RESUMO
Cancer immunotherapy has become arguably the most promising advancement in cancer research and therapy in recent years. The efficacy of cancer immunotherapy is critically dependent on specific physiological and physical processes - collectively referred to as transport barriers - including the activation of T cells by antigen presenting cells, T cells migration to and penetration into the tumor microenvironment, and movement of nutrients and other immune cells through the tumor microenvironment. Nanotechnology-based approaches have great potential to help overcome these transport barriers. In this review, we discuss the ways that nanotechnology is being leveraged to improve the efficacy and potency of various cancer immunotherapies.
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Células Dendríticas/imunologia , Imunoterapia/métodos , Nanopartículas/uso terapêutico , Nanotecnologia , Neoplasias/terapia , Linfócitos T/imunologia , Animais , Apresentação de Antígeno , Movimento Celular , Humanos , Ativação Linfocitária , Neoplasias/imunologia , Microambiente TumoralRESUMO
Disrupted in schizophrenia 1 (DISC1) is a leading candidate susceptibility gene for schizophrenia, bipolar disorder and recurrent major depression, which has been implicated in other psychiatric illnesses of neurodevelopmental origin, including autism. DISC1 was initially identified at the breakpoint of a balanced chromosomal translocation, t(1;11) (q42.1;14.3), in a family with a high incidence of psychiatric illness. Carriers of the translocation show a 50% reduction in DISC1 protein levels, suggesting altered DISC1 expression as a pathogenic mechanism in psychiatric illness. Altered DISC1 expression in the post-mortem brains of individuals with psychiatric illness and the frequent implication of non-coding regions of the gene by association analysis further support this assertion. Here, we provide the first characterization of the DISC1 promoter region. Using dual luciferase assays, we demonstrate that a region -300 to -177 bp relative to the transcription start site (TSS) contributes positively to DISC1 promoter activity, while a region -982 to -301 bp relative to the TSS confers a repressive effect. We further demonstrate inhibition of DISC1 promoter activity and protein expression by forkhead-box P2 (FOXP2), a transcription factor implicated in speech and language function. This inhibition is diminished by two distinct FOXP2 point mutations, R553H and R328X, which were previously found in families affected by developmental verbal dyspraxia. Our work identifies an intriguing mechanistic link between neurodevelopmental disorders that have traditionally been viewed as diagnostically distinct but which do share varying degrees of phenotypic overlap.
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Fatores de Transcrição Forkhead/metabolismo , Proteínas do Tecido Nervoso/genética , Regiões Promotoras Genéticas , Transtorno Bipolar/genética , Linhagem Celular Tumoral , Transtorno Depressivo Maior/genética , Fatores de Transcrição Forkhead/genética , Células HEK293 , Humanos , Mutação Puntual , Esquizofrenia/genéticaRESUMO
Objective: This report describes a hospice-supported no-fee program to support patients living with all levels of dementia and their caregivers. Background: Our medical system struggles to serve the rapidly increasing numbers of patients with dementia. Hospice of the Valley developed a low-cost six-month program to reduce caregiver stress and reduce neurobehavioral disturbances of patients living with dementia, reduce costs for insurers, and increase hospice referrals. Methods: Data were analyzed from 532 patients living with caregivers admitted over 22 months. Caregiver burden, behaviors, hospitalization, and hospice admissions were tracked. Results: Severity of neurobehavioral disturbances and burden to caregivers decreased significantly. Hospitalizations decreased during and after the program, resulting in cost savings for insurance programs. Twenty-five percent of participants were admitted to hospice. Discussion: The Supportive Care for Dementia program was welcomed by community physicians, leading to improved supportive care and increased hospice referrals. The program is replicable and has been adopted by one health plan and is being evaluated by others.
