Journal articles on the topic '33-051]'

Latar Belakang: Skizofrenia adalah salah satu diagnosa medis gangguan jiwa berat dan sering terjadi di Indonesia. salah satu faktor pasien skizofrenia mengalami gangguan fungsi sosial, isolasi sosial atau menarik diri. Isolasi sosial adalah kondisi kesendirian yang di alami oleh individu sebagai kondisi yang negatif dan mengancam, kondisi ini merupakan ketidakmampuan dalam mengungkapkan perasaan. Metode: Desain penelitian menggunakan case study dengan pendekatan proses keperawatan. Tehnik pengambilan sampling yang digunakan adalah convenience sampling. Sampel pada penelitian ini adalah Tn. S Usia 33 tahun. Penelitian dilakukan di lingkungan rusun korem 051 jatiwarna, Bekasi pada tanggal 28 September 2021 sampai 01 Oktober 2021. Pengumpulan data dilakukan dengan wawancara, observasi, dan studi dokumentasi. Instrumen penelitian adalah format asuhan keperawatan Jiwa. Hasil: Setelah dilakukan asuhan keperawatan selama 4 hari dari tanggal 28 September 2021 sampai 01 Oktober 2021 didapatkan hasil klien mampu mengenal penyebab isolasi sosial, keuntungan berhubungan dan kerugian tidak berhubungan dengan orang lain, melatih berkenalan secara bertahap Kesimpulan: Kerja sama antar warga rusun dan klien/keluarga sangat diperlukan untuk keberhasilan asuhan keperawatan klien, komunikasi terapeutik dapat mendorong klien lebih kooperatif, pemanfaatan waktu secara optimal dan dukungan keluarga sangat penting dalam proses keperawatan klien dengan isolasi sosial menarik diri.

AbstractThis study sought to evaluate the number of those overweight and the rate of obesity among 6- and 7-year-olds living in Poland with regard to their place of residence, the parental level of education and the number of children in the family. The analysis was based on a survey of 64 544 children (33 051 boys and 31 493 girls) living in Poland. Overweight and obesity were defined based on body mass index (BMI) using the IOTF cut-off points. To evaluate the rates of overweight and obesity occurrence in children with regard to family socio-economic status, parental level of education, the number of children in the family, and the place of residence (divided into city and village) was used. ‘Only children’ were the most likely group to be overweight or obese. These children were twice as likely to be obese as their peers living in families with four or more children. Overweight and obesity occurred more often amongst children living in cities rather than those living in rural areas. Moreover, these conditions were more frequent among children whose parents had higher levels of education. The most significant predictors of childhood overweight and obesity were the number of children in the family and the educational level of the mother

SCFA provide energy to the host and influence lipid and glucose metabolism, suggesting that they may have an impact on the occurrence of metabolic risk factors. The aim of the present study was to determine the concentration of SCFA in faeces of lean and obese individuals and to analyse whether associations between faecal SCFA and metabolic syndrome parameters are present. Lean (n20) and obese (n20) women of similar age (28·5 (sd7·6)v.30·7 (sd6·5) years,P= 0·33) participated in the study. Anthropometric measurements, body composition, blood pressure and biochemical parameters were assessed. SCFA were extracted from faeces and quantified by GC. Blood pressure and blood glucose, although within the normal limits, were higher in the obese group compared to lean subjects (P< 0·05). Lower HDL concentration and higher insulin and homeostasis model assessment (HOMA) index were observed in the obese than in the lean group (P< 0·05). The median values of SCFA (% w/w) from the lean and obese groups were butyric (0·021v.0·044,P= 0·024), propionic (0·021v.0·051,P= 0·007) and acetic (0·03v.0·061,P= 0·01). SCFA correlated positively with metabolic syndrome risk factors such as adiposity, waist circumference and HOMA index (P< 0·05), and inversely with HDL (P< 0·05). Our results suggest that the higher faecal concentration of SCFA is associated with metabolic risk factors and thus may influence metabolic homeostasis.

Purpose A randomized, phase III trial demonstrated superiority of sunitinib over interferon alfa (IFN-α) in progression-free survival (primary end point) as first-line treatment for metastatic renal cell carcinoma (RCC). Final survival analyses and updated results are reported. Patients and Methods Seven hundred fifty treatment-naïve patients with metastatic clear cell RCC were randomly assigned to sunitinib 50 mg orally once daily on a 4 weeks on, 2 weeks off dosing schedule or to IFN-α 9 MU subcutaneously thrice weekly. Overall survival was compared by two-sided log-rank and Wilcoxon tests. Progression-free survival, response, and safety end points were assessed with updated follow-up. Results Median overall survival was greater in the sunitinib group than in the IFN-α group (26.4 v 21.8 months, respectively; hazard ratio [HR] = 0.821; 95% CI, 0.673 to 1.001; P = .051) per the primary analysis of unstratified log-rank test (P = .013 per unstratified Wilcoxon test). By stratified log-rank test, the HR was 0.818 (95% CI, 0.669 to 0.999; P = .049). Within the IFN-α group, 33% of patients received sunitinib, and 32% received other vascular endothelial growth factor–signaling inhibitors after discontinuation from the trial. Median progression-free survival was 11 months for sunitinib compared with 5 months for IFN-α (P < .001). Objective response rate was 47% for sunitinib compared with 12% for IFN-α (P < .001). The most commonly reported sunitinib-related grade 3 adverse events included hypertension (12%), fatigue (11%), diarrhea (9%), and hand-foot syndrome (9%). Conclusion Sunitinib demonstrates longer overall survival compared with IFN-α plus improvement in response and progression-free survival in the first-line treatment of patients with metastatic RCC. The overall survival highlights an improved prognosis in patients with RCC in the era of targeted therapy.

Abstract Background and Aims Patients with ulcerative colitis [UC] may present as emergencies and require rapid escalation of therapy. This study aimed to assess the mortality, colectomy, and readmission risks, during and following a first emergency admission with UC. Methods Using Hospital Episode Statistics, subjects aged between 18 and 60 years, coded with a first emergency admission with UC, were identified between 2007 and 2017. Influences of demographic factors, comorbidity, anti-tumour necrosis factor [TNF] therapy, and provider UC activity on mortality and colectomy were examined. Results A total of 10 051 subjects (46% female; median age 33 years [interquartile range [IQR] 25–44]) were identified. Mortality was 0.2% in hospital and 0.5% at 12 months and, following colectomy during acute admission, it was 1.4% in hospital and 2.1% at 12 months. Females had reduced risk of colectomy during admission: odds ratio [OR] 0.73 (95% confidence interval [CI] 0.62–0.85). Comparing the period 2007–2011 with 2012–2017, the rate of colectomy fell during acute admissions: OR 0.85 [0.72–0.99], p = 0.038 and at 12 months after admission: OR 0.73 [0.61–0.87]. Anti-TNF therapy increased 4-fold in acute UC admissions from 2007–2017. Those receiving anti-TNF therapy had a 70% increased risk of colectomy during index admission compared with those not receiving anti-TNF: OR 1.72 [1.29–2.31]. Increased time to colectomy during first admission was associated with female sex: hazard ratio [HR] 0.84 [0.72–0.98] and Asian ethnicity: HR 0.61 [0.44–0.85], whereas reduced time was associated with increased comorbidity, lower deprivation, and high provider volume of colectomies for UC: HR 1.59 [1.31–1.93]. Conclusions Mortality following colectomy was 1.4% in hospital and 2.1% at 12 months, and no significant change over time was observed. Colectomy during emergency admission for UC was less common in females. Rates of anti-TNF therapy during emergency admission for UC have increased and overall colectomy rates have fallen. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast

Context: The effect of glycemic control on persisting albuminuria remains unclear. Insulin delivery and glucose variability may be important. Objective: This study aimed to investigate the effect of 1-year treatment with sensor-augmented insulin pump (SAP) or multiple daily injections (MDIs) on albuminuria. Design, Patients, and Methods: This was a randomized controlled open-label parallel trial composed of 60 patients with type 1 diabetes with a history of albuminuria and on stable renin-angiotensin system inhibition, were randomly assigned to SAP or MDI. Urine albumin creatinine ratio (UACR) was measured in three urine samples at all visits. Glucose variability and glomerular filtration rate (51Cr-EDTA-GFR) were measured at beginning and study end. Using linear mixed model, change in UACR between groups was analyzed as intention to treat. Main Outcome Measure: Change in UACR was measured. Results: Fifty-five patients (SAP, n = 26; MDI, n = 29) completed the study. Diabetes duration (mean ± SD, 33 ± 12 y), UACR (geometric mean, 99 mg/g; interquartile range, 37–233 mg/g), 51Cr-EDTA-GFR (94 ± 22 mL/min/1.73m2), glycosylated hemoglobin (HbA1c) (9.0 ± 1.1%), glucose variability (calculated as SD), 4.0 ± 1.0 mmol/l; no-group differences (P ≥ .06 for all). After 1 year, change in UACR was mean, −13%; 95% confidence interval, −39 to 22 with SAP vs mean, 30%; 95% CI, −12 to 92% on MDI treatment (unadjusted P = .051; adjusted for HbA1c, P = .04). HbA1c decreased 1.3 ± 1.0 vs 0.6 ± 1.0% (P = .013), glucose variability decreased 0.9 ± 1.1 vs 0.3 ± 1.0 mmol/L (P = .04), and 51Cr-EDTA-GFR declined 5.6 ± 9.6 vs 3.4 ± 13 mL/min/1.73m2 (P = .50) with SAP vs MDI treatment. There were no changes in blood pressure (P ≥ .27). Conclusion: SAP treatment reduced UACR in a randomized controlled trial in type 1 diabetes patients with a history of albuminuria on stable renin-angiotensin system inhibition. Significance was reached after adjustment. SAP treatment reduced HbA1c and glucose variability (calculated as SD).

Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period ( P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively ( P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively ( P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively ( P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively ( P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

Abstract Abstract 5102 Introduction. Diffuse Large B-Cell Lymphoma (DLBCL) is the most frequent subtype of Non-Hodgkin Lymphoma in the world (35%). Despite of R-CHOP chemotherapy, patients with DLBCL continue to relapse/refractory after treatment. For this reason, the search for biomarkers that could predict refractoriness is necessary for personalized chemotherapies. There are some studies where antioxidant pathways are associated to refractoriness. Our group using a proteomic approach observed that GPX3 is a frequent protein observed in serum of DLBCL patients compared to healthy controls (72% vs. 12%; p=0. 009. Villela et al. Abstract EHA, 2012-only publication). Aim. To evaluate GPX3 levels as a biomarker for primary refractory in patients involved by DLBCL and before treatment. Methods. This study was registered and accepted for IRB's Institutional. From 40 DLBCL patients and 10 healthy controls were obtained serum previous being treated with R-chemo or Chemo alone or as part of donation. We used a commercial ELISA kit (USCNK, Life Science) for obtained GPX3 serum level. We evaluated classical clinical variables and compared to GPX3 level cut off that was obtained trough Area Under Curve (AUC) for primary refractory as dependent factor. Statistical analyses. Descriptive variable Chi2, quantitative variable T-Student or Independent-Sample Median-Test, Relative risk (RR) and confidence intervals 95% were calculated (CI95%). Results. Using proteomic approach, GPX3 was the most frequent protein observed in 72% of the cases, compared with the control group where was only observed in 12% (p=0. 009). These data were validating in 40 patients affected by Diffuse Large B Cell Lymphoma and 10 healthy people using ELISA Kit. We observed difference between GPX3 level in lymphoma patients vs. Healthy control [median (SD): 22(±5. 16) vs. 51(±22), p<0. 001). We obtained GPX3 cut off for AUC as a predictor for overall response vs. primary refractoriness (≥34. 75 mcg/dL vs < 34. 75 mcg/dL, respectively; AUC: 0. 67 (CI95%: 0. 5–0. 82). Variables associated to primary refractoriness vs. no refractoriness were GPX3 (44% vs. 17% respectively, RR=2. 55 [CI95%: 0. 87 to 7. 6]; p=0. 094) and no rituximab vs. rituximab combined in chemotherapy (45. 5% vs. 15. 4% respectively, RR=2. 95 [CI95%: 0. 97 to 8. 96]; p=0. 051. When we analyzed patients treated with vs. without rituximab depending GPX3 level (Cut off 34. 75 mcg/dL), we observed better response when patients received rituximab and had high level of GPX3 (67% vs. 33. 3%, RR= 0. 5 [CI95%: 0. 39 to 1. 21]; p=0. 085]. Conclusions. The GPX3 and Rituximab use were a trend to predictive biomarker of refractoriness but more studies must confirm our data. Disclosures: No relevant conflicts of interest to declare.

