Primitive Old World monkey from the earliest Miocene of Kenya and the evolution of cercopithecoid bilophodonty.

Old World monkeys (Cercopithecoidea) are a highly successful primate radiation, with more than 130 living species and the broadest geographic range of any extant group except humans. Although cercopithecoids are highly variable in habitat use, social behavior, and diet, a signature dental feature unites all of its extant members: bilophodonty (bi: two, loph: crest, dont: tooth), or the presence of two cross-lophs on the molars. This feature offers an adaptable Bauplan that, with small changes to its individual components, permits its members to process vastly different kinds of food. Old World monkeys diverged from apes perhaps 30 million years ago (Ma) according to molecular estimates, and the molar lophs are sometimes incompletely developed in fossil species, suggesting a mosaic origin for this key adaptation. However, critical aspects of the group's earliest evolution remain unknown because the cercopithecoid fossil record before ∼18 Ma consists of only two isolated teeth, one from Uganda and one from Tanzania. Here we describe a primitive Old World monkey from Nakwai, Kenya, dated at ∼22 Ma, that offers direct evidence for the initial key steps in the evolution of the cercopithecoid dentition. The simple dentition and absence of bilophodonty in the Nakwai monkey indicate that the initial radiation of Old World monkeys was first characterized by a reorganization of basic molar morphology, and a reliance on cusps rather than lophs suggests frugivorous diets and perhaps hard object feeding. Bilophodonty evolved later, likely in response to the inclusion of leaves in the diet.

Mapping the Barriers and Facilitators of HCV Treatment Initiation in Methadone Maintenance Therapy Patients: Implications for Intervention Development.

An estimated 70-90% of current methadone users have Hepatitis C (HCV). Current treatments have few side effects and can cure infection in 8-12 weeks, but less than 10% of methadone patients initiate treatment. Engaging this group in treatment is an important strategy to lower both morbidity and mortality from liver disease and eliminate a significant reservoir of HCV in communities. To understand how to address this treatment gap we used commercial marketing techniques called perceptual mapping and vector message modeling to analyze survey data from 100 HCV+ methadone patients from four centers in Philadelphia. Results were used to understand barriers and facilitators to treatment initiation and to devise targeted message strategies to adapt to a mobile health communication intervention. Results indicate that focusing on how treatment can make one feel "in charge", positive interactions with healthcare providers, the positive attributes of the new vs. old HCV treatments, and providing strategies to address tangible barriers to getting treatment, would be important to address in a communication intervention. These marketing methods allow for focusing on specific variables to "move" the group toward a treatment decision, making them an innovative technique to use in developing highly targeted health communication messages.

[Modelling length of hospital stay in motor victims]. / Modelización del tiempo de hospitalización en lesiones por tránsito.

OBJECTIVE: To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. MATERIALS AND METHODS: In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. RESULTS: Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. CONCLUSIONS: Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

Circulating cervical cancer biomarkers potentially useful in medical attention (Review).

Cervical cancer (CC) is a public health problem worldwide, including Mexico. This type of cancer is the fourth most frequent in women worldwide; in Mexico it is the second most common type in women after breast cancer. The diagnosis of CC is based mainly on Pap smears and colposcopy and the identification of molecular tools that serve as a support for these methods is urgent. Regarding this, differential expressions of specific circulating biomolecules has been detected and, based on this, they have been postulated as potential biomarkers for CC diagnosis, prognosis, and/or to identify the response to treatments. Importantly, the combined analysis of these molecules considerably improves their efficacy as biomarkers and their potential use in the medical attention is promising.

[Evaluation of improved nutritional status in patients over 60 years with 6-month follow-up by a nutritionist in a hospital setting in Almería. The MOR-NUT study]. / Evaluación de la mejora del estado nutricional en pacientes mayores de 60 años con seguimiento de 6 meses por un nutricionista en el ámbito hospitalario de Almería. El estudio MOR-NUT.

