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Extracorporeal membrane oxygenation for overwhelming Blastomyces dermatitidis pneumonia
Heidi J Dalton, James H Hertzog, Robert L Hannan, Phyllis Vezza, Gabriel J Hauser
Critical Care , 1999, DOI: 10.1186/cc349
Abstract: Blastomyces dermatitidis, a fungus that is endemic to the midwestern and southcentral USA, is a relatively common cause of pulmonary and cutaneous mycosis in these areas. Both respiratory and extrapulmonary infections are commonly initiated with the inhalation of fungal spores. Following the introduction of amphotericin B, the fatality rate has fallen from 78% to between 21–28%. If a total dose of 2 g amphotericin B is given, the cure rate may rise to 97% [1]. However, if blastomycosis pneumonia is associated with the development of the acute respiratory distress syndrome (ARDS), the mortality rate rises to 50%–80% [2].Extracorporeal membrane oxygenation (ECMO) has been used successfully to support newborn, pediatric and adult patients with cardiac and respiratory diseases that are refractory to conventional therapy. Survival rates of 80% have been achieved in the 13000 neonates who have been supported with ECMO, while survival in the 1500 pediatric patients listed in the International Extracorporeal Life Support Registry who have received ECMO for respiratory failure is 53%. Of the 547 adults listed in the registry, 47% have survived [3].In general, a primary fungal infection, especially when the infection is hematogenous, is a contraindication to the use of ECMO. Historically, patients with hematogenous fungal infections do poorly on ECMO, primarily because the mycosis cannot be eradicated from the synthetic surfaces of the ECMO circuit. The restriction against ECMO support for cardiorespiratory failure secondary to fungal pneumonia without hematogenous spread is less certain. In theory, this condition should not preclude the use of ECMO, but no reports about the use of ECMO in this situation are available.We report our experience with the use of ECMO to support a previously healthy adolescent with respiratory failure secondary to blastomycosis pneumonia to raise awareness of this disease as a cause of pneumonia and better understand the use and limitation of extr
Intra- and inter-individual variation of BIS-index? and Entropy? during controlled sedation with midazolam/remifentanil and dexmedetomidine/remifentanil in healthy volunteers: an interventional study
Matthias Haenggi, Heidi Ypparila-Wolters, Kathrin Hauser, Claudio Caviezel, Jukka Takala, Ilkka Korhonen, Stephan M Jakob
Critical Care , 2009, DOI: 10.1186/cc7723
Abstract: Ten healthy volunteers were sedated in a stepwise manner with doses of either midazolam and remifentanil or dexmedetomidine and remifentanil. One week later the procedure was repeated with the remaining drug combination. The doses were adjusted to achieve three different sedation levels (Ramsay Scores 2, 3 and 4) and controlled by a computer-driven drug-delivery system to maintain stable plasma concentrations of the drugs. At each level of sedation, BIS? and Entropy? (response entropy and state entropy) values were recorded for 20 minutes. Baseline recordings were obtained before the sedative medications were administered.Both inter-individual and intra-individual variability increased as the sedation level deepened. Entropy? values showed greater variability than BIS? values, and the variability was greater during dexmedetomidine/remifentanil sedation than during midazolam/remifentanil sedation.The large intra-individual and inter-individual variability of BIS? and Entropy? values in sedated volunteers makes the determination of sedation levels by processed electroencephalogram (EEG) variables impossible. Reports in the literature which draw conclusions based on processed EEG variables obtained from sedated intensive care unit (ICU) patients may be inaccurate due to this variability.clinicaltrials.gov Nr. NCT00641563.Pain and anxiety are highly prevalent in critically ill patients in intensive care units (ICUs). Sedation, frequently necessary to maintain patient comfort in ICUs, often has undesirable side effects [1,2]. Strategies to reduce the amount of sedatives used have been shown to improve outcomes [3,4]. To avoid oversedation, sedation levels are assessed, usually by waking the patient regularly and evaluating their responses using a validated scoring system, such as the Ramsay Score (RS) [5], the Sedation-Agitation Scale (SAS) [6] or the Richmond Agitation Sedation Score (RASS) [7]. Although sedation guidelines recommend using a structured assessment system
Serotonin transporter gene polymorphisms and brain function during emotional distraction from cognitive processing in posttraumatic stress disorder
Rajendra A Morey, Ahmad R Hariri, Andrea L Gold, Michael A Hauser, Heidi J Munger, Florin Dolcos, Gregory McCarthy
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-76
