Investigation of spherical loudspeaker arrays for local active control of sound.

PubMed

Peleg, Tomer; Rafaely, Boaz

2011-10-01

Active control of sound can be employed globally to reduce noise levels in an entire enclosure, or locally around a listener's head. Recently, spherical loudspeaker arrays have been studied as multiple-channel sources for local active control of sound, presenting the fundamental theory and several active control configurations. In this paper, important aspects of using a spherical loudspeaker array for local active control of sound are further investigated. First, the feasibility of creating sphere-shaped quiet zones away from the source is studied both theoretically and numerically, showing that these quiet zones are associated with sound amplification and poor system robustness. To mitigate the latter, the design of shell-shaped quiet zones around the source is investigated. A combination of two spherical sources is then studied with the aim of enlarging the quiet zone. The two sources are employed to generate quiet zones that surround a rigid sphere, investigating the application of active control around a listener's head. A significant improvement in performance is demonstrated in this case over a conventional headrest-type system that uses two monopole secondary sources. Finally, several simulations are presented to support the theoretical work and to demonstrate the performance and limitations of the system. © 2011 Acoustical Society of America

Contributing towards the betterment of translational epilepsy research in Africa: needs, challenges, resources, and opportunities.

PubMed

Woldeamanuel, Yohannes W; Girma, Belaineh

2014-08-01

Epilepsy affects approximately 50 million people worldwide. Among them, at least 40 million people are currently living in the developing world, where resources and standards of care are suboptimal. Around 90 % of people with epilepsy in resource-poor countries do not currently receive appropriate treatments, at a time when two thirds of these patients could have achieved good control of their epileptic seizures had they had access to appropriate therapies. Scarcity of epilepsy specialists, poor availability or access to diagnostic facilities and treatments, poor community knowledge about epilepsy-related issues, stigma, and other societal and cultural barriers are only some of the issues contributing to this deficiency. These issues in epilepsy treatment have been well recognized, and ongoing concerted efforts to address them have been undertaken by both local authorities and international organizations. In many cases, patients resort to the use of traditional local and alternative medicines (herbs, religious practices, etc.) that are closer to indigenous cosmovision, are more holistic, and are more culture-friendly, preserving an optimum subtlety of Afrocentric character shading. Compared with imported Western medicines, patients find these approaches to be more relevant to their ways of thinking, their ways of being, and their belief systems, more accessible, and more acceptable methods of dealing with health and disease states. The impressive local wealth in these natural resources has established them as a preferred source of healing in these regions, but has also fueled interest in exploring their therapeutic potential in the very few existing local research centers. In this review, we discuss the known issues related to the epilepsy treatment gap in resource-poor regions, focusing in particular on African countries, introduce the role and issues related to the use and validation of alternative medical therapies in epilepsy, and comment on the importance and repercussions of initiatives to validate such therapies, primarily for local practices, but also for possible wider international applications.

Telerobot control system

NASA Technical Reports Server (NTRS)

Backes, Paul G. (Inventor); Tso, Kam S. (Inventor)

1993-01-01

This invention relates to an operator interface for controlling a telerobot to perform tasks in a poorly modeled environment and/or within unplanned scenarios. The telerobot control system includes a remote robot manipulator linked to an operator interface. The operator interface includes a setup terminal, simulation terminal, and execution terminal for the control of the graphics simulator and local robot actuator as well as the remote robot actuator. These terminals may be combined in a single terminal. Complex tasks are developed from sequential combinations of parameterized task primitives and recorded teleoperations, and are tested by execution on a graphics simulator and/or local robot actuator, together with adjustable time delays. The novel features of this invention include the shared and supervisory control of the remote robot manipulator via operator interface by pretested complex tasks sequences based on sequences of parameterized task primitives combined with further teleoperation and run-time binding of parameters based on task context.

Infantile Hemangiomas of the Lip: Patterns, Outcomes, and Implications.

PubMed

Yanes, Daniel A; Pearson, Gregory D; Witman, Patricia M

2016-09-01

Infantile hemangiomas of the lip are potentially problematic because of high visibility and risk of disfigurement and ulceration. This study examined sizes, patterns, and locations of lip hemangiomas, their prognostic value, and their implications in hemangioma pathogenesis. Records of 106 patients seen for lip hemangiomas from 2006 to 2013 at Nationwide Children's Hospital were reviewed. Localized hemangiomas were mapped to a location on the lip based on their focus. Size, location, and morphology were assessed with regard to outcome. Poor outcomes were considered to be marked anatomic deformity, scarring, functional complications, and ulceration. Of 72 untreated hemangiomas with discernible outcomes, 92% of segmental lip hemangiomas were associated with poor outcomes, as opposed to 32% of localized hemangiomas (p < 0.001). Localized lip hemangiomas originated from six distinct locations. Localized untreated hemangiomas with poor outcomes were, on average, approximately 2.36 cm(2) larger (95% confidence interval 1.47, 3.25) than those that resolved favorably (p < 0.001); 52% of upper lip untreated hemangiomas and 6% of lower lip hemangiomas had poor outcomes (p = 0.001), and 61% of untreated localized hemangiomas involving the vermilion border and 25% of those that did not had poor outcomes (p = 0.01). Hemangiomas that received early medical or surgical intervention were less likely to have poor outcomes than untreated hemangiomas (p = 0.03). Localized lip hemangiomas occur in distinct locations on the lip that are not random and appear to reflect known models of facial development. Segmental morphology is associated with poor outcomes. In localized hemangiomas, the upper lip is associated with more problematic outcomes than the lower lip. Large size and involvement of the vermilion border are also valuable prognostic indicators associated with poor outcomes. Early intervention in lip hemangiomas is associated with better outcomes. © 2016 Wiley Periodicals, Inc.

The introduction of local air quality management in the United Kingdom: A review and theoretical framework

NASA Astrophysics Data System (ADS)

Longhurst, J. W. S.; Lindley, S. J.; Watson, A. F. R.; Conlan, D. E.

In the light of recent episodes of poor air quality in many of the U.K.'s major urban areas, concern has been expressed regarding the apparent inability of existing air quality control procedures to effectively tackle contemporary scenarios. As a result of this, a new philosophy for air quality control has been sought which can provide a solid basis for the preservation and future improvement of air quality. It is proposed that a suitable mechanism for this would be found through the adoption of an integrated and holistic local air quality management approach. This paper will present and discuss a theoretical framework for the application of local air quality management in the U.K. and investigate the potential of the Environment Act (1995) to provide such a framework.

Medulloblastoma. The identification of prognostic subgroups and implications for multimodality management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kopelson, G.; Linggood, R.M.; Kleinman, G.M.

1983-01-15

For 43 medulloblatoma patients who had five-and ten-year actuarial survival rates of 56%, prognostic factors of statistical significance included: T-stage, M-stage and histopathologic tumor score. Posterior fossa local control rates were also function of T-stage and TS. Combining TS with T-stage, patients fell into three prognostic and local control groups, which may have different future management implications: Small (T1,2) tumors of favorable (TS less than or equal to 5) histology had a 92% ten-year actuarial survival rate with 100% (8/8) local control; no change from current management is suggested. For the intermediate prognosis group, increasing the irradiation dose alone maymore » improve survival because these tumors exhibited an irradiation dose-response relationship. However, it is the poor prognosis group which might be suitable for future adjuvant chemotherapy or radiosensitizer trials since there is no evidence that higher irradiation doses improve local control. This article identifies prognostic subgroups based on histologic type and TM staging in medulloblastoma patients which potentially may be utilized to improve therapeutic results, and confirms the value of staging patients with central nervous system malignancies.« less

Tectonic control on sea-floor relief and the localization of Lower Mississippian Waulsortian mounds, New Mexico

NASA Astrophysics Data System (ADS)

Jeffery, David L.

1997-11-01

Lower Mississippian carbonate mud-rich bioherms, generally referred to as Waulsortian mounds, are commonly associated with low-paleolatitude carbonate ramp settings and have recently been recognized as important hydrocarbon reservoirs. The factors controlling localization of Waulsortian mounds have heretofore been poorly understood. Stratal relations exposed in the Alamogordo Member of the Lake Valley Formation in the Sacramento Mountains of New Mexico illustrate the effects of tectonism on carbonate sedimentation prior to, during, and after mound growth. They indicate that mound initiation and localization were strongly controlled by tectonically generated, intraramp, sea-floor topography. These observations bear strongly on understanding the controls on localization and growth of mud mounds in general. Stratal geometries observed in the underlying Andrecito Member indicate that this topography was modified by erosional and depositional processes prior to mound initiation. Mounds formed on the surfaces and margins of the intraramp topography as the result of aggradational, in situ accumulation of biogenic sediment. Differences in growth geometry of stratal units within individual mounds and differences between mounds are correlated with position of the mound on the ramp and the deformation occurring immediately prior to mound growth. It is probable that local tectonism continued during mound growth, and that local differences in the amount of relative uplift resulted in different amounts of space for growth of individual mounds, and thus determined differences in mound size and geometry.

The effects on population health status of using dedicated property taxes to fund local public health agencies

PubMed Central

2011-01-01

Background In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. Methods We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. Results Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. Conclusions There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies. PMID:21672231

The effects on population health status of using dedicated property taxes to fund local public health agencies.

PubMed

Honoré, Peggy A; Fos, Peter J; Wang, Xueyuan; Moonesinghe, Ramal

2011-06-14

In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies.

Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden.

PubMed

Preet, Raman; Khan, Nausheen; Blomstedt, Yulia; Nilsson, Maria; Stewart Williams, Jennifer

2016-01-01

To assess dental professionals' understanding of tobacco prevention and control. In Sweden dental hygienists receive training in tobacco prevention and control. The study setting is Västerbotton County in the north of Sweden where a number of successful tobacco control initiatives have been established. A purposeful sample comprising five male and four female dental professionals and trainees was selected. Data were collected through in-depth semi-structured individual interviews and analysed using content analysis. Informants acknowledged limited adherence to tobacco prevention. They were not confident of their knowledge of tobacco and non-communicable disease prevention and had limited awareness of global oral health policies. Reasons for poor adherence included professional fragmentation, lack of training, and the absence of reimbursement for time spent on prevention activities. The success of efforts to reduce smoking in Västerbotton County is attributed to the network of local public health initiatives with very limited involvement by local dental professionals. The findings highlight the need to more actively engage the dental workforce in tobacco control and prevention. Moreover, it is important to recognise that dental professionals can be public health advocates for tobacco control and prevention at global, national and local levels.

Neuroendocrine small cell carcinoma of the uterine cervix.

PubMed

Reig Castillejo, Anna; Membrive Conejo, Ismael; Foro Arnalot, Palmira; Rodríguez de Dios, Nuria; Algara López, Manuel

2010-07-01

Neuroendocrine small cell carcinoma of the uterine cervix (SCC) is a rare disease that mixes clinical and biological characteristics of both cervical neoplasms and neuroendocrine small cell cancer. The prognosis is poor and the optimal treatment has not yet been clarified. Multimodality treatment, with surgery and concurrent chemoradiation has recently been shown to improve local control and survival rates.

The influence of diabetic peripheral neuropathy on local postural muscle and central sensory feedback balance control.

PubMed

Toosizadeh, Nima; Mohler, Jane; Armstrong, David G; Talal, Talal K; Najafi, Bijan

2015-01-01

Poor balance control and increased fall risk have been reported in people with diabetic peripheral neuropathy (DPN). Traditional body sway measures are unable to describe underlying postural control mechanism. In the current study, we used stabilogram diffusion analysis to examine the mechanism under which balance is altered in DPN patients under local-control (postural muscle control) and central-control (postural control using sensory cueing). DPN patients and healthy age-matched adults over 55 years performed two 15-second Romberg balance trials. Center of gravity sway was measured using a motion tracker system based on wearable inertial sensors, and used to derive body sway and local/central control balance parameters. Eighteen DPN patients (age = 65.4±7.6 years; BMI = 29.3±5.3 kg/m2) and 18 age-matched healthy controls (age = 69.8±2.9; BMI = 27.0±4.1 kg/m2) with no major mobility disorder were recruited. The rate of sway within local-control was significantly higher in the DPN group by 49% (healthy local-controlslope = 1.23±1.06×10-2 cm2/sec, P<0.01), which suggests a compromised local-control balance behavior in DPN patients. Unlike local-control, the rate of sway within central-control was 60% smaller in the DPN group (healthy central-controlslope-Log = 0.39±0.23, P<0.02), which suggests an adaptation mechanism to reduce the overall body sway in DPN patients. Interestingly, significant negative correlations were observed between central-control rate of sway with neuropathy severity (rPearson = 0.65-085, P<0.05) and the history of diabetes (rPearson = 0.58-071, P<0.05). Results suggest that in the lack of sensory feedback cueing, DPN participants were highly unstable compared to controls. However, as soon as they perceived the magnitude of sway using sensory feedback, they chose a high rigid postural control strategy, probably due to high concerns for fall, which may increase the energy cost during extended period of standing; the adaptation mechanism using sensory feedback depends on the level of neuropathy and the history of diabetes.

On the effect of local barrier height in scanning tunneling microscopy: Measurement methods and control implications

NASA Astrophysics Data System (ADS)

Tajaddodianfar, Farid; Moheimani, S. O. Reza; Owen, James; Randall, John N.

2018-01-01

A common cause of tip-sample crashes in a Scanning Tunneling Microscope (STM) operating in constant current mode is the poor performance of its feedback control system. We show that there is a direct link between the Local Barrier Height (LBH) and robustness of the feedback control loop. A method known as the "gap modulation method" was proposed in the early STM studies for estimating the LBH. We show that the obtained measurements are affected by controller parameters and propose an alternative method which we prove to produce LBH measurements independent of the controller dynamics. We use the obtained LBH estimation to continuously update the gains of a STM proportional-integral (PI) controller and show that while tuning the PI gains, the closed-loop system tolerates larger variations of LBH without experiencing instability. We report experimental results, conducted on two STM scanners, to establish the efficiency of the proposed PI tuning approach. Improved feedback stability is believed to help in avoiding the tip/sample crash in STMs.

The Timing of Pertussis Cases in Unvaccinated Children in an Outbreak Year: Oregon 2012.

PubMed

Robison, Steve G; Liko, Juventila

2017-04-01

To assess whether, during a 2012 pertussis outbreak, unvaccinated and poorly vaccinated cases occurred earlier on a community level. Pediatric pertussis among children 2 months to 10 years of age in the Oregon Sentinel Surveillance region during an epidemic starting at the beginning of 2012 were stratified by immunization status, age, zip code, and calendar date of disease onset. Differences in median onset as days between fully or mostly vaccinated, poorly vaccinated, and unvaccinated cases were examined overall and within local zip code areas. Disease clusters also were examined using SatScan analysis. Overall, 351 pertussis cases occurred among children aged 2 months to 10 years of age residing in 72 distinct zipcodes. Among unvaccinated or poorly vaccinated cases, their median date of onset was at calendar day 117 (April 26, 2012), whereas for those who were fully or mostly vaccinated the median date of onset was 41 days later, at day 158 (June 6, 2012). Within each local zip code area, the unvaccinated cases were 3.2 times more likely than vaccinated cases to have earlier median dates of onset (95% CI 2.9-3.6). In this outbreak, pertussis cases among unvaccinated children represented an earlier spread of disease across local areas. Controlling outbreaks may require attention to the composition and location of the unvaccinated. Copyright © 2016 Elsevier Inc. All rights reserved.

The time frame of Epstein-Barr virus latent membrane protein-1 gene to disappear in nasopharyngeal swabs after initiation of primary radiotherapy is an independently significant prognostic factor predicting local control for patients with nasopharyngeal carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, S.-Y.; Chang, K.-P.; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Linkou, Taiwan

Purpose: The presence of Epstein-Barr virus latent membrane protein-1 (LMP-1) gene in nasopharyngeal swabs indicates the presence of nasopharyngeal carcinoma (NPC) mucosal tumor cells. This study was undertaken to investigate whether the time taken for LMP-1 to disappear after initiation of primary radiotherapy (RT) was inversely associated with NPC local control. Methods and Materials: During July 1999 and October 2002, there were 127 nondisseminated NPC patients receiving serial examinations of nasopharyngeal swabbing with detection of LMP-1 during the RT course. The time for LMP-1 regression was defined as the number of days after initiation of RT for LMP-1 results tomore » turn negative. The primary outcome was local control, which was represented by freedom from local recurrence. Results: The time for LMP-1 regression showed a statistically significant influence on NPC local control both univariately (p < 0.0001) and multivariately (p = 0.004). In multivariate analysis, the administration of chemotherapy conferred a significantly more favorable local control (p = 0.03). Advanced T status ({>=} T2b), overall treatment time of external photon radiotherapy longer than 55 days, and older age showed trends toward being poor prognosticators. The time for LMP-1 regression was very heterogeneous. According to the quartiles of the time for LMP-1 regression, we defined the pattern of LMP-1 regression as late regression if it required 40 days or more. Kaplan-Meier plots indicated that the patients with late regression had a significantly worse local control than those with intermediate or early regression (p 0.0129). Conclusion: Among the potential prognostic factors examined in this study, the time for LMP-1 regression was the most independently significant factor that was inversely associated with NPC local control.« less

Poorly controlled postoperative pain: prevalence, consequences, and prevention

PubMed Central

Gan, Tong J

2017-01-01

This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs. In addition, the presence and intensity of acute pain during or after surgery is predictive of the development of chronic pain. More effective analgesic/anesthetic measures in the perioperative period are needed to prevent the progression to persistent pain. Although clinical findings are inconsistent, some studies of local anesthetics and nonopioid analgesics have suggested potential benefits as preventive interventions. Conventional opioids remain the standard of care for the management of acute postoperative pain; however, the risk of opioid-related adverse events can limit optimal dosing for analgesia, leading to poorly controlled acute postoperative pain. Several new opioids have been developed that modulate μ-receptor activity by selectively engaging intracellular pathways associated with analgesia and not those associated with adverse events, creating a wider therapeutic window than unselective conventional opioids. In clinical studies, oliceridine (TRV130), a novel μ-receptor G-protein pathway-selective modulator, produced rapid postoperative analgesia with reduced prevalence of adverse events versus morphine. PMID:29026331

Poorly controlled postoperative pain: prevalence, consequences, and prevention.

PubMed

Gan, Tong J

2017-01-01

This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs. In addition, the presence and intensity of acute pain during or after surgery is predictive of the development of chronic pain. More effective analgesic/anesthetic measures in the perioperative period are needed to prevent the progression to persistent pain. Although clinical findings are inconsistent, some studies of local anesthetics and nonopioid analgesics have suggested potential benefits as preventive interventions. Conventional opioids remain the standard of care for the management of acute postoperative pain; however, the risk of opioid-related adverse events can limit optimal dosing for analgesia, leading to poorly controlled acute postoperative pain. Several new opioids have been developed that modulate μ-receptor activity by selectively engaging intracellular pathways associated with analgesia and not those associated with adverse events, creating a wider therapeutic window than unselective conventional opioids. In clinical studies, oliceridine (TRV130), a novel μ-receptor G-protein pathway-selective modulator, produced rapid postoperative analgesia with reduced prevalence of adverse events versus morphine.

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia.

PubMed

Abera, Bayeh; Kibret, Mulugeta; Mulu, Wondemagegn

2014-05-19

Antimicrobial resistance (AMR) is a major global public health problem both in hospital and community acquired infections. The present study assessed the knowledge and beliefs on AMR among physicians and nurses in 13 hospitals in Amhara region, Ethiopia, which is a low-income country. A cross-sectional study using a self-administered questionnaire was applied. A total of 385 participants (175 physicians and 210 nurses) took part in the study. Sixty five percent of physicians and 98% of nurses replied that they need training on antimicrobial stewardship. Only 48% of physicians and 22.8% of nurses had exposures for local antibiogram data. Overall, 278 (72.2%) of participants were knowledgeable about AMR. Majority of participants agreed or strongly agreed AMR as worldwide and national problem but few considered AMR as problem in their own hospitals. The two most important factors mentioned for AMR development were patients' poor adherence to prescribed antimicrobials (86%) and overuse of antibiotics (80.5%). The most leading local factors identified for AMR development were: self-antibiotic prescription (53.5%), lack of access to local antibiogram data (12.3%) and prescriber poor awareness about AMR (9.2%). Factors perceived for excessive antibiotic prescriptions were: patient drive (56%), treatment failure (79%), unknown febrile illnesses (39.7%) and upper respiratory tract infections (33.4%). Majority of physicians and nurses lack up to-date knowledge on AMR. Unavailability of local antibiogram data, self-prescription by patients and poor awareness on AMR are areas of interventions for prevention and control of AMR.

Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder.

PubMed

Aleem, Alexander W; Syed, Usman Ali M; Nicholson, Thema; Getz, Charles L; Namdari, Surena; Beredjiklian, Pedro K; Abboud, Joseph A

2017-09-01

Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of <7% had an average rise in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection ( P <0.001). Well-controlled patients' glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients ( P <0.001). After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.

A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial.

PubMed

Battersby, Nick J; Dattani, Mit; Rao, Sheela; Cunningham, David; Tait, Diana; Adams, Richard; Moran, Brendan J; Khakoo, Shelize; Tekkis, Paris; Rasheed, Shahnawaz; Mirnezami, Alex; Quirke, Philip; West, Nicholas P; Nagtegaal, Iris; Chong, Irene; Sadanandam, Anguraj; Valeri, Nicola; Thomas, Karen; Frost, Michelle; Brown, Gina

2017-08-29

Pre-operative chemoradiotherapy (CRT) for MRI-defined, locally advanced rectal cancer is primarily intended to reduce local recurrence rates by downstaging tumours, enabling an improved likelihood of curative resection. However, in a subset of patients complete tumour regression occurs implying that no viable tumour is present within the surgical specimen. This raises the possibility that surgery may have been avoided. It is also recognised that response to CRT is a key determinant of prognosis. Recent radiological advances enable this response to be assessed pre-operatively using the MRI tumour regression grade (mrTRG). Potentially, this allows modification of the baseline MRI-derived treatment strategy. Hence, in a 'good' mrTRG responder, with little or no evidence of tumour, surgery may be deferred. Conversely, a 'poor response' identifies an adverse prognostic group which may benefit from additional pre-operative therapy. TRIGGER is a multicentre, open, interventional, randomised control feasibility study with an embedded phase III design. Patients with MRI-defined, locally advanced rectal adenocarcinoma deemed to require CRT will be eligible for recruitment. During CRT, patients will be randomised (1:2) between conventional management, according to baseline MRI, versus mrTRG-directed management. The primary endpoint of the feasibility phase is to assess the rate of patient recruitment and randomisation. Secondary endpoints include the rate of unit recruitment, acute drug toxicity, reproducibility of mrTRG reporting, surgical morbidity, pathological circumferential resection margin involvement, pathology regression grade, residual tumour cell density and surgical/specimen quality rates. The phase III trial will focus on long-term safety, regrowth rates, oncological survival analysis, quality of life and health economics analysis. The TRIGGER trial aims to determine whether patients with locally advanced rectal cancer can be recruited and subsequently randomised into a control trial that offers MRI-directed patient management according to radiological response to CRT (mrTRG). The feasibility study will inform a phase III trial design investigating stratified treatment of good and poor responders according to 3-year disease-free survival, colostomy-free survival as well as an increase in cases managed without a major resection. ClinicalTrials.gov, ID: NCT02704520 . Registered on 5 February 2016.

Primary Education for All in the City of Mumbai, India: The Challenge Set by Local Actors. School Mapping and Local-Level Planning.

ERIC Educational Resources Information Center

Juneja, Nalini

This book discusses primary education of the poor in the city of Mumbai, India. It focuses on the city of Mumbai itself and the poor who live in it, answering questions such as What makes the city the way it is? What does it mean to be poor in Mumbai? and How does the poverty of the poor in Mumbai affect their chances of receiving a basic…

Localization of an Underwater Control Network Based on Quasi-Stable Adjustment.

PubMed

Zhao, Jianhu; Chen, Xinhua; Zhang, Hongmei; Feng, Jie

2018-03-23

There exists a common problem in the localization of underwater control networks that the precision of the absolute coordinates of known points obtained by marine absolute measurement is poor, and it seriously affects the precision of the whole network in traditional constraint adjustment. Therefore, considering that the precision of underwater baselines is good, we use it to carry out quasi-stable adjustment to amend known points before constraint adjustment so that the points fit the network shape better. In addition, we add unconstrained adjustment for quality control of underwater baselines, the observations of quasi-stable adjustment and constrained adjustment, to eliminate the unqualified baselines and improve the results' accuracy of the two adjustments. Finally, the modified method is applied to a practical LBL (Long Baseline) experiment and obtains a mean point location precision of 0.08 m, which improves by 38% compared with the traditional method.

Localization of an Underwater Control Network Based on Quasi-Stable Adjustment

PubMed Central

Chen, Xinhua; Zhang, Hongmei; Feng, Jie

2018-01-01

There exists a common problem in the localization of underwater control networks that the precision of the absolute coordinates of known points obtained by marine absolute measurement is poor, and it seriously affects the precision of the whole network in traditional constraint adjustment. Therefore, considering that the precision of underwater baselines is good, we use it to carry out quasi-stable adjustment to amend known points before constraint adjustment so that the points fit the network shape better. In addition, we add unconstrained adjustment for quality control of underwater baselines, the observations of quasi-stable adjustment and constrained adjustment, to eliminate the unqualified baselines and improve the results’ accuracy of the two adjustments. Finally, the modified method is applied to a practical LBL (Long Baseline) experiment and obtains a mean point location precision of 0.08 m, which improves by 38% compared with the traditional method. PMID:29570627

Radiotherapy on hidradenocarcinoma.

PubMed

Lalya, Issam; Hadadi, Khalid; Tazi, El Mehdi; Lalya, Ilham; Bazine, Amine; Andaloussy, Khalid; Elmarjany, Mohamed; Sifat, Hassan; Hassouni, Khalid; Kebdani, Tayeb; Mansouri, Hamid; Benjaafar, Noureddine; Elgueddari, Brahim Khalil

2011-01-01

Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment. We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity. POST OPERATIVE RADIOTHERAPY ALLOWS BETTER LOCAL CONTROL AND SHOULD BE MANDATORY WHEN HISTOLOGICAL FEATURES PREDICTIVE OF RECURRENCE ARE PRESENT: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread.

The Top 10 Energy Wasters in K-12 Facilities (and What to Do about Them)

ERIC Educational Resources Information Center

Leathers, Dave

2010-01-01

Every year, K-12 facilities waste millions of dollars in excess energy consumption. Those dollars may take the form of lost heat through walls, windows, doors, and roofs. Or the villain may be poorly conceived or mismanaged control systems. Those excess funds that districts are sending to the local utility companies could be invested "at home" to…

Systematic Review and Meta-Analysis of Objective and Subjective Quality of Life among Pediatric, Adolescent, and Young Adult Bone Tumor Survivors

PubMed Central

Stokke, Jamie; Sung, Lillian; Gupta, Abha; Lindberg, Antoinette; Rosenberg, Abby R.

2015-01-01

Background Pediatric, adolescent and young adult (AYA) survivors of bone sarcomas are at risk for poor quality of life (QOL). We conducted a systematic review and meta-analysis to summarize the literature describing QOL in this population and differences in QOL based on local control procedures. Procedure Included studies described ≥5 patients <25 years-old who had completed local control treatment for bone sarcoma, defined QOL as a main outcome, and measured it with a validated instrument. Data extraction and quality assessments were conducted with standardized tools. Meta-analyses compared QOL based on surgical procedure (limb-sparing versus amputation) and were stratified by assessment type (objective physical function, clinician-assessed disability, patient-reported disability and patient-reported QOL). Effect sizes were reported as the Standard Mean Difference when multiple instruments were used within a comparison and Weighted Mean Difference otherwise. All were weighted by inverse variance and modeled with random effects. Results Twenty-two of 452 unique manuscripts were included in qualitative syntheses, 8 of which were included in meta-analyses. Manuscripts were heterogeneous with respect to included patient populations (age, tumor type, time since treatment) and QOL instruments. Prospective studies suggested that QOL improves over time, and that female sex and older age at diagnosis are associated with poor QOL. Meta-analyses showed no differences in outcomes between patients who underwent limb-sparing versus amputation for local control. Conclusion QOL studies among children and AYAs with bone sarcoma are remarkably diverse, making it difficult to detect trends in patient outcomes. Future research should focus on standardized QOL instruments and interpretations. PMID:25820683

Localized sinonasal mucosal melanoma: Outcomes and associations with stage, radiotherapy, and positron emission tomography response.

PubMed

Samstein, Robert M; Carvajal, Richard D; Postow, Michael A; Callahan, Margaret K; Shoushtari, Alexander N; Patel, Snehal G; Lee, Nancy Y; Barker, Christopher A

2016-09-01

Sinonasal mucosal melanoma is a rare neoplasm with a poor prognosis. Retrospective analysis was conducted on 78 patients with localized sinonasal mucosal melanoma treated at Memorial Sloan Kettering Cancer Center (MSKCC from 1998-2013). Demographic, tumor, imaging, and treatment factors were recorded and survival and disease-control outcomes were analyzed. Median overall survival (OS) and disease-specific survival (DSS) were 32 and 50 months, respectively. Median locoregional recurrence-free survival (LRFS) and distant recurrence-free survival (DRFS) were 43 and 12 months, respectively. Multivariate analysis demonstrated greater OS in nasal cavity tumors and earlier T classification. Radiotherapy (RT) was associated with significantly greater LRFS (5-years; 35% vs 59%; p = .01), but no difference in OS. Post-RT positron emission tomography (PET) response was associated with greater OS. Distant metastasis is the predominant mode of recurrence in sinonasal mucosal melanoma, but local recurrence remains common. RT is associated with improved local control, but no survival benefit. The prognostic value of post-RT PET imaging warrants further investigation. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1310-1317, 2016. © 2016 Wiley Periodicals, Inc.

Institutions, incentives and the future of fisheries

PubMed Central

Hilborn, Ray; Orensanz, J. M. (Lobo); Parma, Ana M.

2005-01-01

Fisheries around the world are managed with a broad range of institutional structures. Some of these have been quite disastrous, whereas others have proven both biologically and economically successful. Unsuccessful systems have generally involved either open access, attempts at top-down control with poor ability to monitor and implement regulations, or reliance on consensus. Successful systems range from local cooperatives to strong governmental control, to various forms of property rights, but usually involve institutional systems that provide incentives to individual operators that lead to behaviour consistent with conservation. PMID:15744918

Caregiver's depressive symptoms and asthma control in children from an underserved community.

PubMed

Rioseco, Andrea; Serrano, Carolina; Celedón, Juan C; Padilla, Oslando; Puschel, Klaus; Castro-Rodriguez, Jose A

2017-12-01

Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] <20 points) and controls were children with adequate asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01). Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

Bleeding control in endoscopic sinus surgery: a systematic review of the literature.

PubMed

Rodriguez Valiente, A; Roldan Fidalgo, A; Laguna Ortega, D

2013-12-01

In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of β-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.

Sound localization and word discrimination in reverberant environment in children with developmental dyslexia.

PubMed

Castro-Camacho, Wendy; Peñaloza-López, Yolanda; Pérez-Ruiz, Santiago J; García-Pedroza, Felipe; Padilla-Ortiz, Ana L; Poblano, Adrián; Villarruel-Rivas, Concepción; Romero-Díaz, Alfredo; Careaga-Olvera, Aidé

2015-04-01

Compare if localization of sounds and words discrimination in reverberant environment is different between children with dyslexia and controls. We studied 30 children with dyslexia and 30 controls. Sound and word localization and discrimination was studied in five angles from left to right auditory fields (-90o, -45o, 0o, +45o, +90o), under reverberant and no-reverberant conditions; correct answers were compared. Spatial location of words in no-reverberant test was deficient in children with dyslexia at 0º and +90o. Spatial location for reverberant test was altered in children with dyslexia at all angles, except –-90o. Word discrimination in no-reverberant test in children with dyslexia had a poor performance at left angles. In reverberant test, children with dyslexia exhibited deficiencies at -45o, -90o, and +45o angles. Children with dyslexia could had problems when have to locate sound, and discriminate words in extreme locations of the horizontal plane in classrooms with reverberation.

An acute bout of localized resistance exercise can rapidly improve inhibitory control

PubMed Central

Tsukamoto, Hayato; Suga, Tadashi; Takenaka, Saki; Takeuchi, Tatsuya; Tanaka, Daichi; Hamaoka, Takafumi; Hashimoto, Takeshi; Isaka, Tadao

2017-01-01

The positive effect of acute resistance exercise on executive function, such as inhibitory control (IC), is poorly understood. Several previous studies have demonstrated this effect using whole-body resistance exercise. However, it remains unclear whether localized resistance exercise performed using only limited muscle groups could also acutely improve IC. Thus, the present study examined the effect of an acute bout of localized resistance exercise on IC. Twelve healthy men performed a color-word Stroop task (CWST) before and immediately after the experimental conditions, which consisted of 2 resistance exercises and a resting control (CON). Bilateral knee extension was used to create 2 resistance exercise conditions: light-intensity resistance exercise (LRE) and high-intensity resistance exercise (HRE) conditions, which were 40% and 80% of one-repetition maximum, respectively. The resistance exercise session was programmed for 6 sets with 10 repetitions per set. The CWST-measured IC was significantly improved immediately after both LRE and HRE, but it did not improve immediately after CON. However, the improved IC was significantly greater in HRE than in LRE. The present findings showed that IC could be rapidly improved by an acute bout of localized resistance exercise, especially with high-intensity. Therefore, we suggest that in addition to whole-body resistance exercise, localized resistance exercise performed using limited muscle groups may be sufficient for improving IC. PMID:28877232

Effect of Midtreatment PET/CT-Adapted Radiation Therapy With Concurrent Chemotherapy in Patients With Locally Advanced Non–Small-Cell Lung Cancer

PubMed Central

Kong, Feng-Ming; Ten Haken, Randall K.; Schipper, Matthew; Frey, Kirk A.; Hayman, James; Gross, Milton; Ramnath, Nithya; Hassan, Khaled A.; Matuszak, Martha; Ritter, Timothy; Bi, Nan; Wang, Weili; Orringer, Mark; Cease, Kemp B.; Lawrence, Theodore S.; Kalemkerian, Gregory P.

2017-01-01

IMPORTANCE Our previous studies demonstrated that tumors significantly decrease in size and metabolic activity after delivery of 45 Gy of fractionated radiatiotherapy (RT), and that metabolic shrinkage is greater than anatomic shrinkage. This study aimed to determine whether 18F-fludeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) acquired during the course of treatment provides an opportunity to deliver higher-dose radiation to the more aggressive areas of the tumor to improve local tumor control without increasing RT-induced lung toxicity (RILT), and possibly improve survival. OBJECTIVE To determine whether adaptive RT can target high-dose radiation to the FDG-avid tumor on midtreatment FDG-PET to improve local tumor control of locally advanced non–small-cell lung cancer (NSCLC). DESIGN, SETTING, AND PARTICIPANTS A phase 2 clinical trial conducted at 2 academic medical centers with 42 patients who had inoperable or unresectable stage II to stage III NSCLC enrolled from November 2008, to May 2012. Patients with poor performance, more than 10% weight loss, poor lung function, and/or oxygen dependence were included, providing that the patients could tolerate the procedures of PET scanning and RT. INTERVENTION Conformal RT was individualized to a fixed risk of RILT (grade >2) and adaptively escalated to the residual tumor defined on midtreatment FDG-PET up to a total dose of 86 Gy in 30 daily fractions. Medically fit patients received concurrent weekly carboplatin plus paclitaxel followed by 3 cycles of consolidation. MAIN OUTCOMES AND MEASURES The primary end point was local tumor control. The trial was designed to achieve a 20% improvement in 2-year control from 34% of our prior clinical trial experience with 63 to 69 Gy in a similar patient population. RESULTS The trial reached its accrual goal of 42 patients: median age, 63 years (range, 45–83 years); male, 28 (67%); smoker or former smoker, 39 (93%); stage III, 38 (90%). Median tumor dose delivered was 83 Gy (range, 63–86 Gy) in 30 daily fractions. Median follow-up for surviving patients was 47 months. The 2-year rates of infield and overall local regional tumor controls (ie, including isolated nodal failure) were 82% (95% CI, 62%–92%) and 62% (95% CI, 43%–77%), respectively. Median overall survival was 25 months (95% CI, 12–32 months). The 2-year and 5-year overall survival rates were 52% (95% CI, 36%–66%) and 30% (95% CI, 16%–45%), respectively. CONCLUSIONS AND RELEVANCE Adapting RT-escalated radiation dose to the FDG-avid tumor detected by midtreatment PET provided a favorable local-regional tumor control. The RTOG 1106 trial is an ongoing clinical trial to validate this finding in a randomized fashion. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01190527 PMID:28570742

The Enhancement of Bone Allograft Incorporation by the Local Delivery of the Sphingosine 1-phosphate Receptor Targeted Drug FTY720

PubMed Central

Aronin, Caren E Petrie; Shin, Soo J; Naden, Kimberly B; Rios, Peter D; Sefcik, Lauren S; Zawodny, Sarah R; Bagayoko, Namory D; Cui, Quanjun; Khan, Yusuf

2010-01-01

Poor vascularization coupled with mechanical instability is the leading cause of post-operative complications and poor functional prognosis of massive bone allografts. To address this limitation, we designed a novel continuous polymer coating system to provide sustained localized delivery of pharmacological agent, FTY720, a selective agonist for sphingosine 1-phosphate receptors, within massive tibial defects. In vitro drug release studies validated 64% loading efficiency with complete release of compound following 14 days. Mechanical evaluation following six weeks of healing suggested significant enhancement of mechanical stability in FTY720 treatment groups compared with unloaded controls. Furthermore, superior osseous integration across the host-graft interface, significant enhancement in smooth muscle cell investment, and reduction in leukocyte recruitment was evident in FTY720 treated groups compared with untreated groups. Using this approach, we can capitalize on the existing mechanical and biomaterial properties of devitalized bone, add a controllable delivery system while maintaining overall porous structure, and deliver a small molecule compound to constitutively target vascular remodeling, osseous remodeling, and minimize fibrous encapsulation within the allograft-host bone interface. Such results support continued evaluation of drug-eluting allografts as a viable strategy to improve functional outcome and long-term success of massive cortical allograft implants. PMID:20621764

A community-driven hypertension treatment group in rural Honduras.

PubMed

Reiger, Sheridan; Harris, Jeffrey R; Chan, Kwun Chuen Gary; Oqueli, Hector Lopez; Kohn, Marlana

2015-01-01

We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control. This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings. Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols. Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension treatment services provided by the public system.

A community-driven hypertension treatment group in rural Honduras

PubMed Central

Reiger, Sheridan; Harris, Jeffrey R.; Chan, Kwun Chuen Gary; Oqueli, Hector Lopez; Kohn, Marlana

2015-01-01

Background We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control. Design This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings. Results Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols. Conclusions Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension treatment services provided by the public system. PMID:26362420

The Road not Taken: Less Traveled Roads from the TGN to the Plasma Membrane

PubMed Central

Spang, Anne

2015-01-01

The trans-Golgi network functions in the distribution of cargo into different transport vesicles that are destined to endosomes, lysosomes and the plasma membrane. Over the years, it has become clear that more than one transport pathway promotes plasma membrane localization of proteins. In spite of the importance of temporal and spatial control of protein localization at the plasma membrane, the regulation of sorting into and the formation of different transport containers are still poorly understood. In this review different transport pathways, with a special emphasis on exomer-dependent transport, and concepts of regulation and sorting at the TGN are discussed. PMID:25764365

Lignocaine ointment and local anaesthesia in preterm infants.

PubMed Central

Barker, D. P.; Rutter, N.

1995-01-01

The ability of topically applied lignocaine ointment to produce surface anaesthesia was examined in 45 preterm infants (gestational age 25 to 35 weeks) at a median age of 2 days. Two strengths of ointment, 5% and 30%, were tested at 30 and 60 minutes after application to the dorsum of the foot. Anaesthesia was assessed by comparing the response to skin stimulation at the test and control sites, using von Frey hairs. In 84% of cases responses indicated that there was no surface anaesthesia. Topically applied lignocaine ointment is not an effective local anaesthetic in preterm infants, presumably due to poor absorption. PMID:7796241

The Road not Taken: Less Traveled Roads from the TGN to the Plasma Membrane.

PubMed

Spang, Anne

2015-03-10

The trans-Golgi network functions in the distribution of cargo into different transport vesicles that are destined to endosomes, lysosomes and the plasma membrane. Over the years, it has become clear that more than one transport pathway promotes plasma membrane localization of proteins. In spite of the importance of temporal and spatial control of protein localization at the plasma membrane, the regulation of sorting into and the formation of different transport containers are still poorly understood. In this review different transport pathways, with a special emphasis on exomer-dependent transport, and concepts of regulation and sorting at the TGN are discussed.

The puzzle of Buruli ulcer transmission, ethno-ecological history and the end of "love" in the Akonolinga district, Cameroon.

PubMed

Giles-Vernick, Tamara; Owona-Ntsama, Joseph; Landier, Jordi; Eyangoh, Sara

2015-03-01

The "One World One Health Initiative" has attended little to the priorities, concepts and practices of resource-poor communities confronting disease and the implications of these concerns for its biomedical, ecological and institutional approach to disease surveillance and control. Using the example of Buruli ulcer (BU) and its bacterial etiology, Mycobacterium ulcerans, in south-central Cameroon, we build on debates about the contributions of "local knowledge" and "alternative models" to biomedical knowledge of disease transmission. BU's mode of transmission remains poorly understood. Our approach employs ethno-ecological histories - local understandings of the putative emergence and expansion of a locally important, neglected disease. We develop these histories from 52 individual and small group interviews, group discussions, and participant-observation of daily and seasonal activities, conducted in 2013-2013. These histories offer important clues about past environmental and social change that should guide further ecological, epidemiological research. They highlight a key historical moment (the late 1980s and 1990s); specific ecological transformations; new cultivation practices in unexploited zones that potentially increased exposure to M. ulcerans; and ecological degradation that may have lowered nutritional standards and heightened susceptibility to BU. They also recast transmission, broadening insight into BU and its local analog, atom, by emphasizing the role of social change and economic crisis in its emergence and expansion. Copyright © 2014 Elsevier Ltd. All rights reserved.

Do Strict Land Use Regulations Make Metropolitan Areas More Segregated by Income?

PubMed Central

Lens, Michael C.; Monkkonen, Paavo

2018-01-01

Problem, research strategy, and findings Income segregation has risen in each of the last four decades in U.S. metropolitan areas, which can have lifelong impacts on the health, economic productivity, and behaviors of residents. Although it is widely assumed that local land use regulations—such as minimum lot sizes and growth controls—exclude low-income households from wealthier neighborhoods, the empirical research is surprisingly limited. We examine the relationship between land use regulation and segregation by income using new measures for the 95 biggest cities in the United States. We find that density restrictions are associated with the segregation of the wealthy and middle income, but not the poor. We also find that more local pressure to regulate land use is linked to higher rates of income segregation, but that more state control is connected to lower-income segregation. Takeaway for practice Density restrictions do drive urban income segregation of the rich, not the poor, but should be addressed because rich enclaves create significant metropolitan problems. Planners at the local level need assistance from regional and state efforts to ameliorate income segregation. Inclusionary housing requirements have a greater potential to reduce income segregation than bringing higher-income households into lower-income parts of the city. Finally, comprehensive and consistent data on the impacts of local land use regulations should be collected to inform future research and planning practice. PMID:29422701

Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?

PubMed

Thiam, Sylla; Delamou, Alexandre; Camara, Soriba; Carter, Jane; Lama, Eugene Kaman; Ndiaye, Bara; Nyagero, Josephat; Nduba, John; Ngom, Mor

2015-01-01

The Ebola outbreak emerged in a remote corner of Guinea in December 2013, and spread into Liberia and Sierra Leone in the context of weak health systems. In this paper, we report on the main challenges faced by frontline health services and by communities including their perceptions and views on the current Ebola response in the Prefectures of Coyah and Forecariah in Guinea. A cross-sectional study was conducted in December 2014 using mixed approaches: (i) Desk review; (ii) Interviews; and (iii) Direct observation. Almost one year after the beginning of the Ebola virus disease outbreak in West Africa, the perceptions of stakeholders and the observed reality were that the level of preparedness in the two health districts was low. The study identified poor coordination mechanisms, inadequate training of human resources and lack of equipment and supplies to field teams and health facilities as key elements that affected the response. The situation was worsened by the inadequate communication strategy, misconceptions around the disease, ignorance of local culture and customs and lack of involvement of local communities in the control strategies, within the context of poor socioeconomic development. As a result distrust developed between communities and those seeking to control the epidemic and largely contributed to the reluctance of the communities to participate and contribute to the effort. There is a need to rethink the way disease control interventions in the context of an emergency such as Ebola virus disease are designed, planned and implemented in low income countries.

Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?

PubMed Central

Thiam, Sylla; Delamou, Alexandre; Camara, Soriba; Carter, Jane; Lama, Eugene Kaman; Ndiaye, Bara; Nyagero, Josephat; Nduba, John; Ngom, Mor

2015-01-01

Introduction The Ebola outbreak emerged in a remote corner of Guinea in December 2013, and spread into Liberia and Sierra Leone in the context of weak health systems. In this paper, we report on the main challenges faced by frontline health services and by communities including their perceptions and views on the current Ebola response in the Prefectures of Coyah and Forecariah in Guinea. Methods A cross-sectional study was conducted in December 2014 using mixed approaches: (i) Desk review; (ii) Interviews; and (iii) Direct observation. Results Almost one year after the beginning of the Ebola virus disease outbreak in West Africa, the perceptions of stakeholders and the observed reality were that the level of preparedness in the two health districts was low. The study identified poor coordination mechanisms, inadequate training of human resources and lack of equipment and supplies to field teams and health facilities as key elements that affected the response. The situation was worsened by the inadequate communication strategy, misconceptions around the disease, ignorance of local culture and customs and lack of involvement of local communities in the control strategies, within the context of poor socioeconomic development. As a result distrust developed between communities and those seeking to control the epidemic and largely contributed to the reluctance of the communities to participate and contribute to the effort. Conclusion There is a need to rethink the way disease control interventions in the context of an emergency such as Ebola virus disease are designed, planned and implemented in low income countries. PMID:26740850

Radiotherapy on hidradenocarcinoma

PubMed Central

Lalya, Issam; Hadadi, Khalid; Tazi, El Mehdi; Lalya, Ilham; Bazine, Amine; Andaloussy, Khalid; Elmarjany, Mohamed; Sifat, Hassan; Hassouni, Khalid; Kebdani, Tayeb; Mansouri, Hamid; Benjaafar, Noureddine; Elgueddari, Brahim Khalil

2011-01-01

Context: Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment. Case Report: We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity. Conclusion: Post operative radiotherapy allows better local control and should be mandatory when histological features predictive of recurrence are present: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread. PMID:22540063

Phase 2 Study of Concurrent Cetuximab Plus Definitive Thoracic Radiation Therapy Followed by Consolidation Docetaxel Plus Cetuximab in Poor Prognosis or Elderly Patients With Locally Advanced Non-Small Cell Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dilling, Thomas J.; Extermann, Martine; Kim, Jongphil

Background: Recursive partitioning analysis has shown that Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≥2, male sex, and age ≥70 years are prognostic of poor outcome in locally advanced non-small cell lung cancer (LA-NSCLC) patients. Concurrent chemoradiation therapy (CRT) improves survival, but toxicity is a concern in this frail patient cohort. We therefore opened this trial of concurrent definitive thoracic radiation therapy (XRT) and cetuximab, followed by consolidation docetaxel plus cetuximab. Methods and Materials: Eligible patients had pathologically proven, unresectable LA-NSCLC (stage IIA-“dry” IIIB). They had ECOG PS 2 or weight loss ≥5% in 3 months or were aged ≥70 years. Themore » primary objective was progression-free survival (PFS). Secondary objectives included overall survival (OS) and overall response rate (ORR). Results: From May 2008 to November 2010, a total of 32 patients were evaluated in our single-institution, institutional review board–approved prospective clinical trial. Three patients were screen failures and 2 more withdrew consent before treatment, leaving 27 evaluable patients. One was removed because of poor therapy compliance, and 2 were taken off trial because of grade 3 cetuximab-related toxicities but were followed up under intent-to-treat analysis. The median follow-up and OS were 10.5 months. The median PFS was 7.5 months. The ORR was 59.3%. Eight early/sudden deaths were reported. Upon review, 6 patients developed severe pulmonary complications. Conclusions: Patients enrolled in this trial had improved OS compared with poor-PS historical controls (10.5 vs 6.4 months) and comparable OS to good-PS historical controls (10.5 vs 11.9 months) treated with XRT alone. However, pulmonary toxicity is a concern. Consolidative cetuximab/docetaxel, in conjunction with high-dose radiation therapy, is a putative cause.« less

Isolated molecular dopants in pentacene observed by scanning tunneling microscopy

NASA Astrophysics Data System (ADS)

Ha, Sieu D.; Kahn, Antoine

2009-11-01

Doping is essential to the control of electronic structure and conductivity of semiconductor materials. Whereas doping of inorganic semiconductors is well established, doping of organic molecular semiconductors is still relatively poorly understood. Using scanning tunneling microscopy, we investigate, at the molecular scale, surface and subsurface tetrafluoro-tetracyanoquinodimethane p -dopants in the prototypical molecular semiconductor pentacene. Surface dopants diffuse to pentacene vacancies and appear as negatively charged centers, consistent with the standard picture of an ionized acceptor. Subsurface dopants, however, have the effect of a positive charge, evidence that the donated hole is localized by the parent acceptor counterion, in contrast to the model of doping in inorganic semiconductors. Scanning tunneling spectroscopy shows that the electron potential energy is locally lowered near a subsurface dopant feature, in agreement with the localized hole model.

Mandated empowerment: handing antipoverty policy back to the poor?

PubMed

Banerjee, Abhijit V; Duflo, Esther

2008-01-01

The current trend in antipoverty policy emphasizes mandated empowerment: the poor are being handed the responsibility for making things better for themselves, largely without being asked whether this is what they want. Beneficiary control is now being built into public service delivery, while microcredit and small business promotion are seen as better ways to help the poor. The clear presumption is that the poor are both able and happy to exercise these new powers. This essay uses two examples to raise questions about these strategies. The first example is about entrepreneurship among the poor. Using data from a number of countries, we argue that there is no evidence that the median poor entrepreneur is trying his best to expand his existing businesses, even if we take into account the many constraints he faces. While many poor people own businesses, this seems to be more a survival strategy than something they want to do. The second example comes from an evaluation of a program in India that aims to involve poor rural parents in improving local public schools. The data suggest that despite being informed that they now have both the right to intervene in the school and access to funds for that purpose, and despite being made aware of how little the children were learning, parents opt to not get involved. Both examples raise concerns about committing ourselves entirely to antipoverty strategies that rely on the poor doing a lot of the work.

A strong control of the South American SeeSaw on the intra-seasonal variability of the isotopic composition of precipitation in the Bolivian Andes

NASA Astrophysics Data System (ADS)

Vimeux, Françoise; Tremoy, Guillaume; Risi, Camille; Gallaire, Robert

2011-07-01

Water stable isotopes (δ) in tropical regions are a valuable tool to study both convective processes and climate variability provided that local and remote controls on δ are well known. Here, we examine the intra-seasonal variability of the event-based isotopic composition of precipitation (δD Zongo) in the Bolivian Andes (Zongo valley, 16°20'S-67°47'W) from September 1st, 1999 to August 31st, 2000. We show that the local amount effect is a very poor parameter to explain δD Zongo. We thus explore the property of water isotopes to integrate both temporal and spatial convective activities. We first show that the local convective activity averaged over the 7-8 days preceding the rainy event is an important control on δD Zongo during the rainy season (~ 40% of the δD Zongo variability is captured). This could be explained by the progressive depletion of local water vapor by unsaturated downdrafts of convective systems. The exploration of remote convective controls on δD Zongo shows a strong influence of the South American SeeSaw (SASS) which is the first climate mode controlling the precipitation variability in tropical South America during austral summer. Our study clearly evidences that temporal and spatial controls are not fully independent as the 7-day averaged convection in the Zongo valley responds to the SASS. Our results are finally used to evaluate a water isotope enabled atmospheric general circulation model (LMDZ-iso), using the stretched grid functionality to run zoomed simulations over the entire South American continent (15°N-55°S; 30°-85°W). We find that zoomed simulations capture the intra-seasonal isotopic variation and its controls, though with an overestimated local sensitivity, and confirm the role of a remote control on δ according to a SASS-like dipolar structure.

Minority and poor households: patterns of travel and transportation fuel use

DOE Office of Scientific and Technical Information (OSTI.GOV)

Millar, M.; Morrison, R.; Vyas, A.

1986-05-01

This report documents the travel behavior and transportation fuel use of minority and poor households in the US, using information from numerous national-level sources. The resulting data base reveals distinctive patterns of household vehicle availability and use, travel, and fuel use and enables us to relate observed differences between population groups to differences in their demographic characteristics and in the attributes of their household vehicles. When income and residence location are controlled, black (and to a lesser extent, Hispanic and poor) households have fewer vehicles regularly available than do comparable white or nonpoor households; moreover, these vehicles are older andmore » larger and thus have significantly lower fuel economy. The net result is that average black, Hispanic, and poor households travel fewer miles per year but use more fuel than do average white and nonpoor households. Certain other findings - notably, that of significant racial differences in vehicle availability and use by low-income households - challenge the conventional wisdom that such racial variations arise solely because of differences in income and residence location. Results of the study suggest important differences - primarily in the yearly fluctuation of income - between black and white low-income households even when residence location is controlled. These variables are not captured by cross-sectional data sets (either the national surveys used in our analysis or the local data sets that are widely used for urban transportation planning).« less

Compositional controls on early diagenetic pathways in fine-grained sedimentary rocks: Implications for predicting unconventional reservoir attributes of mudstones

USGS Publications Warehouse

Keller, Margaret A.; Macquaker, Joe H.S.; Taylor, Kevin G.; Polya, David

2014-01-01

Diagenesis significantly impacts mudstone lithofacies. Processes operating to control diagenetic pathways in mudstones are poorly known compared to analogous processes occurring in other sedimentary rocks. Selected organic-carbon-rich mudstones, from the Kimmeridge Clay and Monterey Formations, have been investigated to determine how varying starting compositions influence diagenesis.The sampled Kimmeridge Clay Formation mudstones are organized into thin homogenous beds, composed mainly of siliciclastic detritus, with some constituents derived from water-column production (e.g., coccoliths, S-depleted type-II kerogen, as much as 52.6% total organic carbon [TOC]) and others from diagenesis (e.g., pyrite, carbonate, and kaolinite). The sampled Monterey Formation mudstones are organized into thin beds that exhibit pelleted wavy lamination, and are predominantly composed of production-derived components including diatoms, coccoliths, and foraminifera, in addition to type-IIS kerogen (as much as 16.5% TOC), and apatite and silica cements.During early burial of the studied Kimmeridge Clay Formation mudstones, the availability of detrital Fe(III) and reactive clay minerals caused carbonate- and silicate-buffering reactions to operate effectively and the pore waters to be Fe(II) rich. These conditions led to pyrite, iron-poor carbonates, and kaolinite cements precipitating, preserved organic carbon being S-depleted, and sweet hydrocarbons being generated. In contrast, during the diagenesis of the sampled Monterey Formation mudstones, sulfide oxidation, coupled with opal dissolution and the reduced availability of both Fe(III) and reactive siliciclastic detritus, meant that the pore waters were poorly buffered and locally acidic. These conditions resulted in local carbonate dissolution, apatite and silica cements precipitation, natural kerogen sulfurization, and sour hydrocarbons generation.Differences in mud composition at deposition significantly influence subsequent diagenesis. These differences impact their source rock attributes and mechanical properties.

Coaches' Voices Bring 6 Lessons to Light

ERIC Educational Resources Information Center

Brady, Cheryl H.

2007-01-01

In 1996, the Kansas City (Kan.) Public Schools, a largely poor, urban system, was facing a crisis. Talk at local and state levels was about closing a number of poor-performing schools. The author discusses how the district took matters in hand to make significant changes. Partnering with the local National Education Association leadership,…

Functional neuroanatomy of human voluntary cough and sniff production

PubMed Central

Simonyan, Kristina; Saad, Ziad S.; Loucks, Torrey M.J.; Poletto, Christopher J.; Ludlow, Christy L.

2007-01-01

Cough and sniff are both spontaneous respiratory behaviors that can be initiated voluntarily in humans. Disturbances of cough may be life threatening, while inability to sniff impairs the sense of smell in neurological patients. Cortical mechanisms of voluntary cough and sniff production have been predicted to exist; however, the localization and function of supramedullary areas responsible for these behaviors are poorly understood. We used functional magnetic resonance imaging to identify the central control of voluntary cough and sniff compared with breathing. We determined that both voluntary cough and sniff require a widespread pattern of sensorimotor activation along the Sylvian fissure convergent with voluntary breathing. Task-specific activation occurred in a ponto-mesencephalic region during voluntary coughing and in the hippocampus and piriform cortex during voluntary sniffing. Identification of the localization of cortical activation for cough control in humans may help potential drug development to target these regions in patients with chronic cough. Understanding the sensorimotor sniff control mechanisms may provide a new view on the cerebral functional reorganization of olfactory control in patients with neurological disorders. PMID:17574873

Partitioning-defective Protein 6 (Par-6) Activates Atypical Protein Kinase C (aPKC) by Pseudosubstrate Displacement*

PubMed Central

Graybill, Chiharu; Wee, Brett; Atwood, Scott X.; Prehoda, Kenneth E.

2012-01-01

Atypical protein kinase C (aPKC) controls cell polarity by modulating substrate cortical localization. Aberrant aPKC activity disrupts polarity, yet the mechanisms that control aPKC remain poorly understood. We used a reconstituted system with purified components and a cultured cell cortical displacement assay to investigate aPKC regulation. We find that aPKC is autoinhibited by two domains within its NH2-terminal regulatory half, a pseudosubstrate motif that occupies the kinase active site, and a C1 domain that assists in this process. The Par complex member Par-6, previously thought to inhibit aPKC, is a potent activator of aPKC in our assays. Par-6 and aPKC interact via PB1 domain heterodimerization, and this interaction activates aPKC by displacing the pseudosubstrate, although full activity requires the Par-6 CRIB-PDZ domains. We propose that, along with its previously described roles in controlling aPKC localization, Par-6 allosterically activates aPKC to allow for high spatial and temporal control of substrate phosphorylation and polarization. PMID:22544755

Pentadecapeptide BPC 157 cream improves burn-wound healing and attenuates burn-gastric lesions in mice.

PubMed

Mikus, D; Sikiric, P; Seiwerth, S; Petricevic, A; Aralica, G; Druzijancic, N; Rucman, R; Petek, M; Pigac, B; Perovic, D; Kolombo, M; Kokic, N; Mikus, S; Duplancic, B; Fattorini, I; Turkovic, B; Rotkvic, I; Mise, S; Prkacin, I; Konjevoda, P; Stambuk, N; Anic, T

2001-12-01

The effects of the gastric pentadecapeptide BPC 157 were investigated when administered topically or systemically in burned mice. This agent is known to have a beneficial effect in a variety of models of gastrointestinal lesions, as well as on wound or fracture healing. Deep partial skin thickness burns (1.5x1.5 cm) covering 20% of total body area, were induced under anesthesia on the back of mice by controlled burning and gastric lesions were assessed 1, 2, 3, 7, 14 and 21 days following injury. The first application of BPC 157 was immediately following burning, and thereafter, once daily, until 24 h before sacrifice. In the initial experiments, exposure to direct flame for 5 s, the BPC 157 was applied at 10 microg or 10 ng/kg b.w. intraperitoneally (i.p.) by injection or alternatively, topically, at the burn, as a thin layer of cream (50 microg of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream (also used as local vehicle-control)), while silver sulfadiazine 1% cream was a standard agent acting locally. Others received no local medication: they were treated i.p. by injection of distilled water (distilled water-control) or left without any medication (control). In subsequent experiments involving deeper burns (direct flame for 7 s), BPC 157 creams (50 microg, 5 microg, 500 ng, 50 ng or 5 ng of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream), or vehicle as a thin layer of cream, were applied topically, at the burn. Compared with untreated controls, in both experiments, in the BPC 157 cream-treated mice all parameters of burn healing were improved throughout the experiment: less edema was observed and inflammatory cell numbers decreased. Less necrosis was seen with an increased number of capillaries along with an advanced formation of dermal reticulin and collagen fibers. An increased number of preserved follicles were observed. Two weeks after injury, BPC 157 cream-treated mice completely reversed the otherwise poor re-epithelization ratio noted in the untreated control or mice treated with vehicle only. Tensiometry investigation showed an increased breaking strength and relative elongation of burned skin, while water content in burned skin decreased. This was, however, not the case with the vehicle or silver sulfadiazine. Relative to the control values, in silver sulfadiazine cream-treated mice, only collagen fiber formation was increased, in addition to a decreased inflammatory cell number. Relative to control values, BPC 157 given i.p. decreased the number of inflammatory cells, lowered water content in burned skin, and raised breaking strength and relative elongation of burned skin during tensiometry. Through the experimental period, gastric lesions were continuously noted in all thermally injured mice left without local medication and they were consistently attenuated only by BPC 157 treatments: either given i.p. (at either dose), or given locally (at either concentration). Other treatments (i.e. local treatment with silver sulfadiazine cream or neutral cream in mice subjected for 5 s to direct flame), led to only poor, if any attenuation. This stable gastric pentadecapeptide appears to be active and gives a stimulation to burn healing at the defect site. The agent may act by causing an upregulation of the growth factors, as well as influencing other local factors.

An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines.

PubMed

Solon, Orville; Peabody, John W; Woo, Kimberly; Quimbo, Stella A; Florentino, Jhiedon; Shimkhada, Riti

2009-09-01

Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment. We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.

An Evaluation of the Cost-effectiveness of Policy Navigators to Improve Access to Care for the Poor in the Philippines

PubMed Central

Solon, Orville; Peabody, John W.; Woo, Kimberly; Quimbo, Stella A.; Florentino, Jhiedon; Shimkhada, Riti

2009-01-01

Objectives Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. Methods We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost effectiveness of marginal increases in enrollment. Results We found that Policy Navigators improved enrollment in health insurance between 39 and 102% compared to the controls. Policy navigators were cost-effective at $0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Conclusion Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment. PMID:19349090

Clinicopathologic and prognostic factors in adenoid cystic carcinoma of head and neck minor salivary glands: A clinical analysis of 130 cases.

PubMed

He, Shizhi; Li, Pingdong; Zhong, Qi; Hou, Lizhen; Yu, Zhenkun; Huang, Zhigang; Chen, Xuejun; Fang, Jugao; Chen, Xiaohong

This study was to investigate clinicopathologic characteristics and prognostic factors in adenoid cystic carcinoma of head and neck minor salivary glands. We conducted a retrospective review of 130 patients with adenoid cystic carcinoma of head and neck minor salivary glands that were evaluated between 2000 and 2013 in Beijng Tongren Hospital. Five-year overall survival and disease-free survival rates were 80.8% and 55.6%. Local recurrence rate was 40%, regional recurrence 3.8%, and distant metastasis was 28.5%. On univariate analysis, solid histological subtype, perineural invasion, positive surgical margins and advanced stages were found to be poor prognostic indicators. On multivariate analysis, solid histological subtype and positive surgical margins were significant prognostic factors of worse overall survival. Solid histological subtype and positive surgical margins were the most important predictors of poor outcome in adenoid cystic carcinoma of minor salivary glands. Surgery with postoperative radiation were recommended treatment and offered durable local control. Copyright © 2016 Elsevier Inc. All rights reserved.

Open-loop-feedback control of serum drug concentrations: pharmacokinetic approaches to drug therapy.

PubMed

Jelliffe, R W

1983-01-01

Recent developments to optimize open-loop-feedback control of drug dosage regimens, generally applicable to pharmacokinetically oriented therapy with many drugs, involve computation of patient-individualized strategies for obtaining desired serum drug concentrations. Analyses of past therapy are performed by least squares, extended least squares, and maximum a posteriori probability Bayesian methods of fitting pharmacokinetic models to serum level data. Future possibilities for truly optimal open-loop-feedback therapy with full Bayesian methods, and conceivably for optimal closed-loop therapy in such data-poor clinical situations, are also discussed. Implementation of these various therapeutic strategies, using automated, locally controlled infusion devices, has also been achieved in prototype form.

Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma: a 20-year experience.

PubMed

Kelly, Patrick; Zagars, Gunar K; Cormier, Jancie N; Ross, Merrick I; Guadagnolo, B Ashleigh

2011-10-15

Anorectal melanoma is a rare disease with a poor prognosis. Because survival is determined by distant failure, many centers have adopted sphincter-sparing excision for primary tumor control. However, this approach is associated with high rates of local failure (∼50%). In this study, the authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy (RT) for the treatment of localized anorectal melanoma. The authors reviewed the records of 54 patients with localized anorectal melanoma who were treated at the University of Texas MD Anderson Cancer Center from 1989 to 2008. All patients underwent definitive local excision with or without sentinel lymph node biopsy or lymph node dissection. RT (25-36 grays in 5-6 fractions) was delivered to extended fields that targeted the primary site and draining pelvic/inguinal lymphatics in 39 patients and to limited fields that targeted only the primary site in 15 patients. The 5-year rates of local control (LC), lymph node control (NC), and sphincter preservation were 82%, 88%, and 96%, respectively. However, because of the high rate of distant metastasis, the overall survival (OS) rate at 5 years was only 30%. Although there were no significant differences in LC, NC, or OS based on RT field extent, patients who received extended-field RT had higher rates of lymphedema than patients who received limited-field RT. The current results indicated that combined sphincter-sparing local excision and RT is a well tolerated approach that provides effective LC for patients with anorectal melanoma. Inclusion of the inguinal lymph node basins in the RT fields did not improve outcomes and was associated with an increased risk of lymphedema. Copyright © 2011 American Cancer Society.

Whole-brain structural topology in adult attention-deficit/hyperactivity disorder: Preserved global - disturbed local network organization.

PubMed

Sidlauskaite, Justina; Caeyenberghs, Karen; Sonuga-Barke, Edmund; Roeyers, Herbert; Wiersema, Jan R

2015-01-01

Prior studies demonstrate altered organization of functional brain networks in attention-deficit/hyperactivity disorder (ADHD). However, the structural underpinnings of these functional disturbances are poorly understood. In the current study, we applied a graph-theoretic approach to whole-brain diffusion magnetic resonance imaging data to investigate the organization of structural brain networks in adults with ADHD and unaffected controls using deterministic fiber tractography. Groups did not differ in terms of global network metrics - small-worldness, global efficiency and clustering coefficient. However, there were widespread ADHD-related effects at the nodal level in relation to local efficiency and clustering. The affected nodes included superior occipital, supramarginal, superior temporal, inferior parietal, angular and inferior frontal gyri, as well as putamen, thalamus and posterior cerebellum. Lower local efficiency of left superior temporal and supramarginal gyri was associated with higher ADHD symptom scores. Also greater local clustering of right putamen and lower local clustering of left supramarginal gyrus correlated with ADHD symptom severity. Overall, the findings indicate preserved global but altered local network organization in adult ADHD implicating regions underpinning putative ADHD-related neuropsychological deficits.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dirix, Piet; Nuyts, Sandra; Geussens, Yasmyne

Purpose: To evaluate the long-term clinical outcome and toxicity of conventional and three-dimensional conformal radiotherapy for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between January 1976 and February 2003, 127 patients with histologically proven cancer of the paranasal sinuses (n = 119) or nasal cavity (n = 8) were treated with preoperative (n = 61), postoperative (n = 51), or primary (n = 15) radiotherapy, using conventional (n = 74) or three-dimensional conformal (n = 53) techniques. No elective neck irradiation of the cervical lymph nodes was performed in N0 patients. Results: Median follow-up was 5.6more » years (range, 3-307 months) for all patients, and 7.3 years (range, 47-307 months) for patients still alive at the close-out date. The actuarial 5-year local control, overall survival, and disease-free survival rates were 53%, 54%, and 37%, respectively. Only 6 (5%) of all 127 patients and 4 (3%) of 122 originally N0 patients developed a regional failure in the neck. Distant metastasis occurred in 20% of patients. Both primary tumor extent and lymph node involvement were the most important prognostic factors, together with squamous cell carcinoma histology. Conclusion: Local failure remains the dominant cause of poor outcome for patients with sinonasal cancer, despite aggressive local treatment with combined surgery and radiotherapy in operable patients. Distant metastasis and certainly regional relapse were much less common sites of failure. Overall survival remains poor, suggesting the need for more efficacious local and possibly systemic therapy.« less

Poor oral health is associated with an increased risk of esophageal squamous cell carcinoma - a population-based case-control study in China.

PubMed

Chen, Xingdong; Yuan, Ziyu; Lu, Ming; Zhang, Yuechan; Jin, Li; Ye, Weimin

2017-02-01

To further examine the association between oral hygiene and esophageal squamous cell carcinoma (ESCC) risk and the effect modification of other exposures, we conducted a population-based case-control study between 2010 and 2012 in Taixing, China, a high-risk area for ESCC. Cases were primarily recruited from endoscopy units at local hospitals, supplemented by linkage to the local Cancer Registry. Control subjects were frequency matched to cases by sex and age (5-year groups) and were randomly selected from the Taixing Population Registry. For the current analysis, data from 616 histopathologically confirmed cases and 770 controls with complete information on oral hygiene were analyzed. Unconditional logistic regression models, including oral hygiene indicators and potential behavioral confounders, were used to derive odds ratios (ORs) and 95% confidence intervals (CIs). Tooth loss was only marginally significantly associated with ESCC risk (yes vs. no, OR = 1.29, 95% CI 0.94-1.74). However, the excess risk increased with increasing numbers of lost teeth (more than 6 teeth lost vs. none, OR = 1.48, 95% CI 1.04-2.11). Tooth brushing once or less per day, compared with tooth brushing twice or more per day, was associated with a 1.81-fold increased risk of ESCC. In the stratification analyses, the increased risks associated with these indicators of oral health were more pronounced in older subjects (age ≥ 70 years), women, non-smokers, and non-drinkers. Further studies are warranted to verify these findings and to explore the underlying mechanisms, e.g., changed oral microbiota, associated with poor oral hygiene. © 2016 UICC.

