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Tsouknidas I, Perez S, Kunkel E, Tiko-Okoye C, Buckley ME, Gefen JY. Use of sugammadex in prevention of post-operative urinary retention in minimally invasive hernia surgery. Hernia 2024:10.1007/s10029-024-03038-4. [PMID: 38683482 DOI: 10.1007/s10029-024-03038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Post-operative urinary retention (POUR) is a known complication of hernia surgery. Minimally invasive inguinal hernia repair (IHR) is typically done under general anesthesia with neuromuscular blockade (NMB), which is commonly reversed with an anticholinesterase inhibitor paired with an anticholinergic agent. Sugammadex is a unique NMB reversal agent that does not have to be paired with an anticholinergic. We sought to explore the role of sugammadex in reducing the rate of POUR following these procedures. METHODS Data were collected retrospectively at a single institution between February 2016 and October 2019. We identified and studied patients who underwent minimally invasive IHR and received either sugammadex or neostigmine/glycopyrrolate for NMB reversal. The primary endpoint was POUR requiring bladder catheterization. Secondary endpoints included post-operative and 30-day readmissions. RESULTS 274 patients were included in this study (143 received neostigmine and glycopyrrolate, 131 sugammadex). The sugammadex patients were on average 5 years older than the neostigmine/ glycopyrrolate patients (63.2 vs 58.2, p = 0.003), and received less median intravenous fluids (IVF) (900 ml vs 1000 ml; p = 0.015). There was a significant difference in the rate of POUR between the sugammadex and neostigmine/glycopyrrolate patients (0.0% vs 8.4%, p ≤ 0.001). The difference remained significant after controlling for age and IVF. The odds of POUR for those who received neostigmine/glycopyrrolate were 25 × higher than the odds of those who received sugammadex. CONCLUSION The results of this study reflect the protective role of sugammadex against POUR in minimally invasive IHR cases.
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Affiliation(s)
- I Tsouknidas
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
| | - S Perez
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
| | - E Kunkel
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego (UCSD), San Diego, CA, USA
| | - C Tiko-Okoye
- Department of Acute Care, Trauma & Critical Care Surgery, Duke University Hospital, Durham, NC, USA
| | - M E Buckley
- Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - J Y Gefen
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
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Bujold AR, Barre AME, Kunkel E, MacInnes JI. Strain-dependent interactions of Streptococcus suis and Glaesserella parasuis in co-culture. Can J Vet Res 2023; 87:245-253. [PMID: 37790267 PMCID: PMC10542955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/01/2023] [Indexed: 10/05/2023]
Abstract
Streptococcus suis (S. suis) and Glaesserella parasuis (G. parasuis) are ubiquitous colonizers of swine tonsils that can cause systemic disease and death, under undefined conditions. It is not known, however, whether these 2 species interact during initial infection. To investigate whether such interactions occur, the objective of this study was to assess phenotypic differences between mono-and co-cultures of S. suis and G. parasuis when representative strains with different virulence potential were co-cultured in vitro. In cross-streak screening experiments, some G. parasuis (GP) serovar strains (GP3, GP4, GP5) exhibited altered morphology with some S. suis (SS) serovar strains, such as SS2, but not with SS1. Co-culture with GP5 reduced hemolytic activity of SS1, but not of SS2. Although both SS strains outgrew GP isolates in biofilm co-cultures, strain type affected the number of planktonic or sessile cells in co-culture biofilms. Numbers of sessile SS1 increased in co-cultures, but not of GP3. Both planktonic and sessile SS2 increased in co-culture, whereas GP5 decreased. Sessile SS1 increased, but planktonic GP5 decreased in co-culture and planktonic SS2 increased, but sessile GP3 decreased when grown together. The SS2 strain had a competitive advantage over GP3 during mid-exponential co-culture in broth. Streptococcus suis is predicted to use more unique carbon sources, suggesting that S. suis outcompetes G. parasuis in growth and nutrient consumption. This work provides direction for future studies of phenotypic and genotypic interactions between these and other swine tonsil co-colonizers.
