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Biomedical subjects

S Nunes

Publications and source records attributed to S Nunes.

At least 19 recordsLinked to original sources

Immunodiagnosis of Besnoitia besnoiti infection by ELISA and Western blot.

Besnoitia besnoiti, an obligate intracellular apicomplexan protozoan parasite, is the causative agent of bovine besnoitiosis. This infection may dramatically affect body condition and lead to irreversible infertility in males, resulting in important economical losses in livestock production. Identification of serologically positive animals is of major relevance to elaborate appropriate measures of control. While identification of clinical cases is relatively easy to carry out, the finding of subclinical forms of infection is more difficult, thus serology is considered as an appropriate diagnostic tool. In view to improve and validate immunodiagnosis, we evaluated an enzyme-linked immunosorbent assay (ELISA), complemented with a Western blot (both using a somatic B. besnoiti-tachyzoite antigen) to detect anti-B. besnoiti antibodies in bovine sera. The comparative evaluation of the 2 methods, using 13 sera from animals affected by the chronic phase of besnoitiosis and 10 asymptomatic carriers, yielded a diagnostic sensitivity of 87% for ELISA and 91% for Western blot analyses. Specificity was tested with sera from animals with confirmed Toxoplasma gondii (n=5) and Neospora caninum (n=12) infection, and with 64 negative sera from either an endemic or a non-endemic area. The ELISA specificity ranged between 96.4% and 98%, the Western blot specificity between 96.4% and 100%. The present study demonstrated that ELISA and Western blot, using in vitro generated somatic B. besnoiti antigen, is a useful tool combination to reliably detect animals that have been exposed to B. besnoiti infection, including both asymptomatic and symptomatic courses of disease.

Animals↗

Changes in respiratory mechanics and gas exchange during the acute respiratory distress syndrome.

BACKGROUND: The time course of impairment of respiratory mechanics and gas exchange in the acute respiratory distress syndrome (ARDS) remains poorly defined. We assessed the changes in respiratory mechanics and gas exchange during ARDS. We hypothesized that due to the changes in respiratory mechanics over time, ventilatory strategies based on rigid volume or pressure limits might fail to prevent overdistension throughout the disease process. METHODS: Seventeen severe ARDS patients {PaO2/FiO2 10.1 (9.2-14.3) kPa; 76 (69-107) mmHg [median (25th-75th percentiles)] and bilateral infiltrates} were studied during the acute, intermediate, and late stages of ARDS (at 1-3, 4-6 and 7 days after diagnosis). Severity of lung injury, gas exchange, and hemodynamics were assessed. Pressure-volume (PV) curves of the respiratory system were obtained, and upper and lower inflection points (UIP, LIP) and recruitment were estimated. RESULTS: (1) UIP decreased from early to established (intermediate and late) ARDS [30 (28-30) cmH2O, 27 (25-30) cmH2O and 25 (23-28) cmH2O (P=0.014)]; (2) oxygenation improved in survivors and in patients with non-pulmonary etiology in late ARDS, whereas all patients developed hypercapnia from early to established ARDS; and (3) dead-space ventilation and pulmonary shunt were larger in patients with pulmonary etiology during late ARDS. CONCLUSION: We found a decrease in UIP from acute to established ARDS. If applied to our data, the inspiratory pressure limit advocated by the ARDSnet (30 cmH2O) would produce ventilation over the UIP, with a consequent increased risk of overdistension in 12%, 43% and 65% of our patients during the acute, intermediate and late phases of ARDS, respectively. Lung protective strategies based on fixed tidal volume or pressure limits may thus not fully avoid the risk of lung overdistension throughout ARDS.

Adult↗

Natural history of drug-resistant clones of Streptococcus pneumoniae colonizing healthy children in Portugal.

