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Introduction: Identifying effective, sustainable strategies to increase fruit and vegetable consumption is critical to addressing chronic disease risk. Models that provide incentives for produce purchases through reduced-cost or no-cost produce shares are promising. The purpose of our study was to examine the impact on fruit and vegetable intake of Good Food for All, a community-based program to distribute no-cost produce boxes to participants with low incomes. We also assessed program satisfaction and future interest in purchasing an affordable produce box., Methods: The Good Food for All program was implemented in 22 US cities. Surveys were administered at baseline and postintervention. An online research panel was used as a comparison group and weighted to be demographically comparable to the intervention group. Descriptive statistics and adjusted difference-in-difference (ADID) models were used to examine differences in outcomes between groups., Results: Respondents (intervention n = 632; comparison n = 1,153) were primarily White, non-Hispanic, and female. Intervention participants had a greater increase in total fruit consumption frequency (ADID: 0.43 times/d; 95% CI, 0.21-0.64; P < .001), total vegetable consumption frequency (ADID: 0.52 times/d; 95% CI, 0.12-0.91; P = .01), and total fruit and vegetable consumption frequency (ADID: 1.03 times/d; 95% CI, 0.49-1.56; P < .001) than comparison respondents. Most intervention participants reported boxes contained the right amount of food (71.9%) and high-quality produce (68.4%) and were willing to purchase a future produce box (85.0%)., Conclusion: Findings indicate that a produce box distribution model increased fruit and vegetable consumption, had high satisfaction among participants, and generated interest in purchasing affordable produce boxes. Future studies should explore feasibility of offering low-cost produce boxes at grocery stores and determine appropriate pricing models to enhance access and sustainability.

In this study, we present a novel approach to estimating the Hurst exponent of time series data using a variety of machine learning algorithms. The Hurst exponent is a crucial parameter in characterizing long-range dependence in time series, and traditional methods such as Rescaled Range (R/S) analysis and Detrended Fluctuation Analysis (DFA) have been widely used for its estimation. However, these methods have certain limitations, which we sought to address by modifying the R/S approach to distinguish between fractional Lévy and fractional Brownian motion, and by demonstrating the inadequacy of DFA and similar methods for data that resembles fractional Lévy motion. This inspired us to utilize machine learning techniques to improve the estimation process. In an unprecedented step, we train various machine learning models, including LightGBM, MLP, and AdaBoost, on synthetic data generated from random walks, namely fractional Brownian motion and fractional Lévy motion, where the ground truth Hurst exponent is known. This means that we can initialize and create these stochastic processes with a scaling Hurst/scaling exponent, which is then used as the ground truth for training. Furthermore, we perform the continuous estimation of the scaling exponent directly from the time series, without resorting to the calculation of the power spectrum or other sophisticated preprocessing steps, as done in past approaches. Our experiments reveal that the machine learning-based estimators outperform traditional R/S analysis and DFA methods in estimating the Hurst exponent, particularly for data akin to fractional Lévy motion. Validating our approach on real-world financial data, we observe a divergence between the estimated Hurst/scaling exponents and results reported in the literature. Nevertheless, the confirmation provided by known ground truths reinforces the superiority of our approach in terms of accuracy. This work highlights the potential of machine learning algorithms for accurately estimating the Hurst exponent, paving new paths for time series analysis. By marrying traditional finance methods with the capabilities of machine learning, our study provides a novel contribution towards the future of time series data analysis.

Most mammals produce vocal sounds according to the myoelastic-aerodynamic (MEAD) principle, through self-sustaining oscillation of laryngeal tissues. 1 , 2 In contrast, cats have long been believed to produce their low-frequency purr vocalizations through a radically different mechanism involving active muscle contractions (AMC), where neurally driven electromyographic burst patterns (typically at 20-30 Hz) cause the intrinsic laryngeal muscles to actively modulate the respiratory airflow. Direct empirical evidence for this AMC mechanism is sparse. 3 Here, the fundamental frequency (f o ) ranges of eight domestic cats (Felis silvestris catus) were investigated in an excised larynx setup, to test the prediction of the AMC hypothesis that vibration should be impossible without neuromuscular activity, and thus unattainable in excised larynx setups, which are based on MEAD principles. Surprisingly, all eight excised larynges produced self-sustained oscillations at typical cat purring rates. Histological analysis of cat larynges revealed the presence of connective tissue masses, up to 4 mm in diameter, embedded in the vocal fold. 4 This vocal fold specialization appears to allow the unusually low f o values observed in purring. While our data do not fully reject the AMC hypothesis for purring, they show that cat larynges can easily produce sounds in the purr regime with fundamental frequencies of 25 to 30 Hz without neural input or muscular contraction. This strongly suggests that the physical and physiological basis of cat purring involves the same MEAD-based mechanisms as other cat vocalizations (e.g., meows) and most other vertebrate vocalizations but is potentially augmented by AMC., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Financial Disclosure Alisa Beth Goldberg disclosed that money was paid to her institution from Merck and to her directly from UpToDate. Isabel Fulcher received payment as a statistical consultant at Planned Parenthood League of Massachusetts. Jennifer Fortin is employed by Planned Parenthood League of Massachusetts. Rebecca Hofer disclosed that she was employed as a research assistant during the time of the study. She received an hourly wage from Planned Parenthood, including for work related to the study discussed as well as for other studies. She is no longer employed there and received no compensation for reviewing and contributing to the manuscript. In addition, she owns a number of different independent stocks and mutual funds that she has had for many years prior to the current work. These were purchased by her and her family and are not related to the current research. Alex Cottrill disclosed that the original study the Letter to the Editor addresses was funded by a grant paid to the authors' institution from the Society for Family Planning Research Fund. Dr. Cottrill was employed full-time by Planned Parenthood League of Massachusetts (where this study was based) during the 36 months before the original submission. Dr. Cottrill's salary was partly funded by our SFPRF grant during that time. Dr. Cottrill is still on the payroll at PPLM per diem but has not been paid through that grant since. Daniele Roncari received payment from Organon as a trainer for Nexplanon. The other authors did not report any potential conflicts of interest.

Objective: Describe how a multiyear, mixed-methods evaluation informed the evolution of a healthy eating and physical activity social marketing campaign., Design: Focus groups, A/B survey to test messages and images, telephone interviews (2019) with local programmers, and an annual outcome survey., Setting: Statewide through multiple channels: billboards, transit signs, social media, website, and program resources like banners and posters., Participants: Supplemental Nutrition Assistance Program-Education eligible adults, focusing on mothers and caregivers., Intervention(s): Healthy Choices Catch On originally launched in 2006 and has since evolved., Main Outcome Measure(s): Fruit and vegetable consumption, physical activity, and campaign recall., Analysis: Univariate descriptive statistics and multivariate, weighted linear regression modeling. Interview transcriptions were analyzed for common themes., Results: The multiyear evaluation demonstrated a steady increase in campaign exposure from 2013 to 2017, followed by a decline when new messages and images were introduced in 2018 and 2020. People with greater exposure to messages were more likely to eat more fruits and vegetables and be physically active., Conclusions and Implications: Using a combination of evaluation methods can help inform campaign design and evolution while also demonstrating reach and impact., (Copyright © 2022 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs)., Methods: Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter "revision rate per 100 observed component years (CYs)" was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs., Results: A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected., Conclusion: Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described., Level of Evidence: Level III, systematic review of level III studies.

