The evidence behind the level of a random urine protein:creatinine in the diagnosis of preeclampsia: A systematic review

Objective. To determine the accuracy of the urine protein:creatinine ratio (pr:cr) in predicting 300 mg of protein in 24-hour urine collection in pregnant patients with suspected preeclampsia. ^ Methods. A systematic review was performed. Articles were identified through electronic databases and the relevant citations were hand searching of textbooks and review articles. Included studies evaluated patients for suspected preeclampsia with a 24-hour urine sample and a pr:cr. Only English language articles were included. The studies that had patients with chronic illness such as chronic hypertension, diabetes mellitus or renal impairment were excluded from the review. Two researchers extracted accuracy data for pr:cr relative to a gold standard of 300 mg of protein in 24-hour sample as well as population and study characteristics. The data was analyzed and summarized in tabular and graphical form. ^ Results. Sixteen studies were identified and only three studies met our inclusion criteria with 510 total patients. The studies evaluated different cut-points for positivity of pr:cr from 130 mg/g to 700 mg/g. Sensitivities and specificities for pr:cr of 130mg/g -150 mg/g were 90-93% and 33-65%, respectively; for a pr:cr of 300 mg/g were 81-95% and 52-80%, respectively; for a pr:cr of 600-700mg/g were 85-87% and 96-97%, respectively. ^ Conclusion. The value of a random pr:cr to exclude pre-eclampsia is limited because even low levels of pr:cr (130-150 mg/g) may miss up to 10% of patients with significant proteinuria. A pr:cr of more than 600 mg/g may obviate a 24-hour collection.^

Trends in anti-tuberculosis drug resistance from 2003--2007 at Pham Ngoc Thach tuberculosis and lung disease hospital, Ho Chi Minh City, Vietnam

Vietnam is one of the countries with the highest prevalence and incidence of tuberculosis (TB) in the world (1). Although Vietnam has had many successes in TB control, it still faces the challenge of drug resistant and multidrug-resistant tuberculosis (MDR-TB). MDR-TB appears to be relatively stable, but data on MDR-TB continues to be scarce and routine testing of all isolates for drug susceptibility is not performed under Vietnam's National Tuberculosis Program (6). Pham Ngoc Thach Hospital (PNT), the leading tuberculosis and lung disease hospital in Ho Chi Minh City, serves as a reference hospital and laboratory for both Ho Chi Minh City and the Southern Vietnam region. This study is an unmatched, nested case-control study consisting of a secondary analysis of a previously created dataset composed of drug susceptibility and basic demographic data from a cohort of patients diagnosed with tuberculosis at PNT from 2003 through 2007 in order to calculate the prevalence of resistance among acid-fast bacilli smear-positive patients. The susceptibility records for the years 2003-2004 were not representative of the entire population, but over the years 2005-2007 the investigator found a decrease in resistance to all primary TB drugs on which records were available, as well as MDR-TB. Overall, females showed a higher proportion of resistance to TB drugs than males, and females had a greater likelihood of presenting with MDR-TB than males (OR=1.77). Persons 35-54 had greater likelihood of having MDR-TB than younger and older age groups. Among the population with HIV data, HIV-positivity was associated with greater likelihood of MDR-TB (OR=1.70, 95% CI=0.97-3.11). This study shows that rates of TB drug resistance are high, but declining, in one of Vietnam's largest TB hospitals, and that females and HIV-positive individuals are possible high-risk groups in this population.^

HIV incidence estimates and HIV/AIDS concurrent diagnosis in Houston/Harris County

