Sex, But Not Spontaneous Cardiovagal Baroreflex Sensitivity, Predicts Tolerance To Simulated Hemorrhage

Some, but not all studies, suggest that spontaneous cardiovagal baroreflex sensitivity (cBRS; i.e., autonomic control of heart rate) is lower in females. However, it is unknown whether cBRS values are associated with hemorrhagic tolerance, which has repeatedly been demonstrated to be lower in females. PURPOSE: Therefore, the purpose of this study was to test the hypothesis that resting spontaneous cBRS is lower in females and that cBRS is associated with differences in hemorrhagic tolerance between the sexes. METHODS: 25 females (age: 26 ± 6 years) and 27 males (age: 30 ± 5 years) completed a progressive lower-body negative pressure (LBNP – a simulation of hemorrhage) protocol starting at -40 mmHg, which was reduced by 10 mmHg every 3 minutes until presyncope. Presyncope was defined by the subject feeling faint and/or nauseous; a rapid decline in blood pressure (BP) \u3c systolic BP of 80 mmHg; and/or a relative bradycardia accompanied by narrowing of pulse pressure. LBNP tolerance was quantified as cumulative stress index (CSI; mmHg*min). Heart rate (HR) and beat-to-beat BP (finometer) were measured continuously. Spontaneous cBRS was analyzed using the sequence method (i.e., ≥ 3 consecutive cardiac cycles of concordant changes in R-R interval and systolic BP, r2 ≥ 0.8 for such sequences). Data were compared between sexes using a Mann-Whitney U test. A least squares multiple linear regression was used to compare the effect of sex and cBRS on CSI. Data are presented as median ± IQR. RESULTS: Resting BP and HR were not different between the sexes (p \u3e 0.36 for both). Resting cBRS was not different between females and males (21 ± 16 vs. 22 ± 11 ms/mmHg, respectively, p = 0.73). As expected, females had a lower tolerance to LBNP (Females: 385 ± 322, Males: 918 ± 418 mmHg*min, p \u3c 0.0001). Multiple linear regression analysis revealed a significant effect of sex (β = 408, p= 0.04), but not resting cBRS (β = 2.4, p = 0.69) or sex*cBRS (i.e., interaction; β = 1.32, p = 0.87), on CSI. When data from both sexes were combined, there was no correlation between resting cBRS and CSI (r = 0.05, p = 0.71). CONCLUSION: Our cohort did not exhibit sex-related differences in resting cBRS. As expected, females had a lower tolerance to simulated hemorrhage. Importantly, we demonstrated that resting cBRS does not explain the observed sex differences in hemorrhagic tolerance

Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community

Introduction: A project in a Texas border community setting, Prevention Organized against Diabetes and Dialysis with Education and Resources (POD2ER), offered diabetes prevention information, screening, and medical referrals. The setting was a large, longstanding flea market that functions as a shopping mall for low-income people. The priority population included medically underserved urban and rural Mexican Americans. Components of the program addressed those with diabetes, prediabetes, and accompanying relatives and friends. Background: People living in the Lower Rio Grande Valley (LRGV) face challenges of high rates of type 2 diabetes, lack of knowledge about prevention, and inadequate access to medical care. Recent statistics from actual community-wide screenings indicate a high diabetes prevalence, 30.7% among adults in the LRGV compared with 12.3% nationwide. Methods: A diverse team composed of public health faculty, students, a physician, a community health worker, and community volunteers conceived and developed the project with a focus on cultural and economic congruence and a user-friendly atmosphere. The program provided screening for prediabetes and diabetes with a hemoglobin A1c test. Screening was offered to those who were at least 25 years of age and not pregnant. When results indicated diabetes, a test for kidney damage was offered (urinary albumin-to-creatinine ratio). A medical appointment at a community clinic within a week was provided to those who tested positive for diabetes and lacked a medical home. Health education modules addressed all family members. Discussion: The project was successful in recruiting 2,332 high-risk people in 26 months in a community setting, providing clinic referrals to those without a doctor, introducing them to treatment, and providing diabetes prevention information to all project participants. Implications for research and practice are highlighted. Conclusion: This study shows that a regular access point in a place frequented by large numbers of medically marginalized people in a program designed to eliminate cultural and economic barriers can succeed in providing a hard-to-reach community with diabetes prevention services. Aspects of this program can serve as a model for other service provision for similar populations and settings

Rubbing behavior of European brown bears: factors affecting rub tree selectivity and density

