A perpetual switching system in pulmonary capillaries

Of the 300 billion capillaries in the human lung, a small fraction meet normal oxygen requirements at rest, with the remainder forming a large reserve. The maximum oxygen demands of the acute stress response require that the reserve capillaries are rapidly recruited. To remain primed for emergencies, the normal cardiac output must be parceled throughout the capillary bed to maintain low opening pressures. The flow-distributing system requires complex switching. Because the pulmonary microcirculation contains contractile machinery, one hypothesis posits an active switching system. The opposing hypothesis is based on passive switching that requires no regulation. Both hypotheses were tested ex vivo in canine lung lobes. The lobes were perfused first with autologous blood, and capillary switching patterns were recorded by videomicroscopy. Next, the vasculature of the lobes was saline flushed, fixed by glutaraldehyde perfusion, flushed again, and then reperfused with the original, unfixed blood. Flow patterns through the same capillaries were recorded again. The 16-min-long videos were divided into 4-s increments. Each capillary segment was recorded as being perfused if at least one red blood cell crossed the entire segment. Otherwise it was recorded as unperfused. These binary measurements were made manually for each segment during every 4 s throughout the 16-min recordings of the fresh and fixed capillaries (>60,000 measurements). Unexpectedly, the switching patterns did not change after fixation. We conclude that the pulmonary capillaries can remain primed for emergencies without requiring regulation: no detectors, no feedback loops, and no effectors-a rare system in biology. NEW & NOTEWORTHY The fluctuating flow patterns of red blood cells within the pulmonary capillary networks have been assumed to be actively controlled within the pulmonary microcirculation. Here we show that the capillary flow switching patterns in the same network are the same whether the lungs are fresh or fixed. This unexpected observation can be successfully explained by a new model of pulmonary capillary flow based on chaos theory and fractal mathematics

Treatment Burden and Chronic Illness: Who is at Most Risk?

Background: There is a need to ascertain the type and level of treatment burden experienced by people with co-morbidities. This is important to identify the characteristics of participants who are at most risk of treatment burden.  Objective: The aim of this study is to identify the characteristics of participants who are at most risk of treatment burden.  Methods: This cross-sectional study was part of a larger project and recruitment was conducted across four Australian regions: rural, semi-rural and metropolitan. Participants were asked about their treatment burden using an adapted version of a measure, which included the following five dimensions: medication, time and administrative, lifestyle change, social life and financial burden.  Results: In total, 581 participants with various chronic health conditions reported a mean global treatment burden of 56.5 out of 150 (standard deviation = 34.5). Number of chronic conditions (β = .34, p < 0.01), age, (β = −.27, p < 0.01), the presence of an unpaid carer (β = .22, p < 0.001) and the presence of diabetes mellitus and other endocrine conditions (β = .13, p < 0.01) were significant predictors of overall treatment burden. For the five dimensions of treatment burden, social, medicine and administrative burden were predicted by the same cluster of variables: number of conditions, age, presence of an unpaid carer and diabetes. However, in addition to these variables, financial dimensions were also predicted by education level, ethnicity and health insurance. Educational level also influenced lifestyle burden.  Conclusion: A substantial proportion of community-dwelling adults with chronic conditions have considerable levels of treatment burden. Specifically, health professionals should provide greater focus on managing overall treatment burden for persons who are of young age, have an endocrine condition or an unpaid carer, or a combination of these factors

Extension's Dining with Diabetes: Helping People Prevent and Manage Diabetes in Ohio and throughout the Nation

Diabetes is a common, serious and expensive disease in Ohio, the United States and around the world. The complications of untreated or undertreated diabetes are devastating and include heart, kidney, eye and nerve diseases. Studies have shown that when blood glucose is controlled, complications of diabetes are delayed or possibly prevented. Extension's Dining with Diabetes (DWD) program is designed for people with diabetes, their family members and those at risk; and it consists of education, cooking demonstrations, and taste testing. Participants are engaged on the topics of healthy cooking strategies, meal planning, portion control, label reading, physical activity, and goal setting. The program is delivered as a series of four face-to-face sessions with a three-month reunion led by Extension educators partnering with registered nurses, certified diabetes educators or registered dietatians. In addition to Extension offices, local community centers, faith-based organizations, libraries and hospitals are often used as locations in which to offer the program. State and local health departments, clinics, hospitals, pharmacies and community health coalitions are active in marketing the program. DWD has been implemented in Ohio for more than a decade, and is now a national program with more than 38 states participating. Dining with Diabetes has a successful history of being implemented in Ohio and adapted by other states. The national program and evaluation provides the opportunity to demonstrate national impact and how Ohio's efforts compare with other states in terms of improving diabetes outcomes. The national program evaluation includes assessment of knowledge, attitudes and skill gains related to diabetes management. Medium-term outcomes include reported behavior change in the areas of food selection, food preparation, label reading, and physical activity. Participants who reported at three months follow-up demonstrated the ability to maintain or improve dietary change after completing the program.AUTHOR AFFILIATION: Dan Remley, Field Specialist, Food, Nutrition and Wellness, The Ohio State University Extension, [email protected] (Corresponding Author); Shari Gallup, Educator, Family and Consumer Sciences, The Ohio State University Extension; Margaret Jenkins, Educator, Family and Consumer Sciences, The Ohio State University Extension; Tammy Jones, Educator, Family and Consumer Sciences, The Ohio State University Extension; Jenny Lobb, Educator, Family and Consumer Sciences, The Ohio State University Extension; Susan Zies, Educator, Family and Consumer Sciences, The Ohio State University Extension; Marie Economos, Educator, Family and Consumer Sciences, The Ohio State University Extension; Chris Kendle, Educator, Family and Consumer Sciences, The Ohio State University Extension; Chelsea Peckny, Assistant Professor, College of Pharmacy; Joyce Riley, Educator, Family and Consumer Sciences, The Ohio State University Extension; Amy Meehan, Healthy People Program Specialist; Brian Butler, Evaluation Specialist, The Ohio State University Extension; Ingrid Adams, Associate Professor; Lisa Barlage, Educator, Family and Consumer Sciences, The Ohio State University Extension; Candace Heer, Associate Professor; Amanda Bohlen, Educator, Family and Consumer Sciences, The Ohio State University Extension.Diabetes is a common, serious and expensive disease in Ohio, the United States and around the world. The complications of untreated or undertreated diabetes are devastating and include heart, kidney, eye and nerve diseases. Extension's Dining with Diabetes (DWD) program engages participants on the topics of healthy cooking strategies, meal planning, portion control, label reading, physical activity, and goal setting. The program is delivered as a series of four face-to-face sessions with a three-month reunion led by Extension educators partnering with registered nurses, certified diabetes educators or registered dietitians. DWD has a national curricula and evaluation, providing the opportunity to demonstrate national and state-level impact on knowledge, attitudes and skills related to diabetes management