286 results on '"Lien K"'
Search Results
102. Operator Support Systems for New Kinds of Process Operation Work
- Author
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Lindheim, C. and Lien, K. M.
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- 1997
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103. Complex distillation arrangements: extending the Petlyuk ideas
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Christiansen, A. C., Skogestad, S., and Lien, K.
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- 1997
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104. Simultaneous Determination of 18 Polycyclic Aromatic Hydrocarbons in Daily Foods (Hanoi Metropolitan Area) by Gas Chromatography–Tandem Mass Spectrometry
- Author
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Thanh-Thien Tran-Lam, Yen Hai Dao, Lien Kim Thi Nguyen, Hoi Kim Ma, Hai Nguyen Tran, and Giang Truong Le
- Subjects
polycyclic aromatic hydrocarbons (PAHs) ,benzo(a)pyrene ,QuEChERS ,gas chromatography–tandem mass spectrometry (GC–MS/MS) ,daily foods ,food processing ,Chemical technology ,TP1-1185 - Abstract
Polycyclic aromatic hydrocarbons (PAHs)—a large group of organic compounds—are extremely hazardous to human health. In this study, the 198 samples from six groups of daily food products in the Hanoi metropolitan area were collected and prepared by the QuEChERS sample treatment technique. The detection and identification of PAHs were obtained by gas chromatography⁻tandem mass spectrometry (GC⁻MS/MS) determination. The results demonstrated that the recovery of PAH compounds ranged approximately between 71% and 110% when the solvent evaporation condition was optimized using the nitrogen gas at a low temperature (1 °C). The in-house method was validated in terms of linearity, extractive condition, repeatability, recovery, limit of detection (LOD), and limit of quantification (LOQ). The ranges of average PAH levels were 9.3⁻9.6 µg/kg (for instant noodles), 0.22⁻2.48 µg/kg (for cakes) 0.91⁻4.83 µg/kg (dried vegetables), 5.14⁻23.32 µg/kg (teas), 4.82⁻24.35 µg/kg (coffees), and 1.43⁻25.2 µg/kg (grilled meats). The results indicated that the total concentrations of residual PAHs and benzo(a)pyrene in the instant noodles and grilled meat samples surpassed the maximum limits tolerated by the European Commission (35 µg/kg and 5 µg/kg, respectively) in many investigated samples.
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- 2018
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105. Implications of river chemistry variations on an orogenic, subtropical island - A preliminary study
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Lin, G. -W, HONGEY CHEN, Lin, S., and Lien, K. -L
106. Microfluidic systems integrated with pumping/mixing and separation devices for virus detection
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Lien, K. -Y, Liu, C. -Y, Lin, J. -L, Tseng, H. -Y, Wan-Chi Lee, Lei, H. -Y, and Lee, G. -B
107. Predicting catastrophic BGP routing instabilities
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Xie, Geoffrey, Fulp, J. D., Naval Postgraduate School (U.S.)., Department of Computer Science, Nguyen, Lien K., Xie, Geoffrey, Fulp, J. D., Naval Postgraduate School (U.S.)., Department of Computer Science, and Nguyen, Lien K.
- Abstract
Inter-domain routing connects individual pieces of Internet topology, creating an integral, global data delivery infrastructure. Currently, this critical function is performed by the Border Gateway Protocol (BGP) version 4 [RFC1771]. Like all routing protocols, BGP is vulnerable to instabilities that reduce its effectiveness. Among the causes of these instabilities are those which are maliciously induced. Although there are other causes, e.g., natural events and network anomalies, this thesis will focus exclusively on maliciously induced instabilities. Most current models that attempt to predict a BGP routing instability confine their focus to either macro- or micro-level metrics, but not to both. The inherent limitations of each of these forms of metric gives rise to an excessive rate of spurious alerts, both false positives and false negatives. It is the original intent of this thesis to develop an improved BGP instability prediction model by statistically combining BGP instability metrics with user level performance metrics. The motivation for such a model is twofold. 1) To provide sufficient prior warning of impending failure to facilitate proactive protection measures. 2) To improve warning reliability beyond existing models, by demonstrably reducing both false positives and false negatives. However, our analysis of actual network trace data shows that a widely used BGP instability metric, the total number of update messages received in a time period, is not a good indicator of future user level performance., http://archive.org/details/predictingcatast109451642, Civilian, Department of Defense, Approved for public release; distribution is unlimited.
108. Hypomagnesaemic hypocalcaemia in renal failure.
- Author
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Lien, K W, primary
- Published
- 1978
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109. Multiview-Based Cooperative Tracking of Multiple Human Objects
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Lien Kuo-Chin and Huang Chung-Lin
- Subjects
Electronics ,TK7800-8360 - Abstract
Abstract Human tracking is a popular research topic in computer vision. However, occlusion problem often complicates the tracking process. This paper presents the so-called multiview-based cooperative tracking of multiple human objects based on the homographic relation between different views. This cooperative tracking applies two hidden Markov processes (tracking and occlusion processes) for each target in each view. The tracking process locates the moving target in each view, whereas the occlusion process represents the possible visibility of the specific target in that designated view. Based on the occlusion process, the cooperative tracking process may reallocate tracking resources for different trackers in different views. Experimental results show the efficiency of the proposed method.
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- 2008
110. Rebuttal to Comments on Equipartition of Forces: A New Principle for Process Design and Optimization
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Sauar, E., Kjelstrup, S., and Lien, K. M.
- Published
- 1997
111. Conceptual Association of Process Design and Process Control
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Pohjola, V.J., Alha, M.K., and Lien, K.
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- 1994
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112. Characterization of ORNL transuranic waste from the measurement of fission and activation products
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Nguyen, Lien K.
- Abstract
A number of regulatory-based drivers have imposed more rigorous methods to be employed in the characterization of radioactive waste. For Transuranic (TRU) waste, the Waste Isolation Pilot Plant (WIPP) requires, at a minimum, that the waste generator a) provide methods for sampling and analyzing waste streams to establish an acceptable-knowledge baseline, b) develop a recurring sampling plan that will assure that the data quality objectives can be met, and c) calibrate and use nondestructive assay instruments for certifying the waste, by bulk measurement, to the WIPP Waste Acceptance Criteria (WAC). Currently, the entire remote handled transuranic (RH-TRU) waste inventory for ORNL is being generated at the Radiochemical Engineering Development Center (REDC). In an effort to meet the WIPP WAC, Oak Ridge National Laboratory (ORNL) initiated a project in FY 1996 to develop a suitable characterization method for classifying the hot cell solid wastes being generated at REDC. Based on the waste characteristics, REDC wastes can be certified to meet the waste acceptance criteria specified by a designated permanent waste disposal location. Combinations of acceptable process knowledge, radiochemical analyses, and nondestructive assays (NDA) were used to establish baseline RH-TRU waste characteristics for REDC hot cell wastes. A pilot study was initiated to collect random smear samples of the REDC "process waste" items to be analyzed by conventional radiochemistry methods. The Gamma Assay Segmented Passive (GASP) system was used to measure gamma activity in several typical 3-gallon melted polyethylene buckets collected at this facility. Nonparametric and parametric statistical methods were used to estimate the mean alpha to gamma activity ratios for a typical 3-gallon waste bucket assembled at REDC. The radiochemical results were used in conjunction with NDA data to effectively estimate the TRU and the lower bound (at the 95% confidence interval) activities of isotopes that cannot be easily measured by conventional passive/active neutron interrogation techniques. Additional statistical techniques were used to combine the TRU activities estimated from each of the "easy-to-measure" gamma-emitting radionuclides into a single TRU activity estimate for each waste bucket. The methods evaluated for this study provide a best estimate for the activities of alpha-emitting radionuclide wastes contained in a typical REDC waste bucket. Completion of this project should result in the development of an improved waste reporting method to assist REDC in meeting the waste acceptance criteria at WIPP or at an alternate disposal site.
