scholarly journals A Wider Range of Conditions Contributing to Death in a Cohort of People Who Have Injected Drugs. Findings from an Edinburgh Cohort.

2020 ◽  
Author(s):  
Roy Robertson ◽  
Lorraine Copeland ◽  
James McKenzie
Keyword(s):  
Drug Use ◽  
Cause Of Death ◽  
Premature Death ◽  
Clinical Situation ◽  
Drug Deaths ◽  
National Mortality ◽  
Wide Range ◽  
Antiviral Chemotherapy ◽  
Over Time ◽  
Hiv Aids

Abstract BackgroundThe morbidity and mortality attributed to injecting drug use is a substantial contributor to any study on causes of premature death. Understanding the extent of this may be limited by difficulties in observing and recording outcomes over several decades. Historic studies have recorded information in a period when blood borne virus and drug deaths were a smaller proportion or, in the cases of Hepatitis C and HIV/AIDS, absent from National mortality figures.Design and settingA cohort of people who had, ever, injected drugs was established over a prolonged period of observation in one, community based, medical practice in Edinburgh (UK). Outcomes were measured in the clinical situation and by accessing death certificates from national, UK, registers.FindingsCauses of death in a cohort of 794 people who inject drugs (PWIDs) varied over time, some conditions relating to single pathological diagnoses and others were more complicated, multimorbid, and cumulative over time. HIV/AIDS was a striking cause of death until 1995 when antiviral chemotherapy was introduced. Drug related deaths (mainly overdose) remained a significant cause of death and death due to alcohol, respiratory, cardiovascular and cancer (mainly lung) increased over time. A wide range of other causes including suicide and violence and trauma were recorded.ConclusionsMortality resulting from present or historic drug use may be underestimated in current recoding systems, which largely record deaths from overdose or a single pathological event in an acute situation. The range of conditions causing or contributing to premature death is enormous reflecting multiple risks associated with drug use.

scholarly journals Characteristics, Social Factors, and Trends in HIV and AIDS-Related Lymphoma: A 23-Year Analysis Since the Implementation of c ART, a County Hospital AIDS Malignancy Project (CHAMP) Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2304-2304
Author(s):  
Camille E. Demarco ◽  
Pei Lu ◽  
David F. Peace ◽  
Sunny Singh ◽  
Dennis F. Angelov ◽  
...  
Keyword(s):  
Drug Use ◽  
Inner City ◽  
Social Factors ◽  
Survival Data ◽  
B Cell Lymphoma ◽  
Hiv And Aids ◽  
Cancer Type ◽  
Hiv And Cancer ◽  
Over Time ◽  
Hiv Aids

