Comparative analysis of biochemical, hormonal, and mineral compositions of preovulatory and cystic ovarian follicles in buffalo during the non-breeding season.

This study is a comparative analysis of the biochemical, hormonal, and mineral compositions of follicular fluid in preovulatory and cystic follicles of water buffalo (Bubalus bubalis). In total, reproductive tracts from 215 buffalo along with intact ovaries were collected randomly from an abattoir. The incidence of cystic conditions found in this study was 3.72% (8/215), involving the right ovary in 62.5% of instances and the left ovary in 37.5% of instances during the non-breeding season. Follicular fluid was aspirated from preovulatory follicles (12-15 mm diameter, oestrogen-active, follicular phase or stage IV corpus luteum on one of the two ovaries, n = 10) and cystic follicles (at least 20 mm diameter, no corpus luteum on any one of the two ovaries, n = 8). The follicular fluid samples were assayed for biochemical components (uric acid, creatinine, blood urea nitrogen, cholesterol, total protein, glucose, ascorbic acid, and alkaline phosphatase), hormones (progesterone, estradiol, and insulin), and minerals (calcium, magnesium, phosphorus, copper, zinc, and cobalt). Cystic follicles had greater (P < 0.05) concentrations of creatinine, blood urea nitrogen, cholesterol, progesterone, copper, zinc, and cobalt, and lesser (P < 0.05) concentrations of uric acid, glucose, ascorbic acid, estradiol, insulin, calcium, magnesium, and phosphorus compared with preovulatory follicles. These results indicated the marked differences in follicular fluid composition between preovulatory and cystic follicles in buffalo. Some of the changes were indicative of oxidative stress and disturbed steroidogenesis, two important mechanisms shown to be associated with cystic ovarian disease in various species. Further studies are warranted to investigate whether these differences are directly or indirectly involved in the formation of cystic follicles or are mere manifestations of the condition.

Antibiotic resistance genes in the gut microbiota of mothers and linked neonates with or without sepsis from low- and middle-income countries.

Early development of the microbiome has been shown to affect general health and physical development of the infant and, although some studies have been undertaken in high-income countries, there are few studies from low- and middle-income countries. As part of the BARNARDS study, we examined the rectal microbiota of 2,931 neonates (term used up to 60 d) with clinical signs of sepsis and of 15,217 mothers screening for blaCTX-M-15, blaNDM, blaKPC and blaOXA-48-like genes, which were detected in 56.1%, 18.5%, 0% and 4.1% of neonates' rectal swabs and 47.1%, 4.6%, 0% and 1.6% of mothers' rectal swabs, respectively. Carbapenemase-positive bacteria were identified by MALDI-TOF MS and showed a high diversity of bacterial species (57 distinct species/genera) which exhibited resistance to most of the antibiotics tested. Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae/E. cloacae complex, the most commonly found isolates, were subjected to whole-genome sequencing analysis and revealed close relationships between isolates from different samples, suggesting transmission of bacteria between neonates, and between neonates and mothers. Associations between the carriage of antimicrobial resistance genes (ARGs) and healthcare/environmental factors were identified, and the presence of ARGs was a predictor of neonatal sepsis and adverse birth outcomes.

Comparative biochemical profiles, utero-ovarian function, and fertility of the postpartum buffalo with and without subclinical endometritis.

In postpartum buffaloes, the process of uterine involution and changes in blood metabolic profile has not been studied in relation to development of subclinical endometritis (SCE). In this study, buffaloes (n = 100) approaching calving were identified. Weekly blood samples were collected on the day of calving up to 6 weeks post-calving. The diameter of uterine horns and onset of ovarian cyclicity (corpus luteum) were recorded through ultrasonography. On the basis of polymorphonuclear cell (PMN) cell count in endometrial cytology at days 45-50 postpartum, buffaloes were divided into two groups, viz., with SCE (> 5% PMN; n = 38) and without SCE (≤ 5% PMN; n = 62). Buffaloes with SCE took longer (P < 0.05) time to complete uterine involution and had larger (P < 0.05) uterine horn diameter between 3rd and 6th weeks postpartum and lower prostaglandin F2α metabolite (PGFM) concentration on the day of calving (P < 0.05) and 1 week (P < 0.001) post-calving than without SCE group. Buffaloes with SCE had lower (P < 0.001) concentration of glucose at weeks 2 and 3, higher (P < 0.001) ß-hydroxybutyric acid (BHBA) at week 3, and lower serum albumin concentration throughout the sampling period (P < 0.05 to 0.001) except at 1 week post-calving as compared to without SCE group. The urea concentration was significantly lower (P < 0.05 to 0.001) in buffaloes with SCE from 4 weeks post-calving onwards than without SCE group. The calcium concentration was lower in buffaloes with SCE at weeks 5 (P < 0.001) and 6 (P < 0.05) postpartum, whereas the concentration of magnesium and phosphorus was uniform between the two groups. No significant (P > 0.05) difference in onset of ovarian cyclicity between the 2 groups was observed, whereas buffaloes with SCE had longer (P = 0.001) median days open (141 days) than their counterpart (117 days). The first service conception rate, cumulative pregnancy rate, and pregnancy rate at 150 days postpartum were lower (P < 0.05) in buffaloes with SCE than without SCE group. In summary, higher BHBA and lower serum concentrations of glucose, albumin, urea, and calcium control onset of subclinical endometritis which in turn has negative impact on fertility of buffaloes.

Efficacy of dashboard driven dosing of infliximab in inflammatory bowel disease patients; a randomized controlled trial.

OBJECTIVES: Loss of response (LOR) to infliximab (IFX) remains a challenge in the management of inflammatory bowel diseases (IBD). Proactive dosing strategies to achieve and maintain predefined IFX trough levels (TL) may prevent LOR. We aimed to investigate the efficacy of dashboard driven IFX dosing compared to standard dosing in a prospective trial in IBD patients. METHODS: In this multicentre 1:1 'PRECISION' trial, we randomized IBD patients in clinical remission (Harvey Bradshaw Index ≤4 for Crohn's disease (CD) or a partial Mayo score ≤2 for ulcerative colitis (UC)) receiving IFX maintenance treatment. The precision group (PG) received IFX dosing guided by a Bayesian pharmacokinetic model, aiming to achieve and maintain a TL of 3 µg/ml by treatment (de)escalation as indicated by the dashboard. Patients in the control group (CG) continued treatment without dose adaptations. The primary endpoint was the proportion of patients in sustained clinical remission after 1 year. RESULTS: Eighty patients were enrolled (66 CD, 14 UC), and the median [interquartile range] age was 37 years [27-51]). After one year, 28/32 (88%) of patients in the PG were in sustained clinical remission versus 25/39 (64%) in the CG (p = .017). PG patients had lower median faecal calprotectin levels after 1 year (p = .031), whereas no significant differences in median CRP levels were found. CONCLUSION: We demonstrated that the use of a Bayesian dashboard for IFX dosing in maintenance treatment for IBD reduced the incidence of LOR compared to standard dosing. Precision dosing also resulted in lower FCP levels. CLINICALTRIALS.GOV NUMBER: NCT02453776.

Modeling Patient Journeys for Demand Segments in Chronic Care, With an Illustration to Type 2 Diabetes.

Chronic care is an important area for cost-effective and efficient health service delivery. Matching demand and services for chronic care is not easy as patients may have different needs in different stages of the disease. More insight is needed into the complete patient journey to do justice to the services required in each stage of the disease, to the different experiences of patients in each part of the journey, and to outcomes in each stage. With patient journey we refer to the "journey" of the patient along the services received within a demand segment of chronic care. We developed a generic framework for describing patient journeys and provider networks, based on an extension of the well-known model of Donabedian, to relate demand, services, resources, behavior, and outcomes. We also developed a generic operational model for the detailed modeling of services and resources, allowing for insight into costs. The generic operational model can be tailored to the specific characteristics of patient groups. We applied this modeling approach to type 2 diabetes (T2D) patients. Diabetes care is a form of chronic care for patients suffering diabetes mellitus. We studied the performance of T2D networks, using a descriptive model template. To identify and describe demand we made use of the following demand segments within the diabetes type 2 population: patients targeted for prevention; patients with stage 1 diabetes treated by their GP with lifestyle advice; patients with diabetes stage 2 treated by their GP with lifestyle advice and oral medication; patients with stage 3 diabetes treated by their GP with lifestyle advice, oral medication, and insulin injections; patients with stage 4 diabetes with complications (treated by internal medicine specialists). We used a Markov model to describe the transitions between the different health states. The model enables the patient journey through the health care system for cohorts of newly diagnosed T2D patients to be described, and to make a projection of the resource requirements of the different demand segments over the years. We illustrate our approach with a case study on a T2D care network in The Netherlands and reflect on the role of demand segmentation to analyse the case study results, with the objective of improving the T2D service delivery.

Effect of progesterone administration during growing phase of first dominant follicle on follicular wave pattern in buffalo heifers.

In buffaloes, like other domestic mammals, antral follicles develop in a wave-like pattern. Factors predictive of a particular follicular wave pattern are yet to be identified. In this study, we examined the preponderance of 2- versus 3-wave patterns in 46 interovulatory intervals (IOIs) from 36 buffalo heifers, in which a subset of 10 heifers was scanned for 2 consecutive IOIs to record the repeatability of follicular wave pattern. Two-wave pattern was detected in 63.0% and 3-wave follicular pattern in 27.0% IOIs. The dominant follicles (DF) of both wave 1 as well as the ovulatory wave attained a smaller (P < 0.05) maximum diameter in 3-wave cycle as compared to 2-wave cycle. The mean duration of IOI was significantly shorter in 2-wave compared to three-wave cycles (20.5 ± 0.3 vs. 22.3 ± 0.2 days; P < 0.05). Out of 10 buffalo heifers, 7 displayed non-alternating patterns and 3 had alternating follicular wave patterns. We also tested the hypothesis that progesterone administration during early IOI results in increased preponderance of 3-wave pattern and heifers inseminated after ovulation of the third wave DF will have greater fertility. Sixteen heifers subjected to progesterone treatment from D0 (day of ovulation) in a decreasing dose until D5 were compared with control heifers (n = 10). Progesterone treatment significantly reduced the maximum diameter of DF of wave 1 (P < 0.001), whereas the mean duration of IOI remained unchanged (P > 0.05) between the two groups. Progesterone administration during early IOI significantly increased the proportion of 3-wave cycles as compared to control (P < 0.05). The hypothesis that progesterone administration during IOI results in increased preponderance of 3-wave pattern was supported. However, no change in fertility was recorded in progesterone-treated heifers (7 pregnant out of 16; 43.8%) as compared to untreated control heifers (4 out of 10 heifers; 40.0%). In summary, progesterone administration in buffalo heifers during the growing phase of wave 1 resulted in greater preponderance of 3-wave follicular patterns, with no significant effect on fertility.

The cryoprotective effect of iodixanol in buffalo semen cryopreservation.

This is the first report to examine the effect of iodixanol (OptiPrepTM) on cryosurvival of buffalo spermatozoa. A total of thirty ejaculates (five ejaculates from each bull) from six buffalo bulls were used for this experiment. Each ejaculate was divided into four aliquots and diluted in freezing extender supplemented with different concentrations of OptiPrepTM (0, 1.25, 2.5 and 5%) and then cryopreserved. The semen quality variables were evaluated before and after freezing of the semen. There were no effects of OptiPrepTM (P>0.05) on sperm kinetics, motility, abnormality and membrane integrity of fresh extended spermatozoa. However, after freeze-thaw, sperm motility, plasma membrane integrity and distance travelled in cervical mucus of 2.5% OptiPrepTM treated samples showed significantly higher (P<0.05) compared to other treated and control samples. No significant differences (P>0.05) were seen in sperm abnormality and acrosomal integrity of treated and control frozen-thawed samples. The total antioxidant capacity of 2.5 and 5% OptiPrepTM treated frozen-thawed sperm were found to be higher (P<0.05) as compared to other groups; whereas the MDA level in OptiPrepTM treated sperm was significantly lower than the control (P<0.05). In incubation test, 2.5% OptiPrepTM proved to be better in preservation of sperm motility as compared to other treated and control samples. In conclusion, the present study has shown that iodixanol has the ability protect spermatozoa against oxidative stress and resulting overall improvement in the post-thaw semen quality.

