Transportation Among Returning Citizens: "You Just Want to Stay Down and Get High".

The United States is releasing more individuals from prisons than ever before. However, returning citizens face numerous challenges transitioning back into community life and many communities remain ill-equipped in successfully supporting them. This study focuses on transportation as in integral component to the success of returning citizens. Rapid and rigorous qualitative data analysis (RADaR technique) is applied to interviews (n = 15) with individuals having returned to their community about the impact of transportation on their reentry. Analysis resulted in three primary themes; interviewees reinforced existing knowledge of the issues with transportation disadvantage, transportation is an extension of freedom, and transportation is directly connected to reentry success. These findings suggest a tiered structure of transportation freedom for returning citizens. This model of transportation will aid future researchers and policymakers in considering how to better resource returning citizens to maximize their success.

A Blue Step Forward: An Exploratory Study of Law Enforcement Perceptions of Intimate Partner Violence in the Southern United States.

Intimate partner violence (IPV) is a pervasive issue that is underreported to law enforcement. One reason why individuals do not report their victimization stems from a perceived lack of support from law enforcement officials. However, law enforcement perceptions of IPV are largely unknown as the empirical literature on this topic is both limited and dated. To fill this gap in the literature, we conduct an exploratory analysis of how officers perceive IPV events. Utilizing original survey data from 498 law enforcement officers in a Southern state, officer perceptions of offenders, victims, and the credibility of IPV calls are explored. We also evaluate whether those perceptions vary by personal characteristics of officers by utilizing t-tests and correlations. Findings indicate that, overall, officer perceptions have evolved from the historical viewpoint that IPV events were a private family matter to contemporary perceptions that IPV is a serious crime that requires attention from law enforcement. Furthermore, results suggest differences in perceptions by officers' personal characteristics (i.e., gender, rank, age, and years of law enforcement experience). With increasing age and years of law enforcement experience, victim-related factors are less salient in police perceptions of IPV calls. Regarding gender, female officers are less likely than male officers to believe victims may easily leave an abusive relationship and less likely to consider physical evidence of trauma to be very important in determining the credibility of an IPV call-suggesting that female officers are more in tune with the complexity of IPV cases. While officers appear to have a strong understanding of the contours of IPV incidents, overall, clear differences by personal characteristics were evident.

Small-Gauge Pars Plana Vitrectomy for Visually Significant Vitreous Floaters.

Purpose: This article evaluates our experience at a retina-only private practice with small-gauge pars plana vitrectomy (PPV) for visually significant vitreous floaters. We review the surgical outcomes, complication rates, and percentage of second-eye surgery for the same indication. Methods: A retrospective, interventional case series was conducted of consecutive patients undergoing PPV for significant vitreous floaters from September 2014 to December 2018 at a high-volume vitreoretinal surgery practice. Preoperative visual acuity (VA), complication rates, and visual outcome following surgery were evaluated. Results: A total of 104 eyes in 81 patients underwent PPV for visually significant floaters; 35 (43.2%) patients had PPV in both eyes. Mean preoperative VA was 0.16 ± 0.17 logMAR (∼20/29 Snellen equivalent) and improved to 0.12 ± 0.15 logMAR (∼20/26 Snellen; Wilcoxon test, P = .008) at the last follow-up after PPV. All patients had improvement in VA at the final postoperative visit, with a VA of 20/40 or better achieved in 93.3% of cases. The complication rate of vitreous hemorrhage postoperatively was 0.96%. There were no cases of postoperative retinal tears, breaks, or endophthalmitis. Conclusions: Small-gauge PPV in the carefully selected patient is an effective and safe procedure to eliminate symptoms. VA following PPV for vitreous floaters significantly improved. Nearly half of the patients studied (43.2%) underwent PPV in the other eye.

