Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 73
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
J Org Chem ; 86(3): 2184-2199, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33449680

RESUMO

Pathogen-associated molecular patterns activate the immune system via pattern recognition receptors. Recently, newly discovered pathogen-associated molecular patterns, d-glycero-ß-d-mannoheptose phosphate and d-glycero-ß-d-mannoheptose 1,7-biphosphate, were shown to induce a TRAF-interacting protein with a forkhead-associated domain-dependent immune response in human embryonic kidney cells and colonic epithelial cells. Concurrently, ADP-heptose was shown to bind α-kinase 1 and activate TIFA via phosphorylation leading to an immune cascade to ultimately activate NF-κB. These pathogen-associated molecular patterns have raised interest in the pharmaceutical industry for their potential use as immunomodulators. However, little is understood about the host cell uptake of d-glycero-ß-d-mannoheptose phosphate, d-glycero-ß-d-mannoheptose 1,7-biphosphate, and ADP-heptose in vivo and derivatives of these molecules are needed to interrogate this. In this regard, herein we describe 7-O-modifications of d-glycero-ß-d-mannoheptose phosphate to produce molecular probes toward the development of a useful toolbox for biologists. A convergent strategy that involves introduction of a substituent at O-7 before alkene oxidation was investigated and proved successful in the generation of a range of molecular probes.


Assuntos
Heptoses , Fosfatos , Humanos , Fatores Imunológicos , Fosforilação
2.
J Liposome Res ; 31(3): 237-245, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32583693

RESUMO

Archaeosomes, composed of sulphated lactosyl archaeol (SLA) glycolipids, have been proven to be an effective vaccine adjuvant in multiple preclinical models of infectious disease or cancer. In addition to efficacy, the stability of vaccine components including the adjuvant is an important parameter to consider when developing novel vaccine formulations. To properly evaluate the potential of SLA glycolipids to be used as vaccine adjuvants in a clinical setting, a comprehensive evaluation of their stability is required. Herein, we evaluated the long term stability of preformed empty SLA archaeosomes prior to admixing with antigen at 4 °C or 37 °C for up to 6 months. In addition, the stability of adjuvant and antigen was evaluated for up to 1 month following admixing. Multiple analytical parameters evaluating the molecular integrity of SLA and the liposomal profile were assessed. Following incubation at 4 °C or 37 °C, the SLA glycolipid did not show any pattern of degradation as determined by mass spectroscopy, nuclear magnetic resonance (NMR) and thin layer chromatography (TLC). In addition, SLA archaeosome vesicle characteristics, such as size, zeta potential, membrane fluidity and vesicular morphology, were largely consistent throughout the course of the study. Importantly, following storage for 6 months at both 4 °C and 37 °C, the adjuvant properties of empty SLA archaeosomes were unchanged, and following admixing with antigen, the immunogenicity of the vaccine formulations was also unchanged when stored at both 4 °C and 37 °C for up to 1 month. Overall this indicates that SLA archaeosomes are highly stable adjuvants that retain their activity over an extended period of time even when stored at high temperatures.


Assuntos
Lipossomos , Vacinas , Antígenos Arqueais , Imunidade Celular , Lipídeos
3.
Ann Vasc Surg ; 58: 317-325, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731229

RESUMO

BACKGROUND: This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs. METHODS: A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required. RESULTS: Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess. CONCLUSIONS: Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica/instrumentação , Artéria Femoral , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler
4.
J Liposome Res ; 28(4): 305-314, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28948854

