Τετάρτη, 8 Ιουνίου 2016

Disposition kinetics and metabolism of nicotine and cotinine in African American smokers: impact of CYP2A6 genetic variation and enzymatic activity

imageObjective: The rate of nicotine metabolism, determined primarily by CYP2A6 activity, influences tobacco dependence and smoking-induced disease risk. The prevalence of CYP2A6 gene variants differs by race, with greater numbers in African Americans compared with Caucasians. We studied nicotine disposition kinetics and metabolism by the CYP2A6 genotype and enzymatic activity, as measured by the nicotine metabolite ratio (NMR), in African American smokers. Methods: Participants were administered intravenous infusions of deuterium-labeled nicotine and cotinine. Plasma and urine concentrations of nicotine and metabolites were measured and pharmacokinetic parameters were estimated. Results: Pharmacokinetic parameters and urine metabolite excretion data were analyzed by CYP2A6 genotype and by NMR. A number of gene variants were associated with markedly reduced nicotine and cotinine clearances. NMR was strongly correlated with nicotine (r=0.72) and cotinine (r=0.80) clearances. Participants with higher NMR excreted significantly greater nicotine C-oxidation and lower non-C-oxidation products compared with lower NMR participants. Conclusion: CYP2A6 genotype, NMR, and nicotine pharmacokinetic data may inform studies of individual differences in smoking behavior and biomarkers of nicotine exposure.

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The 7 best EMS movies of all time

It's up for debate whether the "best EMS movie" has actually been made yet. The Hollywood take on EMTs' lives shows a much different picture than what a true paramedic deals with day in and day out. Real EMS – monthly inventory checks, driving to (and sitting at) posted locations or writing reports – may not captivate an audience's attention like a Hollywood dramatization.

Nonetheless, we're going to take a stab at naming the best – and in some cases, most accurate – portrayals of EMS. Here's our list of the seven best EMS movies of all time.

7. Crash Landing: The Rescue of Flight 232
Based on a true story, "The Rescue of Flight 232" is based on United Airlines Flight 232 from Denver to Chicago. The flight crashed during an emergency landing in 1989. Even though the focus isn't entirely on EMTs, the perspective of the ground rescue workers is noteworthy.

6. M*A*S*H
"M*A*S*H" the flick (yes, we're referring to the movie here, not the TV series) is a trauma care movie with plenty of emergency medicine parallels. The film is about a unit of medical personnel stationed at a mobile army surgical hospital during the Korean War. We especially appreciate the dark humor.

5. Black Hawk Down
We thought this one worth mentioning for the realistic traumatic wound scenes. "Black Hawk Down" is based on a series of articles published in The Philadelphia Inquirer about a 1993 raid in Mogadishu, Somalia, by the U.S. military. Real war stories mean real emergency medical scenes.

4. Mother, Jugs & Speed
This movie was made in the '70s, and fair warning, it's not politically correct. But humor aside, the semi-realistic theme of competition between privately-owned ambulance companies in Los Angeles makes the movie an easy selection for this list.

3. Bringing Out the Dead
Maybe one of the most underrated Scorsese-directed movies ever, "Bringing Out the Dead" is about a burned-out paramedic dealing with the demons of those he was unable to save. In the midst of his lowest point, paramedic Frank Pierce is faced with his own chance for survival.

2. Paramédico
Paramédico is a documentary that portrays the day-to-day lives of four paramedics in different parts of the world and the different calls they go on. The film takes a candid approach to detail the uncertainty of a paramedic's workday – its realism is what earned it a top spot on this list.

1. Tell Me and I Will Forget
Warning: This is a heavy film, but worth a watch. In this documentary, filmmakers explore the social challenges in South Africa after apartheid, specifically the wave of violent crime that ensued. The documentary is told from a paramedic's perspective to detail the pressure the medical system faced after the social changes.

How did we do" Are we missing your favorite EMS film" What movie do you think should earn the No. 1 spot"

What is the best EMS movie of all time"
Crash Landing: The Rescue of Flight 232
Black Hawk Down
M*A*S*H
Paramédico
Bringing out the Dead
Tell me and I will Forget
Mother Jugs and Speed
Other
Please Specify:
Poll Maker


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Paramedic Vein Glasses Aid First Responders

Columbus, OH—Paramedics and first responders can enhance their vision and be able to treat patients quicker thanks to Paramedic Vein Glasses, created by O2Amp™. The technology amplifies the perception of veins to help first responders administer medication and draw blood faster. "The Paramedic Vein Glasses uses Oxy-Amp™ technology which amplifies the perception of blood oxygenation ...

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Operations Specialist - Global Rescue LLC

COMPANY DESCRIPTION Global Rescue is a worldwide provider of integrated medical, security, intelligence and crisis response services to enterprise, government, and consumer clients. Founded in 2004 in partnership with Johns Hopkins Medicine, Global Rescue's unique operational model provides best-in-class services that identify, monitor, and respond to threats and emergencies. Global Rescue has ...

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Firefighter Paramedic - Hanford Fire Department

HANFORD FIRE DEPARTMENT P.O. BOX 650, MSIN S3-96 RICHLAND, WASHINGTON 99354 Updated: June 07, 2016 Job title: Firefighter-Paramedic Closing Date/Time: 06-30-2016 0800 Pacific Time Job Type: Regular Full-time Salary: $40,072.64 - $57,203 (Adders and certs. excluded) (509) 373-1701 On June 7 2016, the Hanford Fire Department (HFD) Firefighter Paramedic candidate testing and interview processes will open ...

