We investigated whether circulating TGF-β1-regulated miRNAs detectable in plasma are associated with the risk of rapid progression to end-stage renal disease (ESRD) in a cohort of proteinuric ...patients with type 1 diabetes (T1D) and normal eGFR. Plasma specimens obtained at entry to the study were examined in two prospective subgroups that were followed for 7-20 years (rapid progressors and nonprogressors), as well as a reference panel of normoalbuminuric T1D patients. Of the five miRNAs examined in this study, let-7c-5p and miR-29a-3p were significantly associated with protection against rapid progression and let-7b-5p and miR-21-5p were significantly associated with the increased risk of ESRD. In logistic analysis, controlling for HbA1c and other covariates, let-7c-5p and miR-29a-3p were associated with more than a 50% reduction in the risk of rapid progression (P ≤ 0.001), while let-7b-5p and miR-21-5p were associated with a >2.5-fold increase in the risk of ESRD (P ≤ 0.005). This study is the first prospective study to demonstrate that circulating TGF-β1-regulated miRNAs are deregulated early in T1D patients who are at risk for rapid progression to ESRD.
Advances in the management of patients with congenital heart disease (CHD) have made survival to adulthood an expectation. Although the literature is limited, existing evidence suggests that adult ...co-morbidities may be at least as prevalent in patients with CHD, if not more so, than in an age-matched general population. The presence of these co-morbidities in combination with underlying CHD likely places these patients at increased risk for early mortality. Thus, we sought to determine the predicted 10-year mortality risk in a cohort of adults with CHD.
In this single center study, we administered a survey to patients ≥18 years of age with CHD to assess their 10-year mortality risk.
A total of 406 patients agreed to participate. The median age was 41.8 ± 15.3 years, and 58% were female. The average predicted 10-year mortality for the CHD cohort was 13.7 ± 15.8%. For CHD patients ≥50 years of age, the average 10-year mortality risk was 29.8 ± 3.0% compared to 26.1% ± 0.2% in the general population (p < 0.001). Patient with CHD of great complexity had the highest predicted mortality risk at 53.0 ± 7.7%.
In this study examining 10-year mortality risk in adults with CHD, we demonstrated that predicted mortality for CHD patients is higher than the general population with complex patients having the highest predicted 10-year mortality. This tool may provide useful information in clinical decision making. A multi-center approach to validate this tool in the CHD population appears warranted, with broader consideration of CHD-targeted variables.
School-based day treatment is an intensive mental health service for children with social, emotional, and behavioral difficulties. Research on day treatment is scarce and descriptions of program ...models are lacking. We used stimulated recall interviews to explore the moment-to-moment processes and strategies of classroom staff in a day treatment program for children in kindergarten and Grade 1. Several processes and strategies used by staff emerged from the thematic analysis of the interviews. These included a process of individualized intervention, characterized by a continual and cyclical process of attunement, responsiveness, assessment, and evaluation, using a team-based approach, noticing positives about children, a climate of positive relationships, staff regulating their own emotions, being flexible while also being firm and consistent, and seeing children from a developmental perspective. More specific strategies used by staff (e.g., token economy) also emerged from the interviews. Implications for future research and teacher training are discussed.