RESUMO

Archaeosomes composed of archaeal total polar lipids (TPL) or semi-synthetic analog vesicles have been used as vaccine adjuvants and delivery systems in animal models for many years. Typically administered by intramuscular or subcutaneous injections, archaeosomes can induce robust, long-lasting humoral and cell-mediated immune responses against entrapped antigens and provide protection in murine models of infectious disease and cancer. Herein, we evaluated various archaeosomes for transdermal delivery, since this route may help eliminate needle-stick injuries and needle re-use, and therefore increase patient compliance. Archaeosomes composed of TPL from different archaea (Halobacterium salinarum, Methanobrevibacter smithii, Haloferax volcanii) and various semi-synthetic glycolipid combinations were evaluated for their ability to diffuse across the skin barrier using an ex vivo pig skin model and the results were compared to conventional synthetic ester liposomes. Physicochemical characteristics were determined for selected formulations including vesicle size, size distribution, zeta potential, fluidity, antigen (ovalbumin) incorporation efficiency and release. Archaeosomes, in particular those composed of M. smithii TPL or the synthetic glycolipid sulfated S-lactosylarchaeol (SLA) mixed with uncharged glycolipid lactosyl archaeol (LA), appeared to be effective carriers for ovalbumin, achieving much better antigen distribution and vesicle accumulation in the skin epidermis than conventional liposomes. The enhanced skin permeation of archaeosomes may be attributed to their chemical structure and physicochemical properties such as particle size, surface charge, stability, and fluidity of their lipid bilayer.


Assuntos
Portadores de Fármacos , Lipídeos/química , Vacinas , Administração Cutânea , Animais , Archaea , Lipossomos/química , Nanopartículas , Relação Estrutura-Atividade , Suínos , Vacinas/administração & dosagem , Vacinas/química
5.
Adv Exp Med Biol ; 1007: 1-16, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28840549

RESUMO

Genome stability is maintained by a number of elegant mechanisms, which sense and repair damaged DNA. Germline defects that compromise genomic integrity result in cancer predisposition, exemplified by rare syndromes caused by mutations in certain DNA repair genes. These individuals often exhibit other symptoms including progeria and neurodegeneration. Paradoxically, some of these deleterious genetic alterations provide novel therapeutic opportunities to target cancer cells; an excellent example of such an approach being the recent development of poly (ADP-ribose) polymerase inhibitors as the first 'synthetic lethal' medicine for patients with BRCA-mutant cancers. The therapeutic exploitation of synthetic lethal interactions has enabled a novel approach to personalised medicine based on continued molecular profiling of patient and tumour material. This profiling may also aid clinicians in the identification of specific drug resistance mechanisms following relapse, and enable appropriate modification of the therapeutic regimen. This chapter focuses on therapeutic strategies designed to target aspects of the DNA damage response, and examines emerging themes demonstrating mechanistic overlap between DNA repair and neurodegeneration.


Assuntos
Dano ao DNA/efeitos dos fármacos , Reparo do DNA/efeitos dos fármacos , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Medicina de Precisão , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Feminino , Humanos , Masculino , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/genética , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/genética , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/genética
6.
BMC Health Serv Res ; 16: 267, 2016 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-27422660

RESUMO

BACKGROUND: Venous thromboembolism (VTE) prophylaxis in an important aspect of the care of hospitalised patients, for which the National Institute for Health and Care Excellence (NICE) has issued guidance. Guidance compliance continues to be a concern. Junior doctors are the main group responsible for prescribing thromboprophylaxis. We aimed to compare local pharmacological thromboprophylaxis prescribing against NICE guidelines in a surgical department at a district general hospital, and determine whether interventions aimed at improving compliance were effective. METHODS: Over four months, a two cycle audit of prescribing patterns for VTE prophylaxis was performed using data collected at four intervals: 1. Baseline 2. Following pro-forma introduction and feedback 3. A second baseline data collection. 4. Following VTE prophylaxis teaching. RESULTS: A total of 394 admissions were included. Correct identification and prescribing for at-risk patients ranged between 76 and 93 %, whilst risk assessment documentation and explanation to patients occurred in fewer than 50 and 66 % respectively. Prescribing and risk assessment improved in the first cycle (chi2 = 6.75, p = 0.009 and chi2 = 10.70, p = 0.001 respectively), a consequence of one specialty improving following additional feedback. Teaching was not associated with improvements. Overall compliance with NICE guidelines was achieved in no more than 25 % of admissions. CONCLUSIONS: Despite junior doctors generally prescribing VTE thromboprophylaxis appropriately, overall compliance with guidelines remained poor regardless of educational interventions. Verbal feedback was the only intervention associated with modest improvements. A pressurised work environment may limit the impact of educational interventions. Guidance simplification or devolving responsibility to other members of staff may improve compliance.


