RESUMO
OBJECTIVE: The primary objective of this study was to compare the analgesic response to morphine in non-obese, obese and morbidly obese patients for acute pain. METHODS: This was a retrospective cohort study conducted in a tertiary care emergency department in the USA. Consecutive adults who received intravenous morphine 4 mg for pain were included. Patients were categorised into three groups based on body mass index (BMI): non-obese (18.5-29.9 kg/m(2)); obese (30.0-39.9 kg/m(2)); and morbidly obese (≥40 kg/m(2)). Baseline and post-dose pain scores were recorded. Pain was measured on a 0-10 numerical rating scale (0=no pain; 10=worst possible pain). Analgesic response was defined as the difference between the initial pain score and post-dose pain score. RESULTS: 300 patients were included in the study (100 in each group). The median baseline pain scores were 8.5, 8 and 8.5 in the non-obese, obese and morbidly obese groups, respectively (p=0.464). The median analgesic response after morphine administration was 2, 3 and 2 in the non-obese, obese and morbidly obese groups, respectively (p=0.160). In the linear regression analysis (R(2)=0.006), BMI was not predictive of analgesic response (coefficient -0.020; p=0.199). CONCLUSIONS: Obesity status did not influence analgesic response to a fixed dose of morphine. This suggests that obese and morbidly obese patients do not require a higher dose of morphine for acute pain reduction compared to non-obese patients.
Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência , Morfina/uso terapêutico , Obesidade Mórbida , Administração Intravenosa , Adulto , Índice de Massa Corporal , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Análise de Regressão , Estudos Retrospectivos , Estados UnidosRESUMO
The number of deep-water (>80 m) octocoral species recorded from Australian waters has more than tripled from 135 to 457 following six surveys undertaken between 1997 and 2008 on the deep continental margin of south-eastern, western and north-western Australia and the Tasman Sea. This rapid increase in knowledge follows a slow accumulation of records since the earliest collections were made by vessels such as the Géographe and the Naturaliste in the early years of the 19 century. Consistent identification and alpha-labelling of the octocoral fauna between surveys has permitted a multi-region description and comparison. We detail the identities, distributions and regional affinities of 457 octocoral species in 131 genera and 28 families from the orders Alcyonacea and Pennatulacea, including 69 new species, 17 new genera and 43 first records for Australia. Five of the more common genera were widely distributed (present at 35 and 66 sampling stations spanning all of the 4 survey regions), but two were restricted to south-eastern Australia-Pleurogorgia Versluys, 1902 and Tokoprymno Bayer, 1996-and were only sampled from depths below 700 m. The great majority of species (81%) and nearly half of all genera (47%) were only sampled once or twice. The highest average number of species per sampling station (3.2) was reported from the outer shelf. The proportion of new species was highest (22%) on the upper and lower slope bathomes, intermediate (13-15%) on the mid-slope bathome and lowest (8%) on the outer shelf bathome. Species overlap between bathomes was low, but all families were shared across bathomes. Most described species (55 of 69) have an Indo-West Pacific affinity, 20 have an Indian Ocean affinity, while three were previously recorded from the Atlantic Ocean only; 20 appear to be Australian endemics. Octocorals can now be added to an emerging set of taxon-specific data sets-including fishes, ophiuroids and galatheids-that permit regional-scale analysis of biodiversity distributions to support Australia's efforts in marine conservation management. However, because so much of the world octocoral literature is inadequate for accurate identifications to species level, there is a pressing need for taxonomic revisions using modern morphological and molecular techniques to fine-tune the current use of octocorals as indicators of vulnerable marine ecosystems in many national and high seas conservation initiatives.
