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Lawn S, Waddell E, Roberts L, Rioseco P, Beks T, Sharp T, McNeill L, Everitt D, Bowes L, Mordaunt D, Tarrant A, Van Hooff M, Lane J, Wadham B. No Women's Land: Australian Women Veterans' Experiences of the Culture of Military Service and Transition. Int J Environ Res Public Health 2024; 21:479. [PMID: 38673390 PMCID: PMC11050049 DOI: 10.3390/ijerph21040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Women's experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men's experiences and needs. Women veterans' experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans' experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture-proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men-consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women's specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans' mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs.
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Affiliation(s)
- Sharon Lawn
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Lived Experience Australia, Adelaide, SA 5042, Australia
| | - Elaine Waddell
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
| | - Louise Roberts
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
| | - Pilar Rioseco
- Australian Institute of Family Studies, Melbourne, VIC 3006, Australia;
| | - Tiffany Beks
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- School of Education, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Tiffany Sharp
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Cambrian Executive, Adelaide, SA 5000, Australia
| | - Liz McNeill
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
| | - David Everitt
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Defence Force Welfare Association SA, Adelaide, SA 5000, Australia
| | - Lee Bowes
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Defence Force Welfare Association SA, Adelaide, SA 5000, Australia
| | - Dylan Mordaunt
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Southern Adelaide Local Health Network, Adelaide, SA 5042, Australia
| | - Amanda Tarrant
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
- Veterans SA, Adelaide, SA 5000, Australia
| | - Miranda Van Hooff
- Military and Services Health Australia (MESHA), Adelaide, SA 5011, Australia;
| | - Jonathan Lane
- Department of Psychiatry, University of Tasmania, Hobart, TAS 7005, Australia;
| | - Ben Wadham
- Flinders University, Adelaide, SA 5042, Australia; (E.W.); (L.R.); (L.M.); (D.M.); (B.W.)
- Open Door Initiative, Flinders University, Adelaide, SA 5042, Australia; (T.B.); (T.S.); (D.E.); (L.B.); (A.T.)
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Boekelheide K, Olugbosi M, Nedelman J, Everitt D, Smith E, Betteridge M, Sun E, Spigelman M. Male reproductive hormones in patients treated with pretomanid. Int J Tuberc Lung Dis 2022; 26:558-565. [PMID: 35650700 PMCID: PMC9165738 DOI: 10.5588/ijtld.21.0654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: Pretomanid (Pa) is a nitroimidazole-class drug recently approved by the US Food and Drug Administration and other regulatory authorities as part of a regimen for treating highly drug-resistant pulmonary Mycobacterium tuberculosis infections. Studies in rodents identified the testis as a target organ of concern, which led to monitoring of reproductive hormones in >800 male patients enrolled in four clinical trials of Pa-containing regimens and the HRZE (isoniazid+rifampin+pyrazinamide+ethambutol) control regimen. METHODS: Serum hormone levels relevant to male reproductive health – follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B (InhB) and total testosterone (T) – from the four clinical trials were summarized numerically and analyzed by repeated-measures modeling. RESULTS: Hormone levels generally behaved similarly in Pa-containing and HRZE arms. Relative to baseline, serum T and InhB levels generally increased at the end of treatment and follow-up. FSH and LH levels were variable, but were generally at or below baseline levels by follow-up. Before treatment, many patients were borderline hypogonadal, with T levels near the lower limits of the normal range. CONCLUSION: Changes in male hormones in four clinical trials studying patients with TB indicate that Pa-containing treatment was not associated with testicular toxicity but rather led to improvement in the underlying hypogonadism.
