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PubMed2003

Telemonitoring of patients at home: a software agent approach.

To address the issue of the increasing social, economical and medical needs of maintaining at home people in loss of autonomy while preserving privacy and quality of life, the authors present a software agent based telemonitoring and alarm raising system. The article describes the overall architecture, the various components of the model, and the methodology that has been used. It specifically addresses the issue of reflecting in the object oriented model of the system various dimensions including: the physical world of in-home bio-signal sensors, the numerical world of software agents and Internet-related technologies, and the medical and social worlds of patients, physicians and caregivers. In the model, the main stream of information goes from the biophysical world of patients at home to the socio-medical world of carers through a chain of devices including in-home sensors, local area network, home computer, remote server, and carers' computers. Each device hosts software agents with different levels of knowledge and complexity. Internet and Java technologies provide the building blocks of the designed telemonitoring software. Laboratory experiments have been realized using a fully equipped 'smart' demonstration home for telecare. The study takes place into a more general research project on 'smart' homes for telecare conducted at the Hospital Centre of Grenoble, France.

Computer Security↗
PubMed2005

Muscle performance in patients with Crohn's disease in clinical remission.

BACKGROUND: Because patients with Crohn's disease (CD) often show increased energy expenditure, nutritional deficiencies, and general fatigue, all which may persist after a flare, we hypothesized that CD could alter muscle mass and function. This study aimed to assess muscle strength and endurance in CD patients in clinical remission and the influencing factors. METHODS: Forty-one outpatients (17 men and 24 women; age, 37 +/- 10 yr), in remission (CD Activity Index < 150) for > 3 months, and 25 age-matched healthy controls (10 men and 15 women; age, 37 +/- 13 yr) were evaluated. Evaluation included a sit-up test, hand-grip strength test, hand-grip endurance test, lower limb strength test, and lower limb endurance test (LE), as well as a measure of physical activity. RESULTS: No significant difference was found between CD and control groups regarding weight, height, body mass index, fat mass, and fat-free mass. Strength performance was lower in CD subjects compared with controls, particularly for lower limb indexes: lower limb strength test (-24.6%, P < 0.001), LE (-25.8%, P < 0.001), and sit-up test (-25.1%, P < 0.001). Previous disease severity, disease duration, the cumulative dose of glucocorticosteroids, current inflammation, and global habitual physical activity did not affect muscle performance. A recent use of steroids improved LE. CONCLUSIONS: CD patients in clinical remission have decreased muscle function that may affect their quality of life. This pattern is reflected by reduced strength and endurance indexes, particularly for lower limbs. The reasons for these changes need further study. Strength training should be assessed in these patients.

Adult↗
PubMed2006

Pharmacokinetics and lung concentrations of ertapenem in patients with ventilator-associated pneumonia.

OBJECTIVE: We conducted a prospective, open-label study to determine the steady-state serum and epithelial lining fluid (ELF) concentrations of unbound ertapenem administered once daily to critically ill patients with early-onset ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Prospective, open-label study in an intensive care unit and research ward in a university hospital. PATIENTS: Fifteen patients with VAP received 1-h intravenous infusions of 1 g ertapenem once daily. INTERVENTIONS: After 2 days of therapy the steady-state serum and ELF concentrations of free ertapenem were determined by high-performance liquid chromatography. MEASUREMENTS AND RESULTS: The median (interquartile range) free ertapenem peak (C(max)), intermediate (C(12)), and trough (C(min)) concentrations (mg/l) 1, 12, and 24 h after the end of infusion were 30.3 (27.1-37.8), 4.8 (3.9-6.4), and 0.8 (0.5-1.2) in serum and 9.4 (8.0-10.7), 2.0 (1.1-2.5), and 0.3 (0.2-0.4) in ELF, respectively, showing a median free ertapenem percentage penetration in ELF of approx. 30%. The median (interquartile range) serum area under concentration-time curve of free ertapenem during the observational period was 226.7 mg h(-1) l(-1) (202.2-263.9). CONCLUSION: Our study shows satisfactory results, with unbound ertapenem concentrations both in serum and ELF exceeding the MIC(90) values of most of the causative pathogens encountered in early-onset VAP during 50-100% time. This suggests that 1 g intravenous ertapenem administered once daily should be effective during the treatment of early-onset VAP in critically ill patients with no known risk factors for multidrug-resistant pathogens.

