Preliminary Validation of Mirrored Scales for Monitoring Professional Soccer Training Sessions.

We aimed to create a single subjective method to assess both internal training loads and subsequent fatigue. This new training-fatigue (dose-response) scale (TFS) was composed of two similar scales with the same properties, metrics and construction criteria. These two scales were designed to rate the perceived exertion (RPETFS) and perceived fatigue (RPFTFS) in professional soccer players. Twenty-two athletes participated to establish reliability, and 15 participated to establish validity. For reliability, the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were used. For criterion validity, the Spearman's correlation coefficient and linear regression analyses were applied. Associations between RPETFS and RPFTFS were verified by a chi square test, and a further factorial exploratory analysis was conducted. RPETFS and RPFTFS were found to be reliable (ICC 0.74 and 0.77, SEM 0.30 and 0.30, respectively) and valid. RPETFS was best explained by the internal load of the Banister training impulse (p < 0.001), while RPFTFS was best explained by the internal load of the Stagno training impulse (p < 0.001). An association was found between the scales (RPETFS and RPFTFS) in which training duration had a more substantial impact on these subjective perceptions than did training intensity (p < 0.01). RPETFS and RPFTFS scales are reliable and valid for monitoring training sessions in Brazilian professional soccer players. The simultaneous oscillations of the RPETFS and RPFTFS scores can be used by staff members to better plan weekly training programs based on dose-response ratings. Finally, training duration must be carefully controlled because it has a greater impact than intensity on subjective perceptions.

Chemical composition, fermentative losses, and microbial counts of total mixed ration silages inoculated with different Lactobacillus species.

The objective of this study was to evaluate the effects of Lactobacillus inoculants on fermentation, losses, and aerobic stability of a total mixed ration (TMR) silage. A TMR, formulated to meet the requirements of dairy cows producing 25 kg of milk/d, was applied with the following treatments prior to ensiling: 1) Control (CON), 2) Lactobacillus buchneri (105 cfu/g of fresh forage; LB), and 3) Lactobacillus plantarum (105 cfu/g of fresh forage; LP). TMR silages were ensiled for 15 and 60 d in silos equipped with an apparatus for determination of gravimetric DM, gas, and effluent losses. The experiment was performed in a complete randomized design with a 3 × 2 factorial arrangement of the treatments, with 5 replicates per treatment. Chemical changes, microbial counts, fermentation profile, and aerobic stability were measured after opening the silos. Data were submitted to ANOVA, and means were compared by Tukey and T-test and statistical significance was declared at P ≤ 0.05. After 15 d of ensiling, the inclusion of inoculant decreased NDF (P < 0.05) and butyric acid concentrations (P < 0.05) in TMR. LP had the lowest aerobic stability (P < 0.05) and the greatest loss of DM (P < 0.03). Ensiling for 60 d increased ammonia nitrogen (NH3-N), lactic acid bacteria (LAB), aerobic stability, and concentrations of lactic and acetic acid (P < 0.01) and lowered (P < 0.02) total fermentation losses compared to 15 d across all treatments. After 60 d of ensiling, LP lowered pH to the greatest extent. Treatment had no effect on concentrations of DM, CP, ADF, ash, and EE, as well as in vitro DM digestibility. In conclusion, inoculants containing LP or LB did not improve fermentation profile, did not prolong the aerobic stability, nor reduced losses. Furthermore, the 15-d ensiling period was insufficient for adequate bacterial activity.

Effects of holes in plastic film on the storage losses in total mixed ration silage in round bales.

The ensilage of total mixed ration (TMR) is a technology designed to help farmers with limitations to provide a balanced diet for their herds. Our aim was to evaluate the conservation of TMR ensiled in round bales with or without holes in the wrapping plastic film. Eight round bales of a corn silage-based TMR of 1,000 kg (370 kg DM/m3) were prepared. Ten days (d) after ensiling, four bales were randomly punctured with two holes of 25 cm2 each in opposite sides of the bale. The temperature in the center of the bales was recorded during the storage using dataloggers. After 60 d of storage, bales were weighted to assess dry matter (DM) recovery. Silages were sampled for measuring DM content, chemical composition, pH, lactic acid, and microbial counts. The temperature of the sliced bale face was assessed by infrared thermography. The holes in the plastic affected the DM content, DM recovery, and pH, whereas lactic acid, microbial counts, and temperature were not affected by treatments. The holes in the sealing plastic film should be avoided. However, holes of 25 cm2 each were not capable of causing expressive losses in TMR silage stored in 1,000 kg bales.

