Renal and hemodynamic responses to bumetanide in hypertension: Effects of nitrendipine

Renal and hemodynamic responses to bumetanide in hypertension: Effects of nitrendipine. The effects of a calcium antagonist on the response to a loop diuretic were tested in eight hypertensive patients while they received 120mmol · 24hr-1 of dietary Na. Nitrendipine (N; 20 mg) or placebo (P) was administered twice daily for five days and bumetanide (B; 1 mg, i.v.) for the last three days of each period. Cardiac index (CI) was measured during tilt. B alone significantly (P < 0.05; N = 7) reduced CI and increased total peripheral resistance; N prevented these effects of B. Neither drug altered BP consistently. Although three days of B increased plasma renin activity (PRA) during P and N, it increased plasma aldosterone (PAldo) only during P (P, 4.4 ± 1.3 to 7.6 ± 1.0; P < 0.05. N, 5.7 ± 1.3 to 6.0 ± 1.3; pg · liter-1; NS). B increased Na excretion without changing GFR or RPF; this was followed by 18 hours of decreased renal Na excretion. These actions were unchanged by N. N did not change the cumulative excretion of B (P, 268 ± 35 vs. N, 217 ± 21 µg) or the relationship between Na excretion and the log of B excretion. However, Na excretion was increased (P < 0.05) by 40 to 60% in the six hour period following the first two doses of N. Therefore, the cumulative Na balance was more negative during five days of N (P, -47 ± 17 vs. N, -108 ± 24 mmol; P < 0.05). The effect of N and B on Na balance were independent. In conclusion, short-term administration of N: 1) increases CI and reduces TPRI in the post-diuretic state; 2) blunts B-induced increase in PAldo without modifying the rise in PRA; 3) does not change B kinetics or dynamics or the post-diuretic period of renal Na retention; 4) causes negative Na balance which is additive with that produced by B

Better together: Integrating biomedical informatics and healthcare IT operations to create a learning health system during the COVID-19 pandemic

The growing availability of multi-scale biomedical data sources that can be used to enable research and improve healthcare delivery has brought about what can be described as a healthcare data age. This new era is defined by the explosive growth in bio-molecular, clinical, and population-level data that can be readily accessed by researchers, clinicians, and decision-makers, and utilized for systems-level approaches to hypothesis generation and testing as well as operational decision-making. However, taking full advantage of these unprecedented opportunities presents an opportunity to revisit the alignment between traditionally academic biomedical informatics (BMI) and operational healthcare information technology (HIT) personnel and activities in academic health systems. While the history of the academic field of BMI includes active engagement in the delivery of operational HIT platforms, in many contemporary settings these efforts have grown distinct. Recent experiences during the COVID-19 pandemic have demonstrated greater coordination of BMI and HIT activities that have allowed organizations to respond to pandemic-related changes more effectively, with demonstrable and positive impact as a result. In this position paper, we discuss the challenges and opportunities associated with driving alignment between BMI and HIT, as viewed from the perspective of a learning healthcare system. In doing so, we hope to illustrate the benefits of coordination between BMI and HIT in terms of the quality, safety, and outcomes of care provided to patients and populations, demonstrating that these two groups can be better together

Investigating strength and range of motion of the hip complex in ice hockey athletes

CONTEXT: Ice hockey athletes frequently injure the hip complex via a non-contact mechanism. We investigated patterns of strength and range of motion (ROM) to establish major differences compared to soccer athletes. Soccer athletes were compared to ice hockey athletes due to similarities between the two sports with regards to the intermittent nature and high number of lower limb injuries. OBJECTIVE: To compare the differences in ROM and strength of the hip for both the dominant (Dom) and non-dominant (Ndom) limb in ice hockey and soccer athletes. DESIGN: Case control study. SETTING: Bilateral ROM in hip flexion in sitting (FS) and lying (FL), extension, abduction, adduction, and internal rotation (IR) and external rotation (ER) was measured using a goniometer and assessed for strength using a hand held dynamometer on both the Dom and Ndom limbs. Participants. Twenty four male, active, uninjured NCAA division III ice hockey (16) and soccer (8) athletes. MAIN OUTCOME MEASURE: ROM and strength for hip FS, FL extension, abduction, adduction, IR and ER. A mixed model ANOVA was used to investigate interactions and main effects. RESULTS: Ice hockey athletes exhibited greater hip adduction ROM compared to soccer athletes in the Dom leg (both p=0.002) and when both limbs were combined (p = 0.010). Ice hockey athletes had less ROM in ER (p = 0.042) than soccer athletes. Ice hockey athletes displayed less strength in adduction in their Ndom leg compared to their Dom leg (p=0.02) along with less adduction than soccer players in their Ndom leg (p=0.40). Ice hockey athletes displayed less strength in hip adduction (p=0.030), FS (p=0.023) and FL (p=0.030) than soccer athletes. CONCLUSIONS: Our findings suggest that ice hockey athletes may present an 'at risk' profile for non-contact hip injuries, in comparison with soccer athletes with regards to strength and ROM of the hip

