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1.  Medical Therapy for Rheumatic Heart Disease: Is it time to be Proactive rather than Reactive? 
Indian heart journal  2009;61(1):14-23.
Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population.
PMCID: PMC3951844  PMID: 19729684
Valvular Heart Disease; Lipids; Pathophysiology; Clinical Trials
2.  Tuning Smart Microgel Swelling and Responsive Behavior through Strong and Weak Polyelectrolyte Pair Assembly 
The layer-by-layer (LbL) assembly of polyelectrolyte pairs on temperature and pH-sensitive cross-linked poly(N-isopropylacrylamide)-co-(methacrylic acid), poly(NIPAAm-co-MAA), microgels enabled a fine tuning of the gel swelling and responsive behavior according to the mobility of the assembled polyelectrolyte (PE) pair and the composition of the outermost layer. Microbeads with well-defined morphology were initially prepared by synthesis in supercritical carbon dioxide. Upon LbL assembly of polyelectrolytes, interactions between the multilayers and the soft porous microgel led to differences in swelling and thermoresponsive behavior. For the weak PE pairs, namely poly(L-lysine) / poly(L-glutamic acid) and poly(allylamine hydrochloride) / poly(acrylic acid), polycation-terminated microgels were less swollen and more thermoresponsive than native microgel; while polyanion-terminated microgels were more swollen and not significantly responsive to temperature, in a quasi-reversible process with consecutive PE assembly. For the strong PE pair, poly(diallyldimethylammonium chloride) / poly(sodium styrene sulfonate), the differences among polycation and polyanion-terminated microgels are not sustained after the first PE bilayer due to extensive ionic cross-linking between the polyelectrolytes. The tendencies across the explored systems became less noteworthy in solutions with larger ionic strength due to overall charge shielding of the polyelectrolytes and microgel. ATR FT-IR studies correlated the swelling and responsive behavior after LbL assembly on the microgels with the extent of H-bonding and alternating charge distribution within the gel. Thus, the proposed LbL strategy may be a simple and flexible way to engineer smart microgels in terms of size, surface chemistry, overall charge and permeability.
doi:10.1021/la301586t
PMCID: PMC3412153  PMID: 22676290
3.  Vitamin D Deficiency Is Associated With Retinopathy in Children and Adolescents With Type 1 Diabetes 
Diabetes Care  2011;34(6):1400-1402.
OBJECTIVE
To examine the hypothesis that vitamin D deficiency (VDD) is associated with an increased prevalence of microvascular complications in young people with type 1 diabetes.
RESEARCH DESIGN AND METHODS
In a cross-sectional study of 517 patients, 25-hydroxyvitamin D was measured. Retinopathy was assessed by 7-field stereoscopic retinal photography, peripheral neuropathy by thermal and vibration threshold testing, and microalbuminuria by albumin excretion rate or albumin-to-creatinine ratio.
RESULTS
Retinopathy prevalence was higher in cases with VDD versus sufficiency (18 vs. 9%, P = 0.02); deficiency was not associated with microalbuminuria or neuropathy. In logistic regression, retinopathy was associated with VDD (odds ratio 2.12 [95% CI 1.03–4.33]), diabetes duration (1.13, 1.05–1.23), and HbA1c (1.24, 1.02–1.50).
CONCLUSIONS
VDD is associated with an increased prevalence of retinopathy in young people with type 1 diabetes. The inflammatory and angiogenic effects of VDD may contribute to early retinal vascular damage; however, further investigations are warranted.
doi:10.2337/dc11-0103
PMCID: PMC3114351  PMID: 21515836
4.  Does the inclusion of 'professional development' teaching improve medical students' communication skills? 
BMC Medical Education  2011;11:41.
Background
This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations.
Methods
Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported.
Results
Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination.
Conclusions
Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.
doi:10.1186/1472-6920-11-41
PMCID: PMC3141797  PMID: 21708000
communication skills; patient-centredness; medical student; curriculum change; video observation
5.  Lytic Granule Loading of CD8+ T Cells Is Required for HIV-Infected Cell Elimination Associated with Immune Control 
Immunity  2008;29(6):1009-1021.
SUMMARY
Virus-specific CD8+ T cells probably mediate control over HIV replication in rare individuals, termed long-term nonprogressors (LTNPs) or elite controllers. Despite extensive investigation, the mechanisms responsible for this control remain incompletely understood. We observed that HIV-specific CD8+ T cells of LTNPs persisted at higher frequencies than those of treated progressors with equally low amounts of HIV. Measured on a per-cell basis, HIV-specific CD8+ T cells of LTNPs efficiently eliminated primary autologous HIV-infected CD4+ T cells. This function required lytic granule loading of effectors and delivery of granzyme B to target cells. Defective cytotoxicity of progressor effectors could be restored after treatment with phorbol ester and calcium ionophore. These results establish an effector function and mechanism that clearly segregate with immunologic control of HIV. They also demonstrate that lytic granule contents of memory cells are a critical determinant of cytotoxicity that must be induced for maximal per-cell killing capacity.
doi:10.1016/j.immuni.2008.10.010
PMCID: PMC2622434  PMID: 19062316
6.  Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness 
BMJ : British Medical Journal  2000;321(7273):1389-1392.
