Medicine and Health Sciences Commons^™

Ampk Activation Is Not Critical In The Regulation Of Muscle Fa Uptake And Oxidation During Low-Intensity Muscle Contraction, Marcella Raney, Alice Yee, Mark Todd, Lorraine Turcotte

Marcella Raney

To determine the role of AMP-activated protein kinase (AMPK) activation on the regulation of fatty acid (FA) uptake and oxidation, we perfused rat hindquarters with 6 mM glucose, 10 μU/ml insulin, 550 μM palmitate, and [14C]palmitate during rest (R) or electrical stimulation (ES), inducing low-intensity (0.1 Hz) muscle contraction either with or without 2 mM 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside (AICAR). AICAR treatment significantly increased glucose and FA uptake during R (P < 0.05) but had no effect on either variable during ES (P > 0.05). AICAR treatment significantly increased total FA oxidation (P < 0.05) during both R (0.38 ± 0.11 vs. 0.89 ± 0.1 nmol·min−1·g−1) and ES (0.73 ± 0.11 vs. 2.01 ± 0.1 nmol·min−1·g−1), which was paralleled in both conditions by a significant increase and significant decrease in AMPK and acetyl-CoA carboxylase (ACC) activity, respectively (P < 0.05). Low-intensity muscle contraction increased glucose uptake, FA uptake, and total FA oxidation (P < 0.05) despite no change in AMPK (950.5 ± 35.9 vs. 1,067.7 ± 58.8 nmol·min−1·g−1) or ACC (51.2 ± 6.7 vs. 55.7 ± 2.0 nmol·min−1·g−1) activity from R to ES (P > 0.05). When contraction and AICAR treatment were combined, the AICAR-induced increase in AMPK activity (34%) did not account for the synergistic increase in …

Perceived Nursing Work Environment Of Critical Care Nurses, Jeungok Choi, S. Bakken, E. Larson, Y. Du, P. Stone

Jeungok Choi

BACKGROUND: Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment. OBJECTIVES: To report the psychometric properties of the Perceived Nursing Work Environment (PNWE) instrument, and to compare these results with those of other scales derived from the same background instrument: the Nursing Work Index-Revised. METHODS: The Nursing Work Index-Revised was used in a national survey of critical care nurses. Exploratory principal component analysis with orthogonal rotation was conducted. Psychometric properties were examined. Construct validity was …

Heads Or Tails: Randomized Placebo-Controlled Trials, Charles Weijer

Charles Weijer

No abstract provided.

Is Extended Volume External Beam Radiation Therapy Covering The Anastomotic Site Beneficial In Post-Esophagectomy High Risk Patients?, Edward Yu, Rashid Dar, George Rodrigues, Larry Stitt, Gregory Videtic, Pauline Truong, Anna Tomiak, Robert Ash, Ed Brecevic, Richard Inculet, Richard Malthaner, Mark Vincent, Ian Craig, Walter Kocha, Michael Lefcoe

Edward Yu

Background and purpose: To assess the impact of extended volume radiation therapy (RT) with anastomotic coverage on local control in high risk post-operative esophageal cancer patients. Patients and methods: This is a retrospective study of high risk (T(3), T(4), nodes positive, with or without margin involvement) post-operative esophageal cancer patients treated at London Regional Cancer Centre from 1989 to 1999. After esophagectomy, all patients received adjuvant combined modality therapy consisting of four cycles of fluorouracil-based chemotherapy, and loco-regional RT with or without coverage of the anastomotic site. RT dose ranged from 45 to 60 Gy at 1.8-2.0 Gy/fraction with treatment …

Respect: Or, How Respect For Persons Became Respect For Autonomy, M. Therese Lysaught

M. Therese Lysaught

This article provides an intellectual archeology of how the term “respect” has functioned in the field of bioethics. I argue that over time the function of the term has shifted, with a significant turning point occurring in 1979. Prior to 1979, the term “respect” connoted primarily the notion of “respect for persons” which functioned as an umbrella which conferred protection to autonomous persons and those with compromised autonomy. But in 1979, with the First Edition of Principles of Biomedical Ethics by Beauchamp and Childress, and the report of the Ethical Advisory Board (EAB) of the (then) Department of Health, Education, …

Evaluation Of Intra- And Inter-Fraction Motion In Breast Radiotherapy Using Electronic Portal Cine Imaging, Tomas Kron, Chrison Lee, Francisco Perera, Edward Yu

Edward Yu

Breast irradiation is one of the most challenging problems in radiotherapy due to the complex shape of the target volume, proximity of radiation sensitive normal structures and breathing motion. It was the aim of the present study to use electronic portal imaging (EPI) during treatment to determine intra- and inter-fraction motion in patients undergoing radiotherapy and to correlate the magnitude of motion with patient specific parameters. EPI cine images were acquired from the medial tangential fields of twenty radiotherapy patients on a minimum of 5 days each over the course of their treatment. The treatments were administered using 10 MV …

Fixing Family Medicine Residency Training, Jeffrey D. Tiemstra Md

Jeffrey Tiemstra, MD, FAAFP

No abstract provided.

Opportunities In The Palm Of Your Hand: The Challenges Of Handheld Computing For Libraries And Information Services, Andrew Heath, Lisa Kruesi, Kaye Lasserre, Heather Todd, Sarah Thorning

Sarah Thorning

Since the late 1990s there has been considerable growth in the use of Personal Digital Assistants (PDAs) to support the clinical information needs of health professionals and medical students. Information at the point of need has been made possible by handheld computers. PDAs are currently being used for: • accessing clinical information products such as drug information, medical dictionaries, textbooks, clinical guidelines and medical calculators • managing personal information (e.g. schedules and contacts) • storing and retrieving study materials, class notes and readings • recording patient case notes Through funding provided by the Australian Commonwealth Department of Health and Ageing, …

Screening For Parkinson's Disease With Response Time Batteries: A Pilot Study, Andrew Johnson, Philip Vernon, Quincy Almeida, Linda Grantier, Rene Singarayer, Mandar Jog

Andrew M. Johnson

Background: Although significant response time deficits (both reaction time and movement time) have been identified in numerous studies of patients with Parkinson's disease (PD), few attempts have been made to evaluate the use of these measures in screening for PD. Methods: Receiver operator characteristic curves were used to identify cutoff scores for a unit-weighted composite of two choice response tasks in a sample of 40 patients and 40 healthy participants. These scores were then cross-validated in an independent sample of 20 patients and 20 healthy participants. Results: The unit-weighted movement time composite demonstrated high sensitivity (90%) and specificity (90%) in …

Survival Of Patients With Metastatic Breast Cancer: Twenty-Year Data From Two Seer Registries, Patricia Tai, Edward Yu, Vincent Vinh-Hung, Gábor Cserni, Georges Vlastos

Edward Yu

Background: Many researchers are interested to know if there are any improvements in recent treatment results for metastatic breast cancer in the community, especially for 10- or 15-year survival. Methods: Between 1981 and 1985, 782 and 580 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries of the Surveillance, Epidemiology, and End Results (SEER) database. The lognormal statistical method to estimate survival was retrospectively validated since the 15-year cause-specific survival rates could be calculated using the standard life-table actuarial method. Estimated rates were compared to the actuarial data available in 2000. Between 1991 …

Waiver Of Consent For Emergency Research, Andrew Mcrae, Charles Weijer

Charles Weijer

No abstract provided.

Planning Evaluation Of Radiotherapy For Complex Lung Cancer Cases Using Helical Tomotherapy, Tomas Kron, Grigor Grigorov, Edward Yu, Slav Yartsev, Jeff Chen, Eugene Wong, George Rodrigues, Kris Trenka, Terry Coad, Glenn Bauman, Jake Van Dyk

Edward Yu

Lung cancer treatment is one of the most challenging fields in radiotherapy. The aim of the present study was to investigate what role helical tomotherapy (HT), a novel approach to the delivery of highly conformal dose distributions using intensity-modulated radiation fan beams, can play in difficult cases with large target volumes typical for many of these patients. Tomotherapy plans were developed for 15 patients with stage III inoperable non-small-cell lung cancer. While not necessarily clinically indicated, elective nodal irradiation was included for all cases to create the most challenging scenarios with large target volumes. A 2 cm margin was used …

A Systematic Review Of Brachytherapy. Is It An Effective And Safe Treatment For Localised Prostate Cancer?, Jenny Doust, Emma Miller, Gillian Duchesne, Michael Kitchener, David Weller

Jenny Doust

BACKGROUND Brachytherapy is a promising treatment for prostate cancer as it may have reduced rates of impotence and incontinence. OBJECTIVE General practitioners can influence the treatment patients receive by their referral patterns, so it is important they understand the effectiveness and safety of treatment. We reviewed the primary literature on brachytherapy as sole therapy for localised prostate cancer. DISCUSSION Although there have been many studies on the safety and effectiveness of brachytherapy, there have been no trials of brachytherapy versus other treatments that would control for factors such as tumour stage, grade, or initial prostate specific antigen levels. Brachytherapy for …

Spenderblut Vom Rind

Vivian C. McAlister

When Are Research Risks Reasonable In Relation To Anticipated Benefits?, Charles Weijer, Paul Miller

Charles Weijer

The question "When are research risks reasonable in relation to anticipated benefits?" is at the heart of disputes in the ethics of clinical research. Institutional review boards are often criticized for inconsistent decision-making, a problem that is compounded by a number of contemporary controversies, including the ethics of research involving placebo controls, developing countries, incapable adults and emergency rooms. If this pressing ethical question is to be addressed in a principled way, then a systematic approach to the ethics of risk in research is required. Component analysis provides such a systematic approach.

The Quest For Legitimacy: Comment On Cox Macpherson's 'To Strengthen Consensus, Consult The Stakeholders', Charles Weijer

Charles Weijer

No abstract provided.

Prediction Of Radiation Pneumonitis By Dose-Volume Histogram Parameters In Lung Cancer--A Systematic Review, George Rodrigues, Michael Lock, David D'Souza, Edward Yu, Jake Van Dyk

Edward Yu

BACKGROUND AND PURPOSE: To perform a systematic review of the predictive ability of various dose-volume histogram (DVH) parameters (V(dose), mean lung dose (MLD), and normal tissue complication probability (NTCP)) in the incidence of radiation pneumonitis (RP) caused by external-beam radiation therapy. METHODS AND MATERIALS: Studies assessing the relationship between CT-based DVH reduction parameters and RP rate in radically treated lung cancer were eligible for the review. Synonyms for RP, lung cancer, DVH and its associated parameters (NTCP, V(20), V(30), MLD) were combined in a search strategy involving electronic databases, secondary reference searching, and consultation with experts. Individual or group data …

Radiation Treatment Of Lung Cancer--Patterns Of Practice In Canada, Patricia Tai, Edward Yu, Jerry Battista, Jake Van Dyk

Edward Yu

BACKGROUND AND PURPOSE: To assess the patterns of practice among Canadian radiation oncologists who treat lung cancers. PATIENTS AND METHODS: A questionnaire detailing different aspects of radiation treatment of lung cancer was mailed to all radiation oncologists treating lung cancer in Canada. Seventy-two percent (74/103) of radiation oncologists who treat lung cancer from all 34 Canadian cancer centres replied to the questionnaire. RESULTS: (a) Radiotherapy regimens in Canadian cancer centres are in accordance with several major randomised studies. There is still some variation in treatment practice that may be due to unresolved controversies or limited resources. The most frequently used …

