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BACKGROUND: Many countries are seeking to eliminate tuberculosis (TB), but incidence remains high in socially excluded groups such as people experiencing homelessness. There is limited research into the effectiveness of residential respite services (RRS), which provide accomodation and social and clinical support for homeless people with active TB. METHODS: We used a register of all cases of TB diagnosed in London between 1 January 2010 and 3 October 2019 to compare characteristics and outcomes of patients treated in an RRS with patients receiving standard care. The primary outcome was successful treatment completion. We used logistic regression to compare likelihood of completing treatment, and simulation to estimate the absolute change in treatment completion resulting from this service. RESULTS: A total of 78 homeless patients finished an episode of TB treatment at the RRS. Patients treated in the RRS were more likely than patients treated in standard care to have clinical and social risk factors including drug resistance, history of homelessness, drug or alcohol use, and need for directly observed therapy. After adjusting for these factors, patients treated in the RRS had 2.97 times the odds of completing treatment (95% CI = 1.44-6.96). Treatment ended in failure for 8/78 patients treated in the RRS (10%, 95% CI = 5%-20%). We estimated that in the absence of the RRS, treatment would have ended in failure for 17/78 patients (95% CI = 11-25). CONCLUSION: The residential respite service for homeless TB patients with complex social needs was associated with better treatment outcomes.
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Personas con Mala Vivienda , Tuberculosis , Humanos , Estudios Transversales , Londres/epidemiología , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20-40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs. MATERIALS AND METHODS: We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU. RESULTS: Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%). CONCLUSION: Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.
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OBJECTIVES: The aims of this study are (1) to characterize factors influencing self-management behaviors and quality of life in adolescent and young adult (AYA) patients with childhood-onset systemic lupus erythematosus (cSLE) and (2) to identify barriers and facilitators of treatment adherence via focus groups. METHODS: AYAs with cSLE ages 12-24 years and primary caregivers of the adolescents participated in this study. Recruitment occurred during pediatric rheumatology clinic visits at a Midwestern children's hospital or the hospital's cSLE active clinic registry. Information about disease severity was obtained from patient health records. Pain and fatigue questionnaires were administered. Descriptive statistics were used to analyze data. RESULTS: Thirty-one AYA patients and caregivers participated in six focus groups. Ten major themes emerged from sessions; four were expressed both by the AYA and caregiver groups: knowledge deficits about cSLE, symptoms limiting daily function, specifically mood and cognition/learning, barriers and facilitators of adherence, and worry about the future. Themes unique to AYA participants included symptoms limiting daily functioning-pain/fatigue, self-care and management, impact on personal relationships, and health care provider communication/relationship. For caregiver groups unique themes included need for school advocacy, disruption of family schedule, and sense of normalcy for their adolescent. CONCLUSION: AYAs with cSLE face a lifelong disease characterized by pervasive pain, fatigue, organ damage, isolation-social and/or physical-and psycho-socioeducational challenges. This study confirmed that continued psychosocial support, health information education, adherence interventions, and personalized treatment plans are necessary to increase self-management and autonomy in AYAs with cSLE.
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Cuidadores/psicología , Lupus Eritematoso Sistémico/fisiopatología , Lupus Eritematoso Sistémico/psicología , Automanejo , Adolescente , Edad de Inicio , Niño , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Lupus Eritematoso Sistémico/terapia , Masculino , Ohio , Cooperación del Paciente , Calidad de Vida , Sistema de Registros , Encuestas y Cuestionarios , Adulto JovenRESUMEN
New technology has enabled recovery of inaccessible natural gas shale deposits; however, the potential impacts to human health from the migration of brines into drinking water or surface spills are unknown. To provide information that can inform these potential impacts, chemical characterization and in vitro toxicologic testing were conducted using pre- and postinjection waters from conventional and unconventional oil and gas wells. Wastewater concentrations may be diluted or reduced by fate and transport processes when released into the environment by unknown amounts, and laboratory studies only imply potential effects. In acute cytotoxicity and wound healing assays, there was dose-dependent toxicity in human and rat cells with growth promotion at low concentrations. Lethality was measured in time studies up to 10 d postinjection. Produced water samples from both well types were equally toxic to human cells and were corrosive at high concentrations. Measurement of protein and gene expression identified metabolic pathways responding to both well types as NADPH quinone oxidoreductase oxidative stress-responsive enzyme and tight junction protein genes. A KCl sample of matched ionic strength showed a different toxicity profile from produced waters, indicating that salts alone were not the cause of toxicity. Organic chemicals and branched alkanes were present in hydraulic fracture wells, and mainly branched alkanes were present in conventional wells. One organic substance was still present after 240 d. The known properties of these chemicals include potential toxicity to multiple human organs, sensitization, irritation, developmental effects, and tumor promotion, depending on the concentrations and synergistic effects of chemicals during exposure. Environ Toxicol Chem 2018;37:2098-2111. © 2018 SETAC.
