Πέμπτη 25 Φεβρουαρίου 2016

Time for a new metric for hypoxic dose?

The overall "hypoxic dose" associated with altitude training for athletes is typically reported in the literature as hours of exposure. Current recommendations for altitude training are based around the need to acquire a given number of hours within a specific altitude range (typically 1800-3000 m); with the expected erythropoietic change proportional to the hours accumulated. We propose that elevation should also be incorporated when calculating the total dose of altitude exposure and introduce a new metric termed "kilometer hours" to define overall hypoxic dose.



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Something from Nothing? Space research without leaving the planet.

N/A



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Chronic in vivo or acute in vitro resveratrol attenuates endothelium-dependent cyclooxygenase-mediated contractile signaling in hypertensive rat carotid artery

Exaggerated cyclooxygenase (COX) and thromboxane-prostanoid (TP) receptor-mediated endothelium-dependent contraction can contribute to endothelial dysfunction. This study examined the effect of resveratrol (RSV) on endothelium-dependent contraction and cell-signaling in the common carotid artery (CCA) from spontaneously hypertensive (SHR and Wistar Kyoto rats (WKY). Acetylcholine (Ach)-stimulated endothelium-dependent nitric oxide synthase (NOS)-mediated relaxation in pre-contracted SHR CCA was impaired (max.: 73±6% vs. 87±5% in WKY) (p<0.05) by competitive COX-mediated contraction. Chronic (28d) treatment in vivo (drinking water) with a ~0.075 mg•kg-1•d-1 RSV dose neither affected endothelium-dependent relaxation, nor endothelium-dependent contraction and associated prostaglandin (PG) production evaluated in non-precontracted NOS-blocked CCA. In contrast, a chronic ~7.5 mg•kg-1•d-1 RSV dose improved endothelium-dependent relaxation (94±6%), and attenuated endothelium-dependent contraction (58±4% vs. 73±5% in No RSV) and PG production (183±43 vs. 519±93 pg•ml-1), in SHR CCA, while U46619-stimulated TP receptor-mediated contraction was unaffected. In separate acute in vitro experiments, 20µM RSV preincubation attenuated endothelium-dependent contraction (6±4% vs. 62±2% in No Drug) and PG production (121±15 vs. 491±93 pg•ml-1), and attenuated U46619-stimulated contraction (134±5% vs. 171±4%), in non-precontracted NOS-blocked SHR CCA. Compound C, a known AMP-activated protein kinase (AMPK) inhibitor, did not prevent the RSV attenuating effect on Ach- and U46619-stimulated contraction, but did prevent the RSV attenuating effect on PG production (414±58 pg•ml-1). These data demonstrate that RSV can attenuate endothelium-dependent contraction both by suppressing arterial wall PG production, which may be partially mediated by AMPK, and by TP receptor hypo-responsiveness, which does not appear to be mediated by AMPK.



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Hepatitis B infection and vaccination: Knowledge, Attitude and Practices among primary health care personnel in Lucknow

2016-02-25T22-47-01Z
Source: Journal of Research in Medical and Dental Science
MUKESH SHUKLA, SHANTANU TYAGI, NEERAJ KUMAR GUPTA.
Background: Hepatitis B is a major global health problem and one of the most serious type of viral hepatitis, but it can be prevented with strategies like safe and effective vaccination, increasing awareness and by adhering to universal precautions. Objective: The present study aimed to assess the knowledge attitude and practice concerning Hepatitis B infection among the health care personnel in selected Primary Health Care Centres in Lucknow. Materials and methods: Cross-Sectional study was conducted among health care personnel working at the Primary Health Centres in Lucknow. A total of 89 health care personnel comprising of medical officers, staff nurses, laboratory technicians, pharmacists including class IV workers present on the day of data collection were included in the study and interviewed using pretested questionnaire. Descriptive summary using frequencies, proportions and percentages were used to present study results. Result: Majority (93.4%) of the medical officers were aware about type of hepatitis, while knowledge regarding same was comparatively low among staff nurses, paramedical staff and class IV workers (20.0%, 21.8% and 4.5% respectively). Knowledge about symptoms of hepatitis B was found minimal (9.1%) among class IV workers and paramedical staff (18.7%) as compared to doctors (80.0%) and staff nurse (35.0%). Only 13.6% of class IV worker had concern to report each and every case of needle stick injury. Practice to strictly follow of universal precautions and biomedical waste management guidelines was found to be least (9.1% and 18.1% respectively) among class IV workers. Conclusion: The study revealed sub-optimal KAP in concern to several aspects of Hepatitis B infection among primary healthcare personnel. Therefore insights a need to increase the knowledge level as well ideal behaviour in practice through quality training and proper orientation programmes for health care personnel to prevent the spread of hepatitis B infection.


