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1.
J Clin Microbiol ; 59(4)2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33500363

RESUMO

The global outbreak and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have created an urgent need for large-scale testing of populations. There is a demand for high-throughput testing protocols that can be used for efficient and rapid testing of clinical specimens. We evaluated a pooled PCR protocol for testing nasopharyngeal (NP) swabs using known positive/negative and untested clinical samples that were assigned to pools of 5 or 10. In total, 630 samples were used in this study. Individual positive samples with cycle threshold (CT ) values as high as 33 could be consistently detected when pooled with 4 negative samples (pool of 5), and individual positive samples with CT values up to 31 could be consistently detected when pooled with 9 negative samples (pool of 10). Pooling of up to 5 samples can be employed in laboratories for the diagnosis of COVID-19 for efficient utilization of resources, rapid screening of a greater number of people, and faster reporting of test results.

2.
Int J Pediatr Otorhinolaryngol ; 141: 110551, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33338703

RESUMO

OBJECTIVES: Patients with microtia and aural atresia have multiple options for treatment of conductive hearing loss (CHL) and auricle reconstruction; however, little is known about the factors influencing treatment selection. This study aims to review the socioeconomic and clinical data of microtia/atresia patients to evaluate congruency with national data and whether these factors affect treatment decisions. METHODS: Retrospective review of patients evaluated in the microtia and atresia multidisciplinary clinic (MDC) at a tertiary academic children's hospital between 2008 and 2018. Outcomes included demographic, socioeconomic and clinical factors associated with hearing surgery and framework surgery. RESULTS: 373 patients were seen in the Microtia MDC: 193 (51.7%) were male, 187 (50.1%) identified as Hispanic and 23 (6.2%) identified as Asian. 267 (75.6%) patients received a nonsurgical bone conduction hearing device (BCHD); fitting at a younger age was associated with better nonsurgical BCHD compliance. Multivariate analysis was performed on the patients that were eligible for surgery based on age and appropriate follow-up. 70 (18.8%) patients had placement of an osseointegrated BCHD; inconsistent compliance with nonsurgical BCHD decreased the odds of proceeding with osseointegrated BCHD placement. 60 (16.1%) patients underwent framework surgery for external reconstruction. Placement of osseointegrated BCHD was the only factor that was associated with proceeding with framework surgery. Other assessed demographic and socioeconomic factors were statistically not associated with selection of surgical intervention. CONCLUSION: Fitting a nonsurgical BCHD at a younger age is associated with higher likelihood of nonsurgical BCHD compliance, that is in turn associated with patients and families proceeding with osseointegrated BCHD and framework surgery.

3.
Opt Express ; 28(25): 38008-38028, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33379623

RESUMO

In near-eye display systems that support three-dimensional (3D) augmented and virtual reality, a central factor in determining the user experience is the size of the eyebox. The eyebox refers to a volume where the eye receives an acceptable view of the image with respect to a set of criteria and thresholds. The size and location of this volume are primarily driven by optical architecture choices in which designers trade-off a number of constraints, such as field of view, image quality, and product design. It is thus important to clearly quantify how design decisions affect the properties of the eyebox. Recent work has started evaluating the eyebox in 3D based purely on optical criteria. However, such analyses do not incorporate perceptual criteria that determine visual quality, which are particularly important for binocular 3D systems. To address this limitation, we introduce the framework of a perceptual eyebox. The perceptual eyebox is the volume where the eye(s) must be located for the user to experience a visual percept falling within a perceptually-defined criterion. We combine optical and perceptual data to characterize an example perceptual eyebox for display visibility in augmented reality. The key contributions in this paper include: comparing the perceptual eyebox for monocular and binocular display designs, modeling the effects of user eye separation, and examining the effects of eye rotation on the eyebox volume.

