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1.
Diabetologia ; 66(2): 376-389, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36404376

RESUMO

AIMS/HYPOTHESIS: Normalisation of blood glucose in individuals with diabetes is recommended to reduce development of diabetic complications. However, risk of severe hypoglycaemia with intensive insulin therapy is a major obstacle that prevents many individuals with diabetes from obtaining the recommended reduction in HbA1c. Inhibition of glucagon receptor signalling and liver-preferential insulin action have been shown individually to have beneficial effects in preclinical models and individuals with diabetes (i.e. improved glycaemic control), but also have effects that are potential safety risks (i.e. alpha cell hyperplasia in response to glucagon receptor antagonists and increased levels of liver triacylglycerols and plasma alanine aminotransferase activity in response to glucagon receptor antagonists and liver-preferential insulin). We hypothesised that a combination of glucagon inhibition and liver-preferential insulin action in a dual-acting molecule would widen the therapeutic window. By correcting two pathogenic mechanisms (dysregulated glucagon signalling and non-physiological distribution of conventional insulin administered s.c.), we hypothesised that lower doses of each component would be required to obtain sufficient reduction of hyperglycaemia, and that the undesirable effects that have previously been observed for monotreatment with glucagon antagonists and liver-preferential insulin could be avoided. METHODS: A dual-acting glucagon receptor inhibitor and liver-preferential insulin molecule was designed and tested in rodent models (normal rats, rats with streptozotocin-induced hyperglycaemia, db/db mice and mice with diet-induced obesity and streptozotocin-induced hyperglycaemia), allowing detailed characterisation of the pharmacokinetic and pharmacodynamic properties of the dual-acting molecule and relevant control compounds, as well as exploration of how the dual-acting molecule influenced glucagon-induced recovery and spontaneous recovery from acute hypoglycaemia. RESULTS: This molecule normalised blood glucose in diabetic models, and was markedly less prone to induce hypoglycaemia than conventional insulin treatment (approximately 4.6-fold less potent under hypoglycaemic conditions than under normoglycaemic conditions). However, compared to treatment with conventional long-acting insulin, this dual-acting molecule also increased triacylglycerol levels in the liver (approximately 60%), plasma alanine aminotransferase levels (approximately twofold) and alpha cell mass (approximately twofold). CONCLUSIONS/INTERPRETATION: While the dual-acting glucagon receptor inhibitor and liver-preferential insulin molecule showed markedly improved regulation of blood glucose, effects that are potential safety concerns persisted in the pharmacologically relevant dose range.


Assuntos
Diabetes Mellitus , Hiperglicemia , Hipoglicemia , Ratos , Animais , Camundongos , Insulina/uso terapêutico , Glucagon , Glicemia , Receptores de Glucagon , Alanina Transaminase , Estreptozocina , Hipoglicemia/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Modelos Animais de Doenças , Fígado , Diabetes Mellitus/tratamento farmacológico
2.
Phys Rev Lett ; 130(12): 126203, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-37027849

RESUMO

The coupling energies between the buckled dimers of the Si(001) surface were determined through analysis of the anisotropic critical behavior of its order-disorder phase transition. Spot profiles in high-resolution low-energy electron diffraction as a function of temperature were analyzed within the framework of the anisotropic two-dimensional Ising model. The validity of this approach is justified by the large ratio of correlation lengths, ξ_{∥}^{+}/ξ_{⊥}^{+}=5.2 of the fluctuating c(4×2) domains above the critical temperature T_{c}=(190.6±10) K. We obtain effective couplings J_{∥}=(-24.9±1.3) meV along the dimer rows and J_{⊥}=(-0.8±0.1) meV across the dimer rows, i.e., antiferromagneticlike coupling of the dimers with c(4×2) symmetry.

3.
Acta Orthop ; 94: 416-425, 2023 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-37565339

RESUMO

BACKGROUND AND PURPOSE: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). PATIENTS AND METHODS: This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. RESULTS: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). CONCLUSION: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.


