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1
Lee, Seung Eun, Juhwan Yoo, Kyoung-Ah Kim, Kyungdo Han, and Han Seok Choi. "Hip Fracture Risk According to Diabetic Kidney Disease Phenotype in a Korean Population." Endocrinology and Metabolism 37, no. 1 (February 28, 2022): 148–58. http://dx.doi.org/10.3803/enm.2021.1315.
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Background: Diabetic kidney disease (DKD) is associated with an elevated risk of fractures. However, little is known about the association between proteinuric or non-proteinuric DKD and the risk of hip fracture. Thus, we investigated the incidence of hip fractures among Korean adults with type 2 diabetes mellitus (T2DM) stratified by DKD phenotype.Methods: In this retrospective cohort study using the Korean National Health Insurance Service database, patients with T2DM who received at least one general health checkup between 2009 and 2012 were followed until the date of hip fracture, death, or December 31, 2018. We classified the DKD phenotype by proteinuria and estimated glomerular filtration rate (eGFR), as follows: no DKD (PU−GFR−), proteinuric DKD with normal eGFR (PU+GFR−), non-proteinuric DKD with reduced eGFR (PU−GFR+), and proteinuric DKD with reduced eGFR (PU+GFR+)Results: The cumulative incidence of hip fractures was highest in the PU+GFR+ group, followed by the PU−GFR+ group and the PU+GFR− group. After adjustment for confounding factors, the hazard ratio (HR) for hip fracture was still highest in the PU+GFR+ group. However, the PU+GFR− group had a higher HR for hip fracture than the PU−GFR+ group (PU+GFR+ : HR, 1.69; 95% confidence interval [CI], 1.57 to 1.81; PU+GFR− : HR, 1.37; 95% CI, 1.30 to 1.46; PU−GFR+ : HR, 1.20; 95% CI, 1.16 to 1.24 using the PU−GFR− group as the reference category).Conclusion: The present study demonstrated that DKD was significantly associated with a higher risk of hip fracture, with proteinuria as a major determinant.
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Yang, Peng, Xiang-Dong Zheng, Jun-Mei Wang, Wen-Bin Geng, and Xiaoyong Wang. "Undifferentiated-predominant mixed-type early gastric cancer is more aggressive than pure undifferentiated type: a systematic review and meta-analysis." BMJ Open 12, no. 4 (April 2022): e054473. http://dx.doi.org/10.1136/bmjopen-2021-054473.
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BackgroundStudies have shown that differentiated-predominant mixed-type early gastric cancer (EGC) is more aggressive than pure differentiated-type EGC. However, the biological behaviour of undifferentiated-predominant mixed-type (MU) EGC and pure undifferentiated-type (PU) EGC are controversial. This study was conducted to compare the biological behaviour of MU EGC and PU EGC.MethodsA systematic review and meta-analysis of observational studies was conducted using literature published through PubMed and Embase from inception to 9 November 2021. Inclusion criteria were: (1) a direct or indirect comparison of MU and PU; (2) patients with EGC; (3) a specified outcome of lymph node metastasis (LNM), lymphovascular invasion, submucosal invasion and/or ulcer findings; and (4) the primary lesion was obtained. The literature search, data extraction and quality assessment were performed by two independent reviewers. The meta-analysis was conducted with a random-effect model using the Mantel-Haenszel method.ResultsTwelve publications with 5644 patients were included. Patients with MU EGC had significantly higher risk of LNM (OR 2.28; 95% CI 1.72 to 3.03) and submucosal invasion (OR 2.19; 95% CI 1.90 to 2.52) compared with patients with PU EGC. No difference was found between patients with MU and PU EGC with respect to lymphovascular invasion risk (OR 1.81; 95% CI 0.84 to 3.87). After stratifying the data according to depth of tumour invasion, a significantly higher risk for LNM was associated with intramucosal MU EGC (OR 2.56; 95% CI 1.66 to 3.95) and submucosal MU EGC (OR 2.63; 95% CI 2.06 to 3.06). Submucosal MU EGC also had a significantly higher risk of lymphovascular invasion (OR 2.40; 95% CI 1.79 to 3.21) compared with submucosal PU EGC.DiscussionPatients with MU EGC had an increased risk of submucosal invasion and LNM compared with patients with PU EGC . MU patients with submucosal EGC also had an increased lymphovascular invasion risk compared with PU patients. Therefore, attention should be focused on the clinical management of patients with MU EGC.
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Yang, Chiung-Ying, Kuang-Chen Hung, Yea-Yin Yen, Hung-En Liao, Shou-Jen Lan, and Hsin-Cheng Lin. "Anti-Oxidative Effect of Pu-erh Tea in Animals Trails: A Systematic Review and Meta-Analysis." Foods 11, no. 9 (May 4, 2022): 1333. http://dx.doi.org/10.3390/foods11091333.
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This study adopted systematic literature review and meta-analysis methodology to explored anti-oxidative effect of pu-erh tea. Study authors have systemically searched seven databases up until 21 February 2020. In performing the literature search on the above-mentioned databases, the authors used keywords of pu-erh AND (superoxide dismutase OR glutathione peroxidase OR malondialdehyde). Results derived from meta-analyses showed statistically significant effects of pu-erh tea on reducing serum MDA levels (SMD, −4.19; 95% CI, −5.22 to −3.15; p < 0.001; I2 = 93.67%); increasing serum SOD levels (SMD, 2.41; 95% CI, 1.61 to 3.20; p < 0.001; I2 = 91.36%); and increasing serum GSH-Px levels (SMD, 4.23; 95% CI, 3.10 to 5.36; p < 0.001; I2 = 93.69%). Results from systematic review and meta-analyses validated that various ingredients found in pu-erh tea extracts had anti-oxidation effects, a long-held conventional wisdom with limited supporting evidence.
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Burguet, Laure, Benjamin Taton, Mathilde Prezelin-Reydit, Sébastien Rubin, Walter Picard, Didier Gruson, Anne Ryman, et al. "Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis." Journal of Clinical Medicine 11, no. 3 (January 27, 2022): 648. http://dx.doi.org/10.3390/jcm11030648.
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Background: Early diagnosis of thrombotic thrombocytopenic purpura (TTP) versus hemolytic and uremic syndrome (HUS) is critical for the prompt initiation of specific therapies. Objective: To evaluate the diagnostic performance of the proteinuria/creatininuria ratio (PU/CU) for TTP versus HUS. Patients/Methods: In a retrospective study, in association with the “French Score” (FS) (platelets < 30 G/L and serum creatinine level < 200 µmol/L), we assessed PU/CU for the diagnosis of TTP in patients above the age of 15 with thrombotic microangiopathy (TMA). Patients with a history of kidney disease or with on-going cancer, allograft or pregnancy were excluded from the analysis. Results: Between February 2011 and April 2019, we identified 124 TMA. Fifty-six TMA patients for whom PU/CU were available, including 35 TTP and 21 HUS cases, were considered. Using receiver–operating characteristic curves (ROC), those with a threshold of 1.5 g/g for the PU/CU had a 77% sensitivity (95% CI (63, 94)) and a 90% specificity (95% CI (71, 100)) for TTP diagnosis compared with those having an 80% sensitivity (95% CI (66, 92)) and a 90% specificity (95% CI (76, 100) with a FS of 2. In comparison, a composite score, defined as a FS of 2 or a PU/CU ≤ 1.5 g/g, improved sensitivity to 99.6% (95% CI (93, 100)) for TTP diagnosis and enabled us to reclassify seven false-negative TTP patients. Conclusions: The addition of urinary PU/CU upon admission of patients with TMA is a fast and readily available test that can aid in the differential diagnosis of TTP versus HUS alongside traditional scoring.
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Gong, Xiang, Hong-Lin Chen, Jun-Hua Shen, and Bao-Feng Zhu. "Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study." Journal of Wound Care 28, no. 8 (August 2, 2019): 527–31. http://dx.doi.org/10.12968/jowc.2019.28.8.527.
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Objective:To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department.Methods:The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR).Results:A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224).Conclusion:Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.
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Frankel, Heidi, Jason Sperry, and Lewis Kaplan. "Risk Factors for Pressure Ulcer Development in a Best Practice Surgical Intensive Care Unit." American Surgeon 73, no. 12 (December 2007): 1215–17. http://dx.doi.org/10.1177/000313480707301203.
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We describe the incidence of and define risk factors for pressure ulcers (PU) in the surgical intensive care unit (ICU). Twelve months of data were collected on all patients admitted to the intensivist-run surgical ICU of a university hospital. PU patients were those who developed a new stage II or greater lesion during or after a surgical ICU stay as identified in Project Impact®, ICD9 discharge, or ICU complications databases. Patients were nursed in pressure-relieving beds with nutrition initiated by 72 hours. χ2, t test, and logistic regression statistics were used. Three percent (25/820) developed PU. Age, ICU length of stay, Acute Physiology and Chronic Health Evaluation Score (APACHE), and gender were not different between those with and without PU. Patients with PU had a higher blood urea nitrogen/creatinine (30.5/2.2 mg/dL vs 22.0/1.6 mg/dL) and were more frequently vascular patients (28 vs 14.1%), diabetics (40 vs 17.2%), paraplegics (8 vs 0.2%) (all P < 0.01), and patients on pressors (28.0 vs 11.8%, P < 0.02). Multivariate analysis revealed that diabetes (odds ratio [OR] 2.7, 95%, confidence interval [CI] 1.1-6.4), spinal cord injury (OR 16.8, 95%, CI 1.5-183), age > 60 years (OR 2.9,95%, CI 1.2-7.1), and a creatinine >3 mg/dL (OR 3.7,95%, CI 1.2-9.3) were independent predictors of PU. Despite universal use of specialty beds and early nutrition, pressure ulcers developed in 3 per cent. Independent risk factors include age greater than 60 years, diabetes, spinal cord injury, and renal insufficiency. Additional modalities, such as aggressive early mobilization, might be warranted in this cohort.
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Nidra, Gary. "Analisis Interaksionisme Simbolik Tradisi Sam Sip Pu pada Perayaan Imlek di Pulau Bangka." Jurnal Studi Inovasi 1, no. 4 (October 21, 2021): 40–49. http://dx.doi.org/10.52000/jsi.v1i4.68.
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Sam Sip Pu merupakan tradisi dalam menyambut Imlek dengan melaks anakan sembahyang baik itu di rumah ataupun di tempat ibadah. Dalam proses pemilihan persembahan dan perlengkapan yang akan disediakan pada saat sembah yang semua berdasarkan hasil pemaknaan dari masing-masing keluarga terhadap persembahan ataupun alat-alat yang akan digunakan. Latar belakang penelitian tradisi Sam Sip Pu ini adalah simbol-simbol yang digunakan dalam persembahan dan perlengkapan serta pemaknaan terhadap persembahan dan perlengkapan dalam perayaan tradisi Sam Sip Pu di Pulau Bangka. Desain penelitian menggunakan penelitian kualitatif, dengan menggunakan pendekatan verstehen. Sumber data yang digunakan adalah data primer yang berasal dari wawancara terhadap tokoh agama dan masyarakat Tionghoa yang melakukan Tradisi Sam Sip Pu di Pulau Bangka. Sedangkan data sekunder didapat melalui jurnal penelitian, penelitian terdahulu, buku, atau dokumen. Simbol-simbol yang ada pada tradisi Sam Sip Pu itu berupa perlengkapan untuk makanan seperti buah-buahan, kue, Sam Sang, teh, arak, lilin, garu, Kim Ci, dan NyunCi. Pemaknaan perlengkapan seperti Lilin dan Garu melambangkan media menyampaikan doa, Kim Ci melambangkan uang kepada dewa, Nyun Ci melambangkan uang kepada leluhur, barang-barang duplikat (pakaian, uang, dan lain-lain) melambangkan penghormatan, kotak pengantar (hun be) melambangkan pengiriman. Menurut interaksi interaksionisme simbolik Blumer, pertama simbol-simbol yang ada pada tradisi Sam Sip Pu digunakan secara terus-menerus dan memiliki makna, kedua, pengetahuan terhadap makna tersebut bukan hanya dimiliki oleh satu atau dua kelompok saja, tapi pengetahuan tersebut dimiliki oleh masyarakat Tionghoa, ketiga, bisa dilihat dari bagaimana masyarakat Tionghoa mencari alternatif pada saat melaksanakan tradisi Sam Sip Pu seperti penggunaan simbol dan makna yang disematkan pada persembahan, contohnya tahu.
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Arisandi, Defa, Kazuhiro Ogai, Tamae Urai, Miku Aoki, Takeo Minematsu, Shigefumi Okamoto, Hiromi Sanada, Toshio Nakatani, and Junko Sugama. "Development of recurrent pressure ulcers, risk factors in older patients: a prospective observational study." Journal of Wound Care 29, Sup4 (April 1, 2020): S14—S24. http://dx.doi.org/10.12968/jowc.2020.29.sup4.s14.
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Objective: Prevention of recurrent pressure ulcers (PU) is one of the most important challenges in wound care, furthermore, the risk factors for recurrent PUs are still not fully understood. This study aimed to explore the risk factors for recurrent PU development within two weeks, including biophysical skin properties, pro-inflammatory cytokine (tumour necrosis factor [TNF]-α) levels and bacterial species, in older patients. Method: This prospective study was conducted in a long-term care facility with patients whose PU had healed within two months. Biophysical skin properties were evaluated by stratum corneum hydration, pH, sebum content and transepidermal water loss. TNF-α level was measured using skin blotting. Skin bacteria were collected using tape stripping and determined by species-specific gene amplification. These parameters, along with Braden scale and interface pressure, were evaluated every two weeks for a total period of eight weeks. A penalised generalised estimating equation analysis was used to determine the risk factors for recurrent PUs. Results: In total, 20 patients were included in this study, with 57 observations. Of these, recurrent PU was seen in eight observations. Elevation of pH (p=0.049; odds ratio [OR] per 1 unit=3.91, 95% confidence interval [CI]:1.01–15.15), presence of Acinetobacter spp. (p=0.039; OR versus culture-negative=6.28, 95%CI:1.10–35.86) and higher interface pressure (p=0.008; OR per 1 mmHg=1.06, 95%CI:1.01–1.10) on the healed PU were significantly related to the development of recurrent PU. Conclusion: Higher pH, existence of Acinetobacter spp. and higher interface pressure on the site of the healed PU were associated with the development of recurrent PUs in older patients undergoing conservative treatments.
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Grenci, Michelangelo. "Riflettendo sul testo di Anzieu: il gruppo di formazione (come "area transizionale") fra mitologia e crescita." GRUPPI, no. 1 (July 2022): 171–74. http://dx.doi.org/10.3280/gruoa1-2021oa14031.
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L'autore prende spunto dal testo di Anzieu "Ciò che può e non può il gruppo" per riflettere sulla propria esperienza formativa come docente in COIRAG, interrogandosi su alcuni aspetti della fenomenologia dell'assetto gruppale.
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Savukov, Igor. "Configuration–Interaction Perturbation Theory Calculations of Pu II." Atoms 8, no. 3 (July 30, 2020): 39. http://dx.doi.org/10.3390/atoms8030039.
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Configuration–interaction perturbation theory (CI–PT) is applied to calculations of low-energy states of Pu II. This ion is quite challenging due to a large number of possible determinants arising from seven valence electrons and strong relativistic effects. The CI–PT calculations agree with experiments for the energies and g-factors for many low-energy states that allowed positive identification of the theoretical levels. Isotope shifts were also used to aid in identification, and, in case of the odd states, fitting with three independent parameters was used to match theoretical isotope shifts to the experimental values with good accuracy. The CI–PT approach tested here on the Pu II ion can be generally used to calculate properties of many complex atoms, including U I that can find application in fundamental and applied science.
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Peceliuniene, ¹Jurate, ²Guntis Karelis, ³Irena Zukauskaite, Zane Kalnina, Diana Blagovescenska, Emilija Zeltiņa, Jolanta Miceviciene, and Narute Valauskiene. "36 Cognitive functioning in patients aged 60 and older with chronic non- communicable diseases." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e23-e23. http://dx.doi.org/10.1136/jnnp-2020-bnpa.53.
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ObjectiveIt is well established that chronic non-communicable diseases (CND) are linked to early cognitive impairment (CI) before or at the beginning of the old age, bringing those patients at higher risk for dementia.The aim: to evaluate CI of aged 60 or older cognitively healthy patients visiting doctors due to different CNDMethods107 patients aged 60 or older (mean age 74 years; 44 male, 63 female; 25 were visiting general practitioner (GP), 21 – neurologist (NE), 23 – pulmonologist (PU), 38 – otorhinolaryngologist (OT)) for their CND took part in pilot cross sectional study. They filled The Cognitive Failures Questionnaire (CFQ), Subjective Cognitive Complaints (SCCs), Mini-Mental State Examination (MMSE). Results were compared using Pearson Chi-Square and one-way ANOVA.ResultsOT patients had higher CFQ results (M=30.7) comparing to all groups (GP M=24.3; NE M=22.6, PU M=18.3, p=0.001). PU patients had less problems with Forgetfulness (M=8.6), comparing to GP (M=11.4) or OT (M=12.4) groups (p=0.022). OT (M=9.3) had more problems with Distractibility comparing to PU (M=5.7) and GP (M=6.7) groups (p=0.011). OT had higher scores in False Triggering (M=7.9) comparing to GP (M=5.92), NE (M=5.8) and PU (4.8) groups (p=0.011).The cut-off point of row score 45 was overstepped in18.9% of OT group, 8% of GP group, but none in NE or PU group (p=0.026). Results of MMSE showed alike tendencies: PU patients (M=27.8) had higher results than GP (M=25.7) or OT (M=25.6) groups (p=0.029). CI was found in 39.1% of GP and 35.1% of OT, comparing to 19.0% in NE and 3.7% in PU groups (p=0.020). But groups did not differ by SCCs scores, even if 3 or more complains were found in 50.0% of GP, 52.2% of PU, 42.9% of NE and 71.1% OT groups. The only SCCs question where found differences between groups – limitation of daily activities: concerning about possible mistakes 62.5% of GP and PU groups would ask somebody’s help, while it would be done by 52.4% of NE and only 15.8% of OT group (p<0.001).ConclusionsCognitive health in elderly people with CND is not monitored well. About 2/3 of them have subjective cognitive complains (3 or more by SCCs), 1/4 would be named as having CI by MMSE, 8.5% have problems due to forgetfulness, distractibility, false triggering. Cognitive functions are predominantly impaired in OT group patients, however, they declare less need for helping them.
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McEvoy, Natalie, Declan Patton, Pinar Avsar, Ger Curley, Cathal Kearney, Jennifer Clarke, and Zena Moore. "Effects of vasopressor agents on the development of pressure ulcers in critically ill patients: a systematic review." Journal of Wound Care 31, no. 3 (March 2, 2022): 266–77. http://dx.doi.org/10.12968/jowc.2022.31.3.266.
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Objective: The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU. Method: A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool. Results: The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47–88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76μg/min, 95% CI: 6.06–11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10–15.82; p<0.00001). The overall validities of the studies varied between 45–90%, meaning that there is potential for bias within all the included studies. Conclusion: Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper.
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Mizokami, Yuji, Kazunori Oda, Nobuo Funao, Akira Nishimura, Satoshi Soen, Takashi Kawai, Kiyoshi Ashida, and Kentaro Sugano. "Vonoprazan prevents ulcer recurrence during long-term NSAID therapy: randomised, lansoprazole-controlled non-inferiority and single-blind extension study." Gut 67, no. 6 (October 7, 2017): 1042–51. http://dx.doi.org/10.1136/gutjnl-2017-314010.
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ObjectiveTo assess the non-inferiority of vonoprazan to lansoprazole for secondary prevention of non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulcer (PU) and the safety of vonoprazan during extended use.DesignA phase 3, 24-week, multicenter, randomised, double-blind (DB), active-controlled study, followed by a phase 3, ≥28 week, multicenter, single-blind, parallel-group extension study (EXT) in outpatients (n=642) receiving long-term NSAID therapy who are at risk of PU recurrence. The patients received vonoprazan (10 mg or 20 mg) or lansoprazole 15 mg once daily. For DB, non-inferiority of the proportion of patients with recurrent PU within 24 weeks was analysed by Farrington and Manning test (significance level 2.5%, non-inferiority margin 8.3%; primary endpoint), recurrent PU within 12 weeks, bleeding and time-to-event of PU (secondary endpoint) and treatment-emergent adverse events (TEAEs). For EXT, TEAEs (primary endpoint), recurrent PU and safety (secondary) were assessed up to 104 weeks for patients in the extension study.ResultsThe non-inferiority of vonoprazan 10 mg and 20 mg to lansoprazole 15 mg was verified (percentage difference –2.2%,95% CI –6.2% to 1.8%, p<0.001; –2.1%,95% CI –6.1% to 2.0%, p<0.001, respectively). The proportion of patients with endoscopically confirmed recurrent PU within 24 weeks was 3.3%, 3.4% and 5.5%, for vonoprazan 10 mg, 20 mg and lansoprazole 15 mg, respectively. No significant safety concerns were identified.ConclusionThe non-inferiority of vonoprazan (10 and 20 mg) was verified in patients receiving long-term NSAIDs in DB; it was effective and well tolerated in EXT for longer than 1 year, with a safety profile similar to lansoprazole (15 mg).Trial registration numbersNCT01452750, NCT01456260; Results.
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Vattimo, Maria de Fátima Fernandes, and Juliana Guareschi dos Santos. "O efeito protetor do bicarbonato de sódio na nefropatia induzida por contraste radiológico em ratos." Revista da Escola de Enfermagem da USP 47, no. 3 (June 2013): 722–27. http://dx.doi.org/10.1590/s0080-623420130000300028.
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Contrastes radiológicos iodados - CI são causa de lesão renal aguda - LRA. Avaliar o efeito renoprotetor do bicarbonato de sódio (Bic) sobre a função renal (clearance de creatinina, Jaffé, Clcr-ml/min/100g) e o perfil oxidativo (excreção de peróxidos, PU e de malondealdeído urinários, FOX-2 e TBARs, nmol/mgCr ) em ratos com CI. Ratos machos adultos Wistar, 250-300g, tratados 1x/dia, por 5 dias, foram divididos nos grupos: Salina (solução salina 0,9%, 3ml/kg/dia, intraperitoneal-i.p.); CI (ioxitalamato de meglumina e sódio, 3ml/kg, i.p); Bic+Salina (Bic 3ml/kg, i.p, 1 hora antes e 1 hora depois da Salina); Bic+CI (Bic 3ml/kg, i.p, 1 hora antes e 1 hora depois do CI). CI induziu LRA e o Bic confirmou seu efeito renoprotetor antioxidante (Clcr/TBARs/PU Salina: 0,59±0,03/0,11±0,02/1,29±0,24 vs Bic+Salina 0,58±0,03/0,13±0,02/1,32±0,64 vs CI 0,22±0,02A/0,19±0,02A/4,77±0, 24A vs Bic+CI 0,51±0,04B/0,13±0,3B/1,80± 0,04B, A/B p<0,05). O Bic confirmou efeito protetor na LRA por CI, podendo ser considerado como possibilidade terapêutica para pacientes submetidos a CI.
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Avsar, Pinar, Zena Moore, Declan Patton, Tom O'Connor, Aglecia MV Budri, and Linda Nugent. "Repositioning for preventing pressure ulcers: a systematic review and meta-analysis." Journal of Wound Care 29, no. 9 (September 2, 2020): 496–508. http://dx.doi.org/10.12968/jowc.2020.29.9.496.
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Objective: The aim of this systematic review was to assess the effects of different repositioning regimens on pressure ulcer (PU) incidence in at-risk adult individuals without existing PUs. Method: Using systematic review methodology, randomised controlled trials (RCTs), including cluster-RCTs, prospective non-RCTs, pre–post-studies and interrupted-time-series studies were considered. Specifically explored was the impact of the frequency of repositioning, use of repositioning systems and use of turning teams. The search was conducted in January 2019, using PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan. Results: A total of 530 records were returned, of which 16 met the inclusion criteria. Half of studies were conducted in intensive care units (50%). The mean sample size was 629±604 participants. Frequency of repositioning was explored in nine studies. PU incidence was 8% (n=221/2834) for repositioning every 2–3 hours, versus 13% (n=398/3050) for repositioning every 4–6 hours. The odds ratio (OR) was 0.75 (95% confidence interval (CI): 0.61–0.90, p=0.03), suggesting that there is a 25% reduction in the odds of PU development in favour of more frequent repositioning. Use of a repositioning system was explored in three studies. PU incidence was 2% (17/865) for the repositioning system, versus 5.5% (51/926) for care without using the repositioning system. The OR was 0.26 (95% CI: 0.05–1.29, p=0.10); this finding was not statistically significant. Use of a turning team was explored in two studies. PU incidence was 11% (n=22/200) with use of a turning team versus 20% (n=40/200) for usual care. The OR was 0.49 (95% CI: 0.27–0.86, p=0.01) suggesting that there is a 51% reduction in the odds of PU development in favour of use of a turning team. Using GRADE appraisal, the certainty of the evidence was assessed as low. Conclusion: The results of this systematic review indicate that more frequent repositioning and use of a turning team reduce PU incidence. However, given the low certainty of evidence, results should be interpreted with caution.
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Wang, Cixiao, A’na Xie, Weimin Wang, and Hongbin Wu. "Association between medical students’ prior experiences and perceptions of formal online education developed in response to COVID-19: a cross-sectional study in China." BMJ Open 10, no. 10 (October 2020): e041886. http://dx.doi.org/10.1136/bmjopen-2020-041886.
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Objectives(1) Understanding the characteristics of online learning experiences of Chinese undergraduate medical students; (2) Investigating students’ perceptions of ongoing online education developed in response to COVID-19 and (3) Exploring how prior online learning experiences are associated with students’ perceptions.DesignStudents’ familiarity with online learning modes and corresponding perceived usefulness (PU) according to their previous experiences were investigated using an online survey. The survey also collected data on students’ perceptions through their evaluation of and satisfaction with current online learning.SettingIn response to the educational challenges created by COVID-19, medical schools in China have adopted formal online courses for students.ParticipantsThe questionnaire was sent to 225 329 students, of whom 52.38% (118 080/225 329) replied, with valid data available for 44.18% (99 559/225 329).MethodsPearson correlations and t-tests were used to examine the relationship between familiarity and PU. Multiple linear regression and logistic regression analyses were used to determine the impact of prior learning experiences and its interactions with gender, area, learning phase and academic performance on students’ perceptions.ResultsStudents’ PU had a significant positive correlation with their familiarity with online learning modes (p<0.01). Students’ evaluation of and satisfaction with their current online education were positively associated with their familiarity (β=0.46, 95% CI 0.45 to 0.48, p<0.01; OR 1.14, 95% CI 1.13 to 1.14, p<0.01) with and PU (β=3.11, 95% CI 2.92 to 3.30, p<0.01; OR 2.55, 95% CI 2.37 to 2.75, p<0.01) of online learning. Moreover, the higher the students’ learning phases, the lower the associations between PU and students’ evaluation of and satisfaction with ongoing online education.ConclusionsMedical students in China have experiences with various online learning modes. Prior learning experiences are positively associated with students’ evaluation of and satisfaction with current online education. Higher learning phases, in which clinical practices are crucial, and high academic performance led to lower evaluation and satisfaction scores.
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Badiul, P. O., O. I. Korpusenko, N. M. Nor, I. V. Korpusenko, and O. I. Rudenko. "Influence of negative pressure on changes in blood supply in donor zones of perforant flaps formation." Medicni perspektivi 27, no. 3 (September 30, 2022): 115–21. http://dx.doi.org/10.26641/2307-0404.2022.3.265955.
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Our study is based on the establishment of normative indicators of the effect of negative pressure on the skin of the thigh. To do this, a group of healthy volunteers was examined – 35 people: 17 women and 18 men aged 19 to 58. The study was conducted on the clinical basis of the burn centre in 2020-2021. The local vacuum was created using a negative pressure device “AGAT-Dnepr” by applying a silver-containing polyurethane sponge directly on the front surface of the thigh. The pressure (P) – 110-160 mmHg has been applied for 30 minutes. Tissue perfusion was monitored by laser Doppler flowmetry and thermal imaging research. Measurements were performed before vacuum, immediately after the end of the application of negative pressure, for three days at the same time at a constant temperature. According to the results of the cluster analysis, based on the effect of negative pressure on the thigh skin, patients with three types of reactions were identified – low, medium and high perfusion changes. The perfusion level of tissue volume per unit time increased the most rapidly: in the group of high perfusion by 45.56 (95% CI 42.09-51.96) PU; in the group of average perfusion – by 22.49 (95% CI 19.93-28.99) PU; in the low perfusion group – by 22.43 (95% CI 15.90-25.13) PU. The number of erythrocytes per unit tissue changed at a medium rate: in the high perfusion group by 57.77 (95% CI 53.05-62.48) AU; in the group of average perfusion – by 55.86 (95% CI 49.62-65.06) PU; in the low perfusion group – by 34.85 (95% CI 13.19-53.55) PU. Among those surveyed, 12 people were included in the low perfusion group (34.29%), 16 people in the medium perfusion group (45.71%) and 7 people in the high perfusion group (20.0%). Before VAC-action the ascending level of thigh skin temperature T1 ranged from 28.60 to 32.90°C and averaged 31.46 (95% CI 30.97-31.95)°C. Immediately, after the offset of the negative pressure the area of the fields of local skin temperature rise increased, the average temperature level ranged from 30.60 to 35.0°C and the average T2 was 33.59 (95% CI 33.16-34.01)°C. The temperature rise occurred on average by 2.13 (95% 1.72-2.54)°C, which corresponded to an increase of 6.77% with significant (p<0.001) statistical differences. Only 1 examined had a slight decrease in the temperature of the thigh skin from 31.9 to 31.6°C, in the rest of the examined the rise was by 6.4°С maximally, from 28.6 to 35.0°С, there was a temperature rise by 2°С or more degrees among 9 people (25.71%). After 24 hours there was a rise in local body temperature among all examined (100%), after 48 hours – among 25 (71.43%), and after 72 hours – among 21 examined (60.0%). When choosing a donor site of the perforant flaps, we recommend relying on areas which will belong to the group of indicators with high perfusion. According to the analysis, the group of high perfusion will include patients with an initial average level of perfusion in the donor areas per unit time of 15.84 (14.47-17.21) PU, the number of erythrocytes per unit tissue – 58.73 (53.44-64.02) AU and skin temperature – 29.23 (28.65-29.80)°С; to the average according to F rates – 14.36 (13.0-15.73) PU, C rates – 45.37 (39.74-51.0) AU, T rates – 28.17 (27.74-28.60)°С; to the group of low perfusion, respectively, according to F rates – 12.38 (10.74-14.0) PU, C rates – 43.89 (40.18-47.61) AU, T rates – 29.79 (29.17-30.40)°С. In general, the effect of negative pressure contributes to increased perfusion and local microcirculation in tissues, as evidenced by dynamic infrared thermography: increased “hot” skin fields, increased temperature with a temperature gradient ∆T2.1=2.13 (95% 1.72-2.54)°C and for indicators of laser Doppler flowmetry – increase in perfusion by 2.42 times (p<0.001).
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Nixon, Jane, Sarah Brown, Isabelle L. Smith, Elizabeth McGinnis, Armando Vargas-Palacios, E. Andrea Nelson, Julia Brown, et al. "Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT." Health Technology Assessment 23, no. 52 (September 2019): 1–176. http://dx.doi.org/10.3310/hta23520.
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Background Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting The trial was set in 42 secondary and community inpatient facilities in the UK. Participants Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures Time to event. Results From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations A lower than anticipated event rate. Conclusions In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration Current Controlled Trials ISRCTN01151335. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information.
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Muljo, Hery Harjono, Bens Pardamean, Anzaludin Samsinga Perbangsa, Yulius Lie, Kartika Purwandari, Bharuno Mahesworo, Alam Ahmad Hidayat, and Tjeng Wawan Cenggoro. "TAM as a Model to Understand the Intention of Using a Mobile-based Cancer Early Detection Learning Application." International Journal of Online and Biomedical Engineering (iJOE) 16, no. 02 (February 12, 2020): 80. http://dx.doi.org/10.3991/ijoe.v16i02.12609.
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<p class="0abstract">Technology Acceptance Model (TAM) framework was utilized in this study. Its purpose was to determine the correlation between independent variables consisting of Perceived Ease of Use (PEU), Perceived Usefulness (PU), Attitude toward Using (AU) with dependent variable Behavioral Intention to Use (BIU). Data collection techniques were carried out by distributing questionnaires through group discussion forums. Respondents consisted of medical workers and health cadres both in Jakarta and Yogyakarta. Data were analyzed using correlation test and t-test. The results of the correlation test state that the correlation between PEU and AU is 0.30, which shows a weak correlation. Meanwhile, the correlation of PU and AU is 0.56, PEU and BIU is 0.41, and PU and BIU is 0.47, which are considered as moderate correlations. Finally, a strong correlation exists between AU and BIU. T-test results show that the effect of PU on AU is statistically significant with CI = 95%. Likewise, the effects of PEU on AU, AU towards BIU, PU towards BIU, and PEU towards BIU are significant (p < 0.05).</p>
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Zong, Hongliang, Tony Taldone, James H. Ahn, Sarah Brennan, Jeanne P. De Leon, Michael W. Becker, Gail J. Roboz, Gabriela Chiosis, and Monica L. Guzman. "FLT3-ITD+ AML Blast, Progenitor and Stem Cell Populations Demonstrate Higher Sensitivity to the Hsp90 Inhibitor PU-H71,." Blood 118, no. 21 (November 18, 2011): 3500. http://dx.doi.org/10.1182/blood.v118.21.3500.3500.
