15 research outputs found
Prevention and management of hyperglycemia after pancreas transplantation
No full textPURPOSE OF REVIEW:
Pancreas transplantation is considered the optimal therapy for patients with insulin-dependent diabetes. Successful pancreas transplantation achieves euglycemia and allows freedom from insulin therapy. Long-term allograft success may be limited by the development of impaired glucose metabolism. The objectives of the present review are to summarize the possible reasons for endocrine pancreatic dysfunction and to focus on its prevention and management and emphasize the role of immunosuppression.
RECENT FINDINGS:
The diabetogenic effects of current immunosuppressive agents have been well established. Regimens without corticosteroids and calcineurin-inhibitor minimization or avoidance have been promoted. Recent studies have revisited the pathogenesis of type I and type II diabetes and demonstrated common pathways, including apoptosis induction, for the exhaustion and destruction of the pancreatic islets.
SUMMARY:
The immunosuppressive regimens in pancreatic transplantation should be designed and appropriately modified according to the graft immunological and metabolic conditions. New molecules that are able to preserve islet function and maintain optimal insulin secretion should be considered for pancreas transplant recipients
A randomized controlled trial to evaluate the effect of glycemic control on renal transplantation outcomes
No full textContext: Outcomes from intensive glycemic control postrenal transplant have not been studied. Objective: Our objective was to observe the optimal management of hyperglycemia in patients with diabetes or impaired glucose tolerance receiving renal transplantation. Design, Setting, and Patients: We conducted a randomized controlled trial with patients undergoing renal transplantation randomized to either iv insulin therapy (intensive) or standard sc insulin therapy while the patients were admitted to the hospital. Interventions: The study consisted of a 3-day postrenal transplant group treated with intensive iv insulin [blood glucose (BG) = 70-110 mg/dl] or a control group treated with sc insulin (BG = 70-180 mg/dl). Main Outcome Measure: The primary endpoint was delayed graft function (DGF). Secondary endpoints were glycemic control, graft survival, and acute rejection episodes. Results: A total of 104 patients were screened and randomized to either the intensive or control condition; however, the intention-to-treat analysis set consisted of only the 93 participants (n = 44 intensive, n = 49 control) that underwent a renal transplant. DGF was present in 18% (eight of 44) of the intensive group and 24% (12 of 49) of the control group (P = 0.46). The occurrence of severe hypoglycemia (BG 350 mg/dl) were the primary safety outcome measures. There were nine participants with hypoglycemia identified, seven of which (78%) were in the intensive treatment group (P = 0.08). There were 30 instances of hyperglycemia with five participants (11%) in the intensive group and 12 participants (24%) in the control group having at least one hyperglycemic event (P = 0.10). For the 11 rejection episodes, nine were in the intensive treatment group (P = 0.013). Conclusions: The primary outcome measure of DGF was not statistically different for the two treatment groups. Regarding longer-term rejection and graft survival, the intensively treated participants were at higher risk for a rejection episode. Copyright © 2012 by The Endocrine Society
Comparison of efficacy of induction therapy in low immunologic risk African-American kidney transplant recipients
No full textAfrican-Americans (AA) have higher acute rejection rates and poorer long-term graft survival rates when compared with non-AA. It is yet to be demonstrated that the type of induction therapy modifies outcomes in this 'high-risk' population. This retrospective analysis compares the efficacy of induction therapy [antilymphocyte antibodies (ALA) versus interleukin-2 receptor antagonists (IL-2RA)] in the AA population. Some 189 AAs were included. There was no difference in acute rejection at one year between the groups (ALA (12%) or IL-2RA (12%), P = 0.89). Type of induction therapy had no significant effect on death-censored (P = 0.61) or uncensored graft survival (P = 0.32). There was no difference between CMV or BK virus infections between the groups (P = 0.14 and 0.94 respectively). Type of induction therapy does not appear to affect acute rejection rates or long-term graft survival in low-risk AA kidney transplant recipients
Efficacy of induction therapy on acute rejection and graft outcomes in African American kidney transplantation
No full textBACKGROUND:
African Americans (AA) have higher rejection rates and poorer graft outcomes compared to non-AAs. Induction therapy is yet unproven in this high risk population.
METHODS:
This retrospective study compared the efficacy of induction therapy [IL-2 receptor antibodies (IL2RA) or thymoglobulin] vs. no induction.
