120 results on '"Hayden, Douglas"'
Search Results
102. Ouasielastic light scattering from the aging human lens in vivo
- Author
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Thurston, George M., primary, Hayden, Douglas L., additional, Burrows, Pendra, additional, Clark, John I., additional, Taret, Victor G., additional, Kandel, Joel, additional, Courogen, Maria, additional, Peetermans, Joyce A., additional, Bowen, Mark S., additional, Miller, David, additional, Sullivan, Keith M., additional, Storb, Rainer, additional, Stern, Hal, additional, and Benedek, George B., additional
- Published
- 1995
- Full Text
- View/download PDF
103. Evidence for increased interprotein association as a function of age in the living human lens using quasielastic light scattering
- Author
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Thurston, George M., primary and Hayden, Douglas L., additional
- Published
- 1992
- Full Text
- View/download PDF
104. Identification and Interpretation of Longitudinal Gene Expression Changes in Trauma.
- Author
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Rajicic, Natasa, Cuschieri, Joseph, Finkelstein, Dianne M., Miller-Graziano, Carol L., Hayden, Douglas, Moldawer, Lyle L., Moore, Ernest, O'Keefe, Grant, Pelik, Kimberly, Warren, H. Shaw, and Schoenfeld, David A.
- Subjects
LEUCOCYTES ,GENE expression ,ETIOLOGY of diseases ,RESPIRATORY diseases ,BLUNT trauma ,ONTOLOGY ,ANTIGENS ,WOUNDS & injuries ,BLOOD cells ,KILLER cells - Abstract
Rationale: The relationship between leukocyte gene expression and recovery of respiratory function after injury may provide information on the etiology of multiple organ dysfunction. Objectives: To find a list of genes for which expression after injury predicts respiratory recovery, and to identify which networks and pathways characterize these genes. Methods: Blood was sampled at 12 hours and at 1, 4, 7, 21 and 28 days from 147 patients who had been admitted to the hospital after blunt trauma. Leukocyte gene expression was measured using Affymetrix oligonucleotide arrays. A linear model, fit to each probe-set expression value, was used to impute the gene expression trajectory over the entire follow-up period. The proportional hazards model score test was used to calculate the statistical significance of each probe-set trajectory in predicting respiratory recovery. A list of genes was determined such that the expected proportion of false positive results was less than 10%. These genes were compared to the Gene Ontology for 'response to stimulus' and, using Ingenuity software, were mapped into networks and pathways. Measurements and Main Results: The median time to respiratory recovery was 6 days. There were 170 probe-sets representing 135 genes that were found to be related to respiratory recovery. These genes could be mapped to nine networks. Two known pathways that were activated were antigen processing and presentation and JAK- signaling. Conclusions: The examination of the relationship of gene expression over time with a patient's clinical course can provide information which may be useful in determining the mechanism of recovery or lack of recovery after severe injury. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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- View/download PDF
105. Comparison of the Spo2/Fio2 Ratio and the Pao2/Fio2 Ratio in Patients With Acute Lung Injury or ARDS.
- Author
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Rice, Todd W., Wheeler, Arthur P., Bernard, Gordon R., Hayden, Douglas L., Schoenfeld, David A., and Ware, Lorraine B.