Objective
To compare the cost effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients.
Design
Prospective, controlled trial with randomised and patient preference allocation arms.
Setting
General practices in London and greater Manchester.
Participants
464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion.
Interventions
Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists.
Main outcome measures
Beck depression inventory scores, EuroQol measure of health related quality of life, direct treatment and non-treatment costs, and cost of lost production.
Results
197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. At four months, both non-directive counselling and cognitive-behaviour therapy reduced depressive symptoms to a significantly greater extent than usual general practitioner care. There was no significant difference in outcome between treatments at 12 months. There were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. Sensitivity analyses did not suggest that the results depended on particular assumptions in the statistical analysis.
Conclusions
Within the constraints of available power, the data suggest that both brief psychological therapies may be significantly more cost effective than usual care in the short term, as benefit was gained with no significant difference in cost. There are no significant differences between treatments in either outcomes or costs at 12 months.
PMCID: PMC27543  PMID: 11099285
7.  Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness 
BMJ : British Medical Journal  2000;321(7273):1383-1388.
Objective
To compare the clinical effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients.
Design
Prospective, controlled trial with randomised and patient preference allocation arms.
Setting
General practices in London and greater Manchester.
Participants
464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion.
Interventions
Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists.
Main outcome measures
Beck depression inventory scores, other psychiatric symptoms, social functioning, and satisfaction with treatment measured at baseline and at 4 and 12 months.
Results
197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. All groups improved significantly over time. At four months, patients randomised to non-directive counselling or cognitive-behaviour therapy improved more in terms of the Beck depression inventory (mean (SD) scores 12.9 (9.3) and 14.3 (10.8) respectively) than those randomised to usual general practitioner care (18.3 (12.4)). However, there was no significant difference between the two therapies. There were no significant differences between the three treatment groups at 12 months (Beck depression scores 11.8 (9.6), 11.4 (10.8), and 12.1 (10.3) for non-directive counselling, cognitive-behaviour therapy, and general practitioner care).
Conclusions
Psychological therapy was a more effective treatment for depression than usual general practitioner care in the short term, but after one year there was no difference in outcome.
PMCID: PMC27542  PMID: 11099284
9.  Gender factors in reviewer recommendations for manuscript publication 
This study investigated whether the gender of manuscript authors affected reviewers' editorial decisions. Female and male reviewers for five behavioral journals were asked to evaluate identical manuscripts according to their usual criteria. Half the manuscripts were supposedly written by men and half by women. Male reviewers did not evaluate male- and female-authored manuscripts differently. Female reviewers accepted significantly more female-authored (62%) than male-authored (10%) manuscripts. Female-authored manuscripts were accepted significantly more often by female (62%) than by male (21%) reviewers. Information unrelated to the quality of the manuscript appears to have influenced reviewers' decisions. Implications for the journal review process are discussed.
doi:10.1901/jaba.1990.23-539
PMCID: PMC1286270  PMID: 16795738
decisions; gender; journals; blind review
10.  An experimental analysis of electricity conservation procedures1 
Daily electricity consumption of four families was recorded for 106 days. A reversal design, consisting of various experimental conditions interspersed between repeated baseline conditions, was used. During experimental conditions, daily prompts (written conservation slogans attached to front doors) and/or daily feedback (daily kilowatts consumed and daily cost information) were in effect. Maximum consumption occurred during the initial baseline; minimum consumption occurred during different experimental conditions for different families. The mean decrease from the maximum to the minimum for all families was 35%. Reversals in consumption were demonstrated in three families, although successive baselines tended to decrease. No clear differences in effectiveness between prompting and feedback conditions were apparent. The procedures used resulted in considerable dollar savings for the families.
doi:10.1901/jaba.1977.10-665
PMCID: PMC1311244  PMID: 16795572
electricity conservation; reversal design; prompts; feedback; cost information; daily kilowatt hour consumption; suburban families
12.  Effect of Late Night Calcium Supplements on Overnight Urinary Calcium Excretion in Premenopausal and Postmenopausal Women 
British Medical Journal  1973;2(5865):510-512.
The overnight urinary calcium/creatinine ratio is higher in the early years after the menopause than before it. However, the increment of urinary calcium/creatinine after a late evening calcium supplement is less in early postmenopausal than in premenopausal women. It is suggested that calcium therapy in postmenopausal osteoporosis may be best administered as a single late evening dose rather than in divided doses throughout the day.
PMCID: PMC1589586  PMID: 4714465

Results 1-13 (13)