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Bi
Terms modified by Bi Selected AbstractsNatural monoclinic AgPb(Bi2Sb)3S6, an Sb-rich gustaviteACTA CRYSTALLOGRAPHICA SECTION C, Issue 11 2009Richard Pa The crystal structure of the Sb-rich variety of the mineral gustavite, silver lead tris(dibismuth/antimony) hexasulfide, AgPb(Bi2Sb)3S6, consists of blocks of diagonal chains of four octahedra, viz. M1a (Bi), M2a (Sb/Bi), M2b (Bi/Sb) and M1b (Ag), separated by Pb atoms in a trigonal prismatic coordination. Two marginal octahedral sites, M1a and M1b, where the gustavite substitution Ag+ + Bi3+ = 2Pb2+ takes place, are formed by Bi and Ag, respectively. Two central octahedra, M2a and M2b, where the Bi3+ = Sb3+ substitution takes place, are formed by two mixed Bi/Sb sites with different occupancies of Bi and Sb. The alternating occupation of the M1 site by Bi and Ag atoms (which thus creates two distinct sites M1a and M1b) results in the monoclinic space group P21/c. A statistical distribution of Ag/Bi in the M1 position (one mixed Ag/Bi site) was reported for synthetic gustavite, resulting in the orthorhombic space group Cmcm. [source] A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drugDRUG AND ALCOHOL REVIEW, Issue 3 2003Dr ROBERT J. TAIT Abstract The aim of this paper is to evaluate the effectiveness of brief interventions (BI) with adolescents (mean age < 20) in reducing alcohol, tobacco or other drug (ATOD) use by means of a systematic review of BI for adolescent substance use in the English language literature up to 2002. We identified 11 studies involving 3734 adolescents. Follow-up ranged from 6 weeks to 24 months. Motivational interviewing was the predominant approach, underpinning eight studies: the remaining three provided personalized health information. Seven papers reported outcomes for alcohol interventions and four involved other substances (including one with separate alcohol outcomes). The overall effect size was d= 0.126 with borderline homogeneity (Q = 14.9, df = 9, p = 0.09). The effect size from the eight alcohol interventions (n = 1075) was classified as significant but "small" (d = 0.275). The remaining non-alcohol studies were considered separately as interventions involving tobacco or multiple substance use. The two interventions with tobacco involved a substantial sample (n = 2626) but had a very small effect (d = 0.037), while the two interventions addressing multiple substances involved few participants (n = 110) but had a medium , large effect (d = 0.78). Across a diverse range of settings (dental clinic, schools, universities, substance treatment centres) and, therefore, probably diverse clients, BI conferred benefits to adolescent substance users. BI had a small effect on alcohol consumption and related measures. The data for tobacco interventions suggested a very small reduction, particularly with general community interventions. The effect of BI with multiple substances appears substantial but the small sample cautions against expansive generalization. [source] Brief alcohol intervention,where to from here?ADDICTION, Issue 6 2010Challenges remain for research, practice ABSTRACT Brief intervention (BI) is intended as an early intervention for non-treatment-seeking, non-alcohol-dependent, hazardous and harmful drinkers. This text provides a brief summary of key BI research findings from the last three decades and discusses a number of knowledge gaps that need to be addressed. Five areas are described: patient intervention efficacy and effectiveness; barriers to BI implementation by health professionals; individual-level factors that impact on BI implementation; organization-level factors that impact on BI implementation; and society-level factors that impact on BI implementation. BI research has focused largely upon the individual patient and health professional levels, with the main focus upon primary health care research, and studies are lacking in other settings. However, research must, to a larger degree, take into account the organizational and wider context in which BI occurs, as well as interaction between factors at different levels, in order to advance the understanding of how wider implementation of BI can be achieved in various settings and how different population groups can be reached. It is also important to expand BI research beyond its current parameters to investigate more ambitious long-term educational programmes and new organizational models. More widespread implementation of BI will require many different interventions (efforts, actions, initiatives, etc.) at different interlinked levels, from implementation interventions targeting individual health professionals' knowledge, skills, attitudes and behaviours concerning alcohol issues, BI and behaviour change counselling to efforts at the organizational and societal levels that influence the conditions for delivering BI as part of routine health care. [source] Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacyADDICTION, Issue 3 2009Frances J. Kay-Lambkin ABSTRACT Aims To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design Randomized controlled trial. Setting Community-based participants in the Hunter Region of New South Wales, Australia. Participants Ninety-seven people with comorbid major depression and alcohol/cannabis misuse. Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ,live' (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist). Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment. Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ,live' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect. Conclusions Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a ,live' intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress. [source] The needs of carers of patients with anorexia and bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 1 2008Holmer Graap Abstract Objective This study aims to assess the degree of distress and the need for support of carers of patients with anorexia and bulimia nervosa (BN). Methods Thirty-two carers filled out the General Health Questionnaire (GHQ-12) and the Burden Inventory (BI). In addition, they were interviewed with a semi-structured research interview, the Carers' Needs Assessment (CNA), to assess relevant problem areas as well as the needs for helpful interventions. Patients were interviewed with the Eating Disorder Examination (EDE) to assess the severity of the eating disorder. All patients met criteria for anorexia (n,=,16) or BN (n,=,16) according to DSM-IV criteria. Results The mean duration of illness was 5.6 years. The mean age of the carers was 41 years. Most of the carers were mothers or partners. In the CNA we found high numbers of problems as well as high numbers of needed interventions. The most frequently mentioned problem area was ,disappointment caused by the chronic course of the illness, concerns about the patient's future' and the most frequently reported need for support was ,counselling and support by a professional'. In three problem areas carers of persons suffering from anorexia nervosa (AN) reported significantly higher scores than carers of persons suffering from BN. Conclusions Our results suggest that carers themselves have high levels of needs which are usually not addressed in clinical practice. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Prevalence of disabling spasticity 1 year after first-ever strokeEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2008E. Lundström Objective:, To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke. Design:, Cross-sectional survey 1 year after first-ever stroke. Methods:, Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability. Results:, The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS (P = 0.009) and the BI (P = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9,125) and age below 65 years (OR 9.5, CI 1.5,60). Conclusions:, The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment. [source] Continuous infusion of factor concentrates in children with haemophilia A in comparison with bolus injectionsHAEMOPHILIA, Issue 3 2006C. BIDLINGMAIER Summary., Although the concept of continuous infusion (CI) of factor concentrates is well known, prospective paediatric data are rare. We present a prospective open-labelled non-randomized study focusing on safety, efficacy and factor VIII (FVIII) usage compared with bolus injections (BI) in children. In 43 consecutive patients (0.5,17 years; median: 9.6) undergoing different operations, CI was started with an initial FVIII-bolus of 70 IU kg,1 bodyweight, followed by a median infusion rate of 4.4 IU kg,1 h,1 (range: 2.8,9.5) dose adjusted for daily FVIII levels (target: 60,80%). No direct serious adverse events occurred; however, two out of 43 patients, both from the group of four patients with less than 20 exposure days (ED) before starting CI, developed a high-responding inhibitor. Two CI patients showed mild thrombophlebitis or rash. Infusion rates needed to achieve adequate FVIII levels were highly predictable and could be reduced because of decreasing FVIII clearance. Bleeding, requiring additional boli, was observed in eight out of 43 patients. Therapy duration and factor usage of CI were influenced by the procedure, but not by the product used or thrombophilia. Twelve of these CI patients were compared with 12 contemporary consecutive age- and procedure-matched BI patients. Compared with BI patients, CI patients saved 30% FVIII (812.9 vs. 563.2 IU kg,1, P < 0.006). We conclude that CI forms a safe and effective method for perioperative care in children and reduces factor usage. Because of the unknown risk of inhibitor development, we will use CI only in patients beyond 20 ED. [source] A prospective baseline study of frail older people before the introduction of an intermediate care serviceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2005John Young MB MSC FRCP Abstract This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire ,28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people. [source] Cell culture,produced hepatitis C virus does not infect peripheral blood mononuclear cells,HEPATOLOGY, Issue 6 2008Svetlana Marukian Hepatitis C virus (HCV) replicates primarily in the liver, but HCV RNA has been observed in association with other tissues and cells including B and T lymphocytes, monocytes, and dendritic cells. We have taken advantage of a recently described, robust system that fully recapitulates HCV entry, replication and virus production in vitro to re-examine the issue of HCV infection of blood cell subsets. The HCV replicase inhibitor 2,C-methyl adenosine was used to distinguish HCV RNA replication from RNA persistence. Whereas cell culture,grown HCV replicated in Huh-7.5 hepatoma cells, no HCV replication was detected in B or T lymphocytes, monocytes, macrophages, or dendritic cells from healthy donors. No blood cell subset tested expressed significant levels of Claudin-1, a tight junction protein needed for HCV infection of Huh-7.5 cells. A B cell line expressing high levels of Claudin-1, CD81, and scavenger receptor BI remained resistant to HCV pseudoparticle infection. We bypassed the block in HCV entry by transfecting HCV RNA into blood cell subsets. Transfected RNA was not detectably translated and induced high levels of interferon-,. Supernatants from HCV RNA,transfected macrophages inhibited HCV replication in Huh-7.5 cells. Conclusion: We conclude that multiple blocks prevent blood cells from supporting HCV