An Exploration of Racial Differences Among Male Youth Adjudicated for Sexual Offenses.

In 2019, the male adjudicated youth (AY) population in correctional facilities was 33% White and 67% minority. Yet, the distribution among male AY charged with sexual offenses (AYSOs) was 55% White and 45% minority, highlighting the lack of disproportionate minority contact within the AYSO population. Little research on AYSOs has focused explicitly on exploring racial differences within this population. Using secondary data from 720 AY 11-18 years of age, the goal of this exploratory study was to identify differences in length of detention, presence of clinical syndromes, attachment patterns, and childhood trauma experiences among a sample of AYSOs and AYs by race category. Although few racial differences were identified among AYSOs, study results overwhelmingly highlighted differences between AYSOs and AYs.

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study.

BACKGROUND: Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service. METHODS: We analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings. RESULTS: Clients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model. CONCLUSIONS: Addiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed.

Cost Savings from a Navigator Intervention for Repeat Detoxification Clients.

BACKGROUND: Many clients with substance use disorders (SUD) have multiple admissions to a 24-hour level of care for detoxification without ever progressing to SUD treatment. In the US, health insurers have become concerned about the high costs and ineffective results of repeat detox admissions. For other diseases, health systems increasingly target high-risk, high-cost patients with individually tailored interventions delivered by `navigators' who help patients negotiate the complex health care system. Patient incentives are another increasingly common intervention. AIMS OF THE STUDY: (i) To examine how health care spending was affected by an intervention intended to improve entry to SUD treatment among clients who had multiple detox admissions. (ii) To see whether spending effects, overall and by type of service, differed by intervention arm. (iii) To assess whether the intervention resulted in net savings from the payer perspective, after subtracting implementation costs. METHODS: The intervention was implemented in a segment of the Massachusetts Medicaid population, and used Recovery Support Navigators (RSNs) who were trained to effectively engage and connect clients with SUD to follow-up care and community resources. Services were funded using a flat daily rate per client. Additionally, in one of the two intervention arms, clients were offered successive incentive payments for meeting pre-specified milestones to reinforce recovery-oriented behaviors. For this paper, multivariate analyses of claims and administrative data were used to measure the intervention's effect on health care spending, and to estimate net savings to the payer. RESULTS: Health care spending grew 1.6 percentage points more slowly for intervention-enrolled members than for others, implying gross savings of $68 per member per month. After subtracting intervention-related costs, net savings were estimated at $57 per member per month. The intervention was also associated with shifts in the health care service mix from more to less acute settings. DISCUSSION: While the results for total spending did not reach statistical significance, they suggest some potential for insurers to reduce the health care costs associated with repeat detox utilization by using a navigator-based intervention. Analyses reported elsewhere found that this intervention had favorable effects on rates of initiation of SUD treatment. Limitations of the study include the fact that neither subjects nor sites were randomized between study groups; lack of data on crime or productivity outcomes; low participant use of RSN services; and a policy change which altered the participant pool and truncated follow-up for some. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These results suggest some potential for payers to reduce the health care costs associated with repeat detox by using a navigator-based intervention. To the extent that this results in shifting resources from repeat detox to actual treatment, the result should provide longer term benefit to the population coping with SUD. IMPLICATIONS FOR HEALTH POLICY: These results may encourage Medicaid and other payers to further experiment with similar interventions using navigators to decrease health care costs and improved the lives of SUD patients. IMPLICATIONS FOR FURTHER RESEARCH: It could be informative to test similar navigator interventions for detox patients in other settings where enrollment periods are longer.

Prevalence of seven cardiovascular-related genetic polymorphisms in a Chilean mestizo healthy population.

OBJECTIVE: Among the genetic factors associated with cardiovascular disease (CVD), determining polymorphic genotypes could help to understand the appearance of the illness. Ethnic differences in these polymorphisms could explain population variability in susceptibility to CVD. The main goal of this research is to study the presence of more relevant genetic variants of ApoE, CETP, ACE, PAI-1, MTHFR, FII and FVL of the coagulation cascade, to describe the presence of cardiovascular-related variants in a mestizo group of the Chilean people. METHODS AND RESULTS: The studied population comprised 146 unrelated subjects from the general population, diagnosed as healthy, who were genotyped through conventional and/or real-time PCR. The allele frequencies for the Chilean population were: Apo E, ε2: 0.036, ε3: 0.875 and ε4: 0.089; CETP, B1: 0.51 and B2: 0.49; MTHFR, C: 0.52 and T: 0.48; ACE, I: 0.603 and D: 0.397; PAI-1, 4G: 0.381 and 5G: 0.619; FII, G: 0.97 and A: 0.03, and FV Leiden, G: 0.97 and A: 0.03. CONCLUSIONS: This study contributes to establish a first picture in the Chilean mestizo population about the frequencies of these variants, which could act as single or complementary risk factors to trigger CVD. The obtained allele frequencies show great differences in relation to other South American populations.

Characteristics of practitioners in a private managed behavioral health plan.

BACKGROUND: Little is known about the practitioners in managed behavioral healthcare organization (MBHO) networks who are treating mental and substance use disorders among privately insured patients in the United States. It is likely that the role of the private sector in treating behavioral health will increase due to the recent implementation of federal parity legislation and the inclusion of behavioral health as a required service in the insurance exchange plans created under healthcare reform. Further, the healthcare reform legislation has highlighted the need to ensure a qualified workforce in order to improve access to quality healthcare, and provides an additional focus on the behavioral health workforce. To expand understanding of treatment of mental and substance use disorders among privately insured patients, this study examines practitioner types, experience, specialized expertise, and demographics of in-network practitioners providing outpatient care in one large national MBHO. METHODS: Descriptive analyses used 2004 practitioner credentialing and other administrative data for one MBHO. The sample included 28,897 practitioners who submitted at least one outpatient claim in 2004. Chi-square and t-tests were used to compare findings across types of practitioners. RESULTS: About half of practitioners were female, 12% were bilingual, and mean age was 53, with significant variation by practitioner type. On average, practitioners report 15.3 years of experience (SD = 9.4), also with significant variation by practitioner type. Many practitioners reported specialized expertise, with about 40% reporting expertise for treating children and about 60% for treating adolescents. CONCLUSIONS: Overall, these results based on self-report indicate that the practitioner network in this large MBHO is experienced and has specialized training, but echo concerns about the aging of this workforce. These data should provide us with a baseline of practitioner characteristics as we enter an era that anticipates great change in the behavioral health workforce.

Neuromuscular and acute symptoms responses to progressive elastic resistance exercise in patients with chronic obstructive pulmonary disease: Cross-sectional study.

Background: Quadriceps muscle training is a key part in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. However, exercise intensity prescription and progression with the typically used elastic bands is challenging. We aimed to evaluate neuromuscular, acute symptoms and cardiorespiratory responses (heart rate and dyspnea) during progressive elastic resistance exercise in patients with COPD. Methods: Fourteen patients diagnosed with moderate-very severe COPD performed knee extensions at different elastic resistance levels (i.e., colors). The neuromuscular activity was recorded using surface electromyography for the rectus femoris, vastus lateralis and vastus medialis, together with rate of perceived exertion, perceived quadriceps fatigue, dyspnea, oxygen saturation and heart rate. Results: For the vastus lateralis and rectus femoris, increase of muscle activity was evident from a two-level increment when using the red color. For the vastus medialis, there were no muscle activity progressions. Dyspnea, quadriceps fatigue and especially rate of perceived exertion increased in a dose-response fashion and were correlated with the resistance level and muscle activity at the three muscles. Conclusion: Heavy elastic resistance exercise is feasible in COPD patients without excessive dyspnea and a stable cardiorespiratory response. In general, at least two elastic resistance increments are needed to enhance muscle activity for the vastus lateralis and rectus femoris, while there is no increase for the vastus medialis. These results may help to individualize exercise dosing during elastic resistance training in patients with COPD.

Congenital hearing loss: a literature review of the genetic etiology in a Mexican population.

Hearing loss is the most frequent sensory disorder, with an incidence of 1:1500 live newborns. In more than 50% of patients, it is associated with a genetic cause, while in up to 30% of cases, it is related to syndromic entities. We performed a literature review of studies on congenital hearing loss of genetic origin in the Mexican population. We identified eight reports that showed that the pathogenic variants most frequently associated with hearing loss are related to the GJB2 gene, although in a low percentage (3%). Other mutations were identified in the GJB6, SLC26A4, or CHD23 genes. On this basis, a possible diagnostic strategy in Mexican patients with hearing loss is to consider an initial screening of these three genes. If these genes were negative for pathogenic variants, the following steps would be to consider second-generation sequencing analysis focused on panels of genes associated with hearing loss, isolated or syndromic, and if necessary, to perform exome or whole-genome analysis. Establishing an etiologic cause is critical in clinically evaluating patients with congenital hearing loss and their families. It can help determine rehabilitation strategies, such as hearing aids or cochlear implants and provide information on disease progression and genetic counseling in this population.

La pérdida auditiva es la alteración sensorial más frecuente, con una incidencia de 1:1500 recién nacidos vivos. En más del 50% de los pacientes se asocia con una causa genética, mientras que en más del 30% de los casos se asocia con entidades sindrómicas. Se llevó a cabo una revisión de la literatura de las investigaciones sobre la pérdida auditiva congénita de origen genético en la población mexicana. Se identificaron ocho reportes en los que se demostró que las variantes patogénicas más frecuentemente asociadas con pérdida auditiva se encuentran en el gen GJB2, aunque en un porcentaje bajo (3%). Se identificaron otras mutaciones en los genes GJB6, SLC26A4 o CHD23. Con base en esta información, una posible estrategia diagnóstica en pacientes mexicanos con pérdida auditiva es considerar un primer paso en el tamiz diagnóstico con los tres genes mencionados. Si estos genes fueran negativos para variantes patogénicas, el siguiente paso sería considerar el análisis por secuenciación de segunda generación enfocado en paneles de genes asociados con pérdida auditiva, tanto aislada como sindrómica, y en caso necesario, realizar el análisis del exoma o del genoma completo. Establecer una causa etiológica es un componente crítico en la evaluación clínica de los pacientes con pérdida auditiva congénita, ya que puede ayudar a determinar las estrategias de manejo y rehabilitación, como el uso de auxiliares auditivos o implantes cocleares, proporcionar información sobre la progresión de la enfermedad y dar asesoramiento genético en esta población.

Effectiveness of value-based purchasing for substance use treatment engagement and retention.

INTRODUCTION: Many people drop out of substance use disorder (SUD) treatment within the first few sessions, which suggests the need for innovative strategies to address this. We examined the effectiveness of incentive-based contracting for Maine's publicly funded outpatient (OP) and intensive outpatient (IOP) SUD treatment, to determine its potential for improving treatment engagement and retention. METHODS: Maine's incentive-based contract with federally block grant-funded OP and IOP treatment agencies created a natural experiment, in which we could compare treatment engagement and retention with a group of state-licensed treatment agencies that were not part of the incentive-based contract. We used administrative data for OP (N = 18,375) and IOP (N = 5986) SUD treatment admissions from FY2005-FY2011 to capture trends prior to and after the FY2008 contract implementation date. We performed multivariable difference-in-difference logistic regression models following propensity score matching of clients. RESULTS: Two-thirds (66%) of OP admissions engaged in treatment, defined as 4+ treatment sessions, and 85% of IOP admissions satisfied the similar criteria of 4+ treatment days. About 40-45% of OP admissions reached the threshold for retention, defined as 90 days in treatment. IOP treatment completion was attained by 50-58% of admissions. For OP, the incentive and nonincentive groups had no significant differences in percentages with treatment engagement (AOR = 1.28, DID = 5.9%, p = .19), and 90-day retention was significant in the opposite direction of what we hypothesized (AOR = 0.80, DID = -4.6%, p = .0003). For IOP, the incentive group had a significant, but still small, increase in percentage with treatment engagement (AOR = 1.52, DID = 5.5%, p = .003), but the corresponding increase in treatment completion was not similarly significant (AOR = 1.12, DID = 2.7%, p = .53). In all models, individual-level variables were strong predictors of outcomes. CONCLUSION: We found little to no impact of the incentive-based contract on the treatment engagement, retention, and completion measures, adding to the body of evidence that shows few or null results for value-based purchasing in SUD treatment programs. The limited success of such efforts is likely to reflect the bandwidth that providers and programs have to focus on new endeavors, the importance of the incentive funding to their bottom line, and forces beyond their immediate control.

--Effect of multimodal cues from a predatory fish on refuge use and foraging on an amphidromous shrimp.

BACKGROUND: Prey can alter their behavior when detecting predator cues. Little is known about which sensory channel, number of channels, or the interaction among channels that shrimp species use to evaluate the threat from predators. The amphidromous shrimp Xiphocaris elongata has an induced defense, an elongated rostrum, where predatory fishes are present. We sought to test if kairomones or visual cues when presented singly from fish either eating flakes or shrimp, had more effect on altering the temporal feeding and refuge use patterns of long-rostrum (LR) X. elongata. We were also interested in elucidating potential interactions among cues when presented simultaneously in different combinations (kairomones + visual + mechanosensory, kairomones + alarm + visual, kairomones + alarm, kairomones + visual) on the same response variables. We expected that when presented alone kairomones will significantly increase refuge use and decrease foraging, particularly late at night, in comparison to visual cues alone, and that multiple cues when presented simultaneously will further increase refuge use and decrease foraging at night. METHODS: We exposed shrimp to individual or multiple cues from the predatory fish mountain mullet, Augonostomus monticola. We examined shrimp behavior with respect to refuge use and foraging activity during four time periods (after sunset, nighttime, sunrise, and sunset) in a 24-hour period. RESULTS: Shrimp presented fish visual and chemical cues singly did not differ from one another but differed from control shrimp (no cues) with respect to refuge use or foraging. The number of shrimp using refuge in the treatment with most cues (KVM: kairomones+ visual + mechanosensory) was higher than in all the treatments with less cues. A significant decline in foraging was observed when multiple cues were presented simultaneously. The highest number of shrimp foraged one hour after sunset and at nighttime. A significant interaction was observed between cue treatments and time periods, with shrimp in the KVM treatment foraging less and using more refuge late at night and at sunrise than shrimp in other treatments or time periods. CONCLUSIONS: The observation that fish chemical and visual cues when presented singly produced similar refuge use and foraging patterns was contrary to expectation and suggests that visual and chemical cues, when presented alone, provide redundant information to X. elongata with regards to predation threat. The significant increase in refuge use and reduction in foraging observed in the KVM treatment suggest multimodal signal enhancement in the perception of threat. This makes evolutionary sense in "noisy" environments, such as streams, where detection, localization, and intention of predators is much improved when cues are received through multiple sensory channels.

The Effect of Medicaid Expansion on Caregiver's Quality of Life.

Medicaid expansion has been shown to improve access to care, health, and finances in general populations. Until now no studies have considered how Medicaid expansion may affect informal family caregivers who are the backbone of the long term supports and services infrastructure. Family caregivers provide substantial cost savings to Medicare and Medicaid. Yet, they sustain financial, physical, and mental health strain from their caregiving role which Medicaid expansion may offset. This study evaluated the impact of Medicaid expansion on caregivers' mental health using 2015-2018 data from the Behavioral Risk Factor Surveillance System. After adjusting for demographics, socioeconomic status, and health behaviors, caregivers in Medicaid expansion states had a significantly fewer number of poor mental health days in the previous month than caregivers in non-expansion states (ß = -0.528, CI -1.019, -0.036, p < .01). Study findings indicate that Medicaid expansion state status was protective for caregiver's mental health.

Sleeve resection uniportal video assisted thoracoscopic surgery, feasible and reproducible: case report.

Sleeve resection is used in central lung cancer and the objective is to preserve normal lung tissues. Uniportal VATS approach is a complex and challenging new technique that offers the benefits of minimal invasion, without increasing the risks. We presented a 41-year-old male patient, with history of cough with hemoptysis due to an exophytic lesion of the right main bronchus. Diagnosis of neuroendocrine tumor type 1 (carcinoid tumor) was confirmed with bronchoscopy. Complete circumferential resection was performed, with terminal-terminal anastomosis and reconstruction. Satisfactory postoperative evolution. In post-surgical follow-up.

La resección bronquial en manga se emplea en tumores pulmonares que invaden estructuras centrales con el objetivo de preservar tejido pulmonar funcional. El abordaje VATS uniportal es una técnica novel compleja y desafiante, que ofrece los beneficios de la mínima invasión sin incrementar los riesgos. Presentamos el caso de un paciente de 41 años con un cuadro de tos con hemoptisis por lesión exofítica del bronquio principal derecho confirmada por broncoscopia, con diagnóstico de tumor neuroendocrino de tipo 1 (tumor carcinoide), que fue resecado por completo circunferencialmente, con reconstrucción término-terminal. La evolución posoperatoria fue satisfactoria. El seguimiento se realiza en consulta externa.

Are there different vigilance strategies between types of social units in Lama guanicoe?

Group vigilance is a cooperative behaviour in social species that reduces individual risk of predation. Lama guanicoe is a social species of camelid performing cooperative vigilance, but little is known about the vigilance behaviour of different social units. We analysed the vigilance behaviour in different types of social units of L. guanicoe, to better understand the complexity of this behaviour. The best supported models for both the frequency of vigilance and the proportion of time vigilant included the type and size of social units as the most important predictors that affect the vigilance behaviour. Solitary males devoted proportionally more time in vigilance behaviour than family, mixed or bachelor groups, whereas females in female groups spent more time vigilant than guanacos in mixed groups. Frequency of vigilance was higher in family individuals and solitary males than in bachelor or mixed groups. It is likely that that in family and females groups, the presence of offspring would increase the vigilance behaviour to detect possible predators. Topography and habitat characteristics that determine the predation risk, affected vigilance behaviour of mixed groups and solitary males. Our results suggest that vigilance behaviour should not be generalized for this species, since there are differences between the types of social units, probably related to intrinsic characteristics of each one and the perception of risk.

Impact of hospital hospitality house programs on quality of life and mood of patients and caregivers after hematopoietic stem cell transplant.

OBJECTIVE/BACKGROUND: The quality of life (QOL) of hematopoietic stem cell transplant (HSCT) patients and their caregivers decreases during the first 8 days after HSCT. METHODS: This prospective pilot study collected preliminary data on the impact of posttransplant living arrangements (hospital hospitality house [HHH] vs. hotel, apartment, or house ["hotel"]) and other factors on the QOL of HSCT patients and their caregivers. The predefined primary end point was QOL of patients and their caregivers on Day 30 (QOL30) as measured by the linear analog self-assessment (LASA). RESULTS: Forty-four HSCT patients participated (HHH 23, hotel 21; allogeneic 18, autologous 26). No significant differences in QOL30 (mean LASA score) were noted between patient groups (55.6 [HHH] vs. 72.2 [hotel], p = .06) or between caregiver groups (77.8 [HHH] vs. 88.9 [hotel], p = .20). Multivariate analysis for QOL30 showed that baseline QOL (p = .006) and age (p = .049) were significant predictors of QOL30 after adjustment for sex, post-HSCT living place, and transplant type. Older patients (≥60 years) had a significantly lower QOL30 than younger patients (mean score, 51.6 vs. 75.3; p = .02). CONCLUSION: Efforts to improve QOL30 of HSCT patients and caregivers in the confined environment of an HHH should focus on patients with low baseline QOL and older patients.

Validation of prescriber risk indicators obtained from prescription drug monitoring program data.

BACKGROUND: Prescription opioids are commonly overprescribed. However, validated measures of inappropriate controlled substance prescribing are lacking. This study examined associations between prescriber risk indicators developed as part of a public health surveillance project and medical board disciplinary actions against prescribers. METHODS: We compiled 12 prescriber risk indicators using data from the Maine prescription drug monitoring program (PDMP) for 2010. We used logistic regression models to assess the relative likelihood of the top 1%, 2%, 5%, and 10% of prescribers on each risk indicator having been subject to medical board disciplinary actions, those citing inappropriate prescribing, or those involving license suspension or revocation, during 2010-2014, controlling for prescriber medical specialty and gender. RESULTS: The top 1% of prescribers for number of patients, opioid prescriptions per day, and opioid dosage prescribed per day had a greater likelihood of medical board disciplinary actions citing inappropriate prescribing, relative to a matched sample of other (non-top 1%) prescribers. Of the 56 prescribers in the top 1% for opioid prescriptions per day, nine (16.1%) were sanctioned for inappropriate prescribing, compared with 11 of 224 (0.5%) in the comparison group. The top 2% of prescribers for opioid dosage per day, and average distance patients travel to prescriber, had a greater likelihood of actions involving license suspension, revocation, or denial for renewal. CONCLUSIONS: Measures derived from PDMP data may be useful in assessing levels of inappropriate prescribing of controlled substances in a population of prescribers, and in evaluating changes associated with efforts to influence prescriber behavior.

Congenital hearing loss: a literature review of the genetic etiology in a Mexican population / Pérdida auditiva congénita: revisión de la etiología genética en la población mexicana

Abstract Hearing loss is the most frequent sensory disorder, with an incidence of 1:1500 live newborns. In more than 50% of patients, it is associated with a genetic cause, while in up to 30% of cases, it is related to syndromic entities. We performed a literature review of studies on congenital hearing loss of genetic origin in the Mexican population. We identified eight reports that showed that the pathogenic variants most frequently associated with hearing loss are related to the GJB2 gene, although in a low percentage (3%). Other mutations were identified in the GJB6, SLC26A4, or CHD23 genes. On this basis, a possible diagnostic strategy in Mexican patients with hearing loss is to consider an initial screening of these three genes. If these genes were negative for pathogenic variants, the following steps would be to consider second-generation sequencing analysis focused on panels of genes associated with hearing loss, isolated or syndromic, and if necessary, to perform exome or whole-genome analysis. Establishing an etiologic cause is critical in clinically evaluating patients with congenital hearing loss and their families. It can help determine rehabilitation strategies, such as hearing aids or cochlear implants and provide information on disease progression and genetic counseling in this population.

Resumen La pérdida auditiva es la alteración sensorial más frecuente, con una incidencia de 1:1500 recién nacidos vivos. En más del 50% de los pacientes se asocia con una causa genética, mientras que en más del 30% de los casos se asocia con entidades sindrómicas. Se llevó a cabo una revisión de la literatura de las investigaciones sobre la pérdida auditiva congénita de origen genético en la población mexicana. Se identificaron ocho reportes en los que se demostró que las variantes patogénicas más frecuentemente asociadas con pérdida auditiva se encuentran en el gen GJB2, aunque en un porcentaje bajo (3%). Se identificaron otras mutaciones en los genes GJB6, SLC26A4 o CHD23. Con base en esta información, una posible estrategia diagnóstica en pacientes mexicanos con pérdida auditiva es considerar un primer paso en el tamiz diagnóstico con los tres genes mencionados. Si estos genes fueran negativos para variantes patogénicas, el siguiente paso sería considerar el análisis por secuenciación de segunda generación enfocado en paneles de genes asociados con pérdida auditiva, tanto aislada como sindrómica, y en caso necesario, realizar el análisis del exoma o del genoma completo. Establecer una causa etiológica es un componente crítico en la evaluación clínica de los pacientes con pérdida auditiva congénita, ya que puede ayudar a determinar las estrategias de manejo y rehabilitación, como el uso de auxiliares auditivos o implantes cocleares, proporcionar información sobre la progresión de la enfermedad y dar asesoramiento genético en esta población.

Modeling, identification and nonlinear model predictive control of type I diabetic patient.

Patients with type I diabetes nearly always need therapy with insulin. The most desirable treatment would be to mimic the operation of a normal pancreas. In this work a patient affected with this pathology is modeled and identified with a neural network, and a control strategy known as Nonlinear Model Predictive Control is evaluated as an approach to command an insulin pump using the subcutaneous route. A method for dealing with the problems related with the multiple insulin injections simulation and a multilayer neural network identification of the patient model is presented. The controller performance of the proposed strategy is tested under charge and reference disturbances (setpoint). Simulating an initial blood glucose concentration of 250 mg/dl a stable value of 97.0 mg/dl was reached, with a minimum level of 76.1 mg/dl. The results of a simulated 50 g oral glucose tolerance test show a maximum glucose concentration of 142.6 mg/dl with an undershoot of 76.0 mg/dl. According to the simulation results, stable close-loop control is achieved and physiological levels are reached with reasonable delays, avoiding the undesirable low glucose levels. Further studies are needed in order to deal with noise and robustness aspects, issues which are out of the scope of this work.

A study of the disappearance of pesticides during composting using a gas chromatography-tandem mass spectrometry technique.

A simple method for multi-residue analysis of pesticides by low-pressure gas chromatography-tandem mass spectrometry (LP-GC-MS-MS) has been validated in compost samples. The pesticide residues were extracted from the lyophilised samples with organic solvent by stirring. No sample clean-up was required prior to the analysis. The method was applied to determine the fate of two organochlorine pesticides (lindane and endosulfan) and two organophosphates (malathion and chlorpyrifos-methyl) during the composting process in the reactor of a pilot plant. Malathion, chlorpyrifos-methyl and lindane residues almost fully disappeared after 8 days of maturation in the reactor, while endosulfan residues were only partially degraded. Alongside this, a study of natural disappearance of the pesticides was carried out in the laboratory and a characteristic time profile was traced for each pesticide class.

State-Space Approach to Structural Representation of Perturbed Pitch Period Sequences in Voice Signals.

OBJECTIVES: The aim of this study was to propose a state space-based approach to model perturbed pitch period sequences (PPSs), extracted from real sustained vowels, combining the principal features of disturbed real PPSs with structural analysis of stochastic time series and state space methods. METHODS: The PPSs were obtained from a database composed of 53 healthy subjects. State space models were developed taking into account different structures and complexity levels. PPS features such as trend, cycle, and irregular structures were considered. Model parameters were calculated using optimization procedures. For each PPS, state estimates were obtained combining the developed models and diffuse initialization with filtering and smoothing methods. Statistical tests were applied to objectively evaluate the performance of this method. RESULTS: Statistical tests demonstrated that the proposed approach correctly represented more than the 75% of the database with a significance value of 0.05. In the analysis, structural estimates suitably characterized the dynamics of the PPSs. Trend estimates proved to properly represent slow long-term dynamics, whereas cycle estimates captured short-term autoregressive dependencies. CONCLUSIONS: The present study demonstrated that the proposed approach is suitable for representing and analyzing real perturbed PPSs, also allowing to extract further information related to the phonation process.

Multimedia MEDICINA BUCAL como complemento educativo para estudiantes de tercer año de Estomatología / Multimedia MEDICINA BUCAL as an educational complement for third-year dentistry students

Introducción: Medicina Bucal I constituye una de las asignaturas rectoras dentro de la carrera de Estomatología, las nuevas plataformas de las Tecnologías de la Información y las Comunicaciones constituyen una vía adecuada para fomentar su estudio. Objetivo: elaborar una multimedia para el estudio de la asignatura Medicina Bucal I en estudiantes de tercer año de Estomatología. Método: se realizó una investigación de desarrollo tecnológico en la Universidad de Ciencias Médicas de Pinar del Río, de septiembre de 2015 a octubre de 2016. El universo estuvo formado por todos los estudiantes de tercer año de la carrera de Estomatología, así como el claustro de profesores que imparten la asignatura Medicina Bucal I. Se utilizaron métodos teóricos y empíricos, se realizó una revisión de la bibliografía sobre el tema recopilándose la información necesaria para la elaboración de la multimedia. Resultados: el producto recibió valoraciones positivas por parte de los usuarios, y en cuanto a los expertos, la mayoría emitió criterios de muy adecuado respecto a los diferentes aspectos que lo conforman, considerándose pertinente su generalización en la docencia. Conclusiones: se obtuvo un recurso de aprendizaje que permite al estudiante de la carrera de Estomatología interactuar con los contenidos de la asignatura Medicina Bucal I, de fácil acceso y transportación, lo cual contribuyó a elevar la calidad de la enseñanza en el marco del desarrollo del conocimiento(AU)

Introduction: Oral Medicine-I is one of the leading subjects within dentistry studies, the new platforms of Information and Communication Technologies are an appropriate way to promote learning. Objective: to elaborate a multimedia for the study of the Oral Medicine-I subject in third year of dentistry studies. Method: a technological development research was carried out at Pinar del Rio University of Medical Sciences, from September 2015 to October 2016. The target group was comprised of all third-year dentistry students, as well as the staff of professors who teach the subject Oral Medicine-I. Theoretical and empirical methods were used; a literature review of the subject was carried out, compiling the necessary information for the multimedia design. Results: the product resulted in positive assessment from the users, and as for the experts, the majority issued "very adequate" criteria regarding the different aspects of the multimedia, considering its generalization to facilitate the teaching-learning process. Conclusions: a learning resource was obtained that allows dentistry students to interact with the contents of the subject of Oral Medicine-I, it is of easy access and transportation, which contributed to increase the quality of the teaching-learning process within the framework of the development of knowledge(AU)

Do cortisol and corticosterone play the same role in coping with stressors? Measuring glucocorticoid serum in free-ranging guanacos (Lama guanicoe).

Habitat can constrain and shape successful ecological and physiological strategies, thus providing the context for the evolution of life-history traits. However, unpredictable challenges, such as storms, natural disasters, and human activities can also have great effects on stress. Glucocorticoids (GCs) are adrenal steroid hormones that play an important role in how vertebrates cope with these predictable and unpredictable environmental challenges. Although assessing GCs levels can have many applications in the study of wildlife and/or captive animals, with or without capturing individuals, it requires a species-specific complete validation (analytical and biological) before its use. In this work, our aim was to: (a) validate a radioimmunoassay (RIA) for measuring GCs levels in L. guanicoe serum; (b) assess cortisol and corticosterone levels (if present) in serum of wild L. guanicoe individuals; and (c) compare the response to acute stressors (handling, shearing, and release). Our results successfully: (a) validated RIA for asses GCs levels in wild ungulates; (b) confirmed the presence for cortisol and corticosterone and showed that both GCs are differently affected by environmental stimuli in L. guanicoe; and (c) showed that GCs exhibit different patterns in the field and in response to acute stressors, making these camelids an interesting endocrinological model when seeking the adaptive functions of a given variation and further emphasizing the complexity of GC physiology in wild mammals.