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OBJECTIVES: To develop and evaluate two BMI-based instruments to determine perceptions of weight status, particularly perceptions of overweight and obesity, using pictorial images of women and men. METHODS: Pictures of adults with known BMI values were used to construct gender-specific body size guides (BSGs) containing 10 bodies that ranged from underweight to class III obesity. Figures were standardized and a composite face was added to each. The BSGs were administered to 400 adults to assess the psychometric properties of the instruments and weight perceptions. RESULTS: High correlations between the BMIs of respondents and the BMIs of the current body selected by respondents provided strong support for the criterion-related validity of the BSGs, and the logical pattern of responses to items assessing perception of weight categories supported construct validity for the scales. Test-retest reliability, assessed by correlations for both current and ideal body, was also high, despite the lengthy 6-month testing interval. Respondents' perceptions of the bodies within specific weight categories indicated that a majority failed to recognize the overweight female as overweight and perceived the overweight male as normal weight. Obese bodies were generally unrecognized as such until the bodies reached the higher levels of obesity (that is, BMI values >39). Perception of weight was influenced by the respondents' weight status and gender. CONCLUSIONS: Psychometric analyses indicated the BSGs are valid and reliable instruments. These results, coupled with the face validity of the scales and the relationship between the bodies and BMI values, indicate the BSGs offer advantages over existing instruments for researchers of weight perception and body image. Administration of the scales to an adult sample confirmed that overweight and obesity are under-recognized. Increased efforts to improve public understanding of these terms are needed and the BSGs may provide useful tools for this purpose.
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Índice de Masa Corporal , Tamaño Corporal/fisiología , Adulto , Anciano , Imagen Corporal , Peso Corporal/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/psicología , Sobrepeso/diagnóstico , Sobrepeso/psicología , Reproducibilidad de los Resultados , Factores Sexuales , Encuestas y CuestionariosRESUMEN
INTRODUCTION: A shortage of healthcare providers in West Virginia led to creation of a statewide, community-based program with a required three-month rural experience for most state-sponsored health professions students. Project Description: Initiated using funding from the W. K. Kellogg Foundation and expanded using both state funds and Area Health Education Center support, the West Virginia Rural Health Education Partnerships (WVRHEP) program impacts institutions of higher learning, 50 counties, and 332 training sites, and all students in state-funded health professions schools. A longitudinal database has been constructed to study program effects on students' reported attitudes, service orientation, and career intents. METHODS: Baseline data are collected from medical students, and students in all disciplines provide feedback on rotations and information about career intents, social responsibility, and attitudes towards rural practice. RESULTS: Data indicate an association between perceived quality of the rural experience and increased interest in rural health, social responsibility and confidence in becoming part of the community. Medical students may tend to rate social responsibility higher after completion of the first rural rotation. Students who anticipate practice in smaller towns also tend to rate the quality of the rotation higher, to anticipate careers in primary care, and to acknowledge social responsibility. CONCLUSION: As WVRHEP program graduates who have completed these surveys enter practice, both personal and community-specific program characteristics may be identified which strengthen interest in rural practice. The predictive validity of intermediate outcomes of attitudes and career intents in forecasting the ultimate outcomes of recruitment and retention may be studied.
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Selección de Profesión , Empleos en Salud/educación , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Rural , Salud Rural , Estudiantes de Medicina , Actitud , Bases de Datos como Asunto , Educación Médica , Femenino , Humanos , Masculino , Atención Primaria de Salud , Calidad de Vida , Responsabilidad Social , Encuestas y Cuestionarios , Factores de Tiempo , West Virginia , Recursos HumanosRESUMEN
UNLABELLED: Nearly one-third of solitary pulmonary nodules are radiographically indeterminate for the presence of malignancy. METHODS: FDG-PET imaging was used to differentiate benign and malignant solitary pulmonary nodules in 61 patients with radiographically indeterminate nodules. After confirmation of the histological diagnosis, the probability for cancer was established for positive and negative PET scans and compared to the risk estimates calculated using other patient variables. RESULTS: FDG-PET had a sensitivity, specificity and positive predictive value of 93%, 88% and 92%, respectively, for detecting malignancy in indeterminate solitary pulmonary nodules. The probability of malignancy with a positive PET scan is 83%, which increases with the patient's age (90% in >60 yr) and the size of the nodule. A negative PET scan is associated with only a 4.7% risk of malignancy. FDG-PET also accurately characterized hilar/mediastinal lymphadenopathy in 12 patients with associated lymph node lesions. CONCLUSION: FDG-PET imaging can be a useful noninvasive test to determine the risk estimate or probability of cancer as well as preoperative staging in patients with radiographically indeterminate solitary pulmonary nodules.
