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Sample records for active patient population

  1. Population pharmacokinetic modeling of motesanib and its active metabolite, M4, in cancer patients.

    PubMed

    Gosselin, Nathalie H; Mouksassi, Mohamad-Samer; Lu, Jian-Feng; Hsu, Cheng-Pang

    2015-11-01

    Motesanib is a small molecule and potent multikinase inhibitor with antiangiogenic and antitumor activity. Population pharmacokinetic (POPPK) modeling of motesanib and M4, an active metabolite, was performed to assess sources of variability in cancer patients. The analysis included data collected from 451 patients from 8 clinical trials with oral doses of motesanib ranging from 25 to 175 mg, either once daily or twice daily. The POPPK analyses were performed using nonlinear mixed-effect models with a sequential approach. Covariate effects of demographics and other baseline characteristics were assessed with stepwise covariate modeling. A 2-compartment model with food effect on absorption parameters fitted the PK data of motesanib well. The effects albumin and sex on apparent clearance (CL/F) of motesanib were statistically significant. The albumin effect was more important but remained below a 25% difference. A 1-compartment model fitted PK data of M4 well. Effects of race (Asian vs non-Asian) and dosing frequency were identified as statistically significant covariates on the CL/F of M4. The maximum effect of albumin would result in less than 25% change in motesanib CL/F and as such would not warrant any dosing adjustment. However, faster elimination of M4 in Asian patients requires further investigation. PMID:27137719

  2. Regulatory Cell Populations in Relapsing-Remitting Multiple Sclerosis (RRMS) Patients: Effect of Disease Activity and Treatment Regimens

    PubMed Central

    Rodi, Maria; Dimisianos, Nikolaos; de Lastic, Anne-Lise; Sakellaraki, Panagiota; Deraos, George; Matsoukas, John; Papathanasopoulos, Panagiotis; Mouzaki, Athanasia

    2016-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) of autoimmune etiology that results from an imbalance between CNS-specific T effector cells and peripheral suppressive mechanisms mediated by regulatory cells (RC). In this research, we collected blood samples from 83 relapsing remitting MS (RRMS) patients and 45 healthy persons (HC), to assess the sizes of their RC populations, including CD4+CD25highFoxp3+ (nTregs), CD3+CD4+HLA−G+, CD3+CD8+CD28−, CD3+CD56+, and CD56bright cells, and how RC are affected by disease activity (acute phase or remission) and types of treatment (methylprednisolone, interferon, or natalizumab). In addition, we isolated peripheral blood mononuclear cells (PBMC) and cultured them with peptides mapping to myelin antigens, to determine RC responsiveness to autoantigens. The results showed decreased levels of nTregs in patients in the acute phase ± methylprednisolone and in remission + natalizumab, but HC levels in patients in remission or receiving interferon. Patients + interferon had the highest levels of CD3+CD4+HLA−G+ and CD3+CD8+CD28− RC, and patients in the acute phase + methylprednisolone the lowest. Patients in remission had the highest levels of CD3+CD56+, and patients in remission + natalizumab the highest levels of CD56bright cells. Only nTregs responded to autoantigens in culture, regardless of disease activity or treatment. The highest suppressive activity was exhibited by nTregs from patients in remission. In conclusion, in RRMS disease activity and type of treatment affect different RC populations. nTregs respond to myelin antigens, indicating that it is possible to restore immunological tolerance through nTreg induction. PMID:27571060

  3. Population Education. Awareness Activities.

    ERIC Educational Resources Information Center

    Brouse, Deborah E.

    1990-01-01

    Described are awareness activities that deal with human population growth, resources, and the environment. Activities include simulations, mathematical exercises, and discussions of the topic. Specific examples of what individuals can do to help are listed. (KR)

  4. Gelatinase activity of matrix metalloproteinases in the cerebrospinal fluid of various patient populations.

    PubMed

    Valenzuela, M A; Cartier, L; Collados, L; Kettlun, A M; Araya, F; Concha, C; Flores, L; Wolf, M E; Mosnaim, A D

    1999-01-01

    We have studied the enzymatic gelatinolytic activity of matrix metalloproteinases (MMPs) present in cerebrospinal fluid (CSF) of samples obtained from 67 individuals, twenty-one nonneurological patients (considered controls) and 46 subjects with various neurological disorders e.g., vascular lesions, demyelination, inflammatory, degenerative and prion diseases. Biochemical characterization of MMPs, a family of neutral proteolytic enzymes involved in extracellular matrix modeling, included determination of substrate specificity and Ca+2 dependency, as well as the effects of protease inactivators, carboxylic and His (histidine) residue modifiers, and antibiotics. Whereas all CSF samples expressed MMP-2 (gelatinase A) activity, it corresponded in most cases (normal and pathological samples) to its latent form (proenzyme; pMMP-2). In general, inflammatory neurological diseases (especially meningitis and neurocisticercosis) were associated with the presence of a second enzyme, MMP-9 (or gelatinase B). Whereas MMP-9 was found in the CSF of every tropical spastic paraparesis patient studied, its presence in samples from individuals with vascular lesions was uncommon. Patients blood-brain barrier damage was ascertained by determining total CSF protein content using both, the conventional polyacrylamide gel electrophoresis procedure under denaturing conditions and capillary zone electrophoresis.

  5. Regulatory Cell Populations in Relapsing-Remitting Multiple Sclerosis (RRMS) Patients: Effect of Disease Activity and Treatment Regimens.

    PubMed

    Rodi, Maria; Dimisianos, Nikolaos; de Lastic, Anne-Lise; Sakellaraki, Panagiota; Deraos, George; Matsoukas, John; Papathanasopoulos, Panagiotis; Mouzaki, Athanasia

    2016-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) of autoimmune etiology that results from an imbalance between CNS-specific T effector cells and peripheral suppressive mechanisms mediated by regulatory cells (RC). In this research, we collected blood samples from 83 relapsing remitting MS (RRMS) patients and 45 healthy persons (HC), to assess the sizes of their RC populations, including CD4⁺CD25(high)Foxp3⁺ (nTregs), CD3⁺CD4⁺HLA(-)G⁺, CD3⁺CD8⁺CD28(-), CD3⁺CD56⁺, and CD56(bright) cells, and how RC are affected by disease activity (acute phase or remission) and types of treatment (methylprednisolone, interferon, or natalizumab). In addition, we isolated peripheral blood mononuclear cells (PBMC) and cultured them with peptides mapping to myelin antigens, to determine RC responsiveness to autoantigens. The results showed decreased levels of nTregs in patients in the acute phase ± methylprednisolone and in remission + natalizumab, but HC levels in patients in remission or receiving interferon. Patients + interferon had the highest levels of CD3⁺CD4⁺HLA(-)G⁺ and CD3⁺CD8⁺CD28(-) RC, and patients in the acute phase + methylprednisolone the lowest. Patients in remission had the highest levels of CD3⁺CD56⁺, and patients in remission + natalizumab the highest levels of CD56(bright) cells. Only nTregs responded to autoantigens in culture, regardless of disease activity or treatment. The highest suppressive activity was exhibited by nTregs from patients in remission. In conclusion, in RRMS disease activity and type of treatment affect different RC populations. nTregs respond to myelin antigens, indicating that it is possible to restore immunological tolerance through nTreg induction. PMID:27571060

  6. A relationship between CD4 count and oral manifestations of human immunodeficiency virus-infected patients on highly active antiretroviral therapy in urban population

    PubMed Central

    Satyakiran, Gadavalli Vera Venkata; Bavle, Radhika Manoj; Alexander, Glory; Rao, Saritha; Venugopal, Reshma; Hosthor, Sreelatha S

    2016-01-01

    Introduction: Human immunodeficiency virus (HIV) infection gradually destroys the body's immune system, which makes it harder for the body to fight infections. HIV infection causes a quantitative and qualitative depletion of CD4 lymphocyte count, which increases the risk of opportunistic infections. Thus, CD4 count is one of the key factors in determining both the urgency of highly active antiretroviral therapy (HAART) initiation and the need of prophylaxis for opportunistic infections. Aim: This study aims to evaluate the prevalence and variations in the oral manifestations of HIV/acquired immune deficiency syndrome patients on HAART therapy in urban population and their association with CD4 count. Materials and Methods: A study was conducted by screening eighty patients who were HIV positive in an urban location. Both adult and pediatric patients were screened for oral manifestations and simultaneously CD4 count was also evaluated. Patients with HIV infection for variable time period who are under HAART were considered. Statistical Analysis: Measures of central tendency were used to analyse the data. Results: HIV infection destroys the immune system of an individual, making the patient susceptible to various infections and malignancies. With the advent of antiretroviral therapy, the scenario has changed drastically. We have observed that patients with CD4 counts between 164 and 1286 show relatively few oral manifestations. Long-term HAART therapy causes pigmentation, xerostomia and angular cheilitis but is taken up quite well by the patients. Conclusion: In this study, eighty patients with HAART from urban population showed very minimal oral findings because of good accessibility for treatment and awareness about HIV infections. The patients who were on long-standing HAART treatment also showed minimal oral manifestation such as pigmentation and xerostomia. Hence, we conclude that recognition, significance and treatment of these lesions in patients with HIV

  7. Population information activities in Hungary.

    PubMed

    Csahok, I

    1984-12-01

    The focal point for all population information activities in Hungary is the Central Statistical Office which is responsible for the organization and implementation of the decennial population censuses and of the intercensal population surveys and other data collection activities. The Central Statistical Office publishes a large volume of population information. The results of the censuses are presented partly in special census volumes and partly in statistical yearbooks. The Demographic Yearbook and other publications present results of population studies and Hungarian statistics. The Demographic Research Institute, which is part of the Central Statistical Office, is primarily responsible for research activity. The main task of the Institute is to study and analyze population processes and phenomena, as well as explore main demographic trends, carried out by using Hungarian and international demographic data. Demografia and serial publications present results of research activities of the Institute. The Library and Documentation Service, also part of the Central Statistical Office, provides conventional library services. Its main activity is the collection of both Hungarian and foreign and international official statistical publications, as well as theoretical and methodological works. Of a stock of 650,000 volumes covering a wide range of social and economic sciences, in addition to data material, the library has nearly 120,000 official statistical publications consisting mainly of population statistics and demographic data. Another activity of the Library is the processing and dissemination of documentation and it acts as a 2dary source of both Hungarian and foreign publications, especially on demography. The documentation consists of translating articles, book chapters or documents of international organizations, editing annotated bibliographies and disseminating custom-made, user-oriented profiles. This computerized information retrieval system uses Text

  8. A reexamination of integrated population activities.

    PubMed

    Files, L A

    1982-10-01

    The term integrated population activities came into style at the World Population Conference at Bucharest in 1974, where it was used to refer to national planning that recognizes the integral role of population in development, the use of socioeconomic change to solve a nation's population problem, or the implementation of population activities along with health or agricultural projects. In this paper, Laurel Files calls for a more precise definition of the word integrated and the use of different terminology for other types of coordinating activities. She argues that integrated is meaningful only when it refers to planning or implementation of population activities by several ministries, or to the combination of population activities with related services. Beyond restricting the definition, Files calls into question the habit of appending integrated onto population activities as a kind of halo. "Unintegrated" family planning does not deserve a pejorative connotation, for in some situations it may be more effective than integrated family planning.

  9. Population pharmacokinetics of imipenem in burn patients.

    PubMed

    Dailly, Eric; Kergueris, Marie France; Pannier, Michel; Jolliet, Pascale; Bourin, Michel

    2003-12-01

    The interindividual variability of imipenem pharmacokinetic parameters in burn patients suggest that these parameters have to be estimated with a large number of patients. The aim of this study is (i) to estimate these parameters with a population pharmacokinetic approach, and (ii) to test the influence of factors on pharmacokinetics parameters. Data are provided by therapeutic drug monitoring (n = 47,118 samples) and analysed by a nonlinear mixed effect modelling method. Among the tested covariates (age, gender, body weight, height, size of burn and creatinine plasma level) creatinine plasma level affects imipenem pharmacokinetic parameters substantially. The best fit is obtained with a two-compartment model integrating a linear-inverse relationship between imipenem clearance and creatinine plasma level. The estimates of imipenem clearance (16.37 +/- 0.204 L/h) and of the distribution volume of the central compartment (0.376 +/- 0.039 L/kg) are higher in the population of burn patients than the estimates in healthy subjects. This result is connected with high values of glomerule filtration rate and confirms the interest of therapeutic drug monitoring of imipenem in burn patients and particularly for patients with extreme values of creatinine clearance.

  10. Promoting Physical Activity among Underserved Populations.

    PubMed

    Mendoza-Vasconez, Andrea S; Linke, Sarah; Muñoz, Mario; Pekmezi, Dori; Ainsworth, Cole; Cano, Mayra; Williams, Victoria; Marcus, Bess H; Larsen, Britta A

    2016-01-01

    Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations. PMID:27399827

  11. 21 CFR 312.315 - Intermediate-size patient populations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Intermediate-size patient populations. 312.315... for Treatment Use § 312.315 Intermediate-size patient populations. Under this section, FDA may permit an investigational drug to be used for the treatment of a patient population smaller than...

  12. 21 CFR 312.315 - Intermediate-size patient populations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Intermediate-size patient populations. 312.315... for Treatment Use § 312.315 Intermediate-size patient populations. Under this section, FDA may permit an investigational drug to be used for the treatment of a patient population smaller than...

  13. 21 CFR 312.315 - Intermediate-size patient populations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Intermediate-size patient populations. 312.315... for Treatment Use § 312.315 Intermediate-size patient populations. Under this section, FDA may permit an investigational drug to be used for the treatment of a patient population smaller than...

  14. 21 CFR 312.315 - Intermediate-size patient populations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Intermediate-size patient populations. 312.315... for Treatment Use § 312.315 Intermediate-size patient populations. Under this section, FDA may permit an investigational drug to be used for the treatment of a patient population smaller than...

  15. Population activities of the United States government.

    PubMed

    Miles Re, J

    1971-08-01

    The editor's comment in this issue of the journal cites 5 overlapping phases in the evolution of population and family planning programs in the United States. The phases are 1) collecting census data and vital statistics, 1790-, 2) family planning assistance to developing nations, 1963, 3) family planning assistance to the U.S. "disadvantaged," 1964-, 4) overpopulation as a national concern, 1969-, and 5) the multiple action phase, 197? (phase including diverse steps to limit population growth and occurring after basic attitudes toward human reproduction have changed). The issue of the journal focuses on total population size and rates of population increase rather than on the distribution of population, and on federal action rather than on the activities of state and local governments. The editor's comment is followed by an extensive discussion of population activities of the United States government, especially since 1963. Topics discussed include demographic data, international programs, research, federally subsidized family planning services, medical care programs, educational and international programs, national growth policy, and the roles of the legislative and executive branches of government. A directory listing federal agencies with substantial and identifiable programs concerned with population and family planning is appended.

  16. ILO and its population information activities.

    PubMed

    1982-04-01

    The International Labor Organisation (ILO) has authorized population activities since 1968. During the 1970s a population "focal point" was set up for promoting, programming, coordinating and monitoring population activities, and a large scale research program on population and employment was initiated as part of the World Employment Program. Both aspects were incorporated in a Population and Labor Policies Branch in 1975. Population documentation in the ILO is the concern of the Documentation Unit in that Branch, and the Central Library and Documentation Branch of the General Analysis of Labor Problems Department. The Documentation Unit collects materials on population in relation to employment, income and mobility; development planning models, role of women; and population and family welfare education, including printed, visual and audiovisual materials. Available reference tools include subject indexes using terms from the ILO Thesaurus. Monthly accessions lists and periodic bibliographies of relevant ILO publications are produced. The Central Library collects materials on a wide range of related subjects and has been automated since 1965. Its machine readable library file, LABORDOC, is available through Systems Development Corporation. It also produces an abstract journal (International Labor Documentation), a bibliographic list of international organization documents of interest to ILO officials (IGODOC), and a machine readable file describing the 9000 periodicals received or published by the ILO. Publications of the ILO's Bureau of Statistics include Bulletin and Year Book of Labor Statistics and regional volumes of Labor Force Estimates and Projections. The ILO recognizes that much relevant material produced by ILO field offices and other external offices may not reach and be collected at headquarters; the Population Information Network might provide a means of filling this gap.

  17. Enrichment design with patient population augmentation.

    PubMed

    Yang, Bo; Zhou, Yijie; Zhang, Lanju; Cui, Lu

    2015-05-01

    Clinical trials can be enriched on subpopulations that may be more responsive to treatments to improve the chance of trial success. In 2012 FDA issued a draft guidance to facilitate enrichment design, where it pointed out the uncertainty on the subpopulation classification and on the treatment effect outside of the identified subpopulation. We consider a novel design strategy where the identified subpopulation (biomarker-positive) is augmented by some biomarker-negative patients. Specifically, after sufficiently powering biomarker-positive subpopulation we propose to enroll biomarker-negative patients, enough to assess the overall treatment benefit. We derive a weighted statistic for this assessment, correcting for the disproportionality of biomarker-positive and biomarker-negative subpopulations under enriched trial setting. Screening information is utilized for weight determination. This statistic is an unbiased estimate of the overall treatment effect as that in all-comer trials, and is the basis to power for the overall treatment effect. For analysis, testing will be first performed on biomarker-positive subpopulation; only if treatment benefit is established in this subpopulation will overall treatment effect be tested using the weighted statistic. This design approach differs from typical enrichment design or stratified all-comer design in that the former enrolls only biomarker-positive patients and the latter enrolls a regular all-comer population. It also differs from adaptive enrichment by maintaining the trial design and analysis priority on biomarker-positive subpopulation. Therefore the proposed approach not only warrants a high probability of trial success on biomarker-positive subpopulation, but also efficiently assesses the overall treatment effect in the presence of an uncertain treatment benefit among biomarker-negative patients.

  18. Stellar populations in Active Galactic Nuclei III

    NASA Astrophysics Data System (ADS)

    Boisson, C.; Joly, M.; Pelat, D.; Ward, M. J.

    2004-12-01

    In this paper we apply the stellar population synthesis method previously described in Boisson et al. (\\cite{Boisson2000}) to five more AGN. The analysis of these new data strengthen our previous conclusions: i) homogeneity of the stellar population within a class of nuclear activity regardless of the morphological type of the host galaxy; ii) populations within the nuclear regions of LINERs and Seyfert 2s are different: LINERs have a very old metal-rich population while in the Seyfert 2s a contribution of a weak burst of star formation is observed together with the old high metallicity component; iii) in the circum-nuclar region (200 pc ≤D≤1 kpc) of all the active galaxies in our sample, except for NGC 2992, we detect an old burst of star formation (0.2-1 Gyr),which is contrary to what is observed in normal galaxies. We note that the broad OIλ8446 Å emission line detected in the spectrum of the nucleus of NGC 2992 confirms its classification as a Seyfert 1. Based on observations collected at the New Technology Telescope of the European Southern Observatory, La Silla, Chile.

  19. Active Asteroids in the NEO Population

    NASA Astrophysics Data System (ADS)

    Jenniskens, Peter

    2016-01-01

    Some main-belt asteroids evolve into near-Earth objects. They can then experience the same meteoroid-producing phenomena as active asteroids in the main belt. If so, they would produce meteoroid streams, some of which evolve to intersect Earth's orbit and produce meteor showers at Earth. Only few of those are known. Meteoroid streams that move in orbits with Tisserand parameter well in excess of 3 are the Geminids and Daytime Sextantids of the Phaethon complex and the lesser known epsilon Pegasids. The observed activity appears to be related to nearly whole scale disintegrations, rather than dust ejection from volatile outgassing as observed in active comets. There is only a small population of asteroids with a main-belt origin that recently disintegrated into meteoroid streams.

  20. Radiotherapy service delivery models for a dispersed patient population.

    PubMed

    Dunscombe, P; Roberts, G

    2001-01-01

    Access to health care interventions can be impeded when significant patient travel is required. In this economic evaluation we compare, from a societal perspective, three scenarios for the delivery of radiation treatment to an idealized population of 1,600 patients distributed between two urban nodes (1,200 + 400 patients each) separated by up to 500 km. As it is implicitly assumed that the clinical outcome for those patients who access the system is independent of the service delivery model, this study constitutes a cost minimization analysis from a societal perspective. The costs to the health care system are based on an activity costing model developed by us and consistent with recent Canadian studies. The costs to the patient are approximated by a formula that includes direct costs (travel and accommodation) and indirect (time) costs, with the latter based on a human capital approach. A sensitivity analysis has been performed to confirm the robustness of our conclusions both to uncertainties in the input data and to the inclusion of time costs, the estimation of which remains controversial. From a societal cost perspective only, we show that outreach radiotherapy (central comprehensive facility and satellite) is the economically superior service delivery model for separations between 30 km and 170 km. Beyond 170 km, a fully decentralized service would be warranted if the only consideration were societal economic advantage. PMID:11292133

  1. Pectoralis major tendon repairs in the active-duty population.

    PubMed

    Antosh, Ivan J; Grassbaugh, Jason A; Parada, Stephen A; Arrington, Edward D

    2009-01-01

    Rupture of the pectoralis major tendon is an uncommon injury that typically occurs in young, active people. Of this injury population, active-duty military personnel represent a unique, athletic subset that is commonly treated with operative repair. For the retrospective case series reported here, we hypothesized that active-duty soldiers with acute and chronic pectoralis major tendon ruptures treated with operative repair would have high levels of patient satisfaction, quick return to work and sports, and few long-term complications. We retrospectively reviewed all pectoralis major tendon rupture repairs performed at our institution between 2000 and 2007. Charts were thoroughly reviewed, and patients were asked to complete DASH (Disabilities of the Arm, Shoulder, and Hand) and supplemental questionnaires. Paired Student's t test was performed, and Ps were calculated to analyze statistical differences between immediate- and delayed-treatment groups. Fourteen patients were identified. The most common mechanism of injury was bench-pressing weights. Overall DASH, Work Module, and Sports Module scores were good to excellent. There was a statistically significant difference between outcomes for the immediate- and delayed- treatment groups, with the immediate-treatment group having better overall DASH and Work Module scores. Patients had a 30% to 40% objective loss of strength after surgery. Active-duty soldiers reported acceptable overall outcomes after both immediate and delayed treatment for pectoralis major tendon ruptures, but a statistically significant difference was found in overall DASH and Work Module scores between the treatment groups.

  2. Information in Support of Population Activities.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    As part of UNESCO's World Population Year, information services in support of population programs are explained and listed. The information system of the International Planned Parenthood Federation is described and the management of population literature discussed. Information needs of population workers and special aspects of the training and…

  3. Chromospheric Activity in Population II Giants

    NASA Technical Reports Server (NTRS)

    Harper, Graham M.

    2004-01-01

    One of the mysteries of Population II giants is that they still show chromospheric emission despite their great age. The global dynamo which was active during their main-sequence lifetimes is expected to become extremely weak through magnetic rotational braking. The nature of the observed emission is not understood; although acoustic shock waves might provide the heating, acoustic waves are not predicted to drive the observed mass loss - which in turn requires the dissipation of magneto-hydrodynamic waves. This program was designed to search for the faint stellar H Ly beta emission wings and the fluorescent Fe II and H2 emission from one of the brightest, metal poor, Population II stars. These FUSE diagnostics, when combined with existing UV and optical spectra, help determine the major radiative cooling channels for the chromosphere. This observation was to complement that previously planned for the mildly metal deficient giant alpha Boo (K2 III). However, alpha Boo has yet to be observed with FUSE.

  4. Physical Activity Patterns in the Elderly Kashan Population

    PubMed Central

    Sadrollahi, Ali; Hosseinian, Masoumeh; Masoudi Alavi, Negin; Khalili, Zahra; Esalatmanesh, Sophia

    2016-01-01

    Background Physical activity is an important component of health in old age that provides personal independence, physical ability, and quality of life. Objectives The current study aimed to evaluate physical activity and associated factors among the elderly population in Kashan, Iran. Patients and Methods This is a descriptive cross-sectional study. The sample was 400 elderly people (aged more than 60 years) living in Kashan, Iran in 2014. The subjects randomly selected via multi-stage cluster sampling from healthcare centers in three regions of Kashan. The sample size differed by gender and residence type. Each participant’s demographic characteristics and level of physical activity were recorded in a questionnaire, and the data were analyzed by SPSS version 16. Descriptive statistics, chi-square tests, Pearson correlations, and ordinal regression were used in the data analysis. The significance level for all the tests was P < 0.05. Results 237 (59.2%) of the subjects were female. The average age of the study population was 67.6 ± 6.8 years. Their average physical activity energy consumption was 326.21 ± 364.84 according to the metabolic equivalent of hours per week. 20 subjects (5%) reported no physical activity. 320 (80%) and 59 (14.8%) subjects had low and moderate physical activity levels, respectively. Only 1 subject (0.2%) had extreme levels of physical activity. Men (n = 43, 26.4%) were more likely to be moderately or extremely physically active than women were (n = 17, 7.2%). There was a significant relationship between physical activity and sex (P < 0.0001), marital status (P < 0.0001), educational status (P < 0.002), current occupation (P < 0.0001), and personal independence (P < 0.00001). Of course, effective predictive variations included age (P = 0.034), gender (P = 0.001), marital status (P = 0.033), independent status (P = 0), and local environment (P =0.001). Conclusions The study revealed low physical activity in the elderly population in

  5. Physical Activity Patterns in the Elderly Kashan Population

    PubMed Central

    Sadrollahi, Ali; Hosseinian, Masoumeh; Masoudi Alavi, Negin; Khalili, Zahra; Esalatmanesh, Sophia

    2016-01-01

    Background Physical activity is an important component of health in old age that provides personal independence, physical ability, and quality of life. Objectives The current study aimed to evaluate physical activity and associated factors among the elderly population in Kashan, Iran. Patients and Methods This is a descriptive cross-sectional study. The sample was 400 elderly people (aged more than 60 years) living in Kashan, Iran in 2014. The subjects randomly selected via multi-stage cluster sampling from healthcare centers in three regions of Kashan. The sample size differed by gender and residence type. Each participant’s demographic characteristics and level of physical activity were recorded in a questionnaire, and the data were analyzed by SPSS version 16. Descriptive statistics, chi-square tests, Pearson correlations, and ordinal regression were used in the data analysis. The significance level for all the tests was P < 0.05. Results 237 (59.2%) of the subjects were female. The average age of the study population was 67.6 ± 6.8 years. Their average physical activity energy consumption was 326.21 ± 364.84 according to the metabolic equivalent of hours per week. 20 subjects (5%) reported no physical activity. 320 (80%) and 59 (14.8%) subjects had low and moderate physical activity levels, respectively. Only 1 subject (0.2%) had extreme levels of physical activity. Men (n = 43, 26.4%) were more likely to be moderately or extremely physically active than women were (n = 17, 7.2%). There was a significant relationship between physical activity and sex (P < 0.0001), marital status (P < 0.0001), educational status (P < 0.002), current occupation (P < 0.0001), and personal independence (P < 0.00001). Of course, effective predictive variations included age (P = 0.034), gender (P = 0.001), marital status (P = 0.033), independent status (P = 0), and local environment (P =0.001). Conclusions The study revealed low physical activity in the elderly population in

  6. Establishing an active patient partnership.

    PubMed

    Herrier, R N; Boyce, R W

    1995-04-01

    Pharmacists face many changes in the coming decade, some of which threaten their professional survival. Although uncertainty may currently prevail, one of these changes, the shift in the patient-health care professional relationship from the patient taking a passive role to an active partnering role, provides pharmacists with many opportunities to realize the vision of patient-centered care that has been advocated by pharmacy innovators and leaders for almost three decades. To take advantage of these changes, pharmacists must modify their practice paradigms and use their existing strengths, such as easy patient access and high levels of patient trust, to help develop a new model of pharmaceutical care. The concern that the magnitude of these changes will prevent successful practice transformations may be exaggerated. In reality, these proposed "new" roles have been in existence for much of this century. Most pharmacists can expand and enhance their traditional roles as self-care advisors and patient educators simply by incremental improvements in interpersonal and clinical skills. Rather than a Star Trek approach to "go where no man has gone before," the profession needs only a pharmaceutical sequel to Back to the Future.

  7. Population Pharmacokinetic/Pharmacodynamic Analysis of the Bactericidal Activities of Sutezolid (PNU-100480) and Its Major Metabolite against Intracellular Mycobacterium tuberculosis in Ex Vivo Whole-Blood Cultures of Patients with Pulmonary Tuberculosis

    PubMed Central

    Zhu, Tong; Friedrich, Sven O.; Diacon, Andreas

    2014-01-01

    Sutezolid (PNU-100480 [U-480]) is an oxazolidinone antimicrobial being developed for the treatment of tuberculosis. An active sulfoxide metabolite (PNU-101603 [U-603]), which reaches concentrations in plasma several times those of the parent, has been reported to drive the killing of extracellular Mycobacterium tuberculosis by sutezolid in hollow-fiber culture. However, the relative contributions of the parent and metabolite against intracellular M. tuberculosis in vivo are not fully understood. The relationships between the plasma concentrations of U-480 and U-603 and intracellular whole-blood bactericidal activity (WBA) in ex vivo cultures were examined using a direct competitive population pharmacokinetic (PK)/pharmacodynamic 4-parameter sigmoid model. The data set included 690 PK determinations and 345 WBA determinations from 50 tuberculosis patients enrolled in a phase 2a sutezolid trial. The model parameters were solved iteratively. The median U-603/U-480 concentration ratio was 7.1 (range, 1 to 28). The apparent 50% inhibitory concentration of U-603 for intracellular M. tuberculosis was 17-fold greater than that of U-480 (90% confidence interval [CI], 9.9- to 53-fold). Model parameters were used to simulate in vivo activity after oral dosing with sutezolid at 600 mg twice a day (BID) and 1,200 mg once a day (QD). Divided dosing resulted in greater cumulative activity (−0.269 log10 per day; 90% CI, −0.237 to −0.293 log10 per day) than single daily dosing (−0.186 log10 per day; 90% CI, −0.160 to −0.208 log10 per day). U-480 accounted for 84% and 78% of the activity for BID and QD dosing, respectively, despite the higher concentrations of U-603. Killing of intracellular M. tuberculosis by orally administered sutezolid is mainly due to the activity of the parent compound. Taken together with the findings of other studies in the hollow-fiber model, these findings suggest that sutezolid and its metabolite act on different mycobacterial subpopulations

  8. [Population].

    PubMed

    1979-01-01

    Data on the population of Venezuela between 1975 and 1977 are presented in descriptive tables and graphs. Information is included on the employed population according to category, sex, and type of economic activity, and by sex, age, and area on the employment rate and the total, the economically active, and the unemployed population.

  9. Patient barriers to insulin use in multi-ethnic populations.

    PubMed

    Visram, Hasina

    2013-06-01

    Insulin administration is often required in the management of type 2 diabetes mellitus for optimal glycemic control. Despite this, however, many patients are reluctant to initiate insulin treatment. In the general population, there are multiple factors leading to this reluctance including fear of hypoglycemia, needle phobia and weight gain. These barriers are also present in multi-ethnic populations. However, there are several patient barriers that are more prevalent in various ethnic backgrounds that need to be addressed. These barriers include language barriers, poor health literacy, social factors and religious implications. The awareness of these factors as well as potential strategies to help overcome them can lead to the improved management of patients with diabetes from multi-ethnic populations. PMID:24070844

  10. Alcohol Drinking Pattern: A Comparison between HIV-Infected Patients and Individuals from the General Population

    PubMed Central

    Ikeda, Maria Leticia R.; Barcellos, Nemora T.; Alencastro, Paulo R.; Wolff, Fernando H.; Moreira, Leila B.; Gus, Miguel; Brandão, Ajacio B. M.; Fuchs, Flavio D.; Fuchs, Sandra C.

    2016-01-01

    Background Alcohol consumption is highly prevalent in the general population and among HIV-infected population. This study aimed to compare the pattern of alcohol consumption and to describe characteristics associated with heavy alcohol consumption in individuals from the general population with patients infected with HIV. Methods Participants for this analysis came from a population-based cross-sectional study and from a consecutive sampling of patients infected with HIV. Participants aged 18 years or older were interviewed using similar questionnaires with questions pertaining to socio-demographic characteristics, alcohol consumption, smoking, physical activity, and HIV-related characteristics, among others. Blood pressure and anthropometric measures were measured using standardized procedures. Results Weekly alcohol consumption was more prevalent among individuals from the general population than HIV-infected patients: 57.0 vs. 31.1%, P<0.001. The prevalence of heavy episodic drinking was higher in the population sample as well: 46.1 vs. 17.0%, P<0.001. In the general population, heavy alcohol consumption was more prevalent in men. Cigarette smoking was independently associated with heavy alcohol consumption among HIV infected (Prevalence Ratio; PR = 5.9; 95%CI 2.6–13.9; P<0,001) and general population (PR = 2.6; 95%CI 1.9–3.0; P<0.001). Years at school were inversely associated with heavy alcohol consumption among HIV-infected patients and directly associated among participants from the general population, even after controlling for sex, age, skin color, and smoking. Conclusions Heavy alcohol consumption is more prevalent in the general population than among HIV-infected patients. Individuals aware about their disease may reduce the amount of alcoholic beverages consumption comparatively to healthy individuals from the general population. PMID:27362541

  11. Obsessive-compulsiveness in a population of tinnitus patients.

    PubMed

    Folmer, Robert L; Griest, Susan E; Martin, William Hal

    2008-01-01

    The purpose of this study was to use the Maudsley Obsessional-Compulsive Inventory (MOCI) to assess obsessive-compulsiveness in a population of 196 tinnitus patients and to correlate MOCI scores with measures of anxiety, depression, and tinnitus severity. Tinnitus severity was positively correlated with measures of anxiety and depression. Depression was positively correlated with MOCI and anxiety scores. MOCI scores exhibited weaker positive correlations with tinnitus severity and anxiety. Effective management of tinnitus requires identification of psychological disorders or symptoms when they are present so that patients can receive appropriate treatment as soon as possible. The MOCI can be used to assess obsessive-compulsiveness in tinnitus patients. PMID:19205163

  12. A population-based study of active and drug-resistant epilepsies in Northern Italy.

    PubMed

    Giussani, Giorgia; Canelli, Valentina; Bianchi, Elisa; Franchi, Carlotta; Nobili, Alessandro; Erba, Giuseppe; Beghi, Ettore

    2016-02-01

    Drug-resistant epilepsy (DRE) is defined by the International League Against Epilepsy as a failure of adequate trials of two tolerated, appropriately chosen, and used antiepileptic drugs to achieve sustained seizure freedom. Our aim was to calculate the following: (1) the prevalence of active epilepsy and DRE in a well-defined population of Northern Italy and (2) the proportion of incident cases developing DRE. The study population (146,506; year 2008) resided in the province of Lecco, Northern Italy. The medical records of 123 general practitioners were reviewed to identify patients with epilepsy, diagnosed by a neurologist during the period 2000-2008. The point prevalence of active epilepsy and DRE was calculated on December 31, 2008. A total of 747 prevalent patients with epilepsy, 684 patients with active epilepsy, and 342 incident cases were identified. The frequency of DRE was 15.6% (107/684) of all active epilepsies and 10.5% (36/342) of incident cases. The point prevalence was 0.73 per 1000. The standardized prevalence of DRE was 0.7 per 1000 (Italian population) and 0.8 per 1000 (world population). Our data indicate that 1/6 patients with active epilepsy in the general population has DRE, and 1/10 patients with newly diagnosed epilepsy will develop DRE within nine years from the diagnosis.

  13. Low catechol-O-methyltransferase activity in a Saami population.

    PubMed

    Klemetsdal, B; Straume, B; Giverhaug, T; Aarbakke, J

    1994-01-01

    Catechol-O-methyltransferase (COMT) catalyzes the O-methylation of catechol hormones, neurotransmitters and certain drugs. It is subject to genetic polymorphism and ethnic differences. High red blood cell (RBC) COMT activity has been correlated with a poor response to levodopa treatment in Parkinson's disease. RBC COMT was determined in a Norwegian population (n = 213) of whom 115 were Saami (Laaps). The Saami had 16.5% lower RBC COMT activity compared to a non-Saami population sample from the northern part of Norway (n = 50), 13.9 vs. 16.4 units/ml RBC (U) (P = 0.04). This is the first report of any population with lower RBC COMT activity than a Caucasian population. A wide range of RBC COMT activities was found in the entire population examined (1.3-38.3 U).

  14. Leukocyte Activation in Obese Patients

    PubMed Central

    Minervino, Daniele; Gumiero, Daniela; Nicolazzi, Maria Anna; Carnicelli, Annamaria; Fuorlo, Mariella; Guidone, Caterina; Di Gennaro, Leonardo; Fattorossi, Andrea; Mingrone, Geltrude; Landolfi, Raffaele

    2015-01-01

    Abstract The rising prevalence of obesity is a major global health problem. In severe obesity, bariatric surgery (BS) allows to obtain a significant weight loss and comorbidities improvement, among them one of the factors is the thrombotic risk. In this observational study, we measured indices of leukocyte activation in severely obese patients as markers of increased thrombotic risk in relation with serum markers of inflammation before and after BS. Frequency of polymorphonuclear neutrophil-platelet (PLT) and monocyte (MONO)-PLT aggregates as well as of tissue factor (TF) expressing MONOs was measured in the peripheral blood of 58 consecutive obese patients and 30 healthy controls. In 31 of the 58 obese patients, data obtained at the enrollment were compared with those obtained at 3, 6, and 12 months after BS. Compared with healthy controls, obese patients showed a higher frequency of polymorphonuclear leukocyte (PMNL)-PLT aggregates (7.47 ± 2.45 [6.82–8.11]% vs 5.85 ± 1.89 [5.14–6.55]%, P = 0.001), MONO-PLT aggregates (12.31 ± 7.33 [10.38–14.24]% vs 8.14 ± 2.22 [7.31–8.97]%, P < 0.001), and TF expressing MONOs (4.01 ± 2.11 [3.45–4.56]% vs 2.64 ± 1.65 [2.02–3.25]%, P = 0.002). PMNL-PLT and MONO-PLT aggregate frequency was positively correlated with TF expressing MONOs (R2 = 0.260, P = 0.049 and R2 = 0.318, P = 0.015, respectively). BS was performed in 31 patients and induced a significant reduction of the body mass index, and waist and hip circumferences. These effects were associated with a significant decrease of PMNL-PLT aggregates at 12 months (7.58 ± 2.27 [6.75–8.42]% vs 4.47 ± 1.11 [3.93–5.01]%, P < 0.001), and a reduction of TF expressing MONOs at 6 (3.82 ± 2.04 [3.07–4.57]% vs 1.60 ± 1.69 [0.30–2.90]%, P = 0.008) and 12 months (3.82 ± 2.04 [3.07–4.57]% vs 1.71 ± 0.54 [1.45–1.97]%, P = 0.001) after BS. These data suggest that leukocyte

  15. Population Activities Fund Agency (PAFA): the journey so far.

    PubMed

    1993-01-01

    Mechanisms are needed funding Nigerian Federal efforts to implement the National Policy on Population for Development, which was approved by the Armed Forces Ruling Council in February, 1988. Subprojects of the Population Activities Fund Agency (PAFA) which were approves are: the integration of family planning (FP) into maternal and child health (MCH) the promotion of Fp through health education, tertiary centers for reproductive health, public enlightenment on population, population/family life education in primary schools, monitoring of National Population Project impact, and integration of population into planning and budgeting. The last obstacle to implementation of PAFA's activities is the signing into law the decree establishing PAFA as a parastatal. The passage is required for continued operations. The national Population for Development policy is unique in providing for quantitative targets, which has attracted the needed financial support of agencies such as the World Bank. As part of the National Population Policy, the National Population Program (NPP) is developing an effective strategy for securing funding and evaluation of subprojects that are designed and implemented b Collaborating Agencies (CAs), both private and public. NPP aims 1) to provide funds for qualified CAs through the Population Activities Fund (PAF) and Agency (PAFA); 2) to monitor PAFA, which manages PAf with the Department of Population Activities, and 3) to stimulate analysis of sociocultural constraints to fertility reduction and international comparisons, and to design innovative interventions through the Population Research Fund (PRF). PAFA funds implementing agencies at all government and nongovernment levels with approaches to population information and services. The goal of PAFA is to realize NPP objectives. The motto is "Towards an improved quality of life for every Nigerian." The mandate is to provide funding for the PAF and NPP, to monitor CAs, to provide assistance to CAs

  16. Cultural relevance of physical activity intervention research with underrepresented populations

    PubMed Central

    Conn, Vicki S.; Chan, Keith; Banks, JoAnne; Ruppar, Todd M.; Scharff, Jane

    2015-01-01

    This paper describes cultural relevance in physical activity intervention research with underrepresented populations. Seventy-one extant studies which tested interventions to increase physical activity among underrepresented adults were included. Verbatim descriptions of efforts to enhance cultural relevance of study designs and interventions were extracted and then content analyzed. We found strategies to enhance cultural relevance of interventions as soliciting input from population members, linking intervention content with values, addressing language and literacy challenges, incorporating population media figures, using culturally relevant forms of physical activity, and addressing specific population linked barriers to activity. Methodological approaches included specialized recruitment and study locations, culturally relevant measures, underrepresented personnel, and cost-awareness study procedures to prevent fiscal barriers to participation. Most reported activities were surface matching. Existing research neither compared the effectiveness of cultural relevance approaches to standardized interventions nor addressed economic, education, geographic, or cultural heterogeneity among groups. PMID:25228486

  17. Population Pharmacokinetics of Peramivir in Healthy Volunteers and Influenza Patients

    PubMed Central

    Matsuo, Yumiko; Ishibashi, Toru; Hollister, Alan S.

    2015-01-01

    Peramivir is an intravenous anti-influenza agent that inhibits viral growth by selectively inhibiting neuraminidase in human influenza A and B viruses. To characterize its pharmacokinetics, a population pharmacokinetic analysis of peramivir was performed using 3,199 plasma concentration data samples from 332 subjects in six clinical studies in Japan and the United States, including studies with renal impairment subjects, elderly subjects, and influenza patients. A three-compartment model well described the plasma concentration data for peramivir, and creatinine clearance was found to be the most important factor influencing clearance. Age and body weight were also found to be covariates for clearance and the volume of distribution, respectively. No difference in pharmacokinetics was found between genders or between Japanese and U.S. subjects. Small differences in pharmacokinetics were observed between uninfected subjects and influenza patients (clearance was 18% higher and the volume of distribution was 6% lower in influenza patients). Monte Carlo simulations indicated that single adjusted doses of 1/3- and 1/6-fold for patients with moderate and severe renal impairment, respectively, would give areas under the curve comparable to those for patients with normal renal function. The population pharmacokinetic model developed for peramivir should be useful for understanding its pharmacokinetic characteristics and for dose adjustment on the basis of renal function. PMID:26282420

  18. Population pharmacokinetics of oxaliplatin in patients with metastatic cancer.

    PubMed

    Bastian, G; Barrail, A; Urien, S

    2003-11-01

    Our aim was to develop a population pharmacokinetic model of ultrafilterable oxaliplatin in metastatic cancer patients. Oxaliplatin was administered by 2- or 4-h infusions, 50, 65, 75, 85, 100 or 130 mg/m2 to 56 patients. Blood samples were collected over 28 h. Plasma concentrations of ultrafilterable oxaliplatin were determined by flameless atomic absorption spectrophotometry. Population pharmacokinetic analysis was performed using a non-linear mixed-effects modeling method. Ultrafilterable oxaliplatin concentration-time profiles showed a secondary peak or a shoulder aspect post-infusion, attributed to the existence of an enterohepatic recirculation (EHR). They were best described by a two-compartment model incorporating an EHR component. Plasma clearance (CL) was related positively to body weight (BW) and negatively to serum creatinine (SCr), and was greater in male patients than in female patients. This covariate modeling resulted in a decrease in the interindividual variability for CL from 104 to 62%. The central distribution volume (V1) and inter-compartmental clearance (Q) were related to BW. Typical population estimates of CL, central distribution volume (V1), input rate constant into gallbladder (k1B) and lag time for drug reabsorption (TLAG) were 14.1 or 8.5 l/h (male or female patients), 24.9 l, 1.8 h-1 and 2.0 h, respectively. The final pharmacokinetic model was validated using 200 bootstrap samples of the original data. We conclude that a two-compartment with EHR model adequately described ultrafilterable oxaliplatin pharmacokinetics, explaining a secondary transient increase in concentration. This study identified combined-covariate-effects ultrafilterable oxaliplatin clearance, supporting dose adjustment of oxaliplatin based on BW, gender and corrected for SCr level, if drug exposure is thought to be related to therapeutic or toxic issues.

  19. Population pharmacokinetics of oxaliplatin in patients with metastatic cancer.

    PubMed

    Bastian, G; Barrail, A; Urien, S

    2003-11-01

    Our aim was to develop a population pharmacokinetic model of ultrafilterable oxaliplatin in metastatic cancer patients. Oxaliplatin was administered by 2- or 4-h infusions, 50, 65, 75, 85, 100 or 130 mg/m2 to 56 patients. Blood samples were collected over 28 h. Plasma concentrations of ultrafilterable oxaliplatin were determined by flameless atomic absorption spectrophotometry. Population pharmacokinetic analysis was performed using a non-linear mixed-effects modeling method. Ultrafilterable oxaliplatin concentration-time profiles showed a secondary peak or a shoulder aspect post-infusion, attributed to the existence of an enterohepatic recirculation (EHR). They were best described by a two-compartment model incorporating an EHR component. Plasma clearance (CL) was related positively to body weight (BW) and negatively to serum creatinine (SCr), and was greater in male patients than in female patients. This covariate modeling resulted in a decrease in the interindividual variability for CL from 104 to 62%. The central distribution volume (V1) and inter-compartmental clearance (Q) were related to BW. Typical population estimates of CL, central distribution volume (V1), input rate constant into gallbladder (k1B) and lag time for drug reabsorption (TLAG) were 14.1 or 8.5 l/h (male or female patients), 24.9 l, 1.8 h-1 and 2.0 h, respectively. The final pharmacokinetic model was validated using 200 bootstrap samples of the original data. We conclude that a two-compartment with EHR model adequately described ultrafilterable oxaliplatin pharmacokinetics, explaining a secondary transient increase in concentration. This study identified combined-covariate-effects ultrafilterable oxaliplatin clearance, supporting dose adjustment of oxaliplatin based on BW, gender and corrected for SCr level, if drug exposure is thought to be related to therapeutic or toxic issues. PMID:14597876

  20. Pentoxifylline Inhibits WNT Signalling in β-Cateninhigh Patient-Derived Melanoma Cell Populations

    PubMed Central

    Talar, Beata; Gajos-Michniewicz, Anna; Talar, Marcin; Chouaib, Salem; Czyz, Malgorzata

    2016-01-01

    Background The heterogeneity of melanoma needs to be addressed and combination therapies seem to be necessary to overcome intrinsic and acquired resistance to newly developed immunotherapies and targeted therapies. Although the role of WNT/β-catenin pathway in melanoma was early demonstrated, its contribution to the lack of the melanoma patient response to treatment was only recently recognized. Using patient-derived melanoma cell populations, we investigated the influence of pentoxifylline on melanoma cells with either high or low expression of β-catenin. Findings Our results indicate that pentoxifylline inhibits the activity of the canonical WNT pathway in melanoma cell populations with high basal activity of this signalling. This is supported by lowered overall activity of transcription factors TCF/LEF and reduced nuclear localisation of active β-catenin. Moreover, treatment of β-cateninhigh melanoma cell populations with pentoxifylline induces downregulation of genes that are targets of the WNT/β-catenin pathway including connective tissue growth factor (CTGF) and microphthalmia-associated transcription factor (MITF-M), a melanocyte- and melanoma cell-specific regulator. Conclusions These results suggest that pentoxifylline, a drug approved by the FDA in the treatment of peripheral arterial disease, might be tested in a subset of melanoma patients with elevated activity of β-catenin. This pharmaceutical might be tested as an adjuvant drug in combination therapies when the response to immunotherapy is prevented by high activity of the WNT/β-catenin pathway. PMID:27351373

  1. Population Pharmacokinetics of Fosfomycin in Critically Ill Patients

    PubMed Central

    Parker, Suzanne L.; Frantzeskaki, Frantzeska; Wallis, Steven C.; Diakaki, Chryssa; Giamarellou, Helen; Koulenti, Despoina; Karaiskos, Ilias; Lipman, Jeffrey; Dimopoulos, George

    2015-01-01

    This study describes the population pharmacokinetics of fosfomycin in critically ill patients. In this observational study, serial blood samples were taken over several dosing intervals of intravenous fosfomycin treatment. Blood samples were analyzed using a validated liquid chromatography-tandem mass spectrometry technique. A population pharmacokinetic analysis was performed using nonlinear mixed-effects modeling. Five hundred fifteen blood samples were collected over one to six dosing intervals from 12 patients. The mean (standard deviation) age was 62 (17) years, 67% of patients were male, and creatinine clearance (CLCR) ranged from 30 to 300 ml/min. A two-compartment model with between-subject variability on clearance and volume of distribution of the central compartment (Vc) described the data adequately. Calculated CLCR was supported as a covariate on fosfomycin clearance. The mean parameter estimates for clearance on the first day were 2.06 liters/h, Vc of 27.2 liters, intercompartmental clearance of 19.8 liters/h, and volume of the peripheral compartment of 22.3 liters. We found significant pharmacokinetic variability for fosfomycin in this heterogeneous patient sample, which may be explained somewhat by the observed variations in renal function. PMID:26239990

  2. Hypersensitivity to major panallergens in a population of 120 patients

    PubMed Central

    Mezzacappa, Simona; Aruanno, Arianna; Pecora, Valentina; Rizzi, Angela; Ricci, Anna Giulia; Ferraironi, Manuela; Buonomo, Alessandro; Schiavino, Domenico

    2015-01-01

    Introduction Lipid transfer proteins (LTP), profilin and PR-10 are the most important panallergens in central and southern Italy. Lipid transfer proteins are stable molecules, predominantly present in the fruit peel, which can induce systemic symptoms after ingestion of vegetables. Profilin and PR-10 are randomly distributed in the pulp and peel. Both are labile proteins and usually determine reactions restricted to the oral cavity. Panallergens-specific IgE may cross-react with homologues from different plant sources, due to their conserved structure. Aim To assess the pattern of sensitization to panallergens and the correlation with the clinical history and the allergological evaluation of food and aeroallergens. Material and methods One hundred and twenty patients with adverse reactions after vegetables ingestion underwent skin prick tests (SPT) with commercial extracts of plant-derived foods and inhalant allergens and commercial extracts of LTP, profilin and PR-10. Results Many patients presented positive SPT with different plant-food allergens. We found that 76 patients were sensitized to LTP, 14 to profilin and 5 to PR-10. In the LTP-sensitized group, 64 (84%) patients suffered from systemic symptoms while the patients sensitized only to profilin referred the oral allergy syndrome. Conclusions This study shows a high rate of sensitization to LTP in our population according to the literature about food allergy in our geographical area and confirms the literature data about the symptoms referred by patients with sensitization to panallergens. Panallergens should be considered as clinically relevant food allergens. PMID:26366148

  3. Genotypic structure of a Drosophila population for adult locomotor activity

    SciTech Connect

    Grechanyi, G.V.; Korzun, V.M.

    1995-01-01

    Analysis of the variation of adult locomotor activity in four samples taken at different times from a natural population of Drosophila melanogaster showed that the total variation of this trait is relatively stable in time and has a substantial genetic component. Genotypic structure of the population for locomotor activity is characterized by the presence of large groups of genotypes with high and low values of this trait. A possible explanation for the presence of such groups in a population is cyclic density-dependent selection.

  4. Independent Components of Neural Activity Carry Information on Individual Populations

    PubMed Central

    Głąbska, Helena; Potworowski, Jan; Łęski, Szymon; Wójcik, Daniel K.

    2014-01-01

    Local field potential (LFP), the low-frequency part of the potential recorded extracellularly in the brain, reflects neural activity at the population level. The interpretation of LFP is complicated because it can mix activity from remote cells, on the order of millimeters from the electrode. To understand better the relation between the recordings and the local activity of cells we used a large-scale network thalamocortical model to compute simultaneous LFP, transmembrane currents, and spiking activity. We used this model to study the information contained in independent components obtained from the reconstructed Current Source Density (CSD), which smooths transmembrane currents, decomposed further with Independent Component Analysis (ICA). We found that the three most robust components matched well the activity of two dominating cell populations: superior pyramidal cells in layer 2/3 (rhythmic spiking) and tufted pyramids from layer 5 (intrinsically bursting). The pyramidal population from layer 2/3 could not be well described as a product of spatial profile and temporal activation, but by a sum of two such products which we recovered in two of the ICA components in our analysis, which correspond to the two first principal components of PCA decomposition of layer 2/3 population activity. At low noise one more cell population could be discerned but it is unlikely that it could be recovered in experiment given typical noise ranges. PMID:25153730

  5. Benefits of Active Debris Removal on the LEO Debris Population

    NASA Astrophysics Data System (ADS)

    Maniwa, Kazuaki; Hanada, Toshiya; Kawamoto, Satomi

    Since the launch of Sputnik, orbital debris population continues to increase due to ongoing space activities, on-orbit explosions, and accidental collisions. In the future, a great deal of fragments can be expected to be created by explosions and collisions. In spite of prevention of satellite and rocket upper stage explosions and other mitigation measures, debris population in low Earth orbit may not be stabilized. To better limit the growth of the future debris population, it is necessary to remove the existing debris actively. This paper studies about the effectiveness of active debris removal in low Earth orbit where the collision rate with and between space debris is high. This study does not consider economic problems, but investigates removing debris which may stabilize well the current debris population based on the concept of Japan Aerospace Exploration Agency.

  6. Variables associated with patient activation in persons with multiple sclerosis.

    PubMed

    Goodworth, Marie-Christine R; Stepleman, Lara; Hibbard, Judith; Johns, Lisa; Wright, Dustin; Hughes, Mary D; Williams, Mitzi J

    2016-01-01

    Identifying variables associated with patient activation in the multiple sclerosis population could serve to facilitate better multiple sclerosis self-management behaviors. Using a cross-sectional survey design, 199 participants were recruited from a multiple sclerosis center in the Southeastern United States. Depression, multiple sclerosis quality of life, and multiple Sclerosis self-efficacy were all significantly correlated with patient activation. Results of a hierarchical regression indicated that patient activation was significantly related to educational attainment, depression, and self-efficacy but not to quality of life. The results suggest several possible targets for intervention to increase patient activation, including health literacy, depression symptoms, and self-efficacy for multiple sclerosis disease management.

  7. Population Pharmacokinetics of Vancomycin in Postoperative Neurosurgical Patients.

    PubMed

    Li, Xingang; Wu, Yuanxing; Sun, Shusen; Mei, Shenghui; Wang, Jiaqing; Wang, Qiang; Zhao, Zhigang

    2015-11-01

    Neurosurgical procedures may damage the blood-brain barrier to allow more vancomycin distribution into the cerebrospinal fluid (CSF) from blood after intravenous administration. However, a large intersubject variability in CSF vancomycin concentration was observed. We aimed to develop a population pharmacokinetic model to guide vancomycin dosing in patients after neurosurgical operation. Blood and CSF samples were collected and determined from postoperative neurosurgical patients after vancomycin administration. A three-compartment (central, peripheral, and CSF) model was proposed to characterize the pharmacokinetics of vancomycin. A nonlinear mixed-effects modeling approach was applied to fit the blood and CSF data simultaneously. The covariate analysis found that the CSF albumin level was strongly associated with the clearance between central and CSF compartment. Visual predictive check indicated that the proposed population pharmacokinetic model agrees well with the observed vancomycin concentrations. Individualized vancomycin dosage regimens could be developed for postoperative neurosurgical patients with different CSF albumin levels through model simulations. The CSF albumin level is a determinant of CSF vancomycin concentration.

  8. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

    PubMed Central

    McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

    2015-01-01

    Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance. PMID:25793157

  9. Adalimumab in Patients with Active Noninfectious Uveitis.

    PubMed

    Jaffe, Glenn J; Dick, Andrew D; Brézin, Antoine P; Nguyen, Quan Dong; Thorne, Jennifer E; Kestelyn, Philippe; Barisani-Asenbauer, Talin; Franco, Pablo; Heiligenhaus, Arnd; Scales, David; Chu, David S; Camez, Anne; Kwatra, Nisha V; Song, Alexandra P; Kron, Martina; Tari, Samir; Suhler, Eric B

    2016-09-01

    Background Patients with noninfectious uveitis are at risk for long-term complications of uncontrolled inflammation, as well as for the adverse effects of long-term glucocorticoid therapy. We conducted a trial to assess the efficacy and safety of adalimumab as a glucocorticoid-sparing agent for the treatment of noninfectious uveitis. Methods This multinational phase 3 trial involved adults who had active noninfectious intermediate uveitis, posterior uveitis, or panuveitis despite having received prednisone treatment for 2 or more weeks. Investigators and patients were unaware of the study-group assignments. Patients were randomly assigned in a 1:1 ratio to receive adalimumab (a loading dose of 80 mg followed by a dose of 40 mg every 2 weeks) or matched placebo. All patients received a mandatory prednisone burst followed by tapering of prednisone over the course of 15 weeks. The primary efficacy end point was the time to treatment failure occurring at or after week 6. Treatment failure was a multicomponent outcome that was based on assessment of new inflammatory lesions, best corrected visual acuity, anterior chamber cell grade, and vitreous haze grade. Nine ranked secondary efficacy end points were assessed, and adverse events were reported. Results The median time to treatment failure was 24 weeks in the adalimumab group and 13 weeks in the placebo group. Among the 217 patients in the intention-to-treat population, those receiving adalimumab were less likely than those in the placebo group to have treatment failure (hazard ratio, 0.50; 95% confidence interval, 0.36 to 0.70; P<0.001). Outcomes with regard to three secondary end points (change in anterior chamber cell grade, change in vitreous haze grade, and change in best corrected visual acuity) were significantly better in the adalimumab group than in the placebo group. Adverse events and serious adverse events were reported more frequently among patients who received adalimumab (1052.4 vs. 971.7 adverse events

  10. Patient Activation: Public Libraries and Health Literacy

    ERIC Educational Resources Information Center

    Malachowski, Margot

    2011-01-01

    Patient activation is a new term for a perennial problem. People know what they need to do for their health: exercise, eat right, and get enough rest--but how are they motivated to actually do these things? This is what patient activation is. From this author's vantage point as a medical librarian, public libraries are well-placed to be part of…

  11. Internal models for interpreting neural population activity during sensorimotor control.

    PubMed

    Golub, Matthew D; Yu, Byron M; Chase, Steven M

    2015-01-01

    To successfully guide limb movements, the brain takes in sensory information about the limb, internally tracks the state of the limb, and produces appropriate motor commands. It is widely believed that this process uses an internal model, which describes our prior beliefs about how the limb responds to motor commands. Here, we leveraged a brain-machine interface (BMI) paradigm in rhesus monkeys and novel statistical analyses of neural population activity to gain insight into moment-by-moment internal model computations. We discovered that a mismatch between subjects' internal models and the actual BMI explains roughly 65% of movement errors, as well as long-standing deficiencies in BMI speed control. We then used the internal models to characterize how the neural population activity changes during BMI learning. More broadly, this work provides an approach for interpreting neural population activity in the context of how prior beliefs guide the transformation of sensory input to motor output.

  12. Population pharmacokinetics of vancomycin in patients receiving extracorporeal membrane oxygenation

    PubMed Central

    Mulla, Hussain; Pooboni, Suneel

    2005-01-01

    Aims Extracorporeal membrane oxygenation (ECMO) is a life support system used during severe respiratory or cardiorespiratory failure. The objective of this study was to characterize the population pharmacokinetics of vancomycin during ECMO. Methods A population model was developed using WinNonMix (Version 2.0.1) from a total of 366 plasma observations in 45 patients, including term neonates, older children and adults. The study utilized both rich prospective and sparse retrospective data. Prospective samples were drawn at baseline and then 30, 60,90, 120, 180, 240, 300, 360 and 420 min postinfusion. Steady state concentrations were obtained retrospectively from an assay database, cross-referencing with the patients’ medical records. Results Data were examined using a two-compartment model with an additive and proportional residual error. Model fit improved substantially when clearance, CL (l kg−1 h−1) was modelled as a nonlinear function of serum creatinine (Cr) µmol l−1. There was a linear relationship between CL and age up to 1000 days: CL (Age < 1000 days) = [2.4 + 0.0018 × Age (days)]/Cr; CL (Age > 1000 days) = 4.3/Cr. Age also influenced central volume (V1) when included in the model as a dichotomous variable: V1 (Age < 4000 days) = 0.45 l kg−1; V1 (Age > 4000 days) = 0.36 l kg−1. Intercompartmental clearance and tissue volume were estimated to be 0.09 l kg−1 h−1 and 0.25 l kg−1, respectively. Model validation in a separate group of 20 patients revealed a bias of −7.7% and a precision of 26.7%. Conclusions The clearance of vancomycin was decreased and its volume of distribution increased in patients receiving ECMO, suggesting altered drug disposition during this treatment. PMID:16120065

  13. Population pharmacokinetics of levosimendan in patients with congestive heart failure

    PubMed Central

    Jonsson, E Niclas; Antila, Saila; McFadyen, Lynn; Lehtonen, Lasse; Karlsson, Mats O

    2003-01-01

    Aims The aim of this study was to characterize the population pharmacokinetics of levosimendan in patients with heart failure (NYHA grades III and IV) and its relationship to demographic factors, disease severity and concomitant use of digoxin and β-blocking agents. Methods Data from two efficacy studies with levosimendan administered by intravenous infusion were combined (190 patients in total). The data were analysed using a nonlinear mixed-effects modelling approach as implemented in the NONMEM program. The model development was done in three sequential steps. First the best structural model was determined (e.g. a one-, two- or three-compartment pharmacokinetic model). This was followed by the identification and incorporation of important covariates into the model. Lastly the stochastic part of the model was refined. Results A two-compartment model best described levosimendan pharmacokinetics. Clearance and the central volume of distribution were found to increase linearly with bodyweight. No other covariates, including concomitant use of digoxin and β-blocking agents, influenced the pharmacokinetics. In the final model, a 76-kg patient was estimated to have a clearance ± s.e. of 13.3 ± 0.4 l h−1 and a central volume of distribution of 16.8 ± 0.79 l. The interindividual variability was estimated to be 39% and 60% for clearance and central volume of distribution, respectively. Weight changed clearance by 1.5% [95% confidence interval (CI) 0.9%, 2.1%] and the central volume of distribution by 0.9% (95% CI 0.5%, 1.3%) per kg. Conclusions The population pharmacokinetics parameters of levosimendan in this patient group were comparable to those obtained by traditional methods in healthy volunteers and patients with mild heart failure. Bodyweight influenced the clearance and the central volume of distribution, which in practice is accounted for by weight adjusting doses. None of the other covariates, including digoxin and β-blocking agents, significantly

  14. Acculturation and physical activity in a working class multiethnic population

    PubMed Central

    Wolin, Kathleen Y.; Colditz, Graham; Stoddard, Anne M.; Emmons, Karen M.; Sorensen, Glorian

    2008-01-01

    Background Determinants of physical activity in minority populations remain under-explored. Acculturation is one proposed mechanism for the disparities that exist between racial and ethnic groups in health outcomes. Methods This cross-sectional study evaluated the relation of language acculturation and generation in the US since migration with leisure-time and occupational activity. A low-income, multiethnic urban population was recruited from Massachusetts small businesses (SB) (n = 1725) and health centers (HC) (n = 2205). Baseline data were collected between May 2000 and February 2002. Results Individuals with low acculturation reported leisure-time activity 3–5 MET hours/week lower than those who were highly acculturated (P < 0.05). Generation predicted leisure-time activity only in SB participants. In the HC, least acculturated participants reported occupational activity 10–12 MET hours/week higher than highly acculturated participants. In SB men, acculturation was inversely associated with occupational activity; in SB women, language acculturation was positively associated with occupational activity. Generation was not predictive of occupational activity. Conclusion Language acculturation and generation were positively associated with leisure-time activity. Language acculturation is also associated with occupational activity. Acculturation is important to consider when designing public health interventions. PMID:16481031

  15. Population Pharmacokinetics of Benznidazole in Adult Patients with Chagas Disease

    PubMed Central

    Aldasoro, E.; Guerrero, L.; Posada, E.; Serret, N.; Mejía, T.; Urbina, J. A.; Gascón, J.

    2015-01-01

    The aim of the present study was to build a population pharmacokinetic (popPK) model to characterize benznidazole (BNZ) pharmacokinetics in adults with chronic Chagas disease. This study was a prospective, open-label, single-center clinical trial approved by the local ethics committee. Patients received BNZ at 2.5 mg/kg of body weight/12 h (Abarax, Elea Laboratory, Argentina) for 60 days. Plasma BNZ samples were taken several times during the study and analyzed by high-performance liquid chromatography with UV-visible detection (HPLC-UV). The popPK analysis was done with NONMEMv.7.3. Demographic and biological data were tested as covariates. Intraindividual, interoccasion, and residual variabilities were modeled. Internal and external validations were completed to assess the robustness of the model. Later on, simulations were performed to generate BNZ concentration-time course profiles for different dosage regimens. A total of 358 plasma BNZ concentrations from 39 patients were included in the analysis. A one-compartment PK model characterized by clearance (CL/F) and the apparent volume of distribution (V/F), with first-order absorption (Ka) and elimination, adequately described the data (CL/F, 1.73 liters/h; V/F, 89.6 liters; and Ka, 1.15 h−1). No covariates were found to be significant for CL/F and V/F. Internal and external validations of the final model showed adequate results. Data from simulations revealed that a dose of 2.5 mg/kg/12 h might lead to overexposure in most patients. A lower dose (2.5 mg/kg/24 h) was able to achieve trough BNZ plasma concentrations within the accepted therapeutic range of 3 to 6 mg/liter. In summary, we developed a population PK model for BNZ in adults with chronic Chagas disease. Dosing simulations showed that a BNZ dose of 2.5 mg/kg/24 h will adequately keep BNZ trough plasma concentrations within the recommended target range for the majority of patients. (This study has been registered at EudraCT under number 2011

  16. Population Dynamics of Patients with Bacterial Resistance in Hospital Environment.

    PubMed

    Qu, Leilei; Pan, Qiuhui; Gao, Xubin; He, Mingfeng

    2016-01-01

    During the past decades, the increase of antibiotic resistance has become a major concern worldwide. The researchers found that superbugs with new type of resistance genes (NDM-1) have two aspects of transmission characteristics; the first is that the antibiotic resistance genes can horizontally transfer among bacteria, and the other is that the superbugs can spread between humans through direct contact. Based on these two transmission mechanisms, we study the dynamics of population in hospital environment where superbugs exist. In this paper, we build three mathematic models to illustrate the dynamics of patients with bacterial resistance in hospital environment. The models are analyzed using stability theory of differential equations. Positive equilibrium points of the system are investigated and their stability analysis is carried out. Moreover, the numerical simulation of the proposed model is also performed which supports the theoretical findings.