- Published
- 1997
113. Design of hybrid distillation and vapor permeation processes
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Pettersen, T. and Lien, K. M.
- Published
- 1995
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114. Rule Based Synthesis of Separation Systems by Predictive Best First Search with Rules Represented as Trapezoidal Numbers
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Qian, Y. and Lien, K. M.
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- 1995
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115. Dynamic model of a system with phase- and reaction equilibrium
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Moe, H. I., Hauan, S., Lien, K. M., and Hertzberg, T.
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- 1995
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116. Multiplicity in reactive distillation of MTBE
- Author
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Hauan, S., Hertzberg, T., and Lien, K. M.
- Published
- 1995
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117. Phenomenon driven process design methodology: focus on reactive distillation
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Tanskanen, J., Pohjola, V. J., and Lien, K. M.
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- 1995
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118. Decomposed algorithmic synthesis of reactor-separation-recycle systems
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Omtveit, T., Valaskova, Z., Wahl, P. E., and Lien, K. M.
- Published
- 1993
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119. A new robust design model for gas separating membrane modules, based on analogy with counter-current heat exchangers
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Pettersen, T. and Lien, K. M.
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- 1994
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120. Decomposed algorithmic synthesis of reactor-separation-recycle systems
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Omtveit, T., Wah, P. E., and Lien, K. M.
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- 1994
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121. Separation process design and synthesis based on thermodynamic insights
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Jaksland, C. A., Gani, R., and Lien, K. M.
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- 1995
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122. Tues-P62 - Geriatric psychiatry in Denmark, a description of trends in admission pattern and service provision
- Author
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Lien, K. and Sørensen, L.
- Published
- 1998
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123. A Rare Presentation of Drug-Induced Autoimmune Hepatitis and the Role of Male Enhancement Supplements.
- Author
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Enciso J, Vasavada-Patel R, and Lien K
- Abstract
Autoimmune hepatitis (AIH) is a condition characterized by an autoimmune response resulting in chronic inflammatory liver disease. Its presentation is marked by significant increases in serum immunoglobulins and the production of active autoantibodies that target liver tissue. AIH is often associated with other autoimmune disorders, which can lead to overlapping clinical syndromes. However, alternative theories propose that exposure to specific environmental triggers can initiate this autoimmune cascade. We present the case of a 45-year-old male who sought evaluation for abdominal discomfort and was subsequently diagnosed with drug-induced AIH (DIAIH) following prolonged use of an over-the-counter male-enhancing supplement., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Enciso et al.)
- Published
- 2024
- Full Text
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124. The Bias of Medicine in Sickle Cell Disease.
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Anderson D, Lien K, Agwu C, Ang PS, and Abou Baker N
- Subjects
- Humans, United States epidemiology, Social Stigma, Health Personnel, Surveys and Questionnaires, Racism, Anemia, Sickle Cell diagnosis, Anemia, Sickle Cell therapy
- Abstract
Sickle cell disease (SCD) is the most common monogenetic condition in the United States (US) and one that has been subjected to a history of negative bias. Since SCD was first described approximately 120 years ago, the medical establishment has, directly and indirectly, harmed patients by reinforcing biases and assumptions about the disease. Furthermore, negative biases and stigmas have been levied upon patients with SCD by healthcare providers and society, researchers, and legislators. This article will explore the historical context of SCD in the US; discuss specific issues in care that lead to biases, social and self-stigma, inequities in access to care, and research funding; and highlight interventions over recent years that address racial biases and stigma., (© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)
- Published
- 2023
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125. A Rare Case of Post-orchidectomy Arterial Injury With Rapidly Enlarging Scrotal Hematoma Treated With Coil Embolization.
- Author
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Dhillon D, Moynihan HV, Santoro G, Lien K, and Dayan MJ
- Abstract
Testicular cancer is the most common solid tumor in young adult males. Radical inguinal orchidectomy is the gold standard for the diagnosis and treatment of testicular cancer, which is confined to the scrotum and is generally well tolerated. An uncommon, but known, complication of radical orchidectomy is scrotal hematoma. Scrotal hematoma from radical orchidectomy is commonly self-limited and typically self-resolving. We present a rare case of metastatic testicular malignancy diagnosed with radical inguinal orchidectomy complicated by a rapidly enlarging scrotal hematoma, successfully treated with surgical evacuation and image-guided arterial embolization., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dhillon et al.)
- Published
- 2023
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126. Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change.
- Author
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Burcheri A, Coutin A, Bigham BL, Kruse MI, Lien K, Lim R, MacCormick H, Morris J, Ng V, Primiani N, Odorizzi S, Poirier V, Upadhye S, and Primavesi R
- Subjects
- Humans, Curriculum, Health Personnel, Sexual and Gender Minorities, Education, Medical, Emergency Medicine
- Abstract
Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.
- Published
- 2023
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127. Assessing vaccine-mediated protection in an ultra-low dose Mycobacterium tuberculosis murine model.
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Plumlee CR, Barrett HW, Shao DE, Lien KA, Cross LM, Cohen SB, Edlefsen PT, and Urdahl KB
- Abstract
Despite widespread immunization with Bacille-Calmette-Guerin (BCG), the only currently licensed tuberculosis (TB) vaccine, TB remains a leading cause of mortality globally. There are many TB vaccine candidates in the developmental pipeline, but the lack of a robust animal model to assess vaccine efficacy has hindered our ability to prioritize candidates for human clinical trials. Here we use a murine ultra-low dose (ULD) Mycobacterium tuberculosis (Mtb) challenge model to assess protection conferred by BCG vaccination. We show that BCGconfers a reduction in lung bacterial burdens that is more durable than that observed afterconventional dose challenge, curbs Mtb dissemination to the contralateral lung, and, in a smallpercentage of mice, prevents detectable infection. These findings are consistent with the ability of human BCG vaccination to mediate protection, particularly against disseminated disease, in specific human populations and clinical settings. Overall, our findings demonstrate that the ultra-low dose Mtb infection model can measure distinct parameters of immune protection that cannot be assessed in conventional dose murine infection models and could provide an improved platform for TB vaccine testing.
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- 2023
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128. Case report: Basivertebral nerve block during vertebral augmentation: an alternative approach to intraprocedural pain management.
- Author
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Santoro GC, Kulkarni S, Dhillon D, and Lien K
- Abstract
Osteoporotic compression fractures can be treated with vertebral augmentation. Since intraprocedural pain is common during vertebral body endplate manipulation, these procedures are often performed with conscious sedation or general anesthesia. Research has shown that vertebral endplates are innervated by the basivertebral nerve (BVN), which has been successfully targeted via radiofrequency ablation to treat chronic vertebrogenic lower back pain. With this physiology in mind, we evaluated if temporary BVN block would provide sufficient analgesia so that patients could forego sedation during percutaneous vertebral augmentation. Ten patients with single-level vertebral compression fractures were selected. Prior to balloon augmentation, temporary intraosseous BVN block was achieved using 2% lidocaine injection. All ten patients successfully completed their procedure without intraprocedural sedative or narcotic medications, and without significant deviation from baseline vital signs. Temporary BVN block can be used as intraprocedural anesthesia in select patients who may be poor candidates for general anesthesia or conscious sedation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Santoro, Kulkarni, Dhillon and Lien.)
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- 2023
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129. Language discordance as a marker of disparities in cerebrovascular risk and stroke outcomes: A multi-center Canadian study.
