Δευτέρα, 3 Οκτωβρίου 2016

New "ICU" pressure chamber at Oslo University Hospital:

This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio/Streaming.Full intensive care capable. Looking very good, IMO. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2dFqZ4k
via IFTTT

New "ICU" pressure chamber at Oslo University Hospital:

This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio/Streaming.Full intensive care capable. Looking very good, IMO. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2dFqZ4k
via IFTTT

New "ICU" pressure chamber at Oslo University Hospital:

This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio/Streaming.Full intensive care capable. Looking very good, IMO. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2dFqZ4k
via IFTTT

Passive and post-exercise cold-water immersion augments PGC-1α and VEGF expression in human skeletal muscle

Abstract

Purpose

We tested the hypothesis that both post-exercise and passive cold water immersion (CWI) increases PGC-1α and VEGF mRNA expression in human skeletal muscle.

Method

Study 1 Nine males completed an intermittent running protocol (8 × 3-min bouts at 90 % \(\dot{V}{\text{O}}_{2} \hbox{max}\) , interspersed with 3-min active recovery (1.5-min at 25 % and 1.5-min at 50 % \(\dot{V}{\text{O}}_{2} \hbox{max}\) ) before undergoing CWI (10 min at 8 °C) or seated rest (CONT) in a counterbalanced, randomised manner. Study 2 Ten males underwent an identical CWI protocol under passive conditions.

Results

Study 1 PGC-1α mRNA increased in CONT (~3.4-fold; P < 0.001) and CWI (~5.9-fold; P < 0.001) at 3 h post-exercise with a greater increase observed in CWI (P < 0.001). VEGFtotal mRNA increased after CWI only (~2.4-fold) compared with CONT (~1.1-fold) at 3 h post-exercise (P < 0.01). Study 2 Following CWI, PGC-1α mRNA expression was significantly increased ~1.3-fold (P = 0.001) and 1.4-fold (P = 0.0004) at 3 and 6 h, respectively. Similarly, VEGF165 mRNA was significantly increased in CWI ~1.9-fold (P = 0.03) and 2.2-fold (P = 0.009) at 3 and 6 h post-immersion.

Conclusions

Data confirm post-exercise CWI augments the acute exercise-induced expression of PGC-1α mRNA in human skeletal muscle compared to exercise per se. Additionally CWI per se mediates the activation of PGC-1α and VEGF mRNA expression in human skeletal muscle. Cold water may therefore enhance the adaptive response to acute exercise.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dWiCAs
via IFTTT

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

High resolution ultrasonography (HRUS) was first implemented as a diagnostic tool in carpal tunnel syndrome (CTS) in the early 1990s (Buchberger et al., 1991, 1992). The meta-analyses of the large body of literature that has accumulated in the past two decades (Cartwright et al., 2012; Tai et al., 2012) showed that level A evidence support the ultrasonographic measurement of median nerve cross-sectional area at the tunnel inlet (CSA-I) as an accurate diagnostic test for CTS (Cartwright et al., 2012).

from Physiology via xlomafota13 on Inoreader http://ift.tt/2dmLBPp
via IFTTT

Deficient median nerve prepulse inhibition of the blink reflex in cervical dystonia

Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both (Albanese et al., 2013). Cervical dystonia (CD) is a focal dystonia that affects the muscles of the neck and, sometimes, the shoulders. It typically starts in adulthood and may be accompanied by jerky movements of the head and neck. Electrophysiological studies have suggested that decreased inhibition, sensory dysfunction, and abnormal plasticity play roles in the pathophysiology of dystonia (Quartarone and Hallett, 2013).

from Physiology via xlomafota13 on Inoreader http://ift.tt/2dFqhzU
via IFTTT

Repetitive nerve stimulation often fails to detect abnormal decrement in acute severe generalized Myasthenia Gravis

Neuromuscular transmission failure is routinely evaluated in the clinic through repetitive nerve stimulation (RNS) test and single fiber electromyography (SFEMG) or concentric needle electrode jitter analysis (CNE) (Stalberg and Sanders, 2009). The RNS test is often regarded as the fastest non-invasive first line examination method in the diagnostic evaluation of MG (Medicine, 2001a). The successive reduction of amplitude of the compound motor action potential (CMAP) upon 10 supramaximal stimuli in RNS is considered to reflect the safety factor for neuromuscular transmission (Mills, 2005).

from Physiology via xlomafota13 on Inoreader http://ift.tt/2dmLfrM
via IFTTT

Differentiating epileptic from non-epileptic high frequency intracerebral EEG signals with measures of wavelet entropy

High frequency oscillations (HFOs) above 80 Hz are considered a biomarker for epilepsy (Bragin et al. 2010; Zijlmans et al. 2012; Staba et al. 2014). They can be defined as four or more oscillations that clearly stand out from the background EEG. HFOs are divided in ripples (80-250 Hz) and fast ripples (250-500 Hz) (Zijlmans et al. 2012; Staba et al. 2014). Although several studies show that ripples are biomarker for epilepsy, physiological ripples also exist and their distinction from 'epileptic' ripples is not simple (Bragin et al.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2dFq93k
via IFTTT

Repetitive nerve stimulation often fails to detect abnormal decrement in acute severe generalized Myasthenia Gravis

S13882457.gif

Publication date: Available online 3 October 2016
Source:Clinical Neurophysiology
Author(s): Maarika Liik, Anna Rostedt Punga
ObjectiveWe assessed the diagnostic pattern of repetitive nerve stimulation (RNS) test and concentric electrode (CNE) jitter analysis between patients with generalized myasthenia gravis (GMG) with acute versus slow onset.MethodsAll examinations that established the diagnosis of GMG at the department of Clinical Neurophysiology, Uppsala University Hospital, were retrospectively analyzed from January 2012 to December 2014. Patients were grouped according to disease duration at neurophysiological evaluation: acute onset (<4 weeks) or slow onset (⩾4 weeks).ResultsWe identified 41 patients diagnosed with GMG. Of the nine patients with acute onset GMG (5 women) only one patient had abnormal decrement, whereas of the 32 patients with slow onset (13 women) 26 patients (84%) had abnormal decrement. CNE jitter was abnormal in all. AChR antibody status was comparable (78% versus 84%) whereas the MGFA class was higher in the acute onset group (range: 3A-5) compared to the slow onset group (range: 2A-3B).ConclusionsRNS test is frequently normal in cases of acute severe GMG, including myasthenic crisis. Performing CNE jitter analysis is therefore of crucial importance for a correct early diagnosis.SignificanceMG patients with acute severe onset of bulbar or generalized fatigue often have normal findings on RNS test in proximal muscles.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2cO1SLJ
via IFTTT

Deficient median nerve prepulse inhibition of the blink reflex in cervical dystonia

