412 research outputs found

    The legislative reform movement in Illinois, 1964-1977

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    Thesis (B.A.) in Political Science--University of Illinois at Urbana-Champaign, 1983.Bibliography: leaf 49.Microfiche of typescript. [Urbana, Ill.] : Photographic Services, University of Illinois, U of I Library, [1983]. 2 microfiches (56 frames) : negative ; 11 x 15 cm

    Communication with young people in paediatric and adult endocrine consultations: an intervention development and feasibility study

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    Background: Communication is complex in endocrine care, particularly during transition from paediatric to adult services. The aims of this study were to examine the feasibility of interventions to support young people to interact with clinicians. Methods: Development and evaluation of a complex intervention in 2 phases: Pre-intervention observational study; Intervention feasibility study. Purposive sample of recordings of 62 consultations with 58 young people aged 11-25 years with long-term endocrine conditions in two paediatric and two adult endocrine clinics. Proportion of time talked during consultations, number and direction of questions asked; Paediatric Consultation Assessment Tool (PCAT); OPTION shared decision making tool; Medical Information Satisfaction Scale (MISS- 21). Young people were invited to use one or more of: a prompt sheet to help them influence consultation agendas and raise questions; a summary sheet to record key information; and the www.explain.me.uk website. Results: Nearly two thirds of young people (63%) chose to use at least one communication intervention. Higher ratings for two PCAT items (95% CI 0.0 to 1.1 and 0.1 to 1.7) suggest interventions can support consultation skills. A higher proportion of accompanying persons (83%) than young people (64%) directed questions to clinicians. The proportion of young people asking questions was higher (84%) in the intervention phase than in the observation phase (71%). Conclusions: Interventions were acceptable and feasible. The Intervention phase was associated with YP asking more questions, which implies that the availability of interventions could promote interactivity

    Glucagon-like peptide-1 (GLP-1) receptors are not overexpressed in pancreatic islets from patients with severe hyperinsulinaemic hypoglycaemia following gastric bypass

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    Aims/hypothesis: Glucagon-like peptide-1 (GLP-1) receptors are highly overexpressed in benign insulinomas, permitting in vivo tumour visualisation with GLP-1 receptor scanning. The present study sought to evaluate the GLP-1 receptor status in vitro in other pancreatic disorders leading to hyperinsulinaemic hypoglycaemia, specifically after gastric bypass surgery. Methods: Fresh frozen pancreatic tissue samples (n = 7) from six gastric bypass surgery patients suffering from hyperinsulinaemic hypoglycaemia were evaluated for GLP-1 receptor content using in vitro receptor autoradiography, and compared with normal pancreas and with pancreatic insulinoma tissues. Results: GLP-1 receptor analysis of the pancreatic tissues, which histopathologically were compatible with nesidioblastosis and originated from post-bypass hypoglycaemic patients, revealed a mean density value of GLP-1 receptors in the islets of 1,483 ± 183dpm/mg tissue. Pharmacological characterisation indicated the presence of specific GLP-1 receptors. The density of islet GLP-1 receptor in post-gastric bypass patients did not differ from that of normal pancreas (1,563 ± 104dpm/mg tissue, n = 10). Receptor density in pancreatic acini was low in post-bypass and control conditions. In contrast, benign insulinomas showed a high density of GLP-1 receptors, with a mean value of 8,302 ± 1,073dpm/mg tissue (n = 6). Conclusions/interpretation: In contrast to insulinoma, hyperinsulinaemic hypoglycaemia after gastric bypass surgery is not accompanied by overexpression of GLP-1 receptor in individual islets. Thus, patients with post-gastric bypass hyperinsulinaemic hypoglycaemia are not candidates for GLP-1 receptor imaging in vivo using radiolabelled exendin. These GLP-1 receptor data support the notion that the islet pathobiology of post-gastric bypass hypoglycaemia is distinctly different from that of benign insulinoma

    A youth advisory group on health and health research in rural Cambodia

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    Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU’s laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE’s health promotional interventions may have contributed in enhancing community’s health

    Phenology Effects on Productivity and Hatching-Asynchrony of American Kestrels (\u3cem\u3eFalco sparverius\u3c/em\u3e) Across a Continent