- Subjects
ADULT respiratory distress syndrome ,PULSE oximeters ,MEDICAL equipment ,LUNG injuries ,RESPIRATORY insufficiency - Abstract
The article presents information on a study which examines whether the pulse oximetric saturation (SpO
2 )/FIO 2 (S/F) ratio can be replaced with the PaO2/fraction of inspired oxygen (FIO 2 ) [P/F ratio in assessing the oxygenation criterion of acute lung injury (ALI) or adult respiratory distress syndrome (ARDS). It included patients enrolled in the ARDS Network trial of a lower tidal volume ventilator strategy. - Published
- 2007
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- View/download PDF
106. A Genomic Storm in Critically Injured Humans
- Author
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Mindrinos, Michael N., Seok, Junhee, Cuschieri, Joseph, Cuenca, Alex G., Hayden, Douglas L., Hennessy, Laura, Moore, Ernest E., Minei, Joseph P., Bankey, Paul E., Sperry, Jason, Nathens, Avery B., Billiar, Timothy R., Brownstein, Bernard H., Mason, Philip H., Baker, Henry V., Finnerty, Celeste C., Jeschke, Marc G., López, M. Cecilia, Klein, Matthew B., Gamelli, Richard L., Gibran, Nicole S., Arnoldo, Brett, Xu, Weihong, Zhang, Yuping, Calvano, Steven E., McDonald-Smith, Grace P., Storey, John D., Moldawer, Lyle L., Herndon, David N., Lowry, Stephen F., Maier, Ronald V., Davis, Ronald W., Xiao, Wenzhong, Gao, Hong, Johnson, Jeffrey L., West, Michael A., Schoenfeld, David Alan, Cobb, Joseph Perren, Warren, H. Shaw, and Tompkins, Ronald Gary
- Abstract
Human survival from injury requires an appropriate inflammatory and immune response. We describe the circulating leukocyte transcriptome after severe trauma and burn injury, as well as in healthy subjects receiving low-dose bacterial endotoxin, and show that these severe stresses produce a global reprioritization affecting >80% of the cellular functions and pathways, a truly unexpected "genomic storm." In severe blunt trauma, the early leukocyte genomic response is consistent with simultaneously increased expression of genes involved in the systemic inflammatory, innate immune, and compensatory antiinflammatory responses, as well as in the suppression of genes involved in adaptive immunity. Furthermore, complications like nosocomial infections and organ failure are not associated with any genomic evidence of a second hit and differ only in the magnitude and duration of this genomic reprioritization. The similarities in gene expression patterns between different injuries reveal an apparently fundamental human response to severe inflammatory stress, with genomic signatures that are surprisingly far more common than different. Based on these transcriptional data, we propose a new paradigm for the human immunological response to severe injury.
- Published
- 2011
- Full Text
- View/download PDF
107. Risk, decision frames, and experience: impact and relationships in a military setting
- Author
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Hayden, Douglas C., Thomas, James W., Eoyang, C., Naval Postgraduate School (U.S.), and Administrative Sciences
- Subjects
decision frames ,uncertainty ,decision making ,risk preferences ,Management - Abstract
This research effort was designed to examine Army Officers' preference for risk in a variety of military decision-making environments. A questionnaire was developed to elicite an officer's general preference for risk in three areas of decision; combat, finance, and career settings. This survey was administered to approximately 300 Army Officers representing a broad cross-section of the Army population. It was hypothesized that Army Officers would shift their preference for risk on the basis of the decision frame they faced and that some systematic differences between ranks and other distinguishing demographic variables would be evident. The general results support the conclusion that Army Officers are more risk aggressive in combat decisions than in finance decisions. In addition, there is evidence that there is a tendency for senior officers to be relatively more risk aggressive than junior officers. This indicates that the military promotion and reward system may have a preference for the risk seeker over the risk averse officer. http://archive.org/details/riskdecisionfram1094520322 Captain, United States Army Lieutenant, United States Navy Approved for public release; distribution is unlimited.
