Access, provision, and cost of routine eye care: A comparison of Oregon optometrists and ophthalmologists

A study was conducted among optometrists and ophthalmologists that practice in Oregon to measure the differences in several characteristics associated with the provision of routine eye exams, specifically: (1) fees, (2) availability of visual field testing, (3) appointment availability, (4) acceptance of Medicare, and {5) acceptance of Medicaid. A sample of the populations\u27 offices were phoned, a short interview completed, and demographics assessed. Significant differences were found in routine exam fees and availability, provision and fees for visual field testing, and Medicare and/or Medicaid acceptance. Access to optometric care is greater as measured by number of providers, appointment availability and cost. Therefore, optometrists are more accessible and cost effective than other vision care providers

Shell structure and electron-electron interaction in self-assembled InAs quantum dots

Using far-infrared spectroscopy, we investigate the excitations of self-organized InAs quantum dots as a function of the electron number per dot, 1<n<6, which is monitored in situ by capacitance spectroscopy. Whereas the well-known two-mode spectrum is observed when the lowest s - states are filled, we find a rich excitation spectrum for n=3, which reflects the importance of electron-electron interaction in the present, strongly non-parabolic confining potential. From capacitance spectroscopy we find that the electronic shell structure in our dots gives rise to a distinct pattern in the charging energies which strongly deviates from the monotonic behavior of the Coulomb blockade found in mesoscopic or metallic structures.Comment: 4 pages, 3 PostScript figure

Effect of anticoagulants on fibrin clot structure: a comparison between vitamin K antagonists and factor Xa inhibitors

Background Abnormal clot structure has been identified in patients with thrombotic disorders. Anticoagulant therapy offers clear benefits for thrombosis prevention and treatment by reducing blood clot formation and size; nevertheless, there are limited data on the effects of different anticoagulants, where clotting is initiated with different triggers, on clot structure. Objectives Our aim was to investigate the effects of vitamin K antagonists and factor Xa inhibitors on clot structure. Methods Clots from pooled plasma spiked with rivaroxaban, apixaban, or enoxaparin, as well as plasma from patients on warfarin, were compared to plasma without anticoagulation. The kinetic profile of polymerizing clots was obtained by turbidity, fiber density was determined by confocal microscopy, clot pore size was investigated by permeation, and fiber size was analyzed using scanning electron microscopy. Clotting agonist was either tissue factor or thrombin. Results Following clotting with tissue factor, all anticoagulated clots had a significantly increased lag time, with the exception of enoxaparin. Rivaroxaban additionally led to significantly less dense and more permeable clots, with thicker fibers. In contrast, turbidity analysis following initiation with thrombin showed few effects of anticoagulation, with only enoxaparin leading to a prolonged lag time. Enoxaparin clots made with thrombin were less dense and more permeable. Conclusion Our results show that anticoagulants modulate clot structure particularly when induced by tissue factor, most likely due to reduction of thrombin generation. We propose that the effects of different anticoagulants could be assessed with a global clot structure measurement such as permeation or turbidity, providing information on clot phenotype

Evaluación de aceites y harinas, para nutrición humana, obtenidos de semillas de uvas convencionales y orgánicas Bordô del sur de Brasil

The south of Brazil is one of the largest producers of grapes, and as a consequence there is a large generation of waste that can be used as a profitable alternative source. The aim of this work was to obtain and evaluate oil and the flour for human consumption from the residue of cold-pressed Bordô from conventional and organic grape seeds in a winery in the south of Brazil. By cold pressing, the organic oil obtained higher yield. The quality parameters of the conventional oil were better, although with a higher index of peroxides and iodine. The conventional flour presented better results for quality and centesimal composition, mainly due to the higher fiber content and the fact that it did not contain high acidity or humidity. Therefore, the results of products were similar for both crops, but the conventional one was better. However, traces in the agrochemical residue analysis found for the conventional crop might better qualify the organic products.El sur de Brasil es uno de los mayores productores de uva, por lo que existe una gran generación de residuos que se pueden utilizar como fuente alternativa y rentabilizar. El objetivo de este trabajo es obtener y evaluar los aceites y las harinas, para nutrición humana, del residuo de prensado en frío de las semillas de uva convencionales y orgánicas de Bordô en una bodega del sur de Brasil. Al presionar en frío, el aceite orgánico se obtuvo con gran rendimiento. Los parámetros de calidad del aceite convencional fueron mejores, aunque con un mayor índice de peróxidos y de yodo. La harina de semillas convencionales presentó mejores parámetros de calidad y composición centesimal, principalmente debido al mayor contenido en fibra y no tuvieron acidez alta o humedad. Por lo tanto, los resultados de los productos fueron similares para ambos cultivos, pero el convencional fue mejor. Por otro lado, el análisis de trazas de residuos agroquímicos podrían calificar los productos como orgánicos

Dysregulation of Endothelial Nitric Oxide Synthase Does Not Depend on Hemodynamic Alterations in Bicuspid Aortic Valve Aortopathy

Background Bicuspid aortic valves (BAVs) predispose to ascending aortic aneurysm. Turbulent blood flow and genetic factors have been proposed as underlying mechanisms. Endothelial nitric oxide synthase (eNOS) has been implicated in BAV aortopathy, and its expression is regulated by wall shear stress. We hypothesized that if turbulent flow induces aneurysm formation in patients with a BAV, regional differences in eNOS expression would be observed in BAVs. Methods and Results Ascending aortic specimens were harvested intraoperatively from 48 patients with tricuspid aortic valve (19 dilated, 29 nondilated) and 38 with BAV (28 dilated, 10 nondilated) undergoing cardiac surgery. eNOS mRNA and protein concentration were analyzed at the convex and concave aortic wall. In nondilated aortas, eNOS mRNA and protein concentration were decreased in BAV compared with tricuspid aortic valve (all P0.05). However, eNOS expression was increased at the concave wall (versus convexity) in tricuspid aortic valve dilated aortas (all P<0.05). Conclusions Dysregulated eNOS occurs independent of dilation in BAV aortas, suggesting a potential role for aberrantly regulated eNOS expression in the development of BAV-associated aneurysms. The absence of regional variations of eNOS expression suggests that eNOS dysregulation in BAV aortas is the result of underlying genetic factors associated with BAV disease, rather than changes stimulated by hemodynamic alterations. These findings provide insight into the underlying mechanisms of aortic dilation in patients with a BAV

Supporting Indigenous Adaptation in a Changing Climate: Insights from the Stó:lō Research and Resource Management Centre (British Columbia) and the Fort Apache Heritage Foundation (Arizona)

Indigenous peoples are both disproportionately threatened by global climate change and uniquely positioned to enhance local adaptive capacities. We identify actions that support Indigenous adaptation based on organizational and community perspectives. Our data come from two Indigenous organizations that share cultural heritage stewardship missions—the Stó:lō Research and Resource Management Centre (Stó:lō Nation, British Columbia) and the Fort Apache Heritage Foundation (White Mountain Apache Tribe, Arizona). These organizations collaborated with us in exploring community perceptions of climate effects, investigating community adaptation opportunities and constraints, and identifying actions that support Indigenous adaptation. Research methods included engagement with organizational collaborators and semi-structured interviews with organizational representatives and community members and staff. Results confirm that Stó:lō and Apache territories and communities have experienced climate change impacts, such as changes in temperature, hydrology, and increase in extreme weather events. Climate effects are cumulative to colonial depletion of traditional environments and further reduce access to traditional resources, practices, and food security. Results indicated that certain actions are identified by community members as adaptation enablers across case studies—most prominently, perpetuation of Indigenous culture and knowledge, climate education that is tailored to local contexts, collaborative decision-making among community institutions, and integration of climate adaptation into ongoing organizational programs. We conclude that Indigenous-owned organizations are engaged in the expansion of adaptive capacity and hold potential to further support their communities

Fibrinogen αC‐regions are not directly involved in fibrin polymerization as evidenced by a "Double‐Detroit" recombinant fibrinogen mutant and knobs‐mimic peptides

Background: Fibrin polymerization, following fibrinopeptides A and B (FpA, FpB) cleavage, relies on newly exposed α‐ and β‐chains N‐termini (GPR, GHR; A‐, B‐knobs, respectively) engaging pre‐existent a and b pockets in other fibrin(ogen) molecules' γ‐ and (B)β‐chains C‐terminal regions. A role for mostly disordered (A)α‐chains C‐terminal regions "bridging" between fibrin molecules/fibrils has been proposed. Objectives: Fibrinogen Detroit is a clinically observed mutation (AαR19→S) with non‐engaging GPS A‐knobs. By analogy, a similar Bβ‐chain mutation, BβR17→S, should produce non‐engaging GHS B‐knobs. A homozygous “Double‐Detroit” mutant (AαR19→S, BβR17→S; DD‐FG) was developed: with A‐a and B‐b engagements endogenously blocked, other interactions would become apparent. Methods: DD‐FG, wild‐type recombinant (WT‐FG), and human plasma (hp‐FG) fibrinogen self‐association was studied by turbidimetry coupled with fibrinopeptides release HPLC/mass spectrometry analyses, and by light‐scattering following size‐exclusion chromatography (SE‐HPLC). Results: In contrast to WT‐FG and hp‐FG, DD‐FG produced no turbidity increase, irrespective of thrombin concentration. The SE‐HPLC profile of concentrated DD‐FG was unaffected by thrombin treatment, and light‐scattering, at lower concentration, showed no intensity and hydrodynamic radius changes. Compared with hp‐FG, both WT‐FG and DD‐FG showed no FpA cleavage difference, while ~50% FpB was not recovered. Correspondingly, SDS‐PAGE/Western‐blots revealed partial Bβ‐chain N‐terminal and Aα‐chain C‐terminal degradation. Nevertheless, ~70% DD‐FG molecules bearing (A)αC‐regions potentially able to associate were available. Higher‐concentration, nearly‐intact hp‐FG with 500‐fold molar excess GPRP‐NH2/GHRP‐NH2 knobs‐mimics experiments confirmed these no‐associations findings. Conclusions: (A)αC‐regions interactions appear too weak to assist native fibrin polymerization, at least without knobs engagement. Their role in all stages should be carefully reconsidered

El estilo de comunicación del entrenador y la percepción del clima motivacional generado por los entrenadores y compañeros

El presente estudio se propuso evaluar las relaciones entre el estilode comunicación del entrenador y el clima motivacional generado por él ypor los compañeros de equipo. Se observó a tres entrenadores de fútbol conel Sistema de Evaluación de las Conductas del Entrenador (CBAS) en tres partidoscada uno. También participaron 39 jugadores de los mismos equiposque los entrenadores, en la franja de edad de 12 a 14 años, que contestaronlos cuestionarios: a) cuestionario de percepción de los comportamientos delentrenador (CBAS-PBS); b) clima motivacional generado por el entrenador(PMCSQ-2); c) cuestionario del clima motivacional de los iguales en eldeporte (PeerMCYSQ). A partir de los resultados obtenidos, se evidenciauna correlación entre conductas positivas que perciben que emiten los entrenadoresy la percepción de un clima de implicación a la tarea. Además,de una correlación entre el clima de implicación a la tarea generado por elentrenador y el generado por los compañeros. También se encontró unacorrelación positiva entre las percepciones de comportamientos punitivosdel entrenador y la generación de un clima motivacional de implicaciónal ego. El clima de implicación al ego generado por el entrenador tambiénse correlaciona con los dos factores del clima de implicación al ego de loscompañeros, la competencia y el conflicto intra-equipo

Fidedignidade da versão em português do Inventário de Ansiedade e Fobia Social (SPAI) em amostra heterogênea de estudantes universitários brasileiros

Objetivo: Avaliar consistência interna e estabilidade temporal, através de fidedignidade teste-reteste, da versão em português do Inventário de Ansiedade e Fobia Social (SPAI), em uma amostra brasileira heterogênea. Métodos: Após consentimento informado, a versão traduzida e adaptada para o português do SPAI foi testada e re-testada, com 14 dias de intervalo, em uma amostra de 225 estudantes universitários de ambos os gêneros, de quatro cursos de graduação. Após dupla entrada de dados, a análise estatística incluiu Alfa de Cronbach e os coeficientes de correlação de Pearson e Intra-classe. Resultados: A amostra estudada consistiu de 213 estudantes de quatro sub-amostras: 95 estudantes de Direito, 31 de Comunicação Social, 54 de Engenharia Civil e 33 de Odontologia. A média de idade foi de 23 anos (± 6) e 110 (51,6%) eram do gênero feminino. O Alpha de Cronbach foi de 0,96, sem diferenças entre os gêneros. O escore diferencial (total) do SPAI português apresentou coeficiente de Pearson de 0,83 (IC95% 0,78-0,87) e coeficiente Intra-classe de 0,83 (IC95% 0,78-0,86). Não houve diferença estatística nos coeficientes de Pearson entre os gêneros (p = 0,121) ou entre as quatro sub-amostras (p = 0,258). Conclusão: Os resultados não asseguram validade; a versão do SPAI português apresentou boa homogeneidade de conteúdo com nível satisfatório consistência interna. A estabilidade temporal avaliada foi consistente. Os dados demonstram que o SPAI português apresenta fidedignidade perfeitamente aceitável para ambos os gêneros e sugerem sua utilização na população brasileira.Objective: Tto evaluate internal consistency and temporal stability trough test re-test reliability of the Portuguese version of the Social Phobia and Anxiety Inventory (SPAI) in a heterogeneous Brazilian sample. Methods: After informed consent, the translated and adapted version of the SPAI Portuguese was tested and re-tested at a 14-day interval in a sample of 225 university students, both genders, from 4 different undergraduate courses. After double data entry, statistical analysis included Cronbach’s alphas, Pearson and intra-class correlation coefficients. Results: The studied sample consisted of 213 students from 4 sub-samples: 95 law students, 31 social communication students, 54 civil engineering students and 33 dental medicine students. The mean age was 23 (±6) years and 110 (51.6%) were female. The Cronbach’ alpha was 0.96, no difference for both genders. The differential (total) score of the SPAI Portuguese showed Pearson coefficient 0.83 (95% CI 0.78-0.87) and Intra-class coefficient 0.83 (95% CI 0.78-0.86). There was no statistical difference in Pearson coefficients between genders (p = 0.121) and the 4 sub-samples (p = 0.258). Conclusion: The results do not ensure validity, however, the SPAI Portuguese version presented a good content homogeneity with satisfactory level of internal consistency. The temporal stability evaluated was substantial. The results showed that the Portuguese SPAI presents perfectly acceptable reliability for both genders and suggest that it can be used in Brazilian population

The design of avalanche protection dams : Recent practical and theoretical developments

This book discusses the design of dams and other protective measures in the run-out zones of wet- and dry-snow avalanches. It summarises recent theoretical developments and the results of field and laboratory studies, combining them with traditional design guidelines and principles to formulate design recommendations. Not discussed are hazard zoning, land use planning, evacuations, supporting structures in starting zones, snow fences in catchment areas, and other safety measures outside the run-out zone. Reinforcement of individual buildings also falls outside the scope of the book, as do protective measures against landslides and slushflows.European Comissio