BACKGROUND: There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. However, to this date no state-wide analysis exists in any European country. OBJECTIVES: Our aim is to describe the shift work scheduling and to detail the degree of compliance with the Spanish legislation and the European Working Time Directive (EWTD) of Spanish resident physicians, focusing on territorial and specialty distribution. MATERIAL AND METHODS: A descriptive cross-sectional analytical study was designed through an online survey adapted from the existing literature. RESULTS: Out of the 2035 surveyed resident physicians undergoing PGT in Spain, 80.49% exceeded the 48 h per week limit set by the EWTD and 13% of them did not rest after a 24-h on-call shift. The mean number of on-call shifts in the last 3 months was 15.03, with the highest mean reported in Asturias, La Rioja, and Extremadura. 51.6% of respondents had a day-off after a Saturday on-call shift. Significant differences are observed by region and type of specialty. CONCLUSION: Resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labor regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed.
Physicians , Humans , Spain , Cross-Sectional Studies , Europe , Time Factors
AIMS: We describe the epidemiology of sexually transmitted infections (STIs) and HIV in people aged ⩾45 years in England and provide future projections about the burden of STIs in this age group. METHODS: Analysis of national surveillance data in England from 2014 to 2019 for chlamydia, gonorrhoea, herpes, syphilis, anogenital warts and HIV was carried out. Time trends were assessed by the Poisson regression and reported using incidence rate ratios (IRRs). Two scenarios were modelled to predict the number of new STI diagnoses and associated costs in 2040. RESULTS: In 2019, there were 37,692 new STI diagnoses in people ⩾45 years in England. Between 2014 and 2019, there was a significant increase in the rate of new STI diagnoses in men (IRR = 1.05, p = .05) and those aged 45-64 years (IRR = 1.04, p = .05). Absolute numbers of new STI diagnoses in men who have sex with men increased by 76% between 2014 and 2019 (IRR = 1.15, p < .001). In adults aged ⩾50 years, the number of episodes of care for HIV increased over time (age = 50-64 years, IRR = 1.10; age = 65+ years, IRR = 1.13; p <.001). The modelled scenarios predicted an increase in STI diagnoses and costs in older people by 2040. CONCLUSION: STI rates in England are increasing in people aged ⩾45 years. The population is ageing and older people will contribute an increasing burden to STI costs if this trend continues. The reasons for this trend are not fully understood and further longitudinal epidemiological research is needed. Sexual health promotion campaigns and healthcare interventions targeted at older people should be prioritised.
HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Male , Adult , Humans , Aged , Homosexuality, Male , HIV Infections/epidemiology , Sexually Transmitted Diseases/epidemiology , England/epidemiology
Objetivo: La desnutrición hospitalaria incrementa el riesgo de padecer complicaciones, agravado por la escasa formación y sensibilidad en nutrición clínica del personal sanitario. El objetivo del presente estudio es evaluar la capacidad de optimización de la prescripción de nutrición parenteral como consecuencia de la creación de un grupo multidisciplinar. Métodos: Se creó un equipo multidisciplinar para asesorar a los servicios médico-quirúrgicos en nutrición, optimizar la prescripción de nutrición parenteral e informar y empoderar al paciente.Se establecieron las bases para el funcionamiento de un grupo asesor de nutrición parenteral (GANP) que se reunió de forma diaria para evaluar las prescripciones de nutrición parenteral del centro, realizando una entrevista clínica y una valoración nutricional individualizada y decidió sobre el tratamiento nutricional más adecuado en cada paciente.Se establecieron diferentes grados de desempeño (pobre 0-20%, adecuado 21-50%, bueno 51-80% o excelente >80%) en función del porcentaje de NP centrales asumidas y el grado de satisfacción del paciente.Se proporcionaron encuestas de satisfacción voluntarias a los pacientes, y se valoraron en una escala de 0 a 10.Resultados: Se evaluaron 97 pacientes con NP durante un año. El 100% de las NP centrales fueron asumidas por el GANP (68,3% de las NP totales). El 92,7% de las nutriciones totales estuvieron indicadas correctamente y en el 74,8% la prescripción fue adecuada. El grado de satisfacción medio fue de 9,5/10,0.El programa obtuvo un grado de desempeño excelente. Conclusiones: La creación de un grupo de trabajo multidisciplinar contribuye a la optimización de la terapia nutricional. (AU)
