Impact of hemodialysis on P-wave amplitude, duration, and dispersion

Atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing hemodialysis (HD). P wave duration (PWdu) and P wave dispersion (PWdi) have been shown to be predictors of emerging AF in different clinical conditions. We sought to study the impact of HD on PWdu, PWdi, and P wave amplitude in a cohort of patients undergoing HD. Seventeen patients (8 men, 31+/-10 years) were studied. Echocardiography parameters, the sum of the amplitude of P waves in all 12 ECG leads (SP), mean PWdu, and PWdi, along with a host of other parameters (body weight, heart rate, electrolytes and hemoglobin/hematochrit) were measured 1/2h, before and after, HD. SP increased (11.8+/-3.9 vs 15.3+/-4.0 mm, p = 0.004), mean PWdu remained stable (82.7+/-11.1 vs 81.6+/-10.5 ms, p = 0.606), PWdi decreased (51.7+/-19.1 vs 41.7+/-19.1 ms, p = 0.03), and left atrial dimension decreased (37.96+/-3.90 vs 30.62+/-3.38 mm, p = 0.0001), after HD. The change in PWdi correlated with fluid removed by HD (r = -0.55, p = 0.022). Re-measurements of P-wave parameters in a random group of 11 of the 17 patients revealed augmented SP (p = 0.01), and stable mean PWdu (p = 0.36), and PWdi (p = 0.31), after HD. Fluid removed by HD leads to an increase in SP, a stable mean PWdu, and decrease (or stability on re-measurement in a subgroup of patients) in PWdi. Stability of PWdu may be due to the effects of augmentation of the P-wave amplitude and the reduction of the left atrial volume, cancelling each other. Variability of PWdi may stem from the occasional impossibility to measure PWdu (or measure it correctly) in minute P-waves in certain ECG leads, which in turn profoundly affects the PWdi.     

Interactions among sleep disordered breathing,obesity, and sleep duration

Sleep and Biological Rhythms -     

Parasites, predators and the duration of developmental periods

Nest predation has been suggested to be the most important environmental factor determining the evolution of incubation and nestling periods in birds. This paradigm is based on a number of comparative analyses that have shown correlations between rates of nest predation and the relative duration of the nestling period. A second important natural selection pressure on reproduction is caused by parasitism. Here, I investigated the independent effects of daily nest predation rates and daily nest mortality rates due to parasites to assess the relative importance of these two environmental factors as determinants of the relative duration of incubation and nestling periods in birds, using the 43 species for which information on parasite-induced nestling mortality was available. The relative duration of the incubation period was negatively related to daily mortality rate due to parasitism, while nest predation had no significant effect. The relative duration of the nestling period was not significantly related to daily rate of mortality due to parasitism or nest predation. Daily nest predation rate was significantly negatively correlated with daily mortality rate due to parasitism in the subsample of species, for which some mortality due to parasitism was recorded. These findings are mainly based on hole nesters and colonially breeding species, because estimates of parasite-induced mortality generally is unavailable from open nesting and solitarily breeding species, precluding any generalizations to these species. However, the conclusions did not change after statistically controlling for nest site and sociality. These results suggest that developmental rates may be more influenced by the effects of parasites rather than nest predators, and that parasites constitute a neglected selective force affecting developmental rates.     