A total of 3,539 Streptococcus pneumoniae (Pn) were recovered from 4,969 nasopharyngeal samples of children attending 13 day-care centers (DCCs) located in Lisbon, Portugal, during a surveillance study from January, 2001, through March, 2003, integrated in the European intervention project (EURIS, European Resistance Intervention Study). All Pn isolates were tested for anti-biotyping and drug-resistant pneumococci (DRPn) were further tested by serotyping and pulsed-field gel electrophoresis (PFGE). Overall carriage of Pn was very high (71.2%) and 39.9% of the isolates were resistant to antimicrobials (22.5% with decreased susceptibility to penicillin and 17.4% susceptible to penicillin and resistant to other antimicrobials). Serotypes 6B, 14, 23 F, 19F, and 19 A were prevalent among the 1,287 DRPn and 5.8% of the isolates were non-typeable. Eighty PFGE patterns were identified among 1,285 DRPn, and 93.1% of the DRPn belonged to 26 major clonal types that comprised: Pneumococcal Molecular Epidemiology Network (PMEN) clones (76.3%), Portuguese (PT)-DCC clones, previously detected in 1996-1999 (14.3%), and EURIS PT-DCC new clones, identified for the first time in the EURIS study, during 2001-2003 (9.4%). Comparing with previous Portuguese surveillance studies carried out since 1996, we observed that carriage increased from 47% to 71%, but no major changes were detected on the prevalence of pneumococcal serotypes. Moreover, although PMEN clones were predominant in all DCCs, in the present study the majority of them were gradually decreasing in time whereas several PT-DCC and new clones seemed to be increasing.

Anti-Bacterial Agents↗

Assessment of band-based similarity coefficients for automatic type and subtype classification of microbial isolates analyzed by pulsed-field gel electrophoresis.

Pulsed-field gel electrophoresis (PFGE) has been the typing method of choice for strain identification in epidemiological studies of several bacterial species of medical importance. The usual procedure for the comparison of strains and assignment of strain type and subtype relies on visual assessment of band difference number, followed by an incremental assignment to the group hosting the most similar type previously seen. Band-based similarity coefficients, such as the Dice or the Jaccard coefficient, are then used for dendrogram construction, which provides a quantitative assessment of strain similarity. PFGE type assignment is based on the definition of a threshold linkage value, below which strains are assigned to the same group. This is typically performed empirically by inspecting the hierarchical cluster analysis dendrogram containing the strains of interest. This approach has the problem that the threshold value selected is dependent on the linkage method used for dendrogram construction. Furthermore, the use of a linkage method skews the original similarity values between strains. In this paper we assess the goodness of classification of several band-based similarity coefficients by comparing it with the band difference number for PFGE type and subtype classification using receiver operating characteristic curves. The procedure described was applied to a collection of PFGE results for 1,798 isolates of Streptococcus pneumoniae, which documented 96 types and 396 subtypes. The band-based similarity coefficients were found to perform equally well for type classification, but with different proportions of false-positive and false-negative classifications in their minimal false discovery rate when they were used for subtype classification.

Bacterial Typing Techniques↗

Trends in drug resistance, serotypes, and molecular types of Streptococcus pneumoniae colonizing preschool-age children attending day care centers in Lisbon, Portugal: a summary of 4 years of annual surveillance.

Of the nasopharyngeal cultures recovered from 942 day care center (DCC) attendees in Lisbon, Portugal, 591 (62%) yielded Streptococcus pneumoniae during a surveillance performed in February and March of 1999. Forty percent of the isolates were resistant to one or more antimicrobial agents. In particular, 2% were penicillin resistant and 20% had intermediate penicillin resistance. Multidrug resistance to macrolides, lincosamides, and tetracycline was the most frequent antibiotype (17% of all isolates). Serotyping and molecular typing by pulsed-field gel electrophoresis were performed for 202 out of 237 drug-resistant pneumococci (DRPn). The most frequent serotypes were 6B (26%), 14 (22%), 19F (16%), 23F (10%), and nontypeable (12%). The majority (67%) of the DRPn strains were representatives of nine international clones included in the Pneumococcal Molecular Epidemiology Network; eight of them had been detected in previous studies. Fourteen novel clones were identified, corresponding to 26% of the DRPn strains. The remaining 7% of the strains were local clones detected in our previous studies. Comparison with studies conducted since 1996 in Portuguese DCCs identified several trends: (i) the rate of DRPn frequency has fluctuated between 40 and 50%; (ii) the serotypes most frequently recovered have remained the same; (iii) nontypeable strains appear to be increasing in frequency; and (iv) a clone of serotype 33F emerged in 1999. Together, our observations highlight that the nasopharynxes of children in DCCs are a melting pot of successful DRPn clones that are important to study and monitor if we aim to gain a better understanding on the epidemiology of this pathogen.

