Search

Existing research has found that women who use opioids (WWUO) experience challenges to hormonal and long-acting reversible contraception (HC-LARC) access and use. Facilitators of such use are unclear. We conducted a scoping review to comprehensively map the literature on barriers to and facilitators of HC-LARC access and use in the United States among reproductive-aged WWUO. In accordance with the JBI Manual of Evidence Synthesis, we conducted literature searches for empirical articles published from 1990 to 2021. Independent reviewers screened references, first by titles and abstracts, then by full-text, and charted data of eligible articles. We coded and organized HC-LARC barriers and facilitators according to a four-level social-ecological model (SEM) and categorized findings within each SEM level into domains. We screened 4,617 records, of which 28 articles focusing on HC-LARC (n = 18), LARC only (n = 6), or testing an intervention to increase HC-LARC uptake (n = 4) met inclusion criteria. We identified 13 domains of barriers and 11 domains of facilitators across four SEM levels (individual, relationship, community, societal). The most frequently cited barriers and facilitators were methods characteristics, partner and provider relations, transportation, healthcare availability and accessibility, cost, insurance, and stigma. Future studies would benefit from recruiting participants and collecting data in community settings, targeting more diverse populations, and identifying neighborhood, social, and policy barriers and facilitators. Reducing barriers and improving equity in HC-LARC access and use among WWUO is a complex, multifaceted issue that will require targeting factors simultaneously at multiple levels of the social-ecological hierarchy to effect change.

The presence of year-round surface water in streams (i.e., streamflow permanence) is an important factor for identifying aquatic habitat availability, determining the regulatory status of streams, managing land use change, allocating water resources, and designing scientific studies. However, accurate, high resolution, and dynamic prediction of streamflow permanence that accounts for year-to-year variability at a regional extent is a major gap in modeling capability. Herein, we expand and adapt the U.S. Geological Survey (USGS) PRObability of Streamflow PERmanence (PROSPER) model from its original implementation in the Pacific Northwest (PROSPERPNW) to the upper Missouri River basin (PROSPERUM), a geographical region that includes mountain and prairie ecosystems of the northern United States. PROSPERUM is an empirical model used to estimate the probability that a stream channel has year-round flow in response to climatic conditions (monthly and annual) and static physiographic predictor variables of the upstream basin. The structure and approach of PROSPERUM are generally consistent with the PROSPERPNW model but include improved spatial resolution (10 m) and a longer modeling period. Average model accuracy was 81 %. Drainage area, upstream proportion as wetlands, and upstream proportion as developed land cover were the most important predictor variables. The PROSPERUM model identifies decreases in streamflow permanence during climatically drier years, although there is variability in the magnitude across basins highlighting geographically varying sensitivity to drought. Variability in the response of perennial streams to drought conditions among basins in the study area was also observed.

Background: The absolute number of new stroke patients is annually increasing and there still remains only a few Food and Drug Administration (FDA) approved treatments with significant limitations available to patients. Tanshinone IIA (Tan IIA) is a promising potential therapeutic for ischemic stroke that has shown success in pre-clinical rodent studies but lead to inconsistent efficacy results in human patients. The physical properties of Tan-IIA, including short half-life and low solubility, suggests that Poly (lactic-co-glycolic acid) (PLGA) nanoparticle-assisted delivery may lead to improve bioavailability and therapeutic efficacy. The objective of this study was to develop Tan IIA-loaded nanoparticles (Tan IIA-NPs) and to evaluate their therapeutic effects on cerebral pathological changes and consequent motor function deficits in a pig ischemic stroke model. Results: Tan IIA-NP treated neural stem cells showed a reduction in SOD activity in in vitro assays demonstrating antioxidative effects. Ischemic stroke pigs treated with Tan IIA-NPs showed reduced hemispheric swelling when compared to vehicle only treated pigs (7.85 ± 1.41 vs. 16.83 ± 0.62%), consequent midline shift (MLS) (1.72 ± 0.07 vs. 2.91 ± 0.36 mm), and ischemic lesion volumes (9.54 ± 5.06 vs. 12.01 ± 0.17 cm3) when compared to vehicle-only treated pigs. Treatment also lead to lower reductions in diffusivity (−37.30 ± 3.67 vs. −46.33 ± 0.73%) and white matter integrity (−19.66 ± 5.58 vs. −30.11 ± 1.19%) as well as reduced hemorrhage (0.85 ± 0.15 vs 2.91 ± 0.84 cm3) 24 h post-ischemic stroke. In addition, Tan IIA-NPs led to a reduced percentage of circulating band neutrophils at 12 (7.75 ± 1.93 vs. 14.00 ± 1.73%) and 24 (4.25 ± 0.48 vs 5.75 ± 0.85%) hours post-stroke suggesting a mitigated inflammatory response. Moreover, spatiotemporal gait deficits including cadence, cycle time, step time, swing percent of cycle, stride length, and changes in relative mean pressure were less severe post-stroke in Tan IIA-NP treated pigs relative to control pigs. Conclusion: The findings of this proof of concept study strongly suggest that administration of Tan IIA-NPs in the acute phase post-stroke mitigates neural injury likely through limiting free radical formation, thus leading to less severe gait deficits in a translational pig ischemic stroke model. With stroke as one of the leading causes of functional disability in the United States, and gait deficits being a major component, these promising results suggest that acute Tan IIA-NP administration may improve functional outcomes and the quality of life of many future stroke patients.