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Aortic augmentation index in endurance athletes: a role for cardiorespiratory fitness

Abstract

Purpose

Endurance exercise improves cardiovascular health and reduces mortality risk. Augmentation index (AIx) reflects adverse loading exerted on the heart and large arteries and predicts future cardiovascular disease. The purpose of this study was to establish whether endurance athletes possess lower AIx and aortic blood pressure compared to healthy controls, and to determine the association between AIx and cardiorespiratory fitness.

Methods

Forty-six endurance athletes and 43 healthy controls underwent central BP and AIx measurements by non-invasive applanation tonometry before a maximal exercise test. Peak oxygen uptake ( \(\dot{V}{\text{O}}_2}}\) ) was assessed by pulmonary analysis.

Results

Relative to controls, athletes had significantly lower brachial diastolic blood pressure (BP, −4.8 mmHg, p < 0.01), central systolic BP (−3.5 mmHg, p = 0.07), and AIx at a heart rate of 75 beats min−1 (AIx@75, −11.9 %, p < 0.001). No AIx@75 differences were observed between athletes and controls when adjusted for age and \(\dot{V}{\text{O}}_2}}\) [athletes vs controls mean (%) ± SE: −6.9 ± 2.2 vs −5.7 ± 2.3, p = 0.76]. Relative to men with low \(\dot{V}{\text{O}}_2}}\) , those with moderate and high \(\dot{V}{\text{O}}_2}}\) had lower age-adjusted AIx@75 (p < 0.001). In women, those with high \(\dot{V}{\text{O}}_2}}\) had lower AIx@75 than those with low and moderate \(\dot{V}{\text{O}}_2}}\) (p < 0.01).

Conclusions

The lower AIx@75 in endurance athletes is partly mediated by \(\dot{V}{\text{O}}_2}}\) . While an inverse relationship between AIx@75 and \(\dot{V}{\text{O}}_2}}\) was found in men, women with the highest \(\dot{V}{\text{O}}_2}}\) possessed lowest AIx@75 compared to females with moderate or poor cardiorespiratory fitness. We recommend aerobic training aimed at achieving a minimum \(\dot{V}{\text{O}}_2}}\) of 45 ml kg−1 min−1 to decrease the risk of future cardiovascular events and all-cause mortality.



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Heart rate variability (HRV) in deep breathing tests and 5-min short-term recordings: agreement of ear photoplethysmography with ECG measurements, in 343 subjects

Abstract

Purpose

We analyzed heart rate variability (HRV) taken by ECG and photoplethysmography (PPG) to assess their agreement. We also analyzed the sensitivity and specificity of PPG to identify subjects with low HRV as an example of its potential use for clinical applications.

Methods

The HRV parameters: mean heart rate (HR), amplitude, and ratio of heart rate oscillation (E–I difference, E/I ratio), RMSSD, SDNN, and Power LF, were measured during 1-min deep breathing tests (DBT) in 343 individuals, followed by a 5-min short-term HRV (s-HRV), where the HRV parameters: HR, SD1, SD2, SDNN, Stress Index, Power HF, Power LF, Power VLF, and Total Power, were determined as well. Parameters were compared through correlation analysis and agreement analysis by Bland–Altman plots.

Results

PPG derived parameters HR and SD2 in s-HRV showed better agreement than SD1, Power HF, and stress index, whereas in DBT HR, E/I ratio and SDNN were superior to Power LF and RMSSD. DBT yielded stronger agreement than s-HRV. A slight overestimation of PPG HRV over HCG HRV was found. HR, Total Power, and SD2 in the s-HRV, HR, Power LF, and SDNN in the DBT showed high sensitivity and specificity to detect individuals with poor HRV. Cutoff percentiles are given for the future development of PPG-based devices.

Conclusion

HRV measured by PPG shows good agreement with ECG HRV when appropriate parameters are used, and PPG-based devices can be employed as an easy screening tool to detect individuals with poor HRV, especially in the 1-min DBT test.



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Acute muscle and joint mechanical responses following a high-intensity stretching protocol

Abstract

Purpose

A previous study observed a joint passive torque increase above baseline ~30 min after a high-intensity stretching. This study examined the effect of a high-intensity stretching on ankle dorsiflexion passive torque, medial gastrocnemius (MG) shear modulus, and plantar flexors maximal voluntary isometric force (MVIC).

Method

Participants (n = 11, age 27.2 ± 6.5 years, height 172.0 ± 10.0 cm, weight 69.5 ± 10.4 kg) underwent two stretching sessions with plantar flexors isometric contractions performed: (1) 5 min before, 1 min after, and every 10 min after stretching (MVC session); (2) 5 min before, and 60 min after the stretching (no-MVC session).

Results

In both sessions, no changes were observed for MG shear modulus (p > 0.109). In the no-MVC session, passive torque decreased 1 min after stretching (−7.5 ± 8.4 %, p = 0.015), but increased above baseline 30 min after stretching (+6.3 ± 9.3 %, p = 0.049). In the MVC session, passive torque decreased at 1 min (−10.1 ± 6.3 %, p < 0.001), 10 min (−6.3 ± 8.2 %, p = 0.03), 20 min (−8.0 ± 9.2 %, p = 0.017), and 60 min (−9.2 ± 12.4 %, p = 0.034) after the stretching, whereas the MVIC decreased at 1 min (−5.0 ± 9.3 %, p = 0.04) and 10 min (−6.7 ± 8.7 %, p = 0.02) after stretching.

Conclusion

The ankle passive torque increase 30 min following the stretch was not due to the MG shear modulus response; consequently, response may be due to changes in surrounding connective tissue mechanical properties.



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Community paramedicine isn't a fire department cash machine

My immediate reaction to seeing that revenues for the Dallas Fire-Rescue's community paramedicine program were "below expectations" was anything but surprise. In fact, anyone surprised by this news doesn't have realistic expectations of novel EMS business models.