Aged↗
PubMed2005

Impact of HFE genetic testing on clinical presentation of hereditary hemochromatosis: new epidemiological data.

BACKGROUND: Hereditary hemochromatosis (HH) is a common inherited disorder of iron metabolism in Northern European populations. The discovery of a candidate gene in 1996 (HFE), and of its main mutation (C282Y), has radically altered the way to diagnose this disease. The aim of this study was to assess the impact of the HFE gene discovery on the clinical presentation and epidemiology of HH. METHODS: We studied our cohort of 415 patients homozygous for the C282Y allele and included in a phlebotomy program in a blood centre in western Brittany, France. RESULTS: In this cohort, 56.9% of the patients were male and 21.9% began their phlebotomy program before the implementation of the genetic test. A significant decrease in the sex ratio was noticed following implementation of this DNA test, from 3.79 to 1.03 (p < 10(-5)), meaning that the proportion of diagnosed females relatives to males greatly increased. The profile of HH patients at diagnosis changed after the DNA test became available. Serum ferritin and iron values were lower and there was a reduced frequency of clinical signs displayed at diagnosis, particularly skin pigmentation (20.1 vs. 40.4%, OR = 0.37, p < 0.001) and hepatomegaly (11.0 vs. 22.7%, OR = 0.42, p = 0.006). In contrast, fatigue became a more common symptom at diagnosis (68.0 vs. 51.2%, OR = 2.03, p = 0.004). CONCLUSION: This study highlights the importance of the HFE gene discovery, which has simplified the diagnosis of HH and modified its clinical presentation and epidemiology. This study precisely measures these changes. Enhanced diagnosis of HFE-related HH at an early stage and implementation of phlebotomy treatment are anticipated to maintain normal life expectancy for these patients.

Adolescent↗
PubMed2001

[Malar rash in a painting by Jean-Baptiste Siméon Chardin (1699-1779)]

In the present report we describe a typical malar rash, as painted by Jean-Baptiste Siméon Chardin (1699-1779), French painter, one of the greatest of the 18th century, on the face of a child in "Le Bénédicité" (Hermitage, St. Petersburg). Three versions of this theme were more completed by Chardin, in various times of his life, but the malar eruption can be seen solely on the painting at the Hermitage. In the attempt to clarify, on a diagnostic ground, such a cutaneous abnormality, the relationships between systemic lupus erythematosus and parvovirus B19 infection, i.e. the causative agent of fifth disease, are briefly discussed.

Journal Article↗
PubMed2005

Targeted disruption of cytosolic SIR2 deacetylase discloses its essential role in Leishmania survival and proliferation.

Proteins of the SIR2 family are characterized by a conserved catalytic domain that exerts unique NAD-dependent deacetylase activity on histone and various other cellular substrates. Functional analyses of such proteins have been carried out in a number of prokaryotes and eukaryotes organisms but until now, none have described an essential function for any SIR2 genes. Here using genetic approach, we report that a cytosolic SIR2 homolog in Leishmania is determinant to parasite survival. L. infantum promastigote tolerates deletion of one wild-type LiSIR2 allele (LiSIR2+/-) but achievement of null chromosomal mutants (LiSIR2-/-) requires episomal rescue. Accordingly, plasmid cure shows that these parasites maintain episome even in absence of drug pressure. Though single LiSIR2 gene disruption (LiSIR2+/-) does not affect the growth of parasite in the promastigote form, axenic amastigotes display a marked reduction in their capacity to multiply in vitro inside macrophages and in vivo in Balb/c mice. Taken together these data support a stage specific requirement and/or activity of the Leishmania cytosolic SIR2 protein and reveal an unrelated essential function for the life cycle of this unicellular pathogenic organism. The lack of an effective vaccine against leishmaniasis, and the need for alternative drug treatments, makes LiSIR2 protein a new attractive therapeutic target.