Introduction: Background: non-institutionalized elderly patients who are prescribed an oral nutritional supplement (ONS) often have difficulties with compliance, which leads to physical deterioration and increases the risk of malnutrition. Objective: to assess improvement in the nutritional status of patients over 60 years of age, using the Mini Nutritional Assessment (MNA) score after the intervention of a nutritionist during a 6-month follow-up of malnourished patients with an indication for ONS. To demonstrate that the intervention of a nutritionist provides long-term improvements in the nutritional status of malnourished patients who are taking an ONS. Results: the nutritional intervention significantly improved BMI (from 22.9 ± 4.5 to 24.0 ± 4.1; p = 0.001) and the MNA score (from 14.7 ± 4.4 to 20.4 ± 5.8; p < 0.001) of the patients, as well as their perception of health (measured by VAS). Conclusions: the nutritional advice provided by a nutritionist to patients who were taking an ONS provided a high rate of adherence to treatment, which resulted in improvement in the nutritional status of patients.

Introducción: Antecedentes: los pacientes mayores no institucionalizados a los que se les prescribe un suplemento nutricional oral (SNO) suelen tener dificultades con el cumplimiento, lo que origina deterioro físico e incrementa el riesgo de desnutrición. Objetivo: evaluar la proporción de pacientes mayores de 60 años que mejoran su categorización de la versión completa del Mini Nutritional Assessment (MNA) desde el inicio hasta la visita final tras la intervención de un nutricionista en el seguimiento de pacientes desnutridos y con indicación de SNO a lo largo de 6 meses. Demostrar que la intervención de un nutricionista aporta mejoras a largo plazo en el estado nutricional de los pacientes desnutridos que están tomando un SNO. Resultados: la intervención nutricional mejoró significativamente el IMC (de 22,9 ± 4,5 a 24,0 ± 4,1; p = 0,001), y la puntuación MNA (de 14,7 ± 4,4 a 20,4 ± 5,8 p < 0,001) de los pacientes, así como su percepción de la salud (medida mediante una EVA). Conclusiones: el consejo nutricional proporcionado por un nutricionista en los pacientes que están tomando un SNO, consiguió una elevada adherencia al tratamiento, lo que produjo una mejora en el estado nutricional de los pacientes.

Reducing preanalytical laboratory sample errors through educational and technological interventions.

BACKGROUND: A correct preanalytical phase procedure is critical to get an adequate sample and consequently to achieve the most reliable laboratory results, promoting patient safety. Continuous laboratory staff changes create the need to establish improvement strategies to reduce the error risk. The objective was to show how the numbers of preanalytical errors related to unsuitable samples in a hospital setting decrease following two improvement strategies related to new technology and educational actions and how their effects were measured by monitoring indicators. METHODS: Samples were drawn by the laboratory and other hospital departments' nurses without previous patient appointment, therefore, prior tube preparation was not available before the phlebotomy. Corrective measures for these activities were established: educational program for nurses and a system of custom labels, which correlate each laboratory test in the Laboratory Information System (LIS) with the corresponding tube. Three phases were defined based on the implementation dates of the improvement actions to be assessed. The set of indicators designed to monitor the improvement related to clotted, hemolyzed, insufficient, and uncollected samples. Data were collected and indicators calculated from the LIS using a data warehouse application. Patient satisfaction with respect to phlebotomy was also measured annually using a scoring survey. RESULTS: There was a reduction in all types of preanalytical sample errors related to the improvement strategies adopted. The indicators demonstrated that the unavailable, insufficient, and clotted samples decreased between two- and three-fold, whereas hemolysis errors benefited more from these improvement strategies. Patient satisfaction with the laboratory and phlebotomy procedures improved over the past several years as based on the annual satisfaction surveys. CONCLUSIONS: The educational program for nursing personnel is relevant and important as can be seen in the decrease of sample errors and the resulting quality improvement. The custom label system minimizes the potential oversight of forgetting to draw a tube, which happens frequently when operating without appointments, by printing the labels according to requested tests. Detection, identification, and monitoring of the error and implementing strategies to improve preanalytical quality reduces error numbers and thereby improves patient safety and health system outcomes.

Faunal change in the Turkana Basin during the late Oligocene and Miocene.

Faunal evolution over the last 65 million years of earth's history was dominated by mammalian radiations, but much of this era is poorly represented in Africa. Mammals first appeared early in the Mesozoic, living alongside dinosaurs for millions of years, but it was not until the extinction of dinosaurs 65 myr ago that the first major explosion of mammalian taxa took place. The Cenozoic (65 Ma to Recent) witnessed repeated and dynamic events involving the radiation, evolution, and extinction of mammalian faunas. Two of these events, each marking the extinction of one diverse fauna and subsequent establishment of another equally diverse fauna, both involving advanced catarrhine primates, are recorded in sites in the Turkana Basin, despite the poorly represented record of Cenozoic faunas elsewhere in sub-Saharan Africa. The first of these events occurred at the Oligocene-Miocene transition and the other at the Miocene-Pliocene transition.

Effect of Roux-en-Y Gastric Bypass on Lipoprotein Metabolism and Markers of HDL Functionality in Morbid Obese Patients.

PURPOSE: Morbid obesity represents the most severe form of obesity and surgical intervention would be its only successful treatment. Bariatric surgery could generate modifications in carbohydrate metabolism and in lipid profile plus lipoprotein-associated proteins and enzymes, such as lipoprotein-associated phoslipase A2 (Lp-PLA2), cholesteryl ester transfer protein (CETP), and paraoxonase (PON) 1. The aim of the present study was to analyze changes in inflammation markers, carbohydrate metabolism, and lipid parameters in patients who underwent bariatric surgery. METHODS: Thirty-seven patients with morbid obesity were recruited. Evaluations were performed before (T0) and 1 (T1) and 6 (T2) months after surgery. Glucose, insulin, high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoproteins (apo) A-I, and B plus Interleukin 1ß and 6 levels in addition to CETP, Lp-PLA2, and PON 1 activities were determined. RESULTS: Body mass index decreased at T1 and T2 (p < 0.01). An improvement in all markers of insulin resistance (p < 0.05) was observed at T1. hsCRP levels diminished at T2 (p < 0.05). Triglyceride levels decreased at T1 and T2 (p < 0.05). HDL-C and apo A-I showed a decrease at T1 which was completely reversed at T2 (p < 0.05). Lp-PLA2 activity increased at T1, which was reversed at T2 (p < 0.05), and CETP activity was diminished at T2 (p < 0.05). PON and ARE activities decreased at T1 and partially recovered at T2 (p < 0.05). CONCLUSIONS: These results would be indicative of a favorable effect of bariatric surgery on markers of carbohydrate metabolism and cardiovascular disease lipid risk factors.

Achieving continuous improvement in laboratory organization through performance measurements: a seven-year experience.

BACKGROUND: Laboratory performance can be measured using a set of model key performance indicators (KPIs). The design and implementation of KPIs are important issues. KPI results from 7 years are reported and their implementation, monitoring, objectives, interventions, result reporting and delivery are analyzed. METHODS: The KPIs of the entire laboratory process were obtained using Laboratory Information System (LIS) registers. These were collected automatically using a data warehouse application, spreadsheets and external quality program reports. Customer satisfaction was assessed using surveys. Nine model laboratory KPIs were proposed and measured. RESULTS: The results of some examples of KPIs used in our laboratory are reported. Their corrective measurements or the implementation of objectives led to improvement in the associated KPIs results. CONCLUSIONS: Measurement of laboratory performance using KPIs and a data warehouse application that continuously collects registers and calculates KPIs confirmed the reliability of indicators, indicator acceptability and usability for users, and continuous process improvement.

[Socio-demographic and health factors associated with the institutionalization of dependent people]. / Factores sociodemográficos y de salud asociados a la institucionalización de personas dependientes.

