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1.
Sci Rep ; 10(1): 1800, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020005

RESUMO

Aquatic acidification is a major consequence of fossil fuel combustion. In marine ecosystems it was shown, that increasing pCO2 levels significantly affect behavioural and sensory capacities in a diversity of species. This can result in altered predator and prey interactions and thereby change community structures. Just recently also CO2 dependent acidification of freshwater habitats has been shown. Also here, increased levels of pCO2 change organisms' behaviour and sensory capacities. For example, the freshwater crustacean Daphnia's ability to detect predators and accurately develop morphological defences was significantly reduced, rendering Daphnia more susceptible to predation. It was speculated that this may have cascading effects on freshwater food webs. However, for a comprehensive understanding of how increased levels of CO2 affect trophic interactions, it is also important to study how CO2 affects predators. We tested this using the dipeteran phantom midge larva Chaoborus obscuripes, which is a world-wide abundant inhabitant of freshwater impoundments. We monitored activity parameters, predation parameters, and predation rate. Chaoborus larvae are affected by increased levels of pCO2 as we observed an increase in undirected movements and at the same time, reduced sensory abilities to detect prey items. This is likely to affect the larvae's energy budgets. Chaoborus is a central component of many freshwater food-webs. Therefore, CO2 effects on predator and prey levels will likely have consequences for community structures.

2.
AIDS Care ; : 1-8, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870170

RESUMO

It is widely acknowledged that the growing opioid epidemic and associated increase in overdose deaths necessitates a reexamination of processes and procedures related to an opioid prescription for the treatment of chronic pain. However, the perspectives of patients, including those at the highest risk for opioid-related harms, are largely missing from this reexamination. To partially address the gap, we conducted a pair of one-day public deliberations on opioid prescribing in the context of HIV care. Results included recommendations and perspectives from people living with HIV that detail how providers can best assess patient needs, communicate regarding opioids, and reduce the risk of misuse. Participants emphasized the importance of building trust with patients and taking an extensive patient history prior to making decisions about whether to initiate or end an opioid prescription. This trust - together with an understanding of the origin of a patient's pain, history of drug use and other therapies tried - was perceived as essential to effective monitoring and pain management, as well as promotion of positive health outcomes. Ensuring that such patient perspectives are incorporated into the operationalization of guidelines for safe opioid prescribing may help to improve outcomes and quality of care for people living with HIV.

3.
J Opioid Manag ; 15(6): 479-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850509

RESUMO

INTRODUCTION: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking. METHODS: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed. FINDINGS: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice. DISCUSSION: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.


Assuntos
Analgésicos Opioides , Comunicação , Registros Eletrônicos de Saúde , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Tomada de Decisões , Humanos , Naloxona , Médicos , Pesquisa Qualitativa
4.
Contemp Clin Trials Commun ; 16: 100468, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701042

RESUMO

Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafER Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.

5.
PLoS One ; 14(3): e0214013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901351

RESUMO

Filter feeding zooplankton are a crucial component of limnic food webs. Copepods and cladocerans are important prey organisms for first-level predators like the common and abundant larvae of phantom midges (Chaoborus sp.). The latter possess a complex catching basket built of head appendages specialized to capture small crustaceans. The predator-prey-relationship of Chaoborus (Diptera, Nematocera) and Daphnia (Crustacea, Cladocera) has been studied in particular detail owing to the daphniids' ability to react upon the threat of predation with inducible defenses. Daphnia pulex expresses so-called 'neckteeth' in the presence of Chaoborus larvae that are discussed as a defensive trait that interferes with the larval head appendages and their effectiveness has been shown in several studies. Nonetheless, mode of function of these neckteeth is not understood and the hypothesis that they interfere with the predator's head appendages still has to be confirmed. To clarify the role of neckteeth in Daphnia, an understanding of the Chaoborus capture apparatus is essential. Here, we present a detailed three-dimensional analysis of Chaoborus obscuripes' larval head morphology as well as a kinematic analysis of the attack motion, which revealed an impressive strike velocity (14 ms to prey contact). The movement of the larvae's head appendages is reconstructed in the three-dimensional space using a combination of high-speed videography, micro-computed tomography and computer animation. Furthermore, we provide predation trial data to distinguish between pre- and post-attack defensive effects in D. pulex. Our findings suggest a combination of pre- and post-attack defenses with an average effectiveness of 50% each. With this study, we quantitatively describe prey capture kinematics of C. obscuripes and take a further step to reveal the neckteeth' mode of function in D. pulex.