Background Apneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation.  Aims/objectives The authors sought to determine if apneic oxygenation using a high-flow nasal cannula could be used as a safe alternative airway management strategy for the duration of select laryngotracheal procedures. Methods Single institution, multi-site retrospective review of 38 adult (>18 years old) patients undergoing apneic oxygenation in the setting of various laryngotracheal procedures from January 2017 through January 2018. Humidified oxygen was delivered via a high-flow nasal cannula. The data was collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC). Results Twenty-four women and 14 men, mean age 60.0 years (SD 16.1; 36-89) and 70.1 years (SD 7.2; 56-81), respectively, underwent a mean total apneic time of 23.9 minutes (13-40). A statistically significant correlation existed between apneic time and minimum oxygen saturation (Pearson correlation coefficient 0.38; p=0.018). Twenty-one patients resumed spontaneous ventilation without the need for jet ventilation, mask ventilation, or placement of a definitive airway during the procedure.  Conclusions and significance Apneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Rutt et al.)

Previous studies have detected numerous organic contaminants and in vitro bioactivities in surface water from the South Platte River near Denver, Colorado, USA. To evaluate the temporal and spatial distribution of selected contaminants of emerging concern, water samples were collected throughout 2018 and 2019 at 11 sites within the S. Platte River and surrounding tributaries with varying proximities to a major wastewater treatment plant (WWTP). Water samples were analyzed for pharmaceuticals, pesticides, steroid hormones, and wastewater indicators and screened for in vitro biological activities. Multiplexed, in vitro assays that simultaneously screen for agonistic activity against 24 human nuclear receptors detected estrogen receptor (ER), peroxisome proliferator activated receptor-gamma (PPARγ), and glucocorticoid receptor (GR) bioactivities in water samples near the WWTP outflow. Targeted in vitro bioassays assessing ER, GR, and PPARγ agonism corroborated bioactivities for ER (up to 55 ± 9.7 ng/L 17β-estradiol equivalents) and GR (up to 156 ± 28 ng/L dexamethasone equivalents), while PPARγ activity was not confirmed. To evaluate the potential in vivo significance of the bioactive contaminants, sexually-mature fathead minnows were caged at six locations upstream and downstream of the WWTP for 5 days after which targeted gene expression analyses were performed. Significant up-regulation of male hepatic vitellogenin was observed at sites with corresponding in vitro ER activity. No site-related differences in GR-related transcript abundance were detected in female adipose or male livers, suggesting observed environmental concentrations of GR-active contaminants do not induce a detectable in vivo response. In line with the lack of detectable targeted in vitro PPARɣ activity, there were no significant effects on PPARɣ-related gene expression. Although the chemicals responsible for GR and PPAR-mediated bioactivities are unknown, results from the present study provide insights into the significance (or lack thereof) of these bioactivities relative to short-term in situ fish exposures., (Published by Elsevier Ltd.)

Niederreiter and Halton sequences are two prominent classes of higher-dimensional sequences which are widely used in practice for numerical integration methods because of their excellent distribution qualities. In this paper we show that these sequences-even though they are uniformly distributed-fail to satisfy the stronger property of Poissonian pair correlations. This extends already established results for one-dimensional sequences and confirms a conjecture of Larcher and Stockinger who hypothesized that the Halton sequences are not Poissonian. The proofs rely on a general tool which identifies a specific regularity of a sequence to be sufficient for not having Poissonian pair correlations., (© The Author(s) 2021.)

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings. In the context of a clinical forensic examination, physical findings are recorded and biological trace material is gathered and secured. Ideally, all forensic findings are documented in a detailed report combined with photographic documentation, which employs a forensic scale to depict the size of the injuries. However, the integrity of such forensic findings depends particularly on two factors. First, the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence. Second, the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time. Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union (EU); in some states, they are not available at all. As part of the JUST e U! ( Ju ridical st andards for clinical forensic examinations of victims of violence in Eu rope) project, the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria created (in cooperation with its international partner consortium) a questionnaire: the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU. Our paper provides a summary of the responses and an overview of the current situation concerning provided clinical forensic services., (© 2019 The Author(s). Published by Taylor & Francis Group on behalf of the Academy of Forensic Science.)

The fluid mechanics of whistling involve the instability of an air jet, resultant vortex rings, and the interaction of these rings with rigid boundaries (see http://www.canal-u.tv/video/cerimes/etude&#95;radiocinematographique&#95;d&#95;un&#95;siffleur&#95;turc&#95;de&#95;kuskoy.13056 and Meyer J. Whistled Languages. Berlin, Germany: Springer, 2015, p. 74-774). Experimental models support the hypothesis that the sound in human whistling is generated by a Helmholtz resonator, suggesting that the oral cavity acts as a resonant chamber bounded by two orifices, posteriorly by raising the tongue to the hard palate, and anteriorly by pursed lips (Henrywood RH, Agarwal A. Phys Fluids 25: 107101, 2013). However, the detailed anatomical changes in the vocal tract and their relation to the frequencies generated have not been described in the literature. In this study, videofluoroscopic and simultaneous audio recordings were made of subjects whistling with the bilabial (i.e., "puckered lip") technique. One whistling subject was also recorded, using magnetic resonance imaging. As predicted by theory, the frequency of sound generated decreased as the size of the resonant cavity increased; this relationship was preserved throughout various whistling tasks and was consistent across subjects. Changes in the size of the resonant cavity were primarily modulated by tongue position rather than jaw opening and closing. Additionally, when high-frequency notes were produced, lateral chambers formed in the buccal space. These results provide the first dynamic anatomical evidence concerning the acoustic production of human whistling. NEW & NOTEWORTHY We establish a new and much firmer quantitative and physiological footing to current theoretical models on human whistling. We also document a novel lateral airflow mechanism used by both of our participants to produce high-frequency notes.

