RESUMEN
We compiled a human metagenome assembled plasmid (MAP) database and interrogated differences across multiple studies that were originally designed to investigate the composition of the human microbiome across various lifestyles, life stages and events. This was performed as plasmids enable bacteria to rapidly expand their functional capacity through mobilisation, yet their contribution to human health and disease is poorly understood. We observed that inter-sample ß-diversity differences of plasmid content (plasmidome) could distinguish cohorts across a multitude of conditions. We also show that reduced intra-sample plasmidome α-diversity is consistent amongst patients with inflammatory bowel disease (IBD) and Clostridioides difficile infections. We also show that faecal microbiota transplants can restore plasmidome diversity. Overall plasmidome diversity, specific plasmids, and plasmid-encoded functions can all potentially act as biomarkers of IBD or its severity. The human plasmidome is an overlooked facet of the microbiome and should be integrated into investigations regarding the role of the microbiome in promoting health or disease. Including MAP databases in analyses will enable a greater understanding of the roles of plasmid-encoded functions within the gut microbiome and will inform future human metagenome analyses.
Asunto(s)
Enfermedades Inflamatorias del Intestino , Microbiota , Humanos , Enfermedades Inflamatorias del Intestino/genética , Enfermedades Inflamatorias del Intestino/microbiología , Metagenoma , Metagenómica , Plásmidos/genéticaRESUMEN
The first sequenced genome was that of the 3569-nucleotide single-stranded RNA (ssRNA) bacteriophage MS2. Despite the recent accumulation of vast amounts of DNA and RNA sequence data, only 12 representative ssRNA phage genome sequences are available from the NCBI Genome database (June 2019). The difficulty in detecting RNA phages in metagenomic datasets raises questions as to their abundance, taxonomic structure, and ecological importance. In this study, we iteratively applied profile hidden Markov models to detect conserved ssRNA phage proteins in 82 publicly available metatranscriptomic datasets generated from activated sludge and aquatic environments. We identified 15,611 nonredundant ssRNA phage sequences, including 1015 near-complete genomes. This expansion in the number of known sequences enabled us to complete a phylogenetic assessment of both sequences identified in this study and known ssRNA phage genomes. Our expansion of these viruses from two environments suggests that they have been overlooked within microbiome studies.
Asunto(s)
Bacteriófagos/genética , Genoma Viral , Genómica , ARN Viral , Bacteriófagos/clasificación , Bacteriófagos/metabolismo , Regulación Viral de la Expresión Génica , Genómica/métodos , Interacciones Huésped-Patógeno , Filogenia , Transcriptoma , Proteínas ViralesRESUMEN
OBJECTIVES: To evaluate the costs of implementing a church-based, telephone-counseling program for increasing mammography use, and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics. DATA SOURCES/STUDY SETTING: An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion (LAMP) program were followed from 1995 to 1997. STUDY DESIGN: Churches were stratified into blocks and randomized into three intervention arms-telephone counseling, mail counseling, and control. We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics. DATA COLLECTION/EXTRACTION METHODS: We used call records, activity reports, and interviews to collect data on the time and materials needed to organize and carry out the intervention. We constructed a standard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program. PRINCIPAL FINDINGS: The cost in materials and overhead to the church site was $10.89 per participant and $188 per additional screening. However, when the estimated cost for church volunteers' time was included, the cost of the intervention increased substantially. CONCLUSIONS: A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and resources.
