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Being in limbo: The experience of critical illness in intensive care and beyond

Open Journal of Nursing 2012年第3期2卷 270-276页

作者： Agness c. Tembo Vicki parker Isabel Higgins University of New England Armidale Australia University of Newcastle Newcastle Australia

critical illness is a sudden traumatising lived experience that affects the sufferer and their family throwing them into a crisis situation [1,2]. It is disruptive and alienating. critically ill patients emerging from unconsciousness often suffer from confusion that could be momentary or lasting. There is an increasing number of critical illness survivors in intensive care units (IcU)1 with numerous life changing ongoing physiological and psychological sequelae from critical illness and IcU hospitalization, with inadequate ongoing treatment for IcU survivors. Medicalised accounts of critical illness fail to recognise the significant impact on the person, their embodied sense of self and their ability to move on with their life after they leave hospital. The main purpose of this study was to explore the experience of critically ill patients in IcU and beyond. This phenomenological study describes what it was like for twelve people to experience critical illness in IcU and in the months after discharge. The finding was that critical illness is an acute life threatening event with long lasting effects which translate into temporal and biographical disruption, imprisonment by the IcU and its therapies and being trapped in an alien body that is plagued by uncertainty and long lasting conditions arising from the critical illness and the IcU therapies. critical illness survivors are left in a state of limbo characterised by a struggle to reclaim their precritical illness IcU identity and uncertainty about their future. Hence an overarching theme of being in limbo under which three major themes of 1) disrupttion, 2) imprisonment and 3) being trapped were generated from the study.

关键词： critical Illness Intensive care Mechanical Ventilation Daily Sedation Interruption

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Using Pharmacokinetic Modeling and Electronic Health Record Data to Predict clinical and Safety Outcomes after Methylprednisolone Exposure during cardiopulmonary Bypass in Neonates

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congenital Heart Disease 2023年第3期18卷 295-313页

作者： Henry P.Foote Huali Wu Stephen J.Balevic Elizabeth J.Thompson Kevin D.Hill Eric M.graham christoph P.Hornik Karan R.Kumar Department of Pediatrics Duke UniversityDurhamUSA Duke clinical Research Institute DurhamUSA Department of Pediatrics Medical University of South CarolinaCharlestonUSA

Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(cPB)frequently receive intraoperative methylprednisolone(MP)to suppress cPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain ***:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with cPB from 2014–2017 at our *** combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(cmax)and area under the concentration-time curve for 24 h(AUc24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric ***:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of ***(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major *** median cmax and AUc24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major *** median cmax and AUc24 MP exposure was significantly higher for infants requiring *** exposure was associated with death or other safety ***:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical *** study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.

关键词： Neonates cardiopulmonary bypass methylprednisolone exposure

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Mitochondrial ROS and Aging:Understanding Exercise as a Preventive Tool

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Journal of Science in Sport and Exercise 2020年第1期2卷 15-24页

作者： Henver S.Brunetta Andrew M.Holwerda Luc J.c.van Loon graham P.Holloway Department of Human Health and Nutritional Sciences University of GuelphGuelphON NIG 2W1Canada Department of Physiological Sciences Federal University of Santa CatarinaFlorianopolisBrazil Department of Human Biology NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands

Sarcopenia,which is characterized by reduction in muscle mass and strength,contributes to several age-related conditions,including insulin resistance and *** the importance of maintaining muscle mass for healthy aging,the mechanisms contributing to sarcopenia are not fully ***,mitochondria appear to play a key role in the underlying condition,and importantly,respond robustly to exercise *** are intracellular organelles largely attributed to maintaining ATP concentrations,however,the importance of this organelle in overall cellular homeostasis has been expanded in the last decades to include redox signaling,calcium homeostasis,inflammation,and *** lines of evidence suggest that mitochondrial bioenergetics are altered in aged skeletal muscle,resulting in an increase in reactive oxygen species(ROS)production,while conversely genetic/pharmacological approaches that attenuate mitochondrial ROS promote healthy aging and maintenance of muscle *** observations suggest that increased free radicals are one of the bases of the aging process and related ***,we reviewed the current knowledge regarding mitochondrial function and redox balance in aged human skeletal muscle,highlighting the implications of redox unbalance on skeletal muscle mass maintenance and muscle ***,we describe the benefits of exercise and nutrition interventions in the context of improving mitochondrial bioenergetics and functional outcomes regarding skeletal muscle mass and function.

