400 research outputs found

    Knowledge Gaps in the Fetal to Neonatal Transition of Infants With a Congenital Diaphragmatic Hernia

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    Clinical research for infants born with a congenital diaphragmatic hernia (CDH) has until recently mainly focused on advances in prenatal and postnatal treatment. However, during the early perinatal transition period there are major physiological adaptations. For most infants these changes will happen uneventfully, but for CDH infants this marks the beginning of serious respiratory complications. In recent years, there is emerging evidence that the clinical management during the perinatal stabilization period in the delivery room may influence postnatal outcomes. Herein, we discuss major knowledge gaps and novel concepts that aim to optimize fetal to neonatal transition for infants with CDH. One such novel and interesting approach is performing resuscitation with an intact umbilical cord, the efficacy of this procedure is currently being investigated in several clinical trials. Furthermore, close evaluation of neonatal physiological parameters in the first 24 h of life might provide early clues concerning the severity of lung hypoplasia and the risk of adverse outcomes. We will provide an overview of trending concepts and discuss potential areas for future research

    Vascular reactivity is altered in the placentas of fetuses with congenital diaphragmatic hernia

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    Introduction: Infants with congenital diaphragmatic hernia (CDH) often develop pulmonary hypertension but frequently fail to respond to vasodilator therapy, for instance because of an altered pulmonary vasoreactivity. Investigating such alterations in vivo is impossible. We hypothesised that these alterations are also present in fetoplacental vessels, since both vasculatures are exposed to the same circulating factors (e.g. endothelin-1) and respond similarly to certain stimuli (e.g. hypoxia). As proof-of-concept, we compared fetoplacental vasoreactivity between healthy and CDH-affected placentas. Methods: Fetoplacental vascular function of healthy and antenatally diagnosed left-sided CDH fetuses was assessed by wire myography. Placental expression of enzymes and receptors involved in the altered vasoreactive pathways was measured using quantitative PCR. Results: CDH arteries (n = 6) constricted more strongly to thromboxane A2 agonist U46619 (p &lt; 0.001) and dilated less to bradykinin (p = 0.01) and nitric oxide (NO)-donor sodium nitroprusside (p = 0.04) than healthy arteries (n = 8). Vasodilation to prostacyclin analogue iloprost and adenylate cyclase stimulator forskolin, and vasoconstriction to endothelin-1 were not different between both groups. Angiotensin II did not induce vasoconstriction. Phosphodiesterase inhibitors sildenafil and milrinone did not affect responses to sodium nitroprusside, forskolin, or U46619. The mRNA expression of guanylate cyclase 1 soluble subunit alpha 1 (p = 0.003) and protein kinase cyclic guanine monophosphate (cGMP)-dependent 1 (p = 0.02) were reduced in CDH versus healthy placentas. Discussion: The identified changes in the thromboxane and NO-cGMP pathways in the fetoplacental vasculature correspond with currently described alterations in the pulmonary vasculature in CDH. Therefore, fetoplacental arteries may provide an opportunity to predict pulmonary therapeutic responses in infants with CDH.</p

    Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions : A randomized controlled trial in the general hospital setting (CC-DIM)

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    The study was undertaken to establish if collaborative care (CC) is a cost-effective treatment model when provided in the general hospital outpatient setting, rather than the primary care setting, for patients with chronic physical conditions, such as diabetes mellitus (DM), chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD), with comorbid major depressive disorder (MDD). The researchers performed a randomized controlled trial (RCT) evaluating CC provided by a consultant psychiatric nurse (CPN) as care manager; a consultation–liaison (CL) psychiatrist for diagnosis, supervision, and the prescription of antidepressant medication; and a medical specialist who provided treatment for the chronic physical condition. They found CC to be cost-effective with an incremental cost-effectiveness ratio (ICER) of €24,690 per quality-adjusted life year (QALY). Due to the high disease burden in this patient group, this may indicate that the CC model and setting may be preferable. However, the study was small, so replication in a larger study is warranted

    Surface Roughness and Effective Stick-Slip Motion

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    The effect of random surface roughness on hydrodynamics of viscous incompressible liquid is discussed. Roughness-driven contributions to hydrodynamic flows, energy dissipation, and friction force are calculated in a wide range of parameters. When the hydrodynamic decay length (the viscous wave penetration depth) is larger than the size of random surface inhomogeneities, it is possible to replace a random rough surface by effective stick-slip boundary conditions on a flat surface with two constants: the stick-slip length and the renormalization of viscosity near the boundary. The stick-slip length and the renormalization coefficient are expressed explicitly via the correlation function of random surface inhomogeneities. The effective stick-slip length is always negative signifying the effective slow-down of the hydrodynamic flows by the rough surface (stick rather than slip motion). A simple hydrodynamic model is presented as an illustration of these general hydrodynamic results. The effective boundary parameters are analyzed numerically for Gaussian, power-law and exponentially decaying correlators with various indices. The maximum on the frequency dependence of the dissipation allows one to extract the correlation radius (characteristic size) of the surface inhomogeneities directly from, for example, experiments with torsional quartz oscillators.Comment: RevTeX4, 14 pages, 3 figure

    Physical Activity and Sedentary Behavior among US Hispanic/Latino Youth: The SOL Youth Study

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    Purpose: Physical activity and sedentary behavior among diverse Hispanic/Latino youth in the United States is not well documented. The aim of this study was to describe physical activity and sedentary behavior among a representative sample of Hispanic/Latino youth from four US communities using accelerometry and self-reported measures. Methods: From 2012 to 2014, 1466 Hispanic/Latino youth ages 8 to 16 yr, children of participants in the Hispanic Community Health Study/Study of Latinos, enrolled in the SOL youth. Physical activity and sedentary behavior were assessed by interview. After this, youth wore an Actical accelerometer for 1 wk. All statistical analyses accounted for the complex survey design and used sampling weights. Results: The accelerometer wear time adjusted mean minutes per day was: 604.6, sedentary; 178.9, light; 25.4, moderate; and 10.2, vigorous. Generally, higher levels of moderate and vigorous activity occurred among males, Mexican backgrounds, and youth age 8 to 10 yr compared with older age groups. Higher levels of sedentary behavior occurred among youth age 15 to 16 yr compared with younger age groups. The most common activities (reported, ≥1 per month) were of lower intensity, including listening to music (91.9%), homework (87.0%), riding in car/bus (84.3%), and hanging out with friends (83.4%). Common active pursuits included travel by walking (74.6%), physical education class (71.7%), running (71.4%), and recess (71.3%). Conclusions: Time, intensity, and type of physical activity and sedentary behavior varied among Hispanic/Latino youth. These findings can inform efforts to increase physical activity and reduce sedentary behavior among US Hispanic/Latino youth

    Photoproduction of mesons off nuclei

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    Recent results for the photoproduction of mesons off nuclei are reviewed. These experiments have been performed for two major lines of research related to the properties of the strong interaction. The investigation of nucleon resonances requires light nuclei as targets for the extraction of the isospin composition of the electromagnetic excitations. This is done with quasi-free meson photoproduction off the bound neutron and supplemented with the measurement of coherent photoproduction reactions, serving as spin and/or isospin filters. Furthermore, photoproduction from light and heavy nuclei is a very efficient tool for the study of the interactions of mesons with nuclear matter and the in-medium properties of hadrons. Experiments are currently rapidly developing due to the combination of high quality tagged (and polarized) photon beams with state-of-the-art 4pi detectors and polarized targets

    Field Measurements of Terrestrial and Martian Dust Devils

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    Surface-based measurements of terrestrial and martian dust devils/convective vortices provided from mobile and stationary platforms are discussed. Imaging of terrestrial dust devils has quantified their rotational and vertical wind speeds, translation speeds, dimensions, dust load, and frequency of occurrence. Imaging of martian dust devils has provided translation speeds and constraints on dimensions, but only limited constraints on vertical motion within a vortex. The longer mission durations on Mars afforded by long operating robotic landers and rovers have provided statistical quantification of vortex occurrence (time-of-sol, and recently seasonal) that has until recently not been a primary outcome of more temporally limited terrestrial dust devil measurement campaigns. Terrestrial measurement campaigns have included a more extensive range of measured vortex parameters (pressure, wind, morphology, etc.) than have martian opportunities, with electric field and direct measure of dust abundance not yet obtained on Mars. No martian robotic mission has yet provided contemporaneous high frequency wind and pressure measurements. Comparison of measured terrestrial and martian dust devil characteristics suggests that martian dust devils are larger and possess faster maximum rotational wind speeds, that the absolute magnitude of the pressure deficit within a terrestrial dust devil is an order of magnitude greater than a martian dust devil, and that the time-of-day variation in vortex frequency is similar. Recent terrestrial investigations have demonstrated the presence of diagnostic dust devil signals within seismic and infrasound measurements; an upcoming Mars robotic mission will obtain similar measurement types
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