Mixed-methods evaluation of a group psychosocial intervention for refugee, migrant and host community women in Ecuador and Panamá: Results from the Entre Nosotras cluster randomized feasibility trial

Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.

Evaluating the feasibility of a group psychosocial intervention for migrant and host community women in Ecuador and Panamá: protocol for a multi-site feasibility cluster trial

BACKGROUND

Community- and strengths-based psychosocial interventions are central to mental health and psychosocial support guidelines, but rigorous evidence regarding the effectiveness of these interventions is limited. The complexity and variability that is inherent to many community-based psychosocial interventions requires innovative strategies in order to facilitate the comparability and synthesis across research studies without compromising the fit and appropriateness of interventions to specific study populations and context. Entre Nosotras is a community-based psychosocial intervention developed for migrant and host community women that is designed to be flexible enough to enable integration of external intervention components and adaptable to diverse study contexts and populations. This protocol describes a study that aims to evaluate the appropriateness, acceptability, and feasibility of integrating a standardized stress management intervention into Entre Nosotras.

METHODS

This study will evaluate the appropriateness, acceptability, feasibility, and safety of intervention and research procedures for a cluster randomized comparative effectiveness trial conducted in Ecuador and Panamá with migrant and host community women. In this feasibility trial, we will allocate communities nested within the three study sites to the integrated Entre Nosotras + stress management intervention versus Entre Nosotras alone through stratified randomization. Migrant and host community women residing in these study communities who report low to moderate levels of distress will be allocated to the intervention condition that their community is assigned (n = 220 total). We will collect quantitative measures of psychosocial wellbeing, psychological distress, coping, social support, and functioning from study participants. We will collect quantitative measures of fidelity and facilitator competencies through observation and facilitator self-assessment. Data on appropriateness, acceptability, feasibility, and safety will be gathered from participants and facilitators through quantitative assessments at 0, 5, and 10 weeks post-enrollment and qualitative interviews conducted with all facilitators and a subset of 70 study participants during the post-intervention follow-up period.

DISCUSSION

Results from this feasibility trial will determine whether a multi-site cluster randomized comparative effectiveness trial of an adaptable community-based psychosocial intervention for migrant and host community women is relevant, acceptable, and feasible.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05130944 . Registered November 23, 2021-retrospectively registered.

Stress echocardiography with regadenoson for the assessment of perioperative cardiovascular risk in non-cardiac surgery

Funding Acknowledgements

Type of funding sources: None.

Introduction

The most commonly used drug in pharmacological stress echocardiography (SE) for perioperative cardiovascular (CV) risk assessment is dobutamine. Its arrhythmogenic potential and the unpredictable hypertensive response in patients with vascular pathology, makes us often resort to other less accessible and more expensive techniques such as Cardio-MRI or SPECT. Regadenoson is emerging as a safe drug in the detection of myocardial ischemia, although its use has not yet been validated in SE.

Purpose

The objective is to assess the short-medium term prognosis in patients undergoing high-risk noncardiac surgery who undergo SE with regadenoson.

Methods

A unicentric retrospective observational study. We included a subgroup of 58 patients referred for detection of ischemia prior to high-risk noncardiac surgery who underwent SE with regadenoson during the years 2017-2020. No patient has had cardiological symptoms. The test was considered positive if it presented at least one of the following: wall motion abnormalities, electrocardiographic and/or clinical changes compatible with ischemia.  Patients were followed up in the immediate postoperative period (30 days), at 12 months and at 24 months, considering the presence of CV events such as admission for heart failure (HF), chest pain, acute myocardial infarction (AMI) or CV death. It was compared the group with negative (NG) and the group with positive (PG) results.

Results

97% of the patients underwent vascular high-risk noncardiac surgery, 3% underwent other surgeries such as kidney transplantation or lung surgery considered high risk in the preanesthetic assessment. Twelve studies (21%) were positive and of these, only 2 patients underwent coronary artery bypass prior to surgery. The only CV event observed in this period was HF: in the NG 3 episodes were observed compared to 1 in the PG (p = 0.82), only in one of the events for HF was coronary angiography done that did not show coronary artery disease. The time to the NG event was a median of 90 [3-600] days versus 180 days in the PG.  The cumulative incidence (CI) of events in the NG in the immediate postoperative period (30 days post-surgery) was 2%, annual 4% and biannual 7%.