infection. (HEPATOLOGY 2008;48:1843-1850.) [source] DFT study of polymorphism of the DNA double helix at the level of dinucleoside monophosphatesINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 13 2010Valeri I. Poltev Abstract We apply DFT calculations to deoxydinucleoside monophosphates (dDMPs) which represent minimal fragments of the DNA chain to study the molecular basis of stability of the DNA duplex, the origin of its polymorphism and conformational heterogeneity. In this work, we continue our previous studies of dDMPs where we detected internal energy minima corresponding to the "classical" B conformation (BI-form), which is the dominant form in the crystals of oligonucleotide duplexes. We obtained BI local energy minima for all existing base sequences of dDMPs. In the present study, we extend our analysis to other families of DNA conformations, successfully identifying A, BI, and BII energy minima for all dDMP sequences. These conformations demonstrate distinct differences in sugar ring puckering, but similar sequence-dependent base arrangements. Internal energies of BI and BII conformers are close to each other for nearly all the base sequences. The dGpdG, dTpdG, and dCpdA dDMPs slightly favor the BII conformation, which agrees with these sequences being more frequently experimentally encountered in the BII form. We have found BII-like structures of dDMPs for the base sequences both existing in crystals in BII conformation and those not yet encountered in crystals till now. On the other hand, we failed to obtain dDMP energy minima corresponding to the Z family of DNA conformations, thus giving us the ground to conclude that these conformations are stabilized in both crystals and solutions by external factors, presumably by interactions with various components of the media. Overall the accumulated computational data demonstrate that the A, BI, and BII families of DNA conformations originate from the corresponding local energy minimum conformations of dDMPs, thus determining structural stability of a single DNA strand during the processes of unwinding and rewinding of DNA. © 2010 Wiley Periodicals, Inc. Int J Quantum Chem 110:2548,2559, 2010 [source] Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Social Cognitive Reactions to Considering Participation in Weight-Management InterventionsJOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 5 2007Shaelyn M. Strachan This study investigated social cognitive reactions and individual-difference factors associated with selecting a traditional diet intervention (TDI) and a nondiet (NDI) intervention. Participants read balanced descriptions of typical TDI and NDI interventions, and subsequently completed a questionnaire assessing selection of intervention, self-efficacy (SE), and outcome expectations (OE) for each approach; body image (BI); and demographics. MANOVA procedures revealed that selection of intervention moderated ratings of SE and OE for each intervention. In addition, MANOVA procedures revealed a 3-way interaction between intervention selection, intervention rating, and weight status. A MANOVA also revealed that selection groups differed on the overweight preoccupation subscale of the BI measure. Social cognitions and aspects of body image may provide useful information about readiness for weight-management approaches. [source] Factors associated with delirium severity among older patientsJOURNAL OF CLINICAL NURSING, Issue 5 2007Philippe Voyer PhD Aim., The goal of this study was to determine whether the factors associated with delirium varied according to the severity of the delirium experienced by the older patients. Background., Delirium among older patients is prevalent and leads to numerous detrimental effects. The negative consequences of delirium are worse among older adults with severe delirium compared with patients with mild delirium. There has been no study identifying those factors associated with delirium severity among long-term care older patients newly admitted to an acute care hospital. Design., This is a descriptive study. Methods., This is a secondary analysis study of institutionalized older patients newly admitted to an acute care hospital (n = 104). Upon admission, patients were screened for delirium with the Confusion Assessment Method and severity of delirium symptoms were determined by using the Delirium Index. Results., Of the 71 delirious older patients, 32 (45·1%) had moderate-severe delirium while 39 (54·9%) presented mild delirium. In univariate analyses, a significant positive relationship was observed between the level of prior cognitive impairment and the severity of delirium (p = 0·0058). Low mini-mental state examination (MMSE) scores (p < 0·0001), the presence of severe illness at the time of hospitalization (p = 0·0016) and low functional autonomy (BI: p = 0·0017; instrumental activities of daily living: p = 0·0003) were significantly associated with moderate-severe delirium. Older patients suffering from mild delirium used significantly more drugs (p = 0·0056), notably narcotics (p = 0·0017), than those with moderate-severe delirium. Results from the stepwise regression indicated that MMSE score at admission and narcotic medication use are the factors most strongly associated with the severity of delirium symptoms. Conclusions., This present study indicates that factors associated with moderate-severe delirium are different from those associated with mild delirium. Given the result concerning the role of narcotics, future studies should evaluate the role of pain management in the context of delirium severity. Relevance to Clinical Practice., As moderate-severe delirium is associated with poorer outcomes than is mild delirium, early risk factor identification for moderate-severe