[Diabetes update: preventing type 2 diabetes. Individualized stepwise therapy (oral antidiabetic agents). Multifactorial intervention]

Preclinical disorders of glucose metabolism should be systematically included in the high-risk group for diabetes mellitus and affected individuals provided with preventive measures. Their underlying insulin resistance is determined with the help of a checklist and a method called homeostasis model assessment (HOMA). Patients with impaired fasting glucose (IFG) must change their lifestyles. If this does not lead to a response or the patient is unable to modify behavior, medication is required. In the case of manifest type 2 diabetes mellitus, a graded schedule is used for differential management, which should be based on nutritional and exercise therapy. Oral medication with metformin is probably the drug of choice in both obese and non-obese patients. It is crucial not to delay raising the level of treatment until HbA1c has fallen to within an unsatisfactory range (wait-and-see strategy). Rather, the level should be intensified when persistent exacerbation starts to become apparent (proactive therapy). In diabetes mellitus, the same guidelines for secondary prevention apply to the associated cardiovascular risk factors as with coronary heart disease. An intensified and, especially, early treatment is to be preferred over a conservative, wait-and-see approach, in this case as well.

A multifactorial histopathologic score for the prediction of prognosis of resected esophageal adenocarcinomas after neoadjuvant chemotherapy

BACKGROUND For esophageal adenocarcinoma treated with neoadjuvant chemotherapy, postoperative staging classifications initially developed for non-pretreated tumors may not accurately predict prognosis. We tested whether a multifactorial TNM-based histopathologic prognostic score (PRSC), which additionally applies to tumor regression, may improve estimation of prognosis compared with the current Union for International Cancer Control/American Joint Committee on Cancer (UICC) staging system. PATIENTS AND METHODS We evaluated esophageal adenocarcinoma specimens following cis/oxaliplatin-based therapy from two separate centers (center 1: n = 280; and center 2: n = 80). For the PRSC, each factor was assigned a value from 1 to 2 (ypT0-2 = 1 point; ypT3-4 = 2 points; ypN0 = 1 point; ypN1-3 = 2 points; ≤50 % residual tumor/tumor bed = 1 point; >50 % residual tumor/tumor bed = 2 points). The three-tiered PRSC was based on the sum value of these factors (group A: 3; group B: 4-5; group C: 6) and was correlated with patients' overall survival (OS). RESULTS The PRSC groups showed significant differences with respect to OS (p < 0.0001; hazard ratio [HR] 2.2 [95 % CI 1.7-2.8]), which could also be demonstrated in both cohorts separately (center 1 p < 0.0001; HR 2.48 [95 % CI 1.8-3.3] and center 2 p = 0.015; HR 1.7 [95 % CI 1.1-2.6]). Moreover, the PRSC showed a more accurate prognostic discrimination than the current UICC staging system (p < 0.0001; HR 1.15 [95 % CI 1.1-1.2]), and assessment of two goodness-of-fit criteria (Akaike Information Criterion and Schwarz Bayesian Information Criterion) clearly supported the superiority of PRSC over the UICC staging. CONCLUSION The proposed PRSC clearly identifies three subgroups with different outcomes and may be more helpful for guiding further therapeutic decisions than the UICC staging system.

Erosive tooth wear: a multifactorial condition of growing concern and increasing knowledge.

Dental erosion is often described solely as a surface phenomenon, unlike caries where it has been established that the destructive effects involve both the surface and the subsurface region. However, besides removal of the surface, erosion shows dissolution of mineral within the softened layer - beneath the surface. In order to distinguish this process from the carious process it is now called 'near surface demineralization'. Erosion occurs in low pH, but there is no fixed critical pH value concerning dental erosion. The critical pH value for enamel concerning caries (pH 5.5-5.7) has to be calculated from calcium and phosphate concentrations of plaque fluid. In the context of dental erosion, the critical pH value is calculated from the calcium and phosphate concentrations in the erosive solution itself. Thus, critical pH for enamel with regard to erosion will vary according to the erosive solution. Erosive tooth wear is becoming increasingly significant in the management of the long-term health of the dentition. What is considered as an acceptable amount of wear is dependent on the anticipated lifespan of the dentition and is, therefore, different for deciduous compared to permanent teeth. However, erosive damage to the teeth may compromise the patient's dentition for their entire lifetime and may require repeated and increasingly complex and expensive restorations. Therefore, it is important that diagnosis of the tooth wear process in children and adults is made early and that adequate preventive measures are undertaken. These measures can only be initiated when the risk factors are known and interactions between them are present.

A multifactorial analysis of explicitation in translation

The search for translation universals has been an important topic in translation studies over the past decades. In this paper, we focus on the notion of explicitation through a multifaceted study of causal connectives, integrating four different variables: the role of the source and the target languages, the influence of specific connectives and the role of the discourse relation they convey. Our results indicate that while source and target languages do not globally influence explicitation, specific connectives have a significant impact on this phenomenon. We also show that in English and French, the most frequently used connectives for explicitation share a similar semantic profile. Finally, we demonstrate that explicitation also varies across different discourse relations, even when they are conveyed by a single connective.

