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1
Tunda, Amin, Aryuni S. Jabar, Sarmadan Sarmadan, Nur I. Sofian, Megawati Asrul Tawulo, Darmin Tuwu, Wa Ode Lusianai, et al. "PEMBERDAYAAN KOMUNITAS NELAYAN MELALUI PEMBENTUKAN LEMBAGA EKONOMI KERAKYATAN DI DESA BAJO INDAH, KECAMATAN SOROPIA, KABUPATEN KONAWE." Anoa : Jurnal Pengabdian Masyarakat Sosial, Politik, Budaya, Hukum. Ekonomi 1, no. 01 (January 31, 2020): 36. http://dx.doi.org/10.52423/anoa.v1i01.10823.
Повний текст джерелаАнотація:
Komunitas nelayan adalah kelompok masyarakat yang hidup di daerah pesisir. Streotipe yang melekat pada mereka adalah kelompok yang minim dalam peningaktan Sumber Daya Manusia (SDM). Pada konteks penghasilan, komunitas nelayan memiliki pendapatan yang dapat digolongkan dalam kelompok masyarakat sejahtera. Namun, kurangnya SDM membuat kelompok ini tidak mampu mengelola keuangan secara baik. Olehnya itu, dipandang perlu melaksanakan kegiatan pengabdian kepada masyarakat dengan mengusung konsep pemberdayaan komunitas nelayan melalui pemanfaatan Lembaga Ekonomi Kerakyatan. Tujuan dari kegiatan pengabdian kepada masyarakat ini adalah untuk meningkatkan pemahaman komunitas nelayan dalam pengeloaan keuangan dan pentingnya lembaga ekonomi kerakyatan dalam peningkatan kesejahteraan. Kegiatan ini dilaksanakan di Balai Desa Bajo Indah, Kecamatan Soropia, Kabupaten Konawe. Dalam upaya pemecahan masalah komunitas nelayan, maka digunakan metode Focus Goup Discussion (FGD) atau diskusi kelompok terarah untuk mengetahui permasalah serta penanganan atau penemuan solusi secara bersama. Hasil dari kegiatan pengabdian kepada masyarakat, yakni; Kesepakatan bekerjasama dengan berbagai pihak untuk mengikuti kelas belajar informal; Meningkatnya pemahaman komunitas nelayan terhadap tata kelola kuangan rumah tangga; Komunitas nelayan secara bersama-sama menentukan potensi resource, pemanfaatanya, serta pengelolaannya; Komunitas nelayan dan pemerintah desa sepakat membentuk koperasi desa yang bersumber dari dana ADD.
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Primiyani, Yulia, Masrul Masrul, and Hardisman Hardisman. "Analisis Pelaksanaan Program Pos Pembinaan Terpadu Penyakit Tidak Menular di Kota Solok." Jurnal Kesehatan Andalas 8, no. 2 (May 14, 2019): 399. http://dx.doi.org/10.25077/jka.v8.i2.p399-406.2019.
Повний текст джерелаАнотація:
Penyakit Tidak Menular (PTM) menjadi salah satu penyebab utama kematian di dunia. Peningkatan PTM juga terjadi di Provinsi Sumatera Barat. Demikian juga halnya dengan Kota Solok. Salah satu kebijakan pengendalian PTM saat ini adalah melalui Pos Pembinaan Terpadu (Posbindu) PTM berbasis masyarakat dengan melakukan deteksi dini, pemantauan faktor risiko dan tindak lanjut secara promotif dan preventif. Tujuan penelitian ini adalah menganalisis pelaksanaan program posbindu PTM di Kota Solok dengan menganalisis input (kebijakan, ketersediaan sumber daya manusia, anggaran biaya, sarana dan prasarana, petunjuk teknis, peran serta kemitraan), process (perencanaan, pelaksanaan, monitoring evaluasi) dan output (capaian indikator posbindu PTM). Penelitian studi kebijakan dengan pendekatan kualitatif ini dilaksanakan pada bulan April-November 2018. Teknik pengumpulan data dilakukan melalui wawancara mendalam, observasi, Focus Goup Discussion (FGD) dan telaah dokumen. Hasil penelitian menunjukkan bahwa kebijakan posbindu ditetapkan melalui SK Walikota Nomor 188 tahun 2018 namun belum tersosialisasikan sampai pelaksana posbindu, SDM pelaksana posbindu masih belum mencukupi karena baru memiliki 3 orang kader, anggaran biaya berasal dari APBD dan BOK, sarana dan prasarana masih belum memadai, petunjuk teknis telah ada tapi belum dikuasai oleh kader dan kemitraan dengan lintas sektor juga belum terjalin. Pada perencanaan, posbindu belum mempunyai Plan Of Action (POA) dan belum pernah dilakukan sosialisasi dan advokasi, pelaksanaan sudah memakai sistem lima meja, monitoring dan evaluasi masih belum optimal, output posbindu PTM di Kota Solok masih belum tercapai karena angka kunjungan masih rendah.
3
Primiyani, Yulia, Masrul Masrul, and Hardisman Hardisman. "Analisis Pelaksanaan Program Pos Pembinaan Terpadu Penyakit Tidak Menular di Kota Solok." Jurnal Kesehatan Andalas 8, no. 2 (May 14, 2019): 399. http://dx.doi.org/10.25077/jka.v8i2.1018.
Повний текст джерелаАнотація:
Penyakit Tidak Menular (PTM) menjadi salah satu penyebab utama kematian di dunia. Peningkatan PTM juga terjadi di Provinsi Sumatera Barat. Demikian juga halnya dengan Kota Solok. Salah satu kebijakan pengendalian PTM saat ini adalah melalui Pos Pembinaan Terpadu (Posbindu) PTM berbasis masyarakat dengan melakukan deteksi dini, pemantauan faktor risiko dan tindak lanjut secara promotif dan preventif. Tujuan penelitian ini adalah menganalisis pelaksanaan program posbindu PTM di Kota Solok dengan menganalisis input (kebijakan, ketersediaan sumber daya manusia, anggaran biaya, sarana dan prasarana, petunjuk teknis, peran serta kemitraan), process (perencanaan, pelaksanaan, monitoring evaluasi) dan output (capaian indikator posbindu PTM). Penelitian studi kebijakan dengan pendekatan kualitatif ini dilaksanakan pada bulan April-November 2018. Teknik pengumpulan data dilakukan melalui wawancara mendalam, observasi, Focus Goup Discussion (FGD) dan telaah dokumen. Hasil penelitian menunjukkan bahwa kebijakan posbindu ditetapkan melalui SK Walikota Nomor 188 tahun 2018 namun belum tersosialisasikan sampai pelaksana posbindu, SDM pelaksana posbindu masih belum mencukupi karena baru memiliki 3 orang kader, anggaran biaya berasal dari APBD dan BOK, sarana dan prasarana masih belum memadai, petunjuk teknis telah ada tapi belum dikuasai oleh kader dan kemitraan dengan lintas sektor juga belum terjalin. Pada perencanaan, posbindu belum mempunyai Plan Of Action (POA) dan belum pernah dilakukan sosialisasi dan advokasi, pelaksanaan sudah memakai sistem lima meja, monitoring dan evaluasi masih belum optimal, output posbindu PTM di Kota Solok masih belum tercapai karena angka kunjungan masih rendah.
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Vernia, Ana Mercedes. "INSOLARTE: breve revisión de proyectos artísticos en una estancia de investigación." eari educación artística revista de investigación, no. 12 (December 22, 2021): 172. http://dx.doi.org/10.7203/eari.12.19097.
Повний текст джерелаАнотація:
Actualmente la música, aunque está perdiendo representatividad y presencia en las instituciones educativas, contrariamente, está tomando relevancia en la sociedad, en la calidad de vida de las personas, en la inclusión educativa y social, además se estima que es una potente herramienta de vertebración social, de empleabilidad y sostenibilidad. A través de proyectos artísticos, la música se comporta como un nexo de unión que permite la implementación en diferentes contextos y perfiles, de acciones capaces de potenciar la motivación, la autoestima, así como mejorar las competencias sociales y personales. Entre los problemas y los retos actuales, nos encontramos por una parte con la empleabilidad y su relación con la educación y la formación en los futuros maestros/as, y otra parte la importancia de la agenda 2030 y los 17 Objetivos de Desarrollo Sostenible (ODS). Nuestra propuesta se fundamenta en una estancia de investigación que se realizó en la universidad de Barcelona, a través de una convocatoria lanzada por la Conselleria D’educació, Investigació, Cultura i Esport. Direcció General d’Universitat, Investigació i Ciència de la Generalitat Valenciana. Entre los principales objetivos, además de la elaboración de un informe sobre los beneficios de los proyectos artísticos, para la transformación social y educativa, tuvimos presente la relación de la música con la formación de los futuros maestros de educación primaria y los beneficios del arte en general y de la música en especial. Para obtener información se realizaron diferentes entrevistas y se organizaron dos focus goup. Hallamos importante información que refuerza la importancia de la formación musical y sus beneficios, así como la relevancia de los proyectos artísticos en la sociedad, sin ninguna discriminación o exclusión. También reflexionamos sobre el impacto económico de los proyectos artísticos, no solo desde la empleabilidad sino también de lo que puede suponer su relación con la salud y la calidad de vida.
