Search

Complex mixtures of unknown contaminants present a challenge to identify toxicological risks without using large numbers of animals and labor-intensive screens of all organs. This study examined soil extracts from a legacy-contaminated pesticide packaging and blending site. HepG2 cytotoxicity was used as an initial screen of 18 soil samples; then, three extracts (A, B and C) from different locations at the study site were used for testing in animals. The first two extracts were identified as the most toxic in vitro, and the latter extract obtained from a location further from these two toxic sampling sites. Then, target organ toxicities were identified following biweekly oral gavage for one month of three soil extracts (0.1% in polyethylene glycol or PEG) compared to vehicle control in male Sprague-Dawley rats (n = 9-10/group). Exposure to extract A significantly increased neutrophils and lymphocytes compared to control. In contrast, all extracts increased plasma α-2 macroglobulin and caused mild-to-moderate lymphocytic proliferation within the spleen white pulp, all indicative of inflammation. Rats exposed to all soil extracts exhibited acute tubular necrosis. Cholinesterase activity was significantly reduced in plasma, but not brain, after exposure to extract A compared to control. Increased hepatic ethoxyresorufin-o-deethylase activity compared to control was observed following exposure to extracts A and B. Exposure to soil extract C in rats showed a prolonged QTc interval in electrocardiography as well as increased brain lipid peroxidation. Candidate contaminants are organochlorine, organophosphate/carbamate pesticides or metabolites. Overall, HepG2 cytotoxicity did not successfully predict the neurotoxicity and cardiotoxicity observed with extract C but was more successful with suspected hydrocarbon toxicities in extracts A and B. Caution should be taken when extrapolating the observation of no effects from in vitro cell culture to in vivo toxicity, and better cell culture lines or assays should be explored.

Frostbite is caused by exposure to cold temperatures and can lead to severe injury resulting in amputations. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy preventing amputation in frostbite patients. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding complication. The purpose of this study was to characterize bleeding complications in severe frostbite patients managed with and without tPA. Retrospective chart review of severe frostbite patients admitted to a single ABA verified burn center. Bleeding events were grouped: category 0: no bleed; category 1: bleed not resulting in change or intervention; category 2: bleed resulting in change of management; and category 3: bleed resulting in change of management and intervention. Over a 7-year period, 188 patients were included in the study. Most patients had no documentation suggesting a bleeding complication: 69.7% category 0, 19.1% category 1, 4.8% category 2, and 6.4% category 3. There was no significant difference in category 2 or 3 bleeding complications between patients treated with or without tPA. Overall, 9 of the 143 patients (6.3%) treated with tPA had a category 2 or 3 bleeding complication within 12 hours of tPA completion and 12 of 143 (8.4%) within 24 hours of tPA completion. Based on the low risk of severe bleeding and significant benefit relative to limb or digit salvage demonstrated in this study, we conclude that tPA is safe and effective for the treatment of frostbite in appropriately selected patients.

Introduction Frostbite is caused by exposure to cold temperatures and can be a severe injury leading to hospital admissions, surgeries, or amputations. Disease progression involves endothelial injury, thrombosis, and tissue necrosis; therefore, management of patients involves a process of rewarming and restoration of blood flow to the affected area. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy at restoring tissue perfusion in patients with frostbite. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding, a documented adverse effect of tPA administration. The purpose of this study was to characterize specific bleeding complications associated with tPA administration. The secondary objective was to compare the rate of bleeding complications in frostbite patients treated with intravenous (IV) tPA to frostbite patients that did not receive tPA. Methods This single center retrospective study included all adult patients with severe frostbite who presented between October 2013 and March 2020. tPA was given to patients per institutional protocol. To assess for bleeding events, patient charts were reviewed and any instance of bleeding was categorized based on severity. Bleeding was categorized as: 1) none, 2) mild: not clinically significant (bandage or moved IV site), 3) moderate: change of management (tPA stopped, enoxaparin held, or specialty consult), and 4) severe: included a change and intervention (transfusion, fasciotomy for compartment syndrome). Any change in management or any additional therapies used to control bleeding were documented, as well as the timing of bleeding in relation to tPA administration. Results Over a 7-year period 209 patients were analyzed and 202 patients were included. For patients with bleeding events requiring intervention, the mean time to bleed was 105.5 hours (range 4 to 576 hours). Of these, 4 (3 transfusions and 1 fasciotomy for compartment syndrome) were temporally associated with tPA administration (within 24 hours). Two of the 4 patients had minor to moderate traumatic injury prior to admission, the 3rd patient had incomplete work-up at referring center that initiated tPA prior to transport, and the 4th patient was in restraints. Of the patients who did not receive tPA, 3.39% had a severe bleeding event requiring intervention compared to 6.99% of patients treated with tPA (P=0.516). Conclusions Though there was a higher incidence of bleeding in tPA-treated patients, for the majority of patients studied, tPA was safe for the treatment of severe frostbite. Bleeding events occur in frostbite patients treated with or without tPA and warrant close follow-up for these infrequent complications.

