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1.
Ann Oncol ; 34(2): 200-211, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36423745

RESUMO

BACKGROUND: Post-treatment detection of circulating tumour DNA (ctDNA) in early-stage triple-negative breast cancer (TNBC) patients predicts high risk of relapse. c-TRAK TN assessed the utility of prospective ctDNA surveillance in TNBC and the activity of pembrolizumab in patients with ctDNA detected [ctDNA positive (ctDNA+)]. PATIENTS AND METHODS: c-TRAK TN, a multicentre phase II trial, with integrated prospective ctDNA surveillance by digital PCR, enrolled patients with early-stage TNBC and residual disease following neoadjuvant chemotherapy, or stage II/III with adjuvant chemotherapy. ctDNA surveillance comprised three-monthly blood sampling to 12 months (18 months if samples were missed due to coronavirus disease), and ctDNA+ patients were randomised 2 : 1 to intervention : observation. ctDNA results were blinded unless patients were allocated to intervention, when staging scans were done and those free of recurrence were offered pembrolizumab. A protocol amendment (16 September 2020) closed the observation group; all subsequent ctDNA+ patients were allocated to intervention. Co-primary endpoints were (i) ctDNA detection rate and (ii) sustained ctDNA clearance rate on pembrolizumab (NCT03145961). RESULTS: Two hundred and eight patients registered between 30 January 2018 and 06 December 2019, 185 had tumour sequenced, 171 (92.4%) had trackable mutations, and 161 entered ctDNA surveillance. Rate of ctDNA detection by 12 months was 27.3% (44/161, 95% confidence interval 20.6% to 34.9%). Seven patients relapsed without prior ctDNA detection. Forty-five patients entered the therapeutic component (intervention n = 31; observation n = 14; one observation patient was re-allocated to intervention following protocol amendment). Of patients allocated to intervention, 72% (23/32) had metastases on staging at the time of ctDNA+, and 4 patients declined pembrolizumab. Of the five patients who commenced pembrolizumab, none achieved sustained ctDNA clearance. CONCLUSIONS: c-TRAK TN is the first prospective study to assess whether ctDNA assays have clinical utility in guiding therapy in TNBC. Patients had a high rate of metastatic disease on ctDNA detection. Findings have implications for future trial design, emphasising the importance of commencing ctDNA testing early, with more sensitive and/or frequent ctDNA testing regimes.


Assuntos
Antineoplásicos Imunológicos , DNA Tumoral Circulante , Neoplasia Residual , Neoplasias de Mama Triplo Negativas , Humanos , Biomarcadores Tumorais/sangue , Mutação , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/genética , Estudos Prospectivos , Neoplasias de Mama Triplo Negativas/sangue , Neoplasias de Mama Triplo Negativas/diagnóstico , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/genética , Neoplasia Residual/sangue , Neoplasia Residual/diagnóstico , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/genética , Antineoplásicos Imunológicos/uso terapêutico , DNA Tumoral Circulante/sangue
2.
Am J Primatol ; 84(8): e23415, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35856471

RESUMO

To examine how precipitation patterns and climate change impact feeding choices made by a population of critically endangered cotton-top tamarins (Saguinus oedipus), we examined 22 years of feeding data (1999-2020) from 21 groups collected at Parque Natural Regional Bosque Seco El Ceibal Mono Tití in Santa Catalina, Colombia. We describe the diet and examine the role of seasonal rainfall and annual variation in rainfall on diet. Rainfall is highly seasonal (mean annual rainfall 1562 mm [range 940-2680 mm]) with a dry, early rainy, and late rainy season in each year. Over 80 species of plants formed part of the fruit, nectar, and exudate components of the diet. Fruits, although available year-round, were more commonly available and consumed during the late rainy seasons (August-November). Exudates were consumed more frequently in the dry season (December-March) and invertebrate consumption was stable across the year. Nectar feeding from a single species (Combretum fruticosum) peaked in November. Rainfall varied over the years, with 13 years exceeding the 99% confidence intervals for mean rainfall. Ten of these extreme years (both drought and extremely wet) occurred in the last 11 years. Fruit consumption did not vary between extreme and average years, but cotton-top tamarins consumed more invertebrates and exudates in wet years. Presently, cotton-top tamarins appear to be able to cope with these extreme variations in rainfall due to their highly varied diet. However, the forests that these primates depend upon for survival are threatened by human exploitation making it critically important to maintain a generalist feeding strategy for survival as many fruiting trees that compose a large proportion of the diet are removed. As conservation efforts continue, plant species consumed by cotton-top tamarins provide useful data when selecting species for habitat restoration programs.