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Rolston, Cassandra J., Tamlin S. Conner, Lisa K. Stamp, Tia Neha, Suzanne Pitama, Niamh Fanning, Ron Janes, et al. "Improving gout education from patients’ perspectives: a focus group study of Māori and Pākehā people with gout." Journal of Primary Health Care 10, no. 3 (2018): 194. http://dx.doi.org/10.1071/hc18010.
Повний текст джерелаАнотація:
ABSTRACT INTRODUCTION Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and worse gout outcomes than Pākehā. AIM To explore gout patient education in primary care from the perspectives of Māori and Pākehā people with gout. METHODS In total, 69 people with gout were recruited through primary care providers in three locations across New Zealand. Nine semi-structured focus groups were run with Māori and Pākehā participants in separate groups. RESULTS Thematic analysis yielded two themes in relation to gout education: (i) ‘Multiple sources of gout education’; and (ii) ‘Gaps in gout knowledge’. Participants received education from general practitioners, educational resources, family and friends, and their own experiences. Māori participants preferred information to be kanohi-ki-te-kanohi (face-to-face) and with significant others present where necessary. Participants disclosed gaps in gout’s epidemiology and management. Pākehā and Māori participants reported limited understanding of the genetic basis of gout or the biological underpinnings of the condition and its treatments, but learned treatment adherence through experience. DISCUSSION Despite improved gout patient education, knowledge gaps remain and may contribute to poor medication adherence. Gout patient education interventions need to be tailored to culture and incorporate suitable methods of disseminating information about gout management.
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Te Karu, Leanne, Nicola Dalbeth, and Lisa K. Stamp. "Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand." Therapeutic Advances in Musculoskeletal Disease 13 (January 2021): 1759720X2110280. http://dx.doi.org/10.1177/1759720x211028007.
Повний текст джерелаАнотація:
Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.
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Love, Bryan L., Robert Barrons, Angie Veverka, and K. Matthew Snider. "Urate-Lowering Therapy for Gout: Focus on Febuxostat." Pharmacotherapy 30, no. 6 (June 2010): 594–608. http://dx.doi.org/10.1592/phco.30.6.594.
Повний текст джерела
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Tanzi, Maria G. "New rheumatology guidelines focus on special populations, gout, osteoporosis." Pharmacy Today 23, no. 3 (March 2017): 26–27. http://dx.doi.org/10.1016/j.ptdy.2017.02.012.
Повний текст джерела
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Kushnarenko, N. N., T. A. Medvedeva, M. Yu Mishko, and T. M. Karavaeva. "Heart rate-lowering therapy in gout patients with stable coronary artery disease: focus on ivabradine." Russian Journal of Cardiology 25, no. 7 (August 15, 2020): 3980. http://dx.doi.org/10.15829/1560-4071-2020-3980.
Повний текст джерелаАнотація:
Aim. To study the effect of ivabradine and bisoprolol on cardiac hemodynamics and diastolic remodeling in gout patients with coronary artery disease and hypertension and without left ventricular systolic dysfunction.Material and methods. The open randomized parallel clinical trial of 35 men with intercritical gout at the age of 41,4±3,3 years, with class II-III stable angina, hypertension and sinus rhythm without data suggestive of heart failure was performed. All patients included in the study were randomly divided into two groups: eighteen patients took bisoprolol at a dose of 2,5 to 10 mg/day, 17 subjects received bisoprolol 2,5 mg/day with ivabradine (Coraxan, SERVIER, France) 5 mg 2 times a day. Adjustment of the therapy was carried out every 2 weeks until the target heart rate (HR) was reached at 55-60 beats/min and then remained unchanged until 12 weeks of therapy. All patients underwent echocardiography, 24-hour Holter and central aortic blood pressure monitoring, and 3-minute cycle ergometer test with a power of 25, 50, 75 and 100 watts.Results. There was a comparable decrease in the maximum and minimum 24-hour average heart rates in patients receiving only bisoprolol and those taking bisoprolol+ivabradine. Patients taking bisoprolol+ivabradine had a decrease of central systolic and diastolic blood pressure (BP). Pulse pressure in the bisoprolol group increased by 17,7% (p=0,02), and when ivabradine was added, on the contrary, it decreased by 7,0% (p=0,04). Twelve-week therapy with beta-blockers and ivabradine was accompanied by an effective decrease in the pulse wave velocity in both groups (p<0,05). All gout patients did not have a decrease of systolic function and there was an improvement in diastolic remodeling with beta-blockers and ivabradine therapy.Conclusion. The results obtained indicate that the addition of ivabradine to bisoprolol leads to an effective decrease in heart rate, an improvement in arterial stiffness and exercise tolerance. Combination therapy with ivabradine is accompanied by an improvement in clinical outcomes using lower doses of bet-blockers, which requires further study and a double-blind controlled study.
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Reaves, Esther, and Bruce Arroll. "Management of gout in a South Auckland general practice." Journal of Primary Health Care 6, no. 1 (2014): 73. http://dx.doi.org/10.1071/hc14073.
Повний текст джерелаАнотація:
BACKGROUND AND CONTEXT: In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB) has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. ASSESSMENT OF PROBLEMS: The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. RESULTS: The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. STRATEGIES FOR IMPROVEMENT: A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. LESSONS: Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care. KEYWORDS: Allopurinol; cardiovascular diseases; gout; primary health care; uric acid
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Singh, Yogendra, Pankaj Mishra, and Pushpendra Kannojia. "Analysis of animal models based on pre-clinical symptoms of gout." Journal of Drug Delivery and Therapeutics 12, no. 1 (January 15, 2022): 181–84. http://dx.doi.org/10.22270/jddt.v12i1.5270.
Повний текст джерелаАнотація:
Gout is a type of arthritis, which is a group of related disorders caused by episodes of abnormal inflammation in the joints. It is a metabolic disease characterized by high levels of uric acid in the blood. Uric acid is the end product of purine metabolism and hyperuricemia is caused by abnormalities of purine metabolism. Hyperuricemia is a risk factor for gout, heart disease, high blood pressure (hypertension), diabetes, and acute and chronic kidney disease. This research may attract widespread interest to researchers focusing on the different types of crystalline arthritis. There are over 100 types of arthritis. The most common forms are osteoarthritis (degenerative joint disease), rheumatoid arthritis, gout and pseudo-gout, septic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, still's disease etc.
Many animal models are available to get rid of gout, mainly the hyperuricemia animal model, monosodium urate air pouch gout model, Intra-articular gout in rat, Paw edema, Gouty Arthritis Model, and Gouty nephropathy model. Various investigations have created a reliable and economical animal model for arthritis in a relatively short brief timeframe, manifested by long-term gross and behavioral abnormalities along with intra-articular monosodium urate deposition and tophi formation.
Lately years, hyperuricemia disease has gradually increased in the world. There are many updates that can be made by taking the arthritis model. If such a situation prevails, then in a few years, the patients of gout can increase in great quantity and there is some treatment for this disease. In any case, further review is really needed to focus on its particular pathogenesis and drugs.
Keywords: Gout, Arthritis, Gout Animal Model, Inflammation, Hyperuricemia, monosodium urate, crystalline arthritis.
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Zhang, Yingling, Simin Chen, Man Yuan, Yu Xu, and Hongxi Xu. "Gout and Diet: A Comprehensive Review of Mechanisms and Management." Nutrients 14, no. 17 (August 26, 2022): 3525. http://dx.doi.org/10.3390/nu14173525.
