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1.
Opt Express ; 31(15): 24785-24795, 2023 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-37475297

RESUMO

Optical parametric chirped-pulse amplification (OPCPA) using high-energy Nd:glass lasers has the potential to produce ultra-intense pulses (>1023 W/cm2). We report on the performance of the final high-efficiency amplifier in an OPCPA system based on large-aperture (63 × 63-mm2) partially deuterated potassium dihydrogen phosphate (DKDP) crystals. The seed beam (180-nm bandwidth, 110 mJ) was provided by the preceding OPCPA stages. A maximum pump-to-signal conversion efficiency of 41% and signal energy up to 13 J were achieved with a 52-mm-long DKDP crystal due to the flattop super-Gaussian pump beam profile and flat-in-time pulse shape.

2.
Rev Sci Instrum ; 93(10): 103538, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36319383

RESUMO

Electron-temperature (Te) measurements in implosions provide valuable diagnostic information, as Te is negligibly affected by residual flows and other non-thermal effects unlike ion-temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of Te(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The newly implemented phase-2 Particle X-ray Temporal Diagnostic (PXTD) utilizes four fast-rise (∼15 ps) scintillator-channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons (DTn) from OMEGA Cryo-DT implosions. High quality data have been collected from warm implosions at OMEGA. These data have been used to infer spatially integrated Te(t) with <10% uncertainty at peak emission. Nuclear and x-ray emission histories are measured with 10 ps relative timing uncertainty for x rays and DTn and 12 ps for x rays and deuterium-He3 protons (D3Hep). A future upgrade to the system will enable spatially integrated Te(t) with 40 ps time-resolution from cryogenic DT implosions.

3.
BMC Public Health ; 22(1): 254, 2022 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-35135504

RESUMO

BACKGROUND: Physical activity plays an important role in maintaining good health and wellbeing, non-communicable disease prevention and can improve healthcare outcomes. Some progress is being made on incorporating physical activity into routine care, but less on engaging health system leaders in the 'whole systems' approaches which are increasingly recognised as important for addressing complex public health challenges such as physical inactivity. This commentary builds upon the findings of a recent study and aims to identify opportunities for engaging National Health Service (NHS) systems leaders in whole systems approaches to physical activity. OPPORTUNITIES FOR ACTION IN ENGLAND: Pockets of good practice exist from which lessons can be learned, but there are systemic issues that discourage and create barriers, and a need for meaningful engagement, leadership and action at national, regional and local levels. National and regional actors like Sport England, NHS England, health professional bodies, Active Partnerships, the Local Government Association and the Office for Health Improvement and Disparities can encourage and support government and the NHS to change policy drivers, culture and practices. Emerging opportunities include the 2021 White Paper Integration and Innovation, development of local integrated care systems, leadership from health charities and investment in non-clinical interventions ('social prescribing'). At local level, public health and physical activity specialists and other organisations have a key role as champions and facilitators of local whole systems approaches and engagement of local NHS leaderships. Finally, although whole systems action is about collaborative leadership, individual champions of physical activity can make a difference in influencing NHS leaders at every level towards whole systems working.


Assuntos
Exercício Físico , Medicina Estatal , Inglaterra , Humanos , Liderança , Governo Local
4.
Rev Sci Instrum ; 92(2): 023507, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648078

RESUMO

Electron-temperature (Te) measurements in implosions provide valuable diagnostic information, as Te is unaffected by residual flows and other non-thermal effects unlike ion temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of Te(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The proposed diagnostic utilizes five fast-rise (∼15 ps) scintillator channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10 keV-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons. Initial data collected using a prototype nosecone on the existing neutron temporal diagnostic demonstrate the validity of this diagnostic technique. The proposed system will be capable of measuring spatially integrated Te(t) with 20 ps time resolution and <10% uncertainty at peak emission in cryogenic DT implosions.