The purpose of this dissertation was to estimate HIV incidence among the individuals who had HIV tests performed at the Houston Department of Health and Human Services (HDHHS) public health laboratory, and to examine the prevalence of HIV and AIDS concurrent diagnoses among HIV cases reported between 2000 and 2007 in Houston/Harris County. ^ The first study in this dissertation estimated the cumulative HIV incidence among the individuals testing at Houston public health laboratory using Serologic Testing Algorithms for Recent HIV Seroconversion (STARHS) during the two year study period (June 1, 2005 to May 31, 2007). The HIV incidence was estimated using two independently developed statistical imputation methods, one developed by the Centers for Disease Control and Prevention (CDC), and the other developed by HDHHS. Among the 54,394 persons who tested for HIV during the study period, 942 tested HIV positive (positivity rate=1.7%). Of these HIV positives, 448 (48%) were newly reported to the Houston HIV/AIDS Reporting System (HARS) and 417 of these 448 blood specimens (93%) were available for STARHS testing. The STARHS results showed 139 (33%) out of the 417 specimens were newly infected with HIV. Using both the CDC and HDHHS methods, the estimated cumulative HIV incidences over the two-year study period were similar: 862 per 100,000 persons (95% CI: 655-1,070) by CDC method, and 925 per 100,000 persons (95% CI: 908-943) by HDHHS method. Consistent with the national finding, this study found African Americans, and men who have sex with men (MSM) accounted for most of the new HIV infections among the individuals testing at Houston public health laboratory. Using CDC statistical method, this study also found the highest cumulative HIV incidence (2,176 per 100,000 persons [95%CI: 1,536-2,798]) was among those who tested in the HIV counseling and testing sites, compared to the sexually transmitted disease clinics (1,242 per 100,000 persons [95%CI: 871-1,608]) and city health clinics (215 per 100,000 persons [95%CI: 80-353]. This finding suggested the HIV counseling and testing sites in Houston were successful in reaching high risk populations and testing them early for HIV. In addition, older age groups had higher cumulative HIV incidence, but accounted for smaller proportions of new HIV infections. The incidence in the 30-39 age group (994 per 100,000 persons [95%CI: 625-1,363]) was 1.5 times the incidence in 13-29 age group (645 per 100,000 persons [95%CI: 447-840]); the incidences in 40-49 age group (1,371 per 100,000 persons [95%CI: 765-1,977]) and 50 or above age groups (1,369 per 100,000 persons [95%CI: 318-2,415]) were 2.1 times compared to the youngest 13-29 age group. The increased HIV incidence in older age groups suggested that persons 40 or above were still at risk to contract HIV infections. HIV prevention programs should encourage more people who are age 40 and above to test for HIV. ^ The second study investigated concurrent diagnoses of HIV and AIDS in Houston. Concurrent HIV/AIDS diagnosis is defined as AIDS diagnosis within three months of HIV diagnosis. This study found about one-third of the HIV cases were diagnosed with HIV and AIDS concurrently (within three months) in Houston/Harris County. Using multivariable logistic regression analysis, this study found being male, Hispanic, older, and diagnosed in the private sector of care were positively associated with concurrent HIV and AIDS diagnoses. By contrast, men who had sex with men and also used injection drugs (MSM/IDU) were 0.64 times (95% CI: 0.44-0.93) less likely to have concurrent HIV and AIDS diagnoses. A sensitivity analysis comparing difference durations of elapsed time for concurrent HIV and AIDS diagnosis definitions (1-month, 3-month, and 12-month cut-offs) affected the effect size of the odds ratios, but not the direction. ^ The results of these two studies, one describing characteristics of the individuals who were newly infected with HIV, and the other study describing persons who were diagnosed with HIV and AIDS concurrently, can be used as a reference for HIV prevention program planning in Houston/Harris County. ^

Proliferation index in ductal carcinoma in situ of the breast: Relation to estrogen, progesterone and HER2/neu receptors

Background. Ductal carcinoma in situ (DCIS) is the most prevalent precursor to invasive breast cancer (IBC), the second leading cause of death in women in the United States. The three most important prognostic markers for IBC are Estrogen receptor (ER), Progesterone receptor (PR) and HER2/neu. The four groups (IBC) defined as (1) ER and/or PR positive and HER2/neu negative, (2) ER and/or PR positive and HER2/neu positive (3) ER and/or PR negative and HER2/neu positive and (4) negative for all three of these receptors (Triple negative). However, they have not been well studied in DCIS. This is an exploratory study with a primary objective to examine the prevalence of ER, PR, and HER2/neu in DCIS, to explore if the defined groups of IBC occur in DCIS and to consider the biological relationship between these four groups and the proliferative activity of the tumor. A secondary goal of this study is to examine the relationship between grade and proliferative activity. Methods. Using immunohistochemistry, I have measured Ki-67, ER, PR and HER2/neu positivity for a series of cases of DCIS. Results. 20 ER and/or PR positive and HER2/neu negative (50%) with average PI of 0.05, 7 ER and/or PR positive and HER2/neu positive (17.5%) with average PI of 0.14, 10 ER and/or PR negative and HER2/neu positive (25%) with average PI of 0.18, and three triple negative (7.5%) with average PI of 0.18. ER and/or PR positive and HER2/neu positive group has the highest PI (p<0.001). Further, the ER and/or PR positive and HER2/neu positive group show a linear relationship between PI and average ER/PR positivity (R=0.6). PI increases with higher grades. Conclusion. PI appears to depend upon the average fraction of positive ER/PR tumor cells, possibly with a synergistic dependence when HER2/neu is positive. If ER/PR is negative, then both HER2/neu positive and the triple negative cases appear to cluster around an average PI that is higher than the average PI in HER2/neu negative ER/PR positive negative cases. In the triple negative tumors there must be another driver of proliferation.^