Fifteen sheep (53 kg), with catheters in a hepatic vein, the portal vein and a mesenteric vein and artery, were offered a bromegrass (Bromus inermis) hay (104 g crude protein (CP), 700 g neutral-detergent fibre and 65 g acid-detergent lignin/kg dry matter (DM)) ad lib. with different supplements to determine the effects on net flux of oxygen and nutrients across the portal-drained viscera (PDV) and liver. The sheep were unsupplemented (Control) or received 5 g DM/kg body weight (BW) of ground maize (M), 7 g DM/kg BW of soya-bean hulls (H) or 0.73 g DM/kg BW of a mix of feedstuffs high in rumen-undegradable protein (P). Apparent digestible energy (DE) intakes were 5·3, 10·4, 10·6 and 6·7 (SE 0·74) MJ/d and apparent digestible CP intakes were 37, 50, 79 and 68 (SE 4·3) g/d for Control, M, H and P treatments respectively. Splanchnic tissue oxygen consumption rates were 0·23, 0·32, 0·30 and 0·27 (SE 0·054) mol/h, and oxidative metabolism accounted for 0·46, 0·31, 0·33 and 0·47 (SE 0·051) of DE intakes for Control, M, H and P treatments respectively. Supplements increased (P 0·05) release of α-amino nitrogen (AAN) by the PDV (4·2, 17·5, 19·6 and 18·1 mmol/h for Control, M, H and P treatments respectively). Splanchnic net flux of AAN was not affected by supplement treatments. Hepatic release of urea-N was increased (P 0·05) by supplement treatments (27, 40, 46 and 44 mmol/h for Control, M, H and P respectively); the P treatment increased (P 0·05) and the H treatment tended (P = 0·10) to increase splanchnic release of urea-N (7, 10, 20 and 27 mmol/h for Control, M, H and P treatments respectively). Net flux of glucose across the PDV was -4·6, 1·4, -5·6 and -7·2 (SE 1·65) mmol/h for Control, M, H and P treatments respectively. Hepatic glucose released averaged 23 (SE 2·0) mmol/h and was not affected by treatment. Treatments M and H increased (P 0·05) PDV release of propionate compared with the Control treatment (4·5, 15·5, 16·8 and 7·7 mmol/h for Control, M, H and P treatments respectively). Release of acetate by the PDV was 43, 97, 118 and 67 (SE 23·9) mmol/h for Control, M, H and P treatments respectively. In summary, different supplements of low-quality grass did not increase the efficiency of N metabolism by splanchnic tissues. Treatment P had little effect on net flux across splanchnic tissues of glucose, L-lactate. β-hydroxybutyrate and volatile fatty acids (VFA). Overall, treatments M and H had similar effects on splanchnic net fluxes of VFA and L-lactate whereas butyrate and β-hydroxybutyrate releases by the PDV were increased by treatment M.

AbstractFood can be used in an automatic milking system (AMS) to encourage frequent attendance to, and modify behaviour in, an AMS. An AMS was designed such that a cow had to pass from a bedded area through the AMS to enter the feeding area. A visit resulted in milking if the interval since the last milking was greater than 4 h.Fourteen Holstein-Friesian dairy cows were allowed to attend voluntarily an AMS for 15 h/day for three 8-day periods. In period 1 the cows were given forage in the feeding area and concentrates in the bedded area but in period 2 this was reversed. Period 3 repeated period 1. The cows were also divided into two groups of seven, only one of which was given 1 kg of concentrates when milked in each period in a cross-over design.Visits per cow per day increased when the cows were given forage in the feeding area (6·0 v. 4·1 (s.e.d. 0·08) P < 0·05) but milkings per cow per day were only slightly different (2·6 v. 2·4 (s.e.d. = 0·02) P = 0·052). Feeding forage in the feeding area modified forage-eating behaviour by reducing the number of bouts (4·9 v. 7·6 bouts per cow per day, P < 0·05) and total forage eating time (209 v. 289 min per cow per day (s.e.d. = 33·6), P < 0·05). The cows also tended to spend less time lying (529 v. 620 min per cow per day (s.e.d. = 43·2) P = 0·051).There was no effect of feeding/not feeding concentrates in the milking stall on visits per cow per day or milkings per cow per day. However, feeding tended to create more shuffling behaviour during the automatic teat cup attachment process (3·4 v. 6·7 shuffling bouts per milking (s.e.d. 2·07) P = 0·053) but there were no effects on the levels of kicking, successful teat cup attachment rate, vocalization, elimination, hesitations in mounting a step or poor rear leg positions. The cows tended to adjust to a more accessible stance during both the automatic attachment process (from 17% of milkings exhibiting poor leg positions at the start of attachment, to 10% at the end, P < 0·01) and over the course of the experiment (from 26% to 10%, P < 0·02). There was a trend for cows who were not fed to milk out quicker than those who were fed for all milkings per day combined (733 s v. 811 (s.e.d. 43·3) s P = 0·074) but there were no other effects on yield, milk flow rate from the udder or time taken to milk out for all milkings through the day combined or just the first milking of the day.Feeding concentrates in the feeding area can be used as an alternative to feeding forage in the feeding area, but there is no need to feed concentrates in the milking stall. Feeding cows while they were being milked did not improve their behaviour or milking characteristics.

Expressed sequence tag (EST)–derived simple sequence repeat (eSSR) markers are important resources for gene discovery and comparative mapping aimed at crop improvement. In this study, we developed eSSR markers for Medicago truncatula and assessed their cross-species transferability. We detected 36 847 non-redundant sequences (“unigenes”) from 198 642 M. truncatula EST sequences. Mining of microsatellites from the 36 847 unigene sequences (representing ∼25.8 Mb) revealed 14 637 eSSRs in 11 750 SSR-containing ESTs, and primer pairs were successfully designed for 4 636 (39.5%). Of the 14 637 eSSRs, 82.6% were mononucleotide repeats and the rest (in descending order of abundance) were tri-, di-, penta-, and tetranucleotide repeats. When less stringent SSR detection criteria were used, the frequency of dinucleotide repeat motifs increased more than twofold, and the frequencies of di- (11%) and trinucleotide motifs (10.6%) were almost equal. This demonstrates that the eSSR frequency and distribution were related to the choice of search criteria. Forty-one randomly selected primer pairs were validated, and their transferability in three leguminous and three non-leguminous species was assessed. The markers showed a high level of transferability in the leguminous (53%–71%) and non-leguminous (33%–44%) species. The validation studies thus demonstrate the utility of the Medicago eSSRs in assessing genomic relationships in both leguminous and non-leguminous species.

Field studies using 15N microplots were conducted to quantify the uptake and disappearance of fall- and spring-applied urea N on low organic matter, irrigated soils. Urea was mixed with the surface soil to maximize the potential for overwinter nitrification and subsequent losses of the fertilizer N. In three irrigated soils, losses of fall-applied urea averaged 24–31% compared with 11–21% of that applied at seeding. Barley took up 33–42% of spring-applied urea N but only 16–36% of fall-applied urea N. The lower uptake of fall-applied N apparently resulted from higher N losses rather than from the immobilization of fall-applied urea. Fall application resulted in lower soil reserves of residual fertilizer N after the growing season, as compared to spring application, in two of the three studies. Sixty percent of the fertilizer N recovered from the soil remained in the surface 15 cm. The application of 50 mm of water in the fall or 100 mm in the early spring, to intensify any effects of moisture, had a minimal effect on N losses or the distribution of N in the soil. This suggests that an individual rainfall event would not greatly affect the uptake or losses of fall-applied fertilizer on well-drained soil. The observed fertilizer losses, however, support practices such as concentrating fall-applied fertilizers in bands or the use of nitrification inhibitors. Key words: Denitrification, nitrogen, fertilizer, N balance, N losses, urea