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Gas Natural , Yacimiento de Petróleo y Gas , Pruebas de Toxicidad , Aguas Residuales/química , Aguas Residuales/toxicidad , Agua/química , Animales , Regulación de la Expresión Génica/efectos de los fármacos , Células Hep G2 , Humanos , NAD(P)H Deshidrogenasa (Quinona)/metabolismo , Ratas , Contaminantes Químicos del Agua/análisis , Contaminantes Químicos del Agua/toxicidad , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Higher functioning older adults rarely have their balance assessed clinically and as such early decline in balance is not captured. Early identification of declining balance would facilitate earlier intervention and improved management of the ageing process. This study sought to determine if (a) a once off inertial sensor measurement and (b) changes in inertial sensor measurements one year apart can identify declining balance for higher functioning older adults. One hundred and nineteen community dwelling older adults (58 males; 72.5±5.8 years) completed a timed up and go (TUG) instrumented with inertial sensors and the Berg balance scale (BBS) at two time points, one year apart. Temporal and spatio-temporal gait parameters as well as angular velocity and turn parameters were derived from the inertial sensor data. A change in balance from baseline to follow-up was determined by sub-components of the BBS. Changes in inertial sensor parameters from baseline to follow-up demonstrated strong association with balance decline in higher functioning older adults (e.g. mean medial-lateral angular velocity odds ratio=0.2; 95% CI: 0.1-0.5). The area under the Receiver operating characteristic curve (AUC) ranged from 0.8 to 0.9, a marked improvement over change in TUG time alone (AUC 0.6-0.7). Baseline inertial sensor parameters had a similar association with declining balance as age and TUG time. For higher functioning older adults, the change in inertial sensor parameters over time may reflect declining balance. These measures may be useful clinically, to monitor the balance status of older adults and facilitate earlier identification of balance deficits.
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Prueba de Esfuerzo , Equilibrio Postural/fisiología , Trastornos de la Sensación/fisiopatología , Procesamiento de Señales Asistido por Computador , Factores de Edad , Anciano , Fenómenos Biomecánicos/fisiología , Femenino , Humanos , Modelos Logísticos , Masculino , Curva ROC , Trastornos de la Sensación/etiologíaRESUMEN
Operative fixation of midshaft clavicle fractures is controversial with few biomechanical data to assist surgical decision making. The purpose of this 2-phase biomechanical investigation is to report on the effects of plate location and selection on the stability of midshaft clavicle fractures. Thirty matched pairs of human adult formalin-fixed clavicles were used. In the first phase, in which a 3.5-mm reconstruction plate and simulated midshaft transverse clavicle osteotomies were used, we observed the effect of superior plate placement compared with anterior placement on fracture rigidity, construct stiffness, and strength. In the second phase, in which simulated midshaft oblique clavicle osteotomies were repaired on the superior aspect, we compared the fracture rigidity, construct stiffness, and strength of the 3.5-mm reconstruction, 3.5-mm limited contact dynamic compression (LCDC), and 2.7-mm dynamic compression (DC) plates. Intact clavicles were prepared, potted, and tested for axial and torsional stiffness in an Instron test frame equipped with gimbaled fixtures. Clavicles were band-sawed to simulate an osteotomy, repaired, re-mounted on the test frame with shear and opening extensometers placed across the osteotomy site, and then tested to observe axial and torsional fracture rigidity and stiffness. Constructs were then loaded to failure in compression. First-order regressions were used to estimate fracture rigidity (in kilonewtons per millimeter)and retained construct stiffness (in kilonewtons per millimeter), whereas the maximum applied compressive load at collapse or gross deformation determined the failure load. Values for the comparisongroups were tested for significance at the 95% confidence level. In the first phase we found that constructs plated at the superior aspect of the clavicle exhibited significantly greater fracture rigidity and mean retained stiffness than the anterior location (P <.05). In the second phase we found that the torsional fracture rigidity of LCDC-plated constructs significantly exceeded that of the reconstruction and DC plates (P <.05), whereas the axial fracture rigidity of the LCDC-plated constructs significantly exceeded that of the reconstruction plate (P <.05). In retained stiffness the performance of the LCDC-plated constructs significantly exceeded that of the DC plate in torsion (P <.05), whereas in load to failure the LCDC plate withstood significantly more compressive load than the reconstruction plate (P <.05). We concluded that clavicles plated at the superior aspect exhibit significantly greater biomechanical stability than those plated at the anterior aspect. Furthermore, we concluded that the LCDC plate offers significantly greater biomechanical stability than the reconstruction and DC plates.