Assuntos
Anticoagulantes/uso terapêutico , Fidelidade a Diretrizes , Corpo Clínico Hospitalar , Padrões de Prática Médica/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Contraindicações , Revisão de Uso de Medicamentos , Hospitalização , Humanos , Auditoria Médica , Guias de Prática Clínica como Assunto , Medição de Risco , Reino Unido
7.
Ann Vasc Surg ; 28(5): 1139-42, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24184498

RESUMO

INTRODUCTION: Vascular intervention for patients with connective tissue disease (CTD) and symptomatic limbs, particularly with tissue loss, is associated with poor outcomes. The aims of our study were to compare outcomes from arterial interventions for patients with CTD versus overall results for our unit and analyse available baseline patient characteristics to determine whether any features were associated with poor prognosis. METHODS: We retrieved data from a prospectively maintained database of all patients undergoing interventions on the vascular unit since 1984. The database included coding for CTD and tissue loss at presentation. Information was retrieved for each patient with CTD identified for a period of 2 years postoperatively. Additional data were retrieved from patient's notes. RESULTS: CTD was identified in 23 patients, 12 men and 11 women, with a median age of 68 years (range 42-84). The majority of patients suffered from rheumatoid arthritis. Of 13 patients who presented with peripheral arterial disease (PAD) and associated tissue loss, 12 underwent arterial procedures, and 1 had a primary amputation. Of 5 endovascular procedures performed, 4 failed, 2 immediately and 2 subsequently. Seven patients had major amputations at 6 months. At 2 years, 11 of 13 patients (84.6%) had major amputations, and of the remaining 2, 1 had persisting ulceration. In comparison, of the 10 patients presenting with critical limb ischemia without tissue loss, there was 1 amputation, which occurred at 12 months, and 1 patient died, a limb loss/death rate at 24 months of 20%. A backward binary logistic regression analysis showed that neither gender nor age had a significant effect in predicting limb loss, but tissue loss at presentation was associated with a significantly higher rate of amputation. CONCLUSIONS: Patients with CTD and PAD who present with lower limb tissue loss appear to be at greater risk of limb loss after vascular intervention compared with the general vascular population managed by our unit. CTD patients with no tissue loss had outcomes comparable to the general vascular population. We suggest that the management of patients with CTD and PAD presenting with lower limb tissue loss should include focused, aggressive treatment of underlying inflammation and nutrition.


Assuntos
Doenças do Tecido Conjuntivo/complicações , Gerenciamento Clínico , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica , Doenças do Tecido Conjuntivo/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Isquemia/complicações , Isquemia/epidemiologia , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos
8.
Int J Health Care Qual Assur ; 26(1): 6-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23534101

RESUMO

PURPOSE: Clinical data capture and transfer are becoming more important as hospital practices change. Medical record pro-formas are widely used but their efficacy in acute settings is unclear. This paper aims to assess whether pro-forma and aide-memoire recording aids influence data collection in acute medical and surgical admission records completed by junior doctors. DESIGN/METHODOLOGY/APPROACH: During October 2007 to January 2008, 150 medical and 150 surgical admission records were randomly selected. Each was analysed using Royal College of Physicians guidelines. Surgical record deficiencies were highlighted in an aide-memoire printed on all A4 admission sheets. One year later, the exercise was repeated for 199 admissions. FINDINGS: Initial assessment demonstrated similar data capture rates, 77.4 per cent and 75.9 per cent for medicine and surgery respectively (Z = -0.74, p = 0.458). Following the aide-memoire's introduction, surgical information recording improved relatively, 70.5 per cent and 73.9 per cent respectively (Z = 2.01, p = 0.045). One from 11 aide-memoire categories was associated with improvement following clinical training. There was an overall fall in admission record quality during 2008-9 vs 2007-8. RESEARCH LIMITATIONS/IMPLICATIONS: The study compared performance among two groups of doctors working simultaneously in separate wards, representing four months' activity. PRACTICAL IMPLICATIONS: Hospital managers and clinicians should be mindful that innovations successful in elective clinical practice might not be transferable to an acute setting. ORIGINALITY/VALUE: This audit shows that in an acute setting, over one-quarter of clinical admission data were not captured and devices aimed at improving data capture had no demonstrable effect. The authors suggest that in current hospital practice, focussed clinical training is more likely to improve patient admission records than employing recording aids.