Assuntos
Cladóceros/fisiologia , Copépodes/fisiologia , Dípteros/fisiologia , Larva/fisiologia , Comportamento Predatório/fisiologia , Animais , Cadeia Alimentar , Cabeça/fisiologia
6.
SSM Popul Health ; 7: 100373, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30809585

RESUMO

•RWJF Health & Society Scholars (HSS) program outcomes evaluated.•HSS alumni have higher scholarly productivity and impact than control group.•HSS alumni are more engaged in population health research than controls.•HSS alumni and controls are similar on other outcome measures.•Training programs can be evaluated with adequate attention to selection bias.

7.
J Urban Health ; 96(4): 644-651, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29616451

RESUMO

Approximately 25 million people in the United States are limited English proficient (LEP). Appropriate language services can improve care for LEP individuals, and health care facilities receiving federal funds are required to provide such services. Recognizing the risk of inadequate comprehension of prescription medication instructions, between 2008 and 2012, New York City and State passed a series of regulations that require chain pharmacies to provide translated prescription labels and other language services to LEP patients. We surveyed pharmacists before (2006) and after (2015) implementation of the regulations to assess their impact in chain pharmacies. Our findings demonstrate a significant improvement in capacity of chains to assist LEP patients. A higher proportion of chain pharmacies surveyed in 2015 reported printing translated labels, access and use of telephone interpreter services, multilingual signage, and documentation of language needs in patient records. These findings illustrate the potential impact of policy changes on institutional practices that impact large and vulnerable portions of the population.

8.
BMC Cell Biol ; 19(1): 30, 2018 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594127

RESUMO

BACKGROUND: Diapause is a form of dormancy that is genetically predetermined to allow animals to overcome harsh environmental conditions. It is induced by predictive environmental cues bringing cellular activity levels into a state of suspended animation. Entering diapause requires organismal, molecular and cellular adaptation to severely reduced energy flows. Cells must therefore have evolved strategies that prepare them for periods with limited metabolic resources. However, changes that occur on the (sub-)cellular level have not been thoroughly described. RESULTS: We investigated mitotic activity and we monitored cytoskeletal network changes in successive stages of diapausing and non-diapausing Daphnia magna embryos using (immuno-)fluorescent labeling. We find that embryos destined to diapause show a delayed and 2.5x slower mitotic activity in comparison to continuously developing embryos. Development is halted when D. magna embryos reach ~ 3500 cells, whereupon mitotic activity is absent and cytoskeletal components are severely reduced, rendering diapause cells compact and condensed. CONCLUSION: In the initiation phase of diapause, the slower cell division rate points to prolonged interphase duration, preparing the cells for diapause maintenance. During diapause, cytoskeletal depletion and cellular condensation may be a means to save energy resources. Our data provide insights into the sub-cellular change of diapause in Daphnia.


Assuntos
Citoesqueleto/metabolismo , Daphnia/citologia , Daphnia/fisiologia , Diapausa/fisiologia , Mitose , Animais , Contagem de Células , Núcleo Celular/metabolismo , Embrião não Mamífero/fisiologia , Desenvolvimento Embrionário , Feminino
9.
Nat Chem Biol ; 14(12): 1133-1139, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30429602

RESUMO

Infochemicals play important roles in aquatic ecosystems. They even modify food web interactions, such as by inducing defenses in prey. In one classic but still not fully understood example, the planktonic freshwater crustacean Daphnia pulex forms specific morphological defenses (neckteeth) induced by chemical cues (kairomones) released from its predator, the phantom midge larva Chaoborus. On the basis of liquid chromatography, mass spectrometry, and chemical synthesis, we report here the chemical identity of the Chaoborus kairomone. The biologically active cues consist of fatty acids conjugated to the amino group of glutamine via the N terminus. These cues are involved in Chaoborus digestive processes, which explains why they are consistently released despite the disadvantage for its emitter. The identification of the kairomone may allow in-depth studies on multiple aspects of this inducible defense system.


Assuntos
Daphnia/efeitos dos fármacos , Daphnia/fisiologia , Dípteros/química , Feromônios/química , Feromônios/farmacologia , Animais , Cromatografia Líquida de Alta Pressão/métodos , Relação Dose-Resposta a Droga , Glutamina/química , Ensaios de Triagem em Larga Escala/métodos , Larva , Lipídeos/química , Espectrometria de Massas/métodos , Feromônios/administração & dosagem , Relação Estrutura-Atividade
10.
PeerJ ; 6: e4861, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900069

RESUMO

Quantitative analysis of shape and form is critical in many biological disciplines, as context-dependent morphotypes reflect changes in gene expression and physiology, e.g., in comparisons of environment-dependent phenotypes, forward/reverse genetic assays or shape development during ontogenesis. 3D-shape rendering methods produce models with arbitrarily numbered, and therefore non-comparable, mesh points. However, this prevents direct comparisons. We introduce a workflow that allows the generation of comparable 3D models based on several specimens. Translocations between points of modelled morphotypes are plotted as heat maps and statistically tested. With this workflow, we are able to detect, model and investigate the significance of shape and form alterations in all spatial dimensions, demonstrated with different morphotypes of the pond-dwelling microcrustacean Daphnia. Furthermore, it allows the detection even of inconspicuous morphological features that can be exported to programs for subsequent analysis, e.g., streamline- or finite-element analysis.

11.
Am J Mens Health ; 12(4): 989-997, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540129

RESUMO

There is a significant evidence base for the Diabetes Prevention Program, a lifestyle intervention to prevent onset of type 2 diabetes among high-risk individuals; however, translation of this intervention for men has been challenging. This report presents outcomes of the pilot study of an adapted 16-week diabetes prevention program entitled " Power Up for Health." The study goal was to better engage men of color with prediabetes from disadvantaged neighborhoods of New York City. It was implemented at five different recreation centers located in predominantly low-income neighborhoods across New York City. The curriculum was facilitated by male lifestyle coaches only; one group was conducted in Spanish. Primary outcome was weight loss from baseline to 16 weeks. Other measures included lifestyle activities, depressive symptoms, and self-reported health status. Men ( N = 47) were screened by telephone. Of the 29 eligible men who began the program, 25 attended at least 4 sessions (52% non-Latino Black, 32% Latino, mean age 51.7 ± SD 9.9 years, mean body mass index 35 ± SD 6.9 kg/m2). End of program outcomes ( n = 23) varied by site and included a mean weight loss of 3.8% (9.7 lbs); 3 of the 5 sites had a mean weight loss of 5.6%, meeting the national goal of 5%-7%. Men ( n = 23) attended a mean of 11.6 of 16 sessions. Improvement in depressive symptoms, healthy eating and exercise, and health status were also seen. While recruitment was challenging with many lessons learned, the adapted men's diabetes prevention program shows promise of success for participants and their coaches.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Educação em Saúde/organização & administração , Participação do Paciente/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Populações Vulneráveis/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Atitude Frente a Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque , Projetos Piloto , Prevenção Primária/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Adulto Jovem
12.
Am J Mens Health ; 12(4): 981-988, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540130

RESUMO

The National Diabetes Prevention Program (NDPP) has been effectively translated to various community and clinical settings; however, regardless of setting, enrollment among men and lower-income populations is low. This study presents participant perspectives on Power Up for Health, a novel NDPP pilot adaption for men residing in low-income communities in New York City. We conducted nine interviews and one focus group with seven participants after the program ended. Interview and focus group participants had positive perceptions of the program and described the all-male aspect of the program and its reliance on male coaches as major strengths. Men felt the all-male adaptation allowed for more open, in-depth conversations on eating habits, weight loss, body image, and masculinity. Participants also reported increased knowledge and changes to their dietary and physical activity habits. Recommendations for improving the program included making the sessions more interactive by, for example, adding exercise or healthy cooking demonstrations. Overall, findings from the pilot suggest this NDPP adaptation was acceptable to men and facilitated behavior change and unique discussions that would likely not have occurred in a mixed-gender NDPP implementation.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/organização & administração , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Imagem Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/psicologia , Grupos Focais , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
13.
Am J Mens Health ; 12(4): 998-1006, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540131

RESUMO

The Diabetes Prevention Program (DPP) landmark randomized trial demonstrated that participants with prediabetes could reduce their risk for type 2 diabetes by 58% if they achieved 5%-7% weight loss through healthy eating and increasing physical activity. The National DPP (NDPP) is a group intervention based on the DPP and has been widely disseminated by the Centers for Disease Control and Prevention (CDC) and many healthcare institutions. While data show that the program is effective in diverse populations, enrollment among men from low-income and minority communities is low. Thus, the study piloted a novel adaptation focused on men living in disadvantaged neighborhoods. The study approach to adaptation and implementation used characteristics of participatory research, including input from an expert panel of African American and Latino leaders, ongoing consultation with an Advisory Panel, and focus groups with members of the target population. Discussions with these groups focused on male perspectives regarding health promotion and barriers and facilitators to participation in health programming for men. There was general agreement when reviewing ongoing pilot program implementation that the adapted program should have male-only groups with male coaches, as the Advisory Panel had originally suggested. The pilot programs were implemented at five New York City Department of Parks and Recreation sites in Harlem, the Bronx, and Brooklyn in 2015-2016.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Educação em Saúde/organização & administração , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Adaptação Psicológica , Adulto , Afro-Americanos/estatística & dados numéricos , Atitude Frente a Saúde , Grupos Focais , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Projetos Piloto , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Populações Vulneráveis/estatística & dados numéricos
14.
Curr Biol ; 28(2): 327-332.e3, 2018 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-29337079

RESUMO

Anthropogenically released CO2 accumulates in the global carbon cycle and is anticipated to imbalance global carbon fluxes [1]. For example, increased atmospheric CO2 induces a net air-to-sea flux where the oceans take up large amounts of atmospheric CO2 (i.e., ocean acidification [2-5]). Research on ocean acidification is ongoing, and studies have demonstrated the consequences for ecosystems and organismal biology with major impacts on marine food webs, nutrient cycles, overall productivity, and biodiversity [6-9]. Yet, surprisingly little is known about the impact of anthropogenically caused CO2 on freshwater systems due to their more complex biogeochemistry. The current consensus, yet lacking data evidence, is that anthropogenic CO2 does indeed affect freshwater carbon hydrogeochemistry, causing increased pCO2 in freshwater bodies [10-13]. We analyzed long-term data from four freshwater reservoirs and observed a continuous pCO2 increase associated with a decrease in pH, indicating that not only the oceans but also inland waters are accumulating CO2. We tested the effect of pCO2-dependent freshwater acidification using the cosmopolite crustacean Daphnia. For general validity, control pCO2-levels were based on the present global pCO2 average. Treatments were selected with very high pCO2 levels, assuming a continuous non-linear increase of pCO2, reflecting worst-case-scenario future pCO2 levels. Such levels of elevated pCO2 reduced the ability of Daphnia to sense its predators and form adequate inducible defenses. We furthermore determined that pCO2 and not the resulting reduction in pH impairs predator perception. If pCO2 alters chemical communication between freshwater species, this perturbs intra- and interspecific information transfer, which may affect all trophic levels.


Assuntos
Dióxido de Carbono/química , Daphnia/fisiologia , Cadeia Alimentar , Água Doce/química , Animais , Ecossistema , Percepção Olfatória , Feromônios/fisiologia
15.
J Public Health Manag Pract ; 24(4): 318-325, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28650413

RESUMO

CONTEXT: Internal revenue service provisions require not-for-profit hospitals to provide "community benefit." In addition, the Affordable Care Act requires these hospitals to conduct community health needs assessments that involve appropriate stakeholders. These requirements signal government interest in creating opportunities for developing programs that are well tailored and responsive to the needs of the communities served. Gaining meaningful input from residents is a critical aspect of these processes. OBJECTIVE: To implement public deliberations that explore local resident priorities for use of a hospital's community benefit resources to prevent chronic disease. METHODS: Public deliberation is a method of community engagement that can provide guidance to decision makers on value-laden issues when technical solutions alone are inadequate to provide direction or set priorities. Three deliberations featuring presentations by experts and discussions among participants were convened with a cross section of residents in Brooklyn, New York. Participants were asked whether new hospital initiatives should prioritize: clinical prevention, community-based interventions, or action on broader policies affecting population health. Pre- and postsurveys, as well as qualitative methods, were used to assess knowledge and attitudes. RESULTS: Postdeliberation, participants had significant changes in knowledge, particularly on the impact of education on health. Participants prioritized community-based and policy interventions over expanding clinical prevention capacity. CONCLUSIONS: Public deliberation offers a method to probe informed constituent views of how a hospital can best promote its community's health. Informed local residents felt that hospitals should frame health-promoting activities more broadly than is current practice. Not-for-profit hospitals gain significant tax advantages. Increased insurance rates suggest that some hospitals will experience savings in uncompensated care that can be used to promote health more broadly. Vetting priorities for the use of new resources with informed community members can be accomplished through public deliberation. These results suggest community support for nonclinical approaches to disease prevention.


Assuntos
Prioridades em Saúde/tendências , Prevenção Primária/métodos , Saúde Pública/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Patient Protection and Affordable Care Act/organização & administração , Patient Protection and Affordable Care Act/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Saúde Pública/tendências
16.
Front Behav Neurosci ; 12: 330, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30713490

RESUMO

Ecological communities are organized in trophic levels that share manifold interactions forming complex food webs. Infochemicals can further modify these interactions, e.g., by inducing defenses in prey. The micro-crustacean Daphnia is able to respond to predator-specific chemical cues indicating an increased predation risk. Daphnia shows plastic responses by adapting its morphology, behavior, and physiology, increasing organism, and population fitness. This stabilizes community structures. This review will describe the progress that has been made in understanding the high degree of plasticity observed in the model crustacean Daphnia. I summarize current knowledge on the processes of predator detection, ranging from the nature of biologically active chemical cues to the underlying neurophysiological mechanisms. With this, I aim to provide a comprehensive overview on the molecular mechanisms of ad hoc environmental phenotypic adaptation. In times of climate change and pollution understanding information transfer in aquatic systems is valuable as it will allow us to predict whether and how community structures are being affected.

17.
Sci Rep ; 7(1): 9750, 2017 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-28851950

RESUMO

The freshwater crustacean Daphnia is known for its ability to develop inducible morphological defences that thwart predators. These defences are developed only in the presence of predators and are realized as morphological shape alterations e.g. 'neckteeth' in D. pulex and 'crests' in D. longicephala. Both are discussed to hamper capture, handling or consumption by interfering with the predator's prey capture devices. Additionally, D. pulex and some other daphniids were found to armour-up and develop structural alterations resulting in increased carapace stiffness. We used scanning transmission electron microscopy (STEM) and confocal laser scanning microscopy (CLSM) to identify predator-induced structural and shape alterations. We found species specific structural changes accompanying the known shape alterations. The cuticle becomes highly laminated (i.e. an increased number of layers) in both species during predator exposure. Using nano- and micro-indentation as well as finite element analysis (FEA) we determined both: the structure's and shape's contribution to the carapace's mechanical resistance. From our results we conclude that only structural alterations are responsible for increased carapace stiffness, whereas shape alterations appear to pose handling difficulties during prey capture. Therefore, these defences act independently at different stages during predation.


