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BACKGROUND AND OBJECTIVES: The 9-valent human papillomavirus (9vHPV) vaccine Phase III immunogenicity study in 9- to 15-year-old boys and girls was extended to assess immunogenicity and effectiveness through 10 years after the last vaccine dose (NCT00943722). METHODS: Boys (n = 301) and girls (n = 971) who received three 9vHPV vaccine doses in the base study (day 1, months 2 and 6) enrolled in the extension. Serum was collected through month 126 for antibody assessments by competitive Luminex immunoassay and immunoglobulin G-Luminex immunoassay. For effectiveness analysis starting at age 16 years, genital swabs were collected (to assess HPV DNA by polymerase chain reaction) and external genital examinations conducted every 6 months. Primary analyses were conducted in per-protocol populations. RESULTS: Geometric mean antibody titers peaked around month 7, decreased sharply between months 7 and 12, then gradually through month 126. Seropositivity rates remained ≥81% by competitive Luminex immunoassay and ≥95% by immunoglobin G-Luminex immunoassay at month 126 for each 9vHPV vaccine type. After up to 11.0 (median 10.0) years of follow-up postdose 3, there were no cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or condyloma in males or females. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in males and females were low (54.6 and 52.4 per 10000 person-years, respectively) and within ranges expected in vaccinated cohorts, based on previous human papillomavirus vaccine efficacy trials. CONCLUSIONS: The 9vHPV vaccine demonstrated sustained immunogenicity and effectiveness through â¼10 years post 3 doses of 9vHPV vaccination of boys and girls aged 9 to 15 years.
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OBJECTIVE: To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs). STUDY DESIGN: In this cross-sectional study, caregivers of patients who presented to 2 urban PEDs completed a survey regarding their children's ACEs, health care utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years of age not requiring acute stabilization. Prevalence estimates were compared with national and state data from the National Survey of Children's Health by calculating risk differences and 95% CIs. The association of cumulative ACEs with caregiver-reported health care utilization patterns was evaluated using ORs. RESULTS: Among 1000 participants, 28.1% (95% CI 25.3-30.9) had 1 ACE; 17.8% (95% CI15.4-20.2) had ≥2 ACEs. Notably, children with higher cumulative ACEs were seen in the PED more frequently (0, 1, ≥2 visits) (OR 1.18, 95% CI 1.06-1.30, P = .002) and more likely to seek care in PEDs for sick visits (OR 1.16, 95% CI 1.04-1.30, P = .01). About 9% of children exposed to ACEs did not have a primary care provider. Over 85% of caregivers reported never discussing ACEs with their primary care provider. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%). CONCLUSIONS: Given higher PED utilization in children with more ACEs and caregiver acceptance of PED-based screening and intervention, PEDs may represent a strategic and opportune setting to both assess and respond to ACEs among vulnerable populations.
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Experiências Adversas da Infância/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Experiências Adversas da Infância/prevenção & controle , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother. DESIGN: A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child. SETTING: Rural Colombia. PARTICIPANTS: Totally, 2·350 mother-child pairs living in the same household. RESULTS: Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)). CONCLUSIONS: Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.
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Insegurança Alimentar , Desnutrição , Colômbia/epidemiologia , Estudos Transversais , Feminino , Abastecimento de Alimentos , Humanos , Desnutrição/epidemiologia , Estado Nutricional , Prevalência , Fatores SocioeconômicosRESUMO
BACKGROUND: Community health workers (CHWs) are increasingly deployed to support mothers' adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning. METHODS: We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0-23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-for-age (HAZ)<-2 Z-scores (stunting) in children aged 0-23 months. Household surveys were conducted at baseline (606 cases) and 4-year follow-up (606 cases). RESULTS: Maternal and child characteristics were similar in both study arms at baseline and follow-up. Difference-in-differences analysis showed mean HAZ changes were not significantly different in experimental versus control clusters from baseline to endline (P=.469). However, in the subgroup of literate mothers, mean HAZ improved by 1.03 on the Z-score scale in experimental clusters compared to control clusters from baseline to endline (P=.059). Using generalized estimating equations, we demonstrated that stunting in children of mothers who were literate was significantly reduced (Beta=0.77; 95% confidence interval=0.23, 1.31; P<.01), adjusting for covariates. CONCLUSION: Compared with standard training methods, SH may have improved the effectiveness of CHWs as change agents among literate mothers to reduce child stunting. Stunting experienced by the children of illiterate mothers may have involved unaddressed determinants of stunting.
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Agentes Comunitários de Saúde , Mães , Criança , Feminino , Visita Domiciliar , Humanos , Lactente , Peru , Gravidez , População RuralRESUMO
B cells orchestrate pro-survival and pro-apoptotic inputs during unfolded protein response (UPR) to translate, fold, sort, secrete and recycle immunoglobulins. In common variable immunodeficiency (CVID) patients, activated B cells are predisposed to an overload of abnormally processed, misfolded immunoglobulins. Using highly accurate transcript measurements, we show that expression of UPR genes and immunoglobulin chains differs qualitatively and quantitatively during the first 4 h of chemically induced UPR in B cells from CVID patients and a healthy subject. We tested thapsigargin or tunicamycin as stressors and 4-phenylbutyrate, dimethyl sulfoxide and tauroursodeoxycholic acid as chemical chaperones. We found an early and robust decrease of the UPR upon endoplasmic reticulum (ER) stress in CVID patient cells compared to the healthy control consistent with the disease phenotype. The chemical chaperones increased the UPR in the CVID patient cells in response to the stressors, suggesting that misfolded immunoglobulins were stabilized. We suggest that the AMP-dependent transcription factor alpha branch of the UPR is disturbed in CVID patients, underlying the observed expression behavior.
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Linfócitos B/efeitos dos fármacos , Imunodeficiência de Variável Comum/genética , Dimetil Sulfóxido/farmacologia , Fenilbutiratos/farmacologia , Ácido Tauroquenodesoxicólico/farmacologia , Resposta a Proteínas não Dobradas/efeitos dos fármacos , Linfócitos B/imunologia , Linfócitos B/metabolismo , Células Cultivadas , Imunodeficiência de Variável Comum/metabolismo , Imunodeficiência de Variável Comum/patologia , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Estresse do Retículo Endoplasmático/genética , Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/imunologia , Redes Reguladoras de Genes/efeitos dos fármacos , Redes Reguladoras de Genes/imunologia , Humanos , Imunoglobulinas/genética , Imunoglobulinas/metabolismo , Tapsigargina/farmacologia , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Tunicamicina/farmacologia , Resposta a Proteínas não Dobradas/genéticaRESUMO
Regulated transcriptional readthrough during stress maintains genome structure and ensures access to genes that are necessary for cellular recovery. A broad number of genes, including of the bacterial sensor Toll-like receptor 4 (TLR-4), are markedly transcribed on initiating the systemic inflammatory response. Here we study the transcriptional patterns of tlr4 and of its modulator grp78 during human sepsis, and establish their correlations with the outcome of patients. We measured the daily tlr4 and grp78 RNA expression levels in peripheral blood of septic patients, immediately after admission to intensive care, and modeled these RNA values with a sine damping function. We obtained negative correlations between the transcription of tlr4 and grp78 RNA in the survivor group. In contrast, such relation is lost in the deceased patients. Loss of transcriptional homeostasis predicted by our model within the initial 4 days of hospitalization was confirmed by death of those patients up to 28 days later.
