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Background: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and Methods: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-months follow up, and Life Simple7 (LS7) - a cardiovascular disease (CVD) risk score - at 6 months and 1-year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration: NCT05174286.
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BACKGROUND: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. DESIGN AND METHODS: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)-a cardiovascular disease (CVD) risk score-at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. DISCUSSION: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. TRIAL REGISTRATION: NCT05174286; clinicaltrials.gov; August 31st, 2023.
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Negro o Afroamericano , Enfermedades Cardiovasculares , Neoplasias Colorrectales , Agentes Comunitarios de Salud , Detección Precoz del Cáncer , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/etnología , Factores de Riesgo , Entrevista Motivacional , Conducta de Reducción del Riesgo , Medición de Riesgo , Conocimientos, Actitudes y Práctica en Salud , Factores de Tiempo , Dieta Saludable , Derivación y Consulta , Promoción de la Salud/métodos , Valor Predictivo de las PruebasRESUMEN
Objectives: Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. Methods: This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Results: Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Conclusion: Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1) inconsistency between numerical scores and sentiment of textual comments; and 2) inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.
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Medicina de Emergencia , Internado y Residencia , Masculino , Humanos , Femenino , Retroalimentación , Estudios Retrospectivos , Personal de SaludRESUMEN
The unfolded protein response (UPR) is sensitive to proteotoxic and membrane bilayer stress, both of which are sensed by the ER protein Ire1. When activated, Ire1 splices HAC1 mRNA, producing a transcription factor that targets genes involved in proteostasis and lipid metabolism, among others. The major membrane lipid phosphatidylcholine (PC) is subject to phospholipase-mediated deacylation, producing glycerophosphocholine (GPC), followed by reacylation of GPC through the PC deacylation/reacylation pathway (PC-DRP). The reacylation events occur via a two-step process catalyzed first by the GPC acyltransferase Gpc1, followed by acylation of the lyso-PC molecule by Ale1. However, whether Gpc1 is critical for ER bilayer homeostasis is unclear. Using an improved method for C14-choline-GPC radiolabeling, we first show that loss of Gpc1 results in abrogation of PC synthesis through PC-DRP and that Gpc1 colocalizes with the ER. We then probe the role of Gpc1 as both a target and an effector of the UPR. Exposure to the UPR-inducing compounds tunicamycin, DTT, and canavanine results in a Hac1-dependent increase in GPC1 message. Further, cells lacking Gpc1 exhibit increased sensitivity to those proteotoxic stressors. Inositol limitation, known to induce the UPR via bilayer stress, also induces GPC1 expression. Finally, we show that loss of GPC1 induces the UPR. A gpc1Δ mutant displays upregulation of the UPR in strains expressing a mutant form of Ire1 that is unresponsive to unfolded proteins, indicating that bilayer stress is responsible for the observed upregulation. Collectively, our data indicate an important role for Gpc1 in yeast ER bilayer homeostasis.
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Proteínas de Saccharomyces cerevisiae , Saccharomyces cerevisiae , Aciltransferasas/metabolismo , Factores de Transcripción con Cremalleras de Leucina de Carácter Básico/metabolismo , Fosfatidilcolinas/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Proteínas Represoras/metabolismo , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo , Respuesta de Proteína DesplegadaRESUMEN
OBJECTIVE: To examine patterns of collaborative research behavior by gender among veterinary academic faculty to determine whether differences exist in how men and women access resources as a contributing factor to the advancement gap. SAMPLE: 710 faculty from 23 veterinary medical colleges. PROCEDURES: An online questionnaire was sent through listservs at participating institutions and data were collected anonymously. Responses related to professional demographics, resources, collaboration, and elements of environmental culture were analyzed to identify associations among variables. Proportional odds logistic regression was utilized to examine the effect of gender on academic rank. RESULTS: Male and female faculty reported participating in collaborations at equal rates. Men were more likely to engage in research collaborations with other men. These collaborations were more common than collaborations between women or between women and men. Men had 47% higher odds of more advanced academic rank compared with women and controlling for relevant factors. While there was no difference in the value of startup packages listed by men and women, women were more likely to report gender as a disadvantage in accessing resources and opportunities. CLINICAL RELEVANCE: Research productivity is a main factor driving academic promotion. To improve gender equity in career advancement and to support scholarship among all faculty, the creation of institutional development programs focused on facilitating collaborations and resource sharing may be a strategic area for veterinary academic leaders to consider.