Conclusions

A SE test with negative regadenoson prior to high-risk noncardiac surgery presents a low CI of events in the immediate postoperative period and in the short-medium term. Abstract Figure.

Regadenoson stress echocardiography: a road ahead

Funding Acknowledgements

Type of funding sources: None.

Introduction

Drugs use in stress echocardiography (SE) have important limitations due to side effect and contraindications. Regadenoson (R) is emerging as a selective coronary vasodilator for pharmacological stress tests. Several studies have analyzed its diagnostic accuracy, but its prognostic value has not yet been studied.

Purpose

The objective is to assess safety and short-medium term prognosis in patients (p) who underwent SE with R.

Methods

Retrospective observational study. 126 patients were included from 2017 to 2020 and SE to study the detection of myocardial ischemia with R were performed. A positive SE test were consider if presented at least one of the follow: segmental changes in myocardial contractility, electrocardiography ischaemic changes or ischaemic symtomps. Adverse events (AE) were collected. To assess prognosis, we evaluated cardiovascular events (CV) with a median follow-up of 23 months, considering heart failure, angina, myocardial infarction (AMI) o cardiovascular death. We compare negative result SE test group (NG) with group of positive results (PG).

Results

Sixteen (13%) patients, presented AE, generally mild, with nausea in 4 patients. Two patients (1.6%) required the use of aminophylline for severe AE type bronchospasm.

Nineteen studies (15%) were positive: 17 (89%) showed echocardiographically positive results, 5 of them also had clinical or electrocardiographic positivity, one (5%) was considered positive only by electrocardiographic criteria and another by clinical criteria.

 There were no CV deaths at follow-up. In the NG, 6 events were observed versus 2 in the PG (6 vs 11%). Time to event of the NG was a median of 90 [3-600] days versus 110 [40-180] days in the PG. The most frequent event was HF (4 NG vs 1 PG), coronary angiography was performed in only 2 patients with HF of the NG and did not show significant lesions. In the NG there were 2 IAM (2 vs 0), one had severe stenosis in the right coronary artery and the other several moderate diffuse stenosis. There was no events for angina in the NG (0 vs 1). The annual cumulative incidence was 11% in the PG compared to 4% in the NG.

Conclusions

Stress echocardiography with regadenoson is a safe test with a low serious adverse events rate. As concern as prognosis, In our sample, NG presented a lower proportion of events with a lower annual cumulative incidence than PG and also in a 23-month follow-up. Abstract Figure.

Left atrial appendage closure in the presence of thrombus: incidence, technique and outcomes

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with left atrial appendage (LAA) thrombus are excluded for LAA occlusion (LAAO) in clinical trials. However, some of them may require this therapy due to repeated thromboembolisms despite accurate anticoagulation. 

Aim

The aim of the study is to describe the prevalence of LAA thrombosis in patients submitted for LAAO in a high-volume center of LAAO procedures, explaining the employed technique and results in this scenario.

Methods

Single-center retrospective analysis including all consecutive patients referred for LAAO.

Results

LAA thrombus was detected by TEE in 8/76 patients referred for LAAO (10.5%). Five of them underwent LAAO despite the presence of thrombus due to clinical conditions. All the procedures were successfully performed with  Amulet devices (Table). The following preventive measures were putting in place during the implants: avoidance of contrast injection into the LAA during the procedure (non-touch technique), TEE measure for device size election; and TEE device deployment guidance with special care to the the sheath orientation and depth enabling a slow and single implant of the device partially released in the LAA before complete implantation at the entrance of the LAA (Figure. A&B: Large LAA thrombus partially occupying the landing zone. C: Thrombus sealed by LAAO device. D&E: Non-touch technique: echo-guided progressive deployment of the LAAO device without thrombus shifting). No cerebral protection devices were used. TEE performed one month after the procedure ruled out the presence of residual thrombi or leaks in all cases. There were no events after a median follow-up of 17.1 months (range: 32.3-1.1)

Conclusion

LAAO in patient with LAA thrombus can be effectively and safely performed, in high-volume centers  and with an accurate technique, under accurate TEE guidance. Abstract Figure. LAA thrombus and occlusion technique

Femtosecond laser writing of photonic devices in borate glasses compositionally designed to be laser writable

