Summersmelton6417

With careful follow-up, the dose can be relatively intensified, even in patients with impaired liver function and this may contribute to offering comparable treatment. PURPOSE While several advanced contact lens (CL) designs are commercially available for vision correction in keratoconus, their visual performance and optical quality, relative to each other and controls remains unclear. This prospective, crossover study tested the hypothesis that these CL designs would have a differential impact on visual performance and optical quality in subjects with advanced keratoconus, but not in early to moderate disease states. METHODS Spatial vision (logMAR acuity and contrast sensitivity), depth vision (stereoacuity) and optical quality (higher-order wavefront aberrations) were measured on 28 bilaterally mild to advanced keratoconics (age 20-28yrs; 15 males), novice to CL wear, and in 10 age-matched controls using well-established psychophysical and aberrometry techniques. All data were collected on keratoconic subjects with their spectacles and with conventional RGP, Kerasoft®, Rose K2® and Scleral RGP® CL's in randomized order, atleast a week apart from each other. RESULTS All outcome variables deteriorated with keratoconus severity and improved with CL wear, relative to spectacles (p  less then  0.05). This improvement was smaller for Kerasoft CL (p  less then  0.05) and higher but comparable for the other three CL designs (p = 0.3), across all disease severity. Visual functions and optical quality outcomes never reached control levels for any correction modality (p  less then  0.05). CONCLUSION Visual performance and optical quality in keratoconus does not appear to improve commensurately with the sophistication of CL design across disease severity. Non-visual factors like quality of CL fit, wearing comfort and cost may therefore drive the choice of CL dispensed in keratoconus more than the performance efficacy of these lenses. In recent years there have been several attempts to examine Ethnobiology from an evolutionary perspective. I discuss several potential sources of confusion in applying Evolutionary concepts to Ethnobiology. Ethnobiological discussions of evolution have focused more on changes in human populations, or on human impacts upon plants used by humans for a variety of purposes, than on the processes typically emphasized in discussions by biologists studying evolution. There has been little acknowledgment of how the field of biological evolution is changing in the 21st Century. In this article I focus on recent developments in evolutionary thinking that could be effectively integrated into Ethnobiological concepts. These include 1) The increased importance of individual organisms in understanding both population dynamics and microevolutionary change (i.e. natural selection). This change in focus creates the potential for incorporating understandings from Indigenous people who recognize a different set of dynamics thatbject to climate change would be greatly improved by working closely with Indigenous peoples and incorporating concepts from these traditions into practices on a global scale. BACKGROUND AIMS Key obstacles in human iNKT cell translational research and immunotherapy include the lack of robust protocols for dependable expansion of human iNKT cells and the paucity of data on phenotypes in post-expanded cells. METHODS We delineate expansion methods using interleukin (IL)-2, IL-7 and allogeneic feeder cells and anti-CD2/CD3/CD28 stimulation by which to dependably augment Th2 polarization and direct cytotoxicity of human peripheral blood CD3+Vα24+Vβ11+ iNKT cells. RESULTS Gene and protein expression profiling demonstrated augmented Th2 cytokine secretion (IL-4, IL-5, IL-13) in expanded iNKT cells stimulated with anti-CD2/CD3/CD28 antibodies. Cytotoxic effector molecules including granzyme B were increased in expanded iNKT cells after CD2/CD3/CD28 stimulation. Direct cytotoxicity assays using unstimulated expanded iNKT cell effectors revealed α-galactosyl ceramide (α-GalCer)-dependent killing of the T-ALL cell line Jurkat. Moreover, CD2/CD3/CD28 stimulation of expanded iNKT cells augmented their (α-GalCer-independent) killing of Jurkat cells. Co-culture of expanded iNKT cells with stimulated responder cells confirmed contact-dependent inhibition of activated CD4+ and CD8+ responder T cells. DISCUSSION These data establish a robust protocol to expand and novel pathways to enhance Th2 cytokine secretion and direct cytotoxicity in human iNKT cells, findings with direct implications for autoimmunity, vaccine augmentation and anti-infective immunity, cancer immunotherapy and transplantation. BACKGROUND Large-scale adverse events (LSAEs) involve unsafe clinical practices stemming from system issues that may affect multiple patients. Although literature suggests a supportive organizational culture may protect against system-related adverse events, no study has explored such a relationship within the context of LSAEs. This study aimed to identify whether staff perceptions of organizational culture were associated with LSAE incidence. METHODS The team conducted an exploratory analysis using the 2008-2010 data from the US Department of Veterans Affairs (VA) All Employee Survey (AES). LSAE incidence was the outcome variable in two facilities where similar infection control practice issues occurred, leading to LSAEs. For comparison, four facilities where LSAEs had not occurred were selected, matched on VA-assigned facility complexity and geography. The AES explanatory factors included workgroup-level (civility, employee engagement, leadership, psychological safety, resources, rewards) and hospital-level Likert-type scales for four cultural factors (group, rational, entrepreneurial, bureaucratic). Bivariate analyses and logistic regressions were performed, with individual staff as the unit of analysis from the anonymous AES data. RESULTS Responses from 209 AES participants across the six facilities in the sample indicated that the four comparison facilities had significantly higher mean scores compared to the two LSAE facilities for 9 of 10 explanatory factors. The adjusted analyses identified that employee engagement significantly predicted LSAE incidence (odds ratio = 0.58, 95% confidence interval = 0.37-0.90). CONCLUSION Staff at the two exposure facilities in this study described their organizational culture to be less supportive. Lower scores in employee engagement may be a contributing factor for LSAEs. OBJECTIVE To test the acceptability and effectiveness of a lay-coach-facilitated, videoconferenced, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults. METHODS We employed a two-site, participant-randomized controlled trial with 89 older adults (averaging 74 years old) who were recipients of, and initially screened by, home-delivered meals programs. All participants reported loneliness; many reported being socially isolated and/or dissatisfaction with social support. Participants received five weekly videoconference sessions of either Tele-BA or Tele-FV (friendly visits; active control). Three primary outcomes were social interaction (Duke Social Support Index [DSSI] Social Interaction Subscale), subjective loneliness (PROMIS Social Isolation Scale), and DSSI Satisfaction with Social Support Subscale. Depression severity (PHQ-9) and disability (WHODAS 2.0) were secondary outcomes. Mixed-effects regression models were fit to evaluate outcomes at 6- and 12-weeks follow-up. RESULTS Compared to Tele-FV participants, Tele-BA participants had greater increase in social interaction (t [81] = 2.42, p = 0.018) and satisfaction with social support (t [82] = 2.00, p = 0.049) and decrease in loneliness (t [81] = -3.08, p = 0.003), depression (t [82] = -3.46, p = 0.001), and disability (t [81] = -2.29, p = 0.025). CONCLUSION A short-term, lay-coach-facilitated Tele-BA is a promising intervention for the growing numbers of homebound older adults lacking social connectedness. The intervention holds promise for scalability in programs that already serve homebound older adults. More research is needed to solidify the clinical evidence base, cost-effectiveness and sustainability of Tele-BA delivered by lay coaches for homebound and other older adults. The aim of this study is to compare the clinical outcomes of posteroanterior (PA) lag screws versus posterior buttress plate fixation in treatment of posterior malleolar fragments (PMFs) in spiral tibial shaft fracture, and provide guidance for surgeons selecting a treatment strategy. A total of 48 eligible patients with PMFs associated with spiral tibial shaft fracture surgically treated from March 2009 to January 2016 were included in the study. They were divided into the screw group (n = 24) and the plate group (n = 24). All operations were performed via a posterolateral approach by a senior orthopedic surgeon. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), and assessment of ankle range of motion (ROM) were used for clinical evaluation. The radiographic evaluation of posttraumatic arthritis scale was determined by Bargon reference criteria. At the mean follow-up period of 29.5 ± 4.3 and 30.4 ± 4.1 months, respectively (p > .05), all patients in both groups had bone union without severe wound problems or complications. There were no significant differences in AOFAS (92.5 ± 5.3 vs 94.7 ± 5.6, p = .129) and VAS (2.4 ± 0.8 vs 2.2 ± 0.9, p = .196) scores between the groups at final follow-up. No significant differences were found between the groups in injured/contralateral ankle ROM or posttraumatic ankle arthritis scale postoperatively (p > .05). For PMFs in spiral tibial shaft fracture, PA lag screws or posterior buttress plate fixation via a posterolateral approach can achieve good and equivalent clinical and radiological outcomes with minimal complications. The decision to pursue metabolic and bariatric surgery (MBS) for pediatric patients has become increasingly accepted by patients and their families and by health care professionals. The advancement of pre- and post-operative MBS guidelines, based on accumulating evidence for safety, efficacy, and cost-effectiveness help to map the clinical pathway for MBS consideration. Ethical issues remain possible for each case, however, and consultation with ethical experts can provide clarity in the consideration of MBS. Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities. Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS. Youth-onset type 2 diabetes (T2D) is a formidable threat to the health of obese adolescents because of its potential for early-onset and aggressive co-morbidities and complications. The physiology of youth-onset T2D differs from T2D in adults and is associated with a greater degree of insulin resistance, a more rapid decline in pancreatic β-cell function, and a poorer response to medications. Medical management in youth is focused on combining lifestyle intervention and pharmacological treatment, but these therapies have yet to demonstrate improvements in disease progression. Metabolic bariatric surgery (MBS) is now recommended for the treatment of T2D in adults largely because of the beneficial effects on weight, ability to improve glycemic control, and, in a large proportion of people, induce diabetes remission. MBS is now being performed in adolescents with severe obesity and T2D, with initial results also showing high rates of T2D remission. Here, we review the state of medical management of youth-onset T2D and the outcomes of MBS studies in youth with T2D published to date.