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Movilidad Laboral , Docentes Médicos , Animales , Masculino , Femenino , Humanos , Estados Unidos , Factores Sexuales , Encuestas y CuestionariosRESUMEN
Climate change is already impacting coastal communities, and ongoing and future shifts in fisheries species productivity from climate change have implications for the livelihoods and cultures of coastal communities. Harvested marine species in the California Current Large Marine Ecosystem support U.S. West Coast communities economically, socially, and culturally. Ecological vulnerability assessments exist for individual species in the California Current but ecological and human vulnerability are linked and vulnerability is expected to vary by community. Here, we present automatable, reproducible methods for assessing the vulnerability of U.S. West Coast fishing dependent communities to climate change within a social-ecological vulnerability framework. We first assessed the ecological risk of marine resources, on which fishing communities rely, to 50 years of climate change projections. We then combined this with the adaptive capacity of fishing communities, based on social indicators, to assess the potential ability of communities to cope with future changes. Specific communities (particularly in Washington state) were determined to be at risk to climate change mainly due to economic reliance on at risk marine fisheries species, like salmon, hake, or sea urchins. But, due to higher social adaptive capacity, these communities were often not found to be the most vulnerable overall. Conversely, certain communities that were not the most at risk, ecologically and economically, ranked in the category of highly vulnerable communities due to low adaptive capacity based on social indicators (particularly in Southern California). Certain communities were both ecologically at risk due to catch composition and socially vulnerable (low adaptive capacity) leading to the highest tier of vulnerability. The integration of climatic, ecological, economic, and societal data reveals that factors underlying vulnerability are variable across fishing communities on the U.S West Coast, and suggests the need to develop a variety of well-aligned strategies to adapt to the ecological impacts of climate change.
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Cambio Climático , Ecosistema , Animales , Explotaciones Pesqueras , Humanos , Caza , SalmónRESUMEN
AIM: To show that depletion of pancreatic macrophages impairs gestational beta cell proliferation and leads to glucose intolerance. MATERIALS AND METHODS: Genetic animal models were applied to study the effects of depletion of pancreatic macrophges on gestational beta-cell proliferaiton and glucose response. The crosstalk between macrophages and beta-cells was studied in vivo using beta-cell-specific extracellular-signal-regulated kinase 5 (ERK5) knockout and epidermal growth receptor (EGFR) knockout mice, and in vitro using a co-culture system. RESULTS: Beta cell-derived placental growth factor (PlGF) recruited naïve macrophages and polarized them towards an M2-like phenotype. These macrophages then secreted epidermal growth factor (EGF), which activated extracellular signal-regulated kinase 5 (ERK5) signalling in beta cells to promote gestational beta cell proliferation. On the other hand, activation of ERK5 signalling in beta cells likely, in turn, enhanced the production and secretion of PlGF by beta cells. CONCLUSIONS: Our study shows a regulatory loop between macrophages and beta cells through PlGF/EGF/ERK5 signalling cascades to regulate gestational beta cell growth.
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Factor de Crecimiento Epidérmico , Proteína Quinasa 7 Activada por Mitógenos , Animales , Proliferación Celular , Factor de Crecimiento Epidérmico/metabolismo , Factor de Crecimiento Epidérmico/farmacología , Femenino , Macrófagos/metabolismo , Ratones , Proteína Quinasa 7 Activada por Mitógenos/metabolismo , Factor de Crecimiento Placentario/metabolismoRESUMEN
OBJECTIVE: To describe veterinary house officers' perceptions of dimensions of well-being during postgraduate training and to identify potential areas for targeted intervention. SAMPLE: 303 house officers. PROCEDURES: A 62-item questionnaire was generated by use of an online platform and sent to house officers at participating institutions in October 2020. Responses were analyzed for trends and associations between selected variables. RESULTS: 239 residents, 45 rotating interns, and 19 specialty interns responded to the survey. The majority of house officers felt that their training program negatively interfered with their exercise habits, diet, and social engagement. House officers reported engaging in exercise significantly less during times of clinical responsibility, averaging 1.6 exercise sessions/wk (SD ± 0.8) on clinical duty and 2.4 exercise sessions/wk (SD ± 0.9) when not on clinical duty (P < 0.001). Ninety-four percent of respondents reported experiencing some degree of anxiety regarding their physical health, and 95% of house officers reported feeling some degree of anxiety regarding their current financial situation. Overall, 47% reported that their work-life balance was unsustainable for > 1 year; there was no association between specialty and sustainability of work-life balance. Most house officers were satisfied with their current training program, level of clinical responsibility, and mentorship. CLINICAL RELEVANCE: Veterinary house officers demonstrated a poor balance between the demands of postgraduate training and maintenance of personal health. Thoughtful interventions are needed to support the well-being of veterinary house officers.
