454 research outputs found
Clinical intestinal transplantation: New perspectives and immunologic considerations
Background: Although tacrolimus-based immunosuppression has made intestinal transplantation feasible, the risk of the requisite chronic high- dose treatment has inhibited the widespread use of these procedures. We have examined our 1990-1997 experience to determine whether immunomodulatory strategies to improve outlook could be added to drug treatment. Study Design: Ninety-eight consecutive patients (59 children, 39 adults) with a panoply of indications received 104 allografts under tacrolimus-based immunosuppression: intestine only (n = 37); liver and intestine (n = 50); or multivisceral (n = 17). Of the last 42 patients, 20 received unmodified adjunct donor bone marrow cells; the other 22 were contemporaneous control patients. Results: With a mean followup of 32 ± 26 months (range, 1-86 months), 12 recipients (3 intestine only, 9 composite grafts) are alive with good nutrition beyond the 5-year milestone. Forty-seven (48%) of the total group survive bearing grafts that provide full (91%) or partial (9%) nutrition. Actuarial patient survival at 1 and 5 years (72% and 48%, respectively) was similar with isolated intestinal and composite graft recipients, but the loss rate of grafts from rejection was highest with intestine alone. The best results were in patients between 2 and 18 years of age (68% at 5 years). Adjunct bone marrow did not significantly affect the incidence of graft rejection, B-cell lymphoma, or the rate or severity of graft-versus-host disease. Conclusions: These results demonstrate that longterm rehabilitation similar to that with the other kinds of organ allografts is achievable with all three kinds of intestinal transplant procedures, that the morbidity and mortality is still too high for their widespread application, and that the liver is significantly but marginally protective of concomitantly engrafted intestine. Although none of the endpoints were markedly altered by donor leukocyte augmentation (and chimerism) with bone marrow, establishment of the safety of this adjunct procedure opens the way to further immune modulation strategies that can be added to the augmentation protocol
The Association of Types of Training and Practice Settings with Doctors’ Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong
Background
The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.
Objective
This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.
Methods
This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors.
Results
Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting.
Conclusion
Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors' training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors' empathy and enablement for chronic illness patients.published_or_final_versio
Flipping quantum coins
Coin flipping is a cryptographic primitive in which two distrustful parties
wish to generate a random bit in order to choose between two alternatives. This
task is impossible to realize when it relies solely on the asynchronous
exchange of classical bits: one dishonest player has complete control over the
final outcome. It is only when coin flipping is supplemented with quantum
communication that this problem can be alleviated, although partial bias
remains. Unfortunately, practical systems are subject to loss of quantum data,
which restores complete or nearly complete bias in previous protocols. We
report herein on the first implementation of a quantum coin-flipping protocol
that is impervious to loss. Moreover, in the presence of unavoidable
experimental noise, we propose to use this protocol sequentially to implement
many coin flips, which guarantees that a cheater unwillingly reveals
asymptotically, through an increased error rate, how many outcomes have been
fixed. Hence, we demonstrate for the first time the possibility of flipping
coins in a realistic setting. Flipping quantum coins thereby joins quantum key
distribution as one of the few currently practical applications of quantum
communication. We anticipate our findings to be useful for various
cryptographic protocols and other applications, such as an online casino, in
which a possibly unlimited number of coin flips has to be performed and where
each player is free to decide at any time whether to continue playing or not.Comment: 17 pages, 3 figure
Protocol for the 'e-Nudge trial' : a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380]
Background: Cardiovascular disease (including coronary heart disease and stroke) is a major
cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle
modification and drug therapy. The recent standardisation of electronic codes for cardiovascular
risk variables through the United Kingdom's new General Practice contract provides an
opportunity for the application of risk algorithms to identify high risk individuals. This randomised
controlled trial will test the benefits of an automated system of alert messages and practice
searches to identify those at highest risk of cardiovascular disease in primary care databases.
Design: Patients over 50 years old in practice databases will be randomised to the intervention
group that will receive the alert messages and searches, and a control group who will continue to
receive usual care. In addition to those at high estimated risk, potentially high risk patients will be
identified who have insufficient data to allow a risk estimate to be made. Further groups identified
will be those with possible undiagnosed diabetes, based either on elevated past recorded blood
glucose measurements, or an absence of recent blood glucose measurement in those with
established cardiovascular disease.