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Standardization of Bed Rest Studies in the Spaceflight Context

No abstract required for Viewpoint papers



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CHRONIC INTERMITTENT HYPOXIA ALTERS VENTILATORY AND METABOLIC RESPONSES TO ACUTE HYPOXIA IN RATS

We determined the effects of chronic exposure to intermittent hypoxia (CIH) on chemoreflex control of ventilation in conscious animals. Adult male Sprague-Dawley rats were exposed to CIH (nadir oxygen saturation [SpO2], 75%; 15 events/hour; 10 hours/day) or normoxia (NORM) for 21 days. We assessed the following responses to acute, graded hypoxia before and after exposures: ventilation (VE; barometric plethysmography), V.O2 and V. CO2 (analysis of expired air), heart rate (HR) and SpO2 (pulse oximetry via neck collar). We quantifed hypoxia-induced chemoreceptor sensitivity by calculating the stimulus-response relationship between SpO2 and the ventilatory equivalent for V.CO2 (linear regression). An additional aim was to determine whether CIH causes proliferation of carotid body glomus cells (bromodeoxyuridine). CIH exposure increased the slope of the VE/ V.CO2/SpO2 relationship and caused hyperventilation in normoxia. Bromodeoxyuridine staining was comparable in CIH and NORM. Thus, our CIH paradigm augmented hypoxic chemosensitivity without causing glomus cell proliferation.



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Effects of meal ingestion on blood pressure and regional hemodynamic responses after exercise

This study investigated the combined effects of consuming a meal during post-exercise hypotension (PEH) on hemodynamics. Nine healthy young male subjects performed each of three trials in random order. 1) Cycling at 50% of heart rate reserve for 60 min, 2) oral ingestion of a carbohydrate liquid meal (75 g glucose), or 3) carbohydrate ingestion at 40 min after cycling exercise. Blood pressure, heart rate, cardiac output, and blood flow in the superior mesenteric (SMA), brachial, and popliteal arteries were measured continuously before and after each trial. Regional vascular conductance (VC) was calculated as blood flow/mean arterial pressure. Blood pressure decreased relative to baseline values (P<0.05) after exercise cessation. Blood flow and VC in the calf and arm increased after exercise, whereas blood flow and VC in the SMA did not. Blood pressure did not change after meal ingestion; however, blood flow and VC significantly decreased in the brachial and popliteal arteries and increased in the SMA for 120 min after the meal (P<0.05). When the meal was ingested during PEH, blood pressure decreased below PEH levels and remained decreased for 40 min before returning to post-exercise levels. The sustained increase in blood flow and VC in the limbs after exercise was reduced to baseline resting levels immediately after the meal, postprandial cardiac output was unchanged by the increased blood flow in the SMA, and total VC and SMA VC increased. Healthy young subjects can suppress severe hypotension by vasoconstriction of the limbs even when carbohydrate is ingested during PEH.



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In Vitro Antimicrobial Susceptibility of Pathogenic Leptospira Biofilm

Microbial Drug Resistance , Vol. 0, No. 0.


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Emergence of Oxacillinases in Environmental Carbapenem-Resistant Acinetobacter baumannii Associated with Clinical Isolates

Microbial Drug Resistance , Vol. 0, No. 0.


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Rapid Response: EMS providers bear burden when leadership fails

What happened: The TransCare ambulance company, which is one of the major participants in New York City, 911 EMS system filed for bankruptcy on Wednesday.

The result is the immediate loss of 27 ambulances responsible for 81 daily shifts in the city. The liquidation is also resulting in the end of ambulance service in several communities surrounding NYC as well as Maryland.

The FDNY, aware of TransCare's financial problems, had a contingency plan ready and is immediately putting additional ambulances into service. FDNY is also calling on other hospital and third-party EMS providers to increase their ambulance staffing to fill the void created by TransCare.

Why it's significant: New York City is the largest EMS operation in the United States. Each day, FDNY, private agencies and hospital-based EMS services respond to 4,000 911 calls. The sudden loss of a major response and transport agency is likely to have significant impacts throughout the system.

