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Sleep disturbance as a precursor to anxiety, depression, and PTSD among rural Kenyans: A cross-lagged panel analysis from a rural Kenyan interventional cohort. J Sleep Res 2023:e14119. [PMID: 38083983 DOI: 10.1111/jsr.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 05/01/2024]
Abstract
Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well-being within low- or middle-income countries. This study utilised longitudinal cohort data from a community-based empowerment programme in Meru County, Kenya to assess cross-lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18-86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within-time correlations across measures, within-measure correlations across time, and sociodemographic background characteristics. The findings are consistent with research across high-income countries, underscoring the need for more contextualised research into sleep behaviours across low- and middle-income countries. The findings may inform interventions to increase mental and social well-being within Kenya.
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Highlights of Cardiovascular Disease Prevention Studies Presented at the 2023 European Society of Cardiology Congress. Curr Atheroscler Rep 2023; 25:965-978. [PMID: 37975955 DOI: 10.1007/s11883-023-01164-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To summarize selected late-breaking science on cardiovascular (CV) disease prevention presented at the 2023 European Society of Cardiology (ESC) congress. RECENT FINDINGS The NATURE-PARADOX was a naturally randomized trial that used genetic data from the UK Biobank registry to create "cumulative exposure to low-density lipoprotein-cholesterol (LDL-C)" biomarker and evaluate its association with major CV events regardless of plasma LDL-C levels or age. Safety and efficacy data of inclisiran, a PCSK9-interfering mRNA (PCSK9i) administered subcutaneously twice annually, were presented. Data on two new PCSK9is were presented, recaticimab, an oral drug, and lerodalcibep, a subcutaneous drug with a slightly different architecture than currently available PSCK9is. A phase 1 trial on muvalaplin, an oral lipoprotein (a) inhibitor, was presented. An atherosclerotic CV disease (ASCVD) risk prediction algorithm for the Asian population using SCORE2 data was presented. Long-term follow-up of patients enrolled in the CLEAR outcomes trial showed sustained and more significant ASCVD risk reduction with bempedoic acid in high-risk patients. The late-breaking clinical science at the 2023 congress of the ESC extends the known safety and efficacy data of a PCSK9i with the introduction of new drugs in this class. Using cumulative exposure to LDL-C rather than a single value will help clinicians tailor the LDL-C reduction strategy to individual risk and is an important step towards personalized medicine.
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Annual Foot Exams are Associated with Reduced Incident Amputation among Older Veterans with Diabetes. J Appl Gerontol 2023; 42:205-212. [PMID: 36189677 DOI: 10.1177/07334648221129855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We conducted a secondary data analysis to evaluate the association between annual foot exams and incident lower extremity amputations (LEA) among older veterans with diabetes during FY2007-FY2014. Older Veterans with at least one primary care provider visit each year (N = 664,162) and at least one foot exam each year (N = 72,892) and the overlap were identified from the 5 years prior to the study period of interest (FY2002-FY2006 (N = 71,122)). After excluding incident LEA related to cancer and trauma, 71,018 veterans (mean age +/- SD, % male) were included in the final cohort, which was followed from FY2007-FY2014 to evaluate the influence of subsequent annual foot exams and incident LEA. Consistent annual foot exams were protective for incident LEA in older veterans with diabetes, adjusted OR was 0.85 (97% CI: 0.74-0.96). Results indicate that adherence to annual foot exam guidelines can reduce incident LEA in older veterans with diabetes.
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O-078 The VALUE study: a qualitative semi-structured interview study of add-on use by patients, clinicians, and embryologists in the UK and Australia. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Why do patients, clinicians and embryologists opt to use IVF add-ons in fertility treatment?
Summary answer
Add-ons offer options, hope and control in a desperate situation. The perceived drivers differ between patients and professionals; however, both feel add-ons offer bespoke care.
What is known already
Evidence that add-ons offer clinical advantages for the outcomes of IVF is lacking or insufficient. However, they remain popular in the UK and Australia, with over three-quarters of couples opting to use them. Professionals, clinical societies, and the media have latched onto the ethical aspects of offering non-evidence-based add-ons, often provided at an additional cost to vulnerable patients. Conversely, it has also been suggested that patients are driving add-on use. The VALUE study is the first large qualitative study to include both patients and professionals that explores the drivers behind their use, and how the existing evidence is weighed up.
