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Hoffmann S.,U.S. Department of Agriculture | Hald T.,Technical University of Denmark | Angulo F.,Centers for Disease Control and Prevention | Hamzah W.M.B.,Malaysian Ministry of Health | And 13 more authors.
Risk Analysis | Year: 2016

We live in an age that increasingly calls for national or regional management of global risks. This article discusses the contributions that expert elicitation can bring to efforts to manage global risks and identifies challenges faced in conducting expert elicitation at this scale. In doing so it draws on lessons learned from conducting an expert elicitation as part of the World Health Organizations (WHO) initiative to estimate the global burden of foodborne disease; a study commissioned by the Foodborne Disease Epidemiology Reference Group (FERG). Expert elicitation is designed to fill gaps in data and research using structured, transparent methods. Such gaps are a significant challenge for global risk modeling. Experience with the WHO FERG expert elicitation shows that it is feasible to conduct an expert elicitation at a global scale, but that challenges do arise, including: defining an informative, yet feasible geographical structure for the elicitation; defining what constitutes expertise in a global setting; structuring international, multidisciplinary expert panels; and managing demands on experts' time in the elicitation. This article was written as part of a workshop, "Methods for Research Synthesis: A Cross-Disciplinary Approach" held at the Harvard Center for Risk Analysis on October 13, 2013. © 2016 Society for Risk Analysis.

Mojtahedzadeh M.,Teheran University of Medical science | Jafarieh A.,Teheran University of Medical science | Najafi A.,Teheran University of Medical science | Khajavi M.R.,Teheran University of Medical science | Khalili N.,Farzan Clinical Research Institute
Endokrynologia Polska | Year: 2012

Introduction: It is accepted that preventing hyperglycaemia during critical illness while assuring adequate caloric intake can reduce mortality and morbidity. The aim of this study was to compare the metabolic effects of metformin and insulin on hyperglycaemia in ICU patients. Methods: This double-blind randomised clinical trial was performed on 24 patients who were admitted to the intensive care unit (ICU) from 20 March to 20 September 2007. All patients with serious injuries or with major non-abdominal surgeries were included if they met the inclusion criteria, and were assigned randomly to one of the study groups. Patients in Group 1 received intensive insulin therapy, and patients in Group 2 were treated with metformin. Moreover, the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system was used to grade disease severity. Results: Both glycaemic management protocols led to significantly improved glucose levels without any report of hypoglycaemia. The mean initial glucose levels for the insulin group decreased significantly after the intravenous infusion of insulin (p < 0.001). Additionally, the blood glucose concentration was significantly lower after two weeks of metformin administration compared to baseline measurements (p < 0.001). Moreover, the blood glucose concentration decrease during these two weeks was significantly higher in the insulin group (p = 0.01). Besides, APACHE II score was lower than baseline at the end of the study for both therapeutic groups (score of 10 vs. 15 [insulin] and 16 [metformin]). Finally, new renal dysfunction (maximum serum creatinine level at least double the initial value) was observed in three of the patients (two patients from the metformin group and one from the insulin group) in the last days of the protocol, although none of the patients showed lactic acidosis after ICU admission. Conclusions: Both metformin and intensive insulin therapy significantly decreased hyperglycaemia in ICU patients. Insulin caused a greater reduction in blood glucose concentration but required more attention and trained personnel.

Ghanaati H.,Teheran University of Medical science | Motevalli M.,Iran University of Medical science | Jalali A.H.,Teheran University of Medical science | Firouznia K.,Teheran University of Medical science
Neuroradiology Journal | Year: 2010

A 30-year-old woman with pulsating exophthalmia due to posttraumatic carotid-cavernous fistula underwent embolization with a detachable balloon. Because of balloon dislodgement, the drainage was derived to the superior ophthalmic vein and clinical worsening occurred. Complete ophthalmoplegia developed and visual acuity decreased. After a second embolization we inserted two balloons but the same findings were exaggerated. Finally coiling of the internal carotid artery was done and orbital decompression achieved. Ophthalmoplegia, proptosis, Chemosis and nerve paralysis intraocular pressure improved.

Boisson-Dupuis S.,Rockefeller University | Boisson-Dupuis S.,French Institute of Health and Medical Research | Boisson-Dupuis S.,University of Paris Descartes | Baghdadi J.E,Genetics Unit | And 39 more authors.
PLoS ONE | Year: 2011

Background and Objectives: In the last decade, autosomal recessive IL-12Rβ1 deficiency has been diagnosed in four children with severe tuberculosis from three unrelated families from MAR, Spain, and TUR, providing proof-of-principle that tuberculosis in otherwise healthy children may result from single-gene inborn errors of immunity. We aimed to estimate the fraction of children developing severe tuberculosis due to IL-12Rβ1 deficiency in areas endemic for tuberculosis and where parental consanguinity is common. Methods and Principal Findings: We searched for IL12RB1 mutations in a series of 50 children from IRN, MAR, and TUR. All children had established severe pulmonary and/or disseminated tuberculosis requiring hospitalization and were otherwise normally resistant to weakly virulent BCG vaccines and environmental mycobacteria. In one child from IRN and another from MAR, homozygosity for loss-of-function IL12RB1 alleles was documented, resulting in complete IL-12Rβ1 deficiency. Despite the small sample studied, our findings suggest that IL-12Rβ1 deficiency is not a very rare cause of pediatric tuberculosis in these countries, where it should be considered in selected children with severe disease. Significance: This finding may have important medical implications, as recombinant IFN-γ is an effective treatment for mycobacterial infections in IL-12Rβ1-deficient patients. It also provides additional support for the view that severe tuberculosis in childhood may result from a collection of single-gene inborn errors of immunity. © 2011 Boisson-Dupuis et al.

Dinan N.M.,Teheran University of Medical science | Atyabi F.,Teheran University of Medical science | Rouini M.-R.,Teheran University of Medical science | Amini M.,Tehran University of Medical Sciences | And 2 more authors.
Materials Science and Engineering C | Year: 2014

The objective of this study was to use the functionalized multi-wall carbon nanotubes (CNTs) for the delivery of doxorubicin (DOX). Polyethylene glycol (PEG) chains are attached to CNTs then folate-conjugation of PEGylated CNTs was prepared. The amount of drug loading was calculated by the Multivariate Calibration Method for simultaneous quantification of DOX and CNTs. Cytotoxicity was evaluated using the folate receptor-positive HeLa cell line. To assess distribution and elimination of free DOX and drug-loaded CNTs, a recirculating rat liver perfusion system was used and pharmacokinetic parameters were calculated using non-compartmental analysis. Loading efficiency of 84.3 ± 3.1% and 49.3 ± 5.4% was calculated for low-PEGylated and high-PEGylated CNTs respectively. A higher release rate of DOX was achieved at a higher amount of PEGylation. Folate-targeted CNTs expressed a 3.2-fold decrease in IC 50 value compared with non-targeted CNTs. The result from liver perfusion experiments revealed that DOX accumulation in the liver was higher when PEGylation was lower. There was a 2.4-fold decrease in the elimination rate constant compared to free DOX, which was attributed to the redistribution of DOX from hepatocytes in a sustained release pattern that is consistent with an increase in the mean residence time and prolonged circulation. In conclusion, folate-targeted CNTs show great potential as a targeted anticancer delivery system. © 2014 Elsevier B.V.

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