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Gross I.,Eastern Maine Medical Center | Shander A.,Englewood Hospital and Medical Center | Shander A.,Mount Sinai School of Medicine | Sweeney J.,Roger Williams Hospital | Sweeney J.,Brown University
Best Practice and Research: Clinical Anaesthesiology | Year: 2013

Patient blood management (PBM) seeks to improve the clinical outcomes of patients through the application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss. Hence, assessment of the outcomes of patients is essential in evaluating the success of PBM programmes. Clinical outcomes measure the meaningful impact of interventions on patients in terms of living longer or healthier or experiencing fewer complications. The assessment of these outcomes can often be complicated and laborious and, therefore, alternative approaches are sometimes explored. Use of surrogate endpoints such as transfusion rates or volume and haemoglobin level, and creating composite outcomes (to achieve higher frequency for relatively rare clinical events such as mortality and major morbidity) are among the common strategies but their use and interpretation have limitations and need careful consideration. Creating registries of patients managed under PBM can be an effective and feasible approach to provide safety and effectiveness data on various clinical outcomes. While outcome data on PBM programmes are limited, the emerging studies support that PBM can be effective in reducing transfusion and, more importantly, improving the outcomes of the patients. Continued and further research in this field is imperative. © 2012 Elsevier Ltd. All rights reserved. Source


Bond D.S.,The Miriam Hospital | Vithiananthan S.,The Miriam Hospital | Thomas J.G.,The Miriam Hospital | Trautvetter J.,The Miriam Hospital | And 7 more authors.
Surgery for Obesity and Related Diseases | Year: 2015

Background Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however, objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. The objective of this study was to test the efficacy of a preoperative PA intervention (PAI) versus standard presurgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Methods Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; body mass index [BMI] = 45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n = 40) or SC (n = 35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to postintervention change in daily bout-related (≥10 min bouts) and total (≥1 min bouts) MVPA minutes, was assessed objectively via a multisensor monitor worn for 7 days at baseline- and postintervention. Results Retention was 84% at the postintervention primary endpoint. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 min/d in bout-related MVPA (baseline: 4.4±5.5 to postintervention: 21.0±21.4 min/d) compared to no change (-0.3±12.7 min/d; baseline: 7.9±16.6 to postintervention: 7.6±11.5 min/d) for SC (P =.001). Similarly, PAI achieved a mean increase of 21.0±26.9 min/d in total MVPA (baseline: 30.9±21.2 to postintervention: 51.9±30.0 min/d), whereas SC demonstrated no change (-0.1±16.3 min/d; baseline: 33.7±33.2 to postintervention: 33.6±28.5 minutes/d) (P =.001). Conclusion With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes. © 2015 American Society for Bariatric Surgery. Source


Bond D.S.,The Miriam Hospital | Jakicic J.M.,University of Pittsburgh | Unick J.L.,The Miriam Hospital | Vithiananthan S.,The Miriam Hospital | And 5 more authors.
Obesity | Year: 2010

Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2± 9.8 years, 88% female, pre-op BMI = 50.8 9.7kg/m 2) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (1-min and 10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ±80.8 to 212.3± 212.4min/week; P< 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both 1-min (186.0 ±169.0 to 151.2 118.3min/week) and 10-min (41.3 ±109.3 to 39.8 71.3min/week) bouts. At pre-op, the percentage of participants who accumulated 150-min/week of MVPA in bouts 10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes. © 2010 The Obesity Society. Source


Unick J.L.,The Miriam Hospital | Bond D.S.,The Miriam Hospital | Jakicic J.M.,University of Pittsburgh | Vithiananthan S.,The Miriam Hospital | And 5 more authors.
Obesity Surgery | Year: 2012

Background: Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by different monitors are comparable and can be interpreted similarly across studies. Methods: We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro 2 Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≤4 days of ≤8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5-2.9 METs), moderate-to-vigorous (MVPA; ≤3.0 METs), and total PA (TPA; ≤1.5 METs) according to each monitor was compared. Results: Fifty-five participants (BMI 48.4±8.2 kg/m 2) met wear time requirements. Daily time spent in sedentary (RT3 582.9±94.3; SWA 602.3±128.6 min), light (RT3 131.9±60.0; SWA 120.6±65.7 min), MVPA (RT3 25.9±20.9; SWA 29.9±19.5 min), and TPA (RT3 157.8±74.5; SWA 150.6±80.7 min) was similar between monitors (p∈>∈0.05). While the average difference in TPA between the two monitors at the group level was 7.2±64.2 min; the average difference between the two monitors for each participant was 45.6±45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level. Conclusions: Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used. © 2011 Springer Science + Business Media, LLC. Source


The present invention relates to compositions and methods for creation of vector nucleic acid sequences (e.g., retroviral nucleic acid sequences) that comprise two or more exogenous nucleic acid sequences that encode highly homologous (e.g., identical) polypeptide sequences, yet wherein at least one of the exogenous nucleic acid sequences has been mutated using degenerate codons for purpose of reducing homology between the two or more exogenous nucleic acid sequences while maintaining the encoded polypeptide sequence. Preferred nucleic acid sequences include those encoding multi-chimeric immune receptor (CIR) genes. Specific nucleic acid sequences of such CIR genes are also disclosed.

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