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1.
PLoS One ; 15(2): e0228767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045447

RESUMO

INTRODUCTION: Hepatitis C (HCV) infection is a significant health threat, with increasing incidence rates in the setting of the opioid crisis. Many patients miss appointments and cannot initiate treatment. We implemented financial incentives to improve appointment attendance in a primary care-based HCV treatment setting. METHODS: We conducted a systems-level financial incentives intervention at the Adult Primary Care HCV Treatment Program at Boston Medical Center which provides care to many patients with substance use disorders. From April 1 to June 30, 2017, we provided a $15 gift card to patients who attended appointments with an HCV treatment provider. We evaluated the effectiveness of the incentives by 1) conducting a monthly interrupted time series analysis to assess trends in attendance January 2016-September 2017; and 2) comparing the proportion of attended appointments during the intervention to a historical comparison group in the previous year, April 1 to June 30, 2016. RESULTS: 327 visits were scheduled over the study period; 198 during the intervention and 129 during the control period. Of patient visits in the intervention group, 72.7% were attended relative to 61.2% of comparison group visits (p = 0.03). Appointments in the intervention group were more likely to be attended (adjusted odds ratio 1.94, 95% confidence interval 1.16-3.24). Interrupted time series analysis showed that the intervention was associated with an average increase of 15.4 attended visits per 100 appointments scheduled, compared to the period prior to the intervention (p = 0.01). CONCLUSIONS: Implementation of a financial incentive program was associated with improved appointment attendance at a safety-net hospital-based primary care HCV treatment program. A randomized trial to establish efficacy and broader implementation potential is warranted.

2.
Pediatr Res ; 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31618753

RESUMO

BACKGROUND: As clinical exome sequencing (CES) becomes more common, understanding which patients are most likely to benefit and in what manner is critical for the general pediatrics community to appreciate. METHODS: Five hundred and twenty-three patients referred to the Pediatric Genetics clinic at Michigan Medicine were systematically phenotyped by the presence or absence of abnormalities for 13 body/organ systems by a Clinical Genetics team. All patients then underwent CES. RESULTS: Overall, 30% of patients who underwent CES had an identified pathogenic mutation. The most common phenotypes were developmental delay (83%), neuromuscular system abnormalities (81%), and multiple congenital anomalies (42%). In all, 67% of patients had a variant of uncertain significance (VUS) or gene of uncertain significance (GUS); 23% had no variants reported. There was a significant difference in the average number of body systems affected among these groups (pathogenic 5.89, VUS 6.0, GUS 6.12, and no variant 4.6; P < 0.00001). Representative cases highlight four ways in which CES is changing clinical pediatric practice. CONCLUSIONS: Patients with identified variants are enriched for multiple organ system involvement. Furthermore, our phenotyping provides broad insights into which patients are most likely to benefit from genetics referral and CES and how those results can help guide clinical practice more generally.

5.
Sci Rep ; 9(1): 9414, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31263158

RESUMO

Acute promyelocytic leukemia (APL) is characterized by arrested differentiation of promyelocytes. Patients treated with all-trans retinoic acid (ATRA) alone experience relapse, while patients treated with ATRA and arsenic trioxide (ATO) are often relapse-free. This suggests sustained changes have been elicited by the combination therapy. To understand the lasting effects of the combination therapy, we compared the effects of ATRA and ATO on NB4 and ATRA-resistant NB4-MR2 APL cells during treatment versus post treatment termination. After treatment termination, NB4 cells treated with ATRA or ATO reverted to non-differentiated cells, while combination-treated cells remained terminally differentiated. This effect was diminished in NB4-MR2 cells. This suggests combination treatment induced more permanent changes. Combination treatment induced higher expression of target genes (e.g., transglutaminase 2 and retinoic acid receptor beta), which in NB4 cells was sustained post treatment termination. To determine whether sustained epigenetic changes were responsible, we quantified the enrichment of histone modifications by chromatin immunoprecipitation, and CpG methylation by bisulfite-pyrosequencing. While ATRA and combination treatment induced similar histone acetylation enrichment, combination treatment induced greater demethylation of target genes, which was sustained. Therefore, sustained demethylation of target genes by ATRA and ATO combination treatment is associated with lasting differentiation and gene expression changes.