Abstract Introduction: Stroger Hospital (CCH) and the Ruth M. Rothstein CORE Center (CC) are the largest health providers for HIV+ patients (pts) in Chicago and one of the largest HIV clinics in the United States. CCH/CC treat approximately 5,000 HIV+ individuals per year and 40 newly diagnosed HIV-associated cancers annually. The CHAMP Study was originally a retrospective database from 1990 to 2010 of all clinical, demographic, cancer characteristics of pts diagnosed with HIV/AIDS. Since then, the study has compiled data prospectively on all pts with hematological malignancies. In this study, we analyzed various characteristics of pts with HIV/AIDS diagnosed with lymphoma as well as changes seen over time including therapy response since the implementation of combined anti-retroviral therapy (cART). In addition, we assessed variables including drug use, psychiatric history (hx) and time of HIV diagnosis (dx) with respect to cancer presentation. While large population studies of HIV and cancer exist, few studies specifically examine the largest growing HIV demographic, the inner-city HIV population. Methods: Patient's HIV and cancer clinical, laboratory, and survival data were compiled from the CHAMP database. Psychiatric hx and social factors including drug use and time of HIV dx were also analyzed by retrospective chart review and compared between racial and gender groups as well as differences and overall survival (OS). Survival data was examined using Kaplan-Meier analysis and Cox Proportional Hazards model. Statistical comparisons between different groups were performed via the Fisher's exact test. Results: Between 1995-2018, 226 lymphoma pts were identified spanning 26 diagnoses. Fifty-nine percent, 28%, and 11% were African American (AA), Hispanic, and Caucasian, respectively. The cohort was 87% male. The median age by disease ranged from 35-45. Categorized by cancer type; 32% were diffuse large B-cell lymphoma (DLBCL; n=72), 22.5% classic Hodgkin lymphoma (cHL; n=32), 13% Burkitt lymphoma (BL; n=29), 6.7% primary CNS lymphoma (PCNSL; n=15), and 5% plasmablastic lymphoma (PBL; n=11). Seventy-eight percent of pts presented with stage III/IV disease. CD4+ T cell count (CD4) at dx varied by disease, with the median CD4 count ranging from 19 for PCNSL to 260 cells/µL in cHL. DLBCL pts treated with DAEPOCHR (n=23) had a 5-year OS of 80% vs. 68% treated with CHOPR (n=35; p=0.4). cHL had a 5-year OS of 76%. PBL and BL had a 10-year OS of 62% and 58%, respectively. Cases of cHL decreased from 48% of all lymphomas in 2012 (n=8) to 9% in 2017 (p<0.01) while the incidence of BL dropped from 38% in 2004 to 0-10% in 2015-2017. PBL was diagnosed only twice before 2013 to on average of 20% of all lymphomas diagnosed from 2014-17. As a whole, 22% of pts were diagnosed with HIV/AIDS at time of lymphoma dx. Moreover, 13/21 (62%) of Hispanics, 9/41 (22%) AA and 3/11 (30%) Caucasians (p<0.007) with DLBCL and 5/6 (83%) Hispanic vs. 3/18 (18%) AA pts with BL were diagnosed with HIV/AIDS at dx (P<0.007). While Hispanics with DLBCL were more likely to be diagnosed with HIV at lymphoma dx, there was no difference in OS at 5 years, 76% vs. 75%, when stratified by those presenting with compared to those without a known hx of HIV infection. Furthermore, 11/43 (26%) AA DLBCL pts had a hx or known psychiatric disorder compared to 0/20 (0%) Hispanic pts (p<0.037). Men 26/59 (44%) vs. 8/10 (80%) women DLBCL pts had hx of known drug use (p=0.036). No difference in OS by drug use, type of drug, alcohol use, or psychiatric hx was identified in the DLBCL cohort. Conclusions: HIV/AIDS-associated lymphoma in the inner-city remains an AA, male dominated disease, a clear disparity compared to the US HIV/cancer population. Dissimilar to national trends, a statistical decrease in cases of cHL and BL has been noticed over time with a concomitant elevation in PBL. Outcomes for DLBCL were improved with DAEPOCHR compared to CHOPR. Wh en analyzed by race, the majority of Hispanics with lymphoma were diagnosed with HIV at the time of dx, statistically significant, over AA and Caucasians. AA also demonstrated a statistically significant increase in psychiatric hx compared to other races. These findings could explain why 78% of our lymphoma cohort present with advanced stage disease. Combining efforts in prevention/screening of HIV and drug use and providing psychological interventions could help improve outcomes for Hispanics and AA beyond that made with improved therapies. Disclosures No relevant conflicts of interest to declare.

Anti-corruption in History

2017 ◽  
Keyword(s):  
Financial Institutions ◽  
Global Media ◽  
Policy Makers ◽  
The Past ◽  
Human Wellbeing ◽  
Modern Period ◽  
Legitimate Power ◽  
Wide Range ◽  
Scant Attention ◽  
Over Time