Cysteamine supplementation revealed detrimental effect on cryosurvival of buffalo sperm based on computer-assisted semen analysis and oxidative parameters.

The aim of this study was to investigate the effect of addition of cysteamine to the semen extender on post-thaw semen quality. A total of 30 ejaculates were collected from six bulls. Each ejaculate was divided into five equal parts and diluted to final concentration of 80 million sperms/mL using Optixcell®(IMV, France) semen extender supplemented with different concentrations of cysteamine (0, 0.75, 1.25, 2.5 and 5mM) and cryopreserved. In the frozen-thawed samples, the VAP, VSL, VCL ALH and sperm motility of control samples was greater (P<0.05) than cysteamine treated samples. The sperm abnormality and malondialdehyde (MDA) concentration were found highest in 5mM cysteamine treated samples. The cysteamine treated samples travelled significantly less distance in cervical mucus as compared to control. Further, cysteamine decreased acrosomal integrity of sperm. In incubation test, control samples showed better sperm motility as compared to treatment groups. Further, cysteamine supplementation decreased the total antioxidants and increased the MDA concentration of sperm. From the study, we hypothesized that cysteamine cannot stimulate synthesis of glutathione (GSH) intracellularly in sperm to combat free radicals because during the maturation, sperm lost its cytoplasm which is necessary for biochemical reaction in which cysteamine reacts with cystine to form a mixed disulfide which taken up by cells and split into cysteine in the cytoplasm. Synthesis of GSH depends on the availability of cysteine. In conclusion, the results of our study strongly emphasize that cysteamine would not be a suitable additive in extender for freezing buffalo bull semen.

Muscle Activation in World-Champion, World-Class, and National Breaststroke Swimmers.

PURPOSE: To investigate the muscle-activation patterns and coactivation with the support of kinematics in some of the world's best breaststrokers and identify performance discriminants related to national elites at maximal effort. METHODS: Surface electromyography was collected in 8 muscles from 4 world-class (including 2 world champions) and 4 national elite breaststroke swimmers during a 25-m breaststroke at maximal effort. RESULTS: World-class spent less time during the leg recovery (P = .043), began this phase with a smaller knee angle (154.6° vs 161.8°), and had a higher median velocity of 0.18 m/s during the leg glide than national elites. Compared with national elites, world-class swimmers showed a difference in the muscle-activation patterns for all 8 muscles. In the leg-propulsion phase, there was less triceps brachii activation (1 swimmer 6% vs median 23.0% [8.8]). In the leg-glide phase, there was activation in rectus femoris and gastrocnemius during the beginning of this phase (all world-class vs only 1 national elite) and a longer activation in pectoralis major (world champions 71% [0.5] vs 50.0 [4.3]) (propulsive phase of the arms). In the leg-recovery phase, there was more activation in biceps femoris (50.0% [15.0] vs 20.0% [14.0]) and a later and quicker activation in tibialis anterior (40.0% [7.8] vs 52.0% [6.0]). In the stroke cycle, there was no coactivation in tibialis anterior and gastrocnemius for world champions. CONCLUSION: These components are important performance discriminants. They can be used to improve muscle-activation patterns and kinematics through the different breaststroke phases. Furthermore, they can be used as focus points for teaching breaststroke to beginners.

Muscle coordination, activation and kinematics of world-class and elite breaststroke swimmers during submaximal and maximal efforts.

The aims of this study were to describe muscular activation patterns and kinematic variables during the complete stroke cycle (SC) and the different phases of breaststroke swimming at submaximal and maximal efforts. Surface electromyography (sEMG) was collected from eight muscles in nine elite swimmers; five females (age 20.3 ± 5.4 years; Fédération Internationale de Natation [FINA] points 815 ± 160) and four males (27.7 ± 7.1 years; FINA points 879 ± 151). Underwater cameras were used for 3D kinematic analysis with automatic motion tracking. The participants swam 25 m of breaststroke at 60%, 80% and 100% effort and each SC was divided into three phases: knee extension, knee extended and knee flexion. With increasing effort, the swimmers decreased their SC distance and increased their velocity and stroke rate. A decrease during the different phases was found for duration during knee extended and knee flexion, distance during knee extended and knee angle at the beginning of knee extension with increasing effort. Velocity increased for all phases. The mean activation pattern remained similar across the different effort levels, but the muscles showed longer activation periods relative to the SC and increased integrated sEMG (except trapezius) with increasing effort. The muscle activation patterns, muscular participation and kinematics assessed in this study with elite breaststroke swimmers contribute to a better understanding of the stroke and what occurs at different effort levels. This could be used as a reference for optimising breaststroke training to improve performance.

Evaluating a murine model of endometritis using uterine isolates of Escherichia coli from postpartum buffalo.

Ascending infection of the uterus with Gram-negative bacteria is responsible for postpartum endometritis in cattle and buffalo and can adversely affect fertility. Development of a laboratory animal model for bovine endometritis would facilitate the understanding of the pathogenesis as it is difficult to conduct controlled experimentation in the native host. In the present study, 30 virgin Swiss Albino mice (5-8 weeks old) were used to evaluate the pathogenic potential of Escherichia coli, isolated from the normally calved postpartum buffalo to induce endometritis. Mice in the diestrus phase of the estrous cycle were randomly allotted to one of the following four intravaginal inoculation (100 µL) treatments: EG (experimental group)-1: sterile normal saline; EG-2, -3 and -4: E. coli@ 1.5 × 104, 105 and 106 CFU/ml, respectively. The animals were then scarified 36 h post-inoculation to study gross and microscopical lesions. Gross changes were confined to EG-4. Acute endometritis was recorded in 50% of the EG-3 and 66.7% of the EG-4. The rate of acute endometritis development was significantly higher in EG-4 (P<0.05) as compared to the other groups. The present study demonstrated that the animal model for bubaline endometritis can be developed in mice by intravaginal inoculation of E.coli@ 1.5 × 106 CFU/ml at diestrus. Ease of intravaginal inoculation, apparent absence of systemic involvement and high infective rate are the advantages of the model over other studies.

Effect of egg yolk powder on freezability of Murrah buffalo (Bubalus bubalis) semen.

AIM: The aim of this study was to investigate the effect of commercial egg yolk powder as an alternative to fresh egg yolk on freezability of Murrah buffalo semen. MATERIALS AND METHODS: Semen samples (12) from 3 Murrah buffaloes (4 from each bull) with mass motility (≥3+) and total motility (70% and above) were utilized in this study. Immediately after collection, each sample was divided into four groups. Groups I was diluted up to 60×10(6) sperm/ml with tris extender containing 10% fresh egg yolk and Groups II, III, and IV were diluted up to 60×10(6) sperm/ml with tris extender containing 2%, 4%, and 6% egg yolk powder, respectively. Semen samples were processed and cryopreserved followed by examination of frozen semen samples after 24 h. Semen samples from each group were evaluated for total motility, viability, acrosomal integrity, abnormality, and hypo-osmotic swelling test (HOST) response after dilution, pre-freeze, and post-thaw stage. RESULTS: Pre-freeze total motility was significantly (p<0.05) higher in Groups III and IV as compared to Groups I and II, and post-thaw total motility was significantly (p<0.01) higher in Group III as compared to other three groups. Viability was significantly (p<0.05) higher in Groups II, III, and IV than Group I at the pre-freeze stage. Significantly (p<0.01) higher viability and acrosomal integrity were recorded in Group III as compared to other three groups at the post-thaw stage. Abnormality was significantly (p<0.05) higher in Group IV than other three groups. HOST response was significantly (p<0.05) higher in Groups II and III than Groups I and IV at the pre-freeze and post-thaw stages. CONCLUSION: Addition of egg yolk powder at 4% level yielded significantly better results in terms of post-thaw semen quality as compared to the fresh egg yolk and other concentrations of egg yolk powder (2% and 6%).

What made you wait so long? Delays in presentation of retinal detachment: knowledge is related to an attached macula.

PURPOSE: In rhegmatogenous retinal detachment, the time between first symptoms and reattachment surgery is critical to prevent macular detachment. We explored which determinants discriminate between 'macula-ON' and 'macula-OFF' retinal detachments to improve timely treatment. METHODS: Eight-hundred patients with rhegmatogenous retinal detachment admitted for surgery at the Rotterdam Eye Hospital in the Netherlands were eligible to complete a questionnaire to explore the following determinants: (i) patient's delay and doctor's delay; (ii) patient-reported causes for delay; (iii) symptoms as early warning signals; (iv) patient's prior knowledge about retinal detachment; and (v) trait anxiety. RESULTS: Five hundred and twenty-one questionnaires (65%) were analysed. Median interval between first symptoms and surgery was 14 days. Macula-ON/OFF ratio was 46/54. Patient's delay in macula-ON patients (median 3 days) was shorter than in macula-OFF (5 days, p = 0.026). No difference was found in doctor's delay except for 'waiting time for surgery': macula-ON patients were operated on faster (median 1 day) than macula-OFF (median 5 days, p < 0.001). Macula-ON patients more often attributed symptoms to retinal problems. Except floaters, no symptoms were determined as early warning signals for macula-ON. Macula-ON patients more often reported knowing that prognosis would be worse when treated later, even when controlled for previous experience with retinal detachment. CONCLUSION: Macula-ON patients seem to self-refer faster to a healthcare provider, seem more sensitive to floaters and seem more informed. This suggests that increasing awareness, especially about floaters, might increase the proportion of patients with macula still on at the moment of referral to the ophthalmologist.

Quantification of leptin in seminal plasma of buffalo bulls and its correlation with antioxidant status, conventional and computer-assisted sperm analysis (CASA) semen variables.

The present study is the first to quantify leptin in seminal plasma of buffalo and investigate its relationship with seminal attributes. Ten ejaculates each from 10 Murrah buffalo bulls were collected. Semen quality variables such as semen volume, sperm concentration, sperm abnormalities, membrane integrity, antioxidant enzyme activities (superoxide dismutase, catalase and total antioxidant capacity), malondialdehyde (MDA) concentration, as well as sperm kinetics and motility variables were evaluated. The leptin concentration in serum and seminal plasma were estimated by the ELISA method. Bulls were classified in two groups on the basis of sperm concentration with Group I having >800 million sperm/mL and Group II <500 million sperm/mL. Greater (P<0.05) mean sperm abnormalities, seminal leptin concentrations and MDA concentrations were recorded in Group II than Group I. The seminal leptin was positively correlated with sperm abnormalities and MDA concentration while being negatively correlated with sperm concentration, but there was no correlation with sperm kinetic and motility variables, sperm membrane integrity and seminal plasma antioxidant enzyme activity. Thus, the data suggest that seminal leptin has a role in spermatogenesis and can be used as a marker for spermatogenesis to predict the capacity of buffalo bulls for semen production.

Firpronil induced spermotoxicity is associated with oxidative stress, DNA damage and apoptosis in male rats.

The present study is the first to investigate and characterize the fipronil (FPN) induced spermotoxicity in male rats. Male rats were orally given FPN (2.5, 5.0 and 10 mg/kg/day) for 4 weeks. Epididymal sperms were collected and remaining testis was processed for histopathological evaluation. FPN treatment significantly reduced sperm density, motility, viability and per cent intact acrosome along with concomitant increase in spermatozoa abnormalities. Exposure of FPN caused excessive ROS generation, lipid peroxidation and alteration in mitochondrial membrane potential leading to apoptosis of spermatozoa in dose dependent manner. Higher FPN doses (5 and 10 mg/kg) markedly reduced the DNA integrity of spermatozoa. These data suggest that FPN causes male reproductive toxicity through oxidative stress induced DNA damage and apoptosis of spermatozoa.

Homosexuality-related stigma and sexual risk behaviors among men who have sex with men in Hanoi, Vietnam.

This article examined the associations between three forms of homosexuality-related stigma (enacted, perceived, and internalized homosexual stigmas) with risky sexual behaviors, and to describe the mechanisms of these associations, among men who have sex with men (MSM) in Hanoi, Vietnam. We used respondent-driven sampling (RDS) to recruit 451 MSM into a cross-sectional study conducted from August 2010 to January 2011. Data were adjusted for recruitment patterns due to the RDS approach; logistic regression and path analyses were performed. Participants were young and single; most had attended at least some college. Nine out of ten participants engaged in sexual behaviors at moderate to high risk levels. Compared to those who had no enacted homosexual stigma, men having low and high levels of enacted homosexual stigma, respectively, were 2.23 times (95 % CI 1.35-3.69) and 2.20 times (95 % CI 1.04-4.76) more likely to engage in high levels of sexual risk behaviors. In addition, there was an indirect effect of perceived homosexual stigma and internalized homosexual stigma on sexual risk behaviors through depression and drug and alcohol use. Our study provides valuable information to our understanding of homosexual stigma in Vietnam, highlighting the need for provision of coping skills against stigma to the gay community and addressing drinking and drug use among MSM, to improve the current HIV prevention interventions in Vietnam.

Comparison of surveillance sample demographics over two cycles of the National HIV Behavioral Surveillance Project, Houston, Texas.

We examined differences in sample demographics across cycles of the National HIV Behavioral Surveillance project, that examines HIV risk behaviors among men who have sex with men (MSM), injection drug users (IDU), and heterosexuals living in areas of high HIV prevalence (HET). MSM were recruited through venue-based sampling, and IDU and HET through respondent driven sampling (RDS). RDS data were weighted to account for sampling bias. We compared crude prevalence estimates from MSM1 (2004) to those from MSM2 (2008) for demographic factors known to influence risky sexual and drug-use behaviors. We compared crude and adjusted prevalence estimates for IDU1 (2005) and IDU2 (2009) and HET1 (2006) and HET2 (2010). In the MSM cycle, we found differences in age, and the proportions seeking medical care and reporting a recent arrest. There were no differences in the comparison of crude and weighted estimates for the RDS collected samples, nor were there differences comparing HET1 and HET2 weighted estimates. IDU2 recruited a larger proportion of males, and had a higher percent who graduated from high school and who reported recent medical care and a previous HIV test. Differences across MSM cycles may be related to differences in venues identified for each cycle. Differences in the IDU cycles may be due to an effort on our part to increase the racial/ethnic and drug-use diversity of the sample in IDU2. Our findings show the importance of formative work for both venue-based and RDS samples to increase understanding of the dimensions that affect social networks and the dynamics of populations in space and time. With familiarity of the target population, we believe that both venue-based and RDS recruitment approaches for NHBS work well and can be used to evaluate changes in risky sexual and drug use behaviors and in HIV testing behaviors.

Hospital process orientation from an operations management perspective: development of a measurement tool and practical testing in three ophthalmic practices.

BACKGROUND: Although research interest in hospital process orientation (HPO) is growing, the development of a measurement tool to assess process orientation (PO) has not been very successful yet. To view a hospital as a series of processes organized around patients with a similar demand seems to be an attractive proposition, but it is hard to operationalize this idea in a measurement tool that can actually measure the level of PO. This research contributes to HPO from an operations management (OM) perspective by addressing the alignment, integration and coordination of activities within patient care processes. The objective of this study was to develop and practically test a new measurement tool for assessing the degree of PO within hospitals using existing tools. METHODS: Through a literature search we identified a number of constructs to measure PO in hospital settings. These constructs were further operationalized, using an OM perspective. Based on five dimensions of an existing questionnaire a new HPO-measurement tool was developed to measure the degree of PO within hospitals on the basis of respondents' perception. The HPO-measurement tool was pre-tested in a non-participating hospital and discussed with experts in a focus group. The multicentre exploratory case study was conducted in the ophthalmic practices of three different types of Dutch hospitals. In total 26 employees from three disciplines participated. After filling in the questionnaire an interview was held with each participant to check the validity and the reliability of the measurement tool. RESULTS: The application of the HPO-measurement tool, analysis of the scores and interviews with the participants resulted in the possibility to identify differences of PO performance and the areas of improvement--from a PO point of view--within each hospital. The result of refinement of the items of the measurement tool after practical testing is a set of 41 items to assess the degree of PO from an OM perspective within hospitals. CONCLUSIONS: The development and practically testing of a new HPO-measurement tool improves the understanding and application of PO in hospitals and the reliability of the measurement tool. The study shows that PO is a complex concept and appears still hard to objectify.

Effect of single bout versus repeated bouts of stretching on muscle recovery following eccentric exercise.

OBJECTIVES: To analyze the effects of a single bout and repeated bouts of stretching on indirect markers of exercise-induced muscle damage. DESIGN: A randomized controlled clinical trial at a university human research laboratory was conducted. METHODS: Fifty-six untrained males were randomly divided into four groups. (I) a single stretching group underwent a single bout of stretching on the quadriceps muscle; (II) an eccentric exercised group underwent eccentric quadriceps muscle contractions until exhaustion; (III) an eccentric exercise group followed by a single bout of stretching; (IV) an eccentric exercised group submitted to repeated bouts of stretching performed immediately and 24, 48, and 72 h post-exercise. Muscle stiffness, muscle soreness, maximal concentric peak torque, and plasma creatine kinase activity were assessed before exercise and 1, 24, 48, 72, and 96 h post-exercise. RESULTS: All exercised groups showed significant reduction in maximal concentric peak torque and significant increases in muscle soreness, muscle stiffness, and plasma creatine kinase. There were no differences between these groups in all assessed variables, with the exception of markers of muscle stiffness, which were significantly lower in the eccentric exercise group followed by single or repeated bouts. The single stretching group showed no change in any assessed variables during the measurement period. CONCLUSIONS: Muscle stretching performed after exercise, either as single bout or as repeated bouts, does not influence the levels of the main markers of exercise-induced muscle damage; however, repeated bouts of stretching performed during the days following exercise may have favorable effects on muscle stiffness.

Is EEG-biofeedback an effective treatment in autism spectrum disorders? A randomized controlled trial.

EEG-biofeedback has been reported to reduce symptoms of autism spectrum disorders (ASD) in several studies. However, these studies did not control for nonspecific effects of EEG-biofeedback and did not distinguish between participants who succeeded in influencing their own EEG activity and participants who did not. To overcome these methodological shortcomings, this study evaluated the effects of EEG-biofeedback in ASD in a randomized pretest-posttest control group design with blinded active comparator and six months follow-up. Thirty-eight participants were randomly allocated to the EEG-biofeedback, skin conductance (SC)-biofeedback or waiting list group. EEG- and SC-biofeedback sessions were similar and participants were blinded to the type of feedback they received. Assessments pre-treatment, post-treatment, and after 6 months included parent ratings of symptoms of ASD, executive function tasks, and 19-channel EEG recordings. Fifty-four percent of the participants significantly reduced delta and/or theta power during EEG-biofeedback sessions and were identified as EEG-regulators. In these EEG-regulators, no statistically significant reductions of symptoms of ASD were observed, but they showed significant improvement in cognitive flexibility as compared to participants who managed to regulate SC. EEG-biofeedback seems to be an applicable tool to regulate EEG activity and has specific effects on cognitive flexibility, but it did not result in significant reductions in symptoms of ASD. An important finding was that no nonspecific effects of EEG-biofeedback were demonstrated.