Subcutaneous furosemide in advanced heart failure: service improvement project

Objectives: In severe heart disease, parenteral administration of loop diuretic is often needed. We present clinical outcomes from episodes of care using subcutaneous continuous infusion of furosemide (CSCI-furosemide).Methods: Retrospective review of service improvement data. The heart failure nurse specialist, supported by the heart failure-palliative care multi-disciplinary team, works with the community or hospice staff who administer the CSCI-furosemide. Data collected for consecutive patients receiving CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, preferred place of care, goal of treatment, infusion-site reactions, and signs and symptoms of fluid retention (including weight and self-reported breathlessness).Results: 116 people (men 86 [66%]; mean age 79 years, 49 to 97; NYHA class 3 [36/116, 31%] or 4 heart failure [80/116, 69%]) received 130 episodes of CSCI-furosemide (average duration 10 days, 1 to 49), over half in the patient’s own home/care home (80/129,; 61%) aiming to prevent hospital admission. 40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. Average daily furosemide dose was 125 mg (40 to 300mg). The goal of treatment was achieved in (119/130, 91.5%) episodes.The median reduction in weight was 4kg (interquartiles -7 kg to -2 kgs, -22 to +9 kgs). Self-reported breathlessness reduced from 8.2 (+/-1.9) to 5.2 (+/-1.8). Adverse events occurred in 31/130 (24%) episodes; all but 4/130 (3%, localised skin infection) were mild.Conclusions: These preliminary data indicate that CSCI-furosemide is safe and effective for people with severe heart failure. An adequately powered randomised controlled trial is indicated

Community Reactions to Campaigns Addressing Crystal Methamphetamine Use Among Gay and Bisexual Men In New York City

Crystal methamphetamine (aka “crystal meth”) use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed

Self-Aligned Carbon Nanotube Yarns for Multifunctional Optoelectronic Applications

In this work, the morphology and electrocatalytic features of carbon nanotube yarns at the structural level allow for enhanced photoconversion efficiency. The energy conversion of electronhole pairs within the carbon nanotube yarn (CNY) due to the functionalization with nanostructured photoactive TiO₂ phases is remarkable. A well oriented anatase TiO₂ thin layer (approximately 100 nm) forms at the interfaces of CNY and TiO₂ mesoporous film when the sample is precoated and annealed at 350ºC. Field Emission Scanning Electron Microscopy (FESEM) images show the integrity and homogeneity of the TiO₂ surface, which is indicative of the overall durability of the CNY-based dye sensitized solar cell (DSSC); Coating TiO₂ on self-aligned carbon nanotube yarns provides several benefits from their high chemical stability, excellent functionality, nontoxicity and relatively low cost. The maximum photon to current conversion efficiency (ηAM1.5) achieved with prolonged-time stability was 3.1%

Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study

Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants’ sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment

Orbital Evolution of Compact White Dwarf Binaries

The new-found prevalence of extremely low mass (ELM, Mhe<0.2 Msun) helium white dwarfs (WDs) in tight binaries with more massive WDs has raised our interest in understanding the nature of their mass transfer. Possessing small (Menv~1e-3 Msun) but thick hydrogen envelopes, these objects have larger radii than cold WDs and so initiate mass transfer of H-rich material at orbital periods of 6-10 minutes. Building on the original work of D'Antona et al., we confirm the 1e6 yr period of continued inspiral with mass transfer of H-rich matter and highlight that the inspiraling direct-impact double WD binary HM Cancri likely has an ELM WD donor. The ELM WDs have less of a radius expansion under mass loss, thus enabling a larger range of donor masses that can stably transfer matter and become a He mass transferring AM CVn binary. Even once in the long-lived AM CVn mass transferring stage, these He WDs have larger radii due to their higher entropy from the prolonged H burning stage.Comment: 9 pages, 8 figures. Accepted for publication in the Astrophysical Journa

Serine Phosphorylation of L-Selectin Regulates ERM Binding, Clustering, and Monocyte Protrusion in Transendothelial Migration

