Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design: The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion: We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration: ISRCTN: ISRCTN5871969

Degree of Microfiltration Using Self-Etch Adhesive Systems

El objetivo fue contrastar el grado de microfiltración utilizando sistemas adhesivos de autograbado. El estudio de orientación cuantitativa, experimental, prospectivo, transversal y bivariado. Material y métodos: Se recolectaron 20 órganos dentarios terceros molares, divididos en dos grupos de 10 muestras cada uno. Grupo (A) adhesivo autograbado Single Bond Universal 3M (B) adhesivo autograbado dos gotas Ámbar Universal FGM y; posteriormente obturadas con resina Vitra APS (FGM), las muestras fueron sometidos a termociclador durante 5000 ciclos de 5°c (±2) a 55°c (±2), La profundidad de la microfiltración se midió utilizando un índice de penetración con azul de metileno al 2% los resultados fueron observaron con estereoscopio. Resultados: Se realizó prueba de normalidad de Shapiro wilk (p<0,05%), por lo observado se utilizó prueba no paramétrica de U Man Whitney, determinándose que existe diferencias estadísticamente significativas (p<0,05), el grupo A, 30% (3) sin filtración, 20% (2) filtración grado 1, 40 % (4) filtración grado 2, 10% (1) filtración total; y el grupo C, 0% sin filtración, 10 % (1) filtración esmalte, 40% (4) filtración grado 2, 50% (5) filtración total. Conclusión: El grado de microfiltración obtenido con adhesivos de autograbado mostro diferencia estadísticamente relevante.The objective was to contrast the degree of microleakage using self-etching adhesive systems. The study was quantitative, experimental, prospective, cross-sectional and bivariate. Material and methods: 20 third molar dental organs were collected, divided into two groups of 10 samples each. Group (A) self-etching adhesive Single Bond Universal 3M (B) self-etching adhesive two drops Amber Universal FGM and; subsequently obturated with Vitra APS resin (FGM), the samples were subjected to thermocycler for 5000 cycles from 5°c (±2) to 55°c (±2), The depth of microleakage was measured using a penetration index with 2% methylene blue the results were observed with stereoscope. Results: Shapiro wilk normality test was performed (p<0.05%), for the observed was used non-parametric U Man Whitney test, determining that there is statistically significant differences (p<0.05), group A, 30% (3) no filtration, 20% (2) filtration grade 1, 40% (4) filtration grade 2, 10% (1) total filtration; and group C, 0% no filtration, 10 % (1) enamel filtration, 40% (4) grade 2 filtration, 50% (5) total filtration. Conclusion: The degree of microleakage obtained with self-etching adhesives showed statistically relevant differences

Marrow-Infiltrating Regulatory T Cells Correlate with the Presence of Dysfunctional CD4⁺PD-1⁺ Cells and Inferior Survival in Patients with Newly Diagnosed Multiple Myeloma

PURPOSE: Immune dysregulation is described in multiple myeloma(MM). While preclinical models suggest a role for altered T cell immunity in disease progression, the contribution of immune dysfunction to clinical outcomes remains unclear. We aimed to characterise marrow infiltrating T cells in newly diagnosed patients and explore associations with outcomes of first line therapy. EXPERIMENTAL DESIGN: We undertook detailed characterisation of T cells from bone marrow(BM) samples, focusing on immune checkpoints and features of immune dysfunction, correlating with clinical features and progression free survival. RESULTS: We found that patients with MM had greater abundance of BM regulatory T cells (Tregs) which, in turn, expressed higher levels of the activation marker CD25 compared to healthy donors. Patients with a higher frequencies of Tregs (Treghi) had shorter PFS, and a distinct Treg immune checkpoint profile (increased PD-1, LAG-3) compared to Treglopatients. Analysis of CD4 and CD8 effectors revealed that low CD4effector:Treg ratio, and increased frequency of PD-1 expressing CD4effcells were independent predictors of early relapse over and above conventional risk factors such as genetic risk and depth of response. Ex-vivo functional analysis and RNA sequencing revealed that CD4 and CD8 cells from patients with greater abundance of CD4effPD-1+ cells displayed transcriptional and secretory features of dysfunction. CONCLUSIONS: BM infiltrating T cell subsets, specifically Treg and PD-1 expressing CD4 effectors, negatively influence clinical outcomes in newly diagnosed patients. Pending confirmation in larger cohorts and further mechanistic work, these immune parameters may inform new risk models, and present potential targets for immunotherapeutic strategies

The complex interplay between antibiotic resistance and pharmaceutical and personal care products in the environment.

This is the final version. Available from Wiley via the DOI in this record. Antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are important environmental contaminants. Nonetheless, what drives the evolution, spread, and transmission of antibiotic resistance dissemination is still poorly understood. The abundance of ARB and ARGs is often elevated in human-impacted areas, especially in environments receiving fecal wastes, or in the presence of complex mixtures of chemical contaminants, such as pharmaceuticals and personal care products. Self-replication, mutation, horizontal gene transfer, and adaptation to different environmental conditions contribute to the persistence and proliferation of ARB in habitats under strong anthropogenic influence. Our review discusses the interplay between chemical contaminants and ARB and their respective genes, specifically in reference to co-occurrence, potential biostimulation, and selective pressure effects, and gives an overview of mitigation by existing man-made and natural barriers. Evidence and strategies to improve the assessment of human health risks due to environmental antibiotic resistance are also discussed.Portuguese Foundation for Science and Technology (FCT)European Union's Horizon 202Australian Research CouncilAustralian Research CouncilNatural Environment Research CouncilFCT/Ministry of Science, Technology, and Higher EducationFCT/Ministry of Science, Technology, and Higher EducationFCT/Ministry of Science, Technology, and Higher Educatio

Impact of a silver layer on the membrane of tap water filters on the microbiological quality of filtered water

<p>Abstract</p> <p>Background</p> <p>Bacteria in the hospital's drinking water system represent a risk for the acquisition of a nosocomial infection in the severely immunocompromised host. Terminal tap water filters may be used to prevent nosocomial Legionnaires' disease. We present data from water samples using an improved kind of tap water filters.</p> <p>Methods</p> <p>In a blinded study on an intermediate care unit of the thoracic surgery department, a modified type of the Germlyser water filter (Aqua-Free Membrane Technology) with a newly-introduced silver layer on the filtration membrane was compared to its preceding type without such a layer on 15 water outlets. We determined growth of <it>Legionella</it>, other pathogenic bacteria, and the total heterotrophic plate count in unfiltered water and filtered water samples after filter usage intervals of 1 through 4 weeks.</p> <p>Results</p> <p>A total of 299 water samples were tested. Twenty-nine of the 60 unfiltered water samples contained <it>Legionella </it>of various serogroups (baseline value). In contrast, all samples filtered by the original water filter and all but one of the water samples filtered by the modified filter type remained <it>Legionella</it>-free. No other pathogenic bacteria were detected in any filtered sample. The total plate count in water samples increased during use of both kinds of filters over time. However, for the first 7 days of use, there were significantly fewer water samples containing >100 CFU per mL when using the new filter device compared with the older filters or taps with no filter. No advantage was seen thereafter.</p> <p>Conclusion</p> <p>The use of this type of terminal water filter is an appropriate method to protect immunocompromised patients from water-borne pathogens such as <it>Legionella</it>.</p

Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial

Copyright @ 2011 Acera et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.A high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas.Fondo de Investigación Sanitaria del Instituto Carlos III de Madri

Actomyosin-Dependent Cortical Dynamics Contributes to the Prophase Force-Balance in the Early Drosophila Embryo

embryo mitotic spindle during prophase depends upon a balance of outward forces generated by cortical dynein and inward forces generated by kinesin-14 and nuclear elasticity. Myosin II is known to contribute to the dynamics of the cell cortex but how this influences the prophase force-balance is unclear. mutants displaying abnormally small actin caps but normal prophase spindle length in late prophase, myosin II inhibition produced very short spindles.These results suggest that two complementary outward forces are exerted on the prophase spindle by the overlying cortex. Specifically, dynein localized on the mechanically firm actin caps and the actomyosin-driven contraction of the deformable soft patches of the actin cortex, cooperate to pull astral microtubules outward. Thus, myosin II controls the size and dynamic properties of the actin-based cortex to influence the spacing of the poles of the underlying spindle during prophase

Optical Coherence Tomography and Fibrous Cap Characterization

The pathophysiology of acute coronary syndromes has long been associated with atherosclerotic plaque rupture. Inflammation, thinning, and disruption of the fibrous cap have been implicated with the final processes leading to plaque rupture, but confirmation of these mechanisms of coronary thrombosis in humans has been hampered by the lack of imaging methods with sufficient resolution to resolve fibrous cap characterization and thickness in vivo. Intravascular optical coherence tomography (OCT) provides images with micron-level axial and lateral resolution, enabling detailed visualization of micro-structural changes of the arterial wall. The present article provides an overview of the potential role of OCT in identifying and characterizing fibrous cap morphology, thickness, and inflammation in human coronary plaques

Evidence for biological roots in the transgenerational transmission of intimate partner violence

Intimate partner violence is a ubiquitous and devastating phenomenon for which effective interventions and a clear etiological understanding are still lacking. A major risk factor for violence perpetration is childhood exposure to violence, prompting the proposal that social learning is a major contributor to the transgenerational transmission of violence. Using an animal model devoid of human cultural factors, we showed that male rats became highly aggressive against their female partners as adults after exposure to non-social stressful experiences in their youth. Their offspring also showed increased aggression toward females in the absence of postnatal father–offspring interaction or any other exposure to violence. Both the females that cohabited with the stressed males and those that cohabited with their male offspring showed behavioral (including anxiety- and depression-like behaviors), physiological (decreased body weight and basal corticosterone levels) and neurobiological symptoms (increased activity in dorsal raphe serotonergic neurons in response to an unfamiliar male) resembling the alterations described in abused and depressed women. With the caution required when translating animal work to humans, our findings extend current psychosocial explanations of the transgenerational transmission of intimate partner violence by strongly suggesting an important role for biological factors