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Little is known about the effect of light-flicker frequency on poultry, particularly on turkeys. This experiment examined the impact of light-flicker frequency on the behavior, stress, and fear response of Nicholas Select turkey hens reared to 11 wk. The experiment was a randomized complete block design (2 trials), with a one-way factorial analysis evaluating 3 light-flicker frequencies (30, 90, or 195 Hertz; Hz). Birds (n = 3,276 per trial) were housed in 9 individual environmentally controlled rooms (3 replicates per treatment per trial). Data collected included: behavior (4, 8, and 10 wk), incidence of aggressive damage, heterophil-to-lymphocyte ratio, and novel object test (daily d 1-7 and at 4, 8, and 11 wk). Data were analyzed using Proc Mixed (SAS 9.4), with significance declared at P ≤ 0.05. Behavior data are presented as the percentage of time spent performing the behavior. At 4 wk, gentle feather pecking and exploratory behaviors were higher under 195 Hz compared to 30 Hz (P = 0.04 and P = 0.05, respectively). Preening was higher under 90 Hz compared to 30 Hz (P = 0.05). At 8 wk, wing flapping was lowest under 195 Hz (P < 0.01). Gentle feather pecking was higher under 90 and 195 Hz compared to 30 Hz (P = 0.02). Fighting (P = 0.05), aggressive pecking (P = 0.02), and aggressive behaviors (P = 0.01) were lower under 30 Hz compared to 90 Hz. At 10 wk, preening was decreased under 30 Hz (P = 0.03). Incidences of aggressive damage were reduced under 30 Hz compared to 90 Hz (0 d-4 wk; P = 0.01) and under 30 compared to both 90 and 195 Hz (4-8 wk; P = 0.01). At 11 wk, heterophil-to-lymphocyte ratios were lowest under 30 Hz (P = 0.04). The novel object test was unaffected by flicker treatment. In conclusion, many behaviors and the stress and fear responses were unaffected by either visible or non-visible flicker. However, visible flicker (30 Hz) reduced some comfort and exploratory behaviors early in life, and the impact on preening continued to older ages, suggesting minor negative impacts of flicker, particularly early in life.
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Conducta Animal , Miedo , Pavos , Animales , Pavos/fisiología , Femenino , Agresión , Luz , Distribución Aleatoria , Crianza de Animales Domésticos/métodos , Iluminación , Bienestar del Animal , Estrés Fisiológico , Estrés PsicológicoRESUMEN
Light flicker is a commonly overlooked factor of artificial light sources. This study aimed to determine the impacts of light-flicker frequency on performance, general health, and mortality of 11-wk Nicholas Select turkey hens. The experiment consisted of 2 trials (block) in a randomized complete block design, with 3 light-flicker frequency treatments (30, 90, or 195 Hz). Turkeys (n = 364 per replicate) were randomly placed into environmentally controlled rooms (3 room replicates per treatment per trial). Group body weight (BW) and feed consumption were measured at 0, 4, 8, and 11 wk, and feed efficiency (mortality corrected feed-to-gain; F:Gm) was calculated for each period. Mortality and culls were collected twice daily. Flock uniformity, feather condition and cleanliness, footpad score, and mobility were evaluated at 10 wk (30 birds per room). Litter quality and ocular weight and dimensions were evaluated (11 wk; 4 birds per room). Data were analyzed using Proc Mixed (SAS 9.4) and significance was declared when P < 0.05. At 8 wk, BW was lower under 30 Hz compared to 195 Hz (P = 0.03). Feed consumption was lowest under 30 Hz (0-4 wk and 4-8 wk; P < 0.01). Mortality-corrected F:G was improved under 30 Hz for 8 to 11 wk and 0 to 11 wk (P = 0.05 and P = 0.04, respectively). Total mortality was lower under 195 Hz compared to 30 Hz (P = 0.02). Uniformity, gait score, feather condition, and litter quality were unaffected by flicker. Footpad scores were improved under 90 Hz (P = 0.01), leading to an improved average footpad score (P = 0.02). Feather cleanliness was improved under 90 Hz compared to both 30 Hz and 195 Hz (P<0.01). Right eyeball dimensions differed across lighting treatments, with the dorso-ventral diameter being larger in birds under 30 Hz compared to 195 Hz (P = 0.05). The anterior-posterior size also increased in birds under 30 Hz compared to 90 Hz (P = 0.03). Light flicker impacted turkey hens, with the results demonstrating negative impacts on early growth and changes to ocular characteristics.