- Author
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Muir RT, Kapoor A, Cayley ML, Sicard MN, Lien K, Southwell A, Dowlatshahi D, Sahlas DJ, Saposnik G, Mandzia J, Casaubon LK, Hassan A, Perez Y, Selchen D, Murray BJ, Lanctot K, Kapral MK, Herrmann N, Strother S, Yu AYX, Austin PC, Bronskill SE, and Swartz RH
- Abstract
Background: Differences in ischemic stroke outcomes occur in those with limited English proficiency. These health disparities might arise when a patient's spoken language is discordant from the primary language utilized by the health system. Language concordance is an understudied concept. We examined whether language concordance is associated with differences in vascular risk or post-stroke functional outcomes, depression, obstructive sleep apnea and cognitive impairment., Methods: This was a multi-center observational cross-sectional cohort study. Patients with ischemic stroke/transient ischemic attack (TIA) were consecutively recruited across eight regional stroke centers in Ontario, Canada (2012 - 2018). Participants were language concordant (LC) if they spoke English as their native language, ESL if they used English as a second language, or language discordant (LD) if non-English speaking and requiring translation., Results: 8156 screened patients. 6,556 met inclusion criteria: 5067 LC, 1207 ESL and 282 LD. Compared to LC patients: (i) ESL had increased odds of diabetes (OR = 1.28, p = 0.002), dyslipidemia (OR = 1.20, p = 0.007), and hypertension (OR = 1.37, p <0.001) (ii) LD speaking patients had an increased odds of having dyslipidemia (OR = 1.35, p = 0.034), hypertension (OR = 1.37, p <0.001), and worse functional outcome (OR = 1.66, p <0.0001). ESL (OR = 1.88, p <0.0001) and LD (OR = 1.71, p <0.0001) patients were more likely to have lower cognitive scores. No associations were noted with obstructive sleep apnea (OSA) or depression., Conclusions: Measuring language concordance in stroke/TIA reveals differences in neurovascular risk and functional outcome among patients with limited proficiency in the primary language of their health system. Lower cognitive scores must be interpreted with caution as they may be influenced by translation and/or greater vascular risk. Language concordance is a simple, readily available marker to identify those at risk of worse functional outcome. Stroke systems and practitioners must now study why these differences exist and devise adaptive care models, treatments and education strategies to mitigate barriers influenced by language discordance., Competing Interests: None., (© 2023 The Author(s).)
- Published
- 2023
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130. Men Are at Higher Risk of Screening Positive for Vascular Cognitive Impairment Compared to Women after Stroke and Transient Ischemic Attack.
- Author
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Zinman J, Kapoor A, Si K, Sujanthan S, Southwell A, Cayley ML, Sicard MN, Lien K, Murray BJ, Lanctôt K, Herrmann N, Dowlatshahi D, Sahlas DJ, Saposnik G, Mandzia JL, Casaubon LK, Hassan A, Perez Y, and Swartz RH
- Subjects
- Humans, Female, Male, Prospective Studies, Risk Factors, Ischemic Attack, Transient complications, Ischemic Attack, Transient diagnosis, Ischemic Attack, Transient epidemiology, Stroke complications, Stroke epidemiology, Stroke psychology, Cognitive Dysfunction diagnosis, Cognitive Dysfunction epidemiology, Cognitive Dysfunction etiology
- Abstract
While women have greater incidence of dementia, men have higher prevalence of vascular risk factors. This study examined sex differences in risk of screening positive for cognitive impairment after stroke. Ischemic stroke/TIA patients (N = 5969) participated in this prospective, multi-centered study, which screened for cognitive impairment using a validated brief screen. Men showed a higher risk of screening positive for cognitive impairment after adjusting for age, education, stroke severity, and vascular risk factors, suggesting that other factors may be contributing to increased risk among men (OR = 1.34, CI 95% [1.16, 1.55], p < 0.001). The effect of sex on cognitive impairment after stroke warrants further attention.
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- 2023
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131. Workshop-based learning and networking: a scalable model for research capacity strengthening in low- and middle-income countries.
- Author
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Perier C, Nasinghe E, Charles I, Ssetaba LJ, Ahyong V, Bangs D, Beatty PR, Czudnochowski N, Diallo A, Dugan E, Fabius JM, Fong Baker H, Gardner J, Isaacs S, Joanah B, Kalantar K, Kateete D, Knight M, Krasilnikov M, Krogan NJ, Langelier C, Lee E, Li LM, Licht D, Lien K, Lyons Z, Mboowa G, Mwebaza I, Mwesigwa S, Nalwadda G, Nichols R, Penaranda ME, Petnic S, Phelps M, Popper SJ, Rape M, Reingold A, Robbins R, Rosenberg OS, Savage DF, Schildhauer S, Settles ML, Sserwadda I, Stanley S, Tato CM, Tsitsiklis A, Van Dis E, Vanaerschot M, Vinden J, Cox JS, Joloba ML, and Schaletzky J
- Subjects
- Capacity Building, Humans, Poverty, Students, Universities, Developing Countries, Global Health
- Abstract
Science education and research have the potential to drive profound change in low- and middle-income countries (LMICs) through encouraging innovation, attracting industry, and creating job opportunities. However, in LMICs, research capacity is often limited, and acquisition of funding and access to state-of-the-art technologies is challenging. The Alliance for Global Health and Science (the Alliance) was founded as a partnership between the University of California, Berkeley (USA) and Makerere University (Uganda), with the goal of strengthening Makerere University's capacity for bioscience research. The flagship program of the Alliance partnership is the MU/UCB Biosciences Training Program, an in-country, hands-on workshop model that trains a large number of students from Makerere University in infectious disease and molecular biology research. This approach nucleates training of larger and more diverse groups of students, development of mentoring and bi-directional research partnerships, and support of the local economy. Here, we describe the project, its conception, implementation, challenges, and outcomes of bioscience research workshops. We aim to provide a blueprint for workshop implementation, and create a valuable resource for bioscience research capacity strengthening in LMICs.
- Published
- 2022
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132. HIV-1 Proteins gp120 and Tat Promote Epithelial-Mesenchymal Transition and Invasiveness of HPV-Positive and HPV-Negative Neoplastic Genital and Oral Epithelial Cells.
- Author
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Lien K, Mayer W, Herrera R, Padilla NT, Cai X, Lin V, Pholcharoenchit R, Palefsky J, and Tugizov SM
- Subjects
- Humans, Cadherins metabolism, Cell Movement, Epithelial Cells metabolism, Epithelial-Mesenchymal Transition, Genitalia metabolism, Vimentin metabolism, Viral Proteins, HIV Infections, HIV-1 metabolism, Papillomavirus Infections complications, tat Gene Products, Human Immunodeficiency Virus, HIV Envelope Protein gp120
- Abstract
The incidence of human papillomavirus (HPV)-associated anogenital and oropharyngeal cancer in human immunodeficiency virus (HIV)-infected individuals is substantially higher than in HIV-uninfected individuals. HIV may also be a risk factor for the development of HPV-negative head and neck, liver, lung, and kidney cancer. However, the molecular mechanisms underlying HIV-1-associated increase of epithelial malignancies are not fully understood. Here, we showed that HPV-16-immortalized anal AKC-2 and cervical CaSki epithelial cells that undergo prolonged exposure to cell-free HIV-1 virions or HIV-1 viral proteins gp120 and tat respond with the epithelial-mesenchymal transition (EMT) and increased invasiveness. Similar responses were observed in HPV-16-infected SCC-47 and HPV-16-negative HSC-3 oral epithelial cancer cells that were cultured with these viral proteins. EMT induced by gp120 and tat led to detachment of poorly adherent cells from the culture substratum; these cells remained capable of reattachment, upon which they coexpressed both E-cadherin and vimentin, indicative of an intermediate stage of EMT. The reattached cells also expressed stem cell markers CD133 and CD44, which may play a critical role in cancer cell invasion and metastasis. Inhibition of transforming growth factor (TGF)-β1 and MAPK signaling and vimentin expression, and restoration of E-cadherin expression reduced HIV-induced EMT and the invasive activity of HPV-16-immortalized anal and cervical epithelial cells. Collectively, our results suggest that these approaches along with HIV viral suppression with antiretroviral therapy (ART) might be useful to limit the role of HIV-1 infection in the acceleration of HPV-associated or HPV-independent epithelial neoplasia. IMPORTANCE HPV-16-immortalized genital and oral epithelial cells and HPV-negative oral cancer cells that undergo prolonged contact with cell-free HIV-1 virions or with viral proteins gp120 and tat respond by becoming more invasive. EMT cells induced by HIV-1 in cultures of HPV-16-immortalized anal and cervical epithelial cells express the stem cell markers CD133 and CD44. These results suggest that the interaction of HIV-1 with neoplastic epithelial cells may lead to their de-differentiation into cancer stem cells that are resistant to apoptosis and anti-cancer drugs. Thus, this pathway may play a critical role in the development of invasive cancer. Inhibition of TGF-β1 and MAPK signaling and vimentin expression, and restoration of E-cadherin expression reduced HIV-induced EMT and the invasiveness of HPV-16-immortalized anal and cervical epithelial cells. Taken together, these results suggest that these approaches might be exploited to limit the role of HIV-1 infection in the acceleration of HPV-associated or HPV-independent epithelial neoplasia.