Bacterial Typing Techniques↗

Pressure-volume relationships in acute lung injury: methodological and clinical implications.

BACKGROUND: Pressure-volume relationships (PV curves) are the only available method for bedside monitoring of respiratory mechanics. Alveolar recruitment modifies the results obtained from the PV curves. We hypothesized that method-related differences may influence PV-curve guided ventilatory management. METHODS: Twelve acute lung injury (ALI) patients [PaO2/FiO2 13.0 +/- 1.5 kPa (97.6 +/- 11.3 mmHg), bilateral pulmonary infiltrates] were studied. Two PV curves [one at variable, and another at constant level of positive end-expiratory pressure (PEEP)] were obtained from each patient using constant inspiratory flow and end-inspiratory and -expiratory occlusions. Upper and lower inflection points (UIP, LIP) were estimated. Recruitment due to PEEP and during inflation was assessed by respiratory inductive plethysmography (RIP). RESULTS: (1) Pressure-volume curves at constant PEEP tended to provide higher LIP values compared with curves at variable PEEP (mean difference +/- SEM 5.1 +/- 1.9 cmH2O); and (2) recruitment occurred throughout the PV curve with no relationship with LIP or UIP. CONCLUSION: Pressure-volume curves obtained using variable PEEP translate a different physiological reality and seem to be clinically more relevant than curves constructed at constant PEEP. If curves constructed at constant PEEP are used to set the ventilator, unnecessarily high PEEP levels may be used. Respiratory inductive plethysmography technology may be used for monitoring of recruitment at the bedside.

Adolescent↗

Interactions among paternal behavior, steroid hormones, and parental experience in male marmosets (Callithrix kuhlii).

Male black tufted-ear marmosets (Callithrix kuhlii) contribute to the rearing of their offspring. Here we evaluated predictions of hypotheses suggesting that (1) T and E2 influence infant-care behavior in male marmosets, (2) levels of T and E2 are modulated by paternal experience, and (3) paternal behavior and levels of T and E2 in male marmosets covary with stress. We observed the behavior of marmosets in their family groups following the birth of infants and evaluated urinary concentrations of T, E2, and the stress hormone cortisol (CORT) among fathers before and after the birth of young. Urinary levels of T, E2, and CORT were lower among males who carried infants at high rates than males who carried at low rates, and T and CORT levels were negatively correlated with carrying rates across all males. Males had significantly lower T levels while carrying the second compared to the first litter and slightly lower rates of infant-carrying, possibly due to assistance provided by offspring of the first litter. There were increases in CORT levels of fathers after the birth of the first litter, but decreases in CORT after the birth of the second. Our results suggest a relationship in C. kuhlii between paternal behavior, hormones, and paternal experience. Rates of infant-carrying appear to be linked to hormone levels, and hormone levels in turn are affected by experience caring for young. Our data also suggest that T, E2, and CORT have synergistic influences on infant-carrying behavior or alternatively that associations between T and E2 and rates of infant-carrying are influenced by stress or other glucocorticoid-related variables. Finally, we propose a hypothesis suggesting that experience-related changes in hormones reinforce the commitment of males to successful breeding partnerships.

Animals↗

Effect of an acute increase in PCO2 on splanchnic perfusion and metabolism.

OBJECTIVES: To evaluate the acute effects of an increase in PCO2 on splanchnic tissue perfusion and metabolism. DESIGN: Clinical prospective study in the intensive care unit in a university clinic. PATIENTS: Six patients with severe acute lung injury requiring mechanical ventilation. All patients had bilateral infiltrates on chest radiography, a PaO2/FIO2 ratio less than 200 mmHg, and stable hemodynamics without vasoactive drugs. INTERVENTIONS: PCO2 was increased 5-20% by an added dead space from baseline, followed by a return to baseline. MEASUREMENTS AND RESULTS: Splanchnic blood flow was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling and systemic hemodynamics by routine monitoring; we also determined the gastric mucosal-arterial PCO2 difference and splanchnic lactate/pyruvate exchange. PCO2 was increased by an added dead space; after 60 min all measurements were repeated; after return to baseline a third measurement followed. The increase in PCO2 had no significant effect on splanchnic blood flow or indices of perfusion and metabolism. CONCLUSION: Our results suggest that acute moderate changes in PCO2 have no major effect on splanchnic perfusion and metabolism.

