Time Discipline and Health/Communicative Labor in Pediatric Primary Care.

In rural Southern Chile, native Mapuche families receive care mostly from non-indigenous clinicians. Parents and doctors alike orient to the importance of timely medical care, but clinical and communication norms also result in misunderstandings and tension. Parents find it hard to communicate about structural obstacles, and valued practices of care in families may conflict with normative expectations for timely presentation. Parents' disclosures about the duration of their children's illnesses can expose them to clinical censure, which in turn reinforces pernicious negative stereotypes about this racialized and marginalized community.

Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine.

BACKGROUND: Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients' disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. METHODS: Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. RESULTS: We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients' convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). CONCLUSIONS: When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.

Consolidated Melting Gel Coatings on AZ31 Magnesium Alloy with Excellent Corrosion Resistance in NaCl Solutions: An Interface Study.

Magnesium alloys, with a density two-thirds that of aluminum, are very attractive for the industry. However, these alloys are extremely susceptible to corrosion in the presence of aggressive electrolytes such as NaCl solutions. Here, we designed hybrid coatings obtained by the consolidation of organically modified polysilsesquioxanes called "melting gels" for the corrosion protection of AZ31 magnesium alloy in NaCl solutions. The main focus was to study the interaction between coatings and substrate and the influence of the coating thickness on the final properties. Micro-scratch tests, adhesion by tape tests, confocal Raman microscopy, SEM-EDS, and ToF-SIMS indicate good adhesion of coatings based on the interaction of melting gels and substrate. These measurements indicate the presence of the Si-O-Mg bonds between the substrate and coatings. Electrochemical results show very low current densities (10-13 A cm-2) without any breakdown potential and impedance values of 1010 Ω cm2.

Provider and patient expectations for dietary supplement discussions.

BACKGROUND: Dietary supplement use in the United States is common. Patients can procure supplements without a prescription, and often do not disclose supplement use to their healthcare providers. Providers and patients may be uncertain about what would be appropriate or helpful in discussions of supplements during routine office visits. OBJECTIVE: To explore provider and patient expectations for discussions of dietary supplements. DESIGN: Semi-structured interviews were conducted with a purposeful sample of healthcare providers from three specialties and their patients who reported taking supplements. PARTICIPANTS: Thirty-five outpatient providers (14 primary care, six integrative medicine, and 15 complementary and alternative medicine (CAM) providers) and 107 of their patients. APPROACH: Qualitative analysis of transcripts using grounded theory and iterative review. RESULTS: Both providers and patients raised twelve common topics about dietary supplements that they felt were important to discuss during office visits, such as: supplements taken; supplement risks (interactions, safety/harm, side effects/adverse events); treatment benefits; efficacy; alternative treatments; and patient expectations/preferences for treatment. Some topics were mentioned more frequently by providers than patients, such as how to take, reason for taking, and evidence for use. Providers raised several topics that were mentioned infrequently by patients. Supplement costs and regulations were not brought up by any patients, even though consideration of these topics could influence patient decisions to take supplements. Complementary healthcare providers brought up topics not mentioned by primary care providers, such as the importance of supplement brands and supplement mega-dosing. CONCLUSIONS: Patients and providers have concordant views about the need to discuss patient supplement use and ensure patient safety. Patients may undervalue, be unaware of, or discount information about cost or regulations that could affect their decision-making about supplement use. Future studies could examine the value, acceptability, and influence of a more comprehensive approach to discussions to help patients appropriately evaluate supplements.

Chronic caloric restriction partially protects against age-related alteration in serum metabolome.

Calorie restriction (CR) remains the most robust metabolic intervention to extend lifespan and improve healthspan in several species. Using global and targeted mass spectrometry-based metabolomics approaches, here we show that chronic CR prevents age-related changes in specific metabolic signatures. Global metabolomic analysis using ultra-performance liquid chromatography-tandem mass spectrometry detected more than 7,000 metabolites in sera from ad-libitum-fed young, aged, and aged C57BL/6 mice maintained on 40 % CR. Multivariate statistical analysis of mass spectrometry data revealed a clear separation among the young, aged, and aged-CR mice demonstrating the potential of this approach for producing reliable metabolic profiles that discriminate based on age and diet. We have identified 168 discriminating features with high statistical significance (p ≤ 0.001) and validated and quantified three of these metabolites using targeted metabolite analysis. Calorie restriction prevented the age-related alteration in specific metabolites, namely lysophosphatidylcholines (16:1 and 18:4), sphingomyelin (d18:1/12:0), tetracosahexaenoic acid, and 7α-dihydroxy-4-cholesten-3-one, in the serum. Pathway analysis revealed that CR impacted the age-related changes in metabolic byproducts of lipid metabolism, fatty acid metabolism, and bile acid biosynthesis. Our data suggest that metabolomics approach has the potential to elucidate the metabolic mechanism of CR's potential anti-aging effects in larger-scale investigations.

Concordancia de las técnicas subjetivas que miden la amplitud de acomodación / Concordance between subjective techniques that measure amplitude of accommodation

Objetivo: determinar la repetitividad inter observador y la concordancia entre las pruebas e s que miden la amplitud de acomodación (AA). Metodología: fueron evaluados setenta y nueve sujetos entre los 18 a 30 años, que presentaban un estado visual refractivo y acomodativo normales. Las pruebas clínicas realizadas fueron la técnica de Sheard (lente negativo de cerca) Jackson (lente negativo de lejos) y Donders modificada (alejamiento más un lente de -4.00D). Resultados: el Coeficiente de Correlación Intraclase (ICC) mostró que las pruebas de mostraban una alta repetitividad (>0,7); el Coeficiente de Correlación y Concordancia de Lin (ρc) reveló una pobre repetitividad y concordancia entre las pruebas (ρc≤0,9). Los límites de acuerdo para Donders, Sheard y Jackson (+/-1,22; +/-2,02, +/-3,44) revelan una menor variación de la AA entre los observadores para Donders y mayor para Jackson. Conclusión: la repetitividad inter observadora es mayor para la técnica de Donders modificada y la concordancia entre las pruebes pobre, por lo que no son intercambiables.

The purpose was determinate reliability test retest and concordance between clinical techniques that measure amplitude of accommodation. Methods: seventy nine students who had normal visual function, refractive and accommodative skills participated. The techniques were: minus lens (near), minus lens (far) and push down modified (-4.00D lens). Results: Intraclass Correlation Coefficient (ICC) show that test retest was high three techniques (>0,7); Concordance correlation coefficient of Lin (ρc) showed that agreement was poor for all of them (ρc≤0,9). Limits of agreement (95%) were push down modified +/-1,22; minus lens near +/-2,02; minus lens far +/- 3,44. Conclusion: reliability test retest was higher for push down modified and concordance between the techniques was poor so, these are not interchangeable.

Assessment of glycoprotein interactions with 4-[(2-aminoethyl)carbamoyl]phenylboronic acid surfaces using surface plasmon resonance spectroscopy.

Reported here are analyses of the interactions between a select group of solution-phase glycoproteins and a unique boronic acid capture surface. The boronic acid derivative, 4-[(2-aminoethyl)carbamoyl]phenylboronic acid, AECPBA, was synthesized and then immobilized on carboxymethyl dextran surfaces using simple coupling methods. From surface plasmon resonance spectroscopy responses, it is found that model glycoproteins interact strongly with the AECPBA surface and subsequently can be readily released from the AECPBA surface using borate buffer. A striking difference between the glycoproteins fetuin and asialofetuin (desialylated fetuin), in terms of glycoprotein binding to the AECPBA surface, indicates that the interaction of glycoproteins with the immobilized AECPBA is dictated by the terminal saccharide of the heteroglycan chain. Surprisingly, secondary interactions of glycosylated and nonglycosylated proteins with the carboxymethyl dextran hydrogel matrix are observed. Importantly, it is demonstrated that use of tris(hydroxymethyl)aminomethane buffer allows for decreased secondary interactions of nonglycosylated proteins on the AECPBA/dextran surface, as noted with the model protein ExtrAvidin.

Concordancia de las técnicas subjetivas que miden la amplitud de acomodación / Concordance between subjective techniques that measure amplitude of accommodation

Objetivo: determinar la repetitividad inter observador y la concordancia entre las pruebas clínicas que miden la amplitud de acomodación (AA). Metodología: fueron evaluados setenta y nueve sujetos entre los 18 a 30 años, que presentaban un estado visual refractivo y acomodativo normales. Las pruebas clínicas realizadas fueron la técnica de Sheard (lente negativo de cerca) Jackson (lente negativo de lejos) y Donders modificada (alejamiento más un lente de -4.00D). Resultados: el Coeficiente de Correlación Intraclase (ICC) mostró que las pruebas demostraban una alta repetitividad (>0,7); el Coeficiente de Correlación y Concordanciade Lin (pc) reveló una pobre repetitividad y concordancia entre las pruebas (pc<0,9). Los límites de acuerdo para Donders, Sheard y Jackson (+/-1,22; +/-2,02, +/-3,44) revelan una menor variación de la AA entre los observadores para Donders y mayor paraJackson. Conclusión: la repetitividad inter observadora es mayor para la técnica de Donders modificada y la concordancia entre las pruebas es pobre, por lo que no son intercambiables.

The purpose was determinate reliability test retestand concordance between clinical techniques that measure amplitude of accommodation. Methods: seventy nine students who had normal visual function, refractive and accommodative skills participated.The techniques were: minus lens (near), minus lens (far) and push down modified (-4.00D lens). Results: Intraclass Correlation Coefficient (ICC) show that test retest was high three techniques(>0,7); Concordance correlation coefficient of Lin (pc) showed that agreement was poor for all of them(pc<0,9). Limits of agreement (95 percent) were push down modified +/-1,22; minus lens near +/-2,02; minus lens far +/- 3,44. Conclusion: reliability test retest was higher for push down modified and concordance between the techniques was poor so, these are not interchangeable.