The voice of humans and most non-human mammals is generated in the larynx through self-sustaining oscillation of the vocal folds. Direct visual documentation of vocal fold vibration is challenging, particularly in non-human mammals. As an alternative, excised larynx experiments provide the opportunity to investigate vocal fold vibration under controlled physiological and physical conditions. However, the use of a full larynx merely provides a top view of the vocal folds, excluding crucial portions of the oscillating structures from observation during their interaction with aerodynamic forces. This limitation can be overcome by utilizing a hemi-larynx setup where one half of the larynx is mid-sagittally removed, providing both a superior and a lateral view of the remaining vocal fold during self-sustained oscillation. Here, a step-by-step guide for the anatomical preparation of hemi-laryngeal structures and their mounting on the laboratory bench is given. Exemplary phonation of the hemi-larynx preparation is documented with high-speed video data captured by two synchronized cameras (superior and lateral views), showing three-dimensional vocal fold motion and corresponding time-varying contact area. The documentation of the hemi-larynx setup in this publication will facilitate application and reliable repeatability in experimental research, providing voice scientists with the potential to better understand the biomechanics of voice production.

Shooting samples were produced on standard textile pats of six different ammunition types: four ammunitions with exclusively infrared luminescent propellant powder particles, one containing a mixture of luminescent and non-luminescent particles and one with only non-luminescent particles. Unburned propellant powder particles in the gunshot residue (GSR) on the textile of each sample were transferred onto TLC-plates with the aid of an organic solvent. The patterns of the partially and the all-luminescent propellant powder residue on the TLC-plates were visualized in the near infrared wavelength range by the aid of an IR-sensitive camera. The transfer TLC-plates of all six ammunition types were sprayed with a diphenylamine solution, which reacts with the nitrate groups of the nitrocellulose and nitroglycerine and produces deep blue dots thereof. A series of samples with different shooting distances produced with one of the ammunition types was used for the shooting distance determination study. Transfer on TLC-plates was performed and pictures of the plates were taken before and after the chemical reaction. An imaging software was used to measure the density of the particles on the transfer TLC-plate pictures within a defined area around the bullet hole. Curves were drawn with the particle density data vs. the shooting distance. It has been shown, that the transfer of the particles onto a TLC-plate and the chemical reaction eliminate the limitations of the IR-method presented in Part I. Therefore, this method allows shooting distance determination at any textile and for any ammunition type as soon as unburned propellant powder particles are left on the target tissue., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Clinical forensic imaging encompasses the diverse application of imaging procedures that serve the same purpose: to enable the analysis and investigation of criminal activities and consequences of a crime. All kinds of imaging techniques and their corresponding images can be subsumed under "forensigraphy", a more comprehensive term for forensic imaging created by the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria. As the word forensigraphy suggests, criminal imaging material should be of use in forensic investigations. Ideally, this can lead to new findings that would not have been revealed without the application of imaging techniques and are moreover admissible as evidence in criminal proceedings. However, the admissibility of evidence can only be facilitated through the implementation of clinical forensic imaging techniques into the forensic routine case work, which requires a precise pre-analysis of the corresponding legal framework. Because taking and displaying internal images of a person's body touches upon various aspects of one's physical and psychological integrity, imaging methods in general and clinical forensic imaging methods especially have a strong impact on and interfere regularly with the fundamental rights of the concerned person. Particularly with regard to a possible medical context, certain legal regulations have to be taken into account. Therefore, this paper examines forensic imaging in the field of radiological forensigraphy, specifically its in vivo (i.e. clinical) application. It is designed to enlighten readers as to the great significance of legal barriers that emerge from fundamental rights, as laid down in the European Convention on Human Rights (ECHR), when dealing with clinical forensic imaging. As a result, the legal framework of clinical forensic imaging procedures are comprehensively described, the relevant fundamental rights, especially the right to respect for private and family life, the right to data protection and certain procedural guarantees, are concisely presented to further raise awareness regarding the importance of fundamental rights.

Objective: In a randomized controlled trial we compared two models of community health worker-led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models., Method: Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c., Results: A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence ( p = .024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel-Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators., Conclusions: Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants' satisfaction with information provided on diabetes medications and not just improving their knowledge about medications. Future research should explore in more depth other possible mediators and moderators of improvements in medication adherence in low-income minority populations.

Unburned propellant powder particles in gunshot residue (GSR) were detected at near infrared by optical excitation in the visible wavelength range. A series of ammunition (different brands and different manufacturers) was analyzed concerning the luminescence of their propellant. Shooting target samples with different shooting distances were produced on standard textile tissue and analyzed with this optical infrared inspection. The number of luminescent GSR particles per area was measured and curves with particle density vs. shooting distance were drawn. The method was applied on three ammunition types with different particle morphology shot with a pistol and one ammunition type shot with a revolver. The shooting series performed with the revolver showed a large particle density variation within the samples of identical shooting distances. In this case, the ratio of the amount of particles within the area around the bullet hole and within a ring with a defined distance from the bullet hole was calculated. These data resulted in measures with much lower standard deviations, which is a prove that the distribution pattern depends on the shooting distance and not on the amount of GSR particles. It has been shown, that imaging of target tissue with the aid of infrared luminescence is an easy, fast, reproducible and non-destructive method for shooting-distance determination., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Few opportunities exist for early learners to engage in authentic roles on health care teams. In a geriatric optimization clinic for frail high-risk surgical patients, first-year medical and nurse practitioner students were integrated into an interprofessional team as health coaches., Materials and Methods: Frail surgical patients with planned operations were referred to a new preoperative optimization clinic to see a geriatrician, occupational, and physical therapists and a nutritionist. A curriculum for health coaching by early learners was developed, implemented, and evaluated in this clinic. Students attended the clinic visit with their patient, reviewed the interdisciplinary care plan, and called patients twice weekly preoperatively and weekly in the first month after discharge. Students logged all calls, completed patient satisfaction surveys 1 wk before surgery and participated in feedback sessions with team members and medical school faculty. Call success rate was calculated, and team communications were recorded and analyzed., Results: Median call success rate was 69.2% and was lowest among medical students (P = 0.004). Students and research assistants contacted or facilitated patient contact with their medical team 84 times. Overall, patients were extremely satisfied with the health coach experience, felt better prepared for surgery, and would recommend the program to others., Conclusions: Early medical and nurse practitioner students can serve the important function of health coaches for frail patients preparing for surgery. Motivated students benefited from a unique longitudinal experience and gained skills in communication and care coordination. Not all students demonstrated capacity to engage in health coaching this early in their education., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products., Methods: A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data., Results: Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results., Conclusion: Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted.

