Publications by authors named "Robert Garcia"

52 Publications

International Nursing Collaboration to Establish the Philippine Quit Line: Using a Conceptual Model for Partnership and Sustainability in Global Health.

J Addict Nurs 2021 Jan-Mar 01;32(1):27-31

Abstract: Tobacco use remains the single most preventable cause of death and disability worldwide. In the Philippines, 28.3% of the people are current tobacco smokers, which is one of the highest smoking rates in Asia. The World Health Organization estimates that 10 Filipinos die every day from cancer, stroke, and lung and heart disease caused by cigarette smoke and approximately 24 million Filipinos are exposed to secondhand smoke in the home. Although there are quit lines in all 50 U.S. states and territories, there was no access to this smoking cessation program in the Philippines before the initiation of the international collaboration described in this article. In 2012, a Filipino-American nurse with extensive quit line expertise initiated collaboration between the United States and Philippine smoking cessation experts to plan the creation of a quit line at the Lung Center of the Philippines. The Conceptual Model for Partnership and Sustainability in Global Health was used as a foundation for the planning, implementation, and evaluation of the Philippine Quit Line project, which was funded in 2017 by the World Health Organization and the Philippine Department of Health. This funding and other outcomes related to nursing education about tobacco addictions in the Philippines suggest that the Partnership and Sustainability in Global Health Model can provide a blueprint for international collaboration on health projects that are rooted in real collaborative and sustainable partnerships.
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http://dx.doi.org/10.1097/JAN.0000000000000382DOI Listing
March 2021

Incorrect measurements and misleading conclusions in the article "Comparison of the efficacy of tooth alignment among lingual and labial brackets: an in vitro study".

Head Face Med 2020 Apr 22;16(1). Epub 2020 Apr 22.

Head of Department, Department of Orthodontics, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.

Background/objective: To reproduce the methods and results of the study by Alobeid et al. (2018) in which the efficacy of tooth alignment using conventional labial and lingual orthodontic bracket systems was assessed.

Materials/methods: We used the identical experimental protocol and tested (i) regular twin bracket (GAC-Twin [Dentsply]) and lingual twin bracket systems (Incognito [3M]), (ii) together with NiTi 0.014" wires (RMO), and (iii) a simulated malocclusion with a displaced maxillary central incisor in the x-axis (2 mm gingivally) and in the z-axis (2 mm labially).

Results: The method described by Alobeid et al. (2018) is not reproducible, and cannot be used to assess the efficacy of tooth alignment in labial or lingual orthodontic treatment. Major flaws concern the anteroposterior return of the Thermaloy-NiTi wire ligated with stainless steel ligatures. The reproduced experimental setting showed that a deflected Thermaloy-NiTi wire DOES NOT move back at all to its initial stage (= 0 per cent correction) because of friction and binding (see supplemented video), neither with the tested labial nor with the lingual brackets. Furthermore, an overcorrection of up to 138 per cent, which the authors indicate for some labial bracket-wire combinations and which deserves the characterization "irreal", stresses the inappropriateness of the method of measurement.Further flaws include: a) incorrect interpretation of the measurement results, where a tooth tripping around (overcorrection) is interpreted as a better outcome than a perfect 100 per cent correction; b) using a statistical test in an inappropriate and misleading way; c) uncritical copying of text passages from older publications to describe the method, which do not correspond to this experimental protocol and lead to calculation errors; d) wrong citations; e)differences in table and bar graph values of the same variable; f) using a lingual mushroom shaped 0.013" Thermaloy-NiTi wire which does not exist; g) drawing uncritical conclusions of so called "clinical relevance" from a very limited in vitro testing.

Conclusions: Clinical recommendations based on in vitro measurements using the Orthodontic Measurement and Simulation System (OMSS) should be read with caution.
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http://dx.doi.org/10.1186/s13005-020-00221-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175492PMC
April 2020

Endocannabinoid signaling as an intrinsic component of the circuits mediating adaptive responses to repeated stress exposure in adult male sprague dawley rats.

Stress 2020 03 11;23(2):174-189. Epub 2019 Sep 11.

Department of Psychology and Neuroscience and Center for Neuroscience, University of Colorado Boulder, UCB 345, Boulder, CO, 80309, USA.

Evidence implicates the endocannabinoid (eCB) system as a negative modulator of neural and endocrine responses to acute stressors. Recently, eCB signaling was also reported to contribute to habituation of hypothalamo-pituitary-adrenal (HPA) axis responses to repeated homotypic stress. The present studies were initiated to distinguish a potential role of eCB signaling in the expression vs. the acquisition of habituation of the HPA axis response to repeated stress. In each of three experiments, adult male Sprague Dawley rats were exposed to daily, 30-minute sessions of loud white noise (95 dB), which resulted in a progressive decrease in HPA axis response over successive days. Cannabinoid receptor 1 (CB1) antagonist AM251 (0.5, 1.0 or 2.0 mg/kg, i.p.) was used to examine the role of eCB signaling in homotypic stressor habituation and heterotypic (novel) stressor cross-sensitization of neuroendocrine activity. Pretreatment with high dose (2.0 mg/kg) AM251 before each of 7 consecutive, daily loud noise exposures (acquisition of habituation) resulted in potentiation of stress-induced HPA axis activation and disruption of habituation. After an 8 loud noise exposure without AM251 pretreatment, the same group of rats displayed a habituated plasma corticosterone (CORT) level similar to that of controls, indicating that CB1 receptor antagonist pretreatments did not disrupt the acquisition of habituation. In two additional experiments, rats acquired habituation to loud noise drug free, then lower doses of AM251 (0.5 and 1.0 mg.kg) were administered before a final exposure (expression of habituation) to the homotypic stressor and/or a novel heterotypic stressor. CB1 receptor antagonism disrupted the expression of CORT response habituation and some of the c- mRNA reduction associated with it and facilitated novel stressor sensitization in doses that did not potentiate acute responses to these stressors. Collectively, these data suggest a progressive intensification of neural eCB signaling at CB1 receptors with repeated stress exposures.
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http://dx.doi.org/10.1080/10253890.2019.1655538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054150PMC
March 2020

Correlation between Temporomandibular Joints and Nasal Cavity Width in Growing Patients after Rapid Maxillary Expansion.