Anticorruption in History is the first major collection of case studies on how past societies and polities, in and beyond Europe, defined legitimate power in terms of fighting corruption and designed specific mechanisms to pursue that agenda. It is a timely book: corruption is widely seen today as a major problem, undermining trust in government, financial institutions, economic efficiency, the principle of equality before the law and human wellbeing in general. Corruption, in short, is a major hurdle on the “path to Denmark”—a feted blueprint for stable and successful statebuilding. The resonance of this view explains why efforts to promote anticorruption policies have proliferated in recent years. But while the subjects of corruption and anticorruption have captured the attention of politicians, scholars, NGOs and the global media, scant attention has been paid to the link between corruption and the change of anticorruption policies over time and place. Such a historical approach could help explain major moments of change in the past as well as reasons for the success and failure of specific anticorruption policies and their relation to a country’s image (of itself or as construed from outside) as being more or less corrupt. It is precisely this scholarly lacuna that the present volume intends to begin to fill. A wide range of historical contexts are addressed, ranging from the ancient to the modern period, with specific insights for policy makers offered throughout.

scholarly journals A Newfangled Collagenase Inhibitor Topical Formulation Based on Ethosomes with Sambucus nigra L. Extract

2021 ◽  
Vol 14 (5) ◽  
pp. 467
Author(s):  
Ana Henriques Mota ◽  
Inês Prazeres ◽  
Henrique Mestre ◽  
Andreia Bento-Silva ◽  
Maria João Rodrigues ◽  
...  
Keyword(s):  
Biological Activities ◽  
Scientific Evidence ◽  
Release Profile ◽  
Health Claims ◽  
Topical Formulation ◽  
Sambucus Nigra ◽  
Western Asia ◽  
Wide Range ◽  
The Impact ◽  
Over Time

Sambucus nigra L. (S. nigra) is a shrub widespread in Europe and western Asia, traditionally used in medicine, that has become popular in recent years as a potential source of a wide range of interesting bioactive compounds. The aim of the present work was to develop a topical S. nigra extract formulation based on ethosomes and thus to support its health claims with scientific evidence. S. nigra extract was prepared by an ultrasound-assisted method and then included in ethosomes. The ethosomes were analyzed in terms of their size, stability over time, morphology, entrapment capacity (EC), extract release profile, stability over time and several biological activities. The prepared ethosomes were indicated to be well defined, presenting sizes around 600 nm. The extract entrapment capacity in ethosomes was 73.9 ± 24.8%, with an interesting slow extract release profile over 24 h. The extract-loaded ethosomes presented collagenase inhibition activity and a very good skin compatibility after human application. This study demonstrates the potential use of S. nigra extract incorporated in ethosomes as a potential cosmeceutical ingredient and on further studies should be performed to better understand the impact of S. nigra compounds on skin care over the time.

ExpanDrogram: Dynamic Visualization of Big Data Segmentation over Time

2021 ◽  
Vol 13 (2) ◽  
pp. 1-27
Author(s):  
A. Khalemsky ◽  
R. Gelbard
Keyword(s):  
Big Data ◽  
Visual Presentation ◽  
Trend Detection ◽  
Dynamic Visualization ◽  
Segmentation Process ◽  
Key Points ◽  
Wide Range ◽  
History Of ◽  
The Individual ◽  
Over Time

In dynamic and big data environments the visualization of a segmentation process over time often does not enable the user to simultaneously track entire pieces. The key points are sometimes incomparable, and the user is limited to a static visual presentation of a certain point. The proposed visualization concept, called ExpanDrogram, is designed to support dynamic classifiers that run in a big data environment subject to changes in data characteristics. It offers a wide range of features that seek to maximize the customization of a segmentation problem. The main goal of the ExpanDrogram visualization is to improve comprehensiveness by combining both the individual and segment levels, illustrating the dynamics of the segmentation process over time, providing “version control” that enables the user to observe the history of changes, and more. The method is illustrated using different datasets, with which we demonstrate multiple segmentation parameters, as well as multiple display layers, to highlight points such as new trend detection, outlier detection, tracking changes in original segments, and zoom in/out for more/less detail. The datasets vary in size from a small one to one of more than 12 million records.

