Publications by authors named "Ben Brown"

31 Publications

Frequency domain measurements of melt pool recoil force using modal analysis.

Sci Rep 2021 May 26;11(1):10959. Epub 2021 May 26.

Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN, 46556, USA.

Recoil pressure is a critical factor affecting the melt pool dynamics during Laser Powder Bed Fusion (LPBF) processes. Recoil pressure depresses the melt pool. When the recoil pressure is low, thermal conduction and capillary forces may be inadequate to provide proper fusion between layers. However, excessive recoil pressure can produce a keyhole inside the melt pool, which is associated with gas porosity. Direct recoil pressure measurements are challenging because it is localized over an area proportionate to the laser spot size producing a force in the mN range. This paper reports a vibration-based approach to quantify the recoil force exerted on a part in a commercial LPBF machine. The measured recoil force is consistent with estimates from high speed synchrotron imaging of entrained particles, and the results show that the recoil force scales with applied laser power and is inversely related to the laser scan speed. These results facilitate further studies of melt pool dynamics and have the potential to aid process development for new materials.
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http://dx.doi.org/10.1038/s41598-021-90423-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155142PMC
May 2021

Synchronous facial action binds dynamic facial features.

Sci Rep 2021 Mar 30;11(1):7191. Epub 2021 Mar 30.

School of Psychology, University Park, The University of Nottingham, Nottingham, NG7 2RD, UK.

We asked how dynamic facial features are perceptually grouped. To address this question, we varied the timing of mouth movements relative to eyebrow movements, while measuring the detectability of a small temporal misalignment between a pair of oscillating eyebrows-an eyebrow wave. We found eyebrow wave detection performance was worse for synchronous movements of the eyebrows and mouth. Subsequently, we found this effect was specific to stimuli presented to the right visual field, implicating the involvement of left lateralised visual speech areas. Adaptation has been used as a tool in low-level vision to establish the presence of separable visual channels. Adaptation to moving eyebrows and mouths with various relative timings reduced eyebrow wave detection but only when the adapting mouth and eyebrows moved asynchronously. Inverting the face led to a greater reduction in detection after adaptation particularly for asynchronous facial motion at test. We conclude that synchronous motion binds dynamic facial features whereas asynchronous motion releases them, allowing adaptation to impair eyebrow wave detection.
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http://dx.doi.org/10.1038/s41598-021-86725-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010062PMC
March 2021

Use of dried blood spot samples for SARS-CoV-2 antibody detection using the Roche Elecsys ® high throughput immunoassay.

J Clin Virol 2021 03 19;136:104739. Epub 2021 Jan 19.

Field Service, Public Health England, United Kingdom.

Dried blood spot samples (DBS) provide an alternative sample type to venous blood samples for antibody testing. DBS are used by NHS for diagnosing Hepatitis C and by Public Health England for large scale HIV and Hepatitis C serosurveillance; the applicability of DBS based approaches for SARS-CoV-2 antibody detection is uncertain. The study aimed to compare antibody detection in DBS eluates using the Roche Elecsys ® immunoassay with antibody detection in paired plasma samples, using the same assay. The study was in one Police and one Fire & Rescue facility in England; it comprised of 195 participants within a larger sample COVID-19 serodiagnostics study of keyworkers, EDSAB-HOME. Outcome measures were sensitivity and specificity of DBS (the index test) relative to plasma (the reference test), at an experimental cut-off; quality of DBS sample collected; estimates of relative sensitivity of DBS vs. plasma immunoassay in a larger population. 18/195 (9.2%) participants tested positive using plasma samples. DBS sample quality varied markedly by phlebotomist, and low sample volume significantly reduced immunoassay signals. Using an experimental cut-off, sensitivity and specificity of DBS were 89.0% (95% CI 67.2, 96.9%) and 100.0% (95% CI 97.9, 100%) respectively compared with using plasma. The limit of detection for DBS is about 30 times higher than for plasma. DBS use for SARS-CoV-2 serology, though feasible, is insensitive relative to immunoassays on plasma. Sample quality impacts on assay performance. Alternatives, including the collection of capillary blood samples, should be considered for screening programs.
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http://dx.doi.org/10.1016/j.jcv.2021.104739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817498PMC
March 2021

Absorption of Nitrogen during Pulsed Wave L-PBF of 17-4 PH Steel.

Materials (Basel) 2021 Jan 25;14(3). Epub 2021 Jan 25.

Mechanical and Aerospace Engineering Department, Missouri University of Science and Technology, Rolla, MO 65401, USA.

In the fabrication of 17-4 PH by laser powder bed fusion (L-PBF) the well-documented occurrence of large amounts of retained austenite can be attributed to an elevated concentration of nitrogen present in the material. While the effects of continuous wave (CW) laser processing on in-situ nitrogen absorption characteristics have been evaluated, power modulated pulsed wave (PW) laser processing effects have not. In this study the effects of PW L-PBF processing of 17-4 PH on nitrogen absorption, phase composition, and mechanical performance are explored using commercially available PW L-PBF equipment and compared to samples produced by CW L-PBF. PW L-PBF samples fabricated in cover gas conditions with varying amounts of nitrogen demonstrated reduced absorption levels compared to those produced by CW L-PBF with no effects on phase composition and minimal effects on mechanical performance.
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http://dx.doi.org/10.3390/ma14030560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865551PMC
January 2021

Overcoming Barriers to Radiopharmaceutical Therapy (RPT): An Overview From the NRG-NCI Working Group on Dosimetry of Radiopharmaceutical Therapy.