The evolution of the levels of tobacco-specific N-nitrosamines (TSNA), N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in mainstream (MS) cigarette smoke is investigated based on smoke and tobacco chemistry data of cigarette brands sold by Philip Morris International (PMI) between 2000 and 2014. A total of 315 cigarette samples representing a wide range of product and design characteristics manufactured by PMI between 2008 and 2014 were analyzed and compared to a previously published dataset of PMI brands manufactured in 2000. The data indicate that there is a substantial reduction of NNN and NNK levels in tobacco fillers and MS cigarette smoke per mg of tar and per mg of nicotine using Health Canada Intense (HCI) machine-smoking regime. This observed reduction in NNN and NNK levels in MS cigarette smoke is also supported by the downward trend observed on NNN and NNK levels in USA flue-cured Virginia and Burley tobacco lots from 2000 to 2014 crops, reflecting effectiveness of measures taken on curing and agricultural practices designed to minimize TSNA formation in tobacco., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Systemic opioids are immunosuppressive, which could promote tumour recurrence. We, therefore, test the hypothesis that supplementing general anaesthesia with neuraxial analgesia improves long-term oncological outcomes in patients having radical prostatectomy for adenocarcinoma., Methods: Patients who had general anaesthesia with neuraxial analgesia (n=1642) were matched 1:1 based on age, surgical year, pathological stage, Gleason scores, and presence of lymph node disease with those who had general anaesthesia only. Medical records were reviewed. Outcomes of interest were systemic cancer progression, recurrence, prostate cancer mortality, and all-cause mortality. Data were analysed using stratified proportional hazards regression, the Kaplan-Meier method, and log-rank tests. The median follow-up was 9 yr., Results: After adjusting for comorbidities, positive surgical margins, and adjuvant hormonal and radiation therapies within 90 postoperative days, general anaesthesia only was associated with increased risk for systemic progression [hazard ratio (HR)=2.81, 95% confidence interval (CI) 1.31-6.05; P=0.008] and higher overall mortality (HR=1.32, 95% CI 1.00-1.74; P=0.047). Although not statistically significant, similar findings were observed for the outcome of prostate cancer deaths (adjusted HR=2.2, 95% CI 0.88-5.60; P=0.091)., Conclusions: This large retrospective analysis suggests a possible beneficial effect of regional anaesthetic techniques on oncological outcomes after prostate surgery for cancer; however, these findings need to be confirmed (or refuted) in randomized trials., (© The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Changes in the prevalence of obesity of surgical patients overtime and in relation to the general population have not been well characterized., Methods: Height, weight, age and gender data of adult patients who underwent general anesthesia at our institution were abstracted. Reliable data was available for the years 1989-1991 and 2006-2008, and comparisons were made between these epochs. Additional comparisons were made between our Minnesota surgical patients and the general Minnesota population., Results: Substantial changes in patient weight occurred with a decline in normal weight patients (body mass index [BMI] < or =25.0) from 41.6% to 30.9% (P <0.001), while the prevalence of obesity (BMI 30-34.9) increased from 14.9% to 20.6% (P <0.001) and morbidly obesity (BMI > 35) from 7.1% to 14.8% (P <0.001). Minnesota surgical patients had a higher prevalence of obesity in every demographic category (P <0.001) compared to the general population., Conclusion: A substantial increase in the prevalence of obesity and morbid obesity among surgical patients at our institution occurred and the prevalence of obesity in our contemporary practice is higher than the general population. These observations most likely have profound implications on healthcare delivery resources, though its impact has yet to be determined.

The possibility of achieving experimentally controlled, non-vocal acoustic production in non-human primates is a key step to enable the testing of a number of hypotheses on primate behavior and cognition. However, no device or solution is currently available, with the use of sensors in non-human animals being almost exclusively devoted to applications in food industry and animal surveillance. Specifically, no device exists which simultaneously allows: (i) spontaneous production of sound or music by non-human animals via object manipulation, (ii) systematical recording of data sensed from these movements, (iii) the possibility to alter the acoustic feedback properties of the object using remote control. We present two prototypes we developed for application with chimpanzees (Pan troglodytes) which, while fulfilling the aforementioned requirements, allow to arbitrarily associate sounds to physical object movements. The prototypes differ in sensing technology, costs, intended use and construction requirements. One prototype uses four piezoelectric elements embedded between layers of Plexiglas and foam. Strain data is sent to a computer running Python through an Arduino board. A second prototype consists in a modified Wii Remote contained in a gum toy. Acceleration data is sent via Bluetooth to a computer running Max/MSP. We successfully pilot tested the first device with a group of chimpanzees. We foresee using these devices for a range of cognitive experiments.

Background: Many medical exams use 5 options for multiple choice questions (MCQs), although the literature suggests that 3 options are optimal. Previous studies on this topic have often been based on non-medical examinations, so we sought to analyse rarely selected, 'non-functional' distractors (NF-D) in high stakes medical examinations, and their detection by item authors as well as psychometric changes resulting from a reduction in the number of options., Methods: Based on Swiss Federal MCQ examinations from 2005-2007, the frequency of NF-D (selected by <1% or <5% of the candidates) was calculated. Distractors that were chosen the least or second least were identified and candidates who chose them were allocated to the remaining options using two extreme assumptions about their hypothetical behaviour: In case rarely selected distractors were eliminated, candidates could randomly choose another option--or purposively choose the correct answer, from which they had originally been distracted. In a second step, 37 experts were asked to mark the least plausible options. The consequences of a reduction from 4 to 3 or 2 distractors--based on item statistics or on the experts' ratings--with respect to difficulty, discrimination and reliability were modelled., Results: About 70% of the 5-option-items had at least 1 NF-D selected by <1% of the candidates (97% for NF-Ds selected by <5%). Only a reduction to 2 distractors and assuming that candidates would switch to the correct answer in the absence of a 'non-functional' distractor led to relevant differences in reliability and difficulty (and to a lesser degree discrimination). The experts' ratings resulted in slightly greater changes compared to the statistical approach., Conclusions: Based on item statistics and/or an expert panel's recommendation, the choice of a varying number of 3-4 (or partly 2) plausible distractors could be performed without marked deteriorations in psychometric characteristics.

Objective: Review of published studies of birth defects of the renal, liver, and gastrointestinal organ systems in subjects with fetal alcohol spectrum disorders (FASD)., Method: We searched PubMed (http://www.pubmed.gov) using the following terms: fetal alcohol syndrome and: gastrointestinal tract, kidney, liver, and congenital abnormalities for all years and English only citations., Results: We located 12 studies of FASD and defects of or functional impairments for the liver, 12 of renal abnormalities, and only two with gastrointestinal defects. We did not identify specific patterns of malformations or functional deficits for any of the three organ systems. The existing literature suggests a series of nonspecific outcomes in FASD., Conclusions: Fetal alcohol spectrum disorder includes a diagnostic category of alcohol-related birth defects which is clinically difficult to apply. This study adds to the existing literature on birth defects in FASD which is still very limited. The categorical diagnosis of alcohol-related birth defects requires additional research to determine if a specific pattern of organ specific abnormalities or functional deficits emerges in subjects with FASD., ((c) 2009 Wiley-Liss, Inc.)