The reality is that community paramedicine programs across the country are learning how to be self-sufficient. Fire and EMS administrators are being forced to look at their balance sheets and bank accounts in a way that doesn't jibe with traditional EMS funding or reimbursement.

But when it's the health of the patient on the line, taking a chance on such a program is worth every ounce of uncertainty and political pushback. Congratulations to Dallas Fire-Rescue, and especially to Assistant Chief Norman Seals, for knowing how to respond when facing a reporter asking tough questions about a program that has yet to make any money.

No man is an island, and in our well connected world neither is any mobile integrated health care or community paramedicine program. If you're thinking about starting one in your area there are a few things that Dallas and other programs like it can teach us.

Before your start: Learn from others
Gaining information about a community paramedicine program similar to the one you're hoping to create isn't hard to do. For an industry with so many different versions of reality, EMS is well connected and Google can be your best friend.

Given Dallas' proximity to MedStar in Fort Worth I'd hazard to guess that they studied that program. But it also seems safe to assume, that MedStar wasn't the only program that Dallas Fire-Rescue examined.

Step 1: Set realistic expectations and stick to them
Community paramedicine is a new program with a new funding model trying to exist in a new health care landscape. So having a strategic plan that critically evaluates what your agency is trying to accomplish within a given market is imperative. Moving forward on an idea of this size without a plan in place is like going treasure hunting without a map; it's fun for the first 30 minutes, but it gets frustrating not long after.

Keeping stakeholders engaged means you can't promise the stars when the moon will do. Setting these realistic expectations from the beginning allows for open and honest dialogue as the program has its first successes and hits its first roadblocks.

And don't think you'll be immune to the roadblocks. Every successful EMS program has faced issues. It's how EMS leaders handled those issues that predicted how the program fared on the back end.

Step 2: Build relationships
Dr. Marshal Isaacs, Dallas Fire-Rescue medical director said it best. "It's safe to say that every major health care hospital system in Dallas is interested in this topic and this program."

It's also safe to assume that the same could be true in your area, if only the key stakeholders knew what community paramedicine actually is. But it's hard to advocate for program if someone don't know its possibility.

Meet with stakeholders of brick and mortar facilities. Sometimes bigger is better because they have economic flexibility. Other times smaller is smarter because they have less hoops to jump through in order to build a partnership. But you can't know until you're sitting across the table from them.

Step 3: Prove that it's working
Success needs to be measured beyond the single outcome of saving money. Your program will change the structure and/or process of how health care is delivered in your area. This leads to a wide variety of non-traditional outcomes favoring organizations that may not even know you exist — unless you already met with them. Those non-traditional outcomes include:

  • Call volume
  • Emergency department visits
  • Primary care visits
  • Medication adherence
  • Patient satisfaction
  • Employee satisfaction
  • Employee retention
  • 30-day readmissions

Reach out to local researchers and ask for help with the more advanced analytics. They may not have time to help you, but they probably know someone — perhaps a doctoral or masters student in search of a dissertation or thesis topic — who can.

Step 4: Share what you've learned
Once you've created a program, publish and distribute your results, even if they are preliminary and don't reflect positively. Submit a presentation for local, regional and national conferences; write an article for a peer-reviewed journal and then write a column for EMS1, and always make sure to pitch news story ideas to your local media.

Most importantly, make sure the audience knows that you are more than happy to answer any additional questions they may have.

Step 5: Don't forget where you started
Whichever step you're on, don't forget the patients and the providers who are on the ground floor. They will feel every hiccup as your program tries to expand and integrate more fully into the surrounding health care industry. Make sure they are appreciated and have an opportunity to contribute to the program's successful evolution.

Dallas Fire-Rescue may momentarily be in the hot seat with local media, but the great thing about this increased scrutiny is that it means more people within the community are aware that Assistant Chief Seals and his team are trying. Although goodwill won't pay the bills, it can have powerful impact on the success, or failure, of any new enterprise.



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EMS agencies must embrace, adapt to constant change

The nature of public safety is in flux and has always been. Few people, with the exception of a baby with a wet diaper, like or embrace change.

Agencies have to respond appropriately to a constantly changing operational environment, matching resources and supply to the demands of the workplace. Perhaps EMS organizations are the best example of this dynamic.

The argument between city leaders and fire union officials in Sacramento on how to staff their EMS units is emblematic. How do organizations faced with multiple pressures of budget, staffing and call volume respond in a way that is ethically most appropriate"

The nature of the fire service has been changing for decades. Since the 1973 publication of "America Burning," the landmark position paper on the importance of fire prevention, the occurrence of fatal fires in the United States has declined significantly. Much of the success comes from the efforts of the fire service through increased building regulations, better code enforcement, sprinkler system installation and innovations in fire suppression technology.

Simultaneously, as the population grows older and arguably less healthy, the calls for EMS service have steadily climbed. Many fire agencies have responded appropriately by placing greater emphasis on EMS duties while maintaining fire protection services. But the costs of both can be high to taxpayers, with little evidence supporting better patient outcomes. In other instances, poor implementation of EMS services has led to expensive models which may not significantly improve community health overall.

The fire service is not the only segment of the health care industry trying to respond or adapt to change. EMS agencies, both public and private, struggle to maintain funding in a dwindling reimbursement market. While community paramedicine projects are proving their effectiveness in improving community health while reducing the cost of service, some EMS organizations and providers believe that emergency response should be their only function.

I don't advocate for one type of system or another. I've seen plenty of great fire-based, third service and private EMS providers perform tremendous work in protecting and serving their communities.

I've also seen numerous agencies of all types fail to accomplish their mission because they lose sight of it. The only constant in life is change. EMS agencies must embrace that and work diligently to provide appropriate services in a responsible and ethical manner.