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Desoxiglucosa/análogos & derivados , Radioisótopos de Flúor , Neoplasias Pulmonares/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada de Emisión , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fluorodesoxiglucosa F18 , Humanos , Funciones de Verosimilitud , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Probabilidad , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
The accuracy of a logistic prediction model is degraded when it is transported to populations with outcome prevalences different from that of the population used to derive the model. The resultant errors can have major clinical implications. Accordingly, the authors developed a logistic prediction model with respect to the noninvasive diagnosis of coronary disease based on 1,824 patients who underwent exercise testing and coronary angiography, varied the prevalence of disease in various "test" populations by random sampling of the original "derivation" population, and determined the accuracy of the logistic prediction model before and after the application of a mathematical algorithm designed to adjust only for these differences in prevalence. The accuracy of each prediction model was quantified in terms of receiver operating characteristic (ROC) curve area (discrimination) and chi-square goodness-of-fit (calibration). As the prevalence of the test population diverged from the prevalence of the derivation population, discrimination improved (ROC-curve areas increased from 0.82 +/- 0.02 to 0.87 +/- 0.03; p < 0.05), and calibration deteriorated (chi-square goodness-of-fit statistics increased from 9 to 154; p < 0.05). Following adjustment of the logistic intercept for differences in prevalence, discrimination was unchanged and calibration improved (maximum chi-square goodness-of-fit fell from 154 to 16). When the adjusted algorithm was applied to three geographically remote populations with prevalences that differed from that of the derivation population, calibration improved 87%, while discrimination fell by 1%. Thus, prevalence differences produce statistically significant and potentially clinically important errors in the accuracy of logistic prediction models. These errors can potentially be mitigated by use of a relatively simple mathematical correction algorithm.
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Enfermedad Coronaria/epidemiología , Modelos Logísticos , Tamizaje Masivo/estadística & datos numéricos , Adulto , Anciano , Algoritmos , Angiografía Coronaria/estadística & datos numéricos , Enfermedad Coronaria/diagnóstico , Estudios Transversales , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Análisis de Regresión , Muestreo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To investigate how often the ED ordering of stat serum calcium (Ca+2), magnesium (Mg+2), and phosphorus (PO4(-3)) levels affected clinical treatment; to define the diagnoses of patients for whom Ca+2, Mg+2, and PO4(-3) measurements did affect clinical therapy; and to suggest guidelines for more appropriate ordering of these laboratory tests. METHODS: A retrospective chart review was performed in an academic teaching hospital. All adult ED patients who had Ca+2, Mg+2, or PO4(-3) laboratory testing during the 9-month study period were included and evaluated for potential clinical impact of an abnormal Ca+2, Mg+2, or PO4(-3) laboratory test. RESULTS: 1.477 patients had Ca+2, Mg+2, or PO4(-3) measured while in the ED during the study period. Of these, 260 patients (17.6%) had a total of 312 abnormal Ca+2, Mg+2, or PO4(-3) values as defined by results exceeding +/- 15% of normal reference values. Of these, only 5 patients (0.3%) received treatment for abnormal values in the ED, while 75 patients (5.1%) were treated once admitted to the hospital. In this study, the only diagnostic groups to whom significant treatment was administered were diabetic patients (Ca+2 and PO4(-3); alcoholic patients (Mg+2); and renal failure patients (Ca+2, Mg+2, and PO4(-3). CONCLUSION: These results suggest that stat Ca+2, Mg+2, and PO4(-3) levels seldom affect clinical treatment in the ED. The frequency of ordering these tests may be reduced by obtaining Ca+2, Mg+2, or PO4(-3) measurements only for patients known to be at risk for such abnormalities, based on their existing or suspected diagnoses. The authors suggest obtaining these tests, when indicated, on a "non-stat" basis, with the subsequent laboratory results becoming available in-hospital, where treatment is more likely to occur.
