Probability of Trypanosoma cruzi transmission by Triatoma infestans (Hemiptera: Reduviidae) to the opossum Didelphis albiventris (Marsupialia: Didelphidae)

The probability of Trypanosoma cruzi transmission to opossums by independent events of predation and fecal contamination during feeding ("biting") with positive Triatoma infestans was estimated. Negative female opossums were challenged for 23 hr with 10 infected third and fourth instars of T. infestans, and tests for positivity for T. cruzi by xenodiagnosis were performed at 30, 60, and 90 days. From these data, seven probability parameters were estimated by maximum likelihood, and likelihood ratio statistics confidence intervals were calculated. Simultaneous estimation of p1 (probability that a "bite" will infect an opossum), p3 (probability that a bug that has been eaten by an opossum will infect it), and p6 (probability that the opossum will become infected if faced with an infected triatomine), resulted in p̂1 = 0.06, p̂3 = 0.075, and p̂6 = 0.059. On average, each opossum should be exposed to an average of 700 encounters with bugs during its life, resulting in about eight potentially infective contacts, to produce the 35% opossum prevalence found in the field.Facultad de Ciencias Naturales y Muse

Probability of Trypanosoma cruzi transmission by Triatoma infestans (Hemiptera: Reduviidae) to the opossum Didelphis albiventris (Marsupialia: Didelphidae)

The probability of Trypanosoma cruzi transmission to opossums by independent events of predation and fecal contamination during feeding ("biting") with positive Triatoma infestans was estimated. Negative female opossums were challenged for 23 hr with 10 infected third and fourth instars of T. infestans, and tests for positivity for T. cruzi by xenodiagnosis were performed at 30, 60, and 90 days. From these data, seven probability parameters were estimated by maximum likelihood, and likelihood ratio statistics confidence intervals were calculated. Simultaneous estimation of p1 (probability that a "bite" will infect an opossum), p3 (probability that a bug that has been eaten by an opossum will infect it), and p6 (probability that the opossum will become infected if faced with an infected triatomine), resulted in p̂1 = 0.06, p̂3 = 0.075, and p̂6 = 0.059. On average, each opossum should be exposed to an average of 700 encounters with bugs during its life, resulting in about eight potentially infective contacts, to produce the 35% opossum prevalence found in the field.Facultad de Ciencias Naturales y Muse

Barriers to adherence to COPD guidelines among primary care providers

Background: Despite efforts to disseminate guidelines for managing chronic obstructive pulmonary disease (COPD), adherence to COPD guidelines remains suboptimal. Barriers to adhering to guidelines remain poorly understood. Methods: Clinicians from two general medicine practices in New York City were surveyed to identify barriers to implementing seven recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Barriers assessed included unfamiliarity, disagreement, low perceived benefit, low self-efficacy, and time constraints. Exact conditional regression was used to identify barriers independently associated with non-adherence. Results: The survey was completed by 154 clinicians. Adherence was lowest to referring patients with a forced expiratory volume in 1 s (FEV_1) <80% predicted to pulmonary rehabilitation (5%); using FEV_1 to guide management (12%); and ordering pulmonary function tests (PFTs) in smokers (17%). Adherence was intermediate to prescribing inhaled corticosteroids when FEV1 <50% predicted (41%) and long-acting bronchodilators when FEV1 <80% predicted (54%). Adherence was highest for influenza vaccination (90%) and smoking cessation counseling (91%). In unadjusted analyses, low familiarity with the guidelines, low self-efficacy, and time constraints were significantly associated with non-adherence to ≥2 recommendations. In adjusted analyses, low self-efficacy was associated with less adherence to prescribing inhaled corticosteroids (OR: 0.28; 95% CI: 0.10, 0.74) and time constraints were associated with less adherence to ordering PFTs in smokers (OR: 0.31; 95% CI: 0.08, 0.99). Conclusions: Poor familiarity with recommendations, low self-efficacy, and time constraints are important barriers to adherence to COPD guidelines. This information can be used to develop tailored interventions to improve guideline adherence

Multiple-exciton generation in lead selenide nanorod solar cells with external quantum efficiencies exceeding 120.

Multiple-exciton generation-a process in which multiple charge-carrier pairs are generated from a single optical excitation-is a promising way to improve the photocurrent in photovoltaic devices and offers the potential to break the Shockley-Queisser limit. One-dimensional nanostructures, for example nanorods, have been shown spectroscopically to display increased multiple exciton generation efficiencies compared with their zero-dimensional analogues. Here we present solar cells fabricated from PbSe nanorods of three different bandgaps. All three devices showed external quantum efficiencies exceeding 100% and we report a maximum external quantum efficiency of 122% for cells consisting of the smallest bandgap nanorods. We estimate internal quantum efficiencies to exceed 150% at relatively low energies compared with other multiple exciton generation systems, and this demonstrates the potential for substantial improvements in device performance due to multiple exciton generation.NJLKD thanks the Cambridge Commonwealth European and International Trust, Cambridge Australian Scholarships and Mr Charles K Allen for financial support. MLB thanks the German National Academic Foundation (“Studienstiftung”) for financial support. MT thanks the Gates Cambridge Trust, EPSRC and Winton Programme for Sustainability for financial support. F.W.R.R. gratefully thanks financial support from CNPq [Grant number 246050/2012-8]. C.D. acknowledges financial support from the EU [Grant number 312483 ESTEEM2]. This work was supported by the EPSRC [Grant numbers EP/M005143/1, EP/G060738/1, EP/G037221/1] and the ERC [Grant number 259619 PHOTO-EM].This is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/ncomms925

Probability of Trypanosoma cruzi transmission by Triatoma infestans (Hemiptera: Reduviidae) to the opossum Didelphis albiventris (Marsupialia: Didelphidae)

The probability of Trypanosoma cruzi transmission to opossums by independent events of predation and fecal contamination during feeding ("biting") with positive Triatoma infestans was estimated. Negative female opossums were challenged for 23 hr with 10 infected third and fourth instars of T. infestans, and tests for positivity for T. cruzi by xenodiagnosis were performed at 30, 60, and 90 days. From these data, seven probability parameters were estimated by maximum likelihood, and likelihood ratio statistics confidence intervals were calculated. Simultaneous estimation of p1 (probability that a "bite" will infect an opossum), p3 (probability that a bug that has been eaten by an opossum will infect it), and p6 (probability that the opossum will become infected if faced with an infected triatomine), resulted in p̂1 = 0.06, p̂3 = 0.075, and p̂6 = 0.059. On average, each opossum should be exposed to an average of 700 encounters with bugs during its life, resulting in about eight potentially infective contacts, to produce the 35% opossum prevalence found in the field.Facultad de Ciencias Naturales y Muse

The Sagnac Effect in curved space-times from an analogy with the Aharonov-Bohm Effect

In the context of the natural splitting, the standard relative dynamics can be expressed in terms of gravito-electromagnetic fields, which allow to formally introduce a gravito-magnetic Aharonov-Bohm effect. We showed elsewhere that this formal analogy can be used to derive the Sagnac effect in flat space-time as a gravito-magnetic Aharonov-Bohm effect. Here, we generalize those results to study the General Relativistic corrections to the Sagnac effect in some stationary and axially symmetric geometries, such as the space-time around a weakly gravitating and rotating source, Kerr space-time, G\"{odel} universe and Schwarzschild space-time.Comment: 14 pages, 1 EPS figure, LaTeX, accepted for publication in General Relativity and Gravitatio

Prognostic Significance of Lymph Node Metastases in Small Intestinal Neuroendocrine Tumors

Background/Aims: Current staging guidelines for small intestinal neuroendocrine tumors (SI-NETs) differentiate between the presence (N1) and absence (N0) of lymph node (LN) metastases. However, the prognostic significance of the extent of LN involvement remains unknown. In this study, we used data from a population-based cancer registry to examine whether involvement of a higher number of LNs is associated with worse survival. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with histologically confirmed, surgically resected SI-NETS diagnosed between 1988 and 2010. Patients were classified into three groups by the LN ratio (number of positive LNs/number of total LNs examined, LNR):0.2-0.5, and \u3e0.5. We used the Kaplan-Meier method and Cox models to assess NET cancer-specific survival differences (up to 10 years from diagnosis) according to LNR status. Results: We identified 2,984 surgically resected patients with stage IIIb (N1, M0) SI-NETs with detailed LN data. More than half of the NETs were located in the ileum. A higher LNR was significantly associated with worse NET cancer-specific survival (p \u3c 0.0001). Ten-year NET-specific survival was 85, 77, and 74% for patients in the0.2-0.5, and \u3e0.5 LNR groups, respectively. In stratified analyses, higher LNR groups had worse survival only in early tumor (T1, T2) disease (p \u3c 0.0001). Conclusions: The extent of LN involvement provides independent prognostic information on patients with LN-positive SI-NETs. This information may be used to identify patients at high risk of recurrence and inform decisions about the use of adjuvant therapy. (C) 2015 S. Karger AG, Base

Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care

<p>Abstract</p> <p>Background</p> <p>Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting.</p> <p>Methods</p> <p>A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers.</p> <p>Discussion</p> <p>Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01386047">NCT01386047</a></p

Fasciolosis en bovinos hembras en crecimiento del Departamento Berón de Astrada (Corrientes, Argentina)

El objetivo del trabajo fue estudiar la evolución de la fasciolosis bovina a largo plazo, a partir hembras en crecimiento al pie de madre y hasta los 3 años de edad, efectuando el diagnóstico in vivo por coprología y evaluando la respuesta al tratamiento instaurado (albendazole). Las tareas de campo se realizaron en un establecimiento del Departamento Berón de Astrada (Corrientes, Argentina), zona donde la infestación del ganado con Fasciola hepatica es enzoótica. El grupo investigado estuvo inicialmente constituido por 78 animales, los que al final del ensayo se redujeron a 30. Se realizaron seis muestreos de materia fecal para estudios coprológicos por sedimentación (Dennis), los tres primeros coincidentes con los tres tratamientos antiparasitarios efectuados. El día 0 se verificó un 3,85% de animales positivos. La tasa fue de 1,30% al día 71 y de 0% durante los dos muestreos sucesivos, a los 172 y 230 días, avalando la eficacia de los tratamientos recibidos. La interrupción de la administración del antiparasitario provocó que la “fasciolosis” reapareciera al día 553 con 7,69% de animales positivos, nivel que ascendió al 80% el día 850 (ultimo muestreo). Se concluye alertando sobre los efectos contraproducentes de la práctica habitual de interrumpir los tratamientos antiparasitarios contra F. hepatica en animales adultos, porque ellos son losgrandes diseminadores de esta enfermedad parasitaria