Exclusive breast-feeding, the early-life microbiome and immune response, and common childhood respiratory illnesses.

BACKGROUND: The impact of breast-feeding on certain childhood respiratory illnesses remains controversial. OBJECTIVE: We sought to examine the effect of exclusive breast-feeding on the early-life upper respiratory tract (URT) and gut microbiome, the URT immune response in infancy, and the risk of common pediatric respiratory diseases. METHODS: We analyzed data from a birth cohort of healthy infants with prospective ascertainment of breast-feeding patterns and common pediatric pulmonary and atopic outcomes. In a subset of infants, we also characterized the URT and gut microbiome using 16S ribosomal RNA sequencing and measured 9 URT cytokines using magnetic bead-based assays. RESULTS: Of the 1949 infants enrolled, 1495 (76.71%) had 4-year data. In adjusted analyses, exclusive breast-feeding (1) had an inverse dose-response on the ⍺-diversity of the early-life URT and gut microbiome, (2) was positively associated with the URT levels of IFN-α, IFN-γ, and IL-17A in infancy, and (3) had a protective dose-response on the development of a lower respiratory tract infection in infancy, 4-year current asthma, and 4-year ever allergic rhinitis (odds ratio [95% CI] for each 4 weeks of exclusive breast-feeding, 0.95 [0.91-0.99], 0.95 [0.90-0.99], and 0.95 [0.92-0.99], respectively). In exploratory analyses, we also found that the protective association of exclusive breast-feeding on 4-year current asthma was mediated through its impact on the gut microbiome (P = .03). CONCLUSIONS: Our results support a protective causal role of exclusive breast-feeding in the risk of developing a lower respiratory tract infection in infancy and asthma and allergic rhinitis in childhood. They also shed light on potential mechanisms of these associations, including the effect of exclusive breast-feeding on the gut microbiome.

Upper respiratory tract bacterial-immune interactions during respiratory syncytial virus infection in infancy.

BACKGROUND: The risk factors determining short- and long-term morbidity following acute respiratory infection (ARI) due to respiratory syncytial virus (RSV) in infancy remain poorly understood. OBJECTIVES: Our aim was to examine the associations of the upper respiratory tract (URT) microbiome during RSV ARI in infancy with the acute local immune response and short- and long-term clinical outcomes. METHODS: We characterized the URT microbiome by 16S ribosomal RNA sequencing and assessed the acute local immune response by measuring 53 immune mediators with high-throughput immunoassays in 357 RSV-infected infants. Our short- and long-term clinical outcomes included several markers of disease severity and the number of wheezing episodes in the fourth year of life, respectively. RESULTS: We found several specific URT bacterial-immune mediator associations. In addition, the Shannon ⍺-diversity index of the URT microbiome was associated with a higher respiratory severity score (ß =.50 [95% CI = 0.13-0.86]), greater odds of a lower ARI (odds ratio = 1.63 [95% CI = 1.10-2.43]), and higher number of wheezing episodes in the fourth year of life (ß = 0.89 [95% CI = 0.37-1.40]). The Jaccard ß-diversity index of the URT microbiome differed by level of care required (P = .04). Furthermore, we found an interaction between the Shannon ⍺-diversity index of the URT microbiome and the first principal component of the acute local immune response on the respiratory severity score (P = .048). CONCLUSIONS: The URT microbiome during RSV ARI in infancy is associated with the acute local immune response, disease severity, and number of wheezing episodes in the fourth year of life. Our results also suggest complex URT bacterial-immune interactions that can affect the severity of the RSV ARI.

Exploring Implementation of m-Health Monitoring in Postpartum Women with Hypertension.

BACKGROUND: Preeclampsia is a hypertensive disorder in pregnancy where a patients' blood pressure and warning signs of worsening disease need to be closely monitored during pregnancy and the postpartum period. INTRODUCTION: No studies have examined remote patient monitoring using mobile health (m-health) technologies in obstetrical care for women with preeclampsia during the postpartum period. Remote monitoring and m-health technologies can expand healthcare coverage to the patient's home. This may be especially beneficial to patients with chronic conditions who live far from a healthcare facility. MATERIALS AND METHODS: The study was designed to identify and examine the potential factors that influenced use of m-health technology and adherence to monitoring symptoms related to preeclampsia in postpartum women. A sample of 50 women enrolled into the study. Two participants were excluded, leaving a total sample size of 48 women. Users were given m-health devices to monitor blood pressure, weight, pulse, and oxygen saturation over a 2-week period. Nonusers did not receive equipment. The nurse call center monitored device readings and contacted participants as needed. Both groups completed a baseline and follow-up survey. RESULTS: Women who elected to use the m-health technology on average had lower levels of perceived technology barriers, higher facilitating condition scores, and higher levels of perceived benefits of the technology compared with nonusers. Additionally, among users, there was no statistical difference between full and partial users at follow-up related to perceived ease of use, perceived satisfaction, or perceived benefits. DISCUSSION: This study provided a basis for restructuring the management of care for postpartum women with hypertensive disorders through the use of m-health technology. CONCLUSION: Mobile health technology may be beneficial during pregnancy and the postpartum period for women with preeclampsia to closely manage and monitor their blood pressure and warning signs of worsening disease.

Application of a Telecolposcopy Program in Rural Settings.

BACKGROUND: Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. INTRODUCTION: While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. MATERIALS AND METHODS: Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. RESULTS: Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. DISCUSSION: Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. CONCLUSION: Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.

"The crowd is crazy, the crowd is a woman": the oligarchical-federal demophobia of the First Republic and the issue of transferring the capital.

This study examines the expressions of demophobia of the political class of the First Republic, faced with demonstrations against the government in Rio de Janeiro, and relates them to the need to move to the seat of the federal government inland. The demophobic literature produced by liberal Europeans against democratization in their countries pervaded the orientation of the Brazilian political class during the period. Committed to building an oligarchic federation, they saw the population of Rio de Janeiro as a threat. Compared to a subversive crowd of people in a huge, artificial capital suffering from foreign influence, oligarchic federalism valued the 'authentic' Brazilian people, referred to the image of a provincial, orderly population.

Restoration of immunity in lymphopenic individuals with cancer by vaccination and adoptive T-cell transfer.

Immunodeficiency is a barrier to successful vaccination in individuals with cancer and chronic infection. We performed a randomized phase 1/2 study in lymphopenic individuals after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for myeloma. Combination immunotherapy consisting of a single early post-transplant infusion of in vivo vaccine-primed and ex vivo costimulated autologous T cells followed by post-transplant booster immunizations improved the severe immunodeficiency associated with high-dose chemotherapy and led to the induction of clinically relevant immunity in adults within a month after transplantation. Immune assays showed accelerated restoration of CD4 T-cell numbers and function. Early T-cell infusions also resulted in significantly improved T-cell proliferation in response to antigens that were not contained in the vaccine, as assessed by responses to staphylococcal enterotoxin B and cytomegalovirus antigens (P < 0.05). In the setting of lymphopenia, combined vaccine therapy and adoptive T-cell transfer fosters the development of enhanced memory T-cell responses.

Physical victimization of rural methamphetamine and cocaine users.

Substance use and physical violence often coincide, but little has been published on the correlates associated with receipt of partner versus nonpartner physical violence for rural users of methamphetamine and/or cocaine. In this study, participants' substance use, depression and past-year physical victimization were assessed. In separate logistic regression models, received partner violence in females was associated with age; alcohol, cocaine, and methamphetamine abuse/dependence; and number of drugs used in the past 6 months. In males, received nonpartner violence was associated with age, cocaine abuse/dependence, and being Caucasian. Findings suggest a relationship between stimulant use and received violence among rural substance users and a need for victimization screenings in settings where such individuals seek health care.

Young African American perceptions of substance use in rural eastern Arkansas communities.

This study examined barriers to substance abuse treatment through focus group interviews of African American youth in three rural, eastern Arkansas counties in the Mississippi Delta region. Participants in the study included adolescents with a current or prior history of substance use, non-substance using adolescents acquainted with other substance users, and adolescents who initiated substance use during adolescence (N = 41). Grand tour and subsequent probe questions elicited multiple themes regarding rural adolescent substance use, treatment decisions, and preferences. Adolescents' perceptions of substance use indicate that treatment or prevention programs will need to address multiple dimensions, ranging from individual to community-wide factors.

