Shared Decision-making Lowers Medical Expenditures and the Effect Is Amplified in Racially-Ethnically Concordant Relationships.

BACKGROUND: Racial-ethnic disparities are pervasive in health care. One mechanism that may underlie disparities is variation in shared decision-making (SDM), which encompasses high-quality clinician-patient communication, including deliberative discussions about treatment options. OBJECTIVES: To determine whether SDM has causal effects on outcomes and whether these effects are stronger within racial-ethnic concordant clinician-patient relationships. RESEARCH DESIGN: We use instrumental variables to estimate the causal effect of SDM on outcomes. SUBJECTS: A total of 60,584 patients from the 2003-2017 Integrated Public Use Microdata Series Medical Expenditure Panel Survey. Years 2018 and 2019 were excluded due to changes in the Medical Expenditure Panel Survey that omitted essential parts of the SDM index. MEASURES: Our key variable of interest is the SDM index. Outcomes included total, outpatient, and drug expenditures; physical and mental health; and the utilization of inpatient and emergency services. RESULTS: SDM lowers annual total health expenditures for all racial-ethnic groups, but this effect is only moderated among Black patients seen by Black clinicians, more than doubling in size relative to Whites. A similar SDM moderation effect also occurs for both Black patients seen by Black clinicians and Hispanic patients seen by Hispanic clinicians with regard to annual outpatient expenditures. There was no significant effect of SDM on self-reported physical or mental health. CONCLUSIONS: High-quality SDM can reduce health expenditures without negatively impacting overall physical or mental health, supporting a business case for health care organizations and systems to improve racial-ethnic clinician-patient concordance for Black and Hispanic patients.

Rescue of syringyl lignin and sinapate ester biosynthesis in Arabidopsis thaliana by a coniferaldehyde 5-hydroxylase from Eucalyptus globulus.

KEY MESSAGE: The gene coding for F5H from Eucalyptus globulus was cloned and used to transform an f5h -mutant of Arabidopsis thaliana , which was complemented, thus verifying the identity of the cloned gene. Coniferaldehyde 5-hydroxylase (F5H; EC 1.14.13) is a cytochrome P450-dependent monooxygenase that catalyzes the 5-hydroxylation step required for the production of syringyl units in lignin biosynthesis. The Eucalyptus globulus enzyme was characterized in vitro, and results showed that the preferred substrates were coniferaldehyde and coniferyl alcohol. Complementation experiments demonstrated that both cDNA and genomic constructs derived from F5H from E. globulus under the control of the cinnamate 4-hydroxylase promoter from Arabidopsis thaliana, or a partial F5H promoter from E. globulus, can rescue the inability of the A. thaliana fah1-2 mutant to accumulate sinapate esters and syringyl lignin. E. globulus is a species widely used to obtain products that require lignin removal, and the results suggest that EglF5H is a good candidate for engineering efforts aimed at increasing the lignin syringyl unit content, either for kraft pulping or biofuel production.

Screening for High-Risk Human Papillomavirus Reveals HPV52 and HPV58 among Pediatric and Adult Patient Saliva Samples.

Previous research has demonstrated that the human papillomavirus (HPV) can infect a wide range of human tissues, including those within the oral cavity. High-risk oral HPV strains have been associated with the development and progression of oral cancers, including oral squamous cell carcinomas. Although many studies have examined the prevalence of the high-risk strains HPV16 and HPV18, far fewer have assessed the prevalence of other high-risk HPV strains. An approved study protocol was used to identify HPV52 and HPV58 among clinical samples (n = 87) from a saliva biorepository. Quantitative polymerase chain reaction (qPCR) and validated primers for HPV52 and HPV58 were used to facilitate this screening. This screening demonstrated that a total of n = 4/45 or 8.9% of adult saliva samples harbored high-risk HPV52, and n = 2/45 or 4.4% tested positive for high-risk HPV58. In addition, a total of n = 6/42 or 14.3% of the pediatric saliva samples tested positive for high-risk HPV, including n = 5/42 or 11.9% with HPV52 and n = 3/42 or 7.1% for HPV58. These data demonstrate the presence of the high-risk oncogenic HPV52 and HPV58 strains among both adult and pediatric clinical patient samples. More detailed longitudinal research must be conducted to determine whether this prevalence may be increasing or decreasing over time. In addition, these data strongly support public health prevention efforts, such as knowledge and awareness of the nine-valent HPV vaccine covering additional high-risk strains, including HPV52 and HPV58.