Health Disparities and the Law: Wrongs in Search of a Right

2003 ◽  
Vol 29 (2-3) ◽  
pp. 363-380
Author(s):  
Mary Anne Bobinski
Keyword(s):  
Public Health ◽  
Health Planning ◽  
Healthy People ◽  
Public Action ◽  
Traditional Health ◽  
Obesity And Diabetes ◽  
Wide Range ◽  
State Coercion ◽  
Healthy People 2010 ◽  
Over Time

Healthy People 2010 provides our Nation with the wide range of public health opportunities that exist in the first decade of the 21st century. With 467 objectives in 28 focus areas, Healthy People 2010 will be a tremendously valuable asset … . Healthy People 2010 reflects the very best in public health planning—it is comprehensive, it was created by a broad coalition of experts from many sectors, it has been designed to measure progress over time, and, most important, it clearly lays out a series of objectives to bring better health to all people in this country.The current responses to the traditional health perils … have been weakened. At the same time, it seems to this outsider as though the entire public health establishment is united around the proposition that massive public action should be taken to deal with the new “epidemics,” such as obesity and diabetes … . But the use of the term “epidemic” is just the wrong way to think about this issue. There are no noncommunicable epidemics … . Yet the designation [of] obesity as a public health epidemic is designed to signal that state coercion is appropriate … .

scholarly journals Markov-Modulated Continuous-Time Markov Chains to Identify Site- and Branch-Specific Evolutionary Variation in BEAST

2020 ◽  
Vol 70 (1) ◽  
pp. 181-189
Author(s):  
Guy Baele ◽  
Mandev S Gill ◽  
Paul Bastide ◽  
Philippe Lemey ◽  
Marc A Suchard
Keyword(s):  
High Performance ◽  
Markov Models ◽  
Marginal Likelihood ◽  
Likelihood Estimation ◽  
Phylogenetic Inference ◽  
Time Variability ◽  
Substitution Process ◽  
Wide Range ◽  
Markov Modulated ◽  
Over Time

Abstract Markov models of character substitution on phylogenies form the foundation of phylogenetic inference frameworks. Early models made the simplifying assumption that the substitution process is homogeneous over time and across sites in the molecular sequence alignment. While standard practice adopts extensions that accommodate heterogeneity of substitution rates across sites, heterogeneity in the process over time in a site-specific manner remains frequently overlooked. This is problematic, as evolutionary processes that act at the molecular level are highly variable, subjecting different sites to different selective constraints over time, impacting their substitution behavior. We propose incorporating time variability through Markov-modulated models (MMMs), which extend covarion-like models and allow the substitution process (including relative character exchange rates as well as the overall substitution rate) at individual sites to vary across lineages. We implement a general MMM framework in BEAST, a popular Bayesian phylogenetic inference software package, allowing researchers to compose a wide range of MMMs through flexible XML specification. Using examples from bacterial, viral, and plastid genome evolution, we show that MMMs impact phylogenetic tree estimation and can substantially improve model fit compared to standard substitution models. Through simulations, we show that marginal likelihood estimation accurately identifies the generative model and does not systematically prefer the more parameter-rich MMMs. To mitigate the increased computational demands associated with MMMs, our implementation exploits recent developments in BEAGLE, a high-performance computational library for phylogenetic inference. [Bayesian inference; BEAGLE; BEAST; covarion, heterotachy; Markov-modulated models; phylogenetics.]

Sustaining Research-Based Practices in Reading

1999 ◽  
Vol 20 (5) ◽  
pp. 263-287 ◽  
Author(s):  
Janette K. Klingner ◽  
Sharon Vaughn ◽  
Marie Tejero Hughes ◽  
Maria Elena Arguelles
Keyword(s):  
Instructional Practices ◽  
High Rate ◽  
Strategic Reading ◽  
School Year ◽  
Wide Range ◽  
Sustained Use ◽  
Development Experience ◽  
Collaborative Strategic Reading ◽  
Research Based Practices ◽  
Over Time

This study examined the extent to which the reading instructional practices learned by a cohort of teachers who participated in an intensive, yearlong professional development experience during the 1994-1995 school year have been sustained and modified over time. Teachers learned three multileveled practices—partner reading, collaborative strategic reading, and making words—that promote gains in reading for students from a wide range of achievement levels. Teachers were observed and interviewed 3 years later to determine the extent to which they continued to implement the practices, the ways in which they modified them, and factors that influenced their sustained use of the practices. With the exception of one teacher, all the teachers sustained one or more of the three practices at a high rate.