5.
Paediatr Respir Rev ; 36: 106-108, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33160838

RESUMO

The COVID pandemic has passed its first peak for now in many countries while some are still on the rise, with some facing a second wave of cases. Precautions and infection control measures for both pediatric and adult pulmonary function testing (PFT) have been a topic of debate during the pandemic. Many centers had to close their PFT laboratories during the initial periods of the pandemic and are reopening as the numbers of new cases are decreasing. This review aims to summarize different practices of PFT laboratory management in different countries, including patient appointments, personal protective equipment, testing room requirements and telemedicine during and immediately following the COVID pandemic.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/métodos , Ambiente Controlado , Equipamento de Proteção Individual , Testes de Função Respiratória/métodos , Filtros de Ar , Agendamento de Consultas , COVID-19/transmissão , Criança , Atenção à Saúde/organização & administração , Humanos , Internacionalidade , Pais , Pediatria , Distanciamento Físico , Pneumologia , Telemedicina , Ventilação , Salas de Espera
6.
Appl Opt ; 59(26): 7994-8002, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32976475

RESUMO

The full-beam in-tank (FBIT) diagnostic has been deployed to directly measure the target-plane beam fluence profile, when operated at high energy, of the OMEGA Laser System at the University of Rochester's Laboratory for Laser Energetics. This paper presents the results of early measurements taken with this diagnostic and discusses an improvement that has overcome performance limitations discovered during the initial testing. The diagnostic gives new insight into the ability of the OMEGA Laser System to provide uniform fluence profiles that are consistent across all 60 beams in the laser. The ultimate goal of the FBIT diagnostic is to allow accurate assessment of the fluence uniformity on a spherical target in 60-beam implosion experiments.

7.
Vaccine ; 38(11): 2626-2635, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32057572

RESUMO

An effective prophylactic vaccine targeting HIV must induce a robust humoral response and must direct the bulk of this response to the mucosa-the primary site of HIV transmission. The chemokine, CCL28, is secreted by epithelial cells at mucosal surfaces and recruits' cells expressing its receptor CCR10. CCR10 is predominantly expressed by IgA + ASCs. We hypothesized that co-immunization with plasmid DNA encoding consensus envelope antigens with plasmid-encoded CCL28 would enhance anti-HIV IgA responses at mucosal surfaces. Indeed, animals receiving pCCL28 and pEnvA/C had significantly increased HIV-specific IgA in fecal extract. Surprisingly, CCL28 co-immunization induced a significant increase in anti-HIV IgG in the serum in mice compared to those receiving pEnvA/C alone. These robust antibody responses were not associated with changes in the frequency of germinal center B cells but depended upon the expression of CCR10, as these responses we abolished in CCR10-deficient animals. Finally, immunization with CCL28 led to increased frequencies in HIV-specific CCR10 + and CCR10 + IgA + B cells in the small intestine and Peyer's patches of vaccinated animals as compared to those receiving pEnvA/C alone. These data indicate that CCL28 administration can enhance antigen-specific humoral responses systemically and at mucosal surfaces.


Assuntos
Vacinas contra a AIDS/administração & dosagem , Adjuvantes Imunológicos/administração & dosagem , Quimiocinas CC/administração & dosagem , Receptores CCR10/genética , Vacinas de DNA/administração & dosagem , Animais , Anticorpos Anti-HIV/imunologia , HIV-1/imunologia , Imunidade nas Mucosas , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Camundongos , Mucosa/imunologia , Produtos do Gene env do Vírus da Imunodeficiência Humana/imunologia
8.
J Child Orthop ; 13(4): 409-416, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31489048

