Identification of Multiple Levels of Trauma Induced Coagulopathy

Trauma continues to be a major cause of death across the globe. While the exact causes of trauma differ greatly between the military and civilian lifestyles, the ability to stop bleeding after trauma is paramount for survival. Over the past decade coagulation research has transitioned from a classical understanding of plasma based protein coagulation to the current cell focused research. As part of this shift, platelets have become a central player in hemostasis. Unfortunately little is currently understood about how platelet function is affected by trauma. In an effort to better define platelet function during trauma and the resulting shock from exsanguination, a multipronged approach was developed. The hypothesis that the introduction of a state of clinical shock in a controlled environment would allow for an in-depth assessment of trauma-induced coagulopathy led to the development of a swine based model of hemorrhagic shock. In this model a composite injury consisting of soft tissue damage, long bone fracture, and controlled hemorrhage was used to induce a moderate state of hypovolemic shock. As a result of this injury the animals showed both the beginning of a plasma protein consumption coagulopathy as well as kinetic quickening in the clotting process. These surprising results show competing up-regulation and down-regulation of the coagulation system in response to trauma induced shock. To better define the effect of polytrauma on platelet function in a human population a clinical study was conducted. The hypothesis behind the development of this study was that the examination of platelet function during polytrauma would lead to a more complete understanding of the effects of trauma on hemostasis. This study resulted in the identification of two separate but not mutually exclusive coagulopathies in response to trauma. The first was the traditional consumption based coagulopathies recently suggested to be varying degrees of disseminated intravascular coagulopathy. The second was a development a hypercoagulable state that may be attributed to increased platelet function. The identification of these two competing coagulopathies in separate models highlights the inadequacies of the current plasma based clinical testing, and the need for increased whole blood testing in the trauma treatment environment

Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis

Objectives: Despite sleep disturbances being a central complaint in patients with chronic fatigue syndrome (CFS), evidence of objective sleep abnormalities from over 30 studies is inconsistent. The present study aimed to identify whether sleep-specific phenotypes exist in CFS and explore objective characteristics that could differentiate phenotypes, while also being relevant to routine clinical practice. Design: A cross-sectional, single-site study. Setting: A fatigue clinic in the Netherlands. Participants: A consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition. Measures: Patients underwent a single night of polysomnography (all-night recording of EEG, electromyography, electrooculography, ECG and respiration) that was hand-scored by a researcher blind to diagnosis and patient history. Results: Of the 343 patients, 104 (30.3%) were identified with a Primary Sleep Disorder explaining their diagnosis. A hierarchical cluster analysis on the remaining 239 patients resulted in four sleep phenotypes being identified at saturation. Of the 239 patients, 89.1% met quantitative criteria for at least one objective sleep problem. A one-way analysis of variance confirmed distinct sleep profiles for each sleep phenotype. Relatively longer sleep onset latencies, longer Rapid Eye Movement (REM) latencies and smaller percentages of both stage 2 and REM characterised the first phenotype. The second phenotype was characterised by more frequent arousals per hour. The third phenotype was characterised by a longer Total Sleep Time, shorter REM Latencies, and a higher percentage of REM and lower percentage of wake time. The final phenotype had the shortest Total Sleep Time and the highest percentage of wake time and wake after sleep onset. Conclusions: The results highlight the need to routinely screen for Primary Sleep Disorders in clinical practice and tailor sleep interventions, based on phenotype, to patients presenting with CFS. The results are discussed in terms of matching patients’ self-reported sleep to these phenotypes in clinical practice

Not all jellyfish are equal: isotopic evidence for inter- and intraspecific variation in jellyfish trophic ecology

