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INTRODUCTION: Globalization has increased the importance of multicultural research to address health disparities and improve healthcare outcomes for underrepresented communities. The International Nursing Network for HIV Research (The Network) serves as a platform for researchers to collaborate on cross-cultural and cross-national HIV studies. This article discusses the Network's approach to overcoming barriers in multicultural and multinational research in a qualitative context. METHODS: The network created a protocol to guide decision-making throughout the translation process of qualitative data collected from participants in their native languages. The protocol includes aspects of why, when, what, who, how, where, and by what means the translation is completed. RESULTS: The protocol has allowed researchers to enhance the validity, reliability, and cultural sensitivity of translation process, ensuring the clarity and impact of their research findings. DISCUSSION: Rigorous translation practices promote cross-cultural understanding and respect for participants' perspectives, fostering global collaborations and knowledge exchange.
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Purse-seine fishers using drifting fish aggregating devices (dFADs), mainly built with bamboo, plastic buoys, and plastic netting, to aggregate and catch tropical tuna, deploy 46,000-65,000 dFADs per year in the Pacific Ocean. Some of the major concerns associated with this widespread fishing device are potential entanglement of sea turtles and other marine fauna in dFAD netting; marine debris and pollution; and potential ecological damage via stranding on coral reefs, beaches, and other essential habitats for marine fauna. To assess and quantify the potential connectivity (number of dFADs deployed in an area and arriving in another area) between dFAD deployment areas and important oceanic or coastal habitat of critically endangered leatherback (Dermochelys coriacea) and hawksbill (Eretmochelys imbricata) sea turtles in the Pacific Ocean, we conducted passive-drift Lagrangian experiments with simulated dFAD drift profiles and compared them with known important sea turtle areas. Up to 60% of dFADs from equatorial areas were arriving in essential sea turtle habitats. Connectivity was less when only areas where dFADs are currently deployed were used. Our simulations identified potential regions of dFAD interactions with migration and feeding habitats of the east Pacific leatherback turtle in the tropical southeastern Pacific Ocean; coastal habitats of leatherback and hawksbill in the western Pacific (e.g., archipelagic zones of Indonesia, Papua New Guinea, and Solomon Islands); and foraging habitat of leatherback in a large equatorial area south of Hawaii. Additional research is needed to estimate entanglements of sea turtles with dFADs at sea and to quantify the likely changes in connectivity and distribution of dFADs under new management measures, such as use of alternative nonentangling dFAD designs that biodegrade, or changes in deployment strategies, such as shifting locations.
Simulación de las trayectorias de dispositivos de concentración de peces a la deriva para identificar las interacciones potenciales con las tortugas marinas en peligro de extinción Resumen Los pescadores que usan redes de cerco con dispositivos de concentración de peces a la deriva (dFADs), hechos principalmente con bambú, boyas de plástico y redes de plástico, para concentrar y capturar atún, instalan entre 46,000 y 65,000 dFADs al año en el Océano Pacífico. Algunas de las problemáticas principales asociadas con este dispositivo de pesca de uso extenso son el enredamiento potencial de tortugas marinas y otras especies marinas en las redes de los dFADs; los desechos marinos y la contaminación; y el potencial daño ecológico por el varamiento en los arrecifes de coral, playas y otros hábitats esenciales para la fauna marina. Realizamos experimentos lagrangianos de deriva pasiva con la simulación de perfiles de deriva de los dFADs y los comparamos con áreas conocidas de importancia para las tortugas marinas. Esto fue con el objetivo de evaluar y cuantificar la conectividad potencial (número de dFADs instalados en un área que llegan a otra área) entre las áreas de instalación de dFADs y los hábitats oceánicos o costeros importantes para la tortuga laúd (Dermochelys coriacea) y la tortuga de carey (Eretmochelys imbricata), ambas en peligro crítico de extinción, en el Océano Pacífico. Hasta el 60% de los dFADs de las áreas ecuatoriales llegaron a los hábitats esenciales para las tortugas marinas. La conectividad fue menor sólo cuando se usaron áreas en donde actualmente hay dFADs instalados. Nuestras simulaciones identificaron regiones potenciales de interacción entre los dFADs y los hábitats de migración y alimentación de la tortuga laúd en el sureste tropical del Océano Pacífico; los hábitats costeros de ambas especies en el Pacífico occidental (p. ej.: zonas de archipiélagos en Indonesia, Papúa Nueva Guinea y en las Islas Salomón); y en el hábitat de forrajeo de la tortuga laúd en una gran área ecuatorial al sur de Hawái. Se requiere de mayor investigación para estimar el enredamiento de las tortugas marinas con los dFADs en el mar y para cuantificar los cambios probables en la conectividad y la distribución de los dFADs bajo nuevas medidas de manejo, como el uso alternativo de diseños que eviten el enredamiento y sean biodegradables, o cambios en las estrategias de instalación, como la reubicación.