关键词： Mitochondria Redox state Aging Sarcopenia.Exercise Nutrition

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computer-Aided Statics and Strength of Materials

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2000年

作者： Salter graham R.

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Hot-wire chemical vapor deposition low-loss hydrogenated amorphous silicon waveguides for silicon photonic devices

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Photonics Research 2019年第2期7卷 193-200页

作者： SWE Z.OO ANTULIO TARAZONA ALI Z.KHOKHAR RAFIDAH PETRA YOHANN FRANZ GORAN Z.MASHANOVIcH graham T.REED ANNA c.PEAcOcK HAROLD M.H.cHONG School of Electronics and computer Science University of Southampton Optoelectronics Research centre University of Southampton School of Electrical and Electronic Engineering Nanyang Technological University

We demonstrate low-loss hydrogenated amorphous silicon(a-Si:H) waveguides by hot-wire chemical vapor deposition(HWcVD). The effect of hydrogenation in a-Si at different deposition temperatures has been investigated and analyzed by Raman spectroscopy. We obtained an optical quality a-Si:H waveguide deposited at 230°c that has a strong Raman peak shift at 480 cm^(-1), peak width(full width at half-maximum) of 68.9 cm^(-1), and bond angle deviation of 8.98°. Optical transmission measurement shows a low propagation loss of 0.8 dB/cm at the1550 nm wavelength, which is the first, to our knowledge, report for a HWcVD a-Si:H waveguide.

关键词： Hot-wire low-loss amorphous

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国际水稻信息系统及其应用

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中国水稻科学 2005年第2期19卷 193-194页

作者：王磊鄂志国余汉勇汤圣祥 graham c.McLAREN graham c.McLAREN 中国水稻研究所浙江杭州310006 国际水稻研究所生物统计和生物信息学中心菲律宾马尼拉

作为提供全球不同作物种质资源、作物改良和评价信息的综合管理系统———国际作物信息系统(Internationalcrop Information System,简称IcIS)的一个重要子系统, IRIS (International Rice Information System,简称IRIS)提供了水稻种质... 详细信息

作为提供全球不同作物种质资源、作物改良和评价信息的综合管理系统———国际作物信息系统(Internationalcrop Information System,简称IcIS)的一个重要子系统, IRIS (International Rice Information System,简称IRIS)提供了水稻种质系谱、田间试验、分子标记、结构和功能基因组数据以及环境数据。IRIS的数据结构设计使数据库可以储存多语种的信息。目前已有3000多份有中文名称和育种地点等信息的国内品种系谱数据存入中心数据库。用户可以通过单机或因特网(***)对数据库进行访问查询。

关键词：水稻作物改良稻种品种系谱种质资源田间试验育种信息系统国际国内

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Heating, ventilating, and air conditioning analysis and design Faye c. McQuiston, Jerald D. parker, Jeffrey D. Spitler. 5th ed.

Heating, ventilating, and air conditioning analysis and desi...

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2000年

作者： Faye c. McQuiston Jerald D. parker Jeffrey D. Spitler.

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Differences in Soil Microbial Biomass and Activity for Six Agroecosystems with a Management Disturbance Gradient

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Pedosphere 2004年第4期14卷 441-448页

作者： ZHANGWei-Jian FENGJin-Xia J.WU K.parker DepartmentofAgronomy NanjingAgriculturalUniversityNanjing210095（China）. DepartmentofPlantPathology NorthCarolinaStateUniversityRaleighNC27695（USA）