S13882457.gif

Publication date: Available online 3 October 2016
Source:Clinical Neurophysiology
Author(s): Oya Öztürk, Ayşegül Gündüz, Meral E. Kızıltan
ObjectiveWe analyzed prepulse inhibition (PPI) of the blink reflex (BR) in patients with cervical dystonia (CD) to examine the sensory modulation of the motor system.MethodsThis study enrolled 22 consecutive patients with idiopathic CD and 25 age- and gender-matched healthy subjects. Prepulse inhibition of the BR was recorded after stimulating the median nerve at the wrist using an electrical stimulus twice at a perception threshold 100 ms before a test stimulus to the supraorbital nerve.ResultsThe R2 area and amplitude were significantly reduced and the R2 latency delayed after the conditioned stimulus in patients with CD. The R1 latency and amplitude did not differ between trials in patients with CD. In healthy subjects, the R1 amplitude was higher, whereas the R2 latency was delayed and the R2 amplitude and area were reduced after the conditioned stimulus. However, there was significantly less R2 and R2c area suppression in patients compared with healthy subjects. ANOVA showed that reduction of R2 area conditioned stimulus (F=6.620, p=0.003) and conditioned R2 area/test R2 area (F=5.217, p=0.009) were lower in patients with and without sensory tricks compared with healthy subjects, whereas the reduction in PPI was pronounced in patients without a sensory trick compared with healthy subjects.ConclusionsPatients with CD show significantly less prepulse R2 inhibition than healthy subjects, but this occurred without R1 facilitation. The absence of a sensory trick leads to the more pronounced reduction of PPI.SignificanceThe modulatory effects of sensory inputs are lost in patients with CD without sensory tricks.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dqMHG5
via IFTTT

Differentiating epileptic from non-epileptic high frequency intracerebral EEG signals with measures of wavelet entropy

S13882457.gif

Publication date: Available online 3 October 2016
Source:Clinical Neurophysiology
Author(s): Anne H. Mooij, Birgit Frauscher, Mina Amiri, Willem M. Otte, Jean Gotman
ObjectiveTo assess whether there is a difference in the background activity in the ripple band (80-200 Hz) between epileptic and non-epileptic channels, and to assess whether this difference is sufficient for their reliable separation.MethodsWe calculated mean and standard deviation of wavelet entropy in 303 non-epileptic and 334 epileptic channels from 50 patients with intracerebral depth electrodes and used these measures as predictors in a multivariable logistic regression model. We assessed sensitivity, positive predictive value (PPV) and negative predictive value (NPV) based on a probability threshold corresponding to 90% specificity.ResultsThe probability of a channel being epileptic increased with higher mean (p=0.004) and particularly with higher standard deviation (p<0.0001). The performance of the model was however not sufficient for fully classifying the channels. With a threshold corresponding to 90% specificity, sensitivity was 37%, PPV was 80%, and NPV was 56%.ConclusionsA channel with a high standard deviation of entropy is likely to be epileptic; with a threshold corresponding to 90% specificity our model can reliably select a subset of epileptic channels.SignificanceMost studies have concentrated on brief ripple events. We showed that background activity in the ripple band also has some ability to discriminate epileptic channels.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2cO2elj
via IFTTT

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

S13882457.gif

Publication date: Available online 3 October 2016
Source:Clinical Neurophysiology
Author(s): Anita Csillik, Dániel Bereczki, László Bora, Zsuzsanna Arányi
ObjectiveA retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS).Methods118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet.ResultsCSA at the outlet (median: 18 mm2) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15 mm2) and its wrist-to-forearm-ratio (median: 2.2) (p <0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet. LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet / distal tunnel versus inlet / proximal tunnel (p <0.001).ConclusionMedian nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal.SignificanceThe addition of CSA outlet measurements to inlet measurements increased CTS ultrasonographic diagnostic sensitivity and accuracy by 15% and 10%, respectively.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dqN7fI
via IFTTT

Quantitative morphometric study of the subaxial cervical vertebrae endplate

Cervical disc arthroplasty has been gradually adopted as an alternative for the treatment of cervical degenerative disease. However, there is a large discrepancy between footprints of currently available cervical disc prostheses and anatomic dimensions of cervical endplates.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2cOAKae
via IFTTT

A Public Tribute to the Editors and Publishers of Digestive Diseases and Sciences : Personal Experience with Authorship of 43 Publications in this Journal During the Last 29 Years



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dqApgM
via IFTTT

Plasma Level of Interleukin-35 as an Independent Prognostic Indicator in Hepatocellular Carcinoma

Abstract

Background

Hepatocellular carcinoma is a major type of liver cancer with poor prognosis.

Aim

The aim of the study was to determine the prognostic significance of plasma interleukin-35 level in hepatocellular carcinoma.

Methods

A total of 153 hepatocellular carcinoma patients and 153 healthy controls were enrolled. Blood samples were obtained at admission. Plasma interleukin-35 level was analyzed by enzyme-linked immunosorbent assay. Distribution of T cell subset and expression of Fas/FasL protein were detected by flow cytometry. The patients were followed up for 2 years. Poor prognosis was defined as death of hepatocellular carcinoma.

Results

The plasma levels of interleukin-35 were significantly higher in the patients than the controls (25.1 ± 13.1, 9.3 ± 6.3 pg/mL, P < 0.001). After adjusted for multiple confounding factors, the multivariate logistic regression analyses reported that high level of interleukin-35 (≥25.0 pg/mL) was associated with the poor prognosis in the patients (OR 6.63, 95 % CI 3.27–13.47). Compared with the patients with low level of interleukin-35 (<25.0 pg/mL), the patients with high level of interleukin-35 showed higher frequencies of CD4+CD25+FoxP3+ and CD3+Foxp3+ regulatory T cells (P < 0.001 and P < 0.001) and also showed higher apoptosis levels of CD8+ T cells (P < 0.001).

Conclusion

Circulating interleukin-35 concentration might be an independent prognostic indicator in hepatocellular carcinoma. Such prognostic significance could be partly involved in the activation of regulatory T cell and the apoptosis of CD8+ T cell.



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cNRraY
via IFTTT

Efficacy of long-term tenofovir-based rescue therapy in patients with chronic hepatitis B refractory to nucleoside/nucleotide analogs

Abstract

Background

Few studies have investigated the efficacy of long-term tenofovir disoproxil fumarate (TDF)-based rescue therapy in patients with chronic hepatitis B refractory to nucleoside/nucleotide analogs.

Methods

We retrospectively analyzed 40 Japanese patients with chronic hepatitis B refractory to nucleoside/nucleotide analogs who received TDF-based rescue therapy [TDF monotherapy, TDF plus lamivudine (LAM) combination therapy, or TDF plus entecavir (ETV) combination therapy] followed up for a median of 45 months (range 14–99 months). Viral response, changes in hepatitis B surface antigen levels from the baseline, and viral breakthrough during therapy were analyzed.

Results

The proportion of patients with undetectable serum hepatitis B virus (HBV) DNA levels (less than 2.1 log copies per milliliter) (viral response) during TDF-based rescue therapy was 68, 78, 85, 88, 83, 81, 88, and 100 % at 0.5, 1, 1.5, 2, 2.5, 3, 3.5, and 4 years respectively. There were no differences in the viral response rate between the TDF plus LAM group and the TDF plus ETV group. The mean reduction from the baseline in hepatitis B surface antigen levels in patients with LAM-resistant HBV was greater than the reductions in patients with adefovir dipivoxil (ADV)-resistant or ETV-resistant HBV at 2 and 3 years (P = 0.024, and P = 0.025 respectively). However, two patients with ADV- or ETV-resistant HBV at the baseline developed viral breakthrough during TDF-based rescue therapy.

