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Baumer F, Pienaar R, Sahin M, Grant E, Takahashi E. Longitudinal Changes in Diffusion Tractography Values in Tuberous Sclerosis (P03.133). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Xiong C, Roe CM, Buckles V, Fagan A, Holtzman D, Balota D, Duchek J, Storandt M, Mintun M, Grant E, Snyder AZ, Head D, Benzinger TLS, Mettenburg J, Csernansky J, Morris JC. Role of family history for Alzheimer biomarker abnormalities in the adult children study. ACTA ACUST UNITED AC 2011; 68:1313-9. [PMID: 21987546 DOI: 10.1001/archneurol.2011.208] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess whether family history (FH) of Alzheimer disease (AD) alone influences AD biomarker abnormalities. DESIGN Adult Children Study. SETTING Washington University's Charles F. and Joanne Knight Alzheimer's Disease Research Center. PARTICIPANTS A total of 269 cognitively normal middle- to older-aged individuals with and without an FH for AD. MAIN OUTCOME MEASURES Clinical and cognitive measures, magnetic resonance imaging-based brain volumes, diffusion tensor imaging-based white matter microstructure, cerebrospinal fluid biomarkers, and molecular imaging of cerebral fibrillar amyloid with positron emission tomography using the [(11)C] benzothiazole tracer, Pittsburgh compound B. RESULTS A positive FH for AD was associated with an age-related decrease of cerebrospinal fluid Aβ42; the ε4 allele of apolipoprotein E (APOE4) did not alter this effect. Age-adjusted cerebrospinal fluid Aβ42 was decreased for individuals with APOE4 compared with the level for those without, and the decrease was larger for individuals with a positive FH compared with the decrease for those without. The variation of cerebrospinal fluid tau and Pittsburgh compound B mean cortical binding potential increased by age. For individuals younger than 55, an age-related increase in mean cortical binding potential was associated with APOE4 but not FH. For individuals older than 55, a positive FH and a positive APOE4 implied the fastest age-related increase in mean cortical binding potential. A positive FH was associated with decreased fractional anisotropy from diffusion tensor imaging in the genu and splenium of the corpus callosum. CONCLUSION Independent of APOE4, FH is associated with age-related change of several cerebrospinal fluid, Pittsburgh compound B, and diffusion tensor imaging biomarkers in cognitively normal middle- to older-aged individuals, suggesting that non- APOE susceptibility genes for AD influence AD biomarkers.
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Taylor‐Reinwald L, Grant E, Goate A, Morris J, Cairns N. O2‐07‐01: Neuropathology of preclinical and incipient Alzheimer's dementia. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stark S, Roe C, Grant E, Morris J. P1‐201: Risk of Falls Among Older Adults with Preclinical Alzheimer's Disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Castañeda TR, Nogueiras R, Müller TD, Krishna R, Grant E, Jones A, Ottaway N, Ananthakrishnan G, Pfluger PT, Chaudhary N, Solomon MB, Woods SC, Herman JP, Tschöp MH. Decreased glucose tolerance and plasma adiponectin:resistin ratio in a mouse model of post-traumatic stress disorder. Diabetologia 2011; 54:900-9. [PMID: 21181395 DOI: 10.1007/s00125-010-2019-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS Obesity and type 2 diabetes are among the most serious health pathologies worldwide. Stress has been proposed as a factor contributing to the development of these health risk factors; however, the underlying mechanisms that link stress to obesity and diabetes need to be further clarified. Here, we study in mice how chronic stress affects dietary consumption and how that relationship contributes to obesity and diabetes. METHODS C57BL/6J mice were subjected to chronic variable stress (CVS) for 15 days and subsequently fed with a standard chow or high-fat diet. Food intake, body weight, respiratory quotient, energy expenditure and spontaneous physical activity were measured with a customised calorimetric system and body composition was measured with nuclear magnetic resonance. A glucose tolerance test was also applied and blood glucose levels were measured with a glucometer. Plasma levels of adiponectin and resistin were measured using Lincoplex kits. RESULTS Mice under CVS and fed with a high-fat diet showed impaired glucose tolerance associated with low plasma adiponectin:resistin ratios. CONCLUSIONS/INTERPRETATION This study demonstrates, in a novel mouse model, how post-traumatic stress disorder enhances vulnerability for impaired glucose metabolism in an energy-rich environment and proposes a potential adipokine-based mechanism.
