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Background Ectopic deciduosis is a benign presence of endometrial tissue outside of the uterus during pregnancy that rarely presents with pleuropulmonary manifestations and recurrent pneumothorax. Case Description We report a 35-year-old woman at 15 weeks' gestation with a history of recurrent intrapartum right pneumothorax found to have pleural, pulmonary, and diaphragmatic lesions and a middle lobe air leak. Wedge resection of the middle lobe and mechanical pleurodesis was performed. Histopathological analysis was progesterone receptor and PAX8 positive consistent with ectopic deciduosis. Conclusion Ectopic deciduosis is a rare cause of recurrent pneumothorax in pregnancy and should be considered when evaluating these patients.
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OBJECTIVE: To determine whether outcomes achieved by new surgeons are attributable to inexperience or to differences in the context in which care is delivered and patient complexity. BACKGROUND: Although prior studies suggest that new surgeon outcomes are worse than those of experienced surgeons, factors that underlie these phenomena are poorly understood. METHODS: A nationwide observational tapered matching study of outcomes of Medicare patients treated by new and experienced surgeons in 1221 US hospitals (2009-2013). The primary outcome studied is 30-day mortality. Secondary outcomes were examined. RESULTS: In total, 694,165 patients treated by 8503 experienced surgeons were matched to 68,036 patients treated by 2119 new surgeons working in the same hospitals. New surgeons' patients were older (25.8% aged ≥85 vs 16.3%,P<0.0001) with more emergency admissions (53.9% vs 25.8%,P<0.0001) than experienced surgeons' patients. Patients of new surgeons had a significantly higher baseline 30-day mortality rate compared with patients of experienced surgeons (6.2% vs 4.5%,P<0.0001;OR 1.42 (1.33, 1.52)). The difference remained significant after matching the types of operations performed (6.2% vs 5.1%, P<0.0001; OR 1.24 (1.16, 1.32)) and after further matching on a combination of operation type and emergency admission status (6.2% vs 5.6%, P=0.0007; OR 1.12 (1.05, 1.19)). After matching on operation type, emergency admission status, and patient complexity, the difference between new and experienced surgeons' patients' 30-day mortality became indistinguishable (6.2% vs 5.9%,P=0.2391;OR 1.06 (0.97, 1.16)). CONCLUSIONS: Among Medicare beneficiaries, the majority of the differences in outcomes between new and experienced surgeons are related to the context in which care is delivered and patient complexity rather than new surgeon inexperience.
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Competência Clínica , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Medicare , Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/mortalidade , Estados UnidosRESUMO
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
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Humanos , Adolescente , Adulto , Transtorno Autístico , Transtorno do Espectro Autista , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Pais , Resultado do Tratamento , CogniçãoRESUMO
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
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Transtorno do Espectro Autista , Transtorno Autístico , Adolescente , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Cognição , Humanos , Pais , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice. SUMMARY BACKGROUND DATA: In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied. METHODS: We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 ("traditional" era) and 2009 and 2013 ("modern" era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors. RESULTS: Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97-1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83-1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02-1.15), P = 0.015], anesthesia time [9âmin; 95% CI (8-10), P < 0.001], and costs [255USD; 95% CI (2-508), P = 0.049]. CONCLUSIONS: Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.
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Competência Clínica , Admissão e Escalonamento de Pessoal/tendências , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/mortalidade , Tolerância ao Trabalho Programado , Algoritmos , Educação de Pós-Graduação em Medicina , Feminino , Mortalidade Hospitalar/tendências , Humanos , Internato e Residência , Masculino , Medicare , Estados UnidosRESUMO
Laccases are multicopper oxidases that are being studied for their potential application in pretreatment strategies of lignocellulosic feedstocks for bioethanol production. Here, we report the expression and characterization of a predicted laccase (LAC_2.9) from the thermophilic bacterial strain Thermus sp. 2.9 and investigate its capacity to delignify lignocellulosic biomass. The purified enzyme displayed a blue color typical of laccases, showed strict copper dependence and retained 80% of its activity after 16 h at 70 °C. At 60 °C, the enzyme oxidized 2,2'-azino-di-(3-ethylbenzthiazoline sulfonate) (ABTS) and 2,6-dimethoxyphenol (DMP) at optimal pH of 5 and 6, respectively. LAC_2.9 had higher substrate specificity (kcat/KM) for DMP with a calculated value that accounts for one of the highest reported for laccases. Further, the enzyme oxidized a phenolic lignin model dimer. The incubation of steam-exploded eucalyptus biomass with LAC_2.9 and 1-hydroxybenzotriazole (HBT) as mediator changed the structural properties of the lignocellulose as evidenced by Fourier transform infrared (FTIR) spectroscopy and thermo-gravimetric analysis (TGA). However, this did not increase the yield of sugars released by enzymatic saccharification. In conclusion, LAC_2.9 is a thermostable laccase with potential application in the delignification of lignocellulosic biomass.