- Published
- 2022
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133. Behavior Characteristics and Risk for Metabolic Syndrome Among Women in Rural Communities in China.
- Author
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Chen JL, Guo J, Lin CX, Yang J, Mao P, Jiang S, He W, and Lien K
- Subjects
- China epidemiology, Cross-Sectional Studies, Female, Humans, Male, Obesity complications, Obesity epidemiology, Overweight complications, Prevalence, Risk Factors, Rural Population, Metabolic Syndrome epidemiology, Metabolic Syndrome etiology
- Abstract
Background: Rapid economic growth and lifestyle changes in China have resulted in increased metabolic syndrome (MetS) rates. Few investigators have examined sex-specific risk factors and the role of menopause, stress, and sleep on MetS among women in China., Objective: In this study, we aimed to identify the risk factors for MetS among women in rural China., Methods: A cross-sectional study design was used, and participants were recruited from rural areas in China. Female participants older than 18 years were eligible to participate. Participants had their weight, height, waist circumference, blood pressure, and fasting blood measured at study sites. They also completed validated questionnaires regarding sociodemographic information and MetS-related health behaviors., Results: A total of 646 women were included in this study. The overall prevalence of MetS was 26.2%. The MetS group had a greater number of overweight/obese women than the non-MetS group did. For premenopausal women, a higher income, being overweight/obese, and eating salty/marinated food increased their risk for MetS (odds ratio [OR], 2.56, 4.55, and 3.1, respectively). For postmenopausal women, a low level of education (OR, 0.44) and being overweight/obese (OR, 4.98) increased their risk of MetS., Conclusion: Almost half of the women in this study were overweight/obese, and many of them did not meet the national recommendations for a healthy lifestyle, increasing their risk for MetS. Developing cultural and behavioral interventions tailored for overweight/obese women is critical in reducing MetS., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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134. Education about sexual and gender minorities within Canadian emergency medicine residency programs.
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Primavesi R, Burcheri A, Bigham BL, Coutin A, Lien K, Koh J, Kruse M, MacCormick H, Odorizzi S, Ng V, Poirier V, Primiani N, Smith S, Upadhye S, Wallner C, Morris J, and Lim R
- Subjects
- Canada, Curriculum, Humans, Emergency Medicine education, Internship and Residency, Sexual and Gender Minorities
- Abstract
Objectives: The CAEP 2021 2SLGBTQIA +
i panel sought whether a gap exists within Canadian emergency medicine training pertaining to sexual and gender minority communities. This panel aimed to generate practical recommendations on improving emergency medicine education about sexual and gender minorities, thereby improving access to equitable healthcare., Methods: From August 2020 to June 2021, a panel of emergency medicine practitioners, residents, students, and community representatives met monthly via videoconference. A literature review was undertaken, and three mixed methods surveys were distributed to the CAEP member list, CAEP Resident Section, College of Family Physicians of Canada (CFPC)iii Emergency Medicine Members Interest Group, and to emergency medicine residency program directors and their residents. Informed by the review and surveys, recommendations were drafted and refined by panel members before presentation at the 2021 CAEP Academic Symposium. A plenary was presented to symposium attendees composed of national emergency medicine community members, which reported the survey results and literature review. All attendees were divided into small groups to develop an action plan for each recommendation., Conclusions: The panel outlines eight recommendations for closing the curricular gap. It identifies three perceived or real barriers to the inclusion of sexual and gender minority content in emergency medicine residency curricula. It acknowledges three enabling recommendations that are beyond the scope of individual emergency medicine programs or emergency departments (EDs), that if enacted would enable the implementation of the recommendations. Each recommendation is accompanied by two action items as a guide to implementation. Each of the three barriers is accompanied by two action items that offer specific solutions to overcome these obstacles. Each enabling recommendation suggests an action that would shift emergency medicine towards sociocultural competence nationally. These recommendations set the primary steps towards closing the educational gap., (© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)- Published
- 2022
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135. Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients.
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Lien K, Vujcic B, and Ng V
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- Attitude of Health Personnel, Canada, Female, Humans, Surveys and Questionnaires, Emergency Medicine education, Internship and Residency, Physicians
- Abstract
Objectives: Physicians working in the emergency department (ED) will interact with two-spirited, lesbian, gay, bisexual, transgender, queer/questioning and intersex (2SLGBTQI+) persons as colleagues and patients. These patients have unique healthcare needs and encounter negative experiences when seeking medical care, leading to poorer health outcomes and inequities. This study aims to explore the attitudes, behaviour, and comfort of Canadian emergency medicine (EM) physicians in caring for 2SLGBTQI+ patients., Methods: An anonymous survey was distributed to EM staff physicians and residents through the Canadian Association of Emergency Physicians (CAEP) network and social media channels. Demographic information was collected, and participants were asked about their comfort, current knowledge, and desire to gain new knowledge in caring for 2SLGBTQI+ patients. Personal perceptions and practice patterns in treating cisgender heterosexual (cis-het) and 2SLGBTQI+ patients were analysed using five-point Likert scales. Residents were asked additional questions regarding availability of learning experiences during training., Results: 266 surveys were included in the final analysis consisting of 229 (86%) staff physicians and 37 (14%) residents. 97% (n = 258) of all respondents believed 2SLGBTQI+ patients deserve the same quality care from medical institutions as other patients. Further, 83% (n = 221) respondents agreed that they would like to increase their knowledge in taking care of 2SLGBTQI+ patients, while 34% (n = 91) agreed that performing physical examinations on transgender or intersex patients was more challenging than on cis-het patients. Among resident respondents, 46% indicated a lack of didactic teaching devoted to 2SLGBTQI+ care during residency (n = 17/37), while 38% encountered discrimination towards 2SLGBTQI+ patients, with most comments from senior faculty and nursing staff., Conclusions: This study suggests that Canadian EM physicians feel that 2SLGBTQI+ patients deserve equitable care when compared to cis-het patients. Future work should focus on educational needs and curricular enhancements in residency programs and continuing professional development for physicians to improve care for 2SLGBTQI+ patients in the ED., (© 2021. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
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- 2021
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136. A map of metabolic phenotypes in patients with myalgic encephalomyelitis/chronic fatigue syndrome.