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Muth JF, Grant E, Luthy KA, Mattos LS, Braly JC, Dhawan A, Seyam AM, Ghosh TK. Signal Propagation and Multiplexing Challenges in Electronic Textiles. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-736-d1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWeaving, knitting or placing electronic circuits within a textile matrix offer exciting possibilities for large-scale conformal circuits where the circuit dimensions can be measured on the scale of yards instead of inches. However, compared with conventional printed circuit board circuits, the textile manufacturing process and the electrical/mechanical properties of the fibers used in making the textile place unusual constraints on the electrical performance of textile circuits. In the case of distributed sensors connected via an electronic fabric, signal attenuation and the ability to form reliable interconnections are major challenges. To explore these challenges we have woven and knitted a variety of electrical transmission lines and optical fibers in fabrics to analyze their performance. The formation of interconnects and disconnects between conductors woven in textiles is also discussed, and a passive acoustic array is described as a possible electronic textile application.
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Taylor-Reinwald L, Grant E, Morris JC, Cairns NJ. O1‐07‐04: TDP‐43 proteinopathy in cognitively normal (CDR 0) individuals. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barber JCK, Cockwell AE, Grant E, Williams S, Dunn R, Ogilvie CM. Is karyotyping couples experiencing recurrent miscarriage worth the cost? BJOG 2010; 117:885-8. [DOI: 10.1111/j.1471-0528.2010.02566.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grant VJ, Grant E, Marczinski C. Impact of Participation in Simulated Patient Resuscitations On Pediatric Residents' Confidence. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.59a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grant VJ, Grant E, Bhanji F, Cheng A, Duff J, Lockyer J. Use of Simulation in the Development of a Valid and Reliable Pediatric Resuscitation Team Leadership Evaluation to ol. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.58aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eichler F, Grodd W, Grant E, Sessa M, Biffi A, Bley A, Kohlschuetter A, Loes DJ, Kraegeloh-Mann I. Metachromatic leukodystrophy: a scoring system for brain MR imaging observations. AJNR Am J Neuroradiol 2009; 30:1893-7. [PMID: 19797797 DOI: 10.3174/ajnr.a1739] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Metachromatic leukodystrophy (MLD) is a devastating demyelinating disease for which novel therapies are being tested. We hypothesized that MR imaging of brain lesion involvement in MLD could be quantified along a scale. MATERIALS AND METHODS Thirty-four brain MR images in 28 patients with proved biochemical and genetic defects for MLD were reviewed: 10 patients with late infantile, 16 patients with juvenile, and 2 patients with adult MLD. All MR images were reviewed by experienced neuroradiologists and neurologists (2 readers in Germany, 2 readers in the United States) for global disease burden, as seen on the T2 and fluid-attenuated inversion recovery images. A visual scoring method was based on a point system (range, 0-34) derived from the location of white matter involvement and the presence of global atrophy, analogous to the scoring system developed for adrenoleukodystrophy. The readers were blinded to the neurologic findings. RESULTS Thirty-three of 34 MR images showed confluent T2 hyperintensities of white matter. The inter-rater reliability coefficient was 0.988. Scores between readers were within 2 points of each other. Serial MR imaging studies in 6 patients showed significant progressive disease in 3 patients (initial score average, 4; mean follow-up, 24.3) and no change or 1 point progression in 3 patients (initial score average, 12; mean follow-up, 12.66). Projection fibers and the cerebellum tended to be involved only in advanced stages of disease. CONCLUSIONS The MLD MR severity scoring method can be used to provide a measure of brain MR imaging involvement in MLD patients.
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Mattos L, Grant E, Thresher R, Kluckman K. Blastocyst Microinjection Automation. ACTA ACUST UNITED AC 2009; 13:822-31. [DOI: 10.1109/titb.2009.2023664] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Merritt C, Nagle H, Grant E. Fabric-Based Active Electrode Design and Fabrication for Health Monitoring Clothing. ACTA ACUST UNITED AC 2009; 13:274-80. [DOI: 10.1109/titb.2009.2012408] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Worth A, Irshad T, Bhopal R, Brown D, Lawton J, Grant E, Murray S, Kendall M, Adam J, Gardee R, Sheikh A. Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study. BMJ 2009; 338:b183. [PMID: 19190015 PMCID: PMC2636416 DOI: 10.1136/bmj.b183] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome. DESIGN Prospective, longitudinal, qualitative design using in-depth interviews. SETTING Central Scotland. PARTICIPANTS 25 purposively selected South Asian Sikh and Muslim patients, 18 family carers, and 20 key health professionals. RESULTS 92 interviews took place. Most services struggled to deliver responsive, culturally appropriate care. Barriers to accessing effective end of life care included resource constrained services; institutional and, occasionally, personal racial and religious discrimination; limited awareness and understanding among South Asian people of the role of hospices; and difficulty discussing death. The most vulnerable patients, including recent migrants and those with poor English language skills, with no family advocate, and dying of non-malignant diseases were at particularly high risk of inadequate care. CONCLUSIONS Despite a robust Scottish diversity policy, services for South Asian Sikh and Muslim patients with life limiting illness were wanting in many key areas. Active case management of the most vulnerable patients and carers, and "real time" support, from where professionals can obtain advice specific to an individual patient and family, are the approaches most likely to instigate noticeable improvements in access to high quality end of life care. Improving access to palliative care for all, particularly those with non-malignant illnesses, as well as focusing on the specific needs of ethnic minority groups, is required.
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Grant E, Logie D, Masura M, Gorman D, Murray SA. Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study. AIDS Care 2009; 20:1155-60. [PMID: 19012078 DOI: 10.1080/09540120701854634] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Antiretroviral therapy is increasingly available in African communities. We set out to gain patient perceptions on factors that facilitate and challenge access and adherence to such therapy. We carried out two semi-structured interviews 12 months apart with 40 HIV-positive people drawn from three economically deprived townships in the Copperbelt, Zambia. We also conducted a focus group of 12 of these interviewees. Availability of medication in health facilities did not automatically ensure access to those in need. A prerequisite for commencing on treatment was a positive documented HIV test result, but too few HIV testing centres, fear of family and community rejection and male domination in sexual and social decision-making prevented a number from coming forward to be tested. Once within the system of care, further barriers, such as rumours of bad side-effects, inconsistent information, high costs of drugs (at the time of the first interviews), ongoing costs of additional medical tests, overcrowded systems and overworked staff, all hindered access to receiving treatment. When taken, therapy brought side-effects, the most common being increased appetite and hunger. Yet, despite these barriers and challenges many of those on treatment reported good adherence. Immediate factors, such as seeing ill people becoming well; being supported by a friend or family member; and having a watch or clock to keep to a regular regime, were important. The increase in the number of people who were expected to die but were now looking well also shifted community attitudes. HIV/AIDS is beginning to move from a hidden terminal disease to a chronic condition that is treatable.
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Sedmera D, Harris BS, Grant E, Zhang N, Jourdan J, Kurkova D, Gourdie RG. Cardiac expression patterns of endothelin-converting enzyme (ECE): implications for conduction system development. Dev Dyn 2008; 237:1746-53. [PMID: 18489007 DOI: 10.1002/dvdy.21572] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The spatiotemporal distribution of the endothelin-converting enzyme (ECE) protein in the embryonic chick heart and the association of this polypeptide with the developing cardiac conduction system is described here for the first time. Further, we show how cardiac hemodynamic load directly affects ECE level and distribution. Endothelin (ET) is a cytokine involved in the inductive recruitment of Purkinje fibers. ET is produced by proteolytic cleavage of Big-ET by ECE. We generated an antibody against chick ECE recognizing a single band at approximately 70 kD to correlate the cardiac expression of this protein with that reported previously for its mRNA. ECE protein expression was more widespread compared to its mRNA, being present in endothelial cells, mesenchymal cells, and myocytes, and particularly enriched in the trabeculae and nascent ventricular conduction system. The myocardial expression was significantly modified under experimentally altered hemodynamic loading. In vivo, ET receptor blockade with bosentan delayed activation sequence maturation. These data support a role for ECE in avian cardiac conduction system differentiation and maturation.
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Lebel A, Becerra L, Wallin D, Moulton EA, Morris S, Pendse G, Jasciewicz J, Stein M, Aiello-Lammens M, Grant E, Berde C, Borsook D. fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain 2008; 131:1854-79. [DOI: 10.1093/brain/awn123] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Roe CM, Xiong C, Grant E, Miller JP, Morris JC. Education and reported onset of symptoms among individuals with Alzheimer disease. ACTA ACUST UNITED AC 2008; 65:108-11. [PMID: 18195147 DOI: 10.1001/archneurol.2007.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine whether reported age at onset of dementia symptoms among participants with Alzheimer disease (AD) is later for those with fewer years of education and, if so, to see if education is attributed to delayed detection of symptoms. DESIGN Case series. SETTING National Alzheimer's Coordinating Center Minimum Data Set (N=21 880 participants) and Washington University Alzheimer's Disease Research Center (N=1449 participants). RESULTS Reported age at onset of dementia symptoms is slightly younger in participants with more education. Participants with fewer years of education show greater clinical severity of Alzheimer disease at first assessment. CONCLUSION Symptoms of Alzheimer disease are recognized later among those with less education.
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Grant E, Lilly ST, Herath S, Sheldon IM. Escherichia coli
lipopolysaccharide modulates bovine luteal cell function. Vet Rec 2007; 161:695-6. [DOI: 10.1136/vr.161.20.695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. J Pain Symptom Manage 2007; 34:393-402. [PMID: 17616334 DOI: 10.1016/j.jpainsymman.2006.12.009] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 12/13/2006] [Accepted: 12/14/2006] [Indexed: 10/23/2022]
Abstract
Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer (n=24) and heart failure (n=24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heart failure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses.
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Knake S, Shriaishi H, Hamer H, Stufflebeam S, Hara K, Grant E, Rosenow F, Oertel W, Halgren E. Sensitivity and diagnostic value of 306-channel MEG and 70-electrode EEG in the presurgical evaluation of 70 epilepsy patients. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sedmera D, Harris BS, Grant E, Zhang N, Jourdan J, Kurkova D, Gourdie RG. Cardiac expression patterns of endothelin‐converting enzyme (ECE) suggest a role of endothelin signaling in conduction system development. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grant E, Macnab A, Wambera K. The effectiveness of pediatric residency education in preparing graduates to manage neurological and neurobehavioral issues in practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:304-9. [PMID: 17327725 DOI: 10.1097/acm.0b013e31803080c8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Pediatricians are required to manage a variety of neurodevelopmental conditions. In this study, the authors surveyed self-assessment of competency by recent graduates of the University of British Columbia (UBC) pediatric residency training program in various areas of pediatric neurology, from acute care to behavioral assessments. METHOD Forty-six questionnaires were mailed or e-mailed between October 2002 and September 2004 to UBC pediatrics program graduates of 1998-2004. The 29-item questionnaire consisted of 26 questions on a six-point scale and asked respondents to rate their ability to manage specific neurological and developmental symptoms and conditions. Also, three open-ended questions asked respondents which topics required less emphasis or more emphasis and which were appropriate for continuing medical education (CME). Descriptive statistical analyses were performed. RESULTS A total of 39 questionnaires (85% response rate) were completed and returned. The results indicate that 74% of pediatric graduates feel that more of the neurology portion of residency training should be spent on general pediatric behavioral and neurological conditions (e.g., attention-deficit/hyperactivity disorder or developmental delay) and would choose to attend CME on these areas, and 28% of respondents would prefer to receive less training on complex neurological problems that are managed at a subspecialty level (e.g., chronic refractory seizures). CONCLUSIONS Pediatric residents need sufficient, specific training to enable them to competently investigate and manage the neurobehavioral complaints and conditions commonly encountered by general pediatricians in both their office and hospital practice.
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Grant E, Murray SA, Kendall M, Boyd K, Tilley S, Ryan D. Spiritual issues and needs: perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study. Palliat Support Care 2006; 2:371-8. [PMID: 16594399 DOI: 10.1017/s1478951504040490] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Health care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge on their physical, psychological, and social well-being. Patients were also encouraged to explain in what ways their spiritual needs, if they had any, could be addressed. METHODS We conducted two qualitative interviews, 3 months apart, with 20 patients in their last year of life: 13 patients with advanced cancer and 7 with advanced nonmalignant illness. We also interviewed each patient's general practitioner. Sixty-six interviews were tape-recorded, transcribed, and analyzed. RESULTS Patients' spiritual needs centered around their loss of roles and self-identity and their fear of dying. Many sought to make sense of life in relation to a nonvisible or sacred world. They associated anxiety, sleeplessness, and despair with such issues, which at times resulted in them seeking support from health professionals. Patients were best able to engage their personal resources to meet these needs when affirmed and valued by health professionals. SIGNIFICANCE OF RESULTS Enabling patients to deal with their spiritual needs through affirmative relationships with health professionals may improve quality of life and reduce use of health resources. Further research to explore the relationship between spiritual distress and health service utilization is indicated.
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Peters-Golden M, Swern A, Bird SS, Hustad CM, Grant E, Edelman JM. Influence of body mass index on the response to asthma controller agents. Eur Respir J 2006; 27:495-503. [PMID: 16507848 DOI: 10.1183/09031936.06.00077205] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of asthma has been positively associated with obesity. Asthma comprises diverse "phenotypes" reflecting heterogeneity in a number of characteristics, including response to therapy. The present authors examined whether body mass index (BMI) influenced the response to placebo, as well as to two asthma controller medications. A post hoc analysis was performed, pooling data from four double-blind, placebo-controlled studies randomising 3,073 moderate asthmatic adults to montelukast (n=1,439), beclomethasone (n=894) or placebo (n=740). The primary end point was asthma control days; other end points were forced expiratory volume in one second, beta-agonist use and nocturnal awakening. Analyses were conducted using BMI classification into normal (<25.0 kg.m-2; 52% of patients), overweight (25-29.9 kg.m-2; 32%) and obese (>or=30.0 kg.m-2; 16%) categories, as well as BMI as a continuous variable. The treatment groups were balanced for BMI, demographic characteristics and parameters of asthma control. The placebo response for all end points was generally lower with increasing BMI. Similarly, the response to the inhaled corticosteroid decreased, whereas the response to the leukotriene antagonist remained stable. In conclusion, post hoc data from the present study suggested that body mass index may influence the natural history of asthma control (as reflected by response to placebo) and may differentially influence response to the two active agents, warranting explicit testing in future prospective studies.
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