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Inflammatory cytokines are involved in attention deficit hyperactivity disorder (ADHD), a highly prevalent neurodevelopmental disorder. To quantify the baseline levels of pro- and anti-inflammatory cytokines and their changes after methylphenidate (MPH), a total of 31 prepubertal children with ADHD were recruited and subclassified into only two ADHD presentations—ADHD attention deficit (n = 13) or ADHD combined (n = 18). The children were also screened for oppositional defiant conduct disorder (ODCD) and anxiety disorder. Blood samples were drawn at 09:00 and after 4.63 ± 1.87 months of treatment. Four pro-inflammatory cytokines (interleukin-1beta (IL-1β), IL-5, IL-6, tumor necrosis factor-alpha (TNF-α)) and three anti-inflammatory cytokines (IL-4, IL-10, IL-13) were measured using a Luminex® assay. For statistics, a factorial analysis was performed in Stata 15.1. Overall, there were no statistically significant differences in the interleukin (IL) values induced by treatment. When grouped by presentation, the differences were present almost exclusively in ADHD-AD, usually with a profile opposite to that observed in ADHD-C, and with interactions between comorbid factors, with IL-1β (p = 0.01) and IL-13 (p = 0.006) being the ones reaching the greatest statistical significance. These differences are probably related to the ODCD factor, and they disappear after treatment. In conclusion, the changes observed in cytokine levels in prepubertal children only in the ADHD-AD presentation are probably related to comorbidities (specifically ODCD) and are mitigated after treatment. [ABSTRACT FROM AUTHOR]

Policy PointsThe US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate‐ready US health care system.Health care workers have numerous profession‐specific and role‐specific opportunities to address the causes and impacts of climate change.Policies must address institutional barriers to change and create incentives aligned with climate readiness goals.Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula. [ABSTRACT FROM AUTHOR]

The novel disease produced by SARS-CoV-2 mainly harms the respiratory tract, but it has shown the capacity to affect multiple organs. Epidemiologic evidence supports the relationship between Coronavirus Disease 2019 (COVID-19) and pancreatic and hepatic injury development, identified by alterations in these organ function markers. In this regard, it is important to ascertain how the current prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) might affect COVID-19 evolution and complications. Although it is not clear how SARS-CoV-2 affects both the pancreas and the liver, a multiplicity of potential pathophysiological mechanisms seem to be implicated; among them, a direct viral-induced injury to the organ involving liver and pancreas ACE2 expression. Additionally, immune system dysregulation, coagulopathies, and drugs used to treat the disease could be key for developing complications associated with the patient's clinical decline. This review aims to provide an overview of the available epidemiologic evidence regarding developing liver and pancreatic alterations in patients with COVID-19, as well as the possible role that NAFLD/NASH might play in the pathophysiological mechanisms underlying some of the complications associated with COVID-19. This review employed a comprehensive search on PubMed using relevant keywords and filters. From the initial 126 articles, those aligning with the research target were selected and evaluated for their methodologies, findings, and conclusions. It sheds light on the potential pathophysiological mechanisms underlying this relationship. As a result, it emphasises the importance of monitoring pancreatic and hepatic function in individuals affected by COVID-19. [ABSTRACT FROM AUTHOR]

Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual (n = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study's results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.

