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1.
Data Brief ; 50: 109609, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37808540

RESUMEN

This paper presents a collection of small-scale atmospheric datasets obtained from a PCE-FWS 20 N weather station in Pangandaraan, a region situated in the southern part of Java Island. The datasets cover a period from March 2022 to April 2023, with hourly measurements of air temperature, humidity, wind speed, wind direction, and daily rainfall. The instrument was cleaned and calibrated every three months according to the manufacturer's guidelines. Every week the data was downloaded from the memory card, resulting in a total of 48,468 data points available in a publicly accessible repository. The collected data were organized into .csv format and visualized to facilitate analysis. Our study aims to explore the microclimate of Pangandaraan over an extended period and highlights its potential applications in various fields, such as applied oceanography, meteorology, fishing grounds, and agriculture.

2.
Cancers (Basel) ; 14(17)2022 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-36077694

RESUMEN

Homologous recombination deficiency (HRD) is a prevalent in approximately 17% of tumors and is associated with enhanced sensitivity to anticancer therapies inducing double-strand DNA breaks. Accurate detection of HRD would therefore allow improved patient selection and outcome of conventional and targeted anticancer therapies. However, current clinical assessment of HRD mainly relies on determining germline BRCA1/2 mutational status and is insufficient for adequate patient stratification as mechanisms of HRD occurrence extend beyond functional BRCA1/2 loss. HRD, regardless of BRCA1/2 status, is associated with specific forms of genomic and mutational signatures termed HRD scar. Detection of this HRD scar might therefore be a more reliable biomarker for HRD. This review discusses and compares different methods of assessing HRD and HRD scar, their advances into the clinic, and their potential implications for precision oncology.

3.
Mol Cancer Ther ; 20(12): 2372-2383, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34625504

RESUMEN

Hypoxia-activated prodrugs (HAP) are a promising class of antineoplastic agents that can selectively eliminate hypoxic tumor cells. This study evaluates the hypoxia-selectivity and antitumor activity of CP-506, a DNA alkylating HAP with favorable pharmacologic properties. Stoichiometry of reduction, one-electron affinity, and back-oxidation rate of CP-506 were characterized by fast-reaction radiolytic methods with observed parameters fulfilling requirements for oxygen-sensitive bioactivation. Net reduction, metabolism, and cytotoxicity of CP-506 were maximally inhibited at oxygen concentrations above 1 µmol/L (0.1% O2). CP-506 demonstrated cytotoxicity selectively in hypoxic 2D and 3D cell cultures with normoxic/anoxic IC50 ratios up to 203. Complete resistance to aerobic (two-electron) metabolism by aldo-keto reductase 1C3 was confirmed through gain-of-function studies while retention of hypoxic (one-electron) bioactivation by various diflavin oxidoreductases was also demonstrated. In vivo, the antitumor effects of CP-506 were selective for hypoxic tumor cells and causally related to tumor oxygenation. CP-506 effectively decreased the hypoxic fraction and inhibited growth of a wide range of hypoxic xenografts. A multivariate regression analysis revealed baseline tumor hypoxia and in vitro sensitivity to CP-506 were significantly correlated with treatment response. Our results demonstrate that CP-506 selectively targets hypoxic tumor cells and has broad antitumor activity. Our data indicate that tumor hypoxia and cellular sensitivity to CP-506 are strong determinants of the antitumor effects of CP-506.


Asunto(s)
Profármacos/uso terapéutico , Hipoxia Tumoral/efectos de los fármacos , Animales , Humanos , Ratones , Profármacos/farmacología
4.
J Exp Med ; 173(4): 849-58, 1991 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-1901079

RESUMEN

We have taken advantage of some unique properties of H-2Ld to investigate the determinant density requirements for cytotoxic T lymphocyte (CTL) priming versus effector function and to correlate the determinant density requirements with CD8 dependency. In a previous study (Lie, W.-R., N. B. Myers, J. Gorka, R. J. Rubocki, J. M. Connolly, and T. H. Hansen. 1990. Nature [Lond.]. 344:439), we demonstrated that culturing normal cells with peptides known to be restricted by H-2Ld led to a two- to fourfold increase in surface Ld expression. In the present study, we demonstrate the generation of Ld-restricted, peptide-specific in vitro primary CTL by culturing spleen cells with murine cytomegalovirus or tum- peptide at concentrations previously shown to result in maximum induction of Ld expression. Target cells can be sensitized for recognition by these CTL with lower dose of peptide than are required for the primary sensitization. This demonstrates differences in the determinant density requirements for priming versus effector function. The in vitro primary CTL generated with peptide can weakly lyse target cells that express the determinant endogenously, and CTL lines and clones capable of strong lysis of endogenous expressors are easily obtained. In both cases, target cells treated with exogenous peptide are lysed better than target cells expressing antigen endogenously. This suggested that there are differences in the determinant density of peptide-fed versus endogenous targets. This interpretation was substantiated when it was observed that the level of lysis of target cells expressing endogenous determinants correlated inversely with the amount of peptide required to sensitize targets for recognition by various tum- -specific CTL clones. Furthermore, simultaneous titration of both the peptide used to treat target cells and the antibody to CD8 revealed that the various CTL clones analyzed displayed widely disparate CD8 dependencies. In each case, the CD8 dependency correlated inversely with the determinant density requirement. Therefore, CD8 dependency of CTL is relative, but shows an absolute and quantitative correlation with their dependency on determinant density. These findings suggest that under physiologic conditions, where only low determinant densities are likely to be encountered, all CTL clones will show at least partial CD8 dependency.


Asunto(s)
Antígenos de Diferenciación de Linfocitos T/inmunología , Antígenos H-2/inmunología , Péptidos/inmunología , Linfocitos T Citotóxicos/inmunología , Secuencia de Aminoácidos , Animales , Antígenos Virales/inmunología , Antígenos CD8 , Células Cultivadas , Células Clonales , Citotoxicidad Inmunológica , Relación Dosis-Respuesta Inmunológica , Memoria Inmunológica , Técnicas In Vitro , Ratones , Ratones Endogámicos BALB C , Datos de Secuencia Molecular
5.
Semin Radiat Oncol ; 30(2): 187-193, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32381298

RESUMEN

There is now strong clinical and preclinical evidence that lymphocytes, for example, CD8+ T cells, are key effectors of immunotherapy and that irradiation of large blood vessels, the heart, and lymphoid organs (including nodes, spleen, bones containing bone marrow, and thymus in children) causes transient or persistent lymphopenia. Furthermore, there is extensive clinical evidence, across multiple cancer sites and treatment modalities, that lymphopenia correlates strongly with decreased overall survival. At the moment, we lack quantitative evidence to establish the relationship between dose-volume and dose-rate to critical normal structures and lymphopenia. Therefore, we propose that data should be systematically recorded to characterise a possible quantitative relationship. This might enable us to improve the efficacy of radiotherapy and develop strategies to predict and prevent treatment-related lymphopenia. In anticipation of more quantitative data, we recommend the application of the principle of As Low As Reasonably Achievable to lymphocyte-rich regions for radiotherapy treatment planning to reduce the radiation doses to these structures, thus moving toward "Lymphocyte-Sparing Radiotherapy."


Asunto(s)
Inmunoterapia/métodos , Linfocitos/efectos de la radiación , Neoplasias/inmunología , Neoplasias/radioterapia , Terapia Combinada , Humanos , Linfopenia/etiología , Dosificación Radioterapéutica
6.
Mol Oncol ; 14(7): 1555-1568, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32386436

RESUMEN

The extracellular matrix protein fibronectin contains a domain that is rarely found in healthy adults and is almost exclusively expressed by newly formed blood vessels in tumours, particularly in solid tumours, different types of lymphoma and some leukaemias. This domain, called the extra domain B (ED-B), thus has broad therapeutic potential. The antibody L19 has been developed to specifically target ED-B and has shown therapeutic potential when combined with cytokines, such as IL-2. In this review article, we discuss the preclinical research and clinical trials that highlight the potential of ED-B targeting for the imaging and treatment of various types of cancer. ED-B-centred studies also highlight how proper patient stratification is of utmost importance for the successful implementation of novel antibody-based targeted therapies.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Fibronectinas/química , Fibronectinas/metabolismo , Terapia Molecular Dirigida , Neoplasias/tratamiento farmacológico , Diagnóstico por Imagen , Humanos , Neoplasias/diagnóstico por imagen , Dominios Proteicos , Radioinmunoterapia
7.
Cancers (Basel) ; 12(5)2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32455922

RESUMEN

Hypoxia-a common feature of the majority of solid tumors-is a negative prognostic factor, as it is associated with invasion, metastasis and therapy resistance. To date, a variety of methods are available for the assessment of tumor hypoxia, including the use of positron emission tomography (PET). A plethora of hypoxia PET tracers, each with its own strengths and limitations, has been developed and successfully validated, thereby providing useful prognostic or predictive information. The current review focusses on [18F]-HX4, a promising next-generation hypoxia PET tracer. After a brief history of its development, we discuss and compare its characteristics with other hypoxia PET tracers and provide an update on its progression into the clinic. Lastly, we address the potential applications of assessing tumor hypoxia using [18F]-HX4, with a focus on improving patient-tailored therapies.

8.
Br J Radiol ; 93(1108): 20190948, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32101448

RESUMEN

Historically, medical imaging has been a qualitative or semi-quantitative modality. It is difficult to quantify what can be seen in an image, and to turn it into valuable predictive outcomes. As a result of advances in both computational hardware and machine learning algorithms, computers are making great strides in obtaining quantitative information from imaging and correlating it with outcomes. Radiomics, in its two forms "handcrafted and deep," is an emerging field that translates medical images into quantitative data to yield biological information and enable radiologic phenotypic profiling for diagnosis, theragnosis, decision support, and monitoring. Handcrafted radiomics is a multistage process in which features based on shape, pixel intensities, and texture are extracted from radiographs. Within this review, we describe the steps: starting with quantitative imaging data, how it can be extracted, how to correlate it with clinical and biological outcomes, resulting in models that can be used to make predictions, such as survival, or for detection and classification used in diagnostics. The application of deep learning, the second arm of radiomics, and its place in the radiomics workflow is discussed, along with its advantages and disadvantages. To better illustrate the technologies being used, we provide real-world clinical applications of radiomics in oncology, showcasing research on the applications of radiomics, as well as covering its limitations and its future direction.


Asunto(s)
Aprendizaje Profundo/tendencias , Diagnóstico por Imagen/tendencias , Procesamiento de Imagen Asistido por Computador/tendencias , Tecnología Radiológica/tendencias , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Diagnóstico por Imagen/métodos , Femenino , Predicción , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Radiografía/métodos , Tecnología Radiológica/métodos , Flujo de Trabajo
9.
J Clin Invest ; 73(1): 267-71, 1984 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-6606651