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Porphyria cutanea tarda (PCT) is the commonest of the porphyrias (Semin Liver Dis 1998;18:67). It often occurs secondary to an underlying internal disorder, has significant impacts on liver health and longevity, and is a treatable disease. Thus, for the clinician, recognising the disease to make the correct diagnosis, identifying causative underlying diseases, and treating the porphyria and its complications, are crucial. Although reviews on the management of PCT have been written, there have recently been significant advances in the understanding of the factors predisposing to the disease, and of its wider health impacts. This review aims to help the clinician to diagnose and manage patients with PCT, with an emphasis on the impact of recent advances on clinical management.
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PURPOSE: To determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics. SETTING/SAMPLE: A total of 810 participants across eight sites located in three countries. MEASURES: Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk Test. ANALYSIS: Both univariate and multivariant analyses were used. RESULTS: Physical function was significantly associated with Making Time for Exercise (ß = 1.76, p = .039) but not with Resisting Relapse (ß = 1.16, p = .168). Age (ß = -1.88, p = .001), being employed (ß = 16.19, p < .001) and race (ßs = 13.84-31.98, p < .001), hip-waist ratio (ß = -2.18, p < .001), and comorbidities (ß = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (ß = 0.14, p = .029), and Resisting Relapse scores again did not (ß = -0.10, p = .120). Among the covariates, age (ß = -0.16, p < .001), gender (ß = -0.43, p < .001), education (ß = 0.08, p = .026), and hip-waist ratio (ß = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity (r = 0.27). CONCLUSIONS: Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.
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Infecções por HIV , Autoeficácia , Humanos , Tolerância ao Exercício , Exercício Físico , Doença Crônica , RecidivaRESUMO
BACKGROUND: Exposure to mental health problems are becoming increasingly more frequent within physiotherapy. Physiotherapists recognize the need for a biopsychosocial approach, however their knowledge, assessment, and treatment skills specific to mental health problems requires further research. PURPOSE: To profile the level of education and perception of education that physiotherapists have acquired specific to mental health problems; and to profile an understanding of the current practice of physiotherapists specific to mental health problems. METHODS: An online survey addressed the aims of the study and collected data from physiotherapists in Australia and New Zealand (open between 20th of October 2022 to the 20th of March 2023). RESULTS: 139 respondents were included in the analysis. Physiotherapists had a perception that a significantly greater amount of coursework related to mental health needed to be included within their initial degree compared to what they received (mean difference of 20.0%, 95% CI: 17.5 to 22.5). This trend was evident irrespective of the degree level or the year of graduation. Higher perceived knowledge of anxiety (MD of 11.4, p = 0.001, ES: 0.5) and depression (MD of 11.8, p = 0.001, ES: 0.5) was evident in outpatient care physiotherapists. Lack of perceived knowledge is a reason for whether an assessment or treatment strategy is used with patients experiencing a mental health problem. Motivational interviewing and mindfulness were the most frequently used psychologically based techniques. CONCLUSION: This study reveals the need to increase the amount of mental health and psychologically based techniques within Physiotherapy curriculum.
