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Dedifferentiation is the process by which cardiomyocytes take on a gene and protein expression profile that is more similar to fetal. This phenotype occurs more often in acute and chronic injury of the heart and seems to confer a potential survival advantage of these cardiomyocytes (option D). Current approaches include intravenous delivery, but this is limited by poor retention of stem cells in the myocardium (option C). Intracoronary injection of stem cells can be done during percutaneous coronary intervention, but stem cell retention is not as good as 4,5 with transendocardial injection (option A). Transendocardial injection can also be done in the catheterization laboratory, but it requires advanced imaging to identify target areas for injection (option B). Transepicardial injection 6 may be of similar value, but it requires direct visualization of the heart (option D). An alternative to intracardiac injection is activation of resident stem cells, but this approach remains in preclinical investigation (option E). Interest in this population was supported by similarity to adult cardiomyocytes, the potential for autologous utilization, ease of expansion in vitro, and resistance to hypoxic environment (options A through D). Functionally, skeletal muscle fails to couple with endogenous cardiac muscle (option E). Key questions remain as to the mechanism of action and the cell type responsible for the reverse remodeling that has been observed (option A). Initial clinical work 25,26 suggests safety, but additional studies are needed to evaluate efficacy (option E). Beyond issues of identity, whether the postnatal heart harbors a 27,28 population of resident progenitor cells has been hotly debated (options A and C). These groups rely on harvest of stem cells from the heart for expansion and 29,30 then retransplantation (option B). This patient is the ideal candidate for cardiac resynchronization therapy, and upgrading her device to a biventricular pacing system should be strongly recommended before pursuing less proven approaches (options D and E). Current protocols 31,32 allow for differentiation, expansion, and isolation of cardiomyocytes with greater than 90% purity (option D). Disease modeling is primarily limited to heritable, cell-autonomous disorders (option C). Haematopoietic stem cells adopt mature haematopoietic fates in ischaemic myocardium. Fusion of bone-marrow-derived cells with Purkinje neurons, cardiomyocytes and hepatocytes. Bone marrow-derived hematopoietic cells generate cardiomyocytes at a low frequency through cell fusion, but not transdifferentiation.
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Some caution should be applied to information accessed via the World Wide Web, since publication of material without peer review is signifcantly easier (Segal-Isaacson, 2002). Several authors (Buckner, Miller & Kris, 2002; DeBourgh, 2001; Zimmerman, Barnason & Pozehl, 1999) noted that cat rooms had the potential to reduce the perception of isolation of the participants of educational programmes while others documented their disadvantages (McAlpine, Lockerbie & Beaman, 2002), such as the loss of non verbal cues from participants and lack of personal contact. The Development of the Reskilling Programme Rural perioperative nurses were recruited from rural hospitals that planned to use the mobile operating theatre service. The key focus prior to the service beginning, in late 2002, was to design, deliver and assess the merits of a specifc in-service programme for participating nurses. All these hospitals had had working operating theatres in the past and had retained their perioperative nursing staff in other nursing roles. Four nurses from each hospital would ensure safe staffng levels, as suggested by the New Zealand College of Perioperative Nurses. Some hospitals chose to include more than four so that potential annual leave and sick leave days would be covered. Forty nurses completed the entire reskilling programme while two completed part of the programme. In consultation with their managers, 3fi days were allocated to specifc study related to the service (two single study days held at the individual hospitals and a combined national weekend workshop). The primary aim of the reskilling programme was to update the knowledge and skills of the rural perioperative nurses so that they could work with the mobile theatre service, with the secondary aim of familiarising the nurses with the concept of the mobile theatre service. The programme was targeted at a returning to practice/beginning practitioner level. A formalised needs assessment had been considered but for various reasons, was not undertaken. Instead an advisory group of expert perioperative practitioners, representing a typical surgical services team, was set up and consulted via phone or e-mail. The topics chosen were based on perioperative standards of practice published by American, Australian and New Zealand perioperative nursing associations. Mandatory topics covered in this course were informed consent, standard precautions, patient code of rights, scrubbing and gowning, anaesthesia, aseptic technique, patient safety, blood and body fuid exposure, occupational safety and health and recovery room scoring. Copies of the Dissector (the Perioperative Nurses College of New Zealand Journal). This information had been presented to the nurses in draft form at the education sessions. Critique was sought from the rural nurses about this document to ensure that the patient care pathway refected what was realistically expected to happen at their respective hospitals. A postal questionnaire, which allowed for collection of both quantitative and qualitative data, was used to evaluate the effcacy of the reskilling programme.
