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Calcineurin inhibitor sparing strategies in renal transplantation, part one: Late sparing strategies

World Journal of Transplantation 2014年第2期4卷 57-80页

作者： Andrew Scott Mathis gwen Egloff Hoytin Lee Ghin Pharmacy Department Monmouth Medical CenterLong BranchNJ 07740United States School of Pharmacy University of ConnecticutStorrsCT 06268United States

Kidney transplantation improves quality of life and reduces the risk of mortality. A majority of the success of kidney transplantation is attributable to the calcineurin inhibitors(CNIs), cyclosporine and tacrolimus, and their ability to reduce acute rejection rates. However, longterm graft survival rates have not improved over time, and although controversial, evidence does suggest a role of chronic CNI toxicity in this failure to improve outcomes. Consequently, there is interest in reducing or removing CNIs from immunosuppressive regimens in an attempt to improve outcomes. Several strategies exist to spare calcineurin inhibitors, including use of agents such as mycophenolate mofetil(MMF), mycophenolate sodium(MPS), sirolimus, everolimus or belatacept to facilitate late calcineurin inhibitor withdrawal, beyond 6 mo post-transplant; or using these agents to plan early withdrawal within 6 mo; or to avoid the CNIs all together using CNI-free regimens. Although numerous reviews have been written on this topic, practice varies significantly between centers. This review organizes thedata based on patient characteristics(i.e., the baseline immunosuppressive regimen) as a means to aid the practicing clinician in caring for their patients, by matching up their situation with the relevant literature. The current review, the first in a series of two, examines the potential of immunosuppressive agents to facilitate late CNI withdrawal beyond 6 mo post-transplant, and has demonstrated that the strongest evidence resides with MMF/MPS. MMF or MPS can be successfully introduced/maintained to facilitate late CNI withdrawal and improve renal function in the setting of graft deterioration, albeit with an increased risk of acute rejection and infection. Additional benefits may include improved blood pressure, lipid profile and serum *** has less data directly comparing CNI withdrawal to an active CNI-containing regimen, but modest improvement in short-term renal function

关键词： Kidney transplantation Calcineurin inhibitor Withdrawal Sparing Cyclosporine Tacrolimus Renal function Graft survival

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Developing speech and language skills :

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2008年

作者： gwen Lancaster.

Includes bibliographical references (p. 160-164) and index.

ISBN: (纸本)9781843123828;1843123827

Includes bibliographical references (p. 160-164) and index.

关键词： Speech therapy for children. Language disorders in children. Children with disabilities

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Family responsibility dynamics for young adults in transition to adult health care

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Journal of Diabetes Mellitus 2013年第3期3卷 139-144页

作者： Pat Rapley gwen Babel Joey Kaye Suzanne Brown Adjunct Senior Lecturer Curtin University and Centre for Nursing Research Sir Charles Gairdner Hospital Perth Australia Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia

Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28;YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.

关键词： Diabetes Health-Care Transition Parent Adolescent Transition Coordinator

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Healthcare-transition risk assessment for emerging adults with diabetes type 1

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Journal of Diabetes Mellitus 2013年第2期3卷 62-70页

作者： Joey Kaye Pat Rapley gwen Babel Suzanne Brown Adjunct Senior Lecturer Curtin University Centre for Nursing Research Innovation and Quality Sir Charles Gairdner Hospital Perth Western Australia Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Western Australia

AIM: To identify potential risk indicators for emerging adults transitioning to adult health care. BACKGROUND: Without maturity, independence, knowledge and motivation to manage their diabetes and successfully transition to adult healthcare, a proportion of emerging adults will struggle, leaving themselves vulnerable to diabetes-related complications. METHODS: Fifty-three emerging adults (aged 17 - 19 years) recently transitioned from pediatric to adult healthcare were recruited. Data included demographic, glycated haemoglobin, Body Mass Index, base-line and 12-month data from four psychosocial measures: Problem Areas in Diabetes, Diabetes Empowerment Scale, Hospital Anxiety and Depression Scale and dichotomous questions from the Eating Attitude Test. Missed appointments were obtained from hospital records. RESULTS: No significant differences in age, gender, BMI and individual survey scales between three appointment groups. Median HbA1c in the Sat-1 group was 7% (53 mmol/mol), compared with 8.6% (70 mmol/mol) and 8.5% (69 mmol/mol) respectively in the Sat-2 and Unsatisfactory groups. A ROC curve analysis and classification tree analysis identified optimal threshold values for the survey scales and their linear combinations. These values were used to make comparisons across two appointment and three HbA1c status groups. The unsatisfactory appointment group was characterised by statistically higher proportions of participants with (1) a low score for empowerment alone or in combination (less) with perceived problems and (2) statistically higher perceived problems and anxiety scores. CONCLUSIONS: Findings suggest that diabetes self-care confidence, less perception of diabetes as a problem, could be a useful indicator of future appointment attendance. Similarly, depression levels could be a useful predictor of better metabolic control following transition. RELEVANCE TO CLINICAL PRACTICE: This study offers an innovative use of existing metrics to identify at-risk emergin