RESULTS:
One hundred and seventy-five AA patients were included in this analysis. Patients were well matched for demographic and immunologic characteristics in the non-induction and IL2RA induction groups; the Thymoglobulin induction group had significantly higher risk patients. Significantly fewer episodes of acute rejection occurred at one yr in patients treated with thymoglobulin and IL2RA vs. no induction (18% vs. 47%, p = 0.003, 26% vs. 47%, p = 0.02). Three yr graft survival was significantly improved in the IL2RA group compared to the non-induction group (85% vs. 68%, p = 0.032). Despite the thymoglobulin group being at high risk, they had similar graft survival rates compared to both the IL2RA group (76% vs. 85%, p = 0.18) and the non-induction group (76% vs. 68%, p = 0.48). Multivariate analysis demonstrated that induction therapy (combining IL2RA and thymoglobulin) independently reduced the risk of both acute rejection and graft loss.
CONCLUSION:
The use and type of induction therapy in AA patients significantly reduces acute rejection rates and may improve long-term graft outcomes in AA patients
Inflammatory biomarkers, glycemic variability, hypoglycemia, and renal transplant outcomes: Results of a randomized controlled trial
No full textBACKGROUND: We previously reported that compared to standard glycemic control [blood glucose (BG): 70-180 mg/dL], patients randomized to intensive glycemic control (BG: 70-110 mg/dL) were at increased risk of graft rejection in renal transplantation. However, the underlying mechanisms that associate the effect of intensive glycemic control with renal transplant outcomes have not been identified. METHODS: A secondary data analysis of 93 participants (n=44 intensive, n=49 control) was conducted using data from a previous randomized controlled clinical trial. We examined inflammatory biomarkers, glycemic variability, hypoglycemia, and hyperglycemia as potential contributing etiologies by assessing the effect of intensive glycemic control on these characteristics, and evaluate the association of these variables with graft rejection. RESULTS: Intensive glycemic control had no appreciable effect on highly sensitive C-reactive protein, interleukin (IL)-6, tumor necrosis factor alpha, IL-1β, or IL-10 levels at all time points after transplantation. Moreover, neither inflammatory biomarkers nor increased glycemic variability were associated with graft rejection. However, intensive treatment increased the risk of hypoglycemia (BG <70 mg/dL, 84% vs. 25%, P<0.001). In sub-analysis, compared to non-rejecters, rejecters demonstrated higher rates of blood glucose below 70 mg/dL (90% vs. 49%, P=0.02). CONCLUSION: Inflammatory biomarkers and increased glycemic variability lack correlation with clinical outcomes in renal transplant, but importantly, increased perioperative hypoglycemic episodes (BG <70mg/dL) may be a salient etiology that contributed to the increased risk for acute allograft rejection related to intensive glycemic control. Further research is needed to confirm a causal association
Paradise Always Already Lost: Myth, Memory, and Matter in English Literature
No full textThis dissertation follows a collection of agentive objects around and through the networks of humans and nonhumans in four disparate works of English literature: the Anglo-Saxon poem The Dream of the Rood, William Shakespeare\u27s narrative poem The Rape of Lucrece, Thomas Hardy\u27s novel The Woodlanders, and Philip Pullman\u27s trilogy His Dark Materials. Applying the emergent discourses of object-oriented analyses, I posit the need for a critique that considers literary objects not as textual versions of real-world objects but as constructs of human imagination. What happens when we treat nonhuman or inanimate objects in literature as full characters in their own right? What work do nonhumans do to generate the story and the characters? How does our understanding of the human characters depend on the nonhuman ones? Most importantly, what motivates the agency of the fictive nonhuman? I argue that in this particular collection of texts, nonhuman agency stems from authorial nostalgia for the Garden of Eden: a time long past in which humans, nonhumans, and God existed in perfect harmony. Each text preserves this collective memory in a unique way, processing the myth as the author\u27s cultural moment allows.