  17. Population Dynamics of Patients with Bacterial Resistance in Hospital Environment

    PubMed Central

    Qu, Leilei; Pan, Qiuhui; Gao, Xubin; He, Mingfeng

    2016-01-01

    During the past decades, the increase of antibiotic resistance has become a major concern worldwide. The researchers found that superbugs with new type of resistance genes (NDM-1) have two aspects of transmission characteristics; the first is that the antibiotic resistance genes can horizontally transfer among bacteria, and the other is that the superbugs can spread between humans through direct contact. Based on these two transmission mechanisms, we study the dynamics of population in hospital environment where superbugs exist. In this paper, we build three mathematic models to illustrate the dynamics of patients with bacterial resistance in hospital environment. The models are analyzed using stability theory of differential equations. Positive equilibrium points of the system are investigated and their stability analysis is carried out. Moreover, the numerical simulation of the proposed model is also performed which supports the theoretical findings. PMID:26904150

  18. Population Dynamics of Patients with Bacterial Resistance in Hospital Environment.

    PubMed

    Qu, Leilei; Pan, Qiuhui; Gao, Xubin; He, Mingfeng

    2016-01-01

    During the past decades, the increase of antibiotic resistance has become a major concern worldwide. The researchers found that superbugs with new type of resistance genes (NDM-1) have two aspects of transmission characteristics; the first is that the antibiotic resistance genes can horizontally transfer among bacteria, and the other is that the superbugs can spread between humans through direct contact. Based on these two transmission mechanisms, we study the dynamics of population in hospital environment where superbugs exist. In this paper, we build three mathematic models to illustrate the dynamics of patients with bacterial resistance in hospital environment. The models are analyzed using stability theory of differential equations. Positive equilibrium points of the system are investigated and their stability analysis is carried out. Moreover, the numerical simulation of the proposed model is also performed which supports the theoretical findings. PMID:26904150

  19. Erythrocyte thiopurine methyltransferase activity in a Korean population.

    PubMed

    Jang, I J; Shin, S G; Lee, K H; Yim, D S; Lee, M S; Koo, H H; Kim, H K; Sohn, D R

    1996-11-01

    Thiopurine methyltransferase (TPMT) is the enzyme responsible for the S-methylation of thiopurine drugs. The enzyme, present in human red blood cells (RBC), is known to exhibit genetic polymorphism and interethnic differences in its activity have been demonstrated. We have studied the role of TPMT polymorphism in Koreans and compared enzyme activity between this and other ethnic groups. In a population of 360 unrelated healthy Korean subjects TPMT activity showed a large interindividual variation ranging from 3.2 to 22.9 nmol ml-1 packed RBC h-1 with a median value of 12.0 and mode of 11.0 nmol ml-1 packed RBC h-1. The enzyme activity was higher in male subjects than that in female (median values; 12.2 vs 11.2, 95% confidence interval of the difference; -2.1, 4.0 nmol ml-1 packed RBC h-1). All subjects had detectable TPMT activity, but contrary to previous reports in other ethnic groups, this was distributed unimodally. The median RBC TPMT activity was very similar to values found in Caucasian populations, higher than in Floridian blacks and lower than that of a Norwegian Saami population.

  20. Strategies for digital mammography interpretation in a clinical patient population.

    PubMed

    van den Biggelaar, Frank J H M; Kessels, Alphons G H; van Engelshoven, Jos M A; Flobbe, Karin

    2009-12-15

    Mammography is the basic imaging modality for early detection of breast cancer. The aim of this prospective study was to evaluate the impact of different mammogram reading strategies on the diagnostic yield in a consecutive patient population referred for digital mammography to a hospital. First, the effect of using computer-aided detection (CAD) software on the performance of mammogram readers was studied. Furthermore, the impact of employing technologists as either prereaders or double readers was assessed, as compared to the conventional strategy of single reading by a radiologist. Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and 3 technologists with and without the use of CAD software. ROC analysis was used to study the effects of the different strategies. In the conventional strategy, an overall area under the curve (AUC) of 0.92 was found, corresponding to a sensitivity of 84% and specificity of 94%. When applying CAD software, the AUCs were similar before and after CAD for all readers (mean of 0.95). Employing technologists in prereading and double reading of mammograms resulted in a mean AUC of 0.91 and 0.96, respectively. In the prereading strategy, the corresponding sensitivity and specificity were 81 and 96%; in the double reading strategy they were 96 and 79%, respectively. Concluding, in this clinical population, systematic application of CAD software by either radiologist or technologists failed to improve the diagnostic yield. Furthermore, employing technologists as double readers of mammograms was the most effective strategy in improving breast cancer detection in daily clinical practice. PMID:19672861

  1. Concurrent validation of activity monitors in patients with rheumatoid arthritis☆

    PubMed Central

    Backhouse, Michael R.; Hensor, Elizabeth M.A.; White, Derrick; Keenan, Anne-Maree; Helliwell, Philip S.; Redmond, Anthony C.

    2013-01-01

    Background Physical activity is frequently reported in rheumatology but it is difficult to measure objectively outside the gait laboratory. A new generation of activity monitors offers this potential but it has not yet been evaluated in patients with rheumatoid arthritis. This study aimed to evaluate three types of activity monitors in patients with rheumatoid arthritis. Methods The Step-N-Tune, Activ4Life Pro V3.8, and the Intelligent Device for Energy Expenditure and Activity activity monitors were tested concurrently in 12 patients with rheumatoid arthritis as well as in a healthy control group of 12 volunteers. Participants walked at a self selected speed for two minutes and were filmed for later review. Temporal and spatial gait parameters were also validated against the GAITRite walkway and the total number of steps recorded by each activity monitor was compared to a gold standard derived from half speed video replays. Findings Activity monitor performance varied between devices but all showed poorer performance when used in the group with rheumatoid arthritis. Bland–Altman plots demonstrated wider 95% limits of agreement in the group with rheumatoid arthritis and a systematic decrease in agreement between activity monitors and the gold standard with decreasing functional ability. Interpretation Despite some variation between devices, all the activity monitors tested performed reasonably well in healthy young volunteers. All except the Activ4Life showed a marked decrease in performance in patients with rheumatoid arthritis, suggesting Activ4Life could be the most suitable for use in this patient group. The marked between group difference in functional ability, and systematic decrease in device performance with deteriorating gait, indicate that activity monitors require specific validation in target clinical populations. PMID:23522723

  2. Emergence of Bursting Activity in Connected Neuronal Sub-Populations

    PubMed Central

    Pasquale, Valentina; Berdondini, Luca; Chiappalone, Michela

    2014-01-01

    Uniform and modular primary hippocampal cultures from embryonic rats were grown on commercially available micro-electrode arrays to investigate network activity with respect to development and integration of different neuronal populations. Modular networks consisting of two confined active and inter-connected sub-populations of neurons were realized by means of bi-compartmental polydimethylsiloxane structures. Spontaneous activity in both uniform and modular cultures was periodically monitored, from three up to eight weeks after plating. Compared to uniform cultures and despite lower cellular density, modular networks interestingly showed higher firing rates at earlier developmental stages, and network-wide firing and bursting statistics were less variable over time. Although globally less correlated than uniform cultures, modular networks exhibited also higher intra-cluster than inter-cluster correlations, thus demonstrating that segregation and integration of activity coexisted in this simple yet powerful in vitro model. Finally, the peculiar synchronized bursting activity shown by confined modular networks preferentially propagated within one of the two compartments (‘dominant’), even in cases of perfect balance of firing rate between the two sub-populations. This dominance was generally maintained during the entire monitored developmental frame, thus suggesting that the implementation of this hierarchy arose from early network development. PMID:25250616

  3. Factors impacting unbound vancomycin concentrations in different patient populations.

    PubMed

    Oyaert, Matthijs; Spriet, Isabel; Allegaert, Karel; Smits, Anne; Vanstraelen, Kim; Peersman, Nele; Wauters, Joost; Verhaegen, Jan; Vermeersch, Pieter; Pauwels, Steven

    2015-11-01

    The unbound drug hypothesis states that only unbound drug concentrations are active and available for clearance, and highly variable results regarding unbound vancomycin fractions have been reported in the literature. We have determined the unbound vancomycin fractions in four different patient groups by a liquid chromatography tandem mass spectrometry (LC-MS/MS) method and identified factors that modulate vancomycin binding. We have further developed and validated a prediction model to estimate unbound vancomycin concentrations. Vancomycin (unbound and total) concentrations were measured in 90 patients in four different hospital wards (hematology [n = 33 samples], intensive care unit [ICU] [n = 51], orthopedics [n = 44], and pediatrics [age range, 6 months to 14 years; n = 18]) by a validated LC-MS/MS method. Multiple linear mixed model analysis was performed to identify patient variables that were predictive of unbound vancomycin fractions and concentrations. The variables included in the model were patient age, ward, number of coadministered drugs with high protein binding, kidney function (estimated glomerular filtration rate [determined by Chronic Kidney Disease Epidemiology Collaboration formula]), alpha-1-acid glycoprotein, albumin, total bilirubin, IgA, IgM, urea, and total vancomycin concentrations. In the pediatric cohort, the median unbound vancomycin fraction was 81.3% (range, 61.9 to 95.9%), which was significantly higher (P < 0.01) than the unbound fraction found in the three adult patient cohorts (hematology, 60.6% [48.7 to 90.6%]; ICU, 61.7% [47.0 to 87.6%]; orthopedics, 56.4% [45.9 to 78.0%]). The strongest significant predictor of the unbound vancomycin concentration was the total drug concentration, completed by albumin in the pediatric cohort and albumin and IgA in the adult cohorts. Validation of our model was performed with data from 13 adult patients. A mean difference of 0.3 mg/liter (95% confidence interval [CI], -1.3 to 0.7 mg/liter; R(2

  4. Biogeography of Metabolically Active Microbial Populations within the Subseafloor Biosphere

    NASA Astrophysics Data System (ADS)

    Reese, B. K.; Shepard, A.; St. Peter, C.; Mills, H. J.

    2011-12-01

    Microbial life in deep marine sediments is widespread, metabolically active and diverse. Evidence of prokaryotic communities in sediments as deep as 800 m below the seafloor (mbsf) have been found. By recycling carbon and nutrients through biological and geochemical processes, the deep subsurface has the potential to remain metabolically active over geologic time scales. While a vast majority of the subsurface biosphere remains under studied, recent advances in molecular techniques and an increased focus on microbiological sampling during IODP expeditions have provided the initial steps toward better characterizations of the microbial communities. Coupling of geochemistry and RNA-based molecular analysis is essential to the description of the active microbial populations within the subsurface biosphere. Studies based on DNA may describe the taxa and metabolic pathways from the total microbial community within the sediment, whether the cells sampled were metabolically active, quiescent or dead. Due to a short lifespan within a cell, only an RNA-based analysis can be used to identify linkages between active populations and observed geochemistry. This study will coalesce and compare RNA sequence and geochemical data from Expeditions 316 (Nankai Trough), 320 (Pacific Equatorial Age Transect), 325 (Great Barrier Reef) and 329 (South Pacific Gyre) to evaluate the biogeography of microbial lineages actively altering the deep subsurface. The grouping of sediments allows for a wide range of geochemical environments to be compared, including two environments limited in organic carbon. Significant to this study is the use of similar extraction, amplification and simultaneous 454 pyrosequencing on all sediment populations allowing for robust comparisons with similar protocol strengths and biases. Initial trends support previously described reduction of diversity with increasing depth. The co-localization of active reductive and oxidative lineages suggests a potential cryptic

  5. Locations that Support Social Activity Participation of the Aging Population

    PubMed Central

    van den Berg, Pauline; Kemperman, Astrid; de Kleijn, Boy; Borgers, Aloys

    2015-01-01

    Social activities are an important aspect of health and quality of life of the aging population. They are key elements in the prevention of loneliness. In order to create living environments that stimulate older adults to engage in social activities, more insight is needed in the social activity patterns of the aging population. This study therefore analyzes the heterogeneity in older adults’ preferences for different social activity location types and the relationship between these preferences and personal and mobility characteristics. This is done using a latent class multinomial logit model based on two-day diary data collected in 2014 in Noord-Limburg in the Netherlands among 213 respondents aged 65 or over. The results show that three latent classes can be identified among the respondents who recorded social activities in the diary: a group that mainly socializes at home, a group that mainly socializes at a community center and a group that is more likely to socialize at public ‘third’ places. The respondents who did not record any interactions during the two days, are considered as a separate segment. Relationships between segment membership and personal and mobility characteristics were tested using cross-tabulations with chi-square tests and analyses of variance. The results suggest that both personal and mobility characteristics play an important role in social activity patterns of older adults. PMID:26343690

  6. Average activity of excitatory and inhibitory neural populations

    NASA Astrophysics Data System (ADS)

    Roulet, Javier; Mindlin, Gabriel B.

    2016-09-01

    We develop an extension of the Ott-Antonsen method [E. Ott and T. M. Antonsen, Chaos 18(3), 037113 (2008)] that allows obtaining the mean activity (spiking rate) of a population of excitable units. By means of the Ott-Antonsen method, equations for the dynamics of the order parameters of coupled excitatory and inhibitory populations of excitable units are obtained, and their mean activities are computed. Two different excitable systems are studied: Adler units and theta neurons. The resulting bifurcation diagrams are compared with those obtained from studying the phenomenological Wilson-Cowan model in some regions of the parameter space. Compatible behaviors, as well as higher dimensional chaotic solutions, are observed. We study numerical simulations to further validate the equations.

  7. Combining population and patient-specific characteristics for prostate segmentation on 3D CT images

    NASA Astrophysics Data System (ADS)

    Ma, Ling; Guo, Rongrong; Tian, Zhiqiang; Venkataraman, Rajesh; Sarkar, Saradwata; Liu, Xiabi; Tade, Funmilayo; Schuster, David M.; Fei, Baowei

    2016-03-01

    Prostate segmentation on CT images is a challenging task. In this paper, we explore the population and patient-specific characteristics for the segmentation of the prostate on CT images. Because population learning does not consider the inter-patient variations and because patient-specific learning may not perform well for different patients, we are combining the population and patient-specific information to improve segmentation performance. Specifically, we train a population model based on the population data and train a patient-specific model based on the manual segmentation on three slice of the new patient. We compute the similarity between the two models to explore the influence of applicable population knowledge on the specific patient. By combining the patient-specific knowledge with the influence, we can capture the population and patient-specific characteristics to calculate the probability of a pixel belonging to the prostate. Finally, we smooth the prostate surface according to the prostate-density value of the pixels in the distance transform image. We conducted the leave-one-out validation experiments on a set of CT volumes from 15 patients. Manual segmentation results from a radiologist serve as the gold standard for the evaluation. Experimental results show that our method achieved an average DSC of 85.1% as compared to the manual segmentation gold standard. This method outperformed the population learning method and the patient-specific learning approach alone. The CT segmentation method can have various applications in prostate cancer diagnosis and therapy.

  8. Combining Population and Patient-Specific Characteristics for Prostate Segmentation on 3D CT Images

    PubMed Central

    Ma, Ling; Guo, Rongrong; Tian, Zhiqiang; Venkataraman, Rajesh; Sarkar, Saradwata; Liu, Xiabi; Tade, Funmilayo; Schuster, David M.; Fei, Baowei

    2016-01-01

    Prostate segmentation on CT images is a challenging task. In this paper, we explore the population and patient-specific characteristics for the segmentation of the prostate on CT images. Because population learning does not consider the inter-patient variations and because patient-specific learning may not perform well for different patients, we are combining the population and patient-specific information to improve segmentation performance. Specifically, we train a population model based on the population data and train a patient-specific model based on the manual segmentation on three slice of the new patient. We compute the similarity between the two models to explore the influence of applicable population knowledge on the specific patient. By combining the patient-specific knowledge with the influence, we can capture the population and patient-specific characteristics to calculate the probability of a pixel belonging to the prostate. Finally, we smooth the prostate surface according to the prostate-density value of the pixels in the distance transform image. We conducted the leave-one-out validation experiments on a set of CT volumes from 15 patients. Manual segmentation results from a radiologist serve as the gold standard for the evaluation. Experimental results show that our method achieved an average DSC of 85.1% as compared to the manual segmentation gold standard. This method outperformed the population learning method and the patient-specific learning approach alone. The CT segmentation method can have various applications in prostate cancer diagnosis and therapy. PMID:27660382

  9. Internal models for interpreting neural population activity during sensorimotor control

    PubMed Central

    Golub, Matthew D; Yu, Byron M; Chase, Steven M

    2015-01-01

    To successfully guide limb movements, the brain takes in sensory information about the limb, internally tracks the state of the limb, and produces appropriate motor commands. It is widely believed that this process uses an internal model, which describes our prior beliefs about how the limb responds to motor commands. Here, we leveraged a brain-machine interface (BMI) paradigm in rhesus monkeys and novel statistical analyses of neural population activity to gain insight into moment-by-moment internal model computations. We discovered that a mismatch between subjects’ internal models and the actual BMI explains roughly 65% of movement errors, as well as long-standing deficiencies in BMI speed control. We then used the internal models to characterize how the neural population activity changes during BMI learning. More broadly, this work provides an approach for interpreting neural population activity in the context of how prior beliefs guide the transformation of sensory input to motor output. DOI: http://dx.doi.org/10.7554/eLife.10015.001 PMID:26646183

  10. Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.

    PubMed

    Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya

    2016-07-01

    Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844

  11. Population Pharmacokinetics of Pyronaridine in Pediatric Malaria Patients

    PubMed Central

    Ayyoub, Amal; Methaneethorn, Janthima; Ramharter, Michael; Djimde, Abdoulaye A.; Tekete, Mamadou; Duparc, Stephan; Borghini-Fuhrer, Isabelle; Shin, Jang-Sik

    2015-01-01

    Pyramax is a pyronaridine (PYR)-artesunate (PA) combination for the treatment of uncomplicated malaria in adult and pediatric patients. A granule formulation of this combination is being developed for treatment of uncomplicated P. falciparum and P. vivax malaria in pediatric patients. The aims of this study were to describe the pharmacokinetics of PYR using a total of 1,085 blood PYR concentrations available from 349 malaria patients younger than 16 years of age with mild to moderate uncomplicated malaria and to confirm the dosing regimen for the pediatric granule formulation. Nonlinear mixed-effects modeling using NONMEM software was used to obtain the pharmacokinetic and inter- and intraindividual variability parameter estimates. The population pharmacokinetics of PYR were described by a two-compartment model with first-order absorption and elimination. Allometric scaling was implemented to address the effect of body weight on clearance and volume parameters. The final parameter estimates of PYR apparent clearance (CL/F), central volume of distribution (V2/F), peripheral volume of distribution (V3/F), intercompartmental clearance (Q/F), and absorption rate constant (Ka) were 377 liters/day, 2,230 liters, 3,230 liters, 804 liters/day and 17.9 day−1, respectively. Covariate model building conducted using forward addition (P < 0.05) followed by backward elimination (P < 0.001) yielded two significant covariate-parameter relationships, i.e., age on V2/F and formulation on Ka. Evaluation of bootstrapping, visual predictive check, and condition number indicated that the final model displayed satisfactory robustness, predictive power, and stability. Simulations of PYR concentration-time profiles generated from the final model show similar exposures across pediatric weight ranges, supporting the proposed labeling for weight-based dosing of Pyramax granules. (These studies have been registered at ClinicalTrials.gov under registration no. NCT00331136 [phase II study] and

  12. The influence of age on the management of patients with diabetes in the Israeli population.

    PubMed

    Tirosh, Amit; Stern, Zvi; Mazar, Marianna; Calderon-Margalit, Ronit

    2013-08-01

    The authors' aim was to study the association between age and the quality of community health care of diabetes mellitus (DM). This was a cross-sectional study of patients with DM in the setting of a large health maintenance organization (HMO) in Israel. The population included DM patients aged 40-84 years who were identified at emergency rooms or through the HMO's computerized database. A set of quality care indicators were determined. Logistic regressions were used to estimate the odds ratios (OR) for diabetes care indicators, controlling for age and other potential confounders. Older patients were more likely to be in the target range of glycemic control and to be vaccinated against influenza. Patients older than age 70 years received fewer recommendations for physical activity (OR 0.41, P<0.01) and self-foot examination (OR 0.57, P=0.024). The authors found decreased performance of recommendations for physical activity and self-foot examination, and a higher performance of annual blood tests and immunizations among elderly patients with diabetes.

  13. Design for learning: deconstructing virtual patient activities.

    PubMed

    Ellaway, Rachel H; Davies, David

    2011-01-01

    Digital technologies are used in almost every aspect of contemporary health professional education (HPE) but our understanding of their true potential as instructional tools rather than administrative tools has not significantly advanced in the last decade. One notable exception to this has been the rise of the 'virtual patient' as an educational intervention in HPE. This article attempts to deconstruct the virtual patient concept by developing a model of virtual patients as artifacts with intrinsic encoded properties and emergent constructed properties that build on the core concept of 'activity'.

  14. Perioperative nurses' knowledge of indicators for pressure ulcer development in the surgical patient population.

    PubMed

    Lupear, Susan Krauser; Overstreet, Maria; Krau, Stephen D

    2015-06-01

    Despite focused attention to improve the quality and safety of patient care, and the financial impact pressure ulcers (PUs) can have on a health care provider or institution, evidence supports that PUs continue to occur in other patient populations during admission to the hospital. An example of a patient population in which evidence indicates that the development of PUs occurs, is patients who have a surgical procedure. The article discusses a project designed to identify potential knowledge deficits among perioperative nurses of indicators for PU development in the surgical patient population.

  15. Digital signaling decouples activation probability and population heterogeneity

    PubMed Central

    Kellogg, Ryan A; Tian, Chengzhe; Lipniacki, Tomasz; Quake, Stephen R; Tay, Savaş

    2015-01-01

    Digital signaling enhances robustness of cellular decisions in noisy environments, but it is unclear how digital systems transmit temporal information about a stimulus. To understand how temporal input information is encoded and decoded by the NF-κB system, we studied transcription factor dynamics and gene regulation under dose- and duration-modulated inflammatory inputs. Mathematical modeling predicted and microfluidic single-cell experiments confirmed that integral of the stimulus (or area, concentration × duration) controls the fraction of cells that activate NF-κB in the population. However, stimulus temporal profile determined NF-κB dynamics, cell-to-cell variability, and gene expression phenotype. A sustained, weak stimulation lead to heterogeneous activation and delayed timing that is transmitted to gene expression. In contrast, a transient, strong stimulus with the same area caused rapid and uniform dynamics. These results show that digital NF-κB signaling enables multidimensional control of cellular phenotype via input profile, allowing parallel and independent control of single-cell activation probability and population heterogeneity. DOI: http://dx.doi.org/10.7554/eLife.08931.001 PMID:26488364

  16. Population pharmacokinetics of perphenazine in schizophrenia patients from CATIE: impact of race and smoking.

    PubMed

    Jin, Yuyan; Pollock, Bruce G; Coley, Kim; Miller, Del; Marder, Stephen R; Florian, Jeff; Schneider, Lon; Lieberman, Jeffrey; Kirshner, Margaret; Bies, Robert R

    2010-01-01

    The goal of the study was to characterize population pharmacokinetics (PPK) for perphenazine in patients with schizophrenia from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Patients (n = 156) received 8 to 32 mg of perphenazine daily for 14 to 600 days for a total of 421 plasma concentrations measurements. Nonlinear mixed-effects modeling was used to determine PPK characteristics of perphenazine. One- and 2-compartment models with various random effect implementations and mixture distributions were evaluated. Objective function values and goodness-of-fit plots were used as model selection criteria. Age, weight, sex, race, smoking, and concomitant medications were evaluated as covariates. A 1-compartment linear model with proportional error best described the data. The population mean clearance and volume of distribution for perphenazine were 483 L/h and 18 200 L, respectively. Race and smoking status had significant impacts on perphenazine clearance estimates. In addition, the estimated population mean clearance was 48% higher in nonsmoking African Americans than in nonsmoking other races (512 L/h vs 346 L/h). Active smokers eliminated perphenazine 159 L/h faster than nonsmokers in each race. Clearances for smoking African Americans versus smokers in other races were 671 L/h versus 505 L/h, respectively.

  17. 21 CFR 312.315 - Intermediate-size patient populations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... unable to recruit patients for a clinical trial. (2) Drug being developed. The drug is being studied in a clinical trial, but patients requesting the drug for expanded access use are unable to participate in the... clinical trial of the drug in the approximate number of patients expected to receive the drug...

  18. Multi-channel fiber photometry for population neuronal activity recording.

    PubMed

    Guo, Qingchun; Zhou, Jingfeng; Feng, Qiru; Lin, Rui; Gong, Hui; Luo, Qingming; Zeng, Shaoqun; Luo, Minmin; Fu, Ling

    2015-10-01

    Fiber photometry has become increasingly popular among neuroscientists as a convenient tool for the recording of genetically defined neuronal population in behaving animals. Here, we report the development of the multi-channel fiber photometry system to simultaneously monitor neural activities in several brain areas of an animal or in different animals. In this system, a galvano-mirror modulates and cyclically couples the excitation light to individual multimode optical fiber bundles. A single photodetector collects excited light and the configuration of fiber bundle assembly and the scanner determines the total channel number. We demonstrated that the system exhibited negligible crosstalk between channels and optical signals could be sampled simultaneously with a sample rate of at least 100 Hz for each channel, which is sufficient for recording calcium signals. Using this system, we successfully recorded GCaMP6 fluorescent signals from the bilateral barrel cortices of a head-restrained mouse in a dual-channel mode, and the orbitofrontal cortices of multiple freely moving mice in a triple-channel mode. The multi-channel fiber photometry system would be a valuable tool for simultaneous recordings of population activities in different brain areas of a given animal and different interacting individuals.

  19. Perceived quality of healthcare in a multicenter, community-based population of polypathological patients.

    PubMed

    Rincón-Gómez, Manuel; Bernabeu-Wittel, Máximo; Bohórquez-Colombo, Pilar; Moreno-Gaviño, Lourdes; Cassani-Garza, Manuel; Ortiz-Camúñez, María-Ángeles; Ollero-Baturone, Manuel

    2011-01-01

    The objective was to determine perceived quality of care (PQC) in patients with multiple chronic conditions, whose care is structured in Andalusia (Spain) under polypathological patients (PP) care process, and identifying aspects for its improvement. The study was a community-based cross-sectional survey carried out in 4 primary care centers (which attended a total of 62,702 adults, of them, 662 were actively identified as PP). Finally, 461 PP and their caregivers were interviewed (69% of eligible population) including assessment of PQC following SERVQUAL model, clinical and demographical data. On a five-point Likert scale (from 1, 'much worse than expected'; to 5, 'much better'), PQC rated 3.68±0.59 (±S.D.). Independent PQC predictors were: empathy for family physician, identifying nurses, presence of peripheral artery disease or diabetes mellitus with vascular complications, and not having functional limitations. In this population-based survey, PP attended at primary care have an acceptable PQC. Measures aimed to lessening functional deterioration, supporting dependent patients, and improving relationship between PP and their healthcare professionals could increase PQC. PMID:20346523

  20. Perceived quality of healthcare in a multicenter, community-based population of polypathological patients.

    PubMed

    Rincón-Gómez, Manuel; Bernabeu-Wittel, Máximo; Bohórquez-Colombo, Pilar; Moreno-Gaviño, Lourdes; Cassani-Garza, Manuel; Ortiz-Camúñez, María-Ángeles; Ollero-Baturone, Manuel

    2011-01-01

    The objective was to determine perceived quality of care (PQC) in patients with multiple chronic conditions, whose care is structured in Andalusia (Spain) under polypathological patients (PP) care process, and identifying aspects for its improvement. The study was a community-based cross-sectional survey carried out in 4 primary care centers (which attended a total of 62,702 adults, of them, 662 were actively identified as PP). Finally, 461 PP and their caregivers were interviewed (69% of eligible population) including assessment of PQC following SERVQUAL model, clinical and demographical data. On a five-point Likert scale (from 1, 'much worse than expected'; to 5, 'much better'), PQC rated 3.68±0.59 (±S.D.). Independent PQC predictors were: empathy for family physician, identifying nurses, presence of peripheral artery disease or diabetes mellitus with vascular complications, and not having functional limitations. In this population-based survey, PP attended at primary care have an acceptable PQC. Measures aimed to lessening functional deterioration, supporting dependent patients, and improving relationship between PP and their healthcare professionals could increase PQC.

  1. Indolamine 2,3-dioxygenase expression by monocytes and dendritic cell populations in hepatitis C patients

    PubMed Central

    Schulz, S; Landi, A; Garg, R; Wilson, J A; van Drunen Littel-van den Hurk, S

    2015-01-01

    Dendritic cells (DCs) play an important role in the induction of the primary immune response to infection. DCs may express the tryptophan-catabolizing enzyme indolamine2,3-dioxygenase (IDO), which is an inducer of immune tolerance. Because there is evidence that chronic hepatitis C virus (HCV) infection leads to functional impairment of certain DC populations, we analysed IDO expression in DCs and monocytes from chronically infected and recovered HCV patients. The IDO1 and -2 expression was increased significantly in the monocytes of chronic HCV patients but, interestingly, not in those from recovered patients. The myeloid DCs from chronically infected HCV patients also showed enhanced IDO1 expression, while no change in either IDO1 or -2 was found for plasmacytoid DCs. Up-regulation of IDO1 gene expression was confirmed by the presence of enhanced kynurenine/tryptophan ratios in the plasma from chronic HCV patients. Increased IDO1 and -2 expression was also observed in monocytes from healthy donors infected with an adapted mutant of the HCV JFH-1 strain ex vivo, confirming a direct effect of HCV infection. These changes in IDO expression could be prevented by treatment with the IDO inhibitor 1-methyl tryptophan (1-mT). Furthermore, maturation of monocyte-derived DCs from chronically infected HCV patients, as well as well as monocyte-derived DCs infected ex vivo with HCV, was impaired, but this was reversed by 1-mT treatment. This suggests that IDO inhibitors may be used to treat chronic HCV patients in vivo, in conjunction with current therapies, or to activate DCs from patients ex vivo, such that they can be administered back as a DC-based therapeutic vaccine. PMID:25605587

  2. Gamma-N activation of cancer patients

    SciTech Connect

    Wielopolski, L.; Meek, A.G.; Moskowitz, M.; Cohn, S.H.

    1986-01-01

    High energy gamma radiation (8 to 30 MeV) is gaining acceptance for radiation therapy of patients with deep cancers. This radiation is of sufficient energy to induce photonuclear activation of the elements in the human body. Our results of measurements of nitrogen and phosphorus in an anthropomorphic phantom, a cadaver, and a cancer patient with bremsstrahlung radiation from 15 MeV electrons demonstrate the feasibility of a method to monitor these two elements in the human body in vivo by measuring the radioactivity induced in these targets by photonuclear reactions. 14 refs., 3 figs., 2 tabs.

  3. Reduced killer cell activity of lymphocytes from patients with asbestosis.

    PubMed Central

    Kubota, M; Kagamimori, S; Yokoyama, K; Okada, A

    1985-01-01

    Immunological abnormalities in 30 patients with asbestosis were investigated by examining the cytoxicity of natural killer (NK) cells and antibody dependent cellular cytotoxicity by killer (K) cells from peripheral blood lymphocytes; the effects of interferon on NK activity was also examined. Fifteen men and 15 women (mean age 58; range 40-72) with asbestosis but who were free of complications such as tuberculosis, carcinoma, or steroid treatment were the subjects for study. There were nine cases of type 1, 19 cases of type 2, and two cases of type 3 disease as described in the ILO classification of pneumoconiosis. They were all textile workers with a mean duration of 18 years (3-40 years) since first exposure to chrysotile. Controls matched for age and sex were selected from a population without occupational exposure to asbestos. The activity of the NK and K cells in patients with asbestosis was significantly lower than in the control group, but the populations of NK and K cells in the peripheral blood lymphocytes were not significantly different in the two groups. An in vitro experiment showed that the increase in the cytotoxicity of the NK cell after treatment with interferon-alpha was significantly lower in the subjects than in the controls. These results indicate that one of the defence mechanisms in relation to cancer is deficient in patients with asbestosis. PMID:3978049

  4. Thromboembolic complications in Fontan patients: population-based prevalence and exploration of the etiology.

    PubMed

    Idorn, L; Jensen, A S; Juul, K; Reimers, J I; Johansson, P I; Sørensen, K E; Ostrowski, S R; Søndergaard, L

    2013-02-01

    After the Fontan procedure, patients face an increased risk for thromboembolic events (TE). The etiology for this increased thrombogenecity is incompletely understood. This study aimed to determine the prevalence of TE in Danish Fontan patients and to bring new insights into the etiology of TE. Using a population-based design, we retrospectively identified all TEs in 210 Fontan patients. Whole blood assays (thromboelastography, thromboelastography functional fibrinogen and Multiplate) reflecting global hemostasis, clot strength and platelet aggregation were analyzed prospectively in 112 patients and plasma was analyzed in 76 patients for biomarkers reflecting endothelial-, glycocalyx-, platelet-, and fibrinolysis function (histone-complexed DNA fragments, Protein C, soluble CD40 ligand, soluble thrombomodulin, syndecan-1, tissue-type plasminogen activator). The results were compared in groups stratified according to age, antithrombotic therapy, TE, and glycocalyx degradation (syndecan-1 < or ≥ median). Correlation between biomarkers and demographic-, anatomical-, clinical- and biochemical parameters was investigated. The prevalence of TE was 8.1 % after a mean follow-up of 8.4 years. None of the stratified groups demonstrated evidence of hypercoagulability in the whole blood assays and no unexpected significant differences were found between the groups. All biomarkers, except protein C, correlated with one another and after stratification of glycocalyx degradation only syndecan-1 levels ≥ median correlated with other biomarkers. The prevalence of TEs was 8.1 % after mean follow-up of 8.4 years. Overall, the hemostatic profile appeared normal, however, in a subset of patients, evidence of some endothelial activation/damage including glycocalyx degradation and fibrinolysis was found, identifying a potentially more thrombogenic group.

  5. Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study

    PubMed Central

    Chang, Chia-Hsui; Huang, Hui-Yu; Huang, Tao-Min; Lai, Chun-Fu; Lin, Meng-Chun; Ko, Wen-Je; Wu, Kwan-Dun; Yu, Chong-Jen; Shu, Chin-Chung; Lee, Chih-Hsin; Wang, Jann-Yuan

    2013-01-01

    Background Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited. Methods This population-based-cohort study used claim records retrieved from the Taiwan National Health Insurance database. We retrieved records of all hospitalized patients, more than 18 years, who underwent dialysis for acute kidney injury (AKI) during 1999–2008 and validated using the NSARF data. Time-dependent Cox proportional hazards model to adjust for the ongoing effect of end-stage renal disease (ESRD) was conducted to predict long-term de novo active TB after discharge from index hospitalization. Results Out of 2,909 AKI dialysis patients surviving 90 days after index discharge, 686 did not require dialysis after hospital discharge. The control group included 11,636 hospital patients without AKI, dialysis, or history of TB. The relative risk of active TB in AKI dialysis patients, relative to the general population, after a mean follow-up period of 3.6 years was 7.71. Patients who did (hazard ratio [HR], 3.84; p<0.001) and did not (HR, 6.39; p<0.001) recover from AKI requiring dialysis had significantly higher incidence of TB than patients without AKI. The external validated data also showed nonrecovery subgroup (HR = 4.37; p = 0.049) had high risk of developing active TB compared with non-AKI. Additionally, active TB was associated with long-term all-cause mortality after AKI requiring dialysis (HR, 1.34; p = 0.032). Conclusions AKI requiring dialysis seems to independently increase the long-term risk of active TB, even among those who weaned from dialysis at discharge. These results raise concerns that the increasing global burden of AKI will in turn increase the incidence of active TB. PMID:23936044

  6. Clinical Outcomes of Anatomical Total Shoulder Arthroplasty in a Young, Active Population.

    PubMed

    Kusnezov, Nicholas; Dunn, John C; Parada, Stephen A; Kilcoyne, Kelly; Waterman, Brian R

    2016-01-01

    Glenohumeral arthritis in young, active patients poses many treatment challenges, and significant concerns about component loosening and failure limit the available surgical options. We conducted a study of the clinical outcomes of total shoulder arthroplasty (TSA) for glenohumeral arthritis in a young, high-demand population. We searched the Military Health System Management Analysis and Reporting Tool database to retrospectively review the cases of all US military service members who had undergone anatomical TSA (Current Procedural Terminology code 23472) between 2007 and 2014. Demographic information, occupational parameters, and clinical outcomes were extracted from electronic medical records. Twenty-four service members (26 shoulders) met the inclusion criteria. The cohort was predominantly male (n = 25). Mean age was 45.8 years (range, 35-54 years). The most common etiology of glenohumeral arthritis was post-instability arthropathy (50.0%). At mean follow-up of 41 months, 9 patients had a total of 12 complications (46.2%), including 6 component failures caused by neurologic injury (2 cases), adhesive capsulitis (2), and venous thrombosis (2). The reoperation rate for all component failures was 23.1% (6 cases, 5 patients). Ten patients (41.7%) remained on active duty at 2 years, and 5 (20.8%) were subsequently deployed. Ultimately, 9 patients (37.5%) underwent medical discharge for persistent shoulder disability. TSA in young, active patients provides reliable improvements in range of motion and pain. However, roughly one-third of patients in this study were unable to continue high-demand activities by 2 years after surgery. The short-term complication profile (46.2%) and reoperation rate for component failure (23.1%) should be emphasized during preoperative counseling. PMID:27552465

  7. Population pharmacokinetic model of canrenone after intravenous administration of potassium canrenoate to paediatric patients

    PubMed Central

    Suyagh, Maysa; Hawwa, Ahmed F; Collier, Paul S; Millership, Jeffrey S; Kole, Prashant; Millar, Muriel; Shields, Mike D; Halliday, Henry L; McElnay, James C

    2012-01-01

    AIMS To characterize the population pharmacokinetics of canrenone following administration of potassium canrenoate to paediatric patients. METHODS Data were collected prospectively from 23 paediatric patients (2 days to 10 years of age; median weight 4 kg, range 2.16–28.0 kg) who received intravenous potassium canrenoate (K-canrenoate) as part of their intensive care therapy for removal of retained fluids, e.g. in pulmonary oedema due to chronic lung disease and for the management of congestive heart failure. Plasma samples were analyzed by HPLC for determination of canrenone (the major metabolite and pharmacologically active moiety) and the data subjected to pharmacokinetic analysis using NONMEM. RESULTS A one compartment model best described the data. The only significant covariate was weight (WT). The final population models for canrenone clearance (CL/F) and volume of distribution (V/F) were CL/F (l h−1) = 11.4 × (WT/70.0)0.75 and V/F (l) = 374.2 × (WT/70) where WT is in kg. The values of CL/F and V/F in a 4 kg child would be 1.33 l h−1 and 21.4 l, respectively, resulting in an elimination half-life of 11.2 h. CONCLUSIONS The range of estimated CL/F in the study population was 0.67–7.38 l h−1. The data suggest that adjustment of K-canrenoate dosage according to body weight is appropriate in paediatric patients. PMID:22376078

  8. Intracranial haemorrhage among a population of haemophilic patients in Brazil.

    PubMed

    Antunes, S V; Vicari, P; Cavalheiro, S; Bordin, J O

    2003-09-01

    Intracranial haemorrhage (ICH) is a common cause of morbidity and mortality in haemophilic patients. The overall incidence of ICH has been reported to range from 2.2% to 7.5% in patients with haemophilia. From 1987 to 2001, 401 haemophilic patients from the Serviço de Hemofilia, Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo were evaluated. The episodes of ICH were documented by CT scan and the anatomic location, clinical presentation, relationship to trauma and clinical factors, including the presence of HIV infection and the presence of inhibitor, were reviewed. Among 401 haemophilic patients, 45 ICH episodes in 35 (8.7%) patients with age ranging from 4 days to 49 years (mean 10.6 years) were observed. A history of recent trauma was documented in 24 (53.3%) cases. Seventeen (37.8%) episodes occurred in more than one site of bleeding, 12 (26.7%) were subdural, seven (15.5%) subarachnoid, four (8.9%) epidural, two (4.4%) intracerebral and one (2.2%) intraventricular. The most frequent symptoms were headache and drowsiness. All patients were submitted to replacement therapy and neurosurgical intervention was performed in eight (17.8%) patients. Despite the treatment, three (8.6%) haemophilia A patients died due to the ICH event and three presented late sequelae. The most important aspect of ICH management is the early replacement therapy in haemophilic patients. This prompt treatment will increase the chances of a better prognosis. Another impact measure consists in the administration of the deficient coagulation factor after every head trauma, even when considered minor.

  9. Physical activity and subarachnoid haemorrhage: a population based case-control study

    PubMed Central

    Fann, J; Kukull, W; Katon, W; Longstreth, W

    2000-01-01

    OBJECTIVE—To evaluate physical activity as a risk factor for subarachnoid haemorrhage.
METHODS—A population based case-control study in King County, Washington. A standardised, personal interview was used to determine physical activity during the past year and at the onset of the bleed for case patients and a similar reference time for control subjects. Conditional logistic regression and a case cross over analysis were performed in which each case patient served as his or her own control. Subjects were 149 men and women with incident, spontaneous subarachnoid haemorrhage and two control subjects per case patient. Control subjects were identified through random digit dialing and matched on age, sex, and respondent type.
RESULTS—Four of the 149 (2.7%) case patients were engaged in vigorous physical activity at the time of their subarachnoid haemorrhage. With those who were engaged in non-vigorous or no physical activity serving as the reference group, the relative risk of sustaining a subarachnoid haemorrhage for those engaged in vigorous physical activity was 11.6 (95% confidence interval (95% CI) 1.2-113.2). In the case cross over analysis, the relative risk was 15.0 (95% CI 4.3-52.2). Higher levels of long term regular physical activity over the past year were associated with a lower, but not statistically significant, risk of subarachnoid haemorrhage (test for trend, p=0.3).
CONCLUSION—The risk of subarachnoid haemorrhage is increased during vigorous physical activity, although only a few result from this mechanism.

 PMID:11080229

  10. Teaching Astronomy with an Inquiry Activity on Stellar Populations

    NASA Astrophysics Data System (ADS)

    Rafelski, M.; Foley, M.; Graves, G. J.; Kretke, K. A.; Mills, E.; Nassir, M.; Patel, S.

    2010-12-01

    We describe a new inquiry design aimed at teaching advanced high-school to senior college students the basics of stellar populations. The inquiry is designed to have students come up with their own version of the Hertzsprung-Russell diagram as a tool to understand how stars evolve based on their color, mass, and luminosity. The inquiry makes use of pictures and spectra of stars, which the students analyze and interpret to answer the questions they come up with at the beginning. The students undergo a similar experience to real astronomers, using the same tools and methods to figure out the phenomena they are trying to understand. Specifically, they use images and spectra of stars, and organize the data via tables and plots to find trends that will then enable them to answer their questions. The inquiry also includes a "thinking tool" to help connect the trends students observe to the larger picture of stellar evolution. We include a description of the goals of the inquiry, the activity description, the motivations and thoughts that went into the design of the inquiry, and reflections on how the inquiry activity worked in practice.

  11. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  12. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  13. Metatranscriptomic Analysis of Groundwater Reveals an Active Anammox Bacterial Population

    NASA Astrophysics Data System (ADS)

    Jewell, T. N. M.; Karaoz, U.; Thomas, B. C.; Banfield, J. F.; Brodie, E.; Williams, K. H.; Beller, H. R.

    2014-12-01

    Groundwater is a major natural resource, yet little is known about the contribution of microbial anaerobic ammonium oxidation (anammox) activity to subsurface nitrogen cycling. During anammox, energy is generated as ammonium is oxidized under anaerobic conditions to dinitrogen gas, using nitrite as the final electron acceptor. This process is a global sink for fixed nitrogen. Only a narrow range of monophyletic bacteria within the Planctomycetes carries out anammox, and the full extent of their metabolism, and subsequent impact on nitrogen cycling and microbial community structure, is still unknown. Here, we employ a metatranscriptomic analysis on enriched mRNA to identify the abundance and activity of a population of anammox bacteria within an aquifer at Rifle, CO. Planktonic biomass was collected over a two-month period after injection of up to 1.5 mM nitrate. Illumina-generated sequences were mapped to a phylogenetically binned Rifle metagenome database. We identified transcripts for genes with high protein sequence identities (81-98%) to those of anammox strain KSU-1 and to two of the five anammox bacteria genera, Brocadia and Kuenenia, suggesting an active, if not diverse, anammox population. Many of the most abundant anammox transcripts mapped to a single scaffold, indicative of a single dominant anammox species. Transcripts of the genes necessary for the anammox pathway were present, including an ammonium transporter (amtB), nitrite/formate transporter, nitrite reductase (nirK), and hydrazine oxidoreductase (hzoB). The form of nitrite reductase encoded by anammox is species-dependent, and we only identified nirK, with no evidence of anammox nirS. In addition to the anammox pathway we saw evidence of the anammox bacterial dissimilatory nitrate reduction to ammonium pathway (narH, putative nrfA, and nrfB), which provides an alternate means of generating substrates for anammox from nitrate, rather than relying on an external pool. Transcripts for hydroxylamine

  14. Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control

    NASA Astrophysics Data System (ADS)

    Ebert, M. A.; Li, W.; Jennings, L.; Kearvell, R.; Bydder, S.

    2013-06-01

    An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group.

  15. Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control.

    PubMed

    Ebert, M A; Li, W; Jennings, L; Kearvell, R; Bydder, S

    2013-06-21

    An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group.

  16. Theoretical foundation of patient v. population preferences in calculating QALYs.

    PubMed

    Gandjour, Afschin

    2010-01-01

    The cost-effectiveness of health care interventions is often evaluated using quality-adjusted life years (QALYs) as a measure of outcome. There is a debate on whether QALYs should use patient preferences as opposed to community preferences. This article shows that patient preferences have a theoretical foundation in preference-utilitarian theory and welfare economics. In contrast, this study found no compelling theoretical basis for community preferences. There is a need for further development of a normative framework to inform the choice of preference source. PMID:20511562

  17. Minocycline-Induced Cutaneous Hyperpigmentation in an Orthopedic Patient Population

    PubMed Central

    Hanada, Yuri; Berbari, Elie F.; Steckelberg, James M.

    2016-01-01

    Background. The objectives of this study were to estimate the incidence and evaluate risk factors for development of minocycline-induced cutaneous hyperpigmentation in patients with orthopedic infections. Methods. Patients with orthopedic infections evaluated at Mayo Clinic (Rochester, MN) and treated with minocycline from 1 January 2002 to 31 December 2011 were retrospectively identified. Long-term minocycline suppression was defined as daily minocycline use for at least 3 months. A proportional hazards model was used to evaluate potential risk factors. Results. Of 291 patients receiving long-term minocycline suppression, 54% (156 of 291) developed hyperpigmentation after a mean follow-up of 4.8 years (range, 0.3–13.2 years); 88% involved blue-gray pigmentation of normal skin that appeared most commonly in the lower (75%) and upper extremities (44%). The mean duration of minocycline therapy before hyperpigmentation was 1.5 years (range, 0.1–9 years) with a mean cumulative dosage of 107.3 g (range, 8.6–657 g). Notable risk factors include a history of vitamin D deficiency (relative risk [RR], 6.29; 95% confidence interval [CI], 1.91–15.27; P = .0052), presence of a shoulder prosthesis (RR, 3.2; 95% CI, 1.23–6.56; P = .0062), noncirrhotic liver pathology (RR, 3.63; 95% CI, 1.11–8.75; P = .0359), and use of a concurrent medication also known to cause hyperpigmentation (RR, 4.75; 95% CI, 1.83–10.1; P = .0029). Conclusions. Hyperpigmentation associated with the use of long-term minocycline suppression in patients with orthopedic infections is common. PMID:26835479

  18. Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses

    EPA Science Inventory

    Abstract: Objectives/Hypothesis: To measure the populations of 36 fungi in the homes and sinuses of chronic rhinosinusitis (CRS) and non-CRS patients. Study Design: Single-blind cross-sectional study. Methods: Populations of 36 fungi were measured in sinus samples and in the home...

  19. Sports activity following total knee arthroplasty in patients older than 60 years.

    PubMed

    Mayr, Hermann O; Reinhold, Maik; Bernstein, Anke; Suedkamp, Norbert P; Stoehr, Amelie

    2015-01-01

    In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports.

  20. Effects of Active galactic nuclei feedback in galaxy population

    NASA Astrophysics Data System (ADS)

    Lagos, C.; Cora, S.; Padilla, N.

    We analyze the effects of feedback from Active Galactic Nuclei (AGN) on the formation and evolution of galaxies, which is assumed to quench cooling flows in massive halos. With this aim we use an hybrid model that combines a cosmological Lambda CDM simulation with a semi-analytic model of galaxy formation. We consider the semi-analytic model described by Cora (2006) (SAMC06) which has been improved by including AGNs, which are associated with the presence of supermassive black holes (BHs). Modellization of BH includes gas accretion during merger-driven starbursts and black hole mergers (Malbon et al., 2006), accretion during starbursts triggered by disk instabilities (Bower et al. 2006), and accretion of cooling gas from quasi-hydrostatically cooling haloes (Croton et al. 2006); Eddington limit is applied in all accretion processes. It is assumed that feedback from AGNs operates in the later case. We show that this new model can simultaneously explain: (i) the bright-end of the galaxy luminosity function (LF); (ii) the observed older population of stars in massive galaxies, thus reproducing the stellar mass function (SMF); (iii) a star formation rate (SFR) seemingly showing an anti-hierarchical galaxy growth. The success of our model is mainly due to the ability of AGN feedback to suppress further cooling and SF in the most massive structures.

  1. Belimumab Reduces Autoantibodies, Normalizes Low Complement, and Reduces Select B-Cell Populations in Patients With Systemic Lupus Erythematosus

    PubMed Central

    STOHL, WILLIAM; HIEPE, FALK; LATINIS, KEVIN M.; THOMAS, MATHEW; SCHEINBERG, MORTON A.; CLARKE, ANN; ARANOW, CYNTHIA; WELLBORNE, FRANK R.; ABUD-MENDOZA, CARLOS; HOUGH, DOUGLAS R.; PINEDA, LILIA; MIGONE, THI-SAU; ZHONG, Z. JOHN; FREIMUTH, WILLIAM W.; CHATHAM, W. WINN

    2012-01-01

    Objective To assess the effects of the B-lymphocyte stimulator (BLyS)-specific inhibitor belimumab on immunologic biomarkers, including B- and T-cell populations, and maintenance of antibody titers to prior vaccines in autoantibody-positive systemic lupus erythematosus (SLE) patients. Methods Pooled data from two phase 3 trials—BLISS-52 and -76—comparing belimumab 1 or 10 mg/kg vs placebo (each plus standard SLE therapy) were analyzed for changes in autoantibodies, immunoglobulin (Ig), and complement (C); BLISS-76 patients were analyzed for changes in B- and T-cell populations, and effects on prior vaccine-induced antibody levels. Results Belimumab-treated patients experienced significant sustained reductions in IgG and autoantibodies, and improvement in C3/C4, resulting in greater positive-to-negative conversion rates for IgG anti–double-stranded DNA (anti-dsDNA), anti-Smith, anticardiolipin, and antiribosomal P autoantibodies, and normalization of hypergammaglobulinemia and low C3/C4. Belimumab-treated patients experienced significant decreases in naïve and activated B cells, as well as plasma cells, whereas memory B cells and T-cell populations did not decrease. Belimumab did not substantially affect pre-existing antipneumococcal or antitetanus antibody levels. Post-hoc analysis showed greater reductions in SLE disease activity and the risk of severe flares in patients treated with belimumab 10 mg/kg (P ≤ 0.01) who were anti-dsDNA positive with low C3/C4 at baseline. Normalization of C3 or anti-dsDNA by 8 weeks, irrespective of therapy, was predictive of a reduced risk of severe flare over 52 weeks. Conclusion Belimumab appears to promote normalization of serologic activity and reduce BLyS-dependent B-cell subsets in serologically and clinically active SLE. Greater serologic activity may predict a better treatment response to belimumab. PMID:22275291

  2. Comparison of stage at diagnosis of cancer in patients on dialysis versus the general population

    PubMed Central

    Taneja, Shilpa; Mandayam, Sreedhar; Kayani, Zainab Z.; Kuo, Yong-Fang; Shahinian, Vahakn B.

    2008-01-01

    Background The frequent medical encounters in end-stage renal disease (ESRD) patients on dialysis may allow early detection of malignancies despite generally low rates of cancer screening in this population. It is therefore unclear whether dialysis patients are disadvantaged in terms of cancer diagnosis. To address this issue, we compared stage at diagnosis of cancer in a population-based sample of ESRD patients versus the general population. Methods The Surveillance, Epidemiology and End-Results (SEER)-Medicare database was used to identify ESRD patients with incident cancers from 1992 through 1999. Modified Poisson regression models were used to predict non-localized stage of cancer at diagnosis in ESRD patients versus the general population adjusting for demographics, cancer site, region, year of diagnosis and comorbidity. Two general population comparisons were used: standardized SEER public use data and Medicare non-ESRD controls matched 3:1 to ESRD patients. Results A total of 1629 ESRD patients with incident cancer were identified. Overall, the likelihood of non-localized stage at diagnosis was not significantly different for ESRD patients versus the standardized SEER general population (RR 0.90; 95%CI: 0.81-1.01) or matched Medicare controls (RR 0.97; 95%CI: 0.89-1.07). When analyzed by cancer site, colorectal cancers were significantly more likely to be diagnosed earlier in the ESRD group, whereas prostate cancers were significantly more likely to be diagnosed at a later stage. Conclusion In conclusion, this study demonstrates that, with the notable exception of prostate cancer, ESRD patients are not more likely to present with later stage malignancies compared to the general population. PMID:17702737

  3. Patient-Centered Care and Population Health: Establishing Their Role in the Orthopaedic Practice.

    PubMed

    Harwood, Jared L; Butler, Craig A; Page, Alexandra E

    2016-05-18

    As health care increasingly emphasizes high value, the terms "population health" and "patient-centered care" have become common, but their application is less clear. Patient-centered care encourages using data to optimize care for an individual. Population health offers a framework to consider how to efficiently and effectively manage a condition for a population, how prevention affects large groups, and the specific distribution of a given disorder. Integrating both concepts into practice can facilitate required outcome-measure reporting and potentially improve patient outcomes. Clinical practice guidelines and appropriate use criteria are examples of reconciliation of these topics. By embracing attempts to decrease variation in treating musculoskeletal disorders while personalizing delivery to individual patients, surgeons may benefit from the improvement of both efficiency and patient experience. PMID:27194502

  4. Housestaff activism: the emergence of patient-care demands.

    PubMed

    Hoffman, L M

    1982-01-01

    There have been two trends within the physician housestaff movement: increased acceptance of collective bargaining and unions, and a shift from narrower economic to broader political demands, including some involving patient care. Case studies of politically active housestaff associations in New York, Chicago, and Los Angeles are used to examine the emergence of "patient-care" demands and their compatibility with collective bargaining frameworks. As house-staff have become principal providers of care to indigent populations in public hospitals, and economic cutbacks have endangered service as well as the positions of physicians, patient-care demands arise and become infused with demands for participation and control in decision-making. Common factors in the politicization of housestaff have been the contribution of activists of the sixties as leaders, and the impact of fiscal crisis and economic retrenchment in the seventies. However, the emergence and resolution of these issues has differed depending upon legal, political, historical, and organizational variations. In general, patient-care issues are supported by housestaff when they dovetail with housestaff interests. However, physician interests can diverge from those of patients, as in the case of manpower redistribution. On the whole, wages and benefits have done better than educational or patient-care demands. Educational demands have met with counterattack, and patient care, limited by the traditional scope of collective bargaining, has had to evolve indirectly, and has been hurt by long-term economic trends. Finally, national housestaff organization is limited by the wide-ranging politics and ideas of diverse regional organizations which represent different types of training institutions and career orientations.

  5. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.

    PubMed

    Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B

    2016-02-01

    Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.

  6. Characterization of the Patient Population in a Sports Medicine Facility.

    PubMed

    Garrick, J G

    1985-10-01

    In brief: This article presents a statistical portrait of the injuries seen over a five-year period at a large sports medicine facility that serves primarily recreational athletes. About half of the 10,271 injuries treated were caused by overuse. Overuse problems exceeded acute injuries in running, tennis, figure skating, and aerobic dance, while acute injuries were more common in skiing, basketball, football, and soccer. The knee was the anatomic area most often injured in all of the major sports. The prevalence of overuse injuries indicates the importance of instructing patients in prevention methods.

  7. Understanding the Population Structure of North American Patients with Cystic Fibrosis

    PubMed Central

    Li, Weili; Sun, Lei; Corey, Mary; Zou, Fei; Lee, Seunggeun; Cojocaru, Andreea L; Taylor, Chelsea; Blackman, Scott M; Stephenson, Anne; Sandford, Andrew J; Dorfman, Ruslan; Drumm, Mitchell L; Cutting, Garry R; Knowles, Michael R; Durie, Peter; Wright, Fred A; Strug, Lisa J

    2010-01-01

    Rationale It is generally presumed that the Cystic Fibrosis (CF) population is relatively homogeneous, and predominantly of European origin. The complex ethnic make-up observed in the CF patients collected by the North American CF Modifier Gene Consortium has brought this assumption into question, and suggested the potential for population substructure in the three CF study samples collected from North America. It is well appreciated that population substructure can result in spurious genetic associations. Objectives To understand the ethnic composition of the North American CF population, and to assess the need for population structure adjustment in genetic association studies with North American CF patients. Methods Genome-wide single-nucleotide polymorphisms on 3076 unrelated North American CF patients were used to perform population structure analyses. We compared self-reported ethnicity to genotype-inferred ancestry, and also examined whether geographic distribution and CFTR mutation type could explain the structure observed. Main Results Although largely Caucasian, our analyses identified a considerable number of CF patients with admixed African-Caucasian, Mexican-Caucasian and Indian-Caucasian ancestries. Population substructure was present and comparable across the three studies of the consortium. Neither geographic distribution nor mutation type explained the population structure. Conclusion Given the ethnic diversity of the North American CF population, it is essential to carefully detect, estimate and adjust for population substructure to guard against potential spurious findings in CF genetic association studies. Other Mendelian diseases that are presumed to predominantly affect single ethnic groups may also benefit from careful analysis of population structure. PMID:20681990

  8. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations.

    PubMed

    Gupta, A K; Daigle, D; Foley, K A

    2015-06-01

    Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.

  9. Reference Values for the Marx Activity Rating Scale in a Young Athletic Population

    PubMed Central

    Cameron, Kenneth L.; Peck, Karen Y.; Thompson, Brandon S.; Svoboda, Steven J.; Owens, Brett D.; Marshall, Stephen W.

    2015-01-01

    Background: Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. Objective: To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. Results: The median MARS score was significantly higher for men when compared with women (χ2 = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ2 = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ2 = 9.06, df = 1, P = 0.003). Conclusion: Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex

  10. CD26 Expression on T Helper Populations and sCD26 Serum Levels in Patients with Rheumatoid Arthritis

    PubMed Central

    Cordero, Oscar J.; Varela-Calviño, Rubén; López-González, Tania; Calviño-Sampedro, Cristina; Viñuela, Juan E.; Mouriño, Coral; Hernández-Rodríguez, Íñigo; Rodríguez-López, Marina; Aspe de la Iglesia, Bruno; Pego, José María

    2015-01-01

    We studied dipeptidyl peptidase IV (DPP-IV, CD26) expression in different T helper cells and serum soluble DPP-IV/sCD26 levels in rheumatoid arthritis (RA) patients, correlated these with disease activity score (DAS), and examined how they were affected by different therapies, conventional or biological (anti-TNF, anti-CD20 and anti-IL6R or Ig-CTLA4). The percentage of CD4+CD45R0+CD26- cells was greatly reduced in patients (up to 50%) when compared with healthy subjects. Three other subsets of CD4 cells, including a CD26high Th1-associated population, changed variably with therapies. Data from these subsets (frequency and staining density) significantly correlated with DAS28 or DAS28 components but different in each group of patients undergoing the different therapies. Th17 and Th22 subsets were implicated in RA as independent CCR4+ and CCR4- populations each, with distinct CD26 expression, and were targeted with varying efficiency by each therapy. Serum DPP-IV activity rather than sCD26 levels was lower in RA patients compared to healthy donors. DPP-IV and sCD26 serum levels were found related to specific T cell subsets but not to disease activity. We conclude that, according to their CD26 expression, different cell subsets could serve to monitor RA course, and an uncharacterized T helper CD26- subset, not targeted by therapies, should be monitored for early diagnosis. PMID:26177310

  11. Population Pharmacokinetics and Therapeutic Efficacy of Febuxostat in Patients with Severe Renal Impairment.

    PubMed

    Hira, Daiki; Chisaki, Yugo; Noda, Satoshi; Araki, Hisazumi; Uzu, Takashi; Maegawa, Hiroshi; Yano, Yoshitaka; Morita, Shin-Ya; Terada, Tomohiro

    2015-01-01

    The aim of the present study was to determine the influence of severe renal dysfunction (estimated glomerular filtration rate <30 ml/min/1.73 m(2), including hemodialysis) on the pharmacokinetics and therapeutic effects of febuxostat using a population pharmacokinetic analysis. This study recruited patients with hyperuricemia who were initially treated with allopurinol, but were switched to febuxostat, and it consists of 2 sub-studies: a pharmacokinetic study (26 patients) and retrospective efficacy evaluation study (51 patients). The demographic and clinical data of patients were collected from electronic medical records. Plasma febuxostat concentrations were obtained at each hospital visit. Population pharmacokinetic modeling was performed with NONMEM version 7.2. A total of 128 plasma febuxostat concentrations from 26 patients were used in the population pharmacokinetic analysis. The data were best described by a 1-compartment model with first order absorption. Covariate analysis revealed that renal function did not influence the pharmacokinetics of febuxostat, whereas actual body weight significantly influenced apparent clearance and apparent volume of distribution. The retrospective efficacy analysis showed the favorable therapeutic response of febuxostat switched from allopurinol in patients with moderate to severe renal impairment. No serious adverse event associated with febuxostat was observed irrespective of renal function. The population pharmacokinetic analysis and therapeutic analysis of febuxostat revealed that severe renal dysfunction had no influence on the pharmacokinetic parameters of febuxostat. These results suggest that febuxostat is tolerated well by patients with severe renal impairment.

  12. Population.

    ERIC Educational Resources Information Center

    International Planned Parenthood Federation, London (England).

    In an effort to help meet the growing interest and concern about the problems created by the rapid growth of population, The International Planned Parenthood Federation has prepared this booklet with the aim of assisting the study of the history and future trends of population growth and its impact on individual and family welfare, national,…

  13. Population Pharmacokinetics and Pharmacodynamics of Garenoxacin in Patients with Community-Acquired Respiratory Tract Infections

    PubMed Central

    Van Wart, Scott; Phillips, Luann; Ludwig, Elizabeth A.; Russo, Rene; Gajjar, Diptee A.; Bello, Akintunde; Ambrose, Paul G.; Costanzo, Christopher; Grasela, Thaddeus H.; Echols, Roger; Grasela, Dennis M.

    2004-01-01

    Garenoxacin (T-3811ME, BMS-284756) is a novel, broad-spectrum des-F(6) quinolone currently under study for the treatment of community-acquired respiratory tract infections. This analysis assessed garenoxacin population pharmacokinetics and exposure-response relationships for safety (adverse effects [AE]) and antimicrobial activity (clinical cure and bacteriologic eradication of Streptococcus pneumoniae and the grouping of Haemophilus influenzae, Haemophilus parainfluenzae, and Moraxella catarrhalis). Data were obtained from three phase II clinical trials of garenoxacin administered orally as 400 mg once daily for 5 to 10 days for the treatment of community-acquired pneumonia, acute exacerbation of chronic bronchitis, and sinusitis. Samples were taken from each patient before drug administration, 2 h following administration of the first dose, and on the day 3 to 5 visit. Individual Bayesian estimates of the fu (fraction unbound), the Cmax, and the fu for the area under the concentration-time curve from 0 to 24 h (fu AUC0-24) were calculated as measurements of drug exposure by using an ex vivo assessment of average protein binding. Regression analysis was performed to examine the following relationships: treatment-emergent AE incidence and AUC0-24, Cmax, or patient factors; clinical response or bacterial eradication and drug exposure (fu Cmax/MIC, fu AUC0-24/MIC, and other exposure covariates); or disease and patient factors. Garenoxacin pharmacokinetics were described by a one-compartment model with first-order absorption and elimination. Clearance was dependent on creatinine clearance, ideal body weight, age, obesity, and concomitant use of pseudoephedrine. The volume of distribution was dependent on weight and gender. Patients with mild or moderate renal dysfunction had, on average, approximately a 16 or 26% decrease in clearance, respectively, compared to patients of the same gender and obesity classification with normal renal function. AE occurrence was not

  14. [Nurses' and patients' experience of combined health service delivery to all population groups in a hospital].

    PubMed

    Poggenpoel, M; Uys, H; Botes, A; Dörfling, C; Greeff, M; Gross, E; Müller, M; Nolte, A

    1996-06-01

    In a community hospital in Gauteng, the hospital management had, on short notice, to provide combined health services to all population groups. In the past different health services were delivered to each population group. The integration of health service delivery was a sudden change. Based on this, research questions arose, namely: how do nurses and patients experience this change, and how could they be assisted to adjust to the change. The research objectives were twofold, namely: to explore and describe nurses and patients' experience of combined health delivery to all population groups and based on the results to make recommendations to assist them with adjustment to a combined health delivery system. An exploratory, descriptive and contextual research design was followed. Trustworthiness was ensured by applying Guba's approach. Phenomenological and individual focus interviews were conducted with forty nurses and patients who were selected purposively. Field notes were written after completion of each interview. The transcribed data was analysed by using Giorgi's and Kerlinger's methods combined. Results were discussed and a literature control completed. The most important conclusions reached were: there was an insufficient administrative structure in the hospital as a result of insufficient preparation for the combined health service delivery for all population groups; the whites' perception of different populations groups is based on an ethnocentric Western approach. This led to their experience of culture shock that resulted in feelings of anger/frustration, fear and sadness; the willingness of other populations groups to adjust to combined health service delivery led to their experience of happiness; there exists communication problems between population groups because of their not being able to communicate in their own language and the difference in communication styles; the verbalised Christian viewpoint and values of whites nurses and patients are not

  15. Who are medical marijuana patients? Population characteristics from nine California assessment clinics.

    PubMed

    Reinarman, Craig; Nunberg, Helen; Lanthier, Fran; Heddleston, Tom

    2011-01-01

    Marijuana is a currently illegal psychoactive drug that many physicians believe has substantial therapeutic uses. The medical literature contains a growing number of studies on cannabinoids as well as case studies and anecdotal reports suggesting therapeutic potential. Fifteen states have passed medical marijuana laws, but little is known about the growing population of patients who use marijuana medicinally. This article reports on a sample of 1,746 patients from a network of nine medical marijuana evaluation clinics in California. Patients completed a standardized medical history form; evaluating physicians completed standardized evaluation forms. From this data we describe patient characteristics, self-reported presenting symptoms, physician evaluations, other treatments tried, other drug use, and medical marijuana use practices. Pain, insomnia, and anxiety were the most common conditions for which evaluating physicians recommended medical marijuana. Shifts in the medical marijuana patient population over time, the need for further research, and the issue of diversion are discussed.