Study design, size, duration
VALUE was a multinational semi-structured interview study in the UK and Australia. The interview schedule was reached through extensive patient and public involvement. Between January and May 2021, recruitment took place via social media advertisement, email invitation from professional societies, and snowballing. A purposive sampling strategy was planned; all eligible participants (25 patients, 25 embryologists, and 24 clinicians) were interviewed via recorded teleconference. Anonymised verbatim transcripts were analysed iteratively, and themes developed inductively.
Participants/materials, setting, methods
Patient and professional transcripts were coded separately using the software DedooseTM Two separate thematic analyses followed. An inductive approach to analysis was adopted, whereby themes emerged from the data, opposed to constructing a pre-conceived coding scheme. Codes were combined into broader themes, and sub-themes, which were discussed, debated, and named. The wider research team then commented upon and debated the themes and sub-themes, which were settled upon by consensus.
Main results and the role of chance
Thematic analysis of patient interviews identified five themes: ‘vulnerability’; ‘power of the trusted professional opinion’; ‘role of previous experience’; ‘acceptability of add-on’; and ‘the evidence doesn’t apply to me’. The professional interviews identified five themes: ‘Treating desperation’; ‘tensions within evidence-based practice’; ‘success, not profits’; ‘the patient shopper’; and ‘potential for harm’.
Analysis identified that that people undergoing IVF are vulnerable and opting for non-evidence-based treatments at additional cost because of a sense of desperation following unsuccessful cycles. For patients, utilising add-ons lends hope and a sense of control, with considerations of safety and efficacy being ranked lower than hope. For professionals, add-ons are reasonable given the absence of anything else to add, and allows patients the opportunity to exhaust every avenue. At odds with one-another are the themes regarding who is driving add-on use. Patients describe the power of a professional recommendation, believing it to be in their best interest. For professionals, it’s the patients who research and request add-ons, and failing to offer them risks losing patients. The tension between evidence and bespoke care was evident across both analyses, with testimonies being particularly powerful for patients, and for professionals, a belief that add-ons are helpful in the right context.
Limitations, reasons for caution
The VALUE study has captured patients and professionals who have volunteered to talk about this particularly contentious area of medicine. Participants are likely to be a motivated group of individuals who may potentially represent those with strong views regarding add-ons.
Wider implications of the findings
The theme of desperation runs through VALUE’s analyses and whilst we did find that patients drive add-on use, professional opinion for or against add-ons was powerful. Patients want autonomy, but only in the context of informed consent.
Trial registration number
https://osf.io/he7tn/
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SP3.1.1Research Priorities in Emergency General Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Delphi methodology can be used to achieve consensus opinion amongst experts in a particular field. This study used a modified Delphi approach to identify research priorities in emergency general surgery (EGS). The aim was to establish a research agenda using a formal consensus-based approach in an effort to identify questions relevant to EGS that have been prioritised by relevant stakeholders with an equal voice.
Methods
Three rounds were conducted using an electronic questionnaire and involved health care professionals, research personnel, patients and their relatives. In the first round stakeholders were invited to submit clinical research questions that they felt were priorities for future research. In rounds two and three, participants were asked to score individual questions in order of priority using a 5-point Linkert scale. Between rounds an expert panel were asked to analyse results before forwarding questions to subsequent rounds.
Results
Ninety-two EGS research questions were proposed in Phase 1. Following the first round of prioritisation, 47 questions progressed to the final phase. A final list of 17 research questions were identified from the final round of prioritisation. These included questions on peri-operative strategies, EGS outcomes in elderly and frail patients as well as non-technical and technical influences on EGS outcomes.
Conclusion
Our study provides a consensus delivered framework that should determine the research agenda for future EGS projects. It may also assist setting priorities for research funding and multi-centre collaborative strategies within the surgical subspecialty of EGS.
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Gender minority youth: Shifting the paradigm from risk to resilience. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Discourse on the lives, health, and well-being of transgender and other gender minority (TGM) youth frequently revolves around narratives of risk and victimisation. While TGM youth undeniably face many challenges, such singular discourses belie a more complex picture of TGM youth lives and problematically position them as passive victims rather than as social subjects with agency.