Assuntos
Antozoários , Biodiversidade , Lista de Checagem , História Natural , Animais , AustráliaRESUMO
BACKGROUND: Hospital-based breast cancer follow-up provides reassurance to patients despite limited evidence for clinical efficacy. Although alternative models of hospital/community-based follow-up have yielded encouraging results, traditional hospital follow-up continues to be offered to all patients. Survival rates continue to rise; consequently, more patients are likely to require support, as many have a limited understanding of the long-term physical and emotional consequences of cancer and its treatment. We examine levels of psychological distress in breast cancer patients in follow-up 2 years or more from diagnosis. METHODS: This prospective study measured psychological distress levels using standardized measures [Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes for Routine Evaluation (CORE) and Measure Yourself Medical Outcomes Profile (MYMOP)]. Between January and September 2008, 323 consecutive patients were approached in outpatient clinics. Ninety-six patients declined to participate. RESULTS: Two hundred twenty-seven patients took home patient information sheets; 172 (75%) returned completed questionnaires to assess levels of distress (HADS, CORE). MYMOP provided self-reported data on patient symptoms. Patients reported low levels of distress in hospital-based follow-up, which were comparable or better than general population norms, although there was a significant minority of patients reporting high scores (n = 27, 15.7%) on HADS or CORE. There was good agreement between these two measures. All sub-scales of CORE (except risk) correlated well with HADS for anxiety/depression. No significant changes were detected in the standardized measures. MYMOP results showed that 23.8% of respondents reported both physical and emotional symptoms. CONCLUSIONS: Breast cancer survivors reported good psychological outcomes 2 years on from diagnosis. Screening for psychological/emotional distress is a vital part of follow-up care, which should be incorporated into UK policy.
Assuntos
Neoplasias da Mama/psicologia , Alta do Paciente , Estresse Psicológico/diagnóstico , Sobreviventes/psicologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
This exploratory study assessed the belief system regarding alcohol use in a non-clinical population of Mexican American women age 55 and older drawn from a potential population of 1,000 older adults who attend nine senior centers. The overriding research question was: What are the normative attitudes, knowledge, and behavior regarding alcohol in this population of older Mexican American women? Findings from this study can serve as a baseline for comparison for future studies of older Mexican American who are more acculturated or who are second- and third-generation Mexican Americans.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Americanos Mexicanos/estatística & dados numéricos , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Atitude Frente a Saúde , Coleta de Dados , Feminino , Serviços de Saúde para Idosos , Humanos , Pessoa de Meia-Idade , Estados UnidosRESUMO
Alcohol, tobacco and other drug abuse continue to cause major threats to the physiological, psychological, sociological and spiritual health of the nation. According to recent statistics, over 80% of the illegal drugs used by youth, both male and female, is marijuana, with cocaine, opium and their derivatives comprising at least 15% of the drugs used by youth. When considering the ill effects of drug abuse, it is the legal one, alcohol that is responsible for the greatest impact on society. While it remains imperative that allied health professionals understand the many ramifications of substance abuse, it is also critical that leaders of faith communities have the knowledge and skills to meet this challenge competently. Due to the relevance of ministries as a possible resource, the focus of this exploratory study is to assess the knowledge, skills and attitudes of clergy about substance use and abuse and to determine their confidence of clergy in assisting their congregation with need related to this area.
Assuntos
Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Clero/estatística & dados numéricos , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Assistência Religiosa/métodos , Religião e Psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/prevenção & controle , Feminino , Humanos , Relações Interpessoais , Masculino , Abuso de Maconha/prevenção & controle , Pessoa de Meia-Idade , Espiritualidade , Estados UnidosRESUMO
The role of the minister or pastor is pivotal in the development and operation of church-based services and programs and in the delivery of services. They can initiate changes and can equip the officers and members so that families troubled by substance abuse issues can find a climate of acceptance, understanding, and recovery in the local congregation. They can also serve as a referral source to members of the mental health professionals for assistance with alcohol and other substance abuse problems. For our purposes in this article, the term "clergy" refers to congregational and parish clergy. The focus of this discussion pertains to the role of clergy in providing assistance for members of their congregations with substance abuse problems. Implications and recommendations for collaborations and specific resources are also included that may increase the awareness of those issues and to increase effectiveness of service to those needing it.