Повний текст джерелаАнотація:
Gout is well known as an inflammatory rheumatic disease presenting with arthritis and abnormal metabolism of uric acid. The recognition of diet-induced systemic metabolic pathways have provided new mechanistic insights and potential interventions on gout progression. However, the dietary recommendations for gouty patients generally focus on food categories, with few simultaneous considerations of nutritional factors and systemic metabolism. It is worthwhile to comprehensively review the mechanistic findings and potential interventions of diet-related nutrients against the development of gout, including purine metabolism, urate deposition, and gouty inflammation. Although piecemeal modifications of various nutrients often provide incomplete dietary recommendations, understanding the role of nutritional factors in gouty development can help patients choose their healthy diet based on personal preference and disease course. The combination of dietary management and medication may potentially achieve enhanced treatment effects, especially for severe patients. Therefore, the role of dietary and nutritional factors in the development of gout is systematically reviewed to propose dietary modification strategies for gout management by: (1) reducing nutritional risk factors against metabolic syndrome; (2) supplementing with beneficial nutrients to affect uric acid metabolism and gouty inflammation; and (3) considering nutritional modification combined with medication supplementation to decrease the frequency of gout flares.
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Tsurko, V. V., M. A. Gromova, and N. V. Malysheva. "Interdisciplinary approach to the management of patients with chronic gout." Meditsinskiy sovet = Medical Council, no. 8 (July 16, 2020): 144–52. http://dx.doi.org/10.21518/2079-701x-2020-8-144-152.
Повний текст джерелаАнотація:
Gout, one of the most common forms of inflammatory arthritis, is characterized by severe joint pain, which often interferes with daily activities. In recent years, further research on its causes and on improving diagnosis, treatment and prevention has been ongoing. It is known that gout usually occurs due to the accumulation of sodium monourate crystals in joints due to high levels of serum uric acid. In 2019, the Annals of the Rheumatic Diseases journal published new data on imaging and clinical diagnostics methods based on the principles of evidence-based medicine. Formulated by experts, they were adopted as a consensus of the European League Against Rheumatism (EULAR). The American College of Rheumatology (ACR) has now developed new strategies to treat and prevent gout. On May 11, 2020, the Arthritis & Rheumatology Journal presented guidelines for the management of gout patients, including the treatment of acute gout attack, indications for urate-lowering therapy and instructions for its optimal use, as well as recommendations on lifestyle and drugs that are often prescribed to patients with comorbidity. The purpose of this review is to summarize current knowledge with a focus on recent advances in the algorithm for managing acute and chronic gout patients.
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Tsurko, V. V., M. A. Gromova, and N. V. Malysheva. "Interdisciplinary approach to the management of patients with chronic gout." Meditsinskiy sovet = Medical Council, no. 8 (July 16, 2020): 144–52. http://dx.doi.org/10.21518/2079-701x-2020-8-144-152.
Повний текст джерелаАнотація:
Gout, one of the most common forms of inflammatory arthritis, is characterized by severe joint pain, which often interferes with daily activities. In recent years, further research on its causes and on improving diagnosis, treatment and prevention has been ongoing. It is known that gout usually occurs due to the accumulation of sodium monourate crystals in joints due to high levels of serum uric acid. In 2019, the Annals of the Rheumatic Diseases journal published new data on imaging and clinical diagnostics methods based on the principles of evidence-based medicine. Formulated by experts, they were adopted as a consensus of the European League Against Rheumatism (EULAR). The American College of Rheumatology (ACR) has now developed new strategies to treat and prevent gout. On May 11, 2020, the Arthritis & Rheumatology Journal presented guidelines for the management of gout patients, including the treatment of acute gout attack, indications for urate-lowering therapy and instructions for its optimal use, as well as recommendations on lifestyle and drugs that are often prescribed to patients with comorbidity. The purpose of this review is to summarize current knowledge with a focus on recent advances in the algorithm for managing acute and chronic gout patients.
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Guttmann, Allison, Svetlana Krasnokutsky, Michael H. Pillinger, and Adey Berhanu. "Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations." Therapeutic Advances in Drug Safety 8, no. 12 (September 13, 2017): 379–88. http://dx.doi.org/10.1177/2042098617727714.
Повний текст джерелаАнотація:
Gout is a common rheumatic condition, with increasing prevalence in recent decades. The mainstay of treatment for gout is oral urate-lowering therapy (ULT), typically with xanthine oxidase inhibitors (XOIs). Unfortunately, a proportion of patients have persistent gout that is refractory to ULT. Pegloticase, a recombinant pegylated uricase, has been approved by the US Food and Drug Administration for the treatment of refractory gout. However, concern has been raised regarding the risk of infusion reactions, which are now understood to be largely due to the development of antipegloticase antibodies. Discontinuation of pegloticase upon failure to lower serum urate has been shown to markedly reduce infusion reaction risk, but deprives patients of what, in many cases, is a last-resort treatment. In this manuscript, we review the rationale, mechanism of action, efficacy and safety of pegloticase. Additionally, we focus on potential strategies to reduce pegloticase immunogenicity and potentially make this important agent available to a wider group of patients requiring treatment.
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Doherty, Michael, Tim L. Jansen, George Nuki, Eliseo Pascual, Fernando Perez-Ruiz, Leonardo Punzi, Alexander K. So, and Thomas Bardin. "Gout: why is this curable disease so seldom cured?" Annals of the Rheumatic Diseases 71, no. 11 (August 3, 2012): 1765–70. http://dx.doi.org/10.1136/annrheumdis-2012-201687.
Повний текст джерелаАнотація:
Gout is the most common inflammatory arthritis and one in which pathogenesis and risk factors are best understood. One of the treatment objectives in current guidelines is ‘cure’. However, audits show that only a minority of patients with gout receive adequate advice and treatment. Suboptimal care and outcomes reflect inappropriately negative perceptions of the disease, both in patients and providers. Historically, gout has been portrayed as a benign and even comical condition that is self-inflicted through overeating and alcohol excess. Doctors often focus on managing acute attacks rather than viewing gout as a chronic progressive crystal deposition disease. Urate-lowering treatment is underprescribed and often underdosed. Appropriate education of patients and doctors, catalysed by recent introduction of new urate-lowering treatments after many years with no drug development in the field, may help to overcome these barriers and improve management of this easily diagnosed and curable form of potentially severe arthritis.
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Wu, Xinghong, and Chongge You. "The biomarkers discovery of hyperuricemia and gout: proteomics and metabolomics." PeerJ 11 (January 6, 2022): e14554. http://dx.doi.org/10.7717/peerj.14554.
Повний текст джерелаАнотація:
Background Hyperuricemia and gout are a group of disorders of purine metabolism. In recent years, the incidence of hyperuricemia and gout has been increasing, which is a severe threat to people’s health. Several studies on hyperuricemia and gout in proteomics and metabolomics have been conducted recently. Some literature has identified biomarkers that distinguish asymptomatic hyperuricemia from acute gout or remission of gout. We summarize the physiological processes in which these biomarkers may be involved and their role in disease progression. Methodology We used professional databases including PubMed, Web of Science to conduct the literature review. This review addresses the current landscape of hyperuricemia and gout biomarkers with a focus on proteomics and metabolomics. Results Proteomic methods are used to identify differentially expressed proteins to find specific biomarkers. These findings may be suggestive for the diagnosis and treatment of hyperuricemia and gout to explore the disease pathogenesis. The identified biomarkers may be mediators of the link between hyperuricemia, gout and kidney disease, metabolic syndrome, diabetes and hypertriglyceridemia. Metabolomics reveals the main influential pathways through small molecule metabolites, such as amino acid metabolism, lipid metabolism, or other characteristic metabolic pathways. These studies have contributed to the discovery of Chinese medicine. Some traditional Chinese medicine compounds can improve the metabolic disorders of the disease. Conclusions We suggest some possible relationships of potential biomarkers with inflammatory episodes, complement activation, and metabolic pathways. These biomarkers are able to distinguish between different stages of disease development. However, there are relatively few proteomic as well as metabolomic studies on hyperuricemia and gout, and some experiments are only primary screening tests, which need further in-depth study.
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Howren, Alyssa, Drew Bowie, Hyon K. Choi, Sharan K. Rai, and Mary A. De Vera. "Epidemiology of Depression and Anxiety in Gout: A Systematic Review and Metaanalysis." Journal of Rheumatology 48, no. 1 (March 1, 2020): 129–37. http://dx.doi.org/10.3899/jrheum.190974.
Повний текст джерелаАнотація:
Objective.To conduct a systematic review of depression and anxiety among patients with gout that specifically evaluates the prevalence, incidence, determinants, and effects of these mental health comorbidities.Methods.We conducted a literature search in Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO using indexed terms and key words to identify studies reporting on depression/anxiety in patients with gout. This review included full-text articles published in English that reported on patients with gout, evaluated depression/anxiety using a routinely reported measure, and provided estimates or sufficient data on the prevalence, incidence, determinants, or effects of depression/anxiety. Metaanalyses were conducted using random effects models.Results.Twenty of 901 articles identified through the search strategy met our inclusion criteria. All 20 studies evaluated depression, while only 10 assessed anxiety (50%). Metaanalyses suggest a positive association between mental health disorders and gout, as resultant pooled OR were 1.29 (95% CI 1.07–1.56) for depression and 1.29 (95% CI 0.96–1.73) for anxiety. Findings from four studies reporting on the incidence of depression in patients with gout resulted in a pooled HR of 1.17 (95% CI 1.01–1.36). Significant determinants of depression included number of tophi, frequency of flares, and oligo/polyarticular gout.Conclusion.Our systematic review suggests that depression and anxiety are significantly associated with gout, highlighting the need for future research to focus on the onset of mental disorders after gout diagnosis. We also identify potential targets for intervention.
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Kiltz, U., J. Smolen, T. Bardin, A. Cohen Solal, N. Dalbeth, M. Doherty, B. Engel, et al. "Treat-to-target (T2T) recommendations for gout." Annals of the Rheumatic Diseases 76, no. 4 (September 22, 2016): 632–38. http://dx.doi.org/10.1136/annrheumdis-2016-209467.
Повний текст джерелаАнотація:
ObjectivesThe treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout.MethodsA committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived.ResultsAlthough no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance.ConclusionsThis is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon.
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Garanin, A. A., N. L. Novichkova, and N. L. Novichkova. "Prospects of anti-inflammatory and urate-lowering therapy of gout: A vector from the past to the future." Rheumatology Science and Practice 60, no. 2 (May 14, 2022): 205–13. http://dx.doi.org/10.47360/1995-4484-2022-205-213.
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The article provides an overview of new and promising drugs aimed at anti-inflammatory and urate-lowering therapy of gout, both already registered and used in clinical practice, and at the stages of implementation or clinical research and demonstrating their high efficacy and safety. Modern views and approaches to the treatment of gout, reflected in foreign and domestic clinical recommendations, are shown. Emphasis is placed on the safety and efficacy of colchicine in gouty arthritis and its cardioprotective properties in comorbid patients suffering from gout in combination with cardiovascular pathology. Information is provided on the effectiveness of new anti-inflammatory drugs for symptomatic therapy of gout: kanakinumab, according to the experience of which our country occupies a leading position in Europe. The efficacy and safety of anakinra allows us to consider the drug as an effective alternative to the traditional approach to antiinflammatory therapy of gout. Rilonacept provides doctors with more potential treatment algorithms in a population of patients with gout that is difficult to treat with traditional treatment. The historical data on the use of adrenocorticotropic hormone as an anti-inflammatory agent in gout are given. Information on reserve, new and promising urate-lowering drugs is provided. The focus is on the safety and efficacy of febuxostat, based on the results of recent large randomized clinical trials. Other drugs that reduce the level of uric acid in the blood plasma are considered: uricosuric agents (probenecid, benzbromarone, sulfinpyrazone, lezinurad, verinurad, dotinurad and archalophenate), xanthine oxidase inhibitors (allopurinol and topiroxostat), pegylated uricase preparations (pegloticase and rasburicase), which can be considered in the future as reserve drugs with the possibility of combined applications with the main means for urate-lowering therapy.
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Te Karu, Leanne, Matire Harwood, Linda Bryant, Tim Kenealy, and Bruce Arroll. "Compounding inequity: a qualitative study of gout management in an urban marae clinic in Auckland." Journal of Primary Health Care 13, no. 1 (2021): 27. http://dx.doi.org/10.1071/hc20112.
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ABSTRACT INTRODUCTIONGout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIMThis study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODSSemi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTSThree themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was intertwined with socioeconomic disadvantage, precariousness of employment and entrenched inaccurate (yet pliable) patient views on gout, to the detriment of focused, effective care. Structural and funding demands on providers inhibited staff focus on the clear community need. Providers saw the culturally safe and competent approach necessary for improvement as requiring community empowerment with appropriate clinical tools and adequate resourcing. DISCUSSIONDespite provider intent to deliver culturally appropriate and safe care and equitable health outcomes for patients suffering from gout, general practice initiatives without aligned resourcing or incentives are inhibited when inequity is pervasive. Simply asking Māori providers to do more for the same amount of resource may not be effective.
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SINGH, JASVINDER A., WILL J. TAYLOR, LEE S. SIMON, PUJA P. KHANNA, LISA K. STAMP, FIONA M. McQUEEN, TUHINA NEOGI, et al. "Patient-reported Outcomes in Chronic Gout: A Report from OMERACT 10." Journal of Rheumatology 38, no. 7 (July 2011): 1452–57. http://dx.doi.org/10.3899/jrheum.110271.
Повний текст джерелаАнотація:
Objective.To summarize the endorsement of measures of patient-reported outcome (PRO) domains in chronic gout at the 2010 Outcome Measures in Rheumatology Meeting (OMERACT 10).Methods.During the OMERACT 10 gout workshop, validation data were presented for key PRO domains including pain [pain by visual analog scale (VAS)], patient global (patient global VAS), activity limitation [Health Assessment Questionnaire-Disability Index (HAQ-DI)], and a disease-specific measure, the Gout Assessment Questionnaire version 2.0 (GAQ v2.0). Data were presented on all 3 aspects of the OMERACT filters of truth, discrimination, and feasibility. One PRO, health-related quality of life measurement with the Medical Outcomes Study Short-form 36 (SF-36), was previously endorsed at OMERACT 9.Results.One measure for each of the 3 PRO of pain, patient global, and activity limitation was endorsed by > 70% of the OMERACT delegates to have appropriate validation data. Specifically, pain measurement by VAS was endorsed by 85%, patient global assessment by VAS by 73%, and activity limitation by HAQ-DI by 71%. GAQ v2.0 received 30% vote and was not endorsed due to several concerns including low internal consistency and lack of familiarity with the measure. More validation studies are needed for this measure.Conclusion.With the endorsement of one measure each for pain, patient global, SF-36, and activity limitation, all 4 PRO for chronic gout have been endorsed. Future validation studies are needed for the disease-specific measure, GAQ v2.0. Validation for PRO for acute gout will be the focus of the next validation exercise for the OMERACT gout group.
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Mody, Girish M. "Update on hyperuricaemia and gout with evidence based management guidelines." South African Family Practice 57, no. 4 (July 1, 2015): 6. http://dx.doi.org/10.4102/safp.v57i4.4162.
Повний текст джерелаАнотація:
Gout is now the leading cause of inflammatory arthritis, affecting 1–2% of the population. The metabolic syndrome, cardiovascular risk factors, cardiovascular events and mortality are more common with gout. However, the role of uric acid as an independent risk factor is inconclusive. The identification of urate transporters has improved our understanding of urate homeostasis and identified targets for the development of newer drugs. Experience with ultrasound and dual energy computed tomography led to the detection of urate crystals in patients with asymptomatic hyperuricaemia. Several evidence-based management guidelines are now available. The dietary and lifestyle recommendations focus on general health and management of comorbidities. A low dose colchicine regimen is effective and better tolerated than the traditional use of higher doses in acute gout. Alternative measures for acute gout include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Allopurinol is the most widely used initial therapy; treatment is started with 100 mg or less per day, and titrated upwards to achieve a target level of 0.36 mmol/l (in patients with tophi, a lower target of 0.30 mmol/l is recommended). A new non-purine more potent xanthine oxidase inhibitor, febuxostat, is available (currently not registered in South Africa). Probenecid is the most widely used uricosuric agent. Prophylactic therapy with colchicine, NSAIDs or corticosteroids is used when urate lowering therapy is initiated. Although the cause of gout is known and effective treatment is available, gout is poorly managed worldwide with failure to achieve the target urate level.
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Gromova, M. A., and V. V. Tsurko. "New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points." Russian Medical Inquiry 5, no. 2 (2021): 89–95. http://dx.doi.org/10.32364/2587-6821-2021-5-2-89-95.
Повний текст джерелаАнотація:
In May 2020, the updated recommendations of the American College of Rheumatology on the patient management with gout were published. The focus was on the indications for urate-lowering therapy (ULT) and its optimal use, treatment of gout flares, and the importance of lifestyle. A consensus based on current literature and patient preferences resulted in 42 recommendations. The sixteen highly recommended provisions included the following: ULT should be prescribed to all patients with tophi, radiological signs of joint damage or frequent gout flares; allopurinol should be preferred as a ULT first-line drug, including for patients with chronic kidney disease (CKD) above stage III; ULT regimen should begin at a low initial dose of allopurinol (<100 mg/day and below in CKD) or febuxostat (<40 mg/day); the treatment tactics should achieve the goal with dose titration under the control of the serum uric acid (SUA) level to maintain <6 mg/dL (<360 mmol/L). At the beginning of treatment, concomitant anti-inflammatory prophylactic therapy of at least 3–6 months was strongly recommended. Colchicine, nonsteroidal anti-inflammatory drugs or glucocorticoids (oral, intra-articular, or intramuscular) were suggested for the treatment of gout flares. The purpose of this publication was to inform physicians decision-making on the gout treatment about the patient management algorithm and the need to achieve the target level of SUA to prevent flares and complications of the disease. KEYWORDS: gout, hyperuricemia, clinical recommendations, urate-lowering therapy, diet, lifestyle, food, treatment. FOR CITATION: Gromova M.A., Tsurko V.V. New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points. Russian Medical Inquiry. 2021;5(2):89–95. DOI: 10.32364/2587-6821-2021-5-2-89-95.
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Ilyina, A. E., and V. G. Barskova. "How to optimize treatment in patients with gout and chronic arthritis Urisan is in focus." Modern Rheumatology Journal, no. 1 (March 25, 2009): 49. http://dx.doi.org/10.14412/1996-7012-2009-523.
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Serlachius, Anna, Kiralee Schache, Anel Kieser, Bruce Arroll, Keith Petrie, and Nicola Dalbeth. "Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial." JMIR mHealth and uHealth 7, no. 8 (August 13, 2019): e15021. http://dx.doi.org/10.2196/15021.
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Background Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. Objective Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. Methods Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. Results Participants rated the gout app as more engaging (mean difference –0.58, 95% CI –0.96 to –0.21) and more informative (mean difference –0.34, 95% CI –0.67 to –0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference –0.64, 95% CI –1.27 to –0.003) and higher knowledge/understanding of gout (mean difference –0.70, 95% CI –1.30 to –0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference –2.43, 95% CI –3.68 to –1.18), stronger beliefs regarding the severity of symptoms (mean difference –1.97, 95% CI –3.12 to –0.82), and a stronger emotional response to gout (mean difference –2.38, 95% CI –3.85 to –0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. Conclusions Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.
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Adrian, Rinaldi, Yeanneke Liesbeth Tinungki, and Gracia Christy Tooy. "ASUHAN KEPERAWATAN PADA SALAH SATU ANGGOTA KELUARGA DENGAN GANGGUAN MOBILITAS FISIK AKIBAT GOUT ARTRITIS DI WILAYAH KERJA PUSKESMAS TAHUNA BARAT." Jurnal Ilmiah Sesebanua 5, no. 1 (January 21, 2021): 9–13. http://dx.doi.org/10.54484/jis.v5i1.354.
Повний текст джерелаАнотація:
Gout Artritis merupakan salah satu penyakit yang telah lama dikenal dan sampai saat ini masih menjadi penyebab berbagai penyakit. Prevalensi gout artritis menurut World Health Organization (WHO) tahun 2018 gout artritis mengalami kenaikan dengan jumlah 1.370 (33,3%). Gangguan mobilitas fisik ini sering menjadi masalah keperawatan pada kasus Gout Artritis akibat kadar purin tinggi dalam darah, maka tubuh akan meresponnya dengan ditandai adanya hambatan mobilitas fisik pada sendi, menggigil dan badan lemah. Tujuan studi kasus diketahuinya asuhan keperawatan pada salah satu keluarga dengan gangguan mobilitas fisik akibat gout artritis di wilayah kerja Puskesmas Tahuna Barat. Metode studi kasus adalah desain studi kasus deskriptif dengan subjek studi kasus satu orang klien yang diamati dan berfokus untuk mengajarkan latihan rentang gerak (ROM) dan melibatkan keluarga untuk membantu klien dalam meningkatkan pergerakan. Hasil yang diperoleh : Diagnosa keperawatan gangguan mobilitas fisik berhubungan dengan ketidakmampuan keluarga dalam merawat anggota keluarga yang sakit, subjek studi kasus ditemukan nyeri pada lutut dan keluarga tidak tahu perawatan yang dibutuhkan untuk menanggulangi masalah kesehatan atau penyakit yang dialami yang menyebabkan gangguan mobilitas fisik. Kesimpulan : Masalah pada klien teratasi karena klien sudah dapat bergerak walaupun nyeri hilang dan sudah dapat melakukan mobilisasi dini dengan adanya dukungan keluarga. Saran : Perawat lebih meningkatkan pelayanan serta dapat memberikan pendidikan kesehatan pada klien yang menderita gout artritis.
Gout artritis is a disease that has been known for a long time and is still the cause of various diseases. The prevalence of gout artritis to the World Health Organization (WHO) in 2018 gout artritis has increased by 1370 (33,3%). Impaired physical mobility was often a nursing problem in cases of Gout artritis due to high levels of purines in the body´s blood which responds to it by being marked by obstacles to physical mobility in the joints, chills and weakness. The purpose of the case study was to find out nursing care in a family with impaired physical mobility due to gout artritis in the work area Puskesmas of the Tahuna Barat. The case study method was a descriptive case study design with a case study subject of one client who was observed and focus on teaching range of motion (ROM) exercise and involve the family to assist the client in improving movement. The result obtained: Nursing diagnosis of impaired physical mobility related to the inability of the family to care of sick family members, case study subjects found knee pain and the family who did not know the treatment needed to overcome health problem or illnesses that caused physical mobility problems. Conclusion: The Problem in the client was resolved because the client was able to move even though the pain was gone and can do early mobilization with family support. Suggestion: Nurse improve services and can provide health education to client who suffering from gout artritis.
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Isnayanti, Putri, and Herni Rejeki. "Penerapan Kompres Hangat Menggunakan Jahe Merah Untuk Menurunkan Nyeri Pada Lansia Dengan Gout Arthtritis." Prosiding Seminar Nasional Kesehatan 1 (December 3, 2021): 750–54. http://dx.doi.org/10.48144/prosiding.v1i.746.
Повний текст джерелаАнотація:
AbstractGout Arthtritis is a disease, often occurs in the elderly. The symptoms are swelling, redness, heat and pain at night. One of the ways to overcome the disorder is by warm compressing using red ginger. This study aims to apply warm compress using red ginger in reduding pain. To be known, it focused two elderly with gout arthtritis. The result shows by applying the technique, it reduced a pain scale in the fifth meeting. From the first client, it can reduce a pain scale of 9 to 2. Meanwhile, it can reduce a pain scale of 8 to 3 from the second one. The conclusion is the warm compress technique using red ginger could reduce a pain scale in the elderly with gout arthtritis. Therefore, it is expected to apply this technique regularly. Keywords: Gout arthtritis; Warm compress using red gingers; Elderly; Pain
AbstrakGout arthtrtitis merupakan penyakit yang sering terjadi pada lansia. Gejala dari gout arthtrtitis itu sendiri yaitu terjadi pembengkakan, kemerahan, timbul rasa panas dan nyeri pada malam hari, untuk meringankan rasa sakit tersebut. Salah satu tindakan dengan terapi non farmakologi yang dapat dilakukan untuk menurunkan nyeri adalah teknik kompres hangat menggunakan jahe merah. Studi kasus ini bertujuan untuk menerapkan kompres hangat menggunakan jahe merah dalam menurunan nyeri. Fokus studi kasus yaitu pada 2 lansia dengan masalah gout arthritis. Hasil studi kasus menunjukkan teknik kompres hangat menggunakan jahe merah dapat menurunkan skala nyeri pada pertemuan ke 5. Klien pertama dari skala nyeri 9 menjadi 2, sedangkan klien yang kedua dari skala nyeri 8 menjadi 3. Kesimpulannya adalah bahwa teknik kompres hangat menggunakan jahe merah dapat menurunkan skala nyeri pada lansia dengan gout arthtritis. Saran bagi pasien untuk melakukan teknik kompres hangat menggunakan jahe merah dengan rutin dan teratur.Kata kunci : Gout Arthtritis; Kompres hangat jahe merah; Lansia; Nyeri
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Kim, Seong-Kyu. "Interrelationship of Uric Acid, Gout, and Metabolic Syndrome: Focus on Hypertension, Cardiovascular Disease, and Insulin Resistance." Journal of Rheumatic Diseases 25, no. 1 (2018): 19. http://dx.doi.org/10.4078/jrd.2018.25.1.19.
