We conducted a meta‐analysis to synthesize the best available evidence comparing cardiac biventricular structure and function using cardiac magnetic resonance imaging (CMR) and transthoracic ...echocardiography (TTE) in elite female athletes and healthy controls (HC). Chronic exposure to exercise may induce cardiac chamber enlargement as a means to augment stroke volume, a condition known as the “athlete's heart.” These changes have not been clearly characterized in female athletes. Multiple databases were searched from inception to June 18, 2019. Outcomes of interest included left ventricular (LV) and right ventricular (RV) dimensional, volumetric, mass, and functional assessments in female athletes. Most values were indexed to body surface area. The final search yielded 22 studies, including 1000 female athletes from endurance, strength, and mixed athletic disciplines. CMR‐derived LV end‐diastolic volume (LVEDV) and RV end‐diastolic volume (RVEDV) were greater in endurance athletes (EA) versus HC (17.0% and 18.5%, respectively; both p < 0.001). Similarly, TTE‐derived LVEDV and RVEDV were greater in EA versus HC (16.8% and 28.0%, respectively; both p < 0.001). Both LVEF and RVEF were lower in EA versus HC, with the most pronounced difference observed in RVEF via TTE (9%) (p < 0.001). LV stroke volume was greater in EA versus HC via both CMR (18.5%) and TTE (13.2%) (both p < 0.05). Few studies reported data for the mixed athlete (MA) population and even fewer studies reported data for strength athletes (SA), therefore a limited analysis was performed on MA and no analysis was performed on SA. This evidence‐synthesis review demonstrates the RV may be more susceptible to ventricular enlargement. General changes in LV and RV structure and function in female EA mirrored changes observed in male counterparts. Further studies are needed to determine if potential adverse outcomes occur secondary to these changes.
This article focuses on the morphological and physiological effects of endurance‐based exercise on the female heart. Much literature has been described in males, but this data features data that mirrors that of men and particularly focuses on left and right ventricular function using established and advanced imaging modalities.
The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries a risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies the risk ...of occurrence of either high-dose conscious sedation requirements or a failed procedure.
Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of sedation failure, which was defined as one of the following: (1) high-dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented poor patient tolerance to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam and/or >200 μg of fentanyl or the meperidine equivalent. Patients with sedation failure (n = 488) were matched to controls (n = 976) without a sedation failure by endoscopist and endoscopy date.
Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted the risk of sedation failure with an area under the curve of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score ≥3.5 (odds ratio, 17.31; P = 2 × 10−14). Estimated area under the curve of the HCSR score was 0.68 (95% confidence interval, 0.63-0.72) in a validation series of 250 cases and 250 controls.
The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.
Knowing when, why, and how materials evolve, degrade, or fail in radiation environments is pivotal to a wide range of fields from semiconductor processing to advanced nuclear reactor design. A ...variety of methods, including optical and electron microscopy, mechanical testing, and thermal techniques, have been used in the past to successfully monitor the microstructural and property evolution of materials exposed to extreme radiation environments. Acoustic techniques have also been used in the past for this purpose, although most methodologies have not achieved widespread adoption. However, with an increasing desire to understand microstructure and property evolution in situ, acoustic methods provide a promising pathway to uncover information not accessible to more traditional characterization techniques. This work highlights how two different classes of acoustic techniques may be used to monitor material evolution during in situ ion beam irradiation. The passive listening technique of acoustic emission is demonstrated on two model systems, quartz and palladium, and shown to be a useful tool in identifying the onset of damage events such as microcracking. An active acoustic technique in the form of transient grating spectroscopy is used to indirectly monitor the formation of small defect clusters in copper irradiated with self-ions at high temperature through the evolution of surface acoustic wave speeds. These studies together demonstrate the large potential for using acoustic techniques as in situ diagnostics. Such tools could be used to optimize ion beam processing techniques or identify modes and kinetics of materials degradation in extreme radiation environments.