Characterization of identification errors and uses in localization of poor modal correlation

NASA Astrophysics Data System (ADS)

Martin, Guillaume; Balmes, Etienne; Chancelier, Thierry

2017-05-01

While modal identification is a mature subject, very few studies address the characterization of errors associated with components of a mode shape. This is particularly important in test/analysis correlation procedures, where the Modal Assurance Criterion is used to pair modes and to localize at which sensors discrepancies occur. Poor correlation is usually attributed to modeling errors, but clearly identification errors also occur. In particular with 3D Scanning Laser Doppler Vibrometer measurement, many transfer functions are measured. As a result individual validation of each measurement cannot be performed manually in a reasonable time frame and a notable fraction of measurements is expected to be fairly noisy leading to poor identification of the associated mode shape components. The paper first addresses measurements and introduces multiple criteria. The error measures the difference between test and synthesized transfer functions around each resonance and can be used to localize poorly identified modal components. For intermediate error values, diagnostic of the origin of the error is needed. The level evaluates the transfer function amplitude in the vicinity of a given mode and can be used to eliminate sensors with low responses. A Noise Over Signal indicator, product of error and level, is then shown to be relevant to detect poorly excited modes and errors due to modal property shifts between test batches. Finally, a contribution is introduced to evaluate the visibility of a mode in each transfer. Using tests on a drum brake component, these indicators are shown to provide relevant insight into the quality of measurements. In a second part, test/analysis correlation is addressed with a focus on the localization of sources of poor mode shape correlation. The MACCo algorithm, which sorts sensors by the impact of their removal on a MAC computation, is shown to be particularly relevant. Combined with the error it avoids keeping erroneous modal components. Applied after removal of poor modal components, it provides spatial maps of poor correlation, which help localizing mode shape correlation errors and thus prepare the selection of model changes in updating procedures.

Characterizing the mechanical behavior of the zebrafish germ layers

NASA Astrophysics Data System (ADS)

Kealhofer, David; Serwane, Friedhelm; Mongera, Alessandro; Rowghanian, Payam; Lucio, Adam; Campàs, Otger

Organ morphogenesis and the development of the animal body plan involve complex spatial and temporal control of tissue- and cell-level mechanics. A prime example is the generation of stresses by individual cells to reorganize the tissue. These processes have remained poorly understood due to a lack of techniques to characterize the local constitutive law of the material, which relates local cellular forces to the resulting tissue flows. We have developed a method for quantitative, local in vivo study of material properties in living tissue using magnetic droplet probes. We use this technique to study the material properties of the different zebrafish germ layers using aggregates of zebrafish mesendodermal and ectodermal cells as a model system. These aggregates are ideal for controlled studies of the mechanics of individual germ layers because of the homogeneity of the cell type and the simple spherical geometry. Furthermore, the numerous molecular tools and transgenic lines already developed for this model organism can be applied to these aggregates, allowing us to characterize the contributions of cell cortex tension and cell adhesion to the mechanical properties of the zebrafish germ layers.

[Control of scabies in the district of Ytre Nordhordland. An experiment within community medicine in the 1860's].

PubMed

Sandvik, H

1993-01-10

19th century Norway may be likened to the developing countries of today. Scabies was very prevalent, and traditional approaches to treatment were in vain. The poor peasant population would not spend money on such. Thomas Collett (1835-98), the local doctor in a rural district of western Norway, initiated a programme for community control of scabies. The local Board of Health agreed to purchase a large amount of sulphur ointment. 1/8 of a barrel of ointment was placed at the disposal of local teachers. The teachers were instructed to initiate treatment of school-children who were found to be infected with scabies. The household to which the child belonged was also to be treated, as well as the other children at the school. Gradually, the prevalence of scabies declined. Self-care increased, and eventually, the peasants ended up making their own sulphur ointment. Experiences and recommendations from developing countries of today agree with the strategy adopted by Collett. Individual medical treatment of cases and their contacts is too costly, and fails to reduce the total prevalence of scabies.

Experience in estimating neutron poison worths

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiang, R.T.; Congdon, S.P.

1989-01-01

Gadolinia, {sup 135}Xe, {sup 149}Sm, control rod, and soluble boron are five neutron poisons that may appear in light water reactor assemblies. Reliable neutron poison worth estimation is useful for evaluating core operating strategies, fuel cycle economics, and reactor safety design. Based on physical presence, neutron poisons can be divided into two categories: local poisons and global poisons. Gadolinia and control rod are local poisons, and {sup 135}Xe, {sup 149}Sm, and soluble boron are global poisons. The first-order perturbation method is commonly used to estimate nuclide worths in fuel assemblies. It is well known, however, that the first-order perturbation methodmore » was developed for small perturbations, such as the perturbation due to weak absorbers, and that neutron poisons are not weak absorbers. The authors have developed an improved method to replace the first-order perturbation method, which yields very poor results, for estimating local poison worths. It has also been shown that the first-order perturbation method seems adequate to estimate worths for global poisons caused by flux compensation.« less

Case report: Irreversible electroporation for locally advanced pancreatic cancer.

PubMed

Orcutt, Sonia; Kis, Bela; Malafa, Mokenge

2017-01-01

For patients with pancreatic adenocarcinoma who are not candidates for surgical resection, long-term survival is poor, even with currently available systemic and radiation therapy options. However, for those with locally advanced disease who do not have distant metastasis, locoregional control of the tumor has the potential to improve long-term outcomes. A newly developed technology, irreversible electroporation, has advantages over traditional thermal ablation with unresectable cancers in this location. In our case report, we describe the first patient treated with irreversible electroporation at our institution for locally advanced pancreatic cancer. The patient is a 63-year-old man who had a partial response to standard chemotherapy and radiation, but was found on operative assessment to have persistently unresectable disease. He therefore underwent irreversible electroporation to the pancreatic mass. His postoperative course was complicated by delayed gastric emptying and wound infection. Three months after surgery, he had no evidence of distant or recurrent disease. Irreversible electroporation for locally advanced pancreatic cancer is an emerging technique which attempts to improve local control of locally advanced, non-metastatic pancreatic cancer. Early data have demonstrated the potential for improved long-term survival in these patients, although further studies are needed to confirm safety and efficacy of this technique. While there is a positive outlook for the use of irreversible electroporation for locally advanced pancreas cancer, there remain some uncertainties surrounding this therapy, which underscores the importance of future research in this area. Copyright © 2017. Published by Elsevier Ltd.

Electrophysiological Indices of Spatial Attention during Global/Local Processing in Good and Poor Phonological Decoders

ERIC Educational Resources Information Center

Matthews, Allison Jane; Martin, Frances Heritage

2009-01-01

Previous research suggests a relationship between spatial attention and phonological decoding in developmental dyslexia. The aim of this study was to examine differences between good and poor phonological decoders in the allocation of spatial attention to global and local levels of hierarchical stimuli. A further aim was to investigate the…

A phase 1, randomized, controlled dose-escalation study of EP-1300 polyepitope DNA vaccine against Plasmodium falciparum malaria administered via electroporation.

PubMed

Spearman, Paul; Mulligan, Mark; Anderson, Evan J; Shane, Andi L; Stephens, Kathy; Gibson, Theda; Hartwell, Brooke; Hannaman, Drew; Watson, Nora L; Singh, Karnail

2016-11-04

Plasmodium falciparum malaria is one of the leading infectious causes of childhood mortality in Africa. EP-1300 is a polyepitope plasmid DNA vaccine expressing 38 cytotoxic T cell epitopes and 16 helper T cell epitopes derived from P. falciparum antigens expressed predominantly in the liver phase of the parasite's life cycle. We performed a phase 1 randomized, placebo-controlled, dose escalation clinical trial of the EP-1300 DNA vaccine administered via electroporation using the TriGrid Delivery System device (Ichor Medical Systems). Although the delivery of the EP-1300 DNA vaccine via electroporation was safe, tolerability was less than that usually observed with standard needle and syringe intramuscular administration. This was primarily due to acute local discomfort at the administration site during electroporation. Despite the use of electroporation, the vaccine was poorly immunogenic. The reasons for the poor immunogenicity of this polyepitope DNA vaccine remain uncertain. ClinicalTrials.gov NCT01169077. Copyright © 2016 Elsevier Ltd. All rights reserved.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

PubMed Central

Unger, Jean-Pierre; De Paepe, Pierre; Ghilbert, Patricia; Soors, Werner; Green, Andrew

2006-01-01

Abstract Purpose To review the evidence basis of international aid and health policy. Context of case Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care. PMID:17006553

FORUM: Dynamics and Causation of Environmental Equity, Locally Unwanted Land Uses, and Neighborhood Changes

PubMed

Liu

1997-09-01

/ Why are some environmental risks distributed disproportionately in the neighborhoods of the minorities and the poor? A hypothesis was proposed in a recent study that market dynamics contributed to the current environmental inequity. That is, locally unwanted land uses (LULUs) make the host communities home to more poor people and people of color. This hypothesis was allegedly supported by a Houston case study, whereby its author analyzed the postsiting changes of the socioeconomic characteristics of the neighborhoods surrounding solid waste facilities. I argue that such an analysis of postsiting changes alone is insufficient to test the causation hypothesis. Instead, I propose a conceptual framework for analysis of environmental equity dynamics and causation. I suggest that the presiting neighborhood dynamics and the characteristics of control neighborhoods be analyzed as the first test for the causation hypothesis. Furthermore, I present theories of neighborhood change and then examine alternative hypotheses that these theories offer for explaining neighborhood changes and for the roles of LULUs in neighborhood changes. These alternative hypotheses should be examined when analyzing the relationship between LULUs and neighborhood changes in a metropolitan area. Using this framework of analysis, I revisited the Houston case. First, I found no evidence that provided support for the hypothesis that the presence of LULUs made the neighborhoods home to more blacks and poor people, contrary to the conclusion made by the previous study. Second, I examined alternative hypotheses for explaining neighborhood changes-invasion-succession, other push forces, and neighborhood life-cycle; the former two might offer better explanation.KEY WORDS: Environmental equity and justice; Locally unwanted lane uses; Siting; Market dynamics; Invasion-succession; Neighborhood changes

Geological Investigation and analysis in response to Earthquake Induced Landslide in West Sumatra

NASA Astrophysics Data System (ADS)

Karnawati, D.; Wilopo, W.; Salahudin, S.; Sudarno, I.; Burton, P.

2009-12-01

Substantial socio-economical loss occurred in response to the September 30. 2009 West Sumatra Earthquake with magnitude of 7.6. Damage of houses and engineered structures mostly occurred at the low land of alluvium sediments due to the ground amplification, whilst at the high land of mountain slopes several villages were buried by massive debris of rocks and soils. It was recorded that 1115 people died due to this disasters. Series of geological investigation was carried out by Geological Engineering Department of Gadjah Mada University, with the purpose to support the rehabilitation program. Based on this preliminary investigation it was identified that most of the house and engineered structural damages at the alluvial deposits mainly due to by the poor quality of such houses and engineered structures, which poorly resist the ground amplification, instead of due to the control of geological conditions. On the other hand, the existence and distribution of structural geology (faults and joints) at the mountaineous regions are significant in controlling the distribution of landslides, with the types of rock falls, debris flows and debris falls. Despite the landslide susceptibility mapping conducted by Geological Survey of Indonesia, more detailed investigation is required to be carried out in the region surrounding Maninjau Lake, in order to provide safer places for village relocation. Accordingly Gadjah Mada University in collaboration with the local university (Andalas University) as well as with the local Government of Agam Regency and the Geological Survey of Indonesia, serve the mission for conducting rather more detailed geological and landslide investigation. It is also crucial that the investigation (survey and mapping) on the social perception and expectation of local people living in this landslide susceptible area should also be carried out, to support the mitigation effort of any future potential earthquake induced landslides.

Exploring grassroots feedback about cancer challenges in South Africa: a discussion of themes derived from content thematic analysis of 316 photo-narratives

PubMed Central

Edwards, Lynn Barbara; Greeff, Linda Estelle

2017-01-01

Introduction Cancer is an important health problem in Africa with projections that incidence could double by 2030. While sparse, the literature on cancer control in African low- and middle-income countries suggests poor cancer planning, overburdened services and poor outcomes. South Africa has established oncology health care services but also has low cancer awareness, poor cancer surveillance and widespread service challenges. Methods Data for this study was derived from 316 photovoice interviews with cancer patients, families of cancer patients and oncology workers across South Africa. The objectives of the study were to collect first-hand feedback about cancer challenges and to develop recommendations for the improvement of cancer control strategies. Results 9 themes of cancer challenges were distinguished via thematic content analysis of the photo-narratives. The identified themes of cancer challenges were physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma, and schooling challenges. Conclusion The findings of this study offer the patient and family perspective of cancer challenges as a valid contribution to our body of cancer knowledge. The 9 themes of cancer challenges profile the emotional, physical and social impact of cancer on patients and families, and offer detailed subjective information about problem occurrence in the trajectory of care. Recommendations following from the 9 themes of cancer challenges include training for improved patient-centred care standards, the need for cancer surveillance, innovative and locally appropriate cancer awareness campaigns, private and government health care partnerships and the development of psychosocial services. The advocating of findings and recommendations to influence cancer control strategies in South Africa, is indicated. PMID:29541319

Exploring grassroots feedback about cancer challenges in South Africa: a discussion of themes derived from content thematic analysis of 316 photo-narratives.

PubMed

Edwards, Lynn Barbara; Greeff, Linda Estelle

2017-01-01

Cancer is an important health problem in Africa with projections that incidence could double by 2030. While sparse, the literature on cancer control in African low- and middle-income countries suggests poor cancer planning, overburdened services and poor outcomes. South Africa has established oncology health care services but also has low cancer awareness, poor cancer surveillance and widespread service challenges. Data for this study was derived from 316 photovoice interviews with cancer patients, families of cancer patients and oncology workers across South Africa. The objectives of the study were to collect first-hand feedback about cancer challenges and to develop recommendations for the improvement of cancer control strategies. 9 themes of cancer challenges were distinguished via thematic content analysis of the photo-narratives. The identified themes of cancer challenges were physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma, and schooling challenges. The findings of this study offer the patient and family perspective of cancer challenges as a valid contribution to our body of cancer knowledge. The 9 themes of cancer challenges profile the emotional, physical and social impact of cancer on patients and families, and offer detailed subjective information about problem occurrence in the trajectory of care. Recommendations following from the 9 themes of cancer challenges include training for improved patient-centred care standards, the need for cancer surveillance, innovative and locally appropriate cancer awareness campaigns, private and government health care partnerships and the development of psychosocial services. The advocating of findings and recommendations to influence cancer control strategies in South Africa, is indicated.

[A Case of Locally Advanced Thoracic Esophageal Cancer with Larynx Preservation and Curative Resection via Combined Modality Therapy].

PubMed

Iwama, Mitsuru; Kimura, Yutaka; Shiraishi, Osamu; Kato, Hiroaki; Hiraki, Yoko; Tanaka, Yumiko; Yasuda, Atsushi; Shinkai, Masayuki; Imano, Motohiro; Imamoto, Haruhiko; Yasuda, Takushi

2017-11-01

Prognosis of locally advanced esophageal cancer is poor. The greatest prognostic factor of locally advanced esophageal cancer is a local control. We experienced a case of T4 locally advanced thoracic esophageal cancer who was successfully resected without any combined resection after multimodality therapy. A male in 75-year-old. was diagnosed with type 3 locally advanced upper thoracic esophageal cancer whose metastatic right recurrent laryngeal lymph node invaded into the trachea. Definitive chemoradiation therapy(CRT)was performed, leading to a significant shrinkage of the main tumor, but T4 lesion remained. Next, adding DCF therapy(docetaxel, CDDP and 5-FU), a relief of T4 was finally obtained. Then, salvage surgery with subtotalesophagectomy and retrosternalesophagealreconstruction with gastric tube was performed, resulting in R0 resection without any combined resection. The postoperative course was uneventful, and the patient has been alive without recurrence for 1 year after surgery. In locally advanced cancer, focusing on T4 downstaging, it is significantly important in terms of safety, curativity and organ preservation to perform surgery after a sure sign of T4 relief by multimodality therapy.

Factors associated with poor control of 9/11-related asthma 10–11 years after the 2001 World Trade Center terrorist attacks

PubMed Central

Jordan, Hannah T.; Stellman, Steven D.; Reibman, Joan; Farfel, Mark R.; Brackbill, Robert M.; Friedman, Stephen M.; Li, Jiehui; Cone, James E.

2015-01-01

Abstract Objective: To identify key factors associated with poor asthma control among adults in the World Trade Center (WTC) Health Registry, a longitudinal study of rescue/recovery workers and community members who were directly exposed to the 2001 WTC terrorist attacks and their aftermath. Methods: We studied incident asthma diagnosed by a physician from 12 September 2001 through 31 December 2003 among participants aged ≥18 on 11 September 2001, as reported on an enrollment (2003–2004) or follow-up questionnaire. Based on modified National Asthma Education and Prevention Program criteria, asthma was considered controlled, poorly-controlled, or very poorly-controlled at the time of a 2011–2012 follow-up questionnaire. Probable post-traumatic stress disorder, depression, and generalized anxiety disorder were defined using validated scales. Self-reported gastroesophageal reflux symptoms (GERS) and obstructive sleep apnea (OSA) were obtained from questionnaire responses. Multinomial logistic regression was used to examine factors associated with poor or very poor asthma control. Results: Among 2445 participants, 33.7% had poorly-controlled symptoms and 34.6% had very poorly-controlled symptoms in 2011–2012. Accounting for factors including age, education, body mass index, and smoking, there was a dose–response relationship between the number of mental health conditions and poorer asthma control. Participants with three mental health conditions had five times the odds of poor control and 13 times the odds of very poor control compared to participants without mental health comorbidities. GERS and OSA were significantly associated with poor or very poor control. Conclusions: Rates of poor asthma control were very high in this group with post-9/11 diagnosed asthma. Comprehensive care of 9/11-related asthma should include management of mental and physical health comorbidities. PMID:25539137

Primary mucosal sinonasal melanoma—Case report and review of the literature. The role of complex treatment-surgery and adjuvant radiotherapy

PubMed Central

Marinova, Lena; Yordanov, Kaloyan; Sapundgiev, Nikolay

2010-01-01

Aim The place of adjuvant radiotherapy in the treatment of sinonasal melanoma. Background Sinonasal mucosal melanoma is a rare disease with poor prognosis and requires a complex treatment. Elective neck dissection in patients with N0 and adjuvant radiotherapy has been a source of controversy. High late regional recurrence rates rise questions about elective irradiation of the neck nodes in patients with N0 stage disease. Methods We present our two years’ follow up in a case of locally advanced sinonasal melanoma and literature review of the treatment options for mucosal melanoma. Results In locally advanced sinonasal melanoma treated with surgical resection, postoperative radiotherapy and chemotherapy we had local tumor control. Two years later, a regional contralateral recurrence without distant metastasis occurred. Conclusions Literature data for frequent neck lymph nodes recurrences justify elective neck dissection. Postoperative elective neck radiotherapy for patients with locally advanced sinonasal melanoma and clinically N0 appears to decrease the rate of late regional recurrences. PMID:24376954

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghafoori, A. Paiman; Nelson, John W.; Willett, Christopher G.

Purpose: Extrahepatic cholangiocarcinoma is an uncommon but lethal malignancy. We analyzed the role of definitive chemoradiotherapy for patients with nonmetastatic, locally advanced extrahepatic cholangiocarcinoma treated at a single institution. Methods and Materials: This retrospective analysis included 37 patients who underwent external beam radiation therapy (EBRT) with concurrent chemotherapy and/or brachytherapy (BT) for locally advanced extrahepatic cholangiocarcinoma. Local control (LC) and overall survival (OS) were assessed, and univariate regression analysis was used to evaluate the effects of patient- and treatment-related factors on clinical outcomes. Results: Twenty-three patients received EBRT alone, 8 patients received EBRT plus BT, and 6 patients received BTmore » alone (median follow-up of 14 months). Two patients were alive without evidence of recurrence at the time of analysis. Actuarial OS and LC rates at 1 year were 59% and 90%, respectively, and 22% and 71%, respectively, at 2 years. Two patients lived beyond 5 years without evidence of recurrence. On univariate analysis, EBRT with or without BT improved LC compared to BT alone (97% vs. 56% at 1 year; 75% vs. 56% at 2 years; p = 0.096). Patients who received EBRT alone vs. BT alone also had improved LC (96% vs. 56% at 1 year; 80% vs. 56% at 2 years; p = 0.113). Age, gender, tumor location (proximal vs. distal), histologic differentiation, EBRT dose ({<=} or >50 Gy), EBRT planning method (two-dimensional vs. three-dimensional), and chemotherapy were not associated with patient outcomes. Conclusions: Patients with locally advanced extrahepatic cholangiocarcinoma have poor survival. Long-term survival is rare. The majority of patients treated with EBRT had local control at the time of death, suggesting that symptoms due to the local tumor effect might be effectively controlled with radiation therapy, and EBRT is an important element of treatment. Novel treatment approaches are indicated in the therapy for this disease.« less

Sacramento River Flood Control System Evaluation, Phases II-V. Programmatic Environmental Impact Statement/Environmental Impact Report

DTIC Science & Technology

1992-05-01

meetings, call Mr. David Gundlach, Project Manager, Corps of Engineers, at (916) 557-6675 or Mr. Ricardo Pineda , State of California, Reclamation...local Colusa Library and the nearest hearing is tonight in Yuba City. Mr. Ricardo Pineda of the State Reclamation Board sent me a copy which I...last one you had in Colusa although Mr. Pineda said v/e are now combined with Yuba City because the attendance was so poor at the Colusa one. I

Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy.

PubMed

Palta, Manisha; Patel, Pretesh; Broadwater, Gloria; Willett, Christopher; Pepek, Joseph; Tyler, Douglas; Zafar, S Yousuf; Uronis, Hope; Hurwitz, Herbert; White, Rebekah; Czito, Brian

2012-05-01

Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in addition to surgery. A retrospective analysis was performed of all patients undergoing potentially curative pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1976 and 2009. Time-to-event analysis was performed comparing all patients who underwent surgery alone to the cohort of patients receiving CRT in addition to surgery. Local control (LC), disease-free survival (DFS), overall survival (OS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier method. A total of 137 patients with ampullary carcinoma underwent Whipple procedure. Of these, 61 patients undergoing resection received adjuvant (n = 43) or neoadjuvant (n = 18) CRT. Patients receiving chemoradiotherapy were more likely to have poorly differentiated tumors (P = .03). Of 18 patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response (pCR). With a median follow-up of 8.8 years, 3-year local control was improved in patients receiving CRT (88% vs 55%, P = .001) with trend toward 3-year DFS (66% vs 48%, P = .09) and OS (62% vs 46%, P = .074) benefit in patients receiving CRT. Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered.

[Investigation on schistosomiasis japonica infection and preventive knowledge of immigration population in Jinshan District, Shanghai].

PubMed

Shen, Li; Tao, Jian-xiu; Yu, Rui-fang; Shen, Guo-hong; Wu, Jun; Cai, Li; Cao, Chun-li; Xu, Jing; Li, Shi-zhu; Guo, Jia-gang

2014-06-01

To investigate the schistosomiasis japonica infection and preventive knowledge of immigration population in Jinshan District, Shanghai so as to provide the evidence for improving the control work. The immigration population from schistosomiasis endemic provinces and local people were screened by serum IHA screening for schistosome infection, and the positives were further examined by Kato-Katz technique and the miracidium hatching method. The schistosomiasis preventive knowledge and behaviors were investigated by questionnaires. A total of 579 were investigated with 348 immigration people and 231 local people, and among them, the male accounted for 72.0% and female accounted for 28.0%. In the immigration population, the main age group was 20-29 (56.0%), and 56.6% of the immigration had an education level at senior middle school or higher. The most proportion of immigration was from Anhui Province (36.2%). There were 4 IHA positive persons (1.15%) in the immigration, and 1 was positive in the stool test, and the schistosome infection rate was 0.29%. There were no positives in the local people. The schistosomiasis preventive knowledge of the immigration was generally poor, and some people' s behaviors of see doctor and medication were incorrect. There are schistosome infected persons among the immigration population from schistosomiasis endemic provinces, and their schistosomiasis prevention knowledge was poor, thus there is a schistosomiasis transmission risk.

Beyond "banking for the poor": credit mechanisms and women's empowerment.

PubMed

Albee, A

1996-10-01

This article describes some strengths and limitations of credit programs for women in developing countries. It is urged that development planners recognize the importance of the selection of the type of credit mechanism in the long term. Ethical issues should be decided upon before the credit mechanism is operable. Organizations should make clear what level of commitment there is to empower borrowers. Most organizations give loans to women and assume empowerment will take place without devising strategies to ensure empowerment. Credit mechanisms include credit for the poor and credit by the poor. A sound financial portfolio and 100% repayment are not the appropriate criteria for securing the empowerment of women. Empowerment of women is related to "building the capacity of borrowers to manage and control decision making." UNICEF's framework of gender equality and women's empowerment identifies levels of empowerment as "welfare, access, conscientisation, participation, and control." Development planners should be aware that provision of credit also has the potential to increase a poor family's debt. Delinquency may be hidden by overlapping loans that trap borrowers. Fewer installment payments increase the chances of a debt trap. Reducing the number of installments may reduce administrative costs and conform to production processes, but may also lead to a debt trap. There is now considerable emphasis on investing in low-income women entrepreneurs as a highly efficient means of achieving social and economic objectives. Credit programs aim to support the growth of small, self-sustaining businesses, to improve women's opportunities, and to provide alternatives to exploitation by local money-lenders. This article describes the following credit mechanisms: bank guarantee systems, government credit schemes, intermediary projects, direct lending projects, banks for the poor, credit unions, and village-based banks.

Prospective study of the evolution of blood lymphoid immune parameters during dacarbazine chemotherapy in metastatic and locally advanced melanoma patients.

PubMed

Mignot, Grégoire; Hervieu, Alice; Vabres, Pierre; Dalac, Sophie; Jeudy, Geraldine; Bel, Blandine; Apetoh, Lionel; Ghiringhelli, François

2014-01-01

The importance of immune responses in the control of melanoma growth is well known. However, the implication of these antitumor immune responses in the efficacy of dacarbazine, a cytotoxic drug classically used in the treatment of melanoma, remains poorly understood in humans. In this prospective observational study, we performed an immunomonitoring of eleven metastatic or locally advanced patients treated with dacarbazine as a first line of treatment. We assessed by flow cytometry lymphoid populations and their activation state; we also isolated NK cells to perform in vitro cytotoxicity tests. We found that chemotherapy induces lymphopenia and that a significantly higher numbers of naïve CD4+ T cells and lower proportion of Treg before chemotherapy are associated with disease control after dacarbazine treatment. Interestingly, NK cell cytotoxicity against dacarbazine-pretreated melanoma cells is only observed in NK cells from patients who achieved disease control. Together, our data pinpoint that some immune factors could help to predict the response of melanoma patients to dacarbazine. Future larger scale studies are warranted to test their validity as prediction markers.

A historical and socioeconomic analysis of occupational safety and health in India.

PubMed

Vilanilam, J V

1980-01-01

Workers in poor countries of the so-called Third World are more likely to be affected by the dangers of high technology than their counterparts in wealthier countries. Owing to their lack of education, most workers in the "developing" world are unaware of the hazards of their occupations. Moreover, their general backwardness in sanitation and nutrition and climatic proneness of their geographic region to epidemics cause diseases contracted from the work environment to be aggravated. occupational diseases are often misconstrued as diseases resulting from the general environment. Since unemployment in underdeveloped countries is of a very high order, workers are prepared to accept any job, irrespective of the dangers involved. Labor is cheap and easily replaceable, so employers see no need for improving occupational safety and health. Labor unions are mostly controlled by full-time politicians who consider health a political issue, especially when their party controls the country's government. The seriousness of all these factors is heightened by the existing socioeconomic order in poor countries, in which national medievalism and multinational modernism play a crucial role. In order to understand the prevailing socioeconomic order, one has to analyze the social structures of poor countries in the context of today's world economic structure. India is taken as an example of a "developing" country where all the above-mentioned factors and many others are in operation: backwardness of the worker; poor nutrition; lack of concern for public health; proneness to epidemics; and indifference on the part of employers, politicians, and unions toward occupational health; high unemployment, control of the local economy by multinational corporations; and control of the mass media by feudalistic vested interests. This article attempts to analyze the occupational health and safety issue in India from a historical perspective, and stresses the vital need of structural changes in various fields so that workers can have a safe and healthy working environment.

Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience.

PubMed

Patel, Uday B; Taylor, Fiona; Blomqvist, Lennart; George, Christopher; Evans, Hywel; Tekkis, Paris; Quirke, Philip; Sebag-Montefiore, David; Moran, Brendan; Heald, Richard; Guthrie, Ashley; Bees, Nicola; Swift, Ian; Pennert, Kjell; Brown, Gina

2011-10-01

To assess magnetic resonance imaging (MRI) and pathologic staging after neoadjuvant therapy for rectal cancer in a prospectively enrolled, multicenter study. In a prospective cohort study, 111 patients who had rectal cancer treated by neoadjuvant therapy were assessed for response by MRI and pathology staging by T, N and circumferential resection margin (CRM) status. Tumor regression grade (TRG) was also assessed by MRI. Overall survival (OS) was estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging of good and poor responders on MRI or pathology and survival outcomes after controlling for patient characteristics. On multivariate analysis, the MRI-assessed TRG (mrTRG) hazard ratios (HRs) were independently significant for survival (HR, 4.40; 95% CI, 1.65 to 11.7) and disease-free survival (DFS; HR, 3.28; 95% CI, 1.22 to 8.80). Five-year survival for poor mrTRG was 27% versus 72% (P = .001), and DFS for poor mrTRG was 31% versus 64% (P = .007). Preoperative MRI-predicted CRM independently predicted local recurrence (LR; HR, 4.25; 95% CI, 1.45 to 12.51). Five-year survival for poor post-treatment pathologic T stage (ypT) was 39% versus 76% (P = .001); DFS for the same was 38% versus 84% (P = .001); and LR for the same was 27% versus 6% (P = .018). The 5-year survival for involved pCRM was 30% versus 59% (P = .001); DFS, 28 versus 62% (P = .02); and LR, 56% versus 10% (P = .001). Pathology node status did not predict outcomes. MRI assessment of TRG and CRM are imaging markers that predict survival outcomes for good and poor responders and provide an opportunity for the multidisciplinary team to offer additional treatment options before planning definitive surgery. Postoperative histopathology assessment of ypT and CRM but not post-treatment N status were important postsurgical predictors of outcome.

Correlations between Stroop task performance and white matter lesion measures in late-onset major depression.

PubMed

Dalby, Rikke B; Frandsen, Jesper; Chakravarty, M Mallar; Ahdidan, Jamila; Sørensen, Leif; Rosenberg, Raben; Østergaard, Leif; Videbech, Poul

2012-05-31

Cerebral white matter lesions (WMLs) are believed to play an important role in a subset of patients with late-onset depression by affecting the white matter connectivity in circuitries essential for mood and cognition. In this study we used diffusion tensor imaging-based (DTI-based) tractography to assess white matter fiber tracts affected by deep WMLs (DWMLs) in patients with late-onset major depression and age- and gender-matched controls. Tractography outcome, illustrated as pathways affected by DWMLs, was analyzed for associations with cognitive performance on the Stroop Test (ST). The patients (n=17) performed significantly worse on the ST than the controls (n=22). Poor performance on the ST correlated with higher lesion load. Regression analysis showed a significant correlation between poor performance on the ST and tracts affected by DWMLs in multiple brain areas in the control group, but very sparse correlation in the patient group. Our results suggest that DWMLs play an important role in the cognitive performance of controls,whereas their influence in depressed patients is overruled by additional, state-dependent factors. Future focus on the tract-specific localization of WMLs using DTI tractography may reveal important associations between neuroconnectivity and clinical measures. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Outcomes of multiple wire localization for larger breast cancers: when can mastectomy be avoided?

PubMed

Kirstein, Laurie J; Rafferty, Elizabeth; Specht, Michelle C; Moore, Richard H; Taghian, Alphonse G; Hughes, Kevin S; Gadd, Michele A; Smith, Barbara L

2008-09-01

Mastectomy is often recommended when mammography shows a breast cancer with extensive calcifications. We wished to determine whether the use of multiple localizing wires to guide lumpectomy in this setting was associated with increased rates of breast conservation. We also wanted to identify factors that predicted a poor chance of successful lumpectomy, to avoid multiple lumpectomy attempts in a patient who would ultimately require mastectomy. Records of 153 women with breast cancer who underwent lumpectomy for larger lesions that required multiple wire localization and 196 controls who required only single wire localization were reviewed retrospectively. The number of localizing wires, specimen volume, largest specimen dimension, number of surgical procedures, and rates of breast conservation were scored. Seventy-seven percent of patients requiring multiple wire localization had successful breast conservation, compared with 90% of those needing only single wire localization. Only 28% of multiple wire patients required more than 1 excision to achieve clear margins, compared with 36% of single wire patients (p < 0.01). Breast conservation is possible in the great majority of breast cancer patients whose mammographic lesions require multiple localizing wires for excision. The use of multiple wires can decrease the number of procedures required to obtain clear lumpectomy margins.

Perception of Students on Causes of Poor Performance in Chemistry in External Examinations in Umuahia North Local Government of Abia State

ERIC Educational Resources Information Center

Ojukwu, M. O.

2016-01-01

The aim of this study was to investigate the perception of students on the causes of their poor performance in external chemistry examinations in Umuahia North Local Government Area of Abia State. Descriptive survey design was used for the study. Two hundred and forty (240) students were selected through simple random sampling for the study. A…

Weak climatic control of stand-scale fire history during the late holocene.

PubMed

Gavin, Daniel G; Hu, Feng Sheng; Lertzman, Kenneth; Corbett, Peter

2006-07-01

Forest fire occurrence is affected by multiple controls that operate at local to regional scales. At the spatial scale of forest stands, regional climatic controls may be obscured by local controls (e.g., stochastic ignitions, topography, and fuel loads), but the long-term role of such local controls is poorly understood. We report here stand-scale (<100 ha) fire histories of the past 5000 years based on the analysis of sediment charcoal at two lakes 11 km apart in southeastern British Columbia. The two lakes are today located in similar subalpine forests, and they likely have experienced the same late-Holocene climatic changes because of their close proximity. We evaluated two independent properties of fire history: (1) fire-interval distribution, a measure of the overall incidence of fire, and (2) fire synchroneity, a measure of the co-occurrence of fire (here, assessed at centennial to millennial time scales due to the resolution of sediment records). Fire-interval distributions differed between the sites prior to, but not after, 2500 yr before present. When the entire 5000-yr period is considered, no statistical synchrony between fire-episode dates existed between the two sites at any temporal scale, but for the last 2500 yr marginal levels of synchrony occurred at centennial scales. Each individual fire record exhibited little coherency with regional climate changes. In contrast, variations in the composite record (average of both sites) matched variations in climate evidenced by late-Holocene glacial advances. This was probably due to the increased sample size and spatial extent represented by the composite record (up to 200 ha) plus increased regional climatic variability over the last several millennia, which may have partially overridden local, non-climatic controls. We conclude that (1) over past millennia, neighboring stands with similar modern conditions may have experienced different fire intervals and asynchronous patterns in fire episodes, likely because local controls outweighed the synchronizing effect of climate; (2) the influence of climate on fire occurrence is more strongly expressed when climatic variability is relatively great; and (3) multiple records from a region are essential if climate-fire relations are to be reliably described.

The new Waste Law: Challenging opportunity for future landfill operation in Indonesia.

PubMed

Meidiana, Christia; Gamse, Thomas

2011-01-01

The Waste Law No. 18/2008 Article 22 and 44 require the local governments to run environmentally sound landfill. Due to the widespread poor quality of waste management in Indonesia, this study aimed to identify the current situation by evaluating three selected landfills based on the ideal conditions of landfill practices, which are used to appraise the capability of local governments to adapt to the law. The results indicated that the local governments have problems of insufficient budget, inadequate equipment, uncollected waste and unplanned future landfill locations. All of the selected landfills were partially controlled landfills with open dumping practices predominating. In such inferior conditions the implementation of sanitary landfill is not necessarily appropriate. The controlled landfill is a more appropriate solution as it offers lower investment and operational costs, makes the selection of a new landfill site unnecessary and can operate with a minimum standard of infrastructure and equipment. The sustainability of future landfill capacity can be maintained by utilizing the old landfill as a profit-oriented landfill by implementing a landfill gas management or a clean development mechanism project. A collection fee system using the pay-as-you-throw principle could increase the waste income thereby financing municipal solid waste management.

Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model.

PubMed

Zhao, Xi-Lan; Luo, Xiao; Wang, Ze-Xin; Yang, Guo-Li; Liu, Ji-Zhong; Liu, Ya-Qiong; Li, Ming; Chen, Min; Xia, Yong-Mei; Liu, Jun-Jie; Qiu, Shu-Ping; Gong, Xiao-Qing

2015-01-01

Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that observed in normal tissue. To investigate the role of EMMPRIN in regulating ulcer healing, specific antibodies against EMMPRIN were used via direct administration on the pressure ulcer. Local blockage of EMMPRIN resulted in a poor ulcer healing process compared with control ulcers, which was the opposite of our expectation. Furthermore, inhibiting EMMPRIN minimally impacted MMP activity. However, the collagen content in the pressure ulcer was reduced in the EMMPRIN treated group. Angiogenesis and the expression of angiogenic factors in pressure ulcers were also reduced by EMMPRIN local blockage. The results in the present study indicate a novel effect of EMMPRIN in the regulation of pressure ulcer healing by controlling the collagen contents and angiogenesis rather than MMPs activity.

Chromosome position effects on gene expression in Escherichia coli K-12

PubMed Central

Bryant, Jack A.; Sellars, Laura E.; Busby, Stephen J. W.; Lee, David J.

2014-01-01

In eukaryotes, the location of a gene on the chromosome is known to affect its expression, but such position effects are poorly understood in bacteria. Here, using Escherichia coli K-12, we demonstrate that expression of a reporter gene cassette, comprised of the model E. coli lac promoter driving expression of gfp, varies by ∼300-fold depending on its precise position on the chromosome. At some positions, expression was more than 3-fold higher than at the natural lac promoter locus, whereas at several other locations, the reporter cassette was completely silenced: effectively overriding local lac promoter control. These effects were not due to differences in gene copy number, caused by partially replicated genomes. Rather, the differences in gene expression occur predominantly at the level of transcription and are mediated by several different features that are involved in chromosome organization. Taken together, our findings identify a tier of gene regulation above local promoter control and highlight the importance of chromosome position effects on gene expression profiles in bacteria. PMID:25209233

Long-term trends of ambient particulate matter emission source contributions and the accountability of control strategies in Hong Kong over 1998-2008

NASA Astrophysics Data System (ADS)

Yuan, Zibing; Yadav, Varun; Turner, Jay R.; Louie, Peter K. K.; Lau, Alexis Kai Hon

2013-09-01

Despite extensive emission control measures targeting motor vehicles and to a lesser extent other sources, annual-average PM10 mass concentrations in Hong Kong have remained relatively constant for the past several years and for some air quality metrics, such as the frequency of poor visibility days, conditions have degraded. The underlying drivers for these long-term trends were examined by performing source apportionment on eleven years (1998-2008) of data for seven monitoring sites in the Hong Kong PM10 chemical speciation network. Nine factors were resolved using Positive Matrix Factorization. These factors were assigned to emission source categories that were classified as local (operationally defined as within the Hong Kong Special Administrative Region) or non-local based on temporal and spatial patterns in the source contribution estimates. This data-driven analysis provides strong evidence that local controls on motor vehicle emissions have been effective in reducing motor vehicle-related ambient PM10 burdens with annual-average contributions at neighborhood- and larger-scale monitoring stations decreasing by ˜6 μg m-3 over the eleven year period. However, this improvement has been offset by an increase in annual-average contributions from non-local contributions, especially secondary sulfate and nitrate, of ˜8 μg m-3 over the same time period. As a result, non-local source contributions to urban-scale PM10 have increased from 58% in 1998 to 70% in 2008. Most of the motor vehicle-related decrease and non-local source driven increase occurred over the period 1998-2004 with more modest changes thereafter. Non-local contributions increased most dramatically for secondary sulfate and secondary nitrate factors and thus combustion-related control strategies, including but not limited to power plants, are needed for sources located in the Pearl River Delta and more distant regions to improve air quality conditions in Hong Kong. PMF-resolved source contribution estimates were also used to examine differential contributions of emission source categories during high PM episodes compared to study-average behavior. While contributions from all source categories increased to some extent on high PM days, the increases were disproportionately high for the non-local sources. Thus, controls on emission sources located outside the Hong Kong Special Administrative Region will be needed to effectively decrease the frequency and severity of high PM episodes.

[Constipation in patients with diabetes mellitus].

PubMed

Rossol, Siegbert

2007-11-01

Up to 60% of the patients with diabetes mellitus suffer from gastrointestinal tract symptoms that arise pathogenetically from a disturbance of the autonomous nervous system. Patient age, disease duration and poor control of diabetes mellitus correlate positively with the presence of gastrointestinal symptoms. Chronic constipation, in addition to diarrhoea, gall bladder dysfunction and incontinence, is increasingly regarded as a serious problem and for the first time, is now considered in the current guidelines of the professional societies. Modern diagnosis and treatment facilitate systematic control of the symptoms. Treatment necessitates long-term intake of laxatives, proper diabetes control and other accompanying general measures such as adequate amounts of liquids, dietary fibre and exercise. Motility and secretion-stimulating, osmotically active or locally applied laxatives are used. Slow transit constipation, which is typically observed in diabetics, can be best controlled with polyethylene glycol, bisacodyl or sodium picosulphate.

Evaluation of the Ciba Corning Biotrack 512 coagulation monitor for the control of oral anticoagulation.

PubMed Central

Jennings, I; Luddington, R J; Baglin, T

1991-01-01

The Ciba Corning Biotrack 512 coagulation monitor requires a minimal degree of technical expertise to operate, and is already in use for near-patient testing. This study evaluated the monitor for possible use in decentralised control of oral anticoagulant treatment. The monitor compared well with Manchester Reagent, suggesting that it could be used in areas where this thromboplastin is used for centralised control. The inability of the monitor to allow for locally determined geometric mean normal prothrombin times in the calculation of the International Normalised Ratio (INR), and possibly the high International Sensitivity Index (ISI) of the thromboplastin used with the monitor, resulted in poor comparability with some other thromboplastins, particularly Thrombotest. These problems need to be addressed if the monitor is to be used for decentralised anticoagulant control. PMID:1752987

Education Research: Bias and poor interrater reliability in evaluating the neurology clinical skills examination

PubMed Central

Schuh, L A.; London, Z; Neel, R; Brock, C; Kissela, B M.; Schultz, L; Gelb, D J.

2009-01-01

Objective: The American Board of Psychiatry and Neurology (ABPN) has recently replaced the traditional, centralized oral examination with the locally administered Neurology Clinical Skills Examination (NEX). The ABPN postulated the experience with the NEX would be similar to the Mini-Clinical Evaluation Exercise, a reliable and valid assessment tool. The reliability and validity of the NEX has not been established. Methods: NEX encounters were videotaped at 4 neurology programs. Local faculty and ABPN examiners graded the encounters using 2 different evaluation forms: an ABPN form and one with a contracted rating scale. Some NEX encounters were purposely failed by residents. Cohen’s kappa and intraclass correlation coefficients (ICC) were calculated for local vs ABPN examiners. Results: Ninety-eight videotaped NEX encounters of 32 residents were evaluated by 20 local faculty evaluators and 18 ABPN examiners. The interrater reliability for a determination of pass vs fail for each encounter was poor (kappa 0.32; 95% confidence interval [CI] = 0.11, 0.53). ICC between local faculty and ABPN examiners for each performance rating on the ABPN NEX form was poor to moderate (ICC range 0.14-0.44), and did not improve with the contracted rating form (ICC range 0.09-0.36). ABPN examiners were more likely than local examiners to fail residents. Conclusions: There is poor interrater reliability between local faculty and American Board of Psychiatry and Neurology examiners. A bias was detected for favorable assessment locally, which is concerning for the validity of the examination. Further study is needed to assess whether training can improve interrater reliability and offset bias. GLOSSARY ABIM = American Board of Internal Medicine; ABPN = American Board of Psychiatry and Neurology; CI = confidence interval; HFH = Henry Ford Hospital; ICC = intraclass correlation coefficients; IM = internal medicine; mini-CEX = Mini-Clinical Evaluation Exercise; NEX = Neurology Clinical Skills Examination; RITE = residency inservice training examination; UC = University of Cincinnati; UM = University of Michigan; USF = University of South Florida. PMID:19605769

Dirt, disease and death: control, resistance and change in the post-emancipation Caribbean.

PubMed

Pemberton, Rita

2012-12-01

This study examines how health facilities and services were used as an agency of worker control in the British Caribbean between 1838 and 1860. It argues that planter health strategies were based on flawed assumptions. The resultant policy of deprivation of access to medical services by the labouring population backfired within 16 years of freedom when a cholera epidemic rocked the region. It exposed the poor living conditions of the free villages and generated fear and panic among the local elite who were forced to make policy changes regarding health and sanitation. As a result the first steps towards the establishment of public health services in the British Caribbean were stimulated.

Perceptual processing deficits underlying reduced FFOV efficiency in older adults.

PubMed

Power, Garry F; Conlon, Elizabeth G

2017-01-01

Older adults are known to perform more poorly on measures of the functional field of view (FFOV) than younger adults. Specific contributions by poor bottom-up and or top-down control of visual attention to the reduced FFOV of older adults were investigated. Error rates of older and younger adults were compared on a FFOV task in which a central identification task, peripheral localization task, and peripheral distractors were presented in high and low contrast. Older adults made more errors in all conditions. The effect of age was independent of the contrast of the peripheral target or distractors. The performance cost of including the central task was measured and found to be negligible for younger adults. For older adults performance costs were present in all conditions, greater with distractors than without, and greater for a low rather than high contrast central stimulus when the peripheral target was high contrast. These results are consistent with older adults compensating for reduced sensory input or bottom-up capture of attention by relying more heavily on top-down control for which they are resource limited.

Proteomic analysis of serum and sputum analytes distinguishes controlled and poorly controlled asthmatics.

PubMed

Kasaian, M T; Lee, J; Brennan, A; Danto, S I; Black, K E; Fitz, L; Dixon, A E

2018-04-17

A major goal of asthma therapy is to achieve disease control, with maintenance of lung function, reduced need for rescue medication, and prevention of exacerbation. Despite current standard of care, up to 70% of patients with asthma remain poorly controlled. Analysis of serum and sputum biomarkers could offer insights into parameters associated with poor asthma control. To identify signatures as determinants of asthma disease control, we performed proteomics using Olink proximity extension analysis. Up to 3 longitudinal serum samples were collected from 23 controlled and 25 poorly controlled asthmatics. Nine of the controlled and 8 of the poorly controlled subjects also provided 2 longitudinal sputum samples. The study included an additional cohort of 9 subjects whose serum was collected within 48 hours of asthma exacerbation. Two separate pre-defined Proseek Multiplex panels (INF and CVDIII) were run to quantify 181 separate protein analytes in serum and sputum. Panels consisting of 9 markers in serum (CCL19, CCL25, CDCP1, CCL11, FGF21, FGF23, Flt3L, IL-10Rβ, IL-6) and 16 markers in sputum (tPA, KLK6, RETN, ADA, MMP9, Chit1, GRN, PGLYRP1, MPO, HGF, PRTN3, DNER, PI3, Chi3L1, AZU1, and OPG) distinguished controlled and poorly controlled asthmatics. The sputum analytes were consistent with a pattern of neutrophil activation associated with poor asthma control. The serum analyte profile of the exacerbation cohort resembled that of the controlled group rather than that of the poorly controlled asthmatics, possibly reflecting a therapeutic response to systemic corticosteroids. Proteomic profiles in serum and sputum distinguished controlled and poorly controlled asthmatics, and were maintained over time. Findings support a link between sputum neutrophil markers and loss of asthma control. © 2018 John Wiley & Sons Ltd.

Women in water management: the need for local planning.

PubMed

Bhatt, M R

1995-08-01

This article on women's role in water resource management is based on a paper delivered at a seminar organized at the Water and Land Management Institute in Anand, India, in 1994. The article reflects Family Planning International's (FPI) experience in community-based water resource development. Most analyses of village and household water management data exclude women's role. The reasons are identified as the lack of inclusion of women's thinking in land-development research and planning, the dominance of males in planning and consequent male assumptions made about women's work and use of water, the lack of valuation of the nonmonetary nature of women's relationship to water, and the ease of ignoring women. Women's roles that are obstacles to inclusion in research and planning are identified as the lack of effective women's lobbies, the undervaluation by women of their work, and the lack of professional recognition of women as potential users of water or spokespersons for more than their own self-interests as women. National water policies are shifting to community-based management because local authorities are in daily contact with users, of whom about 50% are women. Historically national policy shifted from attention to distribution of investments in the water sector to reorganization of water agencies and to building up the capacity of private or voluntary agencies. The local context allows for more efficient and effective responses to local conditions. Local institutions and groups are better equipped to solicit local participation. One primary lesson learned by FPI is that local water resource planning is very important in strengthening the economic and individual capacity of poor people in underdeveloped areas. FPI's experience in Mahesana, Banaskantha, and Sabarkantha in Gujarat state supports this lesson learned. Water resource development policies resulted in mixed outcomes, and national control has been inefficient and disrespectful to local authorities. Another obstacle in Gujarat to water resource development is identified as increased demand for public water services and inadequate provision of services due to remoteness of the area and financial limitations of central agencies. Infrastructure is poorly maintained.

Cryoablation of Bone Metastases from Renal Cell Carcinoma for Local Tumor Control.

PubMed

Gardner, Carly S; Ensor, Joe E; Ahrar, Kamran; Huang, Steven Y; Sabir, Sharjeel H; Tannir, Nizar M; Lewis, Valerae O; Tam, Alda L

2017-11-15

Patients with bone metastases from renal cell carcinoma often are not surgical candidates and have a poor prognosis. There are limited data on the use of cryoablation as a locoregional therapy for bone metastases. Our objective was to assess the local tumor-control rate following cryoablation of bone metastases in the setting of renal cell carcinoma. We retrospectively reviewed the medical records of patients with metastatic renal cell carcinoma who underwent cryoablation for bone metastases between 2007 and 2014. We excluded patients if the intent of treatment was for pain palliation only, if cryoablation was performed without an attempt for complete tumor control (cytoreduction), or if the patient had no further follow-up beyond the cryoablation procedure. We recorded patient demographics, procedural variables, and complications. Cross-sectional imaging and clinical follow-up were reviewed to determine disease recurrence. The median overall survival and recurrence-free survival were determined using the Kaplan-Meier method. Forty patients (30 male and 10 female) with 50 bone metastases were included for analysis. The mean patient age was 62 years (range, 47 to 82 years). The median follow-up was 35 months (95% confidence interval [CI], 22.7 to 74.4 months). Twenty-five (62.5%) of the 40 patients had oligometastatic disease, defined as ≤5 metastases at the time of ablation. The mean tumor size was 3.4 ± 1.5 cm. Metastases in the pelvic region represented 68% of the treated tumors (34 of 50). The overall local tumor-control rate per lesion was 82% (41 of 50). Patients with oligometastatic disease experienced better local tumor control (96% [24 of 25]) compared with patients who had >5 metastases (53.3% [8 of 15]) (p = 0.001). The local tumor-control rate was better for lesions for which a larger mean difference between maximum ice-ball diameter and maximum lesion diameter was achieved (2.2 ± 0.9 cm for those without recurrence versus 1.35 ± 1.2 cm for those with recurrence; p = 0.005). There were 3 grade-3 complications and 1 grade-4 complication. Cryoablation can be effective for achieving local oncologic control in bone metastases from renal cell carcinoma and may represent a valuable alternative to surgical metastasectomy in select patients. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Stratal stacking patterns and tectono-sedimentary evolution of hyperextended magma-poor rifted margins

NASA Astrophysics Data System (ADS)

Ribes, C.; Gillard, M.; Epin, M. E.; Ghienne, J. F.; Manatschal, G.; Karner, G. D.; Johnson, C. A.

2016-12-01

Research on the formation and evolution of deep-water rifted margins has undergone a major paradigm shift in recent years. An increasing number of studies of present-day and fossil rifted margins allow us to identify and characterize the structural architecture of the most distal parts of rifted margins, the so-called hyperextended, magma-poor rifted margins. However, at present, little is known about the depositional environments, sedimentary facies, stacking patterns, subsidence and thermal history within these domains. In this context, characterizing the stratal stacking patterns and understanding their spatial and temporal evolution is a new challenge. The major difficulty comes from the fact that the observed stratigraphic geometries and facies relationships are a result of the complex interplay between sediment supply and available accommodation, which is controlled by not only the regional generation of accommodation, but also by local tectono-magmatic processes. These parameters are poorly constrained or even sufficiently known in these tectonic settings. Indeed, the complex structural evolution of hyperextended magma-poor rifted margins, including the development of poly-phase in-sequence and out of sequence extensional detachment faults and associated mantle exhumation and magmatic activity, can generate complex accommodation patterns over a highly structured top basement. The presentation summarizes early results concerning the controlling parameters on ultra-deep water stratigraphic stacking patterns and to provide a conceptual framework. This observation-driven approach combines fieldwork from fossil Alpine Tethys margins exposed in the Alps and the analysis of seismic reflection data from present-day deep water rifted margins such as the Australian-Antarctic, East India and Iberia-Newfoundland margins.

The advocacy in action study a cluster randomized controlled trial to reduce pedestrian injuries in deprived communities.

PubMed

Lyons, R A; Towner, E; Christie, N; Kendrick, D; Jones, S J; Hayes, M; Kimberlee, R; Sarvotham, T; Macey, S; Brussoni, M; Sleney, J; Coupland, C; Phillips, C

2008-04-01

Road traffic-related injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety. To design an intervention to improve the uptake of pedestrian safety measures in deprived communities. Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults. Design mixedmethods study, incorporating a cluster randomized controlled trial. Data mixture of Geographical Information Systems data collision locations, road safety interventions, telephone interviews, and questionnaires. Randomization 239 electoral wards clustered within 57 local authorities. Participants 615 politicians representing intervention and control wards. Intervention a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls. Primary outcome number of road safety interventions 25 months after randomization. Secondary outcomes politicians interest and involvement in injury prevention cost of interventions. Process evaluation use of advocacy pack, facilitators and barriers to involvement, and success.

Local and long-range endogenous resting potential gradients antagonistically regulate apoptosis and proliferation in the embryonic CNS.

PubMed

Pai, Vaibhav P; Lemire, Joan M; Chen, Ying; Lin, Gufa; Levin, Michael

2015-01-01

Bioelectric signals, particularly transmembrane voltage potentials (Vmem), play an important role in large-scale patterning during embryonic development. Endogenous bioelectric gradients across tissues function as instructive factors during eye, brain, and other morphogenetic processes. An important and still poorly-understood aspect is the control of cell behaviors by the voltage states of distant cell groups. Here, experimental alteration of endogenous Vmem was induced in Xenopus laevis embryos by misexpression of well-characterized ion channel mRNAs, a strategy often used to identify functional roles of Vmem gradients during embryonic development and regeneration. Immunofluorescence analysis (for activated caspase 3 and phosphor-histone H3P) on embryonic sections was used to characterize apoptosis and proliferation. Disrupting local bioelectric signals (within the developing neural tube region) increased caspase 3 and decreased H3P in the brain, resulting in brain mispatterning. Disrupting remote (ventral, non-neural region) bioelectric signals decreased caspase 3 and highly increased H3P within the brain, with normal brain patterning. Disrupting both the local and distant bioelectric signals produced antagonistic effects on caspase 3 and H3P. Thus, two components of bioelectric signals regulate apoptosis-proliferation balance within the developing brain and spinal cord: local (developing neural tube region) and distant (ventral non-neural region). Together, the local and long-range bioelectric signals create a binary control system capable of fine-tuning apoptosis and proliferation with the brain and spinal cord to achieve correct pattern and size control. Our data suggest a roadmap for utilizing bioelectric state as a diagnostic modality and convenient intervention parameter for birth defects and degenerative disease states of the CNS.

Prognostic value of loss of heterozygosity and sub-cellular localization of SMAD4 varies with tumor stage in colorectal cancer.

PubMed

Jia, Xu; Shanmugam, Chandrakumar; Paluri, Ravi K; Jhala, Nirag C; Behring, Michael P; Katkoori, Venkat R; Sugandha, Shajan P; Bae, Sejong; Samuel, Temesgen; Manne, Upender

2017-03-21

Although loss of heterozygosity (LOH) at chromosome location 18q21 and decreased expression of SMAD4 in invasive colorectal cancers (CRCs) correlate with poor patient survival, the prognostic value of LOH at 18q21 and sub-cellular localization of SMAD4 have not been evaluated in relation to tumor stage. Genomic DNA samples from 209 formalin-fixed, paraffin-embedded sporadic CRC tissues and their matching controls were analyzed for 18q21 LOH, and corresponding tissue sections were evaluated by immunohistochemistry for expression of SMAD4 and assessed for its sub-cellular localization (nuclear vs. cytoplasmic). In addition, 53 frozen CRCs and their matching control tissues were analyzed for their mutational status and mRNA expression of SMAD4. The phenotypic expression pattern and LOH status were evaluated for correlation with patient survival by the use of Kaplan-Meier and Cox regression models. LOH of 18q21 was detected in 61% of the informative cases. In 8% of the cases, missense point mutations were detected in Smad4. In CRCs, relative to controls, there was increased SMAD4 staining in the cytoplasm (74%) and decreased staining in the nuclei (37%). LOH of 18q21 and high cytoplasmic localization of SMAD4 were associated with shortened overall survival of Stage II patients, whereas low nuclear expression of SMAD4 was associated with worse survival, but only for patients with Stage III CRCs. LOH of 18q21 and high cytoplasmic localization of SMAD4 in Stage II CRCs and low nuclear SMAD4 in Stage III CRCs are predictors of shortened patient survival.

Prognostic value of loss of heterozygosity and sub-cellular localization of SMAD4 varies with tumor stage in colorectal cancer

PubMed Central

Jia, Xu; Shanmugam, Chandrakumar; Paluri, Ravi K.; Jhala, Nirag C.; Behring, Michael P.; Katkoori, Venkat R.; Sugandha, Shajan P.; Bae, Sejong; Samuel, Temesgen; Manne, Upender

2017-01-01

Background Although loss of heterozygosity (LOH) at chromosome location 18q21 and decreased expression of SMAD4 in invasive colorectal cancers (CRCs) correlate with poor patient survival, the prognostic value of LOH at 18q21 and sub-cellular localization of SMAD4 have not been evaluated in relation to tumor stage. Methods Genomic DNA samples from 209 formalin-fixed, paraffin-embedded sporadic CRC tissues and their matching controls were analyzed for 18q21 LOH, and corresponding tissue sections were evaluated by immunohistochemistry for expression of SMAD4 and assessed for its sub-cellular localization (nuclear vs. cytoplasmic). In addition, 53 frozen CRCs and their matching control tissues were analyzed for their mutational status and mRNA expression of SMAD4. The phenotypic expression pattern and LOH status were evaluated for correlation with patient survival by the use of Kaplan-Meier and Cox regression models. Results LOH of 18q21 was detected in 61% of the informative cases. In 8% of the cases, missense point mutations were detected in Smad4. In CRCs, relative to controls, there was increased SMAD4 staining in the cytoplasm (74%) and decreased staining in the nuclei (37%). LOH of 18q21 and high cytoplasmic localization of SMAD4 were associated with shortened overall survival of Stage II patients, whereas low nuclear expression of SMAD4 was associated with worse survival, but only for patients with Stage III CRCs. Conclusions LOH of 18q21 and high cytoplasmic localization of SMAD4 in Stage II CRCs and low nuclear SMAD4 in Stage III CRCs are predictors of shortened patient survival. PMID:28423626

Influence of Smoking and Alcohol Drinking Behaviors on Treatment Outcomes of Patients With Squamous Cell Carcinomas of the Head and Neck

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fortin, Andre; Wang, C.S.; Vigneault, Eric

Purpose: To retrospectively evaluate the prognostic value of smoking and drinking status in patients with head-and-neck squamous cell carcinomas. Methods and Materials: All patients with all stages and sites were included if complete information was available on baseline smoking and alcohol behavior (never, former, active), disease stage, primary site, radiation dose, sex, and age. Treatment was radiotherapy in 973 patients, postoperative radiotherapy in 469, and chemoradiotherapy in 429. Statistical analysis was performed with Kaplan-Meier and Cox methods. Results: Data from 1,871 patients were available. At baseline, 9% of patients never smoked, 40% were former smokers, and 51% were active smokers;more » 20% never drank, 25% were former drinkers, and 55% were active drinkers. Smoking was associated with inferior local control and survival. For local control, the hazard ratio (HR) of active smokers vs. former smokers was 1.5 (p = 0.0001). For survival, the HRs of former smokers and active smokers vs. those who never smoked were also statistically significant (1.3 and 1.7, respectively, p = 0.000001). Alcohol drinking was associated with local control (p = 0.03), and was associated with survival. For survival, HRs of former and active drinkers compared with those who never drank were, respectively, 1.1 (p = 0.01) and 1.28 (p = 0.001). Adjusted 5-year local control and survival rates for those who never smoked and never drank were 87% and 77%, respectively, and for those who were both active smokers and active drinkers were 72% (p = 0.007) and 52% (p = 0.0009), respectively. Conclusion: Smoking and drinking at baseline were associated with poor outcomes in these patients.« less

Shorter-Course Whole-Brain Radiotherapy for Brain Metastases in Elderly Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rades, Dirk, E-mail: rades.dirk@gmx.net; Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg; Evers, Jasmin N.

2011-11-15

Purpose: Many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone. Using 10 Multiplication-Sign 3 Gy in 2 weeks is the standard regimen in most centers. Regarding the extraordinarily poor survival prognosis of elderly patients with multiple brain metastases, a shorter WBRT regimen would be preferable. This study compared 10 Multiplication-Sign 3 Gy with 5 Multiplication-Sign 4 Gy in elderly patients ({>=}65 years). Methods and Materials: Data from 455 elderly patients who received WBRT alone for brain metastases were retrospectively analyzed. Survival and local (= intracerebral) control of 293 patients receiving 10 Multiplication-Sign 3 Gy were compared with 162 patientsmore » receiving 5 Multiplication-Sign 4 Gy. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), primary tumor, number of brain metastases, interval from tumor diagnosis to WBRT, extracerebral metastases, and recursive partitioning analysis (RPA) class. Results: The 6-month overall survival rates were 29% after 5 Multiplication-Sign 4 Gy and 21% after 10 Multiplication-Sign 3 Gy (p = 0.020). The 6-month local control rates were 12% and 10%, respectively (p = 0.32). On multivariate analysis, improved overall survival was associated with KPS {>=} 70 (p < 0.001), only one to three brain metastases (p = 0.029), no extracerebral metastasis (p = 0.012), and lower RPA class (p < 0.001). Improved local control was associated with KPS {>=} 70 (p < 0.001), breast cancer (p = 0.029), and lower RPA class (p < 0.001). Conclusions: Shorter-course WBRT with 5 Multiplication-Sign 4 Gy was not inferior to 10 Multiplication-Sign 3 Gy with respect to overall survival or local control in elderly patients. 5 Multiplication-Sign 4 Gy appears preferable for the majority of these patients.« less

Local and synoptic controls on rapid supraglacial lake drainage in West Greenland

NASA Astrophysics Data System (ADS)

Williamson, Andrew; Banwell, Alison; Arnold, Neil; Willis, Ian

2016-04-01

Many supraglacial lakes within the ablation zone of the Greenland Ice Sheet (GrIS) are known to drain rapidly (in <1 day) in the mid- to late melt season, delivering large meltwater pulses to the subglacial drainage system, thus affecting basal water pressures and ice-sheet dynamics. Although it is now generally recognised that rapid lake drainage is caused by hydrofracture, the precise controls on hydrofracture initiation remain poorly understood: they may be linked to a local critical water-volume threshold, or they may be associated with synoptic-scale factors, such as ice thickness, driving stresses, ice velocities and strain rates. A combination of the local water-volume threshold and one or more synoptic-scale factors may explain the overall patterns of rapid lake drainage, but this requires verification using targeted field- and remotely-based studies that cover large areas of the GrIS and span long timescales. Here, we investigate a range of potential controls on rapid supraglacial lake drainage in the land-terminating Paakitsoq region of the ice sheet, northeast of Jakobshavn Isbræ, for the 2014 melt season. We have analysed daily 250-m Moderate Resolution Imaging Spectroradiometer (MODIS) imagery in order to calculate lake areas, depths and volumes, and have developed an automatic lake-tracking algorithm to determine the dates on which all rapid lake drainage events occur. For each rapidly draining lake, the water volumes immediately prior to drainage are compared with other local factors, notably lake-filling rate and ice thickness, and with a variety of synoptic-scale features, such as slope angles, driving stresses, surface velocities, surface strain rates and the incidence of nearby lake-drainage events. We present the outcomes of our statistical analysis to elicit the statistically significant controls on hydrofracture beneath supraglacial lakes.

An effective technique to facilitate radiographic stone visualization with an internal stent during shock wave lithotripsy.

PubMed

Sundaram, C P; Saltzman, B

1998-10-01

We describe a simple method to assist stone localization during shock wave lithotripsy in the presence of a Double J stent. A 4F whistle tip ureteral catheter is passed alongside a previously inserted 6F Double J stent. The tip of the ureteral stent is positioned in the lower or mid third of the ureter. Contrast material is injected through the ureteral catheter during lithotripsy to assist stone localization. This technique has been successful in localization of poorly opacified renal stones during lithotripsy. Radiolucent and poorly calcified renal stones can be easily localized during shock wave lithotripsy, despite the presence of a Double J stent. No special catheters or stents are required for this technique.

Rural-urban disparity in knowledge and compliance with traffic signs among young commercial motorcyclists in selected local government areas in Oyo State, Nigeria.

PubMed

Olumide, Adesola O; Owoaje, Eme T

2017-06-01

This study compared knowledge and compliance with traffic signs among young commercial motorcyclists in rural and urban communities in Oyo state, Nigeria. Information on knowledge and compliance with 10 common traffic signs was obtained from 149 rural and 113 urban commercial motorcyclists aged 18-35 years. Aggregate knowledge scores were computed and categorized as good (≥5) and poor (<5) knowledge. Overall, 98.7% rural versus 61.1% urban motorcyclists had poor knowledge of traffic signs (p < 0.05). After controlling for age, level of education and years of commercial riding, motorcyclists in the rural areas were more likely to have poor knowledge of the traffic signs (OR = 58.15; 95% CI = 11.96-282.79). A higher proportion of rural than urban motorcyclists never obeyed any of the traffic signs. Young rural commercial motorcyclists' knowledge and compliance with the road signs was poorer than their urban counterparts. Interventions to improve the rural motorcyclists' knowledge and ultimately compliance with road signs are urgently required.

A Froude-scaled model of a bedrock-alluvial channel reach: 1. Hydraulics

NASA Astrophysics Data System (ADS)

Hodge, Rebecca A.; Hoey, Trevor B.

2016-09-01

The controls on hydraulics in bedrock-alluvial rivers are relatively poorly understood, despite the importance of the flow in determining rates and patterns of sediment transport and consequent erosion. To measure hydraulics within a bedrock-alluvial channel, we developed a 1:10 Froude-scaled laboratory model of an 18 × 9 m bedrock-alluvial river reach using terrestrial laser scanning and 3-D printing. In the reported experiments, water depth and velocity were recorded at 18 locations within the channel at each of five different discharges. Additional data from runs with sediment cover in the flume were used to evaluate the hydraulic impact of sediment cover; the deposition and erosion of sediment patches in these runs are analyzed in the companion paper. In our data (1) spatial variation in both flow velocity and Froude number increases with discharge; (2) bulk flow resistance and Froude number become independent of discharge at higher discharges; (3) local flow velocity and Reynolds stress are correlated to the range of local bed topography at some, but not most, discharges; (4) at lower discharges, local topography induces vertical flow structures and slower velocities, but these effects decrease at higher discharges; and (5) there is a relationship between the linear combination of bed and sediment roughness and local flow velocity. These results demonstrate the control that bedrock topography exerts over both local and reach-scale flow conditions, but spatially distributed hydraulic data from bedrock-alluvial channels with different topographies are needed to generalize these findings.

Micro-structure and motion of two-dimensional dense short spherocylinder liquids

NASA Astrophysics Data System (ADS)

Wang, Wen; Lin, Jyun-Ting; Su, Yen-Shuo; I, Lin

2018-03-01

We numerically investigate the micro-structure and motion of 2D liquids composed of dense short spherocylinders, by reducing the shape aspect ratio from 3. It is found that reducing shape aspect ratio from 3 causes a smooth transition from heterogeneous structures composed of crystalline ordered domains with good tetratic alignment order to those with good hexagonal bond-orientational order at an aspect ratio equaling 1.35. In the intermediate regime, both structural orders are strongly deteriorated, and the translational hopping rate reaches a maximum due to the poor particle interlocking of the disordered structure. Shortening rod length allows easier rotation, induces monotonic increase of rotational hopping rates, and resumes the separation of rotational and translational hopping time scales at the small aspect ratio end, after the crossover of their rates in the intermediate regime. At the large shape aspect ratio end, the poor local tetratic order has the same positive effects on facilitating local rotational and translational hopping. In contrast, at the small shape aspect ratio end, the poor local bond orientational order has the opposite effects on facilitating local rotational and translational hopping.

Neonatal Hairy Ear Pinnae and Gestational Diabetes: Just a Coincidence?

PubMed

Valerio, Enrico; Riello, Laura; Chirico, Michela; Semenzato, Rossella; Cutrone, Mario

2015-01-01

A newborn girl of 36 weeks gestation was noted to have several anomalies, including bilateral low ear attachment with ear pinnae hypertrichosis, left preauricular pit, micrognathia, short lingual frenulum, and short neck. Pregnancy history revealed poorly controlled maternal gestational diabetes (GD). Localized hypertrichosis of the ear pinnae may represent a potential marker of GD and thereby alert physicians to suspect other potentially GD-associated conditions such as macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, hypertrophic cardiomyopathy, and congenital anomalies, particularly those involving the central nervous system. © 2015 Wiley Periodicals, Inc.

