Study protocol--investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study

Introduction

Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment.

Methods

Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents.

Analysis

Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored.

Ethics and Dissemination

For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties.

Trial registration number

ISRCTN14608554.

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Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations

Background

High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations.

Aim

To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations.

Method

A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested.

Results

The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire.

Conclusions

The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.

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Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

Objectives

Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption.

Setting

ED of a UK tertiary referral hospital.

Participants

All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%).

Primary outcome measures

Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician.

Secondary outcome measures

Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria.

Results

1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with 'Severe' or 'Very Severe' acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003).

Conclusions

Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.

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Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences

Objective

To explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine.

Design

Questionnaire survey.

Setting

Royal College of Obstetricians and Gynaecologists (RCOG).

Participants

O&G consultant members/fellows of the RCOG working in the UK.

Main outcome measures

Measures included a typology of 4 bullying and undermining consequences from major to coping.

Results

There was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on 'frequency of occurrence', 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not.

Conclusions

Significant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions.

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Reducing time to angiography and hospital stay for patients with high-risk non-ST-elevation acute coronary syndrome: retrospective analysis of a paramedic-activated direct access pathway

Objective

To assess whether a novel 'direct access pathway' (DAP) for the management of high-risk non-ST-elevation acute coronary syndromes (NSTEACS) is safe, results in 'shorter time to intervention and shorter admission times'. This pathway was developed locally to enable London Ambulance Service to rapidly transfer suspected high-risk NSTEACS from the community to our regional heart attack centre for consideration of early angiography.

Methods

This is a retrospective case–control analysis of 289 patients comparing patients with high-risk NSTEACS admitted via DAP with age-matched controls from the standard pan-London high-risk ACS pathway (PLP) and the conventional pathway (CP). The primary end point of the study was time from admission to coronary angiography/intervention. Secondary end point was total length of hospital stay.

Results

Over a period of 43 months, 101 patients were admitted by DAP, 109 matched patients by PLP and 79 matched patients through CP. Median times from admission to coronary angiography for DAP, PLP and CP were 2.8 (1.5–9), 16.6 (6–50) and 60 (33–116) hours, respectively (p<0.001). Median length of hospital stay for DAP and PLP was similar at 3.0 (2.0–5.0) days in comparison to 5 (3–7) days for CP (p<0.001).

Conclusions

DAP resulted in a significant reduction in time to angiography for patients with high-risk NSTEACS when compared to existing pathways.

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Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence

Objective

To develop a theoretical model concerning male victims' processes of disclosing experiences of victimisation to healthcare professionals in Sweden.

Design

Qualitative interview study.

Setting

Informants were recruited from the general population and a primary healthcare centre in Sweden.

Participants

Informants were recruited by means of theoretical sampling among respondents in a previous quantitative study. Eligible for this study were men reporting sexual, physical and/or emotional violence victimisation by any perpetrator and reporting that they either had talked to a healthcare provider about their victimisation or had wanted to do so.

Method

Constructivist grounded theory. 12 interviews were performed and saturation was reached after 9.

Results

Several factors influencing the process of disclosing victimisation can be recognised from previous studies concerning female victims, including shame, fear of negative consequences of disclosing, specifics of the patient–provider relationship and time constraints within the healthcare system. However, this study extends previous knowledge by identifying strong negative effects of adherence to masculinity norms for victimised men and healthcare professionals on the process of disclosing. It is also emphasised that the process of disclosing cannot be separated from other, even seemingly unrelated, circumstances in the men's lives.

Conclusions

The process of disclosing victimisation to healthcare professionals was a complex process involving the men's experiences of victimisation, adherence to gender norms, their life circumstances and the dynamics of the actual healthcare encounter.

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'We have beaten HIV a bit: a qualitative study of experiences of peer support during pregnancy with an HIV Mentor Mother project in England

Objectives

To explore the experiences of women living with HIV in England who received or gave Mentor Mother (trained mother-to-mother) volunteer peer support during pregnancy and early motherhood.

Design

Qualitative descriptive study, using semistructured, in-depth interviews and inductive thematic analysis, theoretically informed by phenomenological social psychology.

Setting

A London-based third sector peer support organisation for people living with HIV.

Participants

12 women living with HIV who had given or received Mentor Mother volunteer peer support (6 had given support and 6 had received support). 11 were black African.

Results

The key themes in participants' descriptions of their lives as pregnant women and mothers living with HIV were 'fear and distress', 'stigma and isolation' and 'the gap in maternity care'. The key themes related to Mentor Mother peer support during and after pregnancy were 'support to avoid mother-to-child transmission' (with subthemes 'reinforcing medical advice', 'reframing faith issues', 'prioritisation and problem-solving' and 'practical strategies for managing HIV and motherhood'), and 'emotional support' (with subthemes 'role modelling and inspiring hope', 'openness and non-judgemental acceptance', 'a caring relationship', 'recreating the lost family network', 'being understood from the inside' and 'self-confidence'). The Mentor Mothers' support appeared to be a successful hybrid between the peer education Mentor Mothers programmes in southern Africa and the more general pregnancy volunteer peer support models operating in England.

Conclusions

A Mentor Mother peer support programme is acceptable to, and valued by, black African mothers with HIV in England. Peer support from trained volunteers during and after pregnancy can complement and reinforce medical advice on avoiding mother-to-child transmission of HIV, and can have a multidimensional positive impact on vulnerable mothers' emotional well-being. Mentor Mother peer support should be considered by those designing programmes for the support of pregnant women with HIV and the prevention of mother-to-child transmission of HIV.

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Prevalence of musculoskeletal pain of the neck, upper extremities and lower back among dental practitioners working in Riyadh, Saudi Arabia: a cross-sectional study

Objectives

Studies have shown that dentists have a higher incidence of work-related musculoskeletal (MSK) pain than those in other occupations. The risk factors contributing to MSK pain among Saudi dentists has not been fully studied so this study aims to estimate the prevalence of MSK pain and investigate its associated risk factors among dentists in Saudi Arabia.

Setting and participants

A cross-sectional survey was carried out in the capital city Riyadh, Saudi Arabia, using random cluster sampling. 224 surveys were distributed among dentists with a 91.1% response rate (101 women and 103 men).

Outcomes

The prevalence of MSK pain and its associated risk factors were investigated.

Results

184 (90.2%) respondents reported having MSK pain. Lower back pain was the most commonly reported MSK pain (68.1%). Gender and age were reported to be predictors for at least one type of MSK pain. Older age was associated with lower back pain (OR 1.23; 95% CI 1.00 to 1.50) and women had double the risk of shoulder pain (OR 2.52; 95% CI 1.12 to 5.68). In addition, lower back pain was related to the time the dentist spent with patients (OR 0.28; 95% CI 0.14 to 0.54), while shoulder pain (OR 1.03; 95% CI 1.00 to 1.06) and lower back pain (OR 1.06; 95% CI 1.03 to 1.10) were significantly related to years of experience.

