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1.
Mol Ecol ; 32(9): 2174-2185, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36756702

RESUMO

The genetic consequences of the subdivision of populations are regarded as significant to long-term evolution, and research has shown that the scale and speed at which this is now occurring is critically reducing the adaptive potential of most species which inhabit human-impacted landscapes. Here, we provide a rare and, to our knowledge, the first analysis of this process while it is happening and demonstrate a method of evaluating the effect of mitigation measures such as fauna crossings. We did this by using an extensive genetic data set collected from a koala population which was intensely monitored during the construction of linear transport infrastructure which resulted in the subdivision of their population. First, we found that both allelic richness and effective population size decreased through the process of population subdivision. Second, we predicted the extent to which genetic drift could impact genetic diversity over time and showed that after only 10 generations the resulting two subdivided populations could experience between 12% and 69% loss in genetic diversity. Lastly, using forward simulations we estimated that a minimum of eight koalas would need to disperse from each side of the subdivision per generation to maintain genetic connectivity close to zero but that 16 koalas would ensure that both genetic connectivity and diversity remained unchanged. These results have important consequences for the genetic management of species in human-impacted landscapes by showing which genetic metrics are best to identify immediate loss in genetic diversity and how to evaluate the effectiveness of any mitigation measures.


Assuntos
Variação Genética , Phascolarctidae , Animais , Humanos , Phascolarctidae/genética , Ecossistema , Conservação dos Recursos Naturais/métodos , Deriva Genética , Genética Populacional
2.
J Radiol Prot ; 42(3)2022 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-35947972

RESUMO

The current status and issues regarding positron dosimetry in nuclear medicine are summarized. The suitability of the United Kingdom Health Security Agency extremity and eye beta-gamma personal thermoluminescence dosemeters are then considered. Monte Carlo modelling is performed to determine their responses and derive sets of calibration factors, along withHp(0.07) andHp(3) conversion coefficients, for carbon-11, nitrogen-13, oxygen-15, fluorine-18 and gallium-68 sources, which are commonly used in positron emission tomography (PET) computed tomography; data for these isotopes is assumed extrapolatable to other positron sources. It is found that the dosemeters are adequate for assessing exposures to PET radionuclides, even if their routine calibrations to caesium-137 were maintained. An idealized set of measurements representing gallium-68 exposure scenarios is then described, including reproducible mock-ups of individuals manipulating vials and syringes. Finally, a short case-study is presented that explores occupational doses during routine clinical use of gallium-68. The extremity dosemeter results demonstrated significant variations dependent upon the exposure conditions, with some seen to be comparatively large; whole-body and eye dose rates per activity were found to be lower. The importance of routine dose monitoring of workers is emphasized, with the need for a longer-termed follow-up study demonstrated.


Assuntos
Elétrons , Exposição Ocupacional , Seguimentos , Radioisótopos de Gálio , Humanos , Exposição Ocupacional/análise , Doses de Radiação
3.
J Radiol Prot ; 42(4)2022 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-36130583

RESUMO

Individual monitoring of radiation workers is essential to ensure compliance with legal dose limits and to ensure that doses are As Low As Reasonably Achievable. However, large uncertainties still exist in personal dosimetry and there are issues with compliance and incorrect wearing of dosimeters. The objective of the PODIUM (Personal Online Dosimetry Using Computational Methods) project was to improve personal dosimetry by an innovative approach: the development of an online dosimetry application based on computer simulations without the use of physical dosimeters. Occupational doses were calculated based on the use of camera tracking devices, flexible individualised phantoms and data from the radiation source. When combined with fast Monte Carlo simulation codes, the aim was to perform personal dosimetry in real-time. A key component of the PODIUM project was to assess and validate the methodology in interventional radiology workplaces where improvements in dosimetry are needed. This paper describes the feasibility of implementing the PODIUM approach in a clinical setting. Validation was carried out using dosimeters worn by Vascular Surgeons and Interventional Cardiologists during patient procedures at a hospital in Ireland. Our preliminary results from this feasibility study show acceptable differences of the order of 40% between calculated and measured staff doses, in terms of the personal dose equivalent quantity Hp(10), however there is a greater deviation for more complex cases and improvements are needed. The challenges of using the system in busy interventional rooms have informed the future needs and applicability of PODIUM. The availability of an online personal dosimetry application has the potential to overcome problems that arise from the use of current dosimeters. In addition, it should increase awareness of radiation protection among staff. Some limitations remain and a second phase of development would be required to bring the PODIUM method into operation in a hospital setting. However, an early prototype system has been tested in a clinical setting and the results from this two-year proof-of-concept PODIUM project are very promising for future development.