Adolescent↗

Validation of a new respiratory inductive plethysmograph.

BACKGROUND: The respiratory inductive plethysmograph (RIP) can be used to monitor changes in end-expiratory lung volume (deltaEELV), and thus, used in intensive care when evaluating positive end-expiratory pressure (PEEP)-induced changes in lung volumes in order to optimise the ventilator settings. We validated the newest model of RIP (Respitrace Plus), both under laboratory and clinical conditions, and made a comparison with a previously validated RIP (Respigraph) in the measurement of tidal volume (V(T)), long-term EELV and PEEP-induced acute deltaEELV. METHODS: The in vitro validation was performed using a lung model and the in vivo evaluation in five spontaneously breathing normal subjects, four patients with acute lung injury (ALI) and eight anaesthetised patients. RESULTS: The difference in V(T) values during PEEP manipulations between pneumotachometer (PNT) and RIP in spontaneously breathing volunteers and mechanically ventilated ALI patients was 0.1-0.9% (mean+/-SEM) and -5.2+/-0.6, respectively (effect of device NS). In anaesthetised patients, the difference between the new RIP and spirometer in the measurement of PEEP-induced acute deltaEELV was -2.6+/-1.5% (PEEP-device interaction, P<0.05). In ALI patients, the difference between PNT and RIP in the measurement of PEEP-induced acute deltaEELV was 1.0+/-9.7% (NS). The new RIP had a baseline drift over 50-fold when cold and over 10-fold when warm compared to the old RIP in vitro. CONCLUSION: The new RIP is accurate enough for clinical and research purposes in the measurement of V(T). Semiquantitative measurements of acute deltaEELV can be done with accuracy sufficient for clinical use, but long-term deltaEELV monitoring is not possible. The new RIP should be kept on for several hours before measurements to minimise the drift.

Adult↗

Variation in steroid hormones associated with infant care behaviour and experience in male marmosets (Callithrix kuhlii).

We describe temporal patterns of change in paternal behaviour and urinary concentrations of the steroid hormones testosterone (T) and oestradiol (E(2)) in male black tufted-ear marmosets, Callithrix kuhlii, relative to the birth of their young, and test predictions of the hypotheses that (1) high levels of T are incompatible with paternal care and (2) levels of T and E(2)vary with a father's prior experience in his family group. After young were born, levels of urinary T and E(2)remained near prepartum concentrations and rates at which fathers carried infants were below peak levels until the approximate time that postpartum mating ordinarily occurs, suggesting a possible trade-off between readiness to mate and paternal behaviour in C. kuhlii. Infant-carrying behaviour of fathers occurred at its highest rate 3-4 weeks after parturition and coincided with significant declines in urinary levels of T and E(2), providing preliminary support for the hypothesis that these hormones are antagonistic to paternal behaviour. Urinary T and E(2)declined among fathers regardless of whether their young survived to weaning or died at birth, indicating that variation in these hormones after parturition occurs even in the absence of continued stimuli from infants. When adjusted for declines ordinarily associated with aging, urinary T tended to be lower among fathers with a great deal of prior experience caring for young compared with fathers having little or no experience, suggesting that either experience affects T levels of fathers, or that T levels influence fathers' chances of successfully rearing infants. Overall, our results suggest that in male C. kuhlii, T, and possibly E(2), play an important role in balancing the expression of paternal care with that of other reproductive behaviours. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗

Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury.