5.
PLoS Pathog ; 16(10): e1008986, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33064743

RESUMO

The Type I Interferons (IFN-Is) are innate antiviral cytokines that include 12 different IFNα subtypes and IFNß that signal through the IFN-I receptor (IFNAR), inducing hundreds of IFN-stimulated genes (ISGs) that comprise the 'interferome'. Quantitative differences in IFNAR binding correlate with antiviral activity, but whether IFN-Is exhibit qualitative differences remains controversial. Moreover, the IFN-I response is protective during acute HIV-1 infection, but likely pathogenic during the chronic stages. To gain a deeper understanding of the IFN-I response, we compared the interferomes of IFNα subtypes dominantly-expressed in HIV-1-exposed plasmacytoid dendritic cells (1, 2, 5, 8 and 14) and IFNß in the earliest cellular targets of HIV-1 infection. Primary gut CD4 T cells from 3 donors were treated for 18 hours ex vivo with individual IFN-Is normalized for IFNAR signaling strength. Of 1,969 IFN-regulated genes, 246 'core ISGs' were induced by all IFN-Is tested. However, many IFN-regulated genes were not shared between the IFNα subtypes despite similar induction of canonical antiviral ISGs such as ISG15, RSAD2 and MX1, formally demonstrating qualitative differences between the IFNα subtypes. Notably, IFNß induced a broader interferome than the individual IFNα subtypes. Since IFNß, and not IFNα, is upregulated during chronic HIV-1 infection in the gut, we compared core ISGs and IFNß-specific ISGs from colon pinch biopsies of HIV-1-uninfected (n = 13) versus age- and gender-matched, antiretroviral-therapy naïve persons with HIV-1 (PWH; n = 19). Core ISGs linked to inflammation, T cell activation and immune exhaustion were elevated in PWH, positively correlated with plasma lipopolysaccharide (LPS) levels and gut IFNß levels, and negatively correlated with gut CD4 T cell frequencies. In sharp contrast, IFNß-specific ISGs linked to protein translation and anti-inflammatory responses were significantly downregulated in PWH, negatively correlated with gut IFNß and LPS, and positively correlated with plasma IL6 and gut CD4 T cell frequencies. Our findings reveal qualitative differences in interferome induction by diverse IFN-Is and suggest potential mechanisms for how IFNß may drive HIV-1 pathogenesis in the gut.

6.
Antibiotics (Basel) ; 9(9)2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32906671

RESUMO

Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for "self-care", prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.

7.
PLoS Comput Biol ; 16(9): e1008146, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32970679

RESUMO

According to the efficient coding hypothesis, sensory systems are adapted to maximize their ability to encode information about the environment. Sensory neurons play a key role in encoding by selectively modulating their firing rate for a subset of all possible stimuli. This pattern of modulation is often summarized via a tuning curve. The optimally efficient distribution of tuning curves has been calculated in variety of ways for one-dimensional (1-D) stimuli. However, many sensory neurons encode multiple stimulus dimensions simultaneously. It remains unclear how applicable existing models of 1-D tuning curves are for neurons tuned across multiple dimensions. We describe a mathematical generalization that builds on prior work in 1-D to predict optimally efficient multidimensional tuning curves. Our results have implications for interpreting observed properties of neuronal populations. For example, our results suggest that not all tuning curve attributes (such as gain and bandwidth) are equally useful for evaluating the encoding efficiency of a population.


Assuntos
Biologia Computacional/métodos , Modelos Neurológicos , Células Receptoras Sensoriais/fisiologia , Encéfalo/fisiologia , Humanos
8.
J Vis ; 20(8): 10, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32761107

RESUMO

Binocular fusion relies on matching points in the two eyes that correspond to the same physical feature in the world; however, not all world features are binocularly visible. Near depth edges, some regions of a scene are often visible to only one eye (so-called half occlusions). Accurate detection of these monocularly visible regions is likely to be important for stable visual perception. If monocular regions are not detected as such, the visual system may attempt to binocularly fuse non-corresponding points, which can result in unstable percepts. We investigated the hypothesis that the visual system capitalizes on statistical regularities associated with depth edges in natural scenes to aid binocular fusion and facilitate perceptual stability. By sampling from a large set of stereoscopic natural images with co-registered distance information, we found evidence that monocularly visible regions near depth edges primarily result from background occlusions. Accordingly, monocular regions tended to be more visually similar to the adjacent binocularly visible background region than to the adjacent binocularly visible foreground. Consistent with our hypothesis, perceptual experiments showed that perception tended to be more stable when the image properties of the depth edge were statistically more likely given the probability of occurrence in natural scenes (i.e., when monocular regions were more visually similar to the binocular background). The generality of these results was supported by a parametric study with simulated environments. Exploiting regularities in natural environments may allow the visual system to facilitate fusion and perceptual stability when both binocular and monocular regions are visible.

