Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study.

OBJECTIVE: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS: After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

[Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study]. / Pacientes críticos COVID-19. ¿Han variado el manejo y los resultados en la UCI tras un año de pandemia? Estudio multicéntrico, prospectivo, observacional.

Objective: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic. Methodology: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). Results: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%). Conclusions: After one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

The Effectiveness of Vocal Health Programs in the Prevention of Voice Disorders in Teachers: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effectiveness of voice disorder prevention programs and to verify the effectiveness of direct and indirect voice training on the Voice Handicap Index (VHI), Voice-Related Quality of Life (V-RQOL), maximum phonation time (MPT), fundamental frequency and shimmer, for the prevention of voice disorders in regular-school teachers. METHODS: This is a literature review with meta-analysis, carried out through an electronic search in PubMed, Cochrane Central, Embase, Web of Science, Scopus and BVS, and Google Scholar, as well as ClinicalTrials.gov databases for gray literature. SELECTION CRITERIA: Randomized clinical trials and quasi-experimental studies were selected. The population consisted of regular schoolteachers, adults, with no vocal complaints submitted to a vocal health education and prevention program of voice disorders classified as direct (direct vocal tract training) and indirect (vocal hygiene guidelines that influence voice production). The outcomes vocal self-assessment: fundamental frequency, aerodynamic measurements (maximum phonation time), acoustic measures (shimmer) was analyzed in comparison with other vocal interventions or no vocal intervention. DATA ANALYSIS: Studies were independently assessed using the Cochrane Risk of bias and ROBINS-I tools. Effect sizes were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence. RESULTS: Twenty-six studies were included but, only 12 studies were included in the meta-analysis and investigated for direct and/or indirect intervention compared to no intervention. No studies were judged to be at low risk of bias, and the quality of evidence was considered high only for the Voice Handicap Index. No evidence was found that suggested effectiveness of direct and indirect voice training for any of the outcomes: VHI -1.87 (95% CI -7.03, 3.30), maximum phonation time -1.11 (95% CI -3.40, 1.17), fundamental frequency 0.87 (-1.06, 2.79) and shimmer 0, 28 (-1.50, 2.05). CONCLUSION: Results of this study were not considered significant to conclude on the effectiveness of voice training for preventing dysphonia in teachers.

Alamandine Induces Neuroprotection in Ischemic Stroke Models.

BACKGROUND AND OBJECTIVE: Stroke, a leading cause of mortality and disability, characterized by neuronal death, can be induced by a reduction or interruption of blood flow. In this study, the role of Alamandine, a new peptide of the renin-angiotensin system, was evaluated in in-vitro and in-vivo brain ischemia models. METHODS: In the in-vitro model, hippocampal slices from male C57/Bl6 mice were placed in a glucose-free aCSF solution and bubbled with 95% N2 and 5% CO2 to mimic brain ischemia. An Alamandine concentration-response curve was generated to evaluate cell damage, glutamatergic excitotoxicity, and cell death. In the in-vivo model, cerebral ischemia/ reperfusion was induced by bilateral occlusion of common carotid arteries (BCCAo-untreated) in SD rats. An intracerebroventricular injection of Alamandine was given 20-30 min before BCCAo. Animals were subjected to neurological tests 24 h and 72 h after BCCAo. Cytokine levels, oxidative stress markers, and immunofluorescence were assessed in the brain 72 h after BCCAo. RESULTS: Alamandine was able to protect brain slices from cellular damage, excitotoxicity and cell death. When the Alamandine receptor was blocked, protective effects were lost. ICV injection of Alamandine attenuated neurological deficits of animals subjected to BCCAo and reduced the number of apoptotic neurons/cells. Furthermore, Alamandine induced anti-inflammatory effects in BCCAo animals as shown by reductions in TNFα, IL- 1ß, IL-6, and antioxidant effects through attenuation of the decreased SOD, catalase, and GSH activities in the brain. CONCLUSION: This study showed, for the first time, a neuroprotective role for Alamandine in different ischemic stroke models.

Morphological diversity and discrimination tools of the non-marine ostracod Cypridopsis silvestrii across temporal and spatial scales from Patagonia.

Geometric morphometric methods are powerful tools to discriminate between closely related ostracods taxa as well as to study the relationship between their morphological variations, taxonomy and paleoecology. In this study, valve outline analysis allows the discrimination between the non-marine ostracod C. silvestrii and R. whatleyi juveniles, pointing out differences in the posterior valve area and surface ornamentation. Modern female specimens of C. silvestrii from 23 sites located in a spatial transect (41 to 51 °S) exhibited extensive morphological variability, on the basis of which three morphotypes (acuminated, transitional, subtruncated) were determined. Multivariate analyses showed that acuminated and transitional shapes are not arranged in groups but the subtruncated morphotype, previously described as E. cecryphalium, seems to be associated with low water conductivity (372 µS cm-1), dominant cold (5 ºC) and windy (8.6 m s-1) climatic conditions. The fossil cluster which included nine cores spanning the last 15.6 kyr, only covered acuminated and transitional shapes, which may indicate that these lineages might be older than the subtruncated morphotype. In addition, morphological differences between reproduction modes suggested that parthenogenetic females exhibit de posterior margin more acuminate than sexual females. These results set the ground for more precise ecological and paleoenvironmental studies in Patagonia.

Characterizing ecoregions in Argentinian Patagonia using extant continental ostracods.

In order to characterize Patagonian (Argentina) ecoregions using non-marine ostracods, their associations in 69 environments were assessed. Twenty eight taxa were recorded, including 12 endemic of the Neotropical region. Our results indicate that Patagonian ostracods are mainly influenced by electrical conductivity (EC), altitude, pH, and temperature; and shows a correlation with Argentinian ecoregions. Assemblage I is composed of sites located at high altitude in the Andean Patagonian forest ecoregion. Host waters have low temperature, EC and pH, and support as representative species Cypris pubera, Eucypris virens, Bradleystrandesia fuscata, Tonacypris lutaria and Amphicypris nobilis. Assemblage II, related to mid-altitude environments in the Patagonian Steppe ecoregion, thrived in waters with moderate to high EC, and alkaline pH values. Dominant species includes Limnocythere rionegroensis, L. patagonica, E. virgata, Riocypris whatleyi, Riocypris sarsi, Newnhamia patagonica, Kapcypridopsis megapodus, Ilyocypris ramirezi and Penthesinelula incae. Assemblage III inhabited environments within Monte and Espinal ecoregions, situated in the eastern part of the study area at low altitude, EC moderate and temperate waters, supporting Heterocypris hyalinus, Amphicypris argentinensis, Sarscypridopsis aculeata, Cypridopsis vidua, Herpetocypris intermedia and Chlamidotheca incisa. Our results indicates that Argentinian Patagonia hosts a diverse ostracod fauna and highlights their capacity as proxies in ecological and palaeoenvironmental studies.

Taxonomic revision of Cypridopsis silvestrii comb. nov. (Ostracoda, Crustacea) from Patagonia, Argentina with morphometric analysis of their intraspecific shape variability and sexual dimorphism.

In this study we redescribe an ostracod species belonging to the subfamily Cypridopsinae Kaufmann, 1900, sampled in seven localities of northern and southern Patagonia, Argentina. A new taxonomical combination is proposed, Cypridopsis silvestrii comb. nov., based on detailed description of females and the first descriptions of males. Cypridopsis silvestrii occurred on a wide geographical distribution range, from 40º to 48º S latitude, as well as broad environmental tolerance ranges. We evaluated morphological variations in two populations of C. silvestrii from northern (El Toro lake) and southern (El Sello lake) Patagonia, with contrasting limnological conditions. El Toro is a small shallow lake with high salinity waters and El Sello is a large deep lake with lower salinity. Based on morphometric analysis, our results showed intraspecific variation in valve shape and size between populations. Sexual dimorphism in El Toro population was identified through morphometric analyses. Additionally, comparison of valve outlines in living and subfossil individuals from El Toro lake allowed specimens previously described as juveniles of Eucypris fontana (Graf, 1931) to be identified as adults of C. silvestrii comb. nov. The present contribution increases knowledge of the taxonomic identity, the ecological requirements and the geographical distribution of C. silvestrii, and shows that morphometric analyses are a feasible and useful tool for exploring intraspecific shape differences and assisting in taxonomic identification. Furthermore, the results presented herein provide tools for C. silvestrii identification in paleolimnological studies, and emphasize the usefulness of studying living representatives for clarification of the taxonomic status of species widely distributed in Quaternary sediments.

