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Search Results: 1 - 10 of 937 matches for " Trever Ball "
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Physical activity and dietary behaviors of health clinic workers trying to lose weight  [PDF]
Tan Leng Goh, Trever Ball, Janet M. Shaw, James C. Hannon
Health (Health) , 2012, DOI: 10.4236/health.2012.48079
Abstract: Health clinic workers are potential agents of change for weight loss to patients, yet their behaviors are not well known. This study examined physical activity (PA) levels and dietary habits of health clinic workers who were and who were not trying to lose weight. Participants were 64 community health clinic workers (58 females and 6 males). Moderate-to-vigorous intensity (MVI) time spent in PA was assessed by triaxial accelerometry over 7 consecutive days. Dietary habits and weight loss efforts were determined by a food frequency questionnaire. Differences in MVI and nutrition variables were assessed by One-way ANOVA, comparing those trying to lose weight and those not trying to lose weight. 48 out of 64 health clinic workers (approximately 75%) indicated that they were currently trying to lose weight. There were significant differences (p < 0.05) in Body Mass Index (BMI), daily energy (Kcal) and fat (g) intake between those trying to lose weight and those not trying to lose weight. There were no significant differences in MVI, daily sugar intake (g), vegetable and fruit servings, and daily fiber intake (g) between groups. Health clinic workers trying to lose weight appear to be engaging in some appropriate dietary but not PA behaviors.
Healthy Eating Vital Sign: A New Assessment Tool for Eating Behaviors
Jessica L. J. Greenwood,Junji Lin,Danita Arguello,Trever Ball
ISRN Obesity , 2012, DOI: 10.5402/2012/734682
Abstract:
Healthy Eating Vital Sign: A New Assessment Tool for Eating Behaviors
Jessica L. J. Greenwood,Junji Lin,Danita Arguello,Trever Ball,Janet M. Shaw
ISRN Obesity , 2012, DOI: 10.5402/2012/734682
Abstract: Introduction. Most dietary questionnaires are not created for use in a clinical setting for an adult health exam. We created the Healthy Eating Vital Sign (HEVS) to assess eating behaviors associated with excess weight. This study investigated the validity and reliability of the HEVS. Methods. Using a cross-sectional study design, participants responded to the HEVS and the Block Food Frequency Questionnaire (BFFQ). We analyzed the data descriptively, and, with Pearson’s correlation and Cronbach coefficient alpha. Results. We found moderate correlation ( r h o > 0 . 3 ) between multiple items of the HEVS and BFFQ. The Cronbach's alpha was 0.49. Conclusion. Our results support the criterion validity and internal reliability of the HEVS as compared to the BFFQ. The HEVS can help launch a dialogue between patients and providers to monitor and potentially manage dietary behaviors associated with many chronic health conditions, including obesity. 1. Introduction The United States (US) did not meet the Healthy People 2010 objective to decrease the prevalence of adult obesity to 15% [1]. According to the Centers for Disease Control and Prevention (CDC), 27% of US adults are obese [2]. Flegal et al. report more dismal statistics; 68% of adults are overweight ( B M I ≥ 2 5 ) and 34% are obese ( B M I ≥ 3 0 ) [3]. Multiple factors influence energy balance, or energy intake versus energy expenditure. However, primary care providers have the opportunity to engage with people and potentially affect behaviors that can tilt the energy balance [4]. A provider’s attention to weight has great influence on patients [5, 6]. Therefore, effectively and efficiently managing and preventing overweight and obesity in the primary care setting is warranted [7]. Traditionally, food frequency questionnaires are used to assess habitual dietary behavior. The Block Food Frequency Questionnaire (BFFQ) is a valid and reliable instrument used as a standard tool for nutrition assessment [8, 9]. The BFFQ contains more than 100 questions, takes approximately 45 minutes to complete, and focuses on nutrient intake rather than eating behaviors. Because of its length and the complexities involved in dietary analysis, the BFFQ is too cumbersome for routine clinical screening of patients’ nutritional habits. Recognizing this problem, Glasgow et al. recommended Starting the Conversation-(STC) Diet and the Summary of Diabetes Self-Care Activities (SDSCA) as practical measures for clinical use [10]. The STC-Diet is a 7-item instrument to assess dietary behaviors, created for the New Leaf
Mechanisms of Resistance to Epidermal Growth Factor Receptor Inhibitors and Novel Therapeutic Strategies to Overcome Resistance in NSCLC Patients
Luping Lin,Trever G. Bivona
Chemotherapy Research and Practice , 2012, DOI: 10.1155/2012/817297
Abstract: The epidermal growth factor receptor (EGFR) is a well-characterized oncogene that is frequently activated by somatic kinase domain mutations in non-small cell lung cancer (NSCLC). EGFR TKIs are effective therapies for NSCLC patients whose tumors harbor an EGFR activating mutation. However, EGFR TKI treatment is not curative in patients because of both primary and secondary treatment resistance. Studies over the last decade have identified mechanisms that drive primary and secondary resistance to EGFR TKI treatment. The elucidation of mechanisms of resistance to EGFR TKI treatment provides a basis for the development of therapeutic strategies to overcome resistance and enhance outcomes in NSCLC patients. In this paper, we summarize the mechanisms of resistance to EGFR TKIs that have been identified to date and discusses potential therapeutic strategies to overcome EGFR TKI resistance in NSCLC patients.
Mechanisms of Resistance to Epidermal Growth Factor Receptor Inhibitors and Novel Therapeutic Strategies to Overcome Resistance in NSCLC Patients
Luping Lin,Trever G. Bivona
Chemotherapy Research and Practice , 2012, DOI: 10.1155/2012/817297
Abstract: The epidermal growth factor receptor (EGFR) is a well-characterized oncogene that is frequently activated by somatic kinase domain mutations in non-small cell lung cancer (NSCLC). EGFR TKIs are effective therapies for NSCLC patients whose tumors harbor an EGFR activating mutation. However, EGFR TKI treatment is not curative in patients because of both primary and secondary treatment resistance. Studies over the last decade have identified mechanisms that drive primary and secondary resistance to EGFR TKI treatment. The elucidation of mechanisms of resistance to EGFR TKI treatment provides a basis for the development of therapeutic strategies to overcome resistance and enhance outcomes in NSCLC patients. In this paper, we summarize the mechanisms of resistance to EGFR TKIs that have been identified to date and discusses potential therapeutic strategies to overcome EGFR TKI resistance in NSCLC patients. 1. Introduction Lung cancer is the leading cause of cancer mortality in the United States and worldwide, accounting for 28% of cancer-related deaths in males and 26% of cancer-related deaths in females [1, 2]. Most lung cancer patients present with advanced stage disease, for which conventional chemotherapies patients are only modestly effective. Thus, the 5-year-survival rate of lung cancer patients with metastatic disease is less than 15% [3]. In the last decade, the discovery of mutated oncogenes that encode activated signaling molecules that drive cellular proliferation and promote tumor growth has led to the development of more effective and less toxic targeted drugs for lung cancer patients. Systemic therapies that act against specific activated oncogenes in lung cancers have the potential for improving outcomes for lung cancer patients in an unprecedented manner. Yet, a significant challenge that must be overcome in order to realize the full potential of targeted cancer therapy in lung cancer patients is resistance to treatment with an oncogene inhibitor as monotherapy. The epidermal growth factor receptor (EGFR) is a well-characterized mutated oncogene in non-small cell lung cancer (NSCLC) that is found in ~10–20% of cases in western countries and is associated predominantly with adenocarcinoma histology. EGFR-mutated tumors are dependent to EGFR signaling for their proliferation and survival [4–7]. In lung cancer patients, EGFR mutations are generally exclusive with KRAS and BRAF mutations, and tumors with either KRAS (15–25%) or BRAF (2-3%) mutations are relatively insensitive to EGFR TKIs [8, 9]. The most common activating mutations (~90%) are
A pseudo-Rumsfeldian approach to pleural effusions in mechanically ventilated patients
Jonathan Ball
Critical Care , 2011, DOI: 10.1186/cc10053
Abstract: There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't know.Donald Rumsfeld,former US Secretary of DefenseSmall- to medium-sized pleural effusions are very common radiological findings in mechanically ventilated patients. The pathophysiological causes of pleural effusions in mechanically ventilated patients are well understood with variable contributions from cardiovascular and lymphatic hydrostatic forces, inflammatory changes in vascular permeability, changes in the osmotic and oncotic milieu, and positive pressure ventilation.What are the physiological and prognostic consequences of unilateral and bilateral effusions in mechanically ventilated patients? There are no established methods that assess the physiological impact of a pleural effusion, in terms of gas exchange, pulmonary mechanics, or work of breathing, and hence that predict the potential benefit of drainage. It can be argued that a pleural effusion will cause some degree of local atelectasis in dependent lung parenchyma, resulting in a negative effect on global ventilation perfusion matching and increasing the risks of pneumonia and empyema. Additional potential sequelae include diaphragmatic dysfunction, an increase in the work of breathing, and delayed/protracted weaning from support. Accordingly, enthusiasts for an aggressive drainage management strategy claim that such an approach is safe and effective. However, advocates of a minimal intervention strategy are equally vociferous.As a starting point in establishing some of the answers to these questions, Goligher and colleagues [1] present their systematic review and meta-analysis of available evidence in the previous issue of Critical Care. Their meticulous literature review reveals a surprising lack of published data (19 studies and 1,124 patients) given the very high incidence
Organic and Inorganic Dyes in Polyelectrolyte Multilayer Films
Vincent Ball
Materials , 2012, DOI: 10.3390/ma5122681
Abstract: Polyelectrolyte multilayer films are a versatile functionalization method of surfaces and rely on the alternated adsorption of oppositely charged species. Among such species, charged dyes can also be alternated with oppositely charged polymers, which is challenging from a fundamental point of view, because polyelectrolytes require a minimal number of charges, whereas even monovalent dyes can be incorporated during the alternated adsorption process. We will not only focus on organic dyes but also on their inorganic counterparts and on metal complexes. Such films offer plenty of possible applications in dye sensitized solar cells. In addition, dyes are massively used in the textile industry and in histology to stain textile fibers or tissues. However, the excess of non bound dyes poses serious environmental problems. It is hence of the highest interest to design materials able to adsorb such dyes in an almost irreversible manner. Polyelectrolyte multilayer films, owing to their ion exchange behavior can be useful for such a task allowing for impressive overconcentration of dyes with respect to the dye in solution. The actual state of knowledge of the interactions between charged dyes and adsorbed polyelectrolytes is the focus of this review article.
Recently published papers: a little less ventilation, a little more oxygen please?
Jonathan Ball
Critical Care , 2008, DOI: 10.1186/cc6898
Abstract: Minimising ventilator-induced lung injury while providing optimal respiratory support remains challenging. Limiting tidal volumes to 6 ml/kg (predicted body weight) has been widely adopted, in theory at least, but numerous other debates remain – perhaps most contentiously – regarding positive end-expiratory pressure (PEEP). Two large trials investigating the optimal ventilatory approach to patients with acute lung injury have recently been published.In the first, a combined Canadian, Australian and Saudi Arabian multicentre study, 983 patients were randomised to a 6 ml/kg (predicted body weight) tidal volume with either established ARDSnet PEEP settings or a 'high PEEP strategy with recruitment manoeuvres' [1]. Of note, plateau pressures in the lower PEEP group were limited to 30 cmH2O whilst those in the high-PEEP group were limited to 40 cmH2O. The protocol produced a significantly higher average PEEP in the experimental group, with consequently higher plateau pressures. There was no difference between the two groups with regard to the 28-day mortality, ventilator days, intensive care unit days or days of hospitalisation. There was a significant reduction in the high-PEEP group in the incidence of refractory hypoxaemia and the use of rescue therapies. In short, the high-PEEP strategy did no harm – and may have done some good, in terms of improvements in short-term physiology – but these results did not translate into statistically significant outcome improvements, although there was a trend suggesting that a significantly larger trial might produce such an outcome.The second study, a French multicentre randomised control trial, investigated 767 patients with acute lung injury [2]. The patients were randomised to either a minimal distension strategy (intrinsic plus extrinsic PEEP 5 to 9 cmH2O) or a recruitment strategy, in which the PEEP was maximised and plateau pressures were maintained between 28 and 30 cmH2O. A detailed ventilatory protocol including weaning wa
Recently published papers: More about EGDT, experimental therapies and some inconvenient truths
Jonathan Ball
Critical Care , 2007, DOI: 10.1186/cc6145
Abstract: No one is likely to argue with the belief that prompt and appropriate treatment is effective and should be the standard of care. Back in 2001, Emmanuel Rivers and colleagues published their landmark study of Early Goal Directed Therapy (EGDT) [1]. Perhaps the central concept behind EGDT is that of oxygen debt and the secondary inflammatory insult inflicted by tissue hypoxia, which is modifiable with timely and aggressive cardiovascular support. A series of recently published papers emphasise and further elucidate this idea.Firstly, Rivers and colleagues have published the results of a study of serum biomarkers of systemic inflammation from the majority of patients from their original study [2]. Patients had multiple biomarkers measured periodically over the first 72 hours of their illness. Two separate comparative analyses were performed. First, the protocol group are considered against the standard care group. Second, the whole patient population has been stratified into three groups by severity of admission global dysoxia (serum lactate and central venous oxygen saturations) and compared. Unfortunately, no third analysis of these three groups separated into those in the protocol and standard care groups was performed. Although this post hoc separation would have yielded statistically small groups, the results may well have provided useful hypothesis generation rather than statistically significant results. The results of the treatment comparison analysis demonstrate a statistically significant reduction in the level of all markers in the protocol group. However, the time course and magnitude of this difference is markedly different between the substrates. EGDT appears to obtund the early peak in interleukin 1 receptor antagonist and tumour necrosis factor alpha (although the baseline level was significantly higher in the protocol group). Perhaps the most striking difference however was in caspase-3, a marker of cellular apoptosis, the level of which fell dramatica
Recently published papers: What not to do and how not to do it?
Jonathan Ball
Critical Care , 2005, DOI: 10.1186/cc3812
Abstract: The delivery of oxygen to tissues remains a central tenet of intensive care medicine. Much of the attention has focused on optimizing cardiac output and perfusion pressure, not least because we possess therapeutic tools that affect these parameters. The second element in the equation is oxygen carrying capacity, which is primarily determined by haemoglobin concentration and hence red cell mass. Transfusion of stored red blood cells is used to maintain oxygen carrying capacity, although the optimal use of this therapy remains an area of considerable controversy. It is well established that transfused red blood cells carry but do not efficiently release oxygen for at least 24 hours, because of 2,3-diphospho-glycerate depletion. In addition, they do not deform to facilitate transit through the microcirculation. Use of a low transfusion threshold has been shown to be of benefit [1], as has a more permissive approach [2]. Habib and colleagues [3] have added to this controversy in their detailed study of the effects of anaemia and red blood cell transfusion in patients undergoing cardiopulmonary bypass. They measured changes in renal function as an index of end-organ damage due to impaired tissue oxygen delivery. The results, which are eloquently discussed in an accompanying editorial [4], demonstrate renal injury caused both by anaemia and transfusion. In the words of the editorialist, 'damned if you do/damned if you don't!'However, a recent animal study may yet offer us some salvation. Young and colleagues have been developing a substitute for red blood cell transfusion by conjugating haemoglobin tetramers with polyethylene glycol (PEG). In their most recent paper [5] they resuscitated a pig model of intraoperative haemorrhagic shock with a single, small volume bolus of Ringer's acetate, 10% pentastarch, 4 g/dl stroma-free haemoglobin, or their PEG-conjugated human haemoglobin. The animals then received an autologous blood transfusion, the blood having been removed as t
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