Assuntos
Néctar de Plantas , Saguinus , Animais , Colômbia , Humanos , Estudos Longitudinais , Plantas , Estações do Ano
3.
BMC Med Ethics ; 18(1): 36, 2017 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-28539111

RESUMO

BACKGROUND: Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women's and staff views about the consent procedures used during the internal pilot of a trial (GOT-IT), where the protocol permitted staff to gain verbal consent at recruitment. METHODS: Interviews with staff (n = 27) and participating women (n = 22). Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants' views about the consent procedures used. RESULTS: Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for obtaining written consent at recruitment. CONCLUSIONS: While alternative consent pathways have an important role to play in advancing emergency medicine research, and may be appreciated by potential recruits, they may give rise to unintended ethical and logistical challenges for staff. Staff would benefit from training and support to increase their confidence and willingness to recruit into trials using alternative consent pathways. TRIAL REGISTRATION: This qualitative research was undertaken as part of the GOT-IT Trial (trial registration number: ISCRTN 88609453 ). Date of registration 26/03/2014.


Assuntos
Documentação , Serviço Hospitalar de Emergência , Consentimento Livre e Esclarecido , Seleção de Pacientes , Comportamento Verbal , Adolescente , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido/ética , Entrevistas como Assunto , Obstetrícia , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa , Adulto Jovem
4.
Br J Cancer ; 106(6): 1062-7, 2012 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-22353807

RESUMO

BACKGROUND: The Intergroup Exemestane Study (IES) (ISRCTN11883920) demonstrated improved survival for postmenopausal women with ER-positive/unknown primary breast cancer who switched to exemestane after 2-3 years tamoxifen, compared with those continuing on tamoxifen to complete 5 years therapy. This was achieved without detriment to on-treatment quality-of-life (QoL). We report on- and post-treatment QoL impact in IES. METHODS: A total of 582 patients from 8 countries participated in the QoL substudy. Functional Assessment of Cancer Therapy-Breast (FACT-B) and endocrine symptom subscale (ES) were completed at baseline, 3, 6, 9, 12, 18, 24, 30, 36, 48 and 60 months. The primary endpoint was FACT-B Trial Outcome Index (TOI); secondary endpoints included severity of individual endocrine symptoms. RESULTS: Both the groups showed gradual improvement in overall QoL and lessening of total endocrine symptoms post treatment compared with baseline (P<0.002). There was no evidence of any between-group differences in TOI. Vasomotor complaints remained high on treatment. Vaginal discharge was more frequent (P<0.01) with tamoxifen up to 24 months from baseline. In both the groups, post-treatment libido did not recover to baseline levels. CONCLUSION: Clinical benefits of switching to exemestane are accompanied by good overall QoL. Although some symptoms persist, the majority of endocrine symptoms improve after treatment completion.


Assuntos
Androstadienos/uso terapêutico , Antineoplásicos/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias Primárias Desconhecidas/tratamento farmacológico , Qualidade de Vida , Tamoxifeno/uso terapêutico , Androstadienos/efeitos adversos , Antineoplásicos/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/metabolismo , Neoplasias da Mama/secundário , Ensaios Clínicos Fase III como Assunto , Substituição de Medicamentos , Feminino , Seguimentos , Humanos , Libido/efeitos dos fármacos , Pós-Menopausa , Receptores de Estrogênio/metabolismo , Inquéritos e Questionários , Tamoxifeno/efeitos adversos , Resultado do Tratamento , Descarga Vaginal/induzido quimicamente
5.
Ann Oncol ; 21(3): 498-505, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19717534