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Iluminación , Pavos , Animales , Pavos/fisiología , Femenino , Vivienda para Animales , Distribución Aleatoria , Luz , Crianza de Animales Domésticos/métodos , Bienestar del AnimalRESUMEN
We propose and demonstrate the appearance of an effective attractive three-body interaction in coherently driven two-component Bose-Einstein condensates. It originates from the spinor degree of freedom that is affected by a two-body mean-field shift of the driven transition frequency. Importantly, its strength can be controlled with the Rabi-coupling strength and it does not come with additional losses. In the experiment, the three-body interactions are adjusted to play a predominant role in the equation of state of a cigar-shaped trapped condensate. This is confirmed through two striking observations: a downshift of the radial breathing mode frequency and the radial collapses for positive values of the dressed-state scattering length.
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BACKGROUND: Good mentoring is important for students to support their adjustment to and learning in the clinical environment. The quality of the mentoring relationship is key for students but there is a lack of evidence explaining how a good mentor/mentee relationship establishes and develops over time. AIM: To explore the developing relationship between mentors and mentees participating in a structured midwifery mentoring program in one Local Health District in Sydney, Australia. METHODS: A qualitative interpretive descriptive research design was utilised. Data were collected using 10 focus groups with midwife mentors (n = 31) and seven focus groups and four interviews with Bachelor of Midwifery student mentees (n = 24), over a 12-month period. Thematic analysis using an inductive approach was applied incorporating constant comparison to identify themes and sub-themes. FINDINGS: Three overarching themes and three sub-themes were identified. The first theme was 'The great unknown'. Within the second theme 'Building the relationship' were three subthemes: trying to connect; becoming known; and an insider on your side. The final theme 'the virtuous circle' described the reciprocal relationship and benefits that developed between mentor and mentee. DISCUSSION: The mentor/mentee relationship took time to develop and went through a number of phases. A positive mentor/ mentee relationship flattened hierarchical differences, increased student confidence and capacity for learning, and reflected the midwifery continuity of care relationship between midwife and woman built on respect and partnership. CONCLUSION: Developing a successful midwifery mentoring relationship takes persistence, reassurance, and mutual disclosure ultimately resulting in a recurring cycle of encouragement and support.
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Tutoría , Partería , Femenino , Humanos , Mentores , Partería/educación , Embarazo , Investigación Cualitativa , EstudiantesRESUMEN
We theoretically calculate and experimentally measure the beyond-mean-field (BMF) equation of state in a coherently coupled two-component Bose-Einstein condensate (BEC) in the regime where averaging of the interspecies and intraspecies coupling constants over the hyperfine composition of the single-particle dressed state predicts the exact cancellation of the two-body interaction. We show that with increasing the Rabi-coupling frequency Ω, the BMF energy density crosses over from the nonanalytic Lee-Huang-Yang scaling ân^{5/2} to an expansion in integer powers of density, where, in addition to a two-body BMF term ân^{2}sqrt[Ω], there emerges a repulsive three-body contribution ân^{3}/sqrt[Ω]. We experimentally evidence these two contributions, thanks to their different scaling with Ω, in the expansion of a Rabi-coupled two-component ^{39}K condensate in a waveguide. By studying the expansion with and without Rabi coupling, we reveal an important feature relevant for observing BMF effects and associated phenomena in mixtures with spin-asymmetric losses: Rabi coupling helps preserve the spin composition and thus prevents the system from drifting away from the point of the vanishing mean field.
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BACKGROUND: The Valued Life Activities Scale (VLAs) measures difficulty in daily activities and social participation. With various versions involving a different number of items, we have linguistically and culturally adopted the full VLAs (33-items) and psychometrically tested it in adults with rheumatic and musculoskeletal diseases in the United Kingdom. METHODS: Participants with Rheumatoid Arthritis, Ankylosing Spondylitis, Chronic Pain/ Fibromyalgia, Chronic Hand/ Upper Limb Conditions, Osteoarthritis, Systemic Lupus, Systemic Sclerosis and Primary Sjogren's Syndrome were recruited from out-patient clinics in National Health Service Hospitals, General Practice and patient organisations in the UK. Phase1 involved linguistic and cultural adaptation: forward translation to British English; synthesis; expert panel review and cognitive debriefing interviews. In Phase2 participants completed postal questionnaires to assess internal construct validity using (i) Confirmatory Factor Analysis (CFA) (ii) Mokken scaling and (iii) Rasch model. RESULTS: Responders (n = 1544) had mean age of 59 years (SD13.3) and 77.2% women. A CFA failed to support a total score from the 33-items (Chi Square 3552:df 464: p < 0.0001). Mokken scaling indicated a strong non-parametric association between items. Fit to the Rasch model indicated that the VLAs was characterised by multidimensionality and item misfit, which may have been influenced by clusters of residual item correlations. An item banking approach resolved a 25-item calibrated set whose application could accommodate the 'does not apply to me' response option. CONCLUSIONS: The UK version of the VLAs failed to satisfy classical and modern psychometric standards for complete item sets. However, as the scale is not usually applied in complete format, an item bank approach calibrated 25 items with fit to the Rasch model. Suitable Computer Adaptive Testing (CAT) software could implement the item set, giving patients the choice of whether an item applies to them, or not.
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Enfermedades Musculoesqueléticas , Medicina Estatal , Adulto , Humanos , Lingüística , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
OBJECTIVES: Microbial point-of-care testing (POCT) has potential to revolutionize clinical care. Understanding the prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs). The aim was to investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use. METHODS: Data sources were the MEDLINE and Embase databases. Study eligibility criteria consisted of quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI. Patients presenting to healthcare or research settings with RTI participated. Interventions included upper respiratory tract swab. The methods used were systematic review and meta-analysis. RESULTS: Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. A total of 144 full texts were screened; 21 articles were retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). One hundred and seven (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalization duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies. CONCLUSIONS: A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test results, use of antimicrobials and microbial resistance.
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Pruebas Diagnósticas de Rutina/métodos , Pruebas en el Punto de Atención , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pronóstico , Adulto JovenRESUMEN
BACKGROUND: Limitations in upper limb functioning are common in Musculoskeletal disorders and the Disabilities of the Arm, Shoulder and Hand scale (DASH) has gained widespread use in this context. However, various concerns have been raised about its construct validity and so this study seeks to examine this and other psychometric aspects of both the DASH and QuickDASH from a modern test theory perspective. METHODS: Participants in the study were eligible if they had a confirmed diagnosis of Rheumatoid Arthritis (RA). They were mailed a questionnaire booklet which included the DASH. Construct validity was examined by fit to the Rasch measurement model. The degree of precision of both the DASH and QuickDASH were considered through their Standard Error of Measurement (SEM). RESULTS: Three hundred and thirty-seven subjects with confirmed RA took part, with a mean age of 62.0 years (SD12.1); 73.6% (n = 252) were female. The median standardized score on the DASH was 33 (IQR 17.5-55.0). Significant misfit of the DASH and QuickDASH was observed but, after accommodating local dependency among items in a two-testlet solution, satisfactory fit was obtained, supporting the unidimensionality of the total sets and the sufficiency of the raw (ordinal or standardized) scores. CONCLUSION: Having accommodated local response dependency in the DASH and QuickDASH item sets, their total scores are shown to be valid, given they satisfy the Rasch model assumptions. The Rasch transformation should be used whenever all items are used to calculate a change score, or to apply parametric statistics within an RA population. SIGNIFICANCE AND INNOVATIONS: Most previous modern psychometric analyses of both the DASH and QuickDASH have failed to fully address the effect of a breach of the local independence assumption upon construct validity. Accommodating this problem by creating 'super items' or testlets, removes this effect and shows that both versions of the scale are valid and unidimensional, as applied with a bi-factor equivalent solution to an RA population. The Standard Error of Measurement of a scale can be biased by failing to take into account the local dependency in the data which inflates reliability and thus making the SEM appear better (i.e. smaller) than the true value without bias.