Evaluation of environmental contamination of Clostridium difficile associated diarrhea in hospital rooms at St. Luke's Episcopal Hospital (SLEH) and review of literature on environmental sampling

The study was carried out at St. Luke's Episcopal Hospital to evaluate environmental contamination of Clostridium difficile in the infected patient rooms. Samples were collected from the high risk areas and were immediately cultured for the presence of Clostridium difficile . Lack of microbial typing prevented the study of molecular characterization of the Clostridium difficile isolates obtained led to a change in the study hypothesis. The study found a positivity of 10% among 50 Hospital rooms sampled for the presence of Clostridium difficile. The study provided data that led to recommendations that routine environmental sampling be carried in the hospital rooms in which patients with CDAD are housed and that effective environmental disinfection methods are used. The study also recommended molecular typing methods to allow characterization of the CD strains isolated from patients and environmental sampling to determine their type, similarity and origin.^

Process and outcome evaluation of the hepatitis B perinatal vaccination program in Houston, Texas, 1991--1993

A retrospective cohort study was designed to evaluate the compliance of vaccination dose schedules and vaccination effectiveness at 12 months of age among a total of 226 high-risk infants born to HBsAg-positive pregnant women who participated in the HBV Perinatal Vaccination Program in Houston, Texas, 1991-1993.^ The seroprevalence of HBsAg-positivity was 0.5% among pregnant women who attended prenatal clinics in Houston, Texas, 1991-1993. The Asian women had the highest seroprevalence rate (5.9%), followed by black (1.9%), white (0.7%), and Hispanic women (0.3%). The seroprevalence of HBsAg increased with age (p =.02); the highest seroprevalence rate found among the $>$40 group (5.4%), followed by the 20-40 age group, and the $<$20 age. A steady increase was observed in the number of infants, from 45 in 1991, to 103 in 1993. The majority of these infants were black (58.0%), followed by Hispanic (28.8%), Asian (8.4%), and white infants (4.0%). Significant increases were observed from 1991 to 1993 in the number of infants who initiated vaccination (86.7% to 98.1%, p =.02) and in those infants who were post-tested at 12 months of age (24.4% to 44.7%, p =.04). During the same period an increase was also observed in the number of infants who completed the vaccination dose schedules (62.2% to 72.8%, p =.37). The compliance rates were not statistically significant regarding gender, race or ethnicity, health service area, medical referral source, and residential geographic areas. About 56.0% of the reasons cited for non-compliance among the 144 infants who neither completed the vaccination dose schedules nor received the 12-month post-test were "moved," and "no response/not at home." A total of 82 infants completed the vaccination dose schedules and were post-tested at 12 months of age for anti-HBs-positivity, and 96.3% of these infants seroconverted. A race-specific statistically significant seroconversion difference was found among infants who received all vaccination doses and were post-tested at 12 months of age (100% for the black and the white, 96.3% for the Hispanic, and 80.0% for the Asians infants, p =.05).^ From a public health perspective, the HBV Perinatal Vaccination Program improved during its first three years (1991-1993). It was effective in preventing perinatal HBV infection in almost 97.0% of infants who were vaccinated and post-tested. To increase the efficiency and efficacy of the program, the following recommendations are proposed: (1) Increase the vaccination compliance rate by educating and improving the tracking, communication and coordination channels with those individuals involved in the process and by increasing staff resources. (2) Reduce the post-test vaccination non-compliance by post-testing infants simultaneously with third vaccination dose at 6 months of age, and only post-test those infants who are anti-HBs-negative at 9-12 months of age. (Abstract shortened by UMI.) ^

Apuntes para el estudio del ocio y las formas de sociabilidad de los estratos superiores en la Argentina contemporánea

En este trabajo sostengo que existe una relación entre ocio y estratificación social, o más específicamente, entre las formas de sociabilidad del tiempo libre y los estratos superiores, donde las prácticas de sociabilidad, esparcimiento y deporte operan como instancias de producción y reproducción, así como también de reconversión y recomposición social y simbólica de las categorías sociales de los estratos superiores. En el primer capítulo abordo buena parte de la bibliografía sobre estratificación social, clases sociales y elites para fundamentar el valor analítico de esta dimensión para las ciencias sociales en términos generales, y para el estudio de los fenómenos ligados a la sociabilidad del tiempo libre entre los estratos superiores, en particular. En el segundo capítulo intento fundamentar el valor sociológico de la dimensión del ocio y el tiempo libre, así como sus formas de sociabilidad, especialmente en función de su articulación en torno a los estratos superiores. En el tercer capítulo procuro abordar la relación entre estratos superiores y sociabilidad del tiempo libre para (y desde) el contexto argentino contemporáneo. Intentaré trabajar en torno al modo en que ha sido pensada y es posible pensar esa relación para la escena local, y al mismo tiempo, sobre el modo en que la reflexión enfocada en el contexto local nos permite elaborar marcos de análisis para el estudio del fenómeno de la sociabilidad del tiempo libre entre los estratos superiores, en general. Finalmente, la perspectiva que desarrollo aboga por un desplazamiento analítico que vaya desde las interpretaciones unidimensionales de los fenómenos ligados a la sociabilidad, el deporte y el ocio entre los estratos superiores hacia las lecturas multidimensionales. Un desplazamiento que nos permita interpretar la relación entre los procesos estructurales, las instancias de sociabilidad y las prácticas de los agentes en términos de afinidades, reponiendo la positividad de cada dimensión sin la necesidad de recurrir a las sobredeterminaciones o los reduccionismos de las más variadas especies

Ocio, consumo y deporte entre los estratos superiores : Aportes para la elaboración de un campo problemático

Este artículo tiene como propósito abordar un campo de preocupaciones que giran en torno a la productividad social de los espacios y prácticas del ocio, el consumo y el deporte, en particular en lo relativo a los estratos superiores y sus formas de sociabilidad. En esta dirección, se desarrolla un trabajo crítico en torno a las principales perspectivas sobre ocio y consumo, poniendo de relieve los supuestos normativos subyacentes en algunos casos, y los aportes conceptuales relativos a la positividad del ocio y el consumo como terrenos de estructuración de las categorías sociales, en otros. Finalmente, el artículo analiza los aportes de la sociología y la antropología del deporte para el estudio de la relación entre prácticas deportivas y posiciones sociales, argumentando a favor de la jerarquización del estudio de los fenómenos relativos al deporte, el ocio y el consumo como campos legítimos de investigación de las transformaciones recientes en la estructura social, y en particular, en lo referido a los estratos superiores

Apuntes para el estudio del ocio y las formas de sociabilidad de los estratos superiores en la Argentina contemporánea