RESUMO

BACKGROUND: The antiestrogen tamoxifen may have partial estrogen-like effects on the postmenopausal uterus. Aromatase inhibitors (AIs) are increasingly used after initial tamoxifen in the adjuvant treatment of postmenopausal early breast cancer due to their mechanism of action: a potential benefit being a reduction of uterine abnormalities caused by tamoxifen. PATIENTS AND METHODS: Sonographic uterine effects of the steroidal AI exemestane were studied in 219 women participating in the Intergroup Exemestane Study: a large trial in postmenopausal women with estrogen receptor-positive (or unknown) early breast cancer, disease free after 2-3 years of tamoxifen, randomly assigned to continue tamoxifen or switch to exemestane to complete 5 years adjuvant treatment. The primary end point was the proportion of patients with abnormal (> or =5 mm) endometrial thickness (ET) on transvaginal ultrasound 24 months after randomisation. RESULTS: The analysis included 183 patients. Two years after randomisation, the proportion of patients with abnormal ET was significantly lower in the exemestane compared with tamoxifen arm (36% versus 62%, respectively; P = 0.004). This difference emerged within 6 months of switching treatment (43.5% versus 65.2%, respectively; P = 0.01) and disappeared within 12 months of treatment completion (30.8% versus 34.7%, respectively; P = 0.67). CONCLUSION: Switching from tamoxifen to exemestane significantly reverses endometrial thickening associated with continued tamoxifen.


Assuntos
Androstadienos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias do Endométrio/patologia , Tamoxifeno/uso terapêutico , Idoso , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/patologia , Método Duplo-Cego , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/tratamento farmacológico , Feminino , Seguimentos , Humanos , Agências Internacionais , Pessoa de Meia-Idade , Pós-Menopausa , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
6.
J Med Ethics ; 36(1): 37-45, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20026692

RESUMO

DESIGN: Qualitative interview study. PARTICIPANTS: Fifty-nine patients with a family history of cancer who attend a regional cancer genetics clinic in the UK were interviewed about their current and previous research experiences. FINDINGS: Interviewees gave a range of explanations for research participation. These were categorised as (a) social--research participation benefits the wider society by progressing science and improving treatment for everyone; (b) familial--research participation may improve healthcare and benefit current or future generations of the participant's family; and (c) personal--research participation provides therapeutic or non-therapeutic benefits for oneself. CONCLUSIONS: We discuss the distinction drawn between motives for research participation focused upon self (personal) and others (familial/social), and observe that personal, social and familial motives can be seen as interdependent. For example, research participation that is undertaken to benefit others, particularly relatives, may also offer a number of personal benefits for self, such as enabling participants to feel that they have discharged their social or familial obligations. We argue for the need to move away from simple, static, individualised notions of research participation to a more complex, dynamic and inherently social account.


Assuntos
Pesquisa em Genética , Motivação , Sujeitos da Pesquisa/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Altruísmo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
7.
Science ; 183(4120): 92-4, 1974 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-4855559

RESUMO

Weanling rats eating a low calcium diet voluntarily ingested lead acetate solutions in much greater proportions than did iron-deficient or control weanlings. This increased ingestion occurred even with high concentrations of lead acetate which normal weanlings found extremely aversive. Chronic injections of lead acetate into weanlings did not change lead ingestion, indicating an absence of behavioral regulation of body lead levels. Female lead-injected weanlings did show a significant increase in calcium ingestion. Calcium deficiency may be one component of lead pica.


Assuntos
Cálcio , Chumbo/farmacologia , Pica/etiologia , Animais , Deficiências Nutricionais/complicações , Feminino , Preferências Alimentares/efeitos dos fármacos , Humanos , Ferro , Masculino , Ratos , Fatores Sexuais
8.
Lancet ; 369(9561): 559-70, 2007 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-17307102

RESUMO

BACKGROUND: Early improvements in disease-free survival have been noted when an aromatase inhibitor is given either instead of or sequentially after tamoxifen in postmenopausal women with oestrogen-receptor-positive early breast cancer. However, little information exists on the long-term effects of aromatase inhibitors after treatment, and whether these early improvements lead to real gains in survival. METHODS: 4724 postmenopausal patients with unilateral invasive, oestrogen-receptor-positive or oestrogen-receptor-unknown breast cancer who were disease-free on 2-3 years of tamoxifen, were randomly assigned to switch to exemestane (n=2352) or to continue tamoxifen (n=2372) for the remainder of a 5-year endocrine treatment period. The primary endpoint was disease-free survival; overall survival was a secondary endpoint. Efficacy analyses were intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN11883920. RESULTS: After a median follow-up of 55.7 months (range 0-89.7), 809 events contributing to the analysis of disease-free survival had been reported (354 exemestane, 455 tamoxifen); unadjusted hazard ratio 0.76 (95% CI 0.66-0.88, p=0.0001) in favour of exemestane, absolute benefit 3.3% (95% CI 1.6-4.9) by end of treatment (ie, 2.5 years after randomisation). 222 deaths occurred in the exemestane group compared with 261 deaths in the tamoxifen group; unadjusted hazard ratio 0.85 (95% CI 0.71-1.02, p=0.08), 0.83 (0.69-1.00, p=0.05) when 122 patients with oestrogen-receptor-negative disease were excluded. CONCLUSIONS: Our results suggest that early improvements in disease-free survival noted in patients who switch to exemestane after 2-3 years on tamoxifen persist after treatment, and translate into a modest improvement in overall survival.