Asunto(s)
Cristianismo , Relaciones Comunidad-Institución/economía , Costos de la Atención en Salud/estadística & datos numéricos , Promoción de la Salud/economía , Mamografía/economía , Tamizaje Masivo/economía , Servicios de Salud para Mujeres/economía , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Estudios de Factibilidad , Femenino , Investigación sobre Servicios de Salud , Humanos , Los Angeles , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Grupos Minoritarios , Modelos Econométricos , Pobreza , Evaluación de Programas y Proyectos de Salud , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Servicios de Salud para Mujeres/estadística & datos numéricosRESUMEN
OBJECTIVE: To explore the effects of community-level factors on access to any behavioral health care and specialty behavioral health care. DATA: Healthcare for Communities household survey data, merged to supplemental data from the 1990 Census Area Resource File, 1995 U.S. Census Bureau Small Area Estimates, and 1994 HMO enrollment data. STUDY DESIGN: We use a random intercept model to estimate the influences of community-level factors on access to any outpatient care, any behavioral health care conditional on having received outpatient care, and any specialty behavioral health care conditional on having received behavioral health care. DATA COLLECTION: HCC data were collected in 1997 from about 10,000 households nationwide but clustered in 60 sites. PRINCIPAL FINDINGS: Individuals in areas with greater HMO presence have better overall access to care, which in turn affects access to behavioral health care; individuals in poorer communities have less access to specialty care compared to individuals in wealthier communities. CONCLUSIONS: Our findings of lower access to specialty care among those in poor communities raises concerns about the appropriateness and quality of the behavioral health care they are receiving. More generally, the findings suggest the importance of considering the current status and expected evolution of HMO penetration and the income level in a community when devising health care policy.
Asunto(s)
Medicina de la Conducta , Participación de la Comunidad/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental/estadística & datos numéricos , Medicina de la Conducta/estadística & datos numéricos , Femenino , Sistemas Prepagos de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud/métodos , Investigación sobre Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Distribución Aleatoria , Factores Socioeconómicos , Estados UnidosRESUMEN
The AAN/ACNS report is misleadingly negative regarding the current status of quantitative EEG and tends to discourage its development and use with other related clinical problems. There have been many excellent studies showing that QEEG can be useful for the evaluation and understanding of mild traumatic brain injury, learning disabilities, attention deficit disorders, alcoholism, depression, and other types of substance abuse. In fact, Hughes and John recently provided in this Journal an extensive and detailed review of the use of QEEG in psychiatric disorders. The bias of the AAN/ACNS report is also evident when contrasted to the outstanding review of the clinical utility of QEEG by the American Medical EEG Association, which clearly articulates the opposite points in many cases and concludes that QEEG has reached maturity. At present, the most one can say is that there are legitimate scientific debate and differences of opinion concerning the utility of QEEG, as there are in many other areas of medicine. The AAN/ACNS article should not be considered the definitive opinion. Too many implications for health care are at stake. The debate and research may continue without withholding valuable help from the public. We hope that revised guidelines will be drafted in such a way as to encourage the development of quantitative EEG and brain mapping rather than discourage future research support and use of QEEG with patients. Furthermore, we strongly feel that this technology should be available to, and be explored and used by, nonphysicians who are properly trained and certified.
Asunto(s)
Electroencefalografía , Neurología , Neurofisiología , Sociedades Médicas , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Lesiones Encefálicas/diagnóstico , Humanos , Reproducibilidad de los Resultados , Convulsiones/diagnóstico , Estados UnidosRESUMEN
The response of chronic insomniacs to 100 mg pentobarbital, 300 mg methyprylon, 500 mg glutethimide, and placebo was assessed using our previously described subjective and objective techniques. The purpose of the study was to examine (1) the presence or absence of the subjects' reported insomnia; (2) the subjects' ability to discriminate between active hypnotic drugs and placebo; and (3) whether any preference existed among active medications. Statistically significant findings included a high degree of correlation (P less than 0.001) between subjective and objective data and greater response to active medications as compared to placebo shown on all parameters except objective onset of sleep. In no case was there significant difference between the two nights of placebo. Although methyprylon was most frequently superior to placebo, there was no significant patient preference for any of the active medications.
Asunto(s)
Evaluación de Medicamentos/métodos , Hipnóticos y Sedantes/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Adulto , Ensayos Clínicos como Asunto , Método Doble Ciego , Humanos , Hipnóticos y Sedantes/efectos adversos , Masculino , Placebos , Sueño/efectos de los fármacos , Factores de TiempoRESUMEN
Although anxiolytic sedatives are widely used in clinical practice, the methodology for assessing treatment effect of these compounds has not been well developed. The present double-blind study was designed to refine methodology for evaluating anxiolytics. Choice of rating scale, patient selection, maintenance of the double-blind status, the subjects' environment during the study, and the subjects' understanding of the study are discussed as considerations in reducing sources of variability and bias in the study of anxiolytics. After placebo prescreening, 14 subjects with diagnoses of anxiety recieved 3 to 6 mg lorazepam daily for four weeks, while 14 control subjects received placebo. The Hamilton Anxiety Rating Scale (HARS) and the Wang Anxiety Rating Scale (WARS), with its Anxiolytic Adjunct Scale (AAS), were used to assess changes in anxiety. The Wang and Hamilton ratings correlated well at both comparison periods. Lorazepam demonstrated significant superiority to placebo and produced no serious adverse effects. Anxiolytic efficacy did not differ significantly among the four weekly ratings.
Asunto(s)
Ansiolíticos/farmacología , Ansiolíticos/uso terapéutico , Evaluación de Medicamentos/métodos , Lorazepam/farmacología , Adulto , Anciano , Ansiedad/tratamiento farmacológico , Ensayos Clínicos como Asunto , Humanos , Lorazepam/efectos adversos , Lorazepam/uso terapéutico , Masculino , Persona de Mediana Edad , Placebos , Escalas de Valoración Psiquiátrica , Factores de TiempoRESUMEN
The safety and value of naloxone as a therapeutic aid was demonstrated in a large population of narcotic dependent persons over a two-year period. Naloxone was used to precipitate the narcotic withdrawal syndrome. This withdrawal syndrome was rated according to a previously developed scale. Retrospectively, naloxone rating scores were correlated with the patients' initial dose of methadone. With patients who received 0.8 mg naloxone, good correlation was obtained between the naloxone test score and the optimum methadone dose (mg), as indicated by the patients' physical status during the initial three days of methadone treatment. Three hundred and sixty-three tests were administered to 343 persons and no individuals developed any serious effects such as convulsions, syncope or cardiovascular collapse.
Asunto(s)
Dependencia de Heroína/rehabilitación , Naloxona/uso terapéutico , Opio , Trastornos Relacionados con Sustancias/rehabilitación , Adolescente , Adulto , Evaluación de Medicamentos , Humanos , Metadona/uso terapéutico , Persona de Mediana Edad , Naloxona/administración & dosificaciónRESUMEN
The Wang Anxiety Rating Scale (WARS) was designed to evaluate degrees of anxiety in patients receiving anxiolytic medication. WARS contains 12 pertinent symptoms of anxiety: nervousness, restlessness, excitability, irritability, worrying, disturbed concentration, palpitation, insomnia, hostility, tremors, smoking, and excessive perspiration. Frequently encountered side effects of anxiolytic medications are excluded. The validity of the WARS was determined by correlation with the Hamilton Anxiety Rating Scale (HARS) in a single-blind study in which 20 chronically anxious patients consecutively received placebo (three days), 15 mg clorazepate dipotassium (two weeks), and 22.5 mg clorazepate dipotassium (two weeks). Both anxiety scales, a side effect scale, and a global assessment were completed at regular intervals (periods 0-6). Results show (1) highly significant correlation (P less than 0.001) between WARS and HARS for periods 1-6; (2) greater correlation between HARS and side effect scale than between WARS and side effect scale; (3) greater correlation between WARS and global assessment than between HARS and global assessment; correlated changes in scores for WARS, HARS, and global assessment demonstrate efficacy of active medication.
Asunto(s)
Ansiolíticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Escalas de Valoración Psiquiátrica , Adulto , Ansiolíticos/efectos adversos , Ensayos Clínicos como Asunto , Humanos , MasculinoRESUMEN
In a double-blind crossover study involving 15 insomniac subjects, the hypnotic efficacy of lorazepam, 2 and 4 mg, was compared with flurazepam, 15 and 30 mg, and placebo. Five subjective measures were used: onset, length, and depth of sleep, number of times awakened, and satisfaction with the hypnotic. Lorazepam in 2- and 4-mg doses was comparable in hypnotic efficacy to flurazepam, 30 mg, according to most parameters of measurement. Side effects were minor, although relatively numerous at the 4-mg doses.