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Find video protocols related to scientific articles indexed in Pubmed.
Role of Affective Attitudes and Anticipated Affective Reactions in Predicting Health Behaviors.
Health Psychol
PUBLISHED: 09-16-2014
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Objective: Two measures of affect-affective attitude (AA) and anticipated affective reaction (AAR)-have frequently been used individually, but rarely simultaneously, in correlational studies predicting health behaviors. This research assessed their individual and combined impact in predicting intention and action for a range of health behaviors, controlling for theory of planned behavior (TPB) variables. Method: Self-reported intentions and performance of health behaviors were the main outcome measures. Design: Study 1 is a meta-analysis of published studies (k = 16) measuring the relevant variables. In Study 2, adults (N = 426) completed questionnaires assessing TPB variables, past behavior, AA, AAR, and subsequent behavior for a range of health behaviors. Results: Across both studies, AA and AAR were only moderately intercorrelated, although both had significant correlations with both intentions and behavior. AA was a significant predictor of intentions and behavior after controlling for TPB variables (Studies 1 and 2) plus past behavior (Study 2). In Study 1, AAR was a significant predictor of behavior, but not intentions, when controlling for TPB variables. In Study 2, AAR was a significant predictor of intentions when controlling for both TPB variables plus past behavior (Study 2), but was not a significant predictor of behavior when controlling for either of these variables. Several relationships were moderated by health-behavior category. Conclusions: Both AA and AAR are important predictors of health behaviors and can have independent effects on intentions and action. Studies manipulating both variables to test their independent and combined effects on behavior change are required. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial.
BMC Dermatol.
PUBLISHED: 08-13-2014
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Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to.
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Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.
J Adv Nurs
PUBLISHED: 08-11-2014
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This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies.
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Pediatric post-acute care hospital transitions: an evaluation of current practice.
Hosp Pediatr
PUBLISHED: 07-03-2014
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After discharge from an acute care hospital, some children require ongoing care at a post-acute care hospital. Care transitions occur at both admission to the post-acute care hospital and again at discharge to the home/community. Our objective was to report the current practices used during the admission to and discharge from 7 pediatric post-acute care hospitals in the United States.
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A communication framework for dialysis decision-making for frail elderly patients.
Clin J Am Soc Nephrol
PUBLISHED: 06-26-2014
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Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented. The role of uncertainty is highlighted, and the concept of a goal-directed care plan is introduced. This plan incorporates a time-limited trial that promotes frequent opportunities for reassessment. Using the communication skills presented, the clinician can prepare and guide patients for the dialysis trajectory as it unfolds.
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Evaluating the PRASE patient safety intervention - a multi-centre, cluster trial with a qualitative process evaluation: study protocol for a randomised controlled trial.
Trials
PUBLISHED: 03-21-2014
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Estimates show that as many as one in 10 patients are harmed while receiving hospital care. Previous strategies to improve safety have focused on developing incident reporting systems and changing systems of care and professional behaviour, with little involvement of patients. The need to engage with patients about the quality and safety of their care has never been more evident with recent high profile reviews of poor hospital care all emphasising the need to develop and support better systems for capturing and responding to the patient perspective on their care. Over the past 3 years, our research team have developed, tested and refined the PRASE (Patient Reporting and Action for a Safe Environment) intervention, which gains patient feedback about quality and safety on hospital wards.
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Convection-enhanced delivery of etoposide is effective against murine proneural glioblastoma.
Neuro-oncology
PUBLISHED: 03-16-2014
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Glioblastoma subtypes have been defined based on transcriptional profiling, yet personalized care based on molecular classification remains unexploited. Topoisomerase II (TOP2) contributes to the transcriptional signature of the proneural glioma subtype. Thus, we targeted TOP2 pharmacologically with etoposide in proneural glioma models.
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An interdisciplinary approach to dialysis decision-making in the CKD patient with depression.
Adv Chronic Kidney Dis
PUBLISHED: 01-02-2014
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Depression and depressive symptoms are common in advanced kidney disease and are associated with poor outcomes. For those with CKD not on dialysis, depression may influence how patients cope and prepare for their disease and its management, including decisions about dialysis treatment. Patient self-reported scales exist to better identify depression; how to incorporate these scales into clinical practice and assist with treatment decision-making is less clear. We present a case-based discussion of depressive symptoms in patients with advanced kidney disease not on dialysis. We highlight the contribution of underlying somatic and psychosocial factors in the assessment and management of depression. We further define the role of the interdisciplinary care team, including palliative care and hospice medicine, to assist with symptom management and end-of-life care for CKD patients with depression.
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Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature.
Front Psychiatry
PUBLISHED: 01-01-2014
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The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBIs) in primary health care (PHC) suggests that a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions takes place in this context.
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The effects on tuberculosis treatment adherence from utilising community health workers: a comparison of selected rural and urban settings in Kenya.
PLoS ONE
PUBLISHED: 01-01-2014
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Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them.
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Using supervision to protect vulnerable families.
Nurs Times
PUBLISHED: 12-31-2013
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Sandwell Health Visiting Service identified difficulties in recruiting and retaining health visiting staff and fully meeting the needs of vulnerable families. Following the Laming report, the decision was made to introduce health visiting supervision leads. This resulted in improvements in record keeping and care planning and in better protection and support for vulnerable families.
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Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study.
BMJ Qual Saf
PUBLISHED: 12-24-2013
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Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur.
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"Fact" and "fiction": enlivening health care education.
J Health Organ Manag
PUBLISHED: 12-18-2013
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This paper aims to demonstrate how close analysis of cultural narratives can be employed as effective pedagogical tools in the explication and critique of specific workplace issues relevant to health management education.
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Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial.
BMC Public Health
PUBLISHED: 07-03-2013
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There is some evidence in the literature that emphasising fish consumption may assist with weight loss. The aim was to assess the effects of advice to consume 2 fish meals per week in a weight loss diet.
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Using the Donabedian framework to examine the quality and safety of nursing service innovation.
J Clin Nurs
PUBLISHED: 07-03-2013
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To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome.
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Introducing depression and developmental screenings into the National Programme on Immunization (NPI) in southeast Nigeria: an experimental cross-sectional assessment.
Gen Hosp Psychiatry
PUBLISHED: 05-20-2013
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This study investigates the possibility of introducing depression and developmental screening tools into the National Programme on Immunization (NPI) in southeast Nigeria. The specific objectives were to determine the prevalence of postpartum depression (PPD) among mothers attending immunization clinics and to assess the association of maternal PPD and infant growth in relation to World Health Organization (WHO) recommendations.
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A rat model of chondrocyte death after closed intra-articular fracture.
J Orthop Trauma
PUBLISHED: 05-10-2013
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The development of osteoarthritis after intra-articular fractures has been described for decades, although the exact mechanical and cellular changes that occur remain poorly understood. There are several animal models to study this phenomenon, but they are mechanistically different from physiologic fractures in several important ways. This article describes a novel model that recreates the kinematics present in high-energy trauma and intra-articular fractures.
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Paclitaxel nanosuspensions for targeted chemotherapy - nanosuspension preparation, characterization, and use.
Pharm Dev Technol
PUBLISHED: 04-25-2013
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Abstract Objective: The purpose of this work was to prepare a stable paclitaxel nanosuspension and test it for potential use as a targeted chemotherapeutic. Different particle coatings were employed to assess their impact on cellular uptake in vitro. In vivo work was then performed to demonstrate efficacy in tumor-bearing mouse models. Materials and method: Paclitaxel nanosuspensions were prepared using a homogenization process and coated with excipients. Surface charge was measured by zeta potential, potency by high-performance liquid chromatography, and solubility using an in-line UV probe. Cellular uptake studies were performed via flow cytometry. In vivo experiments were performed to determine residence time, maximum tolerated dose, and the efficacy of paclitaxel nanosuspensions (Paclitaxel-NS). Results: A stable paclitaxel nanosuspension was prepared and coated with various excipients. Studies in mice showed that the nanosuspension was well-tolerated and at least as effective as the IV Taxol control in prolonging mouse survival in a head and neck cancer model as well as an ovarian cancer model with a lower overall drug dose than the traditional IV administration route. Conclusions: The paclitaxel nanosuspension is suitable for cellular uptake. The nanosuspension was effective in prolonging life in two separate xenograft orthotopic murine cancer models through two separate routes of administration.
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Every study begins with a query: how to present a clear research question.
NASN Sch Nurse
PUBLISHED: 04-23-2013
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School nurses have demonstrated a keen interest in research and the research process with the purpose of generating evidence that supports their practice and increases the value of school nursing services. This article will help school nurses to formulate research questions and to identify the components of the research question that delineate the next steps in the development of a research study from such questions. School nurses benefit from collaborating with experienced nurse researchers in order to gain competence in defining research questions.
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Illness trajectories and their relevance to the care of adults with kidney disease.
Curr. Opin. Nephrol. Hypertens.
PUBLISHED: 03-23-2013
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PURPOSE OF REVIEW: Existing practice guidelines for chronic kidney disease advocate a stage-based approach to management, in which treatment recommendations are based largely on the severity of kidney disease, and future risk for adverse health outcomes. However, the course of kidney disease can vary widely among patients with similar levels of kidney function, and each patient will experience their illness in unique ways. RECENT FINDINGS: We summarize recent studies of patterns of kidney function over time among patients with chronic kidney disease, and discuss these findings in the context of relevant conceptual models of illness and communication. Although knowledge of disease severity can provide useful information on life expectancy and risk for future health events, an understanding of each patients illness trajectory and their unique experience of illness is essential in supporting patient-centered care for patients with kidney disease. This information can be helpful in setting realistic expectations for the future, in communicating about prognosis and in aligning treatment decisions with each patients goals and preferences. SUMMARY: We here explain how an understanding of illness trajectories may be useful in predicting and guiding care and decision-making in patients with kidney disease. We highlight the importance of competing disease trajectories, the heterogeneity in renal function trajectories among patients with kidney disease, and the variability in these trajectories over time in individual patients. We discuss how individual disease trajectories can shape each patients experience of illness. Finally, we explain how an understanding of an individual patients illness trajectory and experience of illness may be useful in guiding discussions about prognosis and treatment decisions and in supporting a patient-centered approach to care.
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Hospital length of stay, discharge disposition, and reimbursement by clinical program group in pediatric post-acute rehabilitation.
J Pediatr Rehabil Med
PUBLISHED: 03-14-2013
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To describe hospital length of stay (LOS), discharge disposition, and reimbursement by clinical group for children admitted to pediatric post-acute rehabilitation.
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Vaccines against meningococcal serogroup B disease containing outer membrane vesicles (OMV): lessons from past programs and implications for the future.
Hum Vaccin Immunother
PUBLISHED: 03-07-2013
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The utility of wild-type outer membrane vesicle (wtOMV) vaccines against serogroup B (MenB) meningococcal disease has been explored since the 1970s. Public health interventions in Cuba, Norway and New Zealand have demonstrated that these protein-based vaccines can prevent MenB disease. Data from large clinical studies and retrospective statistical analyses in New Zealand give effectiveness estimates of at least 70%. A consistent pattern of moderately reactogenic and safe vaccines has been seen with the use of approximately 60 million doses of three different wtOMV vaccine formulations. The key limitation of conventional wtOMV vaccines is their lack of broad protective activity against the large diversity of MenB strains circulating globally. The public health intervention in New Zealand (between 2004-2008) when MeNZB was used to control a clonal MenB epidemic, provided a number of new insights regarding international and public-private collaboration, vaccine safety surveillance, vaccine effectiveness estimates and communication to the public. The experience with wtOMV vaccines also provide important information for the next generation of MenB vaccines designed to give more comprehensive protection against multiple strains.
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Recent insights into life expectancy with and without dialysis.
Curr. Opin. Nephrol. Hypertens.
PUBLISHED: 01-24-2013
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Elderly patients comprise the fastest growing population initiating dialysis and also experience the worst outcomes, including increased mortality, loss of functional status, and impaired quality of life. Nephrologists are often challenged with how best to engage in dialysis decision-making discussions within this population. Prognostication tools can assist nephrologists in engaging in these discussions, especially in patients for whom survival benefits may be outweighed by the burdens of treatment.
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Connective tissue growth factor (CTGF/CCN2) is negatively regulated during neuron-glioblastoma interaction.
PLoS ONE
PUBLISHED: 01-03-2013
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Connective-tissue growth factor (CTGF/CCN2) is a matricellular-secreted protein involved in complex processes such as wound healing, angiogenesis, fibrosis and metastasis, in the regulation of cell proliferation, migration and extracellular matrix remodeling. Glioblastoma (GBM) is the major malignant primary brain tumor and its adaptation to the central nervous system microenvironment requires the production and remodeling of the extracellular matrix. Previously, we published an in vitro approach to test if neurons can influence the expression of the GBM extracellular matrix. We demonstrated that neurons remodeled glioma cell laminin. The present study shows that neurons are also able to modulate CTGF expression in GBM. CTGF immnoreactivity and mRNA levels in GBM cells are dramatically decreased when these cells are co-cultured with neonatal neurons. As proof of particular neuron effects, neonatal neurons co-cultured onto GBM cells also inhibit the reporter luciferase activity under control of the CTGF promoter, suggesting inhibition at the transcription level. This inhibition seems to be contact-mediated, since conditioned media from embryonic or neonatal neurons do not affect CTGF expression in GBM cells. Furthermore, the inhibition of CTGF expression in GBM/neuronal co-cultures seems to affect the two main signaling pathways related to CTGF. We observed inhibition of TGF? luciferase reporter assay; however phopho-SMAD2 levels did not change in these co-cultures. In addition levels of phospho-p44/42 MAPK were decreased in co-cultured GBM cells. Finally, in transwell migration assay, CTGF siRNA transfected GBM cells or GBM cells co-cultured with neurons showed a decrease in the migration rate compared to controls. Previous data regarding laminin and these results demonstrating that CTGF is down-regulated in GBM cells co-cultured with neonatal neurons points out an interesting view in the understanding of the tumor and cerebral microenvironment interactions and could open up new strategies as well as suggest a new target in GBM control.
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Metastatic progression with resistance to aromatase inhibitors is driven by the steroid receptor coactivator SRC-1.
Cancer Res.
PUBLISHED: 11-22-2011
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Aromatase inhibitors (AI) are a standard-of-care treatment for postmenopausal, estrogen receptor-positive breast cancers. Although tumor recurrence on AI therapy occurs, the mechanisms underlying acquired resistance to AIs remain unknown. In this study, we examined a cohort of endocrine-treated breast cancer patients and used a cell line model of resistance to the AI letrozole. In patients treated with a first-line AI, hormone receptor switching between primary and resistant tumors was a common feature of disease recurrence. Resistant cells exhibited a switch from steroid-responsive growth to growth factor-responsive and endocrine-independent growth, which was accompanied by the development of a more migratory and disorganized phenotype. Both the resistant cells and tumors from AI-resistant patients showed high expression of the steroid receptor coactivator SRC-1. Direct interactions between SRC-1 and the transcription factor Ets2 regulated Myc and MMP9. SRC-1 was required for the aggressive and motile phenotype of AI-resistant cells. Interestingly, SRC-1 expression in primary and/or recurrent tumors was associated with a reduction in disease-free survival in treated patients. Moreover, there was a significant association between SRC-1 and Ets2 in the recurrent tissue compared with the matched primary tumor. Together, our findings elucidate a mechanism of AI-specific metastatic progression in which interactions between SRC-1 and Ets2 promote dedifferentiation and migration in hormone-dependent breast cancer.
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Increased platelet reactivity in HIV-1-infected patients receiving abacavir-containing antiretroviral therapy.
J. Infect. Dis.
PUBLISHED: 09-16-2011
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Current or recent use of abacavir for treating human immunodeficiency virus type 1 (HIV-1) infection has been associated with increased rates of myocardial infarction (MI). Given the role of platelet aggregation in thrombus formation in MI and the reversible nature of the abacavir association, we hypothesized that patients treated with abacavir would have increased platelet reactivity.
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Effect of 6 weeks consumption of ?-glucan-rich oat products on cholesterol levels in mildly hypercholesterolaemic overweight adults.
Br. J. Nutr.
PUBLISHED: 08-03-2011
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Several regulatory bodies have approved a health claim on the cholesterol-lowering effects of oat ?-glucan at levels of 3·0 g/d. The present study aimed to test whether 1·5 g/d ?-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge. A 6-week randomised controlled trial was conducted in eighty-seven mildly hypercholesterolaemic ( ? 5 mmol/l and < 7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal ?-glucan (control); (2) low-dose oat ?-glucan (1·5 g ?-glucan; oats low - OL) or (3) higher dose oat ?-glucan (3·0 g ?-glucan; oats high - OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed using a linear mixed model and repeated-measures ANOVA, adjusted for weight change. Total cholesterol reduced significantly in all groups ( - 7·8 (sd 13·8) %, - 7·2 (sd 12·4) % and - 5·5 (sd 9·3) % in the OH, OL and control groups), as did LDL-C ( - 8·4 (sd 18·5) %, - 8·5 (sd 18·5) % and - 5·5 (sd 12·4) % in the OH, OL and control groups), but between-group differences were not significant. In responders only (n 60), ?-glucan groups had higher reductions in LDL-C ( - 18·3 (sd 11·1) % and - 18·1 (sd 9·2) % in the OH and OL groups) compared with controls ( - 11·7 (sd 7·9) %; P = 0·044). Intakes of oat ?-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble ?-glucan.
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Documented prevalence of HIV type 1 antiretroviral transmitted drug resistance in Ireland from 2004 to 2008.
AIDS Res. Hum. Retroviruses
PUBLISHED: 07-19-2011
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HIV-1-infected individuals with transmitted HIV drug resistance (TDR) begin antiretroviral therapy (ART) with a lower genetic barrier to resistance and a higher risk of both virological failure and of developing further resistance. TDR surveillance informs HIV-1 public health strategies and first line ART. TDR has not been studied nationally in an Irish population. This study includes all new HIV diagnoses from January 2004 to September 2008 from the National Virus Reference Laboratory, University College Dublin. HIV-1 protease and reverse transcriptase sequences were generated, and resistance mutations identified using the Siemens TRUGENE HIV-1 Genotyping System. Subtypes were determined using web-based genotyping tools. The study comprised 1579 patients. There were 305 new diagnoses in 2004 (173 male; 132 female), 298 in 2005 (175M; 123F), 321 in 2006 (197M; 124F), 297 in 2007 (184M; 113F), and 358 (235M; 123F) in 2008. HIV-1 RNA was sequenced from 158/305 patients in 2004, 199/298 in 2005, 225/321 in 2006, 203/297 in 2007, and 275/358 in 2008. The overall TDR rate was 6.3%, peaking in 2006 at 10.4% and declining to 5.3% in 2008. The majority of TDR was seen in Irish born individuals with HIV-1 subtype B infection. The TDR rate in Ireland is comparatively low. Thus, a health technology assessment is required to ascertain the most cost effective use of genotypic antiretroviral resistance testing (GART) in the future: the current approach of performing baseline GART on all new diagnoses, or perhaps a more targeted approach that focuses on patients commencing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART.
