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Perez-Martinez, P. J., de Fatima Andrade, M., & de Miranda, R. M. (2017). Heavy truck restrictions and air quality implications in Sao Paulo, Brazil. J Environ Manage, 202(Pt 1), 55–68.
Abstract: This study quantified the effects of traffic restrictions on diesel fuel heavy vehicles (HVs) on the air quality of the Bandeirantes corridor using hourly data obtained by continuous monitoring of traffic and air quality at sites located on this avenue. The study addressed the air quality of a city impacted by vehicular emissions and that PM10 and NOX concentrations are mainly due to diesel burning. Data collection was split into two time periods, a period of no traffic constraint on HVs (Nov 2008 and 2009) and a period of constraint (Nov 2010, 2011 and 2012). We found that pollutants on this corridor, mainly PM10 and NOX, decreased significantly during the period from 2008 to 2012 (28 and 43%, 15.8 and 86.9 ppb) as a direct consequence of HV traffic restrictions (a 72% reduction). Rebound effects in the form of increased traffic of light vehicles (LVs) during this time had impacts on the concentration levels, explaining the differences between rates of reduction in HV traffic and pollutants. Reductions in the number of trucks resulted in longer travel times and increased traffic congestion as a consequence of the modal shift towards LVs. We found that a 51% decrease in PM10 (28.8 mug m-3) was due to a reduction in HV traffic (vehicle emissions were estimated to be 71% of total sources, 40.1 mug m-3). This percentage was partially offset by 10% more PM10 emissions related to an increase in LV traffic, while other causes, such as climatic conditions, contributed to a 13% increase in PM10 concentrations. The relationships analyzed in this research served to highlight the need to apply urban transport policies aimed at decreasing pollutant concentrations in Sao Paulo, especially in heavily congested urban corridors on working days.
Keywords: Air pollution trends; Sao Paulo; Traffic-pollutant relationships; Transport emission factors
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Patino, A., Alcalde, V., Gutierrez, C., Romero, M. G., Carrillo, A. M., Vargas, L. E., et al. (2017). Characteristics of Emergency Medicine Residency Programs in Colombia. West J Emerg Med, 18(6), 1120–1127.
Abstract: INTRODUCTION: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogota, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. METHODS: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. RESULTS: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. CONCLUSION: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.
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Oliva, C. R., Zhang, W., Langford, C., Suto, M. J., & Griguer, C. E. (2017). Repositioning chlorpromazine for treating chemoresistant glioma through the inhibition of cytochrome c oxidase bearing the COX4-1 regulatory subunit. Oncotarget, 8(23), 37568–37583.
Abstract: Patients with glioblastoma have one of the lowest overall survival rates among patients with cancer. Standard of care for patients with glioblastoma includes temozolomide and radiation therapy, yet 30% of patients do not respond to these treatments and nearly all glioblastoma tumors become resistant. Chlorpromazine is a United States Food and Drug Administration-approved phenothiazine widely used as a psychotropic in clinical practice. Recently, experimental evidence revealed the anti-proliferative activity of chlorpromazine against colon and brain tumors. Here, we used chemoresistant patient-derived glioma stem cells and chemoresistant human glioma cell lines to investigate the effects of chlorpromazine against chemoresistant glioma. Chlorpromazine selectively and significantly inhibited proliferation in chemoresistant glioma cells and glioma stem cells. Mechanistically, chlorpromazine inhibited cytochrome c oxidase (CcO, complex IV) activity from chemoresistant but not chemosensitive cells, without affecting other mitochondrial complexes. Notably, our previous studies revealed that the switch to chemoresistance in glioma cells is accompanied by a switch from the expression of CcO subunit 4 isoform 2 (COX4-2) to COX4-1. In this study, chlorpromazine induced cell cycle arrest selectively in glioma cells expressing COX4-1, and computer-simulated docking studies indicated that chlorpromazine binds more tightly to CcO expressing COX4-1 than to CcO expressing COX4-2. In orthotopic mouse brain tumor models, chlorpromazine treatment significantly increased the median overall survival of mice harboring chemoresistant tumors. These data indicate that chlorpromazine selectively inhibits the growth and proliferation of chemoresistant glioma cells expressing COX4-1. The feasibility of repositioning chlorpromazine for selectively treating chemoresistant glioma tumors should be further explored.
Keywords: chlorpromazine; cytochrome c oxidase; glioblastoma; inhibitor; stem cells
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Nunes, B. P., Soares, M. U., Wachs, L. S., Volz, P. M., Saes, M. de O., Duro, S. M. S., et al. (2017). Hospitalization in older adults: association with multimorbidity, primary health care and private health plan. Rev Saude Publica, 51, 43.
Abstract: OBJECTIVE: Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization. METHODS: A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bage, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (>/= 2 and >/= 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables. RESULTS: The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8-19.6) and 10.6% (95%CI 9.1-12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition' form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09-2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan. CONCLUSIONS: The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases. OBJETIVO: Avaliar a associacao da multimorbidade, modelo de atencao basica e posse de plano de saude com hospitalizacao. METODOS: Estudo transversal de base populacional com 1.593 idosos (60 anos ou mais) residentes na zona urbana do municipio de Bage, Rio Grande do Sul. O desfecho foi a hospitalizacao no ano anterior a entrevista. A multimorbidade foi avaliada por meio de dois pontos de corte (>/= 2 e >/= 3). O modelo de atencao basica foi definido pela residencia em areas cobertas pela atencao tradicional ou da Estrategia Saude da Familia. A posse de plano de saude foi referida pelos idosos. Realizou-se analise bruta e ajustada por regressao de Poisson utilizando modelo hierarquizado. O ajuste incluiu variaveis demograficas, socioeconomicas, capacidades funcionais e de servicos de saude. RESULTADOS: A ocorrencia de hospitalizacao geral e nao cirurgica foi de 17,7% (IC95% 15,8-19,6) e 10,6% (IC95% 9,1-12,1), respectivamente. Idosos com multimorbidade hospitalizaram mais em comparacao com os idosos sem multimorbidade, independentemente da forma de operacionalizacao da exposicao. O plano de saude aumentou em 1,71 (IC95% 1,09-2,69) vezes a internacao hospitalar entre residentes nas areas da Estrategia Saude da Familia em comparacao aos idosos residentes nas areas tradicionais sem plano de saude. CONCLUSOES: A multimorbidade aumentou a ocorrencia de hospitalizacoes, principalmente aquelas nao cirurgicas. Idosos com plano de saude e residentes em areas de Estrategia Saude da Familia internaram mais, independentemente da presenca de multiplas doencas.
Keywords: Aged; Brazil; *Comorbidity; Cross-Sectional Studies; Female; Hospitalization/*statistics & numerical data; Humans; Male; Middle Aged; Prepaid Health Plans/*statistics & numerical data; Primary Health Care/*standards/statistics & numerical data; Socioeconomic Factors; Urban Population
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Nourallah, B., Digpal, R., Jena, R., & Watts, C. (2017). Irradiating the Subventricular Zone in Glioblastoma Patients: Is there a Case for a Clinical Trial? Clin Oncol (R Coll Radiol), 29(1), 26–33.
Abstract: Glioblastoma is the most common and aggressive adult brain tumour. Over the last 10 years it has emerged that the subventricular zone (SVZ), the largest adult neural stem cell niche, has an important role in the disease. Converging evidence has implicated transformation of adult neural stems in gliomagenesis and the permissive stem cell niche in disease recurrence. Concurrently, clinical studies have suggested that SVZ involvement is a negative prognostic marker. It would follow that irradiating the SVZ may improve outcomes in glioblastoma by directly targeting this putative sanctuary site. To investigate this potential strategy, 11 retrospective studies and 1 prospective study examined the relationship between dose to the SVZ and survival outcomes in glioblastoma patients. This review summarises the theoretical underpinning of this strategy, provides a critical evaluation of the existing evidence and discusses the rationale for a clinical trial.
Keywords: Adult; Brain Neoplasms/*radiotherapy; Glioblastoma/*radiotherapy; Humans; Lateral Ventricles/*radiation effects; Male; Neoplastic Stem Cells/radiation effects; Stem Cell Niche/radiation effects; Cancer stem cells; glioblastoma; neural stem cells; radiotherapy; subventricular zone
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