BACKGROUND: The analysis of the effect that different variables have in the probability that dependent people are institutionalized is a topic scantily studied in Spain. The aim of the work is to analyze as certain socio-demographic and health factors can influence probability of dependent person living in a residence. METHODS: A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with level II and III of dependence. A binary logit regression model has been estimated to identify those factors related to the institutionalization of dependent people. RESULTS: People with ages between 65-74 years old are six times more likely to be institutionalized than younger people (< 65 years old); this probability increases sixteen times for those individuals with ages equal or higher than 95 years. The probability of institutionalization of people who live in an urban area is three times the probability of people who live in a rural area. People who need pharmacological, psychotherapy or rehabilitation treatments have between two and four times more probability of being institutionalized that those who do not need those. CONCLUSIONS: Age, marital status, place of residence, cardiovascular and musculoskeletal diseases and four times of medical treatment are the principal variables associated with the institutionalization of dependent people.

Three years of preanalytical errors: quality specifications and improvement through implementation of statistical process control.

BACKGROUND: The objectives of this research were to show the most frequent preanalytical sample errors from two distinct patient populations and blood-drawing personnel, to calculate preanalytical quality specifications, and to demonstrate an improvement strategy for patients whose samples have been drawn in the primary health care center by means of a monthly preanalytical quality control report based on statistical process control (SPC). MATERIAL AND METHODS: We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples in both populations. To monitor an improvement strategy, we designed a set of indicators. The indicator results for 35 months were entered into the statistical software application, where they were statistically analyzed. The preanalytical quality specifications were calculated using the SPC control charts. The intervention consisted of the sending of a monthly preanalytical quality report to a pilot Decentralized Phlebotomy Center (DPC) and setting up a direct communication channel between the laboratory and the DPC. RESULTS: Fewer errors were observed when the sample drawing was carried out by the laboratory personnel, showing distinct preanalytical quality specifications. Improvements were seen in the DPC after four months of the improvement strategy. CONCLUSIONS: We show a practical and effective methodology for the identification, monitoring, and reduction of preanalytical errors using the technology employed in daily total testing laboratory process.

Perceptions of Barriers and Benefits of HCV Treatment and Correlates to Treatment Intention in Methadone Patients.

While most methadone maintenance treatment (MMT) patients have hepatitis C (HCV), less than 11% initiate treatment. The objective of this study was to assess this population's perceptions of HCV treatment. We surveyed 100 HCV+ MMT patients from four urban programs, asking scaled attitude scores about factors that may affect treatment decisions. Using bivariate and ordinal regression methods, results indicated that while education level and previous discussion about treatment with providers were associated with treatment initiation interest, age, race, gender, insurance type, difficulty paying for health care, and time since screening were not. Those who (a) believed HCV treatment is easy to take and cures quickly, (b) have had positive interactions with physicians, and (c) feel they have had enough HCV education were more likely to indicate treatment willingness. Interventions must emphasize positive treatment attitudes and not only focus on structural barriers to move HCV+ MMT patients towards initiating care.

Ten years of preanalytical monitoring and control: Synthetic Balanced Score Card Indicator.

INTRODUCTION: Preanalytical control and monitoring continue to be an important issue for clinical laboratory professionals. The aim of the study was to evaluate a monitoring system of preanalytical errors regarding not suitable samples for analysis, based on different indicators; to compare such indicators in different phlebotomy centres; and finally to evaluate a single synthetic preanalytical indicator that may be included in the balanced scorecard management system (BSC). MATERIALS AND METHODS: We collected individual and global preanalytical errors in haematology, coagulation, chemistry, and urine samples analysis. We also analyzed a synthetic indicator that represents the sum of all types of preanalytical errors, expressed in a sigma level. We studied the evolution of those indicators over time and compared indicator results by way of the comparison of proportions and Chi-square. RESULTS: There was a decrease in the number of errors along the years (P<0.001). This pattern was confirmed in primary care patients, inpatients and outpatients. In blood samples, fewer errors occurred in outpatients, followed by inpatients. CONCLUSION: We present a practical and effective methodology to monitor unsuitable sample preanalytical errors. The synthetic indicator results summarize overall preanalytical sample errors, and can be used as part of BSC management system.

Use of intraperitoneal interferon alpha-2b therapy after conservative surgery for endometriosis and postoperative medical treatment with depot gonadotropin-releasing hormone analog: a randomized clinical trial.

