RESUMEN
African Americans are more likely to die from tobacco-related diseases and less likely to quit smoking than their white counterparts. Evidence of greater prevalence of posttraumatic stress disorder (PTSD) among African Americans underscores the importance of studying the effects of traumatic event exposure on tobacco dependence treatment outcomes in this group. In this secondary analysis of data from a previously completed randomized control trial, we examined the effects of traumatic event exposure (e.g., serious accident) on tobacco dependence treatment outcomes, as well its moderating effects on the effectiveness of an adapted smoking cessation treatment, in a sample (n = 169) of African American smokers in New York City. Traumatic event exposure did not have a significant impact on tobacco treatment outcomes and did not moderate the relationship between treatment type and outcomes in this sample. While results may be driven by unique sample characteristics, they may also indicate that an average level of traumatic event exposure does not significantly impact tobacco treatment outcomes among African Americans. Future research should examine the effects of higher levels of traumatic event exposure on treatment outcomes, as well as investigating the factors underlying trauma-exposed individuals' difficulties with reducing/quitting smoking in a larger, more diverse African American sample.
Asunto(s)
Cese del Hábito de Fumar , Tabaquismo , Negro o Afroamericano , Humanos , Tabaquismo/terapia , Resultado del Tratamiento , Población BlancaRESUMEN
In the inpatient setting, antibiotics are generally administered via bedside pumps with multiple daily dosing. Utilisation of a continuous antibiotic infusion (CAI) instead might have patient and nursing satisfaction, workflow efficiencies and infection control benefits. We aimed to study the utilisation of CAI in the inpatient setting for routine antibiotic administration. Patients receiving a peripherally inserted central venous catheter (PICC) for antibiotic administration were screened for the study. The patients were randomised to either (1) standard pump and intermittent antibiotic administration (IAA) or (2) CAI via an ambulatory pump. An accelerometer placed on the ankle was used to assess patient activity. Nursing and patient satisfaction surveys were also carried out. Forty patients met the study criteria for enrolment with 21 patients being enrolled in the CAI arm of the study. One hundred and five days of accelerometer recordings were available for analysis. The geometric mean activity was 45 min/day in the standard arm and 64 min/day in the CAI arm. This represented a 42% (95% CI: -14 to 133%, p = 0.16) difference in activity between the two groups. Nursing staff reported that they spent less time throughout their shift attending the antibiotic line or pump in patients who were in the CAI arm of the study (p < 0.001). In addition, patients in this arm of the study were more likely to recommend this method of administration of antibiotics to a family member (p =0.0001). The MOBILISE study showed nursing and patient satisfaction when CAI were utilised in the inpatient setting. A statistically non-significant difference in mobility was seen. The trial was registered (28/03/2018) with the Australia New Zealand Clinical Trials Registry (ACTRN12618000452291).
Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Bombas de Infusión Implantables , Adulto , Anciano , Anciano de 80 o más Años , Sistemas de Liberación de Medicamentos/instrumentación , Sistemas de Liberación de Medicamentos/métodos , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
People who inject drugs (PWID) are susceptible to endovascular and deep-seated infections which require prolonged antibiotic therapy. There are concerns regarding this cohort's suitability for outpatient parenteral antimicrobial therapy (OPAT), but relatively little published data. Our aim is to publish our outcomes in this setting, to inform other clinicians' decisions regarding PWID in OPAT. We reviewed case records of all PWID in our OPAT service from July 2015 to December 2017. Successful completion of OPAT care was defined as completing the duration of parenteral therapy as planned at the outset, with expected clinical improvement. Data was collected on complications including hospital re-admission, new blood stream infections, patient non-compliance including ongoing non-prescribed intravenous drug use, and staff safety compromise. Twenty-eight of 38 (76.2%) episodes of OPAT care for PWID were completed successfully, with 724 bed days of care provided. The cohort was labour intensive to manage with high rates of re-admission, non-attendance and line-associated infections. There were no adverse events for staff safety, and no patient deaths on the programme. OPAT can be a viable option for PWID provided there is careful patient selection, good patient engagement and sufficient resources allocated for patient management.