6.
Commun Biol ; 2: 252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31286069

RESUMO

Although numerous studies have demonstrated that neuronal mechanisms regulate alcohol-related behaviors, very few have investigated the direct role of glia in behavioral responses to alcohol. The results described here begin to fill this gap in the alcohol behavior and gliobiology fields. Since Drosophila exhibit conserved behavioral responses to alcohol and their CNS glia are similar to mammalian CNS glia, we used Drosophila to begin exploring the role of glia in alcohol behavior. We found that knockdown of Cysteine proteinase-1 (Cp1) in glia increased Drosophila alcohol sedation and that this effect was specific to cortex glia and adulthood. These data implicate Cp1 and cortex glia in alcohol-related behaviors. Cortex glia are functionally homologous to mammalian astrocytes and Cp1 is orthologous to mammalian Cathepsin L. Our studies raise the possibility that cathepsins may influence behavioral responses to alcohol in mammals via roles in astrocytes.

7.
Alcohol Clin Exp Res ; 43(9): 1872-1886, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31241765

RESUMO

BACKGROUND: Self-Rating of the Effects of Alcohol (SRE) measures level of response to ethanol (EtOH) in humans. Interestingly, there is a positive relationship between the SRE and risk for abusing alcohol, suggesting mechanistic connections between SRE and alcohol abuse. METHODS: To identify candidate genes with a role in SRE and alcohol-related behavior more generally, we coupled human genetic analyses with studies in Drosophila melanogaster. We first performed a gene-based analysis of Genomewide association studies (GWAS) summary statistics for SRE in the Avon Longitudinal Study of Parents and Children sample. Based on prior findings in humans, orthology to fly genes, and the availability of genetic reagents, we selected a subset of these genes for studies on EtOH behavior in Drosophila. RESULTS: We found 37 genes with nominal associations in our SRE GWAS. We explored the role of 6 orthologous genes in Drosophila EtOH sedation and rapid tolerance. We found that the transcription factor Mef2 is required for normal EtOH sedation in flies. Pan-neuronal expression of 2 independent Mef2 RNAi transgenes significantly reduced Mef2 expression and made flies resistant to EtOH sedation. Additionally, flies with multiple independent mutant alleles of Mef2 were also resistant to EtOH sedation, confirming a role for Mef2 in this behavior. Altered expression of Mef2 did not change EtOH rapid tolerance or cause a net change in internal EtOH concentrations. CONCLUSIONS: Our studies indicate that MEF2B influences SRE in humans and that Mef2 impacts EtOH sedation in Drosophila.

8.
BMC Infect Dis ; 19(1): 346, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023260

RESUMO

BACKGROUND: Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. METHODS: This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. RESULTS: Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p < 0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10 mm, and among those with a skin test result ≥10 mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14 mm was 63.6%, and for those with a quantitative skin test result ≥15 mm it was 82.2%. CONCLUSIONS: There is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Tuberculose , Antituberculosos/uso terapêutico , Estudos Transversais , Hospitais , Humanos , Incidência , Moçambique/epidemiologia , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
9.
J Vasc Interv Radiol ; 30(7): 1043-1047, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30772167

RESUMO

PURPOSE: To evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe-only liver transplants (LLOTs). MATERIALS AND METHODS: Retrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18-73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35-74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed. RESULTS: Technical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group. CONCLUSIONS: TJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling.


Assuntos
Biópsia por Agulha/métodos , Cateterismo Venoso Central/métodos , Veias Hepáticas , Biópsia Guiada por Imagem/métodos , Veias Jugulares , Transplante de Fígado , Complicações Pós-Operatórias/patologia , Adolescente , Adulto , Idoso , Angiografia Digital , Biópsia por Agulha/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Veias Jugulares/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Flebografia , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Radiografia Intervencionista , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
10.
Nat Genet ; 50(10): 1388-1398, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30202056

RESUMO

Structural variants (SVs) can contribute to oncogenesis through a variety of mechanisms. Despite their importance, the identification of SVs in cancer genomes remains challenging. Here, we present a framework that integrates optical mapping, high-throughput chromosome conformation capture (Hi-C), and whole-genome sequencing to systematically detect SVs in a variety of normal or cancer samples and cell lines. We identify the unique strengths of each method and demonstrate that only integrative approaches can comprehensively identify SVs in the genome. By combining Hi-C and optical mapping, we resolve complex SVs and phase multiple SV events to a single haplotype. Furthermore, we observe widespread structural variation events affecting the functions of noncoding sequences, including the deletion of distal regulatory sequences, alteration of DNA replication timing, and the creation of novel three-dimensional chromatin structural domains. Our results indicate that noncoding SVs may be underappreciated mutational drivers in cancer genomes.


