Secondary School Athletic Trainers' Clinical Management Decisions of Low Socioeconomic Status Patients.

CONTEXT: Evidence suggests that negative social determinants of health (SDOH) and lower socioeconomic status (SES) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients that are historically underserved in health care such as low SES patients. However, there is a significant gap in knowledge regarding how SES and SDOH may influence SSATs' clinical management decisions. OBJECTIVE: The purpose of this study was to describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic healthcare. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: NATA SSATs (6.7% response rate). MAIN OUTCOME MEASURE(S): SSATs were asked about their perceptions of patient SES and the SDOH (CVI = 0.83 for relevancy). Questions were ranked on a 4-point Liker scale on level of relevance and agreement. Data were summarized by means and standard deviations (SD), frequencies and proportions (%), and median scores. RESULTS: A total of 380 SSATs participated (years of experience mean=14.9±11.7 years). When providing care, most (71.3%) SSATs believed that their patient's health/health care access SDOH to be the most relevant of the 5 SDOH whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed/strongly agreed that patient SES impacts referral (67.4%) and the reliance on conservative treatment before referral (71.2%). SSATs identified patient/guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to low SES patients. CONCLUSIONS: SSATs perceived health/health care access as the most relevant SDOH when providing care to low SES patients. When SSATs further considered the SES of patients, they identified all SDOHs as barriers to providing health care they were ill equipped to navigate as they delivered care and engaged in patient referral.

Quality of life against seasonal vs perennial allergens: ESPRINT-15 modified in the pediatric population

Introduction: Allergic rhinitis (AR) is a clinical syndrome characterized by IgE-mediated inflam-mation of the nasal mucosa. The present study investigates the quality of life (QoL) with AR among adults, using widely validated questionnaires, unlike in pediatric patients.Materials and methods: A cross-sectional descriptive observational study was conducted, analyzing the QoL of 102 children with AR aged between 10-15 years, belonging to two health centers (HC) in Zaragoza and two HC in Coruña. The comparison of means between the two groups is carried out using the Student's test or the Mann-Whitney test, considering a value of p<0.05 to be significant.Results: Around 102 children were studied, with a majority (59.8%) being male and a mean age of 12 years. Around 76.5% have a family history of atopy. It was found that AR is more prevalent in Zaragoza (p <0.005), and asthmais highly prevalent in Coruña (p <0.001). The most import-ant sensitizations are pollen in Zaragoza (p <0.05) and dust mites in A Coruña (p <0.001). More treatment needs and associated comorbidities (p<0.05) were observed in A Coruña. The results of the ESPRINT-15 show that 63% of the patients have a good QoL, 27% fair, and 8.8%, poor. Those sensitized to mites have a worse score (p = 0.02). It was found that 52% of children expe-rienced improvement during home confinement, with no notable differences between the two populations. The use of the mask favored QoL in patients from Zaragoza (p <0.0 01 (AU)

Inelastic Collisions of O2 with He at Low Temperatures.

Rotationally inelastic collisions of O2 with He in the 10-34 K thermal range are investigated by means of an experimental procedure based on supersonic gas jets probed by Raman spectroscopy. The procedure employs a kinetic master equation (MEQ) that describes the time evolution of the rotational populations of O2 along supersonic jets of O2 and He mixtures. The MEQ is expressed in terms of experimental quantities (number density and rotational populations) measured here, and state-to-state rate coefficients for the O2:He inelastic collisions calculated here, plus those for O2:O2 collisions from the literature. An agreement with the experiments is accomplished for temperatures between 10 and 34 K. Within this thermal range, the role of the fine structure due to electron spin in the collision dynamics of O2 is discussed.

Study of Ras/MAPK pathway gene variants in Chilean patients with Cryptorchidism.