In an experimental setting a laboratory analysis of substances migrating from UV prints under mechanical stress into sweat and saliva simulant was performed. The influence of paper type and curing degree on UV prints was investigated. Five substances were identified at concentrations above the limit of detection in the simulants PPG-3 glyceryl triacrylate, ethoxylated trimethylolpropane triacrylate, trimethylolpropane triacrylate, 2/4-isopropylthioxanthone (ITX), and 2,4-diethylthioxanthone (DETX). Migration of the acrylates and photoinitiators into saliva and sweat simulants were increased when the UV inks were printed on uncoated paper in comparison to coated paper. With an exposure scenario considering a person to leaf through 80 pages of UV-printed paper per day while touching each page with a licked fingertip, Risk Characterisation Ratios (RCR) for oral exposure well below 1 were obtained for all five substances indicating no risk for the general population. The three acrylates are classified for skin sensitisation. The migrated amounts per skin surface area of these three were compared with the EC3 value for a hypothetical substance that could be categorised as strong sensitiser (EC3 = 0.1%). The results show that the risk of skin sensitisation even under worst case conditions can be considered as negligible., (Copyright © 2021 Elsevier Inc. All rights reserved.)

As the final part of a Europe-wide study on the risk from synthetic turf infill consisting of rubber granules derived from end-of-life tyres (ELT), exposure of sportspeople was assessed and compared with health-based reference values for various chemical substances. Based on information from previous project phases, exposure scenarios were established and exposure was calculated for oral, dermal and inhalation routes. Calculated cancer risks for exposure to polycyclic aromatic hydrocarbons were below 1:1 million. Risk characterisation ratios (RCRs) for non-carcinogenic substances were below 1, indicating no health concerns. For 2-hydroxybenzothiazole no toxicological data were found from which to derive a substance-specific reference value. A threshold-of-toxicological concern approach revealed maximum RCRs slightly above 1, which are acceptable, given the conservativism of the approach. ERASSTRI substantially improved the data available for assessing human health risks from using ELT-derived infill material. Overall, no health concerns could be identified for the use of synthetic turfs with ELT-derived infill material., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

End-of-life tyre (ELT)-derived rubber granules are used as synthetic turf infill on sports fields. They contain various chemical substances and there are concerns that exposure to these substances might be harmful for human health. In this second part of a Europe-wide study to address these concerns migration of substances from rubber granules to artificial body fluids (sweat, saliva, gastric juice) was tested and exposure measurements at sports fields were performed to improve the database for exposure assessment. Some PAHs, aluminium, cobalt, benzothiazole, tert-butylamine, MIBK, 4-tert-octylphenol, bisphenol A, and the phthalates DINP and DEHP were found in at least some samples of sweat simulant. The migration rates calculated with these data were used to inform the dermal exposure assessment. In artificial saliva and gastric juice, only aluminium, cobalt, 4-tert-octylphenol and MIBK were detected and migrated fractions were calculated. Bioaccessibility from rubber granules in the gastrointestinal tract was estimated conservatively, assuming complete availability for most substances. In addition, air samples from 17 sports fields in six European countries were analysed. There were no increased concentrations of metals (aluminium, cobalt), PAHs, or other semivolatile substances in air samples, but some volatiles (MIBK: 95th percentile: 18 μg/m 3 , benzothiazole: 95th perc.: 7 μg/m 3 , tert-butylamine: 95th perc.: 31 μg/m 3 , 2-heptanone: 95th perc.: 0.4 μg/m 3 , cyclohexanone: 95th perc.: 1.5 μg/m 3 , and saturated aliphatic hydrocarbons >C9: 95th perc.: 26 μg/m 3 ) were slightly increased in a few samples. In addition, skin wipe samples were obtained from 43 sportspeople after playing on synthetic turfs. Only aluminium was detected above the limit of quantification in these samples (95th perc.: 0.84 mg/sample). These data are important input for risk characterisation as performed in the final study phase. Bioaccessibility data are used for estimating oral and dermal exposure of sportspeople, and air measurements are essential for inhalation exposure assessment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

