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Sexual minority individuals (e.g., lesbian, gay, bisexual people) face sexual health inequalities related to their experiences with providers in sexual health care settings, yet few prior studies have focused on these experiences. Thematic content analysis was used to analyze qualitative interviews with a diverse sample of 58 sexual minority individuals from three cohorts in the USA to explore sexual minority people’s perspectives of sexual health care. Subgroup differences in themes across gender, sexual identity, race/ethnicity, and cohort were also assessed. Our analysis revealed four key themes: erasure, enacted stigma, felt stigma, and affirmative care. Women and genderqueer participants reported erasure in the context of identity dismissal in family planning conversations, and men reported felt stigma in the context of hyperawareness of sexual minority identity. Some sexual minority people of color also reported intersectional felt stigma as a result of multiple marginalized identities. Additionally, fewer men reported erasure compared with women or genderqueer people and fewer gay and lesbian participants reported erasure than bisexual or queer people. The sexual health care experiences of sexual minority people are characterized by erasure, stigma, and affirmative care, with important differences in erasure and stigma across subpopulations of sexual minority people. Implications of these findings include the need for more sexual minority health initiatives and training and the development of affirmative care practices for sexual minority populations, including those with multiple marginalized identities.

Soil-transmitted-helminth (STH) infections are a persistent global public health problem. Control strategies for STH have been based on the use of mass drug administration (MDA) mainly targeting preschool- and school-aged-children, although there is increasing interest in expanding treatment to include adults and others through community-wide MDA. Coverage assessment is critical to understanding the real effectiveness of albendazole (ALB) treatment in those MDA programs. The work described here aims to (i) evaluate the effect of type of diet (a heavy or light meal) and fasting before ALB treatment on the systemic disposition of ALB and its metabolites in treated human volunteers and (ii) evaluate the potential feasibility of detecting albendazole metabolites in urine. The data reported here demonstrate that the systemic availability of the active ALB-sulfoxide (ALBSO) metabolite was enhanced more than 2-fold after food ingestion (a heavy or light meal). ALB dissolution improvement related to the ingestion of food may modify the amount of drug/ metabolites reaching the parasite, affecting drug efficacy and the overall success of MDA strategies. The measurement in urine samples of the amino-ALB-sulfone (NHALBSO2) derivative and ALBSO for up to 96 h suggests that it may be feasible to develop a noninvasive tool to evaluate compliance/adherence to ALB treatment. Fil: Ceballos, Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; Argentina Fil: Nieves, Elvia Ester. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Juarez, Marisa del Valle. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Aveldaño, Raquel René. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Travacio, Marina. Universidad de Buenos Aires; Argentina Fil: Martos, Jorge Leonardo. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Cimino, Rubén Oscar. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Walson, Judd L.. University of Washington; Estados Unidos Fil: Krolewiecki, Alejandro Javier. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Lanusse, Carlos Edmundo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; Argentina Fil: Alvarez, Luis Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; Argentina

Background/Purpose Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals. Methods LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days. Results Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort. Conclusions Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.

Background It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control. Objective To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision. Methods We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines. Results At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P Conclusion Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.

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RationaleThe rupture of the fibrous cap in atherosclerotic lesions is the underlying cause of most thrombi leading to heart attack and a frequent cause of stroke. Caps are produced by smooth muscle cells (SMCs) that are recruited to the subendothelial space. We hypothesized that the recruitment mechanisms are likely common to embryonic artery development, which relies prominently on Notch signaling to form the subendothelial layers of medial SMCs.ObjectiveTo analyze the causal roles of the Notch signaling pathway in SMCs for atherogenesis and cap formation.Methods and ResultsNotch elements involved in arterial media development were found expressed in regions of fibrous cap in mouse plaques. To assess the causal role of Notch signaling in cap formation, we studied atherosclerosis in mice in which the Notch pathway was inactivated specifically in SMCs by conditional knockout of the essential effector transcription factor RBPJ. No major effects were observed on plaque size, but the presence of cap SMCs was significantly reduced. Lineage tracing revealed that the accumulation of SMC-derived plaque cells in the cap region was unaltered but that Notch-defective cells failed to re-acquire the SMC phenotype in the cap. To analyze whether the accumulation of SMC-derived cells in atherogenesis requires down-regulation of Notch signaling, we studied atherosclerosis in mice with constitutive Notch signaling in SMCs achieved by conditional expression of the Notch intracellular domain. Forced Notch signaling inhibited the ability of medial SMCs to contribute to plaque cells, including both cap SMCs and osteochondrogenic cells, and significantly reduced atherosclerosis development.ConclusionsSequential loss and gain of Notch signaling is needed to build the cap SMC population. The shared mechanisms with embryonic arterial media assembly suggest that the fibrous cap forms as a neo-media that restores the connection between endothelium and stabilizing SMCs, which is transiently disrupted by atherogenesis.