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Affiliation(s)
| | | | - J Nedelman
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
| | - D Everitt
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
| | - E Smith
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
| | - M Betteridge
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
| | - E Sun
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
| | - M Spigelman
- TB Alliance, New York, NY, 4RTI International, Research Triangle Park, NC, USA
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Oelofse S, Esmail A, Diacon AH, Conradie F, Olayanju O, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Wills GH, Olugbosi M, del Parigi A, Sun E, Calatroni A, Spigelman M, Dheda K. Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts. Int J Tuberc Lung Dis 2021; 25:453-460. [PMID: 34049607 PMCID: PMC8171246 DOI: 10.5588/ijtld.21.0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: There are no data comparing the 6-9 month oral three-drug Nix regimen (bedaquiline, pretomanid and linezolid [BPaL]) to conventional regimens containing bedaquiline (B, BDQ) and linezolid (L, LZD).METHODS: Six-month post end-of-treatment outcomes were compared between Nix-TB (n = 109) and 102 prospectively recruited extensively drug-resistant TB patients who received an ˜18-month BDQ-based regimen (median of 8 drugs). A subset of patients received BDQ and LZD (n = 86), and a subgroup of these (n = 75) served as individually matched controls in a pairwise comparison to determine differences in regimen efficacy.RESULTS: Favourable outcomes (%) were significantly better with BPaL than with the B-L-based combination regimen (98/109, 89.9% vs. 56/86, 65.1%; adjusted relative risk ratio [aRRR] 1.35; P < 0.001) and in the matched pairwise analysis (67/75, 89.3% vs. 48/75, 64.0%; aRRR 1.39; P = 0.001), despite significantly higher baseline bacterial load and prior second-line drug exposure in the BPaL cohort. Time to culture conversion (P < 0.001), time to unfavourable outcome (P < 0.01) and time to death (P < 0.03) were significantly better or lower with BPaL than the B-L-based combinations.CONCLUSION: The BPaL regimen (and hence substitution of multiple other drugs by pretomanid and/or higher starting-dose LZD) may improve outcomes in drug-resistant TB patients with poor prognostic features. However, prospective controlled studies are required to definitively answer this question.
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Affiliation(s)
- S. Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - A. Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - A. H. Diacon
- Task Applied Science and Stellenbosch University, Cape Town, South Africa
| | - F. Conradie
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
,Sizwe Tropical Disease Hospital, Sandringham, South Africa
| | - O. Olayanju
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - N. Ngubane
- Task Applied Science and Stellenbosch University, Cape Town, South Africa
,King DinuZulu Hospital Complex, Durban, South Africa
| | - P. Howell
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
,Sizwe Tropical Disease Hospital, Sandringham, South Africa
| | | | - A. M. Crook
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - G. H. Wills
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | | | - E. Sun
- TB Alliance, New York, NY, USA
| | - A. Calatroni
- Rho Federal Systems Division, Inc., Durham, NC, USA
| | | | - K. Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Libeyre P, Schild T, Bruton A, Cormany C, Dolgetta N, Gaxiola E, Jong C, Mitchell N, Evans D, Levesy B, Bedakihale V, Garcia Sanchez P, Mariani A, Okugawa R, Reiersen W, Martovetsky N, Everitt D, Hughes D, Reagan T, Freudenberg K, Hatfield D, Chae T, Vandergriff D, Sgobba S, Aviles I, Decool P, Vallet J, Nunio F. From manufacture to assembly of the ITER central solenoid. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2018.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aviles Santillana I, Sgobba S, Castillo Rivero S, Fernandez Pison P, Libeyre P, Everitt D, Martovetsky N. Examination of ITER Central Solenoid prototype joints. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aviles Santillana I, Sgobba S, Castillo Rivero S, Libeyre P, Jong C, Everitt D. Post-mortem analysis of ITER CS helium inlets fatigue tested at cryogenic temperature. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Furin J, Alirol E, Allen E, Fielding K, Merle C, Abubakar I, Andersen J, Davies G, Dheda K, Diacon A, Dooley KE, Dravnice G, Eisenach K, Everitt D, Ferstenberg D, Goolam-Mahomed A, Grobusch MP, Gupta R, Harausz E, Harrington M, Horsburgh CR, Lienhardt C, McNeeley D, Mitnick CD, Nachman S, Nahid P, Nunn AJ, Phillips P, Rodriguez C, Shah S, Wells C, Thomas-Nyang'wa B, du Cros P. Drug-resistant tuberculosis clinical trials: proposed core research definitions in adults. Int J Tuberc Lung Dis 2017; 20:290-4. [PMID: 27046707 DOI: 10.5588/ijtld.15.0490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is a growing public health problem, and for the first time in decades, new drugs for the treatment of this disease have been developed. These new drugs have prompted strengthened efforts in DR-TB clinical trials research, and there are now multiple ongoing and planned DR-TB clinical trials. To facilitate comparability and maximise policy impact, a common set of core research definitions is needed, and this paper presents a core set of efficacy and safety definitions as well as other important considerations in DR-TB clinical trials work. To elaborate these definitions, a search of clinical trials registries, published manuscripts and conference proceedings was undertaken to identify groups conducting trials of new regimens for the treatment of DR-TB. Individuals from these groups developed the core set of definitions presented here. Further work is needed to validate and assess the utility of these definitions but they represent an important first step to ensure there is comparability in clinical trials on multidrug-resistant TB.