- Published
- 1982
108. 1070-103 Effect of aromatase inhibition on lipids and inflammatory markers of cardiovascular disease in elderly hypogonadal men: A double-blind placebo-controlled randomized trial
- Author
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Dougherty, Ryan, Rohrer, Jacqueline L, Hayden, Douglas, and Leder, Benjamin Z
- Published
- 2004
- Full Text
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109. Causality, uncertainty and falsification in clinical research
- Author
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Hayden, Douglas
- Abstract
We address two foundational issues of inductive reasoning and related applications. We first consider the problem of inferring the causal effect of active versus control treatment in randomized clinical trials. We regard the pairwise differences in outcome between active and control subjects as fixed quantities which may or may not be observed depending on treatment allocation. Causal inference consists of observing a sample of pairwise differences in order to estimate the mean of all possible pairwise differences, which constitutes the complete causal effect. However, because this complete effect is unobservable, there is an unavoidable observational uncertainty, which is a fundamental feature of the physical world. We follow with a focus on the problem of falsification of scientific claims based on experimental data. A scientific claim resulting from an experiment is a function of the observed data, which induces a stochastic model on the space of possible claims, and a probability of falsification by a follow-up experiment. The map from the data into the claim space, the structure of the claim space, and the claim falsification probability, provide a mathematical structure for exploring the statistical approach to inductive reasoning. We then turn from foundational issues and causal inference to the weaker question of association in the high-dimensional setting of microarray studies. We propose a permutation test based on the matrix of pairwise distances between individual genomic profiles to test for an association between a binary classifier and gene expression. If the two groups defined by the binary classifier differ in gene expression then the mean between group distance between profiles should exceed the mean within group distance. Finally, we extend the study of association in genomic studies to consider the accuracy of genomic-based prediction of uncomplicated recovery from severe trauma, for which we seek upper bounds. In this case the dimension of the model space precludes an exhaustive model search, so that we bracket this space in the two dimensions of smoothness and complexity. A sequence of models can be thought of as a visualization of the structure of a cross-section of the gene-outcome space.
- Published
- 2012
110. Correspondence.
- Author
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HAGER, DAVID N., KRISHNAN, JERRY A., BROWER, ROY G., and HAYDEN, DOUGLAS L.
- Published
- 2006
111. Letter to the Editor: EFFECT OF RISPERIDONE DOSE ON SERUM PROLACTIN LEVEL
- Author
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Daniels, Gilbert H., Hayden, Douglas L., MA, Goff, Donald C., and Kearns, Ann E.
- Published
- 2001
- Full Text
- View/download PDF
112. Early High-Dose Vitamin D3 for Critically Ill, Vitamin D-Deficient Patients.
- Author
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National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Ginde, Adit A, Brower, Roy G, Caterino, Jeffrey M, Finck, Lani, Banner-Goodspeed, Valerie M, Grissom, Colin K, Hayden, Douglas, Hough, Catherine L, Hyzy, Robert C, Khan, Akram, Levitt, Joseph E, Park, Pauline K, Ringwood, Nancy, Rivers, Emanuel P, Self, Wesley H, Shapiro, Nathan I, Thompson, B Taylor, Yealy, Donald M, and Talmor, Daniel
- Subjects
- *
CATASTROPHIC illness , *CLINICAL trials , *COMPARATIVE studies , *HEALTH status indicators , *LENGTH of stay in hospitals , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *VITAMIN D , *VITAMIN D deficiency , *VITAMINS , *EVALUATION research , *CHOLECALCIFEROL , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *BLIND experiment , *KAPLAN-Meier estimator - Abstract
Background: Vitamin D deficiency is a common, potentially reversible contributor to morbidity and mortality among critically ill patients. The potential benefits of vitamin D supplementation in acute critical illness require further study.Methods: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3 supplementation in critically ill, vitamin D-deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo. The primary end point was 90-day all-cause, all-location mortality.Results: A total of 1360 patients were found to be vitamin D-deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level, <20 ng per milliliter [50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population. The mean day 3 level of 25-hydroxyvitamin D was 46.9±23.2 ng per milliliter (117±58 nmol per liter) in the vitamin D group and 11.4±5.6 ng per milliliter (28±14 nmol per liter) in the placebo group (difference, 35.5 ng per milliliter; 95% confidence interval [CI], 31.5 to 39.6). The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, -2.1 to 7.9; P = 0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points. The severity of vitamin D deficiency at baseline did not affect the association between the treatment assignment and mortality.Conclusions: Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D-deficient patients. (Funded by the National Heart, Lung, and Blood Institute; VIOLET ClinicalTrials.gov number, NCT03096314.). [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