Assuntos
Alcoolismo , Clero/psicologia , Assistência Religiosa , Atitude , Humanos , Relações Interpessoais , Estados UnidosRESUMO
Imagery collected by still and video cameras is an increasingly important tool for minimal impact, repeatable observations in the marine environment. Data generated from imagery includes identification, annotation and quantification of biological subjects and environmental features within an image. To be long-lived and useful beyond their project-specific initial purpose, and to maximize their utility across studies and disciplines, marine imagery data should use a standardised vocabulary of defined terms. This would enable the compilation of regional, national and/or global data sets from multiple sources, contributing to broad-scale management studies and development of automated annotation algorithms. The classification scheme developed under the Collaborative and Automated Tools for Analysis of Marine Imagery (CATAMI) project provides such a vocabulary. The CATAMI classification scheme introduces Australian-wide acknowledged, standardised terminology for annotating benthic substrates and biota in marine imagery. It combines coarse-level taxonomy and morphology, and is a flexible, hierarchical classification that bridges the gap between habitat/biotope characterisation and taxonomy, acknowledging limitations when describing biological taxa through imagery. It is fully described, documented, and maintained through curated online databases, and can be applied across benthic image collection methods, annotation platforms and scoring methods. Following release in 2013, the CATAMI classification scheme was taken up by a wide variety of users, including government, academia and industry. This rapid acceptance highlights the scheme's utility and the potential to facilitate broad-scale multidisciplinary studies of marine ecosystems when applied globally. Here we present the CATAMI classification scheme, describe its conception and features, and discuss its utility and the opportunities as well as challenges arising from its use.
Assuntos
Monitoramento Ambiental/métodos , Invertebrados , Algoritmos , Animais , Biota , Conservação dos Recursos Naturais , EcossistemaRESUMO
[reaction: see text] A novel approach to alpha,alpha-disubstituted-beta-amino acids (beta(2,2)-amino acids) was employed in the synthesis of a series of 3-(pyrrolidin-1-yl)propionic acids possessing high affinity for the CCR5 receptor and potent anti-HIV activity. The rat pharmacokinetics for these new analogues featured higher bioavailabilities and lower rates of clearance as compared to cyclopentane 1.
Assuntos
Fármacos Anti-HIV/farmacologia , Antagonistas dos Receptores CCR5 , Propionatos/farmacologia , Pirrolidinas/farmacologia , Fármacos Anti-HIV/farmacocinética , Disponibilidade Biológica , Propionatos/farmacocinética , Pirrolidinas/farmacocinéticaRESUMO
PURPOSE: The process of breast cancer follow-up has psychosocial benefits for patients, notably reassurance, although attending hospital appointments can increase anxiety. Discharge from hospital follow-up can also invoke anxiety as many patients seek reassurance from continued specialist follow-up. Inevitably, due to increased survival and associated resource issues, opportunities for follow-up and support will be reduced. We delivered and evaluated an intervention which supported the transition from cancer patient to cancer survivor, for breast cancer patients being discharged to primary care. METHODS: We delivered and evaluated a pilot of a patient-centred group intervention 'Preparing Patients for Discharge', aimed at reducing distress. Between January and September 2008, 172 participants were recruited and 74 (43%) expressed an interest in participating in the intervention; 32 of 74 took part, and participated in its evaluation using a semi-structured evaluation questionnaire, standardized measures [Hospital Anxiety and Depression Scale (HADS) and Clinical Outcomes for Routine Evaluation (CORE)] and independent qualitative interviews. RESULTS: The qualitative analysis of questionnaire data indicated key factors were 1) shared experience, 2) support and reassurance, and 3) positive views about cancer and being discharged. The interview data revealed that the intervention enabled participants to: share experiences, focus on emotional needs, and have open discussions about recurrence, while increasing confidence in being discharged and using alternative support services. However, no significant differences were found in pre-post-interventions scores of HADS and CORE. CONCLUSIONS: Providing a structured group intervention approach for breast cancer patients offers an early opportunity to support cancer survivors and facilitate and encourage self-management.