EVALUATION OF MEAT AS A FIRST COMPLEMENTARY FOOD FOR BREASTFED INFANTS: IMPACT ON IRON INTAKE & GROWTH

PubMed Central

Hambidge, K. Michael; Krebs, Nancy F.; Sheng, Xiaoyang; Jiang, Tianjiang; Mazariegos, Manolo; Garces, Ana; Li, Dinghua; Westcott, Jamie; Tshefu, Antoinette; Sami, Neelofar; Chomba, Elwyn; Pasha, Omrana; Lokangaka, Adrien; Goco, Norman; Manasyan, Albert; Wright, Linda L.; Koso-Thomas, Marion; Bose, Carl; Goldenberg, Robert L; Carlo, Waldemar A; McClure, Elizabeth M

2013-01-01

The rationale is considered for promoting the availability of local, affordable, non-fortified food sources of bioavailable iron in developing countries. Intakes of iron from the regular consumption of meat from the age of six months are evaluated with respect to physiological requirements. The paper includes a description of two major randomized controlled trials of meat as a first and regular complementary food that are currently in progress. These trials involve poor communities in Guatemala, Pakistan, Zambia, Democratic Republic of the Congo and China. PMID:22043884

Sustainable vector control and management of Chagas disease in the Gran Chaco, Argentina

PubMed Central

Gürtler, Ricardo E.; Kitron, Uriel; Cecere, M. Carla; Segura, Elsa L.; Cohen, Joel E.

2007-01-01

Chagas disease remains a serious obstacle to health and economic development in Latin America, especially for the rural poor. We report the long-term effects of interventions in rural villages in northern Argentina during 1984–2006. Two community-wide campaigns of residual insecticide spraying immediately and strongly reduced domestic infestation and infection with Trypanosoma cruzi in Triatoma infestans bugs and dogs and more gradually reduced the seroprevalence of children <15 years of age. Because no effective surveillance and control actions followed the first campaign in 1985, transmission resurged in 2–3 years. Renewed interventions in 1992 followed by sustained, supervised, community-based vector control largely suppressed the reestablishment of domestic bug colonies and finally led to the interruption of local human T. cruzi transmission. Human incidence of infection was nearly an order of magnitude higher in peripheral rural areas under pulsed, unsupervised, community-based interventions, where human transmission became apparent in 2000. The sustained, supervised, community-based strategy nearly interrupted domestic transmission to dogs but did not eliminate T. infestans despite the absence of pyrethroid-insecticide resistance. T. infestans persisted in part because of the lack of major changes in housing construction and quality. Sustained community participation grew out of establishing a trusted relationship with the affected communities and the local schools. The process included health promotion and community mobilization, motivation, and supervision in close cooperation with locally nominated leaders. PMID:17913895

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

PubMed

Tolhurst, Rachel; Zhang, Tuohong; Yang, Hui; Gao, Jun; Tang, Shenglan

2004-01-01

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Vector control for malaria and other mosquito-borne diseases. Report of a WHO study group.

PubMed

1995-01-01

Since the Ministerial Conference on Malaria in 1992, which acknowledged the urgent need for worldwide commitment to malaria control, efforts have been directed to implementation of a Global Malaria Control Strategy. Vector control, an essential component of malaria control, has become less effective in recent years, partly as a result of poor use of alternative control tools, inappropriate use of insecticides, lack of an epidemiological basis for interventions, inadequate resources and infrastructure, and weak management. Changing environmental conditions, the behavioural characteristics of certain vectors, and resistance to insecticides have added to the difficulties. This report of a WHO Study Group provides guidelines for the planning, implementation and evaluation of cost-effective and sustainable vector control in the context of the Global Malaria Control Strategy. It reviews the available methods - indoor residual spraying, personal protection, larval control and environmental management - stressing the need for selective and flexible use of interventions according to local conditions. Requirements for data collection and the appropriate use of entomological parameters and techniques are discussed and priorities identified for the development of local capacity for vector control and for operational research. Emphasis is placed both on the monitoring and evaluation of vector control to ensure cost-effectiveness and on the development of strong managerial structures, which can support community participation and intersectoral collaboration and accommodate the control of other vector-borne diseases. The report concludes with recommendations aimed at promoting the targeted and efficient use of vector control in preventing and controlling malaria, thereby reducing the threat to health and socioeconomic development in many tropical countries.

Microbial host interactions and impaired wound healing in mice and humans: defining a role for BD14 and NOD2.

PubMed

Williams, Helen; Campbell, Laura; Crompton, Rachel A; Singh, Gurdeep; McHugh, Brian J; Davidson, Donald J; McBain, Andrew J; Cruickshank, Sheena M; Hardman, Matthew J

2018-04-30

Chronic wounds cause significant patient morbidity and mortality. A key factor in their etiology is microbial infection, yet skin host-microbiota interactions during wound repair remain poorly understood. Microbiome profiles of non-infected human chronic wounds are associated with subsequent healing outcome. Furthermore, poor clinical healing outcome was associated with increased local expression of the pattern recognition receptor NOD2. To investigate NOD2 function in the context of cutaneous healing, we treated mice with the NOD2 ligand muramyl dipeptide (MDP) and analyzed wound repair parameters and expression of anti-microbial peptides. MDP treatment of littermate controls significantly delayed wound repair associated with reduced re-epithelialization, heightened inflammation and upregulation of murine β-Defensins (mBD) 1, 3 and particularly 14. We postulated that although BD14 might impact on local skin microbial communities it may further impact other healing parameters. Indeed, exogenously administered mBD14 directly delayed mouse primary keratinocyte scratch wound closure in vitro. To further explore the role of mBD14 in wound repair, we employed Defb14 -/- mice, and showed they had a global delay in healing in vivo, associated with alterations in wound microbiota. Taken together these studies suggest a key role for NOD2-mediated regulation of local skin microbiota which in turn impacts on chronic wound etiology. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Adjuvant sunitinib following chemoradiotherapy and surgery for locally advanced esophageal cancer: a phase II trial.

PubMed

Horgan, A M; Darling, G; Wong, R; Guindi, M; Liu, G; Jonker, D J; Lister, J; Xu, W; MacKay, H M; Dinniwell, R; Kim, J; Pierre, A; Shargall, Y; Asmis, T R; Agboola, O; Seely, A J; Ringash, J; Wells, J; Marginean, E C; Haider, M; Knox, J J

2016-11-01

The prognosis for locally advanced esophageal cancer is poor despite the use of trimodality therapy. In this phase II study, we report the feasibility, tolerability and efficacy of adjuvant sunitinib. Included were patients with stage IIa, IIB or III cancer of the thoracic esophagus or gastroesophageal junction. Neoadjuvant therapy involved Irinotecan (65 mg/m 2 ) + Cisplatin (30 mg/m 2 ) on weeks 1 and 2, 4 and 5, 7 and 8 with concurrent radiation (50Gy/25 fractions) on weeks 4-8. Sunitinib was commenced 4-13 weeks after surgery and continued for one year. Sixty-one patients were included in the final analysis, 36 patients commenced adjuvant sunitinib. Fourteen patients discontinued sunitinib due to disease recurrence (39%) within the 12-month period, 12 (33%) discontinued due to toxicity, and 3 (8%) requested cessation of therapy. In the overall population, median survival was 26 months with a 2 and 3-year survival rate of 52% and 35%, respectively. The median survival for the 36 patients treated with sunitinib was 35 months and 2-year survival probability of 68%. In a historical control, a prior phase II study with the same trimodality therapy (n = 43), median survival was 36 months, with a 2-year survival of 67%. Initiation of adjuvant sunitinib is feasible, but poorly tolerated, with no signal of additional benefit over trimodality therapy for locally advanced esophageal cancer. © 2015 International Society for Diseases of the Esophagus.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Russo, Andrea L.; Adams, Judith A.; Weyman, Elizabeth A.

Purpose: Squamous cell carcinoma (SCC) is the most common sinonasal cancer and is associated with one of the poor outcomes. Proton therapy allows excellent target coverage with maximal sparing of adjacent normal tissues. We evaluated the long-term outcomes in patients with sinonasal SCC treated with proton therapy. Methods and Materials: Between 1991 and 2008, 54 patients with Stage III and IV SCC of the nasal cavity and paranasal sinus received proton beam therapy at our institution to a median dose of 72.8 Gy(RBE). Sixty-nine percent underwent prior surgical resection, and 74% received elective nodal radiation. Locoregional control and survival probabilities weremore » estimated with the Kaplan-Meier method. Multivariate analyses were performed using the Cox proportional-hazards model. Treatment toxicity was scored using the Common Terminology Criteria for Adverse Events version 4.0. Results: With a median follow-up time of 82 months in surviving patients, there were 10 local, 7 regional, and 11 distant failures. The 2-year and 5-year actuarial local control rate was 80%. The 2-year and 5-year rates of overall survival were 67% and 47%, respectively. Only smoking status was predictive for worse locoregional control, with current smokers having a 5-year rate of 23% compared with 83% for noncurrent smokers (P=.004). Karnofsky performance status ≤80 was the most significant factor predictive for worse overall survival in multivariate analysis (adjusted hazard ratio 4.5, 95% confidence interval 1.6-12.5, P=.004). There were nine grade 3 and six grade 4 toxicities, and no grade 5 toxicity. Wound adverse events constituted the most common grade 3-4 toxicity. Conclusions: Our long-term results show that proton radiation therapy is well tolerated and yields good locoregional control for SCC of the nasal cavity and paranasal sinus. Current smokers and patients with poor performance status had inferior outcomes. Prospective study is necessary to compare IMRT with proton therapy in the treatment of sinonasal malignancy.« less

Tuberculosis infection control measures in health care facilities offering tb services in Ikeja local government area, Lagos, South West, Nigeria.

PubMed

Kuyinu, Y A; Mohammed, A S; Adeyeye, O O; Odugbemi, B A; Goodman, O O; Odusanya, O O

2016-03-15

Tuberculosis infection among health care workers is capable of worsening the existing health human resource problems of low--and middle-income countries. Tuberculosis infection control is often weakly implemented in these parts of the world therefore, understanding the reasons for poor implementation of tuberculosis infection control guidelines are important. This study was aimed at assessing tuberculosis infection control practices and barriers to its implementation in Ikeja, Nigeria. A cross-sectional study in 20 tuberculosis care facilities (16 public and 4 private) in Ikeja, Lagos was conducted. The study included a facility survey to assess the availability of tuberculosis infection control guidelines, the adequacy of facilities to prevent transmission of tuberculosis and observations of practices to assess the implementation of tuberculosis infection control guidelines. Four focus group discussions were carried out to highlight HCWs' perceptions on tuberculosis infection control guidelines and barriers to its implementation. The observational study showed that none of the clinics had a tuberculosis infection control plan. No clinic was consistently screening patients for cough. Twelve facilities (60%) consistently provided masks to patients who were coughing. Ventilation in the waiting areas was assessed to be adequate in 60% of the clinics while four clinics (20%) possessed N-95 respirators. Findings from the focus group discussions showed weak managerial support, poor funding, under-staffing, lack of space and not wanting to be seen as stigmatizing against tuberculosis patients as barriers that hindered the implementation of TB infection control measures. Tuberculosis infection control measures were not adequately implemented in health facilities in Ikeja, Nigeria. A multi-pronged approach is required to address the identified barriers to the implementation of tuberculosis infection control guidelines.

Cyclin D1 localizes in the cytoplasm of keratinocytes during skin differentiation and regulates cell–matrix adhesion

PubMed Central

Fernández-Hernández, Rita; Rafel, Marta; Fusté, Noel P; Aguayo, Rafael S; Casanova, Josep M; Egea, Joaquim; Ferrezuelo, Francisco; Garí, Eloi

2013-01-01

The function of Cyclin D1 (CycD1) has been widely studied in the cell nucleus as a regulatory subunit of the cyclin-dependent kinases Cdk4/6 involved in the control of proliferation and development in mammals. CycD1 has been also localized in the cytoplasm, where its function nevertheless is poorly characterized. In this work we have observed that in normal skin as well as in primary cultures of human keratinocytes, cytoplasmic localization of CycD1 correlated with the degree of differentiation of the keratinocyte. In these conditions, CycD1 co-localized in cytoplasmic foci with exocyst components (Sec6) and regulators (RalA), and with β1 integrin, suggesting a role for CycD1 in the regulation of keratinocyte adhesion during differentiation. Consistent with this hypothesis, CycD1 overexpression increased β1 integrin recycling and drastically reduced the ability of keratinocytes to adhere to the extracellular matrix. We propose that localization of CycD1 in the cytoplasm during skin differentiation could be related to the changes in detachment ability of keratinocytes committed to differentiation. PMID:23839032

Making Poor Choices? Demand Rationalities and School Choice in a Chilean Local Education Market

ERIC Educational Resources Information Center

Bonal, Xavier; Verger, Antoni; Zancajo, Adrián

2017-01-01

Although the literature on school choice rationalities is extensive, different authors interpret the processes of school choice for poor families in different ways. Positions vary between those that consider that poor families have the same capacity to choose as middle class families and those that value structural factors as constraints for…

Deadly Flies, Poor Profits, and Veterinary Pharmaceuticals: Sustaining the Control of Sleeping Sickness in Uganda.

PubMed

Bardosh, Kevin Louis

2016-01-01

Efforts to control neglected tropical diseases have increasingly focused on questions of implementation. But how should we conceptualize the implementation process? Drawing on ethnographic fieldwork between 2010 and 2012, in this article I explore efforts by a small-scale public-private partnership to use private veterinarians to sustainably control zoonotic sleeping sickness in Uganda. With a fundamental tension between business incentives and vector control, I show how divergences in knowledge, power, values, and social norms shaped project implementation and community responses. Reflecting more widely on the relationships between project plans and local realities, I argue that these encounters reveal the heuristic value in approaching global health interventions as evolving 'social experiments.' This metaphor reveals the uncertainty inherent to dominant narratives and models, the role of available expertise in defining the limits of action, and the need for continuous adaption to synchronize with emergent social and institutional topographies.

Aberrant functioning of the putamen links delusions, antipsychotic drug dose, and compromised connectivity in first episode psychosis--Preliminary fMRI findings.

PubMed

Raij, Tuukka T; Mäntylä, Teemu; Kieseppä, Tuula; Suvisaari, Jaana

2015-08-30

The dopamine theory proposes the relationship of delusions to aberrant signaling in striatal circuitries that can be normalized with dopamine D2 receptor-blocking drugs. Localization of such circuitries, as well as their upstream and downstream signaling, remains poorly known. We collected functional magnetic resonance images from first-episode psychosis patients and controls during an audiovisual movie. Final analyses included 20 patients and 20 controls; another sample of 10 patients and 10 controls was used to calculate a comparison signal-time course. We identified putamen circuitry in which the signal aberrance (poor correlation with the comparison signal time course) was predicted by the dopamine theory, being greater in patients than controls; correlating positively with delusion scores; and correlating negatively with antipsychotic-equivalent dosage. In Granger causality analysis, patients showed a compromised contribution of the cortical salience network to the putamen and compromised contribution of the putamen to the default mode network. Results were corrected for multiple comparisons at the cluster level with primary voxel-wise threshold p < 0.005 for the salience network contribution, but liberal primary threshold p < 0.05 was used in other group comparisons. If replicated in larger studies, these findings may help unify and extend current hypotheses on dopaminergic dysfunction, salience processing and pathogenesis of delusions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Constraints on baryonic dark matter in the Galactic halo and Local Group

NASA Technical Reports Server (NTRS)

Richstone, Douglas; Gould, Andrew; Guhathakurta, Puragra; Flynn, Chris

1992-01-01

A four-color method and deep CCD data are used to search for very faint metal-poor stars in the direction of the south Galactic pole. The results make it possible to limit the contribution of ordinary old, metal-poor stars to the dynamical halo of the Galaxy or to the Local Group. The ratio of the mass of the halo to its ordinary starlight must be more than about 2000, unless the halo is very small. For the Local Group, this ratio is greater than about 400. If this local dark matter is baryonic, the process of compact-object formation must produce very few 'impurities' in the form of stars similar to those found in globular clusters. The expected number of unbound stars with MV not greater than 6 within 100 pc of the sun is less than 1 based on the present 90-percent upper limit to the Local Group starlight.

The Little Cub: Discovery of an Extremely Metal-poor Star-forming Galaxy in the Local Universe

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hsyu, Tiffany; Prochaska, J. Xavier; Bolte, Michael

We report the discovery of the Little Cub, an extremely metal-poor star-forming galaxy in the local universe, found in the constellation Ursa Major (a.k.a. the Great Bear). We first identified the Little Cub as a candidate metal-poor galaxy based on its Sloan Digital Sky Survey photometric colors, combined with spectroscopy using the Kast spectrograph on the Shane 3 m telescope at Lick Observatory. In this Letter, we present high-quality spectroscopic data taken with the Low Resolution Imaging Spectrometer at Keck Observatory, which confirm the extremely metal-poor nature of this galaxy. Based on the weak [O iii] λ 4363 Å emissionmore » line, we estimate a direct oxygen abundance of 12 + log(O/H) = 7.13 ± 0.08, making the Little Cub one of the lowest-metallicity star-forming galaxies currently known in the local universe. The Little Cub appears to be a companion of the spiral galaxy NGC 3359 and shows evidence of gas stripping. We may therefore be witnessing the quenching of a near-pristine galaxy as it makes its first passage about a Milky Way–like galaxy.« less

Empirical Determination of Dark Matter Velocities Using Metal-Poor Stars.

PubMed

Herzog-Arbeitman, Jonah; Lisanti, Mariangela; Madau, Piero; Necib, Lina

2018-01-26

The Milky Way dark matter halo is formed from the accretion of smaller subhalos. These sub-units also harbor stars-typically old and metal-poor-that are deposited in the Galactic inner regions by disruption events. In this Letter, we show that the dark matter and metal-poor stars in the Solar neighborhood share similar kinematics due to their common origin. Using the high-resolution eris simulation, which traces the evolution of both the dark matter and baryons in a realistic Milky Way analog galaxy, we demonstrate that metal-poor stars are indeed effective tracers for the local, virialized dark matter velocity distribution. The local dark matter velocities can therefore be inferred from observations of the stellar halo made by the Sloan Digital Sky Survey within 4 kpc of the Sun. This empirical distribution differs from the standard halo model in important ways and suggests that the bounds on the spin-independent scattering cross section may be weakened for dark matter masses below ∼10  GeV. Data from Gaia will allow us to further refine the expected distribution for the smooth dark matter component, and to test for the presence of local substructure.

The Little Cub: Discovery of an Extremely Metal-poor Star-forming Galaxy in the Local Universe

NASA Astrophysics Data System (ADS)

Hsyu, Tiffany; Cooke, Ryan J.; Prochaska, J. Xavier; Bolte, Michael

2017-08-01

We report the discovery of the Little Cub, an extremely metal-poor star-forming galaxy in the local universe, found in the constellation Ursa Major (a.k.a. the Great Bear). We first identified the Little Cub as a candidate metal-poor galaxy based on its Sloan Digital Sky Survey photometric colors, combined with spectroscopy using the Kast spectrograph on the Shane 3 m telescope at Lick Observatory. In this Letter, we present high-quality spectroscopic data taken with the Low Resolution Imaging Spectrometer at Keck Observatory, which confirm the extremely metal-poor nature of this galaxy. Based on the weak [O III] λ4363 Å emission line, we estimate a direct oxygen abundance of 12 + log(O/H) = 7.13 ± 0.08, making the Little Cub one of the lowest-metallicity star-forming galaxies currently known in the local universe. The Little Cub appears to be a companion of the spiral galaxy NGC 3359 and shows evidence of gas stripping. We may therefore be witnessing the quenching of a near-pristine galaxy as it makes its first passage about a Milky Way-like galaxy.

Prospective Study of the Evolution of Blood Lymphoid Immune Parameters during Dacarbazine Chemotherapy in Metastatic and Locally Advanced Melanoma Patients

PubMed Central

Vabres, Pierre; Dalac, Sophie; Jeudy, Geraldine; Bel, Blandine; Apetoh, Lionel; Ghiringhelli, François

2014-01-01

Background The importance of immune responses in the control of melanoma growth is well known. However, the implication of these antitumor immune responses in the efficacy of dacarbazine, a cytotoxic drug classically used in the treatment of melanoma, remains poorly understood in humans. Methods In this prospective observational study, we performed an immunomonitoring of eleven metastatic or locally advanced patients treated with dacarbazine as a first line of treatment. We assessed by flow cytometry lymphoid populations and their activation state; we also isolated NK cells to perform in vitro cytotoxicity tests. Results We found that chemotherapy induces lymphopenia and that a significantly higher numbers of naïve CD4+ T cells and lower proportion of Treg before chemotherapy are associated with disease control after dacarbazine treatment. Interestingly, NK cell cytotoxicity against dacarbazine-pretreated melanoma cells is only observed in NK cells from patients who achieved disease control. Conclusion Together, our data pinpoint that some immune factors could help to predict the response of melanoma patients to dacarbazine. Future larger scale studies are warranted to test their validity as prediction markers. PMID:25170840

Synthesis and characterization of Her2-NLP peptide conjugates targeting circulating breast cancer cells: cellular uptake and localization by fluorescent microscopic imaging.

PubMed

Cai, Huawei; Singh, Ajay N; Sun, Xiankai; Peng, Fangyu

2015-01-01

To synthesize a fluorescent Her2-NLP peptide conjugate consisting of Her2/neu targeting peptide and nuclear localization sequence peptide (NLP) and assess its cellular uptake and intracellular localization for radionuclide cancer therapy targeting Her2/neu-positive circulating breast cancer cells (CBCC). Fluorescent Cy5.5 Her2-NLP peptide conjugate was synthesized by coupling a bivalent peptide sequence, which consisted of a Her2-binding peptide (NH2-GSGKCCYSL) and an NLP peptide (CGYGPKKKRKVGG) linked by a polyethylene glycol (PEG) chain with 6 repeating units, with an activated Cy5.5 ester. The conjugate was separated and purified by HPLC and then characterized by Maldi-MS. The intracellular localization of fluorescent Cy5.5 Her2-NLP peptide conjugate was assessed by fluorescent microscopic imaging using a confocal microscope after incubation of Cy5.5-Her2-NLP with Her2/neu positive breast cancer cells and Her2/neu negative control breast cancer cells, respectively. Fluorescent signals were detected in cytoplasm of Her2/neu positive breast cancer cells (SKBR-3 and BT474 cell lines), but not or little in cytoplasm of Her2/neu negative breast cancer cells (MDA-MB-231), after incubation of the breast cancer cells with Cy5.5-Her2-NLP conjugates in vitro. No fluorescent signals were detected within the nuclei of Her2/neu positive SKBR-3 and BT474 breast cancer cells, neither Her2/neu negative MDA-MB-231 cells, incubated with the Cy5.5-Her2-NLP peptide conjugates, suggesting poor nuclear localization of the Cy5.5-Her2-NLP conjugates localized within the cytoplasm after their cellular uptake and internalization by the Her2/neu positive breast cancer cells. Her2-binding peptide (KCCYSL) is a promising agent for radionuclide therapy of Her2/neu positive breast cancer using a β(-) or α emitting radionuclide, but poor nuclear localization of the Her2-NLP peptide conjugates may limit its use for eradication of Her2/neu-positive CBCC using I-125 or other Auger electron emitting radionuclide.

LOCAL VS. REGIONAL EFFECTS ON FISH DIVERSITY AS MEDIATED BY STREAMFLOW DISTURBANCE REGIME

EPA Science Inventory

abstract

The interplay of local and regional processes on fish diversity is poorly understood, especially related to patterns of streamflow disturbance regime. Articulation of the relationship between flow disturbance patterns and river fishes across local to regional scal...

The Framework Convention on Tobacco Control (FCTC) and the adoption of domestic tobacco control policies: the Ecuadorian experience.

PubMed

Albuja, S; Daynard, R A

2009-02-01

The present work concerns the adoption of domestic tobacco control legislation in Ecuador after ratification of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Analysis of legislation, and data collection via interviews with key actors involved in the adoption and implementation of domestic legislation passed purportedly to implement the FCTC and research of the Ecuadorian Congressional Archives. While the FCTC helped raise awareness about tobacco's imminent and future threats to public health, paradoxically, it had the effect of further entrenching tobacco-friendly norms. Philip Morris, with 87% dominance over the Ecuadorian tobacco market, subtly harnessed the FCTC to protect its interests. This outcome was also influenced by poor governmental readiness and intervention, lack of legislative technical capabilities and weak civil society involvement. The Ecuadorian experience suggests that more support should be provided to health ministries, legislatures and local tobacco control organisations to offset the power of the tobacco industry as developing nations get ready to adopt domestic tobacco control legislation.

Primary Central Nervous System Fibrosarcoma.

PubMed

Vinodh, V P; Harun, Rahmat; Sellamuthu, Pulivendhan; Kandasamy, Regunath

2017-08-01

We report a rare case of a young female with primary brain fibrosarcoma, and to the best of our knowledge, we believe that only <50 cases have been reported or described worldwide so far. Fibrosarcoma is a malignant neoplasm, in which histologically the predominant cells are fibroblasts that divide excessively without cellular control and they can invade local tissues or metastasize. Primary central nervous system fibrosarcomas are very aggressive neoplasms and generally have a poor prognosis. This tumor is either from sarcomatous transformation of a meningioma or arises de novo within the brain parenchyma. Our patient, a 48-year-old woman, who presented with progressive speech disorder over the period of 4 months, showed a left temporoparietal lesion with surrounding edema and local mass effect. Total surgical resection was achieved. Histopathology revealed classical fibrosarcoma features and secondary screening revealed no other distant lesion as diagnosis of primary brain fibrosarcoma was established. This case is deemed to be extremely rare because most reports claim that recurrence is within 6 months with poor prognosis; however, this patient is currently recurrence-free at 3 years. This would suggest of the possibility for a relook into this disease's course and recurrence rate when complete excision is achieved. Due to extreme rarity of these tumors, more comparative studies will be needed to improve the disease outcome.

A tip-localized RhoGAP controls cell polarity by globally inhibiting Rho GTPase at the cell apex.

PubMed

Hwang, Jae-Ung; Vernoud, Vanessa; Szumlanski, Amy; Nielsen, Erik; Yang, Zhenbiao

2008-12-23

Highly elongated eukaryotic cells (e.g., neuronal axons, fungal hyphae, and pollen tubes) are generated through continuous apically restricted growth (tip growth), which universally requires tip-localized Rho GTPases. We used the oscillating pollen tube as a model system to determine the function and regulation of Rho GTPases in tip growth. Our previous work showed that the spatiotemporal dynamics of the apical cap of the activated Rho-like GTPase from Plant 1 (ROP1) are critical for tip growth in pollen tubes. However, the underlying mechanism for the generation and maintenance of this dynamic apical cap is poorly understood. A screen for mutations that enhance ROP1-overexpression-induced depolarization of pollen-tube growth identified REN1 (ROP1 enhancer 1) in Arabidopsis, whose null mutations turn elongated pollen tubes into bulbous cells. REN1 encodes a novel Rho GTPase-activating protein (RhoGAP) required for restricting the ROP1 activity to the pollen-tube tip. REN1 was localized to exocytic vesicles accumulated in the pollen-tube apex, as well as to the apical plasma membrane at the site of ROP1 activation. The apical localization of REN1 and its function in controlling growth polarity was compromised by disruption of ROP1-dependent F-actin and vesicular trafficking, which indicates that REN1 targeting and function is regulated by ROP1 downstream signaling. Our findings suggest that the REN1 RhoGAP controls a negative-feedback-based global inhibition of ROP1. This function provides a critical self-organizing mechanism, by which ROP signaling is spatially limited to the growth site and temporally oscillates during continuous tip growth. Similar spatiotemporal control of Rho GTPase signaling may also play an important role in cell-polarity control in other systems, including tip growth in fungi and cell movement in animals.

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

ERIC Educational Resources Information Center

Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

2005-01-01

Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

Fast-kick-off monotonically convergent algorithm for searching optimal control fields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liao, Sheng-Lun; Ho, Tak-San; Rabitz, Herschel

2011-09-15

This Rapid Communication presents a fast-kick-off search algorithm for quickly finding optimal control fields in the state-to-state transition probability control problems, especially those with poorly chosen initial control fields. The algorithm is based on a recently formulated monotonically convergent scheme [T.-S. Ho and H. Rabitz, Phys. Rev. E 82, 026703 (2010)]. Specifically, the local temporal refinement of the control field at each iteration is weighted by a fractional inverse power of the instantaneous overlap of the backward-propagating wave function, associated with the target state and the control field from the previous iteration, and the forward-propagating wave function, associated with themore » initial state and the concurrently refining control field. Extensive numerical simulations for controls of vibrational transitions and ultrafast electron tunneling show that the new algorithm not only greatly improves the search efficiency but also is able to attain good monotonic convergence quality when further frequency constraints are required. The algorithm is particularly effective when the corresponding control dynamics involves a large number of energy levels or ultrashort control pulses.« less

Voices of the poor from the margins of Bengal: structural inequities and health.

PubMed

Dutta, Mohan J; Dutta, Uttaran

2013-01-01

In opposition to the traditional approaches to health communication that treat the subaltern sectors as passive recipients of messages of enlightenment configured in top-down interventions, the culture-centered approach foregrounds the importance of listening to subaltern communities at the margins through dialogue. We build on earlier culture-centered projects in rural communities of West Bengal, India, to develop participatory research strategies for understanding the local processes through which the structural marginalization of the poor plays out in rural Bengal. Study results point toward the marginalization of the poor both communicatively and economically, attending to the ways in which communicative marginalization lies at the heart of economic oppressions. Through locally articulated concepts of "health as shortage" and "communication as shortage," community members put forth alternative rationalities of health that highlight structural resources at the heart of health. These local articulations of shortage offer an alternative rationality for organizing health promotion efforts in the rural margins of Bengal through the foregrounding of discourses of shortage.

Views from below on the pro-poor growth challenge: the case of rural Rwanda.

PubMed

Ansoms, An

2010-01-01

This article focuses on the Rwandan peasantry to confirm how "views from below" can contribute to a better understanding of the "pro-poor" growth challenge. Based on micro-level evidence gathered in 2007, it examines local peasants' perceptions of the characteristics and degree of poverty for different socioeconomic categories (i.e., peasant groups). It looks at the various opportunities and constraints that influence the potential of these categories or groups for social mobility and their capacity to participate in growth strategies. Further, it considers how local peasants perceive specific policy measures in the Rwandan government's "pro-poor" rural strategies. Their insights could inspire Rwandan policymakers and supporting donors to redirect their efforts toward distribution-oriented growth strategies.

Self-control of traffic lights and vehicle flows in urban road networks

NASA Astrophysics Data System (ADS)

Lämmer, Stefan; Helbing, Dirk

2008-04-01

Based on fluid-dynamic and many-particle (car-following) simulations of traffic flows in (urban) networks, we study the problem of coordinating incompatible traffic flows at intersections. Inspired by the observation of self-organized oscillations of pedestrian flows at bottlenecks, we propose a self-organization approach to traffic light control. The problem can be treated as a multi-agent problem with interactions between vehicles and traffic lights. Specifically, our approach assumes a priority-based control of traffic lights by the vehicle flows themselves, taking into account short-sighted anticipation of vehicle flows and platoons. The considered local interactions lead to emergent coordination patterns such as 'green waves' and achieve an efficient, decentralized traffic light control. While the proposed self-control adapts flexibly to local flow conditions and often leads to non-cyclical switching patterns with changing service sequences of different traffic flows, an almost periodic service may evolve under certain conditions and suggests the existence of a spontaneous synchronization of traffic lights despite the varying delays due to variable vehicle queues and travel times. The self-organized traffic light control is based on an optimization and a stabilization rule, each of which performs poorly at high utilizations of the road network, while their proper combination reaches a superior performance. The result is a considerable reduction not only in the average travel times, but also of their variation. Similar control approaches could be applied to the coordination of logistic and production processes.

Role of Surgical Margin on Local Recurrence in High Risk Extremity Osteosarcoma: A Case-Controlled Study

PubMed Central

Song, Won Seok; Kong, Chang-Bae; Cho, Wan Hyeong; Cho, Sang Hyun; Lee, Jeong Dong; Lee, Soo-Yong

2013-01-01

Background The relationship between surgical margin and local recurrence (LR) in osteosarcoma patients with poor responses to chemotherapy is unclear. Moreover, the incidences of LR according to three different resection planes (bone, soft tissue, and perineurovascular) are not commonly known. Methods We evaluated the incidence of LR in three areas. To assess whether there is a role of surgical margin on LR in patients resistant to preoperative chemotherapy, we designed a case (35 patients with LR) and control (70 patients without LR) study. Controls were matched for age, location, initial tumor volume, and tumor volume change during preoperative chemotherapy. Results LR occurred at the soft tissues in 18 cases (51.4%), at the perineurovascular tissues in 11 cases (31.4%), and at the bones in six cases (17.2%). The proportion of inadequate perineurovascular margin was higher in the case group than in the control group (p = 0.01). Within case-control group (105 patients), a correlation between each margin status and LR at corresponding area was found in the bone (p < 0.001) and perineurovascular area (p = 0.001). Conclusions LR is most common in soft tissues. In patients showing similar unfavorable responses to chemotherapy, the losses of perineurovascular fat plane on preoperative magnetic resonance imaging may be a valuable finding in predicting LR. PMID:24009908

Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases.

PubMed

Bardosh, Kevin

2014-01-01

Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the "neglected" status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.

Nodal recurrence of sinonasal cancer: does the risk of cervical relapse justify a prophylactic neck treatment?

PubMed

Mirghani, Haïtham; Hartl, Dana; Mortuaire, Geoffrey; Armas, Gian Luca; Aupérin, Anne; Chevalier, Dominique; Lefebvre, Jean Louis

2013-04-01

Sinonasal cancers are rare and no high-level evidence exists to determine their optimal management. Prophylactic neck treatment issue remains controversial. The aim of this study was to analyze the pattern of neck failure and to identify any prognostic factors that may influence neck control. A retrospective review of 155 consecutive patients treated for sinonasal malignancy, without prophylactic neck treatment, between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological and pathological parameters were correlated with oncologic outcomes. Eight out of 155 patients (5%) presented initially with neck node metastasis. Complete remission was obtained for 133 patients after treatment completion. During follow up, 16 out of 133 patients (12%) were affected with regional recurrence. Neck failure occurred in 8 out of 51 patients with local failure and in 8 out of 82 patients locally controlled. Isolated nodal failure was observed in 5 patients initially cN0 out of 133 (3.8%) representing 7.3% of all recurrences and 3 of them underwent successful salvage therapy. None of the tested factors were significantly associated with neck control (p>0.05). Lymph node at diagnosis time was significantly and independently associated with poor survival (p=0.0012). Isolated neck relapse, when local control is achieved, is rare and salvage treatment is effective. Routine prophylactic neck treatment has little interest. However, this approach could be profitable to few selected patients, who remain to be defined. Further investigations are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Flat nonlinear optics: metasurfaces for efficient frequency mixing

NASA Astrophysics Data System (ADS)

Nookala, Nishant; Lee, Jongwon; Liu, Yingnan; Bishop, Wells; Tymchenko, Mykhailo; Gomez-Diaz, J. Sebastian; Demmerle, Frederic; Boehm, Gerhard; Amann, Markus-Christian; Wolf, Omri; Brener, Igal; Alu, Andrea; Belkin, Mikhail A.

2017-02-01

Gradient metasurfaces, or ultrathin optical components with engineered transverse impedance gradients along the surface, are able to locally control the phase and amplitude of the scattered fields over subwavelength scales, enabling a broad range of linear components in a flat, integrable platform1-4. On the contrary, due to the weakness of their nonlinear optical responses, conventional nonlinear optical components are inherently bulky, with stringent requirements associated with phase matching and poor control over the phase and amplitude of the generated beam. Nonlinear metasurfaces have been recently proposed to enable frequency conversion in thin films without phase-matching constraints and subwavelength control of the local nonlinear phase5-8. However, the associated optical nonlinearities are far too small to produce significant nonlinear conversion efficiency and compete with conventional nonlinear components for pump intensities below the materials damage threshold. Here, we report multi-quantum-well based gradient nonlinear metasurfaces with second-order nonlinear susceptibility over 106 pm/V for second harmonic generation at a fundamental pump wavelength of 10 μm, 5-6 orders of magnitude larger than traditional crystals. Further, we demonstrate the efficacy of this approach to designing metasurfaces optimized for frequency conversion over a large range of wavelengths, by reporting multi-quantum-well and metasurface structures optimized for a pump wavelength of 6.7 μm. Finally, we demonstrate how the phase of this nonlinearly generated light can be locally controlled well below the diffraction limit using the Pancharatnam-Berry phase approach5,7,9, opening a new paradigm for ultrathin, flat nonlinear optical components.

The rediscovery of the Great Winterberg endemic Lotononis harveyi B.–E.van Wyk after 147 years, and notes on the poorly known Amathole endemic Macowania revoluta Oliv. (southern Great Escarpment, South Africa)

PubMed Central

Clark, Vincent Ralph; Bentley, Joanne; Dold, Anthony P.; Zikishe, Vathiswa; Barker, Nigel P.

2016-01-01

Abstract South Africa’s 800 km-long southern Great Escarpment hosts numerous endemic plant species only known from their type specimens or from very few records. This is a legacy of a 100–150 year lag between the pioneer work of 19th century botanists and repeat fieldwork in the 21st century. As a result, population and ecological data are lacking for many local endemic species. Here we report on the rediscovery of Lotononis harveyi B.–E.van Wyk 147 years after its original description, and provide the first detailed ecological notes on the poorly known shrub Macowania revoluta Oliv. Both species are locally endemic to the Great Winterberg–Amatholes (Eastern Cape Province). With only six known individuals, Lotononis harveyi is recommended the conservation status of Critically Endangered, with fire (and potentially grazing) being the main population constraints. Macowania revoluta is locally abundant, and it is surprising that it has been so poorly collected in recent decades. It occupies an important local niche as a keystone montane wetland species, and its narrow distribution range – combined with pressure from woody alien invasive species – suggests that its conservation status should be Rare. The research further highlights the need for continued biodiversity field research along South Africa’s poorly explored Great Escarpment. PMID:27212887

Are the Formation and Abundances of Metal-poor Stars the Result of Dust Dynamics?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hopkins, Philip F.; Conroy, Charlie, E-mail: phopkins@caltech.edu

Large dust grains can fluctuate dramatically in their local density, relative to the gas, in neutral turbulent disks. Small, high-redshift galaxies (before reionization) represent ideal environments for this process. We show via simple arguments and simulations that order-of-magnitude fluctuations are expected in local abundances of large grains (>100 Å) under these conditions. This can have important consequences for star formation and stellar metal abundances in extremely metal-poor stars. Low-mass stars can form in dust-enhanced regions almost immediately after some dust forms even if the galaxy-average metallicity is too low for fragmentation to occur. We argue that the metal abundances ofmore » these “promoted” stars may contain interesting signatures as the CNO abundances (concentrated in large carbonaceous grains and ices) and Mg and Si (in large silicate grains) can be enhanced and/or fluctuate almost independently. Remarkably, the otherwise puzzling abundance patterns of some metal-poor stars can be well fit by standard IMF-averaged core-collapse SNe yields if we allow for fluctuating local dust-to-gas ratios. We also show that the observed log-normal distribution of enhancements in pure SNe yields, shows very large enhancements and variations up to factors of ≳100 as expected in the dust-promoted model, preferentially in the [C/Fe]-enhanced metal-poor stars. Together, this suggests that (1) dust exists in second-generation star formation, (2) local dust-to-gas ratio fluctuations occur in protogalaxies and can be important for star formation, and (3) the light element abundances of these stars may be affected by the local chemistry of dust where they formed, rather than directly tracing nucleosynthesis from earlier populations.« less

Levodopa modulates small-world architecture of functional brain networks in Parkinson's disease.

PubMed

Berman, Brian D; Smucny, Jason; Wylie, Korey P; Shelton, Erika; Kronberg, Eugene; Leehey, Maureen; Tregellas, Jason R

2016-11-01

PD is associated with disrupted connectivity to a large number of distributed brain regions. How the disease alters the functional topological organization of the brain, however, remains poorly understood. Furthermore, how levodopa modulates network topology in PD is largely unknown. The objective of this study was to use resting-state functional MRI and graph theory to determine how small-world architecture is altered in PD and affected by levodopa administration. Twenty-one PD patients and 20 controls underwent functional MRI scanning. PD patients were scanned off medication and 1 hour after 200 mg levodopa. Imaging data were analyzed using 226 nodes comprising 10 intrinsic brain networks. Correlation matrices were generated for each subject and converted into cost-thresholded, binarized adjacency matrices. Cost-integrated whole-brain global and local efficiencies were compared across groups and tested for relationships with disease duration and severity. Data from 2 patients and 4 controls were excluded because of excess motion. Patients off medication showed no significant changes in global efficiency and overall local efficiency, but in a subnetwork analysis did show increased local efficiency in executive (P = 0.006) and salience (P = 0.018) networks. Levodopa significantly decreased local efficiency (P = 0.039) in patients except within the subcortical network, in which it significantly increased local efficiency (P = 0.007). Levodopa modulates global and local efficiency measures of small-world topology in PD, suggesting that degeneration of nigrostriatal neurons in PD may be associated with a large-scale network reorganization and that levodopa tends to normalize the disrupted network topology in PD. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Sedimentology and preservation of aeolian sediments on steep terrains: Incipient sand ramps on the Atacama coast (northern Chile)

NASA Astrophysics Data System (ADS)

Ventra, Dario; Rodríguez-López, Juan Pedro; de Boer, Poppe L.

2017-05-01

The origin of topographically controlled aeolian landforms in high-relief settings is difficult to synthesize under general models, given the dependence of such accumulations on local morphology. Quaternary sand ramps have been linked to palaeoclimate, regional geomorphology and wind patterns; however, controls on the early development and preservation of such landforms are poorly known. This study describes the morphology and sedimentology of complex sedimentary aprons along steep coastal slopes in the Atacama Desert (Chile). Direct slope accessibility and continuous stratigraphic exposures enable comparisons between active processes and stratigraphic signatures. Stratigraphic facies distribution and its links with patterns of aeolian deposition show that the preservation of wind-laid sediments depends on the morphology and processes of specific slope sectors. The spatial organization of runoff depends on bedrock configuration and directly controls the permanence or erosion of aeolian sediment. The occurrence of either water or mass flows depends on the role of aeolian fines in the rheology of flash floods. In turn, the establishment of a rugged surface topography controlled by patterns of mass-flow deposition creates local accommodation for aeolian fines, sustaining the initial aggradation of a colluvial-aeolian system. By contrast, slopes subject to runoff develop a thin, extensive aeolian mantle whose featureless surface is subject mostly to sediment bypass down- and across-slope; the corresponding stratigraphic record comprises almost exclusively thin debris-flow and sheetflood deposits. Slope morphology and processes are fundamental in promoting or inhibiting aeolian aggradation in mountain settings. Long-term sand-ramp construction depends on climate and regional topography, but the initial development is probably controlled by local geomorphic factors. The observed interactions between wind and topography in the study area may also represent a process analogue for the interpretation of similar geomorphic features on Mars.

A high performing brain-machine interface driven by low-frequency local field potentials alone and together with spikes

NASA Astrophysics Data System (ADS)

Stavisky, Sergey D.; Kao, Jonathan C.; Nuyujukian, Paul; Ryu, Stephen I.; Shenoy, Krishna V.

2015-06-01

Objective. Brain-machine interfaces (BMIs) seek to enable people with movement disabilities to directly control prosthetic systems with their neural activity. Current high performance BMIs are driven by action potentials (spikes), but access to this signal often diminishes as sensors degrade over time. Decoding local field potentials (LFPs) as an alternative or complementary BMI control signal may improve performance when there is a paucity of spike signals. To date only a small handful of LFP decoding methods have been tested online; there remains a need to test different LFP decoding approaches and improve LFP-driven performance. There has also not been a reported demonstration of a hybrid BMI that decodes kinematics from both LFP and spikes. Here we first evaluate a BMI driven by the local motor potential (LMP), a low-pass filtered time-domain LFP amplitude feature. We then combine decoding of both LMP and spikes to implement a hybrid BMI. Approach. Spikes and LFP were recorded from two macaques implanted with multielectrode arrays in primary and premotor cortex while they performed a reaching task. We then evaluated closed-loop BMI control using biomimetic decoders driven by LMP, spikes, or both signals together. Main results. LMP decoding enabled quick and accurate cursor control which surpassed previously reported LFP BMI performance. Hybrid decoding of both spikes and LMP improved performance when spikes signal quality was mediocre to poor. Significance. These findings show that LMP is an effective BMI control signal which requires minimal power to extract and can substitute for or augment impoverished spikes signals. Use of this signal may lengthen the useful lifespan of BMIs and is therefore an important step towards clinically viable BMIs.

Self-perceived oral health and salivary proteins in children with type 1 diabetes.

PubMed

Javed, F; Sundin, U; Altamash, M; Klinge, B; Engström, P-E

2009-01-01

The aim was to validate self-perceived oral health with salivary IgG as an inflammatory parameter in children with type 1 diabetes. Unstimulated whole saliva samples were collected from 36 children with well controlled and 12 with poorly controlled type 1 diabetes and 40 non-diabetic children (Controls). Salivary flow rate, random blood glucose level, salivary protein concentration and immunoglobulin A and G levels were recorded using standard techniques. Data concerning oral health and diabetes status were collected. Self-perceived gingival bleeding (bleeding gums), bad breath and dry mouth were higher in diabetic children when compared with those in controls (P < 0.05). Gingival bleeding was frequently perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.001). Bad breath was common perceived by children with poorly controlled compared to well-controlled type 1 diabetes (P < 0.05) and controls (P < 0.0001). Salivary flow rate was lower in the diabetic children compared to controls (P < 0.01) with no difference between children with poorly controlled and well-controlled type 1 diabetes. Salivary IgG per mg protein concentration was higher in the diabetics when compared with the control group (P < 0.0001). IgG per mg protein levels were also higher in children with poorly controlled when compared with well-controlled type 1 diabetes (P < 0.05). There was no difference in IgA per mg protein and total protein concentrations between children with poorly controlled and well-controlled type 1 diabetes. Self-perceived gingival bleeding and salivary IgG per mg protein concentration were increased in children with type 1 diabetes compared with controls. These variables were also increased in children with poorly controlled compared with well-controlled type 1 diabetes.

Forest conflict in Thailand: northern minorities in focus.

PubMed

Hares, Minna

2009-03-01

This paper aims at exploring the local background of and solutions to the forest conflict in upland areas inhabited by ethnic minorities, who are called hill tribes, in northern Thailand. A so-called hill tribe problem has been officially identified as a result of the slash-and-burn cultivation and other perceived problems, such as opium poppy cultivation, illegal immigration, and the suspicion of disloyalty to the state. This has created distrust and tension between the groups and authorities. The local conflict has recently been related to the dilemma of conserving the forest from all human interference, while many people live and make their livelihood within and adjacent to the protected areas. Furthermore, as the results imply, strictly protected areas and reforestation have also increased the competition over land and natural resources and, thereby, the likelihood of local conflicts. The scarcity and pollution of water, illegal logging, and poor fire control have contributed to the conflicts between local communities. The conflicts between the local communities and officials have been nourished by political and public discussions. Using definitions and terms with negative connotations and ignoring the heterogeneity between the groups or labeling some groups as malevolent have increased distrust and strengthened existing stereotypical images. Conflict resolution starts with efforts toward better mutual understanding, and changes in structures and attitudes are necessary. Local cooperation, utilization of traditional methods, and local institutions are central to conflict solving.

Forest Conflict in Thailand: Northern Minorities in Focus

NASA Astrophysics Data System (ADS)

Hares, Minna

2009-03-01

This paper aims at exploring the local background of and solutions to the forest conflict in upland areas inhabited by ethnic minorities, who are called hill tribes, in northern Thailand. A so-called hill tribe problem has been officially identified as a result of the slash-and-burn cultivation and other perceived problems, such as opium poppy cultivation, illegal immigration, and the suspicion of disloyalty to the state. This has created distrust and tension between the groups and authorities. The local conflict has recently been related to the dilemma of conserving the forest from all human interference, while many people live and make their livelihood within and adjacent to the protected areas. Furthermore, as the results imply, strictly protected areas and reforestation have also increased the competition over land and natural resources and, thereby, the likelihood of local conflicts. The scarcity and pollution of water, illegal logging, and poor fire control have contributed to the conflicts between local communities. The conflicts between the local communities and officials have been nourished by political and public discussions. Using definitions and terms with negative connotations and ignoring the heterogeneity between the groups or labeling some groups as malevolent have increased distrust and strengthened existing stereotypical images. Conflict resolution starts with efforts toward better mutual understanding, and changes in structures and attitudes are necessary. Local cooperation, utilization of traditional methods, and local institutions are central to conflict solving.

Public Health Interventions for Aedes Control in the Time of Zikavirus– A Meta-Review on Effectiveness of Vector Control Strategies

PubMed Central

Bouzid, Maha; Brainard, Julii; Hooper, Lee; Hunter, Paul R.

2016-01-01

Background There is renewed interest in effective measures to control Zika and dengue vectors. A synthesis of published literature with a focus on the quality of evidence is warranted to determine the effectiveness of vector control strategies. Methodology We conducted a meta-review assessing the effectiveness of any Aedes control measure. We searched Scopus and Medline for relevant reviews through to May 2016. Titles, abstracts and full texts were assessed independently for inclusion by two authors. Data extraction was performed in duplicate and validity of the evidence was assessed using GRADE criteria. Findings 13 systematic reviews that investigated the effect of control measures on entomological parameters or disease incidence were included. Biological controls seem to achieve better reduction of entomological indices than chemical controls, while educational campaigns can reduce breeding habitats. Integrated vector control strategies may not always increase effectiveness. The efficacy of any control programme is dependent on local settings, intervention type, resources and study duration, which may partly explain the varying degree of success between studies. Nevertheless, the quality of evidence was mostly low to very low due to poor reporting of study design, observational methodologies, heterogeneity, and indirect outcomes, thus hindering an evidence-based recommendation. Conclusions The evidence for the effectiveness of Aedes control measures is mixed. Chemical control, which is commonly used, does not appear to be associated with sustainable reductions of mosquito populations over time. Indeed, by contributing to a false sense of security, chemical control may reduce the effectiveness of educational interventions aimed at encouraging local people to remove mosquito breeding sites. Better quality studies of the impact of vector control interventions on the incidence of human infections with Dengue or Zika are still needed. PMID:27926934

Influences of large-scale convection and moisture source on monthly precipitation isotope ratios observed in Thailand, Southeast Asia

NASA Astrophysics Data System (ADS)

Wei, Zhongwang; Lee, Xuhui; Liu, Zhongfang; Seeboonruang, Uma; Koike, Masahiro; Yoshimura, Kei

2018-04-01

Many paleoclimatic records in Southeast Asia rely on rainfall isotope ratios as proxies for past hydroclimatic variability. However, the physical processes controlling modern rainfall isotopic behaviors in the region is poorly constrained. Here, we combined isotopic measurements at six sites across Thailand with an isotope-incorporated atmospheric circulation model (IsoGSM) and the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model to investigate the factors that govern the variability of precipitation isotope ratios in this region. Results show that rainfall isotope ratios are both correlated with local rainfall amount and regional outgoing longwave radiation, suggesting that rainfall isotope ratios in this region are controlled not only by local rain amount (amount effect) but also by large-scale convection. As a transition zone between the Indian monsoon and the western North Pacific monsoon, the spatial difference of observed precipitation isotope among different sites are associated with moisture source. These results highlight the importance of regional processes in determining rainfall isotope ratios in the tropics and provide constraints on the interpretation of paleo-precipitation isotope records in the context of regional climate dynamics.

Socioeconomic, Family, and Pediatric Practice Factors Affecting the Level of Asthma Control

PubMed Central

Bloomberg, Gordon R; Banister, Christina; Sterkel, Randall; Epstein, Jay; Bruns, Julie; Swerczek, Lisa; Wells, Suzanne; Yan, Yan; Garbutt, Jane M

2008-01-01

Background Multiple issues bear on effective control of childhood asthma. Objective To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians. Patients and Methods Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by telephone administered questionnaire. Level of asthma control (“well controlled,” partially controlled,” or “poorly controlled”) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12 month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications. Results Asthma was “well controlled” for 24% of children, “partially controlled” for 20%, and “poorly controlled” for 56%. Medicaid insurance (p=0.016), the presence of another family member with asthma (p=0.0168), and outside the home maternal employment, (p=0.025), were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control (OR 0.49, 95% CI 0.28-0.9). Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guidelines recommended controller medication with level of control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality of life scores were observed in both parents and children with poor control. (ANOVA, p<0.05) Conclusion Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. While Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality of life indicators may further reduce morbidity. PMID:19255010

Evaluation of meat as a first complementary food for breastfed infants: impact on iron intake.

PubMed

Hambidge, K Michael; Sheng, Xiaoyang; Mazariegos, Manolo; Jiang, Tianjiang; Garces, Ana; Li, Dinghua; Westcott, Jamie; Tshefu, Antoinette; Sami, Neelofar; Pasha, Omrana; Chomba, Elwyn; Lokangaka, Adrien; Goco, Norman; Manasyan, Albert; Wright, Linda L; Koso-Thomas, Marion; Bose, Carl; Goldenberg, Robert L; Carlo, Waldemar A; McClure, Elizabeth M; Krebs, Nancy F

2011-11-01

The rationale for promoting the availability of local, affordable, non-fortified food sources of bioavailable iron in developing countries is considered in this review. Intake of iron from the regular consumption of meat from the age of 6 months is evaluated with respect to physiological requirements. Two major randomized controlled trials evaluating meat as a first and regular complementary food are described in this article. These trials are presently in progress in poor communities in Guatemala, Pakistan, Zambia, Democratic Republic of the Congo, and China. © 2011 International Life Sciences Institute.

[A summary of the fecundity for the Zang nationality in the Muli region].

PubMed

Wu, W

1983-11-29

The Zang nationality in the Muli region is a major branch of the Tibetan people now living in Sichuan Province. Before 1949, the social economy in the local area was rather backward, public health was poor, the infant mortality rate was high as 50% and the overall population growth was slow. Since 1949, because of changes that have taken place in the social and economic system, the development of the population has also changed on a large scale. According to a recent survey, numerous households are still trying to change their poor financial condition through a population increase. Conversely, there are also some households with a better financial situation who prefer not to have too many children. In addition, fecundity also differs between women with some education and those who are illiterate, and the social impact on fecundity is very obvious. The influence from traditional concepts and psychological factors is also strong. At the present time, the national ploicy of China is for family planning and birth control to prevent an unlimited population growth. Ideological education and propaganda are needed to alter the people's traditional outdated concept of birth so that the common goal of controlling population growth may be achieved.

Factors related to poor asthma control in Latvian asthma patients between 2013 and 2015

PubMed Central

Smits, Dins; Brigis, Girts; Pavare, Jana; Maurina, Baiba; Barengo, Noël Christopher

2017-01-01

Objectives To investigate whether beliefs about asthma medication, cognitive and emotional factors are related to poor asthma control in a sample of Latvian asthma patients in 2015. Design Cross-sectional, self-administered survey. Subjects Three hundred and fifty two asthma patients (mean age 57.5 years) attending outpatient pulmonologist consultations in Riga, Latvia during September 2013 to December 2015. The sample size was calculated to detect a prevalence of poor asthma control of 50% with a margin of error of 5% and a power of 95%. Main outcome measures The validated Beliefs about Medication Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Good asthma control was assessed using the asthma control test (ACT), a validated five-item scale that reliably assesses asthma control over a recall period of four weeks. Logistic regression models were used to predict poor asthma control. Results Patients who had a good control of asthma medication (OR 0.70; 95% CI 0.61–0.79) or were confident that their asthma medication improves illness (OR 0.84; 95% CI 0.74–0.95) had a reduced risk of poor asthma control. The more symptoms (OR 1.63; 95% CI 1.44–1.84) the asthma patients perceived or the more their illness affects their life, the higher the probability of poor asthma control (OR 1.47; 95% CI 1.31–1.65). Some beliefs of necessity and concerns of asthma medication were also statistically significantly related to poor asthma control. Conclusions Beliefs of necessity of asthma medication, cognitive and emotional illness perception factors correlate well with poor asthma control in Latvian patients. PMID:28585881

MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial.

PubMed

Loh, Debbie Ann; Hairi, Noran Naqiah; Choo, Wan Yuen; Mohd Hairi, Farizah; Peramalah, Devi; Kandiben, Shathanapriya; Lee, Pek Ling; Gani, Norlissa; Madzlan, Mohamed Faris; Abd Hamid, Mohd Alif Idham; Akram, Zohaib; Chu, Ai Sean; Bulgiba, Awang; Cumming, Robert G

2015-02-11

The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia. This cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up. Findings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults. ISRCTN22749696.

Creatinine and myoglobin are poor predictors of anaerobic threshold in colorectal cancer and health

PubMed Central

Nyasavajjala, Sitaramachandra M; Phillips, Beth E; Lund, Jon N; Williams, John P

2015-01-01

Aims Myoglobin is a haem protein produced in skeletal muscles. Serum concentrations of myoglobin have been proposed as a surrogate marker of muscle mass and function in both cachectic cancer patients and healthy non-cancer individuals. Creatinine, a metabolite of creatine phosphate, an energy store found in skeletal muscle, is produced at a constant rate from skeletal muscle. Urinary and plasma creatinine have been used in clinical practice as indicators of skeletal muscle mass in health and disease. Our study aimed to test the hypothesis that plasma myoglobin and creatinine concentration could accurately predict skeletal muscle mass and aerobic capacity in colorectal cancer (CRC) patients and matched healthy controls and thereby an indicative of aerobic performance. Methods We recruited 47 patients with CRC and matching number of healthy volunteers for this study. All participants had their body composition measured by dual-energy X-ray absorptiometry scan, aerobic capacity measured to anaerobic threshold (AT) by cardiopulmonary exercise testing and filled in objective questionnaires to assess the qualitative functions. This study was carried out in accordance with the Declaration of Helsinki, after approval by the local National Health Service (NHS) Research Ethics Committee. Results Age-matched groups had similar serum myoglobin and creatinine concentrations in spite of differences in their aerobic capacity. AT was significantly lower in the CRC group compared with matched controls (1.18 ± 0.44 vs. 1.41 ± 0.71 L/min; P < 0.01). AT had significant correlation with lean muscle mass (LMM) among these groups, but myoglobin and creatinine had poor correlation with LMM and AT. Conclusions Serum myoglobin is a poor predictor of muscle mass, and serum myoglobin and creatinine concentrations do not predict aerobic performance in CRC patients or healthy matched controls. PMID:26136188

Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control.

PubMed

Armour, Carol L; Lemay, Kate; Saini, Bandana; Reddel, Helen K; Bosnic-Anticevich, Sinthia Z; Smith, Lorraine D; Burton, Deborah; Song, Yun Ju Christine; Alles, Marie Chehani; Stewart, Kay; Emmerton, Lynne; Krass, Ines

2011-11-01

Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control. Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions.

Evaluation of mucosal adjuvants and immunization routes for the induction of systemic and mucosal humoral immune responses in macaques.

PubMed

Veazey, Ronald S; Siddiqui, Asna; Klein, Katja; Buffa, Viviana; Fischetti, Lucia; Doyle-Meyers, Lara; King, Deborah F; Tregoning, John S; Shattock, Robin J

2015-01-01

Delivering vaccine antigens to mucosal surfaces is potentially very attractive, especially as protection from mucosal infections may be mediated by local immune responses. However, to date mucosal immunization has had limited successes, with issues of both safety and poor immunogenicity. One approach to improve immunogenicity is to develop adjuvants that are effective and safe at mucosal surfaces. Differences in immune responses between mice and men have overstated the value of some experimental adjuvants which have subsequently performed poorly in the clinic. Due to their closer similarity, non-human primates can provide a more accurate picture of adjuvant performance. In this study we immunised rhesus macaques (Macaca mulatta) using a unique matrix experimental design that maximised the number of adjuvants screened while reducing the animal usage. Macaques were immunised by the intranasal, sublingual and intrarectal routes with the model protein antigens keyhole limpet haemocyanin (KLH), β-galactosidase (β-Gal) and ovalbumin (OVA) in combination with the experimental adjuvants Poly(I:C), Pam3CSK4, chitosan, Thymic Stromal Lymphopoietin (TSLP), MPLA and R848 (Resiquimod). Of the routes used, only intranasal immunization with KLH and R848 induced a detectable antibody response. When compared to intramuscular immunization, intranasal administration gave slightly lower levels of antigen specific antibody in the plasma, but enhanced local responses. Following intranasal delivery of R848, we observed a mildly inflammatory response, but no difference to the control. From this we conclude that R848 is able to boost antibody responses to mucosally delivered antigen, without causing excess local inflammation.

Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns

PubMed Central

Castleberry, Steven A.; Golberg, Alexander; Sharkh, Malak Abu; Khan, Saiqa; Almquist, Benjamin D.; Austen, William G.; Yarmush, Martin L.; Hammond, Paula T.

2017-01-01

Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research. PMID:27108403

Government health insurance and spatial peer effects: New evidence from India.

PubMed

Chatterjee, Chirantan; Joshi, Radhika; Sood, Neeraj; Boregowda, P

2018-01-01

What is the role of spatial peers in diffusion of information about health care? We use the implementation of a health insurance program in Karnataka, India that provided free tertiary care to poor households to explore this issue. We use administrative data on location of patient, condition for which the patient was hospitalized and date of hospitalization (10,507 observations) from this program starting November 2009 to June 2011 for 19 months to analyze spatial and temporal clustering of tertiary care. We find that the use of healthcare today is associated with an increase in healthcare use in the same local area (group of villages) in future time periods and this association persists even after we control for (1) local area fixed effects to account for time invariant factors related to disease prevalence and (2) local area specific time fixed effects to control for differential trends in health and insurance related outreach activities. In particular, we find that 1 new hospitalization today results in 0.35 additional future hospitalizations for the same condition in the same local area. We also document that these effects are stronger in densely populated areas and become pronounced as the insurance program becomes more mature suggesting that word of mouth diffusion of information might be an explanation for our findings. We conclude by discussing implications of our results for healthcare policy in developing economies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Leukocytosis and neutrophilia predict outcome in locally advanced esophageal cancer treated with definitive chemoradiation

PubMed Central

Schernberg, Antoine; Moureau-Zabotto, Laurence; Del Campo, Eleonor Rivin; Escande, Alexandre; Ducreux, Michel; Nguyen, France; Goere, Diane; Chargari, Cyrus; Deutsch, Eric

2017-01-01

Purpose To investigate the prognostic value of leukocyte and neutrophil count as biomarkers in patients with locally advanced esophageal squamous cell carcinoma (SCC) undergoing exclusive chemoradiation. Results A total of 126 patients were identified. Respectively, 33% and 35% displayed baseline leukocytosis and neutrophilia. Estimated 3-year OS and PFS from chemoradiation completion were 31% and 25%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS, and LRC (p < 0.01). In multivariate analysis, leukocytosis remained an independent risk factor associated with poorer OS, PFS and LRC (p < 0.05), independently from tumor stage and length, with higher prognostic value for OS compared with patients’ performance status (PS). Materials and Methods Bi-institutional clinical records from consecutive non-operable patients treated between 2003 and 2015 with definitive chemoradiation for locally advanced esophageal carcinoma were reviewed. Leukocytosis and neutrophilia were defined as a leukocyte or neutrophil count over 10 G/L and 7 G/L, respectively. These parameters were studied for their potential correlation with overall survival (OS), progression free survival (PFS), locoregional control (LRC) and distant metastases control (DMC). Conclusions Leukocytosis and neutrophilia were independent prognostic factors of poor OS, PFS, and LRC in this bi-institutional series of locally advanced esophageal SCC treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters might be clinically relevant biomarkers to be considered for further clinical investigations. PMID:28086222

The key role of exudative lesions and their encapsulation: lessons learned from the pathology of human pulmonary tuberculosis.

PubMed

Cardona, Pere-Joan

2015-01-01

A review of the pathology of human pulmonary TB cases at different stages of evolution in the pre-antibiotic era suggests that neutrophils play an instrumental role in the progression toward active TB. This progression is determined by the type of lesion generated. Thus, exudative lesions, in which neutrophils are the major cell type, are both triggered by and induce local high bacillary load, and tend to enlarge and progress toward liquefaction and cavitation. In contrast, proliferative lesions are triggered by low bacillary loads, mainly comprise epithelioid cells and fibroblasts and tend to fibrose, encapsulate and calcify, thus controlling the infection. Infection of the upper lobes is key to the progression toward active TB for two main reasons, namely poor breathing amplitude, which allows local bacillary accumulation, and the high mechanical stress to which the interlobular septae (which enclose secondary lobes) are submitted, which hampers their ability to encapsulate lesions. Overall, progressing factors can be defined as internal (exudative lesion, local bronchogenous dissemination, coalescence of lesions), with lympho-hematological dissemination playing a very limited role, or external (exogenous reinfection). Abrogating factors include control of the bacillary load and the local encapsulation process, as directed by interlobular septae. The age and extent of disease depend on the quality and speed with which lesions liquefy and disseminate bronchially, the volume of the slough, and the amount and distribution of the sloughing debris dispersed.

The key role of exudative lesions and their encapsulation: lessons learned from the pathology of human pulmonary tuberculosis

PubMed Central

Cardona, Pere-Joan

2015-01-01

A review of the pathology of human pulmonary TB cases at different stages of evolution in the pre-antibiotic era suggests that neutrophils play an instrumental role in the progression toward active TB. This progression is determined by the type of lesion generated. Thus, exudative lesions, in which neutrophils are the major cell type, are both triggered by and induce local high bacillary load, and tend to enlarge and progress toward liquefaction and cavitation. In contrast, proliferative lesions are triggered by low bacillary loads, mainly comprise epithelioid cells and fibroblasts and tend to fibrose, encapsulate and calcify, thus controlling the infection. Infection of the upper lobes is key to the progression toward active TB for two main reasons, namely poor breathing amplitude, which allows local bacillary accumulation, and the high mechanical stress to which the interlobular septae (which enclose secondary lobes) are submitted, which hampers their ability to encapsulate lesions. Overall, progressing factors can be defined as internal (exudative lesion, local bronchogenous dissemination, coalescence of lesions), with lympho-hematological dissemination playing a very limited role, or external (exogenous reinfection). Abrogating factors include control of the bacillary load and the local encapsulation process, as directed by interlobular septae. The age and extent of disease depend on the quality and speed with which lesions liquefy and disseminate bronchially, the volume of the slough, and the amount and distribution of the sloughing debris dispersed. PMID:26136741

Nitrogen Starvation and TorC1 Inhibition Differentially Affect Nuclear Localization of the Gln3 and Gat1 Transcription Factors Through the Rare Glutamine tRNACUG in Saccharomyces cerevisiae

PubMed Central

Tate, Jennifer J.; Rai, Rajendra; Cooper, Terrance G.

2015-01-01

A leucine, leucyl-tRNA synthetase–dependent pathway activates TorC1 kinase and its downstream stimulation of protein synthesis, a major nitrogen consumer. We previously demonstrated, however, that control of Gln3, a transcription activator of catabolic genes whose products generate the nitrogenous precursors for protein synthesis, is not subject to leucine-dependent TorC1 activation. This led us to conclude that excess nitrogen-dependent down-regulation of Gln3 occurs via a second mechanism that is independent of leucine-dependent TorC1 activation. A major site of Gln3 and Gat1 (another GATA-binding transcription activator) control occurs at their access to the nucleus. In excess nitrogen, Gln3 and Gat1 are sequestered in the cytoplasm in a Ure2-dependent manner. They become nuclear and activate transcription when nitrogen becomes limiting. Long-term nitrogen starvation and treatment of cells with the glutamine synthetase inhibitor methionine sulfoximine (Msx) also elicit nuclear Gln3 localization. The sensitivity of Gln3 localization to glutamine and inhibition of glutamine synthesis prompted us to investigate the effects of a glutamine tRNA mutation (sup70-65) on nitrogen-responsive control of Gln3 and Gat1. We found that nuclear Gln3 localization elicited by short- and long-term nitrogen starvation; growth in a poor, derepressive medium; Msx or rapamycin treatment; or ure2Δ mutation is abolished in a sup70-65 mutant. However, nuclear Gat1 localization, which also exhibits a glutamine tRNACUG requirement for its response to short-term nitrogen starvation or growth in proline medium or a ure2Δ mutation, does not require tRNACUG for its response to rapamycin. Also, in contrast with Gln3, Gat1 localization does not respond to long-term nitrogen starvation. These observations demonstrate the existence of a specific nitrogen-responsive component participating in the control of Gln3 and Gat1 localization and their downstream production of nitrogenous precursors. This component is highly sensitive to the function of the rare glutamine tRNACUG, which cannot be replaced by the predominant glutamine tRNACAA. Our observations also demonstrate distinct mechanistic differences between the responses of Gln3 and Gat1 to rapamycin inhibition of TorC1 and nitrogen starvation. PMID:25527290

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ampuero, F.; Doss, L.L.; Khan, M.

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and after loading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion >4 cm in diameter) and poor vagnal anatomy were selected for this modality of therapy. In this series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease asmore » a prognostic indicator; despite a local control rate of 59%, only 33% of the patients are alive from 25-51 months. Complications occurred in 12 patients (42%). Six patients (22%) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18%) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.« less

The Effects of Cryotherapy on Proprioception System

PubMed Central

Furmanek, Mariusz Paweł; Słomka, Kajetan; Juras, Grzegorz

2014-01-01

Proprioception plays an important role in the complex mechanism of joint control. Contemporary sport activities impose extremely high physical demands on athletes. Winter sports are played in areas with excessively low temperatures. Moreover, many athletes are subjected to treatments that involve local lowering of the body temperature before, during, and after physical activity. This work reviews the current knowledge regarding the influence of local cryotherapy on the proprioception system. The reviewed literature identified several tests that evaluate different aspects of proprioception. There is no universally agreed protocol, or clear set of criteria for test conditions. The outcomes of different tests and assessments of cryotherapy procedures using different cold modalities are poorly correlated. In general, the published results on the mechanism of cryotherapy effects on proprioception are not uniquely conclusive and are frequently contradictory. Additional high-quality research is required to explicitly answer the following questions: (1) whether local cryotherapy influences all aspects of proprioception; (2) whether the current methods of evaluation are adequate for the exploration of the relationship between cryotherapy and proprioception; and (3) whether the application of local cryotherapy is safe for athletes regarding proprioception. The review clearly showed that there is no comprehensive model relating cryotherapy and proprioception. PMID:25478573

The effects of cryotherapy on proprioception system.