Methods
The “LGBTI+ Landscape and Knowledge Gap Analysis” aimed to systematically map research evidence on sexual and gender minority (SGM) youth in Ireland and other European countries. A scoping review methodology was employed in which the systematic concept searches were linked to the five outcomes of Ireland's Better Outcomes, Better Futures national youth policy framework, which in turn are aligned with the fifteen objectives of the Irish LGBTI+ National Youth Strategy.
Results
One hundred and twenty-six pieces of evidence were included in the final sample for analysis, which were mapped to the fifteen objectives of the National Youth Strategy. Particular attention was given to the positive aspects and protective factors identified throughout the literature. The evidence showed that while TGM youth disproportionately experience stigma, discrimination and unequal health outcomes, there were sources of resilience at the micro-, meso-, and macro- levels that serve as protective factors against health inequalities.
Conclusions
Discourse that focuses exclusively on the ‘at-riskness' of trans and gender minority young people presents a one-dimensional perspective that fails to capture the reality and richness of their lives. Over-emphasising individual risk factors may obscure the structural and social factors that underpin the health inequalities experienced by TGM youth.
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Abstract
Introduction The COVID-19 pandemic has had an inordinate influence on people's lives, including impacts on food behaviours. This study explored the impacts of the COVID-19 crisis and ensuing public health restrictions on food-related practices of families living on a tight budget on the Island of Ireland. Methods Photovoice and creative mapping methods were used whereby parents were requested to take photos of factors influencing food-related decisions and draw maps of their food environments. These items were then used during qualitative interviews with 28 parents from across the Island of Ireland as a reference for discussions around the food environment and food decision-making processes of economically disadvantaged parents. Data were analysed using deductive thematic analysis. Results The findings were situated in Bronfenbrenner's Social Ecological Theoretical framework, conceptualising the COVID-19 crisis as an exogenous socio-historical factor that exerted significant influence on the food-related practices of families in Ireland. The pandemic and responses to it altered patterns of food purchasing, preparation, decision-making and consumption. Changes to practices included increased unhealthy snacking and grazing and consuming fewer meals outside the home. Participants on particularly low incomes relied more on benefits and subsidised food sources and consumed more cheap, processed and frozen foods. Conclusions This study provides insight into the impacts of the COVID-19 crisis on dietary habits. The observed changes to food practices may compound food insecurity and already high levels of obesity, particularly among children and young people, and have future implications on prevalence of nutrition-related conditions. This highlights the need for healthcare professionals and policy-makers to be cognisant of the mounting health issues that will need to be addressed in the wake of COVID-19. Key messages The COVID-19 crisis significantly impacted on family food related behaviours in Ireland. Post-COVID health promoters should re-focus efforts on healthy eating initiatives.
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Changes in mood and health-related quality of life in Look AHEAD 6 years after termination of the lifestyle intervention. Obesity (Silver Spring) 2021; 29:1294-1308. [PMID: 34258889 PMCID: PMC8903054 DOI: 10.1002/oby.23191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The Action for Health in Diabetes (Look AHEAD) study previously reported that intensive lifestyle intervention (ILI) reduced incident depressive symptoms and improved health-related quality of life (HRQOL) over nearly 10 years of intervention compared with a control group (the diabetes support and education group [DSE]) in participants with type 2 diabetes and overweight or obesity. The present study compared incident depressive symptoms and changes in HRQOL in these groups for an additional 6 years following termination of the ILI in September 2012. METHODS A total of 1,945 ILI participants and 1,900 DSE participants completed at least one of four planned postintervention assessments at which weight, mood (via the Patient Health Questionnaire-9), antidepressant medication use, and HRQOL (via the Medical Outcomes Scale, Short Form-36) were measured. RESULTS ILI participants and DSE participants lost 3.1 (0.3) and 3.8 (0.3) kg [represented as mean (SE); p = 0.10], respectively, during the 6-year postintervention follow-up. No significant differences were observed between groups during this time in incident mild or greater symptoms of depression, antidepressant medication use, or in changes on the physical component summary or mental component summary scores of the Short Form-36. In both groups, mental component summary scores were higher than physical component summary scores. CONCLUSIONS Prior participation in the ILI, compared with the DSE group, did not appear to improve subsequent mood or HRQOL during 6 years of postintervention follow-up.
