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Two weeks of diaphragm (DIAm) inactivity imposed by C2SH caused reduced mitochondrial volume density, mitochondrial fragmentation, and a concomitant reduction of SDHmax in type I and IIa DIAm fibers on the lesioned side. Type I and IIa DIAm fibers were far more sensitive to inactivation than type IIx/IIb fibers, which exhibited little pathology. Our results indicate that mitochondria in DIAm fibers are plastic in response to varying levels of activity.

IMPORTANCE Older adults (age Ն65 years) are at risk for high rates of delirium and poor outcomes; however, how to improve outcomes is still being explored.OBJECTIVE To assess whether implementation of a geriatric trauma clinical pathway was associated with reduced rates of delirium in older adults with traumatic injury. DESIGN, SETTING, AND PARTICIPANTSA retrospective case-control study of electronic health records of patients aged 65 years or older with traumatic injury from 2018 to 2020 was conducted at a single level I trauma center. Eligible patients were age 65 years or older admitted to the trauma service and who did not undergo an operation.INTERVENTION The implementation of a clinical pathway based on geriatric best practices, which included order sets, guidelines, automated consultations, and escalation pathways executed by a multidisciplinary team. MAIN OUTCOMES AND MEASURESThe primary outcome was delirium. The secondary outcome was hospital length of stay. Process measures for pathway compliance were also assessed. RESULTSOf the 859 eligible patients, 712 patients were included in the analysis (442 [62.1%] in the baseline group; 270 [37.9%] in the postimplementation group; mean [SD] age: 81.4 [9.1] years; 394 [55.3%] were female). The mechanism of injury was not different between groups, with 247 in the baseline group (55.9%) and 162 in the postimplementation group (60.0%) (P = .43) experiencing a fall. Injuries were minor or moderate in both groups (261 in baseline group [59.0%] and 168 in postimplementation group [62.2%]; P = .87). The adjusted odds ratio for delirium in the postimplementation cohort was 0.54 (95% CI, 0.37-0.80; P < .001). Goals of care documentation improved significantly in the postimplementation cohort vs the baseline cohort with regard to documented goals of care notes (53.7% in the postimplementation cohort [145 of 270] vs 16.7% in the baseline cohort [74 of 442]; P < .001) and a shortened time to discussion from presenting to the emergency department (36 hours in the postimplementation cohort vs 50 hours in the baseline cohort; P = .03). CONCLUSIONS AND RELEVANCEIn this study, implementation of a multidisciplinary clinical pathway for injured older adults at a single level I trauma center was associated with improved care and clinical outcomes. Interventions such as these may have utility in this vulnerable population, and findings should be confirmed across multiple centers.

Phrenic motor neuron (PhMN) development in early onset hypertonia is poorly understood. Yet, respiratory disorders are a common cause of morbidity and mortality. In spa mice, an animal model of early onset hypertonia, we found ~30% fewer PhMNs, compared with controls. This PhMN loss disproportionately affected larger PhMNs. Thus, the number and heterogeneity of the PhMN pool are decreased in spa mice, likely contributing to the hypertonia, impaired neuromotor control, and respiratory disorders.

The e-fluid heated in electronic cigarettes (e-cigarettes) is largely composed of organic compounds, specifically propylene glycol, vegetable glycerin and flavouring compounds. When heated, as it is in an e-cigarette, the chemical species in this fluid have the potential to oxidise into carbon monoxide (CO) and other species. Using diode laser spectroscopy, the concentration of CO in e-cigarette mainstream effluent as a function of e-cigarette power and flavour was measured. Carbon monoxide concentration was found to be a direct function of the power of the resistive heating. At the highest powers testable using commercial e-cigarette components, the maximum CO concentration measured was over 180 ppm. The flavouring compounds in the e-fluid also had an effect on the concentration of carbon monoxide present in the effluent.