Search

The discovery of ketamine as a rapid and robust antidepressant marks the beginning of a new era in the treatment of psychiatric disorders. Ketamine is thought to produce rapid and sustained antidepressant effects through restoration of lost synaptic connections. We investigated this hypothesis in humans for the first time using positron emission tomography (PET) and [

Objective This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). Study Design Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case–control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (20 pounds) versus aGWG (11–20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. Results A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. Conclusion Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. Key Points

Objectives: A nutrition support program for ovarian cancer patients via early consultation with a registered dietician was developed in 2016 at our institution. The initial goal of our nutrition support program was focused on optimizing nutrition counseling for patients receiving NACT, though it has been broadened to include the majority of newly diagnosed ovarian cancer patients. Follow-up visits are patient-initiated. We sought to evaluate outcomes of consultation in these patients to identify how to improve the program and better meet patient needs. Methods: We retrospectively reviewed data from ovarian cancer patients receiving chemotherapy at our institution who ≥1 consult with a registered dietician from 12/2016-5/2020. We reviewed weight at baseline (time of initial consult) and at 6 months and baseline albumin. Patients were categorized using body mass index (BMI) as underweight (BMI Results: 227 patients were included; 216 were actively receiving chemotherapy and 11 were initiating chemotherapy. There were 113 (50%) receiving NACT. Average age was 62 (range 20-92), 44 (19%) patients were BlackBlack, and average baseline BMI was 28 (range 16-55). At initial consultation, 6 (3%) patients were underweight, 73 (32%) were normal weight, 73 (32%) were overweight, and 75 (33%) were obese. Table 1 details weight change data in patients with 6-month weight follow-up. The average weight change from baseline to 6m was -1.67 kg for underweight, -0.27 kg for normal weight, -0.16 kg for overweight, and -1.6 kg for obese patients. Among 116 patients receiving NACT, an initial albumin level was recorded in 83 patients (average 3.8). In 108 patients who underwent primary debulking surgery, initial albumin was obtained in 66 patients (average 3.9). Most patients (180/227, 79%) had a single nutrition consult. Of 47 patients who had at least one follow-up visit, 34 (72%) were receiving NACT. Follow-up visits were problem focused and primarily conducted in-person except for 3 telephone follow-up visits. Review of visit documentation identified several themes, including poor appetite, concerns about weight, and symptom management. Download : Download high-res image (92KB) Download : Download full-size image Conclusions: Given the large proportion of obese patients in our cohort, weight goals (maintain, lose, gain) differ based on patient BMI. Average baseline albumin was similar between patients receiving NACT versus primary debulking surgery and has an unclear role as it was inconsistently followed and can be modified by multiple variables. As more patients who received NACT had patient-initiated follow-up visits, implementing scheduled follow-up for this group of patients would more proactively address a population to improve symptom management.

Between December 2005 and October 2009, FDA approved six targeted therapies shown to significantly extend survival for advanced renal cell carcinoma (RCC) patients in clinical trials. This study aimed to examine changes in survival between the pretargeted and targeted therapy periods in advanced RCC patients in a real‐world setting. Utilizing the 2000–2010 SEER Research files, a pre–post study design with a contemporaneous comparison group was employed to examine differences in survival outcomes for patients diagnosed with advanced RCC (study group) or advanced prostate cancer (comparison group, for whom no significant treatment innovations happened during this period) across the pretargeted therapy era (2000–2005) and the targeted therapy era (2006–2010). RCC patients diagnosed in the targeted therapy era (N = 6439) showed improved survival compared to those diagnosed in the pretargeted therapy era (N = 7231, hazard ratio (HR) for all‐cause death: 0.86, P

The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.

This thesis utilised an exploratory multicase study design to examine aged care in Australia in a shifting policy environment. Using an interpretive approach, this thesis explored the provision of aged care as socially constructed and influenced by multiple factors serving as drivers and barriers extending to the service delivery level. In a broad sense, shifting aged care policy corresponds to observable changes in the aged care context, in which the operation or delivery of aged care is reconstructing the social world of those engaged in it and transforming how aged care currently operates in Australia.