Assuntos
Cardiologia , Exposição Ocupacional , Estudos de Viabilidade , Humanos , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Radiologia Intervencionista , Radiometria/métodos
4.
Public Health ; 186: 44-51, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32768623

RESUMO

BACKGROUND: Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS: The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS: Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION: Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.


Assuntos
Comportamento Autodestrutivo/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Censos , Criança , Bases de Dados Factuais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
5.
Public Health ; 170: 78-88, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30978579

RESUMO

OBJECTIVES: Comprehensive and up-to-date data on fatal injury trends are critical to identify challenges and plan priority setting. This study provides a comprehensive assessment of poisoning mortality trends across Iran. STUDY DESIGN: The data were gathered from various resources, including death registration systems, cemetery databases of Tehran and Esfahan, the Demographic and Health Survey of 2000, and three rounds of national population and housing censuses. METHODS: After addressing incompleteness for child and adult death data separately and using a spatio-temporal model and Gaussian process regression, the level and trend of child and adult mortality were estimated. For estimating cause-specific mortality, the cause fraction was calculated and applied to the level and trend of death. RESULTS: From 1990 to 2015, 40,586 deaths due to poisoning were estimated across the country. The poisoning-related age-standardized death rate per 100,000 was estimated to have changed from 3.08 (95% uncertainty interval [UI]: 2.32-4.11) in 1990 to 0.96 (95% UI: 0.73-1.25) in 2015, and the male/female ratio was 1.35 during 25 years of study with an annual percentage change of -5.4% and -4.0% for women and men, respectively. The annual mortality rate was higher among children younger than 5 years and the elderly population (≥70 years) in the study period. CONCLUSIONS: This study showed that mortality from poisoning declined in Iran over the period from 1990 to 2015 and varied by province. Understanding the reasons for the differences of poisoning mortality by province will help in developing and implementing measures to reduce this burden in Iran.


Assuntos
Intoxicação/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Adulto Jovem
6.
Int J Radiat Biol ; : 1-11, 2023 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-37947483

RESUMO

PURPOSE: Over the last decade or so, ethical and societal aspects of radiological protection have received increasing attention. This is also reflected in the publications of the International Commission on Radiological Protection (ICRP). The current paper aims at identifying relevant ethical and societal topics which should receive attention in the context of radiological protection for offspring and next generations. MATERIALS AND METHODS: We present a non-comprehensive review of the subject, based on presentation made at an ICRP workshop in Budapest in 2022. We first discuss the ethical values promoted by ICRP, and the application of these values in cases of (potential) pre-conceptual and prenatal radiation exposures. We then consider experience gained after the Fukushima accident indicating particular societal concerns about the health effects of such exposures. RESULTS AND CONCLUSIONS: Beneficence/non-maleficence, prudence, justice and dignity, the "core values" of the system of radiological protection have special roles to play when heritable and/or in utero effects are to be considered. Prudence, in particular, must be taken account of in view of the fact that solid scientific data in humans are largely lacking in this area, and it is necessary to rely on insights from animal experiments as well as theoretical considerations. As regards societal considerations, the perception of risk among (potentially) affected populations needs to be taken seriously. Accountability, transparency, and inclusivity, the "procedural values" promoted by ICRP for the practical implementation of the system of radiological protection play a central role in overcoming skepticism and creating trust. Stakeholder involvement should emphasize cooperation and dialogue, which allows for the joint evaluation of an exposure situation by experts and affected people.

7.
Injury ; 54(1): 145-149, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35948513

RESUMO

PURPOSE: Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking. MATERIALS AND METHODS: We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes. RESULTS: Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH. CONCLUSION: This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds.