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Placas Óseas , Clavícula/lesiones , Osteotomía/métodos , Anciano , Fenómenos Biomecánicos , Diseño de Equipo , Humanos , Ensayo de Materiales , Persona de Mediana Edad , Resultado del Tratamiento , Heridas y Lesiones/fisiopatología , Heridas y Lesiones/cirugíaRESUMEN
Obtaining a complete response (CR) is the most powerful predictor of survival in extensive-stage small cell lung cancer (SCLC). Improvements in long-term survival in extensive-stage SCLC can be made if the proportion of complete responders to induction therapy can be increased. We performed a phase II trial of the feasibility of adding paclitaxel to standard cisplatin/etoposide (EP regimen) in extensive-stage SCLC. The primary endpoint for this trial is the proportion of patients (pts) obtaining a CR rather than overall response. The null hypothesis for this trial consists of the absence of a CR rate >20%. Paclitaxel was given at doses of 135 (3 pts) or 170 mg/m(2) i.v. over 3 h on day 1. Cisplatin 60 mg/m(2) was given on day 1. On days 1-3 etoposide 80 mg/m(2) per day i.v. was given. G-CSF was used from days 5 to 14 of each cycle. Cycles were repeated q21 days. A two-stage design was used for patient accrual, based on the occurrence of complete responses. Initially, 16 patients were to be accrued. If more than three complete responses were to occur, a further 20 patients would be accrued to the study (Simon's optimal two stage design). Sixteen patients were enrolled. Two patients had a CR (13%) and nine patients had a partial response (56%) for an overall response rate of 69%. The trial was suspended due to the low CR rate. Review of the literature for paclitaxel based front-line treatment combined with EP therapy, in extensive stage SCLC, consistently shows a CR rate <20% but high overall response rate is maintained (thus most responses are partial). As virtually all long-term survivors in extensive-disease SCLC have had a CR to induction therapy and CR remains the strongest predictor of survival for this disease, this may suggest that paclitaxel added to standard EP may improve progression-free survival (and possibly median survival) but is unlikely to significantly improve long-term survival. Initial randomized phase III data confirm the absence of impact on survival for this triple-drug regimen compared to EP therapy alone. Furthermore, other regimens comparing favorably to the EP regimen have all shown consistent CR rates >20% in the phase II setting. In conclusion, consideration should be given to the use of CR rate as a phase II endpoint to determine if a particular regimen should be compared to the standard in a phase III setting for extensive-stage SCLC. A two-stage phase II design based on a minimum required completed responses for further patient accrual is recommended.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Carcinoma de Células Pequeñas/mortalidad , Carcinoma de Células Pequeñas/patología , Cisplatino/administración & dosificación , Ensayos Clínicos Fase I como Asunto , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Determinación de Punto Final , Etopósido/administración & dosificación , Estudios de Factibilidad , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Estudios Multicéntricos como Asunto , Paclitaxel/administración & dosificación , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Inducción de Remisión , Tasa de Supervivencia , Insuficiencia del TratamientoRESUMEN
Tissue sections were examined from a 2-year bioassay of male Fischer 344 rats treated with potassium bromate administered in drinking water. All animals exhibiting peritoneal mesotheliomas also had mesotheliomas of the tunica vaginalis testis mesorchium (the reverse was not true), and the correlation of these 2 types of mesotheliomas was highly significant (r2 = 0.98). Mapping of the tunica vaginalis tumors at all time points and at all bromate concentrations revealed a pattern of increasing incidence of tumor formation on the mesothelium of the tunica vaginalis testis as a function of proximity to the mesorchial ligament. Thus, the mesorchium appears to be the major mesothelial target site for potassium bromate-mediated carcinogenesis. The frequency of occurrence of mesotheliomas by location was tunica vaginalis testis (25%), mesosplenium (20%), mesentery (10%), mesojejunum/mesocolon (8%), bladder (6.5%), mesogastrium (13%), liver serosa (5%), and kidney, small intestine, and rectum (1% each). A complete cross-section of the rat testis was prepared and used to construct a complete map of the mesothelium. Any attempt to determine the role of local dose and tissue susceptibility for the purpose of interspecies risk extrapolation must take into account the complex anatomy and physiology of this region of the visceral and testicular suspensory apparatus. Improved histologic approaches are needed for adequate assessment of this delicate suspensory system.
