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Background: Invasive cardiac catheterization (CC) temporarily increases pain, discomfort, and anxiety. Procedural sedation is deployed to mitigate these symptoms, though practice varies. Research evaluating peri-procedural patient-reported outcomes is lacking., Methods and Results: We randomized 175 patients undergoing CC to short interval ([SI] group, <6 min) or long interval ([LI] group, ≥6 min) time intervals between initial intravenous sedation and local anesthetic administration. Outcomes included: (1) total pain medication use, (2) patient-reported and behaviorally assessed pain and (3) patient satisfaction during outpatient CC. Generalized linear mixed effect models were used to evaluate the impact of treatment time interval on total medication utilization, pain, and satisfaction. Among enrollees the mean age was 62 (standard deviation [SD] = 13.4), a majority were male (66%), white (74%), and overweight (mean body mass index = 28.5 [SD = 5.6]). Total pain medication use did not vary between treatment groups (p = 0.257), with no difference in total fentanyl (p = 0.288) or midazolam (p = 0.292). Post-treatment pain levels and nurse-observed pain were not statistically significant between groups (p = 0.324 & p = 0.656, respectively. No significant differences with satisfaction with sedation were found between the groups (p = 0.95) Patient-reported pain, satisfaction and nurse-observed measures of pain did not differ, after adjustment for demographic and procedural factors. Analyses of treatment effect modification revealed that postprocedure self-reported pain levels varied systematically between individuals undergoing percutaneous coronary intervention (PCI) (SI = 2.2 [0.8, 3.6] vs. LI = 0.7 [-0.6, 2.0]) compared with participants not undergoing PCI (SI = 0.4 [-0.8, 1.7] vs. LI = 0.7 [-0.3, 1.6]) (p = 0.043 for interaction)., Conclusion: No consistent treatment differences were found for total medication dose, pain, or satisfaction regardless of timing between sedation and local anesthetic. Treatment moderations were seen for patients undergoing PCI. Further investigation of how procedural and individual factors impact the patient experience during CC is needed., (© 2023 Wiley Periodicals LLC.)

Objectives: Patient centeredness is an essential component of high-quality care, yet little is known regarding the patient experience during procedures performed in the cardiac catheterization lab., Background: Available literature focuses on the safe delivery of sedation, but does not address patient-reported satisfaction or comfort. Further delineation of how procedural factors impact the patient experience is needed., Methods: We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients (n = 375) receiving physician ordered, nurse administered procedural sedation (benzodiazepine and/or opioids) between April and June, 2017. Data were abstracted from the procedural database, Electronic Health Record, and Press Ganey © surveys., Results: The mean age was 63 (SD 12.2), a majority were male (n = 226; 60%), white (n = 271; 73%), and overweight (mean body mass index = 29, SD 6.8). Patient-reported satisfaction with pain control and perceived staff concern for comfort were >75th percentile (Press Ganey © survey), with no difference in preprocedure and postprocedure pain scores (p = .596). Intraprocedural medication dose range and mean frequency were highly variable: midazolam (0.25-5.5 mg; 1.48); fentanyl (12.5-200 mcg; 1.63); and hydromorphone (0.5-2.5 mg; 1.33). Median time interval between administration of initial sedation and local anesthetic was 6 min. Patients with longer intervals had less frequent dosing (p < .001) and less total procedural sedation (p < .001). Sensitivity analysis revealed that trainee/fellow involvement (p = .001), younger age (p = .002), and shorter time intervals (p < .001) were associated with increased frequency and larger total dose., Conclusions: Waiting to gain vascular access following administration of procedural was associated with less frequent subsequent dosing, lower overall administration, and similar patient satisfaction. Optimizing processes for administering periprocedural sedation may allow for less medication without impacting patient experience., (© 2019 Wiley Periodicals, Inc.)

This study aimed to determine the influence of finishing diet on beef appearance and lipid oxidation of three beef muscles. A total of 18 Angus steers were selected from three diet treatments: grass-finished (USUGrass), legume-finished (USUBFT), and grain-finished (USUGrain). After processing, longissimus thoracis (LT), triceps brachii (TB), and gluteus medius (GM) steaks were evaluated over a 7-d display period. A muscle × diet interaction was observed for instrumental lightness (L*) and redness (a*) (P ≤ 0.001). Within each combination, USUGrass was considered darker with lower (P < 0.05) L* compared with USUGrain. For USUBFT, L* was similar to USUGrain for the TB and LT, while the L* of USUBFT and USUGrain GM differed (P < 0.05). In terms of redness, LT a* values were elevated (P < 0.05) in USUGrass compared with USUBFT and USUGrain. For GM steaks, a* of USUBFT and USUGrass were each greater (P < 0.05) than USUGrain. Surface a* of TB steaks were greatest (P < 0.05) for USUGrass followed by USUBFT, and with USUGrain, being lowest (P < 0.05). An overall increase in L* was observed throughout display dependent on diet (P = 0.013). During display, USUGrain steaks had the greatest (P < 0.05) L* followed by USUBFT and USUGrass. Additionally, a day × muscle interaction was observed for a* (P = 0.009). Initially, TB steaks had the greatest (P < 0.05) a* values. However, at day 3, a* values were similar (P > 0.05) among muscles. Visual color scores were in agreement with loss of redness (a*) during display, dependent on diet and muscle type (P < 0.001). Similarly, a day × diet × muscle interaction was observed for visual discoloration (P < 0.001). Day and diet interacted to influence thiobarbituric acid reactive substances (TBARS) (P < 0.001). Initial values did not differ (P > 0.05) between USUGrain and USUBFT; however, USUGrass had lower initial (P < 0.05) TBARS than both USUGrain and USUBFT. At days 3 and 7, TBARS were greatest (P < 0.05) in USUGrain steaks, followed by USUBFT, which was greater (P < 0.05) than USUGrass. A diet × muscle interaction was observed for 10 volatile compounds originating from lipid degradation (P ≤ 0.013). These compounds were less (P < 0.05) abundant in USUGrass compared to TB or GM of USUGrain. This study determined grass-finished beef to have a darker more red color and less lipid oxidation in multiple muscles. Possible mechanisms for this may include an increase in endogenous antioxidants in grass-finished beef.

Purpose: An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cerviogenic headache. Pain, function, patient satisfaction and adverse events were appraised., Methods: The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used., Results: Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief. While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect. Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone. Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest. Based on weak evidence, estimates for serious complication for manipulation ranged from one in 20,000 to five in 10,000,000., Recommendations: Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise. The risk rate is uncertain.

As part of the process of developing a Clinical Practice Guideline (CPG) on cervical spine manipulation (CSM), a working group sent out an 82-item postal survey to 150 randomly selected Ontario physiotherapists (PTs) who perform spinal manipulation, to collect information on the socio-demographics, practices, opinions of risk, and attitudes towards CPGs of these PTs (n = 118; response rate = 79%). Of the 118 respondents who performed spinal manipulation, 41 performed CSM. Respondents strongly agreed with three out of six indications listed in the survey for applying CSM: segmental fixation, stiff but stable joint, internal derangement (over 70%). Respondents also strongly agreed (over 88%) that all screening tests listed in the survey should be performed prior to applying CSM: tests for irritability, stability, vascular and neurological systems. Respondents rated patient education, other manual therapy, and exercise as the most common adjuncts to CSM (over 88%). Respondents reported seeing mild complications or side effects only rarely following the application of CSM. Fourteen percent of respondents reported having a written CSM policy or CPG on CSM in their work setting. Feedback from this survey will be used in developing a CSM CPG. A future survey will evaluate changes in clinical practice and in attitudes toward CPGs some time after the dissemination of the CSM CPG., (Copyright 2002 Elsevier Science Ltd.)

This article investigates potential differences in risk perception between experts (loss-prevention managers in the U.K. oil and gas production industry) and nonexperts (managers and students). Extant research on expert versus nonexpert perceptions of risk is reviewed, followed by the present study concerning risk perceptions of seven pen-picture scenarios involving the occurrence of hazardous events in the U.K. oil and gas production industry. In contrast to many of the earlier studies of expert versus nonexpert perceptions of risk, the present analysis concludes that experts did not judge the overall riskiness of the portrayed hazardous events as less risky than the nonexperts. Nevertheless, the experts believe more strongly than our nonexperts that the risks portrayed in the scenarios pose little threat to future generations, are more precisely known, and are relatively controllable. Use of multiple regression analysis to help uncover the basis of overall riskiness assessments for expert and lay respondents was inconclusive, however. Finally, little evidence was found that nonexperts were any more heterogeneous in their risk perceptions than experts. It may be that the nature of the risks assessed in the present study may account for the general lack of clear expert versus nonexpert differences in overall perceptions of the riskiness of hazardous events in the North Sea. Earlier findings of strong expert versus nonexpert differences in risk perception assessed hazards of major public concern. It is inferred that using such extreme hazards may have resulted in an exaggerated view of differences in expert versus public (nonexpert) perception of risk.