End-of-life tyre (ELT)-derived rubber granules are used as synthetic turf infill on sports fields. They contain various chemical substances and there are concerns that exposure to these substances might be harmful for human health. This Europe-wide risk assessment study addresses these concerns. As the first part, chemical substances in samples from recycling companies and from sports fields were analysed. 86 coated and non-coated ELT granule samples from sites in 14 European countries were investigated, together with ten non-ELT materials. An extensive list of potentially relevant substances was compiled, and the infill materials were analysed for these substances, using GC and HPLC methods. Volatilisation of substances was studied in emission chambers. Polycyclic aromatic hydrocarbons (sum of 8 REACH PAHs) were identified at average concentrations below 10 mg/kg. Substances found at higher concentrations in rubber granules were aluminium (arithmetic mean in uncoated samples from sports fields 5383 mg/kg) and cobalt (168 mg/kg), benzothiazole (48 mg/kg) and 2-hydroxybenzothiazole (34 mg/kg), 6PPD (571 mg/kg) and DPG (51 mg/kg), and 4-tert-octylphenol (14 mg/kg). In addition, the following volatiles were found to evaporate from crumb rubber in emission chambers: benzothiazole, tert-butylamine, cyclohexanone, methyl isobutyl ketone, 2-heptanone and saturated aliphatic hydrocarbons higher than C9. With this comprehensive survey we created a profound database on concentrations of chemical substances in ELT-derived infill material, which is essential for a reliable risk assessment. The results were used to inform subsequent investigations (migration studies, exposure monitoring survey)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The use of simulators has shown a profound impact on the development of both training and assessment of endovascular skills. Furthermore, there is evidence that simulator training is of great benefit for novice trainees. However, there are only a few simulators available geared specifically toward novice learners. Whereas research suggests that low-fidelity simulators could fill this gap, there are insufficient data available to determine the role of low-fidelity simulators in the training of endovascular skills., Methods: Medical students in their fifth year (N = 50) with no previous endovascular experience were randomized into three groups: conventional learning through a video podcast (group V; n = 12), low-fidelity simulation training with tablet-paired touch-gesture navigation (group A; n = 12), and low-fidelity simulation training with tablet-paired physical endovascular tool navigation (group S; n = 26). Within their respective groups, all students attended a 1-day class on basic endovascular skills. Questionnaire items for self-assessment before and after the class and assessment after the class of the participant's practical skills on a high-fidelity simulator were analyzed across all three groups as well as for each group separately using nonparametric tests., Results: All 50 participants completed the training. Participants in group S showed a significantly increased interest in working in interventional cardiology (P = .02) and vascular surgery (P = .03) after the class. Evaluation of the questionnaire items after the class showed that participants in group S rated their practical skills significantly higher after the class compared with those in group V and group A (P < .001 for pairwise comparison of all three groups, respectively), creating a significant trend across the three groups. However, analysis of the practical skills assessment for all three groups showed a significant difference between the groups only for choosing a guidewire (P = .045) and a significant trend in performance across the groups for choosing a guidewire and for positioning the guidewire in the vessel (P = .02 and P = .05, respectively). All other steps of the skills assessment showed no significant differences or a trend across the groups., Conclusions: Low-fidelity simulation training, particularly with physical endovascular tool navigation, led to increased motivation in novice trainees. Whereas simulator training was associated with increased confidence of trainees in their skills, assessment of their practical skills showed no actual improvement in this study. Overall, low-fidelity simulation has the potential to benefit novice trainees, but possible risks of simulation training should be further evaluated., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Study Objective: To assess the effects of noninvasive ventilation (NIV) during spontaneous breathing anesthesia on functional residual capacity and ventilation distribution., Design: Prospective and observational study., Setting: Operating room, military teaching hospital., Patients: Eighteen adult patients submitted to digestive endoscopic procedures under spontaneous breathing anesthesia., Interventions: Anesthetic management was standardized. Patients were submitted to combined digestive endoscopic procedures (gastric fibroscopy and colonoscopy) under spontaneous breathing anesthesia in lateral decubitus position. Anesthesia was induced with propofol intravenous 1 mg/kg. Repeated boluses of propofol were administered according to the patients' clinical needs during endoscopic procedures. Ventilation distribution and functional residual capacity were assessed by electrical impedance tomography., Measurements: Ventilation distribution was assessed by electrical impedance changes in left and right lung, and functional residual capacity changes were evaluated by measurement of end-expiratory lung impedance changes. Measures were performed before anesthesia induction, 5 minutes after anesthesia induction during gastric fibroscopy, at the end of gastric fibroscopy, 5 minutes after NIV application during colonoscopy, and at the end of colonoscopy., Main Results: In awake patients, tidal volume was primarily distributed to the dependent lung (57.5% vs 43.1%; P=.009). After anesthesia induction, we observed a shift of ventilation to the nondependent lung (43.1% before anesthesia, 58.9% after anesthesia; P=.002) and marked decrease in end-expiratory lung impedancemetry of -1.68UI (4.47). Noninvasive ventilation application resulted in a significant increase of end-expiratory lung impedancemetry of 1.33 (6.49) (P=.005) but did not impact ventilation distribution., Conclusions: This study showed that NIV application in pressure support mode