Em busca de atenção em rede: contribuições de um programa de residência multiprofissional no âmbito hospitalar / In search of network attention: contributions of a multiprofessional residency program in the hospital context

Resumo Introdução O Sistema Único de Saúde considera o cuidado hospitalar como importante eixo para a construção da integralidade. Os residentes do Programa de Residência Multiprofissional, do Hospital Universitário da Universidade de São Paulo, identificaram dificuldades da equipe médica e de enfermagem em detectar demandas em reabilitação na alta hospitalar, levando residentes a criarem um grupo de apoio à alta. Objetivo Verificar o perfil sociodemográfico e de saúde dos usuários acompanhados pelo grupo de apoio, identificar os desafios para inserção dos usuários na rede de serviços de reabilitação e as estratégias do grupo de apoio para enfrentamento desses desafios. Método Estudo retrospectivo, exploratório e descritivo, baseado em análise documental. Resultados Foram analisados formulários de 251 usuários, 83 (33%) receberam encaminhamento para reabilitação por ocasião na alta hospitalar e 17 (6,7%), a partir das orientações do grupo de apoio à alta; 95 (37,8%) procuraram serviços de reabilitação. Desses, 60 foram efetivamente inseridos em serviços, sendo 46 (18,3%) extra-hospitalares, como centros de reabilitação e unidades básicas de saúde, e 14 (5,6%) no Programa de Atendimento Domiciliar do hospital. Quanto às áreas profissionais, 34 (13,5%) iniciaram tratamento fisioterápico, 29 (11,6%), fonoaudiológico e 11 (4,9%), terapêutico-ocupacional. Identificaram-se insuficiência de encaminhamentos profissionais e dificuldades dos usuários quanto ao acesso e continuidade de atenção. Conclusão O grupo de apoio tem reforçado encaminhamentos prescritos ou sua obtenção em consultas médicas na rede, acolhido demandas por área profissional, orientado usuários para acessar serviços e inserir-se em tratamentos. Os usuários valorizaram a escuta e o acolhimento do grupo de apoio, no qual se configuram estratégias para promoção do cuidado integral em saúde.

Abstract Introduction The Unified Health System considers that hospital care is important for the construction of integrality. Residents in a Multi-professional Residency Program to the Hospital Universitário da Universidade de São Paulo indicated, difficulties of the medical and nursing staff were identified to detecting demands for rehabilitation at hospital discharge, which encouraged residents to create a support group to hospital discharge. Objective To verify the sociodemographic and health profile of users accompanied by the support group, identify challenges for insertion of these users in the rehabilitation care network and identify strategies of the support group to face these challenges. Method Retrospective, exploratory and descriptive study, based on the documentary analysis. Results We analyzed forms of 251 users, 83 (33%) received a referral for rehabilitation at discharge and 17 (6.7%) received referral after guidelines of the discharge support group; 95 (37.8%) sought rehabilitation services. Of these, 60 were effectively included in the services, of which 46 (18.3%) were extra-hospital, such as rehabilitation centers, basic health units and 14 (5.6%) in the Hospital Home Care Program. Concerning professional areas, 34 (13.5%) started physical therapy treatment, 29 (11.6%), speech therapy and 11 (4.9%), therapeutic-occupational. It was identified insufficiency of professional referrals and difficulties of users regarding access and continuity of care. To cope with challenges, the support group has reinforced prescribed referrals or directed obtaining referrals in medical consultations on the network. Conclusion The group has tried to understand user demands by professional area, oriented users to access services and to get treatments. The users have valued the receptiveness of the support group, being a strategy to promote integral health care.

Hepatocellular carcinoma: resection with adjuvant hepatic artery infusion therapy vs resection alone. A systematic review and meta-analysis.