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Atención Ambulatoria/estadística & datos numéricos , Antiinfecciosos/uso terapéutico , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Abuso de Sustancias por Vía Intravenosa/complicaciones , Resultado del Tratamiento , Adulto JovenAsunto(s)
Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Absceso Pulmonar/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Tazobactam/uso terapéutico , Antibacterianos/administración & dosificación , Cefalosporinas/administración & dosificación , Cefalosporinas/sangre , Humanos , Infusiones Parenterales , Absceso Pulmonar/microbiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pacientes Ambulatorios , Pseudomonas aeruginosa/efectos de los fármacos , Tazobactam/administración & dosificación , Tazobactam/sangre , Resistencia betalactámica/efectos de los fármacosRESUMEN
We have recently shown that waste heat from forced-air warming blankets can increase the temperature and concentration of airborne particles over the surgical site. The mechanism for the increased concentration of particles and their site of origin remained unclear. We therefore attempted to visualise the airflow in theatre over a simulated total knee replacement using neutral-buoyancy helium bubbles. Particles were created using a Rocket PS23 smoke machine positioned below the operating table, a potential area of contamination. The same theatre set-up, warming devices and controls were used as in our previous study. This demonstrated that waste heat from the poorly insulated forced-air warming blanket increased the air temperature on the surgical side of the drape by > 5°C. This created convection currents that rose against the downward unidirectional airflow, causing turbulence over the patient. The convection currents increased the particle concentration 1000-fold (2 174 000 particles/m(3) for forced-air warming vs 1000 particles/m(3) for radiant warming and 2000 particles/m(3) for the control) by drawing potentially contaminated particles from below the operating table into the surgical site. Cite this article: Bone Joint J 2013;95-B:407-10.
Asunto(s)
Aire , Artroplastia de Reemplazo de Rodilla , Calor/efectos adversos , Hipotermia/prevención & control , Cuidados Intraoperatorios/instrumentación , Complicaciones Intraoperatorias/prevención & control , Material Particulado , Calor/uso terapéutico , Humanos , Cuidados Intraoperatorios/métodos , Maniquíes , VentilaciónRESUMEN
Patient warming significantly decreases the risk of surgical site infection. Recently there have been concerns that forced air warming may interfere with unidirectional airflow, potentially posing an increased risk of infection. Our null hypothesis was that forced air and radiant warming devices do not increase the temperature and the number of particles over the surgical site when compared with no warming device. A forced air warming device was compared with a radiant warming device and no warming device as a control. The temperature and number of particles were measured over the surgical site. The theatre was prepared as for a routine lower-limb arthroplasty operation, and the same volunteer was used throughout the study. Forced air warming resulted in a significant mean increase in the temperature (1.1°C vs 0.4°C, p < 0.0001) and number of particles (1038.2 vs 274.8, p = 0.0087) over the surgical site when compared with radiant warming, which raises concern as bacteria are known to require particles for transport.
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Movimientos del Aire , Artroplastia de Reemplazo/métodos , Calefacción/métodos , Cuidados Intraoperatorios/métodos , Infecciones Relacionadas con Prótesis/etiología , Microbiología del Aire , Calefacción/efectos adversos , Calefacción/instrumentación , Humanos , Cuidados Intraoperatorios/efectos adversos , Prótesis Articulares/efectos adversos , Quirófanos , Material Particulado/análisis , Infecciones Relacionadas con Prótesis/prevención & control , TemperaturaAsunto(s)
Traumatismos del Tobillo/cirugía , Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Adulto , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/fisiopatología , Fijación de Fractura/tendencias , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Radiografía , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
Ankyloglossia (or tongue-tie) is a relatively uncommon congenital anomaly defined by an abnormally short lingual frenulum. Associations between tongue-tie and breastfeeding problems in infants have been inconsistent, and are a longstanding source of controversy in the medical community. Definitions of ankyloglossia vary, and management suggestions are not based on randomized controlled trials. Surgical correction involves cutting the lingual frenulum (frenotomy). Based on current available evidence, frenotomy cannot be recommended. If, however, the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary, frenotomy should be performed by a clinician experienced with the procedure and with appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await appropriately designed trials.
RESUMEN
A long-standing concept in vision science has held that a single photoreceptor expresses a single type of opsin, the protein component of visual pigment. However, the number of examples in the literature of photoreceptors from vertebrates and invertebrates that break this rule is increasing. Here, we describe a newly discovered Limulus opsin, Limulus opsin5, which is significantly different from previously characterized Limulus opsins, opsins1 and 2. We show that opsin5 is co-expressed with opsins1 and 2 in Limulus lateral and ventral eye photoreceptors and provide the first evidence that the expression of co-expressed opsins can be differentially regulated. We show that the relative levels of opsin5 and opsin1 and 2 in the rhabdom change with a diurnal rhythm and that their relative levels are also influenced by the animal's central circadian clock. An analysis of the sequence of opsin5 suggests it is sensitive to visible light (400-700 nm) but that its spectral properties may be different from that of opsins1 and 2. Changes in the relative levels of these opsins may underlie some of the dramatic day-night changes in Limulus photoreceptor function and may produce a diurnal change in their spectral sensitivity.
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Relojes Biológicos/efectos de la radiación , Ritmo Circadiano/efectos de la radiación , Cangrejos Herradura/metabolismo , Cangrejos Herradura/efectos de la radiación , Luz , Opsinas/metabolismo , Células Fotorreceptoras de Invertebrados/metabolismo , Secuencia de Aminoácidos , Animales , Anticuerpos , Relojes Biológicos/genética , Membrana Celular/metabolismo , Membrana Celular/efectos de la radiación , Ritmo Circadiano/genética , Etidio/metabolismo , Fluorescencia , Secciones por Congelación , Regulación de la Expresión Génica/efectos de la radiación , Cangrejos Herradura/genética , Mediciones Luminiscentes , Datos de Secuencia Molecular , Opsinas/química , Opsinas/genética , Opsinas/inmunología , Células Fotorreceptoras de Invertebrados/citología , Células Fotorreceptoras de Invertebrados/efectos de la radiación , Filogenia , Transporte de ARN/efectos de la radiación , ARN Mensajero/genética , ARN Mensajero/metabolismo , Alineación de Secuencia , Homología de Secuencia de Aminoácido , Transducción de Señal/efectos de la radiaciónRESUMEN
OBJECTIVES: To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure. DESIGN: A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the Abridged Index Medicus in 1995 and 2005. Each journal was reviewed by the principal author and one of four independent reviewers. RESULTS: During the period, the proportion of journals requiring IRB approval increased from 42% (95% CI 32.2% to 51.2%, p<0.001) to 76% (95% CI 66.4% to 83.1%, p<0.001). In 2005, an additional 9% referred to the Declaration of Helsinki or the International Committee of Medical Journal Editors' Uniform requirements for ethical guidelines; 15% (95% CI 8.5% to 22.5%, p<0.01) provided ambiguous or no requirements. The proportion of journals requiring COI disclosure increased from 75% (95% CI 66.6% to 83.3%, p<0.05) to 94% (95% CI 89.4% to 98.6%, p<0.05); 41% had comprehensive requirements, while some addressed only funding source (6%), were vague (10%) or both (14%). Criteria for authorship rose from 40% (95% CI 30.5% to 49.5%, p<0.05) to 72% (95% CI 63.3% to 80.7%, p<0.05). Journals with higher impact factors were more likely to require IRB approval (p<0.01). Journals in anaesthesia and radiology all required IRB approval; requirements in other disciplines varied. CONCLUSIONS: Instructions to authors regarding ethical standards have improved. Some remain incomplete, especially regarding the scope of disclosure of COI. The ethical guidelines presented to authors need further clarification and standardisation.
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Investigación Biomédica/ética , Conflicto de Intereses , Políticas Editoriales , Revelación/ética , Revisión Ética , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
Addition of cholera toxin (100 ng/ml) to quiescent cultures of Swiss 3T3 cells acts synergistically with serum (2-4%), insulin, phorbol esters, epidermal growth factor, and fibroblast-derived growth factor to stimulate DNA synthesis. In the presence of insulin, cholera toxin caused a dose-dependent increase in cumulative [3H]thymidine incorporation into acid-insoluble material and in the intracellular cyclic AMP (cAMP) level. The dose--response curves for the two processes were similar. Furthermore, addition of 1-methyl-3-isobutylxanthine (15--500 microM) or of 4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone (5--100 microM), both of which are potent inhibitors of cyclic nucleotide phosphodiesterase which are potent inhibitors of cyclic nucleotide phosphodiesterase activity, stimulated DNA synthesis and increased cAMP levels in Swiss 3T3 cells. These compounds strikingly potentiated the effect of cholera toxin on DNA synthesis and on cAMP levels. When quiescent Swiss 3T3 cells were exposed to cholera toxin (100 ng/ml) and insulin at 10 micrograms/ml (4- to 7-fold increase in cAMP level) or to these agents and 1-methyl-3-isobutyl xanthine at 50 microM (35-fold increase in cAMP level), DNA synthesis began after a lag of 16 hr. These results indicate that cAMP acts as a mitogenic signal for Swiss 3T3 cells and differ from the widely held view that cyclic AMP inhibits the proliferation of fibroblast cells.
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Toxina del Cólera/farmacología , AMP Cíclico/fisiología , Mitosis/efectos de los fármacos , 3',5'-AMP Cíclico Fosfodiesterasas/antagonistas & inhibidores , Animales , Línea Celular , Medios de Cultivo , ADN/biosíntesis , Relación Dosis-Respuesta a Droga , Sustancias de Crecimiento/sangre , Insulina/farmacología , RatonesRESUMEN
Melittin, an amphipatic polypeptide, increases several fold the activity of Na-K pump in quiescent Swiss 3T3 cells. As with other growth factors, melittin increases the activity of the pump by increasing Na entry into the cell. In contrast, other early responses are not elicited by the toxin. At concentrations that promote ion fluxes, melittin stimulates DNA synthesis in quiescent mouse cells acting synergistically with insulin, epidermal growth factor and with the growth factor released by SV40 BHK cells. In contrast, melittin does not interact synergistically with either phorbol esters of vasopressin. The cellular effects of melittin are consistent with the proposal that ion fluxes signal the initiation of mitogenesis in quiescent cells.
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Venenos de Abeja/farmacología , ADN/biosíntesis , Meliteno/farmacología , ATPasa Intercambiadora de Sodio-Potasio/metabolismo , Sodio/metabolismo , Aminobutiratos/metabolismo , Animales , Células Cultivadas , Desoxiglucosa/metabolismo , Sinergismo Farmacológico , Sustancias de Crecimiento/farmacología , Insulina/farmacología , Ratones , Monensina/farmacología , Uridina/metabolismoAsunto(s)
Colchicina/farmacología , Replicación del ADN/efectos de los fármacos , ADN/biosíntesis , Factor de Crecimiento Epidérmico/farmacología , Péptidos/farmacología , Animales , Células Cultivadas , Factores de Crecimiento de Fibroblastos , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Insulina/farmacología , Cinética , RatonesRESUMEN
Colchicine and other antitubulin agents markedly enhanced the stimulation of DNA synthesis by combinations of various growth factors such as epidermal growth factor, insulin, fibroblast-derived growth factor, and vasopressin in serum-free cultures of several quiescent 3T3 mouse fibroblast cell lines. Enhancing effects were observed based on continuous incorporation of [3H]thymidine into DNA as well as by autoradiographic labeling of cell nuclei. The concentration of colchicine and podophyllotoxin required to produce half-maximal enhancement of DNA synthesis stimulated by epidermal growth factor and insulin was 25-50 nM. Lumicolchicine did not produce enhancing effects. The disassembly of microtubules resulting from the action of colchicine, Colcemid, and vinblastine did not inhibit the stimulation of DNA synthesis in quiescent Swiss 3T3 fibroblasts by fetal bovine serum. We conclude that the cytoplasmic microtubule network in 3T3 mouse fibroblasts does not exert a positive regulatory function in the initiation of DNA synthesis but rather can produce a constraint on the initial action of the peptide growth factors in serum-free media.
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ADN/biosíntesis , Sustancias de Crecimiento/farmacología , Microtúbulos/fisiología , Animales , Línea Celular , Colchicina/farmacología , Demecolcina/farmacología , Sinergismo Farmacológico , Factor de Crecimiento Epidérmico/farmacología , Insulina/farmacología , Ratones , Podofilotoxina/farmacología , Moduladores de Tubulina , Vinblastina/farmacologíaRESUMEN
Vasopressin is shown to be a potent mitogen for Swiss 3T3 cells. The hormone (1--10 ng/ml) causes a striking shift of the dose--response curve for the effect of serum on thymidine incorporation by cultures of 3T3 cells arrested in the G1/G0 phase of the cell cycle. In the absence of added serum, the effect of vasopressin on DNA synthesis is greatly potentiated by insulin, epidermal growth factor, and a factor isolated from medium conditioned by simian virus 40-infected baby hamster kidney cells. The mitogenic effect of vasopressin is dependent on time and hormone concentration. In the presence of insulin, the half-maximal effect elicited by the peptide is obtained at 0.6 ng/ml. [Arg]Vasopressin and [Lys]vasopressin are equally potent. The vasopressins are 10(3)-fold more potent than oxytocin. In the presence of a low (2.5%) concentration of serum, vasopressins stimulate cell proliferation.
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División Celular/efectos de los fármacos , Vasopresinas/farmacología , Animales , Línea Celular , ADN/biosíntesis , Relación Dosis-Respuesta a Droga , Factor de Crecimiento Epidérmico/farmacología , Insulina/farmacología , Cinética , Ratones , Timidina/metabolismoRESUMEN
Addition of serum to quiescent cultures of 3T3 cells rapidly increases lactic acid formation and subsequently stimulates cell division. The stimulation of lactic acid production is seen at high, saturating concentrations of extra-cellular glucose. It is dependent on the time of exposure and on the dose of serum and is not blocked by the addition of cycloheximide, puromycin, or actinomycin D. In contrast, serum only marginally affects glycolysis by rapidly growing 3T6 or SV40-3T3 cells. In addition to serum, epidermal growth factor (0.1 to 10 ng/ml) and insulin (10 to 500 ng/ml) cause a striking stimulation of glycolysis in quiescent 3T3 cells. Neither exogenous cyclic nucleotides nor ouabain effect the glycolytic response, but the presence of Ca2+ markedly influences the activation of glycolysis by epidermal growth factor and by insulin. A novel finding in this study is that homogenates prepared from quiescent cells treated with serum, epidermal growth factor, or insulin show increased glycolysis as compared with homogenates from nonstimulated cultures. This finding will allow further experimental analysis of the cause of increased glycolysis in rapidly proliferating cells.