Assuntos
Genoma Humano , Variação Estrutural do Genoma , Neoplasias/genética , Biologia de Sistemas/métodos , Células A549 , Linhagem Celular Tumoral , Mapeamento Cromossômico , DNA de Neoplasias/análise , DNA de Neoplasias/genética , Genes Neoplásicos , Variação Genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Células K562 , Desequilíbrio de Ligação , Análise de Sequência de DNA/métodos , Integração de Sistemas
11.
Cell Death Dis ; 9(10): 990, 2018 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-30250195

RESUMO

Cancer cells with a less differentiated stem-like phenotype are more resistant to therapeutic manipulations than their differentiated counterparts, and are considered as one of the main causes of cancer persistence and relapse. As such, induction of differentiation in cancer stem-like cells (CSLCs) has emerged as an alternative strategy to enhance the efficacy of anticancer therapies. CSLCs are metabolically distinct from differentiated cells, and any aberration from the intrinsic metabolic state can induce differentiation of CSLCs. Therefore, metabolism-related molecular targets, with a capacity to promote differentiation within CSLCs, are of therapeutic importance. Here, we demonstrate that phosphoglycerate dehydrogenase (PHGDH), an essential enzyme catalyzing the synthesis of amino acid serine, is important for maintaining the poorly differentiated, stem-like state of CSLCs. Our data shows that PHGDH deficiency impairs the tumorsphere formation capacity in embryonal carcinoma stem-like cells (ECSLCs), breast cancer stem-like cells (BCSLCs) and patient-derived brain tumor-initiating cells (BTICs), which is accompanied by the reduced expression of characteristic stemness-promoting factors, such as Oct4, Nanog, Sox-2, and Bmi-1. Mechanistically, PHGDH deficiency in ECSLCs promotes differentiation to various lineages via degradation of Oct4 and by increasing the stability of differentiation marker ß3-tubulin. Furthermore, PHGDH inhibition promotes p-mTOR independent but Beclin-1-dependent autophagy, independent of apoptosis. When studied in combination, the inhibition of both PHGDH and p-mTOR in ECSLCs causes further augmentation of autophagy, and additionally promotes apoptosis, demonstrating the clinical applicability of PHGDH-based manipulations in cancer therapies. Recapitulating these in vitro findings in CSLC models, the intratumoral PHGDH expression in patient-derived tumors is positively correlated with the mRNA levels of stemness factors, especially Oct4, and cancer patients co-expressing high levels of PHGDH and Oct4 display significantly lower survival than those with low PHGDH/Oct4 co-expression. Altogether, this study identifies a clinically-relevant role for PHGDH in the regulation of stemness-differentiation axis within CSLCs.


Assuntos
Autofagia , Neoplasias Encefálicas/metabolismo , Carcinoma Embrionário/metabolismo , Diferenciação Celular , Células-Tronco de Carcinoma Embrionário/metabolismo , Glioblastoma/metabolismo , Fosfoglicerato Desidrogenase/metabolismo , Serina-Treonina Quinases TOR/metabolismo , Neoplasias Testiculares/metabolismo , Proteína Beclina-1/metabolismo , Neoplasias Encefálicas/patologia , Erros Inatos do Metabolismo dos Carboidratos/metabolismo , Carcinoma Embrionário/patologia , Linhagem Celular Tumoral , Glioblastoma/patologia , Humanos , Masculino , Microcefalia/metabolismo , Fator 3 de Transcrição de Octâmero/metabolismo , Fosfoglicerato Desidrogenase/antagonistas & inibidores , Fosfoglicerato Desidrogenase/deficiência , Fosfoglicerato Desidrogenase/genética , Proteólise , Transtornos Psicomotores/metabolismo , Convulsões/metabolismo , Neoplasias Testiculares/patologia , Transfecção , Tubulina (Proteína)/metabolismo , Ubiquitinação
12.
Sci Rep ; 8(1): 11536, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30068981

