The association between gender and priority of admission in Florida stroke patients

Introduction/Objective: Stroke is the fifth leading cause of death in the United States and results in significant morbidity and mortality annually. Its wide prevalence and critical nature make it essential to recognize and properly triage patients with symptoms of stroke so that appropriate time-sensitive interventions may be delivered. Many studies have delineated gender differences in risk, diagnosis and treatment of stroke; however, limited information exists on the association between gender and Emergency Department (ED) triage priority. The objective of this study is to determine if there is a gender difference in the assignation of an emergency priority of admission code among Florida stroke patients. Methods: An observational cross-sectional study was performed through secondary analysis of the Florida Stroke Registry, composed of hospital discharge data collected by the Agency for Healthcare Administration (AHCA) on Florida stroke patients from 2012. A descriptive analysis was utilized to profile the study population, calculating measures of centrality and dispersion of demographic variables. We tested associations of our bivariate analysis using chi-square tests, then performed a multivariate analysis using logistic regression to control for confounders. Odds ratios were used to measure associations. Results: Women were 24% more likely to receive an emergency priority of admission code than men. Following adjustment and stratification by primary stroke center designation, it was determined that women remained more likely to receive a priority code of admission than males. This occurred at a higher rate in primary stroke centers (35% more) than in non-certified hospitals (11% more). Independently, the other factors included in the adjusted analysis (age, race, payer, source of admission, day of the week, and stroke center designation) also held statistically significant associations with emergency priority triage. Conclusions: Gender disparity does exist among Florida stroke patient triage and more research should be conducted concerning the factors influencing the assignation of an emergency priority code. Emergency department care providers may need more gender specific protocols on stroke triage and additional training in recognizing gender specific symptoms. Additional studies need to be conducted in order to identify if gender disparities exist in other links of the stroke chain of survival

In-hospital mortality of non-st segment elevation myocardial infarction in a Puerto Rican population

Introduction: Currently, there is limited published information on in-hospital mortality regarding ST segment elevation and non-ST segment elevation myocardial infarction. This information is even scarcer on the Hispanic population. We aim to study if there is a difference on in-hospital mortality between ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) in a mostly Hispanic population. Methods: A secondary data analysis of a non-concurrent prospective study was performed using the Puerto Rican Heart Attack study database. Dependent variable was in-hospital mortality and independent variable was type of myocardial infarction (STEMI or NSTEMI). We conducted, sequentially, a descriptive, bivariate and multivariate analysis. The chi-squared test was used to compare categorical variables and t-test for continuous variables. Finally, a logistic regression model was used to perform the multivariate analysis. Results: From the 838 Puerto Rican patients hospitalized with ST classification, 310 (37%) were diagnosed with STEMI. Patients with STEMI were younger (65 years vs 68 years; p=0.008), more likely to receive invasive treatment (47.9% vs 27.5%, p<0.001), and less likely to have a history of hypertension (72.5% vs 79.0%, p=0.033) compared to NSTEMI patients. For every 1- year increase in age, there is a 4% increase in in-hospital mortality. Patients with hyperlipidemia were approximately two times more likely to die in the hospital compared to patients without hyperlipidemia. In the unadjusted analysis, there was no significant association between STEMI and NSTEMI patients and in-hospital mortality. After adjusting for confounders, patients with STEMI had twice the risk of dying than those with NSTEMI. Conclusions: Findings from this study suggest that Puerto Ricans with STEMI have double the risk of in-hospital mortality than NSTEMI patients. Our findings were similar to those reported in the literature. A timely recognition of at-risk patients, especially among STEMI patients, may help reduce short-term morality among patients hospitalized with acute myocardial infarction in Puerto Rico

Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCG

La concepción simple de la lectura en alumnos de 4º de primaria de Quito

The simple view of reading is a model that tries to explain the reading comprehension from two variables which are decoding accuracy and oral language comprehension. There is an extensive research on this model in English readers. Although, some studies have been done in other languages with transparent orthographic systems, there are few investigations with Spanish readers. The purpose of this study has been to collect data on the applicability of the simple view of reading to Spanish reading comprehension, so 87 students of a public school from Quito were assessed with the PROLEC-R and CLP tests. The results show that join fluency or reading speed to the model may be more appropriate to explain the Spanish reading comprehension. Oral comprehension was the most related variable to the text reading comprehension; even thought decoding and reading speed made a small additional contribution. On the other hand, reading comprehension of sentences was only related in a significant way to decoding accuracy. These results show that the oral comprehension, the decoding accuracy and the decoding speed are essential in teaching and assessing reading. La concepción simple de la lectura es un modelo que trata de explicar la comprensión lectora a partir de dos variables, que son la habilidad para la descodificación y la comprensión del lenguaje oral. En los últimos años se ha desarrollado un extenso conjunto de investigaciones sobre este modelo en lectores de inglés. Aunque se han realizado estudios en otros idiomas con sistemas ortográficos transparentes, apenas ha habido investigaciones en lectores de español. El propósito de esta investigación ha sido recoger datos sobre la aplicabilidad de la concepción simple de la lectura a la lectura del español. Para ello se evaluó con la batería PROLEC-R y con el test CLP a 87 alumnos de una escuela pública de la ciudad de Quito. Los resultados indican que incorporar la fluidez o velocidad de lectura al modelo puede ser más adecuado para explicar la comprensión lectora del español. La variable más relacionada con la comprensión lectora de textos fue la comprensión oral, aunque la descodificación y la velocidad de lectura hicieron una pequeña contribución adicional. En cambio, la comprensión lectora de oraciones sólo se relacionó de forma significativa con la descodificación. Esto indica que en la enseñanza y en la evaluación de la lectura es necesario considerar especialmente la comprensión oral, la precisión en la descodificación y la velocidad en la descodificación

