When fulminant, patients may develop sepsis, acute respiratory distress syndrome (ARDS), and/or multiple organ failure which are not unique to coronavirus. The pathway is common to multiple inciting ...events and has been the target of treatment for years, with therapeutic plasma exchange uniquely offering benefit on multiple levels by removing inflammatory cytokines, stabilizing endothelial membranes, and resetting the hypercoagulable state 4, 8, 9. SEE PDF Busund and colleagues showed a tendency toward improved mortality with adjunct TPE in adult patients with sepsis and multiple organ failure in the sole, adult-only randomized controlled trial on this subject 10 while a meta-analysis by Rimmer showed mortality benefit in adult patients as well 11.
To perform fragility index (FI) analysis on the evidence that forms the basis of the guidelines for the management of severe traumatic brain injury (TBI), and develop a deeper understanding of the ...pitfalls associated with FI. Meta-epidemiological analysis and numerical simulations. The Brain Trauma Foundation guidelines (4.sup.th edition) for management of severe TBI were used to identify relevant randomised controlled trials (RCTs). FI based on Fisher's exact test and relative risk was performed on eligible RCTs. The relationship between FI, event counts and P values was explored by exhaustively considering different combinations of outcomes for studies of total size ranging from 80 to 10000. Sample size calculations were also performed for a range of power, baseline risk and relative risk, to determine the influence of study design on FI. FI analysis of the severe TBI management guidelines revealed that most studies were associated with a low FI. In the majority of studies, FI was of a similar magnitude to the number lost to follow-up. The simulations revealed that while FI was inversely related to P value, a wide range of FI may be associated with a given P value. FI is also affected by sample size, baseline risk and effect size. Sample size calculations suggest that aside from very high-powered studies, most are likely to yield low FI values in the range typically encountered in the literature. Many studies are underpowered and are expected to be associated with a small FI. Furthermore, FI over-simplifies the complex, non-linear relationships between sample size, effect size and P value, which hinder comparisons of FI between studies. FI places undue importance on the "significance" of P values and accordingly should only be used sparingly.
Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study ...aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone.
A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine-resistant septic shock and multiple organ failure in intensive care units at a tertiary care hospital in Winston-Salem, NC, from August 2015 to March 2019. Adult patients with catecholamine-resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm.
The mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients, respectively. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p = 0.043). Improvements in baseline SOFA scores at 48 h were greater in the TPE group compared to standard care alone (p = 0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 h (p = 0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p = 0.003 and p = 0.006, respectively).
Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.
Arctic and boreal environments are changing rapidly, which could decouple behavioral and demographic traits of animals from the resource pulses that have shaped their evolution. Dall's sheep (Ovis ...dalli dalli) in northwestern regions of the USA and Canada, survive long, severe winters and reproduce during summers with short growing seasons. We sought to understand the vulnerability of Dall's sheep to a changing climate in Lake Clark National Park and Preserve, Alaska, USA. We developed ecological hypotheses about nutritional needs, security from predators, energetic costs of movement, and thermal shelter to describe habitat selection during winter, spring, and summer and evaluated habitat and climate variables that reflected these hypotheses. We used the synoptic model of animal space use to estimate parameters of habitat selection by individual females and calculated likelihoods for ecological hypotheses within seasonal models. Our results showed that seasonal habitat selection was influenced by multiple ecological requirements simultaneously. Across all seasons, sheep selected steep rugged areas near escape terrain for security from predators. During winter and spring, sheep selected habitats with increased forage and security, moderated thermal conditions, and lowered energetic costs of movement. During summer, nutritional needs and security influenced habitat selection. Climate directly influenced habitat selection during the spring lambing period when sheep selected areas with lower snow depths, less snow cover, and higher air temperatures. Indirectly, climate is linked to the expansion of shrub/scrub vegetation, which was significantly avoided in all seasons. Dall's sheep balance resource selection to meet multiple needs across seasons and such behaviors are finely tuned to patterns of phenology and climate. Direct and indirect effects of a changing climate may reduce their ability to balance their needs and lead to continued population declines. However, several management approaches could promote resiliency of alpine habitats that support Dall's sheep populations.
Resistance training may differentially affect morphological adaptations along the length of uni-articular and bi-articular muscles. The purpose of this study was to compare changes in muscle ...morphology along the length of the rectus femoris (RF) and vastus lateralis (VL) in response to resistance training. Following a 2-wk preparatory phase, 15 resistance-trained men (24.0 ± 3.0 y, 90.0 ± 13.8 kg, 174.9 ± 20.7 cm) completed pre-training (PRE) assessments of muscle thickness (MT), pennation angle (PA), cross-sectional area (CSA), and echo-intensity in the RF and VL at 30, 50, and 70% of each muscle's length; fascicle length (FL) was estimated from respective measurements of MT and PA within each muscle and region. Participants then began a high intensity, low volume (4 x 3-5 repetitions, 3min rest) lower-body resistance training program, and repeated all PRE-assessments after 8 weeks (2 d ∙ wk-1) of training (POST). Although three-way (muscle RF, VL x region 30, 50, 70% x time PRE, POST) repeated measures analysis of variance did not reveal significant interactions for any assessment of morphology, significant simple (muscle x time) effects were observed for CSA (p = 0.002) and FL (p = 0.016). Specifically, average CSA changes favored the VL (2.96 ± 0.69 cm2, p < 0.001) over the RF (0.59 ± 0.20 cm2, p = 0.011), while significant decreases in average FL were noted for the RF (-1.03 ± 0.30 cm, p = 0.004) but not the VL (-0.05 ± 0.36 cm, p = 0.901). No other significant differences were observed. The findings of this study demonstrate the occurrence of non-homogenous adaptations in RF and VL muscle size and architecture following 8 weeks of high-intensity resistance training in resistance-trained men. However, training does not appear to influence region-specific adaptations in either muscle.