J Contemp Dent Pract 2019 Jun 1;20(6):686-692. Epub 2019 Jun 1.

Department of Prosthodontics, School of Dental Medicine, Hadath, Lebanon.

Aim: The study tests the correlation between the enlargement of the nasal cavity width, interglenoid fossa distance, and intercondylar distance after rapid maxillary expansion (RME) in growing patients.

Materials And Methods: Cone beam computed tomography (CBCT) was performed for 25 patients presenting a bilateral crossbite (11 males, 14 females, and mean age 11.6 ± 1.6 years) at baseline (T0) and at 6 months after RME (T2), T1 being the end of expander activation. Images were digitized for linear measurements using specific software. Values were compared at the nasal width, interglenoid fossa distance, and intercondylar distance to test the correlation in the transverse dimension.

Results: At T0, a correlation already existing between the interglenoid fossa distance and the intercondylar distance persisted at T2. The correlation between the nasal cavity width and interglenoid fossa distance nonexistent at T0 ended toward statistically significant at T2. Additionally, the lateral position of the condyles was not correlated with the nasal cavity width neither at T0 or T2.

Conclusion: A correlation between the interglenoid fossa distance and intercondylar distance was exhibited 6 months after RME. The correlation between the nasal cavity width and interglenoid fossa distance was close to significant at T2.
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June 2019

Comparison of e-cigarette marketing and availability in tobacco retail outlets among diverse low-income communities in California.

Tob Control 2020 07 19;29(4):469-471. Epub 2019 Jul 19.

Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.

Objective: Research examining marketing and availability of electronic cigarettes (e-cigarettes) within tobacco retail stores is limited, especially among vulnerable communities. However, tobacco retailers tend to be the first point of access to e-cigarette exposure, especially among youth. In response, store observations were conducted among tobacco retailers across five ethnically diverse, low-income communities.

Design: Trained community health workers recorded the presence of e-cigarette products, marketing, self-service displays, product pricing and product placement in the tobacco retail environment across American-Indian Tribal lands in California (n=96) and low-income African-American, Hispanic/Latino (HL), Korean-American (KA) and Non-Hispanic White (NHW) communities in Southern California (n=679) from January 2016 to January 2017. Store characteristics and pricing were analysed by ethnic community.

Results: Compared with retailers in NHW communities, retailers across all other communities were less likely to sell e-cigarette and flavoured e-cigarette products and were less likely to have self-service displays. Compared with retailers in NHW communities, retailers across all other communities were less likely to have e-cigarettes placed near youth-friendly items, while retailers in KA and HL communities were less likely to have exterior advertising compared with retailers in NHW communities.

Conclusions: Findings indicate differences in e-cigarette availability and marketing by ethnic community. In addition, placement of products and marketing that expose youth to e-cigarette and other tobacco products within the retail environment should be restricted and regulated by policymakers and tobacco regulatory agencies to reduce the burden of tobacco-related diseases among vulnerable populations.
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http://dx.doi.org/10.1136/tobaccocontrol-2019-054985DOI Listing
July 2020

A new set of eyes: development of a novel microangioscope for neurointerventional surgery.

J Neurointerv Surg 2019 Oct 16;11(10):1036-1039. Epub 2019 Mar 16.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Background: Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice.

Objective: To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model.

Methods: In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo.

Results: Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model.

Conclusion: A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
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http://dx.doi.org/10.1136/neurintsurg-2018-014610DOI Listing
October 2019

Status epilepticus after C-4 ingestion: using liquid chromatography to quantify toxicity.

Clin Toxicol (Phila) 2019 Sep 7;57(9):819-821. Epub 2019 Feb 7.

c Department of Neurology, William Beaumont Army Medical Center , El Paso , TX , USA.

C-4, a commonly used explosive in military operations, is sometimes consumed by soldiers as a rite of passage. The primary component of C-4 is cyclotrimethylenetrinitramine, or Research Department Explosive (RDX), which causes euphoria along with nausea, vomiting, renal injury, encephalopathy and convulsions when consumed in toxic amounts. We present a case of status epilepticus caused by known ingestion of C-4, in which serum levels of the compound were measured with high-performance liquid chromatography (HPLC). A 22-year-old active-duty male with no prior medical history was brought to the ED with convulsions that only minimally improved traditional anti-epileptic treatment. EEG showed persistent epileptiform activity despite initial management. Continuous propofol infusion, lacosamide and levitiracetam eventually broke the seizures. The patient eventually reported consuming a piece of C-4 four hours prior to the start of his seizure activity. HPLC showed a peak RDX concentration of 3.06 μg/ml. RDX concentration at cessation of seizure activity was 2.43 μg/ml. Per our review of the literature, this is the first case where the explosive's toxicity could directly be measured over time in a human patient. C-4 poisoning must be considered when assessing sudden onset epileptiform activity in soldiers with access to this substance.
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http://dx.doi.org/10.1080/15563650.2018.1562069DOI Listing
September 2019

Functional and Structural Improvement with a Catalytic Carbon Nano-Antioxidant in Experimental Traumatic Brain Injury Complicated by Hypotension and Resuscitation.