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Demência , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Humanos , Cuidadores , Hospitalização , Encaminhamento e Consulta , Demência/terapiaRESUMO
Spinal cord injury (SCI) research with animals aims to understand the neurophysiological responses resultant of injury and to identify effective interventions that can translate into clinical treatments in the future. Consistent and reliable assessments to properly measure outcomes are essential to achieve this aim and avoid issues with reproducibility. The objective of this study was to establish a baseline for implementing the forelimb reaching task (FRT) assessment and analysis that increased reproducibility of our studies. For this study, we implemented a weekly FRT training program for six weeks. During this time the language of the scoring rubric for movement elements that comprise a reaching task was simplified and expanded. We calculated intra- and inter-rater variability among participants of the study both before and after training to determine the effect changes made had on rigor and reproducibility of this behavioral assessment in a cervical SCI rodent model. All animals (n = 19) utilized for FRT behavioral assessments received moderate contusion injuries using the Ohio State University device and were tested for a period of 5 weeks post-SCI. Videos used for scoring were edited and shared with all participants of this study to test FRT score variability and the effect simplification of the scoring rubric had on overall inter-rater reliability. From our results we determined training for a minimum of three weeks in FRT analysis is necessary for rigor and reproducibility of our behavioral studies, as well as the need for two raters to be assigned per animal to ensure accuracy of results.
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Medula Cervical , Traumatismos da Medula Espinal , Animais , Reprodutibilidade dos Testes , Medula Cervical/lesões , Roedores , Modelos Animais de Doenças , Membro Anterior , Recuperação de Função Fisiológica/fisiologia , Medula EspinalRESUMO
BACKGROUND: Sapropterin has been approved as a treatment option for individuals with Phenylketonuria in the United Kingdom. Individuals are assessed as responsive to Sapropterin by a ≥30% reduction in Phenylalanine (Phe) concentrations using dried blood spot (DBS) specimens. DBS quality is critical for accurate and precise measurement of Phe. Currently, UK national guidelines for DBS specimen acceptance do not exist for patient-collected DBS specimens. We adopted evidence-based guidelines for specimen acceptance criteria and retrospectively assessed the impact of introducing these guidelines on specimen rejection rates. Methods: Laboratories were invited to audit the quality of DBS specimens routinely received for Phe monitoring using: (1) existing acceptance/rejection criteria and (2) proposed national guidelines. RESULTS: Ten laboratories audited 2111 specimens from 1094 individuals. Using existing local guidelines, the median rejection rate was 4.0% (IQR 1.5-7.2%). This increased to 21.9% (IQR 10.0-33.0%) using the proposed guidelines. Where reason(s) for rejection were provided (n = 299); 211/299 (70.6%) of DBS specimens were too small or multi-spotted. 380 individuals had more than one sample evaluated; 231/380 (60.8%) provided specimens of acceptable quality, 37/380 (9.7%) consistently provided poor-quality DBS specimens. CONCLUSIONS: There is significant variability in the quality of patient-collected DBS specimens. If unacceptable specimens are not rejected, imprecise/inaccurate results will be used in clinical decision making. Using annual workload data for England, this equates to 12,410 incorrect results. Individuals and parents/carers should receive ongoing training in blood collection technique to ensure use of evidence-based acceptability criteria does not cause undue distress from increased sample rejection rates.
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Laboratórios , Fenilcetonúrias , Humanos , Estudos Transversais , Estudos Retrospectivos , Fenilalanina/uso terapêuticoRESUMO
BACKGROUND: Binge-like alcohol exposure in neonatal rats during the brain growth spurt causes deficits in adult neurogenesis in the hippocampal dentate gyrus (DG). Previous data from our laboratory demonstrated that 12 days of voluntary wheel running (WR) beginning on postnatal day (PD) 30 significantly increased the number of newly generated cells evident in the DG on PD42 in both alcohol-exposed (AE) and control rats, but 30 days later a sustained beneficial effect of WR was evident only in control rats. This study tested the hypothesis that housing rats in environmental complexity (EC) following WR would promote the survival of the newly generated cells stimulated by WR, particularly in AE rats. METHODS: On PD4 to 9, pups were intubated with alcohol in a binge-like manner (5.25 g/kg/d), sham-intubated (SI), or reared normally. In Experiment 1, animals were either assigned to WR during PD30 to 42 or socially housed (SH). On PD42, animals were injected with bromodeoxyuridine (BrdU; 200 mg/kg) and perfused 2 hours later to confirm the WR-induced stimulation of proliferation. In Experiment 2, all animals received WR on PD30 to 42 and were injected with BrdU on the last full day of WR. On PD42, animals were randomly assigned either to EC (WR/EC) or to SH (WR/SH) for 30 days and subsequently perfused and brains were processed for immunohistochemical staining to identify BrdU+-, Ki67+-, and BrdU+/NeuN+-labeled cells in DG. RESULTS: In Experiment 1, WR exposure significantly increased the number of proliferating cells in all 3 postnatal conditions. In Experiment 2, the AE rats given WR/SH had significantly fewer BrdU+ cells compared with control rats given WR/SH. However, WR/EC experience significantly increased the number of surviving BrdU+ cells in both the AE and SI groups compared with WR/SH rats of the same neonatal treatment. Approximately 80% of the surviving BrdU+ cells in the DG across the conditions were colabeled with NeuN. CONCLUSIONS: WR followed by EC could provide a behavioral model for developing interventions in humans to ameliorate hippocampal-dependent impairments associated with fetal alcohol spectrum disorders.
