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BACKGROUND: Cam morphology develops during skeletal growth, but its influence on cartilage and the labrum in high-impact athletes later in life is unknown. PURPOSE: To (1) explore the association between the presence and duration of cam morphology during adolescence and the cartilage and labral status 7 to 12 years later and (2) report the prevalence of cartilage loss and labral damage in a population of young male athletes (<32 years old) who played professional soccer during skeletal growth. STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2. METHODS: A total of 89 healthy male academy soccer players from the Dutch soccer club Feyenoord (aged 12-19 years) were included at baseline. At baseline and 2.5- and 5-year follow-ups, standardized supine anteroposterior pelvis and frog-leg lateral radiographs of each hip were obtained. At 12-year follow-up, magnetic resonance imaging of both hips was performed. Cam morphology was defined by a validated alpha angle ≥60° on radiographs at baseline or 2.5- or 5-year follow-up when the growth plates were closed. Hips with the presence of cam morphology at baseline or at 2.5-year follow-up were classified as having a "longer duration" of cam morphology. Hips with cam morphology only present since 5-year follow-up were classified as having a "shorter duration" of cam morphology. At 12-year follow-up, cartilage loss and labral abnormalities were assessed semiquantitatively. Associations were estimated using logistic regression, adjusted for age and body mass index. RESULTS: Overall, 35 patients (70 hips) with a mean age of 28.0 ± 2.0 years and mean body mass index of 24.1 ± 1.8 participated at 12-year follow-up. Cam morphology was present in 56 of 70 hips (80%). The prevalence of cartilage loss was 52% in hips with cam morphology and 21% in hips without cam morphology (adjusted odds ratio, 4.52 [95% CI, 1.16-17.61]; P = .03). A labral abnormality was present in 77% of hips with cam morphology and in 64% of hips without cam morphology (adjusted odds ratio, 1.99 [95% CI, 0.59-6.73]; P = .27). The duration of cam morphology did not influence these associations. CONCLUSION: The development of cam morphology during skeletal growth was associated with future magnetic resonance imaging findings consistent with cartilage loss in young adults but not with labral abnormalities.

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OBJECTIVES: To compare the bleaching efficacy and tooth sensitivity (TS) of 4% hydrogen peroxide (HP) in adults using a continuous or fractioned protocol. METHODS AND MATERIALS: A single-blind randomized controlled trial with a parallel design was conducted. Eighty-six patients with upper canines A2 or darker were submitted to bleaching with 4% HP gel for three weeks after random allocation into the fractioned protocol (two 30-minute daily applications) or continuous protocol (single one-hour application). We evaluated the color change at baseline, weekly, and 30 days after the bleaching using Vita Classical and Vita Bleachedguide using the units of shade guides (SGU) and by spectrophotometer using CIELab 1976 (ΔEab) and CIEDE 2000 formulas (ΔE00), as well as Whiteness Index (ΔWID). We assessed the absolute risk of TS with a visual analog scale (VAS) and numeric rating scale (NRS). Color changes in each recall were compared with the Student t-test. The risk of TS was evaluated by the Chi-square test, and the intensity by Mann-Whitney test (NRS) and Student t-test (VAS). RESULTS: The mean difference for the ΔSGU Vita Classical (0.5; 95% CI: -0.5 to 1.5), ΔSGU Vita Bleachedguide (-0.4; 95% CI: -1.5 to 0.7), ΔEab (1.4; 95% CI: -0.1 to 2.9), ΔE00 (0.6; 95% CI: -0.4 to 1.6), and ΔWID (-3.2; 95% CI: -7.3 to 0.9) after three weeks of bleaching was not clinically or statistically significant (p>0.10). The absolute risk of TS was 44% (95% CI: 30-58%) and 46% (95% CI: 32-61%) in the fractioned and continuous protocols, respectively (RR=1.0; 95% CI: 0.6 to 1.5; p>0.91). CONCLUSION: A fractioned bleaching protocol with 4% HP (30 minutes twice daily) did not increase the whitening degree nor affect the risk and intensity of TS when compared with the one-hour continuous protocol.

