De Gruyter Contemporary Social Sciences provides a platform for disseminating topical analyses of current events, showcasing new theoretical, empirical or applied research across the social sciences ...and related fields. Through engaging storytelling and in-depth analysis, it presents new work that appeals to a wide audience, and engages with issues of major public interest, highlighting the implications for both policy and professional practice.
Robotic-assisted lobectomy (RL) is becoming a popular alternative technique to video-assisted thoracoscopic lobectomy (VL), although open lobectomy (OL) remains the most common approach. The ...objective of this study is to provide a comparative analysis of perioperative clinical outcomes from elective RL, VL, and OL.
The Premier Healthcare Database was analyzed for lobectomies performed from January 1, 2011, to September 30, 2015. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes were used to identify surgical approaches, complications, and mortality. Propensity score matching (1:1) for patient and hospital characteristics allowed comparison of RL versus OL (n = 2,775 each) and RL versus VL (n = 2,951 each).
Compared with OL in propensity matched analysis, RL was associated with a lower postoperative complication rate (p < 0.0001), shorter hospital stay (p < 0.0001), and lower mortality rate (p = 0.0282). Patients in the RL group were more likely to be discharged home than to a transitional health care facility (p < 0.0001). Compared with VL, the RL group had a lower conversion rate to thoracotomy (p < 0.0001), lower overall postoperative complication rate (p = 0.0061), and shorter hospital stay (p = 0.006). The RL patients also were more likely to be discharged home than to a transitional health care facility (p = 0.0108). The postoperative mortality rates of RL and VL were similar (p = 0.44). There was no difference in iatrogenic injuries when comparing RL with OL and RL with VL (p = 0.1284 and p = 0.5477, respectively).
Robotic-assisted lobectomy was associated with improved outcomes for certain perioperative clinical variables, including shorter length of stay and lower complication rates. It was also was associated with a lower conversion rate to OL compared with VL.
Developmental Changes in Pharmacokinetics and Pharmacodynamics den Anker, John; Reed, Michael D.; Allegaert, Karel ...
Journal of clinical pharmacology,
October 2018, 2018-October, 2018-Oct, 2018-10-00, 20181001, Letnik:
58, Številka:
S10
Journal Article
Recenzirano
Odprti dostop
Effective drug therapy to optimally influence disease requires an understanding of a drug's pharmacokinetic, pharmacodynamic, and pharmacogenomic interrelationships. In pediatrics, age is a continuum ...that can and does add variability in drug disposition and effect. This article addresses the many important factors that influence drug disposition and effect relative to age. What is known about the influence of maturation on the processes of drug absorption, distribution, metabolism, excretion, and drug receptor dynamics are outlined. Our state of understanding of many of these factors remains in flux, however, and only with additional study will we be able to better anticipate and model drug‐response relationships across the age continuum. Being able to continuously improve our care of the ill pediatric patient while simultaneously being able to accurately determine the utility of new drugs and chemical entities in this population requires our enhanced understanding of these disposition characteristics.
The effective treatment of patients diagnosed with drug-resistant tuberculosis is highly dependent on the ability to rapidly and accurately determine the antibiotic susceptibility profile of the ...Mycobacterium tuberculosis isolate(s) involved. Thus, as more clinical microbiology laboratories advance toward the use of DNA sequence-based diagnostics, it is imperative that their predictive functions extend beyond the well-known resistance mutations in order to also encompass as many of the lower-frequency mutations as possible. However, in most cases, fundamental experimental proof that links these uncommon mutations with phenotypic resistance is lacking. One such example is the g878a polymorphism within the
16S rRNA gene. We, and others, have identified this mutation within a small number of drug-resistant isolates, although a consensus regarding exactly which aminoglycoside antibiotic(s) it confers resistance to has not previously been reached. Here, we have employed oligonucleotide-mediated recombineering to introduce the g878a polymorphism into the
gene of Mycobacterium bovis BCG, a close relative of M. tuberculosis, and demonstrate that it confers low-level resistance to streptomycin alone. It does not confer cross-resistance to amikacin, capreomycin, or kanamycin. We also demonstrate that the
mutation exerts a substantial fitness defect
that may at least in part explain why clinical isolates bearing this mutation appear to be quite rare. Overall, this study provides clarity to the phenotype attributable to the
mutation and is relevant to the future implementation of genomics-based diagnostics as well as the clinical management of patients in whom this particular polymorphism is encountered.
Bourbon whisky is one of the world's most popular spirits and is a vital component of U.S. spirits exports. Yet, very limited research has examined the trade patterns of U.S. bourbon whisky. The ...purposes of this paper lie in (i) filling a void in the literature about the driving forces behind U.S. bourbon whisky exports, especially justifying the impact of geographical indications and trade disputes, and (ii) examining global and regional trade efficiency and trade potential of U.S. bourbon whisky, considering consumer preferences. This study adopts the stochastic frontier gravity model and trade inefficiency model to analyze bourbon trade patterns between the U.S. and its primary bourbon trade partners over 1990-2019. Results reveal that economic size, income level, trade facilitation, common language and the weighted share of adults who drink in the importing country are important factors in boosting bourbon trade flows. As expected, U.S. bourbon's geographical indication is playing a significant role in boosting bourbon exports. Trade disputes between the U.S. and its trading partners are found to have significantly negative impacts on U.S. bourbon exports. Our research also reveals that U.S. bourbon whisky has great potential to reach markets throughout the world, particularly in Europe, North America and Oceania.
Nanoporous gold (np-Au) has intriguing material properties that offer potential benefits for many applications due to its high specific surface area, well-characterized thiol-gold surface chemistry, ...high electrical conductivity, and reduced stiffness. The research on np-Au has taken place on various fronts, including advanced microfabrication and characterization techniques to probe unusual nanoscale properties and applications spanning from fuel cells to electrochemical sensors. Here, we provide a review of the recent advances in np-Au research, with special emphasis on microfabrication and characterization techniques. We conclude the paper with a brief outline of challenges to overcome in the study of nanoporous metals.
This paper has three objectives. First, to provide an exposition of the ‘realist turn’ in contemporary organization and management studies. Second, to assess the detailed implications of this ...incipient ‘realist turn’ for the underlying explanatory principles and practices that should inform organization and management studies as a social scientific field. Third, to evaluate the potential, longer‐term, impact of these explanatory principles and practices in an intellectual context where anti‐realist ontologies and epistemologies have been dominant. This will entail a critique of contemporary approaches that draw on a social constructionist ontology and a postmodernist epistemology. Overall, the paper concludes that the ‘realist turn’ creates a significant intellectual opportunity and space in which the historical sociology of dynamic organizational forms and managerial control regimes can be rediscovered and renewed.
OBJECTIVE:To test the hypothesis that ineffective acute treatment of episodic migraine (EM) is associated with an increased risk for the subsequent onset of chronic migraine (CM).
METHODS:In the ...American Migraine Prevalence and Prevention Study, respondents with EM in 2006 who completed the Migraine Treatment Optimization Questionnaire (mTOQ-4) and provided outcome data in 2007 were eligible for analyses. The mTOQ-4 is a validated questionnaire that assesses treatment efficacy based on 4 aspects of response to acute treatment. Total mTOQ-4 scores were used to define categories of acute treatment responsevery poor, poor, moderate, and maximum treatment efficacy. Logistic regression models were used to examine the dichotomous outcome of transition from EM in 2006 to CM in 2007 as a function of mTOQ-4 category, adjusting for covariates.
RESULTS:Among 5,681 eligible study respondents with EM in 2006, 3.1% progressed to CM in 2007. Only 1.9% of the group with maximum treatment efficacy developed CM. Rates of new-onset CM increased in the moderate treatment efficacy (2.7%), poor treatment efficacy (4.4%), and very poor treatment efficacy (6.8%) groups. In the fully adjusted model, the very poor treatment efficacy group had a more than 2-fold increased risk of new-onset CM (odds ratio = 2.55, 95% confidence interval 1.42–4.61) compared to the maximum treatment efficacy group.
CONCLUSION:Inadequate acute treatment efficacy was associated with an increased risk of new-onset CM over the course of 1 year. Improving acute treatment outcomes might prevent new-onset CM, although reverse causality cannot be excluded.
Many enzymes are inhibited by their own substrates, leading to velocity curves that rise to a maximum and then descend as the substrate concentration increases. Substrate inhibition is often regarded ...as a biochemical oddity and experimental annoyance. We show, using several case studies, that substrate inhibition often has important biological functions. In each case we discuss, the biological significance is different. Substrate inhibition of tyrosine hydroxylase results in a steady synthesis of dopamine despite large fluctuations in tyrosine due to meals. Substrate inhibition of acetylcholinesterase enhances the neural signal and allows rapid signal termination. Substrate inhibition of phosphofructokinase ensures that resources are not devoted to manufacturing ATP when it is plentiful. In folate metabolism, substrate inhibition maintains reactions rates in the face of substantial folate deprivation. Substrate inhibition of DNA methyltransferase serves to faithfully copy DNA methylation patterns when cells divide while preventing de novo methylation of methyl-free promoter regions.
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