Conclusions

MSK pain is common among older and female Saudi dentists. Research on the impact of exercise and the ergonomics of the workplace on the intensity of MSK pain and the timing of its onset is required.

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Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis

Objectives

To determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience.

Design

Retrospective analysis of prospectively collected data.

Setting

Single centre series. Outpatient clinics at an elective foot and ankle unit in the UK.

Participants

All new adult patients attending elective orthopaedic outpatient clinics over a 32-month period.

Interventions

All patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment.

Outcome measures

Capture rates of patient-reported and clinician-reported data. All information and technology (IT) failures, language and disability barriers were captured. Patients were asked to rate their experience of using ePROMs. The scoring systems used included EQ-5D-5L, the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Visual Analogue Scale (VAS) pain score.

Results

Out of 2534 new patients, 2176 (85.9%) completed ePROMs, of whom 1090 (50.09%) completed ePROMs at home/work prior to their appointment. 31.5% used a mobile (smartphone/tablet) device. Clinician-reported data were captured on 2491 patients (98.3%). The mean patient experience score of using Patient-Reported Outcome Measures (PROMs) was 8.55±1.85 out of 10 and 666 patients (30.61%) left comments. Of patients leaving comments, 214 (32.13%) felt ePROMs did not adequately capture their symptoms and these patients had significantly lower patient experience scores (p<0.001).

Conclusions

This study demonstrates the successful implementation of technology into a service improvement programme. Excellent capture rates of ePROMs and clinician-validated diagnostic data can be achieved within a National Health Service setting.

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Cross-sectional study of ethnic differences in physical fitness among children of South Asian, black African-Caribbean and white European origin: the Child Heart and Health Study in England (CHASE)

Objective

Little is known about levels of physical fitness in children from different ethnic groups in the UK. We therefore studied physical fitness in UK children (aged 9–10 years) of South Asian, black African–Caribbean and white European origin.

Design

Cross-sectional study.

Setting

Primary schools in the UK.

Participants

1625 children (aged 9–10 years) of South Asian, black African–Caribbean and white European origin in the UK studied between 2006 and 2007.

Outcome measures

A step test assessed submaximal physical fitness from which estimated VO_{2 max} was derived. Ethnic differences in estimated VO_{2 max} were estimated using multilevel linear regression allowing for clustering at school level and adjusting for age, sex and month as fixed effects.

Results

The study response rate was 63%. In adjusted analyses, boys had higher levels of estimated VO_{2 max} than girls (mean difference 3.06 mL O₂/min/kg, 95% CI 2.66 to 3.47, p<0.0001). Levels of estimated VO_{2 max} were lower in South Asians than those in white Europeans (mean difference –0.79 mL O₂/min/kg, 95% CI –1.41 to –0.18, p=0.01); levels of estimated VO_{2 max} in black African–Caribbeans were higher than those in white Europeans (mean difference 0.60 mL O₂/min/kg, 95% CI 0.02 to 1.17, p=0.04); these patterns were similar in boys and girls. The lower estimated VO_{2 max} in South Asians, compared to white Europeans, was consistent among Indian, Pakistani and Bangladeshi children and was attenuated by 78% after adjustment for objectively measured physical activity (average daily steps).

Conclusions

South Asian children have lower levels of physical fitness than white Europeans and black African–Caribbeans in the UK. This ethnic difference in physical fitness is at least partly explained by ethnic differences in physical activity.

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Nerdy TV series awarded the Torsten Wiesel prize

The Big Bang Theory isn't any old sitcom – it's a show that takes its science deadly seriously and stimulates public interest in science. So says the Young Academy of Sweden, which recently awarded the US TV series the newly created Torsten Wiesel Midnight Sun Award.  The Big Bang Theory is about a group of friends, many of whom are researchers at Caltech in California. One of the characters is played by Mayim Bialik, who alongside her acting career is also a doctor of neuroscience. "What's so great about The Big Bang Theory is that it takes its science deadly seriously – they run very careful fact checks," says Christian Broberger, docent of neuroscience at Karolinska Institutet and one of the judges on the Young Academy of Sweden's awards committee. "They're really quick at incorporating new discoveries and good at keeping up with the latest research. We believe that the series, which is terrifically popular, has raised science onto the agenda in a light-hearted way for new audiences." The TV series is also the first recipient of The Torsten Wiesel Midnight Sun Award, which was established to commemorate the 90th birthday of Nobel laureate and neurophysiologist Torsten Wiesel in 2014 in recognition of people or organisations that have made extraordinary efforts to explain or spotlight science. Torsten Wiesel is also the scientific patron of the Young Academy of Sweden, and attended the prize-giving ceremony in May in order to present a work of art to the series' scientific fact-checker, Professor David Salzberg, particle physicist at the University of California in Los Angeles. Salzberg is also responsible for the now cult-status whiteboard that appears in the series bearing all manner of – always correct – formulae. "Physicists like to send their latest discoveries to Salzberg so they can be written up on the board," says Dr Broberger. "It's become a prestige thing to appear there. When Stephen Hawking went to launch one of his latest great theories, part of the pitch was to be included on The Big Bang Theory." Text: Sofia Stridsman Photo: Warner Bros   Footnote: The five-year old Young Academy of Sweden is a multidisciplinary forum established by the Royal Swedish Academy of Sciences.

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Keeping the Olympic village healthy