Objective: The purpose was to assess factors potentially affecting care pharmacists provide to HIV/AIDS patients including comfort level, confidence, education, experience, professional competence, continuity of care and patient-provider relationship between pharmacists and HIV-infected patients. Methods: A 24-item questionnaire assessed the constructs of this study. Surveys were distributed from October 2009 to April 2010 to pharmacists in Alabama with varying levels of experience treating HIV-infected patients. Chi-square tests determined whether relationships existed between responses, consisting of how often respondents reported treating HIV-infected patients, amount of HIV education respondents had, participants' confidence with HIV/AIDS knowledge and comfort level counseling HIV-infected patients about their medications. Results: Thirty-three percent of the pharmacists cared for HIV-infected patients on a monthly basis, yet 86% do not feel very confident with their HIV/AIDS knowledge. Forty-four percent were not comfortable counseling patients on antiretroviral medications, and 77% would feel more comfortable with more education. Significant, positive relationships were revealed concerning how often respondents treat HIV-infected patients and their comfort level counseling them (r=0.208, p

Introduction The current standard to assess chemotherapy tolerability relies on patient self-reporting. However, as the sole mechanism of managing symptom burden, this may be inconsistent and fraught with bias. Mobile wearable health devices have the ability to monitor and aggregate objective activity and sleep data over long periods of time, but have not been systematically used in the oncology clinic. The aim of the study was to assess whether the use of mobile wearable technology establishes patterns of "sleep" and "wake" states in newly diagnosed Multiple Myeloma (NDMM) patients receiving therapy, and whether these patterns differ over time. Methods Patients presenting to the myeloma clinic at Memorial Sloan Kettering Cancer Center (MSKCC) with a new diagnosis of Multiple Myeloma and smart phone or tablet (iOS or Android) compatible with the Garmin Vivofit device were offered to participate in a mobile wearable bio-monitoring study. All eligible participants were required to receive primary chemotherapy treatment at a MSKCC facility. Treatment was determined by physician. NDMM patients were assigned to one of two cohorts (20 in each; Cohort A - patients Results Between February 2017-March 2018, 37 patients (19 males and 18 females) enrolled onto the study, with 20 in cohort A and 17 in cohort B. The mean age was 55 years (range 41-64) for cohort A and 72 years (range 65-82) for cohort B. Treatment regimens included Carfilzomib/Revlimid/Dexamethasone 14(38%), Velcade/Revlimid/Dexamethasone 10(27%), Daratumumab/Carfilzomib Revlimid/Dexamethasone, 7(19%), Cyclophosphamide/Velcade/Dexamethasone 3(8%), Revlimid/Dexamethasone 2(5%), and Velcade/Revlimid/Dexamethasone-Lite 1(3%). Twenty-four patients have completed the trial, and 7 remain active. Six patients came off-study due to the following reasons: lost devices (n=4), intolerable rash during cycle 3 (n=1), and incompletion of baseline activity (n=1). Three patients were excluded for incomplete data sets with no baseline data collection at the time of analysis. Fifteen patients were available for data review including 10 in cohort A and 5 in cohort B. Mean activity for cohort A was 6,437 steps/24 hr period (1,002 - 12,754) versus for cohort B was 3,218.37 steps/24 hr period (387 - 6,155) (p 100% increase, 1 patient had 50-100% increase, and 11 patients had within +/- 50% change in activity from baseline. Conclusion Electronic mobile wearable device monitoring in symptomatic NDMM patients may be a useful tool to assess a patient's overall wellness and health as they are receiving chemotherapy. For three patients, we were able to capture a dramatic increase in activity after initiation of treatment. Overall activity in the elderly NDMM patients is decreased compared to younger patients. Mobile wearable monitoring may be an even more useful strategy for tracking elderly and unfit patients that are more prone to side effects, where the balance of response versus quality of life is paramount. Figure. Figure. Disclosures Mailankody: Physician Education Resource: Honoraria; Janssen: Research Funding; Takeda: Research Funding; Juno: Research Funding. Hassoun:Oncopeptides AB: Research Funding. Lesokhin:Squibb: Consultancy, Honoraria; Serametrix, inc.: Patents & Royalties: Royalties; Janssen: Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Genentech: Research Funding; Takeda: Consultancy, Honoraria. Smith:Celgene: Consultancy, Patents & Royalties: CAR T cell therapies for MM, Research Funding. Shah:Amgen: Research Funding; Janssen: Research Funding. Landgren:Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Research Funding; Pfizer: Consultancy; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding; Merck: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy. Korde:Amgen: Research Funding.

