Relationship between adverse childhood experiences and perceived discrimination in adulthood.

BACKGROUND: Adverse Childhood Experiences (ACEs) and perceived discrimination impact health overtime, however little is known about their association. METHODS: Data for 6,325 participants in the Midlife in the US (MIDUS) study were analyzed across three waves of data. ACEs included emotional or physical abuse, household dysfunction, or financial strain in childhood. Generalized Linear Models with Generalized Estimating Equation approach was used to test the unadjusted and adjusted associations for ACEs and perceived discrimination and perceived inequality. RESULTS: Individuals with ACEs reported significantly higher perceived inequality in work (ß=0.05, 95%CI 0.02-0.07), in home (ß=0.06, 95%CI 0.04-0.09), in family relationships (ß=0.09, 95%CI 0.06-0.11), perceived daily discrimination (ß=0.77, 95%CI 0.58-0.96), and perceived lifetime discrimination (ß=0.24, 95%CI 0.18-0.30). ACE types were significantly associated with more perceived inequality and perceived discrimination. . Abuse was independently associated with all outcomes after adjusting for household dysfunction, financial strain, age, sex, race/ethnicity, education, marital status, and income. LIMITATIONS: Findings cannot speak to the temporal relationship between ACEs and discrimination. It should not be assumed that ACEs cause perceived discrimination, but rather that there is an important association that warrants further investigation. CONCLUSIONS: These findings represent the first step in better understanding the relationship between ACEs and perceived discrimination. As both influence health across the lifespan, understanding the relationship, mechanisms, and pathways for intervening are of great importance from a population health perspective. Efforts to incorporate discussions on experiences with discrimination and inequality may be warranted as a part of treatment for ACEs to address psychosocial stressors across the lifespan.

The differential impact of adverse childhood experiences in the development of pre-diabetes in a longitudinal cohort of US adults.

BACKGROUND: ACEs have a dose-response relationship with diabetes. The relationship between ACEs and pre-diabetes is not well known and may represent an effective area for prevention efforts. METHODS: Data from 1054 participants from two waves of the longitudinal MIDUS study were used. Multivariate general linear regression models assessed the relationship between ACEs and biomarker outcomes. Correlation tests and mediation models investigated the relationship between ACE and pre-diabetes. RESULTS: Individuals reporting ACEs were statistically significantly more likely to have higher BMI (1.13 (0.34-1.92)), higher waist circumference (2.74 (0.72-4.76)), elevated blood fasting insulin levels (2.36 (0.71-4.02)) and higher insulin resistance (HOMA-IR (0.57 (0.08-1.06)). BMI/waist circumference and insulin resistance did not maintain independent relationships with ACEs once HOMA-IR was included in the dichotomized ACE model (p = 0.05 and p = 0.06, respectively), suggesting the relationship between BMI and ACEs may be mediated by insulin resistance. CONCLUSIONS: These results represent one of the first studies to examine the differential impact of ACEs on a diverse set of clinical pre-diabetes measures. Findings suggest sexual and physical abuse, and financial strain during childhood are important factors associated with higher risk for pre-diabetes, and should be considered during intervention development.

Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review.

BACKGROUND: Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery. METHODS: Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews. RESULTS: Six thousand one hundred eighty-seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third-party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter-term outpatient). Out-of-pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one-third of studies. Body-contouring surgery included in only 14%. One study evaluated long-term waitlisted patients. Surgery was cost-effective/cost-saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent. DISCUSSION: There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.

The origins of neuromuscular fatigue post-stroke.