Benedict Chambers and Berit Carow left the world of elite sports to concentrate on their careers as immunologists at Karolinska Institutet. They are now returning to the limelight to help contestants in this summer's Olympic Games in Rio avoid infection. Berit Carow and Benedict Chambers cut healthy, energetic figures, as one would expect of two former sporting elites. And even though they're both still active in their respective sports, they dedicate most of their time to research. Benedict Chambers is a docent at the Centre for Infection Medicine at the Department of Medicine, Huddinge, and Berit Carow is a postdoc researcher at the Department of Microbiology, Tumour and Cell Biology (MTC). Together, they have combined their interests and made four short films designed to help Olympic hopefuls avoid the greatest threat to a medal – missing the games due to illness. As part of its training drive, the International Olympic Committee (IOC) has opened an "Athlete Learning Gateway", a collection of online courses and instruction films on health, nutrition and performance tips. The idea for the project came to Dr Chambers when he saw that there was no information about infections and how to avoid them. It took one week of recording "I went in to Berit at the office and asked if she wanted to join me and she said yes straight away." He contacted the chair of the organisation, who also liked the idea. It took only a week for them to record their films. In four video clips they address basic facts about different infections and their physiological effects, and give the athletes practical tips for staying healthy before and during their stay in the Olympic village. "You can't protect yourself against every eventuality, but there are some simple tricks that can make a big difference, and that's what we want to get across," says Dr Carow. The idea is that the films will make sportspeople think about and discuss health matters. They can then contact both KI researchers, who will be available online to give their expert advice. Because experts is what they truly are. Dr Carow has an impressive CV: she just missed bronze in the double scull (rowing) event in Peking in 2008 and has won several World Championship medals for Germany. And even though she has cut down on the competitions since moving to Sweden, she still rows. Competition for all on equal term Dr Chambers has had a long career as a fencer for the Irish national team and has competed in many world and European championships. He still fences competitively, but no longer at an elite level. He adds that he was in the qualifiers for Rio, but failed to make it all the way. "I knocked out the silver medallist from the London Olympics, which was great, but the next day he announced on TV that he was quitting. Lose against Benedict and there's clearly no point carrying on," he says with a laugh. They like the thought of not just being spectators at the coming Olympics. "We're doing this a lot for the smaller teams that aren't able to bring their own doctors," says Dr Carow. "We want to make the information simple and accessible to all and to contribute to the Olympic philosophy – competition for all on equal terms," she continues. Text: Mårten Göthlin Translation: Neil Betteridge Photo: Gustav Mårtensson   Brief facts about the Rio Olympics *A record number of countries and participants are expected: over 10,000 from 206 countries. *The Swedish Olympic Committee is sending approx. 150 competitors. *Rio will be the first South American Olympic host ever. *28 Olympic events – two more than in London 2012 (newcomers are golf and seven-aside rugby). *To be held from 5 to 21 August 2016. Sources: www.rio2016.org, SOK.

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How We Hope: A Moral Psychology, by Adrienne M. Martin.

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Potentiality: From Dispositions to Modality, by Barbara Vetter.

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Believing Against the Evidence, by Miriam Schleifer McCormick.

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Erp Correlates of Error Processing During Performance on the Halstead Category Test

Publication date: Available online 19 June 2016
Source:International Journal of Psychophysiology
Author(s): I.M. Santos, A.R. Teixeira, A.M. Tomé, A.T. Pereira, P. Rodrigues, P. Vagos, J. Costa, M. Carrito, B. Oliveira, N. DeFilippis, C.F. Silva
The Halstead Category Test (HCT) is a neuropsychological test that measures a person's ability to formulate and apply abstract principles. Performance must be adjusted based on feedback after each trial and errors are common until the underlying rules are discovered. Event-related potential (ERP) studies associated with the HCT are lacking. This paper demonstrates the use of a methodology inspired on Singular Spectrum Analysis (SSA) applied to EEG signals, to remove high amplitude ocular and movement artifacts during performance on the test. This filtering technique introduces no phase or latency distortions, with minimum loss of relevant EEG information. Importantly, the test was applied in its original clinical format, without introducing adaptations to ERP recordings. After signal treatment, the feedback-related negativity (FRN) wave, which is related to error-processing, was identified. This component peaked around 250ms, after feedback, in fronto-central electrodes. As expected, errors elicited more negative amplitudes than correct responses. Results are discussed in terms of the increased clinical potential that coupling ERP information with behavioral performance data can bring to the specificity of the HCT in diagnosing different types of impairment in frontal brain function.feedback-related negativity (FRN), Halstead Category Test, Singular Spectrum Analysis (SSA), event-related potentials (ERP), feedback processing



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An ERP study of recognition memory for concrete and abstract pictures in school-aged children

Publication date: Available online 18 June 2016
Source:International Journal of Psychophysiology
Author(s): Olivier Boucher, Christine Chouinard-Leclaire, Gina Muckle, Alissa Westerlund, Matthew J. Burden, Sandra W. Jacobson, Joseph L. Jacobson
Recognition memory for concrete, nameable pictures is typically faster and more accurate than for abstract pictures. A dual-coding account for these findings suggests that concrete pictures are processed into verbal and image codes, whereas abstract pictures are encoded in image codes only. Recognition memory relies on two successive and distinct processes, namely familiarity and recollection. Whether these two processes are similarly or differently affected by stimulus concreteness remains unknown. This study examined the effect of picture concreteness on visual recognition memory processes using event-related potentials (ERPs). In a sample of children involved in a longitudinal study, participants (N=96; mean age=11.3years) were assessed on a continuous visual recognition memory task in which half the pictures were easily nameable, everyday concrete objects, and the other half were three-dimensional abstract, sculpture-like objects. Behavioral performance and ERP correlates of familiarity and recollection (respectively, the FN400 and P600 repetition effects) were measured. Behavioral results indicated faster and more accurate identification of concrete pictures as "new" or "old" (i.e., previously displayed) compared to abstract pictures. ERPs were characterized by a larger repetition effect, on the P600 amplitude, for concrete than for abstract images, suggesting a graded recollection process dependent on the type of material to be recollected. Topographic differences were observed within the FN400 latency interval, especially over anterior-inferior electrodes, with the repetition effect more pronounced and localized over the left hemisphere for concrete stimuli, potentially reflecting different neural processes underlying early processing of verbal/semantic and visual material in memory.



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W. Bruce Fye, Caring for the Heart: the Mayo Clinic and the Rise of Specialization

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Andreas Mayer, Sites of the Unconscious: Hypnosis and the Emergence of the Psychoanalytic Setting

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Kim Price, Medical Negligence in Victorian Britain: The Crisis of Care under English Poor Law, c. 1834-1900

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Erratum

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D.S. Lucey and Virginia Crossman (eds), Health Care in Ireland and Britain from 1850: voluntary, regional and comparative perspectives

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Elena Conis, Vaccine Nation: Americas Changing Relationship with Immunization

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Laure Murat, The Man Who Thought He Was Napoleon: Toward a Political History of Madness

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Saurabh Mishra, Beastly Encounters of the Raj: Livelihoods, Livestock and Veterinary Health in North India

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Malaria and Colonialism in Korea, c.1876-c.1945

This article considers the problem of malaria in the Korean peninsula from 1876 to 1945, focusing particularly on the impact of Japanese colonial rule. One aspect which receives special attention is malaria in urban contexts. The relationship between malaria and urbanisation is shown to be extremely complex, fluctuating regardless of specific interventions against the disease. In rural and urban areas, Japanese antimalarial measures concentrated on military garrisons, at the expense of both civilian settlers and Koreans. However, it was Koreans who bore the brunt of the malaria problem, which was exacerbated in many areas by agricultural and industrial development and, ultimately, by the war regime introduced from 1938. The worsening of the malaria burden in the final years of Japanese rule left a legacy which lasted long after independence.