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Análisis Químico de la Sangre/estadística & datos numéricos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Electrólitos/sangre , Adulto , Calcio/sangre , Técnicas de Laboratorio Clínico , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales de Enseñanza , Humanos , Magnesio/sangre , Fósforo/sangre , Guías de Práctica Clínica como Asunto , West VirginiaRESUMEN
PURPOSE: This research was conducted to develop a valid, reliable, quick, and nonstigmatizing tool for assessing literacy in the healthcare setting. METHODS: The Literacy Assessment for Diabetes (LAD) instrument was developed as a word recognition test composed of 3 graded word lists in ascending difficulty. This literacy test, which was specific to diabetes, measured a patient's ability to pronounce terms that they would encounter during clinic visits and in reading menu and self-care instructions. The majority of the terms were on a 4th-grade reading level, with the remaining words ranging from the 6th-through 16th-grade levels. To assess reliability and validity, the LAD was compared with the Wide Range Achievement Test (WRAT3) and the Rapid Estimate of Adult Literacy in Medicine (REALM) by administering all 3 tests to 203 participants in a test-retest study design. RESULTS: All 3 tests (LAD, REALM, and WRAT3) reliably detected true intrasubject variation in word recognition from test to retest. In addition, LAD measured word recognition ability similar to the REALM and WRAT3. CONCLUSIONS: The LAD is a reliable and valid instrument for measuring literacy in adults with diabetes. It can be administered in 3 minutes or less, and the raw score is scaled to a reading grade level.
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Diabetes Mellitus/rehabilitación , Factores Socioeconómicos , Escolaridad , Lectura , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: The aim of this study is to investigate whether there might be an eventual change in the enteric nerve responses to electrical field stimulation (EFS) of the isolated bowel segment (IBS) created by omentoenteropexy. METHODS: In the experimental group, an IBS was created in 10 rats using the omentum as the host organ by dividing of its mesentery 4 weeks later. In the control group, a jejunal loop of identical site and length to the IBS was studied in another 10 rats as normal jejunal segment. Longitudinal muscle strips were prepared from the IBSs (n 20) and the normal jejunal segments (n = 20). The effects of atropine, tetrodotoxin, L-arginine, and L-nitroarginine methyl ester (L-NAME) on the responses to transmural EFS were examined in both the IBS and normal jejunal segment using the isometric tension recording technique. RESULTS: Transmural EFS of the IBS strips produced contractile responses. Atropine and tetrodotoxin abolished the EFS-induced contractions of the IBS. Moreover, EFS-induced contractions were increased by the application of L-NAME, and were decreased by the application of L-arginine in the IBS. Mean percent change of IBS's contraction was not found statistically different from mean percent change of normal jejunal segment's contraction on the effects of L-NAME and L-arginine. CONCLUSION: These results suggest that the IBS, created by omentoenteropexy, produced enteric nerve responses to EFS as seen as in normal jejunal segment.
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Sistema Nervioso Entérico/fisiología , Yeyuno/inervación , Animales , Estimulación Eléctrica , Yeyuno/cirugía , Contracción Muscular/fisiología , Músculo Liso/fisiología , Epiplón/cirugía , Ratas , Ratas Sprague-DawleyRESUMEN
PURPOSE: This study was designed to determine the tissue levels of reactive oxygen radicals in caustic esophageal burns in a rat model. METHODS: Forty rats were divided into four groups of 10 animals each. The control rats were uninjured in group A, and the others were injured rats in groups B, C, and D. Through a median laparatomy incision, a 1.5-cm abdominal esophageal segment was isolated and tied with 2-0 chromic sutures in all groups as described by Gehanno. One milliliter of 10% sodium hydroxide solution in groups B, C, and D and 0.9% saline solution in group A were instilled through the isolated segment via a no. 24 cannula for 3 minutes, then the esophagus was rinsed for 1 minute with distilled water. The studied 1.5 cm of the abdominal esophagus was removed from each animal 24 hours after caustic injury in group B, 48 hours after in group C, and 72 hours after in group D. In group A, studied uninjured segments were removed for biochemical investigation. Tissue malondialdehyde (MDA) and glutathione (GSH) levels were determined for each group. RESULTS: The mean MDA levels in esophageal tissue were significantly higher in groups B, C, and D than in group A (P < .05). Moreover, the mean GSH levels in the same esophageal tissues were significantly lower in groups C and D than in groups A and B (P < .05). CONCLUSION: The reactive oxygen radicals may be play an important role in early phase of caustic esophageal burns by increasing the tissue damage.