Fatigue post-stroke is a disabling and persistent symptom affecting many stroke survivors. Despite its high prevalence, the pathophysiology underlying this phenomenon remains obscure. The aim of the present study was to investigate the origins of neuromuscular fatigue post-stroke. Ten chronic stroke survivors and 10 controls sustained an isometric contraction at 30% of maximal voluntary contraction (MVC) with the ankle dorsiflexors. Motor evoked potential (MEP), cortical silent period (SP), voluntary activation, M wave and contractile properties were evaluated before, during and after fatigue among the paretic, non-paretic and control limbs. The pattern of response to fatigue in the non-paretic and control limbs was comparable; therefore, results are presented between the paretic and non-paretic limbs. Before fatigue, reduced MVC peak torque and MEP amplitude were observed on the paretic side in comparison with the non-paretic side. During fatigue, the cortical SP duration increased significantly in both limbs, whereas the MEP amplitude significantly increased only in the non-paretic limb. After fatigue, MVC peak torque decreased significantly in both limbs. Significant reductions in M wave and twitch peak torque were observed in both limbs, pointing to the development of peripheral fatigue. However, central fatigue, evident by a significant reduction in voluntary activation, was greater in the paretic than in the non-paretic limb. After stroke, an inability to increase central excitability in response to an increased cortical inhibition associated with the fatiguing contraction may contribute to central fatigue observed in the paretic limb, which may also be linked to increased self-reported fatigue during activities of daily living. These findings advance our understanding of the neuromuscular basis of fatigue post-stroke.

The expression of protoporphyrinogen oxidase in human tissues.

Protoporphyrinogen oxidase is the penultimate enzyme in the haem biosynthetic pathway. In this study, the expression of protoporphyrinogen oxidase in a variety of human organs has been documented by immunohistochemical means at the light microscopy level in order to shed light on its inter- and intra-organ distribution. The expression varied amongst organs and the various cell types within an organ. The pattern of staining generally reflected presumed metabolic functionality and haem demand. Strongest staining was noted in hepatocytes, proximal convoluted tubules of the kidney, serous cells of the peribronchial gland in the lung, parietal cells of the stomach, tips of the villi in the small intestine and interstitial cells of the testis. Our results suggest that there are some significant sites of haem synthesis in addition to the liver and bone marrow, and should be borne in mind in studies related to haem or porphyrin dynamics and flux.

The function of the midtarsal joint: a review of the literature.

The midtarsal joint (MTJt) consists of the combined articulations of the talonavicular and calcaneocuboid joints and represents the functional articulation between the rearfoot (talus and calcaneus) and the midfoot (navicular and cuboid). The movement of the transverse tarsal region has been described as a segment rotating around two distinct axes of the MTJt; the longitudinal and the oblique. Recent research has suggested that the two axes model of the MTJt is a theory of convenience to explain clinical observation, and that the MTJt moves in a more complex manner. It has been hypothesised that the MTJt has one triplanar axis of motion, so there remains the need to investigate the practical application of this understanding in terms of how this motion affects the MTJt in gait and the implications this may have on podiatric treatment.

Glasslike two-level systems in minimally disordered mixed crystals.

THz spectroscopy is used to identify a broad distribution of two-level systems, characteristic of glasses, in the substitutional monatomic mixed crystal systems, Ba(1-x)Ca(x)F(2) and Pb(1-x)Ca(x)F(2). In these minimally disordered systems, two-level behavior, which was not previously known to occur, begins at a specific CaF(2) concentration. The concentration dependence, successfully modeled using the statistics of the impurity distribution in the lattice, points to a collective dopant tunneling mechanism.

Seven new species of Eimeria Schneider, 1875 (Apicomplexa: Eimeriidae) from colubrid snakes of Guatemala and a discussion of what to call ellipsoid tetrasporocystic, dizoic coccidia of reptiles.

