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1.
J Pers ; 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38962876

RESUMO

BACKGROUND: Does experiencing adversity engender kindness, and if so, for whom? Two studies tested the hypothesis that adversity predicts increased pro-social outcomes, and that this relationship is strongest for individuals who view others as good and trustworthy, or benevolent. METHOD: In Study 1, a cross-sectional survey design was utilized, and in Study 2 a longitudinal survey was conducted. RESULTS: In Study 1 (N = 359), the number of lifetime adverse life events was associated with increased volunteering, empathic concern, and self-reported altruism. The association of adversity and altruism was stronger for those with greater benevolence beliefs. In Study 2 (N = 1157), benevolence beliefs were assessed, and in subsequent years, adverse life events were reported. The number of past-year adverse life events predicted more volunteering and charitable involvement, but only among people with high benevolence beliefs. CONCLUSION: Exposure to adversity may be associated with increased pro-social behavior among those with higher benevolence beliefs. In part, this could be due to benevolence beliefs increasing the expectation that one's efforts will be appreciated and reciprocated.

3.
J Urban Health ; 100(4): 666-675, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37526855

RESUMO

Vacant and abandoned buildings are common features in many post-industrial US cities, and are consistent predictors of violence. Demolition programs are regularly employed as an urban land use policy to stabilize housing markets and mitigate public health problems including violence. The objective of this research was to examine the effect of vacant building removals on violent and property crimes in Baltimore, MD from 2014 to 2019. We conducted a difference-in-differences analysis using spatio-temporal Bayesian mixed models on six crime types on block faces with and without building removals, before compared with after removal. There were significant reductions in total, violent crimes (with and without assaults), thefts, and burglaries on block faces with building removals relative to their controls. Total crimes decreased 1.4% per mi2 (CrI: 0.5 - 2.3%), which translates to a relative reduction ~ 2.6 total crimes per mi2 per year. The largest relative decreases in crime were found among assaults (4.9%; CrI: 3.4 - 6.3%) and violent crimes (3.0%; CrI: 1.9 - 4.1%). Building removals were associated with relative reductions in crime in Baltimore City. The relative reductions in crime, at building removals compared to at control vacant lots, were found among assaults and violent crimes, the crimes of greatest public health concern. Building removals provide co-benefits to their communities, and may be considered part of a crime reduction strategy compatible with other approaches. A systematic effort to understand the role of care for remaining vacant lots could further inform our findings, and efforts to further decrease violence and improve community health.


Assuntos
Crime , Violência , Humanos , Baltimore/epidemiologia , Teorema de Bayes , Roubo
4.
J Environ Manage ; 321: 115928, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35985262

RESUMO

Harmful algal blooms (HABs) remain a persistent issue that threatens both the physical and economic health of the Western Lake Erie basin (WLEB). Edge-of-field conservation practices are recommended to help manage agricultural runoff and reach phosphorus reduction targets in freshwater systems like the Great Lakes (in the USA). Constructed wetlands (CWs) are a specific edge-of-field practice that could prove critical to these efforts. While we know less about why wetlands are installed or implemented than many other private lands conservation practices, prior research does indicate that offsetting the costs of land taken out of production, or targeting land that is not suitable for production will be critical. Our research builds on these findings by assessing how the perceived productivity of the land moderates the relationship between other potential motivating factors and willingness to install wetlands. We also assess how these critical motivations may vary by the conservation-mindedness of the farmer. Our results indicate that the decision to install a constructed wetland is not entirely dependent on the productivity of the land. Associated beneficial functions (e.g., aesthetics, hunting opportunities) positively influence willingness, even on productive land for those farmers who value conservation. We suggest that program providers emphasize the diverse benefits of constructed wetlands, and target farmers who exhibit stronger conservation identities as they may be more likely to consider wetlands regardless of the productivity of their land.


Assuntos
Lagos , Áreas Alagadas , Fazendeiros , Proliferação Nociva de Algas , Humanos , Fósforo
5.
Behav Res Methods ; 54(5): 2479-2501, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35018608

RESUMO

This paper describes a smart tablet-based drawing app to digitally record participants' engagement with the Rey-Osterrieth complex figure (ROCF) task, a well-characterised perceptual memory task that assesses local and global memory. Digitisation of the tasks allows for improved ecological validity, especially in children attracted to tablet devices. Further, digital translation of the tasks affords new measures, including accuracy and computation of the fine motor control kinematics employed to carry out the drawing Here, we report a feasibility study to test the relationship between two neurodevelopmental conditions: autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The smart tablet app was employed with 39 adult participants (18-35) characterised for autistic and ADHD traits, and scored using the ROCF perceptual and organisational scoring systems. Trait scores and conditions were predictor variables in linear regression models. Positive correlations were found between the attention-to-detail, attention-switching and communication subscales of the autistic trait questionnaire and organisational scores on the ROCF task. These findings suggest that autistic traits might be linked to differential performance on the ROCF task. Novelty and future applications of the app are discussed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno Autístico , Aplicativos Móveis , Criança , Adulto , Humanos , Testes Neuropsicológicos
6.
Nat Commun ; 12(1): 6217, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728617

RESUMO

Natural sounds, and bird song in particular, play a key role in building and maintaining our connection with nature, but widespread declines in bird populations mean that the acoustic properties of natural soundscapes may be changing. Using data-driven reconstructions of soundscapes in lieu of historical recordings, here we quantify changes in soundscape characteristics at more than 200,000 sites across North America and Europe. We integrate citizen science bird monitoring data with recordings of individual species to reveal a pervasive loss of acoustic diversity and intensity of soundscapes across both continents over the past 25 years, driven by changes in species richness and abundance. These results suggest that one of the fundamental pathways through which humans engage with nature is in chronic decline, with potentially widespread implications for human health and well-being.


Assuntos
Acústica , Aves/fisiologia , Vocalização Animal/fisiologia , Animais , Biodiversidade , Aves/classificação , Conservação dos Recursos Naturais , Europa (Continente) , Humanos , América do Norte , Dinâmica Populacional , Estações do Ano , Som , Vocalização Animal/classificação
7.
Psychol Sci ; 32(11): 1699-1708, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34705576

RESUMO

Mindfulness appears to promote individual well-being, but its interpersonal effects are less clear. Two studies in adult populations tested whether the effects of mindfulness on prosocial behavior differ according to individuals' self-construals. In Study 1 (N = 366), a brief mindfulness induction, compared with a meditation control condition, led to decreased prosocial behavior among people with relatively independent self-construals but had the opposite effect among those with relatively interdependent self-construals. In Study 2 (N = 325), a mindfulness induction led to decreased prosocial behavior among people primed with independence but had the opposite effect among those primed with interdependence. The effects of mindfulness on prosocial behavior appear to depend on individuals' broader social goals. This may have implications for the increasing popularity of mindfulness training around the world.


Assuntos
Meditação , Atenção Plena , Adulto , Altruísmo , Humanos
8.
Addict Res Theory ; 29(2): 117-128, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33883975

RESUMO

The literature consistently finds that areas with greater density of alcohol outlets (places that sell alcohol) tend to have higher levels of public health harms. However, conflicting findings arise when researchers drill down to identify the type(s) of alcohol outlets with the strongest associations with harms and the mechanisms that explain these associations. These disagreements could be a result of the outdated methods commonly used to quantify the alcohol environment: counts of the number of outlets in an area. This manuscript reviews the events and ideas that shaped the literature on the physical alcohol environment. It then defines the three main methods used to measure alcohol outlet density, conducts an exploratory factor analysis to explore the constructs underlying each method, and presents a novel conceptual framework that summarizes the three methods, their respective underlying constructs, and the setting(s) in which each may be most appropriate. The framework proposes that counts of alcohol outlets measure availability, proximity to the nearest outlet measures accessibility, and spatial access measures measure access, which comprises both availability and accessibility. We argue that researchers should consider using proximity and spatial access measures when possible and outline how doing so may present opportunities to advance theory and the design and implementation of alcohol outlet zoning regulations. Finally, this manuscript draws on research from other areas of the built environment to suggest opportunities to use novel methods to overcome common hurdles (e.g., separating subtypes of outlets, ecologic designs) and a new challenge on the horizon: home delivery.

9.
JDR Clin Trans Res ; 6(4): 368-381, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33030085

RESUMO

OBJECTIVES: To conduct a systematic review and meta-analysis to assess whether individuals with nonsyndromic orofacial clefts (OCs) display a higher frequency of dental anomalies (DAs) when compared with individuals without OCs. METHODS: A literature search of indexed databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and LILACS) was conducted without language restriction up to and including February 1, 2020. Cross-referencing was used to further identify articles. Several cleft teams across the United States and Europe were contacted to obtain unpublished data. The eligibility criteria were observational studies with original data that statistically compared individuals with OC without syndromes and those without OC on any type of DA in primary and/or permanent dentition. Random effects meta-analysis through the Mantel-Haenszel estimator was used to evaluate the association between OC and DA based on odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The literature search generated 933 records, and 75 full-text articles were reviewed. Twenty-six studies encompassing 15,213 individuals met the inclusion criteria. The meta-analysis revealed statistically significant associations between OC and agenesis (OR, 14.2; 95% CI, 9.4 to 21.3), supernumerary teeth (OR, 5.7; 95% CI, 3.3 to 9.7), developmental enamel defects (OR, 5.6; 95% CI, 3.5 to 9.0), microdontia (OR, 14.8; 95% CI, 4.0 to 54.6), peg-shaped anterior teeth (OR, 12.2; 95% CI, 3.6 to 41.2), taurodontism (OR, 1.7; 95% CI, 1.0 to 2.7), tooth malposition and/or transposition (OR, 5.6; 95% CI, 2.8 to 11.5), tooth rotation (OR, 3.2; 95% CI, 1.3 to 8.2), and tooth impaction (OR, 3.6; 95% CI, 1.1 to 12.2). The OR estimates of the reviewed studies exhibited significant heterogeneity (P < 0.0001). No association was observed between OC and fusion and/or gemination. CONCLUSION: Within the limitations of this study, the available evidence suggests that individuals with OCs are more likely to present with a range of DAs than their unaffected peers. KNOWLEDGE TRANSFER STATEMENT: The findings of the current review suggest that individuals with orofacial clefts (OCs) are more likely to present with a range of dental anomalies than their unaffected peers. Understanding the association between OCs and dental anomalies is essential in guiding clinicians during treatment-planning procedures and is important in raising our awareness of the possible need for future dental treatment for patients with OCs.


Assuntos
Fenda Labial , Fissura Palatina , Anormalidades Dentárias , Dente Supranumerário , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Dentição Permanente , Humanos , Anormalidades Dentárias/epidemiologia
10.
Int J Drug Policy ; 82: 102808, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32531514

RESUMO

Greater densities of alcohol outlets are associated with greater incidence of alcohol-related harms. In Australia, public health advocates aiming to limit alcohol availability expend significant energy objecting to new outlets in licensing and planning hearings. This study identifies and reviews the key scientific arguments put forward by industry and public health representatives in liquor and planning hearings to determine the factors that contribute to decisions by the presiding authority and to identify ways forward for researchers wishing to facilitate harm minimisation through these regulatory forums. Scientific evidence presented in 23 cases from Victoria, New South Wales and Western Australia between 2010 and 2018 were assessed using directed content analysis. Cases were identified through the AustLii and Westlaw online databases. The full transcripts of two cases that were identified as representative of the scientific arguments presented in other included cases were also reviewed. Four main arguments that industry used during hearings were identified-causal inference, non-linearities, differentiation and risk mitigation. These arguments were used across many included hearings and raised fundamental questions that public health evidence was often ill-equipped to respond to. The overall success of industry arguments in liquor and planning hearings highlighted the challenges of applying epidemiological evidence to individual case studies. These findings have particular implications and will be of use for researchers and public health experts participating in future licensing hearings, especially those wishing to prevent alcohol-related harm through regulatory mechanisms such as state licensing authorities (i.e. courts).


Assuntos
Consumo de Bebidas Alcoólicas , Saúde Pública , Bebidas Alcoólicas , Humanos , New South Wales , Vitória , Austrália Ocidental
11.
BJA Educ ; 19(10): 329-333, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33456854
12.
Oncogene ; 37(4): 439-449, 2018 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-28967901

RESUMO

Toll-like receptor 5 (TLR5) is considered an attractive target for anticancer immunotherapy. TLR5 agonists, bacterial flagellin and engineered flagellin derivatives, have been shown to have potent antitumor and metastasis-suppressive effects in multiple animal models and to be safe in both animals and humans. Anticancer efficacy of TLR5 agonists stems from TLR5-dependent activation of nuclear factor-κB (NF-κB) that mediates innate and adaptive antitumor immune responses. To extend application of TLR5-targeted anticancer immunotherapy to tumors that do not naturally express TLR5, we created an adenovirus-based vector for intratumor delivery, named Mobilan that drives expression of self-activating TLR5 signaling cassette comprising of human TLR5 and a secreted derivative of Salmonella flagellin structurally analogous to a clinical stage TLR5 agonist, entolimod. Co-expression of TLR5 receptor and agonist in Mobilan-infected cells established an autocrine/paracrine TLR5 signaling loop resulting in constitutive activation of NF-κB both in vitro and in vivo. Injection of Mobilan into primary tumors of the prostate cancer-prone transgenic adenocarcinoma of the mouse prostate (TRAMP) mice resulted in a strong induction of multiple genes involved in inflammatory responses and mobilization of innate immune cells into the tumors including neutrophils and NK cells and suppressed tumor progression. Intratumoral injection of Mobilan into subcutaneously growing syngeneic prostate tumors in immunocompetent hosts improved animal survival after surgical resection of the tumors, by suppression of tumor metastasis. In addition, vaccination of mice with irradiated Mobilan-transduced prostate tumor cells protected mice against subsequent tumor challenge. These results provide proof-of-concept for Mobilan as a tool for antitumor vaccination that directs TLR5-mediated immune response toward cancer cells and does not require identification of tumor antigens.


Assuntos
Adenoviridae/genética , Vacinas Anticâncer/uso terapêutico , Vetores Genéticos/uso terapêutico , NF-kappa B/imunologia , Neoplasias da Próstata/terapia , Receptor 5 Toll-Like/metabolismo , Adjuvantes Imunológicos/genética , Adjuvantes Imunológicos/metabolismo , Adjuvantes Imunológicos/uso terapêutico , Animais , Vacinas Anticâncer/genética , Vacinas Anticâncer/imunologia , Linhagem Celular Tumoral , Vetores Genéticos/genética , Vetores Genéticos/imunologia , Humanos , Imunoterapia/métodos , Injeções Intralesionais , Células Matadoras Naturais , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Peptídeos/genética , Peptídeos/imunologia , Peptídeos/metabolismo , Cultura Primária de Células , Próstata/patologia , Neoplasias da Próstata/genética , Neoplasias da Próstata/imunologia , Neoplasias da Próstata/mortalidade , Transdução de Sinais/imunologia , Receptor 5 Toll-Like/agonistas , Receptor 5 Toll-Like/genética , Receptor 5 Toll-Like/imunologia , Ensaios Antitumorais Modelo de Xenoenxerto
13.
Chem Sci ; 8(7): 4872-4878, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28959411

RESUMO

A carbon dioxide and nitrous oxide solid solution has been captured in a diamond anvil cell following the thermal decomposition of 1,3,5-trinitroperhydro-1,3,5-triazine (RDX) at high temperatures and pressures. This is the first time a carbon dioxide binary solid has been observed at high pressure. This observation has stimulated low temperature crystallographic studies of this binary system using recently developed gas absorption apparatus and computational modelling.

15.
Int J Obes (Lond) ; 40(6): 921-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26984418

RESUMO

BACKGROUND/OBJECTIVE: Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. SUBJECTS/METHODS: To explore the potential involvement of a powerful brainstem anorexia pathway centered around the lateral parabrachial nucleus (lPBN), we measured meal-induced neuronal activation by means of c-Fos immunohistochemistry in a new high-fat diet-induced obese mouse model of Roux-en-Y gastric bypass (RYGB) at 10 and 40 days after RYGB or sham surgery. RESULTS: Voluntary ingestion of a meal 10 days after RYGB, but not after sham surgery, strongly and selectively activates calcitonin gene-related peptide neurons in the external lPBN as well as neurons in the nucleus tractus solitarius, area postrema and medial amygdala. At 40 days after surgery, meal-induced activation in all these areas was greatly diminished and did not reach statistical significance. CONCLUSIONS: The neural activation pattern and dynamics suggest a role of the brainstem anorexia pathway in the early effects of RYGB on meal size and food intake that may lead to adaptive neural and behavioral changes involved in the control of food intake and body weight at a lower level. However, selective inhibition of this pathway will be required for a more causal implication.


Assuntos
Anorexia/fisiopatologia , Modelos Animais de Doenças , Ingestão de Alimentos , Comportamento Alimentar , Derivação Gástrica , Núcleos Parabraquiais/fisiopatologia , Animais , Dieta Hiperlipídica , Imuno-Histoquímica , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/patologia , Obesidade/cirurgia , Resposta de Saciedade
16.
Oncogene ; 35(15): 2003-10, 2016 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-26165835

RESUMO

Genotoxic stresses lead to centrosome amplification, a frequently-observed feature in cancer that may contribute to genome instability and to tumour cell invasion. Here we have explored how the centrosome controls DNA damage responses. For most of the cell cycle, centrosomes consist of two centrioles embedded in the proteinaceous pericentriolar material (PCM). Recent data indicate that the PCM is not an amorphous assembly of proteins, but actually a highly organised scaffold around the centrioles. The large coiled-coil protein, pericentrin, participates in PCM assembly and has been implicated in the control of DNA damage responses (DDRs) through its interactions with checkpoint kinase 1 (CHK1) and microcephalin (MCPH1). CHK1 is required for DNA damage-induced centrosome amplification, whereas MCPH1 deficiency greatly increases the amplification seen after DNA damage. We found that the PCM showed a marked expansion in volume and a noticeable change in higher-order organisation after ionising radiation treatment. PCM expansion was dependent on CHK1 kinase activity and was potentiated by MCPH1 deficiency. Furthermore, pericentrin deficiency or mutation of a separase cleavage site blocked DNA damage-induced PCM expansion. The extent of nuclear CHK1 activation after DNA damage reflected the level of PCM expansion, with a reduction in pericentrin-deficient or separase cleavage site mutant-expressing cells, and an increase in MCPH1-deficient cells that was suppressed by the loss of pericentrin. Deletion of the nuclear export signal of CHK1 led to its hyperphosphorylation after irradiation and reduced centrosome amplification. Deletion of the nuclear localisation signal led to low CHK1 activation and low centrosome amplification. From these data, we propose a feedback loop from the PCM to the nuclear DDR in which CHK1 regulates pericentrin-dependent PCM expansion to control its own activation.


Assuntos
Antígenos/fisiologia , Proteínas de Ciclo Celular/fisiologia , Centrossomo/fisiologia , Dano ao DNA , Proteínas do Tecido Nervoso/fisiologia , Proteínas Associadas à Matriz Nuclear/fisiologia , Proteínas Quinases/metabolismo , Processamento de Proteína Pós-Traducional/fisiologia , Animais , Antígenos/genética , Sítios de Ligação , Proteínas de Ciclo Celular/genética , Linhagem Celular Tumoral , Centríolos/metabolismo , Centríolos/ultraestrutura , Centrossomo/efeitos da radiação , Centrossomo/ultraestrutura , Quinase 1 do Ponto de Checagem , Galinhas , Ativação Enzimática , Retroalimentação Fisiológica , Genes Reporter , Mutação , Proteínas de Neoplasias/metabolismo , Proteínas do Tecido Nervoso/deficiência , Proteínas do Tecido Nervoso/genética , Proteínas Associadas à Matriz Nuclear/genética , Fosforilação , Proteínas Recombinantes de Fusão/metabolismo , Separase/metabolismo
17.
Br J Dermatol ; 174(2): 398-401, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26286218

RESUMO

Plasmablastic lymphoma (PBL) is an unusual subtype of non-Hodgkin lymphoma recently classified as a diffuse immunoblastic lymphoma with a plasma-cell immunophenotype. Originally described in the oral cavity of HIV-positive patients, it has also been recognized to occur rarely at other sites. We describe a previously unreported fistulizing presentation of Epstein-Barr virus (EBV)-positive PBL, reviewing its association with HIV-1 infection and its importance as an AIDS-defining malignancy.


Assuntos
Neoplasias do Ânus/patologia , Infecções por Vírus Epstein-Barr/patologia , Soropositividade para HIV , Linfoma Plasmablástico/patologia , Fístula Retal/patologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Neoplasias do Ânus/virologia , Biópsia , Herpesvirus Humano 4 , Humanos , Masculino , Pessoa de Meia-Idade , Linfoma Plasmablástico/virologia , Fístula Retal/virologia
18.
Int J Obes Suppl ; 6(Suppl 1): S37-S43, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28685029

RESUMO

The relatively stable body weight during adulthood is attributed to a homeostatic regulatory mechanism residing in the brain which uses feedback from the body to control energy intake and expenditure. This mechanism guarantees that if perturbed up or down by design, body weight will return to pre-perturbation levels, defined as the defended level or set point. The fact that weight re-gain is common after dieting suggests that obese subjects defend a higher level of body weight. Thus, the set point for body weight is flexible and likely determined by the complex interaction of genetic, epigenetic and environmental factors. Unlike dieting, bariatric surgery does a much better job in producing sustained suppression of food intake and body weight, and an intensive search for the underlying mechanisms has started. Although one explanation for this lasting effect of particularly Roux-en-Y gastric bypass surgery (RYGB) is simple physical restriction due to the invasive surgery, a more exciting explanation is that the surgery physiologically reprograms the body weight defense mechanism. In this non-systematic review, we present behavioral evidence from our own and other studies that defended body weight is lowered after RYGB and sleeve gastrectomy. After these surgeries, rodents return to their preferred lower body weight if over- or underfed for a period of time, and the ability to drastically increase food intake during the anabolic phase strongly argues against the physical restriction hypothesis. However, the underlying mechanisms remain obscure. Although the mechanism involves central leptin and melanocortin signaling pathways, other peripheral signals such as gut hormones and their neural effector pathways likely contribute. Future research using both targeted and non-targeted 'omics' techniques in both humans and rodents as well as modern, genetically targeted, neuronal manipulation techniques in rodents will be necessary.

19.
J Plast Reconstr Aesthet Surg ; 68(11): 1529-35, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26272008

RESUMO

INTRODUCTION: The deep inferior epigastric artery perforator (DIEAP) flap is currently considered the gold standard for autologous breast reconstruction. With the current economic climate and health cutbacks, we decided to survey reimbursement for DIEAP flaps performed at the main international centres in order to assess whether they are funded consistently. METHODS: Data were collected confidentially from the main international centres by an anonymous questionnaire. RESULTS: Our results illustrate the wide disparity in international DIEAP flap breast reconstruction reimbursement: a unilateral DIEAP flap performed in New York, USA, attracts €20,759, whereas the same operation in Madrid, Spain, will only be reimbursed for €300. Only 35.7% of the surgeons can set up their own fee. Moreover, 85.7% of the participants estimated that the current fees are insufficient, and most of them feel that we are evolving towards an even lower reimbursement rate. In 55.8% of the countries represented, there is no DIEAP-specific coding; in comparison, 74.4% of the represented countries have a specific coding for transverse rectus abdominis (TRAM) flaps. Finally, despite the fact that DIEAP flaps have become the gold standard for breast reconstruction, they comprise only a small percentage of all the total number of breast reconstruction procedures performed (7-15%), with the only exception being Belgium (40%). CONCLUSION: Our results demonstrate that DIEAP flap breast reconstruction is inconsistently funded. Unfortunately though, it appears that the current reimbursement offered by many countries may dissuade institutions and surgeons from offering this procedure. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction, and, in our opinion, the long-term clinical benefits for our patients are so important that this investment of time and money is absolutely essential.


Assuntos
Artérias Epigástricas/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Mamoplastia/economia , Retalho Perfurante/irrigação sanguínea , Mecanismo de Reembolso/economia , Inquéritos e Questionários , Custos e Análise de Custo , Feminino , Humanos , Mamoplastia/métodos , Retalho Perfurante/economia
20.
J Contam Hydrol ; 179: 55-64, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26047819

RESUMO

Vapor-phase multi-stage contaminant mass discharge (CMD) tests were conducted at three field sites to measure mass discharge associated with contaminant sources located in the vadose zone. The three sites represent the three primary stages of the soil vapor extraction (SVE) operations lifecycle-pre/initial-SVE, mid-lifecycle, and near-closure. A CMD of 32g/d was obtained for a site at which soil vapor SVE has been in operation for approximately 6years, and for which mass removal is currently in the asymptotic stage. The contaminant removal behavior exhibited for the vapor extractions conducted at this site suggests that there is unlikely to be a significant mass of non-vapor-phase contaminant (e.g., DNAPL, sorbed phase) remaining in the advective domains, and that most remaining mass is likely located in poorly accessible domains. Given the conditions for this site, this remaining mass is hypothesized to be associated with the low-permeability (and higher water saturation) region in the vicinity of the saturated zone and capillary fringe. A CMD of 25g/d was obtained for a site wherein SVE has been in operation for several years but concentrations and mass-removal rates are still relatively high. A CMD of 270g/d was obtained for a site for which there were no prior SVE operations. The behavior exhibited for the vapor extractions conducted at this site suggest that non-vapor-phase contaminant mass (e.g., DNAPL) may be present in the advective domains. Hence, the asymptotic conditions observed for this site most likely derive from a combination of rate-limited mass transfer from DNAPL (and sorbed) phases present in the advective domain as well as mass residing in lower-permeability ("non-advective") regions. The CMD values obtained from the tests were used in conjunction with a recently developed vapor-discharge tool to evaluate the impact of the measured CMDs on groundwater quality.


Assuntos
Água Subterrânea , Hidrologia/métodos , Compostos Orgânicos Voláteis/análise , Poluentes Químicos da Água/análise , Arizona , Recuperação e Remediação Ambiental , Gases , Água Subterrânea/análise , Água Subterrânea/química , Solo/química , Poluentes do Solo/análise , Utah , Água , Qualidade da Água
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