Assuntos
Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Antibacterianos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Cimentos Ósseos/uso terapêutico , Cefazolina , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Relacionadas à Prótese/tratamento farmacológico , Gentamicinas , América do Norte , Europa (Continente) , Oceania , África
4.
Environ Res ; 214(Pt 4): 114083, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35995220

RESUMO

Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.


Assuntos
Poluição do Ar , Resposta Galvânica da Pele , Poluição do Ar/análise , Teorema de Bayes , Ciclismo , Carbono , Cidades , Humanos , Fuligem/toxicidade , Caminhada
5.
Nano Lett ; 21(17): 7145-7151, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34407373

RESUMO

Heat transfer through heterointerfaces is intrinsically hampered by a thermal boundary resistance originating from the discontinuity of the elastic properties. Here, we show that with shrinking dimensions the heat flow from an ultrathin epitaxial film through atomically flat interfaces into a single crystalline substrate is significantly reduced due to violation of Boltzmann equipartition theorem in the angular phonon phase space. For films thinner than the phonons mean free path, we find phonons trapped in the film by total internal reflection, thus suppressing heat transfer. Repopulation of those phonon states, which can escape the film through the interface by transmission and refraction, becomes the bottleneck for cooling. The resulting nonequipartition in the angular phonon phase space slows down the cooling by more than a factor of 2 compared to films governed by phonons diffuse scattering. These allow tailoring of the thermal interface conductance via manipulation of the interface.

6.
Eur J Nucl Med Mol Imaging ; 48(11): 3618-3630, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33954826

RESUMO

BACKGROUND: Visual inspection and biopsy is the current standard of care for oral cancer diagnosis, but is subject to misinterpretation and consequently to misdiagnosis. Topically applied PARPi-FL is a molecularly specific, fluorescent contrast-based approach that may fulfill the unmet need for a simple, in vivo, non-invasive, cost-effective, point-of-care method for the early diagnosis of oral cancer. Here, we present results from a phase I safety and feasibility study on fluorescent, topically applied PARPi-FL. Twelve patients with a histologically proven oral squamous cell carcinoma (OSCC) gargled a PARPi-FL solution for 60 s (15 mL, 100 nM, 250 nM, 500 nM, or 1000 nM), followed by gargling a clearing solution for 60 s. Fluorescence measurements of the lesion and surrounding oral mucosa were taken before PARPi-FL application, after PARPi-FL application, and after clearing. Blood pressure, oxygen levels, clinical chemistry, and CBC were obtained before and after tracer administration. RESULTS: PARPi-FL was well-tolerated by all patients without any safety concerns. When analyzing the fluorescence signal, all malignant lesions showed a significant differential in contrast after administration of PARPi-FL, with the highest increase occurring at the highest dose level (1000 nM), where all patients had a tumor-to-margin fluorescence signal ratio of >3. A clearing step was essential to increase signal specificity, as it clears unbound PARPi-FL trapped in normal anatomical structures. PARPi-FL tumor cell specificity was confirmed by ex vivo tabletop confocal microscopy. We have demonstrated that the fluorescence signal arose from the nuclei of tumor cells, endorsing our macroscopic findings. CONCLUSIONS: A PARPi-FL swish & spit solution is a rapid and non-invasive diagnostic tool that preferentially localizes fluorescent contrast to OSCC. This technique holds promise for the early detection of OSCC based on in vivo optical evaluation and targeted biopsy of suspicious lesions in the oral cavity. TRIAL REGISTRATION: Clinicaltrials.gov -NCT03085147, registered on March 21st, 2017.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Carcinoma de Células Escamosas/diagnóstico por imagem , Corantes Fluorescentes , Humanos , Neoplasias Bucais/diagnóstico por imagem , Poli(ADP-Ribose) Polimerase-1
7.
Microcirculation ; 27(2): e12593, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31605649