During a survey of Guatemalan herpetofauna in the summers of 1998-2000, 29 presumed new species of Eimeria Schneider, 1875 were found, seven of which have a distinct elongate-ellipsoidal shape (L/W ratio >or= 1.7) and are described herein. Six of the seven new species are similar in oöcyst length, width and L/W ratio and sporocyst length, width and L/W ratio, lack a micropyle, oöcyst residuum, Stieda body, sub-- and parastieda bodies, have a polar granule and sporocyst residuum, and their sporocysts appear to have dehiscence sutures. The seventh is slightly smaller and has sporocysts with a Stieda body. The new species are: E. coniophanes n. sp - whose sporulated oöcysts from Coniophanes fissidens are 29.2x14.9 (27-31x13-16) microm, with sporocysts 10.0 x 7.8 microm; E. coniophis n. sp. -from Conophis lineatus are 32.0x16.5 (30-34x14-18) microm, with sporocysts 10.2 x 8.9microm; E. dryomarchoni n. sp. - from Drymarchon corais are 32.2x17.7 (31-34x17-19) microm, with sporocysts 10.7 x 8.6 microm; E. leptophis n. sp. - from Leptophis mexicanus are 29.5x17.0 (28-31x16-18) microm, with sporocysts 10.0 x 9.1 microm; E. oxybelis n. sp. - from Oxybelis aeneus are 31.8x16.5 (29-33x15-18) microm, with sporocysts 10.3 x 8.8 microm; and E. scaphiodontophis n. sp. - from Scaphiodontophis annulatus are 30.0x15.3 (28-33x14-16) microm, with sporocysts 9.9 x 7.9 microm. Sporulated oöcysts of E. siboni n. sp. from Sibon nebulata are 24.3x14.2 (21-27x13-16) microm, with sporocysts 10.0 x 7.1 microm and with a Stieda body. We conclude that until all aspects of each life-cycle are known, it is prudent at this time to name all tetrasporocystic dizoic coccidia from snakes as members of Eimeria rather than place some of them in Choleoeimeria Paperna & Landsberg, 1989.

Factors associated with the catastrophic decline of a cloudforest frog fauna in Guatemala

Comparison of recent and historical surveys of frog populations in cloudforest habitat in Sierra de las Minas,Guatemala,indicated population declines and local extirpation of several species.Pathological exams of diseased tadpoles indicated infection by amphibian chytridiomycosis. The local habitat has been severely altered by recent establishment of large-scale leatherleaf fern production.Analysis of water chemistry at our study site suggested increased nitrogenation associated with the leatherleaf industry

Una comparación entre un inventario anterior y otro reciente de poblaciones de ranas de bosque nublado en la Sierra de Las Minas de Guatemala demostró disminuciones poblacionales y ausencia localizada de varias especies.El examen patológico de un renacuajo muerto indicó infección por un hongo quítrido propio de los anfibios.El hábitat local ha sido gravemente alterado por el establecimiento reciente de producción a gran escala de helechos ornamentales.El análisis químico del agua en el área de estudio señaló un aumento en nitrogenación asociado al cultivo de helechos

Sorption and oxic degradation of the explosive CL-20 during transport in subsurface sediments.

The abiotic sorption and oxic degradation processes that control the fate of the explosive CL-20, Hexanitrohexaazaisowurtzitane, in the subsurface environment were investigated to determine the potential for vadose and groundwater contamination. Sorption of aqueous CL-20 is relatively small (K(d) = 0.02-3.83 cm3 g(-1) for 7 sediments and 12 minerals), which results in only slight retardation relative to water movement. Thus, CL-20 could move quickly through unsaturated and saturated sediments of comparable composition to groundwater, similar to the subsurface behavior of RDX. CL-20 sorption was mainly to mineral surfaces of the sediments, and the resulting isotherm was nonlinear. CL-20 abiotically degrades in oxic environments at slow rates (i.e., 10s to 100s of hours) with a wide variety of minerals, but at fast rates (i.e., minutes) in the presence of 2:1 phyllosilicate clays (hectorite, montmorillonite, nontronite), micas (biotite, illite), and specific oxides (MnO2 and the ferrous-ferric iron oxide magnetite). High concentrations of surface ferrous iron in a dithionite reduced sediment degraded CL-20 the fastest (half-life < 0.05 h), but 2:1 clays containing no structural or adsorbed ferrous iron (hectorite) could also quickly degrade CL-20 (half-life < 0.2 h). CL-20 degradation rates were slower in natural sediments (half-life 3-800 h) compared to minerals. Sediments with slow degradation rates and small sorption would exhibit the highest potential for deep subsurface migration. Products of CL-20 oxic degradation included three high molecular weight compounds and anions (nitrite and formate). The 2-3.5 moles of nitrite produced suggest CL-20 nitro-groups are degraded, and the amount of formate produced (0.2-1.2 moles) suggests the CL-20 cage structure is broken in some sediments. Identification of further degradation products and CL-20 mineralization rates is needed to fully assess the impact of these CL-20 transformation rates on the risk of CL-20 (and degradation product) subsurface movement.

Resin-dentin interfacial ultrastructure and microtensile dentin bond strength after five-year water storage.