  16. Evolutionary consequences of intra-patient phage predation on microbial populations.

    PubMed

    Seed, Kimberley D; Yen, Minmin; Shapiro, B Jesse; Hilaire, Isabelle J; Charles, Richelle C; Teng, Jessica E; Ivers, Louise C; Boncy, Jacques; Harris, Jason B; Camilli, Andrew

    2014-08-26

    The impact of phage predation on bacterial pathogens in the context of human disease is not currently appreciated. Here, we show that predatory interactions of a phage with an important environmentally transmitted pathogen, Vibrio cholerae, can modulate the evolutionary trajectory of this pathogen during the natural course of infection within individual patients. We analyzed geographically and temporally disparate cholera patient stool samples from Haiti and Bangladesh and found that phage predation can drive the genomic diversity of intra-patient V. cholerae populations. Intra-patient phage-sensitive and phage-resistant isolates were isogenic except for mutations conferring phage resistance, and moreover, phage-resistant V. cholerae populations were composed of a heterogeneous mix of many unique mutants. We also observed that phage predation can significantly alter the virulence potential of V. cholerae shed from cholera patients. We provide the first molecular evidence for predatory phage shaping microbial community structure during the natural course of infection in humans.

  17. Patient Engagement and Activation in Three Underserved Beacon Communities.

    PubMed

    Jardins, Terrisca Des; Drone, Shenetta A; Hashisaka, Susan; Hazzard, Jobyna; Hunt, Susan B; Massey, Kimberly; Rein, Alison; Schachter, Abigail; Turske, Scott

    2015-08-01

    Whether the setting is urban, rural, or somewhere in between, engagement strategies for the underserved require a great deal of flexibility and sensitivity to the socioeconomic, cultural, and geographic conditions of the patient population. The following report details how three unique communities designed specific strategies to engage underserved populations in the management of their chronic conditions.

  18. Patient Engagement and Activation in Three Underserved Beacon Communities.

    PubMed

    Jardins, Terrisca Des; Drone, Shenetta A; Hashisaka, Susan; Hazzard, Jobyna; Hunt, Susan B; Massey, Kimberly; Rein, Alison; Schachter, Abigail; Turske, Scott

    2015-08-01

    Whether the setting is urban, rural, or somewhere in between, engagement strategies for the underserved require a great deal of flexibility and sensitivity to the socioeconomic, cultural, and geographic conditions of the patient population. The following report details how three unique communities designed specific strategies to engage underserved populations in the management of their chronic conditions. PMID:26320912

  19. Dental students' reflections on their experiences with a diverse patient population.

    PubMed

    Victoroff, Kristin Zakariasen; Williams, Kristin A; Lalumandier, James

    2013-08-01

    Recent developments, including national reports and new accreditation standards, have emphasized the need for dental students to be prepared to address the needs of a diverse patient population. The purpose of this study was to explore students' descriptions of and reflections on their day-to-day interactions with a diverse patient population in the clinical setting, using a qualitative approach. All dental students (sixty-six) enrolled in the third year of the D.M.D. program at a Midwestern dental school were required to write a paper reflecting on their experiences working with a diverse patient population in the general dental clinic of the school as part of a behavioral sciences course. All third-year dental students were invited to participate in the study. The students' papers were deidentified prior to data analysis. Forty-two students' papers describing a total of 126 patient-student interactions were reviewed. Data analysis resulted in identification of three key themes: 1) development of cultural awareness and recognition of the need to understand each patient as a unique individual, 2) desire to build rapport with all patients, and 3) realization that the development of cultural competence is a lifelong learning process requiring ongoing experiences working with a diverse patient population. Review of student reflection papers is valuable in providing faculty with an understanding of students' degree of development of cultural competence. A greater understanding of students' day-to-day experiences with a diverse patient population can provide insights for dental educators who develop cultural competence curricula.

  20. Activities of gamma-glutamyl transpeptidase and erythrocyte glutathione dependent enzymes in nasopharyngeal carcinoma patients and normal controls.

    PubMed

    Ngah, W Z; Shamaan, N A; Said, M H; Azhar, M T

    1993-01-01

    Plasma gamma-glutamyltranspeptidase (gamma-GT), glutathione peroxidase (GPx) and glutathione reductase (GR) activities were determined in normal and nasopharyngeal carcinoma (NPC) patients. No difference in enzyme activities was observed in the three major races of the Malaysian population, i.e. Malay, Chinese and Indian patients. However, plasma gamma-GT, erythrocyte glutathione S-transferase (GST) and GPx activities were significantly increased in all NPC patients, while GR activity remained unchanged. Patients with elevated plasma gamma-GT activities also had increased GST and GPx activities. Plasma gamma-GT and GPx activities were then found to be affected by treatment. Patients with plasma gamma-GT activity greater than 70 IU/l had very poor prognoses but patients with decreased gamma-GT activities were found to be in remission.

  1. Exploring Contextual Factors and Patient Activation: Evidence from a Nationally Representative Sample of Patients with Depression

    ERIC Educational Resources Information Center

    Chen, Jie; Mortensen, Karoline; Bloodworth, Robin

    2014-01-01

    Patient activation has been considered as a "blockbuster drug of the century." Patients with mental disorders are less activated compared to patients with other chronic diseases. Low activation due to mental disorders can affect the efficiency of treatment of other comorbidities. Contextual factors are significantly associated with…

  2. The value of a multiplexed gastrointestinal pathogen panel in 2 distinct patient populations.

    PubMed

    Petterson, Jonas; York, Vincent; Ward, Pamela; Green, Nicole; She, Rosemary

    2016-05-01

    We assess the value of the Luminex xTAG Gastrointestinal Pathogen Panel (GPP) in 2 different patient populations: an uninsured, indigent population seeking primary care, and a tertiary care hospital specializing in surgical, transplant, and oncology care. Stool specimens collected April to August 2013 for infectious workup were tested on the GPP, and discordant results were further analyzed by alternative methods. Compared to the tertiary care setting, stool pathogen detection was nearly twice as frequent in the primary care setting (25% versus 14%; P<0.05) with a broader array of pathogens detected (15 versus 4). Overall, the greatest value of the GPP was in detection of viral causes of gastroenteritis that were not routinely sought and in detection of Campylobacter spp. when patients presented late in the disease course. Application of a GPP should consider the characteristics of the patient population to maximize its clinical utility in different healthcare settings. PMID:26906189

  3. Human immunodeficiency virus testing for patient-based and population-based diagnosis.

    PubMed

    Albritton, W L; Vittinghoff, E; Padian, N S

    1996-10-01

    Laboratory testing for human immunodeficiency virus (HIV) has been introduced for individual patient-based diagnosis as well as high-risk and low-risk population-based screening. The choice of test, confirmatory algorithm, and interpretative criteria used depend on the clinical setting. In the context of general population-based testing, factors affecting test performance will have to be considered carefully in the development of testing policy. PMID:8843247

  4. Population pharmacokinetics and pharmacodynamics of rivaroxaban in patients with non-valvular atrial fibrillation: results from ROCKET AF.

    PubMed

    Girgis, I G; Patel, M R; Peters, G R; Moore, K T; Mahaffey, K W; Nessel, C C; Halperin, J L; Califf, R M; Fox, K A A; Becker, R C

    2014-08-01

    Two once-daily rivaroxaban dosing regimens were compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation in ROCKET AF: 20 mg for patients with normal/mildly impaired renal function and 15 mg for patients with moderate renal impairment. Rivaroxaban population pharmacokinetic (PK)/pharmacodynamic (PD) modeling data from ROCKET AF patients (n = 161) are reported and are used to confirm established rivaroxaban PK and PK/PD models and to re-estimate values of the models' parameters for the current AF population. An oral one-compartment model with first-order absorption adequately described rivaroxaban PK. Age, renal function, and lean body mass influenced the PK model. Prothrombin time and prothrombinase-induced clotting time exhibited a near-linear relationship with rivaroxaban plasma concentration; inhibitory effects were observed through to 24 hours post-dose. Rivaroxaban plasma concentration and factor Xa activity had an inhibitory maximum-effect (Emax ) relationship. Renal function (on prothrombin time; prothrombinase-induced clotting time) and age (on factor Xa activity) had moderate effects on PK/PD models. PK and PK/PD models were shown to be adequate for describing the current dataset. These findings confirm the modeling and empirical results that led to the selection of doses tested against warfarin in ROCKET AF.

  5. Patient Activation and Mental Health Care Experiences Among Women Veterans

    PubMed Central

    Pavao, Joanne; Wong, Ava

    2016-01-01

    We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224

  6. Analysis of the genetic ancestry of patients with oral clefts from South American admixed populations.

    PubMed

    Vieira-Machado, Camilla D; de Carvalho, Flavia M; Santana da Silva, Luiz C; Dos Santos, Sidney E; Martins, Claudia; Poletta, Fernando A; Mereb, Juan C; Vieira, Alexandre R; Castilla, Eduardo E; Orioli, Iêda M

    2016-08-01

    Increased susceptibility to cleft lip, with or without cleft palate (CL±P) has been observed in South America, as related to Amerindian ancestry, using epidemiological data, uniparental markers, and blood groups. In this study, it was evaluated whether this increased risk remains when Amerindian ancestry is estimated using autosomal markers and considered in the predictive model. Ancestry was estimated through genotyping 62 insertion and deletion (INDEL) markers in sample sets of patients with CL±P, patients with cleft palate (CP), and controls, from Patagonia in southern Argentina and Belém in northern Brazil. The Amerindian ancestry in patients from Patagonia with CL±P was greater than in controls although it did not reach statistical significance. The European ancestry in patients with CL±P from Belém and in patients with CP from Belém and Patagonia was higher than in controls and statistically significant for patients with CP who were from Belém. This high contribution of European genetic ancestry among patients with CP who were from Belém has not been previously observed in American populations. Our results do not corroborate the currently accepted risks for CL±P and CP estimated by epidemiological studies in the North American populations and probably reflect the higher admixture found in South American ethnic groups when compared with the same ethnic groups from the North American populations. PMID:27105611

  7. Celiac Disease Autoimmunity in Patients with Autoimmune Diabetes and Thyroid Disease among Chinese Population.

    PubMed

    Zhao, Zhiyuan; Zou, Jing; Zhao, Lingling; Cheng, Yan; Cai, Hanqing; Li, Mo; Liu, Edwin; Yu, Liping; Liu, Yu

    2016-01-01

    The prevalence of celiac disease autoimmunity or tissue transglutaminase autoantibodies (TGA) amongst patients with type 1 diabetes (T1D) and autoimmune thyroid disease (AITD) in the Chinese population remains unknown. This study examined the rate of celiac disease autoimmunity amongst patients with T1D and AITD in the Chinese population. The study included 178 patients with type 1 diabetes and 119 with AITD where 36 had both T1D and AITD, classified as autoimmune polyglandular syndrome type 3 variant (APS3v). The study also included 145 patients with type 2 diabetes (T2D), 97 patients with non-autoimmune thyroid disease (NAITD), and 102 healthy controls. Serum islet autoantibodies, thyroid autoantibodies and TGA were measured by radioimmunoassay. TGA positivity was found in 22% of patients with either type 1 diabetes or AITD, much higher than that in patients with T2D (3.4%; p< 0.0001) or NAITD (3.1%; P < 0.0001) or healthy controls (1%; p<0.0001). The patients with APS3v having both T1D and AITD were 36% positive for TGA, significantly higher than patients with T1D alone (p = 0.040) or with AITD alone (p = 0.017). T1D and AITD were found to have a 20% and 30% frequency of overlap respectively at diagnosis. In conclusion, TGA positivity was high in the Chinese population having existing T1D and/or AITD, and even higher when both diseases were present. Routine TGA screening in patients with T1D or AITD will be important to early identify celiac disease autoimmunity for better clinical care of patients. PMID:27427767

  8. Celiac Disease Autoimmunity in Patients with Autoimmune Diabetes and Thyroid Disease among Chinese Population

    PubMed Central

    Zhao, Zhiyuan; Zou, Jing; Zhao, Lingling; Cheng, Yan; Cai, Hanqing; Li, Mo; Liu, Edwin; Yu, Liping; Liu, Yu

    2016-01-01

    The prevalence of celiac disease autoimmunity or tissue transglutaminase autoantibodies (TGA) amongst patients with type 1 diabetes (T1D) and autoimmune thyroid disease (AITD) in the Chinese population remains unknown. This study examined the rate of celiac disease autoimmunity amongst patients with T1D and AITD in the Chinese population. The study included 178 patients with type 1 diabetes and 119 with AITD where 36 had both T1D and AITD, classified as autoimmune polyglandular syndrome type 3 variant (APS3v). The study also included 145 patients with type 2 diabetes (T2D), 97 patients with non-autoimmune thyroid disease (NAITD), and 102 healthy controls. Serum islet autoantibodies, thyroid autoantibodies and TGA were measured by radioimmunoassay. TGA positivity was found in 22% of patients with either type 1 diabetes or AITD, much higher than that in patients with T2D (3.4%; p< 0.0001) or NAITD (3.1%; P < 0.0001) or healthy controls (1%; p<0.0001). The patients with APS3v having both T1D and AITD were 36% positive for TGA, significantly higher than patients with T1D alone (p = 0.040) or with AITD alone (p = 0.017). T1D and AITD were found to have a 20% and 30% frequency of overlap respectively at diagnosis. In conclusion, TGA positivity was high in the Chinese population having existing T1D and/or AITD, and even higher when both diseases were present. Routine TGA screening in patients with T1D or AITD will be important to early identify celiac disease autoimmunity for better clinical care of patients. PMID:27427767

  9. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health.

    PubMed

    Bazemore, Andrew W; Cottrell, Erika K; Gold, Rachel; Hughes, Lauren S; Phillips, Robert L; Angier, Heather; Burdick, Timothy E; Carrozza, Mark A; DeVoe, Jennifer E

    2016-03-01

    Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration. PMID:26174867

  10. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health.

    PubMed

    Bazemore, Andrew W; Cottrell, Erika K; Gold, Rachel; Hughes, Lauren S; Phillips, Robert L; Angier, Heather; Burdick, Timothy E; Carrozza, Mark A; DeVoe, Jennifer E

    2016-03-01

    Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration.

  11. Alterations in the Fecal Microbiota of Patients with HIV-1 Infection: An Observational Study in A Chinese Population

    PubMed Central

    Ling, Zongxin; Jin, Changzhong; Xie, Tiansheng; Cheng, Yiwen; Li, Lanjuan; Wu, Nanping

    2016-01-01

    The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naïve) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients. PMID:27477587

  12. A Population Pharmacokinetic Model for Vancomycin in Adult Patients Receiving Extracorporeal Membrane Oxygenation Therapy.

    PubMed

    Moore, J N; Healy, J R; Thoma, B N; Peahota, M M; Ahamadi, M; Schmidt, L; Cavarocchi, N C; Kraft, W K

    2016-09-01

    The literature on the pharmacokinetics of vancomycin in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy is sparse. A population pharmacokinetic (PK) model for vancomycin in ECMO patients was developed using a nonlinear mixed effects modeling on the concentration-time profiles of 14 ECMO patients who received intravenous vancomycin. Model selection was based on log-likelihood criterion, goodness of fit plots, and scientific plausibility. Identification of covariates was done using a full covariate model approach. The pharmacokinetics of vancomycin was adequately described with a two-compartment model. Parameters included clearance of 2.83 L/hr, limited central volume of distribution 24.2 L, and low residual variability 0.67%. Findings from the analysis suggest that standard dosing recommendations for vancomycin in non-ECMO patients are adequate to achieve therapeutic trough concentrations in ECMO patients. This further shows that ECMO minimally affects the PK of vancomycin in adults including in higher-weight patients. PMID:27639260

  13. A Population Pharmacokinetic Model for Vancomycin in Adult Patients Receiving Extracorporeal Membrane Oxygenation Therapy

    PubMed Central

    Healy, JR; Thoma, BN; Peahota, MM; Ahamadi, M; Schmidt, L; Cavarocchi, NC; Kraft, WK

    2016-01-01

    The literature on the pharmacokinetics of vancomycin in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy is sparse. A population pharmacokinetic (PK) model for vancomycin in ECMO patients was developed using a nonlinear mixed effects modeling on the concentration–time profiles of 14 ECMO patients who received intravenous vancomycin. Model selection was based on log‐likelihood criterion, goodness of fit plots, and scientific plausibility. Identification of covariates was done using a full covariate model approach. The pharmacokinetics of vancomycin was adequately described with a two‐compartment model. Parameters included clearance of 2.83 L/hr, limited central volume of distribution 24.2 L, and low residual variability 0.67%. Findings from the analysis suggest that standard dosing recommendations for vancomycin in non‐ECMO patients are adequate to achieve therapeutic trough concentrations in ECMO patients. This further shows that ECMO minimally affects the PK of vancomycin in adults including in higher‐weight patients. PMID:27639260

  14. Radiation exposures of cancer patients from medical X-rays: how relevant are they for individual patients and population exposure?

    PubMed

    Brix, Gunnar; Nissen-Meyer, Sven; Lechel, Ursula; Nissen-Meyer, Johannes; Griebel, Jürgen; Nekolla, Elke A; Becker, Christoph; Reiser, Maximilian

    2009-11-01

    X-ray procedures have a substantial impact not only on patient care but also on man-made radiation exposure. Since a reliable risk-benefit analysis of medical X-rays can only be performed for diagnosis-related groups of patients, we determined specific exposure data for patients with the ten most common types of cancer. For all patients with the considered cancers undergoing medical X-ray procedures in a maximum-care hospital between 2000 and 2005, patient- and examination-specific data were retrieved from the hospital/radiology information system. From this data, the cumulative 5-year effective dose was estimated for each patient as well as the mean annual effective dose per patient and the mean patient observation time for each cancer site. In total, 151,439 radiographic, fluoroscopic, and CT procedures, carried out in 15,866 cancer patients (age, 62+/-13 years), were evaluated. The mean 5-year cumulative dose varied between 8.6 mSv (prostate cancer) and 68.8 mSv (pancreas cancer). Due to an increasing use of CT scans, the mean annual effective dose per patient increased from 13.6 to 18.2 mSv during the 6-year period. Combining the results obtained in this study for a particular hospital with cancer incidence data for Germany, we estimated that cancer patients having X-ray studies constitute at least 1% of the population but receive more than 10% of the total effective dose related to all medical X-ray procedures performed nationwide per year. A large fraction of this dose is radiobiologically ineffective due to the reduced life expectancy of cancer patients.

  15. A 5A's communication intervention to promote physical activity in underserved populations

    PubMed Central

    2012-01-01

    Background The present study protocol describes the trial design of a clinician training intervention to improve physical activity counseling in underserved primary care settings using the 5As. The 5As (Ask, Advise, Agree, Assist, Arrange) are a clinical tool recommended for health behavior counseling in primary care. Methods/Design The study is a two-arm randomized pilot pragmatic trial to examine a primary care clinician communication intervention on use of the 5As in discussion of physical activity in audio-recorded office visits in an ethnically diverse, low-income patient population. The study setting consists of two federally qualified community health centers in Rochester, NY. Eligible clinicians (n=15) are recruited and randomized into two groups. Group 1 clinicians participate in the training intervention first; Group 2 clinicians receive the intervention six months later. The intervention and its outcomes are informed by self-determination theory and principles of patient-centered communication. Assessment of outcomes is blinded. The primary outcome will be the frequency and quality of 5As discussions as judged by evaluating 375 audio-recorded patient visits distributed over baseline and in the post-intervention period (immediately post and at six months). Secondary outcomes will be changes in patients’ perceived competence to increase physical activity (Aim 2) and patients and clinicians beliefs regarding whether pertinent barriers to promoting exercise have been reduced. (Aim 3). Exploratory outcomes (Aim 4) are potential mediators of the intervention’s effect and whether the intervention affects actual enrollment in the community program recommended for exercise. The analysis will use repeated measures (in the form of recorded office visits) from each clinician at each time point and aggregate measures of Groups 1 and 2 over time. Discussion Results will help elucidate the role of 5As communication training for clinicians on counseling for physical

  16. Analysis of Turner syndrome patients within the Jordanian population, with a focus on four patients with Y chromosome abnormalities.

    PubMed

    Daggag, H; Srour, W; El-Khateeb, M; Ajlouni, K

    2013-01-01

    This study presents findings in Turner syndrome (TS) patients from the Jordanian population, with focus on 4 patients with Y chromosomal abnormalities. From 1989 to 2011, 504 patients with TS stigmata were referred to our institute for karyotyping, resulting in 142 positive TS cases. Of these, 62 (43.7%) had the typical 45,X karyotype and the remaining individuals (56.3%) were found to be mosaics. Fifteen TS patients (10.5%) carried a structural abnormality of the Y chromosome and presented with the mosaic 45,X/46,XY karyotype. From these, 4 TS cases were investigated further. Karyotyping revealed that 1 patient carried a small supernumerary marker chromosome, whereas cytogenetic and molecular analyses showed that 3 patients carried 2 copies of the SRY gene. Further analysis by SRY sequencing revealed no mutations within the gene. The analyzed patients were found to be phenotypically either females or males, depending on the predominance of the cell line carrying the Y chromosome. This study demonstrates the importance of detailed cytogenetic analysis (such as FISH) in TS patients, and it also emphasizes the need for molecular analysis (such as PCR and sequencing) when fragments of the Y chromosome are present.

  17. Vertebral and Intraspinal Anomalies in Indian Population with Congenital Scoliosis: A Study of 119 Consecutive Patients

    PubMed Central

    S, Rajasekaran; G, Balamurali; Shetty, Ajoy

    2016-01-01

    Study Design Retrospective case study by clinical and radiological data analysis. Purpose To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. Overview of Literature This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. Methods A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. Results Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. Conclusions Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the

  18. Characteristics of Discharged Mental Patients in Rural 18-County Sparsely Populated Eastern Montana.

    ERIC Educational Resources Information Center

    Kraenzel, Carl F.; Macdonald, Frances H.

    In order to obtain information about the nature and extent of mental illness in a sparsely populated area, the National Institute of Mental Health and the Montana Agricultural Experiement Station made a study of patients who had been discharged from a Montana state hospital for the mentally ill from January 1, 1963 to July 1, 1965. Only patients…

  19. Patients Taking Imatinib for CML Have Similar Risk of Death as General Population

    Cancer.gov

    In an international study, the risk of death for chronic myelogenous leukemia patients treated with imatinib (Gleevec) who had been in remission for at least 2 years was not different from that of the general population, according to an article in the March 21, 2011 issue of the Journal of the National Cancer Institute.

  20. Methods of Suicide among Cancer Patients: A Nationwide Population-Based Study

    ERIC Educational Resources Information Center

    Chung, Kuo-Hsuan; Lin, Herng-Ching

    2010-01-01

    A 3-year nationwide population-based data set was used to explore methods of suicide (violent vs. nonviolent) and possible contributing factors among cancer patients in Taiwan. A total of 1,065 cancer inpatients who committed suicide were included as our study sample. The regression shows that those who had genitourinary cancer were 0.55 times (p…

  1. Hospital Implementation of Patient-Centered Communication with Aging Minority Populations

    ERIC Educational Resources Information Center

    Langer, Menachem; Langer, Nieli

    2009-01-01

    The composition and needs of culturally diverse older populations should encourage hospitals to address the conflicting demands for access and delivery of ethnically sensitive services. Health communication that is patient-centered and provides culturally and linguistically appropriate care has the potential to reduce racial and ethnic health…

  2. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations

    PubMed Central

    Feng, Alexander; O’Neill, John; Holt, Mitchell; Georgiadis, Catherine; Wright, Martha M; Montezuma, Sandra R

    2016-01-01

    Purpose The purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video. Patients and methods We conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study. Results Pre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008) factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001) pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042) patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002) patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001) patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37). A total of 91% patients responded in a postassessment survey that they now feel more confident of their ability to self-administer eyedrops as their doctor prescribed and that the educational materials were responsible. Conclusion Participants demonstrated an

  3. Active population growth and immigration hypotheses in Western Europe.

    PubMed

    Feld, S

    2000-03-01

    The paper examines, in respect of 12 Western European countries over a period of 20 years, the widely held view that any decline in their working population should be offset by greater reliance on immigrant labor. This research, based on demographic projections and forecasts regarding labor market participation rates by age and sex for each of the countries concerned, focuses on the two most likely scenarios. It appears that only Italy will be faced with a fall in its working population. All other western countries will either maintain the same level or, more generally, see their workforce grow substantially. Accordingly, the authors may safely assert that there is no risk of a shortage of workers between now and the year 2020, and that an increasing supply of labor will render reliance on a greater influx of immigrant workers unnecessary. The second part analyses changes in the structure of the demand for labor. The authors deal chiefly with the phenomenon of the concentration of foreign manpower in each sector, its flexibility and mobility in a context of unemployment, as well as the impact of new technologies and globalization on the main determinants of international migration of labor.

  4. Dental students' regard for patients from often-stigmatized populations: findings from an Indian dental school.

    PubMed

    Madhan, Balasubramanian; Gayathri, Haritheertham; Garhnayak, Lokanath; Naik, Eslavath Seena

    2012-02-01

    The aim of this study was to evaluate and compare a group of Indian dental students' attitudes toward HIV-positive status, substance misuse, intellectual disability, acute mental illness, and lesbian, gay, bisexual, transgender (LGBT) orientation. Two hundred and twelve students at various stages in the dental curriculum anonymously completed the Medical Condition Regard Scale (MCRS) for these conditions. Friedman and Kruskal-Wallis tests were used, respectively, to analyze the intrastage and interstage differences in MCRS scores. The results revealed that the regard of dental students was considerably positive for all the conditions except LGBT, for which it was just borderline positive. Intellectual disability received the highest regard among all the conditions and LGBT the least. An intermediary and comparable regard was noted for acute mental illness and HIV-positive status followed by substance misuse. While the regard for LGBT remained consistent throughout the curriculum, those for other conditions showed a marginal decrease at the completion of the clinical training. Active curricular reforms are required to ensure a more inclusive and nondiscriminatory dental care environment for patients from such often-stigmatized populations, especially those with LGBT orientation and substance misuse. PMID:22319086

  5. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study.

    PubMed

    Banegas, José R; Graciani, Auxiliadora; de la Cruz-Troca, Juan J; León-Muñoz, Luz M; Guallar-Castillón, Pilar; Coca, Antonio; Ruilope, Luis M; Rodríguez-Artalejo, Fernando

    2012-10-01

    Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index<25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c<6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein<115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives. PMID:22949530

  6. Newly diagnosed lung cancer patients' preferences for and beliefs about physical activity prior to chemotherapy.

    PubMed

    Karvinen, Kristina H; Vallance, Jeff; Walker, Paul R

    2016-07-01

    Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients.

  7. Suicidal ideation and attempts in patients with stroke: a population-based study.

    PubMed

    Chung, Jae Ho; Kim, Jung Bin; Kim, Ji Hyun

    2016-10-01

    Stroke is known to be associated with an increase in the risk for suicide. However, there are very few population-based studies investigating the risk of suicidal ideation and attempts in patients with stroke. The purpose of this study was to compare the risk of suicidal ideation and attempts between patients with stroke and population without stroke using nationwide survey data. Individual-level data were obtained from 228,735 participants (4560 with stroke and 224,175 without stroke) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with stroke and population without stroke. Multivariable logistic regression was performed to investigate the independent effects of the stroke on suicidal ideation and attempts. Stroke patients had more depressive mood (12.6 %) than population without stroke (5.7 %, p < 0.001). Stroke patients experienced more suicidal ideation (24.4 %) and attempts (1.3 %) than population without stroke (9.8 and 0.4 %, respectively; both p < 0.001). Stroke was found to increase the risk for suicidal ideation (OR 1.65, 95 % CI 1.52-1.79) and suicidal attempts (OR 1.64, 95 % CI 1.21-2.22), adjusting for demographics, socioeconomic factors, and physical health and mental health factors. We found that stroke increased the risk for suicidal ideation and attempts, independent of other factors that are known to be associated with suicidality, suggesting that stroke per se may be an independent risk factor for suicidality.

  8. Factors affecting the development of adverse drug reactions to β-blockers in hospitalized cardiac patient population

    PubMed Central

    Mugoša, Snežana; Djordjević, Nataša; Djukanović, Nina; Protić, Dragana; Bukumirić, Zoran; Radosavljević, Ivan; Bošković, Aneta; Todorović, Zoran

    2016-01-01

    The aim of the present study was to undertake a study on the prevalence of cytochrome P450 2D6 (CYP2D6) poor metabolizer alleles (*3, *4, *5, and *6) on a Montenegrin population and its impact on developing adverse drug reactions (ADRs) of β-blockers in a hospitalized cardiac patient population. A prospective study was conducted in the Cardiology Center of the Clinical Center of Montenegro and included 138 patients who had received any β-blocker in their therapy. ADRs were collected using a specially designed questionnaire, based on the symptom list and any signs that could point to eventual ADRs. Data from patients’ medical charts, laboratory tests, and other available parameters were observed and combined with the data from the questionnaire. ADRs to β-blockers were observed in 15 (10.9%) patients. There was a statistically significant difference in the frequency of ADRs in relation to genetically determined enzymatic activity (P<0.001), with ADRs’ occurrence significantly correlating with slower CYP2D6 metabolism. Our study showed that the adverse reactions to β-blockers could be predicted by the length of hospitalization, CYP2D6 poor metabolizer phenotype, and the concomitant use of other CYP2D6-metabolizing drugs. Therefore, in hospitalized patients with polypharmacy CYP2D6 genotyping might be useful in detecting those at risk of ADRs. PMID:27536078

  9. Using eHealth to improve health literacy among the patient population.

    PubMed

    Landry, Kathryn E

    2015-01-01

    There is no denying the global influence of eHealth, in its various forms, on the health care system in the 21st Century. Health care professionals are often familiar with technological tools used to enhance health outcomes by assisting clinicians in meeting the needs of the patient population. In an age of social media, web-based information, and material available literally in an instant, it is crucial for nurses to use and proactively share their knowledge regarding accessing and finding credible sources of online health information with the patient population. By improving health literacy among consumers, self-sufficiency and competence can be developed and promoted to improve health outcomes, placing the patient in a participatory starring role of managing and improving his or her overall well-being. PMID:25842526

  10. Using eHealth to improve health literacy among the patient population.

    PubMed

    Landry, Kathryn E

    2015-01-01

    There is no denying the global influence of eHealth, in its various forms, on the health care system in the 21st Century. Health care professionals are often familiar with technological tools used to enhance health outcomes by assisting clinicians in meeting the needs of the patient population. In an age of social media, web-based information, and material available literally in an instant, it is crucial for nurses to use and proactively share their knowledge regarding accessing and finding credible sources of online health information with the patient population. By improving health literacy among consumers, self-sufficiency and competence can be developed and promoted to improve health outcomes, placing the patient in a participatory starring role of managing and improving his or her overall well-being.

  11. N-acetylcarnosine lubricant eyedrops possess all-in-one universal antioxidant protective effects of L-carnosine in aqueous and lipid membrane environments, aldehyde scavenging, and transglycation activities inherent to cataracts: a clinical study of the new vision-saving drug N-acetylcarnosine eyedrop therapy in a database population of over 50,500 patients.

    PubMed

    Babizhayev, Mark A; Micans, Philip; Guiotto, Andrea; Kasus-Jacobi, Anne

    2009-01-01

    enrolled participants in the prospective, randomized, double-masked, placebo-controlled crossover clinical trial after controlling for age, gender, and daily activities. In a cohort in excess of 50,500 various patients seeking cutting-edge medical care, the N-acetylcarnosine topical eyedrops target therapy was demonstrated to have significant efficacy, safety, and good tolerability for the prevention and treatment of visual impairment in this older population with relatively stable patterns of causes for blindness and visual impairment. Overall, accumulated study data demonstrate that the IVP-designed new vision-saving drugs, including N-acetylcarnosine eyedrops, promote health vision and prevent vision disability from senile cataracts, primary open-angle glaucoma, age-related macular degeneration, diabetic retinopathy, and aging. N-acetylcarnosine eyedrop therapy is the crown jewel of the anti-aging medical movement and revolutionizes early detection, treatment, and rejuvenation of aging-related eye-disabling disorders. N-acetylcarnosine, as an innovative medical science tool and component of the home medicine and alternative medicine approaches, has the potential to alleviate visual impairment and its associated social, economic, and political woes for an aging population.

  12. Existing General Population Models Inaccurately Predict Lung Cancer Risk in Patients Referred for Surgical Evaluation

    PubMed Central

    Isbell, James M.; Deppen, Stephen; Putnam, Joe B.; Nesbitt, Jonathan C.; Lambright, Eric S.; Dawes, Aaron; Massion, Pierre P.; Speroff, Theodore; Jones, David R.; Grogan, Eric L.

    2013-01-01

    Background atients undergoing resections for suspicious pulmonary lesions have a 9-55% benign rate. Validated prediction models exist to estimate the probability of malignancy in a general population and current practice guidelines recommend their use. We evaluated these models in a surgical population to determine the accuracy of existing models to predict benign or malignant disease. Methods We conducted a retrospective review of our thoracic surgery quality improvement database (2005-2008) to identify patients who underwent resection of a pulmonary lesion. Patients were stratified into subgroups based on age, smoking status and fluorodeoxyglucose positron emission tomography (PET) results. The probability of malignancy was calculated for each patient using the Mayo and SPN prediction models. Receiver operating characteristic (ROC) and calibration curves were used to measure model performance. Results 89 patients met selection criteria; 73% were malignant. Patients with preoperative PET scans were divided into 4 subgroups based on age, smoking history and nodule PET avidity. Older smokers with PET-avid lesions had a 90% malignancy rate. Patients with PET- non-avid lesions, or PET-avid lesions with age<50 years or never smokers of any age had a 62% malignancy rate. The area under the ROC curve for the Mayo and SPN models was 0.79 and 0.80, respectively; however, the models were poorly calibrated (p<0.001). Conclusions Despite improvements in diagnostic and imaging techniques, current general population models do not accurately predict lung cancer among patients ref erred for surgical evaluation. Prediction models with greater accuracy are needed to identify patients with benign disease to reduce non-therapeutic resections. PMID:21172518

  13. Microbiological activity of soils populated by Lasius niger ants

    NASA Astrophysics Data System (ADS)

    Golichenkov, M. V.; Neimatov, A. L.; Kiryushin, A. V.

    2009-07-01

    Ants are the most widespread colonial insects assigned to the Hymenoptera order. They actively use soil as a habitat; being numerous, they create a specific microrelief. It is shown that ants affect microbiological processes of the carbon and nitrogen cycles. The carbon content in anthills remains stable throughout the growing season, and the respiration intensity is about three times higher as compared with that in the control soil. The highest methane production (0.08 nmol of CH4/g per day) in the anthill is observed at the beginning of the growing season and exceeds that in the control soil by four times. The most active nitrogen fixation (about 4 nmol of C2H4/g per h) in the anthill takes place in the early growing season, whereas, in the control soil, it is observed in the middle of the growing season. At the same time, the diazotrophic activity is higher in the control soil. The lowest denitrification in the anthill is observed at the beginning and end of the growing season. The dynamics of the denitrification in the anthill are opposite to the dynamics of the diazotrophic activity. We suppose that these regularities of the biological activity in the anthill are related to the ecology of the ants and the changes in their food preferences during the growing season.

  14. Paraoxonase-1 and arylesterase activities in patients with colorectal cancer

    PubMed Central

    Afsar, Cigdem Usul; Gunaldı, Meral; Okuturlar, Yıldız; Gedikbası, Asuman; Tiken, Elif Eda; Kahraman, Sibel; Karaca, Feryal; Ercolak, Vehbi; Karabulut, Mehmet

    2015-01-01

    Background: The aim of this study was to evaluate paraoxonase-1 (PON1) and arylesterase (ARE) activities and oxidative stress status in patients with colorectal carcinomas (CRC). Materials and methods: Thirty-three patients (20 male, 13 female) with CRC and 30 healthy controls were enrolled in the study. Blood samples were obtained from the CRC patients before adjuvant therapy. Serum samples from CRC patients and healthy controls were analyzed for PON1 and ARE activities. Results: The PON1 and ARE activities of the patients with CRC were significantly higher compared to those of the control group (PON1 activity is 125.35±20.07 U/L for CRC patients and 1.22±0.48 U/L for control group, P<0.001; ARE activity is 160.76±10.79 U/L for CRC patients). ARE levels showed a positive correlation with smoking status (P=0.04). PON1 activity was higher in colon carcinoma patients (135.95±19.3 U/L) rather than rectal carcinoma patients (97.08±5.24 U/L) but it was not statistically significant (P=0.72). Conclusion: Serum PON1 activity is increased in patients with CRC, and serum ARE levels showed a positive correlation with smoking status. PON1 activity was higher in colon carcinoma patients. There is no other study in literature investigating these activities for CRC patients. It should be reevaluated by larger clinical trials. PMID:26885111

  15. Human hair neutron activation analysis: Analysis on population level, mapping

    NASA Astrophysics Data System (ADS)

    Zhuk, L. I.; Kist, A. A.

    1999-01-01

    Neutron activation analysis is an outstanding analytical method having very wide applications in various fields. Analysis of human hair within last decades mostly based on neutron activation analysis is a very attractive illustration of the application of nuclear analytical techniques. Very interesting question is how the elemental composition differs in different areas or cities. In this connection the present paper gives average data and maps of various localities in the vicinity of drying-out Aral Sea and of various industrial cities in Central Asia.

  16. Identifying Elements of Patient-Centered Care in Underserved Populations: A Qualitative Study of Patient Perspectives

    PubMed Central

    Raja, Sheela; Hasnain, Memoona; Vadakumchery, Tracy; Hamad, Judy; Shah, Raveena; Hoersch, Michelle

    2015-01-01

    Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes. PMID:25993110

  17. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    PubMed

    Raja, Sheela; Hasnain, Memoona; Vadakumchery, Tracy; Hamad, Judy; Shah, Raveena; Hoersch, Michelle

    2015-01-01

    Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes. PMID:25993110

  18. Exploring Patient Activation in the Clinic: Measurement from Three Perspectives

    ERIC Educational Resources Information Center

    Ledford, Christy J. W.; Ledford, Christopher C.; Childress, Marc A.

    2013-01-01

    Objective. To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives. Data Source/Study Setting. Multimethod observation in 2010 within a family medicine clinic. Study Design. Part of an intervention with 130 patients with type 2 diabetes, this observational study…

  19. Heart disease and physical activity: looking beyond patient characteristics.

    PubMed

    Blanchard, Chris M

    2012-01-01

    Physical activity (PA) adherence is a problem that has plagued cardiovascular disease patients for years. Because of this, researchers have advocated for the identification of key theoretical correlates that can be used to guide PA intervention development. The present review will identify key PA correlates for these patients and provide subsequent recommendations to look beyond patient-level correlates.

  20. Patient-reported outcome measures in a population of medically indigent patients with systemic lupus erythematosus in Puerto Rico

    PubMed Central

    Rodríguez-Rivera, Diana V; Rodríguez-Navedo, Yerania; Nieves-Plaza, Mariely; Vilá, Luis M

    2016-01-01

    Objective: To determine patient-reported outcomes measures in indigent patients with systemic lupus erythematosus receiving their healthcare through the Puerto Rico government managed care system and compare these measures with non-indigent patients treated in a private fee-for-service setting. Methods: A cross-sectional study was conducted in a cohort of 98 Puerto Ricans with systemic lupus erythematosus. Patients from the public group (n = 40) were treated in a university-based specialized systemic lupus erythematosus clinic and the private group (n = 58) in a community-based rheumatology practice. Demographic and clinical features and patient-reported outcomes measures per LupusPRO instrument were determined. LupusPRO captures quality-of-life measures in 12 domains. Differences among study groups were examined using chi-square, Fisher’s exact, t-tests, and the Wilcoxon signed-rank test. Results: The mean (standard deviation) age of the study population was 44.9 (12.0) years; 94 (95.9%) were women. Patients in the public setting were younger and were more likely to have renal disease and elevated anti-double-stranded DNA antibodies, and being treated with azathioprine and cyclophosphamide. Patients from the public sector were more likely to have better quality-of-life measures in the LupusPRO domains of pain/vitality and coping. No significant differences were observed for the domains of lupus symptoms, physical health, emotional health, body image, cognition, procreation, lupus medications, desires/goals, social support, and satisfaction with medical care. Conclusion: Despite having a lower socioeconomic status and worse clinical status, systemic lupus erythematosus patients from the public sector had equal or better patient-reported outcomes measures than those treated in the private setting. This favorable outcome may be associated with the comprehensive healthcare received by these patients in a specialized lupus clinic. PMID:27721978

  1. Dog ownership and dog walking to promote physical activity and health in patients.

    PubMed

    Epping, Jacqueline N

    2011-07-01

    Lack of physical activity is a significant risk factor for many chronic diseases and conditions and is associated with significant medical costs. Approximately half of adults and more than a third of adolescents and youth in the United States do not achieve recommended levels of physical activity. Effective population-level strategies are needed to promote activities that are practical, accessible, and sustainable and that can reach a large proportion of the population. Dog walking may be such a strategy. Walking is popular, easy, and sustainable and has a low risk of injury. Owning dogs confers many health benefits, and dog walking, in particular, can help promote physical activity and improve health. Physicians and other health care providers can play a unique and integral role in promoting physical activity among patients by recommending dog walking both to dog owners and to non-dog owners as a purposeful, enjoyable, and sustainable form of regular physical activity. PMID:23531898

  2. Health and economic benefits of physical activity for patients with spinal cord injury

    PubMed Central

    Miller, Larry E; Herbert, William G

    2016-01-01

    Spinal cord injury (SCI) is a traumatic, life-disrupting event with an annual incidence of 17,000 cases in the US. SCI is characterized by progressive physical deconditioning due to limited mobility and lack of modalities to allow safe physical activity that may partially offset these deleterious physical changes. Approximately, 50% of patients with SCI report no leisure-time physical activity and 15% report leisure-time physical activity below the threshold where meaningful health benefits could be realized. Collectively, about 363,000 patients with SCI, or 65% of the entire spinal cord injured population in the US, engages in insufficient physical activity and represents a target population that could derive considerable health benefits from even modest physical activity levels. Currently, the annual direct costs related to SCI exceed US$45 billion in the US. Rehabilitation protocols and technologies aimed to improve functional mobility have potential to significantly reduce the risk of medical complications and cost associated with SCI. Patients who commence routine physical activity in the first post-injury year and experience typical motor function improvements would realize US$290,000 to US$435,000 in lifetime cost savings, primarily due to fewer hospitalizations and less reliance on assistive care. New assistive technologies that allow patients with SCI to safely engage in routine physical activity are desperately needed. PMID:27757043

  3. Commercial filming of patient care activities in hospitals.

    PubMed

    Geiderman, Joel M; Larkin, Gregory L

    2002-07-17

    Commercial filming of patient care activities is common in hospital settings. This article reviews common circumstances in which patients are commercially filmed, explores the potential positive and negative aspects of filming, and considers the ethical and legal issues associated with commercial filming of patients in hospital settings. We examine the competing goals of commercial filming and the duties of journalists vs the rights of patients to privacy. Current standards and recommendations for commercial filming of patient care activities are reviewed and additional recommendations are offered.

  4. Activity of cefazolin against dense populations of enterobacteria.

    PubMed

    Greenwood, D; Chan-Teoh, C H; O'Grady, F

    1975-02-01

    The in vitro activity of cefazolin was assessed by continuous turbidimetric monitoring of cultures of gram-negative bacilli and the results were compared with those previously obtained with other beta-lactam agents using the same strains and methods. Cefazolin was found to induce rapid lysis of ampicillin-susceptible and -resistant strains of Escherichia coli at a lower concentration than any other beta-lactam agent tested; its stability to beta-lactamase, as judged by regrowth studies, was generally considerably greater than that of other antibiotics of this group. Tested against 103 ampicillin-resistant enterobacteria, cefazolin was found to be more active than cephalothin against E. coli, but no systematic increase in susceptibility to cefazolin was seen with other species. A study of cefazolin in an in vitro model which simulates the hydrokinetic features of the urinary bladder showed it to be as active as ampicillin against ampicillin-susceptible E. coli and as active as cephalothin against ampicillin-resistant E. coli.

  5. Activity of cefazolin against dense populations of enterobacteria.

    PubMed

    Greenwood, D; Chan-Teoh, C H; O'Grady, F

    1975-02-01

    The in vitro activity of cefazolin was assessed by continuous turbidimetric monitoring of cultures of gram-negative bacilli and the results were compared with those previously obtained with other beta-lactam agents using the same strains and methods. Cefazolin was found to induce rapid lysis of ampicillin-susceptible and -resistant strains of Escherichia coli at a lower concentration than any other beta-lactam agent tested; its stability to beta-lactamase, as judged by regrowth studies, was generally considerably greater than that of other antibiotics of this group. Tested against 103 ampicillin-resistant enterobacteria, cefazolin was found to be more active than cephalothin against E. coli, but no systematic increase in susceptibility to cefazolin was seen with other species. A study of cefazolin in an in vitro model which simulates the hydrokinetic features of the urinary bladder showed it to be as active as ampicillin against ampicillin-susceptible E. coli and as active as cephalothin against ampicillin-resistant E. coli. PMID:1137370

  6. Screening for Chlamydial Cervicitis in a Sexually Active University Population.

    ERIC Educational Resources Information Center

    Malotte, C. Kevin; And Others

    1990-01-01

    Enzyme-linked immunoabsorbent assays to detect chlamydial cervicitis were performed on samples from 1,320 sexually active university women. Seventy-five had positive tests. Demographic, history, symptom, and physical examination variables were insufficient to predict infection accurately. Concludes that screening during routine visits with this…

  7. Activated natural killer cells accelerate liver damage in patients with chronic hepatitis B virus infection.

    PubMed

    Zheng, Q; Zhu, Y Y; Chen, J; Ye, Y B; Li, J Y; Liu, Y R; Hu, M L; Zheng, Y C; Jiang, J J

    2015-06-01

    Emerging evidence indicates that natural killer (NK) cells may contribute to liver injury in patients with hepatitis B virus (HBV) infection. Because HBV infection progresses through various disease phases, the cytolytic profiles of peripheral and intrahepatic NK cells in HBV-infected patients remain to be defined. In this study, we comprehensively characterized intrahepatic and peripheral NK cells in a cohort of HBV-infected individuals, and investigated their impact on liver pathogenesis during chronic HBV infection. The study population included 34 immune-clearance (IC) patients, 36 immune-tolerant (IT) carriers and 10 healthy subjects. We found that the activity of peripheral NK cells from IC patients was functionally elevated compared to IT carriers and controls, and NK cell activation was indicated by an increased expression of CD69, CD107a, interferon (IFN)-γ and tumour necrosis factor (TNF)-α. Further analysis showed that the increased activity of both peripheral and hepatic NK cells was correlated positively with liver injury, which was assessed by serum alanine aminotransferase levels (ALT) and the liver histological activity index (HAI). Interestingly, the frequency of peripheral NK cells was reduced in IC patients (especially those with higher HAI scores of 3-4), but there was a concomitant increase in hepatic NK cells. The functionally activated NK cells are enriched preferentially in the livers of IC patients and skew towards cytolytic activity that accelerates liver injury in chronic hepatitis B (CHB) patients.

  8. Investigation of the maxillary lateral incisor agenesis and associated dental anomalies in an orthodontic patient population

    PubMed Central

    Kamak, Hasan; Yildirim, Hanifi; Ceylan, Ismail

    2012-01-01

    Objectives: The aim of this study was to investigate the prevalence of maxillary lateral incisor (MLI) agenesis and associated dental anomalies as well as skeletal patterns in an orthodontic population, and then to compare it with the prevalence of these anomalies in the general population. Study Design: The material of the present study included the records of the 3872 orthodontic patients. The followings were recorded for each subject with the agenesis of MLI: Age, sex, unilateral or bilateral absence, anterior-posterior skeletal relationship of the maxilla and mandible, and presence of associated dental anomalies. The occurrence of these anomalies was compared with data previously reported for the general populations. Results: Of the 3872 patients examined, 94 were found to have agenesis of the MLI, representing a prevalence of 2.4 per cent, with females being more frequently observed. The most commonly found associated anomalies were ectopic eruption of maxillary canines and reduced or peg- shaped contralateral incisor with the frequencies of 21.3 per cent and 20.2 per cent respectively. Conclusions: Patients with agenesis of MLI showed a significantly higher prevalence of skeletal Class III malocclusion compared with the general population. The prevalence of ectopic eruption, transposition, and transmigration of the maxillary canine and reduced or peg- shaped MLIs were significantly increased. Key words:Hypodontia, missing laterals, associated dental anomalies. PMID:22549676

  9. Long-Term Health-Related Quality of Life in German Patients with Juvenile Idiopathic Arthritis in Comparison to German General Population

    PubMed Central

    Barth, Swaantje; Haas, Johannes-Peter; Schlichtiger, Jenny; Molz, Johannes; Bisdorff, Betty; Michels, Hartmut; Hügle, Boris; Radon, Katja

    2016-01-01

    Objective Aims of the study were to investigate health-related quality of life (HRQOL) in adult patients with former diagnosis of Juvenile Idiopathic Arthritis (JIA), to compare their HRQOL with the general population and to identify factors related to a poor outcome. Methods In 2012, a cross-sectional survey was performed by mailing a questionnaire to a large cohort of former and current patients of the German Centre for Rheumatology in Children and Adolescents. Only adult patients (≥18 years) with a diagnosis compatible with JIA were included (n = 2592; response 66%). The questionnaire included information about HRQOL (EQ5D), disease-related questions and socio-demographics. Prevalence and 95% confidence intervals (CI) of problems with mobility, self-care, usual activities, pain and anxiety/depression were standardized to the German general population. Factors associated with low HRQOL in JIA patients were identified using logistic regression models. Results Sixty-two percent of the study population was female; age range was 18–73 years. In all dimensions, JIA patients reported statistically significantly more problems than the general population with largest differences in the pain dimension (JIA patients 56%; 95%CI 55–58%; general population 28%; 26–29%) and the anxiety/depression dimension (28%; 27–29% vs. 4%; 4–5%). Lower HRQOL in JIA patients was associated with female sex, older age, lower level of education, still being under rheumatic treatment and disability. Conclusions HRQOL in adult JIA patients is considerably lower than in the general population. As this cohort includes historic patients the new therapeutic schemes available today are expected to improve HRQOL in future. PMID:27115139

  10. Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation

    PubMed Central

    De Pietri, Lesley; Bianchini, Marcello; Rompianesi, Gianluca; Bertellini, Elisabetta; Begliomini, Bruno

    2016-01-01

    AIM To describe the thromboelastography (TEG) “reference” values within a population of liver transplant (LT) candidates that underline the differences from healthy patients. METHODS Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time (r), coagulation time (k), Angle-Rate of polymerization of clot (α Angle), Maximum strenght of clot (MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured (A30 and A60), and Fibrinolysis at 30 and 60 min after MA (Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score (higher or lower than 20) and indications for transplantation (liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score. RESULTS Most of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r (41.5% of the values), k (48.6%), α (43.7%), MA (79.3%), A30 (74.4%) and A60 (80

  11. Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation

    PubMed Central

    De Pietri, Lesley; Bianchini, Marcello; Rompianesi, Gianluca; Bertellini, Elisabetta; Begliomini, Bruno

    2016-01-01

    AIM To describe the thromboelastography (TEG) “reference” values within a population of liver transplant (LT) candidates that underline the differences from healthy patients. METHODS Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time (r), coagulation time (k), Angle-Rate of polymerization of clot (α Angle), Maximum strenght of clot (MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured (A30 and A60), and Fibrinolysis at 30 and 60 min after MA (Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score (higher or lower than 20) and indications for transplantation (liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score. RESULTS Most of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r (41.5% of the values), k (48.6%), α (43.7%), MA (79.3%), A30 (74.4%) and A60 (80

  12. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    PubMed

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  13. Profile of diabetic ketoacidosis in a predominantly African American urban patient population.

    PubMed

    Seyoum, Berhane; Berhanu, Paulos

    2007-01-01

    The occurrence of diabetic ketoacidosis (DKA), a serious but largely preventable acute complication of diabetes mellitus, has been declining in recent years. However, empiric observations indicate that DKA continues to have a major effect on ethnic minority patients in inner-city settings. In this study, we conducted a retrospective analysis of five-year hospital admission data for DKA at a single inner-city hospital that serves a largely uninsured adult African American population. A computer-assisted search of the International Classification of Diseases, Ninth Revision, Clinical Modification codes for DKA revealed 847 admissions for confirmed DKA in 630 patients. Of these, 592 (94%) were African Americans, 22 (3.5%) were Whites, and 16 (2.5%) were Hispanics. The mean age was 43.4 +/- .4 years. Five hundred seventy-one (90.6%) of the patients had type 1 diabetes, and 59 (9.4%) had type 2 diabetes. One hundred forty-five patients (23%) were newly diagnosed with diabetes. Ninety-four (14.9%) of the patients had multiple admissions, ranging from 2 to 23 admissions per patient during the five-year period, while the remaining 391 (62.1%) patients were single admissions. Half of the patients (52%) did not have health insurance. Major precipitating factors for DKA included discontinuation of insulin, infection, and other medical illness in 501 (59.1%), 136 (16.1%), and 30 (3.5%) of the admissions, respectively. In conclusion, these data demonstrate that DKA continues to have a major effect in urban African American patients with diabetes. Therefore, multiple targeted interventions are needed in this population to improve diabetes care and thereby decrease the frequency of DKA.

  14. Sports, Physical Activity and Patient-Reported Outcomes After Medial Unicompartmental Knee Arthroplasty in Young Patients.

    PubMed

    Walker, Tilman; Streit, Julia; Gotterbarm, Tobias; Bruckner, Thomas; Merle, Christian; Streit, Marcus R

    2015-11-01

    One hundred-and-one patients age 60 or younger following medial mobile bearing UKA were reviewed retrospectively with a minimum follow-up of 2 years using the Schulthess activity score, Tegner, UCLA and SF-36 score to assess their level of physical activity and quality of life. Patients showed a rapid recovery and resumption of their activities with a return-to-activity rate of 93%. Most common activities were low impact, whereas high-impact activities showed a significant decrease. Precaution was found to be the main reason for a decrease in the level of activity. The results of this study demonstrate that patients age 60 or younger following medial UKA were able to return to regular physical activities with almost two-thirds of the patients reaching a high activity level (UCLA≥7).

  15. Predictors of Death among Patients Who Completed Tuberculosis Treatment: A Population-Based Cohort Study

    PubMed Central

    Millet, Juan-Pablo; Orcau, Angels; Rius, Cristina; Casals, Marti; de Olalla, Patricia Garcia; Moreno, Antonio; Nelson, Jeanne L.; Caylà, Joan A.

    2011-01-01

    Background Mortality among patients who complete tuberculosis (TB) treatment is still high among vulnerable populations. The objective of the study was to identify the probability of death and its predictive factors in a cohort of successfully treated TB patients. Methods A population-based retrospective longitudinal study was performed in Barcelona, Spain. All patients who successfully completed TB treatment with culture-confirmation and available drug susceptibility testing between 1995–1997 were retrospectively followed-up until December 31, 2005 by the Barcelona TB Control Program. Socio-demographic, clinical, microbiological and treatment variables were examined. Mortality, TB Program and AIDS registries were reviewed. Kaplan-Meier and a Cox regression methods with time-dependent covariates were used for the survival analysis, calculating the hazard ratio (HR) with 95% confidence intervals (CI). Results Among the 762 included patients, the median age was 36 years, 520 (68.2%) were male, 178 (23.4%) HIV-infected, and 208 (27.3%) were alcohol abusers. Of the 134 (17.6%) injecting drug users (IDU), 123 (91.8%) were HIV-infected. A total of 30 (3.9%) recurrences and 173 deaths (22.7%) occurred (mortality rate: 3.4/100 person-years of follow-up). The predictors of death were: age between 41–60 years old (HR: 3.5; CI:2.1–5.7), age greater than 60 years (HR: 14.6; CI:8.9–24), alcohol abuse (HR: 1.7; CI:1.2–2.4) and HIV-infected IDU (HR: 7.9; CI:4.7–13.3). Conclusions The mortality rate among TB patients who completed treatment is associated with vulnerable populations such as the elderly, alcohol abusers, and HIV-infected IDU. We therefore need to fight against poverty, and promote and develop interventions and social policies directed towards these populations to improve their survival. PMID:21980423

  16. Active video gaming in patients with renal transplant: a pilot study

    PubMed Central

    2014-01-01

    Background Patients with renal transplant are at higher risk of mortality from cardiovascular disease (CVD) compared with the general population. Physical activity has been shown to reduce the risk of CVD mortality in these patients. Unfortunately, barriers such as the harsh Canadian climate prevent patients from engaging in and harvesting the health benefits of physical activity. This pilot study explored active video gaming (AVG) as a way for patients with renal transplant to obtain physical activity and examined its effect on their functional status and quality of life (QOL). Main text We recruited nine patients for an 8-week prospective pilot study. All patients received a Microsoft Xbox 360™ video gaming console, a Microsoft Kinect™ sensor, and the video game Your Shape Fitness Evolved 2012. Assessment of each participant before and after the intervention included blood pressure measures, a 6-minute walk test, and the Godin Leisure Time Questionnaire (GLTQ). We analyzed all nine patients at the end of the 8-week study period, and found no changes in blood pressure or GLTQ scores. However, there was a significant increase in the 6-minute walk distance (P = 0.022), which represented a consistent increase for most patients (correlation = 0.977). In addition, participants over the age of 45 years (n = 4) were more likely to use the AVG system (P = 0.042). Conclusion AVG has the potential to improve the functional status in patients with renal transplant. Further research is required to corroborate the full health benefits of AVG in this patient population. PMID:25114788

  17. Estimation of lithium clearance from routine clinical data in Egyptian bipolar patients. A population pharmacokinetic approach.

    PubMed

    ElDesoky, E S; Kumar, V; Alorainy, M S; Hamdi, M M; Derendorf, H

    2008-12-01

    Population pharmacokinetics (PK) of lithium as a mood stabilizer was investigated in Egyptian patients with bipolar affective disorders (n = 50) of whom 31 were suffering from lithium toxicity. The mean (+/- SD) age and body weight of patients were 33 +/- 10 years and 67 +/- 3.6 kg, respectively. Patients selected were maintained on lithium carbonate controlled release tablets at doses of 400 mg/12 hours (n = 43) or 200 mg/12 hours (n = 7) respectively. In 19 patients who continued lithium therapy, 1 blood sample/patient was withdrawn for lithium level determination before the morning dose of the drug was given while for 31 patients who suffered from lithium-related toxicity and cessation of drug intake was therapeutically decided, a single blood was drawn at variable time (36, 48 or 72 h) following the last administered dose of the drug. The data was subjected to population PK analysis using NONMEM and a two-compartment model was used. Due to single point sparse data, not all parameters and their between subject variability (BSV) could be determined. Therefore, lithium clearance (CL) and BSV were estimated while other PK parameters were fixed using available literature information. First order (FO) estimation method was used in the analysis. Covariates were evaluated by univariate analysis using likelihood ratio test. The most significant covariate on lithium CL was found to be creatinine clearance (CrCL). The population CL of lithium in the final model was expressed as CLpop = 0.51 x (CrCL/105.3)0.44. The final population PK parameters estimates of lithium were: CL = 0.51 l/h with 12.7% BSV, V1 (Fixed) = 15.2 l, Q (Fixed) = 7.44 l/h, and V2 (Fixed) = 6.7 l. The mean value of lithium concentration at 12 hours as predicted by the final model in the patients with drug toxicity was 1.3 +/- 0.1 mmol/l versus 0.8 +/- 0.14 mmol/l in patients without toxic signs. External validation of the final model on another group of adult bipolar patients (n = 12) maintained on

  18. In vitro activities of antimicrobial agents against clinical isolates of Flavimonas oryzihabitans obtained from patients with cancer.

    PubMed

    Rolston, K V; Ho, D H; LeBlanc, B; Bodey, G P

    1993-11-01

    We evaluated the in vitro activities of 21 different antimicrobial agents against nine clinical isolates of Flavimonas oryzihabitans obtained from patients with cancer. The organisms were susceptible to most agents commonly used for the empiric therapy (aminoglycosides, ureidopenicillins, extended-spectrum cephalosporins, monobactams, and carbapenems) and prevention of infections (quinolones and trimethoprim-sulfamethoxazole) in this patient population.

  19. In vitro activities of antimicrobial agents against clinical isolates of Flavimonas oryzihabitans obtained from patients with cancer.

    PubMed

    Rolston, K V; Ho, D H; LeBlanc, B; Bodey, G P

    1993-11-01

    We evaluated the in vitro activities of 21 different antimicrobial agents against nine clinical isolates of Flavimonas oryzihabitans obtained from patients with cancer. The organisms were susceptible to most agents commonly used for the empiric therapy (aminoglycosides, ureidopenicillins, extended-spectrum cephalosporins, monobactams, and carbapenems) and prevention of infections (quinolones and trimethoprim-sulfamethoxazole) in this patient population. PMID:8285645

  20. The National Blueprint for Promoting Physical Activity in the Mid-Life and Older Adult Population

    ERIC Educational Resources Information Center

    Chodzko-Zajko, Wojtek; Sheppard, Lisa; Senior, Jane; Park, Chae-Hee; Mockenhaupt, Robin; Bazzarre, Terry

    2005-01-01

    The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The Blueprint identifies barriers to physical activity in the areas of research, home and community programs, medical…

  1. Population and Human Development: A Course Curriculum Including Lesson Plans, Activities and Bibliography.

    ERIC Educational Resources Information Center

    Murphy, Elaine M.

    This course outline suggests materials and learning activities on the interrelated causes and consequences of population growth and other population concerns. Designed to educate general college audiences, it is also intended for use as a preservice course for teachers. In addition, the course can be modified for high school students. The course…

  2. Population and Human Development: A Course Curriculum Including Lesson Plans, Activities, and Bibliography. Revised.

    ERIC Educational Resources Information Center

    Murphy, Elaine M.; Long, Alison T.

    This course outline suggests materials and learning activities on the interrelated causes and consequences of population growth and other population matters. The document describes 15 class sessions which integrate information for sociology, anthropology, psychology, biology, animal behavior, and education. Topics include the history of human…

  3. Temporal behaviour profiles of Mus musculus in nature are affected by population activity.

    PubMed

    Robbers, Yuri; Koster, Eva A S; Krijbolder, Doortje I; Ruijs, Amanda; van Berloo, Sander; Meijer, Johanna H

    2015-02-01

    Animals have circadian clocks that govern their activity pattern, resulting in 24h rhythms in physiology and behaviour. Under laboratory conditions, light is the major external signal that affects temporal patterns in behaviour, and Mus musculus is strictly nocturnal in its behaviour. In the present study we questioned whether under natural conditions, environmental factors other than light affect the temporal profile of mice. In order to test this, we investigated the activity patterns of free-ranging M. musculus in a natural habitat, using sensors and a camera integrated into a recording unit that the mice could freely enter and leave. Our data show that mice have seasonal fluctuations in activity duration (6.7±0.82 h in summer, 11.3±1.80 h in winter). Furthermore, although primarily nocturnal, wild mice also exhibit daytime activity from spring until late autumn. A multivariate analysis revealed that the major factor correlating with increased daytime activity was population activity, defined as the number of visits to the recording site. Day length had a small but significant effect. Further analysis revealed that the relative population activity (compared to the past couple of days) is a better predictor of daytime activity than absolute population activity. Light intensity and temperature did not have a significant effect on daytime activity. The amount of variance explained by external factors is 51.9%, leaving surprisingly little unexplained variance that might be attributed to the internal clock. Our data further indicate that mice determine population activity by comparing a given night with the preceding 2-7 nights, a time frame suggesting a role for olfactory cues. We conclude that relative population activity is a major factor controlling the temporal activity patterns of M. musculus in an unrestricted natural population.

  4. Combined Population Dynamics and Entropy Modelling Supports Patient Stratification in Chronic Myeloid Leukemia

    PubMed Central

    Brehme, Marc; Koschmieder, Steffen; Montazeri, Maryam; Copland, Mhairi; Oehler, Vivian G.; Radich, Jerald P.; Brümmendorf, Tim H.; Schuppert, Andreas

    2016-01-01

    Modelling the parameters of multistep carcinogenesis is key for a better understanding of cancer progression, biomarker identification and the design of individualized therapies. Using chronic myeloid leukemia (CML) as a paradigm for hierarchical disease evolution we show that combined population dynamic modelling and CML patient biopsy genomic analysis enables patient stratification at unprecedented resolution. Linking CD34+ similarity as a disease progression marker to patient-derived gene expression entropy separated established CML progression stages and uncovered additional heterogeneity within disease stages. Importantly, our patient data informed model enables quantitative approximation of individual patients’ disease history within chronic phase (CP) and significantly separates “early” from “late” CP. Our findings provide a novel rationale for personalized and genome-informed disease progression risk assessment that is independent and complementary to conventional measures of CML disease burden and prognosis. PMID:27048866

  5. Combined Population Dynamics and Entropy Modelling Supports Patient Stratification in Chronic Myeloid Leukemia

    NASA Astrophysics Data System (ADS)

    Brehme, Marc; Koschmieder, Steffen; Montazeri, Maryam; Copland, Mhairi; Oehler, Vivian G.; Radich, Jerald P.; Brümmendorf, Tim H.; Schuppert, Andreas

    2016-04-01

    Modelling the parameters of multistep carcinogenesis is key for a better understanding of cancer progression, biomarker identification and the design of individualized therapies. Using chronic myeloid leukemia (CML) as a paradigm for hierarchical disease evolution we show that combined population dynamic modelling and CML patient biopsy genomic analysis enables patient stratification at unprecedented resolution. Linking CD34+ similarity as a disease progression marker to patient-derived gene expression entropy separated established CML progression stages and uncovered additional heterogeneity within disease stages. Importantly, our patient data informed model enables quantitative approximation of individual patients’ disease history within chronic phase (CP) and significantly separates “early” from “late” CP. Our findings provide a novel rationale for personalized and genome-informed disease progression risk assessment that is independent and complementary to conventional measures of CML disease burden and prognosis.