The Ethical Analysis Of Risk In Intensive Care Unit Research, Charles Weijer

Charles Weijer

Research in the intensive care unit (ICU) is commonly thought to pose 'serious risk' to study participants. This perception may be at the root of a variety of impediments to the conduct of clinical trials in the ICU setting. Component analysis offers a promising approach to the ethical analysis of ICU research. Because clinical trials commonly involve a mixture of study interventions, therapeutic and nontherapeutic procedures must be analyzed separately. Therapeutic procedures must meet the requirement of clinical equipoise. Risks associated with nontherapeutic procedures must be minimized consistent with sound scientific design, and be deemed reasonable in relation to the …

Feeding Probiotic Strains Lactobacillus Rhamnosus Gr-1 And Lactobacillus Fermentum Rc-14 Does Not Significantly Alter Hematological Parameters Of Sprague-Dawley Rats, Kingsley Anukam, Emmanuel Osazuwa, Gregor Reid, Raymond Ozolua

Kingsley C Anukam

The potential use of probiotics in restoring the urogenital and gastrointestinal health has received tremendous interest in the last decade, while few safety concerns are still being debated. In order to demonstrate the safety of the probiotic strains, Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14, we designed a study in an animal model to investigate the effects of feeding probiotics on the haematological parameters of rats. The rats were fed daily with 109CFU/ml of the probiotic strains orally with an oro-gastric tube for 21 days. Blood samples were collected by carotid artery cannulation for terminal bleeding into potassium EDTA containers. …

Increased Incidence Of Pertussis And Parapertussis In Hiv-1-Positive Adolescents Vaccinated Previously With Whole-Cell Pertussis Vaccine, Kingsley Anukam, Emmanuel Osazuwa, Theodore Mbata, Ijeoma Ahonkhai

Kingsley C Anukam

No abstract provided.

Impaired Diffusion Capacity Predicts For Decreased Treatment Tolerance And Survival In Limited Stage Small Cell Lung Cancer Patients Treated With Concurrent Chemoradiation, Gregory Videtic, Larry Stitt, Robert Ash, Pauline Truong, A. Dar, Edward Yu, Frances Whiston

Edward Yu

PURPOSE: To determine if stratification of limited stage small cell lung cancer (LSCLC) patients by pre-treatment pulmonary function test (PFT) prognostic indicators predicts for treatment-related toxicity risks and survival following concurrent chemoradiation. MATERIALS AND METHODS: From 1989 to 1999, 215 LSCLC patients received six cycles of alternating cyclophosphamide/doxorubicin/vincristine and etoposide/cisplatin (EP). Thoracic radiation (RT) was initiated only with EP and at cycle 2 or 3. RT dose was: 40 Gy/15 fractions/3 weeks or 50 Gy/25 fractions/5 weeks. RT fields encompassed gross and suspected microscopic disease with a 2 cm margin. Pre-treatment PFT values analyzed included forced expiratory volume in 1s …

A Behavior Genetic Investigation Of The Relationship Between Leadership And Personality, Andrew Johnson, Philip Vernon, Julie Harris, Kerry Jang

Andrew M. Johnson

Phenotypic research on leadership style has long considered the importance of individual differences in personality when identifying the behaviors associated with good leaders. Although leadership and many personality traits have been separately shown to be heritable, these constructs have not been examined with genetically informative data to identify common sources of heritability in the two domains. A logical extension to current research, therefore, is to examine the extent to which factors of personality are predictive of leadership dimensions and the extent to which unique genetic contributions to the relationship between personality and leadership style may be identified. Adult twin pairs …

Clinical Focus On Lung Cancer: A Snapshot Of Lung Cancer For Ontario Health Care Providers And Managers, W. Evans, T. Sullivan, E. Holowaty, Deborah Fitzsimmons, A. Drossos, A. Whitton, M. Greus, B. Zanke, D. Nishri, L. Marrett, S. Bahl, I. Brunskill, S. Quan, B. Theis, B. Hess