PubMed

Furmanek, Mariusz Paweł; Słomka, Kajetan; Juras, Grzegorz

2014-01-01

Proprioception plays an important role in the complex mechanism of joint control. Contemporary sport activities impose extremely high physical demands on athletes. Winter sports are played in areas with excessively low temperatures. Moreover, many athletes are subjected to treatments that involve local lowering of the body temperature before, during, and after physical activity. This work reviews the current knowledge regarding the influence of local cryotherapy on the proprioception system. The reviewed literature identified several tests that evaluate different aspects of proprioception. There is no universally agreed protocol, or clear set of criteria for test conditions. The outcomes of different tests and assessments of cryotherapy procedures using different cold modalities are poorly correlated. In general, the published results on the mechanism of cryotherapy effects on proprioception are not uniquely conclusive and are frequently contradictory. Additional high-quality research is required to explicitly answer the following questions: (1) whether local cryotherapy influences all aspects of proprioception; (2) whether the current methods of evaluation are adequate for the exploration of the relationship between cryotherapy and proprioception; and (3) whether the application of local cryotherapy is safe for athletes regarding proprioception. The review clearly showed that there is no comprehensive model relating cryotherapy and proprioception.

Clinical governance and infection control in the United Kingdom.

PubMed

Masterson, R G; Teare, E L

2001-01-01

The recent organizational changes in the NHS have at their core the concept of clinical governance. Although initially poorly defined and understood this term has now taken on a clear identity, placing quality alongside fiscal probity and corporate governance at the top of NHS priorities. Integral to clinical governance are the basic elements of clear national standards for services and treatments that are to be locally delivered through assured, monitored, high quality healthcare. It is within this framework that workers in infection control must develop their own methods of applying clinical governance. This review explores the implications that the strategy of clinical governance holds for the speciality of infection control, emphasizing the benefits its active adoption can bring and highlighting the key relevance of clinical risk management in this setting. It illustrates clinical governance as a tool to engage colleagues on a multi-disciplinary front, most particularly the crucial link to senior Trust management.

The development of deep karst in the anticlinal aquifer structure based on the coupling of multistage flow systems

NASA Astrophysics Data System (ADS)

Xu, M.; Zhong, L.; Yang, Y.

2017-12-01

Under the background of neotectonics, the multistage underground flow system has been form due the different responses of main stream and tributaries to crust uplift. The coupling of multistage underground flow systems influences the development of karst thoroughly. At first, the research area is divided into vadose area, shunted area and exorheic area based on the development characteristics of transverse valley. Combining the controlling-drain action with topographic index and analyzing the coupling features of multistage underground flow system. And then, based on the coupling of multistage underground flow systems, the characteristics of deep karst development were verified by the lossing degree of surface water, water bursting and karst development characteristics of tunnels. The vadose area is regional water system based, whose deep karst developed well. It resulted the large water inflow of tunnels and the surface water drying up. The shunted area, except the region near the transverse valleys, is characterized by regional water system. The developed deep karst make the surface water connect with deep ground water well, Which caused the relatively large water flow of tunnels and the serious leakage of surface water. The deep karst relatively developed poor in the regions near transverse valleys which is characterized by local water system. The exorheic area is local water system based, whose the deep karst developed poor, as well as the connection among surface water and deep ground water. It has result in the poor lossing of the surface water under the tunnel construction. This study broadens the application field of groundwater flow systems theory, providing a new perspective for the study of Karst development theory. Meanwhile it provides theoretical guidance for hazard assessment and environmental negative effect in deep-buried Karst tunnel construction.

A Learning-Style Theory for Understanding Autistic Behaviors

PubMed Central

Qian, Ning; Lipkin, Richard M.

2011-01-01

Understanding autism's ever-expanding array of behaviors, from sensation to cognition, is a major challenge. We posit that autistic and typically developing brains implement different algorithms that are better suited to learn, represent, and process different tasks; consequently, they develop different interests and behaviors. Computationally, a continuum of algorithms exists, from lookup table (LUT) learning, which aims to store experiences precisely, to interpolation (INT) learning, which focuses on extracting underlying statistical structure (regularities) from experiences. We hypothesize that autistic and typical brains, respectively, are biased toward LUT and INT learning, in low- and high-dimensional feature spaces, possibly because of their narrow and broad tuning functions. The LUT style is good at learning relationships that are local, precise, rigid, and contain little regularity for generalization (e.g., the name–number association in a phonebook). However, it is poor at learning relationships that are context dependent, noisy, flexible, and do contain regularities for generalization (e.g., associations between gaze direction and intention, language and meaning, sensory input and interpretation, motor-control signal and movement, and social situation and proper response). The LUT style poorly compresses information, resulting in inefficiency, sensory overload (overwhelm), restricted interests, and resistance to change. It also leads to poor prediction and anticipation, frequent surprises and over-reaction (hyper-sensitivity), impaired attentional selection and switching, concreteness, strong local focus, weak adaptation, and superior and inferior performances on simple and complex tasks. The spectrum nature of autism can be explained by different degrees of LUT learning among different individuals, and in different systems of the same individual. Our theory suggests that therapy should focus on training autistic LUT algorithm to learn regularities. PMID:21886617

Landscape controls on dissolved organic carbon export from watersheds of the British Columbia outer-coast

NASA Astrophysics Data System (ADS)

Giesbrecht, I.; Tank, S. E.; Frazer, G. W.; Gonzalez Arriola, S.; Korver, M.; Floyd, B. C.; Oliver, A. A.; Lertzman, K. P.

2016-12-01

Global models suggest that the Pacific Coastal Temperate Rainforest of North America (PCTR) exports significant quantities of dissolved organic carbon (DOC) to the coastal ocean. This aquatic flux from land to sea has implications for marine ecosystems and regional carbon budgets. However, DOC concentrations and flux estimates vary substantially across watersheds and drivers of spatial variation are poorly described for this region. For an outer-coast area of the PCTR, with among the highest per unit area DOC yields in the world (Oliver et al. in prep.), we describe and model landscape controls on DOC exports to the coastal ocean. In 2015 we collected three rounds of synoptic samples on Calvert Island, observing a nine-fold variation in DOC concentration (3.8 - 34.3 mg/L) across 59 watersheds that range in size from 0.26 to 21.12 km2 and reach a maximum elevation of 1012 m. We use standard ecosystem maps (Province of BC), LiDAR and other remote sensing data to measure watershed attributes. We use freshwater cation concentrations to explore geochemical signals of bedrock and surficial deposits that may be poorly represented by available geospatial data. We examine the role of topography, climate, waterbodies, geology and the local ecosystem mosaic in controlling DOC concentration and flux. An improved model of spatial controls on freshwater DOC export from the outer-coast of the PCTR will inform regional carbon modeling efforts and enhance our understanding of ecosystem processes at the coastal margin.

Following the clues to neuropathic pain. Distribution and other leads reveal the cause and the treatment approach.

PubMed

Belgrade, M J

1999-11-01

Neuropathic pain can seem enigmatic at first because it can last indefinitely and often a cause is not evident. However, heightened awareness of typical characteristics, such as the following, makes identification fairly easy: The presence of certain accompanying conditions (e.g., diabetes, HIV or herpes zoster infection, multiple sclerosis) Pain described as shooting, stabbing, lancinating, burning, or searing Pain worse at night Pain following anatomic nerve distribution Pain in a numb or insensate site The presence of allodynia Neuropathic pain responds poorly to standard pain therapies and usually requires specialized medications (e.g., anticonvulsants, tricyclic antidepressants, opioid analgesics) for optimal control. Successful pain control is enhanced with use of a systematic approach consisting of disease modification, local or regional measures, and systemic therapy.

Vaccination strategies for SIR vector-transmitted diseases.

PubMed

Cruz-Pacheco, Gustavo; Esteva, Lourdes; Vargas, Cristobal

2014-08-01

Vector-borne diseases are one of the major public health problems in the world with the fastest spreading rate. Control measures have been focused on vector control, with poor results in most cases. Vaccines should help to reduce the diseases incidence, but vaccination strategies should also be defined. In this work, we propose a vector-transmitted SIR disease model with age-structured population subject to a vaccination program. We find an expression for the age-dependent basic reproductive number R(0), and we show that the disease-free equilibrium is locally stable for R(0) ≤ 1, and a unique endemic equilibrium exists for R(0) > 1. We apply the theoretical results to public data to evaluate vaccination strategies, immunization levels, and optimal age of vaccination for dengue disease.

Evaluation of fuzzy inference systems using fuzzy least squares

NASA Technical Reports Server (NTRS)

Barone, Joseph M.

1992-01-01

Efforts to develop evaluation methods for fuzzy inference systems which are not based on crisp, quantitative data or processes (i.e., where the phenomenon the system is built to describe or control is inherently fuzzy) are just beginning. This paper suggests that the method of fuzzy least squares can be used to perform such evaluations. Regressing the desired outputs onto the inferred outputs can provide both global and local measures of success. The global measures have some value in an absolute sense, but they are particularly useful when competing solutions (e.g., different numbers of rules, different fuzzy input partitions) are being compared. The local measure described here can be used to identify specific areas of poor fit where special measures (e.g., the use of emphatic or suppressive rules) can be applied. Several examples are discussed which illustrate the applicability of the method as an evaluation tool.

Percutaneous Curettage and Continuous Irrigation for MRSA Lumbar Spondylodiscitis: A Report of Three Cases

PubMed Central

Yamagami, Yoshiki; Shibuya, Sei; Komatsubara, Satoshi; Yamamoto, Tetsuji; Arima, Nobuo

2009-01-01

There has been a recent increase in pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) associated with an increasing number of compromised patients. As long as serious paralysis is absent, we recommend percutaneous curettage and continuous irrigation as an effective treatment for MRSA lumbar spondylodiscitis. Under local anesthesia, the affected lumbar discs were curetted using percutaneous nucleotomy, and tubes were placed for continuous irrigation. The period of continuous irrigation was generally 2 weeks. Infection was controlled after one procedure in two cases and after two procedures in one case. Postoperative radiography and magnetic resonance imaging (MRI) showed callus formation, normalized signal intensity in vertebral bodies, and regression of abscesses. Open surgery under general anesthesia has been considered risky in patients with poor performance status or old age. The present method, which is an application of needle biopsy, can be performed under local anesthesia and is minimally invasive. PMID:19718264

Pyramidal cell-interneuron interactions underlie hippocampal ripple oscillations.

PubMed

Stark, Eran; Roux, Lisa; Eichler, Ronny; Senzai, Yuta; Royer, Sebastien; Buzsáki, György

2014-07-16

High-frequency ripple oscillations, observed most prominently in the hippocampal CA1 pyramidal layer, are associated with memory consolidation. The cellular and network mechanisms underlying the generation, frequency control, and spatial coherence of the rhythm are poorly understood. Using multisite optogenetic manipulations in freely behaving rodents, we found that depolarization of a small group of nearby pyramidal cells was sufficient to induce high-frequency oscillations, whereas closed-loop silencing of pyramidal cells or activation of parvalbumin- (PV) or somatostatin-immunoreactive interneurons aborted spontaneously occurring ripples. Focal pharmacological blockade of GABAA receptors abolished ripples. Localized PV interneuron activation paced ensemble spiking, and simultaneous induction of high-frequency oscillations at multiple locations resulted in a temporally coherent pattern mediated by phase-locked interneuron spiking. These results constrain competing models of ripple generation and indicate that temporally precise local interactions between excitatory and inhibitory neurons support ripple generation in the intact hippocampus. Copyright © 2014 Elsevier Inc. All rights reserved.

Pyramidal Cell-Interneuron Interactions Underlie Hippocampal Ripple Oscillations

PubMed Central

Stark, Eran; Roux, Lisa; Eichler, Ronny; Senzai, Yuta; Royer, Sebastien; Buzsáki, György

2015-01-01

SUMMARY High-frequency ripple oscillations, observed most prominently in the hippocampal CA1 pyramidal layer, are associated with memory consolidation. The cellular and network mechanisms underlying the generation, frequency control, and spatial coherence of the rhythm are poorly understood. Using multisite optogenetic manipulations in freely behaving rodents, we found that depolarization of a small group of nearby pyramidal cells was sufficient to induce high-frequency oscillations, whereas closed-loop silencing of pyramidal cells or activation of parvalbumin-(PV) or somatostatin-immunoreactive interneurons aborted spontaneously occurring ripples. Focal pharmacological blockade of GABAA receptors abolished ripples. Localized PV inter-neuron activation paced ensemble spiking, and simultaneous induction of high-frequency oscillations at multiple locations resulted in a temporally coherent pattern mediated by phase-locked inter-neuron spiking. These results constrain competing models of ripple generation and indicate that temporally precise local interactions between excitatory and inhibitory neurons support ripple generation in the intact hippocampus. PMID:25033186

Cognitive control components and speech symptoms in people with schizophrenia.

PubMed

Becker, Theresa M; Cicero, David C; Cowan, Nelson; Kerns, John G

2012-03-30

Previous schizophrenia research suggests poor cognitive control is associated with schizophrenia speech symptoms. However, cognitive control is a broad construct. Two important cognitive control components are poor goal maintenance and poor verbal working memory storage. In the current research, people with schizophrenia (n=45) performed three cognitive tasks that varied in their goal maintenance and verbal working memory storage demands. Speech symptoms were assessed using clinical rating scales, ratings of disorganized speech from typed transcripts, and self-reported disorganization. Overall, alogia was associated with both goal maintenance and verbal working memory tasks. Objectively rated disorganized speech was associated with poor goal maintenance and with a task that included both goal maintenance and verbal working memory storage demands. In contrast, self-reported disorganization was unrelated to either amount of objectively rated disorganized speech or to cognitive control task performance, instead being associated with negative mood symptoms. Overall, our results suggest that alogia is associated with both poor goal maintenance and poor verbal working memory storage and that disorganized speech is associated with poor goal maintenance. In addition, patients' own assessment of their disorganization is related to negative mood, but perhaps not to objective disorganized speech or to cognitive control task performance. Published by Elsevier Ireland Ltd.

A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression

DOE Office of Scientific and Technical Information (OSTI.GOV)

Loblaw, D. Andrew, E-mail: andrew.loblaw@sunnybrook.ca; Mitera, Gunita; Ford, Michael

2012-10-01

Purpose: To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC). Methods: A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies. Results: An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16more » Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes. Conclusions: If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Allen, Matthew W.; Schwartz, David L.; Department of Experimental Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX

Purpose: Carcinoma of the nasal cavity and septum has historically been associated with a poor prognosis. This report updates the long-term outcomes for radiotherapy (RT) of this disease site at University of Texas M.D. Anderson Cancer Center. Methods and Materials: A retrospective analysis was performed on the data from 68 patients diagnosed with histologically proven carcinoma of the nasal cavity or septum treated with RT for curative intent between 1969 and 2000. The disease histologic type was as follows: 45 (66%) had squamous cell carcinoma, 12 (18%) had adenoid cystic carcinoma, 8 (12%) had adenocarcinoma, and 3 (4%) had poorly/undifferentiatedmore » carcinoma. Of the 68 patients, 32 (47%) had received definitive RT. Of these, 23 had received external beam RT and 9 brachytherapy. Of the remaining 36 patients, 3 (4%) underwent preoperative external beam RT and 33 (49%) postoperative external beam RT. Of the 68 patients, 13 (19%) received neck RT. The median dose for patients receiving definitive and postoperative RT was 65 and 58.2 Gy, respectively. The median follow-up for the entire cohort was 11 years (range, 2.4-30.1 years). Results: Of the 68 patients, 19 (28%) developed a locoregional relapse, 14 (21%) locally and 5 (7%) regionally. The local control rate at 5 and 10 years was 86% and 76%, respectively. The disease-specific survival rate was 86% and 78%, and the overall survival rate was 82% and 62% at 5 and 10 years, respectively. Conclusion: This extended follow-up of our institutional experience has demonstrated that RT can provide durable long-term locoregional control and survival outcomes for patients with carcinoma of the nasal cavity and septum.« less

[Neoadjuvant chemotherapy of osteosarcoma. Results of the cooperative studies COSS-80 and COSS-82 after 7 and 5 years].

PubMed

Bielack, S; Beck, J; Delling, G; Gerein, V; Grümayer, R; Hiddemann, W; Jobke, A; Jürgens, H; Kornhuber, G; Kotz, R

1989-01-01

The analysis of the results of two German Pediatric Oncology (GPO) cooperative, neoadjuvant chemotherapy trials after a followup of 7 (COSS-80) and 5 years (COSS-82) allows several conclusions concerning both systemic and local treatment of patients suffering from osteosarcoma. A metastasis free survival rate (MFS) of 59% was reached in the reduced study group of the first study, COSS-80. In addition to size of the primary tumor, the extent of chemotherapy induced devitalisation was very closely related to the probability of survival without systemic recurrence. Following this observation, it was the aim of the next study, COSS-82, to improve the MFS of patients with poorly responding tumors by altering their postoperative chemotherapy regimen. However, this "salvage" approach failed. Moreover, an effort to reduce treatment related toxicity by sparing some patients from the side effects of two particularly toxic drugs, adriamycin (ADR) and cisplatinum (CDDP), by only giving these postoperatively and only after insufficient tumor response to preoperative therapy, failed (MFS of the study arm of COSS-82 45% at 5 years vs. 68% for the control arm with primary use of ADR and CDDP, p less than 0.05). The value of an effective primary chemotherapy is further enhanced by the observation, that en bloc resection of tumors which were poor responders to preoperative therapy was associated with an increased risk of distant metastases when compared with amputation and rotation plasty, while this was not the case for good responders. In conclusion, both systemic tumor control and optimal local therapy require that all effects drugs are to be used as early as possible in the primary treatment of osteosarcoma, in order to enforce maximum tumor cell destruction and hence an optimistic outlook for the individual patient.

[Physical therapy of frozen shoulder: literature review].

PubMed

Alvado, A; Pélissier, J; Bénaim, C; Petiot, S; Hérisson, C

2001-03-01

To determine the efficacy of physical treatments in adhesive capsulitis of the shoulder by a systematic review of literature, attempting to perform a meta-analysis from randomised clinical trials. A systematic literature search was conducted to retrieve all randomised controlled trials of physical therapy such as physiotherapy and manipulation, but also arthrographic distension, mobilisation under general anaesthesia or nerve block, arthroscopic distension or arthrolysis, and intra-articular corticoid injections. The main outcome for meta-analysis was the restoration of range of movement between the sixth week and the third month. Only 16 articles could be selected, and only three about capsular distension were included in a meta-analysis because of the heterogeneity of the criteria assessing the functional results and of the poor methodological value of most of the articles. Some open studies stressed the value of daily manipulations and physiotherapy, intra-articular corticosteroid injections, but their quality was poor or limited. Nothing was written about antalgic drugs to facilitate joint mobilisation, and the use of a thoraco-brachial abduction device between exercises was only quoted. The most refractory cases might need more aggressive interventions: arthrographic distension with local anaesthesia and steroid injection; mobilisation under general or local anaesthesia, specially interscalene brachial plexus block; arthroscopic release. But there was no randomised controlled study comparing these three techniques and it seemed impossible to come to any conclusion about the superiority of one of them. The meta-analysis showed yet that capsular distension with intra-articular corticoid injections was better than corticoid injections alone. This demonstrated the need of a consensus about the criteria of assessment, the time of evaluation, before assessing by randomised clinical trials of good quality their therapeutic value.

In vitro antifungal susceptibility to six antifungal agents of 229 Candida isolates from patients with diabetes mellitus.

PubMed

Manfredi, M; McCullough, M J; Polonelli, L; Conti, S; Al-Karaawi, Z M; Vescovi, P; Porter, S R

2006-06-01

The most common antifungal drugs in current clinical use for the treatment of oral candidosis are polyenes and azoles, mainly used topically. Poor glycaemic control in association with other local factors, such as the presence of oral dental prostheses, salivary pH, salivary flow rate and tobacco habits, may lead to the development of oral candidosis. Topical antifungal agents are frequently used to prevent the development of candidal infections in patients with poor metabolic control, particularly in the elderly wearing dentures. The aim of this study was to assess the antifungal susceptibility of Candida isolates to six antifungal agents using a commercially available kit, Fungitest. The isolated were collected from patients affected by diabetes mellitus from two different geographic localities (London, UK, and Parma, Italy) and from a group of healthy non-diabetic subjects. No differences in antifungal susceptibility to the six agents tested were observed between Candida isolates from diabetic and non-diabetic subjects. However, differences were observed between the two geographically different diabetes mellitus populations. Oral yeast isolates from diabetes mellitus patients in the UK more often displayed resistance or intermediate resistance to fluconazole (P=0.02), miconazole (P<0.0001), and ketoconazole (P=0.01) than did isolates from diabetes mellitus patients in Italy. In addition, more C. albicans isolates were found in diabetic and non-diabetic subjects that were susceptible to fluconazole (P=0.0008 and P=0.01, respectively) than non-albicans isolates. The difference in the antifungal resistance of isolates from the two populations of diabetes mellitus patients may be related to differences in the therapeutic management of candidal infections between the two centres.

Lack of in vitro-in vivo correlation for a UC781-releasing vaginal ring in macaques.

PubMed

McConville, Christopher; Smith, James M; McCoy, Clare F; Srinivasan, Priya; Mitchell, James; Holder, Angela; Otten, Ron A; Butera, Salvatore; Doncel, Gustavo F; Friend, David R; Malcolm, R Karl

2015-02-01

This study describes the preclinical development of a matrix-type silicone elastomer vaginal ring device designed to provide controlled release of UC781, a non-nucleoside reverse transcriptase inhibitor. Testing of both human- and macaque-sized rings in a sink condition in vitro release model demonstrated continuous UC781 release in quantities considered sufficient to maintain vaginal fluid concentrations at levels 82-860-fold higher than the in vitro IC50 (2.0 to 10.4 nM) and therefore potentially protect against mucosal transmission of HIV. The 100-mg UC781 rings were well tolerated in pig-tailed macaques, did not induce local inflammation as determined by cytokine analysis and maintained median concentrations in vaginal fluids of UC781 in the range of 0.27 to 5.18 mM during the course of the 28-day study. Analysis of residual UC781 content in rings after completion of both the in vitro release and macaque pharmacokinetic studies revealed that 57 and 5 mg of UC781 was released, respectively. The pharmacokinetic analysis of a 100-mg UC781 vaginal ring in pig-tailed macaques showed poor in vivo-in vitro correlation, attributed to the very poor solubility of UC781 in vaginal fluid and resulting in a dissolution-controlled drug release mechanism rather than the expected diffusion-controlled mechanism.

Eradication of schistosomiasis in Guangxi, China. Part 2: Political economy, management strategy and costs, 1953-92.

PubMed Central

Sleigh, A.; Jackson, S.; Li, X.; Huang, K.

1998-01-01

Reported are the results of a study of the political economy, management, and costs of the successful Guangxi schistosomiasis eradication programme, spanning 40 years from 1953 to 1992. For this purpose we analysed all government data and memoranda on the policy, management, technical support, finance, and the control strategy of the programme. We also interviewed many local staff involved in the programme over the 40-year period and obtained cost data from annual county-level records on seven major categories of variable costs. Schistosomiasis control in Guangxi began with one of the first examples of community participation and rapid assessment in public health history--the use of pre-franked envelopes to return disease questionnaires and suspect snails from rural areas. This approach quickly and accurately delineated the endemic area. This was Mao Zedong's "mass line", incorporating ideas and knowledge from peasants directly into services run for and by them, here the schistosomiasis control programme. Recognition by China's leaders that schistosomiasis was a great economic burden, steadfast prioritizing of the programme over 40 years, local innovative scientific study, agricultural and environmental focus on eradicating the snail hosts and boosting rural production, and mass community education and support were all key factors in the final success. Local leaders motivated programme staff and everyone involved knew the objectives. The programme was always multisectoral, with policy developed centrally, and strategy and collaboration encouraged and rewarded at the grass-roots. These features explain how a very poor autonomous region such as Guangxi finally eradicated schistosomiasis, spending less than US$ 0.50 per protected citizen per year; it is remarkable that the disease and snails were initially found across a large area of complex environments and modern drugs such as praziquantel were not available for most of the 40-year period. The lessons from Guangxi can be adapted elsewhere and should encourage other areas to control endemic schistosomiasis using methods devised to suit the local culture and geography. Images Fig. 2 PMID:9868841

Analysis of air quality in Dire Dawa, Ethiopia.

PubMed

Kasim, Oluwasinaayomi Faith; Woldetisadik Abshare, Muluneh; Agbola, Samuel Babatunde

2017-12-07

Ambient air quality was monitored and analyzed to develop air quality index and its implications for livability and climate change in Dire Dawa, Ethiopia. Using survey research design, 16 georeferenced locations, representing different land uses, were randomly selected and assessed for sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), carbon dioxide (CO 2 ), carbon monoxide (CO),volatile organic compounds (VOCs), and meteorological parameters (temperature and relative humidity). The study found mean concentrations across all land uses for SO 2 of 0.37 ± 0.08 ppm, NO 2 of 0.13 ± 0.17 ppm, CO 2 of 465.65 ± 28.63 ppm, CO of 3.35 ± 2.04 ppm, and VOCs of 1850.67 ± 402 ppm. An air quality index indicated that ambient air quality for SO 2 was very poor, NO 2 ranged from moderate to very poor, whereas CO rating was moderate. Significant positive correlations existed between temperature and NO 2 , CO 2 , and CO and between humidity and VOCs. Significant relationships were also recorded between CO 2 and NO 2 and between CO and CO 2 . Poor urban planning, inadequate pollution control measure, and weak capacity to monitor air quality have implications for energy usage, air quality, and local meteorological parameters, with subsequent feedback into global climate change. Implementation of programs to monitor and control emissions in order to reduce air pollution will provide health, economic, and environmental benefits to the city. The need to develop and implement emission control programs to reduce air pollution in Dire Dawa City is urgent. This will provide enormous economic, health, and environmental benefits. It is expected that economic effects of air quality improvement will offset the expenditures for pollution control. Also, strategies that focus on air quality and climate change present a unique opportunity to engage different stakeholders in providing inclusive and sustainable development agenda for Dire Dawa.

Catch me if you can--the use of image guidance in the radiotherapy of an unusual case of esophageal cancer.

PubMed

Jensen, Alexandra D; Grehn, Christian; Nikoghosyan, Anna; Thieke, Christian; Krempien, Robert; Huber, Peter E; Debus, Jürgen; Münter, Marc W

2009-07-01

Despite maximum therapy the prognosis of esophageal carcinoma still remains extremely poor. New treatment strategies including improved radiation therapy techniques promise better outcome by improving local control through precise dose delivery due to higher conformality. A 62-year-old patient with locally advanced carcinoma of the gastroesophageal junction underwent definitive radiochemotherapy with intensity-modulated radiation therapy (IMRT). On positioning control with the in-room CT, the distal esophagus, and hence the tumor, was found to be highly mobile exhibiting changes in position of up to 4 cm from fraction to fraction. IMRT plans were created for various positions establishing a plan library to choose from as appropriate. CT scans were performed prior to each treatment fraction to clarify esophagus position in order to choose the adequate treatment plan. Image guidance was crucial in this unusual case of esophageal carcinoma. Without the information from position control CTs, the tumor would have received only about half the prescribed dose due to variations in position. For this specific case, in-room CT scans are probably superior to kilo- or megavoltage CTs due to the higher soft-tissue contrast enabling detection of positioning variation of the organ and offering the possibility to use the CT for treatment planning.

Cardiovascular Risk Factors in Patients with Poorly Controlled Diabetes Mellitus.

PubMed

Dizdarevic-Bostandzic, Amela; Begovic, Ermin; Burekovic, Azra; Velija-Asimi, Zelija; Godinjak, Amina; Karlovic, Vanja

2018-02-01

Diabetes mellitus(DM) is considered an independent cardiovascular risk factor. Having in mind concomitant occurence of diabetes and other cardiovascular risk factors, it is expected that patients with poor glucoregulation will have more cardiovascular risk factors and higher cardiovascular risk than patients with good glucoregulation. To compare cardiovascular risk and cardiovascular risk factors between patients with poorly controlled and patients with well-controlled Diabetes mellitus. Hundered ten patients aged 40-70 years suffering from Diabetes mellitus type 2 were included. Research is designed as a retrospective, descriptive study. Patients with glycosylated hemoglobin (HbA1c) > 7% were considered to have poorly controlled diabetes. The following data and parameters were monitored: age,sex, family history, data on smoking and alcohol consumption, BMI (body mass index), blood pressure, blood glucose, total cholesterol, triglycerides, LDL, HDL, fibrinogen, uric acid. For the assessment of cardiovascular risk, the WHO / ISH (World Health Organization/International Society of hypertension) tables of the 10-year risk were used, and due to the assessment of the risk factors prevalence, the optimal values of individual numerical variables were defined. Differences in the mean values of systolic, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol are statistically significant higher in patients with poorly controlled diabetes. Hypertension more frequently occurre in patients with poorly controlled DM. The majority of patients with well-controlled DM belong to the group of low and medium cardiovascular risk, while the majority of patients with poorly controlled DM belong to the group of high and very high cardiovascular risk. In our research, there was a significant difference in cardiovascular risk in relation to the degree of DM regulation, and HbA1c proved to be an important indicator for the emergence of the CVD. There are significant differences in certain risk factors between patients with poorly controlled and well controlled DM. Patients with poorly controlled diabetes mellitus have a higher cardiovascular risk than patients with well controlled diabetes. The value of HbA1c should be considered when assessing cardiovascular risk.

Why don't segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia.

PubMed

Belak, Andrej; Madarasova Geckova, Andrea; van Dijk, Jitse P; Reijneveld, Sijmen A

2018-06-16

The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations. We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories. Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence. Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.

Metal segregation in hierarchically structured cathode materials for high-energy lithium batteries

DOE PAGES

Lin, Feng; Xin, Huolin L.; Nordlund, Dennis; ...

2016-01-11

Controlling surface and interfacial properties of battery materials is key to improving performance in rechargeable Li-ion devices. Surface reconstruction from a layered to a rock salt structure in metal oxide cathode materials is commonly observed and results in poor high-voltage cycling performance, impeding attempts to improve energy density. Hierarchically structured LiNi 0.4Mn 0.4Co 0.2O 2 (NMC-442) spherical powders, made by spray pyrolysis, exhibit local elemental distribution gradients that deviate from the global NMC-442 composition; specifically, they are Ni-rich and Mn-poor at particle surfaces. These materials demonstrate improved Coulombic efficiencies, discharge capacities, and high-voltage capacity retention in lithium half-cell configurations. Themore » subject powders show superior resistance against surface reconstruction due to the tailored surface chemistry, compared to conventional NMC-442 materials. This paves the way towards the development of a new generation of robust and stable high-energy NMC cathodes for Li-ion batteries.« less

Comprehensibility and neural substrate of communicative gestures in severe aphasia.

PubMed

Hogrefe, Katharina; Ziegler, Wolfram; Weidinger, Nicole; Goldenberg, Georg

2017-08-01

Communicative gestures can compensate incomprehensibility of oral speech in severe aphasia, but the brain damage that causes aphasia may also have an impact on the production of gestures. We compared the comprehensibility of gestural communication of persons with severe aphasia and non-aphasic persons and used voxel based lesion symptom mapping (VLSM) to determine lesion sites that are responsible for poor gestural expression in aphasia. On group level, persons with aphasia conveyed more information via gestures than controls indicating a compensatory use of gestures in persons with severe aphasia. However, individual analysis showed a broad range of gestural comprehensibility. VLSM suggested that poor gestural expression was associated with lesions in anterior temporal and inferior frontal regions. We hypothesize that likely functional correlates of these localizations are selection of and flexible changes between communication channels as well as between different types of gestures and between features of actions and objects that are expressed by gestures. Copyright © 2017 Elsevier Inc. All rights reserved.

Metallicity inhomogeneities in local star-forming galaxies as a sign of recent metal-poor gas accretion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sánchez Almeida, J.; Morales-Luis, A. B.; Muñoz-Tuñón, C.

2014-03-01

We measure the oxygen metallicity of the ionized gas along the major axis of seven dwarf star-forming galaxies. Two of them, SDSSJ1647+21 and SDSSJ2238+14, show ≅0.5 dex metallicity decrements in inner regions with enhanced star formation activity. This behavior is similar to the metallicity drop observed in a number of local tadpole galaxies by Sánchez Almeida et al., and was interpreted as showing early stages of assembling in disk galaxies, with the star formation sustained by external metal-poor gas accretion. The agreement with tadpoles has several implications. (1) It proves that galaxies other than the local tadpoles present the samemore » unusual metallicity pattern. (2) Our metallicity inhomogeneities were inferred using the direct method, thus discarding systematic errors usually attributed to other methods. (3) Taken together with the tadpole data, our findings suggest a threshold around one-tenth the solar value for the metallicity drops to show up. Although galaxies with clear metallicity drops are rare, the physical mechanism responsible for them may sustain a significant part of the star formation activity in the local universe. We argue that the star formation dependence of the mass-metallicity relationship, as well as other general properties followed by most local disk galaxies, is naturally interpreted as side effects of pristine gas infall. Alternatives to the metal-poor gas accretion are examined as well.« less

Fiscal decentralisation and infant mortality rate: the Colombian case.

PubMed

Soto, Victoria Eugenia; Farfan, Maria Isabel; Lorant, Vincent

2012-05-01

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998-2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to -0.06). However, this effect was stronger in non-poor municipalities (-0.12) than poor ones (-0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised. Copyright © 2012 Elsevier Ltd. All rights reserved.

[The impact of therapeutic inertia and the degree of the medication adherence on the control goals for patients with diabetes].

PubMed

López-Simarro, F; Moral, I; Aguado-Jodar, A; Cols-Sagarra, C; Mancera-Romero, J; Alonso-Fernández, M; Miravet-Jiménez, S; Brotons, C

2017-11-21

The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

A 'Scottish Poor Law of Lunacy'? Poor Law, Lunacy Law and Scotland's parochial asylums.

PubMed

Farquharson, Lauren

2017-03-01

Scotland's parochial asylums are unfamiliar institutional spaces. Representing the concrete manifestation of the collision between two spheres of legislation, the Poor Law and the Lunacy Law, six such asylums were constructed in the latter half of the nineteenth century. These sites expressed the enduring mandate of the Scottish Poor Law 1845 over the domain of 'madness'. They were institutions whose very existence was fashioned at the directive of the local arm of the Poor Law, the parochial board, and they constituted a continuing 'Scottish Poor Law of Lunacy'. Their origins and operation significantly subverted the intentions and objectives of the Lunacy Act 1857, the aim of which had been to institute a public district asylum network with nationwide coverage.

Enviromental Effects on Internal Color Gradients of Early-Type Galaxies

NASA Astrophysics Data System (ADS)

La Barbera, F.; de Carvalho, R. R.; Gal, R. R.; Busarello, G.; Haines, C. P.; Mercurio, A.; Merluzzi, P.; Capaccioli, M.; Djorgovski, S. G.

2007-05-01

One of the most debated issues of observational and theoretical cosmology is that of how the environment affects the formation and evolution of galaxies. To gain new insight into this subject, we have derived surface photometry for a sample of 3,000 early-type galaxies belonging to 163 clusters with different richness, spanning a redshift range of 0.05 to 0.25. This large data-set is used to analyze how the color distribution inside galaxies depends on several parameters, such as cluster richness, local galaxy density, galaxy luminosity and redshift. We find that the internal color profile of galaxies strongly depends on the environment where galaxies reside. Galaxies in poor and rich clusters are found to follow two distinct trends in the color gradient vs. redshift diagram, with color gradients beeing less steep in rich rather than in poor clusters. No dependence of color gradients on galaxy luminosity is detected both for poor and rich clusters. We find that color gradients strongly depend on local galaxy density, with more shallow gradients in high density regions. Interestingly, this result holds only for low richness clusters, with color gradients of galaxies in rich clusters showing no dependence on local galaxy density. Our results support a reasonable picture whereby young early-type galaxies form in a dissipative collapse process, and then undergo increased (either major or minor) merging activity in richer rather than in poor clusters.

The impact of snow and glaciers on meteorological variables in the Khumbu Valley, Nepalese Himalaya.

NASA Astrophysics Data System (ADS)

Potter, E.; Orr, A.; Willis, I.

2017-12-01

Previous observational studies have suggested that snow and glaciers have a big impact on local meteorological variables in the Himalayas, in particular affecting near surface temperature and the localised wind system. Understanding the impact of changing surface conditions on these systems and is crucial in improving future predictions of glacier melt and precipitation in the Himalayas. However, the mechanisms that control the local meteorology remain poorly understood due to the lack of in-situ data and detailed modelling studies. To investigate these mechanisms, we run the Weather Research and Forecasting (WRF) model at kilometre scale resolution for one month during the monsoon over the Khumbu Valley, Nepalese Himalaya. The model is run with and without snow and glacier coverage at the surface. The impact of adding debris cover into the model is also investigated. In the control run with snow and ice, thermally-driven near-surface winds are found to travel up valley during the day except over the glacier slopes. When the snow and ice is removed from the model, the up valley winds extend over the entire slope. Removal of the snow and ice also results in changes to cloud cover and hydrometeors. A momentum budget approach is used to fully understand the mechanisms that maintain the localised wind system, e.g. to determine the contributions from local forcing or synoptic forcing.

Local host specialization, host-switching, and dispersal shape the regional distributions of avian haemosporidian parasites.

PubMed

Ellis, Vincenzo A; Collins, Michael D; Medeiros, Matthew C I; Sari, Eloisa H R; Coffey, Elyse D; Dickerson, Rebecca C; Lugarini, Camile; Stratford, Jeffrey A; Henry, Donata R; Merrill, Loren; Matthews, Alix E; Hanson, Alison A; Roberts, Jackson R; Joyce, Michael; Kunkel, Melanie R; Ricklefs, Robert E

2015-09-08

The drivers of regional parasite distributions are poorly understood, especially in comparison with those of free-living species. For vector-transmitted parasites, in particular, distributions might be influenced by host-switching and by parasite dispersal with primary hosts and vectors. We surveyed haemosporidian blood parasites (Plasmodium and Haemoproteus) of small land birds in eastern North America to characterize a regional parasite community. Distributions of parasite populations generally reflected distributions of their hosts across the region. However, when the interdependence between hosts and parasites was controlled statistically, local host assemblages were related to regional climatic gradients, but parasite assemblages were not. Moreover, because parasite assemblage similarity does not decrease with distance when controlling for host assemblages and climate, parasites evidently disperse readily within the distributions of their hosts. The degree of specialization on hosts varied in some parasite lineages over short periods and small geographic distances independently of the diversity of available hosts and potentially competing parasite lineages. Nonrandom spatial turnover was apparent in parasite lineages infecting one host species that was well-sampled within a single year across its range, plausibly reflecting localized adaptations of hosts and parasites. Overall, populations of avian hosts generally determine the geographic distributions of haemosporidian parasites. However, parasites are not dispersal-limited within their host distributions, and they may switch hosts readily.

Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim.

PubMed

Kold, Søren; Bechtold, Joan E; Mouzin, Olivier; Elmengaard, Brian; Chen, Xinqian; Søballe, Kjeld

2005-03-01

Revision joint replacement has poorer outcomes compared with primary joint replacement, and these poor outcomes have been associated with poorer fixation. We investigated a surgical technique done during the revision operation to improve access from the marrow space to the implant interface by locally cracking the sclerotic bone rim that forms during aseptic loosening. Sixteen implants were inserted bilaterally by distal femur articulation of the knee joint of eight dogs, using our controlled experimental model that replicates the revision setting (sclerotic bone rim, dense fibrous tissue, macrophages, elevated cytokines) by pistoning a loaded 6.0-mm implant 500 microm into the distal femur with particulate PE. At 8 weeks, one of two revision procedures was done. Both revision procedures included complete removal of the membrane, scraping, lavaging, and inserting a revision plasma-spray Ti implant. The crack revision procedure also used a splined tool to circumferentially locally perforate the sclerotic bone rim before insertion of an identical revision implant. Superior fixation was achieved with the cracking procedure in this experimental model. Revision implants inserted with the rim cracking procedure had a significantly higher pushout strength (fivefold median increase) and energy to failure (sixfold median increase), compared with the control revision procedure. Additional evaluation is needed of local perforation of sclerotic bone rim as a simple bone-sparing means to improve revision implant fixation and thereby increase revision implant longevity.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

Recruitment strategies for a clinical trial of community-based water therapy for osteoarthritis.

PubMed

Davey, Rachel; Edwards, Sarah Matthes; Cochrane, Tom

2003-04-01

This study compares the efficiency of two methods of recruitment into a randomised controlled trial examining the cost-effectiveness of water therapy for elderly people with lower limb osteoarthritis. The direct cost of recruiting patients via general practice was 27.66 Pounds per patient (1.1 personnel hours/patient). The cost per recruited patient from a local newspaper article was 2.72 Pounds (0.2 personnel hours/patient). The cost differential between the two recruitment methods was largely owing to poor administration practices, difficulties in accessing patient information, and difficulties in contacting patients from the general practice computer database.

Analysis and comparison of magnetic sheet insulation tests

NASA Astrophysics Data System (ADS)

Marion-Péra, M. C.; Kedous-Lebouc, A.; Cornut, B.; Brissonneau, P.

1994-05-01

Magnetic circuits of electrical machines are divided into coated sheets in order to limit eddy currents. The surface insulation resistance of magnetic sheets is difficult to evaluate because it depends on parameters like pressure and covers a wide range of values. Two methods of measuring insulation resistance are analyzed: the standardized 'Franklin device' and a tester developed by British Steel Electrical. Their main drawback is poor local repeatability. The Franklin method allows better quality control of industrial process because it measures only one insulating layer at a time. It also gives more accurate images of the distribution of possible defects. Nevertheless, both methods lead to similar classifications of insulation efficiency.

Diabetic foot ulcers: Part II. Management.

PubMed

Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S

2014-01-01

The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Inaccuracy of Wolff-Parkinson-white accessory pathway localization algorithms in children and patients with congenital heart defects.

PubMed

Bar-Cohen, Yaniv; Khairy, Paul; Morwood, James; Alexander, Mark E; Cecchin, Frank; Berul, Charles I

2006-07-01

ECG algorithms used to localize accessory pathways (AP) in patients with Wolff-Parkinson-White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Pre-excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9-32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8-18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation-verified AP location to identify (a) exact match for AP location and (b) match for laterality (left-sided vs right-sided AP). In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non-Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non-Ebstein's CHD patients and should be interpreted with caution.

Rural Poor Economies and Foreign Investors: An Opportunity or a Risk?

PubMed Central

Antoci, Angelo; Russu, Paolo; Ticci, Elisa

2014-01-01

In the current age of commercial and financial openness, remote and poor local economies are becoming increasingly exposed to inflows of external capital. The new investors - enjoying lower credit constraints than local dwellers - might play a propulsive role in local development. At the same time, inflows of external capital can have negative impacts on local natural resource-dependent activities. We analyze a two-sector model where both sectors damage the environment, but only that of domestic producers relies on natural resources. We assess under which conditions the coexistence of the two sectors is compatible with sustainability, defined as convergence to a stationary state characterized by a positive stock of the natural resource. Moreover, we find that capital inflows can be stimulated by an increase in the pollution intensity of incoming activities, but also in the pollution intensity of the domestic sector; in both cases, capital inflows generate environmental degradation and a decrease in welfare for the local population. Finally, we show that a reduction in the cost of capital for external investors and the consequent capital inflows have the effect to increase wages, local investments and welfare of the local populations only if the environmental impact of the external sector is relatively low with respect to that of local activities. Otherwise, an unexpected scenario characterized by a reduction in domestic capital accumulation and the impoverishment of local agents can occur. PMID:25506694

Rural poor economies and foreign investors: an opportunity or a risk?

PubMed

Antoci, Angelo; Russu, Paolo; Ticci, Elisa

2014-01-01

In the current age of commercial and financial openness, remote and poor local economies are becoming increasingly exposed to inflows of external capital. The new investors - enjoying lower credit constraints than local dwellers - might play a propulsive role in local development. At the same time, inflows of external capital can have negative impacts on local natural resource-dependent activities. We analyze a two-sector model where both sectors damage the environment, but only that of domestic producers relies on natural resources. We assess under which conditions the coexistence of the two sectors is compatible with sustainability, defined as convergence to a stationary state characterized by a positive stock of the natural resource. Moreover, we find that capital inflows can be stimulated by an increase in the pollution intensity of incoming activities, but also in the pollution intensity of the domestic sector; in both cases, capital inflows generate environmental degradation and a decrease in welfare for the local population. Finally, we show that a reduction in the cost of capital for external investors and the consequent capital inflows have the effect to increase wages, local investments and welfare of the local populations only if the environmental impact of the external sector is relatively low with respect to that of local activities. Otherwise, an unexpected scenario characterized by a reduction in domestic capital accumulation and the impoverishment of local agents can occur.

Bayesian Localization and Mapping Using GNSS SNR Measurements

DTIC Science & Technology

2014-05-01

Bayesian Localization and Mapping Using GNSS SNR Measurements Jason T. Isaacs1, Andrew T. Irish1, François Quitin2, Upamanyu Madhow1, and João P...Hespanha1 Abstract— In urban areas, GNSS localization quality is often degraded due to signal blockage and multi-path reflections. When several GNSS ...signals are blocked by buildings, the remaining unblocked GNSS satellites are typically in a poor geometry for localization (nearly collinear along the

Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia.

PubMed

Fiseha, Temesgen; Alemayehu, Ermiyas; Kassahun, Wongelawit; Adamu, Aderaw; Gebreweld, Angesom

2018-05-18

The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37-4.96), low educational level (AOR = 7.10, 95% CI 2.94-17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18-4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16-9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10-12.52) or insulin (AOR = 3.26, 95% CI 1.26-8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.

Young People in Transition--The Local Investment. A Handbook Concerning the Social and Vocational Integration of Young People: Local and Regional Initiatives.

ERIC Educational Resources Information Center

Harrison, Jeremy; McLeish, Henry

Written for practitioners rather than policymakers, this document is intended for those who seek to relate educational and training opportunities to local and individual needs; use fresh approaches to integrated services for young people trapped by unemployment, social and economic change, and poor living conditions; and achieve high quality…

Does Radiotherapy after Surgery Affect Outcomes in Ewing's Sarcoma of the Pelvis?

PubMed

Puri, Ajay; Gulia, Ashish; Crasto, Saniya; Vora, Tushar; Khanna, Nehal; Laskar, Siddharth

2018-01-01

The impact of postoperative radiotherapy (PORT) on outcomes has been a matter of debate after adequate resection in Ewing's sarcoma of the pelvis. We evaluated our cases after surgical excision in pelvic Ewing's sarcoma and assessed local control and overall survival (OS) with respect to PORT and chemotherapy-induced percentage necrosis. Forty four surgically operated patients (June 2002-November 2014) of localized Ewing's sarcoma were retrospectively reviewed. There were 31 males and 13 females. Age ranged from 2 to 53 years. All patients received institutional chemotherapy protocol. No patient received preoperative radiotherapy. Specimen was analyzed for margins and chemotherapy-induced percentage necrosis. PORT was offered to patients on case-by-case basis. Presence of a large preoperative soft-tissue component, margin evaluation, and percentage necrosis were factors considered. At time of the last followup, 29 patients were alive, 11 died, and 4 were lost to followup. Survivors had a minimum followup of 2 years (range: 31-118 months, mean = 69 months). One of twenty (5%) patients with PORT had a local recurrence as against 2 of 24 (8%) without PORT. OS of all patients was 76% at 5 years. Twelve patients with <90% necrosis had OS of 56% and 32 with >90% necrosis had OS of 83% ( P = 0.040). OS of patients with PORT was 74%, without PORT was 78% ( P = 0.629). The decision to offer PORT after surgical excision in pelvic Ewing's sarcoma is multifactorial; the absence of PORT in selected cases is not detrimental to local control. Poor responders to chemotherapy had poorer survival while PORT did not impact on outcomes.

Community-owned resource persons for malaria vector control: enabling factors and challenges in an operational programme in Dar es Salaam, United Republic of Tanzania

PubMed Central

2011-01-01

Background Community participation in vector control and health services in general is of great interest to public health practitioners in developing countries, but remains complex and poorly understood. The Urban Malaria Control Program (UMCP) in Dar es Salaam, United Republic of Tanzania, implements larval control of malaria vector mosquitoes. The UMCP delegates responsibility for routine mosquito control and surveillance to community-owned resource persons (CORPs), recruited from within local communities via the elected local government. Methods A mixed method, cross-sectional survey assessed the ability of CORPs to detect mosquito breeding sites and larvae, and investigated demographic characteristics of the CORPs, their reasons for participating in the UMCP, and their work performance. Detection coverage was estimated as the proportion of wet habitats found by the investigator which had been reported by CORP. Detection sensitivity was estimated as the proportion of wet habitats found by the CORPS which the investigator found to contain Anopheles larvae that were also reported to be occupied by the CORP. Results The CORPs themselves perceived their role as professional rather than voluntary, with participation being a de facto form of employment. Habitat detection coverage was lower among CORPs that were recruited through the program administrative staff, compared to CORPs recruited by local government officials or health committees (Odds Ratio = 0.660, 95% confidence interval = [0.438, 0.995], P = 0.047). Staff living within their areas of responsibility had > 70% higher detection sensitivity for both Anopheline (P = 0.016) and Culicine (P = 0.012): positive habitats compared to those living outside those same areas. Discussion and conclusions Improved employment conditions as well as involving the local health committees in recruiting individual program staff, communication and community engagement skills are required to optimize achieving effective community participation, particularly to improve access to fenced compounds. A simpler, more direct, less extensive community-based surveillance system in the hands of a few, less burdened, better paid and maintained program personnel may improve performance and data quality. PMID:21955856

High-Frequency Oscillations and Seizure Generation in Neocortical Epilepsy

ERIC Educational Resources Information Center

Worrell, Greg A.; Parish, Landi; Cranstoun, Stephen D.; Jonas, Rachel; Baltuch, Gordon; Litt, Brian

2004-01-01

Neocortical seizures are often poorly localized, explosive and widespread at onset, making them poorly amenable to epilepsy surgery in the absence of associated focal brain lesions. We describe, for the first time in an unselected group of patients with neocortical epilepsy, the finding that high-frequency (60--100 Hz) epileptiform oscillations…

Adaptive Peer Sampling with Newscast

NASA Astrophysics Data System (ADS)

Tölgyesi, Norbert; Jelasity, Márk

The peer sampling service is a middleware service that provides random samples from a large decentralized network to support gossip-based applications such as multicast, data aggregation and overlay topology management. Lightweight gossip-based implementations of the peer sampling service have been shown to provide good quality random sampling while also being extremely robust to many failure scenarios, including node churn and catastrophic failure. We identify two problems with these approaches. The first problem is related to message drop failures: if a node experiences a higher-than-average message drop rate then the probability of sampling this node in the network will decrease. The second problem is that the application layer at different nodes might request random samples at very different rates which can result in very poor random sampling especially at nodes with high request rates. We propose solutions for both problems. We focus on Newscast, a robust implementation of the peer sampling service. Our solution is based on simple extensions of the protocol and an adaptive self-control mechanism for its parameters, namely—without involving failure detectors—nodes passively monitor local protocol events using them as feedback for a local control loop for self-tuning the protocol parameters. The proposed solution is evaluated by simulation experiments.

Condensation on superhydrophobic surfaces: the role of local energy barriers and structure length scale.

PubMed

Enright, Ryan; Miljkovic, Nenad; Al-Obeidi, Ahmed; Thompson, Carl V; Wang, Evelyn N

2012-10-09

Water condensation on surfaces is a ubiquitous phase-change process that plays a crucial role in nature and across a range of industrial applications, including energy production, desalination, and environmental control. Nanotechnology has created opportunities to manipulate this process through the precise control of surface structure and chemistry, thus enabling the biomimicry of natural surfaces, such as the leaves of certain plant species, to realize superhydrophobic condensation. However, this "bottom-up" wetting process is inadequately described using typical global thermodynamic analyses and remains poorly understood. In this work, we elucidate, through imaging experiments on surfaces with structure length scales ranging from 100 nm to 10 μm and wetting physics, how local energy barriers are essential to understand non-equilibrium condensed droplet morphologies and demonstrate that overcoming these barriers via nucleation-mediated droplet-droplet interactions leads to the emergence of wetting states not predicted by scale-invariant global thermodynamic analysis. This mechanistic understanding offers insight into the role of surface-structure length scale, provides a quantitative basis for designing surfaces optimized for condensation in engineered systems, and promises insight into ice formation on surfaces that initiates with the condensation of subcooled water.

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context

PubMed Central

2014-01-01

Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation. In the last decade, carbon ion radiotherapy facilities have slowly been constructed in Europe and Asia, demonstrating favorable results for many of the malignancies that do poorly with conventional radiotherapy. However, from a radiobiological perspective, much of how this modality works in overcoming radioresistance, and extending local control and survival are not yet fully understood. In this review, we will explain from a radiobiological perspective how carbon ion radiotherapy can overcome the classical and recently postulated contributors of radioresistance (α/β ratio, hypoxia, cell proliferation, the tumor microenvironment and metabolism, and cancer stem cells). Furthermore, we will make recommendations on the important factors to consider, such as anatomical location, in the future design and implementation of clinical trials. With the existing data available we believe that the expansion of carbon ion facilities into the United States is warranted. PMID:24679134

Oxysterol Sensing through the Receptor GPR183 Promotes the Lymphoid-Tissue-Inducing Function of Innate Lymphoid Cells and Colonic Inflammation.

PubMed

Emgård, Johanna; Kammoun, Hana; García-Cassani, Bethania; Chesné, Julie; Parigi, Sara M; Jacob, Jean-Marie; Cheng, Hung-Wei; Evren, Elza; Das, Srustidhar; Czarnewski, Paulo; Sleiers, Natalie; Melo-Gonzalez, Felipe; Kvedaraite, Egle; Svensson, Mattias; Scandella, Elke; Hepworth, Matthew R; Huber, Samuel; Ludewig, Burkhard; Peduto, Lucie; Villablanca, Eduardo J; Veiga-Fernandes, Henrique; Pereira, João P; Flavell, Richard A; Willinger, Tim

2018-01-16

Group 3 innate lymphoid cells (ILC3s) sense environmental signals and are critical for tissue integrity in the intestine. Yet, which signals are sensed and what receptors control ILC3 function remain poorly understood. Here, we show that ILC3s with a lymphoid-tissue-inducer (LTi) phenotype expressed G-protein-coupled receptor 183 (GPR183) and migrated to its oxysterol ligand 7α,25-hydroxycholesterol (7α,25-OHC). In mice lacking Gpr183 or 7α,25-OHC, ILC3s failed to localize to cryptopatches (CPs) and isolated lymphoid follicles (ILFs). Gpr183 deficiency in ILC3s caused a defect in CP and ILF formation in the colon, but not in the small intestine. Localized oxysterol production by fibroblastic stromal cells provided an essential signal for colonic lymphoid tissue development, and inflammation-induced increased oxysterol production caused colitis through GPR183-mediated cell recruitment. Our findings show that GPR183 promotes lymphoid organ development and indicate that oxysterol-GPR183-dependent positioning within tissues controls ILC3 activity and intestinal homeostasis. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Elevated Peritoneal Fluid TNF-α Incites Ovarian Early Growth Response Factor 1 Expression and Downstream Protease Mediators

PubMed Central

Birt, Julie A.; Nabli, Henda; Stilley, Julie A.; Windham, Emma A.; Frazier, Shellaine R.

2013-01-01

Endometriosis-associated infertility manifests itself via multiple, poorly understood mechanisms. Our goal was to characterize signaling pathways, between peritoneal endometriotic lesions and the ovary, leading to failed ovulation. Genome-wide microarray analysis comparing ovarian tissue from an in vivo endometriosis model in the rat (Endo) with controls (Sham) identified 22 differentially expressed genes, including transiently expressed early growth response factor 1 (Egr1). The Egr1 regulates gene requisites for ovulation. The Egr1 promoter is responsive to tumor necrosis factor-alpha (TNF-α) signaling. We hypothesized that altered expression of ovarian EGR1 is induced by elevated peritoneal fluid TNF-α which is upregulated by the presence of peritoneal endometriosis. Endo rats, compared to controls, had more peritoneal fluid TNF-α and quantitative, spatial differences in Egr1 mRNA and EGR1 protein localization in follicular compartments. Interactions between elevated peritoneal fluid TNF-α and overexpression of follicular Egr1/EGR1 expression may affect downstream protease pathways impeding ovulation in endometriosis. Preliminary studies identified similar patterns of EGR1 protein localization in human ovaries from women with endometriosis and compared to those without endometriosis. PMID:23427178

Strong Altitudinal Control on Local Glacier's Response to Holocene Climate Change in Southwest Greenland

NASA Astrophysics Data System (ADS)

Larsen, N. K.; Levy, L.; Strunk, A.; Bjork, A. A.; Olsen, J.; Jeppesen, E.; Lauridsen, T.; Davidson, T. A.

2017-12-01

The sensitivity of glaciers and ice caps (GICs) in Greenland to prolonged warm periods is poorly constrained and geological records documenting the long-term glacial history are needed to put recent observations into a broader perspective. Here we report the results from three proglacial lakes where fluctuations in local glaciers located at different altitudes in Kobbefjord, southwest Greenland have been recorded. Our results show that the lakes received meltwater from the initial deglaciation of the area 9.2 cal. ka BP until 8.7-7.9 cal. ka BP when the meltwater input ceased as the glaciers most likely disappeared. Regrowth of glaciers began again at 5.5 cal. ka BP at 1,370 m a.s.l., 3.6 cal. ka at 1,170 m a.s.l., and 1.6 cal. ka BP at 1,000 m a.s.l., clearly reflecting strong altitudinal control of the GIC response to Neoglacial cooling. Our results highlight that GICs in Kobbefjord, southwest Greenland are primarily influenced by changes in summer air temperatures and winter precipitation and that they are facing a rapid decay that most likely will result in their disappearance within the next centuries as a consequence of global warming.

How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa.

PubMed

Campbell, Catherine; Cornish, Flora

2012-05-01

Much research has examined how to empower the poor to articulate demands for health-enabling living conditions. Less is known about creating receptive social environments where the powerful heed the voices of the poor. We explore the potential for 'transformative communication' between the poor and the powerful, through comparing two well-documented case studies of HIV/AIDS management. The Entabeni Project in South Africa sought to empower impoverished women to deliver home-based nursing to people with AIDS. It successfully provided short-term welfare, but did not achieve local leadership or sustainability. The Sonagachi Project in India, an HIV-prevention programme targeting female sex workers, became locally led and sustainable. We highlight the strategies through which Sonagachi, but not Entabeni, altered the material, symbolic and relational contexts of participants' lives, enabling transformative communication and opportunities for sexual health-enabling social change.

Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

PubMed

Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

2016-11-02

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Suppressor of cytokine signalling (SOCS) 1 and 3 enhance cell adhesion and inhibit migration towards the chemokine eotaxin/CCL11.

PubMed

Stevenson, Nigel J; McFarlane, Cheryl; Ong, Seow Theng; Nahlik, Krystyna; Kelvin, Alyson; Addley, Mark R; Long, Aideen; Greaves, David R; O'Farrelly, Cliona; Johnston, James A

2010-11-05

Suppressors of cytokine signalling (SOCS) proteins regulate signal transduction, but their role in responses to chemokines remains poorly understood. We report that cells expressing SOCS1 and 3 exhibit enhanced adhesion and reduced migration towards the chemokine CCL11. Focal adhesion kinase (FAK) and the GTPase RhoA, control cell adhesion and migration and we show the presence of SOCS1 or 3 regulates expression and tyrosine phosphorylation of FAK, while also enhancing activation of RhoA. Our novel findings suggest that SOCS1 and 3 may control chemotaxis and adhesion by significantly enhancing both FAK and RhoA activity, thus localizing immune cells to the site of allergic inflammation. Copyright © 2010 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India

PubMed Central

Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Background Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. Methods We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. Result There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients’ medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Conclusions Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions. PMID:25188582

Health system challenges in organizing quality diabetes care for urban poor in South India.

PubMed

Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

Diffusion of novel healthcare technologies to resource poor settings.

PubMed

Malkin, Robert; von Oldenburg Beer, Kim

2013-09-01

A new product has completed clinical trials in a distant, resource poor hospital using a few dozen prototypes. The data looks great. The novel medical device solves a widely felt problem. The next goal is to integrate the device into the country's healthcare system and spread the device to other countries. But how? In order to be widely used, the device must be manufactured and distributed. One option is to license the intellectual property (IP) to an interested third party, if one can be found. However, it is possible to manage the manufacturing and distribution without licensing. There are at least two common means for manufacturing a novel medical device targeted to resource poor settings: (a) formal (contract) manufacturing and (b) informal (local) manufacturing. There are three primary routes to diffusion of novel medical devices in the developing world: (1) local distributors (2) direct international sales and (3) international donations. Perhaps surprisingly, the least effective mechanism is direct importation through donation. The most successful mechanism, the method used by nearly all working medical devices in resource-poor settings, is the use of contract manufacturing and a local distributor. This article is written for the biomedical innovator and entrepreneur who wishes to make a novel healthcare technology or product available and accessible to healthcare providers and patients in the developing world. There are very few documented cases and little formal research in this area. To this end, this article describes and explores the manufacturing and distribution options in order to provide insights into when and how each can be applied to scale up a novel technology to make a difference in a resource poor setting.

Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors.

PubMed

Anguita Sánchez, Manuel; Bertomeu Martínez, Vicente; Cequier Fillat, Ángel

2015-09-01

To study the prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain in patients with nonvalvular atrial fibrillation, and to identify associated factors. We studied 1056 consecutive patients seen at 120 cardiology clinics in Spain between November 2013 and March 2014. We analyzed the international normalized ratio from the 6 months prior to the patient's visit, calculating the prevalence of poorly controlled anticoagulation, defined as < 65% time in therapeutic range using the Rosendaal method. Mean age was 73.6 years (standard deviation, 9.8 years); women accounted for 42% of patients. The prevalence of poorly controlled anticoagulation was 47.3%. Mean time in therapeutic range was 63.8% (25.9%). The following factors were independently associated with poorly controlled anticoagulation: kidney disease (odds ratio = 1.53; 95% confidence interval, 1.08-2.18; P = .018), routine nonsteroidal anti-inflammatory drugs (odds ratio = 1.79; 95% confidence interval, 1.20-2.79; P = .004), antiplatelet therapy (odds ratio = 2.16; 95% confidence interval, 1.49-3.12; P < .0001) and absence of angiotensin receptor blockers (odds ratio = 1.39; 95% confidence interval, 1.08-1.79; P = .011). There is a high prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain. Factors associated with poor control are kidney disease, routine nonsteroidal anti-inflammatory drugs, antiplatelet use, and absence of angiotensin receptor blockers. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

NASA Astrophysics Data System (ADS)

Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

2014-09-01

This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

Making cities resilient: Increasing resilience to disasters at the local level.

PubMed

Albrito, Paola

2012-01-01

Half of humanity is now living in cities, according to the United Nations Population Division. The urban population exceeded the rural for the first time in 2008, and by 2050 urbanisation will rise to 70 per cent with increased urban risk. 'Today, 100 cities are in control of 30 per cent of the world's economy.' The need for maintenance and upkeep of these cities makes safety measures for their citizens crucial. In this context, urban risk, city planning and the role of local governments in dealing with risk reduction have been recognised as key factors to build communities resilient to disasters. While many local governments have taken action to reduce vulnerability, especially when it comes to government organising capacity to deal with disasters, much remains to be done. Disaster risk has become an acute and increasingly urban issue. Poorly-planned urban environments, weak urban governance, an old and fragile infrastructure, and rapid population growth have increased pressure on the urban environment and triggered exposure to disaster risk. More and more people are settling in potential danger zones such as flood plains, volcanic flanks or earthquake faults and coastal areas. They do so because planners and local governments fail to provide alternatives, or because they cannot afford safer land. Local government officials are confronted with the threat of disasters daily, and need improved access to policies and tools to cope with them effectively.

Empirical Determination of Dark Matter Velocities Using Metal-Poor Stars

NASA Astrophysics Data System (ADS)

Herzog-Arbeitman, Jonah; Lisanti, Mariangela; Madau, Piero; Necib, Lina

2018-01-01

The Milky Way dark matter halo is formed from the accretion of smaller subhalos. These sub-units also harbor stars—typically old and metal-poor—that are deposited in the Galactic inner regions by disruption events. In this Letter, we show that the dark matter and metal-poor stars in the Solar neighborhood share similar kinematics due to their common origin. Using the high-resolution eris simulation, which traces the evolution of both the dark matter and baryons in a realistic Milky Way analog galaxy, we demonstrate that metal-poor stars are indeed effective tracers for the local, virialized dark matter velocity distribution. The local dark matter velocities can therefore be inferred from observations of the stellar halo made by the Sloan Digital Sky Survey within 4 kpc of the Sun. This empirical distribution differs from the standard halo model in important ways and suggests that the bounds on the spin-independent scattering cross section may be weakened for dark matter masses below ˜10 GeV . Data from Gaia will allow us to further refine the expected distribution for the smooth dark matter component, and to test for the presence of local substructure.

Examining asthma quality of care using a population-based approach

PubMed Central

Klomp, Helena; Lawson, Joshua A.; Cockcroft, Donald W.; Chan, Benjamin T.; Cascagnette, Paul; Gander, Laurie; Jorgenson, Derek

2008-01-01

Background Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators. Methods We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting β-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the χ2 test for proportions and generalized linear modelling techniques. Results In 2002/03, there were 24 616 people aged 5–54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6–9 years and females aged 20–44 years. Males and those in adult age groups (predominantly 20–44 years) had worse quality of care for 4 indicators examined. Interpretation Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting β-agonist medications as recommended by consensus guidelines. PMID:18390944

Factors Associated With Poor Glycemic Control or Wide Glycemic Variability Among Diabetes Patients in Hawaii, 2006–2009

PubMed Central

Sentell, Tetine; Tokumaru, Sheri; Goo, Roy; Davis, James W.; Mau, Marjorie M.

2012-01-01

Introduction Although glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years. Methods This retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications. Results Longer duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year. Conclusion Results indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability. PMID:23017247

Regulation of Centromere Localization of the Drosophila Shugoshin MEI-S332 and Sister-Chromatid Cohesion in Meiosis

PubMed Central

Nogueira, Cristina; Kashevsky, Helena; Pinto, Belinda; Clarke, Astrid; Orr-Weaver, Terry L.

2014-01-01

The Shugoshin (Sgo) protein family helps to ensure proper chromosome segregation by protecting cohesion at the centromere by preventing cleavage of the cohesin complex. Some Sgo proteins also influence other aspects of kinetochore-microtubule attachments. Although many Sgo members require Aurora B kinase to localize to the centromere, factors controlling delocalization are poorly understood and diverse. Moreover, it is not clear how Sgo function is inactivated and whether this is distinct from delocalization. We investigated these questions in Drosophila melanogaster, an organism with superb chromosome cytology to monitor Sgo localization and quantitative assays to test its function in sister-chromatid segregation in meiosis. Previous research showed that in mitosis in cell culture, phosphorylation of the Drosophila Sgo, MEI-S332, by Aurora B promotes centromere localization, whereas Polo phosphorylation promotes delocalization. These studies also suggested that MEI-S332 can be inactivated independently of delocalization, a conclusion supported here by localization and function studies in meiosis. Phosphoresistant and phosphomimetic mutants for the Aurora B and Polo phosphorylation sites were examined for effects on MEI-S332 localization and chromosome segregation in meiosis. Strikingly, MEI-S332 with a phosphomimetic mutation in the Aurora B phosphorylation site prematurely dissociates from the centromeres in meiosis I. Despite the absence of MEI-S332 on meiosis II centromeres in male meiosis, sister chromatids segregate normally, demonstrating that detectable levels of this Sgo are not essential for chromosome congression, kinetochore biorientation, or spindle assembly. PMID:25081981

Comparative evaluation of endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe in obturation of primary teeth: An in vitro study.

PubMed

Hiremath, Mallayya C; Srivastava, Pooja

2016-01-01

The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography. A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test. The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used. Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

Local administration of curcumin-loaded nanoparticles effectively inhibits inflammation and bone resorption associated with experimental periodontal disease.

PubMed

Zambrano, Laura M G; Brandao, Dayane A; Rocha, Fernanda R G; Marsiglio, Raquel P; Longo, Ieda B; Primo, Fernando L; Tedesco, Antonio C; Guimaraes-Stabili, Morgana R; Rossa Junior, Carlos

2018-04-27

There is evidence indicating that curcumin has multiple biological activities, including anti-inflammatory properties. In vitro and in vivo studies demonstrate that curcumin may attenuate inflammation and the connective tissue destruction associated with periodontal disease. Most of these studies use systemic administration, and considering the site-specific nature of periodontal disease and also the poor pharmacodynamic properties of curcumin, we conducted this proof of principle study to assess the biological effect of the local administration of curcumin in a nanoparticle vehicle on experimental periodontal disease. We used 16 rats divided into two groups of 8 animals according to the induction of experimental periodontal disease by bilateral injections of LPS or of the vehicle control directly into the gingival tissues 3×/week for 4 weeks. The same volume of curcumin-loaded nanoparticles or of nanoparticle vehicle was injected into the same sites 2×/week. µCT analysis showed that local administration of curcumin resulted in a complete inhibition of inflammatory bone resorption and in a significant decrease of both osteoclast counts and of the inflammatory infiltrate; as well as a marked attenuation of p38 MAPK and NF-kB activation. We conclude that local administration of curcumin-loaded nanoparticles effectively inhibited inflammation and bone resorption associated with experimental periodontal disease.

