Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “promoter optimization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed2005

The basal ganglia: learning new tricks and loving it.

The field of basal ganglia research is exploding on every level - from discoveries at the molecular level to those based on human brain imaging. A remarkable series of new findings support the view that the basal ganglia are essential for some forms of learning-related plasticity. Other new findings are challenging some of the basic tenets of the field as it now stands. Combined with the new evidence on learning-related functions of the basal ganglia, these studies suggest that the basal ganglia are parts of a brain-wide set of adaptive neural systems promoting optimal motor and cognitive control.

Animals↗
PubMedDate not supplied

Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success.

BACKGROUND: Myocardial ischemia may be considered both a consequence of weaning from ventilation and a potential cause of weaning failure. A limited number of investigations have evaluated myocardial ischemia during mechanical ventilation and weaning and its effect on weaning success. The purpose of this pilot investigation was to determine the prevalence of myocardial ischemia in a diverse group of medical intensive care unit (MICU) patients during baseline mechanical ventilation, during weaning using continuous positive airway pressure, and up to 24 hours after extubation and to evaluate the relationship between ischemia and weaning failure. METHODS: This study was a prospective, repeated-measure, descriptive investigation that studied 43 ventilated MICU patients. Slightly more than half of participants were male (53%), and participants had a mean age of 51.1 +/- 14.6 years and were ventilated an average of 11.7 +/- 11.3 days. Myocardial ischemia was evaluated by examination of plasma cardiac troponin I, creatine phosphokinase-myocardial band (CK-MB), and ST-segment changes on electrocardiogram. Continuous electrocardiographic data were obtained by a calibrated, frequency-modulated, continuous 3-channel electrocardiographic recorder using leads I, II, and V2. RESULTS: Seventy percent of these participants (n = 30) exhibited ST-segment deviation at some point during data collection (baseline mechanical ventilation, during weaning, after extubation). Twenty-four participants exhibited ST-segment deviation at baseline, 7 during weaning, and 8 after extubation. Nine participants exhibited ST-segment deviation at >1 data collection time point. None had ST-segment deviation at all 3 time points. Cardiac enzyme concentrations were highly variable; five participants demonstrated clinically important increases in either CK-MB and/or troponin I. Thirty-five percent of participants required >1 weaning trial. Participants who exhibited ST-segment deviation during baseline ventilation were 60% more likely to fail their initial weaning trial. There were no significant differences in CK-MB or troponin I levels between those participants who were successfully weaned with 1 trial and those who failed to wean during that first trial. CONCLUSIONS: Silent myocardial ischemia was a common occurrence in this diverse group of MICU patients, although only 21% had previously diagnosed coronary disease. Clinicians must be aware of the potential for silent ischemia, monitor and evaluate their patients for such, and intervene to promote optimal cardiovascular function, particularly during the stress of ventilator weaning.

Adult↗
PubMed2005

Position of the American Dietetic Association: fortification and nutritional supplements.

It is the position of the American Dietetic Association (ADA) that the best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from fortified foods and/or supplements can help some people meet their nutritional needs as specified by science-based nutrition standards such as the Dietary Reference Intakes. Dietetics professionals are trained to assess dietary adequacy as well as the need for dietary modification. This position paper addresses increasing the nutrient density of foods or diets through fortification or supplementation when diets fail to deliver consistently adequate amounts of vitamins and minerals. The discussion presents points to consider that relate to both public health and individual applications. Many resources may be used to help guide the dietetics professional to determine responsible, evidence-based recommendations relating to nutrient fortification or supplementation.

Diet↗
PubMed2004

The Lowbury lecture: behaviour in infection control.