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Jones, Graeme, Elena Panova, and Richard Day. "Guideline development for the management of gout: role of combination therapy with a focus on lesinurad." Drug Design, Development and Therapy Volume 11 (October 2017): 3077–81. http://dx.doi.org/10.2147/dddt.s97959.
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Kim, S. K., H. Lee, J. H. Kim, S. H. Park, S. K. Lee, and J. Y. Choe. "Potential interest of dual-energy computed tomography in gout: focus on anatomical distribution and clinical association." Rheumatology 52, no. 2 (December 3, 2012): 402–3. http://dx.doi.org/10.1093/rheumatology/kes308.
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Kim, M.-S., A. Naqavi, T. Scharf, K. J. Weible, R. Völkel, C. Rockstuhl, and H. P. Herzig. "Experimental and theoretical study of the Gouy phase anomaly of light in the focus of microlenses." Journal of Optics 15, no. 10 (September 20, 2013): 105708. http://dx.doi.org/10.1088/2040-8978/15/10/105708.
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Schumacher, H. R., M. A. Becker, E. Lloyd, P. A. MacDonald, and C. Lademacher. "Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study." Rheumatology 48, no. 2 (November 2, 2008): 188–94. http://dx.doi.org/10.1093/rheumatology/ken457.
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Yu, Junjie, Changhe Zhou, Wei Jia, Jun Wu, and Yancong Lu. "Manifestation of Gouy phase anomaly in a coaxial focus array generated by a Dammann zone plate." Journal of the Optical Society of America A 31, no. 5 (April 18, 2014): 1059. http://dx.doi.org/10.1364/josaa.31.001059.
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Cavagna, L., and W. J. Taylor. "The Emerging Role of Biotechnological Drugs in the Treatment of Gout." BioMed Research International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/264859.
Повний текст джерелаАнотація:
One of the most important therapeutic advances obtained in the field of rheumatology is the availability of the so-called bio(techno)logical drugs, which have deeply changed treatment perspectives in diseases such as rheumatoid arthritis and ankylosing spondylitis. According to the steadily increasing attention on gout, due to well-established prognostic and epidemiology implications, in the last 5 years, the same change of perspective has been observed also for this disease. In fact, several bio(techno)logical agents have been investigated both for the management of the articular gout symptoms, targeting mainly interleukin-1β, as well as urate-lowering therapies such as recombinant uricases. Among the IL-1βinhibitors, the majority of studies involve drugs such as anakinra, canakinumab, and rilonacept, but other compounds are under development. Moreover, other potential targets have been suggested, as, for example, the TNF alpha and IL-6, even if data obtained are less robust than those of IL-1βinhibitors. Regarding urate-lowering therapies, the recombinant uricases pegloticase and rasburicase clearly showed their effectiveness in gout patients. Also in this case, new compounds are under development. The aim of this review is to focus on the various aspects of different bio(techno)logical drugs in gouty patients.
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Bullock, Charles S. "Georgia: The GOP Tightens Its Grip." American Review of Politics 26 (April 1, 2005): 43–63. http://dx.doi.org/10.15763/issn.2374-7781.2005.26.0.43-63.
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The presidential election season came to an early end in Georgia. Because the state was universally acknowledged as being safe for President Bush, the parties did not contest its Electoral College votes. The focus of the 2004 election cycle in Georgia came further down the ballot. The election marked the first time that Georgia elected a second Republican senator. The state had one of only three instances in which a House incumbent whose congressional seat had not been redistricted lost. Even more dramatically, Republicans took control of both chambers of the state legislature for the first time in more than 130 years.
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Jones, Graeme, Elena Panova, and Richard Day. "Guideline development for the management of gout: role of combination therapy with a focus on lesinurad [Corrigendum]." Drug Design, Development and Therapy Volume 11 (December 2017): 3589–90. http://dx.doi.org/10.2147/dddt.s158965.
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Douša, Jan, and Gabriel Győri. "Database for tropospheric product evaluations - implementation aspects." Geoinformatics FCE CTU 10 (November 30, 2013): 39–52. http://dx.doi.org/10.14311/gi.10.4.
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The high-performance GOP Tropo database for evaluating tropospheric products has been developed at the Geodetic Observatory Pecný. The paper describes initial database structure and aimed functionality. Special focus was given to the optimizing effort in order to handle billions of records. Evaluation examples demonstrate its current functionality, but future extensions and developments are outlined too.
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Nysom Christiansen, S., F. C. Müller, M. Ǿstergaard, O. Slot, J. Møllenbach Møller, H. F. Børgesen, K. K. Gosvig, and L. Terslev. "OP0177 PROPERTIES AND LOCATIONS OF COLOR-CODED DUAL ENERGY CT LESIONS IN GOUT PATIENTS – A SYSTEMATIC EVALUATION." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 110.1–110. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1757.
Повний текст джерелаАнотація:
Background:Dual energy CT (DECT) has diagnostic potential in gout patients. DECT can automatically colour-code presumed urate deposits based on radiodensity (Hounsfield Units, HU) and DECT ratio (difference in attenuation between high and low kV series) of lesions. However, other materials may imitate properties of urate deposits, most importantly calcium-containing material, dense tendons and artefacts, which may lead to misinterpretations. The characteristics of DECT lesions in gout patients have not yet been systematically investigated.Objectives:To evaluate the properties and locations of colour-coded DECT lesions in gout patients.Methods:DECT were performed in patients with suspected gout. Patients were separated into gout and non-gout patients based on joint fluid microscopy findings. DECT of the hands, knees and feet were performed using default gout settings and colour-coded lesions were registered. Only location-relevant lesions were analysed (e.g. nail bed artefacts excluded). Mean density (mean of HU at 80 kV and Sn150 kV), mean DECT ratio, size and location of each lesion was determined.Subgroup analysis was performed post-hoc evaluating potential differences in properties and locations of lesions. Lesions were separated into groups according to properties (Figure 1, grey box): 1)Size—to separate artefacts characterised by small volume (possible artefacts). 2)DECT ratios—to separate calcium-containing material characterised by high DECT ratio (possible calcium-containing material). 3)Density—to separate dense tendons characterised by low DECT ratio and low HU values (possible dense tendons). Lesion fulfilling all urate characteristics (large volume, low DECT ratio, high density) were labelleddefinite urate deposits. Finally, for non-gout patients, properties ofnon-gout urate-imitation lesions(properties asdefinite urate deposits) were analysed.Results:In total, 3918 lesions (all lesions) were registered in gout patients (n=23), with mean DECT ratio 1.06 (SD 0.13), median density 160.6 HU and median size 6 voxels (Figure 1, blue box). Lesions were seen in all analysed joints, most frequently MTP1 joints (medial side), knee joints and midtarsal joints (Figure 2a). Tendon affections were also common, especially in the knee tendons (patella and quadriceps), malleolus-related tendons (e.g. peroneus and tibialis posterior) and the Achilles tendons (Figure 2a).Subgroup analyses showed thatdefinite urate deposits(figure 2b) were found at the same locations asall lesionin gout patients (figure 2a), with the four most common sites being MTP1 joints, midtarsal joints, and quadriceps and patella tendons (Figure 2b).Possible dense tendonlesions had a mean HU value of 156.5 HU—markedly higher than expected for dense tendons (<100HU)—and lesion-locations were similar todefinite urate deposits(data not shown), indicating that they primarily consisted of true urate deposits. In contrast,possible calcium-containing materialandnon-gout urate-imitating lesionshad distinctly different properties (ratios 1.33 and 1.20, respectively) (Figure 1, yellow and orange box). Furthermore, the locations of these lesions were different fromdefinite urate depositssince they were primarily found in a few weight-bearing joints (knee, midtarsal and talocrural including malleolus regions) and tendons (Achilles and quadriceps), whereas no lesions were found in either MTP1 joints or patella tendons (figure 2c).Conclusion:DECT color-coded lesions in gout patients are heterogeneous in properties and locations. Subgroup analyses found that locations such as MTP1 joints and patella tendons were characterised by almost only showingdefinite urate deposits. A sole focus on these regions in the evaluation of gout patients may therefore improve specificity of DECT scans.Disclosure of Interests:Sara Nysom Christiansen Speakers bureau: SNC has received speaker fees from Bristol Myers Squibb (BMS) and General Electric (GE)., Felix C Müller Employee of: Siemens Healthineers., Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Ole Slot: None declared, Jakob Møllenbach Møller: None declared, Henrik F Børgesen: None declared, Kasper K Gosvig: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen.
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CURTO, Raul, O. Eberhard VOIT, and Marta CASCANTE. "Analysis of abnormalities in purine metabolism leading to gout and to neurological dysfunctions in man." Biochemical Journal 329, no. 3 (February 1, 1998): 477–87. http://dx.doi.org/10.1042/bj3290477.
Повний текст джерелаАнотація:
A modelling approach is used to analyse diseases associated with purine metabolism in man. The specific focus is on deficiencies in two enzymes, hypoxanthine:guanine phosphoribosyltransferase and adenylosuccinate lyase. These deficiencies can lead to a number of symptoms, including neurological dysfunctions and mental retardation. Although the biochemical mechanisms of dysfunctions associated with adenylosuccinate lyase deficiency are not completely understood, there is at least general agreement in the literature about possible causes. Simulations with our model confirm that accumulation of the two substrates of the enzyme can lead to significant biochemical imbalance. In hypoxanthine:guanine phosphoribosyltransferase deficiency the biochemical mechanisms associated with neurological dysfunctions are less clear. Model analyses support some old hypotheses but also suggest new indicators for possible causes of neurological dysfunctions associated with this deficiency. Hypoxanthine:guanine phosphoribosyltransferase deficiency is known to cause hyperuricaemia and gout. We compare the relative importance of this deficiency with other known causes of gout in humans. The analysis suggests that defects in the excretion of uric acid are more consequential than defects in uric acid synthesis such as hypoxanthine:guanine phosphoribosyltransferase deficiency.
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Mccormick, N., L. Lu, C. Yokose, A. Joshi, T. Merriman, K. Saag, Y. Zhang, and H. Choi. "POS0155 WHAT DRIVES RACIAL DISPARITIES IN GOUT IN THE US? – POPULATION-BASED, SEX-SPECIFIC, CASUAL MEDIATION ANALYSIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 305–6. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2967.
Повний текст джерелаАнотація:
BackgroundTraditionally viewed as a disease of White men, global frequency and disability burden of female gout are rising disproportionately to male gout.1 Moreover, emerging US cohort data suggest gout and hyperuricemia impart larger burdens on Black adults than Whites.2 These racial disparities may be largely attributable to differences in non-genetic, mainly modifiable gout risk factors e.g., BMI, diet,3,4 and chronic kidney disease (CKD). However, national-level, general population data on racial differences in burden of gout, and potential mediators, are lacking.ObjectivesTo determine and quantify sex-specific mediators of racial disparities in gout prevalence among a nationally representative sample of US adults.MethodsUsing recent decadal data (2007-2016) on physician-diagnosed gout and hyperuricemia from the National Health and Nutrition Examination Survey, we compared contemporary sex- and race-specific prevalences and conducted sequential causal mediation analysis (adjusting for upstream mediators following causal pathways)5 to determine the proportion of the racial differences attributable to 7 potentially mediating social and clinical factors (see DAG in Figure 1): low education, poverty, body mass index (BMI), alcohol, poor quality diet (poor DASH adherence), diuretic use, and CKD (eGFR <60 mL/min, using the latest equations that do not include a coefficient for Black race6, per National Kidney Foundation and American Society of Nephrology recommendations.7)ResultsAge standardised prevalence of gout was 3.5% and 2.0% in Black and White women, respectively (age-adjusted OR =1.8 [95% CI: 1.3 to 2.5]), and 7.0% and 5.4% in Black and White men (age-adjusted OR =1.3 [1.0 to 1.6]). Most risk factors were more frequent/elevated in Blacks than Whites, except alcohol consumption, which was lower in Blacks (both sexes). BMI levels and poverty were higher in Black women, but similar between Black and White men.Largest mediating factor of excess gout cases among Black women was excess BMI, accounting for 56% of the racial difference (independent of education, poverty, diet, and alcohol), followed by CKD (24%), poverty (17%), and poor diet (12%) (see Table 1).Table 1.Indirect (mediation) effects of potential mediators, using sequential mediation analysis, for the association between Black race and odds of gout in US women and men.WOMENMENEffect Estimate (OR), 95% CIProportion Mediated, %Effect Estimate (OR), 95% CIProportion Mediated, %Indirect (Mediation) EffectEducation (high school or less)1.01 (0.98 to 1.03)2.4%1.01 (0.98 to 1.03)3.3%Poverty1.07 (1.04 to 1.10)16.9%1.00 (0.99 to 1.00)0.53%Alcohol consumption (# drinks/week, continuous)0.99 (0.96 to 1.01)-3.4%0.99 (0.98 to 1.00)-4.5%DASH diet score (continuous; higher scores = ↓ adherence)1.05 (0.96 to 1.01)12.0%1.05 (1.01 to 1.10)19.8%Body mass index (continuous)1.25 (1.14 to 1.37)55.9%1.03 (1.02 to 1.04)11.9%Diuretic use1.03 (1.01 to 1.05)7.6%1.04 (1.02 to 1.06)14.2%Chronic kidney disease1.10 (1.04 to 1.16)23.9%1.12 (1.08 to 1.17)45.6%Direct Effect0.94 (0.68 to 1.30)a−15.2%1.02 (0.83 to 1.26)b9.2%Total Effect1.49 (1.12 to 1.98)100%1.29 (1.05 to 1.57)100%DASH=Dietary Approaches to Stop Hypertension;ap=0.52,bp=0.83Among men, CKD was the largest mediator (46%), followed by poor diet (20%) and diuretic use (14%). BMI (12%) and poverty (0.5%) mediated smaller proportions of the racial difference among men compared to women. Mediators of racial differences in hyperuricemia closely agreed with gout results.ConclusionContrasting with historical views, gout is more frequent among Black adults in the US than their White counterparts, especially women (two-times greater in Black women vs. White). Culturally informed efforts to reduce these disparities should focus on excess adiposity, diet quality, and kidney disease while recognising the impact of poverty in female gout.References[1]Xia; PMID 31624843[2]PMID 24335384[3]Rai BMJ PMID 28487277[4]Yokose JAMA IM (2022)[5]VanderWeele; PMID 25580377[6]NEJM PMID 34554658[7]JASN PMID 34556489Disclosure of InterestsNatalie McCormick: None declared, Leo Lu: None declared, Chio Yokose: None declared, Amit Joshi: None declared, Tony Merriman: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart.Grant/research support from: Ironwood, Horizon
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Zhang, Shuangshuang, Yong Wang, Jinsong Cheng, Ning Huangfu, Ruochi Zhao, Zhenyu Xu, Fuxing Zhang, Wenyuan Zheng, and Dandan Zhang. "Hyperuricemia and Cardiovascular Disease." Current Pharmaceutical Design 25, no. 6 (June 12, 2019): 700–709. http://dx.doi.org/10.2174/1381612825666190408122557.
Повний текст джерелаАнотація:
Purine metabolism in the circulatory system yields uric acid as its final oxidation product, which is believed to be linked to the development of gout and kidney stones. Hyperuricemia is closely correlated with cardiovascular disease, metabolic syndrome, and chronic kidney disease, as attested by the epidemiological and empirical research. In this review, we summarize the recent knowledge about hyperuricemia, with a special focus on its physiology, epidemiology, and correlation with cardiovascular disease. This review also discusses the possible positive effects of treatment to reduce urate levels in patients with cardiovascular disease and hyperuricemia, which may lead to an improved clinical treatment plan.
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El-Sayed, Sherihan, Sally Freeman, and Richard A. Bryce. "A Selective Review and Virtual Screening Analysis of Natural Product Inhibitors of the NLRP3 Inflammasome." Molecules 27, no. 19 (September 21, 2022): 6213. http://dx.doi.org/10.3390/molecules27196213.
Повний текст джерелаАнотація:
The NLRP3 inflammasome is currently an exciting target for drug discovery due to its role in various inflammatory diseases; however, to date, no NLRP3 inhibitors have reached the clinic. Several studies have used natural products as hit compounds to facilitate the design of novel selective NLRP3 inhibitors. Here, we review selected natural products reported in the literature as NLRP3 inhibitors, with a particular focus on those targeting gout. To complement this survey, we also report a virtual screen of the ZINC20 natural product database, predicting favored chemical features that can aid in the design of novel small molecule NLRP3 inhibitors.
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Baybutt, Michelle, Mark Dooris, and Alan Farrier. "Growing health in UK prison settings." Health Promotion International 34, no. 4 (May 29, 2018): 792–802. http://dx.doi.org/10.1093/heapro/day037.
