9 results
Pre-hospital hypothermia is associated with transfusion risk after traumatic injury
- Naheed K. Jivraj, Lilia Kaustov, Kennedy Ning Hao, Rachel Strauss, Jeannie Callum, Homer Tien, Asim Q. Alam
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S2 / September 2020
- Published online by Cambridge University Press:
- 21 October 2020, pp. S12-S20
- Print publication:
- September 2020
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Objectives
In traumatically injured patients, excessive blood loss necessitating the transfusion of red blood cell (RBC) units is common. Indicators of early RBC transfusion in the pre-hospital setting are needed. This study aims to evaluate the association between hypothermia (<36°C) and transfusion risk within the first 24 hours after arrival to hospital for a traumatic injury.
MethodsWe completed an audit of all traumatically injured patients who had emergent surgery at a single tertiary care center between 2010 and 2014. Using multivariable logistic regression analysis, we evaluated the association between pre-hospital hypothermia and transfusion of ≥1 unit of RBC within 24 hours of arrival to the trauma bay.
ResultsOf the 703 patients included to evaluate the association between hypothermia and RBC transfusion, 203 patients (29%) required a transfusion within 24 hours. After controlling for important confounding variables, including age, sex, coagulopathy (platelets and INR), hemoglobin, and vital signs (blood pressure and heart rate), hypothermia was associated with a 68% increased odds of transfusion in multivariable analysis (OR: 1.68; 95% CI: 1.11-2.56).
ConclusionsHypothermia is strongly associated with RBC transfusion in a cohort of trauma patients requiring emergent surgery. This finding highlights the importance of early measures of temperature after traumatic injury and the need for intervention trials to determine if strategies to mitigate the risk of hypothermia will decrease the risk of transfusion and other morbidities.
Effects of a multivitamin/mineral supplement on subjective energy ratings and substrate metabolism during demanding exercise and cognitive tasks
- Fiona Dodd, David Kennedy, Emma Stevenson, Rachel Veasey, Karen Walker, Stephen Reed, Philippa Jackson, Crystal Haskell-Ramsay
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E267
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Introduction
Vitamins and minerals play an essential role within many cellular processes including energy production and metabolism. Biochemical changes and heightened metabolic demands lead to increases in the requirement for certain micronutrients alongside higher excretion of micronutrients through waste products, such as sweat and urine. Previously, supplementation with a multivitamin/mineral (MVM) for ≥ 28 days resulted in improvements to cognition and subjective state. Shifts in metabolism have also been demonstrated during cognitively demanding tasks following MVM in females, both acutely and following 8-week supplementation, suggesting that enhanced recovery is possible following MVM supplementation. The current study aimed to assess these effects further in males and females using metabolically challenging exercise and cognitive tasks.
Materials and MethodsThis randomised, placebo-controlled, parallel groups study investigated the effects of a MVM complex in 82 healthy young (18–35y) exercisers. Subjective ratings and substrate metabolism were assessed during 30 minutes each of increasingly effortful incremental exercise and demanding cognitive tasks. Assessments took place on acute study days following a single dose (Day 1) of MVM, containing 3 times recommended daily allowance of water-soluble vitamins plus CoQ10, and following 4-week supplementation (Day 28).
ResultsEnergy expenditure (EE) was increased during cognitive tasks following MVM across Day 1 and Day 28, with greater effects in males. In males, MVM also increased carbohydrate oxidation and EE during exercise across Day 1 and Day 28. In females, mental tiredness was lower during exercise; increases in physical tiredness following 30 minutes of exercise were attenuated; and stress ratings following cognitive tasks were reduced following MVM. In males, MVM only lowered mental tiredness following 10 minutes of exercise. Those receiving MVM also reported lower ratings of perceived exertion following 10 minutes of exercise. These effects were apparent irrespective of day, but effects on mental tiredness were greater on Day 28. Ferritin levels were also higher on Day 28 in those receiving MVM.
DiscussionThese findings extend on existing knowledge, demonstrating increased carbohydrate oxidation and EE in males following MVM supplementation for the first time. Importantly, they show modulation of EE and subjective tiredness following a single dose, providing further evidence for acute effects of MVM. Differential effects in men and women suggest that whilst males expend more energy, females may conserve their energy but report lower tiredness instead, demonstrating that sex may play an important role in the effects of MVM on energy metabolism and should be considered in future research.
Duration of periconceptional folic acid supplementation in women booking for antenatal care
- Shona Cawley, Laura Mullaney, Rachel Kennedy, Maria Farren, Daniel McCartney, Michael J Turner
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- Journal:
- Public Health Nutrition / Volume 20 / Issue 2 / February 2017
- Published online by Cambridge University Press:
- 05 October 2016, pp. 371-379
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Objective
To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices.
DesignCross-sectional observational study. Women’s clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher.
SettingA large university maternity hospital, Republic of Ireland, January 2014–April 2016.
SubjectsWomen (n 856) recruited at their convenience in the first trimester.
ResultsWhile almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed.
ConclusionsAs the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.
