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In the US, nearly 11% of adults were living with diagnosed diabetes in 2017, and significant type 2 diabetes (T2D) disparities are experienced by socioeconomically disadvantaged, racial/ethnic minority populations, including Hispanics. The standard 15-min primary care visit does not allow for the ongoing self-management support that is needed to meet the complex needs of individuals with diabetes. "Team-based" chronic care delivery is an alternative approach that supplements physician care with contact from allied health personnel in the primary care setting (e.g., medical assistants; MAs) who are specially trained to provide ongoing self-management support or "health coaching." While rigorous trials have shown MA health coaching to improve diabetes outcomes, less is known about if and how such a model can be integrated within real world, primary care clinic workflows. Medical Assistant Health Coaching for Type 2 Diabetes in Diverse Primary Care Settings - A Pragmatic, Cluster-Randomized Controlled Trial will address this gap. Specifically, this study compares MA health coaching versus usual care in improving diabetes clinical control among N = 600 at-risk adults with T2D, and is being conducted at four primary care clinics that are part of two health systems that serve large, ethnically/racially, and socioeconomically diverse populations in Southern California. Electronic medical records are used to identify eligible patients at both health systems, and to examine change in clinical control over one year in the overall sample. Changes in behavioral and psychosocial outcomes are being evaluated by telephone assessment in a subset (n = 300) of participants, and rigorous process and cost evaluations will assess potential for sustainability and scalability.

• Metaphyseal malunions and nonunions of the lower extremity pose a challenge in the setting of complex, multiplanar deformity and poor bone quality• Optimal treatment corrects all parameters of deformity and provides stable fixation for early weight bearing and rehabilitation• Current options for correction include single and double cut osteotomies stabilized with plate fixation, or gradual correction with fine wire circular fixation• Both classic osteotomies and fine wire circular frames have significant limitations• The clamshell osteotomy was developed to simplify the correction of tibial and femoral diaphyseal malunions and nonunions, but had not been studied for use in metaphyseal and meta-diaphyseal deformities.

Despite the diversity in fish auditory structures, it remains elusive how otolith morphology and swim bladder-inner ear (= otophysic) connections affect otolith motion and inner ear stimulation. A recent study visualized sound-induced otolith motion; but tank acoustics revealed a complex mixture of sound pressure and particle motion. To separate sound pressure and sound-induced particle motion, we constructed a transparent standing wave tube-like tank equipped with an inertial shaker at each end while using X-ray phase contrast imaging. Driving the shakers in phase resulted in maximised sound pressure at the tank centre, whereas particle motion was maximised when shakers were driven out of phase (180°). We studied the effects of two types of otophysic connections-i.e. the Weberian apparatus (Carassius auratus) and anterior swim bladder extensions contacting the inner ears (Etroplus canarensis)-on otolith motion when fish were subjected to a 200 Hz stimulus. Saccular otolith motion was more pronounced when the swim bladder walls oscillated under the maximised sound pressure condition. The otolith motion patterns mainly matched the orientation patterns of ciliary bundles on the sensory epithelia. Our setup enabled the characterization of the interplay between the auditory structures and provided first experimental evidence of how different types of otophysic connections affect otolith motion.

The avant-garde literary group OBĖRIU, with its poetics of the absurd, alogism and grotesque, had a great influence on later Soviet Russian literature and on neo-avant-garde movements as well. This paper investigates the connection between OBĖRIU and the neo-avant-garde of the 1970s and 1980s, especially by comparing two representatives of these different ‘ages’ of avant-garde – Daniil Kharms and Dmitrii Prigov. The analysis will focus particularly on the genre of the anecdote, with which they both experimented. After tracing the heritage of OBĖRIU poetics in Conceptualism and in the work of Prigov, who was interested in the form of Kharmsian prose miniatures, the paper will compare the well-known Anecdotes from the Life of Pushkin by Kharms (1937) with a series of quasi-hagiographical texts, Stories about Stalin, by Prigov (1975-1989). These bizarre sketches have several common features related to the genre, the formal structure, and the stylistic devices employed. Despite some striking parallels, however, the analysis will demonstrate that Kharms and Prigov have two different approaches to understanding deconstruction of myths, the grotesque, and the absurd.