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Condicionamiento Físico Animal , Animales , Actitud del Personal de Salud , Personal de Salud , Humanos , Encuestas y CuestionariosRESUMEN
Coastal communities are being impacted by climate change, affecting the livelihoods, food security, and wellbeing of residents. Human wellbeing is influenced by the heath of the environment through numerous pathways and is increasingly being included as a desired outcome in environmental management. However, the contributors to wellbeing can be subjective and the values and perspectives of decision-makers can affect the aspects of wellbeing that are included in planning. We used Q methodology to examine how a group of individuals in fisheries management prioritize components of wellbeing that may be important to coastal communities in the California Current social-ecological system (SES). The California Current SES is an integrated system of ecological and human communities with complex linkages and connections where commercial fishing is part of the culture and an important livelihood. We asked individuals that sit on advisory bodies to the Pacific Fisheries Management Council to rank 36 statements about coastal community wellbeing, ultimately revealing three discourses about how we can best support or improve wellbeing in those communities. We examine how the priorities differ between the discourses, identify areas of consensus, and discuss how these perspectives may influence decision-making when it comes to tradeoffs inherent in climate adaptation in fisheries. Lastly, we consider if and how thoughts about priorities have been affected by the COVID-19 pandemic.
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Alzheimer's Disease (AD) is the sixth leading cause of death in the United States. Recent studies have established a potential link between herpes simplex virus 1 (HSV-1) infection and the development of AD. HSV-1 DNA has been detected in AD amyloid plaques in human brains, and treatment with the antiviral acyclovir (ACV) was reported to block the accumulation of the AD-associated proteins beta-amyloid (Aß) and hyper-phosphorylated tau (p-tau) in Vero and glioblastoma cells. Our goal was to determine whether the accumulation of AD-related proteins is attributable to acute and/or latent HSV-1 infection in mature hippocampal neurons, a region of the brain severely impacted by AD. Primary adult murine hippocampal neuronal cultures infected with HSV-1, with or without antivirals, were assessed for Aß and p-tau expression over 7 days postinfection. P-tau expression was transiently elevated in HSV-1-infected neurons, as well as in the presence of antivirals alone. Infected neurons, as well as uninfected neurons treated with antivirals, had a greater accumulation of Aß42 than uninfected untreated neurons. Furthermore, Aß42 colocalized with HSV-1 latency-associated transcript (LAT) expression. These studies suggest that p-tau potentially acts as an acute response to any perceived danger-associated molecular pattern (DAMP) in primary adult hippocampal neurons, while Aß aggregation is a long-term response to persistent threats, including HSV-1 infection.IMPORTANCE Growing evidence supports a link between HSV-1 infection and Alzheimer's disease (AD). Although AD is clearly a complex multifactorial disorder, an infectious disease etiology provides alternative therapy opportunities for this devastating disease. Understanding the impact that HSV-1 has on mature neurons and the proteins most strongly associated with AD pathology may identify specific mechanisms that could be manipulated to prevent progression of neurodegeneration and dementia.
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Péptidos beta-Amiloides/metabolismo , Herpesvirus Humano 1/fisiología , Neuronas/metabolismo , Aciclovir/farmacología , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/virología , Precursor de Proteína beta-Amiloide/metabolismo , Animales , Antivirales/farmacología , Encéfalo/metabolismo , Chlorocebus aethiops , Femenino , Herpes Simple/metabolismo , Herpesvirus Humano 1/metabolismo , Herpesvirus Humano 1/patogenicidad , Hipocampo/metabolismo , Ratones , Neuronas/virología , Fragmentos de Péptidos/metabolismo , Fosforilación , Placa Amiloide/metabolismo , Cultivo Primario de Células , Células Vero , Replicación Viral/efectos de los fármacos , Proteínas tau/metabolismo , Proteínas tau/farmacologíaRESUMEN
Children are capable of viewing object ownership as categorical and exclusive, but ownership claims can also vary by degree. This study investigated how children use these different conceptions of ownership in a giving and a taking task. In two studies, 4- to 7-year olds (N = 105) could give and take craft objects that they or another child had found (weaker claim) and made (stronger claim). In Study 1, no additional ownership information was given, and in Study 2 categorical ownership was stated ("these belong to you"). The results showed that children used categorical ownership for their own objects but used ownership strength for the other child's objects, taking more of the found items.
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Conducta Infantil/fisiología , Desarrollo Infantil/fisiología , Conducta Social , Niño , Preescolar , Femenino , Humanos , Masculino , PropiedadRESUMEN
Standard forensic practice necessitates that a witness describes an offender's face prior to constructing a visual likeness, a facial composite. However, describing a face can interfere with face recognition, although a delay between description and recognition theoretically should alleviate this issue. In Experiment 1, participants produced a free recall description either 3-4 hr or 2 days after intentionally or incidentally encoding a target face, and then constructed a composite using a modern "feature" system immediately or after 30 min. Unexpectedly, correct naming of composites significantly reduced following the 30-min delay between description and construction for targets encoded 2 days previously. In Experiment 2, participants in these conditions gave descriptions that were better matched to their targets by independent judges, a result which suggests that the 30-min delay actually impairs access to details of recalled descriptions that are valuable for composite effectiveness. Experiment 3 found the detrimental effect of description delay extended to composites constructed from a "holistic" face production system. The results have real-world but counterintuitive implications for witnesses who construct a face 1 or 2 days after a crime: After having recalled the face to a practitioner, an appreciable delay (here, 30 min) should be avoided before starting face construction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Criminales , Reconocimiento Facial , Recuerdo Mental , Reconocimiento en Psicología , Percepción Visual , Adulto , Crimen , Testimonio de Experto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND: ALM201 is a therapeutic peptide derived from FKBPL that has previously undergone preclinical and clinical development for oncology indications and has completed a Phase 1a clinical trial in ovarian cancer patients and other advanced solid tumours. METHODS: In vitro, cancer stem cell (CSC) assays in a range of HGSOC cell lines and patient samples, and in vivo tumour initiation, growth delay and limiting dilution assays, were utilised. Mechanisms were determined by using immunohistochemistry, ELISA, qRT-PCR, RNAseq and western blotting. Endogenous FKBPL protein levels were evaluated using tissue microarrays (TMA). RESULTS: ALM201 reduced CSCs in cell lines and primary samples by inducing differentiation. ALM201 treatment of highly vascularised Kuramochi xenografts resulted in tumour growth delay by disruption of angiogenesis and a ten-fold decrease in the CSC population. In contrast, ALM201 failed to elicit a strong antitumour response in non-vascularised OVCAR3 xenografts, due to high levels of IL-6 and vasculogenic mimicry. High endogenous tumour expression of FKBPL was associated with an increased progression-free interval, supporting the protective role of FKBPL in HGSOC. CONCLUSION: FKBPL-based therapy can (i) dually target angiogenesis and CSCs, (ii) target the CD44/STAT3 pathway in tumours and (iii) is effective in highly vascularised HGSOC tumours with low levels of IL-6.
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Carcinoma Epitelial de Ovario/patología , Diferenciación Celular/efectos de los fármacos , Células Madre Neoplásicas/efectos de los fármacos , Neovascularización Patológica/patología , Neoplasias Ováricas/patología , Péptidos/farmacología , Proteínas de Unión a Tacrolimus , Animales , Carcinoma Epitelial de Ovario/irrigación sanguínea , Carcinoma Epitelial de Ovario/metabolismo , Línea Celular Tumoral , Femenino , Humanos , Receptores de Hialuranos/efectos de los fármacos , Receptores de Hialuranos/metabolismo , Técnicas In Vitro , Interleucina-6/metabolismo , Ratones , Ratones SCID , Neovascularización Patológica/metabolismo , Neoplasias Ováricas/irrigación sanguínea , Neoplasias Ováricas/metabolismo , Factor de Transcripción STAT3/efectos de los fármacos , Factor de Transcripción STAT3/metabolismo , Transducción de Señal , Proteínas de Unión a Tacrolimus/efectos de los fármacos , Proteínas de Unión a Tacrolimus/metabolismo , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
Veterinary internships are common 1-year post-graduate clinical training programs that are offered both at veterinary colleges and in private practice settings. To promote the quality of these training programs, the American Association of Veterinary Medical Colleges (AAVMC) charged a working group to develop these internship guidelines, which were approved by the AAVMC in 2018 and have also been endorsed by the American Association of Veterinary Clinicians. These guidelines are intended to be applicable to all internships, in both academic and private practice settings, and they place particular emphasis on three aspects of internship training programs: competency-based education, intern well-being, and program outcome.
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Educación en Veterinaria , Internado y Residencia , Animales , Humanos , Estados Unidos , UniversidadesRESUMEN
The ability to assess the value of the information one receives and the intentions of the source of that information can be used to establish cooperative relationships and to identify cooperative partners. Across two experiments, 4- to 8-year-old children (Nâ¯=â¯204) received a note with correct, incorrect, or no information that affected their efforts on a search task. Children were told that all informants had played the game before and knew the location of the hidden reward. In the no information condition, children were told that the informant needed to leave before finishing the note and, thus, was not intentionally uninformative. Children rated the note with correct information as more helpful than the note with no information; incorrect information was rated least helpful. When asked about the informant's intentions, children attributed positive intentions when the information was correct and when they received unhelpful information but knew the informant was not intentionally uninformative. Children attributed less positive intentions to the informant when they received incorrect information. When given the chance to reward the informant, children rewarded the informant who provided correct information and no information equally; the informant who provided incorrect information received fewer rewards. Combined, these results suggest that young children assume that informants have positive intentions even when they provide no useful information. However, when the information provided is clearly inaccurate, children infer more negative intentions and reward those informants at lower rates. These results suggest that children tend to reward informants more based on their presumed intentions, placing less weight on the value of the information they provide.
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Toma de Decisiones , Intención , Juicio , Confianza , Niño , Preescolar , Femenino , Juegos Recreacionales , Humanos , Masculino , RecompensaRESUMEN
Nontrauma service (NTS) admissions are an increasing problem as ground-level falls in elderly patients become more common. The admission and evaluation of trauma patients to nontrauma services in trauma centers seeking American College of Surgeons (ACS) verification, must follow the ACS mandates for performance improvement requiring some method of evaluating this population when admitted to services other than trauma, orthopedics, and neurosurgery. The purpose of this study and performance improvement project was to improve our process for the definition and evaluation of trauma patients who were being admitted to nontrauma services. We designed an algorithm to evaluate appropriateness of NTS admission and evaluated outcomes for NTS admissions utilizing that algorithm.We created a scoring algorithm and evaluated appropriateness of NTS admission over 2 years in a community-teaching ACS Level II trauma center. We reviewed trauma registry data using χ and Fisher exact tests to determine differences in outcome for NTS versus trauma service (TS) admissions.From December 2014 to December 2016, NTS admission rate fell from maximum of 28% to 4% stabilizing between 8% and 10%. Mortality and overall complication rate between NTS and TS were similar (p = .40 and .66, respectively), but length of stay was lower for TS admissions (p < .0001).A scoring system of algorithm can be used to determine appropriateness of NTS admissions, and validity of the tool can be confirmed using registry-based outcome data for TS versus NTS admissions.
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Mortalidad Hospitalaria/tendencias , Evaluación de Resultado en la Atención de Salud , Admisión del Paciente/normas , Sistema de Registros , Centros Traumatológicos/organización & administración , Heridas y Lesiones/terapia , Adulto , Anciano , Algoritmos , Causas de Muerte , Atención a la Salud/organización & administración , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente/tendencias , Medición de Riesgo , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas y Lesiones/diagnósticoRESUMEN
OBJECTIVES: The aim of this study was to investigate the relationship between BRCA1 and mitotic arrest deficiency protein 2 (MAD2) protein expression, as determined by immunohistochemistry, and clinical outcomes in epithelial ovarian carcinoma (EOC). METHODS: A tissue microarray consisting of 94 formalin-fixed paraffin-embedded EOC with fully matched clinicopathological data were immunohistochemically stained with anti-BRCA1 and anti-MAD2 antibodies. The cores were scored in a semiquantitative manner evaluating nuclear staining intensity and extent. Coexpression of BRCA1 and MAD2 was evaluated, and patient survival analyses were undertaken. RESULTS: Coexpression of BRCA1 and MAD2 was assessed in 94 EOC samples, and survival analysis was performed on 65 high-grade serous carcinomas (HGSCs). There was a significant positive correlation between BRCA1 and MAD2 expression in this patient cohort (P < 0.0001). Both low BRCA1 and low MAD2 are independently associated with overall survival because of HGSC. Low coexpression of BRCA1 and MAD2 was also significantly associated with overall survival and was driven by BRCA1 expression. CONCLUSION: BRCA1 and MAD2 expressions are strongly correlated in EOC, but BRCA1 expression remains the stronger prognostic factor in HGSC.
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Proteína BRCA1/biosíntesis , Cistadenocarcinoma Seroso/metabolismo , Proteínas Mad2/biosíntesis , Neoplasias Ováricas/metabolismo , Biomarcadores de Tumor/biosíntesis , Cistadenocarcinoma Seroso/patología , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Neoplasias Ováricas/patología , Adhesión en Parafina , Estudios Retrospectivos , Análisis de Matrices TisularesRESUMEN
Past research indicates that female meadow voles (Microtus pennsylvanicus) show decreased neurogenesis within the hippocampus during the breeding season relative to the non-breeding season, whereas male voles show no such seasonal changes. We expanded upon these results by quantifying a variety of endogenous cell proliferation and neurogenesis markers in wild-caught voles. Adult male and female voles were captured in the summer (breeding season) or fall (non-breeding season), and blood samples and brain tissue were collected. Four cellular markers (pHisH3, Ki67, DCX, and pyknosis) were labeled and then quantified using either fluorescent or light microscopy. The volume of the cell layers within the dentate gyrus (hilus and granule cell layer) was significantly larger in males than in females. In both sexes, all the cellular markers decreased significantly in the dentate gyrus during the breeding season relative to the non-breeding season, indicating decreased cell proliferation, neurogenesis, and pyknosis. Only the pHisH3 marker showed a sex difference, with females having a greater density of this cell proliferation marker than males. During the breeding season relative to the non-breeding season, males and females showed the predicted significant increases in testosterone and estradiol, respectively. Overall, these results suggest higher levels of neuronal turn-over during the non-breeding season relative to the breeding season, possibly due to seasonal changes in sex steroids.
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Proliferación Celular/fisiología , Giro Dentado/metabolismo , Neurogénesis/fisiología , Caracteres Sexuales , Animales , Arvicolinae/fisiología , Muerte Celular , Estradiol/metabolismo , Femenino , Hormonas Esteroides Gonadales/metabolismo , Pradera , Masculino , Neuronas/citología , Estaciones del Año , Testosterona/metabolismoRESUMEN
Cancer incidence has been rising in South Korea, coincident with industrialization and with increased longevity. This has opened the way to a presentation of cancer as a symptom of prosperity and social advancement. Cancer care for older South Koreans is marketed widely as a way of giving back to the older generation, and is often portrayed as an opportunity to mobilize technological achievement alongside family care work to honor aging parents. Because breast cancer tends to affect a younger cohort, however, breast cancer patients seek more specific explanations for their illness in order to prevent recurrence. Many breast cancer patients identify 'stress' as the cause of their cancer, reflecting endemic stress in the lives of ordinary South Korean women. While this implies a critique of society and, specifically, of gender constructs, the emphasis on interpersonal 'stress' situates cancer causality in family relationships rather than in social, political, or environmental contexts. Cancer management and stress explanations together mute inquiry into causality.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud/etnología , Neoplasias/etnología , Neoplasias/terapia , Estrés Psicológico/etnología , Antropología Médica , Cuidadores , Humanos , República de Corea/etnologíaRESUMEN
OBJECTIVE To evaluate effects of laparoscopic-assisted incisional gastropexy (LAIG) on gastric motility in dogs by use of a wireless motility device (WMD). ANIMALS 10 healthy client-owned large or giant-breed dogs. PROCEDURES 10 dogs owned by clients interested in prophylactic LAIG were enrolled. To determine effects of LAIG on gastrointestinal motility in dogs during the nonfed state, each dog was evaluated by use of a noninvasive WMD before and > 4 weeks after LAIG. All dogs underwent LAIG, with or without concurrent elective gonadectomy. Data obtained before and after LAIG were analyzed by use of proprietary software to determine the gastric emptying time, small bowel transit time, large bowel transit time, whole bowel transit time, and motility index. RESULTS No changes in variables were detected between measurements obtained before and after prophylactic LAIG. CONCLUSIONS AND CLINICAL RELEVANCE In this study, prophylactic LAIG did not have an effect on gastrointestinal motility. The WMD was tolerated well by all dogs and appeared to be a safe and effective method for evaluating gastrointestinal motility in this population of dogs.