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Maria Pia Donato, Sudden Death: Medicine and Religion in Eighteenth-Century Rome.

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Harnessing the Power of Difference: Colonialism and British Chronic Disease Research, 1940-1975

Recent studies of post-war chronic disease epidemiology have generally focused on the histories of research in the USA and UK. Using the archival records of a major British funding body, the Colonial Medical Research Committee and its successor the Tropical Medical Research Board, this article demonstrates the advantages of bringing a post-colonial analytic to this historiography. It highlights how the administrative and medical interests in population difference at the centre of the new epidemiology came to map onto political apparatus initially created to know, reform and govern colonial subjects. Although detached from imperial aims, British medical scientists nonetheless attached value to colonial populations on the basis of British benefit and turned various sites into laboratories to extract it. This relationship did not die with the end of imperial rule. British scientists continued to pursue chronic disease epidemiology in former colonies well into the post-war period, informing debates about Britain's own public health concerns.

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Howard Chiang (ed.), Psychiatry and Chinese History (Studies for the Society for the Social History of Medicine)

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Leonard Smith, Insanity, Race and Colonialism: Managing Mental Disorder in the Post-Emancipation British Caribbean 1838-1914

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Claudia Malacrida, A Special Hell: Institutional Life in Albertas Eugenic Years

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Louise Hide, Gender and Class in English Asylums, 1890-1914

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Fabrice Brandli and Michel Porret (eds), Les Corps Meurtris: investigations judiciares et expertises medico-legales au XVIIIe siecle

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Werner Trotsken, The Pox of Liberty. How the Constitution left Americans Rich, Free, and Prone to Infection.

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Modified Framingham Risk Score predicted 10-y CAD better than the original score in patients with lupus

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Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care A Multilevel Case–Control Study

Background:

Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings.

Objective:

To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence.

Design:

Multilevel longitudinal nested case–control study.

Setting:

Veterans Health Administration health care regions, from 2006 through 2012.

Participants:

Long-term care residents.

Measurements:

Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks.

Results:

6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R² = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]).

Limitations:

Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non–Veterans Health Administration acute care sources was not considered.

Conclusion:

Only 25% of the variation in regional C difficile incidence in long-term care remained unexplained after importation from acute care facilities and antibiotic use were accounted for, which suggests that improved infection control and antimicrobial stewardship may help reduce the incidence of C difficile in long-term care settings.

Primary Funding Source:

U.S. Department of Veterans Affairs and Centers for Disease Control and Prevention.

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Oral fluoroquinolone treatment was not associated with serious arrhythmia

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Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions A Quasi-experimental Study

Background:

In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults.

Objective:

To evaluate whether the state Medicaid expansions were associated with changes in insurance coverage, access to and utilization of health care, and self-reported health.

Design:

Comparison of outcomes before and after the expansions in states that did and did not expand Medicaid.

Setting:

United States.

Participants:

Citizens aged 19 to 64 years with family incomes below 138% of the federal poverty level in the 2010 to 2014 National Health Interview Surveys.

Measurements:

Health insurance coverage (private, Medicaid, or none); improvements in coverage over the previous year; visits to physicians in general practice and specialists; hospitalizations and emergency department visits; skipped or delayed medical care; usual source of care; diagnoses of diabetes, high cholesterol, and hypertension; self-reported health; and depression.

Results:

In the second half of 2014, adults in expansion states experienced increased health insurance (7.4 percentage points [95% CI, 3.4 to 11.3 percentage points]) and Medicaid (10.5 percentage points [CI, 6.5 to 14.5 percentage points]) coverage and better coverage than 1 year before (7.1 percentage points [CI, 2.7 to 11.5 percentage points]) compared with adults in nonexpansion states. Medicaid expansions were associated with increased visits to physicians in general practice (6.6 percentage points [CI, 1.3 to 12.0 percentage points]), overnight hospital stays (2.4 percentage points [CI, 0.7 to 4.2 percentage points]), and rates of diagnosis of diabetes (5.2 percentage points [CI, 2.4 to 8.1 percentage points]) and high cholesterol (5.7 percentage points [CI, 2.0 to 9.4 percentage points]). Changes in other outcomes were not statistically significant.

Limitation:

Observational study may be susceptible to unmeasured confounders; reliance on self-reported data; limited post-ACA time frame provided information on short-term changes only.

Conclusion:

The ACA Medicaid expansions were associated with higher rates of insurance coverage, improved quality of coverage, increased utilization of some types of health care, and higher rates of diagnosis of chronic health conditions for low-income adults.

Primary Funding Source:

None.

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Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force

Background:

Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages.

Objective:

To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups.

Design:

Decision analysis using a microsimulation model.

Data Sources:

3 systematic evidence reviews.

Target Population:

Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use.

Time Horizon:

Lifetime, 20 years, and 10 years.

Perspective:

Clinical.

Intervention:

Low-dose aspirin (≤100 mg/d).

Outcome Measures:

Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke.

Results of Base-Case Analysis:

Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use.

Results of Sensitivity Analysis:

Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use.

Limitations:

Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex.

Conclusion:

Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit.

Primary Funding Source:

Agency for Healthcare Research and Quality.

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Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Background:

Cardiovascular disease (CVD) is the leading cause of death in the United States.

Purpose:

To update a systematic review about the benefits of aspirin for the primary prevention of cardiovascular events in adults aged 40 years or older and to evaluate effect modification in subpopulations.

Data Sources:

MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (January 2008 to January 2015), and Cochrane Database of Systematic Reviews.

Study Selection:

Two investigators independently reviewed 3396 abstracts and 65 articles according to prespecified criteria. All included trials evaluated aspirin for the primary prevention of cardiovascular events.

Data Extraction:

Two investigators assessed study quality; data were abstracted by 1 reviewer and checked by a second.

Data Synthesis:

Two good-quality and 9 fair-quality randomized, controlled trials were identified. In analyses of all doses, aspirin reduced the risk for nonfatal myocardial infarction (MI) (relative risk [RR], 0.78 [95% CI, 0.71 to 0.87]) but not nonfatal stroke; aspirin showed little or no benefit for all-cause or cardiovascular mortality. Benefits began within the first 5 years. Older adults achieved greater relative MI reduction, but no other effect modifications were found in analyzed subpopulations. In trials with aspirin doses of 100 mg or less per day, the reduction in nonfatal MI benefit persisted (absolute risk reduction, 0.15 to 1.43 events per 1000 person-years) and a 14% reduction in nonfatal stroke benefit was noted, but no benefit was found for all-cause mortality (RR, 0.95 [CI, 0.89 to 1.01]) or cardiovascular mortality (RR, 0.97 [CI, 0.85 to 1.10]).