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Affiliation(s)
- Adina R Bujold
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
| | - Allison M E Barre
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
| | - Elizabeth Kunkel
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
| | - Janet I MacInnes
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
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3
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Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. Can J Psychiatry 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
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Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
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4
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Akbari A, Kunkel E, Bota SE, Harel Z, Le Gal G, Cox C, Hundemer GL, Canney M, Clark E, Massicotte-Azarniouch D, Eddeen AB, Knoll G, Sood MM. Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study. Clin Kidney J 2021; 14:2101-2107. [PMID: 34671466 PMCID: PMC8521786 DOI: 10.1093/ckj/sfaa278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Pregnancy-associated venous thromboembolism (VTE) is associated with high morbidity and mortality. Identification of risk factors of VTE may lead to improved maternal and foetal outcomes. Proteinuria confers a pro-thrombotic state, however, its association with VTE in pregnancy remains unknown. We set out to assess the association of proteinuria and VTE during pregnancy. Methods We conducted a population-based, retrospective cohort study of all pregnant women (≥16 years of age) with a proteinuria measure within 20 weeks of conception (n = 306 244; mean age 29.8 years) from Ontario, Canada. Proteinuria was defined by any of the following: urine albumin:creatinine ratio ≥3 mg/mmol, urine protein:creatinine ratio ≥5 mg/mmol or urine dipstick proteinuria ≥1. The main outcome measure was a diagnosis of VTE up to 24-weeks post-partum. Results A positive proteinuria measurement occurred in 8508 (2.78%) women and was more common with a history of kidney disease, gestational or non-gestational diabetes mellitus and hypertension. VTE events occurred in 625 (0.20%) individuals, with a higher risk among women with positive proteinuria [32 events (0.38%)] compared with women without proteinuria [593 events (0.20%); inverse probability-weighted risk ratio 1.79 (95% confidence interval 1.25-2.57)]. The association was consistent using a more specific VTE definition, in the post-partum period, in high-risk subgroups (hypertension or diabetes) and when the sample was restricted to women with preserved kidney function. Conclusions The presence of proteinuria in the first 20 weeks of pregnancy is associated with a significantly higher risk of VTE.
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Affiliation(s)
- Ayub Akbari
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Ziv Harel
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Conor Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory L Hundemer
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark Canney
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward Clark
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Greg Knoll
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
| | - Manish M Sood
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
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Kobewka D, Heyland DK, Dodek P, Nijjar A, Bansback N, Howard M, Munene P, Kunkel E, Forster A, Brehaut J, You JJ. Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death. J Gen Intern Med 2021; 36:2593-2600. [PMID: 33528779 PMCID: PMC8390722 DOI: 10.1007/s11606-021-06605-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. OBJECTIVE To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. DESIGN Open-label randomized controlled trial. PATIENTS Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. INTERVENTION Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. MAIN MEASURE The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment. KEY RESULTS We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict). CONCLUSIONS Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. PRIMARY FUNDING SOURCE Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.
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Affiliation(s)
- Daniel Kobewka
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. .,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Aman Nijjar
- General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,David Braley Health Sciences Centre, Hamilton, ON, Canada
| | - Peter Munene
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elizabeth Kunkel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Department of National Defence, Ottawa, ON, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada
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Kendzerska T, Aaron SD, Meteb M, Gershon AS, To T, Lougheed MD, Tavakoli H, Chen W, Kunkel E, Sadatsafavi M. Specialist Care in Individuals With Asthma Who Required Hospitalization: A Retrospective Population-Based Study. J Allergy Clin Immunol Pract 2021; 9:3686-3696. [PMID: 34182160 DOI: 10.1016/j.jaip.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients who are at risk for severe asthma exacerbations should receive specialist care. However, the care pattern for such patients in the real world is unclear. OBJECTIVE To describe the pattern of care among individuals with asthma who required hospitalization, and to identify factors associated with receiving asthma specialist care. METHODS This was a retrospective population-based study using health administrative data from two Canadian provinces. Individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma at or within 5 years after the initial asthma diagnosis were included. First, we calculated frequencies of primary and specialist care around the asthma diagnosis: 1 year before and 2 years after in a 6-month period. Next, among individuals diagnosed with asthma by a primary care physician, we used multivariable Cox regressions to identify factors associated with receiving specialist care. RESULTS For 1862 individuals included, we found that most (≥71% per time period) were cared for by primary care physicians 1 year before and 2 years after the asthma diagnosis; the percentage of individuals seen at least once by a specialist for asthma and/or asthma-related respiratory conditions during the first 6 months since the diagnosis did not exceed 40%. Among 1411 of 1862 individuals who were under primary care before the asthma diagnosis (76%), controlling for covariates, living in a rural area or a low-income neighborhood was associated with less likelihood of receiving specialist care. CONCLUSIONS Despite recommendations, more than half of individuals with asthma who required hospitalization did not receive specialist care during the first 2 years since the diagnosis. Identified factors associated with receiving asthma specialist care suggested that access is an important barrier to receiving recommended care.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada; ICES, Ontario, Canada.
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Moussa Meteb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Teresa To
- ICES, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Research Institute, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - M Diane Lougheed
- ICES, Ontario, Canada; Kingston General Hospital Research Institute, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Elizabeth Kunkel
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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8
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Brown D, Henau HD, Garrigan JT, Gerike P, Holt M, Kunkel E, Matthijs E, Waters J, Watkinson RJ. Removal of Nonionics in Sewage Treatment Plants II / Abbauwerte für Nonionics in Klaranlagen II. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1987-240108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Schöberl P, Kunkel E, Espeter K. Vergleichende Untersuchungen über den mikrobiellen Metabolismus eines Nonylphenol- und eines Oxoalkohol- Ethoxylates. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1981-180204] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Keck E, Kunkel E, Matthijs E, Waters J, Watkinson RJ. Abbauwerte von Haushaltswaschmitteln in einer Belebungsanlage/ Removal of Nonionics in a Sewage Treatment Plant. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1986-230414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Marks JH, Salem JF, Adams P, Sun T, Kunkel E, Schoonyoung H, Agarwal S. SP rTaTME: initial clinical experience with single-port robotic transanal total mesorectal excision (SP rTaTME). Tech Coloproctol 2021; 25:721-726. [PMID: 33881657 DOI: 10.1007/s10151-021-02449-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The technical difficulty and steep learning curve of transanal total mesorectal excision (taTME) has limited widespread adoption. The single-port (SP) daVinci robot is designed to facilitate single-incision and natural-orifice transluminal endoscopic surgery (NOTES). This paper describes the first clinical experience of single-port robotic taTME (SP rTaTME). METHODS This was a prospective study on consecutive patients with rectal cancer who underwent SP rTaTME proctosigmoidectomy with handsewn coloanal anastomosis in December 2018 and January 2019. The primary outcome was technical feasibility of the procedure. The secondary outcomes include blood loss, intraoperative complications, length of hospital stay, quality of the TME specimen, short- and long-term morbidity and mortality, as well as short-term oncologic follow -up. RESULTS There were two patients, a 48-year-old male and a 38-year-old female. Both operations were completed successfully without complications or conversion. Estimated blood loss was 200 mL and 130 mL. In both cases the TME was completed transanally using the SP robot. In the first patient, the abdominal portion was completed through an abdominal single-incision; in the second patient the operation was entirely performed transanally as a pure NOTES procedure. In both cases, the final pathology report showed a complete TME with negative margins. Patients were discharged on postoperative day 3 and 4,respectively. There was no long-term morbidity or mortality. CONCLUSIONS SP rTaTME is feasible and can be safely performed. It provides excellent optics and dexterity to work in a limited space. Future studies are required to further define the safety profile and the ultimate utility of the SP robot for taTME.
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Affiliation(s)
- J H Marks
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA.
| | - J F Salem
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - P Adams
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - T Sun
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - E Kunkel
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - H Schoonyoung
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - S Agarwal
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
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Akbari A, Kunkel E, Bota S, Harel Z, Le Gal G, Cox C, Hundemer G, Canney M, Clark E, Massicotte-Azarinouch D, Eddeen A, Knoll G, Sood M. POS-468 PROTEINURIA AND VENOUS THROMBOEMBOLISM IN PREGNANCY: A POPULATION-BASED COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Craig R, Kunkel E, Crowcroft NS, Fitzpatrick MC, de Melker H, Althouse BM, Merkel T, Scarpino SV, Koelle K, Friedman L, Arnold C, Bolotin S. Asymptomatic Infection and Transmission of Pertussis in Households: A Systematic Review. Clin Infect Dis 2021; 70:152-161. [PMID: 31257450 DOI: 10.1093/cid/ciz531] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Indexed: 12/28/2022] Open
Abstract
We conducted a systematic review to describe the frequency of mild, atypical, and asymptomatic infection among household contacts of pertussis cases and to explore the published literature for evidence of asymptomatic transmission. We included studies that obtained and tested laboratory specimens from household contacts regardless of symptom presentation and reported the proportion of cases with typical, mild/atypical, or asymptomatic infection. After screening 6789 articles, we included 26 studies. Fourteen studies reported household contacts with mild/atypical pertussis. These comprised up to 46.2% of all contacts tested. Twenty-four studies reported asymptomatic contacts with laboratory-confirmed pertussis, comprising up to 55.6% of those tested. Seven studies presented evidence consistent with asymptomatic pertussis transmission between household contacts. Our results demonstrate a high prevalence of subclinical infection in household contacts of pertussis cases, which may play a substantial role in the ongoing transmission of disease. Our review reveals a gap in our understanding of pertussis transmission.