The Florida Department of Health (FDOH) initiated a tobacco prevention program in 1989 when it received federal funding to implement tobacco prevention and control activities. By 1997, the State of Florida successfully settled with the tobacco industry for $11.3 billion to recoup Medicaid costs incurred by smokers. As part of the settlement agreement, the FDOH launched the Tobacco Pilot Program targeting tobacco use among underage youth.The Florida Youth Tobacco Survey (FYTS), which was originally part of the Tobacco Pilot Program, is a statewide, school-based anonymous survey that has been conducted annually since 1998. The FYTS collects information regarding the prevalence of tobacco use, attitudes, and related behaviors among middle and high school students throughout Florida and tracks those behaviors over time. The FYTS has been administered to a state-level sample annually since 1998, with county-level surveys being conducted in 2000, 2002, 2006, and 2008.In 2000, the FDOH worked with other state agencies to coordinate school-based surveys to reduce the burden on schools, teachers, and students. The FYTS became part of a multi-agency joint survey effort that also includes the Florida Youth Substance Abuse Survey (FYSAS), the Youth Physical Activity and Nutrition Survey (YPANS), and the Youth Risk Behavior Survey (YRBS).The 2008 FYTS was based on a two-stage cluster probability sample design. First, a random sample of public middle schools and high schools was selected for participation in the survey. Then, within each selected school, a random sample of classrooms was selected, and all students in that class were invited to participate in the survey. To be able to generalize the data to all of Florida, the survey data were statistically weighted. Weighting is a procedure that adjusts for oversampling and for any discrepancies between the sample and the entire population from which the sample is drawn. The weighted responses of the survey participants that are presented in this report were calculated to reflect the prevalence of tobacco usage and related indicators among all Florida public middle and high school students within each county and for Florida as a whole.The 2008 county-level FYTS was implemented in the spring of 2008. Sixty-six of the 67 Florida counties participated in this survey. The survey was administered to 38,510 middle school students (grades six to eight) and 40,283 high school students (grades nine to twelve) in 744 public schools throughout the state. The survey response rate for middle school students was 79% and the survey response rate for high school students was 73%. Sarasota County did not participate in the 2008 Florida Youth Survey and, therefore, has been omitted from this report. In addition, no middle school students from Gilchrist County participated in the survey so results for Gilchrist County are presented at the high school level only.In this report, county values are presented for key indicators with maps for both middle and high school students, followed by detailed tables listing the prevalence by county. On each map, counties have been split into four groups: (1) counties with rates higher than the state rate and statistically significant; (2) counties with rates higher than the state rate, but not statistically significant; (3) counties with rates lower than the state rate, but not statistically significant; and (4) counties with rates lower than the state rate and statistically significant. Confidence intervals (C.I.s) were used to determine significance. A 95% C.I. is a range in which the “true” rate will fall 95% of the time. The tables in this document show the total percentage for the county, as well as the breakdown by gender for each county, including 95% C.I.s. These maps and tables will allow readers to view their county in comparison to other counties, as well as to the State of Florida. Results were omitted if there were less than 30 respondents for a specific indicator.

Cancer is a process involving cell mutation, increased proliferation, invasion, and metastasis. Over the years, this condition has represented one of the most concerning health problems worldwide due to its significant morbidity and mortality. At present, the incidence of cancer continues to grow exponentially. Thus, it is imperative to open new avenues in cancer research to understand the molecular changes driving DNA transformation, cell-to-cell interaction derangements, and immune system surveillance decay. In this regard, evidence supports the relationship between chronic inflammation and cancer. In light of this, a group of bioactive lipids derived from polyunsaturated fatty acids (PUFAs) may have a position as novel anti-inflammatory molecules known as the specialized pro-resolving mediators (SPMs), a group of pro-resolutive inflammation agents that could improve the anti-tumor immunity. These molecules have the potential role of chemopreventive and therapeutic agents for various cancer types, and their effects have been documented in the scientific literature. Thus, this review objective centers around understanding the effect of SPMs on carcinogenesis and their potential therapeutic effect. [ABSTRACT FROM AUTHOR]

