RESUMO
This case study describes how an innovative, triple-win, academic-practice partnership model can be used to deepen the clinical expertise of advanced practice registered nurse (APRN) students and improve rural Americans' access to quality patient care. It features the experience and strategies used by a school of nursing and a local rural hospital system collaborating to provide clinical experiences for APRN students pursuing doctor of nursing practice degrees.
Assuntos
Prática Avançada de Enfermagem/educação , Bacharelado em Enfermagem/organização & administração , Relações Interinstitucionais , Área Carente de Assistência Médica , População Rural/estatística & dados numéricos , Comportamento Cooperativo , Humanos , Maryland , Avaliação das Necessidades , Pesquisa em Educação em Enfermagem , Estudantes de Enfermagem/estatística & dados numéricosRESUMO
This study analyzed a large national survey, the 2016 version of American National Election Study (ANES), to identify the predictors of attitudes toward the equal rights of lesbians, gay men, and transgender individuals. Egalitarian attitudes are associated with being female, younger, more liberal, less Republican, having a higher income and a lower level of fundamentalist religiosity, as well as consuming a wider variety of news media. Liberals tend to consume a larger number of news sources than conservatives. Also, news media diet mediates, instead of moderates, the effects of political ideology on support for the LGT community. Overall, a healthy diet of news media is associated with support for equality rights.
Assuntos
Atitude , Homossexualidade Feminina , Dieta , Feminino , Humanos , Masculino , Meios de Comunicação de Massa , PolíticaRESUMO
We evaluated the efficacy of FISH to detect chromosome anomalies in the evaluation of young (<60 years) patients with AML. Patients were enrolled in E1900, an ECOG clinical trial for AML. The protocol was designed to collect bone marrow or blood for both cytogenetic and FISH studies at study entry (diagnosis). FISH for each patient was performed and utilized eight probe sets to detect t(8;21), t(9;22), t(11;var), t(15;17), inv(16), +8, -5/5q, and -7/7q. We analyzed 237 specimens with complete cytogenetic and FISH results. Results for each specimen were classified by probe set into one of six categories. The concordance rate between cytogenetic and FISH results ranged from 98 to 100% for all probe sets and kappa analysis for concordance had a p-value of <0.0001. The high level of agreement between cytogenetic and FISH results demonstrate the accuracy of a panel of eight FISH probe sets for the detection of significant abnormalities in AML. Data from this investigation support the use of FISH as an adjunct method to increase the yield of useful cytogenetic results in large cooperative trials and demonstrate the potential of FISH as a follow-up study of minimal residual disease in ECOG trials.
Assuntos
Aberrações Cromossômicas , Cromossomos Humanos , Hibridização in Situ Fluorescente/estatística & dados numéricos , Interfase , Leucemia Mieloide/genética , Doença Aguda , Antineoplásicos/uso terapêutico , Medula Óssea/patologia , Bandeamento Cromossômico , Sondas de DNA , DNA de Neoplasias/genética , Humanos , Cariotipagem , Leucemia Mieloide/patologia , Leucemia Mieloide/terapia , Pessoa de Meia-Idade , PrognósticoRESUMO
The presence of a monosomal karyotype (MK+) and/or a complex karyotype (CK+) identifies subcategories of AML with poor prognosis. The prognostic significance of the most common monosomies (monosomy 5, monosomy 7, and monosomy 17) within MK+/CK+AML is not well defined. We analyzed data from 1,592 AML patients age 17-93 years enrolled on ECOG-ACRIN therapeutic trials. The majority of MK+ patients (182/195; 93%) were MK+/CK+ with 87% (158/182) having ≥5 clonal abnormalities (CK≥5). MK+ patients with karyotype complexity ≤4 had a median overall survival (OS) of 0.4y compared to 1.0y for MK- with complexity ≤4 (p<0.001), whereas no OS difference was seen in MK+vs. MK- patients with CK≥5 (p=0.82). Monosomy 5 (93%; 50/54) typically occurred within a highly complex karyotype and had no impact on OS (0.4y; p=0.95). Monosomy 7 demonstrated no impact on OS in patients with CK≥5 (p=0.39) or CK≤4 (p=0.44). Monosomy 17 appeared in 43% (68/158) of CK≥5 patients and demonstrated statistically significant worse OS (0.4y) compared to CK≥5 patients without monosomy 17 (0.5y; p=0.012). Our data suggest that the prognostic impact of MK+is limited to those with less complex karyotypes and that monosomy 17 may independently predict for worse survival in patients with AML.