Limitation:

Evidence for aspirin in primary prevention is heterogeneous and limited by rare events and few credible subgroup analyses.

Conclusion:

The beneficial effect of aspirin for the primary prevention of CVD is modest and occurs at doses of 100 mg or less per day. Older adults seem to achieve a greater relative MI benefit.

Primary Funding Source:

Agency for Healthcare Research and Quality.

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Review: Providing genetic-based risk estimates for disease does not affect risk-reducing behaviors in adults

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VP7 and VP8* genetic characterization of group A rotavirus genotype G12P[8]: Emergence and spreading in the Eastern Brazilian coast in 2014

Abstract

Group A rotavirus (RVA) genotype G12 is habitually associated with diarrhea disease (DD) in African children and recently its detection has increased worldwide. A total of 970 stool samples collected from individuals with DD in the Northeastern, Southeastern and Southern Brazilian regions, Eastern coast, were analyzed and 321 (33%) were positive for RVA and of these, 241 (75%) genotyped as G12P[8]. The rate of RVA positivity was higher among children aged 5 to 10 years old (60%). All RVA infections observed in adults aged > 21 years were G12P[8] (n = 27) showing that this genotype affected older age groups during the year of 2014 in Brazil. Phylogenetic analysis of VP7 and VP8* G12P[8] strains demonstrated an elevated similarity among Brazilian and G12-III prototypes strains circulating worldwide recently, suggesting that this lineage is associated with the global spread of the G12 genotype, considered as the 6^th most prevalent human RVA genotype nowadays; while other G12 lineages remain sporadically detected and usually detected in association with other P genotypes. VP8* analysis revealed that Brazilian strains belong to P[8]-3 lineage, the single P[8] lineage presently detected in the country. No major nucleotide/amino acid disparities were observed among strains recovered from children and adults for VP7 and VP8* genes. These data are essential to support the surveillance studies, particularly in countries where the RVA vaccine was introduced in their National Immunization Program enabling identification of potential alterations in the epidemiological profile that can impact its efficacy in vaccination programs. This article is protected by copyright. All rights reserved

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Contaminants of Emerging Concern: From the Detection to Their Effects on Human Health

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Expression of HIF-2α and VEGF in Cervical Squamous Cell Carcinoma and Its Clinical Significance

CSCC is a systemic disease involving polygenic alteration and multiple steps, and HIF and VEGF are closely associated with tumorigenesis. Specimens surgically resected from 64 cases of CSCC and 22 cases of normal cervical tissue were selected randomly to detect the expression of HIF-2α and VEGF in CSCC for exploring their clinical significance; information regarding the age, lymph node metastasis, and FIGO staging were collected as well; expression of HIF-2α and VEGF was detected by qPCR and immunohistochemistry. We found that the expression of HIF-2α and VEGF mRNA in CSCC was significantly higher than that of normal cervical tissues and showed a positive correlation between them. The positive rates of HIF-2α and VEGF protein expression in CSCC and normal cervical tissues were 93.8% and 18.2%, respectively, with correlation between them. The expression of both HIF-2α and VEGF mRNA did not relate closely to age but the FIGO staging and lymph node metastasis. Compared with the counterpart control group, CSCC tissues with high FIGO staging and lymph node metastasis had a higher level of HIF-2α and VEGF mRNA expression. So, HIF-2α and VEGF were overexpressed in CSCC, which has a great clinical significance for its diagnosis.

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Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, ) and low-flow sevoflurane anesthesia group (Group L, ). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy.

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Genetic Analysis of the Atrial Natriuretic Peptide Gene Polymorphisms among Essential Hypertensive Patients in Malaysia

Background. Atrial natriuretic peptide (ANP) considerably influences blood pressure regulation through water and sodium homoeostasis. Several of the studies have utilized anonymous genetic polymorphic markers and made inconsequent claims about the ANP relevant disorders. Thus, we screened Insertion/Deletion (ID) and G191A polymorphisms of ANP to discover sequence variations with potential functional significance and to specify the linkage disequilibrium pattern between polymorphisms. The relationships of detected polymorphisms with EH with or without Type 2 Diabetes Mellitus (T2DM) status were tested subsequently. Method. ANP gene polymorphisms (I/D and A191G) were specified utilizing mutagenically separated Polymerase Chain Reaction (PCR) in 320 subjects including 163 EH case subjects and 157 controls. Result. This case-control study discovered a significant association between I/D polymorphisms of ANP gene in EH patient without T2DM. However, the study determined no association between G191A polymorphisms of ANP in EH with or without T2DM. In addition, sociodemographic factors in the case and healthy subjects exhibited strong differences (). Conclusion. As a risk factor, ANP gene polymorphisms may affect hypertension. Despite the small sample size in this study, it is the first research assessing the ANP gene polymorphisms in both EH and T2DM patients among Malaysian population.

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Sibel A. Ozkan, Jean-Michel Kauffmann, and Petr Zuman: Electroanalysis in biomedical and pharmaceutical sciences. Voltammetry, amperometry, biosensors, applications

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Surface-enhanced Raman spectroscopy for the analysis of smokeless gunpowders and macroscopic gunshot residues

Abstract

Gunshot residues (GSR) result from the discharge of a firearm being a potential piece of evidence in criminal investigations. The macroscopic GSR particles are basically formed by burned and non-burned gunpowder. Motivated by the demand of trace analysis of these samples, in this paper, the use of surface-enhanced Raman scattering (SERS) was evaluated for the analysis of gunpowders and macroscopic GSR particles. Twenty-one different smokeless gunpowders were extracted with ethanol. SERS spectra were obtained from the diluted extracts using gold nanoaggregates and an excitation wavelength of 633 nm. They show mainly bands that could be assigned to the stabilizers diphenylamine and ethylcentralite present in the gunpowders. Then, macroscopic GSR particles obtained after firing two different ammunition cartridges on clothing were also measured using the same procedure. SERS allowed the detection of the particles collected with an aluminum stub from cloth targets without interferences from the adhesive carbon. The results demonstrate the great potential of SERS for the analysis of macroscopic GSR particles. Furthermore, they indicate that the grain-to-grain inhomogeneity of the gunpowders needs to be considered.