A Fourteen-Year Experience with Vascular Anomalies Encountered during Transaxillary Rib Resection for Thoracic Outlet Syndrome.

BACKGROUND: Transaxillary approach to first rib resection and scalenectomy (TAFRRS) is a well-established technique for treatment of thoracic outlet syndrome (TOS). Although anatomic features encountered during TAFRRS are in general constant, vascular anomalies may be encountered but have not been described to date. Herein we describe vascular abnormalities encountered during TAFRRS. METHODS: We performed a retrospective review of a prospective practice database of 224 operations for TOS performed in 172 patients from March 2000 to March 2014. We excluded 10 patients with missing operative reports, 3 reoperations on the same patient, and 8 non-transaxillary resections. We recorded vascular anomalies identified in operative reports and reviewed computed tomography imaging to delineate the nature of these abnormalities. RESULTS: The overall incidence of vascular anomalies was 11% (22 of 203 TAFRRS). Most patients with anomalies had venous TOS (vTOS) (9 patients, 41%), followed by 7 (32%) with neurogenic TOS (nTOS). The remainder of the patients had arterial TOS (aTOS) (6 patients, 27%). Seven patients (32%) had an abnormal subclavian artery (SCA) with 5 (23%) having an abnormal arterial course in the anterior scalene muscle (ASM); 6 patients (27%) had an abnormal internal mammary artery (IMA) originating from distal SCA; 4 (18%) had abnormalities in the supreme thoracic artery (bifurcation or duplication); 2 (9%) had an abnormal branch from the SCA with anomalous location in the operative field; and 3 (14%) had an abnormal large venous branch penetrating the ASM. In the 19 patients with arterial anomalies, 8 (42%) were recognized as arterial branches penetrating the ASM, and 11 (58%) were noticed as they had anomalous arterial locations within the operative field. Most arterial anomalies were seen in vTOS (9, 45%), followed by nTOS (7, 35%). No intraoperative vascular complications occurred. Perioperative complications included 1 occurrence of postoperative transfusion for bleeding following axillary drain discontinuation and 2 Horner's syndromes. One aberrant IMA was electively ligated to allow complete thoracic outlet decompression. CONCLUSIONS: Arterial anomalies during TAFRRS are encountered in 11% of operations, and may present with vessel locations in unusual areas within the operative field, or as abnormal vessels penetrating the ASM, thus making scalenectomy precarious. Careful attention must be paid to possible abnormal locations of vessels in the thoracic outlet to avoid bleeding complications.

Ethnic differences in sleep duration at 5 years, and its relationship with overweight and blood pressure.

BACKGROUND: Studies on adult population indicate shorter sleep duration in ethnic minority groups than host populations. We examined ethnic differences in sleep duration and its relationship with overweight and blood pressure (BP) among children living in Amsterdam. METHODS: Participants include 2384 children (aged 5 years) and their mothers from the Amsterdam-based longitudinal study. Sleep was categorised into short sleep (<10 h/night) and normal sleep (10-11 h/night). Linear regressions ( Β: were used to study association between sleep duration and systolic BP (SBP) and diastolic BP (DBP). Prevalence ratios (PRs) were used to study ethnic differences in sleep duration and its association with overweight and raised BP. RESULTS: Minority groups reported shorter sleep duration compared to native Dutch, with prevalence ranging from 11.3% in Dutch to 53.1% in Ghanaians. Age-adjusted PRs ranged from 3.38 (95%CI 2.63-4.34) in Moroccans to 4.78 (95%CI 3.36-6.82) in Ghanaian compared with Dutch children. Increased prevalence of overweight was observed among children with short sleep in Dutch and Moroccans only, but this risk was no longer statistically significant after further adjustment for socioeconomic status. Short sleep was not related to SBP and DBP in all groups. No relationship was observed between short sleep and raised BP except for African Surinamese (3.65, 95% CI 1.23-10.8). CONCLUSION: Like adults, children from ethnic minority populations sleep less hours than Dutch children. Efforts to improve ethnic inequalities in sleep hygiene should also include children at younger age. Associations as reported in adults with overweight and BP could not consistently be replicated in children, however.

Zoonotic tuberculosis. A comprehensive ONE HEALTH approach.

The objective of this report is to provide information on Mycobacterium tuberculosis complex infections in animals and in humans. Included is information on the susceptibility of different species as well as information on etiology, epidemiology, pathogenesis, diagnosis, prevention and control of this disease. The term One Health has been adopted to describe the unified human medical and veterinary interdisciplinary/multidisciplinary collaborative approach to zoonoses and will be critical for future endeavors in the control of the global TB epidemic. This unified paradigm is ideally suited for control of bovine TB and many other international public health and clinical health issues. Sharing resources and increasing interaction between public health and veterinary medical scientists can raise awareness of 'shared risk' of bovine TB between humans and animals and, in resource-limited situations, can maximize use of existing infrastructure and reduce unnecessary duplication of effort in disease control programs.

Zoonotic tuberculosis: A comprehensive one health approach

The objective of this report is to provide information on Mycobacterium tuberculosis complex infections in animals and in humans. Included is information on the susceptibility of different species as well as information on etiology, epidemiology, pathogenesis, diagnosis, prevention and control of this disease. The term One Health has been adopted to describe the unified human medical and veterinary interdisciplinary/multidisciplinary collaborative approach to zoonoses and will be critical for future endeavors in the control of the global TB epidemic. This unified paradigm is ideally suited for control of bovine TB and many other international public health and clinical health issues. Sharing resources and increasing interaction between public health and veterinary medical scientists can raise awareness of ‘shared risk' of bovine TB between humans and animals and, in resource-limited situations, can maximize use of existing infrastructure and reduce unnecessary duplication of effort in disease control programs.

El objetivo de este artículo es proporcionar información sobre las infecciones por el Complejo Mycobacterium tuberculosis en animales y en humanos. Se incluye información sobre la susceptibilidad de diferentes especies, así como sobre la etiología, epidemiología, patogenia, diagnóstico, prevención y control de esta enfermedad. La expresión UNA SALUD ha sido adoptada para describir el enfoque unificado de la medicina humana y la veterinaria, de colaboración interdisciplinaria/multidisciplinaria en las zoonosis, que puede resultar fundamental para el control de la endemia mundial de tuberculosis. Este paradigma unificado es especialmente relevante para el control de la tuberculosis bovina. Compartir recursos y lograr una mayor interacción entre la investigación en salud pública y en medicina veterinaria puede elevar la conciencia de “riesgo compartido” de la tuberculosis bovina en humanos y animales y, en situaciones de recursos limitados, puede maximizar el uso de la infraestructura existente y reducir la duplicación innecesaria de esfuerzos en los programas de control de la infección y enfermedad.

Guided bone regeneration produced by new mineralized and reticulated collagen membranes in critical-sized rat calvarial defects.

The aim of this study was to evaluate the bone regenerative effect of glutaraldehyde (GA) cross-linking on mineralized polyanionic collagen membranes in critical-sized defects on rat calvarias. Bone calvarial defects were induced in Wistar rats, which were then divided into five groups: a sham group; a control group, which received a commercial membrane; and GA, 25GA, and 75GA groups, which received one of three different polyanionic collagen membranes mineralized by 0, 25, or 75 hydroxyapatite cycles and then cross-linked by GA. Bone formation was evaluated based on digital radiography and computerized tomography. Histological analyses were performed 4 and 12 weeks after the surgical procedure to observe bone formation, membrane resorption, and fibrous tissue surrounding the membranes. Measurement of myeloperoxidase activity, tumor necrosis factor alpha, and interleukin 1beta production was performed 24 h after surgery. The percentage of new bone formation in the GA, 25GA, and 75GA groups was higher compared with the control and sham groups. In the GA and 25 GA groups, the membranes were still in place and were contained in a thick fibrous capsule after 12 weeks. No significant difference was found among the groups regarding myeloperoxidase activity and interleukin 1beta levels, although the GA, 25GA, and 75GA groups presented decreased levels of tumor necrosis factor alpha compared with the control group. These new GA cross-linked membranes accelerated bone healing of the calvarium defects and did not induce inflammation. In addition, unlike the control membrane, the experimental membranes were not absorbed during the analyzed period, so they may offer advantages in large bone defects where prolonged membrane barrier functions are desirable.

Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial.

OBJECTIVES: To evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension. METHODS: Cluster randomised trial involving four Dutch primary care centres and 146 patients (intervention n=75, control n=71), who met the following inclusion criteria: self-identified Surinamese or Ghanaian; ≥ 20 years; treated for hypertension; SBP ≥ 140 mmHg. All patients received usual hypertension care. The intervention-group was also offered three nurse-led, culturally appropriate hypertension education sessions. BP was assessed with Omron 705-IT and treatment adherence with lifestyle- and medication adherence scales. RESULTS: 139 patients (95%) completed the study (intervention n=71, control n=68). Baseline characteristics were largely similar for both groups. At six months, we observed a SBP reduction of ≥ 10 mmHg -primary outcome- in 48% of the intervention group and 43% of the control group. When adjusted for pre-specified covariates age, sex, hypertension duration, education, baseline measurement and clustering effect, the between-group difference was not significant (OR; 0.42; 95% CI: 0.11 to 1.54; P=0.19). At six months, the mean SBP/DBD had dropped by 10/5.7 (SD 14.3/9.2)mmHg in the intervention group and by 6.3/1.7 (SD 13.4/8.6)mmHg in the control group. After adjustment, between-group differences in SBP and DBP reduction were -1.69 mmHg (95% CI: -6.01 to 2.62, P=0.44) and -3.01 mmHg (-5.73 to -0.30, P=0.03) in favour of the intervention group. Mean scores for adherence to lifestyle recommendations increased in the intervention group, but decreased in the control group. Mean medication adherence scores improved slightly in both groups. After adjustment, the between-group difference for adherence to lifestyle recommendations was 0.34 (0.12 to 0.55; P=0.003). For medication adherence it was -0.09 (-0.65 to 0.46; P=0.74). CONCLUSION: This intervention led to significant improvements in DBP and adherence to lifestyle recommendations, supporting the need for culturally appropriate hypertension care. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN35675524.

Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease).

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.

Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. .

Acute ischemia after revision hallux valgus surgery leading to amputation.

Acute arterial insufficiency after revision hallux valgus surgery is a rare complication. The identification of surgical candidates who are at risk of vascular complications is of utmost importance. The patient-reported symptoms and physical findings combined with noninvasive vascular studies are generally reliable to assess the vascular status but can fail to identify patients with atypical disease patterns. We present the case of a patient with normal pulses who underwent revision hallux valgus surgery, leading to gangrene of the hallux that required transmetatarsal amputation. We reviewed the vascular evaluation methods and causes of acute ischemia after surgery, including vasculitis.

A cluster-randomized controlled trial evaluating the effect of culturally-appropriate hypertension education among Afro-Surinamese and Ghanaian patients in Dutch general practice: study protocol.

BACKGROUND: Individuals of African descent living in western countries have increased rates of hypertension and hypertension-related complications. Poor adherence to hypertension treatment (medication and lifestyle changes) has been identified as one of the most important modifiable causes for the observed disparities in hypertension related complications, with patient education being recommended to improve adherence. Despite evidence that culturally-appropriate patient education may improve the overall quality of care for ethnic minority patients, few studies have focused on how hypertensive individuals of African descent respond to this approach. This paper describes the design of a study that compares the effectiveness of culturally-appropriate hypertension education with that of the standard approach among Surinamese and Ghanaian hypertensive patients with an elevated blood pressure in Dutch primary care practices. METHODS/DESIGN: A cluster-randomized controlled trial will be conducted in four primary care practices in Amsterdam, all offering hypertension care according to Dutch clinical guidelines. After randomization, patients in the usual care sites (n = 2) will receive standard hypertension education. Patients in the intervention sites (n = 2) will receive three culturally-appropriate hypertension education sessions, culturally-specific educational materials and targeted lifestyle support. The primary outcome will be the proportion of patients with a reduction in systolic blood pressure >or= 10 mmHg at eight months after the start of the trial. The secondary outcomes will be the proportion of patients with self-reported adherence to (i) medication and (ii) lifestyle recommendations at eight months after the start of the trial. The study will enrol 148 patients (74 per condition, 37 per site). Eligibility criteria for patients of either sex will be: current diagnosis of hypertension, self-identified Afro-Surinamese or Ghanaian, >or= 20 years, and baseline blood pressure >or= 140/90 mmHg. Primary and secondary outcomes will be measured at baseline and at 3 1/2, 6 1/2, and eight months. Other measurements will be performed at baseline and eight months. DISCUSSION: The findings will provide new knowledge on how to improve blood pressure control and patient adherence in ethnic minority persons with a high risk of negative hypertension-related health outcomes. TRIAL REGISTRATION: ISRCTN35675524.

Dwarfism in insular sloths: biogeography, selection, and evolutionary rate.

The islands of Bocas del Toro, Panama, were sequentially separated from the adjacent mainland by rising sea levels during the past 10,000 years. Three-toed sloths (Bradypus) from five islands are smaller than their mainland counterparts, and the insular populations themselves vary in mean body size. We first examine relationships between body size and physical characteristics of the islands, testing hypotheses regarding optimal body size, evolutionary equilibria, and the presence of dispersal in this system. To do so, we conduct linear regressions of body size onto island area, distance from the mainland, and island age. Second, we retroactively calculate two measures of the evolutionary rate of change in body size (haldanes and darwins) and the standardized linear selection differential, or selection intensity (i). We also test the observed morphological changes against models of evolution by genetic drift. The results indicate that mean body size decreases linearly with island age, explaining up to 97% of the variation among population means. Neither island area nor distance from the mainland is significant in multiple regressions that include island age. Thus, we find no evidence for differential optimal body size among islands, or for dispersal in the system. In contrast, the dependence of body size on island age suggests uniform directional selection for small body size in the insular populations. Although genetic drift cannot be discounted as the cause for this evolution in body size, the probability is small given the consistent direction of evolution (repeated dwarfism). The insular sloths show a sustained rate of evolution similar to those measured in haldanes over tens of generations, appearing to unite micro- and macroevolutionary time scales. Furthermore, the magnitude and rate of this example of rapid differentiation fall within predictions of theoretical models from population genetics. However, the linearity of the relationship between body size and island age is not predicted, suggesting that either more factors are involved than those considered here, or that theoretical advances are necessary to explain constant evolutionary rates over long time spans in new selective environments.

Antipsychotic profile of alstonine: ethnopharmacology of a traditional Nigerian botanical remedy

Although recently developed drugs have brought significant improvement, the treatment of psychotic disorders still presents serious drawbacks. Since inherent complexity and lack of satisfactory understanding of the underlying pathophysiology impose limits for rational drug design, resourceful approaches in the search for antipsychotics are pertinent. This paper reports pharmacological properties of alstonine, a heteroyohimbine type alkaloid, Which exbitited an antipsychotic-like profile, inhibiting amphetamine-induced lethaly, apomorphine-induced steotypy and potentiating barbiturate-induced slleping time. Atypical features of alstonine were the prevention of haloperidol-induced catalepsy and lack of direct interaction with D1, D2 and 5-HT2A receptors, classically linked to antipsychotic mechanism of action.

Aproximación diagnóstica área rural: Segundo curso de planificación en salud / Aproximation diagnosis rural defendant: Second course in Planing in health

Contiene: Características socio-culturales,población,migración,crisis económica en Bolivia,b)situación del departamento c)Caracteristicas socio-sociodemograficasc)Factores de riesgo d)Serevicios básicos sociales e)Oferta de servicios...