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Bromatos/toxicidad , Carcinógenos/toxicidad , Mesotelioma/inducido químicamente , Neoplasias Primarias Múltiples/inducido químicamente , Neoplasias Peritoneales/inducido químicamente , Neoplasias Testiculares/inducido químicamente , Animales , Pruebas de Carcinogenicidad , Masculino , Mesotelioma/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Peritoneales/patología , Lesiones Precancerosas/patología , Ratas , Ratas Endogámicas F344 , Neoplasias Testiculares/patología , Testículo/irrigación sanguínea , Testículo/patologíaRESUMEN
Research has indicated that negative and positive thoughts may affect sport performance. The purpose of this analogue study was to assess whether negative and positive stimuli influenced tennis performance similar to positive and negative thought. The reaction time (RT) of 40 competitive tennis players was measured during a timed response to a tennis ball rotating in a topspin, sidespin, or backspin direction on the computer screen. Immediately prior to the ball presentation, a phrase (accessory stimulus) was presented visually or aurally. The accessory stimulus provided either positive (e.g., 'nice shot') or negative information (e.g., 'bad shot') followed by the subject's name. Analysis showed a main effect only for the type of spin. The slowest RT occurred when responding to a tennis ball rotating in a backspin direction. A significant interaction was found for the sensory modality (audition vs vision) and polarity (positive vs negative) of the accessory stimulus. RT to negative stimuli was slowest when the accessory stimulus was presented aurally. The quickest RT to positive stimuli occurred when the accessory stimulus was presented aurally. These results indicated that negative and positive stimuli, when presented aurally, affected performance as positive and negative thoughts measured in other studies. Not measured was whether negative and positive stimuli actually produce the negative and positive thoughts, respectively, that have been reported to affect performance.
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Tiempo de Reacción , Tenis/psicología , Pensamiento , Adolescente , Adulto , Percepción Auditiva , Femenino , Humanos , Masculino , Refuerzo en Psicología , Percepción VisualRESUMEN
The present study is a retrospective review of the treatment of 12 humeral shaft nonunions by using an intramedullary allograft with compression plating. The average age of the patients was 61 years (range, 36-82 years). Eight cases involved the proximal shaft, 3 cases were at the mid-diaphyseal level, and 1 case was at the distal one third. Follow-up averaged 30 months (range, 12-96 months). Ten patients (83%) went on to uneventful healing at an average of 3 months after surgery. Two failures involving patients with multiple medical conditions occurred secondary to reinjury. Two cases of postoperative radial nerve neuropraxia involved the posterior approach to the humerus. Each resolved with no long-term residual morbidity. One patient developed postoperative adhesive capsulitis of the shoulder that resolved with nonoperative treatment. We feel that a fibular allograft, along with compression plating, can give satisfactory results for humeral shaft nonunions. This technique can be especially helpful in proximal humeral nonunions and in nonunions involving osteoporotic bone. Patients with multiple medical problems at risk for refalls should be protected until complete healing has occurred.