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AIMS: To suggest microbial inoculation as a tool to shorten organic residues stabilization and increase rock phosphate (RP) solubilization through vermicomposting, thus increasing nutrient content in plants and making it more appealing to farmers. Two Trichoderma strains were inoculated alone or combined in a RP apatite-enriched vermicompost. Stability and plant-available phosphorus levels were monitored for 120 days. METHODS AND RESULTS: Observable higher total organic carbon reduction in the treatment with the combined Trichoderma strains, followed by the inoculation with T. asperellum and T. virens. Combined Trichoderma and inoculation with T. virens increased humic acids (HA) content in 38·2 and 25·0%, respectively; non-inoculated vermicompost with T. asperellum increased it by 15·0%. The combined Trichoderma strains and T. virens achieved the stability index based on the humic/fulvic acids (HA/FA) ratio after 120 days. T. asperellum, combined Trichoderma and T. virens increased the citric acid soluble-P content in 83·2, 62·2 and 49·5%, respectively, compared to the non-inoculated vermicompost. CONCLUSIONS: Inoculation with combined T. asperellum and T. virens efficiently accelerated vermicompost stabilization; T. asperellum increased the citric acid soluble-P in the final product. SIGNIFICANCE AND IMPACT OF THE STUDY: Combined Trichoderma inoculation and RP enrichment improves the vermicompost quality, increasing HA and citric acid soluble-P, recycling organic waste nutrients and reducing agricultural dependence on phosphate fertilizers.

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AIMS: The aim of the present study was to evaluate the oral resveratrol effects associated with diet and physical training changes on anthropometric and biochemical parameters. MAIN METHODS: 25 individuals aged from 30 to 60 years old; with Body Mass Index (BMI) ≥ 30 kg/m2 were included in the study. Following the primary evaluation (anthropometric and clinical), the patients were randomly divided into 2 groups: (1) Placebo: Physical activity program + Diet + Placebo; (2) Resveratrol: Physical activity program + Diet + Resveratrol (RVS) (250 mg/day) for three months. Anthropometric and biochemical parameters were evaluated at baseline and after the treatment period. KEY FINDINGS: The main findings showed that the resveratrol supplementation improved total cholesterol (TC), High-density Lipoprotein cholesterol (HDL-c), Very-low density Lipoprotein cholesterol (VLDL-c), urea, creatinine and albumin serum levels. SIGNIFICANCE: These findings indicate that this polyphenol may be an option to potentiate the beneficial effects induced by dietary and physical activity programs in the Metabolic Syndrome (MetS) treatment.

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BACKGROUND: Chagas disease (CD) continues to be a neglected infectious disease with one of the largest burdens globally. Despite the modest cure rates in adult chronic patients and its safety profile, benznidazole (BNZ) is still the drug of choice. Its current recommended dose is based on nonrandomized studies, and efficacy and safety of the optimal dose of BNZ have been scarcely analyzed in clinical trials. METHODS/DESIGN: MULTIBENZ is a phase II, randomized, noninferiority, double-blind, multicenter international clinical trial. A total of 240 patients with Trypanosoma CD in the chronic phase will be recruited in four different countries (Argentina, Brazil, Colombia, and Spain). Patients will be randomized to receive BNZ 150 mg/day for 60 days, 400 mg/day for 15 days, or 300 mg/day for 60 days (comparator arm). The primary outcome is the efficacy of three different BNZ therapeutic schemes in terms of dose and duration. Efficacy will be assessed according to the proportion of patients with sustained parasitic load suppression in peripheral blood measured by polymerase chain reaction. The secondary outcomes are related to pharmacokinetics and drug tolerability. The follow-up will be 12 months from randomization to end of study participation. Recruitment was started in April 2018. CONCLUSION: This is a clinical trial conducted for the assessment of different dose schemes of BNZ compared with the standard treatment regimen for the treatment of CD in the chronic phase. MULTIBENZ may help to clarify which is the most adequate BNZ regimen in terms of efficacy and safety, predicated on sustained parasitic load suppression in peripheral blood. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03191162. Registered on 19 June 2017.

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We introduce a high-performance hyperspectral camera based on the Fourier-transform approach, where the two delayed images are generated by the Translating-Wedge-Based Identical Pulses eNcoding System (TWINS) [Opt. Lett. 37, 3027 (2012)], a common-path birefringent interferometer that combines compactness, intrinsic interferometric delay precision, long-term stability and insensitivity to vibrations. In our imaging system, TWINS is employed as a time-scanning interferometer and generates high-contrast interferograms at the single-pixel level. The camera exhibits high throughput and provides hyperspectral images with spectral background level of -30dB and resolution of 3 THz in the visible spectral range. We show high-quality spectral measurements of absolute reflectance, fluorescence and transmission of artistic objects with various lateral sizes.

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PURPOSE: Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS: Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. FINDINGS: Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. CONCLUSION: In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass.

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Humans and other animals are able to make rough estimations of quantities using what has been termed the approximate number system (ANS). Much evidence suggests that sensitivity to numerosity correlates with symbolic math capacity, leading to the suggestion that the ANS may serve as a start-up tool to develop symbolic math. Many experiments have demonstrated that numerosity perception transcends the sensory modality of stimuli and their presentation format (sequential or simultaneous), but it remains an open question whether the relationship between numerosity and math generalizes over stimulus format and modality. Here we measured precision for estimating the numerosity of clouds of dots and sequences of flashes or clicks, as well as for paired comparisons of the numerosity of clouds of dots. Our results show that in children, formal math abilities correlate positively with sensitivity for estimation and paired-comparisons of the numerosity of visual arrays of dots. However, precision of numerosity estimation for sequences of flashes or sounds did not correlate with math, although sensitivities in all estimations tasks (for sequential or simultaneous stimuli) were strongly correlated with each other. In adults, we found no significant correlations between math scores and sensitivity to any of the psychophysical tasks. Taken together these results support the existence of a generalized number sense, and go on to demonstrate an intrinsic link between mathematics and perception of spatial, but not temporal numerosity. (PsycINFO Database Record

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BACKGROUND: The transition to secondary school is linked to more positive attitudes toward substance use, which prelude the moment of first use. Fresh Start is a school-based prevention program for secondary school freshmen (12-13 years old) to retain negative attitudes. OBJECTIVES: This study evaluates the effectiveness of Fresh Start on the attitudes toward smoking, alcohol use, and cannabis use, and on multiple secondary outcome measures. In addition, the effect of timing of the program within the schoolyear was examined. METHODS: A cluster randomized trial was conducted. 48 classes, containing 1083 secondary school freshmen, were randomly allocated to the experimental or waiting list control condition. Experimental classes completed Fresh Start between October 2015 and January 2016 and waiting list control classes completed Fresh Start between March 2016 and May 2016. Measurements were scheduled at three points in time (September 2015, February 2016, and June 2016). Data were analyzed by means of multilevel analyses. RESULTS: Fresh Start had small but significant effects on the attitudes toward smoking, alcohol use and cannabis use. The majority of secondary outcome measures were not influenced by Fresh Start, although a small, adverse effect was found on the perceived social acceptance of cannabis use by friends. Timing of the intervention within the schoolyear did not influence its effectiveness. Conclusions/Importance: Fresh Start can help to delay the development of positive attitudes toward substance use in secondary school freshmen. Strengths and limitations, implications for practice and suggestions for future research are discussed.

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A Scanning Tunneling Microscopy/Spectroscopy (STM/STS) and synchrotron X-ray diffraction study on clustered C3N4 nanoparticles (nanoflakes) is conducted on green-chemistry synthesized samples obtained from chitosan through high power sonication. Morphological aspects and the electronic characteristics are investigated. The observed bandgap of the nanoflakes reveals the presence of different phases in the material. Combining STM morphology, STS spectra and X-ray diffraction (XRD) results one finds that the most abundant phase is graphitic C3N4. A high density of defects is inferred from the XRD measurements. Additionally, STM-electroluminescence (STMEL) is detected in C3N4 nanoflakes deposited on a gold substrate. The tunneling current creates photons that are three times more energetic than the tunneling electrons of the STM sample. We ponder about the two most probable models to explain the observed photon emission energy: either a nonlinear optical phenomenon or a localized state emission.