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OBJECTIVE: We sought to compare postoperative outcomes of female surgeons (FS) and male surgeons (MS) within general surgery. SUMMARY OF BACKGROUND DATA: FS in the workforce are increasing in number. Female physicians provide exceptional care in other specialties. Differences in surgical outcomes of FS and MS have not been examined. METHODS: We linked the AMA Physician Masterfile to discharge claims from New York, Florida, and Pennsylvania (2012 to 2013) to examine practice patterns and to compare surgical outcomes of FS and MS. We paired FS and MS operating at the same hospital using cardinality matching with refined balance and compared inpatient mortality, any postoperative complication, and prolonged length of stay (pLOS) in FS and MS. RESULTS: Overall practice patterns differed between the 663 FS and 3219 MS. We identified 2462 surgeons (19% FS, 81% MS) at 429 hospitals who met inclusion criteria for outcomes analysis. FS were younger (mean ageâ±âSD FS: 48.5â±â8.4 years, MS: 54.3â±â9.4y; P < 0.001) with less clinical experience (mean yearsâ±âSD FS: 11.6â±â8.3 y, MS: 17.6â±â10.0 years; P < 0.001) than MS before matching. FS had lower rates of inpatient mortality (FS: 1.51%, MS: 2.30%; P < 0.001), any postoperative complication (FS: 12.6%, MS: 16.1%; P < 0.001), and pLOS (FS: 18.4%, MS: 20.7%; P < 0.001) before matching. After matching, FS and MS outcomes were equivalent. CONCLUSION: Surgeon practice patterns vary by sex and experience. FS and MS with similar characteristics who treat similar patients at the same hospital have equivalent rates of inpatient morality, postoperative complications, and prolonged length of hospital stay. Patients should select the surgeon who is the best fit for them regardless of sex.
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Competência Clínica , Avaliação de Resultados em Cuidados de Saúde , Padrões de Prática Médica , Cirurgiões/normas , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicas , Estudos Retrospectivos , Fatores Sexuais , Resultado do TratamentoRESUMO
In this paper, we discuss how life history drawings can serve as a valuable method for global health research. The introduction discusses qualitative approaches to concepts such as reliability, validity and triangulation, and situates the use of participatory visual methods within the broader field of participatory research. The paper reports on an experience using life history drawings as part of extended ethnographic research in rural Mexico and among Mexican migrants living in Atlanta. The primary method for that parent project was comparative ethnographic research, which included life histories collected from 13 pairs of women over 15 months of participant observation. Early in the research, the drawings contributed to a major reorientation in the direction of the research project. The insights generated through analysis of the life history drawings exemplify how this participatory research technique can direct attention to social processes that feel salient to community members. In this case, they called attention to the enormity of social change in this community over one generation, reorienting the study from one focused on change causes by migration to one that focused on two trajectories of change: generational and migration-related.
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Pesquisa Participativa Baseada na Comunidade/métodos , Americanos Mexicanos/psicologia , Sexualidade/etnologia , Mobilidade Social , Migrantes/psicologia , Saúde da Mulher/etnologia , Direitos da Mulher , Fatores Etários , Antropologia Cultural/métodos , Arte , Comparação Transcultural , Feminino , Georgia , Humanos , México , Narrativas Pessoais como Assunto , Pesquisa Qualitativa , População Rural , Sexualidade/psicologiaRESUMO
PURPOSE: The Down syndrome cell adhesion molecule (Dscam) gene is required for normal dendrite arborization and lamination in the mouse retina. In this study, we characterized the developmental localization of the DSCAM protein to better understand the postnatal stages of retinal development during which laminar disorganization occur in the absence of the protein. METHODS: Immunohistochemistry and colocalization analysis software were used to assay the localization of the DSCAM protein during development of the retina. RESULTS: We found that DSCAM was initially localized diffusely throughout mouse retinal neurites but then adopted a punctate distribution. DSCAM colocalized with catenins in the adult retina but was not detected at the active zone of chemical synapses, electrical synapses, and tight junctions. Further analysis identified a wave of colocalization between DSCAM and numerous synaptic and junction proteins coinciding with synaptogenesis between bipolar and retinal ganglion cells. CONCLUSIONS: Research presented in this study expands our understanding of DSCAM function by characterizing its location during the development of the retina and identifies temporally regulated localization patterns as an important consideration in understanding the function of adhesion molecules in neural development.
