Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 511
Filtrar
1.
Phys Rev Lett ; 123(6): 069901, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31491138

RESUMO

This corrects the article DOI: 10.1103/PhysRevLett.121.255304.

2.
BMC Cancer ; 19(1): 892, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492163

RESUMO

BACKGROUND: Cancer is a leading burden of disease in Australia and worldwide, with incidence rates varying with age, sex and geographic location. As part of the Ageing, Chronic Disease and Injury study, we aimed to map the incidence rates of primary cancer diagnoses across western Victoria and investigate the association of age, accessibility/remoteness index of Australia (ARIA) and area-level socioeconomic status (SES) with cancer incidence. METHODS: Data on cancer incidence in the study region were extracted from the Victorian Cancer Registry (VCR) for men and women aged 40+ years during 2010-2013, inclusive. The age-adjusted incidence rates (per 10,000 population/year), as well as specific incidence for breast, prostate, lung, bowel and melanoma cancers, were calculated for the entire region and for the 21 Local Government Areas (LGA) that make up the whole region. The association of aggregated age, ARIA and SES with cancer incidence rates across LGAs was determined using Poisson regression. RESULTS: Overall, 15,120 cancer cases were identified; 8218 (54%) men and 6902 women. For men, the age-standardised rate of cancer incidence for the whole region was 182.1 per 10,000 population/year (95% CI 177.7-186.5) and for women, 162.2 (95% CI: 157.9-166.5). The incidence of cancer (overall) increased with increasing age for men and women. Geographical variations in cancer incidence were also observed across the LGAs, with differences identified between men and women. Residents of socioeconomically disadvantaged and less accessible areas had higher cancer incidence (p < 0.001). CONCLUSION: Cancer incidence rates varied by age, sex, across LGAs and with ARIA. These findings not only provide an evidence base for identifying gaps and assessing the need for services and resource allocation across this region, but also informs policy and assists health service planning and implementation of preventative intervention strategies to reduce the incidence of cancer across western Victoria. This study also provides a model for further research across other geographical locations with policy and clinical practice implications, both nationally and internationally.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31403397

RESUMO

Increases in large wildfire frequency and intensity and a longer fire season in the western USA are resulting in a significant increase in air pollution, including concentrations of PM2.5 (particulate matter <2.5µm in aerodynamic diameter) that pose significant health risks to nearby communities. During wildfires, government agencies monitor PM2.5 mass concentrations providing information and actions needed to protect affected communities; this requires continuously measuring instruments. This study assessed the performance of seven candidate instruments: (1) Met One Environmental beta attenuation monitor (EBAM), (2) Met One ES model 642 (ES642), (3) Grimm Environmental Dust Monitor 164 (EDM), (4) Thermo ADR 1500 (ADR), (5) TSI DRX model 8543 (DRX), (6) Dylos 1700 (Dylos), and (7) Purple Air II (PA-II) in comparison with a BAM 1020 (BAM) reference instrument. With the exception of the EBAM, all candidates use light scattering to determine PM2.5 mass concentrations. Our comparison study included environmental chamber and field components, with two of each candidate instrument operating next to the reference instrument. The chamber component involved six days of comparisons for biomass combustion emissions. The field component involved operating all instruments in an air monitoring station for 39.5 days with hourly average relative humidity (RH) ranging from 19% to 98%. Goals were to assess instrument precision and accuracy and effects of RH, elemental carbon (EC), and organic carbon (OC) concentrations. All replicate candidate instruments showed high hourly correlations (R2≥0.80) and higher daily average correlations (R2≥0.90), where all instruments correlated well (R2≥0.80) with the reference. The DRX and Purple Air overestimated PM2.5 mass concentrations by a factor of ~two. Differences between candidates and reference were more pronounced at higher PM2.5 concentrations. All optical instruments were affected by high RH and by the EC/OC ratio. Equations to convert candidate instruments data to FEM BAM type data are provided to enhance usability of data from candidate instruments. Disclaimer: The statements and conclusions in this paper are solely those of the contributors not necessarily of the California Air Resources Board, Desert Research Institute, U.S. Department of Forest Service, or Washoe County Health District.