J Neurotrauma 2019 07 13;36(13):2139-2146. Epub 2019 Mar 13.

2 Department of Chemistry, Rice University, Houston, Texas.

Hypotension worsens outcome after all severities of traumatic brain injury (TBI), with loss of cerebral autoregulation being a potential contributor. Previously, we demonstrated that intravenous injection of a high capacity catalytic antioxidant, poly(ethylene)glycol conjugated hydrophilic carbon clusters (PEG-HCCs) rapidly restored cerebral perfusion and acutely restored brain oxidative balance in a TBI model complicated by hemorrhagic hypotension without evidence of toxicity. Here, we tested whether these acute effects translated into behavioral and structural benefit. TBI was generated by a cortical contusion impactor in 38 Long Evans rats, followed by blood withdrawal to a target mean arterial pressure of 40 mm Hg. PEG-HCC (2 mg/kg) or diluent was injected intravenously 80 min later at the onset of blood resuscitation followed by another injection 2 h later (doses determined in prior studies). Performance on beam walking (performed on days 1-5) and Morris water maze (MWM) (performed on days 11-15) was tested, and lesion size was determined at the termination. PEG-HCC treatment nearly completely prevented motor dysfunction ( < 0.001 vs. diluent), improved MWM performance ( < 0.001; treatment vs. time interaction) and reduced lesion size by 61% ( = 0.054). Here we show that treatment with PEG-HCCs at a clinically realistic time point (onset of resuscitation) prevented a major portion of the neurological dysfunction induced in this TBI model, and that PEG-HCCs are candidates for additional study as a potential therapeutic agent.
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http://dx.doi.org/10.1089/neu.2018.6027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602099PMC
July 2019

A Conceptual Framework and Pilot Study for Examining Telemedicine Satisfaction Research.

J Med Syst 2019 Jan 25;43(3):51. Epub 2019 Jan 25.

DePaul University, Chicago, IL, USA.

Stakeholder satisfaction is often considered a key to the success of telemedicine systems. However, it can be difficult to understand and compare satisfaction evaluations because of variations in reporting and study designs. This research will contribute to the knowledge by developing a conceptual framework around key concepts that relate to understanding studies on telemedicine satisfaction. The framework is built based on a developmental review of the telemedicine and telehealth literature obtained from searches of PubMed and Google Scholar. Using a conceptual matrix, researchers have synthesized the results into a framework that includes: satisfaction dimensions, stakeholders, type of care, type of system, context and methodologies. This research expands these concepts by discussing attributes of each and tests the framework by conducting a pilot study that identifies the concepts in primary study sources. The results of the framework and the pilot study are reported.
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http://dx.doi.org/10.1007/s10916-019-1161-4DOI Listing
January 2019

Effect of Rapid Maxillary Expansion on Condyle-fossa Relationship in Growing Patients.

J Contemp Dent Pract 2018 Oct 1;19(10):1189-1198. Epub 2018 Oct 1.

Department of Prosthodontics, School of Dental Medicine, Hadath, Lebanon.

Aim: This study tests whether rapid maxillary expansion (RME) exerts long term effects on interglenoid fossa distance and condyle fossa relationship.

Materials And Methods: Consecutive growing patients aged 8 to 13 years were allocated either to the RME group or control group. Cone-beam computed tomography was performed at baseline and at 6 months. Specific software was used to determine fixed landmarks. Multivariate Analysis of Covariance (MANCOVA) models were used, with time by group interaction, using age as a covariate.

Results: Twenty-seven patients with a mean age of 11.4 ± 1.5 years were included. There was an overall significant group by time interaction (p = 0.012, effect size 0.59). Change in the lateral position of the glenoid fossa, the primary outcome, was reached (p = 0.008, effect size 0.258). Change in the laterolateral position of the center of the condyle, and the co-primary outcome was also significant (p = 0.011, effect size = 0.24). Nasal cavity width increased (p = 0.065, effect size = 0.14). There was an initial asymmetry in the horizontal position of the condyles that was carried on with no effect of RME.

Conclusion: Rapid maxillary expansion (RME) produces a significant increase in the interglenoid fossa distance and displacement of the mandibular condyles at 6 months in growing patients compared to a control group.

Clinical Significance: The current study shows that RME is effective during growth, widening the interglenoid fossa distance and the lateral positions of the condyles and eventually enlarging the nasal cavity, without causing asymmetry.
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October 2018

An Efficient Model for Designing Medical Countermeasure Just-in-Time Training During Public Health Emergencies.

Am J Public Health 2018 09;108(S3):S212-S214

All of the authors are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA.

