Subject(s)
Coinfection , Hepatitis B , Pregnancy , Humans , Female , Hepatitis B virus , Timor-Leste/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Prevalence , Hepatitis B/epidemiology , Hepatitis B/prevention & control , Hepatitis B Surface Antigens , Hepatitis B VaccinesABSTRACT
Regulatory B cells (Breg) are a heterogenous population with immune-modulating functions. The rarity of human IL-10+ Breg makes translational studies difficult. Here we report ex vivo expansion of human B cells with in vivo regulatory function (expBreg). CD154-stimulation of human CD19+ B cells drives >900-fold expansion of IL-10+ B cells that is maintained in culture for 14 days. Whilst expBreg-mediated suppressive function is partially dependent on IL-10 expression, CRISPR-mediated gene deletions demonstrate predominant roles for TIM-1 and CD154. TIM-1 regulates STAT3 signalling and modulates downstream suppressive function. In a clinically relevant humanised mouse model of skin transplantation, expBreg prolongs human allograft survival. Meanwhile, CD19+CD73-CD25+CD71+TIM-1+CD154+ Breg cells are enriched in the peripheral blood of human donors with cutaneous squamous cell carcinoma (SCC). TIM-1+ and pSTAT3+ B cells are also identified in B cell clusters within histological sections of human cutaneous SCC tumours. Our findings thus provide insights on Breg homoeostasis and present possible targets for Breg-related therapies.
Subject(s)
B-Lymphocytes, Regulatory , Carcinoma, Squamous Cell , Skin Neoplasms , Animals , Antigens, CD19/metabolism , Carcinoma, Squamous Cell/metabolism , Humans , Interleukin-10/metabolism , Lymphocyte Activation , Mice , STAT3 Transcription Factor/metabolism , Skin Neoplasms/metabolismABSTRACT
BACKGROUND AND PURPOSE: Quantitative imaging biomarkers have not been established for the diagnosis of spinal canal stenosis. This work aimed to lay the groundwork to establish such biomarkers by leveraging the developments in machine learning and medical imaging informatics. MATERIALS AND METHODS: Machine learning algorithms were trained to segment lumbar spinal canal areas on axial views and intervertebral discs on sagittal views of lumbar MRIs. These were used to measure spinal canal areas at each lumbar level (L1 through L5). Machine-generated delineations were compared with 2 sets of human-generated delineations to validate the proposed techniques. Then, we use these machine learning methods to delineate and measure lumbar spinal canal areas in a normative cohort and to analyze their variation with respect to age, sex, and height using a variable-intercept mixed model. RESULTS: We established that machine-generated delineations are comparable with human-generated segmentations. Spinal canal areas as measured by machine are statistically significantly correlated with height (P < .05) but not with age or sex. CONCLUSIONS: Our machine learning methodology demonstrates that this important anatomic structure can be accurately detected and quantitatively measured without human input in a manner comparable with that of human raters. Anatomic deviations measured against the normative model established here could be used to flag spinal stenosis in the future.
Subject(s)
Machine Learning , Magnetic Resonance Imaging/methods , Spinal Canal/anatomy & histology , Adult , Aged , Female , Humans , Lumbar Vertebrae , Male , Middle Aged , Reference Values , Spinal Canal/diagnostic imaging , Spinal Stenosis/diagnostic imagingABSTRACT
Vitamin D (D3) supplementation may be used to increase tenderness in beef from cattle fed zilpaterol hydrochloride (ZH). The study was arranged as a 2 × 2 factorial with fixed effects of ZH (no ZH or ZH fed at 8.3 mg/kg DM for 20 d with a 3-d withdrawal) and D3 (no D3 or 500,000 IU D3·steer·d for 10 d prior to harvest). Cattle ( = 466) were harvested in 2 blocks on the basis of BW with subsequent collection of carcass data. Full loins and inside rounds ( = 144 of each subprimal) were collected for fabrication of 5 steaks from the longissimus lumborum (LL), gluteus medius (GM), and semimembranosus (SM), which were aged for 7, 14, 21, 28, or 35 d. Warner-Bratzler shear force (WBSF) was used to evaluate mechanical tenderness of LL, GM, and SM steaks at all aging periods. Slice shear force (SSF) analysis was conducted on only 14- and 21-d LL steaks. No interactions ( > 0.05) between ZH and D3 occurred throughout the entire study. Supplementing ZH resulted in increased HCW ( < 0.01), larger LM area ( < 0.01), and improved calculated yield grades ( < 0.01) with decreases in fat thickness ( = 0.02) and marbling scores ( = 0.05). Supplementation with D3 increased calculated yield grade ( < 0.01) and decreased ( = 0.01) rib eye area. Feeding ZH increased ( ≤ 0.05) WBSF of LL steaks at each postmortem age interval, whereas D3 had no effect ( > 0.05) on WBSF or SSF of LL steaks. Like for WBSF, ZH supplementation increased SSF values at 14 and 21 d postmortem ( < 0.01) compared with those for non-ZH steaks. There was an interaction between ZH and postmortem age ( < 0.01) for WBSF of LL steaks. At 7 d LL steaks from ZH steers sheared over 0.6 kg greater than non-ZH steaks; however, by 21 d this difference was reduced to an average of 0.2 kg. Differences in distribution between LL steaks below 3.0 kg from non-ZH and ZH-fed cattle were also notable ( ≤ 0.05) through 21 d of aging. At 35 d postmortem a high proportion of LL steaks (68.5%) from ZH-fed steers required less than 3.0 kg to shear. Supplementation with ZH and D3 had no impact ( > 0.05) on WBSF values of GM steaks. Feeding ZH did not alter WBSF of SM steaks, but at 28 d D3 increased ( = 0.04) WBSF values. Shear force in ZH steaks was not effectively reduced by feeding D3 for 10 d to steers prior to harvest. Aging, however, was an effective method of reducing initially greater shear force values in LL steaks and, to a lesser degree, GM steaks from ZH-fed cattle.
Subject(s)
Animal Feed , Dietary Supplements , Food Handling/methods , Food Quality , Red Meat/analysis , Trimethylsilyl Compounds , Vitamin D , Animals , Cattle , Muscle, Skeletal/physiology , Shear StrengthABSTRACT
Providing cattle a more bioavailable zinc (Zn) source prior to administering a beta adrenergic agonist (ßAA) may enhance the metabolic pool of primary nutrients that will influence the magnitude of the ßAA response. Calf-fed Holstein steers were supplemented with a Zn methionine supplement (ZnMet; ZINPRO(®); Zinpro Corporation, Eden Prairie, MN) for 115 ± 5 days prior to harvest along with zilpaterol hydrochloride (ZH; Zilmax(®); Merck Animal Health, Summit, NJ) for the last 20 days with a 3-day withdrawal to evaluate the effects on growth and carcass performance together with gene and protein expression of skeletal muscle, adipose tissue, and fatty acid composition of polar and neutral lipid depots. Steers (n = 1296; initial weight = 468.5 ± 0.5 kg) were sorted by weight, blocked by harvest date, and randomly assigned to pens (n = 12) and treatments: control (90 ppm Zn from ZnSO4) and ZnMet (Control plus 720 mg Zn from ZnMet/hd/d). There were no differences (P > 0.05) in growth performance or carcass characteristics. The ZnMet-fed cattle had reduced (P < 0.05) abundance of myosin heavy chain (MHC)-IIX, ß1-adrenergic receptor (ßAR), peroxisome proliferator-activated receptor gamma, and stearoyl-CoA desaturase mRNA in skeletal muscle tissue. The ZnMet cattle had greater (P < 0.05) abundance of MHC-II protein, increased MHC-IIA and IIX cross-sectional areas (P < 0.05), an increased percentage of MHC-I fibers (P < 0.05), and a decreased percentage of MHC-IIX fibers (P < 0.05). The combination of ZnMet and ZH had positive biological effects on musculoskeletal tissue; however, these molecular effects were not significant enough to impact overall feedlot and carcass performance.
Subject(s)
Animal Feed , Dietary Supplements , Gene Expression Regulation/drug effects , Gene Expression Regulation/genetics , Methionine/analogs & derivatives , Muscle, Skeletal/drug effects , Muscle, Skeletal/metabolism , Organometallic Compounds/administration & dosage , Organometallic Compounds/pharmacology , Animals , Cattle , Male , Methionine/administration & dosage , Methionine/pharmacology , Muscle, Skeletal/chemistry , Myosin Heavy Chains/genetics , Myosin Heavy Chains/metabolism , PPAR gamma/genetics , PPAR gamma/metabolism , RNA, Messenger/genetics , RNA, Messenger/metabolism , Receptors, Adrenergic, beta-1/genetics , Receptors, Adrenergic, beta-1/metabolism , Stearoyl-CoA Desaturase/genetics , Stearoyl-CoA Desaturase/metabolismSubject(s)
Diabetes Complications/therapy , Diabetes Mellitus/therapy , Mental Disorders/therapy , Blood Glucose Self-Monitoring , Diabetes Mellitus/psychology , Hospitalization/statistics & numerical data , Humans , Inpatients , Mental Competency , Mental Disorders/complications , Self Care/standards , Triage , United KingdomABSTRACT
OBJECTIVES: To determine the dietary and supplement intake of omega-3 (n-3) polyunsaturated fatty acids (PUFA) of older Tasmanian adults; their plasma n-3 PUFA status and the relationship between n-3 PUFA intake and plasma status. DESIGN: Cross-sectional study. SETTING: Launceston and surrounding regions, Tasmania, Australia. PARTICIPANTS: Seventy-three community-dwelling older adults: 23 men aged 70 ± 6.1 years and 50 women aged 70 ± 6.7 years. MEASUREMENTS: A validated, semi-quantitative food frequency questionnaire estimated dietary PUFA intake. The plasma phospholipid fraction of venous blood samples was analysed for fatty acid content. Anthropometric data was recorded. RESULTS: Thirty-five participants (48%) regularly ingested a fish oil supplement. Their plasma n-3 PUFA profile contained significantly more eicosapentaenoic acid (EPA) (odds ratio 3.14; 95% CI 1.37% to 7.30%; p<0.05) and docosahexaenoic acid (DHA) (odds ratio 2.64; 95% CI 1.16% to 6.01%; p<0.05) than non-supplement users. Fish and meat were the main dietary sources of n-3 PUFAs. Participants most commonly consumed fish 3-4 times per week. Significant associations of dietary α-linolenic acid (ALA), EPA, docosapentaenoic acid (DPA) and DHA with plasma n-3 PUFAs were noted but not always between dietary and plasma counterparts. CONCLUSION: Without the use of fish oil supplements, most study participants were unable to meet the recommended daily intake of 0.5g EPA and DHA combined; however, the plasma n-3 PUFA profile of non-supplement-users was still robust compared to other Australian and overseas studies.
Subject(s)
Diet/statistics & numerical data , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Omega-3/blood , Health , Nutritional Status , Aged , Aged, 80 and over , Animals , Anthropometry , Cross-Sectional Studies , Dietary Supplements/statistics & numerical data , Docosahexaenoic Acids/blood , Eicosapentaenoic Acid/blood , Fatty Acids, Unsaturated/blood , Female , Fish Oils/administration & dosage , Fishes , Humans , Male , Meat , Middle Aged , Surveys and Questionnaires , TasmaniaABSTRACT
OBJECTIVES: The Mediterranean diet, with a high content of olive oil, is associated with a reduced risk of coronary artery disease. The aim of this study was to determine the effect of oleuropein, one of the polyphenols in olive oil, on vascular smooth muscle cell (SMC) proliferation in vitro. DESIGN: This was an experimental study. MATERIALS AND METHODS: Bovine vascular SMCs were cultured in the presence of 100 µM of oleuropein. On days 1, 3 and 5, cell number was counted. Cell cycle analysis was performed by flow cytometry. Cell cycle regulators were assessed by immunoblotting. RESULTS: Cell proliferation in the presence of oleuropein was significantly inhibited by 92%. Cell cycle analysis revealed that oleuropein treatment blocked cells in the G1-S phase compared with the non-treated group. Among G1 phase regulators, retinoblastoma protein, cyclinD, p21 and p27 were not affected by oleuropein, but extracellular signal-regulated kinase 1/2 (ERK1/2) activation was inhibited. Growth of SMC treated with 100 µM of the mitogen-activated protein (MAP) kinase/ERK kinase 1 (MEK1) inhibitor PD98059 was also significantly inhibited by 70%. CONCLUSIONS: Oleuropein inhibited SMC proliferation through a cell cycle block between the G1 and the S phases, which may be regulated by ERK1/2. These results suggest a mechanism by which olive oil consumption may have beneficial effects on cardiovascular mortality by inhibiting SMC proliferation.
Subject(s)
Cell Cycle/drug effects , Cell Proliferation/drug effects , Myocytes, Smooth Muscle/drug effects , Plant Oils/pharmacology , Pyrans/pharmacology , Vasodilator Agents/pharmacology , Animals , Cattle , Cell Culture Techniques , Iridoid Glucosides , Iridoids , Myocytes, Smooth Muscle/cytology , Myocytes, Smooth Muscle/physiology , Olive Oil , Time FactorsABSTRACT
The objective of this research was to evaluate changes in the muscle conformation of subprimal top-loins (M. longissimus lumborum) from calf-fed Holstein steers fed zilpaterol hydrochloride (ZH). Top-loins (n = 100) were transversely cut into 2.54 cm-thick steaks, weighed, and objectively evaluated via image analysis software for muscle area, width, and length traits. Top-loin steaks from steers fed ZH were heavier (P< 0.01; 367 vs. 337 g) and average muscle area per steak was greater (P < 0.05; 80.9 vs. 77.2 cm(2)) as compared to steaks from control steers. Muscle width (medial-lateral) was not different (P = 0.23) between control steers and those fed ZH. However, steaks from steers fed ZH had greater (P < 0.05) depth (dorsal-ventral) than steaks from control steers throughout the top-loin. The increased muscle depth of top-loins from calf-fed Holstein steers fed ZH may improve the center-of-the-plate salability of a cut that has traditionally suffered from poor muscling.
Subject(s)
Animal Feed , Meat/standards , Muscle, Skeletal/drug effects , Trimethylsilyl Compounds/administration & dosage , Animals , Cattle , Male , Trimethylsilyl Compounds/pharmacologyABSTRACT
To evaluate the impact of zilpaterol hydrochloride (ZH) on carcass cutability and tenderness of calf-fed Holstein steers, calf-fed Holstein carcasses (n = 102) were selected from a pool of 2,300 steers that were fed 0 or 8.3 mg/kg (DM basis) of ZH. Zilpaterol hydrochloride was supplemented the last 20 d of the finishing period and withdrawn for 3 d before slaughter. Carcasses were selected based on carcass weight as well as predetermined USDA Yield grade categories. For tenderness evaluation, steaks from the strip loin, bottom round, and top round (n = 54 per subprimal) were aged for 14 or 21 d postmortem. Carcasses from ZH-fed steers had more (P < 0.01) saleable yield than carcasses from control-fed steers. Additionally, ZH-fed steers had greater (P < or = 0.01) subprimal yield from the shoulder clod, strip loin, peeled tenderloin, top sirloin butt, bottom sirloin tri-tip, peeled knuckle, inside round, bottom round flat, eye of round, heel, and shank. Furthermore, ZH decreased (P < 0.01) the total amount and percentage of bone and fat trim from the carcass. Moisture loss was not affected by ZH in LM or inside round steaks (P > 0.05); however, ZH increased thawing loss (P = 0.05) but reduced cooking loss (P = 0.05) in bottom round steaks. Shear force values of LM and inside round steaks increased with ZH inclusion (P < 0.01), but there was no difference in bottom round steaks (P > 0.05). Steaks aged for 21 d had smaller (P < 0.01) Warner-Bratzler shear force (WBS) values than 14-d steaks from all 3 subprimals. Trained sensory panelists did not detect any differences (P > 0.05) in sensory juiciness, tenderness, or flavor variables of LM or inside round steaks, except ZH steaks from the LM received smaller scores for sustained juiciness (P = 0.01) and overall tenderness (P = 0.04) than control steaks. Although LM steaks from ZH cattle were tougher than control steaks, the ZH-treated steaks had an average WBS value of 4.10 kg, which would be classified as intermediate in tenderness, with trained panelists rating ZH steaks slightly to moderately tender. Feeding ZH improved carcass cutability of calf-fed Holstein steers; however, tenderness was reduced in LM and inside round steaks. The interaction of postmortem tenderization techniques should be investigated to evaluate their impact on palatability in cattle supplemented with beta-agonists to allow the beef industry to take full advantage of the enhancement in performance and carcass yield.
Subject(s)
Food Additives/pharmacology , Meat/standards , Trimethylsilyl Compounds/pharmacology , Animals , Cattle , Male , Meat-Packing Industry , Muscle, Skeletal/drug effectsABSTRACT
Two experiments were conducted to evaluate the effectiveness of zilpaterol hydrochloride (ZH) to enhance growth performance and carcass characteristics in calf-fed Holstein steers. In Exp. 1, Holstein steers (n = 2,311) were fed in a large-pen trial in 2 phases at a commercial feed yard in the desert Southwest. In Exp. 2, a total of 359 steers were fed in a small-pen university study. In Exp. 1 and 2, cattle were implanted with a combination trenbolone acetate-estradiol implant approximately 120 d before slaughter. Cattle were fed ZH for 0, 20, 30, or 40 d before slaughter at a rate of 8.3 mg/kg (DM basis). A 3-d withdrawal was maintained immediately before slaughter. Cattle within an experiment were fed to a common number of days on feed. During the last 120 d before slaughter, ADG was not enhanced by feeding ZH for 20 d (P = 0.33 in Exp. 1, and P = 0.79 in Exp. 2). Gain-to-feed conversion was increased by feeding ZH for all durations in Exp. 1 (P < 0.05). Feeding ZH increased HCW by 9.3 (Exp. 2) to 11.6 (Exp. 1) kg at 20 d compared with the control groups. Across both experiments, dressing percent was increased for all durations of feeding ZH (P < 0.05). Although skeletal maturity score, liver integrity, lean color, fat thickness, and KPH were not affected by feeding ZH for 20 d in either experiment (P >or= 0.6), LM area was increased for all durations of feeding ZH (P < 0.05). The percentage of carcasses identified as USDA Choice was reduced (P < 0.01) for all durations of feeding ZH in Exp. 1. This effect was not observed in Exp. 2. Holstein steers clearly respond to the beta-agonist ZH, and 20 d of feeding ZH with a 3-d withdrawal significantly increased carcass weights, muscling, and carcass leanness.
Subject(s)
Cattle/growth & development , Growth Substances/pharmacology , Trimethylsilyl Compounds/pharmacology , Animal Feed , Animal Husbandry , Animals , Cattle/physiology , Diet/veterinary , Food Additives/pharmacology , Male , Meat/standards , Nutritive Value , Weight Gain/drug effectsABSTRACT
The objective of these studies was to evaluate the effects of zilpaterol hydrochloride (ZH), fed for 0, 20, or 30 d, on meat quality attributes of calf-fed Holstein steers. Steers were slaughtered at a commercial facility, and carcasses were selected by HCW to represent the pen mean. Further carcass selection was based on quality grade (Choice and Select) and yield grade. Proximate composition, measures of water holding capacity, and tenderness using Warner-Bratzler shear force after 7, 14, or 21 d postmortem were evaluated on the shoulder clod (triceps brachii), top butt (gluteus medius), and strip loin (longissimus lumborum). Percentage of purge for the 3 subprimals was not different (P > 0.05) among ZH treatments. Steers fed ZH for 20 d or 30 d had decreased (P < 0.05) percentages of fat in the triceps brachii, compared with 0-d ZH. Percentage of fat was less (P < 0.05) in the gluteus medius and longissimus lumborum when steers were fed ZH for 30 d compared with those steers fed ZH for 0 d. Percentage of fat was greater in Choice triceps brachii (P < 0.05) and longissimus lumborum (P < 0.10) compared with Select. Thaw loss was not different (P > 0.05) for any muscle due to ZH treatment. Only longissimus had a greater (P < 0.05) cooking loss with ZH treatment. Cooking loss was not different (P > 0.05) for the gluteus medius or longissimus lumborum due to quality grade or aging day. At each aging day, the 20- and 30-d ZH longissimus lumborum had greater (P < 0.05) shear force values than 0 d; however, 20- and 30-d ZH had a greater absolute change in shear force from 7 to 21 d than that of 0 d ZH. Triceps brachii steaks were less tender (P < 0.05) after ZH treatment, but gluteus medius steaks were not different (P > 0.05). There was no difference (P > 0.05) in shear force due to quality grade. Results illustrate the use of ZH in calf-fed Holstein steers will have minimal effects on purge, thaw, or cooking loss. Percentage of intramuscular fat will decrease, especially when fed for longer durations. Steaks from ZH treated steers were tougher than steaks from control animals at all aging times, but ZH steaks became more tender with postmortem aging.
Subject(s)
Cattle/physiology , Food Additives/pharmacology , Meat/standards , Trimethylsilyl Compounds/pharmacology , Animals , Cooking , Food Preservation , Male , Meat-Packing Industry , Time FactorsABSTRACT
Zilpaterol hydrochloride (ZH) is designed to increase carcass leanness, chilled side weight (CSW), and percent saleable yield. The objective of this study was to evaluate the effect of a single dose of ZH on cutability and subprimal yield of calf-fed Holstein steers when fed for increasing durations. Two hundred forty steers were fed 8.3 mg/kg of ZH on a DM basis for 0, 20, 30, or 40 d, with a 3-d withdrawal before slaughter. After slaughter, steers were fabricated into 4 pieces (round, loin/flank, rib/plate, and chuck), packaged in combos, shipped to 2 locations, and further fabricated into subprimal pieces and trim. Trim was collected from each primal and separated into groups based on composition of 90, 80, and 50% lean. Zilpaterol hydrochloride increased (P = 0.01) CSW by 6.22 kg and saleable yield by 6.4 kg when included in the diet for 20 d. Furthermore, saleable yield as a percentage of CSW was increased (P = 0.03) 1.18 percentage units when included in the diet for 20 d. Steers fed ZH for 20 d had heavier strip loins (4.47 vs. 4.12 kg, P = 0.02), tenderloins (2.75 vs. 2.49 kg, P = 0.02), and ribeye rolls (5.74 vs. 5.30 kg, P = 0.01) than steers not fed ZH. These advantages are further demonstrated as a percentage of CSW. Strip loins (P = 0.06), tenderloins (P = 0.04), and ribeye rolls (P = 0.04) of ZH-fed steers had a greater percentage of CSW than controls. Zilpaterol hydrochloride also increased the percentage of CSW of the 3 primary components of the round when fed for 20 d. The knuckle was 0.10 percentage units heavier (P = 0.11), the top round was 0.24 percentage units heavier (P = 0.04), and the bottom round was 0.22 percentage units heavier (P = 0.03) in ZH-fed steers when compared with steers not fed ZH. Based on these data, it can be concluded that ZH significantly increased subprimal cutting weights, yields, and percentage saleable yield of calf-fed Holstein steers when fed for at least 20 d before slaughter. Zilpaterol hydrochloride increased percentage of CSW of subprimal cuts from Holstein steers in the round and to a lesser degree in the loin.
Subject(s)
Cattle/physiology , Food Additives/pharmacology , Meat/standards , Trimethylsilyl Compounds/pharmacology , Animal Feed , Animals , Food Additives/administration & dosage , Male , Meat-Packing Industry , Time Factors , Trimethylsilyl Compounds/administration & dosageABSTRACT
A quantitative analysis has been performed to predict the benefit:risk ratio and associated mortality reduction for the UK National Health Service Breast Screening Programme. The analysis is based on the results of an established biological simulation method coupled with dosimetric information and population statistics applicable to the UK breast screening programme. As well as the general breast screening population, the benefit:risk ratios for specific subgroups of women thought to be at higher risk are estimated. The effects of alterations in screening strategy are also investigated. The results indicate favourable benefit:risk ratios and mortality reductions for all women in the programme, with a breast cancer mortality reduction of approximately 9% over the whole UK female population, equivalent to a breast cancer mortality reduction in the region of 25% for the age range 55-69 years.
Subject(s)
Breast Neoplasms/mortality , Breast Neoplasms/prevention & control , Mass Screening/methods , Age Factors , Aged , Breast Implants , Breast Neoplasms/diagnostic imaging , Computer Simulation , Female , Humans , Life Expectancy , Mammography/adverse effects , Mammography/methods , Mass Screening/adverse effects , Middle Aged , Radiation Dosage , Reproducibility of Results , Risk Factors , United KingdomABSTRACT
BACKGROUND: To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. METHODS: Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. RESULTS: With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. CONCLUSIONS: When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs.
Subject(s)
Documentation/methods , Documentation/trends , Intensive Care Units, Pediatric/trends , Medical Records Systems, Computerized/trends , Child , Decision Making, Computer-Assisted , Humans , Medication Errors/trends , Nursing Care/trends , Time and Motion StudiesABSTRACT
Early notions of mania invoked a combination of psychogenic and organic factors, but psychogenic mania has not endured as a concept. We present a 37-year-old woman with an acute manic episode precipitated by the prolonged death of her husband from cancer. To our knowledge this is the first published account of 'maniacal grief' in the absence of pre-existing affective disorder, and with clear causal relations. Mania was clearly induced by the bereavement and we argue that the loss represented more than a non-specific life event. This case supports a re-examination of mania as potentially a 'reactive' or psychogenic phenomenon.
Subject(s)
Bereavement , Bipolar Disorder/psychology , Psychophysiologic Disorders/psychology , Acute Disease , Adult , Bipolar Disorder/diagnosis , Female , Humans , Life Change Events , Psychophysiologic Disorders/diagnosis , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Risk FactorsSubject(s)
Life Style , Marriage , Social Class , Socioeconomic Factors , Wills , Activities of Daily Living/psychology , History, 18th Century , Income/history , Life Style/ethnology , Marriage/ethnology , Marriage/history , Marriage/legislation & jurisprudence , Marriage/psychology , Ownership/economics , Ownership/history , Ownership/legislation & jurisprudence , Social Behavior , Spouses/education , Spouses/ethnology , Spouses/history , Spouses/legislation & jurisprudence , Spouses/psychology , United Kingdom/ethnology , Wills/economics , Wills/ethnology , Wills/history , Wills/legislation & jurisprudence , Wills/psychologyABSTRACT
The UK and European protocols for mammographic dosimetry use conversion factors that relate incident air kerma to the mean glandular dose (MGD) within the breast. The conversion factors currently used were obtained by computer simulation of a model breast with a composition of 50% adipose and 50% glandular tissues by weight (50% glandularity). Relative conversion factors have been calculated which allow the extension of the protocols to breasts of varying glandularity and for a wider range of mammographic x-ray spectra. The data have also been extended to breasts of a compressed thickness of 11 cm. To facilitate the calculation of MGD in patient surveys, typical breast glandularities are tabulated for women in the age ranges 40-49 and 50-64 years, and for breasts in the thickness range 2-11 cm. In addition, tables of equivalent thickness of polymethyl methacrylate have been provided to allow the simulation for dosimetric purposes of typical breasts of various thicknesses.
Subject(s)
Breast/radiation effects , Mammography/methods , Mammography/standards , Radiometry/methods , Adipose Tissue/radiation effects , Adult , Age Factors , Female , Humans , Middle Aged , Monte Carlo Method , Polymethyl Methacrylate/chemistry , X-RaysABSTRACT
The standard quantity used to relate breast surface exposure to radiation risk is the mean dose received by the radiation sensitive tissue contained within the female breast, the mean glandular dose (MGD). At present, little is known about the MGD received by women with breast implants as there is no technique available to facilitate its calculation. The present work has involved modification of the conventional method for MGD estimation to make it applicable to women with augmented breasts. The technique was used to calculate MGDs for a cohort of 80 women with breast implants, which were compared with similar data calculated for a total of 1258 non-augmented women. Little difference was found in median MGD at low compressed breast thickness. At high breast thickness, however, the MGDs received by women with augmented breasts were found to be considerably lower than those relating to their non-augmented counterparts.
Subject(s)
Breast Implants , Breast/pathology , Mammography/methods , Cohort Studies , Female , Humans , Monte Carlo Method , Phantoms, Imaging , X-RaysABSTRACT
The UK National Health Service Breast Screening Programme is currently organized to routinely screen women between the ages of 50 and 64, with screening for older women available on request. The lower end of this age range closely matches the median age for the menopause (51 years), during which significant changes in the composition of the breast are known to occur. In order to quantify the dosimetric effect of these changes, radiographic factors and compressed breast thickness data for a cohort of 1258 women aged between 35 and 79 undergoing breast screening mammography have been used to derive estimates of breast glandularity and mean glandular dose (MGD), and examine their variation with age. The variation of mean radiographic exposure factors with age is also investigated. The presence of a significant number of age trial women within the cohort allowed an extended age range to be studied. Estimates of MGD including corrections for breast glandularity based on compressed breast thickness only, compressed breast thickness and age and for each individual woman are compared with the MGD based on the conventional assumption of a 50:50 adipose/glandular composition. It has been found that the use of the conventional 50:50 assumption leads to overestimates of MGD of up to 13% over the age range considered. By using compressed breast thickness to estimate breast glandularity, this error range can be reduced to 8%, whilst age and compressed breast thickness based glandularity estimates result in an error range of 1%.