delirium by nurses may prove to be of value in preventing further deterioration of those older patients afflicted with delirium. [source] Topographic Patterns of Small Subcortical Infarcts Associated with MCA Stenosis: A Diffusion-Weighted MRI StudyJOURNAL OF NEUROIMAGING, Issue 3 2006Xin Wang MD ABSTRACT Background and Purpose. Small subcortical infarcts (SSI, maximum lesion diameter ,2.0 cm) are usually considered as infarcts caused by small vessel disease. However, SSI can also be associated with large artery occlusive disease such as middle cerebral artery (MCA) stenosis. We performed a prospective study to investigate the relationship between MCA stenosis and SSI distribution and further to investigate the mechanism of SSI caused by MCA stenosis. Methods. Magnetic resonance angiography (MRA) and diffusion-weighed MRI (DWI) of consecutive acute ischemic stroke patients with recent SSI were studied. The distribution of acute infarcts on DWI was categorized as cortical infarct (CI), border zone infarct (BI), or perforating artery infarct (PAI). Results. Totally, 93 cases were recruited, among which 12 had single SSI with MCA stenosis (group 1) and 26 patients had multiple SSI with MCA stenosis (group 2), while 55 patients without MCA stenosis had single SSI (group 3). For patients with single SSI and MCA stenosis, 6 had BI and 6 had PAI; for patients with multiple SSI and MCA stenosis, 25 had BI, 4 had PAI and 9 had CI (compared with group1: P= .001); for patients with single SSI but without MCA stenosis, 20 had BI and 35 had PAI (compared with group1: P= .58). Conclusion. Multiple acute infarcts along the border zone are the commonest pattern in small infarcts with MCA stenosis, especially among those with multiple acute infarcts. Our data suggest that hemodynamic compromise and artery-to-artery embolism may be both important factors for infarcts in patients with MCA stenosis. [source] The scavenger receptor BI and its ligand, HDL: partners in crime against HCV neutralizing antibodiesJOURNAL OF VIRAL HEPATITIS, Issue 2007M. Dreux Summary., Better knowledge of the viral and host factors that determine HCV clearance vs. persistence at the acute stage of infection is needed in order to improve antiviral therapy and develop efficient vaccines. Spontaneous HCV clearance is associated with a strong, early and broad cellular immune response. Yet, several observations suggest that antibody-mediated neutralisation occurs during HCV infection in vivo and that polyclonal antibodies to HCV can be protective. The recent development of HCV infection assays has confirmed that sera from HCV-infected patients neutralise infection in vitro. Recent studies have demonstrated that Nt-antibodies, of narrow specificity, are induced during the early phase of infection and could play a role in controlling viral infection or clearance. Yet, high-titre, broadly cross-reacting Nt-antibodies are readily detected in chronically infected patients, suggesting that their effectiveness is limited in patients who do not resolve the disease. The factors that mitigate the impact of the Nt-antibody response need to be clarified. Here we review some essential features of the Nt-antibody responses to HCV. We then discuss an original mechanism that HCV may use in vivo to attenuate Nt-antibodies, which involves the hyper-variable region-1 of the HCV-E2 glycoprotein, high-density lipoprotein (HDL) and the physiologic activity of the scavenger receptor BI, a receptor shared by both HCV and HDL. [source] Comparison of patient-controlled analgesia with and without a background infusion after appendicectomy in childrenPEDIATRIC ANESTHESIA, Issue 5 2003Karamehmet Yildiz MD Summary Background: There have been many studies using patient-controlled analgesia (PCA) and opioids for postoperative analgesia in children. In this study, we investigated the efficacy, usefulness and analgesic consumption of two different PCA programmes [bolus dose alone (BD) or bolus dose with background infusion (BD + BI)] to evaluate postoperative analgesia for children after emergency appendicectomy. Methods: Forty children, aged between 6 and 15 years and ASA class I or II, undergoing emergency appendicectomy were randomly allocated into two groups. The children were given a loading dose of pethidine 0.3 mg·kg,1 and 150 ,g·kg,1 bolus intravenously in group BD (n = 20) and pethidine 0.3 mg·kg,1 loading dose, 75 ,g·kg,1 bolus and 15 ,g·kg,1·h,1 background infusion in group BD + BI (n = 20). The lockout interval was 20 min in both groups. Results: There were no significant differences in pain, sedation and nausea scores during the 24-h postoperative period between the groups (P > 0.05). Pethidine consumption was significantly lower in group BD + BI than that in group BD for the first 24-h period (P < 0.05). Conclusions: We demonstrated that both these PCA programmes were effective and reliable for postoperative pain relief in children. We believe that giving information about PCA to the children and their parents is useful during the preoperative period. However, the background infusion with lower bolus dose in PCA did not increase pethidine consumption. [source] Enhanced levels of cow's milk antibodies in infancy in children who develop type 1 diabetes later in childhoodPEDIATRIC DIABETES, Issue 5 2008Kristiina Luopajärvi Background:, Early exposure to cow's milk (CM) proteins have been implicated in the pathogenesis of type 1 diabetes (T1D). Objective:, We analyzed the development of the humoral immune response to dietary CM proteins in early childhood and its relation to later T1D. Subjects and methods:, We studied a subgroup of 94 children randomized to be weaned to a CM-based infant formula in the trial to reduce insulin-dependent diabetes mellitus in the genetically at risk (TRIGR) pilot study. All subjects carried human leukocyte antigen-conferred T1D susceptibility and had an affected first-degree relative. After 7 years of follow-up, 8 subjects had progressed to T1D, 15 had at least one disease-associated autoantibody, and 71 remained autoantibody negative (controls). Immunoglobulin (Ig) G and IgA class antibodies to whole CM formula, beta-lactoglobulin (BLG), bovine serum albumin, and alpha-casein and IgG antibodies to bovine insulin (BI) were measured with enzyme-linked immunosorbent assays from sequential samples. Results:, The children with later T1D showed increased IgG levels to BLG from 3 to 18 months of age (p = 0.028) and enhanced IgA levels to CM formula at the age of 9 months (p = 0.022) compared with controls. In the children with an affected father or sibling, IgG antibodies to BI were higher in autoantibody-positive subjects than in autoantibody-negative subjects at 18 months of age (p = 0.022). Conclusion:, An enhanced humoral immune response to various CM proteins in infancy is seen in a subgroup of those children who later progress to T1D. Accordingly, a dysregulated immune response to oral antigens is an early event in the pathogenesis of T1D. [source] The use of basal insulin (NPH) compared with pre-mixed biphasic insulin in patients with type 2 diabetes mellitusPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2007A single centre experience Abstract The aim of this retrospective study was to compare glycaemic control and weight gain in patients with type 2 diabetes (T2DM) commenced on basal insulin (BI) or mixed insulin (MI). Subjects had T2DM (mean duration seven years) poorly controlled while treated with oral hypoglycaemic agents. Two hundred patients (BI 131 [65%], MI 69 [35%], median age 60 years [range 30,97]) were investigated. Follow up was over a mean period of 3.8 years. Patients started on BI had a significantly lower HbA1c (mean 10.6% vs 11.1%, p = 0.007) and higher body mass index (31.8kg/m2vs 29.6, p = 0.005) compared to those on MI. At 3.5 years patients injecting BI were on a lower daily dose of insulin (BI 66.6units vs MI 99.1units, p = 0.02) and a higher proportion were taking metformin (88% vs 62%, p = 0.01). There was no significant difference in HbA1c (8.5% vs 8.4%, p = 0.36) at the end of follow up. At 2.5 years subjects injecting BI had less weight gain (BI mean 4.0kg vs MI mean 8.0kg, p = 0.02). At 3.5 years the difference in weight gain was not statistically significant (mean 5.0kg vs 7.8kg, p = 0.20). In our experience BI, used in combination with metformin, is an effective treatment option in patients with T2DM, maintains glycaemic control over long-term follow up and is associated with less weight gain than MI. Copyright © 2007 John Wiley & Sons. [source] What If They Do Not Want Treatment?: Lessons Learned from Intervention Studies of Non-Treatment-Seeking, Drug-Using Pregnant WomenTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2004Hendree E. Jones Ph.D. Despite specialized drug treatment, many pregnant drug-using women do not seek admission to such programs. This study examined two types of brief drug use intervention models for attracting and retaining pregnant women in drug abuse treatment. Both models offered motivational interviewing (MI) + behavioral incentives (BI) for drug abstinence. One model had an additional case management (CM) component. The addition of CM resulted in less drug use and fewer psychosocial needs, but similar levels of poor participation in the intervention was observed with both models. The intensity of effort expended to retain participants is discussed. [source] SBIRT in Emergency Care Settings: Are We Ready to Take it to Scale?ACADEMIC EMERGENCY MEDICINE, Issue 11 2009Edward Bernstein MD Abstract This article summarizes a panel discussion on "SBIRT in the emergency care setting: are we ready to take it to scale?" Dr. Edward Bernstein commented on the historical developments of emergency department (ED) screening, brief intervention (BI), and referral to treatment (SBIRT) research, practice, and knowledge translation. Dr. Jack Stein addressed SBIRT grant program progress to date, the reimbursement stream, SBIRT lessons learned, and unanswered questions. Dr. Richard Saitz reviewed the limitations of the evidence for alcohol and drug ED screening and BI and cautioned on the danger of proceeding to practice and broad dissemination without evidenced based on randomized controlled trials with sufficient sample size and clinically important outcomes. [source] Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Rebecca M. Cunningham MD Abstract This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening,develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention,conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups,conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies,a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation,conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice. [source] Three-month Follow-up of Brief Computerized and Therapist Interventions for Alcohol and Violence Among TeensACADEMIC EMERGENCY MEDICINE, Issue 11 2009Rebecca M. Cunningham MD Abstract Objectives:, Alcohol use and violent behaviors are well documented among adolescents and have enormous effects on morbidity and mortality. The authors hypothesized that universal computer screening of teens in an inner-city emergency department (ED), followed by a brief intervention (BI), would be 1) feasible (as measured by participation and completion of BI during the ED visit) and well received by teens (as measured by posttest process measures of intervention acceptability) and 2) effective at changing known precursors to behavior change such as attitudes, self-efficacy, and readiness to change alcohol use and violence. Methods:, Adolescent patients (ages 14,18 years) at an urban ED were approached to complete a computerized survey. The survey was conducted daily from 12 noon to 11 pm from September 2006 through November 2008. Adolescents reporting both alcohol use and violence in the past year were randomized to a control group or a 35-minute BI delivered by a computer or therapist as part of the SafERteens study. Validated measures were administered, including demographics, alcohol use, attitudes toward alcohol and violence, self-efficacy for alcohol and violence, readiness to change alcohol and violence, and process questions, including likeability of intervention. Results:, A total of 2,423 adolescents were screened. Thirteen percent of those approached refused. The population was 45% male, 58% African American, and 6.2% Hispanic. Of those screened, 637 adolescents (26%) screened positive; 533 were randomized to participate, and 515 completed the BI prior to discharge. The BIs were well received by the adolescents overall; 97% of those randomized to a BI self-reported that they found one intervention section "very helpful." At posttest, significant reductions in positive attitudes for alcohol use and violence and significant increases in self-efficacy related to alcohol/violence were found for both therapist and computer interventions. At 3-month follow-up there was 81% retention, and generalized estimating equations (GEE) analysis showed that participants in both interventions had significant reductions in positive attitudes for alcohol use (therapist p = 0.002, computer p = 0.0001) and violence (therapist p = 0.012, computer p = 0.007) and significant increases in self-efficacy related to violence (therapist p = 0.0.04, computer p = 0.002); alcohol self-efficacy improved in the therapist BI condition only (therapist p = 0.050, computer p = 0.083). Readiness to change was not significantly improved. Conclusions:, This initial evaluation of the SafERteens study shows that universal computerized screening and BI for multiple risk behaviors among adolescents is feasible, well received, and effective at altering attitudes and self-efficacy. Future evaluations of the SafERteens study will evaluate the interventions' effects on behavioral change (alcohol use and violence) over the year following the ED visit. [source] Characterization and genetic analysis of bovine ,s1 -casein I variantANIMAL GENETICS, Issue 4 2009G. Lühken Summary The aim of this study was to identify the molecular genetic origin underlying the I variant of ,s1 -casein and to develop a DNA-based test for this polymorphism as a tool for genetic analyses independent of milk sample testing. All coding exons and flanking regions of the ,s1 -casein gene were sequenced in DNA samples from cattle of known ,s1 -casein genotypes (BI, CI, II, CC), determined by isoelectric focusing of milk samples. A nucleotide substitution (A>T) in exon 11 (g.19836A>T) leads to the exchange of Glu with Asp at amino acid position 84 of the mature protein (p.Glu84Asp) and perfectly co-segregated with the presence of the ,s1 -casein I variant in the milk of the analysed animals. Genotyping of a total of 680 DNA samples from 31 Bos taurus and Bos indicus cattle breeds and from Bos grunniens, Bison bison and Bison bonasus by restriction fragment length polymorphism analysis revealed the occurrence of Asp at position 84 at low frequencies in Bos taurus and Bos indicus breeds and established its origin from the ,s1 -casein C variant (p.Glu192Gly). Ten different intragenic haplotypes in the gene region from intron 8 to intron 12 were observed by sequencing, of which two occurred in Bison bison and one in Bison bonasus only. Using available casein gene complex information, an association of Asp at position 84 to ,-casein A2 and ,-casein B was shown in the Bos indicus breed Banyo Gudali. Taken together, we can postulate that the ,s1 -casein variant I is caused by a non-synonymous nucleotide substitution in exon 11 of the gene and that it originated within Bos indicus and spread to Bos taurus subsequently. [source] Visceral fat is associated with lower brain volume in healthy middle-aged adultsANNALS OF NEUROLOGY, Issue 2 2010Stéphanie Debette MD Objective Midlife obesity has been associated with an increased risk of dementia. The underlying mechanisms are poorly understood. Our aim was to examine the cross-sectional association of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and computed tomography (CT)-based measurements of subcutaneous (SAT) and visceral (VAT) adipose tissue with various magnetic resonance imaging (MRI) markers of brain aging in middle-aged community adults. Methods Participants from the Framingham Offspring cohort were eligible if in addition to having measurements of BMI, WC, WHR, SAT, and VAT, they had undergone a volumetric brain MRI scan with measurements of total brain volume (TCBV), temporal horn volume (THV), white matter hyperintensity volume (WMHV), and MRI-defined brain infarcts (BI). All analyses were adjusted for age, sex, and time interval between abdominal CT and brain MRI. Results In a sample of 733 community participants (mean age, 60 years; 53% women), we observed an inverse association of BMI (estimate by standard deviation unit ± standard error = ,0.27 ± 0.12; p = 0.02), WC (,0.30 ± 0.12; p = 0.01), WHR (,0.37 ± 0.12; p = 0.02), SAT (,0.23 ± 0.11; p = 0.04), and VAT (,0.36 ± 0.12; p = 0.002) with TCBV, independent of vascular risk factors. The association between VAT and TCBV was the strongest and most robust, and was also independent of BMI (,0.35 ± 0.15; p = 0.02) and insulin resistance (,0.32 ± 0.13; p = 0.01). When adjusting for C-reactive protein levels, the associations were attenuated (,0.17 ± 0.13; p = 0.17 for VAT). No consistently significant association was observed between the anthropometric or CT-based abdominal fat measurements and THV, WMHV, or BI. Interpretation In middle-aged community participants, we observed a significant inverse association of anthropometric and CT-based measurements of abdominal, especially visceral, fat with total brain volume. ANN NEUROL 2010 [source] Evaluating performance of and organisational capacity to deliver brief interventions in Aboriginal and Torres Strait Islander medical servicesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010Katie Panaretto Abstract Objective: This study assessed brief intervention (BI) activity and organisation capacity for smoking, nutrition, alcohol and physical activity (SNAP framework) and key clinical prevention activities in four Aboriginal and Torres Strait Islander medical services in Queensland. Methods: A mixed methods design was used including: staff surveys of knowledge and attitudes (n=39), focus groups to discuss perceived barriers and enablers and chart audits (n=150) to quantify existing BI activity. Results: Of 50 clinical staff, 46 participated in the staff survey and focus groups across the four sites. BI was perceived to be important. There was significant variation in completion of records for SNAP risk factors, key clinical and BI activities across the sites. At least one SNAP factor status was recorded in 130/150 (86.7%) patient charts audited and there was a significant trend of increased recording of SNAP factors with increasing number of patient visits. Of those identified at risk 78% received at least one BI. Where risk was identified 65/96 (67.7%) patients required multiple BIs. BI for tobacco use was consistently high across all sites. Only one site recorded regular care planning and Adult Health Checks. Impacting factors included leadership, high staff turnover, multiple medical records and staff health status. Conclusions: Inflexible staff training, competing health priorities and high levels of staff turnover were identified as key barriers to the delivery of BI in clinical settings. The data suggests a good base of existing BI activity for smoking and key clinical activities which may improve with further support. [source] Mitochondrial cytochrome b sequence yields new insight into the speciation of social voles in south-west AsiaBIOLOGICAL JOURNAL OF THE LINNEAN SOCIETY, Issue 1 2009BORIS KRY, TUFEK We established a cytochrome b (cyt b) phylogeny for six species of social voles. A Bayesian approach to phylogenetic reconstruction (BI) and a maximum likelihood (ML) tree revealed a dichotomy into two major clusters, namely a Microtus guentheri cluster and a M. socialis cluster. The three main lineages that emerged within each of these two clusters were separated by the K2P divergences which are above the intraspecific variation in Microtus. All six species were also retrieved in the minimum spanning network. Within its present taxonomic scope, M. guentheri is paraphyletic and consists of two allopatric sibling species: M. guentheri (Syria, Israel) and M. hartingi (Anatolia and the Balkans). The closest relative to these two species is M. dogramacii, which is possibly a sister species to M. hartingi. The two geographic samples were identified as M. irani, one from Shiraz (Iran) and the other from Balkusan (Turkey). The cyt b sequence confirmed the specific status of M. anatolicus within the M. socialis cluster. Although five species of social voles occur within a radius of < 500 km in the north-eastern corner of the Mediterranean, small-scale sympatry is exceptional. Species richness in this region possibly originates from past fragmentation with subsequent allopatric speciation in refugial areas. © 2009 The Linnean Society of London, Biological Journal of the Linnean Society, 2009, 98, 121,128. [source] Unravelling evolutionary lineages among South African velvet worms (Onychophora: Peripatopsis) provides evidence for widespread cryptic speciationBIOLOGICAL JOURNAL OF THE LINNEAN SOCIETY, Issue 1 2009SAVEL R. DANIELS The endemic South African velvet worm genus Peripatopsis currently contains eight recognized species described from variable morphological characters and the current taxonomy is unsatisfactory. In an attempt to investigate evolutionary relationships within Peripatopsis, we collected 137 individuals from 34 sample localities for six of the eight species. Sequence data derived from two partial mitochondrial (mt)DNA gene loci (COI and 12S rRNA), as well as partial sequence data from the ribosomal nuclear 18S rDNA locus in combination with gross morphological characters and scanning electron microscopy (SEM), was used to examine evolutionary relationships. Phylogenetic relationships were investigated using minimum evolution (ME) and Bayesian inferences (BI). Additionally, we also undertook a maximum likelihood (ML) analyses on the combined DNA sequence data set. The combined DNA evidence topologies derived from the ME, BI, and ML was highly congruent and was characterized by the presence of multiple lineages within recognized taxa. Peripatopsis clavigera, Peripatopsis moseleyi, and Peripatopsis sedgwicki each comprised two evolutionary lineages; Peripatopsis capensis comprised three; and Peripatopsis balfouri comprised six operational taxonomic units respectively. Genealogical exclusivity at both mtDNA and nuclear DNA among the geographically coherent groups coupled with pronounced sequence divergence suggested a two-fold increase in the number of species within Peripatopsis. Previously used gross morphological characters (such as the number of leg pairs and colour) were either highly variable within operational taxonomic