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Health information management and perceptions of the quality of care for children with tracheotomy: a qualitative study.
BMC Health Serv Res
PUBLISHED: 05-23-2011
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Children with tracheotomy receive health care from an array of providers within various hospital and community health system sectors. Previous studies have highlighted substandard health information exchange between families and these sectors. The aim of this study was to investigate the perceptions and experiences of parents and providers with regard to health information management, care plan development and coordination for children with tracheotomy, and strategies to improve health information management for these children.
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A murine model of xenotransplantation of human glioblastoma with immunosuppression by orogastric cyclosporin.
Arq Neuropsiquiatr
PUBLISHED: 03-02-2011
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Several animal experimental models have been used in the study of malignant gliomas. The objective of the study was to test the efficacy of a simple, reproducible and low cost animal model, using human cells of glioblastoma multiforme (GBM) xenotransplantated in subcutaneous tissue of Wistar rats, immunosuppressed with cyclosporin given by orogastric administration, controlled by nonimunosuppressed rats. The animals were sacrificed at weekly intervals and we have observed gradual growth of tumor in the immunosuppressed group. The average tumor volume throughout the experiment was 4.38 cm(3) in the immunosuppressed group, and 0.27 cm(3) in the control one (p<0.001). Tumors showed histopathological hallmarks of GBM and retained its glial identity verified by GFAP and vimentin immunoreaction. Immunosuppression of rats with cyclosporin was efficient in allowing the development of human glioblastoma cells in subcutaneous tissues. The model has demonstrated the maintenance of most of the histopathological characteristics of human glioblastoma in an heterotopic site and might by considered in research of molecular and proliferative pathways of malignant gliomas.
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High-density lipoprotein levels and 10-year cardiovascular risk in HIV-1-infected patients.
AIDS
PUBLISHED: 02-19-2011
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We aimed to determine the contribution of high-density lipoprotein cholesterol (HDL-c) to cardiovascular disease (CVD) risk in a cohort of HIV-infected patients. The contribution of CVD risk factors to the predicted CVD risk was assessed. We estimated the degree of reclassification of CVD risk if HDL-c concentration was increased in all patients by 20 and 40%, respectively. After age, HDL-c contributed most to the overall cardiovascular risk. Increasing HDL-c by 20% and 40% reclassified six and 12 patients to lower CVD risk groups, respectively. In this cohort, HDL-c contributed more to cardiovascular risk than smoking, total cholesterol, systolic blood pressure (SBP) and sex.
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Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process.
Behav Res Ther
PUBLISHED: 02-14-2011
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Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A "treatment responder" analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.
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Effectiveness of a vaccination programme for an epidemic of meningococcal B in New Zealand.
Vaccine
PUBLISHED: 01-16-2011
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New Zealand has experienced a prolonged epidemic of meningococcal B disease since 1991. The epidemic has waned significantly since its most recent peak in 2001. A strain-specific vaccine, MeNZB, was introduced to control the epidemic in 2004, achieving 81% coverage of people under the age of 20. The vaccine was rolled out in a staged manner allowing the comparison of disease rates in vaccinated and unvaccinated individuals in each year. Vaccine effectiveness in people aged under 20 years is estimated using a Poisson regression model in the years 2001-2008, including adjustments for year, season, age, ethnicity, region and socioeconomic status. Further analyses investigate the dose response relationship, waning of the vaccine effect after one year, and cross-protection against other strains of meningococcal disease. The primary analysis estimates MeNZB vaccine effectiveness to be 77% (95% CI 62-85) after 3 doses and a mean follow-up time of 3.2 years. There is evidence for a protective effect after 2 doses 47% (95% CI 16-67), and no evidence for a waning of effectiveness after one year. Simultaneous modelling of invasive pneumococcal disease and epidemic strain meningococcal B suggests a degree of residual confounding that reduces the effectiveness estimate to 68%. There is evidence for some cross-protection of MeNZB against non-epidemic strains. The MeNZB vaccine was effective against the New Zealand epidemic strain of meningococcal B disease. Between July 2004 and December 2008 an estimated 210 epidemic strain cases (95% CI 100-380), six deaths and 15-30 cases of severe sequelae were avoided in New Zealand due to the introduction of the MeNZB vaccine.
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The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people.
Br J Occup Ther
PUBLISHED: 09-08-2010
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INTRODUCTION: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). PURPOSE: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. METHOD: Three hundred and one people (12-18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. RESULTS: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. CONCLUSION: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.
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Health policy responses to rising rates of multi-morbid chronic illness in Australia and New Zealand.
Aust N Z J Public Health
PUBLISHED: 07-24-2010
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To examine current health policy in Australia and New Zealand and assess the extent to which the policies equip these countries to meet the challenges associated with increasing rates of multi-morbid chronic illnesses.
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Pork, beef and chicken have similar effects on acute satiety and hormonal markers of appetite.
Appetite
PUBLISHED: 07-06-2010
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The effects of three different meat-containing breakfast meals (pork, beef or chicken) on acute satiety and appetite regulatory hormones were compared using a within-subjects study design. Thirty fasting non-smoking pre-menopausal women attended a research centre on three test days to consume, a meat-containing meal matched in energy (kJ) and protein content, palatability, and appearance. No difference was found between meat groups for either energy intake or macronutrient profile of food consumed at a subsequent ad libitum buffet lunch, or over the rest of the day. Visual Analogue Scale (VAS) ratings for hunger and satiety over an 180 min period did not differ between test meals. After consumption of the test meals, a significant difference was found in PYY response between pork and chicken meals (P=0.027) but not for levels of CCK, ghrelin, insulin or glucose. This study positions pork, beef, and chicken as equal in their effect on satiety and release of appetite-related intestinal hormones and of insulin.
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Patient characteristics associated with in-hospital mortality in children following tracheotomy.
Arch. Dis. Child.
PUBLISHED: 06-03-2010
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To identify children at risk for in-hospital mortality following tracheotomy.
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Further development of an instrument to assess psychological flexibility in people with chronic pain.
J Behav Med
PUBLISHED: 04-26-2010
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Recently, an expansion of traditional coping models for chronic pain has been offered. This model specifically includes acceptance of chronic pain, as well as the more general process of psychological flexibility. Psychological flexibility includes qualities of behavior such as acceptance and mindfulness, and the capacity to take committed and values-directed or goals-directed action, among other qualities. The present study was intended to refine and validate a measure of psychological flexibility, titled the Brief Pain Response Inventory (BPRI), and determine its relation with key indices of patient functioning. In total, 205 adults with chronic pain who were beginning a program of treatment completed a battery of self-report questionnaires. Exploratory factor analysis indicated the presence of two factors within the items of the BPRI: Flexible Action and Willing Engagement. Subscale and total scores were generally unrelated with patient background variables, although they were related to, and accounted for significant variance in, measures of emotional, physical, and psychosocial functioning. These analyses provide additional support for the relevance of psychological flexibility to the problem of chronic pain, as well as initial evidence for the BPRI as a measure of this process.
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Clients understanding of the role of nurse practitioners.
Aust Health Rev
PUBLISHED: 03-26-2010
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Nurse practitioners (NPs) have an emerging role in the Australian health care system. However, there remains a dearth of data about public understanding of the NP role. The aim of this study was to evaluate clients understanding of the role of the NP and their satisfaction with education received, quality of care and NP knowledge and skill. All authorised NPs working in a designated NP position in Western Australia and those working in three area health services in New South Wales were invited to recruit five consecutive clients to complete the self-administered survey. Thirty-two NPs (NP response rate 93%) recruited 129 clients (client response rate 90%). Two-thirds of clients (63%) were aware they were consulting an NP. The majority rated the following NP-related outcomes as excellent or very good: education provided (89%); quality of care (95%); and knowledge and skill (93%). Less than half reported an understanding that NPs could prescribe medications (40.5%) or interpret X-rays (33.6%). Clients of NPs practising in a rural or remote setting were more likely than those in an urban setting to have previously consulted an NP (P = 0.005), and where applicable would to prefer to see an NP rather than a doctor (P = 0.022). Successful implementation and expansion of the NP role requires NP visibility in the community. Despite high levels of satisfaction, more awareness of the scope of the NP role is required.
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Measuring physical function in children with airway support: a pilot study using computer adaptive testing.
Dev Neurorehabil
PUBLISHED: 03-13-2010
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To assess the responsiveness, examine the scoring range and determine the efficiency of a multidimensional computer adaptive testing version of the Pediatric Evaluation of Disability Inventory (PEDI-MCAT) for children admitted to inpatient pulmonary rehabilitation.
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Measuring life quality, physical function and psychological well-being in neurological illness.
Amyotroph Lateral Scler
PUBLISHED: 03-03-2010
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There is little in the literature comparing experiences of patients with disabling and uniformly terminal illness (e.g. amyotrophic lateral sclerosis) and illness characterized by episodic disability and prognostic uncertainty (e.g. multiple sclerosis). This study aimed to compare experiences of disability, quality of life (QoL) and psychological well-being in ALS and MS. One hundred patients with ALS and MS were interviewed at baseline and at six months. Variables measured included function, health related QoL, individualized QoL and psychological distress. Despite the divergent illness experiences of ALS and MS patients, groups did not differ on individualized QoL or mental well-being, and distress was in the normal range. Despite marked deterioration in ALS patients health, there was no change in mental well-being and QoL. Psychological well-being appeared more important in maintaining QoL (individualized QoL and mental aspects of health related QoL) than physical factors. At the individual level, there was evidence of psychological adaptation to deteriorating function, which underlined the role of specific illness related challenges in determining perceived life quality and emotional well-being. In conclusion, the complex interplay between psychosocial and illness specific factors such as certainty with regard to prognosis has considerable implications for well-being and life quality. Recognizing such factors is essential when designing clinical interventions to promote adjustment and self-management among patients with neurological conditions.
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An integrative approach to advanced kidney disease in the elderly.
Adv Chronic Kidney Dis
PUBLISHED: 02-03-2010
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Chronic kidney disease (CKD) has increasingly become a "geriatric" disease, with a dramatic rise in incidence in the aging population. Patients aged >75 years have become the fastest growing population initiating dialysis. These patients have increased comorbid diseases and functional limitations which affect mortality and quality of life. This review describes the challenges of dialysis initiation and considerations for management of the elderly subpopulation. There is a need for an integrative approach to care, which addresses management issues, health-related quality of life, and timely discussion of goals of care and end-of-life issues. This comprehensive approach to patient care involves the integration of nephrology, geriatric, and palliative medicine practices.
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Intravenous PEG-asparaginase during remission induction in children and adolescents with newly diagnosed acute lymphoblastic leukemia.
Blood
PUBLISHED: 12-10-2009
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Over the past several decades, L-asparaginase, an important component of therapy for acute lymphoblastic leukemia (ALL), has typically been administered intramuscularly rather than intravenously in North America because of concerns regarding anaphylaxis. We evaluated the feasibility of giving polyethylene glycosylated (PEG)-asparaginase, the polyethylene glycol conjugate of Escherichia coli L-asparaginase, by intravenous infusion in children with ALL. Between 2005 and 2007, 197 patients (age, 1-17 years) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 05-01 and received a single dose of intravenous PEG-asparaginase (2500 IU/m(2)) over 1 hour during remission induction. Serum asparaginase activity more than 0.1 IU/mL was detected in 95%, 88%, and 7% of patients at 11, 18, and 25 days after dosing, respectively. Toxicities included allergy (1.5%), venous thrombosis (2%), and pancreatitis (4.6%). We conclude that intravenous administration of PEG-asparaginase is tolerable in children with ALL, and potentially therapeutic enzyme activity is maintained for at least 2 weeks after a single dose in most patients. This trial was registered at www.clinicaltrials.gov as #NCT00400946.
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From cure to care: assessing the ethical and professional learning needs of medical learners in a care-based facility.
Gerontol Geriatr Educ
PUBLISHED: 11-21-2009
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The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five themes emerged as learning needs: the holistic approach to care, withdrawal of treatment and withholding investigations, the collaborative team model, violations to patient autonomy, Do Not Resuscitate and advance directives issues. The results illustrate the importance of preparing medical learners for a philosophical shift in their approach to patient care, as they move from the more cure-based approach of acute care to the care model of care-based facilities.
