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Bridging the gap: opportunities for transitions of care pharmacist review of outpatient parenteral antimicrobial therapy prescriptions prior to hospital discharge
- Sara Stashluk, Michelle Ramos, Tyla Carettini, James B. Cutrell, Seana Mathew, Marguerite Monogue, Jennifer Nguyen, James M. Sanders, Esther Y. Golnabi
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 4 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 18 April 2024, e50
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Purpose:
Pharmacist-led initiatives providing optimization of medications during transitions of care (TOC) have shown to have a positive impact on prescribing practices and patient outcomes. This study aims to evaluate the role and impact of TOC pharmacist review of outpatient parenteral antimicrobial therapy (OPAT) prescriptions prior to hospital discharge.
Methods:In a retrospective chart review, patients with OPAT prescriptions between November 1, 2022 and January 31, 2023 were evaluated using prescription-specific and intervention-specific data points. Prescription-specific data points included intravenous antimicrobials prescribed, indication, prescribing team, and time from OPAT prescription to TOC pharmacist review. Intervention-specific data points included antimicrobial optimization (dose/frequency, duration, and other), prescription clarification, and laboratory monitoring.
Results:Of the 137 OPAT prescriptions evaluated, 67 required intervention by TOC pharmacists (48.9%). The General Infectious Disease Consult team placed 71.5% of OPAT prescriptions and required interventions less frequently (42.9%) compared to the other teams. Antimicrobial optimization interventions accounted for 54.2% of interventions, which were primarily related to medication dose and frequency.
Conclusion:The TOC pharmacists can play a key role in the evaluation of OPAT prescriptions at hospital discharge. This intervention demonstrated how TOC pharmacists can effectively collaborate with the OPAT team, which builds on prior evidence of the role and value of pharmacists in the transitional care setting.
Predictors of Mechanical Ventilation in Guillain–Barré Syndrome with Axonal Subtypes
- Anaclara Michel-Chávez, Erwin Chiquete, Alfonso Gulías-Herrero, Diego Luis Carrillo-Pérez, Antonio Olivas-Martínez, Julio Macías-Gallardo, José de Jesús Aceves-Buendía, Eduardo Ruiz-Ruiz, Tatiana Bliskunova, Jennefer Portillo-Valle, Rafael Cobilt-Catana, Jorge Alberto Ortiz-Quezada, Salvador Durán-Coyote, Elizabeth Rodríguez-Perea, Emmanuel Aguilar-Salas, Carlos Cantú-Brito, Guillermo García-Ramos, Bruno Estañol
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 50 / Issue 2 / March 2023
- Published online by Cambridge University Press:
- 22 February 2022, pp. 221-227
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Background:
The early clinical predictors of respiratory failure in Latin Americans with Guillain–Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis.
Methods:We studied 86 Mexican patients with GBS admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV).
Results:The median age was 40 years (interquartile range: 26–53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors.
Conclusion:These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.
Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
- Sarah Sansom, Michael Lin, Christine Fukuda, Teppei Shimasaki, Thelma Dangana, Nicholas Moore, Rachel Yelin, Yoona Rhee, Lina Tabith, Jianrong Sheng, Enrique Cornejo Cisneros, John Murray, Kyle Chang, Karen Lolans, Michelle Ariston, William Rotunno, Hazel Ramos, Haiying Li, Khaled Aboushaala, Naomi Iwai, Christine Bassis, Vincent Young, Mary Hayden
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s28
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Background: Identification of hospitalized patients with enteric multidrug-resistant organism (MDRO) carriage, combined with implementation of targeted infection control interventions, may help reduce MDRO transmission. However, the optimal surveillance approach has not been defined. We sought to determine whether daily serial rectal surveillance for MDROs detects more incident cases (acquisition) of MDRO colonization in medical intensive care unit (MICU) patients than admission and discharge surveillance alone. Methods: Prospective longitudinal observational single-center study from January 11, 2017, to January 11, 2018. Inclusion criteria were ≥3 consecutive MICU days and ≥2 rectal or stool swabs per MICU admission. Daily rectal or stool swabs were collected from patients and cultured for MDROs, including vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacterales (CRE), third-generation cephalosporin-resistant Enterobacterales (3GCR), and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) (as a subset of 3GCR). MDRO detection at any time during the MICU stay was used to calculate prevalent colonization. Incident colonization (acquisition) was defined as new detection of an MDRO after at least 1 prior negative swab. We then determined the proportion of prevalent and incident cases detected by daily testing that were also detected when only first swabs (admission) and last swabs (discharge) were tested. Data were analyzed using SAS version 9.4 software. Results: In total, 939 MICU stays of 842 patients were analyzed. Patient characteristics were median age 64 years (interquartile range [IQR], 51–74), median MICU length of stay 5 days (IQR, 3–8), median number of samples per admission 3 (IQR, 2–5), and median Charlson index 4 (IQR, 2–7). Prevalent colonization with any MDRO was detected by daily swabbing in 401 stays (42.7%). Compared to daily serial swabbing, an admission- and discharge-only approach detected ≥86% of MDRO cases (ie, overall prevalent MDRO colonization). Detection of incident MDRO colonization by an admission- or discharge-only approach would have detected fewer cases than daily swabbing (Figure 1); ≥34% of total MDRO acquisitions would have been missed. Conclusions: Testing patients upon admission and discharge to an MICU may fail to detect MDRO acquisition in more than one-third of patients, thereby reducing the effectiveness of MDRO control programs that are targeted against known MDRO carriers. The poor performance of a single discharge swab may be due to intermittent or low-level MDRO shedding, inadequate sampling, or transient MDRO colonization. Additional research is needed to determine the optimal surveillance approach of enteric MDRO carriage.
Funding: No
Disclosures: None
Figure 1.
Prevalence of coronavirus disease 2019 (COVID-19) among healthcare professionals working in hospital emergencies during the first-wave peak in 2020 in Porto Alegre, Brazil
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- Ana Luisa F. Dubiela, Daiane F. Dalla Lana, Ana Paula K. Aerts, Cristiani G. de Marques, Renato Cassol, Micheline G. Dalarosa, Vanessa Schultz, Fabiano Ramos, Isabelli Guasso, Fabio F. Dantas Filho, Silvana T. Dal Ponte, João Carlos B. Santana, Michelle D. Santarem, Morgana P. de Camargo, Maria Luiza P. Machado, Teresa Cristina T. Sukiennik, Guilherme Watte, Antonio N. Kalil, Alessandro C. Pasqualotto
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 7 / July 2022
- Published online by Cambridge University Press:
- 29 March 2021, pp. 956-957
- Print publication:
- July 2022
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Fluid–solid Floquet stability analysis of self-propelled heaving foils
- Luis Benetti Ramos, Olivier Marquet, Michel Bergmann, Angelo Iollo
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- Journal of Fluid Mechanics / Volume 910 / 10 March 2021
- Published online by Cambridge University Press:
- 13 January 2021, A28
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We investigate the role of linear mechanisms in the emergence of nonlinear horizontal self-propelled states of a heaving foil in a quiescent fluid. Two states are analysed: a periodic state of unidirectional motion and a quasi-periodic state of slow back and forth motion around a mean horizontal position. The states emergence is explained through a fluid–solid Floquet stability analysis of the non-propulsive symmetric base solution. Unlike a purely hydrodynamic analysis, our analysis accurately determines the locomotion states onset. An unstable synchronous mode is found when the unidirectional propulsive solution is observed. The obtained mode has a propulsive character, featuring a mean horizontal velocity and an asymmetric flow that generates a horizontal force accelerating the foil. An unstable asynchronous mode, also featuring flow asymmetry and a non-zero velocity, is found when the back and forth state is observed. Its associated complex multiplier introduces a slow modulation of the flapping period, agreeing with the quasi-periodic nature of the back and forth regime. The temporal evolution of this perturbation shows how the horizontal force exerted by the flow is alternatively propulsive or resistive over a slow period. For both modes, an analysis of the velocity and force perturbation time-averaged over the flapping period is used to establish physical instability criteria. The behaviour for a large solid-to-fluid density ratio of the modes is thus analysed. The asynchronous fluid–solid mode converges towards the purely hydrodynamic one, whereas the synchronous mode becomes marginally unstable in our analysis not converging to the purely hydrodynamic analysis where it is never destabilised.