From aptamer-based biomarker discovery to diagnostic and clinical applications: an aptamer-based, streamlined multiplex proteomic assay

Recently, we reported an aptamer-based, highly multiplexed assay for the purpose of biomarker identification. To enable seamless transition from highly multiplexed biomarker discovery assays to a format suitable and convenient for diagnostic and life-science applications, we developed a streamlined, plate-based version of the assay. The plate-based version of the assay is robust, sensitive (sub-picomolar), rapid, can be highly multiplexed (upwards of 60 analytes), and fully automated. We demonstrate that quantification by microarray-based hybridization, Luminex bead-based methods, and qPCR are each compatible with our platform, further expanding the breadth of proteomic applications for a wide user community

Land Use and Salinity Drive Changes in SAV Abundance and Community Composition

Conserving and restoring submerged aquatic vegetation (SAV) are key management goals for estuaries worldwide because SAV integrates many aspects of water quality and provides a wide range of ecosystem services. Management strategies are typically focused on aggregated abundance of several SAV species, because species cannot be easily distinguished in remotely sensed data. Human land use and shoreline alteration have been shown to negatively impact SAV abundance, but the effects have varied with study, spatial scale, and location. The differences in reported effects may be partly due to the focus on abundance, which overlooks within-community and among-community dynamics that generate total SAV abundance. We analyzed long-term SAV aerial survey data (1984-2009) and ground observations of community composition (1984-2012) in subestuaries of Chesapeake Bay to integrate variations in abundance with differences in community composition. We identified five communities (mixed freshwater, milfoil-Zannichellia, mixed mesohaline, Zannichellia, and Ruppia-Zostera). Temporal variations in SAV abundance were more strongly related to community identity than to terrestrial stressors, and responses to stressors differed among communities and among species. In one fifth of the subestuaries, the community identity changed during the study, and the probability of such a change was positively related to the prevalence of riprapped shoreline in the subestuary. Mixed freshwater communities had the highest rates of recovery, and this may have been driven by Hydrilla verticillata, which was the single best predictor of SAV recovery rate. Additional species-specific and community-specific research will likely yield better understanding of the factors affecting community identity and SAV abundance, more accurate predictive models, and more effective management strategies

Feasibility of a placebo-controlled trial of antibiotics for possible urinary tract infection in care homes: a qualitative interview study

Background: Diagnosis of suspected urinary tract infection (UTI) in care and nursing home residents is commonly based on vague non-localising symptoms (for example, confusion), potentially leading to inappropriate antibiotic prescription. The safety of withholding antibiotics in such cases could be addressed by a randomised controlled trial (RCT); however, this would require close monitoring of residents, and support from care home staff, clinicians, residents, and families. Aim: To explore the views of residential care and nursing home staff (herein referred to as care home staff) and primary care clinicians on the feasibility and design of a potential RCT of antibiotics for suspected UTI in care home residents, with no localising urinary symptoms. Design & setting: A qualitative interview study with primary care clinicians and care home staff in the UK. Method: Semi-structured interviews with 16 care home staff and 11 primary care clinicians were thematically analysed. Results: Participants were broadly supportive of the proposed RCT. The safety of residents was a priority and there was strong support for using the RESTORE2 (Recognise Early Soft Signs, Take Observations, Respond, Escalate) assessment tool to monitor residents; however, there were concerns about associated training requirements, especially for night and temporary staff. Effective communication (with residents, families, and staff) was deemed essential, and carers were confident that residents and families would be supportive of the RCT if the rationale was clearly explained and safety systems were robust. There were mixed views on a placebo-controlled design. The perceived additional burden was seen as a potential barrier, and the use of temporary staff and the out-of-hours period were highlighted as potential risk areas. Conclusion: The support for this potential trial was encouraging. Future development will need to prioritise resident safety (especially in the out-of-hours period), effective communication, and minimising additional burden on staff to optimise recruitment

Currently prescribed drugs in the UK that could upregulate or downregulate ACE2 in COVID-19 disease: a systematic review.

