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The Effect of Aerobic Exercise on Concussion Recovery: A Pilot Clinical Trial
- Aliyah R. Snyder, Sarah M. Greif, James R. Clugston, David B. FitzGerald, Joshua F. Yarrow, Talin Babikian, Christopher C. Giza, Floyd J. Thompson, Russell M. Bauer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 27 / Issue 8 / September 2021
- Published online by Cambridge University Press:
- 16 November 2021, pp. 790-804
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Objective:
The purpose of this study was to pilot safety and tolerability of a 1-week aerobic exercise program during the post-acute phase of concussion (14–25 days post-injury) by examining adherence, symptom response, and key functional outcomes (e.g., cognition, mood, sleep, postural stability, and neurocognitive performance) in young adults.
Method:A randomized, non-blinded pilot clinical trial was performed to compare the effects of aerobic versus non-aerobic exercise (placebo) in concussion patients. The study enrolled three groups: 1) patients with concussion/mild traumatic brain injury (mTBI) randomized to an aerobic exercise intervention performed daily for 1-week, 2) patients with concussion/mTBI randomized to a non-aerobic (stretching and calisthenics) exercise program performed daily for 1-week, and 3) non-injured, no intervention reference group.
Results:Mixed-model analysis of variance results indicated a significant decrease in symptom severity scores from pre- to post-intervention (mean difference = −7.44, 95% CI [−12.37, −2.20]) for both concussion groups. However, the pre- to post-change was not different between groups. Secondary outcomes all showed improvements by post-intervention, but no differences in trajectory between the groups. By three months post-injury, all outcomes in the concussion groups were within ranges of the non-injured reference group.
Conclusions:Results from this study indicate that the feasibility and tolerability of administering aerobic exercise via stationary cycling in the post-acute time frame following post-concussion (14–25 days) period are tentatively favorable. Aerobic exercise does not appear to negatively impact recovery trajectories of neurobehavioral outcomes; however, tolerability may be poorer for patients with high symptom burden.
Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events
- Jason P. Stopyra, William S. Harper, Tyson J. Higgins, Julia V. Prokesova, James E. Winslow, Robert D. Nelson, Roy L. Alson, Christopher A. Davis, Gregory B. Russell, Chadwick D. Miller, Simon A. Mahler
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 1 / February 2018
- Published online by Cambridge University Press:
- 10 January 2018, pp. 58-62
- Print publication:
- February 2018
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Introduction
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
HypothesisA prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
MethodsA retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
ResultsOver the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
ConclusionsPrehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
,Stopyra JP ,Harper WS ,Higgins TJ ,Prokesova JV ,Winslow JE ,Nelson RD ,Alson RL ,Davis CA ,Russell GB ,Miller CD .Mahler SA Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events . Prehosp Disaster Med.2018 ;33 (1 ):58 –62 .
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Contributors
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- By James P. Bednarz, William C. Carroll, Francis X. Connor, Trevor Cook, Gabriel Egan, Julia Griffin, Brean Hammond, Rui Carvalho Homem, Sujata Iyengar, Russell Jackson, Isabel Karremann, Arthur F. Kinney, Tina Krontiris, Barry Langston, Stephan Laqué, Dennis McCarthy, Ellen MacKay, Roderick H. McKeown, Sonia Massai, L. Monique Pittman, James Purkis, Carol Chillington Rutter, June Schlueter, Charlotte Scott, Will Sharpe, James Shaw, Simon Smith, B. J. Sokol, Stephen Spiess, Gary Taylor, Leslie Thomson, Sir Brian Vickers, William W. Weber
- Edited by Peter Holland, University of Notre Dame, Indiana
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- Shakespeare Survey
- Published online:
- 05 October 2014
- Print publication:
- 02 October 2014, pp vi-vi
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List of contributors
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- By Osamu Arakaki, Michael Barutciski, Nicholas Blake, Claude Cahn, Joyce Chia, Thomas C. (Tom) Clark, David B. Dewitt, Harald Dörig, Alice Edwards, Brian Goodman, Elspeth Guild, Martin Jones, Vitit Muntarbhorn, Anthony Max North, Benjamin Perryman, Sriprapha Petcharamesree, James C. Simeon, Volker Türk, Russel W. Zinn
- Edited by James C. Simeon, York University, Toronto