Local and global processing in block design tasks in children with dyslexia or nonverbal learning disability.

PubMed

Cardillo, Ramona; Mammarella, Irene C; Garcia, Ricardo Basso; Cornoldi, Cesare

2017-05-01

Visuo-constructive and perceptual abilities have been poorly investigated in children with learning disabilities. The present study focused on local or global visuospatial processing in children with nonverbal learning disability (NLD) and dyslexia compared with typically-developing (TD) controls. Participants were presented with a modified block design task (BDT), in both a typical visuo-constructive version that involves reconstructing figures from blocks, and a perceptual version in which respondents must rapidly match unfragmented figures with a corresponding fragmented target figure. The figures used in the tasks were devised by manipulating two variables: the perceptual cohesiveness and the task uncertainty, stimulating global or local processes. Our results confirmed that children with NLD had more problems with the visuo-constructive version of the task, whereas those with dyslexia showed only a slight difficulty with the visuo-constructive version, but were in greater difficulty with the perceptual version, especially in terms of response times. These findings are interpreted in relation to the slower visual processing speed of children with dyslexia, and to the visuo-constructive problems and difficulty in using flexibly-experienced global vs local processes of children with NLD. The clinical and educational implications of these findings are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Linear and non-linear responses of vegetation and soils to glacial-interglacial climate change in a Mediterranean refuge.

PubMed

Holtvoeth, Jens; Vogel, Hendrik; Valsecchi, Verushka; Lindhorst, Katja; Schouten, Stefan; Wagner, Bernd; Wolff, George A

2017-08-14

The impact of past global climate change on local terrestrial ecosystems and their vegetation and soil organic matter (OM) pools is often non-linear and poorly constrained. To address this, we investigated the response of a temperate habitat influenced by global climate change in a key glacial refuge, Lake Ohrid (Albania, Macedonia). We applied independent geochemical and palynological proxies to a sedimentary archive from the lake over the penultimate glacial-interglacial transition (MIS 6-5) and the following interglacial (MIS 5e-c), targeting lake surface temperature as an indicator of regional climatic development and the supply of pollen and biomarkers from the vegetation and soil OM pools to determine local habitat response. Climate fluctuations strongly influenced the ecosystem, however, lake level controls the extent of terrace surfaces between the shoreline and mountain slopes and hence local vegetation, soil development and OM export to the lake sediments. There were two phases of transgressional soil erosion from terrace surfaces during lake-level rise in the MIS 6-5 transition that led to habitat loss for the locally dominant pine vegetation as the terraces drowned. Our observations confirm that catchment morphology plays a key role in providing refuges with low groundwater depth and stable soils during variable climate.

A pilot study of routine immunization data quality in Bunza Local Government area: causes and possible remedies.

PubMed

Omoleke, Semeeh Akinwale; Tadesse, Menberu Getachew

2017-01-01

As a result of poor quality administrative data for routine immunisation (RI) in Nigeria, the real coverage of RI remains unknown, constituting a setback in curtailing vaccine preventable diseases (VPDs). Consequently, the purpose of this pilot study is to identify source(s) and evaluate the magnitude of poor data quality as well as propose recommendations to address the problem. The authors conducted a cross-sectional study in which 5 out of the 22 health facilities providing routine immunization services in Bunza Local Government Area (LGA), Kebbi State, Nigeria, were selected for data quality assessment. The reported coverage of RI in August and September, 2016 was the primary element of evaluation in the selected Health Facilities (HFs). Administered questionnaires were adapted from WHO Data Quality Assurance and RI monitoring tools to generate data from the HFs, as well as standardised community survey tool for household surveys. Data inconsistency was detected in 100% of the selected HFs. Maximum difference between HF monthly summary and RI registration book for penta 3 data quality report analysis was 820% and 767% in MCH Bunza and PHC Balu respectively. However, a minimum difference of 3% was observed at Loko Dispensary. Maximum difference between HF summary and RI registration for measles was 614% at MCH Bunza and 43% minimum difference at Loko. In contrast to the administrative coverage, 60-80% of the children sampled from households were either not immunised or partially immunised. Further, the main sources of poor data quality include heavy workload on RI providers, over-reliance on administrative coverage report, and lack of understanding of the significance of high data quality by RI providers. Substantial data discrepancies were observed in RI reports from all the Health Facilities which is indicative of poor data quality at the LGA level. Community surveys also revealed an over-reporting from administrative coverage data. Consequently, efforts should be geared towards achieving good data quality by immunisation stakeholders as it has implication on disease prevention and control efforts.

A pilot study of routine immunization data quality in Bunza Local Government area: causes and possible remedies

PubMed Central

Omoleke, Semeeh Akinwale; Tadesse, Menberu Getachew

2017-01-01

Introduction As a result of poor quality administrative data for routine immunisation (RI) in Nigeria, the real coverage of RI remains unknown, constituting a setback in curtailing vaccine preventable diseases (VPDs). Consequently, the purpose of this pilot study is to identify source(s) and evaluate the magnitude of poor data quality as well as propose recommendations to address the problem. Methods The authors conducted a cross-sectional study in which 5 out of the 22 health facilities providing routine immunization services in Bunza Local Government Area (LGA), Kebbi State, Nigeria, were selected for data quality assessment. The reported coverage of RI in August and September, 2016 was the primary element of evaluation in the selected Health Facilities (HFs). Administered questionnaires were adapted from WHO Data Quality Assurance and RI monitoring tools to generate data from the HFs, as well as standardised community survey tool for household surveys. Results Data inconsistency was detected in 100% of the selected HFs. Maximum difference between HF monthly summary and RI registration book for penta 3 data quality report analysis was 820% and 767% in MCH Bunza and PHC Balu respectively. However, a minimum difference of 3% was observed at Loko Dispensary. Maximum difference between HF summary and RI registration for measles was 614% at MCH Bunza and 43% minimum difference at Loko. In contrast to the administrative coverage, 60-80% of the children sampled from households were either not immunised or partially immunised. Further, the main sources of poor data quality include heavy workload on RI providers, over-reliance on administrative coverage report, and lack of understanding of the significance of high data quality by RI providers. Conclusion Substantial data discrepancies were observed in RI reports from all the Health Facilities which is indicative of poor data quality at the LGA level. Community surveys also revealed an over-reporting from administrative coverage data. Consequently, efforts should be geared towards achieving good data quality by immunisation stakeholders as it has implication on disease prevention and control efforts. PMID:28979641

Sex differences in physical and mental functioning of Japanese civil servants: explanations from work and family characteristics.

PubMed

Sekine, Michikazu; Chandola, Tarani; Martikainen, Pekka; Marmot, Michael; Kagamimori, Sadanobu

2010-12-01

Poor physical and mental functioning are more common among women than men and those with disadvantaged work and family characteristics. This study aims to clarify whether sex differences in health functioning can be explained by sex differences in work and family characteristics. The subjects were 3787 civil servants (2525 men and 1262 women), aged 20-65, working in a local government on the west coast of Japan. A questionnaire survey was conducted in January 2003. Low employment grade, high demands, long work hours, shift work, being unmarried, having no young children, high family-to-work conflict and high work-to-family conflict were more common among women than men and were independently associated with poor physical and mental functioning. The age-adjusted odds ratios (ORs) of women for poor health functioning were 1.80 for poor physical functioning and 1.77 for poor mental functioning. When adjusted for employment grade and work characteristics (control, demand, support, work hours, and shift work), the sex differences in health functioning attenuated. When adjusted for family characteristics (family structure and work-family conflicts), the sex differences in health functioning further attenuated and were no longer statistically significant. Sex differences in family characteristics contributed more to sex difference in mental functioning than sex differences in work characteristics. Japan belongs to conservative welfare regimes. In such countries, men are able to concentrate on their work with relative freedom from their family tasks and responsibilities, whereas women feel difficulties in maintaining their work-life balances. Such sex differences in work- and family-related stresses may contribute to sex difference in health. Longitudinal research is necessary to clarify the causal nature of these associations. Copyright © 2010 Elsevier Ltd. All rights reserved.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India

PubMed Central

2012-01-01

Introduction Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. Methodology A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Conclusion Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country. PMID:22449205

Understanding words, understanding numbers: an exploration of the mathematical profiles of poor comprehenders.

PubMed

Pimperton, Hannah; Nation, Kate

2010-06-01

Poor comprehenders are children who show significant deficits in their reading comprehension performance, despite average, or above-average word reading ability. To date, there have been no in-depth studies of the mathematical performance profiles of such children. This study aimed to explore the mathematical profiles of poor comprehenders. Given that language impairment is associated with difficulties with mathematics, and that poor comprehenders tend to have oral language weaknesses, we hypothesized that poor comprehenders would show relative weaknesses in aspects of mathematical performance. From a sample of 109 children aged 7-8 years, we selected 14 poor comprehenders and 14 controls with age-appropriate reading comprehension ability. The groups were matched on non-verbal ability, multiple measures of reading accuracy, and chronological age. We compared the performance of the group of poor comprehenders with that of the matched controls on two standardized measures of mathematical ability, one measuring procedural arithmetic prowess and the other tapping higher-level mathematical reasoning. Although there were no group differences in performance on the arithmetic measure, the poor comprehenders showed significantly lower scores than the controls on the mathematical reasoning task. The poor comprehenders exhibited impaired verbal ability relative to controls, with these differences in verbal ability associated with the group differences found on the test of mathematical reasoning. Poor comprehenders' deficits are not limited to the domain of literacy; their underlying profile of impairments also seems to selectively impact on certain components of mathematical ability.

Rural Government--Poor Counties, 1962-87. Rural Development Research Report Number 88.

ERIC Educational Resources Information Center

Reeder, Richard J.; Jansen, Anicca C.

During the 1960s, many rural local governments were believed to provide inadequate government services, which hindered rural development. Rapid growth in government spending has reduced the incidence of government poverty from 78 percent of nonmetropolitan counties in 1962 to only 7 percent in 1987. Those counties still government-poor in 1987…

Exploring the Relationship between Time Management Skills and the Academic Achievement of African Engineering Students--A Case Study

ERIC Educational Resources Information Center

Swart, Arthur James; Lombard, Kobus; de Jager, Henk

2010-01-01

Poor academic success by African engineering students is currently experienced in many higher educational institutions, contributing to lower financial subsidies by local governments. One of the contributing factors to this low academic success may be the poor time management skills of these students. This article endeavours to explore this…

Structural Characterization of Poorly-Crystalline Scorodite, Iron (III)-arsenate Co-precipitates and Uranium Millneutralized Raffinate Solids using X-ray Absorption Fine Structure Spectroscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, N.; Jiang, D; Cutler, J

X-ray absorption fine structure (XAFS) is used to characterize the mineralogy of the iron(III)-arsenate(V) precipitates produced during the raffinate (aqueous effluent) neutralization process at the McClean Lake uranium mill in northern Saskatchewan, Canada. To facilitate the structural characterization of the precipitated solids derived from the neutralized raffinate, a set of reference compounds were synthesized and analyzed. The reference compounds include crystalline scorodite, poorly-crystalline scorodite, iron(III)-arsenate co-precipitates obtained under different pH conditions, and arsenate-adsorbed on goethite. The poorly-crystalline scorodite (prepared at pH 4 with Fe/As = 1) has similar As local structure as that of crystalline scorodite. Both As and Femore » K-edge XAFS of poorly-crystalline scorodite yield consistent results on As-Fe (or Fe-As) shell. From As K-edge analysis the As-Fe shell has an inter-atomic distance of 3.33 {+-} 0.02 A and coordination number of 3.2; while from Fe K-edge analysis the Fe-As distance and coordination number are 3.31 {+-} 0.02 A and 3.8, respectively. These are in contrast with the typical arsenate adsorption on bidentate binuclear sites on goethite surfaces, where the As-Fe distance is 3.26 {+-} 0.03 A and coordination number is close to 2. A similar local structure identified in the poorly-crystalline scorodite is also found in co-precipitation solids (Fe(III)/As(V) = 3) when precipitated at the same pH (pH = 4): As-Fe distance 3.30 {+-} 0.03 A and coordination number 3.9; while at pH = 8 the co-precipitate has As-Fe distance of 3.27 {+-} 0.03 A and coordination number about 2, resembling more closely the adsorption case. The As local structure in the two neutralized raffinate solid series (precipitated at pH values up to 7) closely resembles that in the poorly-crystalline scorodite. All of the raffinate solids have the same As-Fe inter-atomic distance as that in the poorly-crystalline scorodite, and a systematic decrease in the As-Fe coordination is observed when pH is progressively increased; the basic poorly-crystalline scorodite structural feature remains in the raffinate solid up to pH 7.« less

Structural characterization of poorly-crystalline scorodite, iron(III)-arsenate co-precipitates and uranium mill neutralized raffinate solids using X-ray absorption fine structure spectroscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, N; Jiang, D T; Cutler, J

X-ray absorption fine structure (XAFS) is used to characterize the mineralogy of the iron(III)-arsenate(V) precipitates produced during the raffinate (aqueous effluent) neutralization process at the McClean Lake uranium mill in northern Saskatchewan, Canada. To facilitate the structural characterization of the precipitated solids derived from the neutralized raffinate, a set of reference compounds were synthesized and analyzed. The reference compounds include crystalline scorodite, poorly-crystalline scorodite, iron(III)-arsenate co-precipitates obtained under different pH conditions, and arsenate-adsorbed on goethite. The poorly-crystalline scorodite (prepared at pH 4 with Fe/As = 1) has similar As local structure as that of crystalline scorodite. Both As and Femore » K-edge XAFS of poorly-crystalline scorodite yield consistent results on As-Fe (or Fe-As) shell. From As K-edge analysis the As-Fe shell has an inter-atomic distance of 3.33 ± 0.02 Å and coordination number of 3.2; while from Fe K-edge analysis the Fe-As distance and coordination number are 3.31 ± 0.02 Å and 3.8, respectively. These are in contrast with the typical arsenate adsorption on bidentate binuclear sites on goethite surfaces, where the As-Fe distance is 3.26 ± 0.03 Å and coordination number is close to 2. A similar local structure identified in the poorly-crystalline scorodite is also found in co-precipitation solids (Fe(III)/As(V) = 3) when precipitated at the same pH (pH = 4): As-Fe distance 3.30 ± 0.03 Å and coordination number 3.9; while at pH = 8 the co-precipitate has As-Fe distance of 3.27 ± 0.03 Å and coordination number about 2, resembling more closely the adsorption case. The As local structure in the two neutralized raffinate solid series (precipitated at pH values up to 7) closely resembles that in the poorly-crystalline scorodite. All of the raffinate solids have the same As-Fe inter-atomic distance as that in the poorly-crystalline scorodite, and a systematic decrease in the As-Fe coordination is observed when pH is progressively increased; the basic poorly-crystalline scorodite structural feature remains in the raffinate solid up to pH 7.« less

A retrospective evaluation of prognosis and cost-effectiveness of IVF in poor responders according to the Bologna criteria.

PubMed

Busnelli, Andrea; Papaleo, Enrico; Del Prato, Diana; La Vecchia, Irene; Iachini, Eleonora; Paffoni, Alessio; Candiani, Massimo; Somigliana, Edgardo

2015-02-01

Do the Bologna criteria for poor responders successfully identify women with poor IVF outcome? The Bologna criteria effectively identify a population with a uniformly low chance of success. Women undergoing IVF who respond poorly to ovarian hyper-stimulation have a low chance of success. Even if improving IVF outcome in this population represents a main priority, the lack of a unique definition of the condition has hampered research in this area. To overcome this impediment, a recent expert meeting in Bologna proposed a new definition of poor responders ('Bologna criteria'). However, data supporting the relevance of this definition in clinical practice are scanty. Retrospective study of women undergoing IVF-ICSI between January 2010 and December 2012 in two independent infertility units. Women could be included if they fulfilled the definition of poor ovarian response (POR) according to Bologna criteria prior to initiation of the cycle. Women were included only for one cycle. The main outcome was the live birth rate per started cycle. The perspective of the cost analysis was the one of the health provider. Three-hundred sixty-two women from two independent Infertility Units were selected. A binomial distribution model was used to calculate the 95% CI of the rate of success. Characteristics of women who did and did not obtain a live birth were compared. A logistic regression model was used to adjust for confounders. The economic analysis included costs for pharmacological compounds and for the IVF procedure. The benefits were estimated on quality-adjusted life years (QALY). To develop the model, we used the local life-expectancy tables, we applied a 3% discount of life years gained and we used a 0.07 improvement in quality of life associated with parenthood. Sensitivity analyses were performed varying the improvement of the quality of life and including/excluding the male partner. The reference values for cost-effectiveness were the Italian and the local (Lombardy) gross domestic product (GDP) pro capita per year in the studied period and the upper and lower limits suggested by NICE. Overall, 23 women had a live birth (6%, 95% CI: 4-9%), in line with the previous evidence. This proportion did not significantly differ in the different subgroups of poor responders. Positive predictive factors of success were previous deliveries (adjusted OR = 3.0, 95% CI: 1.1-8.7, P = 0.039) and previous chemotherapy (adjusted OR = 13.9, 95% CI: 2.5-77.2, P = 0.003). Age, serum AMH, serum FSH and antral follicle count were not significantly associated with live birth. The total cost per live birth was 87 748 Euros, corresponding to 49 919 Euros per QALY. This is above both the limits suggested by NICE for cost-effectiveness and the Italian and local GDP pro capita. Sensitivity analyses mainly support the robustness of the conclusion. We lack a control group and we cannot thus exclude that an alternative definition of poor responders may be equally if not more valid. Moreover, independent validations are warranted prior to concluding that IVF is not cost-effective. Women should thus not be denied treatment based on our findings. Noteworthy, there is also not yet a consensus on the most appropriate economic model to be used. We recommend the use of the Bologna criteria when designing future studies on poor responders. Large multi-centred international studies are now required to draw definite conclusions on the economic profile of IVF in this situation. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Local environmental quality positively predicts breastfeeding in the UK’s Millennium Cohort Study

PubMed Central

Sear, Rebecca

2017-01-01

ABSTRACT Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis—one ‘objective’ (based on an independent assessor’s neighbourhood scores) and one ‘subjective’ (based on respondent’s scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women’s decision making contexts when considering behaviours relevant to public health. PMID:29354262

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study.

PubMed

Brown, Laura J; Sear, Rebecca

2017-01-01

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Culturally grounded indicators of resilience in social-ecological systems

Treesearch

Eleanor Sterling; Tamara Ticktin; Tē Kipa Kepa Morgan; Georgina Cullman; Diana Alvira; Pelika Andrade; Nadia Bergamini; Erin Betley; Kate Burrows; Sophie Caillon; Joachim Claudet; Rachel Dacks; Pablo Eyzaguirre; Chris Filardi; Nadav Gazit; Christian Giardina; Stacy Jupiter; Kealohanuiopuna Kinney; Joe McCarter; Manuel Mejia; Kanoe Morishige; Jennifer Newell; Lihla Noori; John Parks; Pua‘ala Pascua; Ashwin Ravikumar; Jamie Tanguay; Amanda Sigouin; Tina Stege; Mark Stege; Alaka Wali

2017-01-01

Measuring progress toward sustainability goals is a multifaceted task. International, regional, and national organizations and agencies seek to promote resilience and capacity for adaptation at local levels. However, their measurement systems may be poorly aligned with local contexts, cultures, and needs. Understanding how to build effective, culturally grounded...

Perceptions of good medical practice in the NHS: a survey of senior health professionals.

PubMed

Hutchinson, A; Williams, M; Meadows, K; Barbour, R S; Jones, R

1999-12-01

To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed. A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures. A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils. Senior health professionals involved in the management of medical professional performance. Perceptions of what constitutes good medical practice. Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors. Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.

Eradication of schistosomiasis in Guangxi, China. Part 1: Setting, strategies, operations, and outcomes, 1953-92.

PubMed Central

Sleigh, A.; Li, X.; Jackson, S.; Huang, K.

1998-01-01

Reported are the results of an analysis of a 40-year programme leading to eradication of schistosomiasis in Guangxi, China, a large, poor autonomous region of the country that had the heaviest global burden of the disease. We used historical county data and maps showing the initial distribution and density of Oncomelania snails and the initial prevalence of schistosomiasis to assess the correlation between snail occurrence and human infection. All annual county schistosomiasis reports were collected and analysed, including information on snail abundance and infection, human and animal infection control, stool examinations and patient treatments, clinical and serology examinations, skin test surveillance, patient follow-up, patient treatments, animal examinations, water supply and sanitation, and environmental modification. The findings bear witness to the laborious, systematic and scientific basis of the control programme and how it changed over the 40 years. Of note is the continual search for and treatment of cases, the killing of snails, and the permanent alteration of their habitats using mass community participation and methods adapted to local conditions. The programme has freed more than 10 million people from the risk of schistosomiasis and boosted rural economic development and health. The persistence, good record keeping, evolving and locally flexible strategies, and the clear focus of the control programme were crucial to its eventual success. PMID:9803587

Characterizing Types of Human Mobility to Inform Differential and Targeted Malaria Elimination Strategies in Northeast Cambodia

PubMed Central

Peeters Grietens, Koen; Gryseels, Charlotte; Dierickx, Susan; Bannister-Tyrrell, Melanie; Trienekens, Suzan; Uk, Sambunny; Phoeuk, Pisen; Suon, Sokha; Set, Srun; Gerrets, René; Hoibak, Sarah; Muela Ribera, Joan; Hausmann-Muela, Susanna; Tho, Sochantha; Durnez, Lies; Sluydts, Vincent; d’Alessandro, Umberto; Coosemans, Marc; Erhart, Annette

2015-01-01

Human population movements currently challenge malaria elimination in low transmission foci in the Greater Mekong Subregion. Using a mixed-methods design, combining ethnography (n = 410 interviews), malariometric data (n = 4996) and population surveys (n = 824 indigenous populations; n = 704 Khmer migrants) malaria vulnerability among different types of mobile populations was researched in the remote province of Ratanakiri, Cambodia. Different structural types of human mobility were identified, showing differential risk and vulnerability. Among local indigenous populations, access to malaria testing and treatment through the VMW-system and LLIN coverage was high but control strategies failed to account for forest farmers’ prolonged stays at forest farms/fields (61% during rainy season), increasing their exposure (p = 0.002). The Khmer migrants, with low acquired immunity, active on plantations and mines, represented a fundamentally different group not reached by LLIN-distribution campaigns since they were largely unregistered (79%) and unaware of the local VMW-system (95%) due to poor social integration. Khmer migrants therefore require control strategies including active detection, registration and immediate access to malaria prevention and control tools from which they are currently excluded. In conclusion, different types of mobility require different malaria elimination strategies. Targeting mobility without an in-depth understanding of malaria risk in each group challenges further progress towards elimination. PMID:26593245

Behavioral and Emotional Regulation and Adolescent Substance Use Problems: A Test of Moderation Effects in a Dual-Process Model

PubMed Central

Wills, Thomas A.; Pokhrel, Pallav; Morehouse, Ellen; Fenster, Bonnie

2011-01-01

In a structural model, we tested how relations of predictors to level of adolescent substance use (tobacco, alcohol, marijuana), and to substance-related impaired-control and behavior problems, are moderated by good self-control and poor regulation in behavioral and emotional domains. The participants were a sample of 1,116 public high-school students. In a multiple-group analysis for good self-control, the paths from negative life events to substance use level and from level to behavior problems were lower among persons scoring higher on good behavioral self-control. In a multiple-group analysis for poor regulation, the paths from negative life events to level and from peer substance use to level were greater among persons scoring higher on poor behavioral (but not emotional) regulation; an inverse path from academic competence to level was greater among persons scoring higher on both aspects of poor regulation. Paths from level to impaired-control and behavior problems were greater among persons scoring higher on both poor behavioral and poor emotional regulation. Theoretical implications for the basis of moderation effects are discussed. PMID:21443302

Tailless and Atrophin control Drosophila aggression by regulating neuropeptide signalling in the pars intercerebralis

NASA Astrophysics Data System (ADS)

Davis, Shaun M.; Thomas, Amanda L.; Nomie, Krystle J.; Huang, Longwen; Dierick, Herman A.

2014-02-01

Aggressive behaviour is widespread throughout the animal kingdom. However, its mechanisms are poorly understood, and the degree of molecular conservation between distantly related species is unknown. Here we show that knockdown of tailless (tll) increases aggression in Drosophila, similar to the effect of its mouse orthologue Nr2e1. Tll localizes to the adult pars intercerebralis (PI), which shows similarity to the mammalian hypothalamus. Knockdown of tll in the PI is sufficient to increase aggression and is rescued by co-expressing human NR2E1. Knockdown of Atrophin, a Tll co-repressor, also increases aggression, and both proteins physically interact in the PI. tll knockdown-induced aggression is fully suppressed by blocking neuropeptide processing or release from the PI. In addition, genetically activating PI neurons increases aggression, mimicking the aggression-inducing effect of hypothalamic stimulation. Together, our results suggest that a transcriptional control module regulates neuropeptide signalling from the neurosecretory cells of the brain to control aggressive behaviour.

De-Politicizing Parasites: Reflections on Attempts to Control the Control of Neglected Tropical Diseases

PubMed Central

Parker, Melissa; Allen, Tim

2014-01-01

Large amounts of funding are being allocated to the control of neglected tropical diseases. Strategies primarily rely on the mass distribution of drugs to adults and children living in endemic areas. The approach is presented as morally appropriate, technically effective, and context-free. Drawing on research undertaken in East Africa, we discuss ways in which normative ideas about global health programs are used to set aside social and biological evidence. In particular, there is a tendency to ignore local details, including information about actual drug take up. Ferguson’s ‘anti-politics’ thesis is a useful starting point for analyzing why this happens, but is overly deterministic. Anti-politics discourse about healing the suffering poor may shape thinking and help explain cognitive dissonance. However, use of such discourse is also a means of strategically promoting vested interests and securing funding. Whatever the underlying motivations, rhetoric and realities are conflated, with potentially counterproductive consequences. PMID:24761976

The impact of Chernobyl on health and labour market performance.

PubMed

Lehmann, Hartmut; Wadsworth, Jonathan

2011-09-01

Using longitudinal data from Ukraine we examine the extent of any long-lasting effects of exposure to the Chernobyl disaster on the health and labour market performance of the adult workforce. Variation in the local area level of radiation fallout from the Chernobyl accident is considered as a random exogenous shock with which to try to establish its causal impact on poor health, labour force participation, hours worked and wages. There appears to be a significant positive association between local area-level radiation dosage and perception of poor health, though much weaker associations between local area-level dosage and other specific self-reported health conditions. There is also some evidence to suggest that those who lived in areas more exposed to Chernobyl-induced radiation have significantly lower levels of labour market performance 20 years on. Copyright © 2011 Elsevier B.V. All rights reserved.

[Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico].

PubMed

Hernández-Romieu, Alfonso Claudio; Elnecavé-Olaiz, Alejandro; Huerta-Uribe, Nidia; Reynoso-Noverón, Nancy

2011-01-01

Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was ≤7.0%, poor from 7.01%-9.50% and very poor if HbA1c >9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%. Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal, Quebec: A cross-sectional study

PubMed Central

Deger, Leylâ; Plante, Céline; Jacques, Louis; Goudreau, Sophie; Perron, Stéphane; Hicks, John; Kosatsky, Tom; Smargiassi, Audrey

2012-01-01

BACKGROUND: Little attention has been devoted to the effects on children’s respiratory health of exposure to sulphur dioxide (SO2) in ambient air from local industrial emissions. Most studies on the effects of SO2 have assessed its impact as part of the regional ambient air pollutant mix. OBJECTIVE: To examine the association between exposure to stack emissions of SO2 from petroleum refineries located in Montreal’s (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby. METHODS: The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO2 exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO2 exposure estimates and asthma outcomes. Adjustments were made for child’s age, sex, parental history of atopy and tobacco smoke exposure at home. RESULTS: The adjusted PR for the association between active asthma and SO2 levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO2. The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO2 [95% CI 1.00 to 1.94]). CONCLUSIONS: Results of the present study suggest a relationship between exposure to refinery stack emissions of SO2 and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries. PMID:22536578

Creatinine and myoglobin are poor predictors of anaerobic threshold in colorectal cancer and health.

PubMed

Nyasavajjala, Sitaramachandra M; Phillips, Beth E; Lund, Jon N; Williams, John P

2015-06-01

Myoglobin is a haem protein produced in skeletal muscles. Serum concentrations of myoglobin have been proposed as a surrogate marker of muscle mass and function in both cachectic cancer patients and healthy non-cancer individuals. Creatinine, a metabolite of creatine phosphate, an energy store found in skeletal muscle, is produced at a constant rate from skeletal muscle. Urinary and plasma creatinine have been used in clinical practice as indicators of skeletal muscle mass in health and disease. Our study aimed to test the hypothesis that plasma myoglobin and creatinine concentration could accurately predict skeletal muscle mass and aerobic capacity in colorectal cancer (CRC) patients and matched healthy controls and thereby an indicative of aerobic performance. We recruited 47 patients with CRC and matching number of healthy volunteers for this study. All participants had their body composition measured by dual-energy X-ray absorptiometry scan, aerobic capacity measured to anaerobic threshold (AT) by cardiopulmonary exercise testing and filled in objective questionnaires to assess the qualitative functions. This study was carried out in accordance with the Declaration of Helsinki, after approval by the local National Health Service (NHS) Research Ethics Committee. Age-matched groups had similar serum myoglobin and creatinine concentrations in spite of differences in their aerobic capacity. AT was significantly lower in the CRC group compared with matched controls (1.18 ± 0.44 vs. 1.41 ± 0.71 L/min; P < 0.01). AT had significant correlation with lean muscle mass (LMM) among these groups, but myoglobin and creatinine had poor correlation with LMM and AT. Serum myoglobin is a poor predictor of muscle mass, and serum myoglobin and creatinine concentrations do not predict aerobic performance in CRC patients or healthy matched controls. © 2015 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

What Point-of-Use Water Treatment Products Do Consumers Use? Evidence from a Randomized Controlled Trial among the Urban Poor in Bangladesh

PubMed Central

Luoto, Jill; Najnin, Nusrat; Mahmud, Minhaj; Albert, Jeff; Islam, M. Sirajul; Luby, Stephen; Unicomb, Leanne; Levine, David I.

2011-01-01

Background There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why. Methods We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water's contamination with E. coli (compared to 200 control households). Findings Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls. Conclusion Traditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations. PMID:22028817

Ocular melanoma: an overview of the current status

PubMed Central

Jovanovic, Predrag; Mihajlovic, Marija; Djordjevic-Jocic, Jasmina; Vlajkovic, Slobodan; Cekic, Sonja; Stefanovic, Vladisav

2013-01-01

Ocular melanoma is the second most common type of melanoma after cutaneous and the most common primary intraocular malignant tumor in adults. Large majority of ocular melanomas originate from uvea, while conjunctival melanomas are far less frequent. Incidence of uveal melanoma has remained stable over last three decades. Diagnosis is in most cases established by clinical examination with great accuracy. Local treatment of uveal melanoma has improved, with increased use of conservative methods and preservation of the eye, but survival rates have remained unchanged. Recent advances in cytogenetics and genetics enhanced prognostication and enabled to determine tumors with high metastatic potential. However, due to lack of effective systemic therapy, prognosis of patients with metastasis remains poor and metastatic disease remains the leading cause of death among patients with uveal melanoma. Conjunctival melanoma is rare, but its incidence is increasing. It mostly occurs among white adults. In majority of cases it originates from preceding primary acquired melanosis. Current standard treatment for conjunctival melanoma is wide local excision with adjuvant therapy, including brachytherapy, cryotherapy and topical application of chemotherapeutic agent. Rarity of this tumor limits conduction of controlled trials to define the best treatment modality. As well as for uveal melanoma, prognosis of patients with metastasis is poor because there is no effective systemic therapy. Better understanding of underlying genetic and molecular abnormalities implicated in development and progression of ocular melanomas provides a great opportunity for development of targeted therapy, which will hopefully improve prognosis of patients with metastatic disease. PMID:23826405

Surveillance for falsified and substandard medicines in Africa and Asia by local organizations using the low-cost GPHF Minilab

PubMed Central

Petersen, Albert; Held, Nadja

2017-01-01

Background Substandard and falsified medical products present a serious threat to public health, especially in low- and middle-income countries. Their identification using pharmacopeial analysis is expensive and requires sophisticated equipment and highly trained personnel. Simple, low-cost technologies are required in addition to full pharmacopeial analysis in order to accomplish widespread routine surveillance for poor-quality medicines in low- and middle-income countries. Methods Ten faith-based drug supply organizations in seven countries of Africa and Asia were each equipped with a Minilab of the Global Pharma Health Fund (GPHF, Frankfurt, Germany), suitable for the analysis of about 85 different essential medicines by thin-layer chromatography. Each organization was asked to collect approximately 100 medicine samples from private local medicine outlets, especially from the informal sector. The medicine samples were tested locally according to the Minilab protocols. Medicines which failed Minilab testing were subjected to confirmatory analysis in a WHO-prequalified medicine quality control laboratory in Kenya. Results Out of 869 medicine samples, 21 were confirmed to be substandard or falsified medical products. Twelve did not contain the stated active pharmaceutical ingredient (API), six contained insufficient amounts of the API, and three showed insufficient dissolution of the API. The highest proportion of substandard and falsified medicines was found in Cameroon (7.1%), followed by the Democratic Republic of Congo (2.7%) and Nigeria (1.1%). Antimalarial medicines were most frequently found to be substandard or falsified (9.5% of all antimalarials). Thin-layer chromatography according to the Minilab protocols was found to be specific and reproducible in the identification of medicines which did not contain the stated API. Since only samples which failed Minilab testing were subjected to confirmatory testing using pharmacopeial methods, this study did not assess the sensitivity of the Minilab methodology in the detection of substandard medicines, and may underestimate the prevalence of poor-quality medicines. Conclusions Surveillance for poor-quality medicines can be carried out by local organizations in low- and middle-income countries using a simple, low-cost technology. Such surveillance can identify an important subgroup of the circulating substandard and falsified medical products and can help to prevent them from causing harm in patients. A collaboration of the national drug regulatory authorities with faith-based organizations and other NGOs may therefore represent a promising strategy towards the Sustainable Development Goal of “ensuring access to quality medicines”. PMID:28877208

Brain shaving: adaptive detection for brain PET data

NASA Astrophysics Data System (ADS)

Grecchi, Elisabetta; Doyle, Orla M.; Bertoldo, Alessandra; Pavese, Nicola; Turkheimer, Federico E.

2014-05-01

The intricacy of brain biology is such that the variation of imaging end-points in health and disease exhibits an unpredictable range of spatial distributions from the extremely localized to the very diffuse. This represents a challenge for the two standard approaches to analysis, the mass univariate and the multivariate that exhibit either strong specificity but not as good sensitivity (the former) or poor specificity and comparatively better sensitivity (the latter). In this work, we develop an analytical methodology for positron emission tomography that operates an extraction (‘shaving’) of coherent patterns of signal variation while maintaining control of the type I error. The methodology operates two rotations on the image data, one local using the wavelet transform and one global using the singular value decomposition. The control of specificity is obtained by using the gap statistic that selects, within each eigenvector, a subset of significantly coherent elements. Face-validity of the algorithm is demonstrated using a paradigmatic data-set with two radiotracers, [11C]-raclopride and [11C]-(R)-PK11195, measured on the same Huntington's disease patients, a disorder with a genetic based diagnosis. The algorithm is able to detect the two well-known separate but connected processes of dopamine neuronal loss (localized in the basal ganglia) and neuroinflammation (diffusive around the whole brain). These processes are at the two extremes of the distributional envelope, one being very sparse and the latter being perfectly Gaussian and they are not adequately detected by the univariate and the multivariate approaches.

Migration to the medieval Middle East with the crusades.

PubMed

Mitchell, Piers D; Millard, Andrew R

2009-11-01

During the 12th and 13th centuries thousands of people moved from Europe to the Middle East to fight, undertake pilgrimage, or settle and make a new life. The aim of this research is to investigate two populations from the Crusader kingdom of Jerusalem, by determining who was born in Europe and who came from the Middle East. Oxygen and strontium stable isotope analyses were conducted on the enamel of teeth from skeletal remains excavated from Crusader contexts. Twenty individuals from the coastal city of Caesarea (10 high status and 10 low status), and two local Near Eastern Christian farmers from the village of Parvum Gerinum (Tel Jezreel) were analyzed as a control sample. Results were compared with known geographic values for oxygen and strontium isotopes. The population of the city of Caesarea appears to have been dominated by European-born individuals (probably 19/20, but at least 13/20), with few locals. This was surprising as a much higher proportion of locals were expected. Both controls from the farming village of Parvum Gerinum had spent their childhood in the area of the village, which matches our understanding of limited mobility among poor Medieval farmers. This is the first time that stable isotope analysis has been applied to the study of the migration of peoples between Medieval Europe and the Middle East at the time of the crusades. In view of these findings, we must now rethink past estimations of population social structure in Levantine coastal Medieval cities during the Crusader period.

Photocontrol of Drug Release from Supramolecular Hydrogels with Green Light.

PubMed

Karcher, Johannes; Pianowski, Zbigniew

2018-06-26

Photoresponsive smart materials transform light energy into sophisticated functions. They find increasing biomedical applications in light-induced drug release and photopharmacology, as they can locally provide the desired therapeutic effect due to precise spatiotemporal dosage control. However, the majority of reported studies rely on cytotoxic UV light that poorly penetrates tissues. Here we report the first drug-releasing system based on photochromic low molecular weight supramolecular hydrogels that is triggered with visible light. We demonstrated green-light-induced release of structurally unmodified antibiotic, anticancer, and anti-inflammatory drugs under physiological conditions. Using the antibiotic-loaded gel, we selectively inhibited bacterial growth with green light. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Radiation-Induced Oral Mucositis

PubMed Central

Maria, Osama Muhammad; Eliopoulos, Nicoletta; Muanza, Thierry

2017-01-01

Radiation-induced oral mucositis (RIOM) is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT), which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with head and neck cancers. This review will discuss RIOM definition, epidemiology, impact and side effects, pathogenesis, scoring scales, diagnosis, differential diagnosis, prevention, and treatment. PMID:28589080

Stereotactic Radiosurgery and Hypofractionated Radiotherapy for Glioblastoma.

PubMed

Shah, Jennifer L; Li, Gordon; Shaffer, Jenny L; Azoulay, Melissa I; Gibbs, Iris C; Nagpal, Seema; Soltys, Scott G

2018-01-01

Glioblastoma is the most common primary brain tumor in adults. Standard therapy depends on patient age and performance status but principally involves surgical resection followed by a 6-wk course of radiation therapy given concurrently with temozolomide chemotherapy. Despite such treatment, prognosis remains poor, with a median survival of 16 mo. Challenges in achieving local control, maintaining quality of life, and limiting toxicity plague treatment strategies for this disease. Radiotherapy dose intensification through hypofractionation and stereotactic radiosurgery is a promising strategy that has been explored to meet these challenges. We review the use of hypofractionated radiotherapy and stereotactic radiosurgery for patients with newly diagnosed and recurrent glioblastoma. Copyright © 2017 by the Congress of Neurological Surgeons.

Atomic-scale dynamics of edge dislocations in Ni and concentrated solid solution NiFe alloys

DOE PAGES

Zhao, Shijun; Osetsky, Yuri N.; Zhang, Yanwen; ...

2017-01-19

Single-phase concentrated solid solution alloys (CSAs), including high entropy alloys, exhibit excellent mechanical properties compared to conventional dilute alloys. However, the origin of this observation is not clear yet because the dislocation properties in CSAs are poorly understood. In this work, the mobility of a <110>{111} edge dislocation in pure Ni and equiatomic solid solution Ni 0.5Fe 0.5 (NiFe) is studied using molecular dynamics simulations with different empirical potentials. The threshold stress to initiate dislocation movement in NiFe is found to be much higher compared to pure Ni. The drag coefficient of the dislocation motion calculated from the linear regimemore » of dislocation velocities versus applied stress suggests that the movement of dislocations in NiFe is strongly damped compared to that in Ni. The present results indicate that the mobility of edge dislocations in fcc CSAs are controlled by the fluctuations in local stacking fault energy caused by the local variation of alloy composition.« less

Glioma Surgery: Technological Advances to Achieve a Maximal Safe Resection.

PubMed

Altieri, Roberto; Zenga, Francesco; Fontanella, Marco Maria; Cofano, Fabio; Agnoletti, Alessandro; Spena, Giannantonio; Crobeddu, Emanuela; Fornaro, Riccardo; Ducati, Alessandro; Garbossa, Diego

2015-11-01

Glioblastoma multiforme (GBM) is the most frequent primary central nervous system (CNS) tumor. Despite the best treatment and advances in therapy, prognosis remains poor. One of the mainstays of therapy in GBM is surgical excision. Several studies have confirmed that the extent of resection (EOR) positively influences overall survival (OS) in patients with high-grade gliomas (HGGs). A literature search was performed using PubMed to assess the useful neurosurgical tools to achieve the best neurosurgical performance. In order to achieve the major extent of resection, preserving neurological function, many tools are now available, especially neuronavigation, intraoperative fluorescence, intraoperative ultrasound, and neuromonitoring. In addition to the maximal excision of tumor, the neurosurgeon can use photodynamic therapy (PTD) and local drug delivery (LDD) to improve the local control and bridge conventional radio and chemotherapy. EOR improves OS in patients with HGGs. There are technological possibilities for achieving a complete resection preserving neurological function, and it is not acceptable to perform only biopsy of these lesions.

N-terminal dual lipidation-coupled molecular targeting into the primary cilium.

PubMed

Kumeta, Masahiro; Panina, Yulia; Yamazaki, Hiroya; Takeyasu, Kunio; Yoshimura, Shige H

2018-06-13

The primary cilium functions as an "antenna" for cell signaling, studded with characteristic transmembrane receptors and soluble protein factors, raised above the cell surface. In contrast to the transmembrane proteins, targeting mechanisms of nontransmembrane ciliary proteins are poorly understood. We focused on a pathogenic mutation that abolishes ciliary localization of retinitis pigmentosa 2 protein and revealed a dual acylation-dependent ciliary targeting pathway. Short N-terminal sequences which contain myristoylation and palmitoylation sites are sufficient to target a marker protein into the cilium in a palmitoylation-dependent manner. A Golgi-localized palmitoyltransferase DHHC-21 was identified as the key enzyme controlling this targeting pathway. Rapid turnover of the targeted protein was ensured by cholesterol-dependent membrane fluidity, which balances highly and less-mobile populations of the molecules within the cilium. This targeting signal was found in a set of signal transduction molecules, suggesting a general role of this pathway in proper ciliary organization, and dysfunction in ciliary disorders. © 2018 Molecular Biology Society of Japan and John Wiley & Sons Australia, Ltd.

Community-based participatory research helps farmers and scientists to manage invasive pests in the Ecuadorian Andes.

PubMed

Dangles, O; Carpio, F C; Villares, M; Yumisaca, F; Liger, B; Rebaudo, F; Silvain, J F

2010-06-01

Participatory research has not been a conspicuous methodology in developing nations for studying invasive pests, an increasing threat to the sustainable development in the tropics. Our study presents a community-based monitoring system that focuses on three invasive potato tuber moth species (PTM). The monitoring was developed and implemented by young farmers in a remote mountainous area of Ecuador. Local participants collected data from the PTM invasion front, which revealed clear connection between the abundance of one of the species (Tecia solanivora) and the remoteness to the main market place. This suggests that mechanisms structuring invasive populations at the invasion front are different from those occurring in areas invaded for longer period. Participatory monitoring with local people may serve as a cost-effective early warning system to detect and control incipient invasive pest species in countries where the daily management of biological resources is largely in the hands of poor rural people.

Cholera toxin subunit B-mediated intracellular trafficking of mesoporous silica nanoparticles toward the endoplasmic reticulum

NASA Astrophysics Data System (ADS)

Walker, William Andrew

In recent decades, pharmaceutical research has led to the development of numerous treatments for human disease. Nanoscale delivery systems have the potential to maximize therapeutic outcomes by enabling target specific delivery of these therapeutics. The intracellular localization of many of these materials however, is poorly controlled, leading to sequestration in degradative cellular pathways and limiting the efficacy of their payloads. Numerous proteins, particularly bacterial toxins, have evolved mechanisms to subvert the degradative mechanisms of the cell. Here, we have investigated a possible strategy for shunting intracellular delivery of encapsulated cargoes from these pathways by modifying mesoporous silica nanoparticles (MSNs) with the well-characterized bacterial toxin Cholera toxin subunit B (CTxB). Using established optical imaging methods we investigated the internalization, trafficking, and subcellular localization of our modified MSNs in an in vitro animal cell model. We then attempted to demonstrate the practical utility of this approach by using CTxB-modified mesoporous silica nanoparticles to deliver propidium iodide, a membrane-impermeant fluorophore.

Localized Charges Control Exciton Energetics and Energy Dissipation in Doped Carbon Nanotubes.

PubMed

Eckstein, Klaus H; Hartleb, Holger; Achsnich, Melanie M; Schöppler, Friedrich; Hertel, Tobias

2017-10-24

Doping by chemical or physical means is key for the development of future semiconductor technologies. Ideally, charge carriers should be able to move freely in a homogeneous environment. Here, we report on evidence suggesting that excess carriers in electrochemically p-doped semiconducting single-wall carbon nanotubes (s-SWNTs) become localized, most likely due to poorly screened Coulomb interactions with counterions in the Helmholtz layer. A quantitative analysis of blue-shift, broadening, and asymmetry of the first exciton absorption band also reveals that doping leads to hard segmentation of s-SWNTs with intrinsic undoped segments being separated by randomly distributed charge puddles approximately 4 nm in width. Light absorption in these doped segments is associated with the formation of trions, spatially separated from neutral excitons. Acceleration of exciton decay in doped samples is governed by diffusive exciton transport to, and nonradiative decay at charge puddles within 3.2 ps in moderately doped s-SWNTs. The results suggest that conventional band-filling in s-SWNTs breaks down due to inhomogeneous electrochemical doping.

Dissecting non-coding RNA mechanisms in cellulo by single-molecule high-resolution localization and counting

PubMed Central

Pitchiaya, Sethuramasundaram; Krishnan, Vishalakshi; Custer, Thomas C.; Walter, Nils G.

2013-01-01

Non-coding RNAs (ncRNAs) recently were discovered to outnumber their protein-coding counterparts, yet their diverse functions are still poorly understood. Here we report on a method for the intracellular Single-molecule High Resolution Localization and Counting (iSHiRLoC) of microRNAs (miRNAs), a conserved, ubiquitous class of regulatory ncRNAs that controls the expression of over 60% of all mammalian protein coding genes post-transcriptionally, by a mechanism shrouded by seemingly contradictory observations. We present protocols to execute single particle tracking (SPT) and single-molecule counting of functional microinjected, fluorophore-labeled miRNAs and thereby extract diffusion coefficients and molecular stoichiometries of micro-ribonucleoprotein (miRNP) complexes from living and fixed cells, respectively. This probing of miRNAs at the single molecule level sheds new light on the intracellular assembly/disassembly of miRNPs, thus beginning to unravel the dynamic nature of this important gene regulatory pathway and facilitating the development of a parsimonious model for their obscured mechanism of action. PMID:23820309

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, John W.; Ghafoori, A. Paiman; Willett, Christopher G.

Purpose: Extrahepatic cholangiocarcinoma is a rare malignancy. Despite radical resection, survival remains poor, with high rates of local and distant failure. To clarify the role of radiotherapy with chemotherapy, we performed a retrospective analysis of resected patients who had undergone chemoradiotherapy. Methods and Materials: A total of 45 patients (13 with proximal and 32 with distal disease) underwent resection plus radiotherapy (median dose, 50.4 Gy). All but 1 patient received concurrent fluoropyrimidine-based chemotherapy. The median follow-up was 30 months for all patients and 40 months for survivors. Results: Of the 45 patients, 33 underwent adjuvant radiotherapy, and 12 were treatedmore » neoadjuvantly. The 5-year actuarial overall survival, disease-free survival, metastasis-free survival, and locoregional control rates were 33%, 37%, 42%, and 78%, respectively. The median survival was 34 months. No patient died perioperatively. Patient age {<=}60 years and perineural involvement adversely affected survival on univariate analysis. Patients undergoing R0 resection had a significantly improved rate of local control but no survival advantage. Despite having more advanced disease at presentation, patients treated neoadjuvantly had a longer survival (5-year survival 53% vs. 23%, p = 0.16) and similar rates of Grade 2-3 surgical morbidity (16% vs. 33%, p = 0.24) compared with those treated in the postoperative setting. Conclusion: These study results suggest a possible local control benefit from chemoradiotherapy combined with surgery in patients with advanced, resected biliary cancer. Furthermore, our results suggest that a treatment strategy that includes preoperative chemoradiotherapy might result in improved tumor resectability with similar surgical morbidity compared with patients treated postoperatively, as well as potentially improved survival outcomes. Distant failure remains a significant failure pattern, suggesting the need for more effective systemic therapy.« less

Cell-cycle-dependent localization of human cytomegalovirus UL83 phosphoprotein in the nucleolus and modulation of viral gene expression in human embryo fibroblasts in vitro.

PubMed

Arcangeletti, Maria-Cristina; Rodighiero, Isabella; Mirandola, Prisco; De Conto, Flora; Covan, Silvia; Germini, Diego; Razin, Sergey; Dettori, Giuseppe; Chezzi, Carlo

2011-01-01

The nucleolus is a multifunctional nuclear compartment widely known to be involved in several cellular processes, including mRNA maturation and shuttling to cytoplasmic sites, control of the cell cycle, cell proliferation, and apoptosis; thus, it is logical that many viruses, including herpesvirus, target the nucleolus in order to exploit at least one of the above-mentioned functions. Recent studies from our group demonstrated the early accumulation of the incoming ppUL83 (pp65), the major tegument protein of human cytomegalovirus (HCMV), in the nucleolus. The obtained results also suggested that a functional relationship might exist between the nucleolar localization of pp65, rRNA synthesis, and the development of the lytic program of viral gene expression. Here we present new data which support the hypothesis of a potentially relevant role of HCMV pp65 and its nucleolar localization for the control of the cell cycle by HCMV (arrest of cell proliferation in G1-G1/S), and for the promotion of viral infection. We demonstrated that, although the incoming pp65 amount in the infected cells appears to be constant irrespective of the cell-cycle phase, its nucleolar accumulation is prominent in G1 and G1/S, but very poor in S or G2/M. This correlates with the observation that only cells in G1 and G1/S support an efficient development of the HCMV lytic cycle. We propose that HCMV pp65 might be involved in regulatory/signaling pathways related to nucleolar functions, such as the cell-cycle control. Co-immunoprecipitation experiments have permitted to identify nucleolin as one of the nucleolar partners of pp65.

Socioeconomic inequalities in physical and mental functioning of Japanese civil servants: explanations from work and family characteristics.

PubMed

Sekine, Michikazu; Chandola, Tarani; Martikainen, Pekka; Marmot, Michael; Kagamimori, Sadanobu

2006-07-01

Poor physical and mental functioning is more common among people of low socioeconomic status (SES) and those with disadvantaged work and family characteristics. This study aims to clarify whether the SES inequalities in functioning can be explained by the SES differences in work and family characteristics. The subjects were 3787 male and female civil servants, aged 20-65, working in a local government on the west coast of Japan. Logistic regression analysis was performed to examine (1) whether there were employment-grade (SES) differences in poor physical and mental functioning as measured by the Short Form 36 (SF-36) and (2) whether these SES differences were explained by work and family characteristics. In general, low control at work, high demands, low social support, short and long work hours, shift work, being unmarried, high family-to-work conflict and high work-to-family conflict were independently associated with poor physical and mental functioning in both men and women. In men, the age-adjusted odds ratio (OR) of low-grade employees for poor physical functioning was 1.93 (95% confidence interval: 1.38-2.69) in comparison to high-grade employees. The grade difference was mildly attenuated, when adjusted for work and family characteristics (OR = 1.72)(1.20-2.47). The age-adjusted OR of the low-grade employees for poor mental functioning was 1.88 (1.29-2.74). The grade difference was attenuated and no longer significant when adjusted for work and family characteristics (OR = 1.51)(0.99-2.31). Among women, there were no significant grade-differences in poor physical and mental functioning. Although longitudinal research is necessary to clarify the causal nature of these associations, improvements in SES differences in work and family characteristics may be important for reducing SES inequalities in physical and mental functioning among Japanese men. The different patterns of SES inequalities in health between men and women deserve further research.

Percutaneous laser ablation of benign and malignant thyroid nodules.

PubMed

Papini, Enrico; Bizzarri, Giancarlo; Pacella, Claudio M

2008-10-01

Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.

Categorical Indicator Kriging for assessing the risk of groundwater nitrate pollution: the case of Vega de Granada aquifer (SE Spain).

PubMed

Chica-Olmo, Mario; Luque-Espinar, Juan Antonio; Rodriguez-Galiano, Victor; Pardo-Igúzquiza, Eulogio; Chica-Rivas, Lucía

2014-02-01

Groundwater nitrate pollution associated with agricultural activity is an important environmental problem in the management of this natural resource, as acknowledged by the European Water Framework Directive. Therefore, specific measures aimed to control the risk of water pollution by nitrates must be implemented to minimise its impact on the environment and potential risk to human health. The spatial probability distribution of nitrate contents exceeding a threshold or limit value, established within the quality standard, will be helpful to managers and decision-makers. A methodology based on non-parametric and non-linear methods of Indicator Kriging was used in the elaboration of a nitrate pollution categorical map for the aquifer of Vega de Granada (SE Spain). The map has been obtained from the local estimation of the probability that a nitrate content in an unsampled location belongs to one of the three categories established by the European Water Framework Directive: CL. 1 good quality [Min - 37.5 ppm], CL. 2 intermediate quality [37.5-50 ppm] and CL. 3 poor quality [50 ppm - Max]. The obtained results show that the areas exceeding nitrate concentrations of 50 ppm, poor quality waters, occupy more than 50% of the aquifer area. A great proportion of the area's municipalities are located in these poor quality water areas. The intermediate quality and good quality areas correspond to 21% and 28%, respectively, but with the highest population density. These results are coherent with the experimental data, which show an average nitrate concentration value of 72 ppm, significantly higher than the quality standard limit of 50 ppm. Consequently, the results suggest the importance of planning actions in order to control and monitor aquifer nitrate pollution. © 2013.

Type 1 diabetes: Syndromes in resource-challenged settings.

PubMed

Nagesh, V Sri; Kalra, Sanjay

2015-06-01

Type 1 Diabetes is a complex disorder that is made more complex by the myriad of co-morbid conditions associated with it. Mauriac Syndrome is a well-known but nowadays uncommon condition that presents with growth retardation secondary to poor glycaemic control. Limited Joint Mobility is an often-missed association of diabetes. Its importance lies in the fact that it can cause significant impairment of fine movements in T1DM children. It also indicates poor glycaemic control over a long period of time and can be used as a surrogate marker for development of diabetic microvascular complications. Anaemia in T1DM is protean and can develop due to a combination of nutritional factors, chronic renal disease, coeliac disease and worm infestation. Management is etiological. Vitamin deficiencies are ubiquitous in T1DM and if left untreated, can lead to neurological, haematological and skeletal dysfunction. The best-known co-morbid conditions are the local site reactions clubbed together under the moniker lipodystrophies. These can be either atrophic or hypertrophic and are usually due to repeated injections at the same site, improper technique and needle re-use. Management is often difficult and they are best prevented by appropriate diabetes education and emphasis on proper injection techniques at the time of T1DM diagnosis, with periodic reinforcement. Amyloidosis is a little known condition that shares a lot of features in common with the lipodystrophies and often needs to be differentiated from lipohypertrophy. T1DM is a disease which is often associated with a poor quality of life and these co-morbid conditions also need to be treated for effective general and psychological well-being.

More than a Library?: Urban Poverty and an Exploratory Look at the Role of a Neighborhood Institution

ERIC Educational Resources Information Center

Ly, Carolyn

2010-01-01

Libraries have traditionally tended to be one of the few institutionally provided public resources for local residents in poor, urban, neighborhoods. This paper presents findings from the exploratory phase of an ongoing research project which examines, through participant observation, the "value" of a public library in a poor urban neighborhood.…

Hypertension in Developing Countries: A Major Challenge for the Future.

PubMed

Mohsen Ibrahim, M

2018-05-01

Outline recent epidemiologic data regarding hypertension in developing countries, distinguish differences from developed countries, and identify challenges in management and future perspectives. Increased sugar intake, air and noise pollution, and low birth weight are emerging hypertension risk factors. The major challenges in management are difficulties in accurate diagnosis of hypertension and adequate blood pressure control. In contrast to developed countries, hypertension prevalence rates are on the rise in developing countries with no improvement in awareness or control rates. The increasing burden of hypertension is largely attributable to behavioral factors, urbanization, unhealthy diet, obesity, social stress, and inactivity. Health authorities, medical societies, and drug industry can collaborate to improve hypertension control through education programs, public awareness campaigns, legislation to limit salt intake, encourage generic drugs, development and dissemination of national guidelines, and involving nurses and pharmacists in hypertension management. More epidemiologic data are needed in the future to identify reasons behind increased prevalence and poor blood pressure control and examine trends in prevalence, awareness, treatment, and control. National programs for better hypertension control based on local culture, economic characteristics, and available resources in the population are needed. The role of new tools for hypertension management should be tested in developing world.

The application of lambda-cyhalothrin in tick control.

PubMed

Jurisic, Aleksandar D; Petrovic, Aleksandra P; Rajkovic, Dragana V; Nicin, Slobodan Dj

2010-09-01

In recent years, in urban areas of Novi Sad, unique ecological conditions, specific floristic and faunistic composition and poor habits of citizens in sense of public health, facilitate the development and maintenance of ticks. Regarding the importance of ticks as vectors of severe human and animal diseases, complex and detailed studies are conducted with an aim to find the most efficient methods for tick control. Two tick species, Ixodes ricinus and Dermacentor marginatus, were identified during a 3-year period on the territory of Municipality of Novi Sad. During 2006, the efficacy of the pyrethroid lambda-cyhalothrin in tick control varied from 60.7 to 100%. The highest efficacy recorded in 2007 was 92.3%. The efficacy of lambda-cyhalothrin in 2008 varied from 39.1 to 100%. Lambda-cyhalothrin showed high efficacy in tick control at localities which were improved before the application (mowed, litter removed, abundance control and euthanasia of abandoned cats and dogs). The results of this research indicate that lambda-cyhalothrin has a toxic effect on ticks and could be used as efficient acaricide for tick control, although its efficacy depends on formulation, terrain features and methods of application.

Role of antispasmodics in the treatment of irritable bowel syndrome

PubMed Central

Annaházi, Anita; Róka, Richárd; Rosztóczy, András; Wittmann, Tibor

2014-01-01

Irritable bowel syndrome (IBS) is a long-lasting, relapsing disorder characterized by abdominal pain/discomfort and altered bowel habits. Intestinal motility impairment and visceral hypersensitivity are the key factors among its multifactorial pathogenesis, both of which require effective treatment. Voltage-gated calcium channels mediate smooth muscle contraction and endocrine secretion and play important roles in neuronal transmission. Antispasmodics are a group of drugs that have been used in the treatment of IBS for decades. Alverine citrate, a spasmolytic, decreases the sensitivity of smooth muscle contractile proteins to calcium, and it is a selective 5-HT1A receptor antagonist. Alverine, in combination with simethicone, has been demonstrated to effectively reduce abdominal pain and discomfort in a large placebo-controlled trial. Mebeverine is a musculotropic agent that potently blocks intestinal peristalsis. Non-placebo-controlled trials have shown positive effects of mebeverine in IBS regarding symptom control; nevertheless, in recent placebo-controlled studies, mebeverine did not exhibit superiority over placebo. Otilonium bromide is poorly absorbed from the GI tract, where it acts locally as an L-type calcium channel blocker, an antimuscarinic and a tachykinin NK2 receptor antagonist. Otilonium has effectively reduced pain and improved defecation alterations in placebo-controlled trials in IBS patients. Pinaverium bromide is also an L-type calcium channel blocker that acts locally in the GI tract. Pinaverium improves motility disorders and consequently reduces stool problems in IBS patients. Phloroglucinol and trimethylphloroglucinol are non-specific antispasmodics that reduced pain in IBS patients in a placebo-controlled trial. Antispasmodics have excellent safety profiles. T-type calcium channel blockers can abolish visceral hypersensitivity in animal models, which makes them potential candidates for the development of novel therapeutic agents in the treatment of IBS. PMID:24876726

Impact of payments for environmental services and protected areas on local livelihoods and forest conservation in northern Cambodia.

PubMed

Clements, Tom; Milner-Gulland, E J

2015-02-01

The potential impacts of payments for environmental services (PES) and protected areas (PAs) on environmental outcomes and local livelihoods in developing countries are contentious and have been widely debated. The available evidence is sparse, with few rigorous evaluations of the environmental and social impacts of PAs and particularly of PES. We measured the impacts on forests and human well-being of three different PES programs instituted within two PAs in northern Cambodia, using a panel of intervention villages and matched controls. Both PES and PAs delivered additional environmental outcomes relative to the counterfactual: reducing deforestation rates significantly relative to controls. PAs increased security of access to land and forest resources for local households, benefiting forest resource users but restricting households' ability to expand and diversify their agriculture. The impacts of PES on household well-being were related to the magnitude of the payments provided. The two higher paying market-linked PES programs had significant positive impacts, whereas a lower paying program that targeted biodiversity protection had no detectable effect on livelihoods, despite its positive environmental outcomes. Households that signed up for the higher paying PES programs, however, typically needed more capital assets; hence, they were less poor and more food secure than other villagers. Therefore, whereas the impacts of PAs on household well-being were limited overall and varied between livelihood strategies, the PES programs had significant positive impacts on livelihoods for those that could afford to participate. Our results are consistent with theories that PES, when designed appropriately, can be a powerful new tool for delivering conservation goals whilst benefiting local people. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

PubMed Central

Diwanji, Tejan P.; Mohindra, Pranshu; Vyfhuis, Melissa; Snider, James W.; Kalavagunta, Chaitanya; Mossahebi, Sina; Yu, Jen; Feigenberg, Steven

2017-01-01

The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting. A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT). The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the early-stage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, early-stage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement. PMID:28529896

Pathological response of locally advanced rectal cancer to preoperative chemotherapy without pelvic irradiation.

PubMed

Bensignor, T; Brouquet, A; Dariane, C; Thirot-Bidault, A; Lazure, T; Julié, C; Nordlinger, B; Penna, C; Benoist, S

2015-06-01

Pathological response to chemotherapy without pelvic irradiation is not well defined in rectal cancer. This study aimed to evaluate the objective pathological response to preoperative chemotherapy without pelvic irradiation in middle or low locally advanced rectal cancer (LARC). Between 2008 and 2013, 22 patients with middle or low LARC (T3/4 and/or N+ and circumferential resection margin < 2 mm) and synchronous metastatic disease or a contraindication to pelvic irradiation underwent rectal resection after preoperative chemotherapy. The pathological response of rectal tumour was analysed according to the Rödel tumour regression grading (TRG) system. Predictive factors of objective pathological response (TRG 2-4) were analysed. All patients underwent rectal surgery after a median of six cycles of preoperative chemotherapy. Of these, 20 (91%) had sphincter saving surgery and an R0 resection. Twelve (55%) patients had an objective pathological response (TRG 2-4), including one complete response. Poor response (TRG 0-1) to chemotherapy was noted in 10 (45%) patients. In univariate analyses, none of the factors examined was found to be predictive of an objective pathological response to chemotherapy. At a median follow-up of 37.2 months, none of the 22 patients experienced local recurrence. Of the 19 patients with Stage IV rectal cancer, 15 (79%) had liver surgery with curative intent. Preoperative chemotherapy without pelvic irradiation is associated with objective pathological response and adequate local control in selected patients with LARC. Further prospective controlled studies will address the question of whether it can be used as a valuable alternative to radiochemotherapy in LARC. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Ductile flow by water-assisted cataclasis

NASA Astrophysics Data System (ADS)

den Brok, Bas

2003-04-01

In the presence of water otherwise brittle materials may deform macroscopically ductile by water-assisted cataclastic creep. This is possible as long as (i) solubility is high enough, so that stress-corrosion can occur, and (ii) local stress is low enough, to that fracturing remains subcritical. Water-assisted cataclastic creep (WACC) may play an important role in the middle and lower continental crust where mineral solubilities are high and stresses low. WACC is a poorly understood deformation process. Experiments were performed on very soluble brittle salts (Na-chlorate; K-alum) to study microstructure development by WACC. The experiments were carried out at room temperature and atmospheric pressure in a small see-through vessel. In this way the cataclastic deformation process could be studied "in-situ" under the microscope. Crystals were loaded in the presence of saturated salt solution. It appeared that originally straight mineral surfaces were instable when kept under stress. Grooves (or channels) slowly developed in the surface by local dissolution. These grooves behave like so-called Grinfeld instabilities. They develop because the energy of a grooved surface under stress is lower than the energy of a straight surface under stress. The grooves may deepen and turn into subcritical cracks when local stress further increases. These cracks propagate slowly. They propagate parallel to sigma1 but also at an angle and even perpendicular to sigma1, often following crystallographically controlled directions. The fractures mostly change direction while propagating, locally making turns of more than 180 degrees. Irregular fracture fragments thus develop. The fractures may migrate sideways (as with grain bounday migration) probably by solution-redeposition driven by differences in stress between both sides of the fracture. Thus the shape of the fragments changes. The size of the fracture fragments seems to be controlled by the distance of the grooves, which decreases with increasing stress.

Study of the buffering capacity, pH and salivary flow rate in type 2 well-controlled and poorly controlled diabetic patients.

PubMed

Bernardi, Maria José; Reis, Alessandra; Loguercio, Alessandro Dourado; Kehrig, Ruth; Leite, Mariana Ferreira; Nicolau, José

2007-01-01

This study measured the flow rate, pH and buffering capacity of saliva from well- and poorly metabolically controlled Type 2 diabetic patients in three cities of the southern part of Brazil, compared with healthy individuals from the same cities. Whole saliva was collected by mechanical stimulation and buffering capacity and glucose level were measured. Blood was collected after 12 hours fasting and glucose and glycosylated haemoglobin concentrations were determined. The data were analysed by one-way ANOVA and Student-Newman-Keuls (alpha= 0.05). The flow rate was lower in the Type 2 diabetic patients, regardless of whether they were well or poorly metabolically controlled, compared with healthy individuals (p < 0.05). Salivary glucose concentration was higher in both diabetic patient groups, i.e. well and poorly metabolically controlled, than in the control (p < 0.05). The metabolic control of hyperglycaemia was not sufficient to improve the salivary flow rate or the salivary glucose concentration.

Use of a Business Approach to Improve Disease Surveillance Data Management Systems and Information Technology Process in Florida's Bureau of STD Prevention and Control.

PubMed

Shiver, Stacy A; Schmitt, Karla; Cooksey, Adrian

2009-01-01

The business of sexually transmitted disease (STD) prevention and control demands technology that is capable of supporting a wide array of program activities-from the processing of laboratory test results to the complex and confidential process involved in contact investigation. The need for a tool that enables public health officials to successfully manage the complex operations encountered in an STD prevention and control program, and the need to operate in an increasingly poor resource environment, led the Florida Bureau of STD to develop the Patient Reporting Investigation Surveillance Manager. Its unique approach, technical architecture, and sociotechnical philosophy have made this business application successful in real-time monitoring of disease burden for local communities, identification of emerging outbreaks, monitoring and assurance of appropriate treatments, improving access to laboratory data, and improving the quality of data for epidemiologic analysis. Additionally, the effort attempted to create and release a product that promoted the Centers for Disease Control and Prevention's ideas for integration of programs and processes.

Feline sporotrichosis: histopathological profile of cutaneous lesions and their correlation with clinical presentation.

PubMed

Miranda, Luisa H M; Conceição-Silva, Fátima; Quintella, Leonardo P; Kuraiem, Bianca P; Pereira, Sandro A; Schubach, Tânia M P

2013-07-01

Cutaneous lesions of feline sporotrichosis show high fungal load and are associated with severe disease and elevated zoonotic potential. The present study describes the histopathology and fungal load of the lesions in different clinical presentations of feline sporotrichosis. Cats with sporotrichosis were separated into groups L1, L2 and L3 (lesions in one, two and three or more locations, respectively) and subjected to skin biopsies for histopathology. Eighty-six cats were included in the study. Lesions were suppurative granulomatous in 84 cases and poorly formed granulomas were predominant. The well-formed granulomas were associated with group L1. The high fungal load was predominant in group L3 and in poorly formed granuloma cases and did not occur in well-formed granulomas cases. The good general condition was associated with low fungal load. These findings suggest that the fungal load control in animals with more localized lesions and well-organized response is linked with the improvement in the outcome of infected cats. Copyright © 2013 Elsevier Ltd. All rights reserved.

Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature.

PubMed

Plonczak, Agata M; DiMarco, Aimee N; Dina, Roberto; Gujral, Dorothy M; Palazzo, Fausto F

2017-09-22

Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature. A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy. A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.

Financing Early Childhood Education Programs: State, Federal, and Local Issues

ERIC Educational Resources Information Center

Hustedt, Jason T.; Barnett, W. Steven

2011-01-01

The landscape of financing early childhood education in the U.S. is complex. Programs run the gamut from tuition-supported private centers to public programs supported by federal, state, or local funds. Different funding streams are poorly coordinated. The federal government funds several major targeted programs that are available only to specific…

Predictors of Post-Secondary Academic Outcomes among Local-Born, Immigrant, and International Students in Canada: A Retrospective Analysis

ERIC Educational Resources Information Center

de Silva, Tricia L.; Zakzanis, Konstantine; Henderson, Joanna; Ravindran, Arun V.

2017-01-01

Poor academic performance and dropout are major concerns at post-secondary institutions. Influences include sociodemographic, psychosocial, and academic functioning factors. Canadian literature is limited, and little published data directly compare academic outcomes between local-born, immigrant, and international students. We conducted a…

Sustained Release of an Anti-Glaucoma Drug: Demonstration of Efficacy of a Liposomal Formulation in the Rabbit Eye

PubMed Central

Ang, Marcus; Darwitan, Anastasia; Foo, Selin; Zhen, Ma; Koo, Magdalene; Wong, Tina T.; Venkatraman, Subbu S.