Assuntos
Neoplasias da Mama/psicologia , Alta do Paciente , Autocuidado/métodos , Apoio Social , Sobreviventes/psicologia , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Assistência Centrada no Paciente/organização & administração , Projetos Piloto , Psicologia , Autocuidado/psicologia , Estresse Psicológico , Fatores de TempoRESUMO
BACKGROUND: Seagrass species in the tropics occur in multispecies meadows. How these meadows are maintained through species co-existence and what their ecological drivers may be has been an overarching question in seagrass biogeography. In this study, we quantify the spatial structure of four co-existing species and infer potential ecological processes from these structures. METHODS AND RESULTS: Species presence/absence data were collected using underwater towed and dropped video cameras in Pulau Tinggi, Malaysia. The geostatistical method, utilizing semivariograms, was used to describe the spatial structure of Halophila spp, Halodule uninervis, Syringodium isoetifolium and Cymodocea serrulata. Species had spatial patterns that were oriented in the along-shore and across-shore directions, nested with larger species in meadow interiors, and consisted of multiple structures that indicate the influence of 2-3 underlying processes. The Linear Model of Coregionalization (LMC) was used to estimate the amount of variance contributing to the presence of a species at specific spatial scales. These distances were <2.5 m (micro-scale), 2.5-50 m (fine-scale) and >50 m (broad-scale) in the along-shore; and <2.5 m (micro-scale), 2.5-140 m (fine-scale) and >140 m (broad-scale) in the across-shore. The LMC suggests that smaller species (Halophila spp and H. uninervis) were most influenced by broad-scale processes such as hydrodynamics and water depth whereas large, localised species (S. isoetifolium and C. serrulata) were more influenced by finer-scale processes such as sediment burial, seagrass colonization and growth, and physical disturbance. CONCLUSION: In this study, we provide evidence that spatial structure is distinct even when species occur in well-mixed multispecies meadows, and we suggest that size-dependent plant traits have a strong influence on the distribution and maintenance of tropical marine plant communities. This study offers a contrast from previous spatial models of seagrasses which have largely focused on monospecific temperate meadows.
Assuntos
Alismatales/crescimento & desenvolvimento , Ecossistema , Biologia Marinha/métodos , Clima Tropical , Algoritmos , Alismatales/classificação , Geografia , Malásia , Modelos Teóricos , Dinâmica Populacional , Especificidade da Espécie , Gravação em VídeoRESUMO
Assemblages of megabenthos are structured in seven depth-related zones between â¼700 and 4000 m on the rocky and topographically complex continental margin south of Tasmania, southeastern Australia. These patterns emerge from analysis of imagery and specimen collections taken from a suite of surveys using photographic and in situ sampling by epibenthic sleds, towed video cameras, an autonomous underwater vehicle and a remotely operated vehicle (ROV). Seamount peaks in shallow zones had relatively low biomass and low diversity assemblages, which may be in part natural and in part due to effects of bottom trawl fishing. Species richness was highest at intermediate depths (1000-1300 m) as a result of an extensive coral reef community based on the bioherm-forming scleractinian Solenosmilia variabilis. However, megabenthos abundance peaked in a deeper, low diversity assemblage at 2000-2500 m. The S. variabilis reef and the deep biomass zone were separated by an extensive dead, sub-fossil S. variabilis reef and a relatively low biomass stratum on volcanic rock roughly coincident with the oxygen minimum layer. Below 2400 m, megabenthos was increasingly sparse, though punctuated by occasional small pockets of relatively high diversity and biomass. Nonetheless, megabenthic organisms were observed in the vast majority of photographs on all seabed habitats and to the maximum depths observed--a sandy plain below 3950 m. Taxonomic studies in progress suggest that the observed depth zonation is based in part on changing species mixes with depth, but also an underlying commonality to much of the seamount and rocky substrate biota across all depths. Although the mechanisms supporting the extraordinarily high biomass in 2000-2500 m depths remains obscure, plausible explanations include equatorwards lateral transport of polar production and/or a response to depth-stratified oxygen availability.