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Type 2 Diabetes Subgroups, Risk for Complications, and Differential Effects Due to an Intensive Lifestyle Intervention. Diabetes Care 2021; 44:1203-1210. [PMID: 33707304 PMCID: PMC8132317 DOI: 10.2337/dc20-2372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/31/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We reevaluated the Action for Health in Diabetes (Look AHEAD) intervention, incorporating diabetes subgroups, to identify whether intensive lifestyle intervention (ILI) is associated with differential risk for cardiovascular disease (CVD) by diabetes subgroup. RESEARCH DESIGN AND METHODS In the Look AHEAD trial, 5,145 participants, aged 45-76 years, with type 2 diabetes (T2D) and overweight or obesity were randomly assigned to 10 years of ILI or a control condition of diabetes support and education. The ILI focused on weight loss through decreased caloric intake and increased physical activity. To characterize diabetes subgroups, we applied k-means clustering to data on age of diabetes diagnosis, BMI, waist circumference, and glycated hemoglobin. We examined whether relative intervention effects on the trial's prespecified CVD outcomes varied among diabetes subgroups. RESULTS We characterized four subgroups related to older age at diabetes onset (42% of sample), poor glucose control (14%), severe obesity (24%), and younger age at diabetes onset (20%). We observed interactions (all P < 0.05) between intervention and diabetes subgroups for three separate composite cardiovascular outcomes. Randomization to ILI was associated with increased risk for each cardiovascular outcome only among the poor-glucose-control subgroup (hazard ratio >1.32). Among the three other diabetes subgroups, ILI was not associated with increased risk for CVD. CONCLUSIONS Among overweight and obese adults with T2D, a lifestyle intervention was associated with differential risk for CVD that was dependent on diabetes subgroup. Diabetes subgroups may be important to identify the patients who would achieve benefit and avoid harm from an ILI.
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Allogeneic Mesenchymal Stromal Cells (MSCs) are of Comparable Efficacy to Syngeneic MSCs for Therapeutic Revascularization in C57BKSdb/db Mice Despite the Induction of Alloantibody. Cell Transplant 2018; 27:1210-1221. [PMID: 30016879 PMCID: PMC6434464 DOI: 10.1177/0963689718784862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intramuscular administration of mesenchymal stromal cells (MSCs) represents a therapeutic option for diabetic critical limb ischemia. Autologous or allogeneic approaches may be used but disease-induced cell dysfunction may limit therapeutic efficacy in the former. Our aim was to compare the efficacy of allogeneic and autologous MSC transplantation in a model of hindlimb ischemia in diabetes mellitus and to determine whether allogeneic transplantation would result in the activation of an immune response. MSCs were isolated from C57BL/6 (B6) and diabetic obese C57BKSdb/db mice. Phosphate-buffered saline (control group), and MSCs (1 × 106) from B6 (allogeneic group) or C57BKSdb/db (syngeneic group) were administered intramuscularly into the ischemic thigh of C57BKSdb/db mice following the induction of hindlimb ischemia. MSCs derived from both mouse strains secrete several angiogenic factors, suggesting that the potential therapeutic effect is due to paracrine signaling. Administration of allogeneic MSCs significantly improved blood perfusion as compared with the control group on week 2 and 3, post-operatively. In comparison with the control group, syngeneic MSCs significantly improved blood perfusion at week 2 only. There was no statistical difference in blood perfusion between allogeneic and syngeneic MSC groups at any stages. There was no statistical difference in ambulatory and necrosis score among the three groups. Amputation of toes was only observed in the control group (one out of seven animals). Alloantibody was detected in three out of the eight mice that received allogeneic MSCs but was not observed in the other groups. In summary, we demonstrated comparable efficacy after transplantation of autologous and allogeneic MSCs in a diabetic animal model despite generation of an immune response.