CORRELATION OF SUBRETINAL HYPERREFLECTIVE MATERIAL MORPHOLOGY AND VISUAL ACUITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the association of subretinal hyperreflective material (SHRM) morphological features with visual acuity in eyes with neovascular age-related macular degeneration. METHODS: Retrospective analysis of treatment-naïve patients with neovascular age-related macular degeneration enrolled in randomized anti-vascular endothelial growth factor (VEGF) and anti-platelet-derived growth factor clinical trials. Standardized spectral domain optical coherence tomography images were graded at baseline, 12-week, and 24-week follow-up visits. Masked readers evaluated the morphology of SHRM (reflectivity, shape, anterior, and posterior boundaries) and measured SHRM height, width, and area at the fovea, within the center 1 mm, and outside the center 1 mm. RESULTS: Baseline SHRM characteristics that correlated with worse visual acuity at 12 and 24 weeks included layered appearance (P = 0.006, 0.001), hyperreflective spots in SHRM (P = 0.001, 0.011), and separation between SHRM and outer retina (P = 0.03, 0.019). The disappearance of SHRM correlated with better visual acuity at Weeks 12 and 24 (P < 0.001). Layered appearance of SHRM at baseline was significantly associated with increased reflectivity at Weeks 12 and 24 (P = 0.009, 0.003). Decreasing reflectivity of SHRM lesion at Weeks 12 and 24 correlated with better visual acuity (P < 0.01, 0.01). Increased width and area of baseline SHRM at the foveal center correlated with worse visual acuity at 12 (P < 0.001, <0.001) and 24 weeks (<0.001, <0.001). CONCLUSION: Several attributes of SHRM including, layered appearance, increased reflectivity, larger size, and hyperreflective spots correlated with worse visual acuity at 12- and 24-week follow-ups. Baseline SHRM characteristics can help practitioners predict visual and morphological prognosis and guide therapy.

Drug formulary decision-making: Ethnographic study of 3 pharmacy and therapeutics committees.

PURPOSE: An ethnographic study of 3 pharmacy and therapeutics (P&T) committees was conducted to characterize the process by which evidence is weighted and decisions are made. METHODS: We recorded discussions and conducted an analysis of the transcripts from the 3 P&T committees for a 1-year period. We examined the content and ideas expressed during deliberations and synthesized themes to give a broader picture of the issues arising. Committee discussions were transcribed and the segments of each meeting that addressed any new formulary additions were then analyzed. Using constant comparison method, we generated a series of topic codes to characterize and classify that portion of the discussion. RESULTS: At 26 meetings across the 3 sites, 24 new drug formulary additions were discussed. A total of 1,093 discussion segments were identified and mapped to 7 broad categories related to discussion of evidence of need, efficacy/indications, safety, misuse potential, cost issues, committee decision-making issues, and discussion related to operationalizing use and implementation at the local institution. Overall, the leading category of discussion was efficacy/indications followed by evidence of need, operational issues, and cost issues, with some variation by site. The committees devoted substantially greater portions of their discussion to the logistics of using the drugs in their institutions than they did safety issues. We identified wide variations in specific drugs being considered and the relative amount of time devoted to various issues related to these drugs being discussed. We found discussions generally did not follow a systematic, standardized, rigorous, and reproducible approach. Discussions tended to be more idiosyncratic, individualized, varying from drug to drug, and at times devoted to a variety of tangential issues raised by committee members. CONCLUSION: P&T committee discussions at all 3 sites tended to be idiosyncratic and individualized, varying from drug to drug, and at times devoted to a variety of issues more tangentially raised by committee members. All spent less time talking about drug safety, in each case roughly half the time that they devoted to discussions of efficacy.

Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration.

AIMS: To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD). METHODS: This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded. RESULTS: Mean SFCT at baseline was 187 µm (range: 70-361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2-12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2). CONCLUSIONS: SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.

Beta-Thalassemia Minor Manifesting as Proliferative Retinopathy.

Beta-thalassemia (ß-thalassemia) minor is characterized by a mutation in one of the two ß-globin genes (HBB) that produce the ß-globin chains in the hemoglobin molecule. Although other hemoglobinopathies have been frequently associated with retinal disease, there are limited reports of retinal pathology with ß-thalassemia minor. We report two patients with ß-thalassemia minor presenting with decreased vision, vitreous hemorrhage, and proliferative retinopathy. This case report highlights that patients with ß-thalassemia minor may require routine ocular examinations for peripheral retinal pathology, and ß-thalassemia minor should be considered in the differential diagnosis for proliferative retinopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e161-e164.].

Image Registration based Cervical Cancer Detection and Segmentation Using ANFIS Classifier

Cervical cancer is the leading cancer in women around the world. In this paper, Adaptive Neuro Fuzzy Inference System (ANFIS) classifier based cervical cancer detection and segmentation methodology is proposed. This proposed system consists of the following stages as Image Registration, Feature extraction, Classifications and Segmentation. Fast Fourier Transform (FFT) is used for image registration. Then, Grey Level Co-occurrence Matrix (GLCM), Grey level and trinary features are extracted from the registered cervical image. Next, these extracted features are trained and classified using ANFIS classifier. Morphological operations are now applied over the classified cervical image to detect and segment the cancer region in cervical images. Simulations on large cervical image dataset demonstrate that the proposed cervical cancer detection and segmentation methodology outperforms the state of-the-art methods in terms of sensitivity, specificity and accuracy.

Effect of 6 wk of high-intensity one-legged cycling on functional sympatholysis and ATP signaling in patients with heart failure.

Breathlessness during daily activities is the primary symptom in patients with heart failure (HF). Poor correlation between the hemodynamic parameters of left ventricular performance and perceived symptoms suggests that other factors, such as skeletal muscle function, play a role in determining exercise capacity. We investigated the effect of 6 wk of high-intensity, one-legged cycling (HIC; 8 × 4 at 90% one-legged cycling max) on 1) the ability to override sympathetic vasoconstriction (arterial infusion of tyramine) during one-legged knee-extensor exercise (KEE), 2) vascular function (arterial infusion of ACh, sodium nitroprusside, tyramine, and ATP), and 3) exercise capacity in HF patients with reduced ejection fraction ( n = 8) compared with healthy individuals ( n = 6). Arterial tyramine infusion lowered leg blood flow and leg vascular conductance at rest and during KEE before the training intervention in both groups ( P < 0.05) but not during KEE after the training intervention. There was no difference between groups. The peak vasodilatory response to ATP was blunted in HF patients ( P < 0.05), whereas there was no difference in ACh- and sodium nitroprusside-induced vasodilation between HF patients and healthy individuals. ACh-induced vasodilation increased in HF patients after the training intervention ( P < 0.05). HIC improved aerobic capacity in both groups ( P < 0.05), whereas only HF patients made improvements in the 6-min walking distance ( P < 0.05). These results suggest that exercise hyperemia and functional sympatholysis are not altered in HF patients and that functional sympatholysis is improved with HIC in both HF patients and healthy individuals. Moreover, these results suggest that the peak vasodilatory response to ATP is blunted in HF. NEW & NOTEWORTHY The ability to override sympathetic vasoconstrictor activity (by arterial tyramine infusion) during exercise is not different between heart failure patients and healthy individuals and is improved by high-intensity, one-legged cycling training. The peak vasodilatory response to ATP is reduced in heart failure patients.

Intraoperative OCT for Uveitis-Related Vitreoretinal Surgery in the DISCOVER Study.

PURPOSE: To evaluate the feasibility and usefulness of intraoperative OCT (iOCT) for uveitis-related vitreoretinal surgeries. DESIGN: Prospective consecutive case series. PARTICIPANTS: Seventy-three consecutive patients (74 eyes) with a uveitis-related diagnosis. METHODS: Eyes undergoing surgery for a uveitis-related diagnosis in the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study. Intraoperative OCT was performed at various surgical milestones. Clinical details and evaluation of the role of iOCT were assessed. A standardized surgeon survey was completed to evaluate the usefulness of iOCT during surgery. MAIN OUTCOME MEASURES: Percentage of patients in whom iOCT provided valuable feedback and altered surgical decision making. RESULTS: Seventy-four consecutive eyes with a uveitis-related diagnosis were enrolled in the DISCOVER study. Successful imaging was obtained in 72 of 73 eyes (98.6%). Intraoperative OCT provided valuable feedback for fluocinolone acetonide implant placement in 11 of 13 eyes (84.6%), for chorioretinal biopsies in 13 of 16 eyes (81.2%), and for retinal detachment (RD) repairs in 20 of 27 eyes (74.1%). In subretinal and chorioretinal biopsies, iOCT altered surgical decision making in 38% of patients. In uveitis-related RD repairs, iOCT resulted in alterations in the surgical procedure in 48% of patients, predominantly related to additional membrane peeling. CONCLUSION: Intraoperative OCT during uveitis-related vitreoretinal surgery seems to provide valuable additional information that can impact surgical decision making and may enhance outcomes.

