Descriptive Cost-Effectiveness Analysis of a Counseling and Coordination Model in Psychosocial Care. Integration of Health Care and Social Rehabilitation

Introduction: A psychosocial outreach clinic was established to offer counseling and coordination of healthcare and complementary services for persons with psychosocial and mental problems. The cost-effectiveness of these services was measured based on a pre-post comparison. Methods: A prospective observational study was conducted with clients of the outreach clinic. Data on resource consumption and quality of life were collected at baseline and follow-up after 3, 6, and 12 months using the Client Sociodemographic and Service Receipt Inventory to assess service utilization, and the 12-Item Short Form Health Survey to assess quality of life. The objective of the present analysis was to estimate the relation between monetary expenditure and QALYs (quality-adjusted life-years), before and after the outreach clinic was established, descriptively. The analysis was constructed from payer’s perspective and was supplemented by a sensitivity analysis. Results: A total of 85 participants were included. Total annual expenditures before the intervention were 5,832 € per client for all service segments. During the 12-months study duration expenditures decreased to 4,350 € including the costs associated with outreach clinic services. QALYs for the 12-month study period were 0.6618 and increased about 0.0568 compared to the period before. Discussion: Despite methodological limitations due to small sample size, a pre-post comparison and the retrospective cost data collection, this study suggests acceptability of the outreach clinic as cost-effective. Conclusion: The activities of the outreach clinic as an integrated care model seem to be cost-effective regarding the relation between monetary expenditures and clients’ quality of life

Floral homeotic C function genes repress specific B function genes in the carpel whorl of the basal eudicot California poppy (Eschscholzia californica)

<p>Abstract</p> <p>Background</p> <p>The floral homeotic C function gene <it>AGAMOUS </it>(<it>AG</it>) confers stamen and carpel identity and is involved in the regulation of floral meristem termination in <it>Arabidopsis</it>. <it>Arabidopsis ag </it>mutants show complete homeotic conversions of stamens into petals and carpels into sepals as well as indeterminacy of the floral meristem. Gene function analysis in model core eudicots and the monocots rice and maize suggest a conserved function for <it>AG </it>homologs in angiosperms. At the same time gene phylogenies reveal a complex history of gene duplications and repeated subfunctionalization of paralogs.</p> <p>Results</p> <p><it>EScaAG1 </it>and <it>EScaAG2</it>, duplicate <it>AG </it>homologs in the basal eudicot <it>Eschscholzia californica </it>show a high degree of similarity in sequence and expression, although <it>EScaAG2 </it>expression is lower than <it>EScaAG1 </it>expression. Functional studies employing virus-induced gene silencing (VIGS) demonstrate that knock down of <it>EScaAG1 </it>and <it>2 </it>function leads to homeotic conversion of stamens into petaloid structures and defects in floral meristem termination. However, carpels are transformed into petaloid organs rather than sepaloid structures. We also show that a reduction of <it>EScaAG1 </it>and <it>EScaAG2 </it>expression leads to significantly increased expression of a subset of floral homeotic B genes.</p> <p>Conclusions</p> <p>This work presents expression and functional analysis of the two basal eudicot <it>AG </it>homologs. The reduction of <it>EScaAG1 </it>and <it>2 </it>functions results in the change of stamen to petal identity and a transformation of the central whorl organ identity from carpel into petal identity. Petal identity requires the presence of the floral homeotic B function and our results show that the expression of a subset of B function genes extends into the central whorl when the C function is reduced. We propose a model for the evolution of B function regulation by C function suggesting that the mode of B function gene regulation found in <it>Eschscholzia </it>is ancestral and the C-independent regulation as found in <it>Arabidopsis </it>is evolutionarily derived.</p

Floral homeotic C function genes repress specific B function genes in the carpel whorl of the basal eudicot California poppy (Eschscholzia californica)

<p>Abstract</p> <p>Background</p> <p>The floral homeotic C function gene <it>AGAMOUS </it>(<it>AG</it>) confers stamen and carpel identity and is involved in the regulation of floral meristem termination in <it>Arabidopsis</it>. <it>Arabidopsis ag </it>mutants show complete homeotic conversions of stamens into petals and carpels into sepals as well as indeterminacy of the floral meristem. Gene function analysis in model core eudicots and the monocots rice and maize suggest a conserved function for <it>AG </it>homologs in angiosperms. At the same time gene phylogenies reveal a complex history of gene duplications and repeated subfunctionalization of paralogs.</p> <p>Results</p> <p><it>EScaAG1 </it>and <it>EScaAG2</it>, duplicate <it>AG </it>homologs in the basal eudicot <it>Eschscholzia californica </it>show a high degree of similarity in sequence and expression, although <it>EScaAG2 </it>expression is lower than <it>EScaAG1 </it>expression. Functional studies employing virus-induced gene silencing (VIGS) demonstrate that knock down of <it>EScaAG1 </it>and <it>2 </it>function leads to homeotic conversion of stamens into petaloid structures and defects in floral meristem termination. However, carpels are transformed into petaloid organs rather than sepaloid structures. We also show that a reduction of <it>EScaAG1 </it>and <it>EScaAG2 </it>expression leads to significantly increased expression of a subset of floral homeotic B genes.</p> <p>Conclusions</p> <p>This work presents expression and functional analysis of the two basal eudicot <it>AG </it>homologs. The reduction of <it>EScaAG1 </it>and <it>2 </it>functions results in the change of stamen to petal identity and a transformation of the central whorl organ identity from carpel into petal identity. Petal identity requires the presence of the floral homeotic B function and our results show that the expression of a subset of B function genes extends into the central whorl when the C function is reduced. We propose a model for the evolution of B function regulation by C function suggesting that the mode of B function gene regulation found in <it>Eschscholzia </it>is ancestral and the C-independent regulation as found in <it>Arabidopsis </it>is evolutionarily derived.</p

