Clinical Practice Variability in Temperature Correction of Arterial Blood Gas Measurements and Outcomes in Hypothermia-Treated Patients After Cardiac Arrest

Mechanical ventilation in patients treated with mild therapeutic hypothermia (MTH) for the postcardiac arrest syndrome may be challenging given changes in solubility of arterial blood gases (ABGs) with cooling. Whether ABG measurements should be temperature corrected (TC) remain unknown. We sought to describe practice variability in TC at a single institution and explored the association between TC and neurological outcome. We conducted a retrospective cohort study reviewing electronic health records of all patients treated with MTH after cardiac arrest. We examined whether the percentage of TC ABGs relative to total number of ABGs drawn for each subject during hypothermia was associated with the neurological outcome at hospital discharge and 6?12-month follow-up. The cerebral performance category of 1?2 was defined as a favorable outcome in the logistic regression models. 1223 ABGs were obtained during MTH on 122 subjects over 6 years. TC was never used in 72 subjects (59%; no TC group), made available in 1?74% of ABGs in 17 subjects (14%; intermediate TC group), and made available in ≥75% of ABGs in 33 subjects (27%; mostly TC group). Groups differed in the proportion of subjects with shockable presenting rhythms (47% vs. 47% vs. 76%, p=0.02) and admitting ICU (p=0.005). Favorable 6-month outcomes were more common in the mostly TC than no TC group (48% vs. 25%; OR [95% CI]: 2.9 [1.2?7.1]), but not after adjustment (OR 1.5, 95% CI 0.33?6.9). There was substantial practice variability in the temperature correction strategy. Availability of temperature-corrected ABGs was not associated with improved neurological outcomes after adjusting for covariates.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140256/1/ther.2014.0029.pd

Dynamic clay microstructures emerge via ion complexation waves

Clays control carbon, water and nutrient transport in the lithosphere, promote cloud formation5 and lubricate fault slip through interactions among hydrated mineral interfaces. Clay mineral properties are difficult to model because their structures are disordered, curved and dynamic. Consequently, interactions at the clay mineral-aqueous interface have been approximated using electric double layer models based on single crystals of mica and atomistic simulations. We discover that waves of complexation dipoles at dynamically curving interfaces create an emergent long-range force that drives exfoliation and restacking over time- and length-scales that are not captured in existing models. Curvature delocalizes electrostatic interactions in ways that fundamentally differ from planar surfaces, altering the ratio of ions bound to the convex and concave sides of a layer. Multiple-scattering reconstruction of low-dose energy-filtered cryo electron tomography enabled direct imaging of ion complexes and electrolyte distributions at hydrated and curved mineral interfaces with {\aa}ngstrom resolution over micron length scales. Layers exfoliate and restack abruptly and repeatedly over timescales that depend strongly on the counterion identity, demonstrating that the strong coupling between elastic, electrostatic and hydration forces in clays promote collective reorganization previously thought to be a feature only of active matter

Asymmetry and Inequity in the Inheritance of a Bacterial Adhesive

Pseudomonas aeruginosa is an opportunistic human pathogen that forms biofilm infections in a wide variety of contexts. Biofilms initiate when bacteria attach to a surface, which triggers changes in gene expression leading to the biofilm phenotype.Wehave previously shown, for the P. aeruginosa lab strain PAO1, that the self-produced polymer Psl is the most dominant adhesive for attachment to the surface but that another self-produced polymer, Pel, controls the geometry of attachment of these rod-shaped bacteria—strains that make Psl but not Pel are permanently attached to the surface but adhere at only one end (tilting up off the surface), whereas wild-type bacteria that make both Psl and Pel are permanently attached and lie down flat with very little or no tilting (Cooley et al 2013 Soft Matter 9 3871–6). Here we show that the change in attachment geometry reflects a change in the distribution of Psl on the bacterial cell surface. Bacteria that make Psl and Pel have Psl evenly coating the surface, whereas bacteria that make only Psl have Psl concentrated at only one end.Weshow that Psl can act as an inheritable, epigenetic factor. Rod-shaped P. aeruginosa grows lengthwise and divides across the middle.Wefind that asymmetry in the distribution of Psl on a parent cell is reflected in asymmetry between siblings in their attachment to the surface. Thus, Pel not only promotes P. aeruginosa lying downWe thank Professor Matthew Parsek (University of Washington, Seattle) for his generous gift of bacterial PAO1 strains.Wealso thank Professor Marvin Whiteley (University of Texas at Austin) forWTandΔpsl polysaccharide preparations. SIM imaging (for figure 1) was performed in the Microscopy Core Facility within the Institute for Cellular and Molecular Biology atUTAustin, with the assistance of Julie Hayes. This work was funded by startup funds fromUTAustin and a gift from ExxonMobil to VDG, and by a grant from the Human Frontiers Science Program (HFSP RGY0081/2012-GORDON).Center for Nonlinear Dynamic

