Response of the Salt Gland of the Insectivorous Lizard Novoeumeces schneideri to Ionic and Osmotic Challenges

The reptilian kidney can only produce isoosmotic waste. To supplement renal ion excretion and maintain ionic and osmoregulation, some reptile species rely on extrarenal salt glands that can secrete a hyperosmotic solution. Extrarenal glands among reptile taxa include the cranial gland in lizards, lacrimal gland of marine turtles, and sublingual gland of the estuarine crocodile and sea snakes. Secretion composition varies among these taxa, depending on diet, osmotic load and phylogeny. The salt glands of lizards are unique among reptiles in their ability to vary composition of the secreted fluid, secreting cations (potassium and/or sodium) and anions (chloride and/or bicarbonate). Composition of the secreted fluid depends on the ion load incurred: marine and intertidal lizards secrete primarily sodium chloride, while herbivorous lizards secrete mainly potassium chloride. Most studies on lizard salt glands have been performed on herbivorous and marine species that have high ion loads from their diet. Many insectivorous species also possess salt glands, but their function and contribution to ion regulation have been minimally studied. Compared to marine or desert lizards, the ionic load incurred from the habitat and diet is decreased in insectivorous, arid-adapted lizards. The gland of these species, however, may still be important in maintaining ionic and osmotic balance. My goal in this study was to examine initiation of gland secretion, secretion composition and range, and the importance of the salt gland in ion regulation of an arid-adapted, insectivorous species. To evaluate these questions, I examined the response of Novoeumeces schneideri s (Scincidae) salt gland to ionic and osmotic loads. Novoeumeces schneideri subjects were treated to different combinations of cations (sodium, potassium, and histidine control) and anions (chloride and acetate control) and salt gland secretions were examined. Lizards were injected with ion solutions (sodium chloride, potassium chloride, histidine chloride, sodium acetate, potassium acetate, histidine acetate) or controls (saline and sham injected) daily for 4 days. Secreted salt, feces and urine were collected daily and analyzed for sodium, potassium, and chloride. Daily and total cation and anion secretion rates were calculated, as well as ion secretion budgets among the salt gland, feces, and urate. The salt glands of N. schneideri secreted only in response to chloride, regardless of the accompanying cation. Higher secretion rates were seen when histidine or potassium were accompanied with chloride. Both cations and anions were secreted in narrow ranges among all treatments, indicating limited secretion flexibility. Sodium- treated skinks showed a decreased secretion rate, suggesting a possible inhibitory role of sodium. Secretion composition contained a relatively constant mixture of potassium and sodium, regardless of the cation load. The response of this insectivorous species differs from herbivorous and marine lizard species. Considerable plasticity in the physiology of the salt gland exists across lizard taxa, depending on physiologic needs, indicating ecologic effects on the evolutionary physiology of vertebrates

Impact of the relationship primary caregivers help in the quality of life of patients with advanced cancer.

Introducción: Este estudio evaluó el impacto de la figura del cuidador primario en la calidad de vida (CV) de pacientes con cáncer avanzado. Método: El diseño de investigación es exploratorio descriptivo-correlacional y el muestreo no probabilístico por conveniencia con un error de estimación no superior al 5%. La muestra estuvo compuesta por 34 pacientes diagnosticados con cáncer avanzado y sus respectivos cuidadores primarios, todos ellos pertenecientes a una unidad hospitalaria especializada en tratamientos paliativos. Se administraron los instrumentos FACT-G, SF-36 y la escala de sobrecarga del cuidador de Zarit. Resultados: Los resultados indican que la CV global de los pacientes oncológicos es percibida negativamente, lo que sugiere que los problemas de salud física y emocional deterioran el funcionamiento físico cotidiano y las actividades sociales del mismo. Por su parte, los cuidadores valoran positivamente su CV; no obstante aquellos que proveen de cuidados a pacientes en estadios de funcionalidad más avanzados de la enfermedad presentan un leve grado de sobrecarga en las áreas física, social, psíquica y económica de su vida. Asimismo, se concluyó que la CV del paciente, en la dimensión estado funcional, se ve afectada positivamente por las dimensiones función social, bienestar y vitalidad del cuidador. Conclusiones: Se constata que, efectivamente, el nivel de deterioro en las dimensiones física y funcional del paciente influye en la percepción que éstos tienen de su CV, así como también que los cuidadores de pacientes en estadios más críticos de la enfermedad se ven sobrecargados, probablemente, debido al rol más activo que deben asumir.Introduction: This study evaluated the impact of the primary caregiver on the quality of life (QL) of patients with advanced cancer. Method: The research design is exploratory descriptive-correlational with non-probabilistic sampling for convenience with error not exceeding 5%. The sample was composed of 34 patients diagnosed with advanced cancer and their respective primary caregivers, all of whom from a hospital unit specialized in palliative treatment. The instruments FACT-G, SF-36 and Zarit’s caregiver overload scale were used. Results: The results show that the overall QL of cancer patients is perceived negatively, which suggests that physical and emotional health problems deteriorate the patient’s daily physical and social activities. With regard to caregivers, these rate their own QL positively; however those who provide care to patients with a more advanced state of cancer present a slight amount of overload in the physical, social, psychological and economic aspects of their lives. As such, the study concluded that the patient’s functional state dimension is positively affected by the caregivers’s social functions, welfare and vitality. Conclusions: it can be observed that indeed, the level of deterioration in the functional and physical dimensions of the patient has an influence on the perception that they have of their QL, in addition to caregivers of patients in the more critical stages of the illness regarding themselves as overloaded, probably due to the more active role that they have to take on