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Affiliation(s)
- J Furin
- TB Research Unit, Case Western Reserve University School of Medicine, Room E-202, 2210 Circle Dr, Cleveland, OH 44149, USA.
| | - E Alirol
- Manson Unit Médicins Sans Frontières, London, UK
| | - E Allen
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Fielding
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - C Merle
- Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - I Abubakar
- Department of Infection and Population Health, University College of London, London, UK
| | - J Andersen
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G Davies
- Institutes of Infection and Global Health and of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Dheda
- Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - A Diacon
- Biomedical Sciences, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
| | - K E Dooley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Dravnice
- Tuberculosis Foundation, KNCV, Amsterdam, The Netherlands
| | - K Eisenach
- Pathology and Microbiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - D Everitt
- Global Alliance for TB Drug Development, New York, New York, USA
| | | | | | - M P Grobusch
- Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Gupta
- Otsuka USA, Rockville, Maryland, USA
| | - E Harausz
- TB Research Unit, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - M Harrington
- Treatment Action Group, New York City, New York, USA
| | - C R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - C Lienhardt
- Stop TB Partnership & Stop TB Department, World Health Organization, Geneva, Switzerland
| | - D McNeeley
- Medical Service Corp International, Arlington, Virginia, USA
| | - C D Mitnick
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - S Nachman
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, USA
| | - P Nahid
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - A J Nunn
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - P Phillips
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - C Rodriguez
- Department of Respiratory Medicine, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S Shah
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - C Wells
- Otsuka USA, Rockville, Maryland, USA
| | | | - P du Cros
- Manson Unit Médicins Sans Frontières, London, UK
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Wellman GC, Barrett-Jolley R, Köppel H, Everitt D, Quayle JM. Inhibition of vascular K(ATP) channels by U-37883A: a comparison with cardiac and skeletal muscle. Br J Pharmacol 1999; 128:909-16. [PMID: 10556925 PMCID: PMC1571709 DOI: 10.1038/sj.bjp.0702868] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1 The aim of this study was to investigate the selectivity of the ATP-sensitive potassium (K(ATP)) channel inhibitor U-37883A (4-morpholinecarboximidine-N-1-adamantyl-N'-1-cyclohexyl). Membrane currents through K(ATP) channels were recorded in single muscle cells enzymatically isolated from rat mesenteric artery, cardiac ventricle and skeletal muscle (flexor digitorum brevis). K(ATP) currents were induced either by cell dialysis with 0.1 mM ATP and 0.1 mM ADP, or by application of synthetic potassium channel openers (levcromakalim or pinacidil). 2 U-37883A inhibited K(ATP) currents in smooth muscle cells from rat mesenteric artery. Half inhibition of 10 microM levcromakalim-induced currents occurred at a concentration of 3.5 microM. 3 Relaxations of rat mesenteric vessels caused by levcromakalim were reversed by U-37883A. 1 microM levcromakalim-induced relaxations were inhibited at a similar concentration of U-37883A (half inhibition, 1.1 microM) to levcromakalim-induced KATP currents. 4 K(ATP) currents activated by 100 microM pinacidil were also studied in single myocytes from rat mesenteric artery, skeletal muscle and cardiac ventricle. 10 microM U-37883A substantially inhibited K(ATP) currents in vascular cells, but had little effect in skeletal or cardiac myocytes. Higher concentrations of U-37883A (100 microM) caused a modest decrease in K(ATP) currents in skeletal and cardiac muscle. The sulphonylurea K(ATP) channel antagonist glibenclamide (10 microM) abolished currents in all muscle types. 5 The effect of U-37883A on vascular inward rectifier (KIR) and voltage-dependent potassium (KV) currents was also examined. While 10 microM U-37883A had little effect on these currents, some inhibition was apparent at higher concentrations (100 microM) of the compound. 6 We conclude that U-37883A inhibits K(ATP) channels in arterial smooth muscle more effectively than in cardiac and skeletal muscle. Furthermore, this compound is selective for K(ATP) channels over KV and KIR channels in smooth muscle cells.
