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Pediatric Emergency Care Sep 2014Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control... (Review)
Review
Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration. Acceptance of damage-control resuscitation strategies is reflected in recent changes in the American College of Surgeons' Advanced Trauma Life Support curriculum; the most recent edition has decreased its initial fluid recommendation to 1 L from 2 L, and it now recommends early administration of blood products without specifying any specific ratio. These recommendations are not advocating permissive hypotension or hemostatic resuscitation directly but represent an initial step toward limiting fluid resuscitation and using blood products to treat coagulopathy earlier. Evidence for permissive hypotension exists in animal studies and few adult clinical trials. There is no evidence to support permissive hypotension strategies in pediatrics. Evidence for hemostatic resuscitation in adult trauma management is more comprehensive, and there are limited data to support its use in pediatric trauma patients with severe hemorrhage. Additional studies on the management of children with severe uncontrolled hemorrhage are needed.
Topics: Adult; Animals; Blood Transfusion; Clinical Protocols; Fluid Therapy; Hemorrhage; Humans; Hypotension; Resuscitation
PubMed: 25186511
DOI: 10.1097/PEC.0000000000000217 -
Alcoholism, Clinical and Experimental... Apr 2019Studies have shown that parents have a significant influence on emerging adult college students' drinking during the first year of college. Limited research has been...
BACKGROUND
Studies have shown that parents have a significant influence on emerging adult college students' drinking during the first year of college. Limited research has been conducted to address the question of whether parenting later in college continues to matter in a similar manner. The current study utilized a prospective design to identify associations between parental permissiveness toward alcohol use and monitoring behaviors and student drinking outcomes during the first and fourth years of college.
METHODS
Participants (N = 1,429) at 3 large public universities completed surveys during the fall semesters of their first (T1) and fourth years (T2) (84.3% retention). The study employed a saturated autoregressive cross-lag model to examine associations between parental permissiveness of college student alcohol use, parental monitoring, student drinking, and consequences at T1 and T2, controlling for peer norms, sex, and campus.
RESULTS
Examination of the association between parenting and student drinking outcomes revealed: (i) parental permissiveness was positively associated with drinking at T1 and again at T2; (ii) parental permissiveness had indirect effects on consequences via the effects on drinking at both times. Specifically, a 1-unit increase in parental permissiveness at T1 resulted in students experiencing 4 to 5 more consequences as a result of their drinking; (iii) parental permissiveness was not directly associated with monitoring at T1 or T2; and (iv) parental monitoring was significantly associated with drinking at T1 but not T2.
CONCLUSIONS
The findings provide evidence for the continued importance of parenting in the fourth year of college and parents expressing low permissiveness toward student drinking may be beneficial to reducing risky drinking even as students turn 21.
Topics: Adolescent; Alcohol Drinking in College; Female; Humans; Male; Parenting; Permissiveness; Prospective Studies; Time Factors; Young Adult
PubMed: 30748022
DOI: 10.1111/acer.13978 -
Aesthetic Plastic Surgery Dec 2023Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore,... (Review)
Review
BACKGROUND/PURPOSE
Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty.
METHODS
A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature.
RESULTS
Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled.
CONCLUSION
Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Hemorrhage; Hypotension; Rhinoplasty; Treatment Outcome; Postoperative Complications
PubMed: 36877227
DOI: 10.1007/s00266-023-03298-y -
MBio Jun 2022Chikungunya virus (CHIKV) is an arthritogenic reemerging virus replicating in plasma membrane-derived compartments termed "spherules." Here, we identify the human...
Chikungunya virus (CHIKV) is an arthritogenic reemerging virus replicating in plasma membrane-derived compartments termed "spherules." Here, we identify the human transmembrane protein CD81 as host factor required for CHIKV replication. Ablation of CD81 results in decreased CHIKV permissiveness, while overexpression enhances infection. CD81 is dispensable for virus uptake but critically required for viral genome replication. Likewise, murine CD81 is crucial for CHIKV permissiveness and is expressed in target cells such as dermal fibroblasts, muscle and liver cells. Whereas related alphaviruses, including Ross River virus (RRV), Semliki Forest virus (SFV), Sindbis virus (SINV) and Venezuelan equine encephalitis virus (VEEV), also depend on CD81 for infection, RNA viruses from other families, such as coronaviruses, replicate independently of CD81. Strikingly, the replication-enhancing function of CD81 is linked to cholesterol binding. These results define a mechanism exploited by alphaviruses to hijack the membrane microdomain-modeling protein CD81 for virus replication through interaction with cholesterol. In this study, we discover the tetraspanin CD81 as a host factor for the globally emerging chikungunya virus and related alphaviruses. We show that CD81 promotes replication of viral genomes in human and mouse cells, while virus entry into cells is independent of CD81. This provides novel insights into how alphaviruses hijack host proteins to complete their life cycle. Alphaviruses replicate at distinct sites of the plasma membrane, which are enriched in cholesterol. We found that the cholesterol-binding ability of CD81 is important for its function as an alphavirus host factor. This discovery thus broadens our understanding of the alphavirus replication process and the use of host factors to reprogram cells into virus replication factories.