Abstract: We investigated whether SLC6A4 promoter polymorphisms (5-HTTLPR, rs25531) and several downstream single nucleotide polymorphisms (SNPs) modulated activity of brain regions involved in the cognitive control of emotion in post-9/11 veterans with PTSD. We used functional MRI to examine neural activity in a PTSD group (n = 22) and a trauma-exposed control group (n = 20) in response to trauma-related images presented as task-irrelevant distractors during the active maintenance period of a delayed-response working memory task. Regions of interest were derived by contrasting activation for the most distracting and least distracting conditions across participants.In patients with PTSD, when compared to trauma-exposed controls, rs16965628 (associated with serotonin transporter gene expression) modulated task-related ventrolateral PFC activation and 5-HTTLPR tended to modulate left amygdala activation. Subsequent to combat-related trauma, these SLC6A4 polymorphisms may bias serotonin signaling and the neural circuitry mediating cognitive control of emotion in patients with PTSD.The SLC6A4 SNP rs16965628 and 5-HTTLPR are associated with a bias in neural responses to traumatic reminders and cognitive control of emotions in patients with PTSD. Functional MRI may help identify intermediate phenotypes and dimensions of PTSD that clarify the functional link between genes and disease phenotype, and also highlight features of PTSD that show more proximal influence of susceptibility genes compared to current clinical categorizations.Imaging genetics has been used to identify the role of genes in modulating brain differences associated with behavioral and cognitive symptom features in a number of psychiatric disorders [1,2], including mood disorders [3], anxiety disorders [4-6], and schizophrenia [7]. Whereas imaging genetics has generally relied on exploration of candidate gene effects, gene discovery has generally been accomplished through genome wide association studies (GWAS). Rece
New Insights into the Bacterial Fitness-Associated Mechanisms Revealed by the Characterization of Large Plasmids of an Avian Pathogenic E. coli
Melha Mellata, Jacob T. Maddux, Timothy Nam, Nicholas Thomson, Heidi Hauser, Mark P. Stevens, Suman Mukhopadhyay, Shameema Sarker, Aurélie Crabbé, Cheryl A. Nickerson, Javier Santander, Roy Curtiss
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0029481
Abstract: Extra-intestinal pathogenic E. coli (ExPEC), including avian pathogenic E. coli (APEC), pose a considerable threat to both human and animal health, with illness causing substantial economic loss. APEC strain χ7122 (O78:K80:H9), containing three large plasmids [pChi7122-1 (IncFIB/FIIA-FIC), pChi7122-2 (IncFII), and pChi7122-3 (IncI2)]; and a small plasmid pChi7122-4 (ColE2-like), has been used for many years as a model strain to study the molecular mechanisms of ExPEC pathogenicity and zoonotic potential. We previously sequenced and characterized the plasmid pChi7122-1 and determined its importance in systemic APEC infection; however the roles of the other pChi7122 plasmids were still ambiguous. Herein we present the sequence of the remaining pChi7122 plasmids, confirming that pChi7122-2 and pChi7122-3 encode an ABC iron transport system (eitABCD) and a putative type IV fimbriae respectively, whereas pChi7122-4 is a cryptic plasmid. New features were also identified, including a gene cluster on pChi7122-2 that is not present in other E. coli strains but is found in Salmonella serovars and is predicted to encode the sugars catabolic pathways. In vitro evaluation of the APEC χ7122 derivative strains with the three large plasmids, either individually or in combinations, provided new insights into the role of plasmids in biofilm formation, bile and acid tolerance, and the interaction of E. coli strains with 3-D cultures of intestinal epithelial cells. In this study, we show that the nature and combinations of plasmids, as well as the background of the host strains, have an effect on these phenomena. Our data reveal new insights into the role of extra-chromosomal sequences in fitness and diversity of ExPEC in their phenotypes.
A marketing science perspective on recognition-based heuristics (and the fast-and-frugal paradigm)
John Hauser
Judgment and Decision Making , 2011,
Abstract: Marketing science seeks to prescribe better marketing strategies (advertising, product development, pricing, etc.). To do so we rely on models of consumer decisions grounded in empirical observations. Field experience suggests that recognition-based heuristics help consumers to choose which brands to consider and purchase in frequently-purchased categories, but other heuristics are more relevant in durable-goods categories. Screening with recognition is a rational screening rule when advertising is a signal of product quality, when observing other consumers makes it easy to learn decision rules, and when firms react to engineering-design constraints by offering brands such that a high-level on one product feature implies a low level on another product feature. Experience with applications and field experiments suggests four fruitful research topics: deciding how to decide (endogeneity), learning decision rules by self-reflection, risk reduction, and the difference between utility functions and decision rules. These challenges also pose methodological cautions.