9.
J Burn Care Res ; 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32810219

RESUMO

INTRODUCTION: Children who sustain moderate to large surface area burns present in a hypermetabolic state with increased caloric and protein requirements. A policy was implemented at our institution in 2017 to initiate enteral nutrition (EN) in pediatric burn patients within four hours of admission. We hypothesize that early EN (initiated within 4 hours of admission) is more beneficial than late EN (initiated ≥ 4 hours from admission) for pediatric burn patients and is associated with decreased rates of pneumonia, increased calorie and protein intake, fewer feeding complications, a shorter Intensive Care Unit (ICU) length of stay (LOS), and a reduced hospital LOS. METHODS: Children who sustained a total body surface area (TBSA) burn injury ≥ 10% between 2011 and 2018 were identified in a prospectively maintained burn registry at Children's Hospital Colorado. Patients were stratified into two groups for comparison: early EN and late EN. RESULTS: We identified 132 pediatric burn patients who met inclusion criteria, and most (60%) were male. Approximately half (48%) of the study patients were in the early EN group. The early EN group had lower rates of underfeeding during the first week (p=0.014) and shorter ICU LOS (p=0.025). CONCLUSIONS: Achieving and sustaining adequate nutrition in pediatric burn patients with moderate to large surface area burn injuries is critical to recovery. Early EN in pediatric burn patients is associated with decreased underfeeding and reduced ICU LOS. We recommend protocols to institute feeding for patients with burns ≥ 10% TBSA within four hours of admission at all pediatric burn centers.

10.
Clin Infect Dis ; 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32785665

RESUMO

BACKGROUND: This study assesses acceptability and usability of home-based self-testing for SARS-CoV-2 antibodies using lateral flow immunoassays (LFIA). METHODS: We carried out public involvement and pilot testing in 315 volunteers to improve usability. Feedback was obtained through online discussions, questionnaires, observations and interviews of people who tried the test at home. This informed the design of a nationally representative survey of adults in England using two LFIAs (LFIA1 and LFIA2) which were sent to 10,600 and 3,800 participants, respectively, who provided further feedback. RESULTS: Public involvement and pilot testing showed high levels of acceptability, but limitations with the usability of kits. Most people reported completing the test; however, they identified difficulties with practical aspects of the kit, particularly the lancet and pipette, a need for clearer instructions and more guidance on interpretation of results. In the national study, 99.3% (8,693/8,754) of LFIA1 and 98.4% (2,911/2,957) of LFIA2 respondents attempted the test and 97.5% and 97.8% of respondents completed it, respectively. Most found the instructions easy to understand, but some reported difficulties using the pipette (LFIA1: 17.7%) and applying the blood drop to the cassette (LFIA2: 31.3%). Most respondents obtained a valid result (LFIA1: 91.5%; LFIA2: 94.4%). Overall there was substantial concordance between participant and clinician interpreted results (kappa: LFIA1 0.72; LFIA2 0.89). CONCLUSION: Impactful public involvement is feasible in a rapid response setting. Home self-testing with LFIAs can be used with a high degree of acceptability and usability by adults, making them a good option for use in seroprevalence surveys.

11.
Arterioscler Thromb Vasc Biol ; 40(9): 2227-2243, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640901

RESUMO

OBJECTIVE: Perivascular adipose tissue (PVAT) surrounding arteries supports healthy vascular function. During obesity, PVAT loses its vasoprotective effect. We study pathological conversion of PVAT, which involves molecular changes in protein profiles and functional changes in adipocytes. Approach and Results: C57BL6/J mice were fed a 60% high-fat diet for 12 weeks or a cardioprotective 30% calorie-restricted diet for 5 weeks. Proteomic analysis identified PVAT as a molecularly distinct adipose depot, and novel markers for thermogenic adipocytes, such as GRP75 (stress-70 protein, mitochondrial), were identified. High-fat diet increased the similarity of protein signatures in PVAT and brown adipose, suggesting activation of a conserved whitening pathway. The whitening phenotype was characterized by suppression of UCP1 (uncoupling protein 1) and increased lipid deposition, leptin, and inflammation, and specifically in PVAT, elevated Notch signaling. Conversely, PVAT from calorie-restricted mice had decreased Notch signaling and less lipid. Using the Adipoq-Cre strain, we constitutively activated Notch1 signaling in adipocytes, which phenocopied the changes in PVAT caused by a high-fat diet, even on a standard diet. Preadipocytes from mouse PVAT expressed Sca1, CD140a, Notch1, and Notch2, but not CD105, showing differences compared with preadipocytes from other depots. Inhibition of Notch signaling during differentiation of PVAT-derived preadipocytes reduced lipid deposition and adipocyte marker expression. CONCLUSIONS: PVAT shares features with other adipose depots, but has a unique protein signature that is regulated by dietary stress. Increased Notch signaling in PVAT is sufficient to initiate the pathological conversion of PVAT by promoting adipogenesis and lipid accumulation and may thus prime the microenvironment for vascular disease.


Assuntos
Adipócitos Brancos/metabolismo , Adipogenia , Tecido Adiposo Branco/metabolismo , Lipogênese , Obesidade/metabolismo , Receptores Notch/metabolismo , Adipócitos Brancos/patologia , Tecido Adiposo Branco/patologia , Adiposidade , Animais , Ataxina-1/metabolismo , Aterosclerose/genética , Aterosclerose/metabolismo , Aterosclerose/patologia , Restrição Calórica , Dieta Hiperlipídica , Modelos Animais de Doenças , Endoglina/metabolismo , Feminino , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Obesidade/genética , Obesidade/patologia , Fenótipo , Pró-Proteína Convertase 9/genética , Pró-Proteína Convertase 9/metabolismo , Proteômica , Receptor Notch1/genética , Receptor Notch1/metabolismo , Receptor Notch2/metabolismo , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/metabolismo , Receptores Notch/genética , Transdução de Sinais
12.
BJGP Open ; 4(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32576575

RESUMO

BACKGROUND: Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections. AIM: To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources. DESIGN & SETTING: The study had a qualitative design and was undertaken in primary care settings and care homes. METHOD: Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions. RESULTS: Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use. CONCLUSION: A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.

13.
R I Med J (2013) ; 103(1): 21-24, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013299

RESUMO

BACKGROUND: The Rhode Island Department of Health (RIDOH) has administered the Health Information Technology (HIT) Survey since 2009 to report clinician-level process measures relating to HIT adoption and use. METHODS: RIDOH administers the Rhode Island HIT Survey to all licensed independent practitioners. Descriptive analyses examined HIT adoption and the clinician experience working with HIT. RESULTS: Most physician and Advanced Practice Provider (APP) respondents report using an EHR (92.5% and 94.3%) and e-prescribing medications (84.1% and 81.6%). Less than half of physicians (40.9% or n=565) and APPs (35.4% or n=195) who prescribe controlled substances currently submit controlled substance prescriptions electronically. A higher percentage of physicians, compared to APPs, reported experiencing HIT-related stress (80.9% and 66.6%). The overall prevalence of physicians reporting symptoms of burnout was 29.7% (n=539) but varied between specialties. DISCUSSION: As of 2019, the majority of Rhode Island physicians have adopted EHRs and e-prescribing. Adoption plateaued after 2012, and challenges persist in integrating existing technology into practice.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Prescrição Eletrônica/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Estresse Ocupacional , Rhode Island
14.
Adv Drug Deliv Rev ; 148: 290-307, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31707052

RESUMO

In recent years, regenerative medicine is gaining momentum and is giving hopes for restoring function of diseased, damaged, and aged tissues and organs and nanotechnology is serving as a catalyst. In the ophthalmology field, various types of allogenic and autologous stem cells have been investigated to treat some ocular diseases due to age-related macular degeneration, glaucoma, retinitis pigmentosa, diabetic retinopathy, and corneal and lens traumas. Nanomaterials have been utilized directly as nanoscaffolds for these stem cells to promote their adhesion, proliferation and differentiation or indirectly as vectors for various genes, tissue growth factors, cytokines and immunosuppressants to facilitate cell reprogramming or ocular tissue regeneration. In this review, we reviewed various nanomaterials used for retina, cornea, and lens regenerations, and discussed the current status and future perspectives of nanotechnology in tracking cells in the eye and personalized regenerative ophthalmology. The purpose of this review is to provide comprehensive and timely insights on the emerging field of nanotechnology for ocular tissue engineering and regeneration.