Assuntos
Androstadienos/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/uso terapêutico , Idoso , Androstadienos/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pós-Menopausa , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Análise de Sobrevida , Tamoxifeno/efeitos adversos
9.
Health Technol Assess ; 11(48): iii, ix-105, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17999843

RESUMO

OBJECTIVES: To identify factors associated with good and poor recruitment to multicentre trials. DATA SOURCES: Part A: database of trials started in or after 1994 and were due to end before 2003 held by the Medical Research Council and Health Technology Assessment Programmes. Part B: interviews with people playing a wide range of roles within four trials that their funders identified as 'exemplars'. Part C: a large multicentre trial (the CRASH trial) of treatment for head injury. REVIEW METHODS: The study used a number of different perspectives ('multiple lenses'), and three components. Part A: an epidemiological review of a cohort of trials. Part B: case studies of trials that appeared to have particularly interesting lessons for recruitment. Part C: a single, in-depth case study to examine the feasibility of applying a business-orientated analytical framework as a reference model in future trials. RESULTS: In the 114 trials found in Part A, less than one-third recruited their original target within the time originally specified, and around one-third had extensions. Factors observed more often in trials that recruited successfully were: having a dedicated trial manager, being a cancer or drug trial, and having interventions only available inside the trial. The most commonly reported strategies to improve recruitment were newsletters and mailshots, but it was not possible to assess whether they were causally linked to changes in recruitment. The analyses in Part B suggested that successful trials were those addressing clinically important questions at a timely point. The investigators were held in high esteem by the interviewees, and the trials were firmly grounded in existing clinical practices, so that the trial processes were not alien to clinical collaborators, and the results could be easily applicable to future practice. The interviewees considered that the needs of patients were well served by participation in the trials. Clinical collaborators particularly appreciated clear delineation of roles, which released them from much of the workload associated with trial participation. There was a strong feeling from interviewees that they were proud to be part of a successful team. This pride fed into further success. Good groundwork and excellent communications across many levels of complex trial structures were considered to be extremely important, including training components for learning about trial interventions and processes, and team building. All four trials had faced recruitment problems, and extra insights into the working of trials were afforded by strategies invoked to address them. The process of the case study in Part C was able to draw attention to a body of research and practice in a different discipline (academic business studies). It generated a reference model derived from a combination of business theory and work within CRASH. This enabled identification of weaker managerial components within CRASH, and initiatives to strengthen them. Although it is not clear, even within CRASH, whether the initiatives that follow from developing and applying the model will be effective in increasing recruitment or other aspects of the success of the trial, the reference model could provide a template, with potential for those managing other trials to use or adapt it, especially at foundation stages. The model derived from this project could also be used as a diagnostic tool if trials have difficulties and hence as a basis for deciding what type of remedial action to take. It may also be useful for auditing the progress of trials, such as during external review. CONCLUSIONS: While not producing sufficiently definitive results to make strong recommendations, the work here suggests that future trials should consider the different needs at different phases in the life of trials, and place greater emphasis on 'conduct' (the process of actually doing trials). This implies learning lessons from successful trialists and trial managers, with better training for issues relating to trial conduct. The complexity of large trials means that unanticipated difficulties are highly likely at some time in every trial. Part B suggested that successful trials were those flexible and robust enough to adapt to unexpected issues. Arguably, the trialists should also expect agility from funders within a proactive approach to monitoring ongoing trials. Further research into different recruitment patterns (including 'failures') may help to clarify whether the patterns seen in the 'exemplar' trials differ or are similar. The reference model from Part C needs to be further considered in other similar and different trials to assess its robustness. These and other strategies aimed at increasing recruitment and making trials more successful need to be formally evaluated for their effectiveness in a range of trials.