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Proteínas de Choque Térmico/imunologia , Modelos Biológicos , Sepse/imunologia , Receptor 4 Toll-Like/imunologia , Transcrição Gênica/imunologia , Adulto , Idoso , Intervalo Livre de Doença , Chaperona BiP do Retículo Endoplasmático , Feminino , Proteínas de Choque Térmico/sangue , Humanos , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/sangue , RNA Mensageiro/imunologia , Sepse/sangue , Sepse/mortalidade , Taxa de Sobrevida , Receptor 4 Toll-Like/sangueRESUMO
Fever is a regulated increase of the body temperature resulting from both infectious and non-infectious causes. Fever is known to play a role in modulating immune responses to infection, but the potential of febrile temperatures in regulating antigen binding affinity to antibodies has not been explored. Here we investigated this process under in vitro conditions using Isothermal titration calorimetry and ELISA. We used selected malarial and dengue antigens against specific monoclonal antibodies, and observed a marked increase in the affinity of these antibody-antigen complexes at 40°C, compared to physiological (37°C) or pathophysiological temperatures (42°C). Induced thermal equilibration of the protein partners at these temperatures in vitro, prior to measurements, further increased their binding affinity. These results suggest another positive and adaptive role for fever in vivo, and highlight the favourable role of thermal priming in enhancing protein-protein affinity for samples with limited availability.
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Anticorpos Antivirais/imunologia , Afinidade de Anticorpos , Antígenos Virais/imunologia , Febre/imunologia , Temperatura , Anticorpos Monoclonais/imunologia , Complexo Antígeno-Anticorpo/imunologia , Temperatura Corporal , Calorimetria , Dengue/imunologia , Vírus da Dengue , Ensaio de Imunoadsorção Enzimática , Interações Hospedeiro-Patógeno , Humanos , Malária/imunologia , Plasmodium vivaxRESUMO
OBJECTIVES: To determine the prevalence of and demographic characteristics associated with toxic stress risk factors by universal screening, the impact of screening on referral rates to community resources, and the feasibility and acceptability of screening in a medical home setting. STUDY DESIGN: We developed the Addressing Social Key Questions for Health Questionnaire, a 13-question screen of adverse childhood experiences (ACEs) and unmet social needs. Parents/guardians of children 0-17 years of age received this questionnaire at well-child visits at 4 academic clinics from August 1, 2016 to February 28, 2017. Providers reviewed the tool and referred to community resources as needed. A subset of families completed demographic and satisfaction surveys. Prevalence of ACEs and unmet social needs, community referral rates at 1 site with available data, and family acceptability data were collected. Analyses included frequency distributions, χ2 tests, and Poisson regression. RESULTS: Of 2569 families completing an Addressing Social Key Questions for Health Questionnaire, 49% reported ≥1 stressor; 6% had ≥1 ACE; 47% had ≥1 unmet social need. At 1 site, community referral rates increased from 2.0% to 13.3% (P < .0001) after screening implementation. Risk factors for having a stressor include male sex and African American or Hispanic race. 86% of 446 families want clinics to continue screening. CONCLUSIONS: Universal screening for toxic stress risk factors in pediatric primary care improved identification and management of family needs. Screening was feasible and acceptable to families. Prevalence of unmet social needs but not ACEs was comparable with prior studies. Further evaluation and modification of the screening protocol is needed to increase screening and identification.
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Adultos Sobreviventes de Eventos Adversos na Infância/estatística & dados numéricos , Programas de Rastreamento/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Medição de Risco/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Estados UnidosRESUMO
Phonotraumatic vocal hyperfunction (PVH) is associated with chronic misuse and/or abuse of voice that can result in lesions such as vocal fold nodules. The clinical aerodynamic assessment of vocal function has been recently shown to differentiate between patients with PVH and healthy controls to provide meaningful insight into pathophysiological mechanisms associated with these disorders. However, all current clinical assessment of PVH is incomplete because of its inability to objectively identify the type and extent of detrimental phonatory function that is associated with PVH during daily voice use. The current study sought to address this issue by incorporating, for the first time in a comprehensive ambulatory assessment, glottal airflow parameters estimated from a neck-mounted accelerometer and recorded to a smartphone-based voice monitor. We tested this approach on 48 patients with vocal fold nodules and 48 matched healthy-control subjects who each wore the voice monitor for a week. Seven glottal airflow features were estimated every 50 ms using an impedance-based inverse filtering scheme, and seven high-order summary statistics of each feature were computed every 5 minutes over voiced segments. Based on a univariate hypothesis testing, eight glottal airflow summary statistics were found to be statistically different between patient and healthy-control groups. L1-regularized logistic regression for a supervised classification task yielded a mean (standard deviation) area under the ROC curve of 0.82 (0.25) and an accuracy of 0.83 (0.14). These results outperform the state-of-the-art classification for the same classification task and provide a new avenue to improve the assessment and treatment of hyperfunctional voice disorders.