We recently observed that specific inhibitors of post-proline cleaving aminodipeptidases cause apoptosis in quiescent lymphocytes in a process independent of CD26/dipeptidyl peptidase IV. These results led to the isolation and cloning of a new protease that we have termed quiescent cell proline dipeptidase (QPP). QPP activity was purified from CD26(-) Jurkat T cells. The protein was identified by labeling with [(3)H]diisopropylfluorophosphate and subjected to tryptic digestion and partial amino acid sequencing. The peptide sequences were used to identify expressed sequence tag clones. The cDNA of QPP contains an open reading frame of 1476 base pairs, coding for a protein of 492 amino acids. The amino acid sequence of QPP reveals similarity with prolylcarboxypeptidase. The putative active site residues serine, aspartic acid, and histidine of QPP show an ordering of the catalytic triad similar to that seen in the post-proline cleaving exopeptidases prolylcarboxypeptidase and CD26/dipeptidyl peptidase IV. The post-proline cleaving activity of QPP has an unusually broad pH range in that it is able to cleave substrate molecules at acidic pH as well as at neutral pH. QPP has also been detected in nonlymphocytic cell lines, indicating that this enzyme activity may play an important role in other tissues as well.

The vast majority of lymphocytes in vivo persist in a quiescent state. These resting lymphocytes are maintained through a cellular program that suppresses apoptosis. We show here that quiescent PBMC, but not activated PBMC or transformed lymphocytes, die in the presence of highly specific post-proline aminodipeptidase inhibitors. This form of death has the hallmarks of apoptosis, such as phosphatidylserine externalization and loss of mitochondrial transmembrane potential. However, it differs from apoptosis induced by gamma irradiation in the same cells or by Fas ligation in transformed lymphocytes in terms of caspase involvement. In addition, the aminodipeptidase inhibitor-induced cell death, but not gamma-irradiation-mediated apoptosis, can be prevented by inhibition of the proteasome complex. The target of these inhibitors is not CD26/DPPIV, but probably a novel serine protease, quiescent cell proline dipeptidase, that we have recently isolated and cloned. These studies will yield a better understanding of the requirements and the mechanisms that mediate quiescent lymphocyte homeostasis in vivo.

Using a plasmid-based transpositional recombination assay in vivo, we have demonstrated that Hermes, a short inverted repeat type transposable element from Musca domestica, can transpose in Aedes aegypti embryos. Hermes transpositions in Ae. aegypti have all the characteristics observed during Hermes transposition in its host M. domestica and in related species. These characteristics include an absolute dependence on the expression of the Hermes transposase and a preference for the integration site GTNCAGAC (P < 0.05). In addition, the rate of Hermes transposition in Ae. aegypti (0.286 transpositions per 10,000 donor plasmids screened) was comparable to that observed in Drosophila melanogaster under similar conditions. These results suggest that Hermes can be developed into a gene vector and genetic engineering tool for Ae. aegypti and related mosquitoes.

This case study describes an attempt to modify the sex-role behaviour of a male transsexual in accordance with the subject's preferred sexual identity. The patient was treated before sex-change surgery. Treatment consisted of a modified form of social skills training and comprised such techniques as modelling, behaviour rehearsal and videotape feedback and focused on female elements of behaviour. Behavioural observations and psychometric testing were carried out before and after treatment and indicated significant change. The results indicated that: (a) behavioural intervention facilitated adoption of a new sex role; (b) the techniques used were particularly useful in modifying sex role behaviour; (c) the adoption of a new sex role in line with preferred identity was successful in terms of patient satisfaction.

An investigation into the extent and nature of social inadequacy among outpatients diagnosed as neuroses and personality disorders was undertaken on patients aged 18-49 attending one clinic over a six-month period. A feature of this survey was that each patient took part in a standard social interaction test, and their performance was assessed by two psychologists. A relatively high proportion of patients, one in six on the most conservative estimate, and probably over one in four, were judged by psychologists and psychiatrists to be socially inadequate, and the results showed a clear pattern of behavioural, social and personality factors associated with these judgements. Implications for assessment and treatment are discussed.