Rapidly training numerous staff and volunteers to distribute and dispense medical countermeasures is challenging because of limited resources and evolving information during public health emergencies. The Applied Learning and Development Team within the Division of State and Local Readiness at the Centers for Disease Control and Prevention (CDC) proposes just-in-time training (JITT) templates that can be rapidly customized and implemented early in any public health emergency. The proposed template model aligns with modular training design research to increase relevance and rapid deployment of training. Two case studies are described to demonstrate the potential for training templates to support medical countermeasure responses: (1) customization and implementation of a JITT to prepare staff to work on a CDC task force during the 2016-2017 Zika virus response and (2) a new modular, customizable course to teach the basics about working at a point-of-dispensing site. Flexible JITT templates in these cases reduce the burden on emergency planners and trainers, allowing for rapidly developed, customized training viable for all emergency responses.
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http://dx.doi.org/10.2105/AJPH.2018.304599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129658PMC
September 2018

Impact of Litigation on Compliance With California Physical Education Laws in Elementary Schools.

J Phys Act Health 2018 10 6;15(10):721-729. Epub 2018 Jun 6.

Background: School physical education (PE) is one of the most effective public health tools to increase youth physical activity, yet compliance with PE mandates is low. In an effort to ensure adherence to state PE law, a 2013 lawsuit was filed against 37 California school districts that were found to be noncompliant. This study sought to assess school personnel's perceptions of the lawsuit's impact on PE mandate compliance, understand barriers and facilitators to lawsuit compliance, and identify potential unintended consequences of the lawsuit.

Methods: Phone interviews (n = 97) were conducted with personnel in districts/schools that were parties to the lawsuit and in matched control districts/schools that were not parties to the lawsuit.

Results: Interviewees reported that PE minutes increased in schools that were parties to the lawsuit, primarily due to settlement requirements mandating PE tracking and reporting, thereby increasing accountability for PE. Time lost on paperwork was the most often cited barrier to compliance. Unwillingness to participate in PE-related research for fear of incrimination was the primary unintended consequence.

Conclusions: When existing PE minute laws are not implemented or enforced, greater accountability is needed. In this case, litigation appears to be an effective accountability mechanism to increase compliance with law.
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http://dx.doi.org/10.1123/jpah.2017-0307DOI Listing
October 2018

Effect of Rapid Maxillary Expansion on Glenoid Fossa and Condyle-Fossa Relationship in Growing Patients (MEGP): Study Protocol for a Controlled Clinical Trial.

J Int Soc Prev Community Dent 2018 Mar-Apr;8(2):130-136. Epub 2018 Apr 24.

Department of Biostatistics and Epidemiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

Aims And Objectives: Rapid maxillary expansion (RME) is an orthodontic nonsurgical procedure aiming at increasing the width of the maxilla by opening mainly the intermaxillary suture in patients presenting a transverse maxillary skeletal deficiency. The objectives of the current prospective controlled clinical and radiographic study are to evaluate the hypothesis that RME in growing patients will result in radiographic changes at the level of interglenoid fossa distance, condyle-fossa relationship, and nasal cavity widths compared to the group who received no treatment initially and served as untreated control.

Materials And Methods: In this prospective controlled clinical and radiographic study, forty healthy growing patients selected from a school-based population following a large screening campaign, ranging in age between 8 and 13 years, presenting a maxillary constriction with bilateral crossbite, and candidates for RME are being recruited. The first group will include participants willing to undergo treatment ( = 25) and the other group will include those inclined to postpone ( = 15).

Results: The primary outcome is to compare radiologically the interglenoid fossa distance and the condyle-fossa relationship; nasal cavity width will be a secondary outcome. A multivariable analysis of Covariance model will be used, with the assessment of the time by group interaction, using age as covariate. The project protocol was reviewed and approved by the Ethics Committee of the Lebanese University, National Institute in Lebanon (CUEMB process number 31/04/2015). The study is funded by the Lebanese University and Centre National de Recherche Scientifique, Lebanon (Number: 652 on 14/04/2016).

Conclusion: This prospective controlled clinical trial will give information about the effect of RME on the glenoid fossa and condyle-fossa relationship and its impact on the nasal cavity width.

Trial Registration: Retrospectively registered in BioMed Central (DOI10.1186/ISRCTN77788053).
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http://dx.doi.org/10.4103/jispcd.JISPCD_458_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946521PMC
April 2018

Rapid diagnostics for bloodstream infections: A primer for infection preventionists.

Am J Infect Control 2018 09 13;46(9):1060-1068. Epub 2018 Apr 13.

Freelance Medical Editor, Vero Beach, FL. Electronic address:

Accurate and rapid antimicrobial susceptibility testing with pathogen identification in bloodstream infections is critical to life results for early sepsis intervention. Advancements in rapid diagnostics have shortened the time to results from days to hours and have had positive effects on clinical outcomes and on efforts to combat antimicrobial resistance when paired with robust antimicrobial stewardship programs. This article provides infection preventionists with a working knowledge of available rapid diagnostics for bloodstream infections.
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http://dx.doi.org/10.1016/j.ajic.2018.02.022DOI Listing
September 2018

Impact of Gruesome Photographic Evidence on Legal Decisions: A Meta-Analysis.

Psychiatr Psychol Law 2018 15;25(4):503-521. Epub 2018 Mar 15.

Department of Criminology, Law, and Society, University of California, Irvine, USA.