units, or were invariant, suggesting that alternative morphological characters are necessary for species discrimination. SEM results revealed potentially useful diagnostic characters that can discriminate between at least discriminate some of the newly-identified lineages. © 2009 The Linnean Society of London, Biological Journal of the Linnean Society 2009, 97, 200,216. [source] Binding to dipeptidyl peptidase-4 determines the disposition of linagliptin (BI 1356) , investigations in DPP-4 deficient and wildtype ratsBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 8 2009Silke Retlich Abstract Linagliptin (BI 1356) is a novel dipeptidyl peptidase-4 (DPP-4) inhibitor in clinical development for the treatment of type 2 diabetes. It exhibits non-linear pharmacokinetics and shows concentration-dependent plasma protein binding to its target, DPP-4. The aim of this study was to investigate the impact of saturable binding of linagliptin to plasma and tissue DPP-4 by comparing the pharmacokinetics of linagliptin in wildtype and DPP-4 deficient Fischer rats using non-compartmental and model-based data analysis. The non-compartmental analysis revealed a significantly reduced AUC in DPP-4 deficient rats compared with wildtype rats when single intravenous doses ,1,mg/kg were administered, but the exposure was similar in both strains at higher doses. The terminal half-lives were significantly shorter in DPP-4 deficient rats compared with wildtype rats. For doses ,1,mg/kg, DPP-4 deficient rats exhibited linear pharmacokinetics, whereas the pharmacokinetics of wildtype rats was non-linear. In the model-based analysis these differences could be accounted for by assuming concentration-dependent protein binding in the central and one peripheral compartment in wildtype rats. In the model, disposition parameters for unbound linagliptin were assumed to be identical in both rat strains. Simulations with different doses of linagliptin and different concentrations of binding sites further illustrated that the interdependence of linagliptin and DPP-4 in plasma and in the periphery has a major influence on the disposition of linagliptin in wildtype rats. In conclusion, the study showed that the concentration-dependent binding of linagliptin to its target DPP-4 has a major impact on the plasma pharmacokinetics of linagliptin. Copyright © 2009 John Wiley & Sons, Ltd. [source] Tissue distribution of the novel DPP-4 inhibitor BI 1356 is dominated by saturable binding to its target in ratsBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 5 2009Holger Fuchs Abstract BI 1356 (INN: linagliptin) is an inhibitor of dipeptidyl peptidase-4 (DPP-4). This study investigated whether saturable binding of BI 1356 to its target DPP-4 occurs in tissues and whether drug accumulation occurs at these sites in vivo. In order to test these hypotheses, the tissue distribution of BI 1356 was determined in wild-type and DPP-4 deficient rats at different dose levels by means of whole body autoradiography and measurement of tissue radioactivity concentrations after single i.v. dosing of [14C]-radio labeled BI 1356. The accumulation behavior of drug-related radioactivity in tissues was further explored in an oral repeat dose study. Tissue levels of [14C]BI 1356 related radioactivity were markedly lower in all investigated tissues of the DPP-4 deficient rats and the difference of the dose-dependent increase of radioactivity tissue levels between both rat strains indicates that tissue distribution at low doses of BI 1356 is dominated by binding of BI 1356 to DPP-4 in tissues. As the binding to DPP-4 is strong but reversible, the tissue binding results in a long terminal half-life in several tissues including plasma. The binding capacity to DPP-4 is, however, limited. In the rat, saturation of DPP-4 binding is suggested at an intravenous dose above 0.01,0.1,mg/kg [14C]BI 1356. As the DPP-4 binding capacity is saturated already at low doses, accumulation of BI 1356 in tissues is unlikely, despite the long persistence of low amounts in the body. Copyright © 2009 John Wiley & Sons, Ltd. [source] Type 4 phosphodiesterase inhibitor suppresses experimental bladder inflammationBJU INTERNATIONAL, Issue 10 2008Takeya Kitta OBJECTIVE To evaluate the effects of orally administered YM976, a specific inhibitor of type 4 phosphodiesterase (PDE4), on bladder activity in a rat model with hydrochloric acid (HCl)-induced cystitis (IC), hypothesizing that a PDE4 inhibitor might suppress bladder overactivity and bladder pain responses in bladder-hypersensitive disorders such as IC. MATERIALS AND METHODS Wistar rats with HCl-induced IC were treated with YM976 or vehicle and their voiding observed and assessed by cystometry. The severity of bladder inflammation (BI) was quantified using the BI index (BII), which comprises three factors (oedema, leukocyte infiltration and haemorrhage). Nociceptive neural activity was also examined using an immunohistochemical study of spinal c-fos expression. RESULTS YM976 significantly reduced the number of voids, and the volume per void was significantly higher than in control (vehicle) group. Cystometry showed a significant increase in bladder capacity, voided volume and voiding efficiency, and a decrease in the amplitude of voiding pressure in rats treated with YM976. All BII scores were significantly lower in the YM976 than in the control group. c-fos expression in the spine was less in the YM976 than in the control group. CONCLUSIONS Oral administration of YM976 significantly improved the voiding behaviour and histological damage in rats with IC induced by HCl. These results indicate that PDE4 inhibitor might be effective in relieving bladder symptoms with IC. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||