Assuntos
Fraturas Ósseas , Hipotensão , Choque Hemorrágico , Humanos , Choque Hemorrágico/terapia , Choque Hemorrágico/complicações , Estudos Retrospectivos , Centros de Traumatologia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Artérias/lesões , Fraturas Ósseas/terapia , Espaço Retroperitoneal , Hipotensão/complicações
8.
Eur J Vasc Endovasc Surg ; 43(5): 534-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22342015

RESUMO

The study assessed radiation exposure during EVAR. Two types of patient dose were estimated: effective dose (ED), which allows estimation of radiation risk to the EVAR patient population; and Peak Skin Dose (PSD), which allows us assess the potential for an individual patient to receive a radiation skin injury. An ancillary aim was to examine dose optimization in EVAR procedures. Based on 111 EVAR cases we estimated average ED as 12.4 mSv. Cumulative patient dose in our centre was lower than other studies because the follow up of EVAR patients is based on ultrasound rather than CT. PSD calculated using a published conversion formula closely matched measurements with calibrated gafchromic film. 99% of patients had an estimated PSD of < 2Gy. Results indicate that skin injuries are possible, but very unlikely in EVAR procedures at our centre. EVAR is a high dose procedure and emphasis on dose optimisation is important. We broke the EVAR procedure into 15 steps and, in a phantom study, showed how skin dose changes as procedure steps are varied. The resulting dose matrix has the potential to be used as an educational tool to promote dose optimization.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares , Fluoroscopia , Doses de Radiação , Prótese Vascular , Implante de Prótese Vascular , Humanos , Estudos Retrospectivos
9.
Injury ; 50(10): 1599-1604, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31040028

RESUMO

BACKGROUND: Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI) program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. METHODS: This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO) TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. RESULTS: There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007) and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4-9.4, p = 0.004) and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001) and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001). CONCLUSION: This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.


Assuntos
Fidelidade a Diretrizes , Melhoria de Qualidade/normas , Centros de Traumatologia , Ferimentos e Lesões/terapia , Lista de Checagem , Congressos como Assunto , Medicina Baseada em Evidências , Humanos , Índia/epidemiologia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Ferimentos e Lesões/epidemiologia
10.
Br J Neurosurg ; 22(4): 542-5, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18661421

RESUMO

Plate cage Benezech (PCB) is a titanium-made implant introduced recently in spinal surgery as a new substitute for autograft in cervical spine interbody fusion. It has a plate attached to the anterior surface of the cage to prevent any displacement of the cage, and to provide additional support in patients with dynamic instability. A small number of studies have shown the PCB cage is safe and efficient. We conducted a retrospective study on 54 consecutive patients with cervical spondylosis who underwent anterior cervical discectomy and interbody fusion (ACDF) with a PCB cage between the year 2001 and 2005 with a mean follow up of 24 months (9-62 months). The mean age was 51 years, 27 patients presented with radiculopathy, 15 patients with myelopathy, and eight patients with both. Clinical and functional outcomes were assessed by using Prolo scale, Japanese orthopaedic association (JOA) score, and Visual analogue scale (VAS). Prolo results were documented good to excellent in 43 (86%) of cases and poor in 7 (14%) of cases. Mean preoperative Prolo scale of 4.7 (SD 1.63) improved postoperatively to 8.22 (SD 2.12.) The average preoperative JOA score was 11.7 (SD 2.51) compared with 15.42 (SD 2.20) postoperatively with a mean recovery rate of 76.3%. VAS score improved from 6.65 (SD 1.77) to 1.76 (SD 2.40). All the results were statistically significant (p-value <0.0001).This study suggests that Plate cage Benezech implant is a safe and effective device for anterior cervical discectomy and interbody fusion.