Int J Radiat Oncol Biol Phys 2021 03 10;109(4):905-912. Epub 2020 Dec 10.

Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland. Electronic address:

Radiopharmaceutical therapy (RPT) continues to demonstrate tremendous potential in improving the therapeutic gains in radiation therapy by specifically delivering radiation to tumors that can be well assessed in terms of dosimetry and imaging. Dosimetry in external beam radiation therapy is standard practice. This is not the case, however, in RPT. This NRG (acronym formed from the first letter of the 3 original groups: National Surgical Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group, and the Gynecologic Oncology Group)-National Cancer Institute Working Group review describes some of the challenges to improving RPT. The main priorities for advancing the field include (1) developing and adopting best practice guidelines for incorporating patient-specific dosimetry for RPT that can be used at both large clinics with substantial resources and more modest clinics that have limited resources, (2) establishing and improving strategies for introducing new radiopharmaceuticals for clinical investigation, (3) developing approaches to address the radiophobia that is associated with the administration of radioactivity for cancer therapy, and (4) solving the financial and logistical issues of expertise and training in the developing field of RPT.
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http://dx.doi.org/10.1016/j.ijrobp.2020.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399328PMC
March 2021

A data-driven characterisation of natural facial expressions when giving good and bad news.

PLoS Comput Biol 2020 10 28;16(10):e1008335. Epub 2020 Oct 28.

School of Psychology, University of Nottingham, Nottingham, United Kingdom.

Facial expressions carry key information about an individual's emotional state. Research into the perception of facial emotions typically employs static images of a small number of artificially posed expressions taken under tightly controlled experimental conditions. However, such approaches risk missing potentially important facial signals and within-person variability in expressions. The extent to which patterns of emotional variance in such images resemble more natural ambient facial expressions remains unclear. Here we advance a novel protocol for eliciting natural expressions from dynamic faces, using a dimension of emotional valence as a test case. Subjects were video recorded while delivering either positive or negative news to camera, but were not instructed to deliberately or artificially pose any specific expressions or actions. A PCA-based active appearance model was used to capture the key dimensions of facial variance across frames. Linear discriminant analysis distinguished facial change determined by the emotional valence of the message, and this also generalised across subjects. By sampling along the discriminant dimension, and back-projecting into the image space, we extracted a behaviourally interpretable dimension of emotional valence. This dimension highlighted changes commonly represented in traditional face stimuli such as variation in the internal features of the face, but also key postural changes that would typically be controlled away such as a dipping versus raising of the head posture from negative to positive valences. These results highlight the importance of natural patterns of facial behaviour in emotional expressions, and demonstrate the efficacy of using data-driven approaches to study the representation of these cues by the perceptual system. The protocol and model described here could be readily extended to other emotional and non-emotional dimensions of facial variance.
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http://dx.doi.org/10.1371/journal.pcbi.1008335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652307PMC
October 2020

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.

Lancet Public Health 2020 10 23;5(10):e543-e550. Epub 2020 Sep 23.

The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK.

Background: To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population.

Methods: We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period.

Findings: Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, -18·1 to 36·6) during this time period was not statistically significant.

Interpretation: In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health.

Funding: National Institute of Health Research.
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http://dx.doi.org/10.1016/S2468-2667(20)30201-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511209PMC
October 2020

The impact of self-selection based on HIV risk on the cost-effectiveness of preexposure prophylaxis in South Africa.

AIDS 2020 05;34(6):883-891

Health Economics and Epidemiology Research Office (HERO).

Objectives: We explored the impact and cost-effectiveness of preexposure prophylaxis (PrEP) provision to different populations in South Africa, with and without effective self-selection by individuals at highest risk of contracting HIV (through concurrent partnerships and/or commercial sex).

Design And Methods: We used a previously developed HIV transmission model to analyse the epidemiological impact of PrEP provision to adolescents, young adults, pregnant women, female sex workers (FSWs) and (MSM), and data from South African PrEP programmes to estimate the cost and cost-effectiveness of PrEP (cost in 2019 USD per HIV infection averted over 20 years, 2019, 38). PrEP uptake followed data from early implementation sites, scaled-up linearly over 3 years, with target coverage set to 18% for adolescents, young adults and pregnant women, 30% for FSW and 54% for MSM.