Four erosion plots were monitored from 1983 to 1989 (6 yr) to evaluate the effects of two crop rotations and their constituent crops on runoff and soil loss under natural precipitation near Fort St. John in the Peace River region of British Columbia. Rotation 1 consisted of two cycles of summerfallow — canola (Brassica rapa)-barley (Hordeum vulgare L.), and Rotation 2 included summerfallow — canola-barley-barley underseed to red fescue (Festuca rubra L.)-fescue-fescue. Rainfall and snowmelt runoff were collected and sampled throughout the year to determine seasonal runoff and soil losses. Over the 6 yr, the cumulative runoff and soil losses were consistently greater under Rotation 1 than under Rotation 2. There was a greater than fourfold difference in total soil loss, and 33–35% more total runoff. Rainfall-induced runoff and soil losses were significantly higher for Rotation 1 than for Rotation 2. Snowmelt runoff accounted for 90 and 96% of the total annual runoff and for 39 and 80% of the total annual soil loss from Rotations 1 and 2, respectively. Two large rainfall events during 1983 and 1987, each causing a soil loss in excess of 2000 kg ha−1, accounted for between 85 and 91% of the 6-yr total rainfall-induced erosion from Rotation 1. No differences in runoff or soil loss were detected among crops but the comparisons were insensitive because of high residual variation. Key words: Runoff, soil loss, erosion plots, crop rotations

This paper describes the developments of operating rules for the Malahayu reservoir system in Indonesia. The analysis in this study is based on the use of a simulation model with a nested network flow optimization subprogram, which required hydrologic time series of reservoir inflows as input data. Since estimates of historic naturalized flows were of insufficient length, they were used as a basis for developing a 100-year stochastic series which offered a more challenging input while preserving the relevant statistics of the original historic series. This study shows by how much the reservoir yield could have been increased in the past, assuming that short-term inflow and demand forecasts are available and that the proposed reservoir operating rule is obeyed. The increase is estimated by comparing the long- term average of the simulated diversions at the three weirs with the actual historic diversions which are on the record. A more efficient reservoir operating policy would increase the reservoir yield by 38% in the March-June period and by 33% in the July-October period. If additional local runoff into the weirs is utilized in the same period, the increased supply would range up to 66% in the March-June period and 43% in the July-October period. The results from this study provide a strong argument in favour of investing in modern technology as opposed to massive additional infrastructure development. Key words: linear programming, reservoir rule curve, simulation, optimization, stochastic inflow series.

Apesar do elevado número de espécies e endemismo, a Caatinga encontra-se fortemente degradada e ainda pouco estudada em algumas regiões, como no Submédio São Francisco. Assim, o estudo objetivou realizar um levantamento florístico-fitossociológico do componente arbustivo-arbóreo em uma área de Caatinga em Petrolina, Pernambuco. Foram amostradas 120 parcelas de 50 m², onde todos os indivíduos adultos (DNS > 3 cm) no interior dessas unidades amostrais tiveram medidos seu DNS e altura total. De posse desses dados, foram calculados os valores absolutos e relativos de densidade, frequência, dominância, valor de cobertura, valor de importância, o índice de diversidade de Shannon, equabilidade de Pielou e similaridade florística. Foram amostrados 14 famílias, 28 gêneros e 33 espécies, das quais 13 são endêmicas da Caatinga. O número de indivíduos amostrados foi de 1535. As espécies com maior valor de importância foram Mimosa tenuiflora, Melocactus zehntneri e Poincianella microphylla. A distribuição dos indivíduos em classes de frequência diamétricas geraram uma curva em J invertido, indicando que a comunidade está estável. Diante dos resultados obtidos pode-se concluir que a área de estudo está em franco processo de sucessão ecológica.

Abstract We analyzed 33 y of fish community data collected from a low-order, urban stream in central Illinois, USA, to determine the effects of municipal wastewater management projects and urbanization on fish communities. From 1985 to 2017, species richness, number of pollution-intolerant species, and alternative index of biotic integrity significantly increased at sites across this system. Species diversity likewise increased, but was mostly significant only at sites downstream of the effluent outflow. Ceasing the chlorination of wastewater in 1990 resulted in significant increases in fish community metrics both upstream and downstream of effluent outflow, although effects varied from site to site. Completing a combined sewer overflow abatement project in 2008 resulted in some significant increases in species richness, diversity, and number of pollution-intolerant species at sites downstream of effluent outflow. From 2001 to 2016, the change in the number of pollution-intolerant species correlated inversely with the increased percentage of impervious cover in the study system. There was no significant correlation of other metrics with the change in percent impervious surfaces. These results suggest that urbanization at upstream sites limited to some extent the benefits of water management interventions that improved fish community metrics at downstream sites.

