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To determine whether patients would have equivalent or improved outcomes when receiving non-surgical management versus surgical removal for vocal process granulomas.
A chart review was performed for 53 adults with vocal process granulomas. All patients received baseline anti-reflux treatment consisting of twice-daily proton pump inhibitors and vocal hygiene education. Further treatment approaches were divided into non-surgical (i.e. inhaled corticosteroids, voice therapy, botulinum toxin injections) and surgical groups. Subjective parameters (Voice Handicap Index 10 and Reflux Symptom Index) and outcomes were tabulated and statistically compared. Cause of granuloma was also analysed to determine if this influenced outcomes.
Of 53 patients, 47 (89 per cent) experienced reduction in granuloma size, while 37 (70 per cent) experienced complete resolution. The rate of complete granuloma resolution after initial treatment strategy alone was significantly higher in non-surgical compared to surgical patients (67 and 30 per cent, respectively; p = 0.039). No difference in outcome was seen between iatrogenic and idiopathic granulomas.
Non-surgical patients were more likely to experience initial treatment success than those who underwent surgical removal. Continued emphasis should be placed on conservative treatment options prior to surgery for patients with this condition.
On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.
Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009–2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95 % CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95 % CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95 % CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.
We describe Hedruris dratini n. sp. (Nematoda, Hedruridae) from Hydromedusa tectifera and Phrynops hilarii in Argentina based on morphological and molecular characters. Also, we provide information about its life cycle. The new species differs from other species of the genus by possessing the excretory pore, nerve ring and deirids at equal distance from the anterior end. Additionally, H. dratini n. sp. has mammilated eggs and males possess nine pairs of caudal papillae. The subadults and adults of H. dratini n. sp and H. orestiae were characterized by sequencing the small subunit ribosomal DNA (18S). We present for the first time a life cycle of a species of Hedruris that includes an amphipod as intermediate host and a reptile as definitive host. Furthermore, we analysed the host and geographic distribution of all Hedruris species. Although the genus has a cosmopolitan distribution and parasitizes a great host diversity, the majority of species have a Gondwanian distribution, with amphibians being the preferred hosts.
HLA-G expression has been detected in early preimplantation embryos and it has been postulated that a relationship between embryonic expression of this factor and successful pregnancy may exist. Forty-six patients were prospectively selected from our centre ‘Unidad de Reproducción Humana, Hospital Universitario de Canarias’ for conducting this study. In all cases, metaphase II (MII) oocytes were fertilized using intracytoplasmic sperm injection 2–4 h after retrieval. Embryos were cultured individually in 20 µl droplets of G-1 medium (VitroLife) under oil at 37°C and a 6% CO2 environment. Fertilization was assessed at 18 h postinsemination and all oocytes fertilized were passed into a new culture plaque individually in 300 µl culture medium until day 3 of culture. The culture medium was examined for the expression and secretion of sHLA-G with a sandwich enzyme-linked immunosorbent assay kit (BioVendor, Heidelberg, Germany) according to the manufacturer’s instructions. We found statistical significance between higher levels of sHLA-G secretion and pregnancy rate. When both groups were compared there was no difference in embryo quality of transferred embryos, but a significant difference in the number of oocytes and the embryo quality of the cohort existed that was greater in the pregnant group. A standardized sHLA-G assay with a specifically defined range and standard units provides a non-invasive method to identify the most competent embryos for transfer.
The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile.
Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka’s formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression.
Chileans aged ≥15 years.
Participants (n 2913) from the Chilean National Health Survey 2009–2010.
Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors.
Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.
Healthy lifestyle habits are the cornerstone in the management of familial hypercholesterolaemia (FH). Nevertheless, dietary studies on FH-affected populations are scarce. The present study analyses dietary habits, adherence to a Mediterranean diet pattern and physical activity in an adult population with FH and compares them with their non-affected relatives.
Data came from SAFEHEART, a nationwide study in Spain.
Individuals (n 3714) aged ≥18 years with a genetic diagnosis of FH (n2736) and their non-affected relatives (n 978). Food consumption was evaluated using a validated FFQ.
Total energy intake was lower in FH patients v. non-affected relatives (P<0·005). Percentage of energy from fats was also lower in the FH population (35 % in men, 36 % in women) v. those non-affected (38 % in both sexes, P<0·005), due to the lower consumption of saturated fats (12·1 % in FH patients, 13·2 % in non-affected, P<0·005). Consumption of sugars was lower in FH patients v. non-affected relatives (P<0·05). Consumption of vegetables, fish and skimmed milk was higher in the FH population (P<0·005). Patients with FH showed greater adherence to a Mediterranean diet pattern v. non-affected relatives (P<0·005). Active smoking was lower and moderate physical activity was higher in people with FH, especially women (P<0·005).
Adult patients with FH report healthier lifestyles than their non-affected family members. They eat a healthier diet, perform more physical activity and smoke less. However, this patient group’s consumption of saturated fats and sugars still exceeds guidelines.
The incorporation of triturated tire particles as an aggregate in the concrete mixture is one of the ways to take advantage of this Waste Rubber (WR) in order to improve concrete properties, such as mechanical behavior. In this research we evaluated mechanical behavior of concrete specimens prepared with different amounts WR, which partially substituted the fine aggregate, under an indirect tensile test. In contrast with other’s researcher’s findings, our results show that the specimens with 5% WR present the highest value of indirect tensile strength (TP) of 4.36 MPa. Polynomial relationships between TP and compression strength (f´c), where Tp ranges from 0.1f´c to 0.2f´c. Specimens with the 0, 5 and 10% WR content show two types of failure: normal tension and tiple-cleft failure, described in the norm ASTM 1144-89. Nevertheless, specimens with 15 and 20% WR show a new failure not described in the norm, which is thought to be occurring due to the high amount of WR used.
This study employed the Delphi method, an exploratory method used for group consensus building, to determine the benefits and challenges associated with community engagement in patient-centered outcomes research.
A series of email surveys were sent to the Patient-Centered Outcomes Research Institute (PCORI)-funded researchers (n = 103) in New England. Consensus was achieved through gathering themes and engaging participants in ranking their level of agreement over three rounds. In round one, participant responses were coded thematically and then tallied. In round two participants were asked to state their level of agreement with each of the themes using a Likert scale. Finally, in round three, the group was asked to rank the round two themes based on potential impact.
Results suggested the greatest benefit of community engagement is that it brings multiple perspectives to the table, with 92% ranking it as the first or second most important contribution. Time was ranked as the most significant barrier to engaging community. Strategies to overcome barriers to community engagement include engaging key stakeholders early in the research, being kind and respectful and spending time with stakeholders. The most significant finding was that no researchers reported having specific measures to evaluate community engagement.
Community engagement can enhance both research relevance and methodology when researchers are engaged in meaningful collaborations. Advancing the science of community engagement will require the development of evaluation metrics to examine the multiple domains of partnership.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
Symbiotic stars (SySts) are long-period interacting binaries composed of a hot compact star, an evolved giant star, and a tangled network of gas and dust nebulae. Presently, we know 252 SySts in the Milky Way and 62 in external galaxies. However, these numbers are still in striking contrast with the predicted population of SySts in our Galaxy. In this contribution, I present the concept and the early results from RAMSES II (Raman Search for Extragalactic Symbiotic Stars), a Gemini/GMOS Upgrade Project which makes use of the Raman OVI 6830Å band as a powerful photometric tool to identify new SySts, within and beyond the Galaxy.
Two experiments were carried out to investigate how milking in mid-line (ML) affects the lipolysis level and milk composition in goat livestock, in comparison with low-line (LL) milking. The first experiment took place, in triplicate, on an experimental farm. For each replicate, a crossover design (62 goats, two treatments, ML and LL, in two periods each lasting 4 days) was used. Milk samples were taken daily at 0 and 24 h after milking. In the first experimental replicate, some enzymatic coagulation cheeses were made, which were assessed by a panel of tasters at 50 and 100 days of maturation. In the second experiment, the lipolysis level and composition of tank milk from 55 commercial dairy goat farms (25 ML and 30 LL) were analysed, in milk samples taken in three different weeks. The results of the first experiment showed that ML milking increased free fatty acid (FFA) concentration in raw goat's milk significantly (0.71 v. 0.40 mmol/l, respectively). However, in the milk samples taken from commercial farms the FFA concentration remained unaffected by the milking pipeline height (0.59 v. 0.58 mmol/l for ML and LL, respectively). No significant differences were found in the milk composition, nor in the sensory characteristics in the cured cheeses, which suggests that factors other than the milkline height are able to influence the level of lipolysis under commercial conditions. Therefore, ML milking should not be discouraged, provided that the correct functioning and management of the milking operation and milk storage on the farm is guaranteed.
Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8–95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9–72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.
Serpent Mound, in northern Adams County, Ohio, USA, is one of the most iconic symbols of ancient America and yet there is no widely agreed upon date for the age of its original construction. Some archaeologists consider it to have been built by the Adena culture around 300 bc, while others contend it was built by the Fort Ancient culture around ad 1100. There have been three attempts to obtain radiometric ages for the effigy, but they have yielded inconclusive results. The iconography of the earthwork offers an alternative means of placing the mound in its cultural context. Serpent imagery is abundant in the Fort Ancient culture as well as in the more encompassing Mississippian Ideological Interaction Sphere. Pictographs from Picture Cave in Missouri include a serpent, a humanoid female and a vulvoid in close association. We interpret these elements, in the light of Siouan oral traditions, as First Woman and her consort the Great Serpent. The Picture Cave imagery dates to between ad 950 and 1025. We argue that these same three elements are represented in the original configuration of Serpent Mound and therefore situate its design and original construction in the Early Fort Ancient period.
Analysis of the total surface energy γT and its three components as established by the van Oss-Chaudhury-Good Theory (vOCG) is conducted via Three Liquid Contact Angle Analysis (3LCAA). γT is correlated with the composition of the top monolayers (ML) obtained from High-Resolution Ion Beam Analysis (HR-IBA). Control of γT enables surface engineering for wafer bonding (Nano-BondingTM) and/or epitaxial growth. Native oxides on boron-doped p-Si(100) are found to average γT of 53 ± 1.4 mJ/m2) and are always hydrophilic. An HF in methanol or aqueous HF etch for 60 s always renders Si(100) hydrophobic. Its γT decreases by 20% to 44 ± 3 mJ/m2 in HF in methanol etch and by 10% to 48 ± 3 mJ/m2 in aqueous HF. On the contrary, GaAs(100) native oxides are found to always be hydrophobic. Tellurium n+-doped GaAs(100) yields an average of γT of 37 ± 2 mJ/m2, 96% of which is due to the Lifshitz-Van der Waals molecular interactions (γLW = 36 ± 1 mJ/m2). However, hydrophobic GaAs(100) can be made highly hydrophilic. After etching, γT increases by almost 50% to 66 ± 1.4 mJ/m2. 3LCAA shows that the γT increase is due to electron acceptor and donor interactions, while the Lifshitz-van der Waals energy γLW remains constant. IBA combining the 3.039 ± 0.01 MeV oxygen nuclear resonance with <111> channeling, shows that oxygen on Si(100) decreases by 10% after aqueous HF etching, from 13.3 ± 0.3 monolayers (ML) to 11.8 ± 0.4 ML 1 hour after etch.Te-doped GaAs(100) exhibits consistent oxygen coverage of 7.2 ± 1.4 ML, decreasing by 50% after etching to a highly hydrophilic surface with 3.6 ± 0.2 oxygen ML. IBA shows that etching does not modify the GaAs surface stoichiometry to within 1% . Combining 3LCAA with HR-IBA provides a quantitative metrology to measure how GaAs and Si surfaces can be altered to a different hydroaffinity and surface termination.
The effects of crystal orientation and doping on the surface energy, γT, of native oxides of Si(100) and Si(111) are measured via Three Liquid Contact Angle Analysis (3LCAA) to extract γT, while Ion Beam Analysis (IBA) is used to detect Oxygen. During 3LCAA, contact angles for three liquids are measured with photographs via the “Drop and Reflection Operative Program (DROP™). DROP™ removes subjectivity in image analysis, and yields reproducible contact angles within < ±1°. Unlike to the Sessile Drop Method, DROP can yield relative errors < 3% on sets of 20-30 drops. Native oxides on 5 x 1013 B/cm3 p- doped Si(100) wafers, as received in sealed, 25 wafer teflon boats continuously stored in Class 100/ISO 5 conditions at 24.5°C in 25% controlled humidity, are found to be hydrophilic. Their γT, 52.5 ± 1.5 mJ/m2, is reproducible between four boats from three sources, and 9% greater than γT of native oxides on n- doped Si(111), which averages 48.1 ± 1.6 mJ/m2 on four 4” Si(111) wafers. IBA combining 16O nuclear resonance with channeling detects 30% more oxygen on native oxides of Si(111) than Si(100). While γT should increase on thinner, more defective oxides, Lifshitz-Van der Waals interactions γLW on native oxides of Si(100) remain at 36 ± 0.4 mJ/m2, equal to γLW on Si(111), 36 ± 0.6 mJ/m2, since γLW arises from the same SiO2 molecules. Native oxides on 4.5 x 1018 B/cm3 p+ doped Si(100) yield a γT of 39 ± 1 mJ/m2, as they are thicker per IBA. In summary, 3LCAA and IBA can detect reproducibly and accurately, within a few %, changes in the surface energy of native oxides due to thickness and surface composition arising from doping or crystal structure, if conducted in well controlled clean room conditions for measurements and storage.
We present the results of prompt optical follow-up of the electromagnetic counterpart of GW170817 by the Transient Optical Robotic Observatory of the South Collaboration (TOROS). We detected highly significant dimming in the light curves of the counterpart over the course of only 80 minutes of observations obtained ~35 hr after the trigger with the T80-South telescope. A second epoch of observations, obtained ~59 hr after the event with the EABA 1.5m telescope, confirms the fast fading nature of the transient. The observed colors of the counterpart suggest that this event was a “blue kilonova” relatively free of lanthanides.