Gruesome crime scene and autopsy photographs are admissible evidence under the Federal Rules of Evidence (FRE) if their probative value substantially outweighs their prejudicial impact. Despite important methodological differences and mixed results from past studies, recommendations from the psychological literature have been made about the prejudicial impact of gruesome photographs perhaps prematurely. This meta-analysis investigates whether there is sufficient empirical evidence that presenting gruesome photographs in a trial affects legal decisions. The analysis of 23 studies and 4868 participants shows a small but statistically significant effect of gruesome photographs increasing guilty/liable verdicts or punishments, Hedge's = 0.143, 95% CI: [0.055, 0.232]. However, this effect is significantly, (1) = 8.086, = .004, and substantially moderated by an important methodological distinction: the effect is much larger when studies compare gruesome photographs with no photographs ( = 0.450) than when they are compared with neutral photographs ( = 0.077). These results suggest that gruesome photographs do increase affirmative verdicts, both through a small effect of gruesome content as well as a larger additive of having visual material. These findings help shed light on the mixed empirical results and suggest that important additional research is needed.
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http://dx.doi.org/10.1080/13218719.2018.1440468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818434PMC
March 2018

A Descriptive Longitudinal Study of Changes in Vape Shop Characteristics and Store Policies in Anticipation of the 2016 FDA Regulations of Tobacco Products, Including E-Cigarettes.

Int J Environ Res Public Health 2018 02 11;15(2). Epub 2018 Feb 11.

Department of Preventive Medicine, University of Southern California, 2001 N Soto St., Los Angeles, CA 90032, USA.

After proposing the "Deeming Rule" in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles-area shop employees (assessing their beliefs, awareness, and perceptions of e-cigarettes and related FDA regulations) at two time points one year apart to better understand what vape shop retailers would do given FDA's soon-to-be-enacted Deeming Rule. The study also compared retailer beliefs/awareness/actions and store characteristics immediately after the Deeming Rule proposal versus a year after the Rule had been proposed, right before its enactment. Two data collection waves occurred before the Deeming Rule enactment, with Year 1 surveying 77 shops (2014) and Year 2 surveying 61 shops (2015-2016). Between the data collection points, 16 shops had closed. Among the shops that were open at both time points, the majority (95% in Year 1; 74% in Year 2) were aware of some FDA regulations or other policies applying to vape shops. However, overall awareness of FDA regulations and state/local policies governing e-cigarettes significantly decreased from Year 1 to Year 2. At both time points, all shops offered customers free puffs of nicotine-containing e-liquids (prohibited by the then upcoming Deeming Rule). Perceptions of e-cigarette safety also significantly decreased between the years. Exploring vape shop retailer perceptions and store policies (i.e., free puffs/samples displays, perceptions of e-cigarette safety, etc.) over time will help the FDA assess the needs of the vape shop community and develop more effective retailer education campaigns and materials targeted to increase compliance with the newly enacted regulations.
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http://dx.doi.org/10.3390/ijerph15020313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858382PMC
February 2018

A national survey of interventions and practices in the prevention of blood culture contamination and associated adverse health care events.

Am J Infect Control 2018 05 1;46(5):571-576. Epub 2018 Feb 1.

Independent Clinical Consultant, Infection Prevention and Control, Stony Brook, NY.

The scientific literature indicates that blood culture contamination often leads to inappropriate antimicrobial treatment, adverse patient occurrences, and potential reporting of false-positive central line-associated bloodstream infections. The findings of a national infection prevention survey of blood culture practices and related interventions in hospitals support the need for infection preventionists to expand their participation in the review of topics related to the ordering and collection of blood for culture.
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http://dx.doi.org/10.1016/j.ajic.2017.11.009DOI Listing
May 2018

Promoting appropriate urine culture management to improve health care outcomes and the accuracy of catheter-associated urinary tract infections.

Am J Infect Control 2017 Oct 2;45(10):1143-1153. Epub 2017 May 2.

Department of Pathology, Stony Brook University Hospital, Stony Brook, NY.

Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection. Moreover, national guidelines that provide evidence-based direction on core processes that form the basis for subsequent clinical therapy decisions or surveillance interpretations; that is, the appropriate ordering and collection of urine for laboratory testing and the treatment of patients with symptomatic urinary tract infection, are not widely known or lack adherence. This article provides published evidence on the influence of inappropriate ordering of urine specimens and subsequent treatment of asymptomatic bacteriuria and associated adverse effects; reviews research on bacterial contamination and preservation; and delineates best practices in the collection, handling, and testing of urine specimens for culture or for biochemical analysis in both catheterized and noncatheterized patients. The goal is to provide infection preventionists (IPs) with a cohesive evidence-based framework that will assist them in facilitating the implementation of a urine culture management program that reduces patient harms, enhances the accuracy of catheter-associated urinary tract infection surveillance, improves antibiotic stewardship, and reduces costs.
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http://dx.doi.org/10.1016/j.ajic.2017.03.006DOI Listing
October 2017

Who walks into vape shops in Southern California?: a naturalistic observation of customers.

Tob Induc Dis 2016 26;14:18. Epub 2016 May 26.

Department of Preventive Medicine, University of Southern California, 2001 N. Soto Street, SSB 302A, Los Angeles, CA 90032 USA ; Department of Sociology, University of Southern California, Los Angeles, CA USA.

Background: The rising popularity of electronic cigarettes (e-cigarettes) has been accompanied by the proliferation of vape shops in the United States. Vape shops are devoted to the sale of e-cigarettes and e-juices. This study aimed to describe the age, gender, and ethnicity of customers who frequent these shops, determine whether conversations transpire between retailers and customers, as well as identify the types of activities taking place while customers are inside the store.

Methods: A naturalistic observation study of 186 customers in 59 vape shops in Southern California was completed in locations that were relatively high in Korean, Non-Hispanic white, Hispanic, or African American ethnicity.