Ground flashes with positive polarity associated with both sprites and elves excite the Earth's Schumann resonances to amplitudes several times greater than the background resonances. Theoretical ...predictions for dielectric breakdown in the mesosphere are tested using ELF methods to evaluate vertical charge moments of positive ground flashes. Comparisons of the measured time constants for lightning charge transfer with the electrostatic relaxation time at altitudes of nighttime sprite initiation (50–70 km) generally validate the electrostatic assumption in predictions made initially by Wilson 1925. The measured charge moments (Q dS = 200–2000 C‐km) are large in comparison with ordinary negative lightning but are generally insufficient to account for conventional air breakdown at sprite altitudes. The measured charge moments, however, are sufficient to account for electron runaway breakdown, and the long avalanche length in this mechanism also accounts for the exclusive association of sprites with ground flashes of positive polarity. The association of elves with large peak currents (50–200 kA) measured by the National Lightning Detection Network in a band pass beyond the Schumann resonance range is consistent with an electromagnetic pulse mechanism for these events.
Introduction. Commonly prescribed medications are associated with various gastrointestinal (GI) side effects but few data are available on prescription medication use and polypharmacy in a ...gastroenterology outpatient practice. We aimed to examine the prevalence of polypharmacy, defined as the simultaneous use of 5 or more medications.
Streptococcus iniae is a gram-positive bacterium and one of the primary etiologic agents of piscine streptococcosis, a pervasive disease that costs the global aquaculture industry billions of dollars ...in annual losses. Treatment by antimicrobial administration and prevention by vaccination have had limited success in controlling S. iniae. The primary obstacle for developing effective and sustainable control strategies is a lack of understanding regarding the genetic and antigenic diversity of S. iniae in relation to its pathogenesis. As a re-emerging pathogen, our understanding of the geographic and host range of S. iniae is still expanding. Since the first isolation of S. iniae from skin lesions of a captive Amazon river dolphin (Inia geoffrensis) in 1976, it has been reported from almost 100 wild, farmed, and ornamental fish species inhabiting fresh, euryhaline and marine environments across every continent except Antarctica. Additionally, S. iniae is an opportunistic zoonotic pathogen, capable of causing systemic disease in humans and other mammals. The work presented in this dissertation aims to elucidate the genetics, ecology, and infection dynamics of strains from varied isolation sources with translatable results for aquaculture. A multilocus sequence analysis (MLSA) scheme was developed to understand the genetic relationships between diverse isolates and uncover shared phenotypic and virulence characteristics. The MLSA phylogenies were comparable to established genotyping methods and placed the S. iniae isolates into 5 major clades relating to phenotype and host species. Characterized strains from different genetic backgrounds were assessed for their ability to form biofilms, and for the role of biofilms in environmental persistence and resistance to treatment and disinfection. All strains formed biofilms within 72 hours using the minimum biofilm eradication concentration (MBEC) assay® system, and biofilms drastically increased the aquatic persistence of S. iniae and resistance to antimicrobials commonly used in aquaculture. Finally, live-attenuated vaccine candidates were developed from representative strains from North American clades by rifampin passaging. Candidate strains were attenuated in virulence by in vitro and in vivo assays and elicited a protective immune response in tilapia following intra-coelomic immunization.