Conclusions

Long-term therapy with a TDF-based rescue regimen demonstrated high viral suppression in patients in whom LAM plus ADV combination therapy, ETV plus ADV combination therapy, or ETV monotherapy had failed. However, patients with ADV- or ETV-resistant HBV at the baseline may develop viral breakthrough and resistance, and careful follow-up is advised.



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDf9Cs
via IFTTT

Wrist Injuries in Tennis Players: A Narrative Review

Abstract

The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014–2015) than in early studies (1986–1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014–2015) than in early studies (1986–1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.



from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2dnEjaP
via IFTTT

The Optimal Load for Maximal Power Production During Upper-Body Resistance Exercises: A Meta-Analysis

Abstract

Background

External mechanical power is considered to be one of the most important characteristics with regard to sport performance.

Objective

The purpose of this meta-analysis was to examine the effect of load on kinetic variables such as mean and peak power during bench press and bench press throw, thus integrating the findings of various studies to provide the strength and conditioning professional with more reliable evidence upon which to base their program design.

Methods

A search of electronic databases (MEDLINE, PubMed, Google Scholar, and Web of Science) was conducted to identify all publications up to 31 October 2015. Hedges' g (95 % confidence interval) was estimated using a weighted random-effect model, due to the heterogeneity (I 2) of the studies. Egger's test was used to evaluate possible publication bias in the meta-analysis. A total of 11 studies with 434 subjects and 7680 effect sizes met the inclusion criterion and were included in the statistical analyses. Load in each study was labeled as one of three intensity zones: zone 1 represented an average intensity ranging from 0 to 30 % of one repetition maximum (1RM); zone 2 between 30 and 70 % of 1RM; and zone 3 ≥ 70 % of 1RM.

Results

These results showed different optimal loads for each exercise examined. Moderate loads (from >30 to <70 % of 1RM) appear to provide the optimal load for peak power and mean power in the bench press exercise. Lighter loads (<30 % of 1RM) appear to provide the highest mean and highest peak power production in the bench press throw exercise. However, a substantial heterogeneity was detected I 2 > 75 %.

Conclusion

The current meta-analysis of published literature provides evidence for exercise-specific optimal power loading for upper body exercises.



from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2dNfa8b
via IFTTT

Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Abstract

Background

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

Objective

To the authors' knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Method

Eight research articles and 31 sport policies were reviewed.

Results

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport's policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Conclusion

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.



from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2dnunPc
via IFTTT

Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair

Abstract

Background

Patients who have had an Achilles tendon (AT) rupture repaired are potentially at higher risk for re-rupture than those without previous rupture. Little attention has been given to the neuromechanical modulation of muscle–tendon interaction and muscle activation profiles during human dynamic movements after AT rupture repair.

Objective

The purpose of this study was to examine muscle–tendon behavior and muscle activation during bilateral hopping.

Methods

We enrolled nine subjects who had undergone surgical repair of unilateral AT rupture within the past 1–2 years. Subjects performed bilateral hopping while we took ultrasound, kinematic, and electromyogram recordings and measurements. AT behaviors were also recorded. We then compared responses between values obtained from the ruptured AT leg (LEGATR) and non-ruptured AT leg (LEGNOR).

Results

During hopping, the AT stretching amplitudes were greater in the LEGATR than in the LEGNOR, although the peak AT force and stiffness were smaller in the LEGATR than in the LEGNOR. The AT negative mechanical work did not show any significant differences between both legs. However, positive works were significantly lower in the LEGATR than in the LEGNOR. Electromyogram patterns in both soleus and tibialis anterior muscles clearly differed after ground contact for the LEGATR and the LEGNOR.

Conclusions

These results suggest that the repaired ruptured AT can be compliant and have insufficient Young's modulus, which can influence mechanical responses in muscle activities. The modulation of agonist–antagonist muscle activities corresponding to the different levels of stiffness between the LEGATR and the LEGNOR may not be fully functioning during the pre-activation phase.



from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2dLTJbo
via IFTTT

Effect of timing of hip extension assistance during loaded walking with a soft exosuit

Recent advances in wearable robotic devices have demonstrated the ability to reduce the metabolic cost of walking by assisting the ankle joint. To achieve greater gains in the future it will be important to de...

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2dzd7Hl
via IFTTT

Atlas of human diseases influenced by genetic variants with extreme allele frequency differences

Abstract

Genetic variants with extreme allele frequency differences (EAFD) may underlie some human health disparities across populations. To identify EAFD loci, we systematically analyzed and characterized 81 million genomic variants from 2504 unrelated individuals of 26 world populations (phase III of the 1000 Genomes Project). Our analyses revealed a total of 434 genes, 15 pathways, and 18 diseases and traits influenced by EAFD variants from five continental populations. They included known EAFD genes, such as LCT (lactose tolerance), SLC24A5 (skin pigmentation), and EDAR (hair morphology). We found many novel EAFD genes, including TBC1D2B (autophagy mediator), TRIM40 (gastrointestinal inflammatory regulator), KRT71, KRT75, KRT83, and KRTAP10-1 (hair and epithelial keratin synthesis), PIK3R3 (insulin receptor interaction), DARS (neurological disorders), and NACA2 (skin inflammatory response). Our results also showed four complex diseases significantly associated with EAFD loci, including asthma (adjusted enrichment P = 4 × 10−8), type I diabetes (P = 6 × 10−9), alcohol consumption (P = 0.0002), and attention deficit/hyperactivity disorder (P = 0.003). This study provides a comprehensive atlas of genes, pathways, and human diseases significantly influenced by EAFD variants.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2dC4xnB
via IFTTT

Tooth agenesis and orofacial clefting: genetic brothers in arms?

Abstract

Tooth agenesis and orofacial clefts represent the most common developmental anomalies and their co-occurrence is often reported in patients as well in animal models. The aim of the present systematic review is to thoroughly investigate the current literature (PubMed, EMBASE) to identify the genes and genomic loci contributing to syndromic or non-syndromic co-occurrence of tooth agenesis and orofacial clefts, to gain insight into the molecular mechanisms underlying their dual involvement in the development of teeth and facial primordia. Altogether, 84 articles including phenotype and genotype description provided 9 genomic loci and 26 gene candidates underlying the co-occurrence of the two congenital defects: MSX1, PAX9, IRF6, TP63, KMT2D, KDM6A, SATB2, TBX22, TGFα, TGFβ3, TGFβR1, TGFβR2, FGF8, FGFR1, KISS1R, WNT3, WNT5A, CDH1, CHD7, AXIN2, TWIST1, BCOR, OFD1, PTCH1, PITX2, and PVRL1. The molecular pathways, cellular functions, tissue-specific expression and disease association were investigated using publicly accessible databases (EntrezGene, UniProt, OMIM). The Gene Ontology terms of the biological processes mediated by the candidate genes were used to cluster them using the GOTermMapper (Lewis-Sigler Institute, Princeton University), speculating on six super-clusters: (a) anatomical development, (b) cell division, growth and motility, (c) cell metabolism and catabolism, (d) cell transport, (e) cell structure organization and (f) organ/system-specific processes. This review aims to increase the knowledge on the mechanisms underlying the co-occurrence of tooth agenesis and orofacial clefts, to pave the way for improving targeted (prenatal) molecular diagnosis and finally to reflect on therapeutic or ultimately preventive strategies for these disabling conditions in the future.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2dEPEWE
via IFTTT