The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infection control. To improve healthcare workers' compliance with practices, infection control should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour are acquired through the socialization process and are susceptible to change. Some models have been applied to evaluate predictors of health behaviour but, so far, none have been successfully applied to explain behaviour in the field of infection control. Successful strategies to improve infection control practices result from their multidimensional aspect. Similarly, social models that include several levels of cognitive determinants have more chance of success to explain change in behaviour. Concrete examples applied to infection control issues are presented, including special references to hand hygiene behaviour. The theory of ecological perspective, based on the idea that behaviour is viewed as being affected by and affecting multiple levels of influence, and that it both influences and is influenced by the social environment, seems promising to explain behaviour modification. Studies are needed to assess the key determinants of infection control practices and behaviour promotion among the different populations of healthcare workers, and to implement and evaluate the impact of the different components of multimodal programmes to promote optimal infection control practices.

Behavior↗
PubMedDate not supplied

Community-based research: barriers to recruitment of African Americans.

The elimination of health disparities for African Americans requires culturally relevant, empirical knowledge, which in turn requires including African Americans in research studies. However, power-difference barriers and conceptual barriers continue to inhibit the recruitment of African Americans. The purpose of this article is to define and discuss certain barriers to the recruitment of African Americans into research studies and to present culturally and contextually sensitive strategies to overcoming these barriers. Power-difference barriers reflect unequal authority and often generate mistrust. Conceptual barriers reflect researchers' need for better understanding about African Americans. Effective strategies include collaboration with the community through a community advisory board and conducting community-based participatory action research. Also, integrating alternative conceptual frameworks with mainstream frameworks may reduce researchers' ideological assumptions about African Americans. To promote optimal recruitment of African Americans, researchers must be aware of power-difference barriers and conceptual barriers and move toward active collaboration with African American communities.

Black or African American↗
PubMedDate not supplied

Improving students' diabetes management through school-based diabetes care.

INTRODUCTION: The purpose of this pilot study was to conduct periodic diabetes care visits in school, with the goal of promoting optimal management of diabetes for high-risk youth. METHOD: A convenience sample of 27 students receiving care at a university-affiliated children's diabetes center and enrolled in a large urban school district received the diabetes visit intervention. Intervention effect was measured by parent survey of home/school diabetes management practices, the Self-Efficacy for Diabetes Tool, and a diabetes care-provider survey of subjects' usual care, management competence, and glycemic control. RESULTS: The frequency of diabetes care office visits, insulin adjustment, and home and school blood sugar monitoring all increased. The percentage of children receiving insulin in school doubled. Pre-intervention to post-intervention changes in glycemic control and student self-efficacy did not reach statistical significance. The response to the program was universally positive. DISCUSSION: This study demonstrated that diabetes care visits in school are feasible and not disruptive to the students' educational program. The visits improved diabetes management at home and at school. School nurses' knowledge about diabetes and confidence in diabetes management was improved through a role-modeling approach.

Adolescent↗
PubMedDate not supplied

Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?

