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1.
Telemed Rep ; 3(1): 24-29, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35720443

RESUMEN

Background: Mental health (MH) and substance use disorders (SUDs) are common during pregnancy and the postpartum year, and have a significant impact on maternal and child health. Most women do not receive treatment for these conditions due to barriers to care. Increasing access to these services via telemedicine is one potential solution to overcoming barriers, but it is unknown if this type of service is acceptable to women. The purpose of this study is to evaluate patient satisfaction with, and accessibility to, a maternal MH and SUD telemedicine service delivered to obstetric practices. Methods: The Telemedicine Satisfaction Questionnaire and the Questionnaire for Assessing Patient Satisfaction with Video Consultation were collected via online surveys. Responses were scored on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). Paired t-tests were used to compare round trip travel time and distance between participants home and specialty clinic at an academic medical center versus their local obstetrics clinic where they received telemedicine services. Results: A total of 91.42% (32/35) of women agreed to take part in the study, and 43.75% (14/32) of women were living in a rural community. Patients reported high levels of satisfaction with the following: overall quality of care (mean [M] 4.66 [standard deviation, SD, 0.67]); similarity to face-to-face are (M 4.69 [SD 0.63]); and access to care (M 4.47 [SD 0.81]). Compared with in-person care at an academic medical center, women receiving care via telemedicine spent significantly less time (67.44 minutes vs. 256.31 minutes, p < 0.001) and distance (50.33 miles vs. 236.06 miles, p < 0.001) traveling round trip. Conclusions: Women receiving MH and SUD treatment via telemedicine within their obstetrician's office report high levels of satisfaction and increased access to care with this modality of treatment delivery. Telemedicine may provide one solution to removing barriers to care and mitigating the maternal and child risks associated with of untreated MH and SUDs.

2.
Mil Med ; 2022 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-35714103

RESUMEN

INTRODUCTION: Women Veterans experience a broad range of stressors (e.g., family, relationship, and financial) and high rates of mental health and physical health conditions, all of which contribute to high levels of stress. Personalized Support for Progress (PSP), an evidence-based intervention, is well suited to support women Veterans with high stress as it involves a card-sort task to prioritize concerns as well as pragmatic and emotional support to develop and implement a personalized plan addressing those concerns. Our aims were to explore the population and context for delivery and evaluate the feasibility, acceptability, and utility of PSP delivered by a peer specialist to complement existing services in a Veterans Health Administration (VHA) Women's Wellness Center. MATERIALS AND METHODS: This randomized controlled pilot trial compared treatment as usual plus PSP to treatment as usual and used the a priori Go/No-Go criteria to establish success for each outcome. We interviewed staff regarding the population and delivery context at a VHA Women's Wellness Center and analyzed interviews using a rapid qualitative approach. For the rapid qualitative analysis, we created templated summaries of each interview to identify key concepts within each a priori theme, reviewed each theme's content across all interviews, and finally reviewed key concepts across themes. We evaluated feasibility using recruitment and retention rates; acceptability via Veteran satisfaction, working relationship with the peer, and staff satisfaction; and utility based on the proportion of Veterans who experienced a large change in outcomes (e.g., stress, mental health symptoms, and quality of life). The Syracuse VA Human Subjects Institutional Review Board approved all procedures. RESULTS: Staff interviews highlight that women Veterans have numerous unmet social needs and concerns common among women which increase the complexity of their care; call for a supportive, consistent, trusting relationship with someone on their health care team; and require many resources (e.g., staff such as social workers, services such as legal support, and physical items such as diapers) to support their needs (some of which are available within VHA but may need support for staffing or access, and some of which are unavailable). Feasibility outcomes suggest a need to modify PSP and research methods to enhance intervention and assessment retention before the larger trial; the recruitment rate was acceptable by the end of the trial. Veteran acceptability of PSP was high. Veteran outcomes demonstrate promise for utility to improve stress, mental health symptoms, and quality of life for women Veterans. CONCLUSIONS: Given the high acceptability and promising outcomes for utility, changes to the design to enhance the feasibility outcomes which failed to meet the a priori Go/No-Go criteria are warranted. These outcomes support future trials of PSP within VHA Women's Wellness Centers.

3.
J Clin Neurophysiol ; 2022 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-35512185

RESUMEN

PURPOSE: Individuals with autism spectrum disorder (ASD) have comorbid epilepsy at much higher rates than the general population, and about 30% will be refractory to medication. Patients with drug-resistant epilepsy (DRE) should be referred for surgical evaluation, yet many with ASD and DRE are not resective surgical candidates. The aim of this study was to examine the response of this population to the responsive neurostimulator (RNS) System. METHODS: This multicenter study evaluated patients with ASD and DRE who underwent RNS System placement. Patients were included if they had the RNS System placed for 1 year or more. Seizure reduction and behavioral outcomes were reported. Descriptive statistics were used for analysis. RESULTS: Nineteen patients with ASD and DRE had the RNS System placed at 5 centers. Patients were between the ages of 11 and 29 (median 20) years. Fourteen patients were male, whereas five were female. The device was implanted from 1 to 5 years. Sixty-three percent of all patients experienced a >50% seizure reduction, with 21% of those patients being classified as super responders (seizure reduction >90%). For the super responders, two of the four patients had the device implanted for >2 years. The response rate was 70% for those in whom the device was implanted for >2 years. Improvements in behaviors as measured by the Clinical Global Impression Scale-Improvement scale were noted in 79%. No complications from the surgery were reported. CONCLUSIONS: Based on the authors' experience in this small cohort of patients, the RNS System seems to be a promising surgical option in people with ASD-DRE.

4.
Sci Rep ; 12(1): 7492, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35523817

RESUMEN

Vortex ring collisions have attracted intense interest in both water and air studies (Baird in Proc R Soc Lond Ser Math Phys Sci 409:59-65, 1987, Poudel et al. in Phys Fluids 33:096105, 2021, Lim and Nickels in Nature 357:225, 1992, New et al. in Exp Fluids 57:109, 2016, Suzuki et al. in Geophys Res Lett 34, 2007, Yan et al. in J Fluids Eng 140:054502, 2018, New et al. in J Fluid Mech 899, 2020, Cheng et al. in Phys Fluids 31:067107, 2019, Hernández and Reyes in 29:103604, 2017, Mishra et al. in Phys Rev Fluids, 2021, Zednikova et al. in Chem Eng Technol 42:843-850, 2019, Kwon et al. in Nature 600:64-69, 2021). These toroidal structures spin around a central axis and travel in the original direction of impulse while spinning around the core until inertial forces become predominant causing the vortex flow to spontaneously decay to turbulence (Vortex Rings, https://projects.iq.harvard.edu/smrlab/vortex-rings ). Previous studies have shown the collision of subsonic vortex rings resulting in reconnected vortex rings, but the production of a shock wave from the collision has not been demonstrated visibly (Lim and Nickels in Nature 357:225, 1992, Cheng et al. in Phys Fluids 31:067107, 2019). Here we present the formation of a shock wave due to the collision of explosively formed subsonic vortex rings. As the vortex rings travel at Mach 0.66 toward the collision point, they begin to trap high pressure air between them. Upon collision, high pressure air was imploded and released radially away from the axis of the collision, generating a visible shock wave traveling through and away from the colliding vortices at Mach 1.22. Our results demonstrate a pressure gradient with high pressure release creating a shock wave. We anticipate our study to be a starting point for more explosively formed vortex collisions. For example, explosives with different velocities of detonation could be tested to produce vortex rings of varying velocities.

5.
J Clin Child Adolesc Psychol ; : 1-10, 2022 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-35486470

RESUMEN

OBJECTIVE: Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. METHOD: Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). RESULTS: The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. CONCLUSIONS: Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.

6.
Semin Cell Dev Biol ; 2022 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-35474148

RESUMEN

The histone variant H2A.Z plays a critical role in chromatin-based processes such as transcription, replication, and repair in eukaryotes. Although many H2A.Z-associated processes and features are conserved in plants and animals, a distinguishing feature of plant chromatin is the enrichment of H2A.Z in the bodies of genes that exhibit dynamic expression, particularly in response to differentiation and the environment. Recent work sheds new light on the plant machinery that enables dynamic changes in H2A.Z enrichment and identifies additional chromatin-based pathways that contribute to transcriptional properties of H2A.Z-enriched chromatin. In particular, analysis of a variety of responsive loci reveals a repressive role for H2A.Z in expression of responsive genes and identifies roles for SWR1 and INO80 chromatin remodelers in enabling dynamic regulation of H2A.Z levels and transcription. These studies lay the groundwork for understanding how this ancient histone variant is harnessed by plants to enable responsive and dynamic gene expression (Graphical Abstract).

7.
Cureus ; 14(1): e21620, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35233305

RESUMEN

We report the case of a transgender woman with HIV (CD4 349), shortness of breath, and chest pain, who was found to have multiple mycotic aortic aneurysms by point-of-care ultrasound (PoCUS). This report highlights the utility of point-of-care ultrasonography in the diagnosis and management of this rare clinical entity.Multiple mycotic aortic aneurysms and purulent pericarditis are uncommon. They have high morbidity and mortality and are associated with immunocompromised states (e.g., HIV). Diagnosis of the mycotic aneurysm, and its precursor, infectious aortitis, can be challenging, and delays in care can lead to poor outcomes. Often, as described in this case report, making the diagnosis requires a high clinical suspicion, multiple imaging modalities, and laboratory studies.

9.
Contraception ; 2022 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-35351446

RESUMEN

OBJECTIVE: We aimed to qualitatively describe the contraceptive experiences of individuals with medical conditions and develop an explanatory model of contraceptive decision-making in this context. STUDY DESIGN: We conducted 41 interviews with pre-menopausal patients with a range of medical conditions from Michigan, United States. We identified themes through open coding and comparative analysis until we reached theoretical saturation. We analyzed the themes in the context of the Health Belief Model constructs and patient autonomy. To develop the explanatory model, we qualitatively mapped out relationships between constructs and how they informed contraceptive-decision making. RESULTS: The model posits that contraceptive decisions are affected by the perceived impact of chronic disease on pregnancy, parenting, and contraceptive options. These perceptions were strongly affected by others, particularly health care providers (HCPs). Most worried that pregnancy could threaten their health, fetal health, or ability to parent. Active symptoms of chronic disease (e.g., pain, fatigue) amplified this perceived threat. Patients appreciated when their HCPs acknowledged, rather than dismissed, their concerns about contraceptive side effects that affected their chronic disease symptoms and management (e.g., headaches, worsening mood). Patients with medical contraindications to hormonal contraception and preferred to use coital-dependent methods (e.g., condoms) did not feel supported to do so by their HCPs. Patients who were Black, young, living on low-incomes, or considered medically "high risk" felt discriminated against by HCPs who limited or coerced their contraceptive decisions. CONCLUSIONS: This explanatory model synthesizes factors that underlie, constrain, or promote reproductive and contraceptive decisions and autonomy for individuals with medical conditions. IMPLICATIONS: This new explanatory model can guide the development and evaluation of interventions that support the contraceptive decisions and autonomy of individuals with medical conditions.