RESUMO

OBJECTIVE: The effect of insulin on blood flow distribution within muscle microvasculature has been suggested to be important for glucose metabolism. However, the "capillary recruitment" hypothesis is still controversial and relies on studies using indirect contrast-enhanced ultrasound (CEU) methods. METHODS: We studied how hyperinsulinemia effects capillary blood flow in rat extensor digitorum longus (EDL) muscle during euglycemic hyperinsulinemic clamp using intravital video microscopy (IVVM). Additionally, we modeled blood flow and microbubble distribution within the vascular tree under conditions observed during euglycemic hyperinsulinemic clamp experiments. RESULTS: Euglycemic hyperinsulinemia caused an increase in erythrocyte (80 ± 25%, P < .01) and plasma (53 ± 12%, P < .01) flow in rat EDL microvasculature. We found no evidence of de novo capillary recruitment within, or among, capillary networks supplied by different terminal arterioles; however, erythrocyte flow became slightly more homogenous. Our computational model predicts that a decrease in asymmetry at arteriolar bifurcations causes redistribution of microbubble flow among capillaries already perfused with erythrocytes and plasma, resulting in 25% more microbubbles flowing through capillaries. CONCLUSIONS: Our model suggests increase in CEU signal during hyperinsulinemia reflects a redistribution of arteriolar flow and not de novo capillary recruitment. IVVM experiments support this prediction showing increases in erythrocyte and plasma flow and not capillary recruitment.


Assuntos
Capilares , Hiperinsulinismo , Microcirculação , Músculo Esquelético , Animais , Capilares/metabolismo , Capilares/fisiopatologia , Hiperinsulinismo/metabolismo , Hiperinsulinismo/fisiopatologia , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/fisiopatologia , Ratos , Ratos Sprague-Dawley
8.
Opt Express ; 28(5): 6164-6171, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32225871

RESUMO

Laser beam profilometry is an important scientific task with well-established solutions for beams propagating in air. It has, however, remained an open challenge to measure beam profiles of high-power lasers in ultra-high vacuum and in tightly confined spaces. Here we present a novel scheme that uses a single multi-mode fiber to scatter light and guide it to a detector. The method competes well with commercial systems in position resolution, can reach through apertures smaller than 500×500 µm2 and is compatible with ultra-high vacuum conditions. The scheme is simple, compact, reliable and can withstand laser intensities beyond 2 MW/cm2.

9.
Phys Rev Lett ; 125(3): 033604, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32745420

RESUMO

We demonstrate Bragg diffraction of the antibiotic ciprofloxacin and the dye molecule phthalocyanine at a thick optical grating. The observed patterns show a single dominant diffraction order with the expected dependence on the incidence angle as well as oscillating population transfer between the undiffracted and diffracted beams. We achieve an equal-amplitude splitting of 14ℏk (photon momenta) and maximum momentum transfer of 18ℏk. This paves the way for efficient, large-momentum beam splitters and mirrors for hot and complex molecules.


Assuntos
Ciprofloxacina/química , Indóis/química , Modelos Químicos , Antibacterianos/química , Interferometria/métodos , Isoindóis , Modelos Moleculares , Pigmentos Biológicos/química , Espalhamento de Radiação
10.
Proc Natl Acad Sci U S A ; 114(36): E7441-E7449, 2017 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-28827325

RESUMO

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adults. DLBCL exhibits highly aggressive and systemic progression into multiple tissues in patients, particularly in lymph nodes. Whole-body 18F-fluodeoxyglucose positron emission tomography ([18F]FDG-PET) imaging has an essential role in diagnosing DLBCL in the clinic; however, [18F]FDG-PET often faces difficulty in differentiating malignant tissues from certain nonmalignant tissues with high glucose uptake. We have developed a PET imaging strategy for DLBCL that targets poly[ADP ribose] polymerase 1 (PARP1), the expression of which has been found to be much higher in DLBCL than in healthy tissues. In a syngeneic DLBCL mouse model, this PARP1-targeted PET imaging approach allowed us to discriminate between malignant and inflamed lymph nodes, whereas [18F]FDG-PET failed to do so. Our PARP1-targeted PET imaging approach may be an attractive addition to the current PET imaging strategy to differentiate inflammation from malignancy in DLBCL.