Knowing when, why, and how materials evolve, degrade, or fail in radiation environments is pivotal to a wide range of fields from semiconductor processing to advanced nuclear reactor design. A ...variety of methods, including optical and electron microscopy, mechanical testing, and thermal techniques, have been used in the past to successfully monitor the microstructural and property evolution of materials exposed to extreme radiation environments. Acoustic techniques have also been used in the past for this purpose, although most methodologies have not achieved widespread adoption. However, with an increasing desire to understand microstructure and property evolution in situ, acoustic methods provide a promising pathway to uncover information not accessible to more traditional characterization techniques. This work highlights how two different classes of acoustic techniques may be used to monitor material evolution during in situ ion beam irradiation. The passive listening technique of acoustic emission is demonstrated on two model systems, quartz and palladium, and shown to be a useful tool in identifying the onset of damage events such as microcracking. An active acoustic technique in the form of transient grating spectroscopy is used to indirectly monitor the formation of small defect clusters in copper irradiated with self-ions at high temperature through the evolution of surface acoustic wave speeds. Here, these studies together demonstrate the large potential for using acoustic techniques as in situ diagnostics. Such tools could be used to optimize ion beam processing techniques or identify modes and kinetics of materials degradation in extreme radiation environments.
Objectives To examine resident performance on the Mimic dV-Trainer (MdVT; Mimic Technologies, Inc., Seattle, WA) for correlation with resident trainee level (postgraduate year PGY), console ...experience (CE), and simulator exposure in their training program to assess for internal bias with the simulator. Design Residents from programs of the Southeastern Section of the American Urologic Association participated. Each resident was scored on 4 simulator tasks (peg board, camera targeting, energy dissection ED, and needle targeting) with 3 different outcomes (final score, economy of motion score, and time to complete exercise) measured for each task. These scores were evaluated for association with PGY, CE, and simulator exposure. Setting Robotic skills training laboratory. Participants A total of 27 residents from 14 programs of the Southeastern Section of the American Urologic Association participated. Results Time to complete the ED exercise was significantly shorter for residents who had logged live robotic console compared with those who had not (p = 0.003). There were no other associations with live robotic console time that approached significance (all p ≥ 0.21). The only measure that was significantly associated with PGY was time to complete ED exercise (p = 0.009). No associations with previous utilization of a robotic simulator in the resident’s home training program were statistically significant. Conclusions The ED exercise on the MdVT is most associated with CE and PGY compared with other exercises. Exposure of trainees to the MdVT in training programs does not appear to alter performance scores compared with trainees who do not have the simulator.
Introduction: Many commonly prescribed medications are associated with a variety of gastrointestinal (GI) side effects. Functional GI disorders are characterized by a variety of symptoms that could ...arise due to, or be confused with, medication side effects. We aimed to examine the prevalence of polypharmacy and certain medications in patients referred to a tertiary gastroenterology practice, and the association between the medications and GI complaints. Methods: We performed a retrospective review of consecutive outpatient gastroenterology consultations in 988 unique patients. Information regarding patient demographics, presenting GI symptoms, and detailed individual medication histories. Medications were categorized based on their mechanism of action and were not limited to only those directed at treating GI conditions. Continuous variables were summarized with the sample median and range. Categorical variables were summarized with number and percentage of patients. Spearman's test of correlation was used to assess associations. Results: The most common presenting GI symptoms were abdominal pain (72%), nausea (57%), and constipation (53%). The prevalence of polypharmacy (five or more medication) is 10%. Eighty percent of patients were taking at least one medication and 60% were taking two or more. The most frequently used medication group was PPIs (43%), followed by benzodiazepines (30%), selective serotonin-reuptake or norepinephrine-re uptake inhibitors (SSRIs/SNRIs) (28%), non-steroidal anti-inflammatory drugs (27%), opioids (21%), and anti-epileptics (10%). Diabetes medications, magnesium-containing medications, and other classes were each used by less than 10% of the patients. There is a significant positive correlation between the total number of presenting symptoms and the total number of different medications the patients were currently taking (Spearman's r: 0.09, P=0.006). Conclusion: Although there is a higher use of prescription medicines in our study population (80%) compared to the general population (70%), the prevalence of polypharmacy (5 or more medications) is lower (10%) compared to the general population (21%). There is a higher use of antidepressant (33%) compared to the general population (10%). Though the correlation between the number of different medications and number of presenting symptoms is weak, it suggests that the medications may contribute to the symptoms leading to their GI consultation.
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