  6. Creatine kinase activity in patients with diabetes mellitus type I and type II.

    PubMed

    Jevrić-Causević, Adlija; Malenica, Maja; Dujić, Tanja

    2006-08-01

    Diabetes mellitus can be looked upon as an array of diseases, all of which exhibit common symptoms. While pathogenesis of IDDM (insulin dependant diabetes mellitus) is well understood, the same is not true for diabetes mellitus type II. In the latter case, relative contribution of the two factors (insulin resistance or decreased insulin secretion) varies individually, being highly increased in peripheral tissues and strictly dependant on insulin for glucose uptake. Moreover, in patients with diabetes mellitus type II, disbalance at the level of regulation of glucose metabolism as well as lipid metabolism has been noted in skeletal muscles. It is normal to assume that in this type of diabetes, these changes are reflected at the level of total activity of enzyme creatine kinase. This experimental work was performed on a group of 80 regular patients of Sarajevo General Hospital. Forty of those patients were classified as patients with diabetes type I and forty as patients with diabetes type II. Each group of patients was carefully chosen and constituted of equal number of males and females. The same was applied for adequate controls. Concentration of glucose was determined for each patient with GOD method, while activity of creatine kinase was determined with CK-NAC activated kit. Statistical analysis of the results was performed with SPSS software for Windows. Obtained results point out highly expressed differences in enzyme activity between two populations examined. Changes in enzyme activity are more expressed in patients with diabetes type II. Positive correlation between concentration of glucose and serum activity of the enzyme is seen in both categories of diabetic patients which is not the case for the patients in control group. At the same time, correlation between age and type of diabetes does exist . This is not followed at the level of enzyme activity or concentration of glucose.

  7. Evaluation of properties of the Vestibular Disorders Activities of Daily Living Scale (Brazilian version) in an elderly population

    PubMed Central

    Ricci, Natalia A.; Aratani, Mayra C.; Caovilla, Heloisa H.; Cohen, Helen S.; Ganança, Fernando F.

    2014-01-01

    Background The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. Objective This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. Results Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. Conclusions This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders. PMID:24676704

  8. Elderly multiple myeloma patients experience less deterioration in health-related quality of life than younger patients compared to a normative population: a study from the population-based PROFILES registry.

    PubMed

    van der Poel, M W M; Oerlemans, S; Schouten, H C; van de Poll-Franse, L V

    2015-04-01

    The objectives of this study were to compare health-related quality of life (HRQOL) between multiple myeloma (MM) patients aged ≤65 and >65 years and to compare this with a normative population. Factors associated with HRQOL were identified. The population-based Eindhoven Cancer Registry was used to select MM patients diagnosed from 1999 to 2010. Patients (n = 289) were invited to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire Multiple Myeloma Module 20 (QLQ-MY20), and 212 patients responded (73 %). Data from the normative population (n = 568) were used for comparison. MM patients >65 years scored better on emotional functioning (p < 0.05) and financial problems (p < 0.01) compared to patients ≤65 years. Patients ≤65 years reported better body image and future perspective (p < 0.01). Compared to the normative population, patients ≤65 years scored worse on all EORTC QLQ-C30 functioning scales and on global health/QOL, fatigue, pain, dyspnea, appetite loss, and financial problems (p < 0.01). Patients >65 years scored worse on social, physical, and role functioning and on global health/QOL, fatigue, pain, and dyspnea (p < 0.01). Younger patients had worse HRQOL compared to the normative population than elderly patients. Patients with comorbidities reported lower QOL. The longer the time since diagnosis, the better the physical functioning. No major differences in HRQOL were found between younger and older MM patients. Compared to that of the normative population, HRQOL in younger patients was worse than that in older patients. The number of comorbidities and time since diagnosis were associated with HRQOL. MM patients reported that a high symptom burden and therapy should, besides prolonging survival, be aimed at improving HRQOL.

  9. [Standard radiological characteristics of thoracic sites of tuberculosis in patients with AIDS in a Tunisian population].

    PubMed

    Tiouiri, H; Louzir, B; Ben Salem, N; Beji, M; Kilani, B; Gastli, M; Daghfous, J; Zribi, A

    1995-01-01

    Aspects of tuberculosis on the standard chest X-ray in a population of 18 AIDS patients in Tunisia were examined. The diagnosis of pulmonary tuberculosis was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlagement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, would be explained by immunoradiologic correlation. Thus it is necessary to search for the tuberculosis bacilli in all patients with HIV infection whatever the aspect on the standard chest X-ray.

  10. Population Pharmacokinetics of Colistin Methanesulfonate and Formed Colistin in Critically Ill Patients from a Multicenter Study Provide Dosing Suggestions for Various Categories of Patients

    PubMed Central

    Garonzik, S. M.; Li, J.; Thamlikitkul, V.; Paterson, D. L.; Shoham, S.; Jacob, J.; Silveira, F. P.; Forrest, A.; Nation, R. L.

    2011-01-01

    With increasing clinical emergence of multidrug-resistant Gram-negative pathogens and the paucity of new agents to combat these infections, colistin (administered as its inactive prodrug colistin methanesulfonate [CMS]) has reemerged as a treatment option, especially for critically ill patients. There has been a dearth of pharmacokinetic (PK) data available to guide dosing in critically ill patients, including those on renal replacement therapy. In an ongoing study to develop a population PK model for CMS and colistin, 105 patients have been studied to date; these included 12 patients on hemodialysis and 4 on continuous renal replacement therapy. For patients not on renal replacement, there was a wide variance in creatinine clearance, ranging from 3 to 169 ml/min/1.73 m2. Each patient was treated with a physician-selected CMS dosage regimen, and 8 blood samples for PK analysis were collected across a dosage interval on day 3 or 4 of therapy. A linear PK model with two compartments for CMS and one compartment for formed colistin best described the data. Covariates included creatinine clearance on the total clearance of CMS and colistin, as well as body weight on the central volume of CMS. Model-fitted parameter estimates were used to derive suggested loading and maintenance dosing regimens for various categories of patients, including those on hemodialysis and continuous renal replacement. Based on our current understanding of colistin PK and pharmacodynamic relationships, colistin may best be used as part of a highly active combination, especially for patients with moderate to good renal function and/or for organisms with MICs of ≥1.0 mg/liter. PMID:21555763

  11. eSalud: Designing and Implementing Culturally Competent eHealth Research With Latino Patient Populations

    PubMed Central

    Banas, Jennifer; Smith, Jeremiah; Languido, Lauren; Shen, Elaine; Gutierrez, Sandra; Cordero, Evelyn; Flores, Lucia

    2014-01-01

    eHealth is characterized by technology-enabled processes, systems, and applications that expedite accurate, real-time health information, feedback, and skill development to advance patient-centered care. When designed and applied in a culturally competent manner, eHealth tools can be particularly beneficial for traditionally marginalized ethnic minority groups, such as Latinos, a group that has been identified as being at the forefront of emerging technology use in the United States. In this analytic overview, we describe current eHealth research that has been conducted with Latino patient populations. In addition, we highlight cultural and linguistic factors that should be considered during the design and implementation of eHealth interventions with this population. With increasing disparities in preventive care information, behaviors, and services, as well as health care access in general, culturally competent eHealth tools hold great promise to help narrow this gap and empower communities. PMID:25320901

  12. Assessing the Comorbidity Gap between Clinical Studies and Prevalence in Elderly Patient Populations

    PubMed Central

    He, Zhe; Charness, Neil; Bian, Jiang; Hogan, William R.

    2016-01-01

    Well-designed and well-conducted clinical studies represent gold standard approaches for generating medical evidence. However, elderly populations are systematically underrepresented in studies across major chronic medical conditions, which has hampered the generalizability (external validity) of studies to the real-world patient population. It is the norm that intervention studies often require a homogeneous cohort to test their hypotheses; therefore older adults with co-medications and comorbidities are often excluded. The purpose of this study is to assess the gap between clinical studies on comorbidities and prevalence in elderly populations derived from the National Health and Nutrition Examination Survey (NHANES) and the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) dataset. A comorbidity gap between them was observed and reported in this work.

  13. Detecting bladder fullness through the ensemble activity patterns of the spinal cord unit population in a somatovisceral convergence environment

    NASA Astrophysics Data System (ADS)

    Park, Jae Hong; Kim, Chang-Eop; Shin, Jaewoo; Im, Changkyun; Koh, Chin Su; Seo, In Seok; Kim, Sang Jeong; Shin, Hyung-Cheul

    2013-10-01

    Objective. Chronic monitoring of the state of the bladder can be used to notify patients with urinary dysfunction when the bladder should be voided. Given that many spinal neurons respond both to somatic and visceral inputs, it is necessary to extract bladder information selectively from the spinal cord. Here, we hypothesize that sensory information with distinct modalities should be represented by the distinct ensemble activity patterns within the neuronal population and, therefore, analyzing the activity patterns of the neuronal population could distinguish bladder fullness from somatic stimuli. Approach. We simultaneously recorded 26-27 single unit activities in response to bladder distension or tactile stimuli in the dorsal spinal cord of each Sprague-Dawley rat. In order to discriminate between bladder fullness and tactile stimulus inputs, we analyzed the ensemble activity patterns of the entire neuronal population. A support vector machine (SVM) was employed as a classifier, and discrimination performance was measured by k-fold cross-validation tests. Main results. Most of the units responding to bladder fullness also responded to the tactile stimuli (88.9-100%). The SVM classifier precisely distinguished the bladder fullness from the somatic input (100%), indicating that the ensemble activity patterns of the unit population in the spinal cord are distinct enough to identify the current input modality. Moreover, our ensemble activity pattern-based classifier showed high robustness against random losses of signals. Significance. This study is the first to demonstrate that the two main issues of electroneurographic monitoring of bladder fullness, low signals and selectiveness, can be solved by an ensemble activity pattern-based approach, improving the feasibility of chronic monitoring of bladder fullness by neural recording.

  14. Bone mineral density and body composition in a myelomeningocele children population: effects of walking ability and sport activity.

    PubMed

    Ausili, E; Focarelli, B; Tabacco, F; Fortunelli, G; Caradonna, P; Massimi, L; Sigismondi, M; Salvaggio, E; Rendeli, C

    2008-01-01

    Myelomeningocele causes serious locomotor disability, osteoporosis and pathologic fractures. The aim of this study was to investigate the relationship between body composition, bone mineral density, walking ability and sport activity in myelomeningocele children. 60 patients aged between 5 and 14 yrs with myelomeningocele (22 ambulatory and 38 non-ambulatory), were studied. Fat mass and fat-free-mass were calculated by anthropometry. The bone mineral density at lumbar and femoral neck were evaluated. Bone mineral density at the lumbar and femoral neck was lower than in the normal population. In the non-ambulaty group, bone mineral density was approximately 1 SD lower than in the ambulatory one (p < 0.01). Fat mass was greater than expected but without significantly differences between walking group (mean 26%) and wheel-chair users (25%). Patients practised sport activity had a better bone mineral density and body fat compared with other patients with the same disability. Patients with myelomeningocele have decreased bone mineral density and are at higher risk of pathologic bone fractures. All subjects showed an excess of fat as percentage of body weight and are shorter than normal children. The measurement of bone mineral density may help to identify those patients at greatest risk of suffering of multiple fractures. Walk ability and sport activity, associated with the development of muscle mass, are important factors in promoting bone and body growth, to reduce the risk of obesity and of pathological fractures. PMID:19146196

  15. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study

    PubMed Central

    Forni Ogna, Valentina; Ogna, Adam; Pruijm, Menno; Bassi, Isabelle; Zuercher, Emilie; Halabi, Georges; Phan, Olivier; Bullani, Roberto; Teta, Daniel; Gauthier, Thierry; Cherpillod, Anne; Mathieu, Claudine; Mihalache, Alexandra; Cornette, Francoise; Haba-Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-01-01

    Background. Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm. Methods. 104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin's Questionnaire, and Adjusted Neck Circumference. The OSA predictors were identified on a derivation population and used to develop the diagnostic algorithm, which was validated on an independent population. Results. We found 56% OSA prevalence (AHI ≥ 15/h), which was largely underdiagnosed. Screening scores showed poor performance for OSA screening (ROC areas 0.538 [SE 0.093] to 0.655 [SE 0.083]). Age, neck circumference, and time on renal replacement therapy were the best predictors of OSA and were used to develop a screening algorithm, with higher discriminatory performance than classical screening tools (ROC area 0.831 [0.066]). Conclusions. Our study confirms the high OSA prevalence and highlights the low diagnosis rate of this treatable cardiovascular risk factor in the hemodialysis population. Considering the poor performance of OSA screening tools, we propose and validate a specific algorithm to identify hemodialysis patients at risk for OSA for whom further sleep investigations should be considered. PMID:26229952

  16. Effects of an Individualized Activity Program on Elderly Patients

    ERIC Educational Resources Information Center

    Salter, Carlota de Lerma; Salter, Charles A.

    1975-01-01

    A combined program of Reality Orientation, Activities of Daily Living, and Recreational Activities, together with environmental stimulation, was applied on an individualized basis to 21 elderly patients suffering from both psychological disorders and long-term physical illness. The motivation to participate in the available activities increased…

  17. Long Live Rock! Exploring Active Microbial Populations in North Pond Subsurface Basalt

    NASA Astrophysics Data System (ADS)

    Mills, H. J.; Lehne, J.

    2014-12-01

    Microbial life should be considered as an active source for subsurface alterations of crustal material. Over the past several decades, microbial populations have been qualitatively and quantitatively characterized in marine sediments from the near shore to gyre centers, from the surface to two kilometers below the surface. Recent exploration of the underlying basement has revealed bacterial populations within the basalt. Initial cultivation-based and in situ analysis of subsurface basalt has produced some structural identification of populations that have the potential to alter the crust. Within this study, we have advanced this understanding by characterizing the metabolically active fraction of these populations. A 16S rRNA gene transcript approach was conducted using high throughput sequencing on RNA extracted from breccia, glass basalts and ultramafic basalts of the western flank of the Mid-Atlantic Ridge. Previous research has shown that the fluid within the basement is oxic. As expected, populations associated with aerobic metabolism were detected. In addition, iron-utilizing populations were observed to be metabolically active within the basalt samples characterized. Future characterization will reveal overlap between previous studies to determine the total versus metabolically active populations.

  18. Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study

    PubMed Central

    Hosseini, Seyed Mohammad Sadegh; Asgari, Ali; Rassafiani, Mehdi; Yazdani, Farzaneh; Mazdeh, Mehrdokht

    2016-01-01

    Background: Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture. Methods: In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities. Results: Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious. Conclusion: The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease. PMID:27123437

  19. Population Pharmacokinetics of Doripenem in Critically Ill Patients with Sepsis in a Malaysian Intensive Care Unit

    PubMed Central

    Abd Rahman, Azrin N.; Mat-Nor, Mohd-Basri; Sulaiman, Helmi; Wallis, Steven C.; Lipman, Jeffrey; Roberts, Jason A.; Staatz, Christine E.

    2015-01-01

    Doripenem has been recently introduced in Malaysia and is used for severe infections in the intensive care unit. However, limited data currently exist to guide optimal dosing in this scenario. We aimed to describe the population pharmacokinetics of doripenem in Malaysian critically ill patients with sepsis and use Monte Carlo dosing simulations to develop clinically relevant dosing guidelines for these patients. In this pharmacokinetic study, 12 critically ill adult patients with sepsis receiving 500 mg of doripenem every 8 h as a 1-hour infusion were enrolled. Serial blood samples were collected on 2 different days, and population pharmacokinetic analysis was performed using a nonlinear mixed-effects modeling approach. A two-compartment linear model with between-subject and between-occasion variability on clearance was adequate in describing the data. The typical volume of distribution and clearance of doripenem in this cohort were 0.47 liters/kg and 0.14 liters/kg/h, respectively. Doripenem clearance was significantly influenced by patients' creatinine clearance (CLCR), such that a 30-ml/min increase in the estimated CLCR would increase doripenem CL by 52%. Monte Carlo dosing simulations suggested that, for pathogens with a MIC of 8 mg/liter, a dose of 1,000 mg every 8 h as a 4-h infusion is optimal for patients with a CLCR of 30 to 100 ml/min, while a dose of 2,000 mg every 8 h as a 4-h infusion is best for patients manifesting a CLCR of >100 ml/min. Findings from this study suggest that, for doripenem usage in Malaysian critically ill patients, an alternative dosing approach may be meritorious, particularly when multidrug resistance pathogens are involved. PMID:26482304

  20. Population Pharmacokinetics of Doripenem in Critically Ill Patients with Sepsis in a Malaysian Intensive Care Unit.

    PubMed

    Abdul-Aziz, Mohd H; Abd Rahman, Azrin N; Mat-Nor, Mohd-Basri; Sulaiman, Helmi; Wallis, Steven C; Lipman, Jeffrey; Roberts, Jason A; Staatz, Christine E

    2015-10-19

    Doripenem has been recently introduced in Malaysia and is used for severe infections in the intensive care unit. However, limited data currently exist to guide optimal dosing in this scenario. We aimed to describe the population pharmacokinetics of doripenem in Malaysian critically ill patients with sepsis and use Monte Carlo dosing simulations to develop clinically relevant dosing guidelines for these patients. In this pharmacokinetic study, 12 critically ill adult patients with sepsis receiving 500 mg of doripenem every 8 h as a 1-hour infusion were enrolled. Serial blood samples were collected on 2 different days, and population pharmacokinetic analysis was performed using a nonlinear mixed-effects modeling approach. A two-compartment linear model with between-subject and between-occasion variability on clearance was adequate in describing the data. The typical volume of distribution and clearance of doripenem in this cohort were 0.47 liters/kg and 0.14 liters/kg/h, respectively. Doripenem clearance was significantly influenced by patients' creatinine clearance (CL(CR)), such that a 30-ml/min increase in the estimated CL(CR) would increase doripenem CL by 52%. Monte Carlo dosing simulations suggested that, for pathogens with a MIC of 8 mg/liter, a dose of 1,000 mg every 8 h as a 4-h infusion is optimal for patients with a CL(CR) of 30 to 100 ml/min, while a dose of 2,000 mg every 8 h as a 4-h infusion is best for patients manifesting a CL(CR) of >100 ml/min. Findings from this study suggest that, for doripenem usage in Malaysian critically ill patients, an alternative dosing approach may be meritorious, particularly when multidrug resistance pathogens are involved.

  1. Recommendations for physical activity in patients with multiple sclerosis.

    PubMed

    Petajan, J H; White, A T

    1999-03-01

    For many years, patients with multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, have been advised to avoid exercise. MS is believed to be autoimmune in origin, mediated by activated T cells which penetrate the blood-brain barrier and attack myelin. The pathophysiology, with respect to function is an impairment of saltatory conduction, specifically, slowing of conduction speed and/or conduction block. Symptoms can temporarily worsen on exposure to heat or during physical exercise. Exercise programmes must be designed to activate working muscles but avoid overload that results in conduction block. Fatigue, often severe, affects about 85% of MS patients and, along with motor and sensory symptoms, results in decreased mobility and reduced quality of life. Physical activity and recreation are reduced in patients with MS. Before developing recommendations, physical activity patterns and the physical effects of MS should be assessed in individual patients. Patients may then be functionally classified. Physical activity can also be classified in a pyramid structure, with the most basic functions forming the base and the most integrated functions on top. The muscular fitness pyramid progresses through passive range of motion, active resistive, specific strengthening and integrated strength exercises Overall physical activity may be increased according to functional level by performing activities of daily living, incorporating inefficiencies into daily living, pursuing more active recreation and eventually developing a structured exercise programme. The importance of the proper exercise environment, balance and coordination issues and factors related to adherence are discussed. PMID:10222541

  2. Parthenolide induces MITF-M downregulation and senescence in patient-derived MITF-Mhigh melanoma cell populations

    PubMed Central

    Hartman, Mariusz L.; Talar, Beata; Sztiller-Sikorska, Malgorzata; Nejc, Dariusz; Czyz, Malgorzata

    2016-01-01

    The activity of the M isoform of microphthalmia-associated transcription factor (MITF-M) has been attributed to regulation of differentiation, proliferation, survival and senescence of melanoma cells. MITF expression was shown to be antagonized by the activation of transcription factor NF-κB. Parthenolide, an inhibitor of NF-κB, has not been yet reported to affect MITF-M expression. Our results obtained in patient-derived melanoma cell populations indicate that parthenolide efficiently decreases the MITF-M level. This is neither dependent on p65/NF-κB signaling nor RAF/MEK/ERK pathway activity as inhibition of MEK by GSK1120212 (trametinib) and induction of ERK1/2 activity by parthenolide itself do not interfere with parthenolide-triggered depletion of MITF-M in both wild-type BRAF and BRAFV600E melanoma populations. Parthenolide activity is not prevented by inhibitors of caspases, proteasomal and lysosomal pathways. As parthenolide reduces MITF-M transcript level and HDAC1 protein level, parthenolide-activated depletion of MITF-M protein may be considered as a result of transcriptional regulation, however, the influence of parthenolide on other elements of a dynamic control over MITF-M cannot be ruled out. Parthenolide induces diverse effects in melanoma cells, from death to senescence. The mode of the response to parthenolide is bound to the molecular characteristics of melanoma cells, particularly to the basal MITF-M expression level but other cell-autonomous differences such as NF-κB activity and MCL-1 level might also contribute. Our data suggest that parthenolide can be developed as a drug used in combination therapy against melanoma when simultaneous inhibition of MITF-M, NF-κB and HDAC1 is needed. PMID:26824319

  3. Indomethacin augments lymphokine-activated killer cell generation by patients with malignant mesothelioma

    SciTech Connect

    Manning, L.S.; Bowman, R.V.; Davis, M.R.; Musk, A.W.; Robinson, B.W. )

    1989-10-01

    Human malignant mesothelioma (MM) cells are resistant to natural killer (NK) cell lysis but susceptible to lysis by lymphokine-activated killer (LAK) cells from control individuals. The present study was performed to determine the capacity of patients with MM (n = 22) and individuals occupationally exposed to asbestos (the major population at risk of developing this disease, n = 52) to generate LAK cells capable of effectively lysing human mesothelioma cells. Compared to controls (n = 20), both patient groups demonstrated significantly depressed LAK cell activity against mesothelioma tumor cell targets (55 +/- 3% lysis by controls vs 34 +/- 3% lysis by patients with MM, P less than 0.005; and 45 +/- 3% lysis by asbestos-exposed individuals, P less than 0.025). Addition of 10 micrograms/ml indomethacin during LAK cell generation restored normal LAK cell activity for patients with MM (52 +/- 6% lysis of cultured human MM cells, P = NS compared to controls), suggesting that the defective cytolytic cell function observed in some patients with MM is a result of prostaglandin-induced immunosuppression. The ability of indomethacin to restore suppressed LAK cell activity in patients with MM suggests that the concomitant use of this agent in ex vivo LAK cell generation and in patients undergoing interleukin/LAK cell therapy may be beneficial.

  4. OVERCOMING BARRIERS To DIVERSITY IN CHIROPRACTIC PATIENT AND PRACTITIONER POPULATIONS: A COMMENTARY.

    PubMed

    Young, Kenneth J

    2015-01-01

    Increasing the diversity of practitioner and patient populations has been identified as a worthy goal in the chiropractic profession, which has predominantly white male practitioners and white female patients in the USA. Toward that end, 'diversity' has been the topic of several papers and was the theme of a 2012 conference of chiropractic educators. However, generally just the microcosm of the interactions of practitioners with patients or teachers with students has been discussed. The macrocosm of larger societal issues and government policies has not been broached. Examples of issues and policies that affect diversity within a profession include portrayals of, and value judgements on diversity by the media and politicians, as well as public funding for healthcare and education. Diversity was defined in this paper to mean differences in race, sex, sexual orientation, economic status, ethnicity, religion and other life circumstances in a population. The purpose of this paper is to raise awareness of evidence that social issues and government policy affect the diversity of practitioners and patients, and to suggest that the barriers to diversity present in these realms be addressed with a cogent, profession-wide effort in order to help increase the diversity of people involved with chiropractic. PMID:26647486

  5. OVERCOMING BARRIERS To DIVERSITY IN CHIROPRACTIC PATIENT AND PRACTITIONER POPULATIONS: A COMMENTARY.

    PubMed

    Young, Kenneth J

    2015-01-01

    Increasing the diversity of practitioner and patient populations has been identified as a worthy goal in the chiropractic profession, which has predominantly white male practitioners and white female patients in the USA. Toward that end, 'diversity' has been the topic of several papers and was the theme of a 2012 conference of chiropractic educators. However, generally just the microcosm of the interactions of practitioners with patients or teachers with students has been discussed. The macrocosm of larger societal issues and government policies has not been broached. Examples of issues and policies that affect diversity within a profession include portrayals of, and value judgements on diversity by the media and politicians, as well as public funding for healthcare and education. Diversity was defined in this paper to mean differences in race, sex, sexual orientation, economic status, ethnicity, religion and other life circumstances in a population. The purpose of this paper is to raise awareness of evidence that social issues and government policy affect the diversity of practitioners and patients, and to suggest that the barriers to diversity present in these realms be addressed with a cogent, profession-wide effort in order to help increase the diversity of people involved with chiropractic.

  6. Banding cytogenetic analysis in pediatric patients with acute lymphoblastic leukemia (ALL) in a Brazilian population

    PubMed Central

    2013-01-01

    Background Cytogenetic studies in Brazilian population about childhood acute lymphoblastic leukemia (ALL), the most common childhood malignancy, are scarce. Moreover, Brazilian race is very heterogeneous and is made by the confluence of people of several different origins, from the original Native Brazilians, with the influx of Portuguese colonizers, Black African slaves, and recent European, Arab and Japanese immigration. The purpose of this prospective, multicentric study was to assess the sociodemographic, clinic and cytogenetic characteristics of the children treated for ALL in the Northeast region of Brazil. Results This study includes thirty patients between 4 months and 17 years old treated for ALL from January 1st, 2009 to November 30th, 2010. Cytogenetic analysis showed that in nineteen out of thirty patients (64%) presented some chromosome abnormalities, in which 53% corresponds to numerical abnormalities, 21% structural and numerical abnormalities, and 26% only structural changes. Moreover, seven patients presented complexes karyotype not yet described in the literature. Taken together these results show the importance of the cytogenetic analysis in ALL pediatric patients and illustrates that the studied population presented unexpected complexes karyotypes which were correlated to poor outcome. Conclusion The results demonstrate the importance of banding cytogenetics for ALL diagnosis despite the use of most modern techniques such as FISH and aCGH, and provide reliable insight into the ALL in Brazil. PMID:24025689

  7. Dust Mites Population in Indoor Houses of Suspected Allergic Patients of South Assam, India

    PubMed Central

    Sharma, Dhruba; Dutta, B. K.; Singh, A. B.

    2011-01-01

    Background. In the present study, quality and quantity of indoor dust mites was evaluated at the residence of 150 atopic allergic patients from four different districts of South Assam. Methods. Suspected patients with case history of allergic disease were selected for indoor survey. Dust samples (500 mg) were collected from the selected patient's house and were analyzed using standard methods. Results. About 60% of the selected patients were found suffering from respiratory disorders and rest 40% from skin allergy. The dominant mites recorded from indoor dust samples were Dermatophagoides followed by Blomia, Acarus, and Cheyletus while Caloglyphus was recorded in least number. The distribution of mites on the basis of housing pattern indicates that RCC type of buildings supports maximum dust mite's population followed by Assam type (semi-RCC) buildings, and the lowest count was observed in wooden houses. Environmental factors like temperature, rainfall, and relative humidity are found to determine the indoor mite's population. Severity of allergic attack in some of the typical cases was found to be proportional to the allergen load of mites in the dust samples. Conclusions. The economic status, housing pattern, and local environmental factors determine the diversity and abundance of dust mites in indoor environment. PMID:23724231

  8. Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population.

    PubMed

    Walton, R G; Hudak, R; Green-Waite, R J

    This study was designed to ascertain whether individuals with mood disorders are particularly vulnerable to adverse effects of aspartame. Although the protocol required the recruitment of 40 patients with unipolar depression and a similar number of individuals without a psychiatric history, the project was halted by the Institutional Review Board after a total of 13 individuals had completed the study because of the severity of reactions within the group of patients with a history of depression. In a crossover design, subjects received aspartame 30 mg/kg/day or placebo for 7 days. Despite the small n, there was a significant difference between aspartame and placebo in number and severity of symptoms for patients with a history of depression, whereas for individuals without such a history there was not. We conclude that individuals with mood disorders are particularly sensitive to this artificial sweetener and its use in this population should be discouraged.

  9. Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

    PubMed Central

    Lin, Jui-An; Liao, Chien-Chang; Chang, Chuen-Chau; Chang, Hang; Chen, Ta-Liang

    2011-01-01

    Background Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. Methods A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. Results Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. Conclusion Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients. PMID:22046425

  10. Emotional dysfunction in a geriatric population: staff observations and patients' reports.

    PubMed

    Guilmette, T J; Snow, M G; Grace, J; Giuliano, A J

    1992-06-01

    This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Prevalence of Active and Passive Smoking among Adult Population: Findings of a Population-Based Survey in Kerman (KERCADRS), Iran

    PubMed Central

    Salimzadeh, Hamideh; Najafipour, Hamid; Mirzaiepour, Fatemeh; Navadeh, Soodabeh; Shadkam-Farrokhi, Mitra; Mirzazadeh, Ali

    2016-01-01

    Background Smoking is one of the major modifiable risk factors for non-communicable diseases. Our aim was to report the pattern of active and passive smoking using the data collected through a population-base household survey in Kerman, Iran [(KERCADRS) Kerman Coronary Artery Disease Risk Factors Study]. Methods Using a cluster random sampling design, we recruited 5900 adult persons (15-75 years old) into our survey. After consenting, every participant was interviewed by a trained interviewer. The section for smoking included questions about daily (smoking at least one cigarette per day), non-daily, past and passive cigarette smoking as well as the duration of the exposure. We used Kerman population distribution (as the target population) to adjust our estimates using direct standardization method. Findings Overall, 8.3% of study participants (15.5% in men vs. 0.8% in women, P = 0.010) reported themselves as daily smokers and an additional 1.7% (2.9% in men vs. 0.4% in women, P = 0.010) as non-daily smokers. The passive smoking was common in total (27.5%), while women experienced more exposure than men (30.1% vs. 25.0%, P = 0.010). In daily smokers, 3.2% smoked more than 20 cigarettes per day. Among passive smokers, 62.6% were exposed to cigarette smoke more than 6 days per week. Conclusion Smoking is pretty common among adult populations, particularly in men. A majority of tobacco-free young adult women are exposed to passive smoking. Age and gender oriented interventions are required to change this risk pattern in Kerman community to prevent from further smoking related morbidities and mortalities. PMID:27274789

  12. Association Study for 26 Candidate Loci in Idiopathic Pulmonary Fibrosis Patients from Four European Populations

    PubMed Central

    Kishore, Amit; Žižková, Veronika; Kocourková, Lenka; Petrkova, Jana; Bouros, Evangelos; Nunes, Hilario; Loštáková, Vladimíra; Müller-Quernheim, Joachim; Zissel, Gernot; Kolek, Vitezslav; Bouros, Demosthenes; Valeyre, Dominique; Petrek, Martin

    2016-01-01

    Idiopathic pulmonary fibrosis (IPF) affects lung parenchyma with progressing fibrosis. In this study, we aimed to replicate MUC5B rs35705950 variants and determine new plausible candidate variants for IPF among four different European populations. We genotyped 26 IPF candidate loci in 165 IPF patients from four European countries, such as Czech Republic (n = 41), Germany (n = 33), Greece (n = 40), France (n = 51), and performed association study comparing observed variant distribution with that obtained in a genetically similar Czech healthy control population (n = 96) described in our earlier data report. A highly significant association for a promoter variant (rs35705950) of mucin encoding MUC5B gene was observed in all IPF populations, individually and combined [odds ratio (95% confidence interval); p-value as 5.23 (8.94–3.06); 1.80 × 10−11]. Another non-coding variant, rs7934606 in MUC2 was significant among German patients [2.85 (5.05–1.60); 4.03 × 10−4] and combined European IPF cases [2.18 (3.16–1.50); 3.73 × 10−5]. The network analysis for these variants indicated gene–gene and gene–phenotype interactions in IPF and lung biology. With replication of MUC5B rs35705950 previously reported in U.S. populations of European descent and indicating other plausible polymorphic variants relevant for IPF, we provide additional reference information for future extended functional and population studies aimed, ideally with inclusion of clinical parameters, at identification of IPF genetic markers. PMID:27462317

  13. High Risk of Depressive Disorders in Patients With Gout: A Nationwide Population-Based Cohort Study.

    PubMed

    Changchien, Te-Chang; Yen, Yung-Chieh; Lin, Cheng-Li; Lin, Ming-Chia; Liang, Ji-An; Kao, Chia-Hung

    2015-12-01

    Metabolic abnormalities are common in patients with depressive disorders. However, the relationship between gout and depression is unclear. We explored the causal relationship among gout, antigout medication, and the associated risk of incidental depressive disorders.In this nationwide cohort study, we sampled data from the National Health Insurance Research Database to recruit 34,050 patients with gout as the gout cohort and 68,100 controls (without gout) as the nongout cohort. Our primary endpoint was the diagnosis of depressive disorders during follow-up. The overall study population was followed up until depression diagnosis, withdrawal from the NHI program, or the end of the study. The differences in demographic and clinical characteristics between both cohorts were determined using the Chi-square test for categorical variables and the t-test for continuous variables. Cox proportional hazard regression models were used to examine the effect of gout on the risk of depression, represented using the hazard ratio with the 95% confidence interval.Patients with gout exhibited a higher risk of depressive disorders than controls did. The risk of depressive disorders increased with age and was higher in female patients and those with hypertension, stroke, and coronary artery disease. Nonsteroidal antiinflammatory drug and prednisolone use was associated with a reduced risk of depression. Patients with gout who had received antigout medication exhibited a reduced risk of depressive disorders compared with nongout patients.Our findings support that gout increases the risk of depressive disorders, and that antigout medication use reduces the risk.

  14. Survival of patients with mixed phenotype acute leukemias: A large population-based study.

    PubMed

    Shi, Runhua; Munker, Reinhold

    2015-06-01

    Little is known about the incidence and treatment outcome of patients with acute biphenotypic leukemias. The World Health Organization (WHO) established the term of acute leukemia of ambiguous phenotype in 2001 (revised in 2008) introducing the term of mixed phenotype acute leukemias. Using the database of the Surveillance, Epidemiology, and End Results registry (SEER), we identified 313 patients with mixed phenotype acute leukemias and compared them with 14,739 patients with acute lymphoblastic leukemia and 34,326 patients with acute myelogenous leukemias diagnosed between 2001 and 2011. As a further control group, 1777 patients were included who were not classified as myeloid, lymphoid or biphenotypic (other acute leukemias). The incidence of mixed phenotype acute leukemias is 0.35 cases/1,000,000 person-years. In a multivariate analysis, the prognosis depends strongly on age (as with other leukemias) and it has the worst outcome of all four types of leukemia. However, the prognosis has improved, comparing 2001-2005 with 2006-2011. We present the first comprehensive, population-based study of acute biphenotypic or mixed phenotype acute leukemias according to the WHO classification. Especially in older patients, the prognosis is unfavorable and new treatments should be investigated.

  15. The risk of atrial fibrillation in patients with gout: a nationwide population-based study

    PubMed Central

    Kuo, Yu-Jui; Tsai, Tzu-Hsien; Chang, Hui-Ping; Chua, Sarah; Chung, Sheng-Ying; Yang, Cheng-Hsu; Lin, Cheng-Jei; Wu, Chiung-Jen; Hang, Chi-Ling

    2016-01-01

    Many studies have found that systemic inflammation plays an important role in the pathogenesis of atrial fibrillation (AF). Gout is a chronic systemic inflammatory disorder, but little evidence exists regarding whether the risk of AF is increased in patients with gout. The National Health Insurance Research Database in Taiwan was used in this study, and gout was defined as the occurrence of at least one episode of an acute gout attack requiring medical treatment. A total of 63264 gout and 63264 age- and gender-matched patients were included as the study population. The Cox model was used to evaluate the risk of AF in patients with gout. Patients with gout experienced a greater frequency of co-morbidities compared to patients without gout. The cumulative incidences of AF were 4.61% and 3.04% in patients with and without gout, respectively (log-rank test, P < 0.001). After adjusting for co-morbidities and prescription medication use, gout was found to be associated with AF [hazard ratio (HR), 1.38]. Moreover, the HR for AF decreased with increasing age in our study. Gout was found to be associated with an increased risk of developing AF after adjusting for potential confounders. PMID:27599578

  16. The risk of atrial fibrillation in patients with gout: a nationwide population-based study

    NASA Astrophysics Data System (ADS)

    Kuo, Yu-Jui; Tsai, Tzu-Hsien; Chang, Hui-Ping; Chua, Sarah; Chung, Sheng-Ying; Yang, Cheng-Hsu; Lin, Cheng-Jei; Wu, Chiung-Jen; Hang, Chi-Ling

    2016-09-01

    Many studies have found that systemic inflammation plays an important role in the pathogenesis of atrial fibrillation (AF). Gout is a chronic systemic inflammatory disorder, but little evidence exists regarding whether the risk of AF is increased in patients with gout. The National Health Insurance Research Database in Taiwan was used in this study, and gout was defined as the occurrence of at least one episode of an acute gout attack requiring medical treatment. A total of 63264 gout and 63264 age- and gender-matched patients were included as the study population. The Cox model was used to evaluate the risk of AF in patients with gout. Patients with gout experienced a greater frequency of co-morbidities compared to patients without gout. The cumulative incidences of AF were 4.61% and 3.04% in patients with and without gout, respectively (log-rank test, P < 0.001). After adjusting for co-morbidities and prescription medication use, gout was found to be associated with AF [hazard ratio (HR), 1.38]. Moreover, the HR for AF decreased with increasing age in our study. Gout was found to be associated with an increased risk of developing AF after adjusting for potential confounders.

  17. The risk of atrial fibrillation in patients with gout: a nationwide population-based study.

    PubMed

    Kuo, Yu-Jui; Tsai, Tzu-Hsien; Chang, Hui-Ping; Chua, Sarah; Chung, Sheng-Ying; Yang, Cheng-Hsu; Lin, Cheng-Jei; Wu, Chiung-Jen; Hang, Chi-Ling

    2016-01-01

    Many studies have found that systemic inflammation plays an important role in the pathogenesis of atrial fibrillation (AF). Gout is a chronic systemic inflammatory disorder, but little evidence exists regarding whether the risk of AF is increased in patients with gout. The National Health Insurance Research Database in Taiwan was used in this study, and gout was defined as the occurrence of at least one episode of an acute gout attack requiring medical treatment. A total of 63264 gout and 63264 age- and gender-matched patients were included as the study population. The Cox model was used to evaluate the risk of AF in patients with gout. Patients with gout experienced a greater frequency of co-morbidities compared to patients without gout. The cumulative incidences of AF were 4.61% and 3.04% in patients with and without gout, respectively (log-rank test, P < 0.001). After adjusting for co-morbidities and prescription medication use, gout was found to be associated with AF [hazard ratio (HR), 1.38]. Moreover, the HR for AF decreased with increasing age in our study. Gout was found to be associated with an increased risk of developing AF after adjusting for potential confounders. PMID:27599578

  18. Patient credentialing as a population health management strategy: a diabetes case study.

    PubMed

    Watson, Lindsay L; Bluml, Benjamin M; Skoufalos, Alexandria

    2015-06-01

    When given the opportunity to become actively involved in the decision-making process, patients can positively impact their health outcomes. Understanding how to empower patients to become informed consumers of health care services is an important strategy for addressing disparities and variability in care. Patient credentialing identifies people who have a certain diagnosis and have achieved certain levels of competency in understanding and managing their disease. Patient credentialing was developed to meet 3 core purposes: (1) enhance patient engagement by increasing personal accountability for health outcomes, (2) create a mass customization strategy for providers to deliver high-quality, patient-centered collaborative care, and (3) provide payers with a foundation for properly aligning health benefit incentives. The Patient Self-Management Credential for Diabetes, a first-of-its-kind, psychometrically validated tool, has been deployed within 3 practice-based research initiatives as a component of innovative diabetes care. Results from these projects show improved clinical outcomes, reduced health care costs, and a relationship between credential achievement levels and clinical markers of diabetes. Implementing patient credentialing as part of collaborative care delivered within various settings across the health care system may be an effective way to reduce disparities, improve access to care and appropriate treatments, incentivize patient engagement in managing their health, and expend time and resources in a customized way to meet individual needs.

  19. Population pharmacokinetics of sirolimus in de novo Chinese adult renal transplant patients

    PubMed Central

    Jiao, Zheng; Shi, Xiao-jin; Li, Zhong-dong; Zhong, Ming-kang

    2009-01-01

    AIMS This study was aimed at determining the population pharmacokinetics of sirolimus and identifying factors that explain pharmacokinetic variability in de novo Chinese adult renal transplant patients. METHODS Data were retrospectively extracted from a formal multicentre clinical trial, which was originally designed to evaluate the safety and efficacy of ciclosporin dose reduction and ciclosporin elimination in patients receiving sirolimus. All patients received 12-month treatment, i.e. induction therapy with ciclosporin, sirolimus and corticosteroids during the first 3 months followed by either ciclosporin dose reduction or ciclosporin discontinuation thereafter. Eight-hundred and four sirolimus trough blood concentrations (C0) from 112 patients were used to develop a population pharmacokinetic model using the nonmem program. A one-compartment model with first-order absorption and elimination was selected as the base model. The influence of demographic characteristics, biochemical and haematological indices, ciclosporin daily dose, ciclosporin C0 as well as other commonly used co-medications were explored. RESULTS The typical values with interindividual variability for apparent clearance (CL/F) and apparent volume of distribution (V/F) were 10.1 l h−1 (23.8%) and 3670 l (56.7%), respectively. The residual variability was 29.9%. CL/F decreased significantly with silymarin or glycyrrhizin co-therapy in hepatically impaired patients, and with increasing total cholesterol levels or ciclosporin C0. Moreover, CL/F increased nonlinearly with increasing sirolimus daily dose. The median parameter estimates from a nonparametric bootstrap procedure were comparable and within 5% of the estimates from nonmem. CONCLUSIONS These results provide important information for clinicians to optimize sirolimus regimens in Chinese renal transplant patients. PMID:19660003

  20. Effect of Obesity on the Population Pharmacokinetics of Meropenem in Critically Ill Patients.

    PubMed

    Alobaid, Abdulaziz S; Wallis, Steven C; Jarrett, Paul; Starr, Therese; Stuart, Janine; Lassig-Smith, Melissa; Ordóñez Mejia, Jenny Lisette; Roberts, Michael S; Lipman, Jeffrey; Roberts, Jason A

    2016-08-01

    Severe pathophysiological changes in critical illness can lead to dramatically altered antimicrobial pharmacokinetics (PK). The additional effect of obesity on PK potentially increases the challenge for effective dosing. The aim of this prospective study was to describe the population PK of meropenem for a cohort of critically ill patients, including obese and morbidly obese patients. Critically ill patients prescribed meropenem were recruited into the following three body mass index (BMI) groups: nonobese (18.5 to 29.9 kg/m(2)), obese (30.0 to 39.9 kg/m(2)), and morbidly obese (≥40 kg/m(2)). Serial plasma samples were taken, and meropenem concentrations were determined using a validated chromatographic method. Population PK analysis and Monte Carlo dosing simulations were undertaken with Pmetrics. Nineteen critically ill patients with different BMI categories were enrolled. The patients' mean ± standard deviation (SD) age, weight, and BMI were 49 ± 15.9 years, 95 ± 22.0 kg, and 33 ± 7.0 kg/m(2), respectively. A two-compartment model described the data adequately. The mean ± SD parameter estimates for the final covariate model were as follows: clearance (CL), 15.5 ± 6.0 liters/h; volume of distribution in the central compartment (V1), 11.7 ± 5.8 liters; intercompartmental clearance from the central compartment to the peripheral compartment, 25.6 ± 35.1 liters h(-1); and intercompartmental clearance from the peripheral compartment to the central compartment, 8.32 ± 12.24 liters h(-1) Higher creatinine clearance (CLCR) was associated with a lower probability of target attainment, with BMI having little effect. Although obesity was found to be associated with an increased V1, dose adjustment based on CLCR appears to be more important than patient BMI. PMID:27185798

  1. Management of Hypertension: Adapting New Guidelines for Active Patients.

    ERIC Educational Resources Information Center

    Tanji, Jeffrey L.; Batt, Mark E.

    1995-01-01

    Discusses recent guidelines on hypertension from the National Heart, Lung, and Blood Institute and details the latest management protocols for patients with high blood pressure. The article helps physicians interpret the guidelines for treating active patients, highlighting diagnosis, step care revision, pharmacology, and sports participation…

  2. Salivary Ceruloplasmin Ferroxidase & Oxidase Activities in Celiac Patients

    PubMed Central

    Hasan, Hathama R.; Ghadhban, Jasim M.; Abudal Kadhum, Zahraa I.

    2012-01-01

    The aim of the current study was to evaluate salivary ferroxidase ceruloplasmin activities in celiac patients with different histopathological severity. This study included 75 celiac patients with different mean age (18.68 ± 11.13) year, who had positive screen for celiac antibodies, and who had gastrointestinal symptoms. In order to simplify the comparison with the healthy control group, celiac patients were divided into two groups according to their histopathological severity: severe (marsh IIIa, b, c) & less severe (marsh 0, I). All these patients have been evaluating for salivary ceruloplasmin (Cp) concentration and Cp ferroxidase activities. To confirm the presence of the enzymatic activity of this protein, polyacrylamide gel electrophoresis was carried out and then stained for Cp ferroxidase, as well as for Cp oxidase activity. Furthermore, the concentrations of salivary total protein, albumin, and globulin were measured in the studied groups. A significant increase (p<0.05) in salivary concentration of ceruloplasmin was found in all above mentioned patients groups in comparison to that of the control group, except for total villous atrophy (marsh IIIc) patients subgroup. Salivary Cp ferroxidase activity revealed statistically significant decrease among the patient groups as well as between them and the control group. The result of salivary total protein and globulin showed presence a significant increase (p<0.05) in comparison to that of the control group. Meanwhile albumin levels was found to increase non-significantly (p=0.186). PMID:23675269

  3. Decreased Prolidase Activity in Patients with Posttraumatic Stress Disorder

    PubMed Central

    Bulut, Mahmut; Atli, Abdullah; Kaplan, İbrahim; Kaya, Mehmet Cemal; Bez, Yasin; Özdemir, Pınar Güzel; Sır, Aytekin

    2016-01-01

    Objective Many neurochemical systems have been implicated in the development of Posttraumatic Stress Disorder (PTSD). The prolidase enzyme is a cytosolic exopeptidase that detaches proline or hydroxyproline from the carboxyl terminal position of dipeptides. Prolidase has important biological effects, and to date, its role in the etiology of PTSD has not been studied. In the present study, we aimed to evaluate prolidase activity in patients with PTSD. Methods The study group consisted of patients who were diagnosed with PTSD after the earthquake that occurred in the province of Van in Turkey in 2011 (n=25); the first control group consisted of patients who experienced the earthquake but did not show PTSD symptoms (n=26) and the second control group consisted of patients who have never been exposed to a traumatic event (n=25). Prolidase activities in the patients and the control groups were determined by the ELISA method using commercial kits. Results Prolidase activity in the patient group was significantly lower when compared to the control groups. Prolidase activity was also significantly lower in the traumatized healthy subjects compared to the other healthy group (p<0.01). Conclusion The findings of the present study suggest that the decrease in prolidase activity may have neuroprotective effects in patients with PTSD. PMID:27482243

  4. Risk factors associated with serum levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor in a general population.

    PubMed

    Haupt, Thomas H; Kallemose, Thomas; Ladelund, Steen; Rasmussen, Line Jh; Thorball, Christian W; Andersen, Ove; Pisinger, Charlotta; Eugen-Olsen, Jesper

    2014-01-01

    The soluble urokinase plasminogen activator receptor (suPAR) is a biomarker of mortality risk in various patient populations. However, little is known about the implications of lifestyle for suPAR levels in the general population. Lifestyle, demographic, and cardiovascular disease (CVD) risk factor data were collected from 5,538 participants in the Danish population-based Inter99 study. Their suPAR levels were measured using a sandwich enzyme-linked immunosorbent assay. In the final adjusted model, smoking and morbid obesity were strongly associated with higher suPAR levels (P < 0.001). An unhealthy diet and alcohol abstinence in men were also associated with higher suPAR levels. Physical activity in leisure time had a modest impact on suPAR levels in univariate analysis, but not in the final adjusted model. In conclusion, smoking and morbid obesity were strongly associated with higher serum suPAR levels in this general population. Diet and alcohol consumption also seemed to impact suPAR levels. Lifestyle changes are likely to affect suPAR since ex-smokers had suPAR levels comparable to those of never-smokers. PMID:25574132

  5. Risk Factors Associated with Serum Levels of the Inflammatory Biomarker Soluble Urokinase Plasminogen Activator Receptor in a General Population

    PubMed Central

    Haupt, Thomas H; Kallemose, Thomas; Ladelund, Steen; Rasmussen, Line JH; Thorball, Christian W; Andersen, Ove; Pisinger, Charlotta; Eugen-Olsen, Jesper

    2014-01-01

    The soluble urokinase plasminogen activator receptor (suPAR) is a biomarker of mortality risk in various patient populations. However, little is known about the implications of lifestyle for suPAR levels in the general population. Lifestyle, demographic, and cardiovascular disease (CVD) risk factor data were collected from 5,538 participants in the Danish population-based Inter99 study. Their suPAR levels were measured using a sandwich enzyme-linked immunosorbent assay. In the final adjusted model, smoking and morbid obesity were strongly associated with higher suPAR levels (P < 0.001). An unhealthy diet and alcohol abstinence in men were also associated with higher suPAR levels. Physical activity in leisure time had a modest impact on suPAR levels in univariate analysis, but not in the final adjusted model. In conclusion, smoking and morbid obesity were strongly associated with higher serum suPAR levels in this general population. Diet and alcohol consumption also seemed to impact suPAR levels. Lifestyle changes are likely to affect suPAR since ex-smokers had suPAR levels comparable to those of never-smokers. PMID:25574132

  6. Self-efficacy, transition, and patient outcomes in the sickle cell disease population.

    PubMed

    Molter, Brittany L; Abrahamson, Kathleen

    2015-06-01

    Severe pain is a common symptom of sickle cell disease (SCD). Transitions between adult and pediatric care are a point of particular vulnerability for patients, increasing the risk for poor pain management. The purpose of this literature review was to investigate the relationships among self-efficacy, transition, and SCD health outcomes. A systematic literature search was performed within CINAHL, Academic Search Premier, MEDLINE, and PubMed on published papers between 2003 and 2013. After applying exclusion criteria, 20 articles were used in the final review. Few studies were identified that directly tested the relationship between self-efficacy and SCD outcomes. Although there are few studies on this topic, most demonstrated positive correlations between self-efficacy during transition and positive patient outcomes in the SCD population. Additional studies are needed to support causation. Studies were commonly limited by small sample sizes and attrition. Furthermore, there is a large gap in the literature regarding how self-efficacy can be increased in these patients. Interventions that promote self-efficacy have the potential to improve SCD pain outcomes, but more research is needed to develop interventions to increase these adolescents' self-efficacy. If providers can identify individuals in this population with low self-efficacy, they may be able to intervene early to improve patient outcomes. Most identified studies point to the positive correlation between self-efficacy and positive health outcomes in adolescents with SCD. Self-efficacy has the potential to guide self-care interventions and further research with the SCD population.

  7. Vatalanib population pharmacokinetics in patients with myelodysplastic syndrome: CALGB 10105 (Alliance)

    PubMed Central

    Wang, Xiaofeng; Owzar, Kouros; Gupta, Pankaj; Larson, Richard A; Mulkey, Flora; Miller, Antonius A; Lewis, Lionel D; Hurd, David; Vij, Ravi; Ratain, Mark J; Murry, Daryl J

    2014-01-01

    Aims Vatalanib is an oral anti-angiogenesis agent that inhibits vascular endothelial growth factor receptor tyrosine kinases, which in patients showed auto induction of metabolism and variability in pharmacokinetic (PK) disposition. The objective was to characterize the population PK and time-dependent change in vatalanib clearance and assess exposure–toxicity relationship in patients with myelodysplastic syndrome (MDS). Methods This was an open-label phase II study of vatalanib in MDS patients receiving 750–1250 mg once daily in 28-day cycles. Serial blood samples were obtained and plasma vatalanib concentrations measured by HPLC. Population PK analysis was performed using nonmem 7.2 with FO estimation since FOCE failed. The final model was evaluated using goodness-of-fit plots, bootstrap analysis, and visual predictive check. Results Pharmacokinetic data were complete for 137 patients (86 M, 51 F), of median age 70 years (range 20–91). A one-compartment model with lagged first-order absorption and time-dependent change in oral clearance was fitted to the vatalanib plasma concentration versus time data. The population means for pre-induction and post-induction oral clearance were 24.1 l h–1 (range: 9.6–45.5) and 54.9 l h–1 (range: 39.8–75.6), respectively. The apparent oral clearance increased 2.3-fold, (range: 1.7–4.1-fold) from first dose to steady state. Our data did not identify a significant relationship of the predefined covariates with vatalanib pharmacokinetics, although power to detect such a relationship was limited. Conclusions Vatalanib pharmacokinetics were highly variable and the extent of auto induction was not determined to correlate with any of the pre-defined covariates. PMID:24838014

  8. Physical Activity in a Total Population of Children and Adolescents with Cerebral Palsy

    ERIC Educational Resources Information Center

    Lauruschkus, Katarina; Westbom, Lena; Hallstrom, Inger; Wagner, Philippe; Nordmark, Eva

    2013-01-01

    The aims of this study were to describe the participation in physical activity of children with cerebral palsy (CP) at school and during leisure time and to identify characteristics associated with physical activity. The frequency of receiving physiotherapeutic interventions were described as a variable of interest. A total population of 364…

  9. Gamma band unit activity and population responses in the pedunculopontine nucleus.

    PubMed

    Simon, Christen; Kezunovic, Nebojsa; Ye, Meijun; Hyde, James; Hayar, A; Williams, D K; Garcia-Rill, E

    2010-07-01

    The pedunculopontine nucleus (PPN) is involved in the activated states of waking and paradoxical sleep, forming part of the reticular activating system (RAS). The studies described tested the hypothesis that single unit and/or population responses of PPN neurons are capable of generating gamma band frequency activity. Whole cell patch clamp recordings (immersion chamber) and population responses (interface chamber) were conducted on 9- to 20-day-old rat brain stem slices. Regardless of cell type (I, II, or III) or type of response to the nonselective cholinergic receptor agonist carbachol (excitation, inhibition, biphasic), almost all PPN neurons fired at gamma band frequency, but no higher, when subjected to depolarizing steps (50 +/- 2 Hz, mean +/- SE). Nonaccommodating neurons fired at 18-100 Hz throughout depolarizing steps, while most accommodating neurons exhibited gamma band frequency of action potentials followed by gamma band membrane oscillations. These oscillations were blocked by the sodium channel blocker tetrodotoxin (TTX), suggesting that at least some are mediated by sodium currents. Population responses in the PPN showed that carbachol induced peaks of activation in the theta and gamma range, while glutamatergic receptor agonists induced overall increases in activity at theta and gamma frequencies, although in differing patterns. Gamma band activity appears to be a part of the intrinsic membrane properties of PPN neurons, and the population as a whole generates different patterns of gamma band activity under the influence of specific transmitters. Given sufficient excitation, the PPN may impart gamma band activation on its targets. PMID:20463196

  10. Hematological and Biochemical Markers of Iron Status in a Male, Young, Physically Active Population

    PubMed Central

    Nunes, Lázaro Alessandro Soares; Grotto, Helena Zerlotti W.; Brenzikofer, René; Macedo, Denise Vaz

    2014-01-01

    The aim of this study was to establish reference intervals (RIs) for the hemogram and iron status biomarkers in a physically active population. The study population included male volunteers (n = 150) with an average age of 19 ± 1 years who had participated in a regular and controlled exercise program for four months. Blood samples were collected to determine hematological parameters using a Sysmex XE-5000 analyzer (Sysmex, Kobe, Japan). Iron, total iron-binding capacity (TIBC), transferrin saturation and ferritin, and high-sensitivity C-reactive protein (CRP) concentrations in serum samples were measured using commercial kits (Roche Diagnostics, GmbH, Mannheim, Germany) and a Roche/Hitachi 902 analyzer. The RIs were established using the RefVal program 4.1b. The leucocyte count, TIBC, and CRP and ferritin concentrations exhibited higher RIs compared with those in a nonphysically active population. Thirty volunteers (outliers) were removed from the reference population due to blood abnormalities. Among the outliers, 46% exhibited higher CRP concentrations and lower concentrations of iron and reticulocyte hemoglobin compared with the nonphysically active population (P < 0.001). Our results showed that it is important to establish RIs for certain laboratory parameters in a physically active population, especially for tests related to the inflammatory response and iron metabolism. PMID:25045665

  11. Immunological changes in different patient populations with chronic hepatitis C virus infection

    PubMed Central

    Szereday, Laszlo; Meggyes, Matyas; Halasz, Melinda; Szekeres-Bartho, Julia; Par, Alajos; Par, Gabriella

    2016-01-01

    AIM: To investigate killer inhibitory and activating receptor expression by natural killer (NK), natural killer T-like (NKT-like) and CD8+ T lymphocytes in patients with chronic hepatitis C virus (HCV) infection with elevated and with persistently normal alanine aminotransferase (PNALT). METHODS: The percentage of peripheral blood Treg cells, KIR2DL3, ILT-2, KIR3DL1, CD160, NKG2D, NKG2C expressing NK, T and NKT-like cells, cytokine production and NK cytotoxicity were determined by flow cytometry. Twenty-one patients with chronic HCV infection with elevated alanine aminotransferase, 11 HCV carriers with persistently normal alanine aminotransferase and 15 healthy volunteers were enrolled. RESULTS: No significant differences were observed in the percentage of total T, NK or NKT-like cells between study groups. Comparing the activating and inhibitory receptor expression by NK cells obtained from HCV carriers with PNALT and chronic HCV hepatitis patients with elevated alanine aminotransferase, NKG2D activating receptor expression was the only receptor showing a significant difference. NKG2D expression of NK cells was significantly lower in patients with elevated alanine aminotransferase. The expression of CD160, NKG2D and NKG2C activating receptor by CD8+ T cells were significantly lower in patients with chronic HCV hepatitis than in healthy controls and in HCV carriers with PNALT. Plasma TGF-β1 levels inversely correlated with NKG2D expression by NK cells. In vitroTGF-β1 treatment inhibited NK cells cytotoxic activity and downregulated NKG2D expression. CD8+ T cells from HCV carriers with PNALT showed significantly elevated expression of CD160, NKG2D and NKG2C activating receptors compared to chronic HCV patients with elevated alanine aminotransferase. Enhanced expression of inhibitory KIR2DL3 receptor, and decreased ILT-2 expression on NK cells were also found in chronic hepatitis C patients compared to healthy controls. CONCLUSION: Our study demonstrated a complex

  12. [THE CERTAIN CLINICAL CHARACTERISTICS OF BLOOD IN PATIENTS WITH FAMILY MEDITERRANEAN FEVER OF ARMENIAN POPULATION].

    PubMed

    Pepoian, A Z; Arutunian, N; Grigorian, A; Tsaturian, V V; Manvelian, A M; Dilnian, E; Balaian, M A; Torok, T

    2015-06-01

    The study was carried out to evaluate erythrocyte sedimentation rate, glucose level, rheumatoid factor and C-reactive protein in blood of patients with periodic peritonitis at the stage of remission. Also, effect of colchicine on activity of lactase was analyzed. It is demonstrated that frequency of increase of levels of erythrocyte sedimentation rate and C-reactive protein during period of remission differed depending on gender while at the same time indicators of rheumatoid factor were within limits of normality in all patients. Despite research literature data establishing effect of colchicine on lactose assimilability, no significant inhibition of lactose activity was established in examined volunteers.

  13. Overexpression of a Novel Lymphocyte Population, Positive for an Intracellular CD14-Like Antigen, in Patients Positive for Human Immunodeficiency Virus Type 1

    PubMed Central

    Turner, Dan; Hoffman, Michael; Yust, Israel; Fried, Mordechai; Bleiberg, Margalit; Tartakovsky, Boris

    2004-01-01

    CD14, originally recognized as a lipopolysaccharide (LPS) receptor, has recently been implicated in the process of T-cell suppression and apoptosis. Its soluble form has been shown to bind, in vitro, to human T cells, a process that may carry a negative signal onto these cells. We recently described a novel lymphocyte population in human peripheral blood, a population that expresses an intracellular CD14-like antigen. This novel T-cell population, composed mainly of CD8 cells and of very few CD4 cells, was found to be greatly enhanced in asymptomatic, untreated human immunodeficiency virus (HIV)-positive individuals. In the present study, we further characterized this cell population and found that it differed from other CD8 subpopulations associated with HIV infection such as CD8/CD38. In addition, we followed HIV patients under conditions of highly active antiretroviral therapy (HAART) and observed two groups of patients: patients in whom the CD14-like positive-testing T cells returned to normal within 1 to 3 months, and patients in whom it did not, in spite of a significant plasma HIV-RNA viral load decrease. Thus, this new CD14-like positive-testing lymphocyte population may represent an interesting and important component of the cellular events associated with HIV infection. On the basis of its modulation following HAART, we speculate that it may be used, in the future, as a drug-monitoring cellular marker in antiretroviral treatment. PMID:15539503

  14. HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

    PubMed Central

    2013-01-01

    Objectives HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men. The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms. Methods We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion Habitual drug use is a risk factor for spreading HIV. It is also more

  15. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics

    PubMed Central

    Battelino, Tadej; Danne, Thomas; Hovorka, Roman; Jarosz‐Chobot, Przemyslawa; Renard, Eric

    2015-01-01

    Summary The level of glycaemic control necessary to achieve optimal short‐term and long‐term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid‐acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health‐related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid‐acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost‐effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid‐acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin

  16. Complement Activation in Patients with Focal Segmental Glomerulosclerosis

    PubMed Central

    Thurman, Joshua M.; Wong, Maria; Renner, Brandon; Frazer-Abel, Ashley; Giclas, Patricia C.; Joy, Melanie S.; Jalal, Diana; Radeva, Milena K.; Gassman, Jennifer; Gipson, Debbie S.; Kaskel, Frederick; Friedman, Aaron; Trachtman, Howard

    2015-01-01

    Background Recent pre-clinical studies have shown that complement activation contributes to glomerular and tubular injury in experimental FSGS. Although complement proteins are detected in the glomeruli of some patients with FSGS, it is not known whether this is due to complement activation or whether the proteins are simply trapped in sclerotic glomeruli. We measured complement activation fragments in the plasma and urine of patients with primary FSGS to determine whether complement activation is part of the disease process. Study Design Plasma and urine samples from patients with biopsy-proven FSGS who participated in the FSGS Clinical Trial were analyzed. Setting and Participants We identified 19 patients for whom samples were available from weeks 0, 26, 52 and 78. The results for these FSGS patients were compared to results in samples from 10 healthy controls, 10 patients with chronic kidney disease (CKD), 20 patients with vasculitis, and 23 patients with lupus nephritis. Outcomes Longitudinal control of proteinuria and estimated glomerular filtration rate (eGFR). Measurements Levels of the complement fragments Ba, Bb, C4a, and sC5b-9 in plasma and urine. Results Plasma and urine Ba, C4a, sC5b-9 were significantly higher in FSGS patients at the time of diagnosis than in the control groups. Plasma Ba levels inversely correlated with the eGFR at the time of diagnosis and at the end of the study. Plasma and urine Ba levels at the end of the study positively correlated with the level of proteinuria, the primary outcome of the study. Limitations Limited number of patients with samples from all time-points. Conclusions The complement system is activated in patients with primary FSGS, and elevated levels of plasma Ba correlate with more severe disease. Measurement of complement fragments may identify a subset of patients in whom the complement system is activated. Further investigations are needed to confirm our findings and to determine the prognostic significance of

  17. Adherence to Physical Activity Recommendations and Its Associated Factors: An Interregional Population-Based Study

    PubMed Central

    Alkerwi, Ala’a; Schuh, Barbara; Sauvageot, Nicolas; Zannad, Faiez; Olivier, Arnaud; Guillaume, Michèle; Albert, Adelin; Larsson, Charlotte A.

    2015-01-01

    Background Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity recommendations among populations and identified the demographic, socioeco-nomic, behavioural and health-related factors associated with good compliance. Design and methods Cross-sectional interregional NESCaV survey of 3133 subjects compared three populations, Luxembourg, Lorraine (France) and Wallonia (Belgium), by using the International Physical Activity Questionnaire. Age and gender prevalence rates of physical activity were standardized to the European population. Results The likelihood to meet the recommendations was higher in Luxembourg, after adjustment for age, gender, education, employment, weight status, morbidity score, health perception and level of importance attributed to the practice of physical activity (P<0.0001). The odds for meeting the recommendations were significantly higher among those with secondary than tertiary education. Compared to good self-health perception, subjects with poor or fair self-perceived health were less likely to meet the recommendations; this also applied to those attributing little or enough importance to physical activity compared with great importance. Conclusions Region, education, self-perceived health and perception of importance of physical activity were emerged as independent determinants of meeting the recommendations. Awareness of the positive health effects of physical activity might thus be crucial for motivating the people to become more active. Further research is needed to explore potential region-specific factors which might explain the difference in population behaviours with respect to physical activity. Significance for public health This manuscript describes the prevalence of physical activity level of adult population from three European regions, Luxembourg, Wallonia and Lorraine, based on the

  18. Synchronization of EEG activity in patients with bipolar disorder

    NASA Astrophysics Data System (ADS)

    Panischev, O. Yu; Demin, S. A.; Muhametshin, I. G.; Demina, N. Yu

    2015-12-01

    In paper we apply the method based on the Flicker-Noise Spectroscopy (FNS) to determine the differences in frequency-phase synchronization of the cortical electroencephalographic (EEG) activities in patients with bipolar disorder (BD). We found that for healthy subjects the frequency-phase synchronization of EEGs from long-range electrodes was significantly better for BD patients. In BD patients a high synchronization of EEGs was observed only for short-range electrodes. Thus, the FNS is a simple graphical method for qualitative analysis can be applied to identify the synchronization effects in EEG activity and, probably, may be used for the diagnosis of this syndrome.