BACKGROUND CONTEXT: Although plate fixation enhances the fusion rate in multilevel anterior cervical discectomy and fusion (ACDF), debate exists regarding the efficacy of nonplating to rigid plate fixation in one-level ACDF. PURPOSE: To determine the efficacy of nonplating to rigid plate fixation in regards to fusion rate and clinical outcome in patients undergoing one-level ACDF with autograft. STUDY DESIGN: A review of 69 consecutive patients who underwent one-level ACDF with autograft and with or without rigid anterior cervical plate fixation. PATIENT SAMPLE: Sixty-nine patients who underwent one-level ACDF (mean age, 45 years) were evaluated for radiographic evidence of fusion (mean, 14 months) and for clinical outcome. All patients received tricortical iliac crest autografts. Disc space distraction was 2 mm, the grafts were inserted with the cortical surface positioned anteriorly, and each graft was countersunk 2 mm from the anterior vertebral border. Thirty-eight patients underwent nonplated ACDF and 31 patients underwent plated ACDF. Eighteen Orion (Sofamor-Danek, Memphis, TN), eight Atlantis (Sofamor-Danek) and five PEAK polyaxial (Depuy-Acromed, Rayham, MA) anterior cervical plating systems were used. Rigid plate fixation was used in all patients with instrumentation. Postoperatively, hard collars were worn 6 to 8 weeks in nonplated patients and soft collars were worn for 3 to 4 weeks in plated patients. Twenty-four patients were smokers (54.2% nonplating; 45.8% plating) and work-related injuries entailed 23 patients (47.8% nonplating; 52.2% plating). OUTCOME MEASURES: Fusion was assessed based on last follow-up of lateral neutral, flexion and extension radiographs. Radiographs were evaluated blindly to assess fusion and instrumentation integrity between nonplated and plated patients. Clinical outcomes were assessed with the Cervical Spine Outcomes Questionnaire and also assessed on last follow-up as excellent, good, fair or poor based on Odom's criteria. METHODS: Fusion rate and postoperative clinical outcome were assessed in 69 patients who underwent one-level ACDF with autograft and with or without rigid anterior plate fixation. Additional risk factors were also analyzed. Statistical significance was established at p<.05. RESULTS: Sixty-six patients (95.7%) achieved a solid fusion (100% nonplated; 90.3% plated). Nonunions occurred in three patients (1 smoker; 2 nonsmokers) with Orion instrumentation. Slight screw penetration into the involved and uninvolved interbody spaces occurred in one patient who was a nonsmoker and did not achieve fusion. One superficial cervical wound infection was noted in a nonplated patient. No other intraoperative or postoperative complications were noted. No statistically significant difference was noted between nonplating to rigid plating upon fusion rate (p>.05). All nonunions occurred at the C5-C6 level. Mean estimated intraoperative blood loss was significantly greater in plated patients (p=.043). Revision surgery involved 9.7% of the plated patients, whereas none of the nonplated patients required reoperation. Postoperative clinical outcome was assessed in all patients (mean, 21 months). Excellent results were noted in 18.8%, good results in 72.5% and fair results in 8.7% of the patients. Nonunion patients reported satisfactory clinical outcome. No statistical significance was noted between clinical outcome of fused and nonfused patients, the presence of a work-related injury and the use of plating (p>.05). Demographics and history of smoking were not factors influencing fusion or clinical outcome in this series (p>.05). The effect on fusion by various plate types could not be discerned from this study. CONCLUSION: A 100% and 90.3% fusion rate was obtained for one-level nonplated and plated ACDF procedures with autograft, respectively. The effects of smoking or level of fusion could not be discerned from these one-level cases. Excellent and good clinical outcome results were obtained for 91.3%. Nonplating or rigid plate fixation for ACDF in properly selected patients to treat radiculopathy with or without myelopathy has a high fusion rate and yields a satisfactory clinical outcome. Although controversy exists as to the efficacy of rigid plate fixation in one-level ACDF, solid bone fusion can be adequately obtained without plate fixation and instrumentation-related complications can be avoided. In line with the literature, plate fixation should be reserved for patients unwilling or unable to wear a hard orthosis postoperatively for an extended period of time or for those patients who seek a quicker return to normal activities. Proper patient selection, meticulous operative technique and postoperative care is essential to promote optimal graft-host incorporation.

Adult↗
PubMed2006

Legislation relating to nutraceuticals in the European Union with a particular focus on botanical-sourced products.

Nutraceuticals are food or food ingredients that have defined physiological effects. They do not easily fall into the legal categories of food or drug and often inhabit a grey area between the two. These products in general terms cover health promotion, "optimal nutrition" the concept of enhanced performance--both physically and mentally--and reduction of disease risk factors. In this paper the focus is mainly on legislation governing botanical-sourced nutraceuticals in the European Union (EU). Nutraceutical concept in general has been defined. Different pieces of legislation influencing botanical nutraceuticals are described. The issue of the borderline between food and drug is discussed. The regulatory status of botanical nutraceuticals as food supplement, food ingredient, functional and fortified food, novel foods and foods for particular nutritional use in the diversified, complex and ever-changing European regulatory environment is described. Botanical nutraceuticals present additional problems because of their complex nature and composition particularly with respect to the quality aspects, which in turn affect safety parameters and overall efficacy of the products. Quality issues relating to botanical sources, growth conditions, end products, their specifications and other technical criteria are highlighted. Guiding principles to be observed for conducting in vitro, in vivo studies in animals and their impact on clinical safety data are discussed. Finally, health claims, their types and criteria of substantiation in light of ongoing discussions with regard to the EU frame work of regulation on nutrition and health claims and role of process for the assessment of scientific support for claims (PASSCLAIM) initiative is discussed. The concept of grading of evidence to substantiate different claims and to establish standards, which should not be revoked or reversed by emerging science at a later stage has been considered. These issues are crucial and are being discussed at EU Parliament and Commission level during the development of the health claim regulations.

