Explore the vast range of titles available.

Background Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard. Methods One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7 ® Pulse CO-Oximeter ® , Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC). Results There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p  = 0.106), with minimal bias and modest precision (bias − 0.18%, 95%CI [− 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p  = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [− 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]). Conclusions Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.

Sleep is important for memory consolidation and maintaining metabolic homeostasis, but sleep can expose animals to inclement weather and predators. Consequently, selection of sleeping sites is important. We tested three sets of hypotheses related to selection of bed sites by female American black bears (Ursus americanus) at two study sites. During 2009–2013, we outfitted 14 female black bears west of Ely, Minnesota, with Global Positioning System collars that reported bear locations every 10 min. We visited 101 bed sites, each identified from clusters of estimated locations where a bear was on site for ≥4 h on two or more occasions, and recorded bed characteristics, forest composition, canopy closure, and ground cover. We matched each bed site with a control site where we collected the same data. During 1987–1991, we outfitted three female black bears south of Ely with very high-frequency transmitter collars and walked with the bears to collect detailed behavioral data. We used the written data records to identify 62 bed sites where bears slept ≥2 h and where bed characteristics were documented. We matched each bed site with a control site approximately 6 h different when the bear was active. Of the bed sites, 132 were used during night and 31 during day. The two study areas differed in the amount of lowland habitats. At both sites, female bears chose bed sites disproportionately in lowland sites with high canopy cover and next to a tree, especially a white pine. Female bears with cubs selected upland bed sites more often than did females without cubs and also more often selected sites adjacent to a tree with coarse bark, which cubs could climb easily. Distances to roads and houses did not affect selection of bed sites by females either with or without cubs.

Doc number: 78 Abstract Background: General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy technique is a crucial first step in management, as it is recognized that poor techniques can mislead, delay, or miss a diagnosis of melanoma. There has been little published on the biopsy decisions and techniques of GPs. This study aims to describe the current management choices made by GPs for suspicious melanocytic skin lesions and to compare their choices with the best practice guidelines. Methods: An anonymous survey of GPs presented with three clinical scenarios with increasing complexity of melanoma in which a referral or biopsy decision was specified. Results: 391 mailed surveys with a 76.3% response rate. Mean biopsy experience was 4.14 biopsies per GP per month. The rates of choosing to refer among the three scenarios were 31%, 52% and 81% respectively, with referral to surgery being the most common choice (81%). Most biopsy techniques (55%) were chosen according to best practice guidelines, although non-guideline biopsy techniques chosen included shave (n = 10), punch biopsy (n = 57), wide excisions (n = 65), and flaps (n = 10). The few GPs (n = 5) who identified themselves as skin specialist GPs were no more likely to adhere to guidelines than their colleagues. Conclusion: A majority of referrals and biopsies were chosen by GPs according to best practice guidelines, but concern remains for the high proportion of GPs making non-guideline based choices. How GPs choose to biopsy or refer needs further training, audit, and research if Australia is to improve the outcome of melanoma management in general practice.

Here is a list of the top three BYU Mens Basketball NCAA tournament appearances of all time: BYU makes it to the second round of the Tournament.

This descriptive, qualitative work provides the reader with a review of the pediatric bone marrow transplantation (BMT) literature and a case study of a teenage BMT patient and his family who were followed through their BMT experience at a cancer hospital in California. Chapter 1 is an overview of the BMT process. Chapter 2 contains a review and explanation of existential themes discussed throughout the remaining chapters. Chapter 3 is a review of the issues that arise as a patient and family members experience the pretransplant phase of BMT, including initial diagnosis, ethical considerations, informed consent, and issues related to treating minors. Chapter 4 is a review of the issues arising during the BMT treatment phase, including the coping responses of patients and family members while in the hospital and the experience and treatment of pain. Chapter 5 includes issues pertaining to post-BMT treatment. Discharge, quality of life, living with chronic illness, palliative care, terminal sedation, dying, and grief responses are reviewed. The existential themes of death, freedom, will, responsibility, isolation, meaning, and purpose are discussed in each chapter as they relate to the case study narrative and the relevant biological, psychological, sociological, and spiritual literature.

Human immunodeficiency virus (HIV) infection is an independent risk factor for cardiovascular disease. This risk is magnified by certain antiretrovirals, particularly the protease inhibitor ritonavir, but the pathophysiology of this connection is unknown. We postulated that a major mechanism for antiretroviral-associated cardiac disease is pathologic fibrosis linked to platelet activation with release and activation of transforming growth factor (TGF)-β1, and that these changes could be modeled in a murine system. We also sought to intervene utilizing inhaled carbon monoxide (CO) as proof-of-concept for therapeutics capable of regulating TGF-β1 signaling and collagen autophagy. We demonstrate decreased cardiac function indices, including cardiac output, ejection fraction and stroke volume, and prominent cardiac fibrosis, in mice exposed to pharmacological doses of ritonavir. Cardiac output and fibrosis correlated with plasma TGF-β1 levels. Mice with targeted deletion of TGF-β1 in megakaryocytes/platelets (PF4CreTgfb1flox/flox) were partially protected from ritonavir-induced cardiac dysfunction and fibrosis. Inhalation of low dose CO (250ppm), used as a surrogate for upregulation of inducible heme oxygenase/endogenous CO pathways, suppressed ritonavir-induced cardiac fibrosis. This occurred in association with modulation of canonical (Smad2) and non-canonical (p38) TGF-β1 signaling pathways. In addition, CO treatment suppressed the M1 pro-inflammatory subset of macrophages and increased M2c regulatory cells in the hearts of RTV-exposed animals. The effects of CO were dependent upon autophagy as CO did not mitigate ritonavir-induced fibrosis in autophagy-deficient LC3-/- mice. These results suggest that platelet-derived TGF-β1 contributes to ritonavir-associated cardiac dysfunction and fibrosis, extending the relevance of our findings to other antiretrovirals that also activate platelets. The anti-fibrotic effects of CO are linked to alterations in TGF-β1 signaling and autophagy, suggesting a proof-of-concept for novel interventions in HIV/antiretroviral therapy-mediated cardiovascular disease.