Introduction Cytoreduction either with hypomethylating agents (HMA) or induction chemotherapy (IC) before hematopoietic cell transplantation (HCT) for patients with advanced myelodysplastic syndromes (MDS) has been used in an attempt to decrease post-HCT relapse, but the benefit for post-HCT long-term survival remains a debatable issue. We investigated the impact of previous therapy, and depth of response, as well as donor source on the outcome of allo-HCT for patients with advanced MDS. Method After excluding patients who had chronic myelomonocytic leukemia, we analyzed 303 advanced MDS patients (96 (32%) with RAEB-I, 148 (49%) with RAEB-2, and 59 (19%) with tAML) who underwent transplantation from a matched related/unrelated (MSD/URD, n=75/12) or haploidentical (n= 216) donor (HID) after preparation with myeloablative conditioning regimens (identical with BUCY for MSD and BUCY+ATG for HID) between year 2015 and 2018. Results Baseline characteristics Median age was 42 years old. Of the 303, 142 (47%) received only best supportive care (BSC) before HCT; 18 (6%) received IC, 54 (18%) received HMA, and 89 (29%) received both (IC+HMA). Before therapy, 45 (15%), 141 (46%) and 117 (39%) patients had intermediate 1,2 or high-risk scores per the International Prognostic Scoring System (IPSS). Thirty-six (12%) achieved complete remission (CR), 81 (27%) had marrow CR, 160 (53%) had stable disease, and 26 (9%) had progressive disease before HCT defined by International Working Group (IWG). Patients in CR or marrow CR were grouped together as responders (OR) while patients not in CR were grouped together as non-responders (NR) at HCT. Patients had more high-risk disease by WHO and IPSS in the IC and IC+HMA groups. Other patient and donor characteristics known to affect outcomes such as age, time from diagnosis to HCT, IPSS-R, donor source are comparable between groups. Outcome for the entire cohort CR rate at HCT was 6%, 33%, and 30% for HMA, IC, and IC+HMA groups, respectively (P =.001) while OR rate was 37%, 56%, and 70%, respectively (P =.001). With a median follow-up of 727 days, 2-year disease-free survival (DFS) was 77%, 69%,60%, and 62% for BSC, HMA, IC, and IC+HMA groups, respectively (P = .075); 2-y DFS was 77%, 72%,and 56% for untreated, OR, and NR groups, respectively (P = .026); 2-y DFS was 77%, 78%,and 60% for untreated, CR, and non-CR groups, respectively (P = .008); 2-y DFS was 80% and 57% for MSD/URD and HID groups, respectively (P = .051). Multivariate analyses revealed that older age (hazard ratio [HR], 1.03; P< .0001); higher-risk histologic subtypes (HR, 2.3; P =.003), time from diagnosis to HCT (HR,1.005; P =.027), haploidentical donor (HR, 1.9; P =.012) and NR at HCT (HR, 1.6; P =.05) were poor prognostic factors for DFS. Outcome for patients with EB2 and t-AML Focusing on the 207 patients who had BM blasts of 10% or higher before therapy, CR rate at HCT was 6%, 35%, and 33% for HMA, IC, and IC+HMA groups, respectively (P =.007) while OR rate was 44%, 59%, and 74%, respectively (P =.001); 2-year DFS was 77%, 68%,58%, and 62% for BSC, HMA, IC, and IC+HMA groups, respectively (P = .20); 2-y DFS was 77%, 71%,and 50% for untreated, OR, and NR groups, respectively (P = .025); 2-y DFS was 77%, 77%,and 58% for untreated, CR, and non-CR groups, respectively (P = .015); 2-y DFS was 75% and 64% for MSD/URD and HID groups, respectively (P = .43). Propensity score analysis To allow for potential confounding factors between treatments that could influence outcome, a 1:1 ratio propensity score matching was also performed. Included in the propensity score model were: WHO stage, IPSS score, age, time from diagnosis to HCT, and donor source. We were able to pair-match 104 untreated with 104 cytoreductive and 2-y DFS were 80% vs 68% (p= .14); 2-y DFS was 80%, 76%,and 63% for untreated, OR, and NR groups, respectively (P = .19); 2-y DFS was 80%, 94%,and 64% for untreated, CR, and non-CR groups, respectively (P = .015); 2-y DFS was 85% and 68% for MSD/URD and HID groups (P = .044) and the rate was 82% vs 70% after excluding EB-1 (p= .30). After excluding IC group (n=8), 2-year DFS was 80%, 67%, and 75% for BSC, HMA, and IC+HMA groups, respectively (P = .28). Conclusion In this analysis, various therapy approaches before HCT did not lead to different transplantation outcomes. There was no evidence of a benefit in post-HCT outcome associated with prior cytoreductive therapy for advanced MDS. Further randomized studies need to delineate the role of debulking strategy. Disclosures No relevant conflicts of interest to declare.

Background: Early observational studies suggested that tocilizumab might produce clinical improvement in covid-19 patients leading to the use of tocilizumab. Early underpowered randomised controlled trials (RCTs) however did not show benefit until the most recent largest trial. RECOVERY trial. We aimed to compare the evidence from RCTs and observational studies of the effect of tocilizumab on in-hospital mortality in patients with covid-19. Materials and Methods: Embase and PubMed were searched from July 2020 until 1 March 2021. Observational studies and RCTs assessing in-hospital mortality in patients receiving tocilizumab compared with standard care or placebo were included. The primary outcome was in-hospital mortality closest to 30 days. The risk of bias in observational studies was assessed using the ROBINS-I tool. A fixed effect meta-analysis was used to combine relative risks, with random effects and risk of bias as a sensitivity analysis. Results: Of 5,792 publications screened for inclusion, eight RCTs and 33 observational studies were identified. The RCTs showed an overall relative risk reduction in in-hospital mortality at 30 days of 0.86 (95% confidence interval (CI) 0.78 to 0.96) with no statistically significant heterogeneity. 23 of the observational studies had a severe risk of bias, 10 of which did not adjust for potential confounders. The 10 observational studies with moderate risk of bias reported a larger reduction in mortality at 30-days (relative risk 0.72, 95% CI 0.64 to 0.81) but with significant heterogeneity (P<0.01). Conclusion: This meta-analysis provides strong evidence from RCTs that tocilizumab reduces the risk of mortality in hospitalised covid-19 patients. Observational studies with moderate risk of bias exaggerated the benefits on mortality two-fold and showed heterogeneity. Collectively observational studies provide a less reliable evidence base for evaluating treatments for covid-19.

A expansão rápida da maxila assistida cirurgicamente é um procedimento ortodôntico-cirúrgico realizado em pacientes com maturidade óssea e discrepâncias transversas dos maxilares, unilaterais ou bilaterais, associadas ou não a outras deformidades faciais. O objetivo do presente estudo é apresentar um caso clínico de tratamento ortodôntico-cirúrgico realizado por meio de expansão rápida da maxila assistida cirurgicamente com distrator ósseo palatino. O paciente, do sexo masculino, com 33 anos de idade, apresentava discrepância transversa de maxila medindo 9mm, mordida cruzada anterior e posterior, apinhamento dentário, Classe III dentária e Padrão III de crescimento da face, com excesso vertical do terço inferior. Finalizado o tratamento ortodôntico-cirúrgico, foi realizada uma tomografia computadorizada de feixe cônico do modelo zocalado final para documentação, verificação da estabilidade operatória das estruturas ósseas e ganho de distância transversal da maxila. O paciente apresentou estabilidade óssea dos valores alcançados na expansão cirúrgica. Nos pacientes com deficiência transversal severa, mordida cruzada bilateral, rebordos alveolares superiores verticalizados, deficiências periodontais nos dentes de suporte do distrator dentossuportado e doenças sistêmicas que comprometam o esmalte dentário e a maturação óssea, o melhor tratamento é a expansão rápida da maxila assistida cirurgicamente com distrator ósseo palatino.