Results: Across all shops, the average estimated age of customers was 30.29 years old (SD = 9.70), 53 % were estimated to be non-Hispanic white, and 79 % were males; few minors entered the shops. Conversations about vaping related topics were prevalent (e.g., sampling e-juices, receiving help on hardware, and talking about vaping). Purchases were commonly observed as well as customers lounging in the shop.

Conclusion: Vape shops provide consumers a place to purchase and discuss e-cigarettes and offer an environment that serves as a place of recreation with customers lounging once inside. Findings should inform local tobacco control efforts and regulatory policies in the future.
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http://dx.doi.org/10.1186/s12971-016-0082-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880826PMC
May 2016

Vape shop retailers' perceptions of their customers, products and services: A content analysis.

Tob Prev Cessat 2016 11;2(Suppl). Epub 2017 May 11.

University of Southern California, United States.

Introduction: The popularity of electronic cigarettes (e-cigarettes) has spurred the growth of vape shops, but little is known about the retailers who may play an important role in the introduction and dissemination of vape products. In this paper we examine how retailers profile their customers and their perceptions of vaping, and the services their shops provide.

Methods: Semi-structured interviews were conducted with a convenience sample of retailers (n=77) located across southern California. Open-ended questions were coded and analyzed using a content analysis approach.

Results: Three themes emerged from the content analysis: who vapes, why people vape, and the vape shop environment. Retailers profiled customers as friendly, health conscious, and interested in tobacco cessation or cessation maintenance. Retailers believed e-cigarettes were used recreationally or as products that help curb other addictive behaviors. While most retailers reported positive experiences with vaping, some reported potentially negative experiences including failed cessation attempts, dual use of e-cigarettes and combustible cigarettes, and increased nicotine dependence. Retailers reported that they regularly answer questions about vaping and believe their shops function as social lounges that are tied to other recreational activities.

Conclusions: Retailers attach certain characteristics to their clientele, perceive certain health benefits associated with vaping, and seek to establish their shops as places that provide guidance on vape products as well as shops with a recreational aesthetic. As vape shops grow in popularity, additional research on, and regulation of, these retailers will be necessary. Education campaigns are needed to inform retailers of the benefits and consequences of vaping.
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http://dx.doi.org/10.18332/tpc/70345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517047PMC
May 2017

Employee and customer handling of nicotine-containing e-liquids in vape shops.

Tob Prev Cessat 2016 20;2(Suppl). Epub 2017 Jan 20.

University of Southern California, Los Angeles, USA.

Introduction: Vape shops sell electronic cigarettes and related products such as e-liquids, which may contain nicotine. Direct contact with nicotine can lead to adverse health effects, and few regulations exist on how nicotine is handled in vape shops. This study examined how customers and employees come into contact with, and handle, nicotine-containing e-liquids in vape shops with the goal of informing potential future regulation of nicotine handling in vape shops.

Methods: Data were collected from 77 vape shops in the Los Angeles basin. Characteristics of the shops were documented by employee interviews and in store observations. Data collection was focused on shops located in areas with high concentrations of communities of interest; 20 shops from African-American communities, 17 from Hispanic communities, 18 from Korean communities, and 22 from non-Hispanic White communities.

Results: Half of the vape shops allowed customers to sample e-liquids with nicotine. Most of the shops (83%) provided self-service sampling stations for customers. A majority of shop employees (72%) reported that spills of e-liquids containing nicotine had occurred in the past. While 64% of the shops provided safety equipment, only 34% provided equipment for proper nicotine handling. Furthermore, 62% of shop employees reported handling nicotine without gloves or other safety equipment.

Conclusions: Regulation on the handling of nicotine by customers and vape shop employees is important to prevent unsafe practices and subsequent injury. The frequent occurrence of spills and limited availability of safety equipment in vape shops highlights the need for the creation and enforcement of regulations to protect employees and customers. Appropriate safety training and equipment should be provided to employees to prevent accidental exposure to nicotine. Information on ways to safely handle nicotine should be communicated to vape shop employees and customers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484151PMC
http://dx.doi.org/10.18332/tpc/67295DOI Listing
January 2017

Tobacco Attitudes and Behaviors of Vape Shop Retailers in Los Angeles.

Am J Health Behav 2015 Nov;39(6):794-8

University of Southern California Keck School of Medicine, Los Angeles, CA, USA.

Objectives: The growing popularity of e-cigarettes has been accompanied by the proliferation of vape shops in the US. Vape shops are devoted to the sale and use of e-cigarettes, allowing customers to sample flavors and learn about different hardware from retailers. Research on vape shop retailers is lagging behind their popularity. This study documented the attitudes and behaviors regarding e-cigarettes and other tobacco products of retailers located in Los Angeles.

Methods: Surveys were conducted among retailers at 78 vape shops in 2014.

Results: The majority of retailers (76%) believed e-cigarettes are safer than combustible cigarettes, with about one-fourth believing e-cigarettes are completely safe. Retailers believed e-cigarettes are, on average, safer than products (eg, nicotine patch, gum, and inhaler) that have been approved for cessation by the FDA. About 14% of retailers reported dual use of cigarettes and e-cigarettes in the past month.

Conclusion: This is the first study to investigate tobacco-related behaviors and attitudes of vape shop retailers located in Los Angeles. Educating vape shop retailers on the benefits and harms of e-cigarettes is important, especially if retailers are to be informed about a product that is only now being considered to receive regulation from the FDA.
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http://dx.doi.org/10.5993/AJHB.39.6.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020702PMC
November 2015

Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections.