The design and performance of borate glass samples compositionally pre-designed to be femtosecond laser writable via laser-induced ion migration is reported in this Letter. It is demonstrated that borate glasses modified on purpose with small amounts of La₂O₃ and Na₂O can be straightforwardly used to produce high-index contrast (Δn) waveguides by femtosecond-laser-assisted ion migration. The positive Δn of the waveguides is caused by the local enrichment of La₂O₃ in the guiding region with a slope of 8·10^-3(mol.%)^-1. The value of this is consistent with numerical aperture measurements of the waveguides and local compositional measurements at the guiding region performed by energy-dispersive x-ray micro-analysis. The maximum achievable Δn values can be controlled through the initial La₂O₃ content of the glass. Maximum Δn values >10^-2 for samples with just 5.5 mol. % of La₂O₃ have been produced. This compositional design approach could be potentially used to produce highly efficient femtosecond laser writeable glasses in other glass families.

Role of ion migrations in ultrafast laser written tellurite glass waveguides

We report on a strong cross migration of ions in a Tellurite (Te) based glass to form waveguides using a high repetition rate femtosecond laser. The tellurite glass matrix was modified using oxides of P, Na and Zn elements of which Te and Na ions play an important role to form waveguides upon laser irradiation. Tellurium was observed to migrate causing a positive index change zone whereas sodium cross migrates to the tellurium deficient zone forming a relatively low index change region. We have used micro-Raman analysis to scan across the waveguide cross-section to understand the state of the glass network and the relation between ion migration and glass densification for waveguiding. We have found that there is an increase in TeO3 units and reduction of TeO4 units in the Te rich zones enabling densification. This work will help guide the new commercial glass manufacturing industries that aim at producing mid-infrared transparent glasses like tellurite, tellurides and chalcogenides for the production of waveguide based devices.

High speed inscription of uniform, large-area laser-induced periodic surface structures in Cr films using a high repetition rate fs laser

We report on the fabrication of laser-induced periodic surface structures in Cr films upon high repetition rate fs laser irradiation (up to 1 MHz, 500 fs, 1030 nm), employing beam scanning. Highly regular large-area (9  cm2) gratings with a relative diffraction efficiency of 42% can be produced within less than 6 min. The ripple period at moderate and high fluences is 0.9 μm, with a small period of 0.5 μm appearing at lower energies. The role of the irradiation parameters on the characteristics of the laser-induced periodic surface structures (LIPSS) is studied and discussed in the frame of the models presently used. We have identified the polarization vector orientation with respect to the scan direction as a key parameter for the fabrication of high-quality, large-area LIPSS, which, for perpendicular orientation, allows the coherent extension of the sub-wavelength structure over macroscopic distances. The processing strategy is robust in terms of broad parameter windows and applicable to other materials featuring LIPSS.

Ion migration assisted inscription of high refractive index contrast waveguides by femtosecond laser pulses in phosphate glass

In this Letter, we report on the successful fabrication of low loss, high refractive index contrast waveguides via ion migration upon femtosecond laser writing in phosphate glass. Waveguides were produced in two different phosphate glass compositions with high and low La(2)O(3) content. In the La-rich glass, a large refractive index increase in the guiding region was observed due to the incoming migration of La accompanied by the out-diffusion of K. The much smaller refractive index change in the La-less glass is caused by rearrangements of the glass structure. These results confirm the feasibility of adapting the glass composition for enabling the laser writing of high refractive index contrast structures via spatially selective modification of the glass composition.

Reorganizing and shaping of embedded near-coalescence silver nanoparticles with off-resonance femtosecond laser pulses

We demonstrate that 2D distributions of non-spherical near-coalescence silver nanoparticles (NPs) embedded in an ultrathin dielectric film can be reorganized, shaped and aligned by exposure to ultrashort laser pulses. As-grown samples prepared by pulsed laser deposition show a broad absorption band with a surface plasmon resonance (SPR) at 650 nm, which can be blue-shifted down to 440 nm and transformed to show polarization anisotropy. In situ white light probing of the spectral sample transmission allows control during irradiation of the position and polarization anisotropy of the SPR, effectively controlling particle reorganization and shaping. Using the high spatial resolution of the optical probe technique (better than 10 μm), the dependence of the nanoparticle shape and distribution on the local fluence can be studied in a single irradiated region. The results inferred from the spectral measurements have been confirmed by TEM studies, showing the formation of nanoparticles with prolate shape, preferential alignment along the polarization axis of the laser and a narrow size distribution. This simple and efficient approach for NP shaping and the straightforward extension to multilayer systems offer excellent perspectives for optical encoding, multidimensional data storage and fabrication of complex, polarization-sensitive spectral masks starting from thin films with near-coalescence distributions of NPs.