113. Multi-Omic blood analysis reveals differences in innate inflammatory sensitivity between species.
- Author
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Gregory DJ, Han F, Li P, Gritsenko M, Kyle J, Riley FE, Chavez D, Yotova V, Sindeaux RHM, Hawash MBF, Xu F, Hung LY, Hayden DL, Tompkins RG, Lanford RE, Kobzik L, Hellman J, Jacobs JM, Barreiro LB, Xiao W, and Warren HS
- Abstract
Vertebrates differ greatly in responses to pro-inflammatory agonists such as bacterial lipopolysaccharide (LPS), complicating use of animal models to study human sepsis or inflammatory disorders. We compared transcriptomes of resting and LPS-exposed blood from six LPS-sensitive species (rabbit, pig, sheep, cow, chimpanzee, human) and four LPS-resilient species (mice, rats, baboon, rhesus), as well as plasma proteomes and lipidomes. Unexpectedly, at baseline, sensitive species already had enhanced expression of LPS-responsive genes relative to resilient species. After LPS stimulation, maximally different genes in resilient species included genes that detoxify LPS, diminish bacterial growth, discriminate sepsis from SIRS, and play roles in autophagy and apoptosis. The findings reveal the molecular landscape of species differences in inflammation, and may inform better selection of species for pre-clinical models., Competing Interests: Competing interests: Authors declare that they have no competing interests.
- Published
- 2023
- Full Text
- View/download PDF
114. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension.
- Author
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Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, and Self WH
- Subjects
- Humans, Time Factors, Treatment Outcome, Vasoconstrictor Agents administration & dosage, Vasoconstrictor Agents adverse effects, Vasoconstrictor Agents therapeutic use, Fluid Therapy adverse effects, Fluid Therapy methods, Fluid Therapy mortality, Sepsis complications, Sepsis mortality, Sepsis therapy, Hypotension etiology, Hypotension mortality, Hypotension therapy
- Abstract
Background: Intravenous fluids and vasopressor agents are commonly used in early resuscitation of patients with sepsis, but comparative data for prioritizing their delivery are limited., Methods: In an unblinded superiority trial conducted at 60 U.S. centers, we randomly assigned patients to either a restrictive fluid strategy (prioritizing vasopressors and lower intravenous fluid volumes) or a liberal fluid strategy (prioritizing higher volumes of intravenous fluids before vasopressor use) for a 24-hour period. Randomization occurred within 4 hours after a patient met the criteria for sepsis-induced hypotension refractory to initial treatment with 1 to 3 liters of intravenous fluid. We hypothesized that all-cause mortality before discharge home by day 90 (primary outcome) would be lower with a restrictive fluid strategy than with a liberal fluid strategy. Safety was also assessed., Results: A total of 1563 patients were enrolled, with 782 assigned to the restrictive fluid group and 781 to the liberal fluid group. Resuscitation therapies that were administered during the 24-hour protocol period differed between the two groups; less intravenous fluid was administered in the restrictive fluid group than in the liberal fluid group (difference of medians, -2134 ml; 95% confidence interval [CI], -2318 to -1949), whereas the restrictive fluid group had earlier, more prevalent, and longer duration of vasopressor use. Death from any cause before discharge home by day 90 occurred in 109 patients (14.0%) in the restrictive fluid group and in 116 patients (14.9%) in the liberal fluid group (estimated difference, -0.9 percentage points; 95% CI, -4.4 to 2.6; P = 0.61); 5 patients in the restrictive fluid group and 4 patients in the liberal fluid group had their data censored (lost to follow-up). The number of reported serious adverse events was similar in the two groups., Conclusions: Among patients with sepsis-induced hypotension, the restrictive fluid strategy that was used in this trial did not result in significantly lower (or higher) mortality before discharge home by day 90 than the liberal fluid strategy. (Funded by the National Heart, Lung, and Blood Institute; CLOVERS ClinicalTrials.gov number, NCT03434028.)., (Copyright © 2023 Massachusetts Medical Society.)