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Trasplante Óseo/métodos , Peroné/trasplante , Fracturas no Consolidadas/cirugía , Fracturas del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Femenino , Fijación Intramedular de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Trasplante HomólogoRESUMEN
The gene expression pattern of mesothelial cells in vitro was determined after 4 or 12 h exposure to the rat mesothelial, kidney, and thyroid carcinogen and oxidative stressor potassium bromate (KBrO(3)). Gene expression changes observed using cDNA arrays indicated oxidative stress, mitotic arrest, and apoptosis in treated immortalized rat peritoneal mesothelial cells. Increases occurred in oxidative stress responsive genes HO-1, QR, HSP70, GADD45, GADD153, p21(WAF1/CIP16), GST's, GAPDH, TPX, and GPX-1(0); transcriptional regulators c-jun, c-fos, jun B, c-myc, and IkappaB; protein repair components Rdelta, RC10-II, C3, RC-7, HR6B ubiquitin-conjugating enzyme and ubiquitin; DNA repair components PCNA, msh2, and O-6 methylguanine DNA methyltransferase; lipid peroxide excision enzyme PLA2; and apoptogenic components TNFalpha, iNOS1 and FasL. Decreases occurred in bcl-2 (antiapoptotic), bax alpha, bad, and bok (proapoptotic) and cell cycle control elements (cyclins). Cyclin G and p14ink4b (which inhibit entry into cell cycle) were increased. Numerous signal transduction, cell membrane transport, membrane-associated receptor, and fatty acid biosynthesis and repair components were altered. Morphologic endpoints examined were number of mitotic figures, number of apoptotic cells, and antibody-specific localization of HO-1 (which demonstrated increased HO-1 protein expression). PCR analysis confirmed HO-1, p21(waf1/cip1), HSP70, GPX1, GADD45, QR, mdr1, PGHS, and cyclin D1 changes. A model for KBrO(3)-induced carcinogenicity in the F344 rat mesothelium is proposed, whereby KBrO(3) generates a redox signal that activates p53 and results in transcriptional activation of oxidative stress and repair genes, dysregulation of growth control, and imperfect DNA repair leading to carcinogenesis.
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Bromatos/toxicidad , Células Epiteliales/efectos de los fármacos , Expresión Génica/efectos de los fármacos , Animales , Apoptosis/efectos de los fármacos , Ciclo Celular/efectos de los fármacos , Células Cultivadas , Células Epiteliales/metabolismo , Células Epiteliales/patología , Hemo Oxigenasa (Desciclizante)/metabolismo , Hemo-Oxigenasa 1 , Inmunohistoquímica , Estrés Oxidativo , Ratas , Ratas Endogámicas F344 , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
BACKGROUND: Previous studies have shown that applicants for postgraduate training may misrepresent research citations. We evaluated the research citations that were identified in a review of the Publications and Work and Research sections from the Electronic Residency Application Service (ERAS) data for all applicants to our orthopaedic residency program for the 1998 to 1999 academic year. METHODS: The citations were searched for on Medline. We initially used the name of the first author, then the name of the applicant, the name of the journal, the volume number, the issue number, and the page numbers. When a journal was not listed in Medline, an interlibrary search was instituted with use of the same format. When no match was made for any category, the citation was defined as misrepresented. Point estimates are reported as percentages. RESULTS: Publications were listed on sixty-four (30.0 percent) of 213 applications. One hundred and thirty-eight publications were cited; there were fifteen citations (10.9 percent) to book chapters, twenty-six (18.8 percent) to journals not listed in Ulrich's International Periodicals Directory, and twenty-one (15.2 percent) to articles listed as in press, in print, or submitted for publication. Seventy-six articles that had been cited as appearing in journals listed in Ulrich's Directory were checked and verified. Fourteen (18 percent) of these seventy-six publications were misrepresented. Misrepresentations included citations of nonexistent articles in actual journals and nonauthorship of existing articles. CONCLUSIONS: We concluded that publications listed on postgraduate applications should be scrutinized carefully. Copies of cited publications should be required by residency programs before applications are considered complete. The importance of professionalism needs to be emphasized in the curricula of medical schools. Residency training programs should develop guidelines regarding misrepresentation.
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Autoria , Educación Médica Continua/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Solicitud de Empleo , Ortopedia/educación , Mala Conducta Científica/estadística & datos numéricos , Bases de Datos Bibliográficas , Humanos , Reproducibilidad de los Resultados , Tennessee , UniversidadesRESUMEN
Potassium bromate (KBrO3) is a rodent carcinogen and a nephro- and neurotoxicant in humans. KBrO3 is used in cosmetics and food products and is a by-product of water disinfection by ozonization. KBrO3 is carcinogenic in the rat kidney, thyroid, and mesothelium and is a renal carcinogen in the male mouse. The present study was designed to investigate the relationship of time and dose to bromate-induced tumors in male Fischer 344 (F344) rats and to provide some insight into the development of these tumors. KBrO3 was dissolved in drinking water at nominal concentrations of 0, 0.02, 0.1, 0.2, and 0.4 g/L and administered to male F344 rats as the sole water source for 12, 26, 52, 78, or 100 wk. Renal cell tumors were present after 52 wk of treatment only in the high-dose group. Mesotheliomas developed after 52 wk of treatment on the tunica vaginalis. Mesotheliomas were present at sites other than the testicle after 78 wk of treatment, indicating that their origin was the testicular tunic. Thyroid follicular tumors were present as early as 26 wk in 1 rat each from the 0.1- and 0.2-g/L groups. The present study can be used as a basis for the determination of dose-time relationships of tumor development for a better understanding of KBrO3-induced cancer.
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Bromatos/toxicidad , Carcinógenos/toxicidad , Neoplasias/inducido químicamente , Adenoma/sangre , Adenoma/inducido químicamente , Adenoma/patología , Animales , Bromatos/administración & dosificación , Carcinógenos/administración & dosificación , Carcinoma de Células Renales/sangre , Carcinoma de Células Renales/inducido químicamente , Carcinoma de Células Renales/patología , Relación Dosis-Respuesta a Droga , Neoplasias Renales/sangre , Neoplasias Renales/inducido químicamente , Neoplasias Renales/patología , Masculino , Mesotelioma/sangre , Mesotelioma/inducido químicamente , Mesotelioma/patología , Neoplasias/sangre , Neoplasias/patología , Ratas , Ratas Endogámicas F344 , Neoplasias Testiculares/sangre , Neoplasias Testiculares/inducido químicamente , Neoplasias Testiculares/patología , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/inducido químicamente , Neoplasias de la Tiroides/patología , Tiroxina/sangre , Factores de Tiempo , Triyodotironina/sangreRESUMEN
Precursors and outcomes of adolescent pregnancy receive considerable research attention; however, most studies deal with adolescent mothers. This study examined whether risk factors that are precursors to adolescent fatherhood would be consistent with the family coercion model (G. R. Patterson, 1976) of the development of antisocial behavior in childhood. Hypotheses were tested in the Oregon Youth Study (OYS) sample of 206 at-risk boys who were first seen at 9 or 10 years of age. At 18-20 years of age, the profiles for the 35 adolescent fathers included more arrests and substance use than the other OYS participants. At around 2 years of age, 40% of the children had no contact with their fathers. The children, compared with a normative control sample, had somewhat greater health risks. The at-risk parents, compared with a control sample, were observed to show higher levels of negative reactions when their children were working on a puzzle task.
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Padre/psicología , Responsabilidad Parental , Adolescente , Niño , Relaciones Padre-Hijo , Humanos , Masculino , Grupo Paritario , Encuestas y CuestionariosRESUMEN
A morphologically distinct, filamentous methanogen was isolated from hindguts of the subterranean termite, Reticulitermes flavipes (Kollar) (Rhinotermitidae), wherein it was part of the microbiota colonizing the hindgut wall. Individual filaments of strain RFM-3 were 0.23-0.28 micron in diameter and usually > 50 micron in length and aggregated into flocs that were often >/= 0.1 mm in diameter. Optimal growth of strain RFM-3 was obtained at pH 7.0-7.2 and 30 degrees C with a yeast-extract-supplemented, dithiothreitol-reduced medium in which cells produced stoichiometric amounts of methane from H2 + CO2. The morphology and gram-positive staining reaction of strain RFM-3, as well as its resistance to cell lysis by various chemical agents and its restriction to H2 + CO2 as an energy source, suggested that it was a member of the Methanobacteriaceae. The nucleotide sequence of the SSU-rRNA-encoding gene of strain RFM-3 confirmed this affiliation and also supported its recognition as a new species of Methanobrevibacter, for which the epithet filiformis is herewith proposed. Although M. filiformis was one of the dominant methanogens in R. flavipes collected from Woods Hole (Mass., USA), cells of similar morphology were not consistently observed in R. flavipes collected from different geographical locations.
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Euryarchaeota/aislamiento & purificación , Insectos/microbiología , Intestinos/microbiología , Methanobacteriaceae/aislamiento & purificación , Animales , Euryarchaeota/genética , Euryarchaeota/ultraestructura , Methanobacteriaceae/genética , Methanobacteriaceae/ultraestructura , Filogenia , ARN de Archaea/análisis , ARN de Archaea/genética , ARN Ribosómico/análisis , ARN Ribosómico/genéticaRESUMEN
This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.
Asunto(s)
Pie/cirugía , Piel/microbiología , Dedos del Pie/microbiología , Adolescente , Adulto , Anciano , Aspergillus/aislamiento & purificación , Ropa de Cama y Ropa Blanca , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cuidados Preoperatorios , Staphylococcus/aislamiento & purificación , Trichophyton/aislamiento & purificaciónRESUMEN
A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1 degrees with no fixation, 6.3 degrees with temporary K-wire fixation, and 9.5 degrees with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups (P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation (P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.