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Quemaduras Químicas/metabolismo , Estenosis Esofágica/inducido químicamente , Estenosis Esofágica/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Animales , Cáusticos , Esófago/metabolismo , Glutatión/metabolismo , Malondialdehído/metabolismo , Ratas , Ratas Sprague-Dawley , Hidróxido de SodioRESUMEN
BACKGROUND/PURPOSE: A number of antioxidants are present in human tissues, which comprise the secondary defence system against the oxygen-free radicals and oxidative stress. Therefore, this study was undertaken in an animal model to investigate the effects of antioxidants such as vitamin E, vitamin C, methyl prednisolone, and mannitol, on the treatment of intestinal reperfusion injury when given during ischemia. METHODS: The study was performed on six groups of animals, each composed of six rabbits: Group I, mesenteric ischemia group; group R, ischemia-reperfusion group; group E, ischemia-reperfusion plus Vitamin E treatment; group C, ischemia-reperfusion plus vitamin C treatment; group CS, ischemia-reperfusion plus corticosteroid treatment; and Group M, ischemia-reperfusion plus mannitol treatment. Malondialdehyde (MDA) and glutathione (GSH) levels of the intestinal mucosa were assayed to reflect the free radical formation. RESULTS: Mucosal injury scores in the M and C groups were significantly lower than the R group (P< .01 and P< .01, respectively), and in the E and CS groups, mucosal injury scores were not significantly different from R group. MDA levels in the M and C groups were significantly lower than the R group (P < .01 and P < .01, respectively). GSH levels in the E, C, and M groups, were significantly higher than R group (P < .01, P < .05, and P < .01, respectively). CONCLUSION: The results of this study showed that antioxidant drugs, such as vitamin C and mannitol, may play a role in attenuating reperfusion injury of the gut demonstrated by depression of tissue MDA levels and by elevation of tissue GSH levels.
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Antioxidantes/uso terapéutico , Intestinos/irrigación sanguínea , Isquemia/fisiopatología , Daño por Reperfusión/tratamiento farmacológico , Animales , Ácido Ascórbico/uso terapéutico , Modelos Animales de Enfermedad , Glucocorticoides/uso terapéutico , Glutatión/análisis , Mucosa Intestinal/química , Mucosa Intestinal/patología , Isquemia/metabolismo , Malondialdehído/análisis , Manitol/uso terapéutico , Metilprednisolona/uso terapéutico , Conejos , Vitamina E/uso terapéuticoRESUMEN
The aim of the present study was to investigate the possible role of nitric oxide (NO) as a nonadrenergic, noncholinergic (NANC) mediator in human colon smooth muscle in vitro and to examine its possible interactions with K+ channels. In the presence of atropine (10(-6) M) and guanethidine (10(-5) M), electrical field stimulation (EFS, 1-10 Hz, 0.3 msec, 50 V) for 10 sec induced relaxations which were inhibited by tetrodotoxin (10(-6) M). In the presence of NG-nitro-L-arginine methyl ester (L-NAME, 10(-4) M), relaxations induced by EFS at 1, 2, 4, 8 and 10 Hz were reduced by 38.7 +/- 4.3, 31.5 +/- 3.8, 54.3 +/- 5.4, 59.8 +/- 4.5 and 68.6 +/- 5.3%, respectively. The relaxations inhibited by L-NAME were restored by the preincubation of L-arginine (L-ARG, 10(-3) M) at all frequencies tested. D-Arginine (D-ARG, 10(-3) M) had no effect. Tetraethylammonium (TEA, 10(-4) M) or glibenclamide (10(-6) M) significantly decreased the relaxations induced by EFS. Exogenously applied sodium nitroprusside caused concentration-dependent relaxation with maximum relaxation observed with 10(-3) M. TEA (10(-4) M) and glibenclamide (10(-6) M) significantly depressed the maximum response to sodium nitroprusside. In conclusion, our data indicate that NO is involved in NANC nerve-mediated relaxation in the human colon smooth muscle and the relaxant responses to endogenously released or exogenously applied NO are mediated, in part, by activation of calcium-dependent and ATP-sensitive K+ channels.