Assuntos
Antozoários/fisiologia , Biota/fisiologia , Recifes de Corais , Ecossistema , Biologia Marinha/métodos , Animais , Biomassa , Análise por Conglomerados , Fósseis , Geografia , Dinâmica Populacional , Salinidade , Água do Mar/química , Especificidade da Espécie , Tasmânia , TemperaturaRESUMO
As the science of the aging process moves forward, a recurring challenge is the integration of multiple types of data and information with classical aging theory while disseminating that information to the scientific community. Here we present AGING-kb, a public knowledge base with the goal of conceptualizing and presenting fundamental aspects of the study of the aging process. Aging-kb has two interconnected parts, the Aging-kb tree and the Aging Wiki. The Aging-kb tree is a simple intuitive dynamic tree hierarchy of terms describing the field of aging from the general to the specific. This enables the user to see relationships between areas of aging research in a logical comparative fashion. The second part is a specialized Aging Wiki which allows expert definition, description, supporting information, and documentation of each aging keyword term found in the Aging-kb tree. The Aging Wiki allows community participation in describing and defining concepts and terms in the Wiki format. This aging knowledge base provides a simple intuitive interface to the complexities of aging.
Assuntos
Envelhecimento , Bases de Conhecimento , Animais , Humanos , Modelos Animais , FenótipoRESUMO
The treatment of obstetric brachial plexus palsy (OBPP) with neuroma-in-continuity is controversial. The recent literature advocates excision of neuroma-in-continuity in OBPP and repair with nerve graft irrespective of its neurophysiological conductivity. This approach risks sacrificing the regenerating axons, and the result has not yet been proven to be superior to neurolysis alone. In this case report, the authors aim to outline their strategy of using the combination of preoperative and intraoperative clinical and neurophysiological findings to aid their decision making. The lack of upper trunk recovery and the unfavorable preoperative neurophysiological findings in a child with Narakas Group 4 OBPP at 5 months of age prompted an urgent exploration with the intention of performing neurotization. This procedure was abandoned and neurolysis was performed due to the favorable intraoperative neurophysiological findings. At 4 years of age, the child scored 12 of 15 on Mallet classification and has an excellent range of movement. No secondary operation was needed. The authors hope to highlight the idea that the surgical option for neurolysis alone should be kept open and that intraoperative electromyography can be a valuable tool to add to the surgeon's armamentarium.
Assuntos
Neuropatias do Plexo Braquial/cirurgia , Eletromiografia , Monitorização Intraoperatória/métodos , Paralisia Obstétrica/cirurgia , Cuidados Pré-Operatórios , Pré-Escolar , Potenciais Somatossensoriais Evocados , Humanos , Lactente , Masculino , Recuperação de Função FisiológicaRESUMO
Synthesis of analogs containing more rigid bicyclic piperidine replacements for the 4-benzyloxycarbonyl-(ethyl)amino-piperidine moiety of the CCR5 antagonist structure, 1, is described. Although similar binding affinity to the lead was achieved with some analogs they were overall less potent anti-HIV agents suggesting that other features besides CCR5 binding are required for good anti-viral activity.
Assuntos
Fármacos Anti-HIV/síntese química , Antagonistas dos Receptores CCR5 , Sulfonas/síntese química , Fármacos Anti-HIV/farmacologia , Butanos/síntese química , Butanos/farmacologia , Relação Dose-Resposta a Droga , Concentração Inibidora 50 , Piperidinas/síntese química , Piperidinas/farmacologia , Relação Estrutura-Atividade , Sulfonas/farmacologia , Vírus/efeitos dos fármacosRESUMO
Replacement of the flexible connecting chains between the piperidine moiety and an aromatic group in previous CCR5 antagonists with heterocycles, such as pyrazole and isoxazole, provided potent CCR5 antagonists with excellent anti-HIV-1 activity in vitro. SAR studies revealed optimal placement of an unsubstituted nitrogen atom in the heterocycle to be meta to the bond connected to the 4-position of piperidine. Truncation of a benzyl group to a phenyl group afforded compounds with dramatically improved oral bioavailability, albeit with reduced activity.