Assuntos
Coleta de Dados/métodos , Prontuários Médicos , Admissão do Paciente , Doença Aguda/terapia , Humanos , Anamnese , Sistemas de Identificação de Pacientes , Exame Físico
9.
Ecol Evol ; 13(7): e10245, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37424931

RESUMO

Vegetation loss is a primary cause of habitat degradation and results in a decline in reptile species abundance due to loss of refuge from predators and hot temperatures, and foraging opportunities. Texas horned lizards (Phrynosoma cornutum) have disappeared from many areas in Texas, especially from urbanized areas, probably in large part due to loss of suitable habitat. This species still occurs in some small towns in Texas that still contain suitable habitat. Long-term data from Kenedy and Karnes City, Texas indicate that when study sites experienced significant shrub and vegetation removal horned lizards declined by 79%. We hypothesize the decline was due to the degradation of the thermal landscape for these lizards. We determined the preferred temperature range (T set25 - T set75) of lizards at our study sites and took field measurements of body temperature (T b). Temperature loggers were also placed in three microhabitats across our study sites. Shrubs and vegetation provided the highest quality thermal environment, especially for about 5 h midday when temperatures in the open and buried under the surface in the open exceeded the lizards' critical maximum temperature (CTmax) or were above their preferred temperature range. Horned lizard density was positively related to the thermal quality of the habitat across our sites. Texas horned lizards in these towns require a heterogeneous mix of closely spaced microhabitats and especially thermal refugia, such as shrubs and vegetation along fence lines and in open fields. Maintaining thermal refugia is one of the most important and practical conservation actions that can be taken to help small ectotherms persist in modified human landscapes and cope with increasing temperatures due to climate change.

10.
Perspect Behav Sci ; 46(2): 261-304, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37425985

RESUMO

As a task force appointed by the Executive Council of the Association for Behavior Analysis International (ABAI), we investigated the clinical use of contingent electric skin shock (CESS) in behavior analytic treatments for severe problem behavior. We studied how CESS is used in contemporary behavior analysis, reinforcement-based alternatives to CESS, and current ethical and professional guidelines for applied behavior analysts. We recommended that ABAI uphold clients' right to receive CESS when it is restricted to extreme cases and used under rigorous professional and legal oversight. Our recommendation was rejected by a vote of the full members of ABAI, who instead endorsed an alternative recommendation, developed by members of the Executive Council, that opposed the use of CESS under any condition. Here we present for the record our report and initial recommendations, the formal statement that was rejected by the members of ABAI, and the statement that was endorsed.