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The Difficulty of Prevention: A Behavioral Perspective. Am J Lifestyle Med 2016; 10:14-16. [PMID: 30202254 PMCID: PMC6124857 DOI: 10.1177/1559827615609532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022] Open
Abstract
Behavioral medicine provides insight in to the problem of injury prevention. Society often views unintentional injuries as only an accident when in reality many accident-related injuries are preventable. However, barriers to behavioral change in injury prevention exist for both patients (eg, inconvenience, perceived risk-benefit ratio) and health care providers (eg, feeling of badgering nonadherent patients, patient misinformation). To overcome barriers, the article discusses strategies for health care providers to address injury prevention such as choosing active over passive strategies, informing patients of predictable injury-prone circumstances, and individualizing patient risks.
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Weight Loss Versus Behavioral Change as the Primary Goal in Clinical Practice. Am J Lifestyle Med 2015. [DOI: 10.1177/1559827615579166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physical activity is a well-established lifestyle target that has shown considerable benefit in older adults. Findings from a subset population in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study revealed that changes in behavior (i.e., nonsmoking, physical activity) were superior to achieving numerical goals (i.e., waist circumference) to reduce the risk of recurrent coronary heart disease and all-cause mortality. This study provides strong evidence that health care providers should emphasize behavioral change and not set weight loss as the primary goal in clinical practice.
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Perioperative management of paediatric obstructive sleep apnoea. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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UP.31: Robotic Assisted Radical Prostatectomy in the Renal Allograft Recipient. Urology 2008. [DOI: 10.1016/j.urology.2008.08.354] [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]
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POD-4.09: Accelerated Continence Recovery After Robotic Prostatectomy Using Cornell Anatomic Reconstruction Technique: Experience of 1018 Patients. Urology 2008. [DOI: 10.1016/j.urology.2008.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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UP.76: Impact of Total Anatomic Reconstruction of the Bladder Neck in Obese Men: Continence Outcomes Following Robotic Prostatectomy. Urology 2008. [DOI: 10.1016/j.urology.2008.08.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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VID.05: Early Continence with Novel Restoration of Bladder Neck Anatomy During Robotic Prostatectomy. Urology 2008. [DOI: 10.1016/j.urology.2008.08.312] [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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MP-3.21: Total Reconstruction:Technique for Precision Anastomosis and Continence Preservation. Urology 2008. [DOI: 10.1016/j.urology.2008.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
One- and 7-day-old specific pathogen-free chickens were artificially infected with a field isolate of Salmonella enteritidis, phage type 13A. At intervals up to 42 days of age, birds were killed and liver, lung, spleen, brain, yolk sac, testis or ovary, duodenum, jejunum, ileum, caecum and colon collected for culture. In chickens infected at one day of age and killed 1, 4 and 7 days pi all tissues were infected. Thereafter most non-intestinal tissues (74%) and intestinal tissues (92%) were positive for S. enteritidis. In chickens infected at 7 days of age, all tissues were positive 1 dpi. After post-inoculation day 1, a few non-intestinal tissues (15%) were positive for S. enteritidis while 38% of intestinal tissues were positive.
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The gifts. ACTA ACUST UNITED AC 2004; 8:280, 277-9. [PMID: 15305602 DOI: 10.1177/1091592304267490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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A pilot study of low-dose fludarabine in membranous nephropathy refractory to therapy. Clin Nephrol 1999; 52:67-75. [PMID: 10480216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Lymphocytes are believed to play a role in the induction and perpetuation of membranous nephropathy. Fludarabine is a purine nucleoside analog with selective activity against both dividing and resting lymphocytes. We evaluated the tolerance, toxicity, pharmacokinetics, immunologic, and clinical effects of fludarabine in patients with membranous nephropathy in an single arm pilot study. PATIENTS AND METHODS Eight patients with idiopathic (n = 7) or lupus (n = 1) membranous nephropathy who had failed high-dose prednisone (n = 8) and/or alkylating agents (n = 2), or cyclosporine (n = 1) were treated with 6-monthly cycles of fludarabine (cycles 1-2, 20 mg/m2/day x 2 days, cycles 3-6, 20 mg/m2/day x 3 days). Mean proteinuria was 9 g/day with a mean duration of disease of 25 months (range 12-48). Proteinuria, GFR and effective renal plasma flow were compared before and after completing the treatment. RESULTS Seven patients completed the protocol. CD3, CD4, CD8 and B cell counts decreased by 53%, 46%, 61% and 84%, respectively, at the end of treatment and remained at lower than pretreatment levels 6 months after completing the trial. Despite lymphopenia, serum immunoglobulin levels remained unchanged. Both naive (CD45RA+) and memory CD4+ T cells (CD45RO+) were reduced (naive > memory). Proteinuria decreased by > or = 50% in 5 out of 7 patients (p = 0.11). Filtration fraction improved in all patients with decreased filtration fraction at baseline. The only side-effect observed was one episode of acute bacterial sinusitis that responded promptly to antibiotic therapy. CONCLUSION We conclude that low-dose fludarabine treatment in patients with membranous nephropathy is well tolerated and results in significant lymphopenia involving B more than T cells. In this pilot study improvement in proteinuria and filtration rate were observed. Additional studies are required to determine the optimal dose and clinical efficacy of fludarabine.
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Abstract
BACKGROUND Indinavir, a protease inhibitor widely used to treat patients with HIV infection, has been associated with nephrolithiasis. Distinctive urinary crystals and a spectrum of urologic disorders were noted in patients receiving indinavir. OBJECTIVE To determine the composition of urinary crystals and the frequency of asymptomatic crystalluria and urinary tract symptoms in patients receiving indinavir. PATIENTS Patients with HIV infection who were enrolled in studies conducted at the National Institutes of Health. MEASUREMENTS Microscopic urinalysis, high-performance liquid chromatography (HPLC) and mass spectrometry of urinary crystals and stones, and clinical evaluation of patients with urologic symptoms. RESULTS Of 240 patients receiving indinavir, 142 provided urine specimens for analysis. Twenty-nine (20%) had crystals consisting of plate-like rectangles and fan-shaped or starburst forms. Mass spectrometry and HPLC confirmed that these crystals were composed of indinavir. Of 40 patients who were not receiving indinavir, none had similar crystals (P < 0.001). Nineteen of the 240 patients receiving indinavir (8%) developed urologic symptoms. Of these, 7 (3%) had nephrolithiasis and the other 12 (5%) had previously undescribed syndromes: crystalluria associated with dysuria and crystalluria associated with back or flank pain. Four of the patients with the latter syndrome had radiographic evidence of intrarenal sludging. CONCLUSIONS Indinavir forms characteristic crystals in the urine. This crystalluria may be associated with dysuria and urinary frequency, with flank or back pain associated with intrarenal sludging, and with the classic syndrome of renal colic.
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Abstract
Explores the effects of organizational transformation on career development. Through a case study of a large blue chip company in the brewing industry, illustrates that organizational and managers’ expectations of promotion, responsibility for career development and the role of the line manager in career guidance can be substantially mismatched at the current time. Highlights that this can be seriously disadvantageous to individual motivation and organizational effectiveness. Suggests that the principles of social marketing could inform initiatives to change attitudes to careers and to encourage the valuing of lateral career moves. Considers the implications of this for management developers and career management specialists within organizations and suggests a role for government agencies such as the TEC/LEC network in the UK. Concludes that a range of initiatives should be considered to address this important issue.
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Loss of heterozygosity on chromosome-8 in squamous-cell carcinomas of the head and neck. Int J Oncol 1994; 5:1243-8. [PMID: 21559704 DOI: 10.3892/ijo.5.6.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
LOH studies provide evidence for the implication of novel TSGs in human tumours. The p arm of chromosome 8 has been reported to harbour tumour suppressor genes (TSGs) which are very likely to be involved in the development of colon, lung, bladder and hepatocellular carcinomas. In addition, the c-myc proto-oncogene which is located on the 8q arm, has been found to be overexpressed in SCCHN. In the present study we have investigated the incidence of loss of heterozygosity (LOH) in chromosome 8 in 37 tumour specimens of squamous cell carcinomas of the head and neck (SCCHN), using a bank of 11 polymorphic microsatellite markers. The aim of this work was to assess whether there was an 8p TSG(s) in SCCHN, as reported in other tumours and also to investigate whether other areas of chromosome 8 exhibit a high LOH. A relatively high incidence of LOH was found for the markers D8S87 (29%) on 8p12 and ANK1 (20%) on 8p21.2-p11. These two markers are located in the area in which TSG(s) for other cancers have been previously described. When the data on D8S87 and ANK1 were analyzed together it was found that 13/35 (37%) of the SCCHN specimens had a loss at one or other of these markers, thus indicating that a putative TSG(s) in this region may play a role in the development of the SCCHN. No correlation was found between the LOH data and any of the clinicopathological parameters. We also investigated the incidence of c-myc amplification in 144 SCCHN specimens but only 4% were found to have an amplified c-myc allele, thus indicating that the overexpression of c-myc in SCCHN was not the result of gene amplification.
