Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 27
Filter
1.
Chaos ; 33(11)2023 Nov 01.
Article in English | MEDLINE | ID: mdl-37934181

ABSTRACT

Multifunctional biological neural networks exploit multistability in order to perform multiple tasks without changing any network properties. Enabling artificial neural networks (ANNs) to obtain certain multistabilities in order to perform several tasks, where each task is related to a particular attractor in the network's state space, naturally has many benefits from a machine learning perspective. Given the association to multistability, in this paper, we explore how the relationship between different attractors influences the ability of a reservoir computer (RC), which is a dynamical system in the form of an ANN, to achieve multifunctionality. We construct the "seeing double" problem in order to systematically study how a RC reconstructs a coexistence of attractors when there is an overlap between them. As the amount of overlap increases, we discover that for multifunctionality to occur, there is a critical dependence on a suitable choice of the spectral radius for the RC's internal network connections. A bifurcation analysis reveals how multifunctionality emerges and is destroyed as the RC enters a chaotic regime that can lead to chaotic itinerancy.

2.
Global Spine J ; 12(1): 102-109, 2022 Jan.
Article in English | MEDLINE | ID: mdl-32865046

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Sarcopenia is a risk factor for medical complications following spine surgery. However, the role of sarcopenia as a risk factor for proximal junctional disease (PJD) remains undefined. This study evaluates whether sarcopenia is an independent predictor of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery. METHODS: ASD patients who underwent thoracic spine to pelvis fusion with 2-year clinical and radiographic follow-up were reviewed for development of PJK and PJD. Average psoas cross-sectional area on preoperative axial computed tomography or magnetic resonance imaging at L4 was recorded. Previously described PJD risk factors were assessed for each patient, and multivariate linear regression was performed to identify independent risk factors for PJK and PJF. Disease-specific thresholds were calculated for sarcopenia based on psoas cross-sectional area. RESULTS: Of 32 patients, PJK and PJF occurred in 20 (62.5%) and 12 (37.5%), respectively. Multivariate analysis demonstrated psoas cross-sectional area to be the most powerful independent predictor of PJK (P = .02) and PJF (P = .009). Setting ASD disease-specific psoas cross-sectional area thresholds of <12 cm2 in men and <8 cm2 in women resulted in a PJF rate of 69.2% for patients below these thresholds, relative to 15.8% for those above the thresholds. CONCLUSIONS: Sarcopenia is an independent, modifiable predictor of PJK and PJF, and is easily assessed on standard preoperative computed tomography or magnetic resonance imaging. Surgeons should include sarcopenia in preoperative risk assessment and consider added measures to avoid PJF in sarcopenic patients.

3.
AIDS Care ; 34(5): 597-605, 2022 05.
Article in English | MEDLINE | ID: mdl-34314261

ABSTRACT

Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.


Subject(s)
Alcoholism , HIV Infections , CD4 Lymphocyte Count , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Male , Qualitative Research , Social Stigma , Uganda
4.
Am J Bot ; 108(12): 2435-2451, 2021 12.
Article in English | MEDLINE | ID: mdl-34636420

ABSTRACT

PREMISE: Reconstructing the light environment and architecture of the plant canopy from the fossil record requires the use of proxies, such as those derived from cell wall undulation, cell size, and carbon isotopes. All approaches assume that plant taxa will respond predictably to changes in light environments. However, most species-level studies looking at cell wall undulation only consider "sun" or "shade" leaves; therefore, we need a fully quantitative taxon-specific method. METHODS: We quantified the response of cell wall undulation, cell size, and carbon isotopes of Platanus occidentalis using two experimental setups: (1) two growth chambers at low and high light and (2) a series of outdoor growth experiments using green and black shade cloth at different densities. We then developed and applied a proxy for daily light integral (DLI) to fossil Platanites leaves from two early Paleocene floras from the San Juan Basin in New Mexico. RESULTS: All traits responded to light environment. Cell wall undulation was the most useful trait for reconstructing DLI in the geological record. Median reconstructed DLI from early Paleocene leaves was ~44 mol m-2 d-1 , with values from 28 to 54 mol m-2 d-1 . CONCLUSIONS: Cell wall undulation of P. occidentalis is a robust, quantifiable measurement of light environment that can be used to reconstruct the paleo-light environment from fossil leaves. The distribution of high DLI values from fossil leaves may provide information on canopy architecture; indicating that either (1) most of the canopy mass is within the upper portion of the crown or (2) leaves exposed to more sunlight are preferentially preserved.