Breast-feeding and postpartum maternal weight trajectories
- Laura Mullaney, Amy C O’Higgins, Shona Cawley, Rachel Kennedy, Daniel McCartney, Michael J Turner
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- Journal:
- Public Health Nutrition / Volume 19 / Issue 8 / June 2016
- Published online by Cambridge University Press:
- 15 October 2015, pp. 1397-1404
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Objective
We examined whether breast-feeding, and in particular exclusive breast-feeding, was associated with maternal weight and body composition changes at 4 months postpartum independently of other maternal variables.
DesignProspective longitudinal study. Women were recruited in the first trimester after an ultrasound examination confirmed an ongoing singleton pregnancy. Weight and body composition were measured using advanced bio-electrical impedance analysis at the first antenatal visit and 4 months postpartum. Detailed questionnaires were completed on breast-feeding, socio-economic status, diet and exercise in addition to routine clinical and sociodemographic details.
SettingLarge Irish university maternity hospital.
SubjectsWomen who delivered a baby weighing ≥500 g between November 2012 and March 2014.
ResultsAt the postpartum visit, the mean weight was 70·9 (sd 14·2) kg (n 470) and the mean BMI was 25·9 (sd 5·0) kg/m2. ‘Any breast-feeding’ was reported by 65·1 % of women (n 306). Irish nativity (OR=0·085, P<0·001), current smoking (OR=0·385, P=0·01), relative income poverty (OR=0·421, P=0·04) and deprivation (OR=0·458, P=0·02) were negatively associated with exclusive breast-feeding. At 4 months postpartum there was no difference in maternal weight change between women who exclusively breast-fed and those who formula-fed (+2·0 v. +1·1 kg, P=0·13). Women who exclusively breast-fed had a greater increase in percentage body fat at 4 months postpartum compared with women who formula-fed (+1·0 v. −0·03 %, P=0·02), even though their dietary quality was better. Exclusive breast-feeding was not associated with postpartum maternal weight or body fat percentage change after adjusting for other maternal variables.
ConclusionsThere are many reasons why breast-feeding should be strongly promoted but we found no evidence to support postpartum weight management as an advantage of breast-feeding.
Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Twin to Twin Transfusion Syndrome: A Patient's Perspective
- Rachel Kennedy
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- Twin Research / Volume 6 / Issue 6 / 01 December 2003
- Published online by Cambridge University Press:
- 21 February 2012, pp. 546-548
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Pandemic Influenza Extension Areas in an Urban Pediatric Hospital
- Rachel L. Charney, Eric S. Armbrecht, Brian R. Kennedy, Robert G. Flood
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- Journal:
- Prehospital and Disaster Medicine / Volume 27 / Issue 1 / February 2012
- Published online by Cambridge University Press:
- 25 April 2012, pp. 75-80
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- February 2012
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Introduction The 2009 H1N1 influenza pandemic created a surge of patients with low-acuity influenza-like-illness (ILI) to hospital Emergency Departments (EDs). The development and results of a tiered surge plan to care for these patients at a Pediatric Emergency Department (PED) were studied.
Hypothesis/Problem By providing standard assessment and treatment algorithms within physically separate ILI Extension Areas, it was hypothesized that patient care could be streamlined and the quality of care maintained.
Methods Hospital administrators created the tiered H1N1 surge plan within the framework of the existing emergency operations plan (EOP). After the initial expansion of space and staff utilization within the existing PED footprint, ILI Extension Areas were opened and staffed by non-ED physicians and nursing to provide care rapidly for ILI patients after Registered Nurse (RN) screening. Volumes, length of stay (LOS), left without being seen (LWBS) rates, patient satisfaction, and costs were tracked and measured.
Results Significantly elevated volumes of patients were seen in the months of September and October of 2009 (42.0% and 32.7% increase over 2008). During this time, 612 patients were triaged to the ILI Extension Areas. The LOS was similar to that experienced in prior years. The LWBS rates in September (4.8%) and October (3.4%) were slightly elevated over the 2009 yearly average (3.2%), but remained lower than during a prior, high-volume month. Satisfaction, measured as patients’ “likelihood to recommend,” remained within the range observed during other parts of the year. Cost estimates indicate favorable financial performance for the institution.
Conclusion The tiered surge response plan represented a success in managing large volumes of low-acuity patients during an extended period of time. This design can be utilized effectively in the future during times of patient surge.
Contributors
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- By John A. Barnden, Antal F. Borbely, Brian Bowdle, Cristina Cacciari, Lynne Cameron, Alan Cienki, Seana Coulson, Alice Deignan, Gilles Fauconnier, Charles Forceville, Dedre Gentner, Raymond W. Gibbs,, Rachel Giora, Sam Glucksberg, Mark Johnson, John M. Kennedy, Walter Kintsch, Zoltán Kövecses, George Lakoff, Graham Low, Teenie Matlock, Linda M. McMullen, Cornelia Müller, Rafael Núñez, Elena Semino, Yeshayahu Shen, Dan Sperber, Gerard Steen, Josef Stern, Mark Turner, Deirdre Wilson, Steven L. Winter, Ning Yu, Lawrence M. Zbikowski
- Edited by Raymond W. Gibbs, Jr., University of California, Santa Cruz
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- The Cambridge Handbook of Metaphor and Thought
- Published online:
- 05 June 2012
- Print publication:
- 22 September 2008, pp ix-xii
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