Animals↗
PubMed2006

Decision analysis in aerospace medicine: costs and benefits of a hyperbaric facility in space.

INTRODUCTION: Assembly and maintenance of the International Space Station (ISS) requires an unprecedented number of spacewalks, which expose astronauts to the risk of decompression sickness (DCS). We illustrate the use of decision analysis to compare a hyperbaric oxygen (HBO) chamber to currently available therapy for DCS treatment on the ISS. METHODS: A decision-analytic model that simulates events over the lifespan of the ISS was constructed. Inputs to the model for probabilities, costs, and measures of morbidity and mortality were derived from a variety of sources, including a systematic literature review and an iterative consultation process with personnel at the Canadian Space Agency and the National Aeronautics and Space Administration (NASA). The decision model was analyzed using the methods of Monte-Carlo simulation and expected value calculation. Main outcome measures included the present value of costs and quality adjusted life years (QALYs), and the cumulative probability of mission-related events over the life cycle of the ISS. Sensitivity analysis was performed. RESULTS: The HBO chamber strategy is associated with a mean cost of -12.5 million dollarsw (a net cost saving of 12.5 million dollars) with a 95% CI (-112.8 million dollars, 51.3 million dollars). An HBO chamber reduces the likelihood of a premature shuttle return and a premature Soyuz return by 8% and 3%, respectively. The result is sensitive to the lifespan of the ISS. CONCLUSIONS: At a 50 million dollars cost, an HBO chamber is likely, though not certain, to result in cost savings. Decision analysis is a useful tool for use in priority setting in aerospace medicine.

Cost-Benefit Analysis↗
PubMed1995

The American abortion debate: culture war or normal discourse?

This paper investigates whether James Hunter's culture war thesis is an apt characterization of the American abortion debate. The author focuses on three arguments central to Hunter's analysis: 1) that the abortion debate involves two paradigmatically opposed world views; 2) that debate about abortion, since it involves moral discourse, is structurally different than other political debates; and 3) that the new alignments in abortion politics are culturally significant. Examining existing research in each of these three domains, the author finds that the debate over abortion is more complex than suggested by Hunter. World views of pro-life and pro-choice activists, for example, share a commitment to some overlapping values; the argumentative structure of abortion discourse has a pattern rather similar to that of political debate more generally, and new alignments on abortion, such as that between the Catholic Church and the Southern Baptist Convention, do not displace historically embedded differences in symbolic resources and cultural orientation. As suggested by the author, it may be more helpful, therefore, to think of the abortion debate as an ongoing public conversation about America's cultural tradition and how it should be variously expressed in contemporary laws and practices.

Abortion, Induced↗
PubMed2005

Revisions to chronic disease surveillance indicators, United States, 2004.

To allow public health officials to uniformly define, collect, and report chronic disease data, Indicators for Chronic Disease Surveillance was released by the Council of State and Territorial Epidemiologists in 1999. This publication provided standard definitions for 73 indicators developed by epidemiologists and chronic disease program directors at the state and federal levels. The indicators were selected because of their importance to public health and the availability of state-level data. This report describes the latest revisions to the chronic disease indicators published in 2004. The revised set of 92 indicators includes 24 for cancer; 15 for cardiovascular disease; 11 for diabetes; 7 for alcohol; 5 each for nutrition and tobacco; 3 each for oral health, physical activity, and renal disease; and 2 each for asthma, osteoporosis, and immunizations. The remaining 10 indicators cover such overarching conditions as poverty, education, and life expectancy. Although multiple states have used the indicators, wider adoption depends on increased epidemiology capacity at the state level and improved access to surveillance data.

Chronic Disease↗
PubMed2003

[Chemistry of life: ferments and fermentation in 17th-century iatrochemistry].

The concepts of ferment and fermentation played an important, though heretofore neglected, role in 17th-century physiology. Though these notions can be found in ancient philosophy and medicine, as well as in medieval medicine, they became integral part of the chemical medicine that was advocated by Paracelsus and his school. Paracelsians made fermentation a central concept in their successful effort to give chemical foundation to medicine. Jean Baptiste van Helmont and Sylvius used the concepts of ferment and fermentation to explain a variety of physiological processes in human body. Corpuscular philosophers like Robert Boyle and Thomas Willis reinterpreted these notions in corpuscular terms and separated the concept of ferment from that of fermentation. In the second half of the seventeenth century, physiologist tried to explain fermentation by means of chemical reactions, as for instance acid -alkali, and ruled out the notion of ferment as superfluous to their investigations. At the end of hte seventeenth century fermentation attracted the interest of physicists like Johannes Bernoulli and Isaac Newton, who tried to explain fermentative processes in terms of matter and motion (Bernoulli) and short-range forces (Newton). George Ernst Stahl devoted a work to fermentation: the Zymotechnia. He explained fermentation as the outcome of the reactions of molecules formed of saline, oily and earthy corpuscles with particles of water. He saw fermentation as a mechanical process, i.e. as collision of different kinds of corpuscles.

Chemistry, Pharmaceutical↗
PubMed2004

Life care plans: an emerging area for occupational therapists.

BACKGROUND: Life care plans, or cost of future care reports as they are often called in Canada, are medico-legal documents that predict probable future medical and rehabilitation needs and costs. They are used when someone has sustained a serious personal injury in an accident, as the result of medical malpractice, or due to some other unnatural cause. Life care plans are generally commissioned by third-party payers in order to set aside adequate reserves for future costs or to negotiate a settlement. SCOPE: Life care plans need to be grounded in knowledge of how personal injury law has been applied and interpreted. Therefore, Canadian law pertaining to the costs of future care in personal injury will be briefly reviewed. The balance of the article discusses the process used to develop a life care plan, the necessary content, and accepted formats for reports. The article concludes with a case example that demonstrates the application of life care planning skills. PRACTICE IMPLICATIONS: Occupational therapists are well suited to developing these plans by virtue of their training, knowledge base, and theoretical approaches. This is an emerging consultative role for experienced therapists.

Canada↗
PubMed2006

Glucose intolerance and other cardiovascular risk factors in Haiti. Prevalence of Diabetes and Hypertension in Haiti (PREDIAH).

AIMS: To assess the prevalence of diabetes and other forms of glucose intolerance and to examine their relationship with some cardiovascular risk factors in a population representative of the capital of Haiti. METHODS: This cross-sectional survey was conducted in the metropolitan area of Port-au-Prince, Haiti. A population-based sample of 1620 adults was randomly selected using a two-stage cluster method, stratified in 3 age groups: 20-39, 40-64 and > or =65 years of age. Diagnosis of diabetes and pre-diabetes (IFG and IGT) was based on the 2003 Expert Committee criteria. RESULTS: The total response rate was 69%. The age-standardized prevalence of diabetes was 4.8% in men and 8.9% in women (P=0.0014), with, overall, 70.6% of previously diagnosed cases. Standardized for the Segi world population aged 30-64 years, its prevalence was 7.4% in men and 11.1% in women (NS). The age-standardized prevalence of pre-diabetes was 6.4% in men and 8.0% in women (NS). Hypertension was found in 48.7% in men and 46.5% in women (NS). Its rates in people > or =40 years old were 69.1% in men and 67.2% in women (NS). Abdominal obesity was strongly independently associated with diabetes and pre-diabetes in both genders. Hypertension was shown to be risk factor for pre-diabetes and total glucose intolerance in women. High education was associated with lower risk of diabetes in men. CONCLUSION: Prevalence of diabetes and pre-diabetes is moderately high in Port-au-Prince, Haiti. In people aged > or =40 years, the rate of normal blood pressure is less than 25%. Intervention programs to prevent simultaneously and manage diabetes and hypertension are imperative, and prevention strategies through lifestyle modifications should be cost-effective.

Adult↗
PubMed2002

Glucagon-like peptide 1 as a regulator of food intake and body weight: therapeutic perspectives.

After ingestion of carbohydrate- and fat-rich meals, the incretin hormone glucagon-like peptide 1 (GLP-1) is secreted from the L-cells in the distal put into the circulation. Its major physiological effect lies in a strongly glucose-dependent stimulation of insulin secretion from pancreatic B-cells. Furthermore, GLP-1 suppresses glucagon secretion, stimulates B-cell neogenesis as well as proinsulin biosynthesis and inhibits gastric emptying and acid secretion. Recently, GLP-1 could be shown to reduce caloric intake and to enhance satiety, most likely via specific receptors within the central nervous system, resulting in reduced weight gain in experimental animals. In nondiabetic and Type 2 diabetic human subjects, exogenous GLP-1 reduces hunger, caloric intake and body weight. Therefore, in addition to its well-characterized antidiabetogenic effect, the anorectic effect may offer GLP-1 a potential in the pharmacotherapy of obesity. It is still unknown whether the GLP-1 effect on caloric intake is sustained after long-term treatment. Furthermore, the exact mechanisms by which the peptide exerts its biological effects have not yet been clarified. Due to the rapid degradation of native GLP-1, its therapeutic application is limited by the short half-life. Therefore, suitable modes of administration are needed in order to reach stable plasma concentrations. The present review aims to describe the role of GLP-1 in the central regulation of feeding and to discuss its possible application in the pharmacotherapy of obesity.

Animals↗
PubMed2002

[The scholarly program of Johann Friedrich Meckel the Younger (1781-1833) and it importance for the development of life sciences].

Although Johann Friedrich Meckel the Younger was one of the most famous anatomists, his research work has been severely neglected in the recent historiographical literature on the German morphology. The goal of our study is to approach a general characterization of his research program. Our analysis reveals that Meckel introduced the Cuvierian empiricism in Germany, but he also considered the "Abstraktion" as a main component of the scientific knowledge. According to his epistemology on nascent organisms and transmutable species, both, variability and relatedness of the organic forms are important to the same degree. Meckel explicitly adopted the Jean-Baptiste de Lamarcks (1744-1829) evolutionary theories. Even though in Meckel's discourse about diversity the Cuvierian notion of "functional adaptation" was preserved, the main goal of his research program was to demonstrate empirically the "Allgemeinheit des Bildungstypus". For this purpose, he considered the entire variety of the animal kingdom: normal as well as abnormal organisms, adult specimens and above all embryos. Moreover, he believed that the abnormal development is due to the same laws as the normal development. He applied parallelisms to a new domain, the study of malformation. With Meckel's researches on teratology, a new era in the analyses of the anomalies was opened. They became an integral part of the natural diversity and thus a highly exploited subject of biomedical researches. Meckel's empirical and epistemological writings on the embryology, comparative embryology, teratology, pathology, systematics and comparative anatomy have largely contributed to the foundation of the biological research.

Anatomy↗
PubMed1992

HCMR interview: Pat N. Groner. Interview by Montague Brown.

Pat N. Groner, President Emeritus, Baptist Health Care, Pensacola, Florida, is a man of ideas and action. Pat has ably led his hospital, was founder of the Hospital Research and Development Institute and Voluntary Hospitals of America, and is now a leader in higher education. Whenever and wherever Pat sees an opportunity to improve things, he jumps in with a hundred ideas, most of them real winners. He engages others and fights for constructive change. For all who seek models for the full life well lived, look at Pat Groner.

Academies and Institutes↗