Lessons learned about harmonizing survey measures for the CSER consortium
- Katrina A.B. Goddard, Frank A.N. Angelo, Sara L. Ackerman, Jonathan S. Berg, Barbara B. Biesecker, Maria I. Danila, Kelly M. East, Lucia A. Hindorff, Carol R. Horowitz, Jessica Ezzell Hunter, Galen Joseph, Sara J. Knight, Amy McGuire, Kristin R. Muessig, Jeffrey Ou, Simon Outram, Elizabeth J. Rahn, Michelle A. Ramos, Christine Rini, Jill O. Robinson, Hadley Stevens Smith, Margaret Waltz, Sandra Soo-Jin Lee
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue 6 / December 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 537-546
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Introduction:
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
Methods:A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Results:Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
Conclusions:In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
Sleep quality mediates the relationship between frailty and cognitive dysfunction in non-demented middle aged to older adults
- Sonya Kaur, Nikhil Banerjee, Michelle Miranda, Mitchell Slugh, Ni Sun Suslow, Katalina F. McInerney, Xiaoyan Sun, Alberto Ramos, Tatjana Rundek, Ralph L. Sacco, Bonnie E. Levin
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- Journal:
- International Psychogeriatrics / Volume 32 / Issue 5 / May 2020
- Published online by Cambridge University Press:
- 17 February 2020, p. 663
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Sleep quality mediates the relationship between frailty and cognitive dysfunction in non-demented middle aged to older adults
- Sonya Kaur, Nikhil Banerjee, Michelle Miranda, Mitchell Slugh, Ni Sun-Suslow, Katalina F. McInerney, Xiaoyan Sun, Alberto R. Ramos, Tatjana Rundek, Ralph L. Sacco, Bonnie E. Levin
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- International Psychogeriatrics / Volume 31 / Issue 6 / June 2019
- Published online by Cambridge University Press:
- 22 April 2019, pp. 779-788
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Objectives:
Frailty is associated with cognitive decline in older adults. However, the mechanisms explaining this relationship are poorly understood. We hypothesized that sleep quality may mediate the relationship between frailty and cognition.
Participants:154 participants aged between 50-90 years (mean = 69.1 years, SD = 9.2 years) from the McKnight Brain Registry were included.
Measurements:Participants underwent a full neuropsychological evaluation, frailty and subjective sleep quality assessments. Direct relationships between frailty and cognitive function were assessed using linear regression models. Statistical mediation of these relationships by sleep quality was assessed using nonparametric bootstrapping procedures.
Results:Frailty severity predicted weaker executive function (B = −2.77, β = −0.30, 95% CI = −4.05 – −1.29) and processing speed (B = −1.57, β = −0.17, 95% CI = −3.10 – −0.16). Poor sleep quality predicted poorer executive function (B = −0.47, β = −0.21, 95% CI = −0.79 – −0.08), processing speed (B = −0.64, β = −0.28, 95% CI = −0.98 – −0.31), learning (B = −0.42, β = −0.19, 95% CI = −0.76 – −0.05) and delayed recall (B = −0.41, β = −0.16, 95% CI = −0.80 – −0.31). Poor sleep quality mediated the relationships between frailty severity and executive function (B = −0.66, β = −0.07, 95% CI = −1.48 – −0.39), learning (B = −0.85, β = −0.07, 95% CI = −1.85 – −0.12), delayed recall (B = −0.47, β = −0.08, 95% CI = −2.12 – −0.39) and processing speed (B = −0.90, β = −0.09, 95% CI = −1.85 – −0.20).
Conclusions:Relationships between frailty severity and several cognitive outcomes were significantly mediated by poor sleep quality. Interventions to improve sleep quality may be promising avenues to prevent cognitive decline in frail older adults.
High-through identification of T cell-specific phage-exposed mimotopes using PBMCs from tegumentary leishmaniasis patients and their use as vaccine candidates against Leishmania amazonensis infection
- Gerusa B. Carvalho, Lourena E. Costa, Daniela P. Lage, Fernanda F. Ramos, Thaís T. O. Santos, Patrícia A. F. Ribeiro, Daniel S. Dias, Beatriz C. S. Salles, Mariana P. Lima, Lívia M. Carvalho, Ana C. S. Dias, Patrícia T. Alves, Michelle L. Franklin, Renata A. M. Silva, Mariana C. Duarte, Daniel Menezes-Souza, Bruno M. Roatt, Miguel A. Chávez-Fumagalli, Luiz Ricardo Goulart, Antonio L. Teixeira, Eduardo A. F. Coelho
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- Parasitology / Volume 146 / Issue 3 / March 2019
- Published online by Cambridge University Press:
- 10 September 2018, pp. 322-332
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In the current study, phage-exposed mimotopes as targets against tegumentary leishmaniasis (TL) were selected by means of bio-panning cycles employing sera of TL patients and healthy subjects, besides the immune stimulation of peripheral blood mononuclear cells (PBMCs) collected from untreated and treated TL patients and healthy subjects. The clones were evaluated regarding their specific interferon-γ (IFN-γ) and interleukin-4 (IL-4) production in the in vitro cultures, and selectivity and specificity values were calculated, and those presenting the best results were selected for the in vivo experiments. Two clones, namely A4 and A8, were identified and used in immunization protocols from BALB/c mice to protect against Leishmania amazonensis infection. Results showed a polarized Th1 response generated after vaccination, being based on significantly higher levels of IFN-γ, IL-2, IL-12, tumour necrosis factor-α (TNF-α) and granulocyte-macrophage colony-stimulating factor (GM-CSF); which were associated with lower production of specific IL-4, IL-10 and immunoglobulin G1 (IgG1) antibodies. Vaccinated mice presented significant reductions in the parasite load in the infected tissue and distinct organs, when compared with controls. In conclusion, we presented a strategy to identify new mimotopes able to induce Th1 response in PBMCs from TL patients and healthy subjects, and that were successfully used to protect against L. amazonensis infection.
Antigenicity, immunogenicity and protective efficacy of a conserved Leishmania hypothetical protein against visceral leishmaniasis
- Daniel S. Dias, Vívian T. Martins, Patrícia A. F. Ribeiro, Fernanda F. Ramos, Daniela P. Lage, Grasiele S. V. Tavares, Débora V. C. Mendonça, Miguel A. Chávez-Fumagalli, Jamil S. Oliveira, Eduardo S. Silva, Dawidson A. Gomes, Michele A. Rodrigues, Mariana C. Duarte, Alexsandro S. Galdino, Daniel Menezes-Souza, Eduardo A. F. Coelho
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- Parasitology / Volume 145 / Issue 6 / May 2018
- Published online by Cambridge University Press:
- 08 November 2017, pp. 740-751
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In this study, a Leishmania hypothetical protein, LiHyS, was evaluated regarding its antigenicity, immunogenicity and protective efficacy against visceral leishmaniasis (VL). Regarding antigenicity, immunoblottings and an enzyme-linked immunosorbent assay using human and canine sera showed high sensitivity and specificity values for the recombinant protein (rLiHyS) in the diagnosis of VL. When evaluating the immunogenicity of LiHyS, which is possibly located in the parasite's flagellar pocket, proliferative assays using peripheral blood mononuclear cells from healthy subjects or VL patients showed a high proliferative index in both individuals, when compared to the results obtained using rA2 or unstimulated cultures. Later, rLiHyS/saponin was inoculated in BALB/c mice, which were then challenged with Leishmania infantum promastigotes. The vaccine induced an interferon-γ, interleukin (IL)-12 and granulocyte-macrophage colony-stimulating factor production, which was maintained after infection and which was associated with high nitrite and IgG2a antibody levels, as well as low IL-4 and IL-10 production. Significant reductions in the parasite load in liver, spleen, bone marrow and draining lymph nodes were found in these animals. In this context, the present study shows that the rLiHyS has the capacity to be evaluated as a diagnostic marker or vaccine candidate against VL.
A Compact Planar Magnetron Plasma Sputtering Device for TiO2 Deposition – ERRATUM
- Michelle Marie S. Villamayor, Kenta Doi, Edna Mae D. Cruz, Freya Gay J. Avenir, Motoi Wada, Henry J. Ramos
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1601 / 2014
- Published online by Cambridge University Press:
- 27 March 2014, e4
- Print publication:
- 2014
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A Compact Planar Magnetron Plasma Sputtering Device for TiO2 Deposition
- Michelle Marie S. Villamayor, Kenta Doi, Edna Mae D. Cruz, Freya Gay J. Avenir, Motoi Wada, Henry J. Ramos
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1601 / 2014
- Published online by Cambridge University Press:
- 29 November 2013, jsapmrs-13-1601
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- 2014
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A Compact Planar Magnetron Plasma Sputtering Deposition Device (CPM-PSDD) has been used to deposit TiO2 on silicon, glass and cotton cloth. An 80 mm diameter Ti target was placed at the cathode and was sputtered by argon-oxygen plasma with 10-20 mA discharge current and -300 V to -450 V discharge potential. Reactive oxygen gas fed into the system at 13:1 Ar:O2 sccm ratio for the deposition durations between one to four hours. The deposited films exhibited both anatase and rutile phases. Cotton cloths were dipped in methyl blue to evaluate the photocatalytic activity of the film.
Integrity Monitoring for Carrier Phase Ambiguities
- Shaojun Feng, Washington Ochieng, Jaron Samson, Michel Tossaint, Manuel Hernandez-Pajares, J. Miguel Juan, Jaume Sanz, Àngela Aragón-Àngel, Pere Ramos-Bosch, Marti Jofre
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- Journal:
- The Journal of Navigation / Volume 65 / Issue 1 / January 2012
- Published online by Cambridge University Press:
- 25 November 2011, pp. 41-58
- Print publication:
- January 2012
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The determination of the correct integer number of carrier cycles (integer ambiguity) is the key to high accuracy positioning with carrier phase measurements from Global Navigation Satellite Systems (GNSS). There are a number of current methods for resolving ambiguities including the Least-squares AMBiguity Decorrelation Adjustment (LAMBDA) method, which is a combination of least-squares and a transformation to reduce the search space. The current techniques to determine the level of confidence (integrity) of the resolved ambiguities (i.e. ambiguity validation), usually involve the construction of test statistics, characterisation of their distribution and definition of thresholds. Example tests applied include ratio, F-distribution, t-distribution and Chi-square distribution. However, the assumptions that underpin these tests have weaknesses. These include the application of a fixed threshold for all scenarios, and therefore, not always able to provide an acceptable integrity level in the computed ambiguities. A relatively recent technique referred to as Integer Aperture (IA) based on the ratio test with a large number of simulated samples of float ambiguities requires significant computational resources. This precludes the application of IA in real time.
This paper proposes and demonstrates the power of an integrity monitoring technique that is applied at the ambiguity resolution and positioning stages. The technique has the important benefit of facilitating early detection of any potential threat to the position solution, originating in the ambiguity space, while at the same time giving overall protection in the position domain based on the required navigation performance. The proposed method uses the conventional test statistic for ratio testing together with a doubly non-central F distribution to compute the level of confidence (integrity) of the ambiguities. Specifically, this is determined as a function of geometry and the ambiguity residuals from least squares based ambiguity resolution algorithms including LAMBDA. A numerical method is implemented to compute the level of confidence in real time.
The results for Precise Point Positioning (PPP) with simulated and real data demonstrate the power and efficiency of the proposed method in monitoring both the integrity of the ambiguity computation and position solution processes. Furthermore, due to the fact that the method only requires information from least squares based ambiguity resolution algorithms, it is easily transferable to conventional Real Time Kinematic (RTK) positioning.
Dietary habits and inadequate control of blood pressure in hypertensive adults assisted by a Brazilian Family Doctor Program
- Bárbara da Silva Nalin de Souza, Maria Luiza Garcia Rosa, Jocemir R Lugon, Edna Massae Yokoo, Evandro Tinoco Mesquita, Michele Rodrigues, Carolina da Silva Ramos, Maurício Cagy
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- Journal:
- Public Health Nutrition / Volume 14 / Issue 12 / December 2011
- Published online by Cambridge University Press:
- 07 July 2011, pp. 2176-2184
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Objective
To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP).
DesignA cross-sectional study.
SettingFDP units, Niterói, Rio de Janeiro, Brazil.
SubjectsWe included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated.
ResultsIndividuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95 % CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95 % CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95 % CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance.
ConclusionsThe results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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A polyphenol extract modifies quantity but not quality of liver fatty acid content in high-fat–high-sucrose diet-fed rats: possible implication of the sirtuin pathway
- Manar Aoun, Francoise Michel, Gilles Fouret, Francois Casas, Melanie Jullien, Chantal Wrutniak-Cabello, Jeanne Ramos, Jean-Paul Cristol, Charles Coudray, Marie-Annette Carbonneau, Christine Feillet-Coudray
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- Journal:
- British Journal of Nutrition / Volume 104 / Issue 12 / 28 December 2010
- Published online by Cambridge University Press:
- 02 August 2010, pp. 1760-1770
- Print publication:
- 28 December 2010
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High-fat or high-fat–high-sucrose diets are known to induce non-alcoholic fatty liver disease and this is emerging as one of the most common liver diseases worldwide. Some polyphenols have been reported to decrease rat hepatic lipid accumulation, in particular those extracted from red grapes such as resveratrol. The present study was designed to determine whether a polyphenol extract (PPE), from red grapes, modulates liver fatty acid composition and desaturase activity indexes in rats fed a high-fat–high-sucrose (HFHS) diet, and to explore whether sirtuin-1 deacetylase activation was implicated in the effect of the PPE against liver steatosis. The effect of this PPE on mitochondriogenesis and mitochondrial activity was also explored. The PPE decreased liver TAG content in HFHS+PPE diet-fed rats in comparison with HFHS diet-fed rats. The PPE had no effect on liver fatty acid composition, desaturase activity indexes and stearoyl-CoA desaturase 1 (SCD1) gene expression. Sirtuin-1 deacetylase protein expression was significantly increased with the PPE; AMP kinase protein expression was higher with the PPE in comparison with the HFHS rats, but no modification of phosphorylated AMP kinase was observed. Protein expression of phospho-acetyl-CoA carboxylase was decreased in HFHS rats and returned to basal values with the PPE. Finally, the PPE modulated PPARγ coactivator-1α (PGC-1α) but did not modify mitochondriogenesis and mitochondrial activity. In conclusion, the PPE partially prevented the accumulation of TAG in the liver by regulating acetyl-CoA carboxylase phosphorylation, a key enzyme in lipid metabolism, probably via sirtuin-1 deacetylase activation. However, the PPE had no effect on the qualitative composition of liver fatty acids.
39 - Nutritional amenorrhoea: long-term sequelae
- from Part III - Management of specific disorders
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- By Joanna L. Fried, Columbia Presbyterian Medical Center, New York, USA, Russalind Ramos, Columbia Presbyterian Medical Center, New York, USA, Michelle P. Warren, Columbia Presbyterian Medical Center, New York, USA
- Edited by Adam H. Balen, Sarah M. Creighton, Melanie C. Davies, University College London, Jane MacDougall, Richard Stanhope
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- Paediatric and Adolescent Gynaecology
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- 04 May 2010
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- 01 April 2004, pp 522-532
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Summary
Introduction
The amenorrhoea associated with energy deficit or nutritional imbalance has far-reaching long-term effects, including reduced bone density, stress fractures, osteopenia, osteoporosis, and infertility. This can be illustrated by referring to EG, a 54-year-old woman. She is a former professional ballet dancer who has performed on stages all over the world. Today, she relies on a walker in order to get from place to place. After a lifelong struggle with anorexia nervosa, she suffers from severe osteoporosis. She has suffered numerous fractures in the last 20 years and today her bone mineral density (BMD) is comparable to that of an 80-year-old woman. This is an extreme, though not uncommon, result of long-term nutritionally induced amenorrhoea.
Figure 39.1 shows the BMD scans for three women: a normal 25-year-old woman with regular periods; a 25-year-old woman who has had amenorrhoea for 5 years and has 30% lower total bone mass than most women her age; and a woman in her thirties with a 15 year history of amenorrhoea and osteoporotic bones.
There are a number of different environmental stressors thought to be associated with hypothalamic amenorrhoea (HA). Reproductive function may be affected by weight loss, exercise, nutritional deprivation or emotional stress. Recent research suggests that it may be an adaptive response to chronic low energy intake, and that metabolic factors may mediate reproductive adaptations in response to nutritional insults.