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6 ideal gift ideas for an EMT this Father’s Day

Having a hard time thinking of a gift for Dad this year" Don't fret — EMS1 has compiled six ideas for your paramedic Pop this Father's Day. Check out these perfect gifts to wow him this year:

1. Mr. Wilson Makes it Home

Price: $18.18
This book was written by EMT (and dad, grandfather and foster dog dad) Michael Morse. "Mr. Wilson Makes it Home" is a deeply emotional book about the hardships Morse's family has endured professionally and personally and how he and his family found solace in a little dog. The touching message reminds the reader how important family is — a beautiful reminder on Father's Day.
Link to purchase

2. Activity tracker

Price: about $150 (mid-range)
Activity bands are fun, personal technology gadgets that also keep us on track with our health. Experts recommend getting 10,000 steps or more a day. Get your dad an activity tracker so he can start monitoring his day-to-day movements while at work and at home. Garmin devices are a nice, sleek and trusted brand.
Link to purchase

3. YETI or Hydro Flask water bottles

Price: $21- $89
A nice water bottle is more than just a perfect way to keep beverages hot or cold all day — it's also a smart way to ensure that your dad is staying hydrated at work. YETI and Hydro Flask are known for being two of the top water bottle products on the market.
Links to purchase YETI & Hydro Flask

4. External battery for cell phone

Price: around $30
Your EMS dad likely gets pulled away on 24, 36 or 48-hour shifts. Having a place to charge his phone may not always be an easy or accessible option. An external battery pack for his phone is a thoughtful gift to keep him on the grid (and you in touch with him) while he's away from home.
Link to purchase

5. LED headlamp

Price: varies, $20-$300+
A headlamp can come in handy for your EMS dad both on duty and off. One of our favorite mid-price range headlamps is the Black Diamond Storm headlamp. It's reasonably priced at $50.20 and has a nice sleek design.
Link to purchase

6. Charitable donation

Price: varies according to your price range
If material gifts aren't on your radar, consider a donation. Both The Code Green Campaign and the National EMS Memorial are fantastic organizations to consider — and both specific to the EMS community.
Links to give a gift in your dad's honor: Code Green Campaign & National EMS Memorial

Coming up with thoughtful gifts can be a challenging process. Have you received or given a gift that Dad can't get enough of" Let us (and our readers) hear about it.



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Barriers of using electronic medical records among Saudi physicians

2016-06-08T08-54-21Z
Source: International Journal of Medical Science and Public Health
Husain Alzobaidi, AbdulRhamn Alghamdi.
Background: Adoptions of electronic medical records (EMRs) is restricted by many barriers, which may differ from one facility to another depending on the personal demographic data of such facility. Objective: To assess the barriers of the physicians in Al-Hada Military Hospital in Taif City toward implementing EMR. Materials and Methods: Questionnaire consisted of personal demographic variables, practical demographic variables, cost, data entry, and usefulness variables were distributed to 131 practicing physicians, who accepted to participate, were present at the time of the study (not on vacation or leave), and who were working in Al-Hada Military Hospital in Taif City (excluding visiting or locum physician). Result: Of the 129 physicians, 107 were men representing 83% whereas women represented only 17%. Most of the participants were from family and community medicine (25%), followed by surgery (20%), pediatrics (14%), medicine (12%), and OBG (8%). Twenty-five (19%) strongly agreed that EMR is too costly, 20 (15%) participants strongly agreed that EMR is time-consuming, and 39 (30%) strongly agreed the easiness of data entry into EMR. Conclusion: Generally, the barriers of Al-Hada Military Hospital physicians toward implementing computerization of medical record are mainly the cost and time.


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Study of prevalence and clinical presentation of fibrocalculous pancreatic diabetes in and around Jabalpur (Madhya Pradesh), Central India

2016-06-08T08-54-21Z
Source: International Journal of Medical Science and Public Health
Hakam Singh Patel, Sandeep Kumar Jain.
Background: Fibrocalculous pancreatic diabetes (FCPD) is an uncommon form of diabetes secondary to nonalcoholic chronic calcific pancreatitis of uncertain etiology predominantly found in tropical regions of the world, characterized by abdominal pain and pancreatic calcification. The term Fibrocalculous Pancreatic Diabetes was introduced by the World Health Organization Report in 1985. Objective: To study prevalence and clinical presentation of FCPD in and around Jabalpur (Madhya Pradesh) Central India. Materials and Methods: A total of 891 cases of diabetes mellitus came from in and around Jabalpur and were presented at the OPD of Department of Medicine, Sukh-Sagar Medical College and Hospital between December 2014 and April 2016 and they were included in the study with informed consent. Subjects were put to detailed history, clinical, and laboratory workup including body mass index, blood sugar level (fasting, postprandial), HbA1c, USG, and plain X-ray abdomen and defined criteria were used for diagnosis of FCPD. Result: Of the total enrolled cases of 891, 94.05% of cases of T2DM, 5.61% of cases of T1DM, and only 0.34% of cases of FCPD were found. All 100% of cases of FCPD belonged to 3545 years of age group, low socioeconomical status, and consumed high percentage of carbohydrates as a main source of diet. Abdominal pain was one of the main complaints found in all three patients of FCPD whereas two (66.6%) cases whose plain X-ray abdomen revealed pancreatic calcification were chronic alcoholic. When we investigated further, we found that all the three cases of FCPD had the highest basal, postprandial blood glucose levels, as well as poor glycemic control (HbA1c >7), and mainly (66.6%) responded to insulin therapy. Conclusion: The prevalence rate of FCPD was found to be 0.34% in and around Jabalpur (Central India) that is lower than Southern Indias prevalence rate, probably on account of the economic development, difference in dietary habits, and better levels of malnutrition. Even though the etiology remains unknown more studies need to be conducted to understand the exact nature of the pancreatic pathology in FCPD, what triggers it and if, and how, the process can be arrested, before the development of diabetes.