  19. An Assessment of Patient Navigator Activities in Breast Cancer Patient Navigation Programs Using a Nine-Principle Framework

    PubMed Central

    Gunn, Christine M; Clark, Jack A; Battaglia, Tracy A; Freund, Karen M; Parker, Victoria A

    2014-01-01

    Objective To determine how closely a published model of navigation reflects the practice of navigation in breast cancer patient navigation programs. Data Source Observational field notes describing patient navigator activities collected from 10 purposefully sampled, foundation-funded breast cancer navigation programs in 2008–2009. Study Design An exploratory study evaluated a model framework for patient navigation published by Harold Freeman by using an a priori coding scheme based on model domains. Data Collection Field notes were compiled and coded. Inductive codes were added during analysis to characterize activities not included in the original model. Principal Findings Programs were consistent with individual-level principles representing tasks focused on individual patients. There was variation with respect to program-level principles that related to program organization and structure. Program characteristics such as the use of volunteer or clinical navigators were identified as contributors to patterns of model concordance. Conclusions This research provides a framework for defining the navigator role as focused on eliminating barriers through the provision of individual-level interventions. The diversity observed at the program level in these programs was a reflection of implementation according to target population. Further guidance may be required to assist patient navigation programs to define and tailor goals and measurement to community needs. PMID:24820445

  20. Virtual patients as activities: exploring the research implications of an activity theoretical stance.

    PubMed

    Ellaway, Rachel H

    2014-09-01

    Virtual patients are computer-based simulators of patient encounters for the purposes of instruction, practice, and assessment. Although virtual patients have been around for some time they have yet to become part of mainstream medical education. A major reason for this would seem to be a lack of clarity as to what educational value virtual patients actually have. This paper argues that virtual patients should be seen as activities rather than artifacts and that activity theory can be used to generate different ways to frame scholarship in and around virtual patients. Drawing on the work of Leont'ev and Engeström this paper describes a range of perspectives based on the operations, actions, and objectives in and around virtual patients; the use of virtual patients to mediate activities; and the sociocultural context and the participants in virtual patient activities. This approach allows us to move beyond the 'does or does not work' discourse of much of the existing scholarship around virtual patients and, to an extent, around educational technologies as a whole. Activity perspectives, and activity theory in particular, offer new horizons for research and evaluation that address many of the limitations of intervention-based paradigms of inquiry.

  1. Activation of peripheral blood mononuclear cells in bronchoalveolar lavage fluid from patients with sarcoidosis: visualisation of single cell activation products.

    PubMed Central

    Pantelidis, P.; Southcott, A. M.; Cambrey, A. D.; Laurent, G. J.; du Bois, R. M.

    1994-01-01

    BACKGROUND--Interstitial lung diseases are characterised by the recruitment of mononuclear cells to disease sites where maturation occurs and activation products, including lysozyme (LZM), are released. Analysis of in vitro cell culture supernatants for activation products masks the functional heterogeneity of cell populations. It is therefore necessary to examine the secretion of activation products by single cells to assess whether the activation of newly recruited mononuclear phagocytes at the sites of disease in the lung is uniform and controlled by the local microenvironment. METHODS--The reverse haemolytic plaque assay was used to evaluate, at a single cell level, the ability of bronchoalveolar lavage (BAL) fluid from seven patients with sarcoidosis to activate Ficoll-Hypaque-separated peripheral blood mononuclear cells by comparison with BAL fluid from six normal volunteers and nine patients with systemic sclerosis. Monolayers of peripheral blood mononuclear cells and sheep red blood cells were cultured either alone or in the presence of 20% (v/v) BAL fluid with a polyclonal anti-LZM antibody. LZM/anti-LZM complexes bound to red blood cells surrounding the secreting cells were disclosed following complement lysis of red blood cells and quantification of plaque dimensions using microscopy and image analysis. RESULTS--Bronchoalveolar lavage fluid from all the patients with sarcoidosis increased LZM secretion by peripheral blood mononuclear cells compared with unstimulated mononuclear cells. By contrast, BAL fluid from the other individuals had no effect on LZM secretion. CONCLUSIONS--Single cells activated by BAL fluid can be evaluated by the reverse haemolytic plaque assay. BAL fluid from patients with sarcoidosis, but not from patients with systemic sclerosis or normal individuals, contains components capable of activating mononuclear phagocytes to secrete lysozyme. Images PMID:7831632

  2. Related B cell clones populate the meninges and parenchyma of patients with multiple sclerosis.

    PubMed

    Lovato, Laura; Willis, Simon N; Rodig, Scott J; Caron, Tyler; Almendinger, Stefany E; Howell, Owain W; Reynolds, Richard; O'Connor, Kevin C; Hafler, David A

    2011-02-01

    In the central nervous system of patients with multiple sclerosis, B cell aggregates populate the meninges, raising the central question as to whether these structures relate to the B cell infiltrates found in parenchymal lesions or instead, represent a separate central nervous system immune compartment. We characterized the repertoires derived from meningeal B cell aggregates and the corresponding parenchymal infiltrates from brain tissue derived primarily from patients with progressive multiple sclerosis. The majority of expanded antigen-experienced B cell clones derived from meningeal aggregates were also present in the parenchyma. We extended this investigation to include 20 grey matter specimens containing meninges, 26 inflammatory plaques, 19 areas of normal appearing white matter and cerebral spinal fluid. Analysis of 1833 B cell receptor heavy chain variable region sequences demonstrated that antigen-experienced clones were consistently shared among these distinct compartments. This study establishes a relationship between extraparenchymal lymphoid tissue and parenchymal infiltrates and defines the arrangement of B cell clones that populate the central nervous system of patients with multiple sclerosis.

  3. Screening patients with scleroderma for pulmonary arterial hypertension and implications for other at-risk populations.

    PubMed

    Schwaiger, Johannes P; Khanna, Dinesh; Gerry Coghlan, J

    2013-12-01

    Pulmonary arterial hypertension (PAH) is a progressive vasculopathy that is advanced by the time symptoms develop. As symptoms are nonspecific and the condition uncommon, continued progression toward end-stage disease occurs for an average of 2 years between symptom onset and diagnosis. There is need for earlier diagnosis and treatment, as most patients are severely symptomatic when diagnosed and their mortality is high despite therapy. Screening can help; however, it is not straightforward due to the diversity of patient profiles and lack of sufficiently accurate tools. Echocardiography, currently the best available screening tool, lacks both sensitivity and specificity. The low prevalence of PAH renders many screening tools unfit for purpose. However, this may be overcome, in some instances, by using enrichment tools to preselect screening populations. The majority of data are available for systemic sclerosis. A recent study has demonstrated how lung function can be used to enrich PAH prevalence in a systemic sclerosis population. A screening bundle then selects patients for right heart catheterisation with improved rates of sensitivity compared to current guidelines.

  4. Effectiveness of Chemoradiation for Head and Neck Cancer in an Older Patient Population

    SciTech Connect

    VanderWalde, Noam A.; Meyer, Anne Marie; Deal, Allison M.; Layton, J. Bradley; Liu, Huan; Carpenter, William R.; Weissler, Mark C.; Fleming, Mary E.; and others

    2014-05-01

    Purpose: The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results: The final cohort of 10,599 patients was 68% male and 89% white. Median age was 74 years. Seventy-four percent were treated with RT, 26% were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95% confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95% CI: 1.02-1.15; P=.01). Conclusions: Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.

  5. A preliminary investigation of EZSCAN™ screening for impaired glucose tolerance and diabetes in a patient population

    PubMed Central

    CHEN, XIAOLU; CHEN, LIZHU; DING, RONGJING; SHI, QIUTING; ZHANG, YUANYUAN; HU, DAYI

    2015-01-01

    EZSCAN™ is a non-invasive technology that evaluates sweat gland dysfunction using electrochemical skin conductance measurements, providing an opportunity to determine the risk of impaired glucose tolerance (IGT) and diabetes mellitus (DM). This study was conducted with the aims of detecting IGT and DM and investigating the efficacy and cut-off points of the EZSCAN test in a patient population. The traditional serum and plasma glucose tests were used as comparators. In this cross-sectional study, 270 previously undiagnosed patients (180 women and 90 men) with a high risk of glucose metabolism disorders (≥45 years old) were enrolled. All patients underwent an oral glucose tolerance test (OGTT) and hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and EZSCAN tests. Forty (14.8%) patients had newly diagnosed DM (NDM), 79 (29.3%) had IGT and 151 (55.9%) had normal glucose tolerance. The EZSCAN values of these groups were 48±11, 47±11 and 34±13%, respectively. For all patients, the correlation coefficient of EZSCAN was 0.462 with the OGTT (P<0.001), 0.182 with the FPG test (P<0.001) and 0.379 with the HbA1c test (P<0.001). The EZSCAN cut-off point for the detection of IGT was 37% [sensitivity, 82%; specificity, 62%; area under the curve (AUC), 0.778], and the cut-off point for NDM was 50% (sensitivity, 53%; specificity, 59%; AUC, 0.528). This study demonstrated that the non-invasive EZSCAN system is an effective screening tool for the detection of glucose dysfunction in the population tested, and that its performance in detecting previously undiagnosed IGT is superior to its performance in detecting DM. PMID:26136878

  6. [Substantiation of active surgical tactics for patients with puerperal endometritis].

    PubMed

    Nikonov, A P; Ankirskaia, A S

    1991-01-01

    An active surgical tactics for managing patients (uterine wash and its cavity content vacuum aspiration) was applied in 34 patients with postnatal endometritis. Echography and hysteroscopy demonstrated that in 28 of 34 patients, the endometritis developed in the presence of pathological involvements into the uterine cavity, which made the use of surgical endometrial treatment justifiable. In addition, the surgical treatment substantially decreased the bacterial dissemination of the content in the uterine cavity. The proposed procedure enabled uterine extirpation to be avoided in 5 of 6 patients with partial suture inadequacy. PMID:2042714

  7. Risk of Stroke in Patients With Spontaneous Pneumothorax: A Nationwide, Population-Based Study.

    PubMed

    Cheng, Ching-Yuan; Yeh, Diana Yu-Wung; Lin, Cheng-Li; Kao, Chia-Hung

    2016-04-01

    The association between spontaneous pneumothorax (SP) and stroke has not been reported, and this study aimed to explore this association. We used the National Health Insurance Research Database for conducting a nationwide, population-based, retrospective cohort study of patients newly hospitalized for SP from 2000 to 2010. A total of 2541 patients with newly diagnosed SP were included and compared with patients without SP. We observed that patients with SP were at higher risk for developing stroke, with an adjusted hazard ratio (HR) of 1.56. In addition, these patients had a significantly higher risk of hemorrhagic stroke (adjusted HR = 2.22) than of ischemic stroke (adjusted HR = 1.48). The risk of stroke was the highest in the initial 4 months after hospitalization for SP (adjusted HR = 3.41, 95% confidence interval = 1.98-5.87). In conclusion, our study revealed a correlation between stroke and a history of SP, and the risk of stroke after SP was time sensitive.

  8. Antihypertensive treatment and control in a large primary care population of 21 167 patients.

    PubMed

    Qvarnström, M; Wettermark, B; Ljungman, C; Zarrinkoub, R; Hasselström, J; Manhem, K; Sundström, A; Kahan, T

    2011-08-01

    The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure <140/90 mm Hg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary health-care centres, with a combined registered population of 330 000 subjects. We included all patients > 30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n=21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure <140/90 mm Hg. The number of prescribed drugs increased with age, except among the oldest (> 90 years). Only 29% of patients given monotherapy had a blood pressure <140/90 mm Hg. Women more often received diuretics (52 vs 42%), and less often angiotensin-converting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. β-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control.

  9. Serum trace element differences between Schizophrenia patients and controls in the Han Chinese population

    PubMed Central

    Cai, Lei; Chen, Tianlu; Yang, Jinglei; Zhou, Kejun; Yan, Xiaomei; Chen, Wenzhong; Sun, Liya; Li, Linlin; Qin, Shengying; Wang, Peng; Yang, Ping; Cui, Donghong; Burmeister, Margit; He, Lin; Jia, Wei; Wan, Chunling

    2015-01-01

    Little is known about the trace element profile differences between Schizophrenia patients and healthy controls; previous studies about the association of certain elements with Schizophrenia have obtained conflicting results. To identify these differences in the Han Chinese population, inductively coupled plasma-mass spectrometry was used to quantify the levels of 35 elements in the sera of 111 Schizophrenia patients and 110 healthy participants, which consisted of a training (61/61 for cases/controls included) and a test group including remaining participants. An orthogonal projection to latent structures model was constructed from the training group (R2Y = 0.465, Q2cum = 0.343) had a sensitivity of 76.0% and a specificity of 71.4% in the test group. Single element analysis indicated that the concentrations of cesium, zinc, and selenium were significantly reduced in patients with Schizophrenia in both the training and test groups. The meta-analysis including 522 cases and 360 controls supported that Zinc was significantly associated with Schizophrenia (standardized mean difference [SMD], −0.81; 95% confidence intervals [CI], −1.46 to −0.16, P = 0.01) in the random-effect model. Information theory analysis indicated that Zinc could play roles independently in Schizophrenia. These results suggest clear element profile differences between patients with Schizophrenia and healthy controls, and reduced Zn level is confirmed in the Schizophrenia patients. PMID:26456296

  10. Symptom patterns in dissociative identity disorder patients and the general population.

    PubMed

    Ross, Colin A; Ness, Laura

    2010-01-01

    The authors used the Dissociative Disorders Interview Schedule to compare structured interview symptom patterns in a general population sample (N= 502) and a sample of patients with clinical diagnoses of dissociative identity disorder (N= 303). Based on the Trauma Model, the authors predicted that the patterns would be similar in the 2 samples and that symptom scores would be higher in participants reporting childhood sexual abuse in both samples. They predicted that symptom scores would be higher among women with dissociative identity disorder reporting sexual abuse than among women in the general population reporting sexual abuse, with the clinical sample reporting more severe abuse. These predictions were supported by the data. The authors conclude that symptom patterns in dissociative identity disorder are typical of the normal human response to severe, chronic childhood trauma and have ecological validity for the human race in general.

  11. Comparable Population Pharmacokinetics and Pharmacodynamic Breakpoints of Cefpirome in Cystic Fibrosis Patients and Healthy Volunteers▿

    PubMed Central

    Bulitta, J. B.; Kinzig, M.; Landersdorfer, C. B.; Holzgrabe, U.; Stephan, U.; Sörgel, F.

    2011-01-01

    Cystic fibrosis (CF) patients are often reported to have higher clearances and larger volumes of distribution per kilogram of total body weight (WT) for beta-lactams than healthy volunteers. As pharmacokinetic (PK) data on cefpirome from studies of CF patients are lacking, we systematically compared its population PK and pharmacodynamic breakpoints for CF patients and healthy volunteers of similar body size. Twelve adult CF patients (median lean body mass [LBM] = 45.7 kg) and 12 healthy volunteers (LBM = 50.0 kg) received a single 10-min intravenous infusion of 2 g cefpirome. Plasma and urine concentrations were determined by high-performance liquid chromatography (HPLC). Population PK and Monte Carlo simulations were performed using NONMEM and S-ADAPT and a duration of an unbound plasma concentration above the MIC ≥ 65% of the dosing interval as a pharmacodynamic target. Unscaled clearances for CF patients were similar to those seen with healthy volunteers, and the volume of distribution was 6% lower for CF patients. Linear scaling of total clearance by WT resulted in clearance that was 20% higher (P ≤ 0.001 [nonparametric bootstrap]) in CF patients. Allometric scaling by LBM explained the differences between the two subject groups with respect to average clearance and volume of distribution and reduced the unexplained between-subject variability of renal and nonrenal clearance by 10 to 14%. For the CF patients, robust (>90%) probabilities of target attainment (PTA) were achieved by the administration of a standard dose of 2 g/70 kg WT every 12 h (Q12h) given as 30-min infusions for MICs ≤ 1.5 mg/liter. As alternative dosage regimens, a 5-h infusion of 1.33 g/70 kg WT Q8h achieved robust PTAs for MICs ≤ 8 to 12 mg/liter and a continuous infusion of 4 g/day for MICs ≤ 12 mg/liter. Prolonged infusion of cefpirome is expected to be superior to short-term infusions for MICs between 2 and 12 mg/liter. PMID:21402834

  12. Patients attended by palliative care teams: are they always comparable populations?

    PubMed

    Nabal, Maria; Barcons, Miquel; Moreno, Roberto; Busquets, Xavier; Trujillano, Javier J; Requena, Antonio

    2013-12-01

    Patients attended by palliative care teams: are they always comparable populations? To answer this question we have compared the basic epidemiological characteristics of patients attended by home palliative care teams (HPCT) in two autonomous regions of Spain. We carried out a coordinated analytical, observational and prospective study in two Spanish autonomous regions: Aragon and Catalonia. Data were kept during each home care visit according to patients' needs. Inclusion criteria were: advanced cancer, over 18 years old and first contact with a HPCT. The recruitment period was 6 months. Variables included were: Survival time (days), age, sex, primary disease and extension, place of residence. Functional and cognitive state, and co-morbidity. 10 signs/symptoms: asthenia, anorexia, cachexia, dysphagia, xerostomy, dyspnoea, oedemas, level of consciousness, presence of delirium, presence of pressure ulcers and some treatment data. Others variables considered were: responsible team, origin, destination when discharge, date and place of death, number of visits made and duration of monitoring. We developed a comparison between groups by Chi-squared test or the non-parametric Mann-Whitney U test and a survival analysis by Kaplan-Meier curves and the logrank test to determine differences between factors. The SPSS version 15.0 software package was used. 698 patients were included, 56.2% from Aragon and 43.8% from Catalonia. 60.3% were males, without differences between the regions. Characteristics relative to age, sex, place of residence and extension of oncological diseases were similar for both groups. We found significant differences between the two populations relative to survival time, co-morbidity, functional state, presence and intensity of a number of symptoms and the treatments, patient monitoring and the their destination after discharge. We can conclude that palliative care teams cover different profiles of patients with regard to their co-morbidity, functional

  13. [Creative arts activity in manually handicapped patients].

    PubMed

    Wolf, N

    1986-02-01

    Congenital or acquired conditions directly or indirectly causal in total or partial impairment of manual function are set out. The possibilities for creative-expressive activity, using various techniques, nothwithstanding manual disabilities are pointed out. In Cefischer, who until his war-related loss of both upper limbs had been a renowned cartoonist, a comparison of his works, drawn initially by hand and later with the mouth, reveals his characteristic style of expression having remained the same. Further examples are given of creative expression in the presence of manual disability even under extreme circumstances (such as 11 years of confinement to the Iron Lung). Arts and crafts work of persons with leprosy-related manual handicaps are mentioned; typewriter graphics as a method inaugurated by Basset is presented as used in young people with total manual disability. Partial disability of manual function due to arthritis was present in Renoir, Jawlensky, and Grandma Moses, the course of their conditions is described over time. Contents and form of their pictures, after long years of being manually disabled, do not reveal any essential changes in comparison to their earlier ones. PMID:2938233

  14. A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients

    PubMed Central

    Hazendonk, Hendrika; Fijnvandraat, Karin; Lock, Janske; Driessens, Mariëtte; van der Meer, Felix; Meijer, Karina; Kruip, Marieke; Gorkom, Britta Laros-van; Peters, Marjolein; de Wildt, Saskia; Leebeek, Frank; Cnossen, Marjon; Mathôt, Ron

    2016-01-01

    The role of pharmacokinetic-guided dosing of factor concentrates in hemophilia is currently a subject of debate and focuses on long-term prophylactic treatment. Few data are available on its impact in the perioperative period. In this study, a population pharmacokinetic model for currently registered factor VIII concentrates was developed for severe and moderate adult and pediatric hemophilia A patients (FVIII levels <0.05 IUmL−1) undergoing elective, minor or major surgery. Retrospective data were collected on FVIII treatment, including timing and dosing, time point of FVIII sampling and all FVIII plasma concentrations achieved (trough, peak and steady state), brand of concentrate, as well as patients’ and surgical characteristics. Population pharmacokinetic modeling was performed using non-linear mixed-effects modeling. Population pharmacokinetic parameters were estimated in 75 adults undergoing 140 surgeries (median age: 48 years; median weight: 80 kg) and 44 children undergoing 58 surgeries (median age: 4.3 years; median weight: 18.5 kg). Pharmacokinetic profiles were best described by a two-compartment model. Typical values for clearance, intercompartment clearance, central and peripheral volume were 0.15 L/h/68 kg, 0.16 L/h/68 kg, 2.81 L/68 kg and 1.90 L/68 kg. Interpatient variability in clearance and central volume was 37% and 27%. Clearance decreased with increasing age (P<0.01) and increased in cases with blood group O (26%; P<0.01). In addition, a minor decrease in clearance was observed when a major surgical procedure was performed (7%; P<0.01). The developed population model describes the perioperative pharmacokinetics of various FVIII concentrates, allowing individualization of perioperative FVIII therapy for severe and moderate hemophilia A patients by Bayesian adaptive dosing. PMID:27390359

  15. Prognostic value of serum angiogenic activity in colorectal cancer patients

    PubMed Central

    Gonzalez, Francisco-Jesus; Quesada, Ana-Rodriguez; Sevilla, Isabel; Baca, Juan-Javier; Medina, Miguel-Angel; Amores, Jose; Diaz, Juan Miguel; Rius-Diaz, Francisca; Marques, Eduardo; Alba, Emilio

    2007-01-01

    Abstract Angiogenesis, resulting from an imbalance between angiogenic activator factors and inhibitors, is required for tumour growth and metastasis. The determination of the circulating concentration of all angiogenic factors (activators and inhibitors) is not feasible at present. We have evaluated diagnostic and prognostic values of the measurement of serum angiogenic activity in colorectal carcinoma (CRC) patients. Serum proliferative activity (PA) on human umbilical vein endothelial cells (HUVEC) in vitro, and serum vascular endothelial growth factor (VEGF) levels were determined by ELISA in 53 patients with primary CRC, 16 subjects with non-neoplastic gastrointestinal disease (SC) and 34 healthy individuals. Data were compared with clinical outcome of the patients. Although serum from CRC patients significantly increased the PA of HUVEC, compared to culture control (HUVEC in medium + 10% foetal bovine serum (FBS); P < 0.001); our results indicate that serum PA in CRC patients was similar to that of SC or healthy individuals. There was no correlation between serum PA and circulating VEGF concentrations. Surgery produced a decrease of PA at 8 hrs after tumour resection in CRC patients compared to pre-surgery values (186 ± 47 versus 213 ± 41, P < 0.001). However, an increase in serum VEGF values was observed after surgery (280 [176–450] versus 251 [160–357] pg/ml, P = 0.004). Patients with lower PA values after surgery showed a worse outcome that those with higher PA values. Therefore, this study does not support a diagnostic value for serum angiogenic activity measured by proliferative activity on HUVEC but suggests it could have a prognostic value in CRC patients. PMID:17367506

  16. [Vaccines and preventive activities in patients with inflammatory arthritis].

    PubMed

    Casals-Sánchez, J L; Casals Vázquez, C; Vázquez Sánchez, M Á; Giménez Basallote, S

    2013-10-01

    Patients with inflammatory arthritis and eligible for immunosuppressive therapy account for more than 1% of general population, and represents a significant workload on family doctors. They are prone to other comorbidities, with an increased cardiovascular risk and a higher incidence of infections than the general population, especially skin infections and pneumonitis. This comorbidity can be considered vulnerable to a prevention program-prevention of cardiovascular risk, cancer screening, vaccination schedule for adults. As for prevention through vaccination, importance should be given to pneumococcal infection - significant in adults aged 50 or over, especially amongst immunosuppressed patients. The 13-valent conjugate vaccine, which has been recently approved for adults, must be considered. An attempt has been made to write a simple, applicable document on preventive measures that should be implemented both at primary and secondary care level for those adults.

  17. Development of the Patient Activation Measure for mental health.

    PubMed

    Green, Carla A; Perrin, Nancy A; Polen, Michael R; Leo, Michael C; Hibbard, Judith H; Tusler, Martin

    2010-07-01

    Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH's psychometric properties equal those of the original 13-item PAM. Test-retest reliability and concurrent validity were good, and the PAM-MH showed sensitivity to change. The PAM-MH appears to be a reliable and valid measure of patient activation among individuals with mental health problems. It appears to have potential for use in assessing change in activation. PMID:19728074

  18. From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population.

    PubMed

    Johannesson, A; Larsson, G U; Oberg, T

    2004-04-01

    In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5-7 days. ICEROSS silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic. 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients. PMID:15171573

  19. Plasma and erythrocyte membrane phospholipids and fatty acids in Italian general population and hemodialysis patients

    PubMed Central

    2014-01-01

    Background Dyslipidemia and abnormal phospholipid metabolism are frequent in uremic patients and increase their risk of cardiovascular disease (CVD): ω-3 polyunsaturated fatty acids (PUFAs) may reduce this risk in the general population. In this study we compared the plasma and erythrocyte cell membrane composition of PUFAs in a group of Caucasian hemodialysis (HD) patients and in a control group of healthy subjects and evaluated the erythrocyte/cell membrane fatty acid ratio as a marker of the dietary intake of phospholipids. The relationship between ω-3 and ω-6 fatty acids and the possible differences in PUFAs concentrations were also investigated. Methods and results After obtaining a fully informed consent, a total of ninety-nine HD patients and 160 non uremic control subjects from “Tor Vergata” University Hospital were enrolled into the study. None of them took antioxidant drugs or dietary supplements for at least 90 days prior to the observation. Blood samples were analysed by gas-chromatographic coupled to a mass spectrometric detector. The daily intake of total calories, proteins, lipids and carbohydrates is significantly lower in HD patients than in controls (p < 0.001). Most plasma and erythrocyte PUFA were also reduced significantly in HD patients (p < 0.001). Conclusions Our results suggest that many classes of PUFAs are lacking in HD patients, due to the removal of nutrients during the dialysis and to persistent malnutrition. A dietary treatment addressed to increase plasma ω-3 PUFAs and to optimize ω-6/ω-3 ratio may exert a protective action and reduce the risk of CVD in HD patient. PMID:24655786

  20. Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease: A Nationwide Population-Based Study.

    PubMed

    Wu, Chieh-Hsin; Tung, Yi-Ching; Chai, Chee-Yin; Lu, Ying-Yi; Su, Yu-Feng; Tsai, Tai-Hsin; Kuo, Keng-Liang; Lin, Chih-Lung

    2016-04-01

    To investigate osteoporosis risk in patients with peptic ulcer disease (PUD) using a nationwide population-based dataset. This Taiwan National Health Insurance Research Database (NHIRD) analysis included 27,132 patients aged 18 years and older who had been diagnosed with PUD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 531-534) during 1996 to 2010. The control group consisted of 27,132 randomly selected (age- and gender)-matched patients without PUD. The association between PUD and the risk of developing osteoporosis was estimated using a Cox proportional hazard regression model. During the follow-up period, osteoporosis was diagnosed in 2538 (9.35 %) patients in the PUD group and in 2259 (8.33 %) participants in the non-PUD group. After adjusting for covariates, osteoporosis risk was 1.85 times greater in the PUD group compared to the non-PUD group (13.99 vs 5.80 per 1000 person-years, respectively). Osteoporosis developed 1 year after PUD diagnosis. The 1-year follow-up period exhibited the highest significance between the 2 groups (hazard ratio [HR] = 63.44, 95% confidence interval [CI] = 28.19-142.74, P < 0.001). Osteoporosis risk was significantly higher in PUD patients with proton-pump-inhibitors (PPIs) use (HR = 1.17, 95% CI = 1.03-1.34) compared to PUD patients without PPIs use. This study revealed a significant association between PUD and subsequent risk of osteoporosis. Therefore, PUD patients, especially those treated with PPIs, should be evaluated for subsequent risk of osteoporosis to minimize the occurrence of adverse events.

  1. The Risk of Chronic Pancreatitis in Patients with Psoriasis: A Population-Based Cohort Study

    PubMed Central

    Chiang, Yi-Ting; Huang, Weng-Foung; Tsai, Tsen-Fang

    2016-01-01

    Background Psoriasis is a chronic systemic inflammatory disorder, and studies have revealed its association with a variety of comorbidities. However, the risk of chronic pancreatitis (CP) in psoriasis has not been studied. This study aimed to investigate the risk of CP among patients with psoriasis. Methods Using the Taiwan National Health Insurance Research Database, this population-based cohort study enrolled 48430 patients with psoriasis and 193720 subjects without psoriasis. Stratified Cox proportional hazards models were used to compare the risks of CP between the patients with and without psoriasis. Results The incidence of CP was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls during a mean 6.6-year follow-up period. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude hazard ratio (HR) = 1.81; 95% confidence interval (CI) = 1.53–2.15), and the risk remained significantly higher after adjustments for gender, age group, medications, and comorbidities (adjusted HR (aHR) = 1.76; 95% CI = 1.47–2.10). All psoriasis patient subgroups other than those with arthritis, including those with mild and severe psoriasis and those without arthritis, had significantly increased aHRs for CP, and the risk increased with increasing psoriasis severity. Psoriasis patients taking nonsteroidal anti-inflammatory drugs (aHR = 0.33; 95% CI = 0.22–0.49) and methotrexate (aHR = 0.28; 95% CI = 0.12–0.64) had a lower risk of developing CP after adjustments. Conclusions Psoriasis is associated with a significantly increased risk of CP. The results of our study call for more research to provide additional insight into the relationship between psoriasis and CP. PMID:27467265

  2. Physical activity in an indigenous Ecuadorian forager-horticulturalist population as measured using accelerometry

    PubMed Central

    Madimenos, Felicia C.; Snodgrass, J. Josh; Blackwell, Aaron D.; Liebert, Melissa A.; Sugiyama, Lawrence S.

    2011-01-01

    Objective Minimal information on physical activity is available for non-Western populations undergoing the transition to a market economy. This is unfortunate given the importance of these data for understanding health issues such as the global obesity epidemic. We consider the utility of using accelerometry technology to examine activity patterns and energy use regulation among indigenous Shuar, an Ecuadorian forager-horticulturalist population undergoing economic and lifestyle change. We investigate sex differences in Shuar activity patterns and the effects of reproductive status on activity. Finally, we discuss the potential of accelerometry use in human biology research. Methods Physical activity levels were measured using Actical accelerometers in 49 indigenous Shuar adults (23 males, 26 females) from a rural Ecuadorian community. Female participants were in various reproductive states including pregnant, lactating, and non-pregnant/non-lactating. Results Activity counts (AC), activity energy expenditure (AEE), and physical activity levels (PAL) were significantly higher (P < 0.05) in males than females. Significant differences in energy expenditure were found among pregnant or lactating females and males with pregnant or lactating partners (P < 0.001). Males with pregnant or lactating partners also had significantly higher activity levels than did other men (P < 0.01). Conclusions Shuar activity levels are relatively low compared to other non-Western populations. Despite increasing market integration, pregnant and lactating females seem to be adopting a strategy noted in other subsistence populations where male participation in subsistence activities increases to compensate for their partners’ elevated reproductive costs. Despite certain limitations, use of accelerometry in human biology research shows promise. PMID:21538650

  3. Incidence of utilization- and symptom-defined COPD exacerbations in hospital- and population-recruited patients

    PubMed Central

    Erdal, Marta; Johannessen, Ane; Eagan, Tomas Mikal; Bakke, Per; Gulsvik, Amund; Grønseth, Rune

    2016-01-01

    Objectives The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD. Patients and methods During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied. For multivariate analyses, we chose a negative binomial regression model. Results COPD patients from the population- and hospital-based samples experienced on average 0.4 utilization-defined and 2.9 symptom-defined versus 1.0 and 5.9 annual exacerbations, respectively. The incidence rate ratios for utilization-defined AECOPD were 2.45 (95% CI 1.22–4.95), 3.43 (95% CI 1.59–7.38), and 5.67 (95% CI 2.58–12.48) with Global Initiative on Obstructive Lung Disease spirometric stages II, III, and IV, respectively. The corresponding incidence rate ratios for the symptom-based definition were 3.08 (95% CI 1.96–4.84), 3.45 (95% CI 1.92–6.18), and 4.00 (95% CI 2.09–7.66). Maintenance therapy (regular long-acting muscarinic antagonists, long-acting beta-2 agonists, inhaled corticosteroids, or theophylline) also increased the risk of AECOPD with both exacerbation definitions (incidence rate ratios 1.65 and 1.73, respectively). The risk of AECOPD was 59%–78% higher in the hospital sample than in the population sample. Conclusion If externally valid conclusions are to be made regarding incidence and predictors of AECOPD, studies should be based on general population samples or adjustments should be made on account of a likely higher incidence in other samples. Likewise, the effect of different AECOPD definitions should be taken into consideration.

  4. Incidence of utilization- and symptom-defined COPD exacerbations in hospital- and population-recruited patients

    PubMed Central

    Erdal, Marta; Johannessen, Ane; Eagan, Tomas Mikal; Bakke, Per; Gulsvik, Amund; Grønseth, Rune

    2016-01-01

    Objectives The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD. Patients and methods During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied. For multivariate analyses, we chose a negative binomial regression model. Results COPD patients from the population- and hospital-based samples experienced on average 0.4 utilization-defined and 2.9 symptom-defined versus 1.0 and 5.9 annual exacerbations, respectively. The incidence rate ratios for utilization-defined AECOPD were 2.45 (95% CI 1.22–4.95), 3.43 (95% CI 1.59–7.38), and 5.67 (95% CI 2.58–12.48) with Global Initiative on Obstructive Lung Disease spirometric stages II, III, and IV, respectively. The corresponding incidence rate ratios for the symptom-based definition were 3.08 (95% CI 1.96–4.84), 3.45 (95% CI 1.92–6.18), and 4.00 (95% CI 2.09–7.66). Maintenance therapy (regular long-acting muscarinic antagonists, long-acting beta-2 agonists, inhaled corticosteroids, or theophylline) also increased the risk of AECOPD with both exacerbation definitions (incidence rate ratios 1.65 and 1.73, respectively). The risk of AECOPD was 59%–78% higher in the hospital sample than in the population sample. Conclusion If externally valid conclusions are to be made regarding incidence and predictors of AECOPD, studies should be based on general population samples or adjustments should be made on account of a likely higher incidence in other samples. Likewise, the effect of different AECOPD definitions should be taken into consideration. PMID:27621614

  5. The increased risk of active tuberculosis disease in patients with dermatomyositis – a nationwide retrospective cohort study

    PubMed Central

    Wu, Ping-Hsun; Lin, Yi-Ting; Yang, Yi-Hsin; Lin, Yu-Chih; Lin, Yi-Ching

    2015-01-01

    The risk of active tuberculosis (TB) in patients with dermatomyositis (DM) is poorly understood. The cohort study aimed to investigate the association between DM and the risk of active TB disease. We conducted a population based study on 4,958 patients with newly diagnosed DM and 19,832 matched controls according to age, sex, and index date between 1998 and 2008. The hazard ratios (HRs) and cumulative incidences of active TB disease between DM patients and controls were analyzed. During the study period, a total of 85 (1.7%) DM patients developed active TB disease, which was significantly higher than that of non-DM patients (0.64%). The incidence rate of active TB disease was higher among DM patients than controls (incidence rate ratio 2.95; 95% confidence interval [CI], 2.24 to 3.88). The Cox regression model demonstrated significantly higher active TB disease rate among DM patients compared with controls (adjusted HR, 2.64; 95% CI, 1.97 to 3.54; p < 0.001) after adjusting for age, sex, and underlying medical disorders. The most significant risk factors for developing active TB included male sex, diabetes mellitus comorbidity, and use of corticosteroids and azathioprine in DM patients. In conclusion, DM patients are at a greater risk for active TB disease. PMID:26573418

  6. Natural cytotoxic activity in multiple sclerosis patients: defects in IL-2/interferon gamma-regulatory circuit.

    PubMed

    Braakman, E; van Tunen, A; Meager, A; Lucas, C J

    1986-11-01

    In order to determine the factors underlying the impaired natural cytotoxic (NC) activity in multiple sclerosis (MS) patients, we have analysed the interleukin 2 (IL-2)-interferon gamma-(IFN gamma)-NC activity regulatory circuit in 40 MS patients and 40 matched healthy controls. Exogenous recombinant IFN gamma (rIFN gamma) enhanced NC activity in peripheral blood lymphocytes (PBL) derived from MS patients and controls equally well. In contrast, PBL from MS patients showed a significantly lower increase of NC activity in response to IL-2 than healthy controls. This defect in responsiveness was independent of the dose of IL-2. Even at the highest dose of rIL-2 (1000 U/ml), MS patients showed a decreased response. PBL from MS patients required a 2 to 10 times higher dose of IL-2 to reach NC activity levels comparable to controls. In healthy individuals IL-2 can act upon both Fc gamma R+ and Fc gamma R- NC precursor cells. The decreased responsiveness to IL-2 is not confined to one subpopulation of IL-2-responsive precursor cells because depletion of Fc gamma R+ cells before culture in the presence of IL-2 revealed no significant differences in the contribution of Fc gamma R+ precursor cells to the IL-2 enhanced NC activity between MS patients and controls. Also the number of IL-2-responsive precursor cells appeared to be normal since the number of Fc gamma R+ cells in MS patients and controls was comparable. PBL from MS patients produced significantly lower amounts of IFN gamma upon stimulation with IL-2. Analysis of the different parameters of the regulatory circuit at the population level showed, both for patients and controls, a significant correlation between IFN gamma production and increase of NC activity induced by IL-2. Also the endogenous NC activity and IFN gamma production, both in patients and controls, were correlated. At the individual level, defects in NC activity could not be linked to another parameter of the regulatory circuit.

  7. Introducing community mental health services. The effects on a suburban patient population.

    PubMed

    Stefansson, C G; Cullberg, J

    1986-10-01

    By means of a computerised psychiatric case register, the effects on a defined population with 71,371 inhabitants were studied when the mainly hospital-based psychiatric services in the area were changed to community mental health units with substantial outpatient resources. Diagnostic, social and demographic variables and care utilisation rates were compared. A 29% increase in patients under the new system was observed. Most of the newcomers had acute crisis reactions, were younger, on average, than previous patients and registered alcohol abuse and somatic diseases. Outpatient utilisation increased (170%) and hospital admissions decreased (22%). Compulsory admissions increased (43%), as did sick-leave registrations (21%). These trends are discussed in light of the new organization.

  8. Reconstruction of burst activity from calcium imaging of neuronal population via Lq minimization and interval screening.

    PubMed

    Quan, Tingwei; Lv, Xiaohua; Liu, Xiuli; Zeng, Shaoqun

    2016-06-01

    Calcium imaging is becoming an increasingly popular technology to indirectly measure activity patterns in local neuronal networks. Based on the dependence of calcium fluorescence on neuronal spiking, two-photon calcium imaging affords single-cell resolution of neuronal population activity. However, it is still difficult to reconstruct neuronal activity from complex calcium fluorescence traces, particularly for traces contaminated by noise. Here, we describe a robust and efficient neuronal-activity reconstruction method that utilizes Lq minimization and interval screening (IS), which we refer to as LqIS. The simulation results show that LqIS performs satisfactorily in terms of both accuracy and speed of reconstruction. Reconstruction of simulation and experimental data also shows that LqIS has advantages in terms of the recall rate, precision rate, and timing error. Finally, LqIS is demonstrated to effectively reconstruct neuronal burst activity from calcium fluorescence traces recorded from large-size neuronal population. PMID:27375930

  9. Reconstruction of burst activity from calcium imaging of neuronal population via Lq minimization and interval screening

    PubMed Central

    Quan, Tingwei; Lv, Xiaohua; Liu, Xiuli; Zeng, Shaoqun

    2016-01-01

    Calcium imaging is becoming an increasingly popular technology to indirectly measure activity patterns in local neuronal networks. Based on the dependence of calcium fluorescence on neuronal spiking, two-photon calcium imaging affords single-cell resolution of neuronal population activity. However, it is still difficult to reconstruct neuronal activity from complex calcium fluorescence traces, particularly for traces contaminated by noise. Here, we describe a robust and efficient neuronal-activity reconstruction method that utilizes Lq minimization and interval screening (IS), which we refer to as LqIS. The simulation results show that LqIS performs satisfactorily in terms of both accuracy and speed of reconstruction. Reconstruction of simulation and experimental data also shows that LqIS has advantages in terms of the recall rate, precision rate, and timing error. Finally, LqIS is demonstrated to effectively reconstruct neuronal burst activity from calcium fluorescence traces recorded from large-size neuronal population. PMID:27375930

  10. Activation of Massive Transfusion for Elderly Trauma Patients.

    PubMed

    Murry, Jason S; Zaw, Andrea A; Hoang, David M; Mehrzadi, Devorah; Tran, Danielle; Nuno, Miriam; Bloom, Matthew; Melo, Nicolas; Margulies, Daniel R; Ley, Eric J

    2015-10-01

    Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 nonelderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay. Mean age for NE was 35 years and 73 years for E (P < 0.01). Less than half (43%) of E patients with activation of MTP received 10 or more units of blood products compared with 69 per cent of the NE (P = 0.07). Mortality rates were similar in the NE and the E (53%vs 50%, P = 0.80). After multivariate analysis with Glasgow Coma Scale, injury severity score, and blunt versus penetrating trauma, elderly age was not a predictor of mortality after MTP (P = 0.35). When MTP is activated, survival to discharge in elderly trauma patients is comparable to younger patients.

  11. A World of Six Billion Wall Chart and Activity Guide: Thought Provoking Activities on Population, Resources, and Our Environment.

    ERIC Educational Resources Information Center

    Zero Population Growth, Inc., Washington, DC.

    Population issues are interconnected to many of the most pressing concerns of today, nine of which are addressed on the front of the wallchart included in this guide. The activities in this guide allow students to explore these topics in order to better understand the significance of our current demographic milestone for society and the…

  12. Population Pharmacokinetic Analysis of Piperacillin/Tazobactam in Korean Patients with Acute Infections 

    PubMed Central

    Choi, Hyang-Ki; Bae, In-Gyu; Choi, Won Suk; Hur, Jian; Jin, Sung Joon; Kim, Shin-Woo; Kwon, Ki Tae; Lee, Sang-Rok; Shin, Jae-Gook

    2016-01-01

    Background For more effective and safer usage of antibiotics, the dosing strategy should be individualized based on the patients’ characteristics, including race. The aim of this study was to investigate the population pharmacokinetic (PK) profiles of piperacillin and tazobactam in Korean patients with acute infections. Materials and Methods At least four consecutive 2/0.25 g or 4/0.5 g doses of piperacillin/tazobactam (TZP) were intravenously infused over 1 h every 8 h for patients with creatinine clearance (CLcr) ≤50 ml/min or CLcr >50 mL/min, respectively. Blood samples from 33 patients at a steady-state were taken pre-dose and at 0 min, 30 min, and 4-6 h after the fourth infusion. The population PK analysis was conducted using a non-linear mixed-effects method. A likelihood ratio test was used to select significant covariates, with significance levels of P <0.05 for selection and P <0.01 for elimination. Results Both piperacillin PK and tazobactam PK were well described by a two-compartment model with first-order elimination. Creatinine clearance and body weight, as covariates on clearance (CL) and volume of central compartment (V1), were selected among the covariates possibly affecting PK parameters of both drugs. CL was defined as CL = 2.9 + 4.03 × CLcr /47 for piperacillin and CL = 1.76 + 4.81 × CLcr /47 for tazobactam. V1 was defined as V1 = 19.5 × weight/60 for piperacillin and V1 = 22.6 × weight/60 for tazobactam. Conclusion The PK profiles of TZP at a steady-state in Korean patients with acute infections were well described by a two-compartment model with first-order elimination. Both piperacillin and tazobactam clearances were significantly influenced by creatinine clearance. PMID:27659435

  13. Comparing the Incidence of Falls/Fractures in Parkinson's Disease Patients in the US Population.

    PubMed

    Kalilani, Linda; Asgharnejad, Mahnaz; Palokangas, Tuire; Durgin, Tracy

    2016-01-01

    Patients with Parkinson's disease (PD) may experience falls and/or fractures as a result of disease symptoms. There are limited data available from long-term studies estimating the incidence of falls/fractures in patients with PD. The objective was to compare the incidence rate of falls/fractures in PD patients with non-PD patients in a US population. This was a retrospective study using a US-based claims database (Truven Health MarketScan®) that compared the incidence rate of falls/fractures in PD subjects with non-PD subjects. The study period included the 12 months prior to index date (defined as earliest PD diagnosis [International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0]) and a postindex period to the end of data availability. Fractures were defined by inpatient/outpatient claims as a principal or secondary diagnosis and accompanying procedure codes during the postindex period. Incidence rates and 95% CIs for falls/fractures were calculated as the number of events per 10,000 person-years of follow-up using negative binomial or Poisson regression models. Twenty-eight thousand two hundred and eighty PD subjects were matched to non-PD subjects for the analysis (mean [SD] age, 71.4 [11.8] years; 53% male). A higher incidence rate (adjusted for comorbidities and medications) of all fall/fracture cases and by fall and fracture types was observed for PD subjects versus non-PD subjects; the overall adjusted incidence rate ratio comparing PD to non-PD subjects was 2.05; 95% CI, 1.88-2.24. The incidence rate of falls/fractures was significantly higher in subjects with PD compared with non-PD subjects in a US population. PMID:27583564

  14. Population pharmacokinetic analysis of voriconazole and anidulafungin in adult patients with invasive aspergillosis.

    PubMed

    Liu, Ping; Mould, Diane R

    2014-08-01

    To assess the pharmacokinetics (PK) of voriconazole and anidulafungin in patients with invasive aspergillosis (IA) in comparison with other populations, sparse PK data were obtained for 305 adults from a prospective phase 3 study comparing voriconazole and anidulafungin in combination versus voriconazole monotherapy (voriconazole, 6 mg/kg intravenously [IV] every 12 h [q12h] for 24 h followed by 4 mg/kg IV q12h, switched to 300 mg orally q12h as appropriate; with placebo or anidulafungin IV, a 200-mg loading dose followed by 100 mg q24h). Voriconazole PK was described by a two-compartment model with first-order absorption and mixed linear and time-dependent nonlinear (Michaelis-Menten) elimination; anidulafungin PK was described by a two-compartment model with first-order elimination. For voriconazole, the normal inverse Wishart prior approach was implemented to stabilize the model. Compared to previous models, no new covariates were identified for voriconazole or anidulafungin. PK parameter estimates of voriconazole and anidulafungin are in agreement with those reported previously except for voriconazole clearance (the nonlinear clearance component became minimal). At a 4-mg/kg IV dose, voriconazole exposure tended to increase slightly as age, weight, or body mass index increased, but the difference was not considered clinically relevant. Estimated voriconazole exposures in IA patients at 4 mg/kg IV were higher than those reported for healthy adults (e.g., the average area under the curve over a 12-hour dosing interval [AUC0-12] at steady state was 46% higher); while it is not definitive, age and concomitant medications may impact this difference. Estimated anidulafungin exposures in IA patients were comparable to those reported for the general patient population. This study was approved by the appropriate institutional review boards or ethics committees and registered on ClinicalTrials.gov (NCT00531479). PMID:24913161

  15. Molecular analysis of fungal populations in patients with oral candidiasis using internal transcribed spacer region.

    PubMed

    Ieda, Shinsuke; Moriyama, Masafumi; Takeshita, Toru; Takashita, Toru; Maehara, Takashi; Imabayashi, Yumi; Shinozaki, Shoichi; Tanaka, Akihiko; Hayashida, Jun-Nosuke; Furukawa, Sachiko; Ohta, Miho; Yamashita, Yoshihisa; Nakamura, Seiji

    2014-01-01

    Oral candidiasis is closely associated with changes in the oral fungal flora and is caused primarily by Candida albicans. Conventional methods of fungal culture are time-consuming and not always conclusive. However, molecular genetic analysis of internal transcribed spacer (ITS) regions of fungal rRNA is rapid, reproducible and simple to perform. In this study we examined the fungal flora in patients with oral candidiasis and investigated changes in the flora after antifungal treatment using length heterogeneity-polymerization chain reaction (LH-PCR) analysis of ITS regions. Fifty-two patients with pseudomembranous oral candidiasis (POC) and 30 healthy controls were included in the study. Fungal DNA from oral rinse was examined for fungal species diversity by LH-PCR. Fungal populations were quantified by real-time PCR and previously-unidentified signals were confirmed by nucleotide sequencing. Relationships between the oral fungal flora and treatment-resistant factors were also examined. POC patients showed significantly more fungal species and a greater density of fungi than control individuals. Sixteen fungi were newly identified. The fungal populations from both groups were composed predominantly of C. albicans, though the ratio of C. dubliniensis was significantly higher in POC patients than in controls. The diversity and density of fungi were significantly reduced after treatment. Furthermore, fungal diversity and the proportion of C. dubliniensis were positively correlated with treatment duration. These results suggest that C. dubliniensis and high fungal flora diversity might be involved in the pathogenesis of oral candidiasis. We therefore conclude that LH-PCR is a useful technique for diagnosing and assessing the severity of oral candidal infection.

  16. Population pharmacokinetic analysis of voriconazole and anidulafungin in adult patients with invasive aspergillosis.

    PubMed

    Liu, Ping; Mould, Diane R

    2014-08-01

    To assess the pharmacokinetics (PK) of voriconazole and anidulafungin in patients with invasive aspergillosis (IA) in comparison with other populations, sparse PK data were obtained for 305 adults from a prospective phase 3 study comparing voriconazole and anidulafungin in combination versus voriconazole monotherapy (voriconazole, 6 mg/kg intravenously [IV] every 12 h [q12h] for 24 h followed by 4 mg/kg IV q12h, switched to 300 mg orally q12h as appropriate; with placebo or anidulafungin IV, a 200-mg loading dose followed by 100 mg q24h). Voriconazole PK was described by a two-compartment model with first-order absorption and mixed linear and time-dependent nonlinear (Michaelis-Menten) elimination; anidulafungin PK was described by a two-compartment model with first-order elimination. For voriconazole, the normal inverse Wishart prior approach was implemented to stabilize the model. Compared to previous models, no new covariates were identified for voriconazole or anidulafungin. PK parameter estimates of voriconazole and anidulafungin are in agreement with those reported previously except for voriconazole clearance (the nonlinear clearance component became minimal). At a 4-mg/kg IV dose, voriconazole exposure tended to increase slightly as age, weight, or body mass index increased, but the difference was not considered clinically relevant. Estimated voriconazole exposures in IA patients at 4 mg/kg IV were higher than those reported for healthy adults (e.g., the average area under the curve over a 12-hour dosing interval [AUC0-12] at steady state was 46% higher); while it is not definitive, age and concomitant medications may impact this difference. Estimated anidulafungin exposures in IA patients were comparable to those reported for the general patient population. This study was approved by the appropriate institutional review boards or ethics committees and registered on ClinicalTrials.gov (NCT00531479).

  17. [Physical activity in patients with microvascular complications of diabetes].

    PubMed

    Matoulek, Martin

    2015-04-01

    Physical activity is often underestimated and little used in the treatment of diabetes. The fear of damage, especially in patients with diabetes complications is one of the reasons why it occurs. Physical activity plays an important role in prevention of the progression of peripheral neuropathy and its impact is primarily on the development of muscle strength and the ability to replace the function of nerve fibers damaged disabilities. Demonstrable effect on neuropathy is already recorded a few weeks of regular exercise, long-term programs then demonstrate the safety of occurrence of ulcers in compliance with basic foot care. Present autonomic neuropathy cannot predict response to cardiac respectively, heart rate and blood pressure. Due to other risks (silent ischemia, arrhythmia etc.), it is appropriate to stress test before a prescription of exercise programs. Monitoring of blood pressure, heart rate and blood glucose during the first hours of physical activity is necessary. In patients with autonomic neuropathy of the gastrointestinal tract may significantly affect the composition of the diet not only the ability of physical activity, but can also affect hypoglycaemia due to a slow carbohydrate absorption in these patients. Another risk in patients with autonomic neuropathy is orthostatic hypotension, which may potentiate antihypertensive drugs in "white coat" hypertension. Prescription of patients with retinopathy depends on the form and degree of retinopathy. Only proliferative retinopathy can significantly reduce exercise prescription, and it is always necessary to consult with ophthalmologist. In patients with nephropathy is an important stage of renal insufficiency for prescription of physical activity. Prescription is then influenced by the degree of renal insufficiency in addition to the presence of other associated diseases (anemia, hypertension, osteopathy etc.). Physical activity is essential in patients on dialysis respectively. After renal

  18. Nonlinear analysis of brain activity in magnetic influenced Parkinson patients.

    PubMed

    Anninos, P A; Adamopoulos, A V; Kotini, A; Tsagas, N

    2000-01-01

    Magnetoencephalogram (MEG) recordings were obtained from the brain of patients suffering from Parkinson's disease (PD) using the Superconductive Quantum Interference Device (SQUID). For each patient the magnetic activity was recorded from a total of 64 points of the skull (32 points from each temporal lobe) as defined by a recording reference system, which is based on the 10-20 Electrode Placement System. Some of the recorded points were observed to exhibit abnormal rhythmic activity, characterized by high amplitudes and low frequencies. External magnetic stimulation (EMS) with intensity 1-7.5pT, and frequency the alpha-rhythm of the patient (8-13 Hz) was applied in the left-right temporal, frontal-occipital and vertex (2 minutes over each of the above regions) and the brain magnetic activity was recorded again. The application of the EMS resulted in rapid attenuation of the MEG activity of PD patients. Furthermore, chaotic dynamic methods were used, in order to estimate the correlation dimension D of the reconstructed phase spaces. The estimated values of D, in conjunction with the results derived from the other data analysis methods, strongly support the existence of low dimension chaotic structures in the dynamics of cortical activity of PD patients. In addition, the increased values of D of the MEG after the application of EMS when compared with the corresponding ones obtained from the MEGs prior to the EMS, suggest that the neural dynamics are strongly influenced by the application of EMS. PMID:11154103

  19. UNC13A influences survival in Italian ALS patients: a population-based study

    PubMed Central

    Chiò, Adriano; Mora, Gabriele; Restagno, Gabriella; Brunetti, Maura; Ossola, Irene; Barberis, Marco; Ferrucci, Luigi; Canosa, Antonio; Manera, Umberto; Moglia, Cristina; Fuda, Giuseppe; Traynor, Bryan J.; Calvo, Andrea

    2012-01-01

    The common variant rs12608932, located within an intron of UNC13A gene on chromosome 19p13.3, has been suggested to influence susceptibility to ALS, as well as survival, in patients of north European descent. To examine this possibility further, we evaluated the association of rs12608932 with susceptibility and survival in a population-based cohort of 500 Italian ALS patients and 1,457 Italian control samples. Although rs12608932 was not associated to ALS susceptibility in our series (p=0.124), it was significantly associated with survival under the recessive model (median survival for AA/AC genotypes = 3.5 years [IQR 2.2–6.4]; CC = 2.5 years [IQR 1.6–4.2]; p=0.017). Furthermore, rs12608932 genotype remained an independent prognostic factor in Cox multivariable analysis adjusting for other factors known to influence survival (p=0.023). Overall, minor allele carrier status of rs12608932 was strongly associated with an ~1-year reduction of survival in ALS patients, making it a significant determinant of phenotype variation. The identification of UNC13A as a modifier of prognosis among sporadic ALS patients potentially provides a new therapeutic target aimed at slowing disease progression. PMID:22921269

  20. Aldehyde Dehydrogenase Activity Identifies a Population of Human Skeletal Muscle Cells With High Myogenic Capacities

    PubMed Central

    Vauchez, Karine; Marolleau, Jean-Pierre; Schmid, Michel; Khattar, Patricia; Chapel, Alain; Catelain, Cyril; Lecourt, Séverine; Larghéro, Jérôme; Fiszman, Marc; Vilquin, Jean-Thomas

    2009-01-01

    Aldehyde dehydrogenase 1A1 (ALDH) activity is one hallmark of human bone marrow (BM), umbilical cord blood (UCB), and peripheral blood (PB) primitive progenitors presenting high reconstitution capacities in vivo. In this study, we have identified ALDH+ cells within human skeletal muscles, and have analyzed their phenotypical and functional characteristics. Immunohistofluorescence analysis of human muscle tissue sections revealed rare endomysial cells. Flow cytometry analysis using the fluorescent substrate of ALDH, Aldefluor, identified brightly stained (ALDHbr) cells with low side scatter (SSClo), in enzymatically dissociated muscle biopsies, thereafter abbreviated as SMALD+ (for skeletal muscle ALDH+) cells. Phenotypical analysis discriminated two sub-populations according to CD34 expression: SMALD+/CD34− and SMALD+/CD34+ cells. These sub-populations did not initially express endothelial (CD31), hematopoietic (CD45), and myogenic (CD56) markers. Upon sorting, however, whereas SMALD+/CD34+ cells developed in vitro as a heterogeneous population of CD56− cells able to differentiate in adipoblasts, the SMALD+/CD34− fraction developed in vitro as a highly enriched population of CD56+ myoblasts able to form myotubes. Moreover, only the SMALD+/CD34− population maintained a strong myogenic potential in vivo upon intramuscular transplantation. Our results suggest that ALDH activity is a novel marker for a population of new human skeletal muscle progenitors presenting a potential for cell biology and cell therapy. PMID:19738599

  1. A Cost-effectiveness Analysis of the Arthroplasty Options for Displaced Femoral Neck Fractures in the Active, Healthy, Elderly Population

    PubMed Central

    Slover, James; Hoffman, Michael V.; Malchau, Henrik; Tosteson, Anna N.A.; Koval, Kenneth J.

    2009-01-01

    Purpose: This study was performed to explore the cost-effectiveness of total hip replacement compared with hemiarthroplasty in the treatment of displaced femoral neck fractures in active otherwise healthy older patients in whom the optimum treatment is believed to be an arthroplasty procedure. Methods: A Markov decision model was used to determine whether total hip arthroplasty or hemiarthroplasty was most cost-effective for the management of a displaced femoral neck fracture in this patient population. Results: Total hip arthroplasty was associated with an average cost $3,000 more than hemiarthroplasty, and the average quality-adjusted life year gain was 1.53. The incremental cost-effectiveness ratio associated with the total hip replacement treatment strategy is $1960 per quality-adjusted life-year. Conclusion: Currently available data support the use of total hip arthroplasty as the more cost-effective treatment strategy in this specific population. The increased upfront cost appears to be offset by the improved functional results when compared with hemiarthroplasty in this select patient group. PMID:18701245

  2. Oritavancin Population Pharmacokinetics in Healthy Subjects and Patients with Complicated Skin and Skin Structure Infections or Bacteremia▿

    PubMed Central

    Rubino, Christopher M.; Van Wart, Scott A.; Bhavnani, Sujata M.; Ambrose, Paul G.; McCollam, Jill S.; Forrest, Alan

    2009-01-01

    Oritavancin is a novel glycopeptide antimicrobial agent with potent in vitro activity against a wide variety of gram-positive bacteria, including multidrug-resistant strains of staphylococci and enterococci. A population pharmacokinetic model was developed to describe the disposition of oritavancin with data from a pooled population of phase 1 healthy subjects and phase 2 and 3 patients with complicated skin and skin structure infections or Staphylococcus aureus bacteremia. In addition, the potential influence of factors such as the subject's age, gender, and clinical laboratory measures on oritavancin disposition was evaluated. Oritavancin was administered as both single- and multiple-dose intravenous (i.v.) infusions in fixed doses ranging from 100 to 800 mg or weight-based doses ranging from 0.02 to 10 mg/kg of body weight, with infusion durations ranging from 0.13 to 6.5 h across all studies. The most robust fit to the data (n = 6,290 oritavancin plasma concentrations from 560 subjects) was obtained using a three-compartment model with zero-order i.v. infusion and first-order elimination. The model was parameterized using total clearance (CL), volume of central compartment (Vc), distributional clearances from the central to both the first and second peripheral compartments, and volumes of distribution for both the first and second peripheral compartments. Weight and study phase (phase 1 versus phase 2/3) were identified as significant predictors of the interindividual variability in CL, while body surface area and age were significant for Vc. These results suggest that dose modification may be warranted in patients weighing >110 kg. However, the mild nature of the observed relationships for Vc suggest that dosing adjustments are not necessary for elderly patients. PMID:19635952

  3. Model-based control of plasma glycemia: Tests on populations of virtual patients.

    PubMed

    Palumbo, P; Pizzichelli, G; Panunzi, S; Pepe, P; De Gaetano, A

    2014-11-01

    Closed-loop devices delivering medical treatments in an automatic fashion clearly require a thorough preliminary phase according to which the proposed control law is tested and validated as realistically as possible, before arranging in vivo experiments in a clinical setting. The present note develops a virtual environment aiming to validate a recently proposed model-based glucose control law on a solid simulation framework. From a theoretical viewpoint, the artificial pancreas has been designed by suitably exploiting a minimal set of delay differential equations modeling the glucose-insulin regulatory system; on the other hand, the validation platform makes use of a different, multi-compartmental model to build up a population of virtual patients. Simulations are carried out by properly addressing the available technological limits and the unavoidable uncertainties in real-time continuous glucose sensors as well as possible malfunctioning on the insulin delivery devices. The results show the robustness of the proposed control law that turns out to be efficient and extremely safe on a heterogenous population of virtual patients.

  4. Mechanistic Models Predict Efficacy of CCR5-Deficient Stem Cell Transplants in HIV Patient Populations.

    PubMed

    Hosseini, I; Gabhann, F Mac

    2016-02-01

    Combination antiretroviral therapy (cART) effectively suppresses viral load in HIV-infected individuals, but it is not a cure. Bone marrow transplants using HIV-resistant stem cells have renewed hope that cure is achievable but key questions remain e.g., what percentage of stem cells must be HIV-resistant to achieve cure?. As few patients have undergone transplants, we built a mechanistic model of HIV/AIDS to approach this problem. The model includes major players of infection, reproduces the complete course of the disease, and simulates crucial components of clinical treatments, such as cART, irradiation, host recovery, gene augmentation, and donor chimerism. Using clinical data from 172 cART-naïve HIV-infected individuals, we created virtual populations to predict performance of CCR5-deficient stem-cell therapies and explore interpatient variability. We validated our model against a published clinical study of CCR5-modified T-cell therapy. Our model predicted that donor chimerism must exceed 75% to achieve 90% probability of cure across patient populations.

  5. Mechanistic Models Predict Efficacy of CCR5-Deficient Stem Cell Transplants in HIV Patient Populations.

    PubMed

    Hosseini, I; Gabhann, F Mac

    2016-02-01

    Combination antiretroviral therapy (cART) effectively suppresses viral load in HIV-infected individuals, but it is not a cure. Bone marrow transplants using HIV-resistant stem cells have renewed hope that cure is achievable but key questions remain e.g., what percentage of stem cells must be HIV-resistant to achieve cure?. As few patients have undergone transplants, we built a mechanistic model of HIV/AIDS to approach this problem. The model includes major players of infection, reproduces the complete course of the disease, and simulates crucial components of clinical treatments, such as cART, irradiation, host recovery, gene augmentation, and donor chimerism. Using clinical data from 172 cART-naïve HIV-infected individuals, we created virtual populations to predict performance of CCR5-deficient stem-cell therapies and explore interpatient variability. We validated our model against a published clinical study of CCR5-modified T-cell therapy. Our model predicted that donor chimerism must exceed 75% to achieve 90% probability of cure across patient populations. PMID:26933519

  6. Population pharmacokinetic modelling of NS2330 (tesofensine) and its major metabolite in patients with Alzheimer's disease

    PubMed Central

    Lehr, Thorsten; Staab, Alexander; Tillmann, Christiane; Trommeshauser, Dirk; Raschig, Andreas; Schaefer, Hans Guenter; Kloft, Charlotte

    2007-01-01

    What is already known about this subject Several studies in predominantly healthy subjects have investigated the pharmacokinetics of NS2330 and its major metabolite M1. However, its pharmacokinetics have not been characterized in Alzheimer's disease patients, the target population for NS2330. In addition, no covariates have previously been found to influence the plasma concentration-time profiles of NS2330 and/or M1. What this study adds A descriptive and predictive population pharmacokinetic model for NS2330 and its metabolite was successfully developed in a population of patients with Alzheimer's disease. A covariate analysis elucidated sex and creatinine clearance as having an influence on the plasma concentration-time profiles of NS2330 after long-term treatment. Aims To develop a population pharmacokinetic model for NS2330 and its major metabolite M1 based on data from a 14 week proof of concept study in patients with Alzheimer's disease, and to identify covariates that might influence the pharmacokinetic characteristics of the drug and/or its metabolite. Methods Plasma data from 320 subjects undergoing multiple oral dosing, and consisting of 1969 NS2330 and 1714 metabolite concentrations were fitted simultaneously using NONMEM. Results Plasma concentration-time profiles of NS2330 and M1 were best described by one-compartment models with first-order elimination for both compounds. Absorption of NS2330 was best modelled by a first-order process. Low apparent clearances together with large apparent volumes of distribution resulted in long half-lives of 234 h (NS2330) and 374 h (M1). The covariate analysis identified weight, sex, CLCR, BMI and age as influencing the pharmacokinetics of NS2330 and/or M1. However, simulations performed revealed that only CLCR and sex had a significant effect on the steady-state plasma concentration-time profiles. Females with a creatinine clearance of 35.6 ml min−1 showed a 62% increased exposure compared with males without renal

  7. Risk and Prognosis of Bloodstream Infections among Patients on Chronic Hemodialysis: A Population-Based Cohort Study

    PubMed Central

    Skov Dalgaard, Lars; Nørgaard, Mette; Jespersen, Bente; Jensen-Fangel, Søren; Østergaard, Lars Jørgen; Schønheyder, Henrik Carl; Søgaard, Ole Schmeltz

    2015-01-01

    Background and Objectives Infections are common complications among patients on chronic hemodialysis. This population-based cohort study aims to estimate risk and case fatality of bloodstream infection among chronic hemodialysis patients. Methods In this population-based cohort study we identified residents with end-stage renal disease in Central and North Jutland, Denmark who had hemodialysis as first renal replacement therapy (hemodialysis patients) during 1995–2010. For each hemodialysis patient, we sampled 19 persons from the general population matched on age, gender, and municipality. Information on positive blood cultures was obtained from regional microbiology databases. All persons were observed from cohort entry until first episode of bloodstream infection, emigration, death, or end of hemodialysis treatment, whichever came first. Incidence-rates and incidence-rate ratios were computed and risk factors for bloodstream infection assessed by Poisson regression. Case fatality was compared by Cox regression. Results Among 1792 hemodialysis patients and 33 618 matched population controls, we identified 461 and 1126 first episodes of bloodstream infection, respectively. Incidence rates of first episode of bloodstream infection were 13.7 (95% confidence interval (CI), 12.5–15.0) per 100 person-years among hemodialysis patients and 0.53 (95% CI, 0.50–0.56) per 100 person-years among population controls. In hemodialysis patients, the most common causative microorganisms were Staphylococcus aureus (43.8%) and Escherichia coli (12.6%). The 30-day case fatality was similar among hemodialysis patients and population controls 16% (95% CI, 13%–20%) vs. 18% (95% CI, 15%–20%). Conclusions Hemodialysis patients have extraordinary high risk of bloodstream infection while short-term case fatality following is similar to that of population controls. PMID:25910221

  8. Transient optogenetic inactivation of the medial entorhinal cortex biases the active population of hippocampal neurons.