Evaluation of the upper airway microbiome and immune response with nasal epithelial lining fluid absorption and nasal washes.

Despite being commonly used to collect upper airway epithelial lining fluid, nasal washes are poorly reproducible, not suitable for serial sampling, and limited by a dilution effect. In contrast, nasal filters lack these limitations and are an attractive alternative. To examine whether nasal filters are superior to nasal washes as a sampling method for the characterization of the upper airway microbiome and immune response, we collected paired nasal filters and washes from a group of 40 healthy children and adults. To characterize the upper airway microbiome, we used 16S ribosomal RNA and shotgun metagenomic sequencing. To characterize the immune response, we measured total protein using a BCA assay and 53 immune mediators using multiplex magnetic bead-based assays. We conducted statistical analyses to compare common microbial ecology indices and immune-mediator median fluorescence intensities (MFIs) between sample types. In general, nasal filters were more likely to pass quality control in both children and adults. There were no significant differences in microbiome community richness, α-diversity, or structure between pediatric samples types; however, these were all highly dissimilar between adult sample types. In addition, there were significant differences in the abundance of amplicon sequence variants between sample types in children and adults. In adults, total proteins were significantly higher in nasal filters than nasal washes; consequently, the immune-mediator MFIs were not well detected in nasal washes. Based on better quality control sequencing metrics and higher immunoassay sensitivity, our results suggest that nasal filters are a superior sampling method to characterize the upper airway microbiome and immune response in both children and adults.

High-risk obstetrical call center: a model for regions with limited access to care.

PURPOSE: High-risk obstetrical care can be challenging for women in rural states with limited access. MATERIALS AND METHODS: Data were evaluated from 62,342 obstetrical calls from pregnant and postpartum patients within rural Arkansas to a nurse call center. Call center nurses provided triage using evidence-based guidelines to patients across the state. Data were extracted and analyzed using retrospective data collection and descriptive statistical methods. RESULTS: Women had an average maternal age of 28 years old, average weeks gestation was 27.4, over half had Medicaid 32,513 (52.15%), and the greatest percentage were in their first pregnancy 14,232 (34.1%). The greatest percentage of calls resulted in a recommendation to come to the hospital to be evaluated 25,894 (41.54%) followed by advice with no prescription given 19,442 (31.19%). The most frequent guidelines used included preterm labor 5114 (8.24%) followed by abdominal pain >20 weeks 4,518 (7.28%). CONCLUSIONS: A centralized obstetrical nurse call center model, including 24/7 availability, using triage software for obstetrical care, with experienced labor and delivery nurses to answer and respond to calls and secondary triage performed by OB/GYN physicians or Advance Practice Registered Nurses (APRN) has the potential of improving access to obstetric care in rural areas.

Entre a "Velha" e a "Nova" Ciência Política: Continuidade e Renovação Acadêmica na Primeira Década da Revista DADOS (1966-1976) / Between the "Old" and the "New" Political Science: Continuity and Academic Renovation in the First Decade of DADOS Journal's Publication (1966-1976) / Entre la "Vielle" et la "Nouvelle" Science Politique: Continuité et Rénovation Académique lors de la Première Décennie de la Revue DADOS (1966-1976) / Entre la "Vieja" y la "Nueva" Ciencia Política: Continuidad y Renovación Académica en la Primera Década de la Revista DADOS (1966-1976)

RESUMO O presente artigo apresenta um mapeamento contextualizado dos debates acadêmicos travado ao longo da primeira década de existência da Revista DADOS (1966-1976). Do ponto de vista histórico, trata-se do processo de endurecimento do regime militar; do ponto de vista temático e teórico, cuida-se da passagem da antiga ideologia nacional-desenvolvimentista para uma sociologia do conhecimento que, ao final do período estudado, divide-se entre uma sociologia histórica e uma ciência política, preocupadas ambas com o estudo do autoritarismo em geral e do brasileiro em particular. Quanto aos autores, vê-se a passagem de bastão da velha Ciência Política brasileira, ensaísta e nacionalista, para uma nova, comprometida com uma reflexão rigorosa baseado em critérios profissionais, mas também com os valores democráticos.

ABSTRACT The following article provides a contextualized mapping of the academic debates characterizing the first decade of DADOS journal's publication (1966-1976). Historically speaking, this reflects a tightening of the military dictatorship, while from a thematic and theoretical point of view, it concerns the shift from the former national-developmental ideology to a sociology of knowledge that, at the end of the period under study, splits into a form of historic sociology and a form of political science, with both concerned with the study of authoritarianism in general and the study of this in Brazil in particular. In terms of authors, the shift is one from the old essayist and nationalist Brazilian political science to a new strand committed to rigorous reflection based on professional criteria, as well as democratic values.

RÉSUMÉ Le présent article propose une cartographie contextualisée des débats universitaires menés au long de la première décennie d'existence de la Revue DADOS (1966-1976). Du point de vue historique, il s'agit d'une période de durcissement du régime militaire, tandis que l'on a assisté, au niveau thématique, au passage de l'ancienne idéologie national-développementiste à une sociologie de la connaissance, qui, à la fin de la période en question, s'est divisée entre sociologie historique et science politique, néanmoins toutes deux impliquées dans l'étude de l'autoritarisme en général et de la situation brésilienne à cet égard. Pour ce qui est des auteurs, on constate un passage de relais entre les anciennes sciences politiques brésiliennes pamphlétaires et nationalistes et les nouvelles, engagées dans une réflexion rigoureuse se basant sur des critères professionnels, mais également sur des valeurs démocratiques.

RESUMEN Este artículo presenta un estudio contextualizado de los debates académicos llevados a cabo en el transcurso de la primera década de existencia de la revista DADOS (1966-1976). Desde el punto de vista histórico, se trata del proceso de endurecimiento del régimen militar; desde el punto de vista temático y teórico, se refiere al paso de la antigua ideología nacional-desarrollista a una sociología del conocimiento que, al final del periodo estudiado, se divide entre una sociología histórica y una ciencia política, ambas preocupadas por el estudio del autoritarismo en general y del brasileño en particular. En cuanto a los autores, se ve el paso del testigo de la vieja ciencia política brasileña, ensayista y nacionalista, a una nueva, comprometida con una reflexión rigurosa basada en criterios profesionales y también con los valores democráticos.

Role of acetylcholine in negative patterning in turtles (Chrysemys picta).

Turtles were run on a negative patterning task involving 2 positive elements, a key with white stripes on a black background, and a solid red key, and a compound stimulus combining the 2 elements, white stripes on a red background. Injections of scopolamine, methylscopolamine, or saline were started at the same time that the compound stimulus was introduced, after the animals had been autoshaped to press the key for each of the elements. Scopolamine disrupted the learning of negative patterning, but methylscopolamine had no effect. In contrast, learning of a simple discrimination between the elements was not affected by scopolamine. These results show that muscarinic cholinergic receptors are involved in the learning of negative patterning in turtles.

"A multidão é louca, a multidão é mulher": a demofobia oligárquico-federativa da Primeira República e o tema da mudança da capital / "The crowd is crazy, the crowd is a woman": the oligarchical-federal demophobia of the First Republic and the issue of transferring the capital

Examina as expressões de demofobia da classe política da Primeira República, em faces das manifestações do povo carioca, relacionando-as à necessidade de mudar para o interior a sede do governo federal. A literatura demófoba produzida pelos liberais europeus contrários à democratização em seus países impregnou a orientação da classe política brasileira do período. Empenhados em construir uma federação oligárquica, viam a população do Rio de Janeiro como uma ameaça. Contra um subversivo povo-multidão de uma capital cosmopolita, artificial e estrangeirada, o federalismo oligárquico valorizava um ‘autêntico' povo brasileiro que remetia ao imaginário de uma população interiorana e ordeira.

This study examines the expressions of demophobia of the political class of the First Republic, faced with demonstrations against the government in Rio de Janeiro, and relates them to the need to move to the seat of the federal government inland. The demophobic literature produced by liberal Europeans against democratization in their countries pervaded the orientation of the Brazilian political class during the period. Committed to building an oligarchic federation, they saw the population of Rio de Janeiro as a threat. Compared to a subversive crowd of people in a huge, artificial capital suffering from foreign influence, oligarchic federalism valued the ‘authentic' Brazilian people, referred to the image of a provincial, orderly population.

Entre o Leviatã e o Beemote: soberania, constituição e excepcionalidade no debate político dos séculos XVII e XVIII / Between the Leviathan and the Behemoth: sovereignty, constitution, and exceptionality in 17th and 18th centuries political debate / Entre le Léviathan et le Behemoth: souveraineté, constitution et exceptionnalité dans le débat public aux XVIIe et XVIIIe siècles

The article seeks to retrace the theoretical approaches to the problem of exceptionality of power, i.e., the manifestation of sovereign power within a limited government with shared power - as in the tradition of mixed Constitution (longstanding in political thinking) - in the 17th and 18th centuries. Already present in authors like Machiavelli, Harrington, and Locke, the debate bifurcated between England and France in the early 18th century. The specificities of English politics led it to consecrate a tradition of mixed Constitutionalism in which the discretionary element lost relevance in the political system as a whole. In France, on the other hand, the unpopularity of the nobility and the centrality of sovereignty as a concept disaccredited formulas that compromised with the discretionary nature of power. This bifurcation contributed to the formation of two distinct patterns of Constitutional government: the Anglo-Saxon and the French/Continental.

Dans cet article, le propos est de montrer les voies théoriques empruntées par la question de l'exceptionnalité du pouvoir, c'est-à-dire la manifestation du pouvoir souverain à l'intérieur d'un gouvernement limité et au pouvoir partagé - cas de la constitution mixte, vieille tradition de la pensée politique européenne aux XVIIe -XVIIIe siècles. Débat qu'on retrouve déjà chez des auteurs tels que Machiavel, Harrington et Locke, et qui se dédouble au début du XVIIIe siècle entre l'Angleterre et la France. D'un côté, si les spécificités de la politique anglaise l'ont amenée à consacrer une tradition de constitution mixte où l'élément discrétionnaire voyait son importance amoindrie au sein du système politique, de l'autre , en France, l'impopularité de la noblesse et la centralité du concept de souveraineté ont discrédité les formules s'accommodant du caractère discrétionnaire du pouvoir. Cette bifurcation aurait favorisé la formation de deux modèles différents de gouvernement constitutionnel: l'anglo-saxon et le franco-occidental.

O discurso político monarquiano e a recepção do conceito de poder moderador no Brasil (1822-1824) / Monarchical political discourse and receptiveness to the concept of a moderating power in Brazil (1822-1824)

This article revisits the founding moment of Brazilian political institutions in order to highlight the penetration of French monarchical discourse among statesmen connected to the Brazilian Crown. The concept of a moderating power was thus mobilized strategically by these statesmen to safeguard the Crown's prerogatives from the growing interference of the 1823 Constitutional Congress. The objective was to justify the preeminence of the Prince over Parliament as representative of the nation's sovereignty. This justification introduced new semantic meanings into the concept, such as those of active neutrality, discretionarity, and centralization, which came to be identified with the state itself during the state-building process. The result was that the legal text allowed a monarchical reading of the Chief of State as an axis for government activity, but also another, ultraliberal reading in which he appeared merely as arbiter of the Constitutional system.

Dans cet article, on réexamine le moment fondateur des institutions politiques brésiliennes afin de souligner l'influence du discours monarchiste français sur les hommes d'État liés à la Couronne brésilienne. Ils se seraient servis stratégiquement de l'idée de pouvoir modérateur dans le but de sauvegarder les prérogatives de la Couronne contre les ingérences croissantes de l'Assemblée constituante de 1823, c'est-à-dire justifier la primauté du Prince, comme représentant la souveraineté de la nation, sur le Parlement. Ce but a permis d'assimiler à cette idée de nouveaux sens sémantiques tels que: neutralité active, caractère arbitraire et centralisateur, qui se sont identifiés à l'État naissant. Il en résulte que le texte légal rend possible non seulement une lecture monarchiste du chef de l'État comme axe du gouvernement, mais aussi une autre, ultralibérale, où il ne serait que l'arbitre du système constitutionnel.