Factors Associated with Food Insecurity in Latin America and the Caribbean Countries: A Cross-Sectional Analysis of 13 Countries.
It is estimated that Latin America and the Caribbean (LAC) is the region with the second highest figures for food insecurity (FI) globally, with a prevalence of 40.9% in the entire region. This cross-sectional study analyzes the household factors associated with FI across 13 LAC countries. We used data from the first round of high-frequency phone surveys, conducted by the World Bank. Approximately 4 out of 10 people in LAC experienced FI during the first phase of the COVID-19 pandemic. FI was positively associated with the number of individuals aged from 5 to 18 years, the number of men, the illness, accident, or death of an income-earning household member, and health expenditure due to COVID-19 or other illnesses, as well as the increase in food prices, reduced family income, and job loss by a member of the household. On the other hand, households located in capital cities and those with more bedrooms were less likely to have experienced FI. The design of social policies must focus on the economic deficiencies experienced by the LAC population, with unemployment, reduced income, and high food costs being the main factors that must be addressed to ensure adequate nutrition.


Effect of mechanical load on acetylcholinesterase mRNA levels in the slow soleus muscle of the rat.
The influence of mechanical load on the levels of acetylcholinesterase (AChE) mRNA was studied in order to examine to which extent different loading conditions may be responsible for differences in AChE regulation between the soleus, which is an antigravity muscle, and the fast EDL muscle. Forty-eight female rats were randomly assigned to three groups: a group with hindlimb suspension producing soleus muscle unloading, a group with ablation of synergistic gastrocnemius muscle causing overload of the soleus muscle, and the control group. The soleus muscles were isolated after 8 days of treatment AChE mRNA levels were analyzed by Northern blots and evaluated densitometrically. The values were normalized with beta-actin mRNA level, and then a value of 100% was assigned to the mRNA level in the control EDL muscle. Muscle unloading did not produce a significant increase of the AChE transcript levels, but the levels were rather variable. However, a statistically significant increase of AChE mRNA levels was observed in overloaded soleus muscles. These results corroborate the hypothesis that the slow and fast patterns of activity appear more important then muscle loading for the differences in regulation of AChE mRNA levels in fast and slow muscles.


Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysis.
Background and study aims Laparoscopic sleeve gastrectomy (LSG) is the current standard for bariatric surgery, but it is affected by several postoperative complications. Endoscopic sleeve gastroplasty (ESG) was created as a less invasive alternative to LSG. However, its efficacy and safety compared with LSG is unclear. Materials and methods Relevant publications were identified in MEDLINE/Cochrane/EMBASE/OVID/ PROSPERO and NIH up to January 2020. Studies were selected that included obese patients with a baseline body mass index (BMI) between 30 and 40 kg/m² with a minimum of 12 months of follow-up and with reported incidence of complications. The mean difference in percentage of excess weight loss (%EWL) at 12 months between LSG and ESG represented the primary endpoint. We also assessed the difference in pooled rate of adverse events. The quality of the studies and heterogeneity among them was analyzed. Results Sixteen studies were selected for a total of 2188 patients (LSG: 1429; ESG: 759) with a mean BMI 34.34 and 34.72 kg/m² for LSG and ESG, respectively. Mean %EWL was 80.32 % (± 12.20; 95 % CI; P = 0.001; I² = 98.88) and 62.20 % (± 4.38; 95 % CI; P = 0.005; I² = 65.52) for the LSG and ESG groups, respectively, corresponding to an absolute difference of 18.12 % (± 0.89; 95 % CI, P = 0.0001). The difference in terms of mean rate of adverse events was 0.19 % (± 0.37; 95 %CI; χ 2 = 1.602; P = 0.2056). Conclusions Our analysis showed a moderate superiority of LSG versus ESG. No difference in terms of safety was shown between the two groups. ESG is a less-invasive, repeatable and reversable and acceptable option for mild-moderate obese patients.


Measuring orientation of actin filaments within a cell: orientation of actin in intestinal microvilli.
Orientational distribution of actin filaments within a cell is an important determinant of cellular shape and motility. To map this distribution we developed a method of measuring local orientation of actin filaments. In this method actin filaments within cells are labeled with fluorescent phalloidin and are viewed at high magnification in a fluorescent microscope. Emitted fluorescence is split by a birefringent crystal giving rise to two images created by light rays polarized orthogonally with respect to each other. The two images are recorded by a high-sensitivity video camera, and polarization of fluorescence at any point is calculated from the relative intensity of both images at this point. From the value of polarization, the orientation of the absorption dipole of the dye, and thus orientation of F-actin, can be calculated. To illustrate the utility of the method, we measured orientation of actin cores in microvilli of chicken intestinal epithelial cells. F-actin in microvillar cores was labeled with rhodamine-phalloidin; measurements showed that the orientation was the same when microvillus formed a part of a brush border and when it was separated from it suggesting that "shaving" of brush borders did not distort microvillar structure. In the absence of nucleotide, polarization of fluorescence of actin cores in isolated microvilli was best fitted by assuming that a majority of fluorophores were arranged with a perfect helical symmetry along the axis of microvillus and that the absorption dipoles of fluorophores were inclined at 52 degrees with respect to the axis. When ATP was added, the shape of isolated microvilli did not change but polarization of fluorescence decreased, indicating statistically significant increase in disorder and a change of average angle to 54 degrees. We argue that these changes were due to mechanochemical interactions between actin and myosin-I.


A Visuoperceptual Measure for Videofluoroscopic Swallow Studies (VMV): A Pilot Study of Validity and Reliability in Adults with Dysphagia.
The visuoperceptual measure for videofluoroscopic swallow studies (VMV) is a new measure for analysing the recordings from videofluoroscopic swallow studies (VFSS). This study evaluated the reliability and validity of the pilot version of the VMV using classical test theory (CTT) analysis, informed by the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Forty participants, diagnosed with oropharyngeal dysphagia by fibreoptic endoscopic evaluation of swallowing, were recruited. The VFSS and administration of bolus textures and volumes were conducted according to a standardised protocol. Recordings of the VFSS were rated by three blinded raters: a speech-language pathologist, a radiologist and a phoniatrician. Inter- and intra-rater reliability was assessed with a weighted kappa and resulted in 0.889 and 0.944 overall, respectively. Structural validity was determined using exploratory factor analyses, which found four and five factor solutions. Internal consistency was evaluated with Cronbach's alpha coefficients, which found all but one factor scoring within an acceptable range (>0.70 and <0.95). Hypothesis testing for construct validity found the expected correlations between the severity of dysphagia and the VMV's performance, and found no impact of gender on measure performance. These results suggest that the VMV has potential as a reliable and valid measure for VFSS. Further validation with a larger sample is required, and validation using an item response theory paradigm approach is recommended.


Direct medical costs of adverse events in Dutch hospitals.
Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings. Trained nurses and physicians retrospectively reviewed 7,926 patient records in 21 hospitals. Additional patient information of 7,889 patients was received from the Dutch registration of hospital information. Direct medical costs attributable to AEs were assessed by measuring excess length of stay and additional medical procedures after an AE occurred. Costs were valued using Dutch standardized cost prices. The annual direct medical costs in Dutch hospitals were estimated at a total of euro 355 million for all AEs and euro 161 million for preventable AEs in 2004. The total number of hospital admissions in which a preventable AE occurred was 30,000 (2.3% of all admissions) and more than 300,000 (over 3% of all bed days) bed days were attributable to preventable AEs in 2004. Multilevel analysis showed that variance in direct medical costs was not determined by differences between hospitals or hospital departments. The estimates of the total preventable direct medical costs of AEs indicate that they form a substantial part (1%) of the expenses of the national health care budget and are of importance to hospital management. The cost driver of the direct medical costs is the excess length of stay (including readmissions) in a hospital. Insight in which determinants are associated with high preventable costs will offer useful information for policymakers and hospital management to determine starting points for interventions to reduce the costs of preventable AEs.


Nutritional supplements for dry eye syndrome.
Essential fatty acids have been of interest in the treatment of systemic and ocular diseases, and is most recently of interest in the area of dry eye disease. Systemic and topical omega-3 fatty acids and omega-6 fatty acids have been used recently as an adjunctive treatment for patients with dry eye disease. They appear to have efficacy against the symptoms of dry eye that many patients experience. This symptom is postulated to be secondary to the anti-inflammatory effects that have been previously described. Although this effect is promising, more investigation is warranted in order to standardize indication for use, and composition and dosing for treatment. The use of essential fatty acids as a nutritional supplement is a novel treatment for patients with dry eye syndrome.


Ceragenin CSA-13 induces cell cycle arrest and antiproliferative effects in wild-type and p53 null mutant HCT116 colon cancer cells.
Antimicrobial peptides of the cathelicidin family play a central role in the host defense system. Our group has reported previously that cathelicidin-related or cathelicidin-modified antimicrobial peptides, such as FF/CAP-18, have antiproliferative effects on the squamous cell carcinoma cell line SAS-H1 and colon cancer-derived cell line HCT116. Ceragenin CSA-13, which mimics the hydrophobic and cationic morphology of cathelicidin-related peptides, was developed to reduce synthetic costs and resolve stability issues in the presence of proteases. In this study, we evaluated the antiproliferative effect of CSA-13 on HCT116 cells. We evaluated the effects of CSA-13 in HCT116 cells by measuring cell growth, detecting apoptosis, analyzing the cell cycle, and examining mitochondrial membrane depolarization. Treatment with CSA-13 suppressed HCT116 cell proliferation in a dose-dependent manner, increasing the incidence of apoptosis detected by the binding of Annexin V. Furthermore, cell cycle analysis showed that the cell cycle of CSA-13-treated wild-type and p53 null mutant HCT116 cells was arrested at the G1/S phase, indicating that CSA-13 affects the cell cycle by a p53-independent pathway. Our study showed that CSA-13 exerts an antiproliferative effect in cancer cells similar to that of FF/CAP-18, suggesting that membrane-permeabilizing capability is the common underlying mechanism for anticancer and antimicrobial effects of CSA-13 and anitimicrobial peptides.


Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients.
In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20-39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6-48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001). Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%), numbness or motor weakness (67.8% vs 11.5%), urinary retention (7.4% vs 8.7%), dizziness (2.2% vs 5.2%), and hypotension (3.1% vs 20.3%). In conclusion, PCEA was more frequently associated with numbness, motor weakness, and discontinuation of PCA in younger patients and with hypotension, nausea/vomiting, and a greater need for rescue analgesics/antiemetics among elderly patients. Therefore, in order to minimize the adverse effects of PCEA and enhance pain relief, different PCEA regimens and administration/prevention strategies should be considered for young and elderly patients.


A cinnamoyl esterase from Aspergillus niger can break plant cell wall cross-links without release of free diferulic acids.
A cinnamoyl esterase, ferulic acid esterase A, from Aspergillus niger releases ferulic acid and 5-5- and 8-O-4-dehydrodiferulic acids from plant cell walls. The breakage of one or both ester bonds from dehydrodimer cross-links between plant cell wall polymers is essential for optimal action of carbohydrases on these substrates, but it is not known if cinnamoyl esterases can break these cross-links by cleaving one of the ester linkages which would not release the free dimer. It is difficult to determine the mechanism of the reaction on complex substrates, and so we have examined the catalytic properties of ferulic acid esterase A from Aspergillus niger using a range of synthetic ethyl esterified dehydrodimers (5-5-, 8-5-benzofuran and 8-O-4-) and two 5-5-diferulate oligosaccharides. Our results show that the esterase is able to cleave the three major dehydrodiferulate cross-links present in plant cell walls. The enzyme is highly specific at hydrolysing the 5-5- and the 8-5-benzofuran diferulates but the 8-O-4-is a poorer substrate. The hydrolysis of dehydrodiferulates to free acids occurs in two discrete steps, one involving dissociation of a monoesterified intermediate which is negatively charged at the pH of the reaction. Although ferulic acid esterase A was able to release monoesters as products of reactions with all three forms of diesters, only the 5-5- and the 8-O-4-monoesters were substrates for the enzyme, forming the corresponding free diferulic acids. The esterase cannot hydrolyse the second ester bond from the 8-5-benzofuran monoester and therefore, ferulic acid esterase A does not form 8-5-benzofuran diferulic acid. Therefore, ferulic acid esterase A from Aspergillus niger contributes to total plant cell wall degradation by cleaving at least one ester bond from the diferulate cross-links that exist between wall polymers but does not always release the free acid product.


Distribution of a putative cell surface receptor for fibronectin and laminin in the avian embryo.
The cell substratum attachment (CSAT) antibody recognizes a 140-kD cell surface receptor complex involved in adhesion to fibronectin (FN) and laminin (LM) (Horwitz, A., K. Duggan, R. Greggs, C. Decker, and C. Buck, 1985, J. Cell Biol., 101:2134-2144). Here, we describe the distribution of the CSAT antigen along with FN and LM in the early avian embryo. At the light microscopic level, the staining patterns for the CSAT receptor and the extracellular matrix molecules to which it binds were largely codistributed. The CSAT antigen was observed on numerous tissues during gastrulation, neurulation, and neural crest migration: for example, the surface of neural crest cells and the basal surface of epithelial tissues such as the ectoderm, neural tube, notochord, and dermomyotome. FN and LM immunoreactivity was observed in the basement membranes surrounding many of these epithelial tissues, as well as around the otic and optic vesicles. In addition, the pathways followed by cranial neural crest cells were lined with FN and LM. In the trunk region, FN and LM were observed surrounding a subpopulation of neural crest cells. However, neither molecule exhibited the selective distribution pattern necessary for a guiding role in trunk neural crest migration. The levels of CSAT, FN, and LM are dynamic in the embryo, perhaps reflecting that the balance of surface-substratum adhesions contributes to initiation, migration, and localization of some neural crest cell populations.


RGD peptide-conjugated selenium nanoparticles: antiangiogenesis by suppressing VEGF-VEGFR2-ERK/AKT pathway.
Angiogenesis is essential for tumorigenesis, progression and metastasis. Herein we described the synthesis of RGD peptide-decorated and doxorubicin-loaded selenium nanoparticles (RGD-NPs) targeting tumor vasculature to enhance the cellular uptake and antiangiogenic activities in vitro and in vivo. After internalization by receptor-mediated endocytosis, this nanosystem disassembled under acidic condition with the presence of lysozymes and cell lysate, leading to bioresponsive triggered drug release. Mechanistic investigation revealed that RGD-NPs inhibited angiogenesis through induction of apoptosis and cell cycle arrest in human umbilical vein endothelial cells (HUVECs) via suppression of VEGF-VEGFR2-ERK/AKT signaling axis by triggering ROS-mediated DNA damage. Additionally, RGD-NPs can inhibit MCF-7 tumor growth and angiogenesis in nude mice via down-regulation of VEGF-VEGFR2, effectively reduce the toxicity and prolong the blood circulation in vivo. Our results suggest that the strategy to use RGD-peptide functionalized SeNPs as carriers of anticancer drugs is an efficient way to achieve cancer-targeted antiangiogenesis synergism.


"Take your pill": the role and fantasy of pills in modern medicine.
The pharmaceutical industry has undergone a vast expansion in the 20th and 21st centuries. This article explores the central role now played by pills in clinical practice, but also in the public imagination. First, this article analyzes four properties that, together, account for many of the promises and perils associated with pills: They are ingestible, potent, reproducible, and miniaturized. This allows them to serve as ideal consumer items for widespread distribution and sale and also as model technological "devices" capable of downloading into the body healing chemicals. As such, they seem to promise a disburdening solution to many of life's ills. In our cultural fantasy, often shared by physician and patient alike, pills can be used not only to treat and prevent disease but also raise energy, lose weight, lessen pain, lift mood, cope with stress, and enhance sexual and athletic performance. This article also explores many adverse effects not only of pills themselves but of this exaggerated cultural fantasy of the pill. It tends to distract us from other, more holistic understandings of the locus of disease and healing. It even fosters misunderstandings of the ways in which pills themselves work, which is to assist bodily processes, and the mind's "meaning response." The intent here is not to demonize all pills-many have great therapeutic potential-but to learn how to better choose and use them wisely. We propose that this process be assisted through recontextualizing the pill as a multidimensional gift. Taken in such a way, with appropriate gratitude and discernment, we may ingest fewer pills, but with greater efficacy.


Molluscicidal action of the latex of Euphorbia splendens var. hislopii N.E.B. ("Christ's Crown") (Euphorbiaceae) against Lymnaea columella (Say, 1817) (Pulmonata: Lymnaeidae), intermediate host of Fasciola hepatica Linnaeus, 1758 (Trematode: Fasciolidae): 1- test in laboratory.
The latex action of Euphorbia splendens var. hislopii (Christ's Crown) against snails Lymnaea columella, intermediate host of Fasciola hepatica, derived from irrigation ditches of the Station of Pisciculture at Universidade Federal Rural do Rio de Janeiro, was studied in the laboratory. Lab bioassays, using aqueous solutions of the latex, varying between 0.1 and 10 mg/l, have proven molluscicidal activity of the product collected on the same day the tests were performed, during the four seasons of the year, finding the following lethal concentrations (LC90): 1.51 mg/l in the spring; 0.55 mg/l in the summer; 0.74 mg/l in the fall and 0.93 mg/l in winter, after 24 h exposure of the snails, showing significant differences among the seasons of the year (ANOVA test, F = 11.01, G.L.= 3/33, p < 0.05), as well as among the concentrations (ANOVA test, F = 27.38, G.L.= 11/33, p < 0.05). In the summer, mortality reached 100% from concentration at 0.6 mg/l, the same during fall and in winter as of 1 mg/l, while in spring it only reached 100% mortality as of 2 mg/l. Mortality in the controls was low, reaching 5% in the summer and winter and 10% in the fall and spring. None of the samples died. During the assay, with an aqueous solution of the latex at a concentration of 5 mg/l, in order to check the time of duration of the product effect, in the laboratory, it was observed that the molluscicidal activity remained stable up to the 15th day after the beginning of the test with 100% mortality of L. columella, gradually losing its effect until the 23rd day, when we no longer observed animal mortality. In the control group, there was a random daily variation in mortality rate ranging 0-50% after 48 h of observation for 30 days.


Planning new medical library buildings: an annotated checklist with selected references.
Special attention is paid to several planning essentials for new medical library buildings. These should be covered in the program of requirements that appears as item six on the checklist. The checklist assumes that the decision to build a new medical library has been made and that monies have been allocated for that purpose. References pertaining to the checklist items are provided along with a suggested timetable for achieving each, based on the author's own experiences.


Virtual reality laparoscopic nephrectomy simulator is lacking in construct validity.
Several training models have been developed to improve surgeons' operative skills as well as patient outcomes. Before implementing these models in training programs, their usefulness and accuracy need to be assessed. In this study, we examined the ability of a laparoscopic nephrectomy (LN) virtual reality (VR) simulator to distinguish between different levels of expertise (construct validity). Twenty-two novices (no LN experience), 32 intermediates (<10 LN procedures performed) and 10 experienced urologists (> or =10 LN procedures performed) performed the same retroperitoneal task on the LN VR simulator (Mentice, Sweden) three times, performing a practice task before and after the second time. Outcome parameters were time, blood loss, path length, and total score (combination of 62 different parameters). No significant differences were found between intermediate and experienced participants. Task 3 performance showed no significant difference between any of the groups. Both intermediates and experienced participants were significantly faster than novices on the first two tasks and had a better total score. Learning curves of intermediate and experienced participants were flat after task two. The LN-VR simulator did not distinguish between intermediate and experienced participants. The analysis of the learning curves suggests that the tasks measured dexterity in using the simulator rather than an actual improvement of operative skills. We conclude that the LN-VR simulator does not have sufficient construct validity and is therefore, in its present form, not suitable for implementation in a urologic training program.


