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1.
Ultrasound Q ; 36(2): 138-145, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32511207

RESUMO

PURPOSE: To estimate the diagnostic efficacy of saline-air hysterosalpingo-contrast sonography (SA-HyCoSy) compared with the modified hysterosalpingogram (mHSG) for confirmation of both coil location and tubal occlusion following hysteroscopic sterilization. METHODS: This study included 19 women who underwent both SA-HyCoSy and mHSG where 1 test was followed by the other. Sensitivity, specificity, and positive and negative predictive values for tubal occlusion against the mHSG were calculated for each fallopian tube by 2 independent interpreters. Interrater reliability was assessed using Cohen κ statistic. Procedure time and pain level by 11-point numeric rating scale of SA-HyCoSy and mHSG were also compared. RESULTS: Thirty-eight fallopian tubes were evaluated. Tubal occlusion was noted in 97.3% of tubes for both interpreters with the mHSG compared with 92.1% and 94.7% with SA-HyCoSy. The positive and negative predictive values for tubal occlusion were 100%/100% and 50%/33%, respectively, with an overall agreement of 97.4% and 95.7%, κ = 0.48, P < 0.01. Saline-air HyCoSy changed interpretation of coil insert location in 50% and 44.7% for each interpreter, being downgraded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13), respectively. There were no statistically significant differences in procedural time (7.5 vs 9.4 minutes, P > 0.05) or maximum pain scores (2.3 vs 3.1, P > 0.05) for the mHSG compared with SA-HyCoSy. CONCLUSIONS: Our findings revealed a high degree of diagnostic accuracy with SA-HyCoSy for tubal occlusion, although coil location changed in nearly half of cases. Avoidance of radiation and patient convenience/compliance with SA-HyCoSy may outweigh the drawbacks.

2.
Pediatr Diabetes ; 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501612

RESUMO

BACKGROUND: The Treatment Options for type 2 Diabetes in Adolescent and Youth study, a randomized clinical trial of three treatments for type 2 diabetes (T2DM) in youth, demonstrated treatment failure (defined as sustained HbA1c ≥8%, or inability to wean insulin after 3 months after acute metabolic decomposition) in over half of the participants. Given that binding of mononuclear cells to vascular endothelium, initiated by cellular adhesion molecules and chemokines, is an early step in vascular injury, we sought to evaluate (a) changes in cellular adhesion molecule levels during the trial; (b) effect of diabetes treatment; and (c) association of markers with HbA1c, hypertension, hypercholesterolemia, nephropathy, and retinopathy. METHODS: Participants (n = 515 of 699) that had baseline assessment of adhesion molecules (monocyte chemoattractant protein-1 [MCP-1], vascular cell adhesion marker [VCAM], intercellular adhesion marker [ICAM], and E-Selectin) and at least one other assessment, measured at month 12, 24, or 36, were included. RESULTS: Over 1 to 3 years, significant increases in MCP-1 and decreases in VCAM (both P < .0001) concentrations were found; however, no significant interactions were identified with treatment group for any molecule. For every 1% increase in HbA1c, ICAM increased by 1.8%, VCAM by 1.5%, and E-selectin by 6.8% (all P < .0001). E-selectin increased by 3.7% and 4.2% for every 10 mm Hg increase in systolic and diastolic blood pressure, respectively (both P < .0001). ICAM was 10.2% higher and E-selectin was 15.5% higher in participants with microalbuminuria (both P < .01). There was no significant association of adhesion molecule levels with retinopathy. CONCLUSION: Concentrations of cellular adhesion molecules rise with increasing HbA1c in youth with T2DM, and are associated with blood pressure and microalbuminuria, markers of vascular injury.

3.
Artigo em Alemão | MEDLINE | ID: mdl-32572867

RESUMO

Lithium intoxication presents with a plethora of symptoms. Especially in elderly patients, prompt diagnosis can be delayed as intoxication can mimic symptoms of co-morbidities. We present and discuss a patient with multiple diseases, who presented in an acute confusional state due to lithium intoxication.

4.
J Phys Condens Matter ; 32(40): 405201, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32428895

RESUMO

In this study, we performed density functional theory based calculations to determine the effect of the size of Cu x (x = 1 (adatom), 3 (trimer), 7 (heptamer)) clusters supported on Cu(111) toward the adsorption of CO, O, and CO2, and the dissociation of CO2. CO adsorbs with comparable adsorption energies on the different cluster systems, which are influenced by the reactivity of the Cu atoms in the cluster and the interaction of CO with the Cu atoms in the terrace. The O atom, on the other hand, will always favor to adsorb on hollow sites and is more stable on the hollow sites of smaller clusters. CO2 dissociates with lower activation energy on the cluster region than on flat Cu(111). We obtained the lowest activation energy on Cu3 due to its more reactive Cu atoms than the Cu7 case and due to the possibility of O to adsorb on the cluster region, which is not observed in the Cu1 case. The presented results will provide insights on future studies on supported cluster systems and their possible use as catalysts for CO2-related reactions.

5.
J Clin Microbiol ; 58(7)2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32376666

RESUMO

Metagenomic next-generation sequencing (mNGS) of plasma cell-free DNA (cfDNA) is commercially available, but its role in the workup of infectious diseases is unclear. To understand the clinical utility of plasma mNGS, we retrospectively reviewed patients tested at a pediatric institution over 2 years to evaluate the clinical relevance of the organism(s) identified and the impact on antimicrobial management. We also investigated the effect of pretest antimicrobials and interpretation of molecules of microbial cfDNA per microliter (MPM) of plasma. Twenty-nine of 59 (49%) mNGS tests detected organism(s), and 28/51 (55%) organisms detected were clinically relevant. The median MPM of clinically relevant organisms was 1,533, versus 221 for irrelevant organisms (P = 0.01). mNGS test positive and negative percent agreements were 53% and 79%, respectively, and 50% of negative mNGS tests were true negatives. Fourteen percent of tests impacted clinical management by changing antimicrobial therapy. Immunocompromised status was the only patient characteristic that trended toward a significant clinical impact (P = 0.056). No patients with culture-negative endocarditis had organisms identified by mNGS. There were no significant differences in antimicrobial duration retest between tests with clinically relevant organism(s) and those that returned negative, nor were the MPMs different between pretreated and untreated organisms, suggesting that 10 days of antimicrobial therapy as observed in this cohort did not sterilize testing; however, no pretreated organisms identified resulted in a new diagnosis impacting clinical management. Plasma mNGS demonstrated higher utility for immunocompromised patients, but given the detection of many clinically irrelevant organisms (45%), cautious interpretation and infectious diseases consultation are prudent.

6.
J Glaucoma ; 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32398592

RESUMO

PRéCIS:: Intracameral injection of viscoelastic at the beginning of Ahmed FP7 implantation did not reduce early postoperative complication rates. PURPOSE: To evaluate early postoperative complication rates after a modified technique in which the anterior chamber (AC) is filled with viscoelastic at the beginning of Ahmed FP7 implantation before conjunctival peritomy. SUBJECTS AND METHODS: A retrospective chart review was performed of eyes that underwent Ahmed FP7 implantation with or without viscoelastic fill to ~20 mm Hg by finger tension by a single surgeon (M.R.M). Viscoelastic prevented the AC from becoming shallow at any time during surgery, and additional viscoelastic was injected into the AC at the end of surgery to achieve a final intraocular pressure (IOP) of 20 mm Hg. RESULTS: A total of 159 eyes of 159 patients were included. Mean age was 76.4±10.4 years. Mean preoperative IOP was 30.3±9.7 mm Hg on 2.7±1.2 glaucoma medications. On postoperative day 1, there was an IOP spike ≥30 mm Hg in 0% of patients. Within the first postoperative month, hypotony (<5 mm Hg) occurred in 19 (21.8%) eyes that received viscoelastic fill compared with 5 (13.2%) eyes that did not receive viscoelastic fill (P=0.26). During the early postoperative period (≤3 mo), there was no difference in AC depth, microhyphema, choroidal effusion, or leakage between the 2 groups (P≥0.30 for all). There was a higher rate of layered hyphemas in the viscoelastic-fill group at postoperative week 1 (P=0.01). At 3-month follow-up, mean IOP was 14.9±5.5 mm Hg on 1.6±0.8 medications in the viscoelastic-fill group and 16.0±5.2 mm Hg on 1.0±1.2 medications in the nonviscoelastic-fill group (IOP P=0.35). Compared with baseline, change in IOP at 3 months was similar between both groups (P=0.15). Rates of additional medications and procedures did not differ between the 2 groups at any postoperative visit. CONCLUSIONS: Early intracameral injection of viscoelastic during Ahmed glaucoma valve implantation did not reduce early postoperative complication rates.

7.
J Nutr ; 150(7): 1782-1789, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32359147

RESUMO

BACKGROUND: Methionine is an essential amino acid (AA) with many fundamental roles. Humans often supplement l-Met, whereas dl-Met and dl-2-hydroxy-4-(methylthio)butanoic acid (dl-HMTBA) are more frequently used to supplement livestock. OBJECTIVES: The study aimed to investigate whether dietary Met source alters the absorptive capacity for Met isomers in the small intestine of piglets. METHODS: A total of 27 male 10-wk-old piglets in 3 feeding groups received a diet supplemented with 0.21% dl-Met, 0.21% l-Met, or 0.31% dl-HMTBA to meet the Met + cystine requirement. After ≥10 d, absorptive fluxes of d-Met or l-Met were measured at a physiological concentration of 50 µM and a high concentration of 5 mM in duodenum, middle jejunum, and ileum ex vivo. Data were compared by 2-factor ANOVA. RESULTS: Across diets, fluxes of both Met isomers at both tested concentrations increased from duodenum to ileum by a factor of ∼2-5.5 (P < 0.05). Pigs supplemented with dl-Met had greater (P < 0.085) absorptive fluxes at 50 µM l-Met (0.50, 2.07, and 3.86 nmol · cm-2 · h-1) and d-Met (0.62, 1.41, and 1.19 nmol · cm-2 · h-1) than did pigs supplemented with dl-HMTBA (l-Met: 0.28, 0.76, and 1.08 nmol · cm-2 · h-1; d-Met: 0.34, 0.58, and 0.64 nmol · cm-2 · h-1) in duodenum, jejunum, and ileum, respectively. Only in jejunum of dl-Met-fed pigs, fluxes at 50 µM l-Met were reduced by the omission of luminal Na+ (from 3.27 to 0.86 nmol · cm-2 · h-1; P < 0.05) and by a cocktail of 22 luminal AAs (to 1.05 nmol · cm-2 · h-1; P < 0.05). CONCLUSIONS: Dietary supplementation of dl-Met increases the efficiency of l-Met and d-Met absorption at physiologically relevant luminal Met concentrations along the small intestine of pigs, including a very prominent induction of an Na+-dependent transport system with preference for l-Met in the mid-jejunum. Dietary supplementation with dl-Met could be a promising tool to improve the absorption of Met and other AAs.

9.
PLoS One ; 15(4): e0230424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275725

RESUMO

Increasing concentrations of greenhouse gases (GHGs) are causing global climate change and decreasing the stability of the climate system. Long-term solutions to climate change will require reduction in GHG emissions as well as the removal of large quantities of GHGs from the atmosphere. Natural climate solutions (NCS), i.e., changes in land management, ecosystem restoration, and avoided conversion of habitats, have substantial potential to meet global and national greenhouse gas (GHG) reduction targets and contribute to the global drawdown of GHGs. However, the relative role of NCS to contribute to GHG reduction at subnational scales is not well known. We examined the potential for 12 NCS activities on natural and working lands in Oregon, USA to reduce GHG emissions in the context of the state's climate mitigation goals. We evaluated three alternative scenarios wherein NCS implementation increased across the applicable private or public land base, depending on the activity, and estimated the annual GHG reduction in carbon dioxide equivalents (CO2e) attributable to NCS from 2020 to 2050. We found that NCS within Oregon could contribute annual GHG emission reductions of 2.7 to 8.3 MMT CO2e by 2035 and 2.9 to 9.8 MMT CO2e by 2050. Changes in forest-based activities including deferred timber harvest, riparian reforestation, and replanting after wildfires contributed most to potential GHG reductions (76 to 94% of the overall annual reductions), followed by changes to agricultural management through no-till, cover crops, and nitrogen management (3 to 15% of overall annual reductions). GHG reduction benefits are relatively high per unit area for avoided conversion of forests (125-400 MT CO2e ha-1). However, the existing land use policy in Oregon limits the current geographic extent of active conversion of natural lands and thus, avoided conversions results in modest overall potential GHG reduction benefits (i.e., less than 5% of the overall annual reductions). Tidal wetland restoration, which has high per unit area carbon sequestration benefits (8.8 MT CO2e ha-1 yr-1), also has limited possible geographic extent resulting in low potential (< 1%) of state-level GHG reduction contributions. However, co-benefits such as improved habitat and water quality delivered by restoration NCS pathways are substantial. Ultimately, reducing GHG emissions and increasing carbon sequestration to combat climate change will require actions across multiple sectors. We demonstrate that the adoption of alternative land management practices on working lands and avoided conversion and restoration of native habitats can achieve meaningful state-level GHG reductions.