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Hoel F, Hoel A, Pettersen IK, Rekeland IG, Risa K, Alme K, Sørland K, Fosså A, Lien K, Herder I, Thürmer HL, Gotaas ME, Schäfer C, Berge RK, Sommerfelt K, Marti HP, Dahl O, Mella O, Fluge Ø, and Tronstad KJ
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- Adult, Amino Acids metabolism, Case-Control Studies, Fatty Acids metabolism, Female, Healthy Volunteers, Humans, Male, Metabolomics, Middle Aged, Energy Metabolism, Fatigue Syndrome, Chronic metabolism
- Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disease usually presenting after infection. Emerging evidence supports that energy metabolism is affected in ME/CFS, but a unifying metabolic phenotype has not been firmly established. We performed global metabolomics, lipidomics, and hormone measurements, and we used exploratory data analyses to compare serum from 83 patients with ME/CFS and 35 healthy controls. Some changes were common in the patient group, and these were compatible with effects of elevated energy strain and altered utilization of fatty acids and amino acids as catabolic fuels. In addition, a set of heterogeneous effects reflected specific changes in 3 subsets of patients, and 2 of these expressed characteristic contexts of deregulated energy metabolism. The biological relevance of these metabolic phenotypes (metabotypes) was supported by clinical data and independent blood analyses. In summary, we report a map of common and context-dependent metabolic changes in ME/CFS, and some of them presented possible associations with clinical patient profiles. We suggest that elevated energy strain may result from exertion-triggered tissue hypoxia and lead to systemic metabolic adaptation and compensation. Through various mechanisms, such metabolic dysfunction represents a likely mediator of key symptoms in ME/CFS and possibly a target for supportive intervention.
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- 2021
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137. The revised Approved Instructional Resources score: An improved quality evaluation tool for online educational resources.
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Grock A, Jordan J, Zaver F, Colmers-Gray IN, Krishnan K, Chan T, Thoma B, Alexander C, Alkhalifah M, Almehlisi AS, Alqahtani S, Anderson S, Anderson S, Andrews C, Andruko J, Antony N, Aryal D, Backus B, Baird J, Baker A, Batty S, Baylis J, Beaumont B, Belcher C, Benavides B, Benham M, Botta J, Berger Pelletier E, Bouchard N, Brazil V, Brumfield E, Bryson A, Bunchit W, Butler K, Buzikievich L, Calcara D, Carey R, Carrillo MR, Carroll S, Lyons C, Cassidy L, Challen K, Chan K, Chaplin T, Chatham-Zvelebil N, Chen E, Chen L, Chhabra S, Chin A, Chochi E, Choudhri T, Christensen J, Connors K, Coppersmith V, Cosgrove A, Costello G, Cullison K, D'Alessandro A, Wit K, Decock M, Delbani R, Denq W, Deutscher J, Devine B, Dorsett M, Duda T, Dueweke J, Dunphy T, Dyer S, Eastley KT, Edmonds M, Edwards K, Ehrman R, Elkhalidy Y, Fedor P, Ficiur B, Flynn C, Fraser B, Fu M, Fukakusa J, Funk E, Gaco D, Gawlik V, Ghaffarian K, Gharahbaghian L, Griffith A, Griffith P, Gronowski T, Grossman C, Gucwa J, Gupta P, Gustafson A, Guy A, Haas M, Haciski S, Hajdinjak E, Hall AK, Hammock R, Hansel J, Hart A, Hattin L, Herb B, Hilbert S, Hill J, Hill J, Ho A, House E, House N, Huang SYM, Huffman J, Inboriboon C, Ireland A, Jamal A, Jamil MA, Jansen V, Jarou Z, Jia V, Johnston L, Kalnow D, Kapur P, Kelly S, Kelson K, Kent W, Khakhkhar R, Khurana J, Kilp A, Knapp S, Kohler S, Kruhlak I, Lalani N, Lam S, Lank P, Laurie Z, Lea K, Leber E, Lee CH, Lenes H, Lenora N, Leontowicz J, Lien K, Lin M, Lin Y, Little A, Liu H, Liu I, Liu S, Louka S, Lovell E, Lowe D, Lubberdink A, Luc J, Ma SH, MacLeod H, Mancuso N, Maneshi A, May J, Mayo J, McDonnell M, McLellan S, McQuarrie C, Mead T, Meeuwisse C, Meloy P, Menzies P, Messman A, Miazga S, Mills L, Mix A, Montag S, Moore B, Morgenstern J, Mott S, Mukherj P, Mulla A, Nandalal S, Nikel T, Nood J, Nugent S, Oakland M, Oberholzer W, Otugo O, Oyedokun TS, Pardhan A, Patel K, Paterson Q, Patocka C, Patterson C, Pearlman J, Pelletier-Bui A, Phan M, Poonja Z, Powell A, Premkumar K, Prosen G, Puri V, Quaife T, Raffel R, Raja A, Ramunno R, Rang L, Rannazzisi S, Regan S, Rezaie SR, Ridderikhof M, Rogers V, Roh C, Rosenberg K, Roure M, Rudinsky S, Rudner J, Saleh A, Sanderson W, Scheirer O, Schofield P, Schunk P, Schwarz E, Shahrabadi P, Shappell E, Sheffield J, Singh M, Singson HC, Slessor D, Smith S, Sneath P, Sobehart R, Spearing K, Stempien J, Sternard B, Stratton T, Stuart K, Stuntz B, Susalla M, Sweeney C, Swisher L, Swoboda H, Syed S, Taira T, Tambe N, Tang R, Targonsky E, Taylor A, Taylor R, Taylor T, Ting P, Tiwald G, Tran E, Tran K, Trickovic J, Trinquero P, Tyagi A, Umana M, Vallance P, Van den Berg P, van Diepen K, Vargas L, Verbeek R, Viggers S, Vlodaver Z, Wagner M, Walji N, Walter J, Wan M, Wang R, Wanner G, Warawa W, Ward M, Weekes J, Weersink K, Weessies C, Whalen-Browne A, Whiteside B, Willis M, Wilmer J, Wong N, Woodcroft M, Woods R, Yau L, Yee J, Yeh C, Yurkiw K, Zaver F, and Zozula A
- Abstract
Background: Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations., Objectives: We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool., Methods: As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability., Results: Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95)., Conclusions: We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population., Competing Interests: The authors have no potential conflicts to disclose. All authors had full access to all the study data and had final responsibility for the decision to submit for publication., (© 2021 by the Society for Academic Emergency Medicine.)
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- 2021
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138. Are the factors associated with overweight/general obesity and abdominal obesity different depending on menopausal status?