Modelo multifactorial para optimización de la productividad en el proceso de generación de energía eléctrica : aplicación al caso de las centrales hidroeléctricas venezolanas

Las organizaciones son sistemas o unidades sociales, compuestas por personas que interactúan entre sí, para lograr objetivos comunes. Uno de sus objetivos es la productividad. La productividad es un constructo multidimensional en la que influyen aspectos tecnológicos, económicos, organizacionales y humanos. Diversos estudios apoyan la influencia de la motivación de las personas, de las habilidades y destrezas de los individuos, de su talento para desempeñar el trabajo, así como también del ambiente de trabajo presente en la organización, en la productividad. Por esta razón, el objetivo general de la investigación, es analizar la influencia entre los factores humanos y la productividad. Se hará énfasis en la persona como factor productivo clave, para responder a las interrogantes de la investigación, referidas a cuáles son las variables humanas que inciden en la productividad, a la posibilidad de plantear un modelo de productividad que considere el impacto del factor humano y la posibilidad de encontrar un método para la medición de la productividad que contemple la percepción del factor humano. Para resolver estas interrogantes, en esta investigación se busca establecer las relaciones entre las variables humanas y la productividad, vistas desde la perspectiva de tres unidades de análisis diferentes: individuo, grupo y organización, para la formulación de un modelo de productividad humana y el diseño de un instrumento para su medida. Una de las principales fuente de investigación para la elección de las variables humanas, la formulación del modelo, y el método de medición de la productividad, fue la revisión de la literatura disponible sobre la productividad y el factor humano en las organizaciones, lo que facilitó el trazado del marco teórico y conceptual. Otra de las fuentes para la selección fue la opinión de expertos y de especialistas directamente involucrados en el sector eléctrico venezolano, lo cual facilitó la obtención de un modelo, cuyas variables reflejasen la realidad del ámbito en estudio. Para aportar una interpretación explicativa del fenómeno, se planteó el modelo de los Factores Humanos vs Productividad (MFHP), el cual se analizó desde la perspectiva del análisis causal y fue conformado por tres variables latentes exógenas denominadas: factores individuales, factores grupales y factores organizacionales, que estaban relacionadas con una variable latente endógena denominada productividad. El MFHP se formuló mediante la metodología de los modelos de ecuaciones estructurales (SEM). Las relaciones inicialmente propuestas entre las variables latentes fueron corroboradas por los ajustes globales del modelo, se constataron las relaciones entre las variables latentes planteadas y sus indicadores asociados, lo que facilitó el enunciado de 26 hipótesis, de las cuales se comprobaron 24. El modelo fue validado mediante la estrategia de modelos rivales, utilizada para comparar varios modelos SEM, y seleccionar el de mejor ajuste, con sustento teórico. La aceptación del modelo se realizó mediante la evaluación conjunta de los índices de bondad de ajuste globales. Asimismo, para la elaboración del instrumento de medida de la productividad (IMPH), se realizó un análisis factorial exploratorio previo a la aplicación del análisis factorial confirmatorio, aplicando SEM. La revisión de los conceptos de productividad, la incidencia del factor humano, y sus métodos de medición, condujeron al planteamiento de métodos subjetivos que incorporaron la percepción de los principales actores del proceso productivo, tanto para la selección de las variables, como para la formulación de un modelo de productividad y el diseño de un instrumento de medición de la productividad. La contribución metodológica de este trabajo de investigación, ha sido el empleo de los SEM para relacionar variables que tienen que ver con el comportamiento humano en la organización y la productividad, lo cual abre nuevas posibilidades a la investigación en este ámbito. Organizations are social systems or units composed of people who interact with each other to achieve common goals. One objective is productivity, which is a multidimensional construct influenced by technological, economic, organizational and human aspects. Several studies support the influence on productivity of personal motivation, of the skills and abilities of individuals, of their talent for the job, as well as of the work environment present in the organization. Therefore, the overall objective of this research is to analyze the influence between human factors and productivity. The emphasis is on the individual as a productive factor which is key in order to answer the research questions concerning the human variables that affect productivity and to address the ability to propose a productivity model that considers the impact of the human factor and the possibility of finding a method for the measurement of productivity that includes the perception of the human factor. To consider these questions, this research seeks to establish the relationships between human and productivity variables, as seen from the perspective of three different units of analysis: the individual, the group and the organization, in order to formulate a model of human productivity and to design an instrument for its measurement. A major source of research for choosing the human variables, model formulation, and method of measuring productivity, was the review of the available literature on productivity and the human factor in organizations which facilitated the design of the theoretical and conceptual framework. Another source for the selection was the opinion of experts and specialists directly involved in the Venezuelan electricity sector which facilitated obtaining a model whose variables reflect the reality of the area under study. To provide an interpretation explaining the phenomenon, the model of the Human Factors vs. Productivity Model (HFPM) was proposed. This model has been analyzed from the perspective of causal analysis and was composed of three latent exogenous variables denominated: individual, group and organizational factors which are related to a latent variable denominated endogenous productivity. The HFPM was formulated using the methodology of Structural Equation Modeling (SEM). The initially proposed relationships between latent variables were confirmed by the global fits of the model, the relationships between the latent variables and their associated indicators enable the statement of 26 hypotheses, of which 24 were confirmed. The model was validated using the strategy of rival models, used for comparing various SEM models and to select the one that provides the best fit, with theoretical support. The acceptance of the model was performed through the joint evaluation of the adequacy of global fit indices. Additionally, for the development of an instrument to measure productivity, an exploratory factor analysis was performed prior to the application of a confirmatory factor analysis, using SEM. The review of the concepts of productivity, the impact of the human factor, and the measurement methods led to a subjective methods approach that incorporated the perception of the main actors of the production process, both for the selection of variables and for the formulation of a productivity model and the design of an instrument to measure productivity. The methodological contribution of this research has been the use of SEM to relate variables that have to do with human behavior in the organization and with productivity, opening new possibilities for research in this area.

Estadística Aplicada a los Recursos Marinos. ANOVA multifactorial. Diseños ortogonales

Tema: Diseños con Factores Ortogonales

Curso de ANOVA Multifactorial - Tema 1 - ANOVA Intro

Introducción y conceptos de ANOVA

Assembly of Human Papillomavirus Type-16 Virus-Like Particles: Multifactorial Study of Assembly and Competing Aggregation

Pentameric capsomeres of human papillomavirus capsid protein L1 expressed in Escherichia coli self-assemble into virus-like particles (VLPs) in vitro. A multifactorial experimental design was used to explore a wide range of solution conditions to optimize the assembly process. The degree of assembly was measured using an enzyme-linked immunosorbent assay, and a high-throughput turbidity assay was developed to monitor competing aggregation. The presence of zinc ions in the assembly buffer greatly increased the incidence of aggregation and had to be excluded from the experiment for meaningful analysis. Assembly of VLPs was optimal at a pH of about 6.5, calcium and sodium ions had no measurable effect, and dithiothreitol and glutathione inhibited assembly. Tryptophan fluorescence spectroscopy demonstrated that an increase in urea concentration reduced the rate of VLP formation but had no effect on the final concentration of assembled VLPs. This study demonstrates the use of the hanging-drop vapor-diffusion crystallization method to screen for conditions that promote aggregation and the use of tryptophan fluorescence spectroscopy for real-time monitoring of the assembly process.

The fall and rise of tear albumin levels:a multifactorial phenomenon

Albumin in tears is used as a diagnostic marker of ocular insult and inflammation, but whether its presence in tears is responsive or part of an adaptive reaction remains unresolved. A review of the literature on tear albumin concentration emphasizes that variables such as collection method, stimulus, assay technique, and disease state influence the quoted values to different extents. Influence of assay technique is negligible in comparison to variation in sampling conditions. Ocular disease increases albumin concentrations but not in a specific manner. The literature review also highlighted that little systematic research has been carried out on the daily cycle of tear albumin levels. In order to remedy this shortcoming, we investigated variations in tear albumin concentration during the waking day. The concentration of albumin in 400 tear samples collected from 13 subjects was assessed at 2-hourly intervals throughout the waking day. Highest daytime albumin concentrations were obtained within 10 minutes of waking, with a mean concentration of >50 ± 22 µg/ml. Albumin levels were at their lowest, but most consistent, 2-6 hours post-waking. This pattern was followed by a progressive increase in albumin concentration during the latter part of the day. Although individual subject-to-subject concentration differences were observed, this distinctive pattern of diurnal variation was found in all subjects. The results presented suggest a regulated, not random, pattern of variation within the period of study. © 2013 Elsevier Inc. All rights reserved.

Multifactorial approach to non-viral gene therapy: development of an efficient system for the retina

Tese de Doutoramento, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2016

Using a multifactorial approach to determine fall risk profiles in portuguese older adults

The aim of this study was to use a multifactorial approach to characterize episodic and recurrent fallers risk profiles in Portuguese older adults.

Using a multifactorial approach to determine fall risk profiles in portuguese older adults

The aim of this study was to use a multifactorial approach to characterize episodic and recurrent fallers risk profiles in Portuguese older adults.

Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up

Background: Although the negative consequences on health of being obese are well known, most adults gain weight across the lifespan. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes; however, few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years. Methods and Findings: Totally, 6130 participants from TwinGene, who had up to five assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases and an individual obesity genetic risk score (OGRS) based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age of 65 years, after which the increase leveled off; BMI declined after age of 80 years. A higher OGRS, birth after 1925 and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to 65 years of age. Among men, few factors were identified that influence BMI trajectories in late life, whereas for women type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years. Conclusions: There are two turning points in BMI in late adulthood, one at the age of 65 years and one at the age 80 years. Factors associated with an increase in BMI in midlife were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the lifespan. Current health recommendations need to be adjusted accordingly.