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1.
Ergonomics ; : 1-17, 2024 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-38515318

RESUMEN

This paper examines opportunities and challenges of integrating augmented reality (AR) into education and investigates requirements to enable instructors to author AR educational experiences. Although AR technology is recognised for its potential in educational enhancement, it poses challenges for instructors creating AR-based experiences due to their limited digital skills and the complexity of 3D authoring tools. Semi-structured interviews with 17 aviation instructors identified current pedagogical approaches, gaps, and potential applications of AR in aviation weather education. Additionally, results highlighted the benefits of AR and obstacles to its integration into education, followed by outlining design priorities and user needs for educational AR authoring. For AR authoring toolkit development, this study recommended incorporating interactive AR lesson modules, early development of user requirements, and prebuilt AR modules. Findings will guide the development of a 3D authoring toolkit for non-technologist instructors, enabling wider AR use in aviation weather education and other educational fields.


Research interviews with aviation instructors were conducted to derive design implications of AR authoring toolkits for non-technologist instructors. Key findings highlighted gaps in aviation weather education, potential AR applications, and barriers to AR in education. Design recommendations emphasised incorporating interactive AR lesson modules, initial user requirements, and prebuilt AR modules.

2.
Pilot Feasibility Stud ; 8(1): 77, 2022 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-35366952

RESUMEN

BACKGROUND: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. METHOD: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. DISCUSSION: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021.

4.
Front Public Health ; 10: 1079082, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36793362

RESUMEN

Background: Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods: We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results: During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion: Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.


Asunto(s)
COVID-19 , Depresión , Humanos , Anciano , Depresión/terapia , Investigación Cualitativa , Washingtón , Pobreza
5.
J Med Case Rep ; 14(1): 218, 2020 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-33176863

RESUMEN

BACKGROUND: Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. CASE PRESENTATION: A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. CONCLUSIONS: Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.


Asunto(s)
Barotrauma , Buceo , Parálisis Facial , Altitud , Barotrauma/complicaciones , Nervio Facial , Parálisis Facial/etiología , Parálisis Facial/terapia , Humanos , Masculino , Persona de Mediana Edad
7.
Ecohealth ; 16(2): 306-316, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31016438

RESUMEN

One health emphasizes the interdependent health of humans, animals, and their shared environments and shows promise as an integrated, equitable transdisciplinary approach to important ecohealth issues. Notably, research or programming explicitly examining the intersection of gender and one health is limited, although females represent half of the human population and play important roles in human and animal health around the world. Recognizing these gaps, scholars from the University of Wisconsin-Madison in collaboration with United States Department of Agriculture convened a consultative workshop, "Women and One Health," in 2016. This paper outlines the workshop methods and highlights outcomes toward shared terminology and integration of frameworks from one health, gender analysis, and women in agriculture. Further, recommendations for education, policy, and service delivery at the intersection of women's empowerment and one health are offered as important efforts toward the dual goals of gender equality and sustainable health of humans, animals, and their shared ecosystems.


Asunto(s)
Ecosistema , Salud , Salud Única , Agricultura , Animales , Educación , Femenino , Educación en Salud , Humanos , Comunicación Interdisciplinaria , Masculino , Desarrollo Sostenible , Mujeres
8.
J ECT ; 34(1): e5-e9, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28937549

RESUMEN

OBJECTIVES: Super refractory status epilepticus (SRSE) is a stage beyond refractory status that requires general anesthesia as management. Electroconvulsive therapy (ECT) is recommended only as a potential treatment option beyond general anesthesia and after all other options have been exhausted. Its effect on aborting status has been minimally researched. We present the largest case series to our knowledge exploring the effect of ECT on SRSE. METHODS: Eight adults hospitalized for SRSE received ECT in an attempt to abort status after other treatment modalities were exhausted. Electroconvulsive therapy consisted of a 504-mC (≈99.4 J) stimulus delivered bifrontotemporally with a constant 0.5-millisecond pulse width. Seizure activity during ECT was monitored visually and correlated to the single-channel recording provided by the apparatus. RESULTS: There was neurotelemetry or clinical evidence of improvement within 24 hours after the full course of ECT treatment in 5 (63%) of the 8 cases. Cases that improved were given an average of 7.8 total ECT stimulations, eliciting an average of 4.2 total seizures. CONCLUSIONS: Although it is difficult to determine the exact role of ECT in the improvement of 63% of our cases, we present a series of patients for whom pharmacotherapy, ketogenic diet, and general anesthesia otherwise did not produce an appreciable effect on status prior to implementation of ECT. These findings suggest that cases of SRSE may benefit from ECT administration.