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Chen JL, Guo J, Mao P, Yang J, Jiang S, He W, Lin CX, and Lien K
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- Adult, Body Mass Index, China epidemiology, Cross-Sectional Studies, Diet, Exercise, Female, Humans, Middle Aged, Obesity genetics, Obesity metabolism, Obesity, Abdominal genetics, Obesity, Abdominal metabolism, Overweight epidemiology, Postmenopause physiology, Premenopause physiology, Prevalence, Risk Factors, Rural Population, Surveys and Questionnaires, Waist Circumference, Menopause physiology, Obesity epidemiology, Obesity, Abdominal epidemiology
- Abstract
Rapid modernization in China has impacted the daily lives and health of women, including a rise in obesity. However, little is known about the impact of menopausal status, behavior, and psychosocial factors on the risk of obesity for rural women in China. The aim of this study is to identify risk factors, including demographic information (education, family history of T2DM, menopausal status), obesity-related behavior, and psychosocial factors associated with overweight/general obesity and abdominal obesity. In a cross-sectional study design, participants had their weight, height, and waist circumference measured and completed questionnaires regarding family demographics, obesity-related health behaviors (physical activity, diet, sleep), and psychosocial information (stress, social support, and self-efficacy related to physical activity and healthy diet). A total of 646 women were included in this study; 46.6% were overweight/generally obese, and 48% had abdominal obesity. Postmenopausal women had a higher prevalence of general and central obesity. Regular physical activity decreased the risk for overweight/general obesity and abdominal obesity (OR = .41 and .31, respectively, p = .04) in premenopausal women. Postmenopausal women who had not breastfed their infants and reported moderate/high-stress had a higher risk for overweight/general obesity (OR = 3.93, and 2, respectively) and those who reported less than 6 hours of sleep per day increased their risk for abdominal obesity (OR = 2.08). Different factors associated with obesity were found in Chinese women, depending on menopausal status. Future studies should examine the impact of menopause on a woman's risk for obesity, as well as develop tailored interventions to improve health, well-being and reduce the risk of obesity., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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139. Cardiac Dimensions and Function Are Not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
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Iversen PO, von Lueder TG, Kardel KR, and Lien K
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Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition associated with several negative health outcomes. A hallmark of ME/CFS is decreased exercise capacity and often profound exercise intolerance. The causes of ME/CSF and its related symptoms are unknown, but there are indications of a dysregulated metabolism with impaired glycolytic vs oxidative energy balance. In line with this, we recently demonstrated abnormal lactate accumulation among ME/CFS patients compared with healthy controls after exercise testing. Here we examined if cardiac dimensions and function were altered in ME/CFS, as this could lead to increased lactate production. Methods: We studied 16 female ME/CFS patients and 10 healthy controls with supine transthoracic echocardiography, and we assessed cardiac dimensions and function by conventional echocardiographic and Doppler analysis as well as novel tissue Doppler and strain variables. Results: A detailed analyses of key variables of cardiac dimensions and cardiac function revealed no significant differences between the two study groups. Conclusion: In this cohort of well-described ME/CFS patients, we found no significant differences in echocardiographic variables characterizing cardiac dimensions and function compared with healthy controls., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
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- 2020
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140. Effects of a naturalistic intervention on the speech outcomes of young children with cleft palate.
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Scherer NJ, Kaiser AP, Frey JR, Lancaster HS, Lien K, and Roberts MY
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- Child, Preschool, Female, Humans, Male, Speech, Cleft Lip complications, Cleft Palate complications, Speech Disorders etiology, Speech Disorders therapy, Speech Therapy methods
- Abstract
Purpose : The purpose of this study was to investigate the extent to which a naturalistic communication intervention, Enhanced Milieu Teaching with Phonological Emphasis (EMT + PE) improved the speech outcomes of toddlers with cleft palate with or without cleft lip (CP ± L) Method : This study was a stratified randomised controlled trial.Setting: Treatment was delivered in a university clinic by a trained speech-language pathologist.Thirty children aged between 15 and 36 months ( M = 25) with nonsyndromic CP ± CL and typical cognitive development were randomly assigned to a treatment (EMT + PE) or business as usual comparison condition.Participants in the EMT + PE treatment group received 48, 30-min sessions, over a 6-month period. Fidelity of treatment was high across participants.The primary outcome measures were percent consonants correct (PCC), consonant inventory, compensatory articulation errors, and nasal emission. Result : Regression analyses controlling for pre-intervention child characteristics were conducted for PCC and consonant inventory. Intervention was not a significant predictor of post-intervention outcome. Words per minute differentiated the children who benefitted from the intervention from those who did not. Reduction in compensatory errors and nasal emission occurred in both groups but to a greater degree in the EMT + PE group. Conclusion : EMT + PE is a promising early speech intervention for young children with CP ± L, especially for children with higher rates of word use.
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- 2020
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141. Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department.
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Lien K, Grattan BA, Reynard AL, Peters J, and Parr JL
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Introduction Close outpatient follow-up with a specialist or family physician post-discharge from the emergency department (ED) has been shown to increase adherence to antihypertensive medications, decrease mortality in heart failure, and reduce the odds of myocardial infarction or death after ED presentation for chest pain. A Canadian study demonstrated that 21% of patients who left the ED with a new diagnosis of atrial fibrillation, heart failure, or hypertension were not seen by a physician within 30 days. There is a paucity of research investigating why this follow-up does not occur. This study aimed to elucidate factors that are associated with outpatient follow-up by a family physician clinic following discharge from a local Canadian community emergency department. Methods A retrospective chart review of patients rostered to a family physician who presented to the community ED in the past two years was conducted. The primary outcome examined was a documented follow-up visit with any physician at the clinic within 30 days of the index ED visit. Patients aged 18 or older at the time of the initial ED visit were eligible for inclusion in the study. Exclusion criteria were the following: patients aged 17 or younger at the time of the initial ED visit, those who were not fully assessed at ED visit (i.e., left against medical advice), those whose charts corresponding to the ED visit were unable to be found, patients who were admitted to any facility within 30 days of ED visit, and patients who died within 30 days of the ED visit. Variables of interest extracted from the ED chart and clinic electronic medical record were the following: Canadian Triage and Acuity Scale (CTAS) score, documented discharge instructions, age, sex, primary residence distance from the clinic, last documented clinic visit before ED visit, and the date of and presenting complaint of the next clinic visit after the ED visit. Data were collected as continuous and categorical variables. Descriptive statistics were used to show the number and percentages of patients who followed up in clinic. Binomial regression analysis was used to determine if a specific variable was associated with patient follow-up. Inter-rater reliability between data abstractors was calculated using Fleiss Κ. An alpha-value of 0.05 was chosen, and SPSS version 25.0 (IBM Corp., Armonk, NY) was used for all statistical analyses. Results A total of 234 patients out of 1292 patients met inclusion criteria. 53% of patients were female, and the mean age was 50. Seventy-two (31%) received discharge instructions from the ED physician to follow up with their family doctor. In total, 93 of the 234 patients proceeded to have a documented clinic visit within 30 days (40%). 52% (n = 48) of these were women. Receiving specific discharge instructions increased the adjusted odds of follow-up (OR 3.07, 95% CI: 1.64-5.76; P < 0.05). Patients who followed up also tended to have been seen in clinic in the last three months, but this was not statistically significant. Conclusion Receiving specific discharge instructions to follow-up increased the odds that patients followed up with their family physician after discharge from the ED. ED physicians may consider giving explicit instructions to patients to improve monitoring of ongoing clinical issues. More research needs to be conducted on how to improve transitions of care. Countries with different healthcare models may have other barriers to appropriate follow-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Lien et al.)
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- 2020
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142. HIV-1 proteins gp120 and tat induce the epithelial-mesenchymal transition in oral and genital mucosal epithelial cells.
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Lien K, Mayer W, Herrera R, Rosbe K, and Tugizov SM
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- Cells, Cultured, Child, Preschool, Epithelial Cells cytology, Epithelial Cells physiology, Female, Genitalia virology, HEK293 Cells, HIV Envelope Protein gp120 metabolism, HIV-1 metabolism, Humans, Infant, Infant, Newborn, Keratinocytes drug effects, Keratinocytes physiology, Male, Mouth Mucosa physiology, Mucous Membrane cytology, Mucous Membrane drug effects, Epithelial Cells drug effects, Epithelial-Mesenchymal Transition drug effects, Genitalia cytology, HIV Envelope Protein gp120 pharmacology, Mouth Mucosa drug effects, tat Gene Products, Human Immunodeficiency Virus pharmacology
- Abstract
The oral, cervical, and genital mucosa, covered by stratified squamous epithelia with polarized organization and strong tight and adherens junctions, play a critical role in preventing transmission of viral pathogens, including human immunodeficiency virus (HIV). HIV-1 interaction with mucosal epithelial cells may depolarize epithelia and disrupt their tight and adherens junctions; however, the molecular mechanism of HIV-induced epithelial disruption has not been completely understood. We showed that prolonged interaction of cell-free HIV-1 virions, and viral envelope and transactivator proteins gp120 and tat, respectively, with tonsil, cervical, and foreskin epithelial cells induces an epithelial-mesenchymal transition (EMT). EMT is an epigenetic process leading to the disruption of mucosal epithelia and allowing the paracellular spread of viral and other pathogens. Interaction of cell-free virions and gp120 and tat proteins with epithelial cells substantially reduced E-cadherin expression and activated vimentin and N-cadherin expression, which are well-known mesenchymal markers. HIV gp120- and tat-induced EMT was mediated by SMAD2 phosphorylation and activation of transcription factors Slug, Snail, Twist1 and ZEB1. Activation of TGF-β and MAPK signaling by gp120, tat, and cell-free HIV virions revealed the critical roles of these signaling pathways in EMT induction. gp120- and tat-induced EMT cells were highly migratory via collagen-coated membranes, which is one of the main features of mesenchymal cells. Inhibitors of TGF-β1 and MAPK signaling reduced HIV-induced EMT, suggesting that inactivation of these signaling pathways may restore the normal barrier function of mucosal epithelia., Competing Interests: The authors have declared that no competing interests exist.
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- 2019
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143. Symptoms of depression and cognitive impairment in young adults after stroke/transient ischemic attack.
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Kapoor A, Scott C, Lanctot KL, Herrmann N, Murray BJ, Thorpe KE, Lien K, Sicard M, and Swartz RH
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- Adult, Aged, Aged, 80 and over, Cognitive Dysfunction diagnosis, Cognitive Dysfunction etiology, Depression diagnosis, Depression etiology, Female, Humans, Ischemic Attack, Transient complications, Ischemic Attack, Transient diagnosis, Male, Middle Aged, Neuropsychological Tests, Stroke complications, Stroke diagnosis, Young Adult, Cognitive Dysfunction psychology, Depression psychology, Ischemic Attack, Transient psychology, Stroke psychology
- Abstract
Depression and cognitive complaints are common after stroke; these issues have been studied in older populations, but not in the young. Two hundred and seventy four eligible stroke and TIA patients consented to participate and complete the Center for Epidemiologic Studies Depression Scale, and National Institute of Neurological Disorders and Stroke - Canadian Stroke Network 30-min neuropsychological battery; 57 (21%) were ≤ 50 years of age. Younger patients reported greater symptoms of depression and less executive dysfunction than older patients. This study highlights age differences in post-stroke depression symptoms and cognitive impairment, and emphasizes the need for screening across ages., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2019
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144. Abnormal blood lactate accumulation during repeated exercise testing in myalgic encephalomyelitis/chronic fatigue syndrome.
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Lien K, Johansen B, Veierød MB, Haslestad AS, Bøhn SK, Melsom MN, Kardel KR, and Iversen PO
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- Adolescent, Adult, Biomarkers blood, Case-Control Studies, Fatigue Syndrome, Chronic physiopathology, Female, Humans, Middle Aged, Prognosis, Young Adult, Exercise physiology, Fatigue Syndrome, Chronic blood, Lactates blood
- Abstract
Post-exertional malaise and delayed recovery are hallmark symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Studies on repeated cardiopulmonary exercise testing (CPET) show that previous exercise negatively affects oxygen uptake (VO
2 ) and power output (PO) in ME/CFS. Whether this affects arterial lactate concentrations ([Laa ]) is unknown. We studied 18 female patients (18-50 years) fulfilling the Canadian Consensus Criteria for ME/CFS and 15 healthy females (18-50 years) who underwent repeated CPETs 24 h apart (CPET1 and CPET2 ) with [Laa ] measured every 30th second. VO2 at peak exercise (VO2peak ) was lower in patients than in controls on CPET1 (P < 0.001) and decreased in patients on CPET2 (P < 0.001). However, the difference in VO2peak between CPETs did not differ significantly between groups. [Laa ] per PO was higher in patients during both CPETs (Pinteraction < 0.001), but increased in patients and decreased in controls from CPET1 to CPET2 (Pinteraction < 0.001). Patients had lower VO2 (P = 0.02) and PO (P = 0.002) at the gas exchange threshold (GET, the point where CO2 production increases relative to VO2 ), but relative intensity (%VO2peak ) and [Laa ] at GET did not differ significantly from controls on CPET1 . Patients had a reduction in VO2 (P = 0.02) and PO (P = 0.01) at GET on CPET2 , but no significant differences in %VO2peak and [Laa ] at GET between CPETs. Controls had no significant differences in VO2 , PO or %VO2peak at GET between CPETs, but [Laa ] at GET was reduced on CPET2 (P = 0.008). In conclusion, previous exercise deteriorates physical performance and increases [Laa ] during exercise in patients with ME/CFS while it lowers [Laa ] in healthy subjects., (© 2019 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)- Published
- 2019
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145. B-Lymphocyte Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.
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Fluge Ø, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, Sørland K, Aßmus J, Ktoridou-Valen I, Herder I, Gotaas ME, Kvammen Ø, Baranowska KA, Bohnen LMLJ, Martinsen SS, Lonar AE, Solvang AH, Gya AES, Bruland O, Risa K, Alme K, Dahl O, and Mella O
- Subjects
- Adult, Antineoplastic Agents, Immunological adverse effects, Double-Blind Method, Fatigue Syndrome, Chronic blood, Female, Humans, Infusions, Intravenous, Male, Rituximab adverse effects, Severity of Illness Index, Antineoplastic Agents, Immunological administration & dosage, B-Lymphocytes metabolism, Fatigue Syndrome, Chronic drug therapy, Lymphocyte Depletion, Rituximab administration & dosage
- Abstract
Background: Previous phase 2 trials indicated benefit from B-lymphocyte depletion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)., Objective: To evaluate the effect of the monoclonal anti-CD20 antibody rituximab versus placebo in patients with ME/CFS., Design: Randomized, placebo-controlled, double-blind, multicenter trial. (ClinicalTrials.gov: NCT02229942)., Setting: 4 university hospitals and 1 general hospital in Norway., Patients: 151 patients aged 18 to 65 years who had ME/CFS according to Canadian consensus criteria and had had the disease for 2 to 15 years., Intervention: Treatment induction with 2 infusions of rituximab, 500 mg/m2 of body surface area, 2 weeks apart, followed by 4 maintenance infusions with a fixed dose of 500 mg at 3, 6, 9, and 12 months (n = 77), or placebo (n = 74)., Measurements: Primary outcomes were overall response rate (fatigue score ≥4.5 for ≥8 consecutive weeks) and repeated measurements of fatigue score over 24 months. Secondary outcomes included repeated measurements of self-reported function over 24 months, components of the Short Form-36 Health Survey and Fatigue Severity Scale over 24 months, and changes from baseline to 18 months in these measures and physical activity level. Between-group differences in outcome measures over time were assessed by general linear models for repeated measures., Results: Overall response rates were 35.1% in the placebo group and 26.0% in the rituximab group (difference, 9.2 percentage points [95% CI, -5.5 to 23.3 percentage points]; P = 0.22). The treatment groups did not differ in fatigue score over 24 months (difference in average score, 0.02 [CI, -0.27 to 0.31]; P = 0.80) or any of the secondary end points. Twenty patients (26.0%) in the rituximab group and 14 (18.9%) in the placebo group had serious adverse events., Limitation: Self-reported primary outcome measures and possible recall bias., Conclusion: B-cell depletion using several infusions of rituximab over 12 months was not associated with clinical improvement in patients with ME/CFS., Primary Funding Source: The Norwegian Research Council, Norwegian Regional Health Trusts, Kavli Trust, MEandYou Foundation, and Norwegian ME Association.
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- 2019
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146. The Role of Apathy and Depression on Verbal Learning and Memory Performance After Stroke.