Results: The annual cost of PrEP provision ranges between $75 and $134 per person. PrEP provision adolescents and young adults, regardless of risk behaviour, will each avert 3.2--4.8% of HIV infections over 20 years; provision to high-risk individuals only has similar impact at lower total cost. The incremental cost per HIV infection averted is lower in high-risk vs. all-risk sub-populations within female adolescents ($507 vs. $4537), male adolescents ($2108 vs. $5637), young women ($1592 vs. $10 323) and young men ($2605 vs. $7715), becoming cost saving within 20 years for high-risk adolescents, young women, MSM and FSWs.

Conclusion: PrEP is an expensive prevention intervention but uptake by those at the highest risk of HIV infection will make it more cost-effective, and cost-saving after 14-18 years.
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http://dx.doi.org/10.1097/QAD.0000000000002486DOI Listing
May 2020

A patient-centered perspective on the future of tic disorder diagnosis: response to "Tic disorders revisited: introduction to the term 'tic spectrum disorders" by Müller-Vahl et al.

Eur Child Adolesc Psychiatry 2020 08 2;29(8):1165-1167. Epub 2019 Aug 2.

Stichting Gilles de la Tourette, TicTalk & More, Parnassia Group, Veldhoven, Netherlands.

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http://dx.doi.org/10.1007/s00787-019-01373-xDOI Listing
August 2020

MEBoost: Variable selection in the presence of measurement error.

Stat Med 2019 07 11;38(15):2705-2718. Epub 2019 Mar 11.

Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

We present a novel method for variable selection in regression models when covariates are measured with error. The iterative algorithm we propose, Measurement Error Boosting (MEBoost), follows a path defined by estimating equations that correct for covariate measurement error. We illustrate the use of MEBoost in practice by analyzing data from the Box Lunch Study, a clinical trial in nutrition where several variables are based on self-report and, hence, measured with error, where we are interested in performing model selection from a large data set to select variables that are related to the number of times a subject binge ate in the last 28 days. Furthermore, we evaluated our method and compared its performance to the recently proposed Convex Conditioned Lasso and to the "naive" Lasso, which does not correct for measurement error through a simulation study. Increasing the degree of measurement error increased prediction error and decreased the probability of accurate covariate selection, but this loss of accuracy occurred to a lesser degree when using MEBoost. Through simulations, we also make a case for the consistency of the model selected.
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http://dx.doi.org/10.1002/sim.8130DOI Listing
July 2019

'Scared of going to the clinic': Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities.

South Afr J HIV Med 2018 19;19(1):701. Epub 2018 Jan 19.

Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa.

Background: Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services.

Objective: To examine the context of access to healthcare experienced by these three 'Key Populations', we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province.

Method: We carried out in-depth interviews to explore healthcare workers' perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare.

Results: Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing Key Populations. Female SW, MSM and PWUD described their experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. Our findings suggest that the uptake and effectiveness of health services amongst Key Populations in South Africa is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers.

Conclusion: This research highlights the need to address the broader healthcare provision environment, improving alignment of policies and programming in order to strengthen provision of effective health services that people from Key Populations will be able to access.
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http://dx.doi.org/10.4102/sajhivmed.v19i1.701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843994PMC
January 2018

Attitude shifts and knowledge gains: Evaluating men who have sex with men sensitisation training for healthcare workers in the Western Cape, South Africa.

South Afr J HIV Med 2017 31;18(1):673. Epub 2017 Mar 31.

Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.

Background: Men who have sex with men (MSM) in South Africa experience discrimination from healthcare workers (HCWs), impeding health service access.

Objectives: To evaluate the outcomes of an MSM sensitisation training programme for HCWs implemented in the Western Cape province (South Africa).

Methods: A training programme was developed to equip HCWs with the knowledge, awareness and skills required to provide non-discriminatory, non-judgemental and appropriate services to MSM. Overall, 592 HCWs were trained between February 2010 and May 2012. Trainees completed self-administered pre- and post-training questionnaires assessing changes in knowledge. Two-sample -tests for proportion were used to assess changes in specific answers and the Wilcoxon rank-sum test for overall knowledge scores. Qualitative data came from anonymous post-training evaluation forms completed by all trainees, in combination with four focus group discussions ( = 28) conducted six months after their training.

Results: Fourteen per cent of trainees had received previous training to counsel clients around penile-anal intercourse, and 16% had previously received training around sexual health issues affecting MSM. There was a statistically significant improvement in overall knowledge scores (80% - 87%, < 0.0001), specifically around penile-anal intercourse, substance use and depression after the training. Reductions in negative attitudes towards MSM and increased ability for HCWs to provide non-discriminatory care were reported as a result of the training.

Conclusion: MSM sensitisation training for HCWs is an effective intervention to increase awareness on issues pertaining to MSM and how to engage around them, reduce discriminatory attitudes and enable the provision of non-judgemental and appropriate services by HCWs.
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http://dx.doi.org/10.4102/sajhivmed.v18i1.673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843261PMC
March 2017

Shared activity patterns arising at genetic susceptibility loci reveal underlying genomic and cellular architecture of human disease.

PLoS Comput Biol 2018 03 1;14(3):e1005934. Epub 2018 Mar 1.

Broad Institute of Harvard and MIT, Cambridge, United States of America.

Genetic variants underlying complex traits, including disease susceptibility, are enriched within the transcriptional regulatory elements, promoters and enhancers. There is emerging evidence that regulatory elements associated with particular traits or diseases share similar patterns of transcriptional activity. Accordingly, shared transcriptional activity (coexpression) may help prioritise loci associated with a given trait, and help to identify underlying biological processes. Using cap analysis of gene expression (CAGE) profiles of promoter- and enhancer-derived RNAs across 1824 human samples, we have analysed coexpression of RNAs originating from trait-associated regulatory regions using a novel quantitative method (network density analysis; NDA). For most traits studied, phenotype-associated variants in regulatory regions were linked to tightly-coexpressed networks that are likely to share important functional characteristics. Coexpression provides a new signal, independent of phenotype association, to enable fine mapping of causative variants. The NDA coexpression approach identifies new genetic variants associated with specific traits, including an association between the regulation of the OCT1 cation transporter and genetic variants underlying circulating cholesterol levels. NDA strongly implicates particular cell types and tissues in disease pathogenesis. For example, distinct groupings of disease-associated regulatory regions implicate two distinct biological processes in the pathogenesis of ulcerative colitis; a further two separate processes are implicated in Crohn's disease. Thus, our functional analysis of genetic predisposition to disease defines new distinct disease endotypes. We predict that patients with a preponderance of susceptibility variants in each group are likely to respond differently to pharmacological therapy. Together, these findings enable a deeper biological understanding of the causal basis of complex traits.
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http://dx.doi.org/10.1371/journal.pcbi.1005934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849332PMC
March 2018

Contexts of vulnerability and the acceptability of new biomedical HIV prevention technologies among key populations in South Africa: A qualitative study.

PLoS One 2018 8;13(2):e0191251. Epub 2018 Feb 8.

Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa.

Background: New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships.

Methods: We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers. The interview guide described pre-exposure prophylaxis (PrEP), vaginal rings, rectal microbicides and HIV vaccines, and explored acceptability and product preferences. Focus groups and in-depth interviews (45-80 minutes) were conducted in Xhosa, audiotaped, and transcribed and translated into English. Data were coded and reviewed using framework analysis with NVivo software.

Results: Overall, initial enthusiasm and willingness to use NPTs evolved into concerns about how particular NPTs might affect or require alterations in one's everyday lifestyle and practices. Different product preferences and motivations emerged by population based on similarity to existing practices and contexts of vulnerability. Adult women and female adolescents preferred a vaginal ring and HIV vaccine, motivated by longer duration of protection to mitigate feared repercussions from male partners, including threats to their marriage and safety, and a context of ubiquitous rape. Male adolescents preferred an HIV vaccine, seen as protection in serodiscordant relationships and convenient in obviating the HIV stigma and cost involved in buying condoms. Adult men preferred PrEP, given familiarity with oral medications and mistrust of injections, seen as enabling serodiscordant couples to have a child. MSM preferred a rectal microbicide given familiarity with gel-based lubricants, with concerns about duration of protection in the context of unplanned consensual sex and rape.

Conclusions: Biomedical interventions to prevent HIV transmission, rather than obviating social-structural factors that produce vulnerability, may be limited by these same factors. Implementation of NPTs should engage local communities to understand real-world constraints and strategise to deliver effective, multi-level combination prevention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191251PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805172PMC
March 2018

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data.

J Comp Eff Res 2018 05 14;7(5):483-492. Epub 2017 Nov 14.

St. Vincenz Hospital Paderborn, Department of Cardiology and Intensive Care Medicine, Am Busdorf 2, 33098 Paderborn, Germany.

Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany.

Materials & Methods: Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods.

Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection.

Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence.
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http://dx.doi.org/10.2217/cer-2017-0080DOI Listing
May 2018

Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men.

J Int Assoc Provid AIDS Care 2017 Nov/Dec;16(6):562-571. Epub 2017 Nov 6.

1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIV-prevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM.
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http://dx.doi.org/10.1177/2325957417736611DOI Listing
September 2018

Policy challenges and approaches for the conservation of mangrove forests in Southeast Asia.

Conserv Biol 2016 10 20;30(5):933-49. Epub 2016 Aug 20.

Institute for Marine Research and Observation, Ministry of Fisheries and Marine Affairs, Jalan Baru Perancak, Negara-Jembrana, Bali, 82251, Indonesia.

Many drivers of mangrove forest loss operate over large scales and are most effectively addressed by policy interventions. However, conflicting or unclear policy objectives exist at multiple tiers of government, resulting in contradictory management decisions. To address this, we considered four approaches that are being used increasingly or could be deployed in Southeast Asia to ensure sustainable livelihoods and biodiversity conservation. First, a stronger incorporation of mangroves into marine protected areas (that currently focus largely on reefs and fisheries) could resolve some policy conflicts and ensure that mangroves do not fall through a policy gap. Second, examples of community and government comanagement exist, but achieving comanagement at scale will be important in reconciling stakeholders and addressing conflicting policy objectives. Third, private-sector initiatives could protect mangroves through existing and novel mechanisms in degraded areas and areas under future threat. Finally, payments for ecosystem services (PES) hold great promise for mangrove conservation, with carbon PES schemes (known as blue carbon) attracting attention. Although barriers remain to the implementation of PES, the potential to implement them at multiple scales exists. Closing the gap between mangrove conservation policies and action is crucial to the improved protection and management of this imperiled coastal ecosystem and to the livelihoods that depend on them.
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http://dx.doi.org/10.1111/cobi.12784DOI Listing
October 2016

HIV prevalence and risk among people who inject drugs in five South African cities.