19n01, a broadly neutralizing antibody against omicron BA.1, BA.2, BA.4/5, and other SARS-CoV-2 variants of concern.

This study reports the isolation and characterization of a human monoclonal antibody (mAb) called 19n01. This mAb was isolated by using single-cell RNAseq of B cells from donors infected with the ancestral strain. This mAb possesses a potent and broad capacity to bind and neutralize all previously circulating variants of concern (VOCs), including Omicron sublineages BA.1, BA.2, and BA.4/5. The pseudovirus neutralization assay revealed robust neutralization capacity against the G614 strain, BA.1, BA.2, and BA.4/5, with inhibitory concentration (IC50) values ranging from 0.0035 to 0.0164 µg/mL. The microneutralization assay using the G614 strain and VOCs demonstrated IC50 values of 0.013-0.267 µg/mL. Biophysical and structural analysis showed that 19n01 cross-competes with ACE2 binding to the receptor-binding domain (RBD) and the kinetic parameters confirmed the high affinity against the Omicron sublineages (KD of 61 and 30 nM for BA.2 and BA.4/5, respectively). These results suggest that the 19n01 is a remarkably potent and broadly reactive mAb.

Production of phytohormones, siderophores and population fluctuation of two root-promoting rhizobacteria in Eucalyptus globulus cuttings.

Vegetative propagation by stem cuttings and mini-cuttings has been used worldwide for growing Eucalyptus plants. However, clones and hybrids of this plant present a great variability in their rooting capacity, apart from a gradual decrease in the rooting potential due to the ontogenetic age of the mother plant. Several studies have demonstrated that some bacteria promote plant growth and rooting through the action of direct and indirect mechanisms that are not still completely clear. Considering this, the objective of this study was to assess the production of auxins, abscisic acid and siderophores in Bacillus subtilis and Stenotrophomona maltophilia, which in previous studies increased rooting of E. globulus cuttings. Additionally, the population of these bacteria in the rhizosphere, superficial tissues of the stem-base and callus of the mini-cuttings was identified, and quantified by real-time PCR. Only S. maltophilia produced IAA in the presence of tryptophan; none of the bacterial strains produced ABA, but both produced siderophores. A comparative analysis of the separation profiles showed that there is a diverse microbial community in the rhizosphere, and only S. maltophilia was capable of keeping its population at a density of 2.03 × 10(7) cells/mg in different tissues of the mini-cuttings. The results would indicate that the rooting stimulus in E. globulus could be related to the action of one or several mechanisms such as the production of auxins and siderophores, and it could also be associated with the ability of bacteria to stay in the rhizosphere or in plant callus tissues.

Beyond the outcomes: generic change indicators in a video-feedback intervention with a depressed mother and her baby: a single case study.

Child and dyadic psychotherapy have been scarcely investigated from the psychotherapy process research perspective. Thus, content and mechanisms related to therapeutic change have been overlooked by research. This study aimed at testing the applicability of the generic change indicators (GCI) model to identify moments of change in the parent during dyadic interventions, as well as to explore, describe and illustrate the therapeutic process through a brief mentalization-informed intervention with a depressive mother and her baby, using video-feedback as its main strategy, which has ample evidence about its effectiveness. We conducted a single case qualitative study using the GCI model. The mother's ongoing change was determined by identifying episodes of change (EC) and moments of change (MC). Each MC was then labelled with one of the 19 GCIs. GCIs were observed from the intervention's start. GCI's hierarchical levels were increasing over the intervention, in association with the video-feedback situation. Our findings suggest that the GCI model is feasible to observe and understand dyadic interventions, contributing to the growing body of evidence supporting psychotherapists' training and supervision.

Antigen Targeting of Porcine Skin DEC205+ Dendritic Cells.

Dendritic cell (DC) targeting by DEC205+ cells effectively promotes the internalization of antigens that may trigger a specific immune response. In this study, we evaluated the ability of a recombinant antibody, anti-DEC205 (rAb ZH9F7), to trigger cellular endocytosis in subpopulations of DCs and targeted cells after intradermal injection and subsequent migration toward lymph nodes. Furthermore, the cellular immune response was evaluated in pigs after intradermal application of the antigenized rAb ZH9F7 combined with porcine circovirus type 2 cap antigen (rAb ZH9F7-Cap). We demonstrated that rAb ZH9F7 recognized conventional type 1 and 2 DCs from the blood and skin and monocytes. It promoted receptor-mediated endocytosis and migration of cDCs and moDCs toward regional lymph nodes. Intradermal application of rAb ZH9F7-Cap induced a higher frequency of IFN-γ-secreting CD4+CD8+ T lymphocytes and antibodies against Cap protein than that in the control group. In conclusion, the rAb ZH9F7-Cap system promoted the target of skin cDC1 and cDC2, provoking migration to the regional lymph nodes and inducing a Th1 response, as evidenced by the proliferation of double-positive CD4+CD8+ T cells, which correlates with an enhanced ability to target the cDC1 subset both in vitro and in vivo.