Assuntos
Placas Ósseas , Transplante Ósseo/efeitos adversos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/fisiopatologia , Discotomia/reabilitação , Feminino , Humanos , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Doenças da Medula Espinal/reabilitação , Fusão Vertebral/reabilitação , Titânio , Resultado do Tratamento
11.
Radiat Prot Dosimetry ; 129(1-3): 211-3, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18397931

RESUMO

The use of dual-energy X-ray absorptiometry (DXA) scanners for measuring bone mineral density (BMD) is on the increase. A single DXA scan is a relatively low-dose diagnostic X-ray examination; however, radiation protection (RP) issues should not be trivialised. One objective of the EU 6th Framework SENTINEL co-ordination action was to develop training syllabi in RP and quality assurance (QA) for BMD, and this study presents the results. An EU-wide survey was carried out which confirmed that there was a need for an accredited DXA RP training course in many EU states. There is also limited published guidance on acceptance testing/QA for DXA. Two training syllabi were developed: one on RP and one on QA of DXA systems. A training course was delivered in Ireland in 2006 by the Medical Physics & Bioengineering Department of St James's Hospital, Dublin. Following the training course, a PC-based training CD was developed and will be made available. A harmonised approach to training will promote consistent approaches to radiation safety across the EU.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Desenvolvimento de Programas , Garantia da Qualidade dos Cuidados de Saúde , Proteção Radiológica/legislação & jurisprudência , Proteção Radiológica/métodos , Radiologia/educação , Absorciometria de Fóton/normas , Coleta de Dados , Humanos , Disseminação de Informação
12.
Ir J Psychol Med ; 35(1): 11-21, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-30115201

RESUMO

OBJECTIVES: Research regarding adolescent internet use and mental health is sparse. However, awareness of a young person's internet use is becoming increasingly recognised as an important element of clinical assessment and intervention, and requires the development of an evidence base. The aim of the present study was to better understand the internet use of young people experiencing mental health difficulties and to contrast it with those who currently report no concerns. METHOD: In total, 299 young people aged 12-19 years, across a continuum of mental health difficulties, completed an online survey measuring internet use and related experiences. Young people were assigned to four groups: (a) attending inpatient services; (b) attending outpatient services; (c) a community group with mental health concerns and no clinical support; and (d) a regular community group. RESULTS: Those in the inpatient and outpatient groups visited more potentially harmful websites. Young people attending inpatient and outpatient services showed aspects of both more risky and less risky use. The community group reporting no mental health difficulties showed least risky use. The group experiencing difficulties but not receiving support showed consistently high risky use, suggesting this is a particularly vulnerable group. CONCLUSIONS: Despite methodological limitations, findings suggest that those with mental health difficulties may experience more of the risks and fewer of the benefits offered by the internet. Though further research is needed to clarify these findings, clinicians should consider routine assessment of Internet use when planning interventions for young people experiencing mental health difficulties.


Assuntos
Comportamento do Adolescente/psicologia , Internet , Transtornos Mentais/psicologia , Assunção de Riscos , Adolescente , Serviços Comunitários de Saúde Mental , Feminino , Humanos , Pacientes Internados , Irlanda , Masculino , Transtornos Mentais/terapia , Pacientes Ambulatoriais , Unidade Hospitalar de Psiquiatria , Inquéritos e Questionários
13.
Eur J Trauma Emerg Surg ; 42(6): 671-675, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26626871

RESUMO

INTRODUCTION: The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies. METHODS: This was a retrospective cohort study involving all patients with PAI that presented to a major trauma centre from January 2007 to December 2011. Data were extracted from the trauma registry and patients' electronic medical records. RESULTS: There were 189 patients included in the study, of which 79 (41.8 %) patients complied with the algorithm. The laparotomy rate in the setting of algorithm compliance was significantly lower than algorithm non-compliance (12.7 vs. 68.2 %; p < 0.01) as were unnecessary laparotomy rates (0 vs. 33.3 %; p = 0.03). CONCLUSION: Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.


Assuntos
Traumatismos Abdominais/terapia , Fidelidade a Diretrizes , Ferimentos Perfurantes/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Sistema de Registros , Estudos Retrospectivos , Centros de Traumatologia , Procedimentos Desnecessários/estatística & dados numéricos , Vitória
14.
Radiat Prot Dosimetry ; 117(1-3): 288-90, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16461504

RESUMO

This study reports on the development and evaluation of a protocol for testing DEXA systems, which can be incorporated into a routine medical physics/engineering service. Methodologies are reported for (1) scatter measurement, (2) estimation of reference dose and (3) enquiry into potential sources of overexposure. Results show that fan-beam and cone-beam systems require shielding if the walls or operator are within 1 m of the table. Patient reference dose was estimated using the dose-area product (DAP). This varied over an order of magnitude from 2 to 36 mGy cm2 in the range of systems studied. The inquiry into potential sources of overexposure revealed some weaknesses in current practise including a design which prevents the inclusion of DAP metres; beam non-uniformity; incorrect specification of patient dose and the risk of overexposure when tube operates during patient positioning.


Assuntos
Absorciometria de Fóton/instrumentação , Absorciometria de Fóton/métodos , Radiometria/instrumentação , Radiometria/métodos , Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Densitometria , Relação Dose-Resposta à Radiação , Humanos , Controle de Qualidade , Doses de Radiação , Proteção Radiológica/métodos , Padrões de Referência , Espalhamento de Radiação
15.
Ir J Psychol Med ; 32(3): 247-258, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30185264

RESUMO

OBJECTIVES: The aim of the current study was to gain insight into the process of initiation and progression to problematic use among young people who reach clinically significant levels of substance use requiring treatment. METHOD: Twenty young people, aged between 15 and 19 years from two different drug treatment centres in Ireland were interviewed regarding their views on their pathway into substance use, their progress to more problematic use, their perception of their parents' role, if any, in their trajectory and their typical coping style before treatment. Content analysis was conducted on the resulting narratives. RESULTS: The use of substances to cope with life stressors emerged as a prominent theme at initial and problematic stages of use. Multiple maladaptive coping approaches were reported. Both direct and indirect influences from parents in their substance use problem were cited. However, some participants reported that parents had no causal role in their substance use trajectory, in particular regarding mothers. CONCLUSIONS: The current findings suggest that substance misuse is a multi-determined problem and a number of intervention strategies are suggested to delay onset and related harms associated with adolescent substance use.

16.
Curr Obes Rep ; 4(4): 510-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26364308

RESUMO

New and emerging mobile technologies are providing unprecedented possibilities for understanding and intervening on obesity-related behaviors in real time. However, the mobile health (mHealth) field has yet to catch up with the fast-paced development of technology. Current mHealth efforts in weight management still tend to focus mainly on short message systems (SMS) interventions, rather than taking advantage of real-time sensing to develop just-in-time adaptive interventions (JITAIs). This paper will give an overview of the current technology landscape for sensing and intervening on three behaviors that are central to weight management: diet, physical activity, and sleep. Then five studies that really dig into the possibilities that these new technologies afford will be showcased. We conclude with a discussion of hurdles that mHealth obesity research has yet to overcome and a future-facing discussion.


Assuntos
Dieta , Promoção da Saúde/organização & administração , Obesidade/prevenção & controle , Comportamento de Redução do Risco , Telemedicina , Telefone Celular , Difusão de Inovações , Humanos , Obesidade/terapia , Envio de Mensagens de Texto
17.
Injury ; 46(1): 42-4, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24680471

RESUMO

BACKGROUND: Intercostal catheter (ICC) insertion is the standard pleural decompression and drainage technique for blunt and penetrating traumatic injury. Potentially high complication rates are associated with the procedure, with the literature quoting over 20% in some cases (1-4). Empyema in particular is a serious complication. Risk adverse industries such as the airline industry and military services regularly employ checklists to standardise performance and decrease human errors. The use of checklists in medical practice is exemplified by introduction of the WHO Surgical Safety checklist. METHODS: The Alfred Hospital in Melbourne, Australia is an Adult Level 1 Trauma Centre. In August 2009 The Alfred Trauma Service introduced an evidence-based checklist system for the insertion of ICCs, combined with standardised formal training for resident medical staff, in an attempt to minimise the incidence of ICC related empyema. RESULTS: Between January 2003 and July 2009 the incidence of empyema was 1.44% (29 in 2009 insertions). This decreased to 0.57% between August 2009 and December 2011 (6 in 1060 insertions) when the measures described above were introduced [p=0.038 Fisher's exact test, 2-tailed]. CONCLUSION: Quality control checklists - such as the ICC checklist described - are a sensible and functional means to standardise practice, to decrease procedural error and to reduce complication rates during trauma resuscitation.


Assuntos
Cateterismo/métodos , Descompressão Cirúrgica/métodos , Traumatismos Torácicos/terapia , Toracostomia/métodos , Adulto , Austrália/epidemiologia , Lista de Checagem , Tubos Torácicos , Feminino , Humanos , Masculino , Segurança do Paciente , Guias de Prática Clínica como Assunto , Ressuscitação , Estudos Retrospectivos , Centros de Traumatologia
18.
Br J Radiol ; 88(1049): 20140627, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25761211

RESUMO

OBJECTIVE: In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators. METHODS: Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3). RESULTS: Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis. CONCLUSION: Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit. ADVANCES IN KNOWLEDGE: We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.


Assuntos
Dispositivos de Proteção dos Olhos , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas , Doses de Radiação , Radiologia Intervencionista , Fluoroscopia , Humanos , Irlanda , Radiometria , Carga de Trabalho
19.
J Clin Endocrinol Metab ; 75(6): 1545-9, 1992 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-1464662

RESUMO

The aim of the present study was to determine whether mRNA for the three endothelin peptides (endothelin-1, endothelin-2, and endothelin-3) and the two known receptor subtypes (ETA and ETB) was present in human endometrium at different stages of the menstrual cycle (menstrual, early and mid-proliferative, and early, mid-, and late secretory). Endometrium was obtained from women undergoing surgery for benign disease, and total RNA was extracted using a guanidinium isothiocyanate method. mRNA for endothelin peptide and receptor was detected using the reverse transcriptase-polymerase chain reaction with nested oligonucleotide primers. mRNA for endothelin-1, endothelin-2, and endothelin-3 was demonstrated throughout the menstrual cycle, and three splice variants of mRNA encoding endothelin-3 were found in all samples. The ratio of ETA to ETB receptor mRNA was found to change throughout the menstrual cycle. In the proliferative phase, amplified cDNA product was almost exclusively confined to the ETA receptor, whereas an increase in the amplified product of the ETB receptor cDNA was seen in the secretory and menstrual phases. These studies show that mRNA for endothelin-1, endothelin-2, and endothelin-3 is present in human endometrium at all stages of the menstrual cycle and suggest that different physiological actions of the endothelin peptides may be mediated through changes in the ratio of the ETA and ETB receptor subtypes.


Assuntos
Endométrio/metabolismo , Endotelinas/genética , Ciclo Menstrual/metabolismo , RNA Mensageiro/metabolismo , Receptores de Endotelina/metabolismo , Sequência de Bases , DNA/genética , Feminino , Humanos , Dados de Sequência Molecular , Sondas de Oligonucleotídeos/genética , Reação em Cadeia da Polimerase , Receptores de Endotelina/genética
20.
FEBS Lett ; 321(1): 69-72, 1993 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-8467913

RESUMO

Fragmentation of the actin binding glycolytic enzyme, aldolase, with cyanogen bromide yields an 18K actin binding fragment which corresponds to residues 1-164 of the aldolase sequence. Within this fragment there is a region of sequence (residues 32-52) which is highly homologous to a region of sequence near the C-terminus of actin itself and which is also found in the actin binding domains of a number of other actin binding proteins. A synthetic peptide corresponding to the aldolase sequence 32-52 encompassing this region of homology binds to F-actin and specifically competes with native aldolase for binding to this cytoskeletal protein.


Assuntos
Actinas/metabolismo , Frutose-Bifosfato Aldolase/metabolismo , Proteínas dos Microfilamentos/metabolismo , Sequência de Aminoácidos , Animais , Sítios de Ligação , Ligação Competitiva , Frutose-Bifosfato Aldolase/química , Proteínas dos Microfilamentos/química , Dados de Sequência Molecular , Fragmentos de Peptídeos/metabolismo , Coelhos
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