, there was also a trend toward the reporting of fewer hypoglycemic type symptoms. There was higher nutrient intake on intervention versus baseline days as measured by mean caloric intake (1345 vs. 935 kilocalories, p = 0.008), and improved hydration as measured by mean change in body mass (+352 vs. -364 grams, p < 0.001). Conclusions Our study provides evidence in support of adequate workplace nutrition as a contributor to improved physician cognition, adding to the body of research suggesting that physician wellness may ultimately benefit not only the physicians themselves but also their patients and the health care systems in which they work.

Objectives: Patients with severe intracerebral hemorrhage (ICH) often suffer from impaired capacity and rely on surrogates for decision-making. Restrictions on visitors within healthcare facilities during the pandemic may have impacted care and disposition for patient with ICH. We investigated outcomes of ICH patients during the COVID-19 pandemic compared to a pre-pandemic period., Materials and Methods: We conducted a retrospective review of ICH patients from two sources: (1) University of Rochester Get With the Guidelines database and (2) the California State Inpatient Database (SID). Patients were divided into 2019-2020 pre-pandemic and 2020 pandemic groups. We compared mortality, discharge, and comfort care/hospice. Using single-center data, we compared 30-day readmissions and follow-up functional status., Results: The single-center cohort included 230 patients (n = 122 pre-pandemic, n = 108 pandemic group), and the California SID included 17,534 patients (n = 10,537 pre-pandemic, n = 6,997 pandemic group). Inpatient mortality was no different before or during the pandemic in either cohort. Length of stay was unchanged. During the pandemic, more patients were discharged to hospice in the California SID (8.4% vs. 5.9%, p<0.001). Use of comfort care was similar before and during the pandemic in the single center data. Survivors in both datasets were more likely to be discharged home vs. facility during the pandemic. Thirty-day readmissions and follow-up functional status in the single-center cohort were similar between groups., Conclusions: Using a large database, we identified more ICH patients discharged to hospice during the COVID-19 pandemic and, among survivors, more patients were discharged home rather than healthcare facility discharge during the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 McHugh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We present and discuss opportunities opened up by a new generation of beam shaping optical elements that combine capabilities of digital spatial light polarization converters and diffractive properties of thin liquid crystalline films with patterned orientation of anisotropy axis (diffractive wave plates). Several functions of the new generation beam shapers are demonstrated, among them converting a laser beam of a Gaussian profile into a ring profile in the far field, a flattop profile, and into complex images. We also describe electrically controlled beam shaping optical elements which can be turned off and on within milliseconds by applying a low external voltage. Optical, morphological, and electro-optical properties of the components are characterized.

Background: Rapidly determining the causes of a depressed level of consciousness (DLOC) including coma is a common clinical challenge. Quantitative analysis of the electroencephalogram (EEG) has the potential to improve DLOC assessment by providing readily deployable, temporally detailed characterization of brain activity in such patients. While used commonly for seizure detection, EEG-based assessment of DLOC etiology is less well-established. As a first step towards etiological diagnosis, we sought to distinguish focal and diffuse causes of DLOC through assessment of temporal dynamics within EEG signals., Methods: We retrospectively analyzed EEG recordings from 40 patients with DLOC with consensus focal or diffuse culprit pathology. For each recording, we performed a suite of time-series analyses, then used a statistical framework to identify which analyses (features) could be used to distinguish between focal and diffuse cases., Results: Using cross-validation approaches, we identified several spectral and non-spectral EEG features that were significantly different between DLOC patients with focal vs. diffuse etiologies, enabling EEG-based classification with an accuracy of 76%., Conclusions: Our findings suggest that DLOC due to focal vs. diffuse injuries differ along several electrophysiological parameters. These results may form the basis of future classification strategies for DLOC and coma that are more etiologically-specific and therefore therapeutically-relevant.

The application of UV lidar to measure isoprene concentrations for environmental studies has been investigated. With a hard target lidar system at 223 nm, isoprene mixing ratios above eucalyptus trees were measured with a sensitivity of about 1 ppbv. Results over a long timescale were compared with an existing model of isoprene emission for a wide range of temperature and sunlight values. Fast time dependent results yielded a leaf emission rate of 25 microg g(-1) hour(-1), consistent with emission from other eucalyptus species. Requirements for development of the system for range resolved isoprene number density measurements using atmospheric backscatter lidar are discussed.

Some transposable elements move by a replicative mechanism involving cointegrate formation. Intramolecular cointegration can generate a product called an "adjacent deletion" in which a contiguous chromosomal segment adjacent to the transposon is deleted while the element responsible remains intact. Insertion sequence IS10 is thought to transpose by a nonreplicative mechanism. In the simplest models, nonreplicative transposition cannot give rise to an adjacent deletion because an intrinsic feature of such transposition is excision of the IS element from the donor location. We report here that IS10 can generate adjacent deletions, but at a frequency which is approximately 1/30th the frequency of transposition for the same element. We suggest that these deletions might arise either by nonreplicative transposition events that involve two IS10 elements located on sister chromosomes or by aberrant nonreplicative events involving cleavage and ligation at only one end of the element.

We describe below several new variants of the tetracycline-resistance transposon Tn10 which are more useful than the wild-type transposon for many types of genetic and physical analysis of bacteria. These derivatives have one or more of the following new properties: (i) new drug resistance markers; (ii) high transposition frequencies; (iii) removal of the transposase gene to a position outside of the transposing segment; (iv) internal deletions which eliminate the ability of Tn10 to make adjacent deletion/inversions; or (v) addition of a trp-lac operon fusion segment just inside one terminus such that insertion can automatically generate a transcriptional fusion to the interrupted operon. Phage and plasmid vehicles carrying these new elements are described.

Induced vasodilation by classical conditioning was compared to biofeedback therapy as treatment for idiopathic Raynaud's disease. Classical conditioning therapy consisted of 54 10-min immersions of both hands in water (43 degrees C) simultaneously with whole-body exposure to cold air (0 degrees C), given three times per day, 3 days per week, for 6 weeks. Biofeedback therapy consisted of eight sessions of electromyograph feedback (frontalis) while listening to relaxation tapes, followed by 10 sessions of digital thermal feedback while listening to relaxation tapes. Both groups received 10-min cold stress tests of whole-body exposure to 0 degrees C before and after treatments. Results indicated that both therapies significantly increased the digital temperature response to cold. Although no differences between classical conditioning and biofeedback were found at the end of training, a 1-year follow-up indicated that classical conditioning was more effective.