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Affiliation(s)
- Rodger Craig
- Applied Immunization Research and Evaluation, Public Health Ontario,Toronto.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Montreal, Canada
| | - Elizabeth Kunkel
- Applied Immunization Research and Evaluation, Public Health Ontario,Toronto.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Natasha S Crowcroft
- Applied Immunization Research and Evaluation, Public Health Ontario,Toronto.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Montreal, Canada.,Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Benjamin M Althouse
- Institute for Disease Modeling, Bellevue, Washington.,Information School, University of Washington, Seattle.,Department of Biology, New Mexico State University, Las Cruces
| | - Tod Merkel
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Samuel V Scarpino
- Network Science Institute, Northeastern University, Boston, Massachusetts.,Institute for Scientific Interchange Foundation, Torino, Italy
| | - Katia Koelle
- Department of Biology, Emory University, Atlanta, Georgia
| | - Lindsay Friedman
- Applied Immunization Research and Evaluation, Public Health Ontario,Toronto
| | - Callum Arnold
- Division of Infectious Diseases,The Hospital for Sick Children, Toronto, Canada
| | - Shelly Bolotin
- Applied Immunization Research and Evaluation, Public Health Ontario,Toronto.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Montreal, Canada.,Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
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Kunkel E, Tanuseputro P, Hsu A, Talarico R, Lapenskie J, Calder-Sprackman S, Kobewka D. Diagnostic Testing in Long-Term Care and Resident Emergency Department Visits: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 22:901-906.e4. [PMID: 33281039 DOI: 10.1016/j.jamda.2020.09.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the association between rapid access to radiographs, blood tests, urine cultures, and intravenous (IV) therapy in a long-term care (LTC) home with resident transfers to the emergency department (ED). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS 21,811 residents living in 162 LTC homes in Ontario, Canada. METHODS We administered a survey to LTC homes to collect wait times for radiographs, basic blood tests, urine culture, and IV therapy. Rapid availability was defined as typically receiving test results within 1 or 2 days, or same-day IV therapy. We linked the survey results to administrative data and defined a cohort of residents living in survey-respondent homes between January and May 2017. We followed residents in the linked administrative databases for 6 months, until discharge, or death. Two physicians identified diagnostic codes for ED visits that were potentially preventable with rapid availability of each of the 4 resources. Multilevel logistic regression models estimated associations between potentially preventable ED visits and rapid diagnostic tests and intravenous access while controlling for demographic characteristics, illness severity, LTC home size, chain status, and physician availability. RESULTS Rapid blood tests, radiographs, urine culture, and IV therapy were available in 55%, 47%, 34%, and 45% of LTC homes, respectively. LTC homes that were part of multihome chains were less likely to have rapid access to the 4 resources. Of the 4736 residents (27%) who visited an ED during follow-up, individuals from homes with rapid access to radiographs (odds ratio 0.79, 95% confidence interval 0.66-0.97), urine culture (0.88, 0.72-1.08), blood tests (0.83, 0.69-1.00), and IV therapy (0.93, 0.70-1.23) tended to have fewer potentially preventable ED visits. CONCLUSIONS AND IMPLICATIONS Rapid access to diagnostic testing and IV therapy in LTC reduced ED visits. Improving access to these resources may prevent ED visits and allow residents to stay home.