Assuntos
Cromossomos Humanos Par 17/genética , Leucemia Mieloide Aguda/genética , Monossomia/genética , Prognóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Deleção Cromossômica , Cromossomos Humanos Par 5 , Cromossomos Humanos Par 7 , Humanos , Cariotipagem , Leucemia Mieloide Aguda/mortalidade , Pessoa de Meia-Idade , Taxa de Sobrevida , Adulto JovemRESUMO
Public opinion about gay men and lesbians is a popular topic in both the popular press and academic journals. However, analyses of attitudinal trends are rare. Tracing changes in opinion polls on homosexuals in the United States between 1977 and 2003, the first part of the present study showed that public opinion of this minority group has become more positive over time. Part two of this research utilized a recent national survey to identify factors predicting anti-gay attitudes. The best predictors included respondents' sex, stance of anti-abortion and anti-women's equality, and religiosity. Implications for gay rights advocates were discussed.
Assuntos
Atitude , Homossexualidade Feminina , Homossexualidade Masculina , Direitos Civis , Feminino , Humanos , Masculino , Grupos Minoritários , Filosofia , Preconceito , Opinião Pública , Inquéritos e QuestionáriosRESUMO
Cytogenetic analysis can be important in determining the prognosis and diagnosis of a number of hematological disorders, including myelodysplastic syndromes (MDS). Here, we compared metaphase chromosomal analyses on bone marrow aspirates from MDS patients with interphase fluorescence in situ hybridization (FISH) using probes specific for chromosomes nos. 5, 7, 8, 11, 13 and 20. Forty-three patients enrolled in ECOG protocol E1996 for low risk MDS and five patients enrolled in ECOG protocol E3996 for high risk MDS were studied by both metaphase chromosomal analysis and interphase FISH. Excluding those with a clonal loss of the Y chromosome, an abnormal clone was detected by cytogenetic analysis in 18 of 48 samples (37.5%). In comparison, our FISH panel detected an abnormal clone in 17 of 48 samples (35.4%). Twenty-nine of 30 samples with apparently normal karyotypes, including those with a missing Y chromosome, were also normal by our FISH panel. One patient had an occult deletion of chromosome 11 that was detected by FISH. These results indicate that around 60% of patients with MDS do not have abnormalities that are detectable by either chromosomal or FISH studies. In addition, it appears that interphase FISH studies are nearly as sensitive as cytogenetic analyses and can be a useful tool in studying bone marrow aspirates where cytogenetic analysis is not possible.
Assuntos
Cromossomos Humanos , Interfase/genética , Metáfase/genética , Síndromes Mielodisplásicas/genética , Antineoplásicos/uso terapêutico , Medula Óssea/patologia , Aberrações Cromossômicas , Bandeamento Cromossômico , Ensaios Clínicos como Assunto , Sondas de DNA , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Síndromes Mielodisplásicas/patologiaRESUMO
Using a survey of more than 5,000 American consumers, this study examines connections between attitudes toward same-sex marriage and media consumption. A positive attitude is predicted by being liberal and less religious, supporting gender and racial equality, willing to try anything once, considering television the primary form of entertainment, watching political talk shows, and reading blogs. The theoretical and methodological contributions and real-world implications of these findings are discussed.