2011-01-01

Topical medication remains the first line treatment of glaucoma; however, sustained ocular drug delivery via topical administration is difficult to achieve. Most drugs have poor penetration due to the multiple physiological barriers of the eye and are rapidly cleared if applied topically. Currently, daily topical administration for lowering the intra-ocular pressure (IOP), has many limitations, such as poor patient compliance and ocular allergy from repeated drug administration. Poor compliance leads to suboptimal control of IOP and disease progression with eventual blindness. The delivery of drugs in a sustained manner could provide the patient with a more attractive alternative by providing optimal therapeutic dosing, with minimal local toxicity and inconvenience. To investigate this, we incorporated latanoprost into LUVs (large unilamellar vesicles) derived from the liposome of DPPC (di-palmitoyl-phosphatidyl-choline) by the film hydration technique. Relatively high amounts of drug could be incorporated into this vesicle, and the drug resides predominantly in the bilayer. Vesicle stability monitored by size measurement and DSC (differential scanning calorimetry) analysis showed that formulations with a drug/lipid mole ratio of about 10% have good physical stability during storage and release. This formulation demonstrated sustained release of latanoprost in vitro, and then tested for efficacy in 23 rabbits. Subconjunctival injection and topical eye drop administration of the latanoprost/liposomal formulation were compared with conventional daily administration of latanoprost eye drops. The IOP lowering effect with a single subconjunctival injection was shown to be sustained for up to 50 days, and the extent of IOP lowering was comparable to daily eye drop administration. Toxicity and localized inflammation were not observed in any treatment groups. We believe that this is the first demonstration, in vivo, of sustained delivery to the anterior segment of the eye that is safe and efficacious for 50 days. PMID:21931735

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henry, Rotich K.; Zhao Yongsheng; Dong Jun

This paper provides an overview of the state of municipal solid waste management (MSWM) by local authorities in Kenya as a case study of a low-income developing country. Approaches of possible solutions that can be undertaken to improve municipal solid waste (MSW) services are discussed. Poor economic growth (1.1% in 1993) has resulted in an increase in the poverty level which presently stands at 56%. Migration from the rural areas to the urban areas has resulted in unplanned settlements in suburban areas accommodating about 60% of the urban population on only 5% urban land area. Political interference also hampers smoothmore » running of local authorities. Vulnerability of pollution of surface and groundwater is high because local authorities rarely considered environmental impact in siting MSW disposal sites. Illegal dumping of MSW on the river banks or on the roadside poses environmental and economic threats on nearby properties. Poor servicing of MSW collection vehicles, poor state of infrastructure and the lack of adequate funding militate against optimization of MSW disposal service. The rural economy needs to be improved if rural-urban migration is to be managed. Involvement of stakeholders is important to achieve any meaningful and sustainable MSWM. The role of the informal sector through community-based organizations (CBOs), Non-Governmental Organizations (NGOs) and the private sector in offering solutions towards improvement of MSWM also is explored.« less

Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study.

PubMed

Li, Ling-Jun; Lamoureux, Ecosse; Wong, Tien Yin; Lek, Ngee

2017-06-15

Poor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up. This is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women's and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c <8%). Retinal photography was taken at diabetes annual screening and images were graded by trained graders using a semi-automated computer-based program (Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters. There was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: -0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control. Our findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year's poor glycemic control. Such morphological abnormalities may lead to future development of microvascular complications among T1D pediatric patients with poor glycemic control.

Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer.

PubMed

Sun, Bing; Huang, Zhou; Wu, Shikai; Ding, Lijuan; Shen, Ge; Cha, Lei; Wang, Junliang; Song, Santai

2016-11-08

Brain metastasis (BM) with a cystic component from breast cancer is rare and largely uncharacterized. The purpose of this study was to identify the characteristics of cystic BM in a large cohort of breast cancer patients. A total of 35 eligible patients with cystic BM and 255 patients with solid BM were analyzed. Three factors were significantly associated with an increased probability of developing cystic lesions: age at diagnosis ≤ 40 years, age at BM ≤ 45 years, and poor histological grade (p < 0.05). Patients with cystic metastasis were also characterized by a larger metastasis volume, a shorter progression-free survival (PFS) following their first treatment for BM, and poor overall survival after BM (p < 0.05). Multivariate analysis further demonstrated that local control of cystic BM was only potentially achieved for HER2-negative primary tumors (p = 0.084). Breast cancer patients with parenchymal BM were reviewed from consecutive cases treated at our institution. Cystic BM was defined when the volume of a cystic lesion was greater than 50% of the aggregated volume of all lesions present. Clinicopathologic and radiographic variables were correlated with development of cystic lesions and with prognosis of cystic BM. This study shows that cystic BM from breast cancer, a special morphological type of BM, had worse prognosis than the more commonly observed solid BM. Younger age and low tumor grade were associated with the development of cystic lesions. Further comprehensive research and management of cystic BM are warranted to improve its poor prognosis.

Safety of Epinephrine in Digital Nerve Blocks: A Literature Review.

PubMed

Ilicki, Jonathan

2015-11-01

Digital nerve blocks are commonly performed in emergency departments. Health care practitioners are often taught to avoid performing blocks with epinephrine due to a risk of digital necrosis. To review the literature on the safety of epinephrine 1:100,000-200,000 (5-10 μg/mL) with local anesthetics in digital nerve blocks in healthy patients and in patients with risk for poor peripheral circulation. PubMed, Web of Science, and the Cochrane Library were searched in June 2014 using the query "digital block AND epinephrine OR digital block AND adrenaline". The searches were performed without any limits. Sixty-three articles were identified, and 39 of these were found to be relevant. These include nine reviews, 12 randomized control trials, and 18 other articles. Most studies excluded patients with risk for poor peripheral circulation. Two studies described using epinephrine on patients with vascular comorbidities. No study reported digital necrosis or gangrene attributable to epinephrine, either in healthy patients or in patients with risk for poor peripheral circulation. In total, at least 2797 digital nerve blocks with epinephrine have been performed without any complications. Epinephrine 1:100,000-200,000 (5-10 μg/mL) is safe to use in digital nerve blocks in healthy patients. Physiological studies show epinephrine-induced vasoconstriction to be transient. There are no reported cases of epinephrine-induced harm to patients with risk for poor peripheral circulation despite a theoretical risk of harmful epinephrine-induced vasoconstriction. A lack of reported complications suggests that the risk of epinephrine-induced vasoconstriction to digits may be overstated. Copyright © 2015 Elsevier Inc. All rights reserved.

The short-term outcomes of induction SOX (S-1 + oxaliplatin) ± cetuximab chemotherapy followed by short-course chemoradiotherapy in patients with poor-risk locally advanced rectal cancer.

PubMed

Beppu, Naohito; Yoshie, Hidenori; Kimura, Fumihiko; Aihara, Tsukasa; Doi, Hiroshi; Kamikonya, Norihiko; Matsubara, Nagahide; Tomita, Naohiro; Yanagi, Hidenori; Yamanaka, Naoki

2016-10-01

To evaluate the safety and efficacy of induction SOX (S-1 + oxaliplatin) ± cetuximab chemotherapy followed by short-course chemoradiotherapy and surgery in patients with poor-risk locally advanced rectal cancer. We enrolled eligible patients with poor-risk rectal cancer defined as T3 lower rectal cancer with mesorectal fascia involvement, T4a or T4b tumors or cases with lateral lymph node swelling. The primary endpoint was a pathological complete response (pCR), and the secondary endpoints were the objective response rate (ORR) and the pathological high response rate (Grade 2 plus 3). Twenty eligible patients were enrolled. The majority (75.0 %, 15/20) of the patients completed four cycles of induction chemotherapy, and all patients completed the radiotherapy (25 Gy/10 fractions/5 days). The global rate of Grade 3-4 toxicities was 30.0 % (6/20 patients). The ORRs were 85.0 % (17/20) and 95.0 % (19/20) in the patients who underwent R0 and R1 resection, respectively. The pathological high response rate was 70.0 % (14/20) and the pCR was 10.0 % (2/20). The regimen of induction SOX (S-1 + oxaliplatin) ± cetuximab chemotherapy followed by short-course chemoradiotherapy is safe and is associated with good tumor regression in patients with poor-risk locally advanced rectal cancer.

Internet-based self-management offers an opportunity to achieve better asthma control in adolescents.

PubMed

van der Meer, Victor; van Stel, Henk F; Detmar, Symone B; Otten, Wilma; Sterk, Peter J; Sont, Jacob K

2007-07-01

Internet and short message service are emerging tools for chronic disease management in adolescents, but few data exist on the barriers to and benefits of internet-based asthma self-management. Our objective was to reveal the barriers and benefits perceived by adolescents with well-controlled and poorly controlled asthma to current and internet-based asthma management. Ninety-seven adolescents with mild-to-moderate persistent asthma monitored their asthma control on a designated Web site. After 4 weeks, 35 adolescents participated in eight focus groups. Participants were stratified in terms of age, gender, and asthma control level. We used qualitative and quantitative methods to analyze the written focus group transcripts. Limited self-efficacy to control asthma was a significant barrier to current asthma management in adolescents with poor asthma control (65%) compared to adolescents with good asthma control (17%; p < 0.01). The former group revealed the following several benefits from internet-based asthma self-management: feasible electronic monitoring; easily accessible information; e-mail communication; and use of an electronic action plan. Personal benefits included the ability to react to change and to optimize asthma control. Patients with poor asthma control were able and ready to incorporate internet-based asthma self-management for a long period of time (65%), whereas patients with good control were not (11%; p < 0.01). Our findings reveal a need for the support of self-management in adolescents with poorly controlled asthma that can be met by the application of novel information and communication technologies. Internet-based self-management should therefore target adolescents with poor asthma control.

Efffect of Aeroallergen Sensitization on Asthma Control in African-American Teens with Persistent Asthma

EPA Science Inventory

In African-American adolescents with persistent asthma, allergic profile predicted the likelihood of having poorly controlled asthma despite guidelines-directed therapies. Our results suggest that tree and weed pollen sensitization are independent risk factors for poorly controll...

Reading, Mathematics, and Behavioral Difficulties Interrelate: Evidence from a Cross-lagged Panel Design and Population-based Sample

PubMed Central

Lin, Yu-Chu; Morgan, Paul L.; Farkas, George; Hillemeier, Marianne; Cook, Michael

2015-01-01

We examined three questions. First, do reading difficulties increase children’s risk of behavior difficulties? Second, do behavioral difficulties increase children’s risk of reading difficulties? Third, do mathematics difficulties increase children’s risk of reading or behavioral difficulties? We investigated these questions using a sample of 9,324 children followed from third to fifth grade as they participated in a nationally representative dataset, conducting multilevel logistic regression modeling and including statistical control for many potential confounds. Results indicated that poor readers in third grade were significantly more likely to display poor task management, poor self-control, poor interpersonal skills, internalizing behavior problems, and externalizing behavior problems in fifth grade (odds ratio [OR] range = 1.30 – 1.57). Statistically controlling for a prior history of reading difficulties, children with poor mathematics skills in third grade were also significantly more likely to display poor task management, poor interpersonal skills, internalizing behavior problems, and reading difficulties in fifth grade (OR range = 1.38 – 5.14). In contrast, only those children exhibiting poor task management, but not other types of problem behaviors, in third grade were more likely to be poor readers in fifth grade (OR = 1.49). PMID:26097274

[Factors affecting the control of blood pressure and lipid levels in patients with cardiovascular disease: the PREseAP Study].

PubMed

Orozco-Beltrán, Domingo; Brotons, Carlos; Moral, Irene; Soriano, Nuria; Del Valle, María A; Rodríguez, Ana I; Pepió, Josep M; Pastor, Ana

2008-03-01

The aim of this observational study was to identify factors influencing the control of blood pressure (i.e., <140/90 mmHg, or <130/80 mmHg in diabetic patients) and low-density lipoprotein (LDL) cholesterol level (<100 mg/dL) in 1223 patients with cardiovascular disease. Overall, 70.2% of patients were men, and their mean age was 66.4 years. Blood pressure was poorly controlled in 50.9% (95% confidence interval [CI], 46.9%-54.8%) and the LDL cholesterol level was poorly controlled in 60.1% (95% CI, 56.3%-63.9%). Determinants of poor blood pressure control were diabetes, hypertension, no previous diagnosis of heart failure, previous diagnosis of peripheral artery disease or stroke, obesity, and no lipid-lowering treatment. Determinants of poor LDL cholesterol control were no lipid-lowering treatment, no previous diagnosis of ischemic heart disease, no antihypertensive treatment, and dyslipidemia. The factors affecting blood pressure control were different from those affecting LDL cholesterol control, an observation that should be taken into account when implementing treatment recommendations for achieving therapeutic objectives in secondary prevention.

[Nursing Workforce Characteristics and Control of Diabetes Mellitus in Primary Care: a Multilevel Analysis].

PubMed

Parro Moreno, Ana; Santiago Pérez, M Isolina; Abraira Santos, Victor; Aréjula Torres, José Luis Aréjula Torres; Díaz Holgado, Antonio; Gandarillas Grande, Ana; Morales Asencio, José Miguel; Serrano Gallardo, Pilar

2016-03-04

Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Poor DM control (figures equal or higher than 7% HbA1c). The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control.

Neuropsychological profiles and outcomes in children with new onset frontal lobe epilepsy.

PubMed

Matricardi, Sara; Deleo, Francesco; Ragona, Francesca; Rinaldi, Victoria Elisa; Pelliccia, Sarah; Coppola, Giangennaro; Verrotti, Alberto

2016-02-01

Frontal lobe epilepsy (FLE) is the second most frequent type of localization-related epilepsy, and it may impact neurocognitive functioning with high variability. The prevalence of neurocognitive impairment in affected children remains poorly defined. This report outlines the neuropsychological profiles and outcomes in children with new onset FLE, and the impact of epilepsy-related factors, such as seizure frequency and antiepileptic drug (AED) load, on the neurocognitive development. Twenty-three consecutive children (15 males and 8 females) with newly diagnosed cryptogenic FLE were enrolled; median age at epilepsy onset was 7 years (6-9.6 years). They underwent clinical and laboratory evaluation and neuropsychological assessment before starting AED treatment (time 0) and after one year of treatment (time 1). Twenty age-matched patients affected by idiopathic generalized epilepsy (10 male and 10 females) and eighteen age-matched healthy subjects (9 males and 9 females) were enrolled as controls and underwent the same assessment. All patients with FLE showed a significant difference in almost all assessed cognitive domains compared with controls, mainly in frontal functions and memory. At time 1, patients were divided into two groups according to epilepsy-related factors: group 1 (9 patients) with persisting seizures despite AED polytherapy, and group 2 (14 patients) with good seizure control in monotherapy. A significant difference was highlighted in almost all subtests in group 1 compared with group 2, both at time 0 and at time 1. In children with FLE showing a broad range of neurocognitive impairments, the epilepsy-related factors mostly related to a worse neurocognitive outcome are poor seizure control and the use of AED polytherapy, suggesting that epileptic discharges may have a negative impact on the functioning of the involved cerebral regions. Copyright © 2015 Elsevier Inc. All rights reserved.

Rural health care in New Zealand: the case of Coast to Coast Health Centre, Wellsford, an early Integrated Family Health Centre.

PubMed

Raymont, Antony; Boyd, Mary-Anne; Malloy, Timothy; Malloy, Nancy

2015-12-01

Primary health care is critical, particularly in rural areas distant from secondary care services. To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area.

20 years of local ecological public health: the experience of Sandwell in the English West Midlands.

PubMed

Middleton, J; Saunders, P

2015-10-01

A long-term picture of the economy and living conditions of Sandwell, an area of England's industrial Midlands, is presented to explore how these underpin and influence its 'health economy'. Sandwell's experience illustrates how public health actors have to tackle industrial and other factors which shape human health. The paper explores how the ecological public health perspective has helped inform the modern public health task in an area such as Sandwell. Some lessons are offered, including: the need to understand the specific economic legacy of a local area (in Sandwell, principally one of polluting and then declining manufacturing industries); the continuing story of infection control; the complexity of tackling poor diet; and the importance of the built environment and town planning. Faced by such challenges, local public health action represents, in effect, an attempt to transcend unecological public health. This can be exciting, innovative and ultimately successful; but it also means being prepared to face daunting and politically charged obstacles and superior national or international forces over which local public health practitioners conventionally have little leverage. The paper argues that, in such unequal power circumstances, public health practitioners have to draw on the creativity within the local population and build a facilitative alliance of formal and informal pro-public health actors. Despite the confounding odds and ever-present stretched resources, the Sandwell experience gives grounds for optimism, being a story of constant creativity and effective local alliances. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Effects of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease on Asthma Control in Obesity

PubMed Central

Dixon, Anne E.; Clerisme-Beaty, Emmanuelle M.; Sugar, Elizabeth A.; Cohen, Rubin I.; Lang, Jason E.; Brown, Ellen D.; Richter, Joel E.; Irvin, Charles G.; Mastronarde, John G.

2011-01-01

Background Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. Objectives The purpose of this study was to determine if (i) reflux and/or (ii) symptoms of sleep apnea contribute to poor asthma control in obesity. Methods We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. 304 participants underwent esophageal pH probe testing. 246 participants were evaluated for obstructive sleep apnea symptoms. Results Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control Those with higher body mass index reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control Symptoms and self-report of obstructive sleep apnea were more common with increasing body mass index and associated with worse asthma control as measured by the Juniper Asthma Control Questionnaire and Asthma Symptom Utility Index. Conclusions Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease may contribute significantly to poor asthma control in obese patients. PMID:21819338

The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women.

PubMed

Johnson, Maree; George, Ajesh; Dahlen, Hannah; Ajwani, Shilpi; Bhole, Sameer; Blinkhorn, Anthony; Ellis, Sharon; Yeo, Anthony

2015-01-15

Evidence is emerging that women's poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants. The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women's oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention. This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy. Australian New Zealand Clinical Trials Registry ACTRN12612001271897.

The impact of solar radiation on the heating and cooling of buildings

NASA Astrophysics Data System (ADS)

Witmer, Lucas

This work focuses on the impact of solar energy on the heating and cooling of buildings. The sun can be the primary driver for building cooling loads as well as a significant source of heat in the winter. Methods are presented for the calculation of solar energy incident on tilted surfaces and the irradiance data source options. A key deficiency in current building energy modeling softwares is reviewed with a demonstration of the impact of calculating for shade on opaque surfaces. Several tools include methods for calculating shade incident on windows, while none do so automatically for opaque surfaces. The resulting calculations for fully irradiated wall surfaces underestimate building energy consumption in the winter and overestimate in the summer by significant margins. A method has been developed for processing and filtering solar irradiance data based on local shading. This method is used to compare situations where a model predictive control system can make poor decisions for building comfort control. An MPC system informed by poor quality solar data will negatively impact comfort in perimeter building zones during the cooling season. The direct component of irradiance is necessary for the calculation of irradiance on a tilted surface. Using graphical analysis and conditional probability distributions, this work demonstrates a proof of concept for estimating direct normal irradiance from a multi-pyranometer array by leveraging inter-surface relationships without directly inverting a sky model.

Epidemiologic study of deaths and injuries due to tornadoes.

PubMed

Carter, A O; Millson, M E; Allen, D E

1989-12-01

A case-control study, using both matched and unmatched controls, was carried out on individuals who were injured or killed by a series of tornadoes that passed through Ontario, Canada, on May 31, 1985. Many serious injuries (25%) and almost all (83%) deaths were the result of becoming airborne, while most minor injuries (94%) were due to being struck by objects. Head injury was the most common injury type. Few (21%) of those in buildings chose the recommended location, and most (61%) were not in the least damaged part. Most (91%) had less than one minute's warning, and only 47% had a functioning radio at the time the tornado hit. The following risk factors for injury and death were identified: poor building anchorage; location other than in a basement, especially outdoors; age over 70 years; and high wind strength. These findings support previous findings and point to measures which have potential for preventing death or serious injury in future tornadoes: adequate warning systems and public education to ensure that individuals understand the warning and respond by seeking appropriate shelter. Those in adequately anchored buildings should shelter in an interior room or basement. Those who are outdoors, in poorly anchored buildings, mobile homes, or portable classrooms require access to an adequately anchored building, preferably with a basement, during severe storm warnings. This should be arranged by local authorities.

A College in the City: An Alternative. A Report from Educational Facilities Laboratories.

ERIC Educational Resources Information Center

Educational Facilities Labs., Inc., New York, NY.

A 45-block area of the Bedford-Stuyvesant section of Brooklyn, New York was chosen to illustrate how a poor urban community with the physical potential for restoration might be transformed by a local, unconventional college. About 500,000 poor people live in the area, 95% of whom are Negro or Puerto Rican, and almost 50% of these have only a ninth…

"If the Social Worker Had Called at Least It Would Show They Cared". Young Care Leaver's Perspectives on the Importance of Care

ERIC Educational Resources Information Center

Gaskell, Carolyn

2010-01-01

Young people leaving local authority care are frequently discussed in terms of being socially excluded and having "poor life outcomes". In terms of educational achievement, employment and involvement in the criminal justice system, those with an experience of the care system fare the worst. Within the context of these poor outcomes, the Government…

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

PubMed Central

Balagamwala, Ehsan H.; Angelov, Lilyana; Suh, John H.; Djemil, Toufik; Magnelli, Anthony; Qi, Peng; Zhuang, Tingliang; Godley, Andrew

2016-01-01

Purpose: Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. Methods: We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. Results: Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P = .02), and greater number of irradiated vertebral levels were associated with pain progression. Conclusions: Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted. PMID:27074915

Fostering emotional, social, physical and educational wellbeing in rural India: the methods of a multi-arm randomized controlled trial of Girls First.

PubMed

Leventhal, Katherine Sachs; DeMaria, Lisa M; Gillham, Jane; Andrew, Gracy; Peabody, John W; Leventhal, Steve

2015-10-26

There are 600 million girls in low and middle income countries (LMICs), many of whom are at great risk for poor health and education. There is thus great need for programs that can effectively improve wellbeing for these girls. Although many interventions have been developed to address these issues, most focus on health and education without integrating attention to social and emotional factors. This omission is unfortunate, as nascent evidence indicates that these factors are closely related to health and education. This paper describes the methods of a 4-arm randomized controlled trial among 3,560 adolescent girls in rural Bihar, India that tested whether adding an intervention targeting social-emotional issues (based on a "resilience framework") to an adolescent health intervention would improve emotional, social, physical, and educational wellbeing to a greater extent than its components and a control group. Study arms were: (1) Girls First, a combination of the Girls First Resilience Curriculum (RC) and the Girls First Health Curriculum (HC); (2) Girls First Resilience Curriculum (RC) alone; (3) Girls First Health Curriculum (HC) alone; and (4) a school-as-usual control group (SC). Seventy-six schools were randomized (19 per condition) and 74 local women with a tenth grade education were trained and monitored to facilitate the program. Quantitative data were collected from 3,560 girls over 4 assessment points with very low rates of participant attrition. Qualitative assessments were conducted with a subset of 99 girls and 27 facilitators. In this article, we discuss guiding principles that facilitated trial implementation, including integrating diverse local and non-local sources of knowledge, focusing on flexibility of planning and implementation, prioritizing systematic measurement selection, and striking a balance between scientific rigor and real-world feasibility. Clinicaltrials.gov NCT02429661 . Registered 24 April 2015.

Importin-7 Mediates Nuclear Trafficking of DNA in Mammalian Cells

PubMed Central

Dhanoya, Arjun; Wang, Tse; Keshavarz-Moore, Eli; Fassati, Ariberto; Chain, Benjamin M

2013-01-01

Eukaryotic cells have the ability to uptake and transport endogenous and exogenous DNA in their nuclei, however little is known about the specific pathways involved. Here we show that the nuclear transport receptor importin 7 (imp7) supports nuclear import of supercoiled plasmid DNA and human mitochondrial DNA in a Ran and energy-dependent way. The imp7-dependent pathway was specifically competed by excess DNA but not by excess of maltose-binding protein fused with the classical nuclear localizing signal (NLS) or the M9 peptides. Transport of DNA molecules complexed with poly-l-lysine was impaired in intact cells depleted of imp7, and DNA complexes remained localized in the cytoplasm. Poor DNA nuclear import in cells depleted of imp7 directly correlated with lower gene expression levels in these cells compared to controls. Inefficient nuclear import of transfected DNA induced greater upregulation of the interferon pathway, suggesting that rapid DNA nuclear import may prevent uncontrolled activation of the innate immune response. Our results provide evidence that imp7 is a non-redundant component of an intrinsic pathway in mammalian cells for efficient accumulation of exogenous and endogenous DNA in the nucleus, which may be critical for the exchange of genetic information between mitochondria and nuclear genomes and to control activation of the innate immune response. PMID:23067392

Current and emerging treatments for brain metastases.

PubMed

Lin, Jenny; Jandial, Rahul; Nesbit, Amanda; Badie, Behnam; Chen, Mike

2015-04-01

Brain metastasis in patients with cancer can be indicative of multisystem spread or lead to neurological demise if not locally controlled, and is associated with poor survival and high morbidity. Compared with metastasis to other areas of the body, brain metastasis possesses a unique biology that confers high resistance to systemic therapies. This phenomenon has been historically attributed to the inability of chemotherapeutic agents to pass through the blood-brain barrier. Recent studies challenge this premise, revealing other potentially targetable mechanism(s). Therapies that exploit recent advances in the understanding of brain metastasis are still in early stages of development. Encouragingly, and discovered by happenstance, some molecularly targeted drugs already appear to have efficacy against certain tumors and accompanying cerebral edema. In the meantime, conventional treatment modalities such as surgery and radiation have iteratively reached new levels of refinement. However, these achievements are somewhat muted by the emergence of magnetic resonance (MR)-guided laser interstitial thermal therapy, a minimally invasive neuroablative technique. On the horizon, MR-guided focused ultrasound surgery is similarly intriguing. Even in the absence of further advances, local control is frequently achieved with state-of-the-art therapies. Dramatic improvements will likely require sophisticated approaches that account for the particular effects of the microenvironment of the central nervous system on metastasis.

Tough Composite Hydrogels with High Loading and Local Release of Biological Drugs.

PubMed

Li, Jianyu; Weber, Eckhard; Guth-Gundel, Sabine; Schuleit, Michael; Kuttler, Andreas; Halleux, Christine; Accart, Nathalie; Doelemeyer, Arno; Basler, Anne; Tigani, Bruno; Wuersch, Kuno; Fornaro, Mara; Kneissel, Michaela; Stafford, Alexander; Freedman, Benjamin R; Mooney, David J

2018-05-01

Hydrogels are under active development for controlled drug delivery, but their clinical translation is limited by low drug loading capacity, deficiencies in mechanical toughness and storage stability, and poor control over the drug release that often results in burst release and short release duration. This work reports a design of composite clay hydrogels, which simultaneously achieve a spectrum of mechanical, storage, and drug loading/releasing properties to address the critical needs from translational perspectives. The clay nanoparticles provide large surface areas to adsorb biological drugs, and assemble into microparticles that are physically trapped within and toughen hydrogel networks. The composite hydrogels demonstrate feasibility of storage, and extended release of large quantities of an insulin-like growth factor-1 mimetic protein (8 mg mL -1 ) over four weeks. The release rate is primarily governed by ionic exchange and can be upregulated by low pH, which is typical for injured tissues. A rodent model of Achilles tendon injury is used to demonstrate that the composite hydrogels allow for highly extended and localized release of biological drugs in vivo, while demonstrating biodegradation and biocompatibility. These attributes make the composite hydrogel a promising system for drug delivery and regenerative medicine. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A case-cohort study of recurrent salivary adenoid cystic carcinoma after iodine 125 brachytherapy and resection treatment.

PubMed

Li, Bin-bin; Xie, Xiao-Yan; Jia, Sheng-Nan

2015-02-01

Recurrent adenoid cystic carcinoma (rAdCC) can be challenging to be treated with brachytherapy, although brachytherapy is safe and effective in treating head and neck cancers. Patients of adenoid cystic carcinoma (AdCC), who underwent resection and iodine 125 ((125)I) radioactive seed implantation, were recruited for this study. Clinical data, surgical details of resection and seed implantation, histologic characteristics, and prognosis were studied. There were 16 rAdCC cases among 140 cases of AdCC treated with brachytherapy and resection. The mean follow-up duration for the recurrent cases was 61 months. The 3-year local control rate of rAdCC was 51.6%, and the overall disease-specific survival rate was 49.4%. Eight patients showed distant metastasis (50%, 8/16). The histologic grades of 10 rAdCCs were upgraded (62.5%, 10/16).Two cases displayed sarcomatous transformation after brachytherapy (1.4%, 2/140). Although the overall local control rate and survival rate were relatively favorable, some rAdCCs with an aggressive phenotype appeared to respond poorly to (125)I seed implantation. Preventive adjuvant chemotherapy should be prescribed for these rAdCCs. Copyright © 2014 Elsevier Inc. All rights reserved.

Interference control in working memory: comparing groups of children with atypical development.

PubMed

Palladino, Paola; Ferrari, Marcella

2013-01-01

The study aimed to test whether working memory deficits in children at risk of Learning Disabilities (LD) and/or attention deficit/hyperactivity disorder (ADHD) can be attributed to deficits in interference control, thereby implicating prefrontal systems. Two groups of children known for showing poor working memory (i.e., children with poor comprehension and children with ADHD) were compared to a group of children with specific reading decoding problems (i.e., having severe problems in phonological rather than working memory) and to a control group. All children were tested with a verbal working memory task. Interference control of irrelevant items was examined by a lexical decision task presented immediately after the final recall in about half the trials, selected at random. The interference control measure was therefore directly related to working memory performance. Results confirmed deficient working memory performance in poor comprehenders and children at risk of ADHD + LD. More interestingly, this working memory deficit was associated with greater activation of irrelevant information than in the control group. Poor decoders showed more efficient interference control, in contrast to poor comprehenders and ADHD + LD children. These results indicated that interfering items were still highly accessible to working memory in children who fail the working memory task. In turn, these findings strengthen and clarify the role of interference control, one of the most critical prefrontal functions, in working memory.

Local administration of mangiferin prevents experimental inflammatory mechanical hyperalgesia through CINC-1/epinephrine/PKA pathway and TNF-α inhibition.

PubMed

Rocha, Lilian Wünsch; Bonet, Ivan José Magayewski; Tambeli, Claudia Herrera; de-Faria, Felipe Meira; Parada, Carlos Amilcar

2018-07-05

Steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to control inflammatory pain, but there is a risk of gastrointestinal bleeding and increased heart failure risk. The search for new drugs remains ongoing, and natural products are a source for potential new compounds. Mangiferin, a natural xanthone C-glucoside, has demonstrated biological activity, including anti-inflammatory and analgesic properties, but it's mechanisms are poorly understood. In this study, we investigated the mechanisms underlying the anti-inflammatory and analgesic effects of local administration of mangiferin. We employed an electronic von Frey apparatus to evaluate mechanical hyperalgesia induced by carrageenan in rats. Mangiferin (150-1200 µg/paw), administered locally into the hindpaw, prevented hyperalgesia in a dose-dependent - 150 µg (- 9%), 300 µg (- 27%, P < 0.01), 600 µg (- 77%, P < 0.001) and 1000 µg (- 93%, P < 0.001) - and local manner. Mangiferin showed decreased levels of TNF-α (P < 0.001) and CINC-1 (P < 0.001), but not IL-1β; it also prevented neutrophil migration (P < 0.01), but not the increased COX-2 expression in peripheral tissue challenged with carrageenan. To further explore the mechanisms of mangiferin actions, rats were injected with modulators of inflammation and nociception; mangiferin prevented hyperalgesia induced by IL-1β (P < 0.01), CINC-1 (P < 0.01), epinephrine (P < 0.01), 8-Br-cAMP (P < 0.01) or capsaicin (P < 0.01), but not that induced by PGE 2 or α,β-MeATP. Our study shows that mangiferin has anti-inflammatory and analgesic properties when locally administrated. The control of the inflammatory response and mechanical hyperalgesia by mangiferin depends on the inhibition of TNF-α production/release and the CINC1/epinephrine/PKA pathway, supporting its marked inhibition of inflammatory mechanical hyperalgesia. Copyright © 2018 Elsevier B.V. All rights reserved.

Lithologic Controls on Structure Highlight the Role of Fluids in Failure of a Franciscan Complex Accretionary Prism Thrust Fault

NASA Astrophysics Data System (ADS)

Bartram, H.; Tobin, H. J.; Goodwin, L. B.

2015-12-01

Plate-bounding subduction zone thrust systems are the source of major earthquakes and tsunamis, but their mechanics and internal structure remain poorly understood and relatively little-studied compared to faults in continental crust. Exposures in exhumed accretionary wedges present an opportunity to study seismogenic subduction thrusts in detail. In the Marin Headlands, a series of thrusts imbricates mechanically distinct lithologic units of the Mesozoic Franciscan Complex including pillow basalt, radiolarian chert, black mudstone, and turbidites. We examine variations in distribution and character of structure and vein occurrence in two exposures of the Rodeo Cove thrust, a fossil plate boundary exposed in the Marin Headlands. We observe a lithologic control on the degree and nature of fault localization. At Black Sand Beach, deformation is localized in broad fault cores of sheared black mudstone. Altered basalts, thrust over greywacke, mudstone, and chert, retain their coherence and pillow structures. Veins are only locally present. In contrast, mudstone is virtually absent from the exposure 2 km away at Rodeo Beach. At this location, deformation is concentrated in the altered basalts, which display evidence of extensive vein-rock interaction. Altered basalts exhibit a pervasive foliation, which is locally disrupted by both foliation-parallel and cross-cutting carbonate-filled veins and carbonate cemented breccia. Veins are voluminous (~50%) at this location. All the structures are cut by anastomosing brittle shear zones of foliated cataclasite or gouge. Analyses of vein chemistry will allow us to compare the sources of fluids that precipitated the common vein sets at Rodeo Beach to the locally developed veins at Black Sand Beach. These observations lead us to hypothesize that in the absence of a mechanically weak lithology, elevated pore fluid pressure is required for shear failure. If so, the vein-rich altered basalt at Rodeo Beach may record failure of an igneous basement asperity.

Differential acute and chronic effects of burn trauma on murine skeletal muscle bioenergetics

PubMed Central

Porter, Craig; Herndon, David N.; Bhattarai, Nisha; Ogunbileje, John O.; Szczesny, Bartosz; Szabo, Csaba; Toliver-Kinsky, Tracy; Sidossis, Labros S.

2015-01-01

Altered skeletal muscle mitochondrial function contributes to the pathophysiological stress response to burns. However, the acute and chronic impact of burn trauma on skeletal muscle bioenergetics remains poorly understood. Here, we determined the temporal relationship between burn trauma and mitochondrial function in murine skeletal muscle local to and distal from burn wounds. Male BALB/c mice (8–10 weeks old) were burned by submersion of the dorsum in water (~95°C) to create a full thickness burn on ~30% of the body. Skeletal muscle was harvested from spinotrapezius underneath burn wounds (local) and the quadriceps (distal) of sham and burn treated mice at 3h, 24h, 4d and 10d post-injury. Mitochondrial respiration was determined in permeabilized myofiber bundles by high-resolution respirometry. Caspase 9 and caspase 3 protein concentration were determined by western blot. In muscle local to burn wounds, respiration coupled to ATP production was significantly diminished at 3h and 24h post-injury (P<0.001), as was mitochondrial coupling control (P<0.001). There was a 5- (P<0.05) and 8-fold (P<0.001) increase in respiration in response to cytochrome at 3h and 24h post burn, indicating damage to the outer mitochondrial membranes. Moreover, we also observed greater active caspase 9 and caspase 3 in muscle local to burn wounds, indicating the induction of apoptosis. Distal muscle mitochondrial function was unaltered by burn trauma until 10d post burn, where both respiratory capacity (P<0.05) and coupling control (P<0.05) was significantly lower than sham. These data highlight a differential response in muscle mitochondrial function to burn trauma, where the timing, degree and mode of dysfunction are dependent on whether the muscle is local or distal to the burn wound. PMID:26615714

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pan, Hubert Y.; Morani, Ajaykumar; Wang, Wei-Lien

2015-06-01

Purpose: To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma who underwent chemotherapy and R0 resection without radiation therapy (RT). Methods and Materials: We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of Ewing sarcoma. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. Results: A total of 66more » patients (median age 19 years, range 4-55 years) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73%, and at least partial response by Response Evaluation Criteria in Solid Tumors was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤95%) was an independent predictor of LC (hazard ratio [HR] 6.8, P=.004), PFS (HR 5.2, P=.008), and OS (HR 5.0, P=.008). Metastasis on presentation was also an independent predictor of LC (HR 6.3, P=.011), PFS (HR 6.8, P=.002), and OS (HR 6.7, P=.002). Radiologic partial response was a predictor of PFS (HR 0.26, P=.012), and postchemotherapy tumor volume was associated with OS (HR 1.06, P=.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor postrecurrence survival were time to recurrence <1 year (HR 11.5, P=.002) and simultaneous local and distant relapse (HR 16.8, P=.001). Conclusions: Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant radiation therapy for patients who have poor histologic response after R0 resection.« less

An Integrated WRF-CAMx Modeling Approach for Impact Analysis of Implementing the Emergency PM2.5 Control Measures during Red Alerts in Beijing in December 2015

NASA Astrophysics Data System (ADS)

Jia, J.; Cheng, S.; Lei, L.; Lang, J.

2017-12-01

In December 2015, the Beijing-Tianjin-Hebei (BTH) region experienced several episodes of heavy air pollution. Beijing municipal government therefore issued 2 red alerts on December 7 and 19, respectively, and also implemented emergency control measures to alleviate the negative effects of pollution. It is estimated that the heavy pollutions in 2 red alert periods in Beijing were due mainly to the accumulation of air pollutants from local emission sources and the transboundary transport of pollutants from surrounding areas. The collected meteorological and PM2.5 data indicate that the severity of air pollutions were enlarged by the poor meteorological conditions along with lower mixing layer height. In this study, the WRF-CAMx modeling system was utilized not only for analyzing the contributions of PM2.5 from different sources, but also for quantitatively assessing the effects of implementing various emergency control measures on PM2.5 pollution control during the red alert periods. The modeling results show that local emissions were the most dominant contributors (64.8%-83.5%) among all emission sources, while the main external contributions came from the city of Baoding (3.4%-9.3%). In addition, among 5 different emission source categories, coal and traffic were the two dominant contributors to PM2.5 concentration in urban area of Beijing. Then four pollution control scenarios were designed particularly to investigate the effectiveness of the emergency control measures, and the results show that, generally these emergency control measures have positive effects on air pollution reduction. In particular, restrictive measures of traffic volume control and industrial activity shutdown/suspension have been found as the most effective measures in comparison to other emergency control measures. It is recommended that such effective measures should be considered to implement when next time similar heavy air pollutions occur in the city of Beijing.

Cytosolic proteins can exploit membrane localization to trigger functional assembly

PubMed Central

2018-01-01

Cell division, endocytosis, and viral budding would not function without the localization and assembly of protein complexes on membranes. What is poorly appreciated, however, is that by localizing to membranes, proteins search in a reduced space that effectively drives up concentration. Here we derive an accurate and practical analytical theory to quantify the significance of this dimensionality reduction in regulating protein assembly on membranes. We define a simple metric, an effective equilibrium constant, that allows for quantitative comparison of protein-protein interactions with and without membrane present. To test the importance of membrane localization for driving protein assembly, we collected the protein-protein and protein-lipid affinities, protein and lipid concentrations, and volume-to-surface-area ratios for 46 interactions between 37 membrane-targeting proteins in human and yeast cells. We find that many of the protein-protein interactions between pairs of proteins involved in clathrin-mediated endocytosis in human and yeast cells can experience enormous increases in effective protein-protein affinity (10–1000 fold) due to membrane localization. Localization of binding partners thus triggers robust protein complexation, suggesting that it can play an important role in controlling the timing of endocytic protein coat formation. Our analysis shows that several other proteins involved in membrane remodeling at various organelles have similar potential to exploit localization. The theory highlights the master role of phosphoinositide lipid concentration, the volume-to-surface-area ratio, and the ratio of 3D to 2D equilibrium constants in triggering (or preventing) constitutive assembly on membranes. Our simple model provides a novel quantitative framework for interpreting or designing in vitro experiments of protein complexation influenced by membrane binding. PMID:29505559

Role of Private Enterprise in Cancer Control in Low to Middle Income Countries

PubMed Central

Mahoney, Martin; Okoye, Ifeoma; Ejiogu, Kenneth; George, Saby; Dy, Grace; Jimoh, Mutiu; Salako, Omolola; Ilegbune, Oge; Chugani, Bindiya; Ezeome, Emmanuel; Popoola, Abiodun O.; Michalek, Arthur M.

2016-01-01

Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) where prioritization and allocation of resources to cancer care are often quite poor. In the absence of governmental focus on this problem, public-private partnerships may be an avenue to provide effective cancer control. Methods. This manuscript highlights the establishment of a nongovernmental organization (NGO) to stimulate the development of partnerships between oncology professionals, private enterprise, and academic institutions, both locally and internationally. Examples of capacity building, grant support, establishment of collaborative networks, and the development of a facility to provide clinical care are highlighted. Results. Collaborations were established between oncology professionals at academic institutions in the US and Nigeria. Cancer control workshops were conducted in Nigeria with grant support from the Union for International Cancer Control (UICC). A monthly tumor board conference was established at LASUTH in Lagos, and further capacity building is underway with grant support from the United States NCI. An outpatient, privately funded oncology clinic in Lagos has been launched. Conclusion. In LMICs, effective partnership between public and private institutions can lead to tangible strides in cancer control. The use of creative healthcare financing models can also support positive change. PMID:28070189

Capability of insulator study by photoemission electron microscopy at SPring-8.

PubMed

Ohkochi, Takuo; Kotsugi, Masato; Yamada, Keisuke; Kawano, Kenji; Horiba, Koji; Kitajima, Fumio; Oura, Masaki; Shiraki, Susumu; Hitosugi, Taro; Oshima, Masaharu; Ono, Teruo; Kinoshita, Toyohiko; Muro, Takayuki; Watanabe, Yoshio

2013-07-01

The observation method of photoemission electron microscopy (PEEM) on insulating samples has been established in an extremely simple way. Surface conductivity is induced locally on an insulating surface by continuous radiation of soft X-rays, and Au films close to the area of interest allow the accumulated charges on the insulated area to be released to ground level. Magnetic domain observations of a NiZn ferrite, local X-ray absorption spectroscopy of sapphire, high-resolution imaging of a poorly conducting Li0.9CoO2 film surface, and Au pattern evaporation on a fine rock particle are demonstrated. Using this technique, all users' experiments on poorly conducting samples have been performed successfully at the PEEM experimental station of SPring-8.

Multisystemic Therapy for Adolescents with Poorly Controlled Type I Diabetes: Stability of Treatment Effects in a Randomized Controlled Trial

ERIC Educational Resources Information Center

Ellis, Deborah A.; Templin, Thomas; Naar-King, Sylvie; Frey, Maureen A.; Cunningham, Phillippe B.; Podolski, Cheryl-Lynn; Cakan, Nedim

2007-01-01

The primary purpose of the present study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of…

The Impact of Michigan's Finance Reform on Three Poor School Districts.

ERIC Educational Resources Information Center

Sielke, Catherine C.

In 1994, Michigan voters amended the state constitution to reduce schools' reliance on local property taxes for financial support. School districts were also divided into three funding tiers that were determined by their 1993-94 state and local revenues. This paper presents findings of a study that examined the impact of Michigan's finance reform…

Localized blastomycosis-like pyoderma with good response to cotrimoxazol and cryotherapy.

PubMed

Su, Ozlem; Demirkesen, Cuyan; Onsun, Nahide

2004-05-01

Blastomycosis-like pyoderma is an unusual, exaggerated, vegetative-tissue reaction to a prolonged primary or secondary bacterial infection. It is a rare disease, usually seen in immunocompromized patients. We report a case of localized blastomycosis-like pyoderma responding poorly to classic treatments, but that gave a dramatic response to a combination treatment of cotrimoxazol and cryotherapy.

40 CFR 280.104 - Local government bond rating test.

Code of Federal Regulations, 2010 CFR

2010-07-01

... million or more, excluding refunded obligations, with a Moody's rating of Aaa, Aa, A, or Baa, or a Standard & Poor's rating of AAA, AA, A, or BBB. Where a local government has multiple outstanding issues... bonds of $1 million or more, excluding refunded issues and by also having a Moody's rating of Aaa, A, A...

Impact of the Digital Divide on Computer Use and Internet Access on the Poor in Nigeria

ERIC Educational Resources Information Center

Tayo, Omolara; Thompson, Randall; Thompson, Elizabeth

2016-01-01

We recruited 20 community members in Ido Local Government Area, Oyo state and Yewa Local Government Area, Ogun state in Nigeria to explore experiences and perceptions of Internet access and computer use. Face-to-face interviews were conducted using open-ended questions to collect qualitative data regarding accessibility of information and…

Evaluation of glycemic control in patients with type 2 diabetes mellitus in Chinese communities: a cross-sectional study.

PubMed

Shan, Shan; Gu, Liubao; Lou, Qinglin; Ouyang, Xiaojun; Yu, Yun; Wu, Haidi; Bian, Rongwen

2017-02-01

This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c < 7 %. Multivariate analysis showed that male sex (OR 1.345, 95 % CI 1.022-1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778-2.147; P < 0.001), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020-1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P < 0.05). Compared to diet and exercise, insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054-9.514; P < 0.001). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.

Partnerships and communities in English drug policy: the challenge of deprivation.

PubMed

Macgregor, Susanne; Thickett, Anthony

2011-11-01

From the mid-1990s, UK governments developed partnerships to tackle drugs nationally and locally. Over time, increased resources focused on communities and localities in greatest need. This reflected growing awareness of the concentration of problems in deprived areas, with social and spatial segregation being a feature of post-industrial urban areas. A review of English drug policy since the 1990s, drawing on:- analysis of documents; a review of sociological studies; an illustrative case-study of one northern town; interviews with local policy players; statistical analysis of key indicators with some of these data presented using Geographical Information System (GIS) mapping. In-depth sociological studies demonstrate interconnections between historical patterns, socio-economic change, cultural complexity, deprivation, limited opportunities and illicit drugs. At local level, there are links between concentrated multiple deprivation, poor health, acquisitive crime and problematic drug use. Partnership policies, encouraged by the provision of ring-fenced funds, have been effective in containing problems. Underlying issues of inequality are however neglected in political debates. The article argues that post-industrial towns and cities are characterised by an increase in problems related to poverty and drugs. Both the real shape and perceptions of what is the problem change over time. In England, the profile of the problem drug user was described in a number of sociological studies conducted from the 1980s onwards. Key features were the concentration of problems in certain social groups (such as the poorly educated or unemployed) and in certain areas (inner cities or outer estates). Responding to rising public concern, national drug strategies developed and the New Labour Government after 1997 prioritised the issue of drugs, directing increased resources to drug treatment with tight control over the use of these new monies through target setting and measurement of performance. The emphasis was on the most dangerous drugs and most disadvantaged areas. There is local variation in the pattern of problems and in implementation of national policies. In UK after 1997, New Labour policy aimed to promote a fair and cost-effective distribution of resources and improved availability and quality of treatment services and local policing. Tensions appeared between the drive to meet national targets and local perceptions of need. Ideas of localism, promoting market solutions and flexibility in provision, are now gaining ground in English social policy with the arrival of a Coalition (Conservative/Liberal Democrat) Government. These, together with an emphasis on abstinence and recovery, raise questions about the future adequacy of (a) attention to marginalised problems and stigmatised groups and (b) the distribution of resources in a context of severe fiscal restraint. Copyright © 2011 Elsevier B.V. All rights reserved.

An examination of Eyal & Hurst’s (2008) framework for promoting retention in resource-poor settings through locally-relevant training: A case study for the University of Guyana Surgical Training Program

PubMed Central

Prashad, Anupa J.; Cameron, Brian H.; McConnell, Meghan; Rambaran, Madan; Grierson, Lawrence E. M.

2017-01-01

Background Eyal and Hurst proposed that locally relevant medical education can offset the prevalence of physician “brain drain” in resource-poor regions of the world, and presented a framework of the ethical and pragmatic benefits and concerns posed by these initiatives. The present study explored the framework’s utility through a case study of the University of Guyana Diploma in Surgery (UGDS) program Methods The framework’s utility was evaluated using a case study design that included review and analysis of documents and semi-structured interviews with graduates, trainees, faculty members, and policy makers associated with the UGDS program. Data were analyzed from constructivist and interpretivist perspectives, and compared against the benefits and concerns described by Eyal and Hurst. Results The framework is a useful template for capturing the breadth of experience of locally relevant training in the Guyanese setting. However, the results suggest that delineating the framework factors as either beneficial or concerning may constrict its applicability. The case study design also provided specific insights about the UGDS program, which indicate that the Program has promoted the retention of graduates and a sustainable culture of postgraduate medical education in Guyana. Conclusion It is suggested that the framework be modified so as to represent the benefits and concerns of locally relevant training along a continuum of advantage. These approaches may help us understand retention within a resource-poor country, but also within particularly remote areas and public health care systems generally. PMID:29114344

Cell- and virus-mediated regulation of the barrier-to-autointegration factor's phosphorylation state controls its DNA binding, dimerization, subcellular localization, and antipoxviral activity.

PubMed

Jamin, Augusta; Wicklund, April; Wiebe, Matthew S

2014-05-01

Barrier-to-autointegration factor (BAF) is a DNA binding protein with multiple cellular functions, including the ability to act as a potent defense against vaccinia virus infection. This antiviral function involves BAF's ability to condense double-stranded DNA and subsequently prevent viral DNA replication. In recent years, it has become increasingly evident that dynamic phosphorylation involving the vaccinia virus B1 kinase and cellular enzymes is likely a key regulator of multiple BAF functions; however, the precise mechanisms are poorly understood. Here we analyzed how phosphorylation impacts BAF's DNA binding, subcellular localization, dimerization, and antipoxviral activity through the characterization of BAF phosphomimetic and unphosphorylatable mutants. Our studies demonstrate that increased phosphorylation enhances BAF's mobilization from the nucleus to the cytosol, while dephosphorylation restricts BAF to the nucleus. Phosphorylation also impairs both BAF's dimerization and its DNA binding activity. Furthermore, our studies of BAF's antiviral activity revealed that hyperphosphorylated BAF is unable to suppress viral DNA replication or virus production. Interestingly, the unphosphorylatable BAF mutant, which is capable of binding DNA but localizes predominantly to the nucleus, was also incapable of suppressing viral replication. Thus, both DNA binding and localization are important determinants of BAF's antiviral function. Finally, our examination of how phosphatases are involved in regulating BAF revealed that PP2A dephosphorylates BAF during vaccinia infection, thus counterbalancing the activity of the B1 kinase. Altogether, these data demonstrate that phosphoregulation of BAF by viral and cellular enzymes modulates this protein at multiple molecular levels, thus determining its effectiveness as an antiviral factor and likely other functions as well. The barrier-to-autointegration factor (BAF) contributes to cellular genomic integrity in multiple ways, the best characterized of which are as a host defense against cytoplasmic DNA and as a regulator of mitotic nuclear reassembly. Although dynamic phosphorylation involving both viral and cellular enzymes is likely a key regulator of multiple BAF functions, the precise mechanisms involved are poorly understood. Here we demonstrate that phosphorylation coordinately regulates BAF's DNA binding, subcellular localization, dimerization, and antipoxviral activity. Overall, our findings provide new insights into how phosphoregulation of BAF modulates this protein at multiple levels and governs its effectiveness as an antiviral factor against foreign DNA.

Evidence that communication impairment in schizophrenia is associated with generalized poor task performance.

PubMed

Merrill, Anne M; Karcher, Nicole R; Cicero, David C; Becker, Theresa M; Docherty, Anna R; Kerns, John G

2017-03-01

People with schizophrenia exhibit wide-ranging cognitive deficits, including slower processing speed and decreased cognitive control. Disorganized speech symptoms, such as communication impairment, have been associated with poor cognitive control task performance (e.g., goal maintenance and working memory). Whether communication impairment is associated with poorer performance on a broader range of non-cognitive control measures is unclear. In the current study, people with schizophrenia (n =51) and non-psychiatric controls (n =26) completed speech interviews allowing for reliable quantitative assessment of communication impairment. Participants also completed multiple goal maintenance and working memory tasks. In addition, we also examined (a) simple measures of processing speed involving highly automatic prepotent responses and (b) a non-cognitive control measure of general task performance. Schizophrenia communication impairment was significantly associated with poor performance in all cognitive domains, with the largest association found with processing speed (r s =-0.52). Further, communication impairment was also associated with the non-cognitive control measure of poor general task performance (r s =-0.43). In contrast, alogia, a negative speech symptom, and positive symptoms were less if at all related to cognitive task performance. Overall, this study suggests that communication impairment in schizophrenia may be associated with relatively generalized poor cognitive task performance. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

A reinforcement sensitivity model of affective and behavioral dysregulation in marijuana use and associated problems.

PubMed

Emery, Noah N; Simons, Jeffrey S

2017-08-01

This study tested a model linking sensitivity to punishment (SP) and reward (SR) to marijuana use and problems via affect lability and poor control. A 6-month prospective design was used in a sample of 2,270 young-adults (64% female). The hypothesized SP × SR interaction did not predict affect lability or poor control, but did predict use likelihood at baseline. At low levels of SR, SP was associated with an increased likelihood of abstaining, which was attenuated as SR increased. SP and SR displayed positive main effects on both affect lability and poor control. Affect lability and poor control, in turn, mediated effects on the marijuana outcomes. Poor control predicted both increased marijuana use and, controlling for use level, greater intensity of problems. Affect lability predicted greater intensity of problems, but was not associated with use level. There were few prospective effects. SR consistently predicted greater marijuana use and problems. SP however, exhibited both risk and protective pathways. Results indicate that SP is associated with a decreased likelihood of marijuana use. However, once use is initiated SP is associated with increased risk of problems, in part, due to its effects on both affect and behavioral dysregulation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children.

PubMed

Jochmann, Anja; Artusio, Luca; Jamalzadeh, Angela; Nagakumar, Prasad; Delgado-Eckert, Edgar; Saglani, Sejal; Bush, Andrew; Frey, Urs; Fleming, Louise J

2017-12-01

International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic. Copyright ©ERS 2017.

Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study.

PubMed

Ajayi, Ikeoluwapo O; Jegede, Ayodele S; Falade, Catherine O; Sommerfeld, Johannes

2013-10-24

Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities. This study's findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.

Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management.

PubMed

Braunstein, Lior Z; Galland-Girodet, Sigolene; Goldberg, Saveli; Warren, Laura E G; Sadek, Betro T; Shenouda, Mina N; Abi-Raad, Rita F; MacDonald, Shannon M; Taghian, Alphonse G

2015-12-01

Extensive lymph node (LN) involvement portends significant risk for distant metastasis (DM) among breast cancer patients. As a result, local management may be of secondary import to systemic control in this population. We analyzed patients with ≥10 involved LNs (N3) to evaluate the feasibility of breast conserving therapy (BCT) vs modified radical mastectomy (MRM) in this high-risk cohort. Among 98 women with N3 disease 46 (46.9%) underwent BCT and 52 (53.1%) received MRM. Nearly all patients (92%) received comprehensive radiotherapy (RT) including axillary and supraclavicular fields. The Kaplan-Meier method and Cox regression analyses were used to analyze time-to-event outcomes. Median follow-up was 76 months, with a 5-year DFS of 64.9% and OS of 71.9% among the cohort. Poorly differentiated (p = 0.007), ER-negative tumors (p = 0.015) had adverse DFS outcomes. Treatment groups did not differ with regard to 10-year DFS (45.4% for MRM vs. 57.6% for BCT; p = 0.31), or OS (61.4 vs. 63.7%; p = 0.79). DM-free survival was 48.9% following MRM and 60.6% following BCT (p = 0.19). Patients with ≥10 involved LNs have similar outcomes following BCT or MRM, suggesting that RT may obviate the need for more-extensive surgery. While local control is comparably favorable regardless of surgical approach, systemic control remains a challenge in this population.

Evaluation of larvicides in developing management guidelines for long-term control of pest blackflies (Diptera: Simuliidae) along the Orange River, South Africa.

PubMed

Palmer, R W; Rivers-Moore, N A

2008-12-01

In 2000 and 2001 Orange River levels were higher than normal: associated serious outbreaks of blackfly had a substantial detrimental impact on the local economy. The poor control was attributed to the suspected development of larval resistance to temephos. A long-term solution to blackfly control, through the identification of a suitable replacement to temephos for use during high flow conditions, was proposed. This study, however, failed to identify or register a suitable larvicide for use during high flow conditions. Although permethrin was highly effective against blackfly larvae, it was rejected because of its detrimental impacts on non-target fauna. Various formulations of locally produced dry Bacillus thuringiensis var. israelensis (B.t.i.) were tested, but these were ineffective against blackflies. The study also confirmed that resistance to temephos has developed among Simulium chutteri in the middle and lower Orange River. The feasibility of "reversing" the resistance to temephos through the use of the synergist piperonyl butoxide (PBO) was investigated, but the results were not favourable. Furthermore, PBO was highly toxic to blackflies and non-target organisms, and was not recommended for further testing. This means that B.t.i. currently remains the only symptomatic measure of treatment currently applied. Although resistance to B.t.i. has not been reported for blackflies elsewhere in South Africa, there is a need to remain vigilant and to implement an operational strategy that minimizes the risks of resistance developing.

Improving the Reading of Bisyllabic Words That Involve Context-Sensitive Spelling Rules: Focus on Successes or on Failures?

ERIC Educational Resources Information Center

Steenbeek-Planting, Esther G.; van Bon, Wim H. J.; Schreuder, Robert

2013-01-01

The effect of two training procedures on the improvement of reading accuracy in poor readers was examined in relation to their initial reading level. A randomized controlled trial was conducted with 60 poor readers. Poor readers were assigned to a control group that received no training, or one of two training conditions. One training concentrated…

Stressful working conditions and poor self-rated health among financial services employees.

PubMed

Silva, Luiz Sérgio; Barreto, Sandhi Maria

2012-06-01

To assess the association between exposure to adverse psychosocial working conditions and poor self-rated health among bank employees. A cross-sectional study including a sample of 2,054 employees of a government bank was conducted in 2008. Self-rated health was assessed by a single question: "In general, would you say your health is (...)." Exposure to adverse psychosocial working conditions was evaluated by the effort-reward imbalance model and the demand-control model. Information on other independent variables was obtained through a self-administered semi-structured questionnaire. A multiple logistic regression analysis was performed and odds ratio calculated to assess independent associations between adverse psychosocial working conditions and poor self-rated health. The overall prevalence of poor self-rated health was 9%, with no significant gender difference. Exposure to high demand and low control environment at work was associated with poor self-rated health. Employees with high effort-reward imbalance and overcommitment also reported poor self-rated health, with a dose-response relationship. Social support at work was inversely related to poor self-rated health, with a dose-response relationship. Exposure to adverse psychosocial work factors assessed based on the effort-reward imbalance model and the demand-control model is independently associated with poor self-rated health among the workers studied.

Rationale and design of the ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic trial.

PubMed

Lauffenburger, Julie C; Lewey, Jennifer; Jan, Saira; Nanchanatt, Gina; Makanji, Sagar; Ferro, Christina A; Sheehan, John; Wittbrodt, Eric; Morawski, Kyle; Lee, Jessica; Ghazinouri, Roya; Choudhry, Niteesh K

2017-08-01

Poor glycemic control among patients with diabetes may stem from poor medication and lifestyle adherence or a failure to appropriately intensify therapy. A patient-centered approach could discern the most likely possibility and would then, as appropriate, address patient barriers to non-adherence (using behavioral interviewing methods such as motivational interviewing) or help facilitate choices among treatment augmentation options (using methods such as shared decision-making). To test the impact of a novel telephone-based patient-centered intervention on glycemic control for patients with poorly-controlled diabetes. ENGAGE-DM (ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus) is a pragmatic trial of patients with poorly-controlled diabetes receiving treatment with an oral hypoglycemic agent. We randomized 1400 patients in a large health insurer to intervention or usual care. The intervention is delivered over the telephone by a pharmacist and consists of a 2-step process that integrates brief negotiated interviewing and shared decision-making to identify patient-concordant goals and options for enhancing patients' diabetes management. The trial's primary outcome is disease control, assessed using glycosylated hemoglobin values. Secondary outcomes include medication adherence measures, assessed using pharmacy claims data. This trial will determine whether a novel highly-scalable patient engagement strategy improves disease control and adherence to medications among individuals with poorly-controlled diabetes. Copyright © 2017. Published by Elsevier Inc.

Isolated (localized) idiopathic granulomatous (giant cell) vasculitis in an intramuscular lipoma.

PubMed

Fernando Val-Bernal, J; Val, Daniel; Calvo, Ignacio; Francisca Garijo, M

2006-01-01

Isolated (localized) idiopathic granulomatous vasculitis (IGV) is an uncommon, heterogeneous, and poorly defined group of disorders characterized by infiltration of the arterial wall caused by compactly grouped mononuclear phagocytes, with or without giant cells, in segmental distribution. We report on a 55-year-old woman with IGV limited to an intramuscular lipoma of the left thigh. The vasculitis was identified incidentally upon microscopic examination of the removed tumor. The IGV was centered on two medium-sized arteries, accompanied by narrowing of the lumens, and not associated with secondary changes such as infart or postinfart fibrosis. The inflammatory infiltrate was rich in T-lymphocytes and macrophages, with the presence of giant cells. The patient was asymptomatic and well in a follow-up period of 2 months, during which she was not treated. To our knowledge, this is the first report of lipoma involvement in localized IGV. It is important to distinguish cases of isolated intratumorous IGV from systemic disease, because the latter implies a poor prognosis and requires an aggressive treatment.

Relationship of number of seizures recorded on video-EEG to surgical outcome in refractory medial temporal lobe epilepsy

PubMed Central

Sainju, Rup Kamal; Wolf, Bethany Jacobs; Bonilha, Leonardo; Martz, Gabriel

2014-01-01

Introduction Surgical planning for refractory medial temporal lobe epilepsy (rMTLE) relies on seizure localization by ictal electroencephalography (EEG). Multiple factors impact the number of seizures recorded. We evaluated whether seizure freedom correlated to the number of seizures recorded, and the related factors. Methods We collected data for 32 patients with rMTLE who underwent anterior temporal lobectomy. Primary analysis evaluated number of seizures captured as a predictor of surgical outcome. Subsequent analyses explored factors that may seizure number. Results Number of seizures recorded did not predict seizure freedom. More seizures were recorded with more days of seizure occurrence (p<0.001), seizure clusters (p≤0.011) and poorly localized seizures (PLSz) (p=0.004). Regression modeling showed a trend for subjects with fewer recorded poorly localized seizures to have better surgical outcome (p=0.052). Conclusions Total number of recorded seizures does not predict surgical outcome. Patients with more PLSz may have worse outcome. PMID:22990726

Health-related quality of life among adults 65 years and older in the United States, 2011-2012: a multilevel small area estimation approach.

PubMed

Lin, Yu-Hsiu; McLain, Alexander C; Probst, Janice C; Bennett, Kevin J; Qureshi, Zaina P; Eberth, Jan M

2017-01-01

The purpose of this study was to develop county-level estimates of poor health-related quality of life (HRQOL) among aged 65 years and older U.S. adults and to identify spatial clusters of poor HRQOL using a multilevel, poststratification approach. Multilevel, random-intercept models were fit to HRQOL data (two domains: physical health and mental health) from the 2011-2012 Behavioral Risk Factor Surveillance System. Using a poststratification, small area estimation approach, we generated county-level probabilities of having poor HRQOL for each domain in U.S. adults aged 65 and older, and validated our model-based estimates against state and county direct estimates. County-level estimates of poor HRQOL in the United States ranged from 18.07% to 44.81% for physical health and 14.77% to 37.86% for mental health. Correlations between model-based and direct estimates were higher for physical than mental HRQOL. Counties located in the Arkansas, Kentucky, and Mississippi exhibited the worst physical HRQOL scores, but this pattern did not hold for mental HRQOL, which had the highest probability of mentally unhealthy days in Illinois, Indiana, and Vermont. Substantial geographic variation in physical and mental HRQOL scores exists among older U.S. adults. State and local policy makers should consider these local conditions in targeting interventions and policies to counties with high levels of poor HRQOL scores. Copyright © 2016 Elsevier Inc. All rights reserved.

The Molecular Biology of Adenoid Cystic Carcinoma

PubMed Central

Liu, Jia; Shao, Chunbo; Tan, Marietta L.; Mu, David; Ferris, Robert L.; Ha, Patrick K.

2011-01-01

Background Adenoid cystic carcinoma (ACC) is an unusual salivary gland malignancy that remains poorly understood. Standard treatment, including surgery with postoperative radiation therapy have attained reasonable local control rates, but the propensity for distant metastases has limited any improvement in survival over time. Our understanding of the molecular mechanisms driving adenoid cystic carcinoma is quite rudimentary, due to the infrequent nature of its occurrence. Methods An extensive literature review was performed on salivary gland adenoid cystic carcinoma and basic science research findings. Results This review highlights many findings that are emerging about the carcinogenesis of ACC including cytogenetics, tumor suppressor genes, oncogenes, epigenetic alterations, mitochondrial alterations, and biomarker studies. Conclusions While there have been many discoveries, much still remains unknown about this rare malignancy. PMID:22006498

Canonical and non-canonical Wnt signaling control the regeneration of amputated rodent vibrissae follicles.

PubMed

Yuan, Yan-Ping; Huang, Keng; Xu, Yan-Min; Chen, Xian-Cai; Li, Hai-Hong; Cai, Bo-Zhi; Liu, Yang; Zhang, Huan; Li, Yu; Lin, Chang-Min

2016-02-01

Although mammals are notoriously poor at regeneration compared with many lower-order species, the hair follicle, particular to mammals, is capable of regeneration following partial amputation. The detailed internal mechanism of this phenomenon is still unclear. Development and regrowth of the hair follicle depends on dermal-epidermal interaction within the hair follicle. Previous studies have shown that Wnt/β-catenin, Shh, Bmp, PDGF, TGF and Notch signals all take part in the development and growth of the hair follicle, and the Wnt/β-catenin signaling additionally plays an indispensable role in hair follicle morphogenesis and regrowth. In this study, we investigated the localization, as well as, protein levels of Wnt/β-catenin signaling molecules during amputated whisker follicle regeneration.

Work ability among Finnish workers with type 1 diabetes.

PubMed

Hakkarainen, P; Moilanen, L; Hänninen, V; Heikkinen, J; Räsänen, K

2016-08-01

Work ability represents the balance between individual resources, health status and job demands. As far as we are aware, these issues have not been examined in working people with type 1 diabetes (T1D). To examine how work-related and diabetes-related factors are associated with work ability among male and female workers. Questionnaires were mailed to a random sample of 2500 people with T1D from the Medication Reimbursement Register of The Social Insurance Institution of Finland. The associations of the predictors of poor work ability were examined in a logistic regression analysis. The final sample comprised 767 working people aged 18-64 with T1D; overall response rate 49%. One in every three working men and women with T1D had poor work ability. High job demands and low job control were associated with poor work ability in both genders. Physical work and low worktime control were significantly associated with poor work ability in men but not in women with T1D. A self-reported high value of glycosylated haemoglobin was the only diabetes-related variable associated with poor work ability in both men and women. Work-related factors and poor glycaemic control were associated with poor work ability in individuals with T1D. Thus, job control and worktime control should be taken into account in supporting the work ability of workers with T1D. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Small cell carcinoma of the prostate presenting with Cushing Syndrome. A narrative review of an uncommon condition.

PubMed

Rueda-Camino, José Antonio; Losada-Vila, Beatriz; De Ancos-Aracil, Cristina Lucía; Rodríguez-Lajusticia, Laura; Tardío, Juan Carlos; Zapatero-Gaviria, Antonio

2016-01-01

Small cell carcinoma (SCC) of the prostate is an uncommon condition; there are very few cases in which presenting symptoms are consistent with Cushing Syndrome (CS). We report a new case in which CS triggers the suspicion of an SCC of the prostate and a review of the published cases of SCC of the prostate presenting with CS. The origin of these neoplasms is still unclear. It may be suspected when laboratory features appear in patients diagnosed with prostatic adenocarcinoma which becomes resistant to specific therapy. SCC usually occurs after the 6th decade. Patients suffering SCC of the prostate presenting with CS usually present symptoms such as hypertension, hyperglycemia, alkalosis or hypokalemia; cushingoid phenotype is less frequent. Cortisol and ACTH levels are often high. Prostatic-specific antigen levels are usually normal. CT scan is the preferred imaging test to localize the lesion, but its performance may be improved by adding other tests, such as FDG-PET scan. All patients have metastatic disease at the time of diagnosis. Lymph nodes, liver and bone are the most frequent metastases sites. Surgery and Ketokonazole are the preferred treatments for CS. The prognosis is very poor: 2- and 5-year survival rates are 27.5 and 14.3%, respectively. Key messages When a patient presents with ectopic Cushing Syndrome but lungs are normal, an atypical localization should be suspected. We should suspect a prostatic origin if Cushing Syndrome is accompanied by obstructive inferior urinary tract symptoms or in the setting of a prostatic adenocarcinoma with rapid clinical and radiological progression with relatively low PSA levels. Although no imaging test is preferred to localize these tumors, FDG-PET-TC can be very useful. Hormone marker scintigraphy (e.g. somatostatin) could be used too. As Cushing Syndrome is a paraneoplastic phenomenon, treatment of the underlying disease may help control hypercortisolism manifestations. These tumors are usually metastatic by the time of diagnosis. They have very poor prognosis.

Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline

PubMed Central

Tsao, May N.; Rades, Dirk; Wirth, Andrew; Lo, Simon S.; Danielson, Brita L.; Gaspar, Laurie E.; Sperduto, Paul W.; Vogelbaum, Michael A.; Radawski, Jeffrey D.; Wang, Jian Z.; Gillin, Michael T.; Mohideen, Najeeb; Hahn, Carol A.; Chang, Eric L.