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Músculo Liso/efectos de los fármacos , Óxido Nítrico/farmacología , Parasimpatolíticos/farmacología , Canales de Potasio/efectos de los fármacos , Colon , Interacciones Farmacológicas , Estimulación Eléctrica , Humanos , Canales de Potasio/fisiologíaRESUMEN
In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p = 0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p = 0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs. 72/94), with a better specificity, 55% vs. 76% (p = 0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p = 0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent.
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Soplos Cardíacos/diagnóstico , Adolescente , Cardiología , Niño , Preescolar , Femenino , Cardiopatías Congénitas/fisiopatología , Cardiopatías/fisiopatología , Soplos Cardíacos/etiología , Humanos , Lactante , Relaciones Interprofesionales , Masculino , PediatríaRESUMEN
The purpose of this study was to compare the debonding force of orthodontic brackets bonded with two conventional resin adhesives (Resilience L3 and Light Bond) and a resin-reinforced glass ionomer cement (Fuji Ortho LC). For the in vitro part of the study, 80 extracted premolars were randomly divided into four groups. In groups A and B, brackets were bonded to unetched enamel using Fuji Ortho LC cement in wet and dry conditions, respectively. In groups C and D, brackets were bonded to etched enamel using Resilience L3 and Light Bond, respectively. Debonding force was determined using a servohydraulic testing machine at a crosshead speed of 1 mm/min. Data was analyzed using the ANOVA and Tukey-Kramer multiple comparison test at p<0.05. A significant difference was found in debonding force between unetched Fuji Ortho LC and the two conventional resins. There was no significant difference between the two conventional resins or between unetched resin-reinforced glass ionomer in the wet and dry conditions. For the in vivo part of the study, 30 patients were randomly assigned to one of the three bonding material groups. Bracket survival rates and distributions were obtained by following these patients for 1.2 years. Data was analyzed using the Kaplan-Meier product-limit estimates of survivorship function. Bond failure interface was determined using a modified adhesive remnant index (ARI). These results showed no significant difference between survival rates and distributions among the three bonding materials with respect to the type of malocclusion, type of orthodontic treatment, or location of bracket. There were significant differences between survival distributions of males and females in the unetched Fuji Ortho LC group and among type of teeth in the conventional resin groups. The predominant mode of bracket failure for the unetched Fuji Ortho LC cement was at the enamel-adhesive interface, and for conventional resins, the enamel-adhesive interface and the bracket-adhesive interface. These results suggest that resin-reinforced glass ionomer cement can withstand occlusal and orthodontic forces despite having a bond strength lower than that of conventional resin adhesives.