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care-a Randomized Trial

BACKGROUND: Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. OBJECTIVE: Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. DESIGN: This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic ( \u3e 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. PARTICIPANTS: Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. INTERVENTIONS: Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. MAIN MEASURES: Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. KEY RESULTS: 37.5% of individual arm and 30.3% in group had \u3e 30% improvement in pain interference (d = 7.2%, 95% CI - 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI - 4.2%, 11.4%). CONCLUSIONS: Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. TRIAL REGISTRATION: Clinicaltrials.gov # NCT02456727

Impacto de la relación de ayuda de cuidadores primarios en la calidad de vida de pacientes con cáncer avanzado

Introducción: Este estudio evaluó el impacto de la figura del cuidador primario en la calidad de vida (CV) de pacientes con cáncer avanzado. Método: El diseño de investigación es exploratorio descriptivo-correlacional y el muestreo no probabilístico por conveniencia con un error de estimación no superior al 5%. La muestra estuvo compuesta por 34 pacientes diagnosticados con cáncer avanzado y sus respectivos cuidadores primarios, todos ellos pertenecientes a una unidad hospitalaria especializada en tratamientos paliativos. Se administraron los instrumentos FACT-G, SF-36 y la escala de sobrecarga del cuidador de Zarit. Resultados: Los resultados indican que la CV global de los pacientes oncológicos es percibida negativamente, lo que sugiere que los problemas de salud física y emocional deterioran el funcionamiento físico cotidiano y las actividades sociales del mismo. Por su parte, los cuidadores valoran positivamente su CV; no obstante aquellos que proveen de cuidados a pacientes en estadios de funcionalidad más avanzados de la enfermedad presentan un leve grado de sobrecarga en las áreas física, social, psíquica y económica de su vida. Asimismo, se concluyó que la CV del paciente, en la dimensión estado funcional, se ve afectada positivamente por las dimensiones función social, bienestar y vitalidad del cuidador. Conclusiones: Se constata que, efectivamente, el nivel de deterioro en las dimensiones física y funcional del paciente influye en la percepción que éstos tienen de su CV, así como también que los cuidadores de pacientes en estadios más críticos de la enfermedad se ven sobrecargados, probablemente, debido al rol más activo que deben asumir

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Secretion By the Nasal Salt Glands of Two Insectivorous Lizard Species Is Initiated By an Ecologically Relevant Dietary Ion, Chloride

Salt glands are used by some vertebrates to excrete hyperosmotic NaCl or KCl solutions in response to dietary salt loads. Control of secretion varies across taxa; some secrete in response to osmotic challenges while others secrete in response to specific dietary ions. We hypothesized that differences in control could be related to different diet-related selective pressures on herbivorous, marine, and insectivorous species. We studied control of secretion and flexibility of cation (sodium or potassium) and anion (chloride or bicarbonate) secretion in two insectivorous lizard species, Schneider\u27s skinks (Eumeces schneideri, Scincidae) and green anoles (Anolis carolinensis, Polychrotidae). Lizards were injected daily for four days with combinations of cations (potassium, sodium, and histidine control) and anions (chloride and acetate control), isoosmotic saline, or sham injection. Secretions were collected daily and analyzed for sodium, potassium, and chloride. Both species secreted only in response to chloride; sodium appeared to have a slight inhibitory effect. Regardless of cation load, skinks secreted a combination of potassium and sodium, while anoles secreted solely potassium. In both species, total cation secretion was matched closely by chloride; very little bicarbonate was secreted. As predicted, secretion in insectivorous lizards was initiated by the dietary ion ecologically most important for these species, chloride, which otherwise cannot be excreted without significant water loss (unlike the cations, which may be excreted as insoluble urate salts). This gives further support to the hypothesis that ecological factors drive the evolution of control mechanisms in lizard salt glands