4.
J Proteome Res ; 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31290668

RESUMO

Spectral matching sequence database search engines commonly used on mass spectrometry-based proteomics experiments excel at identifying peptide sequence ions, and in addition, possible sequence ions carrying post-translational modifications (PTMs), but most do not provide confidence metrics for the exact localization of those PTMs when several possible sites are available. Localization is absolutely required for downstream molecular cell biology analysis of PTM function in vitro and in vivo. Therefore, we developed PTMProphet, a free and open-source software tool integrated into the Trans-Proteomic Pipeline, which reanalyzes identified spectra from any search engine for which pepXML output is available to provide localization confidence to enable appropriate further characterization of biologic events. Localization of any type of mass modification (e.g., phosphorylation) is supported. PTMProphet applies Bayesian mixture models to compute probabilities for each site/peptide spectrum match where a PTM has been identified. These probabilities can be combined to compute a global false localization rate at any threshold to guide downstream analysis. We describe the PTMProphet tool, its underlying algorithms, and demonstrate its performance on ground-truth synthetic peptide reference data sets, one previously published small data set, one new larger data set, and also on a previously published phosphoenriched data set where the correct sites of modification are unknown. Data have been deposited to ProteomeXchange with identifier PXD013210.

5.
EMBO Rep ; 20(9): e47495, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31338967

RESUMO

The concerted action of many protein kinases helps orchestrate the error-free progression through mitosis of mammalian cells. The roles and regulation of some prominent mitotic kinases, such as cyclin-dependent kinases, are well established. However, these and other known mitotic kinases alone cannot account for the extent of protein phosphorylation that has been reported during mammalian mitosis. Here we demonstrate that CK1α, of the casein kinase 1 family of protein kinases, localises to the spindle and is required for proper spindle positioning and timely cell division. CK1α is recruited to the spindle by FAM83D, and cells devoid of FAM83D, or those harbouring CK1α-binding-deficient FAM83DF283A/F283A knockin mutations, display pronounced spindle positioning defects, and a prolonged mitosis. Restoring FAM83D at the endogenous locus in FAM83D-/- cells, or artificially delivering CK1α to the spindle in FAM83DF283A/F283A cells, rescues these defects. These findings implicate CK1α as new mitotic kinase that orchestrates the kinetics and orientation of cell division.

6.
Aust J Gen Pract ; 48(4): 222-228, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31256493

RESUMO

BACKGROUND AND OBJECTIVES: The literature reveals a lack of consensus on recommendations for follow-up of skin cancer in general practice for all types of skin cancer. The objective of this paper was to evaluate post-treatment surveillance practices for both melanotic and non-melanotic skin cancers (NMSC) by general practitioners (GPs) in regional Victoria, and to identify challenges in follow-up for skin cancers in rural areas. METHOD: A mixed-method study involving a survey and semi-structured interviews with GPs and registrars in Gippsland was carried out in 2015. RESULTS: The survey of 65 participants showed that 69% (45/65) followed up NMSC opportunistically, while 66% (43/65) reported using a structured follow-up practice for melanoma. Six practitioners from the interviews identified the patient's level of education, time constraints, practitioner accessibility and specialists' availability as some common challenges in follow-up. DISCUSSION: We recommend that rural GPs review follow-up strategies for all skin cancers, through the establishment of guidelines and a recall system.

7.
Res Social Adm Pharm ; 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31278013

RESUMO

BACKGROUND: WhatsApp is an instant messaging application that has grown in popularity over the last decade. The literature has focused on the use of WhatsApp in medical, surgical and nursing disciplines, with little work exploring pharmacists' experiences of using WhatsApp to provide services. OBJECTIVE(S): The aim of this research was to explore pharmacists' experiences of using WhatsApp to support delivery of out-of-hours pharmacy services. METHODS: A qualitative design was underpinned by a phenomenological philosophy. Focus groups and an extract of the WhatsApp transcript were thematically analysed using NVivo. RESULTS: Over three hundred communication events (1580 messages) were analysed in the WhatsApp transcript. Message type was classified as follows; handover (26%, n = 410), procedural queries (26%, n = 410), laptop location (18%, n = 284), whole staff communication (24%, n = 379), clinical queries (5%, n = 79), and administrative communications (1%, n = 16). A total of five focus groups were conducted between October and November 2017 with 27 participants that included pharmacists with different levels of experience. The findings suggest that WhatsApp improved communication between junior and senior pharmacists, particularly during the global cyber crisis, and provided an opportunity to share best practice. Concerns were raised regarding the encroachment of work activities into personal time. Additionally, the tacit approval by senior pharmacists to group information sharing and solution development, despite the potential for non-active participation, highlighted the issue of collective complicity. CONCLUSIONS: WhatsApp can be a useful platform to support the delivery of out-of-hours services through professional development, improving communication and supporting relationships. This paper demonstrates that service managers must consider multiple ethico-legal and social frameworks when developing or allowing the organic development of such communication methods within healthcare provider organisations.