Deborah A Fitzsimmons

Ontario: Cancer Care Ontario

A Systematic Review Of The Diagnostic Accuracy Of Natriuretic Peptides For Heart Failure, Jenny Doust, Paul Glasziou, Eva Pietrzak, Annette Dobson

Jenny Doust

Background The diagnosis of heart failure is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Natriuretic peptides have been proposed as a possible test for assisting diagnosis. We assessed the diagnostic accuracy of brain natriuretic peptide (BNP), including a comparison with atrial natriuretic peptide (ANP). Methods Electronic searches were conducted of MEDLINE and EMBASE from January 1994 to December 2002 and handsearches of reference lists of included studies. We included studies that assessed the diagnostic accuracy of BNP against echocardiographic or clinical criteria or that compared the diagnostic accuracy of BNP with ANP. Two reviewers assessed studies for …

The Role Of Hospital Design In The Recruitment, Retention And Performance Of Nhs Nurses In England, David Reid, David Armstrong, Michael Kane

David N Reid

The primary aim of the research was to explore whether hospital design has an influence on the recruitment, retention and performance of NHS nurses in England, and to further examine which aspects of design matter to nursing staff.

Advance Care Planning And End Of Life Decision Making, Colleen Cartwright, Malcolm Parker

Professor Colleen M Cartwright

BACKGROUND Aging populations with greater rates of cognitive decline demand increased attention to the issues of end of life decision making and advance care planning (ACP). Legislatures have passed statutes that recognise the necessity for both substitute decision making and the declaration in advance of wishes relating to health care. OBJECTIVE This article discusses ACP and the role of the general practitioner. DISCUSSION Advance care planning provides patients, relatives and doctors with greater confidence about the future. There is good evidence that patients desire to discuss end of life care, and GPs are in a good position to engage their …

The Genetic Basis Of Substance Abuse: Mediating Effects Of Sensation Seeking, Andrew Johnson, Philip Vernon

Andrew M. Johnson

Most modern theories of personality are structured hierarchically, with broad higher-order dimensions predicting narrower trait-level variables. This approach is necessarily reductionist, proposing to summarize the majority of trait-specific variability with a smaller number of larger dimensions. Not surprisingly, therefore, significant research has been directed to determining what might be considered to be the most basic dimensions of personality—both with regards to the identification of how many factors are needed to describe personality, and what these factors might be called (Costa & McCrae 1992a; [29] and [30]; Tupes & Christal 1992; Zuckerman 1992; [121] and [122]. While these omnibus factors of …

Dhandha, Dharma And Disease: Traditional Sex Work And Hiv/Aids In Rural India, J. O'Neil, Treena Orchard, J. Swarankar, J. Blanchard, K. Gurav, B. Barlaya, R. Patil, C. Hussain Khan, S. Moses

Dr. Treena Orchard

This paper discusses the results of two ethnographic studies with female sex workers in rural areas of Karnataka and Rajasthan, India. In particular, we focus on women whose socio-economic status, and religious and occupational practices, are part of sex work systems that have historical precedents such that they can be termed “traditional” sex workers. The approach taken in the ethnographic work was informed by current critical approaches in medical anthropology and public health. The paper argues that in the context of an expanding HIV/AIDS epidemic in rural areas of India, understanding the historical and structural factors that operate to perpetuate …

Visual Inspection Time In Parkinson's Disease: Deficits In Early Stages Of Cognitive Processing, Andrew Johnson, Quincy Almeida, Con Stough, James Thompson, Rene Singarayer, Mandar Jog

Andrew M. Johnson

Inspection time (IT) is a simple information processing paradigm dependent on a participant's ability to identify physical properties of a stimulus presented for a specified time interval. In contrast with reaction time (RT) studies, the dependent variable of interest in IT is not related to the motoric speed with which the individual is able to respond, but rather the minimum presentation time necessary for participants to reliably identify physical properties of the stimulus. It is well documented that individuals with Parkinson's disease (PD) experience significant impairment on tests of simple RT, but it is unclear whether such deficits can be …