Background: The objective of this study was a review of published studies utilizing measurement of fatty acid ethyl esters (FAEE) in meconium as biomarkers for prenatal alcohol exposure., Methods: We completed a literature search of PubMed using the terms meconium, fatty acid ethyl esters, biomarkers, and prenatal alcohol exposure. We included only peer reviewed studies utilizing analysis of meconium for the presence of FAEE in humans through the year 2007., Results: We found 10 articles reporting on original research examining the relationship of FAEE from meconium and prenatal alcohol exposure (PAE). The 10 articles used six different PAE assessment strategies and four different analytical techniques for determining FAEE endpoints. The articles included 2,221 subjects (range 4 to 725) with 455 (20.5%) subjects identified as exposed using the methods stated in the articles. FAEE levels above the studies' respective cutoffs were reported for 502 (22.6%) subjects., Conclusions: The accurate identification of alcohol-exposed pregnancies represents a significant challenge in the development of FAEE detection cutoffs to maximize the sensitivity and specificity of the test. We present several options for the improvement of exposure assessment in future studies of FAEE as biomarkers for PAE., ((c) 2008 Wiley-Liss, Inc.)

The present study describes in detail, for the first time, a case of failure with multiplication procedures in a right hemisphere damaged patient (PN). A careful, step-by-step, error analysis made possible to show that an important portion of PN's errors could be better explained as spatial in nature and specifically related to the demands of a multi-digit multiplication. These errors can be distinguished from other types of errors, including those, expected after a right hemisphere lesion, determined by a generic inability to deal with spatial material, or from other deficits, like neglect, affecting cognitive capacities across the board. The best explanation for PN's problems is that he might have difficulties in relying on a visuo-spatial store containing a layout representation specific to multiplication. As a consequence, while knowing what, when and how to carry out the various steps, PN does not know where. What he may thus lack is a spatial schema of multiplication. Such schema is thought to help normal calculators in overcoming working memory demands of complex calculation by representing the information of where exactly each sub-step should be placed.

We analyzed the accumulation of inorganic and organic toxicants in tadpoles from nine populations of the common frog (Rana temporaria) at different altitudes of the Hohe Tauern National Park in Austria). Lead and cadmium concentrations in tadpoles increased with the acidity and metal-to-HCO3(-) ratio in the water exceeding those found in tadpoles from agricultural areas. Organochlorines (DDTs, polychlorinated biphenyls, lindane) and polyaromatic hydrocarbons were present in all of the populations, but only DDTs accumulated significantly compared with the concentrations in their diet.

In this paper we describe a case in which a cash book, dated of the year 2000, was sent to the Forensic Science Division, Document Laboratory, Zurich Canton Police in March 2003. The questioned document was a list of 29 pages containing a consecutive handwritten numbering and dated entries (payments) made of blue ballpoint pen ink. By definition, a cash book has to be written by hand and the entries have to be made daily. The questioned document was suspected to have been written within a short period (e.g., a few hours) and backdated. The document lab was asked to determine the date of the entries of the questioned list. On one hand, we were asked, if the cash book had been kept on account consecutively during the period of one year, and on the other hand, the judges were interested in knowing, if the document could have been written in 2003 and back dated to 2000. To answer these questions, the document was examined for latent elements by electrostatic detection device (ESDA). The relative dating of the entries was performed by the quantification of the ballpoint pen ink dyes and their degradation products using HPLC. Results show that it is possible to determine the relative age of entries written by ballpoint pen within a relatively short time scale, if storage and supporting material of the different samples are the same or at least similar.

Leaf ozone symptoms in natural ecosystems are increasingly reported but ozone effects on tree growth and the mediation of site conditions are still little documented. This study tests two hypotheses: (1) leaf injury in black cherry is associated with decline in radial growth, (2) symptoms are more prevalent on mesic sites. On sites supporting black cherry across Massachusetts, tree growth and leaf ozone injury were surveyed in 1996 using a randomized plot network established in the 1960s. Forty-seven percent of 120 trees sampled for ozone symptoms were symptomatic with generally low levels of injury. Over a 31-year period symptomatic trees had 28% lower stem growth rates than asymptomatic trees. Ozone symptom expression was enhanced in well growing stands on moister, cooler and more elevated sites. Ozone appeared to increase environmental stress and had a more pronounced effect on growth in better growing black cherry stands. This complicates management decisions as thinning increases growth and moisture availability.

Proper name anomia is a frequent finding among patients in the early stages of Alzheimer's disease. The present study investigates naming of famous persons in a group of DAT patients, a group of persons with mild cognitive impairment (MCI) and healthy controls. The study is aimed at distinguishing the relative contributions of semantic and post-semantic factors to difficulties in proper name retrieval. As shown by a significantly lower score in answering semantic questions, DAT patients retrieve less biographical knowledge related to famous persons than healthy elderly subjects and persons with mild cognitive impairment. This finding is in line with the frequent observation of semantic deficits in early and moderate DAT. The high number of Tip-of-the-Tongue (TOT) answers in DAT found in relation to few spontaneously named items shows that post-semantic deficits are as important as semantic deficits in determining anomia for people names in DAT. Moreover, DAT patients were less sensitive to phonological cueing than healthy persons or persons with mild cognitive impairment. These findings suggest that proper name anomia in DAT is not only due to semantic deficits, but also to problems in accessing the phonological representation, as well as to a degradation of phonological representations. Thus, naming deficits in DAT differ not only quantitatively, but also qualitatively from the difficulties of healthy elderly persons. No significant differences were found between persons with mild cognitive impairment and healthy controls in proper name retrieval.

The study of fish concentrations and sediment inventories in 19 European high mountain lakes (40-67 degrees N) shows that a fraction of organochlorine compounds (OCs), the less volatile compounds (LVC; subcooled liquid vapor pressure < or = 10(-2.5) Pa), are trapped in the higher locations. This general trend is not significantly influenced by possible local sources. Compound distribution is related to average air temperatures. The phase-change pseudoenthalpies calculated from the sediment inventories closely match the summed theoretical volatilization and dissolution enthalpies. This fractionation effect is responsible for the accumulation of high concentrations of the LVC, the more persistent and toxic according to literature data, in organisms inhabiting sites far from the locations of synthesis or use.

The common frog, Rana temporaria, spawning at altitudes up to 2600 m, is potentially threatened by UVB radiation. In laboratory experiments we found a specifically UVB absorbing substance (UVAS) in the skin of tadpoles with maximum absorption between 290 and 300 nm. The production of UVAS is induced by both visible light and ultraviolet radiation. The concentrations of UVAS found in tadpoles from the field are about as high as those found in tadpoles from laboratory experiments with UVB radiation under simulated mid-summer conditions. The existence of two powerful sun screen factors (UVAS and melanin pigmentation) may explain the high resistance of R. temporaria tadpoles to the intensive UVB radiation at high altitudes.