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Glote/fisiopatologia , Testes Imediatos , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia , Acelerometria , Adulto , Movimentos do Ar , Diagnóstico por Computador , Feminino , Humanos , Pessoa de Meia-Idade , Smartphone , Prega Vocal/fisiopatologia , Voz , Distúrbios da Voz/etiologia , Adulto JovemRESUMO
OBJECTIVE: To determine the efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of symptomatic cystic thyroid nodules. PATIENTS AND METHODS: Retrospective analysis of patients with benign cystic thyroid nodules treated with PEI from February 1, 2000, through October 31, 2016. The main outcomes were efficacy, defined as symptom relief or reduction in nodule volume of 50% or more, and safety, defined as no or minor adverse events. RESULTS: Twenty patients had PEI. Mean age at the time of PEI was 50 years, and 13 (65%) were women; all patients were euthyroid. Twelve patients (60%) had complex cystic thyroid nodules (>50% cystic component), with the rest being purely cystic. The median largest diameter of the thyroid cyst was 4.5 cm (interquartile range [IQR], 3.2-5.3 cm; range, 2.3-8.0 cm); the median volume pre-PEI was 19.6 mL (IQR, 10.4-48.5 mL; range, 2.8-118.1 mL). The median amount of cystic fluid drained before PEI was 13.5 mL (IQR, 6.8-32.3 mL), and the median amount of ethanol administered was 3 mL (IQR, 2-5 mL; range, 0.5-20 mL). After median follow-up of 2 years, 17 of 19 patients (89%) were asymptomatic. Of 10 patients with available imaging on follow-up, 7 (70%) had a 50% or greater reduction in nodule volume (median volume decrease, 75.64% [IQR, 41.40%-91.99%]). Adverse effects occurred in 4 patients (20%) and were mild and temporary (slight pain, vagal reaction, and bleeding into the cyst). CONCLUSION: Percutaneous ethanol injection seems to be a safe and effective alternative to surgical resection for patients with purely or predominantly cystic thyroid nodules and compressive symptoms who decline surgery or are not good surgical candidates.
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Técnicas de Ablação , Etanol/administração & dosagem , Injeções , Nódulo da Glândula Tireoide/terapia , Drenagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireotropina/sangue , Tiroxina/sangue , UltrassonografiaRESUMO
OBJECTIVE: Oscillations of physiological parameters describe many biological processes and their modulation is determinant for various pathologies. In sepsis, toll-like receptor 4 (TLR4) is a key sensor for signaling the presence of Gram-negative bacteria. Its intracellular trafficking rates shift the equilibrium between the pro- and anti-inflammatory downstream signaling cascades, leading to either the physiological resolution of the bacterial stimulation or to sepsis. This study aimed to evaluate the effects of TLR4 increased expression and intracellular trafficking on the course and outcome of sepsis. RESULTS: Using a set of three differential equations, we defined the TLR4 fluxes between relevant cell organelles. We obtained three different regions in the phase space: (1) a limit-cycle describing unstimulated physiological oscillations, (2) a fixed-point attractor resulting from moderate LPS stimulation that is resolved and (3) a double-attractor resulting from sustained LPS stimulation that leads to sepsis. We used this model to describe available hospital data of sepsis patients and we correctly characterize the clinical outcome of these patients.