2012-01-01

Purpose To systematically review the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases. Methods and Materials Key clinical questions to be addressed in this evidence-based Guideline were identified. Fully published randomized controlled trials dealing with the management of newly diagnosed intraparenchymal brain metastases were searched systematically and reviewed. The U.S. Preventative Services Task Force levels of evidence were used to classify various options of management. Results The choice of management in patients with newly diagnosed single or multiple brain metastases depends on estimated prognosis and the aims of treatment (survival, local treated lesion control, distant brain control, neurocognitive preservation). Single brain metastasis and good prognosis (expected survival 3 months or more): For a single brain metastasis larger than 3 to 4 cm and amenable to safe complete resection, whole brain radiotherapy (WBRT) and surgery (level 1) should be considered. Another alternative is surgery and radiosurgery/radiation boost to the resection cavity (level 3). For single metastasis less than 3 to 4 cm, radiosurgery alone or WBRT and radiosurgery or WBRT and surgery (all based on level 1 evidence) should be considered. Another alternative is surgery and radiosurgery or radiation boost to the resection cavity (level 3). For single brain metastasis (less than 3 to 4 cm) that is not resectable or incompletely resected, WBRT and radiosurgery, or radiosurgery alone should be considered (level 1). For nonresectable single brain metastasis (larger than 3 to 4 cm), WBRT should be considered (level 3). Multiple brain metastases and good prognosis (expected survival 3 months or more): For selected patients with multiple brain metastases (all less than 3 to 4 cm), radiosurgery alone, WBRT and radiosurgery, or WBRT alone should be considered, based on level 1 evidence. Safe resection of a brain metastasis or metastases causing significant mass effect and postoperative WBRT may also be considered (level 3). Patients with poor prognosis (expected survival less than 3 months): Patients with either single or multiple brain metastases with poor prognosis should be considered for palliative care with or without WBRT (level 3). It should be recognized, however, that there are limitations in the ability of physicians to accurately predict patient survival. Prognostic systems such as recursive partitioning analysis, and diagnosis-specific graded prognostic assessment may be helpful. Conclusions Radiotherapeutic intervention (WBRT or radiosurgery) is associated with improved brain control. In selected patients with single brain metastasis, radiosurgery or surgery has been found to improve survival and locally treated metastasis control (compared with WBRT alone). PMID:25925626

Subcortical Local Functional Hyperconnectivity in Cannabis Dependence.

PubMed

Manza, Peter; Tomasi, Dardo; Volkow, Nora D

2018-03-01

Cannabis abuse (CA) has been associated with psychopathology, including negative emotionality and higher risk of psychosis, particularly with early age of initiation. However, the mechanisms underlying this association are poorly understood. Because aberrant dopamine signaling is implicated in cannabis-associated psychopathology, we hypothesized that regular CA would be associated with altered resting-state functional connectivity in dopamine midbrain-striatal circuits. We examined resting-state brain activity of subcortical regions in 441 young adults from the Human Connectome Project, including 30 subjects with CA meeting DSM-IV criteria for dependence and 30 control subjects matched on age, sex, education, body mass index, anxiety, depression, and alcohol and tobacco usage. Across all subjects, local functional connectivity density hubs in subcortical regions were most prominent in ventral striatum, hippocampus, amygdala, dorsal midbrain, and posterior-ventral brainstem. As hypothesized, subjects with CA showed markedly increased local functional connectivity density relative to control subjects, not only in ventral striatum (where nucleus accumbens is located) and midbrain (where substantia nigra and ventral tegmental nuclei are located) but also in brainstem and lateral thalamus. These effects were observed in the absence of significant differences in subcortical volumes and were most pronounced in individuals who began cannabis use earliest in life and who reported high levels of negative emotionality. Together, these findings suggest that chronic CA is associated with changes in resting-state brain function, particularly in dopaminergic nuclei implicated in psychosis but that are also critical for habit formation and reward processing. These results shed light on neurobiological differences that may be relevant to psychopathology associated with cannabis use. Published by Elsevier Inc.

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children.

PubMed

Root, Elisabeth Dowling; Lucero, Marilla; Nohynek, Hanna; Anthamatten, Peter; Thomas, Deborah S K; Tallo, Veronica; Tanskanen, Antti; Quiambao, Beatriz P; Puumalainen, Taneli; Lupisan, Socorro P; Ruutu, Petri; Ladesma, Erma; Williams, Gail M; Riley, Ian; Simões, Eric A F

2014-03-04

Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at greater risk for pneumococcal pneumonia. We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent PCV among children less than 2 y of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographic information system. We use spatial interpolation methods to create smoothed surface maps of vaccination rates and local-level vaccine efficacy across the study area. We then measure the relationship between distance to the main study hospital and local-level vaccine efficacy, controlling for ecological factors, using spatial autoregressive models with spatial autoregressive disturbances. We find a significant amount of spatial variation in vaccination rates across the study area. For the primary study endpoint vaccine efficacy increased with distance from the main study hospital from -14% for children living less than 1.5 km from Bohol Regional Hospital (BRH) to 55% for children living greater than 8.5 km from BRH. Spatial regression models indicated that after adjustment for ecological factors, distance to the main study hospital was positively related to vaccine efficacy, increasing at a rate of 4.5% per kilometer distance. Because areas with poor access to care have significantly higher VE, targeted vaccination of children in these areas might allow for a more effective implementation of global programs.

Cytoplasmic accumulation of activated leukocyte cell adhesion molecule is a predictor of disease progression and reduced survival in oral cancer patients.

PubMed

Sawhney, Meenakshi; Matta, Ajay; Macha, Muzafar A; Kaur, Jatinder; DattaGupta, Siddhartha; Shukla, Nootan K; Ralhan, Ranju

2009-05-01

Activated leukocyte cell adhesion molecule (ALCAM) has been proposed to function as a cell surface sensor for cell density, controlling the transition between local cell proliferation and tissue invasion in cancer progression. Herein, we determined ALCAM expression in 107 oral squamous cell carcinomas (OSCCs), 78 oral lesions (58 hyperplasias and 20 dysplasias) and 30 histologically normal oral tissues using immunohistochemistry and correlated with clinicopathological parameters. Significant increase in ALCAM immunopositivity was observed from normal oral mucosa, hyperplasia, dysplasia to OSCCs (p(trend) < 0.001). Increased ALCAM expression was observed in cytoplasm of epithelial cells as early as in hyperplasia (p = 0.001, OR = 3.8). Sixty-five of 107 (61%) OSCCs showed significant overexpression of ALCAM protein in cytoplasm/membrane of tumor cells (p = 0.043; OR = 3.3) in comparison with the normal oral tissues. Among OSCCs, cytoplasmic ALCAM was associated with advanced tumor size, tumor stage and tobacco consumption. Importantly, cytoplasmic ALCAM was an independent predictor of poor prognosis of OSCCs in multivariate analysis (p = 0.012, OR = 6.2). In an attempt to understand the molecular basis of cytoplasmic localization of ALCAM, 14-3-3 zeta and 14-3-3 sigma were identified as its novel binding partners in oral cancer cells. In conclusion, increased expression of ALCAM is an early event in oral tumorigenesis; its cytoplasmic accumulation in tumor cells is a predictor of poor prognosis of OSCCs, underscoring its potential as a candidate prognostic marker for oral cancer. (c) 2008 Wiley-Liss, Inc.

Treatment and prognostic factors of radiation-associated angiosarcoma (RAAS) after primary breast cancer: a systematic review.

PubMed

Depla, A L; Scharloo-Karels, C H; de Jong, M A A; Oldenborg, S; Kolff, M W; Oei, S B; van Coevorden, F; van Rhoon, G C; Baartman, E A; Scholten, R J; Crezee, J; van Tienhoven, G

2014-07-01

Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities. Databases were searched for articles with published individual patient data on prognostic factors, treatment and follow-up of patients with RAAS. A regression analysis was performed to test the prognostic values of age, interval between primary treatment and RAAS, tumour size and grade on the local recurrence-free interval (LRFI) and overall survival (OS). The effects of treatment modalities surgery, radiation (with or without hyperthermia) and chemotherapy or combinations were evaluated. 74 articles were included, representing data on 222 patients. In these patients, the 5-year OS was 43% and 5-year LRFI was 32%. Tumour size and age were significant prognostic factors on LRFI and OS. Of all patients, 68% received surgery alone, 17% surgery and reirradiation and 6% surgery with chemotherapy. The remaining 9% received primary treatments without surgery. Surgery with radiotherapy had a better 5-year LRFI of 57% compared to 34% for surgery alone (p=0.008). The value of other treatment modalities could not be assessed. This systematic review confirms the poor prognosis of RAAS. Tumour size and age were of prognostic value. The addition of reirradiation to surgery in the treatment of RAAS appears to enhance local control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Measurements of evaporation from a mine void lake and testing of modelling approaches

NASA Astrophysics Data System (ADS)

McJannet, David; Hawdon, Aaron; Van Niel, Tom; Boadle, Dave; Baker, Brett; Trefry, Mike; Rea, Iain

2017-12-01

Pit lakes often form in the void that remains after open cut mining operations cease. As pit lakes fill, hydrological and geochemical processes interact and these need to be understood for appropriate management actions to be implemented. Evaporation is important in the evolution of pit lakes as it acts to concentrate various constituents, controls water level and changes the thermal characteristics of the water body. Despite its importance, evaporation from pit lakes is poorly understood. To address this, we used an automated floating evaporation pan and undertook measurements at a pit lake over a 12 month period. We also developed a new procedure for correcting floating pan evaporation estimates to lake evaporation estimates based on surface temperature differences. Total annual evaporation was 2690 mm and reflected the strong radiation inputs, high temperatures and low humidity experienced in this region. Measurements were used to test the performance of evaporation estimates derived using both pan coefficient and aerodynamic modelling techniques. Daily and monthly evaporation estimates were poorly reproduced using pan coefficient techniques and their use is not recommended for such environments. Aerodynamic modelling was undertaken using a range of input datasets that may be available to those who manage pit lake systems. Excellent model performance was achieved using over-water or local over-land meteorological observations, particularly when the sheltering effects of the pit were considered. Model performance was reduced when off-site data were utilised and differences between local and off-site vapor pressure and wind speed were found to be the major cause.

The evil circle of poverty: a qualitative study of malaria and disability

PubMed Central

2012-01-01

Background This article discusses the link between disability and malaria in a poor rural setting. Global malaria programmes and rehabilitation programmes are organized as vertical and separate programmes, and as such they focus on prevention, cure and control, and disability respectively. When looking at specific conditions and illnesses, the impairing long-term consequences of illness incidents during childhood are not questioned. Methods The study design was ethnographic with an open, exploratory approach. Data were collected in Mangochi District in Malawi through qualitative in-depth interviews and participant observation. Results Despite a local-based health service system, people living in poor rural areas are confronted with a multitude of barriers when accessing malaria prevention and treatment. Lack of skilled health personnel and equipment add to the general burden of poverty: insufficient knowledge about health care, problems connected to accessing the health facility in time, insufficient initiatives to prevent malaria attacks, and a general lack of attention to the long term disabling effects of a malaria attack. Conclusions This study points to the importance of building malaria programmes, research and statistics that take into consideration the consequences of permanent impairment after a malaria attack, as well as the context of poverty in which they often occur. In order to do so, one needs to develop methods for detecting people whose disabilities are a direct result of not having received health services after a malaria episode. This may be done through qualitative approaches in local communities and should also be supplemented by suitable surveys in order to estimate the problem on a larger scale. PMID:22236358

The evil circle of poverty: a qualitative study of malaria and disability.

PubMed

Ingstad, Benedicte; Munthali, Alister C; Braathen, Stine H; Grut, Lisbet

2012-01-11

This article discusses the link between disability and malaria in a poor rural setting. Global malaria programmes and rehabilitation programmes are organized as vertical and separate programmes, and as such they focus on prevention, cure and control, and disability respectively. When looking at specific conditions and illnesses, the impairing long-term consequences of illness incidents during childhood are not questioned. The study design was ethnographic with an open, exploratory approach. Data were collected in Mangochi District in Malawi through qualitative in-depth interviews and participant observation. Despite a local-based health service system, people living in poor rural areas are confronted with a multitude of barriers when accessing malaria prevention and treatment. Lack of skilled health personnel and equipment add to the general burden of poverty: insufficient knowledge about health care, problems connected to accessing the health facility in time, insufficient initiatives to prevent malaria attacks, and a general lack of attention to the long term disabling effects of a malaria attack. This study points to the importance of building malaria programmes, research and statistics that take into consideration the consequences of permanent impairment after a malaria attack, as well as the context of poverty in which they often occur. In order to do so, one needs to develop methods for detecting people whose disabilities are a direct result of not having received health services after a malaria episode. This may be done through qualitative approaches in local communities and should also be supplemented by suitable surveys in order to estimate the problem on a larger scale. © 2012 Ingstad et al; licensee BioMed Central Ltd.

Localization of dysfunction in major depressive disorder: Prefrontal cortex and amygdala

PubMed Central

Murray, Elisabeth A.; Wise, Steven P.; Drevets, Wayne C.

2010-01-01

Despite considerable effort, the localization of dysfunction in major depressive disorder (MDD) remains poorly understood. We present a hypothesis about its localization that builds on recent findings from primate neuropsychology. The hypothesis has four key components: a deficit in the valuation of ‘self’ underlies the core disorder in MDD; the medial frontal cortex represents ‘self’; interactions between the amygdala and cortical representations update their valuation; and inefficiency in using positive feedback by orbital prefrontal cortex contributes to MDD. PMID:21111403

Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

PubMed

Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

2015-01-01

Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

Achieving the same for less: improving mood depletes blood glucose for people with poor (but not good) emotion control.

PubMed

Niven, Karen; Totterdell, Peter; Miles, Eleanor; Webb, Thomas L; Sheeran, Paschal

2013-01-01

Previous studies have found that acts of self-control like emotion regulation deplete blood glucose levels. The present experiment investigated the hypothesis that the extent to which people's blood glucose levels decline during emotion regulation attempts is influenced by whether they believe themselves to be good or poor at emotion control. We found that although good and poor emotion regulators were equally able to achieve positive and negative moods, the blood glucose of poor emotion regulators was reduced after performing an affect-improving task, whereas the blood glucose of good emotion regulators remained unchanged. As evidence suggests that glucose is a limited energy resource upon which self-control relies, the implication is that good emotion regulators are able to achieve the same positive mood with less cost to their self-regulatory resource. Thus, depletion may not be an inevitable consequence of engaging in emotion regulation.

Municipal solid waste management challenges in developing countries--Kenyan case study.

PubMed

Henry, Rotich K; Yongsheng, Zhao; Jun, Dong

2006-01-01

This paper provides an overview of the state of municipal solid waste management (MSWM) by local authorities in Kenya as a case study of a low-income developing country. Approaches of possible solutions that can be undertaken to improve municipal solid waste (MSW) services are discussed. Poor economic growth (1.1% in 1993) has resulted in an increase in the poverty level which presently stands at 56%. Migration from the rural areas to the urban areas has resulted in unplanned settlements in suburban areas accommodating about 60% of the urban population on only 5% urban land area. Political interference also hampers smooth running of local authorities. Vulnerability of pollution of surface and groundwater is high because local authorities rarely considered environmental impact in siting MSW disposal sites. Illegal dumping of MSW on the river banks or on the roadside poses environmental and economic threats on nearby properties. Poor servicing of MSW collection vehicles, poor state of infrastructure and the lack of adequate funding militate against optimization of MSW disposal service. The rural economy needs to be improved if rural-urban migration is to be managed. Involvement of stakeholders is important to achieve any meaningful and sustainable MSWM. The role of the informal sector through community-based organizations (CBOs), Non-Governmental Organizations (NGOs) and the private sector in offering solutions towards improvement of MSWM also is explored.

Long-term follow up of high-dose chemotherapy with autologous stem cell rescue in adults with Ewing tumor.

PubMed

Laurence, Valérie; Pierga, Jean-Yves; Barthier, Sophie; Babinet, Antoine; Alapetite, Claire; Palangié, Thao; de Pinieux, Gonzagues; Anract, Philippe; Pouillart, Pierre

2005-06-01

Ewing tumors remain of poor prognosis, with 5-year overall survival of 55% to 65% in localized patients and not exceeding 25% in primarily metastatic disease. Several reports, mainly in children, have reported that some patients with poor-risk Ewing tumors may benefit from high-dose chemotherapy (HDCT) with autologous stem cell rescue. This retrospective study analyzed 46 patients treated in our institution between 1987 and 2000 for localized or primary metastatic Ewing tumors by HDCT followed by stem cell rescue. Median follow up was 7.1 years. Median age was 21 years (range, 15-46 years). Twenty-two percent of patients had metastases at diagnosis. The tumor site was axial in 56% of patients. Median tumor size was 9.5 cm. The treatment regimen consisted of induction chemotherapy, local treatment, maintenance chemotherapy, and consolidation HDCT based on alkylating agents. No toxic death was observed in the intensive therapy phase. Five-year overall survival and progression-free survival were 63 +/- 7.7% and 47 +/- 7.6%, respectively. Pejorative prognostic factors in this population were metastases at diagnosis (5-year overall survival 34% vs.71%, P = 0.017) and poor pathologic response (5-year overall survival 44% vs.77%, P = 0.03). This retrospective study shows a high long-term survival rate with high-dose chemotherapy in adults.

Relative associations of cattle movements, local spread, and biosecurity with bovine viral diarrhoea virus (BVDV) seropositivity in beef and dairy herds.

PubMed

Gates, M C; Woolhouse, M E J; Gunn, G J; Humphry, R W

2013-11-01

The success of bovine viral diarrhoea virus (BVDV) eradication campaigns can be undermined by spread through local transmission pathways and poor farmer compliance with biosecurity recommendations. This work combines recent survey data with cattle movement data to explore the issues likely to impact on the success of BVDV control in Scotland. In this analysis, data from 249 beef suckler herds and 185 dairy herds in Scotland were studied retrospectively to determine the relative influence of cattle movements, local spread, and biosecurity on BVDV seropositivity. Multivariable logistic regression models revealed that cattle movement risk factors had approximately 3 times greater explanatory power than risk factors for local spread amongst beef suckler herds, but approximately the same explanatory power as risk factors for local spread amongst dairy herds. These findings are most likely related to differences in cattle husbandry practices and suggest that where financial prioritization is required, focusing on reducing movement-based risk is likely to be of greatest benefit when applied to beef suckler herds. The reported use of biosecurity measures such as purchasing cattle from BVDV accredited herds only, performing diagnostic screening at the time of sale, implementing isolation periods for purchased cattle, and installing double fencing on shared field boundaries had minimal impact on the risk of beef or dairy herds being seropositive for BVDV. Only 28% of beef farmers and 24% of dairy farmers with seropositive herds recognized that their cattle were affected by BVDV and those that did perceive a problem were no less likely to sell animals as replacement breeding stock and no more likely to implement biosecurity measures against local spread than farmers with no perceived problems. In relation to the current legislative framework for BVDV control in Scotland, these findings emphasize the importance of requiring infected herds take appropriate biosecurity measures to prevent further disease transmission and conducting adequate follow-up to ensure that biosecurity measures are being implemented correctly in the field. Copyright © 2013 Elsevier B.V. All rights reserved.

The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey.

PubMed

Schiavetti, Benedetta; Wynendaele, Evelien; De Spiegeleer, Bart; Mbinze, Geremie J; Kalenda, Nicodème; Marini, Roland; Melotte, Vera; Hasker, Epco; Meessen, Bruno; Ravinetto, Raffaella; Van der Elst, Josiane; Mutolo Ngeleka, Daniel

2018-03-01

Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of "poor-quality" if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment's efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.

The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey

PubMed Central

Schiavetti, Benedetta; Wynendaele, Evelien; De Spiegeleer, Bart; Mbinze, Geremie J.; Kalenda, Nicodème; Marini, Roland; Melotte, Vera; Hasker, Epco; Meessen, Bruno; Ravinetto, Raffaella; Van der Elst, Josiane; Mutolo Ngeleka, Daniel

2018-01-01

Abstract. Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of “poor-quality” if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment’s efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research. PMID:29313479

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

PubMed Central

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8©), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03–2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05–3.54), patients on insulin (OR=3.14, 95% CI=1.66–6.03), and low-medication adherents (OR=2.25, 95% CI=1.36–3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77–0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control. PMID:27005896

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya.

PubMed

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya.

PubMed

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8 © ), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Special Migrant Initiative. 1982 Survey to Compare the Health Status of Migrants with Local Residents. Final Report.

ERIC Educational Resources Information Center

Ackerman, Alan; Simkovic, Jeff

A northern Colorado survey investigated whether migrants have better or worse health than the local poor population. An availability sample of migrants (202 adults, 101 children) was obtained by contacting migrants who had used Sunrise Community Health Center (Greeley, Colorado) within 24 months and by asking them to indicate other migrant…

Ultrafast Spectroscopic Noninvasive Probe of Vertical Carrier Transport in Heterostructure Devices

DTIC Science & Technology

2016-03-01

where barriers, tunneling , scattering, strong polarization-induced fields, or carrier localization due to Type I or Type II quantum-well structures can... tunneling across junctions, scattering at heterointerfaces, and internal fields. For light-emitting devices, poor charge transport across multilayer...localization of holes and rapid electron tunneling .5 However, direct transport properties were Approved for public release; distribution is

Perception of local three-dimensional shape.

PubMed

Phillips, F; Todd, J T

1996-08-01

The authors present a series of 4 experiments designed to test the ability to perceive local shape information. Observers were presented with various smoothly varying 3-dimensional surfaces where they reported shape index and sign of Gaussian curvature at several probe locations. Results show that observers are poor at making judgments based on these local measures, especially when the region surrounding the local point is restricted or manipulated to make it noncoherent. Shape index judgments required at least 2 degrees of context surrounding the probe location, and performance on sign of Gaussian curvature judgments deteriorated as the contextual information was restricted as well.

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru.

PubMed

Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Bernabé-Ortiz, Antonio

2015-12-01

There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Cross-sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: <7% versus ≥7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire-9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%-14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%-30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR=1.32; 95% CI 1.15-1.51) after adjusting for several potential confounders. There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. © 2015 Wiley Publishing Asia Pty Ltd.

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

PubMed Central

Crispín‐Trebejo, Brenda; Bernabé‐Ortiz, Antonio

2015-01-01

Abstract Introduction There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Methods Cross‐sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: < 7% versus ≥ 7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire‐9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. Results A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%–14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%–30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR = 1.32; 95% CI 1.15–1.51) after adjusting for several potential confounders. Conclusions There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. PMID:26037488

Is small-scale irrigation an efficient pro-poor strategy in the upper Limpopo Basin in Mozambique?

NASA Astrophysics Data System (ADS)

Ducrot, Raphaelle

2017-08-01

In Sub-Saharan Africa, there is evidence that households with access to small-scale irrigation are significantly less poor than households that do not have access to irrigation. However, private motopumps tend to be distributed inequitably. This paper investigates the success of explicit pro-poor interventions with emphasis on small-scale irrigation in the semi-arid Limpopo Basin in Mozambique. It reveals that high irrigation costs are progressively excluding the poor, who are unable to generate a cash income from other activities they need to fund irrigation. In addition, the operation of collective schemes involving the poor is being jeopardized by the development of private irrigation schemes, which benefit from hidden subsidies appropriated by local elites. This results in unequal access to irrigation, which can cause resentment at community level. This weakens community cohesiveness, as well as communities' capacities for collective action and coordination, which are crucial for collective irrigation.

Predictors of Poor Seizure Control in Children Managed at a Tertiary Care Hospital of Eastern Nepal

PubMed Central

POUDEL, Prakash; CHITLANGIA, Mohit; POKHAREL, Rita

2016-01-01

Objective Various factors have been claimed to predict outcome of afebrile seizures in children. This study was aimed to find out the predictors of poor seizure control in children at a resource limited setting. Materials & Methods This prospective study was done from July 1st, 2009 to January 31st, 2012 at B.P. Koirala Institute of Health Sciences, Nepal. Children (1 month-20 yr of age) with afebrile seizures presenting to pediatric neurology clinic were studied. Significant predictors on bivariate analysis were further analyzed with binary logistic model to find out the true predictors. Positive predictive values (PPVs) and negative predictive values (NPVs) for the true predictors were calculated. Results Out of 256 patients (male: female ratio 3:2) with afebrile seizures followed up for median duration of 27 (IQR 12-50) months, seizure was poorly controlled in 20% patients. Three factors predicted poor seizure control. They were frequent (≥1 per month) seizures at onset (OR 12.76, 95% CI 1.44-112.73, PPV 25%, NPV 98%); remote symptomatic etiology (OR 3.56, 95% CI 1.04-12.17, PPV 36%, NPV 92%); and need of more than one anticonvulsant drug (polytherapy) (OR 12.83, 95% CI 5.50-29.9, PPV 56%, NPV 96%). The strongest predictor was need of polytherapy. When all three factors were present, PPV and NPV for prediction of poor seizure control were 70% and 90% respectively. Conclusion Frequent seizures at onset, remote symptomatic etiology of seizure and need of polytherapy were associated with poor seizure control in children with afebrile seizures. PMID:27375756

Elevated Nitrogen Deposition from Alberta Oil Sands Development Stimulates Phosphatase Activity in Dominant Sphagnum Moss Species

NASA Astrophysics Data System (ADS)

Kashi, N. N.; Wieder, R.; Vile, M. A.

2013-12-01

Emissions of NOx associated with Alberta oil sands (AOS) development are leading to locally elevated atmospheric N deposition, in a region where background N deposition has been historically quite low (< 1 kg/ha/yr). This elevated N deposition has the potential to alter the ecosystem structure and function of nutrient-poor boreal peatlands. Nitrogen enrichment may alter soil microbial activity, which could be manifested in changes in extracellular enzyme activities. Since 2011, we have been experimentally adding N as NH4NO3 in simulated precipitation at 0, 5, 10, 15, 20, and 25 kg N ha/yr/ plus no-water controls to a boreal bog and a poor fen (3 replicate plots per treatment). In 2013, acid phosphatase activities in living plant capitulum of Sphagnum angustifolium, Sphagnum fuscum, and Sphagnum magellanicum were quantified in June and July using 4-methyumbelliferylphosphate and fluorescence detection of the enzymatically released methylumbelliferone (MUF). Phosphatase activities did not differ with N treatment for S. angustifolium in the bog (p=0.3409) or the poor fen (p=0.0629), or for S. fuscum in the bog (p=0.1950), averaging 35.0 × 0.7, 61.6 × 1.2, and 41.6 × 0.9 μmol MUF/g DWT/hr, respectively. For S. fuscum in the poor fen, phosphatase activities differed between N treatments (p=0.0275), ranging 40.6 × 1.1 μmol MUF/g DWT/hr in the control plots to 73.7 × 2.0 μmol MUF/g DWT/hr in the 5 kg/ha/yr N treatment plots; increasing N deposition did not result in a gradual change in enzyme activity. On the other hand, S. magellanicum phosphatase activities differed between N treatments (p=0.0189) and showed a pattern of generally increasing activity with increasing N deposition (37.4 × 0.5 μmol MUF/g DWT/hr in control plots; 97.9 × 4.5 μmol MUF/g DWT/hr in the 25 kg/ha/yr N treatment plots). The differing phosphatase responses between these dominant Sphagnum species suggest unique differences in nutrient balance and/or microbial activity. Combining the three moss species and weighting by their abundances within each plot (percent cover), phosphatase activities differed between N treatments in the bog (p=0.0388) and the poor fen (p=0.0005), with the latter exhibiting a clear increase in enzyme activity with increasing N deposition, and a doubling of phosphatase activity between the control plots and the 25 kg/kg/yr N deposition treatment. Although the three moss species responded differently, at the plot scale, increasing N deposition stimulated phosphatase activity, suggesting that microbial enzyme activity in peat is sensitive to increasing N deposition from oil sands development, with potential consequences for peatland nutrient cycling.

Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus.

PubMed

Tang, Yunzhao; Meng, Lingling; Li, Daiqing; Yang, Min; Zhu, Yanjuan; Li, Chenguang; Jiang, Zhenhuan; Yu, Ping; Li, Zhu; Song, Hongna; Ni, Changlin

2014-01-01

Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. "Good sleep quality" was defined as PQSI <5, "average sleep quality" was defined as PQSI 6-8, and "poor sleep quality" was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as <6, 6-8, and >8 hours/night. Short sleep time was defined as sleep duration <6 hours/night. In the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group (χ(2) = 11.16, P = 0.037). The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group (χ(2) = 9.79, P = 0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007-1.092, P = 0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236-0.912, P = 0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P < 0.01). Inadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.

Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery.

PubMed

ter Boo, Gert-Jan A; Grijpma, Dirk W; Moriarty, Thomas F; Richards, Robert G; Eglin, David

2015-06-01

Infectious complications occur in a minor but significant portion of the patients undergoing joint replacement surgery or fracture fixation, particularly those with severe open fractures, those undergoing revision arthroplasty or those at elevated risk because of poor health status. Once established, infections are difficult to eradicate, especially in the case of bacterial biofilm formation on implanted hardware. Local antibiotic carriers offer the prospect of controlled delivery of antibiotics directly in target tissues and implant, without inducing toxicity in non-target organs. Polymeric carriers have been developed to optimize the release and targeting of antibiotics. Passive polymeric carriers release antibiotics by diffusion and/or upon degradation, while active polymeric carriers release their antibiotics upon stimuli provided by bacterial pathogens. Additionally, some polymeric carriers gelate in-situ in response to physiological stimuli to form a depot for antibiotic release. As antibiotic resistance has become a major issue, also other anti-infectives such as silver and antimicrobial peptides have been incorporated in research. Currently, several antibiotic loaded biomaterials for local infection prophylaxis are available for use in the clinic. Here we review their advantages and limitations and provide an overview of new materials emerging that may overcome these limitations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Characteristics of the Localization of Connexin 43 in Satellite Cells during Skeletal Muscle Regeneration In Vivo

PubMed Central

Ishido, Minenori; Kasuga, Norikatsu

2015-01-01

For myogenesis, new myotubes are formed by the fusion of differentiated myoblasts. In the sequence of events for myotube formation, intercellular communication through gap junctions composed of connexin 43 (Cx43) plays critical roles in regulating the alignment and fusion of myoblasts in advances of myotube formation in vitro. On the other hand, the relationship between the expression patterns of Cx43 and the process of myotube formation in satellite cells during muscle regeneration in vivo remains poorly understood. The present study investigated the relationship between Cx43 and satellite cells in muscle regeneration in vivo. The expression of Cx43 was detected in skeletal muscles on day 1 post-muscle injury, but not in control muscles. Interestingly, the expression of Cx43 was not localized on the inside of the basement membrane of myofibers in the regenerating muscles. Moreover, although the clusters of differentiated satellite cells, which represent a more advanced stage of myotube formation, were observed on the inside of the basement membrane of myofibers in regenerating muscles, the expression of Cx43 was not localized in the clusters of these satellite cells. Therefore, in the present study, it was suggested that Cx43 may not directly contribute to muscle regeneration via satellite cells. PMID:26019374

Localized atrophy of the thalamus and slowed cognitive processing speed in MS patients.

PubMed

Bergsland, Niels; Zivadinov, Robert; Dwyer, Michael G; Weinstock-Guttman, Bianca; Benedict, Ralph Hb

2016-09-01

Deep gray matter (DGM) atrophy is common in multiple sclerosis (MS), but no studies have investigated surface-based structure changes over time with respect to healthy controls (HCs). Moreover, the relationship between cognition and the spatio-temporal evolution of DGM atrophy is poorly understood. To explore DGM structural differences between MS and HCs over time in relation to neuropsychological (NP) outcomes. The participants were 44 relapsing-remitting and 20 secondary progressive MS patients and 22 HCs. All were scanned using 3T magnetic resonance imaging (MRI) at baseline and 3-year follow-up. NP examination emphasized consensus standard tests of processing speed and memory. We performed both volumetric and shape analysis of DGM structures and assessed their relationships with cognition. Compared to HCs, MS patients presented with significantly smaller DGM volumes. For the thalamus and caudate, differences in shape were mostly localized along the lateral ventricles. NP outcomes were related to both volume and shape of the DGM structures. Over 3 years, decreased cognitive processing speed was related to localized atrophy on the anterior and superior surface of the left thalamus. These findings highlight the role of atrophy in the anterior nucleus of the thalamus and its relation to cognitive decline in MS. © The Author(s), 2015.

The microtubule-associated protein EB1 maintains cell polarity through activation of protein kinase C.

PubMed

Schober, Joseph M; Kwon, Guim; Jayne, Debbie; Cain, Jeanine M

2012-01-06

The plus-ends of microtubules target the cell cortex to modulate actin protrusion dynamics and polarity, but little is known of the molecular mechanism that couples the interaction. EB1 protein associates with the plus-ends of microtubules, placing EB1 in an ideal spatial position to mediate microtubule-actin cross talk. The objective of the current study was to further understand intracellular signaling involved in EB1-dependent cell polarity and motility. B16F10 mouse melanoma cells were depleted of EB1 protein using short hair-pin RNA interference. Correlative live cell-immunofluorescence microscopy was performed to determine localization of WAVE2 and IQGAP1 to protruding versus retracting edges. EB1 knock down caused poor subcellular separation of WAVE2 and IQGAP1, and overall decreased localization. Activation of PKC corrected defects in WAVE2 and IQGAP1 localization, cell spreading and cell shape to levels observed in control cells, but did not correct defects in cell migration. Consistent with these findings, decreased PKC phosphorylation was observed in EB1 knock down cells. These findings support a model where EB1 protein links microtubules to actin protrusion and cell polarity through signaling pathways involving PKC. Copyright © 2011 Elsevier Inc. All rights reserved.

Locoregional control of tongue base adenoid cystic carcinoma with primary resection and radial forearm free flap reconstruction.

PubMed

Yarlagadda, Bharat B; Meier, Josh C; Lin, Derrick T; Emerick, Kevin S; Deschler, Daniel G

2017-01-01

Adenoid cystic carcinoma of the minor salivary glands can be challenging and marked by high rates of local recurrence despite appropriate surgical resection. Management of this pathology in the base of the tongue is particularly difficult given the poor functional outcomes traditionally associated with an aggressive surgical approach. This article presents a case series of patients who underwent up-front surgical resection followed by free tissue transfer reconstruction. A retrospective analysis was performed of patients with adenoid cystic carcinoma of the base of the tongue who underwent composite resection and reconstruction with a radial forearm free flap. Three patients met inclusion criteria and underwent analysis. All patients achieved locoregional control after at least 4 years of surveillance. In addition, all patients were decannulated and were swallowing without the need for gastrostomy tube feeding. This series demonstrates that for select patients with adenoid cystic carcinoma of the base of the tongue, excellent locoregional control can be achieved with acceptable functional outcomes and prolonged survival when appropriate reconstructive measures are employed.

Investigation of defect rate of lap laser welding of stainless steel railway vehicles car body

NASA Astrophysics Data System (ADS)

Wang, Hongxiao

2015-02-01

In order to resolve the disadvantages such as poor appearance quality, poor tightness, low efficiency of resistance spot welding of stainless steel rail vehicles, partial penetration lap laser welding process was investigated widely. But due to the limitation of processing technology, there will be local incomplete fusion in the lap laser welding seam. Defect rate is the ratio of the local incomplete fusion length to the weld seam length. The tensile shear strength under different defect rate and its effect on the car body static strength are not clear. It is necessary to find the biggest defect rate by numerical analysis of effects of different defect rates on the laser welding stainless steel rail vehicle body structure strength ,and tests of laser welding shear tensile strength.

Predictive Effects of Good Self-Control and Poor Regulation on Alcohol-Related Outcomes: Do Protective Behavioral Strategies Mediate?

PubMed Central

Pearson, Matthew R.; Kite, Benjamin A.; Henson, James M.

2016-01-01

In the present study, we examined whether use of protective behavioral strategies mediated the relationship between self-control constructs and alcohol-related outcomes. According to the two-mode model of self-control, good self-control (planfulness; measured with Future Time Perspective, Problem Solving, and Self-Reinforcement) and poor regulation (impulsivity; measured with Present Time Perspective, Poor Delay of Gratification, Distractibility) are theorized to be relatively independent constructs rather than opposite ends of a single continuum. The analytic sample consisted of 278 college student drinkers (68% women) who responded to a battery of surveys at a single time point. Using a structural equation model based on the two-mode model of self-control, we found that good self-control predicted increased use of three types of protective behavioral strategies (Manner of Drinking, Limiting/Stopping Drinking, and Serious Harm Reduction). Poor regulation was unrelated to use of protective behavioral strategies, but had direct effects on alcohol use and alcohol problems. Further, protective behavioral strategies mediated the relationship between good self-control and alcohol use. The clinical implications of these findings are discussed. PMID:22663345

Facts About Fetal Alcohol Spectrum Disorders (FASDs)

MedlinePlus

... attention Poor memory Difficulty in school (especially with math) Learning disabilities Speech and language delays Intellectual disability ... do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control. Alcohol- ...

Angioedema attacks in patients with hereditary angioedema: Local manifestations of a systemic activation process.

PubMed

Hofman, Zonne L M; Relan, Anurag; Zeerleder, Sacha; Drouet, Christian; Zuraw, Bruce; Hack, C Erik

2016-08-01

Hereditary angioedema (HAE) caused by a deficiency of functional C1-inhibitor (C1INH) becomes clinically manifest as attacks of angioedema. C1INH is the main inhibitor of the contact system. Poor control of a local activation process of this system at the site of the attack is believed to lead to the formation of bradykinin (BK), which increases local vasopermeability and mediates angioedema on interaction with BK receptor 2 on the endothelium. However, several observations in patients with HAE are difficult to explain from a pathogenic model claiming a local activation process at the site of the angioedema attack. Therefore we postulate an alternative model for angioedema attacks in patients with HAE, which assumes a systemic, fluid-phase activation of the contact system to generate BK and its breakdown products. Interaction of these peptides with endothelial receptors that are locally expressed in the affected tissues rather than with receptors constitutively expressed by the endothelium throughout the whole body explains that such a systemic activation process results in local manifestations of an attack. In particular, BK receptor 1, which is induced on the endothelium by inflammatory stimuli, such as kinins and cytokines, meets the specifications of the involved receptor. The pathogenic model discussed here also provides an explanation for why angioedema can occur at multiple sites during an attack and why HAE attacks respond well to modest increases of circulating C1INH activity levels because inhibition of fluid-phase Factor XIIa and kallikrein requires lower C1INH levels than inhibition of activator-bound factors. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Ewing-like sarcomas with BCOR-CCNB3 fusion transcript: a clinical, radiological and pathological retrospective study from the Société Française des Cancers de L'Enfant.

PubMed

Cohen-Gogo, Sarah; Cellier, Cécile; Coindre, Jean-Michel; Mosseri, Véronique; Pierron, Gaëlle; Guillemet, Cécile; Italiano, Antoine; Brugières, Laurence; Orbach, Daniel; Laurence, Valérie; Delattre, Olivier; Michon, Jean

2014-12-01

This retrospective multicenter study assessed the clinical, radiological and pathological presentation, treatment and outcome of 26 patients with Ewing-like sarcoma harboring BCOR-CCNB3 gene fusion transcript. Tumor samples had been collected between 1994 and April 2012. Eligibility criteria included assessment of a BCOR-CCNB3 transcript-positive tumor after molecular analysis and availability of minimal clinical and pathological data. Radiological data were also retrieved when possible. Data were analyzed by descriptive statistics and methods for survival analysis. Median age at diagnosis was 13.1 years (5.9 to 25.6 years). Most patients (24/26) had localized tumors. All tumors but five were localized to bone. CCNB3 immunochemistry showed strong nuclear staining on all samples. No specific radiological features were found. Most patients received chemotherapy (15 according to protocols designed for Ewing tumors), before and/or after local treatment (surgery and/or radiotherapy, with 46.2% receiving both). Local and metastatic relapses were of poor prognosis. Induction chemotherapy and treatment according to an Ewing protocol might influence survival for patients with localized tumors. Sixteen patients are alive in complete remission with a median follow-up of 86 months. Five year overall survival and disease-free survival were respectively 76.5% (95% CI, 58%-95%) and 67.9% (95% CI, 48%-88%). BCOR-CCNB3 transcript-positive Ewing-like sarcoma diagnosis should be discussed for a transcript-negative small round cell sarcoma in a child, adolescent or young adult patient. Diagnosis needs to be stated through CCNB3 immunochemistry or transcript identification. The exquisite chemosensitivity of these tumors should encourage the use of polychemotherapy for appropriate care, associated with best local tumor control. © 2014 Wiley Periodicals, Inc.

Integrating Health into Local Climate Response: Lessons from the U.S. CDC Climate-Ready States and Cities Initiative

PubMed Central

Fox, Mary A.; Kaye, Charlotte; Resnick, Beth

2017-01-01

Summary: Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)’s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level. https://doi.org/10.1289/EHP1838 PMID:28934724

Self-rated diabetes control in a Canadian population with type 2 diabetes: associations with health behaviours and outcomes.

PubMed

Smith, Kimberley J; Pagé, Véronique; Gariépy, Geneviève; Béland, Mélanie; Badawi, Ghislaine; Schmitz, Norbert

2012-01-01

Diabetes control is a multifaceted process involving successful adherence to a self-care regimen as indicated by improved health outcomes. The aim of this study was to ascertain the construct validity of self-reported diabetes control in a population-based survey. This study assessed 1848 participants with type 2 diabetes who took part in the Montreal Diabetes Health and Wellbeing Study in Quebec, Canada. Participants were administered the diabetes complications index as well as sociodemographic and health questions. Fair/poor diabetes control was associated with being less likely to check blood glucose weekly, being less likely to drink alcohol, being more likely to report being physically inactive, reporting fair/poor eating habits, being obese and having 1 or more diabetes complications. When all variables were included in a regression model the two variables most strongly associated with poor fair/poor diabetes control were reporting fair/poor eating habits (odds ratio 1.36, 95% CI 1.00-1.85) and having 2 or more diabetes complications (odds ratio 1.60, 95% CI 1.06-2.40). Results from this study indicate that self-rated diabetes control has associations with diabetes-specific self-care behaviours and outcomes, and is a general indicator of self-care and diabetes-related complications in a population-based survey. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

Expression patterns of emmprin and monocarboxylate transporter-1 in ovarian epithelial tumors.

PubMed

Fukuoka, Miyoko; Hamasaki, Makoto; Koga, Kaori; Hayashi, Hiroyuki; Aoki, Mikiko; Kawarabayashi, Tatsuhiko; Miyamoto, Shingo; Nabeshima, Kazuki

2012-10-01

Emmprin is a transmembrane glycoprotein known as a matrix metalloproteinase inducer and is highly up-regulated in malignant cancer cells. The monocarboxylate transporters (MCTs) are responsible for H(+)-linked transport of monocarboxylates across the cell membrane. It was recently demonstrated that proper plasma membrane localization and activity of MCTs require the presence of emmprin as a chaperone and that MCT-1 also acts as chaperone for emmprin. The objectives of this study were to clarify emmprin and MCT-1 expression patterns in ovarian epithelial tumors and to elucidate the clinicopathological significance of co-localization of the two molecules. Immunohistochemical analysis of 205 epithelial tumors indicated that emmprin is always localized in cell membranes but its distribution differs according to tumor type: in lateral membranes in 89 % of adenomas, in lateral and basal membranes in 76 % of borderline tumors, and in membranes surrounding the entire cell in 98 % of carcinomas. Most carcinomas in situ also showed a lateral and basal expression pattern. In only 21 % of the carcinomas, the cells expressing membranous MCT-1 showed co-localized emmprin expression. Poor co-localization of the two molecules was more frequently found in serous carcinomas. However, the overall survival was not significantly different for the good and poor co-localization carcinoma groups. These findings indicate that the emmprin expression pattern might discriminate between invasive carcinomas and borderline tumors including carcinoma in situ. Moreover, there may be an as yet unidentified regulatory mechanism(s), for localization of MCT-1 and emmprin in cell membranes in vivo.

Prevalence of Neck and Back Pain amongst Aircrew at the Extremes of Anthropometric Measurements

DTIC Science & Technology

2012-09-06

of these safety systems, with potential to exceed the designed upper load limits. Current ergonomics assessments use the 1988 National Health and...position in UH-60 Long goggle flights NVG weight- neck sore. Long hours in poorly designed seats ; helmet/ NVGs and hours of manipulating control...landing Long hours in poorly designed seats ; helmet/ NVGs and hours of manipulating control display units in glass cockpits Repetitive use Poor ramp

Circulating Carbonic Anhydrase IX and Antiangiogenic Therapy in Breast Cancer

PubMed Central

Brown-Glaberman, Ursa; Marron, Marilyn; Chalasani, Pavani; Livingston, Robert; Iannone, Maria; Specht, Jennifer; Stopeck, Alison T.

2016-01-01

Introduction. Carbonic anhydrase IX (CAIX) is a hypoxia regulated metalloenzyme integral to maintaining cellular pH. Increased CAIX expression is associated with poor prognosis in breast cancer. To explore CAIX as a biomarker for breast cancer therapies, we measured plasma CAIX levels in healthy control subjects and in breast cancer patients. Methods. In control subjects we evaluated plasma CAIX stability via commercially available ELISA. We then similarly quantified plasma CAIX levels in (1) locally advanced breast cancer (LABC) patients treated with neoadjuvant paclitaxel + sunitinib (T + S) followed by doxorubicin and cyclophosphamide (AC); (2) metastatic breast cancer (MBC) patients treated with systemic chemotherapy. Results. Plasma CAIX levels were stable at room temperature for at least 48 hours in control subjects. Mean baseline plasma CAIX levels were lower in controls compared to patients with LABC or MBC. In LABC, CAIX levels rose significantly in response to administration of antiangiogenic therapy (T + S) (p = 0.02) but not AC (p = 0.37). In patients with MBC treated without an antiangiogenic agent CAIX levels did not change with therapy. Conclusions. Our results suggest that CAIX may be an easily obtained, stable measure of tumor associated hypoxia as well as a useful pharmacodynamic biomarker for antiangiogenic therapy. PMID:26941473

Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature.

PubMed

Vigo, Federica; Ciammella, Patrizia; Valli, Riccardo; Cagni, Elisabetta; Iotti, Cinzia

2012-08-10

Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient.This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new.

PubMed

Boyle, John; Czito, Brian; Willett, Christopher; Palta, Manisha

2015-08-01

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates.

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new

PubMed Central

Boyle, John; Czito, Brian; Willett, Christopher

2015-01-01

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates. PMID:26261730

Bub1 autophosphorylation feeds back to regulate kinetochore docking and promote localized substrate phosphorylation

PubMed Central

Asghar, Adeel; Lajeunesse, Audrey; Dulla, Kalyan; Combes, Guillaume; Thebault, Philippe; Nigg, Erich A.; Elowe, Sabine

2015-01-01

During mitosis, Bub1 kinase phosphorylates histone H2A-T120 to promote centromere sister chromatid cohesion through recruitment of shugoshin (Sgo) proteins. The regulation and dynamics of H2A-T120 phosphorylation are poorly understood. Using quantitative phosphoproteomics we show that Bub1 is autophosphorylated at numerous sites. We confirm mitosis-specific autophosphorylation of a several residues and show that Bub1 activation is primed in interphase but fully achieved only in mitosis. Mutation of a single autophosphorylation site T589 alters kinetochore turnover of Bub1 and results in uniform H2A-T120 phosphorylation and Sgo recruitment along chromosome arms. Consequently, improper sister chromatid resolution and chromosome segregation errors are observed. Kinetochore tethering of Bub1-T589A refocuses H2A-T120 phosphorylation and Sgo1 to centromeres. Recruitment of the Bub1-Bub3-BubR1 axis to kinetochores has recently been extensively studied. Our data provide novel insight into the regulation and kinetochore residency of Bub1 and indicate that its localization is dynamic and tightly controlled through feedback autophosphorylation. PMID:26399325

Bub1 autophosphorylation feeds back to regulate kinetochore docking and promote localized substrate phosphorylation.

PubMed

Asghar, Adeel; Lajeunesse, Audrey; Dulla, Kalyan; Combes, Guillaume; Thebault, Philippe; Nigg, Erich A; Elowe, Sabine

2015-09-24

During mitosis, Bub1 kinase phosphorylates histone H2A-T120 to promote centromere sister chromatid cohesion through recruitment of shugoshin (Sgo) proteins. The regulation and dynamics of H2A-T120 phosphorylation are poorly understood. Using quantitative phosphoproteomics we show that Bub1 is autophosphorylated at numerous sites. We confirm mitosis-specific autophosphorylation of a several residues and show that Bub1 activation is primed in interphase but fully achieved only in mitosis. Mutation of a single autophosphorylation site T589 alters kinetochore turnover of Bub1 and results in uniform H2A-T120 phosphorylation and Sgo recruitment along chromosome arms. Consequently, improper sister chromatid resolution and chromosome segregation errors are observed. Kinetochore tethering of Bub1-T589A refocuses H2A-T120 phosphorylation and Sgo1 to centromeres. Recruitment of the Bub1-Bub3-BubR1 axis to kinetochores has recently been extensively studied. Our data provide novel insight into the regulation and kinetochore residency of Bub1 and indicate that its localization is dynamic and tightly controlled through feedback autophosphorylation.

Heat and mass transfer are in the interaction of multi-pulsed spray with vertical surfaces in the regime of evaporative cooling

NASA Astrophysics Data System (ADS)

Karpov, P. N.; Nazarov, A. D.; Serov, A. F.; Terekhov, V. I.

2017-10-01

Sprays with a periodic supply drop phase have great opportunities to control the processes of heat transfer. We can achieve optimal evaporative modes of cooling by changing the pulse duration and the repetition frequency while minimizing flow of the liquid phase. Experimental data of investigation of local heat transfer for poorly heated large surface obtained on the original stand with multi nozzle managed the irrigation system impact of the gas-droplet flow present in this work. Researches on the contribution to the intensification of spray options were conducted. Also the growth rate was integral and local heat. Information instantaneous distribution of the heat flux in the description of the processes have helped us. Managed to describe two basic modes of heat transfer: Mode “insular” foil cooling and thick foil with forming of streams. Capacitive sensors allow to monitor the dynamics of the foil thickness, the birth-belt flow, forming and the evolution of waves generated by “bombing” the surface with the droplets.

Micron-scale coherence in interphase chromatin dynamics

PubMed Central

Zidovska, Alexandra; Weitz, David A.; Mitchison, Timothy J.

2013-01-01

Chromatin structure and dynamics control all aspects of DNA biology yet are poorly understood, especially at large length scales. We developed an approach, displacement correlation spectroscopy based on time-resolved image correlation analysis, to map chromatin dynamics simultaneously across the whole nucleus in cultured human cells. This method revealed that chromatin movement was coherent across large regions (4–5 µm) for several seconds. Regions of coherent motion extended beyond the boundaries of single-chromosome territories, suggesting elastic coupling of motion over length scales much larger than those of genes. These large-scale, coupled motions were ATP dependent and unidirectional for several seconds, perhaps accounting for ATP-dependent directed movement of single genes. Perturbation of major nuclear ATPases such as DNA polymerase, RNA polymerase II, and topoisomerase II eliminated micron-scale coherence, while causing rapid, local movement to increase; i.e., local motions accelerated but became uncoupled from their neighbors. We observe similar trends in chromatin dynamics upon inducing a direct DNA damage; thus we hypothesize that this may be due to DNA damage responses that physically relax chromatin and block long-distance communication of forces. PMID:24019504

Substance P accelerates wound healing in type 2 diabetic mice through endothelial progenitor cell mobilization and Yes-associated protein activation

PubMed Central

Um, Jihyun; Yu, Jinyeong; Park, Ki-Sook

2017-01-01

Wound healing is delayed in diabetes due to a number of factors, including impaired angiogenesis and poor dermal healing. The present study demonstrated that subcutaneous administration of substance P (SP) accelerates wound healing in db/db type 2 diabetic mice (db/db mice). SP injection (10 nM/kg, subcutaneously) enhanced angiogenesis, induced the mobilization of endothelial progenitor cells (EPCs) and increased the number of EPC-colony forming units (EPC-CFUs) in the bone marrow of db/db mice. Immunohistochemistry was performed to check the effects of SP on the cellular proliferation and the subcellular localization of Yes-associated protein (YAP) in the wound dermis. SP also upregulated cellular proliferation in the injured dermis of db/db mice. Compared with the control group, an increased number of cells in the wound dermis of SP-treated mice exhibited nuclear localization of YAP, which induces cellular proliferation. The results of the current study indicate that subcutaneous administration of SP may be a promising therapeutic strategy to treat diabetic wounds exhibiting impaired angiogenesis and dysfunctional dermal wound healing. PMID:28339006

Using Source Apportionment to Evaluate the Cross State Transport of Ozone in the Eastern United States

NASA Astrophysics Data System (ADS)

Goldberg, D. L.; Canty, T. P.; Hembeck, L.; Vinciguerra, T.; Carpenter, S. F.; Anderson, D. C.; Salawitch, R. J.; Dickerson, R. R.

2014-12-01

The amount of air pollution crossing state lines has great policy implications. Using the ozone source apportionment tool (OSAT) in the Comprehensive Air-Quality Model with Extensions (CAMx) version 6.10, we can quantify how much ozone is generated locally versus transported from upwind locations. Initial results show that up to 70% of the surface ozone in Maryland during poor air quality days in the summer of July 2011 can be attributed to pollution from outside of the state's borders. Modifications to the CB05 gas-phase chemistry mechanism, supported by literature recommendations and improve agreement with NASA's DISCOVER-AQ Maryland aircraft campaign, can further increase this percentage. Additionally, we show the role of upwind sources and background ozone has become increasingly important as local emissions of ozone precursors continue to drop, starting with the steep reductions imposed in 2002 in response to Maryland's State Implementation Plan submitted to EPA. This study suggests future efforts to control surface ozone must include a meaningful strategy for dealing with cross-state transport of ozone precursors.

Natural disasters and population mobility in Bangladesh.

PubMed

Gray, Clark L; Mueller, Valerie

2012-04-17

The consequences of environmental change for human migration have gained increasing attention in the context of climate change and recent large-scale natural disasters, but as yet relatively few large-scale and quantitative studies have addressed this issue. We investigate the consequences of climate-related natural disasters for long-term population mobility in rural Bangladesh, a region particularly vulnerable to environmental change, using longitudinal survey data from 1,700 households spanning a 15-y period. Multivariate event history models are used to estimate the effects of flooding and crop failures on local population mobility and long-distance migration while controlling for a large set of potential confounders at various scales. The results indicate that flooding has modest effects on mobility that are most visible at moderate intensities and for women and the poor. However, crop failures unrelated to flooding have strong effects on mobility in which households that are not directly affected but live in severely affected areas are the most likely to move. These results point toward an alternate paradigm of disaster-induced mobility that recognizes the significant barriers to migration for vulnerable households as well their substantial local adaptive capacity.

Pharmaceutical quality assurance of local private distributors: a secondary analysis in 13 low-income and middle-income countries.

PubMed

Van Assche, Kerlijn; Nebot Giralt, Ariadna; Caudron, Jean Michel; Schiavetti, Benedetta; Pouget, Corinne; Tsoumanis, Achilleas; Meessen, Bruno; Ravinetto, Raffaella

2018-01-01

The rapid globalisation of the pharmaceutical production and distribution has not been supported by harmonisation of regulatory systems worldwide. Thus, the supply systems in low-income and middle-income countries (LMICs) remain exposed to the risk of poor-quality medicines. To contribute to estimating this risk in the private sector in LMICs, we assessed the quality assurance system of a convenient sample of local private pharmaceutical distributors. This descriptive study uses secondary data derived from the audits conducted by the QUAMED group at 60 local private pharmaceutical distributors in 13 LMICs. We assessed the distributors' compliance with good distribution practices (GDP), general quality requirements (GQR) and cold chain management (CCM), based on an evaluation tool inspired by the WHO guidelines 'Model Quality Assurance System (MQAS) for procurement agencies'. Descriptive statistics describe the compliance for the whole sample, for distributors in sub-Saharan Africa (SSA) versus those in non-SSA, and for those in low-income countries (LICs) versus middle-income countries (MICs). Local private pharmaceutical distributors in our sample were non-compliant, very low-compliant or low-compliant for GQR (70%), GDP (60%) and CCM (41%). Only 7/60 showed good to full compliance for at least two criteria. Observed compliance varies by geographical region and by income group: maximum values are higher in non-SSA versus SSA and in MICs versus LICs, while minimum values are the same across different groups. The poor compliance with WHO quality standards observed in our sample indicates a concrete risk that patients in LMICs are exposed to poor-quality or degraded medicines. Significant investments are needed to strengthen the regulatory supervision, including on private pharmaceutical distributors. An adapted standardised evaluation tool inspired by the WHO MQAS would be helpful for self-evaluation, audit and inspection purposes.

[EEG source localization using LORETA (low resolution electromagnetic tomography)].

PubMed

Puskás, Szilvia

2011-03-30

Eledctroencephalography (EEG) has excellent temporal resolution, but the spatial resolution is poor. Different source localization methods exist to solve the so-called inverse problem, thus increasing the accuracy of spatial localization. This paper provides an overview of the history of source localization and the main categories of techniques are discussed. LORETA (low resolution electromagnetic tomography) is introduced in details: technical informations are discussed and localization properties of LORETA method are compared to other inverse solutions. Validation of the method with different imaging techniques is also discussed. This paper reviews several publications using LORETA both in healthy persons and persons with different neurological and psychiatric diseases. Finally future possible applications are discussed.

Weak tectono-magmatic relationships along an obliquely convergent plate boundary: Sumatra, Indonesia

NASA Astrophysics Data System (ADS)

Acocella, Valerio; Bellier, Olivier; Sandri, Laura; Sébrier, Michel; Pramumijoyo, Subagyo

2018-02-01

The tectono-magmatic relationships along obliquely convergent plate boundaries, where strain partitioning promotes strike-slip structures along the volcanic arc, are poorly known. Here it is unclear if and, in case, how the strike-slip structures control volcanic processes, distribution and size. To better define the possible tectono-magmatic relationships along strike-slip arcs, we merge available information on the case study of Sumatra (Indonesia) with field structural data. The Sumatra arc (entire volcanic belt) consists of 48 active volcanoes. Of these, 46% lie within 10 km from the dextral Great Sumatra Fault (GSF), which carries most horizontal displacement on the overriding plate, whereas 27% lie at >20 km from the GSF. Among the volcanoes at <10 km from GSF, 48% show a possible structural relation to the GSF, whereas only 28% show a clear structural relation, lying in pull-aparts or releasing bends; these localized areas of transtension (local extensional zone) do not develop magmatic segments. There is no relation between the GSF along-strike slip rate variations and the volcanic productivity. The preferred N30°-N40°E volcano alignment and elongation are subparallel to the convergence vector or to the GSF. The structural field data, collected in the central and southern GSF, show, in addition to the dextral motions along NW-SE to N-S striking faults, also normal motions (extending WNW-ESE or NE-SW), suggesting local reactivations of the GSF. Overall, the collected data suggest a limited tectonic control on arc volcanism. The tectonic control is mostly expressed by the mean depth of the slab surface below the volcanoes (130±20 km) and, subordinately, local extension along the GSF. The latter, when WNW-ESE oriented (more common), may be associated with the overall tectonic convergence, as suggested by the structural data; conversely, when NE-SW oriented (less common), the extension may result from co- and post-seismic arc normal extension, as supported by the 2004 mega-earthquake measurements. Overall, the strike-slip arc of Sumatra has intermediate features between those of extensional and contractional arcs.

A demographic survey of unwanted horses in Ireland 2005-2010

PubMed Central

2012-01-01

Background The Irish Horse Industry expanded during the Celtic Tiger boom years, then contracted in the current economic recession. High value horses were traditionally controlled through sale at public auction, private sales and sales to dealers; these are now also being reduced by decreases in production (> 40%), and increases in retirement, re-homing, euthanasia and disposal through Category 2 plants and abattoirs. The absence or banning of horse abattoirs has been shown to have very significant welfare social and economic consequences in the USA. This study described the currently available data on the demographics of unwanted horses in Ireland from 2005 to 2010. Results The majority of horses euthanised by practicing veterinarians are destroyed on medical grounds but the number euthanised at the request of welfare groups and the state, as well as welfare related calls and the number of horses involved in these calls and subsequent visits is increasing reflecting the increasing involvement of the veterinary profession in equine welfare. Welfare groups have limited resources and do not have a tradition of recording data, but they too have reported increasing calls, visits and numbers of horses per visit. Welfare groups provide significant service to equine welfare and the community. Local Authorities report similar trends. Over 300 horses were found dead or required immediate or subsequent euthanasia following welfare group and local authority visits in 2010, which is of national concern. The majority of local authority interfaces with unwanted horses are with urban (60%) rather than rural (40%) horses. Mortality figures are poor indicators of non-fatal neglect. More horses were admitted into the care of local authorities than welfare groups, reflecting significant state and taxpayer investment in the control of low value horses. Category 2 plants and abattoirs represent a significant state investment in licensing and control in the national interest. Abattoirs provide an increasingly important and essential service for the disposal of unwanted horses. Despite the increase in unwanted horses, Ireland is a minority contributor to the EU slaughter total. Conclusions There is a need for annual demographic data compilation and review of the numbers of unwanted horses and ponies within the horse industry to assist policy makers and legislators. PMID:22385906

Direct effects of mitochondrial dysfunction on poor bone health in Leigh syndrome.

PubMed

Kato, Hiroki; Han, Xu; Yamaza, Haruyoshi; Masuda, Keiji; Hirofuji, Yuta; Sato, Hiroshi; Pham, Thanh Thi Mai; Taguchi, Tomoaki; Nonaka, Kazuaki

2017-11-04

Mitochondrial diseases are the result of aberrant mitochondrial function caused by mutations in either nuclear or mitochondrial DNA. Poor bone health has recently been suggested as a symptom of mitochondrial diseases; however, a direct link between decreased mitochondrial function and poor bone health in mitochondrial disease has not been demonstrated. In this study, stem cells from human exfoliated deciduous teeth (SHED) were isolated from a child with Leigh syndrome (LS), a mitochondrial disease, and the effects of decreased mitochondrial function on poor bone health were analyzed. Compared with control SHED, LS SHED displayed decreased osteoblastic differentiation and calcium mineralization. The intracellular and mitochondrial calcium levels were lower in LS SHED than in control SHED. Furthermore, the mitochondrial activity of LS SHED was decreased compared with control SHED both with and without osteoblastic differentiation. Our results indicate that decreased osteoblast differentiation potential and osteoblast function contribute to poor bone health in mitochondrial diseases. Copyright © 2017 Elsevier Inc. All rights reserved.

Perceptual and memorial contributions to developmental prosopagnosia.

PubMed

Ulrich, Philip I N; Wilkinson, David T; Ferguson, Heather J; Smith, Laura J; Bindemann, Markus; Johnston, Robert A; Schmalzl, Laura

2017-02-01

Developmental prosopagnosia (DP) is commonly associated with the failure to properly perceive individuating facial properties, notably those conveying configural or holistic content. While this may indicate that the primary impairment is perceptual, it is conceivable that some cases of DP are instead caused by a memory impairment, with any perceptual complaint merely allied rather than causal. To investigate this possibility, we administered a battery of face perception tasks to 11 individuals who reported that their face recognition difficulties disrupt daily activity and who also performed poorly on two formal tests of face recognition. Group statistics identified, relative to age- and gender-matched controls, difficulties in apprehending global-local relations and the holistic properties of faces, and in matching across viewpoints, but these were mild in nature and were not consistently evident at the level of individual participants. Six of the 11 individuals failed to show any evidence of perceptual impairment. In the remaining five individuals, no single perceptual deficit, or combination of deficits, was necessary or sufficient for poor recognition performance. These data suggest that some cases of DP are better explained by a memorial rather than perceptual deficit, and highlight the relevance of the apperceptive/associative distinction more commonly applied to the allied syndrome of acquired prosopagnosia.

Development, validation and comparison of NIR and Raman methods for the identification and assay of poor-quality oral quinine drops.

PubMed

Mbinze, J K; Sacré, P-Y; Yemoa, A; Mavar Tayey Mbay, J; Habyalimana, V; Kalenda, N; Hubert, Ph; Marini, R D; Ziemons, E

2015-01-01

Poor quality antimalarial drugs are one of the public's major health problems in Africa. The depth of this problem may be explained in part by the lack of effective enforcement and the lack of efficient local drug analysis laboratories. To tackle part of this issue, two spectroscopic methods with the ability to detect and to quantify quinine dihydrochloride in children's oral drops formulations were developed and validated. Raman and near infrared (NIR) spectroscopy were selected for the drug analysis due to their low cost, non-destructive and rapid characteristics. Both of the methods developed were successfully validated using the total error approach in the range of 50-150% of the target concentration (20%W/V) within the 10% acceptance limits. Samples collected on the Congolese pharmaceutical market were analyzed by both techniques to detect potentially substandard drugs. After a comparison of the analytical performance of both methods, it has been decided to implement the method based on NIR spectroscopy to perform the routine analysis of quinine oral drop samples in the Quality Control Laboratory of Drugs at the University of Kinshasa (DRC). Copyright © 2015 Elsevier B.V. All rights reserved.

Salivary function and glycemic control in older persons with diabetes.

PubMed

Chavez, E M; Taylor, G W; Borrell, L N; Ship, J A

2000-03-01

There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population. Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire. Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates. These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.

Rural Action Strengthens Ties between School and Community during Appalachian Ohio's Long Fight for Equitable School Funding. Rural Trust Featured Project.

ERIC Educational Resources Information Center

Null, Elisabeth Higgins

Because school systems throughout America depend on local property taxes for much of their revenue, districts with poor property valuations, especially rural districts, are facing fiscal crises. In response to a lawsuit filed in 1991, the Ohio Supreme Court twice decided that the state's heavy reliance on local property taxes for school funding…

Region effects influence local tree species diversity.

PubMed

Ricklefs, Robert E; He, Fangliang

2016-01-19

Global patterns of biodiversity reflect both regional and local processes, but the relative importance of local ecological limits to species coexistence, as influenced by the physical environment, in contrast to regional processes including species production, dispersal, and extinction, is poorly understood. Failure to distinguish regional influences from local effects has been due, in part, to sampling limitations at small scales, environmental heterogeneity within local or regional samples, and incomplete geographic sampling of species. Here, we use a global dataset comprising 47 forest plots to demonstrate significant region effects on diversity, beyond the influence of local climate, which together explain more than 92% of the global variation in local forest tree species richness. Significant region effects imply that large-scale processes shaping the regional diversity of forest trees exert influence down to the local scale, where they interact with local processes to determine the number of coexisting species.

Evaluation of Ecological Environment Security in Contiguous Poverty Alleviation Area of Sichuan Province

NASA Astrophysics Data System (ADS)

Xian, W.; Chen, Y.; Chen, J.; Luo, X.; Shao, H.

2018-04-01

According to the overall requirements of ecological construction and environmental protection, rely on the national key ecological engineering, strengthen ecological environmental restoration and protection, improve forest cover, control soil erosion, construct important ecological security barrier in poor areas, inhibit poverty alleviation through ecological security in this area from environmental damage to the vicious cycle of poverty. Obviously, the dynamic monitoring of ecological security in contiguous destitute areas of Sichuan province has a policy sense of urgency and practical significance. This paper adopts RS technology and GIS technology to select the Luhe region of Jinchuan county and Ganzi prefecture as the research area, combined with the characteristics of ecological environment in poor areas, the impact factors of ecological environment are determined as land use type, terrain slope, vegetation cover, surface water, soil moisture and other factors. Using the ecological environmental safety assessment model, the ecological environment safety index is calculated. According to the index, the ecological environment safety of the research area is divided into four levels. The ecological environment safety classification map of 1990 in 2009 is obtained. It can be seen that with the human modern life and improve their economic level, the surrounding environment will be destroyed, because the research area ecological environment is now in good, the ecological environment generally tends to be stable. We should keep its ecological security good and improve local economic income. The relationship between ecological environmental security and economic coordinated development in poor areas has very important strategic significance.

Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria (January-March 2012).

PubMed

Ajayi, Nnennaya A; Nwigwe, Chinedu G; Azuogu, Ben N; Onyire, Benson N; Nwonwu, Elizabeth U; Ogbonnaya, Lawrence U; Onwe, Francis I; Ekaete, Tobin; Günther, Stephan; Ukwaja, Kingsley N

2013-11-01

Despite the epidemic nature of Lassa fever (LF), details of outbreaks and response strategies have not been well documented in resource-poor settings. We describe the course of a LF outbreak in Ebonyi State, Nigeria, during January to March 2012. We analyzed clinical, epidemiological, and laboratory data from surveillance records and hospital statistics during the outbreak. Fisher's exact tests were used to compare proportions and t-tests to compare differences in means. The outbreak response consisted of effective coordination, laboratory testing, active surveillance, community mobilization, contact and suspected case evaluation, and case management. Twenty LF cases (10 confirmed and 10 suspected) were recorded during the outbreak. Nosocomial transmission to six health workers occurred through the index case. Only 1/110 contacts had an asymptomatic infection. Overall, there was high case fatality rate among all cases (6/20; 30%). Patients who received ribavirin were less likely to die than those who did not (p=0.003). The mean delay to presentation for patients who died was 11 ± 3.5 days, while for those who survived was 6 ± 2.6 days (p<0.001). The response strategies contained the epidemic. Challenges to control efforts included poor local laboratory capacity, inadequate/poor quality of protective materials, fear among health workers, and inadequate emergency preparedness. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liss, Adam L.; Ben-David, Merav A.; Jagsi, Reshma

2014-05-01

Purpose: To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials: Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by themore » treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results: A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions: In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.« less

Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry.

PubMed

Cheong, Ai Theng; Lee, Ping Yein; Sazlina, Shariff-Ghazali; Mohamad Adam, Bujang; Chew, Boon How; Mastura, Ismail; Jamaiyah, Haniff; Syed Alwi, Syed-Abdul-Rahman; Sri Wahyu, Taher; Nafiza, Mat-Nasir

2013-12-10

Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women. This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control. Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides. Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted.

Local concentration of fast-food outlets is associated with poor nutrition and obesity.