According to the results of geomagnetic, studies primarily made by Spanish research vessel “Hesperidas”, in the region of the Drake Strait linear magnetic anomalies revealed. Modeling of linear magnetic anomalies within the frame of the lithospheric plates tectonics concept allowed to restore C3–C17 chrones. Analysis of the bottom geochronology and calculations of paleogeodynamic parameters showed that the destruction of the American-Antarctic continental bridge and the initialization of the Circum-Antarctic current in the area between South America and Antarctica occurred as a result of the bottom spreading in the Drake Strait region. At the initial stage, the bottom growth occurred in the sea of Scotia at the South-Eastern limit of the Strait in the range of chron C17r (36.969–37.753 million years ago or even earlier). On the next step during chron C11r (29.970–30.591 million years ago) began the formation of a new spreading center with simultaneous attenuation of spreading in the South-Eastern limit of the Strait, which stopped during chron C10n.2n (28.141–28.278 million years ago). The formation of a new centre for the spread of the bottom was accompanied by a heavy jump in spreading axis at the North-Western limit and the beginning of the formation of the Western Scotia paleorige. The maximum values of more than 6 cm/year growth of the bottom on the axis of the ridge reached in the range of C6–C6B (19.7–23.1 million years ago), after which the spreading began to fade and soon after the time of the C3An.1n (6.013–6.254 million years ago) occurred the death of the paleodrainage axis West Scotia ridge and the active phase of the destruction of the American-Antarctic continental bridge in the region of Drake Passage was over.

Increased diversity and representation within medicine is necessary both to stimulate innovation and more appropriately serve the population as a whole. This is especially pertinent in the United S...

Clinical medicine and population health typically operate independently in the United States but they should be more integrated. Recent calls to integrate include an Institute of Medicine report[1]...

Introduction: Brazil’s HIV burden has greatly increased over the past decade, especially for socially marginalized and vulnerable groups such as adolescents, women, and men who have sex with men. The reasoning for worsening HIV outcomes is complex, but ongoing economic and political crises have placed extreme operational and financial burdens on both the public health system and HIV-related civil society, affecting both treatment and prevention efforts and delivery. Context: Community-based HIV-related health-promotion activities have continued in Nova Iguaçu, Rio de Janeiro, despite these setbacks. These efforts have been led by a semi-independent community advisory board and engagement group based at the Hospital Geral de Nova Iguaçu with support from researchers based at the Oswaldo Cruz Foundation. Methods: The research team supported, documented, and participated in various activities led by the community advisory board and engagement group from 2017–2018 including meetings, community workshops/lectures, production of health promotion materials, and the dissemination of research findings. Results: The research team utilized the concepts of vernacular knowledge and critical pedagogy to describe and document the ongoing, bottom-up approach, community-led efforts of the community advisory board and engagement group. In particular, we describe the process of stakeholder engagement, popularization of research results, and resource sharing spearheaded by the community advisory board in Nova Iguaçu. Conclusion: The community advisory board demonstrates how community-led efforts are essential to HIV and AIDS response efforts in light of worsening HIV burdens and global shifts towards biomedicalization. Their HIV-related activities rely on existing community networks and resources with secondary support from a research team. This illustrates a key intervention point between traditional research and an empowering community mobilization that can inform similar efforts in other low-resource settings.

A constitutive model for an interface finite element is proposed to enable simulation of delamination in composite materials with R-curve effects. The constitutive model is formulated in the framework of cohesive zone modelling (CZM). In essence, a multilinear CZ law with an arbitrary number of line segments is developed. The CZ law seeks to enable constitutive modelling of failure mechanisms on multiple scales within the fracture process zone and reduce conventional a priori assumptions regarding the shape of the CZ law. The CZ law relies on damage mechanics, an equivalent one-dimensional formulation, and criteria for mode interactions to simulate delamination under mixed-mode loading. Special emphasis is put on the derivation of interpolation formulas and a constitutive tangent stiffness tensor for the multilinear formulation. The constitutive model is implemented in the commercial FE program ANSYS Mechanical, for implicit finite element analysis (FEA), using user-programmable features. The implementation is verified through single interface element numerical studies, and its applicability is demonstrated by simulating an experiment of quasi-static delamination showing large-scale fiber bridging in pure mode I DCB glass-fiber epoxy specimens. Experimental measurements and simulation outputs using the novel cohesive element is compared to those of the conventional bi- and trilinear CZ laws.

Autism is a heterogeneous disorder. The possibility of determining its characteristics over time will have a great impact on the prognosis and predictions that can be made. In that regard, the intelligence quotient and its possible stability throughout the life cycle can help to better define the phenotype of the disorder and its associated needs.Longitudinal studies show a certain level of stability in intelligence quotient scores, especially starting from the school years. Before, in the preschool stage, there is greater variability, especially in those children who have a borderline intellectual functioning or moderate intellectual disability.More research should continue to be developed to know the cognitive profile of people with autism spectrum disorder and be able to make predictions based on their intellectual functioning.Autismo y cociente intelectual: estabilidad?Introduccion. El autismo es un trastorno heterogeneo. La posibilidad de determinar sus caracteristicas a lo largo del tiempo tendra una gran repercusion en el pronostico y las predicciones que se puedan hacer. En ese sentido, el cociente intelectual y su posible estabilidad a lo largo del ciclo vital pueden ayudar a definir mejor el fenotipo del trastorno y sus necesidades asociadas. Desarrollo. Los estudios longitudinales muestran cierta estabilidad en las puntuaciones del cociente intelectual, sobre todo a partir de los años escolares. Antes, en la etapa preescolar, existe mayor variabilidad, especialmente en aquellos niños que tienen un funcionamiento intelectual limite o discapacidad intelectual moderada. Conclusion. Debe seguirse desarrollando mas investigacion para conocer el perfil cognitivo de las personas con trastorno del espectro autista y poder realizar predicciones a partir de su funcionamiento intelectual.

Over 30 years after HIV was first recognised in the USA, the epidemic continues to pose a disproportionate threat to vulnerable and marginalised populations. Increasing HIV incidence among young men who have sex with men has spurred debate around the content and approach to HIV prevention interventions directed towards this vulnerable population. A comprehensive model for conceptualising the content of sexual health education is described, which can be tailored to the unique needs and experiences of young men who have sex with men through the application of social theory. Vernacular knowledge is incorporated as a manner of nesting sexual health messages within the shared understandings of young men regarding same-sex sexual practices, gender roles and expectations, community mores and conventions and other shared knowledge of sex and sexuality. Critical pedagogy is then discussed as a way of guiding one’s pedagogical approach during intervention design and implementation that is most conducive to ...

This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: "Black men" "Black gay/bisexual" or "Black men who have sex with men," and "qualitative" and/or "ethnography." We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.

Frailty, a state of increased risk of progression towards disability, with particular vulnerability to internal or external stressors, is highly prevalent among older community-dwellers, and, together with disability, represents a burden for both older adults and the society. These reasons, in aging populations, place frailty in the public health agenda (1, 2).

Lesbian, gay, and bisexual (LGB) peoples' healthcare preferences are often developed in response to social and institutional factors that can ultimately deter them from care. Prior qualitative explorations of LGB healthcare preferences have been limited in their ability to identify and compare patterns across age cohort, gender, and race/ethnicity. The current study examines qualitative data from 186 modified Life Story Interviews with three age cohorts of LGB people from New York City, NY, San Francisco, CA, Tucson, AZ, and Austin, TX to understand the factors influencing LGB people's healthcare preferences. Data are analyzed using a directed content analysis approach. Five key themes emerged regarding influences on healthcare preferences: Stigma, provider expertise, identity, service type, and access. Findings suggest that healthcare preferences among LGB people are both complex and closely linked to social changes over time. Healthcare preferences among LGB people are both complex and closely linked to social changes over time.

To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation.Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months.During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety.The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality.

Delamination in laminated composites are efficiently modelled with the cohesive zone model (CZM). The shape of the cohesive law becomes important when simulating delamination in material systems experiencing large scale fiber bridging, as several competing damage mechanisms occurs in the fracture process zone at multiple length scales. For this purpose a multilinear cohesive law has recently been developed in [1], which readily can be adapted to a variety of shapes. However, a key challenge in applying such cohesive laws is their model calibration, i.e. identification of parameters that define the shape of the cohesive law. In this work, a new methodology for experimental characterization of multilinear cohesive laws is proposed. The methodology is an inverse approach, which identifies cohesive laws by iteratively varying cohesive zone parameters using a gradient-based optimization scheme to minimize the error in structural response between a fracture mechanical experiment and a parametric finite element model. The method is demonstrated on a moment loaded double cantilever beam (DCB) specimen made of unidirectional glass-epoxy showing large-scale fiber bridging. Multilinear cohesive laws are characterized which result in an excellent agreement between the finite element simulation and the experiment. The results and sensitivity studies demonstrate the accuracy and robustness of the proposed methodology, even for a large number of design variables in the optimization problem.

Evidence of risk of pressure ulcers in neonates pro is related to the type of bearing surface on which the neonate lays. To prevent pressure ulcers is necessary to know which of the available commercial surfaces is the most convenient. The goal of this work is to evaluate the interface and redistribution pressure of five constant low pressure devices (special surfaces for pressure management [SEMP] both static and mixed) for neonates. Next step will be the study of the properties of the new support surface with healthy subjects under clinical conditions.

El objetivo de este trabajo es el estudio de las propiedades psicométricas de la versión en español del cuestionario Interpersonal Support Evaluation List (ISEL), construido en su versión original por Cohen y Wills (1985). El ISEL evalúa la percepción de disponibilidad de cuatro aspectos diferentes del apoyo social, además de aportar una medida general de apoyo social percibido. El cuestionario se compone de cuatro subescalas (autoestima, información, pertenencia e instrumental). Cada una de ellas está formada por 10 ítems.Tras un riguroso proceso de traducción para generar la versión española del ISEL, se analizó la equivalencia de la versión traducida al español para la escala en su conjunto y para cada subescala en una muestra de universitarios españoles (N = 441). Se obtuvo un valor de alfa para la primera administración de 0.888 y de 0.87 para la segunda. La fiabilidad test-retest fue de r = 0.787. Se comprobó que la estructura factorial podría ser esencialmente unidimensional tras un análisis factorial exploratorio con rotación Varimax. Además, se analizó la validez convergente con la Escala de Soledad (r = -0.692; p < 0.001); el Cuestionario de Autoeficacia Percibida (r = 0.712; p < 0.001); el Cuestionario de Salud General (r = -0.422; p < 0.001) y la Escala de Estrés Percibido (r = -0.400; p = 0.002). Los resultados podrían mostrar que la versión española del ISEL puede ser utilizada con suficientes garantías psicométricas en una población de jóvenes universitarios de habla hispana.

The aim of the present study was focused on the determination of the effect of the diameter of the hand-rim of the racing wheelchair on the heart rate and blood lactate produced at the competition speeds. The study was carried out with a world-class athlete, that made a total of 9 series of 5 minutes, at maintained speed, recovering 10 min between series and testing 3 hand-rim (34, 36 and 38cm of diameter) at 3 different speeds (20, 22 and 24 Km/h). Heart rate and blood lactate was measured. An ANOVA was made and we found statistically significant differences (p In general terms it is possible to conclude that at 20 Km/h the most efficient hand-rim (minor HR and blood lactate) was the one of 36 cm, whereas the least efficient was the one of 34 cm. Both 22 and 24 Km/h the most efficient hand-rim was that of 34 cm whereas the least efficient was that of 38 cm. We can conclude that the election of the optimal diameter of hand-rim supposes such improvement in the mechanical efficiency that in case of the studied athlete, his maximum sustainable speed with the hand-rim of 36 cm would be about 23 Km/h whereas with the hand-rim of 34 cm would be 24 Km/h. KEY WORDS: Wheelchairs. Track and field. Mechanical efficiency.El objetivo del presente estudio se centró en determinar el efecto del diámetro del aro de propulsión de la silla de ruedas de atletismo sobre la frecuencia cardiaca y la lactacidemia que se produce a velocidades de competición. El estudio se llevó a cabo con un atleta de elite mundial, quien realizó un total de 9 series de 5 minutos, a velocidad mantenida, recuperando 10 min entre series y probando 3 aros de propulsión (34, 36 y 38cm de diámetro) a 3 velocidades distintas (20, 22 y 24 Km/h). Se registró la frecuencia cardiaca y la lactacidemia. Se realizó un ANOVA, encontrando diferencias estadísticamente significativas (p En términos generales puede concluirse que a 20 Km/h los aros más eficientes (menor FC y lactacidemia) resultaron ser los de 36 cm, mientras que los menos eficientes resultaron los de 34 cm. Sin embargo, tanto a 22 Km/h como a 24 Km/h los aros de 34 cm se convirtieron en los más eficientes y los de 38 cm en los de menor eficiencia. Puede concluirse que la elección del diámetro de aro óptimo supone una mejora en la eficiencia mecánica tal que en el caso del atleta estudiado, su velocidad máxima sostenible con los aros de 36 cm rondaría los 23 Km/h mientras que con los de 34 cm mantendría 24 Km/h. Palabras clave: Sillas de ruedas. Atletismo. Eficiencia mecánica.

RESUMEN El objetivo del presente estudio se centró en determinar el efecto del diámetro del aro de propulsión de la silla de ruedas de atletismo sobre la frecuencia cardiaca y la lactacidemia que se produce a velocidades de competición. El estudio se llevó a cabo con un atleta de elite mundial, quien realizó un total de 9 series de 5 minutos, a velocidad mantenida, recuperando 10 min entre series y probando 3 aros de propulsión (34, 36 y 38cm de diámetro) a 3 velocidades distintas (20, 22 y 24 Km/h). Se registró la frecuencia cardiaca y la lactacidemia. Se realizó un ANOVA, encontrando diferencias estadísticamente significativas (p En términos generales puede concluirse que a 20 Km/h los aros más eficientes (menor FC y lactacidemia) resultaron ser los de 36 cm, mientras que los menos eficientes resultaron los de 34 cm. Sin embargo, tanto a 22 Km/h como a 24 Km/h los aros de 34 cm se convirtieron en los más eficientes y los de 38 cm en los de menor eficiencia. Puede concluirse que la elección del diámetro de aro óptimo supone una mejora en la eficiencia mecánica tal que en el caso del atleta estudiado, su velocidad máxima sostenible con los aros de 36 cm rondaría los 23 Km/h mientras que con los de 34 cm mantendría 24 Km/h. Palabras clave: Sillas de ruedas. Atletismo. Eficiencia mecánica. ABSTRACT The aim of the present study was focused on the determination of the effect of the diameter of the hand-rim of the racing wheelchair on the heart rate and blood lactate produced at the competition speeds. The study was carried out with a world-class athlete, that made a total of 9 series of 5 minutes, at maintained speed, recovering 10 min between series and testing 3 hand-rim (34, 36 and 38cm of diameter) at 3 different speeds (20, 22 and 24 Km/h). Heart rate and blood lactate was measured. An ANOVA was made and we found statistically significant differences (p In general terms it is possible to conclude that at 20 Km/h the most efficient hand-rim (minor HR and blood lactate) was the one of 36 cm, whereas the least efficient was the one of 34 cm. Both 22 and 24 Km/h the most efficient hand-rim was that of 34 cm whereas the least efficient was that of 38 cm. We can conclude that the election of the optimal diameter of hand-rim supposes such improvement in the mechanical efficiency that in case of the studied athlete, his maximum sustainable speed with the hand-rim of 36 cm would be about 23 Km/h whereas with the hand-rim of 34 cm would be 24 Km/h. KEY WORDS: Wheelchairs. Track and field. Mechanical efficiency.

Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent

Presentamos el caso de un varon de 72 anos, estudiado por demencia tipo Alzheimer con trastornos de la conducta y agresividad. El contexto personal y social del paciente, por las caracteristicas de su enfermedad, especialmente trastornos de conducta, comportamiento agresivo, agitacion, irritabilidad, hiperactividad, desinhibicion sexual, deambulacion erratica, reacciones catastroficas, etc., hacen interesante el conocimiento de esta patologia, sus implicaciones y el abordaje terapeutico.

The effects of sex, slaughter weight and carcass weight on carcass characteristics and meat quality traits were evaluated using 100 Segurena lambs. The management of all lambs was similar prior to slaughter at 19–25 kg. Slaughtered animals with a hot carcass weight below 20 kg were assigned to class B, and those greater than 22 kg to class C. Carcass weight had a significant influence on “non-carcass” components, dressing percentage, subjective carcass conformation, fat deposits, carcass fatness, bone and most carcass measurements. Sex had a significant effect on age at slaughter, “non-carcass” components, rib measurements, dressing percentage, fat deposits, and neck and shoulder percentage. As the weight increased, the carcass measurements also increased. Concurrently, while improving the conformation indices of the carcass, leg and dressing percentages, neither the commercial cuts of the animal nor tissue composition was significantly affected. Sex primarily affected the quantity of all types of fat deposits.

Despite a large body of literature covering sexual identity development milestones, we know little about differences or similarities in patterns of identity development among subgroups of the lesbian, gay, and bisexual (LGB) population. For this study, we assessed identity milestones for 396 LGB New Yorkers, ages 18-59. Sexual identity and disclosure milestones, were measured across gender, sexual identity, race/ethnicity, and age cohort subgroups of the LGB sample. Men experienced most sexual identity milestones earlier than women, but they tended to take more time between milestones. LGBs in younger age cohorts experienced sexual identity milestones and disclosure milestones earlier than the older cohorts. Bisexual people experienced sexual identity and disclosure milestones later than gay and lesbian people. Timing of coming out milestones did not differ by race/ethnicity. By comparing differences within subpopulations, the results of this study help build understanding of the varied identity development experiences of people who are often referred to collectively as "the LGB community." LGB people face unique health and social challenges; a more complete understanding of variations among LGB people allows health professionals and social service providers to provide services that better fit the needs of LGB communities.

Coagulation tests were performed on two venous blood samples and two blood samples from arterial lines taken from 79 patients on an intensive care unit. For the first arterial sample the discard volume was 4.5 ml and for the second arterial sample the discard volume was 16 ml. From each pair of venous samples a mean venous coagulation value was calculated. There were statistically significant differences between arterial and venous results and between the two arterial samples for activated partial thromboplastin time and thrombin time assays but not for prothrombin time, reptilase time and fibrinogen assays. However, these differences were sufficiently small to be of little clinical significance. The bias for the difference in activated partial thromboplastin time values between the first arterial sample and the venous sample was +1.24 s (limits of agreement: -4.39 to +6.87 s) and between the second arterial sample and the venous sample the bias was +0.89 s (limits of agreement: -3.25 to +5.03 s). Only 3.8% of first arterial samples and 1.3% of second arterial samples produced activated partial thromboplastin time values that were more than 10% longer than the corresponding venous values. No heparin was detectable in these arterial samples using a heparin assay (< 0.02 iu.ml-1). The differences between arterial and venous activated partial thromboplastin times were slightly but not significantly greater in subgroups of patients with moderately or severely deranged coagulation compared with a group with normal coagulation. We conclude that samples from arterial lines provide valid activated partial thromboplastin time results using a discard volume of either 4.5 ml or 16 ml.

To evaluate the solubility of five root canal sealers in orange oil, eucalyptol, xylol and chloroform solvents.The solubility of RoekoSeal, Sealer 26, Epiphany, Endomethasone and EZ-Fill sealers was assessed in orange oil, eucalyptol, xylol, chloroform and distilled water. Seventy-five samples of root canal sealers were prepared and then divided into five groups for immersion in solvent for 2, 5 or 10 min. The means of loss weight were determined for each material in each solvent at all immersion periods, and the values were compared by factorial analysis of variance (anova) and SNK multiple comparisons.In the orange and eucalyptus oil groups, there was no significant difference among RoekoSeal, Sealer26, Epiphany and EZ-Fill at the three immersion periods (P0.05). With xylol, no significant differences were found at 5 and 10 min (P0.05) for each root sealer. Orange and eucalyptus oil solvents were as effective as chloroform at 2 min in dissolving all the root sealers.Xylol was the most effective solvent followed by the chloroform and the essential oils (eucalyptol and orange oil). Orange oil behaved in a similar way to eucalyptus oil.