关键词： Diabetes Healthcare Transition Emerging Adults Risk Assessment

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ROADM网络的开通和测试

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电信科学 2008年第12期24卷 6-10页

作者： gwen Amice Bruno Giguère EXFO公司

1引言与任何其他网络一样,ROADM网络测试要求涵盖光纤、光性能和最终传输服务3个方面。网元（NE）如此,完整的端到端网络也不例外。

关键词： ROADM 测试要求网络传输服务光性能端到端光纤网元

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Review: Effects of Dietary Fiber Levels and Composition on the Intestinal Health of Finishing Pigs

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Open Journal of Animal Sciences 2021年第3期11卷 384-398页

作者： gwen Mozamane Tiishetso Maswanganye Bo Liu Dongsheng Che Rui Han Animal Science and Technology Jilin Agricultural University Changchun China

Despite the fact that dietary fiber is predominant in common feedstuff, its level in the diets of monogastrics has seen a proportional increment with the inclusion of co-products. The source and composition of DF could be liable for enormous varieties in their use. A study carried out by scientists proposed that three major components constitute gut health: the diet, the mucosa, and the commensal microbiota. 70% of total body immune cells constitute the gastrointestinal tract of pigs, therefore it is important that it is included when defining intestinal health. Gut health is of substantial importance in the maintenance of growth performance and overall health of monogastrics. The fermentation of DF results in SCFA which enhances mucosal epithelial proliferation and villus height. Nonetheless, supplementing dietary fiber to the diet in moderation may result in an increase in gut size, volume, length and morphological structure of pigs and other non-ruminants. Gut health maintenance exhibits a certain level of complexity and a subtle balance between mucosa, diet, the commensal microflora, including the digestive epithelium and along with mucous overlaying it. The microbial changes of dietary fiber to monosaccharides in the gut include various principal occasions (reactions) intervened by the enzymatic collection of particularized groups from the gut microbiota. Because fermentation is dependent upon source, structure and physio-chemical properties of dietary fiber, it is therefore of great importance to have as much data as possible on various types of dietary fiber and how intestinal health can be enhanced by them. Thus, there is growing evidence that dietary fiber may have prebiotic effects in pigs. In addition, dietary fiber in diets improves pigs well-being by increasing satiety, influencing behaviour and improving overall health. This review aims to shed more light on the dietary

关键词： Intestinal Health Dietary Fiber Fermentation Gut Microbiota Immunity

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川芎嗪对缺氧大鼠和雪貂肺血管的舒张作用

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中国应用生理学杂志 1990年第1期6卷 19-22页

作者：蔡英年 gwen Barer 中国医学科学院基础医学研究所 Department of Medicine University of Sheffield UK.

用大鼠在体肺灌流和雪貂左下肺叶活体灌流方法比较了川芎嗪对缺氧、血管紧张素Ⅱ、高钾、almitrine等所致肺血管收缩的舒张效应。实验结果表明,川芎嗪能使缺氧引起的收缩肺血管明显舒张,此效应可能不通过血管紧张素系统。对高钾引起的... 详细信息

用大鼠在体肺灌流和雪貂左下肺叶活体灌流方法比较了川芎嗪对缺氧、血管紧张素Ⅱ、高钾、almitrine等所致肺血管收缩的舒张效应。实验结果表明,川芎嗪能使缺氧引起的收缩肺血管明显舒张,此效应可能不通过血管紧张素系统。对高钾引起的肺血管收缩,川芎嗪的抑制作用明显小于异搏定。川芎嗪对肺血管的舒张效应表明缺氧和almitrine对肺血管的作用相近。在急性缺氧情况下,川芎嗪对肺血管的舒张作用比对体血管强,这一点对缺氧性肺动脉高压的防治是很有用的。

关键词：川芎嗪缺氧性肺血管收缩鼠雪貂

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A Critical Examination of the Relationship between Wildfires and Climate Change with Consideration of the Human Impact

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Journal of Environmental Protection 2018年第5期9卷 461-467页

作者： Nadin Boegelsack Jonathan Withey gwen O’Sullivan Dena McMartin Faculty of Engineering and Applied Sciences University of Regina Regina SK Canada Faculty of Science and Technology Mount Royal University Calgary AB Canada

The relationship between climate change and wildfires was examined to summarize factors associated with vulnerability to wildfires. The complex and cyclic nature of interaction effects between the two was highlighted and the following conclusions were drawn. Climate change is leading to more frequent wildfires with higher intensity, resulting in release of more gasses and particulate matter that further exacerbates the progression of climate change. Direct and indirect impacts are detailed in the main body. A new fire management policy is deemed necessary, with a more local approach being recommended. Human impacts were found to further complicate the already complex relationship. It is recommended to treat accidental and incendiary fires separately for the purpose of evaluating fire management regimes. This requires successful advances in current fire investigation techniques.

关键词： Wildfire Carbon Emission Climate Change Fire Management

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Simulation Is Not a Pedagogy

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Open Journal of Nursing 2017年第7期7卷 779-787页

作者： gwen D. Erlam Liz Smythe Valerie Wright-St Clair Department of Health and Environmental Sciences Auckland University of Technology (AUT) Auckland New Zealand

Simulation as a teaching/learning tool has evolved at an unprecedented pace which some believe has occurred despite a lack of research into pedagogies appropriate to guide this technology-based learning tool. There seems to be some confusion as to what simulation actually is. Some have called simulation a pedagogy, which is incorrect. Simulation is not a pedagogy, but an immersive teaching/learning platform which is a representation of a functioning system or process. Simulation has been used in undergraduate nursing education in a focused manner for nearly 20 years. Its effectiveness in improving clinical reasoning and critical thinking is not certain if overall instructional design principles do not reflect suitable philosophical paradigms. Simulation as a teaching/learning platform is maximized when instructional design includes the inspiration of behaviorism, cognitivism, and constructivism. Behaviorist design principles include rote learning, repetition, modular learning, stimulus-response, and conditioning. Cognitivist design principles include observational techniques, bootstrapping, and equilibration in the form of assimilation and accommodation. Constructivist design principles include new habit formation through experience and interaction with a “mature social medium” in the form of a simulation facilitator. All of these philosophical underpinnings have the potential to maximize simulation when used as underpinnings in the overall design.

关键词： Simulation Undergraduate Nursing Education Behaviorist Cognitivist Constructivist

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手术后患者疼痛控制满意度状况及影响因素的研究

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中华护理杂志 2007年第3期42卷 197-202页

作者：沈曲李峥 gwen Sherwood Jeanette A.McNeill 厦门大学医学院护理系厦门市361005 中国协和医科大学护理学院北京市100730 美国北卡罗莱纳大学护理学院美国因卡奈特.伍德大学

目的描述手术后患者对疼痛控制的满意度状况,探讨影响疼痛控制满意度的因素。方法采用多阶段抽样方法,随机抽取北京地区5家综合性三级甲等医院,对符合入选标准的304例手术后第2天的住院疼痛患者进行了调查,问卷由休斯顿疼痛情况调查表... 详细信息

目的描述手术后患者对疼痛控制的满意度状况,探讨影响疼痛控制满意度的因素。方法采用多阶段抽样方法,随机抽取北京地区5家综合性三级甲等医院,对符合入选标准的304例手术后第2天的住院疼痛患者进行了调查,问卷由休斯顿疼痛情况调查表、疼痛治疗指数和病历资料核查表3个部分组成。结果术后患者对疼痛控制总体满意度平均评分为7.3。疼痛控制教育、医生对疼痛的处理、疼痛减轻、患者受到的所有针对疼痛的照料、医生或护士是否告诉患者要优先有效地控制疼痛以及手术次数共6个因素进入回归方程,是影响疼痛控制满意度的主要因素。结论患者对术后疼痛控制较为满意;疼痛控制服务因素是影响手术后患者疼痛控制满意度的主要因素。建议制订术后疼痛控制制度和标准,采取针对性措施,改善术后疼痛控制质量,提高术后患者对疼痛控制的满意度。

关键词：疼痛,手术后疼痛控制病人满意度

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