Shift-specific associations between age,chronotype and sleep duration

The objective of this study was to examine the association of age with chronotype and sleep duration in day workers and rotating shift workers, including night shift work. Between October 2012 and February 2015, a cross-sectional study was conducted in a German chemical company. Using the “Munich ChronoType Questionnaire” (MCTQ), data about sleep onset and sleep offset during workdays and work-free days were retrieved and the chronotype was computed during regular voluntary occupational health check-ups. Associations between age and chronotype, as well as sleep duration, were assessed using linear regression analyses. Potential effect modification by the working time system was examined. Within the study period, 4,040 employees (82.3% and 17.7% were engaged in day work and rotating shift work, respectively) completed the questionnaire. Study participants were on average 41.8 years old (Min = 18.0, Max = 65.0, SD = 10.2) and predominantly male (75.4%). Mean chronotype and overall sleep duration was 03:22 (SD = 54 min) and 7.2 h (SD = 1.0 h) respectively. Older age was associated with earlier chronotype and reduced overall sleep duration in both day workers and rotating shift workers (p < 0.001 for all models). Compared to day workers, employees whom engaged in rotating shift work were later chronotypes and had overall a longer sleep duration. With older age, the difference between day and rotating shift workers regarding chronotype increased, while the difference regarding overall sleep duration decreased (p_interaction<0.005 for both models). This finding could indicate that both changes in circadian physiology and exposure to certain work schedules contribute to the age-related changes. Older rotating shift workers, with early chronotypes may have issues with night shifts, while day work and morning shifts may be best compatible to earlier chronotypes. Differences in sleep timing across age groups, might indicate that the same work hours will affect shift workers differently, dependent on their age, suggesting that more flexible and chronotype-adapted work hours could provide useful; especially for older employees. Sleep education in the form of courses and health campaigns could be a way to raise awareness of the importance of a healthy sleep pattern. This could be achieved by learning strategies to better adjust individual sleep patterns to work hours.     

Timing,frequency, and duration of incubation recesses in dabbling ducks

Nest attendance is an important determinant of avian reproductive success, and identifying factors that influence the frequency and duration of incubation recesses furthers our understanding of how incubating birds balance their needs with those of their offspring. We characterized the frequency and timing (start time, end time, and duration) of incubation recesses for mallard (Anas platyrhynchos) and gadwall (Mareca strepera) hens breeding in Suisun Marsh, California, USA, and examined the influences of day of year, ambient temperature at the nest, incubation day, and clutch size on recess frequency and timing using linear mixed models. Mallard, on average, took more recesses per day (1.69 ± 0.80, mean ± standard deviation) than did gadwall (1.39 ± 0.69), and 45% of mallard nest‐days were characterized by two recesses, while only 27% of gadwall nest‐days were characterized by two recesses. Mallard morning recesses started at 06:14 ± 02:46 and lasted 106.11 ± 2.01 min, whereas mallard afternoon recesses started at 16:39 ± 02:11 and lasted 155.39 ± 1.99 min. Gadwall morning recesses started at 06:30 ± 02:46 and lasted 91.28 ± 2.32 min, and gadwall afternoon recesses started at 16:31 ± 01:57 and lasted 192.69 ± 1.89 min. Mallard and gadwall started recesses earlier in the day with increasing ambient temperature, but later in the day as the season progressed. Recess duration decreased as the season progressed and as clutch size increased, and increased with ambient temperature at the nest. The impending darkness of sunset appeared to be a strong cue for ending a recess and returning to the nest, because hens returned to their nests earlier than expected when recesses were expected to end after sunset. Within hens, the timing of incubation recesses was repeatable across incubation days and was most repeatable for mallard afternoon recesses and on days in which hens took only one recess. Hens were most likely to be away from nests between 04:00 and 07:00 and between 16:00 and 19:00; therefore, investigators should search for nests between 07:00 and 16:00. Our analyses identified important factors influencing incubation recess timing in dabbling ducks and have important implications for nest monitoring programs.     

On prevalence, incidence, and duration in general stable populations.

The relationship between prevalence, incidence, and duration of disease is studied in exponentially growing/declining stable populations. Prevalence odds is shown to be a weighted average of age-specific products between incidence and discounted disease duration. If and only if the covariance between incidence and duration is zero, does prevalence odds equal the product of average incidence and average duration. The product of averages is shown typically to overestimate prevalence in epidemiologic applications. Ignoring population growth also tends to lead to overestimation of prevalence.     