Objective: Hospital malnutrition increases the risk of complications, aggravated by the scarce training and sensitivity in clinical nutrition of health personnel. The objective is to evaluate the optimization capacity of parenteral nutrition prescription as a consequence of the creation of a multidisciplinary group.Methods: A multidisciplinary team was created to advise the medical-surgical services on nutrition, optimize the prescription of parenteral nutrition and inform and empower the patient.The foundations were established for the functioning of a parenteral nutrition advisory group (GANP) that met daily to evaluate the centers parenteral nutrition prescriptions, conducting a clinical interview and an individualized nutritional assessment and decided on the most appropriate nutritional treatment in each patient.Different degrees of performance were established (poor 0-20%, adequate 21-50%, good 51-80% or excellent >80%) depending on the percentage of assumed central PNs and the degree of patient satisfaction.Voluntary satisfaction surveys were provided to patients, and they were rated on a scale of 0 to 10.Results: 97 patients with PN were evaluated for one year. 100% of the central NPs were assumed by the GANP (68.3% of the total NPs). 92.7% of the total nutritionals were indicated correctly and in 74.8% the prescription was adequate. The average degree of satisfaction was 9.5/10.0.The program obtained an excellent performance grade.Conclusions: The creation of a multidisciplinary working group contributes to the optimization of nutritional therapy. (AU)
Humans , Parenteral Nutrition , Parenteral Nutrition, Total , Nutrition Assessment , Patients
AIM: To compare the ProTaper Next (PTN) system with a replica-like and a counterfeit system regarding design, metallurgy, mechanical performance and shaping ability. METHODOLOGY: Replica-like (X-File) and counterfeit (PTN-CF) instruments were compared to the PTN system regarding design (microscopy), phase transformation temperatures (differential scanning calorimetry), nickel-titanium ratio (energy-dispersive X-ray spectroscopy), cyclic fatigue, torsional resistance, bending strength, and untouched canal areas in extracted mandibular molars (micro-CT). anova, post hoc Tukey's and Kruskal-Wallis tests were used according to normality assessment (Shapiro-Wilk test) with the significance level set at 5%. RESULTS: Overall similarities in design and nickel-titanium (Ni/Ti) ratio were observed amongst instruments with the X-File having a smoother surface finish. PTN and PTN-CF had mixed austenite plus R-phase (R-phase start approximately at 45 ºC and near 30 ºC, respectively), whilst X-File instruments were austenitic (R-phase started at approximately at 17 ºC) at room temperature (20 ºC). PTN-CF had the greatest inconsistency in the phase transformation temperatures. Time to fracture of PTN-CF X2 and X3 was significantly shorter than PTN and X-File instruments (P < 0.05), whilst no difference was noted in maximum torque to fracture amongst the tested systems (P > 0.05). X-Files and PTN-CF had a stress-induced phase change during bending load. Mean unprepared surface areas of root canals were 25.8% (PTN), 31.1% (X-File) and 32.5% (PTN-CF) with no significant difference amongst groups (P > 0.05). CONCLUSION: Similarities amongst the systems were noted in the Ni/Ti ratio and maximum torque to fracture, whilst differences were observed in the design, phase transformation temperatures and mechanical behaviour. The ProTaper Next counterfeit instruments could be considered as the less secure system considering its low-cyclic fatigue resistance. Apart from these differences, the unprepared canal surface areas, obtained with the tested systems, were similar.
Dental Alloys , Root Canal Preparation , Equipment Design , Materials Testing , Metallurgy , Stress, Mechanical , Titanium , X-Ray Microtomography
El uso de albúmina vía intravenosa está extendido y respaldado por la evidencia científica en determinadas situaciones.Sin embargo, resulta común su uso para corregir un deficienteestado nutricional o un hallazgo analítico de hipoalbuminemia, a pesar de la falta de evidencia, el elevado coste y elriesgo de efectos adversos. El objetivo del trabajo es analizary evaluar el uso de albúmina en un hospital de tercer nivel,tras la suspensión de su consideración como medicamentorestringido y la implantación de la prescripción electrónica y,por tanto, la ausencia de necesidad de informar de la indicación y parámetros clínicos en la prescripción. Se realizó un estudio observacional prospectivo de cuatro semanas en el quese revisaron las prescripciones de albúmina. El tratamiento dedatos se realizó mediante el paquete estadístico Stata.Se confirmó el excesivo e incorrecto uso de albúmina, ya que lamayor parte (54,5%) de las prescripciones no se ajustaban a lasindicaciones de ficha técnica o a las principales recomendaciones, la única justificación fue corregir la hipoalbuminemia. Losparámetros analíticos nutricionales estaban en rango de desnutrición y ningún paciente tenía registro de peso corporal. Se detectaron tratamientos de larga duración, que en muchos casosse prolongaron hasta el alta hospitalaria. La mayor parte delcoste total fue en prescripciones no indicadas. Los tres servicioshospitalarios con más consumo de albúmina fueron MedicinaInterna, Oncología y Medicina Digestiva. Se considera necesarioretomar la monitorización intensiva realizada hace años en elhospital por motivos clínicos, económicos y sostenibles. (AU)