Asunto(s)
Terapia Electroconvulsiva/métodos , Estado Epiléptico/terapia , Adulto , Anciano , Terapia Electroconvulsiva/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
9.
J Patient Saf ; 13(2): 51-61, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28198722

RESUMEN

OBJECTIVE: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. METHODS: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes. RESULTS: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs. CONCLUSIONS: For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.


Asunto(s)
Comunicación , Comprensión , Consenso , Cuidados Críticos , Voluntad en Vida , Médicos , Órdenes de Resucitación , Adulto , Enfermedad Crítica , Medicina de Emergencia , Medicina Familiar y Comunitaria , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad , Seguridad , Encuestas y Cuestionarios , Grabación en Video
10.
Sci Rep ; 6: 34087, 2016 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-27686155

RESUMEN

Complex social networks and behaviors are difficult to observe for free-living marine species, especially those that move great distances. Using implanted acoustic transceivers to study the inter- and intraspecific interactions of sand tiger sharks Carcharias taurus, we observed group behavior that has historically been associated with higher order mammals. We found evidence strongly suggestive of fission-fusion behavior, or changes in group size and composition of sand tigers, related to five behavioral modes (summering, south migration, community bottleneck, dispersal, north migration). Our study shows sexually dimorphic behavior during migration, in addition to presenting evidence of a potential solitary phase for these typically gregarious sharks. Sand tigers spent up to 95 consecutive and 335 cumulative hours together, with the strongest relationships occurring between males. Species that exhibit fission-fusion group dynamics pose a particularly challenging issue for conservation and management because changes in group size and composition affect population estimates and amplify anthropogenic impacts.

11.
Ethiop Med J ; Suppl 2: 37-44, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25546908

RESUMEN

INTRODUCTION: A Twinning Partnership between the University of Wisconsin-Madison (UW) and Addis Ababa University (AAU) in Addis Ababa, Ethiopia was formed to strengthen the development of emergency medical services at AAU's Tikur Anbessa Specialized Hospital (TASHI) through medical education and exchanges. The Twinning philosophy which emphasizes collaboration and joint learning was an ideal program in which QI program was incorporated to maximize success, promote sustainability, and reinforce basic principles for effective healthcare service delivery. This article describes the QI methodology, capacity building strategy, implementation approach, and lessons learned. METHODOLOGY: QI initiative at TASH ED started during EM fellowship in 2010 when Priority problems in the department were identified, and root cause analysis and possible strategies for improvement were devised. Then Baseline and sensitization was undertaken which was followed by Quality Improvement Projects cycles. The Federal Ministry of health key performance indicators (KPI) were used as standard and measurement tool when it was relevant. The findings were analyzed and trends presented to the ED staff and other stakeholders. RESULTS: In the past four years Since QI initiatives started in TASH EM department different achievements have been registered. The main developments were capacity building with QI training of EM fellows, EM residents and EM and critical care nurses. QI Training was also conducted to Tikur Anbessa Hospital and college of health sciences leadership. In addition, various QI projects have been designed and started, while some are finalized and the rest are on implementation. DISCUSSION: The QI experience in the department suggests that a QI program can effectively support, complement, and enhance health system strengthening partnerships, and that establishment of a QI program at the department level is feasible and beneficial, enhancing the adoption and sustainability of health care improvements such as marked improvements in triage, improved infection control and other critical improvements. Therefore, program leaders have determined that scale-up to a hospital-wide QI program is needed to fully realize the potential for increased quality, efficiency and system strengthening.


Asunto(s)
Medicina de Emergencia/organización & administración , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Etiopía , Hospitales Especializados , Humanos , Mejoramiento de la Calidad
12.
J Health Commun ; 19 Suppl 2: 19-28, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25315581

RESUMEN

Patients on warfarin therapy need to achieve and maintain anticoagulation control in order to experience the benefits of treatment while minimizing bleeding risk. Low health literacy skills may hinder patients' ability to use and adhere to warfarin in a safe and effective manner. The authors conducted this study to evaluate the relationship between health literacy and anticoagulation control among patients on chronic warfarin therapy. Participants were recruited from 2 diverse anticoagulation clinics in North Carolina. Time in therapeutic range (TTR) for warfarin therapy was used as a measure of anticoagulation control. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Of the 198 study participants, 51% had limited health literacy (S-TOFHLA score of 0-90) and 33% had poor anticoagulation control (TTR<50%). Participants with limited health literacy were less likely to correctly answer warfarin-related knowledge questions. Limited health literacy was significantly associated with TTR<50% (adjusted odds ratio=2.34, 95% CI [1.01, 5.46]). Findings indicate that limited health literacy is associated with poor anticoagulation control for patients on warfarin therapy. Lack of medication understanding may hinder the safe and effective use of this narrow therapeutic index drug.


Asunto(s)
Anticoagulantes/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Warfarina/uso terapéutico , Anciano , Anticoagulantes/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Warfarina/efectos adversos
13.
J Nurs Adm ; 44(7/8): 378-80, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25072226

RESUMEN

The director of academic nursing education was created to strengthen the relationship between academic nursing education and clinical practice with goals of advancing nurses' academic education and preparing the future pediatric nursing workforce for 1 organization.


Asunto(s)
Educación de Postgrado en Enfermería , Enfermería Pediátrica/educación , Liderazgo , Rol de la Enfermera
14.
Acad Med ; 89(2): 251-6, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24362385

RESUMEN

International immersion experiences do not, in themselves, provide students with the opportunity to develop cultural competence. However, using an anthropological lens to educate students allows them to learn how to negotiate cultural differences by removing their own cultural filters and seeing events through the eyes of those who are culturally different. Faculty at the University of Wisconsin-Madison's Global Health Institute believed that an embedded experience, in which students engaged with local communities, would encourage them to adopt this Cultural Competency 2.0 position. With this goal in mind, they started the Field School for the Study of Language, Culture, and Community Health in Ecuador in 2003 to teach cultural competency to medical, veterinary, pharmacy, and nursing students. The program was rooted in medical anthropology and embraced the One Health initiative, which is a collaborative effort of multiple disciplines working locally, nationally, and globally to obtain optimal health for people, animals, and the environment. In this article, the authors identify effective practices and challenges for using a biocultural approach to educating students. In a semester-long preparatory class, students study the Spanish language, region-specific topics, and community engagement principles. While in Ecuador for five weeks, students apply their knowledge during community visits that involve homestays and service learning projects, for which they partner with local communities to meet their health needs. This combination of language and anthropological course work and community-based service learning has led to positive outcomes for the local communities as well as professional development for students and faculty.


Asunto(s)
Antropología Cultural/métodos , Competencia Cultural/educación , Curriculum , Empleos en Salud/educación , Educación Médica , Educación en Enfermería , Educación en Farmacia , Educación en Veterinaria , Salud Global/educación , Humanos
15.
J Law Med Ethics ; 42 Suppl 2: 32-7, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25564708

RESUMEN

The experience and lessons to date from the University of Wisconsin-Madison Global Health Institute's global health programs, considered together with more recently published competency frameworks related to global health practice, can provide important insights into the development of a core set of interprofessional competencies for global health that can be used across disciplines and professions.


Asunto(s)
Curriculum , Salud Global/educación , Salud Global/normas , Comunicación Interdisciplinaria , Competencia Profesional/normas , Humanos , Universidades , Wisconsin
16.
BMC Ophthalmol ; 13: 48, 2013 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-24066722

RESUMEN

BACKGROUND: Autoimmune retinopathy (AR) and Cancer-Associated Retinopathy (CAR) are associated with a diverse repertoire of anti-retinal autoantibodies (AAbs) but not all antigenic targets have been characterized. Identification of new AAbs may help with clinical diagnosis and prognosis of retinal dysfunction in AR. The goal was to identify frequently targeted retinal autoantigens within the 60-70-kDa molecular weight range. METHODS: Human retinal proteins were separated by SDS-PAGE and 2D gel electrophoresis (2-DE) and sera from AR patients with and without cancer were used to identify immunoreactive proteins by Western blotting. Proteins were identified following separation by electrophoresis, Coomassie staining using in-gel trypsin digestion and mass spectrometric analysis. Circulating serum hsp60 and anti-hsp60 antibody levels were determined by quantitative ELISA. RESULTS: Retrospective evaluation of 819 patients with anti-retinal AAbs showed that 29% patients had AAbs targeted proteins between 60-70-kDa. Shotgun mass spectrometry of human retinal proteins present in 1D-gel found 66 species within this range. To identify the immunoreactive proteins, we performed Western blots of 2-DE gels and showed a group of heat shock proteins (hsps), including hsp60 and CRMP proteins that were frequently recognized by AR patient AAbs, irrespective of cancer status. These results were validated by immunostaining of purified hsp60 and CRMP2 proteins. ELISA results revealed that patients with AR and CAR had significantly increased levels of serum anti-hsp60 antibodies compared to control healthy subjects (p < 0.0001). However, circulating hsp60 protein was not significantly elevated in sera of either patient group. CONCLUSIONS: Different anti-retinal antibodies frequently co-exist in a single patient, creating antibody-arrays related to the syndrome. Hsps and CRMP-2 are newly identified autoantigens in AR. A frequent co-association of anti-hsp antibodies with other anti-retinal AAbs may augment pathogenic processes, leading to retinal degeneration.


Asunto(s)
Autoanticuerpos/sangre , Enfermedades Autoinmunes/inmunología , Proteínas de Choque Térmico/inmunología , Péptidos y Proteínas de Señalización Intercelular/inmunología , Proteínas del Tejido Nervioso/inmunología , Enfermedades de la Retina/inmunología , Adulto , Autoantígenos/inmunología , Western Blotting , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Humanos , Estudios Retrospectivos
17.
Invest Ophthalmol Vis Sci ; 53(1): 406-12, 2012 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-22167100

RESUMEN

PURPOSE: Optic neuritis (ON) is a condition involving primary inflammation, demyelination, and axonal injury in the optic nerve and leads to apoptotic retinal ganglion cell (RGC) death, which contributes to the persistence of visual loss. Currently, ON has no effective treatment. The goal was to determine the effectiveness of immunotherapy with recombinant T-cell receptor ligand (RTL) in preventing ON in humanized HLA-DR2 transgenic mice. METHODS: Experimental autoimmune encephalomyelitis (EAE) was induced with myelin oligodendrocyte glycoprotein in humanized HLA-DR2 (DRß1*1501) transgenic mice. Five consecutive doses of RTL342M were administrated at the onset of ON. The development of autoimmune ON was assessed by histopathology at different time points. The levels of myelin loss, axonal loss, and RGC damage were examined by immunofluorescence. RESULTS: HLA-DR2 mice developed chronic ON 2 days before EAE characterized by progressive neurodegeneration in both organs. RTL342M significantly suppressed inflammation in the optic nerve and spinal cord and provided protection for at least 30 days. Examination of myelin loss showed a marked suppression of demyelination and an increase in myelin recovery in the optic nerve. Moreover, RTL342M treatment revealed a neuroprotective effect on optic nerve axons and RGCs in retinas at postimmunization (PI) day 62. CONCLUSIONS: RTL342M suppressed clinical and histologic signs of EAE/ON by preventing the recruitment of inflammatory cells into the optic nerve and showed neuroprotective effects against ON. However, to achieve full therapeutic benefit, more doses may be needed. These findings suggest a possible clinical application of this novel class of T-cell-tolerizing drugs for patients with optic neuritis.


Asunto(s)
Encefalomielitis Autoinmune Experimental/prevención & control , Inmunoterapia , Ligandos , Neuritis Óptica/prevención & control , Receptores de Antígenos de Linfocitos T/inmunología , Proteínas Recombinantes de Fusión/inmunología , Animales , Axones/patología , Encefalomielitis Autoinmune Experimental/inducido químicamente , Encefalomielitis Autoinmune Experimental/patología , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Glicoproteínas/toxicidad , Cadenas HLA-DRB1/genética , Masculino , Ratones , Ratones Transgénicos , Vaina de Mielina/metabolismo , Glicoproteína Mielina-Oligodendrócito , Neuritis Óptica/inducido químicamente , Neuritis Óptica/patología , Fragmentos de Péptidos/toxicidad , Proteínas Recombinantes de Fusión/uso terapéutico , Células Ganglionares de la Retina/patología , Transgenes
18.
J Ophthalmic Inflamm Infect ; 1(3): 111-21, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21744285

RESUMEN

PURPOSE: Autoimmune retinopathies and optic neuropathies are complex disorders of the retina and the optic nerve, in which patients develop autoantibodies (AAbs) against retinal and optic nerve proteins. Autoimmunity might significantly influence the outcome of retinal and optic nerve degenerative process but the pathogenic process is not fully elucidated. To better understand the role of AAbs in pathogenicity of these suspected autoimmune visual disorders, we focused on unique AAbs specificities associated with the syndrome to identify their antigenic targets in the optic nerve and retina. METHODS: Serum samples were obtained from patients, whose visual disorders were potentially autoimmune in nature, including patients with cancer with possible paraneoplastic syndrome. Autoantibodies were tested against human optic nerve and retinal antigens for specificity by Western blotting and immunofluorescence. RESULTS: Out of 209 tested for anti-optic nerve autoantibodies, 55% showed specific neuronal autoantibodies. The repertoire of anti-optic nerve autoantibodies often differed from anti-retinal antibodies. The major antigenic targets for these antibodies could be divided into four groups. Autoantibodies specific to classical glycolytic enzymes involved in energy production (α and γ enolases, glyceraldehyde 3-phosphate dehydrogenase) also reacted with retinal antigens. Autoantibodies targeted neuronal-specific myelin proteins (MBP, MOG), aquaporin 4, and collapsing response mediator protein 5 reacted with optic nerve antigens. They showed immunostaining of axons and myelin in the optic nerve as determined by double immunofluorescence. CONCLUSION: We identified novel neuronal autoantigens not previously known to be associated with acquired autoimmune retinopathy and optic neuropathy. Knowledge of the full autoantibody repertoire perpetuating this syndrome is an important first requirement in increasing our understanding of the autoimmune process to facilitate better diagnosis, prognosis, and treatment.

19.
Am J Prev Med ; 37(4): 330-9, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19765506

RESUMEN

CONTEXT: Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. EVIDENCE ACQUISITION: Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. EVIDENCE SYNTHESIS: Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose. CONCLUSIONS: These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.


Asunto(s)
Conductas Relacionadas con la Salud , Actividad Motora/fisiología , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Lugar de Trabajo/estadística & datos numéricos , Modificador del Efecto Epidemiológico , Estado de Salud , Humanos , Satisfacción en el Trabajo , Actividades Recreativas , Salud Laboral , Aptitud Física , Calidad de Vida
20.
Exp Mol Pathol ; 87(3): 195-203, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19744478

RESUMEN

Autoimmune retinopathies (AR) are uncommon retinal degenerations with vision loss associated with unique clinical symptoms and findings and with serum anti-retinal autoantibodies. The experimental and clinical studies corroborate that autoantibodies in high titers can penetrate into the retina affecting function of the target antigens, which leads to retinal dysfunction and degeneration. Anti-recoverin and anti-enolase alpha-enolase autoantibodies were more frequently recognized in AR but autoantibodies with other specificities have also been documented, indicating immunological heterogeneity. Our goal was to examine the associations of anti-retinal autoantibodies with retinopathy in order to identify molecular biomarkers for better diagnosis and prognosis of retinopathies. In these studies we examined 39 patients (10 with cancers) of average age of approximately 57 years old with sudden onset of unexplained progressive vision loss and the presence of circulating serum autoantibodies against 40-kDa retinal protein. The patients presented the retinal phenotype characterized by defects in visual fields and reduced scotopic ERG responses. Anti-40-kDa autoantibodies had specificity to the amino terminus of transducin-alpha. None of the normal subjects' sera had anti-40-kDa autoantibodies. In conclusion, the clinical phenotype of patients with anti-transducin-alpha autoantibodies differed from other phenotypes of AR. These patients, often women at a ratio approximately 2:1, had defects in rod (scotopic) photoreceptor function and typically did not have cancers, whereas the anti-recoverin phenotype is associated with cancer and severe loss of rod and cones function, and anti-enolase retinopathy typically presents with cone dysfunction and is equal in cancer and non-cancer patients. Our studies suggest that anti-transducin autoantibodies can serve as molecular biomarkers for retinal phenotypes and could be used for progression of retinal dysfunction and degeneration.


Asunto(s)
Autoanticuerpos/sangre , Enfermedades Autoinmunes/diagnóstico , Degeneración Retiniana/diagnóstico , Transducina/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/sangre , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Degeneración Retiniana/sangre
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