Antibacterial biodegradable Mg-Ag alloys.
The use of magnesium alloys as degradable metals for biomedical applications is a topic of ongoing research and the demand for multifunctional materials is increasing. Hence, binary Mg-Ag alloys were designed as implant materials to combine the favourable properties of magnesium with the well-known antibacterial property of silver. In this study, three Mg-Ag alloys, Mg2Ag, Mg4Ag and Mg6Ag that contain 1.87 %, 3.82 % and 6.00 % silver by weight, respectively, were cast and processed with solution (T4) and aging (T6) heat treatment. The metallurgical analysis and phase identification showed that all alloys contained Mg4Ag as the dominant β phase. After heat treatment, the mechanical properties of all Mg-Ag alloys were significantly improved and the corrosion rate was also significantly reduced, due to presence of silver. Mg(OH)₂ and MgO present the main magnesium corrosion products, while AgCl was found as the corresponding primary silver corrosion product. Immersion tests, under cell culture conditions, demonstrated that the silver content did not significantly shift the pH and magnesium ion release. In vitro tests, with both primary osteoblasts and cell lines (MG63, RAW 264.7), revealed that Mg-Ag alloys show negligible cytotoxicity and sound cytocompatibility. Antibacterial assays, performed in a dynamic bioreactor system, proved that the alloys reduce the viability of two common pathogenic bacteria, Staphylococcus aureus (DSMZ 20231) and Staphylococcus epidermidis (DSMZ 3269), and the results showed that the killing rate of the alloys against tested bacteria exceeded 90%. In summary, biodegradable Mg-Ag alloys are cytocompatible materials with adjustable mechanical and corrosion properties and show promising antibacterial activity, which indicates their potential as antibacterial biodegradable implant materials.


Herpes simplex virus co-infection-induced Chlamydia trachomatis persistence is not mediated by any known persistence inducer or anti-chlamydial pathway.
Several inducers of chlamydial persistence have been described, including interferon-gamma (IFN-gamma), IFN-alpha, IFN-beta, and tumour necrosis factor-alpha (TNF-alpha) exposure, and iron, amino acid or glucose deprivation. A tissue-culture model of Chlamydia trachomatis/herpes simplex virus type-2 (HSV-2) co-infection indicates that viral co-infection stimulates the formation of persistent chlamydiae. This study was designed to ascertain whether co-infection-induced persistence is mediated by a previously characterized mechanism. Luminex assays indicate that IFN-gamma, IFN-alpha, and TNF-alpha are not released from co-infected cells. Semiquantitative RT-PCR studies demonstrate that IFN-beta, IFN-gamma, indoleamine 2,3-dioxygenase, lymphotoxin-alpha and inducible nitric oxide synthase are not expressed during co-infection. These data indicate that viral-induced persistence is not stimulated by any persistence-associated cytokine. Supplementation of co-infected cells with excess amino acids, iron-saturated holotransferrin, glucose or a combination of amino acids and iron does not restore chlamydial infectivity, demonstrating that HSV-2-induced persistence is not mediated by depletion of these nutrients. Finally, inclusions within co-infected cells continue to enlarge and incorporate C(6)-NBD-ceramide, indicating that HSV-2 co-infection does not inhibit vesicular transport to the developing inclusion. Collectively these data demonstrate that co-infection-induced persistence is not mediated by any currently characterized persistence inducer or anti-chlamydial pathway. Previous studies indicate that HSV-2 attachment and/or entry into the host cell is sufficient for stimulating chlamydial persistence, suggesting that viral attachment and/or entry may trigger a novel host pathway which restricts chlamydial development.


A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections.
The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.


A mathematical analysis of the myogenic hypothesis with special reference to autoregulation of renal blood flow.
To test the hypothesis that autoregulation of renal blood flow could result from myogenic regulation of arterial/arteriolar wall tension, we have explored a model based on the assumptions that (1) each preglomerular vessel segment reacts to a change in transmural pressure by altering its internal radius until the initial change in wall tension is reduced by a gain factor, (2) postglomerular structural resistance remains unchanged, (3) extravascular tissue pressure equals intrarenal venous pressure, and (4) the renal vascular system can be represented by one unbranched tube. General equations were obtained for flow and segmental radii and pressure as functions of aortic pressure. With a gain factor of 1 and a glomerular capillary pressure of 50% of aortic pressure under control conditions, the model predictions agree well with experimental data in dogs. Increasing aortic pressure from about 60% of control level causes only slight increase of blood flow. A rise in tissue pressure up to 40% of aortic pressure causes only moderate reduction. Changes in vessel radii begin in proximal vessel segments and spread distally toward glomerulus at increasing changes in aortic and tissue pressures from their control levels. Glomerular capillary pressure is autoregulated in proportion to blood flow. The degree of autoregulation is only moderately dependent on the gain factor: A moderate impairment caused by reducing the gain factor from 1 to 0.7 may be compensated by locating the myogenically responsive wall layer a distance 0.2 times the internal radius from the vessel lumen. "Superautoregulation," i.e., a rise in flow at reduced aortic pressure, is not possible. An upper limit of autoregulation is obtained only with the additional assumption of a fall in contractile force at extreme shortening of the muscle fibers. No definitive biological proof has yet been provided for a segmental wall tension-regulating mechanism in the preglomerular vessels, and obviously its existence cannot be proved by a mathematical model. However, if such a mechanism does exist, it can explain most of the renal resistance changes at varying arterial and intrarenal pressures, as well as the observed autoregulation of terminal interlobular arterial pressure.


Removal of pharmaceuticals, polybrominated flame retardants and UV-filters from sludge by the fungus Trametes versicolor in bioslurry reactor.
Conventional wastewater treatments are inefficient in the removal of many organic pollutants. The presence of these contaminants in the final sludge represents a source of environmental pollution due to the increasing use of biosolids in land application. A biotechnological approach which employed the fungus Trametes versicolor in a sludge-bioslurry reactor was assessed in order to remove several groups of emerging pollutants. Biological fungal activity was monitored by means of ergosterol and laccase determinations. Fifteen out of 24 detected pharmaceuticals were removed at efficiencies over 50% after the treatment, including eight completely degraded. Removal ranged between 16-53% and 22-100% for the brominated flame retardants and the UV-filters, respectively. Only two of all the detected compounds remained unchanged after the treatment. Although elimination results are promising, the toxicity of the final sludge increased after the treatment. This finding is contrary to the toxicity results obtained in similar treatments of sludge with T. versicolor in solid-phase.


Hypertension and the risk of endometrial cancer: a systematic review and meta-analysis of case-control and cohort studies.
A history of hypertension has been associated with increased risk of endometrial cancer in several studies, but the results have not been consistent. We conducted a systematic review and meta-analysis of case-control and cohort studies to clarify the association between hypertension and endometrial cancer risk. PubMed and Embase databases were searched up to 27th of February 2016. Prospective and case-control studies which reported adjusted relative risk estimates and 95% confidence intervals of endometrial cancer associated with a hypertension diagnosis were included. Summary relative risks were estimated using a random effects model. Nineteen case-control studies and 6 cohort studies were included. The summary RR was 1.61 (95% CI: 1.41-1.85, I2 = 86%) for all studies, 1.73 (95% CI: 1.45-2.06, I2 = 89%) for case-control studies and 1.32 (95% CI: 1.12-1.56, I2 = 47%) for cohort studies. The association between hypertension and endometrial cancer was weaker, but still significant, among studies with adjustment for smoking, BMI, oral contraceptive use, and parity, compared to studies without such adjustment. This meta-analysis suggest an increased risk of endometrial cancer among patients with hypertension, however, further studies with more comprehensive adjustments for confounders are warranted to clarify the association.


Chitosan-based hydrogels supplemented with gelatine and Link N enhance extracellular matrix deposition by encapsulated cells in a degenerative intervertebral disc environment.
Injectable therapies for intervertebral disc (IVD) repair are gaining much interest. Recently, a chitosan (CH)-based injectable scaffold has been developed that has similar mechanical properties to human nucleus pulposus (NP) and provides a suitable environment for encapsulated NP cell survival and proteoglycan production. The hypothesis of the study was that the biological response of the encapsulated cells can be further increased by adding gelatine and Link N (LN, a naturally occurring peptide present in cartilage and IVD extracellular matrix), known to increase cell adhesion and proteoglycan production, respectively. The effect of gelatine on the mechanical properties of a CH hydrogel was evaluated through rheological and compressive mechanical tests. Production of proteoglycan [assessed as glycosaminoglycan (GAG)] by encapsulated NP cells was determined in the presence or absence of gelatine in normal or degenerative medium supplemented with LN. Normal and degenerative media replicate the healthy and degenerative disc environment, respectively. Gelatine slightly reduced the gelation rate of CH hydrogel but improved its final mechanical properties in compression. LN had a minimal effect in normal medium but induced significantly more GAG production in degenerative medium (p < 0.001, 4.7-fold superior to the control), reaching similar results to transforming growth factor (TGF)-β (used as a positive control). GAG production was further increased in CH-gelatine hydrogels, confirming an additive effect of LN and gelatine in a degenerative environment. The results supported the concept that CH-gelatine hydrogels supplemented with LN can help restore the function of the NP during the early stages of IVD degeneration.