The use of intravenous albumin is widespread and supported by scientific evidence in certain situations. However, itsuse is common to improve a poor nutritional status or an analytical finding ofhypoalbuminemia, despite the lack ofevidence, the high cost and the risk ofadverse effects. The objective of thisstudy is to analyze and evaluate the useof albumin in a third-level hospital, afterthe suspension of its consideration as arestricted drug and the electronic prescription implementation, and therefore,the absence of the need to report the indication and clinical parameters in theprescription. A four-week prospective observational study was conducted wherealbumin prescriptions were reviewed. Thedata were processed using the Stata statistical software package.The excessive and wrong use of albumin is confirmed, since most of theprescriptions (54,5%) did not conformto the therapeutic indications of thedata sheet or the main recommendations, the only justification was thecorrection of hypoalbuminemia. Theblood test values showed malnutritionand no patient had a body weight record. Long-term treatments were detected and in many cases they weremaintained until hospital discharge.Most of the total cost was in non-indicated prescriptions. The three hospitaldepartments with the highest albuminconsumption were Internal Medicine,Oncology and Gastroenterology. It isconsidered necessary to reintroducethe intensive monitoring performedyears ago in the hospital for clinical,economic and sustainable reasons. (AU)
Humans , Albumins/pharmacology , Albumins/therapeutic use , Inpatients , Malnutrition/therapy , Hypoalbuminemia/therapy , Biological Factors , Prospective Studies
Abstract Forest fires are a natural element in many terrestrial ecosystems, in Mexico one of the main causes of loss of vegetation coverage is related to them. Nevertheless, no research has been carried out in the Tamaulipan thornscrub communities regarding post-fire regenerative strategies of plant species, therefore, is important to generate knowledge about the ecological role of fire in them. The aim of this study is to characterize the arboreal and shrub vegetation of a Tamaulipan thornscrub community in the Northeast of Mexico after a fire. To determine the composition, diversity and structure of the floral community consisting of trees and shrubs, 6 square-shaped sampling sites of 1,600 m2 were established 3 years after the fire. Margalef (DMg), Shannon-Weiner (H') and Pretzsch (A) indices were calculated to determine the richness, diversity and vertical stratification of species, respectively.23 species, 21 genera and 14 families of vascular plants were registered. The most species were Fabaceae (6) and Rhamnaceae (3) and Cordia boissieri was the specie with greater ecological weight (IVI = 20.3%). The indexes of richness and true diversity (DMg = 3.16; D = 16.44) showed high values, which suggests that the post-fire area has a good regeneration and a high species diversity. With these results we can conclude that the fire is an important agent of change in successional stages of Tamaulipan thornscrub with high values of regeneration after a surface fire.
Resumo Os incêndios florestais são um elemento natural em muitos ecossistemas terrestres, no México uma das principais causas de perda de cobertura vegetal está relacionada a eles, no entanto, nenhuma pesquisa foi realizada nas comunidades de espinheiros de Tamaulipan sobre as estratégias regenerativas pós-fogo de espécies de plantas, portanto, é importante gerar conhecimento sobre o papel ecológico do fogo neles. O objetivo deste estudo é caracterizar a vegetação arbórea e arbustiva de uma comunidade de plantas espinhosas no Tamaulipas, nordeste do México após um incêndio. Para determinar a composição, diversidade e estrutura da comunidade vegetal constituída por árvores e arbustos, seis locais de amostragem em forma de quadrado de 1.600 m2 cada um, foram estabelecidos três anos após o incêndio. Índices de Margalef (DMg), Shannon-Weiner (H') e Pretzsch (A) foram calculados para determinar a riqueza, diversidade e estratificação vertical das espécies, respectivamente. Foram registradas 23 espécies, 21 gêneros e 14 famílias de plantas vasculares. As mais ricas foram Fabaceae (6) e Rhamnaceae (3), Cordia boissieri foi a espécie com maior peso ecológico (IVI = 20,3%). Os índices de riqueza e diversidade verdadeira (DMg = 3,16; D = 16,44) apresentaram valores elevados, o que sugere que a área pós-fogo apresenta boa regeneração e alta diversidade Vegetal. Com estes resultados podemos concluir que o fogo é um importante agente de mudança nos estágios sucessionais do espinho de Tamaulipan com altos valores de regeneração após um incêndio na superfície.
Humans , Ecosystem , Fires , Plants , Trees , Biodiversity , Mexico
Functionally graded NiTi orthodontic archwire was tested to assess the evolution of the actuation force as a function of the temperature. Varying actuation forces on the same orthodontic wire allow the optimization of repositioning of the different types of teeth, according its radicular support. The wire was separated into three segments: Incisive, Premolar and Molar. The functionally graded NiTi orthodontic archwire segments have distinct structural and mechanical behavior as confirmed by differential scanning calorimetry, synchrotron-based X-ray diffraction, and thermomechanical analysis. The mechanical behavior was analyzed by three-point bending tests at four different temperatures (5, 20, 25 and 37 °C). In parallel, three-point bending tests were performed by TMA analysis in a temperature range from 5 °C (from cold water) to 40 °C (hot meal). This study showed the comparison of the different segments on the same archwire, providing a better understanding of the behavior of these functionally graded materials.