OBJECTIVE: To evaluate the acute effects of an increased positive end-expiratory pressure (PEEP) on splanchnic tissue perfusion. DESIGN: Clinical prospective study. SETTING: Intensive care unit in a university clinic. PATIENTS: Six patients with severe acute lung injury (ALI) requiring mechanical ventilation. All patients had bilateral infiltrates in chest X-ray, PaO2/FiO2 < 200 mmHg and stable hemodynamics without vasoactive drugs. INTERVENTIONS: PEEP was increased by 5 cmH2O from a clinically selected PEEP level (8/6-11 cmH2O) up to (13/10-14 cmH2O) followed by a return to baseline. MEASUREMENTS AND MAIN RESULTS: Splanchnic blood flow was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling and systemic hemodynamics by routine monitoring. In addition, we estimated gastric mucosal-arterial PCO2 difference and splanchnic lactate/pyruvate exchange. After a baseline measurement, PEEP was increased. After 60 min all measurements were repeated. PEEP was returned to the baseline level and a third measurement followed. PEEP had no effect on cardiac index (baseline I: 3.2/6.1-2.5 l/min/m2; PEEP: 3.3/5.7-2.3 l/min/m2; baseline II: 3.4/6.0-2.5 l/min/m2); neither did PEEP have any effect on splanchnic blood flow (baseline I: 0.91/1.39-0.62 l/min/m2; PEEP: 1.04/1.75-0.54 l/min/m2; baseline II: 1.07/1.42-0.68 l/min/m2, respectively) or perfusion (gastric mucosal-arterial PCO2 difference baseline I: 2.1/12.8-0.6 kPa; PEEP: 1.7/14.5-0.7 kPa; baseline II: 1.7/8.8-0.1 kPa; lactate uptake baseline I: 0.5/1.1-0.3 mmol/min/m2; PEEP: 0.4/1.0-0.3 mmol/min/m2; baseline II: 0.5/0.9-0.3 mmol/min/m2; hepatic venous lactate/pyruvate baseline I: 9.7/10.6-5.7; PEEP: 9.7/14.2-6.4; baseline II: 8.4/12.4-7.3; respectively). CONCLUSION: PEEP by itself does not have a consistent effect on splanchnic blood flow and metabolism when cardiac index is stable and patients are ventilated within the linear part of the pv curve.

Acute Disease↗

Evaluation of a new module in the continuous monitoring of respiratory mechanics.

OBJECTIVE: Bedside monitoring of respiratory mechanics facilitates the use of lung protective ventilation in acute lung injury (ALI). We evaluated a new clinical monitor of respiratory mechanics. DESIGN: Prospective, in vitro and in vivo study. SETTING: University hospital. PATIENTS: Measurements were done using a lung model and in patients after cardiac surgery (n = 10) and in patients with ALI (n = 10). INTERVENTIONS AND MEASUREMENTS: The monitor provides continuous monitoring of pressure, flow and volume waveform and loop data, and automatically collected variables of respiratory mechanics. Breath-by-breath respiratory mechanics data and the automated variables obtained with the new monitor were compared with flow and pressure reference data. RESULTS: Waveform data comparison showed errors of less than 5% for most variables. Automatically recorded respiratory pressures and volumes showed good agreement within clinical standards when compared to reference (errors from 2.5% to 6.2%). Automatically recorded derived variables present poor agreement (errors from 8.1% to 158.3%). CONCLUSIONS: The waveform data of the new monitor is accurate. The value of the automatically derived variables is limited by the fact that inspiratory plateau pressure and plateau compliance have no direct physiological meaning. Nevertheless, in clinical monitoring much information can be derived from the waveform signals alone and from pressure-volume and flow-volume loops. These facilitate monitoring changes in respiratory mechanics in the ALI patient.

Adult↗

Food availability affects behavior but not circulating gonadal hormones in maternal Belding's ground squirrels.

We tested predictions of hypotheses suggesting that the steroid hormones, testosterone (T), progesterone (P), and estradiol (E2), contribute to the energetic regulation of behaviors associated with rearing young in free-living female Belding's ground squirrels (Spermophilus beldingi). We provisioned some female S. beldingi with food rich in fat and calories, and used unprovisioned females as controls. We observed the behavior of females throughout the reproductive cycle, and regularly collected blood samples to measure plasma hormone concentrations. Circulating concentrations of T, P, and E2 were similar in provisioned and unprovisioned females, as were temporal patterns of variation in these hormones. Peaks in rates of nest maintenance and aggressive behavior occurred during gestation and were associated with elevated concentrations of circulating T, P, and E2, raising the possibility that one or more of these hormones mediates behaviors that help females establish maternal nest sites and territories after mating. Temporal patterns of variation in behavior were similar among provisioned and unprovisioned females; however, rates of resting, vigilance, and aggression were higher among provisioned females, whereas unprovisioned females devoted significantly more time to feeding and locomotion. Thus, our data suggest that in maternal S. beldingi, gonadal steroids play a role in mediating behavior associated with raising offspring, but do not facilitate changes in rates of behavior associated with increased energy availability.

Aggression↗

The effect of sedation on weaning following coronary artery bypass grafting: propofol versus oxycodone-thiopental.

BACKGROUND: Propofol has been advocated for sedation in intensive care because of superior recovery characteristics. We hypothesised that the use of two totally different sedation methods after coronary artery bypass grafting should result in differences not only in extubation time, but also in breathing pattern and gas exchange during weaning and after extubation. METHODS: Thirty patients participated in this randomised and controlled study. We used propofol infusion and oxycodone-thiopental bolus dosage, titrated to sedation level 4 or 5 according to Ramsey. Weaning was performed using protocol-based pressure support trials. RESULTS: Total (SD) fentanyl dose during operation was 33 (6) microg x kg(-1) for propofol and 34 (6) microg x kg(-1) for oxycodone-thiopental (ns). The target sedation was achieved equally with both methods. The time from admission to intensive care unit to extubation was 494 (100) min for propofol and 521 (98) min for oxycodone-thiopental (ns). Weaning times were 63 (24) min and 112 (63) min in the propofol and oxycodone-thiopental groups, respectively (P<0.05). Breathing frequency increased and tidal volume decreased from weaning to 2 h postextubation. CONCLUSION: Propofol infusion and oxycodone-thiopental bolus dosages, titrated to the same sedation end point, resulted in similar time from admission to extubation, although the weaning period was shorter in the propofol group. In terms of breathing pattern, gas exchange, blood gases and haemodynamics, the methods were similar. Propofol, despite its attractive pharmacological profile, may offer no clinical benefit in short-term sedation after a moderate dose fentanyl anaesthesia in cardiac surgery.

Carbon Dioxide↗

Genetic diversity and clonal patterns among antibiotic-susceptible and -resistant Streptococcus pneumoniae colonizing children: day care centers as autonomous epidemiological units.

Characterization by antibiotype of the 1,096 Streptococcus pneumoniae recovered from 2,111 nasopharyngeal samples of children attending 16 day care centers (DCCs) in Lisbon, Portugal, and molecular typing of 413 drug-resistant pneumococci (DRPn) and 89 fully drug-susceptible pneumococci (DSPn) has allowed several conclusions. (i) There was an increase in the frequency of DRPn colonizing children in DCCs from 40% in 1996 to 45% in 1997 to 50% in 1998. (ii) Drug resistance spread by cross-transmission of DRPn clones. A few (8 out of 57) DRPn clones were repeatedly isolated from a large number of children in several DCCs and during each period of surveillance, suggesting the epidemic nature of these clones, which included lineages representing internationally spread S. pneumoniae clones. (iii) Dissemination of resistance determinants among pneumococci colonizing the nasopharynx occurred. Association of identical pulsed-field gel electrophoresis patterns with diverse antibiotypes among pneumococci colonizing children suggests that the high prevalence of DRPn involves not only cross-transmission of resistant strains but also dispersal of resistance genes through recombinational mechanisms. (iv) DCCs are autonomous epidemiological units. Among the 413 DRPn, 57 different lineages were detected; these lineages were dispersed among the 16 DCCs to produce unique microbiological profiles for each of the DCCs. Higher genetic diversity and less sharing of clonal types were observed among the DSPn.

Anti-Bacterial Agents↗

Energetic and endocrine mediation of natal dispersal behavior in Belding's ground squirrels.

