Studies on the mechanism of the vitamin K-dependent carboxylation reaction:Carboxylation without the concurrent formation of vitamin K 2,3-epoxide

Bio-organic Synthesi

Subtypes of Late-Life Depression:A Data-Driven Approach on Cognitive Domains and Physical Frailty

Background: With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. Methods: A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. Results: A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression (“mild” and “severe” depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as “amnestic depression,” “frail-depressed, physically dominated,” and “frail-depressed, cognitively dominated.” The prospective analyses showed that patients in the subgroup of “mild depression” and “amnestic depression” had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. Conclusions: Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation

Inclusion in morning meetings

This thesis explores the extent to which teachers implement best practice of inclusion during their daily Morning Meetings. Morning Meetings are a standard practice at the beginning of the school day where student and teachers greet one another, share personal stories and information, participate in a group activity, and read a morning message written by the teachers. Preschool through third grade teachers in local school districts were given a self-reflection survey. The survey was a standardized checklist that was informed by research on inclusive practices and The Morning Meeting Book (Kriete & Davis, 2014). It was modeled after the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC) joint early childhood inclusion policy, which states the defining features of inclusion as access, participation, and supports (2009). The survey lists specific practices that teachers may or may not be implementing that promote inclusion. My hypothesis before the research began was that teachers would struggle to implement the practices that take more time and preparation outside of their normal routine. The analysis of the data showed that my hypothesis was correct to some extent, teachers were more successful when implementing accommodations that they could plan into the whole group, and less successful with one-on-one accommodations that required them to work individually with a student outside of the Morning Meeting

Prevention of Catheter-Related Bacteremia with a Daily Ethanol Lock in Patients with Tunnelled Catheters: A Randomized, Placebo-Controlled Trial

Background: Catheter-related bloodstream infection (CRBSI) results in significant attributable morbidity and mortality. In this randomized, double-blind, placebo-controlled trial, we studied the efficacy and safety of a daily ethanol lock for the prevention of CRBSI in patients with a tunnelled central venous catheter (CVC). Methodology: From 2005 through 2008, each lumen of the CVC of adult hematology patients was locked for 15 minutes per day with either 70%-ethanol or placebo, where after the lock solution was flushed through. As a primary endpoint, the incidence rates of endoluminal CRBSI were compared. Principal Findings: The intent-to-treat analysis was based on 376 patients, accounting for 448 CVCs and 27,745 catheter days. For ethanol locks, the incidence of endoluminal CRBSI per 1000 CVC-days was 0.70 (95%-CI, 0.4-1.3), compared to 1.19 (95% confidence interval, 0.7-1.9) for placebo (incidence rate-ratio, 0.59; 95% confidence interval, 0.27-1.30; P = .19). For endoluminal CRBSI according to the strictest definition (positive hub culture and identical bacterial strain in blood), a 3.6-fold, non-significant, reduction was observed for patients receiving ethanol (2 of 226 versus 7 of 222; P = .103). No lifethreatening adverse events were observed. More patients receiving ethanol discontinued lock-therapy (11 of 226 versus 1 of 222; P = .006) or continued with decreased lock-frequency (10 of 226 versus 0 of 222; P = .002), due to non-severe adverse events. Conclusions: In this study, the reduction in the incidence of endoluminal CRBSI using preventive ethanol locks was nonsignificant, although the low incidence of endoluminal CRBSI precludes definite conclusions. Therefore, the lack of statistical significance may partially reflect a lack of power. Significantly more patients treated with ethanol locks discontinued their prophylactic treatment due to adverse effects, which were non-severe but reasonably ethanol related. Additional studies should be performed in populations with higher incidence of (endoluminal) CRBSI. Alternative sources of bacteremia, like exoluminal CRBSI or microbial translocation during chemotherapy-induced mucositis may have been more important in our patients. Trial Registration: ClinicalTrials.gov NCT00122642

Functional coupling of glycolysis and phosphocreatine utilization in anoxic fish muscle: an in vivo 31P NMR study

Animal science

Quais os riscos-benefícios da sibutramina no tratamento da obesidade/ What are the risk-benefits of sibutramine in the treatment of obesity

A obesidade é uma condição de risco para saúde podendo causar o surgimento de patologias graves. No entanto, a pressão pela estética corporal leva as pessoas a optarem pelo uso da sibutramina em busca de emagrecimento rápido. A administração da sibutramina deve ser realizada com cautela, pois apresentam contraindicações e efeitos colaterais, podendo inclusive causar dependência. A dificuldade de acesso ao atendimento médico tem levado muitas pessoas a buscarem tratamentos inseguros e ineficazes, como dietas sem acompanhamento nutricional e remédios caseiros com plantas sem nenhum tipo de evidência científica. O estudo teve como objetivo Analisar e descrever informações em relação ao uso indiscriminado da sibutramina no tratamento da obesidade, seus riscos, efeitos colaterais, interações medicamentosas e a importância do farmacêutico nesse processo. Com base nos dados divulgados nesta revisão, pode se concluir que os medicamentos para obesidade devem ser tomados com cautela, pois possuem contraindicações e efeitos colaterais, podendo até causar dependência.