Assuntos
Atitude , Homossexualidade/psicologia , Casamento/psicologia , Meios de Comunicação de Massa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Humanos , Masculino , Casamento/legislação & jurisprudência , Pessoa de Meia-Idade , Política , Religião , Justiça Social/psicologia , Estados Unidos , Adulto JovemRESUMO
CI-1031 (ZK-807834) is a novel, synthetic factor Xa (FXa) inhibitor with a Ki of 0.11 nM against human FXa. In human plasma in vitro, CI-1031 doubled PT and aPTT at 0.23 and 0.49 microM, respectively. The in vivo antithrombotic effect of CI-1031 was evaluated in a veno-venous shunt model of thrombosis in anesthetized rabbits. After thrombus formation was verified in the first shunts, rabbits received either vehicle or CI-1031 intravenously (bolus injection of 60, 240, or 480 microg/kg followed by an infusion of 2, 8, or 16 microg/kg/min for 140 min, respectively). The second shunts were inserted after 20 min of infusion of CI-1031 or vehicle. CI-1031 dose-dependently prolonged time to occlusion (TTO) in the second shunts (35 +/- 21, 62 +/- 24, and 120 +/- 0 min for the three dose groups, respectively, vs. 10 +/- 1 min for vehicle). Thrombus mass (TM) was reduced in a dose-dependent manner by CI-1031 (42 +/- 7, 27 +/- 6, and 18 +/- 4 mg vs. 50 +/- 4 mg for vehicle). Maximal TM reduction was 70% with an IC(50) of 0.6 microg/ml. Among all the coagulation parameters tested, PT had the best correlation with plasma CI- 1031 concentration (r = 0.97). Ex vivo plasma anti-FXa activity was also well correlated with plasma concentration of CI-1031 and with PT (r = 0.96 and 0.98, respectively). These results indicate that CI-1031, which is currently undergoing clinical evaluation, is an effective antithrombotic compound with a favorable efficacy-to-bleeding ratio. In addition, CI-1031 concentration in plasma can be monitored using PT or anti-Xa assays, thereby providing reliable methods to ensure safe and accurate dose titration of CI-1031.
Assuntos
Amidinas/farmacologia , Anticoagulantes/farmacologia , Piridinas/farmacologia , Trombose Venosa/tratamento farmacológico , Amidinas/sangue , Amidinas/uso terapêutico , Animais , Anticoagulantes/sangue , Anticoagulantes/uso terapêutico , Biomarcadores , Coagulação Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Inibidores do Fator Xa , Humanos , Tempo de Tromboplastina Parcial , Agregação Plaquetária/efeitos dos fármacos , Tempo de Protrombina , Piridinas/sangue , Piridinas/uso terapêutico , CoelhosRESUMO
PD-198961, 3-(4-5-[(2R,6S)-2,6-dimethyltetrahydro-1(2H)-pyridinyl]pentyl-3-oxo-3,4-dihydro-2-quinoxalinyl)-4-hydroxybenzenecarboximidamide, is a novel, synthetic factor Xa inhibitor with a Ki of 2.7 nM against human factor Xa. The aim of the present study was to evaluate the pharmacokinetic profile and antithrombotic efficacy of PD-198961 in rabbits. When tested in vitro, PD-198961 doubled prothrombin time (PT) and activated partial thromboplastin time (aPTT) at concentrations of 0.13 and 0.32 microM in human plasma, 0.2 and 0.09 microM in rabbit plasma, 0.3 and 0.4 microM in dog plasma, respectively. Intravenous administration of PD-198961 at 1 mg/kg over 30 minutes resulted in a maximal prolongation in PT and aPTT of 4.9 +/- 0.4 and 4.1 +/- 0.9-fold of baseline, respectively. The peak plasma concentration of PD-198961 was 977 +/- 96 ng/ml. The anticoagulant effect of PD-198961 was readily reversible; coagulation parameters and plasma concentration returned to near baseline 15 minutes after cessation of infusion. There was a good correlation between PT prolongation and plasma concentration of PD-198961 (r = 0.93). In an FeCl3-induced model of arterial thrombosis in rabbits, the antithrombotic effects of PD-198961 were compared with that of LB-30057, a direct thrombin inhibitor, and enoxaparin, a low molecular weight heparin (LMWH). PD-198961 dose dependently increased the time to occlusion (TTO), reduced thrombus weight (TW), and decreased the incidence of occlusion. When administered at 3.0 microg/kg/min IV, PD-198961 prolonged TTO from 28 +/- 5 minutes (control) to 120 +/- 0 minutes (P < 0.001) and reduced TW from 9.9 +/- 1.5 mg (control) to 2.8 +/- 0.9 mg (P < 0.01). PD-198961 also dose dependently inhibited ex vivo plasma FXa activity. At the highest dose tested, PD-198961 increased aPTT to 1.4 +/- 0.1-fold of baseline (compared with 1.5 +/- 0.1 and 2.8 +/- 0.3-fold of baseline for LB-30057 [CI-1028] and enoxaparin, respectively), and had modest effects on bleeding time (< or = 2-fold). These results indicate that PD-198961 is a potent FXa inhibitor and an effective antithrombotic agent at doses that produce only modest changes in normal hemostasis.