Ohio fire department stuck without ambulance

The department is relying on mutual aid agreements to help respond to 911 calls.

from EMS via xlomafota13 on Inoreader http://ift.tt/2cOiopU
via IFTTT

Intravenous catheter complications in hemodialysis

2016-10-03T11-22-33Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Shyamala Kumari Volabailu, Venu Gopala Delanthabettu.
Background: Vascular access, still is a problem for hemodialysis. Venous catheters are commonly used for acute angioaccess during maintenance hemodialysis in acute renal failure and end-stage renal failure patients. However, the catheters are often complicated by mechanical or infectious complications which may result in morbidity and or premature removal of the catheter. Even though, there are various studies on central venous catheters used in hemodialysis in western countries less is documented in India. Aims and Objectives: Complications of intravenous catheter used during hemodialysis in our set up. Materials and Methods: This prospective study was conducted on 110 patients selected by random sampling in dialysis units of a government district hospital from October 2014 to September 2015. Patient age, sex, history, type of kidney disease, and associated conditions were also noted according to the pro forma. Date of intravenous catheter insertion, site of insertion, and insertion complications were noted. All patients were followed up until the day of catheter removal. Date of catheter removal, reason for catheter removal, and duration of catheter days were noted. Data were collected and tabulated. Result: Only 47.8% of patients suspected with infections showed bacterial growth in catheter tip culture. However, blood culture showed bacterial growth only in 19.6% of infection suspected patients. Blood culture reported 55.6% Staphylococcus aureus growth followed by Pseudomonas (22.2%), Escherichia coli, and Acinetobacter (11.15%) growth in samples collected from infection suspected dialysis patients. Conclusion: Fever due to infections is the most common cause for catheter removal.


from Scope via xlomafota13 on Inoreader http://ift.tt/2cO69d1
via IFTTT

Emergency Reporting is now nationally NEMSIS 3 certified

Software available October 18th as integrated NEMSIS / NFIRS package or as a standalone ePCR solution

from EMS via xlomafota13 on Inoreader http://ift.tt/2d9hbdV
via IFTTT

Histopathological alterations in lung tissue received as autopsy specimens- a study of 410 cases

2016-10-03T10-50-55Z
Source: International Journal of Medical Science and Public Health
Nirali S Amin, Pooja Y Shah, Ravi G Patel, Varsha S Khant, Shreedhan G Prajapati.
Background: Many millions of people around the world suffer from preventable pulmonary diseases. The clinical and radiological findings in most of the respiratory diseases are nonspecific and correct diagnosis cannot be made solely from them. Histopathological examination serves the purpose in such cases. An autopsy is an important complementary tool for identifying and understanding the pathology of respiratory diseases and to find out the condition of internal organs. Objective: The objective of this study was to find out the prevalence of various lung pathologies by histopathological examination of lung tissue received as autopsy specimens. Material and Methods: The study was done on 410 lung specimens from autopsy cases received in this department over the period of 18 months. Gross findings and microscopic features were recorded. The tissue specimens were fixed in 10% formalin and processed. Paraffin sectioning was done followed by haematoxylin and eosin staining. The sections were then examined by experienced histopathologists. Result: During the period between January 2015 to June 2016, a total of 410 lungs from autopsy specimens were studied. Lung diseases were more common in males as compared to females. Most common lung pathological findings were of pneumonia (20%), tuberculosis (16.1%), emphysema (6.6%) and malignant lesions (1.7%) among the cases studied. Conclusion: Advances in diagnostic technology have not reduced the value of autopsy and a goal-directed autopsy remains a vital component in the study and evaluation of the disease process. There are large numbers of cases of preventable respiratory diseases. This indicates that the autopsy has remained an important complementary tool for identifying and understanding respiratory diseases despite recent advances in diagnostic technology.


from Scope via xlomafota13 on Inoreader http://ift.tt/2cY6AVD
via IFTTT

Assessment of nutritional status of adolescent girls residing in rural area of Belagavi

2016-10-03T10-50-55Z
Source: International Journal of Medical Science and Public Health
Sulakshana S Baliga, Vijaya A Naik, Mallapur M D.
Background: Adolescence is a period of transition between childhood and adulthood. Health and nutrition of the girls will affect the health and survival of future generation. However, there is very little information about the nutritional status of adolescents, particularly from rural areas in India. In view of the above facts, an attempt was made to assess the nutritional status of rural adolescent girls. Objective: To assess the nutritional status of adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village of district Belgaum, Karnataka among 400 adolescent girls of 1019 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire and anthropometric measurements were recorded for assessing the nutritional status. Result: The mean weight of adolescent girls in all age groups was better than Indian Council of Medical Research (ICMR) standards except in the ages 10, 12, and 13 years. The mean height of adolescent girls in all age groups was better than ICMR standards except in the ages 11, 12, 13, and 18 years. The prevalence of thinness in adolescent girls was 62% and prevalence of overweight was 2%. Conclusion: Majority of adolescent girls had mean height and mean weight in all age groups better than ICMR standards. More than half of adolescent girls were thin. None of the girls aged 1519 years were obese.


from Scope via xlomafota13 on Inoreader http://ift.tt/2dCHHwb
via IFTTT

Histomorphological spectrum of salivary gland tumors in a tertiary care hospital—A retrospective study

2016-10-03T10-50-55Z
Source: International Journal of Medical Science and Public Health
Nirali S. Amin, Smita A. Shah, Shreedhan G. Prajapati, Hansa M. Goswami.
Background: Salivary gland tumors are rare, accounting for 310% of the total tumors of head and neck region. Approximately 80% of the salivary gland tumors are found in the parotid gland and 1015% in the submandibular gland. Around 80% of parotid tumors and 50% of submandibular tumors are benign. Salivary gland tumors can show a striking range of morphological diversity between different tumor types and sometimes within an individual tumor mass. Hence, it is important to identify various histomorphological patterns and classify them accordingly. Objectives: The aim of this study was to recognize various histomorphological patterns of salivary gland tumors, their frequency, age, and site distribution. Materials and Methods: It was a retrospective study of 96 cases of salivary gland tumors, diagnosed on histopathological examination over a period of 2 years (July 2012 to June 2014) in the Department of Pathology of a tertiary care hospital. Histopathological examination was done on formalin fixed, paraffin embedded tissue sections stained with hematoxylin and eosin. Result: Out of 96 cases, 60 (62.5%) were benign and 36 (37.5%) were malignant. Benign tumors were frequent in the 3rd and 4th decade, whereas malignant tumors were common in 4th and 5th decades of life. Male:female ratio was 1.6:1. The most common site of occurrence for both benign and malignant tumors was the parotid gland. Pleomorphic adenoma was the most common benign tumor. Mucoepidermoid carcinoma (36.1%) was the most common malignant salivary gland tumor. Parotid was the most common site for mucoepidermoid carcinoma. Conclusion: Salivary gland tumors are relatively rare. Benign salivary gland tumors are more common than malignant ones. There is a male preponderance. The Parotid gland is the commonest site for occurrence of salivary gland tumors. Pleomorphic adenoma is the most frequent benign tumor whereas mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. Histopathological examination is mandatory in the diagnosis of salivary gland tumors as they have a very wide spectrum of morphological patterns.