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- The UNHCR and the Supervision of International Refugee Law
- Published online:
- 05 August 2013
- Print publication:
- 15 August 2013, pp viii-xvi
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Reassessing the chronology of Biblical Edom: new excavations and 14C dates from Khirbat en-Nahas (Jordan)
- Thomas E. Levy, Russell B. Adams, Mohammad Najjar, Andreas Hauptmann, James D. Anderson, Baruch Brandl, Mark A. Robinson, Thomas Higham
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An international team of researchers show how high-precision radiocarbon dating is liberating us from chronological assumptions based on Biblical research. Surface and topographic mapping at the large copper-working site of Khirbat en-Nahas was followed by stratigraphic excavations at an ancient fortress and two metal processing facilities located on the site surface. The results were spectacular. Occupation begins here in the eleventh century BC and the monumental fortress is built in the tenth. If this site can be equated with the rise of the Biblical kingdom of Edom it can now be seen to: have its roots in local Iron Age societies; is considerably earlier than previous scholars assumed; and proves that complex societies existed in Edom long before the influence of Assyrian imperialism was felt in the region from the eighth – sixth centuries BC.
Placental nutrition in a viviparous lizard (Pseudemoia pagenstecheri) with a complex placenta
- Michael B. Thompson, James R. Stewart, Brian K. Speake, Kylie J. Russell, Ruth J. McCartney, Peter F. Surai
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- Journal:
- Journal of Zoology / Volume 248 / Issue 3 / July 1999
- Published online by Cambridge University Press:
- 01 July 1999, pp. 295-305
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- July 1999
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The composition of egg yolks and neonates of the viviparous lizard, Pseudemoia pagenstecheri, one of the most placentotrophic reptiles studied to date, are described. Neonates (43.3 ± 5.2 mg) have twice the dry mass of the initial eggs (22.0 ± 1.9 mg). The protein content of neonates (29.1 ± 1.1 mg) is more than twice that of eggs (12.2 ± 1.1 mg), while the energy content (908.1 ± 107.4 J) is 1.6 times higher than that of the egg (565.0 ± 42.9 J). The energy densities of eggs (27.5 kJ g−1) and neonates (23.1 ± 0.3 kJ g−1) are similar to the energy densities of eggs and neonates of oviparous species. The total ash per neonate (4.1 ± 0.4 mg) is three times greater than that of the egg contents (1.4 ± 0.2). Neonates contain significantly more calcium, sodium and potassium, but not magnesium, than do eggs. Thus, the placenta has a quantitatively important role in supplying nutrients for the embryo. The proportions of triacylglycerol (66%), phospholipid (19%), and free cholesterol (5%) in the eggs are similar to those in eggs of birds and crocodilians, but the proportion of cholesteryl esters (7%) is much higher in eggs of P. pagenstecheri. The proportion of docosahexaenoic acid in the egg phospholipid is relatively low (1.4%) but rises to 5.4% in the neonate. The eggs contain vitamin E (mainly in the form of α-tocopherol) and vitamin A, but no detectable carotenoids. The overall composition of the eggs is not substantially different from that of oviparous species, suggesting that the small egg size relative to neonate size is a result of a reduction in egg size rather than modification by omission of some nutrients from the yolk. The pattern of placental nutrient provision of P. pagenstecheri contains both an obligate and a facultative component suggesting that enhancement of offspring quality through facultative placentotrophy is a general characteristic of placental reptiles independent of pattern of embryonic nutrient provision.
Deep-Level Traps in CCD Image Sensors
- William C. Mccolgin, James P. Lavine, Charles V. Stancampiano, Jeffrey B. Russell
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- MRS Online Proceedings Library Archive / Volume 510 / January 1998
- Published online by Cambridge University Press:
- 10 February 2011, 475
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- January 1998
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We have extended by five the number of deep-level traps known to create dark current in charge-coupled device (CCD) image sensors. These include Mn, Pt, and three much weaker traps that are as yet unidentified. Using dark current spectroscopy (DCS) we show that the generation rates at 55°C range from 6400 electrons/s for Mn to only 2 electrons/s for the weakest trap, which lies 0.27 eV off mid-gap. These weak traps determine the bandwidths and resolution of the trap peaks seen in the dark current spectra.