A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities.
Falls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for residents with dementia. This paper reports the protocol of a project which aims to implement evidence based falls prevention strategies in nine residential aged care facilities (RACFs) in Australia. The facilities in the study include high and low care, small and large facilities, metropolitan and regional, facilities with a specific cultural focus, and target groups recognised as being more challenging to successful implementation of falls prevention practice (e.g. residents with dementia). The project will be conducted from November 2007-November 2009. The project will involve baseline scoping of existing falls rates and falls prevention activities in each facility, an action research process, interactive falls prevention training, individual falls risk assessments, provision of equipment and modifications, organisation based steering committees, and an economic evaluation. In each RACF, staff will be invited to join an action research group that will lead the process of developing and implementing interventions designed to facilitate an evidence based approach to falls management in their facility. In all RACFs a pre/post design will be adopted with a range of standardised measures utilised to determine the impact of the interventions. The care gap in residential aged care that will be addressed through this project relates to the challenges in implementing best practice falls prevention actions despite the availability of best practice guidelines. There are numerous factors that may limit the uptake of best practice falls prevention guidelines in residential aged care facilities. A multi-factorial individualised (to the specific requirements of each facility) approach will be used to develop and implement an action plan in each participating facility based on the best available evidence.


[Carcinoembryonic antigen: diagnosis and tumor progression in gastrointestinal tumors].
Tumour progression in 340 patients with resected gastrointestinal primary tumours was monitored using the gradual increase in carcinoembryonic antigen (CEA) in serum. The commencement of the rise in CEA generally preceded clinical detection of the cancer by several months. The degree to which the rise in CEA correlated with the recurrence of cancer was investigated. There was a marked difference in the distribution of the rises in CEA between local tumour growth and distant metastases. CEA increases of more than 1 microgram CEA/l serum in 10 days occurred exclusively in patients with distant metastases. There was a further marked difference in the distribution of the CEA increase between the group with liver metastases and the groups with peritoneal carcinomatosis or other metastases. The site of the primary tumour had no influence on the CEA increase during formation of metastases.


Effects of free radical generation on mouse pial arterioles: probable role of hydroxyl radicals.
Mouse pial arterioles were exposed to the free radical-generating reactants acetaldehyde and xanthine oxidase. Concentrations of 0.5 mM acetaldehyde and 0.1 U/ml xanthine oxidase caused reversible dilations, whereas higher concentrations produced initial constrictions followed by reversible dilations. The following free radical scavengers inhibited the dilation when added to the lower concentrations of reactants: superoxide dismutase, a superoxide scavenger; catalase, an H2O2 scavenger; and mannitol, a hydroxyl scavenger. In addition, pretreatment of the animal with dimethyl sulfoxide, a hydroxyl scavenger, also inhibited the response. The scavengers were also tested against either the dilation produced by increased inspired CO2 or against the dilation produced by local application of 10(-3) M papaverine. No significant effect was observed. The data support the hypothesis that hydroxyl radicals can dilate pial arterioles, since all the scavengers can ultimately reduce levels of hydroxyl generated by acetaldehyde plus xanthine oxidase.


Clinical and immunological implications of increase in CD208+ dendritic cells in tonsils of patients with immunoglobulin A nephropathy.
The therapeutic effect of tonsillectomy for immunoglobulin A nephropathy (IgAN) has been widely recognized, but the mechanism by which tonsillar immunity leads to glomerulonephritis has been unclear. We investigated subtypes and localization of dendritic cells (DCs) in tonsils and looked for relationships between the tonsillar DCs and the clinical features and renal histological changes of patients with IgAN. We examined tonsils from 33 IgAN patients, using as control tonsillar specimens from subjects without glomerulonephritis. Five distinct markers of DCs (CD303, CD1c, CD209, CD208 and CD1a) were analyzed by immunohistochemistry and flow cytometry. The mRNA levels of these DC markers were evaluated using real-time polymerase chain reaction. The clinical data and histological results obtained evaluating renal biopsy tissues were statistically compared with immunological data. Of the five subtypes of DCs, CD208(+) DCs were significantly increased in the tonsils of IgAN patients compared with that of controls. Furthermore, the number of CD208(+) DCs in the tonsils was positively and linearly correlated with the proportion of crescentic glomeruli in renal biopsy tissues and with the urinary protein level. Only few CD208(+) cells, however, were found in the kidney biopsy specimens of IgAN patients. These observations suggest that increased CD208(+) DCs in tonsils may play a directive role in the pathogenesis of IgAN. The present results support the therapeutic significance of tonsillectomy for IgAN patients.


Self-incompatibility in Petunia: a self/nonself-recognition mechanism employing S-locus F-box proteins and S-RNase to prevent inbreeding.
Many flowering plants producing bisexual flowers have adopted self-incompatibility (SI), a reproductive strategy which allows pistils to distinguish between self and nonself pollen, and to only permit nonself pollen to effect fertilization. To date, three different SI mechanisms have been identified, and this article focuses on the S-RNase-based mechanism using Petunia (Solanaceae) as a model. The genetic basis of this type of SI was established nearly a century ago; the polymorphic S-locus specifies the genetic identity of pollen and the pistil. Molecular genetic studies carried out since the late 1980s have led to the identification of the polymorphic genes at the S-locus that control self/nonself-recognition between pollen and the pistil. The S-RNase gene, which controls pistil specificity, was identified first, and subsequent sequencing of the S-locus region containing S-RNase led to the identification of the S-locus F-box (SLF) gene (now named SLF1). A transgenic approach was used to show that S2-SLF1 (SLF1 of S2-halotype) of Petunia inflata controls pollen specificity. The S-locus contains additional pollen-expressed F-box genes that show sequence similarity with SLF1, and initially they were thought not to be involved in pollen specificity. However, further studies of SLF1 suggested that it is not the only pollen specificity gene. Indeed, it has recently been shown that two previously identified SLF-like genes in P. inflata (now named SLF2 and SLF3) and a yet unknown number of additional SLF-like genes (named SLF4, SLF5, etc.) collaboratively function to control pollen specificity. The significance and implications of this new finding are discussed.


Oxygenated hydrogel promotes re-epithelialization and reduces inflammation in a perturbed wound model in rat.
Chronic wounds can take months or even years to heal and require proper medical intervention. Normal wound healing processes require adequate oxygen supply. Accordingly, destroyed or inefficient vasculature leads to insufficient delivery to peripheral tissues and impair healing. Oxygen is critical for vital processes such as proliferation, collagen synthesis and antibacterial defense. Hyperbaric oxygen therapy (HBOT) is commonly used to accelerate healing however, this can be costly and requires specialized training and equipment. Efforts have turned to the development of topical oxygen delivery systems. Oxysolutions has developed oxygenated gels (P407, P407/P188, nanocellulose based gel (NCG)) with high levels of dissolved oxygen. This study aims to evaluate the efficacy of these newly developed oxygenated products by assessing their impact on healing rates in a rat perturbed wound model. Here, P407/P188 oxygenated gels demonstrated greater re-epithelialization distances compared to its controls at Day 3. In addition, all oxygenated gels had a higher proportion of wounds with complete wound closure. All three oxygenated gels also minimized further escalation in inflammation from Day 3 to Day 10. This highlights the potential of this newly-developed oxygenated gels as an alternative to existing oxygen therapies.


Arteriovenous access monitoring with ultrasound dilution in a pediatric hemodialysis unit.
Permanent arteriovenous (AV) access is the preferred access for dialysis delivery in children and adolescents requiring chronic hemodialysis (HD). Ultrasound dilution (UD) monitoring of AV access flow is widely used in adult HD units for the early detection of stenosis but experience in pediatrics is limited. We monitored all maintenance HD patients with AV access using a noninvasive screening algorithm based on UD access flow. We assessed the effectiveness of this algorithm by comparing it to fistulagrams and its impact on AV access-related morbidity. AV access thrombosis rates fell from 13.5 per 100 patient-months on HD during the baseline period to 3.5 per 100 patient-months on HD during the screening period (p < 0.04). The mean blood flow rate by UD measurement was lower in AV accesses that went on to thrombose compared to those without thrombosis (1,203 ml/min/1.73 m(2) vs. 1,683 ml/min/1.73 m(2), p < 0.001). When compared to fistulagrams, the screening algorithm was 94% sensitive and 77% specific in detecting hemodynamically significant stenosis, with positive and negative predictive values of 83 and 91% respectively. A noninvasive UD screening algorithm of AV access flow is very sensitive in detecting hemodynamically significant stenosis and can decrease AV access thrombosis rates.


No negative effects of bone impaction grafting with bone and ceramic mixtures.
Reconstructing large loaded bone defects with ceramic bone graft extenders is tempting considering the expected future donor bone shortage. However, whether there are negative effects is unknown. Standardized large defects in the acetabulum of goats were created and subsequently reconstructed with metal mesh and impacted morselized cancellous bone grafts or a 50/50% volume mixture of tricalcium phosphate-hydroxyapatite granules and morselized cancellous bone grafts using the bone impaction grafting technique. Subsequently, a cemented total hip prosthesis was inserted. Clinically, no differences were observed between groups. Most of the morselized cancellous bone graft had been resorbed and incorporated into new bone after 15 weeks. The large tricalcium phosphate-hydroxyapatite granules were integrated, the smaller crushed tricalcium phosphate-hydroxyapatite granules were surrounded by osteoclasts or engulfed by macrophages and giant cells. The cement penetration into the reconstructive layer and the quality of the bone based on a semiquantitative score were similar in both groups. We found no suggestion of tricalcium-hydroxyapatite granule-induced third-body wear in this short-term followup study. No negative effects were observed in this study, and therefore, it seems reasonable to use tricalcium-hydroxyapatite granules in a 50/50% volume mix with morselized cancellous bone graft as a bone graft extender in acetabular revision surgery with the bone impaction grafting technique.