Funder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265; Grant(s): MRC Epidemiology Unit programme: MC_UU_12015/4.OBJECTIVE: To review evidence on routinely prescribed drugs in the UK that could upregulate or downregulate ACE2 and potentially affect COVID-19 disease. DESIGN: Systematic review. DATA SOURCE: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science. STUDY SELECTION: Any design with animal or human models examining a currently prescribed UK drug compared with a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression. DATA EXTRACTION AND SYNTHESIS: MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1 April 2020. Methodological quality was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk-of-bias tool for animal studies and Cochrane risk-of-bias tool for human studies. RESULTS: We screened 3360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and one hundred and two were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were angiotensin receptor blockers (ARBs) (n=55) and ACE inhibitors (ACE-I) (n=22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel blockers (n=3) glucagon-like peptide 1 (GLP-1) agonists (n=2) and Non-steroidal anti-inflammatory drugs (NSAIDs) (n=2). CONCLUSIONS: There is an abundance of the academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty among patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease

Attitudes of pregnant women and healthcare professionals towards clinical trials and routine implementation of antenatal vaccination against respiratory syncytial virus : a multicenter questionnaire study

Introduction: Respiratory syncytial virus (RSV) is a common cause of infant hospitalization and mortality. With multiple vaccines in development, we aimed to determine: (1) the awareness of RSV among pregnant women and healthcare professionals (HCPs), and (2) attitudes toward clinical trials and routine implementation of antenatal RSV vaccination.Methods: Separate questionnaires for pregnant women and HCPs were distributed within 4 hospitals in South England (July 2017–January 2018).Results: Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unknown) were analyzed. Most pregnant women (88%) and midwives (66%) had no/very little awareness of RSV, unlike obstetricians (14%). Among pregnant women, 29% and 75% would likely accept RSV vaccination as part of a trial, or if routinely recommended, respectively. Younger women (16–24 years), those of 21–30 weeks’ gestation, and with experience of RSV were significantly more likely to participate in trials [odds ratio (OR): 1.42 (1.72–9.86); OR: 2.29 (1.22–4.31); OR: 9.07 (1.62–50.86), respectively]. White-British women and those of 21–30 weeks’ gestation were more likely to accept routinely recommended vaccination [OR: 2.16 (1.07–4.13); OR: 2.10 (1.07–4.13)]. Obstetricians were more likely than midwives to support clinical trials [92% vs. 68%, OR: 2.50 (1.01–6.16)] and routine RSV vaccination [89% vs. 79%, OR: 4.08 (1.53–9.81)], as were those with prior knowledge of RSV, and who deemed it serious.Conclusions: RSV awareness is low among pregnant women and midwives. Education will be required to support successful implementation of routine antenatal vaccination. Research is needed to understand reasons for vaccine hesitancy among pregnant women and HCPs, particularly midwives.<br/

Submersed Aquatic Vegetation in Chesapeake Bay: Sentinel Species in a Changing World

Chesapeake Bay has undergone profound changes since European settlement. Increases in human and livestock populations, associated changes in land use, increases in nutrient loadings, shoreline armoring, and depletion of fish stocks have altered the important habitats within the Bay. Submersed aquatic vegetation (SAV) is a critical foundational habitat and provides numerous benefits and services to society. In Chesapeake Bay, SAV species are also indicators of environmental change because of their sensitivity to water quality and shoreline development. As such, SAV has been deeply integrated into regional regulations and annual assessments of management outcomes, restoration efforts, the scientific literature, and popular media coverage. Even so, SAV in Chesapeake Bay faces many historical and emerging challenges. The future of Chesapeake Bay is indicated by and contingent on the success of SAV. Its persistence will require continued action, coupled with new practices, to promote a healthy and sustainable ecosystem