70 results
The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy – national comparative cohort study
- Sarah Badger, Lance V Watkins, Paul Bassett, Ashok Roy, Mogbeyiteren Eyeoyibo, Indermeet Sawhney, Kiran Purandare, Laurie Wood, Andrea Pugh, Joanne Hammett, Rory Sheehan, Samuel Tromans, Rohit Shankar
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- Journal:
- BJPsych Open / Volume 10 / Issue 3 / May 2024
- Published online by Cambridge University Press:
- 30 April 2024, e94
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Background
A quarter of People with Intellectual Disabilities (PwID) have epilepsy compared with 1% of the general population. Epilepsy in PwID is a bellwether for premature mortality, multimorbidity and polypharmacy. This group depends on their care provider to give relevant information for management, especially epilepsy. There is no research on care status relationship and clinical characteristics of PwID and epilepsy.
AimExplore and compare the clinical characteristics of PwID with epilepsy across different care settings.
MethodA retrospective multicentre cohort study across England and Wales collected information on seizure characteristics, intellectual disability severity, neurodevelopmental/biological/psychiatric comorbidities, medication including psychotropics/anti-seizure medication, and care status. Clinical characteristics were compared across different care settings, and those aged over and younger than 40 years.
ResultsOf 618 adult PwID across six centres (male:female = 61%:39%), 338 (55%) received professional care whereas 258 (42%) lived with family. Significant differences between the care groups existed in intellectual disability severity (P = 0.01), autism presence (P < 0.001), challenging behaviour (P < 0.001) and comorbid physical conditions (P = 0.008). The two groups did not vary in intellectual disability severity/genetic conditions/seizure type and frequency/psychiatric disorders. The professional care cohort experienced increased polypharmacy (P < 0.001) and antipsychotic/psychotropic use (P < 0.001/P = 0.008).
The over-40s cohort had lower autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) comorbidity (P < 0.001/P = 0.007), increased psychiatric comorbidity and challenging behaviour (P < 0.05), physical multimorbidity (P < 0.001), polypharmacy (P < 0.001) and antipsychotic use (P < 0.001) but reduced numbers of seizures (P = 0.007).
ConclusionPwID and epilepsy over 40 years in professional care have more complex clinical characteristics, increased polypharmacy and antipsychotic prescribing but fewer seizures.
An approach for collaborative development of a federated biomedical knowledge graph-based question-answering system: Question-of-the-Month challenges
- Karamarie Fecho, Chris Bizon, Tursynay Issabekova, Sierra Moxon, Anne E. Thessen, Shervin Abdollahi, Sergio E. Baranzini, Basazin Belhu, William E. Byrd, Lawrence Chung, Andrew Crouse, Marc P. Duby, Stephen Ferguson, Aleksandra Foksinska, Laura Forero, Jennifer Friedman, Vicki Gardner, Gwênlyn Glusman, Jennifer Hadlock, Kristina Hanspers, Eugene Hinderer, Charlotte Hobbs, Gregory Hyde, Sui Huang, David Koslicki, Philip Mease, Sandrine Muller, Christopher J. Mungall, Stephen A. Ramsey, Jared Roach, Irit Rubin, Shepherd H. Schurman, Anath Shalev, Brett Smith, Karthik Soman, Sarah Stemann, Andrew I. Su, Casey Ta, Paul B. Watkins, Mark D. Williams, Chunlei Wu, Colleen H. Xu, The Biomedical Data Translator Consortium
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 14 September 2023, e214
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Knowledge graphs have become a common approach for knowledge representation. Yet, the application of graph methodology is elusive due to the sheer number and complexity of knowledge sources. In addition, semantic incompatibilities hinder efforts to harmonize and integrate across these diverse sources. As part of The Biomedical Translator Consortium, we have developed a knowledge graph–based question-answering system designed to augment human reasoning and accelerate translational scientific discovery: the Translator system. We have applied the Translator system to answer biomedical questions in the context of a broad array of diseases and syndromes, including Fanconi anemia, primary ciliary dyskinesia, multiple sclerosis, and others. A variety of collaborative approaches have been used to research and develop the Translator system. One recent approach involved the establishment of a monthly “Question-of-the-Month (QotM) Challenge” series. Herein, we describe the structure of the QotM Challenge; the six challenges that have been conducted to date on drug-induced liver injury, cannabidiol toxicity, coronavirus infection, diabetes, psoriatic arthritis, and ATP1A3-related phenotypes; the scientific insights that have been gleaned during the challenges; and the technical issues that were identified over the course of the challenges and that can now be addressed to foster further development of the prototype Translator system. We close with a discussion on Large Language Models such as ChatGPT and highlight differences between those models and the Translator system.
Chapter 37 - Peroxisomal Disorders in Children
- from Section IV - Metabolic Liver Disease
- Edited by Frederick J. Suchy, Ronald J. Sokol, William F. Balistreri
- Edited in association with Jorge A. Bezerra, Cara L. Mack, Benjamin L. Shneider
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- Liver Disease in Children
- Published online:
- 19 January 2021
- Print publication:
- 18 March 2021, pp 671-697
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Summary
Peroxisomes are ubiquitous subcellular organelles that are found in essentially all animal and plant cells with the exception of mature anucleated erythrocytes. They carry out many essential biochemical processes, both catabolic and anabolic. Thus, deficiency of numerous peroxisomal proteins essential for structural integrity and metabolic functions causes human disease. These disorders are grouped as either peroxisome biogenesis disorders or isolated peroxisomal protein/enzyme deficiencies. With increased utilization of DNA sequencing as a diagnostic tool, the clinical spectrum of these disorders has expanded, and additional disease genes have been reported. Ultrastructural analysis of hepatic tissue led to the initial association of peroxisomes with human disease. However, not all peroxisomal diseases have liver involvement and thus would not be expected to present to the hepatologist. In this chapter, the focus will be on those diseases in which there is a hepatic component (see Table 37.1).
Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms
- Thomas R. Lynch, Roelie J. Hempel, Ben Whalley, Sarah Byford, Rampaul Chamba, Paul Clarke, Susan Clarke, David G. Kingdon, Heather O'Mahen, Bob Remington, Sophie C. Rushbrook, James Shearer, Maggie Stanton, Michaela Swales, Alan Watkins, Ian T. Russell
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- Journal:
- The British Journal of Psychiatry / Volume 216 / Issue 4 / April 2020
- Published online by Cambridge University Press:
- 18 July 2019, pp. 204-212
- Print publication:
- April 2020
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Background
Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.
AimsTo compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).
MethodRO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.
ResultsAfter 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.
ConclusionsThe RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
Tryptophan metabolic profile in term and preterm breast milk: implications for health
- Louise O'Rourke, Gerard Clarke, Aoife Nolan, Claire Watkins, Timothy G. Dinan, Catherine Stanton, R. Paul Ross, Cornelius Anthony Ryan
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- Journal:
- Journal of Nutritional Science / Volume 7 / 2018
- Published online by Cambridge University Press:
- 04 April 2018, e13
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Breast milk is the only source of the essential amino acid tryptophan (TRP) in breast-fed infants. Low levels of TRP could have implications for infant neurodevelopment. The objectives of the present study were to compare the relationship of TRP and its neuroactive pathway metabolites kynurenine (Kyn) and kynurenic acid (KynA) in preterm and term expressed breast milk (EBM) in the first 14 d following birth, and the relationship of TRP metabolism to maternal stress and immune status. A total of twenty-four mothers were recruited from Cork University Maternity Hospital: twelve term (>38 weeks) and twelve preterm (<35 weeks). EBM samples were collected on days 7 and 14. Free TRP, Kyn and KynA were measured using HPLC, total TRP using MS, cytokines using the Meso Scale Discovery (MSD) assay system, and cortisol using a cortisol ELISA kit. Although total TRP was higher in preterm EBM in comparison with term EBM (P < 0·05), free TRP levels were lower (P < 0·05). Kyn, KynA and the Kyn:TRP ratio increased significantly in term EBM from day 7 to day 14 (P < 0·05), but not in preterm EBM. TNF-α, IL-6 and IL-8 were higher in day 7 preterm and term EBM in comparison with day 14. There were no significant differences between term and preterm EBM cortisol levels. Increased availability of total TRP, lower levels of free TRP and alterations in the temporal dynamics of TRP metabolism in preterm compared with term EBM, coupled with higher EBM inflammatory markers on day 7, may have implications for the neurological development of exclusively breast-fed preterm infants.
Winter Wheat Cultivar Characteristics Affect Annual Weed Suppression
- Gail A. Wicks, Paul T. Nordquist, P. Stephen Baenziger, Robert N. Klein, Roger H. Hammons, John E. Watkins
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- Journal:
- Weed Technology / Volume 18 / Issue 4 / December 2004
- Published online by Cambridge University Press:
- 20 January 2017, pp. 988-998
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Thirteen hard red winter wheat cultivars were evaluated for their ability to suppress summer annual weeds in grain production systems near North Platte, NE, from 1993 through 1997. ‘Turkey’, a 125-yr-old landrace selection, suppressed both broadleaf and grass weeds more than other cultivars. Some relatively new cultivars, such as ‘Arapahoe’, ‘Jules’, ‘Pronghorn’, and ‘Vista’ suppressed summer annual grasses almost as well as Turkey. Total weed density was negatively correlated with number of winter wheat stems/m2, mature winter wheat height, and lodging. Weed density after wheat harvest was positively correlated with delay in winter wheat seeding date and was negatively correlated with precipitation 0 to 30 d after winter wheat seeding, during tillering, tillering to boot stage, and heading to maturity stage. Mean air temperature 0 to 30 d after wheat seeding was positively correlated with weed density. In the spring, weed density was positively correlated with temperatures during the tillering stage, tillering to boot stage, and heading to maturity stage. Stinkgrass and witchgrass densities were positively correlated with severity of wheat leaf rust. The highest grain-producing cultivars included three medium height cultivars ‘Alliance’, Arapahoe, and ‘Niobrara’. Alliance wheat produced 53% more grain than Turkey, and the other two produced 43% more grain.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Stage 2 - Needs Screening
- from PART I - IDENTIFY
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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- Biodesign
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- 11 May 2018
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- 02 February 2015, pp 111-246
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Biodesign
- The Process of Innovating Medical Technologies
- 2nd edition
- Paul G. Yock, Stefanos Zenios, Josh Makower, Todd J. Brinton, Uday N. Kumar, F. T. Jay Watkins, Lyn Denend, Thomas M. Krummel, Christine Q. Kurihara
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- 11 May 2018
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- 02 February 2015
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This step-by-step guide to medical technology innovation, now in full color, has been rewritten to reflect recent trends of industry globalization and value-conscious healthcare. Written by a team of medical, engineering, and business experts, the authors provide a comprehensive resource that leads students, researchers, and entrepreneurs through a proven process for the identification, invention, and implementation of new solutions. Case studies on innovative products from around the world, successes and failures, practical advice, and end-of-chapter 'Getting Started' sections encourage readers to learn from real projects and apply important lessons to their own work. A wealth of additional material supports the book, including a collection of nearly one hundred videos created for the second edition, active links to external websites, supplementary appendices, and timely updates on the companion website at ebiodesign.org. Readers can access this material quickly, easily, and at the most relevant point in the text from within the ebook.
Dedication
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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- 02 February 2015, pp v-vi
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Africa
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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- 02 February 2015, pp 10-13
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Summary
Background
Africa is on the rise. The twenty-first century has been called the “African Century” due to the continent's potential for increased economic development in the coming decades. From 2000–2012, economic growth averaged more than 5 percent per year, driven by the recovery of commodity prices, government economic and policy reforms, and restoration of international donor confidence and aid. Africa's collective gross domestic product (GDP) topped US$1.7 trillion in 2012 (making it nearly comparable to Russia or Brazil), and its middle class expanded to more than 34 percent of the continent's 1 billion people.
Poverty is declining, yet Africa still has the highest poverty rate in the world with 47.5 percent of the population living on less than US$1.25 a day. The continent also accounts for 25 percent of the global disease burden. Maternal health, child health, HIV, tuberculosis, and malaria continue to be the continent's greatest health challenges. What may be surprising is that over the next 10 years, Africa will experience the largest increase in deaths from cardiovascular disease, cancer, respiratory disease, and diabetes of any continent in the world. For instance, the World Health Organization estimated that in 2008 the prevalence of hypertension was highest in its Africa region, with nearly half of the population affected, and this figure is on the rise.
Generalities are difficult to apply across this diverse continent. It is a massive, highly fragmented mosaic of more than 50 countries, with an estimated 2,000 languages spoken and thousands of distinct ethnic groups. The continent's diverse population is expected to double by 2050, from 1 billion to more than 2 billion. Africa is endowed with more than 30 million square miles of varied geography and could fit China, India, the United States, and most of Europe within its physical boundaries. Across this great expanse, the continent's health-care infrastructure is evolving. African governments are working to expand healthcare delivery systems through public and private investment, but in the meantime, millions of people must travel vast distances to receive basic medical care.
Focus on Value
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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- 02 February 2015, pp 1-6
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Summary
What do we mean by “value” and why is it so important?
The escalation of healthcare costs is one of the major economic and political issues of our time. The problem is most apparent in the United States, where healthcare as a share of the economy has more than doubled over the past 35 years. Spending on health accounted for 7.2 percent of the nation's gross domestic product (GDP) in 1970, expanded to 16 percent in 2005, and is projected to be as high as 20 percent of GDP by 2015.
Simply put, the US economy cannot sustain this spending trajectory, which has outpaced GDP growth for years (see Figure V1). The problem is not just straining the federal budget: state and local governments have been forced to reduce support for education, infrastructure, and other critical expenditures as they struggle to fund Medicaid and other health programs. In the private sector, the cost of employment-based health insurance is one of the main reasons workers have seen their wages stagnate.
Despite the fact that the US spends two-and-a-half times more per capita on health than most developed countries, it does not necessarily provide the best care to its citizens. In 2000, when the World Health Organization ranked the health systems of its 191 member states for the first time ever, the US found itself in 37th position. In a more recent study that compared the US to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom on measures of quality, efficiency, access to care, equity, and the ability of citizens to lead long, healthy lives, America occupied last place. As the report pointed out, “While there is room for improvement in every country, the US stands out for not getting good value for its healthcare dollars.”
Against this backdrop, economists, researchers, and policy makers alike have pointed to medical technology as a dominant factor driving increased health expenditures in the US.
China
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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Summary
Background
China is perhaps the most impressive economic development story in modern history. Sustaining annual growth rates upwards of 9 percent for more than two decades, the country's gross domestic product (GDP) reached US$8 trillion in 2012 (second only to the United States at US$16 trillion). This remarkable expansion has lifted hundreds of millions of Chinese out of poverty and created a new middle class that is larger than the entire US population.
With more than 1.35 billion people, China has the largest citizenry in the world. In 2011, the country's urban population surpassed its rural population for the first time, with close to 700 million people living in China's cities. Population growth in China has decreased steadily over the last 20 years due to the controversial one-child policy (from approximately 1.2 percent to less than half of one percent) and is expected to continue to decline. The country's median age is just 35 years, compared to nearly 40 years in more developed countries. However, as a whole, the population is aging rapidly; senior citizens will account for as much as 35 percent of the Chinese people by 2053.
One of the most important challenges facing China in the twenty-first century is how to allocate healthcare resources for its massive population. Despite progress in the country's economic transformation, China significantly lags the developed world in its ability to provide even basic health services to the vast majority of its people. The Chinese government spent approximately 5 percent of GDP on healthcare in 2011, compared to roughly 18 percent spent in the US and 9 percent on average in the OECD countries. Per capita spending on medical technologies is just US$ in China versus US$399 in the US.
China's centrally planned economy provides health insurance coverage to approximately 90 percent of the population under three primary programs (an employer-based system, one for urban residents, and another covering the rural population). These insurance schemes are largely inadequate to cover basic care but rather focus on protecting patients from catastrophic health events. As a result, the Chinese typically pay for basic health services out-of-pocket, causing many individuals to delay diagnosis and treatment until they are critically ill.
Stage 1 - Needs Finding
- from PART I - IDENTIFY
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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Stage 3 - Concept Generation
- from PART II - INVENT
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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PART II - INVENT
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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About the Author Team
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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India
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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Summary
Background
South Asia is generally considered to include Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Over the past 20 years, the region has experienced robust economic growth, averaging 6 percent per year. As a result, poverty rates have declined, with the percentage of South Asians living on less than US$1.25 per day decreasing from 61 percent to 36 percent between 1981 and 2008. While the region is still home to approximately 44 percent of the developing world's poor, growth and development in South Asia are expected to continue.
The largest and most influential country in the region is India. With approximately 1.3 billion people, India is the fourth largest global economy by purchasing power parity (PPP). India's gross domestic product (GDP) reached nearly US$2 trillion in 2012, and it is expected to continue increasing at a healthy rate as the country further integrates into the global economy. Growth will also be driven by increased domestic demand as India's burgeoning middle class expands from roughly 50 million in 2007 to almost 600 million people between by 2025.
India's healthcare system is plagued by low spending levels. Healthcare expenditure per capita was only US$59 in 2011. The country's private and public sector combined spent only about 4 percent of GDP on healthcare in 2011, although the government is planning to increase its share from 1.4 percent to 2.5 percent of GDP over the next five years. In the past half-century, India's public sector has steadily given up market share to the private sector in providing healthcare. Accordingly to one study, the private sector accounted for over 90 percent of all hospitals, 85 percent of doctors, 80 percent of outpatient care, and almost 60 percent of inpatient care.
Fortunately, India's private sector has been responsible for some remarkable innovations in healthcare delivery. Several major hospital systems in the country are able to deliver high-quality outcomes at a fraction of the cost of care in developed country settings. For instance, one cardiac care center offers open-heart
surgery for less than US$2,000 per patient, with outcomes similar to those at US-based centers where the price tag can exceed US$100,000.
Stage 6 - Business Planning
- from PART III - IMPLEMENT
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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Index
- Paul G. Yock, Stanford University, California, Stefanos Zenios, Stanford University, California, Josh Makower, Stanford University, California, Todd J. Brinton, Stanford University, California, Uday N. Kumar, Stanford University, California, F. T. Jay Watkins, Lyn Denend, Stanford University, California, Thomas M. Krummel, Stanford University School of Medicine, California, Christine Q. Kurihara, Stanford University, California
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- 02 February 2015, pp 833-839
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