Assuntos
Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Bases de Dados como Assunto , Humanos , Entrevistas como Assunto , Estudos Multicêntricos como Assunto , Avaliação da Tecnologia Biomédica
10.
Trends Cogn Sci ; 2(1): 31-7, 1998 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-21244960

RESUMO

Although only humans use spoken language, the vocal communication of many animals shares some features with language. Within the context of their family, normal children and young non-human primates develop proficiency in the nuances of their species-specific vocal communication system. Engaging in speech-like phonetic activity, or babbling, occurs in all normal children regardless of their native language. Similar periods of vocal development have not been described previously for non-human primates. However, in the pygmy marmoset, a South American monkey, we found that the primary vocal behavior of infants parallels many characteristics of human infant babbling. These analogous features include universality, repetition, use of a subset of the adult vocal repertoire, recognizably adult-like vocal structure and lack of a clear vocal referent. Also, like human infants, young marmosets develop in a closely knit family unit that includes both parents and often older siblings. In this context, the babbling-like behavior of the marmoset infant stimulates interaction with caregivers, thereby serving a key role in the infant's own development. These developmental and social processes indicate that the study of vocal development in non-human primate species can provide insights into the function of babbling in humans.

11.
Ann N Y Acad Sci ; 807: 340-51, 1997 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-9071362

RESUMO

Affiliative behavior is often expressed through communication, and the nature of affiliative interactions affects the ontogeny of communication. I presented three phenomena that demonstrate the importance of affiliation in vocal development in marmosets and tamarins, but the results have parallels in many other species including birds, dolphins, and humans. Pygmy marmosets use trill-like vocalizations to maintain contact with other group members. Individuals change subtle aspects of call structure when they encounter new social groups or acquire a new mate. This process of vocal accommodation is common in many other species. Infant pygmy marmosets go through a stage of "babbling." producing long sequences of vocalizations that have several similarities to the babbling of human infants. Babbling infants receive more social attention than nonbabbling infants, and these social interactions may shape vocalizations towards more adult forms. In adult cotton-top tamarins, food-associated vocalizations communicate the presence and quality of food. However, reproductively inhibited juveniles and subadults use many other types of calls in feeding situations and display a high proportion of imperfect forms of adult food-associated calls. When subadult monkeys are paired with new mates and change their reproductive status, they rapidly (within 3-6 weeks) display both adult structure and adult usage of food-associated calls, suggesting that affiliative processes can both facilitate and inhibit vocal ontogeny. Three mechanisms of how social interactions affect communication (multimodal stimulation, attentional focus, and reinforcement) were proposed and illustrated through examples of parrots learning English labels for objects and attributes and infant cotton-top tamarins acquiring food-associated vocalizations.


Assuntos
Comportamento Social , Vocalização Animal , Animais , Aves , Callithrix , Comportamento Alimentar , Haplorrinos , Humanos , Lactente , Primatas , Comportamento Sexual Animal
12.
Neuroreport ; 12(10): 2231-6, 2001 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-11447340

RESUMO

Olfactory cues can elicit intense emotional responses. This study used fMRI in male common marmoset monkeys to identify brain areas associated with sexual arousal in response to odors of ovulating female monkeys. Under light anesthesia, monkeys were secured in a specially designed restrainer and positioned in a 9.4 T magnetic resonance spectrometer. When fully conscious, they were presented with the scents of both ovariectomized and ovulating monkeys. The sexually arousing odors of the ovulating monkeys enhanced signal intensity in the preoptic area and anterior hypothalamus compared to the odors of ovariectomized monkeys. These data corroborate previous findings in monkeys based on invasive electrical lesion and stimulation techniques and demonstrate the feasibility of using non-invasive functional imaging on fully conscious common marmosets to study cue-elicited emotional responses.