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Correlation between brain natriuretic peptide and right ventricular systolic pressure

2016-06-08T08-54-21Z
Source: International Journal of Medical Science and Public Health
Khalid Al Sulaiman, Sarah Al Yousef, Abdulmalik Al Kathiri, Shmylan Al Harbi, Abdulkareem Al Bekairy, Hind Al Modaimegh, Saleh Al Dekhail, Thamer Al Sulaiman, Salahdein Aburuz.
Background: Brain natriuretic peptide (BNP) is a cardiac hormone with diuretic, natriuretic, and vasodilatory properties produced by the heart ventricles in response to volume expansion and pressure load. The concentration of BNP is highest in the artery of healthy individuals but in heart failure patients it is shifted to the ventricles. Plasma BNP levels are influenced by many factors including age, renal function, medications, and arrhythmias. BNP is released in response to improved myocardial relaxation and it also plays an important role in the regulatory response to acute elevation in ventricular volume by opposing the effects of the activated renin, angiotensin, and aldosterone system. Objective: To evaluate the correlation between BNP and right ventricular systolic pressure (RVSP) in patients with decompensated heart failure. Materials and Methods: In this retrospective-chart review study, electronic data and medical records between 1 January 2013 and 31 December 2013 were reviewed to screen patients for inclusion into the study. Inclusion criteria included patients admitted to King Abdulaziz Medical City - Cardiac Center (KAMC-CC) with diagnosis of decompensated heart failure and Right Ventricular Systolic Pressure (RVSP) more than 35 mmhg on admission, aged 50 years or older with ejection fraction ≤ 35%, Brain Natriuretic Peptide (BNP) value and Echocardiography (2D) were assessed at least once, the time difference between BNP measurement and Echocardiography less than 72 hours, and New York Hear Association (NYHA) Class III IV. On the other hand, patients with impaired renal function (serum creatinine > 133 μmol/l), atrial arrhythmia, congenital heart disease and cardiogenic shock were excluded. Demographic and clinical data including BNP and RVSP were recorded for eligible patients. Patients were divided into four groups according to their RVSP readings (30-40, 40-50, 50-60, and > 60 mmhg). ANOVA was utilized to assess for group differences. Result: 388 patients with decompensated heart failure were screened during the period from January to December 2013. Only 27 patients met inclusion criteria. The increase in RVSP was associated with an increase in BNP until RVSP reaches a value of > 60 mmhg where BNP starts to decline. The differences between the four groups were statistically significant (F = 5.3, p = 0.007). Post hoc analysis was performed to test the difference between the individual groups and indicated a significant difference between Group one vs. Group two (mean difference: 215.5 ± 71.7, CI: 17.1 to 413.8, p = 0.03) and Group one vs. Group three (mean difference: 234.3 ± 63.8, CI: 414.02 to 60.69, p = 0.006). Conclusion: The study results indicate an association between RVSP and BNP. The increase in RVSP was associated with an increase in BNP until RVSP reaches a value of > 60 mmhg where BNP starts to decline. This correlation can be clinically useful in assessing prognosis and in helping physicians to predict BNP values with known RVSP values and vice versa. Further studies with larger sample size are required to confirm these interesting results.


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Genome editing and the next generation of antiviral therapy

Abstract

Engineered endonucleases such as homing endonucleases (HEs), zinc finger nucleases (ZFNs), Tal-effector nucleases (TALENS) and the RNA-guided engineered nucleases (RGENs or CRISPR/Cas9) can target specific DNA sequences for cleavage, and are proving to be valuable tools for gene editing. Recently engineered endonucleases have shown great promise as therapeutics for the treatment of genetic disease and infectious pathogens. In this review, we discuss recent efforts to use the HE, ZFN, TALEN and CRISPR/Cas9 gene-editing platforms as antiviral therapeutics. We also discuss the obstacles facing gene-editing antiviral therapeutics as they are tested in animal models of disease and transition towards human application.



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EMS agencies must embrace, adapt to constant change

The nature of public safety is in flux and has always been. Few people, with the exception of a baby with a wet diaper, like or embrace change.

Agencies have to respond appropriately to a constantly changing operational environment, matching resources and supply to the demands of the workplace. Perhaps EMS organizations are the best example of this dynamic.

The argument between city leaders and fire union officials in Sacramento on how to staff their EMS units is emblematic. How do organizations faced with multiple pressures of budget, staffing and call volume respond in a way that is ethically most appropriate?

The nature of the fire service has been changing for decades. Since the 1973 publication of "America Burning," the landmark position paper on the importance of fire prevention, the occurrence of fatal fires in the United States has declined significantly. Much of the success comes from the efforts of the fire service through increased building regulations, better code enforcement, sprinkler system installation and innovations in fire suppression technology.

Simultaneously, as the population grows older and arguably less healthy, the calls for EMS service have steadily climbed. Many fire agencies have responded appropriately by placing greater emphasis on EMS duties while maintaining fire protection services. But the costs of both can be high to taxpayers, with little evidence supporting better patient outcomes. In other instances, poor implementation of EMS services has led to expensive models which may not significantly improve community health overall.

The fire service is not the only segment of the health care industry trying to respond or adapt to change. EMS agencies, both public and private, struggle to maintain funding in a dwindling reimbursement market. While community paramedicine projects are proving their effectiveness in improving community health while reducing the cost of service, some EMS organizations and providers believe that emergency response should be their only function.

I don't advocate for one type of system or another. I've seen plenty of great fire-based, third service and private EMS providers perform tremendous work in protecting and serving their communities.