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Affiliation(s)
- Elizabeth Kunkel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amy Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada
| | | | | | - Daniel Kobewka
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Davis-Cheshire R, Cogar C, Collier D, Deriveau W, Kunkel E, Mouser H, Newhouse J. Occupational therapy utilisation of apps in practice in the United States. Disabil Rehabil Assist Technol 2020; 17:948-956. [PMID: 33086022 DOI: 10.1080/17483107.2020.1834629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of this cross-sectional research study was to explore the use of apps by occupational therapy practitioners in the United States to gain a more complete overview of utilisation and perceived effectiveness, and assess trends by population served, practice setting, occupation addressed, and client deficit. METHODS For this cross-sectional study, 160 self-identified occupational therapy practitioners, 126 occupational therapists and 34 occupational therapy assistants, recruited through snowball sampling on social media participated in this 26-question survey available for two weeks online. Data analysis was conducted through SurveyMonkey and SPSS version 26. RESULTS The majority of respondents (71.9%) reported that they have used apps in practice, most frequently as treatment modalities (84.3%) and as recommendations (71.9%) for clients. Likewise, most respondents who reported using apps considered apps to be as effective (70.5%) or better than (27.3%) traditional practice methods. Use of apps was significantly associated with practice setting X2(9, N = 160) = 46.437, p < .001. CONCLUSIONS Occupational therapists are using apps with clients of all age groups, and these apps are being used in all phases of the occupational therapy process. Apps are available that address all eight areas of occupation, and apps are perceived to be as effective or better than traditional occupational therapy interventions.IMPLICATIONS FOR REHABILIATIONThe majority of occupational therapy practitioners surveyed are using apps in practice.Most therapists are being provided devices by employers that support app use in practice.Neuromusculoskeletal and movement related functions and mental functions related to cognition are the primary client impairments therapists are addressing when using apps.Lack of app knowledge and familiarity with apps were the leading barriers to app use in practice.
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Affiliation(s)
| | - Carly Cogar
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Dayna Collier
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Whooby Deriveau
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | | | - Hunter Mouser
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Julia Newhouse
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
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Selim S, Kunkel E, Wegier P, Tanuseputro P, Downar J, Isenberg SR, Li A, Kyeremanteng K, Manuel D, Kobewka DM. A systematic review of interventions aiming to improve communication of prognosis to adult patients. Patient Educ Couns 2020; 103:1467-1497. [PMID: 32284167 DOI: 10.1016/j.pec.2020.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Our objective was to describe interventions that aim to improve communication of prognosis to adult patients and to summarize the effect of interventions. METHODS We included randomized controlled trials of interventions that included prognosis delivery. We excluded studies of decision aids. Our analysis was a narrative synthesis of interventions and outcomes. RESULTS Our search identified 1151 unique records. After screening, and full text review we included 21 reports from 17 RCTs. Only 2 studies used a prediction model to generate prognostic estimates. Four studies used education, ten used patient mediated interventions, and 2 used coordination of care. In some studies education that includes prognosis improves patient reported outcomes, communication and treatment decisions, patient mediated interventions can increase the number of questions patients ask about prognosis. Coordination of care may improve satisfaction. CONCLUSIONS Education for clinicians that includes teaching about how to communicate prognosis may improve patient reported outcomes. Patient mediated interventions can increase the number of prognosis related questions asked by patients. PRACTICE IMPLICATIONS Communication skills training that includes training on delivering prognosis may improve communication and patient reported outcomes, but the evidence is uncertain. Giving patients question prompt lists can help them ask more prognosis related questions.