Topics: Animals; Chikungunya Fever; Chikungunya virus; Cholesterol; Humans; Mice; Tetraspanins; Virus Replication; Viruses
PubMed: 35612284
DOI: 10.1128/mbio.00731-22 -
Critical Care (London, England) Feb 2020Despite sound basis to suspect that aggressive and early administration of nutritional support may hold therapeutic benefits during sepsis, recommendations for... (Review)
Review
Despite sound basis to suspect that aggressive and early administration of nutritional support may hold therapeutic benefits during sepsis, recommendations for nutritional support have been somewhat underwhelming. Current guidelines (ESPEN and ASPEN) recognise a lack of clear evidence demonstrating the beneficial effect of nutritional support during sepsis, raising the question: why, given the perceived low efficacy of nutritionals support, are there no high-quality clinical trials on the efficacy of permissive underfeeding in sepsis? Here, we review clinically relevant beneficial effects of permissive underfeeding, motivating the urgent need to investigate the clinical benefits of delaying nutritional support during sepsis.
Topics: Critical Illness; Energy Intake; Enteral Nutrition; Humans; Nutritional Requirements; Nutritional Support; Sepsis
PubMed: 32059698
DOI: 10.1186/s13054-020-2771-4 -
Journal of Adolescence Dec 2018There are concerns that pornography use increases adolescents' sexual permissiveness, leading to sexual risk-taking. In contrast to most longitudinal explorations of the...
INTRODUCTION
There are concerns that pornography use increases adolescents' sexual permissiveness, leading to sexual risk-taking. In contrast to most longitudinal explorations of the relationship between adolescent pornography use and sexual permissiveness, which were carried out in highly liberal and permissive societies, we aimed to re-assess the target relationship in a more traditional, highly religious society.
METHODS
Informed by the social learning and selective exposure theoretical underpinnings, we used two independent panels of Croatian female and male adolescents (on average 16 years old) to assess the association over 18 and 24 months. Online surveying was used in the Zagreb (n = 372) and classroom-based surveying in the Rijeka panels (n = 753).
RESULTS
Participants reported relatively low levels of permissiveness, but substantial pornography use-particularly adolescent men. Contrary to earlier studies, we observed no significant paths leading from pornography use to sexual permissiveness. The paths leading from sexual permissiveness to pornography use were significant only among female participants in the Zagreb sample and male participants in the Rijeka sample. However, significant and positive covariances between the two constructs suggested the role of unobserved variables.
CONCLUSIONS
In line with the selective exposure hypothesis and the integrative models, this study's findings challenge the notion that pornography use increases sexual permissiveness among adolescents. Although this is reassuring, comprehensive sexuality education and media literacy programs remain important tasks for educational policy in the Information age.
Topics: Adolescent; Adolescent Behavior; Croatia; Erotica; Female; Humans; Longitudinal Studies; Male; Permissiveness; Sexual Behavior; Surveys and Questionnaires
PubMed: 30265879
DOI: 10.1016/j.adolescence.2018.09.006 -
Current Nutrition Reports Mar 2020The childhood obesity epidemic is widely considered to have reached pandemic proportions. Across the world, children with obesity are facing numerous psychological and... (Review)
Review
PURPOSE OF REVIEW
The childhood obesity epidemic is widely considered to have reached pandemic proportions. Across the world, children with obesity are facing numerous psychological and physiological issues that follow them into adulthood, frequently leading to chronic illness and early death. In an effort to combat the compounding effects of childhood overweight, researchers are attempting to identify biological and environmental contributors to child weight. Parenting styles are one recognized influence on child diet and body mass index (BMI). This review is a comprehensive examination of the literature on the influence of parenting style on childhood diet and BMI over the past 5 years.
RECENT FINDINGS
Current research continues to support the use of traditional parenting style categories (i.e., authoritative, authoritarian, permissive, uninvolved/neglectful): however, newer subcategories of Baumrind's styles and the inclusion of previously underrepresented groups (e.g., fathers, cross cultural comparison studies) are shedding more light on the nuance of parenting's relationship with child weight. Parenting styles that focus on the balance of warmth and control (e.g., authoritative) in contrast to the styles dedicated to only one of these constructs (e.g., permissive, authoritarian) seem to promote the healthiest dietary habits and may be protective of child BMI.
Topics: Adolescent; Adult; Authoritarianism; Body Mass Index; Child; Diet; Female; Humans; Male; Parent-Child Relations; Parenting; Pediatric Obesity; Permissiveness; Role
PubMed: 31960342
DOI: 10.1007/s13668-020-00301-9 -
Public Health in Practice (Oxford,... Nov 2021Stricter firearm policies correlate with lower suicides by firearm in the US. However, much work examines policies in isolation and does not investigate firearm policies...
OBJECTIVES
Stricter firearm policies correlate with lower suicides by firearm in the US. However, much work examines policies in isolation and does not investigate firearm policies as they relate to US pro-gun culture. We examine the relation between permissiveness of state firearm laws, gun culture, and suicides by firearm.
STUDY DESIGN
Panel longitudinal study.
METHODS
The count of suicides by firearm for 50 US states from 2000 to 2016 served as the outcome. Permissiveness of multiple state firearm laws, based on ratings from the Traveler's Guide to the Firearm Laws of the Fifty States, served as the exposure. These ratings, measured at the state-year, capture not only the overall policy environment but also the extent to which the state exhibits a pro-gun culture. We applied a fixed effects negative binomial count model, which controls for the population-at-risk, to examine suicides overall and by race/ethnicity and gender.
RESULTS
A 10-unit increase in permissiveness of state firearm laws corresponds with 2% greater suicides by firearm overall (Incidence rate ratio [IRR] = 1.02; 95% CI: 1.01-1.03) and among non-Hispanic white males ([IRR] = 1.02, 95% CI: 1.01-1.02).
CONCLUSIONS
Findings, if replicated, indicate that states enacting more restrictive firearm policies, and lessening a pro-gun culture, may lead to reductions in suicide by firearm.
PubMed: 36101604
DOI: 10.1016/j.puhip.2021.100218 -
Journal of Anaesthesiology, Clinical... 2015Trauma is a leading cause of death worldwide, and almost 30% of trauma deaths are due to blood loss. A number of concerns have been raised regarding the advisability of... (Review)
Review
Trauma is a leading cause of death worldwide, and almost 30% of trauma deaths are due to blood loss. A number of concerns have been raised regarding the advisability of the classic principles of aggressive crystalloid resuscitation in traumatic hemorrhagic shock. Some recent studies have shown that early volume restoration in certain types of trauma before definite hemostasis may result in accelerated blood loss, hypothermia, and dilutional coagulopathy. This review discusses the advances and changes in protocols in fluid resuscitation and blood transfusion for treatment of traumatic hemorrhage shock. The concept of low volume fluid resuscitation also known as permissive hypotension avoids the adverse effects of early aggressive resuscitation while maintaining a level of tissue perfusion that although lower than normal, is adequate for short periods. Permissive hypotension is part of the damage control resuscitation strategy, which targets the conditions that exacerbate hemorrhage. The elements of this strategy are permissive hypotension, minimization of crystalloid resuscitation, control of hypothermia, prevention of acidosis, and early use of blood products to minimize coagulopathy.
PubMed: 26330707
DOI: 10.4103/0970-9185.161664 -
Early Intervention in Psychiatry Mar 2022Cannabis use is associated with greater likelihood of psychosis. The relationship between attitudes about cannabis and use has not been examined in youth at clinical...
AIM
Cannabis use is associated with greater likelihood of psychosis. The relationship between attitudes about cannabis and use has not been examined in youth at clinical high-risk (CHR) for psychosis. Additionally, the shifting legal landscape can provide a valuable context for evaluating use and related attitudes.
METHODS
This study included 174 participants (44 CHR, 43 healthy control [HC] youth-parent dyads). Youth completed measures of self-reported cannabis use confirmed with a urinalysis, self-perceived risk and perceived peer attitudes. Parents reported attitudes about youth use. Legalization occurred halfway during a 5-year study in Colorado, providing an opportunity to cross-sectionally examine its role in use and attitudes.
RESULTS
Frequency of youth reporting cannabis use was significantly higher in CHR (69%) than control group (30%). Use in CHR group was associated with higher perceived peer approval (r = .57), increased parental permissiveness (r = .28) and lower self-perceived risk (r = -.26). Comparing samples participating pre and post-legalization, use remained stable within each group. Group differences in parental permissiveness shifted; trend toward decrease in permissiveness in CHR group (η = .07) and a significant increase in HCs (η = .16) were observed. Post-legalization, use in CHR group correlated with higher perceived peer approval (r = .64), lower self-perceived risk (r = -.51) and higher parental permissiveness (r = .35, trend).
CONCLUSIONS
Taken together, results indicate a relationship between self and peer/parental attitudes about cannabis and use in youth at CHR for psychosis. These factors are important to consider within the legalization context given the changes in parental attitudes and a stronger association between use and attitudes in this group post-legalization.
Topics: Adolescent; Attitude; Cannabis; Humans; Parents; Psychotic Disorders
PubMed: 33942529
DOI: 10.1111/eip.13153