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Modelos Animais de Doenças , Meio Ambiente , Etanol/toxicidade , Hipocampo/fisiologia , Abrigo para Animais , Atividade Motora/fisiologia , Animais , Animais Recém-Nascidos , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Feminino , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Masculino , Atividade Motora/efeitos dos fármacos , Neurogênese/efeitos dos fármacos , Neurogênese/fisiologia , Neurônios/efeitos dos fármacos , Neurônios/patologia , Gravidez , Distribuição Aleatória , Ratos , Ratos Long-EvansRESUMO
The ß-amyloid peptide may play a central role in Alzheimer's disease (AD) pathogenesis. We have evaluated variants in seven Aß-degrading genes (ACE, ECE1, ECE2, IDE, MME, PLAU, and TF) for association with AD risk in the Genetic and Environmental Risk in Alzheimer's Disease Consortium 1 (GERAD1) cohort, and with three cognitive phenotypes in the Lothian Birth Cohort 1936 (LBC1936), using 128 and 121 SNPs, respectively. In GERAD1, we identified a significant association between a four-SNP intragenic ECE1 haplotype and risk of AD in individuals that carried at least one APOE ε4 allele (P = 0.00035, odds ratio = 1.61). In LBC1936, we identified a significant association between a different two-SNP ECE1 intragenic haplotype and non-verbal reasoning in individuals lacking the APOE ε4 allele (P = 0.00036, ß = -0.19). Both results showed a trend towards significance after permutation (0.05 < P < 0.10). A follow-up cognitive genetic study evaluated the association of ECE1 SNPs in three additional cohorts of non-demented older people. Meta-analysis of the four cohorts identified the significant association (Z < 0.05) of SNPs in the ECE-1b promoter with non-verbal reasoning scores, particularly in individuals lacking the APOE ε4 allele. Our genetic findings are not wholly consistent. Nonetheless, the AD associated intronic haplotype is linked to the 338A variant of known ECE1b promoter variant, 338C>A (rs213045). We observed significantly less expression from the 338A variant in two human neuroblastoma cell lines and speculate that this promoter may be subject to tissue-specific regulation.
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Envelhecimento/genética , Doença de Alzheimer/genética , Doença de Alzheimer/fisiopatologia , Ácido Aspártico Endopeptidases/genética , Cognição , Predisposição Genética para Doença , Metaloendopeptidases/genética , Polimorfismo de Nucleotídeo Único/genética , Idoso , Envelhecimento/patologia , Peptídeos beta-Amiloides/metabolismo , Estudos de Coortes , Enzimas Conversoras de Endotelina , Feminino , Humanos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fenótipo , Regiões Promotoras Genéticas/genética , Proteólise , Fatores de RiscoRESUMO
Objective: This report describes a pilot hospice inpatient unit dedicated to individuals experiencing distressing behaviors from dementia. Background: Patients with dementia who experience distressing symptoms cannot be well managed on typical inpatient units. Hospice of the Valley selected one unit to dedicate to dementia care. Methods: Data were analyzed from 237 patients admitted to the unit between May 2019 and April 2020. Behaviors were identified and rated for severity on admission, discharge, and postdischarge. Rates of inpatient death and associated behaviors were calculated. Results: Fifty percent of patients had their behaviors sufficiently managed to allow discharge. The most common behavior exhibited was agitation; the most common symptom leading to death was pain. Discussion: An inpatient hospice unit dedicated to patients with dementia can be successful. The hospice agency gains admissions that would otherwise be diverted to behavioral care settings. This successful pilot may be a model for other hospices.
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Demência , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Assistência ao Convalescente , Humanos , Pacientes Internados , Alta do PacienteRESUMO
Prenatal exposure to alcohol in humans can result in a wide range of deficits collectively referred to as fetal alcohol spectrum disorders. Of these deficits, cognitive impairments are among the most debilitating and long-lasting. Specifically, cognitive impairments in executive functioning suggest damage to the prefrontal cortex (PFC). Several external stimuli, such as morphine, chronic stress, and maternal stress have been found to alter the dendritic structure of cells within the PFC. In this study, three groups of rat pups were used: intubated with alcohol (5.25 g/kg/day; AE), sham intubated (SI), or suckle controls (SC) on PD 4-9. On PD 26-30 rats were anesthetized, perfused with saline and brains were processed for Golgi-Cox staining. Basilar dendritic complexity, spine density, and spine phenotypes were evaluated for Layer II/III neurons in the medial PFC. Results indicate that AE rats have an altered basilar dendritic complexity due to a significant decrease in both length and number of intersections in proximity to the neuronal soma. Furthermore, spine density patterns of basilar dendrites remain unchanged while the density of mature vs. immature spines significantly changes. These effects were not seen in the apical dendrites, indicating alcohol's influence on different neuronal parts in a single cell. In addition, these results suggest that the innervations of the soma and basilar dendrites by thalamic projections may play a role. Thus, our data demonstrates that postnatal exposure to alcohol produces changes in the neuronal organization of rat adolescent PFC that may affect the performance on prefrontal-dependant behavioral tasks.
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Depressores do Sistema Nervoso Central/intoxicação , Dendritos/efeitos dos fármacos , Espinhas Dendríticas/efeitos dos fármacos , Etanol/intoxicação , Córtex Pré-Frontal/efeitos dos fármacos , Células Piramidais/efeitos dos fármacos , Envelhecimento , Análise de Variância , Animais , Depressores do Sistema Nervoso Central/sangue , Etanol/sangue , Córtex Pré-Frontal/patologia , Células Piramidais/patologia , Distribuição Aleatória , Ratos , Ratos Long-EvansRESUMO
Neural stimulation modulates the depolarization of neurons, thereby triggering activity-associated mechanisms of neuronal plasticity. Activity-associated mechanisms in turn play a major role in post-mitotic structure and function of adult neurons. Our understanding of the interactions between neuronal behavior, patterns of neural activity, and the surrounding environment is evolving at a rapid pace. Brain derived neurotrophic factor is a critical mediator of activity-associated plasticity, while multiple immediate early genes mediate plasticity of neurons following bouts of neural activity. New research has uncovered genetic mechanisms that govern the expression of DNA following changes in neural activity patterns, including RNAPII pause-release and activity-associated double stranded breaks. Discovery of novel mechanisms governing activity-associated plasticity of neurons hints at a layered and complex molecular control of neuronal response to depolarization. Importantly, patterns of depolarization in neurons are shown to be important mediators of genetic expression patterns and molecular responses. More research is needed to fully uncover the molecular response of different types of neurons-to-activity patterns; however, known responses might be leveraged to facilitate recovery after neural damage. Physical rehabilitation through passive or active exercise modulates neurotrophic factor expression in the brain and spinal cord and can initiate cortical plasticity commensurate with functional recovery. Rehabilitation likely relies on activity-associated mechanisms; however, it may be limited in its application. Electrical and magnetic stimulation direct specific activity patterns not accessible through passive or active exercise and work synergistically to improve standing, walking, and forelimb use after injury. Here, we review emerging concepts in the molecular mechanisms of activity-derived plasticity in order to highlight opportunities that could add value to therapeutic protocols for promoting recovery of function after trauma, disease, or age-related functional decline.