    PubMed

    Rueckemann, Jon W; DiMauro, Audrey J; Rangel, Lara M; Han, Xue; Boyden, Edward S; Eichenbaum, Howard

    2016-02-01

    The mechanisms that enable the hippocampal network to express the appropriate spatial representation for a particular circumstance are not well understood. Previous studies suggest that the medial entorhinal cortex (MEC) may have a role in reproducibly selecting the hippocampal representation of an environment. To examine how ongoing MEC activity is continually integrated by the hippocampus, we performed transient unilateral optogenetic inactivations of the MEC while simultaneously recording place cell activity in CA1. Inactivation of the MEC caused a partial remapping in the CA1 population without diminishing the degree of spatial tuning across the active cell assembly. These changes remained stable irrespective of intermittent disruption of MEC input, indicating that while MEC input is integrated over long time scales to bias the active population, there are mechanisms for stabilizing the population of active neurons independent of the MEC. We find that MEC inputs to the hippocampus shape its ongoing activity by biasing the participation of the neurons in the active network, thereby influencing how the hippocampus selectively represents information.

  9. Evaluating digestion efficiency in full-scale anaerobic digesters by identifying active microbial populations through the lens of microbial activity

    NASA Astrophysics Data System (ADS)

    Mei, Ran; Narihiro, Takashi; Nobu, Masaru K.; Kuroda, Kyohei; Liu, Wen-Tso

    2016-09-01

    Anaerobic digestion is a common technology to biologically stabilize wasted solids produced in municipal wastewater treatment. Its efficiency is usually evaluated by calculating the reduction in volatile solids, which assumes no biomass growth associated with digestion. To determine whether this assumption is valid and further evaluate digestion efficiency, this study sampled 35 digester sludge from different reactors at multiple time points together with the feed biomass in a full-scale water reclamation plant at Chicago, Illinois. The microbial communities were characterized using Illumina sequencing technology based on 16S rRNA and 16S rRNA gene (rDNA). 74 core microbial populations were identified and represented 58.7% of the entire digester community. Among them, active populations were first identified using the ratio of 16S rRNA and 16S rDNA (rRNA/rDNA) for individual populations, but this approach failed to generate consistent results. Subsequently, a recently proposed mass balance model was applied to calculate the specific growth rate (μ), and this approach successfully identified active microbial populations in digester (positive μ) that could play important roles than those with negative μ. It was further estimated that 82% of microbial populations in the feed sludge were digested in comparison with less than 50% calculated using current equations.

  10. Evaluating digestion efficiency in full-scale anaerobic digesters by identifying active microbial populations through the lens of microbial activity

    PubMed Central

    Mei, Ran; Narihiro, Takashi; Nobu, Masaru K.; Kuroda, Kyohei; Liu, Wen-Tso

    2016-01-01

    Anaerobic digestion is a common technology to biologically stabilize wasted solids produced in municipal wastewater treatment. Its efficiency is usually evaluated by calculating the reduction in volatile solids, which assumes no biomass growth associated with digestion. To determine whether this assumption is valid and further evaluate digestion efficiency, this study sampled 35 digester sludge from different reactors at multiple time points together with the feed biomass in a full-scale water reclamation plant at Chicago, Illinois. The microbial communities were characterized using Illumina sequencing technology based on 16S rRNA and 16S rRNA gene (rDNA). 74 core microbial populations were identified and represented 58.7% of the entire digester community. Among them, active populations were first identified using the ratio of 16S rRNA and 16S rDNA (rRNA/rDNA) for individual populations, but this approach failed to generate consistent results. Subsequently, a recently proposed mass balance model was applied to calculate the specific growth rate (μ), and this approach successfully identified active microbial populations in digester (positive μ) that could play important roles than those with negative μ. It was further estimated that 82% of microbial populations in the feed sludge were digested in comparison with less than 50% calculated using current equations. PMID:27666090

  11. Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study.

    PubMed

    Liu, Ju-Chi; Hsu, Yi-Ping; Kao, Pai-Feng; Hao, Wen-Rui; Liu, Shing-Hwa; Lin, Chao-Feng; Sung, Li-Chin; Wu, Szu-Yuan

    2016-03-01

    Taiwan has the highest prevalence of chronic kidney disease (CKD) worldwide. CKD, a manifestation of vascular diseases, is associated with a high risk of dementia. Here, we estimated the association between influenza vaccination and dementia risk in patients with CKD. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study cohort included all patients diagnosed with CKD (according to International Classification of Disease, Ninth Revision, Clinical Modification codes) at healthcare facilities in Taiwan (n = 32,844) from January 1, 2000, to December 31, 2007. Each patient was followed up to assess dementia risk or protective factors: demographic characteristics of age and sex; comorbidities of diabetes, hypertension, dyslipidemia, cerebrovascular diseases, parkinsonism, epilepsy, substance and alcohol use disorders, mood disorder, anxiety disorder, psychotic disorder, and sleep disorder; urbanization level; monthly income; and statin, metformin, aspirin, and angiotensin-converting enzyme inhibitor (ACEI) use. A propensity score was derived using a logistic regression model for estimating the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) of dementia among vaccinated and unvaccinated CKD patients. The study population comprised 11,943 eligible patients with CKD; 5745 (48%) received influenza vaccination and the remaining 6198 (52%) did not. The adjusted HRs (aHRs) of dementia decreased in vaccinated patients compared with those in unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.68, 0.58, and 0.64; P < 0.0001, P < 0.0001, and P < 0.0001, respectively). In the sensitivity analysis, adjustments were made to estimate the association of age and sex; diabetes, dyslipidemia, hypertension, cerebrovascular diseases, anxiety

  12. Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study.

    PubMed

    Liu, Ju-Chi; Hsu, Yi-Ping; Kao, Pai-Feng; Hao, Wen-Rui; Liu, Shing-Hwa; Lin, Chao-Feng; Sung, Li-Chin; Wu, Szu-Yuan

    2016-03-01

    Taiwan has the highest prevalence of chronic kidney disease (CKD) worldwide. CKD, a manifestation of vascular diseases, is associated with a high risk of dementia. Here, we estimated the association between influenza vaccination and dementia risk in patients with CKD. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study cohort included all patients diagnosed with CKD (according to International Classification of Disease, Ninth Revision, Clinical Modification codes) at healthcare facilities in Taiwan (n = 32,844) from January 1, 2000, to December 31, 2007. Each patient was followed up to assess dementia risk or protective factors: demographic characteristics of age and sex; comorbidities of diabetes, hypertension, dyslipidemia, cerebrovascular diseases, parkinsonism, epilepsy, substance and alcohol use disorders, mood disorder, anxiety disorder, psychotic disorder, and sleep disorder; urbanization level; monthly income; and statin, metformin, aspirin, and angiotensin-converting enzyme inhibitor (ACEI) use. A propensity score was derived using a logistic regression model for estimating the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) of dementia among vaccinated and unvaccinated CKD patients. The study population comprised 11,943 eligible patients with CKD; 5745 (48%) received influenza vaccination and the remaining 6198 (52%) did not. The adjusted HRs (aHRs) of dementia decreased in vaccinated patients compared with those in unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.68, 0.58, and 0.64; P < 0.0001, P < 0.0001, and P < 0.0001, respectively). In the sensitivity analysis, adjustments were made to estimate the association of age and sex; diabetes, dyslipidemia, hypertension, cerebrovascular diseases, anxiety

  13. Physical activity referrals in Swedish primary health care – prescriber and patient characteristics, reasons for prescriptions, and prescribed activities

    PubMed Central

    Leijon, ME; Bendtsen, P; Nilsen, P; Ekberg, K; Ståhle, A

    2008-01-01

    Background Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries. Methods Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff. Results During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%). Conclusion Östergötland County's PAR scheme reached a relatively high proportion

  14. Current nutritional status of patients with rheumatic diseases in the population of Poland

    PubMed Central

    Borowicz, Jacek; Mańczak, Małgorzata; Grygielska, Jolanta; Samel-Kowalik, Piotr; Raciborski, Filip

    2015-01-01

    The aim of the study The aim of the study was to evaluate the current state of nutrition of patients with rheumatic diseases in the Polish population. Material and methods An anonymous questionnaire study was carried out among the patients of the Institute of Rheumatology in Warsaw in the fourth quarter of 2012. Five hundred questionnaires were distributed, and 397 questionnaires were collected and accepted for further analysis (response rate = 79%). Results Overweight or obesity was present in more than half (53%) of the patients (overweight in 30.5% of respondents, obesity in 22.6%). Among obese subjects, 43% of men and 37% of women in the study think that their diet is correct. Sixty-eight percent of respondents declared that they do not follow any special diet and only 18% declared that they follow a diet with a reduced quantity of monosaccharides (no sweets). A milk-free diet was followed by 7% of respondents, a meat-free diet by 6%, and a fruit-and-vegetable diet by 5%. Dietary supplements were regularly used by 26.7% of respondents, whereas 33.8% did not use them at all. The average assessment of physical aptitude (Health Assessment Questionnaire – HAQ) in the group of respondents was 0.71. No statistically significant differences were found between higher level of disability (e.g. HAQ ≥ 1) and the type of diet followed (p = 0.678) or body mass index (BMI) value (p = 0.864) in relation to persons with the value of HAQ < 1. Conclusions More than half of patients suffering from rheumatic diseases are overweight or obese, which corresponds to the body weight profile of the population of Poland. Most patients diagnosed with rheumatic diseases do not follow any special diet. In spite of the frequent use of dietary supplements, the patients do not consult a doctor or a dietician about it. The type of diet and BMI value do not differ according to the level of disability. PMID:27407222

  15. Acquired Idiopathic ADAMTS13 Activity Deficient Thrombotic Thrombocytopenic Purpura in a Population from Japan

    PubMed Central

    Matsumoto, Masanori; Bennett, Charles L.; Isonishi, Ayami; Qureshi, Zaina; Hori, Yuji; Hayakawa, Masaki; Yoshida, Yoko; Yagi, Hideo; Fujimura, Yoshihiro

    2012-01-01

    Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy (TMA). Studies report that the majority of TTP patients present with a deficiency of ADAMTS13 activity. In a database of TMA patients in Japan identified between 1998 and 2008, 186 patients with first onset of acquired idiopathic (ai) ADAMTS13-deficient TTP (ADAMTS13 activity <5%) were diagnosed. The median age of onset of TTP in this group of patients was 54 years, 54.8% were female, 75.8% had renal involvement, 79.0% had neurologic symptoms, and 97.8% had detectable inhibitors to ADAMTS13 activity. Younger patients were less likely to present with renal or neurologic dysfunction (p<0.01), while older patients were more likely to die during the TTP hospitalization (p<0.05). Findings from this cohort in Japan differ from those reported previously from the United States, Europe, and Korea with respect to age at onset (two decades younger in the other cohort) and gender composition (60% to 100% female in the other cohort). We conclude that in one of the largest cohorts of ai-TTP with severe deficiency of ADAMTS13 activity reported to date, demographic characteristics differ in Japanese patients relative to those reported from a large Caucasian registry from Western societies. Additional studies exploring these findings are needed. PMID:22427934

  16. The Influence of Health Literacy and Patient Activation on Patient Information Seeking and Sharing.

    PubMed

    Ledford, Christy J W; Cafferty, Lauren A; Russell, Travis C

    2015-01-01

    This study provided an assessment of how patients looked for information to prepare for a clinical appointment and whether they shared those findings with their provider. A cross-sectional survey allowed insight into patient attitudes, motivations, and behavior in clinical real time. At two hospital-based clinics, 243 patients completed surveys before and after clinical appointments. Younger patients with higher communicative and critical health literacy prepared for clinical appointments with information searches. The predicted association of health literacy and patient activation with information sharing was not supported. This study shows that patients with higher patient activation perceived that their providers responded more positively to patient-obtained medical information. The role of critical health literacy may show that individuals choosing to seek information are considering not just their ability to conduct the search but also their ability to synthesize and critically analyze the results of the information search. An implication for providers is to become skilled in directly asking or passively surveying what outside information sources the patient has engaged with, no matter if the patient does or does not introduce the information.

  17. Cast adrift: Gortex cast liners allow greater patient activity.

    PubMed

    Dubowitz, Gerald; Miller, Deborah M

    2003-01-01

    Extremity fractures are a common injury, with nearly 1.5 million cases reported in the United States in 1998. Treatment often involves lengthy periods of immobilization. This report outlines the use of a Gortex cast liner by a subject who was able to engage in swimming and scuba diving during the healing process. We report that a Gortex cast liner may be considered for an active patient who is keen to return to limited activities during fracture healing. Apparently because of a lack of knowledge of their existence, physicians currently are underutilizing this method of casting in active patients. The use of Gortex liners elsewhere has been reported to have higher patient and physician satisfaction in both use and performance, with no reported detrimental effects on outcome.

  18. Activity patterns and time budgets of the declining sea otter population at Amchitka Island, Alaska

    USGS Publications Warehouse

    Gelatt, Thomas S.; Siniff, Donald B.; Estes, James A.

    2002-01-01

    Time budgets of predators may reflect population status if time spent foraging varies with local prey abun- dance. We assumed that the sea otter (Enhydra lutris) population at Amchitka Island, Alaska, USA, had been at equilibrium since the early 1960s and collected time budgets of otters to be used to represent future conditions of currently expanding sea otter populations. We used radiotelemetry to monitor activity-time budgets of otters from August 1992 to March 1994. Sea otter activity was directly linked to sex, age, weather condition, season, and time of day. Sea otters differed in percent time foraging among cohorts but not within cohorts. Percent time foraging ranged from 21% for females with very young (≤ 3weeks of age) dependent pups to 52% for females with old (≥10 weeks of age) pups. Otters foraged more and hauled out more as local sea conditions worsened. Adult males spent less time foraging during winter and spring, consistent with seasonal changes in prey selection. Time spent for- aging was similar to that reported for otters in California and an established population in Prince William Sound, Alaska, but greater than that of otters in recently established populations in Oregon and Alaska. Despite current evidence indicating that the population was in decline during our study, we were unable to recognize this change using time budgets. Our results illustrate the importance of stratifying analyses of activity patterns by age and sex cohorts and the complexity inherent in comparisons of behavioral data between different populations relying on distinct prey bases.

  19. Survival of Patients with Chronic Myelocytic Leukemia: Comparisons of Estimates from Clinical Trial Settings and Population-Based Cancer Registries

    PubMed Central

    Gondos, Adam; Redaniel, Maria Theresa; Brenner, Hermann

    2011-01-01

    Introduction. The survival of patients with chronic myelocytic leukemia (CML) has improved during the past decades. However, there have been discrepancies between results reported from clinical trials and population-based studies. We aimed to elucidate the extent of these discrepancies. Methods. We examined the 5-year survival rate of patients in clinical trials of CML treatment and compared these results with the survival of patients in the general population using the Surveillance, Epidemiology, and End Results (SEER) database, correcting for differences in the age structure of the patient populations. Results. Twenty-nine trials were identified for data extraction. The survival rate calculated from SEER data was lower than the survival rate in clinical trials in the corresponding period, with differences of 2.1%–50.7%. Age-adapted survival was similar for four trials, but differences up to 35.8% were seen in most. Limitations of the study include the lack of information on chemotherapy in the SEER database and possible heterogeneity of cases. Discussion. The survival rate in clinical trials of CML treatment is higher than the survival rate of all patients with CML. We speculate that the difference may be a result of access to better medications, selection of healthier patients for trials, and the time necessary for adoption of new treatments. This finding underscores the need for population-based studies to give a more realistic idea of survival for patients with a given malignancy in the general population. PMID:21471276

  20. Population pharmacokinetic and pharmacogenetic analysis of tacrolimus in paediatric liver transplant patients

    PubMed Central

    Abdel Jalil, Mariam H; Hawwa, Ahmed F; McKiernan, Patrick J; Shields, Michael D; McElnay, James C

    2014-01-01

    Aims To build a population pharmacokinetic model that describes the apparent clearance of tacrolimus and the potential demographic, clinical and genetically controlled factors that could lead to inter-patient pharmacokinetic variability within children following liver transplantation. Methods The present study retrospectively examined tacrolimus whole blood pre-dose concentrations (n = 628) of 43 children during their first year post-liver transplantation. Population pharmacokinetic analysis was performed using the non-linear mixed effects modelling program (nonmem) to determine the population mean parameter estimate of clearance and influential covariates. Results The final model identified time post-transplantation and CYP3A5*1 allele as influential covariates on tacrolimus apparent clearance according to the following equation: where TVCL is the typical value for apparent clearance, TPT is time post-transplantation in days and the CYP3A5 is 1 where *1 allele is present and 0 otherwise. The population estimate and inter-individual variability (%CV) of tacrolimus apparent clearance were found to be 0.977 l h−1 kg−1 (95% CI 0.958, 0.996) and 40.0%, respectively, while the residual variability between the observed and predicted concentrations was 35.4%. Conclusion Tacrolimus apparent clearance was influenced by time post-transplantation and CYP3A5 genotypes. The results of this study, once confirmed by a large scale prospective study, can be used in conjunction with therapeutic drug monitoring to recommend tacrolimus dose adjustments that take into account not only body weight but also genetic and time-related changes in tacrolimus clearance. PMID:23738951

  1. Population Pharmacokinetics of Oral Baclofen in Pediatric Patients with Cerebral Palsy

    PubMed Central

    He, Yang; Brunstrom-Hernandez, Janice E.; Thio, Liu Lin; Lackey, Shellie; Gaebler-Spira, Deborah; Kuroda, Maxine M.; Stashinko, Elaine; Hoon, Alexander H.; Vargus-Adams, Jilda; Stevenson, Richard D.; Lowenhaupt, Stephanie; McLaughlin, John F.; Christensen, Ana; Dosa, Nienke P.; Butler, Maureen; Schwabe, Aloysia; Lopez, Christina; Roge, Desiree; Kennedy, Diane; Tilton, Ann; Krach, Linda E.; Lewandowski, Andrew; Dai, Hongying; Gaedigk, Andrea; Leeder, J. Steven; Jusko, William J.

    2014-01-01

    Objective To characterize the population pharmacokinetics (PK) of oral baclofen and assess impact of patient-specific covariates in children with cerebral palsy (CP) in order to support its clinical use. Subjects design Children (2-17 years of age) with CP received a dose of titrated oral baclofen from 2.5 mg 3 times a day to a maximum tolerated dose of up to 20 mg 4 times a day. PK sampling followed titration of 10-12 weeks. Serial R- and S-baclofen plasma concentrations were measured for up to 16 hours in 49 subjects. Population PK modeling was performed using NONMEM 7.1 (ICON PLC; Ellicott City, Maryland). Results R- and S-baclofen showed identical concentration-time profiles. Both baclofen enantiomers exhibited linear and dose/kg-proportional PK, and no sex differences were observed. Average baclofen terminal half-life was 4.5 hours. A 2-compartment PK model with linear elimination and transit absorption steps adequately described concentration-time profiles of both baclofen enantiomers. The mean population estimate of apparent clearance/F was 0.273 L/h/kg with 33.4% inter-individual variability (IIV), and the apparent volume of distribution (Vss/F) was 1.16 L/kg with 43.9% IIV. Delayed absorption was expressed by a mean transit time of 0.389 hours with 83.7% IIV. Body weight, a possible genetic factor, and age were determinants of apparent clearance in these children. Conclusion The PK of oral baclofen exhibited dose-proportionality and were adequately described by a 2-compartment model. Our population PK findings suggest that baclofen dosage can be based on body weight (2 mg/kg per day) and the current baclofen dose escalation strategy is appropriate in the treatment of children with CP older than 2 years of age. PMID:24607242

  2. Alteration of spontaneous brain activity in COPD patients

    PubMed Central

    Zhang, Jiaxing; Chen, Ji; Yu, Qian; Fan, Cunxiu; Zhang, Ran; Lin, Jianzhong; Yang, Tianhe; Fan, Ming

    2016-01-01

    Background and objective Airflow limitation in chronic obstructive pulmonary disease (COPD) results in a decrease in oxygen transport to the brain. The aim of the present study was to explore the alteration of spontaneous brain activity induced by hypoxia in patients with COPD. Patients and methods Twenty-five stable patients with COPD and 25 matching healthy volunteers were investigated. Amplitude of low-frequency fluctuation (ALFF) of blood oxygenation level-dependent signal at resting state in the brain was analyzed using functional magnetic resonance imaging. Results Whole-brain analysis using functional magnetic resonance imaging revealed significant decreases in ALFF in the bilateral posterior cingulate gyri and right lingual gyrus and an increase in ALFF in the left postcentral gyrus of patients with COPD. After controlling for SaO2, patients with COPD only showed an increase in ALFF in the left postcentral gyrus. Region of interest analysis showed a decrease in ALFF in the left precentral gyrus and an increase in ALFF in the left caudate nucleus of patients with COPD. In all subjects, ALFF in the bilateral posterior cingulate gyri and right lingual gyrus showed positive correlations with visual reproduction. Conclusion We demonstrated abnormal spontaneous brain activity of patients with COPD, which may have a pathophysiologic meaning. PMID:27555761

  3. Using health information technology to manage a patient population in accountable care organizations.

    PubMed

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.

  4. Using health information technology to manage a patient population in accountable care organizations.

    PubMed

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management. PMID:27296880

  5. Radiotherapy and Survival in Prostate Cancer Patients: A Population-Based Study

    SciTech Connect

    Zhou, Esther H. Ellis, Rodney J.; Cherullo, Edward; Colussi, Valdir; Xu Fang; Chen Weidong; Gupta, Sanjay; Whalen, Christopher C.; Bodner, Donald; Resnick, Martin I.; Rimm, Alfred A.

    2009-01-01

    Purpose: To investigate the association of overall and disease-specific survival with the five standard treatment modalities for prostate cancer (CaP): radical prostatectomy (RP), brachytherapy (BT), external beam radiotherapy, androgen deprivation therapy, and no treatment (NT) within 6 months after CaP diagnosis. Methods and Materials: The study population included 10,179 men aged 65 years and older with incident CaP diagnosed between 1999 and 2001. Using the linked Ohio Cancer Incidence Surveillance System, Medicare, and death certificate files, overall and disease-specific survival through 2005 among the five clinically accepted therapies were analyzed. Results: Disease-specific survival rates were 92.3% and 23.9% for patients with localized vs. distant disease at 7 years, respectively. Controlling for age, race, comorbidities, stage, and Gleason score, results from the Cox multiple regression models indicated that the risk of CaP-specific death was significantly reduced in patients receiving RP or BT, compared with NT. For localized disease, compared with NT, in the monotherapy cohort, RP and BT were associated with reduced hazard ratios (HR) of 0.25 and 0.45 (95% confidence intervals 0.13-0.48 and 0.23-0.87, respectively), whereas in the combination therapy cohort, HR were 0.40 (0.17-0.94) and 0.46 (0.27-0.80), respectively. Conclusions: The present population-based study indicates that RP and BT are associated with improved survival outcomes. Further studies are warranted to improve clinical determinates in the selection of appropriate management of CaP and to improve predictive modeling for which patient subsets may benefit most from definitive therapy vs. conservative management and/or observation.

  6. Suicide Risk by Military Occupation in the DoD Active Component Population

    ERIC Educational Resources Information Center

    Trofimovich, Lily; Reger, Mark A.; Luxton, David D.; Oetjen-Gerdes, Lynne A.

    2013-01-01

    Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide…

  7. Population and Activity of On-road Vehicles in MOVES2014

    EPA Science Inventory

    This report describes the sources and derivation for on-road vehicle population and activity information and associated adjustments as stored in the MOVES2014 default databases. Motor Vehicle Emission Simulator, the MOVES2014 model, is a set of modeling tools for estimating emiss...

  8. Context Fear Learning Specifically Activates Distinct Populations of Neurons in Amygdala and Hypothalamus

    ERIC Educational Resources Information Center

    Trogrlic, Lidia; Wilson, Yvette M.; Newman, Andrew G.; Murphy, Mark

    2011-01-01

    The identity and distribution of neurons that are involved in any learning or memory event is not known. In previous studies, we identified a discrete population of neurons in the lateral amygdala that show learning-specific activation of a c-"fos"-regulated transgene following context fear conditioning. Here, we have extended these studies to…

  9. A Discrete Population of Neurons in the Lateral Amygdala Is Specifically Activated by Contextual Fear Conditioning

    ERIC Educational Resources Information Center

    Wilson, Yvette M.; Murphy, Mark

    2009-01-01

    There is no clear identification of the neurons involved in fear conditioning in the amygdala. To search for these neurons, we have used a genetic approach, the "fos-tau-lacZ" (FTL) mouse, to map functionally activated expression in neurons following contextual fear conditioning. We have identified a discrete population of neurons in the lateral…

  10. ENDOCRINE ACTIVE SUBSTANCES AND DOSE-RESPONSE FOR INDIVIDUALS AND POPULATIONS

    EPA Science Inventory

    Endocrine Active Substances and Dose-Response for Individuals and Populations
    Hugh A. Barton

    Abstract for IUPAC-SCOPE article

    Dose-response characteristics for endocrine disruption have been major focuses in efforts to understand potential impacts on human and ec...

  11. Serum paraoxonase 1 activity in patients with iron deficiency anemia

    PubMed Central

    Gedikbasi, Asuman; Akalin, Nilgul; Gunaldi, Meral; Yilmaz, Deniz; Mert, Meral; Harmankaya, Ozlem; Soylu, Aliye; Karakaya, Pinar; Kumbasar, Abdulbaki

    2016-01-01

    Introduction In this study we aimed to detect paraoxonase 1 (PON-1) activity in iron deficiency anemia (IDA) and to compare it with healthy controls by observing the change after iron therapy. Material and methods In this study, 50 adult patients with IDA and 40 healthy subjects were enrolled. All patients were analyzed at the beginning and after treatment according to laboratory assessments. Results Mean paraoxonase and arylesterase activities in the iron deficiency anemia group were significantly lower than mean activities of the control group (102.4 ±19.2 U/l and 163.3 ±13.68 U/l, respectively and 157.3 ±26.4 U/l and 256.1 ±24.6 U/l, respectively; p = 0.0001 for both). Paraoxonase and arylesterase activities significantly increased after treatment for IDA (143.2 ±13.9 and 197.6 ±27.9 U/l, respectively, p = 0.0001). Mean activities after treatment with iron were significantly lower than mean activities in the control group (p = 0.002; p = 0.0001 respectively). Conclusions Paraoxonase and arylesterase activities in patients with IDA significantly increased after treatment with iron therapy. In adults IDA may also be one of the factors associated with increased risk of atherosclerosis. PMID:27478448

  12. Population-Based Study of QT Interval Prolongation in Patients with Rheumatoid Arthritis

    PubMed Central

    Chauhan, Krati; Ackerman, Michael J.; Crowson, Cynthia S.; Matteson, Eric L.; Gabriel, Sherine E.

    2015-01-01

    Background Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular morbidity and mortality. Heart rate corrected QT interval (QTc) (which is obtained from a 12-lead electrocardiogram (ECG) and reflects ventricular repolarization duration) is a strong predictor of cardiovascular mortality. Our primary purpose is to determine the impact of QTc prolongation on mortality in RA patients. Methods A population-based inception cohort of patients with RA fulfilling 1987 ACR criteria in 1988–2007 was identified, with an age- and sex-matched comparison cohort and followed until death, migration or 12-31-2008. Data were collected on ECG variables, medications known to prolong QT interval, electrolytes, cardiovascular risk factors and disease status and RA disease characteristics. Cox proportional hazards models were used to examine QTc prolongation as predictor of mortality. Results QTc prolongation prior to RA incidence/index date was similar in RA (15%) and non-RA (18%) subjects. During follow-up, the cumulative incidence of QTc prolongation was higher among RA (48% at 20 years after RA incidence) than non-RA (38% at 20 years after index date; p= 0.004). Idiopathic QTc prolongation (excluding prolongations explained by ECG changes, medications, etc.) was marginally associated with all-cause mortality (HR: 1.28; 95% CI: 0.91–1.81, p=0.16), but was not associated with cardiovascular mortality (HR: 1.10; 95% CI:0.43–2.86, p= 0.83) in RA. Conclusion RA patients have a significantly elevated risk of developing QTc prolongation. However, idiopathic prolonged QTc was only marginally associated with all-cause mortality in RA patients. The clinical implications of these findings in RA require further study. PMID:25572282

  13. Risk of Cerebrovascular Events in Pneumoconiosis Patients: A Population-based Study, 1996-2011.

    PubMed

    Chuang, Chieh-Sen; Ho, Shang-Chang; Lin, Cheng-Li; Lin, Ming-Chia; Kao, Chia-Hung

    2016-03-01

    Pneumoconiosis is a parenchymal lung disease that develops through the inhalation of inorganic dust at work. Cerebrovascular and cardiovascular events are leading causes of mortality and adult disability worldwide. This retrospective cohort study investigated the association between pneumoconiosis, and cerebrovascular and cardiovascular events by using a nationwide population-based database in Taiwan. The data analyzed in this study was retrieved from the Taiwan National Health Insurance Research Database. We selected 6940 patients with pneumoconiosis from the database as our study cohort. Another 27,760 patients without pneumoconiosis were selected and matched with those with pneumoconiosis according to age and sex as the comparison cohort. We used univariate and multivariate Cox proportional-hazard regression analyses to determine the association between pneumoconiosis and the risk of cerebrovascular and cardiovascular events after adjusting for medical comorbidities. After adjustment for age, sex, and comorbidities, the patients with pneumoconiosis exhibited a significantly higher incidence of ischemic stroke (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05-1.24) than did those without pneumoconiosis. The incidence of hemorrhagic stroke was higher, but not significant, in the pneumoconiosis patients (HR 1.20, 95% CI 0.99-1.46). No statistically significant differences were observed between the pneumoconiosis and nonpneumoconiosis groups in acute coronary syndrome (HR 1.10, 95% CI 0.95-1.26). The findings of this study reveal an association between pneumoconiosis and a higher risk of cerebrovascular events after adjustment for comorbidities. Healthcare providers should control the related risk factors for primary prevention of stroke in pneumoconiosis patients.

  14. Population pharmacokinetic-pharmacodynamic analysis of voriconazole and anidulafungin in adult patients with invasive aspergillosis.

    PubMed

    Liu, Ping; Mould, Diane R

    2014-08-01

    To evaluate the exposure-response relationships for efficacy and safety of voriconazole and anidulafungin in adult patients with invasive aspergillosis (IA), a population pharmacokinetic-pharmacodynamic (PK-PD) analysis was performed with data from a phase 3, prospective, double-blind, comparative study evaluating voriconazole and anidulafungin combination therapy versus voriconazole (and placebo) monotherapy. Anidulafungin/placebo treatment duration was 2 to 4 weeks, and voriconazole treatment duration was 6 weeks. Efficacy (6-week all-causality mortality and 6-week global response [n = 176]) and safety (hepatic [n = 238], visual [n = 199], and psychiatric [n = 183] adverse events [AEs]) endpoints were analyzed separately using a binary logistic regression model. In IA patients receiving voriconazole monotherapy, no positive associations between voriconazole exposure and efficacy or safety were identified. In IA patients receiving combination therapy, no positive associations between voriconazole or anidulafungin exposures and efficacy were identified. The 6-week survival rate tended to increase as anidulafungin treatment duration increased; this finding should be considered with caution. Additionally, in IA patients receiving combination therapy, a positive association between voriconazole and anidulafungin exposures (area under the curve [AUC] and trough concentration [C(min)]) and hepatic AEs was established; a weak positive association between voriconazole exposure (AUC and C(min)) and psychiatric AEs was also established, but no association between voriconazole exposure and visual AEs was identified. Besides the drug exposures, no other covariates (i.e., CYP2C19 genotype status, age, weight, body mass index, sex, race, or neutropenia status) were identified as significant predictors of the efficacy and safety endpoints in IA patients. This study was registered on ClinicalTrials.gov (NCT00531479). PMID:24914120

  15. Population pharmacokinetic-pharmacodynamic analysis of voriconazole and anidulafungin in adult patients with invasive aspergillosis.

    PubMed

    Liu, Ping; Mould, Diane R

    2014-08-01

    To evaluate the exposure-response relationships for efficacy and safety of voriconazole and anidulafungin in adult patients with invasive aspergillosis (IA), a population pharmacokinetic-pharmacodynamic (PK-PD) analysis was performed with data from a phase 3, prospective, double-blind, comparative study evaluating voriconazole and anidulafungin combination therapy versus voriconazole (and placebo) monotherapy. Anidulafungin/placebo treatment duration was 2 to 4 weeks, and voriconazole treatment duration was 6 weeks. Efficacy (6-week all-causality mortality and 6-week global response [n = 176]) and safety (hepatic [n = 238], visual [n = 199], and psychiatric [n = 183] adverse events [AEs]) endpoints were analyzed separately using a binary logistic regression model. In IA patients receiving voriconazole monotherapy, no positive associations between voriconazole exposure and efficacy or safety were identified. In IA patients receiving combination therapy, no positive associations between voriconazole or anidulafungin exposures and efficacy were identified. The 6-week survival rate tended to increase as anidulafungin treatment duration increased; this finding should be considered with caution. Additionally, in IA patients receiving combination therapy, a positive association between voriconazole and anidulafungin exposures (area under the curve [AUC] and trough concentration [C(min)]) and hepatic AEs was established; a weak positive association between voriconazole exposure (AUC and C(min)) and psychiatric AEs was also established, but no association between voriconazole exposure and visual AEs was identified. Besides the drug exposures, no other covariates (i.e., CYP2C19 genotype status, age, weight, body mass index, sex, race, or neutropenia status) were identified as significant predictors of the efficacy and safety endpoints in IA patients. This study was registered on ClinicalTrials.gov (NCT00531479).

  16. Snowballing movement. Legislators are now active advocates regarding population and development.

    PubMed

    De Leon, B D

    1992-08-01

    Newly industrializing economies (NIEs) in East Asia have demonstrated that the population programs were part of their economic success, such as in Thailand and Indonesia where family planning (FP) was made a way of life. The population growth in the Philippines has put pressure on the environment by migration to uplands where slash-and-burn agriculture adds to deforestation. The Global Committee of Parliamentarians of Population and Development headquartered in New York serves as a liaison for 56 legislative groups sponsoring meetings and seminars. In October 1981 the Asian Conference on Parliamentarians on Population and Development was held in Beijing with the participation of legislators from 19 countries. It set up the Asian Forum for Parliamentarians on Population and Development to contribute and promote activities that facilitate population and development, and to improve the living standards and welfare of people in Asia. The Secretariat is located in Bangkok, Thailand. In October 1987 in Beijing and in October 1990 follow-up regional conferences were organized. The latter was attended by 21 Asian parliamentarians who endorsed the stabilization of population growth to achieve a 1% growth rate for Asia by 2000. The Philippine population numbered 63.9 million in mid-1992 with an annual growth rate of 2.3%. The Philippine House of Representatives started an inquiry about the disturbing demographic trends with implications on economic growth. In 1987 a movement commenced that hosted the Philippine Parliamentarians Conference on Human Survival, Population and Development (PARLCON '88) in Manila. It focused on sustainable development, the conditions of women and children, the environment, and the promotion of FP which was adopted by the House and involved a major segment of legislators. PMID:12343890

  17. Snowballing movement. Legislators are now active advocates regarding population and development.

    PubMed

    De Leon, B D

    1992-08-01

    Newly industrializing economies (NIEs) in East Asia have demonstrated that the population programs were part of their economic success, such as in Thailand and Indonesia where family planning (FP) was made a way of life. The population growth in the Philippines has put pressure on the environment by migration to uplands where slash-and-burn agriculture adds to deforestation. The Global Committee of Parliamentarians of Population and Development headquartered in New York serves as a liaison for 56 legislative groups sponsoring meetings and seminars. In October 1981 the Asian Conference on Parliamentarians on Population and Development was held in Beijing with the participation of legislators from 19 countries. It set up the Asian Forum for Parliamentarians on Population and Development to contribute and promote activities that facilitate population and development, and to improve the living standards and welfare of people in Asia. The Secretariat is located in Bangkok, Thailand. In October 1987 in Beijing and in October 1990 follow-up regional conferences were organized. The latter was attended by 21 Asian parliamentarians who endorsed the stabilization of population growth to achieve a 1% growth rate for Asia by 2000. The Philippine population numbered 63.9 million in mid-1992 with an annual growth rate of 2.3%. The Philippine House of Representatives started an inquiry about the disturbing demographic trends with implications on economic growth. In 1987 a movement commenced that hosted the Philippine Parliamentarians Conference on Human Survival, Population and Development (PARLCON '88) in Manila. It focused on sustainable development, the conditions of women and children, the environment, and the promotion of FP which was adopted by the House and involved a major segment of legislators.

  18. Tibial stress fractures in an active duty population: long-term outcomes.

    PubMed

    Kilcoyne, Kelly G; Dickens, Jonathan F; Rue, John-Paul

    2013-01-01

    Tibial stress fractures are a common overuse injury among military recruits. The purpose of this study was to determine what, if any, long-term effects that tibial stress fractures have on military personnel with respect to physical activity level, completion of military training, recurrence of symptoms, and active duty service. Twenty-six military recruits included in a previous tibial stress fracture study were contacted 10 years after initial injury and asked a series of questions related to any long-term consequences of their tibial stress fracture. Of the 13 patients available for contact, no patients reported any necessary limited duty while on active duty, and no patient reported being separated or discharged from the military as a result of stress fracture. Tibial stress fractures in military recruits are most often an isolated injury and do not affect ability to complete military training or reflect a long-term need for decreased physical activity.

  19. Alcohol Habits in Patients with Long-Term Musculoskeletal Pain: Comparison with a Matched Control Group from the General Population

    ERIC Educational Resources Information Center

    Thelin Bronner, Kerstin Birgitta; Wennberg, Peter; Kallmen, Hakan; Schult, Marie-Louise Birgitta

    2012-01-01

    This prospective study aimed to describe alcohol habits in patients with chronic pain compared with those in a matched control group from the general Swedish population. In total, 100 consecutive patients enrolled were matched against 100 individuals in a control group on the basis of age and sex. Alcohol habits were measured using the Alcohol Use…

  20. Acoustic Coordinated Reset Neuromodulation in a Real Life Patient Population with Chronic Tonal Tinnitus

    PubMed Central

    Hauptmann, Christian; Ströbel, Armin; Williams, Mark; Patel, Nitesh; Wurzer, Hannes; von Stackelberg, Tatjana; Brinkmann, Uwe; Langguth, Berthold; Tass, Peter A.

    2015-01-01

    Purpose. Primary tinnitus has a severe negative influence on the quality of life of a significant portion of the general population. Acoustic coordinated reset neuromodulation is designed to induce a long-lasting reduction of tinnitus symptoms. To test acoustic coordinated reset neuromodulation as a treatment for chronic, tonal tinnitus under real life conditions, an outpatient study “RESET Real Life” was commissioned by ANM GmbH. Herein we present the results of this study. Methods. In a prospective, open-label, nonrandomized, noncontrolled multicenter clinical study with 200 chronic tinnitus patients, tinnitus questionnaire TBF-12 and Global Clinical Improvement-Impression Scale (CGI-I7) are used to study the safety and efficacy of acoustic coordinated reset neuromodulation. 189 patients completed the last 12-month visit, 11 patients dropped out (8 because of nontreatment related reasons; 2 because tinnitus did not change; and 1 because tinnitus got louder). Results. Acoustic coordinated reset neuromodulation caused a statistically and clinically significant decrease in TBF-12 scores as well as in CGI-I7 after 12 months of therapy under real life conditions. There were no persistent adverse events reported that were related to the therapy. Conclusion. The field study “RESET Real Life” provides evidence for safety and efficacy of acoustic coordinated reset neuromodulation in a prospective, open-label, real life setting. PMID:26568958

  1. Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market

    PubMed Central

    Lucinda, Luciane Boreki; Prosdócimo, Ana Claudia Merchan Giaxa; de Carvalho, Katherine Athayde Teixeira; Francisco, Julio Cesar; Baena, Cristina Pellegrino; Olandoski, Marcia; do Amaral, Vivian Ferreira; Faria, José Rocha; Guarita-Souza, Luiz César

    2015-01-01

    Introduction Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. Objective To identify the presence of stress and its phases in hospitalized and active labor market patients with unstable myocardial infarction and observe its correlation with the life of this population with stress. Methods The methodology used was a quantitative, descriptive and transversal research approach conducted with a total of 43 patients, who were still active in the labor market, presenting or not morbidities. Data collection occurred on the fourth day of their hospitalization and patients responded to Lipp's Stress Symptom Inventory for adults. Results Thirty-one patients (72.1%) presented stress and twelve (27.8%) did not. In patients with stress, the identified phases were: alert - one patient (3.2%); resistance -twenty-two patients (71.0%); quasi-exhaustion - six patients (19.4%) and exhaustion - two patients (6.5%). All women researched presented stress. Conclusion The results suggest a high level of stress, especially in the resistance phase, in the male infarcted population, hospitalized and active in the labor market. PMID:25859863

  2. Active Marine Subsurface Bacterial Population Composition in Low Organic Carbon Environments from IODP Expedition 320

    NASA Astrophysics Data System (ADS)

    Shepard, A.; Reese, B. K.; Mills, H. J.; IODP Expedition 320 Shipboard Science Party

    2011-12-01

    The marine subsurface environment contains abundant and active microorganisms. These microbial populations are considered integral players in the marine subsurface biogeochemical system with significance in global geochemical cycles and reservoirs. However, variations in microbial community structure, activity and function associated with the wide-ranging sedimentary and geochemical environments found globally have not been fully resolved. Integrated Ocean Drilling Program Expedition 320 recovered sediments from site U1332. Two sampling depths were selected for analysis that spanned differing lithological units in the sediment core. Sediments were composed of mostly clay with zeolite minerals at 8 meters below sea floor (mbsf). At 27 mbsf, sediments were composed of alternating clayey radiolarian ooze and nannofossil ooze. The concentration of SO42- had little variability throughout the core and the concentration of Fe2+ remained close to, or below, detection limits (0.4 μM). Total organic carbon content ranged from a low of 0.03 wt% to a high of 0.07 wt% between 6 and 30 mbsf providing an opportunity to evaluate marine subsurface microbial communities under extreme electron donor limiting conditions. The metabolically active fraction of the bacterial population was isolated by the extraction and amplification of 16S ribosomal RNA. Pyrosequencing of 16S rRNA transcripts and subsequent bioinformatic analyses provided a robust data set (15,931 total classified sequences) to characterize the community at a high resolution. As observed in other subsurface environments, the overall diversity of active bacterial populations decreased with depth. The population shifted from a diverse but evenly distributed community at approximately 8 mbsf to a Firmicutes dominated population at 27 mbsf (80% of sequences). A total of 95% of the sequences at 27 mbsf were grouped into three genera: Lactobacillus (phylum Firmicutes) at 80% of the total sequences, Marinobacter (phylum

  3. Tools for risk stratification of sudden cardiac death: A review of the literature in different patient populations

    PubMed Central

    Ragupathi, Loheetha; Pavri, Behzad B.

    2014-01-01

    While various modalities to determine risk of sudden cardiac death (SCD) have been reported in clinical studies, currently reduced left ventricular ejection fraction remains the cornerstone of SCD risk stratification. However, the absolute burden of SCD is greatest amongst populations without known cardiac disease. In this review, we summarize the evidence behind current guidelines for implantable cardioverter defibrillator (ICD) use for the prevention of SCD in patients with ischemic heart disease (IHD). We also evaluate the evidence for risk stratification tools beyond clinical guidelines in the general population, patients with IHD, and patients with other known or suspected medical conditions. PMID:24568833

  4. Genetic Diversity in Introduced Golden Mussel Populations Corresponds to Vector Activity

    PubMed Central

    Ghabooli, Sara; Zhan, Aibin; Sardiña, Paula; Paolucci, Esteban; Sylvester, Francisco; Perepelizin, Pablo V.; Briski, Elizabeta; Cristescu, Melania E.; MacIsaac, Hugh J.

    2013-01-01

    We explored possible links between vector activity and genetic diversity in introduced populations of Limnoperna fortunei by characterizing the genetic structure in native and introduced ranges in Asia and South America. We surveyed 24 populations: ten in Asia and 14 in South America using the mitochondrial cytochrome c oxidase subunit I (COI) gene, as well as eight polymorphic microsatellite markers. We performed population genetics and phylogenetic analyses to investigate population genetic structure across native and introduced regions. Introduced populations in Asia exhibit higher genetic diversity (HE = 0.667–0.746) than those in South America (HE = 0.519–0.575), suggesting higher introduction effort for the former populations. We observed pronounced geographical structuring in introduced regions, as indicated by both mitochondrial and nuclear markers based on multiple genetic analyses including pairwise ФST, FST, Bayesian clustering method, and three-dimensional factorial correspondence analyses. Pairwise FST values within both Asia (FST = 0.017–0.126, P = 0.000–0.009) and South America (FST = 0.004–0.107, P = 0.000–0.721) were lower than those between continents (FST = 0.180–0.319, P = 0.000). Fine-scale genetic structuring was also apparent among introduced populations in both Asia and South America, suggesting either multiple introductions of distinct propagules or strong post-introduction selection and demographic stochasticity. Higher genetic diversity in Asia as compared to South America is likely due to more frequent propagule transfers associated with higher shipping activities between source and donor regions within Asia. This study suggests that the intensity of human-mediated introduction vectors influences patterns of genetic diversity in non-indigenous species. PMID:23533614

  5. Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study

    PubMed Central

    Crowson, Cynthia S.; Makol, Ashima; Ytterberg, Steven R.; Saitta, Antonino; Salvarani, Carlo; Matteson, Eric L.; Warrington, Kenneth J.

    2016-01-01

    Objective To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. Methods A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. Results The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. Conclusion In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects. PMID:26901431

  6. Demoralization, Patient Activation, and the Outcome of Spine Surgery

    PubMed Central

    Block, Andrew R

    2016-01-01

    It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities. PMID:27417599

  7. Rifapentine for latent tuberculosis infection treatment in the general population and human immunodeficiency virus-positive patients: summary of evidence.

    PubMed

    Vidal, Júlia Souza; Silva, Marcus Tolentino; Sanchez, Mauro Niskier

    2015-01-01

    Latent tuberculosis infection (LTBI) and human immunodeficiency virus (HIV)-coinfection are challenges in the control of tuberculosis transmission. We aimed to assess and summarize evidence available in the literature regarding the treatment of LTBI in both the general and HIV-positive population, in order to support decision making by the Brazilian Tuberculosis Control Program for LTBI chemoprophylaxis. We searched MEDLINE, Cochrane Library, Centre for Reviews and Dissemination, Embase, LILACS, SciELO, Trip database, National Guideline Clearinghouse, and the Brazilian Theses Repository to identify systematic reviews, randomized clinical trials, clinical guidelines, evidence-based synopses, reports of health technology assessment agencies, and theses that investigated rifapentine and isoniazid combination compared to isoniazid monotherapy. We assessed the quality of evidence from randomized clinical trials using the Jadad Scale and recommendations from other evidence sources using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The available evidence suggests that there are no differences between rifapentine + isoniazid short-course treatment and the standard 6-month isoniazid therapy in reducing active tuberculosis incidence or death. Adherence was better with directly observed rifapentine therapy compared to self-administered isoniazid. The quality of evidence obtained was moderate, and on the basis of this evidence, rifapentine is recommended by one guideline. Available evidence assessment considering the perspective of higher adherence rates, lower costs, and local peculiarity context might support rifapentine use for LTBI in the general or HIV-positive populations. Since novel trials are ongoing, further studies should include patients on antiretroviral therapy. PMID:26516958

  8. A restricted population of CB1 cannabinoid receptors with neuroprotective activity

    PubMed Central

    Chiarlone, Anna; Bellocchio, Luigi; Blázquez, Cristina; Resel, Eva; Soria-Gómez, Edgar; Cannich, Astrid; Ferrero, José J.; Sagredo, Onintza; Benito, Cristina; Romero, Julián; Sánchez-Prieto, José; Lutz, Beat; Fernández-Ruiz, Javier; Galve-Roperh, Ismael; Guzmán, Manuel

    2014-01-01

    The CB1 cannabinoid receptor, the main molecular target of endocannabinoids and cannabis active components, is the most abundant G protein-coupled receptor in the mammalian brain. Of note, CB1 receptors are expressed at the synapses of two opposing (i.e., GABAergic/inhibitory and glutamatergic/excitatory) neuronal populations, so the activation of one and/or another receptor population may conceivably evoke different effects. Despite the widely reported neuroprotective activity of the CB1 receptor in animal models, the precise pathophysiological relevance of those two CB1 receptor pools in neurodegenerative processes is unknown. Here, we first induced excitotoxic damage in the mouse brain by (i) administering quinolinic acid to conditional mutant animals lacking CB1 receptors selectively in GABAergic or glutamatergic neurons, and (ii) manipulating corticostriatal glutamatergic projections remotely with a designer receptor exclusively activated by designer drug pharmacogenetic approach. We next examined the alterations that occur in the R6/2 mouse, a well-established model of Huntington disease, upon (i) fully knocking out CB1 receptors, and (ii) deleting CB1 receptors selectively in corticostriatal glutamatergic or striatal GABAergic neurons. The data unequivocally identify the restricted population of CB1 receptors located on glutamatergic terminals as an indispensable player in the neuroprotective activity of (endo)cannabinoids, therefore suggesting that this precise receptor pool constitutes a promising target for neuroprotective therapeutic strategies. PMID:24843137

  9. Impact of Physical Activity Interventions on Blood Pressure in Brazilian Populations

    PubMed Central

    Bento, Vivian Freitas Rezende; Albino, Flávia Barbizan; de Moura, Karen Fernandes; Maftum, Gustavo Jorge; dos Santos, Mauro de Castro; Guarita-Souza, Luiz César; Faria Neto, José Rocha; Baena, Cristina Pellegrino

    2015-01-01

    Background High blood pressure is associated with cardiovascular disease, which is the leading cause of mortality in the Brazilian population. Lifestyle changes, including physical activity, are important for lowering blood pressure levels and decreasing the costs associated with outcomes. Objective Assess the impact of physical activity interventions on blood pressure in Brazilian individuals. Methods Meta-analysis and systematic review of studies published until May 2014, retrieved from several health sciences databases. Seven studies with 493 participants were included. The analysis included parallel studies of physical activity interventions in adult populations in Brazil with a description of blood pressure (mmHg) before and after the intervention in the control and intervention groups. Results Of 390 retrieved studies, eight matched the proposed inclusion criteria for the systematic review and seven randomized clinical trials were included in the meta-analysis. Physical activity interventions included aerobic and resistance exercises. There was a reduction of -10.09 (95% CI: -18.76 to -1.43 mmHg) in the systolic and -7.47 (95% CI: -11.30 to -3.63 mmHg) in the diastolic blood pressure. Conclusions Available evidence on the effects of physical activity on blood pressure in the Brazilian population shows a homogeneous and significant effect at both systolic and diastolic blood pressures. However, the strength of the included studies was low and the methodological quality was also low and/or regular. Larger studies with more rigorous methodology are necessary to build robust evidence. PMID:26016783

  10. Seismic Risk Assessment of Active Faults in Japan in Terms of Population Exposure to Seismic Intensity

    NASA Astrophysics Data System (ADS)

    Nojima, Nobuoto; Fujiwara, Hiroyuki; Morikawa, Nobuyuki; Ishikawa, Yutaka; Okumura, Toshihiko; Miyakoshi, Junichi

    This study evaluates and compares seismic risks associated with inland crustal earthquakes in Japan on the basis of published data available on the Japan Seismic Hazard Information Station (J-SHIS). First, taking account of prediction uncertainty of the attenuation law of seismic intensity, the evaluation method for population exposure (PEX) to seismic intensity is presented. The method is applied to 333 seismic events potentially caused by main active faults (154 cases) and other active faults (179 cases). The relationship between population exposure and the probability of occurrence of seismic events ("P-PEX relation") and the resultant seismic risk curves are obtained. Generalized risk index which incorporates the effects of focusing on urgency (probability) or significance (PEX) is defined, producing various risk rankings of active faults.

  11. A Trans-Theoretical Approach to Physical Activity Profile in General Population of Mashhad

    PubMed Central

    Shaye, Zahra Abbasi; Bazzaz, Mojtaba Mousavi; Vakili, Veda

    2015-01-01

    Regular physical-activity is necessity for a healthy lifestyle. Despite public health efforts, a minority of population are involved in healthy levels of physical-activity. This study provides evidence about exercise patterns and predictors of Mashhad-Iran population according to TTM change stages. In this cross-sectional study, we surveyed a total number of 564 participants from Mashhad in 2014 by using stages of change questionnaire. Analysis showed 23.4% of participants were in pre-contemplation stage, 18 in contemplation, 24.6% in preparation, 8.10% in action, 14.4% in maintenance and 11.5% were in termination phase. Age, gender, BMI, alcohol consumption, sleep duration, having compeer and encouragement were identified as predictors of pre-contemplation stage. Genders, having company and using bicycle for transportation were predictors of termination phase. Tailor interventions based on the predictors to enhance the physical activity among specific subgroups would be of interest. PMID:26153203

  12. Factors that influence physicians' and medical students' confidence in counseling patients about physical activity.

    PubMed

    Stanford, Fatima Cody; Durkin, Martin W; Stallworth, James Rast; Powell, Caroline Keller; Poston, Mary Beth; Blair, Steven N

    2014-06-01

    Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians' and medical students' confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students' patient populations.

  13. Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

    ERIC Educational Resources Information Center

    Chintanadilok, Jirayos

    2002-01-01

    Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

  14. Suicide risk by military occupation in the DoD active component population.

    PubMed

    Trofimovich, Lily; Reger, Mark A; Luxton, David D; Oetjen-Gerdes, Lynne A

    2013-06-01

    Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide compared to the overall military population even when adjusted for gender, age, and deployment history. The results provide useful information that can help inform the DoD's suicide prevention mission. Data limitations and recommended areas for future research are discussed.

  15. Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study

    PubMed Central

    Chang, Chi Ching; Chiou, Chi Sheng; Lin, Hsiu Li; Wang, Li Hsuan; Chang, Yu Sheng; Lin, Hsiu-Chen

    2015-01-01

    The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis. PMID:26262880

  16. Startle Modification and P50 Gating in Schizophrenia Patients and Controls: Russian Population.

    PubMed

    Storozheva, Zinaida I; Kirenskaya, Anna V; Novototsky-Vlasov, Vladimir Y; Telesheva, Klavdia Y; Pletnikov, Mikhail

    2016-01-01

    Prepulse modification of the acoustic startle response (ASR) and P50 gating are potential neurophysiological endophenotypes of schizophrenia and may be used in the construction of valid clinical biomarkers. Such approach requires a large amount of data obtained in the representative samples from different gender, socio-typological and ethnic groups, replicating studies using the similar protocols and meta-analyses. This is a replication study of ASR and the first study of P50 suppression in Russian patients with schizophrenia (n = 28) and healthy controls (n = 25). ASR and P50 were estimated according to standard protocols. Patients exhibited increased baseline ASR latency (d = 0.35, p = .026) and reduced prepulse inhibition (PPI) at 60 ms interval (d = 0.39, p = .003) and 120 ms interval (d = 0.37, p = .005) relative to controls. In the P50 test patients displayed greater S2 response amplitude (d = 0.24, p = .036) and deficit of P50 suppression (d = 0.43, p = .001). No correlations of PPI and P50 suppression were found in both groups. Only in controls prepulse ASR facilitation (at 2500 ms interval) positively correlated with P50 suppression (r = -.514, p = .013). In patients PPI displayed significant correlations with Difficulty in abstract thinking (N5: r = -.49, p = .005) and Hallucination (P3: r = .40, p = .036) PANSS scales. Logistic regression showed that the combination of PPI and P50 suppression could serve as a diagnostic predictor. Obtained results demonstrated that both PPI and P50 could be regarded as potential schizophrenia biomarkers in Russian population. PMID:26936103

  17. Interleukin-19 impairment in active Crohn's disease patients.

    PubMed

    Cantó, Elisabet; Garcia Planella, Esther; Zamora-Atenza, Carlos; Nieto, Juan Camilo; Gordillo, Jordi; Ortiz, Ma Angels; Metón, Isidoro; Serrano, Elena; Vegas, Esteban; García-Bosch, Orlando; Juárez, Cándido; Vidal, Sílvia

    2014-01-01

    The exact function of interleukin-19 (IL-19) on immune response is poorly understood. In mice, IL-19 up-regulates TNFα and IL-6 expression and its deficiency increases susceptibility to DSS-induced colitis. In humans, IL-19 favors a Th2 response and is elevated in several diseases. We here investigate the expression and effects of IL-19 on cells from active Crohn's disease (CD) patient. Twenty-three active CD patients and 20 healthy controls (HC) were included. mRNA and protein IL-19 levels were analyzed in monocytes. IL-19 effects were determined in vitro on the T cell phenotype and in the production of cytokines by immune cells. We observed that unstimulated and TLR-activated monocytes expressed significantly lower IL-19 mRNA in active CD patients than in HC (logFC = -1.97 unstimulated; -1.88 with Pam3CSK4; and -1.91 with FSL-1; p<0.001). These results were confirmed at protein level. Exogenous IL-19 had an anti-inflammatory effect on HC but not on CD patients. IL-19 decreased TNFα production in PBMC (850.7 ± 75.29 pg/ml vs 2626.0 ± 350 pg/ml; p<0.01) and increased CTLA4 expression (22.04 ± 1.55% vs 13.98 ± 2.05%; p<0.05) and IL-4 production (32.5 ± 8.9 pg/ml vs 13.5 ± 2.9 pg/ml; p<0.05) in T cells from HC. IL-10 regulated IL-19 production in both active CD patients and HC. We observed that three of the miRNAs that can modulate IL-19 mRNA expression, were up-regulated in monocytes from active CD patients. These results suggested that IL-19 had an anti-inflammatory role in this study. Defects in IL-19 expression and the lack of response to this cytokine could contribute to inflammatory mechanisms in active CD patients.

  18. Increased Risk of Additional Cancers Among Patients with Gastrointestinal Stromal Tumors: A Population-Based Study

    PubMed Central

    Murphy, James D.; Ma, Grace L.; Baumgartner, Joel M.; Madlensky, Lisa; Burgoyne, Adam M.; Tang, Chih-Min; Martinez, Maria Elena; Sicklick, Jason K.

    2015-01-01

    Purpose Most gastrointestinal stromal tumors (GIST) are considered non-hereditary or sporadic. However, single-institution studies suggest that GIST patients develop additional malignancies with increased frequencies. We hypothesized that we could gain greater insight into possible associations between GIST and other malignancies using a national cancer database inquiry. Methods Patients diagnosed with GIST (2001–2011) in the Surveillance, Epidemiology, and End Results database were included. Standardized prevalence ratios (SPRs) and standardized incidence ratios (SIRs) were used to quantify cancer risks incurred by GIST patients before and after GIST diagnoses, respectively, when compared with the general U.S. population. Results Of 6,112 GIST patients, 1,047 (17.1%) had additional cancers. There were significant increases in overall cancer rates: 44% (SPR=1.44) before diagnosis and 66% (SIR=1.66) after GIST diagnoses. Malignancies with significantly increased occurrence both before/after diagnoses included other sarcomas (SPR=5.24/SIR=4.02), neuroendocrine-carcinoid tumors (SPR=3.56/SIR=4.79), non-Hodgkin’s lymphoma (SPR=1.69/SIR=1.76), and colorectal adenocarcinoma (SPR=1.51/SIR=2.16). Esophageal adenocarcinoma (SPR=12.0), bladder adenocarcinoma (SPR=7.51), melanoma (SPR=1.46), and prostate adenocarcinoma (SPR=1.20) were significantly more common only before GIST. Ovarian carcinoma (SIR=8.72), small intestine adenocarcinoma (SIR=5.89), papillary thyroid cancer (SIR=5.16), renal cell carcinoma (SIR=4.46), hepatobiliary adenocarcinomas (SIR=3.10), gastric adenocarcinoma (SIR=2.70), pancreatic adenocarcinoma (SIR=2.03), uterine adenocarcinoma (SIR=1.96), non-small cell lung cancer (SIR=1.74), and transitional cell carcinoma of the bladder (SIR=1.65) were significantly more common only after GIST. Conclusion This is the first population-based study to characterize the associations and temporal relationships between GIST and other cancers, both by site and

  19. Review of antifungal therapy, part II: treatment rationale, including specific patient populations.

    PubMed

    Baran, Robert; Hay, Rod J; Garduno, Javier I

    2008-01-01

    This portion of the antifungal review focuses on treatment rationale and suggestions, including special populations such as the elderly, children, and pregnant and immunocompromised individuals. In elderly individuals, the pathogen may be associated with certain comorbidities; treatment should begin with local treatments such as debridement (mechanical or chemical) and a topical. In children, the pathogen most commonly isolated is Trichophyton rubrum. Children should be examined for concomitant tinea and treatment options can begin with a chemical debridement (non-painful) and a topical, with non-responders being treated with combination therapy as in adults. It is suggested that blood tests are monitored at baseline and every 4-8 weeks in children on systemic therapy. Terbinafine is the only systemic in category B and local therapies should be the primary treatment modalities in pregnancy. Prevalence of onychomycosis is high in immunocompromised patients with higher relapse rates after treatment. The same fungal infections that are seen in healthy populations are usually represented in the immunocompromised host. There is a stepwise approach that is suggested in the treatment of onychomycosis. Before treatment, several factors should be determined, which include risk for failure and compliance issues. Strategies for therapy include monotherapy, combination therapy, supplemental therapy, and intermittent therapy. Topical monotherapy is effective in early distal nail disease and for the prevention of reinfection of the cured nail. Combination therapy is an appropriate progression of therapy for patients who failed monotherapy or are at risk for failure. Combined therapies are shown to increase cure rates. Mechanical interventions are essential in reducing fungal burdens to allow other modalities to penetrate, especially in dermatophytomas and onycholysis. PMID:18569273

  20. Prokaryotic diversity and metabolically active microbial populations in sediments from an active mud volcano in the Gulf of Mexico.

    PubMed

    Martinez, Robert J; Mills, Heath J; Story, Sandra; Sobecky, Patricia A

    2006-10-01

    In this study, ribosomes and genomic DNA were extracted from three sediment depths (0-2, 6-8 and 10-12 cm) to determine the vertical changes in the microbial community composition and identify metabolically active microbial populations in sediments obtained from an active seafloor mud volcano site in the northern Gulf of Mexico. Domain-specific Bacteria and Archaea 16S polymerase chain reaction primers were used to amplify 16S rDNA gene sequences from extracted DNA. Complementary 16S ribosomal DNA (crDNA) was obtained from rRNA extracted from each sediment depth that had been subjected to reverse transcription polymerase chain reaction amplification. Twelve different 16S clone libraries, representing the three sediment depths, were constructed and a total of 154 rDNA (DNA-derived) and 142 crDNA (RNA-derived) Bacteria clones and 134 rDNA and 146 crDNA Archaea clones obtained. Analyses of the 576 clones revealed distinct differences in the composition and patterns of metabolically active microbial phylotypes relative to sediment depth. For example, epsilon-Proteobacteria rDNA clones dominated the 0-2 cm clone library whereas gamma-Proteobacteria dominated the 0-2 cm crDNA library suggesting gamma to be among the most active in situ populations detected at 0-2 cm. Some microbial lineages, although detected at a frequency as high as 9% or greater in the total DNA library (i.e. Actinobacteria, alpha-Proteobacteria), were markedly absent from the RNA-derived libraries suggesting a lack of in situ activity at any depth in the mud volcano sediments. This study is one of the first to report the composition of the microbial assemblages and physiologically active members of archaeal and bacterial populations extant in a Gulf of Mexico submarine mud volcano. PMID:16958759

  1. Mortality benefits of population-wide adherence to national physical activity guidelines: a prospective cohort study.

    PubMed

    Long, Gráinne; Watkinson, Clare; Brage, Søren; Morris, Jerry; Tuxworth, Bill; Fentem, Peter; Griffin, Simon; Simmons, Rebecca; Wareham, Nicholas

    2015-01-01

    We quantified the mortality benefits and attributable fractions associated with engaging in physical activity across a range of levels, including those recommended by national guidelines. Data were from the Allied Dunbar National Fitness Survey, a population-based prospective cohort comprising 1,796 male and 2,122 female participants aged 16-96 years, randomly selected from 30 English constituencies in 1990. Participants were tagged for mortality at the Office for National Statistics. Cox multivariable regression quantified the association between self-reported achievement of activity guidelines--150 min of at least moderate activity per week, equivalent here to 30 or more 20-min episodes of at least moderate activity per month--and mortality adjusting for age, sex, smoking status, social class, geographical area, anxiety/depression and interview season. There were 1,175 deaths over a median (IQR) of 22.9 (3.9) years follow-up; a mortality rate of 15.2, 95% confidence interval (CI) 14.4-16.1 per 1,000 person years. Compared with being inactive (no 20-min bouts per month), meeting activity guidelines (30+ bouts) was associated with a 25% lower mortality rate, adjusting for measured confounders. If everyone adhered to recommended-, or even low-activity levels, a substantial proportion of premature mortality might be avoided (PAF, 95% CI 20.6, 6.9-32.3 and 8.9, 4.2-13.4%, respectively). Among a representative English population, adherence to activity guidelines was associated with significantly reduced mortality. Efforts to increase population-wide activity levels could produce large public health benefits and should remain a focus of health promotion efforts.