Jellyfish are highly topical within studies of pelagic food-webs and there is a growing realisation that their role is more complex than once thought. Efforts being made to include jellyfish within fisheries and ecosystem models are an important step forward, but our present understanding of their underlying trophic ecology can lead to their oversimplification in these models. Gelatinous zooplankton represent a polyphyletic assemblage spanning >2,000 species that inhabit coastal seas to the deep-ocean and employ a wide variety of foraging strategies. Despite this diversity, many contemporary modelling approaches include jellyfish as a single functional group feeding at one or two trophic levels at most. Recent reviews have drawn attention to this issue and highlighted the need for improved communication between biologists and theoreticians if this problem is to be overcome. We used stable isotopes to investigate the trophic ecology of three co-occurring scyphozoan jellyfish species (Aurelia aurita, Cyanea lamarckii and C. capillata) within a temperate, coastal food-web in the NE Atlantic. Using information on individual size, time of year and δ 13 C and δ 15 N stable isotope values, we examined: (1) whether all jellyfish could be considered as a single functional group, or showed distinct inter-specific differences in trophic ecology; (2) Were size-based shifts in trophic position, found previously in A. aurita, a common trait across species?; (3) When considered collectively, did the trophic position of three sympatric species remain constant over time? Differences in δ 15 N (trophic position) were evident between all three species, with size-based and temporal shifts in δ 15 N apparent in A. aurita and C. capillata. The isotopic niche width for all species combined increased throughout the season, reflecting temporal shifts in trophic position and seasonal succession in these gelatinous species. Taken together, these findings support previous assertions that jellyfish require more robust inclusion in marine fisheries or ecosystem models

The Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome

OBJECTIVES The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience. METHODS 118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale). RESULTS Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001). Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001). Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001). When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group. CONCLUSIONS Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies

Consumer health benefits through agricultural biotechnology : an economic examination of obstacles to commercial introduction

The first generation of agricultural crops developed using biotechnology have offered the primary producers of the crops agronomic benefits. Some consumers have resisted accepting this technology because of concerns with food and environmental safety, and ethical issues that arise from the processes that are involved in developing these products. The second and third generation of agricultural biotechnology are being developed to offer products with direct benefits to consumers. The focus of this thesis is the second generation, which have added health benefits. Specifically, the obstacles to commercialization of functional foods derived through biotechnology are examined. The three factors which have the potential to set back commercial introduction of functional foods derived through biotechnology are government regulatory uncertainty, consumer aversion and brand risk, and gaining access to intellectual property. The regulations governing functional foods are examined to show the regulatory ambiguity that exists in Canada. Comparisons are drawn to other nations. Literature that focuses on consumer aversion to agricultural biotechnology is reviewed, along with consumer preference studies with regards to genetically modified (GM) foods with and without health benefits. Transaction cost economics literature is used to analyse the problems related to gaining access to intellectual property and the resulting supply chain implications. Three separate theoretical models are developed to examine each of the three factors separately. Government regulatory uncertainty is incorporated into an expected profit model to show the effects of increased uncertainty on the expected profit from a new technology. A heterogeneous consumer preference model is used to show the effects of changing consumer preferences on the market share of the firm introducing the GM functional food to the market. Simulation analysis using this model shows the effects of changing variables on the market shares of three products in the market. Finally a stylized model of the vertical market shows the effects of increased transaction costs incurred in gaining access to intellectual property on the rent that is available for distribution throughout the supply chain. The results show that these factors could be an obstacle to commercial development of functional foods derived through biotechnology. When the three factors are combined, the rent available for distribution is important for the success of the supply chain. Multiple bilateral monopoly negotiations cause this rent to be less than optimal. Increased levels of government regulatory uncertainty, consumer aversion and brand risk, and costs gaining of access to intellectual property decrease the expected rent available for distribution. This could be a problem facing developers of functional foods derived through biotechnology