11.
Ecol Evol ; 13(4): e9966, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37013102

RESUMO

Interactions between invaders and resource availability may explain variation in their success or management efficacy. For widespread invaders, regional variation in plant response to nutrients can reflect phenotypic plasticity of the invader, genetic structure of invading populations, or a combination of the two. The wetland weed Alternanthera philoxeroides (alligatorweed) is established throughout the southeastern United States and California and has high genetic diversity despite primarily spreading clonally. Despite its history in the United States, the role of genetic variation for invasion and management success is only now being uncovered. To better understand how nutrients and genotype may influence A. philoxeroides invasion, we measured the response of plants from 26 A. philoxeroides populations (three cp haplotypes) to combinations of nitrogen (4 or 200 mg/L N) and phosphorus (0.4 or 40 mg/L P). We measured productivity (biomass accumulation and allocation), plant architecture (stem diameter and thickness, branching intensity), and foliar traits (toughness, dry matter content, percent N, and percent P). A short-term developmental assay was also conducted by feeding a subset of plants from the nutrient experiment to the biological control agent Agasicles hygrophila, to determine whether increased availability of N or P to its host influenced agent performance, as has been previously suggested. Alternanthera philoxeroides haplotype Ap1 was more plastic than other haplotypes in response to nutrient amendments, producing more than double the biomass from low to high N and 50%-68% higher shoot: root ratio than other haplotypes in the high N treatment. Alternanthera philoxeroides haplotypes differed in seven of 10 variables in response to increased N. We found no differences in short-term A. hygrophila development between haplotypes but mass was 23% greater in high than low N treatments. This study is the first to explore the interplay between nutrient availability, genetic variation, and phenotypic plasticity in invasive characteristics of the global invader, A. philoxeroides.

12.
PeerJ ; 11: e16580, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38084143

RESUMO

Background: Operation of wind turbines has resulted in collision fatalities for several bat species, and one proven method to reduce these fatalities is to limit wind turbine blade rotation (i.e., curtail turbines) when fatalities are expected to be highest. Implementation of curtailment can potentially be optimized by targeting times when females are most at risk, as the proportion of females limits the growth and stability of many bat populations. The Brazilian free-tailed bat (Tadarida brasiliensis) is the most common bat fatality at wind energy facilities in California and Texas, and yet there are few available data on the sex ratios of the carcasses that are found. Understanding the sex ratios of fatalities in California and Texas could aid in planning population conservation strategies such as informed curtailment. Methods: We used PCR to determine the sex of bat carcasses collected from wind energy facilities during post-construction monitoring (PCM) studies in California and Texas. In California, we received samples from two locations within the Altamont Pass Wind Resource Area in Alameda County: Golden Hills (GH) (n = 212) and Golden Hills North (GHN) (n = 312). In Texas, we received samples from three wind energy facilities: Los Mirasoles (LM) (Hidalgo County and Starr County) (n = 252), Los Vientos (LV) (Starr County) (n = 568), and Wind Farm A (WFA) (San Patricio County and Bee County) (n = 393). Results: In California, the sex ratios of fatalities did not differ from 50:50, and the sex ratio remained stable over the survey years, but the seasonal timing of peak fatalities was inconsistent. In 2017 and 2018, fatalities peaked between September and October, whereas in 2019 and 2020 fatalities peaked between May and June. In Texas, sex ratios of fatalities varied between locations, with Los Vientos being female-skewed and Wind Farm A being male-skewed. The sex ratio of fatalities was also inconsistent over time. Lastly, for each location in Texas with multiple years studied, we observed a decrease in the proportion of female fatalities over time. Discussion: We observed unexpected variation in the seasonal timing of peak fatalities in California and differences in the sex ratio of fatalities across time and facility location in Texas. In Texas, proximity to different roost types (bridge or cave) likely influenced the sex ratio of fatalities at wind energy facilities. Due to the inconsistencies in the timing of peak female fatalities, we were unable to determine an optimum curtailment period; however, there may be location-specific trends that warrant future investigation. More research should be done over the entirety of the bat active season to better understand these trends in Texas. In addition, standardization of PCM studies could assist future research efforts, enhance current monitoring efforts, and facilitate research on post-construction monitoring studies.


Assuntos
Quirópteros , Energia Renovável , Feminino , Masculino , Animais , Razão de Masculinidade , Texas/epidemiologia , Estações do Ano
13.
Vaccines (Basel) ; 11(6)2023 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-37376432