Outcome measures: The intervention will be applied for two years, and outcome data will be
collected for a further year. The primary outcome measure will be the annual rate of cardiovascular
events in the intervention and control arms of the study. Secondary measures include the
proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing
data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial
Effect of Anti-Tuberculous Therapy on Uveitis Associated with Latent Tuberculosis
PURPOSE: To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome. DESIGN: Retrospective cohort study METHODS: 199 eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision and treatment. Outcome measures included: best corrected visual acuity (BCVA) and rate of disease recurrence. RESULTS: This study included eighty-nine patients (69%) received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5±1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64±0.08 recurrences per-year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs. 48.2%, OR 0.47, 95% CI 0.29-0.77, p=0.003). Eyes treated with ATT recurred at an estimated median of 120 months compared with 51 months in eyes with no treatment (p=0.005). CONCLUSIONS: Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB
Experimental plug&play quantum coin flipping
Performing complex cryptographic tasks will be an essential element in future
quantum communication networks. These tasks are based on a handful of
fundamental primitives, such as coin flipping, where two distrustful parties
wish to agree on a randomly generated bit. Although it is known that quantum
versions of these primitives can offer information-theoretic security
advantages with respect to classical protocols, a demonstration of such an
advantage in a practical communication scenario has remained elusive. Here, we
experimentally implement a quantum coin flipping protocol that performs
strictly better than classically possible over a distance suitable for
communication over metropolitan area optical networks. The implementation is
based on a practical plug&play system, designed for quantum key distribution.
We also show how to combine our protocol with coin flipping protocols that are
almost perfectly secure against bounded adversaries, hence enhancing them with
a level of information-theoretic security. Our results offer a powerful toolbox
for future secure quantum communications.Comment: Version 2, 19 pages including detailed security analysi
High-Resolution 3D Structure Determination of Kaliotoxin by Solid-State NMR Spectroscopy
High-resolution solid-state NMR spectroscopy can provide structural information of proteins that cannot be studied by X-ray crystallography or solution NMR spectroscopy. Here we demonstrate that it is possible to determine a protein structure by solid-state NMR to a resolution comparable to that by solution NMR. Using an iterative assignment and structure calculation protocol, a large number of distance restraints was extracted from 1H/1H mixing experiments recorded on a single uniformly labeled sample under magic angle spinning conditions. The calculated structure has a coordinate precision of 0.6 Å and 1.3 Å for the backbone and side chain heavy atoms, respectively, and deviates from the structure observed in solution. The approach is expected to be applicable to larger systems enabling the determination of high-resolution structures of amyloid or membrane proteins
Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective
Background: Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract. Methods: This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning. Results: One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10–12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63–0.83. Conclusion: Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology
Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies
The evidence that red and processed meat influences colorectal carcinogenesis was judged convincing in the 2007 World Cancer Research Fund/American Institute of Cancer Research report. Since then, ten prospective studies have published new results. Here we update the evidence from prospective studies and explore whether there is a non-linear association of red and processed meats with colorectal cancer risk
S-allylmercaptocysteine reduces carbon tetrachloride-induced hepatic oxidative stress and necroinflammation via nuclear factor kappa B-dependent pathways in mice
Purpose To study the protective effects and underlying molecular mechanisms of SAMC on carbon tetrachloride (CCl4)-induced acute hepatotoxicity in the mouse model. Methods Mice were intraperitoneally injected with CCl4 (50 μl/kg; single dose) to induce acute hepatotoxicity with or without a 2-h pre-treatment of SAMC intraperitoneal injection (200 mg/kg; single dose). After 8 h, the blood serum and liver samples of mice were collected and subjected to measurements of histological and molecular parameters of hepatotoxicity. Results SAMC reduced CCl4-triggered cellular necrosis and inflammation in the liver under histological analysis. Since co-treatment of SAMC and CCl4 enhanced the expressions of antioxidant enzymes, reduced the nitric oxide (NO)-dependent oxidative stress, and inhibited lipid peroxidation induced by CCl4. SAMC played an essential antioxidative role during CCl4-induced hepatotoxicity. Administration of SAMC also ameliorated hepatic inflammation induced by CCl4 via inhibiting the activity of NF-κB subunits p50 and p65, thus reducing the expressions of pro-inflammatory cytokines, mediators, and chemokines, as well as promoting pro-regenerative factors at both transcriptional and translational levels. Conclusions Our results indicate that SAMC mitigates cellular damage, oxidative stress, and inflammation in CCl4-induced acute hepatotoxicity mouse model through regulation of NF-κB. Garlic or garlic derivatives may therefore be a potential food supplement in the prevention of liver damage
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