Cette thèse invite à réfléchir à une traduction éthique et décolonisée, vers le français, des œuvres autochtones écrites en anglais, puisque la majorité des écrivains issus des Premiers Peuples en ...Amérique du Nord use de la langue anglaise et que la plupart de leurs traducteurs sont allochtones. Elle part du principe qu’un récit écrit en anglais par un auteur autochtone ne peut pas être traduit de la même manière que serait traduite l’œuvre d’un auteur canadien ou américain de langue anglaise. Cela s’explique par l’aspect généralement politique des écrits autochtones, par le fait que leurs auteurs sont issus de cultures et de visions du monde bien différentes de celles des écrivains euro-américains et qu’il existe un rapport de force entre Autochtones et Allochtones.Ma réflexion se nourrit du travail critique et théorique de certains intellectuels euroaméricains, dont le traductologue Antoine Berman, mais surtout du travail d’écrivains, d’intellectuels et d’universitaires issus des Premiers Peuples comme Craig S. Womack (creek/cherokee) et Kristina Fagan (métisse du Labrador).Le premier chapitre s’intéresse à l’état de la traduction, dans les deux langues officielles, des œuvres autochtones au Canada. En effet, depuis 2010, de plus en plus d’œuvres autochtones sont traduites, principalement de l’anglais vers le français. La thèse se penche sur l’aspect politique des récit autochtones, puis sur les visées de plusieurs récits autochtones, soit la guérison, la compassion et la réappropriation. J’attire aussi l’attention sur certains écueils courants en traduction des récits autochtones, c’est-à-dire l’ethnocentrisme, la rationalisation, la clarification, la « destruction des réseaux vernaculaire » et l’exotisation, qui sont, de l’avis de Berman, des « tendances déformantes » fréquentes en traduction. À ces écueils j’ajoute la volonté de répondre à l’horizon d’attente des lecteurs, le manque de connaissances des cultures autochtones, la volonté de vouloir tout révéler et la difficulté que représente la traduction de l’humour autochtone. J’explore ensuite le rapport des écrivains issus des Premiers Peuples à la langue du colonisateur, puis me penche sur les Rez Englishes, ces dialectes présents dans certains récits autochtones.Dans le deuxième chapitre, je soulève des problèmes pratiques de traduction dans deux œuvres de l’écrivaine salishe-stó:lōe Lee Maracle et quelques particularités de son écriture. Enfin, dans le dernier chapitre, j’applique le fruit de mes réflexions en présentant une traduction au caractère résolument lettriste du recueil de Maracle intitulé First Wives Club: Coast Salish Style(2010).
Progressively decreasing glomerular filtration rate (GFR), or renal decline, is seen in patients with type 1 diabetes (T1D) and normoalbuminuria or microalbuminuria. Here we examined the associations ...of kidney injury molecule-1 (KIM-1) in plasma and urine with the risk of renal decline and determine whether those associations are independent of markers of glomerular damage. The study group comprised patients with T1D from the 2nd Joslin Kidney Study of which 259 had normoalbuminuria and 203 had microalbuminuria. Serial measurements over 4 to 10 years of follow-up (median 8 years) of serum creatinine and cystatin C were used jointly to estimate eGFRcr-cys slopes and time of onset of CKD stage 3 or higher. Baseline urinary excretion of IgG2 and albumin were used as markers of glomerular damage, and urinary excretion of KIM-1 and its plasma concentration were used as markers of proximal tubular damage. All patients had normal renal function at baseline. During follow-up, renal decline (eGFRcr-cys loss 3.3% or more per year) developed in 96 patients and 62 progressed to CKD stage 3. For both outcomes, the risk rose with increasing baseline levels of plasma KIM-1. In multivariable models, elevated baseline plasma KIM-1 was strongly associated with risk of early progressive renal decline, regardless of baseline clinical characteristics, serum TNFR1 or markers of glomerular damage. Thus, damage to proximal tubules may play an independent role in the development of early progressive renal decline in non-proteinuric patients with T1D.
Patients with type 1 diabetes (T1D) with impaired renal function are at increased risk for end-stage renal disease (ESRD). Although the rate of progression varies, determinants and mechanisms of this ...variation are unknown.
We examined serum metabolomic profiles associated with variation in renal function decline in participants with T1D (the Joslin Kidney Study prospective cohort). One hundred fifty-eight patients with proteinuria and chronic kidney disease stage 3 were followed for a median of 11 years to determine estimated glomerular filtration rate slopes from serial measurements of serum creatinine and to ascertain time to onset of ESRD. Baseline serum samples were subjected to global metabolomic profiling.
One hundred ten amino acids and purine and pyrimidine metabolites were detected in at least 80% of participants. Serum levels of seven modified metabolites (C-glycosyltryptophan, pseudouridine, O-sulfotyrosine, N-acetylthreonine, N-acetylserine, N6-carbamoylthreonyladenosine, and N6-acetyllysine) were associated with renal function decline and time to ESRD (
< 0.001) independent of the relevant clinical covariates. The significant metabolites correlated with one another and with the indices of tubular injury.