The white sturgeon (

Purpose The purpose of this study was to assess an institution’s heparin protocols in elderly and nonelderly adult populations to see if a response difference was observed. Methods This was a retrospective cohort study of hospitalized adults who were prescribed unfractionated heparin due to surgery, acute coronary syndrome (ACS), or deep vein thrombosis/pulmonary embolism (DVT/PE) from February 11, 2016, through August 1, 2017. Patients were divided into nonelderly adults 18 to 69 years of age and elderly patients 70 years of age or older. The anti-factor Xa (anti-Xa) level after protocol initiation was compared to the institution’s goal range of 0.3 to 0.7 IU/mL. Outcomes of each protocol in the elderly population were compared to outcomes in their nonelderly counterparts to determine if there was a difference in heparin response. Results A total of 325 patients were included in the analysis, comprising 150 elderly and 175 nonelderly adults. Elderly patients had a higher initial anti-Xa levels than did their nonelderly adult counterparts in the ACS, DVT/PE, and surgery protocols, with P values of 0.02, Conclusion Elderly patients had significantly higher initial anti-Xa levels than did nonelderly adult patients across all protocols. This study identifies the need to further study elderly patients’ increased heparin sensitivity to determine if a separate dosing protocol is needed.

Evidence-based research and interventions to address systemic institutional racism have never been more urgent. Yet, underrepresented minority (URM) professionals in research institutions who primarily produce that evidence have remained abysmally low for decades. This unique study of URM university professors assesses factors-vocational strain, role overload, discrimination, coping strategies-that contribute to health and well-being, research productivity, and ultimately their retention in high impact research positions. We administered a web-based survey assessing demographics, workplace stressors, perceived discrimination, life events, coping strategies, and physical and depressive symptoms. Study participants include 404 faculty of whom 254 are African Americans, 99 are Mexican Americans, and 51 are Puerto Ricans. Hierarchical regression analyses were employed to assess the associations between workplace stress, coping strategies, and symptoms. Results show that perceived discrimination, vocational strain, role overload, and life events directly affected physical symptoms, with self-care (p < 0.001) moderating these effects. Vocational strain and life events had direct effects on depressive symptoms with self-care (p < 0.05) and social support (p < 0.001) moderating these effects. Findings inform health care providers and university leaders about work stress and health conditions that may explain early morbidity and premature departures of URM faculty, and proffer institutional interventions to retain these faculty.

In July 2018, the Food and Drug Administration warned about a possible relationship between dilated cardiomyopathy (DCM) in dogs and the consumption of dog food formulated with potatoes and pulse ingredients. This issue may impede utilization of pulse ingredients in dog food or consideration of alternative proteins. Pulse ingredients have been used in the pet food industry for over 2 decades and represent a valuable source of protein to compliment animal-based ingredients. Moreover, individual ingredients used in commercial foods do not represent the final nutrient concentration of the complete diet. Thus, nutritionists formulating dog food must balance complementary ingredients to fulfill the animal’s nutrient needs in the final diet. There are multiple factors that should be considered, including differences in nutrient digestibility and overall bioavailability, the fermentability and quantity of fiber, and interactions among food constituents that can increase the risk of DCM development. Taurine is a dispensable amino acid that has been linked to DCM in dogs. As such, adequate supply of taurine and/or precursors for taurine synthesis plays an important role in preventing DCM. However, requirements of amino acids in dogs are not well investigated and are presented in total dietary content basis which does not account for bioavailability or digestibility. Similarly, any nutrient (e.g., soluble and fermentable fiber) or physiological condition (e.g., size of the dog, sex, and age) that increases the requirement for taurine will also augment the possibility for DCM development. Dog food formulators should have a deep knowledge of processing methodologies and nutrient interactions beyond meeting the Association of American Feed Control Officials nutrient profiles and should not carelessly follow unsubstantiated market trends. Vegetable ingredients, including pulses, are nutritious and can be used in combination with complementary ingredients to meet the nutritional needs of the dog.

Nowhere is the severity and impact of racism on our nation and its people clearer and more profound than in the arena of health—where racism is literally a matter of life and death. Employing an intersectional lens, this essay addresses four aspects of the complex relationship between health and race, ethnicity, and other systems of inequality. First, we situate the national discourse on health care disparities in an historical and social movement context, followed by several ways that racial and ethnic differences in health are defined. Second, we provide an overview of data on differences in health and health care. Third, we examine dominant and critical models for explaining the differences, specifically comparing traditional biomedical approaches with intersectional social constructionist approaches. We conclude with proposed strategies to reduce and eliminate health inequities across race, ethnicity, gender, and social class.