RESUMEN

HLA-DR histocompatibility antigens are commonly expressed by the melanocytes of melanoma and its precursors, but not by the melanocyte of normal skin. Further, the primary lesion of biologically early melanoma is commonly infiltrated with host T cells. Advanced disease is characterized by a paucity of such cells. To investigate the interaction of melanoma cells and autologous lymphocytes and its dependence on HLA-DR expression, we have established cell lines from biologically early (4 lines) and advanced disease (11 lines) and examined their capacity to stimulate blastogenesis of autologous T cells in vitro. Melanocytes from early disease expressed HLA-DR antigens and stimulated autologous T cells. Those from advanced disease, irrespective of DR expression, were nonstimulatory. To determine whether expression of DR was required for melanoma cells to be stimulatory, we first treated a stimulating cell line of DR3 allospecificity with anti-DR3-specific serum and demonstrated marked inhibition of its capacity to provoke blastogenesis. Next we used fluorescence-activated flow cytometry to sort a stimulating line heterogeneous for DR expression into DR-enriched and -depleted populations. When such cells were examined in the lymphocyte proliferation assay, their stimulatory capacity was proportional to their quantitative expression of HLA-DR. These studies indicate that cell lines may reflect important biological differences between early and advanced melanoma. HLA-DR expression may be an early event in neoplasia of melanocytes. These antigens are able to interact directly with autologous T cells; and their expression is necessary, but not sufficient, for melanoma cells to induce lymphocyte proliferation.


Asunto(s)
Transformación Celular Neoplásica/inmunología , Antígenos de Histocompatibilidad Clase II/inmunología , Activación de Linfocitos , Melanoma/inmunología , Suero Antilinfocítico/farmacología , Unión Competitiva , Línea Celular , Antígenos HLA-DR , Antígenos de Histocompatibilidad Clase II/análisis , Humanos , Melanoma/patología , Melanoma/secundario , Linfocitos T/inmunología , Factores de Tiempo
10.
Phys Med Biol ; 52(7): 1831-43, 2007 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-17374914

RESUMEN

Cosmetic late effects of radiotherapy such as tissue fibrosis are increasingly regarded as being of importance. It is generally considered that the complication probability of a radiotherapy plan is dependent on the dose uniformity, and can be reduced by using better compensation to remove dose hotspots. This work aimed to model the effects of improved dose homogeneity on complication probability. The Lyman and relative seriality NTCP models were fitted to clinical fibrosis data for the breast collated from the literature. Breast outlines were obtained from a commercially available Rando phantom using the Osiris system. Multislice breast treatment plans were produced using a variety of compensation methods. Dose-volume histograms (DVHs) obtained for each treatment plan were reduced to simple numerical parameters using the equivalent uniform dose and effective volume DVH reduction methods. These parameters were input into the models to obtain complication probability predictions. The fitted model parameters were consistent with a parallel tissue architecture. Conventional clinical plans generally showed reducing complication probabilities with increasing compensation sophistication. Extremely homogenous plans representing idealized IMRT treatments showed increased complication probabilities compared to conventional planning methods, as a result of increased dose to areas receiving sub-prescription doses using conventional techniques.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Mama/patología , Radioterapia/métodos , Interpretación Estadística de Datos , Relación Dosis-Respuesta en la Radiación , Femenino , Fibrosis , Humanos , Modelos Estadísticos , Fantasmas de Imagen , Probabilidad , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada/métodos , Estudios Retrospectivos
11.
Medicine (Baltimore) ; 66(5): 327-40, 1987 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-3306259

RESUMEN

In a retrospective review of 116 consecutive allogeneic bone marrow transplants (BMT), severe obstructive airways disease was identified in 11 patients. Lung pathology demonstrated bronchiolitis in 9 patients and physiologic studies showed small-airways disease consistent with bronchiolitis in the other 2. None of the 5 patients with associated infection survived, while 3 of the 6 patients without an identified pathogen stabilized or improved. Analysis of the 11 cases presented and all 25 cases reported in the literature (1982 to 1985) supports the conclusion that graft-versus-host disease is a major risk factor for bronchiolitis in BMT recipients. Among the proposed mechanisms for the development of bronchiolitis after allogeneic BMT, the 2 most likely are graft-versus-host disease directly causing bronchiolitis, and increased immunosuppressive therapy given for graft-versus-host disease predisposing to viral bronchiolitis. The available evidence would suggest that it is prudent to obtain serial pulmonary function tests even in asymptomatic patients post-BMT, and particularly in those with chronic graft-versus-host disease, in the hope that early detection will allow for early intervention that will arrest or reverse the progression of the obstructive airways disease.