The Dream of the Rood chapter uncovers the complex network of mirrors between the poet, the fictive Dreamer, the True Cross who speaks to the Dreamer, and the reader(s) of the poem. I use Jacques Lacan\u27s stages of psychosexual development to trace the contours of this network, and I demonstrate how the poet\u27s Edenic vision takes the form of an early medieval feast hall in heaven in which God presides over a banquet table like Hrothgar over Heorot. The Rape of Lucrece chapter posits that a series of domestic actors (weasels, wind, door locks) join with various pricks in the poem in an attempt to protect Lucrece from her rapist, Tarquin. Through these objects, I investigate the limits of women\u27s speech and its efficacy before concluding with a consideration of the poem\u27s Edenic vision, a Humanist paradise-on-earth, in the guise of the Roman Republic. The next chapter follows a shorn section of hair through The Woodlanders as it performs various functions and is assigned responsibility and power by several different human characters in the novel. The hair acts within a network of man-traps that illustrate the dangers of human artifice in an industrial era, and it reveals to readers Hardy\u27s certainty that we will never reclaim Eden in our postlapsarian world. Finally, I navigate the fantastic worlds of His Dark Materials with the aid of three powerfully agentive objects: a golden compass, a subtle knife, and an amber spyglass. The first and second, I insist, resist not only their user\u27s intentions but also their author\u27s, because they are imbued with so much life and power that the narrative cannot contain them. The spyglass, by contrast, performs exactly as it was designed to do, and reveals the secret of the perfectly symbiotic world of the creatures called mulefa, who model for us a very contemporary new Eden that is populated by hybrids, sustained by materialism and sensuality, and presided over by earthly individuals rather than an omniscient Creator. Pullman\u27s trilogy brings us back to the Garden but insists that our fallen state is our triumph rather than our tragedy
Children Placed Under Care Through the Westchester County Department of Family and Child Welfare: A Comparative Statistical Study of 404 Children Placed During 1945 and 1949
No full textThe importance of the family unit as the most natural, fundamental method of providing and maintaining the physical, emotional and spiritual values of the child is undisputed among people in the field of child welfare, This basic concept also seems reasonable to people with sufficient intellectual endowment who can accept the fact that a child has great dependency needs upon others from the time of his birth and during the years that follow, The preservation of this basic concept, therefore, will do much to extend to the child the security that he needs in his spiritual, intellectual, and physical development. Since the child\u27s character and personality are essentially formed and later developed more fully during the first six years through his relationships with his own home and family, it is extremely important that parental and family strengths be fortified and the moral fiber of the home be preserved.It has been stated for the poor you have always with you. Likewise, evidence has shown that there have been situations in the future when the rights and needs of children to the protection, love and affection will not be met within the settings of their own homes» in these malignant situations, after every attempt to keep the family together has failed, it may become necessary to remove the child or children from their own. homes and to arrange for their care in a new setting which will best meet their individual needs. However, it should be recognized quite early that (placement in a good” institution or in an ideal foster home is at best only substitute care. It has been stated often that foster care should be utilized only after due consideration has been given to the possibility of maintaining the child in his own home under proper conditions. And so it is within the family relationships of these children who have needed to be cared for away from their own homes that the author is focusing on and concerning whom there is a vital need to explore
Property rights analysis of building material pricing
No full textThe institution of property rights, as an important category of constraints or restrictions on human behaviour, provides rules of competition, and delineates the social and legal relationship between a resource owner and the others throughout the world. Forms of ownership rights to resources affect the efficiency of their use. The consensus is that in a real world with significant transactions costs and scarce resources, private property right systems lead to more efficient resource allocation than the others do.
Previous studies about economic implications of non-exclusive resources have focused on the problems of resource misallocations. A few studies also worked on the effects that alternate property rights structures have on the prices and variations in prices of non-exclusive resources. However, the economic analysis of property rights attribute of natural resources used as building materials, such as natural sand and wood, is still an unexplored research area.
The objective of the whole research is to empirically verify Angello and Donnelley's (1975) property rights thesis, as reinterpreted by Lai (1993a) and Lai and Yu (1995), that the variations in prices of non-exclusive resources are much greater than those under more exclusive ownership; and to identify, alternatively, the factors that might have affected ownership rights, inferred from changes in the variations in prices of the resources.
In this thesis, published historical data of natural sand, Total declared costs of new buildings completed, Gross & Usable floor area, Gross value of construction work, and published government data of prices for selected buildings materials, namely Portland cement, sand, hardwood, and plywood, were used. The prices of captured and cultured shrimps, which are collected from super market and street market by the author, were also checked and used. These resources are subject to different degrees of access restrictions and, hence, are good candidates for testing the hypotheses.