En este trabajo sostengo que existe una relación entre ocio y estratificación social, o más específicamente, entre las formas de sociabilidad del tiempo libre y los estratos superiores, donde las prácticas de sociabilidad, esparcimiento y deporte operan como instancias de producción y reproducción, así como también de reconversión y recomposición social y simbólica de las categorías sociales de los estratos superiores. En el primer capítulo abordo buena parte de la bibliografía sobre estratificación social, clases sociales y elites para fundamentar el valor analítico de esta dimensión para las ciencias sociales en términos generales, y para el estudio de los fenómenos ligados a la sociabilidad del tiempo libre entre los estratos superiores, en particular. En el segundo capítulo intento fundamentar el valor sociológico de la dimensión del ocio y el tiempo libre, así como sus formas de sociabilidad, especialmente en función de su articulación en torno a los estratos superiores. En el tercer capítulo procuro abordar la relación entre estratos superiores y sociabilidad del tiempo libre para (y desde) el contexto argentino contemporáneo. Intentaré trabajar en torno al modo en que ha sido pensada y es posible pensar esa relación para la escena local, y al mismo tiempo, sobre el modo en que la reflexión enfocada en el contexto local nos permite elaborar marcos de análisis para el estudio del fenómeno de la sociabilidad del tiempo libre entre los estratos superiores, en general. Finalmente, la perspectiva que desarrollo aboga por un desplazamiento analítico que vaya desde las interpretaciones unidimensionales de los fenómenos ligados a la sociabilidad, el deporte y el ocio entre los estratos superiores hacia las lecturas multidimensionales. Un desplazamiento que nos permita interpretar la relación entre los procesos estructurales, las instancias de sociabilidad y las prácticas de los agentes en términos de afinidades, reponiendo la positividad de cada dimensión sin la necesidad de recurrir a las sobredeterminaciones o los reduccionismos de las más variadas especies

Ocio, consumo y deporte entre los estratos superiores : Aportes para la elaboración de un campo problemático

Este artículo tiene como propósito abordar un campo de preocupaciones que giran en torno a la productividad social de los espacios y prácticas del ocio, el consumo y el deporte, en particular en lo relativo a los estratos superiores y sus formas de sociabilidad. En esta dirección, se desarrolla un trabajo crítico en torno a las principales perspectivas sobre ocio y consumo, poniendo de relieve los supuestos normativos subyacentes en algunos casos, y los aportes conceptuales relativos a la positividad del ocio y el consumo como terrenos de estructuración de las categorías sociales, en otros. Finalmente, el artículo analiza los aportes de la sociología y la antropología del deporte para el estudio de la relación entre prácticas deportivas y posiciones sociales, argumentando a favor de la jerarquización del estudio de los fenómenos relativos al deporte, el ocio y el consumo como campos legítimos de investigación de las transformaciones recientes en la estructura social, y en particular, en lo referido a los estratos superiores

Ocio, consumo y deporte entre los estratos superiores : Aportes para la elaboración de un campo problemático

Este artículo tiene como propósito abordar un campo de preocupaciones que giran en torno a la productividad social de los espacios y prácticas del ocio, el consumo y el deporte, en particular en lo relativo a los estratos superiores y sus formas de sociabilidad. En esta dirección, se desarrolla un trabajo crítico en torno a las principales perspectivas sobre ocio y consumo, poniendo de relieve los supuestos normativos subyacentes en algunos casos, y los aportes conceptuales relativos a la positividad del ocio y el consumo como terrenos de estructuración de las categorías sociales, en otros. Finalmente, el artículo analiza los aportes de la sociología y la antropología del deporte para el estudio de la relación entre prácticas deportivas y posiciones sociales, argumentando a favor de la jerarquización del estudio de los fenómenos relativos al deporte, el ocio y el consumo como campos legítimos de investigación de las transformaciones recientes en la estructura social, y en particular, en lo referido a los estratos superiores

Apuntes para el estudio del ocio y las formas de sociabilidad de los estratos superiores en la Argentina contemporánea

En este trabajo sostengo que existe una relación entre ocio y estratificación social, o más específicamente, entre las formas de sociabilidad del tiempo libre y los estratos superiores, donde las prácticas de sociabilidad, esparcimiento y deporte operan como instancias de producción y reproducción, así como también de reconversión y recomposición social y simbólica de las categorías sociales de los estratos superiores. En el primer capítulo abordo buena parte de la bibliografía sobre estratificación social, clases sociales y elites para fundamentar el valor analítico de esta dimensión para las ciencias sociales en términos generales, y para el estudio de los fenómenos ligados a la sociabilidad del tiempo libre entre los estratos superiores, en particular. En el segundo capítulo intento fundamentar el valor sociológico de la dimensión del ocio y el tiempo libre, así como sus formas de sociabilidad, especialmente en función de su articulación en torno a los estratos superiores. En el tercer capítulo procuro abordar la relación entre estratos superiores y sociabilidad del tiempo libre para (y desde) el contexto argentino contemporáneo. Intentaré trabajar en torno al modo en que ha sido pensada y es posible pensar esa relación para la escena local, y al mismo tiempo, sobre el modo en que la reflexión enfocada en el contexto local nos permite elaborar marcos de análisis para el estudio del fenómeno de la sociabilidad del tiempo libre entre los estratos superiores, en general. Finalmente, la perspectiva que desarrollo aboga por un desplazamiento analítico que vaya desde las interpretaciones unidimensionales de los fenómenos ligados a la sociabilidad, el deporte y el ocio entre los estratos superiores hacia las lecturas multidimensionales. Un desplazamiento que nos permita interpretar la relación entre los procesos estructurales, las instancias de sociabilidad y las prácticas de los agentes en términos de afinidades, reponiendo la positividad de cada dimensión sin la necesidad de recurrir a las sobredeterminaciones o los reduccionismos de las más variadas especies