Effect of complete heart block on in-hospital mortality in a Hispanic population presenting with acute myocardial infarction

Introduction/Objective: Complete heart block (CHB) is an important clinical complication in patients hospitalized with acute myocardial infarction (AMI). Yet, limited information is available on the relationship between the two in the Hispanic population. We want to determine whether a difference exists between in-hospital mortality of patients with and without CHB presenting with AMI in Puerto Rico. Methods: A secondary data analysis was conducted from the Puerto Rican Cardiovascular Surveillance Study in 2007, 2009, and 2011, a non-concurrent prospective study. Our main independent variable was patients with and without CHB and our dependent variable was in- hospital mortality. SPSS V. 20 software was used for data analysis. The in-hospital mortality was examined by using chi-square or Fisher's Exact test for discrete variables and independent t-tests for continuous variables. Age, gender, and diabetes were included as potential confounders in a multivariate analyses using logistic regression. Results: The overall incidence of CHB was low (n=23). Our unadjusted model showed that patients with CHB were 4 times more likely to die compared to those without (OR: 4.1, 95%CI: 1.5-11.1; p=0.014). For every 1- year increase in age, there was a 10% increase on in-hospital mortality risk (OR: 1.1, 95%CI: 1.05-1.07; p<0.001). Women were 50% more likely to die than males (OR: 1.5, 95%CI: 1.2-2.0; p=0.003). In the adjusted model, CHB and age were the only variables significantly associated with mortality. The association between CHB and mortality remained strong (OR: 4.7, 95%CI: 1.7-13.5; p=0.003). No collinearity was detected among any of the explanatory variables. Conclusions: CHB increases the risk of in-hospital mortality after AMI by roughly five times after adjusting for age, gender, and diabetes. As age of the patient increased, so did the mortality. As a result of our study, clinicians may become more aware of the mortality risks associated with a minority population and could tailor their surveillance and treatment plan accordingly

Phenotypic and molecular characterization of plants regenerated from non-cryopreserved and cryopreserved wild Solanum lycopersicum Mill. seeds

BACKGROUND: Before cryopreservation is routinely used, its effect on the trueness-to-type of the regenerated plant material needs to be evaluated. OBJECTIVE: In this work, we studied the effect of seed cryopreservation on the phenotypic and molecular characteristics of wild Solanum lycopersicum Mill. plants. METHODS: Thirty-five morphological traits of plants regenerated from cryopreserved seeds were compared to those measured on plants regenerated from non-cryopreserved seeds. RESULT: No statistically significant differences were observed between cryopreserved and non-cryopreserved samples, either in the first or in the second generation post-liquid nitrogen exposure. However, at the molecular level, the genetic analyses performed on the second generation plants germinated from control and cryopreserved seeds using 14 nuclear Simple Sequences Repeats (SSR) markers uncovered some changes in microsatellite length between control and cryopreserved samples. These results confirm at the botanical phenotype level the effectiveness of seed cryostorage for conservation and regeneration of true-to-type S. lycopersicum plants. CONCLUSION: Further experiments are required to clarify potential phenotypic effects of the changes observed in the DNA

Local hydrological conditions influence tree diversity and composition across the Amazon basin

Tree diversity and composition in Amazonia are known to be strongly determined by the water supplied by precipitation. Nevertheless, within the same climatic regime, water availability is modulated by local topography and soil characteristics (hereafter referred to as local hydrological conditions), varying from saturated and poorly drained to well-drained and potentially dry areas. While these conditions may be expected to influence species distribution, the impacts of local hydrological conditions on tree diversity and composition remain poorly understood at the whole Amazon basin scale. Using a dataset of 443 1-ha non-flooded forest plots distributed across the basin, we investigate how local hydrological conditions influence 1) tree alpha diversity, 2) the community-weighted wood density mean (CWM-wd) – a proxy for hydraulic resistance and 3) tree species composition. We find that the effect of local hydrological conditions on tree diversity depends on climate, being more evident in wetter forests, where diversity increases towards locations with well-drained soils. CWM-wd increased towards better drained soils in Southern and Western Amazonia. Tree species composition changed along local soil hydrological gradients in Central-Eastern, Western and Southern Amazonia, and those changes were correlated with changes in the mean wood density of plots. Our results suggest that local hydrological gradients filter species, influencing the diversity and composition of Amazonian forests. Overall, this study shows that the effect of local hydrological conditions is pervasive, extending over wide Amazonian regions, and reinforces the importance of accounting for local topography and hydrology to better understand the likely response and resilience of forests to increased frequency of extreme climate events and rising temperatures