A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults

Publisher's version (útgefin grein)Abstract Background: Balance impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises; however, the effects on dynamic balance have not been comprehensively reviewed and compared to land exercises. Thus, the purpose of this systematic review and meta-analysis was to compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults. Methods: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, psycINFO), from inception to November 2019, were searched. Studies met the following eligibility criteria: Randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE and LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a standardized mean difference (SMD) and a 95% confidence interval (CI). Results: A total of 11 trials met the inclusion criteria, and 10 studies were eligible for the meta-analysis. The meta-analysis presented that older adults in AE groups demonstrated comparable enhancements in dynamic steady-state balance (SMD =−0.24; 95% CI,−.81 to .34), proactive balance (SMD =−0.21; 95% CI,−.59 to .17), and balance test batteries (SMD =−0.24; 95% CI,−.50 to .03) compared with those in LE groups. Conclusions: AE and LE have comparable impacts on dynamic balance in older adults aged 65 years or older. Thus, this review provides evidence that AE can be utilized as a reasonable alternative to LE to improve dynamic balance and possibly reduce the risk of falls.Peer reviewe

Extended Silicic Volcanism in the Gruithuisen Region—Revisiting the Composition and Thermophysical Properties of Gruithuisen Domes on the Moon

The formation mechanisms, extent, and compositions of red spots on the lunar surface have intrigued the lunar community for decades. By identifying a new dome and another silicic crater in the highlands nearby, we find that the silicic volcanism in the Gruithuisen region extends beyond the three major domes. Our observations indicate that the Gruithuisen domes have low iron and titanium contents. They are enveloped by ejecta from surrounding regions and host silica-rich material excavated by the young craters consistent with previous work. Our boulder maps of the Gamma dome display a high boulder count and indicate that the Diviner rock abundance maps are only sensitive to boulders larger than ∼2 m. The H-parameter values are sensitive to presence of rocks and may be a better indicator of rocks at submeter scales. The Delta dome has gentle slopes, lower rock abundance, and one young crater, and it could serve as a safe and scientifically valuable site for landing and exploration of the domes and nearby region. The dome also displays anomalously high H-parameter in the same region as the crater, indicating the potential presence of pyroclastic materials. We observe up to 200 ppm of OH/H2O on the domes and nearby mare despite the presence of a weak magnetic field to the south of Delta dome, further supporting the potential presence of pyroclastics in the region. This study could potentially aid in logistical and scientific decisions of the future NASA missions in the region

Accuracy of a computer vision system for estimating biomechanical measures of body function in axial spondyloarthropathy patients and healthy subjects

Objective: Advances in computer vision make it possible to combine low-cost cameras with algorithms, enabling biomechanical measures of body function and rehabilitation programs to be performed anywhere. We evaluated a computer vision system's accuracy and concurrent validity for estimating clinically relevant biomechanical measures. Design: Cross-sectional study. Setting: Laboratory. Participants: Thirty-one healthy participants and 31 patients with axial spondyloarthropathy. Intervention: A series of clinical functional tests (including the gold standard Bath Ankylosing Spondylitis Metrology Index tests). Each test was performed twice: the first performance was recorded with a camera, and a computer vision algorithm was used to estimate variables. During the second performance, a clinician measured the same variables manually. Main measures: Joint angles and inter-limb distances. Clinician measures were compared with computer vision estimates. Results: For all tests, clinician and computer vision estimates were correlated (r2 values: 0.360–0.768). There were no significant mean differences between methods for shoulder flexion (left: 2 ± 14° (mean ± standard deviation), t = 0.99, p < 0.33; right: 3 ± 15°, t = 1.57, p < 0.12), side flexion (left: − 0.5 ± 3.1 cm, t = −1.34, p = 0.19; right: 0.5 ± 3.4 cm, t = 1.05, p = 0.30) and lumbar flexion ( − 1.1 ± 8.2 cm, t = −1.05, p = 0.30). For all other movements, significant differences were observed, but could be corrected using a systematic offset. Conclusion: We present a computer vision approach that estimates distances and angles from clinical movements recorded with a phone or webcam. In the future, this approach could be used to monitor functional capacity and support physical therapy management remotely