during spontaneous breathing anesthesia increased functional residual capacity. Other studies are needed to evaluate the clinical impact of this technique during anesthesia, especially in patients with poor respiratory conditions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Although both Gαq- and Gα11-protein signaling are believed to be involved in the regulation of cardiac hypertrophy, their detailed contribution to myocardial function remains elusive., Methods and Results: We studied remodeling processes in healthy transgenic mice with genetically altered Gαq/Gα11-expression, in particular a global Gα11-knockout and a novel inducible cardiac specific Gαq-knockout, as well as a combined double knockout (dKO) mouse line. Echocardiography and telemetric ECG recordings revealed that compared with wild type mice, hearts of dKO mice showed an increased ejection fraction and a decreased heart rate, irrespective of age resulting in a maintained cardiac output. We attributed these findings to the lack of Gα11, which the absence was associated with a decreased afterload. Histological analysis of the extracellular matrix in the heart depicted a diminished presence of collagen in aging hearts of dKO mice compared to wild-type mice. The results of a transcriptome analysis on isolated ventricular cardiac myocytes revealed alterations of the activity of genes involved in the Gαq/Gα11-dependent regulation of the extracellular matrix, such as the matricellular protein Cyr61., Conclusions: From our data we conclude that Gαq/Gα11 signaling pathways play a pivotal role in maintaining gene activity patterns. For the heart we revealed their importance in modulating the properties of the extracellular matrix, a mechanism that might be an important contributor and mechanistic basis for the development of pressure-overload induced cardiac hypertrophy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Consumer exposure to chemicals from products and articles is rarely monitored. Since an assessment of consumer exposure has become particularly important under the European REACH Regulation, dedicated modelling approaches with exposure assessment tools are applied. The results of these tools are critically dependent on the default input values embedded in the tools. These inputs were therefore compiled for three lower tier tools (ECETOC TRA (version 3.0), EGRET and REACT)) and benchmarked against a higher tier tool (ConsExpo (version 4.1)). Mostly, conservative input values are used in the lower tier tools. Some cases were identified where the lower tier tools used less conservative values than ConsExpo. However, these deviations only rarely resulted in less conservative exposure estimates compared to ConsExpo, when tested in reference scenarios. This finding is mainly due to the conservatism of (a) the default value for the thickness of the product layer (with complete release of the substance) used for the prediction of dermal exposure and (b) the complete release assumed for volatile substances (i.e. substances with a vapour pressure ⩾10Pa) for inhalation exposure estimates. The examples demonstrate that care must be taken when changing critical defaults in order to retain conservative estimates of consumer exposure to chemicals., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Clostridium botulinum C2 toxin, Clostridium perfringens iota toxin and Clostridium difficile CDT belong to the family of binary actin ADP-ribosylating toxins and are composed of a binding/translocation component and a separate enzyme component. The enzyme components ADP-ribosylate G-actin in the cytosol of target cells resulting in depolymerization of F-actin, cell rounding and cell death. The binding/translocation components bind to their cell receptors and form complexes with the respective enzyme components. After receptor-mediated endocytosis, the binding/translocation components form pores in membranes of acidified endosomes and the enzyme components translocate through these pores into the cytosol. This step is facilitated by the host cell chaperone heat shock protein 90 and peptidyl-prolyl cis/trans isomerases including cyclophilin A. Here, we demonstrate that a large isoform of cyclophilin A, the multi-domain enzyme cyclophilin 40 (Cyp40), binds to the enzyme components C2I, Ia and CDTa in vitro. Isothermal titration calorimetry revealed a direct binding to C2I with a calculated affinity of 101 nM and to Ia with an affinity of 1.01 μM. Closer investigation for the prototypic C2I revealed that binding to Cyp40 did not depend on its ADP-ribosyltransferase activity but was stronger for unfolded C2I. The interaction of C2I with Cyp40 was also demonstrated in lysates from C2-treated cells by pull-down. Treatment of cells with a non-immunosuppressive cyclosporine A derivative, which still binds to and inhibits the peptidyl-prolyl cis/trans isomerase activity of cyclophilins, protected cells from intoxication with C2, iota and CDT toxins, offering an attractive approach for development of novel therapeutic strategies against binary actin ADP-ribosylating toxins., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Current data on characteristics and outcomes of patients with high blood pressure (BP) managed under clinical practice conditions are limited., Methods and Results: The 3A registry is an open, prospective observational cohort study in German primary care offices, with a 4:1:1 inclusion ratio to either aliskiren (ALIS), an ACE inhibitor/angiotensin receptor blocker (ACEI/ARB), or to an antihypertensive agent not affecting the renin angiotensin system (non-RAS). A nonlinear mixed regression model was used to assess BP changes during follow-up regarding different BP values at inclusion in the various groups. ClinicalTrial.gov identifier is NCT01454583. In the total cohort of 13,433 patients with 1-year follow-up results, the mean age of patients was 64.7 years, 54% were men. Mean number of antihypertensive drugs was higher in the ALIS group compared to the other groups (3.0 drugs versus 2.5 in ACEI/ARB versus 1.6 in non-RAS; p<0.0001). Statistical regression analysis revealed baseline BP as the dominant covariate. After adjustment for baseline BP and 12 other confounders, no significant differences in BP reduction between the three groups were observed. The rate of major cardiac events (death, myocardial infarction, and stroke) was 1.3% in the total cohort, and did not differ across groups., Conclusions: ALIS at beginning of the observation was mostly used by the physicians in patients with higher BP at entry and in higher risk populations. By study end, in all groups, stringent BP lowering measures, usually with combination therapy, led to significant improvements; more than half of these at-risk patients reached the BP targets., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Management of critically ill patients in austere environments is a logistic challenge. Availability of oxygen cylinders for the mechanically ventilated patient may be difficult in such a context. A solution is to use a ventilator able to function with an oxygen concentrator., Objectives: We tested the SeQual Integra™ (SeQual, San Diego, CA) 10-OM oxygen concentrator paired with the Pulmonetic System(®) LTV 1000 ventilator (Pulmonetic Systems, Minneapolis, MN) and evaluated the delivered fraction of inspired oxygen (FiO2) across a range of minute volumes and combinations of ventilator settings., Methods: Two LTV 1000 ventilators were tested. The ventilators were attached to a test lung and FiO2 was measured by a gas analyzer. Continuous-flow oxygen was generated by the OC from 0.5 L/min to 10 L/min and injected into the oxygen inlet port of the LTV 1000. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO2., Results: The LTV 1000 ventilator is a turbine ventilator that is able to deliver high FiO2 when functioning with an oxygen concentrator. However, modifications of the ventilator settings such as increase in minute ventilation affect delivered FiO2 even if oxygen flow is constant on the oxygen concentrator., Conclusions: The ability of an oxygen concentrator to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders in austere environments when used with a turbine ventilator. However, FiO2 has to be monitored continuously because delivered FiO2 decreases when minute ventilation is increased., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Twenty-four hour ambulatory blood pressure (ABP) is superior to office blood pressure (BP) in predicting cardiovascular events. However, its use to optimise BP control in treated hypertensive patients is less well examined., Design and Method: In this observational study conducted in 899 general practitioners' offices, 4078 hypertensive patients with uncontrolled office BP were included. Antihypertensive therapy was intensified and after 1 year office BP and 24-hour ABP were measured to categorise patients according to the ESC/ESH 2007 guidelines., Results: In this cohort (mean office BP 156/90 mmHg, mean ABP 146/85 mmHg), 2059 out of 4078 patients (50.5%) had controlled office BP (<140/90 mmHg) at 1 year examination. Of these apparently controlled patients (N=2059), 1339 (65.8%) had 24-hour ABP ≥ 130/80 mmHg, indicating masked hypertension (32.9% of all treated patients). In the prespecified subgroups the prevalence of masked hypertension was the following: diabetes 28.2%, CVD 29.1%, and CKD 32.1%. White coat hypertension (24h-ABP<130/80 mmHg and office BP ≥ 140/90 mmHg) was found in 12.4% (N=233) of patients with elevated office BP (6.1% of all treated patients), and in 5.7% of the diabetic subgroup, 5.6% CVD and 7.1% CKD. Discrepancies in BP categorisation between office BP and 24-hour ABP were high; all subjects 52.8%, diabetes 50.0%, CVD 49.0% and CKD 50.4%., Conclusion: In hypertensive patients on therapy, 2 out of 3 with apparently controlled office BP had masked hypertension, suggesting a more aggressive therapy, and 1 out of 8 with elevated office BP had white coat hypertension potentially falsely forcing physicians to intensify therapy. The 3A Registry is listed under clinicaltrials.gov, NCT01454583., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We evaluated the effectiveness of an intravascular rewarming technique using CoolGard 3000™ system and Icy™ catheter to maintain normothermia during surgeries of severe burned patients and compared these findings to a historical control group., Methods: This was a controlled non-randomised trial conducted between March 2008 and August 2009. Patients with burns greater than or equal to 40% of the total body surface area were included. Before the first burn excision, the Icy™ catheter was placed in the inferior vena cava via the femoral vein. Warming was then initiated and maintained until the bladder temperature reached over 37.5°C. The bladder temperature was recorded every 30min during surgery and for the first hour post-operatively and compared to a historical control group., Results: We enrolled 4 patients and 11 surgeries in the CoolGard™ group and compared them to 3 patients and 10 surgeries in the historical cohort. All intraoperative bladder temperatures from T=30 were statistically different in the two groups. In the CoolGard™ group, no patient became hypothermic and no surgery was aborted because the patient's temperature had rapidly fallen below the threshold temperature (35.5°C). No device-related complication was reported., Conclusion: The use of an intravenous warming catheter is a novel approach to maintain normothermia during surgery in burn victims and may be more effective than traditional methods., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: Defining the place of regional anaesthesia (RA) for facial wounds in an emergency department., Study Design: Prospective observational study conducted in the emergency department of a regional hospital., Patients and Methods: Two hundred and forty-six successive patients with one or more facial wounds were included from 1st august 2004 to 31st december 2004. Data on patient, operator, wound (measured by the number of stitches), anaesthetic method (RA, local anaesthesia [LA], or no anaesthesia), method of repairing skin, duration of intervention, operator comfort (verbal numeric scale [VNS] from 0 to 10) and pain felt by the patient (visual analogic scale [VAS] from 0 to 10) in the different stages of care were collected., Results: Compared to the LA, the RA of the face decreased the number of punctures (1.36 vs 4.38 punctures, p<0.001) and the quantity of local anaesthetic injected (2.8 ml vs 5.3 ml, p<0.01) for wounds requiring more than 10 stitches. It has improved operator comfort (VNS = 10 [8-10] vs 8 [6.75-10] (p<0.01)). Its effectiveness during skin repair was equivalent to that of the LA by infiltration (VAS 0 [0-1] vs 0 [0-1])., Conclusion: When practicable, the RA of the face is a better technique than the LA for facial wounds treatment., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