Int J Drug Policy 2016 Apr 18;30:107-15. Epub 2016 Jan 18.

United Nations Office on Drugs and Crime, Vienna, Austria.

Background: Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data.

Methods: We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire.

Results: We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p=0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p<0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p=0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p=0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p=0.019).

Conclusions: This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities.
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http://dx.doi.org/10.1016/j.drugpo.2016.01.004DOI Listing
April 2016

Diverse Hormone Response Networks in 41 Independent Drosophila Cell Lines.

G3 (Bethesda) 2016 Jan 15;6(3):683-94. Epub 2016 Jan 15.

Department of Biology, Indiana University, Bloomington, Indiana 47405

Steroid hormones induce cascades of gene activation and repression with transformative effects on cell fate . Steroid transduction plays a major role in the development and physiology of nearly all metazoan species, and in the progression of the most common forms of cancer. Despite the paramount importance of steroids in developmental and translational biology, a complete map of transcriptional response has not been developed for any hormone . In the case of 20-hydroxyecdysone (ecdysone) in Drosophila melanogaster, these trajectories range from apoptosis to immortalization. We mapped the ecdysone transduction network in a cohort of 41 cell lines, the largest such atlas yet assembled. We found that the early transcriptional response mirrors the distinctiveness of physiological origins: genes respond in restricted patterns, conditional on the expression levels of dozens of transcription factors. Only a small cohort of genes is constitutively modulated independent of initial cell state. Ecdysone-responsive genes tend to organize into directional same-stranded units, with consecutive genes induced from the same strand. Here, we identify half of the ecdysone receptor heterodimer as the primary rate-limiting step in the response, and find that initial receptor isoform levels modulate the activated cohort of target transcription factors. This atlas of steroid response reveals organizing principles of gene regulation by a model type II nuclear receptor and lays the foundation for comprehensive and predictive understanding of the ecdysone transduction network in the fruit fly.
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http://dx.doi.org/10.1534/g3.115.023366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777130PMC
January 2016

Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke.

Int J Stroke 2016 Apr 6;11(3):302-12. Epub 2016 Jan 6.

Department of Neurology and Stroke Center, University Hospital Essen, Germany

Background And Aims: Documentation of atrial fibrillation is required to initiate oral anticoagulation therapy for recurrent stroke prevention. Atrial fibrillation often goes undetected with traditional electrocardiogram monitoring techniques. We evaluated whether atrial fibrillation detection using continuous long-term monitoring with an insertable cardiac monitor is cost-effective for preventing recurrent stroke in patients with cryptogenic stroke, in comparison to the standard of care.

Methods: A lifetime Markov model was developed to estimate the cost-effectiveness of insertable cardiac monitors from a UK National Health Service perspective using data from the randomized CRYSTAL-AF trial and other published literature. We also conducted scenario analyses (CHADS2 score) and probabilistic sensitivity analyses. All costs and benefits were discounted at 3.5%.

Results: Monitoring cryptogenic stroke patients with an insertable cardiac monitor was associated with fewer recurrent strokes and increased quality-adjusted life years compared to the standard of care (7.37 vs 7.22). Stroke-related costs were reduced in insertable cardiac monitor patients, but overall costs remained higher than the standard of care (£19,631 vs £17,045). The incremental cost-effectiveness ratio was £17,175 per quality-adjusted life years gained, compared to standard of care in the base-case scenario, which is below established quality-adjusted life years willingness-to-pay thresholds. When warfarin replaced non-vitamin-K oral anticoagulants as the main anticoagulation therapy, the incremental cost-effectiveness ratio was £13,296 per quality-adjusted life years gained.

Conclusion: Insertable cardiac monitors are a cost-effective diagnostic tool for the prevention of recurrent stroke in patients with cryptogenic stroke. The cost-effectiveness results have relevance for the UK and across value-based healthcare systems that assess costs relative to outcomes.
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http://dx.doi.org/10.1177/1747493015620803DOI Listing
April 2016

Exploring repeat HIV testing among men who have sex with men in Cape Town and Port Elizabeth, South Africa.

AIDS Care 2015 19;27(2):229-34. Epub 2014 Aug 19.

a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.