Assuntos
Nanoestruturas/química , Nanotecnologia , Regeneração Nervosa/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Oftalmologia , Sistemas de Liberação de Medicamentos , Humanos , Fármacos Neuroprotetores/química , Medicina Regenerativa , Engenharia Tecidual
15.
Front Neurosci ; 13: 974, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680794

RESUMO

Charcot-Marie-Tooth type 4 (CMT4) is an autosomal recessive severe form of neuropathy with genetic heterogeneity. CMT4B1 is caused by mutations in the myotubularin-related 2 (MTMR2) gene and as a member of the myotubularin family, the MTMR2 protein is crucial for the modulation of membrane trafficking. To enable future clinical trials, we performed a detailed review of the published cases with MTMR2 mutations and describe four novel cases identified through whole-exome sequencing (WES). The four unrelated families harbor novel homozygous mutations in MTMR2 (NM_016156, Family 1: c.1490dupC; p.Phe498IlefsTer2; Family 2: c.1479+1G>A; Family 3: c.1090C>T; p.Arg364Ter; Family 4: c.883C>T; p.Arg295Ter) and present with CMT4B1-related severe early-onset motor and sensory neuropathy, generalized muscle atrophy, facial and bulbar weakness, and pes cavus deformity. The clinical description of the new mutations reported here overlap with previously reported CMT4B1 phenotypes caused by mutations in the phosphatase domain of MTMR2, suggesting that nonsense MTMR2 mutations, which are predicted to result in loss or disruption of the phosphatase domain, are associated with a severe phenotype and loss of independent ambulation by the early twenties. Whereas the few reported missense mutations and also those truncating mutations occurring at the C-terminus after the phosphatase domain cause a rather mild phenotype and patients were still ambulatory above the age 30 years. Charcot-Marie-Tooth neuropathy and Centronuclear Myopathy causing mutations have been shown to occur in proteins involved in membrane remodeling and trafficking pathway mediated by phosphoinositides. Earlier studies have showing the rescue of MTM1 myopathy by MTMR2 overexpression, emphasize the importance of maintaining the phosphoinositides equilibrium and highlight a potential compensatory mechanism amongst members of this pathway. This proved that the regulation of expression of these proteins involved in the membrane remodeling pathway may compensate each other's loss- or gain-of-function mutations by restoring the phosphoinositides equilibrium. This provides a potential therapeutic strategy for neuromuscular diseases resulting from mutations in the membrane remodeling pathway.

16.
BMJ Open ; 9(10): e030845, 2019 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-31662380

RESUMO

OBJECTIVES: To describe public understanding and use of antibiotics. DESIGN: Ipsos MORI Capibus survey of randomly-selected households. SETTING: England, January-April 2017. PARTICIPANTS: 2283 adults (≥15 years) including 777 parents of children <5 years old. DATA COLLECTION AND ANALYSIS: The main survey was undertaken in January 2017 (n=1691); data from an additional sample of parents were collected in April 2017 (n=592). Analyses were weighted to obtain estimates representative of the population. MAIN OUTCOME MEASURES: Responses to questions about antibiotics (awareness and perceptions), recent illness (expectations and experience), delayed and leftover antibiotics, and child illness stratified by demographic and socioeconomic characteristics. RESULTS: Most respondents (83% (1404/1691)) recognised that antibiotics kill bacteria/treat bacterial infections, but a sizeable minority (35% (592/1691)) thought that antibiotics kill viruses/treat viral infections. Overall levels of understanding have not changed substantially since similar surveys in 2003 and 2008/2009. One sixth of respondents who were prescribed antibiotics reported having leftovers (14% (64/498)) and 33% (22/64) kept these for possible future use. 1.3% of all respondents (23/1691) reported taking left-over antibiotics in the past year and 1.6% (26/1691) reported taking antibiotics obtained without a prescription. Higher social grade and educational qualifications were strongly positively associated with antibiotic knowledge; youngest (15-24 years), oldest (65 +years) and black, Asian and minority ethnic adults were less knowledgeable. Among 1319 respondents who had an infection or antibiotics within the past year, 43% (568/1319) said that they had not received any advice or information about antibiotics. CONCLUSIONS: Despite many campaigns, public understanding of antibiotics in England continues to combine correct basic knowledge held by most people with less prevalent but persistent and potentially harmful misunderstandings. These could be addressed through active provision of advice and information during primary and secondary care consultations and more effective public health interventions.