The tracheo-innominate artery fistula is a rare but life-threatening complication of the tracheotomy. Its care management requires a rapid airway control to allow haemostasis by compression and ventilation. The haemostasis must be immediate and two techniques exist: surgery opencast (sternotomy) or interventional radiology. The choice between the two depends largely on the technical platform available. Our case report describes a tracheo-innomninate artery fistula surgically managed with success. The patient carried an anatomic variant, the two carotids come from innominate artery.

We present four experiments on the interpretation of pronouns and reflexives in picture noun phrases with and without possessors (e.g. Andrew's picture of him/himself, the picture of him/himself). The experiments (two off-line studies and two visual-world eye-tracking experiments) investigate how syntactic and semantic factors guide the interpretation of pronouns and reflexives and how different kinds of information are integrated during real-time reference resolution. The results show that the interpretation of pronouns and reflexives in picture NP constructions is sensitive not only to purely structural information, as is commonly assumed in syntactically-oriented theories of anaphor resolution, but also to semantic information (see Kuno, S. (1987). Functional syntax: Anaphora, discourse and empathy. Chicago: University of Chicago Press; Tenny, C. (2003). Short distance pronouns in representational noun phrases and a grammar of sentience. Ms.). Moreover, the results show that pronouns and reflexives differ in the degree of sensitivity they exhibit to different kinds of information. This finding indicates that the form-specific multiple-constraints approach (see Brown-Schmidt, S., Byron, D. K., & Tanenhaus, M. K. (2005). Beyond salience: Interpretation of personal and demonstrative pronouns. Journal of Memory and Language, 53, 292-313; Kaiser, E. (2003). The quest for a referent: A crosslinguistic look at reference resolution. Ph.D. dissertation. University of Pennsylvania, Philadelphia, PA; Kaiser, E. (2005). When salience is not enough: Pronouns, demonstratives and the quest for an antecedent. In: Laury, R. (Ed.), Minimal reference in Finnic: The use and interpretation of pronouns and zero in Finnish and Estonian discourse (pp. 135-162). Helsinki, Finland: Suomalaisen Kirjallisuuden Seura; Kaiser, E., & Trueswell, J. (2008). Interpreting pronouns and demonstratives in Finnish: Evidence for a form-specific approach to reference resolution. Language and Cognitive Processes, 23(5), 709-748), which states that referential forms can exhibit asymmetrical sensitivities to the different constraints guiding reference resolution, also applies in the within-sentence domain.