I've also seen numerous agencies of all types fail to accomplish their mission because they lose sight of it. The only constant in life is change. EMS agencies must embrace that and work diligently to provide appropriate services in a responsible and ethical manner.



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Paramedics save cardiac arrest victim while attending AHA conference

Capt. Les Fryman and firefighter-paramedic Sean Davenport got ROSC on woman attending the AHA ECC meeting with them

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Urorectal septum malformation sequence—Fetal series with the description of a new “intermediate” variant. Time to refine the terminology?



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Chronic intestinal pseudo-obstruction in a child harboring a founder Hirschsprung RET mutation

Chronic intestinal pseudo obstruction (CIPO) is a rare clinical entity characterized by symptoms and signs of intestinal obstruction without either recognizable anatomical abnormalities or intestinal aganglionosis. A Chinese female infant presented to our institution with a clinical diagnosis of CIPO. Aganglionosis was ruled out by full thickness colonic and ileal biopsies and by rectal suction biopsies. Unexpectedly, direct sequencing and PCR amplification of RET proto-oncogene from peripheral blood extracted DNA identified a RET R114H mutation. This mutation has already been reported as strongly associated with Asian patients affected by Hirschsprung's disease (HSCR) and is considered a founder mutation in Asia. The same mutation has never been reported in patients with CIPO, so far. These findings support the role of RET in the development of the enteric nervous system but underline the importance of other genetic or environmental factors contributing to the gastrointestinal phenotype of the disease. Somehow, this RET R114H mutation proved to have a role in the etiology of both CIPO and HSCR and could contribute to a more diffuse imbalance of gut dysmotility. © 2016 Wiley Periodicals, Inc.



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Homozygous deletion of exons 2 and 3 of NPC2 associated with Niemann–Pick disease type C



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Is one diagnosis the whole story? patients with double diagnoses

One of the goals of evaluating a patient in the genetics clinic is to find the diagnosis that would explain his or her clinical presentation. Sometimes the patient's diagnosis remains undefined or does not explain all of the clinical findings. As clinicians are often guided by a "single disorder" paradigm, diagnosing multiple genetic conditions in the same patient requires a heightened sense of awareness. Over the last few years, we evaluated several patients (n = 14) who were found to have more than one genetic diagnosis. In this paper, we will describe their natural history and diagnoses, and draw on the lessons learned from this phenomenon, which we expect to grow in this era of next-generation diagnostic technologies. To our knowledge, this is by far the largest series of patients with double diagnoses. Based on our findings, we strongly recommend that physicians question every diagnosis to determine whether it indeed explains all of the patients' symptoms, and consider whether they should continue the diagnostic evaluation to look for a more accurate and complete set of diagnoses. © 2016 Wiley Periodicals, Inc.



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Quality of life, unmet needs, and iatrogenic injuries in rehabilitation of patients with Ehlers–Danlos Syndrome hypermobility type/Joint Hypermobility Syndrome

Ehlers–Danlos Syndrome, hypermobility type (EDS-HT) and the joint hypermobility syndrome (JHS) are connective tissue disorders that form an overlapping clinical syndrome and are associated with frequent medical visits and substantial morbidity. EDS-HT/JHS-associated pain correlates with poor quality of life. While physical therapy is the recommended treatment for EDS-HT/JHS, little is known about therapy-related patient experiences and iatrogenic injuries. We studied 38 adult EDS-HT/JHS patients, eliciting health-related quality of life (HRQoL) from 28 patients through the RAND SF-36 questionnaire. We also explored physical therapy experiences through focus groups with 13 patients. Our patients displayed poor HRQoL, with 71% reporting worse health over the past year. SF-36 scores were significantly lower than the scores of the average American population (P < 0.001 for 8 of 10 categories assessed), but were comparable to EDS-HT/JHS populations in Belgium, the Netherlands, Sweden, and Italy. Focus groups identified factors associated with: negative past physical therapy experiences, iatrogenic joint injuries, positive treatment experiences, and unmet rehabilitation needs. This group of EDS-HT/JHS patients has significant decrements in HRQoL and many unmet treatment needs, as well as a risk for iatrogenic injuries. We identify several approaches to help meet patients' needs and improve joint rehabilitation in patients with EDS-HT/JHS. © 2016 Wiley Periodicals, Inc.



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Quality of life in adolescents and adults with CHARGE syndrome

Health-related Quality of Life and the Impact of Childhood Neurologic Disability Scale were collected for 53 patients with CHARGE syndrome aged 13–39 years with a mean academic level of 4th grade. The most prevalent new and ongoing issues included bone health issues, sleep apnea, retinal detachment, anxiety, and aggression. Sleep issues were significantly correlated with anxiety, self-abuse, conduct problems, and autistic-like behaviors. Problems with overall health, behavior, and balance most affected the number of social activities in the individual's life. Sensory impairment most affected relationships with friends. Two contrasting case studies are presented and demonstrate that the quality of life exists on a broad spectrum in CHARGE syndrome, just as its physical features range from mild to very severe. A multitude of factors, including those beyond the physical manifestations, such as anxiety and sleep problems, influence quality of life and are important areas for intervention. © 2016 Wiley Periodicals, Inc.



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Transforming the learning outcomes of anaesthesiology training into entrustable professional activities: A Delphi study.