OBJECTIVE: To evaluate the possible therapeutic effects of interferon alpha-2b left in the peritoneum after surgery, followed by or not followed by treatment with GnRH analogs. DESIGN: A prospective, randomized clinical trial. SETTING: University hospital. PATIENT(S): Fifty-two infertile patients with moderate or severe endometriosis. INTERVENTION(S): Laparotomic conservative surgery and either interferon alpha-2b or saline alone left in the pouch of Douglas followed by administration of either GnRH analogs depot or oral indomethacin with transvaginal echography and analysis of CA-125, immunoglobulins, and lymphocyte populations. MAIN OUTCOME MEASURE(S): Recurrence of endometriosis was considered clinically, echographically, and laparoscopically. RESULT(S): Recurrence of endometriosis in four cases without interferon (15.4%) versus 11 patients (42.3%) with interferon alpha-2b. Life table analysis showed significant differences between the groups with and without interferon 21 months after conservative surgery. There were no differences in the recurrence between the groups with or without GnRH analogs. Likewise, there were no significant changes in immunoglobulins and lymphocyte populations among patients with and without recurrence of endometriosis. The patients that received GnRH analogs depot showed a decrease in the number of CD16 and an increase of CD11b cells after treatment. CONCLUSION(S): The use of interferon alpha-2b within the peritoneal cavity after conservative surgery may be inappropriate because it increased later recurrence of endometriosis. The postoperative treatment with GnRH analogs did not significantly reduce the recurrence rate. Immunoglobulins and lymphocyte populations did not change in relation to the recurrence of endometriosis.

[Carbohydrate: current role in diabetes mellitus and metabolic disease]. / Hidratos de carbono: actualización de su papel en la diabetes mellitus y la enfermedad metabólica.

BACKGROUND: There is a prevalence of diabetes mellitus (DM), unknown DM and stress hyperglycemia among hospital patients, and the nutritional treatment is a key part of care, where carbohydrates (CH) intake is a controversial issue. There is also a discussion on the increase of prevalence for DM, obesity and metabolic disease with refined CH or sugar. OBJECTIVES: This review examines the recommendations from different scientific societies about the percentage of CH in the total calorie intake of the diabetic patient, the CH value in the glycemic index and glycemic load, the new CH included in enteral formulae and the association of refined CH with the high prevalence of DM and metabolic disease. METHODS: Systematic review of literature using the electronic scientific databases Pubmed, Science Direct, Scielo, Scopus and Medline. CONCLUSIONS: Scientific societies are flexible about the CH intake in the diet of diabetic patients, suggesting to customize it according to each metabolic profile. Using the glycemic index and glycemic load can provide an extra benefit in the postprandial glycemic control. The new diabetes-specific enteral formulae, with fructooligosaccharides, resistant maltodextrins and fructose-free show efficacy in improving the glycemic control, although more controlled and long-term studies are needed. There is still some controversy about the links between sugar intake and DM, obesity and metabolic disease, although this relationship would be more linked to an increase of the total calorie intake than to a specific nutrient.

Introducción: La diabetes mellitus (DM), la DM no conocida y la hiperglucemia de estrés en pacientes hospitalizados, es prevalente, y el tratamiento nutricional es una parte fundamental de su cuidado, siendo el aporte de hidratos de carbono (HC) uno de los aspectos controvertidos. Igualmente está a debate el incremento de la prevalencia de DM, obesidad y enfermedad metabólica con los HC refinados o azúcares. Objetivos: Esta revisión examina las recomendaciones de las distintas Sociedades Científicas en cuanto al porcentaje que los HC tienen que tener en el contenido calórico total de la dieta del diabético, el valor del índice y carga glucémica de los HC, los nuevos HC incluidos en las fórmulas enterales y la relación de los HC refinados con la alta prevalencia de DM y la enfermedad metabólica. Métodos: Revisión sistemática de la literatura usando las bases científicas electrónicas Pubmed, Science Direct, Scielo, Scopus y Medline. Conclusiones: Las Sociedades Científicas flexibilizan el aporte de HC en la dieta del diabético e indican individualizar la misma en función del perfil metabólico. El uso del índice y carga glucémica puede proporcionar un beneficio adicional en el control glucémico postprandial. Las nuevas fórmulas enterales específicas para diabetes, con fructooligosacáridos, maltodextrinas resistentes y sin fructosa son eficaces en mejorar el control glucémico, aunque necesitamos más estudios controlados y a largo plazo. Persiste controversia sobre la relación entre ingesta de azúcares y DM, obesidad y enfermedad metabólica, aunque la asociación estaría más relacionada con un aumento del aporte calórico total que con un nutriente específico.