Cryptorchidism is one of the most common congenital disorders in boys, and several genetic, hormonal, and environmental factors have been proposed as possible causes for this genitourinary defect. Genetic factors have been intensively searched, but relatively few pathogenic variants have been described. Cryptorchidism is a frequent finding in patients with RASopathies, a group of syndrome caused by mutations in genes of the Ras/MAPK pathway. Our aim was to determine whether patients with isolated cryptorchidism (IC) exhibit Ras/MAPK pathway gene variants associated with RASopathies. Two hundred thirty-nine patients with IC were recruited after orchidopexy. Determination of Ras/MAPK pathway gene variants was performed by high-resolution melting (HRM) analysis followed by sequencing. Restriction or allele-specific amplification assay was applied to (i) variant confirmation; (ii) search in healthy controls; and (iii) segregation analysis. Controls correspond to 100 healthy Chilean adults without a history of cryptorchidism. Molecular analysis showed one synonymous substitution (BRAF_p.Q456Q) in two patients and four missense substitutions (SOS1_ p.R497Q, BRAF_ p.F595L, NRAS_ p.T50I, and MAP2K2_ p.Y134C) in five patients. Our results suggest that some patients with isolated cryptorchidism, but with no evidence of dysmorphic features suggestive of RASopathies, may harbor Ras/MAPK pathway gene alterations.

Copy number variants of Ras/MAPK pathway genes in patients with isolated cryptorchidism.

Cryptorchidism is the most common congenital disorder in boys, but the cause for most cases remains unknown. Patients with Noonan Syndrome are characterized by a typical face, growth retardation, congenital heart defects, learning disabilities and cryptorchidism. Copy number variations of Ras/MAPK pathway genes are unusual in patients with several clinical features of Noonan Syndrome; however, they have not been studied in patients with only one feature of this condition, such as cryptorchidism. Our aim was to determine whether patients with isolated cryptorchidism exhibit Ras/MAPK pathway gene copy number variations (CNVs). Fifty-nine patients with isolated cryptorchidism and negative for mutations in genes associated with Noonan Syndrome were recruited. Determination of Ras/MAPK pathway gene CNVs was performed by Comparative Genome Hybridization array. A CNV was identified in two individuals, a ~175 kb microduplication at 3p25.2, partially including RAF1. A similar RAF1 microduplication has been observed in a patient with testicular aplasia. This suggests that some patients with isolated cryptorchidism may harbor Ras/MAPK pathway gene CNVs.

Decline of Ecological Functions Performed by Dung Beetles in Areas of Atlantic Forest and Contribution of Rollers and Tunnellers in Organic Matter Removal.

The feeding behavior of the Scarabaeinae subfamily has positive implications on ecosystem functioning. We characterize the necrophagous and coprophagous dung beetle assemblages, and we quantify the removal of swine carrion and domestic dog dung in two areas with different degrees of environmental disturbance in an Atlantic Forest remnant located in Florianopolis, SC, Brazil. The experiment was setup at eight sampling points in each area, by installing one control and two collection and removal assessment arenas for collecting necrophagous dung beetles while simultaneously evaluating the removal of carrion (50 g of rotting pork for 48 h). We used the same sample design with 50 g of domestic dog dung for evaluating the coprophagous dung beetle assemblage and dung removal. Our results indicated that necrophagous dung beetles were more sensitive to environmental disturbance owing to a lower richness and changes in species dominance, which resulted in a lower removal in the areas with greater disturbance and lower environmental quality (39.6% carrion removal) in relation to less disturbed areas (75.1% carrion removal). The dung beetle assemblages were similar in structure and removal rates between areas (80% of dung was removed). In assessing the influence of richness, abundance, and biomass of dung beetles on resource removal both for the whole assemblage and for each separate functional guild, only the abundance and biomass of rollers contributed significantly to dung removal. These results highlight the implications of environmental disturbances on the functions of dung beetles, which respond differently according to the resource they use.

Metastatic neuroblastoma in infants: are survival rates excellent only within the stringent framework of clinical trials?