Implications on visual apperception: Energy, duration, structure and synchronization

Although primary visual cortex (V1 or striate) activity per se is not sufficient for visual apperception (normal conscious visual experiences and conscious functions such as detection, discrimination, and recognition), the same is also true for extrastriate visual areas (such as V2, V3, V4/V8/VO, V5/M5/MST, IT, and GF). In the lack of V1 area, visual signals can still reach several extrastriate parts but appear incapable of generating normal conscious visual experiences. It is scarcely emphasized in the scientific literature that conscious perceptions and representations must have also essential energetic conditions. These energetic conditions are achieved by spatiotemporal networks of dynamic mitochondrial distributions inside neurons. However, the highest density of neurons in neocortex (number of neurons per degree of visual angle) devoted to representing the visual field is found in retinotopic V1. It means that the highest mitochondrial (energetic) activity can be achieved in mitochondrial cytochrome oxidase-rich V1 areas. Thus, V1 bear the highest energy allocation for visual representation.In addition, the conscious perceptions also demand structural conditions, presence of adequate duration of information representation, and synchronized neural processes and/or ‘interactive hierarchical structuralism.’ For visual apperception, various visual areas are involved depending on context such as stimulus characteristics such as color, form/shape, motion, and other features. Here, we focus primarily on V1 where specific mitochondrial-rich retinotopic structures are found; we will concisely discuss V2 where smaller riches of these structures are found. We also point out that residual brain states are not fully reflected in active neural patterns after visual perception. Namely, after visual perception, subliminal residual states are not being reflected in passive neural recording techniques, but require active stimulation to be revealed.     

On the relation between expiratory duration and subsequent inspiratory duration

To characterize respiratory interphase relationships in dogs, inspiratory duration (TI) or expiratory duration (TE) was systematically altered by electrical activation of vagal afferents, and the effect on subsequent TE or TI values was measured from the phrenic discharge. A linear TI-subsequent TE relationship was found. Following a vagally mediated prolongation of TE, 1) TI was prolonged, and the TE-subsequent TI relationship was curvilinear, 2) the threshold for inspiratory termination by phasic vagal inputs was increased, 3) the amplitude of the time course of the phrenic discharge was reduced so that the peak discharge reached the same level at inspiratory termination independent of TI, 4) the effect on TI prolongation persisted for several breaths whereas the effect was minimal on subsequent TE values, and 5) for tonic inputs the direct shortening of TI was nearly offset by the indirect lengthening of TI. These studies suggest the existence of slow central mechanisms that provide adaptation to elevated levels of vagal input in the control of TI. These mechanisms may also be responsible for the interphase timing relationships.     

Breastfeeding in Iran: prevalence, duration and current recommendations

Background

Milk ejection is essential for a successful lactation, however techniques to measure milk ejection in women are often complex and invasive. Recent research has demonstrated that at milk ejection, milk duct diameter increased in the breast (measured by ultrasound) at the same time as milk flow rate increased (measured using a weigh balance). This study aimed to evaluate a purpose-built continuous weigh balance (Showmilk, Medela AG) to measure changes in milk flow rate from the breast to identify milk ejections during milk expression. In addition, the Showmilk was used to determine if milk ejection occurred simultaneously in both breasts during double pumping.

Methods

Increased milk flow rates during single pumping were compared to simultaneous ultrasound measurements of increased milk duct diameters in 14 mothers. In addition, increases in milk flow rate were compared between the left and right breasts of 28 mothers during double pumping for 15 minutes with two separate electric breast pumps attached to two Showmilks to record milk flow rate.

Results

Increased milk flow rates were associated with increased milk duct diameters during single pumping. The mean number of milk ejections was not different between the Showmilk (4.2 ± 2.0) and ultrasound (4.5 ± 1.5) techniques. Overall, 67 milk ejections were measured and of these, 48 (72%) were identified by both techniques. The left and right breasts responded synchronously with 95.5% of the flow rate increases corresponding between the breasts. The mean number of milk ejections identified by an increase in milk flow rate during double pumping was 5.1 ± 1.7 and 5.0 ± 1.7 for the left and right breasts, respectively. In addition, mothers chose the same expression vacuum for the left (-198 ± 31 mmHg) and right (193 ± 33 mmHg) breasts.