Animals↗
PubMed2006

Cervical cancer prevention in the era of prophylactic vaccines: a preview for gynecologic oncologists.

OBJECTIVE: The recent approval of a vaccine to prevent HPV infection is an important advance in cervical cancer prevention. This article is intended to provide gynecologic oncologists with a comprehensive background in modern cervical cancer prevention strategies. METHODS: We describe and contrast the quadrivalent and bivalent vaccines. More established cervical cancer prevention strategies are reviewed, with comments on the impact of HPV vaccination. Clinical guidance is provided for use of the approved quadrivalent vaccine. Safety and side effects of both vaccines are reviewed and future questions and challenges are explored. RESULTS: It is vitally important that both vaccinated and unvaccinated women continue to fully engage in cervical cancer prevention, including cervical cancer screening, follow-up of abnormal screens, and treatment of premalignant lesions. A quadrivalent virus-like particle vaccine has now been approved for use in girls and women ages 9 to 26. A bivalent vaccine may be available soon. Vaccine efficacy in clinical trials has been outstanding, with 100% protection against HPV-type-specific cervical intraepithelial neoplasia (CIN) II and III. CONCLUSIONS: Comprehensive cervical cancer protection now includes prophylactic vaccination for girls and young women in addition to screening and treatment of premalignant changes. Gynecologic oncologists will continue to play an important role in promoting optimal prevention practices.

Adolescent↗
PubMed1997

Patient risk factors for pressure ulcers during cardiac surgery.

Patients undergoing cardiac surgery have increased risks for developing pressure ulcers. The researchers conducted this study to identify preoperative, intraoperative, and postoperative factors associated with the development of pressure ulcers among patients undergoing cardiac surgery at the Cleveland Clinic Foundation. The significant factors associated with pressure ulcer development in the study patients were presence of diabetes mellitus and other significant comorbid conditions; low preoperative Braden Risk Assessment Scale scores; lower preoperative hemoglobin, hematocrit, and serum albumin levels; presence of intraaortic balloon pumps in the postoperative period; being turned less often; and more rapid returns to preoperative body temperatures. By incorporating vigilant observation and timely nursing interventions throughout patients' surgical experiences, perioperative nurses can help prevent the development of pressure ulcers and promote optimal patient outcomes.

Adult↗
PubMed1995

Perioperative nursing interventions for intravascular stent placements.

Keeping abreast of changing surgical technologies is among the more challenging aspects of perioperative nursing. Because peripheral vascular disease is a leading cause of lower extremity disabilities that require surgical interventions, new procedures and techniques are being developed continually. These procedures involve the insertion of intraluminal structural supports into patients who have had mixed or unsuccessful results from angioplasty. Perioperative nurses are an integral part of vascular surgery teams performing the insertion of intravascular stents. To function effectively, perioperative nurses must understand the concepts of intravascular stent procedures, nursing diagnoses, and nursing interventions that promote optimal patient outcomes.

Angioplasty, Balloon↗
PubMed1994

Laparoscopic inguinal herniorrhaphy.