Analysis of IgG, IgA and IgM antibodies against SARS-CoV-2 spike protein S1 in convalescent and vaccinated patients with the Pfizer-BioNTech and CanSinoBio vaccines.

The SARS-CoV-2 virus was detected for the first time in December 2019 in Wuhan, China. Currently, this virus has spread around the world, and new variants have emerged. This new pandemic virus provoked the rapid development of diagnostic tools, therapies and vaccines to control this new disease called COVID-19. Antibody detection by ELISA has been broadly used to recognize the number of persons infected with this virus or to evaluate the response of vaccinated individuals. As the pandemic spread, new questions arose, such as the prevalence of antibodies after natural infection and the response induced by the different vaccines. In Mexico, as in other countries, mRNA and viral-vectored vaccines have been widely used among the population. In this work, we developed an indirect ELISA test to evaluate S1 antibodies in convalescent and vaccinated individuals. By using this test, we showed that IgG antibodies against the S1 protein of SARS-CoV-2 were detected up to 42 weeks after the onset of the symptoms, in contrast to IgA and IgM, which decreased 14 weeks after the onset of symptoms. The evaluation of the antibody response in individuals vaccinated with Pfizer-BioNTech and CanSinoBio vaccines showed no differences 2 weeks after vaccination. However, after completing the two doses of Pfizer-BioNTech and the one dose of CanSinoBio, a significantly higher response of IgG antibodies was observed in persons vaccinated with Pfizer-BioNTech than in those vaccinated with CanSinoBio. In conclusion, these results confirm that after natural infection with SARS-CoV-2, it is possible to detect antibodies for up to 10 months. Additionally, our results showed that one dose of the CanSinoBio vaccine induces a lower response of IgG antibodies than that induced by the complete scheme of the Pfizer-BioNTech vaccine.

Rapid, simplified microscale quantitative analysis of lignin H/G/S composition with GC-MS in glass ampules and glass capillaries.

The characterization of monolignols H-, G- and S- units composition Vanholme et al. (2010) of lignin is important in agriculture, forestry, herb medicine, livestock, and health care research Vanholme et al. (2008) and Sticklen (2008). The conventional methods often require a great deal of samples and reagents and are time-consuming. Here, we present a newly developed method with fewer operations. The optimized method is suitable for detecting and characterizing lignin composition of cell wall in different plant species and has the advantages of: •Avoiding the influence of plasticizer by plasticware and enhancing the accuracy of monolignols analysis.•Lowering the required samples from grams to milligrams, and organic reagents from milliliters to microliters.•Reducing the time required from a few days to 6 h.

Educación sobre el dolor en pacientes con dolor lumbar en los últimos 10 años: una revisión exploratoria / Pain Education in Patients with Low-back Pain in the Last 10 Years: an Exploratory Review

Introducción: El síndrome del dolor lumbar (SDL) es una de las causas principales de discapacidad a nivel mundial. La educación sobre el dolor es un tratamiento posible, sin embargo, se desconocen las herramientas disponibles para pacientes con dolor lumbar. Objetivo: Describir las estrategias de educación sobre el dolor en personas con SDL descritas en la literatura científica y gris en los últimos 10 años. Metodología: Revisión exploratoria en las bases de datos MEDLINE/PubMed, CINAHL/EBSCO, Scielo y en Google Académico. Se filtraron por título, resumen y texto completo; incluyendo estudios que reportaran estrategias de educación sobre el dolor lumbar, en inglés o español, publicados en los últimos 10 años y cuyo texto completo estuviera disponible. Se excluyeron estudios en población infantil, adolescentes, animales, embarazadas, pacientes pre y post operatorio, cáncer, y revisiones sistemáticas. Resultados: De un total de 760 artículos, se incluyeron 42 artículos en esta revisión. Se identificaron 33 estrategias de abordaje de educación del dolor lumbar, clasificándose en tres categorías según la forma de entrega del programa de educación; a)presencial, b)no presencial y c)mixtas. Una misma estrategia puede incorporar diferentes instrumentos, siendo las estrategias más frecuentes Educación en neurofisiología del dolor (PNE). Conclusiones: Existen numerosas estrategias para la educación sobre el dolor lumbar, diferenciándose en su metodología y contenido. Futuras investigaciones deberían enfocarse en sus efectos, como una alternativa de terapia no invasiva y complementaria a los tratamientos habituales.