Повний текст джерелаАнотація:
Abstract Globally, prisoners tend to come from marginalized and socially disadvantaged sections of the society and exhibit a high incidence of ill health, linked to social exclusion and multiple complex needs. Prisons therefore offer an important opportunity to tackle inequality and injustice, through promoting health, reducing reoffending and facilitating community reintegration.This paper reports on and critically discusses findings from an evaluative research study, which aimed to identify and explore impacts of prisoners’ participation in an innovative social and therapeutic horticultural programme, ‘Greener on the Outside for Prisons’ (GOOP), delivered in prisons in North West England. Focus groups with 16 prisoners and semi-structured interviews with six prison staff were conducted at five sites. Presented under three overarching themes (health and well-being; skills development, employability, and work preparedness; and relationships), findings suggest that engagement with and participation in GOOP were important in improving positive mental well-being, increasing physical activity and knowledge about healthier eating; developing skills and work readiness; and building relationships and catalysing and strengthening prosocial behaviours, important for good citizenship and effective resettlement. The paper concludes that – in the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide – prison-based horticulture can offer multiple benefits and make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. Furthermore, it contends that by joining up health and justice agendas, programmes such as GOOP have the potential to serve as powerful catalysts for wider systemic change, thereby helping tackle inequalities and social exclusion within societies across the globe.
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Kim, Myun-Sik, Alberto da Costa Assafrao, Toralf Scharf, Carsten Rockstuhl, Silvania F. Pereira, H. Paul Urbach, and Hans Peter Herzig. "Longitudinal–differential phase distribution near the focus of a high numerical aperture lens: study of wavefront spacing and Gouy phase." Journal of Modern Optics 60, no. 3 (February 2013): 197–201. http://dx.doi.org/10.1080/09500340.2013.765053.
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Hull, Sidsel Dan, Marianne Welzel Andersen, Jessica Bengtsson, Nils Skovgaard, Marie Balslev Backe, and Michael Lynge Pedersen. "Prevalence of Patients Receiving Urate-Lowering Medicine in Greenland and Denmark: A Cross-Sectional Case–Control Study." International Journal of Environmental Research and Public Health 19, no. 12 (June 13, 2022): 7247. http://dx.doi.org/10.3390/ijerph19127247.
Повний текст джерелаАнотація:
This study estimates the age- and sex-specific prevalence of patients receiving urate-lowering therapy (ULT) in Greenland and compares the results with estimates in Denmark. Characteristics of patients receiving ULT in Greenland were compared to age- and sex-matched controls. The study was designed as a cross-sectional case–control study based on nationwide data from medical and population registers in Greenland and Denmark. The prevalence of patients receiving ULT was significantly lower in Greenland (0.55%) compared to Denmark (1.40%) (p < 0.001). In both countries, the prevalence increased with age and was higher among men compared to women. In Greenland, patients receiving ULT were more often overweight, and more frequently received blood glucose-, lipid-, and blood pressure-lowering medicine including diuretics compared to age- and sex-matched controls. The prevalence of patients receiving ULT was significantly lower in Greenland compared to Denmark. Common life-style related risk factors for hyperuricemia and gout were observed frequently among ULT-treated patients compared to controls. Along with an increasing prevalence of lifestyle-related diseases in Greenland, the prevalence of patients receiving ULT may increase in the years to come. More focus on detection and management of hyperuricemia and gout in Greenland is warranted to improve quality of health care.
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Sultanova, Regina F., Ryan Schibalski, Irina A. Yankelevich, Krisztian Stadler, and Daria V. Ilatovskaya. "Sex differences in renal mitochondrial function: a hormone-gous opportunity for research." American Journal of Physiology-Renal Physiology 319, no. 6 (December 1, 2020): F1117—F1124. http://dx.doi.org/10.1152/ajprenal.00320.2020.
Повний текст джерелаАнотація:
Sex differences (biological distinctions between males and females) present a complex interplay of genetic, developmental, biological, and environmental factors. More and more studies are shedding light on the importance of sex differences in normal physiology and susceptibility to cancer, cardiovascular and renal conditions, and neurodegenerative diseases. This mini-review is devoted to the role of sex dimorphisms in renal function, with a focus on the distinctions between male and female mitochondria. Here, we cover the aspects of renal mitochondrial bioenergetics where sex differences have been reported to date, for instance, biogenesis, reactive oxygen species production, and oxidative stress. Special attention is devoted to the effects of sex hormones, such as estrogen and testosterone, on mitochondrial bioenergetics in the kidney in physiology and pathophysiology.
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Tomasoa, Valensya Yeslin, Joan Herly Herwawan, and Alisye Siahaya. "Screening dan Pendidikan Kesehatan Bagi Lansia di Kota Ambon." Karya Kesehatan Siwalima 2, no. 1 (December 10, 2022): 1–7. http://dx.doi.org/10.54639/kks.v2i1.832.
Повний текст джерелаАнотація:
Penyakit asam urat atau biasa dikenal sebagai gout merupakan gangguan peradangan kronis autoimun atau respon autoimun, dimana imun seseorang bisa terganggu dan turun yang menyebabkan hancurnya organ sendi dan lapisan pada sinovial, terutama pada tangan, kaki dan lutut. Puskesmas Air Salobar khususnya Kelurahan Kudamati RW. 01 merupakan wilayah lokasi fokus pelayanan kesehatan karena berada di tengah perkotaan Kota Ambon. Dalam pelayanannya tentunya puskesmas Air Salobar memiliki sasaran lansia dalam pelayanannya pada usia >60 tahun. Screening kesehatan dan edukasi agar lansia sangatlah penting dilakukan untuk mengetahui masalah kesehatan yang dialami seperti gout. Metode yang dilakukan Rapid Test menggunakan alat easy touch test strip untuk mengetahui kadar asam urat lansia. Hasil Kegiatan ini adalah hasil pemeriksaan kadar asam didapatkan ada 30 lansia (65.2) yang mengalami peningkatan kadar asam urat dari 46 lansia. Diharapkan kerjasama lintas program dengan Puskesmas dan Dinas Kesehatan dan kerjasama lintas sektor dengan LSM di masyarakat karena menjadi perhatian secara serius dalam penyediaan sarana dan prasarana kegiatan penyuluhan maupun pemeriksaan kadar asam urat khususnya pada lansia.
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Snitow, Melinda E., Rahul S. Bhansali, and Peter S. Klein. "Lithium and Therapeutic Targeting of GSK-3." Cells 10, no. 2 (January 28, 2021): 255. http://dx.doi.org/10.3390/cells10020255.
Повний текст джерелаАнотація:
Lithium salts have been in the therapeutic toolbox for better or worse since the 19th century, with purported benefit in gout, hangover, insomnia, and early suggestions that lithium improved psychiatric disorders. However, the remarkable effects of lithium reported by John Cade and subsequently by Mogens Schou revolutionized the treatment of bipolar disorder. The known molecular targets of lithium are surprisingly few and include the signaling kinase glycogen synthase kinase-3 (GSK-3), a group of structurally related phosphomonoesterases that includes inositol monophosphatases, and phosphoglucomutase. Here we present a brief history of the therapeutic uses of lithium and then focus on GSK-3 as a therapeutic target in diverse diseases, including bipolar disorder, cancer, and coronavirus infections.
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Gammelgaard, Signe Leth. "Faste penge og flydende kød: Materialitet og neoklassisk økonomi i Zolas Nana og Penge." K&K - Kultur og Klasse 45, no. 124 (December 31, 2017): 171–88. http://dx.doi.org/10.7146/kok.v45i124.103917.
Повний текст джерелаАнотація:
This article examines the dynamics of matter and signifiers in Zola’s two novels Nana (1880) and Money (1891). Though Zola’s novels are often read with a focus on capital and economics workings, the context of marginalist economics contemporaneous to Zola is only vaguely described. In drawing upon Jean-Joseph Goux’s work on marginalism and Zola, this topic is addressed, and the article discusses desire, fluidity, scarcity, and value and relates this to the depiction of a disintegrating matter in Nana, and to the motifs of flesh and gold running through the novel. In the reading of Money, the focus is on reckless desire and imagination gone awry, and the push towards an increasingly disconnected abstraction that allows for rapid circulation of values. Here, the two main speculative duelists are seen as representatives of two economic paradigms, and the article finally discusses the depiction of materiality and the uses of this in the novels in the context of a society where values, in the words of Goux, are increasingly fluid and mobile.