Feasibility of combined upper and lower gastrointestinal endoscopic biopsy in the common marmoset (Callithrix jacchus) to evaluate gastrointestinal diseases

Background: Chronic gastroenteropathies, including gluten sensitivity and marmoset wasting syndrome, frequently occur in captive colonies of common marmosets (Callithrix jacchus). Early identification and diagnosis of affected animals are desirable. Endoscopic examination of the colon in marmosets is described, but the small intestine can harbor significant mucosal lesions not representing those in the colon. Evaluating the small intestine currently requires invasive surgical biopsies due to the small patient size, carrying a risk of severe complications. Methods: Endoscopic intubation and multisite biopsy of the duodenum/proximal jejunum are demonstrated in 10 marmosets under general anesthesia. Results: Esophagogastroduodenoscopy with colonoscopy efficiently aid in examining the gastrointestinal tract and obtaining an antemortem histologic diagnosis in marmosets with chronic gastrointestinal signs. Conclusions: This minimally invasive technique is feasible in marmosets. Future investigations into the pathogenesis of chronic gastroenteropathies will benefit from these data, leading to improved animal welfare and better individual and colony health management

Nursing care management to men with cancer

Objective: Discussing the interactions between gender perspective and integrality in the management of nursing care to men with cancer. Method: A qualitative study guided by Grounded Theory. The scenario was a Federal Hospital in the city of Rio de Janeiro - Brazil, and the subjects all 6 nurses from the oncology service, which granted semi-structured interviews. Results: Five categories emerged generating the phenomenon: Redefining the management of nursing care by a gender perspective, in order to ensure comprehensiveness to the man with cancer. In the interaction with men with cancer in anticancer treatment, nurses hear the influence of masculinity in their lives and detect the need for inclusion of a gender perspective in their professional practice. Conclusion: Ensuring complete care to man launches challenge to put in place of it, recognizing their unique needs and so reframe the management of nursing care

CUIDADO DE ENFERMAGEM E EDUCAÇÃO EM SAÚDE COM PROFISSIONAIS DO SURF

Sustentadas no referencial da Teoria das Necessidades Humanas Básicas de Horta, relata-se a vivência do trabalho deconclusão de curso de acadêmicas de Enfermagem no centro Desportivo e Cultural Araguá em Florianópolis/SC, num novo campo deatuação para os enfermeiros – a Enfermagem na atividade física e no esporte. Realizou-se o cuidado de Enfermagem e a educação emsaúde aos atletas do surf, e às crianças da comunidade que participam das atividades que o Araguá oferece. Constatou-se, nesta práticaassistencial, que a Enfermagem tem um papel indispensável no cuidado ao cliente, ao compor a equipe interdisciplinar dos profissionaisque atuam nas atividades desportivas, e possibilita a ampliação de espaço com novas competências que seguramente contribui para oreconhecimento da Enfermagem como profissão.Basado en la Teoría de las Necesidades Humanas Básicas de Horta, el presente artículo relata las vivencias del trabajo deconclusión de curso de estudiantes de enfermería en el Centro Desportivo y Cultural Araguá em Florianópolis/SC en un nuevo campopara los enfermeros: la enfermería en la actividad física y en el deporte. En la práctica asistencial fue realizada la atención de enfermeriay la educación en salud a los atletas del surf y a los niños de la comunidad que participan de lss actividades que el local ofrece. En estapráctica, se ha constatado que la enfermería tiene un papel indispensable en el cuidado al paciente, al componer el equipo intersdisciplinariode los profesionales que trabajan en las actividades deportivas, posibilitando la ampliación del espacio con nuevas habilidades queseguramente contribuyen para el reconocimiento de la enfermería como profesión.Based upon Hortas´s Basic Human Needs Theory, this study reports the graduation assignment performed by twonursing students at the Araguá Cultural and Athletic Center in Florianópolis, Santa Catarina, Brazil. This study examines a relativelynew field of study for nurses – nursing in physical activity and sports. Nursing care and health education were provided to surf athletes,while the children of the local community participate in the activities offered at the Araguá Center. This practice showed that nursinghas its indispensable place in client caring, taking part in the interdisciplinary team of sport professionals thus enabling the area toexpand with new competencies that surely contribute for the recognition of the Nursing profession

Nursing care management to men with cancer

Objetivo: Discutir as interações entre perspectiva de gênero e integralidade na gerência do cuidado de enfermagem a homens com câncer. Método: Estudo qualitativo, orientado pela Teoria Fundamentada nos Dados. O cenário foi um Hospital Federal do Município do Rio de Janeiro - Brasil e os sujeitos, todos os 6 enfermeiros do serviço de oncologia, que concederam entrevistas semi-estruturadas. Resultados: Cinco categorias emergiram gerando o fenômeno: Ressignificando a gerência do cuidado de enfermagem mediante a perspectiva de gênero a fim de assegurar a integralidade ao homem com câncer. Na interação com os homens com câncer em tratamento antineoplásico, enfermeiros ouvem a influência da masculinidade em suas vidas e detectam a necessidade de inclusão da perspectiva de gênero em sua prática profissional. Conclusão: Assegurar a integralidade do cuidado ao homem lança o desafio de se colocar no lugar do mesmo, reconhecer suas necessidades singulares e assim ressignificar a gerência do cuidado de enfermagem.  Descritores: Saúde do Homem; Enfermagem; Assistência Integral à Saúde; Oncologia; Gerência

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta