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1.
Proc Natl Acad Sci U S A ; 119(49): e2215442119, 2022 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-36442117

RESUMO

Sex pheromones are pivotal for insect reproduction. However, the mechanism of sex pheromone communication remains enigmatic in hymenopteran parasitoids. Here we have identified the sex pheromone and elucidated the olfactory basis of sex pheromone communication in Campoletis chlorideae (Ichneumonidae), a solitary larval endoparasitoid of over 30 lepidopteran pests. Using coupled gas chromatography-electroantennogram detection, we identified two female-derived pheromone components, tetradecanal (14:Ald) and 2-heptadecanone (2-Hep) (1:4.6), eliciting strong antennal responses from males but weak responses from females. We observed that males but not females were attracted to both single components and the blend. The hexane-washed female cadavers failed to arouse males, and replenishing 14:Ald and 2-Hep could partially restore the sexual attraction of males. We further expressed six C. chlorideae male-biased odorant receptors in Drosophila T1 neurons and found that CchlOR18 and CchlOR47 were selectively tuned to 14:Ald and 2-Hep, respectively. To verify the biological significance of this data, we knocked down CchlOR18 and CchlOR47 individually or together in vivo and show that the attraction of C. chlorideae to their respective ligands was abolished. Moreover, the parasitoids defective in either of the receptors were less likely to court and copulate. Finally, we show that the sex pheromone and (Z)-jasmone, a potent female attractant, can synergistically affect behaviors of virgin males and virgin females and ultimately increase the parasitic efficiency of C. chlorideae. Our study provides new insights into the molecular mechanism of sex pheromone communication in C. chlorideae that may permit manipulation of parasitoid behavior for pest control.


Assuntos
Receptores Odorantes , Atrativos Sexuais , Masculino , Animais , Insetos , Comunicação , Feromônios , Drosophila
2.
Proc Natl Acad Sci U S A ; 119(8)2022 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-35165195

RESUMO

Mg2GeO4 is important as an analog for the ultrahigh-pressure behavior of Mg2SiO4, a major component of planetary interiors. In this study, we have investigated magnesium germanate to 275 GPa and over 2,000 K using a laser-heated diamond anvil cell combined with in situ synchrotron X-ray diffraction and density functional theory (DFT) computations. The experimental results are consistent with the formation of a phase with disordered Mg and Ge, in which germanium adopts eightfold coordination with oxygen: the cubic, Th3P4-type structure. DFT computations suggest partial Mg-Ge order, resulting in a tetragonal [Formula: see text] structure indistinguishable from [Formula: see text] Th3P4 in our experiments. If applicable to silicates, the formation of this highly coordinated and intrinsically disordered phase may have important implications for the interior mineralogy of large, rocky extrasolar planets.

4.
Biologicals ; 86: 101756, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38479213

RESUMO

An international hybrid meeting held 21-22 June 2023 in Ottawa, Canada brought together regulators, scientists, and industry experts to discuss a set of principles and best practices in the development and implementation of standards. Although the use of international standards (ISs) and international units (IUs) has been an essential part of ensuring human and animal vaccine quality in the past decades, the types and uses of standards have expanded with technological advances in manufacture and testing of vaccines. The needs of stakeholders are evolving in response to the ever-increasing complexity, diversity, and number of vaccine products as well as increasing efforts to replace animal-based potency tests with in vitro assays that measure relevant quality attributes. As such, there must be a concomitant evolution in the design and implementation of both international and in-house standards. Concomitantly, greater harmonization of regulatory expectations must be achieved through collaboration with standard-setting organizations, national control laboratories and manufacturers. Stakeholders provided perspectives on challenges and several recommendations emerged as essential to advancing agreed upon objectives.


Assuntos
Controle de Qualidade , Vacinas , Humanos , Vacinas/normas , Animais , Canadá , Padrões de Referência
5.
J Cardiovasc Nurs ; 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-39007747

RESUMO

BACKGROUND: Predictors have not been determined of serum brain-derived neurotrophic factor (BDNF) levels among patients with heart failure (HF). OBJECTIVE: The primary purpose was to evaluate history of atrial fibrillation, age, gender, and left ventricular ejection fraction as predictors of serum BDNF levels at baseline, 10 weeks, and 4 and 8 months after baseline among patients with HF. METHODS: This study was a retrospective cohort analyses of 241 patients with HF. Data were retrieved from the patients' health records (coded history of atrial fibrillation, left ventricular ejection fraction), self-report (age, gender), and serum BDNF. Linear multiple regression analyses were conducted. RESULTS: One hundred three patients (42.7%) had a history of atrial fibrillation. History of atrial fibrillation was a significant predictor of serum BDNF levels at baseline (ß = -0.16, P = .016), 4 months (ß = -0.21, P = .005), and 8 months (ß = -0.19, P = .015). Older age was a significant predictor at 10 weeks (ß = -0.17, P = .017) and 4 months (ß = -0.15, P = .046). CONCLUSIONS: Prospective studies are needed to validate these results. Clinicians need to assess patients with HF for atrial fibrillation and include treatment of it in management plans.

7.
Cell ; 133(5): 761-3, 2008 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-18510917

RESUMO

Odorant detection in insects involves heterodimers between an odorant receptor (OR) and a conserved seven-transmembrane protein called Or83b, but the exact mechanism of OR signal transduction is unclear. Two recent studies in Nature (Sato et al., 2008; Wicher et al., 2008) now reveal that these OR-Or83b heterodimers form odorant-gated ion channels, revealing a surprising new mode of olfactory transduction.


Assuntos
Proteínas de Drosophila/metabolismo , Drosophila melanogaster/metabolismo , Receptores Odorantes/metabolismo , Animais , Proteínas de Drosophila/genética , Drosophila melanogaster/genética , Modelos Biológicos , Odorantes , Neurônios Receptores Olfatórios/metabolismo , Receptores Odorantes/genética
8.
Cell ; 133(7): 1255-1265, 2008 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-18585358

RESUMO

Detection of volatile odorants by olfactory neurons is thought to result from direct activation of seven-transmembrane odorant receptors by odor molecules. Here, we show that detection of the Drosophila pheromone, 11-cis vaccenyl acetate (cVA), is instead mediated by pheromone-induced conformational shifts in the extracellular pheromone-binding protein, LUSH. We show that LUSH undergoes a pheromone-specific conformational change that triggers the firing of pheromone-sensitive neurons. Amino acid substitutions in LUSH that are predicted to reduce or enhance the conformational shift alter sensitivity to cVA as predicted in vivo. One substitution, LUSH(D118A), produces a dominant-active LUSH protein that stimulates T1 neurons through the neuronal receptor components Or67d and SNMP in the complete absence of pheromone. Structural analysis of LUSH(D118A) reveals that it closely resembles cVA-bound LUSH. Therefore, the pheromone-binding protein is an inactive, extracellular ligand converted by pheromone molecules into an activator of pheromone-sensitive neurons and reveals a distinct paradigm for detection of odorants.


Assuntos
Drosophila melanogaster/metabolismo , Neurônios Receptores Olfatórios/metabolismo , Receptores Odorantes/química , Receptores Odorantes/metabolismo , Atrativos Sexuais/metabolismo , Acetatos/química , Acetatos/metabolismo , Substituição de Aminoácidos , Animais , Proteínas de Drosophila/metabolismo , Feminino , Masculino , Modelos Moleculares , Ácidos Oleicos/química , Ácidos Oleicos/metabolismo , Neurônios Receptores Olfatórios/química , Feromônios/química , Feromônios/metabolismo , Conformação Proteica , Receptores de Superfície Celular/metabolismo , Receptores Odorantes/genética , Receptores de Feromônios/metabolismo
9.
Philos Trans A Math Phys Eng Sci ; 381(2258): 20220346, 2023 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-37634534

RESUMO

We have analysed [Formula: see text] with a combination of synchrotron X-ray diffraction and X-ray absorption spectroscopy across a pressure range of [Formula: see text] GPa with thermal annealing by a [Formula: see text] laser allowing access to all of the known high-density polymorphs of [Formula: see text], and here report their crystallographic information. The metastability of the post-rutile [Formula: see text]-[Formula: see text] and [Formula: see text] structures in [Formula: see text] are investigated by experiment and PW-DFT simulations, revealing a complex energetic landscape and suggesting a significant dependence of the observed phases on the pressure-temperature pathway taken in experiment. This article is part of the theme issue 'Exploring the length scales, timescales and chemistry of challenging materials (Part 1)'.

10.
Mol Cell ; 59(5): 807-18, 2015 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-26257286

RESUMO

Assembly of the RNA-induced silencing complex (RISC) requires formation of the RISC loading complex (RLC), which contains the Dicer-2 (Dcr-2)-R2D2 complex and recruits duplex siRNA to Ago2 in Drosophila melanogaster. However, the precise composition and action mechanism of Drosophila RLC remain unclear. Here we identified the missing factor of RLC as TATA-binding protein-associated factor 11 (TAF11) by genetic screen. Although it is an annotated nuclear transcription factor, we found that TAF11 also associated with Dcr-2/R2D2 and localized to cytoplasmic D2 bodies. Consistent with defective RLC assembly in taf11(-/-) ovary extract, we reconstituted the RLC in vitro using the recombinant Dcr-2-R2D2 complex, TAF11, and duplex siRNA. Furthermore, we showed that TAF11 tetramer facilitates Dcr-2-R2D2 tetramerization to enhance siRNA binding and RISC loading activities. Together, our genetic and biochemical studies define the molecular nature of the Drosophila RLC and elucidate a cytoplasmic function of TAF11 in organizing RLC assembly to enhance RNAi efficiency.


Assuntos
Proteínas de Drosophila/química , Proteínas de Drosophila/metabolismo , Interferência de RNA , Complexo de Inativação Induzido por RNA/química , Complexo de Inativação Induzido por RNA/metabolismo , Fatores Associados à Proteína de Ligação a TATA/química , Fatores Associados à Proteína de Ligação a TATA/metabolismo , Animais , Animais Geneticamente Modificados , Proteínas Argonautas/química , Proteínas Argonautas/genética , Proteínas Argonautas/metabolismo , Sistemas CRISPR-Cas , Linhagem Celular , Proteínas de Drosophila/genética , Drosophila melanogaster/genética , Drosophila melanogaster/metabolismo , Drosophila melanogaster/virologia , Feminino , Técnicas de Inativação de Genes , Genes de Insetos , Masculino , Modelos Biológicos , Mutagênese , Estrutura Quaternária de Proteína , RNA Helicases/química , RNA Helicases/genética , RNA Helicases/metabolismo , RNA Interferente Pequeno/genética , RNA Interferente Pequeno/metabolismo , Proteínas de Ligação a RNA/química , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Complexo de Inativação Induzido por RNA/genética , Ribonuclease III/química , Ribonuclease III/genética , Ribonuclease III/metabolismo , Fatores Associados à Proteína de Ligação a TATA/genética
11.
J Hand Surg Am ; 48(4): 388-395, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36535838

RESUMO

Amnion epithelial and mesenchymal cells have been shown in vitro to contain a variety of regulatory mediators that result in the promotion of cellular proliferation, differentiation, and epithelialization and the inhibition of fibrosis, immune rejection, inflammation, and bacterial invasion. Amniotic membrane-based products are approved for use as human cells, tissues, and cellular- and tissue-based products through Sections 361 or 351 of the Food and Drug Administration. Previously reported clinical applications of human amniotic membranes include nerve repair, tendon injury, joint and cartilage damage, and wound management. Although there is some evidence regarding the use of amniotic allografts in animals, there is a paucity of literature regarding their use in treating pathology of the hand and wrist. Further investigation is necessary to determine their effectiveness and therapeutic value in the upper extremity.


Assuntos
Âmnio , Especialidades Cirúrgicas , Animais , Humanos , Âmnio/transplante , Mãos/cirurgia , Transplante Homólogo , Aloenxertos
12.
J Neurosci ; 41(18): 3948-3957, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33789918

RESUMO

Drosophila odorant receptors (Ors) are ligand gated ion channels composed of a common receptor subunit Or co-receptor (ORCO) and one of 62 "tuning" receptor subunits that confer odorant specificity to olfactory neuron responses. Like other sensory systems studied to date, exposing Drosophila olfactory neurons to activating ligands results in reduced responses to subsequent exposures through a process called desensitization. We recently showed that phosphorylation of serine 289 on the common Or subunit ORCO is required for normal peak olfactory neuron responses. Dephosphorylation of this residue occurs on prolonged odorant exposure, and underlies the slow modulation of olfactory neuron responses we term "slow desensitization." Slow desensitization results in the reduction of peak olfactory neuron responses and flattening of dose-response curves, implicating changes in ORCOS289 phosphorylation state as an important modulator of olfactory neuron responses. Here, we report the identification of the primary kinase responsible for ORCOS289 phosphorylation, PKC98E. Antiserum localizes the kinase to the dendrites of the olfactory neurons. Deletion of the kinase from olfactory neurons in the naive state (the absence of prolonged odor exposure) reduces ORCOS289 phosphorylation and reduces peak odorant responses without altering receptor localization or expression levels. Genetic rescue with a PKC98E predicted to be constitutively active restores ORCO S289 phosphorylation and olfactory neuron sensitivity to the PKC98E mutants in the naive state. However, the dominant kinase is defective for slow desensitization. Together, these findings reveal that PKC98E is an important regulator of ORCO receptors and olfactory neuron function.SIGNIFICANCE STATEMENT We have identified PKC98E as the kinase responsible for phosphorylation of the odorant receptor co-receptor (ORCO) at S289 that is required for normal odorant response kinetics of olfactory neurons. This is a significant step toward revealing the enzymology underlying the regulation of odorant response regulation in insects.


Assuntos
Proteínas de Drosophila/fisiologia , Drosophila melanogaster/fisiologia , Neurônios Receptores Olfatórios/fisiologia , Proteína Quinase C/fisiologia , Animais , Dendritos/enzimologia , Relação Dose-Resposta a Droga , Proteínas de Drosophila/genética , Fenômenos Eletrofisiológicos , Deleção de Genes , Mutação/genética , Odorantes , Neurônios Receptores Olfatórios/enzimologia , Fosforilação , Proteína Quinase C/genética , Interferência de RNA , Receptores Odorantes/genética , Receptores Odorantes/metabolismo
13.
J Card Fail ; 28(4): 519-530, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34763080

RESUMO

BACKGROUND: The objective of this 3-arm randomized controlled trial was to evaluate the efficacy of computerized cognitive training (CCT) in improving primary outcomes of delayed-recall memory and serum brain-derived neurotrophic factor (BDNF) levels; and the secondary outcomes were working memory, instrumental activities of daily living (IADLs) and health-related quality of life (HRQL) in patients with heart failure (HF). METHODS AND RESULTS: Patients (n = 256) were randomly assigned to 8 weeks of CCT using BrainHQ, computerized crossword puzzles active control intervention, and usual care. All patients received weekly nurse-enhancement interventions. Data were collected at enrollment and baseline visits and at 10 weeks and 4 and 8 months. In mixed effects models, there were no statistically significant group or group-by-time differences in outcomes. There were statistically significant differences over time in all outcomes in all groups. Patients improved over time on measures of delayed-recall memory, working memory, IADLs, and HRQL and had decreased serum BDNF. CONCLUSIONS: CCT did not improve outcomes compared with the active control intervention and usual care. Nurse-enhancement interventions may have led to improved outcomes over time. Future studies are needed to test nurse-enhancement interventions in combination with other cognitive interventions to improve memory in persons with HF.


Assuntos
Fator Neurotrófico Derivado do Encéfalo , Insuficiência Cardíaca , Atividades Cotidianas , Cognição , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Qualidade de Vida
14.
Biologicals ; 78: 17-26, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35840492

RESUMO

This online workshop Accelerating Global Deletion of the Abnormal Toxicity Test for vaccines and biologicals. Planning common next steps was organized on October 14th, 2021, by the Animal Free Safety Assessment Collaboration (AFSA), the Humane Society International (HSI), the European Federation of Pharmaceutical Industries and Associations (EFPIA), in collaboration with the International Alliance of Biological Standardization (IABS). The workshop saw a participation of over a hundred representatives from international organizations, pharmaceutical industries and associations, and regulatory authorities of 28 countries. Participants reported on country- and region-specific regulatory requirements and, where present, on the perspectives on the waiving and elimination of the Abnormal Toxicity Test. With AFSA, HSI, EFPIA and IABS representatives as facilitators, the participants also discussed specific country/global actions to further secure the deletion of ATT from all regulatory requirements worldwide.


Assuntos
Testes de Toxicidade , Vacinas , Indústria Farmacêutica , Humanos , Padrões de Referência , Vacinas/efeitos adversos
15.
Phys Rev Lett ; 127(1): 016401, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34270285

RESUMO

A reversible density driven insulator to metal to insulator transition in high-spin MnS_{2} is experimentally observed, leading with a colossal electrical resistance drop of 10^{8} Ω by 12 GPa. Density functional theory simulations reveal the metallization to be unexpectedly driven by previously unoccupied S_{2}^{2-} σ_{3p}^{*} antibonding states crossing the Fermi level. This is a unique variant of the charge transfer insulator to metal transition for negative charge transfer insulators having anions with an unsaturated valence. By 36 GPa the emergence of the low-spin insulating arsenopyrite (P2_{1}/c) is confirmed, and the bulk metallicity is broken with the system returning to an insulative electronic state.

16.
Inorg Chem ; 60(8): 6004-6015, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33788545

RESUMO

The AMnO2 delafossites (A = Na, Cu) are model frustrated antiferromagnets, with triangular layers of Mn3+ spins. At low temperatures (TN = 65 K), a C2/m → P1̅ transition is found in CuMnO2, which breaks frustration and establishes magnetic order. In contrast to this clean transition, A = Na only shows short-range distortions at TN. Here, we report a systematic crystallographic, spectroscopic, and theoretical investigation of CuMnO2. We show that, even in stoichiometric samples, nonzero anisotropic Cu displacements coexist with magnetic order. Using X-ray/neutron diffraction and Raman scattering, we show that high pressures act to decouple these degrees of freedom. This manifests as an isostuctural phase transition at ∼10 GPa, with a reversible collapse of the c-axis. This is shown to be the high-pressure analogue of the c-axis negative thermal expansion seen at ambient pressure. Density functional theory (DFT) simulations confirm that dynamical instabilities of the Cu+ cations and edge-shared MnO6 layers are intertwined at ambient pressure. However, high pressure selectively activates the former, before an eventual predicted reemergence of magnetism at the highest pressures. Our results show that the lattice dynamics and local structure of CuMnO2 are quantitatively different from nonmagnetic Cu delafossites and raise questions about the role of intrinsic inhomogeneity in frustrated antiferromagnets.

17.
Addict Biol ; 26(5): e13045, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34044470

RESUMO

Alcohol-induced aggression is a destructive and widespread phenomenon associated with violence and sexual assault. However, little is understood concerning its mechanistic origin. We have developed a Drosophila melanogaster model to genetically dissect and understand the phenomenon of sexually dimorphic alcohol-induced aggression. Males with blood alcohol levels of 0.04-mg/ml BAC were less aggressive than alcohol-naive males, but when the BAC had dropped to ~0.015 mg/ml, the alcohol-treated males showed an increase in aggression toward other males. This aggression-promoting treatment is referred to as the post-ethanol aggression (PEA) treatment. Females do not show increased aggression after the same treatment. PEA-treated males also spend less time courting and attempt to copulate earlier than alcohol-naive flies. PEA treatment induces expression of the FruM transcription factor (encoded by a male-specific transcript from the fruitless gene), whereas sedating doses of alcohol reduce FruM expression and reduce male aggression. Transgenic suppression of FruM induction also prevents alcohol-induced aggression. In male flies, alcohol-induced aggression is dependent on the male isoform of the fruitless transcription factor (FruM). Low-dose alcohol induces FruM expression and promotes aggression, whereas higher doses of alcohol suppress FruM and suppress aggression.


Assuntos
Agressão , Etanol/metabolismo , Comportamento Sexual Animal/efeitos dos fármacos , Animais , Drosophila melanogaster , Feminino , Regulação da Expressão Gênica , Masculino , Proteínas do Tecido Nervoso/metabolismo , Neurônios/metabolismo , Caracteres Sexuais , Fatores de Transcrição
18.
Biologicals ; 71: 55-60, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33966960

RESUMO

The International Alliance for Biological Standardization and the Coalition for Epidemic Preparedness Innovations organized a joint webinar on the use of platform technologies for vaccine development. To tackle new emerging infectious diseases, including SARS-CoV-2, rapid response platforms, using the same basic components as a backbone, yet adaptable for use against different pathogens by inserting new genetic or protein sequences, are essential. Furthermore, it is evident that development of platform technologies needs to continue, due to the emerging variants of SARS-CoV-2. The objective of the meeting was to discuss techniques for platform manufacturing that have been used for COVID-19 vaccine development, with input from regulatory authorities on their experiences with, and expectations of, the platforms. Industry and regulators have been very successful in cooperating, having completed the whole process from development to licensing at an unprecedented speed. However, we should learn from the experiences, to be able to be even faster when a next pandemic of disease X occurs.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , Desenvolvimento de Medicamentos , SARS-CoV-2/imunologia , Vacinas contra COVID-19/uso terapêutico , Congressos como Assunto , Humanos
19.
Biologicals ; 74: 16-23, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34620540

RESUMO

There is an increasing need to establish quality principles for designing, developing and manufacturing challenge agents as currently these agents are classified differently by various jurisdictions. Indeed, considerations for challenge agent manufacturing vary between countries due to differences in regulatory oversight, the categorization of the challenge agent and incorporation into medicinal/vaccine development processes. To this end, a whitepaper on the guidance has been produced and disseminated for consultation to researchers, regulatory experts and regulatory or advisory bodies. This document is intended to discuss fundamental principles of selection, characterization, manufacture, quality control and storage of challenge agents for international reference. In the development phase, CMC documentation is needed for a candidate challenge agent, while standard operating procedure documentation is needed to monitor and control the manufacturing process, followed by use of qualified methods to test critical steps in the manufacturing process, or the final product itself. These activities are complementary: GMP rules, which intervene only at the time of the routine manufacturing of batches, do not contribute to the proper development and qualification of the candidate product. Some considerations regarding suitability of premises for challenge manufacturing was discussed in the presentation dedicated to "routine manufacturing".


Assuntos
Pesquisa Biomédica/normas , Desenvolvimento de Medicamentos , Experimentação Humana , Desenvolvimento de Vacinas , Humanos , Controle de Qualidade
20.
J Healthc Manag ; 66(1): 48-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411486

RESUMO

EXECUTIVE SUMMARY: Financial distress is a persistent problem in U.S. hospitals, leading them to close at an alarming rate over the past two decades. Given the potential adverse effects of hospital closures on healthcare access and public health, interest is growing in understanding more about the financial health of U.S. hospitals. In this study, we set out to explore the extent to which relevant organizational and environmental factors potentially buffer financially distressed hospitals from closure, and even at the brink of closure, enable some to merge with other hospitals. We tested our hypotheses by first examining how factors such as slack resources, environmental munificence, and environmental complexity affect the likelihood of survival versus closing or merging with other organizations. We then tested how the same factors affect the likelihood of merging relative to closing for financially distressed hospitals that undergo one of these two events. We found that different types of slack resources and environmental forces impact different outcomes. In this article, we discuss the implications of our findings for hospital stakeholders.


Assuntos
Fechamento de Instituições de Saúde , Hospitais , American Hospital Association , Estados Unidos
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