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Gross and Microscopic Lesions in Young Chickens Experimentally Infected with Salmonella enteritidis. Avian Dis 1994. [DOI: 10.2307/1592119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Gross and microscopic lesions in young chickens experimentally infected with Salmonella enteritidis. Avian Dis 1994; 38:816-21. [PMID: 7702516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One-day-old and 7-day-old specific-pathogen-free chickens were orally infected with a field isolate of Salmonella enteritidis phage type 13A. Chickens were sequentially euthanatized at various intervals until 42 days of age, and selected tissues were collected for microscopic evaluation. Eleven of 53 chickens (21%) infected at 1 day of age and 2 of 28 chickens (7%) infected at 7 days of age died. Gross and microscopic lesions were more frequent and severe in chickens infected at 1 day of age and in chickens that died (almost all of these were 1-day-infected as well). Lesions were characterized by mild to severe fibrinous pericarditis, airsacculitis, perihepatitis, peritonitis, cecal cores, and enlarged, firm yolk sacs. Gross the microscopic lesions were present from postinoculation day 2 until termination of this study.
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28
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Chronic exposure to an environmental hazard: risk perceptions and self-protective behavior. Health Psychol 1993. [PMID: 8462503 DOI: 10.1037//0278-6133.12.1.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk perceptions and self-protective behavior of 282 immigrant farm workers (all of Mexican origin) in response to pesticide exposure were examined. Several variables were predicted to influence reactions, but some deviations from past studies were expected because cultural or socioeconomic factors could modify risk responses. In keeping with predictions, greater risk perceptions were associated with beliefs that past harm had occurred, future harm to self or offspring was likely, precautions were less effective, and cancer-causing agents were mostly unavoidable. Self-protective behavior was most likely for those receiving risk information, having greater perceptions of control over health and the occupational situation, and believing that precautionary methods were effective. The discussion considers variability in responses to chronic risk and the broader perspective offered by environmental hazard studies.
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Abstract
The risk perceptions and self-protective behavior of 282 immigrant farm workers (all of Mexican origin) in response to pesticide exposure were examined. Several variables were predicted to influence reactions, but some deviations from past studies were expected because cultural or socioeconomic factors could modify risk responses. In keeping with predictions, greater risk perceptions were associated with beliefs that past harm had occurred, future harm to self or offspring was likely, precautions were less effective, and cancer-causing agents were mostly unavoidable. Self-protective behavior was most likely for those receiving risk information, having greater perceptions of control over health and the occupational situation, and believing that precautionary methods were effective. The discussion considers variability in responses to chronic risk and the broader perspective offered by environmental hazard studies.
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30
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Cooled clothing provides comfort and increases worker productivity. OCCUPATIONAL HEALTH & SAFETY (WACO, TEX.) 1991; 60:20-1. [PMID: 1891161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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31
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Allergy, cold sufferers must cope with effects of OTC medications. OCCUPATIONAL HEALTH & SAFETY (WACO, TEX.) 1991; 60:28, 30. [PMID: 1711185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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32
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Adequately insulated gloves, boots vital for working in extreme cold. OCCUPATIONAL HEALTH & SAFETY (WACO, TEX.) 1990; 59:34. [PMID: 2277696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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33
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Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males. JAMA 1989; 262:2562-6. [PMID: 2509742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.