Scent-mediated communication is considered the principal communication channel in many mammal species. Compared with visual and vocal communication, odors persist for a longer time, enabling individuals to interact without being in the same place at the same time. The brown bear (Ursus arctos), like other mammals, carries out chemical communication, for example, by means of scents deposited on marking (or rub) trees. In this study, we assessed rub tree selectivity of the brown bear in the predominantly deciduous forests of the Cantabrian Mountains (NW Spain). We first compared the characteristics of 101 brown bear rub trees with 263 control trees. We then analyzed the potential factors affecting the density of rub trees along 35 survey routes along footpaths. We hypothesized that: (1) bears would select particular trees, or tree species, with characteristics that make them more conspicuous; and (2) that bears would select trees located in areas with the highest presence of conspecifics, depending on the population density or the position of the trees within the species’ range. We used linear models and generalized additive models to test these hypotheses. Our results showed that brown bears generally selected more conspicuous trees with a preference for birches (Betula spp.). This choice may facilitate the marking and/ or detection of chemical signals and, therefore, the effectiveness of intraspecific communication. Conversely, the abundance of rub trees along footpaths did not seem to depend on the density of bear observations or their relative position within the population center or its border. Our results suggest that Cantabrian brown bears select trees based on their individual characteristics and their location, with no influence of characteristics of the bear population itself. Our findings can be used to locate target trees that could help in population monitoring

A waitlist-controlled trial of group cognitive behavioural therapy for depression and anxiety in Parkinson’s disease

Background: The aim of this study was to evaluate the efficacy of a group Cognitive Behavioural Therapy (CBT) treatment for depression and anxiety in Parkinson’s disease (PD). Methods: A waitlist-controlled trial design was used. Eighteen adults with PD and a comorbid DSM-IV-TR diagnosis of depression and/or anxiety were randomised to either Intervention (8-week group CBT treatment) or Waitlist (8-week clinical monitoring preceding treatment). The Depression, Anxiety, Stress Scale-21 (DASS-21) was the primary outcome. Assessments were completed at Time 1 (pretreatment), Time 2 (posttreatment/post-waitlist) and 1-month and 6-month follow-ups. Results: At Time 2, participants who received CBT reported greater reductions in depression (Mchange = -2.45) than Waitlist participants (Mchange = .29) and this effect was large, d = 1.12, p = .011. Large secondary effects on anxiety were also observed for CBT participants, d = .89, p = .025. All treatment gains were maintained and continued to improve during the follow-up period. At 6-month follow-up, significant and large effects were observed for both depression (d = 2.07) and anxiety (d = 2.26). Conclusions: Group CBT appears to be an efficacious treatment approach for depression and anxiety in PD however further controlled trials with larger numbers of participants are required

Update of Bisphosphonate Flight Experiment

Elevated bone resorption is a hallmark of human spaceflight and bed rest indicating that elevated remodeling is a major factor in the etiology of space flight bone loss. In a collaborative effort between the NASA and JAXA space agencies, we are testing whether an antiresorptive drug would provide additional benefit to in-flight exercise to ameliorate bone loss and hypercalciuria during long-duration spaceflight. Measurements of bone loss include DXA, QCT, pQCT, urinary and blood biomarkers. We have completed analysis of R+1year data from 7 crewmembers treated with alendronate during flight, as well as immediate post flight (R+<2wks) data from 6 of 10 concurrent controls without treatment. The treated astronauts used the Advanced Resistive Exercise Device (ARED) during their missions. The purpose of this report is twofold: 1) to report the results of inflight, post flight and one year post flight bone measures compared with available controls with and without the use of ARED; and 2) to discuss preliminary data on concurrent controls. The figure below compares the BMD changes in ISS crewmembers exercising with and without the current ARED protocol and the alendronate treated crewmembers also using the ARED. This shows that the use of ARED prevents about half the bone loss seen in early ISS crewmembers and that the addition of an antiresorptive provides additional benefit. Resorption markers and urinary Ca excretion are not impacted by exercise alone but are significantly reduced with antiresorptive treatment. Bone measures for treated subjects, 1 year after return from space remain at or near baseline. DXA data for the 6 concurrent controls using the ARED device are similar to DXA data shown in the figure below. QCT data for these six indicate that the integral data are consistent with the DXA data, i.e., comparing the two control groups suggests significant but incomplete improvement in maintaining BMD using the ARED protocol. Biochemical data of the concurrent control group await sample return and analysis. The preliminary conclusion is that an antiresorptive may be an effective adjunct to exercise during long-duration spaceflight

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]