8.
Rural Remote Health ; 19(2): 4987, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31340654

RESUMO

INTRODUCTION: Access to medical services for rural communities is poorer than for metropolitan communities in many parts of the world. One of the strategies to improve rural medical workforce has been rural clinical placements for undergraduate medical students. This study explores the workforce outcomes of one model of such placements - the longitudinal integrated clerkship (LIC) - delivered in year 4, the penultimate year of the medical course, as part of the rural programs delivered by a medical school in Victoria, Australia. The LIC involved student supervision under a parallel consulting model with experienced rural generalist doctors for a whole year in small community rural general practices. METHODS: This study aimed to compare the work locations (regional or more rural), following registration as a medical practitioner, of medical students who had completed 1 year of the LIC, with, first, students who had other types of rural training of comparable duration elsewhere, and second, students who had no rural training. Study participants commenced their medical degree after 2004 and had graduated between 2008 and 2016 and thus were in postgraduate year 1-9 in 2017 when evaluated. Information about the student training location(s), and duration, type and timing of training, was prospectively collected from university administrative systems. The outcome of interest was the main work location in 2017, obtained from the Australian Health Practitioner Regulation Agency's public website. RESULTS: Students who had undertaken the year 4 LIC along with additional rural training in years 3 and/or 5 were more likely than all other groups to be working in smaller regional or rural towns, where workforce need is greatest (relative risk ratio (RRR) 5.62, 95% confidence interval (CI) 2.81-11.20, compared with those having metropolitan training only). Non-LIC training of similar duration in rural areas was also significantly associated, but more weakly, with smaller regional work location (RRR 2.99, 95%CI 1.87-4.77). Students whose only rural training was the year 4 LIC were not significantly associated with smaller regional work location (RRR 1.72, 95%CI 0.59-5.04). Overall, after accounting for both LIC and non-LIC rural training exposure, rural work after graduation was also consistently positively associated with rural background, being an international student and having a return of service obligation under a bonded program as a student. CONCLUSION: This study demonstrates the value of rural LICs, coupled with additional rural training, in contributing to improving Australia's medical workforce distribution. Whilst other evidence has already demonstrated positive educational outcomes for doctors who participate in rural LIC placements, this is the first known study of work location outcomes. The study provides evidence that expanding this model of rural undergraduate education may lead to a better geographically distributed medical workforce.

9.
Arch Dis Child ; 2019 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-31079071

RESUMO

OBJECTIVE: To explore how prolonged hospitalisation of a child with a neurological condition influences the dietary habits of parents, taking account of their attitudes and perceptions of this experience. DESIGN: Qualitative study using semi-structured interviews and inductive thematic analysis. SUBJECTS: Fifteen parents of children (aged 2-16 years) with a neurological condition resulting in prolonged periods of hospitalisation were recruited. RESULTS: Mothers (n=13) and fathers (n=2) who were interviewed experienced frequent hospital visits brought about by their child's condition, or associated medical complications. Dietary habits of parents were affected throughout their time in hospital. Three key themes were identified relating to how hospitalisation influenced this: (1) access to food, (2) emotional and physical well-being and (3) impact on eating patterns and food choice. CONCLUSIONS: Findings from this study suggest that parents in these circumstances need to be better supported within the hospital setting as a number of barriers exist when it comes to accessing food in hospital and making healthy food choices. Additionally, having a child in hospital has a considerable effect on a parent's emotional well-being, which further impacts on their dietary habits. The long-term physical and mental health implications of this may influence their ability to care for the sick child.

