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Author LaGrone, L.N.; Isquith-Dicker, L.N.; Huaman Egoavil, E.; Rodriguez Castro, M.J.A.; Allagual, A.; Revoredo, F.; Mock, C.N.
Title (down) Surgeons' and Trauma Care Physicians' Perception of the Impact of the Globalization of Medical Education on Quality of Care in Lima, Peru Type Observational Study
Year 2017 Publication JAMA Surgery Abbreviated Journal JAMA Surg
Volume 152 Issue 3 Pages 251-256
Keywords *Attitude of Health Personnel; *Developing Countries; Education, Distance; *Education, Medical; Faculty, Medical/psychology; General Surgery/*education/standards; Humans; International Educational Exchange; Internationality; Internship and Residency; Interviews as Topic; Perception; Peru; Qualitative Research; *Quality of Health Care; Surgeons/*psychology; *Traumatology
Abstract Importance: The globalization of medical education-the process by which trainees in any region gain access to international training (electronic or in-person)-is a growing trend. More data are needed to inform next steps in the responsible stewardship of this process, from the perspective of trainees and institutions at all income levels, and for use by national and international policymakers. Objective: To describe the impact of the globalization of medical education on surgical care in Peru from the perspective of Peruvian surgeons who received international training. Design, Setting, and Participants: Observational study of qualitative interviews conducted from September 2015 to January 2016 using grounded theory qualitative research methods. The study was conducted at 10 large public institutions that provide most of the trauma care in Lima, Peru, and included urban resident and faculty surgery and trauma care physicians. Exposures: Access to international surgical rotations and medical information. Main Outcomes and Measures: Outcome measures defining the impact of globalization on surgical care were developed as part of simultaneous data collection and analysis during qualitative research as part of a larger project on trauma quality improvement practices in Peru. Results: Fifty qualitative interviews of surgeons and emergency medicine physicians were conducted at 10 hospitals, including multiple from the public and social security systems. A median of 4 interviews were conducted at each hospital, and fewer than 3 interviews were conducted at only 1 hospital. From the broader theme of globalization emerged subthemes of an eroded sense of agency and a perception of inadequate training on the adaptation of international standards as negative effects of globalization on surgical care in Peru. Access to research funds, provision of incentives for acquisition of advanced clinical training, increased expectations for patient outcomes, and education in quality improvement skills are ways in which globalization positively affected surgeons and their patients in Peru. Conclusions and Relevance: Short-term overseas training of surgeons from low- and middle-income countries may improve care in the surgeons' country of origin through the acquisition of skills and altered expectations for excellence. Prioritization of evidence-based medical education is necessary given widespread internet access and thus clinician exposure to variable quality medical information. Finally, the establishment of centers of excellence in low- and middle-income countries may address the eroded sense of agency attributable to globalization and offer a local example of world-class surgical outcomes, diminishing surgeons' most frequently cited reason for emigration: access to better surgical training.
Address University of Washington, Seattle
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 2168-6254 ISBN Medium
Area Expedition Conference
Notes PMID:27893012 Approved no
Call Number ref @ user @ Serial 97649
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Author Bijangi-Vishehsaraei, K.; Reza Saadatzadeh, M.; Wang, H.; Nguyen, A.; Kamocka, M.M.; Cai, W.; Cohen-Gadol, A.A.; Halum, S.L.; Sarkaria, J.N.; Pollok, K.E.; Safa, A.R.