Comparison of cannabinoid pharmacokinetic properties in occasional and heavy users smoking a marijuana or placebo joint.
Cannabinoid pharmacokinetics in occasional users is well studied, but the interpretation of data from heavy users is difficult. In the present study, blood pharmacokinetic properties were investigated in occasional and heavy users in cannabis and placebo conditions. The results obtained with occasional users were in contrast to those of the heavy users who admitted cannabis use on 4-25 occasions during the previous week. Of the 12 heavy users, 10 exhibited up to 12.3 microg/L Delta(9)-tetrahydrocannabinol (THC) prior to smoking. During the 8 h after smoking, the distribution and elimination patterns were comparable to those of the occasional users and the concentrations returned to 68-196% (median 110%) of the initial values. However, the maximal concentration and the areas under the curves were significantly higher with marked interindividual variation. In contrast to the cannabis conditions, the THC concentrations in the placebo phase decreased more slowly (elimination half-life 17.5-43.5 h vs. 1.0-5.9 h) in accordance with a late elimination phase. The elimination half-lives of 11-hydroxy-THC and 11-nor-9-carboxy-THC in th cannabis conditions (medians 3.1 h and 6.2 h, respectively) were longer than those of THC, which was different in the placebo phase (medians 7.2 h and 13.0 h, respectively). From the results, it must be cautioned that cannabinoid blood concentrations from heavy users in a late elimination phase may be difficult to distinguish from concentrations measured in occasional users after acute cannabis use.


Site-directed mutagenesis of the binding site for ribosomal protein S8 within 16S ribosomal RNA from Escherichia coli.
Twelve specific alterations have been introduced into the binding site for ribosomal protein S8 in Escherichia coli 16S rRNA. Appropriate rDNA segments were first cloned into bacteriophage M13 vectors and subjected to bisulfite and oligonucleotide-directed mutagenesis in vitro. Subsequently, the mutagenized sequences were placed within the rrnB operon of plasmid pNO1301 and the mutant plasmids were used to transform E. coli recipients. The growth rates of cells containing the mutant plasmids were determined and compared with that of cells containing the wild-type plasmid. Only those mutations which occurred at highly conserved positions, or were expected to disrupt the secondary structure of the binding site, increased the doubling time appreciably. The most striking changes in growth rate resulted from mutations that altered a small internal loop within the S8 binding site. This structure is phylogenetically conserved in prokaryotic 16S rRNAs and may play a direct role in S8-16S rRNA recognition and interaction.


Traumatic brain injury: diffusion-weighted MR imaging findings.
Diffuse axonal injury (DAI) accounts for a significant portion of primary intra-axial lesions in cases of traumatic brain injury. The goal of this study was to use diffusion-weighted MR imaging to characterize DAI in the setting of acute and subacute traumatic brain injury. Nine patients ranging in age from 26 to 78 years were examined with conventional MR imaging (including fast spin-echo T2-weighted, fluid-attenuated inversion-recovery, and gradient-echo sequences) as well as echo-planar diffusion-weighted MR imaging 1 to 18 days after traumatic injury. Lesions were characterized as DAI on the basis of their location and their appearance on conventional MR images. Trace apparent diffusion coefficient (ADC) maps were computed off-line with the diffusion-weighted and base-line images. Areas of increased signal were identified on the diffusion-weighted images, and regions of interests were used to obtain trace ADC values. In the nine patients studied, isotropic diffusion-weighted images showed areas of increased signal with correspondingly decreased ADC. In one case, decreased ADC was seen 18 days after the initial event. Decreased ADC can be demonstrated in patients with DAI in the acute setting and may persist into the subacute period, beyond that described for cytotoxic edema in ischemia.


["Coronary arteriographic findings in the patients of arteriosclerotic heart disease combined with cardiac arrhythmias or conduction defects" (author's transl)].
Correlation between cine-coronary arteriographic findings and various cardiac arrhythmias or conduction defects were studied in 40 patients with arteriosclerotic heart disease. These cases were divided into 3 groups according to the type of arrhythmias or conduction defects. The following conclusions were drawn. 1. In the group I of 25 patients whose arrhythmias were atrial origin, there were sinus bradycardia in 9, suins tachycardia in 5, atrial premature beats in 2 and atrial fibrillation in 9. Cine-angiographically, the degree of luminal stenosis of the main coronary arterial branches were mild to moderate in severity compared to that of the other two groups. However, it was remarkable that the sinus node artery was not visualized in 9 of 25 cases (36%). 2. The group II of 5 patients who have shown premature ventricular contractions exhibited moderate to severe degree of stenosis of coronary artery trees, especially much more often in left anterior descending coronary arteries. 3. In the group III of 10 patients who had various type of intraventricular conduction defects, the degree of stenosis of the main coronary artery branches were usually severe and also, the number of the coronary artery involved in stenosis was increased. Interestingly, atrioventricular node arteries were not opacified in 5 of 10 cases. There were 2 cases of complete A-V block where the atrioventricular node artery was not visualized at all both either from right or left coronary artery opacification. It seemed to be hard to draw a clear cut correlation between cine coronary angiographic pictures and a certain type of cardiac arrhythmias or conduction defects in such a small scale of study. However, cind coronary angiography may contribute to rule out local ischemia of the conduction tissue as a primary cause of the development of arrhythmias or conduction defects in patients with arterisclerotic heart disease.


Women's viewpoints on egg freezing in Austria: an online Q-methodology study.
Egg freezing has emerged as a technology of assisted reproductive medicine that allows women to plan for the anticipated loss of fertility and hence to preserve the option to conceive with their own eggs. The technology is surrounded by value-conflicts and is subject to ongoing discussions. This study aims at contributing to the empirical-ethical debate by exploring women's viewpoints on egg freezing in Austria, where egg freezing for social reasons is currently not allowed. Q-methodology was used to identify prevailing viewpoints on egg freezing. 46 female participants ranked a set of 40 statements onto a 9-column forced choice ranking grid according to the level of agreement. Participants were asked to explain their ranking in a follow-up survey. By-person factor analysis was used to identify distinct viewpoints which were interpreted using both the quantitative and the qualitative data. Three distinct viewpoints were identified: (1) "women should decide for themselves", (2) "we should accept nature but change policy", and (3) "we need an informed societal debate". These viewpoints provide insights into how biomedical innovations such as egg freezing are perceived by women in Austria and illustrate the normative tensions regarding such innovations. Acknowledging the different prioritizations of values regarding assisted reproductive technologies is important to better understand the underlying normative tensions in a country where egg freezing for social reasons is currently not allowed. The study adds new empirical insights to the ongoing debate by outlining and discussing viewpoints of those directly affected: women. Following up on the lay persons perspective is particularly important in the context of future biomedical innovations that may challenge established norms and create new tensions. It therefore also adds to the societal debate and supports evidence-informed policy making in that regard.


A comparative study of root coverage obtained with an acellular dermal matrix versus a connective tissue graft: results of 107 recession defects in 50 consecutively treated patients.
Obtaining root coverage has become an important part of periodontal therapy. In this study, 2 surgical root coverage procedures were examined. The control group was treated with a coronally positioned pedicle graft combined with a connective tissue graft. The test group was treated with a coronally positioned pedicle graft combined with an acellular dermal matrix. There was no statistically significant difference in the mean root coverage obtained (96.2% control vs 95.8% test). There was a statistically significant reduction in probing depth (1.2 mm control vs 0.7 mm test) and increase in keratinized tissue (2.0 mm control vs 1.2 mm test) in both groups. The connective tissue graft produced a greater mean probing reduction and mean keratinized tissue increase than the acellular dermal matrix. However, this did not appear to be clinically significant. The results of both procedures were esthetically acceptable to the patients and clinically acceptable in all cases. In this study, the acellular dermal matrix and the connective tissue graft resulted in similar amounts of root coverage.


An international, prospective, multicenter evaluation of the combination of AdvanDx Staphylococcus QuickFISH BC with mecA XpressFISH for detection of methicillin-resistant Staphylococcus aureus isolates from positive blood cultures.
Sepsis caused by Staphylococcus aureus is a major health problem worldwide. Better outcomes are achieved when rapid diagnosis and determination of methicillin susceptibility enable early optimization of antimicrobial therapy. Eight large clinical laboratories, seven from the United States and one from Scotland, evaluated the combination of the Staphylococcus QuickFISH BC and the new mecA XpressFISH assay (both AdvanDx, Woburn, MA, USA) for the detection of methicillin-resistant S. aureus in positive blood cultures. Blood cultures flagged as positive by automated blood culture instruments and demonstrating only Gram-positive cocci in clusters on Gram stain were tested by QuickFISH, a 20-min assay. If only S. aureus was detected, mecA XpressFISH testing followed. The recovered S. aureus isolates were tested by cefoxitin disk diffusion as the reference method. The QuickFISH assay results were concordant with the routine phenotypic testing methods of the testing laboratories in 1,211/1,221 (99.1%) samples and detected 488/491 S. aureus organisms (sensitivity, 99.4%; specificity, 99.6%). Approximately 60% of the samples (730) contained coagulase-negative staphylococci or nonstaphylococci as assessed by the QuickFISH assay and were not tested further. The 458 compliant samples positive exclusively for S. aureus by the QuickFISH assay were tested by the mecA XpressFISH assay, which detected 209 of 211 methicillin-resistant S. aureus organisms (sensitivity, 99.1%; specificity, 99.6%). The mecA XpressFISH assay also showed high reproducibility, with 534/540 tests performed by 6 operators over 5 days achieving reproducible results (98.9% agreement). The combination of the Staphylococcus QuickFISH BC and mecA XpressFISH assays is sensitive, specific, and reproducible for the detection of methicillin-resistant S. aureus and yields complete results in 2 h after the blood culture turns positive.


Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience.
The aim of this study is to examine the clinical data of children who underwent tracheostomy during their stay in Pediatric Intensive Care Unit (PICU), in order to describe the relationship between the timing of tracheostomy, the length of PICU stay and the occurrence of ventilator-associated pneumonia (VAP). This is a retrospective cohort study that collects all patients undergoing tracheostomy during their PICU stay over a six-year period. Data collection included PICU length of stay, days of intubation, days of mechanical ventilation, primary indication for tracheostomy, information about VAP and decannulations. The early tracheostomy group was defined as patients who had ten or fewer days of continuous ventilation, whereas the late tracheostomy group had more than ten days of continuous ventilation. A significant decrease in the rate of VAP incidence was noticed in the early tracheostomy group vs. late group (P=0.004, OR=0.39, 95% CI: 0.18-0.85). No differences were observed about decannulation, need of long-term ventilation and death rate. Significant decreases of days of mechanical ventilation and PICU stay were found in subgroup of patients who underwent early tracheostomy and were decannulated within 18 months. No standard timing for tracheostomy placement has been established in the pediatric population. Early tracheostomy can shorten the days of ventilation and hospitalization in PICU and reduce the incidence of VAP, but further studies are needed to identify patient categories in which it can be of benefit.


Eichhornia crassipes biodiesel as a renewable green fuel for diesel engine applications: performance, combustion, and emission characteristics.
This work examines the feasibility of fuelling biodiesel derived from Eichhornia crassipes in a compression ignition engine. This work also proposes water hyacinth biodiesel (WHB) as a potential alternative energy source since the above species is available extensively in freshwater, marine, and aquatic ecosystems throughout the world. WHB was blended with petroleum diesel fuel at various volume proportions of 10%, 20%, 30%, 40%, and 100% and their properties were analyzed as per ASTM standards for its application as biofuel. The prepared test fuels were analyzed experimentally in a single-cylinder diesel engine at constant speed (1500 rev/min) for its performance, combustion, and emission characteristics. Test results projected that the characteristics of 20% WHB + 80% diesel fuel blend were in par with neat diesel fuel in terms of thermal efficiency, HC, CO, and smoke emissions. However, WHB blends resulted in slightly higher levels of CO2 and NOx emissions. At full load, the attained cylinder pressure and heat release rate of WHB were comparatively lower than diesel fuel. Ignition delay is lowest for B100 blend and therefore the diffusion burning phase of biodiesel phase is found to be dominant in comparison with diesel fuel. For biodiesel blends, the combustion starts earlier due to higher cetane number, lessened delay period, and lowered calorific value followed by lowered HRR. Graphical abstract.


Inglämnlagare: a tool for restructuring Swedish HER record site data for statistical analysis.
Background: This paper presents a new software tool, Inglämnlagare, developed to be open-source, that restructures information about ancient remains in Sweden for analysis. The background is a new version of the ancient sites database, the Historic Environment Record, curated by the Swedish National Heritage Board, that was launched in 2018 with a new database model that structures the information differently compared to previous versions. Methods: The program, written in Python programming language, has multicore support in order to improve performance for large files and uses regular expressions to extract information about individual features of composite sites. Such features, together with their summed amount, are written as new individual fields to a comma-separated value file. The program is delivered as a source script file that can be executed in any Python environment. Use cases: As an example of use, a case study of exploring graves of rectangular shape found within Sweden is provided. The use case also describes the different steps involved in preparing the data in QGIS to run the program, as well as some methods to efficiently analyse and visualize the output. Conclusions: Inglämnlagare will make more information from the Swedish record of ancient sites accessible for research and can be used to explore different content of the record more efficiently than previously possible. While the tool is written specifically for this dataset it also provides an example of how open-source tools can be used for data wrangling making information designed for a specific purpose, such as online dissemination, appropriate for analysis.


Blood flow and ultrastructure in ischemic myocardium of cats given dexamethasone.
Regional myocardial blood flow or myocardial creatine kinase activity and ultrastructure was studied in anesthetized cats subjected to sham operation, 5 h of circumflex-artery ligation, or 2 h of coronary-artery ligation with 3 h of reperfusion. Sham-operated cats were given dexamethasone sodium phosphate (8 mg/kg iv) at the beginning of the experiment. Cats subjected to coronary-artery ligation were given steroid or vehicle before ligation. In sham-operated cats the average blood flow in tissue of the anterior wall was 2.11 +/- 0.37 (SER) ml.g-1.min-1. The corresponding flow for tissue of the posterior wall was 2.22 +/- 0.42 ml.g-1.min-1. Ligation of the circumflex artery produced a range of average blood flow in the posterior basal myocardium that was 52-92% less than that of sham-operated cats. Within the tissue of the posterior left ventricular wall, steroid pretreatment did not prevent loss of creatine kinase activity after coronary-artery ligation. Moreover, steroid pretreatment was ineffective in maintaining myocardial structure in reperfused myocardial tissue. These results indicate that 1) dexamethasone does not effectively increase blood flow within ischemic or reperfused myocardial tissue, and 2) dexamethasone may stabilize ischemic myocardial tissue. However, upon reperfusion, dexamethasone is unable to maintain myocardial ultrastructure in moderately to severely ischemic tissue.


Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients.
This study evaluated the efficacy and tolerability of budesonide in an aqueous nasal spray (BANS) in patients with chronic rhinosinusitis. In this double-blind, placebo-controlled, multicentre, parallel-group study, patients (n = 167) with persistent rhinosinusitis symptoms despite 2-weeks' antibiotic treatment were randomised to receive BANS 128 micrograms b.i.d. or placebo for 20 weeks. Morning combined symptom scores (CSS) in patients receiving BANS decreased by a mean of -1.85 (95% CI -2.27, -1.43), versus -1.02 (-1.43, -0.61) in the placebo group (p = 0.005); corresponding values for evening CSS were -1.78 (-2.22, -1.35) and -1.02 (-1.45, -0.60), respectively (p = 0.012). BANS produced significant reductions in nasal congestion and discharge scores, and improved patients' sense of smell (morning only), versus placebo. Peak nasal inspiratory flow (PNIF) increased significantly during BANS treatment. In allergic patients, BANS significantly (p < 0.001) reduced both morning -1.40 (-2.18, -0.62) and evening -1.37 (-2.15, -0.58) CSS from baseline versus placebo, but changes in non-allergic patients (morning: -0.04 [-0.95, 0.87]; evening: 0.14 [-0.81, 1.09]) were not significant. PNIF was significantly (p < 0.01) increased in both allergic and non-allergic patients from baseline versus placebo. BANS is an effective and well-tolerated treatment for chronic rhinosinusitis.


CHANGES IN ORO-PHARYNGEAL AIRWAY DIMENSIONS AFTER TREATMENT WITH FUNCTIONAL APPLIANCE IN CLASS II SKELETAL PATTERN.
Functional appliances have been used since many decades for the correction of mandibular retrognathism. Similar oral appliances are a treatment modality for patients with Obstructive sleep apnoea. Hence, interception at the right age with these growth modification appliances might benefit a child from developing long-term respiratory insufficiency. Therefore, the purpose of our study was to assess the short-term effects of Twin block appliance (CTB) on pharyngeal airway size in subjects with skeletal Class-II pattern in a sample of Pakistani population. A retrospective study was conducted from orthodontic records of 62 children (31 males, 31 females) with retrognathic mandibles using lateral cephalograms obtained at initial visit and after CTB treatment. Paired t-test was used to compare the pre-functional and post-functional treatment airway size. Independent sample t-test was used for comparison between the genders and statistical significance was kept at ≤ 00.5. The upper airway width (p < 0.001), nasopharyngeal depth (p = 0.03) and upper airway thickness (p = 0.008) was substantially improved after CTB treatment. Males showed a greater increase in upper airway width (p = 0.03) and nasopharyngeal depth (p = 0.01) in comparison to the females. Functional appliance therapy can improve the narrow pharyngeal airway of growing children presenting with deficient mandibles having Class-II skeletal pattern.


[State of central hemodynamics in various kinds of anesthesia during short-term ENT surgery in children].
The study was carried out in 124 children aged 4-10 years with ASA risk I or II. Group 1 consisted of 40 patients operated on under combined anesthesia with midazolam, fentanyl, and N2O, group 2 were 30 children operated on under mask anesthesia with fluothane, and nitric oxide + oxygen, group 3 patients were operated on under combined anesthesia with ketamine, midazolam, and N2O + CO2, and group 4 patients were operated on under thiopental and N2O + CO2. Cardiovascular function was evaluated by the NCCOM3-R-7 device (BoMed) by the bioimpedance method. Satisfactory cardiovascular function was observed in all groups, but the best stability was noted in the midazolam-fentanyl group. Hence, midazolam-fentanyl combination can be the method of choice in short-term ENT operations.


Configuration dependent critical nuclei in the self assembly of magic clusters.
Evidence for the formation of various 2-D structures possessing different numbers of Co-Si magic clusters (size approximately 10.0 +/- 0.5 A), configurations and lifetimes are studied in real time on a Si(111)-(7 x 7) surface at elevated temperature in the STM. Observations of individual cluster diffusion, attachment and detachment dynamics resolve unequivocally the question of self assembly over surface reconstruction. The smallest stable structure consisting of seven individual Co-Si magic clusters arranged in a hexagonal closed packed formation (i = 7) is found to retain sufficient cohesive energy to avoid dissociation. A configuration dependent critical 2-D nuclei (i* = 6) is determined to exist in facilitating the self assembly dynamics.