OBJECTIVE: To evaluate a total-etch three-step adhesive system's resin-dentin interfacial ultrastructure and microtensile dentin bond strength (microTBS) after multi-year storage in water. METHODS: Resin composite crowns were formed on 600 grit SiC flattened extracted human molars using a total-etch three-step adhesive system (Optibond FL, Kerr) and a hybrid resin composite (Prodigy, Kerr). microTBS specimens were fabricated and placed in water with 0.5% chloramine T at 37 degrees C until respective static load to failure testing at one-month, six-months and five-year storage. Failure modes were determined by scanning electron microscopy. The interfacial ultrastructure of the resin-dentin interface was analyzed by transmission electron microscopy (TEM) at 48-hours and 44-months storage. microTBS was modeled with Weibull distribution for survival analysis and failure curve distributions were analyzed by the Wald chi-square statistic for significant differences at alpha=0.05. RESULTS: The characteristic tensile strength (sigma omicron) at one-month, six-months and five-year storage was 52.63, 14.77 and 23.57 Mpa, with a Weibull modulus of 3.04, 1.56 and 1.28, respectively. Failure distributions for all groups were significantly different (p<0.0001) with one-month > five-year > six-months. TEM interfacial morphology demonstrated hydrolytic degradation of hybrid layer components at 44-months storage. SIGNIFICANCE: The decrease in tensile strength and changes in ultrastructure may be caused by water sorption and resultant hydrolytic degradation of the adhesive joint.

Factors associated with the catastrophic decline of a cloudforest frog fauna in Guatemala.

Comparison of recent and historical surveys of frog populations in cloudforest habitat in Sierra de las Minas, Guatemala, indicated population declines and local extirpation of several species. Pathological exams of diseased tadpoles indicated infection by amphibian chytridiomycosis. The local habitat has been severely altered by recent establishment of large-scale leatherleaf fern production. Analysis of water chemistry at our study site suggested increased nitrogenation associated with the leatherleaf industry.

Novel inhibitors of procollagen C-proteinase. Part 2: glutamic acid hydroxamates.

Glutamic acid derived hydroxamates were identified as potent and selective inhibitors of procollagen C-proteinase, an essential enzyme for the processing of procollagens to fibrillar collagens. Such compounds have potential therapeutic application in the treatment of fibrosis.

Depressive symptoms predict medical care utilization in a population-based sample.

BACKGROUND: Several examinations have detected a relation between depressive symptoms and medical utilization. However, selection biases have been involved in most previous examinations. We sought to test the association between depressive symptoms and prospective, increased medical care utilization, in a population-based Canadian sample, while controlling for utilization due to medical illness and controlling for selection bias. METHODS: Data from the Nova Scotia Health Survey 1995, an age- and sex-stratified random sampling of 3227 Nova Scotian adults, included the Center for Epidemiological Studies-Depression scale and items assessing chronic medical conditions and current limitations in daily activities resulting from medical illness. We linked survey data with medical care utilization measures for the year following the survey, including out-patient visits, reimbursement for out-patient services, hospitalizations, and hospitalization days. RESULTS: After controlling for age, sex, count of medical diagnoses and current medical severity, those with a greater level of depressive symptoms were at greater risk of having increased medical care utilization in the following year. These results remained after removing mental health care utilization costs. CONCLUSIONS: In a population-based sample, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures. Whether depressive symptoms are a risk marker or a causal risk factor for increased medical utilization remains to be explored.

The appeal cycle in three cultures: an exploratory comparison of child development.

Mother-child behaviors were studied in three cultural groups: Caucasian American (CA), overseas Japanese (JPN), and Chinese Vietnamese (CVN) immigrants. The children were sixteen to twenty-five months old, and the appeal cycle, with its descriptive analytic method, was the research paradigm. Group differences were found in appeal cycle occurrence and phase frequencies. CA mothers promoted independence through encouragement of decision making and toddler-initiated play, and through nonintrusive interactions. Neither JPN nor CVN mothers encouraged independence. JPN mothers were subtly directive; CVN mothers overtly so. Generally, CA toddlers played independently, evincing a beginning capacity for self-regulation. JPN and CVN toddlers reacted to separation by staying close to their mothers, and fewer were observed to play independently than in the CA group. CVN toddlers played independently more frequently than JPN toddlers, but less frequently than CA toddlers. Quantitative measures of dyadic behaviors generally support the descriptive findings, though methodological constraints did not permit comparison of phase sequencing. The findings reflect cultural differences in child development thought to influence psychic structure formation.

A phase I study of oxidized raffinose cross-linked human hemoglobin.

OBJECTIVE: To evaluate the safety of oxidized-raffinose cross-linked human hemoglobin, Hemolink, in normal healthy volunteers. DESIGN: Randomized, placebo-controlled, double-blind study. SETTING: Clinical research facility of a contract research organization. PATIENTS: Forty-two healthy adult male volunteers of which 33 received Hemolink. INTERVENTIONS: Oxidized-raffinose cross-linked and polymerized hemoglobin as a 10% (w/v) solution, in doses of 0.025-0.6 g/kg or an equivalent volume of lactated Ringer's solution, was infused intravenously on day 1, and subjects were monitored for 3 days in the clinical facility with < or =6 wks follow-up. Major organ function was assessed pre- and postinfusion, by hemodynamic, electrocardiographic, pulmonary function, and clinical chemistry measurements. MEASUREMENTS AND MAIN RESULTS: Doses of 1.7-42 g of hemoglobin were administered with no serious adverse events noted. Abdominal pain of moderate to severe intensity was seen in some subjects at doses >0.4 g/kg and was alleviated with smooth muscle relaxants. There was a dose-dependent increase in mean arterial pressure with a plateau of approximately 14% above baseline at 0.1 g/kg. There was a concomitant reduction in heart rate, with no electrocardiographic abnormalities found. Respiratory function was not affected. There was a dose-dependent increase in serum bilirubin with values above the upper limit of normal at doses of > or =0.4 g/kg. Small increases in aspartate aminotransferase and alanine aminotransferase were noted in some patients, whereas alkaline phosphatase and gamma-glutamyltransferase remained in the normal range. Serum amylase concentrations were normal in 31 of 33 patients receiving Hemolink, whereas lipase was within the normal range in 21 of 33 patients. LDH was increased in a dose-dependent fashion. Two patients had increased creatine kinase concentrations, with a normal creatine kinase-MB mass fraction. All hematologic variables were within the normal range. The half-life of the oligomeric (>64 kDa) fraction of Hemolink was 18-20 hrs. CONCLUSION: Oxidized-raffinose cross-linked hemoglobin, Hemolink, at doses < or =0.6 g/kg were well tolerated in healthy volunteers with no evidence of organ dysfunction. Further investigation of its potential use in surgical and trauma settings appears warranted.

A new Eimeria sP. from the plumbeous Central American caecilian, Dermophis mexicanus (amphibia: gymnophiona) from Volcán Tajumulco, Department of San Marcos, Guatemala.

Fresh fecal samples from 5 caecilians (Dermophis mexicanus) were collected and examined for coccidia in the summer of 1998. The caecilians were collected in the Department of San Marcos, Guatemala. Two of the 5 (40%) specimens of caecilians contained an Eimeria species that is described here as new. This represents the first coccidia described from a gymnophionian host. Sporulated oocysts are spheroidal to subspheroidal, 19.5 X 17.7 (16-23 x 15-21) microm, micropyle and oocyst residuum are absent, and 3 (or more) polar granules are always present. Sporocysts are ovoidal, 11.0 X 7.2 (10-12 x 6-9); a Stieda body and sporocyst residuum are present.

A new species of arboreal pitviper from the Atlantic versant of northern Central America.

A new species of green, prehensile-tailed pitviper of the genus Bothriechis is described from the Atlantic slopes of eastern Guatemala and western Honduras. This species appears to be most closely related to B. bicolor of the Pacific versant of Chiapas (Mexico) and Guatemala. Several other species of Bothriechis occur on the Atlantic versant of northern Central America, including two montane species, B. aurifer and B. marchi but, with one possible exception, these are not known to be sympatric with the new species and occur in different mountain ranges. The widespread B. schlegelii occurs up to at least 900 m on the Sierra de Caral, where the lowest elevation recorded for the new species is 885 m.