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Psychosocial context of adolescent development. Study group report. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1988; 9:11S-19S. [PMID: 3053543 DOI: 10.1016/0197-0070(88)90003-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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35
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Metabolic and renal effects of interleukin-2 immunotherapy for metastatic cancer. Clin Nephrol 1988; 30:141-5. [PMID: 3263237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The systemic administration of recombinant interleukin-2 (IL-2) either alone or in combination with lymphokine activated killer cells is a new approach to the immunotherapy of metastatic cancer in man. Renal toxicity is often a dose-limiting side effect of IL-2 administration. This prospective study of 17 consecutive patients receiving parenteral high dose IL-2 documents a reversible syndrome of hypotension, oliguria, fluid retention, azotemia and very low urinary excretion of sodium (median FeNa of 0.04%). The median nadir urinary uric acid to urinary creatinine ratio during IL-2 therapy was 0.2. This IL-2 regimen induces a reversible renal hypoperfusion syndrome (pre-renal azotemia) without evidence of acute uric acid nephropathy. Hypophosphatemia [median serum phosphorus of 1.9 mg/dl (0.61 mmol/l)] prompted further study of tubular function. Urinary excretions of phosphorus, calcium and magnesium were very low. Arterial blood gases revealed hyperventilation without alkalemia. The hypophosphatemia probably reflects increased utilization of inorganic phosphorus by rapidly proliferating lymphoid cells.
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Prevalence of Urethral Chlamydia Trachomatis and Neisseria Gonorrhoeae Among Asymptomatic, Sexually Active Adolescent Boys. J Urol 1987. [DOI: 10.1016/s0022-5347(17)43682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Prevalence of urethral Chlamydia trachomatis and Neisseria gonorrhoeae among asymptomatic, sexually active adolescent boys. J Infect Dis 1987; 156:223-4. [PMID: 3110306 DOI: 10.1093/infdis/156.1.223] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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38
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Diagnosis and treatment of thyroid cancer in a hemodialysis patient. ANNA JOURNAL 1987; 14:118. [PMID: 3647760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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39
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Evaluation of fluorescein-conjugated monoclonal antibody test to detect Chlamydia trachomatis endocervical infections in adolescent girls. J Pediatr 1986; 108:779-83. [PMID: 3517270 DOI: 10.1016/s0022-3476(86)81068-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We evaluated the fluorescein-conjugated monoclonal antibody (FA) test for screening for Chlamydia trachomatis endocervical infection in a general adolescent clinic. Three hundred sixty-three consecutive adolescent girls, ages 13 to 20 years (mean 17.3 years) were examined. Forty-five (12%) FA smears had insufficient cells. Reason for visit included non-lower genital tract-related disorders in 241 (76%) girls, and lower genital tract-related disorders in 77 (24%). C. trachomatis was isolated by tissue culture in 46 (14%) patients, and Neisseria gonorrhoeae by culture in 22 (7%), and Trichomonas vaginalis was identified by wet mount in 13 (5%). Compared with our tissue culture technique, the performance of the FA test was as follows: sensitivity 61% (28 of 46), specificity 97% (264 of 272), positive predictive value 78% (28 of 36), and negative predictive value 94% (264 of 282). There was no significant difference in test performance by race, although the sensitivity rate (64%) of the test in blacks was twice that (30%) in nonblacks. This apparent difference in test performance by race may actually represent variations in group characteristics, including exposure rate, susceptibility, and number of inclusion forming units available for tissue culture of Chlamydia in blacks compared with nonblacks. In our adolescent clinic, the tissue culture is superior to FA in detecting Chlamydia. We recommend that the FA test be used where tissue culture isolation for Chlamydia is not readily available, where known or predicted chlamydial infection rates are high, and where known or predicted numbers of inclusion forming units of Chlamydia in tissue culture are high.
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Regular haemodialysis in Barbados: the first five years. W INDIAN MED J 1985; 34:184-9. [PMID: 4072182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Road accident prevention. BRITISH MEDICAL JOURNAL 1973; 1:803. [PMID: 4694446 PMCID: PMC1588957 DOI: 10.1136/bmj.1.5856.803-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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42
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Fluoridation of Water. West J Med 1955. [DOI: 10.1136/bmj.1.4918.911-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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