Customising turnaround time indicators to requesting clinician: a 10-year study through balanced scorecard indicators.

AIM: The purpose of this study is, first to present a 10-year monitoring of postanalytical turnaround time (TAT) adapted to different clinicians and patient situations, second to evaluate and analyse the indicators results during that period of time, and finally to show a synthetic appropriate indicator to be included in the balanced scorecard management system. METHODS: TAT indicator for routine samples was devised as the percentage of certain key tests that were verified before a specific time on the phlebotomy day. A weighted mean synthetic indicator was also designed. They were calculated for inpatients at 15:00 and 12:00 and for primary care patients only at 15:00. The troponin TAT of emergency department patients, calculated as the difference between the troponin verification and registration time, was selected as the stat laboratory TAT indicator. RESULTS: The routine and stat TAT improved along the 10-year study period. The synthetic indicator showed the same trend. CONCLUSIONS: The implementation of systematic and continuous monitoring over years, promoted a continuous improvement in TAT which will probably benefit patient outcome and safety.

Should we customise critical value procedure according to patient origin and laboratory turnaround time?

INTRODUCTION: Our routine laboratory critical value notification procedure is based on a short list of six fundamental critical values. The report system for our Stat laboratory is not based on this 'short list'; instead, critical values are always reported according to the patient clinical context and the previous laboratory results. The aim of our work is to show how a critical value notification procedure based on a rigid list of values and thresholds can result in completely different results depending on whether the tests are requested in a stat or a routine manner. MATERIAL AND METHODS: We reviewed the number of critical value notifications based on the short list for the routine laboratory. For the stat laboratory, we studied the number of real notifications based on the pathologist validation of the individualised situation of the patient and calculated the number of notifications that would have been reported if the routine short list would have been used instead. RESULTS: The number of critical values that would have been reported if using the routine short list in stat laboratory was high when compared with the number of critical values that were really reported. CONCLUSIONS: Using a rigid list of laboratory values to notify critical values resulted in completely different results depending on whether the tests were requested in stat or routine. Reporting only really unexpected values through an individual custom-made reporting procedure may avoid the wasting of time and resources and raising false alarms among referring physicians and patients.

Patient identification errors: the detective in the laboratory.

BACKGROUND: The eradication of errors regarding patients' identification is one of the main goals for safety improvement. As clinical laboratory intervenes in 70% of clinical decisions, laboratory safety is crucial in patient safety. We studied the number of Laboratory Information System (LIS) demographic data errors registered in our laboratory during one year. METHODS: The laboratory attends a variety of inpatients and outpatients. The demographic data of outpatients is registered in the LIS, when they present to the laboratory front desk. The requests from the primary care centers (PCC) are made electronically by the general practitioner. A manual step is always done at the PCC to conciliate the patient identification number in the electronic request with the one in the LIS. Manual registration is done through hospital information system demographic data capture when patient's medical record number is registered in LIS. Laboratory report is always sent out electronically to the patient's electronic medical record. Daily, every demographic data in LIS is manually compared to the request form to detect potential errors. RESULTS: Fewer errors were committed when electronic order was used. There was great error variability between PCC when using the electronic order. CONCLUSIONS: LIS demographic data manual registration errors depended on patient origin and test requesting method. Even when using the electronic approach, errors were detected. There was a great variability between PCC even when using this electronic modality; this suggests that the number of errors is still dependent on the personnel in charge of the technology.