891 research outputs found
Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K-1) in severe acute liver disease
Background/Aims: In patients with severe acute liver dysfunction, i.v. phylloquinone (vitamin K-1) may be given to exclude vitamin K deficiency, rather than impaired hepatic synthesis of coagulation factors alone, as the cause of the coagulopathy. However, there have been no studies of the pharmacokinetics or efficacy of i.v. or oral K-1 in such patients.Methods: 49 adults with severe acute liver disease were randomised double-blind to a single 10 mg dose of i.v. or oral mixed-micellar K-1, or placebo. Serum levels of phylloquinone and undercarboxylated prothrombin (PIVKA-II) were assessed before and after treatment.Results: At admission, 13 patients (27 %) had either low serum K-1 levels or elevated PIVKA-II concentrations, indicative of subclinical vitamin K deficiency. In the 16 patients who received i.v. K-1, there was one (6 %) treatment failure (K-1 rise < 10 ng/ml above baseline), compared with 12 of the 15 (80 %) who received oral K, (P < 0.0001). One patient in the placebo group developed overt vitamin K deficiency.Conclusions: A minority of patients with severe acute liver dysfunction have subclinical vitamin K deficiency at the time of presentation, which is corrected by a single dose of i.v. K-1. The intestinal absorption of mixed-micellar K, is unreliable in adults with severe acute liver dysfunction. (c) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved
Changes to nursesâ practice environment over time
© 2016 John Wiley & Sons Ltd Aims: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Background: Positive nurse practice environments have been linked to nurse retention and care quality outcomes. Methods: The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. Results: On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. Conclusions: The decline in nursesâ perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Implication for Nursing Management: Managers need to apply existing evidence to improve nurse practice environments and manage instability
Location of the River Euphrates in the Late Miocene; dating of terrace gravel at Shireen, Syria
International audienceWe report gravel of the River Euphrates, capped by basalt that is Ar-Ar dated to ~9 Ma, at Shireen in northern Syria. This gravel, preserved by the erosion-resistant basalt, allows us for the first time to reconstruct the history of this major river during the Late Miocene. In response to progressive regional surface uplift, the Euphrates extended SE by ~800 km between the early Middle Miocene, when the coast was near Kahramanmara? in southern Turkey, and the Pliocene, when it lay in western Iraq, east of the Arabian Platform uplands
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Feminist Solidarities: Theoretical and Practical Complexities
This article considers the resurgence of interest in feminist solidarity in theory and practice in the contemporary moment in the United States and UK. What does feminist solidarity mean, what forms is it taking, and how might it proliferate? We begin by mapping the changing inflections of solidarity in recent feminist cultural theory, highlighting the range of theoretical components, investments and emphases. Next, we consider the various forms of solidarity presented and created by the Womenâs March and the Womenâs Strike, analysing the differences in terms of the extent of their reach and their political economy. We argue that both phenomena can be understood as reactions to, firstly, several decades of neoliberal impoverishment, which have now exposed neoliberal iterations of feminism as fundamentally inadequate; and secondly, and relatedly, the arrival of misogynistic and reactionary forms of nationalism. Finally, we show that different approaches to feminist solidarity, as well as an expansion of alliances, are necessary in order to extend contemporary feminism as an effective and largeâscale project. We therefore argue that feminist solidarity needs to retain its genealogical roots in left politics whilst being as plural as possible in practice
The changing patterns of group politics in Britain
Two interpretations of ways in which group politics in Britain have presented challenges to democracy are reviewed: neo-corporatism or pluralistic stagnation and the rise of single issue interest groups. The disappearance of the first paradigm created a political space for the second to emerge. A three-phase model of group activity is developed: a phase centred around production interests, followed by the development of broadly based 'other regarding' groups, succeeded by fragmented, inner directed groups focusing on particular interests. Explanations of the decay of corporatism are reviewed. Single issue group activity has increased as party membership has declined and is facilitated by changes in traditional media and the development of the internet. Such groups can overload the policy-making process and frustrate depoliticisation. Debates about the constitution and governance have largely ignored these issues and there is need for a debate
Multiple Components of the VHL Tumor Suppressor Complex Are Frequently Affected by DNA Copy Number Loss in Pheochromocytoma