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    Optimal reproductive performance occurs when birds time reproduction to coincide with peak food availability. Deviation from optimal timing, or mismatch, can affect productivity, though birds may mediate some mismatch effects by altering their incubation behavior. We studied the consequences of nesting timing (i.e., clutch initiation relative to an index of spring start) on productivity across the breeding range of American kestrels (Falco sparverius) in the United States and southern Canada, and associations between nesting timing, incubation behavior, and hatching asynchrony. We used observations from long-term nest box monitoring, remote trail cameras, and community-scientist-based programs to obtain data on clutch initiation, productivity, incubation, and hatching synchrony. Kestrels that initiated clutches after the extended spring index (SI-x, start of spring estimate) had higher rates of nest failure and fewer nestlings than earlier nesters, and effects of nesting timing on productivity were strongest in the Northeast. In contrast, kestrels in the Southwest experienced a more gradual decline in productivity across the season. Spatial effects may be the result of regional differences in growing seasons and temporal nesting windows (duration of nesting season). Specifically, resource availability in the Northeast was highly peaked during the breeding season, potentially resulting in shorter nesting windows. Conversely, resource curves were more prolonged in the Southwest, and growing seasons are becoming longer with climate change, potentially resulting in longer nesting windows. We found an inverse relationship between nesting timing and the onset of male incubation. Males from breeding pairs that initiated clutches after SI-x began incubation sooner than males from breeding pairs that initiated clutches before SI-x. Early-onset of male incubation was positively associated with hatching asynchrony, creating increased age variation in developing young. In sum, nesting phenology relative to the SI-x has consequences for American kestrels’ productivity, and these consequences vary across space. The early onset of incubation may act as a potential adaptive behavior to advance the average hatch date and spread out energetic demands. Given the effects of nesting timing on productivity, kestrels are likely to be sensitive to climate-driven advances in growing seasons and vulnerable to phenological mismatch, particularly in the Northeast

    Doping, European Law and the Implications of Meca-Medina

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    The ruling of the European Court of Justice in the anti-doping case of Meca Medina v. The Commission has important implications for athletes, domestic governing bodies, international federations and supra-national actors such as WADA and the Court of Arbitration for Sport. Meca-Medina has been criticised as an unwelcome interference by the courts in the legitimate activities of sporting organisations, but after Bosman it was fanciful to argue that those organisations should be ‘above the law’ and the courts should have no jurisdiction over their activities. That said, there is a stark difference between the courts having jurisdiction over sports’ decisions and being willing to overturn them - the courts have been, and remain, willing to defer to the expertise of sporting organisations. However, the ECJ’s ruling in MOTOE confirms that the courts will intervene in appropriate circumstances. In order to avoid sanction on competition law grounds sports organisations must thus be able to justify their provisions on (for example) what is an unacceptable level of nandrolone, show that athletes’ fundamental rights such as the right to a fair hearing have been respected, and ensure that any sanctions imposed upon athletes who fall foul of doping regulations are proportionate to the offence committed

    A Root-Cause Analysis of Mortality Following Major Pancreatectomy

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    Abstract Introduction Although mortality rates from pancreatectomy have decreased worldwide, death remains an infrequent but profound event at an individual practice level. Root-cause analysis is a retrospective method commonly employed to understand adverse events. We evaluate whether emerging mortality risk assessment tools sufficiently predict and account for actual clinical events that are often identified by root-cause analysis. Methods We assembled a Pancreatic Surgery Mortality Study Group comprised of 36 pancreatic surgeons from 15 institutions in 4 countries. Mortalities after pancreatectomy (30 and 90 days) were accrued from 2000 to 2010. For root-cause analysis, each surgeon "deconstructed" the clinical events preceding a death to determine cause. We next tested whether mortality risk assessment tools (ASA, POSSUM, Charlson, SOAR, and NSQIP) could predict those patients who would die (n=218) and compared their prognostic accuracy against a cohort of resections in which no patient died (n=1,177). Results Two hundred eighteen deaths (184 Whipple's resection, 18 distal pancreatectomies, and 16 total pancreatectomies) were identified from 11,559 pancreatectomies performed by surgeons whose experience averaged 14.5 years. Overall 30-and 90-day mortalities were 0.96% and 1.89%, respectively. Individual surgeon rates ranged from 0% to 4.7%. Only 5 patients died intraoperatively, while the other 213 succumbed at a median of 29 days. Mean patient age was 70 years old (38% were >75 years old). Malignancy was the indication in 90% of cases, mostly pancreatic cancer (57%). Median operative time was 365 min and estimated blood loss was 700 cc (range, 100-16,000 cc). Vascular repair or multivisceral resections were required for 19.7% and 15.1%, respectively. Seventy-seven percent had a variety of major complications before death. Eighty-seven percent required intensive care unit care, 55% were transfused, and 35% were reoperated upon. Fifty percent died during the index admission, while another 11% died after a readmission. Almost half (n=107) expired between 31 and 90 days. Only 11% had autopsies. Operation-related complications contributed to 40% of deaths, with pancreatic fistula being the most evident (14%). Technical errors (21%) and poor patient selection (15%) were cited by surgeons. Of deaths, 5.5% had associated cancer progression-all occurring between 31 and 90 days. Even after root-cause scrutiny, the ultimate cause of death could not be determined for a quarter of the patients-most often between 31 and 90 days. While assorted risk models predicted mortality with variable discrimination from nonmortalities, they consistently underestimated the actual mortality events we report. Conclusion Root-cause analysis suggests that risk prediction should include, if not emphasize, operative factors related to pancreatectomy. While risk models can distinguish between mortalities and nonmortalities in a collective fashion, they vastly miscalculate the actual chance of death on an individual basis. This study reveals the contributions of both comorbidities and aggressive surgical decisions to mortality
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