Am J Infect Control 2015 Nov 19;43(11):1222-37. Epub 2015 Aug 19.

Medical Oncology, Stony Brook University Hospital, Stony Brook, NY.

Background: A literature search was conducted using keywords for articles published in English from January 1990 to March 2015. Using criteria related to blood culture collection and handling, the search yielded 101 articles. References used also included Microbiology Laboratory standards, guidelines, and textbook information.

Results: The literature identified diverse and complex issues surrounding blood culture practices, including the impact of false-positive results, laboratory definition of contamination, effect on central line-associated bloodstream infection (CLABSI) reporting, indications for collecting blood cultures, drawing from venipuncture sites versus intravascular catheters, selection of antiseptics, use of needleless connectors, inoculation of blood culture bottles, and optimizing program management in emergency departments, education, and implementation of bundled practice initiatives.

Conclusion: Hospitals should optimize best practice in the collection, handling, and management of blood culture specimens, an often overlooked but essential component in providing optimal care of patients in all settings and populations, reducing financial burdens, and increasing the accuracy of reportable CLABSI. Although universal concepts exist in blood culture practices, some issues require further research to determine benefit. Institutions undertaking a review of their blood culture programs are encouraged to use a checklist that addresses elements that encompass the research contained in this review.
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http://dx.doi.org/10.1016/j.ajic.2015.06.030DOI Listing
November 2015

Commentary: Forces That Drive the Vape Shop Industry and Implications for the Health Professions.

Eval Health Prof 2016 09 11;39(3):379-88. Epub 2015 May 11.

Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.

At least three factors may be driving the evolution of the vape shop industry, a rapidly growing market sector that specializes in the sales of electronic cigarettes: (1) the tobacco industry, (2) the public health sector and its diverse stakeholders, and (3) consumer demand. These influences and the responses of the vape shop sector have resulted in a rapidly changing landscape. This commentary briefly discusses these three factors and the implications for the health professions, as they address the vape shop industry and its consequences for public health.
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http://dx.doi.org/10.1177/0163278715586295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021181PMC
September 2016

Consumers' perceptions of vape shops in Southern California: an analysis of online Yelp reviews.

Tob Induc Dis 2014 28;12(1):22. Epub 2014 Nov 28.

Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032 USA.

Background: E-cigarettes are sold at many different types of retail establishments. A new type of shop has emerged, the vape shop, which specializes in sales of varied types of e-cigarettes. Vape shops allow users to sample several types. There are no empirical research articles on vape shops. Information is needed on consumers' beliefs and behaviors about these shops, the range of products sold, marketing practices, and variation in shop characteristics by ethnic community and potential counter-marketing messages.

Methods: This study is the first to investigate marketing characteristics of vape shops located in different ethnic neighborhoods in Los Angeles, by conducting a Yelp electronic search and content analysis of consumer reports on vape shops they have visited. The primary measure was Yelp reviews (N = 103 vape shops in the Los Angeles, California area), which were retrieved and content coded. We compared the attributes of vape shops representing four ethnic communities: African American, Hispanic/Latino, Korean, and White.

Results: Vape shop attributes listed as most important were the selection of flavors or hardware (95%), fair prices (92%), and unique flavors or hardware (89%). Important staff marketing attributes included being friendly (99%), helpful/patient/respectful (97%), and knowledgeable/professional (95%). Over one-half of the shops were rated as clean (52%) and relaxed (61%). Relatively few of the reviews mentioned quitting smoking (32%) or safety of e-cigarettes (15%). The selection of flavors and hardware appeared relatively important in Korean ethnic location vape shops.

Conclusions: Yelp reviews may influence potential consumers. As such, the present study's focus on Yelp reviews addressed at least eight of the FDA's Center for Tobacco Products' priorities pertaining to marketing influences on consumer beliefs and behaviors. The findings suggest that there were several vape shop and product attributes that consumers considered important to disseminate to others through postings on Yelp. Lack of health warnings about these products may misrepresent their potential risk. The main influence variables were product variety and price. There was only a little evidence of influence of ethnic neighborhood; for example, regarding importance of flavors and hardware. Shop observational studies are recommended to discern safety factors across different ethnic neighborhoods.
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http://dx.doi.org/10.1186/s12971-014-0022-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258055PMC
December 2014

National trends in smoking behaviors among Mexican, Puerto Rican, and Cuban men and women in the United States.

Am J Public Health 2014 May 13;104(5):896-903. Epub 2014 Mar 13.

Lyzette Blanco and Dennis R. Trinidad are with the School of Community and Global Health, Claremont Graduate University, Claremont, CA. Robert Garcia is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Eliseo J. Pérez-Stable is with the Department of Medicine, University of California, San Francisco. Martha M. White, Karen Messer, and John P. Pierce are with the Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla.

Objectives: We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States.

Methods: We analyzed data from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods.

Results: Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers.

Conclusions: Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.
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http://dx.doi.org/10.2105/AJPH.2013.301844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987587PMC
May 2014

First, do no harm: the US sexually transmitted disease experiments in Guatemala.

Am J Public Health 2013 Dec 17;103(12):2122-6. Epub 2013 Oct 17.

Michael A. Rodriguez is with the Blum Center on Poverty and Health in Latin America and the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles. Robert García is with The City Project, Los Angeles.