10.
J ECT ; 2022 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-35220356

RESUMEN

OBJECTIVES: Agitation is the most common behavioral symptom of Alzheimer disease (AD) affecting approximately 40% to 60% of the AD population, yet there are no Food and Drug Administration-approved therapies for the myriad of behavioral or psychological symptoms of dementia. There is growing evidence from naturalistic studies that electroconvulsive therapy (ECT) is a safe and effective treatment for agitation in AD patients who are refractory to pharmacotherapy and behavioral interventions. Despite the existing evidence, ECT remains underused because of stigma, lack of education, and concerns regarding adverse cognitive effects. Randomized controlled clinical trials of ECT are an opportunity to provide high-quality evidence of ECT as a safe and efficacious treatment for agitation in the AD population. We describe the methods for the Electroconvulsive Therapy in Alzheimer's Dementia study, which uses a novel, simulated ECT (S-ECT) control group to conduct a single-blind efficacy study of ECT for the treatment of agitation and aggression in individuals with moderate to severe AD. METHODS: We discuss the rationale, study design, methodology, ethical and practical challenges, and management strategies in using an S-ECT group as the comparator arm in this randomized controlled trial of ECT in AD-related treatment refractory agitation and aggression. CONCLUSIONS: Validation of the safety and efficacy of ECT in patients with advanced AD with refractory agitation and aggression is necessary. This can be accomplished through creative formulation of S-ECT groups that effectively maintain the blind while providing scientific integrity.

11.
PLoS One ; 17(2): e0264537, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35226686

RESUMEN

We propose a novel neural network architecture, SZTrack, to detect and track the spatio-temporal propagation of seizure activity in multichannel EEG. SZTrack combines a convolutional neural network encoder operating on individual EEG channels with recurrent neural networks to capture the evolution of seizure activity. Our unique training strategy aggregates individual electrode level predictions for patient-level seizure detection and localization. We evaluate SZTrack on a clinical EEG dataset of 201 seizure recordings from 34 epilepsy patients acquired at the Johns Hopkins Hospital. Our network achieves similar seizure detection performance to state-of-the-art methods and provides valuable localization information that has not previously been demonstrated in the literature. We also show the cross-site generalization capabilities of SZTrack on a dataset of 53 seizure recordings from 14 epilepsy patients acquired at the University of Wisconsin Madison. SZTrack is able to determine the lobe and hemisphere of origin in nearly all of these new patients without retraining the network. To our knowledge, SZTrack is the first end-to-end seizure tracking network using scalp EEG.


Asunto(s)
Electroencefalografía
12.
Neuroimage ; 251: 118973, 2022 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-35131433

RESUMEN

The Virtual Brain (TVB) is now available as open-source services on the cloud research platform EBRAINS (ebrains.eu). It offers software for constructing, simulating and analysing brain network models including the TVB simulator; magnetic resonance imaging (MRI) processing pipelines to extract structural and functional brain networks; combined simulation of large-scale brain networks with small-scale spiking networks; automatic conversion of user-specified model equations into fast simulation code; simulation-ready brain models of patients and healthy volunteers; Bayesian parameter optimization in epilepsy patient models; data and software for mouse brain simulation; and extensive educational material. TVB cloud services facilitate reproducible online collaboration and discovery of data assets, models, and software embedded in scalable and secure workflows, a precondition for research on large cohort data sets, better generalizability, and clinical translation.


Asunto(s)
Encéfalo , Nube Computacional , Animales , Teorema de Bayes , Encéfalo/diagnóstico por imagen , Simulación por Computador , Humanos , Imagen por Resonancia Magnética/métodos , Ratones , Programas Informáticos
13.
Addict Sci Clin Pract ; 17(1): 9, 2022 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-35139919

RESUMEN

BACKGROUND: Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. METHODS: We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. RESULTS: Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. CONCLUSION: This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.


Asunto(s)
Alcoholismo , Consumo de Bebidas Alcohólicas , Alcoholismo/tratamiento farmacológico , Alcoholismo/terapia , Humanos , Cirrosis Hepática/terapia , Atención al Paciente , Investigación Cualitativa
14.
Dev Med Child Neurol ; 64(7): 907-914, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35103306

RESUMEN

AIM: To assess the evolution of bulbar function in nusinersen-treated spinal muscular atrophy type 1 (SMA1). METHOD: This single-centre retrospective study identified 24 patients (14 females and 10 males) with SMA1, treated with nusinersen between 2017 and 2020. We adapted and validated the Paediatric Functional Oral Intake Scale (p-FOIS), which is an outcome measure to assess bulbar function. Analysis considered SMA1 subtype, nutritional support, and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and p-FOIS scores at initiation of nusinersen treatment (baseline) and at 6, 12, and 24 months after initiation. RESULTS: The median age at baseline was 11 months (range 1 month-7 years 6 months). Median age at initiation of tube feeding was 8 months (range 0-2 years 2 months). Fourteen patients were tube fed at baseline. The median p-FOIS score was 3 at baseline and 2 at 12 and 24 months. Four patients, all with type 1c SMA, remained orally fed at 24 months. Median CHOP INTEND scores increased from 32 at baseline to 42 at 12 and 24 months. INTERPRETATION: Impaired bulbar function persisted as a significant complication in most nusinersen-treated patients with SMA1, in contrast to the improvement in motor abilities demonstrated in the majority. p-FOIS allows for tracking of bulbar function progression and treatment response. Larger, prospective studies investigating the longer-term impacts of nusinersen on bulbar function are warranted.


Asunto(s)
Atrofia Muscular Espinal , Atrofias Musculares Espinales de la Infancia , Niño , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Oligonucleótidos/uso terapéutico , Estudios Prospectivos , Estudios Retrospectivos , Atrofias Musculares Espinales de la Infancia/tratamiento farmacológico
15.
Sci Rep ; 12(1): 971, 2022 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-35046462

RESUMEN

Disease results from interactions among the host, pathogen, and environment. Inoculation trials can quantify interactions among these players and explain aspects of disease ecology to inform management in variable and dynamic natural environments. White-nose Syndrome, a disease caused by the fungal pathogen, Pseudogymnoascus destructans (Pd), has caused severe population declines of several bat species in North America. We conducted the first experimental infection trial on the tri-colored bat, Perimyotis subflavus, to test the effect of temperature and humidity on disease severity. We also tested the effects of temperature and humidity on fungal growth and persistence on substrates. Unexpectedly, only 37% (35/95) of bats experimentally inoculated with Pd at the start of the experiment showed any infection response or disease symptoms after 83 days of captive hibernation. There was no evidence that temperature or humidity influenced infection response. Temperature had a strong effect on fungal growth on media plates, but the influence of humidity was more variable and uncertain. Designing laboratory studies to maximize research outcomes would be beneficial given the high costs of such efforts and potential for unexpected outcomes. Understanding the influence of microclimates on host-pathogen interactions remains an important consideration for managing wildlife diseases, particularly in variable environments.


Asunto(s)
Ascomicetos/fisiología , Quirópteros/microbiología , Interacciones Huésped-Parásitos , Microclima , Animales , Composición Corporal , Quirópteros/metabolismo , Femenino , Hibernación , Humedad , Hidrocortisona/metabolismo , Masculino , Temperatura
17.
Pregnancy Hypertens ; 27: 131-133, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35063759

RESUMEN

BACKGROUND: Eclampsia is a pregnancy complicationcharacterized bygeneralized tonic-clonicconvulsions.Not all seizures in pregnancy are eclamptic, and othercauses include epilepsy, infection,stroke,tumor, and ruptured aneurysm. CASE: A 19-year-old G1P0 presentedinlabor at term. She had a generalized tonic-clonicseizure one hour aftervaginaldelivery for which she received methergine for uterine atony. Seizure activity resolved with lorazepam and magnesium sulfate for presumed eclampsia.Brain imaging revealedvasoconstriction of theleftposterior cerebral artery and blood in the subarachnoid space,andshewas diagnosed with eclampsia with reversible cerebral vasoconstrictive syndrome (RCVS). CONCLUSION: RCVS isapregnancy-related cause of seizure that should remain on the differential for any patient presenting with a seizure in the peripartum period, especially with use of vasoconstrictive agents. Management is controversial but involves calcium channel blockers and magnesium sulfate, as well as avoidance of vasoconstrictive agents.


Asunto(s)
Metilergonovina/administración & dosificación , Oxitócicos/efectos adversos , Síndrome de Leucoencefalopatía Posterior/inducido químicamente , Hemorragia Posparto/tratamiento farmacológico , Eclampsia/diagnóstico , Femenino , Humanos , Metilergonovina/efectos adversos , Oxitócicos/administración & dosificación , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Embarazo , Convulsiones/etiología , Adulto Joven
18.
PLoS One ; 17(1): e0261868, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35025922

RESUMEN

Maternal signatures are present in the eggs of some birds, but quantifying interclutch variability within populations remains challenging. Maternal assignment of eggs with distinctive appearances could be used to non-invasively identify renesting females, including hens returning among years, as well as to identify cases of conspecific brood parasitism. We explored whether King Rail (Rallus elegans) eggs with shared maternity could be matched based on eggshell pattern. We used NaturePatternMatch (NPM) software to match egg images taken in the field in conjunction with spatial and temporal data on nests. Since we had only a small number of marked breeders, we analyzed similar clutch images from a study of Eurasian Common Moorhens (Gallinula chloropus chloropus) with color-banded breeders for which parentage at many nests had been verified genetically to validate the method. We ran 66 King Rail clutches (n = 338 eggs) and 58 Common Moorhen clutches (n = 364 eggs) through NPM. We performed non-metric multidimensional scaling and permutational analysis of variance using the best egg match output from NPM. We also explored whether eggs could be grouped by clutch using a combination of egg dimensions and pattern data derived from NPM using linear discriminant analyses. We then scrutinized specific matches returned by NPM for King Rail eggs to determine whether multiple matches between the same clutches might reveal maternity among nests and inform our understanding of female laying behavior. To do this, we ran separate NPM analyses for clutches photographed over several years from two spatially distant parts of the site. With these narrower datasets, we were able to identify four instances where hens likely returned to breed among years, four likely cases of conspecific brood parasitism, and a within-season re-nesting attempt. Thus, the matching output was helpful in identifying congruent egg patterns among clutches when used in conjunction with spatial and temporal data, revealing previously unrecognized site fidelity, within-season movements, and reproductive interference by breeding females. Egg pattern data in combination with nest mapping can be used to inform our understanding of female reproductive effort, success, and longevity in King Rails. These methods may also be applied to other secretive birds and species of conservation concern.


Asunto(s)
Cáscara de Huevo/metabolismo , Animales , Cruzamiento , Pollos , Color , Huevos , Femenino , Comportamiento de Nidificación , Conducta Paterna , Embarazo , Reproducción , Propiedades de Superficie
19.
J Am Board Fam Med ; 35(1): 185-189, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35039426

RESUMEN

Primary care is well-poised to address unmet social needs that affect health. Integrated primary care is increasingly common and can be leveraged to facilitate identification of practice and clinician-level modifiable characteristics and assist practices to address unmet social needs for patients and families. A recent National Academies of Sciences, Engineering, and Medicine (NASEM)'s consensus report identified 5 critical system-level activities to facilitate the integration of addressing social needs into health care: awareness (ask patients), adjustment (flexible intervention delivery), assistance (intervention to address the social need), alignment (link with community resources), and advocacy (policy change). This article outlines how integrated primary care characteristics, such as routine screening, functional workflows, interprofessional team communication, and patient-centered practices, exemplify the NASEM report's activities and offer robust biopsychosocial tools for addressing social needs. We provide a case to illustrate how these strategies might be used in practice.


Asunto(s)
Comunicación , Atención a la Salud , Humanos , Tamizaje Masivo , National Academy of Sciences, U.S. , Atención Primaria de Salud , Estados Unidos
20.
Obes Surg ; 32(4): 1312-1324, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35083703

RESUMEN

Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10 mm Hg.


Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Hipertensión , Laparoscopía , Obesidad Mórbida , Adulto , Antihipertensivos/uso terapéutico , Gastrectomía , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/cirugía , Obesidad Mórbida/cirugía , Resultado del Tratamiento
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