Assuntos
Antibacterianos , Resistência Microbiana a Medicamentos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Inglaterra , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
17.
Behav Res Ther ; 122: 103465, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31539834

RESUMO

Elaborated Intrusion (EI) theory posits a key role for visuospatial working memory (WM) in craving. In line with the predictions of EI theory, several studies have found that WM and craving show mutually interfering effects - for example, performance of visuospatial WM tasks has been found to attenuate naturally occurring cravings. However, the extent to which these effects are driven specifically by visuospatial processing remains unclear. We conducted two experiments to investigate the effects of WM on naturally occurring cravings in more detail. In experiment 1, we examined whether such effects are driven specifically by visuospatial WM processes or can also be induced by a verbal WM task. Subjective craving ratings were attenuated equally by performance of visuospatial and verbal WM tasks, suggesting that craving is not dependent specifically on visuospatial processing. In experiment 2, we examined whether effects of visuospatial WM on craving could be driven by simple distraction. Naturally occurring cravings were attenuated in a control condition with minimal WM demands (watching a video). However, the magnitude of attenuation was significantly greater in a visuospatial WM condition. Taken together, these findings highlight a key role for WM in the attenuation of naturally occurring craving, but do not support the hypothesis that such effects are dependent specifically on visuospatial processing.


Assuntos
Fissura/fisiologia , Memória de Curto Prazo/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Percepção Espacial/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
18.
J Am Heart Assoc ; 8(11): e012366, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31433717

RESUMO

Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy-only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy-only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11-2.85]; P=0.02), age (odds ratio, 1.04 [1.00-1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15-3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all-cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Taxa de Filtração Glomerular , Rim/irrigação sanguínea , Rim/fisiopatologia , Obstrução da Artéria Renal/tratamento farmacológico , Idoso , Fármacos Cardiovasculares/efeitos adversos , Causas de Morte , Progressão da Doença , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/mortalidade , Obstrução da Artéria Renal/fisiopatologia , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
19.
J Gen Intern Med ; 34(11): 2542-2548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31463685

RESUMO

IMPORTANCE: Physician attitudes about websites that publicly report health care quality and experience data have not been recently described. OBJECTIVES: To examine physician attitudes about the accuracy of websites that report information about quality of care and patient experience and to describe physician beliefs about the helpfulness of these data for patients choosing a physician. DESIGN, PARTICIPANTS, AND MEASURES: The Rhode Island Department of Health (RIDOH) and a multi-stakeholder group developed and piloted two questions that were added to RIDOH's biennial physician survey of all 4197 practicing physicians in Rhode Island: (1) "How accurate of a picture do you feel that the following types of online resources give about the quality of care that physicians provide?" (with choices) and (2) "Which types of physician-specific information (i.e., not about the practice overall) would be helpful to include in online resources for patients to help them choose a new physician? (Select all that apply)." Responses were stratified by primary care vs. subspecialty clinicians. Summary statistics and chi-squared tests were used to analyze the results. RESULTS: Among 1792 respondents (response rate 43%), 45% were unaware of RIDOH's site and 54% were unaware of the Centers for Medicare & Medicaid Services (CMS)' quality reporting sites. Only 2% felt that Medicare sites were "very accurate" in depicting physician quality. Most physicians supported public reporting of general information about physicians (e.g., board certification), but just over one-third of physicians felt that performance-based quality measures are "helpful" (and a similar percentage reported that patient reviews felt are "helpful") for patients choosing a physician. CONCLUSIONS: Physician-respondents were either uninformed or skeptical about public reporting websites. In contrast to prior reports that a majority of patients value some forms of publicly reported data, most physicians do not consider quality metrics and patient-generated reviews helpful for patients who are choosing a physician.


Assuntos
Atitude do Pessoal de Saúde , Satisfação do Paciente , Médicos/psicologia , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Médicos/normas , Rhode Island
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