Graphical Abstract

SERS allows the detection of GSR particles collected with adhesive stubs from cloth targets using gold nanoaggregates and an excitation wavelength of 633 nm

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Detection of rare species of volatile organic selenium metabolites in male golden hamster urine

Abstract

Selenium has been considered as an essential trace element in mammals and its intake comes mainly from food. Mammals can metabolize both inorganic and organic species, and urinary excretion is the primary elimination route of selenium. Selenosugars and trimethylselenonium ion have been identified as major urinary metabolites. Other metabolites have been reported, but they were detected in some studies and not in others. Still, a large portion of the ingested selenium eliminated from the body is unknown. Volatile selenium species may account for a certain portion of the unknown species since they can easily be lost during sample analyses. While we analyzed male golden hamster urine in search of potential volatile pheromone(s), four volatile selenium compounds were detected. They were dimethyl selenenylsulfide, dimethyl diselenide, dimethyl bis(thio)selenide, and dimethyl selenodisulfide. When the urine samples were aged and dried for 48 h, dimethyl selenodisulfide tended to increase, while others decreased. The increase might be due to the formation of dimethyl selenodisulfide via reaction of dimethyl diselenide and dimethyl trisulfide whose concentration increased as urine aged. To our knowledge, dimethyl bis(thio)selenide and dimethyl selenodisulfide have never been demonstrated in urine. It remains to be determined whether these species are common metabolites in other animals or hamster-specific.

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A simple graphene-based pipette tip solid-phase extraction of malondialdehyde from human plasma and its determination by spectrofluorometry

Abstract

Determination of malondialdehyde (MDA) in human blood plasma is important because of its role as a biomarker of lipid peroxidation in biological and medical sciences. In this work, a miniaturized graphene-based pipette tip solid-phase extraction technique was developed for very efficient extraction of MDA as its dithiobarbituric acid (TBA) adduct from human plasma. Two milligrams of graphene as sorbent were placed into a pipette tip and MDA-TBA compound was extracted and preconcentrated by it, after 4 repeated aspirating/dispensing cycles, then the column was eluted with 80 μL of dimethyl sulfoxide by 4 repeated aspirating/dispensing cycles and elusion was measured spectrofluorimetrically. Various effective parameters such as type and volume of eluent solvent, temperature, sample volume, number of cycles of extraction and desorption, derivatization reaction time, and pH of the sample solution were investigated and optimized. Under optimum conditions, a linear calibration curve was obtained in the range of 0.5–90 μg L⁻¹ (r ² = 0.991) with a detection limit of 0.3 μg L⁻¹. The relative standard deviations for 8 replicate measurements of 10 and 40 μg L⁻¹ of MDA were found to be 4.51 and 3.78 % respectively. The developed protocol was successfully applied to the determination of MDA in a human blood plasma sample.

Graphical Abstract

A simple graphene-based pipette tip solid-phase extraction of malondialdehyde from human plasma and its determination by spectrofluorometry

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Manipulation of DNA Repair Proficiency in Mouse Models of Colorectal Cancer

Technical and biological innovations have enabled the development of more sophisticated and focused murine models that increasingly recapitulate the complex pathologies of human diseases, in particular cancer. Mouse models provide excellent in vivo systems for deciphering the intricacies of cancer biology within the context of precise experimental settings. They present biologically relevant, adaptable platforms that are amenable to continual improvement and refinement. We discuss how recent advances in our understanding of tumorigenesis and the underlying deficiencies of DNA repair mechanisms that drive it have been informed by using genetically engineered mice to create defined, well-characterized models of human colorectal cancer. In particular, we focus on how mechanisms of DNA repair can be manipulated precisely to create in vivo models whereby the underlying processes of tumorigenesis are accelerated or attenuated, dependent on the composite alleles carried by the mouse model. Such models have evolved to the stage where they now reflect the initiation and progression of sporadic cancers. The review is focused on mouse models of colorectal cancer and how insights from these models have been instrumental in shaping our understanding of the processes and potential therapies for this disease.

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Cancers, Vol. 8, Pages 58: Tomato as a Source of Carotenoids and Polyphenols Targeted to Cancer Prevention

A diet rich in vegetables has been associated with a reduced risk of many diseases related to aging and modern lifestyle. Over the past several decades, many researches have pointed out the direct relation between the intake of bioactive compounds present in tomato and a reduced risk of suffering different types of cancer. These bioactive constituents comprise phytochemicals such as carotenoids and polyphenols. The direct intake of these chemoprotective molecules seems to show higher efficiencies when they are ingested in its natural biological matrix than when they are ingested isolated or in dietary supplements. Consequently, there is a growing trend for improvement of the contents of these bioactive compounds in foods. The control of growing environment and processing conditions can ensure the maximum potential accumulation or moderate the loss of bioactive compounds, but the best results are obtained developing new varieties via plant breeding. The modification of single steps of metabolic pathways or their regulation via conventional breeding or genetic engineering has offered excellent results in crops such as tomato. In this review, we analyse the potential of tomato as source of the bioactive constituents with cancer-preventive properties and the result of modern breeding programs as a strategy to increase the levels of these compounds in the diet.

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Materials, Vol. 9, Pages 490: Reuse of Textile Dyeing Effluents Treated with Coupled Nanofiltration and Electrochemical Processes

The reactive dye Cibacron Yellow S-3R was selected to evaluate the feasibility of combining nanofiltration membranes with electrochemical processes to treat textile wastewater. Synthetic dyeing effluents were treated by means of two nanofiltration membranes, Hydracore10 and Hydracore50. Up to 98% of dye removal was achieved. The influence of salt concentration and pH on membrane treatment was studied. The best dye removal yield was achieved at pH 3 in the presence of 60 g/L of NaCl. After the membrane filtration, the concentrate containing high dye concentration was treated by means of an electrochemical process at three different current densities: 33, 83, and 166 mA/cm2. Results showed a lineal relationship between treatment time and applied current density. Both permeates and electrochemically-decoloured effluents were reused in new dyeing processes (100% of permeate and 70% of decoloured concentrates). Dyed fabrics were evaluated with respect to original dyeing. Colour differences were found to be into the acceptance range.

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Symmetry, Vol. 8, Pages 52: Parity-Time Symmetry and the Toy Models of Gain-Loss Dynamics near the Real Kato’s Exceptional Points

For a given operator D ( t ) of an observable in theoretical parity-time symmetric quantum physics (or for its evolution-generator analogues in the experimental gain-loss classical optics, etc.) the instant t c r i t i c a l of a spontaneous breakdown of the parity-time alias gain-loss symmetry should be given, in the rigorous language of mathematics, the Kato's name of an "exceptional point", t c r i t i c a l = t ( E P ) . In the majority of conventional applications the exceptional point (EP) values are not real. In our paper, we pay attention to several exactly tractable toy-model evolutions for which at least some of the values of t ( E P ) become real. These values are interpreted as "instants of a catastrophe", be it classical or quantum. In the classical optical setting the discrete nature of our toy models might make them amenable to simulations. In the latter context the instant of Big Bang is mentioned as an illustrative sample of possible physical meaning of such an EP catastrophe in quantum cosmology.