INTRODUCTION: SIOPEN INES protocol yielded excellent 5-year survival rates for MYCN-non-amplified metastatic neuroblastoma. Patients deemed ineligible due to lack or delay of MYCN status or late registration were treated, but not included in the study. Our goal was to analyse survival at 10 years among the whole population. MATERIALS AND METHODS: Italian and Spanish metastatic INES patients' data are reported. SPSS 20.0 was used for statistical analysis. RESULTS: Among 98 infants, 27 had events and 19 died, while 79 were disease free. Five- and 10-year event-free survival (EFS) were 73 and 70 %, and overall survival (OS) was 81 and 74 %, respectively. MYCN status was significant for EFS, but not for OS in multivariate analysis. CONCLUSIONS: The survival rates of patients who complied with all the inclusion criteria for INES trials are higher compared to those that included also not registered patients. Five-year EFS and OS for INES 99.2 were 87.8 and 95.7 %, while our stage 4s population obtained 78 and 87 %. Concerning 99.3, 5-year EFS and OS were 86.7 and 95.6 %, while for stage 4 we registered 61 and 68 %. MYCN amplification had a strong impact on prognosis and therefore we consider it unacceptable that many patients were not studied for MYCN and probably inadequately treated. Ten-year survival rates were shown to decrease: EFS from 73 to 70 % and OS from 81 to 74 %, indicating a risk of late events, particularly in stage 4s. Population-based registries like European ENCCA WP 11-task 11 will possibly clarify these data.

Evaluation of abundance indexes in open population studies: a comparison in populations of small mammals in southern Brazil.

Many manuscripts comparing populations and/or analysing the structure of animal communities use indexes of captures as synonymous of abundance. However, the basic methods more suitable to this assumption - probabilistic estimates based on equal capture probability - have not been considered. In this study, the deviations caused by different types of capture indexes are compared with a common probabilistic population estimator (Cormack-Jolly-Seber). The analyses showed that Minimum Number Known Alive (MNKA) and the number of individuals showed greater association with the population estimator than with non-probabilistic indexes based on recaptures. Therefore, none of the indexes presented the same performance to estimate population size estimation which can lead to ecological misinterpretation. Some recommendations were also described.

Síndrome papular purpúrico en guante y calcetín asociado a infección por Parvovirus B19 / Papular purpuric syndrome glove and sock associated with Parvovirus B19 infection

El síndrome papular purpúrico en “guante y calcetín” (SPPGC) es una dermatosis rara, aguda, caracterizada por lesiones eritematosas, pruriginosas y papulares en manos y pies, con una distribución en “guante y calcetín”, asociadas a lesiones orales y fiebre. Parvovirus B19 es en la mayoría de los casos el agente causante del síndrome. Presentamos el caso de un paciente adulto con síndrome papular purpúrico con lesiones poco frecuentes, asociado a Parvovirus B19 que fue confirmado mediante estudio serológico (AU)

Papular-purpuric “gloves and socks” syndrome (PPGSS) is a rare acute dermatosis characterized by pruritic erythematous and papular lesions on the hands and feet in a “gloves and socks” distribution associated with oral lesions and fever. Parvovirus B19 has been implicated in most cases as thecause of this syndrome. We present the case of an adult patient with papular purpuric syndrome with uncommon lesions, associated with parvovirusB19. He was confirmed by serology (AU)

Chemical Interactions and Spin Structure in (O2)4: Implications for the ε-O2 Phase.

The chemical interactions and spin structure of (O2)4 in its ground singlet state are analyzed by means of Quantum Chemical Topology descriptors. The energetic contributions of the Interacting Quantum Atoms approach are used to obtain information about the class of interactions displayed along the dissociation path of (O2)4. The exchange-correlation contribution to the binding energy is non-negligible for the O2-O2 interactions at intermolecular distances close to those found for the pressure induced ε phase of solid (O2) and this strengthening of the intermolecular bonding is built up from a simultaneous weakening of the intramolecular bond. This result is of interest in connection with the observed softening of the IR vibron frequency in the lower pressure range of the ε phase. The spin structure in the real space along the dissociation process is interpreted with the help of the so-called electron number distribution functions. At large distances, the four triplet O2 molecules are arranged in a way consistent with an antiferromagnetic structure, whereas at short distances, a significant spin redistribution is driven by the exchange process and it involves a propensity toward a null magnetic moment per molecule. Such probability behavior can be related with the magnetic evolution of solid oxygen across the δ → ε phase transition. Additional calculations of (O2)4 excited states support the conclusion that the relative stabilization and magnetic features of the ground singlet state are due to the onset of the new intermolecular bonds, and not to an exclusive modification of the electronic character within the O2 molecules.