Long-term increases in the evoked population spike in the CA1 region of rat hippocampus induced by beta-adrenergic receptor activation.
The effects of the selective beta-adrenergic receptor agonist isoproterenol (ISO) were characterized in the CA1 region of the rat hippocampal slice preparation. As has been previously described, 500 nM ISO increased the amplitude of the evoked population spike response without having any effect upon field EPSP (fEPSP) responses. However, the increase in the population spike response was quite persistent and was not reversed by greater than 30 min of washout in the majority of the slices tested; we have termed this prolonged increase beta-adrenergic potentiation (BAP). As with the acute effect of ISO, BAP is confined to an increase in the population spike response and not the fEPSP. In input-output curves, this was clearly observed as a persistent leftward shift in the EPSP-population spike relationship. Similar long-term increases in the population spike could also be elicited by superfusion of the slices for 10 min with 20-25 microM norepinephrine (NE). Although both the acute and the long-term effects of ISO were blocked by pretreatment with timolol, a beta-adrenergic antagonist, the long-term effects were not reversed by superfusion with timolol following ISO treatment, demonstrating that the prolonged effects were not due to slow washout of ISO from the tissue. BAP was not blocked by pretreatment with 50 microM 2-amino-5-phosphonovaleric acid, an NMDA receptor antagonist that blocks hippocampal long-term potentiation and the long-lasting changes in synaptic responses induced in the dentate gyrus by NE and ISO.(ABSTRACT TRUNCATED AT 250 WORDS)


Natural History of Structural Hip Abnormalities and the Potential for Hip Preservation.
Hip osteoarthritis (OA) exerts a significant burden on society, affecting 3% of Americans aged >30 years. Recent advances in the understanding of the pathoanatomy and pathomechanics of the hip have led to treatment options for young adults with hip pain. Femoroacetabular impingement, specifically cam-type femoroacetabular impingement, hip dysplasia, and the sequelae of pediatric hip disease can predispose the hip to early OA. However, many patients with abnormal anatomic findings do not develop early OA, suggesting that there exist other patient characteristics that are protective despite abnormal bony anatomy. Outcome studies show that arthroscopic and open hip procedures improve pain and function in patients with symptomatic hips. However, there is currently limited evidence that these procedures extend the life of the patient's natural hip. Additional studies are needed to determine protective or adaptive factors in patients with abnormal anatomy who do not develop early OA and to determine whether joint preserving hip surgery extends the life of the native hip joint.


Development of the human umbilical vein scaffold for cardiovascular tissue engineering applications.
Biologic function and the mechanical performance of vascular grafting materials are important predictors of graft patency. As such, "functional" materials that improve biologic integration and function have become increasingly sought after. An important alternative to synthetic materials is the use of biomaterials derived from ex vivo tissues that retain significant biologic and mechanical function. Unfortunately, inconsistent mechanical properties that result from tedious, time consuming, manual dissection methods have reduced the potential usefulness of many of these materials. We describe the preparation of the human umbilical vein (HUV) for use as an acellular, three-dimensional, vascular scaffold using a novel, automated dissection methodology. The goal of this investigation was to determine the effectiveness of the autodissection methodology to yield an ex vivo biomaterial with improved uniformity and reduced variance. Mechanical properties, including burst pressure, compliance, uniaxial tension testing, and suture holding capacity, were assessed to determine the suitability of the HUV scaffold for vascular tissue engineering applications. The automated methodology results in a tubular scaffold with significantly reduced sample to sample variation, requiring significantly less time to excise the vein from the umbilical cord than manual dissection methods. Short-term analysis of the interactions between primary human vascular smooth muscle cells and fibroblasts HUV scaffold have shown an excellent potential for cellular integration by native cellular remodeling processes. Our work has shown that the HUV scaffold is mechanically sound, uniform, and maintains its biphasic stress-strain relationship throughout tissue processing. By maintaining the mechanical properties of the native blood vessels, in concert with promising cellular interactions, the HUV scaffold may lead to improved grafts for vascular reconstructive surgeries.


Computer-Assisted Tracking of Chlamydomonas Species.
The green algae Chlamydomonas reinhardtii is a model system for motility in unicellular organisms. Photo-, gravi-, and chemotaxis have previously been associated with C. reinhardtii, and observing the extent of these responses within a population of cells is crucial for refining our understanding of how this organism responds to changing environmental conditions. However, manually tracking and modeling a statistically viable number of samples of these microorganisms is an unreasonable task. We hypothesized that automated particle tracking systems are now sufficiently advanced to effectively characterize such populations. Here, we present an automated method to observe C. reinhardtii motility that allows us to identify individual cells as well as global information on direction, speed, and size. Nutrient availability effects on wild-type C. reinhardtii swimming speeds, as well as changes in speed and directionality in response to light, were characterized using this method. We also provide for the first time the swimming speeds of several motility-deficient mutant lines. While our present effort is focused around the unicellular green algae, C. reinhardtii, we confirm the general utility of this approach using Chlamydomonas moewusii, another member of this genus which contains over 300 species. Our work provides new tools for evaluating and modeling motility in this model organism and establishes the methodology for conducting similar experiments on other unicellular microorganisms.


Pathological characteristics of BRCA-associated breast cancers in Hispanics.
The immunophenotype of BRCA-associated breast cancer has been studied in predominantly non-Hispanic whites (NHW). We evaluated the pathological characteristics of BRCA-associated invasive breast cancer in Hispanics. A case-control study was conducted on breast cancers from Hispanic and NHW women who enrolled in an IRB-approved registry and underwent BRCA gene analysis. BRCA negative controls (41 Hispanic, 39 NHW) were matched on age and ethnicity to BRCA positive cases (39 Hispanic, 35 NHW). A tissue array was constructed to characterize the expression of estrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 and p53 by immunohistochemistry. Mean age at diagnosis was 37.1 years (range 24-59) for Hispanics (80% with Mexican ancestry) and 40.1 years (range 21-63) for NHW (P = 0.03). Hispanic BRCA1 cases were more likely than BRCA negative controls to have tumors that were ER-negative (P < 0.001) and PR-negative (P = 0.001), had higher levels of Ki-67 (P = 0.001) and p53 expression, and lower levels of HER2 overexpression. When stratified by genes, there were no significant differences in expression of ER, Ki-67, HER2, and p53 by ethnicity among mutation carriers. However, a significantly higher proportion of BRCA-positive Hispanics had PR-negative tumors compared to BRCA-positive NHW (80 vs. 57%, OR = 2.9, 95% CI 1.0-8.1, P = 0.04). Hispanic BRCA-associated breast cancers were found to have the unique immunophenotype associated with BRCA mutations; however, there was a trend toward a difference in PR expression among Hispanic BRCA1 and BRCA2 cases. Additional research on the molecular mechanisms involved in the loss of PR in this population is warranted as it could have important implications for the treatment and prevention of breast cancer in Hispanics.


Resisting arrest: a switch from angiogenesis to vasculogenesis in recurrent malignant gliomas.
The cellular and molecular events that initiate and promote malignant glioma development are not completely understood. The treatment modalities designed to promote its demise are all ultimately ineffective, leading to disease progression. In this issue of the JCI, Kioi et al. demonstrate that vasculogenesis and angiogenesis potentially play distinct roles in the etiology of primary and recurrent malignant gliomas, suggesting that patient therapy should perhaps be tailored specifically against the predominant vasculature pathway at a given specific stage of gliomagenesis.


Knowledge, attitude, and performance of medical staff of teaching healthcare settings about hepatitis B and C in Isfahan, Iran.
hospital personnel are at high risk of exposure, infection, and transmission of viral hepatitis. The present study aimed at investigating the knowledge, attitude, and performance of health service providers to provide them with the information required for their educational promotion on viral hepatitis. This cross-sectional study was conducted on 400 staff of the forenamed healthcare settings such as on nurses, midwives, licensed practical nurses, and lab officials in Isfahan, Iran, in 2012. A checklist including demographic data and questions associated with the knowledge (18 questions), attitude (4 questions), and performance (15 questions) on hepatitis B and C was completed by the participants. A total of 388 participants completed the checklist. Participants' knowledge on the ways of transmission, prevalence, vaccination, and prevention methods was moderate (total score = 58.56 ± 10.1 percent) and the attitude was generally positive. Proper vaccination was carried out by 81.4% of the participants. Accidental injury by a needle was reported in 47.7% of the participants, but only 37.6% of them reported it to higher authorities and of them only 13.7% received appropriate treatment. Only 44.3% and 11.6% of participants reported always using gloves and masks, respectively, and 58.8% of the staff covered the needle cap before transferring it to the safety box. Due to excessive contact with patients, a paramedic-educated society is expected to have an optimal level of knowledge, attitude, and performance related to viral hepatitis. Our results from the checklists showed that medical personnel are not appropriately aware of viral hepatitis and their performance, too, is not satisfactory. Further continuous training is required and there needs to be more emphasis on actions regarding behaviors with high risk of infection transmission.


Reversible hydrogenation of graphene on ni(111)-synthesis of "graphone".
Understanding the adsorption and reaction between hydrogen and graphene is of fundamental importance for developing graphene-based concepts for hydrogen storage and for the chemical functionalization of graphene by hydrogenation. Recently, theoretical studies of single-sided hydrogenated graphene, so called graphone, predicted it to be a promising semiconductor for applications in graphene-based electronics. Here, we report on the synthesis of graphone bound to a Ni(111) surface. We investigate the formation process by X-ray photoelectron spectroscopy (XPS), temperature-programmed desorption (TPD), and density-functional theory calculations, showing that the hydrogenation of graphene with atomic hydrogen indeed leads to graphone, that is, a hydrogen coverage of 1 ML (4.2 wt %). The dehydrogenation of graphone reveals complex desorption processes that are attributed to coverage-dependent changes in the activation energies for the associative desorption of hydrogen as molecular H2 .


