Insulin Sensitivity Following Agent Orange Exposure in Vietnam Veterans with High Blood Levels of 2,3,7,8-Tetrachlorodibenzo-\u3cem\u3ep\u3c/em\u3e-Dioxin

Our objective was to determine whether insulin sensitivity was related to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in Vietnam veterans exposed to Agent Orange. Air Force veterans of Operation Ranch Hand, the unit responsible for spraying Agent Orange and other herbicides in Vietnam from 1962 to 1971, and comparison veterans who did not spray herbicides were included. We measured insulin sensitivity (SI) using a frequently sampled iv glucose tolerance test in a matched study of 29 matched pairs of veterans and a quantitative insulin sensitivity check index (QUICKI) based on fasting glucose and insulin in 71 matched pairs. No group differences were found with regard to the mean values of SI, QUICKI, TNFα, adiponectin, and two measures of insulin secretion. However, SI and QUICKI decreased significantly with regard to TCDD (P = 0.01 and 0.02). A corresponding pattern (although not significant) was found for blood levels of TNFα and adiponectin. These data suggest that high blood TCDD levels may promote an insulin-resistant state, but the magnitude of this effect appeared to be small, such that an 18-fold increase in blood TCDD due to increased exposure resulted in only a 10% change in SI in the 29 matched pairs

Myocardial Perfusion Pressure: A Predictor of 24Hour Survival During Prolonged Cardiac Arrest in Dogs

Myocardial perfusion pressure, defined as the aortic diastolic pressure minus the right atria1 diastolic pressure, correlates with coronary blood flow during cardiopulmonary resuscitation (CPR) and predicts initial resuscitation success. Whether this hemodynamic parameter can predict 24-h survival is not known. We examined the relationship between myocardial perfusion pressure and 24-h survival in 60 dogs that underwent prolonged (20 min) ventricular fibrillation and CPR. Forty-two (70%) animals were initially resuscitated and 20 (33%) survived for 24 h. Myocardial perfusion pressure was significantly greater when measured at 5, 10, 15 and 20 min of ventricular fibrillation in the resuscitated animals than in the non-resuscitated animals (P \u3c 0.01). Likewise, the myocardial perfusion pressure was also greater in the animals that survived 24 h than in animals that were resuscitated, but died before 24 h (P \u3c 0.02). Myocardial perfusion pressure measured after 10 min of CPR was 11 2 mmHg in animals never resuscitated, 20 3 mmHg in those resuscitated that died before 24 h and 29 2 mmHg in those that survived 24 h (P \u3c 0.05). A myocardial perfusion pressure at 10 min of CPR of 20 mmHg or less is an excellent predictor of poor survival (negative predictive value = 96%). Myocardial perfusion pressure is a useful index of CPR effectiveness and therefore may be a useful guide in helping to optimize resuscitation efforts

Changes in Expired End-Tidal Carbon Dioxide During Cardiopulmonary Resuscitation in Dogs: A Prognostic Guide for Resuscitation Efforts

Expired end-tidal carbon dioxide (PCO2) measurements made during cardiopulmonary resuscitation have correlated with cardiac output and coronary perfusion pressure when wide ranges of blood flow are included. The utility of such measurements for predicting resuscitation outcome during the low flow state associated with closed chest cardiopulmonary resuscitation remains uncertain. Expired end-tidal PCO2 and coronary perfusion pressures were measured in 15 mongrel dogs undergoing 15 min of closed chest cardiopulmonary resuscitation after a 3 min period of untreated ventricular fibrillation. In six successfully resuscitated dogs, the mean expired end-tidal PCO2 was significantly higher than that in nine nonresuscitated dogs only after 14 min of cardiopulmonary resuscitation (6.2 ± 1.2 versus 3.4 ± 0.8 mmHg; p \u3c 0.05). No differences in expired end-tidal PCO2 values were found at 2, 7 or 12 min of cardiopulmonary resuscitation. A significant decline in end-tidal PCO2 levels during the resuscitation effort was seen in the nonresuscitated group (from 6.3 ± 0.8 to 3.4 ± 0.8 mmHg; p \u3c 0.05); while the successfully resuscitated group had constant PCO2 levels throughout the 15 min of cardiac arrest (ranging from 6.8 ± 1.1 to 6.2 ± 1.2 mmHg). Changes in expired PCO2 levels during cardiopulmonary resuscitation may be a useful noninvasive predictor of successful resuscitation and survival from cardiac arrest

Pre-exposure prophylaxis with OspA-specific human monoclonal antibodies protects mice against tick transmission of Lyme disease spirochetes

Background. Tick transmission of Borrelia spirochetes to humans results in significant morbidity from Lyme disease worldwide. Serum concentrations of antibodies against outer surface protein A (OspA) were shown to correlate with protection from infection with Borrelia burgdorferi, the primary cause of Lyme disease in the United States. Methods. Mice transgenic for human immunoglobulin genes were immunized with OspA protein of B. burgdorferi to generate human monoclonal antibodies (HuMabs) against OspA. HuMabs were generated and tested in in vitro borreliacidal assays and animal protection assays. Results. Nearly 100 unique OspA specific HuMabs were generated and four HuMabs (221-7, 857-2, 319-44, and 212-55) were selected as lead candidates based on borreliacidal activity. HuMab 319-44, 857-2 and 212-55 were borreliacidal against one or two Borrelia genospecies, whereas 221-7 was borreliacidal (IC50 \u3c 1nM) against B. burgdorferi, B. afzelii and B. garinii, the three main genospecies endemic in the US, Europe and Asia. All four HuMabs completely protected mice from infection at 10 mg/kg in a murine model of tick-mediated transmission of B. burgdorferi. Conclusions. Our study indicates that OspA-specific HuMabs can prevent the transmission of Borrelia and administration of these antibodies could be employed as pre-exposure prophylaxis for Lyme disease

Energy system optimisation and smart technologies - a social sciences and humanities annotated bibliography

The challenge: * Systems perspectives on energy involve a holistic view on balancing demand and supply; system optimisation can support security of supply, affordability, sustainability and profitability. * A central, and relatively recent, element of system optimisation is the move towards smart grids, and smart technologies, which concern interconnection of system elements usually through the internet. As well as increasing the resilience of the network, it is hoped this will help “citizens take ownership of the energy transition [and] benefit from new technologies”. * ‘Smartification’ of the energy system introduces a range of new societal conditions and consequences. The aim: * European energy policy has so far mainly relied on research from Science, Technology Engineering and Mathematics (STEM) disciplines. Energy-related Social Sciences and Humanities (energy-SSH) have been significantly underrepresented. The aim of this bibliography is to give policymakers a selected yet broad impression of the SSH research community focusing on ‘energy system optimisation and smart technologies’. Wherever possible, policy deductions or research and innovation recommendations are mentioned. Coverage: * Disciplines covered in this bibliography are broadly representative of the current SSH research community in the area, with a slight bias towards Economics, Sociology and Science & Technology Studies. Nevertheless, robust accounts from Psychology, Politics, Ethnography, Development, Environmental Social Science, Geography, Planning, Law, History and other fields are also included. * Geographically, research presented is primarily from Western and Northern Europe, but with diversity across these regions, and inclusion of some Eastern European and non-European contributions. * Techno-economic accounts are very highly represented in the field of energy system optimisation and smart technologies, a fact highlighted by researchers themselves. Much of this research concentrates on financial cost/benefit of smart grid and technical design, while approaches focusing on social practices or user-centric design are increasing but still underrepresented. The latter were deliberately given higher visibility in this bibliography. Key findings: * Numerous papers presented here focus on how questions of smart technology diffusion, innovation, and adoption might be shifted away from monetary incentives or cost/benefit analyses of technologies. * A unifying message across many topics and disciplines - from energy justice or socio-technical scenarios, to Economics or Ethnography - is that co-operation between techno-economic and SSH approaches needs more attention and is crucial for successful smart grid realisation. * Another important debate for SSH researchers is the deconstruction of overly optimistic visions of smart societies. Many authors urge caution in considering the (financial and social) costs and benefits of smart technologies for all of society, including issues of privacy intrusion. There are calls for more research on both policy initiatives, preferably targeting the community level, and clear communication strategies which fully consider these aspects

Challenges facing gap-based silviculture and possible solutions for mesic northern forests in North America

Gap-based silvicultural systems were developed under the assumption that richness, and diversity of tree species and other biota positively respond to variation in size of harvest-created canopy gaps. However, varying gap size alone often does not meet diversity objectives and broader goals to address contemporary forest conditions. Recent research highlights the need to consider site factors and history, natural disturbance models, within-gap structure and recruitment requirements in addition to light resources for desired tree diversity. This synthesis brings together silvicultural developments and ecological literature on gap-based management, highlighting interactions with other factors such as microsite conditions, non-tree vegetation and more. We pose a revised concept for managers and researchers to use in prescriptions and studies focused on integrated overstory and understory manipulations that increase structural complexity within and around canopy openings

INSTRUCTIONAL DESIGN AND ASSESSMENT A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course

Objective. To implement a simulated interprofessional rounding experience using human patient simulators as a required activity for third-year pharmacy students in a clinical assessment course. Design. Interprofessional student teams consisting of pharmacy, medical, and physician assistant students participated in a simulated interprofessional rounding experience in which they provided comprehensive medical care for a simulated patient in an inpatient setting. Assessment. Students completed a survey instrument to assess interprofessional attitudes and satisfaction before and after participation in the simulated interprofessional rounding experience. Overall student attitudes regarding interprofessional teamwork and communication significantly improved; student satisfaction with the experience was high and students' self-perceived clinical confidence improved after participation. The mean team clinical performance scores were 65% and 75% for each simulated interprofessional rounding experience. Conclusion. Incorporating a simulated interprofessional rounding experience into a required clinical assessment course improved student attitudes regarding interprofessional teamwork and was associated with high student satisfaction

The heart of Rett syndrome: A quantitative analysis of cardiac repolarization

BACKGROUND: Rett syndrome (RTT) is a developmental encephalopathy disorder that is associated with a high incidence of sudden death presumably from cardiorespiratory etiologies. Electrocardiogram (ECG) abnormalities, such as prolonged heart-rate corrected QT (QTc) interval, are markers of cardiac repolarization and are associated with potentially lethal ventricular arrhythmias. This study investigates the cardiac repolarization characteristics of RTT patients, including QTc and T-wave morphology characteristics. METHODS: A retrospective quantitative analysis on 110 RTT patients and 124 age and sex-matched healthy controls was conducted. RESULTS: RTT patients had longer QTc, more abnormal T-wave morphology, and greater heterogeneity of cardiac repolarization parameters compared to controls. Even RTT patients without prolonged QTc had more abnormal ECG and T-wave characteristics than controls. Among RTT patients, CONCLUSIONS: Cardiac repolarization abnormalities are present in RTT patients, even without long QTc. T-wave morphology is related to RTT genotype and may be predictive of mortality. These findings could be used to help the management and monitoring of RTT patients