Orthodontic Wires , Titanium , Calorimetry, Differential Scanning , Dental Alloys , Elasticity , Materials Testing , Mechanical Phenomena , Temperature
OBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.
Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Nivolumab/therapeutic use , Adult , Aged , Aged, 80 and over , Antineoplastic Agents, Immunological/therapeutic use , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/epidemiology , Female , Humans , Incidence , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Male , Middle Aged , Portugal/epidemiology , Progression-Free Survival , Retrospective Studies , Survival Rate/trends , Treatment Outcome
Forest fires are a natural element in many terrestrial ecosystems, in Mexico one of the main causes of loss of vegetation coverage is related to them. Nevertheless, no research has been carried out in the Tamaulipan thornscrub communities regarding post-fire regenerative strategies of plant species, therefore, is important to generate knowledge about the ecological role of fire in them. The aim of this study is to characterize the arboreal and shrub vegetation of a Tamaulipan thornscrub community in the Northeast of Mexico after a fire. To determine the composition, diversity and structure of the floral community consisting of trees and shrubs, 6 square-shaped sampling sites of 1,600 m2 were established 3 years after the fire. Margalef (DMg), Shannon-Weiner (H') and Pretzsch (A) indices were calculated to determine the richness, diversity and vertical stratification of species, respectively.23 species, 21 genera and 14 families of vascular plants were registered. The most species were Fabaceae (6) and Rhamnaceae (3) and Cordia boissieri was the specie with greater ecological weight (IVI = 20.3%). The indexes of richness and true diversity (DMg = 3.16; D = 16.44) showed high values, which suggests that the post-fire area has a good regeneration and a high species diversity. With these results we can conclude that the fire is an important agent of change in successional stages of Tamaulipan thornscrub with high values of regeneration after a surface fire.
Ecosystem , Fires , Biodiversity , Humans , Mexico , Plants , Trees
PURPOSE: Economic evaluations of mental health interventions often measure health benefit in terms of utility values derived from the EQ-5D. For the five-level version of the EQ-5D, there are two methods of estimating utility [crosswalk and stated preference (5L-SP)]. This paper explores potential impacts for researchers and decision-makers when comparing utility values derived from either method in the specific context of mental health. METHODS: Baseline EQ-5D-5L data from three large randomised controlled trials of interventions for mental health conditions were analysed. Utility values were generated using each method. Mean utility values were compared using a series of t tests on pooled data and subgroups. Scenario analyses explored potential impacts on cost-effectiveness decisions. RESULTS: EQ-5D data were available for 1399 participants. The mean utility value for each trial was approximately 0.08 higher when estimated using the 5L-SP approach compared to crosswalk (p < 0.0001). The difference was greatest among people reporting extreme anxiety/depression (mean utility 5L-SP 0.309, crosswalk 0.084; difference = 0.225; p < 0.0001). Identical improvements in health status were associated with higher costs to gain one QALY with the 5L-SP approach; this is more pronounced when improvements are across all domains compared to improvements on the anxiety/depression domain only. CONCLUSIONS: The two approaches produce significantly different utility values in people with mental health conditions. Resulting differences in cost per QALY estimates suggest that thresholds of cost-effectiveness may also need to be reviewed. Researchers and decision-makers should exercise caution when comparing or synthesising data from trials of mental health interventions using different utility estimation approaches.
Mental Health/economics , Psychometrics/economics , Psychometrics/methods , Quality of Life/psychology , Female , Humans , Male , Mental Health/standards , Middle Aged , Surveys and Questionnaires
OBJECTIVE: To assess changes in the salivary expression of IL-1α, IL-1ß, IL-2, IL-6, IL-10, IL-17, and TNF in acute leukemia (AL) patients before and during chemotherapy, and its association with HSV infection, oral candidiasis (OC), and oral mucositis (OM) onset. METHODS: Cohort study in AL patients >15 years starting induction chemotherapy at a Mexican oncological center (2013-2014). Onset of oral lesions (OLs) was assessed during follow-up, and saliva was obtained at baseline, at visit 2 (days 4-12), and at visit 3 (days 13-21) after chemotherapy, treated with a protease inhibitor and stored at -70°C. An enzyme-linked immunosorbent assay was performed. Cox proportional hazards regression models were constructed to estimate hazard ratios and its 95% CI (HR, 95% CI) for OL development. RESULTS: Forty-one patients were followed up, and 17 (41.5%) developed OLs. OL patients had higher baseline salivary IL-1α than those without lesions (p = 0.040). During visit 2, OL patients had higher levels of IL-1α (p = 0.033), IL-1ß (p = 0.016), IL-6 (p = 0.035), and TNF (p = 0.019) than those who did not develop OLs. Patients with HSV infection, OC, and OM showed higher salivary TNF levels during follow-up (HR: 3.52, 95% CI: 1.35-9.14, p = 0.010). CONCLUSION: AL patients undergoing chemotherapy with high salivary TNF levels were more likely to develop HSV infection, OC, and OM.
Candidiasis, Oral/metabolism , Cytokines/metabolism , Herpes Simplex/metabolism , Saliva/metabolism , Stomatitis/metabolism , Adult , Antineoplastic Agents/adverse effects , Biomarkers/metabolism , Candidiasis, Oral/diagnosis , Doxycycline/adverse effects , Female , Herpes Simplex/diagnosis , Humans , Leukemia/drug therapy , Male , Randomized Controlled Trials as Topic , Stomatitis/diagnosis , Stomatitis/etiology , Tumor Necrosis Factor-alpha/metabolism , Young Adult
BACKGROUND: Bipolar disorder (BD) costs the English economy an estimated £5.2billion/year, largely through incomplete recovery. This analysis estimated the cost-effectiveness of group psychoeducation (PEd), versus group peer support (PS), for treating BD. METHODS: A 96-week pragmatic randomised controlled trial (RCT), conducted in NHS primary care. The primary analysis compared PEd with PS, using multiple imputed datasets for missing values. An economic model was used to compare PEd with treatment as usual (TAU). The perspective was Health and Personal Social Services. RESULTS: Participants receiving PEd (n=153) used more (costly) health-related resources than PS (n=151) (net cost per person £1098 (95% CI, £252-£1943)), with a quality-adjusted life year (QALY) gain of 0.023 (95% CI, 0.001-0.056). The cost per QALY gained was £47,739. PEd may be cost-effective (versus PS) if decision makers are willing to pay at least £37,500 per QALY gained. PEd costs £10,765 more than PS to avoid one relapse. The economic model indicates that PEd may be cost-effective versus TAU if it reduces the probability of relapse (by 15%) or reduces the probability of and increases time to relapse (by 10%). LIMITATIONS: Participants were generally inconsistent in attending treatment sessions and low numbers had complete cost/QALY data. Factors contributing to pervasive uncertainty of the results are discussed. CONCLUSIONS: This is the first economic evaluation of PEd versus PS in a pragmatic trial. PEd is associated with a modest improvement in health status and higher costs than PS. There is a high level of uncertainty in the data and results.
Bipolar Disorder/economics , Bipolar Disorder/therapy , Health Education/methods , Primary Health Care/economics , Self-Help Groups , Adult , Cost-Benefit Analysis , Female , Health Care Costs , Humans , Male , Middle Aged , Primary Health Care/statistics & numerical data , Quality-Adjusted Life Years , Surveys and Questionnaires , Young Adult
Abstract Forest fires are a natural element in many terrestrial ecosystems, in Mexico one of the main causes of loss of vegetation coverage is related to them. Nevertheless, no research has been carried out in the Tamaulipan thornscrub communities regarding post-fire regenerative strategies of plant species, therefore, is important to generate knowledge about the ecological role of fire in them. The aim of this study is to characterize the arboreal and shrub vegetation of a Tamaulipan thornscrub community in the Northeast of Mexico after a fire. To determine the composition, diversity and structure of the floral community consisting of trees and shrubs, 6 square-shaped sampling sites of 1,600 m2 were established 3 years after the fire. Margalef (DMg), Shannon-Weiner (H) and Pretzsch (A) indices were calculated to determine the richness, diversity and vertical stratification of species, respectively.23 species, 21 genera and 14 families of vascular plants were registered. The most species were Fabaceae (6) and Rhamnaceae (3) and Cordia boissieri was the specie with greater ecological weight (IVI = 20.3%). The indexes of richness and true diversity (DMg = 3.16; D = 16.44) showed high values, which suggests that the post-fire area has a good regeneration and a high species diversity. With these results we can conclude that the fire is an important agent of change in successional stages of Tamaulipan thornscrub with high values of regeneration after a surface fire.
Resumo Os incêndios florestais são um elemento natural em muitos ecossistemas terrestres, no México uma das principais causas de perda de cobertura vegetal está relacionada a eles, no entanto, nenhuma pesquisa foi realizada nas comunidades de espinheiros de Tamaulipan sobre as estratégias regenerativas pós-fogo de espécies de plantas, portanto, é importante gerar conhecimento sobre o papel ecológico do fogo neles. O objetivo deste estudo é caracterizar a vegetação arbórea e arbustiva de uma comunidade de plantas espinhosas no Tamaulipas, nordeste do México após um incêndio. Para determinar a composição, diversidade e estrutura da comunidade vegetal constituída por árvores e arbustos, seis locais de amostragem em forma de quadrado de 1.600 m2 cada um, foram estabelecidos três anos após o incêndio. Índices de Margalef (DMg), Shannon-Weiner (H) e Pretzsch (A) foram calculados para determinar a riqueza, diversidade e estratificação vertical das espécies, respectivamente. Foram registradas 23 espécies, 21 gêneros e 14 famílias de plantas vasculares. As mais ricas foram Fabaceae (6) e Rhamnaceae (3), Cordia boissieri foi a espécie com maior peso ecológico (IVI = 20,3%). Os índices de riqueza e diversidade verdadeira (DMg = 3,16; D = 16,44) apresentaram valores elevados, o que sugere que a área pós-fogo apresenta boa regeneração e alta diversidade Vegetal. Com estes resultados podemos concluir que o fogo é um importante agente de mudança nos estágios sucessionais do espinho de Tamaulipan com altos valores de regeneração após um incêndio na superfície.
BACKGROUND: To establish the role of antiemetic therapy with neurokinin-1 (NK1) receptor antagonists (RAs) in nonanthracycline and cyclophosphamide (AC)-based moderately emetogenic chemotherapy (MEC) regimens, this study evaluated single-dose intravenous (i.v.) fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with non-AC MEC. PATIENTS AND METHODS: In this international, phase III, double-blind trial, adult cancer subjects scheduled to receive ≥1 non-AC MEC on day 1 were randomized to a regimen comprising single-dose i.v. fosaprepitant 150 mg or placebo along with ondansetron and dexamethasone on day 1; control regimen recipients received ondansetron on days 2 and 3. Primary end points were the proportion of subjects achieving a complete response (CR; no vomiting and no use of rescue medication) in the delayed phase (25-120 h after MEC initiation) and safety. Secondary end points included CR in the overall and acute phases (0-120 and 0-24 h after MEC initiation, respectively) and no vomiting in the overall phase. Nausea and the Functional Living Index-Emesis were assessed as exploratory end points. RESULTS: The fosaprepitant regimen improved CR significantly in the delayed (78.9% versus 68.5%; P < 0.001) and overall (77.1% versus 66.9%; P < 0.001) phases, but not in the acute phase (93.2% versus 91.0%; P = 0.184), versus control. In the overall phase, the proportion of subjects with no vomiting (82.7% versus 72.9%; P < 0.001) and no significant nausea (83.2% versus 77.9%; P = 0.030) was also significantly improved with the fosaprepitant regimen. The fosaprepitant regimen was generally well tolerated. CONCLUSION: Single-dose fosaprepitant added to a 5-HT3 RA and dexamethasone was well tolerated and demonstrated superior control of CINV (primary end point achieved) associated with non-AC MEC. This is the first study to evaluate NK1 RA therapy as an i.v. formulation in a well-defined non-AC MEC population. CLINICALTRIALSGOV: NCT01594749 (https://clinicaltrials.gov/ct2/show/NCT01594749).
Antiemetics/therapeutic use , Antineoplastic Agents/adverse effects , Lung Neoplasms/drug therapy , Morpholines/therapeutic use , Nausea/prevention & control , Vomiting/prevention & control , Antineoplastic Agents/therapeutic use , Double-Blind Method , Female , Humans , Male , Middle Aged , Nausea/chemically induced , Treatment Outcome , Vomiting/chemically induced
INTRODUCCIÓN: Las úlceras venosas (UV) son las úlceras más frecuentes de la extremidad inferior, ellas generan alta morbilidad con importantes costos para los sistemas de salud. OBJETIVO: Determinar el porcentaje de curación de UV mediante un tratamiento convencional frente al mismo tratamiento más oclusión venosa endoluminal con escleroespuma ecoguiada. MATERIAL Y MÉTODOS: Ensayo clínico prospectivo y aleatorizado, realizado en la consulta externa de cirugía vascular del Hospital Occidente de Kennedy-Bogotá, entre los años 2011 y 2012. Se incluye a 44 pacientes mayores de 18 años, portadores de una UV e índice tobillo-brazo mayor a 0,8. Se analizaron en total 48 extremidades. Los pacientes fueron aleatorizados en 2 grupos: a) control (cura local húmeda más vendaje no compresivo) y b) ensayo: al tratamiento del grupo control se asocia inyección de escleroespuma (técnica de Tessari) en el sistema venoso superficial insuficiente, guiado por ecodoppler. Se realizaron controles a las 3, 8, 12 y 24 semanas. RESULTADOS: Al final del seguimiento (24 semanas), la curación de UV fue del 83,3% (20 extremidades) en el grupo de oclusión endoluminal con espuma ecoguiada frente al 12,5% (3 extremidades) del grupo control o convencional (p = 0,0005). No se observaron complicaciones mayores, derivadas de los tratamientos, en ningún grupo. CONCLUSIÓN: La oclusión endoluminal venosa con escleroespuma ecoguiada es segura y efectiva. Las tasas de curación de UV con esta técnica, mínimamente invasiva, son superiores a las del tratamiento conservador con curas húmedas y vendaje no compresivo
INTRODUCTION: Venous ulcers (VU) are the most common ulcers of the lower limb. It has a high morbidity and is a financial strain on the health system. OBJECTIVE: The aim of this study was to determine the rate of healing VU with a conventional treatment versus the use of conventional treatment plus ultrasound-guided foam endoluminal occlusion. MATERIAL AND METHODS: A prospective randomized clinical trial was conducted on patients attending the Vascular Surgery clinics in the Hospital Occidente de Kennedy-Bogotá during 2011-2012. A total of 44 patients age 18 years and over, with venous insufficiency, VU, and an ankle-brachial index greater than 0.8, were included. A total of 48 extremities were analyzed in the two groups; one group a) Control: (conventional treatment with non-compressive bandages, vaseline gauze, and wound care) and b) Study group: control treatment plus endoluminal occlusion with ultrasound-guided foam in the superficial venous system by Tessari method using 1% lapidium hydrochloride (sklerol). Follow-up was carried out at week 3, 8, 12 and 24. RESULTS: The healing rate of the ulcer at week 24 was 20 (83.3%) extremities healed by the endoluminal occlusion with ultrasound-guided foam group vs. 3 (12.5%) extremities healed in the group using the conventional treatment (P=.0005). No major complications arising from treatment were observed in either group. CONCLUSION: The healing rates of the VU after endoluminal occlusion with ultrasound-guided foam is safe and effective. This minimally invasive technique is far superior to conventional treatment with non-compressive bandages, vaseline gauze, and wound care, exclusively. Registration number of this study: NCT01594658 in clinical trials
Humans , Male , Female , Varicose Ulcer/complications , Varicose Ulcer/diagnosis , Varicose Ulcer/surgery , Angioplasty/classification , Angioplasty , Angioplasty/instrumentation , Pharmaceutical Preparations/administration & dosage , Pharmaceutical Preparations/analysis , Varicose Ulcer/chemically induced , Varicose Ulcer/classification , Angioplasty/standards , Angioplasty , Pharmaceutical Preparations/classification , Pharmaceutical Preparations , Pharmaceutical Preparations/supply & distribution
The genome sequence of one OXA-48-producing Klebsiella pneumoniae belonging to sequence type (ST) 405, and three belonging to ST11, were used to design and test ST-specific PCR assays for typing OXA-48-producing K. pneumoniae. The approach proved to be useful for in-house development of rapid PCR typing assays for local outbreak surveillance.
Bacterial Typing Techniques/methods , Disease Outbreaks , Genotyping Techniques/methods , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Polymerase Chain Reaction/methods , Humans , Klebsiella Infections/microbiology , Klebsiella pneumoniae/isolation & purification
Numerous therapies have been implemented in an effort to minimize the debilitating effects of the degenerative eye disease Retinitis Pigmentosa (RP), yet none have provided satisfactory long-term solution. To date there is no treatment that can halt the degeneration of photoreceptors. The recent discovery of the RdCVF protein has provided researchers with a potential therapy that could slow the secondary wave of cone death. In this work, we build on an existing mathematical model of photoreceptor interactions in the presence of RP and incorporate various treatment regiments via RdCVF. Our results show that an optimal control exists for the administration of RdCVF. In addition, our numerical solutions show the experimentally observed rescue effect that the RdCVF has on the cones.
Models, Biological , Photoreceptor Cells, Vertebrate/physiology , Retinitis Pigmentosa/therapy , Thioredoxins/physiology , Algorithms , Cell Death/physiology , Cell Survival/physiology , Disease Progression , Humans , Mathematical Concepts , Mutation , Photoreceptor Cells, Vertebrate/drug effects , Photoreceptor Cells, Vertebrate/pathology , Retinal Pigment Epithelium/pathology , Retinitis Pigmentosa/pathology , Retinitis Pigmentosa/physiopathology , Thioredoxins/administration & dosage
OBJECTIVE: Health and lifestyle factors are associated with variations in serum testosterone levels in ageing men. However, it remains unclear how age-related changes in testosterone may be attenuated by lifestyle modifications. The objective was to investigate the longitudinal relationships between changes in health and lifestyle factors with changes in hormones of the reproductive endocrine axis in ageing men. DESIGN: A longitudinal survey of 2736 community-dwelling men aged 40-79 years at baseline recruited from eight centres across Europe. Follow-up assessment occurred mean (±S.D.) 4.4±0.3 years later. RESULTS: Paired testosterone results were available for 2395 men. Mean (±S.D.) annualised hormone changes were as follows: testosterone -0.1±0.95â nmol/l; free testosterone (FT) -3.83±16.8 âpmol/l; sex hormone-binding globulin (SHBG) 0.56±2.5â nmol/l and LH 0.08±0.57â U/l. Weight loss was associated with a proportional increase, and weight gain a proportional decrease, in testosterone and SHBG. FT showed a curvilinear relationship to weight change; only those who gained or lost ≥15% of weight showed a significant change (in the same direction as testosterone). Smoking cessation was associated with a greater decline in testosterone than being a non-smoker, which was unrelated to weight change. Changes in number of comorbid conditions or physical activity were not associated with significant alterations in hypothalamic-pituitary-testicular (HPT) axis function. CONCLUSIONS: Body weight and lifestyle factors influence HPT axis function in ageing. Weight loss was associated with a rise, and weight gain a fall, in testosterone, FT and SHBG. Weight management appears to be important in maintaining circulating testosterone in ageing men, and obesity-associated changes in HPT axis hormones are reversible following weight reduction.
Aging/physiology , Hypothalamo-Hypophyseal System/physiology , Life Style , Testis/physiology , Weight Gain , Weight Loss , Adult , Aged , Aging/blood , Cohort Studies , Europe , Follow-Up Studies , Humans , Hypothalamo-Hypophyseal System/growth & development , Hypothalamo-Hypophyseal System/metabolism , Longitudinal Studies , Luteinizing Hormone/blood , Luteinizing Hormone/metabolism , Male , Middle Aged , Prospective Studies , Sex Hormone-Binding Globulin/analysis , Sex Hormone-Binding Globulin/metabolism , Smoking Cessation , Testis/growth & development , Testis/metabolism , Testosterone/blood , Testosterone/metabolism
BACKGROUND: Despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage, a large mumps outbreak occurred on the US Territory of Guam during 2009 to 2010, primarily in school-aged children. METHODS: We implemented active surveillance in April 2010 during the outbreak peak and characterized the outbreak epidemiology. We administered third doses of MMR vaccine to eligible students aged 9-14 years in 7 schools with the highest attack rates (ARs) between May 18, 2010, and May 21, 2010. Baseline surveys, follow-up surveys and case-reports were used to determine mumps ARs. Adverse events postvaccination were monitored. RESULTS: Between December 1, 2009, and December 31, 2010, 505 mumps cases were reported. Self-reported Pohnpeians and Chuukese had the highest relative risks (54.7 and 19.7, respectively) and highest crowding indices (mean: 3.1 and 3.0 persons/bedroom, respectively). Among 287 (57%) school-aged case-patients, 270 (93%) had ≥2 MMR doses. A third MMR dose was administered to 1068 (33%) eligible students. Three-dose vaccinated students had an AR of 0.9/1000 compared with 2.4/1000 among students vaccinated with ≤2 doses >1 incubation period postintervention, but the difference was not significant (P = 0.67). No serious adverse events were reported. CONCLUSIONS: This mumps outbreak occurred in a highly vaccinated population. The highest ARs occurred in ethnic minority populations with the highest household crowding indices. After the third dose MMR intervention in highly affected schools, 3-dose recipients had an AR 60% lower than students with ≤2 doses, but the difference was not statistically significant and the intervention occurred after the outbreak peaked. This outbreak may have persisted due to crowding at home and high student contact rates.
Disease Outbreaks , Measles-Mumps-Rubella Vaccine/administration & dosage , Measles-Mumps-Rubella Vaccine/immunology , Mumps/epidemiology , Mumps/prevention & control , Adolescent , Adult , Aged , Child , Child, Preschool , Crowding , Ethnicity , Female , Guam/epidemiology , Humans , Infant , Male , Measles-Mumps-Rubella Vaccine/adverse effects , Middle Aged , Socioeconomic Factors , Young Adult
OBJECTIVE: Independent investigations have shown that socioeconomic status (SES) and learned helplessness (LH) are associated with poor disease outcome in patients with rheumatoid arthritis (RA). Our aim was to investigate the cross-sectional relationship between SES, LH, and disease outcome in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent. METHODS: SES was measured using the Index of Multiple Deprivation 2007 for 553 patients consecutively recruited to the Norfolk Arthritis Register. Patients also completed the Rheumatology Attitudes Index, a measure of LH. SES and LH were investigated as predictors of disease outcome (functional disability [Health Assessment Questionnaire (HAQ)] and disease activity [Disease Activity Score in 28 joints]) in a regression analysis, adjusted for age, sex, and symptom duration. The role of LH in the relationship between SES and disease outcome was then investigated. RESULTS: Compared to patients of the highest SES, those of the lowest SES had a significantly worse outcome (median difference in HAQ score 0.42; 95% confidence interval [95% CI] 0.08, 0.75). Compared to patients with normal LH, patients with low LH had a significantly better outcome and patients with high LH had a significantly worse outcome (median difference in HAQ score 1.12; 95% CI 0.82, 1.41). There was a significant likelihood that LH mediated the association between SES and disease outcome (P = 0.04). CONCLUSION: LH is robustly associated with cross-sectional disease outcome in patients with IP, and appears to mediate the relationship between SES and disease outcome. As LH is potentially modifiable, these findings have potential clinical implications.
Arthritis/economics , Arthritis/psychology , Helplessness, Learned , Adult , Aged , Arthritis/pathology , Arthritis, Rheumatoid/economics , Arthritis, Rheumatoid/epidemiology , Arthritis, Rheumatoid/psychology , Cohort Studies , Cross-Sectional Studies , Female , Humans , Inflammation/economics , Inflammation/epidemiology , Inflammation/psychology , Male , Middle Aged , Registries , Social Class , Treatment Outcome