This prospective cohort study in participants with T1D, proteinuria, and impaired renal function at baseline demonstrated that patients with increased circulating levels of certain modified metabolites experience faster renal function decline, leading to ESRD. Whether some of these candidate metabolites are risk factors or just prognostic biomarkers of progression to ESRD in T1D needs to be determined.
Evidence is limited for BREAST-Q scores in women without breast cancer or breast surgery to establish baseline values for clinical interpretation. The primary aim of this study was to compare ...differences in breast satisfaction and quality of life in women without breast cancer and without breast surgery to patients undergoing breast reconstruction using the BREAST-Q.
The authors performed a single-center, patient-reported outcomes comparative study. A sample of 300 women attending gynecology appointments completed a study-specific demographics form and preoperative BREAST-Q reconstruction module. Eligible women had no history of breast cancer or breast surgery and were not currently pregnant (control group). The authors compared prospectively collected control group data to demographics and preoperative and 12-month postoperative BREAST-Q scores in 300 breast reconstruction patients, retrospectively selected from a prospectively collected registry.
Control group BREAST-Q scores were higher in Satisfaction with Breasts (mean, 59.3 versus 55.3; p < 0.042) and Physical Well-being Chest scores (mean, 84.1 versus 78.8; p < 0.001), and lower for Physical Well-being Abdomen scores (mean, 81.9 versus 88.7; p < 0.001) when compared to breast reconstruction patients' preoperative scores. When compared with breast reconstruction patients' 12-month postoperative scores, control group scores were lower in Satisfaction with Breasts (mean, 59.3 versus 65.5; p < 0.002) and Psychosocial Well-being (mean, 69.5 versus 76.2; p < 0.001) and higher in Physical Well-being Chest (mean, 84.1 versus 78.2; p < 0.001).
The authors found differences in preoperative and 12-month postoperative BREAST-Q scores between breast reconstruction patients and a comparable control population. Establishing normative BREAST-Q data could serve as an important baseline for breast outcomes research and better understanding of patients' ability to recover quality of life following reconstruction.
Risk, II.
Die Praxeologische Wissenssoziologie sowie die Dokumentarische Methode zeichnen sich durch fortdauernde Reflexion, Ausdifferenzierung und Weiterentwicklung ihrer Kategorien in der empirischen ...Auseinandersetzung aus. Im Zentrum stehen das Verhältnis zwischen propositionaler und performativer Logik sowie die Kategorie des konjunktiven Erfahrungsraums. Die Autor*innen bearbeiten dies für organisationale konjunktive Erfahrungsräume und fokussieren pädagogische Felder und solche der sozialen Arbeit. (DIPF/Orig.)
Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher ...morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.
The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.
Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.
In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.
Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.
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Both thromboembolism and excessive bleeding following breast surgery could result in multiple surgical procedures, breast reconstruction failure, or even mortality. This systematic review and ...meta-analysis of 5617 female breast surgery patients compared pharmacological prophylaxis to nonpharmacological prophylaxis interventions during the pre-, intra-, and/or postoperative time points and evaluated associated outcomes and complications. The PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded. Eleven of the 344 studies queried were eligible for systematic review and meta-analysis, with results from 26 of the possible 117 outcomes and complications using strict PRISMA and Cochrane guidelines. Patients receiving intraoperative pharmacological prophylaxis for breast surgery were found to have more reoperations and more occurrences of any bleeding, while patients receiving postoperative pharmacological prophylaxis were found to have more occurrences of any bleeding than patients receiving nonpharmacological prophylaxis. Patients were more likely to receive preoperative pharmacological prophylaxis if they had diabetes mellitus and postoperative chemoprophylaxis if they had higher BMIs. Patients administered pharmacological prophylaxis during the pre-, intra-, and/or postoperative time periods did not show a significant decrease in deep vein thrombosis and/or pulmonary embolism or increase in hematomas compared to those administered nonpharmacological prophylaxis.
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