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Modelos Teóricos , Sepse/fisiopatologia , Receptor 4 Toll-Like/metabolismo , Progressão da Doença , Bactérias Gram-Negativas , Humanos , Lipopolissacarídeos , Transdução de SinaisRESUMO
In some surveys, women and men are interviewed separately in selected households, allowing matching of partner information and analyses of couples. Although individual sampling weights exist for men and women, sampling weights specific for couples are rarely derived. We present a method of estimating appropriate weights for couples that extends methods currently used in the Demographic and Health Surveys (DHS) for individual weights. To see how results vary, we analyze 1912 estimates (means; proportions; linear regression; and simple and multinomial logistic regression coefficients, and their standard errors) with couple data in each of 11 DHS surveys in which the couple weight could be derived. We used two measures of bias: absolute percentage difference from the value estimated with the couple weight and ratio of the absolute difference to the standard error using the couple weight. The latter shows greater bias for means and proportions, whereas the former and a combination of both measures show greater bias for regression coefficients. Comparing results using couple weights with published results using women's weights for a logistic regression of couple contraceptive use in Turkey, we found that 6 of 27 coefficients had a bias above 5 %. On the other hand, a simulation of varying response rates (27 simulations) showed that median percentage bias in a logistic regression was less than 3 % for 17 of 18 coefficients. Two proxy couple weights that can be calculated in all DHS surveys perform considerably better than either male or female weights. We recommend that a couple weight be calculated and made available with couple data from such surveys.
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Demografia/métodos , Características da Família , Inquéritos Epidemiológicos/métodos , Estado Civil , Adolescente , Adulto , África , Distribuição por Idade , Ásia , Viés , Simulação por Computador , República Dominicana , Feminino , Humanos , Renda , Entrevistas como Assunto , América Latina , Masculino , Nicarágua , Análise de Regressão , Adulto JovemRESUMO
BACKGROUND: High rates of mental illness and addictions are well documented among youth in Nicaragua. Limited mental health services, poor mental health knowledge and stigma reduce help-seeking. The Mental Health Curriculum (MHC) is a Canadian school-based program that has shown a positive impact on such contributing factors. This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua. METHODS: High school and university students (aged 14-25 years) were assigned to intervention (12-week MHC; n = 567) and control (wait-list; n = 346) groups in a non-randomized design. Both groups completed measures of mental health knowledge, stigma and function at baseline and 12 weeks. Multivariate analyses and repeated measures analyses were used to compare group outcomes. RESULTS: At baseline, intervention students showed higher substance use (mean difference [MD] = 0.24) and lower perceived stress (MD = -1.36) than controls (p < 0.05); there were no other group differences in function. At 12 weeks, controlling for baseline differences, intervention students reported significantly higher mental health knowledge (MD = 1.75), lower stigma (MD = 1.78), more adaptive coping (MD = 0.82), better lifestyle choices (MD = 0.06) and lower perceived stress (MD = -1.63) (p < 0.05) than controls. The clinical significance as measured by effect sizes was moderate for mental health knowledge, small to moderate for stigma and modest for the other variables. Substance use also decreased among intervention students to similar levels as controls (MD = 0.03) (p > 0.05). CONCLUSIONS: This pilot investigation demonstrates the benefits of the MHC in a low-and-middle-income youth population. The findings replicate results found in Canadian student populations and support its cross-cultural applicability.
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Background: The investigation on the cardiocirculatory system in chinchilla has become increasingly important due to the use of the species in experimental medicine (toxicology, pathology, parasitology etc.). Even though initially this species was regarded with a strict economic interest, in the last period, chinchillas have become an increasingly-encountered patient in veterinary clinics and hospitals. Another aspect is the use of the species in medical research, as experimental model or in parasitology. The present study tackles a combined anatomical and radiological (angiographical) study to accurately describe the vascular anatomy of the initial part of the aortic arch (Arcus aortae).Materials, Methods & Results: The anatomical distribution of collaterals detached from arcus aorticus (brachiocephalic trunk and subclavian arteries) are highlighted in this paper. To do that, the classical stratigraphic anatomical investigation, followed by the radiological study with the help of the contrast substance injected into the vascular bed were used in combination. Several Chinchilla lanigera female carcasses, obtained from a private commercial farming unit in Cluj county, Romania were used for this study. Ten carcasses were used for the anatomical study, being injected into the vascular bed with a mixture of latex and acrylic dye, fixated into formaldehyde 5% and later dissected, while the other ten carcasses were injected at the level of the aortic arch with Visipaque 320 contrast substance and subjected to the angiographical procedure.The anatomical investigation was carried after an initial 5 day-fixation period, while the angiographic procedure was initiated using the TEMCO Grx-01 device and the Veterinary Digital Imaging System® as digital imaging processing software. This combined study shows the differential mode of emergence of the subclavian and carotid arteries in this species.[...]
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Feminino , Animais , Aorta Torácica/anatomia & histologia , Chinchila , Tronco Braquiocefálico/anatomia & histologia , Angiografia/métodos , Angiografia/veterináriaRESUMO
Background: The investigation on the cardiocirculatory system in chinchilla has become increasingly important due to the use of the species in experimental medicine (toxicology, pathology, parasitology etc.). Even though initially this species was regarded with a strict economic interest, in the last period, chinchillas have become an increasingly-encountered patient in veterinary clinics and hospitals. Another aspect is the use of the species in medical research, as experimental model or in parasitology. The present study tackles a combined anatomical and radiological (angiographical) study to accurately describe the vascular anatomy of the initial part of the aortic arch (Arcus aortae).Materials, Methods & Results: The anatomical distribution of collaterals detached from arcus aorticus (brachiocephalic trunk and subclavian arteries) are highlighted in this paper. To do that, the classical stratigraphic anatomical investigation, followed by the radiological study with the help of the contrast substance injected into the vascular bed were used in combination. Several Chinchilla lanigera female carcasses, obtained from a private commercial farming unit in Cluj county, Romania were used for this study. Ten carcasses were used for the anatomical study, being injected into the vascular bed with a mixture of latex and acrylic dye, fixated into formaldehyde 5% and later dissected, while the other ten carcasses were injected at the level of the aortic arch with Visipaque 320 contrast substance and subjected to the angiographical procedure.The anatomical investigation was carried after an initial 5 day-fixation period, while the angiographic procedure was initiated using the TEMCO Grx-01 device and the Veterinary Digital Imaging System® as digital imaging processing software. This combined study shows the differential mode of emergence of the subclavian and carotid arteries in this species.[...](AU)
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Animais , Feminino , Chinchila , Aorta Torácica/anatomia & histologia , Tronco Braquiocefálico/anatomia & histologia , Angiografia/métodos , Angiografia/veterináriaRESUMO
Purpose: The purpose of this study was to determine the validity of preliminary reports showing that glottal aerodynamic measures can identify pathophysiological phonatory mechanisms for phonotraumatic and nonphonotraumatic vocal hyperfunction, which are each distinctly different from normal vocal function. Method: Glottal aerodynamic measures (estimates of subglottal air pressure, peak-to-peak airflow, maximum flow declination rate, and open quotient) were obtained noninvasively using a pneumotachograph mask with an intraoral pressure catheter in 16 women with organic vocal fold lesions, 16 women with muscle tension dysphonia, and 2 associated matched control groups with normal voices. Subjects produced /pae/ syllable strings from which glottal airflow was estimated using inverse filtering during /ae/ vowels, and subglottal pressure was estimated during /p/ closures. All measures were normalized for sound pressure level (SPL) and statistically tested for differences between patient and control groups. Results: All SPL-normalized measures were significantly lower in the phonotraumatic group as compared with measures in its control group. For the nonphonotraumatic group, only SPL-normalized subglottal pressure and open quotient were significantly lower than measures in its control group. Conclusions: Results of this study confirm previous hypotheses and preliminary results indicating that SPL-normalized estimates of glottal aerodynamic measures can be used to describe the different pathophysiological phonatory mechanisms associated with phonotraumatic and nonphonotraumatic vocal hyperfunction.