Objective: On 01-01-99 the new driving licence regulations came into force. Are the visual field criteria mentioned there sufficient for an adequate evaluation of driving fitness?, Methods: Typical (binocular) visual field defects were digitally superimposed onto photographs of traffic scenes to show the influence of such scotomata on visual perception., Results: Exemplary cases clearly show that evaluation of visual field borders alone is not sufficient for evaluating driving fitness. They also prove that binocular scotomata affecting the (para-)central region of the visual field are of special importance to driving performance. The actual guidelines given by the traffic commission of the German Ophthalmological Society (DOG) and the legally defined limits will be critically discussed., Conclusion: From the ophthalmological point of view the actual visual field criteria of the new driving licence regulations do not seem to be sufficient for the evaluation of driving fitness: An additional consideration of (para-)central scotoma is mandatory. This publication provides recommendations for execution and interpretation of perimetric examinations for traffic ophthalmological purposes.

This retrospective study was designed to compare the cost of anesthesia in three different groups of patients who received general anesthesia for a diagnostic dilatation and curettage procedure. The analysis included 194 patients, ASA physical status I, II, or III. All patients were outpatients with similar body mass index and age. The three groups were thiopental/isoflurane (n = 13), propofol/isoflurane (n = 126), and propofol/desflurane (n = 55). Anesthesia drugs, volatile agents, personnel costs, and type of providers were included in the cost comparison. The cost of supplies, inhalation agents, and drugs for the thiopental/isoflurane group were significantly different (P < .001) than the other two groups. The mean +/- SD thiopental/isoflurane combination was $7.00 +/- $2.74, whereas, the mean +/- SD cost of the propofol/isoflurane and propofol/desflurane groups was $12.73 +/- $3.57 and $14.40 +/- $5.05, respectively. The mean +/- SD cost of all three anesthetic drugs/volatile agents/endotracheal tube groups was $12.85 +/- $4.35. No statistically significant differences between the three groups were found in postanesthesia care unit (PACU) drug costs, anesthesia personnel cost, total direct anesthesia costs, or length of stay. The incidence of antiemetic administration intraoperatively and in PACU was significantly different (P < .001) between the thiopental/isoflurane group and the other groups. The thiopental/isoflurane group did not receive any antiemetics in either area, whereas the propofol groups received antiemetics 12.7% of the time. The three anesthesia providers, Certified Registered Nurse Anesthetists, student registered nurse anesthetists (SRNA), and anesthesia residents were reviewed looking at anesthesia supply cost, personnel cost, and total direct anesthesia costs. No statistically significant differences were found between the groups. We conclude that an anesthetic using thiopental/isoflurane is more cost-effective than propofol/desflurane or propofol/isoflurane anesthetics and the postoperative length of stay is no different for the three anesthetic approaches.

As a consequence of atmospheric deposition, effects of pollutants such as acidification and metal contamination are evident even in remote aquatic ecosystems of mountain and polar regions. Due to similar environmental characteristics (e.g., oligotrophy, low buffering capacity, long ice-cover, high precipitation rates), clearwater high altitude and high latitude lakes represent very sensitive ecosystems, which are extremely susceptible to even slight changes of the environment. Thus, the environmental relevance of Cd and Pb for both types of lakes is discussed in relation to their extraordinary sensitivity to environmental changes. The impact of Cd and Pb on fish from high altitude and high latitude lakes is reviewed and biotic and abiotic factors controlling bioavailability and toxicity of metals to fish are summarized. Apart from direct toxic effects of low pH, acidification increases the bioavailability of metals for fish. Furthermore, low concentrations of dissolved organic carbon and suspended particles take influence on the uptake and toxicity of metals in fish from clear high altitude and high latitude lakes. Since even very low concentrations of Cd and Pb may result in high metal concentrations in fish, evaluation of critical metal loads for clear high altitude and high latitude lakes is of major importance.

Although Alpine newts (Triturus alpestris) are found at altitudes up to 2500 m, their larvae proved to be extremely sensitive to UV radiation when exposed in clear tapwater to natural sunlight or to comparable artificial UV-B radiation in the laboratory. The experiments revealed severe skin damages (lysis of epithelial cells) and mortality after a few days of exposure. In their natural habitats above the timberline, however, the larvae are protected by the high concentration of dissolved organic carbon in the water leading to an almost complete absorption of UV radiation within the first few centimeters of the water layer. Furthermore, when exposed to UV radiation larvae show erratic swimming activities that may carry them into protected areas. Only in very shallow natural habitats did we detect sublethal UV-like histological effects. Shallow high mountain ponds with clear water normally lack newt populations, probably as a consequence of both low temperature and the effects of UV radiation.

In order to establish defined immunological parameters for Q fever infection models, a microtitre enzyme-linked immunosorbent fluorescence assay (ELISA) was used for the first time to analyse the humoral immune response of Balb/cJ and C57BL/6J mice after experimental infection with Coxiella burnetii strain 'Nine Mile' in phase I. The experimental infection evoked a seroconversion in all mice within 10 days. Typically, the immune response measured against the whole-cell antigen showed an early increase of immunoglobulin (Ig) M followed by a later increase of the IgG subclasses. The IgA was low during the entire investigation period. Within the IgG subclasses only IgG2a and IgG2b gained higher values, whereby C57BL/6J mice produced high IgG2b titres and significantly lower IgG2a titres. In contrast, Balb/cJ mice developed IgG2a and IgG2b at equal levels. The use of partial antigens of C. burnetii demonstrated that the dominating IgG2b reaction of the C57BL/6J mice was directed against the lipopolysaccharide (LPS) of C. burnetii. This reaction was almost absent in Balb/cJ mice. In contrast, the SP27 protein antigen did not evoke different IgG2b reactions within the two breeds. No significant influence was observed within the two breeds in regard to sex or between hormone synchronized and non-hormone synchronized animals.

Antifungal class I [beta]-1,3-glucanases are believed to be part of the constitutive and induced defenses of plants against fungal infection. Unexpectedly, mutants deficient in these enzymes generated by antisense transformation showed markedly reduced lesion size, lesion number, and virus yield in the local-lesion response of Havana 425 tobacco to tobacco mosaic virus (TMV) and of Nicotiana sylvestris to tobacco necrosis virus. These mutants also showed decreased severity of mosaic disease symptoms, delayed spread of symptoms, and reduced yield of virus in the susceptible response of N. sylvestris to TMV. The symptoms of disease in the responses of both plant species were positively correlated with [beta]-1,3-glucanase content in a series of independent transformants. Taken together, these results provide direct evidence that [beta]-1,3-glucanases function in viral pathogenesis. Callose, a substrate for [beta]-1,3-glucanase, acts as a physical barrier to the spread of virus. Callose deposition in and surrounding TMV-induced lesions was increased in the [beta]-1,3-glucanase-deficient, local-lesion Havana 425 host, suggesting as a working hypothesis that decreased susceptibility to virus resulted from increased deposition of callose in response to infection. Our results suggest novel means, based on antisense transformation with host genes, for protecting plants against viral infection. These observations also raise the intriguing possibility that viruses can use a defense response of the host against fungal infection[mdash]production of [beta]-1,3-glucanases[mdash]to promote their own replication and spread.

Background: Hyperglycemia associated with diabetes mellitus will exacerbate neurologic injury after global brain ischemia. Studies in a rat model of forebrain ischemia (bilateral carotid occlusion plus hypotension for 10 min) discovered that acute restoration of normoglycemia in diabetics, using an insulin infusion, resulted in a neurologic outcome that was similar to normoglycemic rats without diabetes. The current study evaluated cerebral glucose, glycogen, lactate, and high-energy phosphate concentrations to identify metabolic correlates that might account for an alteration in postischemic outcome., Methods: Fifty-four pentobarbital-anesthetized Sprague-Dawley rats were assigned to three groups: chronically hyperglycemic diabetic rats (D; N = 18); insulin-treated, acutely normoglycemic diabetic rats (ID; N = 18); and nondiabetic rats (ND; N = 18). These groups were further divided into groups of six rats each that received either no ischemia, forebrain ischemia of 10 min duration without reperfusion, or ischemia plus 15 min of reperfusion. Brains were excised after in situ freezing, and metabolites were measured using enzymatic fluorometric techniques., Results: Before ischemia, D rats had greater concentrations of brain glucose (12.18 +/- 2.67 micromol/g) than did either ID (5.10 +/- 1.33) or ND (3.20 +/- 0.27) rats (P < 0.05). Preischemic brain glycogen was similar in all groups. At the completion of ischemia, brain lactate concentrations in D were 86% greater than in ID and 61% greater than in ND (P < 0.05), reflecting a higher intraischemic consumption of glucose plus glycogen in D (P < 0.05). High-energy phosphate concentrations, as assessed by the energy charge of the adenylate pool, were better preserved in D (energy charge = 0.60 +/- 0.28) than in either ID (0.29 +/- 0.09) or ND (0.36 +/- 0.07; P < 0.05) rats. After 15 min of reperfusion, the energy charge returned to preischemic values (i.e., 0.91-0.92) in all groups., Conclusions: These studies demonstrated greater intraischemic carbohydrate consumption and lactate production in D than in ID or ND rats. Under these conditions, intraischemic-but not postischemic-energy status was better in D rats. Acute insulin therapy in ID rats resulted in a metabolic profile that was similar to that of ND rats. These results suggest that, in this model, primary energy failure during ischemia is not the origin of greater injury in hyperglycemic diabetics, nor is energy enhancement the origin of improved outcome after acute insulin treatment.

Malignant hyperthermia (MH) is a rare genetic trait characterized by potential life-threatening episodes of hypermetabolism, hyperthermia, and muscle rigidity when susceptible humans or animals are exposed to triggering drugs. The role of norepinephrine (NE) in triggering MH is controversial. The purpose of this study was to show that NE does not initiate nor speed the onset of MH in susceptible swine exposed to known triggering drugs. Three groups of MH susceptible (MHS) pigs were exposed to two times the minimum alveolar anesthetic concentrations (MAC) halothane (2%) for 60 min and monitored continuously until a PaCO2 of 70 mm Hg was obtained as an end point for fulminant MH. This dose of halothane is associated with significant hypotension which was addressed by three modalities: no treatment; NE infusion at 8 micrograms.kg-1.min-1; and intraaortic balloon pump (IABP) with 1:1 augmentation (7.0-mL balloon catheter). NE and epinephrine (Epi) plasma levels were determined at 15-min intervals and at trigger time. All animals developed signs of MH during the study. There was no difference in pHa, lactate, PaCO2, or temperature at control or trigger times between groups. Time to trigger was longer in the untreated group compared to both the NE and the IABP groups which were equal. The NE group had greater NE and Epi plasma levels at all times than either the untreated or IABP group and the levels increased at each sample time. The IABP group had increased NE levels at time of trigger compared to control time period, however, Epi levels did not increase. In the untreated group, individual animals had marked increases in NE levels, but extreme variability in response prevented achievement of a single mean change. This group showed no increase in plasma Epi levels throughout the study. There was no difference in NE levels between the untreated and IABP groups. Three animals in the untreated group died prior to trigger due to complications of hypotension. In conclusion, addition of exogenous NE in high doses did not enhance triggering of MH. The large dose NE infusion resulted in increased total catecholamines throughout the study in the NE group with no effect on time to MH trigger compared to animals where mean arterial pressure (MAP) was maintained by IABP. Animals in all three groups with times to trigger of less than 30 min had significantly higher MAPs at control, 15 min, and trigger time than those with times to trigger of greater than 30 min. We conclude that NE does not trigger MH and that severe reduction of MAP delays the the onset of MH in susceptible swine.

The temporal relationship between intraocular pressure and extraocular muscle activation was studied in cats in response to the administration of the depolarizing muscle relaxant, succinylcholine (i.e. bolus doses of 0.1 and 1.0 mg/kg). Simultaneous changes in intraocular pressure, extraocular muscle force, extraocular electromyograms (EMGs), limb muscle EMGs and hindlimb muscle afferent activity were recorded. Increases in intraocular pressure were associated with extraocular muscle activation and had two components: (1) an initial abrupt increase (lasting seconds) which correlated with fasciculations within the extraocular and hindlimb muscles; and (2) a latter more sustained component (minutes) presumably due to tonic muscle activation which correlated with increases in hindlimb muscle afferent activity (e.g. due to sustained activation of bag 1 intrafusal fibers by succinylcholine). In a separate group of animals, in which the extraocular muscles were detached from the right eye bilateral intraocular pressures were measured: depolarization by succinylcholine caused a significant increase in intraocular pressure only for the eye with intact muscles. Thus, increases in intraocular pressure following the administration of succinylcholine are directly related to the changes in extraocular muscle tension which is dependent on both tonic and phasic muscle fiber responses.

