Introduction. Exercise interventions may assist smoking cessation attempts. One such publicly available 10-week program, Walk or Run to Quit (WRTQ), demonstrated success in smoking cessation and ...physical activity (PA) outcomes. However, initial WRTQ participants (2016-2017) were fairly homogenous in their demographic profile. To increase diversity, subsidies for participation were offered in 2018. This study assessed how the subsidies affected participant demographics, running frequency, smoking cessation, intention to quit, and program attendance and completion. Methods. The $70 registration fee was subsidized for 41% of participants in 2018. A pre-postdesign was used, with participants completing surveys on their demographics and smoking and physical activity behaviours. Descriptive statistics compared the year subsidies were available (2018) and unsubsidized years (2016-2017) and subsidized and unsubsidized participants’ data from 2018. Results. The 2018 participants had lower average attendance and program completion rates compared to 2016-2017 and no statistically significant differences in demographics or smoking cessation and PA outcomes. There were no differences in smoking cessation, run frequency, or demographic variables between the subsidized and unsubsidized participants in 2018. Conclusions. Offering subsidies did not diversify the participant profile. Subsidies did not have a negative impact on attendance nor primary outcomes. Subsidies may not have addressed barriers that prevented a more diverse sample from participating in WRTQ, such as program location, timing, and design. Equitable access to smoking cessation programs remains essential. As subsidies may play a role in reducing financial barriers disproportionately faced by marginalized groups, the implementation of, and recruitment for, such subsidized programs requires further investigation.
Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot.
R P Wunderlich ,
E J Peters and
L A Lavery
Diabetex Foot Care Center, San Antonio, Texas 78212, USA. ...robert@wunderlich.com
Abstract
OBJECTIVE: To document peer-reviewed medical publications that have reported on hyperbaric oxygen (HBO) therapy as an adjunct
to standard lower-extremity wound care, focusing on publications dealing with the diabetic foot. RESEARCH DESIGN AND METHODS:
A review of the medical literature was conducted using MEDLINE. Research articles involving HBO treatment and the diabetic
foot were critiqued to identify factors that may have been a source of bias. RESULTS: Of the published reports on human studies,
seven involved diabetes-related foot pathology. Five of these studies, two of which were randomized, included a control group
that did not receive HBO therapy The controlled diabetic foot studies included an average of 28 subjects in the HBO therapy
group (range 10-62) and an average of 16.2 subjects in the non-HBO control group (range 5-33). Most of the published reports
have several potential sources of bias, including, but not limited to, inadequate evaluation of comorbid conditions relevant
to wound healing, small sample size, and poor documentation of wound size or severity. Four of the seven reports involving
the diabetic foot were published by a group of researchers at the University of Milan between 1987 and 1996. CONCLUSIONS:
Additional randomized placebo-controlled clinical trials in large diabetic populations would further lend credence to the
presumption that HBO therapy improves clinical outcomes. Given the relatively high cost of this treatment modality, perhaps
a more acute awareness of the medical literature would reduce the economic burden that HBO therapy imposes on care providers
that are financially at risk.
Based on findings in rodents, we sought to test the hypothesis that purinergic modulation of synaptic transmission occurs in the human intestine. Time series analysis of intraneuronal free Ca(2+) ...levels in submucosal plexus (SMP) from Roux-en-Y specimens was done using Zeiss LSM laser-scanning confocal fluo-4 AM Ca(2+) imaging. A 3-s fiber tract stimulation (FTS) was used to elicit a synaptic Ca(2+) response. Short-circuit current (I(sc) = chloride secretion) was recorded in mucosa-SMP in flux chambers. A distension reflex or electrical field stimulation was used to study I(sc) responses. Ca(2+) imaging was done in 1,222 neurons responding to high-K(+) depolarization from 61 surgical cases. FTS evoked synaptic Ca(2+) responses in 62% of recorded neurons. FTS caused frequency-dependent Ca(2+) responses (0.1-100 Hz). FTS Ca(2+) responses were inhibited by Omega-conotoxin (70%), hexamethonium (50%), TTX, high Mg(2+)/low Ca(2+) (< or = 100%), or capsaicin (25%). A P2Y(1) receptor (P2Y(1)R) antagonist, MRS-2179 or PLC inhibitor U-73122, blocked FTS responses (75-90%). P2Y(1)R-immunoreactivity occurred in 39% of vasoactive intestinal peptide-positive neurons. The selective adenosine A(3) receptor (AdoA(3)R) agonist 2-chloro-N(6)-(3-iodobenzyl)adenosine-5'-N-methylcarboxamide (2-Cl-IBMECA) caused concentration- and frequency-dependent inhibition of FTS Ca(2+) responses (IC(50) = 8.5 x 10(-8) M). The AdoA(3)R antagonist MRS-1220 augmented such Ca(2+) responses; 2-Cl-IBMECA competed with MRS-1220. Knockdown of AdoA(1)R with 8-cyclopentyl-3-N-(3-{3-(4-fluorosulphonyl)benzoyl-oxy}-propyl)-1-N-propyl-xanthine did not prevent 2-Cl-IBMECA effects. MRS-1220 caused 31% augmentation of TTX-sensitive distension I(sc) responses. The SMP from Roux-en-Y patients is a suitable model to study synaptic transmission in human enteric nervous system (huENS). The P2Y(1)/Galphaq/PLC/inositol 1,3,5-trisphosphate/Ca(2+) signaling pathway, N-type Ca(2+) channels, nicotinic receptors, and extrinsic nerves contribute to neurotransmission in huENS. Inhibitory AdoA(3)R inhibit nucleotide or cholinergic transmission in the huENS.