PubMed

Kruger, Daniel J; Greenberg, Emily; Murphy, Jillian B; DiFazio, Lindsay A; Youra, Kathryn R

2014-01-01

We investigated the relationship of the local availability of fast-food restaurant locations with diet and obesity. We geocoded addresses of survey respondents and fast-food restaurant locations to assess the association between the local concentration of fast-food outlets, BMI, and fruit and vegetable consumption. The survey was conducted in Genesee County, Michigan. There were 1345 individuals included in this analysis, and the response rate was 25%. The Speak to Your Health! Community Survey included fruit and vegetable consumption items from the Behavioral Risk Factor Surveillance System, height, weight, and demographics. We used ArcGIS to map fast-food outlets and survey respondents. Stepwise linear regressions identified unique predictors of body mass index (BMI) and fruit and vegetable consumption. Survey respondents had 8 ± 7 fast-food outlets within 2 miles of their home. Individuals living in close proximity to fast-food restaurants had higher BMIs t(1342) = 3.21, p < .001, and lower fruit and vegetable consumption, t(1342) = 2.67, p = .008. Individuals may be at greater risk for adverse consequences of poor nutrition because of the patterns in local food availability, which may constrain the success of nutrition promotion efforts. Efforts to decrease the local availability of unhealthy foods as well as programs to help consumers identify strategies for obtaining healthy meals at fast-food outlets may improve health outcomes.

Internet use, browsing, and the urban poor: implications for cancer control.

PubMed

Viswanath, K; McCloud, Rachel; Minsky, Sara; Puleo, Elaine; Kontos, Emily; Bigman-Galimore, Cabral; Rudd, Rima; Emmons, Karen M

2013-12-01

Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Internet use increased among intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.

Response of brain metastasis from lung cancer patients to an oral nutraceutical product containing silibinin.

PubMed

Bosch-Barrera, Joaquim; Sais, Elia; Cañete, Noemí; Marruecos, Jordi; Cuyàs, Elisabet; Izquierdo, Angel; Porta, Rut; Haro, Manel; Brunet, Joan; Pedraza, Salvador; Menendez, Javier A

2016-05-31

Despite multimodal treatment approaches, the prognosis of brain metastases (BM) from non-small cell lung cancer (NSCLC) remains poor. Untreated patients with BM have a median survival of about 1 month, with almost all patients dying from neurological causes. We herein present the first report describing the response of BM from NSCLC patients to an oral nutraceutical product containing silibinin, a flavonoid extracted from the seeds of the milk thistle. We present evidence of how the use of the silibinin-based nutraceutical Legasil® resulted in significant clinical and radiological improvement of BM from NSCLC patients with poor performance status that progressed after whole brain radiotherapy and chemotherapy. The suppressive effects of silibinin on progressive BM, which involved a marked reduction of the peritumoral brain edema, occurred without affecting the primary lung tumor outgrowth in NSCLC patients. Because BM patients have an impaired survival prognosis and are in need for an immediate tumor control, the combination of brain radiotherapy with silibinin-based nutraceuticals might not only alleviate BM edema but also prove local control and time for either classical chemotherapeutics with immunostimulatory effects or new immunotherapeutic agents such as checkpoint blockers to reveal their full therapeutic potential in NSCLC BM patients. New studies aimed to illuminate the mechanistic aspects underlying the regulatory effects of silibinin on the cellular and molecular pathobiology of BM might expedite the entry of new formulations of silibinin into clinical testing for progressive BM from lung cancer patients.

Response of brain metastasis from lung cancer patients to an oral nutraceutical product containing silibinin

PubMed Central

Bosch-Barrera, Joaquim; Sais, Elia; Cañete, Noemí; Marruecos, Jordi; Cuyàs, Elisabet; Izquierdo, Angel; Porta, Rut; Haro, Manel; Brunet, Joan; Pedraza, Salvador; Menendez, Javier A.

2016-01-01

Despite multimodal treatment approaches, the prognosis of brain metastases (BM) from non-small cell lung cancer (NSCLC) remains poor. Untreated patients with BM have a median survival of about 1 month, with almost all patients dying from neurological causes. We herein present the first report describing the response of BM from NSCLC patients to an oral nutraceutical product containing silibinin, a flavonoid extracted from the seeds of the milk thistle. We present evidence of how the use of the silibinin-based nutraceutical Legasil® resulted in significant clinical and radiological improvement of BM from NSCLC patients with poor performance status that progressed after whole brain radiotherapy and chemotherapy. The suppressive effects of silibinin on progressive BM, which involved a marked reduction of the peritumoral brain edema, occurred without affecting the primary lung tumor outgrowth in NSCLC patients. Because BM patients have an impaired survival prognosis and are in need for an immediate tumor control, the combination of brain radiotherapy with silibinin-based nutraceuticals might not only alleviate BM edema but also prove local control and time for either classical chemotherapeutics with immunostimulatory effects or new immunotherapeutic agents such as checkpoint blockers to reveal their full therapeutic potential in NSCLC BM patients. New studies aimed to illuminate the mechanistic aspects underlying the regulatory effects of silibinin on the cellular and molecular pathobiology of BM might expedite the entry of new formulations of silibinin into clinical testing for progressive BM from lung cancer patients. PMID:26959886

Internet Use, Browsing, and the Urban Poor: Implications for Cancer Control

PubMed Central

2013-01-01

Background Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. Methods The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Results Internet use increased among Intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals’ sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Conclusions Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information. PMID:24395992

Bridging glycated hemoglobin with quality of life and health state; a randomized case-control study among type 2 diabetes patients.

PubMed

Gillani, Syed Wasif; Ansari, Irfan Altaf; Zaghloul, Hisham A; Abdul, Mohi Iqbal Mohammad; Sulaiman, Syed Azhar Syed; Baig, Mirza R

2018-01-01

The aim of this study was to explore the predictors of QOL and health state and examine the relationship with glycemic control among type 2 diabetes mellitus (T2DM) patients. A randomized cross-sectional case-control study was conducted among n = 600 T2DM patients of Malaysia. Study population was distributed into three groups as: controls: patients with HbA1c ≤ 7 (n = 199), cases arm 1: with HbA1c 7-7.9 (n = 204) and cases arm 2 (n = 197): with HbA1c ≥ 8 consecutively last 3 times. Participants with diabetes history > 10 years exhibits higher mean QOL score among all the three groups. In contrast mean health status score significantly ( p  < 0.001) reduced with the exposure duration of diabetes both within and intergroup assessment that participants with poor glycemic control (arm 2) had significantly higher mean QOL score with knowledge and self-care dimensions as compared to others, however mean health state scores were significantly ( p  < 0.001) lower in all assessment dimensions as compared to controls. The F test of significance showed that demographic and clinical parameters were strong predictors of QOL, whereas self-care activities, comorbidities, ability of positive management and BMI were significant predictors to health state for consistent glycemic control (controls) as compared to poor glycemic control (arm 2) participants. This study suggested that poor glycemic index reported low self-care behavior, increase barriers to daily living activities and poor ability to manage diabetes positively, which cause poor QOL and decrease health state.

Phosphatidylinositol Phosphate 5-Kinase Iγi2 in Association with Src Controls Anchorage-independent Growth of Tumor Cells*

PubMed Central

Thapa, Narendra; Choi, Suyong; Hedman, Andrew; Tan, Xiaojun; Anderson, Richard A.

2013-01-01

A fundamental property of tumor cells is to defy anoikis, cell death caused by a lack of cell-matrix interaction, and grow in an anchorage-independent manner. How tumor cells organize signaling molecules at the plasma membrane to sustain oncogenic signals in the absence of cell-matrix interactions remains poorly understood. Here, we describe a role for phosphatidylinositol 4-phosphate 5-kinase (PIPK) Iγi2 in controlling anchorage-independent growth of tumor cells in coordination with the proto-oncogene Src. PIPKIγi2 regulated Src activation downstream of growth factor receptors and integrins. PIPKIγi2 directly interacted with the C-terminal tail of Src and regulated its subcellular localization in concert with talin, a cytoskeletal protein targeted to focal adhesions. Co-expression of PIPKIγi2 and Src synergistically induced the anchorage-independent growth of nonmalignant cells. This study uncovers a novel mechanism where a phosphoinositide-synthesizing enzyme, PIPKIγi2, functions with the proto-oncogene Src, to regulate oncogenic signaling. PMID:24151076

The Glide/Gcm fate determinant controls initiation of collective cell migration by regulating Frazzled

PubMed Central

Gupta, Tripti; Kumar, Arun; Cattenoz, Pierre B.; VijayRaghavan, K; Giangrande, Angela

2016-01-01

Collective migration is a complex process that contributes to build precise tissue and organ architecture. Several molecules implicated in cell interactions also control collective migration, but their precise role and the finely tuned expression that orchestrates this complex developmental process are poorly understood. Here, we show that the timely and threshold expression of the Netrin receptor Frazzled triggers the initiation of glia migration in the developing Drosophila wing. Frazzled expression is induced by the transcription factor Glide/Gcm in a dose-dependent manner. Thus, the glial determinant also regulates the efficiency of collective migration. NetrinB but not NetrinA serves as a chemoattractant and Unc5 contributes as a repellant Netrin receptor for glia migration. Our model includes strict spatial localization of a ligand, a cell autonomously acting receptor and a fate determinant that act coordinately to direct glia toward their final destination. DOI: http://dx.doi.org/10.7554/eLife.15983.001 PMID:27740455

Exploring the Spatial Association between Social Deprivation and Cardiovascular Disease Mortality at the Neighborhood Level.

PubMed

Ford, Mary Margaret; Highfield, Linda D

2016-01-01

Cardiovascular disease (CVD), the leading cause of death in the United States, is impacted by neighborhood-level factors including social deprivation. To measure the association between social deprivation and CVD mortality in Harris County, Texas, global (Ordinary Least Squares (OLS) and local (Geographically Weighted Regression (GWR)) models were built. The models explored the spatial variation in the relationship at a census-tract level while controlling for age, income by race, and education. A significant and spatially varying association (p < .01) was found between social deprivation and CVD mortality, when controlling for all other factors in the model. The GWR model provided a better model fit over the analogous OLS model (R2 = .65 vs. .57), reinforcing the importance of geography and neighborhood of residence in the relationship between social deprivation and CVD mortality. Findings from the GWR model can be used to identify neighborhoods at greatest risk for poor health outcomes and to inform the placement of community-based interventions.

Confined Doping for Control of Transport Properties in Nanowires and Nanofilms

NASA Astrophysics Data System (ADS)

Zhong, Jianxin; Stocks, G. Malcolm

2006-03-01

Doping, an essential element for manipulation of electronic transport in traditional semiconductor industry, is widely expected to play important role as well in control of transport properties in nanostructures. However, traditional theory of electronic disorder predicts that doping in one-dimensional and two-dimensional systems leads to carrier localization, limiting practical applications due to poor carrier mobility. Here, a novel concept is proposed that offers the possibility to significantly increase carrier mobility by confining the distribution of dopants within a particular region [1]. Thus, the doped nanostructure becomes a coupled system comprising a doped subsystem and a perfect crystalline subsystem. We showed that carrier mobility in such a dopped nanowire or a nanofilm exhibits counterintuitive behavior in the regime of heavy doping. In particular, the larger the dopant concentration the higher the carrier mobility; we trace this transition to the existence of quasi-mobility-edges in the nanowires and mobility edges in nanofilms. *J.X. Zhong and G.M. Stocks, Nano Lett., in press, (2005)

Climatic controls on hurricane patterns: a 1200-y near-annual record from Lighthouse Reef, Belize

NASA Astrophysics Data System (ADS)

Denommee, K. C.; Bentley, S. J.; Droxler, A. W.

2014-01-01

Tropical cyclones (TCs) are powerful agents of destruction, and understanding climatic controls on TC patterns is of great importance. Over timescales of seasons to several decades, relationships among TC track, frequency, intensity and basin-scale climate changes are well documented by instrumental records. Over centuries to millennia, climate-shift influence on TC regimes remains poorly constrained. To better understand these relationships, records from multiple locations of TC strikes spanning millennia with high temporal resolution are required, but such records are rare. Here we report on a highly detailed sedimentary proxy record of paleo-TC strikes from the Blue Hole of Lighthouse Reef, Belize. Our findings provide an important addition to other high-resolution records, which collectively demonstrate that shifts between active and inactive TC regimes have occurred contemporaneously with shifts hemispheric-scale oceanic and atmospheric circulation patterns such as MDR SSTs and NAO mode, rather than with changes in local climate phenomena as has previously been suggested.

Epidermal Notch1 recruits RORγ(+) group 3 innate lymphoid cells to orchestrate normal skin repair.

PubMed

Li, Zhi; Hodgkinson, Tom; Gothard, Elizabeth J; Boroumand, Soulmaz; Lamb, Rebecca; Cummins, Ian; Narang, Priyanka; Sawtell, Amy; Coles, Jenny; Leonov, German; Reboldi, Andrea; Buckley, Christopher D; Cupedo, Tom; Siebel, Christian; Bayat, Ardeshir; Coles, Mark C; Ambler, Carrie A

2016-04-21

Notch has a well-defined role in controlling cell fate decisions in the embryo and the adult epidermis and immune systems, yet emerging evidence suggests Notch also directs non-cell-autonomous signalling in adult tissues. Here, we show that Notch1 works as a damage response signal. Epidermal Notch induces recruitment of immune cell subsets including RORγ(+) ILC3s into wounded dermis; RORγ(+) ILC3s are potent sources of IL17F in wounds and control immunological and epidermal cell responses. Mice deficient for RORγ(+) ILC3s heal wounds poorly resulting from delayed epidermal proliferation and macrophage recruitment in a CCL3-dependent process. Notch1 upregulates TNFα and the ILC3 recruitment chemokines CCL20 and CXCL13. TNFα, as a Notch1 effector, directs ILC3 localization and rates of wound healing. Altogether these findings suggest that Notch is a key stress/injury signal in skin epithelium driving innate immune cell recruitment and normal skin tissue repair.

Partial discharge localization in power transformers based on the sequential quadratic programming-genetic algorithm adopting acoustic emission techniques

NASA Astrophysics Data System (ADS)

Liu, Hua-Long; Liu, Hua-Dong

2014-10-01

Partial discharge (PD) in power transformers is one of the prime reasons resulting in insulation degradation and power faults. Hence, it is of great importance to study the techniques of the detection and localization of PD in theory and practice. The detection and localization of PD employing acoustic emission (AE) techniques, as a kind of non-destructive testing, plus due to the advantages of powerful capability of locating and high precision, have been paid more and more attention. The localization algorithm is the key factor to decide the localization accuracy in AE localization of PD. Many kinds of localization algorithms exist for the PD source localization adopting AE techniques including intelligent and non-intelligent algorithms. However, the existed algorithms possess some defects such as the premature convergence phenomenon, poor local optimization ability and unsuitability for the field applications. To overcome the poor local optimization ability and easily caused premature convergence phenomenon of the fundamental genetic algorithm (GA), a new kind of improved GA is proposed, namely the sequence quadratic programming-genetic algorithm (SQP-GA). For the hybrid optimization algorithm, SQP-GA, the sequence quadratic programming (SQP) algorithm which is used as a basic operator is integrated into the fundamental GA, so the local searching ability of the fundamental GA is improved effectively and the premature convergence phenomenon is overcome. Experimental results of the numerical simulations of benchmark functions show that the hybrid optimization algorithm, SQP-GA, is better than the fundamental GA in the convergence speed and optimization precision, and the proposed algorithm in this paper has outstanding optimization effect. At the same time, the presented SQP-GA in the paper is applied to solve the ultrasonic localization problem of PD in transformers, then the ultrasonic localization method of PD in transformers based on the SQP-GA is proposed. And localization results based on the SQP-GA are compared with some algorithms such as the GA, some other intelligent and non-intelligent algorithms. The results of calculating examples both stimulated and spot experiments demonstrate that the localization method based on the SQP-GA can effectively prevent the results from getting trapped into the local optimum values, and the localization method is of great feasibility and very suitable for the field applications, and the precision of localization is enhanced, and the effectiveness of localization is ideal and satisfactory.

Cushing's syndrome in type 2 diabetes patients with poor glycemic control.

PubMed

Gungunes, Askin; Sahin, Mustafa; Demirci, Taner; Ucan, Bekir; Cakir, Evrim; Arslan, Muyesser Sayki; Unsal, Ilknur Ozturk; Karbek, Basak; Calıskan, Mustafa; Ozbek, Mustafa; Cakal, Erman; Delibasi, Tuncay

2014-12-01

Cushing's syndrome may be more frequent in some specific patient groups such as type 2 diabetes and obesity. The aim of this study was to investigate the prevalence of Cushing's syndrome in outpatients with type 2 diabetes with poor glycemic control despite at least 3-months insulin therapy. Outpatients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite receiving at least 3-months long insulin treatment (insulin alone or insulin with oral antidiabetics) were included. Patients with classic features of Cushing's syndrome were excluded. Overnight 1 mg dexamethasone suppression test (DST) was performed as a screening test. A total of 277 patients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite insulin therapy were included. Two of the 277 patients with type 2 diabetes were diagnosed with Cushing's syndrome (0.72 %). Hypertension was statistically more frequent in the patients with cortisol levels ≥1.8 μg/dL than the patients with cortisol levels <1.8 μg/dL after overnight 1 mg DST (p = 0.041). Statistically significant correlation was determined between cortisol levels after 1 mg DST and age, daily insulin dose (r = 0.266 and p < 0.001, r = 0.163 and p = 0.008, respectively). According to our findings, the prevalence of Cushing's syndrome among patients with type 2 diabetes with poor glycemic control despite insulin therapy is much higher than in the general population. The patients with type 2 diabetes with poor glycemic control despite at least three months of insulin therapy should be additionally tested for Cushing's syndrome if they have high dose insülin requirements.

Adenoid cystic carcinoma of the lacrimal gland.

PubMed

Sanders, Jason C; Mendenhall, William M; Werning, John W

2016-01-01

This is a retrospective analysis of the 50-year University of Florida experience treating adenoid cystic carcinoma of the lacrimal gland with radiation therapy. Between 1965 and 2015, 8 patients with adenoid cystic carcinoma of the lacrimal gland received radiation therapy with curative intent. Four patients received postoperative radiation therapy and 4 received definitive radiation therapy alone. The median follow-up was 3.3 years (range, 0.3 to 11.2 years). All 4 patients who received postoperative radiation therapy received 74.4 Gy. The 4 patients who received radiation therapy alone received a median dose of 72.3 Gy (range, 70.0 to 74.4 Gy). The overall survival rates at 5 and 10 years were 25% and 13%, respectively. The cause-specific survival rates at 5 and 10 years were 29% and 14%, respectively. The local control and freedom from metastases rates at 5 and 10 years were both 43%. Local recurrences occurred in 50% of patients, and distant metastatic disease occurred in 38% of patients. No patients experienced acute complications of treatment that warranted a treatment break. Two patients experienced bone exposure as late complications of treatment. The results of this study illustrate the propensity for adenoid cystic carcinoma of the lacrimal gland to recur both locally and with distant metastases despite aggressive local treatment measures. This study also demonstrates the relatively poor outcomes for individuals with this type of tumor. Copyright © 2016 Elsevier Inc. All rights reserved.

'I was thinking too much': experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe.

PubMed

Kidia, Khameer; Machando, Debra; Bere, Tarisai; Macpherson, Kirsty; Nyamayaro, Primrose; Potter, Lucy; Makadzange, Tariro; Munjoma, Ronald; Marufu, Marshall; Araya, Ricardo; Safren, Steven; O'Cleirigh, Conall; Chibanda, Dixon; Abas, Melanie

2015-07-01

To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care. Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy. © 2015 John Wiley & Sons Ltd.

Precipitation data in a mountainous catchment in Honduras: quality assessment and spatiotemporal characteristics

NASA Astrophysics Data System (ADS)

Westerberg, I.; Walther, A.; Guerrero, J.-L.; Coello, Z.; Halldin, S.; Xu, C.-Y.; Chen, D.; Lundin, L.-C.

2010-08-01

An accurate description of temporal and spatial precipitation variability in Central America is important for local farming, water supply and flood management. Data quality problems and lack of consistent precipitation data impede hydrometeorological analysis in the 7,500 km2 Choluteca River basin in central Honduras, encompassing the capital Tegucigalpa. We used precipitation data from 60 daily and 13 monthly stations in 1913-2006 from five local authorities and NOAA's Global Historical Climatology Network. Quality control routines were developed to tackle the specific data quality problems. The quality-controlled data were characterised spatially and temporally, and compared with regional and larger-scale studies. Two gap-filling methods for daily data and three interpolation methods for monthly and mean annual precipitation were compared. The coefficient-of-correlation-weighting method provided the best results for gap-filling and the universal kriging method for spatial interpolation. In-homogeneity in the time series was the main quality problem, and 22% of the daily precipitation data were too poor to be used. Spatial autocorrelation for monthly precipitation was low during the dry season, and correlation increased markedly when data were temporally aggregated from a daily time scale to 4-5 days. The analysis manifested the high spatial and temporal variability caused by the diverse precipitation-generating mechanisms and the need for an improved monitoring network.

Impaired development of intrinsic connectivity networks in children with medically intractable localization-related epilepsy.

PubMed

Ibrahim, George M; Morgan, Benjamin R; Lee, Wayne; Smith, Mary Lou; Donner, Elizabeth J; Wang, Frank; Beers, Craig A; Federico, Paolo; Taylor, Margot J; Doesburg, Sam M; Rutka, James T; Snead, O Carter

2014-11-01

Typical childhood development is characterized by the emergence of intrinsic connectivity networks (ICNs) by way of internetwork segregation and intranetwork integration. The impact of childhood epilepsy on the maturation of ICNs is, however, poorly understood. The developmental trajectory of ICNs in 26 children (8-17 years) with localization-related epilepsy and 28 propensity-score matched controls was evaluated using graph theoretical analysis of whole brain connectomes from resting-state functional magnetic resonance imaging (fMRI) data. Children with epilepsy demonstrated impaired development of regional hubs in nodes of the salience and default mode networks (DMN). Seed-based connectivity and hierarchical clustering analysis revealed significantly decreased intranetwork connections, and greater internetwork connectivity in children with epilepsy compared to controls. Significant interactions were identified between epilepsy duration and the expected developmental trajectory of ICNs, indicating that prolonged epilepsy may cause progressive alternations in large-scale networks throughout childhood. DMN integration was also associated with better working memory, whereas internetwork segregation was associated with higher full-scale intelligence quotient scores. Furthermore, subgroup analyses revealed the thalamus, hippocampus, and caudate were weaker hubs in children with secondarily generalized seizures, relative to other patient subgroups. Our findings underscore that epilepsy interferes with the developmental trajectory of brain networks underlying cognition, providing evidence supporting the early treatment of affected children. Copyright © 2014 Wiley Periodicals, Inc.

Housing and health in Germany.

PubMed

Pollack, C E; von dem Knesebeck, O; Siegrist, J

2004-03-01

To examine the association between housing tenure and self rated health, controlling for socioeconomic measures and testing the mediating effects of physical features of the home, pollution in the local environment, and relationships with neighbours. Cross sectional panel study with people nested within households. Analyses were performed using multilevel methods. Population based sample in Germany. People aged 16 or older were interviewed in the 1999 wave of the socio-economic panel study (n = 14 055) and nested within households (n = 7381). 44.0% of the population lived in homes that they owned. In bivariate analyses, women, people who live in apartment buildings, reside near cities, live in crowded homes, have homes in need of renovation, report higher pollution, and have distant contact with neighbours are more likely to live in rented homes. In multilevel analyses, renting a home was found to be associated with poor self rated health (OR 1.48, 95% CI 1.31 to 1.68). This relation persisted after controlling for education and income and was partially mediated by the need for household renovation, the perception of air and noise pollution in the local area, and distant relationship with neighbours, all of which were significantly associated with self rated health. This study provides evidence that home ownership is significantly associated with self rated health in Germany, and this relation may be, in part, mediated by physical and social features of home and neighbourhood.

Theory of Mind in Schizophrenia: Associations With Clinical and Cognitive Insight Controlling for Levels of Psychopathology.

PubMed

Popolo, Raffaele; Dimaggio, Giancarlo; Luther, Lauren; Vinci, Giancarlo; Salvatore, Giampaolo; Lysaker, Paul H

2016-03-01

Poor insight in schizophrenia is a risk factor for both poor outcomes and treatment adherence. Accordingly, interest in identifying causes of poor insight has increased. This study explored whether theory of mind (ToM) impairments are linked to poor clinical and cognitive insight independent of psychopathology. Participants with schizophrenia (n = 37) and control subjects (n = 40) completed assessments of ToM with the Hinting Task and the Brüne Picture Sequencing Task, clinical insight and psychopathology with the Positive and Negative Syndrome Scale, and cognitive insight with the Beck Cognitive Insight Scale. Results indicated that the schizophrenia group had greater impairments in ToM relative to control subjects. In the schizophrenia group, the Hinting Task performance was related to both cognitive and clinical insight, with only the relationship with cognitive insight persisting after controlling for psychopathology. Picture Sequencing Task performance was related to cognitive insight only. Future research directions and clinical implications are discussed.

Poor glycemic control as a reason for referral of diabetes patients to specialists in Israel

PubMed Central

Fogelman, Yacov; Karkabi, Khaled; Goldfracht, Margalit

2016-01-01

Aims/introduction Family physicians face the dilemma of when to refer patients with diabetes to specialists. This study examined attitudes of family physicians to referring patients with poor glucose control to diabetes specialists. Materials and methods At continuous medical education courses, family physicians were asked to respond anonymously, as to whether they generally manage the diabetes of their patients, and specifically those with poor glycemic control (HbA1c>9.0%). Results Of 470 respondents, 426 (90%) reported that they generally manage their patients’ diabetes; 202 (43%) reported that they manage the diabetes of patients with HbA1c>9.0%. Board certification in family medicine and affiliation to a health maintenance organization, but not sex, age, years of professional experience, or the proportion of patients with diabetes at their clinics, were associated with referral practices. Conclusions Family medicine residency and organizational support appear to promote treatment by family physicians of patients with poorly controlled diabetes in the primary care setting. PMID:27124172

Adolescent and parent motivation for change affects psychotherapy outcomes among youth with poorly controlled diabetes.

PubMed

Ellis, Deborah A; Berio, Heidi; Carcone, April Idalski; Naar-King, Sylvie

2012-01-01

Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes. Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dose, and youth health status were collected. Structural equation modeling was used to test the direct and indirect effects of motivation on treatment outcomes. Parent motivation was significantly related to alliance and fidelity. Only alliance was significantly related to posttreatment metabolic control. In adolescent models, only motivation was significantly related to alliance. In both models, motivation had a significant indirect effect on metabolic control through alliance. Findings demonstrate the importance of parent and youth initial motivational status and treatment alliance to treatment outcome among youth with poorly controlled diabetes. Additional research on treatment techniques that promote motivation for change is needed.

Effect of a soy isoflavone supplement on lung function and clinical outcomes in patients with poorly controlled asthma: a randomized clinical trial.

PubMed

Smith, Lewis J; Kalhan, Ravi; Wise, Robert A; Sugar, Elizabeth A; Lima, John J; Irvin, Charles G; Dozor, Allen J; Holbrook, Janet T

2015-05-26

Soy isoflavone supplements are used to treat several chronic diseases, although the data supporting their use are limited. Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control. To determine whether a soy isoflavone supplement improves asthma control in adolescent and adult patients with poorly controlled disease. Multicenter, randomized, double-blind, placebo-controlled trial conducted between May 2010 and August 2012 at 19 adult and pediatric pulmonary and allergy centers in the American Lung Association Asthma Clinical Research Centers network. Three hundred eighty-six adults and children aged 12 years or older with symptomatic asthma while taking a controller medicine and low dietary soy intake were randomized, and 345 (89%) completed spirometry at week 24. Participants were randomly assigned to receive soy isoflavone supplement containing 100 mg of total isoflavones (n=193) or matching placebo (n=193) in 2 divided doses administered daily for 24 weeks. The primary outcome measure was change in forced expiratory volume in the first second (FEV1) at 24 weeks. Secondary outcome measures were symptoms, episodes of poor asthma control, Asthma Control Test score (range, 5-25; higher scores indicate better control), and systemic and airway biomarkers of inflammation. Mean changes in prebronchodilator FEV1 over 24 weeks were 0.03 L (95% CI, -0.01 to 0.08 L) in the placebo group and 0.01 L (95% CI, -0.07 to 0.07 L) in the soy isoflavone group, which were not significantly different (P = .36). Mean changes in symptom scores on the Asthma Control Test (placebo, 1.98 [95% CI, 1.42-2.54] vs soy isoflavones, 2.20 [95% CI, 1.53-2.87]; positive values indicate a reduction in symptoms), number of episodes of poor asthma control (placebo, 3.3 [95% CI, 2.7-4.1] vs soy isoflavones, 3.0 [95% CI, 2.4-3.7]), and changes in exhaled nitric oxide (placebo, -3.48 ppb [95% CI, -5.99 to -0.97 ppb] vs soy isoflavones, 1.39 ppb [95% CI, -1.73 to 4.51 ppb]) did not significantly improve more with the soy isoflavone supplement than with placebo. Mean plasma genistein level increased from 4.87 ng/mL to 37.67 ng/mL (P < .001) in participants receiving the supplement. Among adults and children aged 12 years or older with poorly controlled asthma while taking a controller medication, use of a soy isoflavone supplement, compared with placebo, did not result in improved lung function or clinical outcomes. These findings suggest that this supplement should not be used for patients with poorly controlled asthma. clinicaltrials.gov Identifier: NCT01052116.

Effect of Surgery on Health-Related Quality of Life of Patients With Locally Recurrent Rectal Cancer.

PubMed

Pellino, Gianluca; Sciaudone, Guido; Candilio, Giuseppe; Selvaggi, Francesco

2015-08-01

Local recurrences of rectal cancer are best treated with surgical resection. Health-related quality of life is an important outcome measure in rectal cancer, but it has been poorly investigated in local recurrences. The purpose of this study was to assess quality of life in patients receiving or not receiving surgery for locally recurrent rectal cancer. This was a prospective cohort study. The study was conducted at a single tertiary care institution. Patients presenting with local recurrent rectal cancer between December 2002 and December 2011 were included. A control group of patients with nonrecurrent rectal cancer was prospectively enrolled (planned ratio, 1:2). All of the patients received the core Quality of Life Questionnaire C30 of the European Organisation for Research and Treatment of Cancer preoperatively or at diagnosis and then 1 and 3 years later. We compared results according to oncologic clearance (R0 vs R1 vs R2 vs no surgery). Confounding variables were tested with a multivariate logistic regression. Forty-five patients (27 men), median age 62 years (range, 34-80 years), with recurrence were observed. Twelve (26.7%) were not fit for surgery. Twenty one (63.6%), 7 (21.2%), and 5 (15.2%) received R0, R1, and R2 resections. Data for 30 (90.9%) and 25 operated patients (75.75%) were available at 1- and 3-year follow-ups. Irrespective of type of surgery and multimodal treatments, patients receiving R0/R1 resections had improvement in quality of life in all of the domains compared with the R2 and no-surgery groups. Outcomes were inferior compared with nonrecurrent control subjects (N = 71). At 3 years, R0 patients reported scores equal to those of control subjects, with superior emotional functioning. R1 patients had worse symptoms and quality of life at 3-year follow-up. Surgery impaired survival and quality of life of R2 patients compared with those who were not operated on. The study was limited because it involved a single center with a single senior surgeon. Quality of life of patients with locally recurrent rectal cancer is improved by R0 and ameliorated with R1 resection, irrespective of surgical extent. Full recovery, similar to that of nonrecurrent cancer survivors, can be expected in R0 patients but requires longer follow-up times. Surgery with macroscopic involvement of resection margins accelerates quality of life decline and shortens survival.

The influence of environment on the properties of galaxies

NASA Astrophysics Data System (ADS)

Hashimoto, Yasuhiro

1999-11-01

I will present the result of the evaluation of the environmental influences on three important galactic properties; morphology, star formation rate, and interaction in the local universe. I have used a very large and homogeneous sample of 15749 galaxies drawn from the Las Campanas Redshift Survey (Shectman et al. 1996). This data set consists of galaxies inhabiting the entire range of galactic environments, from the sparsest field to the densest clusters, thus allowing me to study environmental variations without combing multiple data sets with inhomogeneous characteristics. Furthermore, I can also extend the research to a ``general'' environmental investigation by, for the first time, decoupling the very local environment, as characterized by local galaxy density, from the effects of larger-scale environments, such as membership in a cluster. The star formation rate is characterized by the strength of EW(OII), while the galactic morphology is characterized by the automatically-measured concentration index (e.g. Okamura, Kodaira, & Watanabe 1984), which is more closely related to the bulge-to-disk ratio of galaxies than Hubble type, and is therefore expected to behave more independently on star formation activity in a galaxy. On the other hand, the first systematic quantitative investigation of the environmental influence on the interaction of galaxies is made by using two automatically-determined objective measures; the asymmetry index and existence of companions. The principal conclusions of this work are: (1)The concentration of the galactic light profile (characterized by the concentration index) is predominantly correlated with the relatively small-scale environment which is characterized by the local galaxy density. (2)The star formation rate of galaxies (characterized by the EW(OII)) is correlated both with the small-scale environment (the local galaxy density) and the larger scale environment which is characterized by the cluster membership. For weakly star forming galaxies, the star formation rate is correlated both with the local galaxy density and rich cluster membership. It also shows a correlation with poor cluster membership. For strongly star forming galaxies, the star formation rate is correlated with the local density and the poor cluster membership. (3)Interacting galaxies (characterized by the asymmetry index and/or the existence of apparent companions) show no correlation with rich cluster membership, but show a fair to strong correlation with the poor cluster membership.

Improving malaria treatment and prevention in India by aiding district managers to manage their programmes with local information: a trial assessing the impact of Lot Quality Assurance Sampling on programme outcomes.

PubMed

Valadez, Joseph J; Devkota, Baburam; Pradhan, Madan Mohan; Meherda, Pramod; Sonal, G S; Dhariwal, Akshay; Davis, Rosemary

2014-10-01

This paper reports the first trial of Lot Quality Assurance Sampling (LQAS) assessing associations between access to LQAS data and subsequent improvements in district programming. This trial concerns India's approach to addressing an increase in malaria-attributable deaths by training community health workers to diagnose, treat and prevent malaria, while using LQAS to monitor sub-district performance and make programme improvements. The Ministry of Health introduced LQAS into four matched high malaria burden districts (Annual Parasite Incidence >5) (N > 5 million). In each sub-district, we sampled four populations in three 6-monthly surveys: households, children <5 years, people with fever in the last 2 weeks and community health workers. In three districts, trained local staff collected, analysed and used data for programme management; in one control district, non-local staff collected data and did not disseminate results. For eight indicators, we calculated the change in proportion from survey one to three and used a Difference-in-Differences test to compare the relative change between intervention and control districts. Coverage increased from survey one to three for 24 of 32 comparisons. Difference-in-Differences tests revealed that intervention districts exhibited significantly greater change in four of six vertical strategies (insecticide treated bed-nets and indoor residual spraying), one of six treatment-seeking behaviours and four of 12 health worker capacity indicators. The control district displayed greater improvement than two intervention districts for one health worker capacity indicator. One district with poor management did not improve. In this study, LQAS results appeared to support district managers to increase coverage in underperforming areas, especially for vertical strategies in the presence of diligent managers. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

An improved maize marketing system for African countries: the case of Zimbabwe.

PubMed

Child, B; Muir, K; Blackie, M

1985-11-01

This article proposes a system for Zimbabwe which retains government control of national stocks and enables the parastatal marketing system to stabilize prices, at the same time ensuring a more rational delivery system in rural areas with prices reflecting storage and transport costs. The local population is encouraged to fulfill local needs, thus avoiding the expense of directing all marketing and processing through the urban areas. A more localized system will also have greater multiplier effects. Zimbabwe's maize marketing system is used to show how this system could be modified with benefits to rural consumers, producers and government. Data suggest there is little market exploitation: price differentials between markts reflect transport costs, returns on storage are reasonable, and voluntary procurement operations are usually able to stabilize prices. Zoning, movement restrictions and compulsory procurement have been shown to destabilize food markets; prices between markets are higher in periods of strict control than when marketing is relatively free. Controlled marketing answers a real political and economic need in Zimbabwe. Existing public food marketing agencies are not inherently inefficient. While stabilizing maize supply, there are important advantages in announcing preplanting prices, but any trade in maize only takes place after price setting. It is unlikely that there would be both imports and exports in any 1 year, except when previous contracts are being fulfilled. 2 policy options are available to cover anticipated periods of insufficient national maize production: the maintenance of a strategic reserve; and importation of maize to cover supply shortfalls. Single-channel marketing should be replaced by an internal free market operating between floor and ceiling prices by supply manipulation to prevent excessive producer and consumer welfare fluctuations. This system would be more efficient and have beneficial effects on development. It is more equitable for the rural poor, and result in greater stability of producer incomes, more reliable food supplies, higher producer prices and the release of public funds.

Gamma Knife radiosurgery for intracranial hemangioblastoma.

PubMed

Silva, Danilo; Grabowski, Mathew M; Juthani, Rupa; Sharma, Mayur; Angelov, Lilyana; Vogelbaum, Michael A; Chao, Samuel; Suh, John; Mohammadi, Alireza; Barnett, Gene H

2016-09-01

Gamma knife radiosurgery (GKRS) has become a treatment option for intracranial hemangioblastomas, especially in patients with poor clinical status and also high-risk surgical candidates. The objective of this study was to analyze clinical outcome and tumor control rates. Retrospective chart review revealed 12 patients with a total of 20 intracranial hemangioblastomas treated with GKRS from May 1998 until December 2014. Kaplan-Meier plots were used to calculate the actuarial local tumor control rates and rate of recurrence following GKRS. Univariate analysis, including log rank test and Wilcoxon test were used on the Kaplan-Meier plots to evaluate the predictors of tumor progression. Two-tailed p value of <0.05 was considered as significant. Median follow-up was 64months (2-184). Median tumor volume pre-GKRS was 946mm(3) (79-15970), while median tumor volume post-GKRS was 356mm(3) (30-5404). Complications were seen in two patients. Tumor control rates were 100% at 1year, 90% at 3years, and 85% at 5years, using the Kaplan-Meier method. There were no statistically significant univariate predictors of progression identified, although there was a trend towards successful tumor control in solid tumors (p=0.07). GKRS is an effective and safe option for treating intracranial hemangioblastoma with favorable tumor control rates. Copyright © 2016 Elsevier Ltd. All rights reserved.

Imaging the distribution of transient viscosity after the 2016 Mw 7.1 Kumamoto earthquake

NASA Astrophysics Data System (ADS)

Moore, James D. P.; Yu, Hang; Tang, Chi-Hsien; Wang, Teng; Barbot, Sylvain; Peng, Dongju; Masuti, Sagar; Dauwels, Justin; Hsu, Ya-Ju; Lambert, Valère; Nanjundiah, Priyamvada; Wei, Shengji; Lindsey, Eric; Feng, Lujia; Shibazaki, Bunichiro

2017-04-01

The deformation of mantle and crustal rocks in response to stress plays a crucial role in the distribution of seismic and volcanic hazards, controlling tectonic processes ranging from continental drift to earthquake triggering. However, the spatial variation of these dynamic properties is poorly understood as they are difficult to measure. We exploited the large stress perturbation incurred by the 2016 earthquake sequence in Kumamoto, Japan, to directly image localized and distributed deformation. The earthquakes illuminated distinct regions of low effective viscosity in the lower crust, notably beneath the Mount Aso and Mount Kuju volcanoes, surrounded by larger-scale variations of viscosity across the back-arc. This study demonstrates a new potential for geodesy to directly probe rock rheology in situ across many spatial and temporal scales.

Permeability of DOPC bilayers under photoinduced oxidation: Sensitivity to photosensitizer.

PubMed

Bacellar, Isabel O L; Baptista, Mauricio S; Junqueira, Helena C; Wainwright, Mark; Thalmann, Fabrice; Marques, Carlos M; Schroder, André P

2018-06-07

The modification of lipid bilayer permeability is one of the most striking yet poorly understood physical transformations that follow photoinduced lipid oxidation. We have recently proposed that the increase of permeability of photooxidized 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) bilayers is controlled by the time required by the oxidized lipid species to diffuse and aggregate into pores. Here we further probe this mechanism by studying photosensitization of DOPC membranes by methylene blue (MB) and DO15, a more hydrophobic phenothiazinium photosensitizer, under different irradiation powers. Our results not only reveal the interplay between the production rate and the diffusion of the oxidized lipids, but highlight also the importance of photosensitizer localization in the kinetics of oxidized membrane permeability. Copyright © 2018. Published by Elsevier B.V.

Intraoperative intracavitary hyperthermic chemotherapy for malignant pleural mesothelioma

PubMed Central

2017-01-01

Malignant pleural mesothelioma (MPM) is a dreadful disease with a poor prognosis. Multimodality therapy including surgical macroscopic complete resection is performed to treat operable MPM. Intraoperative intracavitary hyperthermic chemotherapy for MPM was reviewed. Appropriate papers published between 2006 and present were extracted by the PubMed advanced search by MPM (Title/Abstract), chemotherapy (Title/Abstract), and hyperthermia (All fields). Among the selected papers, those written in English, and treated more than ten MPM patients were reviewed. The intraoperative intracavitary hyperthermic chemotherapy has been performed following extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) for MPM. Cisplatin was mainly used for perfusion, and the morbidity and mortality was acceptable. In conclusion, the intraoperative intracavitary hyperthermic chemotherapy following EPP or P/D for MPM might enhance local control in the chest cavity. PMID:28706901

An Evaluation of TCP with Larger Initial Windows

NASA Technical Reports Server (NTRS)

Allman, Mark; Hayes, Christopher; Ostermann, Shawn

1998-01-01

Transmission Control Protocol (TCP's) slow start algorithm gradually increases the amount of data a sender injects into the network, which prevents the sender from overwhelming the network with an inappropriately large burst of traffic. However, the slow start algorithm can make poor use of the available band-width for transfers which are small compared to the bandwidth-delay product of the link, such as file transfers up to few thousand characters over satellite links or even transfers of several hundred bytes over local area networks. This paper evaluates a proposed performance enhancement that raises the initial window used by TCP from 1 MSS-sized segment to roughly 4 KB. The paper evaluates the impact of using larger initial windows on TCP transfers over both the shared Internet and dialup modem links.

Metastasis to the Glans Penis: An Unusual Site of Rectal Cancer Recurrence.

PubMed

Nunes, Beatriz; Matias, Margarida; Alves, António; Jorge, Marília

2015-01-01

Secondary malignancy of the penis is a rare clinical condition, often associated with disseminated genitourinary malignancies. The prognosis is poor and the treatment options include penectomy, local surgical excision, radiation therapy, chemotherapy and supportive therapy. Neither of these therapeutic options lead to superior treatment outcomes in the literature. The authors report the case of a 66 year-old man with a metastasis to the glans penis from a rectal adenocarcinoma, diagnosed two years after radical treatment for primary disease. The patient underwent palliative treatment with radiotherapy and chemotherapy, remaining asymptomatic and disease-free at one year follow-up. Close follow-up of patients with history of rectal adenocarcinoma is very important. Radiochemotherapy is a feasible and effective therapeutic option for penile metastasis, addressing both disease control and symptomatic improvement.

Plasma-assisted microwave processing of materials

NASA Technical Reports Server (NTRS)

Barmatz, Martin (Inventor); Jackson, Henry (Inventor); Ylin, Tzu-yuan (Inventor)

1998-01-01

A microwave plasma assisted method and system for heating and joining materials. The invention uses a microwave induced plasma to controllably preheat workpiece materials that are poorly microwave absorbing. The plasma preheats the workpiece to a temperature that improves the materials' ability to absorb microwave energy. The plasma is extinguished and microwave energy is able to volumetrically heat the workpiece. Localized heating of good microwave absorbing materials is done by shielding certain parts of the workpiece and igniting the plasma in the areas not shielded. Microwave induced plasma is also used to induce self-propagating high temperature synthesis (SHS) process for the joining of materials. Preferably, a microwave induced plasma preheats the material and then microwave energy ignites the center of the material, thereby causing a high temperature spherical wave front from the center outward.

Equine orbital neoplasia: a review of 10 cases (1983-1998).

PubMed Central

Baptiste, K E; Grahn, B H

2000-01-01

The clinical manifestations, laboratory findings, and survival times of 10 horses with orbital neoplasms are reported. In all cases, orbital neoplasms were malignant and locally invasive with no defined surgical circumscribed edges. It was often difficult to identify the primary cell type of the neoplasia in histologic specimens due to the poorly differentiated, anaplastic nature of the majority of cases. All except one horse were eventually euthanized 2 mo to 5 y after diagnosis due to poor response to treatment, metastasis, or unrelenting orbital neoplasia. Mean survival time increased with surgical treatment, but no significant difference was found among no treatment, chemotherapy, surgical mass removal, or exenteration/enucleation. Equine practitioners should be aware of the marked difference in prognosis of orbital neoplasms compared with ocular or localized eyelid neoplasia. Images Figure 1. Figure 2. Figure 3. PMID:10769765

Social support network typologies and health outcomes of older people in low and middle income countries--a 10/66 Dementia Research Group population-based study.

PubMed

Thiyagarajan, Jotheeswaran A; Prince, Martin; Webber, Martin

2014-08-01

This study aims to assess the construct validity of the Wenger social support network typology in low and middle income countries. We hypothesize that, in comparison with the integrated network type, the non-integrated network type is associated with loneliness, depression, poor quality of life (less happiness), poor self-reported health, increased disability and higher care needs. Cross-sectional one-phase surveys were conducted of all residents aged 65 and over in catchment areas in eight low and middle income countries (India, China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Puerto Rico). Wenger's Practitioner Assessment of Network Type (PANT) was used to measure social network type. Family dependent, local self-contained, wider community-focused and private restricted network types were considered non-integrated, in comparison to the locally integrated network type. Overall, 17,031 participants were interviewed. Family dependent and locally integrated network types were the most prevalent. Adjusted pooled estimates across sites showed that loneliness, depression, less happiness, poor health, disability, and need for care were significantly associated with non-integrated network type. The findings of this study support the construct validity of Wenger's network typology in low and middle income countries. However, further research is required to test the criterion validity of Wenger typology using longitudinal data. Identifying older people who are vulnerable could inform the development of social care interventions to support older people and their families in the context of deteriorating health.

Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru.

PubMed

Newell, Ian; Wiskin, Connie; Anthoney, James; Meza, Graciela; de Wildt, Gilles

2018-01-16

In Peru, despite decades of concerted control efforts, malaria remains a significant public health burden. Peru has recently exhibited a dramatic rise in malaria incidence, impeding South America's progress towards malaria elimination. The Amazon basin, in particular the Loreto region of Peru, has been identified as a target for the implementation of intensified control strategies, aiming for elimination. No research has addressed why vector control strategies in Loreto have had limited impact in the past, despite vector control elsewhere being highly effective in reducing malaria transmission. This study employed qualitative methods to explore factors limiting the success of vector control strategies in the region. Twenty semi-structured interviews were conducted among adults attending a primary care centre in Iquitos, Peru, together with 3 interviews with key informants (health care professionals). The interviews focussed on how local knowledge, together with social and cultural attitudes, determined the use of vector control methods. Five themes emerged. (a) Participants believed malaria to be embedded within their culture, and commonly blamed this for a lack of regard for prevention. (b) They perceived a shift in mosquito biting times to early evening, rendering night-time use of bed nets less effective. (c) Poor preventive practices were compounded by a consensus that malaria prevention was the government's responsibility, and that this reduced motivation for personal prevention. (d) Participants confused the purpose of space-spraying. (e) Participants' responses also exposed persisting misconceptions, mainly concerning the cause of malaria and best practices for its prevention. To eliminate malaria from the Americas, region-specific strategies need to be developed that take into account the local social and cultural contexts. In Loreto, further research is needed to explore the potential shift in biting behaviour of Anopheles darlingi, and how this interacts with the population's social behaviours and current use of preventive measures. Attitudes concerning personal responsibility for malaria prevention and long-standing misconceptions as to the cause of malaria and best preventive practices also need to be addressed.

Local rollback for fault-tolerance in parallel computing systems

DOEpatents

Blumrich, Matthias A [Yorktown Heights, NY; Chen, Dong [Yorktown Heights, NY; Gara, Alan [Yorktown Heights, NY; Giampapa, Mark E [Yorktown Heights, NY; Heidelberger, Philip [Yorktown Heights, NY; Ohmacht, Martin [Yorktown Heights, NY; Steinmacher-Burow, Burkhard [Boeblingen, DE; Sugavanam, Krishnan [Yorktown Heights, NY

2012-01-24

A control logic device performs a local rollback in a parallel super computing system. The super computing system includes at least one cache memory device. The control logic device determines a local rollback interval. The control logic device runs at least one instruction in the local rollback interval. The control logic device evaluates whether an unrecoverable condition occurs while running the at least one instruction during the local rollback interval. The control logic device checks whether an error occurs during the local rollback. The control logic device restarts the local rollback interval if the error occurs and the unrecoverable condition does not occur during the local rollback interval.

Plant Chemistry and Local Adaptation of a Specialized Folivore

PubMed Central

Laukkanen, Liisa; Leimu, Roosa; Muola, Anne; Lilley, Marianna; Salminen, Juha-Pekka; Mutikainen, Pia

2012-01-01

Local adaptation is central for creating and maintaining spatial variation in plant-herbivore interactions. Short-lived insect herbivores feeding on long-lived plants are likely to adapt to their local host plants, because of their short generation time, poor dispersal, and geographically varying selection due to variation in plant defences. In a reciprocal feeding trial, we investigated the impact of geographic variation in plant secondary chemistry of a long-lived plant, Vincetoxicum hirundinaria, on among-population variation in local adaptation of a specialist leaf-feeding herbivore, Abrostola asclepiadis. The occurrence and degree of local adaptation varied among populations. This variation correlated with qualitative and quantitative differences in plant chemistry among the plant populations. These findings provide insights into the mechanisms driving variation in local adaptation in this specialized plant-herbivore interaction. PMID:22666493

Decoding 3D reach and grasp from hybrid signals in motor and premotor cortices: spikes, multiunit activity, and local field potentials.

PubMed

Bansal, Arjun K; Truccolo, Wilson; Vargas-Irwin, Carlos E; Donoghue, John P

2012-03-01

Neural activity in motor cortex during reach and grasp movements shows modulations in a broad range of signals from single-neuron spiking activity (SA) to various frequency bands in broadband local field potentials (LFPs). In particular, spatiotemporal patterns in multiband LFPs are thought to reflect dendritic integration of local and interareal synaptic inputs, attentional and preparatory processes, and multiunit activity (MUA) related to movement representation in the local motor area. Nevertheless, the relationship between multiband LFPs and SA, and their relationship to movement parameters and their relative value as brain-computer interface (BCI) control signals, remain poorly understood. Also, although this broad range of signals may provide complementary information channels in primary (MI) and ventral premotor (PMv) areas, areal differences in information have not been systematically examined. Here, for the first time, the amount of information in SA and multiband LFPs was compared for MI and PMv by recording from dual 96-multielectrode arrays while monkeys made naturalistic reach and grasp actions. Information was assessed as decoding accuracy for 3D arm end point and grip aperture kinematics based on SA or LFPs in MI and PMv, or combinations of signal types across areas. In contrast with previous studies with ≤16 simultaneous electrodes, here ensembles of >16 units (on average) carried more information than multiband, multichannel LFPs. Furthermore, reach and grasp information added by various LFP frequency bands was not independent from that in SA ensembles but rather typically less than and primarily contained within the latter. Notably, MI and PMv did not show a particular bias toward reach or grasp for this task or for a broad range of signal types. For BCIs, our results indicate that neuronal ensemble spiking is the preferred signal for decoding, while LFPs and combined signals from PMv and MI can add robustness to BCI control.

Decoding 3D reach and grasp from hybrid signals in motor and premotor cortices: spikes, multiunit activity, and local field potentials

PubMed Central

Truccolo, Wilson; Vargas-Irwin, Carlos E.; Donoghue, John P.

2012-01-01

Neural activity in motor cortex during reach and grasp movements shows modulations in a broad range of signals from single-neuron spiking activity (SA) to various frequency bands in broadband local field potentials (LFPs). In particular, spatiotemporal patterns in multiband LFPs are thought to reflect dendritic integration of local and interareal synaptic inputs, attentional and preparatory processes, and multiunit activity (MUA) related to movement representation in the local motor area. Nevertheless, the relationship between multiband LFPs and SA, and their relationship to movement parameters and their relative value as brain-computer interface (BCI) control signals, remain poorly understood. Also, although this broad range of signals may provide complementary information channels in primary (MI) and ventral premotor (PMv) areas, areal differences in information have not been systematically examined. Here, for the first time, the amount of information in SA and multiband LFPs was compared for MI and PMv by recording from dual 96-multielectrode arrays while monkeys made naturalistic reach and grasp actions. Information was assessed as decoding accuracy for 3D arm end point and grip aperture kinematics based on SA or LFPs in MI and PMv, or combinations of signal types across areas. In contrast with previous studies with ≤16 simultaneous electrodes, here ensembles of >16 units (on average) carried more information than multiband, multichannel LFPs. Furthermore, reach and grasp information added by various LFP frequency bands was not independent from that in SA ensembles but rather typically less than and primarily contained within the latter. Notably, MI and PMv did not show a particular bias toward reach or grasp for this task or for a broad range of signal types. For BCIs, our results indicate that neuronal ensemble spiking is the preferred signal for decoding, while LFPs and combined signals from PMv and MI can add robustness to BCI control. PMID:22157115

Environmental links to interannual variability in shellfish toxicity in Cobscook Bay and eastern Maine, a strongly tidally mixed coastal region

NASA Astrophysics Data System (ADS)

Horecka, Hannah M.; Thomas, Andrew C.; Weatherbee, Ryan A.

2014-05-01

The Gulf of Maine experiences annual closures of shellfish harvesting due to the accumulation of toxins produced by dinoflagellates of the genus Alexandrium. Factors controlling the timing, location, and magnitude of these events in eastern Maine remain poorly understood. Previous work identified possible linkages between interannual variability of oceanographic variables and shellfish toxicity along the western Maine coastline but no such linkages were evident along the eastern Maine coast in the vicinity of Cobscook Bay, where strong tidal mixing tends to reduce seasonal variability in oceanographic properties. Using 21 years (1985-2005) of shellfish toxicity data, interannual variability in two metrics of annual toxicity, maximum magnitude and total annual toxicity, from stations in the Cobscook Bay region are examined for relationships to a suite of available environmental variables. Consistent with earlier work, no (or only weak) correlations were found between toxicity and oceanographic variables, even those very proximate to the stations such as local sea surface temperature. Similarly no correlations were evident between toxicity and air temperature, precipitation or relative humidity. The data suggest possible connections to local river discharge, but plausible mechanisms are not obvious. Correlations between toxicity and two variables indicative of local meteorological conditions, dew point and atmospheric pressure, both suggest a link between increased toxicity in these eastern Maine stations and weather conditions characterized by clearer skies/drier air (or less stormy/humid conditions). As no correlation of opposite sign was evident between toxicity and local precipitation, one plausible link is through light availability and its positive impact on phytoplankton production in this persistently foggy section of coast. These preliminary findings point to both the value of maintaining long-term shellfish toxicity sampling and a need for inclusion of weather variability in future modeling studies aimed at development of a more mechanistic understanding of factors controlling interannual differences in eastern Gulf of Maine shellfish toxicity.

Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV–tuberculosis coinfection receiving directly observed short-course chemotherapy for tuberculosis

PubMed Central

Sudarsanam, T. D.; John, J.; Kang, G.; Mahendri, V.; Gerrior, J.; Franciosa, M.; Gopal, S.; John, K. R.; Wanke, C. A.; Muliyil, J.

2014-01-01

Summary OBJECTIVE To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis (TB) with and without human immunodeficiency virus (HIV) coinfection on anti-tuberculous therapy. METHOD Randomized controlled trial on the effect of a locally prepared cereal–lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB–HIV-coinfected patients, among whom 51 received and 52 did not receive the supplement. The primary outcome evaluated at completion of TB therapy was outcome of TB treatment, as classified by the national programme. Secondary outcomes were body composition, compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation. RESULTS There was no significant difference in TB outcomes at the end of treatment, but HIV–TB coinfected individuals had four times greater odds of poor outcome than those with TB alone. Among patients with TB, 1/35 (2.9%) supplemented and 5/42(12%) of those not supplemented had poor outcomes, while among TB–HIV-coinfected individuals, 4/13 (31%) supplemented and 3/7 (42.8%) non-supplemented patients had poor outcomes at the end of treatment, and the differences were more marked after 1 year of follow-up. Although there was some trend of benefit for both TB alone and TB–HIV coinfection, the results were not statistically significant at the end of TB treatment, possibly because of limited sample size. CONCLUSION Nutritional supplements in patients are a potentially feasible, low-cost intervention, which could impact patients with TB and TB–HIV. The public health importance of these diseases in resource-limited settings suggests the need for large, multi-centre randomized control trials on nutritional supplementation. PMID:21418447

[Delays in seeking and getting care, in seriously ill women of childbearing age in Kinshasa].

PubMed

Mambu Nyangi Mondo, T; Malengreau, M; Kayembe Kalambayi, P; Lapika Dimomfu, B

2010-06-01

Mortality of adult females is very high in Democratic Republic of Congo and often caused by diseases that could have been controlled if treated in time. This is a qualitative study on delays and their causes in the care-seeking process of 60 women who died prematurely in Kinshasa from non-immediately fatal causes. This study concerned 60 women identified in two Kinshasa mortuaries in March and April 2004 who had died at the age of 18 to 49 years. Deaths considered to be unavoidable were excluded. The history of their disease and death was collected from family members and community leaders, and from the available medical records. The analysis focused on delays occurring at the different stages of the women's care seeking process, from the first signs of danger until death. The analysis identified different delays: the delay in danger awareness, the delay in taking the care-seeking decision and the delay due to alternative care linked to cultural perceptions of the disease, the delay in reaching a medical facility related to lack of money or vehicles, the delay in patient care related to an absent or incompetent health staff or by inappropriate choice of structure, and finally the delay in administration of the prescribed treatment. In Kinshasa, emergency care may be delayed by slow awareness of danger, but most of all by the poor quality and poor organisation of the health services. On the other hand, the use of non-medical alternatives and a poor perception of the medical services do rarely interfere in the decision to seek medical care. In Kinshasa, to guarantee the patients rights to quality health care, one must first strengthen and control medical services. One should also teach people to identify services appropriate to medical emergencies. Transportation and pre-financing of emergency care should be organised by local authorities. 2010 Elsevier Masson SAS. All rights reserved.

Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV-tuberculosis coinfection receiving directly observed short-course chemotherapy for tuberculosis.

PubMed

Sudarsanam, T D; John, J; Kang, G; Mahendri, V; Gerrior, J; Franciosa, M; Gopal, S; John, K R; Wanke, C A; Muliyil, J

2011-06-01

To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis (TB) with and without human immunodeficiency virus (HIV) coinfection on anti-tuberculous therapy. Randomized controlled trial on the effect of a locally prepared cereal-lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB-HIV-coinfected patients, among whom 51 received and 52 did not receive the supplement. The primary outcome evaluated at completion of TB therapy was outcome of TB treatment, as classified by the national programme. Secondary outcomes were body composition, compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation. There was no significant difference in TB outcomes at the end of treatment, but HIV-TB coinfected individuals had four times greater odds of poor outcome than those with TB alone. Among patients with TB, 1/35 (2.9%) supplemented and 5/42(12%) of those not supplemented had poor outcomes, while among TB-HIV-coinfected individuals, 4/13 (31%) supplemented and 3/7 (42.8%) non-supplemented patients had poor outcomes at the end of treatment, and the differences were more marked after 1 year of follow-up. Although there was some trend of benefit for both TB alone and TB-HIV coinfection, the results were not statistically significant at the end of TB treatment, possibly because of limited sample size. Nutritional supplements in patients are a potentially feasible, low-cost intervention, which could impact patients with TB and TB-HIV. The public health importance of these diseases in resource-limited settings suggests the need for large, multi-centre randomized control trials on nutritional supplementation. © 2011 Blackwell Publishing Ltd.

Low Level Waste Conceptual Design Adaption to Poor Geological Conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bell, J.; Drimmer, D.; Giovannini, A.

2002-02-26

Since the early eighties, several studies have been carried out in Belgium with respect to a repository for the final disposal of low-level radioactive waste (LLW). In 1998, the Belgian Government decided to restrict future investigations to the four existing nuclear sites in Belgium or sites that might show interest. So far, only two existing nuclear sites have been thoroughly investigated from a geological and hydrogeological point of view. These sites are located in the North-East (Mol-Dessel) and in the mid part (Fleurus-Farciennes) of the country. Both sites have the disadvantage of presenting poor geological and hydrogeological conditions, which aremore » rather unfavorable to accommodate a surface disposal facility for LLW. The underground of the Mol-Dessel site consists of neogene sand layers of about 180 m thick which cover a 100 meters thick clay layer. These neogene sands contain, at 20 m depth, a thin clayey layer. The groundwater level is quite close to the surface (0-2m) and finally, the topography is almost totally flat. The upper layer of the Fleurus-Farciennes site consists of 10 m silt with poor geomechanical characteristics, overlying sands (only a few meters thick) and Westphalian shales between 15 and 20 m depth. The Westphalian shales are tectonized and strongly weathered. In the past, coal seams were mined out. This activity induced locally important surface subsidence. For both nuclear sites that were investigated, a conceptual design was made that could allow any unfavorable geological or hydrogeological conditions of the site to be overcome. In Fleurus-Farciennes, for instance, the proposed conceptual design of the repository is quite original. It is composed of a shallow, buried concrete cylinder, surrounded by an accessible concrete ring, which allows permanent inspection and control during the whole lifetime of the repository. Stability and drainage systems should be independent of potential differential settlements an d subsidences. Potential radionuclides releases are controlled and have a single discharge point to the biosphere.« less

Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases.

PubMed

Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Sturani, Alessandra; Degli Esposti, Ezio

2013-01-01

Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes-related health care costs. Integration of administrative databases and a laboratory database appears to be suitable for showing that appropriate management of diabetes can help to achieve better resource allocation.

DAILY VARIATION OF PARTICULATE AIR POLLUTION AND POOR CARDIAC AUTONOMIC CONTROL IN THE ELDERLY

EPA Science Inventory

Particulate matter air pollution (PM) has been related to cardiovascular disease mortality in a number of recent studies. The pathophysiologic mechanisms for this association are under study. Low heart rate variability, a marker of poor cardiac autonomic control, is associated wi...

Increased salivary oxidative stress parameters in patients with type 2 diabetes: Relation with periodontal disease.

PubMed

Arana, Carlos; Moreno-Fernández, Ana María; Gómez-Moreno, Gerardo; Morales-Portillo, Cristóbal; Serrano-Olmedo, Isabel; de la Cuesta Mayor, M Carmen; Martín Hernández, Tomás

2017-05-01

The aim of this study was to determine whether there are differences in salivary oxidative stress between patients with diabetes mellitus type 2 (DM2) and healthy non-diabetic patients, and whether this oxidative stress is associated with the presence of periodontal disease in diabetic patients. This observational study included 70 patients divided into three groups according to metabolic control levels: 19 non-diabetic patients (control group); 24 patients with good metabolic control (HbA1c<7%), and 27 patients DM2 with poor metabolic control (HbA1c>7%). The following oxidative stress parameters were measured in all subjects: glutathione peroxidase (GPx), glutathione reductase (GRd), reduced glutathione (GSH) and oxidized glutathione (GSSG). Periodontal health was determined by means of the community periodontal index (CPI) recommended by the WHO. The diabetic group with good metabolic control showed a significant increase in GPx and GRd activity in comparison with the control group (P<.001). The activity of the enzymes measured was significantly less in patients with poor metabolic control in comparison with the control group and well-controlled diabetic groups (P<.001). Both diabetic groups showed higher GSSG/GSH quotients and CPI in comparison with the control group, and both parameters were significantly higher in diabetic patients with poor metabolic control in comparison with well-controlled diabetic patients. Poor metabolic control in DM2 patients is associated with higher levels of salivary oxidative stress and worse periodontal health. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control

PubMed Central

Yawn, Barbara P.

2011-01-01

Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma control. Few adolescents or adults with asthma currently have asthma “checkup” visits, usually seeking medical care only with an exacerbation. Therefore, nonrespiratory-related office visits represent an important opportunity to assess baseline asthma control and the factors that most commonly lead to poor control. Tools such as the Asthma Control Test, the Asthma Therapy Assessment Questionnaire, the Asthma Control Questionnaire, and the Asthma APGAR provide standardized, patient-friendly ways to capture necessary asthma information. For uncontrolled asthma, physicians can refer to the stepwise approach in the 2007 National Asthma Education and Prevention Program guidelines to adjust medication use, but they must consider step-up decisions in the context of quality of the patient's inhaler technique, adherence, and ability to recognize and avoid or eliminate triggers. For this review, a literature search of PubMed from 2000 through August 31, 2010, was performed using the following terms (or a combination of these terms): asthma, asthma control, primary care, NAEPP guidelines, assessment, uncontrolled asthma, burden, impact, assessment tools, triggers, pharmacotherapy, safety. Studies were limited to human studies published in English. Articles were also identified by a manual search of bibliographies from retrieved articles and from article archives of the author. PMID:21878602

The role of the primary care physician in helping adolescent and adult patients improve asthma control.

PubMed

Yawn, Barbara P

2011-09-01

Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma control. Few adolescents or adults with asthma currently have asthma "checkup" visits, usually seeking medical care only with an exacerbation. Therefore, nonrespiratory-related office visits represent an important opportunity to assess baseline asthma control and the factors that most commonly lead to poor control. Tools such as the Asthma Control Test, the Asthma Therapy Assessment Questionnaire, the Asthma Control Questionnaire, and the Asthma APGAR provide standardized, patient-friendly ways to capture necessary asthma information. For uncontrolled asthma, physicians can refer to the stepwise approach in the 2007 National Asthma Education and Prevention Program guidelines to adjust medication use, but they must consider step-up decisions in the context of quality of the patient's inhaler technique, adherence, and ability to recognize and avoid or eliminate triggers. For this review, a literature search of PubMed from 2000 through August 31, 2010, was performed using the following terms (or a combination of these terms): asthma, asthma control, primary care, NAEPP guidelines, assessment, uncontrolled asthma, burden, impact, assessment tools, triggers, pharmacotherapy, safety. Studies were limited to human studies published in English. Articles were also identified by a manual search of bibliographies from retrieved articles and from article archives of the author.

Association of hand and arm disinfection with asthma control in US nurses.

PubMed

Dumas, Orianne; Varraso, Raphäelle; Boggs, Krislyn M; Descatha, Alexis; Henneberger, Paul K; Quinot, Catherine; Speizer, Frank E; Zock, Jan-Paul; Le Moual, Nicole; Camargo, Carlos A

2018-05-01

To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses. In 2014, we invited female nurses with asthma drawn from the Nurses' Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: 'wash/scrub hands with disinfectants/hand sanitizers' (hand hygiene) and 'wash/scrub arms with disinfecting products' (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index. Nurses with partly controlled asthma (ACT: 20-24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose-response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks. Frequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fine-scale natal homing and localized movement as shaped by sex and spawning habitat in Chinook salmon: Insights from spatial autocorrelation analysis of individual genotypes

Treesearch

H. M. Neville; D. J. Isaak; J. B. Dunham; R. F. Thurow; B. E. Rieman

2006-01-01

Natal homing is a hallmark of the life history of salmonid fishes, but the spatial scale of homing within local, naturally reproducing salmon populations is still poorly understood. Accurate homing (paired with restricted movement) should lead to the existence of finescale genetic structuring due to the spatial clustering of related individuals on spawning grounds....

Oncologic outcome after local recurrence of chondrosarcoma: Analysis of prognostic factors.

PubMed

Kim, Han-Soo; Bindiganavile, Srimanth S; Han, Ilkyu

2015-06-01

Literature on outcome after local recurrence (LR) in chondrosarcoma is scarce and better appreciation of prognostic factors is needed. (1) To evaluate post-LR oncologic outcomes of disease-specific survival and subsequent LR and (2) to identify prognostic factors for post-LR oncologic outcomes. Review of 28 patients with locally recurrent chondrosarcoma from the original cohort of 150 patients, who were treated surgically with or without adjuvants between 1982 and 2011, was performed. Mean age was 46 years (range, 21-73) which included 20 males and 8 females with mean follow up of 8.4 ± 7.5 years (range, 1.2-31.0). Post-LR survival at 5 years was 58.6 ± 10.3%. Age greater than 50 years (P = 0.011) and LR occurring within 1 year of primary surgery (P = 0.011) independently predicted poor survival. Seven patients suffered subsequent LR, which was significantly affected by surgical margin for LR (P = 0.038). Long-term survival of locally recurrent chondrosarcoma is achievable in a substantial number of patients. Older age at onset of LR and shorter interval from primary surgery to LR identifies high risk patients for poor post-LR survival while, wide surgical margins at LR surgery reduces the risk of subsequent LR. © 2015 Wiley Periodicals, Inc.

Intraspecific variation in body size and shape in an andean highland anole species, Anolis ventrimaculatus (Squamata: Dactyloidae).

PubMed

Calderón-Espinosa, Martha L; Ortega-León, Angela M; Zamora-Abrego, Joan G

2013-03-01

Variation in body characteristics related to lizard locomotion has been poorly studied at the intraspecific level in Anolis species. Local adaptation due to habitat heterogeneity has been reported in some island species. However, studies of mainland species are particularly scarce and suggest different patterns: high variability among highland lizards and poorly differentiated populations in one Amazonian species. We characterized inter population variation of body size and shape in the highland Andean Anolis ventrimaculatus, an endemic species from Western Colombia. A total of 15 morphometric variables were measured in specimens from the reptile collection of the Instituto de Ciencias Naturales, Universidad Nacional, Colombia. The study included individuals from seven different highland localities. We found size and shape sexual dimorphism, both of which varied among localities. Patterns of variation in body proportions among populations were different in both males and females, suggesting that either sexual or natural selective factors are different in each locality and between sexes. Since this species exhibits a fragmented distribution in highlands, genetic divergence may also be a causal factor of the observed variation. Ecological, behavioral, additional morphological as well as phylogenetic data, may help to understand the evolutionary processes behind the geographic patterns found in this species.