The role of chromosome Y in chronic kidney disease (CKD) remains unknown, as chromosome Y is typically excluded from genetic analysis in CKD. The complex, sex-specific presentation of CKD could be ...influenced by chromosome Y genetic variation, but there is limited published research available to confirm or reject this hypothesis. Although traditionally thought to be associated with male-specific disease, evidence linking chromosome Y genetic variation to common complex disorders highlights a potential gap in CKD research. Chromosome Y variation has been associated with cardiovascular disease, a condition closely linked to CKD and one with a very similar sexual dimorphism. Relatively few sources of genetic variation in chromosome Y have been examined in CKD. The association between chromosome Y aneuploidy and CKD has never been explored comprehensively, while analyses of microdeletions, copy number variation, and single-nucleotide polymorphisms in CKD have been largely limited to the autosomes or chromosome X. In many studies, it is unclear whether the analyses excluded chromosome Y or simply did not report negative results. Lack of imputation, poor cross-study comparability, and requirement for separate or additional analyses in comparison with autosomal chromosomes means that chromosome Y is under-investigated in the context of CKD. Limitations in genotyping arrays could be overcome through use of whole-chromosome sequencing of chromosome Y that may allow analysis of many different types of genetic variation across the chromosome to determine if chromosome Y genetic variation is associated with CKD.
Reducing risk in general practice Tiernan, Siobhan; Chambers, Robyn; Richardson, Katharine ...
Australian family physician,
05/2015, Letnik:
44, Številka:
5
Journal Article
Background Healthcare services are complex and prone to accidents. Most medical incidents are the result of human error. Examination of these incidents can reveal contributing factors that can be ...addressed to prevent recurrence.
Objective: The aim of this paper is to describe the development and institution of an incident review committee (IRC) in the setting of a large general practice.
Discussion: Two hundred incident reports were reviewed, resulting in meaningful clinical and business alterations to the practice. The design and running of the committee was open and collaborative. A satisfaction survey showed high acceptance among staff. The instigation of an IRC in general practice is new and unique, and this paper offers a template for other general practices to replicate.
Background: Chronic disease is responsible for 80% of the burden of disease in Australia. The Australian Government Medicare Benefits Schedule (MBS) provides incentives through specific Medicare ...items to optimise chronic disease management (CDM), yet little is known about factors that influence their uptake. Methods: Exploratory qualitative research was used, which incorporated focus groups and interviews with 26 staff from nine general practices in southeast Queensland, together with review of practice-specific data on CDM income. Content analysis of qualitative data was undertaken to identify barriers, enablers and service models associated with MBS CDM item uptake. Triangulation of methods and data sources facilitated confirmation of findings. Results: Time pressures and unreliable MBS information were common barriers to uptake for general practitioners. Employing a nurse, team-based approaches, recall systems and using only selected MBS CDM item numbers were associated with best uptake. Conclusion: Improved systems within general practice and Medicare may increase the uptake of MBS CDM item numbers.
The show is a project of Kim Mallory and Karen de Nevers, who partnered up several months ago to create Valley Expo Productions with the goal of organizing industry fairs and lifestyle trade shows in ...the valley. Each woman is a small business owner in her own right; Mallory runs a photography studio and de Nevers is a planner and decorator. The day-long show which employs the motto: "Vancouver style, Valley prices" includes a "well-rounded" list of exhibitors who offer a range of products to the bridal industry including accommodations, beauty and hair services, beverages and bartending services, bridal and wedding party fashions and accessories, cakes, catering, ceremony locations, dancing lessons, cleaners, decorations, event supplies and rentals, financial services, fitness and nutrition, florists, gift and gift registry, invitations and stationary, jewelry and rings, lingerie, marriage services, men's formal wear, music and entertainment, photography and video services, reception and banquet facilities, spa services, transportation, travel, winemaking and wedding planners.
BACKGROUND:Catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited cardiac arrhythmia characterized by adrenergically triggered arrhythmias, is inadequately treated by current ...standard of care. Ca/calmodulin-dependent protein kinase II (CaMKII), an adrenergically activated kinase that contributes to arrhythmogenesis in heart disease models, is a candidate therapeutic target in CPVT. However, translation of CaMKII inhibition has been limited by the need for selective CaMKII inhibition in cardiomyocytes. Here, we tested the hypothesis that CaMKII inhibition with a cardiomyocyte-targeted gene therapy strategy would suppress arrhythmia in CPVT mouse models.
METHODS:We developed AAV9-GFP-AIP, an adeno-associated viral vector in which a potent CaMKII inhibitory peptide, autocamtide-2–related inhibitory peptide AIP, is fused to green fluorescent protein (GFP) and expressed from a cardiomyocyte selective promoter. The vector was delivered systemically. Arrhythmia burden was evaluated with invasive electrophysiology testing in adult mice. AIP was also tested on induced pluripotent stem cells derived from patients with CPVT with different disease-causing mutations to determine the effectiveness of our proposed therapy on human induced pluripotent stem cell–derived cardiomyocytes and different pathogenic genotypes.
RESULTS:AAV9-GFP-AIP was robustly expressed in the heart without significant expression in extracardiac tissues, including the brain. Administration of AAV9-GFP-AIP to neonatal mice with a known CPVT mutation (RYR2) effectively suppressed ventricular arrhythmias induced by either β-adrenergic stimulation or programmed ventricular pacing, without significant proarrhythmic effect. Intravascular delivery of AAV9-GFP-AIP to adolescent mice transduced ≈50% of cardiomyocytes and was effective in suppressing arrhythmia in CPVT mice. Induced pluripotent stem cell–derived cardiomyocytes derived from 2 different patients with CPVT with different pathogenic mutations demonstrated increased frequency of abnormal calcium release events, which was suppressed by a cell-permeable form of AIP.
CONCLUSIONS:This proof-of-concept study showed that AAV-mediated delivery of a CaMKII peptide inhibitor to the heart was effective in suppressing arrhythmias in a murine model of CPVT. CaMKII inhibition also reversed the arrhythmia phenotype in human CPVT induced pluripotent stem cell–derived cardiomyocyte models with different pathogenic mutations.
Background
Exposures to structural racism has been identified as one of the leading risk factors for adverse maternal and infant health outcomes among Black women; yet current measures of structural ...racism do not fully account for inequities seen in adverse maternal and infant health outcomes between Black and white women and infants. In response, the purpose of this study was to conceptualize structural racism from the perspectives of Black women across the reproductive lifespan and its potential impact on adverse maternal and infant health outcomes.
Methods
We conducted a series of focus groups with 32 Black women across the reproductive lifespan (5 preconception, 13 pregnant, and 14 postpartum). Study criteria including self-identifying as Black, residing in Oakland or Fresno, California and representing one of three reproductive life tracks (preconception, pregnant, postpartum). We consulted with study participants and an expert advisory board to validate emergent domains of structural racism.
Results
Nine domains of structural racism emerged from a ground theory constant comparative analysis:
Negative Societal Views
;
Housing
;
Medical Care
;
Law Enforcement
;
Hidden Resources
;
Employment
;
Education
,
Community Infrastructure
; and
Policing Black Families
.
Conclusions for Practice
Findings from this study suggest that there is an interplay among structural racism, and social and structural determinants of health which has negative impacts on Black women’s sexual and reproductive health. Furthermore, findings from this study can be used to develop more comprehensive medical assessments and policies to address structural racism experienced by Black women across the reproductive lifespan.
Context
Providing year‐long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and ...setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation.
Methods
Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1‐9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017.
Results
The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio OR, 1.79; 95% confidence interval CI, 1.15–2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54–3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03–6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31–4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39–2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06–3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (<50 000 population) (relative risk ratios RRR 2.97; 95% CI, 1.82–4.83).
Conclusion
These findings inform medical schools about effective rural immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors.
Medical programs immersing students for longer than one year and exposing students to both regional hospitals and rural general practices are shown to optimise rural work outcomes.
Restoration of submerged macrophytes in eutrophic shallow freshwater ecosystems is rarely undertaken without additional measures to improve water clarity. Increasing water clarity is extremely ...difficult to achieve in some eutrophic waters, so this study trialled the establishment of macrophytes directly into a turbid, phytoplankton-dominated system. The submerged macrophyte Vallisneria australis grew successfully in five 48-m² protective exclosures, from transplants attached to steel mesh for anchorage in flocculent sediments. Plant growth, water quality, and zooplankton and macroinvertebrate richness and abundance were measured and compared with open water control plots throughout the growing season. V. australis grew well despite poor water quality (total phosphorus 44â1400 µg lâ»Â¹; total nitrogen 650â14,000 µg lâ»Â¹; chlorophyll a 1.6â770 µg lâ»Â¹; turbidity 3â207 NTU), attaining 85â100% cover after 6 months. Water quality was not improved within macrophyte meadows and zooplankton grazing was not enhanced. Richness and abundance of macroinvertebrates increased and additional native macrophyte species colonised the exclosures. Co-dominance of phytoplankton and macrophytes was achieved in exclosures, with beneficial outcomes for biodiversity. Rapid destruction of macrophyte meadows by waterbirds on removal of protective cages indicated the need for continued protection for long-term establishment of submerged macrophytes.
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly ...received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/- the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group.
ACTRN12611000661976.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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