Adults reason by exclusivity to identify the meanings of novel words. However, it is debated whether, like children, they extend this strategy to disambiguate other referential expressions (e.g., facts about objects). To further inform this debate, this study tested 41 adults on four conditions of a disambiguation task: label/label, fact/fact, label/fact, and fact/label (Scofield & Behrend, 2007). Participants also provided a verbal explanation for their referent selections to tease apart the underlying processes. Results indicated that adults successfully discerned the target object in the label/label and label/fact condition, yet not the remaining two conditions. Verbal reports indicated that the strategy utilized to disambiguate differed depending upon communicative context. These findings confirm that the tendency to reason by exclusivity becomes restricted to word-learning situations with growing linguistic and communicative experience.

This theoretical paper examines current practice in work‐based studies where recognition of prior unaccredited work is normally limited to around 50% of the total programme. The basis of this limiting concept is challenged and consideration is given to a number of factors that have contributed to it. Comparison is made with the current practice of awarding Ph.D.s by previously published work and a model is proposed to facilitate the creation of a postgraduate work‐based award completely by previously completed practice in the workplace. A number of key points are examined in relation to evaluating the model and to illuminating assessment and measurement of the previous work for 100% recognition within a work‐based programme.

Reflective practice is seen as the way forward for both students and academics alike and there is much research that shows that reflective practice leads to better learning. This article, whilst acknowledging that reflective practice is something to which we should strive, recognizes that there are many other considerations that will have to be dealt with by the sector before its use will be universally accepted. The main consideration, probably more than anything else, is the demotivated staff within the higher education environment. It is suggested that this de-motivation occursbecause of lack of resources, lack of recognition, overwork and lack of appreciation of the additional burdens put on academics, and invariably the institutions themselves, by widening participation and lifelong learning initiatives. Therefore, it is suggested that universal reflective practice may come in the longterm but only once the deeper-seated problems within the sector are resolved.

We discuss America's Army, an Internet-based PC game suite developed by the Moves Institute under the auspices of the US Army. The goal within America's Army: Operations was to demonstrate life in the infantry. America's Army: Soldiers was conceived as a realistic look at army personal and career opportunities via sophisticated role-playing.

Study objectives: To investigate whether differing airway interleukin (IL)-18 levels may be implicated in the pathogenesis of asthma and sarcoidosis. Setting: University teaching hospital. Patients and methods: IL-18 levels were measured in BAL fluid and in the supernatant of lipopolysaccharide (LPS)-stimulated alveolar macrophages obtained by BAL from 15 patients with sarcoidosis, 11 patients with asthma, and 13 healthy subjects. We also examined the relationship between IL-18 levels and macrophage and lymphocyte concentrations in BAL fluid. IL-18 was measured using an in-house enzyme-linked immunosorbent assay. Results: IL-18 levels were significantly lower in BAL fluid from patients with asthma (median, 0.0 pg/mL; interquartile range, 0.0 to 0.0 pg/mL) compared to patients with sarcoidosis (median, 222.0 pg/10 6 ; interquartile range, 110 to 340 pg/mL; p 0.009, Mann Whitney rank-sum test) and healthy control subjects (median, 162 pg/mL; interquartile range, 38 to 203 pg/mL; p 0.025, Mann Whitney rank-sum test). Individual analyses comparing IL-18 levels with BAL macrophage counts, and IL-18 with lymphocyte counts in the three groups showed no correlation between these indexes. The mean levels of IL-18 in unstimulated macrophage supernatants were 410 pg/10 6 cells for patients with asthma, 723.4 pg/10 6 cells for patients with sarcoidosis, and 734.8 pg/10 6 cells for healthy control subjects (p > 0.05). Stimulated macrophages from patients with sarcoidosis responded with increasing amounts of IL-18 at lower doses of LPS than macrophages from healthy control subjects or patients with asthma. Conclusion: Our findings suggest that inherently low levels of IL-18 may be associated with the pathogenesis of asthmatic airway inflammation. (CHEST 2002; 121:1421–1426)

This chapter reviews the epidemiological features of the global dissemination of multiresistant Salmonella enterica serovar typhimurium DT104, discusses the possible origins of this clone, hypothesizes about the possible mechanisms by which rapid global dissemination and displacement of other clones may have occurred, and discusses possible means of control. The clonal nature of mr-DT104 is well established by the genetics of antimicrobial resistance and by restriction fragment length polymorphism analyses. Nosocomial salmonellosis associated with nontyphoidal salmonellae occurs in some developing countries. Four hypothetical models are discussed with respect to their ability to explain the ecological characteristics typical of the agent. These models include: model 1: the enlarged niche hypothesis, model 2: the dissemination fitness hypothesis, model 3: the chance dissemination event hypothesis and model 4: the selection focus hypothesis. To date, the discussion of control efforts for mr-DT104 and similar clones has been limited primarily to debates on the use of antimicrobials in livestock, notably subtherapeutic antimicrobials. The epidemiology of multiresistant serovar Typhimurium is not confined by national borders but is global in nature, as well illustrated by mr-DT104. The available evidence indicates that these efforts should center on selection foci, such as calf-raising operations, which serve as reservoirs of serovar Typhimurium and as sites for clonal competition among epidemic multiresistant strains.

A survey was designed to determine how willingly patients reveal personal health information on dental health history forms. After giving informed consent, 107 patients at a university dental hygiene program completed a 10-item survey privately and anonymously. The results suggest that a significant number of patients provide inaccurate or incomplete information to questions routinely asked on the dental health history form.

The MOVES Institute's mission is research, application,and education in the grand challenges of modeling, virtualenvironments, and simulation. Specialties are 3D visualsimulation, networked virtual environments, computer-generatedautonomy, human-performance engineering,immersive technologies, defense /entertainmentcollaboration, and evolving operational modeling.

in W.B. Rouse and K.R. Boff (Eds.) Organizational Simulation: From Modeling & Simulation to Games & Entertainment, New York: Wiley Press, 2005,pp., ISBN 0471681636.

To address disproportionately high rates of diabetes morbidity and mortality in some of Chicago's medically underserved minority neighborhoods, a group of community residents, medical and social service providers, and a local university founded the Chicago Southeast Diabetes Community Action Coalition, a Centers for Disease Control and Prevention REACH 2010 Initiative. A community-based participatory action research model guided coalition activities from conceptualization through implementation. Capacity building activities included training on: diabetes, coalition building, research methods, and action planning. Other activities sought to increase coalition members' understanding of the social causes and potential solutions for health disparities related to diabetes. Trained coalition members conducted epidemiologic analyses, focus groups, a telephone survey, and a community inventory. All coalition members participated in decisions. The participatory process led to increased awareness of the complexities of diabetes in the community and to a state of readiness for social action. Data documented disparities in diabetes. The participatory action research approach (a) encouraged key stakeholders outside of the health care sector to participate (e.g., business sector, church groups); (b) permitted an examination of the sociopolitical context affecting the health of the community; (c) provided an opportunity to focus on preventing the onset of diabetes and its complications; (d) increased understanding of the importance of community research in catalyzing social action aimed at community and systems change and change among change agents.

If you go strictly by the number of young adults playing it at all hours, it's a success. But how does America's Army, the US Army's free PC game strategic communications tool, fare in the real world of costs and benefits? The answer is gratifying and the quality is award winning.

in Design Research: Methods and Perspectives, edited by Brenda Laurel, MIT Press, 1 October 2003, ISBN 0262122634, pp. 268-275. Original non-scanned.

The nucleoside adenosine has been implicated in angiogenesis. A previous study demonstrated that activation of the A(2B) adenosine receptor (AdoR) increases cAMP accumulation, cell proliferation, and VEGF expression in human retinal endothelial cells (HRECs). In the present study, the role of this receptor was further characterized by examination of the effects of the selective A(2B) AdoR antagonists 3-N-propylxanthine (enprofylline) and 3-isobutyl-8-pyrrolidinoxanthine (IPDX) on AdoR-mediated HREC proliferation, capillary tube formation, and signal-transduction pathways.HRECs were exposed to the adenosine analogue 5'-N-ethylcarboxamido-adenosine (NECA) in the absence or presence of AdoR antagonists. Migration was measured using Boyden chambers. Proliferation was assessed by counting cells. Western analysis was used to assess extracellular signal-related kinase (ERK) and cAMP response element-binding protein (CREB) in cell lysates. The effect of AdoR activation on tube formation was studied using cells grown on a synthetic basement membrane matrix.NECA induced proliferation in a concentration-dependent manner that was inhibited by enprofylline and IPDX. NECA stimulated chemotaxis in a concentration-dependent manner that was also blocked by both A(2B) AdoR antagonists. NECA activated ERK and CREB in HRECs. Both A(2B) AdoR antagonists diminished activation of ERK by NECA exposure. ERK activation was also blocked by the ERK-mitogen-activated protein kinase (MAPK) inhibitor PD98059, but not by the protein kinase A (PKA) inhibitor H-89. CREB activation was blocked by H-89, but not by PD98059, suggesting that ERK activation is independent of PKA. NECA enhanced tube formation on the matrix, whereas both A(2B) AdoR antagonists attenuated this effect.The selective A(2B) AdoR antagonists, enprofylline and IPDX, inhibited NECA-stimulated proliferation, ERK activation, cell migration, and capillary tube formation. A(2B) AdoR inhibition may offer a way to inhibit retinal angiogenesis and provide a novel therapeutic approach to treatment of diseases associated with aberrant neovascularization, such as diabetic retinopathy and retinopathy of prematurity.

An oxidant/antioxidant imbalance has been proposed in patients with idiopathic pulmonary fibrosis (IPF). We tested this hypothesis by measuring various parameters of the oxidant/antioxidant balance in the plasma of 12 patients with IPF (7 nonsmokers and 5 smokers); in the bronchoalveolar lavage fluid (BALF) of 24 patients with IPF (17 nonsmokers and 7 smokers) and 31 healthy subjects (23 nonsmokers and 8 smokers). The trolox equivalent antioxidant capacity (TEAC) in plasma and BALF was lower in nonsmoking patients with IPF (plasma 0.55+/-0.1 mM, p

Cet article demontre l’utilite et les specificites du travail en entretien psychologique avec un interprete. L’introduction d’une troisieme personne dans un travail habituellement realise a deux cree une situation nouvelle, non depourvue de difficultes mais qui s’avere tres riche en decouvertes et en enseignements cliniques capables de changer notre vision de la communication qui peut exister entre langues et cultures differentes.

An electro-acoustic transducer comprises first and second panels (18A,18B) each of which can be vibrated to generate sound, a frame (10) for mounting the panels, and first and second seals (20A,B) arranged between the frame and the edges of the panels for holding the panels in the frame, substantially isolating the frame acoustically from the edges of the panel, and substantially sealing the frame to the edges of the panel. One or more actuators (22), such as piezoelectric elements, are provided for receiving a driving signal and vibrating in response thereto, and the actuators are mechanically and acoustically coupled to the first panel at one or more locations remote from the edges of the first panel so that the first panel vibrates in response to vibration of the actuators. The second panel is mechanically and acoustically coupled to the first panel and/or to the actuators at one or more locations remote from the edges of the second panel so that the second panel also vibrates in response to vibration of the actuator means. The acoustic properties of the panels, the seals, the actuators and the couplings can be chosen to obtain a required frequency response from the transducer. Different embodiments are described in which the panels are driven in phase, in anti-phase, and in a more complex manner.

When we began our careers, good science consisted of two basic activities: (i) doing first-rate research and (ii) publishing it in the technical literature for the benefit of scientific colleagues. We firmly believe that a third activity must now be added by all scientists: (iii) informing the general public (and, especially, taxpayers) of the relevance and importance of our work. We are convinced that this applies to even the most esoteric of “basic” research, because understanding how the world works is fundamental to both satisfying natural human curiosity and solving the human predicament. As ecologists, we further contend that, because of the central role ecology must play in resolving the predicament, the structure of rewards in our discipline must be changed. Now all field research is done in systems altered by Homo sapiens , and the degree of disturbance is increasing rapidly virtually everywhere. Sadly, in our countries of origin, even areas nominally designated to preserve biodiversity are to a large extent inadequately inventoried, monitored, and protected. There are many tasks in support of just those areas that can and should be carried out or aided by academic ecologists, and career incentives need to be developed to achieve this. Furthermore, incentives need to be found to promote interdisciplinary involvement of young ecologists, because so many of society's greatest challenges lie at the interface of ecology and the social sciences. In our view, it is necessary to train students in ecology who will be ready and willing to devote part of their professional lives to stemming the tide of environmental degradation and the associated losses of biodiversity and its ecological services, and to teaching the public about the importance of those losses. We believe that such efforts should be rewarded as part of the process by which ecologists are considered for academic posts, granted tenure in universities, elected to membership in learned societies, and so on. Ecology is a discipline with a time limit, because much of what we study, upon which society is dependent, is fast disappearing. Ecologists have a responsibility to humanity, one that we are not yet discharging adequately. It is incumbent on senior ecologists to take the lead in pressing for the needed transformation—and we pledge ourselves to that task.