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Adhesivos/química , Desconsolidación Dental , Cementos de Ionómero Vítreo/química , Soportes Ortodóncicos , Cementos de Resina/química , Grabado Ácido Dental , Resinas Acrílicas/química , Adolescente , Silicatos de Aluminio/química , Análisis de Varianza , Resinas Compuestas/química , Recubrimiento Dental Adhesivo , Esmalte Dental/ultraestructura , Análisis del Estrés Dental/instrumentación , Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/clasificación , Maloclusión/terapia , Ensayo de Materiales , Factores Sexuales , Estrés Mecánico , Propiedades de Superficie , Análisis de SupervivenciaRESUMEN
The purpose of this laboratory study is to devise a simple, diagnostic test to assess possible osteological deficiency as a probable cause of OSA. Modern day skulls of fifty males and forty eight females of Tuscan origin and an additional seventy-five skulls, from India, with their cephalograms were used for this study. Mandibular length and antero-posterior dimension of the nasopharynx--pharyngeal tubercle (PhT) to posterior nasal spine (PNS)--were measured on the Tuscan skulls. The nasopharynx was similarly measured on the Indian skulls and readings multiplied by 1.14, the magnification factor of the cephalometric apparatus used. The PhT-PNS distance was then plotted on the cephalogram of Indian skulls with point PhT at the basiocciput. The possible presence of an osteogenic etiology of OSA can be determined by comparison of the mandibular/pharyngeal ratio obtained from the skull cephalograms to that of the individual patient.
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Cefalometría , Mandíbula/patología , Nasofaringe/patología , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/patología , Adolescente , Adulto , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Hueso Occipital/patología , Valores de Referencia , Caracteres SexualesRESUMEN
Recruitment of graduating family medicine residents into practice in rural West Virginia has been hampered by many factors. A cross-sectional survey was done to obtain the opinions of family medicine residents in West Virginia in 1996 in order to characterize their perceptions regarding certain aspects of their rural training and the relative importance of various factors influencing their future practice location intent. There was a positive association between cumulative resident experience and intent to practice in West Virginia and in rural areas. Perceived preparation for rural practice varied with educational area. There was significant variation in the relative importance of recruiting factors for likelihood of practice in West Virginia and in rural areas. Some recruiting factors tended to be positive or negative discriminators for intent to practice in West Virginia and in rural areas. Enhanced recruitment may be aided by an active community involvement which addresses the identified relevant factors.
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Conducta de Elección , Medicina Familiar y Comunitaria , Internado y Residencia , Servicios de Salud Rural , Estudios Transversales , Recolección de Datos , West Virginia , Recursos HumanosRESUMEN
In the U.S., malaria predominately occurs in travelers and immigrants. We report a series of 40 cases at West Virginia University Hospital, and 24 of whom were students who had visited areas of East Africa, West Africa and Asia usually in either December, January, August or September. Most patients (79%) reported a previous episode of malaria, and P. falciparum was identified in 60%. Fever, chills and rigors were the most common symptoms. Correct use of malaria prophylaxis was recorded in five patients, and only two of these were students. Successful outcomes were recorded in all but one patient. Our series suggests that international students would benefit from the proper use of chemoprophylaxis, thus decreasing the number of cases of malaria seen in university settings.
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Malaria/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antimaláricos/uso terapéutico , Distribución de Chi-Cuadrado , Niño , Femenino , Hospitales Universitarios , Humanos , Lactante , Malaria/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudiantes , Viaje , West Virginia/epidemiologíaRESUMEN
This article explains estimation of gene frequencies from a Bayesian viewpoint using prior information. How to obtain Bayes estimators and the highest posterior density credible sets (Bayesian counterpart to classical confidence intervals) for gene frequencies is described. Tests of hypotheses are also discussed. A readily available mathematical application package is used to demonstrate the mathematical computations.
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A testis is termed ectopic when it lies outside the normal line of descent. A case of testicular ectopia in which the testicle was located cranial and lateral to the internal ring dorsal to the external oblique muscle is reported in a 2-month-old boy. This highly aberrant ectopic testis was treated successfully by orchiopexy; as far as we know, this is the second such case in the literature.