- Published
- 2023
- Full Text
- View/download PDF
115. Early High-Dose Vitamin D 3 for Critically Ill, Vitamin D-Deficient Patients.
- Author
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Ginde AA, Brower RG, Caterino JM, Finck L, Banner-Goodspeed VM, Grissom CK, Hayden D, Hough CL, Hyzy RC, Khan A, Levitt JE, Park PK, Ringwood N, Rivers EP, Self WH, Shapiro NI, Thompson BT, Yealy DM, and Talmor D
- Subjects
- Adult, Cholecalciferol adverse effects, Critical Illness mortality, Double-Blind Method, Female, Humans, Kaplan-Meier Estimate, Length of Stay, Male, Middle Aged, Organ Dysfunction Scores, Treatment Failure, Vitamin D analogs & derivatives, Vitamin D blood, Vitamins adverse effects, Cholecalciferol administration & dosage, Critical Illness therapy, Vitamin D Deficiency drug therapy, Vitamins administration & dosage
- Abstract
Background: Vitamin D deficiency is a common, potentially reversible contributor to morbidity and mortality among critically ill patients. The potential benefits of vitamin D supplementation in acute critical illness require further study., Methods: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D
3 supplementation in critically ill, vitamin D-deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo. The primary end point was 90-day all-cause, all-location mortality., Results: A total of 1360 patients were found to be vitamin D-deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level, <20 ng per milliliter [50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population. The mean day 3 level of 25-hydroxyvitamin D was 46.9±23.2 ng per milliliter (117±58 nmol per liter) in the vitamin D group and 11.4±5.6 ng per milliliter (28±14 nmol per liter) in the placebo group (difference, 35.5 ng per milliliter; 95% confidence interval [CI], 31.5 to 39.6). The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, -2.1 to 7.9; P = 0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points. The severity of vitamin D deficiency at baseline did not affect the association between the treatment assignment and mortality., Conclusions: Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D-deficient patients. (Funded by the National Heart, Lung, and Blood Institute; VIOLET ClinicalTrials.gov number, NCT03096314.)., (Copyright © 2019 Massachusetts Medical Society.)- Published
- 2019
- Full Text
- View/download PDF
116. Seeded-Growth of Silica Rods from Silica-Coated Particles.
- Author
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Hayden DR, Kennedy CL, Velikov KP, van Blaaderen A, and Imhof A
- Abstract
Seeded growth of silica rods from colloidal particles has emerged as a facile method to develop novel complex particle structures with hybrid compositions and asymmetrical shapes. However, this seeded-growth technique has been so far limited to colloidal particles of only a few materials. Here, we first develop a general synthesis for the seeded-growth of silica rods from silica particles. We then demonstrate the growth of silica rods from silica-coated particles with three different cores which highlight the generality of this synthesis: fluorescently labeled organo-silica (fluorescein), metallic (Ag), and organic (PS latex). We also demonstrate the assembly of these particles into supraparticles. This general synthesis method can be extended to the growth of silica rods from any colloidal particle which can be coated with silica.
