The gravid patient will typically experience few difficulties during the course of her pregnancy. A small but significant number of pregnant patients will become ill enough to require the intensive ...care unit for both obstetrical and non-obstetrical problems. Therefore, the obstetrical physician must have an understanding of how to monitor and manage the critically ill pregnant patient and how to approach emergencies unique to pregnancy. In a report of ICU utilization during hospital admission for delivery in the United States in one state, 822,591 admissions from 1984 to 1997 were analyzed. There were 1,023 admissions to the intensive care unit, with mortality in the ICU of 3.3% (1). Predictors for ICU admission in this retrospective analysis included: age greater than 35 (Odds Ratio OR 1.4), African-American ethnicity (OR 1.8), race other than black or white (OR 5.9), treatment in minor teaching hospital (OR 2.0), and transfer to a higher-level hospital for care (OR 2.51) (1). The most common indication for ICU admission involved obstetrical related complications. These included complications of cesarean section, preeclampsia or eclampsia, and peripartum hemorrhage (1–4). The most common risk factors associated with ICU mortality included pulmonary complications, shock, cerebrovascular events, and drug dependence(1). In another study looking at 74 obstetric patients admitted to an ICU over 7 years, the most common reason for admission was respiratory insufficiency (5). Outside of the United States, a much smaller study of ICU admissions in the United Arab Emirates demonstrated similar mortality rates (6). In another series, a majority of obstetric patients admitted (71%) to the ICU required ventilatory support (7).
BACKGROUND: The course of disease for patients with idiopathic pulmonary fibrosis (IPF) is highly heterogeneous. Prognostic models rely on demographic and clinical characteristics and are not ...reproducible. Integrating data from genomic analyses may identify novel prognostic models and provide mechanistic insights into IPF. METHODS: Total RNA of peripheral blood mononuclear cells was subjected to microarray profiling in a training (45 IPF individuals) and two independent validation cohorts (21 IPF/10 controls, and 75 IPF individuals, respectively). To identify a gene set predictive of IPF prognosis, we incorporated genomic, clinical, and outcome data from the training cohort. Predictor genes were selected if all the following criteria were met: 1) Present in a gene co-expression module from Weighted Gene Co-expression Network Analysis (WGCNA) that correlated with pulmonary function (p < 0.05); 2) Differentially expressed between observed "good" vs. "poor" prognosis with fold change (FC) >1.5 and false discovery rate (FDR) < 2 %; and 3) Predictive of mortality (p < 0.05) in univariate Cox regression analysis. "Survival risk group prediction" was adopted to construct a functional genomic model that used the IPF prognostic predictor gene set to derive a prognostic index (PI) for each patient into either high or low risk for survival outcomes. Prediction accuracy was assessed with a repeated 10-fold cross-validation algorithm and independently assessed in two validation cohorts through multivariate Cox regression survival analysis. RESULTS: A set of 118 IPF prognostic predictor genes was used to derive the functional genomic model and PI. In the training cohort, high-risk IPF patients predicted by PI had significantly shorter survival compared to those labeled as low-risk patients (log rank p < 0.001). The prediction accuracy was further validated in two independent cohorts (log rank p < 0.001 and 0.002). Functional pathway analysis revealed that the canonical pathways enriched with the IPF prognostic predictor gene set were involved in T-cell biology, including iCOS, T-cell receptor, and CD28 signaling. CONCLUSIONS: Using supervised and unsupervised analyses, we identified a set of IPF prognostic predictor genes and derived a functional genomic model that predicted high and low-risk IPF patients with high accuracy. This genomic model may complement current prognostic tools to deliver more personalized care for IPF patients.
Rationale
Substance-related behaviour is often viewed as an appetitive behaviour, motivated by the reinforcing effects of the drug. However, there are various indices of substance motivation (e.g. ...attentional bias, behavioural economic demand, craving) and it is unclear how these are related or whether they play an important role in all types of substance-related behaviour.
Objectives
(1) To determine the effect of alcohol devaluation on several indices of alcohol motivation and goal-directed and cue-elicited alcohol behaviour. (2) To investigate which components of motivation mediate any effect of devaluation on behaviour.
Methods
Sixty-two social drinkers gave baseline measures of alcohol craving, behavioural economic demand and choice for alcohol vs. soft drink. Participants tasted alcohol which was either unadulterated (control) or adulterated with a bitter solution (devaluation) before craving and demand were measured again. Alcohol choice was assessed in several phases: extinction (evaluating goal-directed behaviour), in the presence of drink cues (Pavlovian-to-instrumental transfer (PIT, cue-elicited behaviour)), and reacquisition. Attentional bias (AB) was measured by tracking eye movements towards the drink cues during novel PIT trials where both cues were presented. Finally, consumption was evaluated in a taste test.
Results
Alcohol devaluation reduced alcohol-related demand, AB, alcohol choice in all phases, and consumption. Alcohol cues presented during PIT increased alcohol choice above baseline irrespective of devaluation. AB and demand for alcohol fully mediated the effect of devaluation on alcohol choice during extinction, AB fully mediated the effect on cue-elicited (specific PIT) alcohol choice and alcohol consumption.
Conclusions
Alcohol behaviour in social drinkers is largely sensitive to devaluation, i.e. governed by current motivational value of the drug (suggesting goal-directed behaviour). However, a dissociable form of stimulus control can also drive alcohol-seeking independently of drug value (specific PIT). Mediation analyses suggests that AB may play a paradoxical role in both forms of alcohol seeking and consumption.
Aims
To investigate the mediating role of attentional bias for alcohol cues on alcohol‐seeking following devaluation of alcohol.
Design
Between subject.
Setting
Eye‐tracking laboratory at the ...University of Liverpool.
Participants
Student social drinkers (n = 64).
Measurements
An operant choice task in which participants chose between simultaneously presented alcohol and non‐alcohol drink rewards, while attentional bias for alcohol and non‐alcohol drink cues was inferred from eye movements. Participants then consumed 30 mL of an alcoholic beverage, which was either presented alone (no devaluation: n = 32) or had been adulterated to taste unpleasant (devaluation: n = 32). Choice and attentional bias for the alcohol and non‐alcohol drink pictures were then measured again.
Findings
Alcohol devaluation reduced behavioural choice for alcohol (F = 32.64, P < 0.001) and attentional bias for the alcohol pictures indexed by dwell time (F = 22.68, P < 0.001), initial fixation (F = 7.08, P = 0.01) and final fixation (F = 22.44, P < 0.001). Mediation analysis revealed that attentional bias partially mediated the effect of devaluation on alcohol choice; however, the proportion of the variance accounted for by attentional bias is low to moderate (∼30%).
Conclusions
Among student social drinkers, attentional bias is only a partial mediator of alcohol choice following devaluation of alcohol. Value‐based decision‐making may be a more important determinant of drinking behaviour among student social drinkers than attentional bias.
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