RESUMO

Vaccines play an important role in maintaining human and animal health worldwide. There is continued demand for effective and safe adjuvants capable of enhancing antigen-specific responses to a target pathogen. Rabbit hemorrhagic disease virus (RHDV) is a highly contagious calicivirus that often induces high mortality rates in rabbits. Herein, we evaluated the activity of an experimental sulfated lactosyl archaeol (SLA) archaeosome adjuvant when incorporated in subunit vaccine formulations targeting RHDV. The subunit antigens consisted of RHDV-CRM197 peptide conjugates or recombinant RHDV2 VP60. SLA was able to enhance antigen-specific antibody titers and cellular responses in mice and rabbits. Three weeks following immunization, antigen-specific antibody levels in rabbits vaccinated with RHDV2 VP60 + SLA were significantly higher than those immunized with antigen alone, with geomean titers of 7393 vs. 117. In addition, the SLA-adjuvanted VP60-based formulations were highly efficacious in a rabbit RHDV2 challenge model with up to 87.5% animals surviving the viral challenge. These findings demonstrate the potential utility of SLA adjuvants in veterinary applications and highlight its activity in different types of mammalian species.

14.
Ann Vasc Surg ; 26(5): 700-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22503433

RESUMO

BACKGROUND: The mechanism by which the multidisciplinary approach to diabetic foot disease reduces amputation rates is unclear. Ischemia, sepsis, and necrosis represent aspects of severe diabetic foot disease amenable to intervention. In 2006, a vascular unit introduced a rapid access service for severe foot disease, augmenting the established community provision. This study aimed to determine whether concurrent changes in amputation rates were observed, and to identify areas that may have influenced outcomes. METHODS: Unit data prospectively collected during 4 years for patients with lower-limb disease were compared with data retrieved over 2 years before the foot service. Outcome measurements were major amputations, foot surgery, vascular interventions, admissions, and length of stay. RESULTS: Major amputation rates associated with diabetes peaked in 2005 at 24.7/10,000 vs. 1.07/10,000 in 2009; (relative risk = 0.043, 95% confidence interval = 0.006-0.322). The proportion of diabetic to nondiabetic amputations decreased; foot surgery rates also dropped (53.7/10,000 in 2006 vs. 7.5/10,000 in 2009). The number of open revascularization procedures decreased, but the rates of endovascular procedures remained generally constant. Hospital admission rates decreased after initially peaking, and the length of stay was unchanged (16 vs. 15.5 days in 2004 and 2009, respectively). CONCLUSIONS: The integration of a vascular unit with community care has been associated with improved outcomes for patients with diabetic foot disease. Improvements were not related to the increased number of vascular procedures or hospitalizations, but did coincide with a greater proportion of patients attending the foot unit. The referral of patients to the unit facilitates the rapid management of severe disease, reducing delays deleterious to outcomes.


Assuntos
Pé Diabético/terapia , Hospitais de Distrito/organização & administração , Hospitais Gerais/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Ambulatório Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Medicina Estatal/organização & administração , Procedimentos Cirúrgicos Vasculares/organização & administração , Amputação Cirúrgica , Distribuição de Qui-Quadrado , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/organização & administração , Pé Diabético/diagnóstico , Acessibilidade aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Humanos , Tempo de Internação , Salvamento de Membro , Modelos Logísticos , Modelos Organizacionais , Admissão do Paciente , Estudos Prospectivos , Encaminhamento e Consulta/organização & administração , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , País de Gales
15.
BMC Health Serv Res ; 12: 410, 2012 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-23167656

RESUMO

BACKGROUND: Elderly patients are potentially more vulnerable to prolonged hospital stay as they frequently require additional resources to facilitate their discharge. In an acute hospital setting, we aimed to quantify and compare length of stay (LOS) for all patients over and under the age of 65, and identify the number and cause of days lost under the care of a single surgical unit. METHODS: Over a 4 month period from January to April 2010, data on the management and source of potential delay was collected daily on consecutive patients admitted and discharged under the care of one consultant surgeon at a district general hospital. Statistical analysis was then performed with particular focus on actual delays affecting elderly patients. RESULTS: A total of 99 complete inpatients episodes were recorded. There were 30 elective and 69 acute admissions. 10 (33%) elective vs. 42 (61%) acute patients encountered delays, losing 39 and 232 days respectively (χ2 [1, N = 99] = 6.36, p = .012). 23 of a total 39 elderly patients admitted acutely required specialist care of the elderly opinion and placement in community hospitals resulting in delays of 188 days. vs. 36 days for the 16 discharged home and 8 days for 30 patients under 65 (χ2 (2, N = 69) = 26.54, p = <.001). CONCLUSIONS: Elderly patients experiencing acute surgical admission and discharge to community hospitals had prolonged LOS due to significant delays associated with care of the elderly provision. The financial considerations behind bed capacity in primary and secondary care and the provision of care of elderly services need to be balanced against unnecessary occupancy of acute hospital beds with its associated health and economic implications.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Feminino , Hospitais de Distrito/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
16.
AoB Plants ; 14(1): plab078, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35079330