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Molecules, Vol. 21, Pages 802: Antileishmanial Activity and Structure-Activity Relationship of Triazolic Compounds Derived from the Neolignans Grandisin, Veraguensin, and Machilin G

Sixteen 1,4-diaryl-1,2,3-triazole compounds 4–19 derived from the tetrahydrofuran neolignans veraguensin 1, grandisin 2, and machilin G 3 were tested against Leishmania (Leishmania) amazonensis intracellular amastigotes. Triazole compounds 4–19 were synthetized via Click Chemistry strategy by 1,3-dipolar cycloaddition between terminal acetylenes and aryl azides containing methoxy and methylenedioxy groups as substituents. Our results suggest that most derivatives were active against intracellular amastigotes, with IC50 values ranging from 4.4 to 32.7 µM. The index of molecular hydrophobicity (ClogP) ranged from 2.8 to 3.4, reflecting a lipophilicity/hydrosolubility rate suitable for transport across membranes, which may have resulted in the potent antileishmanial activity observed. Regarding structure-activity relationship (SAR), compounds 14 and 19, containing a trimethoxy group, were the most active (IC50 values of 5.6 and 4.4 µM, respectively), with low cytotoxicity on mammalian cells (SI = 14.1 and 10.6). These compounds induced nitric oxide production by the host macrophage cells, which could be suggested as the mechanism involved in the intracellular killing of parasites. These results would be useful for the planning of new derivatives with higher antileishmanial activities.

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ncRNA, Vol. 2, Pages 6: Correction: Vaidyanathan et al. Are We Eating Our Way to Prostate Cancer—A Hypothesis Based on the Evolution, Bioaccumulation, and Interspecific Transfer of miR-150. Non-Coding RNA 2016, 2, 2.

The authors wish to make the following correction to this paper [1].[...]

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IJMS, Vol. 17, Pages 970: Differential Apoptosis Radiosensitivity of Neural Progenitors in Adult Mouse Hippocampus

Mammalian tissue-specific stem cells and progenitors demonstrate differential DNA damage response. Neural progenitors in dentate gyrus of the hippocampus are known to undergo apoptosis after irradiation. Using a mouse model of hippocampal neuronal development, we characterized the apoptosis sensitivity of the different neural progenitor subpopulations in adult mouse dentate gyrus after irradiation. Two different bromodeoxyuridine incorporation paradigms were used for cell fate mapping. We identified two apoptosis sensitive neural progenitor subpopulations after irradiation. The first represented non-proliferative and non-newborn neuroblasts and immature neurons that expressed doublecortin, calretinin or both. The second consisted of proliferative intermediate neural progenitors. The putative radial glia-like neural stem cells or type-1 cells, regardless of proliferation status, were apoptosis resistant after irradiation. There was no evidence of radiation-induced apoptosis in the absence of the Trp53 (p53) gene but absence of Cdkn1a (p21) did not alter the apoptotic response. Upregulation of nuclear p53 was observed in neuroblasts after irradiation. We conclude that adult hippocampal neural progenitors may demonstrate differential p53-dependent apoptosis sensitivity after irradiation.

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Water, Vol. 8, Pages 258: International Severe Weather and Flash Flood Hazard Early Warning Systems—Leveraging Coordination, Cooperation, and Partnerships through a Hydrometeorological Project in Southern Africa

Climate, weather and water hazards do not recognize national boundaries. Transboundary/regional programs and cooperation are essential to reduce the loss of lives and damage to livelihoods when facing these hazards. The development and implementation of systems to provide early warnings for severe weather events such as cyclones and flash floods requires data and information sharing in real time, and coordination among the government agencies at all levels. Within a country, this includes local, municipal, provincial-to-national levels as well as regional and international entities involved in hydrometeorological services and Disaster Risk Reduction (DRR). Of key importance are the National Meteorological and Hydrologic Services (NMHSs). The NMHS is generally the authority solely responsible for issuing warnings for these hazards. However, in many regions of the world, the linkages and interfaces between the NMHS and other agencies are weak or non-existent. Therefore, there is a critical need to assess, strengthen, and formalize collaborations when addressing the concept of reducing risk and impacts from severe weather and floods. The U.S. Agency for International Development/Office of U.S. Foreign Disaster Assistance; the United Nations World Meteorological Organization (WMO); the WMO Southern Africa Regional Specialized Meteorological Center, hosted by the South African Weather Service; the U.S. National Oceanic and Atmospheric Administration/National Weather Service and the Hydrologic Research Center (a non-profit corporation) are currently implementing a project working with Southern Africa NMHSs on addressing this gap. The project aims to strengthen coordination and collaboration mechanisms from national to local levels. The project partners are working with the NMHSs to apply and implement appropriate tools and infrastructure to enhance currently operational severe weather and flash flood early warning systems in each country in support of delivery and communication of warnings for the DRR entities at the regional, national and local levels in order to reduce the loss of life and property.

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Herbal Remedies for Coccidiosis Control: A Review of Plants, Compounds, and Anticoccidial Actions

Coccidiosis is the bane of the poultry industry causing considerable economic loss. Eimeria species are known as protozoan parasites to cause morbidity and death in poultry. In addition to anticoccidial chemicals and vaccines, natural products are emerging as an alternative and complementary way to control avian coccidiosis. In this review, we update recent advances in the use of anticoccidial phytoextracts and phytocompounds, which cover 32 plants and 40 phytocompounds, following a database search in PubMed, Web of Science, and Google Scholar. Four plant products commercially available for coccidiosis are included and discussed. We also highlight the chemical and biological properties of the plants and compounds as related to coccidiosis control. Emphasis is placed on the modes of action of the anticoccidial plants and compounds such as interference with the life cycle of Eimeria, regulation of host immunity to Eimeria, growth regulation of gut bacteria, and/or multiple mechanisms. Biological actions, mechanisms, and prophylactic/therapeutic potential of the compounds and extracts of plant origin in coccidiosis are summarized and discussed.

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Inverse association between gluteofemoral obesity and risk of Barrett’s esophagus in a pooled analysis

Clinical Gastroenterology and Hepatology

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ICECREAM: randomised phase II study of cetuximab alone or in combination with irinotecan in patients with metastatic colorectal cancer with either KRAS, NRAS, BRAF and PI3KCA wild type, or G13D mutated tumours

BMC Cancer

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Experiences and perspectives of children attending a weight loss camp in China: A qualitative study

Child: Care, Health, and Development

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Randomized phase II study of second-line chemotherapy with the best available 5-fluorouracil regimen versus weekly administration of paclitaxel in far advanced gastric cancer with severe peritoneal metastases refractory to 5-fluorouracil-containing regimens (JCOG0407)

Gastric Cancer

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Esophageal cancer patients have a high incidence of severe periodontitis and preoperative dental care reduces the likelihood of severe pneumonia after esophagectomy

Digestive Surgery

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Incidence and predictors of oral feeding intolerance in acute pancreatitis: A systematic review, meta-analysis, and meta-regression

Clinical Nutrition

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Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy

Surgical Endoscopy

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Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer–A multicenter randomized phase III clinical trial (SENORITA trial) protocol

BMC Cancer

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Ultrasound and point shear wave elastography in livers of patients with primary sclerosing cholangitis

Ultrasound in Medicine and Biology

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Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumor thrombosis in a hepatitis B endemic area

Liver International

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Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: A systematic review and meta-analysis

Critical Care

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Malignancies in patients with inflammatory bowel disease: a single-centre experience

Digestion

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Use of azathioprine and corticosteroids during pregnancy and birth outcome in women diagnosed with inflammatory bowel disease

Birth Defects Research Part A: Clinical and Molecular Teratology

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Laparoscopic versus open enucleation for pancreatic neoplasms: Clinical outcomes and pancreatic function analysis

Surgical Endoscopy

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Sexually acquired HCV infection: A review

International Journal of Infectious Diseases

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Pancreatitis quality of life instrument: A psychometric evaluation

The American Journal of Gastroenterology

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Colon cancer operations at high- and low-mortality hospitals

Surgery

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Swallowing function and chronic respiratory diseases: Systematic review

Respiratory Medicine

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Promoter methylation and mRNA expression of HLA-G in relation to HLA-G protein expression in colorectal cancer

Human Immunology

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Higher risk for hematological malignancies in inflammatory bowel disease: A nationwide population-based study in Taiwan

The American Journal of Gastroenterology

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Macular morphology and response to ranibizumab treatment in patients with wet age-related macular degeneration

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A Novel Homozygous p.L539F Mutation Identified in PINK1 Gene in a Moroccan Patient with Parkinsonism

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. Ten of fifteen causative genes linked to familial forms of PD have been reported to cause autosomal recessive forms. Among them, mutations in the PTEN-induced kinase 1 (PINK1) gene were shown to be responsible for a phenotype characterized by early onset, good response to levodopa, and a benign course. Using chromosomal microarray analysis and Sanger sequencing, we identified a homozygous G/C substitution in a 58-year-old Moroccan man diagnosed with recessive inherited Parkinson's disease. This G-to-C transition occurred at position 1617 leading to an amino acid change L/F at position 539 located in highly conserved motif in the C terminal sequence of PINK1. Interestingly, the c.1617G>C substitution is absent in 192 ethnically matched control chromosomes. Our findings have shown that the p.L539F is a novel mutation located in the C terminal sequence of the PINK1 protein that could be pathogenic and responsible for a clinical phenotype resembling idiopathic Parkinson's disease with rapid progression and early cognitive impairment.

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Mechanoregulation of Wound Healing and Skin Homeostasis

Basic and clinical studies on mechanobiology of cells and tissues point to the importance of mechanical forces in the process of skin regeneration and wound healing. These studies result in the development of new therapies that use mechanical force which supports effective healing. A better understanding of mechanobiology will make it possible to develop biomaterials with appropriate physical and chemical properties used to treat poorly healing wounds. In addition, it will make it possible to design devices precisely controlling wound mechanics and to individualize a therapy depending on the type, size, and anatomical location of the wound in specific patients, which will increase the clinical efficiency of the therapy. Linking mechanobiology with the science of biomaterials and nanotechnology will enable in the near future precise interference in abnormal cell signaling responsible for the proliferation, differentiation, cell death, and restoration of the biological balance. The objective of this study is to point to the importance of mechanobiology in regeneration of skin damage and wound healing. The study describes the influence of rigidity of extracellular matrix and special restrictions on cell physiology. The study also defines how and what mechanical changes influence tissue regeneration and wound healing. The influence of mechanical signals in the process of proliferation, differentiation, and skin regeneration is tagged in the study.

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The Relationship of Oxidation Sensitivity of Red Blood Cells and Carbonic Anhydrase Activity in Stored Human Blood: Effect of Certain Phenolic Compounds

It has been reported that many modifications occur with the increase of oxidative stress during storage in erythrocytes. In order to delay these negative changes, we evaluated whether the addition of substances likely to protect antioxidant capacity in stored blood would be useful. Therefore, we investigated the effects of resveratrol, tannic acid, and caffeic acid in lipid peroxidation and antioxidant capacity of erythrocytes in stored blood. Donated blood was taken into four CPD containing blood bags. One bag was used as the control, and the others were supplemented with caffeic acid (30 μg/mL), resveratrol (30 μg/mL), and tannic acid (15 μg/mL), respectively. Erythrocyte lipid peroxidation, sensitivity to oxidation, glutathione levels and carbonic anhydrase, glutathione peroxidase, and catalase activities were measured on days 0, 7, 14, 21, and 28. In the control group, erythrocyte malondialdehyde levels and sensitivity to oxidation were increased whereas glutathione, glutathione peroxidase, and catalase levels were decreased (). Resveratrol and caffeic acid prevented malondialdehyde accumulation and preserved glutathione, glutathione peroxidase, and catalase activities in erythrocytes. We demonstrated that resveratrol, caffeic acid, and tannic acid in stored blood could decrease the sensitivity to oxidation of erythrocytes in vitro but did not exhibit such effects on CA activity.

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The Effect of Adipose-Derived Stem Cells on Full-Thickness Skin Grafts

Background. The purpose of this study was to evaluate the effects of ASCs on full-thickness skin grafts. Specifically, we investigated the anti-inflammatory effects of ASCs that are mediated via regulation of the phenotypes of activated macrophages. Methods. ASCs were isolated, cultured, and injected under full-thickness skin grafts in 15 rats (ASC group). An additional 15 rats served as controls (PBS group). Skin graft survival assessment and vascularization detection were assessed with H&E staining and laser Doppler blood flowmetry (LDF). The effects of ASCs on angiogenesis, anti-inflammation, collagen accumulation-promoting, and antiscarring were assessed. Results. We found that the skin graft survival rate was significantly increased in the ASC group. The neovascularization, collagen deposition, collagen type I to type III ratio, and levels of VEGF and TGF-β3 in the ASC group were markedly higher than those in the PBS group at day 14. Additionally, in the ASC group, the levels of iNOS, IL-1β, and TNF-α were remarkably decreased, whereas the levels of IL-10 and Arg-1 were substantially increased. Conclusions. Our results confirm that ASCs transplantation can effectively improve full-thickness skin graft survival. Additionally, the anti-inflammatory role of ASCs may indirectly contribute to skin graft survival via its effect on macrophage polarization.

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