In Support of Initial Parenteral Medical Management of Intrathecal Baclofen Withdrawal in Spasticity Patients

2021 ◽  
pp. 875512252110392
Author(s):  
Brian L. LaRowe ◽  
Vicki M. Nussbaum
Keyword(s):  
Case Reports ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Clinical Situation ◽  
Intrathecal Baclofen ◽  
Wide Range ◽  
Baclofen Withdrawal

Background: Spasticity may present as a wide range of symptoms and conditions. With this protean presentation, a consensus regarding the best course of treatment does not exist. Those patients most severely affected may receive significant benefit from intrathecal baclofen delivery. However, this therapy may itself lead to patient injury in the event of withdrawal. Objective: Withdrawal from intrathecal baclofen may devolve rapidly into a situation in which the patient may incur significant morbidity and even death. A focused, prompt treatment plan would afford the patient the best possible outcome. Methods: The medical literature was reviewed for reports of plans of treatment of baclofen withdrawal and the results obtained. The nature of this problem does not lend itself to a typical study design, depending on case reports and basic pharmacological science application. The paucity of such reports severely limits categorical comparison of patient characteristics and clinical circumstances. Clinical situations, patient characteristics, and therapies were considered and compared. Outcomes of the varied treatments were evaluated for efficacy. Results: Inaccurate diagnoses, delayed correct diagnoses, and the absence of a consistent, treatment plan contributed to widely disparate outcomes. Prompt, correct diagnosis and intensive care unit–based continuous benzodiazepine infusion with titration led to a controlled clinical situation and maximized patient outcomes. Conclusions: Patients going through withdrawal from intrathecal baclofen achieved best outcomes when treated with a continuous infusion and titration of an intravenous benzodiazepine. A well-defined treatment protocol employing this management, reporting serial outcomes, would enable further refinement of the treatment of this clinical problem.

Modifications of Seizure Susceptibility inDrosophila

2000 ◽  
Vol 83 (2) ◽  
pp. 998-1009 ◽  
Author(s):  
Daniel Kuebler ◽  
Mark A. Tanouye
Keyword(s):  
Idiopathic Epilepsy ◽  
Seizure Susceptibility ◽  
Wild Type ◽  
Physiological Basis ◽  
Seizure Disorders ◽  
Spontaneous Seizures ◽  
Wide Range ◽  
Symptomatic Seizures ◽  
Type Strains ◽  
Over Time

In a given population, certain individuals are much more likely to have seizures than others. This increase in seizure susceptibility can lead to spontaneous seizures, such as seen in idiopathic epilepsy, or to symptomatic seizures that occur after insults to the nervous system. Despite the frequency of these seizure disorders in the human population, the genetic and physiological basis for these defects remains unclear. The present study makes use of Drosophila as a potentially powerful model for understanding seizure susceptibility in humans. In addition to the genetic and molecular advantages of using Drosophila, it has been found that seizures in Drosophila share much in common with seizures seen in humans. However, the most powerful aspect of this model lies in the ability to accurately measure seizure susceptibility across genotypes and over time. In the current study seizure susceptibility was quantified in a variety of mutant and wild-type strains, and it was found that genetic mutations can modulate susceptibility over an extremely wide range. This genetic modulation of seizure susceptibility apparently occurs without affecting the threshold of individual neurons. Seizure susceptibility also varied depending on the experience of the fly, decreasing immediately after a seizure and then gradually increasing over time. A novel phenomenon was also identified in which seizures are suppressed after certain high-intensity stimuli. These results demonstrate the utility of Drosophila as a model system for studying human seizure disorders and provide insights into the possible mechanisms by which seizure susceptibility is modified.

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