Phenomenologies of Scripture addresses two increasingly convergent disciplines: philosophy and biblical studies. On the one hand, the recent “theological turn” in phenomenology has established ...religion as a legitimate area of phenomenological inquiry. If that turn is to be enduringly successful, phenomenology must pay attention to the scriptures on which religious life, practice, and thought are based. On the other hand, biblical studies finds itself in a methodological morass. Contemporary approaches to scripture have raised important questions about the meaning and function of scriptural texts that phenomenology is uniquely positioned to answer: How is the meaning of a text constructed or gleaned? How can the divine be present in human words? Is a scientific approach to the Bible still possible?
Bringing together essays by eight of today’s most prominent philosophers of religion with responses by two leading biblical scholars, Phenomenologies of Scripture reestablishes the possibility of fruitful, dialectical exchange between fields that demand to be read together.
The well-recognized adverse effects of dexamethasone however, coupled with the inappropriate application of nonoperative management for what should clearly be a surgical problem in the DECSA study ...(Markwalder grade ≥2; patients with hemiparesis), may have potentially tarnished the role of steroids in this increasingly important global neurosurgical problem. Holl's survey on national current practices on CSDH management in the Netherlands (Holl et al., 2022) published in Brain and Behavior in 2022 aimed to determine clinical practice attitudes in order to direct the establishment and implementation of practice guidelines and demonstrated that experiences among neurologists and neurosurgeons towards dexamethasone use as a primary therapy or surgical adjunct were mostly positive. A prospective study by Cine published last year compared surgical outcomes in patients receiving dexamethasone therapy with those that did not and found no additional adverse effects with adjuvant steroid use as well as demonstrating a statistically significant reduction in hematoma recurrence by the second postoperative week (Cine, 2023).
ABSTRACT
Introduction: Variations in transverse point of measure on the vastus lateralis (VL) may significantly affect the relationship between structure and function. The purpose of this study was ...to compare changes in muscle architecture at 2 commonly used points of measure (VL0 and VL5). Methods: Maximal strength (1‐repetition maximum 1RM barbell squat) and muscle architecture were assessed PRE and POST 15 weeks of periodized resistance training. VL0 was 50% of the straight line distance between the greater trochanter and lateral epicondyle of the femur. VL5 was 5cm medial to VL0. Results: Increases in 1RM strength (3.7 ± 2.4 kg; P = 0.004) were observed. Changes in muscle thickness (MT) at VL5 were significantly greater than at VL0 (P = 0.006). Changes in strength correlated with changes in muscle architecture at VL0 only (MT: r = 0.561; fascicle length: r = 0.503). Conclusions: Changes in muscle architecture appear to occur in a non‐homogeneous manner. Muscle Nerve 50: 785–793, 2014
Coker, NA, Wells, AJ, and Gepner, Y. The effect of heat stress on measures of running performance and heart rate responses during a competitive season in male soccer players. J Strength Cond Res ...34(4): 1141-1149, 2020-Measures of running performance and heart rate (HR) responses to match play during 3 different heat stress (HS) conditions were assessed in 7 National Collegiate Athletic Association (NCAA) Division I male soccer players. Total distance and distance covered within distinct velocity zones (walking WALK, jogging JOG, low-speed running, high-speed running, sprinting SPRINT, low-intensity running LIR, and high-intensity running HIR) were assessed using global positioning system units for more than 12 matches. Heat stress was monitored during each match, and matches were defined as low (HSlow, n = 4), moderate (HSmod, n = 4), or high (HShigh, n = 4) HS. Minutes played were significantly different across HS conditions (p = 0.03). Therefore, distance covered within each movement velocity was assessed relative to minutes played and as a percentage of total playing time. WALKrel was significantly greater during HShigh compared with HSlow (p = 0.035). LIRrel was significantly greater during HSmod (p = 0.015) compared with HSlow. A trend was observed for %WALK being higher during HShigh compared with HSlow (p = 0.066). %LIR was significantly greater during HShigh compared with HSlow (p = 0.048). High-intensity running was not significantly different across HS conditions. Percent of time spent >85% HRmax was significantly greater during HShigh (p = 0.002) and HSmod (p < 0.001) compared to HSlow. Percent of time spent between 65-84% HRmax was significantly greater during HSlow compared to HShigh (p < 0.001). Results indicate that HS resulted in increased LIR and %HR≥85, while HIR was maintained. High-intensity running performance may be conserved through decreased playing time or the adoption of pacing strategies. This may assist coaches in altering player management strategies to optimize team performance.
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