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Affiliation(s)
- Shehab Selim
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Elizabeth Kunkel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Pete Wegier
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Bruyere Research Institute, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarina R Isenberg
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Aimee Li
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Institut du Savoir Montfort, Ottawa, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Daniel M Kobewka
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
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Rockley M, Kobewka D, Kunkel E, Nagpal S, McIsaac DI, Thavorn K, Forster A. Characteristics of high-cost inpatients with peripheral artery disease. J Vasc Surg 2020; 72:250-258.e8. [DOI: 10.1016/j.jvs.2019.09.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023]
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Rojas K, Raker C, Onstad M, Kunkel E, Clark M, Stuckey A, Gass J. 031 The Impact of Mastectomy Type on the Female Sexual Function Index (FSFI) and Parameters of Intimacy such as Appearance, Satisfaction, and the Breast’s Role in Intimacy. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fogarty S, Onstad M, Stuckey A, Kunkel E, Clark M, Lopes V, Raker C, Robison K, Flores L, Boggis J, Manning L, Blake R, Sargent R, Gass J. Surgical management of breast cancer and impact on sexual function. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2014.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brovko L, Anany H, Bayoumi M, Giang K, Kunkel E, Lim E, Naboka O, Rahman S, Li J, Filipe C, Griffiths M. Antimicrobial light-activated materials: towards application for food and environmental safety. J Appl Microbiol 2014; 117:1260-6. [DOI: 10.1111/jam.12622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/20/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- L. Brovko
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - H. Anany
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
- Microbiology Department; Faculty of Science; Ain Shams University; Cairo Egypt
| | - M. Bayoumi
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
- Food Control Department; Faculty of Veterinary Medicine; Zagazig University; Zagazig Egypt
| | - K. Giang
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - E. Kunkel
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - E. Lim
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - O. Naboka
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - S. Rahman
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - J. Li
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - C.D.M. Filipe
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - M.W. Griffiths
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
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Cobia DC, Carney JS, Buckhalt JA, Middleton RA, Shannon DM, Trippany R, Kunkel E. The Doctoral Portfolio: Centerpiece of a Comprehensive System of Evaluation. Counselor Education and Supervision 2011. [DOI: 10.1002/j.1556-6978.2005.tb01753.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
We have used nascent strand determination analysis to map start sites of DNA replication in the mouse ribosomal gene cluster in which individual copies of the ribosomal genes are separated by intergenic spacer regions. One origin of bidirectional replication (OBR) was localized within a 3 kb region centered about 1.6 kb upstream of the rDNA transcription start site. At least one additional initiation site is situated near the 3' end of the transcription unit. Adjacent to the OBR at the transcription start site are located two amplification-promoting sequences, i.e., APS1 and APS2. Nuclease-hypersensitive sites were identified in both of the two APSs as well as in the OBR region, thus indicating that these sequences have an altered chromatin structure. In the OBR an intrinsically bent region, a purine-rich element and other prospective initiation zone components are found.
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Affiliation(s)
- E Gögel
- Institut für Biochemie, Universität Würzburg, Biozentrum, D-97074 Würzburg, Germany
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Stephan E, Kunkel E. [A traffic psychology comment on "a cost-benefit analysis of courses for repeatedly intoxicated automobile drivers"]. Blutalkohol 1989; 26:347-51. [PMID: 2508728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hundhausen's statements to valuation of repeating training courses show essential deficiencies: Quotations of specialitic authors are placed in a not right context. Relevant empiric results which would withdraw the basis of all his conclusions are not reported by him. So he argues in opposition to published empiric dates (see Winkler 1988, Stephan 1988) and logical arguments (see Stephan 1988), which prove that persons comprised in reality examinations had a above-averades traffic risk. Moreover, he overlooks in his exclusive 'calculatory valuation' that his argue of 'detour production' on the one hand violates the public claim on traffic security and on the other hand the constitutional claim of the alcohol conspicious drivers on proportion of national sanctions and measures. Also in case subsequent trained drivers do not represent a population being specially high relapse dangered, they should be offered the possibility to choose their own milder alternative (shortening of blocking period when having been successful as a course member). This should only be realized when the traffic security is not affected. The attempt to achieve an own valuation of the course success by economic founded scales must be judged as failed because of the not exactly termed premises and the logical consequences as well.
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Kunkel E. [Disclosure of drinking behavior, social drinking and blood alcohol concentration]. Blutalkohol 1985; 22:341-56. [PMID: 4052234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kunkel E. [The probability of recidivism as a criterion of fitness in alcohol-related incidents among automobile drivers]. Blutalkohol 1984; 21:385-95. [PMID: 6536318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kunkel E. [The Frankfurt experiment. A group project with drunk traffic offenders under conditional discharge. II: Psychological aspects of a new sanction for traffic offenders?]. Blutalkohol 1984; 21:332-7. [PMID: 6536313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kunkel E, Geldermann H. Microdetermination of nitrogen with a modified pyrolysis-chemiluminescence system. Mikrochim Acta 1980. [DOI: 10.1007/bf01197613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Frazer A, Hess ME, Mendels J, Gable B, Kunkel E, Bender A. Influence of acute and chronic treatment with desmethylimipramine on catecholamine effects in the rat. J Pharmacol Exp Ther 1978; 206:311-9. [PMID: 210273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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