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Abstract Abstract 3500 Hsp90, one of the best-characterized molecular chaperones, plays indispensable roles in folding and assembly, intracellular transport, stabilization, and degradation of proteins, and therefore, facilitating cell signaling. Hsp90 is also involved in tumorigenesis by stabilizing oncogenic client proteins. Thus, Hsp90 inhibition has been considered a promising therapeutic strategy for different types of cancer including leukemia. PU-H71 is a novel HSP90 inhibitor with high specificity for oncogenic Hsp90. We investigated the effect of PU-H71 in acute myelogenous leukemia (AML), in particularly, AML stem cells (AML-SCs) that are known to give rise to AML blasts, are refractory to conventional therapies, and thus likely to account for AML relapses. The effect of PU-H71 was evaluated using a panel of 12 leukemia cell lines. Among the 12 leukemia cell lines tested, MOLM-13 and MV4-11 cells were the most sensitive (LD50s 253 nM and 120 nM respectively). Both MV4-11 and MOLM-13 carry FLT3-ITD mutation (occurring in ∼40% AML cases) and MLL translocations (occurring in ∼20% AML cases). Both MLL and FLT3 have been reported as client proteins of Hsp90. However, other leukemia cell lines with MLL rearrangements such as THP-1 and a MLL-ENL cell line derived from MLL-ENL transformed human CD34+ cord blood cells exhibited resistance to PU-H71 treatment (LD50 > 2 μM). The data suggested that FLT3-ITD+ AML samples may display higher sensitivity to Hsp90 inhibition. To confirm the higher sensitivity of FLT3-ITD+ AML cells to Hsp90 targeted therapy, 15 primary AML patient samples (8 FLT3-ITD mutants and 7 wild type FLT3) were treated with increasing concentrations of PU-H71. Cell viability on different cell populations was evaluated using multiparameter flow cytometry at 48 hours after treatment with PU-H71. The average LD50 of PU-H71 in FLT3-ITD+ AML cells was 492 nM (95% CI, 127.636 – 856.364). In contrast, the average LD50 in AML samples with wild type FLT3 was 2.795 μM (95% CI, 1.058 – 4.532). The near 6-fold difference between LD50s for PU-H71 was significant (p=0.0068). Importantly PU-H71 also killed FLT3-ITD+ AML stem and progenitor cells more effectively. Furthermore, PU-H71 treatment decreased the ability to form colonies in FLT3-ITD+ AML specimens more effectively than FLT3 WT AMLs (97.6% and 79.3% decrease relative to control respectively; N=3; P=0.0236). Importantly, PU-H71 had minor toxicity to normal blood mononuclear cells and normal cord blood hematopoietic stem cells. FLT3-ITD+ cell lines and primary AML cells treated with 0.5 μM PU-H71 showed a substantial decrease of phosphorylated forms of Erk1/2, JNK, AKT, p70RSK, NF-κB(p65) and Stat5, which was observed within 4 hours post PU-H71 treatment, whereas the phosphorylation levels of MAPK p38 remained unaffected. Immunoblotting and phosphoflow assays corroborated the inhibition of AKT and Stat5 signaling by PU-H71 in stem and progenitor populations. In summary, FLT3-ITD+ AML cells display a stronger response to PU-H71, suggesting that the FLT3-ITD mutation results in a higher dependency on Hsp90 to stabilize the aberrant signaling elicited by constitutive activation of FLT3. Our data suggests that PU-H71 represents a novel therapy for FLT3-ITD+ AML patients with the potential to ablate AML-SCs. Disclosures: Roboz: EpiCept: Consultancy; ChemGenex: Consultancy; Celgene: Consultancy; Boehringer Ingelheim: Consultancy.
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Ambati, Srikanth R., Eloisi Caldas Lopes, Kohji Kosugi, Ullas Mony, Ahmet Zehir, Andre L. Moreira, Paul A. Meyers, Gabriela Chiosis, and Malcolm A. S. Moore. "Activity of PU-H71, a novel HSP90 inhibitor, and bortezomib in Ewing sarcoma preclinical models." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 3101. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.3101.
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3101 Background: Heat shock protein (HSP) 90 regulates the disposition and activity of a large number of deregulated proteins in Ewing sarcoma. We have shown pre-clinical efficacy of PU-H71, a novel HSP90 inhibitor developed at MSKCC, in Ewing sarcoma. Unfolded proteins as a result of HSP90 inhibition are degraded via the ubiquitin-proteasome pathway or the autophagy pathway. We investigated the effects of combined inhibition of HSP90 and the proteasome pathway. Methods: We studied the effects of PU-H71 and bortezomib alone and in combination on cell proliferation and viability in multiple Ewing cell lines, benign stromal cells and hematopoietic stem cells. We performed cell cycle analysis, clonogenic assay, immunoblot analysis, reverse phase protein array and in vivo experiments in NOD/SCID IL2R gamma null (NSG) mice using the A673 cell line transduced with GFP luciferase. Using A673 metastatic model in NSG mice, we investigated the disease burden when treated with PU-H71, bortezomib and in combination. Results: In vitro, PU-H71 and bortezomib treatment resulted in caspase mediated cell death in a dose-dependent and time-dependent manner. Using PU-H71 beads we showed that some of the critical proteins, including IGF1R, hTERT and EWS-FLI1, are stabilized by HSP90. Exposure to PU-H71 resulted in depletion of AKT, ERK, MYC, C-kit, IGF1R and EWS-FLI1. Combination index (CI)-Fa plots and normalized isobolograms indicated synergism between PU-H71 and bortezomib. We noted increased expression of cleaved PARP and cleaved caspase 3 when Ewing cell lines were exposed to a combination of PU-H71 and bortezomib. Based on PK studies we treated mice (4 groups) using vehicle, PU-H71 75mg/kg i.p three times/wk, bortezomib 0.8mg/kg i.v twice/wk or a combination of PU-H71 and bortezomib for 4 wk. Ewing xenografts were significantly inhibited when treated with combination of PU-H71 and bortezomib compared to vehicle or either drug alone. Conclusions: Both PU-H71 and bortezomib have single agent activity against Ewing sarcoma. However they exhibit synergism when combined in in vitro and in vivo models providing a strong rationale for clinical evaluation in Ewing sarcoma.
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Owolabi, Lukman Femi, Aliyu Abdu, Aliyu Ibrahim, Desola Shakirah Owolabi, Aisha Nalado, Adamu Bappa, and Aminu Abdullahi Taura. "Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria." Journal of Neurosciences in Rural Practice 07, S 01 (December 2016): S062—S067. http://dx.doi.org/10.4103/0976-3147.196433.
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ABSTRACT Background: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. Materials and Methods: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). Results: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. Conclusion: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.
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Gazineo, Domenica, Paolo Chiari, Matteo Chiarabelli, Mattia Morri, Fabio D'Alessandro, Tania Sabattini, Elisa Ambrosi, and Cristiana Forni. "Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study." Journal of Wound Care 28, no. 9 (September 2, 2019): 593–99. http://dx.doi.org/10.12968/jowc.2019.28.9.593.
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Objective: To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. Method: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. Results: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806–0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183–2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010–1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006–1.019) and diaper (HR: 1.007; 95% CI 1.001–1.013) in the postoperative period. Conclusion: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.
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Meaume, Sylvie, and Marc Marty. "Pressure ulcer prevention using an alternating-pressure mattress overlay: the MATCARP project." Journal of Wound Care 29, Sup9a (September 1, 2020): S32—S38. http://dx.doi.org/10.12968/jowc.2020.29.sup9a.s32.
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Objective: The primary objective was to assess the incidence of pressure ulcer (PU) in patients at high risk of PU and lying between 15–20 hours per day on an alternating-pressure mattress overlay (APMO). Secondary objectives were the patient's satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use and the moisture level. Method: This prospective observational study was conducted in three rehabilitation centres and two nursing homes between June 2016 and March 2017. To be included, patients should not have PU at baseline and present a high risk of PU (Braden score between 10–15). The primary endpoint was the percentage of patients in whom a PU developed over a 35-day period. Results: A total of 83 patients were included in the study. Neurological disease was responsible for the reduced mobility of 44 (53.7%) patients, 10 patients (12.0%) dropped out (one patient for a serious adverse event (femoral neck fracture) considered not to be related to the APMO, four patients for adverse events, two of which were considered to be related to APMO and five for other reasons, including, in one case, discomfort with the APMO. These patients were considered in the analysis. Over the study period, 1.2% (1/83) (95% confidence interval (CI): 0.03 to 6.53) of patients developed a PU. Patient satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use were considered satisfying for most patients. Conclusion: Based on the findings of this study of a low incidence of PU in participating patients, the use of an AMPO is recommended in high-risk patients lying for between 15–20 hours a day.
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Tavakkoli, Montreh, Justin D. Kaner, Sharma Sahil, Tony Taldone, Swathi Merugu, Gabriela Chiosis, Gail J. Roboz, and Monica L. Guzman. "Epichaperome Abundance Predicts Response to the Epichaperome Inhibitor, Puh-71, in Acute Myeloid Leukemia." Blood 134, Supplement_1 (November 13, 2019): 5145. http://dx.doi.org/10.1182/blood-2019-125175.