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BACKGROUND: The aim of our study is to describe maternal and neonatal morbidity and mortality in patients undergoing trial of labor after cesarean from the Consortium on Safe Labor. METHODS: This was a secondary analysis of the Consortium on Safe Labor database, a retrospective cohort study over a 7 year study period. Maternal and neonatal outcomes were evaluated based on desired delivery mode: planned elective repeat cesarean delivery or trial of labor after cesarean. RESULTS: Of 9858 patients in our analysis, our study population had 4400 patients (45%) who desired trial of labor after cesarean and 5458 patients (55%) who desired elective repeat cesarean delivery. Women who attempted trial of labor after cesarean compared to those who had an elective repeat cesarean delivery were more likely to have an obstetric hemorrhage (adjusted odds ratio 1.6; 95% CI 1.3 -2.0) and blood transfusion (adjusted odds ratio 2.3; 95% CI 1.6 -3.2). CONCLUSION: Maternal morbidity in women undergoing trial of labor after cesarean was predominantly hemorrhage-related.
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Trabalho de Parto , Prova de Trabalho de Parto , Gravidez , Recém-Nascido , Humanos , Feminino , Estudos Retrospectivos , HemorragiaRESUMO
Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.
Even with advances in care, there remain many similarities in interventions for the improved treatment and screening of maternal syphilis over the past 30 years.There is a need for meaningful research that engages community members in study and intervention development and considers the social determinants of health in the context of maternal syphilis care.Examining interventions in relation to the socio-ecological model may help guide policymakers, researchers, and clinicians in intervention development.
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Programas de Rastreamento , Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Humanos , Feminino , Sífilis/diagnóstico , Sífilis/terapia , Gravidez , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal , Serviços de Saúde Materna/organização & administração , Saúde Global , Transmissão Vertical de Doenças Infecciosas/prevenção & controleRESUMO
BACKGROUND: African Americans with MCI may be at increased risk for dementia compared to Caucasians. The effect of race on the efficacy of cognitive training in MCI is unclear. METHODS: We used data from a two-site, 78-week randomized trial of MCI comparing intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles to examine the effect of race on outcomes. The study outcomes were changes from baseline in cognitive and functional scales as well as MRI-measured changes in hippocampal volume and cortical thickness. Analyses used linear models adjusted for baseline scores. This was an exploratory study. RESULTS: A total of 105 subjects were included comprising 81 whites (77.1%) and 24 African Americans (22.8%). The effect of race on the change from baseline in ADAS-Cog-11 was not significant. The effect of race on change from baseline to week 78 in the Functional Activities Questionnaire (FAQ) was significant with African American participants' FAQ scores showing greater improvements at weeks 52 and 78 (P = 0.009, P = 0.0002, respectively) than white subjects. Within the CCT cohort, FAQ scores for African American participants showed greater improvement between baseline and week 78, compared to white participants randomized to CCT (P = 0.006). There was no effect of race on the UPSA. There was no effect of race on hippocampal or cortical thickness outcomes. CONCLUSIONS: Our preliminary findings suggest that web-based cognitive training programs may benefit African Americans with MCI at least as much as Caucasians, and highlight the need to further study underrepresented minorities in AD prevention trials. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).
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Doença de Alzheimer , Disfunção Cognitiva , Humanos , Doença de Alzheimer/psicologia , Negro ou Afro-Americano , Disfunção Cognitiva/psicologia , Treino Cognitivo , Inquéritos e Questionários , BrancosRESUMO
BACKGROUND: The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS: An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS: 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS: COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.
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População Australasiana , Luto , COVID-19 , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Austrália/epidemiologia , COVID-19/psicologia , Pesar , Análise de Classes Latentes , Saúde Mental , Pandemias , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
BACKGROUND: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. OBJECTIVE: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. METHODS: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences-associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. RESULTS: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. CONCLUSIONS: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers' needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps.
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ABSTRACT: As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH.
