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Search Results: 1 - 10 of 27927 matches for " Robert Barker "
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El federalismo y la administración de justicia en los Estados Unidos
Robert Barker
Pensamiento Constitucional , 1998,
Abstract: El propósito de este breve ensayo es el de identificar los aspectos más importantes de la relación entre el federalismo y la administración de justicia en los Estados Unidos y su división de facultadesgubernamentales entre el gobierno nacional (O federal ) y los estados.
La ense anza del Derecho constitucional en los Estados Unidos
Robert Barker
Pensamiento Constitucional , 1999,
Abstract: No contiene resumen
Age at diagnosis of diabetes in Appalachia
Lawrence Barker, Robert Gerzoff, Richard Crespo, Molly Shrewsberry
Population Health Metrics , 2011, DOI: 10.1186/1478-7954-9-54
Abstract: We used data from the Behavioral Risk Factor Surveillance System (2006-2008). We compared age at diagnosis among counties by Appalachian Regional Commission-defined level of economic development. To account for risk differences, we constructed a model for average age at diagnosis of diabetes, adjusting for county economic development, obesity, income, sedentary lifestyle, and other covariates.After adjustment for risk factors for diabetes, people in distressed or at-risk counties (the least economically developed) had their diabetes diagnosed two to three years younger than comparable people in non-Appalachian counties. No significant differences between non-Appalachian counties and Appalachian counties at higher levels of economic development remained after adjusting.People in distressed and at-risk counties have poor access to care, and are unlikely to develop diabetes at the same age as their non-Appalachian counterparts but be diagnosed sooner. Therefore, people in distressed and at-risk counties are likely developing diabetes at younger ages. We recommend that steps to reduce health disparities between the poorest Appalachian counties and non-Appalachian counties be considered.The Appalachian region of the United States extends from southern New York to northern Mississippi [1] (Figure 1). Appalachia includes all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Approximately 42% of Appalachia's population of 24 million people is rural, compared to 20% of the national population [1]. In 2000, Appalachia's population was 88% non-Hispanic white, as compared with about 70% for the rest of the United States [2].Appalachia was slow to develop large urban centers, due in part to rough terrain and a shortage of roads and navigable rivers. In the early days of westward expansion, settlers of the mountainous, often steep-sloped terrain in parts of Appala
Patient Perspective on Use of an Interactive Website for Sleep Apnea
Carl Stepnowsky,Christine Edwards,Tania Zamora,Robert Barker
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/239382
Abstract:
Patient Perspective on Use of an Interactive Website for Sleep Apnea
Carl Stepnowsky,Christine Edwards,Tania Zamora,Robert Barker,Zia Agha
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/239382
Abstract: Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4??±??2.4 and 4.1??±??2.3?hrs/nt; ; mean??±??SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies. 1. Introduction Obstructive sleep apnea (OSA) is a disorder characterized by repeated cessations of breathing during sleep, which can result in a number of potentially serious consequences affecting cardiovascular, physiological, neurocognitive, emotional, and psychosocial functioning [1]. OSA is the most common sleep disorder, affecting about 4% of men and 2% of women aged from 30 to 70 years old in the USA [2]. OSA is a chronic disease that is estimated to contribute 3 billion in additional medical costs in the USA, with a total economic burden greater than 100 billion when including loss of workplace productivity, occupational injury, and greater health care utilization [3]. In addition to its economic burden, OSA is associated with serious long-term adverse health consequences such as hypertension [4], metabolic dysfunction [5], cardiovascular disease [6], neurocognitive deficits [7], and motor vehicle accidents [8]. Nasal continuous positive airway pressure (CPAP) [9] is the treatment of choice for OSA [10], with meta-analytic reports of numerous randomized controlled trials showing that CPAP improves both objectively and subjectively measured daytime sleepiness [11] as well as health-related
Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup
Carl Stepnowsky,Tania Zamora,Robert Barker,Lin Liu,Kathleen Sarmiento
Sleep Disorders , 2013, DOI: 10.1155/2013/314589
Abstract: Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP) devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO), which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI) was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3) and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3). Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring. 1. Introduction Obstructive sleep apnea (OSA) is a chronic medical condition requiring nightly application of therapy to effectively limit the number of apneas and hypopneas that would occur without intervention. The gold-standard treatment for OSA is continuous positive airway pressure therapy (PAP), which provides a pneumatic splint of the soft tissue in the upper airway [1]. PAP devices can measure and record airflow and pressure levels whenever the device is worn. They contain internal, proprietary (i.e., differing by manufacturer) algorithms that identify breathing disturbances and whether these disturbances are due to persistent obstructive or nonobstructive events. Thus, PAP devices can provide a measure of “residual” Apnea-Hypopnea Index (AHI) and its components, the Hypopnea Index (HI) and Apnea Index (AI). Although not equivalent to the indices measured by polysomnography or home sleep testing via Type III devices, the PAP terminology is nonetheless the same. American Academy of Sleep Medicine practice parameters and clinical guidelines recommend routine monitoring of adherence and efficacy data provided by PAP devices as an indication of treatment progress [2, 3]. Because residual AHI is primarily used
Robotic Surgery in Gynecologic Oncology
Robert DeBernardo,David Starks,Nichole Barker,Amy Armstrong,Charles A. Kunos
Obstetrics and Gynecology International , 2011, DOI: 10.1155/2011/139867
Abstract: Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management. 1. Introduction Management of gynecologic cancer often involves surgery followed by radiation, chemotherapy, or a combination of both therapies. It is important for the gynecologic oncologist to consider technical aspects of surgery as it pertains to a patient’s goals for surgical intervention, planned extent of surgical removal of cancer-bearing organs and tissues, a patient’s postoperative speed of recovery, and how these relate to the timing and administration of future anticancer therapies. Techniques of minimally-invasive surgery, initially involving laparoscopy and more recently robot-assisted surgery, have emerged to address these considerations [1–3]. Early on, gynecologic oncologists found that laparoscopic surgery was associated with less surgical morbidity and shortened postoperative recovery. Robotic surgery has expanded the potential cohort of women capable of undergoing minimally-invasive surgery, now cautiously including the morbidly obese, those in poor health, and those having numerous comorbidities [4–7]. Early clinical successes of robotic surgery in the management of gynecologic cancers have prompted gynecologic oncologists to consider this procedure more often. Here, we discuss use of robotic surgery specifically for gynecologic cancer management, focusing on its applications in the management of cervical, endometrial, and ovarian cancers. 2. Technical Aspects of Robotic Surgery in Gynecologic Cancer Management Robotic surgery differs substantially from laparoscopic surgery in important ways. Conventional laparoscopy utilizes a two-dimensional camera with images projected to monitors
Identification of genes associated with regenerative success of Xenopus laevis hindlimbs
Esther J Pearl, Donna Barker, Robert C Day, Caroline W Beck
BMC Developmental Biology , 2008, DOI: 10.1186/1471-213x-8-66
Abstract: In the current study, we have taken advantage of the N1 transgenic line to directly compare morphology and gene expression in same stage regenerating vs. BMP signalling deficient non-regenerating hindlimb buds. The wound epithelium of N1 transgenic hindlimb buds, which forms over the cut surface of the limb bud after amputation, does not transition normally into the distal thickened apical epithelial cap. Instead, a basement membrane and dermis form, indicative of mature skin. Furthermore, the underlying mesenchyme remains rounded and does not expand to form a cone shaped blastema, a normal feature of successful regeneration.Using Affymetrix Gene Chip analysis, we have identified genes linked to regenerative success downstream of BMP signalling, including the BMP inhibitor Gremlin and the stress protein Hsp60 (no blastema in zebrafish). Gene Ontology analysis showed that genes involved in embryonic development and growth are significantly over-represented in regenerating early hindlimb buds and that successful regeneration in the Xenopus hindlimb correlates with the induction of stress response pathways.N1 transgenic hindlimbs, which do not regenerate, do not form an apical epithelial cap or cone shaped blastema following amputation. Comparison of gene expression in stage matched N1 vs. wild type hindlimb buds has revealed several new targets for regeneration research.While all vertebrates are capable of some types of tissue regeneration, most, including humans, have lost the ability to regenerate whole structures such as limbs (epimorphic regeneration), [1]. Amphibians, in contrast, are exceptionally good at it: adult urodeles (newts and salamanders) and larval anurans (frogs and toads) can regenerate limbs, tails, jaws, and, in some cases, even the lens of the eye [2]. Epimorphic regeneration can be thought of as occurring in two phases: wound healing and cell proliferation. Regeneration-competent wound healing of amphibian appendages is generally rapid and involv
Transcriptomic and proteomic analyses of the Aspergillus fumigatus hypoxia response using an oxygen-controlled fermenter
Bridget M Barker, Kristin Kroll, Martin V?disch, Aurélien Mazurie, Olaf Kniemeyer, Robert A Cramer
BMC Genomics , 2012, DOI: 10.1186/1471-2164-13-62
Abstract: Significant increases in transcripts associated with iron and sterol metabolism, the cell wall, the GABA shunt, and transcriptional regulators were observed in response to hypoxia. A concomitant reduction in transcripts was observed with ribosome and terpenoid backbone biosynthesis, TCA cycle, amino acid metabolism and RNA degradation. Analysis of changes in transcription factor mRNA abundance shows that hypoxia induces significant positive and negative changes that may be important for regulating the hypoxia response in this pathogenic mold. Growth in hypoxia resulted in changes in the protein levels of several glycolytic enzymes, but these changes were not always reflected by the corresponding transcriptional profiling data. However, a good correlation overall (R2 = 0.2, p < 0.05) existed between the transcriptomic and proteomics datasets for all time points. The lack of correlation between some transcript levels and their subsequent protein levels suggests another regulatory layer of the hypoxia response in A. fumigatus.Taken together, our data suggest a robust cellular response that is likely regulated both at the transcriptional and post-transcriptional level in response to hypoxia by the human pathogenic mold A. fumigatus. As with other pathogenic fungi, the induction of glycolysis and transcriptional down-regulation of the TCA cycle and oxidative phosphorylation appear to major components of the hypoxia response in this pathogenic mold. In addition, a significant induction of the transcripts involved in ergosterol biosynthesis is consistent with previous observations in the pathogenic yeasts Candida albicans and Cryptococcus neoformans indicating conservation of this response to hypoxia in pathogenic fungi. Because ergosterol biosynthesis enzymes also require iron as a co-factor, the increase in iron uptake transcripts is consistent with an increased need for iron under hypoxia. However, unlike C. albicans and C. neoformans, the GABA shunt appears to play an
Monoallelic deletion of the microRNA biogenesis gene Dgcr8 produces deficits in the development of excitatory synaptic transmission in the prefrontal cortex
Claude M Schofield, Ruby Hsu, Alison J Barker, Caitlyn C Gertz, Robert Blelloch, Erik M Ullian
Neural Development , 2011, DOI: 10.1186/1749-8104-6-11
Abstract: In this study, we show that Dgcr8+/- mice display reduced expression of a subset of microRNAs in the prefrontal cortex, a deficit that emerges over postnatal development. Layer V pyramidal neurons in the medial prefrontal cortex of Dgcr8+/- mice have altered electrical properties, decreased complexity of basal dendrites, and reduced excitatory synaptic transmission.These findings demonstrate that precise microRNA expression is critical for the postnatal development of prefrontal cortical circuitry. Similar defects in neuronal maturation resulting from microRNA deficiency could represent endophenotypes of certain neuropsychiatric diseases of developmental onset.The cerebral cortex is the region in the mammalian brain associated with higher order cognitive and sensory processing. Integral to cortical function are interconnected networks of excitatory and inhibitory neurons, whose activity and connectivity emerge and strengthen through embryonic and postnatal development. Cortical neuron development requires the coordinated expression of specific genes that shape important physiological and structural properties, including dendritic arborization and the formation of GABAergic and glutamatergic synapses. Misregulation of these developmental processes has the potential to alter neuronal function and disrupt cortical circuitry, which may produce cognitive deficits that are a hallmark of certain mental disorders, including autism and schizophrenia. Accordingly, fully understanding the total complement of biological pathways that regulate the functional development of cortical neurons is of paramount importance.microRNAs (miRNAs) are a recently described class of small (approximately 22-nucleotide) non-coding RNAs that function in a regulatory capacity. miRNAs can powerfully control gene expression by binding to complementary sequences within the 3' untranslated region of target messenger RNAs, where they lead to the suppression of translation or mRNA degradation [1,2]. miR
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