RESUMO
OBJECTIVE: We examined the epistatic effect between haplotypes of glycogen synthase kinase-3beta (GSK3B) gene and microtubule-associated protein Tau (MAPT) gene in Alzheimer's disease (AD). METHODS: A genetic association study of three AD cohorts was made. Linear regression analyses were used to examine effects of MAPT polymorphisms on gene expression and alternative splicing. beta-Catenin levels and signaling were determined using Western blot and luciferase reporter assays in cells transfected with a combination of GSK3B and MAPT complementary DNA. RESULTS: Consistent interaction between GSK3B and MAPT genes in three late-onset AD cohorts was observed, with the GSK3B haplotype (T-T) significantly increasing the risk for AD in individuals with at least one H2 haplotype (odds ratio, 1.68-2.33; p = 0.005-0.036). The GSK3B haplotype was significantly protective in the Chinese cohort (odds ratio, 0.33; p = 0.016), after adjusting for the effect of age and sex. There are significant differences in in vivo transcriptional efficiency between the two MAPT haplotypes (H1 and H2) as determined by measurement of cerebellar transcripts (p < 0.001). Overexpression of either MAPT or GSK3B resulted in decreased beta-catenin levels compared with a control vector (p < 0.001). Conversely, cotransfection of both of these molecules increased beta-catenin signaling. INTERPRETATION: Our genetic and biochemical analyses have identified a novel interaction between Tau and GSK-3beta in late-onset AD causative factors. Our data are consistent with an epistatic model of interaction where discordant levels of GSK3B and MAPT gene expression can lead to altered beta-catenin levels and pathogenicity.
Assuntos
Doença de Alzheimer/genética , Predisposição Genética para Doença , Quinase 3 da Glicogênio Sintase/genética , Polimorfismo de Nucleotídeo Único , Proteínas tau/genética , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Estudos de Casos e Controles , Linhagem Celular Transformada , Cerebelo/metabolismo , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Frequência do Gene , Genótipo , Quinase 3 da Glicogênio Sintase/metabolismo , Glicogênio Sintase Quinase 3 beta , Humanos , Masculino , Transfecção , beta Catenina/metabolismoRESUMO
BACKGROUND: therapeutic use of cytokines can induce delirium, and delirium often occurs during infections associated with elevated levels of cytokines. This study examined the association of demographic, clinical and biological factors (IL-1alpha, IL-1beta, IL-1RA, IL-6, TNF-alpha, IFN-gamma, LIF, IGF-I, APOE genotype) with the presence and severity of delirium. METHODS: in an observational prospective longitudinal study, patients aged 70+ were recruited from an elderly medical unit and assessed every 3-4 days (maximum assessments 4). At each time, the scales MMSE, DRS, CAM, APACHEII were administered and blood was withdrawn to estimate the above biological factors. Mixed effects (PQL) and GEE were used to analyse the repeated measurements and investigate the associations at the individual and population average levels. RESULTS: a total of 205 observations on 67 individuals were analysed. Lower levels of IGF-I, and lower levels of circulating IL-1RA, are significantly (P < 0.05) associated with delirium, while the remaining of cytokines, severity of illness and possession of epsilon 4 allele had a non-significant effect. This has been shown by both statistical methods. Similarly lower levels of IGF-I, and high levels of IFN-gamma, are statistically significantly (P < 0.05) associated with higher DRS scores (more severe delirium). CONCLUSIONS: this study finds that (i) low levels of both neuroprotective factors (IGF-I, IL-1RA) are associated with delirium, (ii) high IFN-gamma and low IGF-I have significant effects on delirium severity and (iii) otherwise the pro-inflammatory cytokines studied, APOE genotype and severity of illness do not appear to be associated, in older medically ill patients, with either delirium or severity of it.
Assuntos
Citocinas/sangue , Delírio/sangue , Fator de Crescimento Insulin-Like I/análise , APACHE , Doença Aguda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4/genética , Biomarcadores/sangue , Cognição , Delírio/genética , Delírio/imunologia , Delírio/psicologia , Feminino , Humanos , Interferon gama/sangue , Proteína Antagonista do Receptor de Interleucina 1/sangue , Estudos Longitudinais , Masculino , Estudos ProspectivosRESUMO
There is evidence to suggest a role for immune dysfunction in the pathogenesis of Alzheimer's disease, and it has previously been shown that blood plasma levels of the protein complement factor H, a member of the alternative complement pathway, was specifically elevated in people with late-onset Alzheimer's disease. We have genotyped the common complement factor H Y402H polymorphism in a large case-control cohort to investigate association with late-onset Alzheimer's disease susceptibility and find no evidence that this SNP is associated with disease risk. However, it remains possible that another variant in this gene may modify susceptibility for late-onset Alzheimer's disease.
