The purpose of this study was to assess reliability of lymph node measurements between and within raters in dogs with nodal lymphomas. Three raters measured lymph nodes from 20 dogs twice prior to ...and once after administering chemotherapy. Sum tumour volume (TV) and sum longest diameter (LD) of all lymph nodes at each time point, and the percent change in measurements following chemotherapy, were calculated for each dog. Inter‐ and intra‐rater reliability were assessed with the intraclass correlation coefficient (ICC). ICC for inter‐rater sum TV and sum LD prior to chemotherapy were 0.86 and 0.80, respectively. ICC for inter‐rater sum TV and sum LD after chemotherapy were 0.95 and 0.91, respectively. ICC for percent change in sum TV and sum LD were 0.96 and 0.94, respectively. ICC for intra‐rater reliability ranged from 0.90 to 0.98 for each rater. Inter‐ and intra‐rater reliability in measurements among the three raters was good to excellent.
Do we have to replace the balloon pump when it fails? Bibler, Trevor M.; Crist, Jamie M.; Malek, Janet ...
The Hastings Center report,
January/February 2020, 2020-Jan, 2020-01-00, 20200101, Letnik:
50, Številka:
1
Journal Article
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Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted ...for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra‐aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, “Do we have to replace the balloon pump when it fails?”
Vitrification is a method of cryopreservation that freezes samples rapidly, while forming an amorphous solid (“glass”), typically in small (μL) volumes. The goal of this project was to create, by ...three-dimensional (3D) printing, open vitrification devices based on an elliptical loop that could be efficiently used and stored. Vitrification efforts can benefit from the application of 3D printing, and to begin integration of this technology, we addressed four main variables: thermoplastic filament type, loop length, loop height, and method of loading. Our objectives were to: (1) design vitrification loops with varied dimensions; (2) print prototype loops for testing; (3) evaluate loading methods for the devices; and (4) classify vitrification responses to multiple device configurations. The various configurations were designed digitally using 3D CAD (Computer Aided Design) software, and prototype devices were produced with MakerBot
®
3D printers. The thermoplastic filaments used to produce devices were acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). Vitrification devices were characterized by the film volumes formed with different methods of loading (pipetting or submersion). Frozen films were classified to determine vitrification quality: zero (opaque, or abundant crystalline ice formation); one (translucent, or partial vitrification), or two (transparent, or substantial vitrification, glass). A published vitrification solution was used to conduct experiments. Loading by pipetting formed frozen films more reliably than by submersion, but submersion yielded fewer filling problems and was more rapid. The loop designs that yielded the highest levels of vitrification enabled rapid transfer of heat, and most often were characterized as being longer and consisting of fewer layers (height). 3D printing can assist standardization of vitrification methods and research, yet can also provide the ability to quickly design and fabricate custom devices when needed.
Although aquatic species cryopreservation protocols have been studied around the world over the past 60 yr., germplasm repository development efforts and commercialization have begun only recently. ...The goal of this project was to develop a self‐contained mobile laboratory for on‐site high‐throughput cryopreservation of aquatic species. The objectives of this study were to: (1) identify how a mobile laboratory would function in different operational scenarios, (2) customize an enclosed cargo trailer to function as a mobile laboratory, (3) evaluate the laboratory layout and ability of cryopreservation equipment to operate from generator power, and (4) document the investment costs for private and public groups to integrate a mobile laboratory into an existing cryopreservation facility at three levels of automation and estimate the total cost per trip based on hypothetical assumptions for two scenarios (aquaculture production and repository development). There were three operational designs identified for the mobile laboratory: (1) self‐contained work inside the unit using generator power, (2) work inside the unit using external facility power, and (3) using the equipment inside of a host facility. The investment costs for a base‐level mobile laboratory ranged between US$5670 and US$5787 for private groups and between US$5208 and US$5315 for public groups. With the addition of a range of automated processing equipment, total investment costs ranged from US$13,616 to US$103,529 for private groups and US$12,494 to US$94,891 for public groups. The total cost per trip to cryopreserve sperm of 59 blue catfish, Ictalurus furcatus, males to produce 6300 0.5‐mL French straws was estimated to range from US$6089 to US$14,633 for private and between US$5703 and US$16,938 for public groups depending on the level of automation. Total cost per trip to cryopreserve sperm of 500 males of five different species in the genus Xiphophorus to produce 641 0.25‐mL French straws was estimated to range from US$6653 to US$7640 for private and US$7582 to US$8088 for public groups depending on level of automation. Overall, a commercial‐scale mobile laboratory was developed that can assist current germplasm activities and support future repository and industry development, and the layout information provided can help others to design and build comparable units.
OBJECTIVE:To determine whether central and peripheral vision reaction times (PVRTs) are prolonged in patients with visual dysfunction after sustaining a concussion.
DESIGN:Comparison of Dynavision D2 ...central and PVRTs in patients with postconcussion visual dysfunction were compared with control data from a normative patient database. Concussion patients without visual dysfunction were not included in this study.
SETTING:National Collegiate Athletic Association Division 1 college training room and university based, academic health center.
PARTICIPANTS:Patients were selected for inclusion based on diagnosis of new visual dysfunction as indicated either by physical examination of the team physician or by patient self-report of symptoms. Patients included college athletes, college students, and concussion patientʼs presenting to a university based, academic health center.
INTERVENTION:Measurement of central and PVRTs using a Dynavision D2 reaction time program were used as the dependent variables. Evaluations were conducted from 3 days to 11 months postconcussion, depending on the temporal development of visual symptoms after the concussion. No intervention was used.
MAIN OUTCOME MEASURES:Average central and PVRTs for patients with postconcussion visual symptoms were compared with an asymptomatic control group with no history of concussion.
RESULTS:Both central and PVRTs were significantly prolonged in patients with postconcussion visual symptoms compared with patients with no history of concussion.
CONCLUSIONS:Central and PVRTs are both prolonged in patients with postconcussion visual dysfunction with PVRT being disproportionately prolonged. The percent change from central to PVRT was also increased in patients with postconcussion visual dysfunction.
The development of ethical guidelines and regulations regarding human subjects research has focused upon protection of vulnerable populations by relying on a categorical approach to vulnerability. ...This results in several challenges: First, Institutional Review Boards (IRBs) struggle to interpret and apply the regulations because they are often vague and inconsistent. Second, applying the regulations to subjects who fit within multiple categories of vulnerability can lead to contradictions and the rejection of research that would be permissible if only one category were applicable. Finally, some potential subjects have social and other context-based vulnerabilities that are not described in the federal regulations and therefore not considered in IRB deliberations. IRBs and investigators lack guidance on how to address the problem of multiple vulnerabilities in a way that strikes a balance between protection and respect for persons. In this essay, we evaluate the acceptability of the existing federal regulations with respect to research participants with multiple vulnerabilities, offer strategies for rethinking the concept of vulnerability, and outline a context-based normative framework to account for the compounding effects of multiple vulnerabilities.
The yeast Saccharomyces cerevisiae has a finite life span that is measured by the number of times the individual cell divides. The gene coding for one of several transcripts that are differentially ...expressed during the replicative life span has been cloned. The nucleotide sequence revealed an open reading frame capable of encoding a transmembrane protein of 411 amino acids that displays no significant similarities to any known proteins. Nevertheless, sequences similar to this gene were found in several mammals, including humans. The transcript levels decreased with replicative age of yeast cells. A gene deletion in haploid cells resulted in a pronounced increase (approximately 50%) in mean and in maximum life span. These results indicate that this gene, which we call LAG1, plays a role in determining yeast longevity
It has been suggested that true vipers (Viperidae: Viperinae) possess the ability to detect temperature differences between objects despite the lack of an apparent infrared radiation sensor. We ...tested the ability to distinguish between heated and unheated targets in three species of pitvipers (Viperidae: Crotalinae), four species of true vipers, two species of colubrids (Colubridae: Natricinae, Colubrinae) and Azemiops feae (Viperidae: Azemiopinae). All species of pitvipers tested could distinguish between the warm and cool targets, while no tested species of true viper, colubrid or Azemiops demonstrated this ability. In addition, pitvipers exhibited behaviors that true vipers or Azemiops did not exhibit. Our results suggest that the tested species of true vipers, Azemiops and colubrids may not posses the ability to sense infrared radiation or do not use it in a defensive context, and suggest that some defensive behaviors are associated with the pit organ in pitvipers.
IMPORTANCEObstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the ...literature about management of Jehovahʼs Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking.
OBJECTIVEThis review outlines the medical, ethical, and legal implications of management of Jehovahʼs Witness patients in obstetrical and gynecological settings.
EVIDENCE ACQUISITIONA search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovahʼs Witness patients.
RESULTSEarly diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches.
CONCLUSION AND RELEVANCEAll obstetricians and gynecologists should be familiar with alternatives and “less invasive” options for patients who refuse blood transfusions.
TARGET AUDIENCEObstetricians and gynecologists, family physicians
LEARNING OBJECTIVESAfter completing this activity, the learner should be better able to explain the oxygen delivery systems and response to tissue hypoxia mechanisms in humans, recognize options to correct anemia in Jehovahʼs Witness patients, recognize agents that are used in certain clinical scenarios in obstetrics and gynecology setting to reduce blood loss in patients who are refusing blood transfusion, and identify ethical/legal considerations for Jehovahʼs Witness patients.
Individual cells of the yeast Saccharomyces cerevisiae have a limited replicative life-span. The role of the genes RAS1 and RAS2 in yeast longevity was examined. Overexpression of RAS2 led to a 30% ...increase in the life-span on average and postponed the senescence-related increase in generation time seen during yeast aging. No life-span extension was obtained by overexpression of RAS1. However, deletion of RAS1 prolonged the lifespan. These results suggest that RAS1 and RAS2 play reciprocal roles in determining yeast longevity. RAS1 and RAS2 mRNA and protein levels declined with replicative age, suggesting a diminishing impact on yeast longevity. The major known pathway through which Ras proteins function in yeast involves stimulation of adenylate cyclase. No evidence for a life-span-extending effect of elevated intracellular cAMP was found. Indeed, high intracellular cAMP was associated with curtailed lifespan. A similar decrease in life-span was found on disruption of BCY1, which codes for the regulatory subunit of protein kinase A, the downstream target of cAMP. Importantly, overexpression of an effector domain mutant of RAS2, defective in stimulation of adenylate cyclase, prolonged life-span to the same extent as the wildtype gene, suggesting that the cAMP pathway is neither sufficient nor necessary for increased longevity
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