BACKGROUND: True competency-based medical education should produce graduates meeting fixed standards of competence. Current postgraduate programmes are usually based on a pre-determined length of time in training making them poorly suited for an individual approach. The concept of entrustable professional activities (EPAs) enables a more flexible, personalised and less time-dependent approach to training programmes. An EPA is a unit of professional practice, to be entrusted to a trainee to execute without supervision once they demonstrate sufficient competence. As EPAs relate competencies to clinical practice, they structure training and assessment more logically according to the way clinicians actually work. A first step in building an EPA-based curriculum is to identify the core EPAs of the profession. OBJECTIVES: The aim of this study was to identify EPAs for postgraduate training in anaesthesiology and to provide an example of how an existing curriculum can be transformed into an EPA-based curriculum. DESIGN: A modified Delphi method was used as a consensus approach applying three Delphi rounds. SETTING: Postgraduate specialty training in anaesthesiology in the Netherlands. PARTICIPANTS: All programme directors in anaesthesiology in the Netherlands except for a single programme director who was involved as a researcher in this study and could not participate. MAIN OUTCOME MEASURES: Agreement among participants on a list of EPAs. Agreement was specified as a consensus rate of more than 80%. RESULTS: In this study, 27 programme directors (69% overall response rate) reached consensus on a set of 45 EPAs that describe a curriculum in anaesthesiology for the Netherlands. CONCLUSION: This study is a first step toward a more contemporary curriculum in competency-based postgraduate anaesthesiology training. (C) 2016 European Society of Anaesthesiology

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Survival after long-term isoflurane sedation in critically ill surgical patients.

No abstract available

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Validation of a prediction model for post-discharge nausea and vomiting after general anaesthesia in a cohort of Swedish ambulatory surgery patients.

BACKGROUND: In ambulatory surgery, post-discharge nausea and vomiting (PDNV) has been identified as a significant problem occurring in more than one-third of patients. OBJECTIVE: To validate a simplified PDNV score in a Swedish population. DESIGN: Prospective observational study. SETTING: Two county hospitals in Sweden: Sundsvall from June 2012 to May 2013 and Sunderbyn from January to October 2014. PATIENTS: Adult patients undergoing ambulatory surgery under general anaesthesia. MAIN OUTCOME MEASURES: Postoperative outcomes with a focus on nausea and vomiting were collected at 2, 4, and 6 h after surgery and on the first three postoperative days. The simplified PDNV score, calculated before discharge, included the factors: female sex, age less than 50 years, history of postoperative nausea and vomiting, postoperative nausea and opioids given postoperatively. The prediction performance of the simplified PDNV score was evaluated in terms of discrimination (area under receiver-operating characteristics curve) and calibration plots and was compared with that of the original development study. RESULTS: A total of 559 patients were asked to participate, of which 431 were included in the final study cohort. The overall risk of postoperative nausea and vomiting and PDNV were 18.8 [95% confidence interval (CI), 15.4-22.8]% and 28.1 (95% CI, 24.0-32.5)%, respectively. The discrimination capacity of the simplified PDNV score in our study was similar to that of the original dataset [area under the curve 0.693 (95% CI, 0.638-0.748) vs. 0.706 (0.681-0.731), absolute difference 0.013]. The slope of the calibration curve was 0.893, with a constant of 0.021 (R-square 0.884). CONCLUSION: In a Swedish cohort of patients, the simplified PDNV score performs well in discriminating between patients who will experience post-discharge nausea and/or vomiting after ambulatory surgery. Our results indicate that the simplified PDNV score is as valid in other cohorts as it was in the original development cohort. (C) 2016 European Society of Anaesthesiology

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LICHENS – ENSHROUDING THE BARE ROCKS IN PAPPAD AREA OF SAMBA DISTRICT, JAMMU and KASHMIR

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Mukhtar Ahmad Sheikh, Anil K. Raina, Dalip Kumar Upreti.
A field survey was conducted for collection of lichens in the Jammu division, on fragile, loose sandstone rocks in Pappad area of Samba district of Jammu and Kashmir, on way to famous Mansar Lake. The rocks were devoid of the original forest cover and appear black due to dense growth of dark olive green lichens. Under such climatic conditions, the loose sandstone rocks remains exposed to scorching heat and were mostly dry thus not suitable for the growth of most plants. The lichen specimens were collected from the rocky substrates with the help of hammer, chisel. The specimens were identified by studying the morphology, anatomy and chemistry. The recent literature was consulted for identification of most of the lichen taxa. The study revealed the occurrence of 04 species of lichens belonging to 03 genera and 03 families, it was observed that some unique lichen taxa such as Endocarpon nanum A. Singh & Upreti; Endocarpon subrosettum A. Singh & Upreti; Peltula patellata (Bagl.) Swinsc. & Krog and Phylliscum indicum Upreti are present. The hair like growth on the lower surface (Rhizinae or haptera or umbilicus) of the lichens bind together the sand particles of the rock. The lichens are natures pioneers and establish themselves where other organisms cannot. Thus from the above observation it is well evident that lichens in the Pappad area of Samba district, J & K are playing important role in the binding, stability, hydrology and fertility of these rocks. The lichen taxa growing on the rocks have thick cushion like squamulose thallus, which are closely adpressed to the rocks. The organs of attachment present on the lower side of the thallus compactly bind the sandstone particles tightly together.


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MECONIUM PERITONITIS - REPORT OF A RARE CASE

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Jeevitha K. J., Senthiru Ramachandran, Saravanan, Mahesh Bose.
Aim: To report on a rare case of meconium peritonitis (MP). Case Report: We report a case of G2P1L1 at 37 weeks of gestation, a post caesarean pregnancy with all prior normal ultrasound reports, came with complaints of decreased fetal movements. On ultrasound scan there was features suggestive of meconium peritonitis with small bowel perforation. She was delivered by emergency repeat caesarean section and the neonate underwent laparotomy on the first neonatal day. Discussion: Meconium peritonitis is a rare condition diagnosed in antenatal period which has a high neonatal morbidity and mortality. Meconium peritonitis is an aseptic chemical peritonitis caused due to in-utero bowel perforation, most frequently secondary to obstruction, often diagnosed by routine fetal ultrasound. Conclusion: Early diagnosis and treatment are the keys to successful management of MP.