Title (down) Sulforaphane suppresses the growth of glioblastoma cells, glioblastoma stem cell-like spheroids, and tumor xenografts through multiple cell signaling pathways Type Journal Article
Year 2017 Publication Journal of Neurosurgery Abbreviated Journal J Neurosurg
Volume Issue Pages 1-12
Keywords CCCP = carbonyl cyanide m-chlorophenylhydrazone; DMSO = dimethyl sulfoxide; DSB = double-strand break; EGF = epidermal growth factor; FACS = fluorescence-activated cell sorting; FGF = fibroblast growth factor; GBM = glioblastoma; GSC = glioblastoma stem cell; IC50 = 50% inhibition of cell survival; MRC = mitochondrial respiratory chain; MSC = mesenchymal stromal cell; NAC = N-acetylcysteine; NSG = nonobese diabetic scid gamma; PE = phycoerythrin; ROS = reactive oxygen species; SFN = sulforaphane; SSB = single-strand break; apoptosis; cancer stem cells; glioblastoma; oncology; sulforaphane
Abstract OBJECTIVE Defects in the apoptotic machinery and augmented survival signals contribute to drug resistance in glioblastoma (GBM). Moreover, another complexity related to GBM treatment is the concept that GBM development and recurrence may arise from the expression of GBM stem cells (GSCs). Therefore, the use of a multifaceted approach or multitargeted agents that affect specific tumor cell characteristics will likely be necessary to successfully eradicate GBM. The objective of this study was to investigate the usefulness of sulforaphane (SFN)-a constituent of cruciferous vegetables with a multitargeted effect-as a therapeutic agent for GBM. METHODS The inhibitory effects of SFN on established cell lines, early primary cultures, CD133-positive GSCs, GSC-derived spheroids, and GBM xenografts were evaluated using various methods, including GSC isolation and the sphere-forming assay, analysis of reactive oxygen species (ROS) and apoptosis, cell growth inhibition assay, comet assays for assessing SFN-triggered DNA damage, confocal microscopy, Western blot analysis, and the determination of in vivo efficacy as assessed in human GBM xenograft models. RESULTS SFN triggered the significant inhibition of cell survival and induced apoptotic cell death, which was associated with caspase 3 and caspase 7 activation. Moreover, SFN triggered the formation of mitochondrial ROS, and SFN-triggered cell death was ROS dependent. Comet assays revealed that SFN increased single- and double-strand DNA breaks in GBM. Compared with the vehicle control cells, a significantly higher amount of gamma-H2AX foci correlated with an increase in DNA double-strand breaks in the SFN-treated samples. Furthermore, SFN robustly inhibited the growth of GBM cell-induced cell death in established cell cultures and early-passage primary cultures and, most importantly, was effective in eliminating GSCs, which play a major role in drug resistance and disease recurrence. In vivo studies revealed that SFN administration at 100 mg/kg for 5-day cycles repeated for 3 weeks significantly decreased the growth of ectopic xenografts that were established from the early passage of primary cultures of GBM10. CONCLUSIONS These results suggest that SFN is a potent anti-GBM agent that targets several apoptosis and cell survival pathways and further preclinical and clinical studies may prove that SFN alone or in combination with other therapies may be potentially useful for GBM therapy.
Address Departments of 2 Pharmacology and Toxicology and
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0022-3085 ISBN Medium
Area Expedition Conference
Notes PMID:28059653 Approved no
Call Number ref @ user @ Serial 96613
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Author Barros, J.; Morales, S.; Echavarri, O.; Garcia, A.; Ortega, J.; Asahi, T.; Moya, C.; Fischman, R.; Maino, M.P.; Nunez, C.
Title (down) Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders Type Journal Article
Year 2017 Publication Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999) Abbreviated Journal Rev Bras Psiquiatr
Volume 39 Issue 1 Pages 1-11
Keywords Adolescent; Adult; Chile; Female; Humans; Male; Mental Disorders/complications/*psychology; Middle Aged; Models, Theoretical; Risk Factors; Sensitivity and Specificity; Socioeconomic Factors; Suicide/*prevention & control; Surveys and Questionnaires; Young Adult
Abstract Objective:: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. Methods:: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results:: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one's own capacities and coping abilities. Conclusion:: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.
Address Private practice
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1516-4446 ISBN Medium
Area Expedition Conference
Notes PMID:27783715 Approved no
Call Number ref @ user @ Serial 97654
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Author Khalifa, J.; Tensaouti, F.; Lusque, A.; Plas, B.; Lotterie, J.-A.; Benouaich-Amiel, A.; Uro-Coste, E.; Lubrano, V.; Cohen-Jonathan Moyal, E.
Title (down) Subventricular zones: new key targets for glioblastoma treatment Type Journal Article
Year 2017 Publication Radiation Oncology (London, England) Abbreviated Journal Radiat Oncol
Volume 12 Issue 1 Pages 67
Keywords Glioblastoma; Prognostic factors; Radiotherapy; Stem-cell niche; Subventricular Zone
Abstract BACKGROUND: We aimed to identify subventricular zone (SVZ)-related prognostic factors of survival and patterns of recurrence among patients with glioblastoma. METHODS: Forty-three patients with primary diagnosed glioblastoma treated in our Cancer Center between 2006 and 2010 were identified. All patients received surgical resection, followed by temozolomide-based chemoradiation. Ipsilateral (iSVZ), contralateral (cSVZ) and bilateral (bSVZ) SVZs were retrospectively segmented and radiation dose-volume histograms were generated. Multivariate analysis using the Cox proportional hazards model was assessed to examine the relationship between prognostic factors and time to progression (TTP) or overall survival (OS). RESULTS: Median age was 59 years (range: 25-85). Median follow-up, OS and TTP were 22.7 months (range 7.5-69.7 months), 22.7 months (95% CI 14.5-26.2 months) and 6.4 months (95% CI 4.4-9.3 months), respectively. On univariate analysis, initial contact to SVZ was a poor prognostic factor for OS (18.7 vs 41.7 months, p = 0.014) and TTP (4.6 vs 12.9 months, p = 0.002). Patients whose bSVZ volume receiving at least 20 Gy (V20Gy) was greater than 84% had a significantly improved TTP (17.7 months vs 5.2 months, p = 0.017). This radiation dose coverage was compatible with an hippocampal sparing. On multivariate analysis, initial contact to SVZ and V20 Gy to bSVZ lesser than 84% remained poor prognostic factors for TTP (HR = 3.07, p = 0.012 and HR = 2.67, p = 0.047, respectively). CONCLUSION: Our results suggest that contact to SVZ, as well as insufficient bSVZ radiation dose coverage (V20Gy <84%), might be independent poor prognostic factors for TTP. Therefore, targeting SVZ could be of crucial interest for optimizing glioblastoma treatment.
Address INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irene Joliot-Curie, Toulouse Cedex, 31059, France
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1748-717X ISBN Medium
Area Expedition Conference
Notes PMID:28424082 Approved no
Call Number ref @ user @ Serial 96593
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Author Miguel, M.G.; Barreto, R.P.; Pereira, S.Y.
Title (down) Study of a tropical soil in order to use it to retain aluminum, iron, manganese and fluoride from acid mine drainage Type Journal Article
Year 2017 Publication Journal of Environmental Management Abbreviated Journal J Environ Manage
Volume 204 Issue Pt 1 Pages 563-570
Keywords Acid mine drainage; Column test; Contaminant transport; Liner; Tropical soils; Waste rock pile
Abstract The Ore Treatment Unit (UTM-Caldas), in the city of Caldas, Minas Gerais, Brazil, nowadays in decommissioning stage, was the first uranium extraction mine in Brazil. Several negative environmental impacts in the area have occurred, because of mining, treatment and beneficiation processes. Waste rock pile 4 (WRP-4) generates acid mine drainage (AMD), which is discharged in the Nestor Figueiredo retention pond (NFP). However, leakage of acid water by the NFP dam foundation has been constantly observed. Therefore, this research aimed to investigate a typical tropical soil, in order to use it as mineral liner for the NFP to minimize the leakage of acid water through the dam foundation and to retain predominant chemical species. Geotechnical, chemical and mineralogical tests were performed to characterize the soil and a column test was carried out using the acid mine drainage as contaminant, which contained aluminum (Al), manganese (Mn), iron (Fe) and fluoride (F-). The soil presented micro aggregation, acid pH, and low values of organic matter content and cation exchange capacity, which are characteristics of highly weathered soils. Diffusion was the predominant transport mechanism in the column test. Effluent solutions with pH less than 6.0 indicated the formation of insoluble Al-F complexes in the soil and desorption of iron and manganese at concentrations above those allowed by the Brazilian legislation. At pH greater than 6.0, the desorption of iron and manganese and release of aluminum and fluoride in the free form occurred, with concentrations also higher than the allowed by the Brazilian legislation.
Address Institute of Geoscience, University of Campinas (Unicamp), Brazil
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0301-4797 ISBN Medium
Area Expedition Conference
Notes PMID:28942188 Approved no
Call Number ref @ user @ Serial 97504
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