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Currently, no serum marker has proved helpful in diagnosing intestinal ischemia and reperfusion (I/R) injury. An experimental study was conducted to determine the value of serum D-lactate in detecting intestinal I/R injury. Thirty New Zealand White rabbits were divided into three groups of 10 animals each: sham-operation controls (S); I/R; and I/R plus mannitol treatment (M). Serum samples were obtained before operation (T0), at the end of the ischemic period (T1), after the first 30 min of reperfusion (T2), and at the end of the reperfusion period (T3). In Group S, mean D-lactate levels for T0, T1, and T2 were 0 microgram/dl, while T3 was 5. 8 +/- 4.7 micrograms/dl. Before the operation (T0), serum mean D-lactate levels were 0 microgram/dl in all groups (S, I/R, M). Levels increased after 1 h of ischemia (T1) in groups I/R (83.5 +/- 25.6 micrograms/dl) and M (89.8 +/- 19.9 micrograms/dl), but not in group S (0 microgram/dl). The mean T2 level in group I/R (231.6 +/- 78.6 micrograms/dl) was statistically higher than in group M (140.1 +/- 53.5 micrograms/dl) (P = 0.007). At the end of the reperfusion period, the mean T3 level in group I/R (698.4 +/- 360.4 micrograms/dl) was significantly higher than in group M (158.7 +/- 61.4 micrograms/dl) (P = 0.000). In group I/R, mean D-lactate levels changed significantly at each time point (T1 vs T2, P = 0.001; T2 vs T3, P = 0.004). However, in group M the increase from T1 to T2 was significant (P = 0.012), but that from T2 to T3 was not (P = 0.293). As a result, the mean T3 level was significantly higher than the T2 level in group I/R (P = 0.004), but not in group M. This study confirmed a significance rise in D-lactate levels in animals with I/R injury compared to sham-operated and I/R injury plus M treatment. We suggest that serum D-lactate levels could be a useful marker of intestinal I/R injury before laparatomy.
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Intestinos/irrigación sanguínea , Ácido Láctico/sangre , Daño por Reperfusión/diagnóstico , Animales , Biomarcadores/sangre , Diuréticos Osmóticos/uso terapéutico , Manitol/uso terapéutico , Conejos , Daño por Reperfusión/sangre , Factores de TiempoRESUMEN
BACKGROUND: Visceral proteins and acute phase reactants have commonly been used as indicators of nutritional status, and metabolic response of surgical trauma. AIM: This study was undertaken to determine how some plasma proteins, alone or together reflect metabolic response in neonates recovering from major surgery. METHODS: Serum albumin, pre-albumin (PA), C-reactive protein (CRP), and alpha1-acid glycoprotein (AGP) levels were measured, and the prognostic inflammatory and nutritional index (PINI) was calculated for preoperative day 1 (-1) and postoperative (PO) days 1 (+1) and 7 (+7). RESULTS: PA, CRP, AGP and PINI were significantly different on day +1 from day -1. While AGP and PINI were still significantly higher than that of day -1, PA and CRP returned to the preoperative levels on day +7. CONCLUSION: PA, CRP and AGP measurements are superior to PINI for assessing postoperative metabolic changes in term neonates following uncomplicated major surgery on early and late phase. But this comparison must be performed in the management of more complex cases to determine which one is better to indicate morbidity and mortality.
Asunto(s)
Proteínas Sanguíneas/metabolismo , Procedimientos Quirúrgicos Operativos , Anestesia General , Femenino , Humanos , Recién Nacido , Masculino , Estrés FisiológicoRESUMEN
Measuring the longitudinal change in FEV(1) is useful for assessing the adverse effects of respiratory exposures and pulmonary diseases. Investigators seek to estimate the "true" mean FEV(1) slope (mu(beta)) of an infinite population. The difference between the estimated mean FEV(1) slope (mu(beta)) and the true mean slope, resulting from biological variation and measurement errors, can be minimized by increasing the number of subjects (N), years of follow-up (D), or the frequency of measurements (P). We defined maximum error e(max) such that P[|mu(beta) - mu(beta)| < or = e(max)] = 0.95, and thus e(max) is one-half the width of the 95% confidence interval for mu(beta). We computed the values of e(max) on the basis of actual data obtained from 160 coal miners and working nonminers who had completed 11 spirometry measurements, using recommended equipment and procedures, at 6-mo intervals over 5 yr. Individual 5-yr FEV(1) slopes (Delta FEV(1)) were calculated by linear regression. For a range of values of N, D, and P, tables are provided for e(max), the magnitude of detectable differences in Delta FEV(1) between two groups, and the recommended number of subjects needed in each of two groups to reliably detect the anticipated differences in Delta FEV(1). The tables provide unique guidance for investigators in selecting among various study design options.