The short-term loss of TransCare will be felt by FDNY EMS and other agency providers who will be asked to work more overtime and respond to more calls. Dispatchers may struggle to find ambulances available to respond to calls. It's also reasonable that patients will experience increased response times. With thousands of calls per day, we can be certain that a few patients with time sensitive, life-threatening problems will have potentially longer wait for needed care.

Meanwhile, 225 miles south, AMR is recruiting paramedics to respond to 911 calls assigned to them during peak demand times by D.C. Fire and EMS. This long-promised service improvement comes on the heels of the very public resignation and testimony of DCFEMS medical director Jullette Saussy.

Top takeaways: D.C. and NYC, as well as a Kentucky agency that announced layoffs this week, remind us that the delivery of EMS is tenuously balanced on a razor's edge between survival and failure. Many agencies, public and private, are under significant financial and operational stress. Here are my top three takeaways for EMTs and paramedics:

1. Your safety is number one.
Think of safety as more encompassing than physical safety at a 911 call. Your financial safety is critically important to your survival. Every EMS provider needs an emergency fund of at least $1,000 in case of sudden job loss. It's even better to have savings for three to six months of expenses.

2. FDNY needs to escalate operational changes.
The department is going to begin using SUVs to respond to calls during peak-demand times ahead of ambulances. In addition, FDNY is planning to staff additional ambulances with EMTs. Those service changes need to happen sooner rather than later.

As a department, 75 percent of responses are for medical incidents, but like many communities the high-volume of EMS responses is not reflected in proportional funding. Though not likely to change fast, FDNY needs to better allocate resources to its medical mission.

3. Opportunities abound in EMS.
If you are willing to relocate, there are a lot of opportunities. AMR is recruiting in D.C. and the ink was barely dry on the FDNY contingency plan order when AMR invited displaced TransCare medics to visit its job page.

EMS transitions are never easy. Our thoughts are with the former employees of Transcare and the communities they serve. ...

Posted by American Medical Response on Thursday, February 25, 2016

What's next: In the short-term, we can expect local media to be sniffing for sensational stories of people waiting for ambulances and emergencies that could have been responded to quicker.

I also suspect that politicians, officials and agency leaders will point fingers at one another, shifting the blame and shrugging responsibility, while the field providers on the streets get hammered with more calls, mandated overtime and the ire of an impatient public.

Further reading:

TransCare declares liquidation to New York City and Maryland assets

Increase ambulance service for less money

An open letter to the leaders of DC Fire and EMS

DC Fire and EMS: The shame of EMS

DC fire Lt. facing neglect charges skips disciplinary hearing



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SUPERIOR AMBULANCE JOB FAIR - SUPERIOR AMBULANCE

SUPERIOR AMBULANCE JOB FAIR WHEN: Friday March 11th, 2016 WHERE: 1581 E. 90th Pl, # F Merrillville, IN We are looking for: ØEMT-Basics ØParamedics ØMedicar Drivers What we offer: ØCompetitive Wages ØComprehensive Benefits ØTuition Reimbursement ØCareer Progression

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FirstPass by FirstWatch Informational Video

FirstPass®, from the creators of FirstWatch®, can review the entire patient experience from the time 911 is called to delivery at the hospital. Improving the quality, collection and analysis of data improves billing and financial recovery.

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Monitoring of oropharyngeal leak pressures using cuff manometer/cuff inflator device

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Determining airway sealing pressure /oropharyngeal leak pressure (OLP) is commonly used parameter to access efficacy and functional analysis of supraglottic airway devices. Standard measurement of OLP in a landmark article by Keller et al [1] describes closure of the expiratory valve of anesthesia breathing system and the fresh gas flow is adjusted to 3 L · min−1. OLPs are measured to within 0.5 cm H2O using a calibrated aneroid manometer attached to the proximal end of the laryngeal mask airway or the desired supraglottic airway device.

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FirstPass by FirstWatch Informational Video

FirstPass®, from the creators of FirstWatch®, can review the entire patient experience from the time 911 is called to delivery at the hospital. Improving the quality, collection and analysis of data improves billing and financial recovery.

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FirstPass by FirstWatch Informational Video

FirstPass®, from the creators of FirstWatch®, can review the entire patient experience from the time 911 is called to delivery at the hospital. Improving the quality, collection and analysis of data improves billing and financial recovery.

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