10.
J Sport Rehabil ; : 1-36, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31034322

RESUMO

CONTEXT: Decreased postural balance is a primary risk factor for lower limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at half-time. Its effect on dynamic postural balance remains unclear. OBJECTIVES: To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically-oriented outcome measure. DESIGN: Experimental study. SETTING: University biomechanics laboratory. PATIENTS OR PARTICIPANTS: Twenty-eight elite-level collegiate male field-sport athletes. Intervention(s): Participants were tested on the anterior (ANT), posterior-medial (PM) and posterior-lateral (PL) reach directions of the Star Excursion Balance Test (SEBT) both pre- and post- a 15-minute knee joint cryotherapy application. MAIN OUTCOME MEASURE(S): Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension (FD) of the center-of-pressure (COP) path during the performance of the ANT, PM and PL reach directions of the SEBT. RESULTS: There was a statistically significant decrease in reach distance scores achieved on ANT, PM and PL directions of the SEBT from pre-cryotherapy to post-cryotherapy (p < 0.05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee or ankle joint kinematics (p > 0.05). No significant change in FD was observed for any reach direction following cryotherapy application (p > 0.05). CONCLUSION: The results of the present study indicate that dynamic postural balance, is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.

11.
Cardiovasc Res ; 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30937452

RESUMO

AIMS: Cord blood-derived endothelial colony-forming cells (CB-ECFCs) are a defined progenitor population with established roles in vascular homeostasis and angiogenesis, which possess low immunogenicity and high potential for allogeneic therapy, and are highly sensitive to regulation by reactive oxygen species (ROS). The aim of this study was to define the precise role of the major ROS-producing enzyme, NOX4 NADPH oxidase, in CB-ECFC vasoreparative function. METHODS AND RESULTS: In vitro CB-ECFC migration (scratch-wound assay) and tubulogenesis (tube length, branch number) was enhanced by phorbol 12-myristate 13-acetate (PMA)-induced superoxide in a NOX-dependent manner. CB-ECFCs highly-expressed NOX4 which was further induced by PMA, whilst NOX4 siRNA and plasmid overexpression reduced and potentiated in vitro function, respectively. Increased ROS generation in NOX4-overexpressing CB-ECFCs (DCF fluorescence, flow cytometry) was specifically reduced by superoxide dismutase, highlighting induction of ROS-specific signalling. Laser Doppler imaging of mouse ischaemic hindlimbs at 7 days indicated that NOX4-knockdown CB-ECFCs inhibited blood flow recovery which was enhanced by NOX4-overexpressing CB-ECFCs. Tissue analysis at 14 days revealed consistent alterations in vascular density (lectin expression) and eNOS protein despite clearance of injected CB-ECFCs, suggesting NOX4-mediated modulation of host tissue. Indeed, proteome array analysis indicated that NOX4-knockdown CB-ECFCs largely suppressed tissue angiogenesis, whilst NOX4-overexpressing CB-ECFCs upregulated a number of pro-angiogenic factors specifically-linked with eNOS signalling, in parallel with equivalent modulation of NOX-dependent ROS generation, suggesting that CB-ECFC NOX4 signalling may promote host vascular repair. CONCLUSIONS: Taken together, these findings indicate a key role for NOX4 in CB-ECFCs, thereby highlighting its potential as a target for enhancing their reparative function through therapeutic priming to support creation of a pro-reparative microenvironment and effective postischaemic revascularisation.

12.
Syst Rev ; 8(1): 100, 2019 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-31010419

RESUMO

BACKGROUND: Diabetes is a chronic medical condition that requires patients to be actively engaged in intensive self-management to achieve optimal clinical outcomes. Unfortunately, individuals who are experiencing homelessness often struggle to manage diabetes and consequently suffer numerous and severe complications-both acute and chronic. There are many barriers to optimal diabetes self-management among this population, and this may be exacerbated by the lack of tailoring and customization of care to this unique population. Given this disconnect, it is likely that many organizations have attempted to provide specialized innovations for this population-which may or may not be reported in the formal literature. Our objective is to perform a scoping review to summarize and synthesize the experiences of those who have attempted to provide tailored interventions. METHODS: We propose a mixed methods scoping review that will include both a formal search of the published literature (MEDLINE, CINAHL, EMBASE, Web of Science, Scopus) and a thorough search of the grey literature. Eligible articles and documents are those that report on an intervention or guideline for the management of diabetes among those experiencing homelessness. All titles and abstracts will undergo duplicate review, as will the full article/document. We will include any report that either includes a description of an intervention or provides recommendations for the treatment of individuals who are homeless with diabetes. We will extract both qualitative and quantitative data for analysis and interpretation. Meta-analysis will not be performed. DISCUSSION: Those experiencing homelessness who also have diabetes often struggle to manage their chronic condition. When care is tailored to suit their needs, it is feasible that outcomes may be improved. By collating and synthesizing information from diverse organizations and jurisdictions, we hope to facilitate the sharing of knowledge with others who wish to provide this type of care.

13.
Can J Anaesth ; 66(7): 803-812, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30877585

RESUMO

PURPOSE: Hyperbaric bupivacaine (0.75% in dextrose) is used for spinal obstetric anesthesia. Occasional clusters of anesthetic failures occur in this setting, not readily attributable to clinical factors. We hypothesized that cold temperature exposure is related to bupivacaine instability. METHODS: An electronic survey was distributed to Canadian anesthesiologists to determine consistencies in spinal anesthesia practice, and to invite submission of failed bupivacaine samples for analysis. Another survey for hospital pharmacists focused on bupivacaine logistics. Ultraviolet (UV) spectrometry, differential scanning calorimetry, and high performance liquid chromatography were used to evaluate the effect of temperature on bupivacaine chemical stability. Mass spectrometry (MS) was used to observe bupivacaine and dextrose degradation in laboratory samples of hyperbaric 0.75% bupivacaine in dextrose. Hyperbaric bupivacaine that failed to produce adequate anesthesia in labour and delivery patients was subject to tandem MS/MS analysis on commonly observed ions to look for ion patterns consistent with bupivacaine degradation products and to compare with laboratory samples subjected to cold temperatures. RESULTS: Canadian obstetric anesthesiologists report similar practices and use hyperbaric bupivacaine for spinal anesthesia. Pharmacists surveyed indicated facility storage at room temperature but variable temperatures during shipping. No standard procedure for failure reporting was identified. Analysis of bupivacaine showed a slight decrease in bupivacaine concentration or UV spectral changes after incubation at temperatures ≤ 4°C. Mass spectrometric analysis of hyperbaric bupivacaine from failed spinal anesthesia cases showed complex and inconsistent patterns of ion formation, and different from the ion patterns observed for cooled vs uncooled bupivacaine solutions. Temperature-related changes were noted for dextrose in cooled samples in which dextrose-related ions were formed. CONCLUSIONS: Canadian clinical practice and handling of hyperbaric bupivacaine is consistent. Most respondents indicated an interest in a formal reporting and collection process. Cold exposure did not degrade bupivacaine. A complex and possibly inconsistent reaction involving dextrose was identified that requires further analysis of a larger sample size to elucidate the mechanisms.

14.
Blood Press Monit ; 24(3): 137-145, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30840608

RESUMO

BACKGROUND: Continuous beat-to-beat blood pressure monitoring permits the rapid detection of blood pressure fluctuations for cardiovascular reflex testing and clinical haemodynamic monitoring. In adults, this can be achieved noninvasively with high accuracy, using finger blood pressure monitoring with volume clamp photoplethysmography. However, data are lacking on the validity of finger blood pressure monitoring in children compared to the gold standard - invasive intra-arterial blood pressure monitoring. AIM: We aimed to evaluate the accuracy of novel noninvasive index and middle finger arterial pressure (FinAP) measurements in children. METHODS: Using prototype paediatric finger cuffs, we compared: mean differences, bias and limits of agreement (Bland-Altman analyses); cumulative percentage differences [clinical grade A-D (based on the percentage of heartbeats in agreement with the standard)]; and waveform morphology (regression analysis and smoothing) between both raw FinAP (Finapres NOVA) and reconstructed finger-brachial arterial pressure (reBAP) compared to intra-arterial blood pressure measurements. RESULTS: Eighteen children were tested (aged 3-13 years; 12 male), with data from 13 included in the analysis. The bias for reBAP for the middle finger was 1.8±6.9, 0.3±6.1 and 0.4±5.3 mmHg for systolic, diastolic and mean arterial pressure, with clinical grades of C, B and A, respectively. reBAP improved numerical accuracy, but reduced waveform morphological agreement. CONCLUSION: Middle finger arterial measurements with waveform reconstruction provide an acceptable surrogate for invasive intra-arterial recording in children. Finger blood pressure monitoring is a novel comfortable, convenient and accurate alternative approach for noninvasive beat-to-beat blood pressure monitoring in children.

15.
Chaos ; 29(2): 023132, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30823711

RESUMO

We numerically investigate the existence and stability of higher-order recurrences (HoRs), including super-recurrences, super-super-recurrences, etc., in the α and ß Fermi-Pasta-Ulam-Tsingou (FPUT) lattices for initial conditions in the fundamental normal mode. Our results represent a considerable extension of the pioneering work of Tuck and Menzel on super-recurrences. For fixed lattice sizes, we observe and study apparent singularities in the periods of these HoRs, speculated to be caused by nonlinear resonances. Interestingly, these singularities depend very sensitively on the initial energy and the respective nonlinear parameters. Furthermore, we compare the mechanisms by which the super-recurrences in the two models breakdown as the initial energy and respective nonlinear parameters are increased. The breakdown of super-recurrences in the ß-FPUT lattice is associated with the destruction of the so-called metastable state and thus with relaxation towards equilibrium. For the α-FPUT lattice, we find this is not the case and show that the super-recurrences break down while the lattice is still metastable and far from equilibrium. We close with comments on the generality of our results for different lattice sizes.

16.
ANZ J Surg ; 89(3): 184-190, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30770628

RESUMO

BACKGROUND: Total knee replacement (TKR) has been shown to perform differently in patients with rheumatoid arthritis (RA) when compared to osteoarthritis (OA). In this study, we compare the survivorship between these two groups and examine patient and prosthesis factors that impact the revision rate. METHODS: All RA and OA patients undergoing TKR in Australia from 1 September 1999 to 31 December 2016 were included. Revision rates were assessed using Kaplan-Meier estimates of survivorship. The cumulative percent revision analysed age, gender, prosthesis constraint and revision for infection. RESULTS: There were 541 744 TKR procedures performed including 7542 patients with RA. RA declined as the primary diagnosis from 2.4% of all TKR in 2003 to 0.9% in 2016. Male sex was an independent revision risk in RA patients (hazard ratio (HR) = 1.66, P < 0.001) and OA patients (3.5 years+: HR = 1.09 (1.04-1.15), P < 0.001). Male RA patients had a higher revision rate for infection than females (HR = 3.14, P < 0.001). Females with RA had a lower cumulative percent revision compared to OA females, but males showed no difference between diagnoses. Revision in RA patients was not influenced by age. Compared to OA, RA patients had a decreased revision rate for those aged <65 years, but not for patients aged ≥65 years. CONCLUSION: The rate of revision after TKR in RA patients is lower than those with OA, but patients with RA are at increased risk of infection, particularly the male group. Prosthesis constraint had no influence on revision rate. Mortality in those undergoing TKR with RA was higher than in those with OA.

17.
Knee ; 26(2): 392-399, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638681

RESUMO

BACKGROUND: All-polyethylene (AP) tibial components in patients aged greater than 60 years have stable tibial migration patterns and favorable survival rates when compared to identical Metal-backed (MB) designs. Tibial component migration in younger patients has not been reported. The aim of this study was to examine the migration characteristics of patients aged less than 60 years compared to a previous cohort of AP and MB tibial components of identical design in older patients. METHODS: A prospective consecutive study examined tibial component migration in 21 patients aged less than 60 years undergoing a cemented total knee arthroplasty with an AP tibial component by radiostereometric analysis (RSA) to 24 months. Results were compared to the authors' previous series of 21 patients aged greater than 60 years that were randomized to either an AP or MB tibial component. RESULTS: Both age groups of patients implanted with an AP component had stable migration patterns with no patient having greater than 0.2° rotation or 0.2 mm maximum total point motion. Five of 11 MB tibial components displayed continued migration between one and two years. Subsidence was similar in all groups, whilst maximum total point motion was greater for the MB cohort (0.34 mm, 0.33 mm, 0.61 mm; AP <60, AP >60, MB). CONCLUSIONS: Young patients implanted with an AP tibial component had stable tibial migration patterns comparable to older patients with the same AP implant. Regardless of age, AP tibial components were at least as stable as MB tibial components. LEVEL OF EVIDENCE: Level II, Prospective comparative study.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Polietileno , Análise Radioestereométrica/métodos , Tíbia/cirurgia , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Teste de Materiais/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese
18.
Circ Res ; 124(5): 712-726, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30566039

RESUMO

RATIONALE: SPEG (Striated muscle preferentially expressed protein kinase) has 2 kinase-domains and is critical for cardiac development and function. However, it is not clear how these 2 kinase-domains function to maintain cardiac performance. OBJECTIVE: To determine the molecular functions of the 2 kinase-domains of SPEG. METHODS AND RESULTS: A proteomics approach identified SERCA2a (sarcoplasmic/endoplasmic reticulum calcium ATPase 2a) as a protein interacting with the second kinase-domain but not the first kinase-domain of SPEG. Furthermore, the second kinase-domain of SPEG could phosphorylate Thr484 on SERCA2a, promote its oligomerization and increase calcium reuptake into the sarcoplasmic/endoplasmic reticulum in culture cells and primary neonatal rat cardiomyocytes. Phosphorylation of SERCA2a by SPEG enhanced its calcium-transporting activity without affecting its ATPase activity. Depletion of Speg in neonatal rat cardiomyocytes inhibited SERCA2a-Thr484 phosphorylation and sarcoplasmic reticulum calcium reuptake. Moreover, overexpression of SERCA2aThr484Ala mutant protein also slowed sarcoplasmic reticulum calcium reuptake in neonatal rat cardiomyocytes. In contrast, domain mapping and phosphorylation analysis revealed that the first kinase-domain of SPEG interacted and phosphorylated its recently identified substrate JPH2 (junctophilin-2). An inducible heart-specific Speg knockout mouse model was generated to further study this SPEG-SERCA2a signal nexus in vivo. Inducible deletion of Speg decreased SERCA2a-Thr484 phosphorylation and its oligomerization in the heart. Importantly, inducible deletion of Speg inhibited SERCA2a calcium-transporting activity and impaired calcium reuptake into the sarcoplasmic reticulum in cardiomyocytes, which preceded morphological and functional alterations of the heart and eventually led to heart failure in adult mice. CONCLUSIONS: Our data demonstrate that the 2 kinase-domains of SPEG may play distinct roles to regulate cardiac function. The second kinase-domain of SPEG is a critical regulator for SERCA2a. Our findings suggest that SPEG may serve as a new target to modulate SERCA2a activation for treatment of heart diseases with impaired calcium homeostasis.

19.
Sci Total Environ ; 655: 1037-1046, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-30577098

RESUMO

High water tables (WT) stabilise peatland carbon (C) through regulation of biogeochemical processes. The impact of peatland WT on ecosystem function, including C exchange, alters over time, and the factors that cause some peatlands to display resilience and others to undergo degradation are poorly understood. Here we use CO2 flux measurements, measured by eddy covariance, to compare ecosystem function between two raised bogs; one drainage-affected, with a deep and fluctuating water table and the other near-natural, with a shallow and stable water table. The drainage-affected bog was found to be a moderate sink for CO2 (69 g C m-2 yr-1), which was 134 g C m-2 yr-1 less than the near-natural bog (203 g C m-2 yr-1). Greater ecosystem productivity has allowed the drainage-impacted bog to act as a CO2 sink despite higher ecosystem respiration; most likely due to an increase in photosynthetic capacity caused by expansion of ericaceous shrub cover. The tolerance of the vegetation community, particularly the main peat former Empodisma robustum (Restionaceae), to low and fluctuating WT appears to have been key in allowing the site to remain a sink. Despite the current resilience of the ecosystem CO2 sink, we found gross primary production to be limited under both high and low water tables, even in a year with typical rainfall. This is best explained by the limited physiological ability of ericaceous shrubs to tolerate a fluctuating WT. As such we hypothesise that if the WT continues to drop and become even more unstable, then without further vegetation change, a reduction in gross primary production is likely which may in turn cause the site to become a source for CO2.


Assuntos
Poluentes Atmosféricos/análise , Ciclo do Carbono , Dióxido de Carbono/análise , Água Subterrânea/análise , Áreas Alagadas , Sequestro de Carbono , Finlândia
20.
Diabetol Metab Syndr ; 10: 87, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30524507

RESUMO

Background: Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals' experiences with structural barriers to care and self-management remain under-characterized. Methods: We utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants' diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10. Results: The structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps. Conclusions: FN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA