Vulnerability to the transmission of human visceral leishmaniasis in a Brazilian urban area.

PubMed

Toledo, Celina Roma Sánchez de; Almeida, Andréa Sobral de; Chaves, Sergio Augusto de Miranda; Sabroza, Paulo Chagastelles; Toledo, Luciano Medeiros; Caldas, Jefferson Pereira

2017-05-15

To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability. This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran's I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran's I was used to identify spatial clusters. We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability. The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease. Analisar determinantes para a ocorrência da leishmaniose visceral humana vinculados �

Notes on the phlebotomine sand flies from the Peruvian southeast--I. Description of Lutzomyia (Helcocyrtomyia) adamsi n. sp. (Diptera: Psychodidae).

PubMed

Fernandez, R; Galati, E B; Carbajal, F; Wooster, M T; Watts, D M

1998-01-01

A new species of phlebotomine sand fly, Lutzomyia adamsi n. sp., is described and illustrated from specimens collected during August 1994, in Sandia, Department of Puno-Peru. According to the Oficina Nacional de Evaluacion de Recursos Naturales(ONERN 1976), this locality is situated in the life zone known as humid, mountain, low tropical forest (bh-MBT). Many areas in the northern part of Puno, mainly in the Inambari and Tambopata basins, are endemic to leishmaniasis. These areas are the continuation of others, largely known as "leishmaniasic" in the departments of Cusco and Madre de Dios. The morphological characteristics indicated that this species belongs to the genus Lutzomyia, subgenus Helcocyrtomyia Barretto, 1962.

DESAFÍOS ÉTICOS DE LA INVESTIGACIÓN CON ANIMALES, MANIPULACIÓN GENÉTICA

PubMed Central

Yunta, Eduardo Rodríguez

2012-01-01

En la investigación con animales existen cuestionamientos éticos tanto en el uso como modelos de enfermedades humanas y requisito previo para ensayos en humanos como en la introducción de modificaciones genéticas. Algunos de estos cuestionamientos son: no representar exactamente la condición humana como modelos, realizar pruebas de toxicidad con grave daño para los animales, alterar su naturaleza mediante modificaciones genéticas, riesgos de la introducción de organismos genéticamente modificados. El uso de animales en investigación para beneficio humano, impone al ser humano la responsabilidad moral de respetarlo, no haciéndoles sufrir innecesariamente, al estar trabajando con seres vivientes y sentientes. PMID:23338641

76 FR 4727 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... Drapery Supply, Inc. 74,784 Humana Insurance Green Bay, WI October 22, 2009. Company, Carenetwork, Inc... 74,897 Penske Logistics LLC, El Paso, TX General Electric/ Penske Corporation; Leased Workers Kelly...

La función de la EPA para la protección contra la radiación

EPA Pesticide Factsheets

Conforme al mandato congresional, la Agencia de Protección Ambiental de EE.UU. el la entidad responsable de establecer normas para proteger la salud humana y el medioambiente de materiales radioactivos.

Principals and Computers: Getting Started Together. Special Report: Computers in the Schools.

ERIC Educational Resources Information Center

Holland, Lori; Rude-Parkins, Carolyn

1986-01-01

Outlines five lessons learned at Roosevelt-Perry Elementary School (Kentucky) when the computer education program, Humana Computer Tutor project, was implemented. The principal was important to the success of the program. (MD)

MODELO PARA EVALUACION DE DERRAMES DE HIDROCARBUROS (HSSM) GUIA DEL USUARIO

EPA Science Inventory

The U.S. Environmental Protection Agency is charged by Congress with protecting the Nation's land, air, and water resources. Under a mandate of national environmental laws, the Agency strives to formulate and implement actions leading to a compatible balance between human acti...

[Detection of Brucella with an automatic hemoculture system: Bact/Alert].

PubMed

Casas, J; Partal, Y; Llosá, J; Leiva, J; Navarro, J M; de la Rosa, M

1994-12-01

The ability of in vitro and in vivo detection of Brucella spp. with the Bact/Alert system was studied. Three strains of Brucella melitensis and two of Brucella abortus were used. Different dilutions of the five strains were performed in trypticase soy broth (TSB), achieving concentrations of 1 cfu/ml, 5 cfu/ml, 10 cfu/ml and 100 cfu/ml. Ten ml of each dilution and strain were inoculated into 5 aerobic bottles Bact/Alert and 5 biphasic Hemóline bottles. Furthermore, over a 9 month period, 8,216 bottles of Bact/Alert bottles from hospitalized patients and from the emergency department were processed in the authors' laboratory. The mean detection time for Brucella growth was from 2 to 3 days with the Bact/Alert system, and 14 days in the biphasic bottles. Former bottles processed in the authors' laboratory, 11 aerobic bottles belonged to 5 patients in whom brucelosis was confirmed by bloodculture. The Bact/Alert system detected Brucella melitensis in only on bottle at 2.9 days of incubation. In 7 bottles Bact/Alert detected B. melitensis by a blind pass of these bottles at 10 to 20 days of incubation. These results suggest that the Bact/Alert system does not totally solve the diagnosis of brucellosis. Blind passes of the bloodcultures are required.

Doctor group sues to keep capitation arrangement.

PubMed

2005-05-01

An independent practice association has sued Humana Kansas City Inc. over the health plan's decision to terminate its capitated contract. The suit alleges breach of contract and seeks an injunction to keep the flow of capitated dollars coming.

National Biocontainment Training Center

DTIC Science & Technology

2012-08-01

past reporting year, the training facility’s engineering and maintenance team welcomed trainees from the Institutio Nacional de Enfermedades Virales... Enfermedades Virales Humanas “Dr. Julio Maiztegui” and the Universidad Technologica Nacional attended the NBTC’s Biocontainment Engineering Training Program

An Epidemic of Oroya Fever in the Peruvian Andes

DTIC Science & Technology

1990-01-01

otras Enfermedads MAmisiero de Salud. Lima. Peru. Naval Medical Research Instaitue. Bethesda. Af: Naval Medical Research Institsaae Derachmeint. Dma. Peru...review of the manuscript. tibastonella en la enfermedad de carrion o bar- trhe outstanding field work of Enrique Morales. Jaime tonelosis humana

El federalismo cooperativo en la EPA

EPA Pesticide Factsheets

La EPA acoge el federalismo cooperativo y trabaja en colaboración con los estados, los gobiernos locales y las tribus para implementar las leyes que protegen la salud humana y el medioambiente, en vez de dictar mandatos genéricos desde Washington.

75 FR 82026 - Granting of Request for Early Termination of the Waiting Period Under the Premerger Notification...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

..., LLC. 20110313 G News Corporation. G Wireless Generation, Inc. G Wireless Generation, Inc. 08-DEC-10.... G Exxon Mobil Corporation. G Mobile Eugene Island Pipeline Company. G Exxon Mobil Pipeline Company. G Mobil Oil Exploration & Producing Southeast Inc. 20110256 G Humana Inc. G Welsh, Carson, Anderson...

[Rehabilitation prognosis in the patient with bilateral cortipathy due to prematurity].

PubMed

Trejo Rayón, S; Peñaloza, Y; Balderas Gil, A

1979-01-01

Thirty cases of bilateral corticopathy due to prematurity were studied at the Instituto Nacional de la Comunicación Humana. Taking into account all predisposing features, it is concluded that with adequate preventive measures, it is possible to avoid this pathology and thus obtain a favorable rehabilitation prognosis.

Cobertura desarrollada de Puerto Rico

Treesearch

William A. Gould; Sebastian Martinuzzi; Olga M. Ramos Gonzalez

2008-01-01

Este mapa representa la cobertura desarrollada en Puerto Rico (Martinuzzi et al. 2007). Cobertura desarrollada se define aqui como areas urbanas, construidas y sin vegetacion, que resultan de actividad humana. Tipicamente, estas incluyen estructuras construidas, concreto, asfalto, u otra infraestructura. La cobertura desarrollada se creo mediante el analisis de...

Nuestra misión y lo que hacemos

EPA Pesticide Factsheets

La misión de la Agencia de Protección Ambiental de EE. UU. (EPA, por sus siglas en inglés) es proteger la salud humana y el medioambiente. Cuando el Congreso escribe una ley ambiental, nosotros la implementamos al escribir los reglamentos y las normas.

The Development of Children's Orientations toward Moral, Social, and Personal Orders: More than a Sequence in Development

ERIC Educational Resources Information Center

Turiel, Elliot

2008-01-01

Lawrence Kohlberg first published details of his research on the development of moral judgments in "Vita Humana" (later titled "Human Development"). Along with a series of other articles and essays, he greatly influenced research on moral development. He was instrumental in moving the field out of the narrow confines of analyses of psychological…

Viviendo Con Incendios: Una guia para los duenos de casas en Nuevo Mexico [Living with Fire: A Guide for the Homeowner-New Mexico

Treesearch

U.S. Department of the Interior Bureau of Land Management

2008-01-01

La posibilidad de perdidas humanas y de propiedad en Nuevo Mexico debido a un incendio forestal ha ido incrementando. Para responder a este peligro, entidades locales, estatales, federales, particulares y sin fines de lucro se han unido para crear Como Reducir la Amenaza de Incendios Forestales, un programa dirigido a los propietarios de casas. Este no es un programa...

Analisis del contenido curricular de los Documentos Normativos del Programa de Ciencias en el area de biologia para la escuela superior del sistema de educacion publica de Puerto Rico: 1993-2012

NASA Astrophysics Data System (ADS)

Davila Montanez, Melissa

Esta investigacion de naturaleza cualitativa se ocupo de realizar un analisis de contenido documental de los Documentos Normativos del Programa de Ciencias en el area de biologia de la escuela superior del sistema de educacion publica de Puerto Rico del periodo 1993-2012. Los documentos analizados fueron: Guia Curricular, 1995; Marco Curricular, 2003; Estandares de Excelencia, 1996, 2000 y Estandares de Contenido y Expectativas de Grado, 2007. Se indago si hubo cambios en significados en los Componentes Estructurales: Naturaleza de la ciencia, Paradigmas para la ensenanza de la ciencia, Funcion del curriculo formal, Mision de la ensenanza de la ciencia; Contenidos, destrezas y competencias, Estrategias de ensenanza y Evaluacion/Assessment del aprendizaje. El analisis sugiere que no hubo cambios sustanciales en los significados de los Componentes Estructurales. Los documentos estudiados muestran mayormente caracteristicas similares, aunque los documentos mas recientes eran mas descriptivos, explicativos y especificos.

Impact of Overactive Bladder Step Therapy Policies on Medication Utilization and Expenditures Among Treated Medicare Members.

PubMed

Abbass, Ibrahim M; Caplan, Eleanor O; Ng, Daniel B; Kristy, Rita; Schermer, Carol R; Bradt, Pamela; Collins, Jenna M; Chan, Wai Man Maria; Suehs, Brandon T

2017-01-01

The impact of formulary management strategies on utilization and expenditures in overactive bladder (OAB) treatment has not been extensively investigated. In 2013, step therapy (ST) policies for 2 branded OAB treatments, mirabegron and fesoterodine, were removed from Humana Medicare Advantage Prescription Drug (MAPD) plans and Medicare prescription drug plans (PDP), allowing for an examination of the effect of ST policies on OAB medication use patterns and costs. To assess the impact of removal of formulary restriction policies for mirabegron and fesoterodine on medication utilization patterns and costs associated with OAB treatment in Medicare patients. A retrospective cross-sectional study design was utilized. Subjects included individuals enrolled in Humana MAPD plans or PDPs, aged ≥ 65 years, with ≥ 1 prescription for an OAB medication in 2013. Patient demographic characteristics, OAB medication utilization, and pharmacy cost trends in 2013 were described. OAB medication use was calculated as the number of 30-day-supply equivalent medication claims and reported as a percentage of the total number of 30-day-supply equivalent claims across all OAB products. OAB medication expenditures were calculated as a percentage of the sum of pharmacy costs for OAB medications and reported separately for each month and drug during 2013. Temporal trends of OAB medication utilization and expenditures in 2013 were calculated using ordinary least squares regression. Of 194,511 patients, trends in utilization of OAB medications indicated that on average, there was a statistically significant monthly increase in utilization of mirabegron (regression coefficient [B] = 274; P < 0.001; 95% CI: 218, 330), fesoterodine (B = 167; P < 0.001; 95% CI = 129, 205), oxybutynin extended release (ER; B = 357; P = 0.011; 95% CI = 99, 614), and trospium ER (B = 33; P = 0.001; 95% CI = 17, 50) and statistically significant decreases in utilization of solifenacin (B = -202; P = 0.048; 95% CI

The Impact of Discharge Disposition on Episode-of-Care Reimbursement After Primary Total Hip Arthroplasty.

PubMed

Sabeh, Karim G; Rosas, Samuel; Buller, Leonard T; Roche, Martin W; Hernandez, Victor H

2017-10-01

Total joint arthroplasty (TJA) accounts for more Medicare expenditure than any other inpatient procedure. The Comprehensive Care for Joint Replacement model was introduced to decrease cost and improve quality in TJA. The largest portion of episode-of-care costs occurs after discharge. This study sought to quantify the cost variation of primary total hip arthroplasty (THA) according to discharge disposition. The Medicare and Humana claims databases were used to extract charges and reimbursements to compare day-of-surgery and 91-day postoperative costs simulating episode-of-care reimbursements. Of the patients who underwent primary THA, 257,120 were identified (204,912 from Medicare and 52,208 from Humana). Patients were stratified by discharge disposition: home with home health, skilled nursing facility, or inpatient rehabilitation facility. There is a significant difference in the episode-of-care costs according to discharge disposition, with discharge to an inpatient rehabilitation facility the most costly and discharge to home the least costly. Postdischarge costs represent a sizeable portion of the overall expense in THA, and optimizing patients to allow safe discharge to home may help reduce the cost of THA. Copyright © 2017 Elsevier Inc. All rights reserved.

The Dutch Brucella abortus monitoring programme for cattle: the impact of false-positive serological reactions and comparison of serological tests.

PubMed

Emmerzaal, A; de Wit, J J; Dijkstra, Th; Bakker, D; van Zijderveld, F G

2002-02-01

The Dutch national Brucella abortus eradication programme for cattle started in 1959. Sporadic cases occurred yearly until 1995; the last infected herd was culled in 1996. In August 1999 the Netherlands was declared officially free of bovine brucellosis by the European Union. Before 1999, the programme to monitor the official Brucella-free status of bovine herds was primarily based on periodical testing of dairy herds with the milk ring test (MRT) and serological testing of all animals older than 1 year of age from non-dairy herds, using the micro-agglutination test (MAT) as screening test. In addition, serum samples of cattle that aborted were tested with the MAT. The high number of false positive reactions in both tests and the serum agglutination test (SAT) and complement fixation test (CFT) used for confirmation seemed to result in unnecessary blockade of herds, subsequent testing and slaughter of animals. For this reason, a validation study was performed in which three indirect enzyme-linked immunosorbent assays (ELISAs), the CFT and the SAT were compared using a panel of sera from brucellosis-free cattle, sera from experimentally infected cattle, and sera from cattle experimentally infected with bacteria which are known to induce cross-reactive antibodies (Pasteurella, Salmonella, Yersinia, and Escherichia). Moreover, four ELISAs and the MRT were compared using a panel of 1000 bulk milk samples from Brucella-free herds and 12 milk samples from Brucella abortus- infected cattle. It is concluded that the ELISA obtained from ID-Lelystad is the most suitable test to monitor the brucelosis free status of herds because it gives rise to fewer false-positive reactions than the SAT.

PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA.

PubMed

Vicentine, Fernando Pompeu Piza; Gonzalez, Adriano Miziara; Azevedo, Ramiro Anthero de; Benini, Barbara Burza; Linhares, Marcelo Moura; Lopes-Filho, Gaspar de Jesus; Martins, Jose Luiz; Salzedas-Netto, Alcides Augusto

2016-01-01

Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). There was a lower number of reoperations due to bleeding of the wound area of ​​the hepatic graft when the human fibrinogen and thrombin sponge were used. Estratégia cirúrgica para aumentar o número de transplantes hepáticos na população pediátrica é a transecção hepática ex-situ (redução ou split). No entanto, ela está associada com complicações, tais como hemorragia e fístulas. A esponja de fibrinogênio e trombina humana é útil para melhorar a hemostasia nas operações hepáticas. Comparar transplantes hepáticos pediátricos com transecção hepática ex-situ (redução ou split) com ou sem a esponja de fibrinogênio e trombina humana. Foi realizada análise prospectiva de 21 pacientes submetidos ao transplante de fígado com transecção hepática ex-situ com a aplicação da esponja de fibrinogênio e trombina humana na área cruenta (grupo A) e análise retrospectiva de 59 pacientes sem a esponja (grupo B). As características dos

La Evaluacion del Desarrollo de los Alumnos Preescolares (Assessing the Development of Preschoolers). ERIC Digest.

ERIC Educational Resources Information Center

Katz, Lilian G.

To help parents address those aspects of their child's development which may need special encouragement, support, or intervention, this digest delineates 11 categories of behavior for assessment. Parents should not be alarmed if their children are having difficulty in only a few categories, and they should not judge their children's permanent…

ISOLATION AND IDENTIFICATION OF BRUCELLA SUIS IN PIGS AS ZOONOTIC DISEASE IN ENDEMIC AREAS OF EAST JAVA, INDONESIA.

PubMed

S, Emy Koestanti; Misaco, Wiwik; Chusniati, Sri; Maslachah, Lilik

2018-01-01

Brucellosis in pigs at East Java Indonesia has not only cause great economic losses due to a decrease in productivity of livestock but also are zoonotic. Infection on free brucelosis pigs were initially begun with the infected pigs both male and female, or the use of superior male pigs together. The elimination of the disease either on a group or population is considered as the most effective way to prevent the spread of the disease in pigs. Prevention efforts mainly addressed to vaccination, sanitary maintenace and government policy. The purpose of this study was to isolated and identified Brucella suis as the causative agent. The survey area were the pig farm owned by breeder farmers in the area of East Java Indonesia, at Kediri, Malang, Blitar and Probolinggo district. Blood samples obtained were tested with RBT. Pigs are suspected of being infected with Brucella if the RBT was positive that characterized with agglutination in the test results. If RBT was positive, bacteriological examination will be performed, with samples of visceral foetus organ, ie liver, spleen, placenta and amniotic fluid. Isolation and identification of Brucella suis were used Brucella Broth and Brucella Agar, and if the bacteri growthwill be continued with biochemical test ie H2S, urease, citrate, catalase and oxidase test. The positive results of Brucella suis showed positive urease, catalase andoxidase, but negative for citrate and H2S. RBT and bacteriolgical examination showed that 1 sample was positive Brucella suis , and 19 negative. The positive results showed positive urease, catalase and oxidase, but negative for citrate and H2S. Based on RBT test and bacteriological examination, there was 1 positive sample of brucellla suis, that is sample coming from Kediri district.

ISOLATION AND IDENTIFICATION OF BRUCELLA SUIS IN PIGS AS ZOONOTIC DISEASE IN ENDEMIC AREAS OF EAST JAVA, INDONESIA

PubMed Central

S, Emy Koestanti; Misaco, Wiwik; Chusniati, Sri; Maslachah, Lilik

2018-01-01

Background: Brucellosis in pigs at East Java Indonesia has not only cause great economic losses due to a decrease in productivity of livestock but also are zoonotic. Infection on free brucelosis pigs were initially begun with the infected pigs both male and female, or the use of superior male pigs together. The elimination of the disease either on a group or population is considered as the most effective way to prevent the spread of the disease in pigs. Prevention efforts mainly addressed to vaccination, sanitary maintenace and government policy. The purpose of this study was to isolated and identified Brucella suis as the causative agent. Material and Methods: The survey area were the pig farm owned by breeder farmers in the area of East Java Indonesia, at Kediri, Malang, Blitar and Probolinggo district. Blood samples obtained were tested with RBT. Pigs are suspected of being infected with Brucella if the RBT was positive that characterized with agglutination in the test results. If RBT was positive, bacteriological examination will be performed, with samples of visceral foetus organ, ie liver, spleen, placenta and amniotic fluid. Isolation and identification of Brucella suis were used Brucella Broth and Brucella Agar, and if the bacteri growthwill be continued with biochemical test ie H2S, urease, citrate, catalase and oxidase test. The positive results of Brucella suis showed positive urease, catalase andoxidase, but negative for citrate and H2S. Results: RBT and bacteriolgical examination showed that 1 sample was positive Brucella suis, and 19 negative. The positive results showed positive urease, catalase and oxidase, but negative for citrate and H2S. Conclusion: Based on RBT test and bacteriological examination, there was 1 positive sample of brucellla suis, that is sample coming from Kediri district. PMID:29619446

A study on reproductive performance and related factors of zebu cows in pastoral herds in a semi-arid area of Tanzania.

PubMed

Kanuya, N L; Matiko, M K; Kessy, B M; Mgongo, F O; Ropstad, E; Reksen, O

2006-06-01

A prospective longitudinal study was carried out from September 2001 to June 2004 in three adjacent villages in a semi-arid area of Tanzania. The objectives of this study were to measure the intervals between calving and either resumption of cyclical activity or confirmation of pregnancy, to estimate calving intervals, and to investigate the effect of factors assumed to be related to postpartum reproductive performance. A total of 275 lactation periods from 177 Tanzanian Shorthorn Zebu cows managed in a traditional pastoral system in 46 households were initially included. Animals were initially screened for brucelosis and thereafter examined by palpation per rectum at 2-week intervals. Body condition score (scale 1 to 5) was assessed and girth measurement (cm) taken. Occurrence of other reproductive events such as calving, abortion, death of calf, culling and reason for culling were recorded. In a subset of 98 lactation periods from 91 cows milk samples for progesterone (P4) determination were collected twice per week from day 7 after calving to the time of confirmed pregnancy or until milk production ceased before pregnancy. The data were analysed both univariately and in multivariable Cox proportional hazard (frailty) models. The mean (+/-S.E.M.) calving interval was 500+/-13.6 days. Positive reactors in the brucellosis test were 15.6% of the tested animals. Milk P4 analysis showed the rate of abortion/late embryo loss to be 14.3%. Calf mortality rates varied between 14.6 and 17.4%. A positive relationship was found between the outcome variables likelihood of cyclical activity and likelihood of pregnancy in the Cox model, and the explanatory variables: parity and body condition score (BCS) at calving. A negative relationship was found between the outcome variables, and the explanatory variables: maximum BCS loss and calf survival/mortality. Calving in the rainy season was associated with an increased likelihood of pregnancy.

Development of a 2,4-Dinitrotoluene-Responsive Synthetic Riboswitch in E. coli cells

DTIC Science & Technology

2012-09-01

INTRODUCTION Riboswitches are naturally-occurring genetic regulatory elements found in the 5′ untranslated region of some mRNA. They provide a method...Industrial Genetics at the University of Stuttgart, Germany, respectively. The plasmid pSAL8.1 was kindly provided by Dr. Justin Gallivan from Emory...vol. 252: Ribozymes and siRNA Protocols, 2nd ed. Humana Press, Inc.; 2004, 145-164. (9) Suess, B., and Weigand, J.E. RNA Biology 2008, 5(1), 1-6

The Army’s National Training Center: A Case Study in Management of a Large Defense Project

DTIC Science & Technology

1983-04-26

34Desining . . .," op cit, p. 130. IT. M3l Ior-ritc’h and C. K. Prahalad , "Managing Multi-Organization Enterprises: The Emerging Strategic Frontier...Rational Altor TModel "assumes that what must be explained is an action, i.e., behavior that reflects purpose or intention .Ŗ It assumes "that what human...a fourth element is essential to the success of large-scale commerciali- zation programs: a favorable corporate strategic environment. This element

Gender differences in the field of sexology: new contexts and old definitions.

PubMed

Rohden, Fabiola; Russo, Jane

2011-08-01

To analyze concepts of gender and sexuality present in the field of sex therapeutic interventions. An ethnographic observation was conducted, and it was completed with the analysis of printed material originated from the X Congresso Brasileiro de Sexualidade Humana (10th Brazilian Congress on Human Sexuality), promoted by the Sociedade Brasileira de Estudos em Sexualidade Humana (Brazilian Society of Human Sexuality Studies), and the VIII Congresso Brasileiro sobre Inadequações Sexuais (8th Brazilian Congress on Sexual Inadequacies), promoted by the Associação Brasileira para o Estudo das Inadequações Sexuais (Brazilian Association of Sexual Inadequacy Studies), both held in 2005. The analysis emphasized the interaction between the quantitative perspective in the processing of the variables (participants' gender and profession and lecture topics) and the qualitative perspective in the analysis and interpretation of the more general set of data. The topics of sessions and focus of presentations suggest that the field is divided by the contrast between two medical specialties: gynecology and urology, the former is aimed at female and couple dysfunctions, while the latter is aimed at male dysfunctions. Male sexuality is approached from the predominantly biomedical perspective, centered on the physiology of erection and drug prescription, whereas female sexuality is considered to be conditioned by relationship problems, when psychological intervention is more adequate.

Letter to my children about sex and the catholic church.

PubMed

Connelly, R J

1994-09-01

This essay is directed to a younger generation. It summarizes the conflicting traditions in the Catholic community today: official Church teaching (represented by "Humanae Vitae" and "Veritatis Splendor"), liberal theologians like Charles Curran (who occasioned this letter), and ordinary Catholics struggling in an imperfect world. The paper attempts to integrate values from three traditions, those associated with respect for new life, a loving relationship, and playfulness. The resulting synthesis offers a spiritually and psychologically viable option worth considering, the author believes.

[Medical conglomerates].

PubMed

Austruy, P; Alexandre, L; Richard, F

1988-01-01

Community hospitals is undergoing rapid consolidation into network of private corporations providing health care services. So, the industrialization of health care lead to mega corporate health care. The multi-nationalization of U.S. multi-health care systems as HCA or Humana, has began at the end of the 70. The impact of this phenomena on the French health care system will be important. In order to protect technological independence and to integrate physicians into medical industrial complex, we have to create european multi-health systems.

Distribution of a Community of Mammals in Relation to Roads and Other Human Disturbances in Gabon, Central Africa

PubMed Central

Vanthomme, Hadrien; Kolowski, Joseph; Korte, Lisa; Alonso, Alfonso

2013-01-01

ón a Carreteras y Otras Perturbaciones Humanas en Gabón, Africa Central Resumen Presentamos el primer estudio a nivel de comunidad de la relación entre carreteras y otras perturbaciones humanas con la distribución de mamíferos en Gabón (África central). Nuestro sitio de estudio está dentro de una concesión petrolera en un paisaje litoral heterogéneo. Realizamos muestreos a lo largo de 199 transectos lineales e instalamos cámaras trampa en 99 de ellos para documentar la presencia y abundancia de mamíferos. Utilizamos modelos lineales generalizados con efectos mixtos para documentar las asociaciones entre variables relacionadas con el ecosistema (cobertura de suelo, topografía e hidrología), carreteras (tipo de revestimiento, ancho de derecho de vía, condición, tipo de vehículos que utilizan la carretera, nivel de tráfico, afiliación de los usuarios y el tipo general de carretera) y otras perturbaciones humanas (urbanización, agricultura, caza, tala, recolecta y actividades industriales) y la abundancia o presencia de 17 especies o grupos de mamíferos incluyendo elefantes (Loxodonta cyclotis), búfalo (Syncerus caffer), sitatunga (Tragelaphus spekei), cerdo rojo de río (Potomochoerus porcus), ungulados pequeños, gorila (Gorilla gorilla), chimpancé (Pan troglodytes), chacal con rayas a los lados (Canis adustus), carnívoros, monos y roedores de talla grande. Ciertos tipos de carreteras y otras perturbaciones humanas estuvieron asociadas negativamente con la abundancia o presencia de elefantes, búfalos, gorilas, sitatungas, algunos monos y antílopes. Los patrones de asociación de mamíferos con carreteras y otras perturbaciones humanas fueron diversos e incluyen asociaciones positivas con la presencia de carreteras (cerdo rojo de río, algunos monos y antílopes), agricultura (sitatunga, carnívoros pequeños y roedores de talla grande) y actividades industriales (sitatunga, cerdo rojo de río, antílope rojo y chacal con rayas a los lados

Guia para la Elaboracion y Evaluacion de Proyectos de Investigacion (Guidelines for Reporting and Evaluating Research Projects).

ERIC Educational Resources Information Center

Morles, Victor

This article establishes guidelines for conducting and evaluating research projects according to a scientific methodology. The organizational format suggested here follows an outline with elements and details that should be considered in an investigation. Each part of the proposed outline is explained, and terms are defined. Project evaluation is…

Test de Evaluacion de Conocimientos Medicos-CIIPME (Test of Evaluation of Medical Knowledge-CIIPME). Publication No. 42.

ERIC Educational Resources Information Center

Alfici, C.; And Others

The purpose of this research is to build a test for the evaluation of the knowledge needed by medical students before entering clinical courses in medical school. The criterion for this was provided by teachers in both the pre-clinical and clinical subjects. The Pilot instrument consisted of 335 items that covered 8 sections. Each one of these…

Deconstructing Phonetic Transcription: Covert Contrast, Perceptual Bias, and an Extraterrestrial View of "Vox Humana"

ERIC Educational Resources Information Center

Munson, Benjamin; Edwards, Jan; Schellinger, Sarah K.; Beckman, Mary E.; Meyer, Marie K.

2010-01-01

This article honours Adele Miccio's life work by reflecting on the utility of phonetic transcription. The first section reviews the literature on cases where children whose speech appears to neutralize a contrast in the adult language are found on closer examination to produce a contrast ("covert contrast"). This study presents evidence…

Deconstructing phonetic transcription: covert contrast, perceptual bias, and an extraterrestrial view of Vox Humana.

PubMed

Munson, Benjamin; Edwards, Jan; Schellinger, Sarah K; Beckman, Mary E; Meyer, Marie K

2010-01-01

This article honours Adele Miccio's life work by reflecting on the utility of phonetic transcription. The first section reviews the literature on cases where children whose speech appears to neutralize a contrast in the adult language are found on closer examination to produce a contrast (covert contrast). This study presents evidence from a new series of perception studies that covert contrast may be far more prevalent in children's speech than existing studies would suggest. The second section presents the results of a new study designed to examine whether naïve listeners' perception of children's /s/ and /theta/ productions can be changed experimentally when they are led to believe that the children who produced the sounds were older or younger. Here, it is shown that, under the right circumstances, adults report more tokens of /theta/ to be accurate productions of /s/ when they believe a talker to be an older child than when they believe the talker to be younger. This finding suggests that auditory information alone cannot be the sole basis for judging the accuracy of a sound. The final section presents recommendations for supplementing phonetic transcription with other measures, to gain a fuller picture of children's production abilities.

Deconstructing Phonetic Transcription: Covert Contrast, Perceptual Bias, and an Extraterrestrial View of Vox Humana

PubMed Central

Munson, Benjamin; Edwards, Jan; Schellinger, Sarah; Beckman, Mary E.; Meyer, Marie K.

2010-01-01

This article honours Adele Miccio's life work by reflecting on the utility of phonetic transcription. The first section reviews the literature on cases where children whose speech appears to neutralize a contrast in the adult language are found on closer examination to produce a contrast (covert contrast). We present evidence from a new series of perception studies that covert contrast may be far more prevalent in children's speech than existing studies would suggest. The second section presents the results of a new study designed to examine whether naïve listeners' perception of children's /s/ and /θ/ productions can be changed experimentally when they are led to believe that the children who produced the sounds were older or younger. Here, it is shown that, under the right circumstances, adults report more tokens of /θ/ to be accurate productions of /s/ when they believe a talker to be an older child than when they believe the talker to be younger. This finding suggests that auditory information alone cannot be the sole basis for judging the accuracy of a sound. The final section presents recommendations for supplementing phonetic transcription with other measures, to gain a fuller picture of children's production abilities. PMID:20345255

TLR2 and TLR4 signaling pathways are required for recombinant Brucella abortus BCSP31-induced cytokine production, functional upregulation of mouse macrophages, and the Th1 immune response in vivo and in vitro.

PubMed

Li, Jia-Yun; Liu, Yuan; Gao, Xiao-Xue; Gao, Xiang; Cai, Hong

2014-09-01

Brucella abortus is a zoonotic Gram-negative pathogen that causes brucelosis in ruminants and humans. Toll-like receptors (TLRs) recognize Brucella abortus and initiate antigen-presenting cell activities that affect both innate and adaptive immunity. In this study, we focused on recombinant Brucella cell-surface protein 31 (rBCSP31) to determine its effects on mouse macrophages. Our results demonstrated that rBCSP31 induced TNF-α, IL-6 and IL-12p40 production, which depended on the activation of mitogen-activated protein kinases (MAPKs) by stimulating the rapid phosphorylation of p38 and JNK and the activation of transcription factor NF-κB in macrophages. In addition, continuous exposure (>24 h) of RAW264.7 cells to rBCSP31 significantly enhanced IFN-γ-induced expression of MHC-II and the ability to present rBCSP31 peptide to CD4(+) T cells. Furthermore, we found that rBCSP31 could interact with both TLR2 and TLR4. The rBCSP31-induced cytokine production by macrophages from TLR2(-/-) and TLR4(-/-) mice was lower than that from C57BL/6 macrophages, and the activation of NF-κB and MAPKs was attenuated in macrophages from TLR2(-/-) and TLR4(-/-) mice. In addition, CD4(+) T cells from C57BL/6 mice immunized with rBCSP31 produced higher levels of IFN-γ and IL-2 compared with CD4(+) T cells from TLR2(-/-) and TLR4(-/-) mice. Macrophages from immunized C57BL/6 mice produced higher levels of IL-12p40 than those from TLR2(-/-) and TLR4(-/-) mice. Furthermore, immunization with rBCSP31 provided better protection in C57BL/6 mice than in TLR2(-/-) and TLR4(-/-) mice after B. abortus 2308 challenge. These results indicate that rBCSP31 is a TLR2 and TLR4 agonist that induces cytokine production, upregulates macrophage function and induces the Th1 immune response.

Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America.

PubMed

Buser, Zorica; Ortega, Brandon; D'Oro, Anthony; Pannell, William; Cohen, Jeremiah R; Wang, Justin; Golish, Ray; Reed, Michael; Wang, Jeffrey C

2018-02-01

Retrospective database study. Low back and neck pain are among the top leading causes of disability worldwide. The aim of our study was to report the current trends on spine degenerative disorders and their treatments. Patients diagnosed with lumbar or cervical spine conditions within the orthopedic subset of Medicare and Humana databases (PearlDiver). From the initial cohorts we identified subgroups based on the treatment: fusion or nonoperative within 1 year from diagnosis. Poisson regression was used to determine demographic differences in diagnosis and treatment approaches. Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012, representing a 16.5% (lumbar) decrease and 11% (cervical) increase in the number of diagnosed patients. There was an increase of 18.5% in the incidence of fusion among lumbar patients. For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014. There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments. There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.

El programa de estudios: Naturaleza, objectivos, planeamiento, aplicacion y evaluacion (Curriculum: Its Nature, Objectives, Planning, Application, and Evaluation).

ERIC Educational Resources Information Center

Martinez, Maria L., Comp.

A proposal is advanced to the Latin American nations by the Department of Educational Affairs, Organization of American States (OAS), for a joint program of enacting educational reform. As mediator, the OAS recommends as an initial step the distribution of various publications offering information on actual educational programs currently in…

"Recuperando La Dignidad Humana" [Recovering Human Dignity]: Shuar Mothers Speak out on Intercultural Bilingual Education

ERIC Educational Resources Information Center

Katz, Susan Roberta; Chumpi Nantip, Cornelia Lupe

2014-01-01

This paper presents findings from interviews conducted in December 2011, with seven Shuar mothers of children in an intercultural bilingual school in the southern Amazon region of Ecuador. This study had two objectives: (1) to foreground the perspectives of Shuar parents towards intercultural bilingual education (IBE) as implemented in the Shuar…

75 FR 70703 - Humana Insurance Company a Division of Carenetwork, Inc. Front End Operations and Account...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

... Division of CareNetwork, Inc., Front End Operations and Account Installation-Product Testing Groups, De... a Division of Carenetwork, Inc. Front End Operations and Account Installation-Product Testing Groups..., a Division of CareNetwork, Inc., Front End Operations and Account Installation- Product Testing...

The eminent anatomists who discovered the upper oesophageal sphincter.

PubMed

Marchese-Ragona, R; Ottaviano, G; Masiero, S; Staffieri, C; Martini, A; Staffieri, A; Mion, M; Zaninotto, G; Restivo, D A

2014-10-01

To discover the anatomist who first identified the upper oesophageal sphincter. The authors searched dozens of antique anatomy textbooks kept in the old section of the 'Vincenzo Pinali' Medical Library of Padua University, looking for descriptions of the upper oesophageal sphincter. The oesophageal sphincter was drawn correctly only in 1601, by Julius Casserius, in the book De vocis auditusque organis historia anatomica… (which translates as 'An Anatomical History on the Organs of Voice and Hearing …'), and was properly described by Antonio Maria Valsalva in 1704 in the book De aure humana tractatus… ('Treatise on the Human Ear …'). Anatomists Casserius and Valsalva can be considered the discoverers of the 'oesophageal sphincter'.

TLR2 and TLR4 signaling pathways are required for recombinant Brucella abortus BCSP31-induced cytokine production, functional upregulation of mouse macrophages, and the Th1 immune response in vivo and in vitro

PubMed Central

Li, Jia-Yun; Liu, Yuan; Gao, Xiao-Xue; Gao, Xiang; Cai, Hong

2014-01-01

Brucella abortus is a zoonotic Gram-negative pathogen that causes brucelosis in ruminants and humans. Toll-like receptors (TLRs) recognize Brucella abortus and initiate antigen-presenting cell activities that affect both innate and adaptive immunity. In this study, we focused on recombinant Brucella cell-surface protein 31 (rBCSP31) to determine its effects on mouse macrophages. Our results demonstrated that rBCSP31 induced TNF-α, IL-6 and IL-12p40 production, which depended on the activation of mitogen-activated protein kinases (MAPKs) by stimulating the rapid phosphorylation of p38 and JNK and the activation of transcription factor NF-κB in macrophages. In addition, continuous exposure (>24 h) of RAW264.7 cells to rBCSP31 significantly enhanced IFN-γ-induced expression of MHC-II and the ability to present rBCSP31 peptide to CD4+ T cells. Furthermore, we found that rBCSP31 could interact with both TLR2 and TLR4. The rBCSP31-induced cytokine production by macrophages from TLR2−/− and TLR4−/− mice was lower than that from C57BL/6 macrophages, and the activation of NF-κB and MAPKs was attenuated in macrophages from TLR2−/− and TLR4−/− mice. In addition, CD4+ T cells from C57BL/6 mice immunized with rBCSP31 produced higher levels of IFN-γ and IL-2 compared with CD4+ T cells from TLR2−/− and TLR4−/− mice. Macrophages from immunized C57BL/6 mice produced higher levels of IL-12p40 than those from TLR2−/− and TLR4−/− mice. Furthermore, immunization with rBCSP31 provided better protection in C57BL/6 mice than in TLR2−/− and TLR4−/− mice after B. abortus 2308 challenge. These results indicate that rBCSP31 is a TLR2 and TLR4 agonist that induces cytokine production, upregulates macrophage function and induces the Th1 immune response. PMID:24769793

Evaluacion de que consister y por que se lleva acabo? (Evaluation: What Does it Consist of, and for What Purpose?).

ERIC Educational Resources Information Center

Austin Independent School District, TX. Office of Research and Evaluation.

A guide is presented for the evaluation of the bilingual programs in the Austin, Texas, Independent School District. The reasons for an evaluation and a definition of program objectives and evaluation instruments are given. The program components, objectives and evaluation instruments for each grade level (K-4) are listed. The components involved…

TECNOLOGÍAS DE INFORMACIÓN Y COMUNICACIÓN PARA LA PREVENCIÓN Y CONTROL DE LA INFECCIÓN POR EL VIH Y OTRAS ITS*

PubMed Central

Curioso, Walter H.; Blas, Magaly M.; Kurth, Ann E.; Klausner, Jeffrey D.

2010-01-01

Avances tecnológicos innovadores como Internet, computadoras personales de bolsillo, teléfonos celulares y otros equipos son un arsenal en crecimiento en el esfuerzo de impedir y controlar el VIH y otras infecciones de transmisión sexual (ITS). A pesar que existe una diversidad de tecnologías de información y comunicación en diferentes etapas de desarrollo para la prevención del VIH e ITS, la investigación en esta área se encuentra aún en crecimiento, y el impacto en la incidencia de enfermedad, las evaluaciones con diseños rigurosos y los estudios económicos todavía son muy limitados. Sin embargo, algunas de estas evidencias son prometedoras y poseen un gran potencial para su uso en nuestro medio. En este artículo hemos realizado una revisión sistemática de la literatura relacionada con el uso de la tecnología aplicada a la prevención y control del VIH e ITS. De ser usada apropiadamente, esta tecnología podría mejorar la vigilancia del VIH y otras ITS, diagnóstico, notificación de parejas, prevención, manejo clínico, y capacitación de profesionales de la salud. PMID:26339254

About human taeniasis and Taenia saginata diagnosis by endoscopy.

PubMed

Galán Puchades, María Teresa

2016-10-01

La carta al editor se refiere al artículo de Canaval-Zuleta et al. aceptado para publicación, titulado "Endoscopy as an alternative diagnostic and therapeutic technique for Taenia saginata". El trabajo presenta una serie de incorrecciones que deben ser aclaradas, o al menos parte de ellas en solo 300 palabras. La información sobre las vias de infeccion en taeniasis, así como la patogenia y técnicas de diagnóstico, no se ajustan a la realidad. Asimismo, ya está publicado que el diagnóstico por endoscopia es una técnica muy sensible pero nada específica, pues no permite distinguir entre las 3 especies humanas del género Taenia.

Imaging of Lipids and Metabolites Using Nanospray Desorption Electrospray Ionization Mass Spectrometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lanekoff, Ingela; Laskin, Julia

In recent years, mass spectroscopy imaging (MSI) has emerged as a foundational technique in metabolomics and drug screening providing deeper understanding of complex mechanistic pathways within biochemical systems and biological organisms. We have been invited to contribute a chapter to a new Springer series volume, entitled “Mass Spectrometry Imaging of Small Molecules”. The volume is planned for the highly successful lab protocol series Methods in Molecular Biology, published by Humana Press, USA. The volume is aimed to equip readers with step-by-step mass spectrometric imaging protocols and bring rapidly maturing methods of MS imaging to life science researchers. The chapter willmore » provide a detailed protocol of ambient MSI by use of nanospray desorption electrospray ionization.« less

77 FR 56674 - United States v. Humana Inc. and Arcadian Management Services, Inc.; Public Comment and Response...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

.... Standard of Judicial Review The Clayton Act, as amended by the APPA, requires that proposed consent...-interest standard under the Tunney Act); United States v. InBev N.V./S.A., 2009-2 Trade Cas. (CCH) ] 76,736.... Mass. 1975) (noting that, in this way, the court is constrained to ``look at the overall picture not...

Global environment facility: Independent evaluation of the pilot phase; Fondo para el medio ambiente mundial: evaluacion independiente de la etapa experimental

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1994-06-01

This study responds to a request by participants in the Global Environment Facility (GEF) for an independent evaluation of the pilot phase. It profiles the GEF, discusses its policy framework, and reviews project development procedures and the strategies and projects in each of the GEF`s four focal areas. The study concludes that fundamental changes must occur and recommends specific reforms, such as articulating more clearly the GEF`s mandate, objectives, and strategies; addressing deficiencies in meeting its global focus; improving capacities and procedures within implementing agencies for managing the portfolio; and increasing non-government organization (NGO), country and community-level participation.

Protocolo Nacional para la Evaluacion de Disturbios en Suelos Forestales; Volumen II: Metodos complementarios, estadística y recoleccion de datos

Treesearch

Deborah S. Page-Dumroese; Ann M. Abbott; Thomas M. Rice

2013-01-01

Este documento-El Volumen II: Métodos complementarios, estadística y recolección de datos- define las bases, los métodos estadísticos y de almacenamiento de datos de un Protocolo Nacional para la Evaluación de Disturbios en Suelos Forestales. Esta guía técnica proporciona las bases de un método consistente, con definiciones comunes, para generar datos de alta calidad,...

The Reflective Abstraction Theory and the History of Astronomy. (Spanish Title: La Teoría de la Abstracción Reflexionante y la Historia de la Astronomía.) A Teoria da Abstração Reflexionante e a História da Astronomia.

NASA Astrophysics Data System (ADS)

Chiesa Bartelmebs, Roberta; Batista Siqueira Harres, João; da Silva, João Alberto

2014-12-01

This work is presented as a theoretical essay on some facts from the history of astronomy analyzed according to the theory of reflective abstraction developed by Jean Piaget and collaborators (1970). Its aim is to understand the reasons that led to different astronomers, at the same historical period and culture, to "see" quite different evidences about the same phenomenon. In addition, we intend to facilitate the understanding of science as a human construction, subject to a time epoch and the ways of understanding of each scientist. Este trabajo se presenta como un ensayo teórico sobre algunos hechos históricos de la astronomía, analizados según la teoría de la abstracción reflexionante de Jean Piaget y sus colaboradores (1970). Se trata de comprender los motivos que llevaran a distintos astrónomos, de una misma época histórica y cultural, a "ver" diferentes evidencias sobre un mismo fenómeno. Además, se intenta posibilitar la comprensión de la ciencia como construcción humana, la cual es condicionada por su momento histórico y por las creencias y las formas de entender de los científicos. Este trabalho configura-se como um ensaio teórico a respeito de alguns fatos da história da astronomia analisados segundo a teoria da abstração reflexionante elaborada por Jean Piaget e seus colaboradores (1970). Trata-se de compreender os motivos que levaram diferentes astrônomos, da mesma época histórica e cultural, a "enxergarem" evidências tão diferentes sobre um mesmo fenômeno. Além disso, pretendemos possibilitar a compreensão das Ciências como construção humana, condicionadas a uma época e às crenças e os modos de compreender de cada cientista.

Impact of a pregabalin step therapy policy among medicare advantage beneficiaries.

PubMed

Suehs, Brandon T; Louder, Anthony; Udall, Margarita; Cappelleri, Joseph C; Joshi, Ashish V; Patel, Nick C

2014-06-01

Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST) policy among Medicare Advantage Prescription Drug (MAPD) members. Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01/01/2009) and Thomson Reuters MarketScan(®) (unrestricted cohort) were analyzed for MAPD members aged 65 to 89 years receiving treatment for painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference-in-differences (DID) was used to examine year-over-year changes in disease-related and all-cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between-group compositional differences. We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year-over-year decrease in pregabalin utilization and increase in year-over-year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease-related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost. After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net

The essence of care in health vulnerability: a Heideggerian construction.

PubMed

Cestari, Virna Ribeiro Feitosa; Moreira, Thereza Maria Magalhães; Pessoa, Vera Lúcia Mendes de Paula; Florêncio, Raquel Sampaio; Silva, Maria Rocineide Ferreira da; Torres, Raimundo Augusto Martins

2017-01-01

Reflect on the essence of care in health vulnerability from the phenomenological perspective of Martin Heidegger. Theoretical-reflexive study, anchored in three essential parts: 1) Care in Heidegger; 2) The essence of care in health vulnerability; And 3) Nursing care actions on health vulnerability. Vulnerability must be recognized as an indelible trait of the human condition and has its constituents in the human being, co-presence and care. Caring is an interactive process that reveals itself in the relationship with the other. Respecting the integrity of the Being in vulnerability must be a priority in nursing care, through behaviors that privilege the Being. Understanding ontological care and its relation to vulnerability under Heidegger's phenomenological view allowed us to uncover the facets of care in health vulnerability by adding to the nursing knowledge body a comprehensive and reflective perspective. Refletir sobre a essência do cuidado na vulnerabilidade em saúde sob a perspectiva fenomenológica de Martin Heidegger. Estudo teórico-reflexivo, ancorado em três partes essenciais: 1) O cuidado em Heidegger; 2) A essência do cuidado na vulnerabilidade em saúde; e 3) As ações do cuidar em enfermagem na vulnerabilidade em saúde. A vulnerabilidade deve ser reconhecida como traço indelével da condição humana e tem seus constituintes na pessoa humana, co-presenças e cuidado. O cuidar é um processo interativo que se desvela na relação com o outro. Respeitar a integridade do Ser em vulnerabilidade deve ser prioridade no cuidar em enfermagem, por meio de comportamentos que privilegiem o Ser. Compreender ontologicamente o cuidado e a sua relação com a vulnerabilidade sob o olhar fenomenológico de Heidegger permitiu desvelar as facetas do cuidado na vulnerabilidade em saúde, agregando ao corpo de conhecimento da Enfermagem uma perspectiva compreensiva e reflexiva.

Criptococosis cutánea primaria en paciente inmunocompetente.

PubMed

Vázquez-Osorio, Igor; García-Rodiño, Sara; Rodríguez-Rodríguez, Marta; Labandeira, Javier; Suárez-Peñaranda, José Manuel; Sánchez-Aguilar, MDolores; Vázquez-Veiga, Hugo

2016-05-15

La criptococosis cutánea es una micosis propia de pacientes inmunodeprimidos, sobre todo aquellos con infección por el virusde la inmunodeficiencia humana (VIH). Sin embargo, existen casos infrecuentes de criptococosis cutánea en pacientes inmunocompetentes, que suelen simular otras dermatosis, lo que retrasa su diagnóstico y tratamiento. Presentamos el caso de un varón pluripatológico de 79 años, con úlceras dolorosas en dorso de mano derecha que no respondían a tratamientos tópicos. A través del estudio histopatológico y micológico se alcanzó el diagnóstico de criptococosis cutánea primaria, lográndose la remisión de las lesiones tras 6 meses de tratamiento con fluconazol.

EFRH-phage immunization of Alzheimer's disease animal model improves behavioral performance in Morris water maze trials.

PubMed

Lavie, Vered; Becker, Maria; Cohen-Kupiec, Rachel; Yacoby, Iftach; Koppel, Rela; Wedenig, Manuela; Hutter-Paier, Birgit; Solomon, Beka

2004-01-01

We have developed an immunization procedure for the production of effective anti-beta-amyloid (anti-Abeta) antibodies, using filamentous phage displaying only 4 amino acids. The EFRH sequence, encompassing amino acids 3-6 of the 42 residues of Abeta peptide, was found previously to be the main regulatory site for amyloid modulation and the epitope of anti-aggregating antibodies. Engineered filamentous phage enable the display of various numbers of EFRH copies on the phage and serve as potent carriers of antigens. In the present study we have found that phage displaying high EFRH copy number are effective in eliciting humoral response against the EFRH sequence, which in turn relieves the amyloid burden in the brains of amyloid precursor protein Tg mice and improves their ability to perform cognitive tasks. Copyright 2004 Humana Press Inc.

A Comparison of Brand and Biosimilar Granulocyte-Colony Stimulating Factors for Prophylaxis of Chemotherapy-Induced Febrile Neutropenia.

PubMed

Douglas, Andrea G; Schwab, Phil; Lane, Daniel; Kennedy, Kenneth; Slabaugh, S Lane; Bowe, Andy

2017-12-01

Filgrastim-sndz, a granulocyte-colony stimulating factor (G-CSF), was introduced as a biosimilar to filgrastim in 2015, but real-world comparative effectiveness for filgrastim versus filgrastim-sndz has not been reported to date. To (a) compare the incidence of febrile neutropenia for patients taking filgrastim versus those taking filgrastim-sndz and (b) compare the incidence of a potential serious adverse event for filgrastim versus filgrastim-sndz. This retrospective cohort study identified patients receiving a G-CSF following chemotherapy, using administrative claims from the Humana Research Database. Patients enrolled in a Medicare Advantage Prescription Drug plan with a claim for a G-CSF from October 1, 2015, through September 30, 2016, were identified. G-CSF use had to occur within 6 days of exposure to chemotherapy and without any subsequent chemotherapy within 14 days after G-CSF use. Febrile neutropenia requiring hospitalization was defined as hospitalization within 14 days after G-CSF use with (a) diagnosis of infection and/or neutropenia (broad definition) or (b) infection and neutropenia diagnoses (narrow definition). Serious adverse drug events (spleen rupture, acute respiratory syndrome, serious allergic reactions, capillary leak syndrome, thrombocytopenia, leukocytosis, cutaneous vasculitis, or bones and muscle ache) were also identified within 14 days after G-CSF use. An incidence difference of < 1% with 90% CI crossing zero qualified as support for noninferiority. Two-tailed chi-square tests were also used to investigate differences. A total of 88 filgrastim and 101 filgrastim-sndz patients were identified. Filgrastim and filgrastim-sndz met the criteria for noninferiority based on an incidence difference of -0.6% (90% CI = -5.1%-4.0%; P = 0.84) for the broad definition of febrile neutropenia and a difference of -0.8% (90% CI = -3.8%-2.1%; P = 0.64) for the narrow definition. For the analysis of serious adverse events, an incidence difference of -2

The influence of the parents' educational level on the development of executive functions.

PubMed

Ardila, Alfredo; Rosselli, Monica; Matute, Esmeralda; Guajardo, Soledad

2005-01-01

Information about the influence of educational variables on the development of executive functions is limited. The aim of this study was to analyze the relation of the parents' educational level and the type of school the child attended (private or public school) to children's executive functioning test performance. Six hundred twenty-two participants, ages 5 to 14 years (276 boys, 346 girls) were selected from Colombia and Mexico and grouped according to three variables: age (5-6, 7-8, 9-10, 11-12, and 13-14 years), gender (boys and girls), and school type (private and public). Eight executive functioning tests taken from the Evaluacion Neuropsicologica Infantil; Matute, Rosselli, Ardila, & Ostrosky, (in press) were individually administered: Semantic Verbal Fluency, Phonemic Verbal Fluency, Semantic Graphic Fluency, Nonsemantic Graphic Fluency, Matrices, Similarities, Card Sorting, and the Mexican Pyramid. There was a significant effect of age on all the test scores and a significant effect of type of school attended on all but Semantic Verbal Fluency and Nonsemantic Graphic Fluency tests. Most children's test scores, particularly verbal test scores, significantly correlated with parents' educational level. Our results suggest that the differences in test scores between the public and private school children depended on some conditions existing outside the school, such as the parents' level of education. Implications of these findings for the understanding of the influence of environmental factors on the development of executive functions are presented.

COPD exacerbations associated with the modified Medical Research Council scale and COPD assessment test among Humana Medicare members

PubMed Central

Pasquale, Margaret K; Xu, Yihua; Baker, Christine L; Zou, Kelly H; Teeter, John G; Renda, Andrew M; Davis, Cralen C; Lee, Theodore C; Bobula, Joel

2016-01-01

Background The Global initiative for chronic Obstructive Lung Disease guidelines recommend assessment of COPD severity, which includes symptomatology using the modified Medical Research Council (mMRC) or COPD assessment test (CAT) score in addition to the degree of airflow obstruction and exacerbation history. While there is great interest in incorporating symptomatology, little is known about how patient reported symptoms are associated with future exacerbations and exacerbation-related costs. Methods The mMRC and CAT were mailed to a randomly selected sample of 4,000 Medicare members aged >40 years, diagnosed with COPD (≥2 encounters with International Classification of Dis eases-9th Edition Clinical Modification: 491.xx, 492.xx, 496.xx, ≥30 days apart). The exacerbations and exacerbation-related costs were collected from claims data during 365-day post-survey after exclusion of members lost to follow-up or with cancer, organ transplant, or pregnancy. A logistic regression model estimated the predictive value of exacerbation history and symptomatology on exacerbations during follow-up, and a generalized linear model with log link and gamma distribution estimated the predictive value of exacerbation history and symptomatology on exacerbation-related costs. Results Among a total of 1,159 members who returned the survey, a 66% (765) completion rate was observed. Mean (standard deviation) age among survey completers was 72.0 (8.3), 53.7% female and 91.2% white. Odds ratios for having post-index exacerbations were 3.06, 4.55, and 16.28 times for members with 1, 2, and ≥3 pre-index exacerbations, respectively, relative to members with 0 pre-index exacerbations (P<0.001 for all). The odds ratio for high vs low symptoms using CAT was 2.51 (P<0.001). Similarly, exacerbation-related costs were 73% higher with each incremental pre-index exacerbation, and over four fold higher for high-vs low-symptom patients using CAT (each P<0.001). The symptoms using mMRC were not statistically significant in either model (P>0.10). Conclusion The patient-reported symptoms contribute important information related to future COPD exacerbations and exacerbation-related costs beyond that explained by exacerbation history. PMID:26834468

Estuche de evaluacion del continuo del desarrollo de El Curriculo Creativo (The Creative Curriculum Developmental Continuum Assessment Toolkit for Ages 3-5).

ERIC Educational Resources Information Center

Dodge, Diane Trister; Colker, Laura J.; Heroman, Cate

Intended for use with the Creative Curriculum for Early Childhood, this integrated ongoing student assessment toolkit, in Spanish, is designed for preschool teachers to help them focus on all aspects of a child's development, thereby giving them a way to ensure that all children in their classes are making progress. The assessment kit uses a…

Protocol for the Production of a Vaccine Against Argentinian Hemorrhagic Fever.

PubMed

Ambrosio, Ana María; Mariani, Mauricio Andrés; Maiza, Andrea Soledad; Gamboa, Graciela Susana; Fossa, Sebastián Edgardo; Bottale, Alejando Javier

2018-01-01

Argentinian hemorrhagic Fever (AHF) is a febrile, acute disease caused by Junín virus (JUNV), a member of the Arenaviridae. Different approaches to obtain an effective antigen to prevent AHF using complete live or inactivated virus, as well as molecular constructs, have reached diverse development stages. This chapter refers to JUNV live attenuated vaccine strain Candid #1, currently used in Argentina to prevent AHF. A general standardized protocol used at Instituto Nacional de Enfermedades Virales Humanas (Pergamino, Pcia. Buenos Aires, Argentina) to manufacture the tissue culture derived Candid #1 vaccine is described. Intermediate stages like viral seeds and cell culture bank management, bulk vaccine manufacture, and finished product processing are also separately presented in terms of Production and Quality Control/Quality Assurance requirements, under the Adminitracion Nacional de Medicamentos, Alimentos y Tecnología Medica (ANMAT), the Argentine national regulatory authority.

Predictors of Change in Adherence Status from 1 Year to the Next Among Patients with Type 2 Diabetes Mellitus on Oral Antidiabetes Drugs.

PubMed

Saundankar, Vishal; Peng, Xiaomei; Fu, Haoda; Ascher-Svanum, Haya; Rodriguez, Angel; Ali, Ayad; Slabaugh, Lane; Young, Peinie; Louder, Anthony

2016-05-01

Diabetes is a leading cause of morbidity, mortality, and medical resource utilization in the United States and worldwide. Treatment is aimed at keeping blood glucose levels close to normal and preventing or delaying medical complications. It has been estimated that only 50% of patients with diabetes in the United States achieve glycosylated hemoglobin A1c level < 7%. Nonadherence to antidiabetic medications has been identified as a major factor related to poor glycemic control. To (a) assess adult patients with type 2 diabetes mellitus (T2DM) whose adherence status to oral antidiabetic drugs (OADs) changed from 1 year to the next and (b) identify predictors of change in adherence status. This retrospective study of the Humana Medicare Advantage Database included patients with T2DM and continuous enrollment between 2010 and 2012. Proportion of days covered (PDC) by OADs was calculated for each of the 3 study years (2010, 2011, 2012). Patients were classified as adherent (PDC ≥ 80%) or nonadherent (PDC < 80%) during each year. Patient characteristics from the baseline period (2010) were used as covariates, and adherence status changes from baseline to follow-up year (2011) were used as response variables. Data from the subsequent study periods (2011 as baseline, 2012 as follow-up) were used to validate the model (final model). A total of 238,402 patients met inclusion criteria. Among them, 144,216 (60.5%) were adherent, and 94,186 (39.5%) were nonadherent during the baseline period. Change in adherence status from baseline to follow-up year was observed in 31,320 (21.7%) patients that were adherent and 39,284 (41.7%) patients that were nonadherent during the baseline year. The final model for baseline adherent patients had a receiver-operating characteristic (ROC) index of 73% and a misclassification rate of 39%. The predictors of highest importance were identified as total number of prescriptions filled with 90-day supply, diabetes-related pill burden, longest gap

Propiedades biomecánicas de la membrana limitante interna tras recibir tratamiento intravítreo con ocriplasmina.

PubMed

Vielmuth, Franziska; Schumann, Ricarda G; Spindler, Volker; Wolf, Armin; Scheler, Renate; Mayer, Wolfgang J; Henrich, Paul B; Haritoglou, Christos

2017-01-01

Objetivo: Evaluar la rigidez de la membrana limitante interna (MLI) humana y evaluar los posibles cambios de las propiedades mecánicas tras administrar una inyección intravítrea de ocriplasmina para tratar la tracción vitreomacular. Métodos: Este estudio se compone de una serie de casos intervencionales y comparativos de 12 muestras de MLI extraídas mediante cirugía y obtenidas de forma consecutiva de 9 ojos de 9 pacientes después de someterse sin éxito a vitreólisis farmacológica con ocriplasmina. Durante el mismo periodo de tiempo, 16 muestras de otros 13 ojos sin tratamiento con ocriplasmina se obtuvieron mediante vitrectomía y sirvieron como controles. Todos los pacientes presentaron agujeros maculares o tracción vitreomacular y se sometieron a vitrectomía con disección de la MLI tanto con tinción con azul brillante (AB) como sin ella. Todas las muestras se analizaron con un microscopio de fuerza atómica con imágenes de las regiones de 25 × 25 μm. En todas las muestras, se analizaron tanto la parte de la retina como la del vítreo de la MLI. Resultados: La microscopia de fuerza atómica no reveló diferencias significativas en cuanto a elasticidad de las muestras de MLI extraídas de ojos con o sin tratamiento con ocriplasmina. Las áreas onduladas de la parte de la retina presentaron una mayor rigidez que la parte del vítreo de la MLI. La cartografía topográfica tanto de la parte del vítreo como de la retina de la MLI no mostró ninguna alteración aparente de la morfología en ojos tratados con ocriplasmina en comparación con los ojos no tratados. La tinción con azul brillante conllevó un aumento de la rigidez tisular. Conclusiones: Las inyecciones intravítreas de ocriplasmina no varían las propiedades biomecánicas de la MLI humana. No existen pruebas de un posible efecto enzimático que interfiera con la rigidez de esta membrana basal. © 2017 S. Karger AG, Basel.

As it is in heaven? John Paul II listened to God and misunderstood the message.

PubMed

1993-10-27

This articles focuses on John Paul II's 1993 Veritatis Splendor, an 1798 page encyclical letter to the Church's bishops on the crisis in the Catholic Church of family limitation and the implications for the laity and society. The communication states that a flexible interpretation of theology must be abandoned. Paul VI's 19963 Humanae Vitae is reportedly affirmed. John XXIII's spiritualism and concern with conscience is ignored. This encyclical is identified as not spoken "ex cathedra" or from the throne, which would have made the pronouncement true, unarguable forever, and subject to excommunication for those disobeying. Pope John Paul II is said to be preparing another encyclical on life issues and sexuality. Reference is made in this encyclical to devices that are acceptable to use to gauge a safe period for copulation without impregnation. The devices include the rectal thermometer and the calculator for determining the infertile days in the natural cycle. Veritatis Splendor's position on fertility is viewed as an issue of loyalty to the Church and not as an honest evaluation of the moral implications of artificial birth control. This encyclical comes closer to "ex cathedra" than the Humanae Vitae, which banned the birth control pill, IUD, spermicides, hormonal implants, vasectomies, and tubal ligation. Liberal Catholic theologians are reported to have interpreted Paul VI's statement that "God illuminates from within the hearts of the faithful and invites their assent," as a validation of dissent. Pope John Paul II closes the door to dissent in this proclamation. The Church also closes the door to free will for people to decide for themselves. The Jesuits, with different notions of divine will, are described as potentially concluding that the denial of free will and individual reason for the sake of Papal supremacy must be the work of the devil himself. For good Catholics this encyclical is interpreted as potentially forcing even stronger opposition to the

Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in "real-world" clinical practice. A propensity-matched analysis of 76,940 patients.

PubMed

Li, Xiaoyan Shawn; Deitelzweig, Steve; Keshishian, Allison; Hamilton, Melissa; Horblyuk, Ruslan; Gupta, Kiran; Luo, Xuemei; Mardekian, Jack; Friend, Keith; Nadkarni, Anagha; Pan, Xianying; Lip, Gregory Y H

2017-06-02

The ARISTOTLE trial showed a risk reduction of stroke/systemic embolism (SE) and major bleeding in non-valvular atrial fibrillation (NVAF) patients treated with apixaban compared to warfarin. This retrospective study used four large US claims databases (MarketScan, PharMetrics, Optum, and Humana) of NVAF patients newly initiating apixaban or warfarin from January 1, 2013 to September 30, 2015. After 1:1 warfarin-apixaban propensity score matching (PSM) within each database, the resulting patient records were pooled. Kaplan-Meier curves and Cox proportional hazards models were used to estimate the cumulative incidence and hazard ratios (HRs) of stroke/SE and major bleeding (identified using the first listed diagnosis of inpatient claims) within one year of therapy initiation. The study included a total of 76,940 (38,470 warfarin and 38,470 apixaban) patients. Among the 38,470 matched pairs, 14,563 were from MarketScan, 7,683 were from PharMetrics, 7,894 were from Optum, and 8,330 were from Humana. Baseline characteristics were balanced between the two cohorts with a mean (standard deviation [SD]) age of 71 (12) years and a mean (SD) CHA 2 DS 2 -VASc score of 3.2 (1.7). Apixaban initiators had a significantly lower risk of stroke/SE (HR: 0.67, 95 % CI: 0.59-0.76) and major bleeding (HR: 0.60, 95 % CI: 0.54-0.65) than warfarin initiators. Different types of stroke/SE and major bleeding - including ischaemic stroke, haemorrhagic stroke, SE, intracranial haemorrhage, gastrointestinal bleeding, and other major bleeding - were all significantly lower for apixaban compared to warfarin treatment. Subgroup analyses (apixaban dosage, age strata, CHA 2 DS 2 -VASc or HAS-BLED score strata, or dataset source) all show consistently lower risks of stroke/SE and major bleeding associated with apixaban as compared to warfarin treatment. This is the largest "real-world" study on apixaban effectiveness and safety to date, showing that apixaban initiation was associated with

Operative Management of Patellar Instability in the United States: An Evaluation of National Practice Patterns, Surgical Trends, and Complications.

PubMed

Arshi, Armin; Cohen, Jeremiah R; Wang, Jeffrey C; Hame, Sharon L; McAllister, David R; Jones, Kristofer J

2016-08-01

Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study. To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery. Descriptive epidemiological study. A large private-payer database (PearlDiver) comprising patients covered by Humana and United Healthcare insurance policies was retrospectively reviewed using Current Procedural Terminology (CPT) codes to identify patients who underwent surgery for patellar instability. The study cohort was established by querying for patients billed under CPT codes 27420, 27422, or 27427 while satisfying the diagnostic requirement of patellar instability (International Classification of Diseases-9th Revision codes 718.36, 718.86, or 836.3). Patient demographics, surgical trends, concomitant procedures, and postoperative complications were determined. A total of 6190 patients underwent surgical management for patellar instability. Adolescents (age range, 10-19 years) represented 51.5% of cases, and 59.6% were female. The number of patellar instability procedures increased annually over the study period in both the Humana (P = .004, R (2) = 0.76) and United Healthcare (P = .097, R (2) = 0.54) cohorts. The most common concomitant procedures were lateral retinacular release (43.7%), chondroplasty (31.1%), tibial tubercle osteotomy (13.1%), removal of loose bodies (10.5%), osteochondral grafting (9.5%), and microfracture surgery (9.5%). Manipulation under anesthesia was required in 4.6% of patients within 1 year. Patellar fracture within 1 year and infection within 30 days occurred in 2.1% and 1.2% of patients, respectively. Patellar instability surgery has increased over the past decade

[Clinical diagnosis of dyslexia].

PubMed

Martínez Hermosillo, A; Balderas Gil, A

1980-01-01

In 5 years of experience at the Instituto Nacional de la Comunicacion Humana, 302 clinical histories showed the diagnosis of dyslexia. The following parameters were studied: age, sex, heredofamilial history, gestation, psychomotor development, clinical picture, examination of the language (type, reading, spontaneous writing, dictation, mathematic concepts), laterality, scholarship, scholar failures, psychological study. The following results were obtained: Dyslexia was more important or frequent between 5 to 8.9 years of age. Males predominated 3:1. The heredofamilial history was important. Dyslexia prevailed in products of the first gestations. A high disturbance was found in the psychomotor development of a large percent of dyslexic patients. Examination of language was also important. Dyslexia was more frequent in right-handed patients. Scholar failures in one or more instances were found. The psychological study must be done. If dyslexia is diagnosed on time, it may be prevented and all unwanted sequelae may be avoided.

Universal Principles of Depicting Oneself across the Centuries: From Renaissance Self-Portraits to Selfie-Photographs.

PubMed

Carbon, Claus-Christian

2017-01-01

Selfie-photography is generally thought of as a cultural mass phenomenon of the early 21st century, inseparably related to the development and triumph of the smartphone with integrated camera. Western culture, however, has been highly familiar with self-depictions since the Renaissance days. Putting the contemporary selfie into this historic context covering more than five centuries of cultural development from Dürer's (1500) famous "Self-Portrait at 28" (also known as "Selbstbildnis im Pelzrock") to today's Instagram galleries allows for identifying central parallels concerning the technical and social antecedents as well as common underlying psychological factors and shared properties of different kinds of self-depiction. The article provides an overview of the types of contemporary photographic selfies and compares them with painted self-portraits. Finally, this historic perspective leads us to the insight that self-portraits as well as selfies are both referring to nothing less than the "conditio humana."

HLA antigens in five Amerindian groups (Yuko, Bari, Tunebo, Guane and Paez) of Colombia: results of 'Expedición Humana'.

PubMed

Bernal, J E; Duran, C; Briceno, I; Ortega, J; Papiha, S S

1995-01-01

The serological HLA types (A, B, C and D loci) were studied in five different Indian groups in Colombia. The range of polymorphism was not very restricted in these groups, but there was significant genetic heterogeneity among the five populations in all the HLA loci. The gene frequency data, when converted into a kinship matrix and a two-dimensional eigen vector plot, showed a closer affinity between Bari and Yuko Indians, while Guane, Tunebo and Paez Indians were not only genetically different from the former but also well-differentiated from each other. It seems therefore from this study that geographical proximity may play a greater role than linguistic similarities in the genetic affinities of Colombian Amerindians.

Uso de los Datos de Biomonitoreo para Informar sobre la Evaluacion Infantil (American translation is: USING BIOMONITORING DATA TO INFORM EXPOSURE ASSESSMENT IN CHILDREN)

EPA Science Inventory

Discussing the challenges associated with estimating and interpreting toxicant exposures and health risks from biomonitoring data. This extended abstract was translated in Spanish and published in Acta Toxicologica Argentina.

[Federik Grisogono and alchemistry].

PubMed

Pausek-Bazdar, Snjezana

2011-01-01

Frederico Grisogono's 1958 collection of essays De modo collegiandi, prognosticandi et curandi febres: necnon de humana felicitate ac denique de fluxu et refluxu maris presents his views on alchemy. He acknowledges the traditional association between the sky and earth and the correlation between the seven planets and seven earthly metals. He attempted to empirically determine the position and the properties of these planets (the Sun and the Moon were also considered planets at the time). He clearly distinguished the good and the bad planets and those that agree (love) or disagree (hate) with one another. However, Grisogono abandons the traditional Renaissance viewpoint on planet position inasmuch as he claims that Venus (copper) and Jupiter (tin) need to change places. He discards alchemist practical teaching that base metals can be turned into noble metals such as gold and silver. His argument against it is based on then generally adopted sulphur-mercury metal structure theory.

Universal Principles of Depicting Oneself across the Centuries: From Renaissance Self-Portraits to Selfie-Photographs

PubMed Central

Carbon, Claus-Christian

2017-01-01

Selfie-photography is generally thought of as a cultural mass phenomenon of the early 21st century, inseparably related to the development and triumph of the smartphone with integrated camera. Western culture, however, has been highly familiar with self-depictions since the Renaissance days. Putting the contemporary selfie into this historic context covering more than five centuries of cultural development from Dürer's (1500) famous “Self-Portrait at 28” (also known as “Selbstbildnis im Pelzrock”) to today's Instagram galleries allows for identifying central parallels concerning the technical and social antecedents as well as common underlying psychological factors and shared properties of different kinds of self-depiction. The article provides an overview of the types of contemporary photographic selfies and compares them with painted self-portraits. Finally, this historic perspective leads us to the insight that self-portraits as well as selfies are both referring to nothing less than the “conditio humana.” PMID:28270789

Factores que Influencian la Adquisición de Infecciones de Transmisión Sexual y VIH en Mujeres Jóvenes Chilenas que Participaron en la Intervención Online I-STIPI

PubMed Central

Villegas, Natalia; Cianelli, Rosina; Santisteban, Daniel; Lara, Loreto; Vargas, Jessica

2017-01-01

Resumen El objetivo de este estudio descriptivo de corte transversal fue investigar los siguientes factores asociados a la prevención de las infecciones de transmisión sexual (ITS) y el virus de la inmunodeficiencia humana (VIH): (a) conocimientos, (b) actitudes, (c) autoeficacia, (d) vulnerabilidad, (e) conductas de riesgo, (f) conductas de prevención, y (g) uso de internet en mujeres chilenas entre 18 y 24 años. Se utilizó un cuestionario estructurado disponible en un sitio web seguro para la recolección de datos que incluyó preguntas relacionadas con la prevención de ITS/VIH. Los resultados del estudio indicaron que las mujeres jóvenes están en riesgo de adquirir ITS/VIH y tienen necesidades especiales para la prevención. La familiaridad y frecuencia del uso de internet en esta población puede ser utilizado para la prevención de ITS/VIH. PMID:27257190

Factors Associated with Adherence to and Treatment Duration of Erlotinib Among Patients with Non-Small Cell Lung Cancer.

PubMed

Hess, Lisa M; Louder, Anthony; Winfree, Katherine; Zhu, Yajun E; Oton, Ana B; Nair, Radhika

2017-06-01

In lung cancer, there is an increasing number of oral agents available for patients; however, little is known about the factors associated with adherence to and treatment duration on oral medications in non-small cell lung cancer (NSCLC). To evaluate the clinical and demographic factors associated with adherence and treatment discontinuation, respectively, to oral oncolytics among patients with NSCLC. A retrospective, claims-based analysis of the Humana Research Database supplemented with medical chart review was conducted among patients with NSCLC who started an oral oncolytic between January 1, 2008, and June 30, 2013. Patients were required to be enrolled at least 1 year before the start of oral oncolytics and have no evidence of any oral oncolytic use during this period. Logistic regression models and Cox proportional hazard models were used to identify predictors associated with medication adherence and treatment duration, respectively. Among all oral oncolytics, only the cohort starting on erlotinib had sufficient sample size (n = 1,452). A wide variety of factors were found to be associated with adherence. Low-income subsidy status, previous use of intravenous chemotherapy, and lower total baseline health care costs were significantly related to decreasing adherence (each P < 0.05). Additionally, increasing patient out-of-pocket cost was associated with decreasing adherence to erlotinib (P < 0.0001). Factors significantly related to longer treatment duration included low-income subsidy status (P < 0.001) and having Medicare insurance, (P = 0.0004), dual eligibility (Medicare and Medicaid, P = 0.007), and higher erlotinib out-of-pocket costs (P < 0.0001). There is a need for mechanisms to be in place to identify and address barriers to care. Future research should focus on evaluating and reducing any potential risk to patient outcomes that may be associated with low adherence to or shorter treatment duration on oral chemotherapy. This study was supported by

A Reappraising of Cosmography: the Interface Between Astronomical and Geographic Studies. (Breton Title: Releitura do Conceito de Cosmografia: a Interface Entre os Estudos Astronômicos e Geográficos.) Una Relectura del Concepto de Cosmografía: la Interfase Entre los Estudios Astronómicos y Geográficos

NASA Astrophysics Data System (ADS)

Azevedo Sobreira, Paulo Henrique

2012-12-01

The concept of "Cosmography" is in disuse since the 80s of the last century, but the astronomical themes previously discussed in the school subjects of Geography and Cosmography remain in current textbooks. The use of term "Cosmography" was rescued in this research, and the study of its re-signification prompted the appearance of the term Geographic Cosmography. The Geographic Cosmography is a field of studies of the Geography, whose set of knowledge and skills is predominantly scholar. It studies the interface between terrestrial and celestial knowledge, and assigns a geographic significance to them. It examines human and natural relationships with Sidereal Space and its consequences for society and nature. O conceito de "Cosmografia" está em desuso desde os anos 80 do século XX, mas os temas astronômicos anteriormente abordados nas disciplinas escolares de Cosmografia e de Geografia permanecem nos atuais livros didáticos. O uso do termo "Cosmografia" foi resgatado nesta pesquisa e o estudo de sua ressignificação proporcionou o surgimento do termo Cosmografia Geográfica. A Cosmografia Geográfica é um campo de estudos da Geografia, cujo conjunto de conhecimentos e habilidades é predominantemente escolar. Estuda a interface entre os conhecimentos terrestres e os celestes e lhes atribui significância geográfica. Analisa as relações humanas e naturais com o Espaço Sideral e suas consequências para a sociedade e a natureza.

Aunque el concepto de "Cosmografía" no se usa desde la década de los '80 del siglo pasado, los temas astronómicos que se enseñaban anteriormente en las asignaturas escolares de Cosmografía y de Geografía permanecen en los actuales libros didácticos. El uso del término "Cosmografía" fue rescatado en esta investigación y el estudio de su resignificación proporcionó el surgimiento del término Cosmografía Geográfica. La Cosmografía Geográfica es un campo de estudio de la Geografía, donde

Prevalence and factors associated with human brucellosis in livestock professionals.

PubMed

Mufinda, Franco Cazembe; Boinas, Fernando; Nunes, Carla

2017-06-22

The objective of this study is to estimate the seroprevalence of human brucellosis in livestock professionals and analyze the factors associated with brucellosis focusing on sociodemographic variables and the variables of knowledge and practices related to the characteristics of the activities carried out in livestock. This is a cross-sectional seroepidemiological study with a population of 131 workers of butchers, slaughter rooms, and slaughterhouse and 192 breeders sampled randomly in Namibe province, Angola. The data were obtained from the collection of blood and use of questionnaires. The laboratory tests used were rose bengal and slow agglutination. The questionnaire allowed us to collect sociodemographic information and, specifically on brucellosis, it incorporated questions about knowledge, attitudes, and behaviors of livestock professionals. In addition to the descriptive statistical approach, we used the Chi-square test of independence, Fisher's test, and logistic regression models, using a significance level of 10%. The general weighted prevalence of brucellosis was 15.6% (95%CI 13.61-17.50), being it 5.3% in workers and 16.7% (95%CI 11.39-21.93) in breeders. The statistical significance was observed between human seroprevalence and category (worker and breeder) (p < 0.001) and education level (p = 0.032), start of activity (p = 0079), and service location (p = 0.055). In a multivariate context, the positive factor associated with brucellosis in professionals was the professional category (OR = 3.54; 95%CI 1.57-8.30, related to breeders in relation to workers). Human brucellosis in livestock professionals is prevalent in Namibe province (15.6%), where the professional category was the most important factor. The seroprevalence levels detected are high when compared with those found in similar studies. Estimar a seroprevalência da brucelose humana em profissionais da pecuária e analisar os factores associados à brucelose com foco em vari

The Relationship Between Guideline-Recommended Initiation of Therapy, Outcomes, and Cost for Patients with Metastatic Non-Small Cell Lung Cancer.

PubMed

Casebeer, Adrianne; Antol, Dana Drzayich; DeClue, Richard W; Hopson, Sari; Li, Yong; Khoury, Raya; Michael, Todd; Sehman, Marina; Parikh, Aparna; Stemkowski, Stephen; Bunce, Mikele

2018-06-01

Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-month mortality. End-of-life quality of care indicators included hospital admission and oncology infusions 30 days preceding death and were evaluated using logistic regression models. A generalized linear model assessed the relationship between guideline-recommended initiation of therapy and total health care costs in the 6 months post-index controlling for clinical, demographic, and treatment characteristics. Logistic models for inpatient stays and emergency department visits were also evaluated. Guideline-recommended therapy initiation was observed in 75.5% of patients. Patients not initiating guideline-recommended therapy were older, with a mean (SD) age of 72.5 (6.7) versus 71.2 (6.2) years (P = 0.001), and more frequently identified as having a low-income subsidy (30.0% vs. 16.4%; P < 0.001). Among the 24.6% of patients who died ≤ 6 months post-index, a greater percentage had not initiated guideline-recommended therapy (28.8% vs. 23.2%; P = 0.040). In adjusted models, PS (not

Tools for evaluating Lipolexis oregmae (Hymenoptera: Aphidiidae) in the field: Effects of host aphid and host plant on mummy location and color plus improved methods for obtaining adults

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singh, R.; Hoy, M.A.

Lipolexis oregmae Gahan was introduced into Florida in a classical biological control program directed against the brown citrus aphid, Toxoptera citricida (Kirkaldy), on citrus. Prior to evaluating distribution, host range, and potential nontarget effects of L. oregmae in Florida, we evaluated the role of other potential host aphids and host plants on mummy production and location. Under laboratory conditions, this parasitoid produced the most progeny on the target pest, the brown citrus aphid on citrus. This parasitoid, unlike the majority of aphidiids, did not produce mummies on any of the host plants tested when reared in black citrus aphid T.more » aurantii (Boyer de Fonscolombe) on grapefruit, spirea aphid Aphis spiraecola Patch on grapefruit and pittosporum, cowpea aphid A. craccivora Koch on grapefruit and cowpeas, or melon aphid A. gossypii Glover on grapefruit and cucumber. Thus, sampling for L. oregmae mummies of these host aphids and host plants must involve holding foliage in the laboratory until mummies are produced. This parasitoid requires high relative humidity to produce adults because no adults emerged when mummies were held in gelatin capsules, but high rates of emergence were observed when mummies were held on 1.5% agar plates. In addition, we compared the color of 6 aphid hosts and the color of mummies produced by L. oregmae when reared in them to determine if color of mummies could be used to identify L. oregmae . Mummy color varied between aphid hosts and tested host plants, and is not a useful tool for identifying L. oregmae for nontarget effects. (author) [Spanish] Lipolexis oregmae Gahan fue introducida en Florida por medio de un programa de control biologico clasico dirigido contra el afido pardo de los citricos, Toxoptera citricida (Kirkaldy), sobre Citrus. Prioritario a la evaluacion de la distribucion, el rango de los hospederos y los efectos potenciales de L. oregmae sobre los organismos que no son el enfoque de control en la

Evaluacion de los recursos potenciales del petroleo y gas, en Centro y Suramerica [Evaluation of potential petroleum and gas resources in Central and South America

USGS Publications Warehouse

Schenk, C.S.

2001-01-01

El Servicio Geológico de los Estados Unidos (USGS, por sus siglas en inglés) completó recientemente un estudio evaluativo de recursos potenciales de petróleo y gas en 130 provincias de petróleo seleccionadas en diferentes partes del mundo (USGS, 2000). De estas 130 provincias, 23 se encuentran en Suramérica, Centroamérica, y la región del Caribe (fig. 1). El estudio comprendió desde las provincias de petróleo establecidas con un largo historial de producción, como la Cuenca de Maracaibo, hasta las provincias fronterizas de poca o ninguna producción, como la Cuenca de Guyana-Suriname. No todas las provincias con historial de producción o con potencial de producción fueron evaluadas en el Estudio Evaluativo USGS 2000. Al presente, el USGS está evaluando muchas de las provincias restantes de petróleo y gas, en Centro y Suramérica. En cada provincia hemos (1) definido geológicamente el total de los sistemas de petróleo, (2) definido las unidades evaluadas que forman parte de todos los sistemas de petróleo, y (3) evaluado el volumen potencial de petróleo y gas convencional en cada unidad evaluada. Definimos un total de 26 sistemas de petróleo y 55 unidades evaluadas en las 23 provincias

The Papal Commission on Birth Control-revisited.

PubMed

Norris, Charles W

2013-02-01

The Papal Commission on Population, the Family, and Birth-rate met in Rome from 1963 to 1966. After these years of deliberation a Majority Report, written by Rev. Henri de Riedmatten, O.P., Chairman of the commission, counseled that the received Catholic and magisterial teaching of Casti connubii on the immorality of contraception be changed. Dr. Germain Grisez and Fr. John C. Ford opposed this decision and issued a Minority Report which basically was ignored by the secular press. In 1968, Pope Paul VI issued his most famous encyclical Humanae vitae, reaffirming the traditional magisterial teaching. In 2011, 44 years later, Dr. Grisez released several documents relating to these events. Following an Introduction, the author divides the work into four sections. First, the paper addresses the four part "materials prepared for Cardinal Ottaviani." Next he develops the contribution of Karol Cardinal Wojytla et al. Concerning the principles of conjugal life in 1966. Finally he provides a conclusion as to how the above topics promote natural family planning (NFP) and the constant teaching of the Catholic Church; then an addendum.

Astronomía en la cultura

NASA Astrophysics Data System (ADS)

López, A.; Giménez Benitez, S.; Fernández, L.

La Astronomía en la Cultura es el estudio interdisciplinario a nivel global de la astronomía prehistórica, antigua y tradicional, en el marco de su contexto cultural. Esta disciplina abarca cualquier tipo de estudios o líneas de investigación en que se relacione a la astronomía con las ciencias humanas o sociales. En ella se incluyen tanto fuentes escritas, relatos orales como fuentes arqueológicas, abarcando entre otros, los siguientes temas: calendarios, observación práctica, cultos y mitos, representación simbólica de eventos, conceptos y objetos astronómicos, orientación astronómica de tumbas, templos, santuarios y centros urbanos, cosmología tradicional y la aplicación ceremonial de tradiciones astronómicas, la propia historia de la astronomía y la etnoastronomía (Krupp, 1989) (Iwaniszewski, 1994). En nuestro trabajo abordamos la historia y situación actual de esta disciplina, sus métodos y sus relaciones con otras áreas de investigación.

Trombose venosa profunda e vírus chicungunha

PubMed Central

Marques, Marcos Arêas; Adami de Sá, Fernanda Penza; Lupi, Otília; Brasil, Patricia; von Ristow, Arno

2017-01-01

Resumo Algumas infecções virais sistêmicas podem estar relacionadas ao desenvolvimento de trombose venosa profunda e/ou embolia pulmonar. Essa associação já está bem descrita em pacientes com infeções pelo vírus da imunodeficiência humana (HIV), hepatite C ou influenza. Recentemente introduzido no continente americano, o vírus chicungunha, agente etiológico da febre de chicungunha, ainda não tem essa relação bem sedimentada, mas com o aumento progressivo de sua incidência e pelo fato dessa infecção causar, muitas vezes, uma restrição severa da locomoção por poliartralgia e uma possível lesão endotelial direta, casos de tromboembolismo venoso podem começar a ser descritos. Neste relato de caso, descrevemos um paciente que desenvolveu trombose de veia poplítea direita durante internação para tratamento de febre por infecção por vírus chicungunha e poliartralgia severa. PMID:29930626

Expect the unexpected: a role for behavioral economics in understanding the impact of cost-sharing on emergency department utilization.

PubMed

Tzeel, Albert; Brown, Jack

2010-07-01

AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (-58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in

Expect the Unexpected: A Role for Behavioral Economics in Understanding the Impact of Cost-Sharing on Emergency Department Utilization

PubMed Central

Tzeel, Albert; Brown, Jack

2010-01-01

Background As employers and payers address increasing healthcare costs, they resort to the tenets of classical economics: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. Objective To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. Method In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Results Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (−58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department

Early Experience with Employee Choice of Consumer-Directed Health Plans and Satisfaction with Enrollment

PubMed Central

Fowles, Jinnet Briggs; Kind, Elizabeth A; Braun, Barbara L; Bertko, John

2004-01-01

Objective To assess the initial impact of offering consumer-defined health plan (CDHP) options on employees. Data Sources/Study Setting A mail survey of 4,680 employees in the corporate offices of Humana Inc. in June 2001. Study Design The study was a cross-sectional mail survey of employees aged 18 and older who were eligible for health care benefits. The survey was conducted following open enrollment. The primary outcome is the choice of consumer-directed health plan or not; the secondary outcome is satisfaction with the enrollment process. Important covariates include sociodemographic characteristics (age, gender, race, educational level, exempt or nonexempt status, type of coverage), health status, health care utilization, and plan design preferences. Data Collection Methods A six-page questionnaire was mailed to the home of each employee, followed by a reminder postcard and two subsequent mailings to nonrespondents. Principal Findings The response rate was 66.2 percent. Seven percent selected one of the two new plan options. Because there were no meaningful differences between employees choosing either of the two new options, these groups were combined in multivariate analysis. A logistic regression modeled the likelihood of choosing the novel plan options. Those selecting the new plans were less likely to be black (odds ratio [OR] 0.46), less likely to have only Humana coverage (OR 0.30), and more likely to have single coverage (OR 1.77). They were less likely to have a chronic health problem (OR 0.56) and more likely to have had no recent medical visits (OR 3.21). They were more likely to believe that lowest premiums were the most important plan attribute (OR 2.89) and to think there were big differences in the premiums of available plans (OR 5.19). Employees in fair or poor health were more likely to have a difficult time during the online enrollment process. They were more likely to find the communications very helpful (OR 0.42) and the benefits

Estándares Consolidados de Reporte de Evaluaciones Económicas Sanitarias: Versión en Español de la Lista de Comprobación CHEERS.

PubMed

Augustovski, Federico; García Martí, Sebastián; Pichon-Riviere, Andrés

2013-12-01

It is important to have adequate and updated guides for reporting health economic evaluations (HEE). Due to their nature and methodological complexity, HEE have particular challenges for adequate reporting, which can be greater than more traditional study designs such as randomized controlled trials. CHEERS (Consolidated Health Economic Evaluation Reporting Standards) have recently been published in English. Our objectives were to adapt the CHEERS list to Spanish. We followed the recommended methods of the Equator (Enhancing the Quality and Transparency Of health Research) network. We made an initial translation to Spanish, a back translation to English, and an initial Spanish version that was circulated through ISPOR and REDETSA. Finally, a final Spanish version was consolidated. The list contains 24 items grouped in Title and Abstract; Introduction; Methods; Results; Discussion; and Other (which included conflict of interest reporting). The scope of use is independent of methodological vehicle (either single-study or evidence synthesis-based HEE); type of strategies to evaluate (clinical or public health; preventive, diagnostic, curative, palliative). Most of the items are generic and apply to any study design; while some of them are particularly oriented to single-study or evidence-synthesis/modeling studies. Diffusion and use of the CHEERS checklist in Spanish will contribute to a more consistent and transparent reporting of health economic evaluations in Spanish speaking contexts. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Evidence of Critical Thinking in High School Humanities Classrooms (Evidencias del Pensamiento Crítico en las Clases de Ciencias Humanas en Bachillerato)

ERIC Educational Resources Information Center

Alfonso, David Vargas

2015-01-01

Critical thinking skills (CTS) are a group of higher order thinking abilities related with complex processes of learning like contextualization or problem solving. This exploratory research study identified whether critical thinking skills were present in high school humanities classrooms. The study was carried out in a private school in Bogotá,…

Group A rotavirus gastroenteritis: post-vaccine era, genotypes and zoonotic transmission.

PubMed

Luchs, Adriana; Timenetsky, Maria do Carmo Sampaio Tavares

2016-01-01

ABSTRACTThis article provides a review of immunity, diagnosis, and clinical aspects of rotavirus disease. It also informs about the changes in epidemiology of diarrheal disease and genetic diversity of circulating group A rotavirus strains following the introduction of vaccines. Group A rotavirus is the major pathogen causing gastroenteritis in animals. Its segmented RNA genome can lead to the emergence of new or unusual strains in human populations via interspecies transmission and/or reassortment events.RESUMOEste artigo fornece uma revisão sobre imunidade, diagnóstico e aspectos clínicos da doença causada por rotavírus. Também aponta as principais mudanças no perfil epidemiológico da doença diarreica e na diversidade genética das cepas circulantes de rotavírus do grupo A, após a introdução vacinal. O rotavírus do grupo A é o principal patógeno associado à gastroenterite em animais. Seu genoma RNA segmentado pode levar ao surgimento de cepas novas ou incomuns na população humana, por meio de transmissão entre espécies e eventos de rearranjo.

Accounting for the Impact of Conservation on Human Well-Being

PubMed Central

Milner-Gulland, EJ; Mcgregor, JA; Agarwala, M; Atkinson, G; Bevan, P; Clements, T; Daw, T; Homewood, K; Kumpel, N; Lewis, J; Mourato, S; Palmer Fry, B; Redshaw, M; Rowcliffe, JM; Suon, S; Wallace, G; Washington, H; Wilkie, D

2014-01-01

Los conservacionistas cada vez más se comprometen con el concepto del bienestar humano para mejorar el diseño y la evaluación de sus intervenciones. Desde la convención de la influyente Comisión Sarkozy en 2009, los investigadores del desarrollo han estado refinando las conceptualizaciones y los marcos de trabajo para entender y medir el bienestar humano y están comenzando a convergir con un entendimiento común de cuál es la mejor forma de hacer esto. En la conservación el término bienestar humano tiene un uso amplio, pero existe la necesidad de la orientación en su operación para medir los impactos de las intervenciones de la conservación sobre la gente. Presentamos un marco de trabajo para entender el bienestar humano que podría ser útil particularmente en la conservación. El marco de trabajo incluye tres condiciones: cumplir con las necesidades, perseguir objetivos y experimentar una calidad satisfactoria de vida. Resumimos algunas de las complejidades involucradas en la evaluación de los efectos del bienestar de las intervenciones de la conservación con el entendimiento de que el bienestar varía entre la gente, en el tiempo y con las prioridades del evaluador. Los retos clave para la investigación de los impactos del bienestar de las intervenciones de la conservación incluyen la necesidad de crear una colección de estudios de caso para trazar lecciones generalizables: hacer uso del potencial de la tecnología moderna para apoyar la investigación del bienestar; y contextualizar espacial y temporalmente las evaluaciones de los impactos de la conservación sobre el bienestar dentro del marco más amplio del cambio social. Existen caminos que atraviesan la confusión que rodea al término bienestar, y los marcos de trabajo existentes, como el del acercamiento de Bienestar en Países en Desarrollo, pueden ayudar a los conservacionistas a negociar los obstáculos de la operación del concepto. Los conservacionistas tienen la oportunidad de

Pilot assessment of mercury exposure in selected biota from the lowlands of Nicaragua [Evaluacion piloto de exposicion al mercurio en biota selecta de las tierras bajas de Nicaragua

Treesearch

O.P. Lane; W.J. Arendt; M.A. Torrez; J.C. Gamez Castellon

2013-01-01

Methylmercury, a potent neurotoxin, can damage health of humans and wildlife. In 2012, we collected 73 blood and feather samples from birds among diverse foraging guilds to assess mercury exposure in wetland habitats associated with Lakes Managua and Nicaragua. Blood levels (0.72 parts per million) in a piscivorous Neotropic Cormorant Phalacrocorax brasilianus from...

Preliminary evaluation of thermal and nonthermal waters at selected sites in Panama, Central America. Evaluacion preliminar de aguas termales y no termales de sitios seleccionados en Panama, Centroamerica

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shevenell, L.

1989-11-01

Thirty-one thermal and nonthermal water samples were collected in Panama by the Instituto de Recursos Hidraulicos y Electrificacion and analyzed by the Earth and Space Sciences Division at Los Alamos National Laboratory to evaluate the geothermal potential of four different areas. Chemical and isotopic analyses were performed on each sample. Because samples from several areas were submitted, the chemistry of the samples is varied, with total dissolved solids of thermal fluids ranging from 900 to nearly 10,000 mg/{ell}. All water samples studied are meteoric in origin, and none of the thermal waters exhibit an {sup 18}O enrichment, which is characteristicmore » of high-temperature isotopic, exchange between water and rock. At all four areas, calculated geothermometer temperatures within a reservoir of less than 160{degrees}C. 4 refs., 4 figs., 6 tabs.« less

Nigral dopamine type-1 receptors are reduced in Huntington's disease: A postmortem autoradiographic study using ( sup 3 H)SCH 23390 and correlation with ( sup 3 H)forskolin binding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Filloux, F.; Wagster, M.V.; Folstein, S.

1990-11-01

Intrastriatal injection of excitatory amino acids, particularly quinolinic acid, has been proposed as an animal model of Huntington's disease. Such neurotoxic lesions of caudate-putamen result in marked dopamine type-1 (D1) receptor losses in the injected nuclei as well as in the ipsilateral substantia nigra pars reticulata. Postmortem human substantia nigra from Huntington's disease brains and from control brains were examined using in vitro autoradiography. A marked reduction in ({sup 3}H)SCH 23390 binding (labeling D1 receptors) in the substantia nigra of postmortem brains of Huntington's patients was identified, thus paralleling the alterations seen in the animal models. A positive, statistically significantmore » correlation was also encountered between D1 receptor binding (labeled by ({sup 3}H)SCH 23390) and ({sup 3}H)forskolin binding (which identifies adenylate cyclase, a second messenger system linked to D1 receptor activation). The results suggest that in the human--as in lower vertebrates--D1 receptors are located on striatonigral terminals and that D1 receptor loss tends to be paralleled by a reduction in adenylate cyclase. Radioactive agents selective for the D1 receptor may prove useful in future studies of Huntington's disease using positron emission tomography scanning.« less

Polygalacturonase and ethanol production in Kluyveromyces marxianus: potential use of polygalacturonase in foodstuffs.

PubMed

Serrat, Manuel; Bermúdez, Rosa C; Villa, Tomás G

2004-04-01

The coproduction of ethanol and polygalacturonase (PG) in a pilot-scale batch fermentor using yeast extract--glucose (YD)--and sugar beet molasses (SBM)-based media was implemented utilizing a new high-PG-producing strain of Kluyveromyces marxianus. A certain growth inhibition was observed in SBM medium, causing ethanol and PG production to be lower. Ethanol productivity and accumulation values of 1.94 g/(L x h) and 40 g/L, respectively, were attained in YD, whereas the best fermentation efficiency (95.1%) was achieved with SBM medium. Maximal PG synthesis occurred at the end of cell growth, with values of 1.08 and 0.46 U/(mg x h) for the YD and SBM media, respectively. When the cultures reached stationary phase, PG production stopped. The highest accumulation level (17 U/mL) occurred in YD medium, in agreement with previous laboratory-scale studies carried out for this strain. The potential applications of the crude enzyme preparations were evaluated with different fruit juices and vegetable slices. The enzyme was able to increase the filtration rate of orange, pear, and apple juices by twofold. Additionally, complete clarification of apple juice was readily accomplished, whereas cucumber, carrot, and banana tissues were macerated to a lesser extent. Copyright 2004 Humana Press Inc.

Re-Creating Missing Population Baselines for Pacific Reef Sharks

PubMed Central

Nadon, Marc O; Baum, Julia K; Williams, Ivor D; Mcpherson, Jana M; Zgliczynski, Brian J; Richards, Benjamin L; Schroeder, Robert E; Brainard, Russell E

2012-01-01

that density of reef sharks has declined to 3–10% of baseline levels in these areas. Resumen Los tiburones y otros depredadores mayores son escasos en la mayoría de los arrecifes de coral, pero estudios de su ecología histórica proporcionan evidencia cualitativa de que los depredadores una vez fueron numerosos en estos ecosistemas. Sin embargo, la cuantificación de la densidad de tiburones en ausencia de humanos (línea de base) es obstaculizada por la falta de datos de series de tiempo pertinentes. Recientemente, los investigadores han utilizado muestreos visuales submarinos, de extensión espacial limitada o de diseño no estándar, para inferir asociaciones negativas entre la abundancia de tiburones de arrecife y las poblaciones humanas. Analizamos datos de 1607 muestreos por remolque de buzos (transectos >1ha muestreados por observadores remolcados por una lancha) realizados en 46 arrecifes en el Océano Pacífico centro-occidental, arrecifes que incluyeron algunos de los más prístinos del mundo. Las estimaciones de densidad de tiburones fue sustancialmente menor (<10%) que estimaciones publicadas a partir de muestreos a lo largo de transectos pequeños (<0.02 ha), lo cual no es consistente con las pirámides de biomasa invertidas (la biomasa de depredadores es mayor que la biomasa de presas) reportadas para arrecifes prístinos por otros autores. Examinamos la relación entre la densidad de tiburones de arrecife observados en los muestreos por remolque de buzos y la población humana en modelos y consideramos la influencia de la productividad oceánica primaria, la temperatura de la superficie del mar, la superficie del arrecife y su complejidad física. Utilizamos estos modelos para estimar la densidad de tiburones en ausencia de humanos. Las densidades de Carcharhinus amblyrhynchos, Triaenodon obesus y el grupo de “tiburones estrictamente arrecifales” incrementó sustancialmente a medida que disminuyó la población humana y que incrementó la

Status and distribution of Chihuahuan Desert Grasslands in the United States and Mexico (Evaluacion del estado y distribucion de los pastizales del Desierto Chihuahuense en los Estados Unidos y Mexico)

Treesearch

Martha Desmond; Jennifer Atchley Montoya

2006-01-01

Grasslands comprise a small part of the Chihuahuan Desert but are vital to the biological diversity of the ecoregion. Characteristic grasses of the Chihuahuan Desert are tobosa (Pleuraphis mutica) and black grama (Bouteloua eriopoda) but other common species include alakali sacaton (Sporobolus airoides), big alkali sacaton (S. wrightii), mesa dropseed (S. flexuosus),...

"La Evaluacion de la Actuacion Oral de los Hispanoparlantes Bilingues Mediante las Directrices de ACTFL (Evaluation of the Oral Presentation of the Bilingual Spanish Speaking Professionals by Moderators of the ACTFL).

ERIC Educational Resources Information Center

Alonso, Esther

1997-01-01

Discusses the validity of a rating scale created by the American Council on the Teaching of Foreign Languages for the purpose of measuring the oral language proficiency of bilingual professionals who are speakers of English and Spanish. Notes that this scale measures various levels of competence and features of an individual's speech. (14…

Evaluacion de Programas de Alfabetizacion. Consulta Tecnica Regional (Maracaibo, Venezuela, 30 Noviembre-6 Diciembre 1987) Informe Final. (Evaluation of Literacy Programs. Regional Technical Meeting (Maracaibo, Venezuela, November 30-December 6, 1987).

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Santiago (Chile). Regional Office for Education in Latin America and the Caribbean.

The objectives of this seminar were to identify problems in evaluating literacy programs and to design a working strategy to confront them. Four presentations included national case studies from Brazil, Honduras, Nicaragua, and Venezuela. Central questions asked concerned who and what were evaluated and how were the results to be used. In Brazil,…

[80 years of soial service in medicine].

PubMed

Hace 80 años, la Escuela de Medicina de la Universidad Nacional, en voz de su director, Gustavo Baz Prada, hizo una propuesta que pronto se convirtió en realidad y finalmente en norma, la que desde entonces se conoce como SS. Esta iniciativa se vio como una manera para que los estudiantes de medicina del último año retribuyeran a la sociedad una parte de lo que esta invirtió en su educación, consolidaran su formación mediante la exposición a las realidades de todos los días en los medios más necesitados, se pusieran a prueba sobre sus verdaderas capacidades para atender pacientes y participaran en la solución de un problema de atención sanitaria que en ese entonces era mucho más apremiante que ahora. Unos años después, los recién egresados de otras licenciaturas (pasantes) también fueron incorporados a esta estrategia y, al fin, se reconoció formalmente como una responsabilidad de las instituciones educativas. Las aportaciones del SS a la salud de las personas y a la formación de los médicos han sido incuestionables, y la experiencia humana que ha representado para quienes lo han vivido ha dejado marcas indelebles.

All-Cause, Stroke/Systemic Embolism-, and Major Bleeding-Related Health-Care Costs Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants.

PubMed

Deitelzweig, Steve; Luo, Xuemei; Gupta, Kiran; Trocio, Jeffrey; Mardekian, Jack; Curtice, Tammy; Hlavacek, Patrick; Lingohr-Smith, Melissa; Menges, Brandy; Lin, Jay

2018-05-01

In this study, all-cause, stroke/systemic embolism (SE)-related, and major bleeding (MB)-related health-care costs among elderly patients with nonvalvular atrial fibrillation (NVAF) initiating treatment with different oral anticoagulants (OACs) were compared. Patients ≥65 years of age initiating OACs, including apixaban, rivaroxaban, dabigatran, and warfarin, were identified from the Humana Research Database between January 1, 2013, and September 30, 2015. Propensity score matching was used to separately match the different OAC cohorts with the apixaban cohort. All-cause health-care costs and stroke/SE-related and MB-related medical costs per patient per month (PPPM) were compared using generalized linear or 2-part regression models. Compared to apixaban, rivaroxaban was associated with significantly higher all-cause health-care costs (US$2234 vs US$1846 PPPM, P < .001) and MB-related medical costs (US$106 vs US$47 PPPM, P < .001), dabigatran was associated with significantly higher all-cause health-care costs (US$1980 vs US$1801 PPPM, P = .007), and warfarin was associated with significantly higher all-cause health-care costs (US$2386 vs US$1929 PPPM, P < .001), stroke/SE-related medical costs (US$42 vs US$18 PPPM, P < .001), and MB-related medical costs (US$132 vs US$51 PPPM, P < .001). Among elderly patients with NVAF, other OACs were associated with higher all-cause health-care costs than apixaban.

Forthcoming ethical issues in biological psychiatry.

PubMed

Helmchen, Hanfried

2005-01-01

Ethical issues in biological psychiatry are framed by (i) progress in the neurosciences, and (ii) a changing socio-cultural context. With regard to forthcoming neurotechniques to modify specifically defined brain functions by pharmacological substances with selective effects, by activating neuroplasticity including neurogenesis, or by implantation of neuronal tissues or computer-brain interfaces, etc., ethical problems will develop (i) at the border between therapy of diseases and enhancement of abilities in healthy people with regard to effects on society (e.g., social justice: equal access, loss of societal diversity) as well as on human value systems (e.g., personality, efforts, conditio humana), and (ii) at the border between the medical system and the wellness market with regard to financing what by whom? Ethical dilemmas in psychiatry develop (i) between the individual's best and the common good (demanded from outside medicine), (ii) among different ethical principles (inside medicine), iii) if solutions are influenced by personal reasons without observing ethical principles. Ethical guidelines are necessary for ethical orientation, but may protect against misconduct only (i) if psychiatrists are educated in ethics and (ii) if psychiatric acting is under continuous debate (by ethical review boards or the public). Thus, if we psychiatrists will become ethically sensitive by reflecting and perhaps solving our current ethical dilemmas we will be prepared to deal with forthcoming ethical issues in biological psychiatry.

Revision curricular a partir de un analisis comparativo de las discrepancias en los curriculos de una escuela de optometria en Puerto Rico con las competencias requeridas para las agencias de revalida y acreditacion 2004

NASA Astrophysics Data System (ADS)

Rivera Pacheco, Andres

El proposito de esta investigacion, un estudio cualitativo de caso, fue comparar y contrastar el curriculo vigente de la Escuela de Optometria de la UIAPR con las competencias y estandares requeridos por las agencias de acreditacion y de revalida. Con este proposito, decidimos realizar una revision y un analisis de documentos: el prontuario de cada uno de los cursos de los curriculos implantados en el 1993 y en el 2001; las competencias y estandares establecidos por las agencias de revalida y de acreditacion; y las estadisticas en las que se analiza el porcentaje de estudiantes que aprueban cada una de las partes de los examenes de revalida entre el 1998 al 2003. Se realizaron entrevistas dirigidas para dar apoyo y complementar la revision y el analisis de estos documentos. Los participantes de las entrevistas fueron tres estudiantes de la clase de optometria del 2004 (ultima clase del curriculo del 1993); tres estudiantes de la clase de optometria del 2005 (primera clase graduanda del curriculo vigente) y tres profesores y/o directores de los Departamentos de Ciencias Basicas, Ciencias Clinicas y Cuidado al Paciente. Esta investigacion se enmarco en el modelo de evaluacion curricular de discrepancia de Malcolm Provus y en el modelo de desarrollo basado en competencias. Uno de los hallazgos mas importantes del estudio es que los cambios que se implantaron al curriculo del 2001 no han logrado que los estudiantes mejoren su ejecucion en los examenes de revalida. Por otro lado, se encontro que el curriculo vigente atiende completamente los estandares de la practica de Optometria, pero no las competencias. Esta informacion fue validada mediante el uso de una tabla de cotejo para el analisis de los cursos y de la informacion obtenida de las entrevistas. El estudio determina y concluye que existen discrepancias entre los prontuarios de los cursos del curriculo y las competencias requeridas por la agencia de revalida. Segundo, que el Departamento de Ciencias Basicas es el

Implementación de un modelo de capacitación multimedial para brindar orientación alimentaria a los beneficiarios de un programa de ayuda social en México.

PubMed

Amaya-Castellanos, Maritza Alejandra; Morales-Ruan, María Del Carmen; Uribe-Carvajal, Rebeca; Jiménez-Aguilar, Alejandra; Salazar-Coronel, Araceli Apolonia; Martínez-Tapia, Brenda; Shamah-Levy, Teresa

2018-03-01

Introducción: Se implementó un modelo de capacitación en orientación alimentaria para la población beneficiaria y el personal operativo del Programa de Abasto Rural (PAR) de Diconsa, el cual es una iniciativa social de ayuda alimentaria que abastece productos básicos y complementarios, además de brindar capacitación en localidades de alta marginación en México. Objetivo: Documentar la utilización de la Metodología de Capacitación Multimedial (MCM) en el desarrollo de un esquema de capacitación sobre orientación alimentaria y su implementación en la población beneficiaria del PAR, a través de la propia estructura operativa del PAR. Metodología: El modelo se fundamenta en la MCM, integrada por cuatro elementos didácticos e indivisibles que conforman el paquete pedagógico multimedial (PPM), compuesto a su vez por tres videos y rotafolios, material impreso, prácticas y las relaciones interpersonales. Los ejes temáticos fueron: alimentación correcta para una vida saludable, alimentación materno-infantil, elecciones saludables y gasto familiar. El modelo fue replicado en cascada en los tres niveles operativos del PAR (responsables de capacitación, supervisores operativos y beneficiarios del PAR), con un componente de multiplicación horizontal, e implementado como piloto en cuatro estados de México. Resultados: Se observó un cambio positivo sobre los conocimientos en alimentación correcta en todos los niveles de capacitación, principalmente en los beneficiarios del PAR. La evaluación del proceso mostró conocimientos previos de los responsables de capacitación en los temas, buen desempeño como facilitadores, y habilidades de presentación y manejo del grupo de los supervisores operativos. A partir de las evaluaciones y del acompañamiento en la prueba piloto, fueron modificados las actividades, las estrategias y los materiales educativos del PPM. Conclusiones: La capacitación multimedial y la educación nutricional promueven procesos de

La preparacion en ciencia de los candidatos a maestros del nivel elemental primario segun la reforma de la educacion cientifica en Puerto Rico: Una propuesta de secuencia curricular

NASA Astrophysics Data System (ADS)

Rodriguez Plaza, Evelyn

El proposito de esta investigacion fue identificar los componentes de la preparacion en ciencia que deben recibir los estudiantes del Bachillerato en Artes en Educacion Elemental, Nivel Primario, de acuerdo a los documentos que dirigen la reforma de la educacion cientifica en Puerto Rico. Tambien, se identificaron los componentes de los cursos que forman parte de la preparacion en ciencia de estos estudiantes. Se compararon los componentes de la preparacion en ciencia y los componentes de los cursos para determinar congruencias y discrepancias. Con los datos recopilados se identificaron los componentes de los cursos de una secuencia curricular para la preparacion en ciencia de los candidatos a maestros del nivel elemental primario. La secuencia curricular que se propone en esta investigacion incluye cursos de contenido cientifico y de metodologia en la ensenanza de la ciencia disenados para satisfacer las necesidades de los candidatos. Se recomienda que en los procesos para el diseno, la implantacion y la evaluacion de estos cursos participen profesores de ciencia, profesores de educacion y maestros del nivel elemental primario. Todos los cursos de la secuencia curricular deben tener un enfoque constructivista. Las experiencias educativas que se incluyan en los cursos deben aspirar a desarrollar en los candidatos los atributos de la cultura cientifica y actitudes positivas hacia la ciencia y hacia la ensenanza de esta disciplina. El modelaje por parte de los profesores que ensenen los cursos de la secuencia curricular es fundamental en el desarrollo profesional de los candidatos. Se recomienda que en los cursos de contenido cientifico se estudien los conceptos y los conocimientos cientificos que forman parte del curriculo de Kindergarten a tercer grado de forma integrada y con una profundidad universitaria. Estos cursos deben tener un enfoque interdisciplinario e incluir el estudio de la naturaleza de la ciencia y un componente de laboratorio para desarrollar los

Primera Reunion de la Comision Nacional de Analisis y Evaluacion del Sistema Educativo: Informe Final (The First Meeting of the National Committee for Analysis and Evaluation of the Educational System: Final Report).

ERIC Educational Resources Information Center

Ministerio de Cultura y Educacion, Buenos Aires (Argentina). Centro National de Documentacion e Informacion Educativa.

This document contains the legislation creating the National Committee for Analysis and Evaluation of the Educational System and the final report of that committee's first meeting. The report deals with each level from elementary to higher education. For each level it describes and considers curriculum, school buildings, human resources, current…

ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.

PubMed

Mehta, Shivan J; Polsky, Daniel; Zhu, Jingsan; Lewis, James D; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin G

2015-07-01

The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group. We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only. There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive. The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.

Association of obesity with healthcare utilization and costs in a Medicare population.

PubMed

Suehs, Brandon T; Kamble, Pravin; Huang, Joanna; Hammer, Mette; Bouchard, Jonathan; Costantino, Mary E; Renda, Andrew

2017-12-01

To examine the association of obesity with healthcare resource utilization and costs in a Medicare population. This study was a retrospective cohort study using Humana Medicare Advantage (MA) claims data. Body mass index (BMI) was assessed using ICD-9-CM status codes (V85 hierarchy) that have been validated in the data source to classify patients into BMI categories: normal (N), overweight (Ow), obese class I (ObI), obese class II (ObII), and obese class III (ObIII). Healthcare resource utilization (HRU) and costs were determined based on claims data. Descriptive statistics were used to examine baseline characteristics and HRU across BMI classes. Multivariable analysis was used to examine the association between BMI class and outcome measures. Among the 172,866 patients aged ≥65 years that were identified, BMI distribution was: N, 21%; Ow 37%; ObI, 24%, ObII, 10%; and ObIII, 9%. Inpatient, emergency department and outpatient utilization increased with greater BMI level, and greater BMI level was associated with higher total healthcare, medical and pharmacy costs. Greater prevalence of several cardiometabolic conditions, total medication use, and use of specific medication classes was observed with increasing BMI class. Greater BMI was associated with greater HRU and costs and observed increase in prevalence of cardiometabolic conditions. These results reflect an urgent need to address the epidemic of obesity and the resulting excessive clinical and economic burden on the healthcare system.

Las dificultades de sentir: el rol de las emociones en la estigmatización del VIH/SIDA

PubMed Central

MARZÁN-RODRÍGUEZ, Melissa; VARAS-DÍAZ, Nelson

2009-01-01

Resumen El Virus de Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han sido motivo de estigmatización para las personas que viven con ellos. Esta estigmatización se ha estudiado consecuentemente desde la perspectiva de opiniones de agentes estigmatizantes. Estas opiniones han obviado sistemáticamente el rol de las emociones en el proceso de estigmatización. Llevamos a cabo este estudio con el propósito de identificar el rol de las emociones en el proceso de estigmatización de las personas que viven con el virus (PVVS) por parte de profesionales de la salud. Para lograr este objetivo utilizamos un diseño exploratorio y cualitativo en el cual utilizamos la técnica de entrevistas semiestructuradas a profundidad. La muestra estuvo compuesta por 80 profesionales de la salud y estudiantes de las siguientes especialidades: psicología, trabajo social, medicina y enfermería. Los resultados reflejaron la existencia de emociones asociadas al VIH/SIDA tales como pena, lástima, compasión, asco, fobia y miedo entre los/as profesionales y estudiantes que participaron. Las personas participantes evidenciaron la necesidad de controlar sus emociones al interactuar con PVVS. Los resultados apuntan a la necesidad de explorar aquellos factores que mediatizan las emociones, tales como el contexto social en que se manifiestan y ante quiénes se revelan, para lograr entender a cabalidad el estigma que rodea al VIH/SIDA. PMID:20212916

Astronomía para ciegos y amblíopes. Proyecto de construcción de un planetario especial en la ciudad de Mar del Plata

NASA Astrophysics Data System (ADS)

Musso, S.

?`Qué es la Astronomía para Ciegos?. El trabajo es una adaptación en base a la escala de magnitudes de Hipparco que cambia el concepto de luz por una adaptación sonora, donde las estrellas de magnitud 6 se escuchan en 10 dB, más o menos lo que consideramos el umbral de la audición humana. Quienes no escuchan muy bien no pueden escuchar las magnitudes 6, de la misma manera que muchos de nosotros, que no poseemos una visión perfecta, no podemos observar esas mismas estrellas en el cielo (más allá de la polución). A los astros de magnitud 5 vamos a relacionarlos a un sonido en 20 dB. Y así sucesivamente. También los colores estarán representados en una convención de graves a agudos y lo mismo algunas características del cielo. Por ejemplo, la Vía Láctea se mostrará como un ``ruido", como bien nos lo hicieron ver nuestros futuros destinatarios. En Mar del Plata nos encontramos ya trabajando en un proyecto que tiene como objetivo final la construcción del Primer Planetario Acústico del Mundo, una herramienta para la enseñanza de la astronomía, un espacio para la lucha contra la discriminación del discapacitado y una posibilidad de ``ver el cielo de un modo diferente".

The five traps of performance measurement.

PubMed

Likierman, Andrew

2009-10-01

Evaluating a company's performance often entails wading through a thicket of numbers produced by a few simple metrics, writes the author, and senior executives leave measurement to those whose specialty is spreadsheets. To take ownership of performance assessment, those executives should find qualitative, forward-looking measures that will help them avoid five common traps: Measuring against yourself. Find data from outside the company, and reward relative, rather than absolute, performance. Enterprise Rent-A-Car uses a service quality index to measure customers' repeat purchase intentions. Looking backward. Use measures that lead rather than lag the profits in your business. Humana, a health insurer, found that the sickest 10% of its patients account for 80% of its costs; now it offers customers incentives for early screening. Putting your faith in numbers. The soft drinks company Britvic evaluates its executive coaching program not by trying to assign it an ROI number but by tracking participants' careers for a year. Gaming your metrics. The law firm Clifford Chance replaced its single, easy-to-game metric of billable hours with seven criteria on which to base bonuses. Sticking to your numbers too long. Be precise about what you want to assess and explicit about what metrics are assessing it. Such clarity would have helped investors interpret the AAA ratings involved in the financial meltdown. Really good assessment will combine finance managers' relative independence with line managers' expertise.

PubMed

Marzán-Rodríguez, Melissa; Varas-Díaz, Nelson

2006-01-01

El Virus de Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han sido motivo de estigmatización para las personas que viven con ellos. Esta estigmatización se ha estudiado consecuentemente desde la perspectiva de opiniones de agentes estigmatizantes. Estas opiniones han obviado sistemáticamente el rol de las emociones en el proceso de estigmatización. Llevamos a cabo este estudio con el propósito de identificar el rol de las emociones en el proceso de estigmatización de las personas que viven con el virus (PVVS) por parte de profesionales de la salud. Para lograr este objetivo utilizamos un diseño exploratorio y cualitativo en el cual utilizamos la técnica de entrevistas semiestructuradas a profundidad. La muestra estuvo compuesta por 80 profesionales de la salud y estudiantes de las siguientes especialidades: psicología, trabajo social, medicina y enfermería. Los resultados reflejaron la existencia de emociones asociadas al VIH/SIDA tales como pena, lástima, compasión, asco, fobia y miedo entre los/as profesionales y estudiantes que participaron. Las personas participantes evidenciaron la necesidad de controlar sus emociones al interactuar con PVVS. Los resultados apuntan a la necesidad de explorar aquellos factores que mediatizan las emociones, tales como el contexto social en que se manifiestan y ante quiénes se revelan, para lograr entender a cabalidad el estigma que rodea al VIH/SIDA.

Further genetic characterization of the two Trypanosoma cruzi Berenice strains (Be-62 and Be-78) isolated from the first human case of Chagas disease (Chagas, 1909).

PubMed

Cruz, R E; Macedo, A M; Barnabé, C; Freitas, J M; Chiari, E; Veloso, V M; Carneiro, C M; Bahia, M T; Tafuri, Washington L; Lana, M

2006-03-01

We describe here an extension of a previous genetic characterization of Trypanosoma cruzi strains (Be-62 and Be-78) isolated from the patient Berenice, the first human case of Chagas disease [Chagas, C., 1909. Nova Tripanomíase humana. Estudos sobre morfologia e o ciclo evolutivo do Schizotrypanum cruzi, n. gen., n. sp., agente etiolójico da nova entidade morbida do homem. Mem. Inst. Oswaldo Cruz 1, 159-218]. We wanted to verify the composition of T. cruzi populations originated from these two isolates. In the present work, 22 enzymatic loci (MLEE), nine RAPD primers and 7 microsatellite loci were analyzed. Clones from both strains were also characterized to verify whether these strains are mono or polyclonal. Be-62 and Be-78 strains were different in 3 out of 22 enzymatic systems, in 3 out of 9 RAPD primers tested and in all microsatellite loci investigated. However, our data suggests that both strains are phylogenetically closely related, belonging to genetic group 32 from Tibayrenc and Ayala [Tibayrenc, M., Ayala, F.J., 1988. Isoenzime variability in Trypanosoma cruzi, the agent of Chagas' disease: genetical, taxonomical, and epidemiological significance. Evolution 42, 277-292], equivalent to zymodeme 2 and T. cruzi II major lineage which, in Brazil, comprises parasites from the domestic cycle of the disease. Microsatellite analyses showed differences between the parental strains but suggested that both populations are monoclonal since each strain and their respective clones showed the same amplification products.

RELAGH - The challenge of having a scientific network in Latin America: An account from the presidents.

PubMed

Rojas-Martínez, Augusto; Giraldo-Ríos, Alejandro; Jiménez-Arce, Gerardo; de Vargas, Aída Falcón; Giugliani, Roberto

2014-03-01

Latin America and the Caribbean region make up one of the largest areas of the world, and this region is characterized by a complex mixture of ethnic groups sharing Iberian languages. The area is comprised of nations and regions with different levels of social development. This region has experienced historical advances in the last decades to increase the minimal standards of quality of life; however, several factors, such as concentrated populations in large urban centers and isolated and poor communities, still have an important impact on medical services, particularly genetics services. Latin American researchers have greatly contributed to the development of human genetics and historic inter-ethnic diversity, and the multiplicity of geographic areas are unique for the study of gene-environment interactions. As a result of regional developments in the fields of human and medical genetics, the Latin American Network of Human Genetics (Red Latinoamericana de Genética Humana - RELAGH) was created in 2001 to foster the networking of national associations and societies dedicated to these scientific disciplines. RELAGH has developed important educational activities, such as the Latin American School of Human and Medical Genetics (ELAG), and has held three biannual meetings to encourage international research cooperation among the member countries and international organizations. Since its foundation, RELAGH has been admitted as a full regional member to the International Federation of Human Genetics Societies. This article describes the historical aspects, activities, developments, and challenges that are still faced by the Network.

[Itraconazole and secnidazole capsules vs. vaginal ovules of fluocinolone acetonide, nystatin and metronidazole in the symptomatic treatment of vaginitis].

PubMed

Alvarado García, A; Gaviño Ambriz, S

1998-04-01

Evaluation of oral treatment in vaginitis and vaginosis using Itraconazol and sechidazol, in comparison to topic treatment using vaginal ovules of acetonido of fluocinolona 0.50 mg, nistatina 100,000 U and metronidazol 500 mg. Longitudinal, prospective and open comparative study. Servicio de Reproducción Humana(Human Reproduction Department), Centro Médico Nacional "20 de Noviembre". Forty female patients, without any relevant differences in their general characteristics, chose diagnosis was vaginitis and vaginosis, who were medically treated through external consultation, divided in two groups of twenty each one. Group 1 oral treatment with itraconazol and secnidazol. Group 2 had topic treatment with fluocinolona, nistatina and metronidazol. All of the patients were controlled in seven and fourteen days time, in order to evaluate the intensity of their clinical symptomatology, as well as the efficacy in both ways of treatment. Leukorrhea was the most important symptom in all the cases, going from minor to serious white discharge. After the treatment, we found a relevant difference statistically significative in patients treated with intraconazol and secnidazol. We did not find any differences in relation to ardor, pruritus, dispareunia and disuria at post-treatment evaluation. However, group 1 betterment was statistically significative between the first and the seventh days of treatment. Treating vaginitis or vaginosis (or both) with itraconazol and secnidazol takes less time for betterment in addition to comfort and easiness of oral administration; therefore, we consider them proper medicines in these specific cases.

Chemical and Physical Signatures for Microbial Forensics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cliff, John B.; Kreuzer, Helen W.; Ehrhardt, Christopher J.

Chemical and physical signatures for microbial forensics John Cliff and Helen Kreuzer-Martin, eds. Humana Press Chapter 1. Introduction: Review of history and statement of need. Randy Murch, Virginia Tech Chapter 2. The Microbe: Structure, morphology, and physiology of the microbe as they relate to potential signatures of growth conditions. Joany Jackman, Johns Hopkins University Chapter 3. Science for Forensics: Special considerations for the forensic arena - quality control, sample integrity, etc. Mark Wilson (retired FBI): Western Carolina University Chapter 4. Physical signatures: Light and electron microscopy, atomic force microscopy, gravimetry etc. Joseph Michael, Sandia National Laboratory Chapter 5. Lipids: FAME,more » PLFA, steroids, LPS, etc. James Robertson, Federal Bureau of Investigation Chapter 6. Carbohydrates: Cell wall components, cytoplasm components, methods Alvin Fox, University of South Carolina School of Medicine David Wunschel, Pacific Northwest National Laboratory Chapter 7. Peptides: Peptides, proteins, lipoproteins David Wunschel, Pacific Northwest National Laboratory Chapter 8. Elemental content: CNOHPS (treated in passing), metals, prospective cell types John Cliff, International Atomic Energy Agency Chapter 9. Isotopic signatures: Stable isotopes C,N,H,O,S, 14C dating, potential for heavy elements. Helen Kreuzer-Martin, Pacific Northwest National Laboratory Michaele Kashgarian, Lawrence Livermore National Laboratory Chapter 10. Extracellular signatures: Cellular debris, heme, agar, headspace, spent media, etc Karen Wahl, Pacific Northwest National Laboratory Chapter 11. Data Reduction and Integrated Microbial Forensics: Statistical concepts, parametric and multivariate statistics, integrating signatures Kristin Jarman, Pacific Northwest National Laboratory« less

The Vocal Tract Organ: A New Musical Instrument Using 3-D Printed Vocal Tracts.

PubMed

Howard, David M

2017-10-27

The advent and now increasingly widespread availability of 3-D printers is transforming our understanding of the natural world by enabling observations to be made in a tangible manner. This paper describes the use of 3-D printed models of the vocal tract for different vowels that are used to create an acoustic output when stimulated with an appropriate sound source in a new musical instrument: the Vocal Tract Organ. The shape of each printed vocal tract is recovered from magnetic resonance imaging. It sits atop a loudspeaker to which is provided an acoustic L-F model larynx input signal that is controlled by the notes played on a musical instrument digital interface device such as a keyboard. The larynx input is subject to vibrato with extent and frequency adjustable as desired within the ranges usually found for human singing. Polyphonic inputs for choral singing textures can be applied via a single loudspeaker and vocal tract, invoking the approximation of linearity in the voice production system, thereby making multiple vowel stops a possibility while keeping the complexity of the instrument in reasonable check. The Vocal Tract Organ offers a much more human and natural sounding result than the traditional Vox Humana stops found in larger pipe organs, offering the possibility of enhancing pipe organs of the future as well as becoming the basis for a "multi-vowel" chamber organ in its own right. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vigilando la Calidad del Agua de los Grandes Rios de la Nacion: El Programa NASQAN del Rio Grande (Rio Bravo del Norte)

USGS Publications Warehouse

Lurry, Dee L.; Reutter, David C.; Wells, Frank C.; Rivera, M.C.; Munoz, A.

1998-01-01

La Oficina del Estudio Geologico de los Estados Unidos (U.S. Geological Survey, 0 USGS) ha monitoreado la calidad del agua de la cuenca del Rio Grande (Rio Bravo del Norte) desde 1995 como parte de la rediseiiada Red Nacional para Contabilizar la Calidad del Agua de los Rios (National Stream Quality Accounting Network, o NASOAN) (Hooper and others, 1997). EI programa NASOAN fue diseiiado para caracterizar las concentraciones y el transporte de sedimento y constituyentes quimicos seleccionados, encontrados en los grandes rios de los Estados Unidos - incluyendo el Misisipi, el Colorado y el Columbia, ademas del Rio Grande. En estas cuatro cuencas, el USGS opera actualmente (1998) una red de 40 puntos de muestreo pertenecientes a NASOAN, con un enfasis en cuantificar el flujo en masa (la cantidad de material que pasa por la estacion, expresado en toneladas por dial para cada constituyente. Aplicacando un enfoque consistente, basado en la cuantificacion de flujos en la cuenca del Rio Grande, el programa NASOAN esta generando la informacion necesaria para identificar fuentes regionales de diversos contaminantes, incluyendo sustancias qui micas agricolas y trazas elementos en la cuenca. EI efecto de las grandes reservas en el Rio Grande se puede observar segun los flujos de constituyentes discurren a 10 largo del rio. EI analisis de los flujos de constituyentes a escala de la cuenca proveera los medios para evaluar la influencia de la actividad humana sobre las condiciones de calidad del agua del Rio Grande.

RELAGH - The challenge of having a scientific network in Latin America: An account from the presidents

PubMed Central

Rojas-Martínez, Augusto; Giraldo-Ríos, Alejandro; Jiménez-Arce, Gerardo; de Vargas, Aída Falcón; Giugliani, Roberto

2014-01-01

Latin America and the Caribbean region make up one of the largest areas of the world, and this region is characterized by a complex mixture of ethnic groups sharing Iberian languages. The area is comprised of nations and regions with different levels of social development. This region has experienced historical advances in the last decades to increase the minimal standards of quality of life; however, several factors, such as concentrated populations in large urban centers and isolated and poor communities, still have an important impact on medical services, particularly genetics services. Latin American researchers have greatly contributed to the development of human genetics and historic inter-ethnic diversity, and the multiplicity of geographic areas are unique for the study of gene-environment interactions. As a result of regional developments in the fields of human and medical genetics, the Latin American Network of Human Genetics (Red Latinoamericana de Genética Humana - RELAGH) was created in 2001 to foster the networking of national associations and societies dedicated to these scientific disciplines. RELAGH has developed important educational activities, such as the Latin American School of Human and Medical Genetics (ELAG), and has held three biannual meetings to encourage international research cooperation among the member countries and international organizations. Since its foundation, RELAGH has been admitted as a full regional member to the International Federation of Human Genetics Societies. This article describes the historical aspects, activities, developments, and challenges that are still faced by the Network. PMID:24764765

The business case for payer support of a community-based health information exchange: a humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care.

PubMed

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R

2011-07-01

As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.

The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care

PubMed Central

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R.

2011-01-01

Background As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. Objective To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel Methods The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Results Post–propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. Conclusions When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care. PMID:25126351

Financial and clinical characteristics of fibromyalgia: a case-control comparison.

PubMed

Palacio, Ana; Uribe, Claudia L; Li, Hua; Hanna, John; Deminski, Michael; Alvir, Jose; Chandran, Arthi; Sanchez, Robert

2010-05-01

To compare healthcare utilization and costs between subjects with and without fibromyalgia (FM) using claims data from a large health benefits company in the United States. Retrospective cohort. We analyzed 24 months of medical and pharmacy claims data comparing healthcare utilization and costs among Humana members diagnosed with FM to a propensity score matched control group without a diagnosis for FM. FM cases were identified as members aged 18 years and older, with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification codes 729.0 and/or 729.1. The first medical claim for FM was utilized as the index date. A total of 9988 FM cases and 9988 controls were included in the analysis. Compared with controls, the use of pain-related medications by FM cases was approximately 2 times higher with opioids being used most commonly. FM cases utilized a mean (SD) of 22.5 (23.9) and 31.1 (26.6) outpatient services per year in the prediagnosis and postdiagnosis periods, respectively, compared with 14.8 (20.5) and 16.3 (24.5) among controls (P <.01). Office visits, tests, and procedures represented the majority of utilization. During the postdiagnosis period, the mean per-patient per-month costs for outpatient services among FM cases was $377 ($760) and $217 ($740.87) among controls (P <.01). FM cases had significantly higher utilization and costs compared with controls. Office visits, tests and procedures, and the use of pain-related medications accounted for the largest absolute differences between the 2 groups.

TRICARE: the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); specialized treatment services (STS) program--DoD. Notice.

PubMed

1998-11-16

This notice is to advise interested parties that Naval Hospital Jacksonville (NAVHOSPJAX), Florida, has been designated a regional Specialized Treatment Services facility (STSF) for total joint replacement. The application for this STSF designation was submitted by NAVHOSPJAX and approved by the Assistant Secretary of Defense (Health Affairs). The Lead Agent for TRICARE Region 3 will oversee that the STSF maintains the quality and standards required for specialized treatment services. This designation covers the following Diagnostic Related Groups: 209--Major Joint and Limb Reattachment Procedures of Lower Extremity 491--Major Joint and Limb Reattachment Procedures of Upper Extremity DoD beneficiaries who reside in the NAVHOSPJAX STS Catchment Area must be evaluated by NAVHOSPJAX before receiving TRICARE/CHAMPUS cost sharing for procedures that fall under the above Diagnostic Related Groups, in accordance with TRICARE/CHAMPUS Nonavailability Statement policy. Travel and lodging for the patient and, if stated to be medically necessary by a referring physician, for a nonmedical attendant, will be reimbursed by NAVHOSPJAX in accordance with the provision of the Joint Federal Travel Regulation. Although evaluation in person is preferred, it is possible to conduct the evaluation telephonically if the patient is unable to travel to NAVHOSPJAX. If the procedures cannot be performed at NAVHOSPJAX, Humana Military Healthcare Services will provide a medical necessity review prior to issuance of a Nonavailability Statement or other similar authorizations. The NAVHOSPJAX STSF Catchment Area includes zip codes within TRICARE Region 3 that fall within a 200-mile radius South and West of NAVHOSPJAX.

[Retraction of papers in bioethics: proposal for a paradigmatic case].

PubMed

Herranz Rodríguez, Gonzalo

2011-01-01

The phenomenon of ethically deficient publication in the field of bioethics is practically unknown. In contrast to the numerous articles and regulations on the ethics of biomedical publications, there is a practical absence of articles devoted to consider the nature, types and prevalence of ethically defective publications in the bioethical literature. No regulatory framework for misbehavior in this field has been proposed until now. Certainly, this is a difficult subject. On one side, it is not easy to draw the ethical limits of the freedoms of thought and expression in bioethics, a discipline that flourishes in the open debate of principles, norms, cases, and imaginary scenarios, where the boundaries between rhetoric and misrepresentation are frequently blurred. After showing some examples of minor violations taken from the literature, the author deals with the moral duty to retract fraudulent bioethical articles, especially when they include deliberate distortions of the data or conclusions from published biomedical research. A detailed analysis of a fraudulent article is made (Haring B. ″New Dimensions of Responsible Parenthood. ″ Theological Studies 37, (1976), 120-132), in which an almost systematic distortion of data and opinions of the cited literature has been made. The article, published in a time of intense and critical protest against the encyclical Humanae vitae, pretends to condemn the methods of natural family planning, the only acceptable means to the Pope, on the allegation that those methods were harmful for the embryo and fetus. According to the author, the retraction of Haring's article is necessary.

Using Self-reports or Claims to Assess Disease Prevalence: It's Complicated.

PubMed

St Clair, Patricia; Gaudette, Étienne; Zhao, Henu; Tysinger, Bryan; Seyedin, Roxanna; Goldman, Dana P

2017-08-01

Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates. Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence. Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc. Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack. Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences. Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

Novel approaches to models of Alzheimer's disease pathology for drug screening and development.

PubMed

Shaughnessy, Laura; Chamblin, Beth; McMahon, Lori; Nair, Ayyappan; Thomas, Mary Beth; Wakefield, John; Koentgen, Frank; Ramabhadran, Ram

2004-01-01

Development of therapeutics for Alzheimer's disease (AD) requires appropriate cell culture models that reflect the errant biochemical pathways and animal models that reflect the pathological hallmarks of the disease as well as the clinical manifestations. In the past two decades AD research has benefited significantly from the use of genetically engineered cell lines expressing components of the amyloid-generating pathway, as well as from the study of transgenic mice that develop the pathological hallmarks of the disease, mainly neuritic plaques. The choice of certain cell types and the choice of mouse as the model organism have been mandated by the feasibility of introduction and expression of foreign genes into these model systems. We describe a universal and efficient gene-delivery system, using lentiviral vectors, that permits the development of relevant cell biological systems using neuronal cells, including primary neurons and animal models in mammalian species best suited for the study of AD. In addition, lentiviral gene delivery provides avenues for creation of novel models by direct and prolonged expression of genes in the brain in any vertebrate animal. TranzVector is a lentiviral vector optimized for efficiency and safety that delivers genes to cells in culture, in tissue explants, and in live animals regardless of the dividing or differentiated status of the cells. Genes can also be delivered efficiently to fertilized single-cell-stage embryos of a wide range of mammalian species, broadening the range of the model organism (from rats to nonhuman primates) for the study of disease mechanism as well as for development of therapeutics. Copyright 2004 Humana Press Inc.

Recommendations for the use of microarrays in prenatal diagnosis.

PubMed

Suela, Javier; López-Expósito, Isabel; Querejeta, María Eugenia; Martorell, Rosa; Cuatrecasas, Esther; Armengol, Lluis; Antolín, Eugenia; Domínguez Garrido, Elena; Trujillo-Tiebas, María José; Rosell, Jordi; García Planells, Javier; Cigudosa, Juan Cruz

2017-04-07

Microarray technology, recently implemented in international prenatal diagnosis systems, has become one of the main techniques in this field in terms of detection rate and objectivity of the results. This guideline attempts to provide background information on this technology, including technical and diagnostic aspects to be considered. Specifically, this guideline defines: the different prenatal sample types to be used, as well as their characteristics (chorionic villi samples, amniotic fluid, fetal cord blood or miscarriage tissue material); variant reporting policies (including variants of uncertain significance) to be considered in informed consents and prenatal microarray reports; microarray limitations inherent to the technique and which must be taken into account when recommending microarray testing for diagnosis; a detailed clinical algorithm recommending the use of microarray testing and its introduction into routine clinical practice within the context of other genetic tests, including pregnancies in families with a genetic history or specific syndrome suspicion, first trimester increased nuchal translucency or second trimester heart malformation and ultrasound findings not related to a known or specific syndrome. This guideline has been coordinated by the Spanish Association for Prenatal Diagnosis (AEDP, «Asociación Española de Diagnóstico Prenatal»), the Spanish Human Genetics Association (AEGH, «Asociación Española de Genética Humana») and the Spanish Society of Clinical Genetics and Dysmorphology (SEGCyD, «Sociedad Española de Genética Clínica y Dismorfología»). Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Bedsharing at home, breastfeeding and sudden infant death. Recommendations for health professionals

PubMed

2017-10-01

El Grupo de Trabajo en Muerte Súbita e Inesperada del Lactante, junto con la Subcomisión de Lactancia Materna de la Sociedad Argentina de Pediatría, elaboraron nuevas recomendaciones sobre la práctica del colecho, en la cual el niño duerme en la misma superficie junto a su madre, situación que es motivo de controversia. El colecho favorece la lactancia materna, que, a su vez, es protectora de la muerte súbita del lactante. Un pequeño grupo de niños presenta mayor riesgo de muerte súbita del lactante y accidentes fatales durante el colecho en ciertas circunstancias, que incluyen dormir en un sillón o sofá, padres fumadores, ingesta de sedantes, drogas y/o consumo de alcohol, niños prematuros y/o de bajo peso. El colecho en niños alimentados con leche humana, sin los factores de riesgo mencionados y con padres responsables de implementar un ambiente de sueño seguro, no aumenta el riesgo de muerte súbita del lactante. Esta guía no recomienda taxativamente la prohibición del colecho. Instruye a los profesionales de la salud a propalar a las familias un mensaje balanceado que incluya tanto los riesgos como los beneficios del colecho, lo que les permite a los padres una decisión informada al respecto. El documento señala que la cohabitación sin colecho es el lugar más seguro para los bebés al momento de dormir.

INTERVENCIÓN EDUCATIVA EFECTIVA EN VIH PARA MUJERES

PubMed Central

Miner, Sarah; Poupin, Lauren; Bernales, Margarita; Ferrer, Lilian; Cianelli, Rosina

2016-01-01

RESUMEN En Chile se estima que aproximadamente 38 mil personas viven con el Virus de Inmunodeficiencia Humana [VIH]. En el año 2001, 1.092 mujeres chilenas vivían con VIH, actualmente se cree que hay más de 7.600 mujeres con el virus. Frente a estas cifras surge la necesidad de crear estrategias de prevención dirigidas a mujeres chilenas. Objetivo analizar los estudios ya realizados en la prevención de VIH para determinar qué aspectos se deben incluir en programas exitosos de prevención de VIH en mujeres. Diseño y Método se realizó una revisión de la literatura utilizando la base de datos Proquest, CINAHL, Pubmed y Scielo. Los límites comprendieron: textos completos, de los últimos 10 años, de acceso gratuito y escrito en español o inglés. Se seleccionaron 15 artículos para la revisión. Resultados todos los artículos comprenden la evaluación del efecto de una intervención sobre conocimiento y conductas relacionadas con VIH/SIDA. Catorce muestran resultados significativos en cambios positivos de conducta o conocimientos relacionados con la prevención de VIH. Conclusiones los programas de prevención de VIH en mujeres pueden ser efectivos para lograr cambios de conducta y de conocimiento. Las intervenciones exitosas son aquellas basadas en teorías o modelos de prevención y en cambios de conductas, todas adaptadas a la cultura de la población estudiada. PMID:27667897

A Pos-Graduacao Nas Ciencias Humanas e o Paradigma da Medicina: A Era da Especializacao. (Post-Graduation in the Human Sciences and the Paradigm of Medicine: The Era of Specialization.)

ERIC Educational Resources Information Center

Costa, Celio Juvenal

2000-01-01

Reflects on the current tendency in Brazilian higher education for greater and greater specialization, particularly in human sciences and in medicine. Calls for less specialization and a more historic and general preparation, especially in teacher education. (BT)

Vecinos y Rehabilitation: Assessing the Needs of Indigenous People with Disabilities in Mexico. Final Report [English Version] = Vecinos y Rehabilitation: Evaluacion de las Necesidades de los Indigenas con Discapacidades en Mexico. Reporte Final [Version en Espanol].

ERIC Educational Resources Information Center

Marshall, Catherine A.; And Others

Available in English and Spanish, this document reports on a survey of the circumstances and needs of disabled indigenous people in Oaxaca state, Mexico. Assisted by a Oaxaca disabilities consumer organization and an advisory committee of government officials, health care educators, community service providers, and indigenous people with…

Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population.

PubMed

Everhart, Damian; Vaccaro, Jamieson; Worley, Karen; Rogstad, Teresa L; Seleznick, Mitchel

2017-08-01

The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013-2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912-6.059), prophylactic; OR, 1.356 (95% CI 1.164-1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 [95% CI 0.093-0.498], prophylactic; 0.673 [95% CI 0.547-0.798], therapeutic) and readmissions (OR 2.444 [95% CI 1.298-4.602], prophylactic; 2.074 [95% CI 1.644-2.616], therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters.

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014.

PubMed

Lipman, Marc D; Carstensen, Samuel Evan; Deal, Dylan Nicole

2017-01-01

Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased ( P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.

Are We Still Prescribing Opioids for Osteoarthritis?

PubMed

DeMik, David E; Bedard, Nicholas A; Dowdle, S Blake; Burnett, Robert A; McHugh, Michael A; Callaghan, John J

2017-12-01

The United States is in the midst of an opioid epidemic. These medications continue to be used to manage pain associated with osteoarthritis, despite mounting evidence questioning the benefits. The rate at which opioids are prescribed for osteoarthritis is largely unknown. We sought to identify rates of opioid prescriptions for osteoarthritis and identify factors associated with higher rates of prescribing. We queried the Humana, Inc. administrative claims database from 2007 to 2014. Patients with osteoarthritis were identified using International Classification of Diseases 9th Revision codes and classified as having hip, knee, or any joint osteoarthritis. Claims data were reviewed to identify opioid prescriptions associated with a diagnosis of osteoarthritis. Rates of prescribing were trended over time and stratified by sex, age, and geographic region. From 2007 to 2014, 17.0% of patients with any joint osteoarthritis, 13.4% of patients with hip osteoarthritis, and 15.9% with knee osteoarthritis were prescribed an opioid for their condition. Yearly rates of prescription were fairly stable over this period. Patients in the South had the highest odds of opioid prescription, while those in the Northeast had the lowest. Patients ≤49 years old were more likely to receive a prescription than those ≥50 years old. This study provides important epidemiologic data about the use of opioids for osteoarthritis. Despite increasing evidence calling proposed benefits into question and increasing awareness of risks of opioids, prescribing rates remained stable between 2007 and 2014. This provides important baseline data as we work to combat excessive and inappropriate opioid use within the United States. Copyright © 2017 Elsevier Inc. All rights reserved.

[Effects of lead exposure on the human body and health implications].

PubMed

Moreira, Fátima Ramos; Moreira, Josino Costa

2004-02-01

To review the literature concerning the risks associated with exposure to lead and lead compounds, especially in children and in populations that are occupationally exposed. Using "chumbo" [lead] and "efeitos" [effects] as search terms, two large databases, namely PubMed (United States National Library of Medicine) and LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde [Latin American and Caribbean Literature in the Health Sciences]), were searched for studies on lead toxicity from 1988 to 2002. Other sources used to conduct the search include the web page of the United States Agency for Toxic Substances and Disease Registry, in Atlanta, Georgia, and the library of the Toxicology Laboratory of the Center for Workers' Health and Human Ecology at the National School of Public Health [Centro de Estudos da Saúde de Trabalhador e Ecologia Humana, Escola Nacional de Saúde Pública], Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. The toxic effects of lead and lead compounds have been extensively studied for over a century. In recent years, epidemiologic studies have focused primarily on the neurotoxic effects of lead on children, particularly in terms of impaired intellectual ability and behavioral problems. However, there is still insufficient information on the mechanisms of action that account for such toxicity. More in-depth studies are also needed on the effects of lead exposure on bone, the central nervous system, the cardiovascular system, the kidneys, the liver, the male and female reproductive systems, and the endocrine system. The potential teratogenicity and carcinogenicity of lead, as well as its effect on pregnancy outcomes and neonatal growth and development, also require further study.

Pain conditions ranked by healthcare costs for members of a national health plan.

PubMed

Pasquale, Margaret K; Dufour, Robert; Schaaf, David; Reiners, Andrew T; Mardekian, Jack; Joshi, Ashish V; Patel, Nick C

2014-02-01

Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain-related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per-member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis (OA), childbirth, injuries, and non-hip, non-spine fractures (adjusted annual total costs for the commercial members were $119 million, $98 million, $69 million, $61 million, and $48 million, respectively). The top 5 conditions for Medicare members were OA, back pain, hip fractures, injuries, and non-hip, non-spine fractures (adjusted annual costs for the Medicare members were $327 million, $218 million, $117 million, $82 million, and $67 million, respectively). The conditions ranked highest for both per-member and total healthcare costs were hip fractures, childbirth, and non-hip, non-spine fractures. Among these, hip fractures in the Medicare member population had the highest mean cost per member (adjusted per-member cost was $21,058). Further examination specific to how pain is managed in these high-cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management. © 2013 Humana Inc. and Pfizer Inc. Pain Practice © 2013 World Institute of Pain.