<p>研究目的:本研究探討婚姻初期自身及伴侶對關係的正向與負向整體評估對形塑華人夫妻的婚姻我(婚 姻關係中與配偶相互尊重並維護和諧互動的關係自我概念)與家族我(家人團體中達成家人共識與團結 並實現家族目標的團體自我概念)的影響。研究方法:兩波間隔兩年的追蹤調查共蒐集到93對夫妻的有 效資料，第一波施測時平均婚齡為1.30年(標準差0.68年)，丈夫與妻子的平均年齡分別為31.46歲(標 準差3.51歲)與29.89歲(標準差2.84歲)。研究結果:分別針對正向婚姻品質(模型一)與負向婚姻品 質(模型二)進行行動者&mdash;伴侶相依模式分析，皆獲得可接受的整體適配度。模型一結果指出，夫妻雙 方的正向婚姻品質對自身婚姻我與家族我皆具正向顯著的行動者效果，妻子的正向婚姻品質對丈夫婚姻 我具正向顯著的伴侶效果，其餘效果未達顯著水準。模型二結果發現，妻子負向婚姻品質對自身婚姻我 與家族我具負向顯著的行動者效果，並對丈夫婚姻我與家族我也有負向顯著的伴侶效果，其餘效果未達 顯著水準。研究結論:婚姻生活中的正、負向婚姻品質在婚姻初期有著形塑、再構婚姻我與家族我的作 用，且在夫妻間有著不同影響。最後探討抽樣偏誤、缺乏細緻運作機制等相關研究限制與未來方向，並 期望各項發現可供實務應用，增進理解婚姻生活經驗形塑華人多元自我概念的運作機制。</p> <p>&nbsp;</p><p>Context and Objectives: Marriage brings many challenges, which require careful management and adjustment by both spouses. One of the noteworthy challenges is that individuals will start to view themselves in different ways. During the newlywed period, the self-concepts corresponding to the couple’s new role of spouse and family group members will be developed. As a spouse in a marital relationship, Chinese couples’ marital self-concept (MSC) represents their relationship-oriented self-construal to have mutual love and support with their spouses and maintain a harmonious interaction in their relationship. As a member of both the original family and in-law family, Chinese couples’ familial self-concept (FSC) represents their group-oriented self-construal to honor their families, reach consensus among family members, and achieve the goals of all their family members. Even though the self- concept has an important effect on couples’ marital adaptation, research on how the marriage couples’ self- concepts would be reconstructed is scarce. Because one’s self-concept would be reconstructed by life experience, the purpose of this study is to investigate how marriage life influences Chinese couples’ MSC and FSC in the early stage of marriage. Considering that positive and negative self-involved experiences could drive dissimilar mechanisms, this study attempts to explore the specific effect of positive and negative marital quality. Then, based on the nature of interdependence between marriage couples, this study also uses the actor-partner interdependence model to further explore the actor effect and partner effect between husbands and wives. Method: This study conducted two waves of follow-up surveys separated by a 2-year lag and collected a total of 93 valid dyad-data from couples living in the north (n = 53), middle (n = 11), south (n = 20), and east regions of Taiwan (n = 9). The average length of marriage at the first wave was 1.30 years (SD = 0.68 years), and the average age of the husband and wife were 31.46 years old (SD = 3.51 years) and 29.89 years old (SD = 2.84 years), respectively. This study used structural equation modeling to analyze two hypothetical actor-partner interdependence models. Results: The first model investigated the actor- and partner-effect of positive marital quality on couples’ MSC and FSC and showed acceptable model fit (􏴆 2 = 264.16; df = 204; p = .003; 􏴆 2/df = 1.29; CFI = .93; TLI = .91; RMSEA = .056; SRMR = .052). The actor-effects of husbands’ and wives’ positive marital quality was positively significant on their own MSC (husbands:􏴇11 = .50, SE = 0.11,p < .001; wives:&gamma;32 = .55,SE = 0.12,p < .001) and FSC (husbands: 􏴇 21 = .33, SE = 0.12, p = .007; wives: 􏴇 42 = .27, SE = 0.13, p = .034). The partner-effect of wives’ positive maritalqualitywaspositivelysignificantonhusbands’MSC(􏴇12 =.24,SE =0.12,p =.036),andtheotherpartner- effects were non-significant. The second model investigated the actor- and partner-effect of negative marital quality and also showed acceptable model fit (􏴆 2 = 253.49; df = 204; p = .011; 􏴆 2/df = 1.24; CFI = .93; TLI = .91; RMSEA = .051; SRMR = .059). The actor-effect and the partner-effect of husbands’ negative marital quality were non-significant on their own and with wives’ MSC and FSC. However, the actor-effect and the partner-effect of wives’ negative marital quality were negatively significant on their own and with husbands’ MSC (actor-effect: 􏴇 32 = -.53, SE = 0.14, p < .001; partner-effect: 􏴇 12 = -.48, SE = 0.15, p = .001) and FSC (actor-effect: 􏴇 42 = -.42, SE = 0.14, p = .003; partner-effect: 􏴇 22 = -.35, SE = 0.15, p = .025). Discussion and Conclusion: This study highlighted that positive and negative marital quality in the early stage of marriage can shape and restructure Chinese couples’ self-identification as a spouse and a family group member. Additionally, husbands’ and wives’ marriage life experiences can have different influences on their own and their partners’ self-concepts. Particularly, the wives’ both positive and negative marital qualities have impressive impacts on shaping their own and their husbands’ marital and familial self-concept. The limitation of sampling bias and its influences on the current results are discussed, and the understanding of the detailed mechanism linking positive and negative marital quality to Chinese couples’ self-concept is still very limited and requires further exploration and more attention. These findings might be of importance in providing professional consultants and family life educators a better understanding of how Chinese couples’ marital and familial self-concept will be affected by their life experiences in the early stage of marriage.</p> <p>&nbsp;</p>