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Artritis Reumatoide/diagnóstico , Evaluación de la Discapacidad , Articulación del Codo/fisiopatología , Articulaciones de la Mano/fisiopatología , Articulación del Hombro/fisiopatología , Anciano , Artritis Reumatoide/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To develop a consensual list of the most important aspects of activity pacing (AP) as an intervention within the context of non-pharmacological rheumatology care. METHOD: An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced in AP across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panel identified and ranked the most important goals of AP, behaviours of AP (the actions people take to meet the goal of AP), strategies to change behaviour in AP, and contextual factors that should be acknowledged when instructing AP. Additionally, topics for future research on AP were formulated and prioritized. RESULTS: The Delphi panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour, and 10 contextual factors of AP. These items were integrated into a consensual list containing the most important aspects of AP interventions in non-pharmacological rheumatology care. Nine topics for future research on AP with the highest ranking were included in a research agenda highlighting that future research should focus on the effectiveness of AP interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panellists, respectively. CONCLUSIONS: The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of AP. This study is an important first step in achieving more transparency and homogeneity in the concept of AP in both rheumatology daily clinical practice and research.
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INTRODUCTION: Rheumatoid arthritis (RA) fatigue is distressing, leading to unmanageable physical and cognitive exhaustion impacting on health, leisure and work. Group cognitive-behavioural (CB) therapy delivered by a clinical psychologist demonstrated large improvements in fatigue impact. However, few rheumatology teams include a clinical psychologist, therefore, this study aims to examine whether conventional rheumatology teams can reproduce similar results, potentially widening intervention availability. METHODS AND ANALYSIS: This is a multicentre, randomised, controlled trial of a group CB intervention for RA fatigue self-management, delivered by local rheumatology clinical teams. 7 centres will each recruit 4 consecutive cohorts of 10-16 patients with RA (fatigue severity ≥ 6/10). After consenting, patients will have baseline assessments, then usual care (fatigue self-management booklet, discussed for 5-6 min), then be randomised into control (no action) or intervention arms. The intervention, Reducing Arthritis Fatigue by clinical Teams (RAFT) will be cofacilitated by two local rheumatology clinicians (eg, nurse/occupational therapist), who will have had brief training in CB approaches, a RAFT manual and materials, and delivered an observed practice course. Groups of 5-8 patients will attend 6 × 2 h sessions (weeks 1-6) and a 1 hr consolidation session (week 14) addressing different self-management topics and behaviours. The primary outcome is fatigue impact (26 weeks); secondary outcomes are fatigue severity, coping and multidimensional impact, quality of life, clinical and mood status (to week 104). Statistical and health economic analyses will follow a predetermined plan to establish whether the intervention is clinically and cost-effective. Effects of teaching CB skills to clinicians will be evaluated qualitatively. ETHICS AND DISSEMINATION: Approval was given by an NHS Research Ethics Committee, and participants will provide written informed consent. The copyrighted RAFT package will be freely available. Findings will be submitted to the National Institute for Health and Care Excellence, Clinical Commissioning Groups and all UK rheumatology departments. ISRCTN: 52709998; Protocol v3 09.02.2015.
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Artritis Reumatoide/complicaciones , Terapia Cognitivo-Conductual , Fatiga/terapia , Grupo de Atención al Paciente , Adaptación Psicológica , Afecto , Artritis Reumatoide/psicología , Terapia Cognitivo-Conductual/economía , Terapia Cognitivo-Conductual/métodos , Análisis Costo-Beneficio , Fatiga/etiología , Humanos , Calidad de Vida , AutocuidadoRESUMEN
Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.
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Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Coinfección/inmunología , Infecciones por VIH/inmunología , Tuberculosis Pulmonar/inmunología , ADP-Ribosil Ciclasa 1/inmunología , Adulto , Fármacos Anti-VIH/uso terapéutico , Antígenos Bacterianos/inmunología , Antituberculosos/uso terapéutico , Proliferación Celular , Coinfección/tratamiento farmacológico , Femenino , Citometría de Flujo , Infecciones por VIH/tratamiento farmacológico , Antígenos HLA-DR/inmunología , Humanos , Interferón gamma/inmunología , Interleucina-10/inmunología , Interleucina-12/inmunología , Interleucina-13/inmunología , Interleucina-2/inmunología , Activación de Linfocitos/inmunología , Masculino , Tuberculosis Pulmonar/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Impaired transmission through glutamatergic circuits has been postulated to play a role in the underlying pathophysiology of schizophrenia. Furthermore, inhibition of the N-methyl-d-aspartate (NMDA) subtype of ionotropic glutamate receptors (NMDAR) induces a syndrome that recapitulates many of the symptoms observed in patients with schizophrenia. Selective activation of metabotropic glutamate receptor subtype 5 (mGlu5) may provide a novel therapeutic approach for treatment of symptoms associated with schizophrenia through facilitation of transmission through central glutamatergic circuits. Here, we describe the characterization of two novel N-aryl piperazine mGlu5 positive allosteric modulators (PAMs): 2-(4-(2-(benzyloxy)acetyl)piperazin-1-yl)benzonitrile (VU0364289) and 1-(4-(2,4-difluorophenyl)piperazin-1-yl)-2-((4-fluorobenzyl)oxy)ethanone (DPFE). VU0364289 and DPFE induced robust leftward shifts in the glutamate concentration-response curves for Ca(2+) mobilization and extracellular signal-regulated kinases 1 and 2 phosphorylation. Both PAMs displayed micromolar affinity for the common mGlu5 allosteric binding site and high selectivity for mGlu5. VU0364289 and DPFE possessed suitable pharmacokinetic properties for dosing in vivo and produced robust dose-related effects in reversing amphetamine-induced hyperlocomotion, a preclinical model predictive of antipsychotic-like activity. In addition, DPFE enhanced acquisition of contextual fear conditioning in rats and reversed behavioral deficits in a mouse model of NMDAR hypofunction. In contrast, DPFE had no effect on reversing apomorphine-induced disruptions of prepulse inhibition of the acoustic startle reflex. These mGlu5 PAMs also increased monoamine levels in the prefrontal cortex, enhanced performance in a hippocampal-mediated memory task, and elicited changes in electroencephalogram dynamics commensurate with procognitive effects. Collectively, these data support and extend the role for the development of novel mGlu5 PAMs for the treatment of psychosis and cognitive deficits observed in individuals with schizophrenia.
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Antipsicóticos/farmacología , Hipercinesia/tratamiento farmacológico , Memoria a Corto Plazo/efectos de los fármacos , Nootrópicos/farmacología , Piperazinas/farmacología , Receptor del Glutamato Metabotropico 5/agonistas , Receptores de N-Metil-D-Aspartato/metabolismo , Regulación Alostérica , Animales , Antipsicóticos/química , Antipsicóticos/farmacocinética , Antipsicóticos/uso terapéutico , Relación Dosis-Respuesta a Droga , Evaluación Preclínica de Medicamentos , Células HEK293 , Humanos , Hipercinesia/metabolismo , Hipercinesia/psicología , Masculino , Aprendizaje por Laberinto/efectos de los fármacos , Ratones , Ratones Noqueados , Actividad Motora/efectos de los fármacos , Nootrópicos/química , Nootrópicos/farmacocinética , Nootrópicos/uso terapéutico , Piperazinas/química , Piperazinas/farmacocinética , Piperazinas/uso terapéutico , Ratas , Ratas Sprague-Dawley , Receptor del Glutamato Metabotropico 5/genética , Receptores de N-Metil-D-Aspartato/genética , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/metabolismo , TransfecciónRESUMEN
OBJECTIVE: To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles. METHODS: Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali. RESULT: Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%). CONCLUSION: This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.
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Antituberculosos/uso terapéutico , VIH/aislamiento & purificación , Tipificación Molecular/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis/microbiología , Adolescente , Adulto , Anciano , Técnicas de Tipificación Bacteriana , Estudios Transversales , Femenino , Seropositividad para VIH/complicaciones , Humanos , Masculino , Malí , Persona de Mediana Edad , Mycobacterium/aislamiento & purificación , Mycobacterium bovis/aislamiento & purificación , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , Factores de Riesgo , Esputo , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Adulto JovenRESUMEN
OBJECTIVE: Fatigue is an overwhelming rheumatoid arthritis (RA) symptom caused by interacting clinical and psychosocial factors. Cognitive-behavioral therapy (CBT) addresses links between thoughts, feelings, and behaviors and uses cognitive restructuring to facilitate behavior changes. In a randomized controlled trial, a group CBT program for RA fatigue improved fatigue impact, severity, and perceived coping, as well as mood and quality of life. The aim of this study was to explore the patient perspective of the program and the impact of behavior changes. METHODS: Ten exit focus groups were held (38 patients). Transcripts were analyzed by an independent researcher using a hybrid thematic approach, with a subset analyzed by a team member and patient partner. RESULTS: Three overarching themes were identified. In "they made us work it out ourselves" (program factors facilitating changes), patients spontaneously identified elements of group CBT as pivotal, including guided discovery, the impact of metaphors, and working as a group. In "feeling much better about yourself and coping much better" (the nature of changes), patients described cognitive changes, including enhanced self-efficacy and problem solving, and emotional changes, including being less volatile and fearful of fatigue. In "my life has changed so much it's unbelievable" (benefits beyond fatigue), patients reengaged in previously abandoned activities, were more active, and enjoyed greater social participation. CONCLUSION: Patients highlighted that CBT elements were key to making behavior changes and that these had far-reaching impacts on their lives. This suggests it could be beneficial in clinical practice to incorporate cognitive-behavioral approaches into patient education programs that aim to enhance self-management.
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Artritis Reumatoide/complicaciones , Terapia Cognitivo-Conductual , Fatiga/etiología , Fatiga/terapia , Grupos Focales , Adaptación Psicológica , Adulto , Anciano , Artritis Reumatoide/psicología , Fatiga/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Autocuidado , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
PURPOSE: Foot health interventions such as foot orthoses for people with rheumatoid arthritis (RA) reduce pain, improve function and improve overall quality of life. Additionally, patient education (PE) is considered essential in achieving good outcomes with interventions such as foot orthoses, footwear and self-care. The aim of this literature review was to identify evidence in relation to the content, use and delivery of PE in the management of RA foot problems. METHODS: An electronic search of the following databases was performed: PubMed, CINAHL, AMED, Medline and the Cochrane Library, between March 2000 and March 2010. In order to be included, studies had to be published in English, involve adults (>18 years) with RA, and assist in answering the research question. No publications regarding PE for the management of foot health-related problems in RA were found. However, other key terms emerged that embraced PE for people with RA and informed a further search. Thirty-two papers met the inclusion criteria and were reviewed with regard to the subject area, content of the paper, methodological issues and their key findings. RESULTS: The present review provides evidence for the effectiveness of PE for people with RA delivered via a staged approach, with the content and timing of education provision being driven by the needs of the patient. CONCLUSIONS: The effect of PE delivered from a podiatric context needs to be explored, and the nature and requirements of PE for individuals with RA-related foot problems from a patient and practitioner perspective requires investigation. Alternative and innovative ways of providing PE and, potentially, self-management need to be investigated and defined.
