Security Requirements for a Lifelong Electronic Health Record System: An Opinion

This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein

Plastia sustitutiva del LCA con tendones de la pata de ganso cuadruples

Se han estudiado retrospectivamente 44 casos de pacientes a los que se les realizó por vía artrocóspica una plastia sustitutiva intraticular de reconstrucción del LCA, con tendones de Semitendinoso y Recto Interno antólogos, en 4 fascículos. La edad media de los pacientes fue de 25 años. Los resultados a corto plazo (2 años) obtenidos con KT-1000 a 30 Ib han sido excelente-bueno en 40 casos y aceptable en 4 casos. Cuatro casos referían sensación de inestabilidad. Los test de Lachman y Pívot-Shift fueron positivos en 3 casos. Con el test de Lysholm se obtuvo resultado excelente-bueno en 36 casos, regular en 6 y malo en 2 casos. Este tipo de plastia presenta una baja morbilidad de la zona dadora del injerto, comparativamente con la plastia HTH patelar antóloga, y sin alteración del aparato extensor.A retrospective study of 44 patients, who underwent an arthroscopically assisted ACL (anterior cruciata ligament) reconstruction with quadrupled semitendinosus/gracilis tendon autografts was performed. The mean age was 25 years. Short term outcomes of knee stability (2 years follow-up) with KT-1000 arthrometer at 30 pounds were excellent or good in 40 cases and acceptable in 4. Pain or joint swelling were not found. Instability complaints were found in 4 cases. Lachman and Pivot-shift were found positive in 3 cases. Lysholm questionnaire scores were excellent or good in 36 cases, fair in 6 cases and per in two cases, the donor site morbidity associated with hamstring harvest seems to be minimal compared with bonepatellar tendon-bone autograft without impairment of the extensor mechanism

Total and high molecular weight adiponectin have similar utility for the identification of insulin resistance

<p>Abstract</p> <p>Background</p> <p>Insulin resistance (IR) and related metabolic disturbances are characterized by low levels of adiponectin. High molecular weight adiponectin (HMWA) is considered the active form of adiponectin and a better marker of IR than total adiponectin. The objective of this study is to compare the utility of total adiponectin, HMWA and the HMWA/total adiponectin index (S_Aindex) for the identification of IR and related metabolic conditions.</p> <p>Methods</p> <p>A cross-sectional analysis was performed in a group of ambulatory subjects, aged 20 to 70 years, in Mexico City. Areas under the receiver operator characteristic (ROC) curve for total, HMWA and the S_Aindex were plotted for the identification of metabolic disturbances. Sensitivity and specificity, positive and negative predictive values, and accuracy for the identification of IR were calculated.</p> <p>Results</p> <p>The study included 101 men and 168 women. The areas under the ROC curve for total and HMWA for the identification of IR (0.664 <it>vs</it>. 0.669, <it>P </it>= 0.74), obesity (0.592 <it>vs</it>. 0.610, <it>P </it>= 0.32), hypertriglyceridemia (0.661 <it>vs</it>. 0.671, <it>P </it>= 0.50) and hypoalphalipoproteinemia (0.624 <it>vs</it>. 0.633, <it>P </it>= 0.58) were similar. A total adiponectin level of 8.03 μg/ml was associated with a sensitivity of 57.6%, a specificity of 65.9%, a positive predictive value of 50.0%, a negative predictive value of 72.4%, and an accuracy of 62.7% for the diagnosis of IR. The corresponding figures for a HMWA value of 4.25 μg/dl were 59.6%, 67.1%, 51.8%, 73.7% and 64.2%.</p> <p>The area under the ROC curve of the S_Aindex for the identification of IR was 0.622 [95% CI 0.554-0.691], obesity 0.613 [95% CI 0.536-0.689], hypertriglyceridemia 0.616 [95% CI 0.549-0.683], and hypoalphalipoproteinemia 0.606 [95% CI 0.535-0.677].</p> <p>Conclusions</p> <p>Total adiponectin, HMWA and the S_Aindex had similar utility for the identification of IR and metabolic disturbances.</p

Acculturation, Body Mass Index, Waist Circumference, and Physical Activity in Mexican Origin Women

Purpose: Longer time in the United States (US) is associated with increased risk of obesity in Hispanic immigrants, particularly for women. Although previous research has established an association between nutrition and acculturation, little attention has focused on physical activity. In this study, we examine the associations between acculturation on Mexican origin women’s body mass index (BMI), waist circumference (WC), and report of moderate to vigorous physical activity (MVPA). Method: Mexican origin women ≥18 years (n=120) from South Carolina (n=60) and Texas Lower Rio Grande Valley (n=60) completed a survey and anthropometric measures. Participants reported MVPA in hours per week, country of birth, age at migration (\u3c16\u3eyears, 16-25 years, and ≥26 years), and language use. Using these latter two as indicators of acculturation, we evaluated associations between acculturation and BMI, WC, and MVPA. Results: Age standardized means for BMI indicated lowest BMI and waist circumference measures among women either with middle-range English language proficiency or who had immigrated to the US between the ages of 16-25; however, the relationship with BMI was more robust. Age standardized means for MVPA show that women who migrated at younger ages (\u3c16\u3eyears) had the lowest MVPA levels, followed by those migrating as younger adults (16-25 years), then adults (≥26 years). Similarly, women with lowest English proficiency levels had the lowest reported MVPA and those with highest English proficiency had highest reported MVPA. Conclusions: The relationship between acculturation and obesity and MVPA is multifaceted. While the relationship between MVPA and the two indicators of acculturation appear to be linear, the direction of association varied by acculturation indicator. Moreover, the association with acculturation indicators and measures of obesity was not linear. The findings from this study have implications in how researchers interpret the relationship between acculturation, obesity and obesity risk factors

Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinelnodes after neoadjuvant therapy (ADARNAT trial)

Introduction: Breast cancer surgery currently focuses on de-escalating treatment without compromising patient survival. Axillary radiotherapy (ART) now replaces axillary lymph node dissection (ALND) in patients with limited sentinel lymph node (SLN) involvement during the primary surgery, and this has significantly reduced the incidence of lymphedema without worsening the prognosis. However, patients treated with neoadjuvant systemic treatment (NST) cannot benefit from this option despite the low incidence of residual disease in the armpit in most cases. Data regarding the use of radiotherapy instead of ALND in this population are lacking. This study will assess whether ART is non-inferior to ALND in terms of recurrence and overall survival in patients with positive SLN after NST, including whether it reduces surgery-related adverse effects. Methods and analyses: This multicenter, randomized, open-label, phase 3 trial will enroll 1660 patients with breast cancer and positive SLNs following NST in approximately 50 Spanish centers over 3 years. Patients will be stratified by NST regimen and nodal involvement (isolated tumoral cells or micrometastasis versus macrometastasis) and randomly assigned 1:1 to ART without ALND (study arm) or ALND alone (control arm). Level 3 and supraclavicular radiotherapy will be added in both arms. The primary outcome is the 5-year axillary recurrence determined by clinical and radiological examination. The secondary outcomes include lymphedema or arm dysfunction, quality of life based (EORTC QLQ-C30 and QLQ-BR23 questionnaires), disease-free survival, and overall survival. Discussion: This study aims to provide data to confirm the efficacy and safety of ART over ALND in patients with a positive SLN after NST, together with the impact on morbidity. Ethics and dissemination: The Research Ethics Committee of Bellvitge University Hospital approved this trial (Protocol Record PR148/21, version 3, 1/2/2022) and all patients must provide written informed consent. The involvement of around 50 centers across Spain will facilitate the dissemination of our results

Concentration Endurance Test (d2): Normative data for Spanish-speaking pediatric population

OBJECTIVE: To generate normative data for the Concentration Endurance Test (d2) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the d2 test as part of a larger neuropsychological battery. The Total number of items processed (TN), Total number of correct responses (CR), Total performance (TP), and Concentration performance (CP) scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. TN scores were affected by age2 for Guatemala and Puerto Rico; CR scores were affected by age2 for Mexico; TP scores were affected by age2 for Chile, Mexico, Puerto Rico, and Spain; and CP scores for Mexico and Spain. Models indicated that children whose parents had a MLPE >12 years obtained higher scores compared to children whose parents had a MLPE≤12 years for Mexico and Spain in all scores, and Puerto Rico for TN, CR, and TP, and Guatemala and Paraguay for CP scores. Sex affect the scores for Ecuador and Honduras (CP scores). CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the d2 test in pediatric populations

Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinel nodes after neoadjuvant therapy (ADARNAT trial)

IntroductionBreast cancer surgery currently focuses on de-escalating treatment without compromising patient survival. Axillary radiotherapy (ART) now replaces axillary lymph node dissection (ALND) in patients with limited sentinel lymph node (SLN) involvement during the primary surgery, and this has significantly reduced the incidence of lymphedema without worsening the prognosis. However, patients treated with neoadjuvant systemic treatment (NST) cannot benefit from this option despite the low incidence of residual disease in the armpit in most cases. Data regarding the use of radiotherapy instead of ALND in this population are lacking. This study will assess whether ART is non-inferior to ALND in terms of recurrence and overall survival in patients with positive SLN after NST, including whether it reduces surgery-related adverse effects.Methods and analysesThis multicenter, randomized, open-label, phase 3 trial will enroll 1660 patients with breast cancer and positive SLNs following NST in approximately 50 Spanish centers over 3 years. Patients will be stratified by NST regimen and nodal involvement (isolated tumoral cells or micrometastasis versus macrometastasis) and randomly assigned 1:1 to ART without ALND (study arm) or ALND alone (control arm). Level 3 and supraclavicular radiotherapy will be added in both arms. The primary outcome is the 5-year axillary recurrence determined by clinical and radiological examination. The secondary outcomes include lymphedema or arm dysfunction, quality of life based (EORTC QLQ-C30 and QLQ-BR23 questionnaires), disease-free survival, and overall survival.DiscussionThis study aims to provide data to confirm the efficacy and safety of ART over ALND in patients with a positive SLN after NST, together with the impact on morbidity.Ethics and disseminationThe Research Ethics Committee of Bellvitge University Hospital approved this trial (Protocol Record PR148/21, version 3, 1/2/2022) and all patients must provide written informed consent. The involvement of around 50 centers across Spain will facilitate the dissemination of our results.Trial registrationClinicalTrials.gov, identifier number NCT04889924

Understanding 'non-genetic' inheritance : insights from molecular-evolutionary crosstalk

The idea for this paper was initially proposed by I.A.-K. and was further developed by all authors in a workshop generously funded by grant No 789240 from the European Research Council (ERC) to F.J.W. S.E.S. acknowledges support from Wesleyan University and The John Templeton Foundation.Understanding the evolutionary and ecological roles of 'non-genetic' inheritance (NGI) is daunting due to the complexity and diversity of epigenetic mechanisms. We draw on insights from molecular and evolutionary biology perspectives to identify three general features of 'non-genetic' inheritance systems: (i) they are functionally interdependent with, rather than separate from, DNA sequence; (ii) precise mechanisms vary phylogenetically and operationally; and (iii) epigenetic elements are probabilistic, interactive regulatory factors and not deterministic 'epialleles' with defined genomic locations and effects. We discuss each of these features and offer recommendations for future empirical and theoretical research that implements a unifying inherited gene regulation (IGR) approach to studies of 'non-genetic' inheritance.Publisher PDFPeer reviewe