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Envelhecimento/metabolismo , Cateninas/genética , Moléculas de Adesão Celular/genética , Neurogênese/genética , Células Bipolares da Retina/metabolismo , Células Ganglionares da Retina/metabolismo , Envelhecimento/genética , Animais , Animais Recém-Nascidos , Cateninas/metabolismo , Moléculas de Adesão Celular/metabolismo , Dendritos/metabolismo , Dendritos/ultraestrutura , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Camundongos , Camundongos Transgênicos , Mutação , Neuritos/metabolismo , Neuritos/ultraestrutura , Células Bipolares da Retina/ultraestrutura , Células Ganglionares da Retina/ultraestrutura , Sinapses/metabolismo , Sinapses/ultraestrutura , Junções Íntimas/metabolismo , Junções Íntimas/ultraestruturaRESUMO
This study describes HIV, sexually transmitted infections (STI) and risk factors associated with Mycoplasma genitalium among female sex workers (FSWs) in four cities in Honduras. In 2006, 795 FSWs from Tegucigalpa, San Pedro Sula, La Ceiba and Comayagua were recruited using respondent-driven sampling (RDS) and tested for HIV prevalence and STI. HIV prevalence ranged from no infections in Comayagua to 5.4% in Tegucigalpa. With the exception of Comayagua, more than 20% of FSWs were infected with M. genitalium. M. genitalium in the aggregated cities was associated with HIV positivity, being aged ≤30 years old, drinking alcohol more than once weekly and always using condoms with regular clients in the past month. In comparison with a 2001 surveillance study we found lower rates of HIV infection. Interventions for HIV control and prevention among FSWs, including promotion of condom use, are needed in Honduras.
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Soropositividade para HIV/epidemiologia , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium , Trabalho Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas , Preservativos , Intervalos de Confiança , Feminino , Honduras/epidemiologia , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Infecções por Mycoplasma/microbiologia , Razão de Chances , Prevalência , Fatores de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/microbiologia , Adulto JovemRESUMO
AIM: This study aims to estimate the cost-effectiveness from a societal perspective of seven dental caries prevention programmes among schoolchildren in Chile: three community-based programmes: water-fluoridation, salt-fluoridation and dental sealants; and four school-based programmes: milk-fluoridation; fluoridated mouthrinses (FMR); APF-Gel, and supervised toothbrushing with fluoride toothpaste. METHODS: Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating each programme, using a societal perspective, were identified and estimated. The comparator was non-intervention. Health outcomes were measured as dental caries averted over a 6-year period. Costs were estimated as direct treatment costs, programmes costs and costs of productivity losses as a result of each dental caries prevention programme. Incremental cost-effectiveness ratios were calculated for each programme. Sensitivity analyses were conducted over key parameters. RESULTS: Primary cost-effectiveness analysis (discounted) indicated that four programmes showed net social savings by the DMFT averted. These savings encompassed a range of values per diseased tooth averted; US$16.21 (salt-fluoridation), US$14.89 (community water fluoridation); US$14.78 (milk fluoridation); and US$8.63 (FMR). Individual programmes using an APF-Gel application, dental sealants, and supervised tooth brushing using fluoridated toothpaste, represent costs for the society per diseased tooth averted of US$21.30, US$11.56 and US$8.55, respectively. CONCLUSION: Based on cost required to prevent one carious tooth among schoolchildren, salt fluoridation was the most cost-effective, with APF-Gel ranking as least cost-effective. Findings confirm that most community/school-based dental caries interventions are cost-effective uses of society's financial resources. The models used are conservative and likely to underestimate the real benefits of each intervention.
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Cárie Dentária/prevenção & controle , Promoção da Saúde/economia , Fluoreto de Fosfato Acidulado/uso terapêutico , Animais , Cariostáticos/administração & dosagem , Cariostáticos/uso terapêutico , Criança , Chile , Odontologia Comunitária/economia , Redução de Custos , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Índice CPO , Cárie Dentária/economia , Eficiência , Fluoretação/economia , Fluoretos/administração & dosagem , Fluoretos/uso terapêutico , Custos de Cuidados de Saúde , Humanos , Leite , Modelos Econômicos , Antissépticos Bucais/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde/economia , Selantes de Fossas e Fissuras/uso terapêutico , Odontologia Preventiva/economia , Avaliação de Processos em Cuidados de Saúde/economia , Serviços de Odontologia Escolar/economia , Cloreto de Sódio na Dieta/administração & dosagem , Escovação Dentária/métodos , Cremes Dentais/uso terapêuticoRESUMO
INTRODUCTION: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. AIM: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. METHOD: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with advanced cancer. RESULTS: Four domains of vulnerability derived from Kipnis's taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others--for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. CONCLUSIONS: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualize vulnerability using the domains identified in this study and consider the research context and interviewers' skills.