Abstract Rhamdia quelen is a commercially important fish in South America. During the survey of myxozoan infections in fishes from Pardo River, Paranapanema River basin, São Paulo State, Brazil, we describe three new species of Henneguya found parasitizing gills of R. quelen: Henneguya bagre n. sp., Henneguya breviscauda n. sp and Henneguya novaerae n. sp. The descriptions were based on myxospores morphology and small subunit ribosomal DNA partial sequences. Phylogenetic analysis showed a clade formed by species that parasitize Siluriformes, with Henneguya jundiai as a sister species of Henneguya bagre n. sp., Henneguya breviscauda n. sp and Henneguya novaerae n. sp. Our study indicates that the parasites infecting R. quelen belong to a lineage of myxozoans infecting Heptapteridae fishes. Using molecular and morphological characterization, the species were identified as new species for the genus Henneguya. Based on our analysis we recommend monitoring the presence of these parasites in farmed fishes, to analyze possible pathologies caused by them.

Introduction: In the study of neurodegenerative diseases, the possibility to follow the fate of specific cells or molecules within the whole body would be a milestone to better understand the complex evolution of disease mechanisms and to monitor the effects of therapies. The techniques available today do not allow the visualization of disease-relevant cells within the whole tridimensional biological context at high spatial resolution.Methods: Here we show the results from the first validation steps of a novel approach: by combining the conjugate nanobodies anti-glial fibrillary acidic protein (GFAP) and metal-nanoparticles (i.e. 2 nm gold NP) with X-ray phase contrast tomography (XPCT) we would be able to obtain a tridimensional visualization and identification of cells of interest together with the surrounding tissue and the vascular and neuronal networks.Results: By exploiting the X-ray attenuation properties of metal nanoparticles and the specific targeting capabilities of nanobodies, we could give XPCT the specificity it presently lacks, making it no longer a pure morphological but a molecular and targeted imaging technique. In our case, we synthesized and characterized Gold-NP/GFAP nanobody to target the astrocytes of mouse brain.Discussion: The results of the first tests presented in this paper have provided us with information on the feasibility of the approach, encouraging us to carry out further experiments in order to achieve the ultimate goal of setting up this new imaging technique.

The prototype of a hoeing and spot spraying device was used to evaluate the impacts of digital technologies in vegetable production on labour, economic and social issues. These impacts were analysed in a case study conducted on a farm in Switzerland. Working-time requirements were modelled on the basis of time studies conducted during field trials. The results were used in a cost analysis and a comparison with a conventional plant-protection strategy. Furthermore, an in-depth interview with the farm manager revealed the personal, intellectual and social characteristics of successful technology adopters and the impact of applying a new technology to the working process. While one might expect digital technologies to substitute labour with capital, the prototype, in its current form, requires both higher investments and a higher input of labour per hectare. This study shows that the success of new technologies relies on enthusiastic farm managers in addition to public and consumer support, which can be gained by promoting the reduced amount of pesticides applied by these digital technologies.

In the present study, we examined 30 individuals of introduced African cichlids, Oreochromis niloticus and Coptodon rendalli, collected in a river spring of the Pardo River, Paranapanema River basin, southeastern Brazil. Based on morphological and molecular analyses of the partial LSU rDNA gene, we identified four species of monogeneans, Cichlidogyrus tilapiae, C. thurstonae, C. mbirizei, and Scutogyrus longicornis on the gills of O. niloticus, whereas individuals of C. rendalli were infested only with C. papernastrema. This is the first record of C. mbirizei and C. papernastrema in tilapias from Brazil. The ecological consequences of the introduction of exotic species of tilapia such as O. niloticus and C. rendalli along with their monogenean parasites in a wild environment represented by a river spring are discussed. Our new molecular data on Cichlidogyrus and Scutogyrus contribute to the investigation of the phylogenetic interrelationships of these widely distributed genera of monogeneans since their species composition is still unsettled.

ObjectiveWe examined associations among socioeconomic adversity, social resources, and allostatic load in Hispanic/Latino youth, who are at high risk for obesity and related cardiometabolic risks.MethodsParticipants were 1343 Hispanic/Latino youth (51% male; ages 8-16 years) offspring of Hispanic Community Health Study/Study of Latinos participants. Between 2012 and 2014, youth underwent a fasting blood draw and anthropometric assessment, and youth and their enrolled caregivers provided social and demographic information. A composite indicator of allostatic load represented dysregulation across general metabolism, cardiovascular, glucose metabolism, lipid, and inflammation/hemostatic systems. Socioeconomic adversity was a composite of caregiver education, employment status, economic hardship, family income relative to poverty, family structure, and receipt of food assistance. Social resources were a composite of family functioning, parental closeness, peer support, and parenting style variables.ResultsMultivariable regression models that adjusted for sociodemographic factors, design effects (strata and clustering), and sample weights revealed a significant, positive, association between socioeconomic adversity and allostatic load (β = .10, p = .035), and a significant, inverse association between socioeconomic adversity and social resources (β = -.10, p = .013). Social resources did not relate to allostatic load and did not moderate or help explain the association of adversity with allostatic load (all p values > .05).ConclusionsStatistically significant, but small associations of socioeconomic adversity with both allostatic load and social resources were identified. The small effects may partially reflect range restriction given overall high socioeconomic adversity and high social resources in the cohort.