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COVID-19 , Infecções por HIV , Humanos , COVID-19/epidemiologia , Pandemias , Infecções por HIV/epidemiologia , Populações Vulneráveis , São Francisco , Estudos Observacionais como AssuntoRESUMO
This paper is an examination of the methodological and theoretical perspectives of a study with an inquiry focus on the experiences and perspectives of staff who worked at an injectable opiate assisted (iOAT) clinic. Twenty-two staff members, including nurses, social workers, and peer support workers, were interviewed. The goal of the study was to uncover how the clinic staff provided care to the clients who attend the clinic, their perspectives on how the clinic program impacted both them and their clients, and their experiences with the program itself. This interpretive descriptive study was underpinned by critical social theory. Thematic analysis was undertaken to identify recurring, converging, and contradictory patterns of interaction, key concepts and emerging themes. In this paper we examine and discuss how the relationship between critical social theory and interpretive description enhanced the study. Examples from the study are presented to provide insight into the relationship.
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Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses, with a prevalence of approximately 1% to 7%. It is defined by the presence of at least two cardinal symptoms (nasal blockage, obstruction, or congestion; anterior or posterior nasal drainage; facial pain or pressure; and hyposmia) for at least three consecutive months, with objective findings on imaging or nasal endoscopy. CRS can result in significant patient costs and lower quality of life due to severe fatigue, depression, and sometimes reduced cognitive function. The condition is categorized as primary or secondary and with or without nasal polyps. Treatment is directed at reducing symptoms, improving mucus clearance, reducing inflammation, enhancing ciliary function, and removing bacteria and biofilms from the nasal mucosa. First-line treatment comprises nasal saline irrigation and intranasal corticosteroids. Acute exacerbation of CRS is common and is defined as a transient worsening of symptoms. The role of oral antibiotics and oral corticosteroids for acute exacerbations is unclear. Optimal maintenance therapy can help alleviate exacerbations. Patients with refractory CRS that is not responsive to first-line treatment and patients with alarm symptoms should be referred to an otolaryngologist for further evaluation and consideration of surgical management. Identifying patients who have CRS with nasal polyps or comorbid conditions such as atopic dermatitis, asthma, or eosinophilic esophagitis is especially important to ensure they are referred to a specialist for consideration of biologic therapy.
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Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Pólipos Nasais/complicações , Qualidade de Vida , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapia , Corticosteroides/uso terapêutico , Doença CrônicaRESUMO
Background: Minimally invasive repair of pectus excavatum involves placement of retrosternal support (Nuss) bars. Hardware removal has been rarely associated with life-threatening hemorrhage from the heart, aorta, internal mammary arteries, and/or lung. There is no accepted standard intraoperative monitoring technique used during removal. We hypothesized that the use of transesophageal echocardiography (TEE) during Nuss bar removal would enhance safety of the procedure and be cost-effective. Methods: IRB-approved retrospective review of patients who underwent Nuss bar removal with intraoperative TEE monitoring over a 4-year period, from March 2013 to May 2017, was completed. Bar removal procedures were performed supine, under general anesthesia. TEE images were monitored and any distortion of the cardiac silhouette, new pericardial effusion, and/or cardiac arrhythmias would be considered evidence of possible bar adherence, triggering possible conversion to sternotomy or thoracotomy. Results: In total, 87 consecutive patients, mean age of 20 years, were identified. Bars had been in place for a mean of 30 months. Average procedure time was 67 minutes. No patients experienced arrhythmias, cardiac injury, or significant hemorrhage during removal. TEE gave excellent visualization of the cardiac silhouette and pericardium in all cases. No patient required insertion of an arterial line, a postoperative chest X-ray, or overnight hospitalization. Patients were discharged from the recovery room an average of 89 minutes postprocedure. Conclusion: TEE offers a minimally invasive safe way to visualize the pericardium and its contents during Nuss bar removal. Significant cardiac/mediastinal injuries should be immediately visible. The use of TEE is cost-effective and allows safe discharge the day of surgery.