The migration of circulating leukocytes toward damaged tissue is absolutely fundamental to the inflammatory response, and transendothelial migration (TEM) describes the first cellular barrier that is breached in this process. Human CD14(+) inflammatory monocytes express L-selectin, bestowing a non-canonical role in invasion during TEM. In vivo evidence supports a role for L-selectin in regulating TEM and chemotaxis, but the intracellular mechanism is poorly understood. The ezrin-radixin-moesin (ERM) proteins anchor transmembrane proteins to the cortical actin-based cytoskeleton and additionally act as signaling adaptors. During TEM, the L-selectin tail within transmigrating pseudopods interacts first with ezrin to transduce signals for protrusion, followed by moesin to drive ectodomain shedding of L-selectin to limit protrusion. Collectively, interaction of L-selectin with ezrin and moesin fine-tunes monocyte protrusive behavior in TEM. Using FLIM/FRET approaches, we show that ERM binding is absolutely required for outside-in L-selectin clustering. The cytoplasmic tail of human L-selectin contains two serine (S) residues at positions 364 and 367, and here we show that they play divergent roles in regulating ERM binding. Phospho-S364 blocks direct interaction with ERM, whereas molecular modeling suggests phospho-S367 likely drives desorption of the L-selectin tail from the inner leaflet of the plasma membrane to potentiate ERM binding. Serine-to-alanine mutagenesis of S367, but not S364, significantly reduced monocyte protrusive behavior in TEM under flow conditions. Our data propose a model whereby L-selectin tail desorption from the inner leaflet of the plasma membrane and ERM binding are two separable steps that collectively regulate protrusive behavior in TEM

Matrix Rigidity Regulates Cancer Cell Growth and Cellular Phenotype

Background: The mechanical properties of the extracellular matrix have an important role in cell growth and differentiation. However, it is unclear as to what extent cancer cells respond to changes in the mechanical properties (rigidity/stiffness) of the microenvironment and how this response varies among cancer cell lines. Methodology/Principal Findings: In this study we used a recently developed 96-well plate system that arrays extracellular matrix-conjugated polyacrylamide gels that increase in stiffness by at least 50-fold across the plate. This plate was used to determine how changes in the rigidity of the extracellular matrix modulate the biological properties of tumor cells. The cell lines tested fall into one of two categories based on their proliferation on substrates of differing stiffness: ‘‘rigidity dependent’ ’ (those which show an increase in cell growth as extracellular rigidity is increased), and ‘‘rigidity independent’’ (those which grow equally on both soft and stiff substrates). Cells which grew poorly on soft gels also showed decreased spreading and migration under these conditions. More importantly, seeding the cell lines into the lungs of nude mice revealed that the ability of cells to grow on soft gels in vitro correlated with their ability to grow in a soft tissue environment in vivo. The lung carcinoma line A549 responded to culture on soft gels by expressing the differentiated epithelial marker E-cadherin and decreasing the expression of the mesenchymal transcription factor Slug. Conclusions/Significance: These observations suggest that the mechanical properties of the matrix environment play

MnDOT Flash Flood Vulnerability and Adaptation Assessment Pilot Project

MnDOT planners and engineers have long considered minimizing the risk of flash flooding in the siting and design of the state\u2019s roadway network. However, as has been the standard practice worldwide, they have traditionally assumed that future climate conditions will be similar to those recorded in the past. Climate change challenges this assumption and calls for new approaches to understanding vulnerabilities across the highway system and at specific transportation facilities so that appropriate actions, adaptations, can be taken to minimize expanding risks. This project, one of 19 Federal Highway Administration (FHWA) climate vulnerability pilot studies nationwide looking at the effects of climate hazards on the transportation system, represents a starting point for developing these new approaches. The focus of this pilot study is on flash flooding risks to the highway system. While flooding is not the only threat to the state\u2019s highway system posed by climate change, it is likely to be one of the most significant and has already caused extensive disruptions to the transportation system in many areas