Propofol infusion syndrome (PRIS) is a new clinical entity reported in critically ill patients. Lactic acidosis, cardiac failure and rhabdomyolysis are the features. Lactic acidosis related to short-term propofol administration has been described during general anaesthesia. Lactic acidosis could be an early marker of PRIS. We report here a case of very early lactic acidosis in a 66-year-old-man receiving propofol during a neurosurgery. The outcome was good after discontinuation of propofol.

Purpose: To evaluate enrollment patterns, healthcare use, and factors associated with enrollment in San Francisco's Healthy Young Adults (HYA) program, a comprehensive public health insurance program for young adults who age out of public insurance., Methods: In a group of young adults who were all eligible for HYA, we compared demographic characteristics by enrollment status. Demographic information and use patterns were obtained for individuals who were continuously enrolled in HYA for 12 months., Results: Nearly one quarter of eligible young adults enrolled in the program. Those who enrolled were more likely to have used vision or pharmacy services in the 2 years prior to enrollment, to be Asian, and to be from Chinese-speaking families (p < .001) than those who did not enroll. The large majority (80%) of young adults who enrolled in HYA had a primary care or dental visit during the 12-month study period. More than one third (40%) of enrollees used the prescription benefit, while much smaller percentages used radiology services, the emergency department or inpatient facilities., Conclusions: Young adults in the City and County of San Francisco who enrolled in HYA had high use rates. Ethnic disparities in enrollment indicate the need for targeted outreach. Adverse selection into the program, although present, was minimal. Local innovations are one way to address the problem of uninsurance in the United States, and HYA could be replicated elsewhere.

We report a case of transient acquired and isolated factor VII deficiency associated with severe head trauma. A 16-year-old boy was involved in a motor vehicle accident. CT scan showed frontal brain contusion and a cerebral haematoma (5 cm). First prothrombine time (PT) was normal. Rapidly, a severe coagulopathy developed, unresponsiving to fresh frozen plasma and vitamin K. Haemostatic markers analysis showed an isolated deficiency of factor VII at 15%. No inhibitory activity against factor VII could be detected. We successfully treated the deficiency with intermittent intravenous human factor VII (factor VII-LFB) during 10 days. Factor VII return to normal at 84%. Physiopathological and therapeutic aspects of this rare pathology are presented.

We report a case of intracranial dural arteriovenous (DAVF) draining into the spinal medullary veins. A 49-year-old woman presented a rapidly progressive ascending myelopathy resulting in a C3-C4 tetraplegia associated with acute respiratory failure at the twelfth hour. MRI revealed swelling of the cervical spinal cord, hyperintensity on T2 and enhancement of enlarged veins on MR angiography. A conventional angiography showed the DAVF with venous drainage into the spinal vein extending to the conus medullaris. After embolization, neurological recovery occurred during the first week, allowing tracheal extubation on day 2. Clinical, radiological and therapeutic aspects of this uncommon pathology are presented.

On-line comprehension studies of flexible word-order languages find that noncanonical ('scrambled') structures induce more difficulty than canonical structures [e.g., Hyona & Hujanen, Q. J. Exp. Psychol. 50A (1997) 841-858], with this difference being attributed to the structural complexity/infrequency of these forms. However, by presenting sentences in isolation, most existing studies have not examined the extent to which processing patterns can be explained by discourse factors. In Finnish, an articleless flexible word-order language with canonical SVO order, word order can be used to encode the given/new distinctions: OVS marks the object as given and the subject as new; SVO is more flexible, being used in multiple contexts. Thus, the observed dispreference for noncanonical orders in previous work may arise from additional presuppositions needed to understand them out of context [cf. Crain & Steedman, Natural Language Parsing, (1985), 320-358]. Two experiments were conducted to examine these issues in Finnish. Experiment 1 used a self-paced reading task to show that the usual difficulty associated with noncanonical constructions is partially alleviated in the presence of appropriate discourse contexts. In Experiment 2, the eye gaze of listeners was tracked as they heard spoken descriptions of scenes, so as to test whether specific on-line referential processes are involved in SVO/OVS comprehension: Upon hearing an OV... sequence, Finnish listeners should expect the upcoming noun to be discourse-new, whereas an SV... sequence makes no such prediction. The results confirmed these predictions. As compared to SVO, OVS sentences showed anticipatory eye movements to a discourse-new referent at the second noun onset, even before participants had enough acoustic information to recognize this word. Our findings illustrate that in a flexible word-order language, a noncanonical order can result in anticipatory processes regarding the discourse status of a yet-to-be-heard constituent.