Lateral tibial plateau fractures with significant articular depression and metaphyseal comminution in the setting of osteoporosis are challenging to manage. The subchondral bone defect and capacious cancellous void after surgical elevation of the articular surface is usually filled with nonstructural graft such as autologous cancellous bone graft, allogenic cancellous bone graft, or bone graft substitutes. Reports have shown a high rate of subsidence with these grafts when patients start to bear weight and ultimately failure of the construct. Structural grafts demonstrated stronger mechanical properties and lower subsidence rates. The purpose of this note is to describe a novel surgical technique using structural tricortical iliac crest allograft for the treatment of osteoporotic depressed lateral tibia plateau fracture. [ABSTRACT FROM AUTHOR]

Abstract The magnitude and distribution of strain imposed on the peripheral airspaces by mechanical ventilation at the microscopic level and the consequent deformations are unknown despite their importance for understanding the mechanisms occurring at the onset of ventilator-induced lung injury. Here a 4-Dimensional (3D + time) image acquisition and processing technique is developed to assess pulmonary acinar biomechanics at microscopic resolution. Synchrotron radiation phase contrast CT with an isotropic voxel size of 6 µm3 is applied in live anesthetized rats under controlled mechanical ventilation. Video animations of regional acinar and vascular strain are acquired in vivo. Maps of strain distribution due to positive-pressure breaths and cardiovascular activity in lung acini and blood vessels are derived based on CT images. Regional strain within the lung peripheral airspaces takes average values of 0.09 ± 0.02. Fitting the expression S = kV n , to the changes in peripheral airspace area (S) and volume (V) during a positive pressure breath yields an exponent n = 0.82 ± 0.03, suggesting predominant alveolar expansion rather than ductal expansion or alveolar recruitment. We conclude that this methodology can be used to assess acinar conformational changes during positive pressure breaths in intact peripheral lung airspaces.

Separation Anxiety (SA) is a behavioral syndrome that may affect dogs of different ages and that is characterized by intense clinical signs. Traditional veterinary clinic efforts rely on harmful side effect drugs. Overall, homeopathy handles individual idiosyncrasies and susceptibilities and deal with them using a single medicine through the law of similarity. This study aimed to determine whether individualized homeopathic medicines have a greater effect than placebo for dogs suffering from SA or not, assessing its relation to behavioral settings, cortisol levels, and blood cells count before and after therapy. It also focused on setting a demographic profile of these dogs. Owners filled out a score questionnaire. Twenty-one dogs were recruited and repertorized in accordance to classical homeopathy. A pharmacist was responsible to randomize and dispense verum medicine or placebo. On the 30th day, reappraisal of owners were allowed altering the dispensed medicine. The final assessment occurred on the 60th day. In verum group, destructive behavior analysis had a significant statistical difference intra-group over the trial compared to the placebo group. The mean of cortisol levels in the placebo group was significantly higher on the 60th day of the trial when compared to the verum group, whose levels were sustained over the same period. Although evidenced behavioral improvements could be related to homeopathic preparations, it was not feasible to set any connection between homeopathic interventions, behavioral issues, and plasma components

Summary: The pancreatic islet is a highly structured micro-organ that produces insulin in response to rising blood glucose. Here we develop a label-free and automatic imaging approach to visualize the islets in situ in diabetic rodents by the synchrotron radiation X-ray phase-contrast microtomography (SRμCT) at the ID17 station of the European Synchrotron Radiation Facility. The large-size images (3.2 mm × 15.97 mm) were acquired in the pancreas in STZ-treated mice and diabetic GK rats. Each pancreas was dissected by 3000 reconstructed images. The image datasets were further analysed by a self-developed deep learning method, AA-Net. All islets in the pancreas were segmented and visualized by the three-dimension (3D) reconstruction. After quantifying the volumes of the islets, we found that the number of larger islets (=>1500 μm3) was reduced by 2-fold (wt 1004 ± 94 vs GK 419 ± 122, P

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.