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1.
Nat Mater ; 22(4): 459-465, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36658327

ABSTRACT

Spin-valley locking is ubiquitous among transition metal dichalcogenides with local or global inversion asymmetry, in turn stabilizing properties such as Ising superconductivity, and opening routes towards 'valleytronics'. The underlying valley-spin splitting is set by spin-orbit coupling but can be tuned via the application of external magnetic fields or through proximity coupling. However, only modest changes have been realized to date. Here, we investigate the electronic structure of the V-intercalated transition metal dichalcogenide V1/3NbS2 using microscopic-area spatially resolved and angle-resolved photoemission spectroscopy. Our measurements and corresponding density functional theory calculations reveal that the bulk magnetic order induces a giant valley-selective Ising coupling exceeding 50 meV in the surface NbS2 layer, equivalent to application of a ~250 T magnetic field. This energy scale is of comparable magnitude to the intrinsic spin-orbit splittings, and indicates how coupling of local magnetic moments to itinerant states of a transition metal dichalcogenide monolayer provides a powerful route to controlling their valley-spin splittings.

2.
Osteoporos Int ; 32(2): 333-341, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32808139

ABSTRACT

Among 4238 cancer and 16,418 cancer-free individuals with incident major non-traumatic fractures (hip, clinical vertebral, forearm, humerus), post-fracture osteoporosis care was equally poor for both groups, whether assessed from bone mineral density (BMD) testing, initiation of osteoporosis therapy or either intervention (BMD testing and/or osteoporosis therapy). INTRODUCTION: Most individuals sustaining a fracture do not undergo evaluation and/or treatment for osteoporosis. Cancer survivors are at increased risk for osteoporosis and fracture. Whether cancer survivors experience a similar post-fracture "care gap" is unclear. Using population-based databases, we assessed whether cancer patients are evaluated and/or treated for osteoporosis after a major fracture. METHODS: From the Manitoba Cancer Registry, we identified cancer cases (first cancer diagnosis between 1987 and 2013) and cancer-free controls with incident major non-traumatic fractures (from provincial physician billing claims and hospitalization databases). The outcomes were performance of BMD testing (from the BMD Registry), initiation of osteoporosis therapy (from drug dispensation database) or either intervention (BMD testing and/or osteoporosis therapy) in the 12 months post-fracture. RESULTS: There were 4238 cancer and 16,418 cancer-free individuals who sustained a fracture after the index date (cancer diagnosis) and were followed for at least 1 year post-fracture. Subsequent BMD testing was performed in 11.0% of cancer cases versus 11.5% non-cancer controls (P = 0.43), osteoporosis treatment in 22.9% cancer cases versus 21.8% non-cancer controls (P = 0.15), and either testing or treatment in 28.9% cancer cases versus 28.4% non-cancer controls (P = 0.53). Predictors of BMD testing and/or initiation of therapy were similar for non-cancer and cancer patients. Post-fracture interventions were consistently used more frequently among women, older patients (age 50 years or older), those who sustained fractures in a later calendar period, and (for treatment) after vertebral fracture. Cancer-specific variables (cancer type, years from cancer diagnosis to fracture, specialty of care provider) showed only weak and inconsistent effects. CONCLUSIONS: A large care gap exists among cancer patients who sustain a fracture, similar to the general population, whereby the evaluation or treatment for osteoporosis is seldom conducted. Care maps may need to be developed for cancer populations to improve post-fracture care.


Subject(s)
Bone Density Conservation Agents , Fractures, Bone , Neoplasms , Osteoporosis , Osteoporotic Fractures , Bone Density , Bone Density Conservation Agents/therapeutic use , Female , Humans , Manitoba/epidemiology , Middle Aged , Neoplasms/complications , Neoplasms/epidemiology , Osteoporosis/drug therapy , Osteoporosis/epidemiology , Osteoporosis/etiology , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/etiology , Osteoporotic Fractures/prevention & control
3.
Osteoporos Int ; 29(9): 2101-2109, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29858634

ABSTRACT

The American Orthopaedic Association initiated the Own the Bone (OTB) quality improvement program in 2009. Herein we show that the data collected through this program is similar to that collected in other large studies. Thus, the OTB registry functions as an externally valid cohort for studying fragility fracture patients. INTRODUCTION: The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry. METHODS: The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world. RESULTS: Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures. CONCLUSION: OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.


Subject(s)
Osteoporotic Fractures/epidemiology , Quality Improvement , Registries , Secondary Prevention/standards , Age Distribution , Aged , Aged, 80 and over , Bone Density/physiology , Bone Density Conservation Agents/therapeutic use , Databases, Factual , Drug Utilization/statistics & numerical data , Female , Humans , Male , Middle Aged , Osteoporosis/drug therapy , Osteoporotic Fractures/physiopathology , Osteoporotic Fractures/prevention & control , Sex Distribution , United States/epidemiology
4.
Child Care Health Dev ; 44(4): 583-591, 2018 07.
Article in English | MEDLINE | ID: mdl-29460321

ABSTRACT

BACKGROUND: Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses. METHODS: Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. RESULTS: Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). CONCLUSIONS: Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.


Subject(s)
Health Knowledge, Attitudes, Practice , Health Policy , Immunization Programs/statistics & numerical data , Parents/psychology , Patient Acceptance of Health Care/statistics & numerical data , Vaccination/statistics & numerical data , Australia , Child , Child, Preschool , Family Characteristics , Female , Humans , Infant , Longitudinal Studies , Male , Parents/education , Time Factors , Vaccination/psychology
5.
J Clin Microbiol ; 55(7): 2074-2085, 2017 07.
Article in English | MEDLINE | ID: mdl-28446570

ABSTRACT

Achromobacter species are increasingly being detected in cystic fibrosis (CF) patients, with an unclear epidemiology and impact. We studied a cohort of patients attending a Canadian adult CF clinic who had positive sputum cultures for Achromobacter species in the period from 1984 to 2013. Infection was categorized as transient or persistent (≥50% positive cultures for 1 year). Those with persistent infection were matched 2:1 with age-, sex-, and time-matched controls without a history of Achromobacter infection, and mixed-effects models were used to assess pulmonary exacerbation (PEx) frequency and lung function decline. Isolates from a biobank were retrospectively assessed, identified to the species level by nrdA sequencing, and genotyped using pulsed-field gel electrophoresis (PFGE). Thirty-four patients (11% of those in our clinic), with a median age of 24 years (interquartile range [IQR], 20.3 to 29.8 years), developed Achromobacter infection. Ten patients (29%) developed persistent infection. Persistence did not denote permanence, as most patients ultimately cleared infection, often after years. Patients were more likely to experience PEx at incident isolation than at prior or subsequent visits (odds ratio [OR], 2.7 [95% confidence interval {CI}, 1.2 to 6.7]; P = 0.03). Following persistent infection, there was no difference in annual lung function decline (-1.08% [95% CI, -2.73 to 0.57%] versus -2.74% [95% CI, -4.02 to 1.46%]; P = 0.12) or the odds of PEx (OR, 1.21 [95% CI, 0.45 to 3.28]; P = 0.70). Differential virulence among Achromobacter species was not observed, and no cases of transmission occurred. We demonstrated that incident Achromobacter infection was associated with a greater risk of PEx; however, neither transient nor chronic infection was associated with a worsened long-term prognosis. Large, multicenter studies are needed to clarify the clinical impact, natural history, and transmissibility of Achromobacter.


Subject(s)
Achromobacter/isolation & purification , Cystic Fibrosis/complications , Gram-Negative Bacterial Infections/epidemiology , Achromobacter/classification , Achromobacter/genetics , Adolescent , Adult , Female , Follow-Up Studies , Gram-Negative Bacterial Infections/pathology , Humans , Male , North America/epidemiology , Prevalence , Respiratory Function Tests , Retrospective Studies , Treatment Outcome , Young Adult
6.
Phys Rev Lett ; 118(26): 261301, 2017 Jun 30.
Article in English | MEDLINE | ID: mdl-28707937

ABSTRACT

The first searches for axions and axionlike particles with the Large Underground Xenon experiment are presented. Under the assumption of an axioelectric interaction in xenon, the coupling constant between axions and electrons g_{Ae} is tested using data collected in 2013 with an exposure totaling 95 live days ×118 kg. A double-sided, profile likelihood ratio statistic test excludes g_{Ae} larger than 3.5×10^{-12} (90% C.L.) for solar axions. Assuming the Dine-Fischler-Srednicki-Zhitnitsky theoretical description, the upper limit in coupling corresponds to an upper limit on axion mass of 0.12 eV/c^{2}, while for the Kim-Shifman-Vainshtein-Zhakharov description masses above 36.6 eV/c^{2} are excluded. For galactic axionlike particles, values of g_{Ae} larger than 4.2×10^{-13} are excluded for particle masses in the range 1-16 keV/c^{2}. These are the most stringent constraints to date for these interactions.

7.
Phys Rev Lett ; 118(25): 251302, 2017 Jun 23.
Article in English | MEDLINE | ID: mdl-28696768

ABSTRACT

We present experimental constraints on the spin-dependent WIMP-nucleon elastic cross sections from the total 129.5 kg yr exposure acquired by the Large Underground Xenon experiment (LUX), operating at the Sanford Underground Research Facility in Lead, South Dakota (USA). A profile likelihood ratio analysis allows 90% C.L. upper limits to be set on the WIMP-neutron (WIMP-proton) cross section of σ_{n}=1.6×10^{-41} cm^{2} (σ_{p}=5×10^{-40} cm^{2}) at 35 GeV c^{-2}, almost a sixfold improvement over the previous LUX spin-dependent results. The spin-dependent WIMP-neutron limit is the most sensitive constraint to date.

8.
Phys Rev Lett ; 118(2): 021303, 2017 Jan 13.
Article in English | MEDLINE | ID: mdl-28128598

ABSTRACT

We report constraints on spin-independent weakly interacting massive particle (WIMP)-nucleon scattering using a 3.35×10^{4} kg day exposure of the Large Underground Xenon (LUX) experiment. A dual-phase xenon time projection chamber with 250 kg of active mass is operated at the Sanford Underground Research Facility under Lead, South Dakota (USA). With roughly fourfold improvement in sensitivity for high WIMP masses relative to our previous results, this search yields no evidence of WIMP nuclear recoils. At a WIMP mass of 50 GeV c^{-2}, WIMP-nucleon spin-independent cross sections above 2.2×10^{-46} cm^{2} are excluded at the 90% confidence level. When combined with the previously reported LUX exposure, this exclusion strengthens to 1.1×10^{-46} cm^{2} at 50 GeV c^{-2}.

9.
Osteoporos Int ; 27(2): 499-507, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26294292

ABSTRACT

UNLABELLED: This study evaluates the incidence of bone fractures in women with BC.We found that women with invasive breast cancer are at an increased risk for bone fractures, with fractures most commonly occurring at lower extremity and vertebral sites. The risk is further increased in women undergoing cancer therapy. INTRODUCTION: Bone loss and fractures in breast cancer have generally been attributed to aromatase inhibitor use. This study assessed the incidence of fractures after invasive breast cancer diagnosis and evaluated bone density and FRAX risk calculation at time of fracture occurrence. METHODS: Retrospective cohort study of women with invasive breast cancer [June 2003-December 2011] who participated in an academic hospital based genetic biobank. Demographic and clinical characteristics were abstracted from the electronic medical record (EMR). RESULTS: A total of 422 women with invasive breast cancer were assessed; 79 (28 %) sustained fractures during the observation period; fractures occurred at multiple skeletal sites in 27 cases (116 fractures). The incidence of fractures was 40 per 1000 person-years. Women who sustained fractures were mostly white and had a family history of osteoporosis (36.9 %, p = 0.03) or history of a prior fracture (6/79, p = 0.004). Fractures occurred 4.0 years (range 0-12 years) after cancer diagnosis. Fracture cases had femoral neck bone mineral density (BMD) of 0.72 + 0.12 g/cm(2), T-score of -1.2, that is, within the low bone mass range. Fractures most commonly occurred in lower extremities, vertebral, and wrist sites. Hip fractures accounted for 11 % of fractures, occurring at a median age of 61 years. CONCLUSIONS: Fractures occur shortly after commencing cancer therapy. Rapid bone loss associated with cancer therapy may precipitate fractures. Fractures occur at relatively higher BMD in BC. Occurrence of fractures in invasive breast cancer raises the possibility of cancer-induced impairment in bone quality.


Subject(s)
Breast Neoplasms/epidemiology , Osteoporotic Fractures/epidemiology , Absorptiometry, Photon/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Bone Density/physiology , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/physiopathology , Female , Humans , Illinois/epidemiology , Incidence , Middle Aged , Neoplasm Invasiveness , Osteoporosis/epidemiology , Osteoporosis/physiopathology , Osteoporotic Fractures/etiology , Osteoporotic Fractures/physiopathology , Retrospective Studies
10.
Phys Rev Lett ; 116(16): 161301, 2016 Apr 22.
Article in English | MEDLINE | ID: mdl-27152785

ABSTRACT

We present constraints on weakly interacting massive particles (WIMP)-nucleus scattering from the 2013 data of the Large Underground Xenon dark matter experiment, including 1.4×10^{4} kg day of search exposure. This new analysis incorporates several advances: single-photon calibration at the scintillation wavelength, improved event-reconstruction algorithms, a revised background model including events originating on the detector walls in an enlarged fiducial volume, and new calibrations from decays of an injected tritium ß source and from kinematically constrained nuclear recoils down to 1.1 keV. Sensitivity, especially to low-mass WIMPs, is enhanced compared to our previous results which modeled the signal only above a 3 keV minimum energy. Under standard dark matter halo assumptions and in the mass range above 4 GeV c^{-2}, these new results give the most stringent direct limits on the spin-independent WIMP-nucleon cross section. The 90% C.L. upper limit has a minimum of 0.6 zb at 33 GeV c^{-2} WIMP mass.

11.
Phys Rev Lett ; 116(16): 161302, 2016 Apr 22.
Article in English | MEDLINE | ID: mdl-27152786

ABSTRACT

We present experimental constraints on the spin-dependent WIMP (weakly interacting massive particle)-nucleon elastic cross sections from LUX data acquired in 2013. LUX is a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility (Lead, South Dakota), which is designed to observe the recoil signature of galactic WIMPs scattering from xenon nuclei. A profile likelihood ratio analysis of 1.4×10^{4} kg day of fiducial exposure allows 90% C.L. upper limits to be set on the WIMP-neutron (WIMP-proton) cross section of σ_{n}=9.4×10^{-41} cm^{2} (σ_{p}=2.9×10^{-39} cm^{2}) at 33 GeV/c^{2}. The spin-dependent WIMP-neutron limit is the most sensitive constraint to date.

12.
J Xray Sci Technol ; 23(6): 791-7, 2015.
Article in English | MEDLINE | ID: mdl-26756414

ABSTRACT

X-ray backscatter imaging can be used for a wide range of imaging applications, in particular for industrial inspection and portal security. Currently, the application of this imaging technique to the detection of landmines is limited due to the surrounding sand or soil strongly attenuating the 10s to 100s of keV X-rays required for backscatter imaging. Here, we introduce a new approach involving a 140 MeV short-pulse (< 100 fs) electron beam generated by laser wakefield acceleration to probe the sample, which produces Bremsstrahlung X-rays within the sample enabling greater depths to be imaged. A variety of detector and scintillator configurations are examined, with the best time response seen from an absorptive coated BaF2 scintillator with a bandpass filter to remove the slow scintillation emission components. An X-ray backscatter image of an array of different density and atomic number items is demonstrated. The use of a compact laser wakefield accelerator to generate the electron source, combined with the rapid development of more compact, efficient and higher repetition rate high power laser systems will make this system feasible for applications in the field. Content includes material subject to Dstl (c) Crown copyright (2014). Licensed under the terms of the Open Government Licence except where otherwise stated. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@ nationalarchives.gsi.gov.uk.


Subject(s)
Bombs/classification , Lasers , Radiographic Image Enhancement/instrumentation , Scattering, Radiation , Tomography, X-Ray Computed/instrumentation , Warfare , Equipment Design , Equipment Failure Analysis , Phantoms, Imaging , X-Rays
13.
Histochem Cell Biol ; 141(1): 85-99, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24043511

ABSTRACT

Hepatic stellate cells (HSCs) play an important role in several (patho)physiologic conditions in the liver. In response to chronic injury, HSCs are activated and change from quiescent to myofibroblast-like cells with contractile properties. This shift in phenotype is accompanied by a change in expression of intermediate filament (IF) proteins. HSCs express a broad, but variable spectrum of IF proteins. In muscle, syncoilin was identified as an alpha-dystrobrevin binding protein with sequence homology to IF proteins. We investigated the expression of syncoilin in mouse and human HSCs. Syncoilin expression in isolated and cultured HSCs was studied by qPCR, Western blotting, and fluorescence immunocytochemistry. Syncoilin expression was also evaluated in other primary liver cell types and in in vivo-activated HSCs as well as total liver samples from fibrotic mice and cirrhotic patients. Syncoilin mRNA was present in human and mouse HSCs and was highly expressed in in vitro- and in vivo-activated HSCs. Syncoilin protein was strongly upregulated during in vitro activation of HSCs and undetectable in hepatocytes and liver sinusoidal endothelial cells. Syncoilin mRNA levels were elevated in both CCl4- and common bile duct ligation-treated mice. Syncoilin immunocytochemistry revealed filamentous staining in activated mouse HSCs that partially colocalized with α-smooth muscle actin, ß-actin, desmin, and α-tubulin. We show that in the liver, syncoilin is predominantly expressed by activated HSCs and displays very low-expression levels in other liver cell types, making it a good marker of activated HSCs. During in vitro activation of mouse HSCs, syncoilin is able to form filamentous structures or at least to closely interact with existing cellular filaments.


Subject(s)
Hepatic Stellate Cells/metabolism , Intermediate Filament Proteins/metabolism , Liver/pathology , Muscle Proteins/metabolism , Actins/pharmacokinetics , Animals , Carbon Tetrachloride/pharmacology , Cell Differentiation , Cell Line , Desmin/pharmacology , Fibrosis/pathology , HEK293 Cells , Hepatic Stellate Cells/cytology , Hepatocytes/pathology , Humans , Intermediate Filament Proteins/genetics , Intermediate Filament Proteins/pharmacokinetics , Liver/cytology , Male , Mice , Mice, Inbred BALB C , Muscle Proteins/genetics , Muscle Proteins/pharmacokinetics , RNA Interference , RNA, Messenger/biosynthesis , RNA, Small Interfering , Tubulin/pharmacokinetics
14.
Phys Rev Lett ; 112(9): 091303, 2014 Mar 07.
Article in English | MEDLINE | ID: mdl-24655239

ABSTRACT

The Large Underground Xenon (LUX) experiment is a dual-phase xenon time-projection chamber operating at the Sanford Underground Research Facility (Lead, South Dakota). The LUX cryostat was filled for the first time in the underground laboratory in February 2013. We report results of the first WIMP search data set, taken during the period from April to August 2013, presenting the analysis of 85.3 live days of data with a fiducial volume of 118 kg. A profile-likelihood analysis technique shows our data to be consistent with the background-only hypothesis, allowing 90% confidence limits to be set on spin-independent WIMP-nucleon elastic scattering with a minimum upper limit on the cross section of 7.6 × 10(-46) cm(2) at a WIMP mass of 33 GeV/c(2). We find that the LUX data are in disagreement with low-mass WIMP signal interpretations of the results from several recent direct detection experiments.

15.
J Clin Microbiol ; 50(2): 318-25, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22135252

ABSTRACT

This study investigated "creep" in vancomycin and daptomycin MICs among methicillin-resistant Staphylococcus aureus (MRSA) isolates from blood cultures over a 5-year period in a hospital in the United Kingdom, using different susceptibility testing methods. Trends in vancomycin and daptomycin susceptibility were evaluated by using Etest performed prospectively on isolates in routine clinical practice from December 2007 to December 2010 (n = 102). Comparison was made to results from prospective testing of subcultures at the Scottish MRSA Reference Laboratory, using an automated system (Vitek 2) and retrospective testing (Etest and CLSI reference broth microdilution [BMD] method) of stored isolates from 2006 to 2010 (n = 208). Spearman's rank correlations revealed a significant increase in vancomycin MIC (P = 0.012) and a significant decrease in daptomycin MIC (P = 0.03) by year of study for Etest results from the time of isolation. However, neither trend was replicated in MICs from automated or retrospective testing. The Friedman test revealed a significant difference between vancomycin MICs obtained from the same samples by different testing methods (χ(2) [3 degrees of freedom] = 97; P < 0.001). MICs from automated testing and Etest analysis of stored isolates were significantly lower than those from Etest analysis at the time of isolation for both antibiotics (P < 0.001). Effects of storage on the MIC appeared within the first 6 months of storage. Inconsistent evidence on vancomycin MIC creep and the relevance of the MIC to clinical outcome may arise from differences in susceptibility testing methods, including storage of isolates. There is a need to standardize and streamline susceptibility testing of vancomycin against MRSA.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Vancomycin Resistance , Vancomycin/pharmacology , Blood/microbiology , Daptomycin/pharmacology , Humans , Microbial Sensitivity Tests/methods , Prospective Studies , Retrospective Studies , Scotland , Time Factors
16.
Osteoporos Int ; 23(10): 2489-98, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22273834

ABSTRACT

UNLABELLED: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. INTRODUCTION: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age. METHODS: Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009. RESULTS: Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. CONCLUSION: An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.


Subject(s)
Electronic Health Records/organization & administration , Osteoporosis/drug therapy , Osteoporotic Fractures/prevention & control , Aged , Attitude of Health Personnel , Bone Density Conservation Agents/therapeutic use , Calcium/therapeutic use , Female , Focus Groups , Health Knowledge, Attitudes, Practice , Hospitalization , Humans , Illinois , Male , Middle Aged , Osteoporosis/diagnosis , Patient Education as Topic/methods , Patient-Centered Care/organization & administration , Quality Improvement/organization & administration
17.
Rev Sci Tech ; 31(1): 135-44, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22849273

ABSTRACT

This paper focuses on antimicrobial stewardshipin human healthcare, and some concepts possibly transferable to veterinary medicine. Antimicrobial stewardship is a multidisciplinary effort to reduce antimicrobial resistance in human pathogens, when future drug development is dwindling. These strategies encourage healthcare staff to use antimicrobials prudently and, when needed, for as short a duration and with as narrow a spectrum as possible. Various methods are involved in stewardship within the healthcare setting, often implemented simultaneously, which sometimes makes evaluation of specific measures difficult. All healthcare workers must accept responsibility for stewardship, although the role of infectious diseases physicians, microbiologists, pharmacists and infection control practitioners is crucial, as are appropriate surveillance systems and information technology. Support from management and government is also beneficial. Considering the frequent use of antimicrobials in animals, it would seem sensible to apply a similarly critical approach to conserve the efficacy of the antimicrobials still available, now and in the future.


Subject(s)
Anti-Infective Agents/administration & dosage , Drug Resistance, Microbial , Drug Utilization/standards , Interdisciplinary Communication , Animals , Drug Utilization Review , Global Health , Humans
19.
Sci Total Environ ; 765: 142679, 2021 Apr 15.
Article in English | MEDLINE | ID: mdl-33077226

ABSTRACT

Concentrations of dissolved organic carbon (DOC) have increased in lakes throughout North America and Europe over the last three decades. Recovery from acid deposition and climate change have both been postulated as the primary mechanisms for the increase in DOC. To provide a clearer insight into the mechanisms responsible for increasing DOC we evaluated changes in lake and peat porewater chemistry collected in an area of approximately 33,000 km2 surrounding Sudbury, Ontario, a region undergoing dramatic recovery from acidic deposition. DOC concentrations varied considerably among the 44 lakes and over time (samples annually from 1981 to 2018), but the Sens Slope value showed a strong increase in lake DOC concentration over time, at 0.05 mg/ L y-1 (p < 0.001) that was related to increasing pH [0.03 units y-1, p < 0.001] and decreasing lake SO4 concentration [-0.24 mg/ L y-1; p < 0.001], but showed no relationship with temperature or precipitation. Similar strong relationships between DOC and pH (positive) and SO4 (negative) were observed in 18 peatlands sampled in the region. In a spatial analysis of 82 lakes sampled in 2018, concentrations of DOC in lakes were highest in flatter catchments with a greater wetland area, suggesting that wetlands are a major source of DOC in lakes. Optical properties of DOC obtained from extracts of wetland and upland soils at 6 catchments could be distinguished, primarily due to upland litter extracts having distinct optical properties from mineral soils or wetland soils. Optical properties of DOC in lakes however were inconsistent with those measured in soil extracts indicating that they are not useful for distinguishing DOC sources in these lakes. A predictive model was developed to explain DOC trends within Sudbury lakes using a stepwise linear regression combined with hierarchical partitioning to confirm the most influential processes on DOC. Almost 50% of the variability in DOC change in the 44 lakes was explained by the magnitude in lake pH change, catchment size and catchment sparse tree cover showing that recovery from acidic deposition is overwhelmingly responsible for increasing DOC in Sudbury lakes.

20.
Scand J Med Sci Sports ; 20(4): 662-9, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19793214

ABSTRACT

In an in vivo laboratory controlled study, 12 healthy male students cycled at self-chosen work-rates while listening to a program of six popular music tracks of different tempi. The program lasted about 25 min and was performed on three occasions--unknown to the participants, its tempo was normal, increased by 10% or decreased by 10%. Work done, distance covered and cadence were measured at the end of each track, as were heart rate and subjective measures of exertion, thermal comfort and how much the music was liked. Speeding up the music program increased distance covered/unit time, power and pedal cadence by 2.1%, 3.5% and 0.7%, respectively; slowing the program produced falls of 3.8%, 9.8% and 5.9%. Average heart rate changes were +0.1% (faster program) and -2.2% (slower program). Perceived exertion and how much the music was liked increased (faster program) by 2.4% and 1.3%, respectively, and decreased (slower program) by 3.6% and 35.4%. That is, healthy individuals performing submaximal exercise not only worked harder with faster music but also chose to do so and enjoyed the music more when it was played at a faster tempo. Implications of these findings for improving training regimens are discussed.


Subject(s)
Acoustic Stimulation/psychology , Athletic Performance/physiology , Bicycling/physiology , Music , Adolescent , Humans , Male , Young Adult
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