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População Negra/psicologia , Neoplasias/psicologia , Cuidados Paliativos/normas , Projetos de Pesquisa/normas , População Branca/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Comparação Transcultural , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Pesquisa Qualitativa , Relações Pesquisador-Sujeito/psicologia , Confiança/psicologia , Populações Vulneráveis , Índias Ocidentais/etnologiaRESUMO
BACKGROUND: Injection drug use is a growing public health crisis along the U.S.-Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California. METHODS: Using in-depth qualitative interviews conducted from August 2006-March 2007 with 40 key stakeholders - pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel - we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation. RESULTS: Topics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. CONCLUSIONS: Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.
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Atitude , Programas de Troca de Agulhas/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Redução do Dano , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Aplicação da Lei , Masculino , México , Pessoa de Meia-Idade , Farmacêuticos/psicologia , Política , ReligiãoRESUMO
BACKGROUND: The Mexico-U.S. border region is experiencing rising rates of blood-borne infections among injection drug users (IDUs), emphasizing the need for harm reduction interventions. METHODS: We assessed the religious and cultural factors affecting the acceptability and feasibility of three harm reduction interventions--Needle exchange programs (NEPs), syringe vending machines, and safer injection facilities (SIFs)--in Tijuana, Mexico. In-depth qualitative interviews were conducted with 40 community stakeholders to explore cultural and societal-related themes. RESULTS: Themes that emerged included Tijuana's location as a border city, family values, and culture as a mediator of social stigma and empathy towards IDUs. Perception of low levels of both awareness and socio-cultural readiness for harm reduction interventions was noted. Religious culture emerged as a theme, highlighting the important role religious leaders play in determining community responses to harm reduction and rehabilitation strategies for IDUs. The influence of religious culture on stakeholders' opinions concerning harm reduction interventions was evidenced by discussions of family and social values, stigma, and resulting policies. CONCLUSION: Religion and politics were described as both a perceived benefit and deterrent, highlighting the need to further explore the overall influences of culture on the acceptability and implementation of harm reduction programs for drug users.
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Pain is a common cancer-related symptom, but little research has been conducted that explores the meanings of this symptom across different ethnic groups. This study involved qualitative interviews to explore and compare the meanings of pain among 26 Black Caribbean and 19 White patients with advanced cancer. Patients were recruited from oncology outpatient clinics, a lung clinic and palliative care teams. Interview transcripts were analysed using the framework approach. A total of 23/26 Black Caribbean and 15/19 White patients reported cancer-related pain. Accounts of Black Caribbean and White patients identified pain as a 'challenge' that needed to be mastered by the individual, not necessarily by drugs and identified pain as an 'enemy' that represented an unfair attack. Two further meanings of pain emerged from Black Caribbean patients' accounts: pain as a 'test of faith' that referred to confirmation and strengthening of religious belief, and pain as a 'punishment' that was associated with wrongdoing. These meanings influenced the extent patients were able to accommodate their distress. Pain assessment needs to consider the patients' narratives that include the meanings they attribute to this symptom, and which may be governed by culture.