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Artritis Reumatoide/terapia , Enfermedades del Pie/terapia , Educación del Paciente como Asunto , Adulto , Humanos , Aparatos OrtopédicosRESUMEN
Previously, we determined that a primary cause of proportional stunted growth in a line of Brahman cattle was related to an apparent refractoriness in metabolic response to GH in young animals. The objective of this study was to determine the effect of administration of GH, insulin (INS), and GH plus INS to mature miniature Brahman cows (n = 6; 9.7 ± 2.06 y; 391 ± 48.6 kg) and bulls (n = 8; 9.4 ± 2.00 y; 441 ± 54.0 kg) on circulating concentrations of metabolic hormones and metabolites, primarily IGF-I and IGF-I binding proteins. We hypothesized that IGF-I secretion could be enhanced by concomitant administration of exogenous GH and INS, and neither alone would be effective. Animals were allotted to a modified crossover design that included four treatments: control (CON), GH, INS, and GH + INS. At the start of the study, one-half of the cattle were administered GH (Posilac; 14-d slow release) and the other one-half served as CON for 7 d. Beginning on day 8, and for 7 d, INS (Novolin L) was administered (0.125 IU/kg BW) twice daily (7:00 AM and 7:00 PM) to all animals; hence, the INS and GH + INS treatments. Cattle were rested for 14 d and then were switched to the reciprocal crossover treatments. Blood samples were collected at 12-hour intervals during the study. Compared with CON, GH treatment increased (P < 0.01) mean plasma concentrations of GH (11.1 vs 15.7 ± 0.94 ng/mL), INS (0.48 vs 1.00 ± 0.081 ng/mL), IGF-I (191.3 vs 319.3 ± 29.59 ng/mL), and glucose (73.9 vs 83.4 ± 2.12 mg/dL) but decreased (P < 0.05) plasma urea nitrogen (14.2 vs 11.5 ± 0.75 mg/dL). Compared with INS, GH + INS treatment increased (P < 0.05) mean plasma concentration of INS (0.71 vs 0.96 ± 0.081 ng/mL), IGF-I (228.7 vs 392.3 ± 29.74 ng/mL), and glucose (48.1 vs 66.7 ± 2.12 mg/dL), decreased (P < 0.01) plasma urea nitrogen (13.6 vs 10.4 ± 0.76 mg/dL), and did not affect GH (13.5 vs 12.7 ± 0.95 ng/mL). In the miniature Brahman model, both the GH and GH + INS treatments dramatically increased circulating concentrations of IGF-I in mature cattle, suggesting that this line of Brahman cattle is capable of responding to bioactive GH.
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Bovinos/sangre , Hormona del Crecimiento/administración & dosificación , Factor I del Crecimiento Similar a la Insulina/análisis , Insulina/administración & dosificación , Animales , Glucemia/análisis , Nitrógeno de la Urea Sanguínea , Hormona del Crecimiento/sangre , Proteína 2 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 4 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 5 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteínas de Unión a Factor de Crecimiento Similar a la Insulina/sangreRESUMEN
BACKGROUND: Deciding whether or not to perform a health behaviour is an active decision-making process which has an impact on current and future behaviour and can be influenced by the beliefs both of patients and their healthcare professionals. The aim of this study was to explore rheumatoid arthritis (RA) patients' and occupational therapists' (OTs) perceptions of the benefits of and barriers to performing joint protection (JP). METHODS: A mixed methods design was used. Questionnaires applied a theoretical framework of key themes to assess the relevance of JP benefits and barriers both to people with RA and OTs. Focused interviews with people with RA then enabled data triangulation. Investigator triangulation was used to check the validity of data interpretation. FINDINGS: Ten people with RA and nine OTs participated. From the questionnaires, both groups agreed that highly relevant key themes for JP benefits were physical well-being, potential benefit and personal control. By contrast, the three key themes for JP barriers - negative attitude of others, negative impact on others and taking time from other things - were relevant for the majority of the OTs but not patients. The interviews enabled an understanding of the meaning behind RA patients' ratings, particularly their differences from OTs. People with RA explained JP benefits, and disease acceptance had altered some initial barriers into perceived benefits over time. CONCLUSIONS: Emphasizing benefits and identifying individually relevant barriers could be an important communication strategy for OTs in understanding patients' rationale for whether or not to adopt JP methods.
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Artritis Reumatoide/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Articulaciones/fisiología , Terapia Ocupacional , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/psicología , Barreras de Comunicación , Evaluación de la Discapacidad , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Autocuidado , Encuestas y CuestionariosRESUMEN
Ovarian function is dependent on the establishment and continual remodelling of a complex vascular system. This enables the follicle and/or corpus luteum (CL) to receive the required supply of nutrients, oxygen and hormonal support as well as facilitating the release of steroids. Moreover, the inhibition of angiogenesis results in the attenuation of follicular growth, disruption of ovulation and drastic effects on the development and function of the CL. It appears that the production and action of vascular endothelial growth factor A (VEGFA) is necessary at all these stages of development. However, the expression of fibroblast growth factor 2 (FGF2) in the cow is more dynamic than that of VEGFA with a dramatic upregulation during the follicular-luteal transition. This upregulation is then likely to initiate intense angiogenesis in the presence of high VEGFA levels. Recently, we have developed a novel ovarian physiological angiogenesis culture system in which highly organised and intricate endothelial cell networks are formed. This system will enable us to elucidate the complex inter-play between FGF2 and VEGFA as well as other angiogenic factors in the regulation of luteal angiogenesis. Furthermore, recent evidence indicates that pericytes might play an active role in driving angiogenesis and highlights the importance of pericyte-endothelial interactions in this process. Finally, the targeted promotion of angiogenesis may lead to the development of novel strategies to alleviate luteal inadequacy and infertility.