Beginning in 1946, the United States government immorally and unethically-and, arguably, illegally-engaged in research experiments in which more than 5000 uninformed and unconsenting Guatemalan people were intentionally infected with bacteria that cause sexually transmitted diseases. Many have been left untreated to the present day. Although US President Barack Obama apologized in 2010, and although the US Presidential Commission for the Study of Bioethical Issues found the Guatemalan experiments morally wrong, little if anything has been done to compensate the victims and their families. We explore the backdrop for this unethical medical research and violation of human rights and call for steps the United States should take to provide relief and compensation to Guatemala and its people.
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http://dx.doi.org/10.2105/AJPH.2013.301520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828982PMC
December 2013

Physical education and student activity: evaluating implementation of a new policy in Los Angeles public schools.

Ann Behav Med 2013 Feb;45 Suppl 1:S122-30

Samuels & Associates, 1222 Preservation Way, Oakland, CA 94612, USA.

Background: California law has standards for physical education (PE) instruction in K-12 public schools; audits found that the Los Angeles Unified School District did not enforce the standards. In 2009, the district adopted a PE policy to comply with these standards.

Purpose: This study aimed to evaluate the outcomes of the PE policy in district schools.

Methods: PE class observations were conducted using the System for Observing Fitness Instruction Time in the 2010-2011 and 2011-2012 school years in an income-stratified random sample of 34 elementary, middle, and high schools to assess changes in PE class size, class duration, and time students spent in moderate to vigorous physical activity.

Results: PE class duration increased in high-income elementary schools. Mean class size decreased in low-income middle schools.

Conclusions: There was limited implementation of the PE policy 2 years after passage. Opportunities exist to continue monitoring and improving PE quantity and quality.
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http://dx.doi.org/10.1007/s12160-012-9431-0DOI Listing
February 2013

Treatment of mild traumatic brain injury with an erythropoietin-mimetic peptide.

J Neurotrauma 2013 May 20;30(9):765-74. Epub 2012 Sep 20.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.

Mild traumatic brain injury (mTBI) results in an estimated 75-90% of the 1.7 million TBI-related emergency room visits each year. Post-concussion symptoms, which can include impaired memory problems, may persist for prolonged periods of time in a fraction of these cases. The purpose of this study was to determine if an erythropoietin-mimetic peptide, pyroglutamate helix B surface peptide (pHBSP), would improve neurological outcomes following mTBI. Sixty-four rats were randomly assigned to pHBSP or control (inactive peptide) 30 μg/kg IP every 12 h for 3 days, starting at either 1 hour (early treatment) or 24 h (delayed treatment), after mTBI (cortical impact injury 3 m/sec, 2.5 mm deformation). Treatment with pHBSP resulted in significantly improved performance on the Morris water maze task. Rats that received pHBSP required 22.3±1.3 sec to find the platform, compared to 26.3±1.3 sec in control rats (p=0.022). The rats that received pHBSP also traveled a significantly shorter distance to get to the platform, 5.0±0.3 meters, compared to 6.1±0.3 meters in control rats (p=0.019). Motor tasks were only transiently impaired in this mTBI model, and no treatment effect on motor performance was observed with pHBSP. Despite the minimal tissue injury with this mTBI model, there was significant activation of inflammatory cells identified by labeling with CD68, which was reduced in the pHBSP-treated animals. The results suggest that pHBSP may improve cognitive function following mTBI.
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http://dx.doi.org/10.1089/neu.2012.2431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653382PMC
May 2013

Histopathological and behavioral effects of immediate and delayed hemorrhagic shock after mild traumatic brain injury in rats.

J Neurotrauma 2012 Jan 6;29(2):322-34. Epub 2012 Jan 6.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

The purpose of this study was to investigate the increased susceptibility of the brain, after a controlled mild cortical impact injury, to a secondary ischemic insult. The effects of the duration and the timing of the secondary insult after the initial cortical injury were studied. Rats anesthetized with isoflurane underwent a 3 m/sec, 2.5-mm deformation cortical impact injury followed by hypotension to 40 mm Hg induced by withdrawing blood from a femoral vein. The duration of hypotension was varied from 40 to 60 min. The timing of 60 min of hypotension was varied from immediately post-injury to 7 days after the injury. Outcome was assessed by behavioral tasks and histological examination at 2 weeks post-injury. A separate group of animals underwent measurement of the acute physiology including mean blood pressure (MAP), intracranial pressure (ICP), and cerebral blood flow (CBF) using a laser Doppler technique. Increasing durations of hypotension resulted in marked expansion of the contusion, from 6.5±1.8 mm³ with sham hypotension to 27.1±3.9 mm³ with 60 min of hypotension. This worsening of the contusion was found only when then hypotension occurred immediately after injury or at 1 h after injury. CA3 neuron loss followed a similar pattern, but the injury group differences were not significant. Motor tasks, including beam balance and beam walking, were significantly worse following 50 and 60 min of hypotension. Performance on the Morris water maze task was also significantly related to the injury group. Studies of the acute cerebral hemodynamics demonstrated that CBF was significantly more impaired during hypotension in the animals that underwent the mild TBI compared to those that underwent sham TBI. The perfusion deficit was worst at the impact site, but also significant in the pericontusional brain. With 50 and 60 min of hypotension, CBF did not recover following resuscitation at the impact site, and recovered only transiently in the pericontusional brain. These results demonstrate that mild TBI, like more severe levels of TBI, can impair the brain's ability to maintain CBF during a period of hypotension, and result in a worse outcome.
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http://dx.doi.org/10.1089/neu.2011.1979DOI Listing
January 2012