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Atitude Frente a Saúde/etnologia , População Negra/psicologia , Cultura , Neoplasias/psicologia , Medição da Dor/psicologia , População Branca/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , População Negra/etnologia , Comparação Transcultural , Feminino , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Pesquisa Qualitativa , Doente Terminal/psicologia , Índias Ocidentais/etnologia , População Branca/etnologiaRESUMO
The clustered protocadherins (Pcdhs) are single-pass transmembrane proteins that constitute a subfamily within the cadherin superfamily. In mammals, they are arranged in three consecutive clusters named alpha, beta, and gamma. These proteins are expressed in the nervous system and are targeted to mature synapses.Interestingly, different neurons express different subsets of isoforms; however, little is known about the functions and expression of the clustered Pcdhs. Previous phylogenetic analyses that compared rodent and human clusters postulated the recent occurrence of gene duplication events. Using standard phylogenetic methods, I confirmed the prior observations, and I show that duplications are likely to occur through unequal crossing-over events between two, and sometimes three, different Pcdh genes. The results are consistent with the fact that these genes undergo gene conversion. Recombination events between different clustered Pcdh genes appear to underlie concerted evolution through gene conversion and gene duplications through unequal crossing-over. In this work, I provided evidence that the unit of duplication of these genes in both the mouse and the human and within each cluster is the same. The unit of duplication includes the extracellular domain-coding sequence of an isoform and its promoter along with the cytoplasmic domain-coding region of the immediately upstream isoform in the cluster.(AU)
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Humanos , Ratos , Animais , Sequência de Aminoácidos , Caderinas/genética , Evolução Molecular , Modelos Biológicos , Modelos Genéticos , Dados de Sequência Molecular , Família Multigênica , Filogenia , Estrutura Terciária de Proteína/genética , Ratos , Homologia de Sequência de AminoácidosRESUMO
The clustered protocadherins (Pcdhs) are single-pass transmembrane proteins that constitute a subfamily within the cadherin superfamily. In mammals, they are arranged in three consecutive clusters named alpha, beta, and gamma. These proteins are expressed in the nervous system and are targeted to mature synapses.Interestingly, different neurons express different subsets of isoforms; however, little is known about the functions and expression of the clustered Pcdhs. Previous phylogenetic analyses that compared rodent and human clusters postulated the recent occurrence of gene duplication events. Using standard phylogenetic methods, I confirmed the prior observations, and I show that duplications are likely to occur through unequal crossing-over events between two, and sometimes three, different Pcdh genes. The results are consistent with the fact that these genes undergo gene conversion. Recombination events between different clustered Pcdh genes appear to underlie concerted evolution through gene conversion and gene duplications through unequal crossing-over. In this work, I provided evidence that the unit of duplication of these genes in both the mouse and the human and within each cluster is the same. The unit of duplication includes the extracellular domain-coding sequence of an isoform and its promoter along with the cytoplasmic domain-coding region of the immediately upstream isoform in the cluster.
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Humanos , Ratos , Animais , Sequência de Aminoácidos , Caderinas/genética , Evolução Molecular , Modelos Biológicos , Modelos Genéticos , Estrutura Terciária de Proteína/genética , Dados de Sequência Molecular , Família Multigênica , Filogenia , Ratos , Homologia de Sequência de AminoácidosRESUMO
BACKGROUND: We examined human immunodeficiency virus (HIV) prevalence and correlates among female sex workers (FSWs) in Tijuana and Ciudad Juarez, 2 large cities on the Mexico-US border. METHODS: FSWs aged > or =18 years underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with HIV infection. RESULTS: In 924 FSWs, the prevalence of HIV, gonorrhea, chlamydia, and syphilis titers > or =1:8 was 6%, 6.4%, 13%, and 14.2%, respectively. Factors independently associated with HIV were the injection of cocaine (odds ratio [OR], 2.96); the smoking, snorting, or inhalation of methamphetamine (OR, 3.32); and syphilis titers > or =1:8 (OR, 4.16). CONCLUSIONS: Culturally appropriate interventions are needed to identify and treat ulcerative sexually transmitted infections and reduce HIV risks associated with stimulants among FSWs in the Mexico-US border region.
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Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/epidemiologia , Trabalho Sexual , Adulto , Feminino , Infecções por HIV/etnologia , Humanos , México/epidemiologia , Razão de Chances , Prevalência , Fatores de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias , Sexo sem ProteçãoRESUMO
OBJECTIVE: To characterize the overlap between injection drug use and sex work by women in Tijuana and Cd. Juarez, situated on the Mexico-U.S. border. METHODS: FSWs aged > or =18 years who were not knowingly HIV-positive and reported having unprotected sex with > or =1 client in the prior 2 months underwent interviews and testing for HIV, syphilis, gonorrhea and Chlamydia. Logistic regression identified factors associated with injecting drugs within the last month. RESULTS: Of 924 FSWs, 18.0% had ever injected drugs. Among FSW-IDUs (N=114), prevalence of HIV, syphilis titers > or =1:8, gonorrhea and Chlamydia was significantly higher at 12.3%, 22.7%, 15.2% and 21.2% compared to 4.8%, 13.1%, 5.2% and 11.9% among other FSWs (N=810). FSW-IDUs also had more clients in the past 6 months (median: 300 versus 240, p=0.02). Factors independently associated with injecting drugs in the past month included living in Tijuana, being younger, being married/common-law, longer duration in the sex trade, speaking English, earning less for sex without condoms, often using drugs before sex, and knowing other FSWs who injected drugs. CONCLUSIONS: FSW-IDUs had higher STI levels, engaged in riskier behaviors and were more vulnerable to having unsafe sex with clients compared to other FSWs, indicating that this subgroup is an important bridge population requiring focused prevention.