RESUMO

Schinus terebinthifolia is a problematic invasive alien plant (IAP) in South Africa that is a high priority target for biological control. Biological control has been implemented in the states of Florida and Hawaii (USA), where S. terebinthifolia is also an IAP. Phylogeographic work determined that there have been multiple introductions of two lineages (haplotype A and B) into the USA. Haplotype A was introduced to western Florida and Hawaii, while haplotype B was introduced to eastern Florida. Haplotypes A and B have subsequently hybridized in Florida, resulting in novel plant genotypes. Biological control agents in the USA are known to vary in efficacies on the two different haplotypes and hybrids. This study used molecular techniques to uncover the source populations of S. terebinthifolia in South Africa using chloroplast DNA and microsatellites. Populations from the introduced ranges in Florida (east, west and hybrids) and Hawaii were included (n = 95). All South Africa populations (n = 51) were found to be haplotype A. Microsatellite analysis determined shared alleles with western Florida and Hawaiian populations. The likely source of South African S. terebinthifolia was determined to be western Florida through the horticultural trade. These results will help guide a biological control programme to source agents that perform well on these populations in the USA. Furthermore, the presence of only one haplotype in South Africa highlights the need to ensure no further introductions of other haplotypes of the plant are made, in order to avoid similar hybridization events like those recorded in Florida.

17.
Genome Biol Evol ; 14(1)2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34849831

RESUMO

The southwestern and central United States serve as an ideal region to test alternative hypotheses regarding biotic diversification. Genomic data can now be combined with sophisticated computational models to quantify the impacts of paleoclimate change, geographic features, and habitat heterogeneity on spatial patterns of genetic diversity. In this study, we combine thousands of genotyping-by-sequencing (GBS) loci with mtDNA sequences (ND1) from the Texas horned lizard (Phrynosoma cornutum) to quantify relative support for different catalysts of diversification. Phylogenetic and clustering analyses of the GBS data indicate support for at least three primary populations. The spatial distribution of populations appears concordant with habitat type, with desert populations in AZ and NM showing the largest genetic divergence from the remaining populations. The mtDNA data also support a divergent desert population, but other relationships differ and suggest mtDNA introgression. Genotype-environment association with bioclimatic variables supports divergence along precipitation gradients more than along temperature gradients. Demographic analyses support a complex history, with introgression and gene flow playing an important role during diversification. Bayesian multispecies coalescent analyses with introgression (MSci) analyses also suggest that gene flow occurred between populations. Paleo-species distribution models support two southern refugia that geographically correspond to contemporary lineages. We find that divergence times are underestimated and population sizes are overestimated when introgression occurred and is ignored in coalescent analyses, and furthermore, inference of ancient introgression events and demographic history is sensitive to inclusion of a single recently admixed sample. Our analyses cannot refute the riverine barrier or glacial refugia hypotheses. Results also suggest that populations are continuing to diverge along habitat gradients. Finally, the strong evidence of admixture, gene flow, and mtDNA introgression among populations suggests that P. cornutum should be considered a single widespread species under the General Lineage Species Concept.