Background: Changes in basal temperature of > or = 1 degree C (e.g., fever-induced hyperthermia or anesthesia-related hypothermia) are a common occurrence in neurologically impaired patients. The current study tested the hypothesis that temperature changes as small as 1 degree C or 2 degrees C would significantly alter post-ischemic functional neurologic outcome and cerebral histopathology. The hypothesis was tested in a canine model of transient, complete cerebral ischemia., Methods: After institutional approval, 21 dogs were randomly assigned to one of three temperature-specific groups: (1) a reference group maintained at 37.0 +/- 0.3 degree C (target temperature +/- range); (2) a 38.0 +/- 0.3 degree C group; or (3) a 39.0 +/- 0.3 degree C group (n = 7 per group). Complete cerebral ischemia 12.5 min in duration was produced using an established model of arterial hypotension plus intracranial hypertension. Right atrial and cranial (beneath the temporalis muscles) temperatures were maintained at the target value, beginning 20 min before ischemia and ceasing 1 h postischemia. Thereafter, temperatures were returned to 37.0 +/- 0.3 degree C in all dogs. After discharge from the intensive care environment, all dogs were placed in a temperature-controlled recovery area. Neurologic assessment was performed by a blinded observer at 24, 48, and 72 h postischemia using a 100-point scoring scale. After the 72 h examination (with the dogs anesthetized) or at the time of ischemia-related death, the brains were excised and preserved. The brains subsequently were histologically scored by a neuropathologist who was unaware of the treatment groups. All 21 dogs were included in the analysis of neurologic function; however, only dogs that survived for > or = 24 h postischemia were included in the histopathology analysis., Results: Dogs were well matched for systemic physiologic variables throughout the study, with the exception of temperature. During the 72 h postischemic examination, dogs maintained at 37 degrees C were either normal or near normal. In contrast, dogs maintained at 39 degrees C were either comatose or died from ischemia-related causes. Dogs maintained at 38 degrees C were intermediate between 37 degrees C and 39 degrees C dogs. When compared with the reference group, both 38 degrees C and 39 degrees C dogs had significantly worse neurologic function scores (P < 0.01 and < 0.001, respectively) and histopathology scores (P < 0.01 for both). There also was a significant correlation between neurologic function and histopathology rank scores (rs = 0.96; P < 0.001)., Conclusions: Small, clinically relevant changes in temperature (1 degree C or 2 degrees C) resulted in significant alterations in both postischemic neurologic function and cerebral histopathology. Assuming that our results are transferable to humans, the results suggest that, in patients at imminent risk for ischemic neurologic injury, body temperature should be closely monitored. Further, the clinician should aggressively treat all episodes of hyperthermia until the patient is no longer at risk for ischemic neurologic injury.

Background: Research has demonstrated that platelet activating factor may modulate, in part, the severity of postischemic neurologic injury. The proposed mechanism involves a platelet activating factor-mediated release of cerebral cellular lipids and free fatty acids, resulting in increased cerebral edema and cell injury. The present study tested the hypothesis that a specific platelet activating factor antagonist, BN 52021, would improve neurologic outcome after 12 min of complete global cerebral ischemia in a canine model., Methods: Using an established canine model of complete cerebral ischemia, dogs were assigned randomly to receive, in a blinded fashion, either 20 mg/kg BN 52021 intravenously (N = 8) or placebo (N = 7) 5 min before cerebral ischemia. After cerebral ischemia and recovery, neurologic assessment was performed by a blinded observer for 72 h. Immediately thereafter, the brains were harvested and later were evaluated histologically by a neuropathologist blinded to the treatment groups., Results: Dogs were well matched for systemic physiologic variables during all portions of the study. One placebo-treated dog and one BN 52021-treated dog were not included in the statistical analysis because of failure to meet preestablished protocol criteria. BN 52021, when compared to placebo, affected neither neurologic functional recovery nor overall histopathology scores. Regional histopathology was improved in BN 52021-treated dogs in only 1 of 18 brain regions studied (i.e., the parietal cortex). When both treatment groups were combined, there was a significant correlation between neurologic function rank and histopathology rank., Conclusions: The present data demonstrate that the platelet activating factor antagonist BN 52021, at a dose of 20 mg/kg intravenously given 5 min before cerebral ischemia, did not protect the brain from injury in this canine model of complete global ischemia.

Background and Methods: The effects of iv infusions of 6% hetastarch or 10% pentastarch on blood glucose concentrations were tested in 12 nondiabetic and 12 streptozotocin-induced diabetic pentobarbital-anesthetized Sprague-Dawley rats weighing 313 to 473 g. All rats were paralyzed and mechanically ventilated. After control measurements of blood glucose concentrations were taken, rats were divided into four groups. Groups 1 (n = 6) and 2 (n = 6) comprised nondiabetic rats that received iv infusions of hetastarch or pentastarch, respectively, at a rate of 2.0 mL over 30 mins. Groups 3 (n = 6) and 4 (n = 6) comprised diabetic rats that also received iv hetastarch or pentastarch, respectively, at the same rate and duration of infusion., Results: Neither hetastarch nor pentastarch infusions significantly altered blood glucose values over the 3-hr study period, regardless of whether the rats were diabetic or nondiabetic., Conclusions: Assuming these data are transferable to humans, the authors conclude that hydroxyethyl starch solutions do not produce or exacerbate hyperglycemia, and furthermore, that their use is not contraindicated in subjects having hyperglycemia from diabetes mellitus or iatrogenic causes.

In several investigations the authors tried to find a objective correlation to the subjective positive reactions after venting an earmold. There was no notable effect neither on insertion gain nor on speech intelligibility in different background noise situations. In this study the most comfortable hearing level has been used. This stimulus is influenced by the suprathreshold loudness growth. The measurement has been carried out with and without venting. Comparing the results there can be seen only a little effect of venting at all frequencies. Might be that patient's report about improvement after venting results from the direct input of low frequencies through the vent to the eardrum. These frequency region plays a special part of hearing comfort to reach a comfortable sound quality.

Experimental and clinical studies have revealed a worsened neurologic outcome after cerebral ischemia in hyperglycemic subjects, including hyperglycemic diabetic subjects. A possible therapy to reduce the magnitude of ischemic brain injury in diabetic subjects would be to use an insulin infusion to reduce brain glucose concentrations to values found in those who are normoglycemic and non-diabetic. The present study, using hyperglycemic diabetic rats, examined the effect of an insulin infusion on plasma and brain glucose concentrations to determine their relationship while plasma glucose concentrations decreased. In addition, plasma and brain glucose concentrations were compared to those in diabetic and nondiabetic rats treated with saline. Saline had no effect on the plasma or brain glucose concentrations in the diabetic rats or nondiabetic rats. The saline-treated diabetic rats had increased plasma and brain glucose concentrations as well as an increased brain-to-plasma glucose ratio when compared to the saline-treated nondiabetic rats. When an insulin infusion was used in diabetic rats to decrease plasma glucose to nondiabetic levels over approximately 2 h, the brain glucose concentration decreased. However, the brain-to-plasma glucose ratio remained at the "diabetic" value, so that the brain glucose concentration tended to remain increased when compared to normoglycemic, nondiabetic rats. We conclude that if these results are applicable to humans, measurement of plasma glucose in diabetic patients will underestimate the amount of glucose in the brain and this relationship will not be influenced by acute insulin therapy.