from Scope via xlomafota13 on Inoreader http://ift.tt/2cY5jxR
via IFTTT

A comparative study of sevoflurane and propofol for laryngeal mask airway insertion

2016-10-03T10-50-55Z
Source: International Journal of Medical Science and Public Health
Binita Patel, Hemangini Patel, Bansari Kantharia.
Background: Laryngeal Mask Airway (LMA) is a useful advent in the airway management, filling a niche between the face mask and the tracheal tube in terms of both the anatomical position and the degree of invasiveness. Propofol is an intravenous anesthetic agent which depresses both laryngeal and pharyngeal reflexes and provides profound relaxation of pharyngeal muscles. Incidences of agging coughing, laryngospasm are less while using propofol than thiopentone. Sevoflurane is pleasant smelling, non-irritating to the airway, has a low blood gas solubility coefficient, good muscle relaxant effect, and high inspired concentration can be given without side effects or discomfort. It allows rapid smooth inhalation induction with excellent recovery characteristics. Objective: To compare the quality of the condition provided for successful LMA insertion by sevoflurane induction with propofol induction methods. Materials and Methods: Study was carried out in 100 patients at the New Civil Hospital, Surat. Patients were randomly divided into 2 groups comprising of 50 patients each. In Group-P induction with propofol 3 mg/kg intravenously over 30 seconds and in Group-S induction have done with inhalational sevoflurane 8% and nitrous oxide 50% in oxygen. Results: The mean pulse rate before induction in Group-P was 79.92±9.18 beats/min and in Group-S it was 80.96±10.11 beats/min, p>0.05. Following LMA insertion the mean pulse rate increased in both the groups. However, the mean pulse rate did not differ significantly between the groups at any time following LMA insertion, p>0.05. The mean systolic blood pressure before induction in Group-P was 119.92±9.44 mmHg and in Group-S it was 118.40±8.60 mmHg, p>0.05. Comparing the 2 groups, this difference was insignificant. Following LMA insertion the mean systolic blood pressure decreased but mean systolic blood pressure did not differ significantly on comparing both groups at any time following LMA insertion, p>0.05. The mean SPO2% at baseline in Group-P was 99.54±0.89% and in Group-S it was 99.72±12.7%, p>0.05. The mean time for cessation of verbal communication in Group-P was 32.9±7.07 seconds and in Group-S, it was 33.7±5.13 seconds. The mean time to successful LMA insertion in Group-P was 79.4±27.63 seconds and in Group-S, it was 128.5±19.46 seconds, p


from Scope via xlomafota13 on Inoreader http://ift.tt/2dCHtVK
via IFTTT

Evaluation of a Population Based Approach to Familial Colorectal Cancer

ABSTRACT

As Newfoundland has the highest rate of familial CRC in the world, we started a population-based clinic to provide colonoscopic and Lynch syndrome (LS) screening recommendations to families of CRC patients based on family risk. Of 1091 incident patients 52% provided a family history. Seventy-two percent of families were at low or intermediate-low risk of CRC and colonoscopic screening recommendations were provided by letter. Twenty eight per cent were at high and intermediate-high risk and were referred to the genetic counsellor, but only 30% (N = 48) were interviewed by study end. Colonoscopy was recommended more frequently than every 5 years in 35% of families. Lower family risk was associated with older age of proband but the frequency of screening colonoscopy recommendations varied across all age groups, driven by variability in family history. Twenty four percent had a high MMR Predict score for a Lynch Syndrome mutation, and 23% fulfilled the Provincial Program criteria for LS screening. A population-based approach in the provision of colonoscopic screening recommendations to families at risk of CRC was limited by the relatively low response rate. A family history first approach to the identification of LS families was inefficient.

Thumbnail image of graphical abstract

Flow chart for patients provided colonoscopic screening recommendations in the familial colorectal cancer clinic.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2dEEFIz
via IFTTT

Running decreases knee intra-articular cytokine and cartilage oligomeric matrix concentrations: a pilot study

Abstract

Introduction

Regular exercise protects against degenerative joint disorders, yet the mechanisms that underlie these benefits are poorly understood. Chronic, low-grade inflammation is widely implicated in the onset and progression of degenerative joint disease.

Purpose

To examine the effect of running on knee intra-articular and circulating markers of inflammation and cartilage turnover in healthy men and women.

Methods

Six recreational runners completed a running (30 min) and control (unloaded for 30 min) session in a counterbalanced order. Synovial fluid (SF) and serum samples were taken before and after each session. Cytokine concentration was measured in SF and serum using a multiplexed cytokine magnetic bead array. Ground reaction forces were measured during the run.

Results

There were no changes in serum or SF cytokine concentration in the control condition. The cytokine GM-CSF decreased from 10.7 ± 9.8 to 6.2 ± 5.9 pg/ml pre- to post-run (p = 0.03). IL-15 showed a trend for decreasing concentration pre- (6.7 ± 7.5 pg/ml) to post-run (4.3 ± 2.7 pg/ml) (p = 0.06). Changes in IL-15 concentration negatively correlated with the mean number of foot strikes during the run (r 2 = 0.67; p = 0.047). The control condition induced a decrease in serum COMP and an increase in SF COMP, while conversely the run induced an increase in serum COMP and a decrease in SF COMP. Changes in serum and SF COMP pre- to post-intervention were inversely correlated (r 2 = 0.47; p = 0.01).

Conclusions

Running appears to decrease knee intra-articular pro-inflammatory cytokine concentration and facilitates the movement of COMP from the joint space to the serum.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2d8Mndm
via IFTTT

Acute exacerbation of irritable bowel syndrome prevented by prn oral triptan

Abstract

We report a case of irritable bowel syndrome (IBS), diarrhea subtype, characterized by daily 'morning rush' and episodic acute exacerbations brought on by common IBS trigger foods including insoluble fiber, red wine and large/rich meals. The patient also had a history of migraine headaches, and a family history suggesting a common diathesis for both disorders. Given hypothesized contributions to IBS from dysregulation of the enteric serotonergic system, a trial of low-dose triptan medication was implemented in the context of the patient's known IBS triggers, with highly satisfactory results.



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dUANq0
via IFTTT

Recent trends and future directions for the medical treatment of ulcerative colitis

Abstract

Recently, several medical treatments for ulcerative colitis (UC) have been developed, including 5-aminosalicylic acids (5-ASAs), corticosteroids, thiopurine, calcineurin inhibitors, and anti-tumor necrosis factor (TNF) α treatments. Treatment options including calcineurin inhibitors and anti-TNF treatment for refractory UC are discussed in this article. Furthermore, upcoming treatments are introduced, such as golimumab, vedolizumab, AJM300, tofacitinib. Budesonide foamwill be used as one treatment option in patients with distal colitis. Herbal medicine, such as Qing-Dai is also effective for active UC and may be useful for patients who are refractory to anti-TNFα treatments. In the near future, physicians will able to use many different treatments for UC patients. However, we should not forget 5-ASA and corticosteroids as the fundamental treatments for UC patients.



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dqt9RG
via IFTTT

Distance CME to host virtual reality demo

Attendees can take part in treatment of an 8-year-old patient with asthma during the 2016 EMS World Expo.

from EMS via xlomafota13 on Inoreader http://ift.tt/2dLlvog
via IFTTT

Attend a conference because EMS is bigger than your department

I began my career in EMS as a small town volunteer. I knew very little about EMS as a profession. I had a brand new state certification, a National Registry patch and a completed orientation packet for my local service agency.