RESUMO

Although the Drosophila melanogaster (fly) model is a popular platform for investigating diet-related phenomena, it can be challenging to measure the volume of agar-based food media flies consume. We addressed this challenge by developing a dye-based method called Consumption-Excretion (Con-Ex). In Con-Ex studies, flies consume solid food labeled with dye, and the volume of food consumed is reflected by the sum of the dye inside of and excreted by flies. Flies consumed-excreted measurable amounts of FD&C Blue No. 1 (Blue 1) and other dyes in Con-Ex studies, but only Blue 1 was readily detectable at concentrations that had no discernable effect on consumption-excretion. In studies with Blue 1, consumption-excretion (i) increased linearly with feeding duration out to 24 h at two different laboratory sites, (ii) was sensitive to starvation, mating status and strain, and (iii) changed in response to alteration of media composition as expected. Additionally, the volume of liquid Blue 1 consumed from capillary tubes was indistinguishable from the volume of Blue 1 excreted by flies, indicating that excreted Blue 1 reflects consumed Blue 1. Our results demonstrate that Con-Ex with Blue 1 as a food tracer is a useful method for assessing ingestion of agar-based food media in adult flies.


Assuntos
Benzenossulfonatos/análise , Corantes/análise , Drosophila melanogaster/fisiologia , Ingestão de Alimentos , Entomologia/métodos , Coloração e Rotulagem/métodos , Animais
13.
J Neural Eng ; 15(6): 066003, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30124202

RESUMO

OBJECTIVE: Stereotactic frame systems are the gold-standard for stereotactic surgeries, such as implantation of deep brain stimulation (DBS) devices for treatment of medically resistant neurologic and psychiatric disorders. However, frame-based systems require that the patient is awake with a stereotactic frame affixed to their head for the duration of the surgical planning and implantation of the DBS electrodes. While frameless systems are increasingly available, a reusable re-attachable frame system provides unique benefits. As such, we created a novel reusable MRI-compatible stereotactic frame system that maintains clinical accuracy through the detachment and reattachment of its stereotactic devices used for MRI-guided neuronavigation. APPROACH: We designed a reusable arc-centered frame system that includes MRI-compatible anchoring skull screws for detachment and re-attachment of its stereotactic devices. We validated the stability and accuracy of our system through phantom, in vivo mock-human porcine DBS-model and human cadaver testing. MAIN RESULTS: Phantom testing achieved a root mean square error (RMSE) of 0.94 ± 0.23 mm between the ground truth and the frame-targeted coordinates; and achieved an RMSE of 1.11 ± 0.40 mm and 1.33 ± 0.38 mm between the ground truth and the CT- and MRI-targeted coordinates, respectively. In vivo and cadaver testing achieved a combined 3D Euclidean localization error of 1.85 ± 0.36 mm (p < 0.03) between the pre-operative MRI-guided placement and the post-operative CT-guided confirmation of the DBS electrode. SIGNIFICANCE: Our system demonstrated consistent clinical accuracy that is comparable to conventional frame and frameless stereotactic systems. Our frame system is the first to demonstrate accurate relocation of stereotactic frame devices during in vivo MRI-guided DBS surgical procedures. As such, this reusable and re-attachable MRI-compatible system is expected to enable more complex, chronic neuromodulation experiments, and lead to a clinically available re-attachable frame that is expected to decrease patient discomfort and costs of DBS surgery.


Assuntos
Imagem por Ressonância Magnética/instrumentação , Neuronavegação/instrumentação , Técnicas Estereotáxicas/instrumentação , Animais , Parafusos Ósseos , Cadáver , Estimulação Encefálica Profunda , Reutilização de Equipamento , Humanos , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Imagens de Fantasmas , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Suínos , Tomografia Computadorizada por Raios X
14.
J Ambul Care Manage ; 41(4): 308-313, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30148771

RESUMO

Team-based care may address burnout in primary care; few studies have examined the impact of nurse practitioner-physician (NP-MD) teams on provider burnout. This article describes a model of NP-MD care teams in an urban safety-net primary care practice. Average time to third next available appointment with a team provider (either NP or MD) decreased by nearly 20 days after implementation of the model. In total, 79% of MDs reported that the model was very or extremely helpful in reducing the burden of work between visits and 100% of NPs reported that they were very or extremely satisfied with their current job.


Assuntos
Esgotamento Profissional/prevenção & controle , Acesso aos Serviços de Saúde , Profissionais de Enfermagem/psicologia , Equipe de Assistência ao Paciente/organização & administração , Médicos/psicologia , Atenção Primária à Saúde/organização & administração , Adulto , Boston , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Provedores de Redes de Segurança , População Urbana
15.
BMJ Case Rep ; 20182018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30065052

RESUMO

A 58-year-old man with limited cutaneous systemic sclerosis and myositis overlap complicated by interstitial lung disease presented with several months of progressive dyspnoea and weakness. CT chest revealed extensive pneumomediastinum that was not present on imaging 6 months before this study and appeared to be spontaneous, with no preceding trauma, infection or invasive procedures.


Assuntos
Dispneia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/fisiopatologia , Enfisema Mediastínico/diagnóstico por imagem , Miosite/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Evolução Fatal , Humanos , Masculino , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/fisiopatologia , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Miosite/complicações , Miosite/diagnóstico por imagem , Radiografia Torácica , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Assistência Terminal
16.
Womens Health Issues ; 28(4): 367-374, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29784276

RESUMO

BACKGROUND: Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associations between drug use, IPV, and depressive symptoms and sexual risk behaviors by 400 women with alcohol misuse attending an urban sexually transmitted infections clinic. METHODS: Participants completed computer-assisted interviews querying drug use, IPV, and depressive symptoms and sexual risk behavior outcomes-unprotected sex under the influence of alcohol, sex for drugs/money, and number of lifetime sexual partners. We used multivariable analysis to estimate prevalence ratios (PR) for independent and joint associations between drug use, IPV, and depressive symptoms and our outcomes. To investigate synergy between risk factors we calculated the relative excess prevalence owing to interaction for all variable combinations. RESULTS: In multivariable analysis, drug use, IPV, and depressive symptoms alone and in combination were associated with higher prevalence/count of risk behaviors compared with women with alcohol misuse alone. The greatest prevalence/count occurred when all three were present (unprotected sex under the influence of alcohol [PR, 2.6; 95% confidence interval, 1.3-4.9]), sex for money or drugs [PR, 2.6; 95% confidence interval, 1.7-4.2], and number of lifetime partners [PR, 3.2; 95% confidence interval, 1.9-5.2]). Drug use, IPV, and depressive symptoms did not interact synergistically to increase sexual risk behavior prevalence. CONCLUSIONS: A higher prevalence of sexual risk behaviors by women with alcohol misuse combined with drug use, IPV, and depressive symptoms supports the need for alcohol interventions addressing these additional comorbidities.


Assuntos
Depressão/epidemiologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Assunção de Riscos , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
17.
Sci Rep ; 8(1): 4359, 2018 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-29531352

RESUMO

Functional and genomic heterogeneity of individual cells are central players in a broad spectrum of normal and disease states. Our knowledge about the role of cellular heterogeneity in tissue and organism function remains limited due to analytical challenges one encounters when performing single cell studies in the context of cell-cell interactions. Information based on bulk samples represents ensemble averages over populations of cells, while data generated from isolated single cells do not account for intercellular interactions. We describe a new technology and demonstrate two important advantages over existing technologies: first, it enables multiparameter energy metabolism profiling of small cell populations (<100 cells)-a sample size that is at least an order of magnitude smaller than other, commercially available technologies; second, it can perform simultaneous real-time measurements of oxygen consumption rate (OCR), extracellular acidification rate (ECAR), and mitochondrial membrane potential (MMP)-a capability not offered by any other commercially available technology. Our results revealed substantial diversity in response kinetics of the three analytes in dysplastic human epithelial esophageal cells and suggest the existence of varying cellular energy metabolism profiles and their kinetics among small populations of cells. The technology represents a powerful analytical tool for multiparameter studies of cellular function.


Assuntos
Tecnologia Biomédica/métodos , Comunicação Celular , Metabolismo Energético , Análise de Célula Única , Animais , Linhagem Celular , Células Epiteliais/fisiologia , Desenho de Equipamento , Esôfago/citologia , Humanos , Potencial da Membrana Mitocondrial , Consumo de Oxigênio , Tamanho da Amostra
18.
Sci Total Environ ; 628-629: 715-721, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29454211

RESUMO

The sustainability of rural, community-managed water systems in sub-Saharan Africa depends in part on the ability of local water committees to repair breakdowns and carry out the operation and maintenance (O&M) of the system. Much of sub-Saharan Africa has two distinct seasons that affect the availability of water sources and how people use water. Little is known about how seasonality affects water system management. This qualitative study is based on 320 interviews and focus group discussions and examines the effects of season on community water use and management in Ghana, Kenya and Zambia. Participants revealed that seasonality affects water availability, water system breakdowns, resource mobilization, committee activity, and external support availability. In the rainy season, participants typically reported spending less time and money on water collection because rainwater harvesting and seasonal streams, ponds, wells and reservoirs are available. In the dry season, people used improved groundwater sources more often and spent more money and time collecting water. Although seasonal changes in household water demand and use have been examined previously, our data suggest that seasonality also influences community management through differential water system use, system breakdowns and management characteristics. We found that water committees generally have less money, time and access to external support during the rainy season, making them less able to carry out O&M. Our results suggest that community engagement should take place over a long period of time so that seasonal patterns in management can be understood and incorporated into water committee training. External support actors should make a more targeted effort to understand the cultural and economic patterns in a community in order to train committees with appropriate management strategies.


Assuntos
Conservação dos Recursos Hídricos/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Gana , Humanos , Quênia , População Rural , Estações do Ano , Água , Abastecimento de Água/métodos , Zâmbia
19.
Health Secur ; 16(1): 8-13, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29406796

RESUMO

The CDC recommended active monitoring of travelers potentially exposed to Ebola virus during the 2014 West African Ebola virus disease outbreak, which involved daily contact between travelers and health authorities to ascertain the presence of fever or symptoms for 21 days after the travelers' last potential Ebola virus exposure. From October 25, 2014, to December 29, 2015, the New York City Department of Health and Mental Hygiene (DOHMH) monitored 5,359 persons for Ebola virus disease, corresponding to 5,793 active monitoring events. Most active monitoring events were in travelers classified as low (but not zero) risk (n = 5,778; 99%). There were no gaps in contact with DOHMH of ≥2 days during 95% of active monitoring events. Instances of not making any contact with travelers decreased after CDC began distributing mobile telephones at the airport. Ebola virus disease-like symptoms or a temperature ≥100.0°F were reported in 122 (2%) active monitoring events. In the final month of active monitoring, an optional health insurance enrollment referral was offered for interested travelers, through which 8 travelers are known to have received coverage. Because it is possible that active monitoring will be used again for an infectious threat, the experience we describe might help to inform future such efforts.


Assuntos
Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Vigilância da População/métodos , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Aeroportos , Criança , Pré-Escolar , Ebolavirus/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Medição de Risco , Adulto Jovem
20.
Transfusion ; 58 Suppl 1: 549-557, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29443411

RESUMO

Central venous access has become invaluable in the treatment of patients with a wide array of acute and chronic disease entities. Central venous catheters provide durable, short-term and long-term access solutions while saving the patient from repeated peripheral needle sticks. Central venous catheters include: non-tunneled central venous catheters, tunneled central venous catheters, and port catheters. Typically, the placement of a central venous catheter is performed by Vascular and Interventional Radiologists. The purpose of this article is to familiarize the reader with the role of Interventional Radiology in the placement and management of intravascular or implantable access devices, with a focus on discussing indications for central venous catheter placement, implantation techniques, potential complications, and management of catheter dysfunction.


Assuntos
Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Radiografia Intervencionista , Cateterismo Venoso Central/instrumentação , Humanos
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