Asunto(s)
Trasplante de Médula Ósea , Bronquiolitis Viral/etiología , Enfermedad Injerto contra Huésped/mortalidad , Adolescente , Adulto , Anemia Aplásica/terapia , Bronquiolitis Viral/mortalidad , Bronquiolitis Viral/patología , Femenino , Enfermedad Injerto contra Huésped/patología , Humanos , Leucemia/terapia , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico
12.
Semin Nucl Med ; 23(4): 334-46, 1993 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8256140

RESUMEN

Nuclear imaging in the definition of the components of the congenitally enlarged extremity is important in the design of a successful therapeutic regimen. In our series of 32 patients evaluated for primary lymphedema, 85% were determined to have abnormalities that were not purely lymphatic in origin. The multiscintigraphic approach defines the components of the lymphatic and vascular systems with the use of technetium-99m [99mTc] antimony sulfide colloid (99mTc Sb2S3) for lymphatic, 99mTc diethylenetriamine pentacetic acid (DTPA) for capillary-interstitial, and 99mTc-tagged red blood cells for venous systems.


Asunto(s)
Linfedema/diagnóstico por imagen , Antimonio , Niño , Preescolar , Femenino , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagen , Linfedema/congénito , Masculino , Cintigrafía , Compuestos de Tecnecio , Pentetato de Tecnecio Tc 99m
13.
J Cancer Res Clin Oncol ; 124(1): 19-26, 1998 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9498830

RESUMEN

Some ellipticine derivative salts, including 9-chloro-2-methylellipticinium (CME), have been found to have a marked selectivity against all eight brain tumor cell lines of the U.S. National Cancer Institute's disease-oriented in vitro screen. We initiated in vivo antitumor studies to explore the feasibility for further development of this class of compounds. We found that CME was extremely toxic to nude mice when given i.p. at a dose of 25 mg/kg for 3 consecutive days. Animals treated by this route experienced an increase in hepatic transaminases and histopathological changes in the liver, compatible with mitochondrial damage. In contrast, when the portal circulation was bypassed and the same dose of CME was given i.v., animals tolerated daily bolus injections for 5 consecutive days. This 5-day i.v. bolus schedule had consistent antitumor activity, with 28.1% growth delay on s.c. implanted human U251 gliomas. When the potentially high peaks of CME in the portal circulation were avoided by using a 3-day continuous infusion with osmotic minipumps implanted i.p. to release 3.4 mg kg(-1) h(-1) or 6.6 mg kg(-1) h(-1) CME, there were only modest increases in liver enzymes and leukopenia, but no meaningful antitumor activity was observed. In contrast, continuous infusion in the s.c. space was well tolerated and was accompanied by a demonstrable growth delay in s.c. U251 human gliomas of 37.8%. When CME was used in conjunction with carmustine, etoposide or cisplatin, no synergistic activities were observed, but additive effects were demonstrated. Our pharmacokinetic and disposition studies with CME argue against the notion that large and invasive tumors in the brain lack blood-brain barrier features. When CME was used in animals bearing orthotopically implanted U251 gliomas in the brain of nude mice, the survival of the treated animals was not better than vehicle controls, and the addition of CME to carmustine therapy did not improve the survival of those animals treated with carmustine alone. We conclude that, in spite of its marked cytotoxicity in vitro on a variety of human brain tumor cell lines, including U251 glioma cells, CME has a modest antitumor effect on extracranially implanted U251 glioma tumors, and no beneficial effect in animals bearing the same U251 tumor in the brain, owing to a poor penetration into the brain parenchyma.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Elipticinas/uso terapéutico , Glioma/tratamiento farmacológico , Animales , Antineoplásicos/administración & dosificación , Antineoplásicos/toxicidad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Barrera Hematoencefálica/fisiología , Neoplasias Encefálicas/mortalidad , Carmustina/administración & dosificación , Enfermedad Hepática Inducida por Sustancias y Drogas , Cisplatino/administración & dosificación , Ensayos de Selección de Medicamentos Antitumorales , Elipticinas/administración & dosificación , Elipticinas/farmacocinética , Elipticinas/toxicidad , Etopósido/administración & dosificación , Estudios de Factibilidad , Femenino , Glioma/mortalidad , Humanos , Inyecciones Intraperitoneales , Inyecciones Intravenosas , Ratones , Ratones Desnudos , Trasplante de Neoplasias , Tasa de Supervivencia , Trasplante Heterólogo
14.
Surg Clin North Am ; 73(3): 451-69, 1993 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-8497796