RESUMO

PURPOSE: In 1959, Maroteaux and Lamy initially designated pseudoachondroplasia as a distinct dysplasia different from achondroplasia the most common form of skeletal dysplasia. Pseudoachondroplasia is caused by a mutation in the collagen oligomeric matrix protein gene (COMP) gene on chromosome 19p13.1-p12 encoding the COMP. The COMP gene mutations result in rendering the articular and growth plate cartilages incapable of withstanding routine biomechanical loads with resultant deformity of the joints. The purpose of the study was to characterize the typical orthopaedic findings in pseudoachondroplasia. METHODS: The charts and radiographs of 141 patients with pseudoachondroplasia were analyzed. This cohort, to our knowledge, represents the largest group of patients describing the typical orthopaedic manifestations of pseudoachondroplasia. RESULTS: Patients with pseudoachondroplasia have normal craniofacial appearance with normal intelligence. Short stature is not present at birth and generally appears by two to four years of age. The condition is a form of spondyloepiphyseal dysplasia and the long bones are characterized by dysplastic changes in the epiphysis, metaphysis and vertebral bodies. Radiographically the long bones have altered the appearance and structure of the epiphyses with small irregularly formed or fragmented epiphyses or flattening. The metaphyseal regions of the long bones show flaring, widening or 'trumpeting'. The cervical (89%) and thoracic and lumbar vertebrae show either platyspondyly, ovoid, 'cod-fish' deformity or anterior 'beaking'. Kyphosis (28%), scoliosis (58%) and lumbar lordosis (100%) are commonly seen. The femoral head and acetabulum are severely dysplastic (100%). The knees show either genu valgum (22%), genu varum (56%) or 'windswept' deformity (22%). CONCLUSION: Most commonly these distortions of the appendicular and the axial skeleton lead to premature arthritis particularly of the hips and often the knees not uncommonly in the 20- to 30-year-old age group. LEVEL OF EVIDENCE: III.

9.
Rev Sci Instrum ; 90(5): 053001, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31153238

RESUMO

The Dynamic Compression Sector (DCS) laser is a 100-J ultraviolet Nd:glass system designed and built by the Laboratory for Laser Energetics for experimental research at the DCS located at the Advanced Photon Source (Argonne National Laboratory). Its purpose is to serve as a shock driver to study materials under extreme dynamic pressures. It was designed to deposit energy within a uniformly illuminated 500-µm spot on target, with additional optics provided to implement spot sizes of 250 and 1000 µm. Designed after larger-scale glass lasers such as OMEGA and the National Ignition Facility, the laser consists of a fiber front end with interferometer-based pulse shaping, a Nd:glass regenerative amplifier, a four-pass rod amplifier, and a 15-cm glass disk amplifier, through which six passes are made in a bowtie geometry. The output is frequency tripled from 1053 to 351 nm by using a pair of type-II phase-matched KDP crystals, with a third to increase conversion bandwidth. The super-Gaussian spot in the far field is achieved with a distributed phase plate and a 1-m aspherical focusing lens. Beam smoothing is achieved by smoothing by spectral dispersion and polarization smoothing, resulting in a root-mean-square variation in intensity on target of ±8.7%.

10.
Osteoarthritis Cartilage ; 27(7): 1018-1025, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30716537

RESUMO

OBJECTIVE: Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA. METHODS: Patients were categorized based on use of the following oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study scale), health literacy ("How confident are you filling out medical forms by yourself?"), and depressive symptoms (Patient Health Questionnaire-8). Models were adjusted for demographic and clinical characteristics. RESULTS: In this sample (mean age 64.2 years, 23.6% women), 30.6% (n = 110) reported taking opioid analgesics for OA, 54.2% (n = 195) reported non-opioid use, and 15.3% (n = 55) reported no oral analgesic use. Opioid users had lower mean social support scores (10.0 vs 10.5 vs 11.9, P = 0.007) and were more likely to have moderate-severe depressive symptoms (42.7% vs 24.1% vs 14.5%, P < 0.001). Health literacy did not differ by treatment group type. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95%CI 1.08-8.07) when adjusted for sociodemographic and clinical factors. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. CONCLUSIONS: Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid analgesics for OA.