I was eager to learn how to become one of the confident, capable providers who made up the volunteer crew. My entire EMS world consisted of my classmates, my instructor and the EMTs who ran the ambulance corps.

I knew nothing about the history of EMS, had never met our medical director, was unaware of the existence of a state office of EMS and didn't know what was meant by EMS CE. My state only required National Registry testing for initial certification. Retaining membership simply required renewing by check every year.

I knew that the state EMS office, usually said with dread or disdain as "THE STATE," required us to meet staffing, clinical and equipment standards and if we screwed up, we would get in trouble with "THE STATE."

In a silo
Like most of the ambulance corps membership, I had a full-time job, a young family, a social life and little interest in being involved in EMS other than what was required of me, which was signing up for shifts, attendance at in-service training and regular monthly meetings.

I lacked confidence, constantly asked questions looking for help with both understanding and skills practice. My peers tried to help by telling me that I was unlikely to kill anybody and that many of the scenarios I worried about rarely happened. Well meaning, but not helpful.

The culture of volunteer EMS has traditionally been insular. Information, collaboration and sharing of resources is not only limited, but often viewed as suspect. Volunteer agencies share the same goals, experiences and difficulties nationwide, but are often resistant to change and new ideas, especially from outsiders. In large companies this happens with departments, which are referred to as corporate silos.

It didn't occur to me that I could — or should — go outside of my agency for additional education or experience. Like a lot of volunteers, I was a victim of the silo effect [1]. .

Rethink performance metrics
The only thing I knew about EMS outside of my town was that we were better than pretty much all the other agencies in the area because we did not pass calls. We always got a crew to respond in our service area. This was our number one priority.

At the time, I never even questioned why the fact that we actually showed up for 911 calls was considered a big deal. Our concept of success was based on only two things: not failing at our most basic responsibility to show up and not getting in trouble with the state EMS office.

Understanding that showing up is not a measure of excellence came later in my career.

You don't know what you don't know
A few times a year, flyers were posted about free education opportunities at nearby hospitals, usually a lecture by an emergency medicine doctor or a hospital-based paramedic. There was also a poster for the annual state EMS conference, a weekend event with a substantial registration fee.

At the time, we earned points for showing up for calls that could be reimbursed for uniform equipment. I didn't need boots and I had a top of the line sparky gear bag already so I asked if I could use my points to attend. I quickly heard the usual excuses for staying home:

"People only go to those things to get drunk and screw around, like any convention."

"There is nothing there for regular EMTs."

"Nurses and paramedics go because they need education credits. It's way over your head."

Eventually, a paramedic friend dragged me to one of the free continuing education offerings at our local hospital. It was on stroke assessment and a new initiative for stroke alerts.

I realized then that I had no idea exactly how much I did not know and how much I should know about prehospital care.

It's not what you think
Many EMTs, especially volunteers, have had little exposure to dynamic learning experiences. Buy-in for mandated continuing education has been limited as it is often viewed as a necessary evil with questionable relevance or value. Death by PowerPoint and war stories, both ineffective educational methodologies for assessing or improving competency, had become the expectation.

Leave the conference a better EMT
I had been an EMT for almost eight years when I attended my first EMS conference. I had subscriptions to several EMS trade publications and had discovered and become a regularly reader of "Life Under the Lights" by Chris Kaiser, "Street Watch: Notes of a Paramedic" by Peter Canning, "Rescuing Providence" by Michael Morse, "A Day in the Life of an Ambulance Driver" by Kelly Grayson, and some other EMS blogs. I was excited to find out that some of the familiar names from articles I had been reading by Ray Barishansky, Allison Bloom, Jason Dush, Rommie Duckworth, Kelly Grayson and Tracey Loscar would be teaching at the conference and chose their classes to attend.

I particularly remember a class I attended by accidently going to the wrong room. I accidentally found myself in an ALS review on triads. During the presentation, I learned about the trauma triad of death and airway management techniques which immediately changed the way I practiced.

I also had the opportunity to meet people from the state EMS office. I was pleasantly surprised to find that most of them were human.

That evening group of EMTs who had arrived as strangers gathered by the pool, at the bar and in the restaurant. Debates, discussions, gossip and of course some shenanigans continued into the late night.

I had forgotten how much fun my EMT class had been and the camaraderie that had developed. Here it was again on a much bigger scale. The energy was palpable. My EMS world was no longer limited to my hometown.

I left my first conference a very different EMT. I was hooked. Since then, time and money permitting, I never miss an educational opportunity.

Education is not always painful
Leave the silo, get out of the bubble and give a regional, state or national conference a try. Network with other EMTs, share ideas and experiences, collect business cards, see the newest EMS products and attend classes for CE credit that look interesting and challenging.

As an added bonus you will leave with enough pens, notepads, koozies, hand sanitizers and carabiners to last until next year's conference.

And it will be painless.

Have you attended a regional, statewide or national EMS conference" Why or why not"

Share your answers in the comments.

References
1. The Silo Effect: The Peril of Expertise and the Promise of Breaking Down Barriers by Gillian Tett, Simon &Schuster Sept. 2015



from EMS via xlomafota13 on Inoreader http://ift.tt/2dmCv2y
via IFTTT

Plasticity in mitochondrial cristae density allows metabolic capacity modulation in human skeletal muscle

Abstract

Mitochondrial energy production involves the movement of protons down a large electrochemical gradient through ATP synthase located on the folded inner membrane, known as cristae. In mammalian skeletal muscle, the density of cristae in mitochondria is thought to be constant. However, recent experimental studies have shown that respiration per mitochondria varies.Modelling studies have hypothesised that this variation in respiration per mitochondria depends on plasticity in cristae density, but currently evidence for such a mechanism is lacking. Here, we confirm this hypothesis by showing that, in human skeletal muscle, contrary to the current view, the mitochondrial cristae density is not constant, but exhibits plasticity with long-term endurance training. Furthermore, we show that frequently recruited mitochondria-enriched fibres have significantly increased cristae density and that, at whole-body level, muscle mitochondrial cristae density is a better predictor of maximal oxygen uptake rate than muscle mitochondrial volume. Our findings establish elevating mitochondrial cristae density as a regulatory mechanism for increasing metabolic power in human skeletal muscle. We propose that this mechanism allows evasion of the trade-off between cell occupancy by mitochondria and other cellular constituents and improved metabolic capacity and fuel catabolism during prolonged elevated energy requirements.

This article is protected by copyright. All rights reserved



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dMzx5D
via IFTTT

Attend a conference because EMS is bigger than your department

I began my career in EMS as a small town volunteer. I knew very little about EMS as a profession. I had a brand new state certification, a National Registry patch and a completed orientation packet for my local service agency.

I was eager to learn how to become one of the confident, capable providers who made up the volunteer crew. My entire EMS world consisted of my classmates, my instructor and the EMTs who ran the ambulance corps.

I knew nothing about the history of EMS, had never met our medical director, was unaware of the existence of a state office of EMS and didn't know what was meant by EMS CE. My state only required National Registry testing for initial certification. Retaining membership simply required renewing by check every year.