RESUMEN

A series of more than 200,000 groin hernias repaired at Shouldice Hospital since 1945 has had an overall recurrence rate of 1%. Thorough and extensive dissection is essential. The technique employed since 1953 for inguinal hernia repair is described in detail. Adjunctive measures for the repair of femoral hernias and for the most difficult recurrent hernias also are discussed.


Asunto(s)
Hernia Femoral/cirugía , Hernia Inguinal/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Recurrencia
15.
J Contin Educ Nurs ; 21(6): 260-6, 1990.
Artículo en Inglés | MEDLINE | ID: mdl-2122990

RESUMEN

A training program in breast cancer nursing was evaluated in terms of its effects on 55 nurse participants and 18 breast cancer patients who were assigned to a control or to a program group. The quasi-experimental evaluation design employed both standard and investigator-developed instruments. Pre- and posttests were used to measure nurse participants' knowledge and attitudes and appraisal of usefulness and satisfaction with the program. Effect on patient outcomes was measured by means of a Perception of Care Questionnaire, a Breast Cancer Knowledge Quiz, and the Multiple Affect Adjective Checklist. In the cognitive and attitude domains, nurse participants improved significantly and appraised the program as highly useful and satisfactory. Program group patients scored significantly higher scores on the Perception of Care and Breast Cancer Knowledge Questionnaires and exhibited significantly less anxiety than control group patients. Results support the use of evaluation as a part of systematic program development. The evaluation of patient outcomes is a challenging but essential component of program evaluation.


Asunto(s)
Neoplasias de la Mama/enfermería , Educación Continua en Enfermería/normas , Conocimientos, Actitudes y Práctica en Salud , Neoplasias de la Mama/psicología , Comportamiento del Consumidor , Humanos , Personal de Enfermería en Hospital/educación , Evaluación de Programas y Proyectos de Salud
16.
Prog Cardiovasc Nurs ; 10(1): 27-34, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7770438

RESUMEN

The purpose of this study was to determine the degree to which certain factors are related to obesity in Mexican-American and Anglo preschool children. The following questions were addressed: To what extent is obesity in these children related to maternal: 1) nutrition knowledge, 2) feeding practices, 3) values, 4) socioeconomic status, 5) acculturation and 6) demographic variables. A descriptive correlational design was used with 189 Mexican-American and 188 Anglo mother-child pairs recruited from WIC Clinics. Children's triceps and subscapular skinfold thicknesses, as well as weight for height Zscores were assessed. Obesity was defined as at or above the 85th percentile. Questionnaires were administered to the mothers of each child. Data analysis included logistic and multiple linear regressions, and descriptive statistics. Findings suggest risks associated with childhood obesity involving biologic, family and feeding practice factors. These risk factors provide a basis for assessment and program development for the prevention of obesity, especially in Mexican-American children.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos , Madres , Obesidad/etnología , Población Blanca , Índice de Masa Corporal , Cuidado del Niño/métodos , Preescolar , Conducta Alimentaria , Femenino , Humanos , Modelos Logísticos , Masculino , Obesidad/epidemiología , Obesidad/psicología , Oportunidad Relativa , Factores de Riesgo , Clase Social , Encuestas y Cuestionarios , Estados Unidos
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