INTERMITTENT VERSUS CONTINUOUS HYPOXIA: IMPACT ON HEMODYNAMIC VARIABLES AND GENE EXPRESSION

The physiologic response to hypoxia may be determined by variables such as exposure pattern and inducible nitric oxide synthase (iNOS) expression. Blood pressure (BP) and heart rate (HR) responses to daily exposure (X 3 days) of intermittent hypoxia (IH) vs. continuous hypoxia (CH) (equivalent total exposure time) were compared. The relation between BP and HR responses and iNOS expression under IH and CH conditions was also examined. On 3 consecutive days, 10 normal males had six 10-min. hypoxic exposures (oxyhemoglobin saturation, SpO2: 80-90%), with each exposure separated by 10 min. of normoxia. Subjects also had 3 consecutive days of CH (60 min/day; SpO2: 80-90%). IH and CH exposure blocks were separated by a greater than 7 days. BP, HR, and SpO2 were recorded during the 5 min. prior to and the last 5 min. of each daily IH and CH exposure. Venous blood for iNOS mRNA was obtained before exposure on day 1, and 2 hrs. after the last exposure on day 3. HR, systolic and diastolic BP were significantly (p less than 0.05) increased from baseline- to end-exposure on each day, regardless of IH or CH. There was a significant negative correlation (p less than 0.01) between both diastolic and mean BP with iNOS at the end of the day 3 IH session. Hypoxic stress reflected by IH and CH is associated with significant, but comparable changes in BP. Negative correlation between BP and iNOS mRNA in conjunction with IH, but not CH, exposure suggests that the hemodynamic response to IH may be modulated by iNOS

Suicidality and gambling among young adults in Great Britain: results from a cross-sectional online survey

Background Suicide rates in young people have increased in England and Wales since 2010. There are a range of possible explanations for this increase, and problem gambling has been suggested as a potential risk factor. We aimed to examine the association between suicidality (suicidal thoughts and suicide attempts) and problem gambling specifically for young adults in Great Britain, where gambling has become more widely available and normalised in the past two decades. Methods We analysed data from the Emerging Adults Gambling Survey: a cross-sectional, online, non-probability sample survey of young adults aged 16–24 years living in Great Britain, who were selected from a YouGov online panel. Participants were eligible if they had not taken part in any other YouGov survey on gambling in the past year. We examined associations between problem gambling (defined as a score of 8 or higher on the Problem Gambling Severity Index [PGSI]) and suicidal thoughts and suicide attempts in the year before survey completion in a series of regression models, with and without adjustment for sociodemographic factors, alcohol use, video gaming, anxiety, loneliness, and impulsivity. Findings 3549 eligible participants completed the survey between June 25 and Aug 16, 2019. 24 (37·0% [95% CI 25·6–50·2]) of 62 men who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 38 (3·6% [2·6–5·0]) of 1077 men who had not attempted suicide or had suicidal thoughts in the past year. 13 (14·5% [8·5–23·6]) of 85 women who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 25 (2·0% [1·4–3·0]) of 1184 women who had not attempted suicide or had suicidal thoughts in the past year. The adjusted odds ratio for attempted suicide was 9·0 (4·1–19·7) in men with scores that indicated problem gambling and 4·9 (2·0–12·0) in women with scores that indicated problem gambling, compared with participants of the same gender with PGSI scores of 0. Interpretation Problem gambling appears to be associated with suicide attempts in both young men and young women. This association persisted after adjusting for anxiety, impulsivity, life satisfaction, and other factors, which suggests that other mechanisms, such as the severity and multiplicity of harms experienced, or gambling to cope with life stressors, might underpin this relationship. Young people with problem-gambling behaviours should be considered at risk for suicidality

Arterial Compliance and Vascular Function in Patients with Obstructive Sleep Apnea

Lecture presentations hosted by the College of Nursing featuring faculty, graduate students, nursing professionals, and allied health experts. Each lunchtime lecture is devoted to a timely topic examining the training, research and scholarly needs of the nursing community.Lecture

Tales from the Hypoxic Side High Altitude Scientific Adventures in the Himalaya

Lecture presentations hosted by the College of Nursing featuring faculty, graduate students, nursing professionals, and allied health experts. Each lunchtime lecture is devoted to a timely topic examining the training, research and scholarly needs of the nursing community.Lectures; Himalaya

Heights and haematology: the story of haemoglobin at altitude

In order to compensate for the low partial pressure of oxygen at altitude, the human body undergoes a number of physiological changes. A vital component in this process is the increase in the concentration of circulating haemoglobin. The role of HIF‐1α, erythropoietin and red blood cells in this acclimatisation process is described, together with the fall in plasma volume that increases the concentration of haemoglobin in the early stages of hypoxic exposure

A review of the literature on the accuracy, strengths, and limitations of visual, thoracic impedance, and electrocardiographic methods used to measure respiratory rate in hospitalized patients.

BackgroundRespiratory rate (RR) is one of the most important indicators of a patient's health. In critically ill patients, unrecognized changes in RR are associated with poorer outcomes. Visual assessment (VA), impedance pneumography (IP), and electrocardiographic-derived respiration (EDR) are the three most commonly used methods to assess RR. While VA and IP are widely used in hospitals, the EDR method has not been validated for use in hospitalized patients. Additionally, little is known about their accuracy compared with one another. The purpose of this systematic review was to compare the accuracy, strengths, and limitations of VA of RR to two methods that use physiologic data, namely IP and EDR.MethodsA systematic review of the literature was undertaken using prespecified inclusion and exclusion criteria. Each of the studies was evaluated using standardized criteria.ResultsFull manuscripts for 23 studies were reviewed, and four studies were included in this review. Three studies compared VA to IP and one study compared VA to EDR. In terms of accuracy, when Bland-Altman analyses were performed, the upper and lower levels of agreement were extremely poor for both the VA and IP and VA and EDR comparisons.ConclusionGiven the paucity of research and the fact that no studies have compared all three methods, no definitive conclusions can be drawn about the accuracy of these three methods. The clinical importance of accurate assessment of RR warrants new research with rigorous designs to determine the accuracy, and clinically meaningful levels of agreement of these methods

A review of the literature on the accuracy, strengths, and limitations of visual, thoracic impedance, and electrocardiographic methods used to measure respiratory rate in hospitalized patients.

BackgroundRespiratory rate (RR) is one of the most important indicators of a patient's health. In critically ill patients, unrecognized changes in RR are associated with poorer outcomes. Visual assessment (VA), impedance pneumography (IP), and electrocardiographic-derived respiration (EDR) are the three most commonly used methods to assess RR. While VA and IP are widely used in hospitals, the EDR method has not been validated for use in hospitalized patients. Additionally, little is known about their accuracy compared with one another. The purpose of this systematic review was to compare the accuracy, strengths, and limitations of VA of RR to two methods that use physiologic data, namely IP and EDR.MethodsA systematic review of the literature was undertaken using prespecified inclusion and exclusion criteria. Each of the studies was evaluated using standardized criteria.ResultsFull manuscripts for 23 studies were reviewed, and four studies were included in this review. Three studies compared VA to IP and one study compared VA to EDR. In terms of accuracy, when Bland-Altman analyses were performed, the upper and lower levels of agreement were extremely poor for both the VA and IP and VA and EDR comparisons.ConclusionGiven the paucity of research and the fact that no studies have compared all three methods, no definitive conclusions can be drawn about the accuracy of these three methods. The clinical importance of accurate assessment of RR warrants new research with rigorous designs to determine the accuracy, and clinically meaningful levels of agreement of these methods