The reflections presented in this article are part of the results produced by the research “Policies, Management and the Right to Higher Education: new modes of Regulation and trends under construction”, linked to the Universitas-Br Network, developed by Thematic Axis 7, whose research focuses on Rural Higher Education. The article provides analysis on teacher forming policies, focusing on the setbacks imposed on such policies, based on the approval of the “new” National Curriculum Guidelines for Initial Teacher Forming for Basic Education and the institution of the Common National Base for Education. Initial Forming of Teachers of Basic Education, especially in the field of the degree in Rural Education. The research method is anchored in historical and dialectical materialism through the categories of totality, historicity and mediation, in the field of teacher education policies in Brazil. Bibliographic studies of Resolutions No. 02/2015 and No. 02/2019 and the manifests of national scientific entities of teacher education were carried out. The results reveal dismantles and setbacks in the field of teacher forming policies, with the dissemination of skills pedagogy in the approval of Resolution No. 2/2019, which ignores the implementation of critical and emancipatory projects in the field of initial and continuing teacher forming. The Ministry of Education and the National Council of Education take measures to deconstruct policies aimed at rural, indigenous and quilombola subjects and threaten the continuity of the the degree in Rural Education Courses, which provokes a return to diverse and plural subjects in the guarantee of their rights.ResumoAs reflexões apresentadas neste artigo integram parte dos resultados produzidos pela pesquisa “Políticas, Gestão e Direito à Educação Superior: novos modos de Regulação e tendências em construção”, ligada à Rede Universitas-Br, desenvolvida pelo Eixo Temático 7, cuja investigação centra-se na Educação Superior do Campo. O artigo traz análises sobre as políticas de formação docente, com foco nos retrocessos impostos a tais políticas, especialmente às Licenciaturas em Educação do Campo, a partir da aprovação das “novas” Diretrizes Curriculares Nacionais para a Formação Inicial de Professores para a Educação Básica e a instituição da Base Nacional Comum para a Formação Inicial de Professores da Educação Básica. O método da pesquisa se ancora no materialismo histórico e dialético por meio das categorias totalidade, historicidade e mediação no campo das políticas de formação de professores no Brasil. Realizou-se estudos bibliográficos das Resoluções Nº 02/2015 e Nº 02/2019 e dos manifestos das entidades científicas nacionais da formação docente. Os resultados revelam desmontes e retrocessos no campo das políticas de formação de professores, com a disseminação da pedagogia das competências na aprovação da Resolução Nº 2/2019, que buscam deslegitimar a implementação de projetos críticos e emancipatórios no campo da formação inicial e continuada de professores. O Ministério da Educação e o Conselho Nacional de Educação tomam medidas que desconstroem políticas direcionadas aos sujeitos do campo, indígenas e quilombolas e ameaçam a continuidade dos cursos de Licenciatura em Educação do Campo, o que provoca uma r-existência dos sujeitos diversos e plurais na garantia de seus direitos.Palavras-chave: Formação de professores, Políticas públicas, Educação superior do campo, Licenciatura em Educação do Campo.Keywords: Teacher forming, Public policy, Higher education, Rural education.ReferencesAGUIAR, Márcia Ângela da S; DOURADO, Luiz Fernandes. BNCC e formação de professores: concepções, tensões, atores e estratégias. Revista Retratos da Escola, Brasília, v. 13, n. 25, p. 33-37, jan./mai. 2019. Disponível em: http//www.esforce.org.br. Acesso em 03. Jun, 2019.ANFOPE. A Anfope repudia a aprovação pelo CNE da Resolução que define as novas Diretrizes Curriculares para Formação Inicial de Professores da Educação Básica e Institui a Base Nacional Comum para a Formação Inicial de Professores da Educação Básica (BNC-Formação), [página online], 2019b. Disponível em: http://www.anfope.org.br/anfope-repudia-a-aprovacao-pelo-cne-da-resolucao-quedefine-as-novas-diretrizes-curriculares-para-formacao-inicial-de-professores-da-educacao-basica-einstitui-a-base-nacional-comum-para-a-formacao-in/. Acessado em 03/12/2019.ANFOPE. A ANFOPE se posiciona em defesa da Resolução 02/215 e pede arquivamento do parecer que propõe a sua alteração, [página online], 2019a. Disponível em: http://www.anfope.org.br/anfope-seposiciona-em-defesa-da-resolucao-02-215-e-pede-arquivamento-do-parecer-que-propoe-a-sua-alteracao/. Acessado em: 03/12/2019.ANFOPE. A ANFOPE se posiciona em defesa da Resolução 02/215 e pede arquivamento do parecer que propõe a sua alteração, [página online], 2019a. Disponível em: http://www.anfope.org.br/anfope-seposiciona-em-defesa-da-resolucao-02-215-e-pede-arquivamento-do-parecer-que-propoe-a-sua-alteracao/. Acessado em: 03/12/2019.ANFOPE. Documento Final do XIII Encontro Nacional da Anfope, 2016. Campinas, SP: Associação Nacional pela Formação dos Profissionais da Educação (ANFOPE), [página online], 2016. Texto digitado.ANFOPE. Reunião da Comissão Bicameral do Conselho Nacional de Educação sobre a Formação Inicial e Continuada de Professores, [página online]. Brasília, 2018. Disponível em: https://www.anfope.org.br/wpcontent/uploads/2018/05/ANFOPE-CNE-9abr-2018-.pdf. Acessado em: 03/12/2019.ANFOPE; et al. Contra a descaracterização da Formação de Professores. Nota das entidades nacionais em defesa da Resolução 02 /2015. [página online], 2019. 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Abstract Purpose: Mesenchymal stem/stromal cell therapy may reduce radiation-induced xerostomia. We investigated the long-term safety of autologous adipose tissue-derived mesenchymal stem/stromal cells (ASC) injections into the submandibular glands. Patients and Methods: A investigator-initiated, randomized, single-center, placebo-controlled trial. Previous oropharyngeal squamous cell carcinoma patients with radiation-induced xerostomia were randomly (1:1) allocated to receive a 2.8 million ASCs/cm3 injection or placebo in both submandibular glands and followed for minimally 2 years. The primary endpoint was number of serious adverse events (SAEs). Secondary endpoints included whole saliva flow rates and xerostomia-related symptoms. Data analysis was based on the intention-to-treat (ITT) population using repeated measures mixed-effects linear models. Results: Thirty-three patients were randomized; 30 patients were treated (ASC group, n=15; placebo group, n=15). Long-term safety data were collected from all 30 patients. During follow-up, 6/15 (40%) of the ASC-treated patients versus 5/15 (33%) of the placebo patients experienced an SAE; no SAEs appeared to be treatment-related. Unstimulated whole saliva flow rate increased to 0.20 and 0.16 mL/min in the ASC and placebo group, respectively, yielding a 0.05 mL/min (95% CI: 0.00 to 0.10, P=.051) difference between groups. Patient-reported xerostomia symptoms diminished according to a decreased Xerostomia Questionnaire summary score of 35.0 and 45.1, respectively (-10.1 [-18.1 to -2.2], P=.013). Three of the Visual Analog Scale xerostomia measures indicated clinical benefit following use of ASC. Conclusions:Our data show that ASC therapy is safe with a clinically relevant effect on xerostomia-related symptoms. Confirmation in larger randomized controlled trials is warranted.

Background: Periparturient mortality in goats have a great economic impact on the livelihood of marginal farmers. Pregnancy toxaemia, a metabolic disease in small ruminants occurs as a result of negative energy balance consequent to enhanced requirement for glucose by the developing fetuses in the last trimester (last 6 to 4 weeks) of gestation. The present study was aimed to identify diagnostic and prognostic indicators of pregnancy toxaemia. Methods: During the period October 2016 to September 2018, a total of 516 adult non descriptive does were brought to Veterinary University Peripheral Hospital, Madhavaram Milk Colony, Chennai - 51, of which 264 (51.16%) were treated for medical conditions. Among the does treated for various medical conditions, 72 does were in their last six weeks of gestation carrying twins/triplets and presented with the history of off feed. They were subjected to determination of blood β-hydroxybutyric acid (BHBA) level by means of a portable blood ketone and glucose monitoring system and qualitative urinalysis using urine dip stick. Does with BHBA level greater than 0.8 mmol/L and less than 1.6 mmol/L were classified as sub-clinical pregnancy toxaemic group (n=12) and BHBA level greater than 1.6 mmol/L were classified as clinical pregnancy toxaemic group (n=12) and subjected to therapy while the remaining 48 does had BHBA levels less than 0.8 mmol/L. The control animals were selected from adult Tellicherry does in the age group of 2 to 4 years maintained at Livestock Farm Complex (LFC), Madhavaram Milk Colony, Chennai - 600 051. Result: All the twelve does of sub-clinical pregnancy toxaemic group recovered completely with a cure rate of 100%, while in the clinical pregnancy toxaemic group the cure rate was only 33%. Reliable diagnostic indicators of pregnancy toxaemia include blood â-hyroxybutyric acid concentration (³ 0.8 mmol/L) and presence of ketone body, glucose and protein in urine, while hypergly­caemia in advanced pregnancy toxaemic does indicate fetal death.

Abstract STUDY QUESTION What is the association between ART conception and treatment parameters and the risk of birth defects? SUMMARY ANSWER Compared to naturally conceived singleton infants, the risk of a major nonchromosomal defect among ART singletons conceived with autologous oocytes and fresh embryos without use of ICSI was increased by 18%, with increases of 42% and 30% for use of ICSI with and without male factor diagnosis, respectively. WHAT IS KNOWN ALREADY Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects but have been limited by small sample size and inadequate statistical power, failure to differentiate results by plurality, differences in birth defect definitions and methods of ascertainment, lack of information on ART treatment parameters or study periods spanning decades resulting in a substantial historical bias as ART techniques have improved. STUDY DESIGN, SIZE, DURATION This was a population-based cohort study linking ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 1 January 2004 to 31 December 2015 that resulted in live births from 1 September 2004 to 31 December 2016 in Massachusetts and North Carolina and from 1 September 2004 to 31 December 2015 for Texas and New York: these were large and ethnically diverse States, with birth defect registries utilizing the same case definitions and data collected, and with high numbers of ART births annually. A 10:1 sample of non-ART births were chosen within the same time period as the ART birth. Naturally conceived ART siblings were identified through the mother’s information. Non-ART children were classified as being born to women who conceived with ovulation induction (OI)/IUI when there was an indication of infertility treatment on the birth certificate, but the woman did not link to the SART CORS; all others were classified as being naturally conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 135 051 ART children (78 362 singletons and 56 689 twins), 23 647 naturally conceived ART siblings (22 301 singletons and 1346 twins) and 9396 children born to women treated with OI/IUI (6597 singletons and 2799 twins) and 1 067 922 naturally conceived children (1 037 757 singletons and 30 165 twins). All study children were linked to their respective State birth defect registries to identify major defects diagnosed within the first year of life. We classified children with major defects as either chromosomal (i.e. presence of a chromosomal defect with or without any other major defect) or nonchromosomal (i.e. presence of a major defect but having no chromosomal defect), or all major defects (chromosomal and nonchromosomal). Logistic regression models were used to generate adjusted odds ratios (AORs) and 95% CI to evaluate the risk of birth defects due to conception with ART (using autologous oocytes and fresh embryos), and with and without the use of ICSI in the absence or presence of male factor infertility, with naturally conceived children as the reference. Analyses within the ART group were stratified by combinations of oocyte source (autologous, donor) and embryo state (fresh, thawed), with births from autologous oocytes and fresh embryos as the reference. Analyses limited to fresh embryos were stratified by oocyte source (autologous, donor) and the use of ICSI. Triplets and higher-order multiples were excluded. MAIN RESULTS AND THE ROLE OF CHANCE A total of 21 998 singleton children (1.9%) and 3037 twin children (3.3%) had a major birth defect. Compared to naturally conceived children, ART singletons (conceived from autologous oocytes, fresh embryos without the use of ICSI) had increased risks of a major nonchromosomal birth defect (AOR 1.18, 95% 1.05, 1.32), cardiovascular defects (AOR 1.20, 95% CI 1.03, 1.40), and any birth defect (AOR 1.18, 95% CI 1.09, 1.27). Compared to naturally conceived children, ART singletons conceived (from autologous oocytes, fresh embryos) with the use of ICSI, the risks were increased for a major nonchromosomal birth defect (AOR 1.30, 95% CI 1.16, 1.45 without male factor diagnosis; AOR 1.42, 95% CI 1.28, 1.57 with male factor diagnosis); blastogenesis defects (AOR 1.49, 95% CI 1.08, 2.05 without male factor; AOR 1.56, 95% CI 1.17, 2.08 with male factor); cardiovascular defects (AOR 1.28, 95% CI 1.10,1.48 without male factor; AOR 1.45, 95% CI 1.27, 1.66 with male factor); in addition, the risk for musculoskeletal defects was increased (AOR 1.34, 95% CI 1.01, 1.78 without male factor) and the risk for genitourinary defects in male infants was increased (AOR 1.33, 95% CI 1.08, 1.65 with male factor). Comparisons within ART singleton births conceived from autologous oocytes and fresh embryos indicated that the use of ICSI was associated with increased risks of a major nonchromosomal birth defect (AOR 1.18, 95% CI 1.03, 1.35), blastogenesis defects (AOR 1.65, 95% CI 1.08, 2.51), gastrointestinal defects (AOR 2.21, 95% CI 1.28, 3.82) and any defect (AOR 1.11, 95% CI 1.01, 1.22). Compared to naturally conceived children, ART singleton siblings had increased risks of musculoskeletal defects (AOR 1.32, 95% CI 1.04, 1.67) and any defect (AOR 1.15, 95% CI 1.08, 1.23). ART twins (conceived with autologous oocytes, fresh embryos, without ICSI) were at increased risk of chromosomal defects (AOR 1.89, 95% CI 1.10, 3.24) and ART twin siblings were at increased risk of any defect (AOR 1.26, 95% CI 1.01, 1.57). The 18% increased risk of a major nonchromosomal birth defect in singleton infants conceived with ART without ICSI (∼36% of ART births), the 30% increased risk with ICSI without male factor (∼33% of ART births), and the 42% increased risk with ICSI and male factor (∼31% of ART births) translates into an estimated excess of 386 major birth defects among the 68 908 singleton children born by ART in 2017. LIMITATIONS, REASONS FOR CAUTION In the SART CORS database, it was not possible to differentiate method of embryo freezing (slow freezing vs vitrification), and data on ICSI was only available in the fresh embryo ART group. In the OI/IUI group, it was not possible to differentiate type of non-ART treatment utilized, and in both the ART and OI/IUI groups, data were unavailable on duration of infertility. WIDER IMPLICATIONS OF THE FINDINGS The use of ART is associated with increased risks of a major nonchromosomal birth defect, cardiovascular defect and any defect in singleton children, and chromosomal defects in twins; the use of ICSI further increases this risk, the most with male factor infertility. These findings support the judicious use of ICSI only when medically indicated. The relative contribution of ART treatment parameters versus the biology of the subfertile couple to this increased risk remains unclear and warrants further study. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data. E.W. is a contract vendor for SART; all other authors report no conflicts. TRIAL REGISTRATION NUMBER N/A.