Natal dispersal, the permanent departure of an individual from its birth site, is sex biased in most mammals, with males dispersing at higher rates or over greater distances than do female conspecifics. Because dispersal movements may be energetically expensive, their occurrence should theoretically be influenced by energy availability. Moreover, the male bias typical of mammalian dispersal suggests that this behavior might be mediated by gonadal androgens. Using free-living Belding's ground squirrels (Spermophilus beldingi) as subjects, we provisioned juveniles with extra food to evaluate energetic influences on male dispersal behavior. Provisioning increased body mass and body fat of juvenile males and caused them to disperse at younger ages, but did not affect blood glucose levels. Dispersing males were fatter than same-aged males that had not yet dispersed. Moreover, body fat of provisioned and unprovisioned males did not differ when evaluated relative to the week during which they dispersed, suggesting that there may be a fat threshold for dispersal. In a second experiment, we measured plasma concentrations of testosterone (T) in provisioned and unprovisioned, free-living juveniles to evaluate the hypothesis that male dispersal behavior is activated by concurrent high levels of T. We observed no increase in plasma T associated with dispersal by juvenile males, no sex differences in circulating T among juveniles, and no effects of food provisioning on juvenile T levels. In a third experiment with free-living S. beldingi, we concurrently altered early androgen exposure by treating females with T at birth and manipulated energy availability by food provisioning. Perinatal T-treatment increased the likelihood of dispersal among juvenile females. Provisioning increased body mass and body fat of juveniles and caused males and T-treated females to disperse at significantly younger ages than either their unprovisioned counterparts or the few provisioned control females that dispersed. These results suggest that early T exposure in this species determines the probability of dispersal, whereas the amount of energy an individual has stored as fat strongly influences the timing of dispersal. Early T exposure also appears to cause the timing of dispersal to respond to energy availability and body fat in a male-typical way, possibly by organizing masculine mass and fat thresholds for dispersal.

Adipose Tissue↗

Endocrine and energetic mediation of play behavior in free-living Belding's ground squirrels.

Many juvenile mammals play, and rates and patterns of play behavior often differ between young males and females. The sexual dimorphisms typical of mammalian play suggest that it might be influenced by gonadal hormones. Moreover, because play competes with growth, physical development, and acquisition of fat reserves for available energy, play behavior should theoretically be influenced by energetic variables. We examined patterns of social play behavior and endocrine and energetic mediation of social play in free-living juvenile Belding's ground squirrels (Spermophilus beldingi). Bouts of social play in young S. beldingi resembled adult copulation and fighting, and young males initiated sexual play but not play fighting at much higher rates than did young females. To elucidate the proximal causes of play, we altered early androgen exposure by treating females with testosterone (T) at birth and used females treated with oil vehicle as controls. We concurrently manipulated energy availability by provisioning with extra food and used unprovisioned squirrels as controls. Hourly rates of play behavior were highest near the time of weaning and declined thereafter among both experimental and control groups of juveniles. Thus, we observed no influence of either T treatment or food provisioning on the temporal patterning of play behavior. Perinatal T treatment had no effect on play fighting, but caused rates of sexual play behavior initiated by young females to increase to near those observed for young males, suggesting that T organizes a masculine tendency to initiate sexual play behavior but not play fighting. Food provisioning increased rates of play among males and females from both T-treated and control litters, suggesting that energy availability limits play behavior.

Aggression↗

Acute respiratory distress syndrome: frequency, clinical course, and costs of care.

OBJECTIVE: To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN: A 3-yr (1993 through 1995) retrospective descriptive analysis of all patients with ARDS treated in Kuopio University Hospital. SETTING: Intensive care unit in the university hospital. PATIENTS: Fifty-nine patients fulfilled the definition of ARDS: Pao2/Fio2 <200 mm Hg (33.3 kPa) during mechanical ventilation and bilateral infiltrates on chest radiograph. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: With a patient data management system, the day-by-day data of hemodynamics, ventilation, respiratory mechanics, gas exchange, and organ failures were collected during the period that Pao2/Fio2 ratio was <200 mm Hg (33.3 kPa). The frequency of ARDS was 4.9 cases/100,000 inhabitants/yr. Pneumonia and sepsis were the most common causes of ARDS. Mean age was 43+/-2 yrs. At the time of lowest Pao2/Fio2, the nonsurvivors had lower arterial and venous oxygen saturations and higher arterial lactate than survivors, whereas there were no differences between the groups in other parameters. Multiple organ dysfunction preceded the worst oxygenation in both the survivors and nonsurvivors. The intensive care mortality was 37%; hospital mortality and mortality after a minimum 8 months of follow-up was 42%. The most frequent cause of death was multiple organ failure. The effective costs of intensive care per survivor were US $73,000. CONCLUSIONS: The outcome of ARDS is unpredictable at the time of onset and also at the time of the worst oxygenation. Keeping the inspiratory pressures low (30-35 cm H2O [2.94 to 3.43 kPa]) reduces the frequency of pneumothorax, and might lower the mortality. Most patients are young, and therefore the costs per saved year of life are low.

Adolescent↗