Hepatocellular carcinoma (HCC) has a recurrence rate of up to 70% in 5 years after resection, detrimentally lowering survival. The role of adjuvant therapy remains controversial; therefore, the aim of this study was to evaluate the disease-free and overall survival of patients with HCC, not candidates for transplantation, undergoing resection and adjuvant hepatic artery infusion therapy vs resection alone. Our meta-analysis showed that adjuvant HAIC improves overall and disease-free survival after resection, especially in tumors ≥7 cm.

Tempo ideal de vibração sonorizada de língua em crianças disfônicas / Ideal time of sonorous tongue vibration of dysphonic children / Tiempo ideal de la vibración sonora del lengua en niños disfónicas

Objetivo: verificar o tempo ideal do exercício de vibração sonorizada de língua (EVSL) na voz de crianças disfônicas. Método: participaram vinte e sete crianças, entre 04 e 11 anos, com diagnóstico de nódulo ou cisto de pregas vocais. Dessas crianças, onze fizeram parte do grupo experimental (GE) e 16 do grupo controle (GC). A vogal sustentada /ε/ e a contagem de 1 a 10 foram registradas antes (m0) e após o primeiro (m1), terceiro (m3), quinto (m5) e o sétimo (m7) minuto de execução do EVSL. As gravações foram apresentadas a três fonoaudiólogas, que julgaram se houve modificação da qualidade vocal. Os parâmetros acústicos avaliados na vogal sustentada foram frequência fundamental, jitter, shimmer, glotal to noise excitation (GNE) e ruído. Resultados: na avaliação perceptivo-auditiva, não houve modificações significativas entre os momentos de execução do EVSL. Na análise acústica, observou-se que o parâmetro ruído diminuiu e o parâmetro GNE aumentou após três minutos de realização do exercício no GE, em comparação com o GC. Conclusão: não houve melhora em nenhum dos tempos na avaliação perceptivoauditiva da voz de crianças disfônicas com o EVSL. A análise acústica indicou melhora da qualidade vocal aos três minutos de execução do exercício.

Purpose: verify the ideal time of the sonorous tongue vibration exercise (STVE) in the voice of dysphonic children. Method: participated twenty-seven children, from four to 11 years, diagnosed with nodules or cysts of vocal folds. Eleven children were part of the experimental group (GE) and 16 were part of the control group (GC). A sustained vowel /ε/ and count one to 10 were recorded before (m0) and after the first (m1), third (m3), fifth (m5) and the seventh (m7) minute of execution of the STVE. The recordings have been presented to three speech therapists that judged whether there was change in voice quality. The acoustic parameters evaluated in sustained vowel were fundamental frequency, jitter, shimmer, glottal to noise excitation (GNE) and noise. Results: there were no significant changes in the auditory perception evaluation between the moments of STVE execution. In the acoustic analysis, it was observed that the noise parameter decreased and the GNE parameter increased after three minutes of performing the exercise in GE, compared to the GC. Conclusion: there was no improvement in any of the times in the auditory perceptual analysis in the voice of dysphonic children with the STVE. The acoustic analysis indicated improvement in vocal quality in the third minute of exercise performance.

Objetivo: comprobar el momento ideal del ejercicio de vibración sonora del lengua (EVSL) en la voz de niños disfónicas. Método: participado veinte y siete niños, de 04 a 11 años, con diagnóstico de nódulos o quistes de los pliegues vocales. De estos niños, once eran parte del grupo experimental (GE) y 16 parte del grupo de control (GE). El sostenido vocal /ε/ y el recuento de 1 a 10 se registraron antes (m0) y después de la primero (m1), tercero (m3), quinto (m5) y séptimo (m7) minuto del ejecución de EVSL. Las grabaciones se presentaron a tres logopedas, que juzgaron si había modificación de la calidad vocal. Los parámetros acústicos evaluado en vocal sostenida fueron frecuencia fundamental, jitter, shimmer, glotal to noise excitation (GNE) y ruido. Resultado: en la evaluación perceptual, no hubo modificaciones significativos entre los momentos de ejecución de EVSL. En el análisis acústico, se observó que el parámetro de ruido disminuye y parámetro GNE aumentó después de tres minutos de ejecución del ejercicio en GE, en comparación con el GC. Conclusión: no hubo mejoría en cualquier de las tiempos en la evaluación perceptual de la voz de los niños disfónicas con EVSL. El análisis acústico indica mejoría en la calidad de la voz después de tres minutos de ejecución del ejercicio.