  2. Hydrogenase Activity of Mineral-Associated and Suspended Populations of Desulfovibrio desulfuricans Essex 6

    SciTech Connect

    C.L. Reardon; T.S. Magnuson; E.S. Boyd; W.D. Leavitt; D.W. Reed; G.G. Geesey

    2014-02-01

    The interactions between sulfate-reducing microorganisms and iron oxides influence a number of important redox-sensitive biogeochemical processes including the formation of iron sulfides. Enzymes, such as hydrogenase which catalyze the reversible oxidation of molecular hydrogen, are known to mediate electron transfer to metals and may contribute to the formation and speciation of ferrous sulfides formed at the cell–mineral interface. In the present study, we compared the whole cell hydrogenase activity of Desulfovibrio desulfuricans strain Essex 6 growing as biofilms on hematite (hematite-associated) or as suspended populations using different metabolic pathways. Hematite-associated cells exhibited significantly greater hydrogenase activity than suspended populations during sulfate respiration but not during pyruvate fermentation. The enhanced activity of the hematite-associated, sulfate-grown cells appears to be dependent on iron availability rather than a general response to surface attachment since the activity of glass-associated cells did not differ from that of suspended populations. Hydrogenase activity of pyruvate-fermenting cells was stimulated by addition of iron as soluble Fe(II)Cl2 and, in the absence of added iron, both sulfate-reducing and pyruvate-fermenting cells displayed similar rates of hydrogenase activity. These data suggest that iron exerts a stronger influence on whole cell hydrogenase activity than either metabolic pathway or mode of growth. The location of hydrogenase to the cell envelope and the enhanced activity at the hematite surface in sulfate-reducing cells may influence the redox conditions that control the species of iron sulfides on the mineral surface.

  3. Patient activation and advocacy: which literacy skills matter most?

    PubMed

    Martin, Laurie T; Schonlau, Matthias; Haas, Ann; Derose, Kathryn Pitkin; Rosenfeld, Lindsay; Buka, Stephen L; Rudd, Rima

    2011-01-01

    Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the United States increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy--a component of health literacy itself--when faced with a hypothetical barrier to scheduling a medical appointment. Although all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

  4. Polypharmacy Reviews Among Elderly Populations Project: Assessing Needs in Patient-Provider Communication

    PubMed Central

    Balignasay, Mia-Danica; Nigg, Claudio R

    2013-01-01

    Adults sixty-five years of age and older are a growing population, and are the largest consumers of prescription and nonprescription medications in the United States with potentially increased medication interaction risks. Therefore, an investigation to determine if elderly populations at two minority serving, independent housing sites perceived any issues regarding their medication use, including any communication challenges with their providers. The data were collected using a survey in which participants had to recall information about their medication use and past provider interaction. Participants (N=21; 90.5% female; using 5.1 ± 2.6 medications) completed a needs assessment. Results indicated that patients felt comfortable talking to their doctors. However, the communication that occurs may not have included education on polypharmacy. Many participants did not believe that they could describe details about their medications, such as the purpose (47.6%), instructions (42.9%), side effects (66.7%), and the possible risk of addiction (42.9%). This assessment indicates a need for an intervention that is focused on communication about polypharmacy and medication review education. PMID:23386990

  5. Development and pilot evaluation of novel genetic educational materials designed for an underserved patient population.

    PubMed

    Lubitz, Rebecca Jean; Komaromy, Miriam; Crawford, Beth; Beattie, Mary; Lee, Robin; Luce, Judith; Ziegler, John

    2007-01-01

    Genetic counseling for BRCA1 and BRCA2 mutations involves teaching about hereditary cancer, genetics and risk, subjects that are difficult to grasp and are routinely misunderstood. Supported by a grant from the Avon Foundation, the UCSF Cancer Risk Program started the first genetic testing and counseling service for a population of traditionally underserved women of varied ethnic and social backgrounds at the San Francisco General Hospital (SFGH). Informed by educational theory and clinical experience, we devised and piloted two simplified explanations of heredity and genetic risk, with the aim of uncovering how to best communicate genetics and risk to this underserved population. A "conventional" version comprised pictures of genes, pedigrees, and quantitative representations of risk. A "colloquial" pictorial version used an analogy of the "information book" of genes, family stories and vignettes, and visual representations of risk, without using scientific words such as genes or chromosomes. A verbal narrative accompanied each picture. We presented these modules to four focus groups of five to eight women recruited from the SFGH Family Practice Clinic. Overall, women preferred a picture-based approach and commented that additional text would have been distracting. The majority of women preferred the colloquial version because it was easier to understand and better conveyed a sense of comfort and hope. We conclude that simplicity, analogies, and familiarity support comprehension while vignettes, family stories, and photos of real people provide comfort and hope. These elements may promote understanding of complex scientific topics in healthcare, particularly when communicating with patients who come from disadvantaged backgrounds.

  6. Resource allocation in a patient population exhibiting bimodal and logarithmic cost behavior.

    PubMed

    Patterson, Charles W

    2011-12-01

    Budgeting and forecasting is a part of the resource allocation process. Statistical models used in these processes often use data based on unimodal or normal probability distributions using mean values for analysis. However, health care data are frequently skewed and stratified, demanding careful analyses. In this study, financial data was examined over a 10-month period at an overseas federal health care facility in a patient population of 70 with a primary diagnosis of post-traumatic stress disorder without a concurrent concussive injury. There were 823 direct provider contacts incurring a total cost of $286,917 that included allocated fixed overhead. The data were stratified and highly variable as two distinct groups based on chronicity. Group A (acute) consisted of 62 cases costing $117,612. Group B (chronic) consisted of 8 cases costing $169,755. This data, presented in descending order, fit a logarithmic equation with an r value of 0.95. Using this equation, a decreasing linear budget model is developed that represents an alternative nonparametric approach to allocate resources for this population. The model predicted an expenditure of $284,880, within 0.70% of the amount actually spent, and addresses the subcomponent simplification issue raised by a 2008 Rand study and mitigates problems associated with data stratification or transformations. PMID:22338354

  7. Survival rate of breast cancer patients in Malaysia: a population-based study.

    PubMed

    Abdullah, Nor Aini; Wan Mahiyuddin, Wan Rozita; Muhammad, Nor Asiah; Ali, Zainudin Mohamad; Ibrahim, Lailanor; Ibrahim Tamim, Nor Saleha; Mustafa, Amal Nasir; Kamaluddin, Muhammad Amir

    2013-01-01

    Breast cancer is the most common cancer among Malaysian women. Other than hospital-based results, there are no documented population-based survival rates of Malaysian women for breast cancers. This population- based retrospective cohort study was therefore conducted. Data were obtained from Health Informatics Centre, Ministry of Health Malaysia, National Cancer Registry and National Registration Department for the period from 1st Jan 2000 to 31st December 2005. Cases were captured by ICD-10 and linked to death certificates to identify the status. Only complete data were analysed. Survival time was calculated from the estimated date of diagnosis to the date of death or date of loss to follow-up. Observed survival rates were estimated by Kaplan- Meier method using SPSS Statistical Software version 17. A total of 10,230 complete data sets were analysed. The mean age at diagnosis was 50.6 years old. The overall 5-year survival rate was 49% with median survival time of 68.1 months. Indian women had a higher survival rate of 54% compared to Chinese women (49%) and Malays (45%). The overall 5-year survival rate of breast cancer patient among Malaysian women was still low for the cohort of 2000 to 2005 as compared to survival rates in developed nations. Therefore, it is necessary to enhance the strategies for early detection and intervention.

  8. The impact of patient cost-sharing on low-income populations: evidence from Massachusetts.

    PubMed

    Chandra, Amitabh; Gruber, Jonathan; McKnight, Robin

    2014-01-01

    Greater patient cost-sharing could help reduce the fiscal pressures associated with insurance expansion by reducing the scope for moral hazard. But it is possible that low-income recipients are unable to cut back on utilization wisely and that, as a result, higher cost-sharing will lead to worse health and higher downstream costs through increased use of inpatient and outpatient care. We use exogenous variation in the copayments faced by low-income enrollees in the Massachusetts Commonwealth Care program to study these effects. We estimate separate price elasticities of demand by type of service. Overall, we find price elasticities of about -0.16 for this low-income population - similar to elasticities calculated for higher-income populations in other settings. These elasticities are somewhat smaller for the chronically sick, especially for those with asthma, diabetes, and high cholesterol. These lower elasticities are attributable to lower responsiveness to prices across all categories of service, and to some statistically insignificant increases in inpatient care.

  9. Resource allocation in a patient population exhibiting bimodal and logarithmic cost behavior.

    PubMed

    Patterson, Charles W

    2011-12-01

    Budgeting and forecasting is a part of the resource allocation process. Statistical models used in these processes often use data based on unimodal or normal probability distributions using mean values for analysis. However, health care data are frequently skewed and stratified, demanding careful analyses. In this study, financial data was examined over a 10-month period at an overseas federal health care facility in a patient population of 70 with a primary diagnosis of post-traumatic stress disorder without a concurrent concussive injury. There were 823 direct provider contacts incurring a total cost of $286,917 that included allocated fixed overhead. The data were stratified and highly variable as two distinct groups based on chronicity. Group A (acute) consisted of 62 cases costing $117,612. Group B (chronic) consisted of 8 cases costing $169,755. This data, presented in descending order, fit a logarithmic equation with an r value of 0.95. Using this equation, a decreasing linear budget model is developed that represents an alternative nonparametric approach to allocate resources for this population. The model predicted an expenditure of $284,880, within 0.70% of the amount actually spent, and addresses the subcomponent simplification issue raised by a 2008 Rand study and mitigates problems associated with data stratification or transformations.

  10. p53 Arg72Pro polymorphism predicts survival outcome in lung cancer patients in Indian population.

    PubMed

    Sreeja, Leelakumari; Syamala, Vani; Raveendran, Praveenkumar B; Santhi, Sarojam; Madhavan, Jayaprakash; Ankathil, Ravindran

    2008-02-01

    In response to many forms of cellular stress, including DNA damage, the p53 protein functions to induce growth arrest, DNA repair, or apoptosis. Common allele variants in the TP53 gene modulate pathways of lung carcinogenesis and susceptibility to or prognosis of lung cancer. The prognostic role of the polymorphism was assessed in 422 subjects using PCR-RFLP. Logistic regression analysis showed a dominant presentation of Pro/Pro homozygotes in lung carcinoma population than in control population (OR = 2.1, P = 0.003). We further investigated the association of p53 codon 72 polymorphism with prognosis in 170 lung cancer patients. Kaplan-Meier survival analyses showed a significant difference in survival between p53 variant genotypes and overall survival (P = 0.02). Cox regression analysis showed p53 Arg72Pro heterozygous genotype was overall an independent prognostic factor (Risk ratio of death, 2.2; P = 0.02), suggesting Pro72Pro genotype to be a potential risk factor favoring the development of lung carcinoma and that Arg72Pro genotype is independently associated with a poorer prognosis of lung cancer. PMID:18181044

  11. Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population

    PubMed Central

    Tarasenko, Yelena N.; Howell, Britteny M.; Studts, Christina R.; Strath, Scott J.; Schoenberg, Nancy E.

    2015-01-01

    Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden. PMID:25608476

  12. Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population.

    PubMed

    Tarasenko, Yelena N; Howell, Britteny M; Studts, Christina R; Strath, Scott J; Schoenberg, Nancy E

    2015-08-01

    Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden.

  13. Segmenting CT prostate images using population and patient-specific statistics for radiotherapy

    SciTech Connect

    Feng, Qianjin; Foskey, Mark; Chen Wufan; Shen Dinggang

    2010-08-15

    Purpose: In the segmentation of sequential treatment-time CT prostate images acquired in image-guided radiotherapy, accurately capturing the intrapatient variation of the patient under therapy is more important than capturing interpatient variation. However, using the traditional deformable-model-based segmentation methods, it is difficult to capture intrapatient variation when the number of samples from the same patient is limited. This article presents a new deformable model, designed specifically for segmenting sequential CT images of the prostate, which leverages both population and patient-specific statistics to accurately capture the intrapatient variation of the patient under therapy. Methods: The novelty of the proposed method is twofold: First, a weighted combination of gradient and probability distribution function (PDF) features is used to build the appearance model to guide model deformation. The strengths of each feature type are emphasized by dynamically adjusting the weight between the profile-based gradient features and the local-region-based PDF features during the optimization process. An additional novel aspect of the gradient-based features is that, to alleviate the effect of feature inconsistency in the regions of gas and bone adjacent to the prostate, the optimal profile length at each landmark is calculated by statistically investigating the intensity profile in the training set. The resulting gradient-PDF combined feature produces more accurate and robust segmentations than general gradient features. Second, an online learning mechanism is used to build shape and appearance statistics for accurately capturing intrapatient variation. Results: The performance of the proposed method was evaluated on 306 images of the 24 patients. Compared to traditional gradient features, the proposed gradient-PDF combination features brought 5.2% increment in the success ratio of segmentation (from 94.1% to 99.3%). To evaluate the effectiveness of online

  14. Brain activation induced by psychological stress in patients with schizophrenia.

    PubMed

    Castro, M N; Villarreal, M F; Bolotinsky, N; Papávero, E; Goldschmidt, M G; Costanzo, E Y; Drucaroff, L; Wainsztein, A; de Achával, D; Pahissa, J; Bär, K-J; Nemeroff, C B; Guinjoan, S M

    2015-10-01

    Environmental influences are critical for the expression of genes putatively related to the behavioral and cognitive phenotypes of schizophrenia. Among such factors, psychosocial stress has been proposed to play a major role in the expression of symptoms. However, it is unsettled how stress interacts with pathophysiological pathways to produce the disease. We studied 21 patients with schizophrenia and 21 healthy controls aged 18 to 50years with 3T-fMRI, in which a period of 6min of resting state acquisition was followed by a block design, with three blocks of 1-min control-task, 1-min stress-task and 1-min rest after-task. Self-report of stress and PANSS were measured. Limbic structures were activated in schizophrenia patients by simple tasks and remained active during, and shortly after stress. In controls, stress-related brain activation was more time-focused, and restricted to the stressful task itself. Negative symptom severity was inversely related to activation of anterior cingulum and orbitofrontal cortex. Results might represent the neurobiological aspect of hyper-reactivity to normal stressful situations previously described in schizophrenia, thus providing evidence on the involvement of limbic areas in the response to stress in schizophrenia. Patients present a pattern of persistent limbic activation probably contributing to hypervigilance and subsequent psychotic thought distortions.

  15. Effect of trimebutine on colonic myoelectrical activity in IBS patients.

    PubMed

    Frexinos, J; Fioramonti, J; Bueno, L

    1985-01-01

    The effect of trimebutine 100 mg i.v. and placebo on colonic myoelectrical activity was investigated in 10 patients with the irritable bowel syndrome (IBS) (5 constipated and 5 diarrhoeic), using an intraluminal probe supporting 8 groups of electrodes. At each site examined from transverse to sigmoid colon, the electromyograms exhibited two kinds of spike bursts: short spike bursts (SSB) localized at one electrode site and appearing rhythmically at 10.3/min, and long spike bursts (LSB), isolated or propagated orally or aborally. Computerized analysis of the duration of each kind of spike burst showed that, as compared to the control, trimebutine 100 mg, selectively inhibited by 43 to 73% the mean duration of LSB activity in the transverse, descending and sigmoid colon, from 0 to 30 min after administration. The inhibitory effect was similar in constipated and diarrhoeic patients. Placebo injection did not significantly affect (p greater than 0.05) the duration of LSB and SSB activity. Variance analysis indicated that the inhibitory effect of trimebutine was significantly greater (p less than 0.05) on LSB activity in the transverse than the descending colon, and that it was absent from the sigmoid colon. The results suggest that trimebutine selectively inhibits the propulsive activity of the proximal two thirds of the colon in IBS patients, and that this effect cannot entirely explain its therapeutic efficacy in IBS. PMID:3987797

  16. Likelihood of mechanistic roles for dopaminergic, serotonergic and glutamatergic receptors in tardive dyskinesia: A comparison of genetic variants in two independent patient populations

    PubMed Central

    Ivanova, Svetlana A; Loonen, Anton JM; Bakker, P Roberto; Freidin, Maxim B; ter Woerds, Nienke J; Al Hadithy, Asmar FY; Semke, Arkadiy V; Fedorenko, Olga Yu; Brouwers, Jacobus RBJ; Bokhan, Nikolay A; van Os, Jim; van Harten, Peter N; Wilffert, Bob

    2016-01-01

    Objectives: An established theory for the pathogenesis of tardive dyskinesia is disturbed dopaminergic receptor sensitivity and/or dopaminergic intracellular signaling. We examined associations between genetic variants of neurotransmitter receptors and tardive dyskinesia. Methods: We assessed tardive dyskinesia in Caucasian psychiatric inpatients from Siberia (N = 431) and a long-stay population from the Netherlands (N = 168). These patients were genotyped for 43 tag single nucleotide polymorphisms in five neurotransmitter receptor genes, and the results for the two populations were compared. Results: Several significant associations with tardive dyskinesia were identified, but only GRIN2A (rs1345423) was found in both patient populations. This lack of agreement was probably due to the small effect size of the associations, the multiple testing and the small sample size of the Dutch patient population. After reviewing the literature, we propose that the constitutive stimulatory activity of serotonergic type 2 receptors may be relevant. Conclusions: Inactivity of the serotonergic, type 2C receptor or blockade of these receptors by atypical antipsychotic drugs may decrease the vulnerability to develop tardive dyskinesia. PMID:27127627

  17. Problems in selecting the adequate patient population from existing data files for assessment studies of new diagnostic tests.

    PubMed

    van der Schouw, Y T; Van Dijk, R; Verbeek, A L

    1995-03-01

    Assessment of new diagnostic tests should be carried out in a population with suspicion of disease. This 'indicated' population may comprise all patients for whom the target disease is part of the differential diagnosis. To investigate this empirically, data from a study on ultrasonography for scrotal pathology diagnosis was used for assessment of ultrasonography for epididymitis. The population could be selected according to several inclusion criteria, varying from patients with epididymitis mimicking diseases in their differential diagnosis, to patients with only epididymitis mentioned in their differential diagnosis. Different methods of population gathering led to large variations in the test characteristics of ultrasonography (sensitivity 76-83%, specificity 79-97%, prevalence of epididymitis for test-negative patients 56-5%). These results suggest selection bias depending on the true disease status. We advocate prospective assessment studies in populations with disease suspicion, as defined by signs, symptoms and complaints. Constituting an indicated population from an existing file of retrospectively gathered data may pose problems.

  18. Consistent estimation of complete neuronal connectivity in large neuronal populations using sparse "shotgun" neuronal activity sampling.

    PubMed

    Mishchenko, Yuriy

    2016-10-01

    We investigate the properties of recently proposed "shotgun" sampling approach for the common inputs problem in the functional estimation of neuronal connectivity. We study the asymptotic correctness, the speed of convergence, and the data size requirements of such an approach. We show that the shotgun approach can be expected to allow the inference of complete connectivity matrix in large neuronal populations under some rather general conditions. However, we find that the posterior error of the shotgun connectivity estimator grows quickly with the size of unobserved neuronal populations, the square of average connectivity strength, and the square of observation sparseness. This implies that the shotgun connectivity estimation will require significantly larger amounts of neuronal activity data whenever the number of neurons in observed neuronal populations remains small. We present a numerical approach for solving the shotgun estimation problem in general settings and use it to demonstrate the shotgun connectivity inference in the examples of simulated synfire and weakly coupled cortical neuronal networks. PMID:27515518

  19. Consistent estimation of complete neuronal connectivity in large neuronal populations using sparse "shotgun" neuronal activity sampling.

    PubMed

    Mishchenko, Yuriy

    2016-10-01

    We investigate the properties of recently proposed "shotgun" sampling approach for the common inputs problem in the functional estimation of neuronal connectivity. We study the asymptotic correctness, the speed of convergence, and the data size requirements of such an approach. We show that the shotgun approach can be expected to allow the inference of complete connectivity matrix in large neuronal populations under some rather general conditions. However, we find that the posterior error of the shotgun connectivity estimator grows quickly with the size of unobserved neuronal populations, the square of average connectivity strength, and the square of observation sparseness. This implies that the shotgun connectivity estimation will require significantly larger amounts of neuronal activity data whenever the number of neurons in observed neuronal populations remains small. We present a numerical approach for solving the shotgun estimation problem in general settings and use it to demonstrate the shotgun connectivity inference in the examples of simulated synfire and weakly coupled cortical neuronal networks.

  20. Solving the inverse problem for aggregation in activated sludge flocculation using a population balance framework.

    PubMed

    Nopens, I; Nere, N; Vanrolleghem, P A; Ramkrishna, D

    2007-01-01

    Many systems contain populations of individuals. Often, they are regarded as a lumped phase, which might, for some applications, lead to inadequate model predictive power. An alternative framework, Population Balance Models, has been used here to describe such a system, activated sludge flocculation in which particle size is the property one wants to model. An important problem to solve in population balance modelling is to determine the model structure that adequately describes experimentally obtained data on for instance, the time evolution of the floc size distribution. In this contribution, an alternative method based on solving the inverse problem is used to recover the model structure from the data. In this respect, the presence of similarity in the data simplifies the problem significantly. Similarity was found and the inverse problem could be solved. A forward simulation then confirmed the quality of the model structure to describe the experimental data.

  1. Association of autophagy-related IRGM polymorphisms with latent versus active tuberculosis infection in a Chinese population.

    PubMed

    Lu, Yanjun; Li, Qian; Peng, Jing; Zhu, Yaowu; Wang, Feng; Wang, Chunyu; Wang, Xiong

    2016-03-01

    The autophagy-related immunity-related GTPase family M protein, IRGM, plays an important role in the defense against tuberculosis (TB) infection. IRGM polymorphisms are associated with TB infection susceptibility, and recent studies demonstrate host genetic differences between active and latent TB. Here, we investigated the association between IRGM polymorphisms and TB infection type in a Chinese population. We recruited 268 and 321 patients with confirmed or latent TB, respectively, and 475 TB-free healthy controls. Three single nucleotide polymorphisms, rs10065172, rs10051924, and rs13361189 within IRGM were genotyped using TaqMan-based assays. Interferon-gamma release levels were tested by T-SPOT. rs10065172 (P = 0.024, OR 0.67 (95% CI 0.48-0.95)), rs10051924 (P = 0.01, OR 0.64 (95% CI 0.46-0.90)), and rs13361189 (P = 0.055, OR 0.72 (95% CI 0.51-1.01)) were associated with a protective role against latent TB progression. Haplotype analysis showed that TCC was protective for latent TB (P = 0.022, OR 0.74 (95% CI 0.57-0.96)) whereas TTC conferred a higher risk of active TB. Additionally, patients with the rs10065172 TT genotype had a higher response to TB specific antigens. Thus, IRGM polymorphism differences between latent and active TB suggests that genetic differences in autophagy might partly affect host TB infection status. PMID:26980495

  2. Integrated population pharmacokinetics of etanercept in healthy subjects and in patients with rheumatoid arthritis and ankylosing spondylitis.

    PubMed

    Zhou, Simon Y; Shu, Cathye; Korth-Bradley, Joan; Raible, Donald; Palmisano, Maria; Wadjula, Joseph; Fatenejad, Saeed; Bjornsson, Thorir

    2011-06-01

    Etanercept pharmacokinetics in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis were assessed separately with distinct models using population pharmacokinetics methods of limited precision. The different model structures and associated significant covariates identified by these earlier methods made it difficult to compare etanercept pharmacokinetics among disease groups. This integrated analysis aimed to establish a framework to evaluate previously established population pharmacokinetic models of etanercept, and to identify consistent and important demographic and disease factors that affected etanercept pharmacokinetics in a diverse population of healthy subjects and patients with RA and AS. In this integrated analysis, cumulative rich and sparse etanercept concentration data from 53 healthy volunteers, 212 patients with RA, and 346 patients with AS were examined and compared using nonlinear mixed effect methodology implemented the in NONMEM VI software package. A more precise estimation method (FOCEi) was employed and compared with the first-order method in population pharmacokinetics model building and evaluation. The integrated analysis found that an optimal population pharmacokinetics model with a 2-compartment structure adequately characterized etanercept pharmacokinetics in all subject groups. Health status or disease type did not significantly affect etanercept pharmacokinetics. In adult patients with RA and AS, age and body weight do not significantly affect etanercept pharmacokinetics. PMID:20852002

  3. [Exercises in patients with myositis--active treatment intervention?].

    PubMed

    Babić-Naglić, Durdica

    2012-01-01

    Polymyositis, dermatomyositis and inclusion body myositis are rare inflammatory myopathies characterized by muscle weakness. Regardless of pharmacological treatment in most patients remain muscle weakness and inability to perform daily activities. Until recently, the prevailing opinion was that active exercises can exacerbate the inflammatory activity in the muscles and is now known that active exercise and exercise with resistance improve strength and endurance of muscles, aerobic capacity and overall functional ability. Exercises are prescribed according to the disease activity, manual muscle test or dynamometer measurements, range of motion, cardiorespiratory capacity and clinical status of the locomotor system. Each of the components can be influenced by targeted exercises and should be a integral part of myositis therapy.

  4. Genetic polymorphisms and activity of PON1 in a Mexican population

    SciTech Connect

    Rojas-Garcia, A.E.; Solis-Heredia, M.J.; Pina-Guzman, B.; Vega, L.; Lopez-Carrillo, L.; Quintanilla-Vega, B. . E-mail: mquintan@cinvestav.mx

    2005-06-15

    Human paraoxonase (PON1) plays a role in detoxification of organophosphorus (OP) compounds by hydrolyzing the bioactive oxons, and in reducing oxidative low-density lipoproteins, which may protect against atherosclerosis. Some PON1 polymorphisms have been found to be responsible for variations in catalytic activity and expression and have been associated with susceptibility to OP poisoning and vascular diseases. Both situations are of public health relevance in Mexico. Therefore, the aim of this study was to evaluate PON1 phenotype and the frequencies of polymorphisms PON1 -162, -108, 55, and 192 in a Mexican population. The studied population consisted of unrelated individuals (n = 214) of either gender, 18-52 years old. Serum PON1 activity was assayed using phenylacetate and paraoxon as substrates. PON1 variants, -162, 55, and 192, were determined by real-time PCR using the TaqMan System, and PON1 -108 genotype by PCR-RFLP. We found a wide interindividual variability of PON1 activity with a unimodal distribution; the range of enzymatic activity toward phenylacetate was 84.72 to 422.0 U/mL, and 88.37 to 1645.6 U/L toward paraoxon. All four PON1 polymorphisms showed strong linkage disequilibrium (D% >90). PON1 polymorphisms -108, 55, and 192 were independently associated with arylesterase activity; whereas the activity toward paraoxon was related only with PON1 192 polymorphism, suggesting that this polymorphism is determinant to infer PON1 activity. A better understanding of the phenotype and genotypes of PON1 in Mexican populations will facilitate further epidemiological studies involving PON1 variability in OP poisoning and in the development of atherosclerosis.

  5. Estimating the personal cure rate of cancer patients using population-based grouped cancer survival data.

    PubMed

    Binbing Yu; Tiwari, Ram C; Feuer, Eric J

    2011-06-01

    Cancer patients are subject to multiple competing risks of death and may die from causes other than the cancer diagnosed. The probability of not dying from the cancer diagnosed, which is one of the patients' main concerns, is sometimes called the 'personal cure' rate. Two approaches of modelling competing-risk survival data, namely the cause-specific hazards approach and the mixture model approach, have been used to model competing-risk survival data. In this article, we first show the connection and differences between crude cause-specific survival in the presence of other causes and net survival in the absence of other causes. The mixture survival model is extended to population-based grouped survival data to estimate the personal cure rate. Using the colorectal cancer survival data from the Surveillance, Epidemiology and End Results Programme, we estimate the probabilities of dying from colorectal cancer, heart disease, and other causes by age at diagnosis, race and American Joint Committee on Cancer stage.

  6. Barriers associated with reduced physical activity in COPD patients*

    PubMed Central

    Amorim, Priscila Batista; Stelmach, Rafael; Carvalho, Celso Ricardo Fernandes; Fernandes, Frederico Leon Arrabal; Carvalho-Pinto, Regina Maria; Cukier, Alberto

    2014-01-01

    OBJECTIVE: To evaluate the ability of COPD patients to perform activities of daily living (ADL); to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT), and an ADL limitation score. METHODS: In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL) scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. RESULTS: We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5 ± 25.8 min/day vs. 105.2 ± 49.4 min/day; p < 0.001), as was the distance walked (3.9 ± 1.9 km/day vs. 6.4 ± 3.2 km/day; p < 0.001). The COPD patients also walked fewer steps/day. The most common self-reported barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. CONCLUSIONS: Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures. PMID:25410838

  7. Investigating patient expectations and treatment outcome in a chronic low back pain population

    PubMed Central

    Sanderson, Kristen B; Roditi, Daniela; George, Steven Z; Atchison, James W; Banou, Evangelia; Robinson, Michael E

    2012-01-01

    Objective This study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1) pain, (2) fatigue, (3) emotional distress, and (4) level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants. Patients Forty-seven chronic low back pain patients were recruited from university-affiliated pain clinics. Design The study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment. Outcome measures A patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment. Results Results suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45) = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily activities, F(1, 45) = 5.46, P < 0.05. There were no significant effects of time for emotional distress or fatigue or any significant group by time interactions. Contrary to our hypothesis, no significant correlations were found between pretreatment expectations and usual level ratings at post-treatment across the four domains. Conclusion Patients sought larger reductions in

  8. Population pharmacokinetics of recombinant human C1 inhibitor in patients with hereditary angioedema

    PubMed Central

    Farrell, Colm; Hayes, Siobhan; Relan, Anurag; van Amersfoort, Edwin S; Pijpstra, Rienk; Hack, C Erik

    2013-01-01

    Aims To characterize the pharmacokinetics (PK) of recombinant human C1 inhibitor (rhC1INH) in healthy volunteers and hereditary angioedema (HAE) patients. Methods Plasma levels of C1INH following 294 administrations of rhC1INH in 133 subjects were fitted using nonlinear mixed-effects modelling. The model was used to simulate maximal C1INH levels for the proposed dosing scheme. Results A one-compartment model with Michaelis–Menten elimination kinetics described the data. Baseline C1INH levels were 0.901 [95% confidence interval (CI): 0.839–0.968] and 0.176 U ml−1 (95% CI: 0.154–0.200) in healthy volunteers and HAE patients, respectively. The volume of distribution of rhC1INH was 2.86 l (95% CI: 2.68–3.03). The maximal rate of elimination and the concentration corresponding to half this maximal rate were 1.63 U ml−1 h−1 (95% CI: 1.41–1.88) and 1.60 U ml−1 (95% CI: 1.14–2.24), respectively, for healthy volunteers and symptomatic HAE patients. The maximal elimination rate was 36% lower in asymptomatic HAE patients. Peak C1INH levels did not change upon repeated administration of rhC1INH. Bodyweight was found to be an important predictor of the volume of distribution. Simulations of the proposed dosing scheme predicted peak C1INH concentrations above the lower level of the normal range (0.7 U ml−1) for at least 94% of all patients. Conclusions The population PK model for C1INH supports a dosing scheme on a 50 U kg−1 basis up to 84 kg, with a fixed dose of 4200 U above 84 kg. The PK of rhC1INH following repeat administration are consistent with the PK following the first administration. PMID:23594263

  9. New colistin population pharmacokinetic data in critically ill patients suggesting an alternative loading dose rationale.

    PubMed

    Grégoire, N; Mimoz, O; Mégarbane, B; Comets, E; Chatelier, D; Lasocki, S; Gauzit, R; Balayn, D; Gobin, P; Marchand, S; Couet, W

    2014-12-01

    Colistin is an old antibiotic that has recently gained a considerable renewal of interest as the last-line defense therapy against multidrug-resistant Gram-negative bacteria. It is administered as colistin methanesulfonate (CMS), an inactive prodrug, and it was shown that due to slow CMS conversion, colistin plasma concentrations increase very slowly after treatment initiation, which constitutes the rationale for a loading dose in critically ill patients. However, faster CMS conversion was observed in healthy volunteers but using a different CMS brand, which may also have a major impact on colistin pharmacokinetics. Seventy-three critically ill patients not undergoing dialysis received multiple doses of CMS. The CMS concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and a pharmacokinetic analysis was conducted using a population approach. We confirmed that CMS renal clearance and colistin concentrations at steady state are mostly governed by creatinine clearance, but we predict a typical maximum concentration of drug in serum (Cmax) of colistin close to 2 mg/liter, occurring 3 h after an initial dose of 2 million international units (MIU) of CMS. Accordingly, the estimated colistin half-life (t1/2) was relatively short (3.1 h), with rapid attainment of steady state. Our results are only partially consistent with other recently published results. We confirm that the CMS maintenance dose should be adjusted according to renal function in critically ill patients. However, much higher than expected colistin concentrations were observed after the initial CMS dose, with rapid steady-state achievement. These discrepancies challenge the pharmacokinetic rationale for a loading dose, which may still be appropriate for rapid bacterial eradication and an improved clinical cure rate. PMID:25267662

  10. New Colistin Population Pharmacokinetic Data in Critically Ill Patients Suggesting an Alternative Loading Dose Rationale

    PubMed Central

    Grégoire, N.; Mimoz, O.; Mégarbane, B.; Comets, E.; Chatelier, D.; Lasocki, S.; Gauzit, R.; Balayn, D.; Gobin, P.; Marchand, S.

    2014-01-01

    Colistin is an old antibiotic that has recently gained a considerable renewal of interest as the last-line defense therapy against multidrug-resistant Gram-negative bacteria. It is administered as colistin methanesulfonate (CMS), an inactive prodrug, and it was shown that due to slow CMS conversion, colistin plasma concentrations increase very slowly after treatment initiation, which constitutes the rationale for a loading dose in critically ill patients. However, faster CMS conversion was observed in healthy volunteers but using a different CMS brand, which may also have a major impact on colistin pharmacokinetics. Seventy-three critically ill patients not undergoing dialysis received multiple doses of CMS. The CMS concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and a pharmacokinetic analysis was conducted using a population approach. We confirmed that CMS renal clearance and colistin concentrations at steady state are mostly governed by creatinine clearance, but we predict a typical maximum concentration of drug in serum (Cmax) of colistin close to 2 mg/liter, occurring 3 h after an initial dose of 2 million international units (MIU) of CMS. Accordingly, the estimated colistin half-life (t1/2) was relatively short (3.1 h), with rapid attainment of steady state. Our results are only partially consistent with other recently published results. We confirm that the CMS maintenance dose should be adjusted according to renal function in critically ill patients. However, much higher than expected colistin concentrations were observed after the initial CMS dose, with rapid steady-state achievement. These discrepancies challenge the pharmacokinetic rationale for a loading dose, which may still be appropriate for rapid bacterial eradication and an improved clinical cure rate. PMID:25267662

  11. Gender Differences in Clinical Presentations of Cystic Fibrosis Patients in Azeri Turkish Population

    PubMed Central

    Vahedi, Leila; Jabarpoor-Bonyadi, Morteza; Ghojazadeh, Morteza; Vahedi, Amir

    2016-01-01

    Background Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF. Methods The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann-Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant. Results The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p<0.001). Age duration differed between genders. Male and female patients were further under 9 and 4 years, respectively. The occurrence of ΔF508 mutation was 0.51 times more in females than in males. Age, diagnosis and sex were closely associated: males were diagnosed at a significantly later age than females (p=0.05). While this compression performed based on clinical presentations, males with respiratory disease had a later median age at diagnosis than females at lifespan (p=0.001). The risk of infertility in males was approximately two times greater than in females (p=0.02). Conclusion These findings indicate gender differences in CF patients. Future studies are needed to establish other differences and evaluate the causes for the gender variations.

  12. Population structure of Pneumocystis jirovecii isolated from immunodeficiency virus-positive patients.

    PubMed

    Esteves, Francisco; Gaspar, Jorge; Tavares, Adélcia; Moser, Inês; Antunes, Francisco; Mansinho, Kamal; Matos, Olga

    2010-03-01

    Pneumocystis jirovecii pneumonia (PcP) is an important opportunistic infection among immunocompromised patients. Genetic characterization of P. jirovecii isolated from HIV-positive patients, based on identification of multiple nucleotide sequences at eight distinct loci, was achieved by using PCR with DNA sequencing and RFLP. The present study showed that the mitochondrial large-subunit rRNA (mtLSU rRNA), the cytochrome b (CYB), the superoxide dismutase (SOD), the beta-tubulin (beta-tub), the dihydrofolate reductase (DHFR) and the dihydropteroate synthase (DHPS) loci sequences were more variable and therefore giving additional information than the thioredoxin reductase (Trr1) and the thymidylate synthase (TS) genes. Genotyping at those six most informative loci enabled the identification of 48 different P. jirovecii multilocus genotypes (MLGs). Significant statistical associations between infecting P. jirovecii genotypes and patients' age groups or PcP clinical status were found. Also, mtLSU rRNA sequences and specific genotypes from other three loci (CYB, SOD, and DHFR) were statistically associated. The results suggested large recombination between most P. jirovecii MLGs. However, one MLG occurred at a higher frequency than would be expected according to panmictic expectations, suggesting linkage disequilibrium and clonal propagation. The persistence of this specific MLG may be a consequence of clonal reproduction of this successful genotypic array in a P. jirovecii population with epidemic structure. The present study provided the description of multiple genomic regions of P. jirovecii, improving the understanding of genetic variability and frequency distribution of polymorphic genotypes, and exploring the criteria of clonality by testing over-representation of MLGs.

  13. Using a virtual patient activity to teach nurse prescribing.

    PubMed

    Hurst, Heather M; Marks-Maran, Diane

    2011-05-01

    The Faculty of Health and Social Care Sciences at Kingston University/St George's University of London (KU/SGUL) provides a module to train registered nurses to qualify as independent nurse prescribers. During the programme the participants engage in an online learning activity using a virtual patient (VP). The aim of this VP activity is to enable students to consolidate their learning and to practice the range of skills that the students have been developing related to prescribing. The activity was designed by the module leader and was run as a pilot on two groups of students (n = 34). An evaluative study was undertaken on the value of this blended learning activity to the student and their prescribing practice. This paper presents the development, implementation and evaluation of the VP activity. Findings showed that the VP activity was perceived as being particular useful for helping them to learn the skills of patient history/assessment, decision-making and prescription writing. The VP was also perceived as being helpful in developing their confidence.

  14. Basophil activation test with food additives in chronic urticaria patients.

    PubMed

    Kang, Min-Gyu; Song, Woo-Jung; Park, Han-Ki; Lim, Kyung-Hwan; Kim, Su-Jung; Lee, Suh-Young; Kim, Sae-Hoon; Cho, Sang-Heon; Min, Kyung-Up; Chang, Yoon-Seok

    2014-01-01

    The role of food additives in chronic urticaria (CU) is still under investigation. In this study, we aimed to explore the association between food additives and CU by using the basophil activation test (BAT). The BAT using 15 common food additives was performed for 15 patients with CU who had a history of recurrent urticarial aggravation following intake of various foods without a definite food-specific IgE. Of the 15 patients studied, two (13.3%) showed positive BAT results for one of the tested food additives. One patient responded to monosodium glutamate, showing 18.7% of CD203c-positive basophils. Another patient showed a positive BAT result to sodium benzoate. Both patients had clinical correlations with the agents, which were partly determined by elimination diets. The present study suggested that at least a small proportion of patients with CU had symptoms associated with food additives. The results may suggest the potential utility of the BAT to identity the role of food additives in CU.

  15. Basophil Activation Test with Food Additives in Chronic Urticaria Patients

    PubMed Central

    Kang, Min-Gyu; Song, Woo-Jung; Park, Han-Ki; Lim, Kyung-Hwan; Kim, Su-Jung; Lee, Suh-Young; Kim, Sae-Hoon; Cho, Sang-Heon; Min, Kyung-Up

    2014-01-01

    The role of food additives in chronic urticaria (CU) is still under investigation. In this study, we aimed to explore the association between food additives and CU by using the basophil activation test (BAT). The BAT using 15 common food additives was performed for 15 patients with CU who had a history of recurrent urticarial aggravation following intake of various foods without a definite food-specific IgE. Of the 15 patients studied, two (13.3%) showed positive BAT results for one of the tested food additives. One patient responded to monosodium glutamate, showing 18.7% of CD203c-positive basophils. Another patient showed a positive BAT result to sodium benzoate. Both patients had clinical correlations with the agents, which were partly determined by elimination diets. The present study suggested that at least a small proportion of patients with CU had symptoms associated with food additives. The results may suggest the potential utility of the BAT to identity the role of food additives in CU. PMID:24527415

  16. Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

    PubMed Central

    Schubert, Tim; Winter, Corinna; Brandes, Mirko; Hackenberg, Lars; Wassmann, Hansdetlef; Liem, Dennis; Rosenbaum, Dieter; Bullmann, Viola

    2010-01-01

    Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland–Morris score were used to assess the patients’ clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm2. The radiographic results did not

  17. Work stress, sleep deficiency and predicted 10-year cardiometabolic risk in a female patient care worker population

    PubMed Central

    Jacobsen, Henrik Børsting; Reme, Silje Endresen; Sembajwe, Grace; Hopcia, Karen; Stiles, Tore C.; Sorensen, Glorian; Porter, James H.; Marino, Miguel; Buxton, Orfeu M.

    2014-01-01

    Objectives The aim of this study was to investigate the longitudinal effect of work-related stress, sleep deficiency and physical activity on 10-year cardiometabolic risk among an all-female worker population. Methods Data on patient care workers (n=99) was collected two years apart. Baseline measures included: job stress, physical activity, night work and sleep deficiency. Biomarkers and objective measurements were used to estimate 10-year cardiometabolic risk at follow-up. Significant associations (P<0.05) from baseline analyses were used to build a multivariable linear regression model. Results The participants were mostly white nurses with a mean age of 41 years. Adjusted linear regression showed that having sleep maintenance problems, a different occupation than nurse, and/or not exercising at recommended levels at baseline increased the 10-year cardiometabolic risk at follow-up. Conclusions In female workers prone to work-related stress and sleep deficiency, maintaining sleep and exercise patterns had a strong impact on modifiable 10-year cardiometabolic risk. PMID:24809311

  18. Proliferative Activity in Libyan Breast Cancer with Comparison to European and Central African Patients

    PubMed Central

    Boder, Jamela; Abdalla, Fathi; Elfagieh, Mohamed; Collan, Yrjö

    2013-01-01

    Background. We evaluated the relation of proliferative indices with clinicopathological features and prognosis in breast cancer (BC) of Libyan female patients. The data were compared with corresponding results in Finland and Nigeria. Patients and Methods. Histological samples of breast cancer from 130 patients were retrospectively studied. Mitotic activity index (MAI) and standardized mitotic index (SMI) were estimated. Results. There were statistically significant correlations between the proliferative indices and most clinicopathological features, with the strongest association observed for histological grade (P = 0.01 for SMI and P = 0.003 for MAI). The proliferative differences between Libyan, Nigerian, and Finnish population were prominent. The mean values of SMI and MAI in Libyan BC patients were 32.1 mitotic figures per square millimeter and 27.3 mitotic figures per 10 high-power fields, respectively. This is clearly lower than those in Nigeria but much higher than those in Finland. The differences between countries are seen in whole material and are also present in subgroups. The results indicated that mitotic activities can be reliable prognostic indicators in Libyan BCs, as they were among Finnish and Nigerian females. Univariate and multivariate analyses found at cut-offs of 19 and 44 mitosis/mm2 of SMI were the most significant prognostic factors. Conclusions. Proliferative indices with careful estimation of the MAI and SMI could be applied as quantitative criteria for Libyan BC to separate the patients into good, moderate, and bad prognosis groups. PMID:24106717

  19. Atrial conduction times and left atrium mechanical functions in patients with active acromegaly.

    PubMed

    Ilter, A; Kırış, A; Kaplan, Ş; Kutlu, M; Şahin, M; Erem, C; Civan, N; Kangül, F

    2015-03-01

    The aim of this study was to evaluate atrial electromechanical delay (EMD), P wave dispersion (Pwd), and left atrial (LA) mechanical functions in patients with active acromegaly. Twenty-three patients with active acromegaly and 27 age- and sex-matched controls were included in this study. All atrial electromechanical interval parameters (PA lateral, PA septum, PA tricuspid, interatrial EMD, intra-LA EMD, and intra-right atrial EMD) were measured from mitral lateral annulus, mitral septal annulus, and right ventricular tricuspid annulus by tissue Doppler imaging. LA volumes were measured by the disk method in the apical four-chamber view and were indexed to the body surface area. Mechanical function parameters of LA were calculated. Pwd was performed by 12-lead electrocardiograms. Atrial electromechanical intervals (PA lateral, PA septum, PA tricuspid, interatrial EMD, intra-LA EMD, and intra-right atrial EMD) and Pwd were similar between patients with acromegaly and control subjects (all p > 0.05). LA volumes (maximum, minimum, and presystolic) and LA mechanical functions were not significantly different between the groups (all p > 0.05). Additionally, serum levels of growth hormone and insulin-like growth factor-1 were not correlated with atrial electromechanical parameters and LA mechanical functions. Atrial electrical conduction times were not prolonged and LA mechanical functions were not impaired in patients with active acromegaly compared with controls. And the prevalence of supraventricular arrhythmia risk may not increase in this population.

  20. Identification of factors regulating thiopurine methyltransferase activity in a Norwegian population.

    PubMed

    Klemetsdal, B; Straume, B; Wist, E; Aarbakke, J

    1993-01-01

    Red blood cell (RBC) thiopurine methyltransferase (TPMT), an inactivating pathway of 6-mercaptopurine, is controlled by genetic polymorphism and is subject to ethnic variation. RBC TPMT is a good predictor of clinical outcome in children with acute lymphoblastic leukemia. RBC TPMT activity was determined in 226 patients, 176 of them living in northern Norway (of which 123 were Saami (Lapps)). Demographic variables, use of drugs and presence of chronic diseases were evaluated as possible predictors of RBC TPMT activity by a multiple regression model. Men had higher RBC TPMT activity compared to women. Living in the northernmost county of Norway was associated with increased RBC TPMT activity irrespective of ethnicity. The use of diuretics was associated with increased RBC TPMT activity. The gender difference in RBC TPMT activity may indicate a need to treat male subjects more aggressively with thiopurine drugs compared to female subjects.

  1. Influence of combined pollution of antimony and arsenic on culturable soil microbial populations and enzyme activities.

    PubMed

    Wang, Qiongshan; He, Mengchang; Wang, Ying

    2011-01-01

    The effects of both combined and single pollution of antimony (Sb) and arsenic (As) in different concentrations on culturable soil microbial populations and enzyme activities were studied under laboratory conditions. Joint effects of both Sb and As were different from that of Sb or As alone. The inhibition rate of culturable soil microbial populations under Sb and As pollution followed the order: bacterial > fungi > actinomycetes. There existed antagonistic inhibiting effect on urease and acid phophatase and synergistic inhibiting effect on protease under the combined pollution of Sb (III) and As (III). Only urease appeared to be the most sensitive indicator under Sb (V) and As (V) pollution, and there existed antagonistic inhibiting effect on acid phophatase and synergistic inhibiting effect on urease and protease under Sb (V) and As (V) combined pollution at most time. In this study, we also confirmed that the trivalent states of Sb and As were more toxic to all the microbes tested and more inhibitory on microbial enzyme activities then their pentavalent counterparts. The results also suggest that not only the application rate of the two metalloids but also the chemical form of metalloids should be considered while assessing the effect of metalloid on culturable microbial populations and enzyme activities. Urease and acid phosphatase can be used as potential biomarkers to evaluate the intensity of Sb (III) and As (III) stress.

  2. Travel determinants and multi-scale transferability of national activity patterns to local populations

    SciTech Connect

    Henson, Kriste M; Gou; ias, Konstadinos G

    2010-11-30

    The ability to transfer national travel patterns to a local population is of interest when attempting to model megaregions or areas that exceed metropolitan planning organization (MPO) boundaries. At the core of this research are questions about the connection between travel behavior and land use, urban form, and accessibility. As a part of this process, a group of land use variables have been identified to define activity and travel patterns for individuals and households. The 2001 National Household Travel Survey (NHTS) participants are divided into categories comprised of a set of latent cluster models representing persons, travel, and land use. These are compared to two sets of cluster models constructed for two local travel surveys. Comparison of means statistical tests are used to assess differences among sociodemographic groups residing in localities with similar land uses. The results show that the NHTS and the local surveys share mean population activity and travel characteristics. However, these similarities mask behavioral heterogeneity that are shown when distributions of activity and travel behavior are examined. Therefore, data from a national household travel survey cannot be used to model local population travel characteristics if the goal to model the actual distributions and not mean travel behavior characteristics.

  3. Heterotrophic activity and biodegradation of labile and refractory compounds by groundwater and stream microbial populations.

    PubMed Central

    Ladd, T I; Ventullo, R M; Wallis, P M; Costerton, J W

    1982-01-01

    The bacteriology and heterotrophic activity of a stream and of nearby groundwater in Marmot Basin, Alberta, Canada, were studied. Acridine orange direct counts indicated that bacterial populations in the groundwater were greater than in the stream. Bacteria that were isolated from the groundwater were similar to species associated with soils. Utilization of labile dissolved organic material as measured by the heterotrophic potential technique with glutamic acid, phenylalanine, and glycolic acid as substrates was generally greater in the groundwater. In addition, specific activity indices for the populations suggested greater metabolic activity per bacterium in the groundwater. 14C-labeled lignocellulose, preferentially labeled in the lignin fraction by feeding Picea engelmannii [14C]phenylalanine, was mineralized by microorganisms in both the groundwater and the stream, but no more than 4% of the added radioactivity was lost as 14CO2 within 960 h. Up to 20% of [3'-14C]cinnamic acid was mineralized by microorganisms in both environments within 500 h. Both microbial populations appear to influence the levels of labile and recalcitrant dissolved organic material in mountain streams. PMID:7125651

  4. Spatial Modeling of Indian Agriculture, Economic Activity and Population under Climate Change

    NASA Astrophysics Data System (ADS)

    McCord, G. C.

    2010-12-01

    We present a spatial model of economic activity and human population built on physical geography that takes particular account of its effects through agricultural productivity and transport costs for trade. A major component of this work is an agricultural model, driven in part by high-resolution climate data and model output. We put forward India as the initial region for this modeling work; India is a relatively data-rich country, it exhibits significant within-country spatial and temporal variation in agricultural productivity, urbanization rates, and population growth rates, and the climate dynamics of the monsoon are well-studied and expected to change on decadal time scales. Agricultural productivity is modeled as a function of soil, climate, and technology variables. Farmers locate optimally given varying geography and transport costs; in turn, food availability defines urbanization rates and economic activity in non-agricultural sectors. This “social system” integrated assessment model is a step towards a valuable policy tool, but requires a significant mobilization of data and a grid-cell-level system of equations to describe the underlying dynamics of the model. We test against past trends of social-natural system progression in demography, human location, income, food production, etc., and argue that the model could be used to assess future trends under varying climate change scenarios, and eventually serve to model feedbacks through effects on migration, population growth rates, or economic activity.

  5. Dynamical quorum sensing and clustering dynamics in a population of spatially distributed active rotators

    NASA Astrophysics Data System (ADS)

    Sakaguchi, Hidetsugu; Maeyama, Satomi

    2013-02-01

    A model of clustering dynamics is proposed for a population of spatially distributed active rotators. A transition from excitable to oscillatory dynamics is induced by the increase of the local density of active rotators. It is interpreted as dynamical quorum sensing. In the oscillation regime, phase waves propagate without decay, which generates an effectively long-range interaction in the clustering dynamics. The clustering process becomes facilitated and only one dominant cluster appears rapidly as a result of the dynamical quorum sensing. An exact localized solution is found to a simplified model equation, and the competitive dynamics between two localized states is studied numerically.

  6. Molecular Heterogeneity in a Patient-Derived Glioblastoma Xenoline Is Regulated by Different Cancer Stem Cell Populations

    PubMed Central

    Garner, Jo Meagan; Ellison, David W.; Finkelstein, David; Ganguly, Debolina; Du, Ziyun; Sims, Michelle; Yang, Chuan He; Interiano, Rodrigo B.; Davidoff, Andrew M.; Pfeffer, Lawrence M.

    2015-01-01

    Malignant glioblastoma (GBM) is a highly aggressive brain tumor with a dismal prognosis and limited therapeutic options. Genomic profiling of GBM samples has identified four molecular subtypes (Proneural, Neural, Classical and Mesenchymal), which may arise from different glioblastoma stem-like cell (GSC) populations. We previously showed that adherent cultures of GSCs grown on laminin-coated plates (Ad-GSCs) and spheroid cultures of GSCs (Sp-GSCs) had high expression of stem cell markers (CD133, Sox2 and Nestin), but low expression of differentiation markers (βIII-tubulin and glial fibrillary acid protein). In the present study, we characterized GBM tumors produced by subcutaneous and intracranial injection of Ad-GSCs and Sp-GSCs isolated from a patient-derived xenoline. Although they formed tumors with identical histological features, gene expression analysis revealed that xenografts of Sp-GSCs had a Classical molecular subtype similar to that of bulk tumor cells. In contrast xenografts of Ad-GSCs expressed a Mesenchymal gene signature. Adherent GSC-derived xenografts had high STAT3 and ANGPTL4 expression, and enrichment for stem cell markers, transcriptional networks and pro-angiogenic markers characteristic of the Mesenchymal subtype. Examination of clinical samples from GBM patients showed that STAT3 expression was directly correlated with ANGPTL4 expression, and that increased expression of these genes correlated with poor patient survival and performance. A pharmacological STAT3 inhibitor abrogated STAT3 binding to the ANGPTL4 promoter and exhibited anticancer activity in vivo. Therefore, Ad-GSCs and Sp-GSCs produced histologically identical tumors with different gene expression patterns, and a STAT3/ANGPTL4 pathway is identified in glioblastoma that may serve as a target for therapeutic intervention. PMID:25955030

  7. Decoding Target Distance and Saccade Amplitude from Population Activity in the Macaque Lateral Intraparietal Area (LIP)

    PubMed Central

    Bremmer, Frank; Kaminiarz, Andre; Klingenhoefer, Steffen; Churan, Jan

    2016-01-01

    Primates perform saccadic eye movements in order to bring the image of an interesting target onto the fovea. Compared to stationary targets, saccades toward moving targets are computationally more demanding since the oculomotor system must use speed and direction information about the target as well as knowledge about its own processing latency to program an adequate, predictive saccade vector. In monkeys, different brain regions have been implicated in the control of voluntary saccades, among them the lateral intraparietal area (LIP). Here we asked, if activity in area LIP reflects the distance between fovea and saccade target, or the amplitude of an upcoming saccade, or both. We recorded single unit activity in area LIP of two macaque monkeys. First, we determined for each neuron its preferred saccade direction. Then, monkeys performed visually guided saccades along the preferred direction toward either stationary or moving targets in pseudo-randomized order. LIP population activity allowed to decode both, the distance between fovea and saccade target as well as the size of an upcoming saccade. Previous work has shown comparable results for saccade direction (Graf and Andersen, 2014a,b). Hence, LIP population activity allows to predict any two-dimensional saccade vector. Functional equivalents of macaque area LIP have been identified in humans. Accordingly, our results provide further support for the concept of activity from area LIP as neural basis for the control of an oculomotor brain-machine interface.

  8. A sodium afterdepolarization in rat superior colliculus neurons and its contribution to population activity.

    PubMed

    Ghitani, Nima; Bayguinov, Peter O; Basso, Michele A; Jackson, Meyer B

    2016-07-01

    The mammalian superior colliculus (SC) is a midbrain structure that integrates multimodal sensory inputs and computes commands to initiate rapid eye movements. SC neurons burst with the sudden onset of a visual stimulus, followed by persistent activity that may underlie shifts of attention and decision making. Experiments in vitro suggest that circuit reverberations play a role in the burst activity in the SC, but the origin of persistent activity is unclear. In the present study we characterized an afterdepolarization (ADP) that follows action potentials in slices of rat SC. Population responses seen with voltage-sensitive dye imaging consisted of rapid spikes followed immediately by a second distinct depolarization of lower amplitude and longer duration. Patch-clamp recordings showed qualitatively similar behavior: in nearly all neurons throughout the SC, rapid spikes were followed by an ADP. Ionic and pharmacological manipulations along with experiments with current and voltage steps indicated that the ADP of SC neurons arises from Na(+) current that either persists or resurges following Na(+) channel inactivation at the end of an action potential. Comparisons of pharmacological properties and frequency dependence revealed a clear parallel between patch-clamp recordings and voltage imaging experiments, indicating a common underlying membrane mechanism for the ADP in both single neurons and populations. The ADP can initiate repetitive spiking at intervals consistent with the frequency of persistent activity in the SC. These results indicate that SC neurons have intrinsic membrane properties that can contribute to electrical activity that underlies shifts of attention and decision making. PMID:27075543

  9. Decoding Target Distance and Saccade Amplitude from Population Activity in the Macaque Lateral Intraparietal Area (LIP)

    PubMed Central

    Bremmer, Frank; Kaminiarz, Andre; Klingenhoefer, Steffen; Churan, Jan

    2016-01-01

    Primates perform saccadic eye movements in order to bring the image of an interesting target onto the fovea. Compared to stationary targets, saccades toward moving targets are computationally more demanding since the oculomotor system must use speed and direction information about the target as well as knowledge about its own processing latency to program an adequate, predictive saccade vector. In monkeys, different brain regions have been implicated in the control of voluntary saccades, among them the lateral intraparietal area (LIP). Here we asked, if activity in area LIP reflects the distance between fovea and saccade target, or the amplitude of an upcoming saccade, or both. We recorded single unit activity in area LIP of two macaque monkeys. First, we determined for each neuron its preferred saccade direction. Then, monkeys performed visually guided saccades along the preferred direction toward either stationary or moving targets in pseudo-randomized order. LIP population activity allowed to decode both, the distance between fovea and saccade target as well as the size of an upcoming saccade. Previous work has shown comparable results for saccade direction (Graf and Andersen, 2014a,b). Hence, LIP population activity allows to predict any two-dimensional saccade vector. Functional equivalents of macaque area LIP have been identified in humans. Accordingly, our results provide further support for the concept of activity from area LIP as neural basis for the control of an oculomotor brain-machine interface. PMID:27630547

  10. Decoding Target Distance and Saccade Amplitude from Population Activity in the Macaque Lateral Intraparietal Area (LIP).

    PubMed

    Bremmer, Frank; Kaminiarz, Andre; Klingenhoefer, Steffen; Churan, Jan

    2016-01-01

    Primates perform saccadic eye movements in order to bring the image of an interesting target onto the fovea. Compared to stationary targets, saccades toward moving targets are computationally more demanding since the oculomotor system must use speed and direction information about the target as well as knowledge about its own processing latency to program an adequate, predictive saccade vector. In monkeys, different brain regions have been implicated in the control of voluntary saccades, among them the lateral intraparietal area (LIP). Here we asked, if activity in area LIP reflects the distance between fovea and saccade target, or the amplitude of an upcoming saccade, or both. We recorded single unit activity in area LIP of two macaque monkeys. First, we determined for each neuron its preferred saccade direction. Then, monkeys performed visually guided saccades along the preferred direction toward either stationary or moving targets in pseudo-randomized order. LIP population activity allowed to decode both, the distance between fovea and saccade target as well as the size of an upcoming saccade. Previous work has shown comparable results for saccade direction (Graf and Andersen, 2014a,b). Hence, LIP population activity allows to predict any two-dimensional saccade vector. Functional equivalents of macaque area LIP have been identified in humans. Accordingly, our results provide further support for the concept of activity from area LIP as neural basis for the control of an oculomotor brain-machine interface. PMID:27630547

  11. The Effects of Eight-Month Physical Activity Intervention on Vigilance Performance in Adult Obese Population.

    PubMed

    Monleón, Cristina; Ballester, Rafael; Sanchis, Carlos; Llorens, Francesc; Martín, Marta; Pablos, Ana

    2015-01-01

    We aim to analyze the effects of an 8-month physical activity intervention on cardiorespiratory fitness, body mass index (BMI), and vigilance performance in an adult obese population. We conducted an 8-month physical activity intervention based on dance and rhythmic activities. The weekly frequency was 2 sessions of 1 hr per day. Training sessions were divided into 3 phases: a 10-min warm-up, 40 min of dance and rhythmic activities, and 10 min to cool-down. To assess cardiorespiratory fitness, participants performed a modified version of the 6-min walk test from the Senior Fitness Test battery (Larsson & Mattsson, 2001; Rikli & Jones, 1999). Vigilance performance was measured by means of the psychomotor vigilance task (PVT). Two measurements were performed immediately before and after the intervention. The results revealed that participants improved their cardiorespiratory fitness, BMI, and vigilance performance after the intervention. All in all, findings contribute new empirical evidence to the field that investigates the benefits of physical activity intervention on cognitive processes in obese population.

  12. Neutrophil activation in ivermectin-treated onchocerciasis patients.

    PubMed

    Njoo, F L; Hack, C E; Oosting, J; Stilma, J S; Kijlstra, A

    1993-11-01

    Ivermectin is a safe and effective drug for onchocerciasis treatment. In certain individuals, however, therapy is accompanied by adverse reactions. The mechanisms underlying these reactions are not yet known. The aim of the present study was to investigate whether neutrophils are involved in the development of these adverse reactions. Elastase and lactoferrin, two markers for the release of neutrophil azurophilic and specific granule contents respectively, were measured by radioimmunoassays in plasma of onchocerciasis patients with varying degrees of side effects, as well as in control subjects before and 1 and 2 days after ivermectin treatment. A considerable increase of elastase levels after treatment was observed, whereas lactoferrin levels did not change. The percentage of patients with elevated elastase levels was significantly correlated with the degree of side effects. These findings suggest that neutrophil activation may be involved in the development of adverse reactions in these patients.

  13. Tuberculosis in HIV-positive patients: cellular response and immune activation in the lung.

    PubMed

    Law, K F; Jagirdar, J; Weiden, M D; Bodkin, M; Rom, W N

    1996-04-01

    The host response to Mycobacterium tuberculosis is dependent on the accumulation and activation of cytotoxic and memory CD4+ T cells, resulting in granuloma formation and delayed type hypersensitivity. We characterized the cellular response of radiographically involved lung segments from 17 HIV-positive and 11 HIV-negative patients with acute tuberculosis (TB) using bronchoalveolar lavage (BAL) and compared the response to uninvolved segments, normal control subjects and peripheral blood. In both HIV-positive and HIV-negative patients, radiographically involved segments had significantly increased numbers of total cells per milliliter, percent of neutrophils recovered, and percent of lymphocytes recovered compared with uninvolved segments or normal control subjects, but HIV-positive patients had a lower proportion of lymphocytes in the involved segments than HIV-negative patients with tuberculosis (19 +/- 5% versus 33 +/- 5%; p < 0.05). Lymphocyte subset analysis demonstrated that HIV-positive patients had markedly reduced percentages of CD4+ lymphocytes (CD4+ lymphocytes in HIV-positive TB involved site 25 +/- 6%; HIV-negative TB involved site 73 +/- 2%; p < 0.01) and an increase in the percentage of CD8+ lymphocytes (HIV positive involved site 61 +/- 6% versus HIV negative involved site 19 +/- 3%; p < 0.01). Immunohistochemistry of lung biopsy tissue in five HIV-negative patients showed similar lymphocyte subset profiles as BAL, indicating that BAL reflects cell populations in tissue granulomas. BAL lymphocytes from four HIV-positive and four HIV-negative tuberculosis patients demonstrated immune activation by staining with a murine antibody to TIA-1, a cytoplasmic protein associated with cytotoxicity and apoptosis (HIV positive 48 +/- 6%, HIV negative 31 +/- 7%, normals 11 +/- 5%). Steady state mRNA for gamma-interferon was decreased in four HIV-positive patients when compared with four HIV-negative patients. IL-8 production was comparable in HIV-negative and

  14. Sexual Activity and Heart Patients: A Contemporary Perspective.

    PubMed

    Stein, Ricardo; Sardinha, Aline; Araújo, Claudio Gil S

    2016-04-01

    Sexual activity (SA) encompasses several behaviors such as kissing (Ki), touching (T), oral (O) stimulation, masturbation (M), and vaginal/anal intercourse (I). The acronym KiTOMI is proposed here to represent these behaviors. SA, particularly coitus, is a major aspect of health-related quality of life and is often considered the most pleasant and rewarding exercise performed during an entire lifetime. Although several studies have been conducted on sexuality, relatively limited information is available regarding SA in patients with heart disease. Moreover, the level of evidence of this limited information is nearly always B or C. This article provides a comprehensive and updated review of the relevant literature and offers evidence and expert-based practical messages regarding SA in patients with heart disease. Considering the rationale for exercise prescription, SA is typically well tolerated by most clinically stable patients with heart disease. Even in more debilitated and sicker individuals, KiT activities would most likely be feasible and desirable. The absolute risk of major adverse cardiovascular events during SA is typically very low. Even lower death rates have been reported for specific groups, such as women in general, aerobically fit men, and asymptomatic young adults with congenital heart disease. Finally, we emphasize the relevance of sexual counselling for patients and their partners, including the proper use of medications to treat erectile dysfunction. Counselled patients will be reassured and adequately informed regarding how to gradually resume habitual SA after a major cardiac event or procedure, starting with KiT and progressively advancing to KiTOM until all KiTOMI activities are allowed. PMID:26690295

  15. Population and hierarchy of active species in gold iron oxide catalysts for carbon monoxide oxidation

    NASA Astrophysics Data System (ADS)

    He, Qian; Freakley, Simon J.; Edwards, Jennifer K.; Carley, Albert F.; Borisevich, Albina Y.; Mineo, Yuki; Haruta, Masatake; Hutchings, Graham J.; Kiely, Christopher J.

    2016-09-01

    The identity of active species in supported gold catalysts for low temperature carbon monoxide oxidation remains an unsettled debate. With large amounts of experimental evidence supporting theories of either gold nanoparticles or sub-nm gold species being active, it was recently proposed that a size-dependent activity hierarchy should exist. Here we study the diverging catalytic behaviours after heat treatment of Au/FeOx materials prepared via co-precipitation and deposition precipitation methods. After ruling out any support effects, the gold particle size distributions in different catalysts are quantitatively studied using aberration corrected scanning transmission electron microscopy (STEM). A counting protocol is developed to reveal the true particle size distribution from HAADF-STEM images, which reliably includes all the gold species present. Correlation of the populations of the various gold species present with catalysis results demonstrate that a size-dependent activity hierarchy must exist in the Au/FeOx catalyst.

  16. Are variations in rates of attending cultural activities associated with population health in the United States?

    PubMed Central

    Wilkinson, Anna V; Waters, Andrew J; Bygren, Lars Olov; Tarlov, Alvin R

    2007-01-01

    Background Population studies conducted in Sweden have revealed an association between attendance at cultural activities and health. Using data from US residents, we examined whether the association could be observed in the US. Methods Participants in the current study included 1,244 individuals who participated in the 1998 General Social Survey. Results A significant association between cultural activities and self-reported health (SRH) was observed, even after controlling for age, gender, marital status, race, number of children, subjective social class, employment status, household income, and educational attainment. Specifically, the more cultural activities people reported attending, the better was their SRH. Conclusion The data confirm that an association between cultural activity and health is present in a US sample. The data do not mean that the association is causal, but they suggest that further longitudinal research is warranted. PMID:17764546

  17. Population and hierarchy of active species in gold iron oxide catalysts for carbon monoxide oxidation

    PubMed Central

    He, Qian; Freakley, Simon J.; Edwards, Jennifer K.; Carley, Albert F.; Borisevich, Albina Y.; Mineo, Yuki; Haruta, Masatake; Hutchings, Graham J.; Kiely, Christopher J.