Pneumatic Displacement of Submacular Hemorrhage with Subretinal Air and Tissue Plasminogen Activator: Initial United States Experience.

PURPOSE: To present the initial multicenter experience of using subretinal air injection in combination with tissue plasminogen activator (tPA) at the time of pars plana vitrectomy (PPV) to displace submacular hemorrhage (SMH). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Patients with SMH resulting from age-related macular degeneration or polypoidal choroidal vasculopathy. METHODS: Chart review of patients who underwent displacement of SMH with PPV, subretinal injection of air and tPA (125 mg/mL), partial fluid-air exchange with gas tamponade, and preoperative, intraoperative, or postoperative intravitreal injection of anti-vascular endothelial growth factor agent at 5 sites in the United States. None of the surgeons had prior experience with using subretinal air. MAIN OUTCOME MEASURES: Frequency and extent of SMH displacement, preoperative and postoperative visual acuities and retinal thickness, and postoperative complications. RESULTS: Twenty-four eyes of 24 patients were included (11 men; mean age, 79.1 years) with a mean follow-up of 12.5 months (range, 3-28 months). At 3 months after surgery, complete displacement of SMH from the foveal center was achieved in 24 eyes (100%), displaced beyond the arcades in 75% and beyond the equator in 20%. Residual subretinal pigment epithelial hemorrhage was seen in 5 eyes (20.8%). Mean preoperative and postoperative visual acuity was 1.95 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/1783) and 0.85 logMAR (Snellen equivalent, 20/141; P < 0.0001), respectively. Visual acuity improved in 23 eyes (95.8%) and was unchanged in 1 eye. Mean central retinal thickness improved from 463.7 µm before surgery to 311.3 µm at the final visit (P = 0.026). CONCLUSIONS: This initial experience of injecting subretinal air at the time of tPA injection during PPV showed the technique to be effective, with high consistency to displace SMH away from the fovea and even out to the periphery, and resulted in improved VA and retinal thickness. Some cases of subretinal pigment epithelial hemorrhage also benefit from this technique.

Epicardial, pericardial and total cardiac fat and cardiovascular disease in type 2 diabetic patients with elevated urinary albumin excretion rate.

Background We evaluated the association of cardiac adipose tissue including epicardial adipose tissue and pericardial adipose tissue with incident cardiovascular disease and mortality, coronary artery calcium, carotid intima media thickness and inflammatory markers. Design A prospective study of 200 patients with type 2 diabetes and elevated urinary albumin excretion rate (UAER). Methods Cardiac adipose tissue was measured from baseline echocardiography. The composite endpoint comprised incident cardiovascular disease and all-cause mortality. Coronary artery calcium, carotid intima media thickness and inflammatory markers were measured at baseline. Cardiac adipose tissue was investigated as continuous and binary variable. Analyses were performed unadjusted (model 1), and adjusted for age, sex (model 2), body mass index, low-density lipoprotein cholesterol, smoking, glycated haemoglobin, and systolic blood pressure (model 3). Results Patients were followed-up after 6.1 years for non-fatal cardiovascular disease ( n = 29) or mortality ( n = 23). Cardiac adipose tissue ( p = 0.049) and epicardial adipose tissue ( p = 0.029) were associated with cardiovascular disease and mortality in model 1. When split by the median, patients with high cardiac adipose tissue had a higher risk of cardiovascular disease and mortality than patients with low cardiac adipose tissue in unadjusted (hazard ratio 1.9, confidence interval: 1.1; 3.4, p = 0.027) and adjusted (hazard ratio 2.0, confidence interval: 1.1; 3.7, p = 0.017) models. Cardiac adipose tissue ( p = 0.033) was associated with baseline coronary artery calcium (model 1) and interleukin-8 (models 1-3, all p < 0.039). Conclusions In type 2 diabetes patients without coronary artery disease, high cardiac adipose tissue levels were associated with increased risk of incident cardiovascular disease or all-cause mortality even after accounting for traditional cardiovascular disease risk factors. High cardiac adipose tissue amounts were associated with subclinical atherosclerosis (coronary artery calcium) and with the pro-atherogenic inflammatory marker interleukin-8.

Childhood Maltreatment and Child Protective Services Involvement Among the Commercially Sexually Exploited: A Comparison of Women Who Enter as Juveniles or as Adults.

A risk for commercial sexual exploitation is childhood maltreatment. It's unknown whether juveniles in commercial sexual exploitation experience more childhood maltreatment than adults or how involved child protective services is in investigating maltreatment, a focus of this study. Women (N = 96) who sold sex commercially completed a cross-sectional questionnaire. Descriptive statistics, t tests, chi-squares, and odds ratios were used to examine differences in background, childhood maltreatment, and child protective services involvement by juvenile or adult entry. Although 93% of participants experienced child maltreatment, juveniles had increased odds of parent/caregiver sexual abuse, being left alone, being kicked out, and running away from a parent/caregiver. There were no differences in cumulative childhood maltreatment resulting in an investigation or removal, indicating that juveniles not investigated or removed by child protective services had as much childhood maltreatment as juveniles who were investigated or removed by child protective services. Results highlight the need for child welfare staff to recognize childhood maltreatment as risks for commercial sexual exploitation.

Electronic hybridisation implications for the damage-tolerance of thin film metallic glasses.

A paramount challenge in materials science is to design damage-tolerant glasses. Poisson's ratio is commonly used as a criterion to gauge the brittle-ductile transition in glasses. However, our data, as well as results in the literature, are in conflict with the concept of Poisson's ratio serving as a universal parameter for fracture energy. Here, we identify the electronic structure fingerprint associated with damage tolerance in thin film metallic glasses. Our correlative theoretical and experimental data reveal that the fraction of bonds stemming from hybridised states compared to the overall bonding can be associated with damage tolerance in thin film metallic glasses.

Coccospheres confer mechanical protection: New evidence for an old hypothesis.

UNLABELLED: Emiliania huxleyi has evolved an extremely intricate coccosphere architecture. The coccosphere is comprised of interlocking coccoliths embedded in a polysaccharide matrix. In this work, we performed in-situ scanning electron microscopy based compression tests and conclude that coccospheres have a mechanical protection function. The coccosphere exhibits exceptional damage tolerance in terms of inelastic deformation, recovery and stable crack growth before catastrophic fracture, a feature, which is not found in monolithic ceramic structures. Some of the mechanical features of the coccospheres are due to their architecture, especially polysaccharide matrix that acts as a kind of bio-adhesive. Our data provide strong evidence for the mechanical protection-hypothesis of coccolithophore calcification, without excluding other functions of calcification such as various biochemical roles discussed in the literature. STATEMENT OF SIGNIFICANCE: Although bio-mechanics of shell structures like nacre have been studied over the past decade, coccospheres present an architecture that is quite distinct and complex. It is a porous cell structure evolved to protect the living algae cell inside it in the oceans, subjected to significant hydrostatic pressure. Despite being made of extremely brittle constituents like calcium carbonate, our study finds that coccospheres possess significant damage tolerance especially due to their interlocking coccolith architecture. This will have consequences in bio-mimetic design, especially relating to high pressure applications.

Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill.

PURPOSE: Glaucoma medications reduce the risk of progressive visual field loss, but adherence to these medications is often poor. A better understanding of the appropriate metrics for quantifying glaucoma medication adherence is needed. We describe and compare different means of quantifying glaucoma medication adherence. METHODS: Adults with glaucoma were enrolled in a prospective 2-site study. Participants completed a self-report instrument and received electronic medication monitors to use for ∼3 months. Pharmacy records were queried regarding requested refills over the monitoring period; medication possession ratio (MPR) was calculated. RESULTS: Of the 137 total participants, those who answered "Very confident" to the question, "How confident are you that you always remember to use your glaucoma medications?" and "No" to the question, "In the past 4 weeks, did you ever forget to take your medicine?" were more likely [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.19-6.52] to take ≥80% of the prescribed doses according to electronic medication monitors. Mean MPR was 1.49, standard deviation (SD) 0.82, range 0.1-5.31. The proportion of participants taking greater than or equal to 80% of the prescribed doses according to the electronic monitors was 59% for participants with MPR <1.2 (n = 27), 63% for participants with MPR 1.2-1.8 (n = 27), and 88% for MPR >1.8 (n = 25). CONCLUSIONS: Asking about confidence may be a good method of screening for poor adherence for glaucoma medication. MPR may be an inadequate representation of glaucoma medication adherence.

Primary adenocarcinoma of pigmented ciliary epithelium in a phthisical eye.

We report a case of adenocarcinoma of the pigmented ciliary epithelium arising in a phthisical eye. A 92-year-old man who initially presented with severe ocular pain had calcification extending from the posterior pole to ciliary body on B-scan ultrasonography to a degree not previously reported. We highlight the importance of screening for intraocular neoplasms in adults with a long-standing phthisical eye.

Sympathetic Vasoconstrictor Responsiveness of the Leg Vasculature During Experimental Endotoxemia and Hypoxia in Humans.

OBJECTIVE: Sympathetic vasoconstriction regulates peripheral circulation and controls blood pressure, but sepsis is associated with hypotension. We evaluated whether apparent loss of sympathetic vasoconstrictor responsiveness relates to distended smooth muscles or to endotoxemia and/or hypoxia. DESIGN: Prospective descriptive study. SETTING: Hospital research laboratory. SUBJECTS: Ten healthy young men (age [mean ± SD], 31 ± 8 yr; body weight, 83 ± 10 kg) participated in the study. INTERVENTIONS: Leg blood flow and mean arterial pressure were determined, whereas leg vascular conductance was calculated during 1) adenosine infusion (vasodilator control), 2) hypoxia (FIO2 = 10%), 3) endotoxemia, and 4) endotoxemia + hypoxia. Leg sympathetic vasoconstrictor responsiveness (reduction in leg vascular conductance) was evaluated by femoral artery tyramine infusion. MEASUREMENTS AND MAIN RESULTS: Endotoxemia increased body temperature from 36.9 ± 0.4°C to 38.6 ± 0.5°C (p < 0.01) and plasma tumor necrosis factor-α from 6 pg/mL (3-8 pg/mL) to 391 pg/mL (128-2258 pg/mL) (p < 0.01; median [range]). Mean arterial pressure decreased similarly during endotoxemia (-11% ± 16%) and endotoxemia + hypoxia (-10% ± 15%; both p < 0.05). Leg blood flow and leg vascular conductance were not affected by endotoxemia, whereas both were elevated by adenosine infusion (leg blood flow, +94% ± 61%; leg vascular conductance, +97% ± 57%), hypoxia (leg blood flow: +93% ± 58%; leg vascular conductance, +100% ± 115%), and endotoxemia + hypoxia (leg blood flow, +67% ± 120%; leg vascular conductance, +65% ± 57%; p < 0.05). Endotoxemia lessened the tyramine-induced reduction in leg vascular conductance (-28% ± 13%) compared with the reduction during adenosine infusion (-47% ± 5%; p < 0.05). Also, endotoxemia + hypoxia (-17% ± 21%) attenuated the tyramine-induced reduction in leg vascular conductance compared with both adenosine infusion and hypoxia (-45% ± 13%; p < 0.05). CONCLUSIONS: Both endotoxemia and combined hypoxia and endotoxemia blunted sympathetic vasoconstrictor responsiveness. Furthermore, tyramine normalized the doubled leg vascular conductance during administration of adenosine, suggesting that distension of vascular smooth muscles does not explain blunted sympathetic vasoconstrictor responsiveness during endotoxemia.