Assuntos
Fármacos Anti-HIV/síntese química , Fármacos Anti-HIV/farmacocinética , Antagonistas dos Receptores CCR5 , Piperidinas/síntese química , Piperidinas/farmacocinética , Animais , Fármacos Anti-HIV/química , Divisão Celular/efeitos dos fármacos , Células HeLa , Humanos , Estrutura Molecular , Piperidinas/química , Pirazóis/química , Pirazóis/farmacocinética , Ratos , Relação Estrutura-AtividadeRESUMO
Efforts toward the exploration of the title compounds as CCR5 antagonists are disclosed. The basis for such work stems from the fact that cellular proliferation of HIV-1 requires the cooperative assistance of both CCR5 and CD4 receptors. The synthesis and SAR of pyrrolidineacetic acid derivatives as CCR5 antagonists displaying potent binding and antiviral properties in a HeLa cell-based HIV-1 infectivity assay are discussed.
Assuntos
Fármacos Anti-HIV/síntese química , Antagonistas dos Receptores CCR5 , HIV-1/efeitos dos fármacos , Pirrolidinas/síntese química , Acetatos/química , Fármacos Anti-HIV/farmacologia , Sítios de Ligação , Divisão Celular/efeitos dos fármacos , Células HeLa , Humanos , Piperidinas/síntese química , Piperidinas/farmacologia , Pirrolidinas/química , Relação Estrutura-AtividadeRESUMO
A series of CCR5 antagonists containing bicyclic isoxazolidines was generated through a nitrone mediated cycloaddition with olefins bearing the preferred pharmacophores previously described. Potent antagonists (3 and 16) were generated with enhanced affinity for the CCR5 receptor while maintaining antiviral activity against HIV.
Assuntos
Fármacos Anti-HIV/síntese química , Antagonistas dos Receptores CCR5 , Isoxazóis/síntese química , Fármacos Anti-HIV/farmacologia , Compostos Bicíclicos Heterocíclicos com Pontes/síntese química , Compostos Bicíclicos Heterocíclicos com Pontes/química , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , HIV-1/efeitos dos fármacos , Humanos , Isoxazóis/química , Isoxazóis/farmacologia , Testes de Sensibilidade Microbiana , Conformação Molecular , Ligação Proteica , Pirrolidinas/síntese química , Pirrolidinas/química , Pirrolidinas/farmacologia , Relação Estrutura-AtividadeRESUMO
Incorporation of acidic functional groups into a lead CCR5 antagonist identified from a targeted combinatorial library resulted in compounds with enhanced anti-HIV-1 activity and attenuated L-type calcium channel affinity.
Assuntos
Fármacos Anti-HIV/síntese química , Fármacos Anti-HIV/farmacologia , Antagonistas dos Receptores CCR5 , HIV-1/efeitos dos fármacos , Animais , Fármacos Anti-HIV/farmacocinética , Células CHO , Canais de Cálcio Tipo L/efeitos dos fármacos , Fenômenos Químicos , Físico-Química , Quimiocina CCL4 , Cricetinae , Meia-Vida , Células HeLa , Humanos , Proteínas Inflamatórias de Macrófagos/antagonistas & inibidores , Ratos , Receptores CCR5/química , Relação Estrutura-AtividadeRESUMO
Modifications of the alkyl acetic acid portion and the phenyl on pyrrolidine in our lead pyrazole compound 1 afforded the isopropyl compound 9. This compound is a potent CCR5 antagonist showing good in vitro antiviral activity against HIV-1, an excellent selectivity profile, and good oral bioavailability in three animal species. During this investigation, a new method for the preparation of alpha-(pyrrolidin-1-yl)-alpha,alpha-dialkyl acetic acid from a pyrrolidine and alpha-bromo-alpha,alpha-dialkyl acetic acid using silver triflate was discovered. This allowed us to prepare compounds such as 24 and 25 for the first time. A novel Pd-mediated N-dealkylation of alpha-(pyrrolidin-1-yl)acetic acid was also uncovered.