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/psicologia , Manejo da Dor/métodos , Administração Oral , Idoso , Análise de Variância , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos Transversais , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Psicologia , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Mucosal Immunol ; 11(2): 462-473, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28745326

RESUMO

Protection against Mycobacterium tuberculosis (Mtb) infection requires CD4 T cells to migrate into the lung and interact with infected macrophages. In mice, less-differentiated CXCR3+ CD4 T cells migrate into the lung and suppress growth of Mtb, whereas CX3CR1+ terminally differentiated Th1 cells accumulate in the blood vasculature and do not control pulmonary infection. Here we examine CD4 T-cell differentiation and lung homing during primary Mtb infection of rhesus macaques. Mtb-specific CD4 T cells simultaneously appeared in the airways and blood ∼21-28 days post exposure, indicating that recently primed effectors are quickly recruited into the lungs after entering circulation. Mtb-specific CD4 T cells in granulomas display a tissue-parenchymal CXCR3+CX3CR1-PD-1hiCTLA-4+ phenotype. However, most granuloma CD4 T cells are found within the outer lymphocyte cuff and few localize to the myeloid cell core containing the bacilli. Using the intravascular stain approach, we find essentially all Mtb-specific CD4 T cells in granulomas have extravasated across the vascular endothelium into the parenchyma. Therefore, it is unlikely to be that lung-homing defects introduced by terminal differentiation limit the migration of CD4 T cells into granulomas following primary Mtb infection of macaques. However, intralesional positioning defects within the granuloma may pose a major barrier to T-cell-mediated immunity during tuberculosis.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Granuloma do Sistema Respiratório/imunologia , Pulmão/imunologia , Macaca mulatta/imunologia , Macrófagos Alveolares/imunologia , Mycobacterium tuberculosis/fisiologia , Tuberculose/imunologia , Animais , Antígenos de Bactérias/imunologia , Comunicação Celular , Movimento Celular , Células Cultivadas , Humanos , Evasão da Resposta Imune , Imunidade Celular , Pulmão/microbiologia , Macaca mulatta/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Receptores CXCR3/metabolismo
12.
J Prev Alzheimers Dis ; 4(3): 174-182, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29182708

RESUMO

BACKGROUND: Objectives: Elevated plasma total homocysteine (tHcy) is associated with increased risk of cardiovascular disease, stroke and dementia. Results of clinical trials using B-vitamins to reduce the cognitive risks attributed to tHcy have been inconsistent. The high prevalence of both hyperhomocysteinemia and cognitive impairment among kidney transplant recipients makes them an important population in which to evaluate the effect of lowering homocysteine on cognitive function. We therefore evaluated whether B-vitamin therapy to lower tHcy would prevent cognitive-decline in a cohort of stable kidney transplant recipients. DESIGN: The study was a longitudinal ancillary of the FAVORIT trial, a randomized, placebo-controlled multi-site trial of high-dose B vitamins to reduce cardiovascular and cerebrovascular events in clinically stable kidney transplant recipients with elevated tHcy. PARTICIPANTS: 584 participants from 18 sites across North America. INTERVENTION: The intervention consisted of a daily multivitamin containing high-doses of folate (5.0 mg), vitamin B12 (1.0 mg) and vitamin B6 (50 mg). The placebo consisted of a daily multi-vitamin containing no folate and recommended daily allowances of vitamins B12 and B6 (0 mg folate; 2.0 µg vitamin B12; 1.4 mg vitamin B6). MEASUREMENTS: Annual neuropsychological assessment for up to 5 years (mean 3.3 years) using a standardized test battery. Efficacy was analyzed on an intention-to-treat basis using end-of-trial data. Subgroup analyses included stratification for baseline plasma B-vitamin and tHcy concentrations. RESULTS: At baseline, cognitive impairment was common with 61% of participants falling more than one standard deviation below published norms for at least one cognitive test. Fewer than 1% of participants had insufficient plasma folate < 5 ng/ml or vitamin B12 < 148 pmol/L. However, 44.6% had plasma B6 concentrations < 30 nmol/L. At follow-up, processing speed and memory scores were modestly but significantly better in the B-vitamin supplement group than in controls (p≤0.05). There was no interaction between baseline tHcy, B-vitamin status and treatment on the cognitive outcomes. CONCLUSIONS: High-dose B-vitamin supplementation provided modest cognitive benefit for kidney transplant recipients with elevated baseline tHcy. Since nearly all participants were folate and vitamin B12 sufficient at baseline, the potential cognitive benefits of folate and B12 supplementation in individuals with poor B-vitamin status remains to be determined.


Assuntos
Transtornos Cognitivos/dietoterapia , Suplementos Nutricionais , Hiper-Homocisteinemia/dietoterapia , Transplante de Rim , Complicações Pós-Operatórias/dietoterapia , Complexo Vitamínico B/administração & dosagem , Cognição , Transtornos Cognitivos/sangue , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Ácido Fólico/administração & dosagem , Ácido Fólico/sangue , Seguimentos , Homocisteína/sangue , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/etiologia , Hiper-Homocisteinemia/psicologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , América do Norte , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/psicologia , Resultado do Tratamento , Complexo Vitamínico B/sangue
13.
J Vet Intern Med ; 31(6): 1757-1764, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28891088

RESUMO

BACKGROUND: The epidemiology of kidney disease is not extensively described in dogs. HYPOTHESIS/OBJECTIVES: To better understand the prevalence of elevated serum creatinine concentration in dogs. ANIMALS: Client-owned dogs. METHODS: A retrospective, observational cross-sectional study design was used. We made a dataset of 115,631 hospital visits of all dogs presenting from October 2010 to October 2014. We estimated the prevalence and risk of elevated serum creatinine, defined as >1.6 mg/dL, in evaluated dogs. RESULTS: Of 115,631 visits, 98,693 were outpatient visits and 16,938 were hospital admissions. Among outpatient visits, 9,983 (10.1%) had serum creatinine assessment (4,423 [44.3%] visits were first visits), whereas, among hospital admissions, 12,228 (60.0%) had at least 1 serum creatinine (7,731 [75.6%] admissions were first admissions). The prevalence of elevated serum creatinine concentration in all evaluated dogs was 11.5% (95% CI: 11.0%, 11.9%); 10.2% (95% CI: 9.6%, 10.8%) of inpatients and 12.9% (95% CI: 12.1%, 13.8%) of outpatients had elevated serum creatinine concentration. The relative risk (RR) of elevated serum creatinine concentration was significantly higher in geriatric dogs (outpatient RR 1.45 [95% CI: 1.23, 1.70], inpatient RR 1.43 [95% CI: 1.16, 1.76]) and lower in young dogs (outpatient RR 0.39 [95% CI: 0.26, 0.59], inpatient RR 0.44 [95% CI: 0.32, 0.62]) when compared to the measured population risk. CONCLUSIONS AND CLINICAL IMPORTANCE: When selected for laboratory evaluation, the proportion of dogs presenting to an academic medical center with evidence of kidney injury is high compared to previous reports and might reflect a population of sicker dogs.


Assuntos
Creatinina/sangue , Doenças do Cão/epidemiologia , Nefropatias/veterinária , Fatores Etários , Animais , Estudos Transversais , Doenças do Cão/sangue , Cães , Feminino , Nefropatias/sangue , Nefropatias/epidemiologia , Masculino , Massachusetts/epidemiologia , Prevalência , Estudos Retrospectivos
14.
Am J Transplant ; 17(10): 2640-2649, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28371433

RESUMO

Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [α1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine α1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling α1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine α1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD.


Assuntos
Biomarcadores/urina , Doenças Cardiovasculares/urina , Transplante de Rim , Nefrite Intersticial/urina , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Casos e Controles , Feminino , Fibrose , Ácido Fólico/administração & dosagem , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
Am J Transplant ; 17(9): 2390-2399, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28257169

RESUMO

Cystatin C and beta-2-microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFRcys ), B2M (eGFRB2M ), and creatinine (eGFRcr ) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case-cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFRcr , eGFRcys , and eGFRB2M were 46.0, 43.8, and 48.8 mL/min/1.73m2 , respectively. After multivariable adjustment, hazard ratios for eGFRcys and eGFRB2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09-3.76; p = 0.03) and 2.56 (1.35-4.88; p = 0.004) for cardiovascular events; 3.92 (2.11-7.31) and 4.09 (2.21-7.54; both p < 0.001) for mortality; and 9.49 (4.28-21.00) and 15.53 (6.99-34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFRcr . We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.


Assuntos
Biomarcadores/metabolismo , Doenças Cardiovasculares/mortalidade , Rejeição de Enxerto/mortalidade , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Mortalidade/tendências , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Creatinina/metabolismo , Cistatina C/metabolismo , Método Duplo-Cego , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Microglobulina beta-2/metabolismo
16.
Eur J Clin Nutr ; 71(2): 284-286, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27507071

RESUMO

Malnourishment is prevalent in hospitalized patients and associated with adverse medical outcomes. Thus, nutrition screening to identify high-risk patients is widespread. However, no single universal tool has been shown to be suitable for all hospital departments. To address this challenge, a novel, tailored, electronic tool for nutritional screening was developed and evaluated. The Rambam Automated Nutrition Computerized Screening tool efficiently screens all newly admitted patients and does not rely on self-reported height and weight estimates. Validation was carried out in medical wards (n=94), and compared to the Malnutrition Universal Screening Tool, length of stay and an independent assessment by a professional dietician. Results from this research support the use of automated, flexible tools that instantaneously incorporate relevant available data from the electronic health record. Tools that are adaptable to meet the needs of individual hospital departments, can save valuable time and ensure full screening of all admitted patients.


Assuntos
Cuidados Críticos/métodos , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Avaliação Nutricional , Medição de Risco/métodos , Adulto , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Estado Nutricional
17.
Artigo em Inglês | MEDLINE | ID: mdl-29745380

RESUMO

BACKGROUND: Because chronic kidney disease (CKD) is associated with muscle wasting, older adults with CKD are likely to have physical function deficits. Physical activity can improve these deficits, but whether CKD attenuates the benefits is unknown. Our objective was to determine if CKD modified the effect of a physical activity intervention in older adults. METHODS: This is an exploratory analysis of the LIFE-P study, which compared a 12-month physical activity program (PA) to a successful aging education program (SA) in older adults. CKD was defined as a baseline eGFR < 60 mL/min/1.73 m2. We examined the Short Physical Performance Battery (SPPB) at baseline, 6 and 12 months. Secondary outcomes included serious adverse events (SAE) and adherence to intervention frequency. Linear mixed models were adjusted for age, sex, diabetes, hypertension, CKD, intervention, site, visit, baseline SPPB, and interactions of intervention and visit and of intervention, visit, and baseline CKD. RESULTS: The sample included 368 participants. CKD was present in 105 (28.5%) participants with a mean eGFR of 49.2 ± 8.1 mL/min/1.73 m2. Mean SPPB was 7.38 ± 1.41 in CKD participants; 7.59 ± 1.44 in those without CKD (p = 0.20). For CKD participants in PA, 12-month SPPBs increased to 8.90 (95% CI 8.32, 9.47), while PA participants without CKD increased to 8.40 (95% CI 8.01, 8.79, p = 0.43). For CKD participants in SA, 12-month SPPBs increased to 7.67 (95% CI 7.07, 8.27), while participants without CKD increased to 8.12 (95% CI 7.72, 8.52, p = 0.86). Interaction between CKD and intervention was non-significant (p = 0.88). Number and type of SAEs were not different between CKD and non-CKD participants (all p > 0.05). In PA, adherence for CKD participants was 65.5 ± 25.4%, while for those without CKD was 74.0 ± 22.2% (p = 0.12). CONCLUSION: Despite lower adherence, older adults with CKD likely derive clinically meaningful benefits from physical activity with no apparent impact on safety, compared to those without CKD.

18.
Rev Sci Instrum ; 87(11): 11D701, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27910508

RESUMO

A Particle X-ray Temporal Diagnostic (PXTD) has been implemented on OMEGA for simultaneous time-resolved measurements of several nuclear products as well as the x-ray continuum produced in High Energy Density Plasmas and Inertial Confinement Fusion implosions. The PXTD removes systematic timing uncertainties typically introduced by using multiple instruments, and it has been used to measure DD, DT, D3He, and T3He reaction histories and the emission history of the x-ray core continuum with relative timing uncertainties within ±10-20 ps. This enables, for the first time, accurate and simultaneous measurements of the x-ray emission histories, nuclear reaction histories, their time differences, and measurements of Ti(t) and Te(t) from which an assessment of multiple-ion-fluid effects, kinetic effects during the shock-burn phase, and ion-electron equilibration rates can be made.

19.
Rev Sci Instrum ; 87(5): 053501, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27250417

RESUMO

A next-generation neutron temporal diagnostic (NTD) capable of recording high-quality data for the highest anticipated yield cryogenic deuterium-tritium (DT) implosion experiments was recently installed at the Omega Laser Facility. A high-quality measurement of the neutron production width is required to determine the hot-spot pressure achieved in inertial confinement fusion experiments-a key metric in assessing the quality of these implosions. The design of this NTD is based on a fast-rise-time plastic scintillator, which converts the neutron kinetic energy to 350- to 450-nm-wavelength light. The light from the scintillator inside the nose-cone assembly is relayed ∼16 m to a streak camera in a well-shielded location. An ∼200× reduction in neutron background was observed during the first high-yield DT cryogenic implosions compared to the current NTD installation on OMEGA. An impulse response of ∼40 ± 10 ps was measured in a dedicated experiment using hard x-rays from a planar target irradiated with a 10-ps short pulse from the OMEGA EP laser. The measured instrument response includes contributions from the scintillator rise time, optical relay, and streak camera.

20.
Mucosal Immunol ; 9(1): 13-23, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25943275

RESUMO

There have been encouraging results for the development of an effective HIV vaccine. However, many questions remain regarding the quality of immune responses and the role of mucosal antibodies. We addressed some of these issues by using a simian immunodeficiency virus (SIV) DNA vaccine adjuvanted with plasmid-expressed mucosal chemokines combined with an intravaginal SIV challenge in rhesus macaque (RhM) model. We previously reported on the ability of CCR9 and CCR10 ligand (L) adjuvants to enhance mucosal and systemic IgA and IgG responses in small animals. In this study, RhMs were intramuscularly immunized five times with either DNA or DNA plus chemokine adjuvant delivered by electroporation followed by challenge with SIVsmE660. Sixty-eight percent of all vaccinated animals (P<0.01) remained either uninfected or had aborted infection compared with only 14% in the vaccine naïve group. The highest protection was observed in the CCR10L chemokines group, where six of nine animals had aborted infection and two remained uninfected, leading to 89% protection (P<0.001). The induction of mucosal SIV-specific antibodies and neutralization titers correlated with trends in protection. These results indicate the need to further investigate the contribution of chemokine adjuvants to modulate immune responses and the role of mucosal antibodies in SIV/HIV protection.


Assuntos
Vacinas contra a AIDS/administração & dosagem , Anticorpos Antivirais/biossíntese , Quimiocinas/imunologia , Imunidade nas Mucosas/efeitos dos fármacos , Síndrome de Imunodeficiência Adquirida dos Símios/prevenção & controle , Vacinas de DNA/administração & dosagem , Vacinas contra a AIDS/genética , Vacinas contra a AIDS/imunologia , Adjuvantes Imunológicos/administração & dosagem , Animais , Quimiocinas/administração & dosagem , Quimiocinas/genética , Feminino , Imunidade Celular/efeitos dos fármacos , Ligantes , Macaca mulatta , Plasmídeos/química , Plasmídeos/imunologia , Receptores CCR/genética , Receptores CCR/imunologia , Receptores CCR10/genética , Receptores CCR10/imunologia , Síndrome de Imunodeficiência Adquirida dos Símios/imunologia , Síndrome de Imunodeficiência Adquirida dos Símios/virologia , Vírus da Imunodeficiência Símia/efeitos dos fármacos , Vírus da Imunodeficiência Símia/imunologia , Vacinação , Vacinas de DNA/genética , Vacinas de DNA/imunologia , Vagina/efeitos dos fármacos , Vagina/imunologia , Vagina/virologia
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