Different management practices in six agroecosystems located near Goldsboro, Nc, USA were conducted including a successional field (SU), a plantation woodlot (WO), an integrated cropping system with animals (IN), an organic farming system (OR), and two cash-grain cropping systems employing either tillage (cT) or no-tillage (NT) to examine if and how microbial biomass and activity differ in response to alterations in disturbance intensity from six land management strategies. Results showed that soil microbial biomass and activity differed, with microbial activity in intermediately disturbed ecosystems (NT, OR, IN) being significantly higher (P ＜ 0.01) than systems with either high or low disturbance intensities. There was also a significant and a highly significant ecosystem effect from the treatments on microbial biomass c (MBc) (P ＜ 0.05) and on microbial activity (respiration) (P ＜ 0.01), respectively. Multiple comparisons of mean respiration rates distinctly separated the six ecosystem types into three groups: cT ＜ NT, SU and WO ＜ OR and ***, for detecting microbial response to disturbance changes these results indicated that the active component of the soil microbial community was a better indicator than total biomass.

关键词：农业系统碳保持力干扰强度单位面积微生物数量土壤微生物活性

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Reappraisal of glucocorticoids in castrate-resistant prostate cancer

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Asian Journal of Andrology 2014年第5期16卷 666-666页

作者： Oliver Sartor christopher c.parker Johann de Bono Department of Urology and Medicine Tulane MedicalSchool Tulane New Orleans Louisiana USA Department of Urology The Royal Marsden NHSFoundation Trust Sutton UK

Recent reports and discussions of .preclinical prostate cancer models have emphasized the possibility that enzalutamide resistance may be mediated by glucocorticoid receptors （GR）.In both in vitro and xenograft animal studies, it is possible to show that the GR is up-regulated in prostate cancer cell lines and that dexamethasone reverses enzalutamide induced growth inhibition. In these model systems, GR agonists can induce a subset of androgen receptor target genes including prostate-specific antigen. These investigators also report a correlation between GR expression in patient-derived prostate cancer specimens and clinical response to enzalutamide. The authors discuss the possibility that these findings have important clinical relevance. We note that the current clinical evidence for GR mediating drug resistance or disease progression in patients with castrate-resistant prostate cancer （cRPc） is very limited at best.

关键词： Reappraisal glucocorticoids castrate-resistant

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Evaluating the regulation of transporter proteins and P-glycoprotein in rats with cholestasis and its implication for digoxin clearance

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World Journal of Gastrointestinal Pathophysiology 2022年第3期13卷 73-84页

作者： parker Giroux Patrick B Kyle chalet Tan Joseph D Edwards Michael J Nowicki Hua Liu Division of Pediatric Gastroenterology Department of PediatricsUniversity of Mississippi Medical CenterJacksonMS 39216United States Department of Pathology University of Mississippi Medical CenterJacksonMS 39216United States Department of Pharmaceutics and Drug Delivery University of MississippiOxfordMS 38677United States

BAcKGROUND cardiac and hepatic functionality are intertwined in a multifaceted *** processes involving one may affect the other through a variety of mechanisms,including hemodynamic and membrane transport *** To better understand the effect of extrahepatic cholestasis on regulations of membrane transporters involving digoxin and its implication for digoxin *** Twelve adult rats were included in this study;baseline hepatic and renal laboratory values and digoxin pharmacokinetic(PK)studies were established before evenly dividing them into two groups to undergo bile duct ligation(BDL)or a sham *** 7 d repeat digoxin PK studies were completed and tissue samples were taken to determine the expressions of cell membrane transport proteins by quantitative western blot and real-time polymerase chain *** were analyzed using SigmaStat *** between pre-surgery and post-surgery in the same experimental group were compared by paired t-test,while independent t-test was employed to compare the means between sham and BDL *** Digoxin clearance was decreased and liver function,but not renal function,was impaired in BDL *** resulted in significant up-regulation of multidrug resistance 1 expression in the liver and kidney and its down-regulation in the small *** anion transporting polypeptides(OATP)1A4 was up-regulated in the liver but down-regulated in intestine after ***4c1 expression was markedly increased in the kidney following *** The results suggest that cell membrane transporters of digoxin are regulated during extrahepatic *** regulations are favorable for increasing digoxin excretion in the kidney and decreasing its absorption from the intestine to compensate for reduced digoxin clearance due to cholestasis.

关键词： cholestasis Digoxin clearance Organic anion transporting polypeptides P-glycoproteins/multidrug resistance 1 Bile duct ligation

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