Despite the high prevalence of HIV among men who have sex with men (MSM) - and the general adult population - in South Africa, there is little data regarding the extent to which MSM seek repeat testing for HIV. This study explores reported histories of HIV testing, and the rationales for test seeking, among a purposive sample of 34 MSM in two urban areas of South Africa. MSM participated in activity-based in-depth interviews that included a timeline element to facilitate discussion. Repeat HIV testing was limited among participants, with three-quarters having two or fewer lifetime HIV tests, and over one-third of the sample having one or fewer lifetime tests. For most repeat testers, the time gap between their HIV tests was greater than the one-year interval recommended by national guidelines. Analysis of the reasons for seeking HIV testing revealed several types of rationale. The reasons for a first HIV test were frequently one-time occurrences, such as a requirement prior to circumcision, or motivations likely satisfied by a single HIV test. For MSM who reported repeat testing at more timely intervals, the most common rationale was seeking test results with a sex partner. Results indicate a need to shift HIV test promotion messaging and programming for MSM in South Africa away from a one-off model to one that frames HIV testing as a repeated, routine health maintenance behavior.
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http://dx.doi.org/10.1080/09540121.2014.947914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286446PMC
April 2015

Epidemiology of HIV-1 subtypes among men who have sex with men in Cape Town, South Africa.

J Acquir Immune Defic Syndr 2014 Apr;65(4):473-80

*Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and †Department of Medicine, University of Cape Town, Cape Town, South Africa; ‡Division of Medical Virology and §Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; ‖Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; ¶Center for Learning and Innovation, San Francisco Department of Public Health, San Francisco, CA; #University of California, San Francisco; and **National Health Laboratory Services, Cape Town, South Africa.

Objective: Early studies in Cape Town identified independent HIV-1 epidemics, with distinct viral subtypes, among men who have sex with men (MSM) and the heterosexual population. However, few recent HIV-1 subtype data are available for MSM in South Africa. We examined HIV-1 subtypes among MSM in Cape Town.

Design: Cross-sectional survey.

Methods: Self-identified MSM were recruited from geographically and racially disparate communities across Cape Town. Participants completed behavioral questionnaires and underwent HIV testing. Virus isolated from infected participants underwent complete env gp160 sequencing, and HIV-1 subtypes were assigned through phylogenetic analysis.

Results: In total, 194 HIV-infected MSM were enrolled: 67% black African, 24% colored, and 9% white men. More black African men identified as bisexual or heterosexual compared with other races. Overall, 31%-66% of men reported a recent partner of another race. HIV-1 subtypes were confirmed for 143 participants: 81% were subtype C, 14% B, 1% A1, 1% F2, and 3 recombinant viruses. Subtype C virus was associated with black African race (P = 0.003 compared with colored; P < 0.001 compared with white), men who identified as bisexual/heterosexual (P = 0.01), and reported a female sexual partner in the last year (P = 0.02). Compared with previous studies, an increasing prevalence of subtype C virus was noted among white MSM.

Conclusions: This molecular epidemiology study provides novel evidence of sexual network links between the heterosexual and MSM epidemics and between historically racially disparate communities. These findings provide insights into the drivers of HIV epidemics in different population groups and may have implications for prevention strategies.
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http://dx.doi.org/10.1097/QAI.0000000000000067DOI Listing
April 2014

HIV risk and associations of HIV infection among men who have sex with men in peri-urban Cape Town, South Africa.

BMC Public Health 2011 Oct 5;11:766. Epub 2011 Oct 5.

Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.

Background: The HIV epidemic in Sub Saharan Africa has been traditionally assumed to be driven by high risk heterosexual and vertical transmission. However, there is an increasing body of data highlighting the disproportionate burden of HIV infection among MSM in the generalized HIV epidemics across of Southern Africa. In South Africa specifically, there has been an increase in attention focused on the risk status and preventive needs of MSM both in urban centers and peri-urban townships. The study presented here represents the first evaluation of HIV prevalence and associations of HIV infection among MSM in the peri-urban townships of Cape Town.

Methods: The study consisted of an anonymous probe of 200 men, reporting ever having had sex with another man, recruited through venue-base sampling from January to February, 2009.

Results: Overall, HIV prevalence was 25.5% (n = 51/200). Of these prevalent HIV infections, only 6% of HIV-1 infected MSM were aware of their HIV status (3/50). 0% of men reported always having safe sex as defined by always wearing condoms during sex and using water-based lubricants. Independent associations with HIV infection included inconsistent condom use with male partners (aOR 2.3, 95% CI 1.0-5.4), having been blackmailed (aOR 4.4, 95% CI 1.6-20.2), age over 26 years (aOR 4.2, 95% CI 1.6-10.6), being unemployed (aOR 3.7, 95% CI 1.5-9.3), and rural origin (aOR 6.0, 95% CI 2.2-16.7). Bisexual activity was reported by 17.1% (34/199), and a total of 8% (16/200) reported having a regular female partner. Human rights violations were common with 10.5% (n = 21/200) reporting having been blackmailed and 21.0% (n = 42/200) reporting being afraid to seek health care.

Conclusions: The conclusions from this study include that a there is a high risk and underserved population of MSM in the townships surrounding Cape Town. The high HIV prevalence and high risk sexual practices suggest that prevalence will continue to increase among these men in the context of an otherwise slowing epidemic. These data further highlight the need to better characterize risk factors for HIV prevention and appropriate targeted combination packages of HIV interventions including biomedical, behavioural, and structural approaches to mitigate HIV risk among these men.
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http://dx.doi.org/10.1186/1471-2458-11-766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196714PMC
October 2011

Cost-effectiveness of cardiac resynchronization therapy in patients with asymptomatic to mild heart failure: insights from the European cohort of the REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular Dysfunction).

Eur Heart J 2011 Jul 25;32(13):1631-9. Epub 2010 Nov 25.

Department of Cardiology, Karolina University Hospital, Stockholm, Sweden.

Aims: To assess the cost-effectiveness of cardiac resynchronization therapy (CRT) compared with optimal medical therapy in patients with New York Heart Association (NYHA) II heart failure (HF) or NYHA I with previous HF symptoms.

Methods And Results: A proportion in state model with Monte Carlo simulation was developed to assess the costs, life years and quality-adjusted life year (QALYs) associated with CRT-ON and -OFF over a 10 year time period. Data from 262 patients in the European cohort of the REVERSE clinical trial (QRS ≥ 120 ms, left ventricular ejection fraction ≤ 40%, CRT-ON, n = 180, CRT-OFF, n = 82) were used to model all-cause mortality, change in NYHA class and resource use. EQ-5D preference weights were taken from a previous cost-effectiveness model of CRT and unit costs from national UK databases. Costs and benefits were discounted at 3.5% p.a. Extensive deterministic and probabilistic sensitivity analyses were performed. Compared with CRT-OFF, 0.94 life years or 0.80 QALYs were gained in the CRT ON group at an additional cost of €11 455, yielding an incremental cost-effectiveness ratio of €14.278 per quality-adjusted life year (QALY) gained. At a threshold of €33 000 (£30 000) per QALY gained, the probability that CRT is cost-effective is 79.6%. Cardiac resynchronization therapy becomes cost effective after ∼4.5 years. Cardiac resynchronization therapy needs only to demonstrate a modest impact on all cause mortality (hazard ratio = 0.82) in order to demonstrate cost-effectiveness. The results are robust to changes in all other parameters.

Conclusion: Cardiac resynchronization therapy is a cost-effective intervention for patients with mildly symptomatic HF and for asymptomatic patients with left ventricular dysfunction and previous HF symptoms.
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http://dx.doi.org/10.1093/eurheartj/ehq408DOI Listing
July 2011

A comparison between monophasic and biphasic defibrillation for the cardioversion of persistent atrial fibrillation in patients with and without heart failure.

Int J Cardiol 2011 Mar 25;147(3):405-8. Epub 2009 Oct 25.

Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull HU16 5JQ, United Kingdom.

Aims: Atrial fibrillation (AF) and heart failure commonly coexist. Restoring sinus rhythm using external direct current cardioversion (DCCV) may improve left ventricular function, exercise capacity and quality of life (QoL). However, DCCV may be less successful at restoring sinus rhythm in patients with heart failure. We aimed to determine whether biphasic DCCV was superior to monophasic DCCV for the restoration of sinus rhythm in patients with heart failure.

Methods: 592 consecutive cardioversion procedures were performed on 503 patients for persistent AF, 261 (44%) procedures using monophasic defibrillation and 331 (56%) using biphasic. Patients with symptomatic heart failure were identified for further analysis.

Results: 173 cardioversions were performed on 149 patients with heart failure. The overall success rate of cardioversion in this group was 82.7% (83.3% and 82.2% for monophasic and biphasic respectively). There was no difference in the success rate of cardioversion for those with heart failure compared to those without heart failure (p = 0.141). Furthermore, there was no substantial difference in success rates according to defibrillation type (83.3% v. 84.2% for monophasic and 82.2% v. 88.5% for biphasic, p = 0.502 and 0.085 respectively).

Conclusion: External defibrillation is similarly effective at restoring SR in patients with and without HF and both mono- and biphasic shocks have a high rate of success. However, significantly less energy (maximal and cumulative) is required to restore SR using biphasic defibrillation.
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http://dx.doi.org/10.1016/j.ijcard.2009.09.545DOI Listing
March 2011

Assessing the anomalous research on Hispanic victimization: a methodological critique of a victimological enigma.

Authors:
Ben Brown

J Interpers Violence 2009 Dec 24;24(12):1931-63. Epub 2008 Dec 24.

University of Texas at Brownsville, TX 78520, USA.

This article provides an overview and critique of the research on Hispanic victimization. Analyses of data gathered prior to the mid- to late 1990s consistently show Hispanics were victimized at disproportionately high rates, but numerous recent studies indicate Hispanics were not victimized at disproportionately high rates. Given that research has consistently shown victimization rates are highest among the poor and that Hispanics are a disproportionately impoverished demographic, the findings that Hispanics were not victimized at disproportionately high rates are enigmatic. It is suggested that social changes in the United States-specifically, the increase in the portion of the Hispanic population composed of immigrants and the development of Latin American enclaves-have reduced the efficacy of conventional methodological tactics and that the recent findings on Hispanic victimization were affected by the inadequate representation of disadvantaged Hispanics (especially immigrants and migrants) in survey studies and the reluctance of Hispanic immigrants to report crimes to the police. Finally, it is argued that the practice of conducting analyses of ethnic variation in victimization wherein all non-Hispanics (Asians, Blacks, Native Americans, and Whites) are amalgamated into a single category and compared with Hispanics has generated misleading results.
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http://dx.doi.org/10.1177/0886260508327701DOI Listing
December 2009

Speech recognition 2008.

Healthc Q 2008 ;11(4):99-101, 4

KLAS, Orem, Utah, USA.

Annual hospital patient visits in the United States number almost 300 million, with outpatient visits approaching one billion. While patient visits are growing at a compounding rate of 3% per year, the requirements for documentation are increasing disproportionately to that growth due to heightened regulations and the desire for greater transparency in preparation for pay for performance. Currently, dictation and transcription are the primary means of documenting these visits and populating the patient record with the relevant information. In recent years, healthcare provider organizations have reported dramatic benefits in workflow efficiency and cost-savings by adopting speech recognition technology. The KLAS study reviewed speech recognition systems in an effort to determine the state of the solutions, vendor scoring, physician usage and quantifiable benefits.
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January 2009

Community picture archiving and communications systems: burgeoning market.

Healthc Q 2008 ;11(2):112-5, 4

KLAS, Orem, Utah, USA.

Choosing a PACS is tougher than it used to be. More and more vendors are offering solutions in the smaller hospital space, and analyzing the sheer number of vendors, the various technology choices and breadth of product offerings is challenging. However, even the smallest healthcare organizations are documenting the return on investment from reduction in film and film storage costs, reduction in lost films, and an increase in radiologist and physician satisfaction and productivity. The bottom line - there should be a PACS solution that can meet most organizations' needs and pocketbook.
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September 2008

An economic evaluation of cetuximab combined with radiotherapy for patients with locally advanced head and neck cancer in Belgium, France, Italy, Switzerland, and the United Kingdom.

Value Health 2008 Sep-Oct;11(5):791-9. Epub 2008 Jan 11.

IMS Health, London, UK.

Objectives: A phase III randomized trial that compared the combination of cetuximab and radiotherapy to radiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck provided a platform for a comprehensive economic evaluation. The study was conducted to estimate the cost-effectiveness of cetuximab in combination with radiotherapy compared to radiotherapy alone, for the treatment of locally advanced head and neck cancer in patients for whom chemoradiotherapy is inappropriate or intolerable.

Methods: Separate economic analyses were conducted for Belgium, France, Italy, Switzerland, and the United Kingdom. The economic model was based on individual patient data extracted from an international phase III trial. Country-specific costs of care from official sources were applied in each analysis. Clinical expert panels supplemented resource use estimates from the phase III trial and validated assumptions used to extrapolate costs and health outcomes beyond the follow-up of the phase III trial.

Results: In the base-case analysis, the incremental cost per quality-adjusted life-year for patients receiving radiotherapy in combination with cetuximab compared to radiotherapy alone among all countries was in the range of 7538 euros to 10,836 euros. Sensitivity analysis showed the results to be robust.

Conclusion: This cost-effectiveness analysis indicated that the addition of cetuximab to high-dose radiotherapy offers a good value-for-money alternative to radiotherapy alone in the treatment of locally advanced head and neck cancer in five European countries.
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http://dx.doi.org/10.1111/j.1524-4733.2007.00302.xDOI Listing
July 2009

Abnormal function and glucose metabolism in the type-2 diabetic db/db mouse heart.

Can J Physiol Pharmacol 2007 Mar-Apr;85(3-4):289-94

University Laboratory of Physiology, Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Rd, OX1 3PT, Oxford, England.

This study examined cardiac function and glucose metabolism in the 6-month-old db/db mouse, a model of type-2 diabetes. Cine magnetic resonance spectroscopy (MRI) was used to measure cardiac function in vivo. The db/db mice had decreased heart rates (17%, p<0.01) and stroke volumes (21%, p<0.05) that resulted in lower cardiac output (35%, p<0.01) than controls. Although there was no difference in ejection fraction between the 2 groups, db/db mouse hearts had a 35% lower maximum rate of ejection (p<0.01) than controls. In a protocol designed to assess maximal insulin-independent glucose uptake, hearts were isolated and perfused in Langendorff mode and subjected to 0.75 mL.min(-1).(g wet mass)(-1) low flow ischemia for 32 min. Glucose uptake during ischemia was 21% lower than in controls, and post-ischemic recovery of cardiac function was decreased by 30% in db/db mouse hearts (p<0.05). Total cardiac GLUT 4 protein was 56% lower (p<0.01) in db/db mice than in controls. In summary, the db/db mouse has abnormal left ventricular function in vivo, with impaired glucose uptake during ischemia, leading to increased myocardial damage.
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http://dx.doi.org/10.1139/y07-028DOI Listing
October 2007
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