Análise vocal na infância: uma revisão integrativa / Vocal analysis in children: an integrative review / Análisis Vocal en la infancia: una revisión integradora

Objetivo: realizar uma revisão integrativa de literatura sobre as características de vozes normais e disfônicas e a prevalência de lesões nas pregas vocais em crianças. Métodos: trata-se de uma revisão integrativa da literatura. Foi realizado o levantamento dos artigos científicos por meio das bases de dados Medline, LILACS, IBECS, PubMed e ISI Web of Science. Na busca dos artigos foram utilizados os descritores "Distúrbios da Voz", "Disfonia", "Rouquidão", "Qualidade da Voz", "Acústica da Fala", "Voz", "Fonação", "Pregas Vocais", "Pediatria", "Criança", "Pré-Escolar". Para a análise dos dados, as informações coletadas foram organizadas de maneira concisa em um banco de dados, realizado de forma descritiva, considerando as informações referentes à amostra, objetivos, metodologia e resultados principais, e organizadas por similaridade de conteúdo. Resultados: foram identificados 770 artigos, dos quais 36 estavam diretamente relacionados ao objetivo da revisão e foram analisados. Conclusões: a qualidade vocal das crianças sem alterações vocais é caracterizada por valores de frequência fundamental que decrescem com o aumento da idade e com diferenças em relação ao sexo. O tempo máximo de fonação aumenta com a idade. Em crianças disfônicas a qualidade vocal é soprosa e rugosa, com grau de alteração de leve a moderado; as medidas acústicas da voz, os valores de tempo máximo de fonação estão alterados; frequência fundamental é reduzida ou os valores de frequência fundamental observados em crianças com alteração foram mais baixos do que os valores da normalidade. A lesão de prega vocal mais prevalente até seis anos de idade é o cisto e, após esta idade, é o nódulo vocal.

Objective: to perform an integrative literature review about the characteristics of normal and dysphonic voices and the prevalence of vocal cords lesions in children. Methods: it is a literature integrative review. The survey of scientific articles was carried out through data bases Medline, LILACS, IBECS (through the VHL Search Portal), PubMed and ISI Web of Science. In the search of the articles were used the descriptors "Voice Disorders", "Dysphonia", "Hoarseness", "Voice Quality", "Speech Acoustics", "Voice", "Phonation", "Vocal Cords", "Pediatrics", "Child", "Child Preschool". For the analysis of the data, the information collected was organized in a concise manner in a database, being performed in a descriptive way, considering the information about the sample, objectives, methodology and main results, and organized by content similarity. Results: 770 articles were identified, of which 36 were directly related to objective of the review and were analyzed. Conclusions: the vocal quality of children without vocal changes is characterized by fundamental frequency values that decrease with increase of age and with differences in relation to gender. The maximum phonation time increases with age. In dysphonic children the vocal quality is blow and rough, with a grade of alteration from mild to moderate; the acoustic measures of the voice, the maximum phonation time values are altered; the fundamental frequency is severe. The cyst is vocal cords lesion most prevalent up to six years age, and after this age is the vocal nodule.

Objetivo: Realizar una revisión integradora de la literatura sobre las características de vozes normales y disfonicas y la prevalencia de lesiones de las cuerdas vocales en niños. Métodos: se realizó una investigación integrativa de la literatura a través de articulos cientificos enontrados en las bases de datos Medline, LILACS IBECS, PubMed y ISI Web of Science. En busca de artículos se utilizaron los descriptores "Trastornos de la Voz", "Disfonía", "Ronquera", "Calidad de la Voz", "Acústica del Habla", "Voz", "Fonación", "Pliegues Vocales", "Pediatría", "Niño", "Preescolar". Para el análisis de datos, la información recogida se organizó de manera concisa en una base de datos realizada de una manera descriptiva, teniendo en cuenta la información sobre la muestra, objetivos, metodología y resultados principales, organizados por la similitud del contenido. Resultados: fueron identificados 770 artículos de los cuales 36 estaban directamente relacionadas con el objetivo de la revisión y fueron analizados. Conclusiones: La calidad vocal de los niños sin trastornos vocales se caracteriza por la disminución de la frecuencia vocal fundamental con el aumento de la edad y con diferencias en relación al sexo. El tiempo máximo de fonación aumenta con la edad. Los niños con disfonía tienen una calidad de voz susurrante y rugosa, con un grado de alteración de leve a moderada; las medidas acústicas de la voz, y los valores de tiempo máximo de fonación están alterados. La frecuencia fundamental es reduzida o los valores de frecuencia fundamental obsevados en niños com alteración, fueron mas bajos que los valores de normalidad. La lesión de pliega vocal más prevalente hasta seis años de edad es el quiste. Después de esta edad son los nódulos vocales.

Analytical optimization of a phenolic-rich herbal extract and supplementation in fermented milk containing sweet potato pulp.

The aims of the present study were to optimize and characterize the phenolic composition of a herbal extract composed of green mate (Ilex paraguariensis), clove (Syzygium aromaticum), and lemongrass (Cymbopogon citratus) and to propose the addition of this polyphenol-rich extract to fermented milks (FM) with/without sweet potato pulp (Ipomoea batatas). Proximate composition, pH, acidity, instrumental texture profile, total phenolic content (TPC), antioxidant activity (AA) of all formulations were measured, and sensory attributes were also investigated. The addition of a lyophilized extract (1g 100g-1) containing 87.5% clove and 12.5% green mate increased the AA and TPC, while FM with added sweet potato pulp had the best sensory acceptance. The TPC and total reducing capacity had a slight change during 21days of storage. The data showed that herbal extracts and sweet potato pulp may be used to develop new dairy foods with potential functional properties.

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

OBJECTIVE: This study aimed to verify the effects of execution time on auditory-perceptual and acoustic responses in children with dysphonia completing straw phonation exercises. STUDY DESIGN: A randomized, prospective, comparative intra-subject study design was used. METHODS: Twenty-seven children, ranging from 5 to 10 years of age, diagnosed with vocal cord nodules or cysts, were enrolled in the study. All subjects included in the Experimental Group were also included in the Control Group which involved complete voice rest. Sustained vowels (/a/e/ε/e/) counting from 1 to 10 were recorded before the exercises (m0) and then again after the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of straw phonation exercises. The recordings were randomized and presented to five speech therapists, who evaluated vocal quality based on the Grade Roughness Breathiness Asthenia/Strain Instability scale. For acoustic analysis, fundamental frequency, jitter, shimmer, glottal to noise excitation ratio, and noise parameters were analyzed. RESULTS: Reduced roughness, breathiness, and noise measurements as well as increased glottal to noise excitation ratio were observed in the Experimental Group after 3 minutes of exercise. Reduced grade of dysphonia and breathiness were noted after 5 minutes. CONCLUSION: The ideal duration of straw phonation in children with dysphonia is from 3 to 5 minutes.

"Where they (live, work and) spray": pesticide exposure, childhood asthma and environmental justice among Mexican-American farmworkers.

Asthma prevalence is reportedly low for children of Mexican descent compared with other ethnic groups and Latino subgroups. The results of our exploratory ethnographic research among children of farmworkers in California dramatically suggest otherwise. Unstructured and semi-structured open-ended interviews and photovoice methods were combined to explore the lived experiences of members of a marginalized farmworker community. This research gives voice to a population of families living in the highly toxic, yet agriculturally wealthy environment of the San Joaquin Valley. Little work has been reported employing photovoice, a community-based participatory research method, to study childhood exposure to pesticides. A rich narrative about perceptions of pesticide exposure emerged from the ethnographic interviews. Thematic analysis yielded beliefs about the relationship between air quality and childhood asthma. The findings suggest that childhood asthma should be reviewed within the context of local levels of environmental exposure and the principles of environmental justice.

Chlamydia trachomatis in human immunodeficiency virus-infected men treated at a referral hospital for sexually transmitted diseases in the Amazonas, Brazil

OBJECTIVES: The aim of the present study was to determine the Chlamydia trachomatis prevalence and to identify the demographic, behavioural and clinical factors associated with C. trachomatis in human immunodeficiency virus infected men. STUDY: This was a cross-sectional study of C. trachomatis prevalence among human immunodeficiency virus-infected men enrolled at the Outpatient clinic of acquired immunodeficiency syndrome of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil. C. trachomatis deoxyribonucleic acid from urethral samples was purified and submitted to real time polymerase chain reaction to identify the presence of C. trachomatis. RESULTS: A total of 276 human immunodeficiency virus-infected men were included in the study. The prevalence of C. trachomatis infection was 12% (95% confidence interval 8.1%-15.7%). The mean age of the participants was 34.63 (standard deviation 10.80) years. Of the 276 human immunodeficiency virus-infected men, 93 (56.2%) had more than one sexual partner in the past year and 105 (38.0%) reported having their first sexual intercourse under the age of 15 years. Men having sex with men and bisexuals amounted to 61.2% of the studied population. A total of 71.7% had received human immunodeficiency virus diagnosis in the last three years and 55.1% were using antiretroviral therapy. Factors associated with C. trachomatis infection in the logistic model were being single (p<0.034), men having sex with men (p<0.021), and having previous sexually transmitted diseases (p<0.001). CONCLUSION: The high prevalence of C. trachomatis infection among human immunodeficiency virus-infected men highlights that screening human immunodeficiency virus-infected men for C. trachomatis, especially among men having sex with men, is paramount to control the spread of C. trachomatis infection. .

Chlamydia trachomatis in human immunodeficiency virus-infected men treated at a referral hospital for sexually transmitted diseases in the Amazonas, Brazil.

OBJECTIVES: The aim of the present study was to determine the Chlamydia trachomatis prevalence and to identify the demographic, behavioural and clinical factors associated with C. trachomatis in human immunodeficiency virus infected men. STUDY: This was a cross-sectional study of C. trachomatis prevalence among human immunodeficiency virus-infected men enrolled at the Outpatient clinic of acquired immunodeficiency syndrome of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil. C. trachomatis deoxyribonucleic acid from urethral samples was purified and submitted to real time polymerase chain reaction to identify the presence of C. trachomatis. RESULTS: A total of 276 human immunodeficiency virus-infected men were included in the study. The prevalence of C. trachomatis infection was 12% (95% confidence interval 8.1%-15.7%). The mean age of the participants was 34.63 (standard deviation 10.80) years. Of the 276 human immunodeficiency virus-infected men, 93 (56.2%) had more than one sexual partner in the past year and 105 (38.0%) reported having their first sexual intercourse under the age of 15 years. Men having sex with men and bisexuals amounted to 61.2% of the studied population. A total of 71.7% had received human immunodeficiency virus diagnosis in the last three years and 55.1% were using antiretroviral therapy. Factors associated with C. trachomatis infection in the logistic model were being single (p<0.034), men having sex with men (p<0.021), and having previous sexually transmitted diseases (p<0.001). CONCLUSION: The high prevalence of C. trachomatis infection among human immunodeficiency virus-infected men highlights that screening human immunodeficiency virus-infected men for C. trachomatis, especially among men having sex with men, is paramount to control the spread of C. trachomatis infection.

Biologically driven neural platform invoking parallel electrophoretic separation and urinary metabolite screening.

This work reveals a computational framework for parallel electrophoretic separation of complex biological macromolecules and model urinary metabolites. More specifically, the implementation of a particle swarm optimization (PSO) algorithm on a neural network platform for multiparameter optimization of multiplexed 24-capillary electrophoresis technology with UV detection is highlighted. Two experimental systems were examined: (1) separation of purified rabbit metallothioneins and (2) separation of model toluene urinary metabolites and selected organic acids. Results proved superior to the use of neural networks employing standard back propagation when examining training error, fitting response, and predictive abilities. Simulation runs were obtained as a result of metaheuristic examination of the global search space with experimental responses in good agreement with predicted values. Full separation of selected analytes was realized after employing optimal model conditions. This framework provides guidance for the application of metaheuristic computational tools to aid in future studies involving parallel chemical separation and screening. Adaptable pseudo-code is provided to enable users of varied software packages and modeling framework to implement the PSO algorithm for their desired use.