Assuntos
Exoesqueleto/fisiologia , Fenômenos Biomecânicos , Daphnia/fisiologia , Exoesqueleto/anatomia & histologia , Animais , Daphnia/anatomia & histologia , Água Doce , Microscopia Confocal , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão
18.
Acad Radiol ; 24(2): 232-245, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28395794

RESUMO

We present an overview of the Centers for Quantitative Imaging Excellence (CQIE) program, which was initiated in 2010 to establish a resource of clinical trial-ready sites within the National Cancer Institute (NCI)-designated Cancer Centers (NCI-CCs) network. The intent was to enable imaging centers in the NCI-CCs network capable of conducting treatment trials with advanced quantitative imaging end points. We describe the motivations for establishing the CQIE, the process used to initiate the network, the methods of site qualification for positron emission tomography, computed tomography, and magnetic resonance imaging, and the results of the evaluations over the subsequent 3 years.


Assuntos
Imagem por Ressonância Magnética/normas , Neoplasias/diagnóstico , Tomografia por Emissão de Pósitrons/normas , Tomografia Computadorizada por Raios X/normas , Institutos de Câncer/normas , Ensaios Clínicos como Assunto/normas , Desenho de Equipamento , Humanos , National Cancer Institute (U.S.) , Neoplasias/terapia , Imagens de Fantasmas , Estados Unidos
19.
Popul Health Manag ; 20(5): 342-347, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28106511

RESUMO

Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.


Assuntos
Serviços de Saúde para Idosos/normas , Serviços de Saúde Mental/normas , Tutoria/métodos , Médicos de Atenção Primária/educação , Telecomunicações , Idoso , Idoso de 80 Anos ou mais , Educação a Distância , Humanos , New York
20.
J Morphol ; 277(10): 1320-8, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27418246

RESUMO

Daphnia (Crustacea, Cladocera) are well known for their ability to form morphological adaptations to defend against predators. In addition to spines and helmets, the carapace itself is a protective structure encapsulating the main body, but not the head. It is formed by a double layer of the integument interconnected by small pillars and hemolymphatic space in between. A second function of the carapace is respiration, which is performed through its proximal integument. The interconnecting pillars were previously described as providing higher mechanical stability against compressive forces. Following this hypothesis, we analyzed the carapace structure of D. pulex using histochemistry in combination with light and electron microscopy. We found the distal integument of the carapace to be significantly thicker than the proximal. The pillars appear fibrous with slim waists and broad, sometimes branched bases where they meet the integument layers. The fibrous structure and the slim-waisted shape of the pillars indicate a high capacity for withstanding tensile rather than compressive forces. In conclusion they are more ligaments than pillars. Therefore, we measured the hemolymphatic gauge pressure in D. longicephala and indeed found the hemocoel to have a pressure above ambient. Our results offer a new mechanistic explanation of the high rigidity of the daphniid carapace, which is probably the result of a light-weight construction consisting of two integuments bound together by ligaments and inflated by a hydrostatic hyper-pressure in the hemocoel. J. Morphol. 277:1320-1328, 2016. © 2016 Wiley Periodicals, Inc.


Assuntos
Exoesqueleto/anatomia & histologia , Daphnia/anatomia & histologia , Resistência à Tração , Exoesqueleto/fisiologia , Exoesqueleto/ultraestrutura , Animais , Força Compressiva , Daphnia/fisiologia
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