Ichthyofauna diversity of Taperoá II reservoir, semi-arid region of Paraíba, Brazil.

To determine the fish species present in Taperoá II Reservoir, and their relevance to the local economy, this research aimed to evaluate the composition, abundance, degree of dominance and constancy of species, along with diversity, richness, evenness and similarity indices in a tropical semi-arid fish assemblage, during one year. Six 24 hour-long samplings were carried out between October 2005 and October 2006 using cast, seine and gillnets. The 889 collected individuals belonged to 11 species from 9 families. Temporal variation was observed in the capture frequency of different species, and a significant negative correlation between precipitation and number of individuals was also observed. Among the recorded families, Characidae showed a higher frequency of occurrence (38.4%), mostly due to Astyanax bimaculatus (Linnaeus, 1758) and A. fasciatus (Cuvier, 1819). Eight species were categorised as constant, two as accessory and one as accidental. Diversity index values were intermediate with low fluctuation throughout the study period, and no correlation with precipitation or water volume. However, the greatest diversity value was recorded in March 2006, when the peak of the precipitation was recorded. Evenness values showed a similar trend to the diversity index.

Inelastic collisions in molecular oxygen at low temperature (4 ≤ T ≤ 34 K). Close-coupling calculations versus experiment.

Close-coupling calculations and experiment are combined in this work, which is aimed at establishing a set of state-to-state rate coefficients for elementary processes ij → lm in O(2):O(2) collisions at low temperature involving the rotational states i, j, l, m of the vibrational ground state of (16)O(2)((3)Σ(g)(-)). First, a set of cross sections for inelastic collisions is calculated as a function of the collision energy at the converged close-coupled level via the MOLSCAT code, using a recent ab-initio potential energy surface for O(2)-O(2) [M. Bartolomei et al., J. Chem. Phys. 133, 124311 (2010)]. Then, the corresponding rates for the temperature range 4 ≤ T ≤ 34 K are derived from the cross sections. The link between theory and experiment is a Master Equation which accounts for the time evolution of rotational populations in a reference volume of gas in terms of the collision rates. This Master Equation provides a linear function of the rates for each rotational state and temperature. In the experiment, the evolution of rotational populations is measured by Raman spectroscopy in a tiny reference volume (≈2 × 10(-4) mm(3)) of O(2) travelling along the axis of a supersonic jet at a velocity of ≈700 m/s. The accuracy of the calculated rates is assessed experimentally for 10 ≤ T ≤ 34 K by means of the Master Equation. The rates, jointly with their confidence interval estimated by Monte Carlo simulation, account to within the experimental uncertainty for the evolution of the populations of the N = 1, 3, 5, 7 rotational triads along the supersonic jet. Confidence intervals range from ≈6% for the dominant rates at 34 K, up to ≈17% at 10 K. These results provide an experimental validation of state-to-state rates for O(2):O(2) inelastic collisions calculated in the close-coupling approach and, indirectly, of the anisotropy of the O(2)-O(2) intermolecular potential employed in the calculation for energies up to 300 cm(-1).

The prevalence of coeliac disease is significantly higher in children compared with adults.

BACKGROUND: Some limited studies of coeliac disease have shown higher frequency of coeliac disease in infancy and adolescence than in adulthood. This finding has remained unnoticed and not adequately demonstrated. AIM: To assess whether there are age and gender differences in coeliac disease prevalence. METHODS: A total of 4230 subjects were included consecutively (1 to ≥80 years old) reproducing the reference population by age and gender. Sample size was calculated assuming a population-based coeliac disease prevalence of 1:250. After an interim analysis, the paediatric sample was expanded (2010 children) due to high prevalence in this group. Anti-transglutaminase and antiendomysial antibodies were determined and duodenal biopsy was performed if positive. Log-linear models were fitted to coeliac disease prevalence by age allowing calculation of percentage change of prevalence. Differences between groups were compared using Chi-squared test. RESULTS: Twenty-one subjects had coeliac disease (male/female 1:2.5). Coeliac disease prevalence in the total population was 1:204. Coeliac disease prevalence was higher in children (1:71) than in adults (1:357) (P = 0.00005). A significant decrease of prevalence in older generations was observed [change of prevalence by age of -5% (95% CI: -7.58 to -2.42%)]. In the paediatric expanded group (1-14 years), a decrease of coeliac disease prevalence was also observed [prevalence change: -17% (95% CI: -25.02 to -6.10)]. CONCLUSIONS: The prevalence of coeliac disease in childhood was five times higher than in adults. Whether this difference is due to environmental factors influencing infancy, or latency of coeliac disease in adulthood, remains to be demonstrated in prospective longitudinal studies.

Nonadiabatic couplings in the collisional removal of O(2)(b (1)Sigma(g) (+),v) by O(2).

The effect of nonadiabatic couplings on the collisional removal of O(2)(b (1)Sigma(g) (+),v) by O(2)(X (3)Sigma(g) (-), v=0) is investigated. Two-dimensional adiabatic and quasidiabatic potential energy surfaces for the excited dimer states and the corresponding nonadiabatic radial couplings have been computed by means of ab initio calculations. Alternately, a two-state theoretical model, based on the Landau-Zener and Rosen-Zener-Demkov assumptions, has been employed to derive analytical forms for the nonadiabatic couplings and an adiabatic-to-diabatic transformation only depending on a reduced set of adiabatic energy terms. Compared to the ab initio results, the predictions of the model are found to be highly accurate. Quantum dynamics calculations for the removal of the first ten vibrational states of O(2)(b (1)Sigma(g) (+),v) indicate a clear dominant contribution of the vibration-electronic relaxation mechanism relative to the vibration-translation energy transfer. Although the present reduced-dimensionality model precludes any quantitative comparison with experiments, it is found that the removal probabilities for v=1-3 are qualitatively consistent with the experimental observations, once the vibrational structure of the fragments is corrected with spectroscopical terms. Besides, the model served to show how the computation of the adiabatic PESs just at the crossing seam was sufficient to describe the nonadiabatic dynamics related to a given geometrical arrangement. This implies considerable savings in the calculations which will eventually allow for larger accuracy in the ab initio calculations as well as higher dimensional treatments.

Leuprolide acetate gonadotrophin response patterns during female puberty.

OBJECTIVE: To assess normative data and the usefulness of spontaneous and LHRH analogue-stimulated serum LH and FSH levels measured by immunoradiometric assays (IRMA) in the evaluation of normal puberty. DESIGN: Prospective. Healthy girls in Tanner I and Tanner II from the local community were invited to participate (n = 47). METHODS: A leuprolide acetate test (500 mcg/m(2); sc) was performed. LH and FSH levels were determined using IRMA. Tanner II girls were assessed every 6 months until Tanner V. Girls who progressed from Tanner II to Tanner III in the next 6 months were called Tanner II-2; otherwise, they were called Tanner II-1. RESULTS: The prepubertal upper limit (CI 95%) was 0.49 IU/l for basal LH and 5.1 IU/l for stimulated LH. Taking into account these LH cut-off limits, 72.2% and 66.7% of Tanner II-1 and 41.6% and 41.7% of Tanner II-2 subjects presented overlapping values for basal and stimulated LH, respectively, as compared with the Tanner I group. The cut-offs for basal and stimulated LH to predict progression from Tanner II to Tanner III in the next 6 months were a basal LH level > or =0.49 IU/l (Sensitivity = 0.58; 1-Specificity = 0.33) and a poststimulated LH level > or =4.75 IU/l (Sensitivity = 0.67; 1-Specificity = 0.44). CONCLUSION: According to an IRMA, the basal and leuprolide acetate gonadotrophin response patterns during the beginning stages of puberty overlapped between Tanner I and Tanner II, and the cut-offs of basal and stimulated LH levels to predict progress from Tanner II to Tanner III had low sensitivities for the following 6 months.

Quantifying the biodiversity value of tropical primary, secondary, and plantation forests.

Biodiversity loss from deforestation may be partly offset by the expansion of secondary forests and plantation forestry in the tropics. However, our current knowledge of the value of these habitats for biodiversity conservation is limited to very few taxa, and many studies are severely confounded by methodological shortcomings. We examined the conservation value of tropical primary, secondary, and plantation forests for 15 taxonomic groups using a robust and replicated sample design that minimized edge effects. Different taxa varied markedly in their response to patterns of land use in terms of species richness and the percentage of species restricted to primary forest (varying from 5% to 57%), yet almost all between-forest comparisons showed marked differences in community structure and composition. Cross-taxon congruence in response patterns was very weak when evaluated using abundance or species richness data, but much stronger when using metrics based upon community similarity. Our results show that, whereas the biodiversity indicator group concept may hold some validity for several taxa that are frequently sampled (such as birds and fruit-feeding butterflies), it fails for those exhibiting highly idiosyncratic responses to tropical land-use change (including highly vagile species groups such as bats and orchid bees), highlighting the problems associated with quantifying the biodiversity value of anthropogenic habitats. Finally, although we show that areas of native regeneration and exotic tree plantations can provide complementary conservation services, we also provide clear empirical evidence demonstrating the irreplaceable value of primary forests.

Comparison of leptin levels, body composition and insulin sensitivity and secretion by OGTT in healthy, early pubertal girls born at either appropriate- or small-for-gestational age.

BACKGROUND: Small for gestational age (SGA) has been associated with decreased insulin sensitivity (IS). A possible mechanism is the postnatal development of a metabolically disadvantageous body composition (BC). AIM: To determine whether there are differences between IS and BC in girls in early puberty who were SGA (birth weight < 10th percentile) or appropriate for gestational age (AGA, 10th-90th percentile). METHODS: Age-matched (SGA/AGA) early pubertal girls (Tanner II) were recruited from local schools. We determined waist circumference (WC), the sum of four skinfolds (S4S), and per cent fat mass (fat %) by impedanciometry. Leptin and OGTT assays were performed. The insulinogenic index (I-In), HOMA-IR (homeostasis model assessment of insulin resistance) and WBISI (whole body insulin sensitivity) were calculated. RESULTS: Median age (interquartile range) for 30 SGA and 35 AGA girls was 10.2 (1.1) vs. 9.8 (0.9), respectively (P = NS). BMI percentiles were 62.6 (56) vs. 67.4 (39); WC 60.5 (9.5) vs. 62.2 (6.5) cm; S4S 52 (30) vs. 52.2 (29.5) cm, and fat %[26.2 (6.7) vs. 28.5 (6.3)] was similar in both groups. SGA girls had higher leptin levels [15.4 (9.7) vs. 9.6 (11) ng/ml; P = 0.01] and I-In [2.05 (1.86) vs. 1.47 (1.27) microU/ml* mg/dl; P = 0.02]. No differences between HOMA-IR [2.07 (1.26) vs. 2.04 (1.4)] and WBISI [5.3 (3.3) vs. 5.1 (3.1)] were found between groups. CONCLUSION: The higher leptin level and I-In in girls born SGA at the beginning of puberty may be early indicators of an underlying subtle degree of insulin resistance, despite similar BMI and BC to AGA girls.

Corticosteroid-induced osteoporosis in children: outcome after two-year follow-up, risk factors, densitometric predictive cut-off values for vertebral fractures.

OBJECTIVE: To identify factors that contribute to a decreased Z score of volumetric spine bone mineral density (ZvSBMD) and the development of vertebral fractures (VF) in children receiving chronic systemic corticosteroid therapy (SCT); to describe their outcome after 2 years, and to define predictive threshold values for ZvSBMD for VF. METHODS: Fifty-five children on SCT for >or= 6 months were prospectively followed for 2 years. In children with a ZvSBMD > -1.5, we prescribed preventive measures for osteoporosis and densitometry annually. In children with ZvSBMD

Gammaglutamil transpeptidasa sérica. Marcador de alcoholismo crónico / No disponible

No disponible