I knew that the state EMS office, usually said with dread or disdain as "THE STATE," required us to meet staffing, clinical and equipment standards and if we screwed up, we would get in trouble with "THE STATE."

In a silo
Like most of the ambulance corps membership, I had a full-time job, a young family, a social life and little interest in being involved in EMS other than what was required of me, which was signing up for shifts, attendance at in-service training and regular monthly meetings.

I lacked confidence, constantly asked questions looking for help with both understanding and skills practice. My peers tried to help by telling me that I was unlikely to kill anybody and that many of the scenarios I worried about rarely happened. Well meaning, but not helpful.

The culture of volunteer EMS has traditionally been insular. Information, collaboration and sharing of resources is not only limited, but often viewed as suspect. Volunteer agencies share the same goals, experiences and difficulties nationwide, but are often resistant to change and new ideas, especially from outsiders. In large companies this happens with departments, which are referred to as corporate silos.

It didn't occur to me that I could — or should — go outside of my agency for additional education or experience. Like a lot of volunteers, I was a victim of the silo effect [1]. .

Rethink performance metrics
The only thing I knew about EMS outside of my town was that we were better than pretty much all the other agencies in the area because we did not pass calls. We always got a crew to respond in our service area. This was our number one priority.

At the time, I never even questioned why the fact that we actually showed up for 911 calls was considered a big deal. Our concept of success was based on only two things: not failing at our most basic responsibility to show up and not getting in trouble with the state EMS office.

Understanding that showing up is not a measure of excellence came later in my career.

You don't know what you don't know
A few times a year, flyers were posted about free education opportunities at nearby hospitals, usually a lecture by an emergency medicine doctor or a hospital-based paramedic. There was also a poster for the annual state EMS conference, a weekend event with a substantial registration fee.

At the time, we earned points for showing up for calls that could be reimbursed for uniform equipment. I didn't need boots and I had a top of the line sparky gear bag already so I asked if I could use my points to attend. I quickly heard the usual excuses for staying home:

"People only go to those things to get drunk and screw around, like any convention."

"There is nothing there for regular EMTs."

"Nurses and paramedics go because they need education credits. It's way over your head."

Eventually, a paramedic friend dragged me to one of the free continuing education offerings at our local hospital. It was on stroke assessment and a new initiative for stroke alerts.

I realized then that I had no idea exactly how much I did not know and how much I should know about prehospital care.

It's not what you think
Many EMTs, especially volunteers, have had little exposure to dynamic learning experiences. Buy-in for mandated continuing education has been limited as it is often viewed as a necessary evil with questionable relevance or value. Death by PowerPoint and war stories, both ineffective educational methodologies for assessing or improving competency, had become the expectation.

Leave the conference a better EMT
I had been an EMT for almost eight years when I attended my first EMS conference. I had subscriptions to several EMS trade publications and had discovered and become a regularly reader of "Life Under the Lights" by Chris Kaiser, "Street Watch: Notes of a Paramedic" by Peter Canning, "Rescuing Providence" by Michael Morse, "A Day in the Life of an Ambulance Driver" by Kelly Grayson, and some other EMS blogs. I was excited to find out that some of the familiar names from articles I had been reading by Ray Barishansky, Allison Bloom, Jason Dush, Rommie Duckworth, Kelly Grayson and Tracey Loscar would be teaching at the conference and chose their classes to attend.

I particularly remember a class I attended by accidently going to the wrong room. I accidentally found myself in an ALS review on triads. During the presentation, I learned about the trauma triad of death and airway management techniques which immediately changed the way I practiced.

I also had the opportunity to meet people from the state EMS office. I was pleasantly surprised to find that most of them were human.

That evening group of EMTs who had arrived as strangers gathered by the pool, at the bar and in the restaurant. Debates, discussions, gossip and of course some shenanigans continued into the late night.

I had forgotten how much fun my EMT class had been and the camaraderie that had developed. Here it was again on a much bigger scale. The energy was palpable. My EMS world was no longer limited to my hometown.

I left my first conference a very different EMT. I was hooked. Since then, time and money permitting, I never miss an educational opportunity.

Education is not always painful
Leave the silo, get out of the bubble and give a regional, state or national conference a try. Network with other EMTs, share ideas and experiences, collect business cards, see the newest EMS products and attend classes for CE credit that look interesting and challenging.

As an added bonus you will leave with enough pens, notepads, koozies, hand sanitizers and carabiners to last until next year's conference.

And it will be painless.

Have you attended a regional, statewide or national EMS conference? Why or why not?

Share your answers in the comments.

References
1. The Silo Effect: The Peril of Expertise and the Promise of Breaking Down Barriers by Gillian Tett, Simon &Schuster Sept. 2015



from EMS via xlomafota13 on Inoreader http://ift.tt/2dDWXhC
via IFTTT

Prostaglandins mediate zymosan-induced sickness behavior in mice

Abstract

Previous studies have demonstrated that zymosan, a cell wall component of the yeast Saccharomyces cerevisiae, induces inflammation in experimental models. However, few studies have evaluated the potential of zymosan to induce sickness behavior, a central motivational state that allows an organism to cope with infection. To determine whether zymosan administration results in sickness behavior, mice were submitted to the forced swim (FST) and open field (OFT) tests 2, 6, and 24 h after treatment with zymosan (1, 10, or 100 mg/kg). Additionally, to evaluate the possible relationship between zymosan-induced sickness behavior and prostaglandin synthesis, mice were pretreated with the cyclooxygenase inhibitors indomethacin (10 mg/kg) and nimesulide (5 mg/kg) and the glucocorticoid drug dexamethasone (1 mg/kg). Zymosan induced time-dependent decreases in locomotor activity in the OFT, and an increase in immobility in the FST, and increased plasma levels of corticosterone at 2 h. Pretreatment with indomethacin, nimesulide, or dexamethasone blocked zymosan-induced behavioral changes in both the FST and OFT at 2 h post administration. These findings confirm previous observations that zymosan induces sickness behavior. Furthermore, our results provide new evidence that prostaglandin synthesis is necessary for this effect, as anti-inflammatory drugs that inhibit prostaglandin synthesis attenuated zymosan-induced behavioral changes.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dml0Q3
via IFTTT

Peroxisome proliferator-activated receptor gamma co-activator 1 gene Gly482Ser polymorphism is associated with the response of low-density lipoprotein cholesterol concentrations to exercise training in elderly Japanese

Abstract

Muscle peroxisome proliferator-activated receptor gamma co-activator 1 (PGC-1)α gene expression is influenced by the Gly482Ser gene polymorphism, which is a candidate genetic risk factor for diabetes mellitus and obesity. This study investigated the effects of PGC-1 gene Gly482Ser polymorphisms on alterations in glucose and lipid metabolism induced by exercise training. A 12-week intervention study was performed for 119 participants who were more than 65 years of age and completed exercise training at lactate threshold intensity. Total cholesterol and low-density lipoprotein cholesterol were significantly reduced in Gly/Gly but not in Gly/Ser and Ser/Ser participants after exercise. The Gly/Gly genotype of the PGC-1 gene Gly482Ser polymorphism influences the effects of moderate-intensity exercise training on low-density lipoprotein cholesterol and total cholesterol concentrations in older people.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2dM2ZIU
via IFTTT

Reduced port laparoscopic cholecystectomy: single and a half incision lap chole

Indian Journal of Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMTneK
via IFTTT