Assuntos
Linfonodos/patologia , Linfoma Difuso de Grandes Células B/patologia , Animais , Linhagem Celular Tumoral , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/administração & dosagem
11.
Nano Lett ; 19(7): 4594-4600, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31251073

RESUMO

When graphene is placed on a crystalline surface, the periodic structures within the layers superimpose and moiré superlattices form. Small lattice rotations between the two materials in contact strongly modify the moiré lattice parameter, upon which many electronic, vibrational, and chemical properties depend. While precise adjustment of the relative orientation in the degree- and sub-degree-range can be achieved via careful deterministic transfer of graphene, we report on the spontaneous reorientation of graphene on a metallic substrate, Ir(111). We find that selecting a substrate temperature between 1530 and 1000 K during the growth of graphene leads to distinct relative rotational angles of 0°, ± 0.6°, ±1.1°, and ±1.7°. When modeling the moiré superlattices as two-dimensional coincidence networks, we can ascribe the observed rotations to favorable low-strain graphene structures. The dissimilar thermal expansion of the substrate and graphene is regarded as an effective compressive biaxial pressure that is more easily accommodated in graphene by small rotations rather than by compression.

12.
Diabetes Obes Metab ; 21(10): 2294-2304, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31183936

RESUMO

AIMS: We previously quantified the hypoglycaemia-sparing effect of portal vs peripheral human insulin delivery. The current investigation aimed to determine whether a bioequivalent peripheral vein infusion of a hepatopreferential insulin analog, insulin-406, could similarly protect against hypoglycaemia. MATERIALS AND METHODS: Dogs received human insulin infusions into either the hepatic portal vein (PoHI, n = 7) or a peripheral vein (PeHI, n = 7) for 180 minutes at four-fold the basal secretion rate (6.6 pmol/kg/min) in a previous study. Insulin-406 (Pe406, n = 7) was peripherally infused at 6.0 pmol/kg/min, a rate determined to decrease plasma glucose by the same amount as with PoHI infusion during the first 60 minutes. Glucagon was fixed at basal concentrations, mimicking the diminished α-cell response seen in type 1 diabetes. RESULTS: Glucose dropped quickly with PeHI infusion, reaching 41 ± 3 mg/dL at 60 minutes, but more slowly with PoHI and Pe406 infusion (67 ± 2 and 72 ± 4 mg/dL, respectively; P < 0.01 vs PeHI for both). The hypoglycaemic nadir (c. 40 mg/dL) occurred at 60 minutes with PeHI infusion vs 120 minutes with PoHI and Pe406 infusion. ΔAUCepinephrine during the 180-minute insulin infusion period was two-fold higher with PeHI infusion compared with PoHI and Pe406 infusion. Glucose production (mg/kg/min) was least suppressed with PeHI infusion (Δ = 0.79 ± 0.33) and equally suppressed with PoHI and Pe406 infusion (Δ = 1.16 ± 0.21 and 1.18 ± 0.17, respectively; P = NS). Peak glucose utilization (mg/kg/min) was highest with PeHI infusion (4.94 ± 0.17) and less with PoHI and Pe406 infusion (3.58 ± 0.58 and 3.26 ± 0.08, respectively; P < 0.05 vs Pe for both). CONCLUSIONS: Peripheral infusion of hepatopreferential insulin can achieve a metabolic profile that closely mimics portal insulin delivery, which reduces the risk of hypoglycaemia compared with peripheral insulin infusion.