Hydraulics are a first order control on CO2 efflux from fluvial systems

Evasion of carbon dioxide (CO2) from fluvial systems is now recognized as a significant component of the global carbon cycle. However the magnitude of, and controls on, this flux remain uncertain and improved understanding of both are required to refine global estimates of fluvial CO2 efflux. CO2 efflux data show no pattern with latitude suggesting that catchment biological productivity is not a primary control and that an alternative explanation for inter-site variability is required. It has been suggested that increased flow velocity and turbulence enhance CO2 efflux, but this is not confirmed. Here, using contemporaneous measurements of efflux (range: 0.07 – 107 µmol CO2 m-2 s-1), flow hydraulics (mean velocity range: 0.03 – 1.39 m s-1) and pCO2 (range: 174 – 10712 µatm) at six sites, we find that flow intensity is a primary control on efflux across two climatically different locations (where pH is not a limiting factor) and that the relationship is refined by incorporating the partial pressure of CO2 (pCO2) of the water. A remaining challenge is how to upscale from point to reach or river basin level. Remote imaging or river surface may be worth exploring if subjectivity in interpreting surface state can be overcome

Empirical Bayesian models for analysing molecular serotyping microarrays.

BACKGROUND: Microarrays offer great potential as a platform for molecular diagnostics, testing clinical samples for the presence of numerous biomarkers in highly multiplexed assays. In this study applied to infectious diseases, data from a microarray designed for molecular serotyping of Streptococcus pneumoniae was used, identifying the presence of any one of 91 known pneumococcal serotypes from DNA extracts. This microarray incorporated oligonucleotide probes for all known capsular polysaccharide synthesis genes and required a statistical analysis of the microarray intensity data to determine which serotype, or combination of serotypes, were present within a sample based on the combination of genes detected. RESULTS: We propose an empirical Bayesian model for calculating the probabilities of combinations of serotypes from the microarray data. The model takes into consideration the dependencies between serotypes, induced by genes they have in common, and by homologous genes which, although not identical, are similar to each other in sequence. For serotypes which are very similar in capsular gene composition, extra probes are included on the microarray, providing additional information which is integrated into the Bayesian model. For each serotype combination with high probability, a second model, a Bayesian random effects model is applied to determine the relative abundance of each serotype. CONCLUSIONS: To assess the accuracy of the proposed analysis we applied our methods to experimental data from samples containing individual serotypes and samples containing combinations of serotypes with known levels of abundance. All but two of the known serotypes of S. pneumoniae that were tested as individual samples could be uniquely determined by the Bayesian model. The model also enabled the presence of combinations of serotypes within samples to be determined. Serotypes with very low abundance within a combination of serotypes can be detected (down to 2% abundance in this study). As well as detecting the presence of serotype combinations, an approximate measure of the percentage abundance of the serotypes within the combination can be obtained.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

A Search for Additional Bodies in the GJ 1132 Planetary System from 21 Ground-based Transits and a 100 Hour Spitzer Campaign

We present the results of a search for additional bodies in the GJ 1132 system through two methods: photometric transits and transit timing variations of the known planet. We collected 21 transit observations of GJ 1132b with the MEarth-South array since 2015. We obtained 100 near-continuous hours of observations with the $Spitzer$ Space Telescope, including two transits of GJ 1132b and spanning 60\% of the orbital phase of the maximum period at which bodies coplanar with GJ 1132b would pass in front of the star. We exclude transits of additional Mars-sized bodies, such as a second planet or a moon, with a confidence of 99.7\%. When we combine the mass estimate of the star (obtained from its parallax and apparent $K_s$ band magnitude) with the stellar density inferred from our high-cadence $Spitzer$ light curve (assuming zero eccentricity), we measure the stellar radius of GJ 1132 to be $0.2105^{+0.0102}_{-0.0085} R_\odot$, and we refine the radius measurement of GJ 1132b to $1.130 \pm 0.056 R_\oplus$. Combined with HARPS RV measurements, we determine the density of GJ 1132b to be $6.2 \pm 2.0$\ g cm$^{-3}$, with the mass determination dominating this uncertainty. We refine the ephemeris of the system and find no evidence for transit timing variations, which would be expected if there was a second planet near an orbital resonance with GJ 1132b.Comment: 29 pages, 4 Tables, 8 Figures, Submitted to ApJ. Comments welcom