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Affiliation(s)
- G C Wellman
- Department of Cell Physiology and Pharmacology, Leicester University, University Road, Leicester LE1 9HN
| | - R Barrett-Jolley
- Department of Cell Physiology and Pharmacology, Leicester University, University Road, Leicester LE1 9HN
| | - H Köppel
- Department of Cell Physiology and Pharmacology, Leicester University, University Road, Leicester LE1 9HN
| | - D Everitt
- Department of Cell Physiology and Pharmacology, Leicester University, University Road, Leicester LE1 9HN
| | - J M Quayle
- Department of Medicine, Cardiovascular Research Institute, Leicester University, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, P.O. Box 65, Leicester, LE2 7LX
- Author for correspondence:
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Ruggieri EV, Bugelski PJ, Kaplan JM, Everitt D, Lipani J, Jorkasky DK, Boike SC, DeClement F, Moore FD, Herzyk DJ. Relationships between antibodies against human soluble complement receptor 1 (hsCR1) from various species. J Clin Immunol 1996; 16:97-106. [PMID: 8690778 DOI: 10.1007/bf01540956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The relationships between antibodies against human soluble complement receptor 1 (hsCR1) were studied in rodents, dogs, nonhuman primates, and humans. An antibody response occurred in all species except humans. The anti-hsCR1 antibodies from the various species were characterized to determine if they recognize similar epitopes on the hsCR1 molecule. Dog and monkey sera, positve for hsCR1 binding, were used as blocking antibodies against mouse anti-hsCR1 monoclonal antibodies as well as mouse and rat anti-hsCR1-positive sera. Human sera (blood group antisera: anti-Knops, anti-McCoy, anti-Knops/McCoy, anti-Swain-Langley) and serum from one burn patient (who became seropositive despite ever receiving treatment with hsCR1) were also used to test blocking of mouse, rat, dog, and monkey anti-hsCR1. Characterization of anti-hsCR1 antibodies from different species demonstrated that hsCR1 causes divergent antibody responses among animals. While mouse, rat, and dog antibodies cross inhibit binding by approximately 50%, monkey antibodies recognize primarily different epitopes of the hsCR1 molecule. Moreover, human antibodies binding hsCR1 are completely different from the animal antibodies, including monkey. This study indicates that although hsCR1 is immunogenic in animals, there is a difference in response between species, particularly between nonprimates and primates, and finally, that this antibody response is not predictive for humans.
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Affiliation(s)
- E V Ruggieri
- SmithKline Beecham Pharmaceuticals, King of Prussia, Pennsylvania 19406-0939, USA
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Abstract
PURPOSE Despite the widespread use of neuroleptic medications for the elderly, little is known about the frequency of treatment for drug-induced parkinsonian syndromes in this age group, particularly with L-dopa-type drugs, which are more appropriate for the treatment of true idiopathic Parkinson's disease. PATIENTS AND METHODS We identified 3,512 patients aged 65 to 99 enrolled in a large state Medicaid program who were newly prescribed a drug to treat parkinsonian symptoms. Controls were comparable program enrollees of similar age who had not been prescribed an antiparkinsonian drug. In a case-control study, we evaluated the use of neuroleptic drugs in the 90 days before initiation of antiparkinsonian therapy. RESULTS Patients taking neuroleptics were 5.4 times more likely to begin antiparkinsonian medication than were nonusers (95% confidence interval [CI] 4.8 to 6.1). They also had a greater than two-fold increase in risk of beginning therapy with a dopaminergic drug specific for idiopathic Parkinson's disease, not generally indicated for treatment of drug-induced parkinsonism (adjusted odds ratio 2.2, 95% CI 1.9 to 2.7). Clear dose-response relationships were demonstrated, as were differences among neuroleptics. Among all patients started on dopaminergic drugs in this population, 37% of such therapy was attributable to prior neuroleptic use. Continuation of the neuroleptic persisted in 71% of patients so treated. CONCLUSION Neuroleptic use is a common cause of extrapyramidal dysfunction in the elderly, and the side effect is frequently treated by adding an anticholinergic or dopaminergic drug to the regimen. The use of anticholinergic drugs presents risks of additional drug side effects; the use of dopaminergic drugs, generally not appropriate for drug-induced parkinsonian syndrome, suggests that extrapyramidal neuroleptic side effects may often be mistaken for idiopathic Parkinson's disease in older patients.
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Affiliation(s)
- J Avorn
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Cunningham DA, Howard J, Rechnitzer PA, Goode RB, Everitt D, Griffith J, Daniels J. Cardiovascular fitness in a selected group of dentists. J Sports Med 1975; 3:205-11. [PMID: 1207110 DOI: 10.1177/036354657500300501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thirty-three dentists were studied as part of an exercise rehabilitation clinic in order to evaluate their cardiovascular capacity and coronary prone risk factors. Measurements were made of their physical work capacity, predicted maximal oxygen uptake, fatness, serum lipids and uric acid levels, pulmonary peak flow rates and personality Type A or B. The group as a whole exhibited a moderately high level of fitness and a very active life style which probably reflected their presence at a clinic of this type. Cardiovascular fitness varibles increased with age. This increase may be due to a need and desire on the part of the dentists to maintain their physical fitness as they become older. This need for improved self image may also be a factor in their joining an exercise rehabilitation clinic.
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