Subject(s)
Photosynthesis , Trees , Carbon Isotopes , Plant Leaves , Sunlight
5.
Chaos ; 31(7): 073122, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34340331

ABSTRACT

The learning capabilities of a reservoir computer (RC) can be stifled due to symmetry in its design. Including quadratic terms in the training of a RC produces a "square readout matrix" that breaks the symmetry to quell the influence of "mirror-attractors," which are inverted copies of the RC's solutions in state space. In this paper, we prove analytically that certain symmetries in the training data forbid the square readout matrix to exist. These analytical results are explored numerically from the perspective of "multifunctionality," by training the RC to specifically reconstruct a coexistence of the Lorenz attractor and its mirror-attractor. We demonstrate that the square readout matrix emerges when the position of one attractor is slightly altered, even if there are overlapping regions between the attractors or if there is a second pair of attractors. We also find that at large spectral radius values of the RC's internal connections, the square readout matrix reappears prior to the RC crossing the edge of chaos.

6.
Spine Deform ; 9(5): 1315-1321, 2021 09.
Article in English | MEDLINE | ID: mdl-33970432

ABSTRACT

BACKGROUND: Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. METHODS: We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. RESULTS: 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. CONCLUSIONS: A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. LEVEL OF EVIDENCE: Level II.


Subject(s)
Povidone-Iodine , Vancomycin , Child , Humans , Powders , Retrospective Studies , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Therapeutic Irrigation
7.
Chaos ; 31(1): 013125, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33754772

ABSTRACT

Multifunctionality is a well observed phenomenological feature of biological neural networks and considered to be of fundamental importance to the survival of certain species over time. These multifunctional neural networks are capable of performing more than one task without changing any network connections. In this paper, we investigate how this neurological idiosyncrasy can be achieved in an artificial setting with a modern machine learning paradigm known as "reservoir computing." A training technique is designed to enable a reservoir computer to perform tasks of a multifunctional nature. We explore the critical effects that changes in certain parameters can have on the reservoir computers' ability to express multifunctionality. We also expose the existence of several "untrained attractors"; attractors that dwell within the prediction state space of the reservoir computer were not part of the training. We conduct a bifurcation analysis of these untrained attractors and discuss the implications of our results.


Subject(s)
Computers , Neural Networks, Computer , Machine Learning
8.
Clin Infect Dis ; 71(5): 1320-1323, 2020 08 22.
Article in English | MEDLINE | ID: mdl-31773132

ABSTRACT

Although rare, subclinical tuberculosis disease can be missed during evaluations for latent tuberculosis infection, and can manifest with symptoms during latent tuberculosis treatment. Among over 8000 patients treated for latent tuberculosis we found no evidence of acquired drug resistance, underscoring the safety of rifampin monotherapy for latent tuberculosis.


Subject(s)
Latent Tuberculosis , Tuberculosis , Antitubercular Agents/therapeutic use , Humans , Isoniazid/therapeutic use , Latent Tuberculosis/diagnosis , Latent Tuberculosis/drug therapy , Rifampin/therapeutic use , Tuberculosis/drug therapy
9.
Int J STD AIDS ; 30(3): 284-291, 2019 03.
Article in English | MEDLINE | ID: mdl-30417749

ABSTRACT

Socioeconomic status (SES) appears to have positive and negative associations with sexually transmitted infection (STI) risk in resource-limited settings, but few studies have evaluated nationally representative data. We assessed multiple SES measures and their effect on STI risk. We conducted a secondary analysis of data from the Uganda Demographic and Health Survey (UDHS 2011). The primary outcome (STI risk) was self-reported STIs and/or symptoms in the prior 12 months. We examined associations between multiple SES measures and STI risk using a mixed-effects Poisson regression model. The results showed that of the 9256 sexually active individuals, 7428 women and 1828 men were included in the analysis. At an individual level, middle wealth quintile and disposable income were associated with STI risk, whereas being in the richest wealth quintile was protective. Residence in wealthier regions (adjusted incidence rate ratio [aIRR] 3.92, 3.62, and 2.75, for Central, Western, and Eastern regions; p < 0.01) was associated with increased STI risk. Regional level analysis revealed stochastic variability of STI risk across geographical region (variance 0.03; p = 0.01). The bilateral association between SES and STI risk underscores the need for multi-sectoral interventions to address the upstream effects of poverty on STI risk and downstream effects of STIs on health and economic productivity.


Subject(s)
Sexually Transmitted Diseases/epidemiology , Social Class , Adolescent , Adult , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Multilevel Analysis , Population Surveillance , Poverty , Prevalence , Uganda/epidemiology , Young Adult
10.
Open Forum Infect Dis ; 6(11): ofz478, 2019 Nov.
Article in English | MEDLINE | ID: mdl-32042847

ABSTRACT

BACKGROUND: Seizures commonly occur in patients with cryptococcal meningitis, yet risk factors and outcomes related to seizures are not well described. METHODS: We performed post hoc analyses on participants prospectively enrolled in 3 separate human immunodeficiency virus (HIV)-associated cryptococcal meningitis clinical trials during 2010-2017. Documentation of seizures at presentation or during hospitalization and antiseizure medication receipt identified participants with seizures. We summarized participant characteristics by seizure status via Kruskal-Wallis and χ 2 tests. Cox proportional hazards models analyzed the relationship between seizures and mortality. We compared mean quantitative neurocognitive performance Z (QNPZ-8) scores, and individual domain z-scores, at 3-months using independent t tests. RESULTS: Among 821 HIV-infected cryptococcal meningitis participants, 28% (231 of 821) experienced seizures: 15.5% (127 of 821) experienced seizures at presentation, and 12.7% (104 of 821) experienced incident seizures. Participants with seizures at presentation had a significantly lower Glasgow coma scale ([GCS] <15; P < .001), CD4 count (<50 cells/mcL; P = .02), and higher cerebrospinal fluid (CSF) opening pressure (>25 cm H2O; P = .004) when compared with participants who never experienced seizures. Cerebrospinal fluid fungal burden was higher among those with seizures at presentation (125 000 Cryptococcus colony-forming units [CFU]/mL CSF) and with seizures during follow-up (92 000 CFU/mL) compared with those who never experienced seizures (36 000 CFU/mL, P < .001). Seizures were associated with increased 10-week mortality (adjusted hazard ratio = 1.45; 95% confidence interval, 1.11-1.89). Participants with seizures had lower neurocognitive function at 3 months (QNPZ-8 = -1.87) compared with those without seizures (QNPZ-8 = -1.36; P < .001). CONCLUSIONS: Seizures were common in this HIV-associated cryptococcal meningitis cohort and were associated with decreased survival and neurocognitive function.

11.
PLoS One ; 12(12): e0189055, 2017.
Article in English | MEDLINE | ID: mdl-29244807

ABSTRACT

Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to long-term ART outcomes in this important region will aid the successful scale-up of ART programs. We enrolled 559 HIV-infected Ugandan adults starting ART in 2004-2005 at the Infectious Diseases Institute in Kampala, Uganda and followed them for 10 years. We documented baseline employment status, regular household income, education level, housing description, physical ability, and CD4 count. Viral load was measured every six months. Proportional hazard regression tested for associations between baseline characteristics and 1) mortality, 2) virologic failure, and 3) mortality or virologic failure as a composite outcome. Over ten years 23% (n = 127) of participants died, 6% (n = 31) were lost-to-follow-up and 23% (107/472) experienced virologic treatment failure. In Kaplan-Meier analysis we observed an association between employment and mortality, with the highest cumulative probability of death occurring in unemployed individuals. In univariate analysis unemployment and disease severity were associated with mortality, but in multivariable analysis the only association with mortality was disease severity. We observed an association between higher household income and an increased incidence of both virologic failure and the combined outcome, and an association between self-employment and lower incidence of virologic failure and the combined outcome when compared to unemployment. Formal education level and housing status were unrelated to outcomes. It is feasible to achieve good ten-year survival, retention-in-care, and viral suppression in a socioeconomically diverse population in a resource-limited setting. Unemployment appears to be related to adverse 10-year ART outcomes. A low level of formal education does not appear to be a barrier to successful long-term ART.


Subject(s)
Anti-HIV Agents/therapeutic use , Employment/statistics & numerical data , HIV Infections/drug therapy , HIV Infections/mortality , Income/statistics & numerical data , Adult , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Educational Status , Female , HIV Infections/pathology , HIV Infections/virology , Humans , Kaplan-Meier Estimate , Longitudinal Studies , Lost to Follow-Up , Male , Proportional Hazards Models , Severity of Illness Index , Social Class , Treatment Outcome , Uganda/epidemiology , Viral Load
12.
Open Forum Infect Dis ; 4(2): ofx077, 2017.
Article in English | MEDLINE | ID: mdl-28584857

ABSTRACT

BACKGROUND: Because of investments in human immunodeficiency virus (HIV) care in sub-Saharan Africa, the number of people aware of their status and receiving antiretroviral therapy (ART) has increased; however, HIV/acquired immune deficiency syndrome (AIDS) mortality still remains high. METHODS: We performed retrospective analysis of 3 sequential prospective cohorts of HIV-infected Ugandan adults presenting with AIDS and meningitis from 2006 to 2009, 2010 to 2012, and 2013 to 2016. Participants were categorized as follows: (1) unknown HIV status; (2) known HIV+ without ART; (3) known HIV+ with previous ART. We further categorized 2006 and 2013 cohort participants by duration of HIV-status knowledge and of ART receipt. RESULTS: We screened 1353 persons with suspected meningitis. Cryptococcus was the most common pathogen (63%). Over the decade, we observed an absolute increase of 37% in HIV status knowledge and 59% in antecedent ART receipt at screening. The 2006 cohort participants were new/recent HIV diagnoses (65%) or known HIV+ but not receiving ART (35%). Many 2013 cohort participants were new/recent HIV diagnoses (34%) and known HIV+ with <1 month ART (20%), but a significant proportion were receiving ART 1-4 months (11%) and >4 months (30%). Four percent of participants discontinued ART. From 2010 to 2016, meningitis cases per month increased by 33%. CONCLUSIONS: Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality.

13.
J Knee Surg ; 30(4): 359-363, 2017 May.
Article in English | MEDLINE | ID: mdl-27626369

ABSTRACT

Accurate placement of the femoral tunnel is critical for long-term clinical success following anterior cruciate ligament (ACL) reconstruction. The purpose of the present study is to evaluate the accuracy of femoral tunnel placement when referencing osseous landmarks during ACL reconstruction. We hypothesize that referencing osseous landmarks during ACL reconstruction consistently results in anatomic placement of the ACL femoral tunnel. This study was a retrospective case series. We reviewed 83 consecutive ACL reconstructions performed by a single surgeon. The lateral intercondylar ridge and lateral bifurcate ridge were referenced intraoperatively for anatomic placement of the ACL femoral tunnel during single-bundle reconstruction. Using these landmarks, the femoral tunnel was placed in the center of the anteromedial bundle footprint on the lateral wall of the intercondylar notch. We reviewed all operative notes and intraoperative arthroscopic images to assess tunnel placement. Postoperative anteroposterior and lateral radiographs were obtained in all patients. Anatomic placement was confirmed by review of lateral radiographs utilizing both the quadrant method (QM) and Blumensaat-ridge ratio (BRR). We used a total of 80 patients for our study. Review of arthroscopic images confirmed anatomic placement of the ACL femoral tunnel in all patients. All patients demonstrated that the femoral tunnel was placed anatomically according to the BRR method. Using the QM, all femoral tunnels were placed anatomically except for one tunnel that was placed slightly anteriorly. There was excellent agreement between the two radiographic measurement techniques. The principal finding of this study indicates that the lateral intercondylar ridge and the lateral bifurcate ridge are reliable landmarks for anatomic placement of the ACL femoral tunnel. Referencing osseous landmarks during surgery can help surgeons avoid nonanatomic placement of the ACL femoral tunnel, especially in cases where the soft-tissue footprint is no longer present. Furthermore, both the radiographic QM and the BRR are valid techniques to assess for anatomic ACL femoral tunnel placement both intraoperatively and postoperatively.


Subject(s)
Anatomic Landmarks , Anterior Cruciate Ligament Reconstruction/methods , Arthroscopy , Femur/surgery , Knee Joint/diagnostic imaging , Anterior Cruciate Ligament/diagnostic imaging , Anterior Cruciate Ligament/surgery , Female , Humans , Intraoperative Period , Male , Retrospective Studies
14.
Ecol Evol ; 6(13): 4318-31, 2016 07.
Article in English | MEDLINE | ID: mdl-27386078

ABSTRACT

Paleoecological studies document the net effects of atmospheric and climate change in a natural laboratory over timescales not accessible to laboratory or ecological studies. Insect feeding damage is visible on well-preserved fossil leaves, and changes in leaf damage through time can be compared to environmental changes. We measured percent leaf area damaged on four fossil leaf assemblages from the Bighorn Basin, Wyoming, that range in age from 56.1 to 52.65 million years (Ma). We also include similar published data from three US sites 49.4 to ~45 Ma in our analyses. Regional climate was subtropical or warmer throughout this period, and the second oldest assemblage (56 Ma) was deposited during the Paleocene-Eocene Thermal Maximum (PETM), a geologically abrupt global warming event caused by massive release of carbon into the atmosphere. Total and leaf-chewing damage are highest during the PETM, whether considering percent area damaged on the bulk flora, the average of individual host plants, or a single plant host that occurs at multiple sites. Another fossil assemblage in our study, the 52.65 Ma Fifteenmile Creek paleoflora, also lived during a period of globally high temperature and pCO 2, but does not have elevated herbivory. Comparison of these two sites, as well as regression analyses conducted on the entire dataset, demonstrates that, over long timescales, temperature and pCO 2 are uncorrelated with total insect consumption at the ecosystem level. Rather, the most important factor affecting herbivory is the relative abundance of plants with nitrogen-fixing symbionts. Legumes dominate the PETM site; their prevalence would have decreased nitrogen limitation across the ecosystem, buffering generalist herbivore populations against decreased leaf nutritional quality that commonly occurs at high pCO 2. We hypothesize that nitrogen concentration regulates the opposing effects of elevated temperature and CO 2 on insect abundance and thereby total insect consumption, which has important implications for agricultural practices in today's world of steadily increasing pCO 2.

16.
Biochim Biophys Acta ; 1848(7): 1451-61, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25839356

ABSTRACT

Gad-1 and Gad-2 are antimicrobial peptide (AMP) sequences encoded by paralogous genes. They are rich in histidine, which suggests that their activity might be pH-dependent. We examined their structure-function relationships with a view to learning how to improve AMP therapeutic ratios. Activity assays with Gram-negative bacteria and cancer cell lines demonstrate that Gad-2 is substantially more active at slightly acidic pH than it is at neutral pH. By contrast, the activity of Gad-1 at lower pH is similar to its activity at pH7. Circular dichroism spectra indicate that the greater functional plasticity of Gad-2 correlates with a greater structural plasticity; Gad-2's percent helicity varies dramatically with altered pH and lipid environment. Interestingly, Gad-2's highest levels of helicity do not correspond to the conditions where it is most active. High resolution solution NMR structures were determined in SDS micelles at pH5, conditions that induce an intermediate level of helicity in the peptides. Gad-1 is more helical than Gad-2, with both peptides exhibiting the greatest helical tendencies in their central region and lowest helicity in their N-termini. The high resolution structures suggest that maximum activity relies on the appropriate balance between an N-terminal region with mixed hydrophobic/hydrophilic structure features and an amphipathic central and C-terminal region. Taken together with previous studies, our results suggest that to improve the therapeutic ratio of AMPs, consideration should be given to including sequential histidine-pairs, keeping the overall charge of the peptide modest, and retaining a degree of structural plasticity and imperfect amphipathicity.


Subject(s)
Antimicrobial Cationic Peptides/chemistry , Fish Proteins/chemistry , Gadus morhua/metabolism , Protein Structure, Secondary , Amino Acid Sequence , Animals , Antimicrobial Cationic Peptides/pharmacology , Cell Line, Tumor , Cell Survival/drug effects , Circular Dichroism , Dose-Response Relationship, Drug , Escherichia coli/drug effects , Escherichia coli/growth & development , Fish Proteins/pharmacology , Hemolysis/drug effects , Humans , Hydrophobic and Hydrophilic Interactions , Magnetic Resonance Spectroscopy , Mice , Microbial Sensitivity Tests , Models, Molecular , Molecular Sequence Data , Protein Isoforms/chemistry , Protein Isoforms/pharmacology , Structure-Activity Relationship
17.
Curr Opin Psychiatry ; 25(5): 342-7, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22854415

ABSTRACT

PURPOSE OF REVIEW: This article summarizes research and commentaries on psychotherapy for adults with intellectual disabilities published since 2008. RECENT FINDINGS: There have been very few empirical studies of the effectiveness of psychotherapy in this context over recent years despite a strong perception that such approaches are not only necessary but also of great value. There have been some interesting, though so far only suggestive, findings concerning the relationship between intellectual level and suitability for treatment, primarily with cognitive behavioural therapy. Therapies based on mindfulness are emerging as important new developments. Despite their heritage, psychodynamic approaches continue to rely on opinion over evidence to support their use. SUMMARY: Research on both processes in therapy and its outcomes needs to be undertaken with renewed vigour if specialist psychotherapy for people with intellectual disability is to flourish, or indeed survive, in the public healthcare system. However, it may have much a broader value for people with intellectual disability, especially those in residential services, than can be easily quantified.


Subject(s)
Intellectual Disability/therapy , Mental Disorders/therapy , Psychotherapy/methods , Adult , Empirical Research , Evidence-Based Medicine , Health Services Research , Humans
18.
Case Rep Gastroenterol ; 5(3): 623-7, 2011 Sep.
Article in English | MEDLINE | ID: mdl-22125507

ABSTRACT

Exacerbations of Crohn's disease are not infrequently associated with bacterial gastroenteritis. The recognition of synchronous infections in such patients is vital for the initiation of appropriate antimicrobial therapy. Furthermore, the detection of active bacterial infections may lead the clinician to delay starting biological therapy. We report here a man presenting with an exacerbation of his Crohn's disease during a trip to Thailand. Stool cultures were positive for the unusual gut pathogen Edwardsiella tarda. The patient's symptoms resolved with concurrent antibiotic and steroid therapy. This finding demonstrates the value of performing stool culture in all patients presenting with exacerbations of inflammatory bowel diseases.

19.
Acta Biomater ; 7(6): 2678-85, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21324383

ABSTRACT

Magnesium phosphates such as newberyite (MgHPO(4)·3H(2)O) are formed in vivo and are known to be biodegradable and nontoxic after implantation. Indeed, magnesium apatites have been shown to support osteoblast differentiation and function, and bone formation can occur around metallic magnesium implants. However, very little is known regarding the precipitation and stability of magnesium phosphates in physiological environments. In order to address this, the aqueous formation of magnesium phosphate as a function of pH, temperature and ion concentration is reported. Physicochemical characterization of the precipitates was carried out; additionally, biocompatibility and gene expression of osteoblast differentiation markers for bone formation via an in vitro cell culture assay were determined. Precipitation conditions for newberyite, tribasic magnesium phosphate pentahydrate, holtedahlite, bobierrite and cattiite were determined. Under physiological conditions of pH, temperature and magnesium phosphate concentration, no precipitates were formed. However, at concentrations 10-100 times higher than physiological, magnesium phosphate precipitates of cattiite and newberyite were formed. These two minerals demonstrated biocompatibility with osteoblast cultures and induced osteoblast adhesion and differentiation. The pattern of expression of OCN and CollA1 genes in the presence of newberyite crystals was comparable to that of calcium phosphate bioceramics. In our experiments, we have shown that certain magnesium phosphate phases such as newberyite and cattiite are able to promote in vivo osteogenic activity in a similar way to calcium phosphates such as hydroxyapatite and brushite. This confirms the great potential of magnesium phosphate ceramics in the development of new biomaterials for bone regeneration.


Subject(s)
Biocompatible Materials , Magnesium Compounds , Phosphates , 3T3 Cells , Animals , Base Sequence , DNA Primers , Hydrogen-Ion Concentration , Male , Mice , Mice, Inbred C57BL , Microscopy, Electron, Scanning , Osmolar Concentration , Reverse Transcriptase Polymerase Chain Reaction , Temperature , X-Ray Diffraction
20.
Can J Physiol Pharmacol ; 89(2): 143-8, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21326346

ABSTRACT

The mechanisms by which enteropathogenic Escherichia coli (EPEC) causes intestinal epithelial cell apoptosis remain unclear. We tested the hypothesis that apoptosis-inducing factor (AIF) is involved in apoptosis induced by EPEC. Infection of intestinal epithelial cells in vitro with EPEC led to the mitochondrial and cytosolic accumulation of AIF. This effect was partially dependent on caspase activity. Knockdown of AIF with siRNA blocked cellular apoptosis in response to EPEC infection, as assessed by poly(ADP-ribose) polymerase cleavage and oligonucleosome formation. Taken together, these data suggest that caspase-dependent mobilization of AIF contributes to EPEC-induced epithelial cell apoptosis.


Subject(s)
Apoptosis Inducing Factor/metabolism , Apoptosis/physiology , Enteropathogenic Escherichia coli/physiology , Intestinal Mucosa/metabolism , Intestinal Mucosa/microbiology , Apoptosis Inducing Factor/genetics , Caspases/metabolism , Cell Line , Cytosol/metabolism , Epithelial Cells/metabolism , Epithelial Cells/microbiology , Epithelial Cells/pathology , Escherichia coli Infections/metabolism , Escherichia coli Infections/microbiology , Escherichia coli Infections/pathology , Gene Knockdown Techniques , HeLa Cells , Humans , Intestinal Mucosa/pathology , Mitochondria/metabolism , Poly(ADP-ribose) Polymerases/metabolism , RNA, Small Interfering/genetics
SELECTION OF CITATIONS
SEARCH DETAIL
...