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Fishman KN, Ashbaugh AR, Lanctôt KL, Cayley ML, Herrmann N, Murray BJ, Sicard M, Lien K, Sahlas DJ, and Swartz RH
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- Adolescent, Adult, Aged, Aged, 80 and over, Cognition, Depression complications, Female, Humans, Male, Mental Recall, Middle Aged, Neuropsychological Tests, Stroke complications, Young Adult, Apathy, Depression psychology, Memory, Stroke psychology, Verbal Learning
- Abstract
Objective: Psychiatric symptoms, including depression and apathy, may significantly impede functional and cognitive capabilities following a cerebrovascular event. This study examined the role of apathy and depression on learning and memory performance in stroke patients., Method: Stroke patients (n = 140 [119 ischemic, 21 hemorrhagic], mean age = 60.6 [SD = 15.1]) completed the Apathy Evaluation Scale (AES), the Center for Epidemiologic Studies Depression Scale (CES-D), and the California Verbal Learning Test-Second Edition (CVLT-II)., Results: Using a 2 × 2 MANOVA with depression (CESD ≥ 16) and apathy (AES ≥ 34) as the independent variables and cognitive performance (i.e., verbal acquisition, short-term free recall, and long-term free recall) as the dependent variables, we found a main effect for apathy (F[3,134] = 2.98, p = .034), such that apathetic stroke patients (n = 24) performed significantly worse on verbal acquisition (F[1,136] = 6.44; p = .012), short-term free recall (F[1,136] = 7.86; p = .006), and long-term free recall (F[1,136] = 8.37; p = .004) than nonapathetic stroke patients (n = 116). There was no main effect of depression on cognitive performance (F[1,136] = 1.72, p = .155)., Conclusions: These results suggest that apathy, not depression, is related to verbal memory performance in stroke patients. Future research should explore whether treatment of apathy (e.g., improving motivation) could be a novel target for improving cognition after stroke. Researchers should also examine whether this model can be applied to other aspects of cognition, including executive function and other areas of memory including autobiographical and working memory., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2019
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147. Toward a paradigm shift from deficit-based to proactive speech and language treatment: Randomized pilot trial of the Babble Boot Camp in infants with classic galactosemia.
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Peter B, Potter N, Davis J, Donenfeld-Peled I, Finestack L, Stoel-Gammon C, Lien K, Bruce L, Vose C, Eng L, Yokoyama H, Olds D, and VanDam M
- Subjects
- Child, Preschool, Communication, Humans, Infant, Parents, Pilot Projects, Galactosemias, Speech
- Abstract
Background: Speech and language therapy is typically initiated reactively after a child starts showing delays. Infants with classic galactosemia (CG), a metabolic disease with a known high risk for both speech and language disorders, hold the keys towards evaluating whether preventive treatment is effective when the risks are known at birth. We present pilot data from a randomized parallel trial of an innovative proactive speech and language intervention program, the Babble Boot Camp (BBC). Method : Five children with CG, otherwise healthy, participated in the study from approximately 2 to 24 months of age. One of these was randomly selected as control receiving conventional management, which typically starts at age 2-3 years. A pediatric speech-language pathologist met weekly via telepractice with the parents in the treatment cohort. Parents implemented the prespeech, speech, and language stimulation and expansion activities according to the intervention protocol. The control child was still too young for conventional treatment. Primary outcome measures were speech sound production complexity in babble and speech and expressive vocabulary size. Secondary outcome measures were vocalization rates and developmental milestones in communication, motor, and cognition. The trial is ongoing. Results : All four treated children had higher speech sound skills in babble, three had higher speech sound skills in meaningful speech, two had higher expressive vocabularies, three had higher global developmental scores, and two had higher vocalization rates, compared to the control child with CG. Discussion: Given the high risk for speech and language delays in children with CG, finding on-schedule abilities in two or more of the treated children but not the untreated child is unexpected under random conditions. The trends toward beneficial effects of the BBC on speech sound production, expressive language, and communication milestones warrant appropriately powered larger clinical trials with full randomization. Trial registration: ClinicalTrials.gov NCT03838016 (12
th February 2019)., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Peter B et al.)- Published
- 2019
- Full Text
- View/download PDF
148. Meta-synthesis of fathers' experiences raising children on the autism spectrum.
- Author
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Lashewicz BM, Shipton L, and Lien K
- Subjects
- Adult, Child, Humans, Male, Qualitative Research, Autism Spectrum Disorder, Child Rearing psychology, Fathers psychology
- Abstract
Parents raising children with autism have distinct experiences that influence their well-being, relationships, engagement with the public, and interaction with education and healthcare systems. However, experiences of fathers of children with autism have been largely overlooked by researchers. This meta-synthesis is our synthesis of qualitative accounts of fathers' experiences and we included peer reviewed and gray literature articles that: (1) reported primary qualitative research, (2) included fathers of children with autism as participants, and (3) reported qualitative findings on the first-hand experiences of fathers of children with autism. Studies were appraised for quality and many theoretical and methodological deficiencies identified. Six studies met quality appraisal criteria and three main themes of findings from these studies were generated: (1) adaptation and concern with the future, (2) the importance of cultural context, and (3) reverence for one's child and new opportunities. Fathers' experiences illuminate a need for father-oriented resources that recognize fathers' value in children's lives.
- Published
- 2019
- Full Text
- View/download PDF
149. Plasma Cell-Free DNA Next-Generation Sequencing to Diagnose and Monitor Infections in Allogeneic Hematopoietic Stem Cell Transplant Patients.
- Author
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Fung M, Zompi S, Seng H, Hollemon D, Parham A, Hong DK, Bercovici S, Dolan E, Lien K, Teraoka J, Logan AC, and Chin-Hong P
- Abstract
Allogeneic hematopoietic stem cell transplant patients are at risk for common and atypical infections. Superior diagnostics can decrease infection-related morbidity and mortality. A novel plasma cell-free DNA next-generation sequencing test detected an uncommon presentation of Chlamydia trachomatis and recurrent and metastatic complications of Staphylococcus aureus bacteremia before standard microbiology.
- Published
- 2018
- Full Text
- View/download PDF
150. Overgangen fra digitoksin til digoksin i årene 2011–13.
- Author
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Lien K, Spigset O, Westin AA, and Slørdal L
- Subjects
- Adult, Aged, Aged, 80 and over, Anti-Arrhythmia Agents administration & dosage, Anti-Arrhythmia Agents adverse effects, Digitoxin administration & dosage, Digitoxin adverse effects, Digoxin administration & dosage, Digoxin adverse effects, Drug Monitoring, Drug and Narcotic Control, Female, Humans, Male, Middle Aged, Norway, Anti-Arrhythmia Agents blood, Digitoxin blood, Digoxin blood, Drug Substitution adverse effects
- Abstract
Background: The withdrawal of digitoxin and subsequent substitution with digoxin around 2012 may have led to an increased health risk for patients. The aim of this study was to follow individual patients during the switch., Material and Method: Serum concentrations of digitoxin and digoxin, measured at the Department of Clinical Pharmacology at St Olavs University Hospital in the period 1 January 2011-31 December 2013 were reviewed. Patients who had switched from digitoxin to digoxin and whose serum concentrations of both drugs had been measured during this period were included., Results: A total of 304 patients, 1686 samples and 1858 serum concentration analyses were included in the study. Therapeutic serum concentrations were measured in 171 patients (56.3 %) before the switch and 176 (57.9 %) after this had taken place. Altogether 108 patients (35.5 %) had therapeutic concentrations both before and after the change. For 58.9 % of the patients, the change resulted in a reduction in serum concentration of digitalis, calculated as digoxin equivalents. The proportion of patients with assumed supratherapeutic concentrations fell from 43.1 % to 33.9 %; however, the proportion of patients with toxic serum concentrations rose from 0.3 % to 3.0 %., Interpretation: Although the switch led to a reduction in dose and serum concentration for many, a significant number of patients may have been put in harm's way.
- Published
- 2018
- Full Text
- View/download PDF
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