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Tórax em Funil , Humanos , Adulto Jovem , Adulto , Tórax em Funil/diagnóstico por imagem , Tórax em Funil/cirurgia , Ecocardiografia Transesofagiana , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hemorragia , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Hemorrhage anticipation and management has shifted significantly over the past decade due to evolution of data surrounding management of obstetric hemorrhage. Limited data exists which describe the practical use and clinical application of hemorrhage management. Our goal was to identify obstetric hemorrhage management patterns in a cohort of practicing Maternal Fetal Medicine physicians. METHODS: We administered a survey to Maternal Fetal Medicine (MFM) fellows and faculty that addressed the management of hemorrhage including risk assessment, uterotonic use, antifibrinolytic use, cell saver use, and abnormal placentation management. An email was sent out regarding the survey to a listserv of all Maternal Fetal Medicine fellow program coordinators to disseminate to their faculty and fellows. Eighty responses were obtained. RESULTS: A total of 78 surveys were analyzed. Participants preferred methylergonovine as a first line agent (nâ=â57; 73%, nâ=â62; 80%). Most participants would consider using cell salvage when also activating MTP (28, 48%) or during scheduled deliveries who are high risk of hemorrhage (40, 69%). Approximately a third of providers would use TXA (tranexamic acid) prophylactically (nâ=â21; 28%). Only 26% of MFM fellows felt comfortable performing cesarean hysterectomy without Gynecologic Oncology. CONCLUSION: In comparison to prior reports, TXA use has increased substantially. Further, when looking at the management of abnormal placentation, the use of magnetic resonance imaging and embolization have both increased. Possibly due to the rise in centers of excellence for treatment of accreta spectrum disorders, Maternal Fetal Medicine fellows still feel largely unprepared to perform a cesarean hysterectomy without Gynecologic Oncology.
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Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care.
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Desigualdades de Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Inuíte , Neoplasias , Racismo , Determinantes Sociais da Saúde , Feminino , Humanos , Canadá , Neoplasias/terapia , Racismo/etnologia , Disparidades em Assistência à Saúde/etnologia , Determinantes Sociais da Saúde/etnologia , Atenção à Saúde/etnologiaRESUMO
Gene therapy approaches using adeno-associated viral vectors have been successfully tested in the equine post-traumatic osteoarthritis (PTOA) model. Owing to differences in the levels of transgene expression and adverse tissue reactions observed in published studies, we sought to identify a safe therapeutic dose of scAAVIL-1ra in an inflamed and injured joint that would result in improved functional outcomes without any adverse events. scAAVIL-1ra was delivered intra-articularly over a 100-fold range, and horses were evaluated throughout and at the end of the 10-week study. A dose-related increase in IL-1ra levels with a decrease in PGE2 levels was observed, with the peak IL-1ra concentration being observed 7 days post-treatment in all groups. Perivascular infiltration with mononuclear cells was observed within the synovial membrane of the joint treated with the highest viral dose of 5 × 1012 vg, but this was absent in the lower-dosed joints. The second-highest dose of scAAVeqIL-1ra 5 × 1011 vg demonstrated elevated IL-1ra levels without any cellular response in the synovium. Taken together, the data suggest that the 10-fold lower dose of 5 × 1011vg scAAVIL-1ra would be a safe therapeutic dose in an equine model of PTOA.
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Proteína Antagonista do Receptor de Interleucina 1 , Osteoartrite , Animais , Cavalos/genética , Proteína Antagonista do Receptor de Interleucina 1/genética , Proteína Antagonista do Receptor de Interleucina 1/metabolismo , Projetos Piloto , Vetores Genéticos , Osteoartrite/terapia , Osteoartrite/metabolismo , Modelos AnimaisRESUMO
Objective.Repair of nerve gap injuries can be achieved through nerve autografting, but this approach is restricted by limited tissue supply and donor site morbidity. The use of living nerve allografts would provide an abundant tissue source, improving outcomes following peripheral nerve injury. Currently this approach is not used due to the requirement for systemic immunosuppression, to prevent donor-derived cells within the transplanted nerve causing an immune response, which is associated with severe adverse effects. The aim of this study was to develop a method for delivering immunosuppression locally, then to test its effectiveness in reducing the immune response to transplanted tissue in a rat model of nerve allograft repair.Approach.A coaxial electrospinning approach was used to produce poly-ϵ-caprolactone fibre sheets loaded with the immunosuppressant tacrolimus. The material was characterised in terms of structure and tacrolimus release, then testedin vivothrough implantation in a rat sciatic nerve allograft model with immunologically mismatched host and donor tissue.Main results.Following successful drug encapsulation, the fibre sheets showed nanofibrous structure and controlled release of tacrolimus over several weeks. Materials containing tacrolimus (and blank material controls) were implanted around the nerve graft at the time of allograft or autograft repair. The fibre sheets were well tolerated by the animals and tacrolimus release resulted in a significant reduction in lymphocyte infiltration at 3 weeks post-transplantation.Significance.These findings demonstrate proof of concept for a novel nanofibrous biomaterial-based targeted drug delivery strategy for immunosuppression in peripheral nerve allografting.