    2016-01-01

    The identity of active species in supported gold catalysts for low temperature carbon monoxide oxidation remains an unsettled debate. With large amounts of experimental evidence supporting theories of either gold nanoparticles or sub-nm gold species being active, it was recently proposed that a size-dependent activity hierarchy should exist. Here we study the diverging catalytic behaviours after heat treatment of Au/FeOx materials prepared via co-precipitation and deposition precipitation methods. After ruling out any support effects, the gold particle size distributions in different catalysts are quantitatively studied using aberration corrected scanning transmission electron microscopy (STEM). A counting protocol is developed to reveal the true particle size distribution from HAADF-STEM images, which reliably includes all the gold species present. Correlation of the populations of the various gold species present with catalysis results demonstrate that a size-dependent activity hierarchy must exist in the Au/FeOx catalyst. PMID:27671143

  18. Protection motivation theory and physical activity in the general population: a systematic literature review.

    PubMed

    Bui, Linh; Mullan, Barbara; McCaffery, Kirsten

    2013-01-01

    An appropriate theoretical framework may be useful for guiding the development of physical activity interventions. This review investigates the effectiveness of the protection motivation theory (PMT), a model based on the cognitive mediation processes of behavioral change, in the prediction and promotion of physical activity participation. A literature search was conducted using the databases MEDLINE, PsycINFO, PubMed, and Web of Science, and a manual search was conducted on relevant reference lists. Studies were included if they tested or applied the PMT, measured physical activity, and sampled from healthy populations. A total of 20 studies were reviewed, grouped into four design categories: prediction, stage discrimination, experimental manipulation, and intervention. The results indicated that the PMT's coping appraisal construct of self-efficacy generally appears to be the most effective in predicting and promoting physical activity participation. In conclusion, the PMT shows some promise, however, there are still substantial gaps in the evidence.

  19. Paraoxonase Activity and Oxidative Status in Patients with Tinnitus

    PubMed Central

    Akyüz, Servet; Somuk, Battal Tahsin; Soyalic, Harun; Yılmaz, Beyhan; Taskin, Abdullah; Bilinc, Hasan; Aksoy, Nurten

    2016-01-01

    Background and Objectives The aim of this study was to investigate serum paraoxanase-1 (PON) activity, total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) in tinnitus; and to compare the results with data from healthy subjects. Subjects and Methods A total of 114 subjects-54 patients with tinnitus and 60 healthy controls were enrolled in this study. Serum PON activity, TOS, TAS, and OSI levels were measured. Results In the tinnitus group, TAS, and PON were significantly lower than in the control group (p<0.001). However, the TOS, and OSI levels were significantly higher in the tinnitus group than in the control group (p<0.001). Conclusions According to the data obtained from the present study, patients with tinnitus were exposed to potent oxidative stress. Oxidative stress may be the key contributing factor to the pathogenesis of tinnitus. PMID:27144229

  20. Venous thromboembolism and subsequent risk of cancer in patients with liver disease: a population-based cohort study

    PubMed Central

    Montomoli, Jonathan; Erichsen, Rune; Søgaard, Kirstine Kobberøe; Körmendiné Farkas, Dóra; Bloch Münster, Anna-Marie; Sørensen, Henrik Toft

    2015-01-01

    Objective Venous thromboembolism (VTE) may be a marker of occult cancer in the general population. While liver disease is known to increase the risk of VTE and cancer, it is unclear whether VTE in patients with liver disease is also a marker of occult cancer. Design A population-based cohort study. Setting Denmark. Participants We used population-based health registries to identify all patients with liver disease in Denmark with a first-time diagnosis of VTE (including superficial or deep venous thrombosis and pulmonary embolism) during 1980–2010. Patients with non-cirrhotic liver disease and patients with liver cirrhosis were followed as two separate cohorts from the date of their VTE. Measures For each cohort, we computed the absolute and relative risk (standardised incidence ratio; SIR) of cancer after VTE. Results During the study period, 1867 patients with non-cirrhotic liver disease and 888 with liver cirrhosis were diagnosed with incident VTE. In the first year following VTE, the absolute risk of cancer was 2.7% among patients with non-cirrhotic liver disease and 4.3% among those with liver cirrhosis. The SIR for the first 90 days of follow-up was 9.96 (95% CI 6.85 to 13.99) among patients with non-cirrhotic liver disease and 13.11 (95% CI 8.31 to 19.67) among patients with liver cirrhosis. After 1 year of follow-up, SIRs declined, but remained elevated in patients with non-cirrhotic liver disease (SIR=1.50, 95% CI 1.23 to 1.81) and patients with liver cirrhosis (SIR=1.95, 95% CI 1.45 to 2.57). Conclusions VTE may be a marker of occult cancer in patients with liver disease. PMID:26462285

  1. THE THERAPEUTIC VALUE OF SPORTS ACTIVITY IN NEUROTIC PATIENTS

    PubMed Central

    Kranidiotis, P. T.

    1973-01-01

    Five cases of neurotic patients being oriented to sports practice as an additional therapeutic measure are reported in brief. The working mechanisms of sublimation, overcompensation, sharing aggressive guilt within group, displacement, turning aggressive feelings toward one's self, and denial of win used in the canalization of inner needs through sports activity are discussed. The favourable influence of sports activity in the expression of various conflictual tendencies and on the overall neurotic symptomatology is stressed and the usefulness of the dynamic exploration in sports orientation of athletes is concluded.

  2. A population of patient-specific adult acquired flatfoot deformity models before and after surgery.

    PubMed

    Spratley, E M; Matheis, E A; Hayes, C W; Adelaar, R S; Wayne, J S

    2014-09-01

    Following IRB approval, a cohort of 3-D rigid-body computational models was created from submillimeter MRIs of clinically diagnosed Adult Acquired Flatfoot Deformity patients and employed to investigate postoperative foot/ankle function and surgical effect during single-leg stance. Models were constrained through physiologic joint contact, passive soft-tissue tension, active muscle force, full body weight, and without idealized joints. Models were validated against patient-matched controls using clinically utilized radiographic angle and distance measures and plantar force distributions in the medial forefoot, lateral forefoot, and hindfoot. Each model further predicted changes in strain for the spring ligament, deltoid ligament, and plantar fascia, as well as joint contact loads for three midfoot joints, the talonavicular, navicular-1st cuneiform, and calcaneocuboid. Radiographic agreement ranged across measures, with average absolute deviations of <5° and <4 mm indicating generally good agreement. Postoperative plantar force loading in patients and models was reduced for the medial forefoot and hindfoot concomitant with increases in the lateral forefoot. Model predicted reductions in medial soft-tissue strain and increases in lateral joint contact load were consistent with in vitro observations and elucidate the biomechanical mechanisms of repair. Thus, validated rigid-body models offer promise for the investigation of foot/ankle kinematics and biomechanical behaviors that are difficult to measure in vivo.

  3. Population activity in the human dorsal pathway predicts the accuracy of visual motion detection.

    PubMed

    Donner, Tobias H; Siegel, Markus; Oostenveld, Robert; Fries, Pascal; Bauer, Markus; Engel, Andreas K

    2007-07-01

    A person's ability to detect a weak visual target stimulus varies from one viewing to the next. We tested whether the trial-to-trial fluctuations of neural population activity in the human brain are related to the fluctuations of behavioral performance in a "yes-no" visual motion-detection task. We recorded neural population activity with whole head magnetoencephalography (MEG) while subjects searched for a weak coherent motion signal embedded in spatiotemporal noise. We found that, during motion viewing, MEG activity in the 12- to 24-Hz ("beta") frequency range is higher, on average, before correct behavioral choices than before errors and that it predicts correct choices on a trial-by-trial basis. This performance-predictive activity is not evident in the prestimulus baseline and builds up slowly after stimulus onset. Source reconstruction revealed that the performance-predictive activity is expressed in the posterior parietal and dorsolateral prefrontal cortices and, less strongly, in the visual motion-sensitive area MT+. The 12- to 24-Hz activity in these key stages of the human dorsal visual pathway is correlated with behavioral choice in both target-present and target-absent conditions. Importantly, in the absence of the target, 12- to 24-Hz activity tends to be higher before "no" choices ("correct rejects") than before "yes" choices ("false alarms"). It thus predicts the accuracy, and not the content, of subjects' upcoming perceptual reports. We conclude that beta band activity in the human dorsal visual pathway indexes, and potentially controls, the efficiency of neural computations underlying simple perceptual decisions.

  4. Participation of iatrogenically coagulopathic patients in wilderness activities.

    PubMed

    Hawkins, Seth C; Caudell, Michael J; Deloughery, Thomas G; Murray, William

    2013-09-01

    An increasing number of patients routinely undergo long-term anticoagulation with warfarin or other pharmacological agents. There is little evidence and no consensus documents in the literature regarding the appropriateness and relative risk of their participation in wilderness activities. We present a case report, conduct an analysis of the limited literature that is available, and make recommendations for wilderness medicine practitioners and screening personnel.

  5. Factors affecting daily activities of patients with cerebral infarction

    PubMed Central

    Liu, Peng; Zhou, Cheng-ye; Zhang, Ying; Wang, Yun-feng; Zou, Chang-lin

    2010-01-01

    BACKGROUND: Stroke is the leading cause of death and long-term disability. This study was undertaken to investigate the factors influencing daily activities of patients with cerebral infarction so as to take interventional measures earlier to improve their daily activities. METHODS: A total of 149 patients with first-episode cerebral infarction were recruited into this prospective study. They were admitted to the Encephalopathy Center, Department of Neurology, the First Affiliated Hospital of Wenzhou Medical College in Zhejiang Province from August 2008 to December 2008. The baseline characteristics of the patients and cerebral infarction risk factors on the first day of admission were recorded. White blood cell (WBC) count, plasma glucose (PG), and many others of laboratory targets were collected in the next morning. Barthel index (BI) was calculated at 2 weeks and 3 months respectively after onset of the disease at the outpatient clinic or by telephone call. Lung infection, urinary tract infection and atrial fibrillation if any were recorded on admission. The National Institute of Health Stroke Scale (NIHSS) scores and the GCS scores were recorded within 24 hours on and after admission, at the second week, and at the third month after the onset of cerebral infarction respectively. RESULTS: The factors of BI at 2 weeks and 3 months after onset were the initial PG level, WBC count and initial NIHSS scores. Besides, urinary tract infection on admission was also the factor for BI at 3 months. CONCLUSION: Active measures should be taken to control these factors to improve the daily activities of patients with cerebral infarction. PMID:25214953

  6. The Association of Active Cancer With Venous Thromboembolism Location: A Population-Based Study

    PubMed Central

    Tafur, Alfonso J.; Kalsi, Henna; Wysokinski, Waldemar E.; McBane, Robert D.; Ashrani, Aneel A.; Marks, Randolph S.; Crusan, Daniel J.; Petterson, Tanya M.; Bailey, Kent R.; Heit, John A.

    2011-01-01

    OBJECTIVE: To test active cancer for an association with venous thromboembolism (VTE) location. PATIENTS AND METHODS: Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN, residents with incident VTE during the 35-year period 1966-2000 (N=3385). We restricted analyses to residents with objectively diagnosed VTE during the 17-year period from January 1, 1984, to December 31, 2000 (N=1599). For each patient, we reviewed the complete medical records in the community for patient age, gender, and most recent body mass index at VTE onset; VTE event type and location; and previously identified independent VTE risk factors (ie, surgery, hospitalization for acute medical illness, active cancer, leg paresis, superficial venous thrombosis, and varicose veins). Using logistic regression we tested active cancer for an association with each of 4 symptomatic VTE locations (arm or intra-abdominal deep venous thrombosis [DVT], intra-abdominal DVT, pulmonary embolism, and bilateral leg DVT), adjusted for age, gender, body mass index, and other VTE risk factors. RESULTS: In multivariate analyses, active cancer was independently associated with arm or intra-abdominal DVT (odds ratio [OR], 1.76; P=.01), intra-abdominal DVT (OR, 2.22; P=.004), and bilateral leg DVT (OR, 2.09; P=.02), but not pulmonary embolism (OR, 0.93). CONCLUSION: Active cancer is associated with VTE location. Location of VTE may be useful in decision making regarding cancer screening. PMID:21193652

  7. IGF1 stimulates crypt expansion via differential activation of 2 intestinal stem cell populations.

    PubMed

    Van Landeghem, Laurianne; Santoro, M Agostina; Mah, Amanda T; Krebs, Adrienne E; Dehmer, Jeffrey J; McNaughton, Kirk K; Helmrath, Michael A; Magness, Scott T; Lund, P Kay

    2015-07-01

    Insulin-like growth factor 1 (IGF1) has potent trophic effects on normal or injured intestinal epithelium, but specific effects on intestinal stem cells (ISCs) are undefined. We used Sox9-enhanced green fluorescent protein (EGFP) reporter mice that permit analyses of both actively cycling ISCs (Sox9-EGFP(Low)) and reserve/facultative ISCs (Sox9-EGFP(High)) to study IGF1 action on ISCs in normal intestine or during crypt regeneration after high-dose radiation-induced injury. We hypothesized that IGF1 differentially regulates proliferation and gene expression in actively cycling and reserve/facultative ISCs. IGF1 was delivered for 5 days using subcutaneously implanted mini-pumps in uninjured mice or after 14 Gy abdominal radiation. ISC numbers, proliferation, and transcriptome were assessed. IGF1 increased epithelial growth in nonirradiated mice and enhanced crypt regeneration after radiation. In uninjured and regenerating intestines, IGF1 increased total numbers of Sox9-EGFP(Low) ISCs and percentage of these cells in M-phase. IGF1 increased percentages of Sox9-EGFP(High) ISCs in S-phase but did not expand this population. Microarray revealed that IGF1 activated distinct gene expression signatures in the 2 Sox9-EGFP ISC populations. In vitro IGF1 enhanced enteroid formation by Sox9-EGFP(High) facultative ISCs but not Sox9-EGFP(Low) actively cycling ISCs. Our data provide new evidence that IGF1 activates 2 ISC populations via distinct regulatory pathways to promote growth of normal intestinal epithelium and crypt regeneration after irradiation.

  8. Outcomes of combined trabecular micro-bypass and phacoemulsification in a predominantly Hispanic patient population

    PubMed Central

    Gallardo, Mark J; Supnet, Richard A; Giamporcaro, Jane Ellen; Hornbeak, Dana M

    2016-01-01

    Purpose The purpose of this study was to evaluate intraocular pressure (IOP) and topical ocular hypotensive medication burden at 12 months postoperatively in a predominantly Hispanic patient population with primary open-angle glaucoma each implanted with one trabecular micro-bypass stent during cataract surgery. Methods This was a retrospective, consecutive case series. The main objective was to assess reduction of IOP and/or medication burden in all eyes at the 12-month postoperative exam. A secondary objective was to assess outcomes in 3 subgroups, distinguished preoperatively by IOP control and by medication burden (suboptimal or maximum therapy) and with different treatment goals. Group 1 had medication-controlled IOP and goal to reduce medications while maintaining IOP control (n=65); Group 2 had uncontrolled IOP on ≤2 medications and goal to reduce IOP and maintain/reduce medication burden (n=31); and Group 3 had uncontrolled IOP on ≥3 medications and goal to reduce IOP and avoid filtering surgery (n=38). Evaluations included IOP, medication use, cup-to-disc ratio, visual fields, complications, and interventions. One hundred subjects (134 eyes) have been followed for 12 months. Results Most patients (80%) were Hispanic and had moderate or severe glaucoma (87%). At 12 months, mean IOP reduced to 12.9 mmHg vs 16.5 mmHg preoperatively; 92% had an IOP ≤15 mmHg at 12 months (99% had ≤18 mmHg). Mean medication burden had decreased to 0.9 vs 2.3 preoperatively. At the 12-month time point, 94% of all eyes achieved their predefined treatment goal of reduced IOP and/or medications. Reductions in medication burden for Group 1, and in IOP for Groups 2 and 3, were highly statistically significant (P<0.001). Two eyes in Group 3 had filtering surgery; the remaining 95% avoided such treatment. No other complications were reported. Conclusion This mainly Hispanic population with predominantly moderate or severe glaucoma had substantial reduction of IOP and medication

  9. Level of Physical Activity in Population Aged 16 to 65 Years in Rural Kerala, India.

    PubMed

    Aslesh, O P; Mayamol, P; Suma, R K; Usha, K; Sheeba, G; Jayasree, A K

    2016-01-01

    Kerala is a state in India with a high prevalence of cardiovascular diseases and diabetes. In order to control these diseases, the prevalence of modifiable risk factors such as low physical activity need to be studied. For this a cross-sectional study was conducted to assess the level of physical activity among 240 residents aged between 15 and 65 years in Kulappuram, a village in north Kerala. Low level of physical activity was seen in 65.8% of the study participants. The average duration of moderate to vigorous intensity physical activity per day in different domains such as work, travel, and recreation were 40.5, 10.1, and 12.7 minutes, respectively. The average duration of sedentary activities was 284.3 minutes per day. The level of physical activity was more among those engaged in unskilled work (adjusted odds ratio = 4.32; confidence interval = 1.38-13.51) and unmarried persons (adjusted odds ratio = 3.65; confidence interval = 1.25-10.65). No statistically significant difference in physical activity level was seen in different age, education, religious, and economic categories. The study concludes that the physical activity level was low in the study population.

  10. Dynamics of Population Activity in Rat Sensory Cortex: Network Correlations Predict Anatomical Arrangement and Information Content.

    PubMed

    Sabri, Mohammad Mahdi; Adibi, Mehdi; Arabzadeh, Ehsan

    2016-01-01

    To study the spatiotemporal dynamics of neural activity in a cortical population, we implanted a 10 × 10 microelectrode array in the vibrissal cortex of urethane-anesthetized rats. We recorded spontaneous neuronal activity as well as activity evoked in response to sustained and brief sensory stimulation. To quantify the temporal dynamics of activity, we computed the probability distribution function (PDF) of spiking on one electrode given the observation of a spike on another. The spike-triggered PDFs quantified the strength, temporal delay, and temporal precision of correlated activity across electrodes. Nearby cells showed higher levels of correlation at short delays, whereas distant cells showed lower levels of correlation, which tended to occur at longer delays. We found that functional space built based on the strength of pairwise correlations predicted the anatomical arrangement of electrodes. Moreover, the correlation profile of electrode pairs during spontaneous activity predicted the "signal" and "noise" correlations during sensory stimulation. Finally, mutual information analyses revealed that neurons with stronger correlations to the network during spontaneous activity, conveyed higher information about the sensory stimuli in their evoked response. Given the 400-μm-distance between adjacent electrodes, our functional quantifications unravel the spatiotemporal dynamics of activity among nearby and distant cortical columns. PMID:27458347

  11. Dynamics of Population Activity in Rat Sensory Cortex: Network Correlations Predict Anatomical Arrangement and Information Content

    PubMed Central

    Sabri, Mohammad Mahdi; Adibi, Mehdi; Arabzadeh, Ehsan

    2016-01-01

    To study the spatiotemporal dynamics of neural activity in a cortical population, we implanted a 10 × 10 microelectrode array in the vibrissal cortex of urethane-anesthetized rats. We recorded spontaneous neuronal activity as well as activity evoked in response to sustained and brief sensory stimulation. To quantify the temporal dynamics of activity, we computed the probability distribution function (PDF) of spiking on one electrode given the observation of a spike on another. The spike-triggered PDFs quantified the strength, temporal delay, and temporal precision of correlated activity across electrodes. Nearby cells showed higher levels of correlation at short delays, whereas distant cells showed lower levels of correlation, which tended to occur at longer delays. We found that functional space built based on the strength of pairwise correlations predicted the anatomical arrangement of electrodes. Moreover, the correlation profile of electrode pairs during spontaneous activity predicted the “signal” and “noise” correlations during sensory stimulation. Finally, mutual information analyses revealed that neurons with stronger correlations to the network during spontaneous activity, conveyed higher information about the sensory stimuli in their evoked response. Given the 400-μm-distance between adjacent electrodes, our functional quantifications unravel the spatiotemporal dynamics of activity among nearby and distant cortical columns. PMID:27458347

  12. In vitro induction of lymphokine-activated killer (LAK) activity in patients with neuroblastoma.

    PubMed

    Handgretinger, R; Bruchelt, G; Kimmig, A; Dopfer, R; Niethammer, D; Treuner, J

    1989-01-01

    Therapy of disseminated neuroblastoma remains an unsolved problem in pediatric oncology. Therefore, new therapeutic approaches have to be developed for this malignancy. In this paper, we investigated the possibility of the in vitro generation and expansion of lymphokine-activated killer (LAK) cells in patients with disseminated neuroblastoma. Although the patients had very low Natural Killer (NK) activity, it was possible to induce LAK activity in peripheral mononuclear lymphocytes (PMNC) by incubation with Interleukin-2 (IL-2). Moreover, the PMNCs could be expanded up to 50-fold in the presence of Interleukin-2 while maintaining or even increasing their LAK activity. The target cells were neuroblastoma cell lines and, in one case, autologous neuroblastoma cells. Additionally, it was possible to induce LAK cell activity against autologous neuroblastoma cells in bone marrow-derived mononuclear cells.

  13. Population based study of social and productive activities as predictors of survival among elderly Americans

    PubMed Central

    Glass, Thomas A; de Leon, Carlos Mendes; Marottoli, Richard A; Berkman, Lisa F

    1999-01-01

    Objectives To examine any association between social, productive, and physical activity and 13 year survival in older people. Design Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants’ homes. Proportional hazards models were used to model survival from time of initial interview. Setting City of New Haven, Connecticut, United States. Participants 2761 men and women from a random population sample of 2812 people aged 65 and older. Main outcome measure Mortality from all causes during 13 years of follow up. Results All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. Conclusions Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people. Key messagesLittle is known about predictors of survival among elderly peoplePhysical activity is clearly good for health, but the potential benefits of social activities have not been studiedSocial and productive activities are as effective as fitness activities in lowering the risk of deathEnhanced social activities may help to increase the quality and length of life PMID:10454399

  14. Prevalence and impact of body physical changes in HIV patients treated with highly active antiretroviral therapy: results from a study on patient and physician perceptions.

    PubMed

    Cabrero, Esther; Griffa, Laura; Burgos, Angel

    2010-01-01

    Patients infected with HIV treated with highly active antiretroviral therapy (HAART) frequently develop body physical changes (BPC) that have an important psychosocial burden. The purpose of this study was to determine the prevalence of BPC observed by HIV-infected patients and their attending physicians and to assess the impact BPC had on daily life. In this epidemiologic multicenter study, patients with HIV infection and their treating physicians filled out parallel questionnaires about their perceptions of specific BPC and their impact on daily activities. A total of 965 patient-physician questionnaires were collected across 98 health centers. Patient's mean age was 43.7 +/- 8.5 years and 72.6% were men. Adjusted prevalence of perceived BPC by patients and physicians was 55.1% (95% confidence interval [CI]: 52.0-58.1) and 55.2% (95% CI: 52.1-58.2), respectively (p = 1.000). Overall patient-physician agreement concerning perception of BPC was 83% (p < 0.0005). The most common BPC was lipoatrophy, described by 46.8% (95% CI: 43.7-49.8) of patients and 49.4% (95% CI: 46.3-52.5) of physicians (p = 0.033) followed by lipohypertrophy. No gender differences were observed in the global prevalence of BPC (p = 0.649). However, significantly more women reported lipoatrophy of the lower limbs (p = 0.009) and buttocks (p = 0.007), as well as lipohypertrophy (p = 0.007), than men; 58.2% (95% CI: 54.0-62.4) patients noted that BPC negatively affected their daily activities. This study reflects the high prevalence of patient and physician-perceived BPC in the HIV population, and the adverse impact on daily life. Physicians should be aware of the psychosocial consequences of BPC in HIV patients in order to improve patient well-being.

  15. Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997–2006

    PubMed Central

    Cronin-Fenton, D P; Søndergaard, F; Pedersen, L A; Fryzek, J P; Cetin, K; Acquavella, J; Baron, J A; Sørensen, H T

    2010-01-01

    Background: Venous thromboembolism (VTE) frequently complicates cancer. Data on tumour-specific VTE predictors are limited, but may inform strategies to prevent thrombosis. Methods: We computed incidence rates (IRs) with 95% confidence intervals (CIs) for VTE hospitalisation in a cohort of cancer patients (n=57 591) and in a comparison general-population cohort (n=287 476) in Denmark. The subjects entered the study in 1997–2005, and the follow-up continued through 2006. Using Cox proportional-hazards regression, we estimated relative risks (RRs) for VTE predictors, while adjusting for comorbidity. Results: Throughout the follow-up, VTE IR was higher among the cancer patients (IR=8.0, 95% CI=7.6–8.5) than the general population (IR=4.7, 95% CI=4.3–5.1), particularly in the first year after cancer diagnosis (IR=15.0, 95% CI=13.8–16.2, vs IR=8.6, 95% CI=7.6–9.9). Incidence rates of VTE were highest in patients with pancreas (IR=40.9, 95% CI=29.5–56.7), brain (IR=17.7, 95% CI=11.3–27.8) or liver (IR=20.4, 95% CI=9.2–45.3) tumours, multiple myeloma (IR=22.6, 95% CI=15.4–33.2) and among patients with advanced-stage cancers (IR=27.7, 95% CI=24.0–32.0) or those who received chemotherapy or no/symptomatic treatment. The adjusted RR (aRR) for VTE was highest among patients with pancreas (aRR=16.3, 95% CI=8.1–32.6) or brain cancer (aRR=19.8 95% CI=7.1–55.2), multiple myeloma (aRR=46.1, 95% CI=13.1–162.0) and among patients receiving chemotherapy, either alone (aRR=18.5, 95% CI=11.9–28.7) or in combination treatments (aRR=16.2, 95% CI=12.0–21.7). Conclusions: Risk of VTE is higher among cancer patients than in the general population. Predictors of VTE include recency of cancer diagnosis, cancer site, stage and the type of cancer-directed treatment. PMID:20842120

  16. THE MERGER-TRIGGERED ACTIVE GALACTIC NUCLEUS CONTRIBUTION TO THE ULTRALUMINOUS INFRARED GALAXY POPULATION

    SciTech Connect

    Draper, A. R.; Ballantyne, D. R.

    2012-07-10

    It has long been thought that there is a connection between ultraluminous infrared galaxies (ULIRGs), quasars, and major mergers. Indeed, simulations show that major mergers are capable of triggering massive starbursts and quasars. However, observations by the Herschel Space Observatory suggest that, at least at high redshift, there may not always be a simple causal connection between ULIRGs and mergers. Here, we combine an evolving merger-triggered active galactic nucleus (AGN) luminosity function with a merger-triggered starburst model to calculate the maximum contribution of major mergers to the ULIRG population. We find that major mergers can account for the entire local population of ULIRGs hosting AGNs and {approx}25% of the total local ULIRG luminosity density. By z {approx} 1, major mergers can no longer account for the luminosity density of ULIRGs hosting AGNs and contribute {approx}<12% of the total ULIRG luminosity density. This drop is likely due to high-redshift galaxies being more gas rich and therefore able to achieve high star formation rates through secular evolution. Additionally, we find that major mergers can account for the local population of warm ULIRGs. This suggests that selecting high-redshift warm ULIRGs will allow for the identification of high-redshift merger-triggered ULIRGs. As major mergers are likely to trigger very highly obscured AGNs, a significant fraction of the high-redshift warm ULIRG population may host Compton thick AGNs.

  17. Polyomavirus JCV excretion and genotype analysis in HIV-infected patients receiving highly active antiretroviral therapy

    NASA Technical Reports Server (NTRS)

    Lednicky, John A.; Vilchez, Regis A.; Keitel, Wendy A.; Visnegarwala, Fehmida; White, Zoe S.; Kozinetz, Claudia A.; Lewis, Dorothy E.; Butel, Janet S.

    2003-01-01

    OBJECTIVE: To assess the frequency of shedding of polyomavirus JC virus (JCV) genotypes in urine of HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHODS: Single samples of urine and blood were collected prospectively from 70 adult HIV-infected patients and 68 uninfected volunteers. Inclusion criteria for HIV-infected patients included an HIV RNA viral load < 1000 copies, CD4 cell count of 200-700 x 106 cells/l, and stable HAART regimen. PCR assays and sequence analysis were carried out using JCV-specific primers against different regions of the virus genome. RESULTS: JCV excretion in urine was more common in HIV-positive patients but not significantly different from that of the HIV-negative group [22/70 (31%) versus 13/68 (19%); P = 0.09]. HIV-positive patients lost the age-related pattern of JCV shedding (P = 0.13) displayed by uninfected subjects (P = 0.01). Among HIV-infected patients significant differences in JCV shedding were related to CD4 cell counts (P = 0.03). Sequence analysis of the JCV regulatory region from both HIV-infected patients and uninfected volunteers revealed all to be JCV archetypal strains. JCV genotypes 1 (36%) and 4 (36%) were the most common among HIV-infected patients, whereas type 2 (77%) was the most frequently detected among HIV-uninfected volunteers. CONCLUSION: These results suggest that JCV shedding is enhanced by modest depressions in immune function during HIV infection. JCV shedding occurred in younger HIV-positive persons than in the healthy controls. As the common types of JCV excreted varied among ethnic groups, JCV genotypes associated with progressive multifocal leukoencephalopathy may reflect demographics of those infected patient populations.

  18. Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort.

    PubMed

    Eneanya, Nwamaka D; Winter, Michael; Cabral, Howard; Waite, Katherine; Henault, Lori; Bickmore, Timothy; Hanchate, Amresh; Wolf, Michael; Paasche-Orlow, Michael K

    2016-01-01

    The Patient Activation Measure (PAM) assesses facets of patient engagement to identify proactive health behaviors and is an important predictor of health outcomes. Health literacy and education are also important for patient participation and successful navigation of the health care system. Because health literacy, education, and patient activation are associated with racial disparities, we sought to investigate whether health literacy and education would mediate racial differences in patient activation. Participants were 265 older adults who participated in a computer-based exercise interventional study. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Of 210 eligible participants, 72% self-identified as Black and 28% as White. In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation. These findings are especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement. PMID:27524777

  19. Physical Activity and Influenza-Coded Outpatient Visits, a Population-Based Cohort Study

    PubMed Central

    Siu, Eric; Campitelli, Michael A.; Kwong, Jeffrey C.

    2012-01-01

    Background Although the benefits of physical activity in preventing chronic medical conditions are well established, its impacts on infectious diseases, and seasonal influenza in particular, are less clearly defined. We examined the association between physical activity and influenza-coded outpatient visits, as a proxy for influenza infection. Methodology/Principal Findings We conducted a cohort study of Ontario respondents to Statistics Canada’s population health surveys over 12 influenza seasons. We assessed physical activity levels through survey responses, and influenza-coded physician office and emergency department visits through physician billing claims. We used logistic regression to estimate the risk of influenza-coded outpatient visits during influenza seasons. The cohort comprised 114,364 survey respondents who contributed 357,466 person-influenza seasons of observation. Compared to inactive individuals, moderately active (OR 0.83; 95% CI 0.74–0.94) and active (OR 0.87; 95% CI 0.77–0.98) individuals were less likely to experience an influenza-coded visit. Stratifying by age, the protective effect of physical activity remained significant for individuals <65 years (active OR 0.86; 95% CI 0.75–0.98, moderately active: OR 0.85; 95% CI 0.74–0.97) but not for individuals ≥65 years. The main limitations of this study were the use of influenza-coded outpatient visits rather than laboratory-confirmed influenza as the outcome measure, the reliance on self-report for assessing physical activity and various covariates, and the observational study design. Conclusion/Significance Moderate to high amounts of physical activity may be associated with reduced risk of influenza for individuals <65 years. Future research should use laboratory-confirmed influenza outcomes to confirm the association between physical activity and influenza. PMID:22737242

  20. Increased orbitofrontal cortex activation associated with “pro-obsessive” antipsychotic treatment in patients with schizophrenia

    PubMed Central

    Schirmbeck, Frederike; Mier, Daniela; Esslinger, Christine; Rausch, Franziska; Englisch, Susanne; Eifler, Sarah; Meyer-Lindenberg, Andreas; Kirsch, Peter; Zink, Mathias

    2015-01-01

    Background Patients with schizophrenia have an approximately 10-fold higher risk for obsessive–compulsive symptoms (OCS) than the general population. A large subgroup seems to experience OCS as a consequence of second-generation antipsychotic agents (SGA), such as clozapine. So far little is known about underlying neural mechanisms. Methods To investigate the role of SGA treatment on neural processing related to OCS in patients with schizophrenia, we stratified patients according to their monotherapy into 2 groups (group I: clozapine or olanzapine; group II: amisulpride or aripiprazole). We used an fMRI approach, applying a go/no-go task assessing inhibitory control and an n-back task measuring working memory. Results We enrolled 21 patients in group I and 19 patients in group II. Groups did not differ regarding age, sex, education or severity of psychotic symptoms. Frequency and severity of OCS were significantly higher in group I and were associated with pronounced deficits in specific cognitive abilities. Whereas brain activation patterns did not differ during working memory, group I showed significantly increased activation in the orbitofrontal cortex (OFC) during response inhibition. Alterations in OFC activation were associated with the severity of obsessions and mediated the association between SGA treatment and co-occurring OCS on a trend level. Limitations The main limitation of this study is its cross-sectional design. Conclusion To our knowledge, this is the first imaging study conducted to elucidate SGA effects on neural systems related to OCS. We propose that alterations in brain functioning reflect a pathogenic mechanism in the development of SGA-induced OCS in patients with schizophrenia. Longitudinal studies and randomized interventions are needed to prove the suggested causal interrelations. PMID:25268790

  1. Increased Long-Term Risk of Dementia in Patients With Carbon Monoxide Poisoning: A Population-Based Study.

    PubMed

    Wong, Chung-Shun; Lin, Ying-Chin; Hong, Li-Yee; Chen, Tzu-Ting; Ma, Hon-Ping; Hsu, Yung-Ho; Tsai, Shin-Han; Lin, Yuh-Feng; Wu, Mei-Yi

    2016-01-01

    Carbon monoxide (CO) poisoning may cause toxicity of the central nervous system and heart. However, the association between CO poisoning and long-term dementia risk remains unestablished. We investigated the incidence of dementia in patients with CO poisoning in Taiwan and evaluated whether they had a higher risk of dementia than did the general population.A nationwide population-based cohort study was conducted among patients with CO poisoning identified using Taiwan's National Health Insurance Research Database (NHIRD) during 2004 to 2013. CO poisoning was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study cohort comprised patients with CO poisoning between 2005 and 2010 (N = 14,590). Each patient was age-, sex-, and index date-matched with 4 randomly selected controls from the comparison cohort (N = 58,360). All patients were followed from the study date until dementia development, death, or the end of 2013. Cox proportional hazards regressions were performed for comparing the hazard ratios for dementia between the 2 cohorts.Incident cases of dementia were identified from the NHIRD.After adjustment for potential confounders, the study cohort was independently associated with a higher dementia risk (adjusted hazard ratio, 2.75; 95% confidence interval, 2.26-3.35).This population-based cohort study indicated that patients with CO poisoning have a higher risk of dementia than do people without CO poisoning.

  2. Gorlin–Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature

    PubMed Central

    Lata, Jeevan; Verma, Nitin; Kaur, Amandeep

    2015-01-01

    Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested. PMID:26604574

  3. [THE STATE AND PERSPECTIVES OF DEVELOPMENT OF TRAUMATOLOGICAL ORTHOPEDIC OUT-PATIENT CARE TO POPULATION OF THE PRIVOLJSKII FEDERAL OKRUG].

    PubMed

    Norkin, I A; Baratov, A W; Andreeva, T M; Yushina, B S; Fedonnikov, A S

    2015-01-01

    The article presents the results of analysis ofmanpower support of specialized out-patient traumatological orthopedic care in the Privoljskii federal okrug. The manpower deficiency of traumatologist-orthopedist at the out-patient stage was established especially especially in rural area. This is cause of low indicators ofdispensary monitoring of patients with consequences of traumas and diseases of musculo-skeletal system and factual unavailability of rehabilitation care to patients of given profile. The experience oftraining and re-training of traumatologist-orthopedist is presented. The organization of hospital-substituting forms of medical service of profile patients in the Saratovskaia oblast. The directions of development of organization of specialized out-patient care to population of the region.

  4. Evidence for brain glial activation in chronic pain patients.

    PubMed

    Loggia, Marco L; Chonde, Daniel B; Akeju, Oluwaseun; Arabasz, Grae; Catana, Ciprian; Edwards, Robert R; Hill, Elena; Hsu, Shirley; Izquierdo-Garcia, David; Ji, Ru-Rong; Riley, Misha; Wasan, Ajay D; Zürcher, Nicole R; Albrecht, Daniel S; Vangel, Mark G; Rosen, Bruce R; Napadow, Vitaly; Hooker, Jacob M

    2015-03-01

    Although substantial evidence has established that microglia and astrocytes play a key role in the establishment and maintenance of persistent pain in animal models, the role of glial cells in human pain disorders remains unknown. Here, using the novel technology of integrated positron emission tomography-magnetic resonance imaging and the recently developed radioligand (11)C-PBR28, we show increased brain levels of the translocator protein (TSPO), a marker of glial activation, in patients with chronic low back pain. As the Ala147Thr polymorphism in the TSPO gene affects binding affinity for (11)C-PBR28, nine patient-control pairs were identified from a larger sample of subjects screened and genotyped, and compared in a matched-pairs design, in which each patient was matched to a TSPO polymorphism-, age- and sex-matched control subject (seven Ala/Ala and two Ala/Thr, five males and four females in each group; median age difference: 1 year; age range: 29-63 for patients and 28-65 for controls). Standardized uptake values normalized to whole brain were significantly higher in patients than controls in multiple brain regions, including thalamus and the putative somatosensory representations of the lumbar spine and leg. The thalamic levels of TSPO were negatively correlated with clinical pain and circulating levels of the proinflammatory citokine interleukin-6, suggesting that TSPO expression exerts pain-protective/anti-inflammatory effects in humans, as predicted by animal studies. Given the putative role of activated glia in the establishment and or maintenance of persistent pain, the present findings offer clinical implications that may serve to guide future studies of the pathophysiology and management of a variety of persistent pain conditions.

  5. Left ventricular synchronicity is impaired in patients with active acromegaly.

    PubMed

    Kırış, Abdulkadir; Erem, Cihangir; Turan, Oğuzhan Ekrem; Civan, Nadim; Kırış, Gülhanım; Nuhoğlu, Irfan; Ilter, Abdulselam; Ersöz, Halil Onder; Kutlu, Merih

    2013-08-01

    Acromegaly is associated with a variety of cardiovascular disturbances such as left ventricular hypertrophy, diastolic cardiac dysfunction, and hypertension. Left ventricular (LV) dyssynchrony means the impairment of synchronicity and is defined as the loss of the simultaneous peak contraction of corresponding cardiac segments. The objective of this study was to investigate whether acromegalic patients have left ventricular dyssynchrony. Dyssynchrony was evaluated in 30 patients with active acromegaly and 30 controls. All the patients and controls were subjected to a tissue synchronization imaging. The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-mid-segmental model was measured on ejection phase TSI images and four TSI parameters of systolic dyssynchrony were computed. All TSI parameters of LV dyssynchrony increased in patients with acromegaly compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (43.5 ± 13.5 vs 26.2 ± 12.5, p < 0.001); the maximal difference in Ts between any 2 of the 12 LV segments (133.3 ± 38 vs 84.6 ± 37.6, p < 0.001); the SD of the 6 basal LV segments (41.1 ± 15.9 vs 25.4 ± 14.8, p = 0.001); and the maximal difference in Ts between any 2 of the 6 basal LV segments (102.6 ± 37.5 vs 65.2 ± 36.9, p = 0.001). In addition, there were significant relationships between the levels of growth hormone/insulin-like growth factor-1 and Ts-SD-12. LV synchronicity has been impaired in patients with acromegaly. Left ventricular dyssynchrony is associated with disease activity and it may contribute to the harmful cardiovascular effects of acromegaly.

  6. Activity of mitogen-activated protein kinases in the esophageal epithelium of patients with Barrett's esophagus.

    PubMed

    Chwiesko, A; Baniukiewicz, A; Semeniuk, J; Kaczmarski, M; Wasielica-Berger, J; Milewski, R; Dabrowski, A

    2015-01-01

    Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is associated with an increased risk of esophageal cancer. Mitogen-activated protein kinases may play an important role in the pathogenesis of this process. We aimed to evaluate mitogen-activated protein kinases activity in esophageal mucosa of patients with BE and find possible relationship between reflux type and BE. Twenty-four patients (mean age: 59 years) with gastroesophageal reflux disease symptoms and endoscopically suspected esophageal metaplasia (ESEM) were prospectively enrolled for testing by a multichannel intraluminal impedance monitoring along with a Bilitec 2000. Endoscopic biopsies were taken from methylene blue-positive pit patterns (sites suggesting specialized intestinal metaplasia [SIM]), from 2 cm above the Z-line and from cardial parts of the stomach. The biopsies were analyzed for extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38 activity by Western blot. Seventeen ESEMs had histologically proven metaplasia: eight patients had SIM and nine had gastric-type epithelia (GE). Biliary reflux was more evident in SIM (P = 0.019) but not in GE (P = 0.019); non-biliary reflux was typical for GE (P = 0.005) but not for SIM (P = 0.04). Strong activations of ERK and p38 were found predominantly in SIM, but not in normal esophageal mucosa (NE) (P = 0.01 and P < 0.001 respectively). Strong signals for active JNK and p38 were detected in GE, but not in NE (P = 0.006 and P = 0.02 respectively). ERK activity was significantly higher than p38 activity in ESEM patients only with GE (P = 0.02). The strong activation of ERK, but not JNK is indicative of SIM. The presence of bile in gastroesophageal refluxate is predisposing to SIM, but not to GE in esophageal mucosa.

  7. New orally active anticoagulant agents for the prevention and treatment of venous thromboembolism in cancer patients

    PubMed Central

    Gerotziafas, Grigoris T; Mahé, Isabelle; Elalamy, Ismail

    2014-01-01

    Patients with cancer have a 6–7-fold higher risk of venous thromboembolism (VTE) as compared with non-cancer patients. Effective and safe anticoagulation for the prevention and treatment of VTE is the cornerstone of the management of patients with cancer, aiming to decrease morbidity and mortality and to improve quality of life. Unfractionated heparin, low molecular weight heparins, fondaparinux and vitamin K antagonists (VKAs) are used in the prevention and treatment of VTE in cancer patients. Heparins and fondaparinux are administered subcutaneously. VKAs are orally active, but they have a narrow therapeutic window, numerous food and drug interactions, and treatment requires regular laboratory monitoring and dose adjustment. These limitations among others have important negative impact on the quality of life of patients and decrease adherence to the treatment. New orally active anticoagulant (NOAC) agents are specific inhibitors of activated factor Xa (FXa) (rivaroxaban and apixaban) or thrombin (dabigatran). It is expected that NOACs will improve antithrombotic treatment. Cancer patients are a particular group that could benefit from treatment with NOACs. However, NOACs present some significant interactions with drugs frequently used in cancer patients, which might influence their pharmacokinetics, compromising their efficacy and safety. In the present review, we analyzed the available data from the subgroups of patients with active cancer who were included in Phase III clinical trials that assessed the efficacy and safety of NOACs in the prevention and treatment of VTE. The data from the Phase III trials in prophylaxis of VTE by rivaroxaban or apixaban highlight that these two agents, although belonging to the same pharmacological group (direct inhibitors of factor Xa), have substantially different profiles of efficacy and safety, especially in hospitalized acutely ill medical patients with active cancer. A limited number of patients with VTE and active

  8. Dynamical Criticality in the Collective Activity of a Population of Retinal Neurons

    NASA Astrophysics Data System (ADS)

    Mora, Thierry; Deny, Stéphane; Marre, Olivier

    2015-02-01

    Recent experimental results based on multielectrode and imaging techniques have reinvigorated the idea that large neural networks operate near a critical point, between order and disorder. However, evidence for criticality has relied on the definition of arbitrary order parameters, or on models that do not address the dynamical nature of network activity. Here we introduce a novel approach to assess criticality that overcomes these limitations, while encompassing and generalizing previous criteria. We find a simple model to describe the global activity of large populations of ganglion cells in the rat retina, and show that their statistics are poised near a critical point. Taking into account the temporal dynamics of the activity greatly enhances the evidence for criticality, revealing it where previous methods would not. The approach is general and could be used in other biological networks.

  9. TASK DIFFICULTY MODULATES ACTIVITY OF SPECIFIC NEURONAL POPULATIONS IN PRIMARY VISUAL CORTEX

    PubMed Central

    Chen, Yao; Martinez-Conde, Susana; Macknik, Stephen L.; Bereshpolova, Yulia; Swadlow, Harvey A.; Alonso, Jose-Manuel

    2008-01-01

    Spatial attention enhances our ability to detect stimuli at restricted regions of the visual field. This enhancement is thought to depend on the difficulty of the task being performed, but the underlying neuronal mechanisms for this dependency remain largely unknown. Here we demonstrate that task difficulty modulates neuronal firing rate at the earliest stages of cortical visual processing (area V1) in the macaque monkey. These modulations are spatially specific: increasing task difficulty enhances V1 neuronal firing rate at the focus of attention and suppresses it in regions surrounding the focus. Moreover, we show that response enhancement and suppression are mediated by distinct populations of neurons that differ in direction selectivity, spike width, interspike interval distribution and contrast sensitivity. Our results provide strong support for center-surround models of spatial attention and suggest that task difficulty modulates the activity of specific populations of neurons in the primary visual cortex. PMID:18604204

  10. Physical activity in patients with advanced-stage cancer: a systematic review of the literature.

    PubMed

    Albrecht, Tara A; Taylor, Ann Gill

    2012-06-01

    The importance of physical activity for chronic disease prevention and management has become generally well accepted. The number of research interventions and publications examining the benefits of physical activity for patients with cancer has been rising steadily. However, much of that research has focused on the impact of physical activity either prior to or early in the cancer diagnosis, treatment, and survivorship process. Research focusing on the effects of physical activity, specifically for patients with advanced-stage cancer and poorer prognostic outcomes, has been addressed only recently. The purpose of this article is to examine the state of the science for physical activity in the advanced-stage disease subset of the cancer population. Exercise in a variety of intensities and forms, including yoga, walking, biking, and swimming, has many health benefits for people, including those diagnosed with cancer. Research has shown that, for people with cancer (including advanced-stage cancer), exercise can decrease anxiety, stress, and depression while improving levels of pain, fatigue, shortness of breath, constipation, and insomnia. People diagnosed with cancer should discuss with their oncologist safe, easy ways they can incorporate exercise into their daily lives. PMID:22641322

  11. Differences in aggression, activity and boldness between native and introduced populations of an invasive crayfish

    USGS Publications Warehouse

    Pintor, L.M.; Sih, A.; Bauer, M.L.

    2008-01-01

    Aggressiveness, along with foraging voracity and boldness, are key behavioral mechanisms underlying the competitive displacement and invasion success of exotic species. However, do aggressiveness, voracity and boldness of the invader depend on the presence of an ecologically similar native competitor in the invaded community? We conducted four behavioral assays to compare aggression, foraging voracity, threat response and boldness to forage under predation risk of multiple populations of exotic signal crayfish Pacifastacus leniusculus across its native and invaded range with and without a native congener, the Shasta crayfish P. fortis. We predicted that signal crayfish from the invaded range and sympatric with a native congener (IRS) should be more aggressive to outcompete a close competitor than populations from the native range (NR) or invaded range and allopatric to a native congener (IRA). Furthermore, we predicted that IRS populations of signal crayfish should be more voracious, but less bold to forage under predation risk since native predators and prey likely possess appropriate behavioral responses to the invader. Contrary to our predictions, results indicated that IRA signal crayfish were more aggressive towards conspecifics and more voracious and active foragers, yet also bolder to forage under predation risk in comparison to NR and IRS populations, which did not differ in behavior. Higher aggression/voracity/ boldness was positively correlated with prey consumption rates, and hence potential impacts on prey. We suggest that the positive correlations between aggression/voracity/boldness are the result of an overall aggression syndrome. Results of stream surveys indicated that IRA streams have significantly lower prey biomass than in IRS streams, which may drive invading signal crayfish to be more aggressive/voracious/bold to acquire resources to establish a population. ?? 2008 The Authors.

  12. A population-based profile of adult Canadians living with participation and activity limitations

    PubMed Central

    Goodridge, Donna; Lawson, Josh; Marciniuk, Darcy; Rennie, Donna

    2011-01-01

    Background: Currently, one out of every seven Canadians is affected by limitations to their participation and activity. This study describes the self-reported main causes of these limitations in a national sample. Methods: The 2006 Participation and Activity Limitation Survey was a two-phase stratified survey based on filter questions posed in the 2006 Census of Population conducted by Statistics Canada. Respondents to the survey represent 5 185 980 Canadian adults with activity and participation limitations. We used these data to develop a profile of our population of interest: adult Canadians with activity and participation limitations. Associations between demographic variables and self-reported causes of activity and participation limitations were assessed using multiple logistic regression. Results: One quarter of participants did not attribute their disability to any medical cause. The most prevalent medical conditions to which disabilities were attributed were musculoskeletal (46.1%), cardio/cerebrovascular (12.3%), mental health (8.4%), neurologic (6.0%), endocrine (6.0%) and respiratory (4.5%) conditions. Significant associations were noted between sociodemographic variables and participants’ attributions of medical conditions as cause of disability. Multiple logistic regression with bootstrapping showed that people who reported a medical cause for their limitation were more likely (p < 0.05) to be female, widowed, 40 years of age or older, born in Canada or white and were less likely (p < 0.05) to be in the highest income category or to be employed (i.e., to work more than 0 h/w). Interpretation: Most people living with activity and participation limitations report having a musculoskeletal disorder. However, a significant proportion of respondants did not attribute their limitations to a medical cause. PMID:21825051

  13. Serum amylase activity and renal amylase activity clearance in patients with severely impaired renal function and in patients treated with renal allotransplantation.

    PubMed

    Pedersen, E B; Brock, A; Kornerup, H J

    1976-03-01

    Serum amylase activity was measured in 29 nondialysed patients with severe renal failure, in 24 uraemic patients treated with chronic haemodialysis, and in 29 patients treated with renal allotransplantation. Simultaneous measurement of renal amylase activity clearance (CAm) and creatinine clearance (CCr) was performed in 25 patients with severe renal failure and in 19 transplanted patients. Serum amylase activity was elevated in all three groups. CAm was significantly correlated to CCr both in the group with severe renal failure and in the transplanted group. Unlike in the group of transplanted patients, the ratio CAm/CCr was significantly increased in patients with severe impaired renal function. It is concluded that the elevation of serum amylase activity in patients with impaired renal function is primarily due to decreased glomerular filtration rate. The value of CAm/CCr for diagnosing acute pancreatitis is doubtful in patients with severe renal disease.

  14. Improved cognitive, affective and anxiety measures in patients with chronic systemic disorders following structured physical activity.

    PubMed

    Teixeira, Robson Bonoto; Marins, João Carlos Bouzas; de Sá Junior, Antonio Reis; de Carvalho, Cristiane Junqueira; da Silva Moura, Tiago Augusto; Lade, Carlos Gabriel; Rizvanov, Albert A; Kiyasov, Andrey P; Mukhamedyarov, Marat A; Zefirov, Andrey L; Palotás, András; Lima, Luciana Moreira

    2015-11-01

    Mental illnesses are frequent co-morbid conditions in chronic systemic diseases. High incidences of depression, anxiety and cognitive impairment complicate cardiovascular and metabolic disorders such as hypertension and diabetes mellitus. Lifestyle changes including regular exercise have been advocated to reduce blood pressure and improve glycaemic control. The purpose of this project was to evaluate the effect of physical training on the most prevalent corollary psychiatric problems in patients with chronic organic ailments. This longitudinal study assessed the mental health of hypertensive (age: 57 ± 8 years) and/or diabetic (age: 53 ± 8 years) patients using mini-mental state examination, Beck's depression inventory, Beck's anxiety inventory and self-reporting questionnaire-20 before and after a 3-month supervised resistance and aerobic exercise programme comprising structured physical activity three times a week. Clinically relevant improvement was observed in the Beck's depression inventory and Beck's anxiety inventory scores following the 12-week training (61%, p = 0.001, and 53%, p = 0.02, respectively). Even though statistically not significant (p = 0.398), the cognitive performance of this relatively young patient population also benefited from the programme. These results demonstrate positive effects of active lifestyle on non-psychotic mental disorders in patients with chronic systemic diseases, recommending exercise as an alternative treatment option. PMID:26410835

  15. Smoking further increases platelet activity in patients with mild hypertension.

    PubMed

    Gleerup, G; Winther, K

    1996-01-01

    In this study the authors examine whether smoking further heightens platelet activity and reduces fibrinolysis above that already present in mild hypertension. Ten smokers and 11 non-smokers, all with mild hypertension (defined as a diastolic pressure between 90 and 110 mm Hg) were compared for their platelet activity in vitro and in vivo and for their fibrinolytic activity. Successive measurements were made with the patients lying at rest after they had assumed the erect posture for 10 min and at the end of a 5-min moderately strenuous exercise test. The threshold for platelet aggregation by ADP in vitro was significantly lower in samples taken from the smokers at rest (1.4 +/- 0.9 mumol L(-1)) than in the non-smokers (3.5 +/- 2.5 mumol L(-1)), and the difference persisted both in the upright posture and after exercise. The level of platelet release of beta-thromboglobulin was, likewise, higher in the smokers in the upright posture. Neither standing up nor physical exercise had any significant influence on either of these two indices of platelet activity. The euglobulin clot lysis time was slightly longer in the smokers than in the non-smokers in all three experimental situations, but the differences were not significant. Inhibitor of tissue plasminogen activator was not materially different in the two groups (Table 2). The results indicate that smoking adds a further element of heightened platelet activity to that inherently present in hypertension.

  16. Transfer of genetic therapy across human populations: molecular targets for increasing patient coverage in repeat expansion diseases.

    PubMed

    Varela, Miguel A; Curtis, Helen J; Douglas, Andrew G L; Hammond, Suzan M; O'Loughlin, Aisling J; Sobrido, Maria J; Scholefield, Janine; Wood, Matthew J A

    2016-02-01

    Allele-specific gene therapy aims to silence expression of mutant alleles through targeting of disease-linked single-nucleotide polymorphisms (SNPs). However, SNP linkage to disease varies between populations, making such molecular therapies applicable only to a subset of patients. Moreover, not all SNPs have the molecular features necessary for potent gene silencing. Here we provide knowledge to allow the maximisation of patient coverage by building a comprehensive understanding of SNPs ranked according to their predicted suitability toward allele-specific silencing in 14 repeat expansion diseases: amyotrophic lateral sclerosis and frontotemporal dementia, dentatorubral-pallidoluysian atrophy, myotonic dystrophy 1, myotonic dystrophy 2, Huntington's disease and several spinocerebellar ataxias. Our systematic analysis of DNA sequence variation shows that most annotated SNPs are not suitable for potent allele-specific silencing across populations because of suboptimal sequence features and low variability (>97% in HD). We suggest maximising patient coverage by selecting SNPs with high heterozygosity across populations, and preferentially targeting SNPs that lead to purine:purine mismatches in wild-type alleles to obtain potent allele-specific silencing. We therefore provide fundamental knowledge on strategies for optimising patient coverage of therapeutics for microsatellite expansion disorders by linking analysis of population genetic variation to the selection of molecular targets.

  17. Population Structure and Antimicrobial Susceptibility of Both Nonpersistent and Persistent Pseudomonas aeruginosa Isolates Recovered from Cystic Fibrosis Patients

    PubMed Central

    Fernández-Olmos, Ana; García-Castillo, María; Alba, José María; Morosini, María Isabel; Lamas, Adelaida; Romero, Beatriz; Galán, Juan Carlos; del Campo, Rosa

    2013-01-01

    Seventy-six Pseudomonas aeruginosa isolates recovered from chronically (n = 18) and nonchronically (n = 18) colonized cystic fibrosis (CF) patients (2002 to 2009) were grouped in separate polyclonal populations. International CF epidemic clones were not identified, but the high-risk clone ST274, also found circulating in Spanish hospitals, was present. Persistent isolates were more resistant to antibiotics than nonpersistent isolates. PMID:23761158

  18. MEFV alterations and population genetics analysis in a large cohort of Greek patients with familial Mediterranean fever.

    PubMed

    Giaglis, S; Papadopoulos, V; Kambas, K; Doumas, M; Tsironidou, V; Rafail, S; Kartalis, G; Speletas, M; Ritis, K

    2007-05-01

    Familial Mediterranean fever (FMF) is a disease characterized by recurrent, self-limiting bouts of fever and serositis and caused by altered pyrin due to mutated MEFV gene. FMF is common in the Mediterranean Basin populations, although with varying genetic patterns. The spectrum and clinical significance of MEFV alterations in Greece has yet not been elucidated. The aim of this study was to analyze the spectrum of MEFV alterations in FMF patients and healthy individuals in Greece. A cohort of 152 Greek FMF patients along with 140 Greek healthy controls was enrolled. Non-isotopic RNase cleavage assay (NIRCA) and sequencing allowed mutational and haplotypic analysis of the entire coding sequence of MEFV. The ARLEQUIN 2.0, DNASP 4.0 and PHYLIP software were used for population genetics analysis. Among patients, 127 (83.6%) carried at least one known mutation. The most common mutations identified were M694V (38.1%), M680I (19.7%), V726A (12.2%), E148Q (10.9%) and E230K (6.1%). The total carrier rate among healthy individuals was 0.7%. The presence of R202Q homozygosity in 12 of the remaining 25 MEFV negative FMF patients might be considered as disease related in Greeks. Population genetics analysis revealed that Greeks rely closer to the eastern rather than western populations of the Mediterranean Basin. PMID:17489852

  19. Activity and growth of microbial populations in pressurized deep-sea sediment and animal gut samples.

    PubMed

    Tabor, P S; Deming, J W; Ohwada, K; Colwell, R R

    1982-08-01

    Benthic animals and sediment samples were collected at deep-sea stations in the northwest (3,600-m depth) and southeast (4,300- and 5200-m depths) Atlantic Ocean. Utilization rates of [14C]glutamate (0.67 to 0.74 nmol) in sediment suspensions incubated at in situ temperatures and pressures (3 to 5 degrees C and 360, 430, or 520 atmospheres) were relatively slow, ranging from 0.09 to 0.39 nmol g-1 day-1, whereas rates for pressurized samples of gut suspensions varied widely, ranging from no detectable activity to a rapid rate of 986 nmol g-1 day-1. Gut flora from a holothurian specimen and a fish demonstrated rapid, barophilic substrate utilization, based on relative rates calculated for pressurized samples and samples held at 1 atm (101.325 kPa). Substrate utilization by microbial populations in several sediment samples was not inhibited by in situ pressure. Deep-sea pressures did not restrict growth, measured as doubling time, of culturable bacteria present in a northwest Atlantic sediment sample and in a gut suspension prepared from an abyssal scavenging amphipod. From the results of this study, it was concluded that microbial populations in benthic environments can demonstrate significant metabolic activity under deep-ocean conditions of temperature and pressure. Furthermore, rates of microbial activity in the guts of benthic macrofauna are potentially more rapid than in surrounding deep-sea sediments. PMID:6127054

  20. Anesthetic action on extra-synaptic receptors: effects in neural population models of EEG activity

    PubMed Central

    Hashemi, Meysam; Hutt, Axel; Sleigh, Jamie

    2014-01-01

    The role of extra-synaptic receptors in the regulation of excitation and inhibition in the brain has attracted increasing attention. Because activity in the extra-synaptic receptors plays a role in regulating the level of excitation and inhibition in the brain, they may be important in determining the level of consciousness. This paper reviews briefly the literature on extra-synaptic GABA and NMDA receptors and their affinity to anesthetic drugs. We propose a neural population model that illustrates how the effect of the anesthetic drug propofol on GABAergic extra-synaptic receptors results in changes in neural population activity and the electroencephalogram (EEG). Our results show that increased tonic inhibition in inhibitory cortical neurons cause a dramatic increase in the power of both δ− and α− bands. Conversely, the effects of increased tonic inhibition in cortical excitatory neurons and thalamic relay neurons have the opposite effect and decrease the power in these bands. The increased δ-activity is in accord with observed data for deepening propofol anesthesia; but is absolutely dependent on the inclusion of extrasynaptic (tonic) GABA action in the model. PMID:25540612

  1. Outcome of Community-Acquired Staphylococcus aureus Bacteraemia in Patients with Diabetes: A Historical Population-Based Cohort Study

    PubMed Central

    Smit, Jesper; Thomsen, Reimar Wernich; Schønheyder, Henrik Carl; Nielsen, Henrik; Frøslev, Trine; Søgaard, Mette

    2016-01-01

    Background Patients with diabetes (DM) experience increased risk of Staphylococcus aureus bacteraemia (SAB), but the prognostic impact of diabetes in patients with SAB remain unclear. Therefore, we investigated 30-day all-cause mortality in patients with and without DM. Methods Population-based medical databases were used to conduct a cohort study of all adult patients with community-acquired SAB in Northern Denmark, 2000–2011. Using Cox proportional hazards regression, we computed hazard ratios as estimates of 30-day mortality rate ratios (MRRs) among patients with and without DM. We further investigated whether the prognostic impact of DM differed among patients with and without recent preadmission healthcare contacts (within 30 days of the current hospitalization) and by age, sex, marital status, level of comorbidity, and DM-related characteristics (e.g., duration of DM and presence of DM complications). Results Among 2638 SAB patients, 713 (27.0%) had DM. Thirty-day cumulative mortality was 25.8% in patients with DM and 24.3% in patients without DM, for an adjusted MRR (aMRR) of 1.01 (95% confidence interval (CI), 0.84–1.20). In analyses with and without recent healthcare contacts, the corresponding aMRRs were 0.84 (95% CI, 0.62–1.14) and 1.13 (95% CI, 0.91–1.41), respectively. Compared to patients without DM, the aMRR was 0.94 (95% CI, 0.74–1.20) for male patients with DM and 1.13 (95% CI, 0.87–1.47) for female patients with DM. The prognostic influence of DM on mortality did not differ notably with age, level of comorbidity, or characteristics of patients with DM. Conclusion Patients with DM and community-acquired SAB did not experience higher 30-day mortality than patients without DM. PMID:27082873

  2. Association of functional genetic variants in PPARδ encoding peroxisome proliferator-activated receptor delta with ischemic stroke in Chinese Uyghur population.

    PubMed

    Tong, Yeqing; Zhan, Faxian; Cai, Li; Han, ShengHong; Guan, Xuhuan; Lin, Liangqiang; Li, Xiaoxia; Hou, Shuangyi; Lu, Qing; Liu, Jiafa

    2015-11-15

    PPARδ belongs to a receptor family of ligand-activated transcription factors involved in the regulation of inflammation, cellular glucose uptake, protection against atherosclerosis and endothelial cell function. Through these effects, they might be involved with the ischemic stroke (IS). We recruited 200 subjects (100 IS patients diagnosed by CTs or/and magnetic resonance imaging (MRI) and 100 normal healthy controls from Chinese Uyghur population) to assess the nature of the functional polymorphisms of PPARδ +294T/C and any links with IS in this unique population. We found that the C allele of the PPARδ +294T/C polymorphism was more common in controls than IS subjects in the Uyghur population. C allele carriage may be associated with an increased risk of IS in Uyghurs with a strong trend (OR 1.79, 95% CI: 1.11-2.89). Additionally, the PPARδ CC and TC genotypes were less frequent in Uyghur population than in Han population. Our population and ethnic-based study demonstrates that the PPARδ +294C allele maybe an independent risk of IS in Chinese Uyghurs especially in the male (OR 1.99, 95%CI:1.06-3.72) and obesity populations (OR 2.36, 95%CI: 1.19-4.67), which were consistent with Tunisian Population. Moreover, total cholesterol, fasting blood glucose, waist-to-hip ratio, hypertension, history of heart diseases, and negative events may increase the risk of IS, with a trend for HDL to be a protective factor for IS in the Uyghur population. However, larger populations are warranted to validate our findings.

  3. Understanding physical activity participation in spinal cord injured populations: Three narrative types for consideration.

    PubMed

    Papathomas, Anthony; Williams, Toni L; Smith, Brett

    2015-01-01

    The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives.

  4. Understanding physical activity participation in spinal cord injured populations: Three narrative types for consideration

    PubMed Central

    Papathomas, Anthony; Williams, Toni L.; Smith, Brett

    2015-01-01

    The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives. PMID:26282868

  5. Inhibition of bactericidal activity by pentachlorophenol in two phagocyte populations from Fundulus heteroclitus

    SciTech Connect

    Roszell, L.E.; Anderson, R.S.

    1994-12-31

    The effects of pentachlorophenol (PCP) on the bactericidal activity of pronephritic phagocytes were studied in an estuarine fish, Fundulus heteroclitus. Following in vitro exposure to sublethal doses of PCP, macrophages and eosinophils were challenged with Listonella anguillarum, the bacterium responsible for vibriosis in marine and freshwater fish. Quantification of surviving bacteria was based on the reduction of MTT (3-[4,5 dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide). Bacteridical activity was inhibited at PCP concentrations greater than 5 ppm in both leukocyte populations; at 20 ppm bactericidal activity was essentially eliminated. The primary cellular mechanisms of bactericidal activity in these cells are phagocytosis and the phagocytically induced production of reactive oxygen intermediates (ROIs) including superoxide (O{sub 2}{sup {minus}}) and hydrogen peroxide (H{sub 2}O{sub 2}). Previous experiments have shown that these activities are inhibited at similar concentrations of PCP. These results indicate that the suppression of phagocytosis and the subsequent oxidative burst is responsible for the reduced killing seen in the current experiments. Nonspecific immune activities of phagocytic cells such as macrophages and eosinophils act as a first line of defense against invading pathogens; the suppression of these functions could ultimately lead to decreased resistance to infectious disease.

  6. Dynamic hyperinflation during activities of daily living in COPD patients.

    PubMed

    Silva, Cláudia S; Nogueira, Fabiana R; Porto, Elias F; Gazzotti, Mariana R; Nascimento, Oliver A; Camelier, Aquiles; Jardim, José R

    2015-08-01

    The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL