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1.
Transplant Direct ; 10(9): e1692, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39220219

RESUMEN

Background: Organ transplantation is a well-established intervention but is reliant on the donation of organs and tissues, mostly from deceased donors. The proportion of Australians proceeding to organ donation (OD) has increased, but the proportion of Indigenous Australians proceeding remains two-thirds that of non-Indigenous Australians. We sought to explore perceived barriers and enablers for the involvement of Indigenous peoples in the OD process. Methods: Qualitative methodology centered around focus groups was used to capture the experiences and perspectives of Indigenous people regarding OD. A purposively sampled group of Aboriginal Liaison Officers working within the Alice Springs Hospital Intensive Care Unit (ASH ICU) participated in up to 6 focus groups during 2021 with subsequent thematic analysis of the enablers and barriers to Indigenous participation in the OD process. The ASH ICU is the only ICU servicing Central Australia, and 70% of admissions are Indigenous patients. Results: Four primary themes emerged: OD is a new and culturally taboo topic; conversations related to OD are confronting; education is needed (both about OD and cultural education for clinicians); and lack of trust in the healthcare system. Conclusions: There are cultural barriers to engaging in the OD process and clinicians need more training on the delivery of culturally safe communication is needed. Despite this, there was a recognition that OD is important. Education about OD needs to be place based, culturally and linguistically appropriate, informed by local knowledge, delivered in community, and occur before a family member is admitted to ICU.

2.
Cardiovasc Diagn Ther ; 14(4): 725-730, 2024 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-39263474

RESUMEN

Indigenous Australians are known to have a higher prevalence of coronary artery disease (CAD) than non-Indigenous counterparts. Atherogenic lipid profiles, characterised by low serum levels of high-density lipoprotein (HDL) and higher serum triglycerides, have been shown to be more prevalent in Indigenous Australians. The use of computed tomography coronary angiography (CTCA) for risk stratification and diagnosis of CAD has been validated in moderate risk populations, but limited data exists in specific high-risk populations such as Indigenous Australians. Through a retrospective study of patient records, we aimed to confirm if an atherogenic lipid profile occurred in Indigenous Australians undergoing CTCA in the Northern Territory of Australia and if so, whether this correlated with the prevalence or burden of CAD. We demonstrate that Indigenous Australians have similar prevalence (52.6% vs. 50.3%, P=0.80) and burden of CAD (Leaman score 6.03±4.66 vs. 6.96±4.82, P=0.44) on CTCA as non-Indigenous patients, but were 8 years younger (41.9±8.9 vs. 50.0±11.9 years, P<0.001) at the time of examination. We confirmed the presence of an atherogenic lipid profile in Indigenous patients and showed low serum-HDL was associated with very premature (patients aged 18-35 years) CAD in comparison to premature (patients aged 36-55 years) and mature-onset (patients aged 56 years and older) CAD (0.71±0.25 vs. 1.09±0.35 vs. 1.18±0.36 mmol/L, P=0.009). Future clinical guidelines should consider the role of CTCA in Indigenous Australians and whether younger patients may benefit. The causes of premature CAD, including atherogenic lipid profiles, require an ongoing focus in order to achieve equitable cardiovascular outcomes for Indigenous and non-Indigenous Australians.

3.
Prim Care Diabetes ; 18(5): 547-554, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39232978

RESUMEN

AIMS: Diabetic nephropathy, vision loss and diabetic retinopathy (DR) are frequent comorbidities among individuals with type 2 diabetes (T2D). The Retinopathy in People Currently On Renal Dialysis (RiPCORD) study sought to examine the epidemiology and risk of vision impairment (VI) and DR among a cohort of Indigenous and non-Indigenous Australians with T2D currently receiving haemodialysis for end-stage renal failure (ESRF). METHODS: A total of 106 Indigenous and 109 non-Indigenous Australians were recruited in RiPCORD across five haemodialysis centres in urban and remote settings. Clinical assessments, questionnaires and medical record data determined the rates of ocular complications and risk factor profiles. RESULTS: Prevalence rates include unilateral VI, 23.5 %; bilateral VI, 11.7 %; unilateral blindness, 14.2 %; and bilateral blindness, 3.7 %, with no significant differences between sub-cohorts (p=0.30). DR prevalence rates were 78.0 % among non-Indigenous Australians and 93.1 % among Indigenous Australians (p=<0.001). Non-Indigenous ethnicity (OR: 0.28) and pre-dialysis diastolic blood pressure (OR: 0.84 per 10-mmHg) were protective, while peripheral vascular disease (OR: 2.79) increased DR risk. CONCLUSIONS: Ocular complications among individuals with T2D and ESRF are disproportionately high, especially for Indigenous Australians, and beyond what can be accounted for by risk factor variation. Findings suggest a need to improve screening and preventative efforts within this high-risk population group.


Asunto(s)
Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Retinopatía Diabética , Fallo Renal Crónico , Diálisis Renal , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Australia/epidemiología , Ceguera/epidemiología , Ceguera/diagnóstico , Ceguera/etnología , Ceguera/etiología , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/etnología , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/terapia , Retinopatía Diabética/epidemiología , Retinopatía Diabética/etnología , Retinopatía Diabética/diagnóstico , Fallo Renal Crónico/terapia , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etnología , Modelos Logísticos , Oportunidad Relativa , Prevalencia , Medición de Riesgo , Factores de Riesgo , Aborigenas Australianos e Isleños del Estrecho de Torres
5.
Nat Commun ; 15(1): 7080, 2024 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-39152141

RESUMEN

C4'-modified nucleoside analogues continue to attract global attention for their use in antiviral drug development and oligonucleotide-based therapeutics. However, current approaches to C4'-modified nucleoside analogues still involve lengthy (9-16 steps), non-modular routes that are unamenable to library synthesis. Towards addressing the challenges associated with their syntheses, we report a modular 5-step process to a diverse collection of C4'-modified nucleoside analogues through a sequence of intramolecular trans-acetalizations of readily assembled polyhydroxylated frameworks. Overall, the 2-3 fold reduction in step-count compares favorably to even recently reported biocatalytic approaches and should ultimately enable new opportunities in drug design around this popular chemotype.


Asunto(s)
Nucleósidos , Nucleósidos/química , Nucleósidos/síntesis química , Estereoisomerismo , Antivirales/síntesis química , Antivirales/química , Acetales/química , Diseño de Fármacos
6.
J Clin Med ; 13(15)2024 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-39124559

RESUMEN

Background/Objectives: This retrospective case series analyzed visual outcomes in patients with a prior history of implantable collamer lens (ICL) implantation who underwent cataract extraction (CE). A secondary aim was to investigate the relationship between vault height and the rate of cataract development. Methods: Visual acuity and refraction measurements were collected after CE at one week, one month and six months. Vault height measurements were correlated to the time until symptomatic cataracts were removed. Results: A total of 44 eyes were analyzed at six months after CE with efficacy and safety indexes of 1.20 ± 1.11 and 1.50 ± 1.06, respectively. In addition, 70% of eyes had a post-operative uncorrected distance visual acuity (UDVA) within one line of pre-operative corrected distance visual acuity (CDVA). Refractive predictability at six months demonstrated that 43% and 69% of eyes were within ±0.25 D and ±0.50 D of SEQ target, respectively. Astigmatism measured by refractive cylinder was ≤0.25 D in 17% and ≤0.50 D in 34% of eyes pre-operatively compared to 40% and 60% of eyes, respectively, at six months post-operatively. Vault heights one week after ICL (p < 0.0081) and one week before CE (p < 0.0154) demonstrated a positive linear regression with the time until CE. Conclusions: This sample population achieved favorable visual outcomes six months after CE, similar to six months after ICL implantation. Patients with a history of ICL implantation will similarly have a good visual prognosis after CE.

8.
Med J Aust ; 221(5): 258-263, 2024 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-39140407

RESUMEN

OBJECTIVE: To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale. DESIGN: Prospective diagnostic accuracy study. SETTING: Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. PARTICIPANTS: 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. MAIN OUTCOME MEASURE: Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. RESULTS: The seven-item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ-9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode. CONCLUSION: Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.


Asunto(s)
Depresión , Psicometría , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Australia , Depresión/diagnóstico , Depresión/etnología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/etnología , Tamizaje Masivo/métodos , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/normas , Psicometría/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Encuestas y Cuestionarios/normas , Aborigenas Australianos e Isleños del Estrecho de Torres
9.
J Phys Chem A ; 128(36): 7511-7523, 2024 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-39192559

RESUMEN

Two-photon absorption (2PA), where a pair of photons are absorbed simultaneously, is recognized as a potent bioimaging technique, which depends on the quantified 2PA probability, defined as cross-section (σ2PA). The absorbed photons either have equivalent (ω1 = ω2) or different frequencies (ω1 ≠ ω2), where the former is degenerate 2PA (D-2PA) and the latter is nondegenerate 2PA (ND-2PA). ND-2PA is of particular interest since it is a promising imaging technology with flexibility of photon frequencies and enhanced cross sections, however, it remains a relatively unexplored area compared to D-2PA. This work utilizes time-dependent density functional theory (TD-DFT) and second-order approximate coupled-cluster with the resolution-of-identity approximation (RI-CC2), for the excitation from S0 to S1, to investigate σD-2PA and σND-2PA of FP chromophore models. Interestingly, comparing CAM-B3LYP with the RI-CC2 computations shows qualitative and, in fact, near quantitative agreement in the computed improvements of σND-2PA for comparable (relative) frequency detunings, despite the known underestimations of 2PA cross sections, for TD-DFT results relative to RI-CC2 values. As expected from the 2-state model, the computed values of σND-2PA are quantitatively larger than σD-2PA, where chromophores with the largest values of σD-2PA show greater potential for σND-2PA improvement. Anionic chromophores demonstrated improvements up to 14%, while substantial enhancements were observed in neutral chromophores with some achieving a 30% increase. This work investigates the ND-2PA photophysical characteristics of FP chromophores and identifies qualitative patterns in the computed properties of ND-2PA relative to D-2PA.

10.
Lancet Rheumatol ; 2024 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-38971169

RESUMEN

The first inhabitants of Australia and the traditional owners of Australian lands are the Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander peoples are two to four times more likely to have systemic lupus erythematosus (SLE) than the general Australian population. Phenotypically, SLE appears distinctive in Aboriginal and Torres Strait Islander peoples and its severity is substantially increased, with mortality rates up to six times higher than in the general Australian population with SLE. In particular, Aboriginal and Torres Strait Islander peoples with SLE have increased prevalence of lupus nephritis and increased rates of progression to end-stage kidney disease. The reasons for the increased prevalence and severity of SLE in this population are unclear, but socioeconomic, environmental, and biological factors are all likely to be implicated, although there are no published studies investigating these factors in Aboriginal and Torres Strait Islander peoples with SLE specifically, indicating an important knowledge gap. In this Review, we summarise the data on the incidence, prevalence, and clinical and biological findings relating to SLE in Aboriginal and Torres Strait Islander peoples and explore potential factors contributing to its increased prevalence and severity in this population. Importantly, we identify health disparities and deficiencies in health-care provision that limit optimal care and outcomes for many Aboriginal and Torres Strait Islander peoples with SLE and highlight potentially addressable goals to improve outcomes.

11.
Cureus ; 16(6): e62065, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38989397

RESUMEN

Various etiologies, including diabetic keratopathy (DK), dry eye disease (DED), and neurotrophic keratopathy (NK), can disrupt corneal homeostasis, exacerbating corneal epithelial defects. Topical insulin has emerged as a promising therapy for promoting corneal wound healing and addressing underlying pathologies. This review systematically evaluates the efficacy of topical insulin across different corneal disorders. A literature review was conducted across the PubMed, Google Scholar, and Scopus research databases. The search resulted in a total of 19 articles, consisting of clinical trials, retrospective studies, and case reports. In DK, topical insulin accelerates corneal wound healing post-vitreoretinal surgery with lower concentrations showing higher outcomes when compared to conventional therapy, possibly due to improved epithelial stem cell migration. In comparison, the dry-eye disease results are inconclusive regarding patient-reported outcomes and corneal staining. For NK, topical insulin accelerates corneal wound healing and restores corneal nerve sensation. Other persistent epithelial defect (PED) etiologies that have been treated with topical insulin are infection, immune-mediated, mechanical and chemical trauma, and chronic ocular surface alterations. Although individual mechanisms for the benefits of topical insulin for each of these etiologies have not been studied, the literature demonstrates that topical insulin is efficacious for PEDs regardless of etiology. Future clinical trials need to be conducted to further evaluate optimal dosing, duration, and use of topical insulin for the restoration of the corneal surface.

12.
BMJ Open ; 14(7): e085109, 2024 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-39079726

RESUMEN

BACKGROUND: Australia does not have a national strategy for Aboriginal and Torres Strait Islander adolescent health and as a result, policy and programming actions are fragmented and may not be responsive to needs. Efforts to date have also rarely engaged Aboriginal and Torres Strait Islander people in co-designing solutions. The Roadmap Project aims to work in partnership with young people to define priority areas of health and well-being need and establish the corresponding developmentally appropriate, evidence-based actions. METHODS AND ANALYSIS: All aspects of this project are governed by a group of Aboriginal and Torres Strait Islander young people. Needs, determinants and corresponding responses will be explored with Aboriginal and Torres Strait Islander adolescents (aged 10-24 years) across Australia through an online qualitative survey, interviews and focus group discussions. Parents, service providers and policy makers (stakeholders) will share their perspectives on needs and support required through interviews. Data generated will be co-analysed with the governance group and integrated with population health data, policy frameworks and evidence of effective programmes (established through reviews) to define responsive and effective actions for Aboriginal and Torres Strait Islander adolescent health and well-being. ETHICS AND DISSEMINATION: Ethical approval for this study has been obtained from the Aboriginal Health Council of South Australia (Ref: 04-21-956), the Aboriginal Health and Medical Research Council of New South Wales (Ref: 1918/22), the Western Australian Aboriginal Health Ethics Committee (Ref: HREC1147), the Northern Territory Health and Menzies School of Health Research (Ref: 2022-4371), ACT Health Human Research Ethics Committee (Ref: 2022.ETH.00133), the St. Vincent's Hospital, Victoria (Ref: HREC 129/22), University of Tasmania (Ref: 28020), Far North Queensland Human Research Ethics Committee (Ref: HREC/2023/QCH/89911) and Griffith University (Ref: 2023/135). Prospective adolescent participants will provide their own consent for the online survey (aged 13-24 years) and, interviews or focus group discussions (aged 15-24 years); with parental consent and adolescent assent required for younger adolescents (aged 10-14 years) participating in interviews.Study findings (priority needs and evidence-based responses) will be presented at a series of co-design workshops with adolescents and stakeholders from relevant sectors. We will also communicate findings through reports, multimedia clips and peer-reviewed publications as directed by the governance group.


Asunto(s)
Salud del Adolescente , Servicios de Salud del Indígena , Adolescente , Niño , Femenino , Humanos , Masculino , Adulto Joven , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres , Grupos Focales , Servicios de Salud del Indígena/organización & administración , Investigación Cualitativa , Proyectos de Investigación
13.
Int J Prison Health (2024) ; 20(2): 240-256, 2024 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-38984602

RESUMEN

PURPOSE: Aboriginal and Torres Strait Islander (Aboriginal) people are overrepresented in Australian prisons, where they experience complex health needs. A model of care was designed to respond to the broad needs of the Aboriginal prisoner population within the nine adult prisons across South Australia. The purpose of this paper is to describe the methods and findings of the Model of Care for Aboriginal and Torres Strait Islander Prisoner Health and Wellbeing for South Australia. DESIGN/METHODOLOGY/APPROACH: The project used a qualitative mixed-method approach, including a rapid review of relevant literature, stakeholder consultations and key stakeholder workshop. The project was overseen by a Stakeholder Reference Group, which met monthly to ensure that the specific needs of project partners, stakeholders and Aboriginal communities were appropriately incorporated into the planning and management of the project and to facilitate access to relevant information and key informants. FINDINGS: The model of care for Aboriginal prisoner health and wellbeing is designed to be holistic, person-centred and underpinned by the provision of culturally appropriate care. It recognises that Aboriginal prisoners are members of communities both inside and outside of prison. It notes the unique needs of remanded and sentenced prisoners and differing needs by gender. SOCIAL IMPLICATIONS: Supporting the health and wellbeing of Indigenous prison populations can improve health outcomes, community health and reduce recidivism. ORIGINALITY/VALUE: Only one other model of care for Aboriginal prisoner health exists in Australia, an Aboriginal Community Controlled Health Organisation-initiated in-reach model of care in one prison in one jurisdiction. The South Australian model of care presents principles that are applicable across all jurisdictions and provides a framework that could be adapted to support Indigenous peoples in diverse prison settings.


Asunto(s)
Aborigenas Australianos e Isleños del Estrecho de Torres , Prisioneros , Adulto , Femenino , Humanos , Masculino , Servicios de Salud del Indígena/organización & administración , Prisioneros/psicología , Prisiones/organización & administración , Investigación Cualitativa , Australia del Sur
14.
PLoS One ; 19(7): e0305472, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39042661

RESUMEN

BACKGROUND: Indigenous populations globally have significantly high rates of type 2 diabetes compared to their non-Indigenous counterparts. This study aims to implement and evaluate the effectiveness of a culturally and contextually informed Aboriginal Diabetes Workforce Training Program on Aboriginal primary health care workforce knowledge, attitude, confidence, skill and practice relating to diabetes care. METHODS: A Cluster Randomised Crossover Control Trial with two arms (Group A and Group B) will be conducted with Aboriginal primary health care services in South Australia. These services primarily provide primary health care to Aboriginal and Torres Strait Islander people. All healthcare service sites will be randomised into groups A and B to receive the training program. The training program consists of three components: 1) Peer support network, 2) E-Learning modules and 3) onsite support. Aboriginal Health Workers of participating sites will be invited to participate in the monthly online peer support network and all chronic disease staff are eligible to participate in the E-Learning modules and onsite support. The Peer Support Network runs for the entirety of the study, 17 months. Training components 2 and 3 occur simultaneously and are 2.5 months in length, with a six-month washout period between the two randomised groups undertaking the training. All primary outcomes of the study relate to diabetes management in a primary health care settings and measure participants' knowledge, attitude, confidence, practice and skills. These will be collected at seven time points across the entire study. Secondary outcomes measure satisfaction of the peer support network using a survey, interviews to understand enablers and barriers to participation, health service systems characteristics through focus groups, and medical record review to ascertain diabetes patients' care received and their clinical outcomes up to 12 months post training intervention. DISCUSSION: The findings will explore the effectiveness of the training program on Aboriginal primary health care provider knowledge, attitude, confidence, skill and practice relating to diabetes care. The final findings will be published in 2027. TRIAL REGISTRATION: The study was prospectively registered in The Australian New Zealand Clinical Trials Registry (ANZCTR), with registration number ACTRN12623000749606 at ANZCTR - Registration. Universal Trial Number (UTN) U1111-1283-5257.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Diabetes Mellitus Tipo 2 , Personal de Salud , Humanos , Estudios Cruzados , Diabetes Mellitus Tipo 2/terapia , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Servicios de Salud del Indígena , Atención Primaria de Salud , Australia del Sur , Ensayos Clínicos Controlados Aleatorios como Asunto , Aborigenas Australianos e Isleños del Estrecho de Torres
15.
Trials ; 25(1): 493, 2024 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-39030640

RESUMEN

BACKGROUND: Aboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology's use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting. METHODS: This is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia. DISCUSSION: The trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2 , Hemoglobina Glucada , Adulto , Humanos , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Control Glucémico , Hipoglucemia/sangre , Hipoglucemia/prevención & control , Hipoglucemiantes/uso terapéutico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento
16.
Phys Chem Chem Phys ; 26(30): 20663-20671, 2024 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-39041061

RESUMEN

Presented in this work is a thorough determination of the transition states between the different isomers of cyclic tetra-atomic silicon carbide, germanium carbide, and germanium silicide clusters. Through use of density functional theory (B3LYP-D3BJ, M06-2X, ωB97X-D4, and B2GP-PLYP) in conjunction with the aug-cc-pVTZ basis set, transition state structures and their barrier heights are determined for the interconversions between the various isomers for the family of tetra-atomic SiC, GeC, and GeSi compounds. SiC dust grains are known to be prevalent in interstellar dust, and among this group, so far only diamond-shaped (d-)SiC3 has been detected in the interstellar medium (ISM). Determining which other structures might be detectable not only depends on their intrinsic spectroscopic features, but whether or not they are likely to exist as isomers in interstellar environments. By examining the energy barrier heights for transitions between isomers, we determined that many of these structures are unlikely to exhibit interconversion in the ISM, outside of hotter circumstellar environments. Although Boltzmann population ratios at approximate circumstellar temperatures suggest the presence of higher energy minima, it is likely that once interconversion happens, as molecules travel away from a star and cool, they will get kinetically trapped in the potential energy well they inhabit, making how the ratios freeze out dependent on the time and pathways the molecules take to cool down. As such, many of these higher energy minima may still be good candidates for detection including (rhomboidal) r-SiC3, r-GeC3, r-GeSi3, (trapezoidal) t-Si2C2, r-Ge2C2, and d-Si3C.

17.
Int Med Case Rep J ; 17: 683-693, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39071183

RESUMEN

Posterior capsular opacification (PCO), also known as "secondary cataract", is a common complication following cataract surgery that can significantly impair visual acuity. The incidence of PCO varies widely in the literature, influenced by intraocular lens (IOL) type and patient risk factors. Neodymium-doped yttrium-aluminum-garnet (YAG) laser posterior capsulotomy is the standard treatment for PCO-related visual impairment. Recurrence of PCO after initial treatment with YAG capsulotomy, though more common in children, is rare in adults. Its underlying pathophysiological mechanisms are similar to that of primary PCO, which includes proliferation, migration, and/or clustering of lens epithelial cells (LECs), with subsequent reclosure of the posterior aperture. Potential risk factors for PCO recurrence that have been speculated through a comprehensive search of the current literature include younger age, female sex, high myopia, diabetes, vitrectomized status, uveitis, low-diopter IOLs, and certain IOL types with higher water content. We present a case of recurrent PCO in a highly myopic 48-year-old male following cataract surgery and implantable collamer lens (ICL) explantation who received a hydrophobic acrylic lens with 4% water content. Surgical techniques that may reduce recurrent PCO occurrence and appropriate postoperative care are emphasized to assist surgeons in their approach to patients at high-risk for this complication.

18.
J Phys Chem A ; 128(27): 5351-5361, 2024 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-38942734

RESUMEN

An extensive, high-level theoretical study on tetra-atomic germanium carbide/silicide clusters is presented. Accurate harmonic and anharmonic vibrational frequencies and rotational constants are calculated at the CCSD(T)-F12a(b)/cc-pVT(Q)Z-F12 levels of theory. With growing capabilities to discern more of the chemical composition of the interstellar medium (ISM), an accurate database of reference material is required. The presence of carbon is ubiquitous in the ISM, and silicon is known to be present in interstellar dust grains; however, germanium-containing molecules remain elusive. To begin understanding the presence and role of germanium in the ISM, we present this study of the vibrational and rotational spectroscopic properties of various germanium-containing molecules to aid in their potential identification in the ISM with modern observational tools such as the James Webb Space Telescope. Structures studied herein include rhomboidal (r-), diamond (d-), and trapezoidal (t-) tetra-atomic molecules of the form GexC4-x and GexSi4-x, where x = 0-4. The most promising structure for detection is r-Ge2C2 via the ν4 mode with a frequency of 802.7 cm-1 (12.5 µm) and an intensity of 307.2 km mol-1. Other molecules that are potentially detectable, i.e., through vibrational modes or rotational transitions, include r-Ge3C, r-GeSi3, d-GeC3, r-GeC3, and t-Ge2C2.

19.
Gigascience ; 132024 01 02.
Artículo en Inglés | MEDLINE | ID: mdl-38837943

RESUMEN

Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.


Asunto(s)
Genómica , Humanos , Genómica/métodos , Genómica/ética , Seguridad Computacional , Nube Computacional , Consentimiento Informado
20.
J Comput Chem ; 2024 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-38944673

RESUMEN

Conformational ensemble generation and the search for the global minimum conformation are important problems in computational chemistry. In this work, a variant on the conformer-rotamer ensemble sampling tool (CREST) iterative metadynamics (iMTD) algorithm designed for determining structural ensembles and energetics of noncovalent clusters of flexible molecules is presented. We term this new algorithm a low-energy diversity-enhanced variant on CREST, or LEDE-CREST. As with CREST, the energies are evaluated using the semiempirical GFN2-xTB extended tight binding approach. The utility of the algorithm is highlighted by generating ensembles for a variety of noncovalent clusters of flexible or rigid monomers using both CREST and LEDE-CREST.

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