Transporting critically ill patients Eagle, Sarah
British journal of nursing (Mark Allen Publishing),
26/1995 Jul 13, Letnik:
4, Številka:
13
Journal Article
Recenzirano
Some 10000 patients a year are moved to or between intensive care units (ICUs) in the UK (Royal College of Anaesthetists, 1989). This figure looks set to increase considerably with plans to further ...develop regional ICUs already under discussion.
Ocean acidification will potentially inhibit calcification by marine organisms; however, the response of the most prolific ocean calcifiers, coccolithophores, to this perturbation remains under ...characterized. Here we report novel chemical constraints on the response of the widespread coccolithophore species Ochrosphaera neapolitana (O. neapolitana) to changing-CO
conditions. We cultured this algae under three pCO
-controlled seawater pH conditions (8.05, 8.22, and 8.33). Boron isotopes within the algae's extracellular calcite plates show that this species maintains a constant pH at the calcification site, regardless of CO
-induced changes in pH of the surrounding seawater. Carbon and oxygen isotopes in the algae's calcite plates and carbon isotopes in the algae's organic matter suggest that O. neapolitana utilize carbon from a single internal dissolved inorganic carbon (DIC) pool for both calcification and photosynthesis, and that a greater proportion of dissolved CO
relative to HCO
enters the internal DIC pool under acidified conditions. These two observations may explain how O. neapolitana continues calcifying and photosynthesizing at a constant rate under different atmospheric-pCO
conditions.
Diet is a crucial trait of an animal's lifestyle and ecology. The trophic level of an organism indicates its functional position within an ecosystem and holds significance for its ecology and ...evolution. Here, we demonstrate the use of zinc isotopes (δ
Zn) to geochemically assess the trophic level in diverse extant and extinct sharks, including the Neogene megatooth shark (Otodus megalodon) and the great white shark (Carcharodon carcharias). We reveal that dietary δ
Zn signatures are preserved in fossil shark tooth enameloid over deep geologic time and are robust recorders of each species' trophic level. We observe significant δ
Zn differences among the Otodus and Carcharodon populations implying dietary shifts throughout the Neogene in both genera. Notably, Early Pliocene sympatric C. carcharias and O. megalodon appear to have occupied a similar mean trophic level, a finding that may hold clues to the extinction of the gigantic Neogene megatooth shark.
This article discusses the condition of continuous traumatic stress as common on the African continent and in other international settings characterised by very high levels of ongoing violence and ...threat of community, political or war-related origin. Through consideration of three case studies from South Africa, contexts of continuous traumatic stress are described, and the mental health and physical health effects of living in such contexts are elaborated. Cautions are raised about attempting to transpose existing posttraumatic stress models onto individuals exposed to situations of continuous traumatic stress, and guidelines for optimal interventions with such cases are proposed.
Understanding how neuronal circuits control nociceptive processing will advance the search for novel analgesics. We use functional imaging to demonstrate that lateral hypothalamic ...parvalbumin-positive (LH
) glutamatergic neurons respond to acute thermal stimuli and a persistent inflammatory irritant. Moreover, their chemogenetic modulation alters both pain-related behavioral adaptations and the unpleasantness of a noxious stimulus. In two models of persistent pain, optogenetic activation of LH
neurons or their ventrolateral periaqueductal gray area (vlPAG) axonal projections attenuates nociception, and neuroanatomical tracing reveals that LH
neurons preferentially target glutamatergic over GABAergic neurons in the vlPAG. By contrast, LH
projections to the lateral habenula regulate aversion but not nociception. Finally, we find that LH
activation evokes additive to synergistic antinociceptive interactions with morphine and restores morphine antinociception following the development of morphine tolerance. Our findings identify LH
neurons as a lateral hypothalamic cell type involved in nociception and demonstrate their potential as a target for analgesia.
Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ...ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.
We sought to compare the sensitivity, specificity, accuracy, and interobserver agreement of the two most commonly used classification systems for conjunctival melanocytic intraepithelial lesions with ...the new World Health Organization (WHO) classification.
Retrospective case series and evaluation of classification systems.
We reviewed the pathology and medical records of all patients who underwent a primary biopsy procedure for conjunctival primary acquired melanosis (PAM) at Wills Eye Hospital between 1974 and 2002 who had ≥36 months of follow-up. Data collected included age, sex, clinical findings, recurrence, and progression to melanoma. Twelve ophthalmic pathologists analyzed scanned hematoxylin and eosin–stained virtual microscopic slides using 3 classification systems: PAM, conjunctival melanocytic intraepithelial neoplasia, and the WHO 4th edition classification of conjunctival melanocytic intraepithelial lesions. Observer agreement, sensitivity, specificity, and diagnostic accuracy of each classification system were assessed.
There were 64 patients who underwent 83 primary excisions with cryotherapy for conjunctival PAM who had adequate tissue for histopathologic evaluation. The interobserver agreement in distinction between the low- and high-grade lesions was 76% for PAM, 67% for conjunctival melanocytic intraepithelial neoplasia, and 81% for WHO classification system. Low-grade lesions provided the greatest interpretative challenge with all 3 classification systems. The 3 classification systems had comparable accuracy of 81%-83% in their ability to identify lesions with potential for recurrence.
This study highlights the comparable strengths and limitations of the 3 classification systems for conjunctival melanocytic intraepithelial lesions and suggests that the simplified WHO classification scheme is appropriate for evaluation of these lesions.
•Validation of the WHO classification for CMILs.•PAM, C-MIN, and WHO classification schemes have accuracy of 81%-83%.•The interobserver agreement is 81% for low-vs high-grade CMIL.•Low-grade lesions present the greatest interpretative challenge with all 3 systems.
Major depressive disorder is thought to arise in part from dysfunction of the brain's “reward circuitry”, consisting of the mesolimbic dopamine system and the glutamatergic and neuromodulatory inputs ...onto this system. Both chronic stress and antidepressant treatment regulate gene transcription in many of the brain regions that make up these circuits, but the exact nature of the transcription factors and target genes involved in these processes remain unclear. Here, we demonstrate induction of the FosB family of transcription factors in ∼25 distinct regions of adult mouse brain, including many parts of the reward circuitry, by chronic exposure to the antidepressant fluoxetine. We further uncover specific patterns of FosB gene product expression (i.e., differential expression of full-length FosB, ΔFosB, and Δ2ΔFosB) in brain regions associated with depression – the nucleus accumbens (NAc), prefrontal cortex (PFC), and hippocampus – in response to chronic fluoxetine treatment, and contrast these patterns with differential induction of FosB isoforms in the chronic social defeat stress model of depression with and without fluoxetine treatment. We find that chronic fluoxetine, in contrast to stress, causes induction of the unstable full-length FosB isoform in the NAc, PFC, and hippocampus even 24 h following the final injection, indicating that these brain regions may undergo chronic activation when fluoxetine is on board, even in the absence of stress. We also find that only the stable ΔFosB isoform correlates with behavioral responses to stress. These data suggest that NAc, PFC, and hippocampus may present useful targets for directed intervention in mood disorders (ie, brain stimulation or gene therapy), and that determining the gene targets of FosB-mediated transcription in these brain regions in response to fluoxetine may yield novel inroads for pharmaceutical intervention in depressive disorders.
•Fluoxetine induces FosB gene products in ∼25 distinct regions of adult mouse brain.•Patterns of FosB gene products induced by fluoxetine differ by brain region.•FosB gene product induction by fluoxetine differs from induction by stress.•Only ΔFosB levels in PFC and nucleus accumbens correlate with behavioral response to stress.
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