Reduction of covalently closed circular dna with long-term nucleos(t)ide analogue treatment in chronic hepatitis b

Journal of Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDiiaM
via IFTTT

The individual and combined effects of obesity- and ageing-induced systemic inflammation on human skeletal muscle properties

International Journal of Obesity

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMTkQh
via IFTTT

Methylferulate from Tamarix aucheriana inhibits growth and enhances chemosensitivity of human colorectal cancer cells: Possible mechanism of action

BMC Complementary and Alternative Medicine

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDjgE2
via IFTTT

Combined assessment using optical colonoscopy and computed tomographic colonography improves the determination of tumor location and invasion depth

Asian Journal of Endoscopic Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMTt6o
via IFTTT

Aerobic versus resistance exercise in non-alcoholic fatty liver disease: A systematic review

Journal of Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDjbA2
via IFTTT

Nadolol reduces insulin sensitivity in liver cirrhosis: A double-blind randomized cross-over trial

Diabetes/Metabolism Research and Reviews

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMXgjK
via IFTTT

Classification and regression tree analysis of acute-on-chronic hepatitis B liver failure: Seeing the forest for the trees

Journal of Viral Hepatitis

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDitTG
via IFTTT

The benefit of sleeve gastrectomy in obese adolescents on nonalcoholic steatohepatitis and hepatic fibrosis

The Journal of Pediatrics

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMTjvH
via IFTTT

Prevalence of Helicobacter pylori infection in newly arrived refugees attending the Migrant Health Service, South Australia

Helicobacter

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDjMlh
via IFTTT

Maternal adipokines and insulin as biomarkers of pregnancies complicated by overweight and obesity

Diabetology & Metabolic Syndrome

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMThnz
via IFTTT

The operative management of children with complex perianal Crohn's disease

Journal of Pediatric Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDixCM
via IFTTT

A 1-year prospective study of the effect of infliximab on bone metabolism in inflammatory bowel disease patients

European Journal of Gastroenterology & Hepatology

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMSlj5
via IFTTT

Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections among blood donors at Shiyan, Central China

BMC Infectious Diseases

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDjPO3
via IFTTT

The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Surgery Today

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMRWx9
via IFTTT

Mitigation of stomach dehiscence risk during gastrostomy tube changes - A retrospective analysis of patient outcomes

Journal of Pediatric Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDjlrc
via IFTTT

Assessing the relationship between A Body Shape Index and mortality in a group of middle-aged men

Clinical Nutrition

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMSdjm
via IFTTT

Somatostatin analogues compared to placebo and other pharmacological agents in the management of symptoms of inoperable malignant bowel obstruction: A systematic review

Journal of Pain and Symptom Management

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDi17V
via IFTTT

Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis

British Journal of Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2cMRVt5
via IFTTT

Predictors for bowel resection and the presence of a pathological lead point for operated childhood intussusception: A multi-center study

Journal of Pediatric Surgery

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2dDiqqY
via IFTTT

Metagenomics: Marine genomics goes viral



from Genetics via xlomafota13 on Inoreader http://ift.tt/2dDitD4
via IFTTT

Genetic engineering: Allele-specific genome editing of disease loci



from Genetics via xlomafota13 on Inoreader http://ift.tt/2cMRFdx
via IFTTT

Epigenetic inheritance of acquired traits through sperm RNAs and sperm RNA modifications

Studies have demonstrated that paternal traits acquired in response to environmental conditions can be inherited by the offspring, sometimes persisting for multiple generations. In this Review, the authors discuss the accumulating evidence of a major role for sperm RNAs and RNA modifications in the inheritance of acquired traits and the mechanisms that may underlie this.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2dDixTo
via IFTTT

Cardiovascular profile of aluminium phosphide poisoning and its clinical significance

2016-10-03T00-46-49Z
Source: International Journal of Advances in Medicine
Sudhir Kalawat, Vibhuti Thakur, Ashok Thakur, N. D. Punjabi.
Background: Aluminium phosphide is a solid fumigant pesticide and it has currently aroused interest with increasing number of poisoning cases in past three decades. Over the time it has become an effective and widely used medium for suicide and homicide. Aluminium phosphide has highly effective killing power. Death is due to its direct toxic effect over the heart leading to peripheral circulatory failure .Aluminium phosphide poisoning affects the most of the organs. Early symptoms include nausea, vomiting, retrosternal and epigastric pain, dyspnea, anxious, agitation and smell of garlic breath. Methods: 50 patients, who were admitted in MICU, following consumption of aluminium phosphide tablets were included in the study. Patients clinical evaluation was done as per standard. PaO2 was noted with pulse oxymeter. Troponin I, ECG and echo of the patients was done to study the cardiac toxicities and pathological reports were correlated. Results: Out of 50 cases, ECG was normal in 20 cases and abnormal in 30 cases-sinus tachycardia was most common finding (24%) while heart block was least (4%). On echo, hypokinesia was seen in 40% cases, decreased ejection fraction in 8% cases and normal echo was seen in 12% cases. Serum troponin test was positive in 26%. Out of 50 cases, 19 died and rest 31 cases survived. Conclusions: AgNO3 test, ECG and pulse oxymetry are bed side, cost effective tools and should be done in all cases. Echocardiography is a useful tool to evaluate cardiac function and cardiac anatomy. Whenever it is available, it must be done in cases of aluminium phosphide poisoning. Serum troponin-I test should be done to assess significant myocardial damage. Thus, proper clinical work out along with relevant investigations and management as per standard protocol may save many more lives.


from Scope via xlomafota13 on Inoreader http://ift.tt/2dJUthf
via IFTTT

Comparison of pulse oximetry and colour: a better index of oxygenation in neonatal resuscitation

2016-10-03T00-41-58Z
Source: International Journal of Contemporary Pediatrics
Akanksha Bansal, Ghanshyam Das, Ravi Ambey.
Background: Colour is an unreliable indicator of tissue oxygenation in the first few minutes of life. Little data is available about the progression of SpO2 in the new-borns delivered by normal vaginal route and caesarean section. So this study was conducted. The objectives of this study were to compare the new-borns colour and oxygen saturation readings as an index of oxygenation and to find a more reliable one, and to compare the oxygen saturation profiles of the new-borns delivered by normal vaginal route and caesarean section. Methods: This was a prospective observational study conducted over a period of one year in a tertiary care hospital on 500 newborns between 28-42 weeks, requiring routine care. Simultaneous assessment of colour and oxygen saturation readings was done at 30 second intervals after birth till 10 minutes of life. Results: No significant difference has been found in the median SpO2 values of the new-borns requiring routine care that were pink and cyanosed since birth (p≥ 0.05). About 5.30 minutes required for most of the cyanosed new-borns to become pink (p≥ 0.05). Mean time±SD required for cyanosed new-born for getting pink was 1.96±1.33 minutes. Oxygen saturation rises slowly in new-borns delivered by caesarean section as compared to those delivered vaginally, especially in the first few minutes of life and more in preterm than term new-borns. Conclusions: Unnecessary use of oxygen can be avoided by taking into account pulse oximetry. Separate sets of reference SpO2 should be used for new-borns delivered by normal vaginal route and caesarean section.


from Scope via xlomafota13 on Inoreader http://ift.tt/2dlHBuZ
via IFTTT