Acute myocardial infarction: an uncommon complication of takotsubo cardiomyopathy

Transient left ventricular apical ballooning or Takotsubo syndrome (TS) is characterized by transient left ventricular dysfunction, electrocardiographic changes that mimic acute myocardial infarction (AMI), and minimal release of myocardial enzymes, with no evidence of obstructive coronary artery disease. Although prognosis and outcome are relatively good, reported complications include intraventricular thrombi and embolic events. We report an extremely rare case of AMI complicating the early in-hospital course of a patient with TS.

Workspace Analysis and Design Improvement of a Carotid Flow Measurement System

Heart and cerebrovascular diseases such as arteriosclerosis and myocardial ischemia dysfunction are currently among the main causes of death in developed countries. Recently, wave intensity (WI), which is an index used to obtain the force of cardiac contraction, has been investigated as a method for early-stage diagnosis of the above-mentioned diseases. Nevertheless, experimental tests have proven that the manual measurements of WI by means of commercial ultrasonic diagnostic systems require too much time and can be affected by the operator's skills. For this purpose, the introduction of robotic-assisted technology has advantages in terms of repetitiveness and accuracy of the measurement procedure. Therefore, at Waseda University, the development of a carotid blood flow measurement system has been proposed to support doctors while using ultrasound diagnostic equipment to measure the WI. This robotic system is composed of a serial robot with a wrist having a six-degree-of-freedom (6-DOF) parallel mechanism. The main focus is to obtain a suitable workspace performance of the 6-DOF parallel mechanism wrist. In this paper, a workspace analysis is carried out on a wrist prototype built for the Waseda-Tokyo Women's Medical Aloka Blood Flow Measurement System No.1 Refined (WTA-1R). Then, mechanical design enhancements are proposed and validated to provide a suitable workspace performance both as reachable workspace and dexterity, and a refined prototype WTA-1RII has been built.

Linear and third-order nonlinear optical responses of multilayered Ag:Si3N4 nanocomposites

The linear and third-order nonlinear responses of tailored Si3N4/Ag/Si3N4 trilayers and (Si3N4/Ag)n/Si3N4 multilayers grown by alternating ion-beam sputtering have been studied by combining complementary characterization techniques such as transmission electron microscopy, spectroscopic ellipsometry and degenerate four-wave mixing. The linear optical response dominated by the surface plasmon resonance of Ag nanoparticles has been measured over the whole visible range while the third-order nonlinear susceptibility has been probed at the surface plasmon resonance wavelength. Due to the weak in-plane interaction between Ag nanoparticles, the linear and nonlinear optical responses of the Si3N4/Ag/Si3N4 trilayers are mainly influenced by the size and shape of the nanoparticles. A maximum value of 1.1 x 10(-7) esu has been found at 635 nm for the effective third-order nonlinear susceptibility of the trilayer with the highest amount of silver. The linear optical response of the (Si3N4/Ag)n/Si3N4 multilayers is shown to be dominated by the surface plasmon resonance of isolated layers of weakly interacting nanoparticles at wavelengths shorter than 600 nm whereas a contribution due to vertical interactions has been shown for higher wavelengths. Below the vertical percolation threshold, their nonlinear optical response at the surface plasmon resonance wavelength is similar to the one of an isolated assembly of nanoparticles, and the effective third-order nonlinear susceptibility is slightly increased by decreasing the thickness of the Si3N4 spacer.

Independent control of beam astigmatism and ellipticity using a SLM for fs-laser waveguide writing

We have used a low repetition rate (1 kHz), femtosecond laser amplifier in combination with a spatial light modulator (SLM) to write optical waveguides with controllable cross-section inside a phosphate glass sample. The SLM is used to induce a controllable amount of astigmatism in the beam wavefront while the beam ellipticity is controlled through the propagation distance from the SLM to the focusing optics of the writing set-up. The beam astigmatism leads to the formation of two separate disk-shaped foci lying in orthogonal planes. Additionally, the ellipticity has the effect of enabling control over the relative peak irradiances of the two foci, making it possible to bring the peak irradiance of one of them below the material transformation threshold. This allows producing a single waveguide with controllable cross-section. Numerical simulations of the irradiance distribution at the focal region under different beam shaping conditions are compared to in situ obtained experimental plasma emission images and structures produced inside the glass, leading to a very satisfactory agreement. Finally, guiding structures with controllable cross-section are successfully produced in the phosphate glass using this approach.

Longitudinal course of suicidal ideation in patients with newly diagnosed thoracic cancers

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Background: While cancer itself is associated with elevated suicide rates, thoracic cancers have the highest rates. Previous studies of suicidal ideation (SI) in cancer patients have all been cross-sectional. This study investigates the longitudinal course of SI in newly diagnosed thoracic cancer patients. Methods: Between 8/7/07–9/16/08, a prospective cohort was recruited from consecutive new patients at a thoracic oncology clinic in an academic cancer center. At initial visit and approximately every two months afterward, participants completed the Patient Health Questionnaire depression and anxiety modules, which include one item measuring SI over the prior two weeks. Participants were assessed at points of care; those not returning within follow up periods were not assessed. Factors bivariately associated with SI at initial visit were entered into multiple logistic regression models to identify independent predictors. Linear mixed effects models investigated change in SI level over time within individuals. Results: 373 participants enrolled. At initial visit, 254 (68.1%) had known lung cancers, 38 (10.2%) had esophageal cancer. 127 (34.1%) had advanced cancer. Mean age was 63.71 (11.50) and 200 (53.6%) were women. 368 completed initial assessment. At initial visit, 21 (5.7%) expressed SI and 111 (30.16%) met criteria for depressive or anxiety disorders. While ECOG performance status was associated with SI in bivariate analyses, only depression and anxiety remained independent predictors, both p=.01. Cancer type and stage were not significantly associated. Controlling for performance status, SI was more likely in those with any depressive or anxiety disorders (OR=7.14, 95% CI 2.48–20.55). Levels of SI within individuals decreased over time (p=.02). Only 2.2% (3/135) had SI at two months and none at four and six months. One participant (4.8%) with SI at initial visit had a known suicide attempt during the study period. Conclusions: Newly diagnosed thoracic cancer patients had a 6% SI rate at initial visit, slightly lower than other reports with mixed cancers. SI appears to decrease over time, with highest risk early after diagnosis. Given previous data that suicide rates are highest with thoracic cancers, our findings may suggest greater likelihood to act on SI.

[Table: see text]

Code status documentation in the outpatient electronic medical records of patients with metastatic cancer

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Background: Advanced care planning is an essential component of cancer care for patients with incurable malignancies. However, the extent to which clinicians clearly document end-of-life care discussions and code status preferences in ambulatory medical records is unknown. The goal of the study was to investigate the rate of code status documentation in the electronic longitudinal medical record (LMR) of patients with metastatic cancers. Methods: We conducted a retrospective review of outpatient medical records of 2498 patients with metastatic solid tumors seen at an academic cancer center from 10/1/06 through 2/29/08. An electronic database was used to gather information on patient demographics, cancer type, and visits to the cancer center. The sample consisted of patients with metastatic breast, colorectal, non-colorectal gastrointestinal (GI), bladder/kidney, ovarian, prostate, and lung cancers. For the study endpoints, we queried the LMR to determine completion and designation of code status, which could be documented as follows: full code, do not resuscitate (DNR)/do not intubate (DNI), or DNR/DNI with specific resuscitation requests. Multiple logistic regression was used to identify independent predictors of code status completion and resuscitation preference. Results: Among the 2498 patients, 508 (20.3%) had a documented code status. Code status was documented more frequently in patients with metastatic non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers compared to patients with genitourinary malignancies (bladder/kidney [4/89, 4.5%], ovarian [4/93, 4.3%] and prostate [7/365, 1.9%] cancers). Independent predictors of having documented code status included cancer type and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. Conclusions: Despite the incurable nature of metastatic cancers, a minority of patients had a code status documented in the outpatient medical record. Given the importance of advanced care planning for those with terminal illness, interventions are needed to encourage discussion and documentation of end-of-life care preferences in patients with advanced cancer.

No significant financial relationships to disclose.

Near-infrared spatial solitons in heavy metal oxide glasses

We demonstrate two-dimensional spatial solitons excited by near-infrared picosecond pulses in Kerr-like heavy metal oxide glasses with a nonlinearity one order of magnitude larger than in fused silica. Solitons were obtained at 820 nm owing to the presence of multiphoton absorption, which prevented catastrophic collapse.

[Transapical approach for aortic stented valve implantation: experimental results]

OBJECTIVE

Percutaneous aortic valve replacement has been performed in humans mainly for non-surgical candidates. We evaluated on animals a transapical approach to deliver an aortic stented valve without cardiopulmonary bypass.

METHODS

A tubular pericardial valve fixed within a cobalt-nickel stent (Medtronic, Inc.) was implanted using a transapical approach in five adult sheep. A left thoracotomy was used to access the apex of the heart. The crimped valve was deployed in orthotopic position with a valvuloplasty balloon catheter on the beating heart after decreasing the left ventricular pressure by using either drugs or inferior vena cava occlusion. Deployments were performed under fluoroscopy and epicardial 2D Doppler echocardiography. Exact positioning of the valve into the target area was confirmed by autopsy at the end of the procedures.

RESULTS

Valves were unsuccessfully deployed at the target site in all cases but one. Three valves were implanted in a supra-annular position with two of them in supracoronary position. One valve was implanted below the native annulus in the outflow tract. Valvular leak was noted in all but one implants. Coronary obstruction occurred twice and early valve retrograde migration once. Ventricular fibrillation or diastolic cardiac arrest occurred less than 20 minutes after stent deployment in all cases.

CONCLUSION

In our experience the transapical approach does not facilitate delivery of a stented valve. Despite its technically feasibility, advanced stent design and improvements in delivery system are required before to continue experimental studies in transapical approach for aortic stented valve.

Acute effect of hemodialysis on sympathetic skin response

Sympathetic skin response (SSR) is a useful and simple test for unmyelinated axon function in peripheral sensorimotor neuropathies. SSR was tested on a group of patients undergoing chronic regular hemodialysis before and after a single dialysis session. Nineteen patients in hemodialysis for more than three months were included. Nine patients were on dialysis with cellulosic membranes (CA, 3 male and 6 female, aged 57.7 +/- 16.4 years) and ten ones were on dialysis with non-cellulosic membranes (NC, 4 male and 6 female, aged 50.2 +/- 15.9 years) were studied. There were no differences neither in Kt/V values (NC 1.37 +/- 0.34 vs. CA 1.22 +/- 0.27) nor in TAC ones (NC 41.5 +/- 18.2 vs. CA 41.3 +/- 14.1 mg/dL). After hemodialysis with NC amplitude significantly increased (994 +/- 1015 vs. 382 +/- 465 microv baseline, p < 0.05). Latency did not change (1.76 +/- 0.83 vs. 2.07 +/- 0.50 s baseline). After hemodialysis with CA neither amplitude changed (1368 +/- 1074 vs. 1240 +/- 1594 microv baseline), nor did latency (1.79 +/- 0.35 vs. 1.94 +/- 0.59 s baseline). Hemodialysis with non-cellulosic membranes (but not with cellulose acetate) yields a short-term improvement of sympathetic skin response. This effect is similar to those seen in nerve conduction velocities and it may be related to increased middle-molecules depuration.

Ultrafast laser-induced phase transitions in amorphous GeSb films

Time-resolved measurements of the spectral dielectric function reveal new information about ultrafast phase transitions induced by femtosecond laser pulses in Sb-rich amorphous GeSb films. The excitation generates a nonthermal phase within 200 fs. The dielectric function of this phase differs from that of the crystalline phase, contrary to previous suggestions of a disorder-to-order transition. The observed dielectric function is close to that of the liquid phase, indicating an ultrafast transition from the amorphous phase to a different disordered state.

Evaluation of a colorimetric Babesia bigemina-DNA probe within an epidemiological survey

An epidemiological survey was conducted in southeast Mexico, in an effort to establish the serological reactivity and carrier status to Babesia bigemina of an indigenous cattle population. The prevalence was obtained through the Indirect Fluorescent Antibody Test (IFAT), using an in vitro culture-derived B. bigemina antigen. A specific, digoxigenin-coupled, approximately 6 Kb B. bigemina-DNA probe (BBDP), was used to indicate the presence of the parasite. Serum samples from 925 animals of all ages, were obtained within the three regions (I, II, III) of the state of Yucatan and tested by IFAT. In addition, whole blood samples drawn from 136 of the same animals of region II were analyzed using the BBDP. Positive IFAT (IFAT+) reactions were observed in 531 sera for a 57% overall prevalence. Regional values were: I = 157+ (56%), II = 266+ (68%) and III 108+ (42%). Only 32 (23%) of the blood samples tested with BBDP showed distinctive hybridization signal, in contrast with 100 (73%) IFAT+ animals. The response distribution for IFAT vs. BBDP was: +/+ 23, +/- 77, -/+ 9 and -/- 27 respectively. It was found that the analytical sensitivity of BBDP appears to be low for its utilization in widespread epidemiological surveys. It was considered, however, that the colorimetric probe might be useful to safely detect transmission prone carriers, since it is able to detect parasitemias as low as 0.001%.

Effects of exposing broiler breeders to nicarbazin contaminated feed

Ten-mo-old broiler feeds were fed nicarbazin (NCZ) at 0, 25, 50 and 100 ppm of their diet for 2, 4, or 6 days to simulate accidental contamination of their feed with the medicant. Reduced egg production was observed in all treatments except 25 and 50 ppm NCZ for 2 days. A consistent reduction in egg weight occurred only at the maximum treatment level of 100 ppm for 6 days. Reduction in hatchability was generally evident by Days 5 and 6 of the experiment except for the lowest treatment of 25 ppm NCZ for 2 days. Due partially to the low number of eggs set, no statistically significant reduction in hatchability was seen for the group receiving 50 ppm NCZ for 4 days, but hatchability had dropped over 17 percentage points (from 93.3 to 75.5%) by Days 5 and 6 of the experiment, and continued to drop to a low of 31% on Days 11 and 12 of the experiment. Shell pigmentation was the most sensitive characteristic measured, with significant depigmentation occurring after only 2 days of feeding 25 ppm NCZ. Generally, the severity and duration of effects were in proportion to medicant concentration and length of treatment time. Fertility was not influenced by the medicant.

Production and egg-quality responses of White Leghorn layers to anticoccidial agents

Two studies were conducted to determine the effects of anticoccidial agents on the production and reproduction of White Leghorns. In Experiment 1, nicarbazin (NCZ) was fed at 0, 20, 50, and 100 ppm. Hen-day egg production, egg weight, the egg-yolk DNC (4-4'-dinitrocarbanilide) level, and egg-yolk mottling were affected by the treatments. When response was evidenced, the relationship between those variables and the level of NCZ was basically linear. Decreased egg production occurred from Days 5 and 6 of the treatment through Days 1 and 2 of withdrawal. On Days 9 and 10 of treatment, the control hens peaked at 92% hen-day production, while hens fed 20, 50, and 100 ppm of NCZ peaked late--at 90, 82, and 80%, respectively. Compared to the controls, egg weight was reduced linearly as the level of dietary NCZ increased. The egg-yolk DNC level increased from Days 3 and 4 of treatment through Days 9 and 10 of withdrawal. Egg yolk mottling generally increased along with the level and duration of feeding NCZ. If the NCZ was mistakenly fed to White Leghorn layers, ill effects would be alleviated within 10 days after drug withdrawal. In Experiment 2, halofuginone (3 ppm), maduramicin (5 ppm), monensin (100 ppm), narasin (70 ppm), nicarbazin (125 ppm), robenidine (33 ppm), and salinomycin (60 ppm) were fed to White Leghorn hens at the levels specified in parentheses. Nicarbazin reduced egg production, depressed egg weight, reduced shell thickness, and caused egg-yolk mottling; but internal egg quality, as measured by Haugh Units, was unaffected. Halofuginone, maduramicin, monensin, narasin, robenidine, and salinomycin did not have a meaningful effect on the variables measured when fed to White Leghorn layers.

Reproduction responses of broiler-breeders to anticoccidial agents

Two experiments were conducted to determine the effects of anticoccidial agents on production and reproduction of broiler breeders. In Experiment 1, nicarbazin (NCZ) was fed at 20, 50, and 100 ppm. There was no depression in egg production, egg weight, or fertility from feeding these levels. As level of NCZ increased, there was a linear decrease in hatchability. The amount of 4,4'-dinitrocarbanilide (DNC) in the egg yolks increased linearly as the levels of NCZ went up; the degree of egg-shell depigmentation was directly related to the level of NCZ fed starting at 50 ppm. Experiment 2 utilized a different strain of broiler breeders. Halofuginone (3 ppm), maduramicin (5 ppm), monensin (100 ppm), narasin (70 ppm), NCZ (125 ppm), robenidine (33 ppm), and salinomycin (60 ppm) were fed to broiler breeders at the levels listed. Only NCZ reduced egg production. Narasin induced a reduction in egg weight. Both narasin and salinomycin caused a significant drop in hatchability. Feeding NCZ also induced a rapid and more severe decrease in hatchability. Monensin was the only anticoccidial agent that reduced fertility. Halofuginone, maduramicin, and robenidine had no biologically significant effect on henday production, egg weight, hatch of fertile eggs, or shell depigmentation. Feeding NCZ at 125 ppm caused a complete bleaching of brown-shell eggs by the 3rd consecutive day of treatment; but 7 days after NCZ was withdrawn from the feed, pigmentation returned to the pretreatment level.

Response of 21 Canadian field isolates of chicken coccidia to commercial anticoccidial drugs

Coccidia were isolated from 30 broiler farms in major poultry-producing provinces of Canada; 21 mixed-species isolates were tested for sensitivity to anticoccidial drugs. Eimeria acervulina was identified in 20 samples, E. maxima in 15, and E. tenella in 10 of the mixed-species isolates. On the basis of weight gain after infection, 3 isolates were judged sensitive to amprolium, 5 to monensin, 9 to salinomycin, 14 to lasalocid, 19 to halofuginone, and 20 to nicarbazin. Similar trends in sensitivity/tolerance were identified from the percent reduction of intestinal lesion scores of medicated birds compared with scores of unmedicated, infected controls. These results were consistent with the previous pattern of use of anticoccidial drugs in commercial poultry in Canada.

Pigmented breast carcinoma. A clinical and histopathologic simulator of malignant melanoma

A case of infiltrating breast carcinoma presenting as a pigmented lesion of the areola and nipple is described. The pigmentation was found to be primarily due to interspersed melanocytes and melanophages within the tumor. The histologic criteria and the differential immunohistochemical staining characteristics of melanoma and breast carcinoma are presented. Also emphasized is the difficulty in differentiating pagetoid malignant melanoma and epidermotrophic breast carcinoma.

Health behavior of elderly Hispanic women: does cultural assimilation make a difference?

The role of cultural assimilation in Hispanic health behavior has received little empirical examination. Prior studies have operationalized assimilation primarily in terms of language preference and have obtained weak or no effects. We interviewed 603 elderly Hispanic women residing in Los Angeles to evaluate the usefulness of cultural factors as predictors of preventive health behavior (e.g., physical examination, screening for breast cancer) more rigorously. Factor analysis of responses yielded four dimensions of cultural assimilation: "language preference", "country of birth", "contact with homeland", and "attitudes about children's friends." After controlling for education and age, no dimension of assimilation associated strongly or consistently with health behavior. Of the four dimensions, use of English language associated most closely with increased screening, although most of the effects for language were small in magnitude. These findings, coupled with those of other studies, strongly suggest that cultural factors may have little impact on the health behavior of Hispanics. Access to and availability of services, affective reactions toward screening, and sociodemographic factors are stronger determinants of Hispanic health practices.

A survey of sensitivity to anticoccidial drugs in 60 isolates of coccidia from broiler chickens in Brazil and Argentina

Coccidia were isolated from 90 broiler farms in 15 poultry-producing areas in Brazil and Argentina. Sixty isolates were tested for sensitivity to 7 anticoccidial drugs. The common species were: a) Eimeria tenella, 47 isolates; b) E. maxima, 49 isolates; c) E. acervulina, 44 isolates; d) E. mitis, 26 isolates; and e) E. brunetti, 12 isolates. Isolates were considered sensitive to drugs if intestinal lesion scores of medicated broilers were reduced by at least 50% compared with unmedicated infected broilers or if weight gain was at least 75% of that of uninfected birds in a 6-day laboratory test. According to lesion scores, there was evidence of resistance or seriously reduced sensitivity to monensin in 20 isolates, narasin in 29, salinomycin in 11, maduramicin in 1, clopidol in 36, amprolium in 40, and nicarbazin in 1. According to broiler weight gain, there was resistance to monensin in 36 isolates, narasin in 32, salinomycin in 28, maduramicin in 2, clopidol in 28, amprolium in 50, and nicarbazin in 4. These results suggested incomplete cross resistance of coccidia to polyether ionophorous drugs. The degree of resistance might be explained by previous patterns of use of these drugs.