Pheochromocytomas (PCC) are rare tumors that arise in chromaffin tissue of the adrenal gland. PCC are frequently inherited through predisposing mutations in genes such as the von Hippel-Lindau (VHL) tumor suppressor. VHL is part of the VHL elongin BC protein complex that also includes CUL2/5, TCEB1, TCEB2, and RBX1; in normoxic conditions this complex targets hypoxia-inducible factor 1 alpha (HIF1A) for degradation, thus preventing a hypoxic response. VHL inactivation by genetic mechanisms, such as mutation and loss of heterozygosity, inhibits HIF1A degradation, even in the presence of oxygen, and induces a pseudohypoxic response. However, the described <10% VHL mutation rate cannot account for the high frequency of hypoxic response observed. Indeed, little is known about genetic mechanisms disrupting other complex component genes. Here, we show that, in a panel of 171 PCC tumors, 59.6% harbored gene copy number loss (CNL) of at least one complex component. CNL significantly reduced gene expression and was associated with enrichment of gene targets controlled by HIF1. Interestingly, we show that VHL-related renal clear cell carcinoma harbored disruption of VHL alone. Our results indicate that VHL elongin BC protein complex components other than VHL could be important for PCC tumorigenesis and merit further investigation
Learning through social spaces: migrant women and lifelong learning in post-colonial London
This article shows how migrant women engage in learning through social spaces. It argues that such spaces are little recognised, and that there are multiple ways in which migrant women construct and negotiate their informal learning through socialising with other women in different informal modes. Additionally, the article shows how learning is shaped by the socio-political, geographical and multicultural context of living in London, outlining ways in which gendered and racialised identities shape, construct and constrain participation in lifelong learning. The article shows that one way in which migrant women resist (post)colonial constructions of difference is by engaging in informal and non-formal lifelong learning, arguing that the benefits are (at least) two-fold. The women develop skills (including language skills) but also use their informal learning to develop what is referred to in this article as 'relational capital'. The article concludes that informal lifelong learning developed through social spaces can enhance a sense of belonging for migrant women
The impact of marketisation on postgraduate career preparedness in a high skills economy
This study focuses on the consequences for high skills development of the erosion of the once clear demarcation between higher education and business. It contributes to the broader debate about the relevance of higher education for thewell-being of the society of the future. The research explores the effects of marketisation on the postgraduate curriculum and studentsâ preparedness for careers in public relations and marketing communications. Interviews with lecturers and students in two universities in the UK and Australia indicate that a tension exists between academic rigour and corporate relevancy. The consequences are a diminution of academic attachment to critique and wider social/cultural engagement, with a resulting impoverishment of studentsâ creative abilities and critical consciences. Subsequently, graduates of public relations and marketing communications, and to some extent those from other profession-related disciplines, are insufficiently prepared for careers as knowledge workers in a future high-skills economy
Psychopolitics: Peter Sedgwickâs legacy for mental health movements
This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of âanti-psychiatryâ the failure of which, Sedgwick argued, lay in its deconstruction of the category of âmental illnessâ, a gesture that resulted in a politics of nihilism. âThe radical who is only a radical nihilistâ, Sedgwick observed, âis for all practical purposes the most adamant of conservativesâ. Sedgwick argued, rather, that the concept of âmental illnessâ could be a truly critical concept if it was deployed âto make demands upon the health service facilities of the society in which we liveâ. The paper contextualizes Psychopolitics within the âcrisis tendenciesâ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of âmental illnessâ â Sedgwick's critical concept â has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless âSedgwickianâ
Randomized placebo-controlled trial assessing the effect of 24-week fenofibrate therapy on circulating markers of abdominal aortic aneurysm: Outcomes from the FAME-2 trial
Background-There is no drug therapy for abdominal aortic aneurysm (AAA). FAME-2 (Fenofibrate in the Management of Abdominal Aortic Aneurysm 2) was a placebo-controlled randomized trial designed to assess whether administration of 145 mg of fenofibrate/d for 24 weeks favorably modified circulating markers of AAA. Methods and Results-Patients with AAAs measuring 35 to 49 mm and no contraindication were randomized to fenofibrate or identical placebo. The primary outcome measures were the differences in serum osteopontin and kallistatin concentrations between groups. Secondary analyses compared changes in the circulating concentration of AAA-associated proteins, and AAA growth, between groups using multivariable linear mixed-effects modeling. A total of 140 patients were randomized to receive fenofibrate (n=70) or placebo (n=70). By the end of the study 3 (2.1%) patients were lost to follow-up and 18 (12.9%) patients had ceased trial medication. A total of 85% of randomized patients took =80% of allocated tablets and were deemed to have complied with the medication regimen. Patientsâ allocated fenofibrate had expected reductions in serum triglycerides and estimated glomerular filtration rate, and increases in serum homocysteine. No differences in serum osteopontin, kallistatin, or AAA growth were observed between groups. Conclusions-Administering 145 mg/d of fenofibrate for 24 weeks did not significantly reduce serum concentrations of osteopontin and kallistatin concentrations, or rates of AAA growth in this trial. The findings do not support the likely benefit of fenofibrate as a treatment for patients with small AAAs. Clinical Trial Registration-URL: www.anzctr.org.au. Unique identifier: ACTRN12613001039774
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