Introduction: Low back pain syndrome (LBP) is one of the leading causes of disability worldwide. Education about pain is a possible treatment, however, the strategies are unknown for patients with low back pain. Objective: Describe the pain education strategies in people with LBP described in the scientific and gray literature in the last 10 years. Methods: Exploratory review in the databases MEDLINE / PubMed, CINAHL / EBSCO, Scielo and in Google Scholar. They were filtered by title, abstract and full text; including studies that reported education strategies for LBP, in English or Spanish, published in the last 10 years and whose full text was available. Studies in children, adolescents, animals, pregnant women, pre- and post-operative patients, cancer, and systematic reviews were excluded. Results: Out of a total of 760 articles, 42 articles were included in this review. Thirty-three strategies for the education approach LBP were identified, classified into three categories according to the delivery method of the education program; a) face-to-face, b) non-face-to-face and c) mixed. The same strategy can incorporate different instruments, the most frequent strategy is Education in the Neurophysiology of Pain. Conclusions: There are numerous strategies for education about low back pain, differing in their methodology and content. Future research should focus on its effects, as a non-invasive therapy alternative and complementary to the usual treatments.

Work-Family Balance, Job Satisfaction And Family Support In Basic School Teachers / Equilibrio trabajo-familia, satisfacción laboral y apoyo familiar en docentes de escuelas básicas

Resumen El objetivo general del estudio consistió en identificar la relación entre las variables Equilibrio trabajo-familia, Satisfacción laboral y Apoyo familiar en una muestra de noventa y nueve docentes, pertenecientes a establecimientos municipales de educación básica, a quienes se les administró el cuestionario de Interacción Trabajo-Familia SWING, el Inventário de Percepção de Suporte Familiar (IPSF) y el Cuestionario de Satisfacción Laboral S20/23. Se concluye que para mejorar la relación y el equilibrio en la interfaz trabajo-familia es indispensable contar con políticas organizacionales amigables hacia la familia, sobre todo en las prestaciones que la organización despliega para apoyar a sus trabajadores. No obstante contar con el apoyo familiar, como un lugar de recuperación y de comprensión, es fundamental para dar respuesta a las demandas de estos dos ámbitos.

Abstract It analyzed the relationship between the variables Balancing Work Family, Job Satisfaction and Family Support in a sample of 99 teachers belonging to municipal schools of Basic Education, who were administered the questionnaire Work-Family Interaction SWING, Family Support Inventory (IPSF) and Job Satisfaction Questionnaire S20 / 23. And between Job Satisfaction and Family Support (r = 0.292; p <0.01), a significant relationship between variables Work Family Balance and Job Satisfaction (p <0.01 r = 0.466) was observed. No significant relationship between Balancing Work and Family Support Family (p> 0.01 r = 0.181) was observed. In addition, a linear regression model, which yielded results in job satisfaction with their dimensions, explaining 30.6% variability Work Family Balance and 14.2% variability Family Support was performed.

Transgenic trees and forestry biosafety

The benefits from the development of transgenic trees are expected from the improvement of traits as growth and form, wood quality, industrial processes, disease and insect resistance, herbicide tolerance, ecological restoration, rooting ability, etc. One of the first reported field trials with genetically modified forest trees was established in Belgium in 1988 and the characteristic evaluated was herbicide tolerance in poplars. Since then, there have been more than 200 reported trials, involving at least 15 forest species. The majority of the field trials have been carried out in the USA (64 percent). More than 50 percent of the field trials are done with Populus species and the main target traits are herbicide tolerance (31 percent), followed by marker genes (23 percent) and insect resistance (14 percent). Until today, there is only one report on commercial-scale production of transgenic forest trees which is Populus nigra with the Bt gene release in China in 2002 and established on commercial plantations in 2003. Operational application of GMO's in forestry depends on technical, economical, political and public aspects, but the development of adequate regulatory frameworks and public acceptance of transgenic trees will define the future of this technology in forestry.