Assuntos
Idade de Início , Doença de Alzheimer/genética , Substituição de Aminoácidos , Fator H do Complemento/genética , Polimorfismo de Nucleotídeo Único , Idoso , Estudos de Coortes , DNA/sangue , DNA/genética , DNA/isolamento & purificação , Frequência do Gene , Predisposição Genética para Doença , Genótipo , HumanosRESUMO
The varepsilon4 allele of the APOE locus is the only confirmed risk factor for late-onset Alzheimer's disease (LOAD). The phosphate and tensin homolog (PTEN) gene is both a biological and positional candidate gene for LOAD. Eight polymorphisms spanning this gene were selected from dbSNP and genotyped in pooled DNA samples of both cases and controls. No evidence for association with LOAD was obtained in this study although further investigation revealed low levels of linkage disequlibrium (LD) between the genotyped SNPs. Our results suggest that it is unlikely that genetic variation within the PTEN gene contributes to risk of LOAD.
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Doença de Alzheimer/genética , Química Encefálica/genética , Marcadores Genéticos/genética , Predisposição Genética para Doença/genética , PTEN Fosfo-Hidrolase/genética , Polimorfismo Genético/genética , Idoso , Idoso de 80 Anos ou mais , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Análise Mutacional de DNA , Feminino , Frequência do Gene/genética , Testes Genéticos , Humanos , Desequilíbrio de Ligação/genética , Masculino , Mutação/genética , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
OBJECTIVE: To document outcomes of a randomized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations (MCOs). DESIGN: Patients, continuously enrolled between July 1999, and March 2001, were randomly assigned to the PhoenixCare program or a control group receiving usual MCO care. SETTING: Hospice of the Valley, Phoenix, Arizona. PARTICIPANTS: Participants were 192 patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy. INTERVENTION: Intensive home-based case management provided by registered nurse casemanagers, in coordination with patients' existing source of medical care, comprised the intervention. Program foci included disease and symptom management, patient self-management of illness and knowledge of illness-related resources, preparation for end-of life, physical and mental functioning, and utilization of medical services. OUTCOME MEASURES: Outcomes, assessed every 3 months by telephone interview, included measures related to all program foci; the SF-36 was used to evaluate physical and mental functioning; emergency department visits exemplified medical service utilization. RESULTS: Compared to controls, PhoenixCare patients exhibited significantly better outcomes on self-management of illness, awareness of illness-related resources, and legal preparation for end of life. They reported lower symptom distress, greater vitality, better physical functioning and higher self-rated health than randomized controls. Emergency department utilization was equivalent across groups. Patients with COPD showed stronger responsiveness to the intervention. CONCLUSION: A novel model of patient care that combined greatly enhanced palliative carefocused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.
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Administração de Caso/organização & administração , Hospitais para Doentes Terminais/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Cuidados Paliativos/organização & administração , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Análise de Variância , Arizona , Humanos , Programas de Assistência Gerenciada/organização & administraçãoRESUMO
In the last 10 years, the field of zoological medicine has seen an expansive broadening into the arenas of free-ranging wildlife, conservation medicine, and ecosystem health. During the spring/summer of 2005, we prepared and disseminated a survey designed to identify training and educational needs for individuals entering the wildlife medicine and ecosystem health fields. Our data revealed that few wildlife veterinarians believe that the training they received in veterinary school adequately prepared them to acquire and succeed in their field. Wildlife veterinarians and their employers ranked mentorship with an experienced wildlife veterinarian, training in leadership and communication, courses and externships in wildlife health, and additional formal training beyond the veterinary degree as important in preparation for success. Employers, wildlife veterinarians, and job seekers alike reported that understanding and maintaining ecosystem health is a key component of the wildlife veterinarian's job description, as it is critical to protecting animal health, including human health. Today's wildlife veterinarians are a new type of transdisciplinary professional; they practice medicine in their communities and hold titles in every level of government and academia. It is time that we integrate ecosystem health into our curricula to nurture and enhance an expansive way of looking at veterinary medicine and to ensure that veterinary graduates are prepared to excel in this new and complex world, in which the health of wildlife, domestic animals, and people are interdependent.