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BACKGROUND: Common bean is a legume of social and nutritional importance as a food crop, cultivated worldwide especially in developing countries, accounting for an important source of income for small farmers. The availability of the complete sequences of the two common bean genomes has dramatically accelerated and has enabled new experimental strategies to be applied for genetic research. DArTseq has been widely used as a method of SNP genotyping allowing comprehensive genome coverage with genetic applications in common bean breeding programs. RESULTS: Using this technology, 6286 SNPs (1 SNP/86.5 Kbp) were genotyped in genic (43.3%) and non-genic regions (56.7%). Genetic subdivision associated to the common bean gene pools (K = 2) and related to grain types (K = 3 and K = 5) were reported. A total of 83% and 91% of all SNPs were polymorphic within the Andean and Mesoamerican gene pools, respectively, and 26% were able to differentiate the gene pools. Genetic diversity analysis revealed an average H E of 0.442 for the whole collection, 0.102 for Andean and 0.168 for Mesoamerican gene pools (F ST = 0.747 between gene pools), 0.440 for the group of cultivars and lines, and 0.448 for the group of landrace accessions (F ST = 0.002 between cultivar/line and landrace groups). The SNP effects were predicted with predominance of impact on non-coding regions (77.8%). SNPs under selection were identified within gene pools comparing landrace and cultivar/line germplasm groups (Andean: 18; Mesoamerican: 69) and between the gene pools (59 SNPs), predominantly on chromosomes 1 and 9. The LD extension estimate corrected for population structure and relatedness (r2SV) was ~ 88 kbp, while for the Andean gene pool was ~ 395 kbp, and for the Mesoamerican was ~ 130 kbp. CONCLUSIONS: For common bean, DArTseq provides an efficient and cost-effective strategy of generating SNPs for large-scale genome-wide studies. The DArTseq resulted in an operational panel of 560 polymorphic SNPs in linkage equilibrium, providing high genome coverage. This SNP set could be used in genotyping platforms with many applications, such as population genetics, phylogeny relation between common bean varieties and support to molecular breeding approaches.

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BACKGROUND: This study sought to discover the beliefs of nursing professionals in the organ donation process and to establish a relationship between the training and the beliefs of these professionals. METHODS: This was a quantitative and exploratory study composed of 611 nursing professionals. The sample characteristics and the response frequencies were presented through the use of descriptive statistics. The Kruskal-Wallis test was used to evaluate the different results between the professional categories. RESULTS: When evaluating the association between professional nursing, technical and nursing auxiliaries, and beliefs in the donation process, significant differences were found regarding the belief that the transplant improves the quality of life of the recipient, that there is no death while there is a heartbeat, that people are hijacked for organ withdrawal, and that it is possible to buy an organ for transplantation. CONCLUSIONS: For the beliefs presented by nursing professionals, it is evident that there is a need for educational programs to deconstruct negative beliefs and promote change in the professionals' posture.

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PURPOSE: Rural bypass of Critical Access Hospitals (CAHs) for elective inpatient and outpatient surgical procedures has not been studied. Residents choosing to have their elective surgeries elsewhere, when the local CAH provides those surgical services, erode their rural hospital's financial base. The purpose of this research is to describe the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among CAHs that offer elective surgical services, and factors predictive of bypass. METHODS: A sample of elective surgery discharges was created from the 2011 Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Databases for Colorado, North Carolina, Vermont, and Wisconsin. Frequencies of procedures bypassed and CAH volume distribution were performed. Logistic regression was used to model factors associated with rural bypass for elective surgical care. FINDINGS: The rural bypass rate for elective surgical procedures is 48.4%. Procedures bypassed most are operations on the musculoskeletal system, eye, and digestive system. Annual volume distribution for elective surgical procedures among CAHs varied widely. Patients who are younger, medically complex, at higher surgical risk, and have private insurance are at higher odds of bypass. Patients are also more likely to bypass low-volume hospitals. CONCLUSION: Rural hospitals should consider developing surgical services that are performed electively and on an outpatient basis that are attractive to a broader rural population. CAHs that already offer elective surgical procedures and yet who are still bypassed must examine the mutable factors that drive bypass behavior.

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BACKGROUND: Patient demographics and outcomes may influence patient satisfaction. We aim to investigate the relationship between postoperative complications and survey-based satisfaction in the context of payer status. METHODS: Institutional data were used to identify major complication occurrence and linked to patient satisfaction surveys. The impact of complication occurrence on satisfaction was investigated and stratified by payer status. RESULTS: In all, 1,597 encounters were identified with an 18% major complication rate. Satisfaction scores in specific domains were significantly more likely to be above the median for patients without complications (P < .01) and for payer status Medicaid/low income (P < .05). In sensitivity analyses, we found no significant interactions among payer status, complications, and satisfaction scores. CONCLUSIONS: Significant differences exist for individual satisfaction survey domains between patients with and without major postoperative complications and by payer status. Payer status was not found to have an impact on the intersection of major complications and patient satisfaction.

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BACKGROUND: Rural communities have disproportionately faced primary care shortages for decades in spite of policy efforts to prepare and attract primary care health professionals to practice in rural locales. Insight into how primary care physicians' service patterns in rural areas differ from those in less rural places is important to better inform recruitment strategies that target primary care providers and rural communities. OBJECTIVES: The purpose of this research is to describe how primary care physician service patterns vary by rural-urban location for a large, privately insured population. We discuss implications of service pattern variation on policy efforts to attract primary care providers to underserved rural areas. METHODS: Claims data from fully insured commercial health insurance beneficiaries were used to develop service pattern profiles for primary care providers located in 1 of 4 types of rural-urban areas in Iowa in 2009. The 4 area types are metropolitan, micropolitan, noncore area adjacent to a metro area, and noncore/nonadjacent rural area. RESULTS: There were differences in primary care physicians' service patterns by rural-urban area type. Physicians in nonmetropolitan areas provided relatively more care on a per physician basis than those in the metropolitan area type, as well as more surgery, maternity, emergency, and nursing facility services than metropolitan physicians. CONCLUSION: Primary care physicians who value practicing a relatively diverse range of services may find locating in rural areas an appealing choice. Health systems and policy makers seeking to attract primary care physicians to rural areas can incorporate this reality into a recruitment strategy.

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Brazil is the biggest coffee producer in the world and different plantation management systems have been applied to improve sustainability and soil quality. Little is known about the environmental effects of these different management systems, therefore, the goal of this study was to use soil biological parameters as indicators of changes. Soils from plantations in Southeastern Brazil with conventional (CC), organic (OC) and integrated management systems containing intercropping of Brachiaria decumbens (IB) or Arachis pintoi (IA) were sampled. Total organic carbon (TOC), microbial biomass carbon (MBC) and nitrogen (MBN), microbial activity (C-CO2), metabolic quotient (qCO2), the enzymes dehydrogenase, urease, acid phosphatase and arylsulphatase, arbuscular mycorrhizal fungi (AMF) colonization and number of spores and soil fauna were evaluated. The greatest difference between the management systems was seen in soil organic matter content. The largest quantity of TOC was found in the OC, and the smallest was found in IA. TOC content influenced soil biological parameters. The use of all combined attributes was necessary to distinguish the four systems. Each management presented distinct faunal structure, and the data obtained with the trap method was more reliable than the TSBF (Tropical Soils) method. A canonic correlation analysis showed that Isopoda was correlated with TOC and the most abundant order with OC. Isoptera was the most abundant faunal order in IA and correlated with MBC. Overall, OC had higher values for most of the biological measurements and higher populations of Oligochaeta and Isopoda, corroborating with the concept that the OC is a more sustainable system.