Objective. Only a few studies assessing the sleep effects of low doses of melatonin (aMT) have been performed in the past, most of them in adults, and only one in subjects with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to provide evidence of the changes induced by aMT doses as low as 1 mg in the sleep pattern of pediatric patients with ADHD under treatment with methylphenidate (MPH). Methods. Children and adolescents (7–15 years) with ADHD who were receiving extended-release MPH were recruited. A seven-week sleep diary was collected prior to starting a four-week treatment with 1 mg of aMT (30 min before bedtime). Seven-day actigraphic assessments of sleep were performed before and after treatment. Results. Twenty-seven patients (17 males, 62.96%) participated in the study, who had been receiving MPH for 1.57 (1.11) months. A significant increase in sleep duration (TST) was observed after one month of treatment (463 (49) min to 485 (41) min; p < 0.040), with nonsignificant improvements in sleep-onset latency (SOL), nocturnal awakenings, or sleep efficiency. Only minor adverse effects were reported. Conclusion. Low doses of melatonin (1 mg) are able to increase TST in children and adolescents with ADHD receiving treatment with psychostimulants, with an adequate tolerability profile. Further placebo-controlled trials adjusting the time of aMT administration to the individual circadian profile should explore the effects of low doses of this hormone to shorten SOL in this population of patients. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a common complication of a non-kidney solid organ transplant (NKSOT). Identifying predisposing factors is crucial for an early approach and correct referral to nephrology. Methods: This is a single-center retrospective observational study of a cohort of CKD patients under follow-up in the Nephrology Department between 2010 to 2020. Statistical analysis was performed between all the risk factors and four dependent variables: end-stage renal disease (ESKD); increased serum creatinine ≥50%; renal replacement therapy (RRT); and death in the pre-transplant, peri-transplant, and post-transplant periods. Results: 74 patients were studied (7 heart transplants, 34 liver transplants, and 33 lung transplants). Patients who were not followed-up by a nephrologist in the pre-transplant (p < 0.027) or peri-transplant (p < 0.046) periods and those who had the longest time until an outpatient clinic follow-up (HR 1.032) were associated with a higher risk of creatinine increase ≥50%. Receiving a lung transplant conferred a higher risk than a liver or heart transplant for developing a creatinine increase ≥50% and ESKD. Peri-transplant mechanical ventilation, peri-transplant and post-transplant anticalcineurin overdose, nephrotoxicity, and the number of hospital admissions were significantly associated with a creatinine increase ≥50% and developing ESKD. Conclusions: Early and close follow-up by a nephrologist was associated with a decrease in the worsening of renal function. [ABSTRACT FROM AUTHOR]

In recent years there has been a considerable increase in the publishing of textbooks and monographs covering what was formerly known as random or irregular deterministic motion, now referred to as deterministic chaos. There is still substantial interest in a matter that is included in many graduate and even undergraduate courses on classical mechanics. Based on the Hamiltonian formalism, the main objective of this paper is to provide, from the physicist's point of view, an overall and intuitive review of this broad subject (with some emphasis on the Kolmogorov-Arnold-Moser theorem and the stability of planetary motions) which may be useful to both students and instructors. (Contains 8 footnotes and 10 figures.)

Background: Increasing evidence supports a neuroinflammatory basis in ADHD damaging glial function and thereby altering dopaminergic (DA) neurotransmission. Previous studies focusing on the S100B protein as a marker of glial function have shown contradictory results. We conducted a clinical trial to investigate differences in S100B levels between ADHD patients and controls, as well as observe gradual changes in S100B concentrations after a triple therapy (TT) containing methylphenidate (MPH), melatonin (aMT) and omega-3 fatty acids (ω-3 PUFAs). Methods: 62 medication-naïve children with ADHD (ADHD-G) and 65 healthy controls (C-G) were recruited. Serum S100B was measured at baseline (T0) in ADHD-G/C-G, and three (T3) and six months (T6) after starting TT in the ADHD-G, together with attention scores. Results: A significant increase in S100B was observed in the ADHD-G vs. C-G. In the ADHD-G, significantly higher S100B values were observed for comparisons between T0–T3 and between T0–T6, accompanied by a significant improvement in attention scores for the same timepoint comparisons. No significant differences were found for S100B between T3–T6. Conclusion: Our results agree with the hypothesis of glial damage in ADHD. Further studies on the link between DA and S100B are required to explain the transient increase in S100B following TT. [ABSTRACT FROM AUTHOR]

Background: Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood. Objective: To explore the mental health impacts of climate change in vulnerable populations globally. Methods: We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis. Findings/Results: One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance. Conclusions: Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world. [ABSTRACT FROM AUTHOR]

Omega-3 fatty acids (ω-3 FAs) are well-known for their actions on immune/inflammatory and neurological pathways, functions that are also under circadian clock regulation. The daily photoperiod represents the primary circadian synchronizer ('zeitgeber'), although diverse studies have pointed towards an influence of dietary FAs on the biological clock. A comprehensive literature review was conducted following predefined selection criteria with the aim of updating the evidence on the molecular mechanisms behind circadian rhythm regulation by ω-3 FAs. We collected preclinical and clinical studies, systematic reviews, and metanalyses focused on the effect of ω-3 FAs on circadian rhythms. Twenty animal (conducted on rodents and piglets) and human trials and one observational study providing evidence on the regulation of neurological, inflammatory/immune, metabolic, reproductive, cardiovascular, and biochemical processes by ω-3 FAs via clock genes were discussed. The evidence suggests that ω-3 FAs may serve as non-photic zeitgebers and prove therapeutically beneficial for circadian disruption-related pathologies. Future work should focus on the role of clock genes as a target for the therapeutic use of ω-3 FAs in inflammatory and neurological disorders, as well as on the bidirectional association between the molecular clock and ω-3 FAs. [ABSTRACT FROM AUTHOR]