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The epichaperome, which was previously described by our team (Rodina et al. Nature 2016, Joshi et al. Nature Reviews Cancer 2018), is a complex hyper-connected network of chaperones and co-chaperones that are present in a subset of tumors, and its role is to facilitate the survival of malignant cells. We have previously shown abundant epichaperome networks in different tumor types, including AML. PU-H71 is a novel epichaperome inhibitor that selectively targets cells expressing the epichaperome. We hypothesize that personalizing PU-H71 in AML based on epichaperome abundance will significantly improve the clinical efficacy of PU-H71. To investigate this, we assessed the frequency of epichaperome abundance in primary AML samples and sought to develop a method with clinical application to predict response to PU-H71. We screened 55 de novo and relapsed/refractory primary AML bone marrow and peripheral blood samples for epichaperome abundance and cytotoxicity. Epichaperome abundance was assessed by incubating cells with FITC-bound PU-H71 (labeled F2) for 4 hours followed by analysis by multi-parameter flow cytometry. A chemically similar FITC-bound PU-H71, which does not bind the epichaperome, termed F9, was used as a control (Taldone et al. Bioorg Med Chem Lett 2011). MV411 cell lines were also used as positive controls (given known epichaperome abundance and high sensitivity to PU-H71), and intra-sample T-cells were used as negative controls. Furthermore, we assessed cell survival by incubating cells with 0.5uM PU-H71 for 48-hours followed by evaluation by multi-parameter flow cytometry. All analyses were performed in duplicates or triplicates. The ratio of blast F2 to F9 was combined with the F2-F9 blast to T cell ratio to calculate epichaperome abundance. Data on epichaperome abundance was available in 50 patient samples. Cytotoxicity data was available in 41 patients. 22/41 (54%) of patient samples underwent ≥60% cell death, respectively, and 7/41 (17%) were resistant to PU-H71, as defined by < 5% cytotoxicity. An ROC curve using epichaperome cut-offs of 1, 2.5, 4.5, 6, 8 and 15 provided an AUC of 0.97 (95% CI 0.889-1.056, p=0.006). Using a cut-off of 4.5 for epichaperome abundance, 22/50 (44%) of samples expressed high levels of the epichaperome, and sensitivity and specificity for predicting >60% in vitro cytotoxicity to PU-H71 were 81.8% (95% CI 59.7-94.8%) and 94.7% (95% CI 74-100%) (Figure 1). This method's diagnostic accuracy was 87.8%, with positive and negative likelihood ratios of 15.5 and 0.19. Collectively, our data suggests that this flow cytometry-based evaluation of epichaperome abundance is a promising tool for detecting epichaperome abundance and personalizing the treatment of PU-H71 in patients with AML. Disclosures Chiosis: Samus Therapeutics: Equity Ownership, Patents & Royalties: Intellectual rights to the PU-FITC assay. Roboz:Trovagene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sandoz: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche/Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Orsenix: Consultancy, Membership on an entity's Board of Directors or advisory committees; MEI Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celltrion: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Actinium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amphivena: Consultancy, Membership on an entity's Board of Directors or advisory committees; Argenx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astex: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Eisai: Consultancy, Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Consultancy, Membership on an entity's Board of Directors or advisory committees. Guzman:Samus Therapeutics: Patents & Royalties: intellectual rights to the PU-FITC assay; Cellectis: Research Funding; SeqRx: Consultancy.
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Varticovski, Lyuba, Mollie H. Wright, Eloisi Caldas-Lopes, Gabriela Chiosis, and Ana I. Robles. "Synergy of the Purine-Scaffold HSP90 Inhibitor, PU-H71, with Doxorubicin in Non-Hodgkin’s Lymphoma Cell Lines." Blood 110, no. 11 (November 16, 2007): 1399. http://dx.doi.org/10.1182/blood.v110.11.1399.1399.
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Abstract For over 30 years CHOP (cyclophosphamide-doxorubicin-vincristine-prednisolone) has been the standard therapy for Diffuse Large B-cell Lymphoma (DLBCL). Although DLBCL is one of the most chemotherapy-responsive human malignancies, less than 50% of newly diagnosed patients are cured with the conventional anthracycline-based chemotherapy. Novel strategies are sought out to improve the survival of these patients. Heat Shock protein 90 (HSP90) is a molecular chaperone critical for correct conformational folding of many cellular proteins. Many of those proteins are signal-transducing regulators of cell growth, DNA damage response, and survival. Cancer cells are particularly dependent on these regulators for maintenance of the transformed phenotype. Thus, HSP90 is an attractive target for cancer therapy. HSP90 inhibitors block the ATP-binding pocket and inhibit an essential ATPase activity, altering the function of the HSP90 complex and leading to destabilization and eventual degradation of mis-folded proteins. Inhibitors of HSP90 have shown promise alone or in combination with chemotherapy or radiation in preclinical studies, and are currently undergoing PhaseI/II clinical trials. Future clinical trials on their efficacy will likely explore if any additional benefit is apparent from their combination with conventional therapies. We recently demonstrated that schedule of administration of 17DMAG following Doxorubicin (DOX) ia critical for in vitro sensitivity of DLBCL cells. We examined whether the newly developed purine-scaffold HSP90 inhibitor, PU-H71, could similarly enhance the toxicity of cells to DOX when applied 24 hours after exposure to DOX. We found that sequential addition of PU-H71 to DOX resulted in reduction of DOX IC50, from 400 nM to 75 nM. To evaluate the role of schedule of drug exposure as a determinant of the overall response, we analyzed the interaction of DOX and PU-H71 on cell survival. We applied standard criteria for synergy: the median effect/Combination Index (CI) method using an equimolar (1:1) ratio of DOX:PU-H71. Addition of PU-H71 to cells pretreated with DOX for 24 hours was consistently synergistic over the entire range of drug doses, with CI = 0.75 at Fa = 0.5. Although addition of PU-H71 prior to DOX was synergistic with CI = 0.7 at Fa = 0.5, this was only evident for higher doses. Only additive-to-antagonistic effects were observed at lower drug concentrations (Fa < 0.3). These results raise the question on whether synergy between PU-H71 and DOX will be observed at the concentrations achievable clinically. Conclusions: our observations provide a rationale for further preclinical testing and stress the need to consider schedule of exposure as a critical determinant of the overall response when designing clinical trials that combine HSP90 inhibitors with DNA damaging agents.
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Li, Min, Wenchao Dan, Hui Zhang, Yong’en Yun, and Qingyong He. "Xiao Chai Hu Tang for Peptic Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Evidence-Based Complementary and Alternative Medicine 2021 (April 29, 2021): 1–13. http://dx.doi.org/10.1155/2021/6693677.
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A peptic ulcer (PU) is a digestive disorder most commonly found in clinical practice. An oriental herbal formula, Xiao Chai Hu Tang (XCHT), has been used to treat PU for an extended period in China. The effectiveness and safety of XCHT in treating peptic ulcers was evaluated using a systematic review of randomized controlled trials (RCTs). Studies were systematically retrieved from CNKI, Embase, Medline, PubMed, SinoMed, VIP, Wanfang, and Web of Science. The following information was extracted from the relevant RCTs: the clinical efficacy rate, recurrence rate, clinical efficacy of traditional Chinese medicine, and the adverse effects. 13 RCTs, including 1334 patients, were included in this review. The meta-analysis showed that treatment with XCHT was superior to conventional pharmacotherapy (CPT) in improving the clinical efficacy rate (RR: 1.20, 95% confidence intervals (CIs): 1.08–1.34, P = 0.0007 ), poor appetite (RR: 0.30, 95% CI: 0.15–0.61, P = 0.0009 ), abdominal distension (RR: 0.61, 95% CI: 0.39–0.96, P = 0.03 ), vomiting (RR: 0.33, 95% CI: 0.19–0.55, P < 0.0001 ), and stomach pain (RR: 0.36, 95% CI: 0.19–0.68, P = 0.002 ) and reducing adverse events (RR: 0.23, 95% CI: 0.07–0.69, P = 0.009 ). XCHT considerably increased the total clinical efficacy rate (RR: 1.22, 95% CI: 1.15–1.30, P < 0.00001 ) as both monotherapy and adjunctive therapy. The recurrence rate (RR = 0.29; 95% CI: 0.16–0.52, P < 0.0001 ) was remarkably decreased in the XCHT plus CPT group. The meta-analysis did not show a significant beneficial effect of XCHT compared with CPT in reducing the recurrence rate (RR = 0.45; 95% CI: 0.07–3.10, P = 0.42 ) and acid reflux (RR: 0.76, 95% CI: 0.47–1.23, P = 0.26 ). Our findings show that XCHT can treat peptic ulcers as part of an alternative medicine approach.
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Anzieu, Didier. "Ciò che può e non può il gruppo." GRUPPI, no. 2 (October 2021): 15–27. http://dx.doi.org/10.3280/gruoa2-2020oa12578.
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Presentiamo la traduzione di un testo di Anzieu del 1984, pubblicato nel libro di Kaës Le travail de l'inconscient. In questo testo Anzieu tocca molti aspetti della psicoanalisi di gruppo del suo tempo e ciò permette di cogliere le evoluzioni teoriche e tecniche di questa disciplina. Il saggio si apre con una breve introduzione di Kaës, che evidenzia come il metodo definisce in negativo ciò che non può conoscere, riconoscere e quindi trasformare: proprio questa è la chiave di lettura per approcciarsi e comprendere l'intero scritto. Anzieu apre il testo prendendo in esame l'interazione tra i partecipanti del gruppo, il conduttore e l'osservatore: in base al livello evolutivo il gruppo può reagire con vissuti persecutori o depressivi. I terapeuti devono far attenzione a non idealizzare il gruppo come oggetto totale onnipotente o parziale feticistico, e a non cadere quindi nell'illusione che il gruppo può tutto. L'autore prosegue parlando di diverse tecniche di conduzione di gruppo e delineando possibili scenari interattivi, spesso persecutori e conflittuali, che i gruppi stessi e i loro conduttori mettono inconsciamente in atto con e/o verso le istituzioni in cui sono inseriti. Le istituzioni, a loro volta, posso determinare e condizionare l'esistenza stessa dei gruppi e dei loro destini. Per l'autore diventa fondamentale la creazione temporanea di uno spazio transizionale in cui costruire un apparato psichico gruppale, intermedio tra quello individuale e quello istituzionale, che renda possibile la simbolizzazione, la catarsi e la perlaborazione dei conflitti vissuti tra terapeuta-gruppo-istituzione.
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Anyanwu, Philip Emeka, Koen Pouwels, Anne Walker, Michael Moore, Azeem Majeed, Benedict W. J. Hayhoe, Sarah Tonkin-Crine, et al. "Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study." BJGP Open 4, no. 3 (July 14, 2020): bjgpopen20X101052. http://dx.doi.org/10.3399/bjgpopen20x101052.
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BackgroundIn 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%–23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015–2016.AimTo investigate whether the effects of the Quality Premium (QP), which provided performance-related financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing.Design & settingLongitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016.MethodLinear generalised estimating equations models were fitted, examining the effect of the 2015–2016 QP on the number of antibiotic items per specific therapeutic group age–sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation.ResultsAntibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015–2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p<0.001). Practices with low workforce and those with higher diabetes prevalence had greater reductions in prescribing following 2015–2016 QP compared with other practices (interaction p<0.001).ConclusionIn high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.
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Godin, Benoît. "La mesure de la science et la construction statistique d'un territoire : la Région de la capitale nationale du Canada." Canadian Journal of Political Science 33, no. 2 (June 2000): 333–58. http://dx.doi.org/10.1017/s0008423900000123.
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Le développement et l'institutionnalisation de la statistique sociale sont intimement liés à l'État. En effet, trés tôt dans l'histoire de l'État moderne, celui–ci devint un important patron de la production statistique et l'État est aujourd'hui un producteur direct de statistiques via ses organismes nationaux. Quels facteurs ont bien pu motiver les gouvernements à investir le champ de la mesure de la société?
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Sharma, Krishan K., Juan Felipe Rico, Michael W. Becker, Gail J. Roboz, Gabriela Chiosis, and Monica L. Guzman. "HSP70 Inhibitor, YK5, Synergizes with Chemotherapeutic Agents and Prevents Chemoresistance in Acute Myelogenous Leukemia (AML)." Blood 120, no. 21 (November 16, 2012): 2476. http://dx.doi.org/10.1182/blood.v120.21.2476.2476.
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Abstract Abstract 2476 Stress-inducible heat shock protein 70 (HSP70) is a major cytoprotective factor and a molecular chaperone that interacts with HSP90 to form a multi-chaperone complex. Cancer cells are highly dependent on this complex due to their increased demand for protein synthesis. HSP70 overexpression inhibits apoptosis and has been associated with drug resistance and poor prognosis. YK5, a novel inhibitor of tumor-HSP70, has been shown to induce potent cell death in AML blast, progenitor, and stem cell populations with minimal effects in normal hematopoietic cells. Due to the role of HSP70 in drug resistance, we examined the effect of combining YK5 with other chemotherapeutic agents, including arsenic trioxide, cytarabine, suberoylanilide hydroxamic acid (SAHA) and PU-H71, a novel tumor-specific HSP90 inhibitor. We tested the ability of YK5 to synergize with either AsO3, AraC, SAHA, or PU-H71 in primary AML samples. Using multiparameter flow cytometry to measure viability after 48 hours of treatment, we found that combining 1μM YK5 with either 500nM AsO3 or PU-H71 resulted in a significant increase in cell death when compared to either agent alone (n=9, mean viability: 51.8, 67.2, and 13.4% for AsO3, YK5, and AsO3/YK5, respectively, P = 0.0018; mean viability: 57.1 and 20.8% for PU-H71 and PU-H71/YK5, respectively, P = 0.0029). A synergistic relationship between YK5 and both AsO3 and PU-H71 was found in all nine primary samples (combination indexes 0.29 – 0.76 with YK5/AsO3, 0.33 – 0.83 with YK5/PU-H71). In contrast, the combination of YK5 with either AsO3 or PU-H71 in CD34+ cord blood mononuclear cells did not result in a significant increase in cell death when compared to either agent alone (mean viability: 42.4, 72.4, and 37.2% for AsO3, YK5, and AsO3/YK5, respectively; mean viability: 61.1 and 51.1% for PU-H71 and PU-H71/YK5, respectively). YK5 in combination with either AraC or SAHA, however, did not result in a significant increase in cell death when compared to either drug alone, with an additive effect being demonstrated with a 1:1 YK5 to AraC/SAHA drug ratio (Mean CI = 0.9918). To determine the mechanism of the observed synergistic activity, intracellular HSP70 and active caspase-3, a client of HSP70, were measured using flow cytometry. Both AsO3 and PU-H71 significantly increased intracellular HSP70 and caspase-3 (Mean fold change = 18.3, 21.0 of HSP70 and 9.9, 8.3 of Caspase-3 for AsO3 and PU-H71 treatment, respectively), while treatment with AraC or SAHA resulted in no change in HSP70 levels. Furthermore, quantitative PCR revealed that treatment with either AsO3 or PU-H71 strongly upregulated HSPA1A and HSPA6, the main stress-inducible isoforms of HSP70 (Mean fold change = 15.9, 14.1 of HSPA1A, and 20.8, 23.4 of HSPA6 for AsO3 and PU-H71 treatment, respectively). AraC and SAHA had no significant upregulation of these genes. We have previously shown that increased levels of HSPA1A correlate with sensitivity to HSP70 inhibition via YK5. To further explore the mechanism of this observed synergy, flow cytometry was used to measure the levels of reactive oxygen species (ROS). Treatment with AsO3, PU-H71, AraC, or SAHA resulted in a significant increase in ROS (Mean fold change = 2.75, 1.92, 2.89, 1.67, respectively). Quantitative PCR also confirmed the activation of the oxidative stress response by the upregulation of heme oxygenase 1 (HMOX1) by treatment with these drugs (Mean fold change = 10.9, 8.7, 11.2, 7.7, respectively). YK5, however, did not induce ROS or upregulate HMOX1. Interestingly, pretreatment with NAC in primary AML samples (n=4) resulted in no protection from YK5 synergistic effect when combined with either AsO3 or PU-H71. These results suggest that YK5 synergizes with AsO3 and PU-H71 due to the increase in intracellular HSP70 caused by these drugs. This synergy is most likely due to the activation of the heat shock response and independent of the production of ROS due to drug treatment. In summary, we have found that the novel tumor-HSP70 inhibitor YK5 can synergize with AsO3 and PU-H71 in primary human AML, and that the basis of this synergism is due to the increase in intracellular HSP70 caused by these chemotherapeutic agents. HSP70 inhibition represents a novel approach in AML treatment and can be particularly significant to drug-resistant patients when combined with other chemotherapy. Disclosures: Roboz: Astex Pharmaceuticals: Research Funding.
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Glazkova, P. A., D. A. Kulikov, A. A. Glazkov, S. A. Terpigorev, D. A. Rogatkin, G. G. Shekhyan, K. A. Krasulina, A. V. Kulikov, M. B. Makmatov-Rys, and F. N. Paleev. "Reactivity of skin microcirculation as a biomarker of cardiovascular events. Pilot study." Clinical Hemorheology and Microcirculation 78, no. 3 (August 3, 2021): 247–57. http://dx.doi.org/10.3233/ch-201016.
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BACKGROUND: The role of microcirculatory disorders is progressively being accepted in the pathogenesis of cardiovascular diseases. OBJECTIVE: The purpose of current study is to assess whether we can consider skin microcirculation disorders as a biomarker of cardiovascular events. METHODS: Group 1 consisted of healthy volunteers (n = 31); group 2 (n = 42) consisted of patients with diseases that increase the risk of cardiovascular events; group 3 (n = 39) included patients with the history of cardiovascular events. Skin microcirculation measurement was performed using laser Doppler flowmetry during the heating test. RESULTS: LDF parameters reflecting the rapid response of microcirculation to heating (“Slope 120 s” and “Slope 180 s”) significantly differed in three groups (p < 0.05). A decrease in the “Slope 180 s” parameter less than 0.5 PU/s is associated with cardiovascular events (sensitivity 69.2%, specificity 66.7%; the area under the ROC curve, 0.667; 95% confidence interval [CI], 0.545–0.788, p = 0.01). Multivariable logistic regression analysis revealed that “Slope 180 s≤0.5 PU/s” was significantly related to cardiovascular events (adjusted odds ratio = 3.9, p = 0.019, CI 95% 1.2–12). CONCLUSIONS: Reduced reactivity of the skin microcirculation may be useful as a biomarker of severe damage to the cardiovascular system and is promising as a risk factor for cardiovascular events.
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Coquery-Vidrovitch, Catherine. "Villes Africaines Anciennes : Une Civilisation Mercantile Pré-Négrière Dans L'Ouest Africain, XVIe et XVIIe Siècles." Annales. Histoire, Sciences Sociales 46, no. 6 (December 1991): 1389–410. http://dx.doi.org/10.3406/ahess.1991.279016.
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Les écrits récents sur l'histoire urbaine africaine, celle-ci d'ailleurs souvent abordée en chapitre liminaire par de solides études géographiques, ont eu tendance à mettre l'accent sur les phénomènes d'hypertrophie urbaine contemporains issus de la colonisation. Or non seulement l'urbanisation africaine subsaharienne est ancienne (des découvertes archéologiques récentes ont notamment démontré qu'elle préexistait à l'influence musulmane), mais elle a pu dans certains cas présenter des formes mercantiles relativement complexes bien antérieures au fait colonial.
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Marrero Marrero, Mª del Carmen. "Las anécdotas en las Memorias del conde de Ségur." Çédille 3 (April 1, 2007): 107. http://dx.doi.org/10.21071/ced.v3i.5361.
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Le récit des anecdotes dans le cadre des Mémoires nous montre une vision détaillée de la personnalité de l’auteur, projetant dans l’écriture les traits de vraisemblance et d’individualité, ces traits-ci, présents dans l’œuvre du comte Louis Philippe de Ségur Ségur Mémoires ou souvenirs et anecdotes. Les anecdotes littéraires constituent des sources remarquables d’information sur l’auteur qui les raconte ou sur le thème évoqué. A travers la lecture attentive des ses Mémoires j’ai pu apprécier la finesse de son style littéraire dans lequel on reflète sa capacité évocatrice des événements. Dans l’analyse de cette oeuvre j’ai distingué deux clases d’anecdotes celles du type intime ou personnel et les anecdotes historiques, culturelles et sociales ces dernières ayant eu une répercussion dans des domaines différents. Grâce à ce travail j’ai pu connaître, plus en profondeur, la vie du comte de Ségur, qui, a essayé, en tout moment, d’apporter sa vision objective de la réalité pour équilibrer les critiques étrangères négatives sur la politique française prérrevolutionnaire.
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Cristini, Carlo, Eleonora Riva, Alessandra Minelli, Davide Cavagna, Elisa Spader, and Anna Maria Della Vedova. "La clinica del trauma: una sintesi su trattamenti e tecniche." RICERCHE DI PSICOLOGIA, no. 3 (December 2021): 1–35. http://dx.doi.org/10.3280/rip2021oa12110.
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Gli autori propongono una rassegna riguardo agli interventi ed alle tecniche che possono essere utilizzati dai clinici quando si trovano ad affrontare esperienze traumatiche dei loro pazienti. Partendo dall'assunto che si prende in cura la "persona" e non il "disturbo" gli autori sostengono che non esiste una terapia elettiva del trauma. Ci si può avvalere di diversi indirizzi: la terapia cognitivacomportamentale, ed in particolare quella focalizzata sul trauma, la desensibilizzazione e rielaborazione attraverso i movimenti oculari, meglio nota con l'acronimo EMDR, i trattamenti multipli integrati, il trattamento analitico, la psicoterapia sensomotoria, l'arteterapia, la pratica yoga, la mindfulness ed altri. L'intervento migliore nasce da un orientamento creativo, interessato e rispettoso della persona che si ha di fronte, unitamente alla capacità del terapeuta di entrare in relazione, costruendo un contesto sicuro nel quale il paziente può esprimere il proprio vissuto traumatico. Gli autori inseriscono, inoltre, contributi delle neuroscienze e della neuropsicologia che hanno fornito un fondamentale ampliamento della conoscenza sul trauma.
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Savukov, Igor M., Dmytro Filin, Pinghan Chu, and Michael W. Malone. "Relativistic Configuration-Interaction and Perturbation Theory Calculations for Heavy Atoms." Atoms 9, no. 4 (November 30, 2021): 104. http://dx.doi.org/10.3390/atoms9040104.
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Heavy atoms present challenges to atomic theory calculations due to the large number of electrons and their complicated interactions. Conventional approaches such as calculations based on Cowan’s code are limited and require a large number of parameters for energy agreement. One promising approach is relativistic configuration-interaction and many-body perturbation theory (CI-MBPT) methods. We present CI-MBPT results for various atomic systems where this approach can lead to reasonable agreement: La I, La II, Th I, Th II, U I, Pu II. Among atomic properties, energies, g-factors, electric dipole moments, lifetimes, hyperfine structure constants, and isotopic shifts are discussed. While in La I and La II accuracy for transitions is better than that obtained with other methods, more work is needed for actinides.
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Dumas, Jean. "L’évolution des premiers mariages au Canada." Articles 16, no. 2 (October 20, 2008): 237–65. http://dx.doi.org/10.7202/600615ar.
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RÉSUMÉ L’objet de cet article est de voir dans quelle mesure les phénomènes socio-politiques majeurs des soixante dernières années (la crise des années 1930, la Seconde Guerre mondiale, etc.) ont pu affecter le comportement des Canadiens face au (premier) mariage. Au terme d’une analyse aussi bien transversale que longitudinale, l’auteur conclut que si ces phénomènes n’ont guère influencé l’intensité finale (à 50 ans) de la nuptialité des générations, ils en ont par contre profondément marqué le calendrier, et à travers celui-ci, les indices du moment.
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Akhter, Ayeasha, Md Mobarak Karim, Sabeha Jannat, and K. M. Anwarul Islam. "Determining factors of intention to adopt internet banking services: A study on commercial bank users in Bangladesh." Banks and Bank Systems 17, no. 1 (March 31, 2022): 125–36. http://dx.doi.org/10.21511/bbs.17(1).2022.11.
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E-commerce and e-business are necessary components of today’s internet banking due to the developing global economy. Alternatively, in this technological era, the banking sector’s success is associated with creating bank users’ intention to adopt internet banking services. Therefore, the aim of this study is to determine the influencing factors of intention to adopt internet banking services of commercial bank users’ in the Bangladeshi context. A survey questionnaire was formulated based on past works of literature to find out the research objective. The convenience sampling method has been used in this study. For the data collection purpose, 250 bank users were asked request to participate in the research. As a fully completed survey, 180 responses were received where the response rate was 72% and the sample size was n = 180. For correlation analysis and hypotheses testing, SPSS version 26.0 was used. The results of the study show that Perceived Security Risk (PSR), Perceived Usefulness (PU), Perceived Ease of Use (PEU), Social Influence (SI), and Consumer Innovativeness (CI) have a statistical and significant impact on the intention to adopt internet banking services. It is concluded that the bank management committee should utilize PU, PEU, SI, and CI to amplify the level of willingness to adopt and embrace general banking services through internet platforms among bank users in their online banking transactions. For the future research study, this paper outlines several significant implications and offers some directions for the bank management committee of a commercial bank.
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Giulino Roth, Lisa, Herman van Besien, Anna Rodina, Tony Taldone, Hediye Erdjument-Bromage, Matthew J. Barth, Gabriela Chiosis, and Ethel Cesarman. "Targeting the Hsp90 Oncoproteome in Burkitt Lymphoma." Blood 126, no. 23 (December 3, 2015): 592. http://dx.doi.org/10.1182/blood.v126.23.592.592.
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Abstract Introduction: Novel therapies are urgently needed in pediatric Burkitt lymphoma (pBL) where the survival for relapsed disease is less than 20%. Heat shock protein 90 (Hsp90) is molecular chaperone that protects proteins from proteolytic degradation including oncogenic signaling complexes. The clinical development of broad-spectrum Hsp90 inhibitors has previously been limited by suboptimal target inhibition and off-target toxicities. PU-H71 is a next-generation Hsp90 inhibitor that preferentially targets tumor enriched (te-Hsp90), the functionally distinct pool of Hsp90 present in tumor cells. PU-H71 is not toxic to normal B-cells and has demonstrated pre-clinical efficacy in diffuse large B-cell lymphoma, but has not been studied in Burkitt lymphoma. In the current study, we evaluated te-Hsp90 as a potential therapeutic target in pediatric Burkitt lymphoma. Methods and Results: To evaluate overall Hsp90 protein expression in primary pBL tumors we performed immunohistochemistry on a tissue microarray. Fifty-three of 59 cases (90%) demonstrated high levels of Hsp90 expression defined as >90% tumor cell positivity (Fig. 1A). To evaluate the sensitivity of pBL to te-Hsp90 inhibition we performed in-vitro viability assays with the ATP-based CellTiter-Glo¨ in a panel of pBL cell lines (Ramos, DG-75, Raji, Namalwa, Daudi, Jiyoye, CA-46, Raji 2R, Raji 4RH) and in-vivo studies with a Ramos xenograft model of pBL. pBL cells were sensitive to inhibition by PU-H71 with IC50s in the low nanomolar range (151-337nM, Fig 1B). The Raji 2R and Raji 4RH pBL cell lines with acquired resistance to chemotherapy (Czuczman et al, Clin Cancer Res 2008) were also sensitive to PU-H71 (IC50 175-181nM). In contrast, normal peripheral blood lymphocytes were resistant (IC50 >37,000nM). In pBL xenograft studies, PU-H71 decreased tumor volume (p<0.01, Fig. 1C) and prolonged survival (p<0.01, Fig. 1D). To evaluate the targets of PU-H71 in pBL we performed high affinity capture followed by proteomic analysis using mass spectrometry. Cellular lysates from pBL cell lines were incubated with PU-H71 conjugated agarose beads and the cargo was subject to tandem mass spectrometry. Data was analyzed using Ingenuity Pathway Analysis¨. PI3K and mTOR signaling were among the top networks identified. Given the data supporting a crucial role for PI3K in BL (Sanders et al, Cancer Cell 2012), we further investigated protein targets in this pathway. We found a significant number of proteins in the mTOR (p<0.0001) and PI3K (p<0.0001) signaling pathways including ERK, mTOR, and multiple isoforms of PI3K (p110-β; p110-γ, p110-δ). PI3K targets were validated by pull-downs with PU-H71 conjugated beads (Fig 2A). To investigate the activity of PI3K inhibition in pBL we evaluated a panel of PI3K inhibitors in pBL. Agents with a narrow spectrum of PI3K isoform inhibition such as idelalisib (p110δ inhibition) and IPI-145 (p110 δ and γ inhibition) did not have activity in pBL. In contrast, agents that broadly target PI3K/mTOR such as BEZ235 (pan PI3K and mTOR inhibition) and BKM120 (pan PI3K inhibition) demonstrated activity (IC50 35nM-2602nM). Based on this we concluded that PI3K inhibition is effective in pBL only when multiple components of the pathway are targeted. We hypothesized that PU-H71 will therefore synergize with PI3K inhibitors through dual targeting of PI3K signaling. To test this we evaluated the combination of PU-H71 + BKM-120 and PU-H71 + BEZ235 in four pBL cell lines (Ramos, Namalwa, Daudi, DG-75). The combined response at 48-72 hours was evaluated using the Chou-Talalay method. Both combinations were synergistic in 3 of 4 cell lines with a combinatorial index at the IC50 of <1 (CI 0.44-0.79, Fig. 2B). Conclusion: Our work demonstrates that Hsp90 is over-expressed in primary pBL tumors and that te-Hsp90 inhibition with PU-H71 is toxic to pBL in-vitro and in-vivo. The oncoprotein targets of Hsp90 in pBL include multiple components of the PI3K/mTOR signaling pathway, highlighting the importance of this pathway in pBL. The anti-lymphoma activity of PU-H71 is synergistic with pan-PI3K inhibition as well as dual PI3K/mTOR inhibition. Overall this work provides support for te-Hsp90 as a therapeutic target in BL and suggests the potential for combination therapy with PU-H71 and inhibitors of PI3K/mTOR. Disclosures Cesarman: Weill Cornell Medical College: Patents & Royalties: applied for patent for 6-ETI.
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Bradley, Declan T., Sarah E. Allen, Helen Quinn, Brenda Bradley, and Matthew Dolan. "Social norm feedback reduces primary care antibiotic prescribing in a regression discontinuity study." Journal of Antimicrobial Chemotherapy 74, no. 9 (May 20, 2019): 2797–802. http://dx.doi.org/10.1093/jac/dkz222.
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Abstract Background Reducing antibiotic prescribing is a priority for health authorities responsible for preventing antimicrobial resistance. Northern Ireland has high rates of antimicrobial use. We implemented a social norm feedback intervention and evaluated its impact. Objectives To estimate the size and duration of the effect of a social norm feedback letter to GPs who worked in the 20% of practices with the highest antimicrobial prescribing. Methods The letter was sent in October 2017 to 221 GPs in 67 practices. To assess the effect of the intervention, we used a sharp non-parametric regression discontinuity (RD) design, with prescribing rates in the four calendar quarters following the intervention as the outcome variables. Results In the quarter following the intervention (October to December 2017) there was a change of −25.7 (95% CI = −42.5 to −8.8, P = 0.0028) antibiotic items per 1000 Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU). At 1 year, the coefficient was −58.7 (95% CI = −116.7 to −0.7, P = 0.047) antibiotic items per 1000 STAR-PU. The greatest change occurred soon after the intervention. Approximately 18900 fewer antibiotic items were prescribed than if the intervention had not been made (1% of Northern Ireland’s annual primary care antibiotic prescribing). Conclusions A social norm feedback intervention reduced antibiotic prescribing in the intervention practices. The diminishing effect over time suggests the need for more frequent feedback. The RD method allowed measurement of the effectiveness of an intervention that was delivered as part of normal business, without a randomized trial.
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Perreault, Robert B. "Veillée chez Antoinette Bourgeois." Terrains 16 (September 14, 2018): 63–76. http://dx.doi.org/10.7202/1051325ar.
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Antoinette Bourgeois (1902-1991), fille du photographe franco-américain Ulric Bourgeois (1874-1963) de Manchester au New-Hampshire, et la dernière survivante de sa famille, raconte ses souvenirs en 1978. Elle parle de son père, reconnu pour ses photos du Québec rural et de Manchester. Grâce à celui-ci, elle a pu rencontrer Charlie Lambert, surnommé l’ermite du Mosquito Pond dans les bois près de Manchester, ainsi que le prêtre-écrivain Henri d’Arles, un client de son père. Lorsque la soeur cadette d’Antoinette, Irène Bourgeois, tomba victime de la polio, c’est au frère André qu’elle a eu recours pour sa guérison. Par la suite, Antoinette entra la vie religieuse chez les Soeurs de Sainte Jeanne d’Arc de Sillery, Québec, sous le nom de soeur Céline. Par conséquent, elle a pu connaître des membres du clergé franco-américain du Rhode-Island, partisans d’un côté ou de l’autre du mouvement Sentinelliste. Elle rencontra également Marie-Rose Ferron, surnommée la Petite Rose, stigmatisée de Woonsocket au Rhode-Island. Enfin, après vingt ans de vie religieuse, Antoinette retourna dans sa famille pour s’occuper de ses parents jusqu’à leur décès.
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Dupuis, Jean-Pierre. "Le développement minier en Abitibi: les projets des colons." Recherche 34, no. 2 (April 12, 2005): 233–60. http://dx.doi.org/10.7202/056769ar.
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L'auteur montre que le développement de l'Abitibi n'est pas seulement l'échec de l'idéologie et du projet agriculturistes prônés par les élites traditionnelles et la réussite de l'idéologie et des projets capitalistes promus par les entrepreneurs nord-américains dans les domaines minier et forestier. Il est aussi le résultat des projets des colons engagés dans l'aventure abitibienne. L'analyse montre que ceux-ci ont pu réaliser leurs propres objectifs même dans les communautés censées être complètement soumises à l'ordre industriel. Le cas du développement minier et de deux communautés minières sert de toile de fond à cette démonstration.
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Gérôme, Noëlle. "L'anthropologie industrielle sur le terrain : une expérience poitevine." Anthropologie et Sociétés 10, no. 1 (September 10, 2003): 59–70. http://dx.doi.org/10.7202/006320ar.
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Résumé RÉSUMÉ /SUMMARY L'anthropologie industrielle sur le terrain : une expérience poitevine Le développement récent des travaux d'ethnologie industrielle exige la prise en considération de la conjoncture sociale de la mise en place et du déroulement des recherches. Celles-ci ne peuvent aboutir sans la collaboration pour parties égales et spécifiques des groupes, des individus et des institutions concernés par la démarche anthropologique. L'article expose l'exemple de la Caisse d'Activités Sociales de l'Électricité et du Gaz de France de Poitiers, qui a pu établir une collaboration active avec le Musée de la ville qui s'est ainsi ouvert à la culture ouvrière et industrielle.
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Yu, Zhiyuan, and Doudou Jin. "Determinants of Users’ Attitude and Intention to Intelligent Connected Vehicle Infotainment in the 5G-V2X Mobile Ecosystem." International Journal of Environmental Research and Public Health 18, no. 19 (September 25, 2021): 10069. http://dx.doi.org/10.3390/ijerph181910069.
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With the accelerating industrialization of 5G-V2X and smart automobiles, the intelligent connected vehicle (ICV) integrated with sophisticated communication, caching, computing, and control techniques enhance the functionality of in-vehicle infotainment (IVI) and also provide more powerful telematic or entertainment choices in vehicular environment. The diverse needs of ICV users (e.g., drivers and passengers) can be satisfied during commuting and traveling. However, considering the limitations of transportation environment, the potential attitude and usage behavior for the upcoming ICV infotainment directly impacts on the traffic and road safety in sustainable cities. In this paper, we conduct an online and offline survey to investigate the key factors influencing the user attitude and intention of ICV infotainment, where the answers of a total of 502 valid respondents (i.e., IVI users) are collected in China. A conceptual technology acceptance model with the constructs of perceived usefulness (PU), perceived ease of use (PEOU), social influence (SI), consumer innovation (CI), and perceived risk (PR) is established, and then assessed via partial least square structural equation modeling. We find that the constructs of PU, PEOU, CI, and SI have a direct impact on attitude and usage intention, of which 46.8% and 73.4% of variance, respectively, are explained. The respondents show positive attitudes and higher usage intention towards the ICV infotainment. Although PR has insignificant path with attitude and intention, the driving experience moderation effect exists between PR and usage intention. We can see that ICV infotainment will become a trend in future transportation scenario. Through this survey, reference for traffic safety and usage norms will be provided to reduce the risky of public health issues (e.g., traffic accidents) in the context of ICV infotainment.
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Debusschere, C., A. Vanhaecke, M. Cutolo, E. Deschepper, and V. Smith. "THU0334 LASER SPECKLE CONTRAST ANALYSIS FOR MEASUREMENT OF PERIPHERAL BLOOD PERFUSION IN SYSTEMIC SCLEROSIS PATIENTS: CAN IT PREDICT FUTURE ISCHEMIC DIGITAL TROPHIC LESIONS?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 398.1–398. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2438.
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Background:Vasculopathy is a hallmark of systemic sclerosis (SSc). Laser speckle contrast analysis (LASCA) is a research tool to assess peripheral blood perfusion (PBP) (1). At this moment, its reliability has been attested in SSc patients, but its predictive value for future ischemic digital trophic lesions (DTL) is unknown (1).Objectives:To investigate in an unselected, prospective SSc cohort if baseline LASCA PBP measurements can discriminate between patients who will develop ischemic DTL (iDTL) and those who will not.Methods:Patients (fulfilling 2013 ACR/EULAR criteria and/or 2001 LeRoy and Medsger criteria) were recruited during the period of December 2017 to September 2018. LASCA was performed at baseline, in standardized conditions (1). Regions of interest (ROIs) (diameter 1 cm) were outlined at the 2nd-5thfingertip both volar and dorsal. The ‘average PBP’ of these ROIs was calculated (expressed in arbitrary perfusion units [PU]). A monthly telephone survey was conducted for 1 year to investigate DTL occurrence. DTL were considered ‘ischemic’ if not related to calcinosis. Logistic regression and ROC analysis were used to assess if average PBP is predictive of future iDTL.Results:Of the 106 patients with complete follow-up (92 women [86,8%]; 18 limited SSc [17,0%], 82 limited cutaneous SSc [77,4%], 6 diffuse cutaneous SSc [5,7%]), 29 patients (27,4%) had a DTL history. Forty-nine patients (46,2%) were on vasodilator therapy. Only 7 patients developed at least 1 iDTL during follow-up (6,6%) (Figure 1a). Performing univariate logistic regression (ULR), average PBP was not predictive for future iDTL (Table 1). Of note, analyzing only the patients not taking vasodilators, average PBP in the ‘iDTL group’ (n = 3) was median 46,8 PU (min. 45,6 - max. 68,8) vs. median 141,4 PU (min. 24,4 - max. 269,5) in the ‘no iDTL group’ (n = 54) (Figure 1b). In this subgroup, all 3 patients who developed iDTL (100%) had an average PBP ≤ 70 PU whereas only 9 of the 54 patients without iDTL development (16,7%) had such PBP values.Table 1.Results of ULRSummary statisticsULRVariableiDTL cases(n = 7)Non-iDTL cases(n = 99)ParameterOR(95% CI)pROC AUC(95% CI)Average PBP (PU) mean (+/- SD)123,0 (74,6)142,9 (61,9)Average PBP (linear)0,995(0,982-1,007)0,4180,597(0,352-0,843)Conclusion:In this pilot study with an unselected day-to-day SSc population, where patients were allowed to continue vasodilators, there was an unexpected low iDTL incidence, undermining the power of our study. Even though, the observations in the subgroup of patients not taking vasodilators deserve future investigation to assess whether low PBP values, as measured by LASCA, are associated with a higher iDTL incidence.References:[1]Cutolo M, Vanhaecke A, et al. Autoimmun Rev. 2018;17(8):775-80.Figure 1.Distribution of ‘average PBP’ as measured by LASCA for ‘no iDTL group’ and ‘iDTL group’Disclosure of Interests:Claire Debusschere: None declared, Amber Vanhaecke: None declared, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha, Ellen Deschepper: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl
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Wright, Gavin. "Les Fondements Historiques de la Domination Economique Américaine." Annales. Histoire, Sciences Sociales 53, no. 3 (June 1998): 537–67. http://dx.doi.org/10.3406/ahess.1998.279684.
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La prééminence économique des États-Unis est l'un des traits marquants de l'histoire mondiale du 20e siècle. La domination américaine a été si nette et si évidente qu'elle semble souvent ne requérir aucune explication. L'historien Paul Kennedy écrit quant à lui, dans son étude très appréciée, The Rise and the Fall of the Great Powers:Les États-Unis semblaient posséder tous les avantages économiques dont certaines autres puissances détenaient une partie, mais ils ne comptaient aucun des handicaps de celles-ci… A la fin de la guerre de Sécession, les États-Unis ont pu exploiter, pour se transformer à une cadence stupefiante, les nombreux avantages dont ils étaient dotés: riches etendues cultivables, importantes quantites de matieres premieres, et possibilite de developper ces ressources grace a revolution particulierement heureuse de la technologie moderne (rail, machine a vapeur, equipement minier); faibles contraintes sociales ou geographiques ; absence de menace etrangere importante ; flux d'investissements etrangers et, progressivement, nationaux... Etant donne ces avantages, tout le processus de developpement etait virtuellement inévitable. C'est-à-dire que seule une opiniatre betise humaine, une guerre civile presque incessante ou une catastrophe naturelle auraient pu hypothequer cette expansion ou dissuader des millions d'immigrants de traverser l'Atlantique pour obtenir leur part d'or et grossir la main-d'œuvre.
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van der Werf, Esther T., Lorna J. Duncan, Paschen von Flotow, and Erik W. Baars. "Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016." BMJ Open 8, no. 3 (March 2018): e020488. http://dx.doi.org/10.1136/bmjopen-2017-020488.
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ObjectiveTo determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England.DesignRetrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age–sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores.SettingPrimary Care.Participants7283 NHS GP surgeries in England.Primary outcome measureThe association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome.ResultsIM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices.ConclusionNHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.
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Chaudat, Philippe, and Olivier Leservoisier. "De l’apprentissage du terrain au terrain comme apprentissage. L’expérience d’une pédagogie inversée." Emulations - Revue de sciences sociales, no. 39-40 (April 1, 2022): 31–50. http://dx.doi.org/10.14428/emulations.039-40.02.
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Partant d’une expérience de plusieurs années d’encadrement de stages de terrain en ethnologie, cet article propose une réflexion sur les enjeux et les modalités de l’apprentissage de l’enquête ethnographique, tant du point de vue des enseignants que de celui des étudiants. Il s’interroge à la fois sur les recompositions que cet apprentissage a pu connaître au fil des ans et sur les transformations que celui-ci engendre dans les pratiques pédagogiques. L’examen des conditions d’enseignement de l’enquête de terrain conduit ainsi à analyser les effets d’une pédagogie inversée, tout en rendant compte de la portée heuristique du dialogue entre des dispositifs pédagogiques (enseignement et stage) complémentaires et essentiels dans la formation à la recherche par la recherche.
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Hobæk Haff, Marianne. "Regard enthousiaste sur "Ny fransk grammatikk - morfologi, syntaks og semantikk" (NFG) par Hans Petter Helland." Oslo Studies in Language 12, no. 1 (June 29, 2021): 71–85. http://dx.doi.org/10.5617/osla.8910.
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Dans cet hommage à Hans Petter Helland, j’ai examiné deux sujets traités dans sa grammaire, Ny fransk grammatikk – morfologi, syntaks og semantikk (2006). En premier lieu, j’ai étudié la comparaison entre le futur simple et le futur périphrastique, un sujet de sa thèse de doctorat, Sémantique et pragmatique temporelles. Futur simple et futur périphrastique (1994). J’ai pu constater que, depuis 1994, Helland a modifié l’analyse sémantique de la périphrase de façon à rendre celle-ci plus compréhensible pour les étudiants. En second lieu, j’ai abordé les constructions hypothétiques, un de mes sujets favoris en matière verbale. Malgré quelques réserves, je trouve que la présentation qu’il fait est intéressante et très bonne d’un point de vue pédagogique.
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Guienne, Véronique. "Savoir se vendre : qualité sociale et disqualification sociale." Cahiers de recherche sociologique, no. 43 (May 3, 2011): 7–20. http://dx.doi.org/10.7202/1002475ar.
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Savoir se vendre est présenté comme une qualité sociale nécessaire. Cette injonction est analysée à travers les manuels de management, qui sont comme autant de codes de morale contemporains. Afin de comprendre comment cet esprit de marchandisation a pu s’imposer avec une telle évidence, l’article relève les différentes formes de vente de soi : la vente métaphorique, renoncement à des valeurs par intérêt; l’activité de louage, fondement du contrat de travail; la vente réelle, d’une personne ou d’une partie de celle-ci, comme l’est la vente d’organes. La prostitution est alors analysée comme condensant de façon abusive ces différentes dimensions alors qu’elle est totalement congruente avec les standards contemporains de la vente de soi.