Assuntos
Lagartos , Animais , Teorema de Bayes , DNA Mitocondrial/genética , Demografia , Variação Genética , Lagartos/genética , Filogenia , Filogeografia , Estados Unidos
18.
Ecol Evol ; 11(10): 5355-5363, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34026012

RESUMO

Texas horned lizards (Phrynosoma cornutum) have a number of ways to avoid predation, including camouflage, sharp cranial horns, flattening of the body, and the ability to squirt blood from the eyes. These characteristics and their relatively low survival rates in the wild suggest these lizards are under high predation pressure. These lizards have been declining in much of their eastern range due to increased urbanization, agriculture, and loss of prey species. However, they can be still be found in some small south Texas towns where they can reach densities that are much higher (~50 lizards/ha) than in natural areas (~4-10 lizards/ha). We hypothesized that one reason for the high densities observed in these towns may be due to reduced predation pressure. We used model Texas horned lizards to test whether predation levels were lower in two south Texas towns than on a nearby ranch. We constructed models from urethane foam, a material that is ideal for preserving marks left behind by predators. Models (n = 126) and control pieces of foam (n = 21) were left in the field for 9 days in each location in early and late summer and subsequent predation marks were categorized by predator taxa. We observed significantly more predation attempts on the models than on controls and significantly fewer attempts in town (n = 1) compared with the ranch (n = 60). On the ranch, avian predation attempts appear to be common especially when the models did not match the color of the soil. Our results suggest that human-modified environments that have suitable habitat and food resources may provide a refuge for some prey species like horned lizards from predators.

19.
PeerJ ; 8: e10348, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33240657

RESUMO

There are increasing concerns regarding bat mortality at wind energy facilities, especially as installed capacity continues to grow. In North America, wind energy development has recently expanded into the Lower Rio Grande Valley in south Texas where bat species had not previously been exposed to wind turbines. Our study sought to characterize genetic diversity, population structure, and effective population size in Dasypterus ega and D. intermedius, two tree-roosting yellow bats native to this region and for which little is known about their population biology and seasonal movements. There was no evidence of population substructure in either species. Genetic diversity at mitochondrial and microsatellite loci was lower in these yellow bat taxa than in previously studied migratory tree bat species in North America, which may be due to the non-migratory nature of these species at our study site, the fact that our study site is located at a geographic range end for both taxa, and possibly weak ascertainment bias at microsatellite loci. Historical effective population size (NEF) was large for both species, while current estimates of Ne had upper 95% confidence limits that encompassed infinity. We found evidence of strong mitochondrial differentiation between the two putative subspecies of D. intermedius (D. i. floridanus and D. i. intermedius) which are sympatric in this region of Texas, yet little differentiation using microsatellite loci. We suggest this pattern is due to secondary contact and hybridization and possibly incomplete lineage sorting at microsatellite loci. We also found evidence of some hybridization between D. ega and D. intermedius in this region of Texas. We recommend that our data serve as a starting point for the long-term genetic monitoring of these species in order to better understand the impacts of wind-related mortality on these populations over time.

20.
Sci Rep ; 10(1): 20390, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33230206

RESUMO

Peru is experiencing a "gastronomic boom" that is increasing the demand for seafood. We investigated two implicit assumptions of two popular sustainable seafood consumer-based initiatives: (1) seafood is labelled correctly, and (2) the recommended species are healthy for consumers. We used DNA barcoding to determine the taxonomic identity of 449 seafood samples from markets and restaurants and analysed the concentration of total mercury (THg) in a sub-sample (271 samples) of these. We found that a third of seafood is mislabelled and that over a quarter of all samples had mercury levels above the upper limit recommended by the US EPA (300 ng/g ww). Additionally, 30% of samples were threatened and protected species. Mislabelling often occurred for economic reasons and the lack of unique common names. Mislabelled samples also had significantly higher mercury concentrations than correctly labelled samples. The "best choice" species compiled from two sustainable seafood guides had less mislabelling, and when identified correctly through DNA barcoding, had on average lower mercury than the other species. Nevertheless, some high mercury species are included in these lists. Mislabelling makes the efforts of seafood campaigns less effective as does the inclusion of threatened species and species high in mercury.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA