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Anesthesiology and Medicine, General & Internal

HORTICULTURE, Rhapis excelsa, coconut husk, fertilizers, casca de coco, and adubos

As avaliações foram realizadas em quatro substratos compostos de mistura de fibra de coco triturada (FC) e substrato comercial Plantmax HT® (SC), nas proporções de 0, 25, 50 e 75% de FC, em vasos com capacidade para 35 L, em delineamento de blocos ao acaso, com quatro repetições e três vasos por parcela, com uma planta por vaso. A adubação das plantas foi feita alternando-se, a cada três meses, 25 g de 4-14-8 com 10 g de uréia por vaso, a partir do plantio e durante os 24 meses do período experimental. O crescimento foi avaliado medindo-se a altura da haste inicial (da base do caule à inserção da última folha completamente expandida), número de folhas da haste inicial, número de perfilhos, número de folhas dos perfilhos, altura dos perfilhos e teores de nutrientes da última folha completamente expandida da haste inicial. A qualidade foi avaliada através de análise sensorial visual, baseado nos critérios "gostei"(muito ou pouco) e "compraria"(sim ou não). Não houve diferença entre os tratamentos sobre as características de crescimento, exceto para o número de folhas da haste inicial. As plantas com melhor aceitação foram aquelas cultivadas na mistura com 50% FC e 50% SC. Nenhuma das plantas apresentou sintoma visual de deficiência de nutrientes, sendo os teores foliares encontrados em plantas sadias com padrão de qualidade para comercialização de: 17,80 - 18,29 g kg-1 de N; 0,66 - 0,81 g kg-1 de NO-3; 2,02 - 2,34 g kg-1 de P; 18,11 - 20,40 g kg-1 de K; 11,63 - 13,84 g kg-1 de Cl; 2,69 - 4,04 g kg-1 de Ca; 1,61 - 2,07 g kg-1 de S; 1,98 - 2,64 g kg-1 de Mg.
It was evaluated the quality and nutrient content of lady palm in four substrates made up of a mixture of shredded coconut fiber (FC) and commercial substrate Plantmax HT® (SC), in proportions of 0, 25, 50 and 75% of FC, in 35 liters containers, in a randomized block experiment with four replicates and three pots per plot, with one plant per pot. The plants were fertilized every three months alternating 25 g of 4-14-8 with 10 g of urea per pot, at planting and throughout the 24 months of the experimental period. Growth was evaluated by measuring the height of the initial stem (from the stem base to leaf insertion of the most recently expanded leaf), number of leaves in the original stem, number of offsets, number of leaves in offsets, offset height and nutrient content of last completely expanded leaf in the initial stem. The quality was evaluated by visual sensorial analysis using the criteria "I liked it"(a lot or a little) and "I would buy it"(yes or no). There was no significant difference on the growth characteristics among treatments, except on the number of leaves of the initial stem. Plants with the best acceptance were those grown in the mixture 50% FC and 50 % SC. None of the plants showed visual nutrient deficiency symptoms; the leaf nutrient content of healthy plants with market quality standards were: 17.80 - 18.29 g kg-1 of N; 0.66 - 0.81 g kg-1 of NO-3 ; 2.02 - 2.34 g kg-1 of P; 18.11 - 20.40 g kg-1 of K; 11.63 - 13.84 g kg-1 of Cl; 2.69 - 4.04 g kg-1 of Ca; 1.61 - 2.07 g kg-1 of S; 1.98 - 2.64 g kg-1 of Mg.

AGRICULTURAL ECONOMICS & POLICY, AGRICULTURAL ENGINEERING, AGRICULTURE, DAIRY & ANIMAL SCIENCE, AGRICULTURE, MULTIDISCIPLINARY, AGRONOMY, biological agents, fungi disease, Phaseolus vulgaris, seed coating, agentes biológicos, enfermedades fúngicas, and recubrimiento a la semilla

RESUMEN Se evaluó el efecto del tratamiento a las semillas con cepas de actinomicetos (EA2, CB14 y su combinación) sobre la incidencia de la marchitez de las posturas causadas por Rhizoctonia solani Kühn en Phaseolus vulgaris L. cv. Velasco largo en condiciones de casa de cultivo. Se comparó con Trichoderma harzianum A-34, Celest®Top 312 FS y dos controles (positivo y negativo). Se empleó suelo Pardo mullido medianamente lavado estéril y no estéril, bajo un diseño completamente aleatorizado. El tratamiento a la semilla fue realizado por recubrimiento, con almidón de yuca 8 % como adherente. La incidencia por R. solani se determinó a los 21 días posteriores a la siembra de las semillas. En el suelo no estéril se encontraron las menores incidencias provocadas por R. solani con el uso del Celest®Top 312 FS, el cual no difirió de la combinación de actinomicetos CB14+EA2, pero sí respecto al resto de los tratamientos. En el suelo estéril, los menores porcentajes de incidencia se obtuvieron al utilizar la combinación de cepas de actinomicetos (CB14+EA2)
The effect of seed treatment with the actinomycetes strains EA2 and CB14, and their combination, on damping-off incidence caused by Rhizoctonia solani Kühn in Phaseolus vulgaris L. cv. Velasco largo was evaluated under greenhouse conditions. These strains were compared with Trichoderma harzianum A-34, Celest®Top 312 FS and two controls (positive and negative). Inceptisol sterile and non-sterile soil was used under a completely randomized design. The coating seeds with strains were made using 8 % cassava starch. The incidence of R. solani was determined 21 days after sowing. In non-sterile soil, the lowest incidences caused by R. solani were found with Celest®Top 312 FS, which did not significantly differ from the combination of actinomycete strains CB14 + EA2, but yes with the rest of the treatments. In the sterile soil, the lowest percentages of incidences were obtained with the combination of actinomycete strains (CB14 + EA2)

SURGERY, varicose veins, great saphenous vein, reflux patterns, eco-Doppler, veias varicosas, grande veia safena, and padrões de refluxo

Introduction: Varicose veins are frequent and cause problems for patients and health care services. Varicose vein surgery is one of the three more frequent surgical procedures. Eco-Doppler observations have changed completely concepts of varicose veins beginning and progression with great reflex on clinical practice and treatment. Eco-Doppler as shown great saphenous vein (GSV) as an interfascial vein and not a superficial one, varicose veins with competent saphenofemoral junction as well as varicose veins just involving collaterals or collaterals with segments of GSV but not a continuous descending involvement of the GSV. Consequently two main patterns of venous reflux as been defined: the axial reflux with a continuous reflux of GSV trunk from groin to malleolus and the segmental reflux with reflux of segments of saphenous trunk but not a continuous descending reflux starting at the junction. This segmental reflux pattern presents in our practice three sub-types: sub-type 1, just involving superficial branches, sub-type 2, involving superficial branches plus segments of saphenous trunk and sub-type 3 with reflux of saphenofemoral junction plus tight collateral, with a non dilated GSV bellow the confluence of this collateral. Aim: Can we preserve the GSV when treating varicose veins with a segmental reflux pattern? Can we do a much lesser aggressive and quick surgery with equal or even better results as with classic surgery? Metolodgy: 54 consecutive patients with segmental reflux pattern operated on with phlebectomy of varicose superficial collaterals and with preservation of GSV. Clinical follow-up with symptomatic relieve, cosmetic results and no recurrence of varicose veins expressed as worthwhile surgery. Eco-Doppler follow - up expressed as: disappearance of previous segmental reflux of GSV, maintenance of previous reflux or progression of segmental reflux to an axial one. Mean follow-up time: 12,1 months. Results: Clinical results: 98,5 of patients consider surgery as worthwhile. Eco-Doppler results: 58% with no reflux, 40 % with maintenance of previous reflux and just 1 case (2%) with progression of reflux to an axial pattern. Conclusions: Clinical and eco-Doppler results of our study, support preservation of GSV when the pattern of reflux is a segmental one. The answer to our question: can we preserve the GSV is a positive yes we can. Our findings also support the concept that varicose veins are a local and multifocal process starting at any vein segment and not a progressive descending one starting at the sapheno-femoral- junction. Superficial varicose branches appear as main players and not the saphenous trunk as consider before.
Introdução: As varizes dos membros inferiores são situação muito frequente causando problemas aos doentes e ao SNS. A cirurgia das varizes é das três mais frequentes cirurgias. As observações do exame eco-Doppler vieram revolucionar o conceito de aparecimento e progressão das varizes dos membros inferiores com reflexo no tratamento das mesmas. As observações do eco-Doppler mostraram a grande veia safena como uma veia interfascial e não superficial, veias varicosas com junção safeno femoral competente, bem como veias varicosas que envolvem somente veias colaterais ou veias colaterais e segmentos da grande veia safena, mas sem um envolvimento descendente progressivo desta veia a partir da juncao com a veia femural. Consequentemente foram definidos dois padrões principais de refluxo venoso: o refluxo axial com envolvimento contínuo descendente da grande veia safena desde a junção safenofemoral ao maléolo e o refluxo segmentar com envolvimento de segmentos da grande veia safena e/ou veias colaterais, mas sem continuidade descendente da GVS. O padrão de refluxo segmentar surge na nossa prática clinica com 3 subtipos: no subtipo 1 estão apenas refuxivos ramos superficiais, no subtipo 2 estão envolvidos ramos superficiais e segmentos da grande veia safena, mas sem refluxo descendente continuo da GVS e no subtipo 3 verifica-se refluxo ao nível da junção safenofemoral e de veias colaterais da coxa estando a GVS normal e sem refluxo abaixo da confluência da colateral varicosa. Objetivo: Na cirurgia das varizes dos membros inferiores com padrão de refluxo segmentar é possível proceder a simples flebectomias das colaterais varicosas preservando a GVS? ou seja proceder a uma cirurgia menos invasiva com iguais ou melhores resultados que a cirurgia clássica? Metodologia: Foram operados 54 doentes com padrão de refluxo segmentar com flebectomia das colaterais varicosas e preservação da grande veia safena. O seguimento clínico considerou o alívio sintomático e resultados cosméticos e a não recorrência de varizes, avaliados pela equipa cirúrgica e os doentes como cirurgia que valeu a pena. O seguimento por eco-Doppler classificou os refluxos segmentares prévios em: desaparecimento, persistência ou progressão para refluxo axial. O tempo médio de seguimento foi de 12,1 meses. Resultados clínicos: 98.5% dos doentes avaliaram a cirurgia como positiva. Resultados do Eco-Doppler: 58% com ausência de refluxo, 40% com persistência de refluxo e 1 caso (2%) com progressão do refluxo. Conclusão: Os resultados clínicos e seguimento por eco-Doppler, sustentam como possível a preservação da GVS nos doentes com padrão de refluxo segmentar. A resposta à questão: podemos preservar a GVS quando o refluxo é segmentar? é um sim podemos. Os nossos achados são também a favor do conceito de que as veias varicosas são um processo local e multifocal com início em qualquer segmento de veias colaterais ou safenas e não um processo descendente do tronco da safena com início na junção safenofemoral. As colaterais varicosas superficiais aparentam ter um papel de actor principal neste processo e não o tronco da veia safena, como considerado no conceito clássico.

Education & Educational Research, Education, Scientific Disciplines, Nursing, child abuse, child sexual abuse, prevention, abuso infantil, abuso sexual infantil, and prevención

El abuso sexual infantil se presenta mayormente a nivel intrafamiliar es decir son los padres, tíos, hermanos, padrastros, que se aprovechan de la inocencia del niño, situación esta que impacta en gran manera su vida; el presente estudio tuvo como propósito Determinar el Nivel de conocimiento que poseen los padres en Relación al Abuso Sexual Infantil. Se efectuó un estudio de campo de carácter descriptivo, no experimental transeccional. La población considerada estuvo conformada por 80 madres de los niños y niñas en edad escolar del sector Colinas de Mara II, Morón, estado Carabobo. La muestra correspondió 25% de la población objeto del estudio es decir 19 madres. La recolección de la información se obtuvo a través de un cuestionario con 19 ítems, de alternativas de respuestas dicotómicas (SÍ-NO), siendo validado por juicio de expertos. Y un coeficiente de confialidad de 0,79 por el método de alfa de Crombach. Del Análisis de los resultados se Concluyó, que un 50% de los padres encuestados no dialogan con su hijos sobre esta situación, medida vital que permite prevenir el abuso sexual infantil, lo que hace más relevante la necesidad de poner en práctica estrategias educativas para la prevención del abuso sexual infantil y así contribuir a combatir este flagelo social.
Child sexual abuse occurs mostly within the family, i.e. the parents, uncles, brothers, stepfathers, who prey on the innocence of youth, a situation that impacts greatly on the child's life. This study was aimed at determining the level of knowledge parents have in relation to Child Sexual Abuse. A cross-sectional, non experimentan descriptive field study was made. The population consisted of 80 mothers of school age children from the Mara Hill II sector, Moron, Carabobo State. The sample consisted of 25% of the population surveyed, i.e. 19 mothers. Data collection was obtained through a questionnaire with 19 items of dichotomous response options (YES-NO), and was validated by expert opinion. The confidence coefficient was 0.79 according to the Crombach alpha. Analysis of the results concluded that 50% of the parents surveyed do not talk to their children about the situation, when talkimg is a vital method of preventing child sexual abuse. It is, theregore, of great importance implement educational strategies for prevention of child sexual abuse and so help to combat this social scourge.

Metastasis -- Care and treatment, Metastasis -- Analysis, Chemotherapy -- Analysis, Carcinoma -- Care and treatment, Carcinoma -- Analysis, Cancer -- Care and treatment, Cancer -- Analysis, and Cancer -- Chemotherapy

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/S0140-6736(17)33297-X Byline: Prof Thomas Powles, MD [thomas.powles@bartshealth.nhs.uk] (a,*), Ignacio Duran, MD (b,c), Michiel S van der Heijden, MD (d), Yohann Loriot, MD (e), Nicholas J Vogelzang, MD (f), Ugo De Giorgi, MD (g), Prof Stephane Oudard, MD (h), Prof Margitta M Retz, MD (i), Daniel Castellano, MD (j), Prof Aristotelis Bamias, PhD (k), Aude Flechon, MD (l), Gwenaelle Gravis, MD (m), Prof Syed Hussain, MD (n), Toshimi Takano, MD (o), Ning Leng, PhD (p), Edward E Kadel III, BS (p), Romain Banchereau, PhD (p), Priti S Hegde, PhD (p), Sanjeev Mariathasan, PhD (p), Na Cui, PhD (p), Xiaodong Shen, PhD (p), Christina L Derleth, MD (p), Marjorie C Green, MD (p), Alain Ravaud, MD (q) Summary Background Few options exist for patients with locally advanced or metastatic urothelial carcinoma after progression with platinum-based chemotherapy. We aimed to assess the safety and efficacy of atezolizumab (anti-programmed death-ligand 1 [PD-L1]) versus chemotherapy in this patient population. Methods We conducted this multicentre, open-label, phase 3 randomised controlled trial (IMvigor211) at 217 academic medical centres and community oncology practices mainly in Europe, North America, and the Asia-Pacific region. Patients (aged [greater than or equal to]18 years) with metastatic urothelial carcinoma who had progressed after platinum-based chemotherapy were randomly assigned (1:1), via an interactive voice and web response system with a permuted block design (block size of four), to receive atezolizumab 1200 mg or chemotherapy (physician's choice: vinflunine 320 mg/m.sup.2, paclitaxel 175 mg/m.sup.2, or 75 mg/m.sup.2 docetaxel) intravenously every 3 weeks. Randomisation was stratified by PD-L1 expression (expression on <1% [IC0] or 1% to <5% [IC1] of tumour-infiltrating immune cells vs [greater than or equal to]5% of tumour-infiltrating immune cells [IC2/3]), chemotherapy type (vinflunine vs taxanes), liver metastases (yes vs no), and number of prognostic factors (none vs one, two, or three). Patients and investigators were aware of group allocation. Patients, investigators, and the sponsor were masked to PD-L1 expression status. The primary endpoint of overall survival was tested hierarchically in prespecified populations: IC2/3, followed by IC1/2/3, followed by the intention-to-treat population. This study, which is ongoing but not recruiting participants, is registered with ClinicalTrials.gov, number NCT02302807. Findings Between Jan 13, 2015, and Feb 15, 2016, we randomly assigned 931 patients from 198 sites to receive atezolizumab (n=467) or chemotherapy (n=464). In the IC2/3 population (n=234), overall survival did not differ significantly between patients in the atezolizumab group and those in the chemotherapy group (median 11*1 months [95% CI 8*6--15*5; n=116] vs 10*6 months [8*4--12*2; n=118]; stratified hazard ratio [HR] 0*87, 95% CI 0*63--1*21; p=0*41), thus precluding further formal statistical analysis. Confirmed objective response rates were similar between treatment groups in the IC2/3 population: 26 (23%) of 113 evaluable patients had an objective response in the atezolizumab group compared with 25 (22%) of 116 patients in the chemotherapy group. Duration of response was numerically longer in the atezolizumab group than in the chemotherapy group (median 15*9 months [95% CI 10*4 to not estimable] vs 8*3 months [5*6--13*2]; HR 0*57, 95% CI 0*26--1*26). In the intention-to-treat population, patients receiving atezolizumab had fewer grade 3--4 treatment-related adverse events than did those receiving chemotherapy (91 [20%] of 459 vs 189 [43%] of 443 patients), and fewer adverse events leading to treatment discontinuation (34 [7%] vs 78 [18%] patients). Interpretation Atezolizumab was not associated with significantly longer overall survival than chemotherapy in patients with platinum-refractory metastatic urothelial carcinoma overexpressing PD-L1 (IC2/3). However, the safety profile for atezolizumab was favourable compared with chemotherapy, Exploratory analysis of the intention-to-treat population showed well-tolerated, durable responses in line with previous phase 2 data for atezolizumab in this setting. Funding F Hoffmann-La Roche, Genentech. Author Affiliation: (a) Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK (b) Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain (c) Institute of Biomedicine of Seville, Seville, Spain (d) Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands (e) Departement de Medecine Oncologique, Universite Paris-Saclay, Gustave Roussy, Villejuif, France (f) US Oncology Research, Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA (g) Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori IRST IRCCS, Meldola, Italy (h) Oncology Department, European Georges Pompidou Hospital, Rene Descartes University, Paris, France (i) Department of Urology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (j) University Hospital 12 de Octubre, Medical Oncology Department CIBER-ONC, Madrid, Spain (k) National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece (l) Centre Leon Berard, Lyon, France (m) Department of Cancer Medicine, Institut Paoli Calmette, Marseille, France (n) Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth University Hospitals NHS Trust, Plymouth, UK (o) Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan (p) Genentech, South San Francisco, CA, USA (q) Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France * Correspondence to: Dr Thomas Powles, Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London E1 4NS, UK

MULTIDISCIPLINARY SCIENCES, neck pain, disability, physiotherapy, translation, dor no pescoço, incapacidade, fisioterapia, and tradução

INTRODUCTION: the Danish questionnaire entitled The Copenhagen Neck Functional Disability Scale(CNFDS) is a tool for self-assessment of cervical complaints,originally developed in English, of which there is, so far, no translation into Brazilian Portuguese. The process involvedin this researchproved to be relevant for the exploration of the questionnaire and the realization of adjustments necessary for it to be functiona l and applicable in Portuguese Language and Brazilian Culture settings. Thus, once this has been carried out, many health professionals will benefit from this version in their clinical practice. OBJECTIVE: To perform the translation and cultural adaptation to Brazilian Portuguese of the Escala funcional de incapacidade do pescoço de Copenhagen (The Copenhagen Neck Functional Disability Scale - CNFDS). METHODS: The questionnaire was translated into Brazilian Portuguese by two bilingual, Brazilian physiotherapists who were aware of the objective of this research. The back-translation was performed by a third person, a Brazilian, bilingual English teacher, who had not participated in the previous step. After comparing the resulting translations, a single translated version was produced named the Escala Funcional de Incapacidade do Pescoço de Copenhagen (EFIPC) and in each question the option "not applicable" was added to the answer key. During the translation and cultural adaptation process there were no changes and/or eliminations of any questions. RESULT: The composition of the Escala Funcional de Incapacidade do Pescoço de Copenhagen reflects the original English version, with a total of 15 questions, with the questions numbered 1 to 5 presenting a positive direction response (a "yes" answer indicates good cervical condition), and questions numbered 6 to 15 presenting a negative direction response (a "yes" answer indicates poor cervical condition. CONCLUSION: The process involved in this research allowed the achievement of thedesired goal, and thus it was possible totranslate and culturally adapt to Brazilian Portuguese the content of the CNFDS questionnaire, giving riseto the Escala funcional de incapacidade do pescoço de Copenhagen.
INTRODUÇÃO: o questionário dinamarquês intitulado The Copenhagen Neck Functional Disability Scale (CNFDS) é um instrumento de autoavaliação de queixa cervical originalmente desenvolvido no idioma inglês e que não existe, até esse momento, sua tradução para o português brasileiro. O processo envolvido nessa pesquisa se mostrou relevante para a exploração do questionário e realização dos ajustes necessários para que esse seja funcional e aplicável na Língua e Cultura Portuguesa Brasileira. Portanto, uma vez sido feito isso, profissionais da saúde poderão se beneficiar dessa versão em sua prática clínica. OBJETIVO: realizar a tradução e adaptação cultural para o português brasileiro da escala funcional de incapacidade do pescoço de Copenhagen (The Copenhagen Neck Functional Disability Scale - CNFDS). MÉTODO: o questionário em questão foi traduzido para a língua portuguesa brasileira por dois fisioterapeutas brasileiros e fluentes na língua portuguesa e inglesa. A retrotradução foi realizada por uma terceira pessoa, brasileira, bilíngue e professora de inglês, não participante da etapa anterior. Após comparação das traduções produziu-se uma única versão traduzida, denominada Escala Funcional de Incapacidade do Pescoço de Copenhagen (EFIPC) sendo que, em cada questão foi acrescentada a opção "não se aplica" na chave de resposta. No processo de tradução e adaptação cultural não houve modificação e/ou eliminação de nenhuma questão. RESULTADO: a composição da Escala Funcional de Incapacidade do Pescoço de Copenhagen reflete a versão original em inglês, ou seja, com um total de 15 questões, sendo que as questões de número 1 a 5 apresentam direção de resposta positiva (resposta "sim" indica uma boa condição cervical), e as questões de número 6 a 15 apresentam direção de resposta negativa (resposta "sim" indica uma má condição cervical. CONCLUSÃO: o processo envolvido nessa pesquisa permitiu atingir o objetivo desejado e, assim, foi possível traduzir e adaptar culturalmente para o português brasileiro o conteúdo do questionário CNFDS, dando origem à escala funcional de incapacidade do pescoço de Copenhagen.

Objective: Antibiotic treatment of acute otitis media (AOM) has been suggested to increase the risk of future AOM episodes by causing unfavorable shifts in microbial flora. Because current evidence on this topic is inconclusive and long-term follow-up data are scarce, we wanted to estimate the effect of antibiotic treatment for a first AOM episode occurring during infancy on AOM recurrences and AOM-related health care utilization later in life. Methods: We obtained demographic information and risk factors from data of the Wheezing Illnesses Study Leidsche Rijn, a prospective birth cohort study in which all healthy newborns born in Leidsche Rijn (between 2001 and 2012), The Netherlands, were enrolled. These data were linked to children’s primary care electronic health records up to the age of four. Children with at least one family physician-diagnosed AOM episode before the age of two were included in analyses. The exposure of interest was the prescription of oral antibiotics (yes vs no) for a child’s first AOM episode before the age of two years. Results: 848 children were included in analyses and 512 (60%) children were prescribed antibiotics for their first AOM episode. Antibiotic treatment was not associated with an increased risk of total AOM recurrences (adjusted rate ratio: 0.94, 95% CI: 0.78–1.13), recurrent AOM (≥3 episodes in 6 months or ≥4 in one year; adjusted risk ratio: 0.79, 95% CI: 0.57–1.11), or with increased AOM-related health care utilization during children’s first four years of life. Conclusions: Oral antibiotic treatment of a first AOM episode occurring during infancy does not affect the number of AOM recurrences and AOM-related health care utilization later in life. This information can be used when weighing the pros and cons of various AOM treatment options.

Ischemia -- Analysis

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/S0140-6736(16)00163-X Byline: Prof Mayank Goyal, MD (a), Bijoy K Menon, MD (a), Wim H van Zwam, MD (b), Prof Diederik W J Dippel, MD (c), Prof Peter J Mitchell, MBBS (d), Prof Andrew M Demchuk, MD (a), Prof Antoni Davalos, MD (f), Prof Charles B L M Majoie, MD (g), Prof Aad van der Lugt, MD (c), Maria A de Miquel, MD (h), Prof Geoffrey A Donnan, MD (i), Prof Yvo B W E M Roos, MD (g), Prof Alain Bonafe, MD (j), Reza Jahan, MD (k), Prof Hans-Christoph Diener, MD (l), Lucie A van den Berg, MD (g), Prof Elad I Levy, MD (m), Olvert A Berkhemer, MD (g), Vitor M Pereira, MD (n), Jeremy Rempel, MD (o), Monica Millan, MD (p), Prof Stephen M Davis, MD (e), Prof Daniel Roy, MD (q), John Thornton, MD (r), Luis San Roman, MD (s), Marc Ribo, MD (t), Debbie Beumer, MD (b), Prof Bruce Stouch, PhD (u), Scott Brown, PhD (v), Bruce C V Campbell, MD (e), Prof Robert J van Oostenbrugge, MD (b), Prof Jeffrey L Saver, MD (w), Prof Michael D Hill, MD (a), Dr Tudor G Jovin, MD [jovintg@upmc.edu] (x,*) for the HERMES collaborators Summary Background In 2015, five randomised trials showed efficacy of endovascular thrombectomy over standard medical care in patients with acute ischaemic stroke caused by occlusion of arteries of the proximal anterior circulation. In this meta-analysis we, the trial investigators, aimed to pool individual patient data from these trials to address remaining questions about whether the therapy is efficacious across the diverse populations included. Methods We formed the HERMES collaboration to pool patient-level data from five trials (MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND IA) done between December, 2010, and December, 2014. In these trials, patients with acute ischaemic stroke caused by occlusion of the proximal anterior artery circulation were randomly assigned to receive either endovascular thrombectomy within 12 h of symptom onset or standard care (control), with a primary outcome of reduced disability on the modified Rankin Scale (mRS) at 90 days. By direct access to the study databases, we extracted individual patient data that we used to assess the primary outcome of reduced disability on mRS at 90 days in the pooled population and examine heterogeneity of this treatment effect across prespecified subgroups. To account for between-trial variance we used mixed-effects modelling with random effects for parameters of interest. We then used mixed-effects ordinal logistic regression models to calculate common odds ratios (cOR) for the primary outcome in the whole population (shift analysis) and in subgroups after adjustment for age, sex, baseline stroke severity (National Institutes of Health Stroke Scale score), site of occlusion (internal carotid artery vs M1 segment of middle cerebral artery vs M2 segment of middle cerebral artery), intravenous alteplase (yes vs no), baseline Alberta Stroke Program Early CT score, and time from stroke onset to randomisation. Findings We analysed individual data for 1287 patients (634 assigned to endovascular thrombectomy, 653 assigned to control). Endovascular thrombectomy led to significantly reduced disability at 90 days compared with control (adjusted cOR 2*49, 95% CI 1*76--3*53; p<0*0001). The number needed to treat with endovascular thrombectomy to reduce disability by at least one level on mRS for one patient was 2*6. Subgroup analysis of the primary endpoint showed no heterogeneity of treatment effect across prespecified subgroups for reduced disability (p.sub.interaction=0*43). Effect sizes favouring endovascular thrombectomy over control were present in several strata of special interest, including in patients aged 80 years or older (cOR 3*68, 95% CI 1*95--6*92), those randomised more than 300 min after symptom onset (1*76, 1*05--2*97), and those not eligible for intravenous alteplase (2*43, 1*30--4*55). Mortality at 90 days and risk of parenchymal haematoma and symptomatic intracranial haemorrhage did not differ between populations. Interpretation Endovascular thrombectomy is of benefit to most patients with acute ischaemic stroke caused by occlusion of the proximal anterior circulation, irrespective of patient characteristics or geographical location. These findings will have global implications on structuring systems of care to provide timely treatment to patients with acute ischaemic stroke due to large vessel occlusion. Funding Medtronic. Author Affiliation: (a) Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada (b) Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (c) Erasmus MC University Medical Center, Rotterdam, Netherlands (d) Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (e) Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia (f) Hospital Germans Trias y Pujol, Barcelona, Spain (g) Academic Medical Center, Amsterdam, Netherlands (h) Hospital de Bellvitge, Barcelona, Spain (i) Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia (j) Hospital Guy de Chaulliac, Montpellier, France (k) UCLA Medical Center, Los Angeles, CA, USA (l) Department of Neurology, University Hospital Essen, Essen, Germany (m) State University of New York, Buffalo, Buffalo, NY, USA (n) University of Toronto, Toronto, ON, Canada (o) University of Edmonton, Edmonton, AB, Canada (p) Hospital Germans Trials y Pujol, Barcelona, Spain (q) CHUM Notre-Dame Hospital, Montreal, QC, Canada (r) Beaumont Hospital, Dublin, Ireland (s) Hospital Clinic, Barcelona, Spain (t) Hospital Vall d'Hebron, Barcelona, Spain (u) Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA (v) Altair Biostatistics, St Louis Park, MN, USA (w) David Geffen School of Medicine, University of Los Angeles, Los Angeles, CA, USA (x) University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, Pittsburgh, PA, USA * Correspondence to: Dr Tudor Jovin, University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, Pittsburgh, PA 15213, USA

Social Sciences, Interdisciplinary, Art, Literary Theory & Criticism, Humanities, Multidisciplinary, Language & Linguistics, Economics, Education, Scientific Disciplines, Literature, Literature, African, Australian, Canadian, a/-rounding, acoustic analysis, case study, classic Afrikaans, co-articulation, dark [f], /l/-velarisation, Modern Afrikaans, formant frequency, vowel language change, /a/-ronding, akoestiese analise, donker [f], gevallestudie, klassieke Afrikaans, koartikulasie, /l/-velarisasie, Moderne Afrikaans, taalverandering, and vokaalformantfrekwensies

In hierdie artikel word verslag gedoen van 'n reeks ondersoeke na die spraakproduksie van 'n enkele jong, vroulike spreker - 'n bekende radiopersoonlikheid verbonde aan Radio Sonder Grense, van wie dit bekend is dat sy die lang /a/-vokaal tot [u] rond. Die resultate van hierdie akoesties-fonetiese ondersoek word vergelyk met dié van soortgelyke vorige studies maar wat van 'n veel oppervlakkiger aard is. In die ondersoek is veral gefokus op die invloed wat /l/ kan hê op voorafgaande vokale. Dit geld veral kort /a/, soos in byvoorbeeld 'n geslote sillabe in /al/ (in wals), of in 'n oop sillabe, soos in /a-ta/ (alle). Lang /a/ is ook hier ter sprake, byvoorbeeld in /mal/ (maal) en /ma-la/ (male). Die spreker se akoestiese metinge in terme waarvan ronding van lang /a/ tot [u] bepaal is, naamlik veral die tweede vokaalformantfrekwensie (F2), kom in 'n beduidende mate ooreen met dié wat in vorige studies gevind is. Dit word uitgewys dat ook kort /a/ merkbaar tot [u]¹ voor /l/ 'n geronde kwaliteit aanneem, veral in geslote sillabes. Hierdie bevinding ten opsigte van die rondende neiging van kort /Q/ is nog nie tevore waargeneem, geanaliseer en beskryf nie. Die laterale konsonant /l/ na agtervokale blyk 'n donker kwaliteit te hê weens die terugtrek van die tongliggaam, wat soms daaraan 'n retrofleksiewe eienskap verleen (Hamann 2003). Hier is sprake van 'n waarskynllike koartikulasie tussen sodanige donker [1] en voorafgaande /a/, met as resultaat 'n geronde [u]. Dit is ook die geval met die lang /a/, waarvan dit reeds bekend is dat dit in benadrukte posisies gerond word. Voor [1] blyk dit nog meer die geval te wees. /l/-velarisasie is 'n verskynsel wat waarskynlik by hierdie studie betrek behoort te word. In die resultate van 'n post hoc-ondersoek, waarby 'n ultrasoniese aftaster en 'n lip- videokamera gebruik is, word hierdie vermoede bevestig. Ander faktore wat ook moontlik 'n rol kan speel by hierdie verskynsel is nie in hierdie studie in ag geneem nie. Lin, Beddor en Coetzee (2013) noem woordfrekwensie as 'n beïnvloedende faktor by /l/-vokalisasie; dit kan moontlik ook van toepassing wees by velarisasie. Recasens en Espinosa (2005) noem ook nog verskille in artikulasiesluiting, dorsopalatale kontakgrootte, sluitingsduur en formantfrekwensie. Laasgenoemde is van toepassing by die prominente rol van F1 wat in die huidige ondersoek gevind is. Afgesien van die te verwagte verhoging van F2, suggereer die resultate wat in hierdie studie gevind is, 'n meer prominente rol van F1. Dit is hier selfs 'n sterker leidraad vir ronding in die geval van beide vokale. Die resultate bevestig die siening dat die Afrikaanse vokaalsisteem, veral wat betref die lang /a/-ronding, aan die verander is, en dit suggereer ook die moontlikheid dat kort /a/ dieselfde pad mag volg. Die gedrag daarvan voor /l/ ondersteun sodanige waarskynlikheid. Dit hou interessante konsekwensies in vir 'n beter begrip van die proses van, en die teorie oor taalverandering in die algemeen.
The present study is a follow-up of previous ones on the rounding of the long low /a/ vowel in Afrikaans, a relatively new sound variation. Against the background of existing descriptions I report a similar tendency of rounding of short /α/ vowel, specifically when followed by the lateral consonant /l/. I suggest an explanation of such rounding as being the result of a process of coarticulation, specifically under the influence of a distinct dark, retroflex quality of this lateral. A post hoc investigation with an ultrasound scanner and lip video camera confirmed this to be the case. The vowel productions of a single speaker, known to be a clear rounding of long /a/ was explored in an extensively designed case study. The phenomenon of /a/-rounding implies a qualitative change of the /a/ to [n] as in [jn] (ja; "yes") and in [snnks (snaaks; "funny"). Apart from superficial references to its existence in linguistic handbooks, such as De Villiers and Ponelis (1987:100), the first systematic study was done by Wissing (2006), followed-up by more recent other studies (Wissing 2010; 2013). Rounding is currently seemingly limited to the speech of young adult female speakers of Afrikaans, but it appears as if it has lately been spreading to the broader Afrikaans speaking community at a rather noticeable pace. It is provoking extremely negative reactions in especially the case of older, or more conservative Afrikaans speaking persons. On the other hand, younger users of Afrikaans do not even seem to notice the existence of this phenomenon, especially in their own language use. Such a vowel change is apparently part of a larger vowel shift which has recently been taking place, viz. the lowering of the front-mid vowel /e/ to almost the position of the short low /a/, or the shifting of /u/ from a back to a more centralised position (cf. Wissing 2010). Broadly defined, language change is a topic that integrates the social as well as the cognitive aspects of what it means to be human. A central feature of a language in the process of change is variation. During a period of change, there is variation in the language between forms that represent the current/previous stage and forms that represent the innovative/new stage of the language. Consequently, the rounding of/a/ could be of linguistic significance when considered against this general linguistic backdrop. The present investigation aims in particular at both broadening, developing and understanding of /a/-rounding to [a] in modern Afrikaans. In order to achieve this, firstly the existing knowledge concerning this phenomenon was summarised, whereafter a variety of carefully constructed stimuli were used in an in-depth case study of the pronunciation of a young female radio presenter at Radio Sonder Grense, the leading Afrikaans public broadcaster (hence referred to as C). The testing material was created with a view to obtaining a fuller understanding of /a/-rounding to [α] in Afrikaans in two respects. Firstly, the stimulus series concerning the degree to which long /a/ vowels are subjected to such rounding was expanded considerably. Secondly, stimuli were included with the aim of examining the possible co-articulatory influence of the rounding of /a/ followed by the lateral consonant /l/ (characterised as a dark l in the case of English pronunciation) on especially the short /a/-vowel, as in wals ("waltz"). Dark /l/ has received much attention in literature. Moreover, word frequency also has been shown (Lin, Beddor & Coetzee 2013) to influence the magnitude of the tongue tip gesture in laterals, especially with regard to /l/ vocalization. It might be applicable on the case of /l/-velarisation as well. Degree of darkness, differences in articulatory closure, dorsopalatal contact size, closure duration, relative timing of events and formant frequency (cf. Recasens & Espinosa 2005) are some of the important factors to take into account when studying this consonant and its co-articulatory effects on phonetic environment. Up until now none of these have been mentioned in Afrikaans phonetic literature. In the present article I superficially touch on some of them. Obviously these facets deserve fundamental attention. I utilised three different types of recording tasks, namely firstly the reading of carrier phrases containing a focus form with the structure /sVs/ (eg. among others, saas and sas); secondly, the naming of the letters of the alphabet (with an interest in a, h, k; all pronounced with a long [a]), and thirdly, the reading of a variety of isolated words and phrases, mostly containing words relevant to this study. In some cases C was prompted to orally complete a task, for example, a noun like val was to be read, but its diminutive (valletjie) and plural forms (valle) were to be completed without visual stimulus. Syllable structure was controlled systematically. In the case of val, /a/ appears in a closed syllable, but in valletjie and valle the syllables are open. These tasks had to be carried out twice. Recordings were done with high quality equipment, in use by RSG. Processing and acoustic analyses of the recordings were performed by means of standard procedures. As is conventional in studies of this nature, acoustic characteristics of the production of long /a/ and short /Q/ were investigated via vowel formant frequencies, F1 as well as F2. F1, the first formant, corresponds to vowel openness (vowel height). An open vowel, such as /a/, has high F1 frequencies, while close vowels, like /i/, have low F1 frequencies. The second formant, F2, corresponds to the front positions of a vowel. Back vowels, which are normally at the same time also rounded, have low F2 frequencies, in contrast to front vowels, which have high F2 frequencies. Generally the results clearly confirm the audible perception that C is a strong rounder of the long /a/. There is a very positive correlation between C's acoustic measurements and that previously found for another young female individual (Wissing 2006) as well as that of twenty others of about the same age (Wissing 2013). This finding strongly suggests a restriction on the number of participants as well as the range of required stimuli in instances of experiments of this kind, especially in the case of pilot studies. The role of syllable structure was found to be of limited importance. The short /a / was rounded to a significant degree when followed by /l/ in open as well as closed syllables, but to a small degree as in the case of open syllables. Of special importance is the finding that F1 also plays a significant role in the expression of degree of roundedness of the /a/ vowel, albeit not quite to the same extent as is the case with F2, generally considered to be the sole carrier of roundedness. The fact that the rounded [n] is frequently misinterpreted (as the rounded vowel [o] (in kom "come")), from a perceptual angle supports the current results of the analysis of the rounded [n] in Afrikaans. Of course, [o] is characterised inter alia by a higher F1 than that of the unrounded [a]. In many languages the existence of dark /l/ ([f]) is well-known (cf. Hamann 2003; also Lin, Beddor & Coetzee 2014 and references cited by them). With regard to Afrikaans, a co-articulatory effect of this lateral was found to be clearly manifested in the present study on the rounding to [a] of the short /a/, but also of the long /a/. In a broader linguistic perspective the present findings should be of distinctive importance to those interested in language change in general, and more specifically in sound variation.

Belgium

Summary Background Biomarkers of intestinal inflammation, such as faecal calprotectin and C-reactive protein, have been recommended for monitoring patients with Crohn's disease, but whether their use in treatment decisions improves outcomes is unknown. We aimed to compare endoscopic and clinical outcomes in patients with moderate to severe Crohn's disease who were managed with a tight control algorithm, using clinical symptoms and biomarkers, versus patients managed with a clinical management algorithm. Methods CALM was an open-label, randomised, controlled phase 3 study, done in 22 countries at 74 hospitals and outpatient centres, which evaluated adult patients (aged 18--75 years) with active endoscopic Crohn's disease (Crohn's Disease Endoscopic Index of Severity [CDEIS] >6; sum of CDEIS subscores of >6 in one or more segments with ulcers), a Crohn's Disease Activity Index (CDAI) of 150--450 depending on dose of prednisone at baseline, and no previous use of immunomodulators or biologics. Patients were randomly assigned at a 1:1 ratio to tight control or clinical management groups, stratified by smoking status (yes or no), weight (2 years) after 8 weeks of prednisone induction therapy, or earlier if they had active disease. In both groups, treatment was escalated in a stepwise manner, from no treatment, to adalimumab induction followed by adalimumab every other week, adalimumab every week, and lastly to both weekly adalimumab and daily azathioprine. This escalation was based on meeting treatment failure criteria, which differed between groups (tight control group before and after random assignment: faecal calprotectin [greater than or equal to]250 [mu]g/g, C-reactive protein [greater than or equal to]5mg/L, CDAI [greater than or equal to]150, or prednisone use in the previous week; clinical management group before random assignment: CDAI decrease of 200; clinical management group after random assignment: CDAI decrease of <100 points compared with baseline or CDAI [greater than or equal to]200, or prednisone use in the previous week). De-escalation was possible for patients receiving weekly adalimumab and azathioprine or weekly adalimumab alone if failure criteria were not met. The primary endpoint was mucosal healing (CDEIS <4) with absence of deep ulcers 48 weeks after randomisation. Primary and safety analyses were done in the intention-to-treat population. This trial has been completed, and is registered with ClinicalTrials.gov, number NCT01235689. Findings Between Feb 11, 2011, and Nov 3, 2016, 244 patients (mean disease duration: clinical management group, 0*9 years [SD 1*7]; tight control group, 1*0 year [2*3]) were randomly assigned to monitoring groups (n=122 per group). 29 (24%) patients in the clinical management group and 32 (26%) patients in the tight control group discontinued the study, mostly because of adverse events. A significantly higher proportion of patients in the tight control group achieved the primary endpoint at week 48 (56 [46%] of 122 patients) than in the clinical management group (37 [30%] of 122 patients), with a Cochran--Mantel--Haenszel test-adjusted risk difference of 16*1% (95% CI 3*9--28*3; p=0*010). 105 (86%) of 122 patients in the tight control group and 100 (82%) of 122 patients in the clinical management group reported treatment-emergent adverse events; no treatment-related deaths occurred. The most common adverse events were nausea (21 [17%] of 122 patients), nasopharyngitis (18 [15%]), and headache (18 [15%]) in the tight control group, and worsening Crohn's disease (35 [29%] of 122 patients), arthralgia (19 [16%]), and nasopharyngitis (18 [15%]) in the clinical management group. Interpretation CALM is the first study to show that timely escalation with an anti-tumour necrosis factor therapy on the basis of clinical symptoms combined with biomarkers in patients with early Crohn's disease results in better clinical and endoscopic outcomes than symptom-driven decisions alone. Future studies should assess the effects of such a strategy on long-term outcomes such as bowel damage, surgeries, hospital admissions, and disability. Funding AbbVie. Author Affiliation: (a) Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA (b) Inflammatory Bowel Disease Unit, Department of Medicine, University of Calgary, Calgary, AB, Canada (c) Imelda General Hospital, Bonheiden, Belgium (d) Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE Clinical Centre, Prague, Czech Republic (e) First Medical Faculty, Charles University, Prague, Czech Republic (f) AZ Delta, Roeselare-Menen, Belgium (g) Hepato-Gastroenterologie HK, sro, Hradec Kralove, Czech Republic (h) Department of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey (i) Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria (j) Presidio Columbus, Fondazione Policlinico Gemelli Universita Cattolica, Rome, Italy (k) Service de Gastro-enterologie et Nutrition Clinique, Nice, France (l) Universite de Nice-Sophia-Antipolis, Nice, France (m) Oxford University Hospitals, Oxford, UK (n) Department of Biomedical Sciences, Humanitas University, Milan, Italy (o) Humanitas Clinical and Research Centre, Milan, Italy (p) Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA (q) Department of Gastroenterology, University of Leuven, Leuven, Belgium (r) Department of Medicine, University of California, Los Angeles, CA, USA (s) Department of Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany (t) AbbVie Inc, North Chicago, IL, USA (u) AbbVie Spain SLU, Madrid, Spain (v) Academic Medical Center, Amsterdam, Netherlands * Correspondence to: Prof Jean-Frederic Colombel, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA Byline: Prof Jean-Frederic Colombel, MD [jean-frederic.colombel@mssm.edu] (a), Prof Remo Panaccione, MD (b), Peter Bossuyt, MD (c), Prof Milan Lukas, MD (d,e), Filip Baert, MD (f), Tomas Vanasek, MD (g), Prof Ahmet Danalioglu, MD (h), Gottfried Novacek, MD (i), Alessandro Armuzzi, MD (j), Prof Xavier Hebuterne, MD (k,l), Prof Simon Travis, MD (m), Prof Silvio Danese, MD (n,o), Walter Reinisch, MD (i), Prof William J Sandborn, MD (p), Prof Paul Rutgeerts, MD (q), Prof Daniel Hommes, MD (r), Prof Stefan Schreiber, MD (s), Ezequiel Neimark, MD (t), Bidan Huang, PhD (t), Qian Zhou, PhD (t), Paloma Mendez, BS (u), Joel Petersson, PhD (t), Kori Wallace, MD (t), Anne M Robinson, PharmD (t), Roopal B Thakkar, MD (t), Prof Geert D'Haens, MD (v)