The objective is to evaluate the comprehensive communication of women's fashion enterprises in Nicaragua in order to identify strengths and communication needs. To this end, the questionnaire of the Integral Communication Audit Model (MACI) was applied to women entrepreneurs in the fashion sector belonging to the Nicaraguan Network of Women Entrepreneurs (REN). The results show strengths in most of the communication dimensions, mainly in organisational behaviour, dissemination of information, external relations and company image; but weaknesses in key aspects such as infrastructure, formation of working groups, and transmission of the company's financial information. [ABSTRACT FROM AUTHOR]

Options for optimizing the energy and spatial resolution of gamma-ray imaging detectors based on thick, monolithic crystals shaped like fiat-topped pyramids were studied. Monte Carlo simulations were made of the scintillation light transport for evaluating the effect of four parameters on the energy resolution, the spatial resolutions, and the depth of interaction (DOI) resolution of the gamma-ray imaging detector. These four parameters are: the reflectivity of the surface coating; the scatter mean free path; the absorption mean free path of the scintillation light; and the angle that defines the inclination of the sides of the pyramidal frustum. In real detectors, the values for the mean free paths for optical photons are normally not known. We estimated these by comparing MC simulations of detector resolutions to measurements for three gamma-ray imaging detectors with LYSO and LSO from different suppliers and with different surface coatings and geometries. The gamma-ray imaging detector measures the energy, centroids, and depth of interaction of the gamma-ray. DOI enhanced charge dividing readouts were used to measure the depth of interaction. Index Terms--Crystal geometry, gamma ray imaging, interaction depth, monolithic scintillator, surface coating.

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Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population. [ABSTRACT FROM AUTHOR]

The objective of this systematic review is to evaluate the existing evidence supporting the effectiveness of the neutropenic diet in decreasing infection and mortality among cancer patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus for relevant articles published from database inception until March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for this review. Individual studies were evaluated using the Oxford Center for Evidence-Based Medicine guidelines. A total of 473 articles were identified and 11 articles were selected after assessing eligibility. Our review showed that the neutropenic diet does not decrease infection rates or mortality among cancer patients. Currently, there is no uniform definition for the neutropenic diet across different institutions. For example, some institutions follow general food safety practices while others avoid foods that increase exposure to microbes and bacteria, and some follow both. Given these differences in practice regarding what constitutes a neutropenic diet, it is advisable that safe food handling and preparation practices recommended by the Food and Drug Administration be uniformly followed for neutropenic patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop a risk model for the prediction of 30-day unplanned readmission rate after surgery for colon cancer. Method: This study was a cross-sectional analysis of data from Nationwide Readmissions Database, collected during 2010–2014. Patients ≥ 18 years of age who underwent surgery for colon cancer were included in the study. The primary outcome of the study was 30-day unplanned readmission rate. Results: There were 141,231 index hospitalizations for surgical treatment of colon cancers and 16,551 had unplanned readmissions. Age, sex, primary payer, Elixhauser comorbidity index, node positive or metastatic disease, length of stay, hospital bedsize, teaching status, hospital ownership, presence of stoma, surgery types, surgery procedures, infectious complications, surgical complications, mechanical wounds, pulmonary complications, and gastrointestinal complications were selected for the risk analysis during backward regression model. Based on the estimated coefficients of selected variables, risk scores were developed and stratified as low risk (≤ 1.08), moderate risk (> 1.08 to ≤ 1.5), and high risk (> 1.5) for unplanned readmission. Validation analysis (n = 42,269) showed that 7.1% of low-risk individuals, 11.1% of moderate-risk individuals, and 17.1% of high-risk individuals experienced unplanned readmissions (P < 0.001). Pairwise comparisons also showed statistically significant differences between low-risk and moderate-risk participants (P < 0.001), between moderate-risk and high-risk participants (P < 0.001), and between low-risk and high-risk participants (P < 0.001). The area under the ROC curve was 0.622. Conclusions: Our risk model could be helpful for risk-stratifying patients for readmission after surgical treatment for colon cancer. This model needs further validation by incorporating all possible clinical variables. [ABSTRACT FROM AUTHOR]

One factor limiting the current applicability extent of hadron therapy is the lack of a reliable method for real time treatment monitoring. The use of Compton imaging systems as monitors requires the correct reconstruction of the distribution of prompt gamma productions during patient irradiation. In order to extract the maximum information from all the measurable events, we implemented a spectral reconstruction method that assigns to all events a probability of being either partial or total energy depositions. The method, implemented in a list-mode maximum likelihood expectation maximization algorithm, generates a four dimensional image in the joint spatial-spectral domain, in which the voxels containing the emission positions and energies are obtained. The analytical model used for the system response function is also employed to derive an analytical expression for the sensitivity, which is calculated via Monte Carlo integration. The performance of the method is evaluated through reconstruction of various experimental and simulated sources with different spatial and energy distributions. The results show that the proposed method can recover the spectral and spatial information simultaneously, but only under the assumption of ideal measurements. The analysis of the Monte Carlo simulations has led to the identification of two important degradation sources: the mispositioning of the gamma interaction point and the missing energy recorded in the interaction. Both factors are related to the high energy transferred to the recoil electrons, which can travel far from the interaction point and even escape the detector. These effects prevent the direct application of the current method in more realistic scenarios. Nevertheless, experimental point-like sources have been accurately reconstructed and the spatial distributions and spectral emission of complex simulated phantoms can be identified. [ABSTRACT FROM AUTHOR]

Background: Cancer and cardiovascular diseases (CVDs) are leading causes of morbidity and mortality. We analyzed national data to examine the prevalence of CVD risk factors among adult cancer survivors in the United States. Methods: Participants included adults ≥18 years of age from the National Health and Nutrition Examination Survey 2001–2002 to 2013–2014. CVD risk factors included hypertension, diabetes, dyslipidemia, obesity, smoking, and physical activity. Prevalence of 1, 2, or ≥3 CVD risk factors was compared between cancer and noncancer participants. All CVD risk factors were adjusted for age and smoking and additionally for sex. Differences in CVD risk factors among cancer and noncancer participants were identified using logistic regression analysis. Results: Among 35,379 eligible participants, 2906 (8.4%) had a history of cancer. The proportion of participants having a single CVD risk factor was lower among cancer survivors compared with noncancer participants (25.8% vs. 33.9%, P < 0.001). The proportions of participants having two CVD risk factors (33.5% vs. 24.6%, P < 0.001) and ≥3 CVD risk factors (27.4% vs. 16.4%, P < 0.001) were higher among cancer survivors. However, these associations lost significance upon adjusting for age. The odds of total hypertension (odds ratio [OR] 1.25, 95% confidence interval [CI]: 1.11–1.40) and total diabetes (OR 1.33, 95% CI: 1.08–1.65) were significantly higher among cancer survivors. Conclusions: Our study showed that adult cancer survivors in the United States had higher levels of CVD risk factors primarily due to age-related factors, in addition to cancer complications. There is a significant need for improved CVD risk assessment and prevention services for cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). Methods: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ2 and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations. Results: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, Ptrend < .01). Factors associated with higher palliative care consultations were increasing age, ≥80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84). Conclusion: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use. [ABSTRACT FROM AUTHOR]

Introduction: Ther e continue to be lar ge inequities in the r epr esentation of women at pr ogr essive levels of training and seniority in both academic and community practice settings. Gender inequity in medicine is not only problematic in its own right but has the potential to deliver inequitable outcomes, including the neglect of important research and care that continues to disadvantage women patients. As significant evidence is emerging on gender inequities in the medical profession, it is an opportune time to review the current evidence on the persisting gaps, potential causes, and possible solutions. Methods: A rapid scoping review was conducted for articles on the topic of gender inequity and the medical profession in PubMed and Google Scholar. The search was limited to articles published from 1990 to the search date (June 1, 2017), and included only papers published in English. Results: An initial 1055 articles were screened according to established inclusion and exclusion criteria. After initial and full-text review, supplemented by a hand search through the article references, 45 articles were included in the review. Articles were classified as a) evidence for gender inequities, b) causes of inequities, and c) solutions for inequities. Only 13% of articles found (6 studies) addressed possible interventions to reduce inequities. Significant gaps exist in the literature, particularly around part-time work options, parental and family leave options, and addressing implicit biases to reduce sexism in professional settings. Discussion: The evidence highlights substantial inequities in the r epr esentation of women in the medical profession, in both the academic and community settings, in medical literature, and in leadership positions. This review also highlighted substantial gaps in the literature on understanding what can be done to reduce these gaps. More research is needed in the area of gender inequities in medicine to improve the representation of women in medicine. [ABSTRACT FROM AUTHOR]

Twenty-five years after the end of the Chilean military dictatorship (1973-1990), the redemocratization process still has not drawn to a close. The persistent tensions in civil-military relations have sparked the concern of national and international human rights organizations and have even begun to occupy a space in the country's cultural production. In this article, I will focus on El mocito (Marcela Said and Jacques de Certau, 2011). This film tackles Chile's dictatorial past through the perspective of a civilian who was closely connected to the Armed Forces. It addresses the case of an individual living on the border between worlds often perceived as mutually exclusive. He is a civilian, but he was also a member of the DINA--Chile's secret police under Pinochet-- though not as a member of the Armed Forces, but rather in the role of a butler. Although, as far as the public knows, he never participated in torture or assassinations, through this position, he was aware of what was taking place, bore witness to events related to state repression, and by fulfilling the tasks of his work, in many ways sustained the framework of the authoritarian system. By focusing on an atypical actor who is simultaneously an outsider and an insider in both the Armed Forces and the civil society, the documentary presents a unique perspective on these two groups and their intersections. In so doing, the film poses questions about responsibility for, and complicity with, the cruelty that took place during the military regime and beyond that all members of Chilean society must consider. How far can we extend responsibility for what happened? How do we measure the guilt or innocence of those who did not commit or order the perpetration of crimes, but were nevertheless part of the system that condoned such acts? Can victims exist within the group typically thought of as victimizers? What forms does cruelty take in civil society in non-authoritarian contexts? These queries imply a questioning of the military institution in its present form and challenge both the concept of the citizen shaped within democracy and the possibilities of nunca más/never again in Chile today. [ABSTRACT FROM AUTHOR]

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been a growing problem in human medicine since the 1960s, and more recently in veterinary medicine with the appearance of livestock-associated MRSA (LA-MRSA). Nevertheless, information about the presence of MRSA in rabbits is quite scarce since only one LA-MRSA identification has been previously reported. The present study aimed to determine genotypic characterization by verifying the presence of resistance determinants, virulence, and toxin genes of different S. aureus strains that cause lesions in rabbits, and their phenotypic traits based on the antimicrobial susceptibility profile. The analysis of 240 S. aureus isolates obtained from different lesion types collected from 89 Spanish and Portuguese rabbit commercial farms in the last 4 years (2014-2017) was performed. The methicillin-resistant gene mecA was found in 11.25% of the studied isolates (27 of 240) from 19 farms (13 Spanish and 6 Portuguese). Staphylococcal cassette chromosome mec (SCCmec) typing predominantly revealed type III (n = 15). Additionally, three MRSA isolates carrying the mecC gen were detected in samples from three different farms (two Spanish and one Portuguese). None of the 30 MRSA isolates was PVL-positive or tst-positive. After the multilocus sequence typing (MLST) procedure, 16 belonged to ST2855, 6 to ST146, 6 to ST398, and 2 ST4774. No ST121 isolate was mec-positive. ST398 and ST4774 isolates lacked the immuneevasion-cluster (IEC) genes. ST2855 strains were associated with the presence only of the sak gene, and ST146 isolates were ascribed to IEC type E. Therefore, this is the first description of LA-MRSA from rabbits belonging to ST2855. Interestingly, one ST2855 and two ST4774 isolates were mecC-positive, which could act as a mecCMRSA reservoir. More studies are needed to further characterize these isolates and their relationship with humans and other animal species. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the numerous investigations carried out in relation to melatonin, there is a lack of knowledge about the specific melatonin secretion patterns in the diverse primary sleep disturbances. The objective of this study was to analyze the plasma melatonin concentrations in children with primary sleep disorders and the effects of melatonin therapy on their serum levels and their actigraphic sleep parameters.Methods: Fourteen participants (nine girls; seven to 14 years old) diagnosed with diverse primary sleep disorders were recruited. Four different melatonin secretion patterns were identified: low plasma melatonin levels, absence of a circadian rhythm, advanced acrophase, and delayed acrophase. A placebo (one week) was administered followed by three months of melatonin therapy (3 mg/night). Urinary 6-sulfatoxymelatonin levels, 24-hour plasma melatonin concentrations, and a seven-day actigraphic record were collected after both treatments.Results: After melatonin therapy, a significant increase (P < 0.001) of urinary 6-sulfatoxymelatonin excretion with a clear circadian variation was observed. Plasma melatonin concentrations were also significantly higher with a recovery in the circadian rhythm. Actual sleep time was significantly longer, with a substantial reduction in the sleep onset latency and night awakenings. No severe side effects were reported.Conclusions: The main clinical implication of this study is to demonstrate the efficacy of melatonin in three main circumstances: an insufficient hormone production, a disturbed circadian rhythm, and an advanced or delayed acrophase. As ongoing work, we are exploring the effect of different doses of melatonin on the regulation of its concentrations and of its secretion rhythm. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyze circadian patterns of urinary 6-sulphatoxymelatonin (aMT6s) excretion in children with primary sleep disorders in comparison with healthy controls. A total of 124 control children and 124 patients (aged 4-14 years) diagnosed with diverse primary sleep disorders were recruited. aMT6s concentrations were measured in diurnal and nocturnal urine, as well as in 24-hour urine. aMT6s levels were significantly higher and showed significantly more evident circadian variations in the control group (P < .001). Four different melatonin (aMT) production and excretion patterns were distinguished in the group with sleep disorders: (1) standard aMT production pattern, (2) low aMT production pattern, (3) aMT production pattern with absence of circadian variation, and (4) aMT hyperproduction pattern. This study highlights the importance of analyzing specific alterations of aMT secretion in each sleep disorder and provides evidences to explain why not all children with sleep disturbances do respond to aMT treatment. [ABSTRACT FROM AUTHOR]

This article discusses the civil-military relationship during the post-dictatorship period in Chilean history, dating from 1990. The author comments on the impact of the political change and transition at this time on the Chilean military. The history of Chilean armed forces from the early 20th century and its interaction with Chilean society is also examined.

A DAQ architecture for a PET system is presented that focuses on modularity, scalability and reusability. The system defines two basic building blocks: data acquisitors and concentrators, which can be replicated in order to build a complete DAQ of variable size. Acquisition modules contain a scintillating crystal and either a position-sensitive photomultiplier (PSPMT) or an array of silicon photomultipliers (SiPM). The detector signals are processed by AMIC, an integrated analog front-end that generates programmable analog outputs which contain the first few statistical moments of the light distribution in the scintillator. These signals are digitized at 156.25 Msamples/s with free-running ADCs and sent to an FPGA which detects single gamma events, extracts position and time information online using digital algorithms, and submits these data to a concentrator module. Concentrator modules collect single events from acquisition modules and perform coincidence detection and data aggregation. A synchronization scheme over data links is implemented that calibrates each link’s latency independently, ensuring that there are no limitations on module mobility, and that the architecture is arbitrarily scalable. Prototype boards with both acquisition and concentration functionality have been built for evaluation purposes. The performance of a small PET system with two detectors based on continuous scintillators is presented. A synchronization error below 50 ps rms is measured, and energy resolutions of 19% and 24% and timing resolutions of 2.0 ns and 4.7 ns FWHM are obtained for PMT and SiPM photodetectors, respectively. [ABSTRACT FROM PUBLISHER]

In this work we describe a procedure to reduce the number of signals detected by an array of 256 Silicon Photomultipliers (SiPMs) using a resistor network to divide the signal charge into few readout channels. Several configurations were modeled, and the pulsed signal at the readout contacts were simulated. These simulation results were experimentally tested on a specifically designed and manufactured set of printed circuit boards. Three network configurations were modeled. The modeling provided encouraging results for all three configurations. The measurements on the prototypes constructed for this study, however, provided useful position-sensitivity for only one of the network configurations. The lack of input signal amplification into the networks, the SiPM dark current, as well as the complexity of an eight layers board with parasitic capacitances, could have caused the degradation of resolving the impact photon position. This is hard to overcome with external printed circuit boards and components. [ABSTRACT FROM PUBLISHER]