- Published
- 2019
- Full Text
- View/download PDF
117. Analysis of factorial time-course microarrays with application to a clinical study of burn injury.
- Author
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Zhou B, Xu W, Herndon D, Tompkins R, Davis R, Xiao W, Wong WH, Toner M, Warren HS, Schoenfeld DA, Rahme L, McDonald-Smith GP, Hayden D, Mason P, Fagan S, Yu YM, Cobb JP, Remick DG, Mannick JA, Lederer JA, Gamelli RL, Silver GM, West MA, Shapiro MB, Smith R, Camp DG 2nd, Qian W, Storey J, Mindrinos M, Tibshirani R, Lowry S, Calvano S, Chaudry I, West MA, Cohen M, Moore EE, Johnson J, Moldawer LL, Baker HV, Efron PA, Balis UG, Billiar TR, Ochoa JB, Sperry JL, Miller-Graziano CL, De AK, Bankey PE, Finnerty CC, Jeschke MG, Minei JP, Arnoldo BD, Hunt JL, Horton J, Cobb JP, Brownstein B, Freeman B, Maier RV, Nathens AB, Cuschieri J, Gibran N, Klein M, and O'Keefe G
- Subjects
- Adult, Age Factors, Analysis of Variance, Burns immunology, Child, Child, Preschool, Cross-Sectional Studies, Data Interpretation, Statistical, Databases, Genetic, Female, Gene Expression Profiling statistics & numerical data, Genes, Immunoglobulin, Genes, Mitochondrial, Humans, Infant, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Prognosis, Software, Time Factors, Burns genetics, Oligonucleotide Array Sequence Analysis statistics & numerical data
- Abstract
Time-course microarray experiments are capable of capturing dynamic gene expression profiles. It is important to study how these dynamic profiles depend on the multiple factors that characterize the experimental condition under which the time course is observed. Analytic methods are needed to simultaneously handle the time course and factorial structure in the data. We developed a method to evaluate factor effects by pooling information across the time course while accounting for multiple testing and nonnormality of the microarray data. The method effectively extracts gene-specific response features and models their dependency on the experimental factors. Both longitudinal and cross-sectional time-course data can be handled by our approach. The method was used to analyze the impact of age on the temporal gene response to burn injury in a large-scale clinical study. Our analysis reveals that 21% of the genes responsive to burn are age-specific, among which expressions of mitochondria and immunoglobulin genes are differentially perturbed in pediatric and adult patients by burn injury. These new findings in the body's response to burn injury between children and adults support further investigations of therapeutic options targeting specific age groups. The methodology proposed here has been implemented in R package "TANOVA" and submitted to the Comprehensive R Archive Network at http://www.r-project.org/. It is also available for download at http://gluegrant1.stanford.edu/TANOVA/.
- Published
- 2010
- Full Text
- View/download PDF
118. Analysis of factors that modify susceptibility and rate of progression in amyotrophic lateral sclerosis (ALS).
- Author
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Qureshi MM, Hayden D, Urbinelli L, Ferrante K, Newhall K, Myers D, Hilgenberg S, Smart R, Brown RH, and Cudkowicz ME
- Subjects
- Adult, Aged, Amyotrophic Lateral Sclerosis diagnosis, Amyotrophic Lateral Sclerosis pathology, Case-Control Studies, Cohort Studies, Disability Evaluation, Disease Progression, Female, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Amyotrophic Lateral Sclerosis epidemiology, Amyotrophic Lateral Sclerosis physiopathology
- Abstract
We conducted case-control and prospective longitudinal studies to examine risk factors and predictors of disease progression for ALS. Ninety-five subjects with ALS and 106 healthy control subjects were enrolled. All subjects completed a risk factor questionnaire at enrollment. The ALS subjects were prospectively followed for one year to define factors that influence the rate of disease progression, measured by rate of change in percent predicted forced vital capacity (%FVC) and the ALS functional rating scale (ALSFRS) score. The association of each potential risk factor with ALS was determined using univariate logistic regression. A random slope model was used to determine the association of each risk factor with disease progression. The demographic characteristics of ALS subjects and controls at enrollment did not differ. Significant risk factors for ALS included reported exposure to lead (p = 0.02) and pesticides (p = 0.03). Disease progression was faster in the ALS subjects having bulbar onset and a shorter time period between onset of symptoms and diagnosis. Pertinent variables not associated with either causation or progression of ALS included physical activity, cigarette smoking and a history of physical trauma or other clinical disorders.