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Abstract Brazil is the biggest coffee producer in the world and different plantation management systems have been applied to improve sustainability and soil quality. Little is known about the environmental effects of these different management systems, therefore, the goal of this study was to use soil biological parameters as indicators of changes. Soils from plantations in Southeastern Brazil with conventional (CC), organic (OC) and integrated management systems containing intercropping of Brachiaria decumbens (IB) or Arachis pintoi (IA) were sampled. Total organic carbon (TOC), microbial biomass carbon (MBC) and nitrogen (MBN), microbial activity (C-CO2), metabolic quotient (qCO2), the enzymes dehydrogenase, urease, acid phosphatase and arylsulphatase, arbuscular mycorrhizal fungi (AMF) colonization and number of spores and soil fauna were evaluated. The greatest difference between the management systems was seen in soil organic matter content. The largest quantity of TOC was found in the OC, and the smallest was found in IA. TOC content influenced soil biological parameters. The use of all combined attributes was necessary to distinguish the four systems. Each management presented distinct faunal structure, and the data obtained with the trap method was more reliable than the TSBF (Tropical Soils) method. A canonic correlation analysis showed that Isopoda was correlated with TOC and the most abundant order with OC. Isoptera was the most abundant faunal order in IA and correlated with MBC. Overall, OC had higher values for most of the biological measurements and higher populations of Oligochaeta and Isopoda, corroborating with the concept that the OC is a more sustainable system.

Resumo O Brasil é o maior produtor mundial de café e diferentes sistemas de manejo têm sido aplicados para melhorar a sustentabilidade e a qualidade do solo. Pouco se conhece sobre os efeitos ambientais desses sistemas de manejo, assim, o objetivo desse estudo foi utilizar parâmetros biológicos do solo como indicadores de mudanças nos sistemas. Foram amostrados, na região sudeste do Brasil, solos com cultivo convencional (CC), orgânico (OC) e sistema integrado de cultivo consorciado com Brachiaria decumbens (IB) ou com Arachis pintoi (IA) na entrelinha. Foram avaliados o carbono orgânico total (TOC), carbono e nitrogênio da biomassa microbiana (MBC e MBN), atividade microbiana (C-CO2), quociente metabólico (qCO2), as enzimas desidrogenase, urease, fosfatase ácida e arilsulfatase, a colonização e número de esporos de fungos micorrízicos arbusculares (AMF) e a fauna do solo. A maior diferença entre os sistemas de manejo foram verificadas no teor de matéria orgânica do solo. O maior teor de TOC foi encontrado no OC, e o menor teor encontrado no sistema IA. O teor de TOC influenciou os parâmetros biológicos e a diferenciação da fauna do solo. O uso combinado de todos os atributos foi necessário para diferenciar os quatro sistemas de cultivo. Cada manejo apresentou estruturas diferentes de fauna, e dados obtidos com o método de armadilhas tipo pitfall foi mais confiável do que o método TSBF (Solos Tropicais). A análise de correlação canônica mostrou que Isopoda foi correlacionado com TOC e a ordem mais abundante em OC. Isoptera foi a ordem da fauna mais abundante em IA e foi correlacionada com MBC. Em geral, OC apresentou os maiores valores para a maioria dos atributos biológicos, inclusive para abundância de indivíduos de Oligochaeta e Isopoda, corroborando com o conceito de que OC é um sistema mais sustentável.

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OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries. METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching. CONCLUSION: This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

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Necrotizing myopathies (NM) are defined by histological features. Muscle biopsy demonstrates marked muscle necrosis with regeneration, with little or an absence of inflammatory infiltrate. Histological pattern of NM is unspecific and can be encountered in diverse conditions as acquired myopathies and muscular dystrophies. Among acquired forms of NM, necrotizing autoimmune myopathy (NAM) is a recently recognized sub-group of the idiopathic inflammatory myopathies. Classically, patients present with a subacute severe proximal myopathy, associated with a markedly elevated creatine kinase level, usually greater than 10 times the upper limit of normal. Nevertheless, the clinical presentation can be misleading, with chronic course mimicking muscular dystrophy. Different forms of NAM can be distinguished with various underlying inciting conditions, including autoantibodies to the SRP, autoantibodies to the HMG-CoA reductase, association to connective tissue disease or underlying malignancy. Other associated conditions need yet to be identified. To confirm a diagnosis of NAM, other causes of NM should be excluded as toxic myopathies, muscular dystrophies and other inflammatory myopathies with a misleading histological pattern. NAM is a rare condition but is probably underdiagnosed. Both clinicoserologic and pathologic data must be taken into account to improve this diagnosis. We propose guidelines for diagnosis of NAM according to clinical course, to be used in clinical practice.

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