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Nanofibras , Tacrolimo , Ratos , Animais , Tacrolimo/farmacologia , Tacrolimo/uso terapêutico , Linfócitos T , Transplante Homólogo , Nervo Isquiático/fisiologia , Aloenxertos/transplante , Regeneração Nervosa/fisiologiaRESUMO
Obtaining the mechanical properties of soft tissues is critical in many medical fields, such as regenerative medicine and surgical simulation training. Although various tissue-characterization methods have been developed, such as AFM, indentation, and elastography, there remain some limitations on their accuracy and validity for measuring small and fragile soft tissues. This paper presents a tensile testing technique to measure the mechanical properties of soft tissues directly and accurately. Tensile testing was chosen as the primary method because of its simple procedure and ability to derive mechanical properties without requiring many assumptions or complicated models. However, tensile testing on soft tissues presents challenges related to gripping the tissue sample without affecting its inherent properties, applying minuscule forces to the sample, and measuring the cross-section area and strain of the sample. To solve these issues, this study presents a sub-micro scale tensile testing system that uses a flexure mechanism and a novel 3D-printed sample holder for gripping the tissue samples. The system also measures tested samples' cross-section area and strain using two high-resolution cameras. The system was validated by testing standard materials and used to characterize the elastic modulus, yield stress, and yield strain of lung tissue slices from six different mice. The results from the validation tests showed a less than 2.5% error for elastic modulus values measured using the tensile tester. At the same time, results from the mice lung tissue measurements revealed qualitative findings that closely matched those seen in the literature and displayed low coefficient of variation values, demonstrating the high repeatability of the system.
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Técnicas de Imagem por Elasticidade , Fenômenos Mecânicos , Animais , Camundongos , Módulo de Elasticidade , Medicina Regenerativa , Impressão Tridimensional , Resistência à Tração , Estresse MecânicoRESUMO
The label 'Stop' potentially generates conflict-signifying important corrective action, or a warning not to touch. To examine potential conflict between an incongruent label (i.e. STOP) and an imperative command (i.e. MOVE!), 18 participants used a computer mouse to move a crosshair cursor to targets with superimposed labels. Trials systematically varied Imperative (blank or MOVE!), Label (+GO + or STOP) and movement Distance. Kinematic analyses examined response latency, movement duration and accuracy. Incongruent labels had little impact upon response latencies, but they affected cursor deceleration and the variability of cursor placement. Although reading is assumed to be obligatory, the impact of written labels is not immediate, instead affecting cursor deceleration. Indeed, responses to controls labelled STOP were less accurate than those labelled + GO+. As labelled interfaces can create error versus command confusions, enhancing the discriminability of controls to afford more obvious visible cues as to method of use is recommended. Practitioner summary: Emergency stop and shutdown controls can cause response conflict as their labels signify both urgent corrective actions and 'don't touch'. Response conflict caused by confusing superimposed labels is resolved as cursors near the target control and may result in reduced movement accuracy. Prior warnings may influence resolution of response conflict. Abbreviations: Hz: Hertz; M: Mean; ms: millisecond; mm: millimetre; S: second; SD: Standard Deviation; SE: Standard Error; USB: Universal Serial Bus.