The Role of Perceived Barriers to Maternal Communication in Risky Sexual Behavior Among Mexican Adolescents

This study examined gender differences in perceived barriers to communication about sex between mothers and adolescents (ages 12 to 19) in Mexico. We also explored associations between 3 risky sexual behaviors (contraception use, age of first coitus, and sexual experience) and these barriers separate by gender. A total of 1,436 participants (47% female) completed surveys measuring risky sexual behaviors and 3 barriers to communication (lack of confidence or knowledge about sex, talk perceived as encouraging sex, and talk perceived as unnecessary). Findings revealed that boys were likely to perceive more barriers to communication than were girls. Talk perceived as encouraging sex was associated with vaginal sex among all adolescents. Female adolescents who perceived their mother as having less knowledge and confidence about sex were also more likely to have had sexual intercourse and less likely to have used contraception. Boys who perceived talk as unnecessary were more likely to have had sexual intercourse. These findings amplify our understanding of both barriers to communication about sex and risky sexual behaviors among adolescents in Mexico

Use of pooled serum samples to assess herd disease status using commercially available ELISAs

Pooled samples are used in veterinary and human medicine as a cost-effective approach to monitor disease prevalence. Nonetheless, there is limited information on the effect of pooling on test performance, and research is required to determine the appropriate number of samples which can be pooled. Therefore, this study aimed to evaluate the use of pooled serum samples as a herd-level surveillance tool for infectious production-limiting diseases: bovine viral diarrhoea (BVD), infectious bovine rhinotracheitis (IBR), enzootic bovine leukosis (EBL) and Neospora caninum (NC), by investigating the maximum number of samples one can pool to identify one positive animal, using commercial antibody-detection ELISAs. Four positive field standards (PFS), one for each disease, were prepared by pooling highly positive herd-level samples diagnosed using commercially available ELISA tests. These PFS were used to simulate 18 pooled samples ranging from undiluted PFS to a dilution representing 1 positive in 1,000 animals using phosphate-buffered saline as diluent. A 1:10 dilution of the PFS resulted in positive results for IBR, BVD and EBL. Moreover, for IBR and BVD, results were still positive at 1:100 and 1:30 dilutions, respectively. However, for NC, a lower dilution (8:10) was required for a seropositive result. This study indicates that, at herd-level, the use of pooled serum is a useful strategy for monitoring infectious diseases (BVD, IBR and EBL) but not NC, using readily available diagnostic assays

High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation

9 p.BACKGROUND When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear. METHODS In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital. RESULTS The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups. CONCLUSIONS Basing the decision to decannulate on suctioning frequency plus continuous highflow oxygen therapy rather than on 24-hour capping trials plus intermittent highflow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.

Grade V small bowel injury after blunt abdominal trauma: a case report

Injury of the small intestine or mesentery that requires surgical intervention is relatively uncommon, presenting less than 1% of all trauma. Unstable hemodynamically patients with peritoneal irritation signs and stable hemodynamically patients with radiological signs of intestine or mesentery lesions need an exploratory laparotomy. A 33-year-old male patient, suffered a car accident in which he had a frontal impact collision and was between two structures for 30 minutes, and rescued by the fire department. Physical examination of the abdomen presents generalized pain on palpation of moderate intensity and rebound sign. An exploratory laparotomy was performed, the findings were: hemoperitoneum of 1500 ml was found, lesion in the bucket loop of 1.2 meters, 1.8 meters from the Treitz angle and 70 cm from the ileocecal valve. We managed with drainage, vascular control, resection of the devascularized intestinal loop and small bowel shotgun stoma were. The patient was transferred to the intensive care unit for hemodynamic management and a second look was performed 5 days after surgery where cavity lavage, stoma dismantling and end-to-end anastomosis of the small intestine in two planes were performed. On post-operative day 7 drains were removed, and the patient was discharged from the surgical service due to improvement, without complications. We recommend a multidisciplinary approach to patients with polytrauma, since they lead to a better and faster recovery, in the same way it allows us to detect and treat any abnormality that impacts the quality of life of patients early

Composite Higgs Sketch

The coupling of a composite Higgs to the standard model fields can deviate substantially from the standard model values. In this case perturbative unitarity might break down before the scale of compositeness is reached, which would suggest that additional composites should lie well below this scale. In this paper we account for the presence of an additional spin 1 custodial triplet of rhos. We examine the implications of requiring perturbative unitarity up to the compositeness scale and find that one has to be close to saturating certain unitarity sum rules involving the Higgs and the rho couplings. Given these restrictions on the parameter space we investigate the main phenomenological consequences of the spin 1 triplet. We find that they can substantially enhance the Higgs di-photon rate at the LHC even with a reduced Higgs coupling to gauge bosons. The main existing LHC bounds arise from di-boson searches, especially in the experimentally clean channel where the charged rhos decay to a W-boson and a Z, which then decay leptonically. We find that a large range of interesting parameter space with 700 GeV < m(rho) < 2 TeV is currently experimentally viable.Comment: 37 pages, 12 figures; v4: sum rule corrected, conclusions unchange

Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

Objective. To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting in.ammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard. Methods. Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI. Results. The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant. Conclusion. Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US. © 2010, American College of Rheumatology

Cytotoxic CD8⁺ T lymphocytes expressing ALS-causing SOD1 mutant selectively trigger death of spinal motoneurons.

Adaptive immune response is part of the dynamic changes that accompany motoneuron loss in amyotrophic lateral sclerosis (ALS). CD4 &lt;sup&gt;+&lt;/sup&gt; T cells that regulate a protective immunity during the neurodegenerative process have received the most attention. CD8 &lt;sup&gt;+&lt;/sup&gt; T cells are also observed in the spinal cord of patients and ALS mice although their contribution to the disease still remains elusive. Here, we found that activated CD8 &lt;sup&gt;+&lt;/sup&gt; T lymphocytes infiltrate the central nervous system (CNS) of a mouse model of ALS at the symptomatic stage. Selective ablation of CD8 &lt;sup&gt;+&lt;/sup&gt; T cells in mice expressing the ALS-associated superoxide dismutase-1 (SOD1) &lt;sup&gt;G93A&lt;/sup&gt; mutant decreased spinal motoneuron loss. Using motoneuron-CD8 &lt;sup&gt;+&lt;/sup&gt; T cell coculture systems, we found that mutant SOD1-expressing CD8 &lt;sup&gt;+&lt;/sup&gt; T lymphocytes selectively kill motoneurons. This cytotoxicity activity requires the recognition of the peptide-MHC-I complex (where MHC-I represents major histocompatibility complex class I). Measurement of interaction strength by atomic force microscopy-based single-cell force spectroscopy demonstrated a specific MHC-I-dependent interaction between motoneuron and SOD1 &lt;sup&gt; G93A &lt;/sup&gt; CD8 &lt;sup&gt;+&lt;/sup&gt; T cells. Activated mutant SOD1 CD8 &lt;sup&gt;+&lt;/sup&gt; T cells produce interferon-γ, which elicits the expression of the MHC-I complex in motoneurons and exerts their cytotoxic function through Fas and granzyme pathways. In addition, analysis of the clonal diversity of CD8 &lt;sup&gt;+&lt;/sup&gt; T cells in the periphery and CNS of ALS mice identified an antigen-restricted repertoire of their T cell receptor in the CNS. Our results suggest that self-directed immune response takes place during the course of the disease, contributing to the selective elimination of a subset of motoneurons in ALS