- Published
- 2006
- Full Text
- View/download PDF
119. Comparison of two fluid-management strategies in acute lung injury.
- Author
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Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, and Harabin AL
- Subjects
- Blood Pressure, Diuretics therapeutic use, Ethnicity, Female, Fluid Therapy adverse effects, Furosemide therapeutic use, Hemodynamics, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Respiration, Artificial statistics & numerical data, Respiratory Distress Syndrome mortality, Respiratory Distress Syndrome physiopathology, Respiratory Function Tests, Survival Analysis, Treatment Outcome, Water-Electrolyte Balance, Fluid Therapy methods, Respiratory Distress Syndrome therapy
- Abstract
Background: Optimal fluid management in patients with acute lung injury is unknown. Diuresis or fluid restriction may improve lung function but could jeopardize extrapulmonary-organ perfusion., Methods: In a randomized study, we compared a conservative and a liberal strategy of fluid management using explicit protocols applied for seven days in 1000 patients with acute lung injury. The primary end point was death at 60 days. Secondary end points included the number of ventilator-free days and organ-failure-free days and measures of lung physiology., Results: The rate of death at 60 days was 25.5 percent in the conservative-strategy group and 28.4 percent in the liberal-strategy group (P=0.30; 95 percent confidence interval for the difference, -2.6 to 8.4 percent). The mean (+/-SE) cumulative fluid balance during the first seven days was -136+/-491 ml in the conservative-strategy group and 6992+/-502 ml in the liberal-strategy group (P<0.001). As compared with the liberal strategy, the conservative strategy improved the oxygenation index ([mean airway pressure x the ratio of the fraction of inspired oxygen to the partial pressure of arterial oxygen]x100) and the lung injury score and increased the number of ventilator-free days (14.6+/-0.5 vs. 12.1+/-0.5, P<0.001) and days not spent in the intensive care unit (13.4+/-0.4 vs. 11.2+/-0.4, P<0.001) during the first 28 days but did not increase the incidence or prevalence of shock during the study or the use of dialysis during the first 60 days (10 percent vs. 14 percent, P=0.06)., Conclusions: Although there was no significant difference in the primary outcome of 60-day mortality, the conservative strategy of fluid management improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures. These results support the use of a conservative strategy of fluid management in patients with acute lung injury. (ClinicalTrials.gov number, NCT00281268 [ClinicalTrials.gov].)., (Copyright 2006 Massachusetts Medical Society.)
- Published
- 2006
- Full Text
- View/download PDF
120. Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure.
- Author
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Brower RG, Morris A, MacIntyre N, Matthay MA, Hayden D, Thompson T, Clemmer T, Lanken PN, and Schoenfeld D
- Subjects
- Blood Pressure, Cross-Over Studies, Female, Heart Rate, Humans, Male, Middle Aged, Respiratory Distress Syndrome etiology, Tidal Volume, Positive-Pressure Respiration methods, Respiratory Distress Syndrome therapy
- Abstract
Objective: Positive end-expiratory pressure (PEEP) and recruitment maneuvers (RMs) may partially reverse atelectasis and reduce ventilation-associated lung injury. The purposes of this study were to assess a) magnitude and duration of RM effects on arterial oxygenation and on requirements for oxygenation support (Fio2/PEEP) in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) receiving ventilation with low tidal volumes and high levels of PEEP; and b) frequency of adverse respiratory and circulatory events attributable to RMs., Design: Prospective, randomized, crossover study., Setting: Thirty-four intensive care units at 19 hospitals., Patients: Seventy-two patients with early ALI/ARDS. Baseline PEEP and Fio2 were 13.8 +/- 3.0 cm H2O and 0.39 +/- 0.10, respectively (mean +/- sd)., Interventions: We conducted RMs by applying continuous positive airway pressure of 35-40 cm H2O for 30 secs. We conducted sham RMs on alternate days. We monitored oxyhemoglobin saturation by pulse oximetry (SpO2), Fio2/PEEP, blood pressure, and heart rate for 8 hrs after RMs and sham RMs. We examined chest radiographs for barotrauma., Measurements and Main Results: Responses to RMs were variable. Greatest increments from baseline SpO2 within 10 mins after RMs were larger than after sham RMs (1.7 +/- 0.2 vs. 0.6 +/- 0.3 %, mean +/- SEM, p < .01). Systolic blood pressure decreased more +/- 1.1 mm Hg, p < .01). Changes in Fio2/PEEP requirements were not significantly different at any time after RMs vs. sham RMs. Barotrauma was apparent on first radiographs after one RM and one sham RM., Conclusions: In ALI/ARDS patients receiving mechanical ventilation with low tidal volumes and high PEEP, short-term effects of RMs as conducted in this study are variable. Beneficial effects on gas exchange in responders appear to be of brief duration. More information is needed to determine the role of recruitment maneuvers in the management of ALI/ARDS.
- Published
- 2003
- Full Text
- View/download PDF
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