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Pressão do Ar , Disfonia/fisiopatologia , Glote/fisiopatologia , Doenças da Laringe/fisiopatologia , Fonação/fisiologia , Adulto , Algoritmos , Feminino , Humanos , Processamento de Sinais Assistido por Computador , Interface Usuário-ComputadorRESUMO
Johnsongrass (Sorghum halepense) is a striking example of a post-Columbian founder event. This natural experiment within ecological time-scales provides a unique opportunity for understanding patterns of continent-wide genetic diversity following range expansion. Microsatellite markers were used for population genetic analyses including leaf-optimized Neighbor-Joining tree, pairwise FST, mismatch analysis, principle coordinate analysis, Tajima's D, Fu's F and Bayesian clusterings of population structure. Evidence indicates two geographically distant introductions of divergent genotypes, which spread across much of the US in <200 years. Based on geophylogeny, gene flow patterns can be inferred to have involved five phases. Centers of genetic diversity have shifted from two introduction sites separated by ~2000 miles toward the middle of the range, consistent with admixture between genotypes from the respective introductions. Genotyping provides evidence for a 'habitat switch' from agricultural to non-agricultural systems and may contribute to both Johnsongrass ubiquity and aggressiveness. Despite lower and more structured diversity at the invasion front, Johnsongrass continues to advance northward into cooler and drier habitats. Association genetic approaches may permit identification of alleles contributing to the habitat switch or other traits important to weed/invasive management and/or crop improvement.
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Ecossistema , Variação Genética , Sorghum/genética , Teorema de Bayes , Colômbia , Genótipo , Espécies Introduzidas , Desequilíbrio de Ligação , Repetições de Microssatélites/genética , Análise de Componente Principal , Sorghum/crescimento & desenvolvimento , Estados UnidosRESUMO
BACKGROUND: Collaborations between clinical/operational leaders and researchers are advocated to develop "learning health systems," but few practical examples are reported. OBJECTIVES: To describe collaborative efforts to reduce missed appointments through an interactive voice response and text message (IVR-T) intervention, and to develop and validate a prediction model to identify individuals at high risk of missing appointments. RESEARCH SUBJECTS AND DESIGN: Random assignment of 8804 adults with primary care appointments to a single IVR-T reminder or no reminder at an index clinic (IC) and 7497 at a replication clinic (RC) in an integrated health system in Denver, CO. MEASURES: Proportion of missed appointments; demographic, clinical, and appointment-specific predictors of missed appointments. RESULTS: Patients receiving IVR-T had a lower rate of missed appointments than those receiving no reminder at the IC (6.5% vs. 7.5%, relative risk=0.85, 95% confidence interval, 0.72-1.00) and RC (8.2% vs. 10.5%, relative risk=0.76, 95% confidence interval, 0.65-0.89). A 10-variable prediction model for missed appointments demonstrated excellent discrimination (C-statistic 0.90 at IC, 0.89 at RC) and calibration (P=0.99 for Osius and McCullagh tests). Patients in the 3 lowest-risk quartiles missed 0.4% and 0.4% of appointments at the IC and RC, respectively, whereas patients in the highest-risk quartile missed 24.1% and 28.9% of appointments, respectively. CONCLUSIONS: A single IVR-T call reduced missed appointments, whereas a locally validated prediction model accurately identified patients at high risk of missing appointments. These rigorous studies promoted dissemination of the intervention and prompted additional research questions from operational leaders.