Background: Better understanding and addressing health inequities is a growing global priority. Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.

In this community-based research, we reveal social processes contributing to health inequities among the resident Latino population – predominantly new immigrants – in a working-class, urban community with an historical, social and political landscape defined by a Black–White social divide and its attendant racial tensions. Using the social determinants of health framework, we identify both macro- and micro-level structures and processes that threaten the health and well-being of individual Latinos and the broader communities where they live and work: discrimination, social isolation, communication barriers, host community residents’ fear of immigrants, and racial/ethnic competition for work, housing, and educational and social resources.

Purpose. The implementation of standard order sets for patient-controlled analgesia (PCA) is described. Summary. A review of naloxone usage at the University of Minnesota Medical Center (UMMC) from January to June 2004 found that 8% of patients receiving PCA had severe respiratory depression. A subanalysis of each event found that 85% of these patients had never before received opioid therapy. To reduce the risk of respiratory depression with PCA, separate standard order sets were developed for patients new to or tolerant of opioid therapy. A major component of both order sets was the standardization of a 10-minute lockout interval between each PCA dose. Implementation of the new PCA order sets raised concerns among health care professionals at UMMC that medication safety may be improved at the cost of increased pain. After implementation of the order sets, prescriber compliance, pharmacist interventions, the frequency of adverse effects, and patients’ pain management were evaluated. After implementation of standard order sets for patients receiving PCA, 57% of patients’ pain was documented as being controlled, and the orders for 93% of patients were in compliance with the recommended dosage interval of ≥10 minutes. There were no reports of oversedation or respiratory depression requiring reversal with naloxone. Conclusion. The implementation of standard order sets for PCA resulted in a dramatic decrease in the number of cases of severe respiratory depression and increased use of the order set for patients new to opioid therapy. Changing the order sets to improve medication safety did not appear to negatively affect patients’ satisfaction with pain management.

Hurricane Katrina slammed into the Gulf Coast in August 2005 with devastating consequences. Almost all analyses of the disaster have been dedicated to the way the hurricane affected New Orleans. This volume examines the impact of Katrina on southern Mississippi. While communities along Mississippi's Gulf Coast shared the impact, their socioeconomic and demographic compositions varied widely, leading to different types and rates of recovery. This volume furthers our understanding of the pace of recovery and its geographic extent, and explores the role of inequalities in the recovery process and those antecedent conditions that could give rise to a 'recovery divide'. It will be especially appealing to researchers and advanced students of natural disasters and policy makers dealing with disaster consequences and recovery.

Since the mid-1980s, scholarship and college courses that address multiple dimensions of inequality under the rubric of race, class, gender, and (recently) sexuality studies have grown rapidly. Most courses now employ a set of readings, many of which are drawn from a growing number of anthologies. A strength of this approach is its presentation of the diversity of human experiences and the multiplicity of critical perspectives. A weakness is its failure to convey the commonalities in race, class, gender, and sexuality analyses of social reality. To aid in teaching and research on race, class, gender, and sexuality, this article presents six common themes that characterize this scholarship. Race, class, gender, and sexuality are historically and globally specific, socially constructed power relations that simultaneously operate at both the macro (societal) and micro (individual) levels of society. Scholarship in this tradition emphasizes the interdependence of knowledge and activism.

Purpose The factors motivating pharmacy students to pursue residency and fellowship training in 2011 versus 1993 were assessed. Methods A survey replicating previous research was electronically sent to 794 residency directors and 29 fellowship program directors with a request to forward the survey to current residents and fellows. A similar survey was sent to 124 colleges of pharmacy with a request to forward the survey to the faculty member most involved with residency and fellowship promotion within their doctor of pharmacy (Pharm.D.) curriculum. Participants were asked to rank leading motivating factors and barriers to pharmacy students pursuing these programs. Additional data collected included when and the methods by which these programs are promoted. Results Among residents and fellows, 865 usable surveys were returned. The leading motivating reasons for residents and fellows to pursue training were “to gain knowledge and experience,” “to gain confidence,” and “understood as a prerequisite for certain jobs.” A total of 124 U.S. pharmacy schools were surveyed, and 65 (52%) returned completed responses. “Understood as a prerequisite for certain jobs,” “faculty stressing importance,” and “recognition of the new and challenging roles for pharmacists in the future” were the factors most frequently cited by faculty members. Conclusion Compared with previous research, a new factor motivating pharmacy students to pursue residency and fellowship training is the consideration that these opportunities are a prerequisite for certain jobs. This development may be attributable to trends in the supply and demand of pharmacists, the recognition of the value in these programs by major pharmacy organizations, and the evolving role of pharmacists in direct patient care.