Assuntos
Hipoglicemiantes , Insulina Regular Humana , Insulina , Veia Porta/metabolismo , Animais , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 1 , Cães , Gluconeogênese , Humanos , Hipoglicemia/metabolismo , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/farmacologia , Infusões Intravenosas , Insulina/administração & dosagem , Insulina/análogos & derivados , Insulina/sangue , Insulina/farmacologia , Insulina Regular Humana/administração & dosagem , Insulina Regular Humana/farmacologia , Fígado/metabolismo , Masculino
13.
Bioconjug Chem ; 29(11): 3776-3782, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-30354077

RESUMO

The preclinical potential of many diagnostic and therapeutic small molecules is limited by their rapid washout kinetics and consequently modest pharmacological performances. In several cases, these could be improved by loading the small molecules into nanoparticulates, improving blood half-life, in vivo uptake and overall pharmacodynamics. In this study, we report a nanoemulsion (NE) encapsulated form of PARPi-FL. As a proof of concept, we used PARPi-FL, which is a fluorescently labeled sensor for olaparib, a FDA-approved small molecule inhibitor of the nuclear enzyme poly(ADP-ribose)polymerase 1 (PARP1). Encapsulated PARPi-FL showed increased blood half-life, and delineated subcutaneous xenografts of small cell lung cancer (SCLC), a fast-progressing disease where efficient treatment options remain an unmet clinical need. Our study demonstrates an effective method for expanding the circulation time of a fluorescent PARP inhibitor, highlighting the pharmacokinetic benefits of nanoemulsions as nanocarriers and confirming the value of PARPi-FL as an imaging agent targeting PARP1 in small cell lung cancer.


Assuntos
Antineoplásicos/administração & dosagem , Corantes Fluorescentes/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Ftalazinas/administração & dosagem , Piperazinas/administração & dosagem , Poli(ADP-Ribose) Polimerase-1/antagonistas & inibidores , Inibidores de Poli(ADP-Ribose) Polimerases/administração & dosagem , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Animais , Antineoplásicos/farmacocinética , Antineoplásicos/uso terapêutico , Linhagem Celular Tumoral , Modelos Animais de Doenças , Emulsões/química , Feminino , Corantes Fluorescentes/farmacocinética , Corantes Fluorescentes/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Camundongos , Camundongos Nus , Nanoestruturas/química , Veículos Farmacêuticos/química , Ftalazinas/farmacocinética , Ftalazinas/uso terapêutico , Piperazinas/farmacocinética , Piperazinas/uso terapêutico , Inibidores de Poli(ADP-Ribose) Polimerases/farmacocinética , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Carcinoma de Pequenas Células do Pulmão/patologia
14.
Phys Rev Lett ; 121(17): 173002, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30411911

RESUMO

We establish that matter-wave diffraction at near-resonant ultraviolet optical gratings can be used to spatially separate individual conformers of complex molecules. Our calculations show that the conformational purity of the prepared beam can be close to 100% and that all molecules remain in their electronic ground state. The proposed technique is independent of the dipole moment and the spin of the molecule and thus paves the way for structure-sensitive experiments with hydrocarbons and biomolecules, such as neurotransmitters and hormones, which have evaded conformer-pure isolation so far.

15.
Prev Med ; 109: 62-70, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29330030

RESUMO

We conducted a health impact assessment (HIA) of cycling network expansions in seven European cities. We modeled the association between cycling network length and cycling mode share and estimated health impacts of the expansion of cycling networks. First, we performed a non-linear least square regression to assess the relationship between cycling network length and cycling mode share for 167 European cities. Second, we conducted a quantitative HIA for the seven cities of different scenarios (S) assessing how an expansion of the cycling network [i.e. 10% (S1); 50% (S2); 100% (S3), and all-streets (S4)] would lead to an increase in cycling mode share and estimated mortality impacts thereof. We quantified mortality impacts for changes in physical activity, air pollution and traffic incidents. Third, we conducted a cost-benefit analysis. The cycling network length was associated with a cycling mode share of up to 24.7% in European cities. The all-streets scenario (S4) produced greatest benefits through increases in cycling for London with 1,210 premature deaths (95% CI: 447-1,972) avoidable annually, followed by Rome (433; 95% CI: 170-695), Barcelona (248; 95% CI: 86-410), Vienna (146; 95% CI: 40-252), Zurich (58; 95% CI: 16-100) and Antwerp (7; 95% CI: 3-11). The largest cost-benefit ratios were found for the 10% increase in cycling networks (S1). If all 167 European cities achieved a cycling mode share of 24.7% over 10,000 premature deaths could be avoided annually. In European cities, expansions of cycling networks were associated with increases in cycling and estimated to provide health and economic benefits.


Assuntos
Ciclismo/estatística & dados numéricos , Exercício Físico/fisiologia , Avaliação do Impacto na Saúde , Meios de Transporte , Acidentes de Trânsito , Poluição do Ar , Cidades , Análise Custo-Benefício , Europa (Continente) , Humanos , Mortalidade Prematura , Material Particulado/análise
16.
Int J Geriatr Psychiatry ; 33(3): 475-481, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28833581

RESUMO

OBJECTIVE: Integrated community mental health teams (CMHTs) are a key component of specialist old age psychiatry services internationally. However, in England, significant shifts in policy, including a focus on dementia and age inclusive services, have influenced provision. This study portrays teams in 2009 against which subsequent service provision may be compared. METHODS: A bespoke national postal survey of CMHT managers collected data on teams' structure, composition, organisation, working practices, case management, and liaison activities. RESULTS: A total of 376 CMHTs (88%) responded. Teams comprised a widespread of disciplines. However, just 28% contained the full complement of professionals recommended by government policy. Over 93% of teams had a single point of access, but some GPs bypassed this, and 40% of teams did not accept direct referrals from care homes. Initial assessments were undertaken by multiple disciplines, and 71% of teams used common assessment documentation. Nevertheless, many social workers maintained both NHS and local authority records. In 92% of teams, nominated care coordinators oversaw the support provided by other team members. However, inter-agency care coordination was less prevalent. Few teams offered the range of outreach/liaison activities anticipated in the national dementia strategy. CONCLUSIONS: Compared with previous studies, teams had grown and changed, with a clear increase in non-medical practitioners, particularly support workers. Measures to facilitate integrated care within CMHTs (eg, common access and documentation) were widespread, but integration across health and social care/primary and secondary services was less developed. Consideration of barriers to further integration, and the impact of current reforms is potentially fruitful.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Idoso , Inglaterra , Humanos , Encaminhamento e Consulta/organização & administração
17.
Int J Geriatr Psychiatry ; 32(9): 1027-1036, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-27515770

RESUMO

OBJECTIVES: The study sought to identify the variables associated with increased length of stay on old age psychiatry inpatient wards. It also explored the factors related to delayed discharge and the likelihood of patients admitted from home returning there. METHODS: Data were collected on the sociodemographic, clinical and service receipt characteristics of a 6-month series of admissions to seven wards in England in 2010/2011. The cohort was followed for a 9- to 11-month period. The relationship between patients' status on admission and the specified outcome variables was explored. RESULTS: Information was collected on 216 admissions, of whom 165 were discharged in the study period. Mean length of stay was 64 days. Female gender, higher dependency, greater challenging behaviour and locality predicted extended stay. Forty per cent of cases experienced delayed discharge. Better physical health, more cognitive impairment, receipt of social care and locality were associated with delayed discharge. The vast majority of patients admitted from home returned there. Younger patients and patients with less dependency, cognitive impairment and challenging behaviour had a higher likelihood of returning home. Patients receiving social care or admitted because of carer stress, a risk of self-neglect, accidental self-harm or abuse/exploitation were less likely to return home. CONCLUSIONS: The study provides a useful starting point for identifying cases on which future efforts to improve inpatient outcomes might centre and suggests local rather than national responses may be needed. It also highlights an urgent need for a national focus on the scope, purpose and effectiveness of acute inpatient care. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Idoso , Estudos de Coortes , Inglaterra , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
J Phys Chem A ; 121(8): 1597-1606, 2017 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-28140598

RESUMO

The lowest two electronically excited singlet states of indole and its derivatives are labeled as La or Lb, based on the orientation of the transition dipole moment (TDM) and the magnitude of the permanent electric dipole moment. Rotationally resolved electronic Stark spectroscopy in combination with high level ab initio calculations offers the possibility to determine these characteristics and thus the electronic nature of the excited states. In the present contribution this approach was pursued for the systems 4- and 6-fluoroindole and the results compared to the previously investigated system 5-fluoroindole. Changing the position of the fluorine atom from 5 to 4 or 6 is accompanied by an increasing amount of La character in the S1 state. This dramatically influences the orientation of the TDM and erases its ability to be a reasonable identifier of the nature of the excited states for both molecules. However, for 4-fluoroindole, where the influence of the La is weak, the nature of the S1 state can still be assigned to be mainly Lb based on the excited state dipole moment. For 6-fluoroindole, this is not the case anymore, and the La/Lb nomenclature completely breaks down due to heavily mixed excited states.

19.
Bioconjug Chem ; 27(8): 1789-95, 2016 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-27356886

RESUMO

In recent years, both site-specific bioconjugation techniques and bioorthogonal pretargeting strategies have emerged as exciting technologies with the potential to improve the safety and efficacy of antibody-based nuclear imaging. In the work at hand, we have combined these two approaches to create a pretargeted PET imaging strategy based on the rapid and bioorthogonal inverse electron demand Diels-Alder reaction between a (64)Cu-labeled tetrazine radioligand ((64)Cu-Tz-SarAr) and a site-specifically modified huA33-trans-cyclooctene immunoconjugate ((ss)huA33-PEG12-TCO). A bioconjugation strategy that harnesses enzymatic transformations and strain-promoted azide-alkyne click chemistry was used to site-specifically append PEGylated TCO moieties to the heavy chain glycans of the colorectal cancer-targeting huA33 antibody. Preclinical in vivo validation studies were performed in athymic nude mice bearing A33 antigen-expressing SW1222 human colorectal carcinoma xenografts. To this end, mice were administered (ss)huA33-PEG12-TCO via tail vein injection and-following accumulation intervals of 24 or 48 h-(64)Cu-Tz-SarAr. PET imaging and biodistribution studies reveal that this strategy clearly delineates tumor tissue as early as 1 h post-injection (6.7 ± 1.7%ID/g at 1 h p.i.), producing images with excellent contrast and high tumor-to-background activity concentration ratios (tumor:muscle = 21.5 ± 5.6 at 24 h p.i.). Furthermore, dosimetric calculations illustrate that this pretargeting approach produces only a fraction of the overall effective dose (0.0214 mSv/MBq; 0.079 rem/mCi) of directly labeled radioimmunoconjugates. Ultimately, this method effectively facilitates the high contrast pretargeted PET imaging of colorectal carcinoma using a site-specifically modified immunoconjugate.


Assuntos
Imunoconjugados/química , Tomografia por Emissão de Pósitrons/métodos , Alcinos/química , Animais , Azidas/química , Sítios de Ligação , Linhagem Celular Tumoral , Transformação Celular Neoplásica , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Radioisótopos de Cobre , Humanos , Imunoconjugados/metabolismo , Imunoconjugados/farmacocinética , Marcação por Isótopo , Camundongos , Distribuição Tecidual
20.
Chemphyschem ; 17(17): 2736-43, 2016 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-27247250

RESUMO

The estimate of the magnitude and the orientation of molecular electric dipole moments from the vector sum of bond or fragment dipole moments is a widely used approach in chemistry. However, the limitations of this intuitive model have rarely been tested experimentally, particularly for electronically excited states. Herein, we find rules for a number of indole derivatives by using rotationally resolved electronic Stark spectroscopy and ab initio calculations. Based on a natural-bond-orbital analysis, we discuss whether the vector additivity rule can be applied in a given electronic state. From a comparison of the experimental data with ab initio calculations, we deduced that the additivity model does not apply when the flow of electron density from the substituent is opposed to that inside the chromophore.

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