The correlation between the temperature dependence of the kinetic and thermodynamic properties of a series of metallic glass-forming liquids is investigated using the concept of fragility. The ...results indicate a correlation between the kinetic fragility and thermodynamic fragility in these liquids. The correlation depends critically on the approach used to evaluate the thermodynamic fragility. Two distinct correlation lines are found for the metal-metalloid and for the all-metallic-constituents glass-forming liquids. For the same thermodynamic fragility the metal-metalloid liquids exhibit a distinctively larger kinetic fragility than the pure-metallic liquids. From the evaluation of the Gibbs free-energy difference between the undercooled liquid and the crystalline phase mixture, a correlation between the kinetic fragility and the driving force for nucleation is found, showing that for glass formation in metallic alloys the thermodynamic and kinetic contributions act together.
Functional Status of Persons With Diabetes-Related Lower-Extremity Amputations
Edgar J.G. Peters , MD 1 2 ,
Michael R. Childs , DPM 1 ,
Robert P. Wunderlich , DPM 3 ,
Lawrence B. Harkless , DPM 1 ,
...David G. Armstrong , DPM 4 and
Lawrence A. Lavery , DPM, MPH 3
1 Department of Orthopedics, University of Texas Health Science Center, San Antonio, Texas
2 Vrije Universiteit, Amsterdam, the Netherlands
3 Loyola University, Maywood, Illinois
4 Southern Arizona Veterans Affairs Medical Center, Tuscon, Arizona
Abstract
OBJECTIVE —It is reasonable to predict that diabetes-related lower-extremity amputations have a detrimental impact on quality of life.
However, we are unaware of any study in the medical literature describing the functional level of diabetic patients with amputations.
The objective of this study was to evaluate amputations among diabetic patients and to determine the functional level of these
patients with the Sickness Impact Profile (SIP).
RESEARCH DESIGN AND METHODS —We enrolled 124 patients with diabetes. Case subjects ( n = 35) were defined as patients who had undergone amputation of the lower-extremity, and control subjects ( n = 89) were defined as patients who had not undergone amputation. Study participants received a standard history and physical
examination.
RESULTS —Both the physical dimension scores (33.5 ± 14.9 vs. 22.3 ± 14.7, P < 0.001) and the total SIP scores (27.6 ± 9.9 vs. 22.5 ± 10.3, P = 0.013) were significantly higher for amputees. However, the psychosocial dimension scores were not significantly different
between case and control subjects (14.9 ± 8.9 vs. 15.2 ± 10.0, P > 0.05). Post hoc analysis showed that the group of patients who had undergone transtibial amputation had a significantly
higher total impairment score than patients who had not undergone amputation ( P = 0.039). This is in contrast to patients with toe or midfoot amputations, for whom total impairment scores were not significantly
higher than those for the control subjects. Interestingly, bilateral amputees did not have significantly higher scores on
either SIP dimension compared with unilateral amputees.
CONCLUSIONS —These findings exemplify the detrimental physical and psychosocial health status of patients with diabetes-related lower-extremity
amputation.
SIP, Sickness Impact Profile
Footnotes
Address correspondence and reprint requests to Edgar J.G. Peters, Geuzenkade 66-I, 1056 KN Amsterdam, the Netherlands. E-mail:
ejgpeters{at}usa.net .
Received for publication 29 March 2001 and accepted in revised form 5 July 2001.
L.B.H. is a member of the speakers bureau for Ortho McNeil, Novartis, Bristol-Myers Squibb, Dermik, and Kinetic Concepts Inc.;
is a member of the advisory panel for Novartis and Wyeth Ayerst; is a consultant for Abbott Laboratories; and has received
a research grant from Wyeth Ayerst.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Antiferromagnets are enriching spintronics research by many favorable properties that include insensitivity to magnetic fields, neuromorphic memory characteristics, and ultra-fast spin dynamics. ...Designing memory devices with electrical writing and reading is one of the central topics of antiferromagnetic spintronics. So far, such a combined functionality has been demonstrated via 90° reorientations of the Néel vector generated by the current-induced spin orbit torque and sensed by the linear-response anisotropic magnetoresistance. Here we show that in the same antiferromagnetic CuMnAs films as used in these earlier experiments we can also control 180° Néel vector reversals by switching the polarity of the writing current. Moreover, the two stable states with opposite Néel vector orientations in this collinear antiferromagnet can be electrically distinguished by measuring a second-order magnetoresistance effect. We discuss the general magnetic point group symmetries allowing for this electrical readout effect and its specific microscopic origin in CuMnAs.
The goal of most studies published on sand contaminants is to gather and discuss knowledge to avoid faecal contamination of water by run-offs and tide-retractions. Other life forms in the sand, ...however, are seldom studied but always pointed out as relevant. The Mycosands initiative was created to generate data on fungi in beach sands and waters, of both coastal and freshwater inland bathing sites. A team of medical mycologists and water quality specialists explored the sand culturable mycobiota of 91 bathing sites, and water of 67 of these, spanning from the Atlantic to the Eastern Mediterranean coasts, including the Italian lakes and the Adriatic, Baltic, and Black Seas. Sydney (Australia) was also included in the study. Thirteen countries took part in the initiative. The present study considered several fungal parameters (all fungi, several species of the genus Aspergillus and Candida and the genera themselves, plus other yeasts, allergenic fungi, dematiaceous fungi and dermatophytes). The study considered four variables that the team expected would influence the results of the analytical parameters, such as coast or inland location, urban and non-urban sites, period of the year, geographical proximity and type of sediment. The genera most frequently found were Aspergillus spp., Candida spp., Fusarium spp. and Cryptococcus spp. both in sand and in water. A site-blind median was found to be 89 Colony-Forming Units (CFU) of fungi per gram of sand in coastal and inland freshwaters, with variability between 0 and 6400 CFU/g. For freshwater sites, that number was 201.7 CFU/g (0, 6400 CFU/g (p = 0.01)) and for coastal sites was 76.7 CFU/g (0, 3497.5 CFU/g). For coastal waters and all waters, the median was 0 CFU/ml (0, 1592 CFU/ml) and for freshwaters 6.7 (0, 310.0) CFU/ml (p < 0.001). The results advocate that beaches should be monitored for fungi for safer use and better management.
Display omitted
•Fungi are missing from water and sand health protection regulatory parameters.•Both sand and water should be monitored for fungi.•The median value of 89 CFU/g of all fungi may serve as a reference for sand regulation.•Candida albicans, dermatophytes, endemic fungi and other fungi should be considered.•Fungal analysis of water needs more data before reference values can be established.
We investigated the combination of lymphodepleting chemotherapy followed by the adoptive transfer of autologous tumor reactive lymphocytes for the treatment of patients with refractory metastatic ...melanoma.
Thirty-five patients with metastatic melanoma, all but one with disease refractory to treatment with high-dose interleukin (IL) -2 and many with progressive disease after chemotherapy, underwent lymphodepleting conditioning with two days of cyclophosphamide (60 mg/kg) followed by five days of fludarabine (25 mg/m(2)). On the day following the final dose of fludarabine, all patients received cell infusion with autologous tumor-reactive, rapidly expanded tumor infiltrating lymphocyte cultures and high-dose IL-2 therapy.
Eighteen (51%) of 35 treated patients experienced objective clinical responses including three ongoing complete responses and 15 partial responses with a mean duration of 11.5 +/- 2.2 months. Sites of regression included metastases to lung, liver, lymph nodes, brain, and cutaneous and subcutaneous tissues. Toxicities of treatment included the expected hematologic toxicities of chemotherapy including neutropenia, thrombocytopenia, and lymphopenia, the transient toxicities of high-dose IL-2 therapy, two patients who developed Pneumocystis pneumonia and one patient who developed an Epstein-Barr virus-related lymphoproliferation.
Lymphodepleting chemotherapy followed by the transfer of highly avid antitumor lymphocytes can mediate significant tumor regression in heavily pretreated patients with IL-2 refractory metastatic melanoma.
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