Raman Spectroscopic Study Of Ion-Implanted And Annealed Silicon.
- David. D. Tuschel, James P. Lavine, Jeffrey B. Russell
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- Journal:
- MRS Online Proceedings Library Archive / Volume 406 / 1995
- Published online by Cambridge University Press:
- 15 February 2011, 549
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- 1995
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Raman spectroscopy is used to characterize silicon implanted with arsenic and then annealed. The implant dose ranged from 2 × 1012 to 2 × 1013/cm2. The as-implanted samples show a decreased Raman intensity of the 520 cm−1 optical mode, and increased Raman intensity between 400 and 500 cm−1 with respect to an unimplanted silicon wafer. The higher arsenic doses show an increase in the second-order transverse acoustic-mode (TA) intensity around 300 cm−1 relative to the secondorder transverse optical-mode (TO) intensity near 970 cm−1. Annealing restores the 2TA/2TO relative intensities and sharpens the weak peaks between 600 and 900 cm−1. The Raman spectrum is altered by the lowest dose implant and the annealing steps do not lead to a complete recovery of the pre-implant Raman spectrum. This permits the monitoring of lowdose ion-implant damage recovery with Raman spectroscopy.
Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge
- Bruce A. Houtchens, Terry P. Clemmer, Harry C. Holloway, Alexander A. Kiselev, James S. Logan, Ronald C. Merrell, Arnauld E. Nicogossian, Haik A. Nikogossian, Russell B. Rayman, Ashot E. Sarkisian, John H. Siegel
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- Journal:
- Prehospital and Disaster Medicine / Volume 8 / Issue 1 / March 1993
- Published online by Cambridge University Press:
- 28 June 2012, pp. 57-66
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- March 1993
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Introduction:
The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.
Methods:During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.
Results:Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.
Conclusion:These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Production of tricarballylic acid by rumen microorganisms and its potential toxicity in ruminant tissue metabolism
- James B. Russell, Neil Forsberg
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- Journal:
- British Journal of Nutrition / Volume 56 / Issue 1 / July 1986
- Published online by Cambridge University Press:
- 09 March 2007, pp. 153-162
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- July 1986
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1. Rumen microorganisms convert trans-aconitate to tricarballylate. The following experiments describe factors affecting the yield of tricarballylate, its absorption from the rumen into blood and its effect on mammalian citric acid cycle activity in vitro.
2. When mixed rumen microorganisms were incubated in vitro with Timothy hay (Phleum praiense L.) and 6.7 mM-trans-aconitate, 64 % of the trans-aconitate was converted to tricarballylate. Chloroform and nirate treatments inhibited methane production and increased the yield of tricarballylate to 82 and 75% respectively.
3. Sheep given gelatin capsules filled with 20 g trans-aconitate absorbed tricarballylate and the plasma concentration ranged from 0.3 to 0.5 mM 9 h after administration. Feeding an additional 40 g potassium chloride had little effect on plasma tricarballylate concentrations. Between 9 and 36 h there was a nearly linear decline in plasma tricarballylate.
4. Tricarballylate was a competitive inhibitor of the enzyme, aconitate hydratase (aconitase; EC 4.2.1.3), and the inhibitor constant, KI, was 0.52 mM. This KI value was similar to the Michaelis-Menten constant (Km) of the enzyme for citrate.
5. When liver slices from sheep were incubated with increasing concentrations of tricarballylate, [I4C]acetate oxidation decreased. However, even at relatively high concentrations (8 mM), oxidation was still greater than 80% of the maximum. Oxidation of [I4C]acetate by isolated rat liver cells was inhibited to a greater extent by tricarballylate. Concentrations as low as 0.5 mM caused a 30% inhibition of citric acid cycle activity.