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Vasos Sanguíneos/fisiología , Neovascularización Fisiológica/fisiología , Ovario/irrigación sanguínea , Animales , Bovinos , Femenino , Humanos , Fase Luteínica/metabolismo , Fase Luteínica/fisiología , Modelos Biológicos , Folículo Ovárico/irrigación sanguínea , Folículo Ovárico/metabolismo , Folículo Ovárico/fisiología , Ovario/fisiologíaRESUMEN
Miniature Brahman cattle at the USDA ARS Subtropical Agriculture Research Station in Brooksville, FL have normal proportioned growth but are approximately 70% of mature height and weight when compared with Brahman cattle in the same herd. Pedigree analyses suggest that the condition is inherited through a recessive allele. The miniature Brahman cattle in the Brooksville herd have been used for studies of growth and reproduction, but the underlying causative mutation is unknown. Presumably, the miniature condition could arise from a mutation in the GH gene. The objective, therefore, was to clone the GH cDNA from Brooksville miniature Brahman cattle, compare its sequence to normal Brahman cattle, and test the biological activity of the native GH protein. Messenger RNA was isolated from the pituitary, and a cDNA for the protein coding region of the GH gene was amplified by reverse-transcription polymerase chain reaction (PCR) from each of 2 miniature Brahman bulls. The cDNA were cloned into plasmid vectors, and top and bottom strands were sequenced by automated DNA sequencing. The sequence of both cDNA clones derived from miniature cattle differed from Bos indicus GH (GenBank AF034386) at base number 641 because there was a cytosine (C) instead of a thymine (T). The C to T change encoded a mutation (threonine to methionine) at amino acid 200 (T200M mutation). The mutation was confirmed by sequencing of an additional 2 miniature cattle and comparing their sequence to 2 normal cattle. The threonine is located in the fourth alpha helix of GH and is 1 of 8 amino acids that participate in binding of GH to the GH receptor. Twelve miniature Brahman and 9 normal Brahman cattle were tested by using a restriction fragment length polymorphism analysis that employed the BsmBI restriction enzyme (specific for the mutated nucleotide). The 12 miniature Brahman cattle were homozygous for the mutation (-/-). Seven of the normal Brahman cattle were homozygous for the wild-type allele (+/+), and 2 were heterozygous (+/-). When tested in a cell-based bioassay, GH isolated from the pituitary of -/- cattle (n=4) had approximately 60% activity when compared with GH isolated from the pituitary of +/+ cattle (n=5). In summary, miniature Brahman cattle were homozygous for a single nucleotide polymorphism that encodes a mutation in an amino acid involved in binding of GH to the GH receptor. Cattle of normal size had at least 1 copy of the normal GH allele. Threonine 200 in bovine GH is required for normal growth in cattle.
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Enfermedades de los Bovinos/genética , Enanismo/veterinaria , Hormona del Crecimiento/genética , Mutación Puntual/genética , Animales , Secuencia de Bases , Bovinos , Clonación Molecular , Citosina , ADN Complementario/química , ADN Complementario/genética , Enanismo/genética , Hormona del Crecimiento/metabolismo , Homocigoto , Datos de Secuencia Molecular , Linaje , Hipófisis/química , Polimorfismo de Longitud del Fragmento de Restricción , Polimorfismo de Nucleótido Simple/genética , ARN Mensajero/genética , ARN Mensajero/aislamiento & purificación , Receptores de Somatotropina/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de Secuencia , Análisis de Secuencia de ADN , TiminaRESUMEN
PURPOSE: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. METHODS AND MATERIALS: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. RESULTS: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). CONCLUSION: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.