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Testing for HIV: concise guidance.
Clin Med
PUBLISHED: 11-05-2009
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HIV is now a treatable medical condition and the majority of those living with the virus remain fit and well on treatment. Despite this a significant number of people in the UK are unaware of their HIV infection and remain at risk to their own health and of passing their virus unwittingly on to others. Late diagnosis is the most important factor associated with HIV-related morbidity and mortality in the U.K. Testing for HIV infection is often not performed due to misconceptions held by healthcare workers even when it is clinically indicated and this contributes to missed or late diagnosis. This article summarises the recommendations from the U.K. national guidelines for HIV testing 2008. The guidelines provide the information needed to enable any clinician to perform an HIV test within good clinical practice and encourage normalisation of HIV testing. The full version is available at www.bhiva.org/cmsl 222621.asp.
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Prevalence, emergence, and factors associated with a viral papillomatosis and carcinomatosis syndrome in wild, reintroduced, and captive western barred bandicoots (Perameles bougainville).
Ecohealth
PUBLISHED: 09-14-2009
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Once widespread across western and southern Australia, wild populations of the western barred bandicoot (WBB) are now only found on Bernier and Dorre Islands, Western Australia. Conservation efforts to prevent the extinction of the WBB are presently hampered by a papillomatosis and carcinomatosis syndrome identified in captive and wild bandicoots, associated with infection with the bandicoot papillomatosis carcinomatosis virus type 1 (BPCV1). This study examined the prevalence and distribution of BPCV1 and the associated syndrome in two island and four mainland (reintroduced and captive) WBB populations in Western Australia, and factors that may be associated with susceptibility to this syndrome. BPCV1 and the syndrome were found in the wild WBB population at Red Cliff on Bernier Island, and in mainland populations established from all or a proportion of founder WBBs from Red Cliff. BPCV1 and the syndrome were not found in the wild population on Dorre Island or in the mainland population founded by animals exclusively from Dorre Island. Findings suggested that BPCV1 and the syndrome were disseminated into mainland WBB populations through the introduction of affected WBBs from Red Cliff. No difference in susceptibility to the syndrome was found between Dorre Island, Bernier Island, and island-cross individuals. Severity of lesions and the number of affected animals observed in captivity was greater than that observed in wild populations. This study provided epidemiological evidence to support the pathological and molecular association between BPCV1 infection and the papillomatosis and carcinomatosis syndrome and revealed increasing age as an additional risk factor for this disease.
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Anion effects on electrostatic charging of sterically stabilized, water insoluble drug particles.
Int J Pharm
PUBLISHED: 07-16-2009
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Water-insoluble suspensions of itraconazole and budesonide were sterically stabilized using nonionic polymers (poloxamer 188 or polysorbate 80) and probed for polymer-anion interactions by measuring changes in particle zeta potential. Anions comprising a range of functionalities and aqueous solubilities were examined. Results showed that the more hydrophobic anions partitioned to the particle interface, and a simple model for predicting anion adsorption was developed from their calculated properties. Anions with a calculated Klopman water solubility less than 10 microM or a calculated log P>3.5 were adsorbed to the particle-polymer interface effectively increasing the overall particle charge. Anions of similar hydrophobicities with sulfonate or sulfate functionalities showed a much higher degree of particle charging compared with their carboxylate and phosphonate analogs at pH 9.5. In addition, the electrostatic charging of particles occurred at lower solution concentrations of sulfonate derivatives. These results suggest that the relative basicity of the oxoanion functionality may influence protonation or ion-pairing phenomena of the anions when adsorbed at the particle-polymer interface. Cetyltetramethylammonium bromide (CTAB) produced a positively charged particle consistent with the model developed for anion adsorption. Particle charging of sterically stabilized drug suspensions appeared largely independent of drug and polymer type. Anion hydrophobicity (solubility) and headgroup functionality dictated the observed charging behavior.
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Predictors of clinical outcomes and hospital resource use of children after tracheotomy.
Pediatrics
PUBLISHED: 07-13-2009
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The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use.
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Properties and clinical performance of vaccines containing outer membrane vesicles from Neisseria meningitidis.
Vaccine
PUBLISHED: 05-28-2009
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Meningococcal outer membrane proteins have been used for over 20 years in more than 80 million doses; either as carrier protein in a Haemophilus influenzae type b (Hib) polysaccharide conjugate vaccine or as vesicle vaccine formulations against meningococcal disease. Conventional wild-type outer membrane vesicle (wtOMV) vaccines are the only formulations that have shown efficacy against serogroup B meningococcal disease. This has been demonstrated in Cuba, Norway and New Zealand; where epidemics, dominated by one particular strain or clone, were causing high rates of disease and wtOMV vaccines have been used for epidemic control. The most significant limitation for widespread use of wtOMV is that the immune response is strain-specific in infants, mostly directed against the immuno-dominant porin protein, PorA. The natural orientation of surface-exposed membrane antigens and the preservation of good physico-chemical stability are key features of OMV vaccines. The efficacy, tolerability and safety of wtOMV vaccines have been well proven. The most recent experience from New Zealand demonstrated a vaccine effectiveness of 80% for children less than 5 years of age, over a period of 24 months. Such results are encouraging for the further use of "tailor-made" OMV vaccines for epidemic control. Moreover, it provides opportunities for development of OMV vaccines with various additional cross-protective potential. There is good reason to believe that in the coming few years the "OMV-concept" will be exploited further and that a number of cross-protective "universal" antigens will be included in vaccines against serogroup B meningococcal disease. The desire to have a global vaccine strategy that enables susceptible individuals to be protected against all the relevant serogroups of meningococcal disease may become a reality.
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Development and evaluation of a minimum data set for children with airway support for transfers between acute and post-acute care.
Dev Neurorehabil
PUBLISHED: 05-26-2009
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To generate consensus on the reasons why children with airway support transfer between acute and post-acute care; develop a minimum data set to transmit between care settings; and examine transfer reports to determine the frequency of data set content.
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Use of an observational cohort study to estimate the effectiveness of the New Zealand group B meningococcal vaccine in children aged under 5 years.
Int J Epidemiol
PUBLISHED: 05-08-2009
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In July 2004 a strain-specific vaccine was introduced to combat an epidemic of group B meningococcal disease in New Zealand. We estimated the effectiveness of this vaccine in pre-school-aged children.
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Immunogenicity and tolerability in infants of a New Zealand epidemic strain meningococcal B outer membrane vesicle vaccine.
Pediatr. Infect. Dis. J.
PUBLISHED: 04-23-2009
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An outer membrane vesicle meningococcal vaccine (MeNZB), was developed for the New Zealand epidemic strain of Neisseria meningitidis B:4:P1.7-2,4.
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Aerosol based detectors for the investigation of phospholipid hydrolysis in a pharmaceutical suspension formulation.
J Pharm Biomed Anal
PUBLISHED: 04-03-2009
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A high performance liquid chromatography (HPLC) method was developed to quantify free fatty acids (FFA) in a pharmaceutical suspension formulated with phospholipids as stabilizing agents. Specifically, a suspension of crystalline itraconazole microparticles stabilized with Lipoid E80 was used as a model system to study the physicochemical stability of an aqueous, phospholipid-based suspension for injection. The hydrolysis of the phospholipids during storage at elevated temperatures (40 degrees C) necessitated the development of a suitable HPLC method for the determination of free fatty acid content in the suspension samples. HPLC methods using two types of aerosol detectors were investigated for the above purpose. Reversed-phase separation coupled with either an evaporative light scattering detector (ELSD) or a Corona(Plus) charged aerosol detector (CAD) was used. A comparison of the methods indicated that the CAD method provided better sensitivity, precision, recovery, and linearity for the parameters evaluated. As a result, this method was chosen for the stability study of itraconazole suspension and has been incorporated in subsequent formulation studies.
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Genomic and genic deletions of the FOX gene cluster on 16q24.1 and inactivating mutations of FOXF1 cause alveolar capillary dysplasia and other malformations.
Am. J. Hum. Genet.
PUBLISHED: 03-27-2009
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Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, neonatally lethal developmental disorder of the lung with defining histologic abnormalities typically associated with multiple congenital anomalies (MCA). Using array CGH analysis, we have identified six overlapping microdeletions encompassing the FOX transcription factor gene cluster in chromosome 16q24.1q24.2 in patients with ACD/MPV and MCA. Subsequently, we have identified four different heterozygous mutations (frameshift, nonsense, and no-stop) in the candidate FOXF1 gene in unrelated patients with sporadic ACD/MPV and MCA. Custom-designed, high-resolution microarray analysis of additional ACD/MPV samples revealed one microdeletion harboring FOXF1 and two distinct microdeletions upstream of FOXF1, implicating a position effect. DNA sequence analysis revealed that in six of nine deletions, both breakpoints occurred in the portions of Alu elements showing eight to 43 base pairs of perfect microhomology, suggesting replication error Microhomology-Mediated Break-Induced Replication (MMBIR)/Fork Stalling and Template Switching (FoSTeS) as a mechanism of their formation. In contrast to the association of point mutations in FOXF1 with bowel malrotation, microdeletions of FOXF1 were associated with hypoplastic left heart syndrome and gastrointestinal atresias, probably due to haploinsufficiency for the neighboring FOXC2 and FOXL1 genes. These differences reveal the phenotypic consequences of gene alterations in cis.
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Delivering a safe and effective strain-specific vaccine to control an epidemic of group B meningococcal disease.
N. Z. Med. J.
PUBLISHED: 03-27-2009
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In response to a devastating group B meningococcal disease epidemic in New Zealand, a case was prepared for new health funding and a new outer membrane vesicle vaccine, MeNZB, developed. Following clinical trials demonstrating satisfactory immunogenicity and safety profiles a national implementation strategy was prepared. MeNZB was introduced halfway through the 14th year of the epidemic with a campaign targeting children and young people aged under 20 years delivered over 2 years. By its completion in June 2006, the vaccine had been delivered to more than 1 million young people. All of the above steps were achieved within 5 years. This unique endeavour was possible due to a private/public partnership between the New Zealand Ministry of Health and Chiron Vaccines. This paper summarises the outcomes of this campaign including coverage levels achieved, evidence of vaccine effectiveness and safety, and the strategies used to manage key events and risks that emerged during the campaign.
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Interactions and reactions in some 2,2-disubstituted biphenyls--an open or shut case.
Org. Biomol. Chem.
PUBLISHED: 02-14-2009
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2-Dimethylaminobiphenyls bearing an electron deficient alkene in the 2 position show either Me2N...C=C interactions (2.941-2.976 A) or form a new N-C bond (1.586-1.604 A) to give a zwitterion. The former provides a model for an intermolecular interaction, while the latter provides structural information on organic anionic systems uncoordinated by metal cations.
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General psychological acceptance and chronic pain: there is more to accept than the pain itself.
Eur J Pain
PUBLISHED: 01-21-2009
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An increasing body of research demonstrates that acceptance of pain is significantly associated with the quality of daily functioning in people with chronic pain. The aim of the present study was to examine acceptance more broadly in relation to a wider range of undesirable experiences these people may encounter, such as other physical symptoms, experiences of emotional distress, or distressing thoughts. One hundred forty-four, consecutive, adult patients attending interdisciplinary treatment for chronic pain participated in this study. They completed the Acceptance and Action Questionnaire-II (AAQ-II [Bond F, Hayes SC, Baer RA, Carpenter KM, Orcutt HK, Waltz T, Zettle RD. Preliminary psychometric properties of the Acceptance Action Questionnaire-II: a revised measure of psychological flexibility and acceptance, submitted for publication]), measuring their general psychological acceptance. They also completed measures of emotional, physical, and psychosocial functioning, pain acceptance, and mindfulness. The AAQ-II achieved satisfactory internal consistency, alpha=.89, and factor analysis revealed a unitary factor structure. Primary results showed that general psychological acceptance significantly correlated with depression, r=-.69, pain-related anxiety, r=-.59, physical disability, r=-.42, and psychosocial disability, r=-.65, all p<.001. Hierarchical regression analyses showed that general psychological acceptance added a significant increment of explained variance to the prediction of patient functioning, independent of patient background characteristics, pain, acceptance of pain, and mindfulness. These results suggest that, when people with chronic pain are willing to have undesirable psychological experiences without attempting to control them, they may function better and suffer less. General acceptance may have a unique role to play in the disability and suffering of chronic pain beyond similar processes such as acceptance of pain or mindfulness.
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Development of clinical competencies for emergency nurse practitioners: a pilot study.
Australas Emerg Nurs J
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Nurse practitioner education and practice has been guided by generic competency standards in Australia since 2006. Development of specialist competencies has been less structured and there are no formal standards to guide education and continuing professional development for specialty fields. There is limited international research and no Australian research into development of specialist nurse practitioner competencies. This pilot study aimed to test data collection methods, tools and processes in preparation for a larger national study to investigate specialist competency standards for emergency nurse practitioners. Research into specialist emergency nurse practitioner competencies has not been conducted in Australia.
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The expression of cholesterol metabolism genes in monocytes from HIV-infected subjects suggests intracellular cholesterol accumulation.
J. Infect. Dis.
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Human immunodeficiency virus (HIV) infection is associated with increased cardiovascular risk and reduced high-density lipoprotein cholesterol (HDL-c). In vitro, HIV impairs monocyte-macrophage cholesterol efflux, a major determinant of circulating HDL-c, by increasing ABCA1 degradation, with compensatory upregulation of ABCA1 messenger RNA (mRNA).
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Communication skills training for dialysis decision-making and end-of-life care in nephrology.
Clin J Am Soc Nephrol
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Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh (n=22). Pre- and post-workshop surveys evaluated efficacy of the curriculum and measured changes in perceived preparedness on the basis on workshop training. Overall, 14% of fellows were white and 50% were male. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86% and 100%. Only 36% (8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skills were important to being a "great nephrologist." Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5-1.14; P<0.01), including delivering bad news, expressing empathy, and discussing dialysis initiation and withdrawal. All respondents (21 of 21) reported they would recommend this training to other fellows. NephroTalk is successful for improving preparedness among nephrology fellows for having difficult conversations about dialysis decision-making and end-of-life care.
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NephroTalk: communication tools to enhance patient-centered care.
Semin Dial
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Nephrologists frequently must discuss serious news with patients, especially those with advanced comorbidities. These discussions include giving bad news, addressing prognosis, and assisting with treatment decision making. Few data exist about how nephrologists approach these difficult conversations. This article presents a framework for engaging in these discussions using a case example, and provides tools for assisting with treatment decision making for initiating or forgoing dialysis. Communication skills presented include Ask-Tell-Ask for discussing serious news, the N-U-R-S-E acronym for recognizing and responding to emotion; tools for naming uncertainty when addressing prognosis; and using big picture questions to elicit patient care preferences for treatment decision making. This article provides nephrologists with the framework and skills to better engage in patient-centered decision making.
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The effectiveness of a four-layer compression bandage system in comparison with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomised controlled trial.
Int Wound J
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An increasing number of compression systems available for treatment of venous leg ulcers and limited evidence on the relative effectiveness of these systems are available. The purpose of this study was to conduct a randomised controlled trial to compare the effectiveness of a four-layer compression bandage system and Class 3 compression hosiery on healing and quality of life (QL) in patients with venous leg ulcers. Data were collected from 103 participants on demographics, health, ulcer status, treatments, pain, depression and QL for 24 weeks. After 24 weeks, 86% of the four-layer bandage group and 77% of the hosiery group were healed (P = 0·24). Median time to healing for the bandage group was 10 weeks, in comparison with 14 weeks for the hosiery group (P = 0·018). The Cox proportional hazards regression found participants in the four-layer system were 2·1 times (95% CI 1·2-3·5) more likely to heal than those in hosiery, while longer ulcer duration, larger ulcer area and higher depression scores significantly delayed healing. No differences between groups were found in QL or pain measures. Findings indicate that these systems were equally effective in healing patients by 24 weeks; however, a four-layer system may produce a more rapid response.
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A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study.
Int Wound J
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This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study.
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Advancing formaldehyde cross-linking towards quantitative proteomic applications.
Anal Bioanal Chem
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Formaldehyde is a key fixation reagent. This review explores its application in combination with qualitative and quantitative mass spectrometry (MS). Formalin-fixed and paraffin-embedded (FFPE) tissues form a large reservoir of biologically valuable samples and their investigation by MS has only recently started. Furthermore, formaldehyde can be used to stabilise protein-protein interactions in living cells. Because formaldehyde is able to modify proteins, performing MS analysis on these samples can pose a challenge. Here we discuss the chemistry of formaldehyde cross-linking, describe the problems of and progress in these two applications and their common aspects, and evaluate the potential of these methods for the future.
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AIB1:ER? transcriptional activity is selectively enhanced in aromatase inhibitor-resistant breast cancer cells.
Clin. Cancer Res.
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The use of aromatase inhibitors (AI) in the treatment of estrogen receptor (ER)-positive, postmenopausal breast cancer has proven efficacy. However, inappropriate activation of ER target genes has been implicated in the development of resistant tumors. The ER coactivator protein AIB1 has previously been associated with initiation of breast cancer and resistance to endocrine therapy.
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Asparaginase-associated myelosuppression and effects on dosing of other chemotherapeutic agents in childhood acute lymphoblastic leukemia.
Pediatr Blood Cancer
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Although L-asparaginase (ASP) is associated with several toxicities, its myelosuppressive effect has not been well characterized. On DFCI ALL Consortium Protocol 05-01 for children with newly diagnosed acute lymphoblastic leukemia, the Consolidation phase and the initial portion of the Continuation phase were identical for standard risk patients, except ASP was given only during Consolidation. Comparing the two treatment phases revealed that low blood counts during Consolidation with ASP resulted in more dosage reductions of 6-mercaptopurine and methotrexate. The myelosuppressive effect of ASP should be considered when designing treatment regimens to avoid excessive toxicity and dose reductions of other critical chemotherapy agents.
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Health Care Seeking Behavior among Caregivers of Sick Children Who Had Cerebral Malaria in Northwestern Nigeria.
Malar Res Treat
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Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9%) and grandparents 4 (12.1%). Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%), patent medicine seller 12 (36.4%), home treatment 10 (30.3%), and herbal concoction 6 (18.2%) with majority 24 (72.7%) using more than one option. Antimalarial therapy was instituted in 25 (75.6%) of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.
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Discussions of the kidney disease trajectory by elderly patients and nephrologists: a qualitative study.
Am. J. Kidney Dis.
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Elderly patients with advanced kidney disease experience considerable disability, morbidity, and mortality. Little is known about the impact of physician-patient interactions on patient preparation for the illness trajectory. We sought to describe how nephrologists and older patients discuss and understand the prognosis and course of kidney disease leading to renal replacement therapy.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.