Conclusion

The Showmilk can simply and non-invasively record milk ejections by measuring increases in milk flow rate that correspond with increases in milk duct diameter. For the first time measurement of milk flow rate has been used to confirm that milk ejections occur simultaneously in the left and right breasts during double pumping. The use of the Showmilk will facilitate further research into the relationship of milk ejection and milk removal.     

Estimating mean response as a function of treatment duration in an observational study, where duration may be informatively censored

After a treatment is found to be effective in a clinical study, attention often focuses on the effect of treatment duration on outcome. Such an analysis facilitates recommendations on the most beneficial treatment duration. In many studies, the treatment duration, within certain limits, is left to the discretion of the investigators. It is often the case that treatment must be terminated prematurely due to an adverse event, in which case a recommended treatment duration is part of a policy that treats patients for a specified length of time or until a treatment-censoring event occurs, whichever comes first. Evaluating mean response for a particular treatment-duration policy from observational data is difficult due to censoring and the fact that it may not be reasonable to assume patients are prognostically similar across all treatment strategies. We propose an estimator for mean response as a function of treatment-duration policy under these conditions. The method uses potential outcomes and embodies assumptions that allow consistent estimation of the mean response. The estimator is evaluated through simulation studies and demonstrated by application to the ESPRIT infusion trial coordinated at Duke University Medical Center.     

Simple scaling laws for influenza A rise time, duration, and severity

Simple scaling laws are developed for the severity and characteristic time scales of influenza A infection in man. The scaling laws are based on a model of the infection described by six coupled ordinary differential equations that describe the time courses of the numbers of infectious viral particles, activated cytotoxic T-lymphocytes, interferon molecules, infected cells, uninfected cells, and the subset of uninfected cells that are protected by interferon from viral infection. Computer simulations show that the disease can be regarded approximately as a two-stage process. In the first stage, the growth in the number of infected cells is determined primarily by the interferon-enhanced limitation in the available number of target cells. In the second stage, the bulk of the duration of the infection is determined mainly by the destruction of the infected cells by the cytotoxic T-lymphocytes. The severity and characteristic times of the infection are found to depend simply on the logarithm of the initial number of viruses.     

Relation between energy metabolism,glycolysis, noradrenaline release and duration of ischemia

We studied the effect of 12–36 min of global ischemia followed by 36 min of reperfusion in Langendorff perfused rabbit hearts (n = 26). Metabolism was determined in terms of peak and total release of purines (adenosine, inosine, hypoxanthine), lactate and noradrenaline during reperfusion; and myocardial content of nucleotides (ATP, ADP, AMP), glycogen and noradrenaline at the end of reperfusion. An inverse relationship (r = –0.79) existed between duration of ischemia and developed pressure post-ischemia. Early during reperfusion, after 12 min of ischemia, the purine concentration (peak release) increased 100x (p < 0.01), that of lactate and noradrenaline lOx (p < 0.05) . Total purine release rose with progression of the ischemic period (30x after 36 min of ischemia; p < 0.01), concomitant with a reduction in nucleotide content. Lactate release was independent from the duration of ischemia, although glycogen had declined by 30% (p < 0.01) after 36 min of ischemia. The acid insoluble glycogen fraction, which presumably contains proglycogen, increased substantially during short-term ischemia. Peak noradrenaline increased 100x and 200x (p < 0.05) after 24 and 36 min of ischemia, respectively. Total noradrenaline release due to various periods of ischemia mirrored its peak release. Function recovery was inversely related to total purine and noradrenaline efflux (both r =–0.81); it correlated with tissue nucleotide content (r = 0.84). In conclusion, larger amounts of noradrenaline are released only after a substantial drop in myocardial ATP. During severe ischemia ATP consumption more than limited ATP production by anaerobic glycolysis, is a key factor affecting recovery on subsequent reperfusion. In contrast to lactate efflux, purine and noradrenaline release are useful markers of ischemic and reperfusion damage.     

Thiazole-derived potent, highly bioavailable short duration growth hormone secretagogues.

Replacement of the phenyl in 3 with a 2-pyridyl or 4-thiazolyl group resulted in increased potency in the rat pituitary cell GH release assay and in beagles.