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Animais Selvagens , Competência Clínica , Educação em Veterinária/organização & administração , Educação em Veterinária/normas , Saúde Pública , Animais , Animais de Zoológico , Escolha da Profissão , Certificação , Conservação dos Recursos Naturais , Currículo , Coleta de Dados , Ecossistema , Educação Continuada , Educação em Veterinária/tendências , Humanos , Mentores , Inquéritos e Questionários , Medicina VeterináriaRESUMO
This study assessed the impact of a nursing assistant-led functional intervention in an urban hospice. Thirty-three patients participated. A physical therapist trained 4 nursing assistants to assess 4 basic functional activities at admission and discharge and to provide daily activity training to intervention group participants. Control group participants were assessed at admission and discharge and received the usual standard of care. Both groups improved. The intervention group participants demonstrated significant improvement in the Timed up and Go test as well as their self-reported ability to achieve goals on the Patient-Specific Functional Scale. Control group participants made significant improvements in the ability to move from supine to sit in bed. These findings suggest that nursing assistants can provide activity-based assessment and intervention leading to improved function among patients in hospice.
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Hospitais para Doentes Terminais/organização & administração , Assistentes de Enfermagem/organização & administração , Cuidados Paliativos/organização & administração , Modalidades de Fisioterapia/organização & administração , Melhoria de Qualidade/organização & administração , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pacientes Internados , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Assistentes de Enfermagem/educação , Projetos Piloto , Qualidade de VidaRESUMO
The hypothesis that polymorphisms in the gene for nicastrin (NCSTN) are associated with differences in cognitive level and ageing was tested in 462 relatively healthy surviving participants of the Scottish Mental Survey 1932. None had a history of dementia. They were tested on the Moray House Test of verbal reasoning at age 11 in 1932 and at age 79 between 1999 and 2001. At age 79 they also took tests of non-verbal reasoning, short- and long-term verbal declarative memory, Verbal Fluency, and a short screening test for dementia. Subjects who possessed at least one copy of the NCSTN B haplotype (Hap B) had higher scores on the Moray House Test (a test principally of verbal reasoning) at age 11 (p=0.036) and age 79 (p=0.027). The effect of Hap B on cognition at age 79 was non-significant after adjusting for the effect at age 11. Therefore, the effect of Hap B in this sample is on the life-long stable trait of cognitive ability, and not on age-related cognitive change. The possibility that this result might be a selection effect was not supported by the samples being in Hardy-Weinberg equilibrium with respect to the distribution of NCSTN genotypes.
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Envelhecimento/genética , Cognição/fisiologia , Glicoproteínas de Membrana/genética , Idoso , Secretases da Proteína Precursora do Amiloide , Criança , Genótipo , Humanos , Testes Neuropsicológicos , Polimorfismo GenéticoRESUMO
Alzheimer's disease (AD) is a disorder without a molecular marker in peripheral tissues or a disease modifying treatment. As increasing evidence has suggested a role for glycogen synthase kinase-3 (GSK-3) in the pathogenesis of the condition we measured total GSK-3 protein (alpha and beta isoforms) and GSK-3 activity (serine 9 phosphorylation) in a group of healthy elderly people, in AD and in mild cognitive impairment (MCI). Total GSK-3 protein was increased in both AD and in MCI without a compensatory decrease in activity. These data suggest that GSK-3 assays might be a useful diagnostic marker in a readily available tissue and moreover that GSK-3 activity is increased in the prodromal phase of the disorder suggesting that inhibition of GSK-3 might be a useful therapeutic strategy.
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Doença de Alzheimer/enzimologia , Biomarcadores/análise , Linfócitos/enzimologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/enzimologia , Eletroforese em Gel de Poliacrilamida , Quinase 3 da Glicogênio Sintase , Humanos , Imuno-HistoquímicaRESUMO
The gene encoding alpha-T-catenin, CTNNA3, is positioned within a region on chromosome 10, showing strong evidence of linkage to Alzheimer's disease (AD), and is therefore a good positional candidate gene for this disorder. We have demonstrated that alpha-T-catenin is expressed in human brain, and like other alpha-catenins, it inhibits Wnt signaling and is therefore also a functional candidate. We initially genotyped two single-nucleotide polymorphisms (SNPs) in the gene, in four independent samples comprising over 1200 cases and controls but failed to detect an association with either SNP. Similarly, we found no evidence for association between CTNNA3 and AD in a sample of subjects showing linkage to chromosome 10, nor were these SNPs associated with Abeta deposition in brain. To comprehensively screen the gene, we genotyped 30 additional SNPs in a subset of the cases and controls (n > 700). None of these SNPs was associated with disease. Although an excellent candidate, we conclude that CTNNA3 is unlikely to account for the AD susceptibility locus on chromosome 10.