Intercellular communication has recently been shown to occur via transfer of cargo loaded within extracellular vesicles (EVs). Present within all biofluids of the body, EVs can contain various ...signaling factors, including coding and noncoding RNAs (e.g., mRNA, miRNA, lncRNA, snRNA, tRNA, yRNA), DNA, proteins, and enzymes. Multiple types of cells appear to be capable of releasing EVs, including cancer, stem, epithelial, immune, glial, and neuronal cells. However, the functional impact of these circulating signals among neural networks within the brain has been difficult to establish given the complexity of cellular populations involved in release and uptake, as well as inherent limitations of examining a biofluid. In this brief commentary, we provide an analysis of the conceptual and technical considerations that limit our current understanding of signaling mediated by circulating EVs relative to their impact on neural function.
Having good intentions to engage in healthy behaviours, to change our lives in a positive direction and make substantial, lasting changes may not always translate into actions or behaviour that is ...maintained. Motivational Interviewing is a directive person‐centred approach designed to explore ambivalence and activate motivation for change Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behaviour. London: Guilford Press, 1991. A key component of a motivational interviewing conversation is to acknowledge that clients have every right to make no change. It uses a guiding communication style which invites people to consider their own situation and find their own solutions to situations that they identify as problematic that are preventing change. Motivational Interviewing was first introduced in adult health addiction services in the early 1980s. It has developed in the physical health specialties, and in the last 20 years or so attention has turned to the potential of Motivational Interviewing in the paediatric setting and the challenges of using it in families with children at differing ages and developmental stages. This article summarizes studies published from 2006 to 2011 of Motivational Interviewing in individuals across the lifespan with type 1 and type 2 diabetes and obesity.
Long-lived subduction complexes, such as the Franciscan Complex of California, include tectonic contacts that represent exhumed megathrust horizons that collectively accommodated thousands of ...kilometres of slip. The chaotic nature of mélanges in subduction complexes has spawned proposals that these mélanges form as a result of megathrust displacement. Detailed field and petrographic relationships, however, show that most Franciscan mélanges with exotic blocks formed by submarine landsliding. Field relationships at El Cerrito Quarry in the eastern San Francisco Bay area suggest that subduction slip may have been accommodated between the blueschist facies metagreywacke of the Angel Island nappe above and the prehnite-pumpellyite facies metagreywacke of the Alcatraz nappe below. Although a 100-200 m-thick mélange zone separates the nappes, this mélange is a variably deformed, prehnite-pumpellyite facies sedimentary breccia and conglomerate deposited on the underlying coherent sandstone, so the mélange is part of the lower nappe. A 20-30 m-thick fault zone between the top of the mélange, and the base of the Angel Island nappe displays an inverted metamorphic gradient with jadeite-glaucophane-lawsonite above lawsonite-albite assemblages. This zone has a strong seaward (SW)-vergent shear fabric and hosts ultracataclasite and pseudotachylite. These relationships suggest that significant subduction megathrust displacement at depths of 15-30 km was accommodated within the 20-30 m-thick fault zone. Field studies elsewhere in the Franciscan Complex suggest similar localization of megathrust slip, with some examples lacking mélanges. The narrow megathrust zone at El Cerrito Quarry, its uniform sense-of-shear, and the localization of slip along the contact of, rather than within a mélange, contrast sharply with the predictions of numerical models for subduction channels.
Timely recognition and diagnosis are important in order to allow for best efforts at conservative therapies or operative interventions. 1 While a traumatic chylothorax is a recognized complication ...after blunt thoracic trauma, bilateral chylothoraces after blunt trauma is a rarer occurrence. 1 We report the case of a 21-year-old male trauma patient involved in a motor vehicle collision who sustained a T11 vertebral body fracture where bilateral chylothoraces subsequently developed. The patient received 50-60 mL of heavy cream via his nasogastric tube in the operating room, prior to the procedure, to help increase the amount of chyle produced and help aid in the identification of the thoracic duct leak. 1 The pleural fluid analysis will demonstrate a turbid, creamy consistency, a triglyceride concentration >110 mg/dL, and the presence of chylomicrons, effectively cinching the diagnosis.
Coronavirus patients demonstrate varying degrees of respiratory insufficiency; many will progress to respiratory failure with a severe version of acute respiratory distress syndrome refractory to ...traditional supportive strategies. Providers must consider alternative therapies to deter or prevent the cascade of decompensation to fulminant respiratory failure.
This is a case-series of five COVID-19 positive patients who demonstrated severe hypoxemia, declining respiratory performance, and escalating oxygen requirements. Patients met the following criteria: COVID-19 positivity, worsening respiratory performance, severe hypoxemia (PaO2 ≤ 80) despite traditional supportive measures, escalating supplemental oxygen requirements, and D-dimer greater than 1.5 μg/mL. All patients received protocol directed thrombolytic therapy with tissue plasminogen activator (tPA).
All five patients improved without deleterious effects of thrombolytic therapy. Patient one was on maximum ventilator support, paralytics, and prone positioning without improvement. During tPA administration his PaO2/FIO2 ratio improved from 69 to 127. Ventilator support was weaned immediately on posttreatment day 1, and he was extubated on posttreatment day 12. Our second through fifth patients were not intubated at time of initiation of tPA therapy. These patients each required significant oxygen supplementation trending toward intubation. After tPA therapy, all patients demonstrated a noticeable increase in PaO2 values overtime. Three of these patients avoided intubation due to COVID-19-associated respiratory failure.
Administration of thrombolytics was followed by overall improvement in patients' oxygen requirements, and in three cases, prevented progression to mechanical ventilation, without deleterious effects. Clinical trials of thrombolytic therapy would further serve to underscore the efficacy and utility of this therapy.
Case series of therapeutic effect, Level V.
We statistically reconstruct austral summer (winter) surface air temperature fields back to
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900 (1706) using 22 (20) annually resolved predictors from natural and human archives from southern ...South America (SSA). This represents the first regional-scale climate field reconstruction for parts of the Southern Hemisphere at this high temporal resolution. We apply three different reconstruction techniques: multivariate principal component regression, composite plus scaling, and regularized expectation maximization. There is generally good agreement between the results of the three methods on interannual and decadal timescales. The field reconstructions allow us to describe differences and similarities in the temperature evolution of different sub-regions of SSA. The reconstructed SSA mean summer temperatures between 900 and 1350 are mostly above the 1901–1995 climatology. After 1350, we reconstruct a sharp transition to colder conditions, which last until approximately 1700. The summers in the eighteenth century are relatively warm with a subsequent cold relapse peaking around 1850. In the twentieth century, summer temperatures reach conditions similar to earlier warm periods. The winter temperatures in the eighteenth and nineteenth centuries were mostly below the twentieth century average. The uncertainties of our reconstructions are generally largest in the eastern lowlands of SSA, where the coverage with proxy data is poorest. Verifications with independent summer temperature proxies and instrumental measurements suggest that the interannual and multi-decadal variations of SSA temperatures are well captured by our reconstructions. This new dataset can be used for data/model comparison and data assimilation as well as for detection and attribution studies at sub-continental scales.
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