Discusión: género y psicoanálisis. Cuando lo reprimido vuelve: lo subversivo de la subjetividad femenina
Ursula Hauser
Actualidades en Psicología , 2002,
Die Entzauberung einer Ikone: Annette Schlichters Studie über den weiblichen Wahnsinn Breaking the Spell of an Icon: Annette Schlichter’s Dissertation on Female Insanity
Claudia Hauser
querelles-net , 2002,
Abstract: Die repr sentationskritisch angelegte Studie Annette Schlichters setzt sich mit lteren feministischen – literarischen und theoretischen – Texten zum weiblichen Wahnsinn“ auseinander. Am Beispiel von Sylvia Plaths Roman The Bell Jar zeigt sie die Schw chen des soziokulturellen Zugangs von Phyllis Chesler und Elaine Showalter, der die Analogie von Weiblichkeit und Wahnsinn reproduziert. Einen m glichen Ausweg aus dem Repr sentationsdilemma erm glicht nach Schlichter das Genre der Theorie-Fiktion, wie es Luce Irigarays Essays This Sex Which Is Not One“ und When Our Lips Speak Together“ und Kathy Ackers Roman Don Quixote – which was a dream“ zeigen. Hier seien Ans tze einer Resignifikation von Weiblichkeit festzustellen. Annette Schlichter’s study of madness and representation analyses older works on women and madness, drawing on both fiction and theory. Using Sylvia Plath’s novel The Bell Jar as an example, she demonstrates the weaknesses of Phyllis Chesler’s and Elaine Showalter’s socio-cultural approach which reproduces the analogy of femininity and insanity. According to Schlichter, the genre of theory-fiction—such as Luce Irigaray’s essays “This Sex Which Is Not One” and “When Our Lips Speak Together”, or Kathy Acker’s novel “Don Quixote—which was a dream”—provide one possible solution to the dilemma of representation, as these works show beginnings of a resignification of femininity.
Cechy kliniczne choroby afektywnej dwubiegunowej wyst puj ce rodzinnie – przes anka do badań genetyczno-molekularnych
Joanna Hauser
Neuropsychiatria i Neuropsychologia , 2007,
Abstract: Epidemiological studies suggest that individual variationin susceptibility to bipolar affective disorder (BP) islargely genetic, reflecting alleles of moderate effect inmultiple genes. Molecular genetic studies have identifiedseveral potential regions of linkage, but specific genesthat contribute to the illness remain unclear. Progressin identifying the genetic basis of bipolar affectivedisorder has been disappointing probably because ofgenetic and phenotypic heterogeneity of this illness. Itis highly likely that using alternative phenotypes insteadof only DSM and ICD diagnostic criteria will lead morerapid success in the search for susceptibility genes. BPis clinically heterogeneous, and clinical features that runin families may help define more homogeneousphenotypes. The objective of this paper is to describeclinical phenotypes that can be employed in psychiatricgenetic studies of BP. Linkage and association studiesare summarized in reference to subtypes of BP.
Farmakogenomika leków przeciwdepresyjnych
Joanna Hauser
Neuropsychiatria i Neuropsychologia , 2006,
Abstract: Genetic factors are believed to play a major role in thevariation of treatment response and the incidence ofadverse effects of medications. Pharmacogenetics isconcerned with the role of genetic factors in predictingdrug response and adverse effects. This requires someknowledge of either the drug’s pharmacokinetic orpharmacodynamic profile so that candidate genes can bestudied. Considering the hypothesis for the mechanismof action of antidepressants, most pharmacogeneticstudies have concentrated on polymorphisms in genesinvolved in the serotonergic and noradrenergic system.Many studies have reported an association between theresponse to SSRI and 5-HTTLPR polymorphism. Theaim of pharmacogenomic is to study the relationshipbetween whole genome factors including the expressedtranscriptome and proteome and drug response. It ishoped that pharmacogenomic studies will lead to theprediction of response to antidepressants and reductionof adverse effects.
H ufigkeit der einzelnen klimakterischen Symptome und ihr unterschiedliches Ansprechen auf die Hormonersatztherapie
Hauser GA
Journal für Menopause , 1999,
Abstract: Die Analyse von 100 Frauen mit klimakterischen Beschwerden, beurteilt nach der Menopause Rating Scale I ab Therapiebeginn und verfolgt über Monate und Jahre, ergibt neue Aspekte. Die H ufigkeit der einzelnen Symptome entspricht nicht den Angaben in der Literatur, insbesondere klagen nur unter 80 % über Wallungen, beachtenswerte 69 % über Gelenk- und Muskelbeschwerden und 53 % über Sexualst rungen. Das Ansprechen auf die Hormonersatztherapie entspricht nicht der H ufigkeit; so reagieren beispielsweise funktionelle Herzbeschwerden (die nur 42 % der Patientinnen als Symptom angeben) in 97 % positiv, die Sexualst rungen, die nur in 53 % der F lle vorkommen, reagieren immerhin in 74 % positiv. Auch der Beginn der Besserung stellt sich je nach Symptom unterschiedlich früh ein. W hrend Wallungen, Schlafst rungen und Nervosit t schnell (innerhalb 10 Tagen) und intensiv reagieren, verzeichnen Gelenk-/Muskelbeschwerden und Sexualst rungen durchschnittlich eine Versp tung bis zu einigen Monaten. Mittelschwere und leichte Symptome reagieren auf Hormonersatztherapie vergleichbar wie die schweren Symptome, nicht etwa mehr oder weniger. Wenn z. B. Wallungen unter der Therapie verschwinden, die Sexualst rungen aber noch nicht, so kann sp ter ohne weiteres auch bei diesem Symptom Besserung eintreten. Bisher war die differenzierte Wirkung der Hormonersatztherapie auf die einzelnen Symptome nicht bekannt. Diese Kenntnisse k nnen für die Compliance bei der Betreuung der Frauen eine gro e Rolle spielen.
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