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Certain trace elements in particular databases can have missing values even for commonly consumed foods, and this can result in substantial underestimation of calculated intake. Database values for a specifc nutrient can also be based on out-dated analytical methods that might provide systematically higher or lower values than the method currently in use. Dietary assessment How to assess the nutrient intake of a group Micronutrients the goal of assessing nutrient intake of groups is to determine the prevalence of inadequate or excessive nutrient intakes within a pre-defned group of individuals. Assessing nutrient intake of groups is an integral part of dietary monitoring, for example, in national dietary surveys or dietary intervention studies. The key to an appropriate assessment of inadequacy at the group level is to think in terms of a continuous probability-of-inadequacy scale where the prevalence of inadequacy increases as intake decreases (illustrated in Figure 3. What proportion of the group has a relatively high probability of inadequate intakefi For a detailed description of this approach and its assumptions, see IoM (6) and example 1. If the assessment results in a high prevalence and thus a high probability of inadequate nutrient intake that can only be explained by an implausibly low reported energy intake, the results might indicate that the risk is real. Biochemical measurements of nutritional status, however, are necessary to substantiate whether there is an actual lack of intake of the nutrient in question. The probability approach has recently been successfully applied to a nutrient status biomarker (7), and this can be used as a complementary tool for assessing adequacy or excess. Energy In the assessment of energy intake at the group level, the estimated average energy intake is compared with the reference value for energy intake for the specifc group in which body size, age, sex, and appropriate levels of physical activity are taken into account. The proportion of the group with intakes above or below the reference value can be assessed. A prerequisite for an appropriate assessment of energy intake at the group level is to ensure that energy intake is accurately assessed, and the approach suggested by Black (9) is useful in this regard. In the assessment of the usual energy contribution from protein, fat, and carbohydrates, the proportion of the group that has a usual energy contribution from these macronutrients within or outside the recommended intake range is estimated. In the assessment of the usual energy contribution from macronutrients with a recommended upper threshold. Likewise, when the energy contribution from macronutrients with a recommended lower threshold.
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Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. Calcium homeostasis during pregnancy and lactation in Brazilian women with low calcium intakes: a longitudinal study. The retention of calcium, iron, phosphorus, and magnesium during pregnancy: the adequacy of prenatal diets with and without supplementation. Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Changes in bone mineral density and calcium metabolism in breastfeeding women: a one year follow-up study. A systematic review of the effect of diet in prostate cancer prevention and treatment. Phosphorus-containing compounds have important roles in bone mineralization, cell structure, cellular metabolism, regulation of subcellular processes, and maintenance of acid-base homeostasis. Phosphate is the most abundant anion in the human body and comprises about 1% of the total body mass. It is predominantly an intracellular anion, and in the skeleton phosphate is generally complexed with calcium in the form of hydroxyapatite. In sof tissue and cell membranes, phosphorus exists mainly as phosphate esters and to a lesser extent as phosphoproteins and free phosphate ions. In the extracellular fuid, about one-tenth of the phosphorus content is bound to proteins, one-third is complexed to sodium, calcium, and magnesium, and the remainder is present as inorganic phosphate (1, 2). Serum phosphate concentration varies with age, with the highest concentration in infants. The concentrations decline towards adulthood, and the normal range in adults is 0. Some forms of dietary phosphorus are less bioavailable, especially the phosphorus in the phytic acid found in the outer layer of cereal grains. The actual bioavailability depends on the way these grain products are processed and the amount of residual phytate. The intake from food additives is largely unknown, but it is likely to be of signifcant importance. Dietary phosphate is absorbed by the epithelium of the duodenum and jejunum in the small intestine via both passive difusion, which depends on the amount of phosphorus in the intestine, and an active sodiumdependent process that is regulated by calcitriol (1,25-dihydroxyvitamin D3. Calcitriol in turn is regulated by serum phosphate such that a decrease in phosphate concentration leads to an increase in the synthesis of calcitriol. Phosphate absorption is thought to depend on the function of sodiumdependent phosphate transporters. Net absorption from a mixed diet has been reported to vary between 55% and 70% in adults and between 65% and 90% in infants and children.