Recent advances in laparoscopic techniques present a promising approach to the surgical treatment of inguinal hernias. Higher success rates, better cosmetic results, less pain, and shorter postoperative recovery periods have precipitated an increased consumer demand for laparoscopic rather than traditional herniorrhaphy. The transabdominal, preperitoneal laparoscopic procedure presents a promising approach to successful inguinal hernia repair. Perioperative nurses should be aware of the direct correlation between laparoscopic success rates and surgical team members' training and experience. Adequate preparation and current knowledge promote optimal patient outcomes.

Contraindications↗
PubMed1997

Do you know what a dietetic technician can do? A focus on clinical technicians and their expanded roles and responsibilities.

Dietetic technicians, registered, play a key role in providing quality, cost-effective client care and foodservice management and are guided by the mission statement of the American Dietetic Association to promote optimal nutrition, health, and well-being. Many organizations use dietetic technicians to complete the screening and/or basic level assessments. The dietetic technician also can assist with patient monitoring and complete such tasks as calculating and documenting calorie counts, providing basic diet instruction, monitoring diet consumption and compliance, and determining tolerance of nutritional supplements. Since the last role delineation study was conducted, dietetic technicians have expanded into many different work settings, and practice roles have changed accordingly.

Allied Health Personnel↗
PubMed1997

Dietitians: experts about food systems?

Dietary advice that promotes optimal nutrition presupposes adequate land for growing food, environmental quality conducive to food production, stable government, a strong economy, and community food security (or a reliable transportation system). Without these conditions, recommendations for optimal nutrition become moot. Our profession will be strengthened as we develop a broad knowledge of our entire food system.

Dietary Services↗
PubMed2000

Wrist-enhanced instrumentation: moving toward totally endoscopic coronary artery bypass grafting.

BACKGROUND: With the introduction of the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) into minimally invasive cardiac operations the outlook for performing coronary artery bypass operations "closed chest" became a reality. METHODS: Between May 1999 and December 1999 this new wrist-enhanced instrumentation was used in 61 patients. Six patients suffering from single-vessel coronary artery disease and one female patient with double-vessel disease underwent totally endoscopic coronary artery bypass. Thirty-seven patients with single-vessel disease underwent a minimally invasive direct coronary artery bypass procedure. Seventeen patients with double-vessel disease were treated using the robotic-enhanced Dresden technique. RESULTS: Perioperative survival was 100%. In all patients the internal mammary arteries were safely harvested endoscopically and had excellent quality. In both totally endoscopic coronary artery bypass groups all patients were operated on through three stab incisions. CONCLUSIONS: Our preliminary experience with this new surgical technique using robotic-enhanced minimally invasive methods for coronary artery disease promotes optimism regarding further development of these procedures and application in patients with coronary artery disease.

Coronary Artery Bypass↗
PubMed1988

The long-term success of skeletal muscle in aortic repair.

To determine the efficacy of skeletal muscle for aortic repair, 23 swine underwent repair of descending thoracic aortic defects. In one group, a vascularized muscle flap was used to patch a 2- to 3-cm aortic defect. In two other groups, a short segment of aorta was removed and a 2-cm tube graft of freshly harvested but devascularized skeletal muscle or Vicryl mesh was used to repair the aorta. Swine were followed for up to sixteen months after implantation. There were no deaths or graft-related complications in the vascularized muscle patch group, and after sixteen months, there were no stenoses or aneurysmal dilatations of the flaps. Histologically, a mature pseudointimal layer had been deposited under the muscle flap and was grossly indistinguishable from normal arterial wall. In the group that received devascularized muscle tube grafts, however, suture line dehiscences occurred in 3 of 7 animals within two weeks of operation. There were no dehiscences in the 9 recipients of a Vicryl tube graft, a finding suggesting that deposition of pseudointimal elements was rapid enough to ensure vascular integrity as the Vicryl was absorbed. Postmortem examination of these animals demonstrated stenoses ranging from 30 to 50%, thereby indicating a lack of growth in the new pseudointimal wall. These results demonstrate the long-term reliability of vascularized skeletal muscle for use in major vascular reconstruction, and suggest the beneficial effects of avoiding prosthetic material and promoting optimal pseudointimal formation.

Animals↗
PubMed1999

The role of cytochrome b559 and tyrosineD in protection against photoinhibition during in vivo photoactivation of photosystem II

In vivo photoactivation of Photosystem II was studied in the FUD39 mutant strain of the green alga Chlamydomonas reinhardtii which lacks the 23 kDa protein subunit involved in water oxidation. Dark grown cells, devoid of oxygen evolution, were illuminated at 0.8 μE m-2s-1 light intensity which promotes optimal activation of oxygen evolution, or at 17 μE m-2s-1, where photoactivation compete with deleterious photodamage. The involvement of the two redox active cofactors tyrosineD and cytochrome b559 during the photoactivation process, was investigated by EPR spectroscopy. TyrosineD on the D2 reaction center protein functions as auxiliary electron donor to the primary donor P+680 during the first minutes of photoactivation at 0.8 μE m-2s-1 (compare with Rova et al., Biochemistry, 37 (1998) 11039-11045.). Here we show that also cytochrome b559 was rapidly oxidized during the first 10 min of photoactivation with a similar rate to tyrosineD. This implies that both cytochrome b559 and tyrosineD may function as auxiliary electron donors to P+680 and/or the oxidized tyrosine&z.ccirf;Z on the D1 protein, to avoid photoinhibition before successful photoactivation was accomplished. As the catalytic water-oxidation successively became activated, TyrosineD remained oxidized while cytochrome b559 became rereduced to the equilibrium level that was observed prior to photoactivation. At 17 μE m-2s-1 light intensity, where photoinhibition competes significantly with photoactivation, tyrosineD was very rapidly completely oxidized, after which the amount of oxidized tyrosineD decreased due to photoinhibition. In contrast, cytochrome b559 became reduced during the first 2 min of photoactivation at 17 μE m-2s-1. After this, it was reoxidized, returning to the equilibrium level within 10 min. Thus, during in vivo photoactivation in high-light cytochrome b559 serves two functions. Initially, it probably oxidizes the reduced primary acceptor pheophytin, thereby relieving the acceptor side of reductive pressure, and later on it serves as auxiliary electron donor, preventing donor-side photoinhibition.

Journal Article↗
PubMed2001

Fetal intra-nigral ventral mesencephalon and kidney tissue bridge transplantation restores the nigrostriatal dopamine pathway in hemi-parkinsonian rats.

We have previously demonstrated that intranigral transplantation of fetal ventral mesencephalic (VM) tissue and nigrostriatal administration of glial cell line-derived neurotrophic factor (GDNF) restores striatal dopamine input in hemiparkinsonian rats. Since it has been found that GDNF is highly expressed in fetal kidney, we examined the possibility that fetal kidney tissue may provide trophic support, similar to GDNF, to an intranigral dopamine (DA) transplant and restore the nigrostriatal pathway. Adult Sprague-Dawley rats were anesthetized and unilaterally injected with 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle. Completeness of the lesion was evaluated by measuring amphetamine-induced rotation. One month after 6-OHDA lesioning, fetal VM cells were grafted into the lesioned nigral area followed by transplantation of fetal kidney tissue or vehicle along a pathway from nigra to striatum. Animals receiving these transplants showed a significant decrease both in amphetamine-induced rotation and in postural asymmetry 1 to 3 months after grafting. Immunocytochemical studies demonstrated tyrosine hydroxylase (TH) positive fiber tracts in the lesioned striatum. Control animals that received vehicle injection after the intranigral graft or no transplantation showed no alterations in amphetamine-induced turning and no TH-positive fibers in the lesioned striatum. These results indicate that combinations of fetal nigral and kidney transplants may restore the nigrostriatal DA pathway in Parkinsonian rats. As fetal kidney contains a variety of trophic proteins, it may provide a synergistic admixture to optimally promote DA fiber outgrowth.

Amphetamine↗