Trifluoroacetate (TFA) is commonly used in a variety of pharmaceutical applications. Because of its toxic nature, it is important to reliably measure the effective removal of TFA. We developed an ion chromatography (IC) method to determine the concentration of residual TFA in samples found in the pharmaceutical industry. A high-capacity anion-exchange column was used to separate trace trifluoroacetate from an excess of chloride, phosphate, and other anions without the need for sample preparation. TFA was detected by suppressed conductivity. A method with four KOH eluent step changes was optimized and reproducibly executed using automated generation of the KOH eluent. We used this method to determine TFA in the following samples: a phosphate-buffered saline (PBS), an acetate-buffered saline containing protein, and a commercial peptide. The method detection limits for TFA in these samples were all less than 90 ng/ml.

Growth factors, hormones, and matrix proteins regulate osteoblast proliferation and differentiation, acting through cognate receptors. Since each of the receptors are coupled to a variety of distinct signal transduction pathways, in this report we evaluated whether there is a common convergent intermediate step that allows cross-talk among the various pathways. Since extracellular signal-regulated kinases 1 and 2 (Erk1/2) play a role in mitogenesis and differentiation processes, we evaluated the effects of various osteotrophic factors on Erk1/2 phosphorylation in osteoblasts. Osteoblasts isolated from the metaphyseal marrow (MM) and diaphyseal marrow (DM) of 4-6 week old male rat longitudinal bones were grown to confluency and Erk1/2-phosphorylation was evaluated using antibodies that recognized either the total or the phosphorylated form of the kinase. There was very little Erk1/2 phosphorylation in cells kept in suspension. Both MM and DM cells attached to fibronectin (FN), demonstrated Erk1/2 phosphorylation that persisted for at least up to 8h. Platelet-derived growth factor AB (PDGF-AB) induced a transient and robust Erk1/2 phosphorylation that was attenuated by 2h. Studies with specific inhibitors indicated that the effects of these factors were mediated by protein kinase C, by receptor tyrosine kinase, as well as by protein phosphatases. Parathyroid hormone (PTH 1-34), a bone anabolic agent however, caused a down-regulation of FN stimulated Erk1/2 phosphorylation in MM derived cells. The inhibitory effect of PTH was mediated through cAMP-dependent protein kinase A (PKA) activation. The data collectively suggest that a combination of diverse extracellular stimuli regulates Erk1/2 phosphorylation that may ultimately influence osteoblast proliferation and/or differentiation.

Ion chromatography was used to determine trace anionic contamination on the surface of hard disk drive components. These contaminants can have a detrimental effect on device reliability and yield. Disk drive components were soaked in deionized water and these extracts were analyzed for anions. The anions fluoride, acetate, formate, acrylate, methacrylate, chloride, nitrite, bromide, nitrate, benzoate, sulfate, oxalate, phthalate and phosphate were separated on a high-performance anion-exchange column and determined at concentrations less than 1 microg/l with suppressed conductivity detection. The extract solutions were analyzed either by injecting 1 ml or by preconcentrating 5 ml. We evaluated the performance of both methods.

Objective: To examine the durability of the Stentor and Vanguard endovascular devices in human implants., Methods: The textile covering, the polypropylene ligatures and the stent metal of 34 devices (25 Stentor, 9 Vanguard) with a mean duration of implantation of 28.8 +/- 16 months was examined by means of stereomicroscopy and scanning electron microscopy., Results: The polyester textile covering showed gaps along the sutured seam and isolated holes in the fabric. All of the examined polypropylene ligatures were worn, some ruptured. Four different types of stent corrosion were classified--pits (100%), bizarre craters (68%), large deficiencies (14%) and fractures (32%)., Conclusion: Holes in the polyester fabric and frame dislocations are specific for the design of Stentor and Vanguard grafts. The early corrosion of the stent metal Nitinol in these devices is surprising. Until more experience is gained with other devices, we have to be reminded, that the "gold standard" for the long-term durability of artificial vascular grafts is still "today's" conventional graft.

An ion chromatography method was developed to determine trace anionic contamination in matrices that have a high concentration of nitrate ion. Contaminant anions of interest were separated on an IonPac AS15 high-capacity anion-exchange column and detected by suppressed conductivity detection. An EG40 eluent generator was used to prepare high-purity and carbonate-free potassium hydroxide. Using the EG40, performance at trace levels was enhanced because background conductivity decreased and retention time reproducibility improved. Trace anionic contamination from the mobile phase was minimized when using the eluent generator compared to using conventionally prepared sodium hydroxide eluents. The signal-to-noise ratio was also improved with the use of a temperature controlled conductivity cell and chromatography hardware in the microbore (2-mm) format. The eluent concentration was optimized to separate the contaminant anions from the excess of the nitrate matrix ions. The procedure was demonstrated for a solution of reagent-grade sodium nitrate and high-purity 0.7% nitric acid. Method detection limits for chloride, sulfate and phosphate of 150 microg/l and lower were achieved.