952 resultados para Primary variables of empowerment


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OBJECTIVE: The primary aim of the study was to evaluate whether rheumatoid arthritis (RA) patients considered to be in remission according to clinical criteria sets still had persisting ultrasound (US) synovitis. We further intended to evaluate the capacity of our US score to discriminate between the patients with a clinically active disease versus those in remission. METHODS: This is an observational study nested within the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) rheumatoid arthritis cohort. A validated US score (SONAR score) based on a semi-quantitative B-mode and Doppler (PwD) score as part of the regular clinical workup by rheumatologists in different clinical settings was used. To define clinically relevant synovitis, the same score was applied to 38 healthy controls and the 90st percentile was used as cut-off for 'relevant' synovitis. RESULTS: Three hundred and seven patients had at least one US examination and concomitant clinical information on disease activity. More than a third of patients in both DAS28 and ACR/EULAR remission showed significant gray scale synovitis (P=0.01 and 0.0002, respectively) and PwD activity (P=0.005 and 0.0005, respectively) when compared to controls. The capacity of US to discriminate between the two clinical remission groups and patients with active disease was only moderate. CONCLUSION: This observational study confirms that many patients considered to be in clinical remission according the DAS and the ACR/EULAR definitions still have residual synovitis on US. The prognostic significance of US synovitis and the exact place of US in patients reaching clinical remission need to be further evaluated.

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The amiloride-sensitive epithelial sodium channel constitutes the rate-limiting step for sodium reabsorption in epithelial cells that line the distal part of the renal tubule, the distal colon, the duct of several exocrine glands, and the lung. The activity of this channel is upregulated by vasopressin and aldosterone, hormones involved in the maintenance of sodium balance, blood volume and blood pressure. We have identified the primary structure of the alpha-subunit of the rat epithelial sodium channel by expression cloning in Xenopus laevis oocytes. An identical subunit has recently been reported. Here we identify two other subunits (beta and gamma) by functional complementation of the alpha-subunit of the rat epithelial Na+ channel. The ion-selective permeability, the gating properties and the pharmacological profile of the channel formed by coexpressing the three subunits in oocytes are similar to that of the native channel.

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Structural equation models (SEM) are commonly used to analyze the relationship between variables some of which may be latent, such as individual ``attitude'' to and ``behavior'' concerning specific issues. A number of difficulties arise when we want to compare a large number of groups, each with large sample size, and the manifest variables are distinctly non-normally distributed. Using an specific data set, we evaluate the appropriateness of the following alternative SEM approaches: multiple group versus MIMIC models, continuous versus ordinal variables estimation methods, and normal theory versus non-normal estimation methods. The approaches are applied to the ISSP-1993 Environmental data set, with the purpose of exploring variation in the mean level of variables of ``attitude'' to and ``behavior''concerning environmental issues and their mutual relationship across countries. Issues of both theoretical and practical relevance arise in the course of this application.

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A major challenge in community ecology is a thorough understanding of the processes that govern the assembly and composition of communities in time and space. The growing threat of climate change to the vascular plant biodiversity of fragile ecosystems such as mountains has made it equally imperative to develop comprehensive methodologies to provide insights into how communities are assembled. In this perspective, the primary objective of this PhD thesis is to contribute to the theoretical and methodological development of community ecology, by proposing new solutions to better detect the ecological and evolutionary processes that govern community assembly. As phylogenetic trees provide by far, the most advanced tools to integrate the spatial, ecological and evolutionary dynamics of plant communities, they represent the cornerstone on which this work was based. In this thesis, I proposed new solutions to: (i) reveal trends in community assembly on phylogenies, depicted by the transition of signals at the nodes of the different species and lineages responsible for community assembly, (ii) contribute to evidence the importance of evolutionarily labile traits in the distribution of mountain plant species. More precisely, I demonstrated that phylogenetic and functional compositional turnover in plant communities was driven by climate and human land use gradients mostly influenced by evolutionarily labile traits, (iii) predict and spatially project the phylogenetic structure of communities using species distribution models, to identify the potential distribution of phylogenetic diversity, as well as areas of high evolutionary potential along elevation. The altitudinal setting of the Diablerets mountains (Switzerland) provided an appropriate model for this study. The elevation gradient served as a compression of large latitudinal variations similar to a collection of islands within a single area, and allowed investigations on a large number of plant communities. Overall, this thesis highlights that stochastic and deterministic environmental filtering processes mainly influence the phylogenetic structure of plant communities in mountainous areas. Negative density-dependent processes implied through patterns of phylogenetic overdispersion were only detected at the local scale, whereas environmental filtering implied through phylogenetic clustering was observed at both the regional and local scale. Finally, the integration of indices of phylogenetic community ecology with species distribution models revealed the prospects of providing novel and insightful explanations on the potential distribution of phylogenetic biodiversity in high mountain areas. These results generally demonstrate the usefulness of phylogenies in inferring assembly processes, and are worth considering in the theoretical and methodological development of tools to better understand phylogenetic community structure.

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Stable isotopes of carbonates (delta(13)C(carb), delta(18)O(carb)), organic matter (delta(13)C(org), delta(15)N(org)) and major, trace and rare earth element (REE) compositions of marine carbonate rocks of Late Permian to Early Triassic age were used to establish the position of the Permian-Triassic boundary (PTB) at two continuous sections in the Velebit Mountain, Croatia. The chosen sections - Rizvanusa and Brezimenjaca - are composed of two lithostratigraphic units, the Upper Permian Transitional Dolomite and the overlying Sandy Dolomite. The contact between these units, characterized by the erosional features and sudden occurrence of ooids and siliciclastic grains, was previously considered as the chronostratigraphic PTB. The Sandy Dolomite is characterized by high content of non-carbonate material (up to similar to 30 wt.% insoluble residue), originated from erosion of the uplifted hinterland. A relatively rich assemblage of Permian fossils (including Geinitzina, Globivalvulina, Hemigordius, bioclasts of gastropods, ostracods and brachiopods) was found for the first time in Sandy Dolomite, 5 m above the lithologic boundary in the Rizvanusa section. A rather abrupt negative delta(13)C(carb) excursion in both sections appears in rocks showing no recognizable facies change within the Sandy Dolomite, -2 parts per thousand at Rizvanusa and -1.2 parts per thousand at Brezimenjaca, 11 m and 0.2 m above the lithologic contact, respectively. This level within the lower part of the Sandy Dolomite is proposed as the chemostratigraphic PTB. In the Rizvanusa section, the delta(13)C(org) values decline gradually from similar to-25 parts per thousand in the Upper Permian to similar to-29 parts per thousand in the Lower Triassic. The first negative delta(13)C(org) excursion occurs above the lithologic contact, within the uppermost Permian deposits, and appears to be related to the input of terrigenous material. The release of isotopically light microbial soil-biomass into the shallow-marine water may explain this sudden decrease of delta(13)C(org) values below the PTB. This would support the hypothesis that in the western Tethyan realm the land extinction, triggering a sudden drop of woody vegetation and related land erosion, preceded the marine extinction. The relatively low delta(15)N(org) values at the Permian-Triassic (P-Tr) transition level, close to approximate to 0 parts per thousand, and a secondary negative delta(13)C(org) excursion of -0.5 parts per thousand point to significant terrestrial input and primary contribution of cyanobacteria. The profiles of the concentrations of redox-sensitive elements (Ce, Mn, Fe, V), biogenic or biogenic-scavenged elements (P, Ba, Zn, V), Ce/Ce* values, and normalized trace elements, including Ba/Al, Ba/Fe, Ti/Al, Al/(Al + Fe + Mn) and Mn/Ti show clear excursions at the Transitional Dolomite-Sandy Dolomite lithologic boundary and the chemostratigraphic P-Tr boundary. The stratigraphic variations indicate a major regression phase marking the lithologic boundary, transgressive phases in the latest Permian and a gradual change into shallow/stagnant anoxic marine environment towards the P-Tr boundary level and during the earliest Triassic. (C) 2010 Elsevier B.V. All rights reserved.

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Ultraviolet radiation is the major cause of skin cancer, but promotes vitamin D synthesis, and vitamin D has been inversely related to the risk of several common cancers including prostate, breast and colorectum. We therefore computed the incidence of prostate, breast and colorectal cancer following skin cancer using the datasets of the Swiss cancer Registries of Vaud and Neuchâtel. Between 1974 and 2005, 6,985 histologically confirmed squamous cell skin cancers, 21,046 basal cell carcinomas and 3,346 cutaneous malignant melanomas were registered, and followed up to the end of 2005 for the occurrence of second primary cancer of the prostate, breast and colorectum. Overall, 680 prostate cancers were observed versus 568.3 expected (standardized incidence ratio (SIR) = 1.20; 95% confidence interval (CI): 1.11-1.29), 440 breast cancers were observed versus 371.5 expected (SIR = 1.18; 95% CI: 1.08-1.30) and 535 colorectal cancers were observed versus 464.6 expected (SIR = 1.15; 95% CI: 1.06-1.25). When basal cell, squamous cell and skin melanoma were considered separately, all the SIRs for prostate, breast and colorectal cancers were around or slightly above unity. Likewise, the results were consistent across strata of age at skin cancer diagnosis and location (head and neck versus others), and for male and female colorectal cancers. These findings, based on a population with a long tradition of systematic histologic examination of all surgically treated skin lesions, do not support the hypothesis that prostate, breast and colorectal cancer risk is decreased following skin cancer.

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Mosquito community composition in dynamic landscapes from the Atlantic Forest biome (Diptera, Culicidae). Considering that some species of Culicidae are vectors of pathogens, both the knowledge of the diversity of the mosquito fauna and how some environment factors influence in it, are important subjects. In order to address the composition of Culicidae species in a forest reserve in southern Atlantic Forest, we compared biotic and abiotic environmental determinants and how they were associated with the occurrence of species between sunset and sunrise. The level of conservation of the area was also considered. The investigation was carried out at Reserva Natural do Morro da Mina, in Antonina, state of Paraná, Brazil. We performed sixteen mosquito collections employing Shannon traps at three-hour intervals, from July 2008 to June 2009. The characterization of the area was determined using ecological indices of diversity, evenness, dominance and similarity. We compared the frequency of specimens with abiotic variables, i.e., temperature, relative humidity and pluviosity. Seven thousand four hundred ten mosquito females were captured. They belong to 48 species of 12 genera. The most abundant genera were Anopheles, Culex, Coquillettidia, Aedes and Runchomyia. Among the species, the most abundant was Anopheles cruzii, the primary vector of Plasmodium spp. in the Atlantic Forest. Results of the analyses showed that the abiotic variables we tested did not influence the occurrence of species, although certain values suggested that there was an optimum range for the occurrence of culicid species. It was possible to detect the presence of species of Culicidae with different epidemiologic profiles and habitat preference.