AS RELAÇÕES ENTRE GESTÃO DA DIVERSIDADE E CULTURA ORGANIZACIONAL EM UMA EMPRESA DO SETOR PORTUÁRIO DO RIO DE JANEIRO

A cultura de uma organização é importante para que seus colaboradores possuam mesmos objetivos e valores. Porém, em busca de manter uma estratégia competitiva e agir de forma responsável na comunidade em que se encontra, a empresa precisa inovar e adaptar-se. A gestão da diversidade apresenta-se como uma válida forma de enfrentar estes novos desafios e exigências. Contudo, há muitos obstáculos para que uma gestão da diversidade seja bem-sucedida. Este estudo propõe-se em entender como a diversidade pode afetar a cultura de uma organização. Além disso, como a cultura pode afetar a estratégia de gestão da diversidade. Foi utilizado para este objetivo um estudo de caso em profundidade com seis entrevistas. As entrevistas foram apoiadas em um roteiro semi estruturado. A análise dos dados obtidos foi feita pela análise de conteúdo. De acordo com a pesquisa realizada, sugere que a cultura organizacional e a gestão da diversidade estão diretamente conectadas e que podem influenciar positivamente uma a outra, porém precisam manter um equilíbrio em suas ações para que não causem prejuízos à organização.

Twist fields, the elliptic genus, and hidden symmetry

We combine infinite dimensional analysis (in particular a priori estimates and twist positivity) with classical geometric structures, supersymmetry, and noncommutative geometry. We establish the existence of a family of examples of two-dimensional, twist quantum fields. We evaluate the elliptic genus in these examples. We demonstrate a hidden SL(2,ℤ) symmetry of the elliptic genus, as suggested by Witten.

Skp2 is oncogenic and overexpressed in human cancers

Skp2 is a member of the F-box family of substrate-recognition subunits of SCF ubiquitin–protein ligase complexes that has been implicated in the ubiquitin-mediated degradation of several key regulators of mammalian G1 progression, including the cyclin-dependent kinase inhibitor p27, a dosage-dependent tumor suppressor protein. In this study, we examined Skp2 and p27 protein expression by immunohistochemistry in normal oral epithelium and in different stages of malignant oral cancer progression, including dysplasia and oral squamous cell carcinoma. We found that increased levels of Skp2 protein are associated with reduced p27 in a subset of oral epithelial dysplasias and carcinomas compared with normal epithelial controls. Tumors with high Skp2 (>20% positive cells) expression invariably showed reduced or absent p27 and tumors with high p27 (>20% positive cells) expression rarely showed Skp2 positivity. Increased Skp2 protein levels were not always correlated with increased cell proliferation (assayed by Ki-67 staining), suggesting that alterations of Skp2 may contribute to the malignant phenotype without affecting proliferation. Skp2 protein overexpression may lead to accelerated p27 proteolysis and contribute to malignant progression from dysplasia to oral epithelial carcinoma. Moreover, we also demonstrate that Skp2 has oncogenic potential by showing that Skp2 cooperates with H-RasG12V to malignantly transform primary rodent fibroblasts as scored by colony formation in soft agar and tumor formation in nude mice. The observations that Skp2 can mediate transformation and is up-regulated during oral epithelial carcinogenesis support a role for Skp2 as a protooncogene in human tumors.