10.
FASEB J ; 34(6): 7773-7785, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32304142

RESUMO

Interindividual variability and sexual dimorphisms in the development of nonalcoholic fatty liver disease (NAFLD) are still poorly understood. In the present study, male and female strains of Collaborative Cross (CC) mice were fed a high-fat and high-sucrose (HF/HS) diet or a control diet for 12 weeks to investigate interindividual- and sex-specific variations in the development of NAFLD. The severity of liver steatosis varied between sexes and individual strains and was accompanied by an elevation of serum markers of insulin resistance, including increases in total cholesterol, low-density lipoproteins, high-density lipoproteins, phospholipids, and glucose. The development of NAFLD was associated with overexpression of the critical fatty acid uptake and de novo lipogenesis genes Pparg, Mogat1, Cd36, Acaab1, Fabp2, and Gdf15 in male and female mice. The expression of Pparg, Mogat1, and Cd36 was positively correlated with liver triglycerides in male mice, and Mogat1 and Cd36 expression were positively correlated with liver triglycerides in female mice. Our results indicate the value of CC mice in combination with HF/HS diet-induced alterations as an approach to study the susceptibility and interindividual variabilities in the pathogenesis of nonalcoholic fatty liver and early nonalcoholic steatohepatitis at the population level, uncovering of susceptible and resistant cohorts, and identifying sex-specific molecular determinants of disease susceptibility.

11.
Trends Cogn Sci ; 24(6): 451-465, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32340798

RESUMO

Our ability to remember or imagine specific events involves the construction of complex mental representations, a process that engages cortical and hippocampal regions in a core posterior medial (PM) brain network. Existing theoretical approaches have described the overarching contributions of the PM network, but less is known about how episodic content is represented and transformed throughout this system. Here, we review evidence of key functional interactions among PM regions and their relation to the core cognitive operations and representations supporting episodic construction. Recent demonstrations of intranetwork functional diversity are integrated with existing accounts to inform a network-based model of episodic construction, in which PM regions flexibly share and manipulate event information to support the variable phenomenology of episodic memory and simulation.

12.
Transfusion ; 60(4): 870-874, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32056233

RESUMO

BACKGROUND: The clinical and laboratory features of hemolytic disease of the newborn can be challenging to diagnose during pregnancy in the apparent absence of a blood group antibody. Low-frequency antibodies go undetected due to the lack of appropriate antigen-positive reagent red blood cells (RBCs). CASE REPORT: A pregnant woman of Southeast Asian descent was referred to a maternal-fetal medicine outpatient clinic due to a complicated obstetric history and a negative antibody screen. This initial visit at 29 weeks and 0 days' gestational age (GA) was unremarkable. A hydropic infant, born at 29 weeks and 5 days' GA, succumbed on the seventh day of life. Comprehensive laboratory testing was performed after birth. The hospital blood bank performed a maternal antibody identification. Direct antiglobulin test was performed on the cord blood. A reference laboratory confirmed an anti-Mia , performed paternal Mia phenotyping, and identified a hybrid glycophorin B-A-B GP*Mur allele. DISCUSSION: Maternal alloimmunization to low-frequency antigens remains a challenge. Southeast Asians make up a significant percentage in some US locations. Worldwide reports on the frequency of maternal alloimmunization of the MNS system can be used to guide the use of specific reagent RBCs for testing. Such strategies rely on the identification of blood donor units for reagent manufacture and use in perinatal antibody screens. CONCLUSION: The incidence of Mia and related antibodies is significant among Southeast Asians. In North America, prenatal antibody screening cells are not routinely chosen to match this population. The clinical and societal implications are discussed.

13.
Neuroepidemiology ; 54(2): 157-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32018263

RESUMO

In recent years, a rapidly increasing collection of investigative methods in addition to changes in diagnostic criteria for dementia have followed "high-tech" trends in medicine, with the aim to better define the dementia syndrome and its biological substrates, mainly in order to predict risk prior to clinical expression. These approaches are not without challenge. A set of guidelines have been developed by a group of European experts in population-based cohort research through a series of workshops, funded by the Joint Program for Neurodegenerative Disorders (JPND). The aims of the guidelines are to assist policy makers and researchers to understand (1) What population studies for ageing populations should encompass and (2) How to interpret the findings from population studies. Such studies are essential to provide evidence relevant to the understanding of healthy and frail brain ageing, including the dementia syndrome for contemporary and future societies by drawing on the past.

14.
Diabetes ; 69(5): 1000-1010, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32051148

RESUMO

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated that intensive glucose control reduced the risk of developing diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). We evaluated multiple risk factors and phenotypes associated with DPN and CAN in this large, well-characterized cohort of participants with type 1 diabetes, followed for >23 years. DPN was defined by symptoms, signs, and nerve conduction study abnormalities in ≥2 nerves; CAN was assessed using standardized cardiovascular reflex tests. Generalized estimating equation models assessed the association of DPN and CAN with individual risk factors measured repeatedly. During DCCT/EDIC, 33% of participants developed DPN and 44% CAN. Higher mean HbA1c was the most significant risk factor for DPN, followed by older age, longer duration, greater height, macroalbuminuria, higher mean pulse rate, ß-blocker use, and sustained albuminuria. The most significant risk factor for CAN was older age, followed by higher mean HbA1c, sustained albuminuria, longer duration of type 1 diabetes, higher mean pulse rate, higher mean systolic blood pressure, ß-blocker use, estimated glomerular filtration rate <60 mL/min/1.73 m2, higher most recent pulse rate, and cigarette smoking. These findings identify risk factors and phenotypes of participants with diabetic neuropathy that can be used in the design of new interventional trials and for personalized approaches to neuropathy prevention.

15.
J Autism Dev Disord ; 50(4): 1221-1237, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31907730

RESUMO

Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.

16.
J Community Health ; 45(4): 712-716, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31897964

RESUMO

Approximately 4.1 million adults in the United States have past or current hepatitis C virus (HCV) infection. Despite efforts to test at least once for the 1945-1965 birth cohort population and others identified at risk, the completion of the annual risk assessment tool and testing of these patients has been suboptimal. The aim of this project was to reduce HCV risk assessment and testing barriers and improve both these rates by 30% within a federally qualified health center setting in Baltimore, Maryland. As part of ongoing efforts to promote HCV risk screening and testing, targeted interventions of staff education, streamlined risk screening assessment, automated electronic health record alerts, push reports, and standing orders were integrated into current screening and testing practices. This study examined the risk assessment tool use and testing rates for 1 month before and after project implementation. All patients who were seen for a primary care visit during the month preceding (n = 8911) and following (n = 8228) the intervention were evaluated. A total of 2973 risk assessments and 1831 HCV tests were completed pre-intervention compared to 3708 risk assessments and 3790 tests post-intervention, demonstrating a 35% and 125% improvement respectively. Seropositivity prevalence of 2.1% pre-intervention increased to 2.9% post-intervention. Efficiencies in workflow processes and staff education successfully impacted the HCV risk screening tool completions and testing rates for the birth cohort and non-birth cohort patients. Integrating such strategies in the primary care workflow can increase HCV detection and timely follow up for vulnerable populations.

17.
J Neurosci ; 40(8): 1701-1709, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-31826947

RESUMO

The hallmark of episodic memory is recollecting multiple perceptual details tied to a specific spatial-temporal context. To remember an event, it is therefore necessary to integrate such details into a coherent representation during initial encoding. Here we tested how the brain encodes and binds multiple, distinct kinds of features in parallel, and how this process evolves over time during the event itself. We analyzed data from 27 human subjects (16 females, 11 males) who learned a series of objects uniquely associated with a color, a panoramic scene location, and an emotional sound while fMRI data were collected. By modeling how brain activity relates to memory for upcoming or just-viewed information, we were able to test how the neural signatures of individual features as well as the integrated event changed over the course of encoding. We observed a striking dissociation between early and late encoding processes: left inferior frontal and visuo-perceptual signals at the onset of an event tracked the amount of detail subsequently recalled and were dissociable based on distinct remembered features. In contrast, memory-related brain activity shifted to the left hippocampus toward the end of an event, which was particularly sensitive to binding item color and sound associations with spatial information. These results provide evidence of early, simultaneous feature-specific neural responses during episodic encoding that predict later remembering and suggest that the hippocampus integrates these features into a coherent experience at an event transition.SIGNIFICANCE STATEMENT Understanding and remembering complex experiences are crucial for many socio-cognitive abilities, including being able to navigate our environment, predict the future, and share experiences with others. Probing the neural mechanisms by which features become bound into meaningful episodes is a vital part of understanding how we view and reconstruct the rich detail of our environment. By testing memory for multimodal events, our findings show a functional dissociation between early encoding processes that engage lateral frontal and sensory regions to successfully encode event features, and later encoding processes that recruit hippocampus to bind these features together. These results highlight the importance of considering the temporal dynamics of encoding processes supporting multimodal event representations.

18.
Br J Ophthalmol ; 104(5): 697-702, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31409650

RESUMO

AIMS: To develop a nomogram for prediction of visual acuity outcome following plaque radiotherapy for uveal melanoma. METHODS: Retrospective review of uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab injections at 4-month intervals for 2 years duration. Two nomograms for poor visual acuity outcome (Snellen <20/200) were developed based on (1) Clinical risk factors. (2) Or clinical and treatment risk factors. RESULTS: There were 1131 included cases. The most important clinical risk factors (points for nomogram) for poor visual acuity outcome included subretinal fluid involving four quadrants (100), tumour thickness >4 mm (69), presenting visual acuity ≤20/30 (65), non-Caucasian race (58), tumour shape mushroom, bilobed, or multilobulated (57), and insulin-dependent diabetes (54). Risk of poor visual acuity at 2 years and 4 years increased from 11% and 24% with 40 points to 97% and >99% with 304 points. A second analysis was performed using both clinical and treatment risk factors. The most important factors included presenting visual acuity ≤20/30 (100), tumour largest basal diameter >11 mm (80), radiation dose rate to tumour base ≥164 cGy/hour (78), tumour thickness >4 mm (76), insulin-dependent diabetes (75) and abnormal foveolar status by optical coherence tomography at presentation (72). Risk of poor visual acuity at 2 years and 4 years increased from 6% and 14% with 56 points to 88% and 99% with 496 points. CONCLUSIONS: A nomogram using clinical or treatment risk factors can predict visual acuity outcome following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma and is available online at https://fighteyecancer.com/nomograms/.

19.
Augment Altern Commun ; 35(4): 263-273, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31868037

RESUMO

This ex-post facto study reanalyzed data from Romski et al. to examine whether intervention focus moderated the relationship between pre-intervention standardized measures of receptive language and post-intervention standardized measures of receptive and expressive language age and observations of expressive target vocabulary size. In all, 62 toddlers with developmental delay were randomly assigned to augmented communication-input (AC-I), augmented communication-output (AC-O), or spoken communication (SC) interventions. AC-I provided augmented language input via spoken language and a speech-generating device (SGD); AC-O encouraged the production of augmented output via an SGD; and SC provided spoken input and encouraged spoken output without using an SGD. Intervention focus moderated the impact of initial receptive language on expressive language age and expressive target vocabulary size. Participants in AC-I, when compared to those in the other two interventions, had a significantly stronger relationship between initial receptive language and post-intervention expressive language age. For expressive target vocabulary size, participants in AC-O showed a strong relationship and those in AC-I a slightly weaker relationship between initial receptive language and expressive target vocabulary size; no significant relationship was found in the SC group. Results emphasize that different interventions may have distinct outcomes for children with higher or lower initial receptive language.

20.
MMWR Morb Mortal Wkly Rep ; 68(50): 1153-1157, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31856145

RESUMO

In the United States, driving while impaired is illegal. Nonetheless, an estimated 10,511 alcohol-impaired driving deaths occurred in 2018.* The contribution of marijuana and other illicit drugs to these and other impaired driving deaths remains unknown. Data from the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (NSDUH) indicated that in the United States during 2014, 12.4% of all persons aged 16-25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana (1). The impairing effects of alcohol are well established, but less is known about the effects of illicit substances or other psychoactive drugs (e.g., marijuana, cocaine, methamphetamines, and opioids, including heroin). This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged ≥16 years, using 2018 public-use data from NSDUH. Prevalences of driving under the influence of marijuana and illicit drugs other than marijuana were assessed for persons aged ≥16 years by age group, sex, and race/ethnicity. During 2018, 12 million (4.7%) U.S. residents reported driving under the influence of marijuana in the past 12 months; 2.3 million (0.9%) reported driving under the influence of illicit drugs other than marijuana. Driving under the influence was more prevalent among males and among persons aged 16-34 years. Effective measures that deter driving under the influence of drugs are limited (2). Development, evaluation, and further implementation of strategies to prevent alcohol-impaired,† drug-impaired, and polysubstance-impaired driving, coupled with standardized testing of impaired drivers and drivers involved in fatal crashes, could advance understanding of drug- and polysubstance-impaired driving and support prevention efforts.


Assuntos
Dirigir sob a Influência/estatística & dados numéricos , Drogas Ilícitas , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
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