Basically, the hypotheses formulated in this research are strongly supported. The main findings are that the variations in prices of non-exclusive resources are greater than those of exclusive resources; for the same resource, the price ratios of exclusive resource and non-exclusive resource would fall over time.
This is an original contribution to the theory of property rights.
The originality of this dissertation lies in its exploration of the economic relationship between property rights ownership and selected building materials, as well as in the application of variances to the research of building materials. This is a novel contribution to research on Hong Kong’s sustainable development as she heavily relies on the real estate market for economic development.published_or_final_versionReal Estate and ConstructionDoctoralDoctor of Philosoph
Preliminary reliability of the occupational therapist teacher interaction scale
No full textDepartment Head: Wendy Wood.Includes bibliographical references (pages 28-34).This preliminary study sought to identify a reliable means of capturing and rating interactions between occupational therapists (OTs) and teachers according to the dyads' qualities of collaboration. Five OT and teacher dyads were recorded in their authentic environments as participants discussed on-going student needs. Judgment study methodology, including using "thin slice" segments from the videotaped interactions, was employed. A coding scheme was created specific to this study's question and by a panel of judges to code the collaborative characteristics of each dyad's interaction. This coding scheme, the Occupational Therapist Teacher Interaction Scale (OTIS), included 23 items and was divided into three subdomains: OT Interaction Qualities, Teacher Interaction Qualities, and Pair Interaction Qualities. Data was analyzed to determine effective reliability using intraclass correlations. Results showed that all three OTIS subdomains achieved effective reliability with an ICC of greater than .75 and that 18 of the 23 individual items did as well. These findings indicate that judgment methodology and the OTIS are reliable means of capturing and rating collaboration between OTs and teachers. Further research is indicated to assess validity of the findings and begin to correlate collaborative practice with student outcomes
Molecular genetic analysis of a "sine oculis" enhancer and the "leventina" gene as a model system to study human macular degeneration in "Drosophila"
No full textThe leventina gene as a model system to study human macular degeneration in Drosophila. Age-related macular degeneration (AMD) is one of the most frequent reasons for blindness of the elderly people and accounts for approximately 50% of registered blindness in the industrial world. AMD pathogenesis is poorly understood and there is no beneficial medical or surgical treatment possible in most cases. The autosomal dominant retinal disease Malattia Leventinese (ML) has a similar phenotype to AMD and seems to be an early onset form. It has recently been shown that ML is caused by a single point mutation (Arg345Trp) that affects the extracellular matrix protein EFEMP1. Studying the molecular function of EFEMP1 could therefore be helpful to understand the pathomechanism of both, ML and AMD. In the last decade striking homologies between Drosophila and vertebrate eye development have been revealed. In addition, the fly model was useful to gain insight into the molecular mechanisms that lead to neurodegenerative diseases like Alzheimer, Parkinson and Chorea Huntington. In this thesis, Drosophila melanogaster was used as a model system in an attempt to reveal the function of EFEMP1 and its putative Drosophila homologue the leventina gene, in the molecular mechanisms of eye development and its function in the retina of adult flies. Pax-6, the master control gene of eye development, is able to induce ectopic eyes in Drosophila and ectopic eye structures in vertebrates. In the ribbonworm Lineus (Nemertini) Pax-6 is also important for regeneration and maintenance of the retina. This is in agreement with our working hypothesis that Pax-6 is involved in maintenance and regeneration of the human retina. The transmembrane receptor Notch genetically lies upstream of Pax-6. The Notch signaling cascade appears in many steps of eye development in human, mouse and Drosophila. Activation of Notch increases the expression of the transcription factor
Pax-6 in frogs.
EFEMP1 displays a high amino acid similarity to the ligands of the Notch receptor.
The point mutation in EFEMP1 that causes ML could result in a loss of its ability to
activate the Notch signaling cascade leading to a inappropriate Pax-6 transcription and
therefore cause ML. Based on this hypothesis one of our approaches was to test
whether EFEMP1 interacts with Notch. If this is the case, EFEMP1 as a soluble Notch
ligand could be a therapeutic tool to activate Notch, increase the transcription of Pax-6
and thereby slow down retinal degeneration.
With the so far used methods we were not able to get any evidence that EFEMP1 is
indeed a Notch ligand despite the convincing sequence homology to known Notch
ligands