Big Data and Total Hip Arthroplasty: How Do Large Databases Compare?

PubMed

Bedard, Nicholas A; Pugely, Andrew J; McHugh, Michael A; Lux, Nathan R; Bozic, Kevin J; Callaghan, John J

2018-01-01

Use of large databases for orthopedic research has become extremely popular in recent years. Each database varies in the methods used to capture data and the population it represents. The purpose of this study was to evaluate how these databases differed in reported demographics, comorbidities, and postoperative complications for primary total hip arthroplasty (THA) patients. Primary THA patients were identified within National Surgical Quality Improvement Programs (NSQIP), Nationwide Inpatient Sample (NIS), Medicare Standard Analytic Files (MED), and Humana administrative claims database (HAC). NSQIP definitions for comorbidities and complications were matched to corresponding International Classification of Diseases, 9th Revision/Current Procedural Terminology codes to query the other databases. Demographics, comorbidities, and postoperative complications were compared. The number of patients from each database was 22,644 in HAC, 371,715 in MED, 188,779 in NIS, and 27,818 in NSQIP. Age and gender distribution were clinically similar. Overall, there was variation in prevalence of comorbidities and rates of postoperative complications between databases. As an example, NSQIP had more than twice the obesity than NIS. HAC and MED had more than 2 times the diabetics than NSQIP. Rates of deep infection and stroke 30 days after THA had more than 2-fold difference between all databases. Among databases commonly used in orthopedic research, there is considerable variation in complication rates following THA depending upon the database used for analysis. It is important to consider these differences when critically evaluating database research. Additionally, with the advent of bundled payments, these differences must be considered in risk adjustment models. Copyright © 2017 Elsevier Inc. All rights reserved.

Development and applications of groundwater remediation technologies in the USA

NASA Astrophysics Data System (ADS)

Barcelona, Michael J.

2005-03-01

recientemente descubiertos causarán la revisión de las tecnologías "maduras", pues aquellos pueden ser persistentes, móviles y difíciles para tratar in situ. Las evaluaciones de la efectividad de las tecnologías de recuperación, incluirán eventualmente la formación de subproductos, consecuencias geoquímicas y la sostenibilidad. Las experiencias de campo de largo plazo, que se han hecho aplicando tecnologías de recuperación, pueden por si solas suministrar los datos necesarios para soportar las afirmaciones sobre su efectividad.

Reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome.

PubMed

Lima, Ivana Cristina Vieira de; Cunha, Maria da Conceição Dos Santos Oliveira; Cunha, Gilmara Holanda da; Galvão, Marli Teresinha Gimeniz

2017-05-25

To analyze the reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome (AIDS). Cross-sectional and descriptive study carried out from January to December, 2015, in the outpatient care of infectious disease unit in a hospital located in Fortaleza, Ceará. Data were collected through a form applied by interview in a private setting. 102 women participated in the study. Most were aware that they were serologically positive with human immunodeficiency virus (HIV) during prenatal care (96.1%) and did not intend to have more children (63.7%). Women who were less than 39 years of age, had a higher educational level, and a shorter time of antiretroviral therapy had better chances of having children (p≤0.05). Having a steady partner increased the chance of desiring to have children, while tubal ligation was higher among women that did not receive counseling on family planning. Knowledge of family planning was limited because of lack of assistance provided by health professionals. Analisar aspectos reprodutivos e conhecimento sobre planejamento familiar de mulheres com síndrome da imunodeficiência adquirida (Aids). Estudo transversal, descritivo, realizado de janeiro a dezembro de 2015, no ambulatório de infectologia de um hospital em Fortaleza, Ceará. Os dados foram coletados por meio de formulário, aplicado por entrevista em ambiente privativo. Participaram do estudo 102 mulheres. A maioria delas teve conhecimento da sorologia positiva para vírus da imunodeficiência humana (HIV) durante o pré-natal (96,1%), e estas não pretendiam mais ter filhos (63,7%). Mulheres com idade menor que 39 anos, maior escolaridade e menor tempo de terapia antirretroviral tiveram maiores chances de ter filhos (p≤0,05). Mulheres com idade menor que 39 anos e maior escolaridade tiveram maiores chances de ter informações corretas sobre ter filhos na vigência do HIV (p≤0,05). Ter parceiro fixo aumentou a chance de desejar ter

Are Trends in Total Hip Arthroplasty Bearing Surface Continuing to Change? 2007-2015 Usage in a Large Database Cohort.

PubMed

Bedard, Nicholas A; Burnett, Robert A; DeMik, David E; Gao, Yubo; Liu, Steve S; Callaghan, John J

2017-12-01

Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics. The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex. Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P < .001). CoP usage decreased with age, while MoP bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2). Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice. Copyright © 2017 Elsevier Inc. All rights reserved.

Georg Büchner, Sigmund Freud and the "Schädelnerven" (cranial nerves) - research on the brain and soul in the 19th century.

PubMed

Hildebrandt, Gerhard; Ruppert, Christina; Stienen, Martin N; Surbeck, Werner

2014-10-01

One of the authors' encounter with one of Sigmund Freud's original works about the anatomy of the human brain stem and his interest in the scientist, anatomist, philosopher, writer and revolutionary Georg Büchner led to re-examination and review of the original writings of two major 19th century protagonists of brain anatomy research. The aim of the authors is to highlight the achievements of both Freud and Büchner in the field of comparative brain morphology. The medical and philosophical publications of Georg Büchner were reviewed with reference to the historical-critical edition of his complete works and writings (the so-called Marburg edition). Evaluation of the neuroanatomical achievements of Sigmund Freud was based on a summary of his publications and also partially on his autobiographical writings. After careful review of their publications both Freud and Büchner should be acknowledged as brain scientists focusing particularly on comparative morphology. Both chose fish as the subject of their macroscopic (Büchner) and microscopic (Freud) neuroanatomical studies, and both cut across their own language and cultural space by continuing their work in France. In interpreting their findings both were influenced by their respective contemporary methodological schools of thought. Büchner became a soul scientist/psychologist by turning to the writing of literary texts, heralding the end of his idealistic and metaphysical interpretation of life. Likewise, Freud increasingly devoted himself to the destiny of man and his "conditio humana," eventually turning away from anatomical brain research. Review of the biographies and medical-scientific, as well as philosophical publications, of Georg Büchner and Sigmund Freud reveal striking parallels between the two researchers in addition to common insights that have generally been ignored or only marginally addressed in the past. Both should be appreciated and remembered as forerunners of today's neuroscientific

[Health insurance in the contributive and subsidized regimes and its impact on the service providers].

PubMed

Prada, Luis M

2004-01-01

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients.

PubMed

Deitelzweig, Steven; Luo, Xuemei; Gupta, Kiran; Trocio, Jeffrey; Mardekian, Jack; Curtice, Tammy; Lingohr-Smith, Melissa; Menges, Brandy; Lin, Jay

2017-10-01

To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) of elderly (≥65 years of age) nonvalvular atrial fibrillation (NVAF) patients initiating apixaban vs. rivaroxaban, dabigatran, or warfarin. NVAF patients with Medicare Advantage coverage in the US initiating oral anticoagulants (OACs, index event) were identified from the Humana database (1 January 2013-30 September 2015) and grouped into cohorts depending on OAC initiated. Propensity score matching (PSM), 1:1, was conducted among patients treated with apixaban vs. each other OAC, separately. Rates of S/SE and MB were evaluated in the follow-up. Cox regressions were used to compare the risk of S/SE and MB between apixaban and each of the other OACs during the follow-up. The matched pairs of apixaban vs. rivaroxaban (n = 13,620), apixaban vs. dabigatran (n = 4654), and apixaban vs. warfarin (n = 14,214) were well balanced for key patient characteristics. Adjusted risks for S/SE (hazard ratio [HR] vs. rivaroxaban: 0.72, p = .003; vs. warfarin: 0.65, p < .001) and MB (HR vs. rivaroxaban: 0.49, p < .001; vs. warfarin: 0.53, p < .001) were significantly lower during the follow-up for patients treated with apixaban vs. rivaroxaban and warfarin. Adjusted risks for S/SE (HR: 0.78, p = .27) and MB (HR: 0.82, p = .23) of NVAF patients treated with apixaban vs. dabigatran trended to be lower, but did not reach statistical significance. In the real-world setting after controlling for differences in patient characteristics, apixaban is associated with significantly lower risk of S/SE and MB than rivaroxaban and warfarin, and a trend towards better outcomes vs. dabigatran among elderly NVAF patients in the US.

The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?

PubMed

Bedard, Nicholas A; Dowdle, Spencer B; Anthony, Christopher A; DeMik, David E; McHugh, Michael A; Bozic, Kevin J; Callaghan, John J

2017-09-01

Despite American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPGs) related to the non-arthroplasty management of osteoarthritis (OA) of the knee, non-recommended treatments remain in common use. We sought to determine the costs associated with non-arthroplasty management of knee OA in the year prior to total knee arthroplasty (TKA) and stratify them by CPG recommendation status. The Humana database was reviewed from 2007 to 2015 for primary TKA patients. Costs for hyaluronic acid (HA) and corticosteroid injections, physical therapy, braces, wedge insoles, opioids, non-steroidal anti-inflammatories, and tramadol in the year prior to TKA were calculated. Cost was defined as reimbursement paid by the insurance provider. Costs were analyzed relative to the overall non-inpatient costs for knee OA and categorized based on CPG recommendations. In total 86,081 primary TKA patients were analyzed and 65.8% had at least one treatment in the year prior to TKA. Treatments analyzed made up 57.6% of the total non-inpatient cost of knee OA in the year prior to TKA. Only 3 of the 8 treatments studied have a strong recommendation for their use (physical therapy, non-steroidal anti-inflammatories, tramadol) and costs for these interventions represented 12.2% of non-inpatient knee OA cost. In contrast, 29.3% of the costs are due to HA injections alone, which are not supported by CPGs. In the year prior to TKA, over half of the non-inpatient costs associated with knee OA are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this is due to HA injections alone. If only interventions recommend by the CPG are utilized then costs associated with knee OA could be decreased by 45%. Copyright © 2017 Elsevier Inc. All rights reserved.

On Ensino de Astronomia: Desafios para Implantação

NASA Astrophysics Data System (ADS)

Faria, R. Z.; Voelzke, M. R.

2008-09-01

Em 2002 o ensino de Astronomia foi proposto como um dos temas estruturadores pelos Parâmetros Curriculares Nacionais e sugerido como facilitador para que o aluno compreendesse a Física como construção humana e parte do seu mundo vivencial, mas raramente seus conceitos foram ensinados. A presente pesquisa discute dois aspectos relacionados à abordagem de Astronomia. O primeiro aspecto é se ela está sendo abordada pelos professores do Ensino Médio e o segundo, aborda a maneira como ela está sendo ensinada. Optou-se pela aplicação de um questionário a partir do 2° semestre de 2006 e durante o ano de 2007 com professores que ministram a disciplina de Física, os quais trabalham em escolas estaduais em Rio Grande da Serra, Ribeirão Pires e Mauá no estado São Paulo. Dos 66,2% dos professores que responderam ao questionário nos municípios de Rio Grande da Serra, Ribeirão Pires e Mauá, 57,4% não aplicaram nenhum tópico de astronomia, 70,2% não utilizaram laboratório, 89,4% não utilizaram qualquer tipo de programa computacional, 83,0% nunca fizeram visitas com alunos a museus e planetários e 38,3% não indicaram qualquer tipo de livro ou revista referente à astronomia aos seus alunos. Mesmo considerando a Astronomia um conteúdo potencialmente significativo, esta não fez parte dos planejamentos escolares. Portanto são necessárias propostas que visem estratégias para a educação continuada dos professores como, por exemplo, cursos específicos sobre o ensino em Astronomia.

Catholic perspectives on populations issues II.

PubMed

Murphy, F X

1981-02-01

This Bulletin discusses the history and current status of the population problem from a Roman Catholic viewpoint. While upholding human rights and admitting the right of couples to control the size of their families, the Catholic Church continues to prohibit the use of artificial methods of contraception as sinful. This position hinders the Church, with its some 750 million adherents, from taking an effective lead in confronting the growing threat of global overpopulation. Rhythm has been permitted since 1930 but Pope Pius 12 in 1958 forbade contraceptive use of the pill. Despite the liberal spirit engendered by Vatican Council 2 and against the recommendation of a papal birth control commission, Pope Paul 6 in his 1968 Encyclical Humanae vitae reaffirmed the ban on artificial contraception, apparently convinced that this was necessary to combat growing sexual immorality, family breakdown, and materialism. This stance has been upheld by Pope John Paul 2 and the 1980 Synod of Bishops. The decision ignores the pleas of a number of responsible churchmen speaking for their people at the Synod and of a growing majority of Catholic theologians and laity, that Church teaching must be updated to take account of the facts of modern life. Surveys reveal that Catholic married couples increasingly find Church-approved natural family planning methods unsatisfactory and feel obliged to turn to artificial methods to regulate their family size. On the world scale, Pope John Paul 2 and the Vatican, while insisting on human rights and the need for a reordering of unjust economic, social, and political structures, seem to be neglecting the threat of civilizational breakdown that looms with the prospect of too many people in too little space with too few resources.

The second twenty-five years.

PubMed

Kippley, J F

1993-01-01

Between 1964 and 1968, the liberal Catholic press had prepared the laity for the change expected to occur after the release of Pope Paul VI's encyclical "Humanae Vitae," but almost no one read it when it was released in July 1968. The media gave the impression that no one agreed with the Pope. The Archbishop of Baltimore denounced his dissenting priests. The media publicized the discord, resulting in his fellow bishops not supporting him or the Pope. Sound theology was limited then. Today many Catholic leaders and scholars openly defend the encyclical, e.g., since 1978, Pope John Paul II has supported the doctrine of marital noncontraception. Pope Pius XII called for every woman to breast feed. The 1969 publication of the Breastfeeding and Natural Child Spacing was the catalyst for 10 years of research which confirmed breast feeding's contraceptive effect. Family planning specialists and demographers agreed in the Bellagio Consensus in 1988 that mothers who practiced exclusive breast feeding and were amenorrheic need not use a contraceptive for the first 6 months postpartum. Recent research shows that this rule depends on the population, e.g., women in Bangladesh meeting the criteria do not need to use contraceptives for 1 year. Few natural family planning groups existed in 1968 (e.g., 1 diocese), but today there are natural family planning teachers in 49 US states and in 13 countries. Some Catholics are calling for couples wanting to marry to take a course in natural family planning. The media widely publicized the new unnatural family planning methods, especially the pill. Recently a baby magazine allocated natural family planning 2/3rd of a page. A reporter for the "Washington Post" plans to interview a Catholic leader about natural family planning, completely on his/her own initiative.

The Nursing Diagnosis Development of Unemployment Disorder: Content Validation With Nursing Experts.

PubMed

Bocchino, Anna; Medialdea, María Jesús; Lepiani, Isabel; Mejías, Concepción; Dueñas, María

2017-10-01

This study aimed to validate the definition and define the characteristics and related factors of unemployment disorder, a proposed nursing diagnosis. Using Fehring's diagnostic content validity model, Spanish experts were asked to assess the adequacy of the label, defining the characteristics and other related factors. The content validity index was 0.8690. A total of 16 defining characteristics reached major criteria (>0.80). The present study supports the proposed development of a nursing diagnosis for the human response to unemployment. The results suggest that the inclusion of the "unemployment disorder" diagnostic NANDA-I taxonomy would allow nursing professionals to identify the disorder and its causes and manifestations, and therefore provide the information needed for planning more relevant interventions and results. Validación de la definición, características definitorias y factores relacionados de trastorno por desempleo, una propuesta de diagnóstico enfermero. METODOLOGÍA: Usando el modelo de validación de contenido de Fehring, se consensuó mediante expertos españoles la denominación de la etiqueta, las características definitorias y otros factores relacionados. El índice de validez de contenido global fue 0.8690. Un total de 16 características definitorias alcanzaron carácter crítico (>0.80). CONCLUSIÓN: El presente estudio apoya la propuesta de elaborar un diagnóstico de enfermería para la respuesta humana al desempleo. IMPLICACIONES PRÁCTICAS: Los resultados obtenidos sugieren que la inclusión en la taxonomía NANDA-I del diagnóstico "trastorno por desempleo" permitiría a los profesionales de enfermería identificar el problema, sus causas y manifestaciones, y por lo tanto ofrecerían la información necesaria para planificar las intervenciones y resultados más pertinentes. © 2016 NANDA International, Inc.

Un estudio de evaluacion educativa manipulativos en el aprendizaje de las matematicas con estudiantes hispanos adquiriendo ingles academico como segunda lengua (A Study of the Use of Manipulatives in the Assessment of Mathematics Instruction with ESL Hispanic Students).

ERIC Educational Resources Information Center

Lara-Alecio, Rafael; Parker, Richard; Aviles, Claudia; Mason, Samantha; Irby, Beverly J.

1998-01-01

As an alternative form of mathematics assessment for use with limited-English-proficient students, 14 mathematics tasks using manipulatives were administered to 45 Hispanic students in grades 1-3 and readministered 2-3 weeks later. Test reliability and validity, task difficulty, and the relationship among test subscales across grades were…

Reaching Higher. A Parent's Guide to the Washington Assessment of Learning. Revised = Para llegar mas arriba. Una guia para padres sobre la evaluacion del aprendizaje de los estudiantes del estado de Washington (Washington Assessment of Student Learning). Revisado.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia.

This guide in English and Spanish is designed to answer questions parents may have about the Washington Assessment of Student Learning (WASL), including how it will help improve their children's education, how it is scored, and how to use the information it provides. In Washington, clear educational goals for subject content, thinking skills, and…

A protocol for storage and long-distance shipment of Mediterranean fruit fly (Diptera: Tephritidae) eggs. II. Assessment of the optimal temperature and the substrate for male-only production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maman, E.; Caceres, C.

The present study has been conducted to assess the effect and interaction of various storage substrates and conditions on eggs of the Mediterranean fruit fly (medfly) Ceratitis capitata (Wiedemann). Tests were carried out with the genetic sexing strain VIENNA 8/D53, a strain that carries a temperature sensitive lethal (tsl) mutation that allows the selective killing of female zygotes. This study identifies strategies to enhance the storage and transport conditions through assessment of effect on egg, pupal and adult survival in order to facilitate the establishment of satellite mass rearing facilities for the production of male medflies. Eggs were immersed inmore » two different substrates and stored at different temperatures and for different time periods. Findings from this study suggest that egg storage periods, and to some extent, the storage substrates have significant effects on pupal and adult survival. For 72-h storage periods, the eggs preserved in agar solution at 10 deg. C produced the most pupae. There was an inverse relationship between the concentration of dissolved oxygen in the substrate during storage and the quality and survival of the stored/transported eggs. Apparently low levels of dissolved oxygen reduce metabolic rates, allowing the storage period to be prolonged. (author) [Spanish] El presente estudio fue conducido para evaluar el efecto e interaccion de varios substratos y condiciones de almacenamiento en huevos de la mosca mediterranea de la fruta, Ceratitis capitata (Wiedemann). Las pruebas se realizaron con la cepa en la cual es posible separar los sexos geneticamente VIENNA 8/D53, la cual contiene una mutacion letal sensible a la temperatura que permite la eliminacion selectiva de los zigotos femeninos. Este estudio identifica estrategias para mejorar las condiciones de almacenamiento y transporte por medio de la evaluacion de su efecto en la supervivencia de huevos, pupas y adultos, esto para facilitar el establecimiento de

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cuda, J.P.; Dunford, J.C.; Leavengood, J.M. Jr.

, fue realizado como parte de un estudio de factibilidad para determinar si conota es una candidata apropiada para un programa de control biologico clasico. En general, especimenes de aproximadamente unos 4,000 artropodos y unos 400 nematodos fueron recolectados. Muestras recolectadas pasando una red sobre vegetacion mezclada, cortando la vegetacion y tomando centros del suelo fueron dominados por representantes de artropodos de los ordenes de Hemiptera, Hymenoptera, Diptera, y Acari. Nematodos en el genero Pratylenchus, que causan lesiones sobre tejido, fueron asociados regularmente con las raices de conota. Ninguno de los organismos recolectados eran especialistas sobre conota. Aunque el control biologico clasico de la conota es factible basado sobre la magnitud de la infestacion, las perdidas economicas, la resistencia hacia los metodos de control convencionales y el informe en la India de un posible enemigo natural especifico a esta planta, la posicion botanica de este pasto maleza requiere una evaluacion de riesgo economico formal antes de continuar con un programa de control biologico clasico. (author)« less

Impact of a Step Therapy for Guanfacine Extended-Release on Medication Utilization and Health Care Expenditures Among Individuals Receiving Treatment for ADHD.

PubMed

Suehs, Brandon T; Sikirica, Vanja; Mudumby, Pallavi; Dufour, Robert; Patel, Nick C

2015-09-01

While step therapy (ST) policies are generally effective at reducing cost through the managed utilization of targeted medications, the clinical implications of ST policies are not clear and may vary across therapeutic areas. Guanfacine extended-release (GXR) is approved by the FDA for the treatment of attention-deficit/hyperactivity disorder (ADHD) as both monotherapy and adjunctive to stimulant treatment. At the introduction of GXR to the market, Humana implemented an ST policy on GXR requiring the documentation of previous treatment, intolerance, or contraindication to generic clonidine or guanfacine. To examine the impact of a GXR ST coverage determination (i.e., approved vs. denied) on medication utilization and health care costs among members of a commercial health plan with an ST policy for GXR.  This study was a retrospective cohort study of administrative claims data. Humana commercial members prescribed GXR who had an ST coverage determination review were identified. All members included in this analysis were required to be aged 6-17 years, have a diagnosis of ADHD or be receiving stimulant medication, have an ST coverage determination (index event) between September 1, 2009, and May 30, 2012, and have 6 months of pre- and post-index continuous enrollment. Members were assigned to either the approved or denied group based on the outcome of the ST coverage determination. Medical and pharmacy claims data were used to measure baseline demographic and clinical characteristics and to measure medication utilization and health care costs. Outcomes assessed during follow-up included ADHD medication use, proportion of days covered (PDC) with any ADHD medication treatment, time to first observed post-index ADHD treatment, and all-cause and mental health (MH)-related health care costs. Administrative costs associated with the coverage determination process were also estimated. Bivariate and multivariable adjusted analyses were conducted to compare medication

TRICARE; the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); specialized treatment services (STS) program--DoD. Notice.

PubMed

1998-11-16

This notice is to advise interested parties that Dwight D. Eisenhower Army Medical Center (EAMC), Fort Gordon, Georgia, has been designated a regional Specialized Treatment Services facility (STSF) for Neurosurgery, Orthopedic Surgery, General Surgery, Peripheral Vascular Surgery, and Head and Neck Surgery. The application for this STSF designation was submitted by the Lead Agent for TRICARE Region 3 and approved by the Assistant Secretary of Defense (Health Affairs). The Lead Agent will oversee that the STSF maintains the quality and standards required for specialized treatment services. This designation covers the following Diagnostic Related Groups: 001--Craniotomy, Age Greater than 17, Except for Trauma 004--Spinal Procedures 049--Major Head and Neck Procedures 191--Pancreas, Liver and Shunt Procedures with CC 110--Major Cardiovascular Procedures with CC 111--Major Cardiovascular Procedures without CC 286--Adrenal and Pituitary Procedures 209--Major Joint and Limb Reattachment Procedures of Lower Extremity 491--Major Joint and Limb Reattachment of Upper Extremity DoD beneficiaries who reside in the EAMC STS Catchment Area must be evaluated by EAMC before receiving TRICARE/CHAMPUS cost sharing for procedures that fall under the above Diagnostic Related Groups, in accordance with TRICARE/CHAMPUS Nonavailability Statement policy. Travel and lodging for the patient and, if stated to be medically necessary by a referring physician, for a nonmedical attendant, will be reimbursed by EAMC in accordance with the provisions of the Joint Federal Travel Regulation. Although evaluation in person is preferred, it is possible to conduct the evaluation telephonically if the patient is unable to travel to EAMC. If the procedure cannot be performed at EAMC, Humana Military Healthcare Services will provide a medical necessity review prior to issuance of a Nonavailability Statement or other similar authorizations. The EAMC STSF Catchment Area is defined by zip codes in the Defense

Common usage of cardiologic anatomical terminology: critical analysis and a trilingual discussion proposal.

PubMed

Werneck, Alexandre Lins; Batigália, Fernando

2009-01-01

ambiguities, inconsistencies, inutilities, and repetitions concerning the Nomenclature addressed to the Allied Health Sciences by prioritizing the inclusion of official technical terms and a judicious selection of commonly used terms. Efforts to standardize lists of structures in Humana Anatomy lead to both opportunities of scientific update and conceptual enlightenment.

Emerging arboviruses and public health challenges in Brazil.

PubMed

Lima-Camara, Tamara Nunes

2016-06-27

Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País.

Evaluation of the Pooled Cohort Equations for Prediction of Cardiovascular Risk in a Contemporary Prospective Cohort.

PubMed

Emdin, Connor A; Khera, Amit V; Natarajan, Pradeep; Klarin, Derek; Baber, Usman; Mehran, Roxana; Rader, Daniel J; Fuster, Valentin; Kathiresan, Sekar

2017-03-15

Most guidelines suggest a baseline risk assessment to guide atherosclerotic cardiovascular disease (ASCVD) prevention strategies. The American Heart Association/American College of Cardiology Pooled Cohort Equations (PCEs) is one tool to assess baseline risk; however, the accuracy of this tool has been called into question. We aimed to examine the calibration and discrimination of the PCEs in the BioImage study, a contemporary multiethnic cohort of asymptomatic adults enrolled from 2008 to 2009 in the Humana Health System in Chicago, Illinois, and Fort Lauderdale, Florida. Our primary end point was hard ASCVD, defined as cardiovascular death, myocardial infarction, and stroke. A total of 3,635 adults who were not on lipid-lowering therapy at baseline were followed for a maximum of 4.6 years. The mean age was 68.6 years; 2000 (55%) participants were women and 935 patients reported being of non-white race (26%). Although 74 ASCVD events were observed over a median follow-up of 2.7 years, 198 events were predicted by the PCEs. The observed event rate was 7.9 per 1,000 participant-years (95% confidence interval [CI] 6.1 to 9.8), whereas the predicted rate by the PCEs was 21 per 1,000 participant-years (95% CI 20.7 to 21.8). This represents an overestimation of 167% (Hosmer-Lemeshow chi-square = 173; p <0.001). With regard to discrimination, the C-statistic of the PCEs was 0.65 (CI 0.58 to 0.71). In an analysis restricted to 3,080 participants without diabetes mellitus and with low-density lipoprotein cholesterol between 70 and 189 mg/dl, the PCEs similarly overestimated risk by 181% (152 predicted events vs 54 observed events; p <0.001). The PCEs substantially overestimate ASCVD risk in this middle-aged adult insured population. Refinement of existing risk prediction functions may be warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies.

PubMed

Goudouris, Ekaterini Simões; Rego Silva, Almerinda Maria do; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Silva Segundo, Gesmar Rodrigues; Barreto, Irma Cecília; Dorna, Mayra de Barros; Barros, Myrthes Anna; Forte, Wilma Carvalho Neves

2017-01-01

In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. RESUMO Nos últimos anos, novas imunodeficiências primárias e defeitos genéticos têm sido descritos. Recentemente, produtos de imunoglobulina, com aprimoramento em sua composição e para uso por via subcutânea, tornaram-se disponíveis em nosso meio. Com o objetivo de orientar o médico no uso da imunoglobulina humana para o tratamento das imunodeficiências primárias, os membros do Grupo de Assessoria em Imunodeficiências da Associação Brasileira de Alergia e Imunologia produziram um documento que teve por base uma revisão narrativa da literatura e sua experiência profissional, atualizando o I Consenso Brasileiro publicado em 2010. Apresentam-se novos conhecimentos sobre indicações e eficácia do tratamento com imunoglobulina nas imunodeficiências primárias, aspectos relevantes sobre a produção, forma de utilização (vias de administração, farmacocinética, doses e intervalos), efeitos adversos (principais efeitos, prevenção, tratamento e notificação), monitorização do

Difficulties with Emotion Regulation and Psychopathology Interact to Predict Early Smoking Cessation Lapse

PubMed Central

Zvolensky, Michael J.; Schmidt, Norman B.

2015-01-01

There is little knowledge about how emotion regulation difficulties interplay with psychopathology in terms of smoking cessation. Participants (n = 250; 53.2 % female, Mage = 39.5, SD = 13.85) were community-recruited daily smokers (≥8 cigarettes per day) who self-reported motivation to quit smoking; 38.8 % of the sample met criteria for a current (past 12-month) psychological disorder. Emotion regulation deficits were assessed pre-quit using the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer in J Psychopathol Behav Assess 26(1):41–54, 2004) and smoking behavior in the 28 days post-quit was assessed using the Timeline Follow-Back (TLFB; Sobell and Sobell in Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, 1992). A Cox proportional-hazard regression analysis was used to model the effects of past-year psychopathology, DERS (total score), and their interaction, in terms of time to lapse post-quit day. After adjusting for the effects of gender, age, pre-quit level of nicotine dependence, and treatment condition, the model revealed a non-significant effect of past-year psychopathology (OR = 1.14, CI95 % = 0.82–1.61) and difficulties with emotion regulation (OR = 1.01, CI95 % = 1.00–1.01) on likelihood of lapse rate. However, the interactive effect of psychopathology status and difficulties with emotion regulation was significant (OR = 0.98, CI95 % = 0.97–0.99). Specifically, there was a significant conditional effect of psychopathology status on lapse rate likelihood at low, but not high, levels of emotion regulation difficulties. Plots of the cumulative survival functions indicated that for smokers without a past-year psychological disorder, those with lower DERS scores relative to elevated DERS scores had significantly lower likelihood of early smoking lapse, whereas for smokers with past-year psychopathology, DERS scores did not differentially impact lapse rate likelihood. Smokers with emotion

Difficulties with Emotion Regulation and Psychopathology Interact to Predict Early Smoking Cessation Lapse.

PubMed

Farris, Samantha G; Zvolensky, Michael J; Schmidt, Norman B

2016-06-01

There is little knowledge about how emotion regulation difficulties interplay with psychopathology in terms of smoking cessation. Participants ( n = 250; 53.2 % female, M age = 39.5, SD = 13.85) were community-recruited daily smokers (≥8 cigarettes per day) who self-reported motivation to quit smoking; 38.8 % of the sample met criteria for a current (past 12-month) psychological disorder. Emotion regulation deficits were assessed pre-quit using the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer in J Psychopathol Behav Assess 26(1):41-54, 2004) and smoking behavior in the 28 days post-quit was assessed using the Timeline Follow-Back (TLFB; Sobell and Sobell in Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, 1992). A Cox proportional-hazard regression analysis was used to model the effects of past-year psychopathology, DERS (total score), and their interaction, in terms of time to lapse post-quit day. After adjusting for the effects of gender, age, pre-quit level of nicotine dependence, and treatment condition, the model revealed a non-significant effect of past-year psychopathology ( OR = 1.14, CI 95 % = 0.82-1.61) and difficulties with emotion regulation ( OR = 1.01, CI 95 % = 1.00-1.01) on likelihood of lapse rate. However, the interactive effect of psychopathology status and difficulties with emotion regulation was significant ( OR = 0.98, CI 95 % = 0.97-0.99). Specifically, there was a significant conditional effect of psychopathology status on lapse rate likelihood at low, but not high, levels of emotion regulation difficulties. Plots of the cumulative survival functions indicated that for smokers without a past-year psychological disorder, those with lower DERS scores relative to elevated DERS scores had significantly lower likelihood of early smoking lapse, whereas for smokers with past-year psychopathology, DERS scores did not differentially impact lapse rate likelihood. Smokers with emotion

Para Candidatos en Programas de Centros de Cuidado y Educacion Infantil con Bebes y "Toddlers": Asociado en Desarrollo Infantil Sistema de Evaluacion y Normas de Competencia CDA (Infant/Toddler Caregivers in Center-Based Programs: The Child Development Associate Assessment System and Competency Standards).

ERIC Educational Resources Information Center

Council for Early Childhood Professional Recognition, Washington, DC.

This Spanish-language booklet outlines the requirements of the Child Development Associate (CDA) credential for caregivers working in center-based infant and toddler day care programs. Part 1 provides an overview of the CDA credentialing system and the various options, settings, standards, and stages of the CDA assessment system. Part 2 explains…

Quality management systems for fruit fly (Diptera: Tephritidae) sterile insect technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caceres, C.; Robinson, A.; McInnis, D.

de cinco anos bajo el proyecto de Investigacion Coordinada (PIC) sobre 'el Aseguramiento de la Calidad de Moscas de las Frutas Criadas y Liberadas para su Uso en Programas de TIE'. Los participantes en el PIC representan 16 paises con experiencia en campos de investigacion basica y aplicada. Para asegurar que los procedimientos desarrollados fueran apropiados y pertinentes, se realizaron una variedad de estudios para el desarrollo de protocolos para evaluar la compatibilidad y para mejorar los procedimientos de colonizacion y manejo de cepas salvajes. Estudios especificos trataron asuntos relacionados con la nutricion de insectos, los protocolos de irradiacion, la dispersion y supervivencia en el campo, evaluacion del comportamiento en jaulas de campo, y el mejoramiento de la competitividad sexual. Los objetivos fundamentales fueron el aumentar la eficiencia y reducir los costos de los programas operacionales de control de moscas de las frutas donde TIE es utilizada. Muchos de los protocolos desarrollados o mejorados durante el PIC seran incorporados en el Manual Internacional de Control de Calidad para Moscas Estriles de la familia Tephritidae, para estandarizar componentes claves como la produccion, esterilizacion, envio, manejo y liberacion de insectos esteriles. (author)« less

Assessment of Management to Mitigate Anthropogenic Effects on Large Whales

PubMed Central

Van Der Hoop, Julie M; Moore, Michael J; Barco, Susan G; Cole, Timothy VN; Daoust, Pierre-Yves; Henry, Allison G; McAlpine, Donald F; McLellan, William A; Wimmer, Tonya; Solow, Andrew R

2013-01-01

provide managers with direction for modifying regulated measures and can be applied globally to mortality-driven conservation issues. Evaluación del Manejo para Mitigar Efectos Antropogénicos sobre Ballenas Mayores Resumen Los gobiernos de Estados Unidos y Canadá han respondido a requerimientos legales para reducir la mortalidad de ballenas inducida por humanos por medio de impacto con embarcaciones y enmarañamiento en artes de pesca mediante la implementación de un conjunto de acciones reguladoras. Analizamos los patrones espaciales y temporales de la mortalidad de ballenas mayores en el Atlántico Noroccidental (23.5°N a 48.0°N), de 1970 a 2009, en el contexto de cambios de manejo. Utilizamos un modelo logístico multinomial ajustado por la máxima probabilidad de detección de tendencias en mortalidades por causa específica en el tiempo. Comparamos el número de muertes provocadas por humanos con los niveles de remoción biológica potencial (i.e., mortalidad específica provocada por humanos sustentable). De 1970 a 2009, hubo 1762 muertes (conocidas) y lesiones serias (casi fatales) involucrando 8 especies de ballenas mayores. Determinamos la causa de 43% de todas las muertes; de ellas, 67% (502) resultaron de interacciones humanas. El enmarañamiento en artes de pesca fue la causa principal de muerte en todas las especies (n = 323), seguida de causas naturales (n = 248) e impacto de embarcaciones (n = 171). Los niveles sustentables de mortalidad establecidos fueron excedidos consistentemente hasta en 650% en 2 especies. Las probabilidades de muerte por enmarañamiento y por impacto de embarcaciones incrementaron significativamente de 1990 a 2009. No hubo cambio significativo en la intensidad local de mortalidad por todas las causas o por impacto de embarcaciones antes y después de 2003, año en el que se implementaron numerosos esfuerzos de mitigación. Hasta ahora, los esfuerzos regulatorios no han reducido los efectos letales de las actividades humanas

Nursing diagnoses in patients with immune-bullous dermatosis.

PubMed

Brandão, Euzeli da Silva; Santos, Iraci Dos; Lanzillotti, Regina Serrão; Ferreira, Adriano Menis; Gamba, Mônica Antar; Azulay-Abulafia, Luna

2016-08-15

identificados a partir do raciocínio clínico, em todos os participantes do estudo, representando as respostas humanas mais frequentes nesta amostra. A aplicação do Protocolo de Avaliação do Cliente em Dermatologia facilitou a avaliação integral, além de propiciar a identificação dos diagnósticos de acordo com a North American Nursing Diagnosis Association International. os diagnósticos de enfermagem apresentados ratificam a necessidade do trabalho interdisciplinar durante atendimento a esta clientela. Para melhor descrição dos fenômenos relacionados à clientela em questão, sugere-se a inclusão de dois fatores de risco/relacionados em três diagnósticos desta taxonomia. Cabe ressaltar a contribuição dos achados para o cuidar/educar/pesquisar em enfermagem em dermatologia. identificar los diagnósticos de enfermería en pacientes con inmuno dermatosis ampollosa. investigación cuantitativa y descriptiva, realizada en tres instituciones ubicadas en Río de Janeiro y Mato Grosso do Sul, Brasil, utilizando el Protocolo de Evaluación del Cliente en Dermatología en la consulta de enfermería. Se utilizó estadística descriptiva simples para el análisis de datos. 14 sujetos participaron en el estudio, nueve con diagnóstico de pénfigo vulgar, dos de pénfigo foliáceo y tres de penfigoide ampolloso. La edad osciló entre 27 y 82 años, predominio femenino con 11 mujeres. Se discutieron 14 diagnósticos de enfermería identificados desde el razonamiento clínico, en todos los participantes en el estudio, que representa las respuestas humanas más comunes en esta muestra. La aplicación del Protocolo de Evaluación de Dermatología facilitó la evaluación global, además de proporcionar la identificación de los diagnósticos de acuerdo con la North American Nursing Diagnosis Association International. los diagnósticos de enfermería presentados confirman la necesidad del trabajo interdisciplinario en el servicio a estos clientes. Para una mejor descripci

Para Candidatos en Programas de Centros de Cuidado y Educacion Infantil con Ninos de Edad Pre-escolar: Asociado en Desarrollo Infantil Sistema de Evaluacion y Normas de Competencia CDA (Preschool Caregivers in Center-Based Programs: The Child Development Associate Assessment System and Competency Standards).

ERIC Educational Resources Information Center

Council for Early Childhood Professional Recognition, Washington, DC.

This Spanish-language booklet outlines the requirements of the Child Development Associate (CDA) credential for preschool teachers or caregivers who work in center-based preschool day care programs. Part 1 provides an overview of the CDA credentialing system and the various options, settings, standards, and stages of the CDA assessment system.…

Human Relations Activities for the Single Parent To Develop More Effective Parent/Child Relations. Bilingual Guide = Actividades sobre relaciones humanas para ayudar al padre-soltero o madre-soltera a desarrollar una relacion efectiva entre padre e hijo Guia bilingue.

ERIC Educational Resources Information Center

Peterson, Susan

Written in English and Spanish, this bilingual guide offers 10 activities which single parents can use to improve their relationships with their children. Objectives of activities include: (1) developing children's responsibility for work tasks in the home; (2) improving sibling relationships; (3) discussing emergencies with children; (4)…

Camões e a cosmogonia

NASA Astrophysics Data System (ADS)

Costa, J. M.

2003-08-01

Os Lusíadas, escrito por Luis de Camões em 1572, é um poema épico renascentista e a visão Cosmogônica do autor é apresentada, principalmente, no último canto do poema, quando Tétis mostra ao Gama a Máquina do Mundo. A Cosmogonia de Camões neste poema reflete uma visão de uma época de transição, que ainda não incorporou os elementos da revolução Copernicana. É uma visão Grego- Ptolomaica e também medieval. O poeta guia-se pela tradução e notas feita por Pedro Nunes, inventor do Nonio, do Tratado da Esfera "De Sphaera" do Astrônomo Inglês John Holywood, mais conhecido pelo nome latinizado de Johannes Sacrobosco. Outra provável fonte de Camões, de acordo com Luciano Antonio Pereira da Silva em Astronomia de os Lusíadas, é o "Theoricae novae Planetarum" (1460) do astrólogo Alemão Jorge Purbáquio (1423 - 1461). A Astronomia de Os Lusíadas representa a ciência do tempo de Camões. Camões nunca emprega a palavra constelação e seu catálogo é bastante completo. A Máquina do Mundo tem a Terra no centro. Em redor, em círculos concêntricos, a lua (Diana), Mercúrio, Vênus, o Sol (Febo), Marte, Júpiter e Saturno. Envolvendo estes astros tem o firmamento seguido pelo "Céu Áqueo" ou cristalino, depois o 1o Móbil, esfera que arrasta todas as outras consigo. Este trabalho, multidisciplinar, serve tanto para ensinar aos alunos da Física como das Ciências Humanas, a concepção de mundo do renascimento de uma forma belamente poética em versos decassílabos Este trabalho também ajuda na apreciação do maior clássico da língua portuguesa e mostra como as Ciências e as artes, em geral, estão correlacionadas e refletem a visão de mundo da época em que foi produzida.

Seroprevalence of hepatitis C virus among people living with HIV/AIDS in Latin America and the Caribbean: a systematic review.

PubMed

Tengan, Fatima Mitiko; Ibrahim, Karim Yakub; Dantas, Bianca Peixoto; Manchiero, Caroline; Magri, Mariana Cavalheiro; Bernardo, Wanderley Marques

2016-11-09

Studies have shown that the immunosuppression induced by the human immunodeficiency virus (HIV) accelerates the natural history of liver disease associated with hepatitis C virus (HCV), with 3- to 5-fold higher odds of coinfected individuals developing cirrhosis. However, estimates of the seroprevalence of hepatitis C among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLHA) in Latin America and the Caribbean (LAC) are widely variable. We performed a systematic review to estimate the seroprevalence of HCV among PLHA. We searched studies on HIV and HCV infections in LAC included in the PubMed, LILACS and Embase databases in December of 2014 with no time or language restrictions. The following combinations of search terms were used in the PubMed and Embase databases: (HIV OR Acquired Immunodeficiency Syndrome Virus OR AIDS OR HTLV OR Human Immunodeficiency Virus OR Human T Cell) AND (HCV OR HEPATITIS C OR HEPATITIS C VIRUS OR HEPACIVIRUS) AND (name of an individual country or territory in LAC). The following search terms were used in the LILACS database: (HIV OR AIDS OR Virus da Imunodeficiencia Humana) AND (HCV OR Hepatite C OR Hepacivirus). An additional 11 studies were identified through manual searches. A total of 2,380 publications were located, including 617 duplicates; the remaining articles were reviewed to select studies for inclusion in this study. A total of 37 studies were selected for systematic review, including 23 from Brazil, 5 from Argentina, 3 from Cuba, 1 from Puerto Rico, 1 from Chile, 1 from Colombia, 1 from Mexico, 1 from Peru and 1 from Venezuela. The estimated seroprevalence of HCV infection varied from 0.8 to 58.5 % (mean 17.37; median 10.91), with the highest in Argentina and Brazil and the lowest in Venezuela and Colombia. Investigation of HCV infection among PLHA and of HIV infection among people living with HCV is highly recommended because it allows for better follow up, counseling and treatment of HIV

Impact of Clinical Practice Guidelines on Use of Intra-Articular Hyaluronic Acid and Corticosteroid Injections for Knee Osteoarthritis.

PubMed

Bedard, Nicholas A; DeMik, David E; Glass, Natalie A; Burnett, Robert A; Bozic, Kevin J; Callaghan, John J

2018-05-16

The efficacy of corticosteroid and hyaluronic acid injections for knee osteoarthritis has been questioned. The purpose of this study was to determine the impact of the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines on the use of these injections in the United States and determine if utilization differed by provider specialty. Patients with knee osteoarthritis were identified within the Humana database from 2007 to 2015, and the percentage of patients receiving a knee injection relative to the number of patients having an encounter for knee osteoarthritis was calculated and was trended for the study period. The impact of each edition of the AAOS clinical practice guidelines on injection use was evaluated with segmented regression analysis. Injection trends were also analyzed relative to the specialty of the provider performing the injection. Of 1,065,175 patients with knee osteoarthritis, 405,101 (38.0%) received a corticosteroid injection and 137,005 (12.9%) received a hyaluronic acid injection. The rate of increase in hyaluronic acid use, per 100 patients with knee osteoarthritis, decreased from 0.15 to 0.07 injection per quarter year (p = 0.02) after the first clinical practice guideline, and the increase changed to a decrease at a rate of -0.12 injection per quarter (p < 0.001) after the second clinical practice guideline. After the first clinical practice guideline, the rate of increase in utilization of corticosteroids, per 100 patients with knee osteoarthritis, significantly lessened to 0.12 injection per quarter (p < 0.001), and after the second clinical practice guideline, corticosteroid injection use plateaued (p = 0.72). The trend in use of hyaluronic acid injections by orthopaedic surgeons and pain specialists decreased with time following the second-edition clinical practice guideline but did not change for primary care physicians or nonoperative musculoskeletal providers. Subtle but significant changes in hyaluronic acid

El rol de Ia colaboracion y el Modelo de Aprendizaje Basado en Proyectos (ABPr) mediante el lente de la Teoria de Actividad (CHAT): un estudio de caso con estudiantes de 9no grado

NASA Astrophysics Data System (ADS)

Delgado, Isabel C.

Los modelos de eensenanza y aprendizaje constructivistas conceptualizan el aprendizaje como un proceso activo. El modelo de Aprendizaje Basado en Proyectos (ABPr) se distingue por una serie de componentes, entre los cuales se destaca el aspecto colaborativo y cooperativo como un reto al momento de su implantacion. Son pocas las investigaciones que se concentran en este aspecto del modelo. En este estudio, se analizaron las diversas interacciones que surgen durante la implantacion de una unidad curricular sobre el tema de Geologia de Puerto Rico, la cual se diseno con el modelo ABPr cuyo enfoque es orientacion a proyectos. Particularmente, se examinaron las interacciones sociales que surgen entre los pares y entre pares y docente durante el proceso de planificacion y desarrollo de los productos finales, al igual que las interacciones entre los estudiantes y el material didactico en estas etapas del modelo. La investigacion es de tipo cualitativo e incorpora como diseno el estudio de caso. Las diversas interacciones constituyen la unidad de analisis. En el estudio participaron 19 estudiantes de 9no grado, a quienes se organizaron en 5 grupos colaborativos por temas de interes (Pangea, Placas tectonicas, Volcanes, Tsunamis y Terremotos). Las tecnicas que se utilizaron para recopilar los datos fueron: observaciones participativas, grupos focales y analisis de documentos (cuadernos reflexivos y respuestas de los estudiantes a la pregunta central del proyecto). Para el analisis de los datos se aplico la teoria de actividad (CHAT) que concentra la unidad de analisis en la actividad humana en un contexto particular. Los resultados del estudio senalan que las interacciones entre pares, entre pares y docente, asi como entre estudiantes y material didactico son fundamentales en el proceso de aprendizaje. Una mayor interaccion entre pares durante las etapas de planificar y desarrollar los productos finales de la unidad, promueve una mejor comprension de los conceptos de la

Adherence to non-vitamin-K-antagonist oral anticoagulant medications based on the Pharmacy Quality Alliance measure.

PubMed

McHorney, Colleen A; Crivera, Concetta; Laliberté, François; Nelson, Winnie W; Germain, Guillaume; Bookhart, Brahim; Martin, Silas; Schein, Jeffrey; Lefebvre, Patrick; Deitelzweig, Steven

2015-12-01

CMS Star Ratings help inform beneficiaries about the performance of health and drug plans. Medication adherence is currently weighted at nearly half of a Part D plan's Star Ratings. Including the adherence to non-vitamin-K-antagonist oral anticoagulants (NOACs) as a measure in the Star Ratings program may increase a plan's incentives to improve patient adherence. To assess the adherence to medication of patients who used the NOACs rivaroxaban, dabigatran, or apixaban in 2014 based on the Pharmacy Quality Alliance (PQA) adherence measure. Healthcare claims from the Humana database between July 2013 and December 2014 were analyzed. Adult patients with ≥2 dispensings of NOAC agents in 2014, at least 180 days apart, with >60 days of supply, and ≥180 days of continuous enrollment prior to the index NOAC were identified. The PQA measure was calculated as the percentage of patients who had a proportion of days covered (PDC) ≥0.8. Multivariate logistic regression analyses were also conducted adjusting for baseline confounders. A total of 11,095 rivaroxaban, 6548 dabigatran, and 3532 apixaban users were identified. Based on the PQA adherence measure (PDC ≥0.8), a significantly higher proportion of rivaroxaban users (72.7%) was found to be adherent compared to dabigatran (67.2%: p < 0.001) and apixaban (69.5%: p < 0.001) users. Compared to apixaban users, the adjusted likelihood of being adherent was significantly higher for rivaroxaban users (unadjusted OR [95% CI]: 1.17 [1.08-1.27], p < 0.001; adjusted OR [95% CI]: 1.20 (1.10-1.31), p < 0.001) and significantly lower for dabigatran users (unadjusted OR [95% CI]: 0.90 [0.82-0.98], p = 0.019; adjusted OR [95% CI]: 0.85 [0.77-0.93], p < 0.001). Limitations of the study are potential inaccuracies in claims data, possible change in patterns over time, and the impossibility of knowing whether all supplied tablets were taken. Using the PQA's adherence measure, rivaroxaban users were found to have

Assessment of the usability of a digital learning technology prototype for monitoring intracranial pressure.

PubMed

Carvalho, Lilian Regina de; Évora, Yolanda Dora Martinez; Zem-Mascarenhas, Silvia Helena

2016-08-29

to assess the usability of a digital learning technology prototype as a new method for minimally invasive monitoring of intracranial pressure. descriptive study using a quantitative approach on assessing the usability of a prototype based on Nielsen's ten heuristics. Four experts in the area of Human-Computer interaction participated in the study. the evaluation delivered eight violated heuristics and 31 usability problems in the 32 screens of the prototype. the suggestions of the evaluators were critical for developing an intuitive, user-friendly interface and will be included in the final version of the digital learning technology. avaliar a usabilidade de um protótipo educacional digital sobre um novo método para monitoração da pressão intracraniana de forma minimamente invasivo para enfermeiros e médicos. estudo descritivo com abordagem quantitativa sobre a avaliação de usabilidade de um protótipo com base nas dez Heurísticas de Nielsen. Participaram quatro especialistas da área de Interação Humano Computador. a avaliação resultou em oito heurísticas violadas e 31 problemas de usabilidade nas 32 telas do protótipo. as sugestões dos avaliadores foram cruciais para o desenvolvimento de uma interface amigável e intuitiva e serão consideradas na versão final da tecnologia educacional digital. evaluar la usabilidad de un prototipo educacional digital sobre un nuevo método para monitorización de la presión intracraneal, de manera mínimamente invasiva. estudio descriptivo con abordaje cuantitativo sobre la evaluación de usabilidad de un prototipo con base en las diez reglas Heurísticas de Nielsen. Participaron cuatro especialistas del área de Interacción Humana Computador. la evaluación resultó en ocho reglas heurísticas violadas y 31 problemas de usabilidad en las 32 pantallas del prototipo. las sugestiones de los evaluadores fueron cruciales para el desarrollo de una interfaz amigable e intuitiva y éstas serán consideradas en la

[Not Available].

PubMed

Baladia, Eduard; Frutos Pérez-Surio, Alberto; Martínez-Rodríguez, Rodrigo

2016-06-30

Objetivos: dar a conocer las recomendaciones relacionadas con la Nutrición Humana y Dietética (NHyD) de la Guía de Práctica Clínica para el manejo de la enfermedad de Parkinson del Sistema Nacional de Salud (GPC-EP/SNS) y favorecer su difusión e implementación en la práctica. El objetivo secundario es presentar la implicación de los profesionales de la NHyD en la elaboración de la guía.Material y métodos: siguiendo el Manual Metodológico de Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud, se formularon las preguntas clínicas, se realizó una búsqueda sistemática para cada pregunta en bases de datos (PubMed/Medline, Embase, Cochrane Library, CRD, LILACS, IBECS y ClinicalTrials), se definieron los criterios de elegibilidad, al menos dos investigadores seleccionaron los estudios, se realizó lectura crítica de la literatura se resumió en tablas de síntesis de evidencia y se establecieron las recomendaciones.Resultados: se propusieron 14 preguntas relacionadas directamente con NHyD-Parkinson, de las cuales solamente 3 pudieron incluirse. Se formuló una pregunta relacionada con la terapia de logopedia aplicada en personas con EP que presentan problemas de deglución, tratamiento donde se imbrican los profesionales de la NHyD. De 642 artículos localizados, únicamente 2 pudieron ser incluidos para contestar las correspondientes preguntas. De las evidencias halladas, se derivaron 11 recomendaciones directa o indirectamente relacionados con la NHyD.Conclusiones: la implicación de profesionales sanitarios en equipos multidisciplinares mejora el resultado final de las guías y la atención sanitaria de los pacientes. Es necesario que los profesionales sanitarios de la NHyD (los/las dietistas-nutricionistas) se impliquen en iniciativas basadas en la mejor evidencia científica disponible y que formen parte de los equipos de trabajo multidisciplinares.

Pressure ulcer dressings in critical patients: a cost analysis.

PubMed

Silva, Dinara Raquel Araújo; Bezerra, Sandra Marina Gonçalves; Costa, Jéssica Pereira; Luz, Maria Helena Barros Araújo; Lopes, Vanessa Caminha Aguiar; Nogueira, Lidya Tolstenko

2017-06-12

presión. Estudio observacional descriptivo en la Unidad de Cuidados Intensivos del noreste de Brasil, de noviembre a diciembre del año 2015. Se aplicó la Pressure Ulcer Scale for Healing y formulario para la caracterización y evaluación de los costos. Los valores de la moneda brasileña (Reales- R$) se convirtieron al dólar estadounidense (US$) a razón de $0.26/R$. Se realizaron análisis univariados y bivariados. La muestra consistió en 15 pacientes con lesiones al menos en Etapa 2. Hubo una reducción significativa en el costo de los materiales de curación entre las evaluaciones inicial y final (p=0,002), con un promedio de US$11.9 (±7.4). Los tratamientos tópicos más comunes son los ácidos grasos esenciales y papaína. Se verificó una reducción de los costos proporcional a las etapas de las lesiones. Se hace hincapié en el papel de los enfermeros en el desarrollo de planes de cuidados basados en la evidencia, para una mejor gestión de la atención.

Population change and socio-cultural values.

PubMed

1982-06-01

The developing countries of the world in general, and those of Asia and the Pacific in particular, recognize that unplanned population growth is a stumbling block to socioeconomic development. Discussion here focuses on population growth and social, economic, and institutional forces, which are referred to as sociocultural values. Generally, sociocultural values change sluggishly over time. The rate at which a country's sociocultural values change depends on several factors such as the stage of economic development and modernization and whether a country has an open or closed door policy. "The Value of Children Study: A Crossnational Study" by Fred Arnold et al. shows that there are positive and negative values attributed to children in the Asian countries. These are: positive general values--emotional benefits, economic benefits and security, self enrichment and development, identification with children, and family cohesiveness and continuity; negative general values--emotional costs, economic costs, restrictions on opportunity costs, physical demands, and family costs; large family values--sibling relationships, sex preferences, child survival; and small family values--maternal health and societal costs. Possibly the most formidable obstacle to the success of antinatalist population policies is that of religious values. It appears that the Muslim world is divided on the issue of fertility control. Conflicting views regarding fertility control is perhaps aggravated by the fact that there is no central international religious official hierarchy that issues out edicts. Despite the presence of a centralized religious hierarchy and a network of churches from the Vatican to the village levels among the Catholics, and a clearer elucidation of the Humanae Vitae, a liberal attitude to population regulation and family planning has emerged, largely because of the declining quality of life of the people resulting from unplanned births. Economic benefits of children include

Women, sexuality, ecology, and the church.

PubMed

Ruether, R R

1993-01-01

as evil has appeared throughout the ages, and was not seriously challenged until the 1960s. The Vatican Council commission of Pope Paul VI in 1067 accepted any medically recommended method as legitimate within committed marriage. The minority report was included in the 1968 Humanae Vitae which revived tradition. Dissent appeared and was squelched through many means including political censorship.

Educación sobre sexualidad y prevención del VIH: un diagnóstico para América Latina y el Caribe

PubMed Central

DeMaria, Lisa M.; Galárraga, Omar; Campero, Lourdes; Walker, Dilys M.

2016-01-01

RESUMEN Objetivo Mostrar, a través de un diagnóstico en América Latina y el Caribe, el panorama legislativo y curricular sobre sexualidad y prevención contra el virus de inmunodeficiencia humana (VIH) en el ámbito escolar, contrastándolo con los comportamientos sexuales reportados en encuestas demográficas y de salud. Métodos En mayo de 2008 se realizó, con el apoyo del Fondo de Población de las Naciones Unidas (UNFPA), una encuesta a informantes clave en 34 países de la Región. El cuestionario autoaplicado solicitó información sustantiva de agentes de las diferentes partes interesadas, como ministerios de educación y de salud, sobre los programas de prevención contra el VIH/Sida que se están aplicando en las escuelas. Resultados Respondieron a la encuesta 27 países que representan 95,5% de la población objetivo (6 a 18 años de edad). La mayoría de los países informó tener al menos un libro de texto o un capítulo específico para enseñar los temas de educación sobre sexualidad y prevención del VIH. En la escuela secundaria se cubren la mayor parte de los temas pertinentes relevantes para la educación sobre sexualidad, pero no todos. Por ejemplo, el problema de la discriminación por orientación o preferencia sexual no se incluye en los programas escolares. Conclusiones El material educativo sobre sexualidad debe ser revisado y actualizado periódicamente de modo que refleje los avances en los temas y en la forma de tratar los contenidos. En cada país el currículo debe abordar el tema del respeto a la diversidad sobre orientación, preferencia e identidad sexuales, y en particular el manejo apropiado de la educación para prevenir infecciones de transmisión sexual (ITS) en hombres que tienen sexo con hombres. Los esfuerzos de evaluación de la efectividad de los programas deben contemplar desenlaces tales como marcadores biológicos (incidencia y prevalencia de ITS y embarazo) y no únicamente indicadores de conocimiento y

Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases.

PubMed

Virk, Sohrab S; Phillips, Frank M; Khan, Safdar N

2018-03-01

OBJECTIVE Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that often requires surgery. Studies have shown the clinical equivalency of anterior versus posterior approaches for CSM surgery. The purpose of this study was to determine the amount and type of resources used for anterior and posterior surgical treatment of CSM by using large national databases of clinical and financial information from patients. METHODS This study consists of 2 large cohorts of patients who underwent either an anterior or posterior approach for treatment of CSM. These patients were selected from the Medicare 5% National Sample Administrative Database (SAF5) and the Humana orthopedic database (HORTHO), which is a database of patients with private payer health insurance. The outcome measures were the cost of a 90-day episode of care, as well as a breakdown of the cost components for each surgical procedure between 2005 and 2014. RESULTS A total of 16,444 patients were included in this analysis. In HORTHO, there were 10,332 and 1556 patients treated with an anterior or posterior approach for CSM, respectively. In SAF5, there were 3851 and 705 patients who were treated by an anterior or posterior approach for CSM, respectively. The mean ± SD reimbursements for anterior and posterior approaches in the HORTHO database were $20,863 ± $2014 and $23,813 ± $4258, respectively (p = 0.048). The mean ± SD reimbursements for anterior and posterior approaches in the SAF5 database were $18,219 ± $1053 and $25,598 ± $1686, respectively (p < 0.0001). There were also significantly higher reimbursements for a rehabilitation/skilled nursing facility and hospital/inpatient care for patients who underwent a posterior approach in both the private payer and Medicare databases. In all cohorts in this study, the hospital-related reimbursement was more than double the surgeon-related reimbursement. CONCLUSIONS This study provides resource utilization information for a 90-day episode of

Advanced Imaging Adds Little Value in the Diagnosis of Femoroacetabular Impingement Syndrome.

PubMed

Cunningham, Daniel J; Paranjape, Chinmay S; Harris, Joshua D; Nho, Shane J; Olson, Steven A; Mather, Richard C

2017-12-20

Femoroacetabular impingement (FAI) syndrome is an increasingly recognized source of hip pain and disability in young active adults. In order to confirm the diagnosis, providers often supplement physical examination maneuvers and radiographs with intra-articular hip injection, magnetic resonance imaging (MRI), or magnetic resonance arthrography (MRA). Since diagnostic imaging represents the fastest rising cost segment in U.S. health care, there is a need for value-driven diagnostic algorithms. The purpose of this study was to identify cost-effective diagnostic strategies for symptomatic FAI, comparing history and physical examination (H&P) alone (utilizing only radiographic imaging) with supplementation with injection, MRI, or MRA. A simple-chain decision model run as a cost-utility analysis was constructed to assess the diagnostic value of the MRI, MRA, and injection that are added to the H&P and radiographs in diagnosing symptomatic FAI. Strategies were compared using the incremental cost-utility ratio (ICUR) with a willingness to pay (WTP) of $100,000/QALY (quality-adjusted life year). Direct costs were measured using the Humana database (PearlDiver). Diagnostic test accuracy, treatment outcome probabilities, and utilities were extracted from the literature. H&P with and without supplemental diagnostic injection was the most cost-effective. Adjunct injection was preferred in situations with a WTP of >$60,000/QALY, low examination sensitivity, and high FAI prevalence. With low disease prevalence and low examination sensitivity, as may occur in a general practitioner's office, H&P with injection was the most cost-effective strategy, whereas in the reciprocal scenario, H&P with injection was only favored at exceptionally high WTP (∼$990,000). H&P and radiographs with supplemental diagnostic injection are preferred over advanced imaging, even with reasonable deviations from published values of disease prevalence, test sensitivity, and test specificity. Providers

Nonadherence to oral linezolid after hospitalization: a retrospective claims analysis of the incidence and consequence of claim reversals.

PubMed

Ball, Amy T; Xu, Yihua; Sanchez, Robert J; Shelbaya, Ahmed; Deminski, Michael C; Nau, David P

2010-12-01

Linezolid is available in an oral as well as an intravenous formulation. It is an oxazolidinone antibiotic and is effective in treating resistant gram-positive organisms such as methicillin-resistant Staphylococcus aureus and multidrug-resistant Streptococcus pneumoniae. The goals of this study were to identify the incidence of claim reversals for oral linezolid in members who were recently discharged from a hospital and to study the subsequent pattern of health care utilization to quantify the consequences for members who have a reversed linezolid claim. This study was a retrospective claims analysis of Humana Medicare Advantage Prescription Drug patients who had a claim for oral linezolid after an inpatient discharge between April 1, 2006, and June 30, 2008. The incidence of reversed claims among those with a linezolid prescription was measured as a proxy for medication adherence. Propensity scores were calculated to account for differences in patients' propensity to have a reversed claim. The association of the claim reversal with subsequent expenditures was assessed through 3 multivariate regression models wherein the dependent variables were drug, medical, and total costs for the 60-day period after discharge. The key independent variable was the occurrence of a reversed linezolid claim, and control variables included the propensity score quartiles and other clinical and demographic characteristics. All costs were provided in US dollars and from the year in which they occurred. Of 1046 patients identified (mean [SD] age, 69 [12] years; 51% male), 252 patients (24.1%) had a claim reversal for linezolid. Among these, 125 patients (49.6%) received linezolid within 10 days of the initial reversal, 39 patients (15.5%) received other antibiotics, and 88 patients (34.9%) did not receive any antibiotics. The unadjusted, mean outpatient drug costs were $696 and $2265 for patients with and without a reversal, respectively, whereas mean medical costs were $13,567 and

Effects of Educational Messaging on Urgent and Emergent Care–Seeking Behaviors Among Publicly Insured Populations

PubMed Central

Cambon, Jesse; Cordier, Tristan; Munnich, Elizabeth L.; Renda, Andrew; Kapur, Bobby; Hoxhaj, Shkelzen; Williams, Meredith

2018-01-01

Background The impact of messaging campaigns on influencing urgent care– and emergent care–seeking behaviors, including the use of in-network providers, is not well-understood. Although out-of-network healthcare utilization can have negative financial consequences for patients in narrow network Affordable Care Act plans, individuals with time-sensitive medical conditions, and especially patients visiting the emergency department, may not think about out-of-network issues. Inappropriate or avoidable emergency department visits can also create unnecessary costs for patients. Objective To evaluate the impact of 5 messaging strategies to educate individuals about the use of in-network providers and when care should be sought in the emergency department, urgent care center, or other sites of care. Methods Using a retrospective analysis, individuals aged ≥18 years who were enrolled in an individually purchased Affordable Care Act–compliant Humana plan as of July 1, 2015, were randomized to 1 of 5 messaging arms (e-mail, magnet mailer with or without e-mail, and key-tag mailer with or without e-mail) or to a control group. The outreach was implemented and evaluated in 2 distinct, geographically defined populations of Orlando, Palm Beach, and Tampa, Florida (Population 1); and Atlanta, Georgia, and San Antonio and Austin, Texas (Population 2). The relative number of each emergency department, urgent care, and out-of-network visits during follow-up was modeled using negative binomial regression. Cox proportional hazard models were used to calculate the risk for ≥1 of each visit type (assessed separately) and high emergency department utilization (defined as ≥3 visits during follow-up) relative to the control, while accounting for variable follow-up time. Results The relative numbers of each visit type assessed were not significantly different for any message group compared with the control in either population. The risk for an emergency department visit was 4

Development and Validation of a Predictive Model to Identify Individuals Likely to Have Undiagnosed Chronic Obstructive Pulmonary Disease Using an Administrative Claims Database.

PubMed

Moretz, Chad; Zhou, Yunping; Dhamane, Amol D; Burslem, Kate; Saverno, Kim; Jain, Gagan; Devercelli, Giovanna; Kaila, Shuchita; Ellis, Jeffrey J; Hernandez, Gemzel; Renda, Andrew

2015-12-01

Despite the importance of early detection, delayed diagnosis of chronic obstructive pulmonary disease (COPD) is relatively common. Approximately 12 million people in the United States have undiagnosed COPD. Diagnosis of COPD is essential for the timely implementation of interventions, such as smoking cessation programs, drug therapies, and pulmonary rehabilitation, which are aimed at improving outcomes and slowing disease progression. To develop and validate a predictive model to identify patients likely to have undiagnosed COPD using administrative claims data. A predictive model was developed and validated utilizing a retro-spective cohort of patients with and without a COPD diagnosis (cases and controls), aged 40-89, with a minimum of 24 months of continuous health plan enrollment (Medicare Advantage Prescription Drug [MAPD] and commercial plans), and identified between January 1, 2009, and December 31, 2012, using Humana's claims database. Stratified random sampling based on plan type (commercial or MAPD) and index year was performed to ensure that cases and controls had a similar distribution of these variables. Cases and controls were compared to identify demographic, clinical, and health care resource utilization (HCRU) characteristics associated with a COPD diagnosis. Stepwise logistic regression (SLR), neural networking, and decision trees were used to develop a series of models. The models were trained, validated, and tested on randomly partitioned subsets of the sample (Training, Validation, and Test data subsets). Measures used to evaluate and compare the models included area under the curve (AUC); index of the receiver operating characteristics (ROC) curve; sensitivity, specificity, positive predictive value (PPV); and negative predictive value (NPV). The optimal model was selected based on AUC index on the Test data subset. A total of 50,880 cases and 50,880 controls were included, with MAPD patients comprising 92% of the study population. Compared

Effects of rivaroxaban versus warfarin on hospitalization days and other health care resource utilization in patients with nonvalvular atrial fibrillation: an observational study from a cohort of matched users.

PubMed

Laliberté, François; Cloutier, Michel; Crivera, Concetta; Nelson, Winnie W; Olson, William H; Schein, Jeffrey; Vanderpoel, Julie; Germain, Guillaume; Lefebvre, Patrick

2015-03-01

Compared with warfarin, the new target-specific oral anticoagulant agents may have advantages, such as shorter hospital length of stay, in patients with nonvalvular atrial fibrillation (NVAF). The objective of the present study was to assess, among patients with NVAF, the effects of rivaroxaban versus warfarin on the number of hospitalization days and other health care resource utilization in a cohort of rivaroxaban users and matched warfarin users. Data from health care claims dated from May 2011 to December 2012 from the Humana database were analyzed. Adult patients newly initiated on treatment with rivaroxaban or warfarin, with ≥2 diagnoses of AF (ICD-9-CM code 427.31), and without valvular AF were identified. Based on propensity score methods, warfarin recipients were matched 1:1 to rivaroxaban recipients. The end of the observation period was defined as the end of data availability, the end of insurance coverage, death, the date of a switch to another anticoagulant agent, or day 14 of treatment nonpersistence. The total number of hospitalization days and other health care resource utilization parameters (numbers of hospitalizations, emergency department [ED] visits, and outpatient visits) were evaluated using the method by Lin et al. Matches for all rivaroxaban recipients were found, and the characteristics of the matched groups (n = 2253 per group) were well balanced. The mean age of both cohorts was 74 years; 46% were female. The estimated mean total numbers of hospitalization days were significantly less in rivaroxaban users compared with those in warfarin users (all-cause, 2.71 vs 3.87 days [P = 0.032]; AF-related, 2.11 vs 3.02 days [P = 0.014]). The numbers of outpatient visits were also significantly less (all-cause, 25.26 vs 35.79 visits [P < 0.001]; AF-related, 5.48 vs 9.06 visits [P < 0.001]). Rivaroxaban users had a lesser estimated mean number of all-cause hospitalizations compared with warfarin users (0.55 vs 0.73; P = 0.084), and a significantly

Alfabetización en Astronomía de docentes de Educación Primaria y de Educación Secundaria en La Plata

NASA Astrophysics Data System (ADS)

De Biasi, M. S.; Orellana, R. B.

2014-10-01

La educación de este siglo tiene como uno de sus retos alcanzar la alfabetización cientfica de todos los ciudadanos para que comprendan y tomen decisiones sobre el mundo natural y sus cambios originados por la actividad humana utilizando el conocimiento científico. En esta misión los docentes de los niveles obligatorios de enseñanza juegan un papel clave por su rol de agentes multiplicadores del conocimiento. Se requiere, entonces de una adecuada alfabetización en ciencias de los docentes o, como mínimo, que dominen los temas científicos a enseñar. En el campo de la Astronomía, numerosas investigaciones han señalado que maestros de primaria y estudiantes de profesorados poseen una escasa formación en estos temas (Camino 1995 y 1999, Gangui 2010), que frecuentemente presentan a los alumnos concepciones alternativas o no científicas de los fenómenos astronómicos cotidianos (Kriner 2004, Vega Navarro 2007, Gangui et al 2010); a lo que se suma la presentación confusa o errónea de algunos temas astronómicos en los textos escolares (Kriner 2004). Desde 2011, la Facultad de Ciencias Astronómicas y Geofísicas, UNLP, ofrece un curso de capacitación destinado a fortalecer y actualizar los contenidos académicos y didácticos de los docentes del distrito La Plata utilizando diversas estrategias didácticas. Los contenidos comprenden los temas astronómicos de los diseños curriculares vigentes. La evaluación diagnóstica de los conocimientos previos de los docentes cursantes sobre los contenidos de mayor presencia en los diseños curriculares mostró resultados similares a las investigaciones arriba mencionadas. Referente a los movimientos de la Tierra, en promedio, el 54% poseía conceptos erróneos y el 16% no los sabía; con referencia a la Luna el 56% poseía conceptos erróneos y un 4% no los sabía. Los resultados del curso mostraron que el 95% de los docentes revirtió sus conceptos previos erróneos, que adquirió criterios para la búsqueda de

A protocol for eliciting nonmaterial values through a cultural ecosystem services frame

PubMed Central

Gould, Rachelle K; Klain, Sarah C; Ardoin, Nicole M; Satterfield, Terre; Woodside, Ulalia; Hannahs, Neil; Daily, Gretchen C; Chan, Kai M

2015-01-01

Servicios Ambientales Culturales Resumen Los deseos, necesidades y valores no materiales de los accionistas influyen frecuentemente sobre el éxito de los proyectos de conservación. Estas consideraciones son difíciles de articular y caracterizar, lo que resulta en entendimiento limitado en el manejo y la política. Concebimos un protocolo de entrevista diseñado para mejorar el entendimiento de los servicios ambientales culturales (SAC). El protocolo inicia con la discusión de actividades relacionadas con ecosistemas (p. ej.: recreación, cacería) y manejo; después señala a los SAC, dando pie a los valores que encierran conceptos identificados en la Evaluación Ambiental del Milenio (2005) y explorado en otras investigaciones sobre SAC. Hicimos pruebas piloto del protocolo en Hawái y Columbia Británica. En cada localidad entrevistamos a 30 individuos de diversos entornos. Analizamos los resultados de las dos localidades para determinar la efectividad del protocolo de entrevista en la obtención de valores no materiales. Los componentes cualitativos y espaciales del protocolo nos ayudaron a caracterizar los valores culturales, sociales y éticos asociados con el ecosistema de múltiples maneras. Los mapas y las preguntas de situación, o de tipo viñeta, ayudaron a los encuestados a articular valores difíciles de discutir. Las preguntas abiertas permitieron a los encuestados expresar una diversidad de valores ambientales y demostraron ser suficientemente flexibles para que los encuestados comunicaran valores que el protocolo no buscaba explícitamente. Finalmente, los resultados sugieren que ciertos valores, aquellos mencionados frecuentemente en la entrevista, son particularmente prominentes para poblaciones particulares. El protocolo puede proporcionar datos eficientes, contextuales y basados en lugar sobre la importancia de atributos ambientales particulares para el bienestar humano. Los datos cualitativos son complementarios para las evaluaciones cuantitativas y

Establishing IUCN Red List Criteria for Threatened Ecosystems

PubMed Central

Rodríguez, Jon Paul; Rodríguez-Clark, Kathryn M; Baillie, Jonathan E M; Ash, Neville; Benson, John; Boucher, Timothy; Brown, Claire; Burgess, Neil D; Collen, Ben; Jennings, Michael; Keith, David A; Nicholson, Emily; Revenga, Carmen; Reyers, Belinda; Rouget, Mathieu; Smith, Tammy; Spalding, Mark; Taber, Andrew; Walpole, Matt; Zager, Irene; Zamin, Tara

2011-01-01

porque la Unión Internacional para la Conservación de la Naturaleza (UICN) ha desarrollado criterios objetivos, repetibles y transparentes para evaluar el riesgo de extinción que explícitamente separa la evaluación de riesgo de la definición de prioridades. En el IV Congreso Mundial de Conservación en 2008, el proceso comenzó a desarrollar e implementar estándares globales comparables para ecosistemas. Un grupo de trabajo establecido por la UICN ha formulado un sistema inicial de categorías y criterios cuantitativos, análogos a los utilizados para especies, para asignar niveles de amenaza a ecosistemas a niveles local, regional y global. Un sistema final requerirá de definiciones de ecosistemas; cuantificación del estatus de ecosistemas; identificación de las etapas de degradación y pérdida de los ecosistemas; medidas de riesgo (criterios) alternativas; umbrales de clasificación para esos criterios y métodos estandarizados para la realización de evaluaciones. El sistema deberá reflejar el nivel y tasa de cambio en la extensión, composición, estructura y funcionamiento de un ecosistema, y tener sus raíces conceptuales en la teoría ecológica y la investigación empírica. Sobre la base de esos requerimientos y la hipótesis de que el riesgo del ecosistema es una función del riesgo de las especies que lo componen, proponemos un conjunto de 4 criterios: declinaciones recientes en la distribución o funcionamiento ecológica, pérdida total histórica en la distribución o funcionamiento ecológico, distribución pequeña combinada con declinación, o distribución muy pequeña. La mayor parte del trabajo se ha concentrado en ecosistemas terrestres, pero también se requieren umbrales y criterios comparables para ecosistemas dulceacuícolas y marinos. Estos son los primeros pasos de un proceso de consulta internacional que llevará a una propuesta unificada que será presentada en el próximo Congreso Mundial de Conservación en 2012. PMID:21054525

A Influência da Escola e da Mídia na Obtenção dos Conhecimentos Astronômicos

NASA Astrophysics Data System (ADS)

da Cunha, W. S.; Voelzke, M. R.; Amaral, L. H.

2006-08-01

O universo em que vivemos possui segredos jamais imaginados pelo homem, fruto da pequena proporção que ocupamos diante de um cosmos infinito. A astronomia funciona como um instrumento que sacia a sede humana em desvendar esses segredos, estudando as galáxias, quasares, pulsares além da existência de todos os elementos que preenchem o espaço cósmico, o vácuo, não mais vazio como se pensou em outros tempos. A mídia explora esse campo de forma mística e também científica. A difusão adequada e dentro dos padrões educacionais vigentes, de conceitos astronômicos, se faz necessária, devido sua presença nos conteúdos escolares, centros de ciência e na mídia, de modo geral. A reforma do Currículo Básico da Escola Pública da maioria dos Estados brasileiros introduziu conceitos astronômicos desde a pré-escola até o Ensino Médio. Num estudo realizado com 1.032 alunos do Ensino Médio de seis escolas estaduais, revelou-se através da aplicação de um questionário que abordava conheciment os básicos em astronomia, como estes foram adquiridos e qual era a infra-estrutura oferecida pela escola: para 66,2% dos entrevistados o professor já fez alguma apresentação a respeito de astronomia. O presente estudo revelou também que 44,5% dos alunos entrevistados adquiriram seus conhecimentos astronômicos na escola, 28,1% através da televisão e 27,4% afirmaram que seus conhecimentos foram obtidos através de outros tipos de mídia (internet, filmes e revistas). Embora o estudo revele claramente que há certo equilíbrio na forma em que os alunos obtiveram seus conhecimentos astronômicos, a mídia ainda explora e muitas vezes desperta o interesse pela astronomia com assuntos que não fazem parte de nosso cotidiano como, por exemplo, o homem na Lua, os projetos espaciais e a primeira viagem de um astronauta brasileiro no espaço. Porém, em certos casos, a mídia pode promover conhecimentos incompletos ou mesmo equivocados sobre os conceitos que envolvam

Birds and people in semiarid northeastern Brazil: symbolic and medicinal relationships

PubMed Central

2013-01-01

Abstract Background At least 511 species of birds occur in the semiarid region of northeastern Brazil and many of them interact with human populations in a number of different ways, including their use in zootherapeutics and their links with local beliefs. Objective The present work examined these types of birds/human interactions (use in zootherapeutics and their links with local beliefs) in the semiarid region of Rio Grande do Norte State in northeastern Brazil. Methods Information was obtained through semi-structured interviews with 120 local residents. Results A total of 16 wild bird species distributed among 11 families were found to interact directly with humans, with Columbidae being the best represented family. Seven species were identified in the medicinal category, five were related to symbolic aspects, while four species were identified as being related to both categories (medicinal and symbolic). Conclusion The accumulated folk knowledge, beliefs, and practices involving the avifauna in the semiarid region of Brazil, whether symbolic or medicinal, demonstrated the cultural importance of this vertebrate group to local human populations and revealed a belief system intrinsically related to cynegetic practices in the region. Portuguese abstract Introdução No semiárido do Brasil ocorrem 511 espécies de aves, algumas das quais interagem frequentemente com as populações humanas locais de diferentes formas, incluindo o uso como zooterápico e a inserção em crenças. Objetivo Esta pesquisa registrou as aves diretamente associadas a essas formas de interação (o uso como zooterápico e a inserção em crenças) na região semiárida do Estado do Rio Grande do Norte, Nordeste do Brasil. Métodos As informações foram obtidas através de entrevistas semiestruturadas aplicadas a 120 moradores locais. Resultados Foram registradas 16 espécies de aves silvestres distribuídas em 11 famílias, sendo Columbidae a que apresentou o maior número de

[Towards an evolution of sexual ethics].

PubMed

Dominga Trapasso, R

1991-01-01

years. The 1930 letter of Pope Pius XI, Casti Conubi, largely reiterated the traditional teachings but also declared that the happiness of the couple, not just procreation, is a finality of marriage. In 1951, Pope Pius XII in a famous address to a group of nurses and obstetricians recognized the possibility of spacing births by the rhythm method, which was regarded as "natural" because it did not impede procreation in a direct form. In 1963, during the 2nd Vatican Council, Pope John XXIII created a commission to study the question of birth control. Its 68 members were unable to agree and presented 2 reports to Pope Paul VI, who adopted the minority position, held by only 4 members, that maintained the traditional Church position but without proposing theological reasons. The 1968 letter Humanae Vitae once again declared sex and procreation inseparable and all attempts at birth control illicit. It is time for a new ethics that recognizes sex as a vital and marvelous dimension of sexuality.

Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders.

PubMed

Brock, Felipe; Bettinelli, Luiz Antonio; Dobner, Taise; Stobbe, Júlio César; Pomatti, Gabriela; Telles, Cristina Trevizan

2016-08-08

apresentavam hipoalbuminemia. a prevalência de hipoalbuminemia mostrou-se elevada, acometendo aproximadamente nove entre dez idosos, sendo que o estado nutricional, da mesma maneira que o tempo de internação , está relacionado à diminuição dos níveis de albumina sérica. Assim, sugere-se monitorar os níveis de albuminemia para avaliar o risco que o paciente tem de desenvolver desnutrição e demais complicações durante a internação hospitalar. estimar la prevalencia de hipoalbuminemia en ancianos hospitalizados, considerando las variables sociodemográficas, estado nutricional y tiempo de internación. estudio transversal, en 200 pacientes internados en hospital de gran porte del sur de Brasil, durante un período de tres meses. Fueron realizadas evaluaciones, análisis de exámenes de laboratorio y se realizó una entrevista usando un cuestionario. el promedio de albuminemia fue 2,9 ± 0,5g/dL. El diagnóstico de hipoalbuminemia, fue encontrado en 173 sujetos (87%), y no revelado en 27 (13%), que presentaron albuminemia normal (p=0,000). Se constató que después de seis días de internación la prevalencia de niveles bajos aumentó significativamente para 90% (p=0,002), con promedio de 2,7 ± 0,5g/dL. Utilizando la Mini Evaluación Nutricional, se observó que 41 pacientes estaban desnutridos, y que de estos, 40 presentaban hipoalbuminemia. la prevalencia de hipoalbuminemia se mostró elevada, afectando aproximadamente nueve entre diez ancianos, siendo que el estado nutricional, de la misma manera que el tiempo de internación, está relacionado a la disminución de los niveles de albúmina sérica. Así, se sugiere monitorizar los niveles de albuminemia para evaluar el riesgo que el paciente tiene de desarrollar desnutrición y demás complicaciones durante la internación hospitalaria.

Impact of payments for environmental services and protected areas on local livelihoods and forest conservation in northern Cambodia

PubMed Central

Clements, Tom; Milner-Gulland, E J

2015-01-01

potenciales de los pagos por servicios ambientales (PSA) y áreas protegidas (APs) sobre los resultados ambientales y las subsistencias locales en los países en desarrollo son polémicos y se han debatido ampliamente. La evidencia disponible es escasa; ha habido pocas evaluaciones rigurosas de los impactos ambientales y sociales de las APs y particularmente los PSA. Medimos el impacto sobre los bosques y el bienestar humano en tres diferentes programas de PSA que se llevan a cabo dentro de dos APs en el norte de Camboya usando un panel de aldeas de intervención y controles emparejados. Tanto los PSA como las APs brindaron resultados ambientales adicionales en relación a los contrafácticos, esto quiere decir que redujeron las tasas de deforestación significativamente en relación a los controles. Las áreas protegidas incrementaron el acceso seguro a los recursos del suelo y el bosque para las viviendas locales, beneficiando a los usuarios de los recursos del bosque pero restringiendo la habilidad de las viviendas para expandirse y diversificar su agricultura. Los impactos de los pagos por servicios ambientales sobre el bienestar de las viviendas estuvieron relacionados con la magnitud de los pagos proporcionados. Los dos programas de PSA de mayor paga y con conexión al mercado tuvieron impactos positivos significativos, mientras que un programa de menor paga con el objetivo de proteger a la biodiversidad no tuvo un efecto detectable sobre las viviendas, a pesar de sus resultados ambientales positivos. Las viviendas que se inscribieron a los programas de PSA con mayor paga, sin embargo, necesitaban típicamente más bienes capitales, por lo que eran menos pobres y tenían mayor seguridad alimentaria que otros aldeanos. Por esto, mientras los impactos de las APs sobre el bienestar de las viviendas fueron limitados en general y variaron dependiendo de las estrategias de subsistencia, los programas de PSA tuvieron impactos positivos significativos sobre las viviendas para

Supervised physical therapy in women treated with radiotherapy for breast cancer.

PubMed

Leal, Nara Fernanda Braz da Silva; Oliveira, Harley Francisco de; Carrara, Hélio Humberto Angotti

2016-08-15

e, na avaliação 3, os déficits de todos os movimentos estavam recuperados. Na análise da perimetria não foi observada diferença significativa. o protocolo fisioterapêutico supervisionado aplicado foi efetivo na recuperação do déficit de abdução pós-radioterapia e de flexão e rotação externa quando avaliados até 2 meses após o término da radioterapia. Número do registro do ensaio clínico: NCT02198118. evaluar el efecto de la terapia física en el rango de movimiento de los hombros y la perimetría de las extremidades superiores en mujeres tratadas con radioterapia debido a cáncer de mama. un total de 35 participantes fueron aleatorizadas en dos grupos, 18 en el grupo control y 17 en el grupo de estudio. Ambos grupos fueron sometidos a tres evaluaciones para evaluar el rango de movimiento de los hombros y la perimetría de las extremidades superiores, y el grupo de estudio fue sometido a terapia física supervisada de las extremidades superiores. el grupo de control tuvo déficits en la rotación externa en la evaluación 1, 2, y 3, mientras que el grupo de estudio tuvo déficits en la flexión, abducción y rotación externa en la evaluación 1. El déficit en la abducción fue recuperado en la evaluación 2, mientras que los déficits en todos los movimientos fueron recuperados en la evaluación 3. No se observaron diferencias significativas en la perimetría. la terapia física supervisada aplicada fue efectiva en la recuperación del déficit en la abducción después de la radioterapia y los déficits en flexión y rotación externa fueron recuperados dos meses después de terminada la radioterapia. Número de registro del ensayo clínico: NCT02198118.

Assessment of the nursing care product (APROCENF): a reliability and construct validity study.

PubMed

Cucolo, Danielle Fabiana; Perroca, Márcia Galan

2017-04-06

utilizada com extração por componentes principais e rotação varimax (validação do construto). a consistência interna revelou alfa de 0,85, correlação entre itens variando de 0,13 a 0,61 e item-total de 0,43 a 0,69. A equivalência interavaliadores foi obtida e todos os itens evidenciaram cargas fatoriais significantes. esta investigação mostrou evidências de confiabilidade e validade do construto do instrumento para avaliação do produto do cuidar em enfermagem. Sua aplicação na prática de enfermagem possibilita identificar melhorias necessárias no processo produtivo contribuindo para decisões gerenciais e assistenciais. verificar las estimativas de confiabilidad y validez de constructo de la escala "Evaluación del producto del cuidar en enfermería" (APROCENF) y su aplicabilidad. este estudio de validación incluyó en su muestra 40 (confiabilidad inter-evaluadores) y 172 (validez de constructo) evaluaciones efectuadas por enfermeros al final del turno de trabajo en nueve unidades de internación de un hospital universitaria del sudeste brasileño. Los datos fueron recolectados entre febrero y septiembre de 2014 de forma interrumpida. Fueron calculados los coeficientes alfa de Cronbach y correlación de Spearman (consistencia interna), la correlación intraclase y Kappa ponderado (confiabilidad inter-evaluadores)y el análisis factorial exploratorio fue utilizado con extracción por componentes principales y rotación varimax (validación de constructo). la consistencia interna reveló alfa de0,85,correlación entre ítems variando de 0,13 a 0,61 y ítem-total de 0,43 a 0,69. La equivalencia inter-evaluadores fue alcanzada y todos los ítems evidenciaron cargas factoriales significantes. esta investigación mostró evidencias de confiabilidad y validez del constructo del instrumento para evaluación del producto del cuidar en enfermería. Su aplicación en la práctica de enfermería posibilita identificar mejoras necesarias en el proceso productivo

Characterisation of gas and particle emissions from wildfires =

NASA Astrophysics Data System (ADS)

Vicente, Ana Margarida Proenca

Os incendios florestais sao uma importante fonte de emissao de compostos gasosos e de aerossois. Em Portugal, onde a maioria dos incendios ocorre no norte e centro do pais, os incendios destroem todos os anos milhares de hectares, com importantes perdas em termos economicos, de vidas humanas e qualidade ambiental. As emissoes podem alterar consideravelmente a quimica da atmosfera, degradar a qualidade do ar e alterar o clima. Contudo, a informacao sobre as carateristicas das emissoes dos incendios florestais nos paises do Mediterrâneo e limitada. Tanto a nivel nacional como internacional, existe um interesse crescente na elaboracao de inventarios de emissoes e de regulamentos sobre as emissoes de carbono para a atmosfera. Do ponto de vista atmosferico da monitorizacao atmosferica, os incendios sao considerados um desafio, dada a sua variabilidade temporal e espacial, sendo de esperar um aumento da sua frequencia, dimensao e severidade, e tambem porque as estimativas de emissoes dependem das carateristicas dos biocombustiveis e da fase de combustao. O objetivo deste estudo foi quantificar e caraterizar as emissoes de gases e aerossois de alguns dos mais representativos incendios florestais que ocorreram no centro de Portugal nos veroes de 2009 e de 2010. Efetuou-se a colheita de amostras de gases e de duas fracoes de particulas (PM2.5 e PM2.5-10) nas plumas de fumo em sacos Tedlar e em filtros de quartzo acoplados a um amostrador de elevado volume, respetivamente. Os hidrocarbonetos totais (THC) e oxidos de carbono (CO e CO2) nas amostras gasosas foram analisados em instrumentos automaticos de ionizacao de chama e detetores nao dispersivos de infravermelhos, respetivamente. Para algumas amostras, foram tambem quantificados alguns compostos de carbonilo apos reamostragem do gas dos sacos Tedlar em cartuchos de silica gel revestidos com 2,4-dinitrofenilhidrazina (DNPH), seguida de analise por cromatografia liquida de alta resolucao. Nas particulas, analisou-se o

Serious game development as a strategy for health promotion and tackling childhood obesity.

PubMed

Dias, Jéssica David; Mekaro, Marcelo Shinyu; Cheng Lu, Jennifer Kaon; Otsuka, Joice Lee; Fonseca, Luciana Mara Monti; Zem-Mascarenhas, Silvia Helena

2016-08-15

avaliação serviram de subsídio para adequações no software com a finalidade de disponibilizá-lo futuramente à população alvo da pesquisa. O grande diferencial do jogo proposto é o fato do mesmo ser um recurso educacional aberto. as avaliações com especialistas demonstraram que o jogo tem grande potencial educacional e considerado adequado para a aplicação futura com o público-alvo. O serious game pode ser um recurso didático tecnológico acessível para uso em escolas e unidades de saúde, além de poder ser reutilizado para a produção de outros jogos educacionais através do acesso de seu código fonte. desarrollar y evaluar un serious game (Juego serio) sobre alimentación saludable y ejercicio físico para la promoción de la salud y ayudar en el enfrentamiento de la obesidad infantil. estudio descriptivo, aplicado y metodológico. Para el desarrollo del juego, se iniciaron los siguientes pasos: conceptualización, pre-producción con el desarrollo de la documentación del juego, creación de prototipos, producción y evaluación por expertos informáticos y en salud. un prototipo se ha desarrollado hasta la versión beta. El juego se evaluó positivamente tanto en términos de jugabilidad y mecánica como en relación con el contenido presentado, destacándose como una poderosa estrategia para la promoción de la salud. La información de la fase de evaluación contribuyó a los ajustes en el software con el fin de que esté disponible en el futuro para la población objetivo de esa investigación. La gran vantaja del juego propuesto es el hecho de que es un recurso educativo abierto. las evaluaciones de los expertos mostraron que el juego tiene un gran potencial educativo y es considerado adecuado para la aplicación futura para el público objetivo. El serious game puede convertirse en un recurso para la enseñanza tecnológica disponible para uso en las escuelas y en los centros de salud, y también puede ser reutilizado para la producción de

Astronomy, Art and Mythology in a Public Elementary School in Itaocara/rj. (Spanish Title: Astronomía, Arte y Mitologia en el Ensino Fundamental en Una Escuela de la Red Estatal en ITAOCARA/RJ.) Astronomia, Arte e Mitologia no Ensino Fundamental em Escola da Rede Estadual em ITAOCARA/RJ

NASA Astrophysics Data System (ADS)

Oliveira Bernardes, Adriana; Ramos dos Santos, Arleidimar

2008-12-01

conocimientos recibidos. El trabajo en sí ha mostrado además de la posibilidad de la inclusión de la Astronomía en la Educación Primaria, la posibilidad de un trabajo interdisciplinario en los niveles iniciales incluyendo Astronomía, Arte y Mitología. Los resultados presentados por los estudiantes en las Olimpiadas promovidas en la escuela y por la OBA (Olimpiada Brasilera de Astronomía) permitieron verificar un creciente aprendizaje y estimulo hacia las materias científicas, comprobados por la apropiada expresión de los conceptos adquiridos de astronomía y presentados en evaluaciones o en informes obtenidos de ellos mismos, sus familias y profesores. Desenvolvendo um trabalho voluntário junto aos alunos do ensino fundamental no 1º ciclo (1ª a 4ª série), os monitores de Astronomia membros do CAIMP (Clube de Astronomia de Itaocara Marcos Pontes), que eram em sua maioria alunos do ensino médio, desenvolveram um trabalho de aproximação entre os alunos do Colégio Estadual Teotônio Brandão Vilela e os temas envolvendo Ciências e Astronomia. Através de oficinas de informática, artes, vídeos educativos e teatros de fantoches, os alunos puderam expressar seus conhecimentos e emoções diante das lendas mitológicas com as quais começaram a ter contato. O trabalho desenvolvido pelos monitores junto aos alunos proporcionou a integração entre as turmas do colégio e os levou a participação em atividades de maneira a estimular sua oralidade e aumentar sua auto-estima. Trabalhando várias formas de expressões, os alunos puderam realizar seus experimentos e conhecer alguns conceitos de Física e Astronomia, enquanto adquiriam autonomia para se expressarem de acordo com seus sentimentos e conhecimentos adquiridos. O trabalho em si mostrou além da possibilidade de inserção de Astronomia no Ensino Fundamental, a possibilidade de realização de um trabalho interdisciplinar nas séries iniciais envolvendo Astronomia, Arte e Mitologia. Os resultados apresentados

Self-image and perception of mother and father in psychotic and borderline patients.

PubMed

Armelius, K; Granberg

2000-02-01

eine mangelnde Separation von ihren Müttern und eine geringe Differenzierung zwischen Autonomie und Kontrolle. Es wird außerdem diskutiert, wie die Ergebnisse auf die realen Beziehungen der Patienten zu anderen Menschen Einflus nehmen könnten. Des patients psychotiques et Borderline ont évalué leur image d'eux-mêmes et leur perception de leur mère et père à l'aide du modèle de l'Analyse Structural du Comportement Social (SASB. Les patients Borderline avaient des imagess plus négatives d'eux-mêmes et de leurs parents, surtout de leur père, que les patients psychotiques et les sujets normaux, alors que les patients psychotiques se jugeaient à peine différemment des sujets normaux. L'image de soi était en relation avec les images des deux parents pour les patients Borderline et pour les sujets normaux, alors que pour les patients psychotiques, seulement l'image de la mère jouait un rôle pour leur image. En plus, les patients psychotiques ne différenciaient pas entre les pôles de contrôle et d'autonomie dans l'image de soi introjectée. Nous en avons conclu que les patients Borderline se caractérisent par un attachement négatif, et les patients psychotiques par une faible séparation de la mère ainsi qu'une différenciation modeste entre autonomie et contrôle. L'influence de ceci sur les relations des patients avec les autrs est discutée dans cet article. Pacientes limítrofes y psicóticos evaluaron su autoimagen y la percepción que tenían de sus padres usando el modelo de Análisis estructural del comportamiento social (SASB). Los pacientes limítrofes registraron imágenes más negativas de sí mismos y de sus progenitores, especialmente de su padre, que los pacientes psicóticos y los normales, mientras que las evaluaciones de los pacientes psicóticos no difirieron mucho de las de los sujetos normales. La autoimagen tuvo relación con la imagen de ambos progenitores tanto en el caso de los pacientes limítrofes como de los sujetos normales

Stages of change of behavior in women on a multi-professional program for treatment of obesity.

PubMed

Bevilaqua, Cheila Aparecida; Pelloso, Sandra Marisa; Marcon, Sonia Silva

2016-10-10

pré dispostas a realizarem mudanças na alimentação e na atividade física. No entanto, só foi observada diferença significativa em relação ao peso, índice de massa corporal (IMC), circunferência da cintura e relação cintura-quadril e prontidão para mudança entre as integrantes do grupo intervenção. a intervenção programada foi efetiva na perda de peso, diminuição da circunferência da cintura e relação cintura-quadril e na mudança de comportamentos relacionados à prática de exercícios físicos e alimentar. verificar la efectividad de un programa de intervención sobre medidas antropométricas y de la fase de preparación para cambio de comportamiento, en mujeres con exceso de peso. el grupo intervención (GI) estuvo constituido por 13 mujeres y el grupo control por 20. La intervención tuvo duración de 16 semanas e incluyó práctica orientada de actividad física tres veces en la semana y educación en salud una vez por semana. La aplicación del cuestionario de fase de preparación para cambio de comportamiento y para las evaluaciones antropométricas fueron realizadas en dos momentos, antes y después del período de intervención. El análisis estadístico se realizó con pruebas de comparación y asociación. en general, en el momento inicial, las participantes de los dos grupos estaban predispuestas a realizar cambios en la alimentación y en la actividad física. Sin embargo, solamente entre las integrantes del grupo intervención fue observada diferencia significativa en relación: al peso; al índice de masa corporal (IMC); a la circunferencia de la cintura y relación cintura-cadera; y, a la preparación para el cambio. la intervención programada fue efectiva en: pérdida de peso, disminución de la circunferencia de la cintura y relación cintura-cadera, y en el cambio de comportamiento relacionado a la práctica de ejercicios físicos y de alimentación.

[Injecting without getting infected: injectors' strategies to prevent HIV and HCV.

PubMed

Mateu-Gelabert, P; Friedman, S; Sandoval, M

2007-10-01

OBJETIVO: Desde principios de los noventa, en la ciudad de Nueva York se han implementado con éxito programas para reducir la incidencia del virus de la inmunodeficiencia humana (VIH) y, en menor medida, del virus de la hepatitis C (VHC). A pesar de ello, aproximadamente el 70% de los usuario de drogas inyectables (UDI) están infectados por el VHC. Queremos investigar cómo el 30% restante se las ha arreglado para no infectarse. El Staying safe (nombre original del estudio) explora los comportamientos y mecanismos que ayudan a evitar la infección por el VHC y el VIH a largo plazo. MATERIAL Y M#ENTITYSTARTX000E9;TODOS: Hemos utilizado el concepto de «desviación positiva» aplicado en otros campos de salud pública. Estudiamos las estrategias, prácticas y tácticas de prevención de aquellos UDI que, viviendo en contextos de alta prevalencia, se mantienen sin infectar por VIH y el VHC, a pesar de haberse inyectado heroína durante años. Los resultados preliminares presentados en este artículo incluyen el análisis de las entrevistas realizadas a 25 UDI (17 doble negativos, 3 doble positivos y 5 con infección por el VHC y sin infección por el VIH). Se usaron entrevistas semiestructuradas que exploraban con detalle la historia de vida de los sujetos, incluyendo su consumo de drogas, redes sociales, contacto con instituciones, relaciones sexuales y estrategias de protección y vigilancia. RESULTADOS: La intencionalidad es importante para no infectarse, especialmente durante períodos de involución (períodos donde hay un deterioro económico y/o social que llevan al que se inyecta a situaciones de mayor riesgo). Presentamos tres dimensiones independientes de intencionalidad que conllevan comportamientos que pueden ayudar a prevenir la infección: a) evitar «el mono» (síntomas de abstención) asegurando el acceso a la droga; b) «llevarlo bien» para no convertirse en un junkie y así evitar la «muerte social» y la falta de acceso a los recursos, y c

Pincharse sin infectarse: estrategias para prevenir la infección por el VIH y el VHC entre usuarios de drogas inyectables

PubMed Central

MATEU-GELABERT, P.; FRIEDMAN, S.; SANDOVAL, M.

2011-01-01

Resumen Objetivo Desde principios de los noventa, en la ciudad de Nueva York se han implementado con éxito programas para reducir la incidencia del virus de la inmunodeficiencia humana (VIH) y, en menor medida, del virus de la hepatitis C (VHC). A pesar de ello, aproximadamente el 70% de los usuario de drogas inyectables (UDI) están infectados por el VHC. Queremos investigar cómo el 30% restante se las ha arreglado para no infectarse. El Staying safe (nombre original del estudio) explora los comportamientos y mecanismos que ayudan a evitar la infección por el VHC y el VIH a largo plazo. Material y métodos Hemos utilizado el concepto de «desviación positiva» aplicado en otros campos de salud pública. Estudiamos las estrategias, prácticas y tácticas de prevención de aquellos UDI que, viviendo en contextos de alta prevalencia, se mantienen sin infectar por VIH y el VHC, a pesar de haberse inyectado heroína durante años. Los resultados preliminares presentados en este artículo incluyen el análisis de las entrevistas realizadas a 25 UDI (17 doble negativos, 3 doble positivos y 5 con infección por el VHC y sin infección por el VIH). Se usaron entrevistas semiestructuradas que exploraban con detalle la historia de vida de los sujetos, incluyendo su consumo de drogas, redes sociales, contacto con instituciones, relaciones sexuales y estrategias de protección y vigilancia. Resultados La intencionalidad es importante para no infectarse, especialmente durante períodos de involución (períodos donde hay un deterioro económico y/o social que llevan al que se inyecta a situaciones de mayor riesgo). Presentamos tres dimensiones independientes de intencionalidad que conllevan comportamientos que pueden ayudar a prevenir la infección: a) evitar «el mono» (síntomas de abstención) asegurando el acceso a la droga; b) «llevarlo bien» para no convertirse en un junkie y así evitar la «muerte social» y la falta de acceso a los recursos, y c) seguir sin

TECHNOLOGICAL INFORMATION REGARDING PREBIOTICS AND PROBIOTICS NUTRITION VERSUS THE PATENT REGISTERS: WHAT IS NEW?

PubMed

Reis, José Maciel Caldas Dos; Pinheiro, Maurício Fortuna; Oti, André Takashi; Feitosa-Junior, Denilson José Silva; Pantoja, Mauro de Souza; Barros, Rui Sérgio Monteiro

2016-01-01

Food is a key factor both in prevention and in promoting human health. Among the functional food are highlighted probiotics and prebiotics. Patent databases are the main source of technological information about innovation worldwide, providing extensive library for research sector. Perform mapping in the main patent databases about pre and probiotics, seeking relevant information regarding the use of biotechnology, nanotechnology and genetic engineering in the production of these foods. Electronic consultation was conducted (online) in the main public databases of patents in Brazil (INPI), United States (USPTO) and the European Patent Bank (EPO). The research involved the period from January 2014 to July 2015, being used in the title fields and summary of patents, the following descriptors in INPI "prebiotic", "prebiotic" "probiotics", "probiotic" and the USPTO and EPO: "prebiotic", "prebiotics", "probiotic", "probiotics". This search haven't found any deposit at the brazilian patents website (INPI) in this period; US Patent &Trademark Office had registered 60 titles in patents and the European Patent Office (EPO) showed 10 documents on the issue. Information technology offered by genetic engineering, biotechnology and nanotechnology deposited in the form of titles and abstracts of patents in relation to early nutritional intervention as functional foods, has increasingly required to decrease the risks and control the progression of health problems. But, the existing summaries, although attractive and promising in this sense, are still incipient to recommend them safely as a therapeutic tool. Therefore, they should be seen more as diet elements and healthy lifestyles. A alimentação é fator primordial tanto na prevenção quanto na promoção para a saúde humana. Dentre os alimentos funcionais destacam-se os probióticos e prebióticos. Os bancos de dados de patentes representam a maior fonte de informação tecnológica acerca de inovação em nível mundial

Parasitism, productivity, and population growth: response of Least Bell's Vireos (Vireo bellii pusillus) and Southwestern Willow Flycatchers (Empidonax traillii extimus) to cowbird (Molothrus spp.) control

USGS Publications Warehouse

Kus, Barbara E.; Whitfield, Mary J.

2005-01-01

previas a la captura y, en consecuencia, ha incrementado significativamente la productividad estacional de las parejas reproductivas. Ese mejora en productividad, a su vez, ha resultado en que el número de Vireo belli pusillus se incrementara 8 veces. La abundancia de Empidonax trailli extimus en cambio, ha variado poco, e incluso en algunos sitios, se ha reducido a pesar del control de los Molothrus. Aunque aparentemente el control de Molothrus fue exitoso por los resultados obtenidos a corto plazo, el control de los Molothrus posee consecuencias potencialmente negativas para la recuperación a largo plazo de las especies en peligro. De la forma en que es actualmente aplicado, el control de los Molothrus carece de criterios biológicos predeterminados que permitan dejar de aplicarlo. Esto implica que las especies que se quiera proteger dependan eternamente de la intervención humana. El hecho de que que el manejo de las especies en peligro se base en la dependencia prolongada en el control de los Molothrus podría distraer la atención sobre la identificación y el manejo de otros factores que limitan dichas poblaciones-en particular, la disponibilidad de hábitat. Basándonos en nuestro análisis de estos programas a largo plazo, sugerimos que el control de Molothrus quede reservado para las crisis de manejo de corto plazo. Cuando fuera apropiado, es de esperar que dicho manejo sea reemplazado por prácticas enfatizadas hacia la restauración y el mantenimiento de los procesos naturales de los cuales esas especies en realidad dependen.

The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?

PubMed

Bedard, Nicholas A; Pugely, Andrew J; Elkins, Jacob M; Duchman, Kyle R; Westermann, Robert W; Liu, Steve S; Gao, Yubo; Callaghan, John J

2017-01-01

Infection after total knee arthroplasty (TKA) can result in disastrous consequences. Previous research regarding injections and risk of TKA infection have produced conflicting results and in general have been limited by small cohort size. The purpose of this study was to evaluate if intraarticular injection before TKA increases the risk of postoperative infection and to identify if time between injection and TKA affect the risk of TKA infection. The Humana data set was reviewed from 2007 to 2014 for all patients who received a knee injection before TKA. Current Procedural Terminology (CPT) codes and laterality modifiers were used to identify patients who underwent knee injection followed by ipsilateral TKA. Postoperative infection within 6 months of TKA was identified using International Classification of Diseases, 9 th Revision/CPT codes that represent two infectious endpoints: any postoperative surgical site infection (encompasses all severities of infection) and operative intervention for TKA infection (surrogate for deep TKA infection). The injection cohort was stratified into 12 subgroups by monthly intervals out to 12 months corresponding to the number of months that had elapsed between injection and TKA. Risk of postoperative infection was compared between the injection and no injection cohorts. In total, 29,603 TKAs (35%) had an injection in the ipsilateral knee before the TKA procedure and 54,081 TKA cases (65%) did not. The PearlDiver database does not currently support line-by-line output of patient data, and so we were unable to perform a multivariate analysis to determine whether other important factors may have varied between the study groups that might have had a differential influence on the risk of infection between those groups. However, the Charlson Comorbidity index was no different between the injection and no injection cohorts (2.9 for both) suggesting similar comorbidity profiles between the groups. The proportion of TKAs developing any

Is response-guided therapy being applied in the clinical setting? The hepatitis C example.

PubMed

Harris, Jennifer B; Ward, Melea A; Schwab, Phil

2015-02-01

Response-guided therapy (RGT) is a treatment model that bases adjustments to therapeutic regimens on individualized patient physiologic response. This approach is applied to patients with chronic hepatitis C virus (HCV) infection who are treated with a triple therapy regimen of boceprevir or telaprevir in combination with pegylated interferon and ribavirin. As RGT expands in other pharmacologic regimens, including the treatment of breast cancer and acute myeloid leukemia, a measurement of how this approach is applied in clinical practice is important to determine whether the benefits of RGT are being optimized. To measure adherence to the RGT guidelines and to the treatment futility rules based on the drug labeling information for boceprevir and for telaprevir in the treatment of patients with chronic HCV infection. A retrospective observational cohort study was conducted using the large Humana research database, which includes pharmacy, medical, and laboratory claims, as well as enrollment data for more than 1.5 million fully insured commercial members, 1.9 million Medicare Advantage members, and 2.4 million Medicare Part D members from all 50 states. The study population included patients aged ≥18 years to <90 years who were fully insured with commercial or Medicare Advantage coverage. A pharmacy claim for boceprevir or telaprevir was used to identify patients receiving triple therapy for HCV infection. Medical, pharmacy, and laboratory claims were reviewed from the date of the first boceprevir or telaprevir pharmacy claim between May 2011 and February 2012 through a 32-week follow-up period, during which patients were required to have continuous health plan enrollment eligibility. This time period allowed for the occurrences of required HCV RNA laboratory monitoring and the assessment of treatment patterns. The use of RGT for boceprevir and telaprevir includes the monitoring of HCV RNA levels at routine intervals to determine how to proceed with therapy

Chronic pre-operative opioid use is a risk factor for increased complications, resource use and costs after cervical fusion.

PubMed

Jain, Nikhil; Brock, John L; Phillips, Frank M; Weaver, Tristan; Khan, Safdar N

2018-04-27

As healthcare transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and post-operative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. To answer the following questions from a large cohort of patients who underwent primary cervical fusion for degenerative pathology: (1) What is the patient profile associated with pre-operative COT? (2) Is pre-operative COT a risk factor for 90-day systemic complications, emergency department (ED) visits, readmission, and one-year adverse events? (3) What are the risk factors and one-year adverse events related to long-term post-operative opioid use? and (4) How much did payers reimburse for management of complications and adverse events? Retrospective review of Humana commercial insurance data (2007-Q3 2015). 29,101 patients undergoing primary cervical fusion for degenerative pathology. Patients and procedures of interest were included using International Classification of Diseases (ICD) coding. Patients with opioid prescriptions for >6 months before surgery were considered as having pre-operative COT. Patients with continued opioid use till one-year after surgery were considered as long-term users. Descriptive analysis of patient cohorts has been done. Multiple-variable logistic regression analyses adjusting for approach, number of levels of surgery, discharge disposition, and comorbidities were done to answer first three study questions. Reimbursement data from insurers has been reported to answer our fourth study question. Of the entire cohort, 6,643 (22.8%) had pre-operative COT. Pre-operative COT was associated with a higher risk of 90-day wound complications (OR 1.39, 95% CI:1.16-1.66), all-cause 90-day ED visits (adjusted OR 1.22, 95% CI:1.13-1.32), and pain-related ED visits (adjusted OR 1.39, 95% CI:1

Seguridad del paciente en Radioterapia Intraoperatoria: Impacto de los elementos controlados por el Radiofisico

NASA Astrophysics Data System (ADS)

Tarjuelo, Juan Lopez

Introduccion: En la administracion de la radioterapia intervienen profesionales y equipos de tratamiento, por lo que existe el riesgo de error y se precisa que dicho equipamiento funcione conforme a lo esperado. A los radiofisicos les corresponde participar en las actividades de garantia o aseguramiento de la calidad, incluyendo el control de calidad de los equipos, y en la evaluacion de los riesgos asociados. La radioterapia intraoperatoria (RIO) es una tecnica radioterapica de intensificacion de dosis, altamente selectiva, dirigida a volumenes anatomicos restringidos durante el tratamiento quirurgico oncologico, basada en la administracion de una dosis absorbida alta por medio de un haz de electrones tras el examen visual directo del lecho tumoral. Como incorporar los ultimos avances en el refuerzo de la seguridad en radioterapia es una tarea ambiciosa y compleja, resulta mas concreta y de inmediata aplicacion su introduccion en la RIO. El objetivo es analizar los elementos que reducen los riesgos y aumentan la seguridad en la RIO y su dosimetria, y valorar la funcion del radiofisico en esta labor. Material y metodos: Se emplearon el planificador Radiance de GMV y el acelerador lineal de los tratamientos de RIO Elekta Precise, controlado con el verificador diario de haces Daily QA Check 1090 y medido con las camaras de ionizacion PPC 40, FC65-G y FC65-P de PTW-Freiburg, a su vez verificadas con fuentes radiactivas adecuadas de estroncio-90 modelos CDP y CDC de IBA Dosimetry. Se realizo un analisis de modos de fallo y efectos (failure mode and effect analysis, FMEA) con el fin de identificar los elementos que forman la RIO y aplicar las herramientas necesarias para la minimizacion de los riesgos y la mejora de la seguridad en la tecnica. Se estudiaron las verificaciones diarias de dicho acelerador Precise con el control estadistico de procesos (statistical process control, SPC) y se simularon intervenciones para devolverlo al estado llamado en control. El SPC

Geographic range size and extinction risk assessment in nomadic species

PubMed Central

Runge, Claire A; Tulloch, Ayesha; Hammill, Edd; Possingham, Hugh P; Fuller, Richard A

2015-01-01

planning. Tamaño de Extensión Geográfica y Evaluación de Riesgo de Extinción en Especies Nómadas Resumen El tamaño de extensión geográfica se conceptualiza frecuentemente como un atributo fijo de las especies y se trata como tal para los propósitos de cuantificación de riesgo de extinción; se asume que las especies que ocupan extensiones geográficas más pequeñas tienen un riesgo de extinción más alto, cuando todo lo demás es igual. Sin embargo, muchas especies son móviles y sus movimientos varían desde migraciones de ida y vuelta relativamente predecibles hasta movimientos irregulares complejos, como los que muestran las especies nómadas. Estos movimientos pueden llevar a expansiones sustanciales temporales y a una reducción de las extensiones geográficas, todo esto con el potencial de llegar a niveles que pueden presentar un riesgo de extinción. Al enlazar los datos de presencia con las condiciones ambientales al momento de la observación de las especies nómadas pudimos modelar las distribuciones dinámicas de 43 especies de aves de zonas áridas a lo largo de la isla de Australia durante cada mes a lo largo de once años y calculamos el tamaño de extensión mínima y el alcance de las fluctuaciones en el tamaño de extensión geográfica a partir de estos modelos. Hubo una enorme variabilidad en la distribución espacial pronosticada a lo largo del tiempo: diez especies variaron en el tamaño de extensión geográfica por más de una orden de magnitud y dos especies variaron por más de dos órdenes de magnitud. Durante situaciones de condiciones ambientales pobres, varias especies que actualmente no se encuentran clasificadas como amenazadas a nivel global redujeron sus extensiones a áreas muy pequeñas, esto a pesar de su gran tamaño de extensión geográfica normal. Este hallazgo genera preguntas sobre lo idóneo de las evaluaciones convencionales del riesgo de extinción con base en el tamaño estático de extensión geográfica (p. ej

Accuracy of a pediatric early warning score in the recognition of clinical deterioration.

PubMed

Miranda, Juliana de Oliveira Freitas; Camargo, Climene Laura de; Nascimento, Carlito Lopes; Portela, Daniel Sales; Monaghan, Alan

2017-07-10

intervalo de 5 a 10 minutos entre as avaliações, para aplicação do Brighton Paediatric Early Warning Score, para o contexto brasileiro e do padrão de referência. Os dados foram processados e analisados nos programas Statistical Package for the Social Sciences e VassarStats.net. O desempenho do Brighton Paediatric Early Warning Score para o contexto brasileiro foi avaliado por meio dos indicadores de sensibilidade, especificidade, valores preditivos, área sob a curva ROC, razões de probabilidades e probabilidade pós-teste. o Brighton Paediatric Early Warning Score para o contexto brasileiro apresentou sensibilidade de 73,9%, especificidade de 95,5%, valor preditivo positivo de 73,3%, valor preditivo negativo de 94,7%, área sob a Receiver Operating Characteristic Curve de 91,9% e a probabilidade pós-teste positivo foi de 80%. o Brighton Paediatric Early Warning Score, para o contexto brasileiro, apresentou bom desempenho, considerado válido para o reconhecimento de sinais de alerta de deterioração clínica das crianças estudadas. evaluar la precisión de la versión traducida y adaptada del Brighton Paediatric Early Warning Score para el contexto brasileño, en el reconocimiento de la deterioración clínica. estudio de test diagnóstico para medir la precisión del Brighton Paediatric Early Warning Score para el contexto brasileño, en relación a un estándar de referencia. La muestra estuvo compuesta por 271 niños de 0 a 10 años, evaluadas de forma ciega por especialistas en pediatría, una enfermera y un médico, con intervalo de 5 a 10 minutos entre las evaluaciones, para aplicación del Brighton Paediatric Early Warning Score para el contexto brasileño. Los datos fueron procesados y analizados en los programas Statistical Package for the Social Sciences y VassarStats.net. El desempeño del Brighton Paediatric Early Warning Score para el contexto brasileño fue evaluado por medio de los indicadores de sensibilidad, especificidad, valores predictivos, �

Analysis of Outcomes After TKA: Do All Databases Produce Similar Findings?

PubMed

Bedard, Nicholas A; Pugely, Andrew J; McHugh, Michael; Lux, Nathan; Otero, Jesse E; Bozic, Kevin J; Gao, Yubo; Callaghan, John J

2018-01-01

Use of large clinical and administrative databases for orthopaedic research has increased exponentially. Each database represents unique patient populations and varies in their methodology of data acquisition, which makes it possible that similar research questions posed to different databases might result in answers that differ in important ways. (1) What are the differences in reported demographics, comorbidities, and complications for patients undergoing primary TKA among four databases commonly used in orthopaedic research? (2) How does the difference in reported complication rates vary depending on whether only inpatient data or 30-day postoperative data are analyzed? Patients who underwent primary TKA during 2010 to 2012 were identified within the National Surgical Quality Improvement Programs (NSQIP), the Nationwide Inpatient Sample (NIS), the Medicare Standard Analytic Files (MED), and the Humana Administrative Claims database (HAC). NSQIP is a clinical registry that captures both inpatient and outpatient events up to 30 days after surgery using clinical reviewers and strict definitions for each variable. The other databases are administrative claims databases with their comorbidity and adverse event data defined by diagnosis and procedure codes used for reimbursement. NIS is limited to inpatient data only, whereas HAC and MED also have outpatient data. The number of patients undergoing primary TKA from each database was 48,248 in HAC, 783,546 in MED, 393,050 in NIS, and 43,220 in NSQIP. NSQIP definitions for comorbidities and surgical complications were matched to corresponding International Classification of Diseases, 9 Revision/Current Procedural Terminology codes and these coding algorithms were used to query NIS, MED, and HAC. Age, sex, comorbidities, and inpatient versus 30-day postoperative complications were compared across the four databases. Given the large sample sizes, statistical significance was often detected for small, clinically unimportant

Long-term immigrant adaptation: eight-year follow-up study among immigrants from Russia and Estonia living in Finland.

PubMed

Jasinskaja-Lahti, Inga

2008-02-01

observó ningunas diferencias en su nivel del bienestar psicológico entre las dos evaluaciones. Entre las tres dimesiones de adaptación que fueron evaluadas, adaptación sociocultural, medida como aptitud de comprensión, habla, lectura y escritura en finlandes fue el predictor más significante de los resultados en otras dimensiones de adaptación de los inmigrantes a largo plazo (i.e. socioeconómica y psicológica). Particularmente, cuando mejor era el dominio inicial del idioma finlandes, mejores eran los resultados de adaptación socioeconómica y psicológica después de 8 años de residencia. Estos estudios demuestran la importancia de la evaluación en paralelo y longitudinal de diferentes resultados de adaptación de los inmigrantes para saber cuáles particulares dimensiónes de adaptación son las más críticas en el principio de aculturación para determinar el desarrollo.

PREFACE: XVII Congress of Bioengineering and VI Clinical Engineering Conference

NASA Astrophysics Data System (ADS)

Rocha, Darío

2011-09-01

at least 12 different countries. In the three days of planned activities, more than 800 participants were registered and over 2000 people visited the associated expo. Several symposia and thematic meetings were held simultaneously. Around 207 works were presented, each evaluated by two referees, and 181 presentations were finally accepted. The organizers of the Congress proposed that the 14 best works be published in the Journal of Physics Conference Series. A few of the speakers deserve a special mention: James Lin, PhD, USA, Wireless noninvasive sensing and physiological signatures and vital signs; Luis Kun, PhD, USA, Biomedical Engineering and Global Health Transformation: A vision of opportunities and challenges; Mario Munich, PhD, USA, Avances en Robótica y Aplicaciones en Salud (Advances in robotics and health applications); Jose Folgueras, PhD, Cuba, Generación de productos de alto valor agregado a través del conocimiento (Generating products adding value through knowledge); Daniel Goroso, PhD, Brazil, Avanço e tecnología en Medicina Física y Rehabilitación (Advances in technology in physical medicine and rehab); Adolfo Spangenberg, PhD, Brazil, Telemedicine and Health - New perspectivas in development countries; Francisco Rojo Pérez, PhD, Spain, Propiedades del Comportamiento Mecánico y la rotura de la aorta humana (Properties of mechanical behaviour and rupture of the human aorta); and Eduardo de Forteza, PhD, Argentina, La fusión del humanismo médico y la tecnología (Fusion between medical humanism and technology), among others. We would like to thank the institutions, universities, government bodies, and private enterprises that supported and facilitated this Congress, and the members of the Organizing Commitee: Eng David Astegiano (Science and Technology State Minister), Eng Carlos Cerruti (Past President of the Rosario Tecnology Center), Eng Viviana Rotger (Past President of SABI) and MSc Guillermo Civetta (Manager of RTP). The members of the

Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia.

PubMed

MacEwan, Joanna P; Forma, Felicia M; Shafrin, Jason; Hatch, Ainslie; Lakdawalla, Darius N; Lindenmayer, Jean-Pierre

2016-11-01

Poor medication adherence contributes to negative treatment response, symptom relapse, and hospitalizations in schizophrenia. Many health plans use claims-based measures like medication possession ratios or proportion of days covered (PDC) to measure patient adherence to antipsychotics. Classifying patients solely on the basis of a single average PDC measure, however, may mask clinically meaningful variations over time in how patients arrive at an average PDC level. To model patterns of medication adherence evolving over time for patients with schizophrenia who initiated treatment with an oral atypical antipsychotic and, based on these patterns, to identify groups of patients with different adherence behaviors. We analyzed health insurance claims for patients aged ≥ 18 years with schizophrenia and newly prescribed oral atypical antipsychotics in 2007-2013 from 3 U.S. insurance claims databases: Truven MarketScan (Medicaid and commercial) and Humana (Medicare). Group-based trajectory modeling (GBTM) was used to stratify patients into groups with distinct trends in adherence and to estimate trends for each group. The response variable was the probability of adherence (defined as PDC ≥ 80%) in each 30-day period after the patient initiated antipsychotic therapy. GBTM proceeds from the premise that there are multiple distinct adherence groups. Patient demographics, health status characteristics, and health care resource use metrics were used to identify differences in patient populations across adherence trajectory groups. Among the 29,607 patients who met the inclusion criteria, 6 distinct adherence trajectory groups emerged from the data: adherent (33%); gradual discontinuation after 3 months (15%), 6 months (7%), and 9 months (5%); stop-start after 6 months (15%); and immediate discontinuation (25%). Compared to patients 18-24 years of age in the adherent group, patients displaying a stop-start pattern after 6 months had greater odds of having a history of drug

Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture.

PubMed

Weaver, Jessica; Sajjan, Shiva; Lewiecki, E Michael; Harris, Steven T; Marvos, Panagiotis

2017-04-01

The prevalence and cost of subsequent fractures among patients with an incident fracture are not well defined. To assess the prevalence of, and costs associated with, subsequent fractures in the year after an incident fracture. This was a retrospective claims database analysis using data from Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (commercial group). Patients included in the study had a claim for a qualifying fracture occurring between January 2008 and December 2013 (index fracture), were continuously enrolled in the health plan for ≥ 1 year before and after the index fracture, and were aged ≥ 65 years in the Medicare group or ≥ 50 years in the commercial group at the time of the index fracture. Subsequent fractures were identified by ICD-9-CM codes and were defined as the second fracture occurring ≥ 3 to ≤ 12 months after the index fracture (≥ 6 to ≤ 12 months for fractures at the same site as the index fracture). Rates of subsequent fractures were calculated as the number of patients who had a subsequent fracture divided by the total sample size. After propensity matching of demographic and clinical variables, we determined the total medical and pharmacy costs accrued within 1 year of the index fracture by patients with and without a subsequent fracture. Health care costs were compared between patients with and without a subsequent fracture using McNemar's test. A total of 45,603 patients were included in the Medicare group, and 54,145 patients were included in the commercial group. In the Medicare group, 7,604 (16.7%) patients experienced a subsequent fracture. The proportion of patients with a subsequent fracture was highest among patients with multiple index fractures (26.2%, n = 905), followed by those with hip (25.5%, n = 1,280) and vertebral (20.2%, n = 1,908) index fractures. In the commercial group, 6,256 (11.6%) patients experienced a subsequent fracture. The proportion

Effect of Apixaban Versus Warfarin Use on Health Care Resource Utilization and Costs Among Elderly Patients with Nonvalvular Atrial Fibrillation.

PubMed

Deitelzweig, Steven; Luo, Xuemei; Gupta, Kiran; Trocio, Jeffrey; Mardekian, Jack; Curtice, Tammy; Lingohr-Smith, Melissa; Menges, Brandy; Lin, Jay

2017-11-01

The clinical trial ARISTOTLE showed that apixaban was superior to warfarin in reducing the risks of stroke and bleeding among patients with nonvalvular atrial fibrillation (NVAF). Further study of the effect of apixaban versus warfarin use on health care resource utilization (HCRU) and associated costs in the real-world setting is warranted, especially among elderly patients who are at higher risk of stroke and bleeding. To compare HCRU and costs among elderly NVAF patients treated with apixaban versus warfarin in the United States. Elderly patients (aged ≥ 65 years) with Medicare coverage who initiated apixaban or warfarin were identified from the Humana research database during January 1, 2013-September 30, 2015. Patients were required to have 12 months of continuous insurance coverage before drug initiation (baseline period) and an atrial fibrillation diagnosis during the baseline period or on the date of drug initiation. NVAF patients were grouped into cohorts depending on the drug initiated. Propensity score matching (PSM) was conducted to control for differences in demographics and clinical characteristics of study cohorts. Patients were followed after the index date for a variable length of follow-up. All-cause and disease-specific HCRU and costs during the follow-up were evaluated before and after PSM and reported as per patient per year. Of the overall (unmatched) population, 8,250 patients (mean age: 78.0 years) initiated apixaban and 14,051 patients (mean age: 78.2 years) initiated warfarin. Among NVAF patients who initiated apixaban versus those who initiated warfarin, mean Charlson Comorbidity Index (CCI) scores (3.0 vs. 3.4, P < 0.001); stroke risk scores, including CHADS 2 (2.7 vs. 2.9, P < 0.001) and CHA 2 DS 2 -VASc (4.6 vs. 4.7, P < 0.001); and bleeding risk scores, including HAS-BLED (3.1 vs. 3.2, P < 0.001), were lower. Additionally, total annual all-cause health care costs were lower during the baseline period for patients treated with

Diagnosis and Treatment of Osteoporosis Before and After Fracture: A Side-by-Side Analysis of Commercially Insured and Medicare Advantage Osteoporosis Patients.

PubMed

Weaver, Jessica; Sajjan, Shiva; Lewiecki, E Michael; Harris, Steven T

2017-07-01

Although treatment for osteoporosis is recommended by U.S. clinical guidelines, a lack of diagnosis and treatment is common among patients with osteoporotic fractures. To determine the rates of osteoporosis diagnosis and treatment before and after various types of fractures. This was a retrospective claims analysis using data from the Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (Commercial group). Patients included in the study had a claim for a qualifying fracture occurring between January 2008 and December 2013 (the index fracture), were continuously enrolled in the health plan for ≥ 1 year before and after the index fracture, and were aged ≥ 65 years in the Medicare group or ≥ 50 years in the Commercial group at the time of the index fracture. Fragility fractures and osteoporosis diagnoses were identified from ICD-9-CM codes. Treatment for osteoporosis included oral and injectable therapies identified by National Drug Code numbers and Healthcare Common Procedure Coding System codes. Diagnosis and treatment rates were assessed during the 1-year periods before and after the index fracture. All analyses were conducted by fracture type (vertebral, hip, nonhip/nonvertebral [NHNV], and multiple), with stratification by age and sex. No comparisons were made between the Medicare and Commercial groups; rather, McNemar tests were used to compare prefracture versus postfracture diagnosis and treatment rates within each group. For inclusion in the Medicare group, 45,603 patients were identified, and 54,145 patients were identified for the Commercial group. In the prefracture period, the osteoporosis diagnosis rates ranged from 12.0% (NHNV) to 21.5% (vertebral) in the Medicare group and from 5.3% (NHNV) to 12.1% (vertebral) in the Commercial group. In the postfracture period, diagnosis rates significantly increased (P < 0.001)-and nearly doubled-for all fracture types but did not exceed 42.1% (vertebral

Meta-Analysis of Attitudes toward Damage-Causing Mammalian Wildlife

PubMed Central

KANSKY, RUTH; KIDD, MARTIN; KNIGHT, ANDREW T

2014-01-01

íferos Silvestres Causantes de Daños Resumen Muchas poblaciones de mamíferos amenazados persisten fuera de áreas protegidas formales y su supervivencia depende de la buena voluntad de las comunidades que coexisten con ellos. Un entendimiento de las posturas, y específicamente de la tolerancia, de los individuos y las comunidades y los factores que los determinan es fundamental para diseñar estrategias que alivien el conflicto humano – vida silvestre. Llevamos a cabo un meta-análisis para identificar los factores que afectaron las posturas hacia cuatro grupos de mamíferos terrestres. Los elefantes (65%) provocaron las posturas más positivas. Los siguieron los primates (55%), los ungulados (53%) y los carnívoros (44%). Los residentes urbanos presentaron las posturas más positivas (80%), seguidos por los granjeros comerciales (51%) y los granjeros comunales (26%). Un índice de tolerancia a los daños mostró que la tolerancia humana a los ungulados y primates fue proporcional a la probabilidad de experimentar daños mientras que los elefantes provocaron niveles de tolerancia más altos de lo esperado y los carnívoros provocaron niveles de tolerancia más bajos de lo esperado. Contrario a la sabiduría convencional, experimentar daños no fue siempre el factor dominante para determinar las posturas. Los granjeros comunales tuvieron una baja probabilidad de ser positivos hacia los carnívoros independientemente de la probabilidad de experimentar daños, mientras que los granjeros comerciales y los residentes urbanos tuvieron mayor probabilidad de ser positivos hacia los carnívoros independientemente de los daños. Los residentes urbanos tuvieron mayor probabilidad de ser positivos hacia los ungulados, los elefantes y los primates cuando la probabilidad de daños fue baja, pero no cuando fue alta. Los granjeros comerciales y comunales tuvieron una mayor probabilidad de ser positivos hacia los ungulados, los primates y los elefantes independientemente de la probabilidad de

Hydrogeology in North America: past and future

NASA Astrophysics Data System (ADS)

Narasimhan, T. N.

2005-03-01

balance o para continuar con la explotación de los sistemas hidrogeológicos para un beneficio máximo. Aunque existe actualmente una tendencia hacia la conciencia ambiental y ecológica, las actitudes humanas podrían cambiar en caso de que grandes partes del mundo poblado estén sujetas a las presiones de sequías que duran por muchas décadas.

"Act on Threes" Paradigm for Treatment Intensification of Type 2 Diabetes in Managed Care: Results of a Randomized Controlled Study with an Educational Intervention Targeting Improved Glycemic Control.

PubMed

Bieszk, Nella; Reynolds, Shannon L; Wei, Wenhui; Davis, Cralen; Kamble, Pravin; Uribe, Claudia

2016-09-01

Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia. To assess the impact of an educational intervention specifically designed to align patients and their physicians with 2012 American Diabetes Association (ADA) guidelines on glycated hemoglobin (A1c) testing frequency and insulin initiation. The "Act on Threes" educational intervention was a 12-month, randomized controlled prospective study that included Medicare Advantage patients aged 18-85 years with T2D, who received ≥ 3 oral antidiabetes drugs (OADs) and/or had A1c not at goal and/or had no recent A1c evaluation over 12 months, as identified through the analysis of administrative claims data (May 1, 2011-April 30, 2013) from the Humana database. Identified patients were randomized 3:1 to receive the Act on Threes educational intervention in conjunction with standard care (intervention group) or standard care alone (control group). For the educational intervention, patients and physicians were simultaneously mailed general and targeted information aimed at aligning them to 3 vital aspects of A1c control: timely measurement of A1c every 3 months; timely treatment intensification to meet A1c goals with treatment intensification every 3 months if A1c is not at goal; and insulin initiation when appropriate, including patients receiving ≥ 3 OADs with A1c not at goal. Control patients were only enrolled if the treating physician was not involved in the care of any patients in the intervention group. The primary outcome measures were A1c testing frequency based on the ADA standard for compliance

Numerical modelling and hydrochemical characterisation of a fresh-water lens in the Belgian coastal plain

NASA Astrophysics Data System (ADS)

Vandenbohede, A.; Lebbe, L.

2002-05-01

ée de canal de marée est étudiée. L'évolution hydrochimique de la lentille d'eau douce est reconstituée, révélant que les principales réactions chimiques sont l'échange de cations, la dissolution de calcite et l'oxydation de matières organiques. La formation et l'évolution de la lentille d'eau douce sont modélisées en recourant à un modèle en deux dimensions de transport de soluté dépendant de la densité la sensibilité au drainage et les conductivités sont étudiées. Le niveau du drainage influence surtout la profondeur de la lentille d'eau douce, alors que le temps de formation de la lentille est surtout influencé par la conductivité. Resumen. La distribución de las aguas dulces y salinas en acuíferos costeros está influenciada por muchos procesos. Se ilustra la influencia de la heterogeneidad del medio y de la interferencia humana mediante acciones tales como la recuperación de terrenos en la llanura costera belga, donde, hacia el año 1200 D.C., se aprovechó un medio sometido a fluctuaciones mareales. La salinidad del acuífero, que fue invadido por agua salada, está siendo rebajada desde entonces. La distribución espacial de turba, arcilla, limo y arena influencia el flujo general y la distribución de agua dulce y salina, además de afectar el esquema de drenaje, y origina el desarrollo de lentejones de agua dulce. Se inspecciona la calidad del agua en y en torno a los lentejones de agua dulce bajo la cresta de un canal mareal invertido. Se reconstruye la evolución hidroquímica de los lentejones de agua dulce, proponiendo como reacciones principales el intercambio catiónico, la disolución de calcita y la oxidación de materia orgánica. Se modela la formación y evolución de los lentejones mediante un modelo bidimensional de transporte con densidad variable, y se estudia la sensibilidad del drenaje y de las conductividades. El nivel de drenaje influencia sobretodo la profundidad de los lentejones de agua dulce, mientras el tiempo

Change in genetic correlation due to selection using animal model evaluation.

PubMed

Strandén, I; Mäntysaari, E A; Mäki-Tanila, A

1993-01-12

énérations. La corrélation génétique après sélection a été comparée à différents niveaux de corrélations génétique et environnementale pour deux critères de sélection différents. Les changements de corrélation génétique étaient similaires dans les simulations et les prédictions analytiques. Après un cycle de sélection, la méthode récurrente AM et la simulation donnaient les prédictions similaires alors que la sélection phénotypique prédisait habituellement des changements de corrélations génétiques plus importants. Après plusieurs cycles de sélection, les deux formules analytiques prédisaient des changements de corrélation plus importants que la simulation. RÉSUMÉ: Cambio en la correlación genética debido a selección usando evaluaciones con modelo animal Se estudió el efecto de la selección sobre la correlación genética entre dos caracteres utilizando simulación de Monte Carlo y cálculos analíticos. El esquema de selección simulado estuvo basado en un núcleo adulto y cerrado de ovulación multiple y transferencia de embriones. El criterio de selección fue un indice calculado a partir de un modelo animal multicarácter (AM). Se derivaron fórmulas analíticas aplicables a cualquier método de evaluación para predecir cambios debidos a selección en las (co)varianzas genéticas bajo selección multicarácter usando distintos métodos de valoración. Se investigaron dos fórmulas, una que asumía selección fenotípica y la otra basada en un índice de selección AM recurrente con dos generaciones. El método AM recurrente aproximaba la información de parientes a través de una matriz de relaciones aditivas que contemplaba dos generaciones. La correlación genética tras la selección fue comparada bajo distintos niveles de correlación genética y ambiental iniciales con dos criterios de selección diferentes. Los cambios en correlatión genética fueron similares en las predicciones analíticas y con simulación. Tras un ciclo

Use and abuse of the urban groundwater resource: Implications for a new management strategy

NASA Astrophysics Data System (ADS)

Drangert, J.-O.; Cronin, A. A.

'OMS et UNICEF), établissant que la plupart des eaux résiduaires des zones urbaines reste non traitée (65% en Asie, 86% en Amérique latine et 100% en Afrique). La tâche à réaliser pour l'homme est de protéger les ressources en eau souterraine en sorte qu'elle reste disponible pour les habitants des villes dans le futur. Dans les prochaines 50 années, il faut s'attendre à ce que la population urbaine s'accroisse de 3 à 6 milliards de personnes selon les estimations des Nations Unies; aussi il est impératif de ne pas continuer à polluer les eaux souterraines sous les nouvelles zones urbaines en cours de construction. Dans cet article, nous analyserons la qualité des eaux souterraines et leur protection à la lumière des récents changements de politique de l'eau, c'est-à-dire de la gestion de l'alimentation en eau jusqu'à une gestion de la demande et en abordant éventuellement la période de gestion du recyclage. La urbanización lleva a una demanda elevada y concentrada de agua de calidad adecuada, acompañada por el vertido de volúmenes análogamente mayores de aguas residuales. Los alimentos se importan a ciudades donde los microorganismos y nutrientes de los excrementos humanos son descargados a ríos, lagos y, también, aguas subterráneas. Más aún, gran número de los bienes de consumo son eliminados vía las tuberías de las cloacas. Las deudas medioambientales, es decir, el empobrecimiento de las condiciones medioambientales, que requerirán de aportaciones humanas y económicas para rehabilitarlas, son comunes a todas las ciudades, sobretodo en el Hemisferio Sur, donde, según la Valoración Global de Suministro de Agua y Saneamiento (OMS y UNICEF), la mayor parte de las aguas residuales urbanas no son tratadas (65% en Asia, 86% en Latinoamérica, 100% en África). La tarea pendiente consiste en proteger los recursos de aguas subterráneas para que estén disponibles de forma rápida para los habitantes urbanos también el futuro. En los pr

Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

PubMed

Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua

2016-06-01

proportion of LCGP users and the proportion of LCGP fills out of all medications available through LCGPs increased from 2007 to 2012. There is a high rate of LCGP use among Medicare beneficiaries aged 65 years or greater. Claims-based research and quality assurance programs focusing on the benefits and harms of medications available through these programs are at risk of underestimating the true medication exposure in this population and should account for this possibility in sensitivity analyses. Managed care organizations should incentivize the reporting of LCGP medication use or make adjustments to generic medication benefit structures to more effectively capture true medication exposure. No direct sources of funding were used to conduct this study. Data acquisition was supported by the University of Kentucky Center for Clinical and Translational Science through funding from NIH NCATS grant #UL1TR000117. Brown is the Humana-Pfizer Research Fellow at the Institute for Pharmaceutical Outcomes & Policy at the University of Kentucky College of Pharmacy and is provided salary from these corporations. However, neither company provided any direct funding for the current study nor provided any input or guidance for the design, methods, or drafting of the manuscript. Pauly has no financial disclosures or conflicts of interest. Portions of these results were presented at the 20th International Society for Pharmacoeconomics and Outcomes Research International Meeting; May 16-20, 2015; Philadelphia, Pennsylvania. Study concept and design were primarily contributed by Brown, along with the other authors. Brown took the lead in data collection and interpretation, along with Pauly and Talbert. All authors participated in the writing and revision of the manuscript.

Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta-analysis.

PubMed

Kollmann, M; Martins, W P; Lima, M L S; Craciunas, L; Nastri, C O; Richardson, A; Raine-Fenning, N

2016-12-01

/embarazos en curso (RR: 1,28 (IC 95%, 1,01-1,63)) y de embarazos confirmados ecográficamente (RR: 1,26 (IC 95%, 1,04-1,53)) en comparación con un placebo o la no intervención. Se encontró también evidencia de baja calidad en que no hay diferencias relevantes clínicamente en las tasas de nacimientos vivos/embarazos en curso (RR: 1,03 (IC 95%, 0,80-1,34)) y las tasas de embarazos confirmados ecográficamente (RR: 0,99 (IC 95%, 0.81-1,22)) al comparar la gonadotropina menopáusica humana para la inducción de la ovulación y la preparación artificial con el valerato de estradiol para preparar el endometrio para la transferencia de embriones congelados (TEC). La baja calidad de la evidencia sugiere que el manitol, en comparación con la no intervención (RR: 0,54 (IC 95%, 0,39-0,77)), y los protocolos de antagonistas, en comparación con los protocolos de agonistas (RR: 0,63 (IC 95%, 0,49-0,80)), reducen las tasas de SHO. CONCLUSIÓN: Hay evidencia de calidad baja a moderada que sugiere que los protocolos de antagonistas son preferibles a los de agonistas, ya que reducen la tasa de SHO sin interferir con el embarazo confirmado ecográficamente y los nacimientos vivos en las mujeres con SOP. Además, existe evidencia de baja calidad que indica un beneficio del uso de metformina como aporte suplementario en embarazos confirmados ecográficamente y en nacimientos vivos; y que la inducción de la ovulación y la administración de estradiol parecen ser igualmente eficaces para la preparación del endometrio antes de la TEC en mujeres con SOP. Para el resto de procedimientos, la evidencia es de muy baja calidad, y por ello no permite extraer conclusiones importantes. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients

PubMed Central

Fleming, M. F.; Krupitsky, E.; Tsoy, M.; Zvartau, E.; Brazhenko, N.; Jakubowiak, W.; E. McCaul, M.

2006-01-01

��emploi d’une combinaison du cliché thoracique, de la bacilloscopie et des cultures d’expectoration. Chez 62% des patients, les critères DSM-IV pour utilisation courante d’alcool ou pour dépendance étaient présents. L’utilisation de drogues est inhabituelle: deux patients seulement ont signalé une utilisation récente de l’héroïne par voie intraveineuse. Il n’y avait qu’un seul cas d’infection VIH. Le score total moyen de la batterie d’évaluation des risques a été de 3,4. Il y avait de la dépression chez 60% de 1’échantillon, dont 17% étaient en dépression sévère. L’utilisation ou la dépendance à l’égard de l’alcool étaient associées avec une multiplication par huit de la résistance aux médicaments (OR 8,58 ; IC95% 2,09-35,32). Les patients atteints de rechute de TB ou de TB chronique sont plus susceptibles de répondre aux critérés d’abus ou de dépendance de l’alcool (OR 2,56; IC95% 1,0-6,54). CONCLUSION: Les maladies liées à l’utilisation d’alcool sont fréquentes chez les patients traités pour TB active et sont associées à une morbidité significative. Des enquêtes complémentaires sont nécessaires pour examiner les relations entre les maladies liées à l’utilisation d’alcool et la résistance à l’égard des médicaments antituberculeux. MARCO DE REFERENCIA: El consumo de alcohol, la tuberculosis (TB) farmacorresistente y los comportamientos de riesgo para la infección por el virus de la inmunodeficiencia humana (VIH) constituyen una preocupación creciente en los pacientes con TB en la Fedéración de Rusia. MÉTODOS: Se llevó a cabo un estudio de prevalencia del consumo de alcohol y del comportamiento de riesgo para la infección por el VIH en una muestra de 200 adultos, hombres y mujeres, ingresados por TB en dos hospitales de San Petersburgo e Ivanovo en la Federación de Rusia. RESULTADOS: El 72% de los individuos fueron de sexo masculino. La media de la edad fue 41 años. El diagn

Aquifer overexploitation: what does it mean?

NASA Astrophysics Data System (ADS)

Custodio, Emilio

2002-02-01

actividades humanas y por la propia explotación del acuífero. Sin embargo, en la práctica se suele considerar que hay sobreexplotación cuando se observan o se perciben ciertos resultados negativos de la explotación, tales como un descenso continuado del nivel del agua, un deterioro de su calidad, un encarecimiento del agua extraída, o daños ecológicos. Pero estos efectos no están necesariamente relacionados con el hecho de que la extracción sea mayor que la recarga, puesto que pueden ser simplemente el resultado de interferencias o del dilatado período transitorio que sigue a los cambios en los términos del balance de agua, y cuya duración depende del tamaño del acuífero, y de su permeabilidad y coeficiente de almacenamiento. Las extracciones del acuífero suponen una disminución del almacenamiento de agua subterránea durante este periodo transitorio. Para decidir que grado de "sobreexplotación del acuífero" es aconsejable o admisible hace falta la consideración detallada y actualizada de los efectos de la explotación y las medidas de corrección que se adopten. Para esa decisión no basta con reglas generales y el apoyo de algunas observaciones indirectas. Se necesitan observaciones de control, buen conocimiento del acuífero y cálculos o modelación del comportamiento, y todo ello en el marco de un conjunto de objetivos y políticas establecidas por una institución de gestión, con la implicación de aquellos que tienen un interés en el agua subterránea, y teniendo en cuenta los condicionantes ambientales y sociales. La sobreexplotación de acuíferos, que con frecuencia suele asociarse a algo éticamente malo, no tiene por qué ser necesariamente así durante cierto tiempo, sino una etapa en la evolución hacia un desarrollo sustentable. En la realidad la designación de sobreexplotación de acuíferos es principalmente un adjetivo que trata de calificar a una evolución preocupante bajo determinados puntos de vista, sin que tenga una significaci

Hydrodynamic characteristics of the western Doñana Region (area of El Abalario), Huelva, Spain

NASA Astrophysics Data System (ADS)

Trick, Thomas; Custodio, Emilio

èle a été calé en utilisant d'une part les valeurs des paramètres hydrauliques obtenus par des essais de pompage et d'après les données piezométriques mesurées à différentes profondeurs, et d'autre part l'apport estimé de la ravine de La Rocina. L'écoulement d'eau souterraine s'effectue par drainage latérale dans trois directions, d'une part vers la côte, d'autre part à travers la ravine de La Rocina et finalement directement vers les Marais de Doñana situés à l'est et sud-est dans le delta du fleuve Guadalquivir. Avec une pluviométrie moyenne comprise entre 550 et 600 mm, la recharge nette moyenne annuelle des nappes, pour des périodes de temps assez longues, est estimée entre 100 et 200 mm dans les aires de végétation autochtone, et elle est nettement inférieure dans les aires plantées deucalyptus. Le modèle transitoire montre que la recharge varie dans l'espace et qu'elle n'est pas clairement proportionnelle aux précipitations annuelles. L'évapotranspiration phréatique joue un rôle important et diminue la valeur nette de la recharge des nappes de 0,4 à 0,6 de la valeur calculée avec un modèle de bilan d'eau dans le sol. La section modélisée est utilisée pour étudier l'effet de l'extraction d'eau souterraine sur la profondeur du niveau phréatique en soustrayant le flux vertical, calculé grâce à une formule d'hydraulique des puits, de la nappe profonde semi-confinée. Le résultat de cette extraction est une diminution de l'évapotranspiration phréatique, du flux au niveau de la ravine de La Rocina et de la fréquence d'inondation des lagunes. La substitution de forêts d'eucalyptus par de la végétation autochtone peut permettre la remonté des niveaux phréatiques et même réactiver d'anciens ravins affluents à La Rocina. La región de Doñana, situada en el sudoeste de España, incluye una gran e importante reserva natural, cuyos humedales están siendo afectados por la actividad humana. La extensa plantación de