Activation of PPARγ and inhibition of cell proliferation reduces key proteins associated with the basal subtype of bladder cancer in As3+-transformed UROtsa cells.
Environmental exposure to arsenite (As3+) has a strong association with the development of human urothelial cancer (UC) and is the 5th most common cancer in men and the 12th most common cancer in women. Muscle invasive urothelial cancer (MIUC) are grouped into basal or luminal molecular subtypes based on their gene expression profile. The basal subtype is more aggressive and can be associated with squamous differentiation, characterized by high expression of keratins (KRT1, 5, 6, 14, and 16) and epidermal growth factor receptor (EGFR) within the tumors. The luminal subtype is less aggressive and is predominately characterized by elevated gene expression of peroxisome proliferator-activated receptor- gamma (PPARγ) and forkhead box protein A1 (FOXA1). We have previously shown that As3+-transformed urothelial cells (As-T) exhibit a basal subtype of UC expressing genes associated with squamous differentiation. We hypothesized that the molecular subtype of the As-T cells could be altered by inducing the expression of PPARγ and/or inhibiting the proliferation of the cells. Non-transformed and As-T cells were treated with Troglitazone (TG, PPARG agonist, 10 μM), PD153035 (PD, an EGFR inhibitor, 1 μM) or a combination of TG and PD for 3 days. The results obtained demonstrate that treatment of the As-T cells with TG upregulated the expression of PPARγ and FOXA1 whereas treatment with PD decreased the expression of some of the basal keratins. However, a combined treatment of TG and PD resulted in a consistent decrease of several proteins associated with the basal subtype of bladder cancers (KRT1, KRT14, KRT16, P63, and TFAP2A). Our data suggests that activation of PPARγ while inhibiting cell proliferation facilitates the regulation of genes involved in maintaining the luminal subtype of UC. In vivo animal studies are needed to address the efficacy of using PPARγ agonists and/or proliferation inhibitors to reduce tumor grade/stage of MIUC.


Fungicidal Activity of Essential Oils from Cinnamomum cassia against the Pathogenic Fungi of Panax notoginseng Diseases.
The frequent disease of Panax notoginseng caused by the pathogenic fungi in field cultivation has become the major threaten to the sustainable development of it. The present study was conducted to find natural agent with potential inhibition against pathogen. Therefore, the inhibitory effects of Cinnamomum cassia (L.) J.Presl essential oils (EOs) against P. notoginseng associated pathogenic fungi were conducted both in vitro and in vivo experiments. The results of the Oxford cup test revealed that C. cassia dry bark EO (50 mg/mL) had significant inhibitory activity on the growth of all tested fungi, and the growth of various pathogens was completely inhibited, except for that of Fusarium solani. Therefore, the constituents of C. cassia EOs were analyzed by GC/MS, and the research demonstrated that the main constituents of C. cassia dry bark EO were trans-cinnamaldehyde (75.65 %), (E)-2-methoxycinnamaldehyde (6.08 %), cinnamaldehyde (3.47 %) and cinnamyl acetate (1.02 %). The MIC results showed that C. cassia dry bark EO and the main compounds had good antifungal effect on the tested strains, and the inhibitory effect was similar to that of hymexazol (chemical pesticide). By analyzing the value of the fraction inhibitory concentration index (FICI), additive effects, irrelevant effects and synergistic effects were observed after the mixture of hymexazol against various pathogens. Moreover, in vivo model showed that C. cassia dry bark EO could reduce the occurrence of anthrax in P. notoginseng. To widen the resources of C. cassia available, the compositions of both C. cassia fresh bark and leaf EOs were also tested and many common compositions existed among them. Taken together, it was concluded that C. cassia EO had the potential use in the field to reduce the pathogenic disease.


Association Between Hospital Participation in Value-Based Programs and Timely Initiation of Post-Acute Home Health Care, Functional Recovery, and Hospital Readmission After Joint Replacement.
This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely initiation of home health rehabilitation services with improvement in self-care, mobility, and 90-day hospital readmission. This retrospective cohort study used Medicare inpatient claims and home health assessment data from 2016 to 2017 for older adults discharged to home with home health following hospitalization after joint replacement. Multilevel multivariate logistic regression was used to examine the association between hospital participation in BPCI or CJR programs and timely initiation of home health rehabilitation service. A 2-staged generalized boosted model was used to examine the association between delay in home health initiation and improvement in self-care, mobility, and 90-day risk-adjusted hospital readmission. Compared with patients discharged from hospitals that did not have BPCI or CJR, patients discharged from hospitals with these programs had a lower likelihood of delayed initiation of home health rehabilitation services for both knees and hip replacement. Using propensity scores as the inverse probability of treatment weights, delay in the initiation of home health rehabilitation services was associated with lower improvement in self-care (odds ratio [OR] = 1.23; 95% CI = 1.20-1.26), mobility (OR = 1.15; 95% CI = 1.13-1.18), and higher rate of 90-day hospital readmission (OR = 1.19; 95% CI = 1.15-1.24) for knee replacement. Likewise, delayed initiation of home health rehabilitation services was associated with lower improvement in self-care (OR = 1.16; 95% CI = 1.13-1.20) and mobility (OR = 1.26; 95% CI = 1.22-1.30) for hip replacement. Hospital participation in BPCI or comprehensive CJR was associated with early home health rehabilitation care initiation, which was further associated with significant increases in functional recovery and lower risks of hospital readmission. Policy makers may consider incentivizing health care providers to initiate early home health services and care coordination in value-based payment models.


Economic reflections on proton pump inhibitor therapy for non-erosive reflux disease.
Proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease is a good example of the evolution of economic analysis. Initial studies were simple models constructed on spreadsheets and described the most cost-effective therapy in terms of cost per cure of esophagitis. This tells a third-party payer what is the most efficient approach to healing esophagitis (technical efficiency) but does not give any indication of whether treating esophagitis is good value for money in the first place or whether health care dollars would be better spent in treating other diseases (allocative efficiency). As economic analyses became more sophisticated, more complex models were constructed. Outcomes were expressed in terms of cost per quality-adjusted life year gained or the question was framed in terms of the probability a strategy would be cost effective depending on willingness to pay for a month free from symptoms. These approaches answer the question of whether treating gastroesophageal reflux disease is good value for money. Models have traditionally evaluated treatment of esophagitis, but this does not address the most efficient therapy of non-erosive reflux disease. This article describes a simplified model (for illustrative purposes only) and suggests that PPI therapy is a cost-effective approach for the treatment of esophagitis whether generic or proprietary PPI costs are applied. PPI therapy is also likely to be a cost-effective strategy for non-erosive reflux disease at generic but not at proprietary prices.


Placental MRI: Developing Accurate Quantitative Measures of Oxygenation.
The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort.


Reduced Na(+) and higher K(+) channel expression and function contribute to right ventricular origin of arrhythmias in Scn5a+/- mice.
Brugada syndrome (BrS) is associated with ventricular tachycardia originating particularly in the right ventricle (RV). We explore electrophysiological features predisposing to such arrhythmic tendency and their possible RV localization in a heterozygotic Scn5a+/- murine model. Na(v)1.5 mRNA and protein expression were lower in Scn5a+/- than wild-type (WT), with a further reduction in the RV compared with the left ventricle (LV). RVs showed higher expression levels of K(v)4.2, K(v)4.3 and KChIP2 in both Scn5a+/- and WT. Action potential upstroke velocity and maximum Na(+) current (I(Na)) density were correspondingly decreased in Scn5a+/-, with a further reduction in the RV. The voltage dependence of inactivation was shifted to more negative values in Scn5a+/-. These findings are predictive of a localized depolarization abnormality leading to slowed conduction. Persistent Na(+) current (I(pNa)) density was decreased in a similar pattern to I(Na). RV transient outward current (I(to)) density was greater than LV in both WT and Scn5a+/-, and had larger time constants of inactivation. These findings were also consistent with the observation that AP durations were smallest in the RV of Scn5a+/-, fulfilling predictions of an increased heterogeneity of repolarization as an additional possible electrophysiological mechanism for arrhythmogenesis in BrS.


Who knows what: An exploration of the infant feeding message environment and intracultural differences in Port-au-Prince, Haiti.
Worldwide, mothers with young children receive many messages about infant feeding. Some messages are generated by health providers and others by the households, communities, and social contexts in which women live. We aimed to determine the scope of infant feeding messages in urban Haiti and to examine intracultural differences in salience of these messages and their alignment with international guidelines. We applied the method of free listing with 13 health workers and 15 human immunodeficiency virus (HIV)-infected and 15 HIV-uninfected mothers with infants 0-6 months old at Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince, Haiti. Participants listed all messages women receive about infant feeding and specifically about HIV and infant feeding. Message salience was determined by frequency of mention and recall order; messages were coded for key themes. For all groups, the World Health Organization infant feeding recommendations were salient, especially those related to exclusive breastfeeding. Messages across all groups focused on infant health outcomes, with less emphasis on maternal outcomes. Cultural beliefs were also elicited and showed higher salience for mothers than health workers, particularly for consequences of poor maternal nutrition. Health workers' free lists were poorly correlated to those of mothers, whereas those of mothers were highly correlated, regardless of HIV status. Inasmuch as many salient messages were culturally generated, and differences existed between mothers and health workers, we conclude that it is important for health workers to acknowledge the broader infant feeding message environment, and discrepancies within that environment, to address successes and failures in the messages reaching mothers, given potential consequences for mothers' breastfeeding behaviours.