Assuntos
Mapeamento Encefálico/métodos , Sinais (Psicologia) , Atrativos Sexuais/fisiologia , Comportamento Sexual Animal/fisiologia , Animais , Núcleo Hipotalâmico Anterior/fisiologia , Callithrix , Feminino , Imageamento por Ressonância Magnética/métodos , Masculino , Bulbo Olfatório/fisiologia , Ovariectomia , Ovulação/fisiologia , Área Pré-Óptica/fisiologia
13.
Science ; 251(4995): 813-4, 1991 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-17775460
14.
Soc Sci Med ; 45(9): 1337-55, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9351153

RESUMO

Randomized controlled trials (RCTs) are widely accepted by the scientific community as the most rigorous way of evaluating interventions in health care. Although their central feature, random allocation of treatment, is generally seen as methodologically appropriate, its application has caused much debate amongst health professionals and ethicists. This paper describes the views of parents who consented that their critically ill newborn baby should be enrolled in a neonatal trial. In-depth interviews were used to determine their response to the trial and randomization. The nature of the trial was often poorly understood. The random basis of the allocation of treatment and the rationale behind this approach were also problematic issues. Some parents did not perceive a random element in the process at all. These findings advance understanding of the perceptions of trial participants and raise important issues for those concerned with RCTs. Greater understanding of participants' views provides the potential to improve the management of future trials and so the experience of those agreeing to take part.


Assuntos
Ética Médica , Oxigenação por Membrana Extracorpórea , Consentimento Livre e Esclarecido , Pais/educação , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Pais/psicologia , Educação de Pacientes como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/psicologia , Resultado do Tratamento , Reino Unido
15.
J Comp Psychol ; 106(3): 254-61, 1992 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1395495

RESUMO

In Experiment 1, infant rhesus monkeys (Macaca mulatta) were separated and then reunited with mothers, united with a male, or placed in an empty cage. Infants girned more when with mothers or the male than when alone. Girns declined over time when infants were united with the male. Coo rates were high when the infant was alone or with the male. Shrieks, barks, and fear-related behavior were higher with the male. In Experiment 2 the vocalizations of infants were examined during separation when alone or when mothers or a male were in the same room. Infants cooed more when mothers or a male were present. Cooing increased over time, with a greater increase in the mothers' presence. Girns were given to both mothers and males, but more were given to mothers. Coos and girns are both affiliative vocalizations but are differentially modulated as infants cease cooing when they receive contact comfort.


Assuntos
Macaca mulatta , Vocalização Animal , Comunicação Animal , Animais , Animais Recém-Nascidos , Comportamento Animal , Feminino , Masculino , Relações Mãe-Filho , Apego ao Objeto , Projetos de Pesquisa
16.
Arch Dis Child Fetal Neonatal Ed ; 89(3): F208-11, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15102721

RESUMO

BACKGROUND: Interviews with neonatologists in a related study had revealed a degree of discomfort with approaching bereaved parents for postmortem examinations (PMs) and a widespread concern that parents should not be further distressed or feel under pressure to consent. OBJECTIVE: To report the attitudes of bereaved parents to trial related perinatal PMs, in the light of declining perinatal PM rates and poor levels of participation in pathology studies. METHODS: A qualitative study was carried out, using semistructured interviews. The study involved 11 interviews with 18 bereaved parents from five UK neonatal units. The parents had consented to the enrolment of their baby in one of two neonatal trials. RESULTS: The data provide support for the careful approach described by neonatologists in a related study, but also suggest that it may be possible to approach more parents without undermining their wellbeing. The interviews show the variety of reactions to PMs that one would expect, from parents who were clear that they did not want a PM to others who felt that they needed the information from the examination. Between these extremes were parents who were initially discomforted by the idea but who then made the decision to go ahead. Parents who elected to have a PM did so for their own needs, or to contribute to a trial, or for both reasons. The fact that the subject was raised was generally not seen as inappropriate, and none stated that they felt that they were actually pressured into making their decision. The data also suggest that for some parents the degree of caution and selectivity exercised by the neonatologists may not be entirely appropriate. In two cases, consent for the PM was driven by a sense of making an altruistic contribution to research, and, in another two, altruism was expressed in the context of their own desire for information from a PM. CONCLUSIONS: It is important to determine whether trial related pathology studies are considered by professionals and lay people to be worth while and feasible. If there is support for such studies, the challenge is to develop the means to approach more parents in the most sensitive way.


Assuntos
Atitude , Autopsia , Luto , Pais , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Recém-Nascido , Masculino
17.
Arch Dis Child Fetal Neonatal Ed ; 89(3): F204-7, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15102720

RESUMO

OBJECTIVE: To describe the attitudes of neonatologists to trial related perinatal postmortem examinations (PMs), in the light of declining perinatal PM rates and poor levels of participation in pathology studies. METHODS: A qualitative study was carried out, using semistructured interviews. Twenty six neonatologists from five UK neonatal units were interviewed; five UK perinatal pathologists also contributed to the study. The professionals involved were all linked to one or both of two neonatal trials. RESULTS: Pathologists expressed concern over the difficulties experienced in UK perinatal pathology and the impact on research of inadequate levels of samples. The interviews with neonatologists reveal discomfort over approaching bereaved parents for PMs, and a widespread concern that parents should not be further distressed or feel under pressure to consent. Although there was support for neonatal trials, the study highlights a view that PMs may be unnecessary if the cause of death seems apparent or when a baby was born prematurely, and a devaluation of PMs among some younger staff. Poor rates of participation in pathology studies may be accounted for by a notable sense of disconnection between trial interventions and pathology studies. CONCLUSIONS: Neonatologists were concerned to protect vulnerable parents and varied in whether they saw this as compatible with inclusion in trial related pathology studies. Dedicated research is needed to document and gain an understanding of the consent process and should examine the usefulness and impact of consent forms. It should assess whether professionals might benefit from training, to help parents to come to their decisions.


Assuntos
Atitude do Pessoal de Saúde , Autopsia , Neonatologia , Patologia Clínica , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Recém-Nascido , Entrevistas como Assunto , Masculino , Pais , Consentimento do Representante Legal , Reino Unido
18.
Arch Dis Child Fetal Neonatal Ed ; 89(3): F200-3, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15102719

RESUMO

Perinatal postmortem rates are declining world wide. In the United Kingdom, perinatal pathology has recently been seriously undermined by controversy. There are important consequences for perinatal trials that include pathology studies. This review looks at the reasons for the decline in perinatal postmortem examinations and the effects on research.


Assuntos
Autopsia , Doenças do Recém-Nascido/patologia , Patologia Clínica/métodos , Atitude , Atitude do Pessoal de Saúde , Causas de Morte , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Pais , Consentimento do Representante Legal , Reino Unido
19.
Am J Primatol ; 12(2): 127-140, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-31973507

RESUMO

Hormonal profiles during postpartum estrus, time of conception, and pregnancy were determined in urine samples from six cotton-top tamarins (Saguinus oedipus oedipus). Noninvasive collection techniques permitted daily sampling throughout lactation and pregnancy. Urinary estrone (E1), estradiol (E2), and both bioactive and immunoreactive luteinizing hormone/chorionic gonadotropin (LH/CG) measures revealed an interval of 19 ± 2.07 (S E M) days between parturition and the postpartum ovulatory LH peak. An increase in both E1 and E2 was seen prior to the LH peak; however, E1 and E2 continued to increase to their highest concentrations after the LH peak. Since postpartum ovulations resulted in pregnancy, neither postpartum estrus nor conception was suppressed by lactation. The length of gestation (measured from the LH peak to parturition) was 183.7 ± 1.14 (S E M) days, which is at least 30 days longer than that previously reported for other callitrichid species. Both E1 and E2 reached their maximum levels during midpregnancy but showed a rapid decline at parturition. Gestational levels of CG were first detectable approximately 20 days after the LH peak and continued to be elevated for approximately 80 days. The Sub-Human Primate Tube Test (SHPTT) for pregnancy did not detect the LH Peak and was less sensitive than other methods in detecting CG. Two RIA methods and a bioassay technique could not distinguish between LH and CG. We concluded that monitoring both estrogen and LH concentration was needed to determine when ovulation occurs in the cotton-top tamarin, since peak values of estrogen are seen after the ovulatory LH peak. Also, these tamarins were pregnant the majority of the time, indicating an unusually high fertility rate in contrast to most noncallitrichid primate species.

20.
Am J Primatol ; 38(1): 85-100, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-31914712

RESUMO

Groups of individually marked cotton-top tamarins (Saguinus oedipus), located in La Reserva Forestal Protectora Serranía de Coraza-Montes de María in Colosó Colombia, were studied over a period of 5 years. Data on group composition, stability, birthing seasons, and dispersal patterns are used to examine the reproductive strategies and tactics used by males and females. Both monogamous groups and groups containing two pregnant females have been observed. All groups contained at least one adult female and male, with several groups containing several adult males and females. Both males and females dispersed to neighboring groups, and there were no sex differences in rates of emigration. Males were more likely to immigrate into a new group following the death/emigration of a resident male. Females appeared to tolerate immigrating females but would actively defend their breeding position during fertile periods. © 1996 Wiley-Liss, Inc.

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