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INFLUENCE OF END STAGE RENAL DISEASE IN ALTERATION OF SOME TRACE ELEMENTS IN SUDANESE PATIENTS

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Kamal Eldin Ahmed Abdelsalam, Eshteag Mohammed Musllem.
Background: The role of trace elements in hemodialysis (HD) patients has not yet been clearly recognized. To minimize the health consequences of persistent HD, the levels of trace elements should be seriously adjusted. Methods: The study was across-sectional conducted in Khartoum state of Sudan between August 2013 and April 2015 included 150 patients with end stage renal disease treated with hemodialysis and 75 healthy volunteers as control group. Informed consent was assigned by each participant before taking the blood sample. All samples were analyzed for magnesium, zinc and copper. Results: Compared with healthy controls, in hemodialysis patients average serum levels of zinc (Zn) (663 μg/L) and copper (Cu) (797μg/L) were insignificantly different; however, magnesium (Mg) levels (38.61 mg/L) were significantly increased. According to sex of ESRD patients, serum Mg level was increased significantly in females, while insignificant changes were observed in Cu level. This study stated that Zn, Cu and Mg levels were significantly increased in elder patients more than younger ones. Zn, Cu and Mg were increased as increasing duration of dialysis, changing significantly in serum Zn and Cu. Conclusions: Our results concluded that in hemodialysis, aging, and sex have significant effects on Zn, Cu and Mg.


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Visual tour of EMT training



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UNUSUAL CAUSE OF BLEEDING PER RECTUM IN CHILDREN – CASE REPORT

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Ahmed A. Al-Jarie, Abdullah Hilal, Mohammed R. AL-HAYLI, Zainah A. Sabr, Safa M. AL-Haider, Maha T. almofareh, Nihal I. Mirza.
Background: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. The Zygomycetes includes two fungal orders: Mucorales and Entomophthorales, with completely different pathogenic potentials. Basidiobolusranarum was first described in 1886 in frogs. We present a case of bleeding per rectum in a 3-year-old male patient, resident of Southwestern of Saudi Arabia. The diagnosis was confirmed by characteristic histopathlogical findings. The aim of presenting the case is to increase awareness among health care professionals in areas of endemicity, so appropriate specimen processing may lead to enhanced case detection and reporting. Conclusion: Antifungal therapy is adequate to cure Gastrointestinal Basidiobolomycosis infection if the fugal mass is unrespectable.


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Use of the bougie for intubation



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BIOINFORMATICS ADVANCES IN GENOMICS – A REVIEW

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Raphael John Ogbe, Dickson O. Ochalefu, Olumide B. Olaniru.
Genomics is a discipline in genetics that applies recombinant DNA technology, DNA sequencing methods and bioinformatics to sequence, assemble and analyze the function and structure of genome, the complete set of DNA within a single cell of an organism. Bioinformatics is an inter-disciplinary scientific field that develops methods for storing, retrieving, organizing and analyzing biological data. The advances in bioinformatics have in turn made considerable impact on the development and improvements of genomics technologies such as shot-gun sequencing and high-throughput sequencing methods. The various genomics technologies are used for DNA and genome sequencing, assembly and annotations, which have several applications in medicine, agriculture, pharmaceuticals, biotechnology, research etc. These genomics technologies aided by bioinformatics have contributed to the successful completion of whole organism genome analysis, from prokaryotes to eukaryotes. In fact, the assembly of the human genome is one of the greatest achievements of bioinformatics.


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Visual tour of EMT training



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QUANTIFICATION OF ANTIOXIDANTS IN UNDERUTILIZED VEGETABLE LEAVES

2016-06-07T23-38-39Z
Source: International Journal of Current Research and Review
Mary Jenefer Sharmila P., Dorothy Jaganathan, Kumaravel S..
Introduction: Green leafy vegetables are an excellent source of bioactive compounds beyond human nutrition. There are many underutilized vegetable leaves which are equally a power house of bioactive compounds with reference to antioxidants. Much literature confirms that brassicca vegetables are high in antioxidants but the antioxidant studies these vegetable leaves are scarce as they are underutilized and neglected hence the present study was framed. Aim: To analyze the total antioxidants, total phenols and total flavonoids in the leaves of cauliflower radish and beetroot leaves. Methodology: Total antioxidants were analysed using Dpph method and phenols by Folin-Ciocalteu method and Total flavonoids were determined spectrophotometrically. Results: The observations were read in triplicates. The data was analyzed statistically showing the presence of total antioxidants, total phenols and total flavonoids in leaves of cauliflower radish and beetroot which can a therapeutic role in the health of humans. Conclusion: Hence the present study reveals the benefits of these underutilized leaves which are packed with antioxidants that can prevent from all degenerative diseases and these antioxidant leaves can be also treated in formulation of functional foods and in food and health industry.


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Use of the bougie for intubation



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Development of an effective therapy and objective assessment for children with birth injuries.

Sitting in a Huple, a patented hemisphere-like tool, permanently stimulates the vestibular system, thus improving the balancing ability of children with movement disorders. The Gezenguz Foundation for Children with Birth Injuries has been successfully applying this tool in therapy. By attaching x-Inertial Measurement Unit, a wireless three-dimensional orientation sensor, to the Huple, it can serve as an input peripheral for simple PC games. Children are thus motivated; they willingly perform balance training as well as participate in the game-like test. This improves the accuracy and reproducibility of the assessment. Knowing the actual state of the participants is an important element of feedback for the therapy. This paper describes in detail the development of the therapeutic and assessment method on the basis of the Huple: the definition of the movement pattern, the parameters characterizing the movement, and the algorithms used to rank children. Measurement series of 10 children with movement disorders validate the effectiveness of the game-like assessment. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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